2021-11-15T14:17:04-06:00 2020-12-31 ERNST & YOUNG US LLP 155 N Wacker Drive Chicago IL 60606 990 2020-01-01 300093022 TRI-COUNTY MEMORIAL FOUNDATION INC % DAN KLIDZEJS TRI- 7155384361 18601 LINCOLN STREET WHITEHALL WI 54773 DAN KLIDZEJS FINC ADMINISTRATOR 7155384361 2021-11-15 true DAN KLIDZEJS 999009999 JESS WAGENER P01622613 3128792000 2021-11-15 3 2020 2022-09-23 18:48:47Z DAN KLIDZEJS 18601 LINCOLN STREET WHITEHALL WI 54773 38401 false X WWW.GUNDERSENHEALTH.ORG/TRI-COUNTY/FOUNDATION X 2001 WI SEE SCHEDULE O 7 7 0 7 0 0 38573 26088 0 0 6262 5130 2266 7183 47101 38401 9043 20504 0 0 0 0 0 0 0 15345 4020 24388 24524 22713 13877 820329 838226 359377 363397 460952 474829 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. false false 24524 20504 TRI-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. 24524 true false false false false false false false false false false false false true false false true false false false false false false false false false false true false false false false false false false false false false false false false false true false false true 0 0 0 false false false false false false false false false false false false X 7 7 false false false false true false false true true false false true true true true false false false false false WI X DAN KLIDZEJS 7155384361 18601 LINCOLN STREET WHITEHALL WI 54773 DANIEL KLIDZEJS FINANCE ADMINISTRATOR 1.0 40.0 X 0 103025 31142 KURT JOHNSON CHAIRPERSON 0.5 0.0 X X 0 0 0 K ROGER GILBERT VICE-CHAIRPERSON 0.5 0.0 X X 0 0 0 DAVE PIENTOK TRUSTEE 0.5 0.0 X 0 0 0 RACHEL RISBERG TRUSTEE 0.5 0.0 X 0 0 0 GLEN JOHNSON TRUSTEE 0.5 0.0 X 0 0 0 FRED BOE TRUSTEE 0.5 0.0 X 0 0 0 WANDA CARTRETTE TRUSTEE 0.5 0.0 X 0 0 0 0 103025 31142 0 false false false 0 26088 26088 0 5130 5130 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MISCELLANEOUS INCOME 900099 7183 7183 7183 38401 12313 8500 8500 12004 12004 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2692 2692 0 0 0 0 0 0 0 0 0 0 0 0 MISCELLANEOUS EXPENSES 1328 1328 0 0 24524 24524 0 0 0 0 820329 838226 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 820329 838226 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 359377 363397 359377 363397 X 346793 343083 114159 131746 460952 474829 820329 838226 13877 X false true X true false X X 1 TRI-COUNTY MEMORIAL HOSPITAL INC 390704510 3 true 0 0 1 0 0 true false false false false true false false false false false false false false false true false SCHEDULE A, PART IV, LINE 6 In 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. 0 DUE TO TRI-COUNTY MEMORIAL HOSPITAL 363397 363397 FORM 990, SCHEDULE D, PART X, LINE 2 PART INCOME 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. EMPLOYEE ASSISTANCE FUND 16 5804 SCHOLARSHIPS 6 6200 FORM 990, PART I, LINE 1 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. 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 MADE AVAILABLE FOR REVIEW TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12A 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. FORM 990, PART XII, LINE 2C, OVERSIGHT OF THE AUDIT TRI-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. 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