2019-11-13T14:22:07-06:00 2018-12-31 420714325 RSM US LLP 801 NICOLLET MALL WEST TOWER STE 1100 MINNEAPOLIS MN 554022526 990 2018-01-01 471693199 FARIBAULT AREA HOSPICE FOUNDATION FARI 5073324731 200 STATE AVENUE FARIBAULT MN 55021 KEN BETSINGER CHAIR 5073324731 2019-11-11 1 KACIE MCEWEN P01599614 6123324300 66.98.98.3 2019-11-11 13:57:13 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 B56786F7D21A8F39D00ED83C272556B8DDCB8C36 2018 2020-03-31 21:24:44Z KEN BETSINGER 200 STATE AVENUE FARIBAULT MN 55021 27120 0 X FARIBAULTAREAHOSPICEFOUNDATION.ORG X 2014 MN TO IMPROVE THE QUALITY OF LIFE FOR PATIENTS AND THEIR LOVED ONES IN THE DISTRICT ONE HOSPITAL AREA. 11 11 0 30 0 0 22042 25212 0 0 717 1908 0 0 22759 27120 102122 197998 0 0 0 0 0 0 0 3563 7526 105685 205524 -82926 -178404 1245780 1067376 0 0 1245780 1067376 X FARIBAULT AREA HOSPICE FOUNDATION IS ORGANIZED AND OPERATED IN ACCORDANCE WITH IRC 501(C)(3) TO RAISE FUNDS FROM THE PUBLIC THAT ARE USED TO ENHANCE THE SCOPE AND QUALITY AND OTHERWISE SUPPORT THE MISSION OF FARIBAULT AREA HOSPICE, WHICH IS TO IMPROVE THE QUALITY OF LIFE THROUGH COMFORT, CARE, SUPPORT AND COMPASSION FOR PATIENS AND THEIR LOVED ONES IN THE DISTRICT ONE HOSPTAIL SERVICE AREA. 0 0 164300 159124 0 THE FOUNDATION PROVIDES SUPPORT FOR INDIVIDUAL HOSPICE PATIENTS AND THEIR LOVED ONES TO IMPROVE THE QUALITY OF LIFE THROUGH COMFORT CARE, SUPPORT AND COMPASSION. THE FOUNDATION PROVIDED FINANCIAL ASSISTANCE TO HOSPICE PATIENTS AND THEIR FAMILIES TO ASSIST WITH EXPENSES, SUCH AS PAYMENT OF UTILITY BILLS, GIFT CARDS FOR GROCERIES AND OTHER HOUSEHOLD EXPENSES, ETC. 38874 38874 0 THE FOUNDATION ALSO MAKES DISTRIBUTIONS TO ORGANIZATIONS THAT QUALIFY AS PUBLIC CHARITIES TO SUPPORT THE EXEMPT PURPOSE OF PROVIDING FINANCIAL SUPPORT FOR ENHANCING THE SCOPE AND QUALITY AND OTHERWISE SUPPORTING THE MISSION OF THE FARIBAULT AREA HOSPICE FOUNDATION, WHICH IS TO IMPROVE THE QUALITY OF LIFE THROUGH COMFORT CARE, SUPPORT AND COMPASSION FOR PATIENTS AND THEIR LOVED ONES IN THE DISTRICT ONE HOSPICE SERVICE AREA. 203174 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 1 1 0 0 0 0 0 MN X RICK MILLER DISTRICT ONE HOSPITAL 5073324731 200 STATE AVENUE FARIBAULT MN 55021 X RICK MILLER CHIEF EXECUTIVE DIRECTOR 1.00 X X 0 0 0 KEN BETSINGER CHAIR 0.60 X X 0 0 0 PATTY VOEGELE VICE CHAIR 0.60 X X 0 0 0 GARY VOEGELE TREASURER 0.60 X X 0 0 0 KEN KANGAS DIRECTOR 0.60 X 0 0 0 KRIS DREVLOW DIRECTOR 0.60 X 0 0 0 AUDREY TEBO DIRECTOR 0.60 X 0 0 0 NORMA SHULTZ DIRECTOR 0.60 X 0 0 0 CALISTA VOS DIRECTOR 0.60 X 0 0 0 SARAH EDWARDS DIRECTOR 0.60 X 0 0 0 CRAIG BRIEMHORST DIRECTOR 0.60 X 0 0 0 0 0 0 0 0 0 0 0 25212 25212 1908 1908 27120 0 0 1908 38874 38874 159124 159124 1575 1575 1084 1084 1083 1083 750 750 OTHER BUSINESS EXPENSE 3009 3009 TAXES & LICENSES 25 25 205524 203174 2350 0 1245780 327093 740283 1245780 1067376 0 0 X 1245780 1067376 1245780 1067376 1245780 1067376 -178404 0 X 0 0 0 X 36047 24966 22042 25212 108267 36047 24966 22042 25212 108267 7799 100468 2 715 718 717 1908 4060 112327 X SCHEDULE A, PART VI, LIST OF UNUSUAL GRANTS: DESCRIPTION: AMOUNT: 0. DESCRIPTION: AMOUNT: 0. 1 ALLINA HEALTH SYSTEM OWATANA HOSPITAL FOUNDATION PO BOX 43 MINNEAPOLIS MN 55440 363261413 501(C)(3) 38334 OWATONNA HOPSITAL FOUNDATION - PROGRAM SUPPORT FOR HONORING CHOICES MINNESOTA OF FARIBAULT - OWATONNA - PROVIDING ADVANCED CARE DIRECTIVES, INCLUDING A CONVERSATION ABOUT HOSPICE CARE & SERVICES. 1 0 HOSPICE SUPPORT 62 159124 PART I, LINE 2: FARIBAULT AREA HOSPICE FOUNDATION PROVIDES SUPPORT FOR INDIVIDUAL HOSPICE PATIENTS AND THIER LOVED ONES. FINANCIAL ASSISTANCE IS PROVIDED TO HOSPICE PATIENTS TO ASSIST WITH EXPENSES (HOSPICE SUPPORT, THERAPY, TRANSPORTATION, ETC.) PAYMENTS ARE MADE DIRECTLY TO THE SERVICE PROVIDER AND NOT THE INDIVIDUAL PATIENT. INDIVIDUALS IN NEED OF ASSISTANCE MUST SUBMIT THE COMPLETED APPLICATION; WHICH IS THEN REVIEWED AND APPROVED OR DENIED BY A COMMITTEE, BASED UPON THE REQUESTS. FORM 990, PART I, LINE 6 TOTAL NUMBER OF VOLUNTEERS: NUMEROUS VOLUNTEERS ENGAGED AS MEMBERS OF THE BOARD OF DIRECTORS. IN ADDITION, THERE ARE A NUMBER OF VOLUNTEERS THAT ORGANIZE AND STAFF AN ANNUAL FUNDRAISER (LIGHT OF LIFE), A HOLIDAY TREE LIGHTING THAT OCCURS EACH DECEMBER. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY RICK MILLER OF DISTRICT ONE HOSPITAL ON BEHALF OF THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO SIGN THE CONFLICT OF INTEREST ACKNOWLEDGEMENT/QUESTIONNAIRE ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 OFFICERS AND DIRECTORS OF THE FOUNDATION DO NOT RECEIVE COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D).