Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
Cameron Regional Medical Cntr Foundation
 
Employer identification number
74-2933060
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) Cameron Regional Medical Center Inc
1600 East Evergreen Street
Cameron,MO64429 		44-0668347 501(C)(3) 18,000       Equipment for Cameron Regional Medical CenterEquipment for Cameron Regional Medical Center
(2) Cameron Missouri Veterans Home Assistance League
1111 Euclid Avenue
Cameron,MO64429 		43-1750775 501(C)(3) 5,000       Donation to Bus Campaign Fund to purchase 14-passenger wheelchair accessible bus
(3) Community Foundation of Northwest Missouri
1006 West St Maartens Dr Suite B
St Joseph,MO64506 		27-0436182 501(C)(3) 5,000       Donation to stregthen the community
(4) City of Cameron
205 North Main Street
Cameron,MO64429 		44-6000153   5,000       Donation for City of Cameron's Walking Trail
(5) Rotary International Plattsburg Rotary Club
712 W Fairway
Plattsburg,MO64477 		43-6050152 501(C)(3) 5,000       Donation for City of Plattsburg's Perkins Walking Trail
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
5
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2014
Page 2

Schedule I (Form 990) 2014
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
non-cash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of non-cash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
Part I, Line 2: All of the organization's grants are made directly to Cameron Regional Medical Center, Inc., and to benefit the citizens served by the hospital, in accordance with the corporate bylaws.
Schedule I (Form 990) 2014



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