2013-03-15T14:26:46-05:00 2012-04-30 390758449 WIPFLI LLP 7601 FRANCE AVENUE SOUTH SUITE 400 MINNEAPOLIS MN 55435 990 2011-05-01 391726539 AMERY REGIONAL MEDICAL CENTER FOUNDATION INC AMER 7152688000 265 GRIFFIN STREET EAST AMERY WI 54001 DAN LIEN 7152688000 2013-03-15 1 KRISTEN HAGER CPA P01359220 9525483400 2013-03-15 2011 2016-03-07 17:11:31Z DAN LIEN 265 GRIFFIN STREET EAST AMERY WI 54001 48811 0 X WWW.AMERYMEDICALCENTER.ORG X 1991 WI THE FOUNDATION EXISTS TO PROMOTE THE HEALTH AND WELLNESS OF THE PEOPLE IN THE COMMUNITIES SERVED BY AMERY REGIONAL MEDICAL CENTER (ARMC) AND BY PARTICIPATING IN VARIOUS FUNDRAISING ACTIVITIES. 12 10 0 60 0 0 0 37814 0 0 0 361 0 1779 0 39954 0 30677 0 0 0 0 0 0 0 0 0 0 30677 0 9277 130664 139941 0 0 130664 139941 NONE 0 0 30677 30677 ARMC PATIENTS ARE NOT ALWAYS ABLE TO SECURE THEIR OWN TRANSPORTATION FOR THEIR BEHAVIORAL HEALTH APPOINTMENTS. TO MEET THIS NEED THE FOUNDATION PROVIDED FUNDS TO PURCHASE A SPECIALLY EQUIPPED PASSENGER VAN. THE FOUNDATION PROVIDED FUNDS TO CREATE A SAFE CHILDREN'S PLAY AREA AND TOYS FOR THE AMERY CLINIC. 30677 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 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 X 12 10 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 0 0 0 WI X SCOTT EDIN 7152688000 265 GRIFFIN STREET EAST AMERY WI 54001 BETH HEINZ 1.00 X 0 0 0 MARYANN SCOGLIO 1.00 X 0 1000 0 ANN SEAGREN 1.00 X 0 200 0 JOHN WHITE MD 1.00 X 0 1200 0 KATHRYN ISAKSON 1.00 X 0 25982 343 DYLAN COE MD 1.00 X 0 1200 0 RANAE NYGAARD 1.00 X 0 109292 6934 ROSS BULLARD 1.00 X 0 0 0 HEIDI ERSPAMER 1.00 X 0 1200 0 DANIEL LIEN 1.00 X X 0 1200 0 JAMES LEADHOLM 1.00 X X 0 1200 0 MICHAEL JENSEN 1.00 X X 0 1200 0 JOAN BRYNES 1.00 X X 0 1200 0 0 144874 7277 0 0 0 0 0 18365 19449 37814 361 361 10636 18365 8857 1779 1779 39954 0 0 2140 30677 30677 30677 30677 0 0 130664 139941 130664 139941 0 0 X 130664 139941 130664 139941 130664 139941 9277 0 X X 0 1 1 X 0 X 53140 12201 23675 10151 37814 136981 53140 12201 23675 10151 37814 136981 7972 129009 4366 379 948 776 361 6830 143811 66030 0.89710 0.77800 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 39954 30677 9277 9277 50873639 50833685 50833685 39954 0 39954 50763312 50732635 50732635 30677 0 30677 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740-10, INCOME TAXES, REQUIRES AN ORGANIZATION TO ASSESS 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 TAX 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. MANAGEMENT DOES NOT BELIEVE THE HOSPITAL HAS ANY MATERIAL UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS. THE HOSPITAL RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2012 AND 2011. FEDERAL RETURNS FOR TAX YEARS 2008 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XII, LINE 2D - OTHER ADJUSTMENTS: CONSOLIDATED ENTITY REVENUE 50,824,828. FUNDRAISING EVENT EXPENSE 8,857. PART XIII, LINE 2D - OTHER ADJUSTMENTS: CONSOLIDATED ENTITY EXPENSE 50,723,778. FUNDRAISING EVENT EXPENSE 8,857. GOLF TOURNAMENT 29001 18365 10636 1519 3940 1286 2112 29001 18365 10636 1519 3940 1286 2112 8857 1779 1 AMERY REGIONAL MEDICAL CENTER INC 265 GRIFFIN STREET EAST AMERY WI 54001 390908320 501(C)(3) 175 30502 FMV VAN, TOYS FOR CHILDREN, CHILDREN'S PLAY AREA SUPPORT AMERY REGIONAL MEDICAL CENTER, INC. 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION MONITORS THE USE OF GRANT FUNDS THROUGH ITS ONGOING RELATIONSHIP WITH AMERY REGIONAL MEDICAL CENTER, INC. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS 5 CLASSES OF MEMBERSHIP; CHARTER MEMBERS, LIFETIME MEMBERS, REGULAR MEMBERS, HONORARY MEMBERS, AND NON-VOTING MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A CHARTER MEMBERS, LIFETIME MEMBERS, REGULAR MEMBERS, AND HONORARY MEMBERS HAVE RIGHTS TO ELECT THE DIRECTORS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY THE ORGANIZATION'S SENIOR ACCOUNTANT, THEN THE CEO AND CFO. FORM 990, PART VI, SECTION B, LINE 12C AS PART OF THE PERFORMANCE REVIEW PROCESS, PERSONS ARE ASKED TO REVIEW THE CONFLICT OF INTEREST POLICY AND THEN COMPLETE A FORM AND SIGN. THE HUMAN RESOURCE DEPARTMENT OF ARMC ENSURES THE FORM IS RETURNED BY ALL STAFF AND REVIEWS THE FORMS. IF A POTENTIAL CONFLICT IS IDENTIFIED, THE COMPLIANCE OFFICER FOLLOWS UP. THE GOVERNING BOARD COMPLETE AND SIGN THE CONFLICT OF INTEREST FORM YEARLY. THE FORMS ARE REVIEWED BY THE BOARD SECRETARY AND IF A POTENTIAL CONFLICT IS IDENTIFIED, THE COMPLIANCE OFFICER FOLLOWS UP. BOARD MEMBERS WITH CONFLICTS ARE RESTRICTED FROM VOTING ON SUCH MATTERS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS OF THE ORGANIZATION ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. AMERY REGIONAL MEDICAL CENTER INC 265 GRIFFIN STREET EAST AMERY WI 54001 390908320 HEALTHCARE SERVICES WI 501(C)(3) LINE 3 AMERY REGIONAL MEDICAL CENTER FOUNDATION 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0