VERNON MEMORIAL HEALTHCARE FOUNDATION INC: Form 990, tax year 2011
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- Organization
- VERNON MEMORIAL HEALTHCARE FOUNDATION INC (EIN 39-1515716)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-08-06
- IRS object ID
- 201302189349301500
- Schema version
- 2011v1.5
- 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 | 2013-08-06T15:24:41-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390758449 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3703 OAKWOOD HILLS PARKWAY | AddressLine1 |
| City | EAU CLAIRE | City |
| State | WI | State |
| ZIP Code | 54701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391515716 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VERNON MEMORIAL HEALTHCARE FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | VERN | NameControl |
| Phone | 6086372101 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 507 SOUTH MAIN STREET | AddressLine1 |
| City | VIROQUA | City |
| State | WI | State |
| ZIP Code | 54665 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RYAN CALLAN | Name |
| Title | PRESIDENT | Title |
| Phone | 6086372101 | Phone |
| Date Signed | 2013-07-31 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | HOLLY POKRANDT CPA | Name |
| PTIN | P00449155 | PTIN |
| Phone | 7158323407 | Phone |
| Date Prepared | 2013-07-31 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | RYAN CALLAN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 507 SOUTH MAIN STREET | AddressLine1 |
| City | VIROQUA | City |
| State | WI | State |
| ZIP Code | 54665 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 657637 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1984 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | TO SOLICIT, RECEIVE, AND ACCEPT GIFTS, DEVICES, OR BEQUESTS ON BEHALF OF VERNON MEMORIAL HEALTHCARE AND FOR SCHOLARSHIPS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 15 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 127415 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 569289 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 13009 | InvestmentIncomePriorYear |
| Investment Income Current Year | 11104 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 26873 | OtherRevenuePriorYear |
| Other Revenue Current Year | 25984 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 167297 | TotalRevenuePriorYear |
| Total Revenue Current Year | 606377 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 27000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 12140 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 39630 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 37572 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 41916 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 4825 | OtherExpensePriorYear |
| Other Expenses Current Year | 6644 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 71455 | TotalExpensesPriorYear |
| Total Expenses Current Year | 56356 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 95842 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 550021 | RevenuesLessExpensesCY |
| Total Assets BOY | 573747 | TotalAssetsBOY |
| Total Assets EOY | 1110926 | TotalAssetsEOY |
| Total Liabilities BOY | 0 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 573747 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1110926 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 12140 | Expense |
| Grants | 12140 | Grants |
| Description | THE VERNON MEMORIAL HEALTHCARE FOUNDATION PROVIDED 10 INDIVIDUALS WHO ARE PURSUING OR FURTHERING THEIR EDUCATION IN THE HEALTH CARE FIELD SCHOLARSHIPS DURING 2012. THE FOUNDATION ALSO GRANTED VERNON MEMORIAL HEALTHCARE, INC. $4,390 TO BE USED FOR VARIOUS PROGRAMS. | Description |
| Total Program Service Expense | 12140 | 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 | 0 | 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 | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 1 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 1 | 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 | 0 | 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 |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| 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 | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | 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 | 1 | 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 | 0 | WhistleblowerPolicy |
| Document Retention Policy | 0 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MARY KOENIG | NamePerson |
| Telephone Number | 6086372101 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 507 SOUTH MAIN STREET | AddressLine1 |
| City | VIROQUA | City |
| State | WI | State |
| ZIP Code | 54665 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| JANA DREGNE | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| TOM SIMONSON | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| MARNY GILLEN | ||||||
| SECRETARY | 1.00 | X | 0 | 0 | 0 | X |
| RYAN CALLAN | ||||||
| CHAIRMAN | 1.00 | X | 0 | 0 | 0 | X |
| DIAN KRAUSE | ||||||
| CHAIRMAN | 1.00 | X | 0 | 0 | 0 | X |
| LENAY KUMLIN | ||||||
| VICE CHAIRMAN | 1.00 | X | 0 | 0 | 0 | X |
| BRIAN MURPHY | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| PHYLLIS MALIN | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| DEBRA MASHAK-HUNDT | ||||||
| TREASURER | 1.00 | X | 0 | 0 | 0 | X |
| ERIC NOTTESTAD | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| JEANETTA KIRKPATRICK | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| MARTHA OLSON | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| JOE BERRA | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| SHAWNA STRINGHAM | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| PHYLLIS EKLOV | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | 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 | 6900 | FundraisingEvents |
| All Other Contributions | 562389 | AllOtherContributions |
| Total Contributions | 569289 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10790 | TotalRevenueColumn |
| Exclusion | $10,790 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 42238 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 41924 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 314 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 314 | TotalRevenueColumn |
| Exclusion | $314 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 35320 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 6900 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 9336 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 25984 | TotalRevenueColumn |
| Exclusion | $25,984 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 606377 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $37,088 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4390 | Total |
| Program Services | 4390 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7750 | Total |
| Program Services | 7750 | ProgramServices |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2300 | Total |
| Management And General | 2300 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37572 | Total |
| Fundraising | 37572 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1484 | Total |
| Fundraising | 1484 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2860 | Total |
| Fundraising | 2860 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56356 | Total |
| Program Services | 12140 | ProgramServices |
| Management And General | 2300 | ManagementAndGeneral |
| Fundraising | 41916 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 44216 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 375337 | BOY |
| EOY | 873816 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 198410 | BOY |
| EOY | 192894 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 573747 | BOY |
| EOY | 1110926 | 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 | 136539 | BOY |
| EOY | 51340 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 313193 | BOY |
| EOY | 935571 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 124015 | BOY |
| EOY | 124015 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 573747 | BOY |
| EOY | 1110926 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 573747 | BOY |
| EOY | 1110926 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 550021 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -12842 | ReconcilationOtherChanges |
| Method Of Accounting Cash | X | MethodOfAccountingCash |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 0 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type3 Func Int | X | SupportingOrg509a3Type3FuncInt |
| Certification Checkbox | X | CertificationCheckbox |
| 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 | VERNON MEMORIAL HEALTHCARE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390806404 | EIN |
| Type Of Organization | 3 | TypeOfOrganization |
| Listed In Governing Doc | 0 | ListedInGoverningDoc |
| Supported Organization Notified | 1 | SupportedOrganizationNotified |
| Organized In US | 1 | OrganizedInUS |
| Amount | $4,390 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 4390 | 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 D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 124015 | BeginningOfYearBalance |
| Contributions | 0 | Contributions |
| Investment Earnings Or Losses | 7750 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 7750 | GrantsOrScholarships |
| End Of Year Balance | 124015 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 124015 | BeginningOfYearBalance |
| Contributions | 0 | Contributions |
| Investment Earnings Or Losses | 7000 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 7000 | GrantsOrScholarships |
| End Of Year Balance | 124015 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 124015 | BeginningOfYearBalance |
| Contributions | 0 | Contributions |
| Investment Earnings Or Losses | 6028 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 6028 | GrantsOrScholarships |
| End Of Year Balance | 124015 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 124015 | BeginningOfYearBalance |
| Contributions | 0 | Contributions |
| Investment Earnings Or Losses | 8550 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 8550 | GrantsOrScholarships |
| End Of Year Balance | 124015 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
| Total Revenue | 606377 | TotalRevenue |
| Total Expenses | 56356 | TotalExpenses |
| Excess Or Deficit For Year | 550021 | ExcessOrDeficitForYear |
| Prior Period Adjustments | -12842 | PriorPeriodAdjustments |
| Total Adjustments | -12842 | TotalAdjustments |
| Excess Or Deficit Per FS | 537179 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 615713 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 9336 | OtherRevenues |
| Revenue Not Rptd F990 | 9336 | RevenueNotRptdF990 |
| Revenue Subtotal | 606377 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 606377 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 65692 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 9336 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 9336 | ExpensesNotRptdF990 |
| Expenses Subtotal | 56356 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 56356 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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: | IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE FOUNDATION ASSESSES 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 2012. FEDERAL RETURNS FOR THE YEARS ENDED SEPTEMBER 30, 2009, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. AS OF AND FOR THE YEAR ENDED SEPTEMBER 30, 2012, THERE WERE NO MATERIAL TAX PENALTIES OR INTEREST RELATED TO TAX PENALTIES RECORDED BY THE FOUNDATION IN THE FINANCIAL STATEMENTS. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | FUND-RAISING EXPENSES NET AGAINST REVENUE 9,336. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | FUND-RAISING EXPENSES NET AGAINST REVENUE 9,336. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | X | MailSolicitations |
| In Person Solicitations | X | InPersonSolicitations |
| Solicitation Of Non Govt Grants | X | SolicitationOfNonGovtGrants |
| Special Fundraising Events | X | SpecialFundraisingEvents |
| Agreement Ref Fundraising | 1 | AgreementRefFundraising |
Fundraiser Activity Information FundraiserActivityInformation
Name Of Organization NameOfOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE SWEENEY GROUP | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5816 LEDGEMONT COURT | AddressLine1 |
| City | MADISON | City |
| State | WI | State |
| ZIP Code | 53711 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | HOSPICE HOUSE FUNDRAISER | Activity |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFunds |
| Gross Receipts | 497405 | GrossReceipts |
| Amount Retained By Contractor | 29656 | AmountRetainedByContractor |
| Net To Organization | 467749 | NetToOrganization |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Gross Receipts | 497405 | TotalGrossReceipts |
| Total Retained By Contractors | 29656 | TotalRetainedByContractors |
| Total Net To Organization | 467749 | TotalNetToOrganization |
| Licensed States | WI | LicensedStates |
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF OUTING | NameOfEvent1 |
| Gross Receipts Event1 | 21555 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 4235 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 17320 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 3104 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 270 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 203 | OtherDirectExpensesEvent1 |
| Name Of Event2 | GALA | NameOfEvent2 |
| Gross Receipts Event2 | 20665 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 2665 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 18000 | GrossRevenueEvent2 |
| Food And Beverage Event2 | 5736 | FoodAndBeverageEvent2 |
| Other Direct Expenses Event2 | 24 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 42220 | GrossReceiptsTotal |
| Charitable Contributions Total | 6900 | CharitableContributionsTotal |
| Gross Revenue Total Events | 35320 | GrossRevenueTotalEvents |
| Rent Facility Costs Total Events | 3104 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 6006 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 227 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 9337 | DirectExpenseSummaryEvents |
| Net Income Summary | 25983 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | SCHOLARSHIPS | TypeOfGrant |
| Number Of Recipients | 10 | NumberOfRecipients |
| Amount Of Cash Grant | 7750 | AmountOfCashGrant |
| Method Of Valuation | FMV | MethodOfValuation |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | 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. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 5: | PRIOR PERIOD ADJUSTMENTS: -12,842. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VERNON MEMORIAL HEALTHCARE INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 507 SOUTH MAIN STREET | AddressLine1 |
| City | VIROQUA | City |
| State | WI | State |
| ZIP Code | 54655 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390806404 | EIN |
| Primary Activities | HOSPITAL | PrimaryActivities |
| Legal Domicile State | WI | 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 | 0 | 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 |
| 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 | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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