2012-06-27T12:35:28-05:00 2011-12-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2011-01-01 481112955 Citizens Foundation CITI 7854627511 100 E College Drive Colby KS 67701 Kevan Trenkle 7854627511 2012-06-20 1 Gary D Knoll P00203954 7852334226 2012-06-20 2011 2016-02-24 21:20:13Z Kevan Trenkle 100 E College Drive Colby KS 67701 308070 0 X N/A X 1991 KS Fundraising for the benefit of Citizen's Medical Center, Inc. 24 17 0 27 0 0 115620 102939 0 0 44541 87702 1 0 160162 190641 3500 5500 0 0 0 0 0 0 0 10946 233512 14446 239012 145716 -48371 1700340 1639412 101 119 1700239 1639293 X To support health care, treatment, health related education, as well as the promotion of health and wellness for northwest Kansas. To promote health and well being of people through the development, promotion, improvement and support of all forms of healthcare service and means for the delivery of such service as well as the support and enhancement of existing health care treatment facilities. 0 0 5500 5500 Provide scholarships according to the restricted endowment fund guidelines. 228850 Provide support for health care services in the community. 1093 Provide coats for needy children in the community. 235443 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 X 24 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 X Kevan Trenkle 7854627511 100 E College Drive Colby KS 67701 X Loretta Weeks 1.00 X X 0 0 0 Vern Schwanke 1.00 X X 0 0 0 Sue Evans 1.00 X X 0 0 0 Terry Wendell 1.00 X X 0 0 0 Sean Hankin 1.00 X 0 0 0 Kasiah Rothchild 1.00 X 0 0 0 Kathy Kersenbrock-Ostmeyer 1.00 X 0 0 0 0 0 0 0 0 0 0 0 75195 27744 102939 87702 87702 95000 95000 0 0 22429 75195 22429 0 190641 0 0 87702 5500 5500 2305 2305 1264 1264 228850 228850 Coat Project 1093 1093 239012 235443 3569 0 17935 6994 1008139 904052 673641 728313 625 53 1700340 1639412 101 119 101 119 X 1330244 1269298 369995 369995 1700239 1639293 1700340 1639412 X -48371 -12575 X 0 0 0 X 20147 1103143 49148 102514 27744 1302696 20147 1103143 49148 102514 27744 1302696 1302696 16125 19327 3693 44541 87702 171388 1474084 171594 0.88370 0.92950 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 726432 516260 27145 1597 1268240 621836 99940 6195 1539 726432 263408 332872 27773 1000 1217 621836 200012 55000 13476 4000 1080 263408 1.00000 1 0 0 Health Care Expansion 62260 50089 12171 12171 Harvest for Health Golf Tournament 19563 10824 8739 8739 1 5010 4518 492 492 86833 65431 21402 21402 21402 0 0 Scholarships for health care education 4 5500 FMV Terry Wendell Foundation Treasurer and Director Mr. Wendell is Secretary and Trustee of Citizens Medical Center, Inc., a related organization. 0 Kathy Kersenbrock-Ostmeyer Foundation Director Mrs. Kersenbrock-Ostmeyer is a Voting Member of Citizens Medical Center, Inc., a related organization. 0 Vern Schwanke Foundation Vice Chairperson and Director Mr. Schwanke is a Trustee of Citizens Medical Center, Inc., a related organization. 0 Rosalie Seemann Foundation Voting Member Mrs. Seemann is Treasurer and Trustee of Citizens Medical Center, Inc., a related organization. 0 Vera Sloan Foundation Voting Member Mrs. Sloan is a Voting Member of Citizens Medical Center, Inc., a related organization. 0 Sheila Frahm Foundation Voting Member Mrs. Frahm is a Voting Member of Citizens Medical Center, Inc., a related organization. 0 Larry Barrett Foundation Voting Member Mr. Barrett is a Voting Member of Citizens Medical Center, Inc., a related organization. 0 One time adjustment to Endowment Funds: Form 990, Schedule D, Part V, Line 1b 2011 Contributions $ 600 Endowment Funds not previously reported 515,600 Total Schedule D, Part V, Line 1b $516,260 Form 990, Part VI, Section B, line 11 Form 990 provided to governing body and reviewed prior to filing. Form 990, Part VI, Section B, line 12c A conflict of interest disclosure form is provided with a copy of the current conflict of interest policy. This disclosure form is completed by each Member upon election and annually thereafter. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon written request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Transfers from Citizens Medical Center, Inc. -12,575. Total to Form 990, Part XI, Line 5: -12,575. Citizens Medical Center Inc 100 E College Drive Colby KS 67701 480892178 Acute Care Hospital KS 501(c)(3) Line 3 0 Citizens Medical Center Employee Benefit Trust 100 E College Drive Colby KS 67701 900413751 Retirement plan for employees of Citizens Medical Center, Inc. KS 501(c)(9) 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Citizens Medical Center Inc B 228850 Citizens Medical Center Inc E 12575