2017-05-10T11:49:34-05:00 2016-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2015-07-01 810496987 Sheridan Health Care Foundation Inc SHER 4067653700 440 W Laurel Avenue Plentywood MT 59254 Paul Hansen Chairperson 4067653700 2017-05-10 1 Kim Hunwardsen CPA P00484560 6122536500 2017-05-10 2015 2021-01-29 14:40:06Z Greg Maurer 440 W Laurel Avenue Plentywood MT 59254 175767 0 X www.sheridanmemorial.net/foundation X 1994 MT To support Sheridan Memorial Health Care Facility. 9 9 0 14 0 0 100901 112907 0 0 27802 23062 30218 28705 158921 164674 206415 32417 0 0 0 0 0 0 0 0 0 206415 32417 -47494 132257 1188629 1301033 0 0 1188629 1301033 X To support Sheridan Memorial by promoting its image in the community and by providing financial contributions through fundraising activities for the expansion and maintenance of the facility and for services provided to our community and surrounding areas. 0 0 32417 32417 Contributions were made to Sheridan Memorial Hospital Association, a 501(c)(3) organization, to help fund medical activities. Sheridan Health Care Foundation contributed $32,417.39 in fiscal year 2016 to Sheridan Memorial Hospital Association to help purchase items for several ancillary services, departments and support staff.Sheridan Health Care Foundation supported Sheridan Memorial's Electronic Medical Record installation by lending the facility $575,000. This loan in conjunction with other loans of Association monies made it possible for our Clinic, CAH and Nursing Home to become compliant with EMR requirements. The balance of the loan to the hospital at June 30, 2016 was $170,973.12.Sheridan Health Care Foundation held a fundraising event for Sheridan Memorial Nursing Home as the facility prepared to make extensive renovations and updates. Approximately $27,000.00 was raised through the event and promotion. The Nursing Home restricted funds raised from the fundraising event held November 28, 2015 have and will be used as needed. 32417 1 1 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 0 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 0 0 X 9 9 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X Connie Anderson 4067653709 440 W Laurel Avenue Plentywood MT 59254 X Paul Hansen Chairperson 0.50 0.00 X X 0 0 0 Bill McCoy Vice Chairperson 0.50 1.00 X X 0 0 0 Kim Ferguson Secretary 0.50 0.00 X X 0 0 0 Josh Jensen Treasurer 0.50 0.00 X X 0 0 0 Tina Wivholm Director 0.50 0.00 X 0 0 0 Nikki Sampsen Director 0.50 0.00 X 0 0 0 Taylor Fjeldheim Director 0.50 0.00 X 0 0 0 Joan Tommerup Director 0.50 0.00 X 0 0 0 Beatie Petersen Director 0.50 0.00 X 0 0 0 Greg Mauer President/CEO 0.10 40.00 X 0 0 0 0 0 0 0 0 0 0 0 6800 106107 112907 23062 23062 29883 6800 6593 23290 23290 9915 4500 5415 5415 164674 0 0 51767 32417 32417 32417 32417 0 0 333034 624377 545792 503771 308403 170973 1400 1912 1188629 1301033 0 0 X 843914 902693 230799 284356 113916 113984 1188629 1301033 1188629 1301033 132257 -19853 0 X 0 1 X 0 0 X 173655 325602 76076 100901 112907 789141 173655 325602 76076 100901 112907 789141 2813 786328 1074 15075 29280 27802 23062 96293 885434 116566 0.88810 0.85950 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 113916 68 145 145 113984 113916 64 64 113916 113916 72 72 113916 37530 76386 27 27 113916 27195 10335 37530 1.00000 0 0 0 Notes Receivable-Sheridan Memorial Hospital Association 170973 C 170973 X 164674 0 164674 0 164674 32417 0 32417 0 32417 Part V, Line 4: Gifts given to the Endowment Fund at Sheridan Health Care Foundation are invested and carefully managed to protect the principal; they are intended to be a part of the permanent investment reserve which will remain for perpetuity. Interest from endowments will go towards Sheridan Health Care Foundation's unrestricted fund to allow for additional revenue to ensure the future of the Foundation and Sheridan Memorial Hospital Association unless otherwise stipulated by the donor. Part X, Line 2: The Foundation is organized as a Montana nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from Federal income taxes under Internal Revenue Code Section 501(c)(3). The Foundation is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Foundation is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Foundation has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990-T) with the IRS. The Foundation believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Foundation would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense, if such interest and penalties are incurred. Christmas Kickoff 18540 2000 16540 379 759 Golf Tournament 18143 4800 13343 1300 2400 1366 389 36683 6800 29883 1300 2400 1745 1148 6593 23290 1 Sheridan Memorial Hospital Association 440 W Laurel Ave Plentywood MT 59254 810243720 501(c)(3) 32417 General Support 1 0 Part I, Line 2: Sheridan Health Care Foundation, Inc. was established exclusively for the benefit of Sheridan Memorial Hospital Association. The Foundation's Board of Directors includes one member of the Hospital Board and the CEO of the Hospital is the Foundation President. These relationships help to ensure and monitor the appropriate use of funds distributed from the Foundation to the Hospital. Form 990, Part VI, Section A, line 1 Sheridan Health Care Foundation's Executive Committee consists of all 9 Board Members plus the Foundation's former Chair. This committee is not active; however is defined if the need arises. Form 990, Part VI, Section A, line 2 Paul Hansen and Kim Ferguson - Business Relationship Bill McCoy and Joan Tommerup - Business Relationship Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing board. There is an Executive Committee defined in the bylaws, but they have never met. The Investment/Finance Committee meets on occasion, but only to gather suggestions to present at the next Board Meeting to put to a vote. Form 990, Part VI, Section B, line 11 The board reviews an electronic copy of the Form 990 before the final copy is filed with the IRS. Form 990, Part VI, Section B, line 12c Annually the Foundation Board of Directors sign a conflict of interest policy. Any potential conflicts are made known to the entire board and board members with a conflict must abstain from voting on the conflicted issue. Form 990, Part VI, Section B, line 15 Sheridan Health Care Foundation, Inc. does not compensate the Foundation Executive Director. The director wages are paid from Sheridan Memorial Hospital Association. Sheridan Health Care Foundation does not compensate any other management or officers. Form 990, Part VI, Section C, line 19 Governing documents and the conflict of interest policy related to the Sheridan Health Care Foundation are available upon request. Sheridan Memorial Hospital Association 440 W Laurel Ave Plentywood MT 59254 810243720 Hospital MT 501(c)(3) Line 3 N/A 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0