2017-02-09T09:59:16-06:00 2016-06-30 450250985 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2015-07-01 431975486 Friends of FMC Foundation Inc FRIE 4067783331 PO Box 820 Baker MT 59313 David Stevens President of Board 4067783331 2017-02-02 1 Kim C Hunwardsen P00484560 6122536500 2017-02-01 2015 2021-01-29 14:40:06Z X David Stevens PO Box 820 Baker MT 59313 115075 0 X www.fallonmedical.org X 2002 MT To coordinate Fallon Medical Complex, Inc's fundraising programs. 7 5 0 95 0 0 67914 57795 0 0 28486 30029 27228 19111 123628 106935 15439 1000 0 0 27498 33384 0 0 17058 11532 11544 54469 45928 69159 61007 1107359 1174036 0 0 1107359 1174036 X 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." 0 0 1669 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. 1000 1000 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. 2669 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 7 5 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X Marjorie Losing 4067785103 PO Box 820 Baker MT 59313 David Stevens President 0.50 0.00 X X 0 0 0 Rosanne Varner Vice President 0.50 0.00 X X 0 0 0 Cori Thurlow Secretary/Treasurer (as of Jan 2016) 0.50 40.00 X X 0 37742 358 Susan Stevens Secretary/Treasurer 0.50 40.00 X X 0 68139 11040 Darcy Pankratz Director 0.50 0.00 X 0 0 0 Doug Varner Director 0.50 0.50 X 0 0 0 Mike Griffith Director 0.50 0.00 X 0 0 0 Craig Pinnow Director 0.50 0.00 X 0 0 0 Karol Zachmann Foundation Director 19.00 21.00 X 0 43749 14089 0 149630 25487 0 0 0 0 0 18771 39024 57795 26721 26721 3308 0 3308 3308 3308 27251 18771 8140 19111 19111 106935 0 0 49140 1000 1000 33384 1669 15023 16692 2720 2720 7753 7753 705 705 Misc. Fundraising Expen 366 366 45928 2669 26201 17058 1107359 1174036 1107359 1174036 0 0 X 816051 844638 118259 146349 173049 183049 1107359 1174036 1107359 1174036 61007 5670 0 X 0 1 X 1 0 X 91006 341667 150710 67914 57795 709092 91006 341667 150710 67914 57795 709092 381665 327427 11770 14605 23447 21829 26721 98372 807464 126395 0.40550 0.35420 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 230502 10000 2532 243034 208676 21794 1032 1000 230502 190592 20000 1084 3000 208676 172588 21012 992 4000 190592 150010 22230 1348 1000 172588 0.17300 0.75320 0.07380 0 0 0 X 70286 0 70286 36649 36649 106935 54068 8140 8140 45928 0 45928 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. Mammo Whammo 13539 7637 5902 920 235 243 Breast CA Luncheon 11931 6747 5184 250 5 20552 4387 16165 1348 2201 2943 46022 18771 27251 1170 1583 2201 3186 8140 19111 Karol Zachmann Family Member of Board Members Susan Stevens and David Stevens 33384 Wages 0 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. Fallon Medical Center 202 S 4th St W Baker MT 59313 363808993 Critical Access Hospital MT 501(c)(3) Line 3 N/A 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0