2014-05-14T16:30:40-05:00 2013-09-30 390758449 WIPFLI LLP 3703 OAKWOOD HILLS PARKWAY EAU CLAIRE WI 54701 990 2012-10-01 391515716 VERNON MEMORIAL HEALTHCARE FOUNDATION INC VERN 6086372101 507 SOUTH MAIN STREET VIROQUA WI 54665 RYAN CALLAN 6086372101 2014-05-12 1 HOLLY POKRANDT CPA P00449155 7158323407 2014-05-07 2012 2015-11-30 17:44:51Z RYAN CALLAN 507 SOUTH MAIN STREET VIROQUA WI 54665 321369 0 X N/A X 1984 WI TO SOLICIT, RECEIVE, AND ACCEPT GIFTS, DEVICES, OR BEQUESTS ON BEHALF OF VERNON MEMORIAL HEALTHCARE AND FOR SCHOLARSHIPS. 13 13 0 15 0 0 569289 264758 0 0 11104 11722 25984 20606 606377 297086 12140 781570 0 0 0 0 37572 0 1745 6644 5395 56356 786965 550021 -489879 1110926 621047 0 0 1110926 621047 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 781570 781570 THE VERNON MEMORIAL HEALTHCARE FOUNDATION PROVIDED 8 INDIVIDUALS WHO ARE PURSUING OR FURTHERING THEIR EDUCATION IN THE HEALTH CARE FIELD SCHOLARSHIPS DURING 2013. THE FOUNDATION ALSO GRANTED VERNON MEMORIAL HEALTHCARE, INC. $775,570 TO BE USED FOR THE CONSTRUCTION OF A NEW HOSPICE HOUSE AND VARIOUS PROGRAMS AND EQUIPMENT PURCHASES. 781570 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 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 LENAY KUMLIN 1.00 X 0 0 0 BRIAN MURPHY 1.00 X 0 0 0 PHYLLIS MALIN 1.00 X 0 0 0 ERIC NOTTESTAD 1.00 X 0 0 0 JEANETTA KIRKPATRICK 1.00 X 0 0 0 SHAWNA STRINGHAM 1.00 X 0 0 0 PHYLLIS EKLOV 1.00 X 0 0 0 WILLIAM BOOLAN 1.00 X 0 0 0 RUSSELL HOLTE 1.00 X 0 0 0 RYAN CALLAN 1.00 X X 0 0 0 MARTHA OLSON 1.00 X X 0 0 0 DEBRA MASHAK-HUNDT 1.00 X X 0 0 0 JOE BERRA 1.00 X X 0 0 0 0 0 0 0 0 0 0 0 12470 252288 264758 8297 8297 14549 11124 3425 3425 3425 33765 12470 13159 20606 20606 297086 0 0 32328 775570 775570 6000 6000 3650 3650 396 396 854 854 495 495 786965 781570 3650 1745 44216 37878 873816 392630 192894 190539 1110926 621047 0 0 X 51340 39874 935571 457158 124015 124015 1110926 621047 1110926 621047 -489879 0 X 0 1 X 0 0 X X X 0 0 0 VERNON MEMORIAL HEALTHCARE 390806404 3 0 1 1 775570 1 775570 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 124015 6000 6000 124015 124015 7750 7750 124015 124015 7000 7000 124015 124015 6028 6028 124015 124015 8550 8550 124015 1.00000 0 0 0 X 310245 13159 13159 297086 0 297086 800124 13159 13159 786965 0 786965 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: INVESTMENT INCOME ON ENDOWMENT FUNDS ARE TO BE USED FOR NURSING SCHOLARSHIPS PER DONOR RESTRICTIONS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE FOUNDATION IS A NONPROFIT ENTITY AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. IT IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE FOUNDATION DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE FOUNDATION RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2013 OR 2012. FEDERAL RETURNS FOR THE YEARS ENDED SEPTEMBER 30, 2010, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NET AGAINST REVENUE 13,159. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NET AGAINST REVENUE 13,159. GOLF OUTING 20384 20384 1080 3867 1156 613 HOSPICE GALA 25851 12470 13381 5736 707 46235 12470 33765 1080 3867 6892 1320 13159 20606 1 VERNON MEMORIAL HEALTHCARE INC 507 SOUTH MAIN STREET VIROQUA WI 54665 390806404 501(C)(3) 775570 FMV TO BE USED FOR THE CONSTRUCTION OF A NEW HOSPICE HOUSE AND VARIOUS PROGRAMS AND EQUIPMENT PURCHASES. 1 0 SCHOLARSHIPS 8 6000 FMV 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 0 0 0 0