2017-11-15T08:30:38-06:00 2016-12-31 390758449 Wipfli LLP 3703 Oakwood Hills Pkwy Eau Claire WI 54701 990EZ 2016-01-01 300093022 TRI-COUNTY MEMORIAL FOUNDATION INC TRI- 7155384361 18601 LINCOLN STREET WHITEHALL WI 54773 JONI OLSON CEO, tri-county memorial hospital 7155384361 2017-11-13 1 PAUL M TRACZEK CPA P01368830 7158323407 2017-11-13 216.54.158.12 2017-11-13 15:09:43 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 28CD8CEAA75BD86222655C2FDB3DC3905C47D94D 2016 2017-02-10 21:41:12Z X X www.gundersenhealth.org/tri-county/foundation X X 50220 X 17655 27805 4760 50220 18299 3653 21952 28268 398570 0 426838 X 399724 429919 399724 429919 1154 3081 398570 426838 X TRI-COUNTY MEMORIAL FOUNDATION, INC. EXISTS TO SUPPORT THE MISSION OF TRI-COUNTY MEMORIAL HOSPITAL, INC. IN THE COMMUNITIES AND SURROUNDING AREAS WHICH ARE SERVICED BY TRI-COUNTY MEMORIAL HOSPITAL, INC. TRI-COUNTY MEMORIAL HOSPITAL, INC. PROVIDES SERVICES TO ALL MEMBERS OF THE PUBLIC WHO NEED MEDICAL SERVICES. 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 THE HOSPITAL AND NURSING HOME IN NEEDED AREAS. AT TIMES, EQUIPMENT IS PURCHASED TO SUPPORT THE HOSPITAL AND NURSING HOME AND OFTEN THERE ARE SCHOLARSHIPS PROVIDED TO MEET HEALTHCARE TRAINING AND EDUCATION NEEDS. DURING THE PERIOD JANUARY 1, 2016 THROUGH DECEMBER 31, 2016, $5,200 IN SCHOLARSHIPS WERE GRANTED TO STUDENTS IN THE AREA PURSUING CAREERS IN MEDICAL FIELDS AND $1,393 WAS DONATED TO AN EMPLOYEE MISSION TRIP TO NICARAGUA. IN ADDITION, $4,000 WAS GRANTED TO FOUR LOCAL FOOD PANTRIES, AND $2,712 WAS DONATED TO THE RELAY FOR LIFE. 18299 18299 18299 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 BRIAN THEILER 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 4994 0 1 4994 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: 4,760. 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: 6,593. 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: 4,994. 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: RELAY FOR LIFE DONATION. Grantee Name: Relay for Life of Trempealeau County. Property Description: Cancer Research. Amount Given: 2,712. 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. Total included on Form 990-EZ, line 10: 18,299. Form 990-EZ, Part II, Line 26 - Other Liabilities Description: ACCOUNTS PAYABLE - DUE TO HOSPITAL. Beg. of Year Amount: 1,154. End of Year Amount: 3,081. 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.