2013-08-06T15:24:41-05:00 2012-09-30 390758449 WIPFLI LLP 3703 OAKWOOD HILLS PARKWAY EAU CLAIRE WI 54701 990 2011-10-01 391515716 VERNON MEMORIAL HEALTHCARE FOUNDATION INC VERN 6086372101 507 SOUTH MAIN STREET VIROQUA WI 54665 RYAN CALLAN 6086372101 2013-07-31 1 HOLLY POKRANDT CPA P00449155 7158323407 2013-07-31 2011 2016-02-24 21:20:13Z RYAN CALLAN 507 SOUTH MAIN STREET VIROQUA WI 54665 657637 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 127415 569289 0 0 13009 11104 26873 25984 167297 606377 27000 12140 0 0 0 0 39630 37572 41916 4825 6644 71455 56356 95842 550021 573747 1110926 0 0 573747 1110926 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 12140 12140 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. 12140 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 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 JANA DREGNE 1.00 X 0 0 0 TOM SIMONSON 1.00 X 0 0 0 MARNY GILLEN 1.00 X X 0 0 0 RYAN CALLAN 1.00 X X 0 0 0 DIAN KRAUSE 1.00 X X 0 0 0 LENAY KUMLIN 1.00 X X 0 0 0 BRIAN MURPHY 1.00 X 0 0 0 PHYLLIS MALIN 1.00 X 0 0 0 DEBRA MASHAK-HUNDT 1.00 X X 0 0 0 ERIC NOTTESTAD 1.00 X 0 0 0 JEANETTA KIRKPATRICK 1.00 X 0 0 0 MARTHA OLSON 1.00 X 0 0 0 JOE BERRA 1.00 X 0 0 0 SHAWNA STRINGHAM 1.00 X 0 0 0 PHYLLIS EKLOV 1.00 X 0 0 0 0 0 0 0 0 0 0 0 6900 562389 569289 10790 10790 42238 41924 314 314 314 35320 6900 9336 25984 25984 606377 0 0 37088 4390 4390 7750 7750 2300 2300 37572 37572 1484 1484 2860 2860 56356 12140 2300 41916 0 44216 375337 873816 198410 192894 573747 1110926 0 0 X 136539 51340 313193 935571 124015 124015 573747 1110926 573747 1110926 X 550021 -12842 X 0 1 0 X 0 X X X 0 0 0 VERNON MEMORIAL HEALTHCARE 390806404 3 0 1 1 4390 1 4390 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 124015 0 7750 7750 124015 124015 0 7000 7000 124015 124015 0 6028 6028 124015 124015 0 8550 8550 124015 1.00000 0 0 0 606377 56356 550021 -12842 -12842 537179 615713 9336 9336 606377 0 606377 65692 9336 9336 56356 0 56356 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. X X X X 1 THE SWEENEY GROUP 5816 LEDGEMONT COURT MADISON WI 53711 HOSPICE HOUSE FUNDRAISER 0 497405 29656 467749 497405 29656 467749 WI GOLF OUTING 21555 4235 17320 3104 270 203 GALA 20665 2665 18000 5736 24 42220 6900 35320 3104 6006 227 9337 25983 1 SCHOLARSHIPS 10 7750 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: PRIOR PERIOD ADJUSTMENTS: -12,842. 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 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0