FRIENDS OF FMC FOUNDATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- FRIENDS OF FMC FOUNDATION (EIN 43-1975486)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-02-15
- IRS object ID
- 201440499349300754
- 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 | 2014-02-15T08:21:24-06:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450250985 | 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 | 800 Nicollet Mall Ste 1300 | AddressLine1 |
| City | Minneapolis | City |
| State | MN | State |
| ZIP Code | 554027033 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 431975486 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Friends of FMC Foundation Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FRIE | NameControl |
| Phone | 4067783331 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 202 S 4th St W | AddressLine1 |
| City | Baker | City |
| State | MT | State |
| ZIP Code | 59313 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | David Stevens | Name |
| Title | President of Board | Title |
| Phone | 4067783331 | Phone |
| Date Signed | 2014-02-17 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Kim C Hunwardsen | Name |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | Phone |
| Date Prepared | 2014-02-17 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | David Stevens | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 202 S 4th St W | AddressLine1 |
| City | Baker | City |
| State | MT | State |
| ZIP Code | 59313 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 390720 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.fallonmedical.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2002 | YearFormation |
| State Legal Domicile | MT | StateLegalDomicile |
| Activity Or Mission Description | To coordinate Fallon Medical Complex, Inc's fundraising programs. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 47 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 91006 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 341667 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 13334 | InvestmentIncomePriorYear |
| Investment Income Current Year | 25073 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -2032 | OtherRevenuePriorYear |
| Other Revenue Current Year | 13170 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 102308 | TotalRevenuePriorYear |
| Total Revenue Current Year | 379910 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 33041 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 5256 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 21196 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 17771 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 10006 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 7143 | OtherExpensePriorYear |
| Other Expenses Current Year | 20120 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 61380 | TotalExpensesPriorYear |
| Total Expenses Current Year | 43147 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 40928 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 336763 | RevenuesLessExpensesCY |
| Total Assets BOY | 527908 | TotalAssetsBOY |
| Total Assets EOY | 868174 | TotalAssetsEOY |
| Total Liabilities BOY | 0 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 527908 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 868174 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | Friends of FMC Foundation's mission is to help ensure the continuing quality of local healthcare services in the Fallon Medical Complex service area by raising funds for the purpose of enhancing the quality and dignity of life of all persons employed and served by Fallon Medical Complex. "Friends Helping Friends." | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 15145 | Expense |
| Grants | 2256 | Grants |
| Description | The purpose of Friends of Fallon Medical Complex Foundation is to provide, through all of its funds and activities, direct or indirect benefit to Fallon Medical Complex (FMC), a not-for-profit healthcare corporation, in support of its mission, so long as FMC qualifies as an organization described in Section 501(c)(3) of the Internal Revenue Code. The Foundation obtains and receives contributions, donations, gifts, or bequests entirely for the development of one or more endowment funds, to be used for financial assistance to FMC for medical education, equipment upgrades and purchases, physical plant improvements and additions, personnel programs, and any aspect of promotion and public relations devoted to the delivery of health care services in FMC's service area. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3000 | Expense |
| Grants | 3000 | Grants |
| Description | The Friends of Fallon Medical Complex Foundation distributes funds from its capital pool for the purpose of funding scholarships to students from our service area who are pursuing a formal education in a healthcare-related field. The scholarship process is governed by established formal program criteria that define how requests are to be submitted by applicants and how they are to be evaluated by the Board of Directors. During the past fiscal year, the Board awarded three scholarships (worth $1,000 each) to students, all distributed during the year to the scholars college of choice. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 18145 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Own Website | X | OwnWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Selena Nelson | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4067785103 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 820 | AddressLine1 |
| City | Baker | City |
| State | MT | State |
| ZIP Code | 59313 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (10 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|---|
| Michael Griffith | |||||||
| President (July-Nov) | 1.00 | 0.00 | X | X | 0 | 0 | 0 |
| David Stevens | |||||||
| VP (July-Nov)/President (Nov-June) | 1.00 | 0.00 | X | X | 0 | 0 | 0 |
| Rosanne Varner | |||||||
| Director (July-Nov)/VP (Nov-June) | 1.00 | 0.00 | X | X | 0 | 0 | 0 |
| Susan Stevens | |||||||
| Secretary/Treasurer | 1.00 | 0.00 | X | X | 0 | 0 | 0 |
| Gloria Boggs | |||||||
| Director (July-Dec) | 1.00 | 0.50 | X | 0 | 0 | 0 | |
| Darcy Pankratz | |||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| Doug Varner | |||||||
| Director (Feb-June) | 1.00 | 0.50 | X | 0 | 0 | 0 | |
| Mike Griffith | |||||||
| Director (April-June) | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| Craig Pinnow | |||||||
| Director (June) | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| Karol Zachmann | |||||||
| Foundation Director | 24.00 | 16.00 | X | 0 | 14154 | 7487 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 14154 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 7487 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Fundraising Events | 12735 | FundraisingEvents |
| Related Organizations | 20846 | RelatedOrganizations |
| All Other Contributions | 308086 | AllOtherContributions |
| Total Contributions | 341667 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 14605 | TotalRevenueColumn |
| Exclusion | $14,605 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 10468 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 10468 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10468 | TotalRevenueColumn |
| Exclusion | $10,468 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 23980 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 12735 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 10810 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 13170 | TotalRevenueColumn |
| Exclusion | $13,170 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 379910 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $38,243 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2256 | Total |
| Program Services | 2256 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3000 | Total |
| Program Services | 3000 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17771 | Total |
| Program Services | 889 | ProgramServices |
| Management And General | 7997 | ManagementAndGeneral |
| Fundraising | 8885 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2000 | Total |
| Management And General | 2000 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3757 | Total |
| Management And General | 3757 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 871 | Total |
| Fundraising | 871 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13444 | Total |
| Program Services | 12000 | ProgramServices |
| Management And General | 1227 | ManagementAndGeneral |
| Fundraising | 217 | Fundraising |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | FundraisingFundraising | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Misc. Fundraising Expen | 33 | 33 | |
| Licenses & Taxes | 15 | 15 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43147 | Total |
| Program Services | 18145 | ProgramServices |
| Management And General | 14996 | ManagementAndGeneral |
| Fundraising | 10006 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 527808 | BOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 88 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 0 | LandBuildingsEquipmentBasis |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 868086 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 100 | BOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 527908 | BOY |
| EOY | 868174 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 396968 | BOY |
| EOY | 701590 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17891 | BOY |
| EOY | 33535 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 113049 | BOY |
| EOY | 133049 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 527908 | BOY |
| EOY | 868174 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 527908 | BOY |
| EOY | 868174 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 336763 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 3503 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 99573 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 95114 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 84381 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 91006 | CurrentTaxYearMinus1Year |
| Current Tax Year | 341667 | CurrentTaxYear |
| Total | 711741 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 99573 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 95114 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 84381 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 91006 | CurrentTaxYearMinus1Year |
| Current Tax Year | 341667 | CurrentTaxYear |
| Total | 711741 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 400655 | AmountsSubstContributorsTotal |
| Public Support Total170 | 311086 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 6333 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 5116 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6870 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 11770 | CurrentTaxYearMinus1Year |
| Current Tax Year | 14605 | CurrentTaxYear |
| Total | 44694 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 756435 | TotalSupport |
| Gross Receipts From Admissions Etc | 69901 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.41130 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.54920 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
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 D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 172588 | BeginningOfYearBalance |
| Contributions | 21012 | Contributions |
| Investment Earnings Or Losses | 992 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 4000 | GrantsOrScholarships |
| End Of Year Balance | 190592 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 150010 | BeginningOfYearBalance |
| Contributions | 22230 | Contributions |
| Investment Earnings Or Losses | 1348 | InvestmentEarningsOrLosses |
| Administrative Expenses | 1000 | AdministrativeExpenses |
| End Of Year Balance | 172588 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.22380 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.69810 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.07810 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 394223 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 3503 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 3503 | RevenueNotRptdF990 |
| Revenue Subtotal | 390720 | RevenueSubtotal |
| Other Revenues Not Included | -10810 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -10810 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 379910 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 53957 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 10810 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 10810 | ExpensesNotRptdF990 |
| Expenses Subtotal | 43147 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 43147 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Intended Use of Endowment Funds: | Part V, Line 4: | Permanently restricted funds are used to provide a source of income to be used for Long Term Care, and/or equipment purchases on behalf of Fallon Medical Complex, and for scholarships. Principal has been invested and the generated income (temporarily restricted) is used for said purpose. |
| Description of Uncertain Tax Positions Under FIN 48: | Part X, Line 2: | The Complex is organized as a nonprofit organization and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code. The Complex is also exempt from state income taxes. The Complex is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Complex is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Complex 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 Complex believes 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 financial statements. The Complex 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. The Complex is no longer subject to federal or state tax examinations by tax authorities for the years before June 30, 2010. |
| Part XI, Line 4b - Other Adjustments: | Fundraising Expenses -10,810. | |
| Part XII, Line 2d - Other Adjustments: | Fundraising Expenses 10,810. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Mammo Whammo | NameOfEvent1 |
| Gross Receipts Event1 | 11432 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 8730 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 2702 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 1120 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 322 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 1020 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 204 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 213 | OtherDirectExpensesEvent1 |
| Name Of Event2 | Fantasy Food Fair | NameOfEvent2 |
| Gross Receipts Event2 | 8222 | GrossReceiptsEvent2 |
| Gross Revenue Event2 | 8222 | GrossRevenueEvent2 |
| Non Cash Prizes Event2 | 667 | NonCashPrizesEvent2 |
| Food And Beverage Event2 | 2455 | FoodAndBeverageEvent2 |
| Entertainment Event2 | 250 | EntertainmentEvent2 |
| Other Direct Expenses Event2 | 206 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 6 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 17061 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 4005 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 13056 | GrossRevenueOtherEvents |
| Cash Prizes Other Events | 580 | CashPrizesOtherEvents |
| Non Cash Prizes Other Events | 2651 | NonCashPrizesOtherEvents |
| Food And Beverage Other Events | 352 | FoodAndBeverageOtherEvents |
| Other Direct Expenses Other Events | 770 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 36715 | GrossReceiptsTotal |
| Charitable Contributions Total | 12735 | CharitableContributionsTotal |
| Gross Revenue Total Events | 23980 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 1700 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 3640 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 1020 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 3011 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 250 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 1189 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 10810 | DirectExpenseSummaryEvents |
| Net Income Summary | 13170 | NetIncomeSummary |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Karol Zachmann | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | Family Member of Board Members Susan Stevens and David Stevens | Relationship |
| Amount Of Transaction | 17771 | AmountOfTransaction |
| Description Of Transaction | Wages | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 2 | Karol Zachmann, Susan Stevens, and David Stevens have family relationships. Doug Varner and Rosanne Varner have a family relationship. |
| Form 990, Part VI, Section A, line 8b | The organization does not have a committee that acts on behalf of the governing body. |
| Form 990, Part VI, Section B, line 11 | Information for the Form 990 is compiled by the executive staff. The corporation accountants prepare the form which is emailed or mailed to the Board of Directors for the review and comment during one of their regular meetings. |
| Form 990, Part VI, Section B, line 12c | Our policy requires a duty to disclose any conflicts annually as well as during discussions. Given the occupational diversity of our Board of Directors as well as the relatively small size of our community and service area, virtually all relaionships that may cause potential conflicts of interest are known by one or more members of the board. |
| The Foundation Director is the only paid employee of the Organization. Wages are paid by Fallon Medical Complex, a related organization. | |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents, conflict of interest policy and financial statements are available for public inspection at the corporation's place of business upon request. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fallon Medical Center | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 820 | AddressLine1 |
| City | Baker | City |
| State | MT | State |
| ZIP Code | 59313 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363808993 | EIN |
| Primary Activities | Critical Access Hospital | PrimaryActivities |
| Legal Domicile State | MT | LegalDomicileState |
| Exempt Code Section | 501(c)(3) | ExemptCodeSection |
| Public Charity Status | Line 3 | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |