2018-11-15T08:39:33-06:00 2017-12-31 390758449 WIPFLI LLP 4890 OWEN AYRES COURT SUITE 200 EAU CLAIRE WI 54701 990EZ 2017-01-01 300093022 TRI-COUNTY MEMORIAL FOUNDATION INC TRI- 7155384361 18601 LINCOLN STREET WHITEHALL WI 54773 JONI OLSON CEO, TRI-COUNTY MEMORIAL HOSPITAL 7155384361 2018-11-14 1 HOLLY POKRANDT CPA P00449155 7158323407 2018-11-14 137.26.200.211 2018-11-14 10:28:52 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 558C6F47C777A73CECB93EB9107DCB0C387663C8 2017 2019-02-21 02:37:17Z X X WWW.GUNDERSENHEALTH.ORG/TRI-COUNTY/FOUNDATION X X 60521 X 32117 24974 3430 60521 47133 14959 62092 -1571 426838 0 425267 X 429919 425868 429919 425868 3081 601 426838 425267 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. 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, 2017 THROUGH DECEMBER 31, 2017, $5,200 IN SCHOLARSHIPS WERE GRANTED TO STUDENTS IN THE AREA PURSUING CAREERS IN MEDICAL FIELDS. IN ADDITION, $4,000 WAS GRANTED TO FOUR LOCAL FOOD PANTRIES. 47133 47133 47133 KURT JOHNSON CHAIRMAN 0.50 0 0 0 KATHY KULIG TRUSTEE 0.50 0 0 0 LINDA BAXA TRUSTEE 0.50 0 0 0 K ROGER GILBERT VICE CHAIRMAN 0.50 0 0 0 DAVE PIENTOK TRUSTEE 0.50 0 0 0 WANDA CARTRETTE TRUSTEE 0.50 0 0 0 DUANE BYOM TRUSTEE 0.50 0 0 0 JONI OLSON PRESIDENT/CEO 0.50 0 0 0 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ROXANE SCHLEICH 18601 LINCOLN STREET WHITEHALL WI 54773 7155384361 0 0 0 0 0 0 0 0 0 0 NONE NONE 1 X X 1 TRI-COUNTY MEMORIAL HOSPITAL INC 390704510 3 1 37933 0 1 37933 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 FORM 990-EZ, PART I, LINE 4 - OTHER INVESTMENT INCOME DESCRIPTION: INTEREST INCOME. AMOUNT: 3,430. FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION FOR PROPERTY AND EQUIPMENT PURCHASES. GRANTEE NAME: TRI-COUNTY MEMORIAL HOSPITAL. GRANTEE ADDRESS: 18601 LINCOLN STREET WHITEHALL, WI 54773. GRANTEE RELATIONSHIP: RELATED PARTY. PROPERTY DESCRIPTION: HOSPITAL EQUIPMENT. AMOUNT GIVEN: 37,933. FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: FOOD PANTRY OPERATION DONATIONS. GRANTEE NAME: CITY OF BLAIR. GRANTEE ADDRESS: 122 SOUTH URBERG AVENUE BLAIR, WI 54616. PROPERTY DESCRIPTION: FOOD PANTRY OPERATIONS. AMOUNT GIVEN: 1,000. FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: FOOD PANTRY OPERATION DONATIONS. GRANTEE NAME: CITY OF ARCADIA. GRANTEE ADDRESS: 1358 HILLVIEW DRIVE ARCADIA, WI 54612. PROPERTY DESCRIPTION: FOOD PANTRY OPERATIONS. AMOUNT GIVEN: 1,000. FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: FOOD PANTRY OPERATION DONATIONS. GRANTEE NAME: CITY OF WHITEHALL. GRANTEE ADDRESS: 36124 SUNSET BOULEVARD WHITEHALL, WI 54773. PROPERTY DESCRIPTION: FOOD PANTRY OPERATIONS. AMOUNT GIVEN: 1,000. FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: FOOD PANTRY OPERATION DONATIONS. GRANTEE NAME: CITY OF INDEPENDENCE. GRANTEE ADDRESS: 23688 ADAMS STREET INDEPENDENCE, WI 54747. PROPERTY DESCRIPTION: FOOD PANTRY OPERATIONS. AMOUNT GIVEN: 1,000. FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: SCHOLARSHIPS TO INDIVIDUALS. GRANTEE NAME: N/A. PROPERTY DESCRIPTION: SCHOLARSHIP. AMOUNT GIVEN: 5,200. TOTAL INCLUDED ON FORM 990-EZ, LINE 10: 47,133. FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIES DESCRIPTION: ACCOUNTS PAYABLE - DUE TO HOSPITAL. BEG. OF YEAR AMOUNT: 3,081. END OF YEAR AMOUNT: 601. THE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY,OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT.THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY,OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT.