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Nonprofiteer
← TRICOUNTY MEMORIAL FOUNDATION INC

Form 990 for tax year 2022

Filed by TRICOUNTY MEMORIAL FOUNDATION INC.

Totals

Total revenue
$90,177
Total expenses
$22,672
Contributions and grants received
$81,990
Grants paid
$10,403
Program service revenue
$0
Investment income
$8,412
Other revenue
-$225
Total assets, end of year
$1,201,079
Total liabilities, end of year
$394,194
Net assets or fund balances, end of year
$806,885
Program services expenses (Part IX)
$22,672
Management and general expenses
$0
Fundraising expenses
$0
Program service expenses (Part III)
$22,672

Program services were 100.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1f · All other contributions, gifts and grants

    $81,990

  • 3 · Investment income

    total $8,412 · excluded $8,412

  • 8a · Fundraising events: gross income

    $28,028

  • 8b · Fundraising events: direct expenses

    $28,253

  • 8c · Net income from fundraising events

    total -$225 · excluded -$225

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $9,403 · program services $9,403

  • 2 · Grants to domestic individuals

    total $1,000 · program services $1,000

  • 13 · Office expenses

    total $54 · program services $54

  • 24a · Other expenses: PROGRAM EXPENSES

    total $12,139 · program services $12,139

  • 24e · All other expenses

    total $76 · program services $76

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    beginning of year $1,002,842 · end of year $1,119,806

  • 3 · Pledges and grants receivable

    beginning of year $128,997 · end of year $81,273

  • 25 · Other liabilities

    beginning of year $392,459 · end of year $394,194

  • 27 · Net assets without donor restrictions

    beginning of year $316,992 · end of year $319,925

  • 28 · Net assets with donor restrictions

    beginning of year $422,388 · end of year $486,960

Mission and programs · 2022

Mission

TRI-COUNTY MEMORIAL FOUNDATION, INC. EXISTS TO SUPPORT THE MISSION OF TRI-COUNTY MEMORIAL HOSPITAL, INC. WHICH IS TO DISTINGUISH OURSELVES THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, AND IMPROVED HEALTH IN THE COMMUNITIES WE SERVE.

  • TRI-COUNTY MEMORIAL FOUNDATION, INC. PROVIDES SUPPORT TRI-COUNTY MEMORIAL HOSPITAL, INC., COMMUNITY ORGANIZATIONS, AND INDIVIDUALS TO FURTHER THE PURPOSE OF HEALTH AND EDUCATIONAL NEEDS. TRI-COUNTY MEMORIAL HOSPITAL, INC. PROVIDES HEALTH SERVICES TO THEIR LOCAL AREAS. THE SERVICE AREA IS ABOUT A 25-MILE RADIUS AROUND THE FACILITY AND INCLUDES ABOUT 15,000 INDIVIDUALS. TRI-COUNTY MEMORIAL FOUNDATION, INC. PROVIDES SUPPORT TO TRI-COUNTY HOSPITAL, CLINICS, ASSISTED LIVING, AND NURSING HOME. AT TIMES, EQUIPMENT IS PURCHASED TO SUPPORT THE HOSPITAL, CLINICS, ASSISTED LIVING, AND NURSING HOME. DURING THE PERIOD JANUARY 1, 2022 THROUGH DECEMBER 31, 2022, $1,000 IN SCHOLARSHIPS WERE GRANTED TO STUDENTS IN THE AREA PURSUING CAREERS IN MEDICAL FIELDS.

    Expenses $22,672 · Grants $10,403

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Kurt Johnson

    CHAIRMAN

    Total calculated
    $0
    Hours/week
    0.5

  • Rachel Risberg

    VICE CHAIRMAN

    Total calculated
    $0
    Hours/week
    0.5

  • Fred Boe

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.5

  • K Roger Gilbert

    TRUSTEE (TERMED OCT)

    Total calculated
    $0
    Hours/week
    0.5

  • Glen Johnson

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.5

  • Shirley Miller

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.5

  • Dave Pientok

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.5

  • J Michael Warner

    TRUSTEE

    Total calculated
    $0
    Hours/week
    0.5

  • Joni Olson

    ADMINISTRATOR

    Total calculated
    $261,186
    From this org
    $0
    From related orgs
    $206,921
    Other
    $54,265
    Hours/week
    0.5 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $181,884 related
    Bonus
    $0 + $200 related
    Other
    $0 + $24,837 related
    Deferred
    $0 + $30,388 related
    Nontaxable benefits
    $0 + $23,877 related
    Filer's total
    $0 + $261,186 related

  • Dan Klidzejs

    FINANCE ADMINISTRATOR (TERMED MAY)

    Total calculated
    $60,530
    From this org
    $0
    From related orgs
    $52,175
    Other
    $8,355
    Hours/week
    1 + 40 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

None.

Answered no

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • GUNDERSEN LUTHERAN ENVISION LLC

    C · RENEWABLE ENERGY · WI · controlled entity

  • 3REALESTATE LLC

    C · RENTAL · WI · controlled entity

  • BEL-REGIONAL HOME MEDICAL INC

    C · DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS · WI · controlled entity

  • BELLIN INVESTMENTS INC

    C · OTHER · WI · controlled entity

Provenance

Return type
form_990
Tax year
2022
Filed
14 November 2023
IRS schema version
2022v5.0
Source object
202333199349301938

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