2012-07-05T13:47:13-05:00 2011-09-30 WIPFLI LLP 3703 OAKWOOD HILLS PARKWAY EAU CLAIRE WI 54701 990 2010-10-01 391515716 VERNON MEMORIAL HEALTHCARE FOUNDATION INC VERN 6086372101 507 SOUTH MAIN STREET VIROQUA WI 54665 MARY KOENIG 6086372101 2012-06-21 1 HOLLY POKRANDT CPA 7158323407 2012-06-21 2010 2016-02-24 21:20:13Z MARY KOENIG 507 SOUTH MAIN STREET VIROQUA WI 54665 179169 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 13 0 0 0 127415 0 0 0 13009 0 26873 0 167297 0 27000 0 0 0 0 0 39630 44329 0 4825 0 71455 0 95842 477905 573747 0 0 477905 573747 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 27000 27000 THE VERNON MEMORIAL HEALTHCARE FOUNDATION PROVIDED 10 INDIVIDUALS WHO ARE PURSUING OR FURTHERING THEIR EDUCATION IN THE HEALTH CARE FIELD SCHOLARSHIPS DURING 2011. THE FOUNDATION ALSO GRANTED VERNON MEMORIAL HEALTHCARE, INC. $20,000 TO BE USED FOR EMPLOYEE CONTINUING EDUCATION. 27000 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 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 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 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 WAYNE GATES 1.00 X 0 0 0 JOHN ZAHM 1.00 X X 0 0 0 MARNY GILLEN 1.00 X X 0 0 0 DR ROBERT KNADLE 1.00 X 0 0 0 DAN KANIS 1.00 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 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 0 0 0 0 0 0 0 0 0 0 0 1970 125445 127415 13009 13009 38745 1970 11872 26873 26873 167297 0 0 39882 20000 20000 7000 7000 39630 39630 126 126 SUPPLIES 4699 4699 71455 27000 126 44329 0 0 265736 375337 212169 198410 477905 573747 0 0 X 123847 136539 230043 313193 124015 124015 477905 573747 477905 573747 95842 0 X 0 0 0 X X X 0 0 0 VERNON MEMORIAL HEALTHCARE 390806404 3 0 1 1 20000 1 20000 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 124015 0 7000 7000 124015 124015 0 6028 6028 124015 124015 0 8550 8550 124015 1.00000 0 0 0 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. X X X X 1 THE SWEENEY GROUP 2998 OSMUNDSEN RD MADISON WI 53711 HOSPICE HOUSE FUNDRAISER 0 84037 33250 50787 84037 33250 50787 WI GALA 18272 1970 16302 3668 697 GOLF OUTING 22443 22443 260 760 3830 2314 343 40715 1970 38745 260 760 3830 5982 1040 11872 26873 1 VERNON MEMORIAL HEALTHCARE INC 507 SOUTH MAIN STREET VIROQUA WI 54665 390806404 501(C)(3) 20000 SUBSIDIZE CONTINUING EDUCATION OF EMPLOYEES 1 0 SCHOLARSHIPS 10 7000 FMV OTHER INFORMATION: PART IV: 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 APROVE 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 WILL BE NOTIFIED AT A REGULAR MEETING WHEN THE 990 HAS BEEN COMPLETED AND IS AVAILABLE FOR REVIEW. THE RETURN WILL BE AVAILABLE FOR REVIEW AT VERNON MEMORIAL HOSPITAL, INC. FORM 990, PART VI, SECTION B, LINE 12 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. VERNON MEMORIAL HEALTHCARE INC 507 SOUTH MAIN STREET VIROQUA WI 54655 390806404 HOSPITAL WI 501(C)(3) LINE 3 N/A 0 0 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0