TRICOUNTY MEMORIAL FOUNDATION INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- TRICOUNTY MEMORIAL FOUNDATION INC (EIN 30-0093022)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-15
- IRS object ID
- 202203199349301030
- Schema version
- 2021v4.2
- 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 | 2022-11-15T07:08:07-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | 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 | JONI OLSON | PersonNm |
| Person Title | ADMINISTRATOR | PersonTitleTxt |
| Phone | 7155384361 | PhoneNum |
| Signature | 2022-11-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JONI | PersonFirstNm |
| Person Last | OLSON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2022-11-11 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JONI OLSON | PrincipalOfficerNm |
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 | $300,823 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | 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 | 12 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $26,088 | PYContributionsGrantsAmt |
| CY Contributions Grants | $296,688 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $5,130 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,161 | CYInvestmentIncomeAmt |
| PY Other Revenue | $7,183 | PYOtherRevenueAmt |
| CY Other Revenue | $974 | CYOtherRevenueAmt |
| PY Total Revenue | $38,401 | PYTotalRevenueAmt |
| CY Total Revenue | $300,823 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $20,504 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $23,329 | 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 | $4,020 | PYOtherExpensesAmt |
| CY Other Expenses | $12,943 | CYOtherExpensesAmt |
| PY Total Expenses | $24,524 | PYTotalExpensesAmt |
| CY Total Expenses | $36,272 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $13,877 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $264,551 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $838,226 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,131,839 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $363,397 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $392,459 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $474,829 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $739,380 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $36,272 | ExpenseAmt |
| Grant | $23,329 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | TRI-COUNTY MEMORIAL FOUNDATION, INC. PROVIDES SUPPORT FOR 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, 2021 THROUGH DECEMBER 31, 2021, $4,200 IN SCHOLARSHIPS WERE GRANTED TO STUDENTS IN THE AREA PURSUING CAREERS IN MEDICAL FIELDS. | Desc |
| Total Program Service Expenses | $36,272 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | 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 | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| 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 | JONI OLSON | 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 (10 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt |
|---|---|---|---|---|---|---|---|
| KURT JOHNSON | |||||||
| CHAIRMAN | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| K ROGER GILBERT | |||||||
| VICE CHAIRMAN | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| FRED BOE | |||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| WANDA CARTRETTE | |||||||
| TRUSTEE (THRU FEB) | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| GLEN JOHNSON | |||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| DAVE PIENTOK | |||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| RACHEL RISBERG | |||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| J MICHAEL WARNER | |||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| JONI OLSON | |||||||
| ADMINISTRATOR | 0.50 | Yes (X) | $0 | $204,488 | $51,195 | 40.00 | |
| DAN KLIDZEJS | |||||||
| FINANCE ADMINISTRATOR | 1.00 | Yes (X) | $0 | $113,697 | $35,179 | 40.00 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $318,185 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $86,374 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $296,688 | AllOtherContributionsAmt |
| Total Contributions | $296,688 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,161 | TotalRevenueColumnAmt |
| Exclusion | $3,161 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $974 | TotalRevenueColumnAmt |
| Exclusion | $974 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $974 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $300,823 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $4,135 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,129 | TotalAmt |
| Program Services | $19,129 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,200 | TotalAmt |
| Program Services | $4,200 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,034 | TotalAmt |
| Program Services | $8,034 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,859 | TotalAmt |
| Program Services | $4,859 | ProgramServicesAmt |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50 | TotalAmt |
| Program Services | $50 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,272 | TotalAmt |
| Program Services | $36,272 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $838,226 | BOYAmt |
| EOY | $1,002,842 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $128,997 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $838,226 | BOYAmt |
| EOY | $1,131,839 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $363,397 | BOYAmt |
| EOY | $392,459 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $363,397 | BOYAmt |
| EOY | $392,459 | 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 | $343,083 | BOYAmt |
| EOY | $316,992 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $131,746 | BOYAmt |
| EOY | $422,388 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $474,829 | BOYAmt |
| EOY | $739,380 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $838,226 | BOYAmt |
| EOY | $1,131,839 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $264,551 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | 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 | Yes (1) | 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 | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO TRI-COUNTY MEMORIAL HOSPITAL | Desc |
| Amt | $392,459 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $392,459 | TotalLiabilityAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRIENDS OF THE WHITEHALL PUBLIC LIBRARY INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 36351 MAIN ST | AddressLine1Txt |
| City | WHITEHALL | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54773 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 461606462 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $10,000 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | FUNDS TO HELP BUILD NEW LIBRARY | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JONI OLSON | PersonNm |
| Title | ADMINISTRATOR | TitleTxt |
| Base Compensation Filing Org | $0 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $199,663 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $2,000 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $2,825 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $29,459 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $0 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $21,736 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $0 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $255,683 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (23 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 | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | Yes (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 | Yes (1) | |
| GUNDERSEN LUTHERAN ADMIN SERVICES INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391606449 | SUPPORTING ORGANIZATION | WI | 501(C)(3) | LINE 12B, II | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| GUNDERSEN LUTHERAN CREDENTIALING SERVICES INC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391856898 | CREDENTIALING SERVICE | WI | 501(C)(3) | LINE 12C, III-FI | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| GUNDERSEN LUTHERAN HEALTH SYSTEM INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391866425 | SUPPORTING ORGANIZATION | WI | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| 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 | Yes (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 | Yes (1) | |
| HARMONY COMMUNITY HEALTHCARE INC | |||||||||||
| 815 MAIN AVENUE SOUTH | HARMONY | MN | 55939 | 410711606 | HEALTH CARE | MN | 501(C)(3) | LINE 10 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (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 | Yes (1) | |
| LUTHERAN REAL ESTATE HOLDING CORP | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391480826 | HOUSING | WI | 501(C)(3) | LINE 12C, III-FI | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (1) | |
| MEMORIAL HEALTHCARE FOUNDATION OF ADAMS CTY | |||||||||||
| 402 WEST LAKE STREET | FRIENDSHIP | WI | 53934 | 391775074 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC | Yes (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 | Yes (1) | |
| MEMORIAL HOSPITAL OF BOSCOBEL FOUNDATION INC | |||||||||||
| 205 PARKER STREET | BOSCOBEL | WI | 55939 | 391688793 | FOUNDATION | WI | 501(C)(3) | LINE 7 | MEMORIAL HOSPITAL OF BOSCOBEL | Yes (1) | |
| MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC | |||||||||||
| 402 W LAKE STREET | FRIENDSHIP | WI | 53934 | 390944012 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (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 | Yes (1) | |
| PALMER MEMORIAL FOUNDATION | |||||||||||
| 112 JEFFERSON STREET | WEST UNION | IA | 52175 | 421032878 | FOUNDATION | IA | 501(C)(3) | LINE 7 | PALMER LUTHERAN HEALTH CENTER | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (1) | |
| TRI-STATE AMBULANCE INC | |||||||||||
| 235 CAUSEWAY BLVD | LA CROSSE | WI | 54601 | 391965415 | MEDICAL TRANSPORTATION | WI | 501(C)(3) | LINE 3 | GUNDERSEN LUTHERAN HEALTH SYSTEM INC | Yes (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 | Yes (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 | Yes (1) | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| GUNDERSEN LUTHERAN ENVISION LLC | |||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 264706546 | RENEWABLE ENERGY | WI | N/A | C | Yes (1) |
| 3REALESTATE LLC | |||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | RENTAL | WI | N/A | C | Yes (1) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |