FURP.ORG / PUBLIC DATA EXPLORER

MILE BLUFF MEDICAL CENTER FOUNDATION INC: Form 990EZ, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
MILE BLUFF MEDICAL CENTER FOUNDATION INC (EIN 27-1865510)
Tax period
2017-10-01 to 2018-09-30
Filed
2019-08-15
IRS object ID
201922279349200127
Schema version
2017v2.3
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

FieldValueIRS element (for citing)
Return2019-08-15T10:16:08-05:00ReturnTs
Tax Period End2018-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN450250958PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Eide Bailly LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1800 Nicollet Mall Ste 1300AddressLine1Txt
CityMinneapolisCityNm
State AbbreviationMNStateAbbreviationCd
ZIP554027033ZIPCd
FieldValueIRS element (for citing)
Return Type990EZReturnTypeCd
Tax Period Begin2017-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN271865510EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Mile Bluff Medical Center FoundationBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMILEBusinessNameControlTxt
Phone6088476161PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11050 Division StreetAddressLine1Txt
CityMaustonCityNm
State AbbreviationWIStateAbbreviationCd
ZIP53948ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJames O'KeefePersonNm
Person TitlePresident/CEOPersonTitleTxt
Phone6088476161PhoneNum
Signature2019-08-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKim Hunwardsen CPAPreparerPersonNm
PTINP00484560PTIN
Phone6122536500PhoneNum
Preparation2019-08-13PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address216.147.181.47IPv4AddressTxt
FieldValueIRS element (for citing)
IP2019-08-13IPDt
IP Tm09:04:46IPTm
IP TimezoneCDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id330E77A2EC15986A2DC713C7FDB26B906589BB96AtSubmissionCreationDeviceId
At Submission Filing Device Id330E77A2EC15986A2DC713C7FDB26B906589BB96AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990-EZ IRS990EZ

FieldValueIRS element (for citing)
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Website Addressn/aWebsiteAddressTxt
Organization501c3Yes (X)Organization501c3Ind
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Gross Receipts$144,792GrossReceiptsAmt
Info In Schedule O Part IYes (X)InfoInScheduleOPartIInd
Contributions Gifts Grants Etc$127,726ContributionsGiftsGrantsEtcAmt
Program Service Revenue$5,537ProgramServiceRevenueAmt
Investment Income$1,686InvestmentIncomeAmt
Fundraising Gross Income$9,843FundraisingGrossIncomeAmt
Special Events Direct Expenses$10,039SpecialEventsDirectExpensesAmt
Special Events Net Income Loss-$196SpecialEventsNetIncomeLossAmt
Total Revenue$134,753TotalRevenueAmt
Grants And Similar Amounts Paid$65,242GrantsAndSimilarAmountsPaidAmt
Occupancy Rent Utlts And Maint$1,034OccupancyRentUtltsAndMaintAmt
Printing Publications Postage$379PrintingPublicationsPostageAmt
Other Expenses Total$36,241OtherExpensesTotalAmt
Total Expenses$102,896TotalExpensesAmt
Excess Or Deficit For Year$31,857ExcessOrDeficitForYearAmt
Net Assets Or Fund Balances BOY$209,285NetAssetsOrFundBalancesBOYAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Net Assets Or Fund Balances EOY$241,142NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIYes (X)InfoInScheduleOPartIIInd

Cash Savings And Investments CashSavingsAndInvestmentsGrp

FieldValueIRS element (for citing)
BOY$206,416BOYAmt
EOY$236,972EOYAmt

Other Assets Total Detail OtherAssetsTotalDetail

FieldValueIRS element (for citing)
BOY$14,980BOYAmt
EOY$14,991EOYAmt

Form990 Total Assets Form990TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$221,396BOYAmt
EOY$251,963EOYAmt

Sum Of Total Liabilities SumOfTotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$12,111BOYAmt
EOY$10,821EOYAmt

Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp

FieldValueIRS element (for citing)
BOY$209,285BOYAmt
EOY$241,142EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
Primary Exempt PurposeMile 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

FieldValueIRS element (for citing)
Description Program Srvc AccomMile 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$65,242GrantsAndAllocationsAmt
Program Service Expenses$102,896ProgramServiceExpensesAmt
FieldValueIRS element (for citing)
Total Program Service Expenses$102,896TotalProgramServiceExpensesAmt
Info In Schedule O Part IVYes (X)InfoInScheduleOPartIVInd

Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (12 entries)

TitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
James O'Keefe
President/CEO0.25$0$0$0
Sandy Linsmeyer
Treasurer0.25$0$0$0
Christine Carter
Secretary0.25$0$0$0
Dr Daniel Kattenbraker
Director0.25$0$0$0
Dr Ann Hoffman
Director0.25$0$0$0
Edward Miller
Director0.25$0$0$0
Larry Willer
Director0.25$0$0$0
Dr Kevin Butterfield
Director0.25$0$0$0
Dr Cassondra Kovach
Director0.25$0$0$0
Randy Scott
Director0.25$0$0$0
Dennis Loging
Director0.25$0$0$0
Dr Leon Radant
Director (Oct-Dec)0.25$0$0$0
FieldValueIRS element (for citing)
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
Activities Not Previously Rpt0ActivitiesNotPreviouslyRptInd
Chg Made To Orgnzng Doc Not Rpt0ChgMadeToOrgnzngDocNotRptInd
Organization Had UBI0OrganizationHadUBIInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Organization Dissolved Etc0OrganizationDissolvedEtcInd
Direct Indirect Pltcl Expend$0DirectIndirectPltclExpendAmt
Made Loans To From Officers0MadeLoansToFromOfficersInd
Tax Imposed Under IRC4911$0TaxImposedUnderIRC4911Amt
Tax Imposed Under IRC4912$0TaxImposedUnderIRC4912Amt
Tax Imposed Under IRC4955$0TaxImposedUnderIRC4955Amt
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
Tax Imposed On Organization Mgr$0TaxImposedOnOrganizationMgrAmt
Tax Reimbursed By Organization$0TaxReimbursedByOrganizationAmt
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1James O'KeefeBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11050 Division StreetAddressLine1Txt
CityMaustonCityNm
State AbbreviationWIStateAbbreviationCd
ZIP53948ZIPCd
FieldValueIRS element (for citing)
Phone6088476161PhoneNum
FieldValueIRS element (for citing)
Foreign Financial Account0ForeignFinancialAccountInd
Foreign Office0ForeignOfficeInd
Donor Advised Fnds0DonorAdvisedFndsInd
Operate Hospital0OperateHospitalInd
Tanning Services Provided0TanningServicesProvidedInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
School Operating0SchoolOperatingInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Part VI Of Comp Of Hghst Pd EmplNONEPartVIOfCompOfHghstPdEmplTxt
Part VI Hghst Pd Cntrct Prof SrvcNONEPartVIHghstPdCntrctProfSrvcTxt
Filed Schedule AYes (1)FiledScheduleAInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
IRS Written DeterminationYes (X)IRSWrittenDeterminationInd
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1Mile Bluff Medical Center IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN390992883EIN
Organization Type3OrganizationTypeCd
Governing Document ListedYes (1)GoverningDocumentListedInd
Support$58,492SupportAmt
Other Support$37,654OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$58,492SupportSumAmt
Other Support Sum$37,654OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (1)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt Org0OperateBenefitNonSuprtOrgInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1Golf OutingEvent1Nm
Gross Receipts Event1$33,643GrossReceiptsEvent1Amt
Charitable Contri Event1$23,800CharitableContriEvent1Amt
Gross Revenue Event1$9,843GrossRevenueEvent1Amt
Cash Prizes Event1$700CashPrizesEvent1Amt
Non Cash Prizes Event1$2,122NonCashPrizesEvent1Amt
Food And Beverage Event1$5,867FoodAndBeverageEvent1Amt
Other Direct Expenses Event1$1,350OtherDirectExpensesEvent1Amt
Gross Receipts Total$33,643GrossReceiptsTotalAmt
Charitable Contributions Tot$23,800CharitableContributionsTotAmt
Gross Revenue Total Events$9,843GrossRevenueTotalEventsAmt
Cash Prizes Total Events$700CashPrizesTotalEventsAmt
Non Cash Prizes Total Events$2,122NonCashPrizesTotalEventsAmt
Food And Beverage Total Events$5,867FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events$1,350OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$10,039DirectExpenseSummaryEventsAmt
Net Income Summary-$196NetIncomeSummaryAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990-EZ, Part I, Line 4 - Other Investment IncomeDescription: Interest Income. Amount: 1,686.
Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts PaidActivity 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: 58,492.
Form 990-EZ, Part I, Line 16 - Other ExpensesDescription: Supplies. Amount: 4,938. Description: Travel. Amount: 728. Description: Women's Night Out expenses. Amount: 1,881. Description: Dues and subscriptions. Amount: 445. Description: Entertainment/meals. Amount: 902. Description: Marketing. Amount: 17,343. Description: Nurses Helping Nurses. Amount: 10,004. Total to Form 990-EZ, line 16: 36,241.
Form 990-EZ, Part II, Line 24 - Other AssetsDescription: Pledges receivable. Beg. of Year Amount: 9,421. End of Year Amount: 9,428. Description: Investment - other security. Beg. of Year Amount: 5,559. End of Year Amount: 5,563.
Form 990-EZ, Part II, Line 26 - Other LiabilitiesDescription: Accounts payable. Beg. of Year Amount: 3,500. End of Year Amount: 4,120. Description: Due to Mile Bluff Medical Center. Beg. of Year Amount: 8,611. End of Year Amount: 6,701.

Transfer Prsnl Bnft Contracts Decl TransferPrsnlBnftContractsDecl

FieldValueIRS element (for citing)
DeclarationThe 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