WINNESHIEK MEDICAL CENTER FOUNDATION: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: WINNESHIEK MEDICAL CENTER FOUNDATION (EIN 42-1237298)
Tax period: 2012-07-01 to 2013-06-30
Filed: 2013-11-14
IRS object ID: 201343189349308319
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 B
Schedule D
Schedule I
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-11-14T16:53:36-06:00	Timestamp
Tax Period End Date	2013-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	HACKER NELSON & CO PC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 507	AddressLine1
City	DECORAH	City
State	IA	State
ZIP Code	52101	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	421237298	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	WINNESHIEK MEDICAL CENTER	BusinessNameLine1
Business Name Line2	FOUNDATION	BusinessNameLine2

Field	Value	IRS element (for citing)
Name Control	WINN	NameControl
Phone	5633873037	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	901 MONTGOMERY	AddressLine1
City	DECORAH	City
State	IA	State
ZIP Code	52101	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	JUSTIN GULLEKSON	Name
Title	PRESIDENT	Title
Phone	5633873037	Phone
Date Signed	2013-10-15	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	NEIL W SCHRAEDER	Name
Phone	5633823637	Phone
Date Prepared	2013-11-13	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-25 16:41:14Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	JUSTIN GULLEKSON	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	901 MONTGOMERY	AddressLine1
City	DECORAH	City
State	IA	State
ZIP Code	52101	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	342489	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.WINMEDICAL.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1984	YearFormation
State Legal Domicile	IA	StateLegalDomicile
Activity Or Mission Description	TO RECEIVE CONTRIBUTIONS FOR CAPITAL EXPENDITURES NOT AVAILABLE THROUGH BUDGET PROCESS.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	9	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	9	NbrIndependentVotingMembers
Total Nbr Employees	0	TotalNbrEmployees
Total Nbr Volunteers	9	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	112960	ContributionsGrantsPriorYear
Contributions Grants Current Year	334789	ContributionsGrantsCurrentYear
Program Service Revenue CY	0	ProgramServiceRevenueCY
Investment Income Prior Year	9228	InvestmentIncomePriorYear
Investment Income Current Year	7700	InvestmentIncomeCurrentYear
Other Revenue Current Year	0	OtherRevenueCurrentYear
Total Revenue Prior Year	122188	TotalRevenuePriorYear
Total Revenue Current Year	342489	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	133334	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	147004	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Current Year	0	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	1500	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	5161	TotalFundrsngExpCurrentYear
Other Expense Prior Year	14710	OtherExpensePriorYear
Other Expenses Current Year	26970	OtherExpensesCurrentYear
Total Expenses Prior Year	149544	TotalExpensesPriorYear
Total Expenses Current Year	173974	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-27356	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	168515	RevenuesLessExpensesCY
Total Assets BOY	516111	TotalAssetsBOY
Total Assets EOY	690515	TotalAssetsEOY
Total Liabilities EOY	0	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	516111	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	690515	NetAssetsOrFundBalancesEOY
Mission Description	TO RECEIVE CONTRIBUTIONS FOR CAPITAL EXPENDITURES NOT AVAILABLE THROUGH BUDGET PROCESS.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	164499	Expense
Grants	147004	Grants
Description	TO RECEIVE CONTRIBUTIONS FOR CAPITAL EXPENDITURES NOT AVAILABLE THROUGH LOCAL TAXES AND BUDGET PROCESS.	Description
Total Program Service Expense	164499	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	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	true	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	true	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	false	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	true	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
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	9	NbrVotingGoverningBodyMembers
Number Independent Voting Members	9	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	true	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	true	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	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	false	CompensationProcessCEO
Compensation Process Other	false	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	WINNESHIEK MEDICAL CENTER	NamePerson
Telephone Number	5633822911	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	901 MONTGOMERY	AddressLine1
City	DECORAH	City
State	IA	State
ZIP Code	52101	ZIPCode

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

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation
DAWN MUHLBAUER
VICE-PRESIDE	1.00	X	X	0	0	0
JOHN NOEL
SECRETARY/TR	1.00	X	X	0	0	0
DAN FRETHEIM
DIRECTOR	1.00	X		0	0	0
DIANE TACKE
DIRECTOR	1.00	X		0	0	0
JUSTIN GULLEKSON
PRESIDENT	1.00	X	X	0	0	0
JERRY SAMUELSON
DIRECTOR	1.00	X		0	0	0
DOUG NELSON
DIRECTOR	1.00	X		0	0	0
AMY BRUENING
DIRECTOR	1.00	X		0	0	0
ARLENE HOULIHAN
DIRECTOR	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
All Other Contributions	334789	AllOtherContributions
Total Contributions	334789	TotalContributions

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	7700	TotalRevenueColumn
Related Or Exempt Function Income	7700	RelatedOrExemptFunctionIncome

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	342489	TotalRevenueColumn
Related Or Exempt Function Income	7700	RelatedOrExemptFunctionIncome

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	147004	Total
Program Services	147004	ProgramServices

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	750	Total
Management And General	750	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	2255	Total
Fundraising	2255	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	3003	Total
Management And General	97	ManagementAndGeneral
Fundraising	2906	Fundraising

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	18549	Total
Program Services	17495	ProgramServices
Management And General	1054	ManagementAndGeneral

Other Expenses OtherExpenses (2 entries)

DescriptionDescription	TotalTotal	Management And GeneralManagementAndGeneral
POSTAGE AND SHIPPING	2377	2377
BANK FEES	36	36

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	173974	Total
Program Services	164499	ProgramServices
Management And General	4314	ManagementAndGeneral
Fundraising	5161	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	7100	BOY
EOY	200	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	384859	BOY
EOY	557001	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	124152	BOY
EOY	133314	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	516111	BOY
EOY	690515	EOY

Total Liabilities TotalLiabilities

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

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	507856	BOY
EOY	682348	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	8255	BOY
EOY	8167	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	516111	BOY
EOY	690515	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	516111	BOY
EOY	690515	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	168515	ReconcilationRevenueExpenses
Reconciliation Unrealized Invest	5889	ReconciliationUnrealizedInvest
Method Of Accounting Cash	X	MethodOfAccountingCash
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	false	AuditCommittee
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Supporting Organization509a3	X	SupportingOrganization509a3
Supporting Org509a3 Type3 Func Int	X	SupportingOrg509a3Type3FuncInt
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	WINNESHIEK MEDICAL CENTER	BusinessNameLine1
Business Name Line2	WINNESHIEK MEDICAL CENTER	BusinessNameLine2

Field	Value	IRS element (for citing)
EIN	420680467	EIN
Type Of Organization	3	TypeOfOrganization
Listed In Governing Doc	true	ListedInGoverningDoc
Supported Organization Notified	true	SupportedOrganizationNotified
Organized In US	true	OrganizedInUS
Amount	$147,004	Amount

Field	Value	IRS element (for citing)
Total Number Of Supported Orgs	1	TotalNumberOfSupportedOrgs
Sum Of Amounts	147004	SumOfAmounts

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	8255	BeginningOfYearBalance
Investment Earnings Or Losses	32	InvestmentEarningsOrLosses
Other Expenditures	120	OtherExpenditures
End Of Year Balance	8167	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	8540	BeginningOfYearBalance
Investment Earnings Or Losses	65	InvestmentEarningsOrLosses
Other Expenditures	350	OtherExpenditures
End Of Year Balance	8255	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	8193	BeginningOfYearBalance
Contributions	300	Contributions
Investment Earnings Or Losses	112	InvestmentEarningsOrLosses
Other Expenditures	65	OtherExpenditures
End Of Year Balance	8540	EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	8276	BeginningOfYearBalance
Investment Earnings Or Losses	157	InvestmentEarningsOrLosses
Other Expenditures	240	OtherExpenditures
End Of Year Balance	8193	EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	8289	BeginningOfYearBalance
Investment Earnings Or Losses	325	InvestmentEarningsOrLosses
Other Expenditures	338	OtherExpenditures
End Of Year Balance	8276	EndOfYearBalance

Field	Value	IRS element (for citing)
Permanent Endowment EOY Balance	1.00000	PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs	false	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	false	EndowmentsHeldByRelatedOrgs

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

Field	Value	IRS element (for citing)
Identifier	INTENDED USES FOR ENDOWMENT FUNDS	Identifier
Return Reference	SCHEDULE D, PAGE 2, PART V, LINE 4	ReturnReference
Explanation	THE ENDOWMENT FUNDS ARE USED FOR EDUCATIONAL PURPOSES.	Explanation

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	WINNESHIEK MEDICAL CTR	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	901 MONTGOMERY ST	AddressLine1
City	DECORAH	City
State	IA	State
ZIP Code	52101	ZIPCode

Field	Value	IRS element (for citing)
EIN Of Recipient	420680467	EINOfRecipient
Amount Of Cash Grant	147004	AmountOfCashGrant
Purpose Of Grant	OB PROJECT AND MISC	PurposeOfGrant

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS	FORM 990, PAGE 6, PART VI, LINE 4	THERE WERE TWO CHANGES TO THE WMC FOUNDATION BYLAWS. THE FOUNDATION'S ANNUAL MEETING WILL BE IN JANUARY RATHER THAN IN DECEMBER. THE FOUNDATION WILL ELECT ITS OWN OFFICERS IN JANUARY RATHER THAN HAVING THE THOSE OFFICERS APPOINTED BY THE WMC BOARD IN THE PRECEDING DECEMBER.
ELECTION OF MEMBERS AND THEIR RIGHTS	FORM 990, PAGE 6, PART VI, LINE 7A	THE CHIEF ADMINISTRATIVE OFFICER OF WINNESHIEK MEDICAL CENTER SHALL SERVE AS AN EX-OFFICIO NONVOTING MEMBER OF THE BOARD.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11B	THE BOARD WILL REVIEW THE FORM 990 PRIOR TO THE BOARD SECRETARY'S SIGNATURE AND FILING OF THE RETURN.
ENFORCEMENT OF CONFLICTS POLICY	FORM 990, PAGE 6, PART VI, LINE 12C	ANNUALLY, ALL BOARD MEMBERS RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY. THEY SUBMIT A SIGNED AND DATED FORM THAT AFFIRMS THAT THEY HAVE READ, UNDERSTAND, AND AGREE TO THE STANDARDS SET FORTH IN THE POLICY.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.