2011-11-14T11:24:02-06:00 2010-12-31 990 2010-01-01 411658658 FAIRMONT COMMUNITY HOSPITAL FOUNDATION FAIR 5072388177 800 MEDICAL CENTER DR PO BOX 800 FAIRMONT MN 56031 SHELLY KRAHMER 5072844571 2011-11-14 2010 2016-03-07 17:11:31Z SHELLY KRAHMER 800 MEDICAL CENTER DR PO BOX 800 FAIRMONT MN 56031 265121 0 X N/A X 1989 MN ENHANCING HEALTH CARE THROUGH CHARITABLE SUPPORT 14 14 0 199 0 0 257869 250946 0 0 44230 2587 20135 11588 322234 265121 246487 217351 0 0 0 0 0 0 0 71 24 246558 217375 75676 47746 1799709 2006031 23586 15344 1776123 1990687 X ENHANCING HEALTH CARE THROUGH CHARITABLE SUPPORT. 0 0 216071 216071 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. 1280 1280 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. 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). 217351 1 1 0 0 0 0 0 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 8 0 0 0 0 0 0 0 1 1 0 0 0 0 X 14 14 1 1 0 0 1 1 1 1 1 0 0 1 0 0 0 0 0 0 MN X DARLA NELSON PHILIPP 5072388177 PO BOX 800 FAIRMONT MN 56031 BERTHELSEN MD STEPHEN 1.00 X 0 0 0 COLE MARY 1.00 X 0 0 0 DRAUT RUTH 1.00 X 0 0 0 FORSTROM DOUG 1.00 X 0 0 0 HANSEN DALE 1.00 X 0 0 0 JENKINSON JERRY 1.00 X X 0 0 0 JOHANNECK BONITA 1.00 X X 0 0 0 KAHLER DIANA 1.00 X 0 0 0 KRAHMER SHELLY 1.00 X X 0 0 0 MEYER JOAN 1.00 X 0 0 0 MORRIS MD MARIE 1.00 X 0 0 0 MUSSER MARCIA 1.00 X 0 0 0 NAWROCKI DONNA 1.00 X 0 0 0 NAWROCKI DUANE 1.00 X X 0 0 0 PRIBYL STEPHEN J 1.00 X 1438 0 146 SUTER BRIAN 1.00 X 401 0 2 THEOBALD MICKEY 1.00 X 0 0 0 VUOCOLO MD PHILIP 1.00 X 4217 0 3716 ZAHARIA JOHN 1.00 X 0 0 0 6056 0 3864 0 0 0 0 0 74657 26759 149530 10953 250946 2587 2587 11588 74657 0 11588 11588 265121 0 0 14175 216071 216071 1280 1280 BANK FEES 24 24 217375 217351 24 0 481229 535864 1268480 1470167 50000 0 1799709 2006031 23586 15344 23586 15344 X 622999 770552 579304 641839 573820 578296 1776123 1990687 1799709 2006031 X 47746 166818 X 0 0 0 X 453239 585170 203359 257869 250946 1750583 453239 585170 203359 257869 250946 1750583 141906 1608677 80095 42305 51007 44230 2587 220224 41067 79436 60255 15655 11588 208001 2178808 0.73830 0.78460 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1141459 61371 145922 56895 1291857 929871 54803 213923 57129 9 1141459 1381448 5 -387157 64425 929871 0.53000 0.47000 0 0 0 FIXED INCOME & EQUITY SECURITIES 1470167 F 1470167 ANNUITY OBLIGATIONS 15344 15344 Description of Intended Use of Endowment Funds: Part V, Line 4: 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. HOSPICE TOUR OF TABLES 10657 6494 4163 FESTIVAL OF TREES 68498 61073 7425 2 7090 7090 86245 74657 11588 11588 1 FAIRMONT MEDICAL CENTER -- MAYO HEALTH SYSTEM 800 MEDICAL CENTER DRIVE FAIRMONT MN 56031 410760836 501(C)(3) 216071 SUPPORT OF MISSION 1 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: 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. 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. Form 990, Part VI, Section C, line 19 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 166,818.