2023-11-15T07:17:47-06:00 2022-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-01-01 300093022 TRI-COUNTY MEMORIAL FOUNDATION INC TRI- 7155384361 18601 LINCOLN STREET WHITEHALL WI 54773 JONI OLSON ADMINISTRATOR 7155384361 2023-11-14 1 JONI OLSON 999009999 0 MICHAEL J PETERSON CPA P01833529 2187224705 2023-11-10 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JONI OLSON 18601 LINCOLN STREET WHITEHALL WI 54773 118430 0 X WWW.GUNDERSENHEALTH.ORG/TRI-COUNTY/FOUNDATION X 2001 WI 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. 7 7 0 12 0 0 296688 81990 0 0 3161 8412 974 -225 300823 90177 23329 10403 0 0 0 0 0 0 0 12943 12269 36272 22672 264551 67505 1131839 1201079 392459 394194 739380 806885 X 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. 0 0 22672 10403 0 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, ASSISTED LIVING, AND NURSING HOME. AT TIMES, EQUIPMENT IS PURCHASED TO SUPPORT THE HOSPITAL, CLINICS, ASSISTED LIVING, AND NURSING HOME. DURING THE PERIOD JANUARY 1, 2022 THROUGH DECEMBER 31, 2022, $1,000 IN SCHOLARSHIPS WERE GRANTED TO STUDENTS IN THE AREA PURSUING CAREERS IN MEDICAL FIELDS. 22672 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 1 0 1 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 WI X JONI OLSON 7155384361 18601 LINCOLN STREET WHITEHALL WI 54773 KURT JOHNSON CHAIRMAN 0.50 X X 0 0 0 RACHEL RISBERG VICE CHAIRMAN 0.50 X X 0 0 0 FRED BOE TRUSTEE 0.50 X 0 0 0 K ROGER GILBERT TRUSTEE (TERMED OCT) 0.50 X 0 0 0 GLEN JOHNSON TRUSTEE 0.50 X 0 0 0 SHIRLEY MILLER TRUSTEE 0.50 X 0 0 0 DAVE PIENTOK TRUSTEE 0.50 X 0 0 0 J MICHAEL WARNER TRUSTEE 0.50 X 0 0 0 JONI OLSON ADMINISTRATOR 0.50 40.00 X 0 206921 54265 DAN KLIDZEJS FINANCE ADMINISTRATOR (TERMED MAY) 1.00 40.00 X 0 52175 8355 0 259096 62620 0 0 1 0 0 81990 81990 8412 8412 28028 28253 -225 -225 90177 0 0 8187 9403 9403 1000 1000 54 54 PROGRAM EXPENSES 12139 12139 76 76 22672 22672 0 0 1002842 1119806 128997 81273 1131839 1201079 392459 394194 392459 394194 X 316992 319925 422388 486960 739380 806885 1131839 1201079 67505 0 X 0 1 X 1 0 X X 1 TRI-COUNTY MEMORIAL HOSPITAL INC 390704510 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DUE TO TRI-COUNTY MEMORIAL HOSPITAL 394194 394194 GOLF OUTING 11910 11910 3963 LADIES NIGHT OUT EVENT 8558 8558 3434 9 7560 7560 20856 28028 28028 28253 28253 -225 0 0 0 0 0 0 0 0 0 JONI OLSON ADMINISTRATOR 0 181884 0 200 0 24837 0 30388 0 23877 0 261186 0 0 FORM 990, PART VI, SECTION A, LINE 4 GUNDERSEN AND BELLIN HEALTH SYSTEMS, INC. (BELLIN), EACH A WISCONSIN NONPROFIT, NON-STOCK CORPORATION, ENTERED INTO A COMBINATION AGREEMENT DATED JULY 29, 2022 (THE AGREEMENT), TO ALIGN THEIR RESPECTIVE OPERATIONS AND TO FORM A SINGLE NONPROFIT HEALTH SYSTEM THROUGH THE CREATION OF BELLIN GUNDERSEN HEALTH SYSTEM, INC., A WISCONSIN NONPROFIT, NON-STOCK CORPORATION (BELLIN GUNDERSEN). ON DECEMBER 1, 2022, UPON CONSUMMATION OF THE ALIGNMENT OF THE TWO SYSTEMS (THE AFFILIATION), BELLIN GUNDERSEN BECAME THE SOLE CORPORATE MEMBER OF BOTH BELLIN AND GUNDERSEN. BELLIN AND GUNDERSEN AND THEIR RESPECTIVE AFFILIATES ARE EXPECTED TO MAINTAIN THEIR RESPECTIVE CORPORATE EXISTENCE. IN DECEMBER 2022, THE BYLAWS OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. WERE AMENDED AND RESTATED TO UPDATE THE SOLE CORPORATE MEMBER TO BELLIN GUNDERSEN HEALTH SYSTEM, INC. THE BYLAWS WERE ALSO UPDATED TO SPECIFY THE POWERS RETAINED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. THE CHIEF EXECUTIVE OFFICER OF BELLIN GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. RETAINS AUTHORITY TO APPROVE ANY SIGNIFICANT CHANGES TO THE CORPORATION. SUBJECT TO THE RESERVED POWERS SPECIFIED IN THE BYLAWS, THE AFFAIRS OF THE CORPORATION SHALL BE MANAGED BY ITS BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION SHALL BE TRI COUNTY MEMORIAL HOSPITAL, INC. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN IS REVIEWED BY THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C TRI-COUNTY MEMORIAL FOUNDATION MONITORS CONFLICTS ON AN ANNUAL BASIS BY REVIEWING DISCLOSURES ON COMPLETED CONFLICT OF INTEREST STATEMENTS. ANY MEMBERS WITH NOTED CONFLICTS ARE ASKED TO ABSTAIN FROM VOTING ON ANY POTENTIALLY CONFLICTED MATTERS. FORM 990, PART VI, SECTION C, LINE 19 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. BELLIN GUNDERSEN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 920504278 PARENT WI 501(C)(3) LINE 12B, II N/A 0 BELLIN HEALTH SYSTEMS INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512904 SUPPORT OF HEALTHCARE ORGANIZATIONS WI 501(C)(3) LINE 12B, II N/A 0 BELLIN COLLEGE INC 3201 EATON ROAD GREEN BAY WI 54311 391620530 NURSING COLLEGE WI 501(C)(3) LINE 2 BELLIN HEALTH SYSTEMS INC 1 BELLIN MEMORIAL HOSPITAL INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 390884478 HOSPITAL WI 501(C)(3) LINE 3 BELLIN HEALTH SYSTEMS INC 1 BELLIN PSYCHIATRIC CENTER INC PO BOX 23725 GREEN BAY WI 54305 391657627 PSYCHIATRIC HOSPITAL WI 501(C)(3) LINE 3 BELLIN HEALTH SYSTEMS INC 1 THE BELLIN HEALTH FOUNDATION INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391809171 FOUNDATION WI 501(C)(3) LINE 7 BELLIN HEALTH SYSTEMS INC 1 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391866425 SUPPORTING ORGANIZATION WI LINE 12B, II N/A 0 GUNDERSEN ADMINISTRATIVE SERVICES INC 1910 SOUTH AVENUE LA CROSSE WI 54601 391606449 SUPPORTING ORGANIZATION WI 501(C)(3) LINE 12B, II GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 GUNDERSEN CLINIC LTD 1836 SOUTH AVENUE LA CROSSE WI 54601 391028657 HEALTH CARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 GUNDERSEN LUTHERAN CREDENTIALING SERVICES INC 1910 SOUTH AVENUE LA CROSSE WI 54601 391856898 CREDENTIALING SERVICES WI 501(C)(3) LINE 12C, III-FI GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 GUNDERSEN LUTHERAN MEDICAL CENTER INC 1910 SOUTH AVENUE LA CROSSE WI 54601 390813416 HEALTH CARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391249705 FOUNDATION WI 501(C)(3) LINE 7 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 LAKE MICHIGAN HEALTH SERVICES INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512903 SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITAL WI 501(C)(3) LINE 12B, II BELLIN HEALTH SYSTEMS INC 1 LUTHERAN HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391751934 INDEPENDENT LIVING WI 501(C)(3) LINE 10 LUTHERAN REAL ESTATE HOLDING CORP 1 LUTHERAN REAL ESTATE HOLDING CORPORATION 1910 SOUTH AVENUE LA CROSSE WI 56401 391480826 HOUSING WI 501(C)(3) LINE 12C, III-FI GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 COMMUNITY HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391586700 INDEPENDENT LIVING WI 501(C)(3) LINE 10 LUTHERAN REAL ESTATE HOLDING CORP 1 TWEETEN LUTHERAN HEALTHCARE CENTER INC 125 FIFTH AVENUE SE SPRING GROVE MN 55974 411565003 HEALTH CARE MN 501(C)(3) LINE 10 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 HARMONY COMMUNITY HEALTHCARE INC 815 MAIN AVENUE S HARMONY MN 55939 410711606 HEALTH CARE MN 501(C)(3) LINE 10 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 MEMORIAL HEALTHCARE FOUNDATION INC PO BOX 40 FRIENDSHIP WI 53934 391775074 FOUNDATION WI 501(C)(3) LINE 12A, I MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC 1 MEMORIAL HOSPITAL OF BOSCOBEL 205 PARKER STREET BOSCOBEL WI 53805 390845590 HEALTH CARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC 402 W LAKE STREET FRIENDSHIP WI 53934 390944012 HEALTH CARE WI 501(C)(3) LINE 3 GUNDERSEN LUTERHAN HEALTH SYSTEM INC 1 OCONTO HOSPITAL & MEDICAL CENTER INC 820 ARBUTUS AVENUE OCONTO WI 54153 061745397 HOSPITAL WI 501(C)(3) LINE 3 BELLIN MEMORIAL HOSPITAL INC 1 SAINT ELIZABETH'S HOSPITAL OF WABASHA 1200 5TH GRANT BOULEVARD WEST WABASHA MN 55981 410693877 HEALTH CARE MN 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 ST JOSEPH'S HEALTH SERVICES INC 400 WATER AVENUE HILLSBORO WI 54634 390929538 HEALTH CARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 ST JOSEPH'S MEMORIAL FOUNDATION INC 400 WATER AVENUE HILLSBORO WI 54634 391455787 FOUNDATION WI 501(C)(3) LINE 12A, I ST JOSEPH'S HEALTH SERVICES INC 1 TRI-COUNTY MEMORIAL HOSPITAL INC 18601 LINCOLN STREET WHITEHALL WI 54773 390704510 HEALTH CARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 TRI-STATE AMBULANCE INC 235 CAUSEWAY BLVD LA CROSSE WI 54603 391965415 MEDICAL TRANSPORTATION WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 TRI-STATE REGIONAL AMBULANCE INC 235 CAUSEWAY BLVD LA CROSSE WI 54603 391962965 MEDICAL TRANSPORTATION WI 501(C)(3) LINE 10 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 PALMER LUTHERAN HEALTH CENTER 112 JEFFERSON STREET WEST UNION IA 52175 421320763 HEALTH CARE IA 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 GUNDERSEN LUTHERAN ENVISION LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 264706546 RENEWABLE ENERGY WI N/A C 1 3REALESTATE LLC 1900 SOUTH AVENUE LA CROSSE WI 54601 RENTAL WI N/A C 1 BEL-REGIONAL HOME MEDICAL INC 617 S ROOSEVELT GREEN BAY WI 54301 391504766 DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS WI N/A C 1 BELLIN INVESTMENTS INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391564939 OTHER WI N/A C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0