FAIRMONT COMMUNITY HOSPITAL FOUNDATION: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- FAIRMONT COMMUNITY HOSPITAL FOUNDATION (EIN 41-1658658)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-14
- IRS object ID
- 201103189349303400
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-14T11:24:02-06:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411658658 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRMONT COMMUNITY HOSPITAL FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FAIR | NameControl |
| Phone | 5072388177 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 MEDICAL CENTER DR PO BOX 800 | AddressLine1 |
| City | FAIRMONT | City |
| State | MN | State |
| ZIP Code | 56031 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SHELLY KRAHMER | Name |
| Title | PRESIDENT | Title |
| Phone | 5072844571 | Phone |
| Date Signed | 2011-11-14 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | SHELLY KRAHMER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 MEDICAL CENTER DR PO BOX 800 | AddressLine1 |
| City | FAIRMONT | City |
| State | MN | State |
| ZIP Code | 56031 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 265121 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1989 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | ENHANCING HEALTH CARE THROUGH CHARITABLE SUPPORT | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 199 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 257869 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 250946 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 44230 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2587 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 20135 | OtherRevenuePriorYear |
| Other Revenue Current Year | 11588 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 322234 | TotalRevenuePriorYear |
| Total Revenue Current Year | 265121 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 246487 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 217351 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 71 | OtherExpensePriorYear |
| Other Expenses Current Year | 24 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 246558 | TotalExpensesPriorYear |
| Total Expenses Current Year | 217375 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 75676 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 47746 | RevenuesLessExpensesCY |
| Total Assets BOY | 1799709 | TotalAssetsBOY |
| Total Assets EOY | 2006031 | TotalAssetsEOY |
| Total Liabilities BOY | 23586 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 15344 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1776123 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1990687 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | ENHANCING HEALTH CARE THROUGH CHARITABLE SUPPORT. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 216071 | Expense |
| Grants | 216071 | Grants |
| Description | THE FOUNDATION ENHANCES HEALTH CARE THROUGH CHARITABLE SUPPORT. PROCEEDS FROM EVENTS WERE USED BY FAIRMONT MEDICAL CENTER - MAYO HEALTH SYSTEM (FMC) FOR CAPITAL EQUIPMENT. IN THE PAST YEAR THE FOUNDATION WAS ABLE TO PURCHASE INFUSION PUMPS, A VIDEO SWALLOW CHAIR, A BLANKET WARMER FOR CHEMOTHERAPY, 6 RECLINERS FOR PATIENT ROOMS, A MOTORIZED PATIENT TRANSPORT CHAIR, 75 IV POLES, 4 CHEMOTHERAPY TREATMENT CHAIRS, A REFRIGERATOR FOR THE LABORATORY, AND WHEELCHAIRS FOR THE CLINIC. SEE SCHEDULE O FOR EXPLANATION OF ADDITIONAL EXPENSES RELATED TO THIS ACTIVITY.THE FOUNDATION RECEIVED DONATED MANAGEMENT AND GENERAL SERVICES OF APPROXIMATELY $183,822 FROM FMC FOR THE YEAR ENDED DECEMBER 31, 2010. THIS AMOUNT IS NOT REFLECTED IN THE ACCOMPANYING STATEMENTS OF ACTIVITIES AS CONTRIBUTION INCOME AND MANAGEMENT AND GENERAL, SPECIAL EVENTS, AND FUNDRAISING EXPENSES. THE DONATED SERVICES FROM FMC INCLUDE MISCELLANEOUS EXPENSES NECESSARY IN THE IMPLEMENTATION AND OPERATION OF FUNDRAISING AND SPECIAL EVENTS. IN ADDITION, THE FOUNDATION RECEIVED DONATED USE OF FACILITIES FROM FMC. THE VALUE OF THE USE OF FACILITIES WAS NOT MATERIAL AND HAS NOT BEEN RECORDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1280 | Expense |
| Grants | 1280 | Grants |
| Description | THE FOUNDATION AWARDS THE ERMA H. ROSEN NURSING SCHOLARSHIP. SCHOLARSHIP(S) ARE AWARDED TO NURSING STUDENT(S) WHO HAVE COMPLETED TWO FULL YEARS AND ARE ENTERING THE THIRD YEAR OF AN ACCREDITED NURSING PROGRAM. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | THE FOUNDATION HAD APPROXIMATELY 180 VOLUNTEERS WHO CONTRIBUTED APPROXIMATELY 12,000 HOURS. (AT AN APPROXIMATE VALUE OF $256,320 BASED ON STATISTICS FROM THE INDEPENDENT SECTOR). | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 217351 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 8 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 0 | ConflictOfInterestPolicy |
| Whistleblower Policy | 0 | WhistleblowerPolicy |
| Document Retention Policy | 0 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DARLA NELSON PHILIPP | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5072388177 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 800 | AddressLine1 |
| City | FAIRMONT | City |
| State | MN | State |
| ZIP Code | 56031 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| BERTHELSEN MD STEPHEN | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| COLE MARY | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| DRAUT RUTH | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| FORSTROM DOUG | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| HANSEN DALE | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| JENKINSON JERRY | ||||||
| VP (JAN-SEPT) | 1.00 | X | 0 | 0 | 0 | X |
| JOHANNECK BONITA | ||||||
| SECY/TREASURER | 1.00 | X | 0 | 0 | 0 | X |
| KAHLER DIANA | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| KRAHMER SHELLY | ||||||
| VP (SEPT-DEC) | 1.00 | X | 0 | 0 | 0 | X |
| MEYER JOAN | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| MORRIS MD MARIE | ||||||
| TRUSTEE (DEC) | 1.00 | X | 0 | 0 | 0 | |
| MUSSER MARCIA | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| NAWROCKI DONNA | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| NAWROCKI DUANE | ||||||
| PRESIDENT | 1.00 | X | 0 | 0 | 0 | X |
| PRIBYL STEPHEN J | ||||||
| TRUSTEE (JAN-SEPT) | 1.00 | X | 1438 | 0 | 146 | |
| SUTER BRIAN | ||||||
| TRUSTEE (SEPT-DEC) | 1.00 | X | 401 | 0 | 2 | |
| THEOBALD MICKEY | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| VUOCOLO MD PHILIP | ||||||
| TRUSTEE (JAN-NOV) | 1.00 | X | 4217 | 0 | 3716 | |
| ZAHARIA JOHN | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 6056 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 3864 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Fundraising Events | 74657 | FundraisingEvents |
| Government Grants | 26759 | GovernmentGrants |
| All Other Contributions | 149530 | AllOtherContributions |
| Noncash Contributions | 10953 | NoncashContributions |
| Total Contributions | 250946 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2587 | TotalRevenueColumn |
| Exclusion | $2,587 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 11588 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 74657 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 0 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 11588 | TotalRevenueColumn |
| Exclusion | $11,588 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 265121 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $14,175 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 216071 | Total |
| Program Services | 216071 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1280 | Total |
| Program Services | 1280 | ProgramServices |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | BANK FEES | Description |
| Total | 24 | Total |
| Management And General | 24 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 217375 | Total |
| Program Services | 217351 | ProgramServices |
| Management And General | 24 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 481229 | BOY |
| EOY | 535864 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1268480 | BOY |
| EOY | 1470167 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50000 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1799709 | BOY |
| EOY | 2006031 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23586 | BOY |
| EOY | 15344 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23586 | BOY |
| EOY | 15344 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 622999 | BOY |
| EOY | 770552 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 579304 | BOY |
| EOY | 641839 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 573820 | BOY |
| EOY | 578296 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1776123 | BOY |
| EOY | 1990687 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1799709 | BOY |
| EOY | 2006031 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 47746 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 166818 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 0 | FSAudited |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 453239 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 585170 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 203359 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 257869 | CurrentTaxYearMinus1Year |
| Current Tax Year | 250946 | CurrentTaxYear |
| Total | 1750583 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 453239 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 585170 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 203359 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 257869 | CurrentTaxYearMinus1Year |
| Current Tax Year | 250946 | CurrentTaxYear |
| Total | 1750583 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 141906 | AmountsSubstContributorsTotal |
| Public Support Total170 | 1608677 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 80095 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 42305 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 51007 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 44230 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2587 | CurrentTaxYear |
| Total | 220224 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 41067 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 79436 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 60255 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 15655 | CurrentTaxYearMinus1Year |
| Current Tax Year | 11588 | CurrentTaxYear |
| Total | 208001 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 2178808 | TotalSupport |
| Public Support Pertcentage170 | 0.73830 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.78460 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1141459 | BeginningOfYearBalance |
| Contributions | 61371 | Contributions |
| Investment Earnings Or Losses | 145922 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 56895 | GrantsOrScholarships |
| End Of Year Balance | 1291857 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 929871 | BeginningOfYearBalance |
| Contributions | 54803 | Contributions |
| Investment Earnings Or Losses | 213923 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 57129 | GrantsOrScholarships |
| Administrative Expenses | 9 | AdministrativeExpenses |
| End Of Year Balance | 1141459 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1381448 | BeginningOfYearBalance |
| Contributions | 5 | Contributions |
| Investment Earnings Or Losses | -387157 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 64425 | GrantsOrScholarships |
| End Of Year Balance | 929871 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.53000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.47000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | FIXED INCOME & EQUITY SECURITIES | Description |
| Book Value | 1470167 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 1470167 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ANNUITY OBLIGATIONS | Description |
| Amount | $15,344 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 15344 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Description of Intended Use of Endowment Funds: | Identifier |
| Return Reference | Part V, Line 4: | ReturnReference |
| Explanation | ENDOWMENT FUNDS ARE USED TO PROVIDE FINANCIAL SUPPORT FOR THE PURCHASE OF EQUIPMENT AND DEVELOPMENT OF PROGRAMS TO CARE FOR PATIENTS AT FAIRMONT MEDICAL CENTER - MAYO HEALTH SYSTEM. | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | HOSPICE TOUR OF TABLES | NameOfEvent1 |
| Gross Receipts Event1 | 10657 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 6494 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 4163 | GrossRevenueEvent1 |
| Name Of Event2 | FESTIVAL OF TREES | NameOfEvent2 |
| Gross Receipts Event2 | 68498 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 61073 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 7425 | GrossRevenueEvent2 |
| Total Number Of Other Events | 2 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 7090 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 7090 | CharitableContribOtherEvents |
| Gross Receipts Total | 86245 | GrossReceiptsTotal |
| Charitable Contributions Total | 74657 | CharitableContributionsTotal |
| Gross Revenue Total Events | 11588 | GrossRevenueTotalEvents |
| Net Income Summary | 11588 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRMONT MEDICAL CENTER -- MAYO HEALTH SYSTEM | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 MEDICAL CENTER DRIVE | AddressLine1 |
| City | FAIRMONT | City |
| State | MN | State |
| ZIP Code | 56031 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 410760836 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 216071 | AmountOfCashGrant |
| Purpose Of Grant | SUPPORT OF MISSION | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: TRANSFERS OR GRANTS TO ORGANIZATIONS WILL BE USED PURSUANT TO THE POLICIES AND PROCEDURES OF THE GRANTEE ORGANIZATIONS AND TO FURTHER THE EXEMPT PURPOSES OF THE GRANTEE ORGANIZATIONS. BOTH THE FILING ORGANIZATION AND THE GRANTEE ORGANIZATION MAINTAIN ADEQUATE BOOKS AND RECORDS OF SUCH TRANSFERS OR GRANTS. CAPITAL CONTRIBUTIONS WILL ALSO BE APPROVED BY THE GOVERNING BODY AND NOTED IN BOARD MINUTES. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section A, line 2 | DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT OF FAIRMONT MEDICAL CENTER - MAYO HEALTH SYSTEM, THE FOLLOWING INDIVIDUAL(S): MARIE MORRIS M.D., STEPHEN PRIBYL, BRIAN SUTER, AND PHILIP VUOCOLO, M.D. HAVE A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS: STEPHEN BERTHELSEN, M.D, MARIE MORRIS, M.D., MARCIA MUSSER, STEPHEN PRIBYL, BRIAN SUTER, AND PHILIP VUOCOLO, M.D. | |
| Form 990, Part VI, Section A, line 3 | FAIRMONT COMMUNITY HOSPITAL FOUNDATION RECEIVED DONATED MANAGEMENT AND GENERAL SERVICES FROM FAIRMONT MEDICAL CENTER - MAYO HEALTH SYSTEM (FMC). THE DONATED SERVICES FROM FMC INCLUDE MISCELLANEOUS EXPENSES NECESSARY IN THE IMPLEMENTATION AND OPERATION OF FUNDRAISING AND SPECIAL EVENTS. | |
| Form 990, Part VI, Section A, line 6 | THE MEMBERS OF THE CORPORATION ARE THE MEMBERS OF RECORD OF FAIRMONT COMMUNITY HOSPITAL ASSOCIATION AS OF 9/30/01 AND OTHER PEOPLE INTERESTED IN THE PROMOTION OF THE GENERAL WELFARE AND PUBLIC HEALTH OF THE FAIRMONT, MN REGION THAT HAVE CONTRIBUTED NOT LESS THAN $250. | |
| Form 990, Part VI, Section A, line 7a | THE GOVERNING BODY IS ELECTED BY THE MEMBERS. | |
| Form 990, Part VI, Section A, line 7b | DECISIONS IN SUCH AREAS AS DISSOLUTION AND AMENDMENT OF ARTICLES OF INCORPORATION REQUIRE APPROVAL BY BOTH MEMBERS AND THE GOVERNING BODY. | |
| Form 990, Part VI, Section B, line 11 | THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE ORGANIZATION'S FINANCE STAFF. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF THE FOUNDATION'S GOVERNING BODY VIA US MAIL, E-MAIL, OR DISTRIBUTION AT A BOARD MEETING. HIGHLIGHTS ARE PRESENTED TO BOARD MEMBERS, AND THE REVIEW IS DOCUMENTED IN MEETING MINUTES. ALL QUESTIONS ARE ADDRESSED PRIOR TO FILING THE FORM 990. | |
| THE FILING ORGANIZATION'S GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE FOUNDATION DOES NOT HAVE A CONFLICT OF INTEREST POLICY TO MAKE AVAILABLE. | Form 990, Part VI, Section C, line 19 | |
| Changes in Net Assets or Fund Balances: | Net unrealized gains on investments: 166,818. | Form 990, Part XI, line 5: |