2025-05-13T13:15:56-05:00 2024-06-30 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2023-07-01 391499140 BEAVER DAM COMMUNITY HOSPITALS FOUNDATION INC BEAV 9203566514 707 SOUTH UNIVERSITY AVENUE BEAVER DAM WI 53916 ALLEN SCHWAB BOARD OF DIRECTORS CO-CHAIR 9203566514 2025-05-12 1 0 KIMBERLY ANDERSON P00188889 6086628600 2025-05-12 2023 2025-03-06 01:10:19Z ALLEN SCHWAB 707 SOUTH UNIVERSITY AVENUE BEAVER DAM WI 53916 668716 0 X WWW.BDCH.COM/FOUNDATION X 1984 WI WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH MEANINGFUL RELATIONSHIPS BUILT ON GRATITUDE AND PHILANTHROPY. 12 12 0 12 0 0 593133 604696 0 0 55436 64020 0 0 648569 668716 1047916 872051 0 0 0 0 0 0 0 25869 22276 1073785 894327 -425216 -225611 5366783 5143558 2205 4591 5364578 5138967 WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH MEANINGFUL RELATIONSHIPS BUILT ON GRATITUDE AND PHILANTHROPY. 0 0 872051 872051 0 IMPROVING COMMUNITY HEALTH, SAFETY, AND QUALITY BY PROVIDING FUNDS FOR ORGANIZATIONS, LOCAL YMCA, MENTAL HEALTH PROGRAM, FOOD BANK ASSISTANCE, AEDS, WALKING PATHS, NATURE CENTERS, ATHLETIC FIELDS, AND PLAYGROUNDS. SUPPORTING MARSHFIELD MEDICAL CENTER - BEAVER DAM (MMC-BD) BY PROVIDING FUNDING FOR THE FOLLOWING: MEALS ON WHEELS PROGRAM, COMMUNITY HEALTH EMPLOYEE WELLNESS AND CYCLING WITHOUT AGE, WOMENS HEALTH, AND LIFELINE EQUIPMENT. 872051 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 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 12 12 0 0 0 0 1 0 0 1 1 0 0 1 1 0 1 1 1 0 0 0 WI X JANETTE TOWNSEND 9208876384 707 SOUTH UNIVERSITY AVENUE BEAVER DAM WI 53916 X RICH APPEL BOARD MEMBER 1.00 X 0 0 0 DR JOHN EATON BOARD MEMBER 1.00 X 0 0 0 DUANE FOULKES BOARD MEMBER 1.00 X 0 0 0 STEVE HANNAN BOARD MEMBER 1.00 X 0 0 0 MARIE LOTTO BOARD MEMBER 1.00 X 0 0 0 MAGGIE RENTMEESTER BOARD MEMBER 1.00 X 0 0 0 ARLETTA TREJO BOARD MEMBER 1.00 X 0 0 0 BEN WESTRA BOARD MEMBER 1.00 X 0 0 0 CHUCK NEUMAN CO-CHAIR 3.00 X X 0 0 0 AL SCHWAB CO-CHAIR 3.00 X X 0 0 0 DENISE FITZSIMMONS VICE CHAIR 3.00 X X 0 0 0 DR SHARON HAASE TREASURER 3.00 X X 0 0 0 0 0 0 0 0 0 0 0 604696 604696 64020 64020 668716 0 0 64020 872051 872051 19184 19184 DUES/SUBSCRIPTIONS 3092 3092 894327 872051 22276 0 35541 1463293 5274916 3680265 56326 5366783 5143558 2205 4591 2205 4591 X 2385475 2140857 2979103 2998110 5364578 5138967 5366783 5143558 -225611 0 X 0 1 X 1 0 X 800320 706695 623365 571915 604696 3306991 800320 706695 623365 571915 604696 3306991 5000 3280 1260 1420 10960 0 5000 3280 1260 1420 10960 3296031 47328 27739 27139 53663 64020 219889 47328 27739 27139 53663 64020 219889 17308 22991 40299 864956 734434 650504 648569 668716 3567179 0.92400 0.92070 0.06160 0.05440 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: SPECIAL EVENT RECEIPTS GAMING RECEIPTS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 102673 2444 105117 100900 1773 102673 100500 400 100900 100407 97 500 100500 100407 100407 0.47500 0.52500 0 0 0 X 668716 0 668716 0 668716 1065440 171113 171113 894327 0 894327 PART V, LINE 4: THE FUND IS DESIGNED TO PROVIDE SCHOLARSHIP ASSISTANCE IN THE FORM OF GRANTS FOR TUITION. PART X, LINE 2: THE FOUNDATION IS ORGANIZED AS A WISCONSIN NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER IRC SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3), QUALIFY FOR THE CHARITABLE CONTRIBUTIONS DEDUCTION UNDER IRC SECTIONS 170(B)(1)(A)(VI) AND (VIII), AND HAVE BEEN DETERMINED NOT TO BE A PRIVATE FOUNDATION UNDER IRC SECTIONS 509(A)(1) AND (3), RESPECTIVELY. THE FOUNDATION IS ANNUALLY REQUIRED TO FILE A RETRUN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE FOUNDATION IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSES. THE FOUNDATION HAS DETERMINED THAT IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990-T) WITH THE IRS. PART XII, LINE 2D - OTHER ADJUSTMENTS: DONATED SERVICES 171,113. 1 THE GATHERING SOURCE INC W7115 WI-16 60 JUNEAU WI 53039 462956183 501(C)(3) 200000 0 FACILITY IMPROVEMENTS & RENOVATION CHURCH HEALTH SERVICE 115 N CENTER ST BEAVER DAM WI 53916 391759669 501(C)(3) 150000 0 FACILITY RENOVATION BEAVER DAM HOCKEY ASSOCIATION 609 GOULD STREET BEAVER DAM WI 53916 391305932 501(C)(3) 100000 0 ZAMBONI REPLACEMENT CITY OF BEAVER DAM 400 S UNIVERSITY AVE BEAVER DAM WI 53916 396005396 GOV'T 75000 0 PICKLEBALL COURTS SOCIETY ST VINCENT DE PAUL COUNCIL 125 DODGE DR STE 100 BEAVER DAM WI 53916 390936375 501(C)(3) 50000 0 FINANCIAL ASSISTANCE PROGRAM MAYVILLE OPEN DOOR INC 20 S MAIN S MAYVILLE WI 53050 473191497 501(C)(3) 25000 0 PROGRAMMING SPACE DEVELOPMENT - REPLACEMENT CHECK FOR # 11179 (ISSUED IN AUGUST 2023) YMCA OF DODGE COUNTY 220 CORPORATE DRIVE BEAVER DAM WI 53916 390975426 501(C)(3) 25000 0 FINANCIAL ASSISTANCE PROGRAM BEAVER DAM FIRE DEPARTMENT 205 S LINCOLN AVE BEAVER DAM WI 53916 561685809 GOV'T 50000 0 CARDIAC MONITORS VILLAGE OF HUSTISFORD N3906 CTY RD EE NEOSHA WI 53059 396006290 GOV'T 15000 0 ACCESSIBLE KAYAK LAUNCH MARSHFIELD CLINIC HEALTH SYSTEM 1000 N OAK AVE MARSHFIELD WI 54449 461495343 501(C)(3) 28884 0 MOTORIZED SCOOTERS FOR HOSPITAL VILLAGE OF CLYMAN 713 MORGAN ST CLYMAN WI 530169818 391049477 GOV'T 9360 0 BACKSTOP & AED LIVING HOPE FOOD PANTRY INC PO BOX 519 FOX LAKE WI 53933 813450246 501(C)(3) 8692 0 REFRIGERATOR AND FREEZER FIRST LUTHERAN CHURCH 311 W MACKIE ST BEAVER DAM WI 53916 390937512 501(C)(3) 5775 0 CONVECTION OVENS FOR FIRST LUTHERAN LOAVES & FISHES PROGRAM 13 0 PART I, LINE 2: THE ORGANIZATION REQUESTING A GRANT MUST COMPLETE A REQUEST FORM STATING AMOUNT REQUESTED, WHAT THE MONEY WILL PURCHASE, THE PURPOSE OF THE PROJECT OR PROGRAM, HOW MANY PEOPLE WILL BE AFFECTED BY THE PROJECT OR PROGRAM, HOW IT WILL BE REPORTED TO BDCHF, ETC. THE GRANT REQUESTS ARE REVIEWED BY THE FUND ALLOCATION COMMITTEE AND THOSE REQUESTS DEEMED APPROPRIATE IN REGARD TO THE MISSION OF BDCHF ARE THEN PASSED ON TO THE BOARD OF DIRECTORS FOR APPROVAL. THE ORGANIZATION RECEIVING APPROVAL MUST THEN SUBMIT PROOF OF THEIR EXPENSE (I.E. PAID INVOICE) TO BDCHF BEFORE ANY FUNDS CAN BE TRANSFERRED. THE ORGANIZATION MONITORS EMPLOYEE HARDSHIP ASSISTANCE THROUGH A COMMITTEE OF PEER EMPLOYEES WITH THE CHIEF TALENT OFFICER AS THE COMMITTEE CHAIR. FORM 990, PART VI, SECTION A, LINE 1A THE BOARD OF DIRECTORS MAY BY APPROPRIATE RESOLUTION DESIGNATE ONE OR MORE COMMITTEES, EACH OF WHICH SHALL CONSIST OF THREE OR MORE DIRECTORS ELECTED BY THE BOARD, WHICH TO THE EXTENT PROVIDED IN SAID RESOLUTIONS OR IN THESE BY-LAWS, SHALL HAVE AND MAY EXERCISE, WHEN THE BOARD OF DIRECTORS IS NOT IN SESSION, THE POWERS OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE AFFAIRS OF THE CORPORATION, EXCEPT ACTION WITH RESPECT TO ELECTION OF OFFICERS AND THE FORMATION OF AND THE FILING OF VACANCIES IN COMMITTEES WITH LIMITED BOARD AUTHORITY PURSUANT TO THIS SUBSECTION. THE BOARD OF DIRECTORS MAY ELECT ONE OR MORE DIRECTORS AS ALTERNATE MEMBERS OF ANY SUCH COMMITTEE, WHO MAY TAKE THE PLACE OF ANY ABSENT COMMITTEE MEMBER OR MEMBERS AT ANY MEETING OF SUCH COMMITTEE. THE DESIGNATION OF SUCH COMMITTEE OR COMMITTEES AND THE DELEGATION THERETO OF AUTHORITY SHALL NOT OPERATE TO RELIEVE THE BOARD OF DIRECTORS OR ANY INDIVIDUAL DIRECTOR OF ANY RESPONSIBILITY IMPOSED UPON THE BOARD OF DIRECTORS OR ANY INDIVIDUAL DIRECTOR BY LAW. THERE SHALL BE AN EXECUTIVE COMMITTEE OF THE BOARD CONSISTING OF THE FOUR OFFICERS OF THE CORPORATION AND SUCH OTHER DIRECTORS AND DESIGNATED BY THE BOARD. FORM 990, PART VI, SECTION A, LINE 6 THE BEAVER DAM COMMUNITY HOSPITALS FOUNDATION (BDCHF) HAS A SINGLE CLASS OF VOTING MEMBERS AND THE SOLE MEMBER OF THAT CLASS IS BEAVER DAM COMMUNITY HOSPITALS, INC. (BDCH), A WISCONSIN NONPROFIT CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE DIRECTOR OF FINANCE AND ACCOUNTING OF BDCH AND THE FOUNDATION BOARD CHAIR. FORM 990, PART VI, SECTION B, LINE 12C "INTERESTED PERSON" MEANS ANY INDIVIDUAL WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST AND WHO IS: (I) A MEMBER OF THE BOARD OF DIRECTORS OF THE BDCH FOUNDATION (COLLECTIVELY "BOARD OR "BOARDS"); (II) AN OFFICER, INCLUDING, BUT NOT LIMITED TO, THE CEO OF BDCH; (III) A MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS; (IV) AN EMPLOYEE WITH DECISION-MAKING AUTHORITY OR RESPONSIBILITY OF A SIGNIFICANT NATURE LEVEL; OR (V) ANY OTHER INDIVIDUAL AFFILIATED WITH BDCHF WHOSE DISCLOSURE PURSUANT TO THIS POLICY IS DEEMED NECESSARY BY A BOARD OF DIRECTORS OR THE CEO. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF HIS OR HER FINANCIAL INTEREST, OR THAT OF A FAMILY MEMBER, AND ALL MATERIAL FACTS TO A BOARD OF DIRECTORS, OR TO THE MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS, CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. SUCH DISCLOSURE SHALL BE MADE EITHER THROUGH THE REQUIRED ANNUAL QUESTIONNAIRE OR WHEN A CONFLICT OF INTEREST NOT DISCLOSED ON THE QUESTIONNAIRE OTHERWISE ARISES. A FINANCIAL INTEREST IS NOT NECESSARILY A CONFLICT OF INTEREST. A PERSON WHO HAS A FINANCIAL INTEREST HAS A CONFLICT OF INTEREST ONLY IF THE APPLICABLE BOARD OR COMMITTEE DECIDES THAT A CONFLICT OF INTEREST EXISTS. THEREFORE, AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON TO CLARIFY OR OBTAIN ADDITIONAL INFORMATION RELEVANT TO THE FINANCIAL INTEREST, HE OR SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE DISINTERESTED BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. ONCE THE DISINTERESTED MEMBERS OF THE BOARD OR COMMITTEE HAVE DETERMINED THAT A CONFLICT OF INTEREST EXISTS WITH RESPECT TO A PARTICULAR TRANSACTION OR ARRANGEMENT: (A) THE CHAIR OF THE BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. (B) AFTER EXERCISING DUE DILIGENCE, THE DISINTERESTED MEMBERS OF THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER BDCHF CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. (C) IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS OR COMMITTEE MEMBERS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN BDCHF'S BEST INTEREST AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO BDCHF. BASED UPON ITS DETERMINATION, THE BOARD SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. (D) THE INTERESTED PERSON SHALL LEAVE THE ROOM WHILE THE MATTER GIVING RISE TO THE CONFLICT OF INTEREST IS VOTED ON AND ONLY DISINTERESTED DIRECTORS OR COMMITTEE MEMBERS MAY VOTE TO DETERMINE WHETHER TO APPROVE THE TRANSACTION OR ARRANGEMENT. THE DISINTERESTED MEMBERS OF THE BOARD OR COMMITTEE MAY, IN THEIR DISCRETION, REQUIRE THE INTERESTED PERSON TO LEAVE THE ROOM WHILE THE PROPOSED TRANSACTION OR ARRANGEMENT IS DISCUSSED. IN DETERMINING WHETHER AND WHEN TO REQUIRE THE INTERESTED PERSON TO LEAVE THE ROOM DURING DISCUSSION OF THE PROPOSED TRANSACTION OR ARRANGEMENT, THE DISINTERESTED DIRECTORS OR COMMITTEE MEMBERS SHALL BALANCE THE NEED TO PRESERVE THE INDEPENDENCE OF THE DETERMINATION PROCESS WITH THE NEED TO FACILITATE THE DISCUSSION BY HAVING SUCH PERSON ON HAND TO ANSWER QUESTIONS OR OTHERWISE PROVIDE ADDITIONAL INFORMATION OR KNOWLEDGE THAT MAY BE OF GREAT ASSISTANCE TO THE BOARD OR COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 BDCHF DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. IT DOES, HOWEVER, MAKE ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. BEAVER DAM COMMUNITY HOSPITALS INC 707 SOUTH UNIVERSITY AVENUE BEAVER DAM WI 53916 391157876 HEALTHCARE WI 501(C)(3) LINE 3 N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0