2020-08-14T06:55:44-05:00 2019-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2018-10-01 391515716 VERNON MEMORIAL HEALTHCARE FOUNDATION INC VERN 6086372101 507 SOUTH MAIN STREET VIROQUA WI 54665 DAVID HARTBERG CEO 6086372101 2020-08-13 1 MICHAEL J PETERSON CPA P01833529 2187224705 2020-08-12 4.4.25.242 2020-08-13 14:49:06 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 2018 2020-11-06 18:47:13Z DAVID HARTBERG 507 SOUTH MAIN STREET VIROQUA WI 54665 477257 0 X HTTP://WWW.VMH.ORG/CONTENT/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 12 0 0 283325 379297 0 0 9720 13807 77625 72140 370670 465244 385098 400367 0 0 0 0 0 0 0 12073 26316 397171 426683 -26501 38561 1291258 1407949 959834 1036903 331424 371046 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 400367 400367 0 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. 0 0 0 400367 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 1 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 WI X KAREN TRAYNOR 6086374964 507 SOUTH MAIN STREET VIROQUA WI 54665 X GARY BRUNSLIK DIRECTOR 1.00 X 0 0 0 PAUL LARSEN DIRECTOR 1.00 1.00 X 0 0 0 REBECCA LARSON DIRECTOR 1.00 X 0 0 0 BONNIE RATH 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 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 1.00 X X 0 0 0 DAVID HARTBERG CEO - VMH 1.00 40.00 X 0 0 0 KAREN TRAYNOR CFO - VMH 1.00 40.00 X 0 0 0 0 0 0 0 0 0 0 0 379297 379297 13807 13807 84153 12013 72140 72140 465244 0 0 85947 392867 392867 7500 7500 7750 7750 2000 2000 14961 14961 1105 1105 500 500 426683 400367 26316 0 77472 46930 953670 1078675 11949 260116 270395 1291258 1407949 8481 12364 951353 1024539 959834 1036903 X 207408 247030 124016 124016 331424 371046 1291258 1407949 38561 1061 0 X X 1 X 0 1 0 X 417302 310453 411286 283325 379297 1801663 417302 310453 411286 283325 379297 1801663 1801663 13058 12798 11636 9720 13807 61019 1862682 290236 0.96720 0.97030 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 124016 10278 7500 2778 124016 124016 8000 8000 124016 124016 8000 8000 124016 124016 6000 6000 124016 124015 5626 5625 124016 1.00000 0 0 0 DONOR IMPOSED LIABILITY 1024539 1024539 90795 1061 12013 -387523 -374449 465244 0 465244 51173 12013 -387523 -375510 426683 0 426683 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. AMISH AUCTION 50632 50632 GOLF OUTING 18280 18280 380 3280 1688 886 1 15241 15241 5127 652 84153 84153 380 3280 6815 1538 12013 72140 1 VERNON MEMORIAL HEALTHCARE INC 507 SOUTH MAIN STREET VIROQUA WI 54665 390806404 501(C)(3) 392867 FMV VARIOUS PROGRAMS AND EQUIPMENT 1 0 SCHOLARSHIPS 7 7500 FMV PART I, LINE 2: 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. 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.