VERNON MEMORIAL HEALTHCARE FOUNDATION INC: Form 990EZ, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- VERNON MEMORIAL HEALTHCARE FOUNDATION INC (EIN 39-1515716)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-05-06
- IRS object ID
- 201131269349200808
- 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 | 2011-05-06T08:59:47-05:00 | 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 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3703 OAKWOOD HILLS PARKWAY | AddressLine1 |
| City | EAU CLAIRE | City |
| State | WI | State |
| ZIP Code | 54701 | 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 | 391515716 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VERNON MEMORIAL Healthcare FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | VERN | NameControl |
| Phone | 6086372101 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 507 SOUTH MAIN STREET | AddressLine1 |
| City | VIROQUA | City |
| State | WI | State |
| ZIP Code | 54665 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MARY KOENIG | Name |
| Title | CFO | Title |
| Phone | 6086372101 | Phone |
| Date Signed | 2011-05-03 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | HOLLY POKRANDT CPA | Name |
| Phone | 7158323407 | Phone |
| Date Prepared | 2011-05-03 | 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 Cash | X | MethodOfAccountingCash |
| Web Site | n/a | WebSite |
| Organization501c | X | Organization501c |
| Gross Receipts | 98015 | GrossReceipts |
| Contributions Gifts Grants Etc | 65815 | ContributionsGiftsGrantsEtc |
| Investment Income | 11270 | InvestmentIncome |
| Special Events Gross Revenue | 20930 | SpecialEventsGrossRevenue |
| Special Events Direct Expenses | 18259 | SpecialEventsDirectExpenses |
| Special Events Net Income Loss | 2671 | SpecialEventsNetIncomeLoss |
| Total Revenue | 79756 | TotalRevenue |
| Grants And Similar Amounts Paid | 9797 | GrantsAndSimilarAmountsPaid |
| Fees And Oth Pymt To Ind Contractors | 1200 | FeesAndOthPymtToIndContractors |
| Other Expenses Total | 1861 | OtherExpensesTotal |
| Total Expenses | 12858 | TotalExpenses |
| Excess Or Deficit For Year | 66898 | ExcessOrDeficitForYear |
| Net Assets Or Fund Balances BOY | 411007 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 477905 | NetAssetsOrFundBalancesEOY |
Cash Savings And Investments CashSavingsAndInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 411007 | BOY |
| EOY | 477905 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 411007 | BOY |
| EOY | 477905 | 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 | 411007 | BOY |
| EOY | 477905 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Exempt Purpose | SEE STATEMENT 4 | PrimaryExemptPurpose |
Program Service Accomplishment ProgramServiceAccomplishment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Service Accom | The Vernon Memorial Healthcare Foundation, Inc. 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. | DescriptionProgramServiceAccom |
| Grants And Allocations | 9797 | GrantsAndAllocations |
| Program Service Expenses | 9797 | ProgramServiceExpenses |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | 9797 | TotalProgramServiceExpenses |
Officer Director Trustee Key Empl OfficerDirectorTrusteeKeyEmpl (11 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 |
|---|---|---|---|---|---|---|---|---|
| CHET LEE | ||||||||
| 507 SOUTH MAIN STREET | VIROQUA | WI | 54665 | DIRECTOR | 1.00 | 0 | 0 | 0 |
| JANA DREGNE | ||||||||
| 507 SOUTH MAIN STREET | VIROQUA | WI | 54665 | TREASURER | 1.00 | 0 | 0 | 0 |
| TOM SIMONSON | ||||||||
| 507 SOUTH MAIN STREET | VIROQUA | WI | 54665 | DIRECTOR | 1.00 | 0 | 0 | 0 |
| WAYNE GATES | ||||||||
| 507 SOUTH MAIN STREET | VIROQUA | WI | 54665 | VICE CHAIRMAN | 1.00 | 0 | 0 | 0 |
| JON ZAHM | ||||||||
| 507 SOUTH MAIN STREET | VIROQUA | WI | 54665 | DIRECTOR | 1.00 | 0 | 0 | 0 |
| MARNY GILLEN | ||||||||
| 507 SOUTH MAIN STREET | VIROQUA | WI | 54665 | SECRETARY | 1.00 | 0 | 0 | 0 |
| DR ROBERT KNADLE | ||||||||
| 507 SOUTH MAIN STREET | VIROQUA | WI | 54665 | DIRECTOR | 1.00 | 0 | 0 | 0 |
| DAN KANIS | ||||||||
| 507 SOUTH MAIN STREET | VIROQUA | WI | 54665 | DIRECTOR | 1.00 | 0 | 0 | 0 |
| RYAN CALLAN | ||||||||
| 507 SOUTH MAIN STREET | VIROQUA | WI | 54665 | DIRECTOR | 1.00 | 0 | 0 | 0 |
| DIAN KRAUSE | ||||||||
| 507 SOUTH MAIN STREET | VIROQUA | WI | 54665 | CHAIRMAN | 1.00 | 0 | 0 | 0 |
| LENAY KUMLIN | ||||||||
| 507 SOUTH MAIN STREET | VIROQUA | WI | 54665 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MARY KOENIG | NamePerson |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 507 SOUTH MAIN STREET | AddressLine1 |
| City | VIROQUA | City |
| State | WI | State |
| ZIP Code | 54665 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6086372101 | 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) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type3 Func Int | X | SupportingOrg509a3Type3FuncInt |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VERNON MEMORIAL HEALTHCARE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390806404 | EIN |
| Type Of Organization | 3 | TypeOfOrganization |
| Listed In Governing Doc | 0 | ListedInGoverningDoc |
| Supported Organization Notified | 1 | SupportedOrganizationNotified |
| Organized In US | 1 | OrganizedInUS |
| Amount | $3,770 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 3770 | SumOfAmounts |
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 G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GALA | NameOfEvent1 |
| Gross Receipts Event1 | 11150 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 7020 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 4130 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 0 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 5520 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 0 | RentFacilityCostsEvent1 |
| Other Direct Expenses Event1 | 3356 | OtherDirectExpensesEvent1 |
| Name Of Event2 | GOLF OUTING | NameOfEvent2 |
| Gross Receipts Event2 | 23776 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 6976 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 16800 | GrossRevenueEvent2 |
| Cash Prizes Event2 | 300 | CashPrizesEvent2 |
| Non Cash Prizes Event2 | 3437 | NonCashPrizesEvent2 |
| Rent Facility Costs Event2 | 3000 | RentFacilityCostsEvent2 |
| Other Direct Expenses Event2 | 2646 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 34926 | GrossReceiptsTotal |
| Charitable Contributions Total | 13996 | CharitableContributionsTotal |
| Gross Revenue Total Events | 20930 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 300 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 8957 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 3000 | RentFacilityCostsTotalEvents |
| Other Direct Expenses Total Events | 6002 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 18259 | DirectExpenseSummaryEvents |
| Net Income Summary | 2671 | NetIncomeSummary |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Gaming Rec Keeper Person | DANA HOHLFELDER | NameOfGamingRecKeeperPerson |
Address Of Gaming Rec Keeper US AddressOfGamingRecKeeperUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 507 SOUTH MAIN STREET | AddressLine1 |
| City | VIROQUA | City |
| State | WI | State |
| ZIP Code | 54665 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Manager Name Person | DANA HOHLFELDER | GamingManagerNamePerson |
| Gaming Manager Compensation | 15859 | GamingManagerCompensation |
| Gaming Manager Services Provided | The development coordinator plans, organizes, executes, and coordinates an effective and continuing fund development, annual giving, and other fundraising programs. | GamingManagerServicesProvided |
| Gaming Manager Is Employee | X | GamingManagerIsEmployee |
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