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TRICOUNTY MEMORIAL FOUNDATION INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
TRICOUNTY MEMORIAL FOUNDATION INC (EIN 30-0093022)
Tax period
2020-01-01 to 2020-12-31
Filed
2021-11-15
IRS object ID
202143199349318999
Schema version
2020v4.1
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

FieldValueIRS element (for citing)
Return2021-11-15T14:17:04-06:00ReturnTs
Tax Period End2020-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1155 N Wacker DriveAddressLine1Txt
CityChicagoCityNm
State AbbreviationILStateAbbreviationCd
ZIP60606ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN300093022EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1TRI-COUNTY MEMORIAL FOUNDATION INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% DAN KLIDZEJSInCareOfNm
Business Name ControlTRI-BusinessNameControlTxt
Phone7155384361PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line118601 LINCOLN STREETAddressLine1Txt
CityWHITEHALLCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54773ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDAN KLIDZEJSPersonNm
Person TitleFINC ADMINISTRATORPersonTitleTxt
Phone7155384361PhoneNum
Signature2021-11-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstDANPersonFirstNm
Person LastKLIDZEJSPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJESS WAGENERPreparerPersonNm
PTINP01622613PTIN
Phone3128792000PhoneNum
Preparation2021-11-15PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDAN KLIDZEJSPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line118601 LINCOLN STREETAddressLine1Txt
CityWHITEHALLCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54773ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$38,401GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.GUNDERSENHEALTH.ORG/TRI-COUNTY/FOUNDATIONWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2001FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionSEE SCHEDULE OActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers7TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$38,573PYContributionsGrantsAmt
CY Contributions Grants$26,088CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$6,262PYInvestmentIncomeAmt
CY Investment Income$5,130CYInvestmentIncomeAmt
PY Other Revenue$2,266PYOtherRevenueAmt
CY Other Revenue$7,183CYOtherRevenueAmt
PY Total Revenue$47,101PYTotalRevenueAmt
CY Total Revenue$38,401CYTotalRevenueAmt
PY Grants And Similar Paid$9,043PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$20,504CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$15,345PYOtherExpensesAmt
CY Other Expenses$4,020CYOtherExpensesAmt
PY Total Expenses$24,388PYTotalExpensesAmt
CY Total Expenses$24,524CYTotalExpensesAmt
PY Revenues Less Expenses$22,713PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$13,877CYRevenuesLessExpensesAmt
Total Assets BOY$820,329TotalAssetsBOYAmt
Total Assets EOY$838,226TotalAssetsEOYAmt
Total Liabilities BOY$359,377TotalLiabilitiesBOYAmt
Total Liabilities EOY$363,397TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$460,952NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$474,829NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTRI-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 SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$24,524ExpenseAmt
Grant$20,504GrantAmt
DescTRI-COUNTY MEMORIAL FOUNDATION, INC. PROVIDES SUPPORT TO 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, ASSITED LIVING, AND NURSING HOME. AT TIMES, EQUIPMENT IS PURCHASED TO SUPPORT THE HOSPITAL, CLINICS, ASSISTED LIVING, AND NURSING HOME. DURING THE PERIOD JANUARY 1, 2020 THROUGH DECEMBER 31, 2020, $6,200 IN SCHOLARSHIPS WERE GRANTED TO STUDENTS IN THE AREA PURSUING CAREERS IN MEDICAL FIELDS.Desc
Total Program Service Expenses$24,524TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsYes (true)GrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonDAN KLIDZEJSPersonNm
Phone7155384361PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line118601 LINCOLN STREETAddressLine1Txt
CityWHITEHALLCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54773ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (8 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
DANIEL KLIDZEJS
FINANCE ADMINISTRATOR1.040.0Yes (X)$0$103,025$31,142
KURT JOHNSON
CHAIRPERSON0.50.0Yes (X)$0$0$0Yes (X)
K ROGER GILBERT
VICE-CHAIRPERSON0.50.0Yes (X)$0$0$0Yes (X)
DAVE PIENTOK
TRUSTEE0.50.0$0$0$0Yes (X)
RACHEL RISBERG
TRUSTEE0.50.0$0$0$0Yes (X)
GLEN JOHNSON
TRUSTEE0.50.0$0$0$0Yes (X)
FRED BOE
TRUSTEE0.50.0$0$0$0Yes (X)
WANDA CARTRETTE
TRUSTEE0.50.0$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$103,025TotReportableCompRltdOrgAmt
Total Other Compensation$31,142TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
All Other Contributions$26,088AllOtherContributionsAmt
Total Contributions$26,088TotalContributionsAmt
Total Program Service Revenue$0TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$5,130TotalRevenueColumnAmt
Exclusion$5,130ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUS INCOMEDesc
Business900099BusinessCd
Total Revenue Column$7,183TotalRevenueColumnAmt
Exclusion$7,183ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$7,183OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$38,401TotalRevenueColumnAmt
Exclusion$12,313ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$8,500TotalAmt
Program Services$8,500ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$12,004TotalAmt
Program Services$12,004ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$2,692TotalAmt
Program Services$2,692ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUS EXPENSESDesc
Total$1,328TotalAmt
Program Services$1,328ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$24,524TotalAmt
Program Services$24,524ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$820,329BOYAmt
EOY$838,226EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$820,329BOYAmt
EOY$838,226EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$359,377BOYAmt
EOY$363,397EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$359,377BOYAmt
EOY$363,397EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$346,793BOYAmt
EOY$343,083EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$114,159BOYAmt
EOY$131,746EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$460,952BOYAmt
EOY$474,829EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$820,329BOYAmt
EOY$838,226EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$13,877ReconcilationRevenueExpnssAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1TRI-COUNTY MEMORIAL HOSPITAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN390704510EIN
Organization Type3OrganizationTypeCd
Governing Document ListedYes (true)GoverningDocumentListedInd
Support$0SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$0SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (true)ListedByNameGoverningDocInd
Suprt Org No IRS DeterminationfalseSuprtOrgNoIRSDeterminationInd
Supported Org Section C456falseSupportedOrgSectionC456Ind
Supported Org Not Organized USfalseSupportedOrgNotOrganizedUSInd
Organization Change Suprt OrgfalseOrganizationChangeSuprtOrgInd
Support Non Supported OrgYes (true)SupportNonSupportedOrgInd
Payment Substantial ContribtrfalsePaymentSubstantialContribtrInd
Loan Disqualified PersonfalseLoanDisqualifiedPersonInd
Controlled Disqualified PrsnfalseControlledDisqualifiedPrsnInd
Disqualified Prsn Controll IntfalseDisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr IntfalseDisqualifiedPrsnOwnrIntInd
Excess Business Holdings RulesfalseExcessBusinessHoldingsRulesInd
Contribution ControllerfalseContributionControllerInd
Contribution FamilyfalseContributionFamilyInd
Contribution35 ControlledfalseContribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (true)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt OrgfalseOperateBenefitNonSuprtOrgInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE A, PART IV, LINE 6FormAndLineReferenceDesc
ExplanationIn keeping with the Foundation's mission to support Tri-County Memorial Hospital in improving the health of the communities we serve, the Foundation made donations of $3,420 to area food pantries, AND $3,000 to a local school district towards a program for training certified nursing assistants.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp
LandLandGrp
BuildingsBuildingsGrp
Leasehold ImprovementsLeaseholdImprovementsGrp
EquipmentEquipmentGrp
Other Land BuildingsOtherLandBuildingsGrp
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO TRI-COUNTY MEMORIAL HOSPITALDesc
Amt$363,397Amt
FieldValueIRS element (for citing)
Total Liability$363,397TotalLiabilityAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceFORM 990, SCHEDULE D, PART X, LINE 2 PARTFormAndLineReferenceDesc
ExplanationINCOME TAX MATTERS (DOLLARS IN THOUSANDS) THE SYSTEM QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE), WITH THE EXCEPTION OF GUNDERSEN LUTHERAN ENVISION, LLC, WHICH is a for-profit entity. AT DECEMBER 31, 2020 AND 2019, NET DEFERRED TAX ASSETS OF $7,948 AND $6,900, RESPECTIVELY, WHICH PRIMARILY ARE RELATED TO NET OPERATING LOSS CARRYFORWARDS, HAVE VALUATION ALLOWANCES OF $7,948 AND $6,900, RESPECTIVELY, RECORDED AGAINST THEM DUE TO THE UNCERTAINTY OF REALIZING THOSE BENEFITS IN THE FUTURE. AT DECEMBER 31, 2020, THE SYSTEM'S FEDERAL NET OPERATING LOSS CARRYFORWARDS WERE APPROXIMATELY $29,800, AND THE STATE NET OPERATING LOSS CARRYFORWARDS WERE APPROXIMATELY $27,900, WHICH WILL EXPIRE BETWEEN 2029 AND 2038. THE SYSTEM HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS. THE SYSTEM'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR 2015 AND PRIOR YEARS.ExplanationTxt

Schedule I IRS990ScheduleI

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntCash GrantCashGrantAmt
EMPLOYEE ASSISTANCE FUND16$5,804
SCHOLARSHIPS6$6,200

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART I, LINE 1TRI-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.
FORM 990, PART VI, SECTION A, LINE 6THE SOLE MEMBER OF THE CORPORATION SHALL BE TRI COUNTY MEMORIAL HOSPITAL, INC.
FORM 990, PART VI, SECTION B, LINE 11BTHE RETURN IS MADE AVAILABLE FOR REVIEW TO THE BOARD OF DIRECTORS PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12ATRI-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 19TRI-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.
FORM 990, PART XII, LINE 2C, OVERSIGHT OF THE AUDITTRI-COUNTY MEMORIAL FOUNDATION, INC IS INCLUDED IN THE CONSOLIDATED AUDIT WITH THE GUNDERSEN HEALTH SYSTEM, AND THE GUNDERSEN HEALTH SYSTEM BOARD HAS RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (24 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
GUNDERSEN LUTHERAN HEALTH SYSTEM INC
1836 SOUTH AVENUELA CROSSEWI54601391866425SUPPORT ORGWI501(C)(3)LINE 12B,IINAfalse
GUNDERSEN LUTHERAN MEDICAL CENTER INC
1910 SOUTH AVENUELA CROSSEWI54601390813416HEALTHCAREWI501(C)(3)LINE 3GLHSfalse
GUNDERSEN CLINIC LTD
1836 SOUTH AVENUELA CROSSEWI54601391028657HEALTHCAREWI501(C)(3)LINE 3GLHSfalse
GUNDERSEN LUTHERAN ADMIN SVS
1910 SOUTH AVELA CROSSEWI54601391606449SUPPORT ORGWI501(C)(3)LINE 12B,IIGLHSfalse
GUNDERSEN LUTHERAN MEDICAL FOUNDATION
1836 SOUTH AVELA CROSSEWI54601391249705FOUNDATIONWI501(C)(3)LINE 7GLHSfalse
GUNDERSEN LUTHERAN CREDENTIALING SVC
1910 SOUTH AVENUELA CROSSEWI54601391856898CREDENTIALINGWI501(C)(3)LN 12C IIIGLHSfalse
TRI-COUNTY MEMORIAL HOSPITAL INC
18601 LINCOLN STREETWHITEHALLWI54773390704510HEALTHCAREWI501(C)(3)LINE 3GLHSfalse
HARMONY COMMUNITY HEALTHCARE INC
815 MAIN AVENUE SOUTHHARMONYMN55939410711606HEALTHCAREMN501(C)(3)LINE 10GLHSfalse
TWEETEN LUTHERAN HEALTHCARE CENTER INC
125 FIFTH AVENUE SESPRING GROVEMN55974411565003HEALTHCAREMN501(C)(3)LINE 10GLHSfalse
TRI-STATE AMBULANCE INC
235 CAUSEWAY BLVDLA CROSSEWI54603391965415MDCL TRANSPORWI501(C)(3)LINE 3GLHSfalse
TRI-STATE REGIONAL AMBULANCE INC
235 CAUSEWAY BLVDLA CROSSEWI54603391962965MDCL TRANSPORWI5001(C)(3)LINE 10GLHSfalse
LUTHERAN REAL ESTATE HOLDING CORPORATION
1910 SOUTH AVENUELA CROSSEWI54601391480826HOUSINGWI501(C)(3)LN 12C, IIIGLHSfalse
LUTHERAN HOUSING OF LA CROSSE INC
1900 SOUTH AVENUELA CROSSEWI54601391751934IND. LIVINGWI501(C)(3)LINE 10LRHCfalse
COMMUNITY HOUSING OF LA CROSSE INC
1900 SOUTH AVENUELA CROSSEWI54601391586700IND. LIVINGWI501(C)(3)LINE 10LRHCfalse
ST JOSEPH'S HEALTH SERVICES INC
400 WATER AVENUEHILLSBOROWI54634390929538HEALTHCAREWI501(C)(3)LINE 3GLHSfalse
ST JOSEPH'S MEMORIAL FOUNDATION
400 WATER AVENUEHILLSBOROWI54634391455787FOUNDATIONWI501(C)(3)LINE 12A, IS JOSEPH HSfalse
MEMORIAL HOSPITAL OF BOSCOBEL
205 PARKER STREETBOSCOBELWI53805390845590HEALTHCAREWI501(C)(3)LINE 3GLHSfalse
MEMORIAL HOSPITAL OF BOSCOBEL FOUNDATION
205 PARKER STREETBOSCOBELWI53805391688793FOUNDATIONWI501(C)(3)LINE 7MHOBfalse
BOSCOBEL AREA HEALTHCARE PARTNERS
205 PARKER STREETBOSCOBELWI53805450498844FUNDRAISINGWI501(C)(3)LINE 7NAfalse
PALMER LUTHERAN HEALTH CENTER INC
112 JEFFERSON STREETWEST UNIONIA52175421320763HEALTHCAREIA501(C)(3)LINE 3GLHSfalse
PALMER MEMORIAL FOUNDATION
112 JEFFERSON STREETWEST UNIONIA52175421032878FOUNDATIONIA501(C)(3)LINE 7PLHCfalse
MOUNDVIEW MEMORIAL HOSPITALS & CLINICS
402 WEST LAKE STREETFRIENDSHIPWI53934390944012HEALTHCAREWI501(C)(3)LINE 3GLHSfalse
MEMORIAL HC FDN OF ADAMS COUNTY INC
402 WEST LAKE STREETFRIENDSHIPWI53934391775074FOUNDATIONWI501(C)(3)LINE 12A, IMMHCfalse
SAINT ELIZABETH'S HOSPITAL OF WABASHA
1200 5TH GRANT BOULEVARD WESTWABASHAMN55981410693877HEALTHCAREMN501(C)(3)LINE 3GLHSfalse

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1GUNDERSEN LUTHERAN ENVISION LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11836 SOUTH AVENUEAddressLine1Txt
CityLA CROSSECityNm
State AbbreviationWIStateAbbreviationCd
ZIP54601ZIPCd
FieldValueIRS element (for citing)
EIN264706546EIN
Primary ActivitiesRENEWABLE ENERGYPrimaryActivitiesTxt
Legal Domicile StateWILegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1GLHSBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeC CORPEntityTypeTxt
Share Of Total Income$0ShareOfTotalIncomeAmt
Share Of EOY Assets$0ShareOfEOYAssetsAmt
Controlled OrganizationYes (true)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd