TRICOUNTY MEMORIAL FOUNDATION INC: Form 990, tax year 2024
View the entire original 990 at ProPublica ↗
- Organization
- TRICOUNTY MEMORIAL FOUNDATION INC (EIN 30-0093022)
- Tax period
- 2024-10-01 to 2025-09-30
- Filed
- 2026-08-13
- IRS object ID
- 202602259349301725
- Schema version
- 2024v5.1
- 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) |
|---|---|---|
| Return | 2026-08-13T17:01:59+00:00 | ReturnTs |
| Tax Period End | 2025-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 135565207 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 EAST RANDOLPH DRIVE SUITE 5500 | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 606016436 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 300093022 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRI-COUNTY MEMORIAL FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | TRI- | BusinessNameControlTxt |
| Phone | 7155384361 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18601 LINCOLN STREET | AddressLine1Txt |
| City | WHITEHALL | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54773 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KRISTY MILLERING | PersonNm |
| Person Title | FINANCE ADMINISTRATOR | PersonTitleTxt |
| Signature | 2026-08-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RILEY KOBRICK | PreparerPersonNm |
| PTIN | P02401884 | PTIN |
| Phone | 3126651000 | PhoneNum |
| Preparation | 2026-08-12 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KRISTY MILLERING | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18601 LINCOLN STREET | AddressLine1Txt |
| City | WHITEHALL | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54773 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $118,645 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GUNDERSENHEALTH.ORG/TRI-COUNTY/FOUNDATION | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2001 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TRI-COUNTY MEMORIAL FOUNDATION, INC. EXISTS TO SUPPORT THE MISSION OF TRI-COUNTY MEMORIAL HOSPITAL, INC. WHICH IS TO DISTINGUISH OURSELVES THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, AND IMPROVED HEALTH IN THE COMMUNITIES WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 20 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $135,856 | PYContributionsGrantsAmt |
| CY Contributions Grants | $33,816 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $37,953 | PYInvestmentIncomeAmt |
| CY Investment Income | $42,372 | CYInvestmentIncomeAmt |
| PY Other Revenue | $4,458 | PYOtherRevenueAmt |
| CY Other Revenue | $31,547 | CYOtherRevenueAmt |
| PY Total Revenue | $178,267 | PYTotalRevenueAmt |
| CY Total Revenue | $107,735 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $11,979 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $9,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $62,098 | PYOtherExpensesAmt |
| CY Other Expenses | $14,126 | CYOtherExpensesAmt |
| PY Total Expenses | $74,077 | PYTotalExpensesAmt |
| CY Total Expenses | $23,126 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $104,190 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $84,609 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,459,674 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,549,032 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $395,584 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $400,333 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,064,090 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,148,699 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TRI-COUNTY MEMORIAL FOUNDATION, INC. PROVIDES SUPPORT TRI-COUNTY MEMORIAL HOSPITAL, INC., COMMUNITY ORGANIZATIONS, AND INDIVIDUALS TO FURTHER THE PURPOSE OF HEALTH AND EDUCATIONAL NEEDS. TRI-COUNTY MEMORIAL HOSPITAL, INC. PROVIDES HEALTH SERVICES TO THEIR LOCAL AREAS. THE SERVICE AREA IS ABOUT A 25-MILE RADIUS AROUND THE FACILITY AND INCLUDES ABOUT 15,000 INDIVIDUALS. TRI-COUNTY MEMORIAL FOUNDATION, INC. PROVIDES SUPPORT TO TRI-COUNTY HOSPITAL, CLINICS, AND ASSISTED LIVING. AT TIMES, EQUIPMENT IS PURCHASED TO SUPPORT THE HOSPITAL, CLINICS, AND ASSISTED LIVING. DURING THE PERIOD OCTOBER 1, 2024 THROUGH SEPTEMBER 30, 2025, $4,200 IN SCHOLARSHIPS WERE GRANTED TO STUDENTS IN THE AREA PURSUING CAREERS IN MEDICAL FIELDS. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $23,126 | ExpenseAmt |
| Grant | $9,000 | GrantAmt |
| Desc | TRI-COUNTY MEMORIAL FOUNDATION, INC. PROVIDES SUPPORT TRI-COUNTY MEMORIAL HOSPITAL, INC., COMMUNITY ORGANIZATIONS, AND INDIVIDUALS TO FURTHER THE PURPOSE OF HEALTH AND EDUCATIONAL NEEDS. TRI-COUNTY MEMORIAL HOSPITAL, INC. PROVIDES HEALTH SERVICES TO THEIR LOCAL AREAS. THE SERVICE AREA IS ABOUT A 25-MILE RADIUS AROUND THE FACILITY AND INCLUDES ABOUT 15,000 INDIVIDUALS. TRI-COUNTY MEMORIAL FOUNDATION, INC. PROVIDES SUPPORT TO TRI-COUNTY HOSPITAL, CLINICS, AND ASSISTED LIVING. AT TIMES, EQUIPMENT IS PURCHASED TO SUPPORT THE HOSPITAL, CLINICS, AND ASSISTED LIVING. DURING THE PERIOD OCTOBER 1, 2024 THROUGH SEPTEMBER 30, 2025, $4,200 IN SCHOLARSHIPS WERE GRANTED TO STUDENTS IN THE AREA PURSUING CAREERS IN MEDICAL FIELDS. | Desc |
| Total Program Service Expenses | $23,126 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (true) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (true) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Policies Reference Chapters | false | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KRISTY MILLERING | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7155384361 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18601 LINCOLN STREET | AddressLine1Txt |
| City | WHITEHALL | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54773 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| KURT JOHNSON | ||||||||
| BOARD OF DIRECTORS, CHAIRMAN | 2.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RACHEL RISBERG | ||||||||
| BOARD OF DIRECTORS, VICE CHAIRMAN | 2.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DOHN GALSTAD | ||||||||
| BOARD OF DIRECTORS | 2.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| FRED BOE | ||||||||
| BOARD OF DIRECTORS | 2.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| J MICHAEL WARNER | ||||||||
| BOARD OF DIRECTORS | 2.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| LEAH JACOBS | ||||||||
| BOARD OF DIRECTORS | 2.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| SHIRLEY MILLER | ||||||||
| BOARD OF DIRECTORS | 2.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| DANIEL COENEN | ||||||||
| ADMINISTRATOR | 20.0 | 30.0 | Yes (X) | $0 | $165,449 | $47,722 | ||
| JOHN CEELEN | ||||||||
| CHIEF FINANCIAL OFFICER | 1.0 | 49.0 | Yes (X) | $0 | $728,316 | $54,052 | ||
| KRISTY MILLERING | ||||||||
| FINANCE ADMINISTRATOR | 16.0 | 34.0 | Yes (X) | $0 | $131,354 | $42,400 | ||
| SCOTT RATHGABER MD | ||||||||
| CEO | 1.0 | 49.0 | Yes (X) | $0 | $1,324,275 | $73,275 | ||
| JONI OLSON | ||||||||
| ADMINISTRATOR, (END 9.30.24) | 0.0 | 0.0 | $0 | $169,390 | $41,223 | Yes (X) | ||
| STEVE LITTLE | ||||||||
| FORMER CHIEF FINANCIAL OFFICER | 0.0 | 0.0 | $0 | $209,856 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,728,640 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $258,672 | TotalOtherCompensationAmt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NONE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $0 | FundraisingAmt |
| All Other Contributions | $33,816 | AllOtherContributionsAmt |
| Total Contributions | $33,816 | TotalContributionsAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $0 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $42,372 | TotalRevenueColumnAmt |
| Exclusion | $42,372 | ExclusionAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $42,457 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $10,910 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $31,547 | TotalRevenueColumnAmt |
| Exclusion | $31,547 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $107,735 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $73,919 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,800 | TotalAmt |
| Program Services | $4,800 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,200 | TotalAmt |
| Program Services | $4,200 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57 | TotalAmt |
| Program Services | $57 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,128 | TotalAmt |
| Program Services | $2,128 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PROGRAM EXPENSE | Desc |
| Total | $11,941 | TotalAmt |
| Program Services | $11,941 | ProgramServicesAmt |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,126 | TotalAmt |
| Program Services | $23,126 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,438,101 | BOYAmt |
| EOY | $1,537,509 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,573 | BOYAmt |
| EOY | $10,573 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $950 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $0 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $0 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,459,674 | BOYAmt |
| EOY | $1,549,032 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $100 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $1,000 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $395,584 | BOYAmt |
| EOY | $399,233 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $395,584 | BOYAmt |
| EOY | $400,333 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $332,263 | BOYAmt |
| EOY | $354,609 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $731,827 | BOYAmt |
| EOY | $794,090 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,064,090 | BOYAmt |
| EOY | $1,148,699 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,459,674 | BOYAmt |
| EOY | $1,549,032 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $84,609 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRI-COUNTY MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390704510 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | false | GoverningDocumentListedInd |
| Support | $0 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | false | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | false | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | false | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | false | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | false | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | false | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | false | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | false | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | false | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | false | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | false | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | false | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (true) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | false | OperateBenefitNonSuprtOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE A, PART I, LINE 12G(IV) | THE ORGANIZATION IS DESIGNATED BY CLASS OR PURPOSE. SEE PART IV, SECTION A, LINE 1 DISCLOSURE. |
| SCHEDULE A, PART IV, SECTION A, LINE 1 SUPPORTED ORGS LISTED BY NAME | THE CORPORATION IS ORGANIZED AND SHALL BE OPERATED EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC AND EDUCATIONAL PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED (OR THE CORRESPONDING PROVISIONS OF ANY FUTURE UNITED STATES INTERNAL REVENUE LAW) (HEREINAFTER THE "INTERNAL REVENUE CODE"); TO ENGAGE IN ACTIVITIES RELATING TO THE AFOREMENTIONED PURPOSES; AND TO INVEST IN, RECEIVE, HOLD, USE AND DISPOSE OF ALL PROPERTY, REAL OR PERSONAL, AS MAY BE NECESSARY OR DESIRABLE TO CARRY INTO EFFECT THE AFOREMENTIONED PURPOSES. |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| FEDERAL INCOME TAXES | |
| DUE TO TRI-COUNTY MEMORIAL HOSPITAL | $399,233 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $399,233 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Other Revenue | $0 | OtherRevenueAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $0 | RevenueSubtotalAmt |
| Other Revenues Not Included | $0 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $0 | TotalRevenuePerForm990Amt |
| Other Expenses Included | $0 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $0 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $0 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $0 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PART X, LINE 2 FIN 48 (ASC 740) FOOTNOTE | FormAndLineReferenceDesc |
| Explanation | THE SYSTEM AND MOST OF ITS SUBSIDIARIES ARE CLASSIFIED AS TAX-EXEMPT ORGANIZATIONS AS DESCRIBED IN SECTIONS 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES ON RELATED INCOME, PURSUANT TO SECTION 501(A) OF THE CODE. THESE ORGANIZATIONS ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES TO THE EXTENT THEY HAVE UNRELATED BUSINESS INCOME. THE SYSTEM HAS NO MATERIAL UNCERTAIN TAX POSITIONS. CERTAIN SUBSIDIARIES ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. SOME OF THESE CORPORATIONS HAVE ACCUMULATED NET OPERATING LOSS CARRYFORWARDS THAT ARE AVAILABLE TO OFFSET FUTURE TAXABLE INCOME, IF ANY, AND HAVE BEEN FULLY RESERVED. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF OUTING | Event1Nm |
| Gross Receipts Event1 | $19,679 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $19,679 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $5,019 | RentFacilityCostsEvent1Amt |
| Other Direct Expenses Event1 | $491 | OtherDirectExpensesEvent1Amt |
| Event2 | ANNUAL APPEAL | Event2Nm |
| Gross Receipts Event2 | $17,085 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $17,085 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $2,074 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 1 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $5,693 | GrossReceiptsOtherEventsAmt |
| Gross Revenue Other Events | $5,693 | GrossRevenueOtherEventsAmt |
| Oth Direct Expnss Other Events | $3,326 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $42,457 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $42,457 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $5,019 | RentFcltyCostsTotalEventsAmt |
| Oth Direct Expnss Total Events | $5,891 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $10,910 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $31,547 | NetIncomeSummaryAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STEVE LITTLE | ||||||||||||||
| FORMER CHIEF FINANCIAL OFFICER | $0 | $209,856 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $209,856 | $0 | $0 |
| JOHN CEELEN | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $0 | $598,104 | $0 | $129,468 | $0 | $744 | $0 | $29,147 | $0 | $24,905 | $0 | $782,368 | $0 | $0 |
| SCOTT RATHGABER MD | ||||||||||||||
| CEO | $0 | $1,278,368 | $0 | $0 | $0 | $45,907 | $0 | $48,300 | $0 | $24,975 | $0 | $1,397,550 | $0 | $0 |
| DANIEL COENEN | ||||||||||||||
| ADMINISTRATOR | $0 | $133,985 | $0 | $0 | $0 | $31,464 | $0 | $23,568 | $0 | $24,154 | $0 | $213,171 | $0 | $0 |
| KRISTY MILLERING | ||||||||||||||
| FINANCE ADMINISTRATOR | $0 | $130,279 | $0 | $0 | $0 | $1,075 | $0 | $18,798 | $0 | $23,602 | $0 | $173,754 | $0 | $0 |
| JONI OLSON | ||||||||||||||
| ADMINISTRATOR, (END 9.30.24) | $0 | $165,292 | $0 | $0 | $0 | $4,098 | $0 | $23,561 | $0 | $17,662 | $0 | $210,613 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PART I, LINE 3 ARRANGEMENT USED TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION | A RELATED ORGANIZATION OF THE FILING ORGANIZATION USES ONE OR MORE OF THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY, AND -APPROVAL BY THE BOARD OF COMPENSATION COMMITTEE |
| SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN | CERTAIN INDIVIDUALS LISTED IN SCHEDULE J, PART II, PARTICIPATE IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN TO WHICH THE ORGANIZATION MAKES ANNUAL CONTRIBUTIONS. THESE CONTRIBUTIONS ARE AT RISK AND DO NOT BECOME VESTED AND PAYABLE UNLESS AND UNTIL THE INDIVIDUAL SATISFIES A SUBSTANTIAL FUTUTE SERVICE REQUIREMENT. THE FOLLOWING INDIVIDUALS HAD CONTRIBUTIONS MADE TO THE PLAN FOR CALENDAR YEAR 2024: JOHN CEELEN |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, LINE 15A | COMPENSATION IS DETERMINED BY A RELATED ORGANIZATION. COMPENSATION FOR THE CEO AND KEY EXECUTIVES ARE SET BY THE EXECUTIVE COMMITTEE OF THE BOARD SUPPORTED BY MARKET DATA FROM SURVEYS AND AN INDEPENDENT CONSULTANTS REPORT. THE COMPENSATION IS DETERMINED BY MEMBERS OF THE EXECUTIVE COMMITTEE WITHOUT CONFLICT AND IS DOCUMENTED. |
| FORM 990, PART VI, LINE 15B | SENIOR LEADERS: COMPENSATION IS DETERMINED BY A RELATED ORGANIZATION. COMPENSATION FOR THOSE WHO REPORT TO THE CEO IS TAKEN TO THE EXECUTIVE COMMITTEE FOR DISCUSSION/APPROVAL. |
| FORM 990, PART VI, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS | THE SOLE MEMBER OF THE CORPORATION SHALL BE TRI-COUNTY MEMORIAL HOSPITAL, INC. |
| FORM 990, PART VI, LINE 11B REVIEW OF FORM 990 BY GOVERNING BODY | THE FORM 990 IS REVIEWED BY THE ACCOUNTING MANAGER AND PRINCIPAL OFFICER. IT WILL BE MADE AVAILABLE FOR ALL BOARD MEMBERS BEFORE FILING. |
| FORM 990, PART VI, LINE 12C CONFLICT OF INTEREST POLICY | GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. (GLAS) ANNUALLY REQUIRES EXECUTIVE LEADERSHIP (VICE PRESIDENTS AND ABOVE), BOARD MEMBERS, MEDICAL GOVERNORS AND FOUNDATION BOARD MEMBERS TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED DISCLOSURE STATEMENTS ARE REVIEWED BY A CONFLICT OF INTEREST REVIEW PANEL WHICH INCLUDES REPRESENTATIVES FROM LEGAL, COMPLIANCE, MEDICAL LEADERSHIP, HUMAN RESOURCES AND SUPPLY CHAIN. INDIVIDUALS REPORTING A POTENTIAL CONFLICT OF INTEREST ARE SENT A RESOLUTION THANKING THEM FOR THEIR SERVICE TO THE ORGANIZATION, ADVISING THEM OF ANY RESTRICTIONS RELATED TO THEIR CONFLICT (I.E. INDIVIDUALS WITH A RELATIONSHIP TO ANOTHER ORGANIZATION ARE ADVISED THAT THEY MUST ABSTAIN FROM DECISION MAKING THAT WOULD DIRECTLY AND SOLELY IMPACT GLAS) AND REMINDING THEM OF THEIR CONFIDENTIALITY OBLIGATIONS WITH RESPECT TO GLAS' HEALTHCARE, EMPLOYMENT AND PROPRIETARY INFORMATION. |
| FORM 990, PART VI, LINE 19 REQUIRED DOCUMENTS AVAILABLE TO THE PUBLIC | TRI-COUNTY MEMORIAL FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF- INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT ITS BUSINESS LOCATION DURING NORMAL BUSINESS HOURS. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (28 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| BELLIN GUNDERSEN HEALTH SYSTEM INC | ||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 920504278 | SUPPORT ORG | WI | 501(C)(3) | TYPE III-FI | NA | false |
| GUNDERSEN LUTHERAN HEALTH SYSTEM INC | ||||||||||
| 1836 SOUTH AVE | LA CROSSE | WI | 54601 | 391866425 | SUPPORT ORG | WI | 501(C)(3) | TYPE II | BGHS | false |
| GUNDERSEN LUTHERAN MEDICAL CENTER INC | ||||||||||
| 1910 SOUTH AVE | LA CROSSE | WI | 54601 | 390813416 | HEALTHCARE | WI | 501(C)(3) | 3 | GLHS | false |
| GUNDERSEN CLINIC LTD | ||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391028657 | HEALTHCARE | WI | 501(C)(3) | 3 | GLHS | false |
| GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES INC | ||||||||||
| 1910 SOUTH AVE | LA CROSSE | WI | 54601 | 391606449 | SUPPORT ORG | WI | 501(C)(3) | TYPE II | GLHS | false |
| GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC | ||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391249705 | FOUNDATION | WI | 501(C)(3) | 7 | GLHS | false |
| TRI-COUNTY MEMORIAL HOSPITAL INC | ||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 390704510 | HEALTHCARE | WI | 501(C)(3) | 3 | GLHS | false |
| HARMONY COUMMUNITY HEALTHCARE INC | ||||||||||
| 815 MAIN AVE | SOUTH HARMONY | MN | 55939 | 410711606 | HEALTHCARE | MN | 501(C)(3) | 10 | GLHS | false |
| TWEETEN LUTHERAN HEALTHCARE CENTER INC | ||||||||||
| 125 FIFTH AVE SE | SPRING GROVE | MN | 55974 | 411565003 | HEALTHCARE | MN | 501(C)(3) | 10 | GLHS | false |
| TRI STATE AMBULANCE INC | ||||||||||
| 235 CAUSEWAY BOULEVARD | LA CROSSE | WI | 54603 | 391965415 | MEDICAL TRANSPORT | WI | 501(C)(3) | 3 | GLHS | false |
| TRI-STATE REGIONAL AMBULANCE INC | ||||||||||
| 235 CAUSEWAY BOULEVARD | LA CROSSE | WI | 54603 | 391962965 | MEDICAL TRANSPORT | WI | 501(C)(3) | 10 | GLHS | false |
| LUTHERAN REAL ESTATE HOLDING CORPORATION | ||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391480826 | HOUSING | WI | 501(C)(3) | TYPE III-FI | GLHS | false |
| COMMUNITY HOUSING OF LA CROSSE INC | ||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391586700 | INDEPENDENT LIVING | WI | 501(C)(3) | 10 | LREH CORP | false |
| LUTHERAN HOUSING OF LA CROSSE INC | ||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391751934 | INDEPENDENT LIVING | WI | 501(C)(3) | 10 | LREH CORP | false |
| ST JOSEPH'S HEALTH SERVICES INC | ||||||||||
| 400 WATER AVE | HILLSBORO | WI | 54634 | 390929538 | HEALTHCARE | WI | 501(C)(3) | 3 | GLHS | false |
| ST JOSEPH MEMORIAL FOUNDATION INC | ||||||||||
| 400 WATER AVE | HILLSBORO | WI | 54634 | 391455787 | FOUNDATION | WI | 501(C)(3) | TYPE I | STJ HLTH SVC | false |
| MEMORIAL HOSPITAL OF BOSCOBEL | ||||||||||
| 205 PARKER STREET | BOSCOBEL | WI | 53805 | 390845590 | HEALTHCARE | WI | 501(C)(3) | 3 | GLHS | false |
| PALMER LUTHERAN HEALTH CENTER INC | ||||||||||
| 112 JEFFERSON STREET | WEST UNION | IA | 52175 | 421320763 | HEALTHCARE | IA | 501(C)(3) | 3 | GLHS | false |
| MOUNDVIEW MEMORIAL HOSPITALS AND CLINICS | ||||||||||
| 402 WEST LAKE STREET | FRIENDSHIP | WI | 53934 | 390944012 | HEALTHCARE | WI | 501(C)(3) | 3 | GLHS | false |
| MEMORIAL HEALTHCARE FOUNDATION INC | ||||||||||
| 402 WEST LAKE STREET | FRIENDSHIP | WI | 53934 | 391775074 | FOUNDATION | WI | 501(C)(3) | TYPE I | MDV HOSP | false |
| SAINT ELIZABETH'S HOSPITAL OF WABASHA INC | ||||||||||
| 1200 FIFTH GRANT BLVD WEST | WABASHA | MN | 55981 | 410693877 | HEALTHCARE | MN | 501(C)(3) | 3 | GLHS | false |
| BELLIN HEALTH SYSTEMS INC | ||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391512904 | SUPPORT ORG | WI | 501(C)(3) | TYPE II | BGHS | false |
| LAKE MICHIGAN HEALTH SERVICES INC | ||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391512903 | SUPPORT ORG | WI | 501(C)(3) | TYPE II | BHS | false |
| BELLIN COLLEGE INC | ||||||||||
| 3201 EATON ROAD | GREEN BAY | WI | 54311 | 391620530 | EDUCATION | WI | 501(C)(3) | 2 | BHS | false |
| BELLIN PSYCHIATRIC CENTER INC | ||||||||||
| PO BOX 23725 | GREEN BAY | WI | 54301 | 391657627 | HEALTHCARE | WI | 501(C)(3) | 3 | BHS | false |
| BELLIN MEMORIAL HOSPITAL INC | ||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 390884478 | HEALTHCARE | WI | 501(C)(3) | 3 | BHS | false |
| THE BELLIN HEALTH FOUNDATION INC | ||||||||||
| PO BOX 23400 | GREEN BAY | WI | 54301 | 391809171 | FOUNDATION | WI | 501(C)(3) | 7 | BHS | false |
| OCONTO HOSPITAL & MEDICAL CENTER INC | ||||||||||
| 820 ARBUTUS AVENUE | OCONTO | WI | 54153 | 061745397 | HEALTHCARE | WI | 501(C)(3) | 3 | BMH | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | Address Line2ForeignAddress/AddressLine2Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GUNDERSEN LUTHERAN ENVISION LLC | |||||||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 264706546 | RENEWABLE ENERGY | WI | NA | C CORPORATION | false | ||||||
| GUNDERSEN EDGE LLC | |||||||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 921783811 | OTHER | WI | NA | C CORPORATION | false | ||||||
| BEL-REGIONAL HOME MEDICAL INC | |||||||||||||||
| 617 S ROOSEVELT | GREEN BAY | WI | 54301 | 391504766 | DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS | WI | NA | C CORPORATION | false | ||||||
| BG ASSURANCE | |||||||||||||||
| SELF INSURANCE | NA | C CORPORATION | false | 20 GENESIS CLOSE PO BOX 30600 | GEORGE TOWN | GRAND CAYMAN | CJ | KY11203 | CJ | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |