MILE BLUFF MEDICAL CENTER FOUNDATION INC: Form 990EZ, tax year 2018
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- Organization
- MILE BLUFF MEDICAL CENTER FOUNDATION INC (EIN 27-1865510)
- Tax period
- 2018-10-01 to 2019-09-30
- Filed
- 2020-08-10
- IRS object ID
- 202042239349201124
- 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 | 2020-08-10T15:45:49-05:00 | ReturnTs |
| Tax Period End | 2019-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Nicollet Mall Ste 1300 | AddressLine1Txt |
| City | Minneapolis | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554027033 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990EZ | ReturnTypeCd |
| Tax Period Begin | 2018-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 271865510 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mile Bluff Medical Center Foundation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MILE | BusinessNameControlTxt |
| Phone | 6088476161 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1050 Division Street | AddressLine1Txt |
| City | Mauston | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53948 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | James O'Keefe | PersonNm |
| Person Title | President/CEO | PersonTitleTxt |
| Phone | 6088476161 | PhoneNum |
| Signature | 2020-08-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim Hunwardsen CPA | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | PhoneNum |
| Preparation | 2020-08-05 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 216.147.181.47 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-08-06 | IPDt |
| IP Tm | 16:14:14 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 9EB6867304309B5BA7CF1F8994B8B429DCF961D0 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 9EB6867304309B5BA7CF1F8994B8B429DCF961D0 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-09-23 17:36:50Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Website Address | n/a | WebsiteAddressTxt |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Gross Receipts | $191,918 | GrossReceiptsAmt |
| Info In Schedule O Part I | Yes (X) | InfoInScheduleOPartIInd |
| Contributions Gifts Grants Etc | $171,903 | ContributionsGiftsGrantsEtcAmt |
| Program Service Revenue | $4,814 | ProgramServiceRevenueAmt |
| Investment Income | $2,790 | InvestmentIncomeAmt |
| Gaming Gross Income | $6,000 | GamingGrossIncomeAmt |
| Fundraising Gross Income | $6,411 | FundraisingGrossIncomeAmt |
| Special Events Direct Expenses | $18,540 | SpecialEventsDirectExpensesAmt |
| Special Events Net Income Loss | -$6,129 | SpecialEventsNetIncomeLossAmt |
| Total Revenue | $173,378 | TotalRevenueAmt |
| Grants And Similar Amounts Paid | $86,067 | GrantsAndSimilarAmountsPaidAmt |
| Fees And Other Pymt To Ind Cntrct | $100 | FeesAndOtherPymtToIndCntrctAmt |
| Occupancy Rent Utlts And Maint | $9,910 | OccupancyRentUtltsAndMaintAmt |
| Printing Publications Postage | $20 | PrintingPublicationsPostageAmt |
| Other Expenses Total | $46,757 | OtherExpensesTotalAmt |
| Total Expenses | $142,854 | TotalExpensesAmt |
| Excess Or Deficit For Year | $30,524 | ExcessOrDeficitForYearAmt |
| Net Assets Or Fund Balances BOY | $241,142 | NetAssetsOrFundBalancesBOYAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Net Assets Or Fund Balances EOY | $271,666 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part II | Yes (X) | InfoInScheduleOPartIIInd |
Cash Savings And Investments CashSavingsAndInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $236,972 | BOYAmt |
| EOY | $267,103 | EOYAmt |
Other Assets Total Detail OtherAssetsTotalDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,991 | BOYAmt |
| EOY | $19,313 | EOYAmt |
Form990 Total Assets Form990TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $251,963 | BOYAmt |
| EOY | $286,416 | EOYAmt |
Sum Of Total Liabilities SumOfTotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,821 | BOYAmt |
| EOY | $14,750 | EOYAmt |
Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $241,142 | BOYAmt |
| EOY | $271,666 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Primary Exempt Purpose | Mile Bluff Medical Center Foundation provides philanthropic opportunities and support to Mile Bluff Medical Center, assisting in fulfilling its mission, adhering to its core values and pursuing its vision to provide the community with exceptional, personalized healthcare services. | PrimaryExemptPurposeTxt |
Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Srvc Accom | 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. | DescriptionProgramSrvcAccomTxt |
| Grants And Allocations | $86,067 | GrantsAndAllocationsAmt |
| Program Service Expenses | $142,854 | ProgramServiceExpensesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $142,854 | TotalProgramServiceExpensesAmt |
Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (6 entries)
| TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|
| James O'Keefe | ||||
| President/CEO | 0.30 | $0 | $0 | $0 |
| Sandy Linsmeyer | ||||
| Treasurer | 0.30 | $0 | $0 | $0 |
| Christine Carter | ||||
| Secretary | 0.30 | $0 | $0 | $0 |
| Dr Ann Hoffman | ||||
| Director | 0.30 | $0 | $0 | $0 |
| Molly Scully | ||||
| Director | 0.30 | $0 | $0 | $0 |
| Nora Scully | ||||
| Director | 0.30 | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Chg Made To Orgnzng Doc Not Rpt | 0 | ChgMadeToOrgnzngDocNotRptInd |
| Organization Had UBI | 0 | OrganizationHadUBIInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtcInd |
| Direct Indirect Pltcl Expend | $0 | DirectIndirectPltclExpendAmt |
| Made Loans To From Officers | 0 | MadeLoansToFromOfficersInd |
| Tax Imposed Under IRC4911 | $0 | TaxImposedUnderIRC4911Amt |
| Tax Imposed Under IRC4912 | $0 | TaxImposedUnderIRC4912Amt |
| Tax Imposed Under IRC4955 | $0 | TaxImposedUnderIRC4955Amt |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| Tax Imposed On Organization Mgr | $0 | TaxImposedOnOrganizationMgrAmt |
| Tax Reimbursed By Organization | $0 | TaxReimbursedByOrganizationAmt |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | James O'Keefe | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1050 Division Street | AddressLine1Txt |
| City | Mauston | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53948 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6088476161 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Donor Advised Fnds | 0 | DonorAdvisedFndsInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Tanning Services Provided | 0 | TanningServicesProvidedInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| School Operating | 0 | SchoolOperatingInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Part VI Of Comp Of Hghst Pd Empl | NONE | PartVIOfCompOfHghstPdEmplTxt |
| Part VI Hghst Pd Cntrct Prof Srvc | NONE | PartVIHghstPdCntrctProfSrvcTxt |
| Filed Schedule A | Yes (1) | FiledScheduleAInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| IRS Written Determination | Yes (X) | IRSWrittenDeterminationInd |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mile Bluff Medical Center Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390992883 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $76,567 | SupportAmt |
| Other Support | $66,287 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $76,567 | SupportSumAmt |
| Other Support Sum | $66,287 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
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 G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Golf Outing | Event1Nm |
| Gross Receipts Event1 | $32,958 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $26,547 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $6,411 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $700 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $3,829 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $3,710 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $2,701 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $0 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $219 | OtherDirectExpensesEvent1Amt |
| Event2 | Piano Fondue | Event2Nm |
| Gross Receipts Event2 | $8,111 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $8,111 | CharitableContriEvent2Amt |
| Non Cash Prizes Event2 | $150 | NonCashPrizesEvent2Amt |
| Rent Facility Costs Event2 | $200 | RentFacilityCostsEvent2Amt |
| Food And Beverage Event2 | $874 | FoodAndBeverageEvent2Amt |
| Entertainment Event2 | $3,000 | EntertainmentEvent2Amt |
| Other Direct Expenses Event2 | $157 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $41,069 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $34,658 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $6,411 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $700 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $3,979 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $3,910 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $3,575 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $3,000 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $376 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $15,540 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$9,129 | NetIncomeSummaryAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990-EZ, Part I, Line 4 - Other Investment Income | Description: Interest Income. Amount: 2,790. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Operational support. Grantee Name: Mile Bluff Medical Center, Inc.. Grantee Address: 1050 Division Street Mauston, WI 53948-1997. Grantee Relationship: Supported organization. Amount Given: 76,567. |
| Form 990-EZ, Part I, Line 16 - Other Expenses | Description: Supplies. Amount: 17,750. Description: Travel. Amount: 814. Description: Women's Night Out expenses. Amount: 5,010. Description: Dues and subscriptions. Amount: 562. Description: Entertainment/meals. Amount: 41. Description: Promotion/marketing. Amount: 12,090. Description: Nurses Helping Nurses. Amount: 9,936. Description: Men's Night Out expenses. Amount: 554. Total to Form 990-EZ, line 16: 46,757. |
| Part V, Line 35: | The revenue include in Part I, line 2 is from a women and men's health initiative. Line 6a is gaming revenue from a raffle held during a fundraising event. |
| Form 990-EZ, Part II, Line 24 - Other Assets | Description: Pledges receivable. Beg. of Year Amount: 9,428. End of Year Amount: 13,750. Description: Investment - other security. Beg. of Year Amount: 5,563. End of Year Amount: 5,563. |
| Form 990-EZ, Part II, Line 26 - Other Liabilities | Description: Accounts payable. Beg. of Year Amount: 4,120. End of Year Amount: 8,310. Description: Due to Mile Bluff Medical Center. Beg. of Year Amount: 6,701. End of Year Amount: 6,440. |
Transfer Prsnl Bnft Contracts Decl TransferPrsnlBnftContractsDecl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Declaration | The organization did not, during the year, receive any funds, directly,or indirectly, to pay premiums on a personal benefit contract.The organization, did not, during the year, pay any premiums, directly,or indirectly, on a personal benefit contract. | DeclarationDesc |