2023-11-10T07:13:35-06:00 2022-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-01-01 391688793 MEMORIAL HOSPITAL OF BOSCOBEL FOUNDATION INC MEMO 6083756300 205 PARKER STREET BOSCOBEL WI 53805 JERRY BERGE PRESIDENT - BOARD OF DIRECTORS 6083756300 2023-10-27 1 JERRY BERGE 999009999 1 MICHAEL J PETERSON CPA P01833529 2187224705 2023-10-27 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z BOSCOBEL AREA HOSPITAL AND CLINICS FOUNDATION JERRY BERGE 205 PARKER STREET BOSCOBEL WI 53805 115459 0 X WWW.GUNDERSENHEALTH.ORG/BOSCOBEL/FOUNDATI X 1990 WI THE MEMORIAL HOSPITAL OF BOSCOBEL FOUNDATION, INC. WAS ESTABLISHED FOR THE SOLE PURPOSE OF SUPPORTING THE PROGRAMS AND SERVICES OF GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS. THE MISSION IS TO SECURE AND MANAGE GIFT SUPPORT TO ASSIST THE HOSPITAL TO MEET THE NEEDS OF THE COMMUNITY BY FUNDING FACILITIES AND EQUIPMENT, STAFF DEVELOPMENT, AND AN ENDOWMENT. 10 10 0 20 0 0 59916 84959 0 0 65914 25629 2030 2113 127860 112701 3567 179914 0 0 0 0 0 0 0 9747 11951 13314 191865 114546 -79164 912401 726541 0 0 912401 726541 BOSCOBEL AREA HOSPITAL AND CLINICS FOUNDATION EXISTS TO INSPIRE DONOR SUPPORT FOR GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS AND ENSURE GIFTS ARE USED EFFECTIVELY AND RESPONSIBLY TO IMPROVE THE HEALTH OF THE PEOPLE AND THE COMMUNITIES WE SERVE. 0 0 179914 179914 0 THE FOUNDATION SUPPORTS THE PROMOTION, DEVELOPMENT, AND IMPROVEMENT OF THE QUALITY AND DELIVERY OF HEALTH PRESERVATION AND HEALTH CARE SERVICES OF GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS (WHICH PROVIDES SERVICES TO PATIENTS THROUGH A CRITICAL ACCESS HOSPITAL AND SEVERAL CLINICS), AND THE MAKING OF DISTRIBUTIONS TO OR FOR THE BENEFIT OF THE HOSPITAL THROUGH THE RAISING OF FUNDS BY MEANS OF SOLICITING AND ACCEPTING GIFTS, GRANTS, AND CONTRIBUTIONS. 179914 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X RONDA FOSTERLING 6083756300 205 PARKER STREET BOSCOBEL WI 53805 X JERRY BERGE PRESIDENT 0.30 X X 0 0 0 KAREN WACKER VICE PRESIDENT 0.30 X X 0 0 0 BRENNEN CLARK SECRETARY/TREASURER 0.30 X X 0 0 0 THERESA BRAUDT DIRECTOR/ADMINISTRATOR 0.30 X 0 0 0 GLENN GRISWOLD DIRECTOR 0.30 X 0 0 0 MICHELLE FARRELL DIRECTOR (THRU DEC) 0.30 X 0 0 0 CHUCK SCHWAB DIRECTOR 0.30 X 0 0 0 DANELLE SCHMID DIRECTOR 0.30 X 0 0 0 DAN SWENSON DIRECTOR 0.30 X 0 0 0 NATALIE TOLLEFSON FOUNDATION DIRECTOR/MANAGER BUS OPS 12.00 X 0 0 0 SALLY WALTZ DIRECTOR 0.30 X 0 0 0 BEN WOOD DIRECTOR 0.30 X 0 0 0 0 0 0 0 0 0 0 0 14614 70345 84959 11648 11648 13981 0 13981 13981 13981 4871 14614 2758 2113 2113 112701 0 0 27742 179914 179914 5585 5585 537 537 5776 5776 53 53 191865 179914 11951 0 245621 148763 666780 577778 912401 726541 0 0 X 867715 683352 44686 43189 912401 726541 912401 726541 -79164 39394 -146090 0 X 0 0 0 X 190225 69711 124973 59916 84959 529784 190225 69711 124973 59916 84959 529784 107988 421796 24628 8323 13273 12941 11648 70813 600597 90506 0.70230 0.72040 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED GOLF OUTING 19485 14614 4871 54 1728 976 19485 14614 4871 54 1728 976 2758 2113 1 BOSCOBEL MEMORIAL HOSPITAL 205 PARKER STREET BOSCOBEL WI 53805 390845590 501(C)(3) 179914 0 FMV GENERAL SUPPORT 1 0 PART I, LINE 2: ALL DONEES ARE REQUIRED TO SUBMIT THEIR GRANT FUNDING REQUESTS TO THE FOUNDATION BOARD FOR REVIEW AND APPROVAL. GRANT FUNDING REQUESTS MUST INCLUDE A DESCRIPTION OF WHAT THE FUNDS WILL BE USED FOR AND HOW THEY WILL BENEFIT THE PATIENTS AND STAFF OF GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS AND HELP TO IMPROVE THE OVERALL HEALTH OF THE COMMUNITIES IT SERVES. DONEES ARE ASKED TO REPORT BACK HOW THE FUNDS WERE USED. IF THE REQUESTS ARE DEEMED BENEFICIAL TO THE HEALTH AND WELL-BEING OF THOSE WE SERVE, THE FUNDS ARE AWARDED. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 WAS PROVIDED TO ALL MEMBERS OF THE BOARD OF DIRECTORS BEFORE FILING. THE BOARD MEMBERS HAD THE OPPORTUNITY TO DISCUSS INFORMATION INCLUDED IN THE FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS DISCLOSES ANY CONFLICTS OF INTEREST BY COMPLETING A QUESTIONNAIRE AND DISCLOSURE FORM ANNUALLY. EMPLOYEES ARE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY UPON HIRE AND AT ANNUAL INTERVALS. IF ANY SIGNIFICANT CONFLICTS ARISE WITH MEMBERS OF THE BOARD OF DIRECTORS, MANAGEMENT, OR KEY EMPLOYEES, IT IS PROPERLY DOCUMENTED AND FOLLOWED UP ON BY THE APPROPRIATE GOVERNING GROUP OR DEPARTMENT WITHIN THE ORGANIZATION ACCORDING TO THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 FOR THE PURPOSES OF DETERMINING COMPENSATION, MEMORIAL HOSPITAL OF BOSCOBEL FOUNDATION, INC. RELIED ON ITS AFFILIATED ORGANIZATION, GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC., TO ESTABLISH THE COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. GUNDERSEN LUTHERAN HEALTH SYSTEM USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION SURVEY OR STUDY, COMPENSATION COMMITTEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 MEMORIAL HOSPITAL OF BOSCOBEL FOUNDATION, INC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.