2016-08-01T15:18:38-05:00 2015-09-30 390758449 WIPFLI LLP 3703 OAKWOOD HILLS PKWY EAU CLAIRE WI 54701 990 2014-10-01 391515716 VERNON MEMORIAL HEALTHCARE FOUNDATION INC VERN 6086372101 507 SOUTH MAIN STREET VIROQUA WI 54665 MARTHA OLSON CHAIRPERSON 6086372101 2016-08-01 1 HOLLY POKRANDT CPA P00449155 7158323407 2016-08-01 2014 2016-12-15 16:53:06Z MARTHA OLSON 507 SOUTH MAIN STREET VIROQUA WI 54665 475664 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. 13 13 0 13 0 0 251066 417302 0 0 8592 13058 24808 32410 284466 462770 42406 427944 0 0 0 0 0 0 2043 9668 10443 52074 438387 232392 24383 853439 1375142 0 1079318 853439 295824 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 427944 427944 THE VERNON MEMORIAL HEALTHCARE FOUNDATION PROVIDED 4 INDIVIDUALS WHO ARE PURSUING OR FURTHERING THEIR EDUCATION IN THE HEALTH CARE FIELD SCHOLARSHIPS DURING 2015. THE FOUNDATION ALSO GRANTED VERNON MEMORIAL HEALTHCARE, INC. $422,319 TO BE USED FOR VARIOUS PROGRAMS AND EQUIPMENT PURCHASES. 427944 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 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 0 0 X 13 13 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 LENAY KUMLIN DIRECTOR 1.00 X 0 0 0 MARTHA OLSON CHAIRPERSON 1.00 X X 0 0 0 MIKE WELCH DIRECTOR 1.00 X 0 0 0 PHYLLIS EKLOV DIRECTOR 1.00 X 0 0 0 PHYLLIS MALIN DIRECTOR 1.00 X 0 0 0 RACHEL HANSON DIRECTOR 1.00 X 0 0 0 RUSSELL HOLTE DIRECTOR 1.00 X 0 0 0 RYAN CALLAN VICE CHAIRPERSON 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 0 0 0 0 0 0 0 0 417302 417302 13058 13058 45304 12894 32410 32410 462770 0 0 45468 422319 422319 5625 5625 6350 6350 2050 2050 1089 1089 954 954 438387 427944 8400 2043 42114 62461 621083 1005427 96914 190242 210340 853439 1375142 4691 0 1074627 0 1079318 X 44185 146994 685239 24814 124015 124016 853439 295824 853439 1375142 24383 -16886 -565112 X X 0 1 X 1 0 X 127415 569289 264758 251066 417302 1629830 127415 569289 264758 251066 417302 1629830 1629830 13009 10790 8297 5439 13058 50593 1680423 189640 0.96990 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 124015 5626 5625 124017 124015 8625 8625 124015 124015 6000 6000 124015 124015 7750 7750 124015 124015 7000 7000 124015 0 0 0 DONOR IMPOSED ST LIABILITY 683677 DONOR IMPOSED LT LIABILITY 390950 1074627 65786 -16886 -16886 82672 2050 378048 380098 462770 58289 0 58289 2050 378048 380098 438387 PART V, LINE 4: INVESTMENT INCOME ON ENDOWMENT FUNDS ARE TO BE USED FOR NURSING SCHOLARSHIPS PER DONOR RESTRICTIONS. PART XI, LINE 4B - OTHER ADJUSTMENTS: SEE BELOW PART XII, LINE 4B - OTHER ADJUSTMENTS: SEE BELOW PART XI LINE 4B AND PART XII LINE 4B INCLUDED IN OTHER LINE 4B IS $390,942 RELATED TO AMOUNTS DESIGNATED BY DONORS FOR SPECIFIC ORGANIZATIONS OFFSET BY DIRECT EXPENSES OF $12,894 FOR FUNDRAISING EVENTS. GOLF OUTING 19504 19504 380 3862 1449 761 GALA 25800 25800 6442 45304 45304 380 3862 7891 761 12894 32410 1 VERNON MEMORIAL HEALTHCARE INC 507 SOUTH MAIN STREET VIROQUA WI 54665 390806404 501(C)(3) 422319 FMV VARIOUS PROGRAMS AND EQUIPMENT SCHOLARSHIPS 4 5625 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 XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCE OF $(565,112) IS THE RECONCILIATION OF BEGINNING NET ASSETS FROM A CASH BASIS TO AN ACCRUAL BASIS. FORM 990, PART XII, LINE 9 VERNON MEMORIAL HEALTHCARE FOUNDATION CHANGED ITS METHOD OF ACCOUNTING DURING FISCAL YEAR 2015 FROM CASH BASIS TO ACCRUAL BASIS FOR FINANCIAL STATEMENT AND TAX REPORTING PURPOSES. 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