2018-07-31T16:02:22-05:00 2017-09-30 390758449 Wipfli LLP 4890 Owen Ayres Court Suite 200 Eau Claire WI 54701 990 2016-10-01 391515716 VERNON MEMORIAL HEALTHCARE FOUNDATION INC VERN 6086372101 507 SOUTH MAIN STREET VIROQUA WI 54665 Phyllis Eklov Chairperson 6086372101 2018-07-23 1 HOLLY POKRANDT CPA P00449155 7158323407 2018-07-23 2016 2022-09-23 18:48:47Z PHYLLIS EKLOV 507 SOUTH MAIN STREET VIROQUA WI 54665 462121 0 X www.vmh.org X 1984 WI TO SOLICIT, RECEIVE, AND ACCEPT GIFTS, DEVICES, OR BEQUESTS ON BEHALF OF VERNON MEMORIAL HEALTHCARE AND FOR SCHOLARSHIPS. 13 13 0 13 0 0 310453 411286 0 0 12798 11636 27226 27945 350477 450867 311174 430471 0 0 0 0 0 0 2831 7351 15751 318525 446222 31952 4645 934601 1163279 595301 805778 339300 357501 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 430471 430471 THE VERNON MEMORIAL HEALTHCARE FOUNDATION PROVIDED 5 INDIVIDUALS WHO ARE PURSUING OR FURTHERING THEIR EDUCATION IN THE HEALTH CARE FIELD SCHOLARSHIPS DURING fiscal year 2017. The Foundation also granted Vernon Memorial Healthcare, Inc. $418,560 to be used for various programs and equipment purchases. 430471 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 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 WI X MARY KOENIG 6086372101 507 SOUTH MAIN STREET VIROQUA WI 54665 X bonnie rath Director 1.00 X 0 0 0 aaron cade director 1.00 X 0 0 0 Shawna Stringham director 1.00 X 0 0 0 William Doolan DireCTOR 1.00 X 0 0 0 Linda DeGarmo Director 1.00 X 0 0 0 chris rozeske director 1.00 X 0 0 0 Martha Olson 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 Phyllis Eklov chairperson 1.00 X X 0 0 0 marty snustead vice chairperson 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 0 0 0 0 0 0 0 0 411286 411286 11636 11636 39199 11254 27945 27945 450867 0 0 39581 418560 418560 11911 11911 6950 6950 2000 2000 3970 3970 2831 2831 446222 430471 12920 2831 76658 76802 617497 834786 10014 230432 251691 934601 1163279 6148 595301 799630 595301 805778 X 186069 202000 29215 31485 124016 124016 339300 357501 934601 1163279 4645 13556 0 X X 1 X 0 1 0 X 264758 251066 417302 310453 411286 1654865 264758 251066 417302 310453 411286 1654865 1654865 8297 5439 13058 12798 11636 51228 1706093 0.97000 0.97300 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 124016 8000 8000 124016 124016 6000 6000 124016 124015 5626 5625 124016 124015 8625 8625 124015 124015 6000 6000 124015 1.00000 0 0 0 Donor Imposed ST liability 155805 Donor Imposed LT liability 643825 799630 Part V, Line 4: INVESTMENT INCOME ON ENDOWMENT FUNDS ARE TO BE USED FOR NURSING SCHOLARSHIPS PER DONOR RESTRICTIONS. Golf Outing 17938 17938 380 3092 1164 275 Gala 21261 21261 6343 39199 39199 380 3092 7507 275 11254 27945 1 Vernon Memorial Healthcare Inc 507 South Main Street Viroqua WI 54665 390806404 501(c)(3) 418560 FMV Various programs and equipment 1 Scholarships 5 8000 FMV Part I, Line 2: DONEES ARE REQUIRED TO COMPLETE A FUNDING REQUEST FORM AND SUBMIT THE COMPLETED FORM TO THE FOUNDATION. THE REQUESTS MUST INCLUDE A DETAILED DESCRIPTION OF WHAT THE FUNDS WILL BE USED FOR INCLUDING BUDGET AND ESTIMATED COSTS, REASON FOR THE REQUEST, OTHER FUNDING RESOURCES, AND A TIMEFRAME FOR THE PROJECT. THE FOUNDATION HAS TWO MONTHS TO APPROVE OR DENY THE FUNDING REQUEST. AN ORAL PRESENTATION MAY ALSO BE REQUESTED BEFORE FINAL APPROVAL IS GIVEN. UPON COMPLETION OF THE FUNDED PROJECT OR PURCHASE OF EQUIPMENT, THE DONEE IS REQUIRED TO MAKE EITHER AN ORAL OR WRITTEN REPORT ABOUT HOW THE FUNDS WERE SPENT. 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 12c 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. Annual conflict of interest statements are signed by all board members. 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. Form 990, Part VI, Line 13 Vernon Memorial Healthcare Foundation, Inc. relies on and follows the policies of Vernon Memorial Healthcare, Inc. Form 990, Part VI, Line 14 Vernon Memorial Healthcare Foundation, Inc. relies on and follows the policies of Vernon Memorial Healthcare, Inc. VERNON MEMORIAL HEALTHCARE INC 507 SOUTH MAIN STREET VIROQUA WI 54655 390806404 Hospital WI 501(c)(3) Line 3 N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0