2024-11-13T14:32:41-06:00 2023-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2023-01-01 521771615 WILSON HEALTH FOUNDATION WILS 9374985572 915 WEST MICHIGAN STREET SIDNEY OH 45365 JULIE COVAULT COO 9374985572 2024-11-13 1 1 TYLER K GREENE CPA P00057872 3176334705 2024-11-13 2023 2024-10-15 13:58:12Z JULIE COVAULT 915 WEST MICHIGAN STREET SIDNEY OH 45365 3600293 0 X WWW.WILSONHEALTH.ORG/FOUNDATION X 1976 OH SERVE THE CITIZENS OF SHELBY COUNTY AND SURROUNDING AREA THROUGH DISTRIBUTION OF FUNDS FOR CHARITABLE PURPOSES THROUGH SHELBY COUNTY MEMORIAL HOSPITAL. 14 12 0 12 0 0 334465 589446 0 0 260350 734028 -2089 -21241 592726 1302233 223976 537512 0 0 185082 176112 0 0 106161 173097 106161 582155 819785 10571 482448 13517334 15660513 0 0 13517334 15660513 SERVE THE CITIZENS OF SHELBY COUNTY AND SURROUNDING AREA THROUGH DISTRIBUTION OF FUNDS FOR CHARITABLE PURPOSES THROUGH SHELBY COUNTY MEMORIAL HOSPITAL 0 0 537512 537512 RAISE FUNDS TO SUPPORT WILSON MEMORIAL HOSPITAL BY HOLDING SPECIAL EVENTS DURING THE YEAR. 537512 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 OH X PEGGY PUTHOFF 9374985431 915 WEST MICHIGAN STREET SIDNEY OH 45365 MICKEY A HAMER CHAIR 1.00 0.00 X X 0 0 0 MATT HOYING CHAIR ELECT 1.00 0.00 X X 0 0 0 BRANDON F SIMON TREASURER/SECRETARY 1.00 0.00 X X 0 0 0 ZACK BOSSLET BOARD MEMBER 1.00 0.00 X 0 0 0 GREG DICKMAN BOARD MEMBER 1.00 0.00 X 0 0 0 H ROGER FULK BOARD MEMBER 1.00 40.00 X 0 0 0 MITCHELL HOYING BOARD MEMBER 1.00 0.00 X 0 0 0 JOSH KOLTAK BOARD MEMBER 1.00 0.00 X 0 0 0 MIKE LOCHARD BOARD MEMBER 1.00 0.00 X 0 0 0 DR ALLISON PEPPLE BOARD MEMBER 1.00 40.00 X 0 334889 35940 ANGIE ROSS BOARD MEMBER 1.00 0.00 X 0 0 0 MARIAN SPICER BOARD MEMBER 1.00 1.00 X 0 0 0 KENT WITT BOARD MEMBER 1.00 0.00 X 0 0 0 DOUG BORCHERS BOARD MEMBER PARTIAL TERM 1.00 0.00 X 0 0 0 KEITH SCHNIPPEL BOARD MEMBER PARTIAL TERM 1.00 0.00 X 0 0 0 MARK KLOSTERMAN WMH CEO 1.00 40.00 X X 0 590826 52680 KARLA YOUNG EXECUTIVE DIRECTOR 40.00 0.00 X 0 78873 5053 0 1004588 93673 0 0 1 0 0 86682 502764 589446 472282 472282 2517292 2255546 261746 261746 261746 21273 86682 42514 -21241 -21241 1302233 0 0 712787 X 537512 537512 176112 176112 82258 82258 702 702 7207 7207 218 218 DUES & SUB. 12416 12416 3360 3360 819785 537512 176112 106161 434377 211967 5207 5207 0 0 13082957 15448546 13517334 15660513 0 0 X 7065515 6698265 6451819 8962248 13517334 15660513 13517334 15660513 X 482448 1391372 269359 X X 0 1 X 1 0 X X 1 SHELBY CO MEMORIAL HOSPITAL ASSOC DBA WILSON MEMORIAL HOSPITAL 344427944 3 1 537512 0 1 537512 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 301311 17815 12264 306862 306430 6626 11744 301311 273646 43861 11077 306430 255507 18139 273646 244447 11060 255507 0.31025 0.68975 0 1 0 5207 5207 0 0 X PART V, LINE 4: THE HOSPITAL HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR ENDOWMENT ASSETS THAT ATTEMPT TO BALANCE THE MISSION OF BUILDING CAPITAL FOR FUTURE USE WITH THE CORRESPONDING OBLIGATION TO SUPPORT CURRENT AND FUTURE NEEDS OF THE HOSPITAL. PART X, LINE 2: THE HOSPITAL, FOUNDATION, SLEEP LAB LLC, WHMG, WOSC AND VRSC HAVE FILED THEIR APPLICABLE FEDERAL AND STATE INCOME TAX RETURNS FOR PERIODS THROUGH DECEMBER 31, 2022. THESE INCOME TAX RETURNS ARE GENERALLY OPEN TO EXAMINATION BY THE RELEVANT TAXING AUTHORITIES FOR A PERIOD OF THREE YEARS FROM THE LATER OF THE DATE THE RETURN WAS FILED OR ITS DUE DATE (INCLUDING APPROVED EXTENSIONS). ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN AND RECOGNIZE A TAX LIABILITY IF AN UNCERTAIN POSITION HAS BEEN TAKEN THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THESE ENTITIES AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2023 AND 2022, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE ENTITIES ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. CASINO NIGHT 50285 43824 6461 582 1160 7149 12361 1328 GOLF OUTING 57670 42858 14812 2110 10771 5841 1212 107955 86682 21273 2692 1160 17920 18202 2540 42514 -21241 1 SHELBY COUNTY MEMORIAL HOSPITAL ASSOC INC 915 W MICHIGAN ST SIDNEY OH 45365 344427944 501(C)3 537512 0 SPECIFIC PURPOSE DONATIONS 1 PART I, LINE 2: TRANSACTIONS ARE RECORDED ON THE WILSON MEMORIAL HOSPITAL'S BOOKS AND ARE REVIEWED BY THE WILSON MEMORIAL FOUNDATION EMPLOYEES TO ENSURE COMPLIANCE WITH THE GRANT REQUIREMENTS. ONCE THAT IS COMPLETED THE FUNDS ARE TRANSFERRED. X X X 0 0 0 0 0 0 0 0 0 MARK KLOSTERMAN WMH CEO 0 447214 0 132422 0 11190 0 19425 0 33255 0 643506 0 0 DR ALLISON PEPPLE BOARD MEMBER 0 213997 0 94414 0 26478 0 9529 0 26411 0 370829 0 0 PART I, LINE 3 A RELATED ORGANIZATION, WILSON MEMORIAL HOSPITAL, USED THE FOLLOWING METHODS TO DETERMINE THE COMPENSATION OF THE FOUNDATION'S EXECUTIVE DIRECTOR: -COMPENSATION COMMITTEE -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE RETURN IS REVIEWED AT A BOARD MEETING PRIOR TO THE FILING OF THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE ORIGINAL REQUEST FOR ALL FOUNDATION BOARD MEMBERS IS TO SIGN CORPORATE COMPLIANCE WHEN THEY JOIN THE BOARD. THE UPDATED COMPLIANCE WAS SIGNED 11/2021. THE ENTIRE BOARD WILL RECEIVE NEW CORPORATE COMPLIANCE DOCUMENTS FOR SIGNATURE EVERY THREE YEARS. THE NEXT IS NOVEMBER 2024. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING THE FILING ORGANIZATION'S EXECUTIVE DIRECTOR'S COMPENSATION IS COMPLETED BY A RELATED ORGANIZATION, WILSON MEMORIAL HOSPITAL. WILSON MEMORIAL HOSPITAL'S HR COMMITTEE OF THE BOARD CONDUCTS AN ANNUAL EVALUATION PROCESS. COMPENSATION IS BENCHMARKED WITH SURVEYS FROM LIKE SIZED HEALTHCARE ORGANIZATIONS. THE BOARD OF TRUSTEES APPROVES THE COMPENSATION PACKAGES ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 82,258. TOTAL EXPENSES 82,258. FORM 990, PART XI, LINE 9: TRANSFERS FROM AFFILIATES 269,359. FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND NO PROCESSES HAVE CHANGED FROM THE PRIOR YEAR. SHELBY COUNTY MEMORIAL HOSPITAL DBA WILSON MEMORIAL HOSPITAL 915 WEST MICHIGAN STREET SIDNEY OH 45365 344427944 PROVIDE HEALTHCARE SERVICES OH 501(C)(3) LINE 3 N/A 0 SLEEP LAB LLC 915 W MICHIGAN ST SIDNEY OH 45365 SLEEP LAB STUDIES OH N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1