2020-04-08T08:33:49-05:00 2019-06-30 450250985 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2018-07-01 431975486 Friends of FMC Foundation Inc FRIE 4067783331 PO Box 820 Baker MT 59313 Rosanne Varner President of Board 4067783331 2020-04-07 1 Kim C Hunwardsen P00484560 6122536500 2020-04-07 216.147.181.49 2020-04-07 14:53:01 CD P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC F9BEE9501A3B4F00F190E63700B8BF2BC70C7B96 2018 2020-09-23 17:36:50Z Rosanne Varner PO Box 820 Baker MT 59313 104982 0 X www.fallonmedical.org X 2002 MT To coordinate Fallon Medical Complex, Inc's fundraising programs. 7 6 0 84 0 0 20480 38129 0 0 32810 43808 14215 11162 67505 93099 19431 21512 0 0 0 0 0 0 0 13256 13083 32687 34595 34818 58504 1262362 1357259 0 0 1262362 1357259 To help ensure the continuing quality of local healthcare services for our community. "Friends Helping Friends" 0 0 20012 20012 The purpose of Friends of Fallon Medical Complex Foundation is to provide, through all of its funds and activities, direct or indirect benefit to Fallon Medical Complex (FMC), a not-for-profit healthcare corporation, in support of its mission, so long as FMC qualifies as an organization described in Section 501(c)(3) of the Internal Revenue Code. The Foundation obtains and receives contributions, donations, gifts, or bequests entirely for the development of one or more endowment funds, to be used for financial assistance to FMC for medical education, equipment upgrades and purchases, physical plant improvements and additions, personnel programs, and any aspect of promotion and public relations devoted to the delivery of health care services in FMC's service area. 1500 1500 The Friends of Fallon Medical Complex Foundation distributes funds from its capital pool for the purpose of funding scholarships to students from our service area that are pursuing a formal education in a healthcare-related field. The scholarship process is governed by established formal program criteria that define how requests are to be submitted by applicants and how they are to be evaluated by the Board of Directors. During the past fiscal year, the Board awarded three scholarships (worth $500) to students to the scholar's college of choice. 21512 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 7 6 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X Marjorie Losing 4067785303 PO Box 820 Baker MT 59313 Rosanne Varner President 0.50 0.00 X X 0 0 0 Craig Pinnow Vice President 0.50 0.00 X X 0 0 0 Cori Thurlow Secretary/Treasurer 0.50 40.00 X X 0 39640 893 Kim Cuppy Director (Apr-Jun) 0.50 0.00 X 0 0 0 Doug Varner Director 0.50 0.50 X 0 0 0 Mike Griffith Director 0.50 0.00 X 0 0 0 David Stevens Director 0.50 0.00 X 0 0 0 Darcy Pankratz Wassmann Director (Jul-Mar) 0.50 0.00 X 0 0 0 Karol Zachmann Foundation Director 19.00 21.00 X 0 43366 19375 0 83006 20268 0 0 0 0 0 12964 1233 23932 1233 38129 33100 33100 10708 0 10708 10708 10708 23045 12964 11883 11162 11162 93099 0 0 54970 20012 20012 1500 1500 210 210 2900 2900 8741 8741 1232 1232 34595 21512 13083 0 1262362 1357259 1262362 1357259 0 0 X 910979 1025200 168334 139010 183049 193049 1262362 1357259 1262362 1357259 58504 36393 0 X 0 1 X 1 0 X 40416 24411 25354 20480 38129 148790 40416 24411 25354 20480 38129 148790 48713 100077 21829 26721 22670 26083 33100 130403 279193 130913 0.35850 0.35420 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 244418 10000 1403 255821 243715 703 244418 243034 681 243715 230502 10000 2532 243034 208676 21794 1032 1000 230502 0.16400 0.75500 0.08100 0 0 0 X 97874 38241 2562 40803 57071 36028 36028 93099 84719 38241 11883 50124 34595 0 34595 Part V, Line 4: Permanently restricted funds are used to provide a source of income to be used for Long Term Care, and/or equipment purchases on behalf of Fallon Medical Complex, and for scholarships. Principal has been invested and the generated income (temporarily restricted) is used for said purpose. Part X, Line 2: The Foundation is organized as a Montana nonprofit organization and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code. The Foundation is also exempt from state income taxes. The Foundation is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Foundation is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Foundation has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990-T) with the IRS. The Foundation believes it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the 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. Part XI, Line 2d - Other Adjustments: Net Assets released from Restrictions 2,562. Part XI, Line 4b - Other Adjustments: Fundraising Expenses in Revenue for Tax Purposes -11,883. Contributions Reported in Fund Balance for Financial Statements 46,508. Investment Income Reported in Fund Balance for Financial Statements 1,403. Part XII, Line 2d - Other Adjustments: Fundraising Expenses in Revenue for Tax Purposes 11,883. Mammo Whammo 12058 6625 5433 400 100 1724 436 Breast CA Luncheon 13616 5525 8091 100 1 10335 814 9521 931 4153 1055 36009 12964 23045 500 1031 1724 4153 1491 8899 14146 1 Fallon Medical Center 202 S 4th St W Baker MT 59313 363808993 501(c)(3) 20012 General Support 1 0 Part I, Line 2: The Hospital has a formal process in place in order to request funds from the Foundation. The Foundation board of directors must approve any amounts requested by the Hospital. In this process the Hospital must describe what they are requesting. Form 990, Part VI, Section A, line 2 Karol Zachmann and David Stevens have family relationships. Doug Varner and Rosanne Varner have a family relationship. Doug Varner has a business relationship with Karol Zachmann and Cori Thurlow. Form 990, Part VI, Section A, line 8b The organization does not have a committee that acts on behalf of the governing body. Form 990, Part VI, Section B, line 11b Information for the Form 990 is compiled by the executive staff. The corporation's accountants prepare the form which is emailed or mailed to the Board of Directors for the review and comment during one of their regular meetings prior to filing with the IRS. Form 990, Part VI, Section B, line 12c The Organization's conflict of interest policy requires a duty to disclose any conflicts annually as well as during discussions. The policy covers all members of the board. Board Members complete a questionnaire annually addressing potential areas of conflicts. Conflicts are determined by each individual. If a conflict arises, the board member abstains from voting on matters that gave rise to the conflict. Form 990, Part VI, Section B, line 15 The Foundation Director is paid by Fallon Medical Complex, a related organization, for her services to both the Foundation and the Fallon Medical Complex. Fallon Medical Complex uses the Montana Hospital Association (MHA) annual compensation data to help determine compensation for employees including the Foundation director. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy and financial statements are available for public inspection at the corporation's place of business upon request. Fallon Medical Center 202 S 4th St W Baker MT 59313 363808993 Critical Access Hospital MT 501(c)(3) Line 3 N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0