FRIENDS OF FMC FOUNDATION: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- FRIENDS OF FMC FOUNDATION (EIN 43-1975486)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-02-09
- IRS object ID
- 201720409349300617
- Schema version
- 2015v3.0
- 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 | 2017-02-09T09:59:16-06:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250985 | 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 | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 431975486 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Friends of FMC Foundation Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FRIE | BusinessNameControlTxt |
| Phone | 4067783331 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 820 | AddressLine1Txt |
| City | Baker | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59313 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | David Stevens | PersonNm |
| Person Title | President of Board | PersonTitleTxt |
| Phone | 4067783331 | PhoneNum |
| Signature | 2017-02-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim C Hunwardsen | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | PhoneNum |
| Preparation | 2017-02-01 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | David Stevens | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 820 | AddressLine1Txt |
| City | Baker | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59313 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $115,075 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.fallonmedical.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2002 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | To coordinate Fallon Medical Complex, Inc's fundraising programs. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 95 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $67,914 | PYContributionsGrantsAmt |
| CY Contributions Grants | $57,795 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $28,486 | PYInvestmentIncomeAmt |
| CY Investment Income | $30,029 | CYInvestmentIncomeAmt |
| PY Other Revenue | $27,228 | PYOtherRevenueAmt |
| CY Other Revenue | $19,111 | CYOtherRevenueAmt |
| PY Total Revenue | $123,628 | PYTotalRevenueAmt |
| CY Total Revenue | $106,935 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $15,439 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $27,498 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $33,384 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $17,058 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $11,532 | PYOtherExpensesAmt |
| CY Other Expenses | $11,544 | CYOtherExpensesAmt |
| PY Total Expenses | $54,469 | PYTotalExpensesAmt |
| CY Total Expenses | $45,928 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $69,159 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $61,007 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,107,359 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,174,036 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,107,359 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,174,036 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Friends of FMC Foundation's mission is to help ensure the continuing quality of local healthcare services in the Fallon Medical Complex service area by raising funds for the purpose of enhancing the quality and dignity of life of all persons employed and served by Fallon Medical Complex. "Friends Helping Friends." | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $1,669 | ExpenseAmt |
| Desc | The purpose of Friends of Fallon Medical Complex Foundation is to provide, through all of its funds and activities, direct or indirect benefit to Fallon Medical Complex (FMC), a not-for-profit healthcare corporation, in support of its mission, so long as FMC qualifies as an organization described in Section 501(c)(3) of the Internal Revenue Code. The Foundation obtains and receives contributions, donations, gifts, or bequests entirely for the development of one or more endowment funds, to be used for financial assistance to FMC for medical education, equipment upgrades and purchases, physical plant improvements and additions, personnel programs, and any aspect of promotion and public relations devoted to the delivery of health care services in FMC's service area. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,000 | ExpenseAmt |
| Grant | $1,000 | GrantAmt |
| Desc | The Friends of Fallon Medical Complex Foundation distributes funds from its capital pool for the purpose of funding scholarships to students from our service area who are pursuing a formal education in a healthcare-related field. The scholarship process is governed by established formal program criteria that define how requests are to be submitted by applicants and how they are to be evaluated by the Board of Directors. During the past fiscal year, the Board awarded one scholarship (worth $1,000) to a student which was distributed during the year to the scholar's college of choice. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $2,669 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | 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 | Yes (1) | 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 | Yes (1) | 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 | 1 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| 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 | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Marjorie Losing | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4067785103 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 820 | AddressLine1Txt |
| City | Baker | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59313 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| David Stevens | |||||||
| President | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Rosanne Varner | |||||||
| Vice President | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Cori Thurlow | |||||||
| Secretary/Treasurer (as of Jan 2016) | 0.50 | 40.00 | Yes (X) | Yes (X) | $0 | $37,742 | $358 |
| Susan Stevens | |||||||
| Secretary/Treasurer | 0.50 | 40.00 | Yes (X) | Yes (X) | $0 | $68,139 | $11,040 |
| Darcy Pankratz | |||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Doug Varner | |||||||
| Director | 0.50 | 0.50 | Yes (X) | $0 | $0 | $0 | |
| Mike Griffith | |||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Craig Pinnow | |||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Karol Zachmann | |||||||
| Foundation Director | 19.00 | 21.00 | Yes (X) | $0 | $43,749 | $14,089 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $149,630 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $25,487 | 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 | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $18,771 | FundraisingAmt |
| All Other Contributions | $39,024 | AllOtherContributionsAmt |
| Total Contributions | $57,795 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,721 | TotalRevenueColumnAmt |
| Exclusion | $26,721 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,308 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,308 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,308 | TotalRevenueColumnAmt |
| Exclusion | $3,308 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $27,251 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $18,771 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $8,140 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,111 | TotalRevenueColumnAmt |
| Exclusion | $19,111 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $106,935 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $49,140 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,000 | TotalAmt |
| Program Services | $1,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,384 | TotalAmt |
| Program Services | $1,669 | ProgramServicesAmt |
| Management And General | $15,023 | ManagementAndGeneralAmt |
| Fundraising | $16,692 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,720 | TotalAmt |
| Management And General | $2,720 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,753 | TotalAmt |
| Management And General | $7,753 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $705 | TotalAmt |
| Management And General | $705 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Misc. Fundraising Expen | Desc |
| Total | $366 | TotalAmt |
| Fundraising | $366 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,928 | TotalAmt |
| Program Services | $2,669 | ProgramServicesAmt |
| Management And General | $26,201 | ManagementAndGeneralAmt |
| Fundraising | $17,058 | FundraisingAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,107,359 | BOYAmt |
| EOY | $1,174,036 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,107,359 | BOYAmt |
| EOY | $1,174,036 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $816,051 | BOYAmt |
| EOY | $844,638 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $118,259 | BOYAmt |
| EOY | $146,349 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $173,049 | BOYAmt |
| EOY | $183,049 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,107,359 | BOYAmt |
| EOY | $1,174,036 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,107,359 | BOYAmt |
| EOY | $1,174,036 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $61,007 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $5,670 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| 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 | $91,006 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $341,667 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $150,710 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $67,914 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $57,795 | CurrentTaxYearAmt |
| Total | $709,092 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $91,006 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $341,667 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $150,710 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $67,914 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $57,795 | CurrentTaxYearAmt |
| Total | $709,092 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $381,665 | SubstantialContributorsTotAmt |
| Public Support Total170 | $327,427 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $11,770 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $14,605 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $23,447 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $21,829 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $26,721 | CurrentTaxYearAmt |
| Total | $98,372 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $807,464 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $126,395 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.40550 | PublicSupportCY170Pct |
| Public Support PY170 | 0.35420 | 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 Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $230,502 | BeginningYearBalanceAmt |
| Contributions | $10,000 | ContributionsAmt |
| Investment Earnings Or Losses | $2,532 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $243,034 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $208,676 | BeginningYearBalanceAmt |
| Contributions | $21,794 | ContributionsAmt |
| Investment Earnings Or Losses | $1,032 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $1,000 | GrantsOrScholarshipsAmt |
| End Year Balance | $230,502 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $190,592 | BeginningYearBalanceAmt |
| Contributions | $20,000 | ContributionsAmt |
| Investment Earnings Or Losses | $1,084 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $3,000 | GrantsOrScholarshipsAmt |
| End Year Balance | $208,676 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $172,588 | BeginningYearBalanceAmt |
| Contributions | $21,012 | ContributionsAmt |
| Investment Earnings Or Losses | $992 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $4,000 | GrantsOrScholarshipsAmt |
| End Year Balance | $190,592 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $150,010 | BeginningYearBalanceAmt |
| Contributions | $22,230 | ContributionsAmt |
| Investment Earnings Or Losses | $1,348 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $1,000 | AdministrativeExpensesAmt |
| End Year Balance | $172,588 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.17300 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.75320 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.07380 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $70,286 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $70,286 | RevenueSubtotalAmt |
| Other Revenues Not Included | $36,649 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $36,649 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $106,935 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $54,068 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $8,140 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $8,140 | ExpensesNotReportedAmt |
| Expenses Subtotal | $45,928 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $45,928 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | Permanently restricted funds are used to provide a source of income to be used for Long Term Care, and/or equipment purchases on behalf of Fallon Medical Complex, and for scholarships. Principal has been invested and the generated income (temporarily restricted) is used for said purpose. |
| Part X, Line 2: | The Foundation is organized as a nonprofit organization and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code. The Foundation is also exempt from state income taxes. 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 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 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. |
| Part XI, Line 4b - Other Adjustments: | Fundraising Expenses in Revenue for Tax Purposes -8,140. Contributions Reported in Fund Balance for Financial Statements 43,848. Investment Income Reported in Fund Balance for Financial Statements 941. |
| Part XII, Line 2d - Other Adjustments: | Fundraising Expenses in Revenue for Tax Purposes 8,140. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Mammo Whammo | Event1Nm |
| Gross Receipts Event1 | $13,539 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $7,637 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $5,902 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $920 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $235 | NonCashPrizesEvent1Amt |
| Other Direct Expenses Event1 | $243 | OtherDirectExpensesEvent1Amt |
| Event2 | Breast CA Luncheon | Event2Nm |
| Gross Receipts Event2 | $11,931 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $6,747 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $5,184 | GrossRevenueEvent2Amt |
| Cash Prizes Event2 | $250 | CashPrizesEvent2Amt |
| Other Events Total | 5 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $20,552 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $4,387 | CharitableContriOtherEventsAmt |
| Gross Revenue Other Events | $16,165 | GrossRevenueOtherEventsAmt |
| Non Cash Prizes Other Events | $1,348 | NonCashPrizesOtherEventsAmt |
| Food And Beverage Other Events | $2,201 | FoodAndBeverageOtherEventsAmt |
| Oth Direct Expnss Other Events | $2,943 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $46,022 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $18,771 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $27,251 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $1,170 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $1,583 | NonCashPrizesTotalEventsAmt |
| Food And Beverage Total Events | $2,201 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $3,186 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $8,140 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $19,111 | NetIncomeSummaryAmt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Karol Zachmann | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Family Member of Board Members Susan Stevens and David Stevens | RelationshipDescriptionTxt |
| Transaction | $33,384 | TransactionAmt |
| Transaction | Wages | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 2 | Karol Zachmann, Susan Stevens, and David Stevens have family relationships. Doug Varner and Rosanne Varner have a family relationship. Doug Varner and Karol Zachmann have a business relationship. |
| Form 990, Part VI, Section A, line 8b | The organization does not have a committee that acts on behalf of the governing body. |
| Form 990, Part VI, Section B, line 11 | Information for the Form 990 is compiled by the executive staff. The corporation's accountants prepare the form which is emailed or mailed to the Board of Directors for the review and comment during one of their regular meetings prior to filing with the IRS. |
| Form 990, Part VI, Section B, line 12c | The Organization's conflict of interest policy requires a duty to disclose any conflicts annually as well as during discussions. The policy covers all members of the board. Board Members complete a questionnaire annually addressing potential areas of conflicts. Conflicts are determined by each individual. If a conflict arises, the board member abstains from voting on matters that gave rise to the conflict. |
| Form 990, Part VI, Section B, line 15 | The Foundation Director is the only paid employee of the Organization. Wages are paid by Fallon Medical Complex, a related organization. Fallon Medical Complex uses the Montana Hospital Association (MHA) annual compensation data to help determine compensation for employees including the Foundation director. |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents, conflict of interest policy and financial statements are available for public inspection at the corporation's place of business upon request. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fallon Medical Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 202 S 4th St W | AddressLine1Txt |
| City | Baker | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59313 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363808993 | EIN |
| Primary Activities | Critical Access Hospital | PrimaryActivitiesTxt |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 3 | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |