SHERIDAN HEALTH CARE FOUNDATION INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
SHERIDAN HEALTH CARE FOUNDATION INC (EIN 81-0496987)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-03-15
IRS object ID
201200759349301260
Schema version
2010v3.4
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

FieldValueIRS element (for citing)
Timestamp2012-03-15T15:53:58-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CHMS PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1741 3RD AVE SAddressLine1
CityGLASGOWCity
StateMTState
ZIP Code59230ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN810496987EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SHERIDAN HEALTHCARE FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSHERNameControl
Phone4067651420Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1440 W LAUREL AVENUEAddressLine1
CityPLENTYWOODCity
StateMTState
ZIP Code59254ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSANDRA CHRISTENSENName
TitleCEOTitle
Phone4067651420Phone
Date Signed2012-03-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRICHARD A WIENS CPAName
Phone4062289391Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSANDRA CHRISTENSENNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1440 W LAUREL AVENUEAddressLine1
CityPLENTYWOODCity
StateMTState
ZIP Code59254ZIPCode
FieldValueIRS element (for citing)
Gross Receipts332706GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SHERIDANMEMORIAL.NET/FOUNDATIONWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1994YearFormation
State Legal DomicileMTStateLegalDomicile
Activity Or Mission DescriptionTO SUPPORT SHERIDAN MEMORIAL HOSPITAL AND NURSING HOME.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers21TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year170115ContributionsGrantsPriorYear
Contributions Grants Current Year253866ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year58662InvestmentIncomePriorYear
Investment Income Current Year78840InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year228777TotalRevenuePriorYear
Total Revenue Current Year332706TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year102473GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY78705GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year0OtherExpensePriorYear
Other Expenses Current Year0OtherExpensesCurrentYear
Total Expenses Prior Year102473TotalExpensesPriorYear
Total Expenses Current Year78705TotalExpensesCurrentYear
Revenues Less Expenses Prior Year126304RevenuesLessExpensesPriorYear
Revenues Less Expenses CY254001RevenuesLessExpensesCY
Total Assets BOY784893TotalAssetsBOY
Total Assets EOY1038894TotalAssetsEOY
Total Liabilities BOY0TotalLiabilitiesBOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY784893NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1038894NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO SUPPORT SHERIDAN MEMORIAL HOSPITAL AND NURSING HOME BY PROMOTING ITS IMAGE IN THE COMMUNITY AND BY PROVIDING FINANCIAL CONTRIBUTIONS THROUGH FUNDRAISING ACTIVITIES FOR THE EXPANSION AND MAINTENANCE OF THE FACILITY AND FOR SERVICES PROVIDED TO OUR COMMUNITY AND SURROUNDING AREAS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense78705Expense
DescriptionDISTRIBUTIONS MADE TO SHERIDAN MEMORIAL HOSPITAL, A 501(C)3 ORGANIZATION, TO HELP FUND MEDICAL ACTIVITIES.Description
Total Program Service Expense78705TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SANDRA CHRISTIENSEN CEOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4067651420TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1440 W LAUREL AVENUEAddressLine1
CityPLENTYWOODCity
StateMTState
ZIP Code59254ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
ARDELL ANGVICK
TREASURER1.00XX000
JANDY JORGENSON
SECRETARY1.00X000
JANET MCCABLE
VICE-CHAIRMAN1.00XX000
LEEANN JENSEN
DIRECTOR1.00X000
BILL MCCOY
DIRECTOR1.00X000
PAUL HANSEN
CHAIRMAN2.00X000
JIM MAUS
DIRECTOR1.00X000
BEATIE PETERSON
DIRECTOR1.00X000
JOAN TOMMERUP
DIRECTOR1.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
All Other Contributions253866AllOtherContributions
Total Contributions253866TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column78840TotalRevenueColumn
Related Or Exempt Function Income78840RelatedOrExemptFunctionIncome

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column332706TotalRevenueColumn
Related Or Exempt Function Income78840RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total78705Total
Program Services78705ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total78705Total
Program Services78705ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY467058BOY
EOY531815EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY11051BOY
EOY10596EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY306784BOY
EOY496483EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY784893BOY
EOY1038894EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY592105BOY
EOY858208EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY165713BOY
EOY153491EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY27075BOY
EOY27195EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY784893BOY
EOY1038894EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY784893BOY
EOY1038894EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses254001ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee0AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years80872CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years83786CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years236013CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year170115CurrentTaxYearMinus1Year
Current Tax Year253866CurrentTaxYear
Total824652Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years80872CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years83786CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years236013CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year170115CurrentTaxYearMinus1Year
Current Tax Year253866CurrentTaxYear
Total824652Total
FieldValueIRS element (for citing)
Public Support Total170824652PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years43707CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8570CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years20963CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year58662CurrentTaxYearMinus1Year
Current Tax Year78810CurrentTaxYear
Total210712Total
FieldValueIRS element (for citing)
Total Support1035364TotalSupport
Public Support Pertcentage1700.79650PublicSupportPertcentage170
Public Support Pertcent Prior Year0.83650PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance27075BeginningOfYearBalance
Contributions120Contributions
End Of Year Balance27195EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance26855BeginningOfYearBalance
Contributions220Contributions
End Of Year Balance27075EndOfYearBalance
FieldValueIRS element (for citing)
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
ExplanationUNREALIZED LOSSESExplanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1SHERIDAN MEMORIAL HOSPITAL ASSNBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1440 W LAUREL AVEAddressLine1
CityPLENTYWOODCity
StateMTState
ZIP Code59254ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient810243720EINOfRecipient
Amount Of Cash Grant78705AmountOfCashGrant
Purpose Of GrantGRANTS ARE DISTRIBUTED TO PROJECTS THAT WILL IMPROVE THE QUALITY OF HEALTH CARE GIVEN BY THE HOSPITAL.PurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 2LEANN JENSEN IS PAUL HANSEN'S MOTHER-IN-LAW.
FORM 990, PART VI, SECTION B, LINE 11RETURN IS REVIEWED AT A REGULAR BOARD MEETING.
THE POLICY IS REVIEWED ANNUALLY BY THE BOARD.FORM 990, PART VI, SECTION B, LINE 12C
ALL GOVERNING DOCUMENTS RELATED TO THE SHERIDAN HEALTHCARE FOUNDATION ARE AVAILABLE UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1SHERIDAN MEMORIAL HOSPITAL ASSOCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1440 W LAUREL AVEAddressLine1
CityPLENTYWOODCity
StateMTState
ZIP Code59254ZIPCode
FieldValueIRS element (for citing)
EIN810243720EIN
Primary ActivitiesHOSPITALPrimaryActivities
Legal Domicile StateMTLegalDomicileState
Exempt Code Section501(C)3ExemptCodeSection
Public Charity Status170(B)(1)(A)(III)PublicCharityStatus
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1SHERIDAN MEMORIAL HOSPITAL ASSNBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeBTransactionType
Amount Involved78705AmountInvolved

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.