TOMAH HEALTH COMMUNITY FOUNDATION INC: Form 990EZ, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- TOMAH HEALTH COMMUNITY FOUNDATION INC (EIN 39-1823757)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-02-14
- IRS object ID
- 201100459349201005
- Schema version
- 2009v1.7
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-02-14T13:31:30-06:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5601 Green Valley Drive Ste 700 | AddressLine1 |
| City | Minneapolis | City |
| State | MN | State |
| ZIP Code | 554371145 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990EZ | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391823757 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tomah Memorial Hospital Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | TOMA | NameControl |
| Phone | 6083722181 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 Butts Avenue | AddressLine1 |
| City | Tomah | City |
| State | WI | State |
| ZIP Code | 54660 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Ryan Steele | Name |
| Title | Chair | Title |
| Phone | 6083722181 | Phone |
| Date Signed | 2011-02-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Kim Hunwardsen CPA | Name |
| Phone | 9529446166 | Phone |
| Date Prepared | 2011-02-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Schedule B Not Required | X | ScheduleBNotRequired |
| Web Site | N/A | WebSite |
| Organization501c | X | Organization501c |
| Gross Receipts | 37241 | GrossReceipts |
| Contributions Gifts Grants Etc | 24807 | ContributionsGiftsGrantsEtc |
| Investment Income | 7854 | InvestmentIncome |
| Special Events Gross Revenue | 4580 | SpecialEventsGrossRevenue |
| Special Events Direct Expenses | 6356 | SpecialEventsDirectExpenses |
| Special Events Net Income Loss | -1776 | SpecialEventsNetIncomeLoss |
| Total Revenue | 30885 | TotalRevenue |
| Grants And Similar Amounts Paid | 57000 | GrantsAndSimilarAmountsPaid |
| Fees And Oth Pymt To Ind Contractors | 1400 | FeesAndOthPymtToIndContractors |
| Other Expenses Total | 768 | OtherExpensesTotal |
| Total Expenses | 59168 | TotalExpenses |
| Excess Or Deficit For Year | -28283 | ExcessOrDeficitForYear |
| Net Assets Or Fund Balances BOY | 427588 | NetAssetsOrFundBalancesBOY |
| Other Changes In Net Assets | 6371 | OtherChangesInNetAssets |
| Net Assets Or Fund Balances EOY | 405676 | NetAssetsOrFundBalancesEOY |
Cash Savings And Investments CashSavingsAndInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 427278 | BOY |
| EOY | 405236 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 310 | BOY |
| EOY | 440 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 427588 | BOY |
| EOY | 405676 | EOY |
Sum Of Total Liabilities SumOfTotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Net Assets Or Fund Balances NetAssetsOrFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 427588 | BOY |
| EOY | 405676 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Exempt Purpose | SUPPORT OF TOMAH MEMORIAL HOSPITAL AND SURROUNDING COMMUNITY. | PrimaryExemptPurpose |
Program Service Accomplishment ProgramServiceAccomplishment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Service Accom | The mission of Tomah Memorial Hospital Foundation is to support the community of Tomah and the healthcare providers that serve its residents. The focus of its suupport will be community-based wellness, facility upgrades, and the development of programs that benefit the local hospital and surrounding communities. | DescriptionProgramServiceAccom |
| Grants And Allocations | 57000 | GrantsAndAllocations |
| Program Service Expenses | 57678 | ProgramServiceExpenses |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | 57678 | TotalProgramServiceExpenses |
Officer Director Trustee Key Empl OfficerDirectorTrusteeKeyEmpl (10 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | TitleTitle | Avg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPosition | CompensationCompensation | Contri To Empl Benefit Plans EtcContriToEmplBenefitPlansEtc | Expense Account Other AllowancesExpenseAccountOtherAllowances |
|---|---|---|---|---|---|---|---|---|
| Ryan Steele | ||||||||
| 321 Butts Avenue | Tomah | WI | 54660 | Chair | 1.00 | 0 | 0 | 0 |
| Ray Habelman Jr | ||||||||
| 321 Butts Avenue | Tomah | WI | 54660 | Vice Chair | 1.00 | 0 | 0 | 0 |
| Jennifer Mubarak | ||||||||
| 321 Butts Avenue | Tomah | WI | 54660 | Secretary | 1.00 | 0 | 0 | 0 |
| Mike Mayhew | ||||||||
| 321 Butts Avenue | Tomah | WI | 54660 | Treasurer | 1.00 | 0 | 0 | 0 |
| Laura Damrow | ||||||||
| 321 Butts Avenue | Tomah | WI | 54660 | Director | 1.00 | 0 | 0 | 0 |
| Jennifer Parker | ||||||||
| 321 Butts Avenue | Tomah | WI | 54660 | Director | 1.00 | 0 | 0 | 0 |
| Gloria Dippen | ||||||||
| 321 Butts Avenue | Tomah | WI | 54660 | Director | 1.00 | 0 | 0 | 0 |
| Therese Conway | ||||||||
| 321 Butts Avenue | Tomah | WI | 54660 | Director | 1.00 | 0 | 0 | 0 |
| Sandra Humphrey | ||||||||
| 321 Butts Avenue | Tomah | WI | 54660 | Director | 1.00 | 0 | 0 | 0 |
| Pete Reichardt | ||||||||
| 321 Butts Avenue | Tomah | WI | 54660 | Director | 1.00 | 0 | 0 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRpt |
| Made Changes To Orgnzng Etc Doc | 0 | MadeChangesToOrgnzngEtcDoc |
| Organization Had UBI | 0 | OrganizationHadUBI |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtc |
| Direct Indirect Political Expend | 0 | DirectIndirectPoliticalExpend |
| Made Loans To From Officers | 0 | MadeLoansToFromOfficers |
| Tax Imposed Under IRC4911 | 0 | TaxImposedUnderIRC4911 |
| Tax Imposed Under IRC4912 | 0 | TaxImposedUnderIRC4912 |
| Tax Imposed Under IRC4955 | 0 | TaxImposedUnderIRC4955 |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTrans |
| Amount Of Tax Imposed On Org Mgr | 0 | AmountOfTaxImposedOnOrgMgr |
| Amount Of Tax Reimbursed By Org | 0 | AmountOfTaxReimbursedByOrg |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Joseph Zeps | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 Butts Avenue | AddressLine1 |
| City | Tomah | City |
| State | WI | State |
| ZIP Code | 54660 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6083740286 | TelephoneNumber |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Foreign Office | 0 | ForeignOffice |
| Maintain Any Donor Advised Funds | 0 | MaintainAnyDonorAdvisedFunds |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Engage Political Cmpgn Activities | 0 | EngagePoliticalCmpgnActivities |
| Engage In Lobbying Activities | 0 | EngageInLobbyingActivities |
| Operating School | 0 | OperatingSchool |
| Trnsfrs Exempt Non Char Related Org | 0 | TrnsfrsExemptNonCharRelatedOrg |
| Part VI Of Comp Of Highest Paid Empl | NONE | PartVIOfCompOfHighestPaidEmpl |
| Part VIA Hghst Paid Cntrct Prof Ser | NONE | PartVIAHghstPaidCntrctProfSer |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 78412 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 29985 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 29264 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 29496 | CurrentTaxYearMinus1Year |
| Current Tax Year | 24807 | CurrentTaxYear |
| Total | 191964 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 5290 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 5270 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6240 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 5270 | CurrentTaxYearMinus1Year |
| Current Tax Year | 4580 | CurrentTaxYear |
| Total | 26650 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 83702 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 35255 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 35504 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 34766 | CurrentTaxYearMinus1Year |
| Current Tax Year | 29387 | CurrentTaxYear |
| Total | 218614 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 30000 | CurrentTaxYearMinus3Years |
| Total | 30000 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 30000 | CurrentTaxYearMinus3Years |
| Total | 30000 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 188614 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 9285 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 14188 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 13571 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 10690 | CurrentTaxYearMinus1Year |
| Current Tax Year | 7854 | CurrentTaxYear |
| Total | 55588 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 9285 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 14188 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 13571 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 10690 | CurrentTaxYearMinus1Year |
| Current Tax Year | 7854 | CurrentTaxYear |
| Total | 55588 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 92987 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 49443 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 49075 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 45456 | CurrentTaxYearMinus1Year |
| Current Tax Year | 37241 | CurrentTaxYear |
| Total | 274202 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.68790 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.71660 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.20270 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.18200 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Golf outing | NameOfEvent1 |
| Gross Receipts Event1 | 22622 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 18367 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 4255 | GrossRevenueEvent1 |
| Other Direct Expenses Event1 | 6356 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 22622 | GrossReceiptsTotal |
| Charitable Contributions Total | 18367 | CharitableContributionsTotal |
| Gross Revenue Total Events | 4255 | GrossRevenueTotalEvents |
| Other Direct Expenses Total Events | 6356 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 6356 | DirectExpenseSummaryEvents |
| Net Income Summary | -2101 | NetIncomeSummary |
Transfer Prsnl Bnft Contracts Decl TransferPrsnlBnftContractsDecl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Declaration | The organization did not, during the year, receive any funds, directly,or indirectly, to pay premiums on a personal benefit contract.The organization, did not, during the year, pay any premiums, directly,or indirectly, on a personal benefit contract. | Declaration |
Comments