2021-08-16T10:27:56-05:00 2020-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2019-10-01 271865510 Mile Bluff Medical Center Foundation MILE 6088476161 1050 Division Street Mauston WI 53948 James O'Keefe President/CEO 6088476161 2021-08-13 1 Kim Hunwardsen CPA P00484560 6122536500 2021-08-13 2019 2022-09-23 18:48:47Z James O'Keefe 1050 Division Street Mauston WI 53948 222477 0 X http://www.milebluff.com X 2009 WI Give individuals and businesses the opportunity to take an active role to impact local healthcare. 7 4 0 4 0 0 0 210435 0 4676 0 2418 0 -5158 0 212371 0 86675 0 0 0 0 0 0 42243 0 42343 0 129018 0 83353 286416 360867 14750 5848 271666 355019 X Mile Bluff Medical Center Foundation provides philanthropic opportunities and support to Mile Bluff Medical Center and assists it in fulfilling its mission, adhering to its core values and pursuing its vision to provide the community with exceptional, personalized health care services. 0 0 86675 86675 4676 Mile Bluff Medical Center Foundation strives to build and cultivate community partnerships that ensure lifelong commitments to healthcare advancement, personal well-being and improvement throughout Mile Bluff's six-county service area. 86675 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 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 1 0 0 0 0 0 0 X 7 4 1 0 0 0 1 1 0 1 0 0 0 0 1 1 1 1 1 0 0 0 WI X James O'Keefe 6088476161 1050 Division Street Mauston WI 53948 James O'Keefe Pres/CEO Mile Bluff Medical Ctr 0.30 40.00 X X 0 404022 14000 Dan Kattenbraker MD Director 0.30 40.00 X 0 75265 3759 Martha Airth-Kindree Executive Director 20.00 0.00 X X 0 67580 13870 Nora Scully Chair 0.30 0.00 X X 0 0 0 Sandy Linsmeyer Treasurer 0.30 0.50 X X 0 0 0 Molly Scully Secretary 0.30 0.00 X X 0 0 0 Christine Carter Director 0.30 0.00 X 0 0 0 0 546867 31629 0 0 1 0 0 16769 193666 210435 Women's Night Out Reve 900099 4676 4676 4676 2418 2418 4948 16769 10106 -5158 -5158 212371 4676 0 -2740 86675 86675 100 100 11474 11474 9874 9874 1038 1038 223 223 200 200 Nurses Helping Nurses 14087 14087 Women's Night Out Expen 4609 4609 Dues & Subscriptions 738 738 129018 86675 100 42243 267103 342212 13750 13092 5563 5563 286416 360867 8310 -592 6440 6440 14750 5848 X 147684 262802 123982 92217 271666 355019 286416 360867 83353 0 X 0 1 X 0 0 X X X 1 Mile Bluff Medical Center Inc 390992883 3 1 86675 0 1 86675 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 Schedule A, Part IV, Section A, Line 1: The Foundation was organized and will be operated exclusively to benefit and carry out the purposes of the Medical Center and certain of the Medical Center's related organizations (collectively, the "Supported Organizations"). The Medical Center is a Wisconsin nonstock corporation that is a Code Section 501(c)(3) organization and a public charity described in Code Sections 170(b)(1)(A)(iii) and 509(a)(1). As set forth in the Foundation's Articles of Incorporation, in order for one of the Medical Center's related organizations to qualify as a Supported Organization of the Foundation, the related organization must (1) be described in Code Section 501(c)(3); (2) be a public charity described in Code Section 509(a)(1) or 509(a)(2); and (3) be directly or indirectly controlled by, under common control with, or in control of the Medical Center. Schedule A, Part IV, Section B, Line 1: The Foundation's Supported Organizations serve as its members, will elect all of the Foundation's directors, and have the authority to amend the Foundation's governing documents. At this time, only the Medical Center is acting as a member, and therefore Supported Organization, of the Foundation. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 Due to Mile Bluff Medical Center 6440 6440 X Part X, Line 2: The Foundation believes that it has appropriate support for any tax positions taken affecting their annual filing requirements, and as such, do not have any uncertain tax positions that are material to the consolidated financial statements. The Foundation would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Golf Outing 21717 16769 4948 700 2391 4948 2067 21717 16769 4948 700 2391 4948 2067 10106 -5158 1 Mile Bluff Medical Center 1050 Division Street Mauston WI 539481997 390992883 501(c)(3) 86675 General Operations 1 0 Part I, Line 2: The Foundation is a supporting organization of Mile Bluff Medical Center. The mission is to provide support to Mile Bluff Medical Center and assist in fulfilling its mission of providing healthcare services. The officers of the Medical Center and board members work closely together to ensure the funds are used for the intended purpose. 0 0 0 0 0 0 0 0 0 James O'Keefe Pres/CEO Mile Bluff Medical Ctr 0 352088 0 51934 0 0 0 14000 0 0 0 418022 0 0 Schedule J, Part I, Line 3: The President/CEO is compensated by Mile Bluff Medical Center, a related organization, for services provided to the Medical Center. Mile Bluff Medical Center has processes in place to determine compensation. Form 990, Part VI, Section A, line 2 Nora Scully and Molly Scully have a family relationship. James O'Keefe, Dan Kattenbraker, MD, Martha Airth-Kindree, and Sandy Linsmeyer have a business relationship. Form 990, Part VI, Section A, line 6 The Foundation has a single class of voting members. The sole member of that class is Mile Bluff Medical Center, Inc. Form 990, Part VI, Section A, line 7a The sole member elects the Board of Directors. Form 990, Part VI, Section A, line 8b The Foundation does not have committees with authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The Form 990 was not provided to the governing body before it was filed. The CEO of Mile Bluff Medical Center, a related organization, reviews the Form 990. Form 990, Part VI, Section B, line 12c The Foundation's Board of Directors is required to annually complete a Conflict of Interest Policy. The Board members must disclose any possible conflict of interest whenever the conflict pertains to a matter being considered by the Board of Directors. Any Director having a conflict of interest on any matter shall abstain from voting on the matter and shall not be counted in determining the quorum for the vote on the matter. The minutes of the meeting involving any such situation shall reflect that a disclosure was made, the abstention from voting, and the quorum situation. If a Director is uncertain as to whether he or she has a conflict of interest which requires abstention, or if a Director asserts that another Director has such a conflict, the Board of Directors, by majority vote of those present other than the Director having the possible conflict, shall decide whether abstention is required. If abstention is required, the affected Director shall abstain from voting on the matter. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are available to the public upon request. Mile Bluff Medical Center Inc 1050 Division Street Mauston WI 539481997 390992883 Provision of health care services WI 501(c)(3) Line 3 N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0