CALUMET AREA COMMUNITY HEALTH FOUNDATION INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: CALUMET AREA COMMUNITY HEALTH FOUNDATION INC (EIN 39-1948002)
Tax period: 2011-10-01 to 2012-09-30
Filed: 2012-11-30
IRS object ID: 201223359349300822
Schema version: 2011v1.2
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
Form 990
Schedule A
Schedule D
Schedule I
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-11-30T14:07:13-00:00	Timestamp
Tax Period End Date	2012-09-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Ronald J Langenfeld CPA SC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	632 Fremont St PO Box 173	AddressLine1
City	Kiel	City
State	WI	State
ZIP Code	530420173	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	391948002	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Calumet Area Community Health Foundation Inc	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	CALU	NameControl
Phone	9208499371	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	451 E Brooklyn Street	AddressLine1
City	Chilton	City
State	WI	State
ZIP Code	53014	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	Paul Hugo	Name
Title	President	Title
Date Signed	2012-11-30	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	Ronald Langenfeld	Name
Phone	9208942143	Phone
Date Prepared	2012-11-30	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	Paul Hugo	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	451 E Brooklyn Street	AddressLine1
City	Chilton	City
State	WI	State
ZIP Code	53014	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	571327	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	www.cachf.org	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1997	YearFormation
State Legal Domicile	WI	StateLegalDomicile
Activity Or Mission Description	To promote the health, welfare and health related education which directly or indirectly support and benefit Calumet Medical Center and the health of citizens residing within the Chilton, New Holstein, Kiel, Hilbert, Potter, Stockbridge and Brillion zip codes.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	9	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	8	NbrIndependentVotingMembers
Total Nbr Employees	1	TotalNbrEmployees
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	142	ContributionsGrantsPriorYear
Contributions Grants Current Year	21000	ContributionsGrantsCurrentYear
Program Service Revenue CY	0	ProgramServiceRevenueCY
Investment Income Prior Year	686242	InvestmentIncomePriorYear
Investment Income Current Year	202999	InvestmentIncomeCurrentYear
Other Revenue Prior Year	653	OtherRevenuePriorYear
Other Revenue Current Year	550	OtherRevenueCurrentYear
Total Revenue Prior Year	687037	TotalRevenuePriorYear
Total Revenue Current Year	224549	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	342000	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	31500	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	20721	SalariesEtcPriorYear
Salaries Etc Current Year	19879	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	39840	OtherExpensePriorYear
Other Expenses Current Year	42345	OtherExpensesCurrentYear
Total Expenses Prior Year	402561	TotalExpensesPriorYear
Total Expenses Current Year	93724	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	284476	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	130825	RevenuesLessExpensesCY
Total Assets BOY	6244129	TotalAssetsBOY
Total Assets EOY	7126751	TotalAssetsEOY
Total Liabilities BOY	302320	TotalLiabilitiesBOY
Total Liabilities EOY	317969	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	5941809	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	6808782	NetAssetsOrFundBalancesEOY
Mission Description	To promote the health, welfare and health related education which directly or indirectly support and benefit Calumet Medical Center and the health of citizens residing within the Chilton, New Holstein, Kiel, Hilbert, Potter, Stockbridge and Brillion zip codes.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	31500	Expense
Grants	31500	Grants
Revenue	224549	Revenue
Description	See Annual Report for Program Achievements	Description
Total Program Service Expense	31500	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	false	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	true	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	true	GrantsToOrganizations
Grants To Individuals	true	GrantsToIndividuals
Schedule J Required	false	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	true	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transaction Related Entity	false	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	0	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	1	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Form8899 Filed	false	Form8899Filed
Form1098 C Filed	false	Form1098CFiled
Excess Business Holdings	false	ExcessBusinessHoldings
Taxable Distributions	false	TaxableDistributions
Distribution To Donor	false	DistributionToDonor
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	9	NbrVotingGoverningBodyMembers
Number Independent Voting Members	8	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	true	LocalChapters
Policies Reference Chapters	true	PoliciesReferenceChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	false	ConflictOfInterestPolicy
Whistleblower Policy	false	WhistleblowerPolicy
Document Retention Policy	false	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	false	CompensationProcessOther
Investment In Joint Venture	false	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	Paul Hugo	NamePerson
Telephone Number	9208498700	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	451 E Brooklyn Street	AddressLine1
City	Chilton	City
State	WI	State
ZIP Code	53014	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	OfficerOfficer	Key EmployeeKeyEmployee	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Individual Trustee Or DirectorIndividualTrusteeOrDirector
Paul Hugo
President	010.00	X	X	18450	0	0
TJ Friederichs
Vice President	002.00	X		0	0	0
Norbert Keuler
Treasurer	002.00	X		0	0	0
Mary Langenfeld
Secretary	002.00	X		0	0	0
Michael Ariens
Director	002.00			0	0	0	X
Daniel Thiel
Director	002.00			0	0	0	X
Gene Tipler MD
Director	002.00			0	0	0	X
Joe Mathes
Director	002.00			0	0	0	X
Travis Anderson
Director	002.00			0	0	0	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	18450	TotalReportableCompFromOrg
Formers Listed	false	FormersListed
Total Comp GT150 K	false	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources
All Other Contributions	21000	AllOtherContributions
Total Contributions	21000	TotalContributions

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	150057	TotalRevenueColumn
Related Or Exempt Function Income	150057	RelatedOrExemptFunctionIncome

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	550	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	550	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	550	TotalRevenueColumn
Related Or Exempt Function Income	550	RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	399720	Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	346778	Securities

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	52942	Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	52942	TotalRevenueColumn
Related Or Exempt Function Income	52942	RelatedOrExemptFunctionIncome

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	224549	TotalRevenueColumn
Related Or Exempt Function Income	203549	RelatedOrExemptFunctionIncome

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	15500	Total
Program Services	15500	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	16000	Total
Program Services	16000	ProgramServices

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	0	Total

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	18450	Total
Management And General	18450	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	0	Total

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	0	Total

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	0	Total

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	1429	Total
Management And General	1429	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	10010	Total
Management And General	10010	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	0	Total

Field	Value	IRS element (for citing)
Fees For Services Prof Fundraising		FeesForServicesProfFundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	26945	Total
Management And General	26945	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	0	Total

Advertising Advertising

Field	Value	IRS element (for citing)
Total	1348	Total
Management And General	1348	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	1136	Total
Management And General	1136	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	0	Total

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	0	Total

Travel Travel

Field	Value	IRS element (for citing)
Total	0	Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	0	Total

Interest Interest

Field	Value	IRS element (for citing)
Total	0	Total

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	197	Total
Management And General	197	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	1846	Total
Management And General	1846	ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescription	TotalTotal	Management And GeneralManagementAndGeneral
Postage	64	64
Dues Subscriptions	695	695
License Permits	104	104

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	0	Total

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	93724	Total
Program Services	31500	ProgramServices
Management And General	62224	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	9102	BOY
EOY	8623	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	380528	BOY
EOY	693406	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	1163	BOY
EOY	1171	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	249328	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	12346	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	237179	BOY
EOY	236982	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	5616157	BOY
EOY	6186569	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	6244129	BOY
EOY	7126751	EOY

Grants Payable GrantsPayable

Field	Value	IRS element (for citing)
BOY	300000	BOY
EOY	316000	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	2320	BOY
EOY	1969	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	302320	BOY
EOY	317969	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	5918460	BOY
EOY	6786235	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1791	BOY
EOY	989	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	21558	BOY
EOY	21558	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	5941809	BOY
EOY	6808782	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	6244129	BOY
EOY	7126751	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	130825	ReconcilationRevenueExpenses
Reconcilation Other Changes	736148	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	true	AuditCommittee
Financial Statement Separate	X	FinancialStatementSeparate
Federal Grant Audit Required	false	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	false	ContribByControllingIndividual
Contribution By Related Party	false	ContributionByRelatedParty
Contrib By35 Controlled Entity	false	ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Calumet Medical Center	BusinessNameLine1

Field	Value	IRS element (for citing)
EIN	390905385	EIN
Type Of Organization	7	TypeOfOrganization
Listed In Governing Doc	true	ListedInGoverningDoc
Supported Organization Notified	true	SupportedOrganizationNotified
Organized In US	true	OrganizedInUS
Amount	$15,500	Amount

Field	Value	IRS element (for citing)
Total Number Of Supported Orgs	1	TotalNumberOfSupportedOrgs
Sum Of Amounts	15500	SumOfAmounts
Public Support Pertcentage170	0.00000	PublicSupportPertcentage170
Public Support Percentage509	0.00000	PublicSupportPercentage509
Investment Income Percentage	0.00000	InvestmentIncomePercentage

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Included On FS	false	IncludedOnFS

Land Land

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	236208	InvestmentCostOrOtherBasis
Book Value	236208	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	10484	OtherCostOrOtherBasis
Depreciation	10470	Depreciation
Book Value	14	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	2636	OtherCostOrOtherBasis
Depreciation	1876	Depreciation
Book Value	760	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	236982	TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
Description	Accrued Wages Payroll Taxes	Description
Amount	$1,969	Amount

Field	Value	IRS element (for citing)
Total Of Amounts	1969	TotalOfAmounts
Total Revenue	224549	TotalRevenue
Total Expenses	93724	TotalExpenses
Excess Or Deficit For Year	130825	ExcessOrDeficitForYear
Net Unrealized GL On Investments	736148	NetUnrealizedGLOnInvestments
Total Adjustments	736148	TotalAdjustments
Excess Or Deficit Per FS	866973	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	933752	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	736148	NetUnrealizedGainsInvestments
Revenue Not Rptd F990	736148	RevenueNotRptdF990
Revenue Subtotal	197604	RevenueSubtotal
Investment Expenses Not Included	26945	InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt	26945	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	224549	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	66779	TotExpensesEtcAuditedFinclStmt
Expenses Subtotal	66779	ExpensesSubtotal
Investment Expenses Not Included2	26945	InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt	26945	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	93724	TotalExpensesPerForm990

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	true	RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	Calumet Medical Center	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	614 Memorial Drive	AddressLine1
City	Chilton	City
State	WI	State
ZIP Code	53014	ZIPCode

Field	Value	IRS element (for citing)
EIN Of Recipient	390905385	EINOfRecipient
IRC Section	170b1Aiii	IRCSection
Amount Of Cash Grant	15500	AmountOfCashGrant
Purpose Of Grant	See Annual Report	PurposeOfGrant

Field	Value	IRS element (for citing)
Total Nbr Of Other Organizations	1	TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

Field	Value	IRS element (for citing)
Type Of Grant	Scholarships	TypeOfGrant
Number Of Recipients	16	NumberOfRecipients
Amount Of Cash Grant	16000	AmountOfCashGrant

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Form 990 Part VI	11b	The process the organization uses is to include the Form 990 review in its Board of Directors meeting agenda and Board Members are able to to review the Form 990 at this meeting.
Form 990 Part VI	15a	The organization determines the CEOs compensation based on comparability data furnished by the Association of Small Foundations.
Form 990 Part VI	19	The organization makes its documents and financial statements available to the public upon request.
Form 990 Part XI	5	Net Unrealized Gain on Investments
Form 990 Part VIII	7	The acquired and sold dates used for sale of securities are default dates due to the numerous number of security sales.
		Form 990 Part VI Section B Line 11b The process the organization uses is to include the Form 990 review in its Board of Directors meeting agenda and Board Members are able to to review the Form 990 at this meeting. Form 990 Part VI Section B Line 15a The organization determines the CEOs compensation based on comparability data furnished by the Association of Small Foundations. Form 990 Part VI Section C Line 19 The organization makes its documents and financial statements available to the public upon request. Form 990 Part XI Line 5 Net Unrealized Gain on Investments Form 990 Part VIII Line 7 The acquired and sold dates used for sale of securities are default dates due to the numerous number of security sales.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

Field	Value	IRS element (for citing)
Business Name Line1	CALUMET MEDICAL CENTER	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	614 MEMORIAL DRIVE	AddressLine1
City	CHILTON	City
State	WI	State
ZIP Code	53014	ZIPCode

Field	Value	IRS element (for citing)
EIN	390905385	EIN
Primary Activities	HOSPITAL	PrimaryActivities
Legal Domicile State	WI	LegalDomicileState
Exempt Code Section	170b1Aiii	ExemptCodeSection
Public Charity Status	7	PublicCharityStatus
Direct Controlling Entity NA	N/A	DirectControllingEntityNA
Controlled Org	false	ControlledOrg

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	false	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	true	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	false	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	false	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	false	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	false	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	false	ExchangeOfAssets
Rental Of Facilities To Other Orgs	false	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	false	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	false	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	false	PerformOfServicesByOtherOrgs
Sharing Of Facilities	true	SharingOfFacilities
Sharing Of Paid Employees	false	SharingOfPaidEmployees
Reimbursement Paid To Other Org	false	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	false	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	false	OtherTransferToOtherOrg
Other Transfer From Other Org	false	OtherTransferFromOtherOrg