MILE BLUFF MEDICAL CENTER FOUNDATION INC: Form 990EZ, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MILE BLUFF MEDICAL CENTER FOUNDATION INC (EIN 27-1865510)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-04-02
- IRS object ID
- 201430929349200013
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-04-02T16:46:57-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450250958 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3999 PENNSYLVANIA AVE SUITE 100 | AddressLine1 |
| City | DUBUQUE | City |
| State | IA | State |
| ZIP Code | 52002 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990EZ | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 271865510 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mile Bluff Medical Center Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MILE | NameControl |
| Phone | 6088476161 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1050 Division Street | AddressLine1 |
| City | Mauston | City |
| State | WI | State |
| ZIP Code | 53948 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | James O'Keefe | Name |
| Title | President/CEO | Title |
| Phone | 6088476161 | Phone |
| Date Signed | 2014-03-25 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Carmen Krantz | Name |
| PTIN | P00031958 | PTIN |
| Phone | 5635561790 | Phone |
| Date Prepared | 2014-03-24 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Web Site | n/a | WebSite |
| Organization501c3 | X | Organization501c3 |
| Gross Receipts | 103434 | GrossReceipts |
| Info In Schedule O Part I | X | InfoInScheduleOPartI |
| Contributions Gifts Grants Etc | 92030 | ContributionsGiftsGrantsEtc |
| Program Service Revenue | 7080 | ProgramServiceRevenue |
| Investment Income | 1156 | InvestmentIncome |
| Fundraising Gross Income | 3168 | FundraisingGrossIncome |
| Special Events Direct Expenses | 6435 | SpecialEventsDirectExpenses |
| Special Events Net Income Loss | -3267 | SpecialEventsNetIncomeLoss |
| Total Revenue | 96999 | TotalRevenue |
| Grants And Similar Amounts Paid | 22880 | GrantsAndSimilarAmountsPaid |
| Other Expenses Total | 29413 | OtherExpensesTotal |
| Total Expenses | 52293 | TotalExpenses |
| Excess Or Deficit For Year | 44706 | ExcessOrDeficitForYear |
| Net Assets Or Fund Balances BOY | 85942 | NetAssetsOrFundBalancesBOY |
| Other Changes In Net Assets | 0 | OtherChangesInNetAssets |
| Net Assets Or Fund Balances EOY | 130648 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part II | X | InfoInScheduleOPartII |
Cash Savings And Investments CashSavingsAndInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 86564 | BOY |
| EOY | 141629 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4339 | BOY |
| EOY | 6148 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 90903 | BOY |
| EOY | 147777 | EOY |
Sum Of Total Liabilities SumOfTotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4961 | BOY |
| EOY | 17129 | EOY |
Net Assets Or Fund Balances NetAssetsOrFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 85942 | BOY |
| EOY | 130648 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Primary Exempt Purpose | Provide financial support to Mile Bluff Medical Center, Inc. | PrimaryExemptPurpose |
Program Service Accomplishment ProgramServiceAccomplishment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Service Accom | Mile Bluff Medical Center Foundation serves as a major fundraising arm, and provides philanthropic opportunities as a means of support for the Medical Center. The Foundation assists Mile Bluff Medical Center in fulfilling its mission, while adhering to its core values and pursuing its vision to provide the community with healthcare evolving for life. | DescriptionProgramServiceAccom |
| Grants And Allocations | 22880 | GrantsAndAllocations |
| Program Service Expenses | 52293 | ProgramServiceExpenses |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | 52293 | TotalProgramServiceExpenses |
Officer Director Trustee Key Empl OfficerDirectorTrusteeKeyEmpl (7 entries)
| TitleTitle | Avg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPosition | CompensationCompensation | Contri To Empl Benefit Plans EtcContriToEmplBenefitPlansEtc | Expense Account Other AllowancesExpenseAccountOtherAllowances |
|---|---|---|---|---|
| James O'Keefe | ||||
| President/CEO | 0.25 | 0 | 0 | 0 |
| Molly Scully | ||||
| Secretary | 0.25 | 0 | 0 | 0 |
| Sandy Linsmeyer | ||||
| Treasurer | 0.25 | 0 | 0 | 0 |
| Christine Carter | ||||
| Director | 0.25 | 0 | 0 | 0 |
| P Michael McCormick DDS | ||||
| Director | 0.25 | 0 | 0 | 0 |
| Dan Kattenbraker MD | ||||
| Director | 0.25 | 0 | 0 | 0 |
| Larry Willer | ||||
| Director | 0.25 | 0 | 0 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRpt |
| Made Changes To Orgnzng Etc Doc | 0 | MadeChangesToOrgnzngEtcDoc |
| Organization Had UBI | 0 | OrganizationHadUBI |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtc |
| Direct Indirect Political Expend | 0 | DirectIndirectPoliticalExpend |
| Made Loans To From Officers | 0 | MadeLoansToFromOfficers |
| Tax Imposed Under IRC4911 | 0 | TaxImposedUnderIRC4911 |
| Tax Imposed Under IRC4912 | 0 | TaxImposedUnderIRC4912 |
| Tax Imposed Under IRC4955 | 0 | TaxImposedUnderIRC4955 |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTrans |
| Amount Of Tax Imposed On Org Mgr | 0 | AmountOfTaxImposedOnOrgMgr |
| Amount Of Tax Reimbursed By Org | 0 | AmountOfTaxReimbursedByOrg |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | James O'Keefe | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1050 Division Street | AddressLine1 |
| City | Mauston | City |
| State | WI | State |
| ZIP Code | 53948 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6088476161 | TelephoneNumber |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Foreign Office | 0 | ForeignOffice |
| Maintain Any Donor Advised Funds | 0 | MaintainAnyDonorAdvisedFunds |
| Does Org Have Hospital | 0 | DoesOrgHaveHospital |
| Tanning Services Provided | 0 | TanningServicesProvided |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Engage Political Cmpgn Activities | 0 | EngagePoliticalCmpgnActivities |
| Engage In Lobbying Activities | 0 | EngageInLobbyingActivities |
| Operating School | 0 | OperatingSchool |
| Trnsfrs Exempt Non Char Related Org | 0 | TrnsfrsExemptNonCharRelatedOrg |
| Part VI Of Comp Of Highest Paid Empl | NONE | PartVIOfCompOfHighestPaidEmpl |
| Part VIA Hghst Paid Cntrct Prof Ser | NONE | PartVIAHghstPaidCntrctProfSer |
| Filed Schedule A | 1 | FiledScheduleA |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Written IRS Determination | X | WrittenIRSDetermination |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mile Bluff Medical Center Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390992883 | EIN |
| Type Of Organization | 3 | TypeOfOrganization |
| Listed In Governing Doc | 1 | ListedInGoverningDoc |
| Amount | $22,880 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 22880 | SumOfAmounts |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Annual Golf Outing | NameOfEvent1 |
| Gross Receipts Event1 | 18287 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 15119 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 3168 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 894 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 1116 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 1628 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 1540 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 1256 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 18287 | GrossReceiptsTotal |
| Charitable Contributions Total | 15119 | CharitableContributionsTotal |
| Gross Revenue Total Events | 3168 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 894 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 1116 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 1628 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 1540 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 1256 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 6434 | DirectExpenseSummaryEvents |
| Net Income Summary | -3266 | NetIncomeSummary |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Other Investment Income | Form 990-EZ, Part I, Line 4 | Interest Income 1,156.. |
| Grants and Similar Amounts Paid | Form 990-EZ, Part I, Line 10 | Activity Classification: Operational support. Grantee Name: Mile Bluff Medical Center, Inc.. Grantee Address: 1050 Division Street Mauston, WI 53948-1997. Grantee Relationship: Supported organization. Amount Given: 22,880. |
| Other Expenses | Form 990-EZ, Part I, Line 16 | Description: Supplies. Amount: 12,889. Description: Continuing education. Amount: 470. Description: Travel. Amount: 849. Description: Women's Night Out expenses. Amount: 3,199. Description: Dues and subscriptions. Amount: 580. Description: Entertainment/meals. Amount: 40. Description: Marketing. Amount: 9,668. Description: Nurses Helping Nurses. Amount: 1,718. Total to Form 990-EZ, line 16: 29,413. |
| Other Assets | Form 990-EZ, Part II, Line 24 | Description: Pledges receivable. Beg. of Year Amount: 4,339. End of Year Amount: 6,148. |
| Other Liabilities | Form 990-EZ, Part II, Line 26 | Description: Accounts payable. Beg. of Year Amount: 4,961. End of Year Amount: 11,966. Description: Due to Mile Bluff Medical Center. Beg. of Year Amount: 0. End of Year Amount: 5,163. |
Transfer Prsnl Bnft Contracts Decl TransferPrsnlBnftContractsDecl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Declaration | The organization did not, during the year, receive any funds, directly,or indirectly, to pay premiums on a personal benefit contract.The organization, did not, during the year, pay any premiums, directly,or indirectly, on a personal benefit contract. | Declaration |