VERNON MEMORIAL HEALTHCARE FOUNDATION INC: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- VERNON MEMORIAL HEALTHCARE FOUNDATION INC (EIN 39-1515716)
- Tax period
- 2018-10-01 to 2019-09-30
- Filed
- 2020-08-14
- IRS object ID
- 202002279349301000
- Schema version
- 2018v3.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-08-14T06:55:44-05:00 | ReturnTs |
| Tax Period End | 2019-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391515716 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VERNON MEMORIAL HEALTHCARE | BusinessNameLine1Txt |
| Business Name Line2 | FOUNDATION INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | VERN | BusinessNameControlTxt |
| Phone | 6086372101 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 507 SOUTH MAIN STREET | AddressLine1Txt |
| City | VIROQUA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54665 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID HARTBERG | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6086372101 | PhoneNum |
| Signature | 2020-08-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2020-08-12 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 4.4.25.242 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-08-13 | IPDt |
| IP Tm | 14:49:06 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-11-06 18:47:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID HARTBERG | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 507 SOUTH MAIN STREET | AddressLine1Txt |
| City | VIROQUA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54665 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $477,257 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTP://WWW.VMH.ORG/CONTENT/FOUNDATION | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1984 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO SOLICIT, RECEIVE, AND ACCEPT GIFTS, DEVICES, OR BEQUESTS ON BEHALF OF VERNON MEMORIAL HEALTHCARE AND FOR SCHOLARSHIPS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 12 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $283,325 | PYContributionsGrantsAmt |
| CY Contributions Grants | $379,297 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $9,720 | PYInvestmentIncomeAmt |
| CY Investment Income | $13,807 | CYInvestmentIncomeAmt |
| PY Other Revenue | $77,625 | PYOtherRevenueAmt |
| CY Other Revenue | $72,140 | CYOtherRevenueAmt |
| PY Total Revenue | $370,670 | PYTotalRevenueAmt |
| CY Total Revenue | $465,244 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $385,098 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $400,367 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,073 | PYOtherExpensesAmt |
| CY Other Expenses | $26,316 | CYOtherExpensesAmt |
| PY Total Expenses | $397,171 | PYTotalExpensesAmt |
| CY Total Expenses | $426,683 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$26,501 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $38,561 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,291,258 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,407,949 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $959,834 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,036,903 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $331,424 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $371,046 | NetAssetsOrFundBalancesEOYAmt |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $400,367 | ExpenseAmt |
| Grant | $400,367 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | THE VERNON MEMORIAL HEALTHCARE FOUNDATION PROVIDED 7 INDIVIDUALS WHO ARE PURSUING OR FURTHERING THEIR EDUCATION IN THE HEALTH CARE FIELD SCHOLARSHIPS DURING FISCAL YEAR 2019. THE FOUNDATION ALSO GRANTED VERNON MEMORIAL HEALTHCARE, INC. $392,867 TO BE USED FOR VARIOUS PROGRAMS AND EQUIPMENT PURCHASES. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $0 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $400,367 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | 0 | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | 0 | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | 0 | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KAREN TRAYNOR | PersonNm |
| Phone | 6086374964 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 507 SOUTH MAIN STREET | AddressLine1Txt |
| City | VIROQUA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54665 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| GARY BRUNSLIK | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PAUL LARSEN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | 1.00 | |
| REBECCA LARSON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BONNIE RATH | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CHRIS ROZESKE | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JULIE STEINER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MIKE WELCH | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARTY SNUSTEAD | |||||||
| CHAIRPERSON | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| AARON CADE | |||||||
| VICE CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| RACHEL HANSON | |||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| SHARI JACOBSON | |||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| DAVID HARTBERG | |||||||
| CEO - VMH | 1.00 | $0 | $0 | $0 | 40.00 | Yes (X) | |
| KAREN TRAYNOR | |||||||
| CFO - VMH | 1.00 | $0 | $0 | $0 | 40.00 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $379,297 | AllOtherContributionsAmt |
| Total Contributions | $379,297 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,807 | TotalRevenueColumnAmt |
| Exclusion | $13,807 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $84,153 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $12,013 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $72,140 | TotalRevenueColumnAmt |
| Exclusion | $72,140 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $465,244 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $85,947 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $392,867 | TotalAmt |
| Program Services | $392,867 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,500 | TotalAmt |
| Program Services | $7,500 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,750 | TotalAmt |
| Management And General | $7,750 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,000 | TotalAmt |
| Management And General | $2,000 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,961 | TotalAmt |
| Management And General | $14,961 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,105 | TotalAmt |
| Management And General | $1,105 | ManagementAndGeneralAmt |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $500 | TotalAmt |
| Management And General | $500 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $426,683 | TotalAmt |
| Program Services | $400,367 | ProgramServicesAmt |
| Management And General | $26,316 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $77,472 | BOYAmt |
| EOY | $46,930 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $953,670 | BOYAmt |
| EOY | $1,078,675 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $11,949 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $260,116 | BOYAmt |
| EOY | $270,395 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,291,258 | BOYAmt |
| EOY | $1,407,949 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,481 | BOYAmt |
| EOY | $12,364 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $951,353 | BOYAmt |
| EOY | $1,024,539 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $959,834 | BOYAmt |
| EOY | $1,036,903 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $207,408 | BOYAmt |
| EOY | $247,030 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $124,016 | BOYAmt |
| EOY | $124,016 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $331,424 | BOYAmt |
| EOY | $371,046 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,291,258 | BOYAmt |
| EOY | $1,407,949 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $38,561 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,061 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (1) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | 0 | FSAuditedInd |
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $417,302 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $310,453 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $411,286 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $283,325 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $379,297 | CurrentTaxYearAmt |
| Total | $1,801,663 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $417,302 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $310,453 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $411,286 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $283,325 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $379,297 | CurrentTaxYearAmt |
| Total | $1,801,663 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $1,801,663 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $13,058 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $12,798 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $11,636 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,720 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,807 | CurrentTaxYearAmt |
| Total | $61,019 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $1,862,682 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $290,236 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.96720 | PublicSupportCY170Pct |
| Public Support PY170 | 0.97030 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $124,016 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $10,278 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $7,500 | GrantsOrScholarshipsAmt |
| Other Expenditures | $2,778 | OtherExpendituresAmt |
| End Year Balance | $124,016 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $124,016 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $8,000 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $8,000 | GrantsOrScholarshipsAmt |
| End Year Balance | $124,016 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $124,016 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $8,000 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $8,000 | GrantsOrScholarshipsAmt |
| End Year Balance | $124,016 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $124,016 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $6,000 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $6,000 | GrantsOrScholarshipsAmt |
| End Year Balance | $124,016 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $124,015 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $5,626 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $5,625 | GrantsOrScholarshipsAmt |
| End Year Balance | $124,016 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DONOR IMPOSED LIABILITY | Desc |
| Amt | $1,024,539 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,024,539 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $90,795 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $1,061 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $12,013 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | -$387,523 | OtherRevenueAmt |
| Revenue Not Reported | -$374,449 | RevenueNotReportedAmt |
| Revenue Subtotal | $465,244 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $465,244 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $51,173 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $12,013 | DonatedServicesUseFcltsAmt |
| Other Expenses Included | -$387,523 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$375,510 | ExpensesNotReportedAmt |
| Expenses Subtotal | $426,683 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $426,683 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 -385,523. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | INVESTMENT MANAGEMENT FEES -2,000. GRANT EXPENSE INCLUDED AS REVENUES -385,523. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | AMISH AUCTION | Event1Nm |
| Gross Receipts Event1 | $50,632 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $50,632 | GrossRevenueEvent1Amt |
| Event2 | GOLF OUTING | Event2Nm |
| Gross Receipts Event2 | $18,280 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $18,280 | GrossRevenueEvent2Amt |
| Cash Prizes Event2 | $380 | CashPrizesEvent2Amt |
| Rent Facility Costs Event2 | $3,280 | RentFacilityCostsEvent2Amt |
| Food And Beverage Event2 | $1,688 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $886 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 1 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $15,241 | GrossReceiptsOtherEventsAmt |
| Gross Revenue Other Events | $15,241 | GrossRevenueOtherEventsAmt |
| Food And Beverage Other Events | $5,127 | FoodAndBeverageOtherEventsAmt |
| Oth Direct Expnss Other Events | $652 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $84,153 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $84,153 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $380 | CashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $3,280 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $6,815 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $1,538 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $12,013 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $72,140 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VERNON MEMORIAL HEALTHCARE INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 507 SOUTH MAIN STREET | AddressLine1Txt |
| City | VIROQUA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54665 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 390806404 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $392,867 | CashGrantAmt |
| Valuation Method Used | FMV | ValuationMethodUsedDesc |
| Purpose Of Grant | VARIOUS PROGRAMS AND EQUIPMENT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 7 | RecipientCnt |
| Cash Grant | $7,500 | CashGrantAmt |
| Valuation Method Used | FMV | ValuationMethodUsedDesc |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE VERNON MEMORIAL HEALTHCARE FOUNDATION, INC. HAS DEVELOPED A SCHOLARSHIP APPLICATION PROCESS AND HAS IMPLEMENTED A BLINDED PROCESS FOR SCORING COMPLETE APPLICATIONS WITH AWARDS BASED UPON THE SCORING OUTCOMES. DETAILED RECORDS ARE MAINTAINED TO SUPPORT THE PROCESS. REQUESTS FOR FUNDS TO SUPPORT VERNON MEMORIAL HEALTHCARE PROGRAM SERVICES OR EQUIPMENT PURCHASE ARE MADE IN WRITING AND REVIEWED BY THE VERNON MEMORIAL HEALTHCARE FOUNDATION BOARD FOR DECISION MAKING WITH REGARD TO AWARD OF FUNDS. THE BOARD REQUIRES A FOLLOW-UP REPORT ONCE A PROJECT IS COMPLETED. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 8B | THE FOUNDATION DOES NOT HAVE ANY COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE BOARD OF DIRECTORS HAVE RECEIVED A COPY OF FORM 990 PRIOR TO FILING. |
| 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. |
| FORM 990, PART XII, LINE 2C | THE BOARD OF DIRECTORS FOR THE HOSPITAL SELECTS THE ACCOUNTANT FOR THE REVIEW OF THE FINANCIAL STATEMENTS. THE BOARD OF DIRECTORS FOR THE FOUNDATION OVERSEES THE PROCESS. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. |
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