2023-12-13T15:16:24-06:00 2023-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2022-07-01 391649104 DOOR COUNTY MEMORIAL HOSPITAL FOUNDATION INC DOOR 9207461071 228 S 18TH AVENUE STURGEON BAY WI 54235 BRIAN STEPHENS CEO, DOOR COUNTY MEMORIAL HOSPITAL 9207461071 2023-12-08 1 BRIAN STEPHENS 999009999 1 TERRI REXRODE CPA MST P00096513 9206620016 2023-12-08 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DOOR COUNTY MEDICAL CENTER FOUNDATION BRIAN STEPHENS 228 S 18TH AVENUE STURGEON BAY WI 54235 1322111 0 X N/A X 1990 WI DOOR COUNTY MEMORIAL HOSPITAL FOUNDATION, INC. IS A NONSTOCK, NONPROFIT CORPORATION WHICH RECEIVES GIFTS AND BEQUESTS, RAISES FUNDS FOR SPECIFIC PURPOSES OR NEEDS, ADMINISTERS AND INVESTS FUNDS, AND DISBURSES PAYMENTS TO AND FOR THE BENEFIT OF TAX-EXEMPT ORGANIZATIONS, INCLUDING DOOR COUNTY MEMORIAL HOSPITAL. 13 13 0 220 0 0 1073377 1217867 0 0 206 12886 10005 321 1083588 1231074 997902 984168 0 0 0 0 0 0 3447 36342 44261 1034244 1028429 49344 202645 2195136 2561562 1411 13114 2193725 2548448 TO SUPPORT, DIRECTLY OR INDIRECTLY, THE GOALS OF DOOR COUNTY MEDICAL CENTER BY PROVIDING THE FUND RAISING AND VOLUNTEER OPPORTUNITIES NECESSARY TO ENSURE QUALITY CARE FOR ALL RESIDENTS AND VISITORS IN THE COMMUNITIES WE SERVE. 0 0 940168 940168 0 DOOR COUNTY MEMORIAL HOSPITAL FOUNDATION, INC. IS A NONSTOCK, NONPROFIT CORPORATION WHICH RECEIVES GIFTS AND BEQUESTS, RAISES FUNDS FOR SPECIFIC PURPOSES OR NEEDS, ADMINISTERS AND INVESTS FUNDS, AND DISBURSES PAYMENTS TO AND FOR THE BENEFIT OF DOOR COUNTY MEMORIAL HOSPITAL. THE AUXILIARY ENGAGES IN ACTIVITIES TO SUPPORT THE HOSPITAL INCLUDING A GIFT SHOP. 44000 44000 0 AS A PART OF ITS MISSION, DOOR COUNTY MEMORIAL HOSPITAL FOUNDATION, INC. DONATES FUNDS TO THE COMMUNITY IN THE FORM OF SCHOLARSHIPS TO PROMOTE EDUCATION. 984168 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 1 0 0 0 0 1 0 1 1 0 0 1 1 1 1 0 0 0 0 0 WI X MIKE HERLACHE 9207461071 1843 MICHIGAN STREET STURGEON BAY WI 54235 SALLY PFEIFER PRESIDENT 0.30 X X 0 0 0 COLLIN JEANQUART VICE PRESIDENT 0.30 X X 0 0 0 RICHARD HAUSER SECRETARY 0.30 X X 0 0 0 STEVE ABRAHAMSON TREASURER 0.30 X X 0 0 0 SUE GUILETTE DIRECTOR 0.30 X 0 0 0 NELL HERLACHE DIRECTOR 0.30 X 0 0 0 JELAINE HORTON DIRECTOR 0.30 X 0 0 0 TYLER HUBBARD DIRECTOR 0.30 X 0 0 0 JACK JACKSON DIRECTOR 0.30 X 0 0 0 BARB KLEZIEN DIRECTOR 0.30 X 0 0 0 KAAREN NORTHROP DIRECTOR 0.30 X 0 0 0 TODD TRIMBERGER DIRECTOR 0.30 X 0 0 0 BRUCE SHEWCHUK DIRECTOR 0.30 X 0 0 0 MICHAEL HERLACHE EXECUTIVE DIRECTOR 40.00 X 0 119347 23745 BRIAN STEPHENS DIRECTOR/CEO 0.30 41.00 X 0 337331 36022 0 456678 59767 0 0 1 0 0 26950 2950 221353 966614 1217867 12886 12886 52286 221353 64111 -11825 -11825 39072 26926 12146 12146 1231074 0 0 13207 940168 940168 44000 44000 15000 15000 90 90 3221 3221 5811 5811 3870 3870 16269 12822 3447 1028429 984168 40814 3447 35616 27331 625092 893546 195427 120457 11557 12243 1327444 1507985 2195136 2561562 1411 13114 1411 13114 X 1546836 1783105 646889 765343 2193725 2548448 2195136 2561562 X 202645 152078 X 0 1 X 0 0 X 1143242 1334930 1554164 1073377 1217867 6323580 1143242 1334930 1554164 1073377 1217867 6323580 1660255 4663325 2374 1147 176 206 12886 16789 6340369 420373 0.73550 0.69960 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1327444 28463 152078 0 0 1507985 1753865 7897 -213945 209360 11013 1327444 1118315 314961 330790 10201 1753865 1129604 14146 11409 29019 7825 1118315 1126377 3259 55464 47903 7593 1129604 1.00000 0.00000 0.00000 1 0 0 INTEREST IN NET ASSETS OF DOOR COUNTY COMMUNITY FOUNDATION, INC. 1507985 1507985 1750369 428258 428258 1322111 -91037 -91037 1231074 1547724 428258 91037 519295 1028429 0 1028429 PART V, LINE 4: THE FUNDS ARE HELD TO SUPPORT THE CANCER CENTER FACILITY AND DOOR COUNTY MEMORIAL HOSPITAL. PART XI, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSE -64,111. COST OF GOODS SOLD -26,926. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSE 64,111. COST OF GOODS SOLD 26,926. GOLF OUTING 140137 121560 18577 18577 ANGEL BALL 50465 35269 15196 15196 3 83037 64524 18513 30338 273639 221353 52286 64111 64111 -11825 1 DOOR COUNTY MEMORIAL HOSPITAL 323 SOUTH 18TH AVENUE STURGEON BAY WI 54235 390806324 501(C)(3) 940168 0 TO OFFSET THE COST OF BUILDING RENOVATION AND ADDITION TO THE HOSPITAL. 1 0 EDUCATIONAL SCHOLARSHIP RECIPIENTS 32 44000 PART I, LINE 2: AFTER RECEIVING A REQUSET, THE BOARD OF DIRECTORS APPROVES AND DISTRIBUTES GRANTS TO DOOR COUNTY HOSPITAL, AN ORGANIZATION SUPPORTED BY DOOR COUNTY MEDICAL CORPORATION. A SCHOLARSHIP COMMITTEE DETERMINES THE DISTRIBUTION OF SCHOLARSHIPS BASED UPON APPLICATIONS FOR THE FUNDS. 0 0 0 0 0 0 0 0 0 BRIAN STEPHENS DIRECTOR/CEO 0 328149 0 0 0 9182 0 18159 0 17863 0 373353 0 0 FORM 990, PART VI, SECTION A, LINE 2 MICHAEL HERLACHE AND NELL HERLACHE HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 7A DOOR COUNTY MEDICAL CORPORATION HAS THE OPPORTUNITY TO APPROVE/ELECT/APPOINT THE MAJORITY OF THE FOUNDATION BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE 990 WILL BE E-MAILED TO EACH MEMBER OF THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING THE 990. FORM 990, PART VI, SECTION B, LINE 12C ALL NEW BOARD MEMBERS MUST SIGN THE CONFLICT OF INTEREST STATEMENT. EVERY 4 YEARS, THE CONFLICT OF INTEREST STATEMENT IS DISTRIBUTED TO ALL BOARD MEMBERS. IT IS REVIEWED BY THE BOARD OF DIRECTORS AND EACH BOARD MEMBER IS ASKED TO SIGN IT AND IT IS FILED. IF A CONFLICT EXISTS, THE INTERESTED PERSON MAY MAKE A PRESENTATION AT A BOARD OR COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION AND VOTE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES DOCUMENTS AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF DOOR COUNTY COMMUNITY FOUNDATION, INC. 152,078. DOOR COUNTY MEMORIAL HOSPITAL 323 SOUTH 18TH AVENUE STURGEON BAY WI 54235 390806324 HEALTHCARE SERVICES WI 501(C)(3) 3 DOOR COUNTY MEDICAL CORPORATION 1 DOOR COUNTY MEDICAL CORPORATION 323 SOUTH 18TH AVENUE STURGEON BAY WI 54235 814221171 SUPPORT OF RELATED HEALTHCARE ORGANIZATION WI 501(C)(3) LINE 12B, TYPE II 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 DOOR COUNTY MEMORIAL HOSPITAL B 940168 FMV DOOR COUNTY MEMORIAL HOSPITAL O 428258 FMV