SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990.Right pointing arrow large image Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
KATERI MEDICAL SERVICES INC
 
Employer identification number

27-1601433
Part I
General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants and
other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in the region (d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in the region		 (f) Total expenditures
for and investments
in the region
SUB-SAHARAN, AFRICA   1 GRANT FOR OPERATIONS MEDICAL CLINIC 178,291
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ....   1 178,291
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b)   1 178,291
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2020
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Schedule F (Form 990) 2020
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Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount
of noncash
assistance 		(h) Description
of noncash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
SUB-SAHARAN AFRICA MEDICAL SUPPORT 178,291 CASH      
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......MediumBullet
1
3 Enter total number of other organizations or entities .......................MediumBullet
 
Schedule F (Form 990) 2020
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Schedule F (Form 990) 2020Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
noncash
assistance 		(g) Description
of noncash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2020
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Schedule F (Form 990) 2020
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Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule F (Form 990) 2020
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Schedule F (Form 990) 2020
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Part V
Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.
ReturnReference Explanation
SCHEDULE F, PAGE 1, PART I, LINE 2 STARTING IN 2004 KATERI MEDICAL SERVICES INC (KMSI) HAS PROVIDED FINANCIAL SUPPORT TO THE ANGLICAN DIOCESE OF KADUNA FOR THE KATERI CLINIC. IN 2013, CONSTRUCTION STARTED IN IBURU FOR A 2ND CLINIC FOR THE DIOCESE WHICH OPENED IN 2017 AS THE NANCY MASON MEMORIAL CLINIC. DURING 2016, CONSTRUCTION STARTED FOR A CLINIC/HOSPITAL IN THE DIOCESE OF KAFANCHAN LOCATED IN GIDAN WAYA. THIS CLINIC OPENED IN 2018 AS THE ARTHUR AND ESTER BRADLEY MEMORIAL ANGLICAN HOSPITAL. IN 2017, GROUND WAS BROKEN FOR A NEW HOSPITAL IN DIOCESE OF GUSAU. THIS CLINIC OPENED IN 2019 AS GRACELAND HOSPITAL. DURING 2020, KMSI STARTED A RELATIONSHIP WITH THE THOMAS FURRER FOUNDATION (A CLINIC/HOSPITAL FOUNDED BY ONE OF THE FIRST DOCTORS THAT WORKED AT THE KATERI CLINIC) IN PORT HARCOURT-A LOCATION KMSI HAD IN PREVIOUS YEARS PROVIDED FUNDING FOR SOME MEDICAL EQUIPMENT AND USED THE FACILITY FOR A MEDICAL OUTREACH IN THAT AREA. IN ADDITION, KMSI ASSISTED THE DIOCESE OF BARI AND THE DIOCESE OF KEBBI WITH SOME MINOR EXPENSES IN 2020 AS BOTH LOCATION APPEAR TO BE PARTNERS IN THE FUTURE. IN ALL LOCATIONS, KMSI PROVIDES FUNDING FOR SOME PAYROLL OFFSET, MEDICAL EQUIPMENT AND SUPPLIES AS WELL AS CONSTRUCTION (BOTH NEW AND RENOVATIONS) WHEN NEEDED. KMSI REQUIRES MONTHLY REPORTING FROM EACH LOCATION TO SHOW WHERE THE FINANCIAL SUPPORT HAS BEEN USED AND TO PROVIDE DATA WHICH SUPPORTS A DOLLARS SPENT PER PATIENT RATIO.
SCHEDULE F, PAGE 1, PART I, LINE 3 SUB-SAHARAN, AFRICA 165,791 12,500
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule F (Form 990) 2020
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