2016-05-16T14:43:52-05:00 2015-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2014-07-01 810496987 Sheridan Health Care Foundation Inc SHER 4067653700 440 W Laurel Avenue Plentywood MT 59254 Greg Maurer CEO for Sheridan Memorial Hospital 4067653700 2016-05-16 1 Lisa Chaffee CPA P00193453 6122536500 2016-05-16 2014 2016-08-17 19:52:53Z Greg Maurer 440 W Laurel Avenue Plentywood MT 59254 169321 0 X www.sheridanmemorial.net/foundation X 1994 MT To support Sheridan Memorial Health Care Facility. 9 9 0 13 0 0 76076 100901 0 0 29280 27802 45799 30218 151155 158921 94358 206415 0 0 0 0 0 0 0 0 0 94358 206415 56797 -47494 1246631 1188629 0 0 1246631 1188629 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 206415 206415 Distributions made to Sheridan Memorial Hospital Association, a 501(c)(3) organization, to help fund medical activities. Sheridan Health Care Foundation contributed $206,415 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, 2015 was $308,403. 206415 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 Jim Maus Director (thru 12/1/14) 0.50 0.00 X 0 0 0 Greg Mauer President/CEO (as of March 2015) 0.10 40.00 X 0 0 0 Rob Brandt Interim CEO (thru Feb 2015) 0.10 40.00 X 0 0 0 Sandra Christensen CEO (thru July 2014) 0.10 40.00 X 0 0 0 0 0 0 0 0 0 0 0 6640 94261 100901 27802 27802 30703 6640 5900 24803 24803 9915 4500 5415 5415 158921 0 0 58020 206415 206415 206415 206415 0 0 104041 333034 547660 545792 575000 308403 19930 1400 1246631 1188629 0 0 X 927447 843914 205268 230799 113916 113916 1246631 1188629 1246631 1188629 -47494 -10508 0 X 0 1 X 0 0 X 253866 173655 325602 76226 100901 930250 253866 173655 325602 76226 100901 930250 930250 78840 1074 15075 29280 27802 152071 1082321 76768 0.85950 0.84530 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 113916 64 64 113916 113916 72 72 113916 37530 76386 27 27 113916 27195 10335 37530 27075 120 27195 1.00000 0 0 0 Notes Receivable-Sheridan Memorial Hospital Association 308403 C 308403 X 72918 0 72918 86003 86003 158921 206415 0 206415 0 206415 Part V, Line 4: The endowment consists of individual funds established by donors to provide annual funding for specific activities and general operations of the Hospital. 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. Part XI, Line 4b - Other Adjustments: Contributions reported in fund balance for financial statements 86,003. Christmas Kickoff 22199 1840 20359 200 200 Golf Tournament 15144 4800 10344 1300 2400 800 1000 37343 6640 30703 1300 2400 1000 1200 5900 24803 1 Sheridan Memorial Hospital Association 440 W Laurel Ave Plentywood MT 59254 810243720 501(c)(3) 206415 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 committeess 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. 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 organization's CEO. The Hospital has a management agreement with Billings Clinic. The CEO is compensated by Sheridan Memorial Hospital Association as part of that arrangement. 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 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0