2023-11-13T16:48:43-06:00 2022-12-31 480928496 WOODS & DURHAM CHTD 619 LINCOLN AVE CLAY CENTER KS 67432 990 2022-01-01 481035296 CLAY COUNTY HOSPITAL FOUNDATION CLAY 7856322144 PO BOX 512 CLAY CENTER KS 67432 CHRISTI RICE DIRECTOR 7856322144 2023-11-07 1 CHRISTI RICE 999009999 1 CORRINE E URBAN P01226863 7856325657 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z CHRISTI RICE PO BOX 512 CLAY CENTER KS 67432 68179 0 X N/A X 1987 KS TO PROVIDE VOLUNTARY GIFT SUPPORT FOR THE CLAY COUNTY MEDICAL CENTER 12 12 0 13 0 0 592371 36033 0 0 24688 18442 30552 -4152 647611 50323 0 113132 0 0 0 0 0 0 0 284941 6861 284941 119993 362670 -69670 1462160 1331910 0 0 1462160 1331910 TO PROVIDE VOLUNTARY GIFT SUPPORT FOR THE CLAY COUNTY MEDICAL CENTER 0 0 113132 113132 CAPITAL AND GENERAL IMPROVEMENTS TO CLAY COUNTY MEDICAL CENTER 113132 1 1 0 0 0 1 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 KS X CHRISTI RICE 7856322144 617 LIBERTY CLAY CENTER KS 67432 X SANDY FOX TREASURER 0.00 0.00 X X 0 0 0 SCOTT PATTERSON PRESIDENT 0.00 X X 0 0 0 MIKE RYAN BOARD MEMBER 0.00 X 0 0 0 SCOTT LEITZEL SECRETARY 0.00 X X 0 0 0 JOHN KELLEY CHIEF MEDICAL OFFICER 0.00 X 0 0 0 MARIA PFIZENMAIER BOARD MEMBER 0.00 X 0 0 0 TIM SHARP BOARD MEMBER 0.00 X 0 0 0 TERRI PARRY BOARD MEMBER 0.00 X 0 0 0 LES SPENCE BOARD MEMBER 0.00 X 0 0 0 STEVE MCMAHAN BOARD MEMBER 0.00 X 0 0 0 SUSAN SWANSON BOARD MEMBER 0.00 X 0 0 0 KYLIE PRUSER BOARD MEMBER 0.00 X 0 0 0 JIM GIERHAN BOARD MEMBER 0.00 X 0 0 0 CHRISTI RICE DIRECTOR 0.00 X 0 0 0 AUSTIN GILLARD CHIEF EXECUTIVE OFFICER 0.00 X 0 0 0 DUSTIN MULLIN BOARD MEMBER 0.00 X 0 0 0 0 0 0 0 0 0 0 0 36033 36033 18442 18442 13704 17856 -4152 -4152 -4152 50323 14290 0 0 113132 113132 5910 5910 836 836 20 20 REPORTING FEES 95 95 119993 113132 6861 0 25341 29204 645118 587767 52058 27236 243423 68126 183312 175297 556331 512406 1462160 1331910 0 0 X 0 0 0 0 1462160 1331910 1462160 1331910 1462160 1331910 -69670 -60580 0 X 0 0 0 X 545448 126475 134721 592371 36033 1435048 545448 126475 134721 592371 36033 1435048 405878 88200 25700 282525 7200 809503 0 405878 88200 25700 282525 7200 809503 625545 30029 23496 21285 38707 32147 145664 30029 23496 21285 38707 32147 145664 11557 7537 33405 52499 575477 161528 163543 664483 68180 1633211 0.38300 0.08920 X PART IV, SECTION C, LINE 1 THE CHIEF MEDICAL OFFICER OF THE HOSPITAL IS ON THE FOUNDATION'S BOARD. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2 4 0 36033 108480 991694 0 0 X 0 2846176 -157614 1765 2686797 2385394 462217 1435 2846176 2300185 86084 875 2385394 2206805 94220 840 2300185 1647874 559736 805 2206805 0.04000 0.96000 0 0 23017 23017 220406 68126 152280 175297 INVESTMENT IN AMERICAN FUNDS - UNRESTRICTED 403927 F INVESTMENT IN AMERICAN FUNDS - ENDOWED 47522 F INVESTMENT IN EDWARD JONES - ENDOWED 60957 F 512406 PART III, LINE 1A: FOOTNOTE TEXT: THE FOUNDATION HAS RECEIVED DONATIONS OF ARTWORK OVER THE YEARS. THESE WORKS HAVE BEEN INVENTORIED AND ARE DISPLAYED AROUND THE HOSPITAL FACILITIES. THESE ITEMS INCLUDE FRAMED PHOTOS AND PAINTINGS. THESE ARE GIFTED ITEMS AND, ACCORDINGLY, NO "INVENTORY" OF ARTWORK IS RECORDED IN THESE FINANCIAL STATEMENTS. THE COLLECTION WOULD NOT BE MATERIAL IN VALUE TO THESE FINANCIAL STATEMENTS. PART III, LINE 4: THE ARTWORK THAT THE FOUNDATION HAS RECEIVED OVER THE YEARS INCLUDES FRAMED PHOTOS AND PAINTINGS. THE ARTWORK IS ON DISPLAY AROUND THE HOSPITAL. PART V, LINE 4: TO PROVIDE SUPPORT FOR THE CLAY COUNTY MEDICAL CENTER. 1 CLAY COUNTY MEDICAL CENTER 617 LIBERTY ST CLAY CENTER KS 67432 486023060 113132 0 CAPITAL AND GENERAL IMPROVEMENTS TO CLAY COUNTY MEDICAL CENTER FORM 990, PART VI, SECTION B, LINE 11B A COPY IS NOT MADE AVAILABLE TO ALL MEMBERS FOR REVIEW BEFORE FILING FORM 990, PART VI, SECTION C, LINE 19 THE CLAY COUNTY HOSPITAL FOUNDATION BYLAWS WILL BE MADE AVAILABLE TO THE PUBLIC WHEN REQUESTED ALONG WITH ANY FINANCIAL INFORMATION CONTAINED IN THE ANNUAL FORM 990 FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC SANDY FOX - 1310 13TH STREET, CLAY CENTER, KS 67432. SCOTT PATTERSON - 204 FREDERICK STREET, CLAY CENTER, KS 67432. MIKE RYAN - 200 E. BARTLETT, CLIFTON, KS 66937. SCOTT LEITZEL - 1569 PAWNEE DR, CLAY CENTER, KS 67432. JOHN KELLEY - 1677 PRAIRIE RD, CLAY CENTER, KS 67432. MARIA PFIZENMAIER - 1277 HACKBERRY RD, CLAY CENTER, KS 67432. TIM SHARP - 711 W ELM ST, RILEY, KS 66531. TERRI PARRY - 945 26TH ROAD, MORGANVILLE, KS 67468. LES SPENCE - 502 4TH ST, LINN, KS 66953. STEVE MCMAHAN - 1807 POGUE RD, CLAY CENTER, KS 67432. SUSAN SWANSON - 1422 5TH ST, CLAY CENTER, KS 67432. KYLIE PRUSER - 101 E BARTLETT ST, CLIFTON, KS 66937. JIM GIERHAN - 1010 NAVAJO RD, CLAY CENTER, KS 67432. CHRISTI RICE - 617 LIBERTY ST, CLAY CENTER, KS 67432. AUSTIN GILLARD - 617 LIBERTY ST, CLAY CENTER, KS 67432. DUSTIN MULLIN - 494 8TH RD, CLAY CENTER, KS 67432. FEDERAL ELECTION SECTION 1.263(A)-1(F) DE MINIMIS SAFE HARBOR ELECTION FOR THE YEAR ENDING DECEMBER 31, 2022 CLAY COUNTY HOSPITAL FOUNDATION IS MAKING THE DE MINIMIS SAFE HARBOR ELECTION UNDER REG. SEC. 1.263(A)-1(F). FEDERAL ELECTION SECTION 1.263(A)-3(H) SAFE HARBOR ELECTION FOR SMALL TAXPAYERS FOR THE YEAR ENDING DECEMBER 31, 2022 CLAY COUNTY HOSPITAL FOUNDATION IS MAKING THE SAFE HARBOR ELECTION UNDER REG. SEC. 1.263(A)-3(H) FOR THE FOLLOWING ELEGIBLE BUILDING PROPERTY(S). DESCRIPTION OF ELIGIBLE PROPERTY(S): RESIDENTIAL RENTAL REAL ESTATE LAFAYETTE SQUARE LLC 617 LIBERTY STREET CLAY CENTER KS 67432 454007818 RENTAL REAL ESTATE KS 13704 204500 CLAY COUNTY HOSPITAL FOUNDATION CLAY COUNTY MEDICAL CENTER 617 LIBERTY CLAY CENTER KS 67432 486023060 ACCUTE CARE HOSPITAL KS N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1