TOMAH HEALTH COMMUNITY FOUNDATION INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- TOMAH HEALTH COMMUNITY FOUNDATION INC (EIN 39-1823757)
- Tax period
- 2016-10-01 to 2017-09-30
- Filed
- 2018-08-07
- IRS object ID
- 201822199349300342
- Schema version
- 2016v3.0
- 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 | 2018-08-07T12:43:09-05:00 | ReturnTs |
| Tax Period End | 2017-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 411765929 | 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 | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391823757 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tomah Memorial Hospital Foundation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | TOMA | BusinessNameControlTxt |
| Phone | 6083722181 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 Butts Avenue | AddressLine1Txt |
| City | Tomah | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54660 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Joseph Zeps | PersonNm |
| Person Title | CFO - Tomah Memorial Hospital | PersonTitleTxt |
| Phone | 6083722181 | PhoneNum |
| Signature | 2018-08-07 | 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 | 9529446166 | PhoneNum |
| Preparation | 2018-08-07 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Peter Reichardt | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 Butts Avenue | AddressLine1Txt |
| City | Tomah | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54660 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $55,627 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.tomahhospital.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1996 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | Support of Tomah Memorial Hospital and surrounding community. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $35,429 | PYContributionsGrantsAmt |
| CY Contributions Grants | $40,255 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $4,524 | PYInvestmentIncomeAmt |
| CY Investment Income | $5,462 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,493 | PYOtherRevenueAmt |
| CY Other Revenue | $1,871 | CYOtherRevenueAmt |
| PY Total Revenue | $42,446 | PYTotalRevenueAmt |
| CY Total Revenue | $47,588 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $14,600 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $287,537 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,050 | PYOtherExpensesAmt |
| CY Other Expenses | $2,363 | CYOtherExpensesAmt |
| PY Total Expenses | $16,650 | PYTotalExpensesAmt |
| CY Total Expenses | $289,900 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $25,796 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$242,312 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $593,215 | TotalAssetsBOYAmt |
| Total Assets EOY | $658,763 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $276,234 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $593,215 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $382,529 | NetAssetsOrFundBalancesEOYAmt |
| Mission | The mission of Tomah Memorial Hospital Foundation is to support the community of Tomah and the healthcare providers that serve its residents. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $287,537 | ExpenseAmt |
| Grant | $287,537 | GrantAmt |
| Desc | Tomah Memorial Hospital Foundation's focus of support continues to center on community-based wellness, facility upgrades, and the development of programs that benefit the local hospital and surrounding communities. During its 2017 fiscal year, the Foundation provided support to various community and healthcare organizations, including area PTO groups, a local food pantry, youth leadership programs, the county health department, and a free healthcare clinic. Additionally, the Foundation granted scholarships to several area students that are pursuing careers in the healthcare field. | Desc |
| Total Program Service Expenses | $287,537 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Joseph Zeps | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6083740307 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 Butts Avenue | AddressLine1Txt |
| City | Tomah | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54660 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| Peter Reichardt | ||||||
| President | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Brian Eirschele | ||||||
| Vice President | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Kate Schanhofer | ||||||
| Secretary | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Deb Welch | ||||||
| Treasurer | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Jeremy Haldeman | ||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Derek Burnstad | ||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Joellyn Edgerton | ||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Chris Pokela | ||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Jenny McCoy | ||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| John McMullen | ||||||
| Director (thru Mar 2017) | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Eric PriseDirector | ||||||
| of Public Relations | 5.00 | Yes (X) | $9,105 | $0 | $409 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $9,105 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $409 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $29,150 | FundraisingAmt |
| All Other Contributions | $11,105 | AllOtherContributionsAmt |
| Total Contributions | $40,255 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,462 | TotalRevenueColumnAmt |
| Exclusion | $5,462 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $9,400 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $29,150 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $8,039 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,361 | TotalRevenueColumnAmt |
| Exclusion | $1,361 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $510 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $510 | TotalRevenueColumnAmt |
| Exclusion | $510 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,588 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $7,333 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $283,037 | TotalAmt |
| Program Services | $283,037 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,500 | TotalAmt |
| Program Services | $4,500 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,700 | TotalAmt |
| Management And General | $1,700 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $535 | TotalAmt |
| Management And General | $535 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $128 | TotalAmt |
| Management And General | $128 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $289,900 | TotalAmt |
| Program Services | $287,537 | ProgramServicesAmt |
| Management And General | $2,363 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $593,215 | BOYAmt |
| EOY | $658,763 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $593,215 | BOYAmt |
| EOY | $658,763 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,234 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $275,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $276,234 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $593,215 | BOYAmt |
| EOY | $382,529 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $593,215 | BOYAmt |
| EOY | $382,529 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $593,215 | BOYAmt |
| EOY | $658,763 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$242,312 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $31,626 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $29,719 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $27,136 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $33,350 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $35,429 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $40,255 | CurrentTaxYearAmt |
| Total | $165,889 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $29,719 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $27,136 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $33,350 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $35,429 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $40,255 | CurrentTaxYearAmt |
| Total | $165,889 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $165,889 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,679 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,359 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,901 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,524 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,462 | CurrentTaxYearAmt |
| Total | $20,925 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $186,814 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $36,942 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.88800 | PublicSupportCY170Pct |
| Public Support PY170 | 0.86690 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Golf outing | Event1Nm |
| Gross Receipts Event1 | $38,550 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $29,150 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $9,400 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $3,773 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $3,600 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $666 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $38,550 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $29,150 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $9,400 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $3,773 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $3,600 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $666 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $8,039 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $1,361 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tomah Memorial Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 Butts Ave | AddressLine1Txt |
| City | Tomah | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54660 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 390799566 | RecipientEIN |
| IRC Section | 501(c)(3) | IRCSectionDesc |
| Cash Grant | $275,000 | CashGrantAmt |
| Purpose Of Grant | Provide support for hospital upgrades | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | The Foundation board discusses and determines the best use of funds for any health related projects within Monroe County. They are committed to providing the healthcare essential to the community and future generations. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule J, Compensation from Unrelated Organization: | FormAndLineReferenceDesc |
| Explanation | Eric Prise, Director of Public Relations, is compensated by Tomah Memorial Hospital, an unrelated organization, for services provided to the Hospital and Foundation. Eric spends approximately 10% of his time on the Foundation. The compensation on Part VII reflects the time spent on the Foundation. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 8b | The Organization does not have committees with authority to act on behalf of the governing body. |
| Form 990, Part VI, Section B, line 11b | The 990 is provided to the board members before it is filed. The CFO of Tomah Memorial Hospital reviews the Form 990. |
| Form 990, Part VI, Section B, line 12c | Officers and board members complete a conflict of interest policy annually. The Board reviews any potential conflicts. If the Board determined a conflict existed, the person involved would abstain from voting on any matter related to the conflict. |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents, conflict of interest policy and financial statements are available to the public upon request. |
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