2020-11-16T10:43:31-06:00 2019-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2019-01-01 300093022 TRI-COUNTY MEMORIAL FOUNDATION INC TRI- 7155384361 18601 LINCOLN STREET WHITEHALL WI 54773 DAN KLIDZEJS FINANCE ADMINISTRATOR, (TCMH) 7155384361 2020-11-11 1 MICHAEL J PETERSON CPA P01833529 2187224705 2020-11-11 71.13.38.61 2020-11-11 16:34:26 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 2019 2021-01-29 14:40:06Z DAN KLIDZEJS 18601 LINCOLN STREET WHITEHALL WI 54773 47101 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 7 0 0 33293 38573 27645 0 4469 6262 0 2266 65407 47101 31730 9043 0 0 0 0 0 0 0 23036 15345 54766 24388 10641 22713 435908 820329 0 359377 435908 460952 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 24388 9043 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, 2019 THROUGH DECEMBER 31, 2019, $3,000 IN SCHOLARSHIPS WERE GRANTED TO STUDENTS IN THE AREA PURSUING CAREERS IN MEDICAL FIELDS. 24388 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 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 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 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 WI X DAN KLIDZEJS 7155384361 18601 LINCOLN STREET WHITEHALL WI 54773 X FRED BOE TRUSTEE 0.50 X 0 0 0 WANDA CARTRETTE TRUSTEE 0.50 X 0 0 0 GLEN JOHNSON TRUSTEE 0.50 X 0 0 0 DAVE PIENTOK TRUSTEE 0.50 X 0 0 0 RACHEL RISBERG TRUSTEE 0.50 X 0 0 0 KURT JOHNSON CHAIRMAN 0.50 X X 0 0 0 K ROGER GILBERT VICE CHAIRMAN 0.50 X X 0 0 0 DAN KLIDZEJS FINANCE ADMINISTRATOR 1.00 40.00 X 0 0 0 0 0 0 0 0 0 0 0 38573 38573 6262 6262 2266 2266 2266 47101 0 0 8528 6043 6043 3000 3000 111 111 11057 11057 MISCELLANEOUS EXPENSES 4177 4177 24388 24388 0 0 433208 820329 2700 0 435908 820329 0 359377 0 359377 X 324080 346793 111828 114159 435908 460952 435908 820329 X 22713 2331 X 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 0 DUE TO TRI COUNTY MEMORIAL HOSPITAL 359377 359377 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 C, LINE 19 TRI-COUNTY MEMORAL 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 XI, LINE 9: NET ASSETS RELEASED FOR RESTRICTIONS 3,831. TEMPORARY RESTRICTED CONTRIBUTIONS -1,500. FORM 990, PART XII, LINE 2C, OVERSIGHT OF THE AUDIT: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS BY AN INDEPENDENT ACCOUNTANT. THE BOARD OF DIRECTORS GIVES THE FINAL APPROVAL OF THE AUDIT FIRM AND AUDIT REPORTS AND TAKES TIME ANNUALLY TO MEET WITH THE AUDITORS WITHOUT MANAGEMENT PRESENT. THERE WAS NO CHANGE TO THIS PROCESS DURING THE FILING PERIOD. TRI-COUNTY MEMORIAL HOSPITAL INC 18601 LINCOLN STREET WHITEHALL WI 54773 390704510 HOSPITAL WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0