TY 2023 Form 990PF

- TIN:

Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation

or Section 4947(a)(1) Trust Treated as Private Foundation

Do not enter social security numbers on this form as it may be made public.
right arrow

Go to www.irs.gov/Form990PF for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public Inspection

For calendar year 2023, or tax year beginning 01-01-2023 , and ending 12-31-2023

Name of foundation
COMMUNITY HOSPITAL BUILDING INC

Number and street (or P.O. box number if mail is not delivered to street address)PO BOX 129
Room/suite

City or town, state or province, country, and ZIP or foreign postal code
ROCKY FORD, CO81067

A Employer identification number

84-6031485

B Telephone number (see instructions)

(719) 688-0812

C If exemption application is pending, check here right arrow

G Check all that apply: Initial returnInitial return of a former public charity
Final returnAmended return
Address change Name change

D 1. Foreign organizations, check here............. right arrow

2. Foreign organizations meeting the 85%
test, check here and attach computation ... right arrow

E If private foundation status was terminated
under section 507(b)(1)(A), check here ....... right arrow

H Check type of organization: Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust Other taxable private foundation

F If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here ....... right arrow

I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16) right arrow

$2,279,317J Accounting method: Cash Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)

	Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)	(a) Revenue and expenses per books		(b) Net investment income	(d) Disbursements for charitable purposes (cash basis only)


1	Contributions, gifts, grants, etc., received (attach schedule)
2	Check .............
3	Interest on savings and temporary cash investments	10,766		10,766
4	Dividends and interest from securities...	38,608		38,608
5a	Gross rents............	62,174		62,174
b	Net rental income or (loss) -17,916
6a	Net gain or (loss) from sale of assets not on line 10	List of Attached Documents: // Content	-31,524
b	Gross sales price for all assets on line 6a 921,503
7	Capital gain net income (from Part IV, line 2)...
8	Net short-term capital gain.........
9	Income modifications...........
10a	Gross sales less returns and allowances
b	Less: Cost of goods sold....
c	Gross profit or (loss) (attach schedule).....
11	Other income (attach schedule).......
12	Total. Add lines 1 through 11........	80,024		111,548
13	Compensation of officers, directors, trustees, etc.
14	Other employee salaries and wages......
15	Pension plans, employee benefits.......
16a	Legal fees (attach schedule).........
b	Accounting fees (attach schedule).......	List of Attached Documents: // Content	2,395	2,395
c	Other professional fees (attach schedule)....
17	Interest...............
18	Taxes (attach schedule) (see instructions)...	List of Attached Documents: // Content	450	450
19	Depreciation (attach schedule) and depletion...	List of Attached Documents: // Content	14,257	14,257
20	Occupancy..............	2,786		2,786
21	Travel, conferences, and meetings.......
22	Printing and publications..........
23	Other expenses (attach schedule).......	List of Attached Documents: // Content	73,173	73,173
24	Total operating and administrative expenses.
	Add lines 13 through 23..........	93,061		93,061	0
25	Contributions, gifts, grants paid.......	79,671			79,671
26	Total expenses and disbursements. Add lines 24 and 25	172,732		93,061	79,671
27	Subtract line 26 from line 12:
a	Excess of revenue over expenses and disbursements	-92,708
b	Net investment income (if negative, enter -0-)			18,487
c	Adjusted net income (if negative, enter -0-)...

For Paperwork Reduction Act Notice, see instructions.

Cat. No. 11289X Form 990-PF (2023)

Form 990-PF (2023)

Page 2

Part II		Balance Sheets	Beginning of year	End of year
Part II		Balance Sheets	(a) Book Value	(b) Book Value	(c) Fair Market Value
	1	Cash—non-interest-bearing.............	28,715	25,966	25,966
	2	Savings and temporary cash investments.........	62,782	67,112	67,112
	3	Accounts receivable
		Less: allowance for doubtful accounts
	4	Pledges receivable
		Less: allowance for doubtful accounts
	5	Grants receivable.................
	6	Receivables due from officers, directors, trustees, and other
		disqualified persons (attach schedule) (see instructions).....
	7	Other notes and loans receivable (attach schedule)
		Less: allowance for doubtful accounts
	8	Inventories for sale or use..............
	9	Prepaid expenses and deferred charges..........
	10a	Investments—U.S. and state government obligations (attach schedule)
	b	Investments—corporate stock (attach schedule).......	1,464,441	List of Attached Documents: // Content 1,376,085	1,441,239
	c	Investments—corporate bonds (attach schedule).......
	11	Investments—land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	12	Investments—mortgage loans.............
	13	Investments—other (attach schedule)..........
	14	Land, buildings, and equipment: basis 607,661
		Less: accumulated depreciation (attach schedule) 362,196	251,564	List of Attached Documents: // Content 245,465	745,000
	15	Other assets (describe )
	16	Total assets (to be completed by all filers—see the
		instructions. Also, see page 1, item I)	1,807,502	1,714,628	2,279,317
	17	Accounts payable and accrued expenses..........
	18	Grants payable.................
	19	Deferred revenue.................
	20	Loans from officers, directors, trustees, and other disqualified persons
	21	Mortgages and other notes payable (attach schedule)......
	22	Other liabilities (describe )
	23	Total liabilities (add lines 17 through 22).........		0
		Foundations that follow FASB ASC 958, check here
		and complete lines 24, 25, 29 and 30.
	24	Net assets without donor restrictions...........
	25	Net assets with donor restrictions............
		Foundations that do not follow FASB ASC 958, check here
		and complete lines 26 through 30.
	26	Capital stock, trust principal, or current funds........
	27	Paid-in or capital surplus, or land, bldg., and equipment fund
	28	Retained earnings, accumulated income, endowment, or other funds	1,807,502	1,714,628
	29	Total net assets or fund balances (see instructions).....	1,807,502	1,714,628
	30	Total liabilities and net assets/fund balances (see instructions).	1,807,502	1,714,628

Part III

Analysis of Changes in Net Assets or Fund Balances

Total net assets or fund balances at beginning of year—Part II, column (a), line 29 (must agree with end-of-year figure reported on prior year’s return) ...............

1,807,502

Enter amount from Part I, line 27a .....................

-92,708

Other increases not included in line 2 (itemize) right arrow

Add lines 1, 2, and 3 ..........................

1,714,794

Decreases not included in line 2 (itemize) right arrow

List of Attached Documents:

// Content

166

Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .

1,714,628

Form 990-PF (2023)

Page 3

Part IV

Capital Gains and Losses for Tax on Investment Income

(a) List and describe the kind(s) of property sold (e.g., real estate, 2-story brick warehouse; or common stock, 200 shs. MLC Co.)		(b) How acquired P—Purchase D—Donation	(c) Date acquired (mo., day, yr.)	(d) Date sold (mo., day, yr.)
1a
b
c
d
e

(e) Gross sales price		(f) Depreciation allowed (or allowable)	(g) Cost or other basis plus expense of sale	(h) Gain or (loss) (e) plus (f) minus (g)
a
b
c
d
e

Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(i) F.M.V. as of 12/31/69	(j) Adjusted basis as of 12/31/69	(k) Excess of col. (i) over col. (j), if any
a
b
c
d
e

2	Capital gain net income or (net capital loss)	If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7	2
3	Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
	If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0- in Part I, line 8 ...................		3

Part V

Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)

1a	Exempt operating foundations described in section 4940(d)(2), check here and enter “N/A" on line 1.
	Date of ruling or determination letter: (attach copy of letter if necessary–see instructions)	1	257
b	All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) of Part I, line 12, col. (b)
2	Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)	2
3	Add lines 1 and 2...........................	3	257
4	Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)	4
5	Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- .....	5	257
6	Credits/Payments:

a	2023 estimated tax payments and 2022 overpayment credited to 2023	6a	83
b	Exempt foreign organizations—tax withheld at source......	6b
c	Tax paid with application for extension of time to file (Form 8868)...	6c
d	Backup withholding erroneously withheld ..........	6d

7	Total credits and payments. Add lines 6a through 6d..............		7	83
8	Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached.		8
9	Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......		9	174
10	Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...		10
11	Enter the amount of line 10 to be: Credited to 2024 estimated tax	Refunded	11

Form 990-PF (2023)

Page 4

Part VI-A

Statements Regarding Activities

During the tax year, did the foundation attempt to influence any national, state, or local legislation or did

Yes

it participate or intervene in any political campaign? ....................

Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions

for the definition.................................

If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials

published or distributed by the foundation in connection with the activities.

Did the foundation file Form 1120-POL for this year?.....................

Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:

(1) On the foundation. right arrow

$ (2) On foundation managers. right arrow

Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed

on foundation managers. right arrow

Has the foundation engaged in any activities that have not previously been reported to the IRS?.......

If "Yes," attach a detailed description of the activities.

Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles

of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....

Did the foundation have unrelated business gross income of $1,000 or more during the year?.........

If "Yes," has it filed a tax return on Form 990-T for this year?...................

Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........

If "Yes," attach the statement required by General Instruction T.

Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:

By language in the governing instrument, or

By state legislation that effectively amends the governing instrument so that no mandatory directions

that conflict with the state law remain in the governing instrument? ................

Yes

Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),

and Part XIV..................................

Yes

Enter the states to which the foundation reports or with which it is registered (see instructions)

If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney

General (or designate) of each state as required by General Instruction G? If "No," attach explanation .

Yes

Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)

or 4942(j)(5) for calendar year 2023 or the taxable year beginning in 2023? See the instructions for Part XIII.

If "Yes," complete Part XIII .............................

Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names

and addresses. ...............................

At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the

meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............

Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had

advisory privileges? If "Yes," attach statement. See instructions.................

Did the foundation comply with the public inspection requirements for its annual returns and exemption application?

Yes

Website address right arrow

N/A

The books are in care of right arrow

PATRICK HANCOCK Telephone no. right arrow

(719) 688-0812

Located at right arrow

P O BOX 129ROCKY FORDCO ZIP+4 right arrow

81067

Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here ......... right arrow

and enter the amount of tax-exempt interest received or accrued during the year ........ right arrow

16 At any time during calendar year 2023, did the foundation have an interest in or a signature or other authority over YesNo

a bank, securities, or other financial account in a foreign country? .................

16 No

See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country right arrow

Form 990-PF (2023)

Page 5

Part VI-B

Statements Regarding Activities for Which Form 4720 May Be Required

File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.

Yes

During the year did the foundation (either directly or indirectly):

(1) Engage in the sale or exchange, or leasing of property with a disqualified person? ...........

1a(1)

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)

a disqualified person? ..............................

1a(2)

(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........

1a(3)

(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............

1a(4)

(5) Transfer any income or assets to a disqualified person (or make any of either available

for the benefit or use of a disqualified person)? ......................

1a(5)

(6) Agree to pay money or property to a government official? (Exception. Check "No"

if the foundation agreed to make a grant to or to employ the official for a period

after termination of government service, if terminating within 90 days.) ...............

1a(6)

If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations

section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ..........

Organizations relying on a current notice regarding disaster assistance check here ........ right arrow

Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,

that were not corrected before the first day of the tax year beginning in 2023? .............

Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private

operating foundation defined in section 4942(j)(3) or 4942(j)(5)):

At the end of tax year 2023, did the foundation have any undistributed income (Part XII, lines 6d

and 6e) for tax year(s) beginning before 2023?....................

If "Yes," list the years right arrow

20, 20, 20, 20

Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)

(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)

to all years listed, answer "No" and attach statement—see instructions.) ..............

If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.

20, 20, 20, 20

Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at

any time during the year? ..............................

If "Yes," did it have excess business holdings in 2023 as a result of (1) any purchase by the foundation

or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved

by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)

the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine

if the foundation had excess business holdings in 2023.) .....................

Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?

Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its

charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2023? ..

Form 990-PF (2023)

Page 6

Part VI-B

Statements Regarding Activities for Which Form 4720 May Be Required (continued)

During the year did the foundation pay or incur any amount to:

Yes

(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........

5a(1)

(2) Influence the outcome of any specific public election (see section 4955); or to carry

on, directly or indirectly, any voter registration drive? ....................

5a(2)

(3) Provide a grant to an individual for travel, study, or other similar purposes? .............

5a(3)

(4) Provide a grant to an organization other than a charitable, etc., organization described

in section 4945(d)(4)(A)? See instructions ........................

5a(4)

(5) Provide for any purpose other than religious, charitable, scientific, literary, or

educational purposes, or for the prevention of cruelty to children or animals? .............

5a(5)

If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in

Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ........

Organizations relying on a current notice regarding disaster assistance check ......... right arrow

If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the

tax because it maintained expenditure responsibility for the grant? .................

If "Yes," attach the statement required by Regulations section 53.4945–5(d).

Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on

a personal benefit contract? .............................

Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....

If "Yes" to 6b, file Form 8870.

At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?

If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? .....

Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or

excess parachute payment during the year? .........................

Part VII

Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors

1 List all officers, directors, trustees, foundation managers and their compensation. See instructions

(a) Name and address	(b) Title, and average hours per week devoted to position	(c) Compensation (If not paid, enter -0-)	(d) Contributions to employee benefit plans and deferred compensation	(e) Expense account, other allowances
JOHN KNAPP	DIRECTOR 000.00	0	0	0
HWY 71 ROCKY FORD,CO81067	DIRECTOR 000.00	0	0	0
DAVID KITCH	PRESIDENT 000.00	0	0	0
994 ELIZABETH DRIVE ROCKY FORD,CO81067	PRESIDENT 000.00	0	0	0
WILLIAM HANCOCK	DIRECTOR 000.00	0	0	0
26751 COUNTY ROAD 18 ROCKY FORD,CO81067	DIRECTOR 000.00	0	0	0
LORETTA SHARON	SECRETARY 000.00	0	0	0
4566 COUNTY LANE 8 OLNEY SPRINGS,CO81062	SECRETARY 000.00	0	0	0
PATRICK HANCOCK	TREASURER 000.00	0	0	0
28043 EMERALD STREET ROCKY FORD,CO81067	TREASURER 000.00	0	0	0
DOROTHY SALLEE	DIRECTOR 000.00	0	0	0
32431 COUNTY ROAD 5 FOWLER,CO81039	DIRECTOR 000.00	0	0	0

2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."


(a) Name and address of each employee paid more than $50,000	(b) Title, and average hours per week devoted to position	(c) Compensation	(d) Contributions to employee benefit plans and deferred compensation	(e) Expense account, other allowances
NONE









Total number of other employees paid over $50,000...................

Form 990-PF (2023)

Page 7

Part VII

Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors (continued)

3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a) Name and address of each person paid more than $50,000	(b) Type of service	(c) Compensation
NONE

Total number of others receiving over $50,000 for professional services............. right arrow

Part VIII-A

Summary of Direct Charitable Activities

List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.	Expenses
1


2


3


4

Part VIII-B

Summary of Program-Related Investments (see instructions)

Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.	Amount
1	N/A
2


All other program-related investments. See instructions.
3

Total. Add lines 1 through 3......................... right arrow

Form 990-PF (2023)

Page 8

Part IX

Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)

Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,

purposes:

Average monthly fair market value of securities...................

1,411,464

Average of monthly cash balances.......................

67,607

Fair market value of all other assets (see instructions)................

24,680

Total (add lines 1a, b, and c).........................

1,503,751

Reduction claimed for blockage or other factors reported on lines 1a and

1c (attach detailed explanation) .............

Acquisition indebtedness applicable to line 1 assets..................

Subtract line 2 from line 1d.........................

1,503,751

Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see

instructions) .............................

22,556

Net value of noncharitable-use assets. Subtract line 4 from line 3. ............

1,481,195

Minimum investment return. Enter 5% (0.05) of line 5................

74,060

Part X

Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow

and do not complete this part.)

Minimum investment return from Part IX, line 6..................

74,060

Tax on investment income for 2022 from Part V, line 5.......

257

Income tax for 2022. (This does not include the tax from Part V.) ...

Add lines 2a and 2b............................

257

Distributable amount before adjustments. Subtract line 2c from line 1............

73,803

Recoveries of amounts treated as qualifying distributions................

Add lines 3 and 4............................

73,803

Deduction from distributable amount (see instructions).................

Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1 ...

73,803

Part XI

Qualifying Distributions (see instructions)

Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:

Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........

79,671

Program-related investments—total from Part VIII-B..................

Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,

purposes...............................

Amounts set aside for specific charitable projects that satisfy the:

Suitability test (prior IRS approval required)....................

Cash distribution test (attach the required schedule) .................

Qualifying distributions. Add lines 1a through 3b. Enter here and on Part XII, line 4. .......

79,671

Form 990-PF (2023)

Page 9

Part XII

Undistributed Income (see instructions)

		(a) Corpus	(c) 2022	(d) 2023
1 Distributable amount for 2023 from Part X, line 7				73,803
2 Undistributed income, if any, as of the end of 2022:
a Enter amount for 2022 only.......			732
b Total for prior years:20 , 20, 20
3 Excess distributions carryover, if any, to 2022:
a From 2018......
b From 2019......
c From 2020......
d From 2021......
e From 2022......
f Total of lines 3a through e ........
4Qualifying distributions for 2023 from Part
XI, line 4: $ 79,671
a Applied to 2022, but not more than line 2a			732
b Applied to undistributed income of prior years (Election required—see instructions).....
c Treated as distributions out of corpus (Election required—see instructions)........
d Applied to 2023 distributable amount.....				73,803
e Remaining amount distributed out of corpus		5,136
5 Excess distributions carryover applied to 2023.
(If an amount appears in column (d), the same amount must be shown in column (a).)
6Enter the net total of each column as indicated below:
a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5		5,136
b Prior years’ undistributed income. Subtract line 4b from line 2b ..........
c Enter the amount of prior years’ undistributed income for which a notice of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed......
d Subtract line 6c from line 6b. Taxable amount —see instructions ...........
e Undistributed income for 2022. Subtract line 4a from line 2a. Taxable amount—see instructions .............
f Undistributed income for 2023. Subtract lines 4d and 5 from line 1. This amount must be distributed in 2024 ..........				0
7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(F) or 4942(g)(3) (Election may be required - see instructions) .......
8 Excess distributions carryover from 2018 not applied on line 5 or line 7 (see instructions) ...
9 Excess distributions carryover to 2024. Subtract lines 7 and 8 from line 6a ......		5,136
10 Analysis of line 9:
a Excess from 2019....
b Excess from 2020....
c Excess from 2021....
d Excess from 2022....
e Excess from 2023....	5,136

Form 990-PF (2023)

Page 10

Part XIII

Private Operating Foundations (see instructions and Part VI-A, question 9)

1a If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2023, enter the date of the ruling ...... right arrow

b Check box to indicate whether the organization is a private operating foundation described in section 4942(j)(3) or4942(j)(5)

2a Enter the lesser of the adjusted net income from Part I or the minimum investment return from Part IX for each year listed ..........	Tax year	Prior 3 years			(e) Total
	(a) 2023	(b) 2022	(c) 2021	(d) 2020	(e) Total

b 85% (0.85) of line 2a .........
c Qualifying distributions from Part XI, line 4 for each year listed .....
d Amounts included in line 2c not used directly for active conduct of exempt activities ..........
e Qualifying distributions made directly for active conduct of exempt activities. Subtract line 2d from line 2c ....
3 Complete 3a, b, or c for the alternative test relied upon:
a “Assets" alternative test—enter:
(1) Value of all assets ......
(2) Value of assets qualifying under section 4942(j)(3)(B)(i)
b “Endowment" alternative test— enter 2/3 of minimum investment return shown in Part IX, line 6 for each year listed ..
c “Support" alternative test—enter:
(1) Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties) ....
(2) Support from general public and 5 or more exempt organizations as provided in section 4942(j)(3)(B)(iii)....
(3) Largest amount of support from an exempt organization
(4) Gross investment income

Part XIV

Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)

1Information Regarding Foundation Managers:

aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)

bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.

2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:

Check here right arrow

if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions

aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:

DAVID KITCH
P O BOX 129
ROCKY FORD,CO81067
(719) 254-3235

bThe form in which applications should be submitted and information and materials they should include:

NO REQUIRED FORMAT, GRANT REQUESTS MUST BE BY GOVERNMENTAL UNITS OR 501(C)(3) NON PROFIT ENTITIES.

cAny submission deadlines:

VARIES FROM YEAR TO YEAR.

dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:

GRANTS WILL BE AWARDED ONLY TO NON PROFIT AND GOVERNMENTAL UNITS THAT ARE IN THE SERVICE AREA THAT WAS COVERED BY THE FORMER HOSPITAL FROM WHICH THE GRANT FUNDS WERE GENERATED.

Form 990-PF (2023)

Page 11

Part XIV

Supplementary Information (continued)

3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient	If recipient is an individual, show any relationship to any foundation manager or substantial contributor	Foundation status of recipient	Purpose of grant or contribution	Amount
Name and address (home or business)		Foundation status of recipient	Purpose of grant or contribution	Amount
aPaid during the year
ARKANSAS VALLEY RESOURCE CENTER 415 COLORADO AVE LA JUNTA,CO81050			GENERAL OPERATIONS	5,000
FOWLER RURAL FIRE PROTECTION DIST PO BOX 91 FOWLER,CO81039			EQUIPMENT	10,000
MANZANOLA RURAL FIRE DISTRICT PO BOX 177 MANZANOLA,CO81058			5 NEW NOZZLES AND FIRE HOSE	15,000
CROWLEY COUNTY AMBULANCE 611 E 9TH STREET ORDWAY,CO81063			BALLISTIC GEAR, STORAGE CABINETS	10,355
ARK VALLEY PREGNANCY CENTER 118 W 4TH ST LA JUNTA,CO81050			PREGNANCY TESTS AND EDUCATION	2,000
ROCKY FORD EMS P O BOX 326 ROCKY FORD,CO81067			AMBULANCE GURNEY SYSTEM	20,000
TRI-COUNTY CARE CENTER 512 N MAIN ST ROCKY FORD,CO81067			15 CAR SEATS	1,000
BLACKBURN-DENNIS COMMUNITY CENTER 208 6TH ST FOWLER,CO81039			GENERAL OPERATIONS	2,500
FOWLER POLICE DEPARTMENT 114 E CRANSTON AVE FOWLER,CO81039			AUTOMATED EXTERNAL DEFIBRILLATORS	6,316
HOSPICE 531 LEWIS AVE LA JUNTA,CO81050			GENERAL OPERATIONS	7,500
Total ................................. 3a				79,671

bApproved for future payment

Total ................................. 3b

Form 990-PF (2023)

Page 12

Part XV-A

Analysis of Income-Producing Activities

Enter gross amounts unless otherwise indicated.	Unrelated business income		Excluded by section 512, 513, or 514		(e) Related or exempt function income (See instructions.)
1Program service revenue:	(a) Business code	(b) Amount	(c) Exclusion code	(d) Amount	(e) Related or exempt function income (See instructions.)
a
b
c
d
e
f
gFees and contracts from government agencies
2 Membership dues and assessments ....
3 Interest on savings and temporary cash investments ...........			14	10,766
4 Dividends and interest from securities ....			14	38,608
5 Net rental income or (loss) from real estate:
aDebt-financed property......
bNot debt-financed property.....					-17,916
6 Net rental income or (loss) from personal property
7 Other investment income .....
8 Gain or (loss) from sales of assets other than inventory ............			14		-31,524
9 Net income or (loss) from special events:
10 Gross profit or (loss) from sales of inventory
11 Other revenue: a
b
c
d
e
12 Subtotal. Add columns (b), (d), and (e) ..				49,374	-49,440

13Total. Add line 12, columns (b), (d), and (e)..................

-66

(See worksheet in line 13 instructions to verify calculations.)

Part XV-B

Relationship of Activities to the Accomplishment of Exempt Purposes

Line No.	Explain below how each activity for which income is reported in column (e) of Part XV-A contributed importantly to the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See instructions.)

Form 990-PF (2023)

Page 13

Part XVI

Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations

Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?

Yes

Transfers from the reporting foundation to a noncharitable exempt organization of:

(1) Cash...................................

1a(1)

(2) Other assets.................................

1a(2)

Other transactions:

(1) Sales of assets to a noncharitable exempt organization....................

1b(1)

(2) Purchases of assets from a noncharitable exempt organization..................

1b(2)

(3) Rental of facilities, equipment, or other assets.......................

1b(3)

(4) Reimbursement arrangements...........................

1b(4)

(5) Loans or loan guarantees.............................

1b(5)

(6) Performance of services or membership or fundraising solicitations................

1b(6)

Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............

If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.

(a) Line No.	(b) Amount involved	(c) Name of noncharitable exempt organization	(d) Description of transfers, transactions, and sharing arrangements

Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........Yes No

If "Yes," complete the following schedule.

(a) Name of organization	(b) Type of organization	(c) Description of relationship

Sign Here

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
				May the IRS discuss this return with the preparer shown below? See instructions. Yes No
	Signature of officer or trustee	Date	Title

Paid Preparer Use Only	Print/Type preparer's name	Preparer's Signature	Date	Check if self- employed	PTIN
	Firm's name				Firm's EIN
	Firm's address				Phone no.

Form 990-PF (2023)

Additional Data

Software ID:
Software Version:

Form 990PF - Special Condition Description:

Special Condition Description

- TIN:

TY 2023 AccountingFeesSchedule

Name:

COMMUNITY HOSPITAL BUILDING INC

EIN:

84-6031485

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
ACCOUNTING FEES	995	995
RESIDENTIAL-ROCKY FORD, CO	1,400	1,400

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

TY 2023 DepreciationSchedule

Name:

COMMUNITY HOSPITAL BUILDING INC

EIN:

84-6031485

Description of Property	Date Acquired	Cost or Other Basis	Prior Years' Depreciation	Computation Method	Rate / Life (# of years)	Current Year's Depreciation Expense	Net Investment Income
LAND - MCCLELLAND	1987-01-15	14,696
HEALTH DEPT BUILDING	1987-01-15	28,026	20,191	S/L	50.0000	561	561
MCCLELLAND APARTMENTS	1987-01-15	242,742	174,778	S/L	50.0000	4,855	4,855
MCCLELLAND COMMONS AREA	1987-01-15	16,000	11,520	S/L	50.0000	320	320
TABLE AND CHAIRS	1987-04-15	200	200	S/L	10.0000
FURNITURE	1987-05-15	797	797	S/L	10.0000
FURNITURE	1987-06-15	1,491	1,491	S/L	10.0000
EQUIPMENT	1987-07-15	135	135	S/L	10.0000
COOLER	1987-08-15	1,292	1,292	S/L	10.0000
FURNITURE	1987-10-15	1,035	1,035	S/L	10.0000
DRAPES	1988-02-15	393	393	S/L	10.0000
ANDREWS APARTMENT	1991-05-15	24,038	15,189	S/L	50.0000	480	480
DISHWASHER	1992-01-15	564	564	S/L	10.0000
CARPET	1996-01-15	1,582	1,582	S/L	10.0000
EQUIPMENT	1996-03-15	160	160	S/L	10.0000
DISHWASHER 4	1997-05-15	399	399	S/L	10.0000
ALARM - FRONT ENTRY SYSTEM	1998-02-15	968	968	S/L	10.0000
DISHWASHER	1998-04-15	449	449	S/L	10.0000
DISHWASHER	1998-04-15	475	475	S/L	10.0000
CARPET	1998-10-15	3,422	3,422	S/L	10.0000
CARPET	1998-12-15	4,622	4,622	S/L	10.0000
KITCHEN RANGE	2000-04-13	819	819	S/L	10.0000
KITCHEN RANGE	2000-11-08	690	690	S/L	10.0000
BLINDS	2000-11-08	104	104	S/L	5.0000
CARPETING	2000-07-17	8,650	8,650	S/L	10.0000
CARPETING	2004-05-06	3,975	3,975	S/L	10.0000
CENTRAL AIR COND	2004-06-04	3,191	3,191	S/L	10.0000
FURNACE & FIX - ATRIUM	2004-02-08	6,834	6,834	S/L	10.0000
GRIMSLEY UNIT 1	2004-01-01	47,619	18,092	S/L	50.0000	952	952
WINDOW BLINDS	2005-06-14	883	883	S/L	10.0000
KITCHEN RANGE	2005-04-28	599	599	S/L	5.0000
LAND 802 S. 13 TH	2006-11-30	64,108
AIR CONDITIONING	2008-11-04	2,754	2,754	S/L	10.0000
CARPET UNIT 2	2008-07-08	2,391	2,391	S/L	10.0000
NEW AIR CONDITIONER	2012-01-30	2,683	2,683	S/L	10.0000
UNIT 1 NEW CARPETING	2012-06-11	3,766	3,766	S/L	10.0000
MICRO WAVE KITCHEN	2012-06-27	139	139	S/L	3.0000
DRAPERIES SPRING CREST	2012-06-28	1,276	1,276	S/L	10.0000
CABINETS BACK OF UNITS	2012-07-03	695	486	S/L	15.0000	47	47
CABLE TV	2012-10-25	500	500	S/L	10.0000
DRAPERIES SPRING CREST	2012-12-04	260	260	S/L	10.0000
FLOORING UNIT 6	2013-01-31	560	555	S/L	10.0000	5	5
WATER HEATER	2013-01-31	1,075	1,066	S/L	10.0000	9	9
FLOORING UNIT 8	2013-03-31	500	488	S/L	10.0000	12	12
DISH WASHER	2013-04-30	341	330	S/L	10.0000	11	11
DISH WASHER UNIT 8	2013-09-30	491	454	S/L	10.0000	37	37
FENCING LOT	2013-05-31	3,585	2,290	S/L	15.0000	239	239
ROOF ON MCCLELLAND MANOR	2014-11-15	42,696	23,127	S/L	15.0000	2,846	2,846
GAZEBO	2014-09-15	10,837	6,051	S/L	15.0000	722	722
RANGE UNIT 4	2015-12-04	480	340	S/L	10.0000	48	48
NEW DOORS	2016-03-16	680	306	S/L	15.0000	45	45
AIR CONDITIONER UNIT 6	2016-08-08	2,101	1,348	S/L	10.0000	210	210
FLOORING	2016-10-29	5,700	3,515	S/L	10.0000	570	570
STOVE	2017-04-10	1,107	637	S/L	10.0000	110	110
HVAC	2017-06-14	2,194	1,225	S/L	10.0000	220	220
BATHROOM REMODEL	2017-10-05	6,490	2,271	S/L	15.0000	433	433
FURNACE 6	2017-08-07	3,600	1,950	S/L	10.0000	360	360
AIR CONDITIONER APT 8	2018-05-07	2,500	2,500	200DB	5.0000
CARPERT APT 3	2020-08-14	3,930	950	S/L	10.0000	393	393
HVAC APT 3	2020-08-25	2,437	569	S/L	10.0000	243	243
STOVE	2021-03-22	1,211	212	S/L	10.0000	121	121
5 HVAC UNITS DN PMT	2021-10-14	11,565
HVAC UNITS	2023-06-30	8,160		S/L	10.0000	408	408

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

TY 2023 GainLossSaleOtherAssetsSch

Name:

COMMUNITY HOSPITAL BUILDING INC

EIN:

84-6031485

Name	Date Acquired	How Acquired	Date Sold	Purchaser Name	Gross Sales Price	Basis	Basis Method	Sales Expenses	Total (net)	Accumulated Depreciation
RBC 10092 ST		PURCHASE			406,350	412,092			-5,742
RBC 10092 LT		PURCHASE			515,153	540,935			-25,782

- TIN:

TY 2023 InvestmentsCorpStockSchedule

Name:

COMMUNITY HOSPITAL BUILDING INC

EIN:

84-6031485

Name of Stock	End of Year Book Value	End of Year Fair Market Value
RBC WEALTH MANAGEMENT ACCOUNTS	1,376,022	1,441,239
WINDSTREAM HOLDINGS	63

- TIN:

TY 2023 LandEtcSchedule2

Name:

COMMUNITY HOSPITAL BUILDING INC

EIN:

84-6031485

Category / Item	Cost / Other Basis	Accumulated Depreciation	Book Value	End of Year Fair Market Value
BUILDINGS & EQUIPMENT	528,857	362,196	166,661	660,000
LAND	78,804		78,804	85,000

- TIN:

TY 2023 OtherDecreasesSchedule

Name:

COMMUNITY HOSPITAL BUILDING INC

EIN:

84-6031485

Description	Amount
FEDERAL INCOME TAX	166

- TIN:

TY 2023 OtherExpensesSchedule

Name:

COMMUNITY HOSPITAL BUILDING INC

EIN:

84-6031485

Description	Revenue and Expenses per Books	Net Investment Income
RESIDENTIAL-ROCKY FORD, CO
UTILTIES	12,002	12,002
SUPPLIES	1,198	1,198
CLEANING	15	15
OFFICE	881	881
INSURANCE	6,858	6,858
REPAIRS & MAINTENANCE	24,598	24,598
CONTRACT LABOR	14,400	14,400
SNOW REMOVAL	575	575
LAWN CARE	1,120	1,120
EXPENSES
INVESTMENT FEES	11,526	11,526

- TIN:

TY 2023 TaxesSchedule

Name:

COMMUNITY HOSPITAL BUILDING INC

EIN:

84-6031485

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
FOREIGN TAXES	450	450