2021-08-13T10:12:19-05:00 2020-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2019-10-01 391515716 VERNON MEMORIAL HEALTHCARE FOUNDATION INC VERN 6086372101 507 SOUTH MAIN STREET VIROQUA WI 54665 MIKE SANDERS INTERIM CFO 6086372101 2021-08-11 1 MICHAEL J PETERSON CPA P01833529 2187224705 2021-08-11 2019 2022-09-23 18:48:47Z DAVID HARTBERG 507 SOUTH MAIN STREET VIROQUA WI 54665 362085 0 X WWW.VMH.ORG/COMMUNITY/VMH-FOUNDATION/ X 1984 WI TO SOLICIT, RECEIVE, AND ACCEPT GIFTS, DEVICES, OR BEQUESTS ON BEHALF OF VERNON MEMORIAL HEALTHCARE AND FOR SCHOLARSHIPS. 11 11 0 11 0 0 379297 360092 0 0 13807 1993 72140 0 465244 362085 400367 394838 0 0 0 0 0 0 0 26316 10854 426683 405692 38561 -43607 1407949 1530696 1036903 1183051 371046 347645 THE VERNON MEMORIAL HEALTHCARE FOUNDATION IS DEDICATED TO DEVELOPING AND SUPPORTING THE PROGRAMS, SERVICES, FACILITIES AND EDUCATION WHICH ENHANCE THE ACCESSIBILITY TO QUALITY HEALTHCARE AND WELLNESS IN THE COMMUNITIES SERVED BY VERNON MEMORIAL HEALTHCARE INC. 0 0 394838 394838 0 THE VERNON MEMORIAL HEALTHCARE FOUNDATION PROVIDED 6 INDIVIDUALS WHO ARE PURSUING OR FURTHERING THEIR EDUCATION IN THE HEALTH CARE FIELD SCHOLARSHIPS DURING FISCAL YEAR 2020. THE FOUNDATION ALSO GRANTED VERNON MEMORIAL HEALTHCARE, INC. $386,338 TO BE USED FOR VARIOUS PROGRAMS AND EQUIPMENT PURCHASES. 394838 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 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 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 WI X MIKE SANDERS 6086374964 507 SOUTH MAIN STREET VIROQUA WI 54665 X KYLE BAKKUM CEO - VMH (THRU DECEMBER) 1.00 X 0 0 0 DAVID HARTBERG CEO - VMH 1.00 X 0 0 0 KAREN TRAYNOR CFO - VMH 1.00 X 0 0 0 MARTY SNUSTEAD CHAIRPERSON 1.00 X X 0 0 0 AARON CADE VICE CHAIR 1.00 X X 0 0 0 RACHEL HANSON TREASURER 1.00 X X 0 0 0 SHARI JACOBSON SECRETARY (THRU DECEMBER) 1.00 X X 0 0 0 BONNIE RATH SECRETARY 1.00 X 0 0 0 GARY BRUNSLIK DIRECTOR 1.00 X 0 0 0 PAUL LARSEN TREASURER 1.00 X 0 0 0 REBECCA LARSON DIRECTOR 1.00 X 0 0 0 CHRIS ROZESKE DIRECTOR 1.00 X 0 0 0 JULIE STEINER DIRECTOR 1.00 X 0 0 0 MIKE WELCH DIRECTOR 1.00 X 0 0 0 PETER WALBY DIRECTOR 1.00 X 0 0 0 0 0 0 0 0 0 0 0 39958 320134 360092 1993 1993 0 39958 0 0 362085 0 0 1993 386338 386338 8500 8500 7100 7100 2000 2000 557 557 1105 1105 92 92 405692 394838 10854 0 46930 20095 1078675 1203719 11949 19000 270395 287882 1407949 1530696 12364 173 1024539 1182878 1036903 1183051 X 247030 223629 124016 124016 371046 347645 1407949 1530696 -43607 20206 0 X 1 X 0 1 0 X 310453 411286 283325 379297 360092 1744453 310453 411286 283325 379297 360092 1744453 423971 1320482 12798 11636 9720 13807 10900 58861 1803314 244932 0.73230 0.79230 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 124016 17488 8500 8988 124016 124016 10278 7500 2778 124016 124016 8000 8000 124016 124016 8000 8000 124016 124016 6000 6000 124016 0.00000 1.00000 0.00000 0 0 0 DONOR IMPOSED LIABILITY 1182878 1182878 118102 20206 97853 -362042 -243983 362085 0 362085 141503 97853 97853 43650 362042 362042 405692 PART V, LINE 4: INVESTMENT INCOME ON ENDOWMENT FUNDS ARE TO BE USED FOR NURSING SCHOLARSHIPS PER DONOR RESTRICTIONS. PART XI, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT FEES -2,000. GRANT EXPENSE INCLUDED AS REVENUE -360,042. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT MANAGEMENT FEES 2,000. GRANT EXPENSE INCLUDED AS REVENUE 360,042. BED CAMPAIGN 39958 39958 39958 39958 1 VERNON MEMORIAL HEALTHCARE INC 507 SOUTH MAIN STREET VIROQUA WI 54665 390806404 501(C)(3) 386338 VARIOUS PROGRAMS AND EQUIPMENT 1 0 SCHOLARSHIPS 6 8500 PART I, LINE 2: THE FOUNDATION MAKES DONATIONS OR AWARDS TO VERNON MEMORIAL HEALTHCARE (VMH) AND MAKES PAYMENT OF CERTAIN INDIVIDUAL SCHOLARSHIPS VIA A DEFINED SCHOLARSHIP PROGRAM. FOR DONATIONS MADE TO VMH, THE FOUNDATION'S BOARD RECEIVES A WRITTEN REQUEST FOR FUNDING CONSIDERATION FOR REVIEW AND ACTION BY THE BOARD AS A PART OF A REGULAR BOARD MEETING. APPLICANTS ASKING TO BE CONSIDERED FOR A SCHOLARSHIP AWARD FOLLOW A DEFINED POLICY, APPLICATIONS ARE REVIEWED BY A COMMITTEE OF THE BOARD TO ENSURE ELIGIBILITY UNDER THE CRITERIA OF THE PROGRAM WITH RECOMMENDATIONS FOR SCHOLARSHIP AWARDS MADE TO THE FULL BOARD FOR THEIR CONSIDERATION AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS WILL HAVE RECEIVED A COPY OF FORM 990 AFTER THE SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12 ALL BOARD MEMBERS OF VERNON MEMORIAL HEALTHCARE FOUNDATION, INC. ARE REQUIRED TO DISCLOSE ALL POSSIBLE CONFLICTS OF INTEREST WHEN FIRST ELECTED TO THE BOARD OF DIRECTORS. DURING THEIR TERMS, IF ANY BUSINESS RELATIONSHIPS ARE ENTERED INTO WHICH MAY AFFECT THEIR INDEPENDENCE AS A MEMBER, THE MEMBER MUST IMMEDIATELY DISCLOSE THESE RELATIONSHIPS. FORM 990, PART VI, SECTION C, LINE 19 VERNON MEMORIAL FOUNDATION, INC. HAS MADE ITS FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC ON A PER REQUEST BASIS.