2025-08-12T11:19:00-05:00 2024-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-10-01 391688793 MEMORIAL HOSPITAL OF BOSCOBEL FOUNDATION INC MEMO 6083756300 205 PARKER STREET BOSCOBEL WI 53805 JERRY BERGE PRESIDENT - BOARD OF DIRECTORS 6083756300 2025-08-12 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-08-11 2023 2025-03-06 01:10:19Z BOSCOBEL AREA HOSPITAL AND CLINICS FOUNDATION JERRY BERGE 205 PARKER STREET BOSCOBEL WI 53805 144707 0 X WWW.GUNDERSENHEALTH.ORG/BOSCOBEL/FOUNDATI X 1990 WI TO ASSIST THE HOSPITAL TO MEET THE HEALTH NEEDS OF THE COMMUNITY 14 14 0 25 0 0 14393 108307 0 0 14429 26303 5952 6205 34774 140815 29355 255315 0 0 0 0 0 0 0 7643 17753 36998 273068 -2224 -132253 752833 716029 0 0 752833 716029 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 254115 254115 0 THE FOUNDATION SUPPORTS THE PROMOTION, DEVELOPMENT, AND IMPROVEMENT OF THE QUALITY AND DELIVERY OF HEALTH PRESERVATION AND HEALTH CARE SERVICES OF MEMORIAL HOSPITAL OF BOSCOBEL DBA 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. 1200 1200 0 DURING THE PERIOD OCTOBER 1, 2023 THROUGH SEPTEMBER 30, 2024, $1,200 IN SCHOLARSHIPS WERE GRANTED TO 4 STUDENTS PURSUING NURSING-RELATED DEGREE PROGRAM THROUGH THE SLAMAN FAMILY MEMORIAL SCHOLARSHIP. 255315 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 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X NATALIE TOLLEFSON 6083756300 205 PARKER STREET BOSCOBEL WI 53805 X NATALIE TOLLEFSON FOUNDATION DIR./MANAGER BUS OPER. 12.00 X 0 0 0 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 DICK BEINBORN DIRECTOR 0.30 X 0 0 0 THERESA BRAUDT DIRECTOR 0.30 X 0 0 0 DE ANNE CHAPPELL DIRECTOR 0.30 X 0 0 0 PETE ESSER DIRECTOR 0.30 X 0 0 0 GLENN GRISWOLD DIRECTOR 0.30 X 0 0 0 ALLISON KLUG DIRECTOR 0.30 X 0 0 0 DOUG KNOBLE DIRECTOR 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 SALLY WALTZ DIRECTOR 0.30 X 0 0 0 0 0 0 0 0 0 0 0 13700 94607 108307 16310 16310 9993 0 9993 9993 9993 10097 13700 3892 6205 6205 140815 0 0 32508 254115 254115 1200 1200 7955 7955 5629 5629 3430 3430 739 739 273068 255315 17753 0 133447 146517 619386 569512 752833 716029 0 0 X 729650 597626 23183 118403 752833 716029 752833 716029 -132253 95449 0 X 0 0 0 X 124973 59916 84959 14393 108307 392548 124973 59916 84959 14393 108307 392548 22000 370548 7969 12941 11648 11645 16310 60513 0 2030 2758 5952 6205 16945 470006 0.78840 0.81980 X PART II, SHORT YEAR EXPLANATION: THE 2022 COLUMN OF PART II REPRESENTS A SHORT-YEAR PERIOD FROM JANUARY 1, 2023 THROUGH SEPTEMBER 30, 2023 DUE TO A CHANGE IN YEAR END. THE REASON FOR THIS CHANGE IS DUE TO A MERGER WITH THE BELLIN GUNDERSEN HEALTH SYSTEM. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED GOLF OUTING 23797 13700 10097 500 1359 1512 521 23797 13700 10097 500 1359 1512 521 3892 6205 1 BOSCOBEL MEMORIAL HOSPITAL 205 PARKER STREET BOSCOBEL WI 53805 390845590 501(C)(3) 94559 159556 FMV BUILDING FOR ADDITION 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.