FAIRMONT COMMUNITY HOSPITAL FOUNDATION: Form 990, tax year 2017
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- Organization
- FAIRMONT COMMUNITY HOSPITAL FOUNDATION (EIN 41-1658658)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-05-14
- IRS object ID
- 201821349349305242
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-05-14T13:18:19-05:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 411736772 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PIERCE ACCOUNTING AND TAX SERVICES | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 51 DOWNTOWN PLZ | AddressLine1Txt |
| City | FAIRMONT | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 560311702 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411658658 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRMONT COMMUNITY HOSPITAL FOUNDAT | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FAIR | BusinessNameControlTxt |
| Phone | 5072355547 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 E BLUE EARTH AVE | AddressLine1Txt |
| City | FAIRMONT | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56031 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JANE KOTEWA | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 5072355547 | PhoneNum |
| Signature | 2018-05-11 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SARA PIERCE | PreparerPersonNm |
| PTIN | P01222000 | PTIN |
| Phone | 5072384304 | PhoneNum |
| Preparation | 2018-05-14 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 167.68.16.49 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-05-14 | IPDt |
| IP Tm | 13:18:19 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | EC3CFB9FF873EC89FAAF1F420748751FA338FCC8 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 34966950C0FA5538C1DF343E326E4FA816957CDC | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JANE KOTEWA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 840 S ORIENT STREET | AddressLine1Txt |
| City | FAIRMONT | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56031 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $277,602 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1989 | FormationYr |
| Activity Or Mission | ENHANCING HEALTH CARE THROUGH CHARITABLE SUPPORT | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 200 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $19,147 | PYContributionsGrantsAmt |
| CY Contributions Grants | $247,244 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $49,139 | PYInvestmentIncomeAmt |
| CY Investment Income | $30,358 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $68,286 | PYTotalRevenueAmt |
| CY Total Revenue | $277,602 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $252,392 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $120,315 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $35,074 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $35,057 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $25,891 | PYOtherExpensesAmt |
| CY Other Expenses | $35,650 | CYOtherExpensesAmt |
| PY Total Expenses | $313,357 | PYTotalExpensesAmt |
| CY Total Expenses | $191,022 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$245,071 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $86,580 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,829,560 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,208,406 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $34,143 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $28,154 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,795,417 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,180,252 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | ENHANCING HEALTH CARE THROUGH CHARITABLE SUPPORT | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Desc | FOUNDATION ENHANCES HEALTH CARE BY PURCHASING EQUIPMENT AND SUPPLIES FOR USE BY FAIRMONT MEDICAL CENTER - MAYO HEALTH SYSTEM. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | FOUNDATION AWARDS SCHOLARSHIPS TO THIRD YEAR NURSING STUDENTS IN AN ACCREDITED NURSING PROGRAM. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | FOUNDATION HAS ABOUT 200 VOLUNTEERS THAT CONTRIBUTE APPROXIMATELY 12,000 HOURS OF TIME TO VARIOUS HEALTH CARE RELATED ACTIVITIES. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $129,906 | ExpenseAmt |
| Grant | $120,315 | GrantAmt |
| Desc | FOUNDATION HAS ABOUT 200 VOLUNTEERS THAT CONTRIBUTE APPROXIMATELY 12,000 HOURS OF TIME TO VARIOUS HEALTH CARE RELATED ACTIVITIES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $129,906 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $120,315 | TotalOtherProgSrvcGrantAmt |
| Total Program Service Expenses | $129,906 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (true) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (true) | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 5 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 200 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | false | ConflictOfInterestPolicyInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KAYLA CAVEN | PersonNm |
| Phone | 5072355547 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 E BLUE EARTH AVENUE | AddressLine1Txt |
| City | FAIRMONT | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56031 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (3 entries)
| TitleTitleTxt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|
| BOB ENGMAN | ||||
| SECRETARY | Yes (X) | $0 | $0 | $0 |
| JANE KOTEWA | ||||
| PRESIDENT | Yes (X) | $0 | $0 | $0 |
| PAUL EDMAN | ||||
| TREASURER | Yes (X) | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| All Other Contributions | $247,244 | AllOtherContributionsAmt |
| Total Contributions | $247,244 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,358 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $30,358 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $277,602 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $30,358 | RelatedOrExemptFuncIncomeAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,315 | TotalAmt |
| Program Services | $105,315 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,000 | TotalAmt |
| Program Services | $15,000 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,057 | TotalAmt |
| Management And General | $35,057 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,163 | TotalAmt |
| Management And General | $16,163 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,845 | TotalAmt |
| Management And General | $4,845 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,361 | TotalAmt |
| Program Services | $3,361 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,167 | TotalAmt |
| Management And General | $3,167 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,884 | TotalAmt |
| Management And General | $1,884 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| ANNUAL MEETING | $2,934 | $2,934 |
| BANK | $1,599 | $1,599 |
| DUES | $1,585 | $1,585 |
| MISC | $112 | $112 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $191,022 | TotalAmt |
| Program Services | $129,906 | ProgramServicesAmt |
| Management And General | $61,116 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,912 | BOYAmt |
| EOY | $2,534 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,798,648 | BOYAmt |
| EOY | $3,205,872 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,829,560 | BOYAmt |
| EOY | $3,208,406 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,143 | BOYAmt |
| EOY | $28,154 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,143 | BOYAmt |
| EOY | $28,154 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $367,353 | BOYAmt |
| EOY | $603,385 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $108,652 | BOYAmt |
| EOY | $113,326 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,319,412 | BOYAmt |
| EOY | $2,463,541 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,795,417 | BOYAmt |
| EOY | $3,180,252 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,829,560 | BOYAmt |
| EOY | $3,208,406 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $86,580 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $298,255 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | false | FSAuditedInd |
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 | $436,200 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $11,166 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $48,658 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $19,147 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $247,244 | CurrentTaxYearAmt |
| Total | $762,415 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $436,200 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $11,166 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $48,658 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $19,147 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $247,244 | CurrentTaxYearAmt |
| Total | $762,415 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $762,415 | PublicSupportTotal170Amt |
| Total Support | $762,415 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $30,358 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 1.00000 | PublicSupportCY170Pct |
| Public Support PY170 | 0.94840 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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 D IRS990ScheduleD
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,090,337 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $97,310 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $3,595 | GrantsOrScholarshipsAmt |
| End Year Balance | $2,184,052 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,697,134 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $397,369 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $4,166 | GrantsOrScholarshipsAmt |
| End Year Balance | $2,090,337 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Financial Derivatives FinancialDerivativesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | $3,205,872 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $3,205,872 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ANNUITY OBLIGATIONS | Desc |
| Amt | $28,154 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $28,154 | TotalLiabilityAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRMONT MEDICAL CENTER-MAYO HEALTH | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 MEDICAL CENTER DRIVE | AddressLine1Txt |
| City | FAIRMONT | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56031 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 410760836 | RecipientEIN |
| IRC Section | 501C3 | IRCSectionDesc |
| Cash Grant | $105,315 | CashGrantAmt |
| Purpose Of Grant | SUPPORT OF MISSION | PurposeOfGrantTxt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash Grant | $15,000 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, PAGE 1, PART I, LINE 2 | FormAndLineReferenceDesc |
| Explanation | SCHEDULE I, PART I, LINE 2: TRANSFERS OR GRANTS TO ORGANIZATIONS WILL BE USED PURSUANT TO THE POLICIES AND PROCEDURES OF THE GRANTEE ORGANIZATIONS AND TO FURTHER THE EXEMPT PURPOSES OF THE GRANTEE ORGANIZATIONS. BOTH THE FILING ORGANIZATION AND THE GRANTEE ORGANIZATION MAINTAIN ADEQUATE BOOKS AND RECORDS OF SUCH TRANSFERS OR GRANTS. CAPITOL CONTRIBUTIONS WILL ALSO BE APPROVED BY THE GOVERNING BODY AND NOTED IN BOARD MINUTES. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4D | FOUNDATION HAS ABOUT 200 VOLUNTEERS THAT CONTRIBUTE APPROXIMATELY 12,000 HOURS OF TIME TO VARIOUS HEALTH CARE RELATED ACTIVITIES. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE TAX RETURN IS PREPARED BY A CPA UNRELATED TO THE ORGANIZATION. THE RETURN IS REVIEWED BY OFFICERS OF THE CORPORATION AND MADE AVAILABLE TO BOARD MEMBERS. HIGHLIGHTS ARE PRESENTED TO THE BOARD AND CONCERNS DOCUMENTED PRIOR TO MAILING. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE FILING ORGINAZATION'S GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE FOUNDATION DOES NOT HAVE A CONFLICT OF INTEREST POLICY TO MAKE AVAILABLE. |