2017-07-25T14:56:56-05:00 2016-09-30 390758449 Wipfli LLP 3703 Oakwood Hills Pkwy Eau Claire WI 54701 990 2015-10-01 391515716 VERNON MEMORIAL Healthcare FOUNDATION INC VERN 6086372101 507 SOUTH MAIN STREET VIROQUA WI 54665 Martha Olson Chairperson 6086372101 2017-07-21 1 HOLLY POKRANDT CPA P00449155 7158323407 2017-07-19 2015 2021-01-29 14:40:06Z Martha Olson 507 SOUTH MAIN STREET VIROQUA WI 54665 360587 0 X www.vmh.org X 1984 WI TO SOLICIT, RECEIVE, AND ACCEPT GIFTS, DEVICES, OR BEQUESTS ON BEHALF OF VERNON MEMORIAL HEALTHCARE AND FOR SCHOLARSHIPS. 11 11 0 0 0 0 417302 310453 0 0 13058 12798 32410 27226 462770 350477 427944 311174 0 0 0 0 0 0 2251 10443 7351 438387 318525 24383 31952 1375142 934601 1079318 595301 295824 339300 THE VERNON MEMORIAL HEALTHCARE FOUNDATION IS DEDICATED TO DEVELOPING AND SUPPORTING THE PROGRAMS, SERVICES, FACILITIES AND EDUCATION WHICH ENHANCE THE ACCESSIBILITY TO QUALITY HEALTHCARE AND WELLNESS IN THE COMMUNITIES SERVED BY VERNON MEMORIAL HEALTHCARE. 0 0 311174 311174 THE VERNON MEMORIAL HEALTHCARE FOUNDATION PROVIDED 4 INDIVIDUALS WHO ARE PURSUING OR FURTHERING THEIR EDUCATION IN THE HEALTH CARE FIELD SCHOLARSHIPS DURING 2016. The Foundation also granted Vernon Memorial Healthcare, Inc. $305,174 to be used for various programs and equipment purchases. 311174 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 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 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 WI X MARY KOENIG 6086372101 507 SOUTH MAIN STREET VIROQUA WI 54665 X Debra Mashak-Hundt Treasurer 1.00 X X 0 0 0 Martha Olson vice Chairperson 1.00 X X 0 0 0 Mike Welch Director 1.00 X 0 0 0 Phyllis Eklov CHAIRPERSON 1.00 X X 0 0 0 Rachel Hanson Director 1.00 X 0 0 0 RYAN CALLAN DIRECTOR 1.00 X X 0 0 0 Shawna Stringham Secretary 1.00 X X 0 0 0 William Doolan DireCTOR 1.00 X 0 0 0 Linda DeGarmo Director 1.00 X 0 0 0 Shari Jacobson director 1.00 X 0 0 0 BONNIE RATH DIRECTOR 1.00 X 0 0 0 phyllis malin DIRECTOR 1.00 X 0 0 0 RUSSEL HOLTE DIRECTOr 1.00 X 0 0 0 LENAY KUMLIN DIRECTOR 1.00 X 0 0 0 0 0 0 0 0 0 0 0 310453 310453 12798 12798 37336 10110 27226 27226 350477 0 0 40024 305174 305174 6000 6000 3100 3100 2000 2000 1297 1297 954 954 318525 311174 5100 2251 62461 76658 1005427 617497 96914 10014 210340 230432 1375142 934601 4691 0 1074627 595301 1079318 595301 X 146994 186069 24814 29215 124016 124016 295824 339300 1375142 934601 31952 11524 0 X 1 X 0 1 0 X 569289 264758 251066 417302 310453 1812868 569289 264758 251066 417302 310453 1812868 1812868 10790 8297 5439 13058 12798 50382 1863250 0.97300 0.96990 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 124016 6000 6000 124016 124015 5626 5625 124016 124015 8625 8625 124015 124015 6000 6000 124015 124015 7750 7750 124015 0 0 0 Donor Imposed ST liability 114613 Donor Imposed LT liability 480688 595301 Part V, Line 4: INVESTMENT INCOME ON ENDOWMENT FUNDS ARE TO BE USED FOR NURSING SCHOLARSHIPS PER DONOR RESTRICTIONS. Golf Outing 16111 16111 570 1300 1144 Gala 21225 21225 7096 37336 37336 570 8396 1144 10110 27226 1 Vernon Memorial Healthcare Inc 507 South Main Street Viroqua WI 54665 390806404 501(c)(3) 305174 FMV Various programs and equipment 1 0 Scholarships 6 6000 FMV Part I, Line 2: DONEES ARE REQUIRED TO COMPLETE A FUNDING REQUEST FORM AND SUBMIT THE COMPLETED FORM TO THE FOUNDATION. THE REQUESTS MUST INCLUDE A DETAILED DESCRIPTION OF WHAT THE FUNDS WILL BE USED FOR INCLUDING BUDGET AND ESTIMATED COSTS, REASON FOR THE REQUEST, OTHER FUNDING RESOURCES, AND A TIMEFRAME FOR THE PROJECT. THE FOUNDATION HAS TWO MONTHS TO APPROVE OR DENY THE FUNDING REQUEST. AN ORAL PRESENTATION MAY ALSO BE REQUESTED BEFORE FINAL APPROVAL IS GIVEN. UPON COMPLETION OF THE FUNDED PROJECT OR PURCHASE OF EQUIPMENT, THE DONEE IS REQUIRED TO MAKE EITHER AN ORAL OR WRITTEN REPORT ABOUT HOW THE FUNDS WERE SPENT. Form 990, Part VI, Section B, line 11 THE BOARD OF DIRECTORS have received a copy of form 990 prior to filing. Form 990, Part VI, Section B, line 12c All board members of Vernon Memorial Healthcare Foundation, Inc. are required to disclose all possible conflicts of interest when first elected to the Board of Directors. During their terms, if any business relationships are entered into which may affect their independence as a member, the member must immediately disclose these relationships. Annual conflict of interest statements are signed by all board members. Form 990, Part VI, Section C, line 19 VERNON MEMORIAL FOUNDATION, INC. HAS MADE ITS FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC ON A PER REQUEST BASIS. Form 990, Part VI, Line 13 Vernon Memorial Healthcare Foundation, Inc. relies on and follows the policies of Vernon Memorial Healthcare, Inc. Form 990, Part VI, Line 14 Vernon Memorial Healthcare Foundation, Inc. relies on and follows the policies of Vernon Memorial Healthcare, Inc. VERNON MEMORIAL HEALTHCARE INC 507 SOUTH MAIN STREET VIROQUA WI 54655 390806404 Hospital WI 501(c)(3) Line 3 N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0