ST CROIX VALLEY HEALTH CARE FOUNDATION: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: ST CROIX VALLEY HEALTH CARE FOUNDATION (EIN 39-1424605)
Tax period: 2012-10-01 to 2013-09-30
Filed: 2014-08-14
IRS object ID: 201422269349302967
Schema version: 2012v2.3
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
Form 990
Schedule A
Schedule D
Schedule G
Schedule I
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2014-08-14T13:20:19-05:00	Timestamp
Tax Period End Date	2013-09-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	CARLSON HIGHLAND & CO LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	304 3RD AVENUE	AddressLine1
City	OSCEOLA	City
State	WI	State
ZIP Code	54020	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-10-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	391424605	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	ST CROIX VALLEY HEALTHCARE FDN	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	STCR	NameControl
Phone	7154833261	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	235 STATE STREET	AddressLine1
City	ST CROIX FALLS	City
State	WI	State
ZIP Code	540240499	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	FAY L CANEDAY	Name
Title	TREASURER/SECRETARY	Title
Phone	7154833261	Phone
Date Signed	2014-08-10	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	TODD D ANDERSON CPA	Name
Phone	7152944880	Phone
Date Prepared	2014-08-14	DatePrepared
Self Employed	X	SelfEmployed

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2015-11-30 17:44:51Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	ELVIRA SCHMIDT	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	3348-30TH AVE	AddressLine1
City	FREDERIC	City
State	WI	State
ZIP Code	54837	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	59290	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1983	YearFormation
State Legal Domicile	WI	StateLegalDomicile
Activity Or Mission Description	TO PROMOTE QUALITY HEALTH CARE FOR INDIVIDUALS, FAMILIES AND COMMUNITIES IN THE ST. CROIX VALLEY BY CONDUCTING CHARITABLE, EDUCATIONAL, SCIENTIFIC AND FUNDRAISING ACTIVITIES IN SUPPORT OF OUR COMMUNITIES' HEALTH CARE ORGANIZATIONS.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	16	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	16	NbrIndependentVotingMembers
Total Nbr Employees	0	TotalNbrEmployees
Total Nbr Volunteers	16	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Current Year	8561	ContributionsGrantsCurrentYear
Program Service Revenue CY	0	ProgramServiceRevenueCY
Investment Income Current Year	42	InvestmentIncomeCurrentYear
Other Revenue Current Year	50687	OtherRevenueCurrentYear
Total Revenue Current Year	59290	TotalRevenueCurrentYear
Grants And Similar Amnts CY	64050	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Current Year	0	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	23994	TotalFundrsngExpCurrentYear
Other Expenses Current Year	32198	OtherExpensesCurrentYear
Total Expenses Current Year	96248	TotalExpensesCurrentYear
Revenues Less Expenses CY	-36958	RevenuesLessExpensesCY
Total Assets BOY	539202	TotalAssetsBOY
Total Assets EOY	521144	TotalAssetsEOY
Total Liabilities EOY	0	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	539202	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	521144	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	TO PROMOTE QUALITY HEALTH CARE FOR INDIVIDUALS, FAMILIES AND COMMUNITIES IN THE ST. CROIX VALLEY BY CONDUCTING CHARITABLE, EDUCATIONAL, SCIENTIFIC AND FUNDRAISING ACTIVITIES IN SUPPORT OF OUR COMMUNITIES' HEALTH CARE ORGANIZATIONS.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	64050	Expense
Grants	64050	Grants
Description	CONTRIBUTED CAPITAL EQUIPMENT 60,450 TO THE ST CROIX REGIONAL MEDICAL CENTER AND AWARDED 3,600 OF SCHOLARSHIPS FOR STUDENTS PURSUING DEGREES IN HEALTH RELATED FIELDS.	Description
Total Program Service Expense	64050	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	false	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	false	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	false	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	true	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	true	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	false	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	false	ScheduleORequired
Number Forms Transmitted With1096	0	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	0	NumberOfEmployees
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	16	NbrVotingGoverningBodyMembers
Number Independent Voting Members	16	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	false	ConflictOfInterestPolicy
Whistleblower Policy	false	WhistleblowerPolicy
Document Retention Policy	false	DocumentRetentionPolicy
Compensation Process CEO	false	CompensationProcessCEO
Compensation Process Other	false	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
States Where Copy Of Return Is Filed	MN	StatesWhereCopyOfReturnIsFiled
States Where Copy Of Return Is Filed	WI	StatesWhereCopyOfReturnIsFiled
Other Website	X	OtherWebsite
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	FAYE CANEDAY	NamePerson
Telephone Number	7154833261	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	235 STATE STREET	AddressLine1
City	ST CROIX FALLS	City
State	WI	State
ZIP Code	54024	ZIPCode

Field	Value	IRS element (for citing)
No Listed Persons Compensated	X	NoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Average Hours Per Week RelatedAverageHoursPerWeekRelated
DARRELL ANDERSON
VICE PRESIDE	1.00	X	X	0	0	0
CHERYL BJORNSTAD
BOARD MEMBER	1.00	X		0	0	0
FAY CANEDAY
TREASURER/SE	1.00	X	X	0	0	0
LOREN CANEDAY
BOARD MEMBER	1.00	X		0	0	0
DAVE DOBOSENSKI
BOARD MEMBER	1.00	X		0	0	0
CONNIE ERICKSON
BOARD MEMBER	1.00	X		0	0	0
LYNN LONGNECKER
BOARD MEMBER	1.00	X		0	0	0
KELLY LUSCHEN
BOARD MEMBER	1.00	X		0	0	0
STEVE MCCORMACK
BOARD MEMBER	1.00	X		0	0	0
ROBERT NELSON
BOARD MEMBER	1.00	X		0	0	0
SUE NELSON
BOARD MEMBER	1.00	X		0	0	0
MIKE ROCHFORD
BOARD MEMBER	1.00	X		0	0	0
ELVIRA SCHMIDT
PRESIDENT	2.00	X	X	0	0	0	0.00
DENISE SINCLEAR TODD
BOARD MEMBER	1.00	X		0	0	0
JOHN TREMBLE
BOARD MEMBER	1.00	X		0	0	0
SANDRA WILLIAMS
BOARD MEMBER	1.00	X		0	0	0

Field	Value	IRS element (for citing)
Formers Listed	false	FormersListed
Total Comp GT150 K	false	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources
Fundraising Events	8561	FundraisingEvents
Total Contributions	8561	TotalContributions

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	42	TotalRevenueColumn
Related Or Exempt Function Income	42	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Gross Income Fundraising Events	50687	GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events	8561	CntrbtnsRprtdFundraisingEvents

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	50687	TotalRevenueColumn

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	59290	TotalRevenueColumn
Related Or Exempt Function Income	42	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	X	InfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	64050	Total
Program Services	64050	ProgramServices

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	32198	Total
Management And General	8204	ManagementAndGeneral
Fundraising	23994	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	96248	Total
Program Services	64050	ProgramServices
Management And General	8204	ManagementAndGeneral
Fundraising	23994	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	97812	BOY
EOY	32818	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
EOY	147775	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	441390	BOY
EOY	340551	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	539202	BOY
EOY	521144	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Field	Value	IRS element (for citing)
Do Not Follow SFAS117	X	DoNotFollowSFAS117

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

Field	Value	IRS element (for citing)
BOY	539202	BOY
EOY	521144	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	539202	BOY
EOY	521144	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	539202	BOY
EOY	521144	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	-36958	ReconcilationRevenueExpenses
Reconciliation Unrealized Invest	18900	ReconciliationUnrealizedInvest
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	false	FSAudited

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Supporting Organization509a3	X	SupportingOrganization509a3
Supporting Org509a3 Type3 Func Int	X	SupportingOrg509a3Type3FuncInt
Certification Checkbox	X	CertificationCheckbox
Contrib By Controlling Individual	false	ContribByControllingIndividual
Contribution By Related Party	false	ContributionByRelatedParty
Contrib By35 Controlled Entity	false	ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	ST CROIX REGIONAL MEDICAL CENTER	BusinessNameLine1

Field	Value	IRS element (for citing)
EIN	390890676	EIN
Type Of Organization	3	TypeOfOrganization
Listed In Governing Doc	true	ListedInGoverningDoc
Supported Organization Notified	true	SupportedOrganizationNotified
Organized In US	true	OrganizedInUS
Amount	$64,050	Amount

Field	Value	IRS element (for citing)
Total Number Of Supported Orgs	1	TotalNumberOfSupportedOrgs
Sum Of Amounts	64050	SumOfAmounts

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Tot Revenue Etc Audited Fincl Stmt	78190	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	18900	NetUnrealizedGainsInvestments
Revenue Not Rptd F990	18900	RevenueNotRptdF990
Revenue Subtotal	59290	RevenueSubtotal
Total Revenue Per Form990	59290	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	96248	TotExpensesEtcAuditedFinclStmt
Expenses Subtotal	96248	ExpensesSubtotal
Total Expenses Per Form990	96248	TotalExpensesPerForm990

Schedule G IRS990ScheduleG

Field	Value	IRS element (for citing)
Licensed States	WI	LicensedStates

Events Information EventsInformation

Field	Value	IRS element (for citing)
Name Of Event1	FUNDRAISER	NameOfEvent1
Gross Receipts Event1	59248	GrossReceiptsEvent1
Charitable Contributions Event1	8561	CharitableContributionsEvent1
Gross Revenue Event1	50687	GrossRevenueEvent1
Gross Receipts Total	59248	GrossReceiptsTotal
Charitable Contributions Total	8561	CharitableContributionsTotal
Gross Revenue Total Events	50687	GrossRevenueTotalEvents
Net Income Summary	50687	NetIncomeSummary

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	false	RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	ST CROIX REGIONAL MEDICAL CENTER	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	235 STATE ST	AddressLine1
City	ST CROIX FALLS	City
State	WI	State
ZIP Code	54024	ZIPCode

Field	Value	IRS element (for citing)
EIN Of Recipient	390890676	EINOfRecipient
IRC Section	501C3	IRCSection
Amount Of Cash Grant	64050	AmountOfCashGrant
Purpose Of Grant	PURCHASE MEDICAL EQP	PurposeOfGrant

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	64050	TotalNbrOf501C3AndGovtGrants

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
ORGANIZATION'S MISSION	FORM 990 - ORGANIZATION'S MISSION	TO PROMOTE QUALITY HEALTH CARE FOR INDIVIDUALS, FAMILIES AND COMMUNITIES IN THE ST. CROIX VALLEY BY CONDUCTING CHARITABLE, EDUCATIONAL, SCIENTIFIC AND FUNDRAISING ACTIVITIES IN SUPPORT OF OUR COMMUNITIES' HEALTH CARE ORGANIZATIONS.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11B	NO REVIEW WAS OR WILL BE CONDUCTED.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	NO DOCUMENTS AVAILABLE TO THE PUBLIC
OTHER FEES FOR SERVICES	FORM 990, PART IX, LINE 11G	BANK & CC FEES 0 1,153 0 OFFICE EXPENSES 0 6,924 0 ADVERTISING 0 53 0 MISCELLANEOUS 0 74 0 FOOD & PRIZES 0 0 23,994