2024-08-07T07:56:39-05:00 2023-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-01-01 391775074 MEMORIAL HEALTHCARE FOUNDATION INC MEMO 6083398391 PO BOX 40 FRIENDSHIP WI 53934 FRANK PEREZ-GUERRA VICE-CHAIR 6083398391 2024-08-06 1 0 MICHAEL J PETERSON CPA P01833529 2187224705 2024-08-06 2023 2024-08-08 14:25:15Z FRANK PEREZ-GUERRA PO BOX 40 FRIENDSHIP WI 53934 213430 0 X WWW.GUNDERSENHEALTH.ORG/MOUNDVIEW/FOUNDATION X 1993 WI THE MEMORIAL HEALTHCARE FOUNDATION'S MISSION IS TO SUPPORT MOUNDVIEW MEMORIAL HOSPITAL & CLINICS THROUGH FUND RAISING AND PUBLIC AWARENESS. 12 7 0 40 0 0 63651 159332 0 0 37121 28468 -3946 -37021 96826 150779 40503 78481 0 0 0 0 0 0 0 0 0 40503 78481 56323 72298 1494969 1603145 0 0 1494969 1603145 THE MEMORIAL HEALTHCARE FOUNDATION'S MISSION IS TO SUPPORT MOUNDVIEW MEMORIAL HOSPITAL & CLINICS THROUGH FUND RAISING AND PUBLIC AWARENESS. 0 0 78481 78481 0 THE PURPOSE OF THE FOUNDATION IS TO RAISE FUNDS WHICH WILL BE USED TO SUPPORT MOUNDVIEW MEMORIAL HOSPITAL AND CLINICS THROUGH ACTIVITIES OF ANNUAL GIVING, CAPITAL CAMPAIGN AND SPECIAL EVENTS, WHICH WILL BE USED TO BENEFIT THE FRIENDSHIP AND ADAMS COMMUNITIES. 78481 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 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 12 7 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 0 0 0 0 0 WI X FRANK PEREZ-GUERRA 6083398371 402 W LAKE STREET FRIENDSHIP WI 53934 X SCOTT RATHGABER CEO-GHS 1.00 40.00 X 0 0 0 GERALD OETZEL CFO-GHS (THRU 08/23) 1.00 40.00 X 0 0 0 STEVE LITTLE CFO-GHS (BEG 08/23) 1.00 40.00 X 0 0 0 FRANK PEREZ-GUERRA VICE CHAIR & CEO GMHC 1.00 40.00 X X 0 0 0 KEVIN MOORE CHAIR 1.00 X X 0 0 0 JASON HOHENSTEIN TREASURER 1.00 X X 0 0 0 JESSE SCHABLE SECRETARY 1.00 X X 0 0 0 CARRIE EASTERLY DIRECTOR 1.00 40.00 X 0 0 0 LIZ HENDRICKSEN DIRECTOR 1.00 X 0 0 0 GREG HUTCHESON DIRECTOR 1.00 40.00 X 0 0 0 LAURIE INDA DIRECTOR (TERM JAN) 1.00 2.50 X 0 0 0 BONNIE NACHREINER DIRECTOR 1.00 X 0 0 0 MANDY RICHARDSON DIRECTOR 1.00 40.00 X 0 0 0 RICHARD STERNHAGEN DIRECTOR (TERM JAN) 1.00 2.50 X 0 0 0 TOM WERMUTH DIRECTOR 1.00 X 0 0 0 LORI WITTIG DIRECTOR 1.00 40.00 X 0 0 0 KARA WORMET DIRECTOR 1.00 2.50 X 0 0 0 0 0 0 0 0 0 0 0 157074 2258 159332 7573 7573 20895 0 20895 20895 20895 25630 157074 62651 -37021 -37021 150779 0 0 -8553 78481 78481 78481 78481 0 0 119058 162281 871253 902495 504658 538369 1494969 1603145 0 0 X 990311 1064776 504658 538369 1494969 1603145 1494969 1603145 72298 35878 0 X 0 0 0 X X 1 MOUNDVIEW MEMORIAL HOSPITAL & CLINICS 390944012 3 1 78481 0 1 78481 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART IV, SECTION A, LINE 1 THE MEMORIAL HEALTHCARE FOUNDATION OF ADAMS CO. (THE "FOUNDATION") HAS A HISTORIC AND CONTINUING RELATIONSHIP WITH MOUNDVIEW MEMORIAL HOSPITAL & CLINICS (THE "HOSPITAL"). THE HOSPITAL IS AND HISTORICALLY HAS BEEN THE SOLE CORPORATE MEMBER OF THE FOUNDATION. IN ADDITION, THE MISSION OF THE FOUNDATION IS TO SUPPORT THE HOSPITAL THROUGH FUND RAISING AND PUBLIC AWARENESS. SINCE THE FOUNDATION'S INCEPTION, IT HAS FINANCIALLY SUPPORTED PROJECTS AT THE HOSPITAL BASED ON THE NEEDS OF THE COMMUNITIES IT SERVICES. THE FOUNDATION PROVIDES LIFESAVING EQUIPMENT, UPGRADES, AND IMPROVEMENTS TO THE HOSPITAL AS WELL AS FUNDS LOCAL HEALTHCARE PROGRAMS. PART IV, SECTION A, LINE 6 THE SUPPORTING ORGANIZATION WILL MAKE GRANTS TO ORGANIZATIONS THAT THE SUPPORTED ORGANIZATION ITSELF WOULD SUPPORT DUE TO THE SUPPORTED ORGANIZATION'S EXEMPT PURPOSE. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1375912 20000 44952 1440864 387577 1070051 -81716 1375912 307241 80336 387577 253190 8348 45703 307241 210345 14063 28782 253190 0.62636 0.37364 0.00000 0 0 0 ASSETS HELD IN CHARITABLE TRUST 538369 538369 PART V, LINE 4: THE PURPOSE OF THE ENDOWMENT FUND IS TO SUPPORT HOSPITAL OPERATIONS. DINNER AUCTION 124144 116514 7630 32900 7525 1825 GOLF TOURNAMENT 58560 40560 18000 600 1568 9335 8166 732 182704 157074 25630 600 34468 9335 15691 2557 62651 -37021 1 MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC 402 WEST LAKE STREET FRIENDSHIP WI 53934 390944012 501(C)(3) 78481 0 FUNDING OF MEDICAL EQUIPMENT AND CAPITAL PROJECTS 1 0 PART I, LINE 2: THE BOARD OF DIRECTORS APPROVES GRANTS MADE TO THE HOSPITAL. 0 0 0 0 0 0 0 0 0 SCHEDULE J, PART II: PURSUANT TO IRS FORM 990 INSTRUCTIONS, THIS SHORT PERIOD RETURN COVERS THE DATES 01/01/2023 THROUGH 09/30/2023 AND THERE IS NO CALENDAR YEAR ENDING WITHIN THE PERIOD AND THUS NO REPORTABLE COMPENSATION. SCHEDULE J, PART 1, LINE 3: A RELATED ORGANIZATION OF THE FILING ORGANIZATION USES ONE OR MORE OF THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY, AND -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PLEASE REFER TO THE FORM 990, PART VI, LINE 15A DISCLOSURE IN SCHEDULE O FOR ADDITIONAL DETAILS ON HOW COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED. X AUCTION ITEMS 0 32900 COST 0 0 0 PART I, COLUMN (B): THE ORGANIZATION TRACKS THE NUMBER OF CONTRIBUTORS FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE FOUNDATION IS MOUNDVIEW MEMORIAL HOSPITAL & CLINICS. FORM 990, PART VI, SECTION A, LINE 7A MOUNDVIEW MEMORIAL HOSPITAL & CLINICS HAS THE AUTHORITY TO ELECT AND REMOVE DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS ARE SUBJECT TO RATIFICATION OF MOUNDVIEW MEMORIAL HOSPITAL & CLINICS: AMENDMENT OF THE BYLAWS, MERGER & CONSOLIDATION OR DISSOLUTION, CREATION OF SUBSIDIARIES OR AFFILIATES, ADOPTION OF THE ANNUAL REPORT, SELECTION AND RETENTION OF THE EXECUTIVE DIRECTOR, CAPITAL EXPENDITURES IN EXCESS OF $25,000, EXTENSION OF ANY LOANS BY OR BORROWINGS OF AMOUNTS GREATER THAT $25,000, SALE OF ANY CAPITAL ASSETS WITH BOOK OR MARKET VALUE EXCEEDING $10,000 FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO ACTING COMMITTEES WITHIN THE ORGANIZATION FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED BY THE HOSPITAL, CEO, AND CFO PRIOR TO FILING. THE BOARD REVIEWS THE 990 AND APPROVES IT AFTER IT IS COMPLETED. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED EVERY YEAR BY THE BOARD AND BY THE HOSPITAL CEO. OFFICERS AND DIRECTORS ARE REQUIRED TO REVIEW THE POLICY AND DISCLOSE CONFLICTS. THE CEO REVIEWS THE SIGNED STATEMENTS. IF THERE IS A CONFLICT, THE CONFLICT WOULD BE DECLARED AND THE MEMBER WOULD ABSTAIN FROM VOTING. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION BELIEVES THE GOVERNING DOCUMENTS AND POLICIES ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION. FORM 990, PART VII, SECTION A PURSUANT TO IRS FORM 990 INSTRUCTIONS, THIS SHORT PERIOD RETURN COVERS THE DATES 01/01/2023 THROUGH 09/30/2023 AND THERE IS NO CALENDAR YEAR ENDING WITHIN THE PERIOD AND THUS NO REPORTABLE COMPENSATION. BELLIN COLLEGE INC 3201 EATON ROAD GREEN BAY WI 54311 391620530 NURSING AND RADIOLOGIC SCIENCE COLLEGE WI 501(C)(3) LINE 2 BELLIN HEALTH SYSTEMS INC 1 BELLIN GUNDERSEN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 920504278 PARENT WI 501(C)(3) LINE 12B, II N/A 0 BELLIN HEALTH SYSTEMS INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512904 SUPPORT OF HEALTHCARE ORGANIZATIONS WI 501(C)(3) LINE 12B, II BELLIN GUNDERSEN HEALTH SYSTEMS INC 1 BELLIN MEMORIAL HOSPITAL INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 390884478 HEALTH CARE WI 501(C)(3) LINE 3 BELLIN HEALTH SYSTEMS INC 1 BELLIN PSYCHIATRIC CENTER INC PO BOX 23725 GREEN BAY WI 54305 391657627 PSYCHIATRIC HOSPITAL WI 501(C)(3) LINE 3 BELLIN HEALTH SYSTEMS INC 1 COMMUNITY HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391586700 INDEPENDENT LIVING WI 501(C)(3) LINE 10 GUNDERSEN LUTHERAN HEALTH SYSTEM 1 GUNDERSEN CLINIC LTD 1910 SOUTH AVENUE LA CROSSE WI 54601 391028657 HEALTHCARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM 1 GUNDERSEN LUTHERAN ADMINSTRATIVE SVC 1910 SOUTH AVENUE LA CROSSE WI 54601 391606449 SUPPORTING ORG WI 501(C)(3) LINE 12B, II GUNDERSEN LUTHERAN HEALTH SYSTEM 1 GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391866425 SUPPORTING ORG WI 501(C)(3) LINE 12B, II N/A 0 GUNDERSEN LUTHERAN MEDICAL CENTER INC 1910 SOUTH AVENUE LA CROSSE WI 54601 390813416 HEALTHCARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM 1 GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391249705 FOUNDATION WI 501(C)(3) LINE 7 GUNDERSEN LUTHERAN HEALTH SYSTEM 1 HARMONY COMMUNITY HEALTHCARE INC 815 MAIN AVENUE SOUTH HARMONY MN 55939 410711606 HEALTHCARE MN 501(C)(3) LINE 10 GUNDERSEN LUTHERAN HEALTH SYSTEM 1 LAKE MICHIGAN HEALTH SERVICES INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512903 SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITAL WI 501(C)(3) LINE 12B, II BELLIN HEALTH SYSTEMS INC 1 LUTHERAN HOUSING OF LA CROSSE 1900 SOUTH AVENUE LA CROSSE WI 54601 391751934 INDEPENDENT LIVING WI 501(C)(3) LINE 10 GUNDERSEN LUTHERAN HEALTH SYSTEM 1 LUTHERAN REAL ESTATE HOLDING CORP 1910 SOUTH AVENUE LA CROSSE WI 54601 391480826 HOUSING WI 501(C)(3) LINE 12C, III-FI GUNDERSEN LUTHERAN HEALTH SYSTEM 1 MEMORIAL HOSPITAL OF BOSCOBEL 205 PARKER STREET BOSCOBEL WI 53805 390845590 HEALTHCARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM 1 MOUNDVIEW MEMORIAL HOSPITAL & CLINICS 402 WEST LAKE STREET FRIENDSHIP WI 53934 390944012 HOSPITAL WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM 1 OCONTO HOSPITAL & MEDICAL CENTER INC 820 ARBUTUS AVENUE OCONTO WI 54153 061745397 HEALTH CARE WI 501(C)(3) LINE 3 BELLIN MEMORIAL HOSPITAL INC 1 PALMER LUTHERAN HEALTH CENTER 112 JEFFERSON STREET WEST UNION IA 52175 421320763 HEALTHCARE IA 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM 1 SAINT ELIZABETH'S HOSPITAL OF WABASHA 1200 GRANT BLVD WABASHA MN 55981 410693877 HEALTHCARE MN 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM 1 ST JOSEPH'S HEALTH SERVICES INC 400 WATER AVENUE HILLSBORO WI 54634 390929538 HEALTHCARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM 1 ST JOSEPH'S MEMORIAL FOUNDATION INC 400 WATER AVENUE HILLSBORO WI 54634 391455787 FOUNDATION WI 501(C)(3) LINE 12A, I GUNDERSEN LUTHERAN HEALTH SYSTEM 1 THE BELLIN HEALTH FOUNDATION INC PO BOX 23400 GREEN BAY WI 54301 391809171 FOUNDATION WI 501(C)(3) LINE 7 BELLIN HEALTH SYSTEMS INC 1 TRI-COUNTY MEMORIAL FOUNDATION INC 18601 LINCOLN STREET WHITEHALL WI 54773 300093022 FOUNDATION WI 501(C)(3) LINE 12A, I TRI-COUNTY MEMORIAL HOSPITAL 1 TRI-COUNTY MEMORIAL HOSPITAL 18601 LINCOLN STREET WITHEHALL WI 54773 390704510 HEALTHCARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEM 1 TRI-STATE AMBULANCE INC 235 CAUSEWAY BOLEVARD LA CROSSE WI 54603 391965415 MEDICAL TRANSPORT WI 501(C)(3) LINE 10 GUNDERSEN LUTHERAN HEALTH SYSTEM 1 TRI-STATE REGIONAL AMBULANCE INC 235 CAUSEWAY BOLEVARD LA CROSSE WI 54603 391962965 MEDICAL TRANSPORT WI 501(C)(3) LINE 10 GUNDERSEN LUTHERAN HEALTH SYSTEM 1 TWEETEN LUTHERAN HEALTHCARE CENTER INC 125 FIFTH AVENUE SE SPRING GROVE MN 55974 411565003 HEALTHCARE WI 501(C)(3) LINE 10 GUNDERSEN LUTHERAN HEALTH SYSTEM 1 GUNDERSEN LUTHERAN ENVISION LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 264706546 RENEWABLE ENERGY WI N/A C 0 GUNDERSEN EDGE LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 921783811 INNOVATION WI N/A C 0 BEL-REGIONAL HOME MEDICAL INC 617 S ROOSEVELT GREEN BAY WI 54301 391504766 DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS WI N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0