2021-10-26T14:40:17-05:00 2021-03-31 430352985 KERBER ECK & BRAECKEL LLP 3401 OFFICE PARK DRIVE MARION IL 62959 990 2020-04-01 371041283 CHRISTOPHER RURAL HEALTH PLANNING CORPORATION CHRI 6187242436 PO BOX 155 CHRISTOPHER IL 62822 KIMBERLY MITROKA CEO 6187242436 2021-10-26 1 KIMBERLY MITROKA 999009999 AMBER HALSTEAD P01343727 6189938724 2021-10-25 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z KIMBERLY MITROKA PO BOX 155 CHRISTOPHER IL 62822 32372123 0 X WWW.CRHPC.ORG X 1977 IL TO PLAN, PROMOTE AND DEVELOP A PRIMARY HEALTH CARE SYSTEM FOR THE MEDICALLY UNDERSERVED POPULATION IN RURAL AREAS AND TO PROVIDE ACCESSIBLE, COMPREHENSIVE, QUALITY HEALTHCARE TO ALL THE PEOPLE WITHIN THE COMMUNITY. 10 10 348 0 0 0 4393618 6965947 24877249 24943213 307618 307348 97818 155615 29676303 32372123 0 0 0 0 19419487 20854700 0 0 0 7431275 8182825 26850762 29037525 2825541 3334598 30148307 39435316 9100248 13234289 21048059 26201027 TO PLAN, PROMOTE AND DEVELOP A PRIMARY HEALTH CARE SYSTEM FOR THE MEDICALLY UNDERSERVED POPULATION IN RURAL AREAS AND TO PROVIDE ACCESSIBLE, COMPREHENSIVE, QUALITY HEALTHCARE TO ALL THE PEOPLE WITHIN THE COMMUNITY. 0 0 23669660 24943213 FEDERALLY QUALIFIED RURUAL HEALTH CLINIC - PROVIDES QUALITY PRIMARY HEALTHCARE, DENTAL SERVICES AND PHARMACY REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY TO UNDERSERVED RURAL COMMUNITIES. CHARITY CARE WAS PROVIDED AT THE COST OF $1,687,484. 23669660 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 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 0 0 1 47 0 1 348 1 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X KIM MITROKA 6187242436 PO BOX 155 CHRISTOPHER IL 62822 DOROTHY DEANGELO SEC - TREAS 2.00 X 0 0 0 MARIAN SMITH-FURLOW DIRECTOR 2.00 X 0 0 0 RICHARD SCHABLOWSKY VICE CHAIRMAN 2.00 X 0 0 0 GERALD HEARRING BOARD CHAIRMAN 2.00 X 0 0 0 PAUL CRUZ DIRECTOR 2.00 X 0 0 0 LISA HOPKINS DIRECTOR 2.00 X 0 0 0 GARY KELLY DIRECTOR 2.00 X 0 0 0 TOM KONOPASEK DIRECTOR 2.00 X 0 0 0 RUTH STANFORD DIRECTOR 2.00 X 0 0 0 JOHN HOSSELTON DIRECTOR 2.00 X 0 0 0 SALLY CESAR COO 40.00 X 128416 0 13764 BRANNON JOHNSON CFO 40.00 X 139720 0 7070 KIMBERLY MITROKA CEO 40.00 X 245582 0 25037 DAVID ISRAEL PHYSICIAN 32.00 X 301760 0 31900 MICHAEL BLAIN PHYSICIAN 32.00 X 319181 0 24562 BENJAMIN RATHERT PHYSICIAN 32.00 X 340995 0 17287 STEVEN MITCHELL PHYSICIAN 32.00 X 313030 0 48365 DAVID DELOSO PHYSICIAN 32.00 X 340995 0 17287 2129679 0 185272 41 0 1 0 OFFICE MANAGEMENT SERVICES 1709 HARRISON ST SUITE A MT VERNON IL 62864 OFFICE 369422 E-CLINICAL WORKS LLC PO BOX 847950 BOSTON MA 02284 CLINIC SOFTWARE 352186 J&S INVESTMENTS PO BOX 581 FAIRFIELD IL 62837 RENTOR 230562 GROWING MEDIA 1051 SOUTH WALL ST SUITE 8 CARBONDALE IL 62901 MARKETING 200399 4 6963080 2867 6965947 PATIENT SERVICE REVENUE 621400 24897363 24897363 WELL CHILD VISIT INCENTIVE 900099 37350 37350 MEDICAID EHR INCENTIVE 900099 8500 8500 24943213 306518 306518 20580 0 20580 20580 20580 830 0 830 830 830 MISCELLANEOUS REVENUES 900099 135035 135035 135035 32372123 24943213 0 462963 574482 574482 17167148 15020951 2146197 259616 210600 49016 1654198 1323436 330762 1199256 1002269 196987 24059 24059 38000 38000 502551 467128 35423 268968 268968 3613084 3332694 280390 768854 697646 71208 25425 10483 14942 14435 2757 11678 316613 316613 772367 509906 262461 100272 41255 59017 DATA PROCESSING 547362 23736 523626 ADMIN FEES 480062 479386 676 MINOR EQUIPMENT 267190 199482 67708 OUTSIDE LAB 264406 264406 179177 83525 95652 29037525 23669660 5367865 0 3729018 6261506 1010750 5080610 2589292 2687572 57882 44692 336982 557857 169733 188649 21596558 6452547 14879022 15144011 7351494 9446135 24134 24284 30148307 39435316 2463155 2820874 8832 6628261 6311939 0 4101476 9100248 13234289 X 21048059 26201027 21048059 26201027 30148307 39435316 3334598 1818370 0 X 0 1 X 1 1 1 X 3814025 4708870 3875775 4393618 6965947 23758235 3814025 4708870 3875775 4393618 6965947 23758235 23758235 581826 215010 366669 324358 327928 1815791 34207 92132 90710 81078 135035 433162 26007188 0.91350 0.90590 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - 2016 AMOUNT: $ 34,207. 2017 AMOUNT: $ 92,132. 2018 AMOUNT: $ 90,710. 2019 AMOUNT: $ 81,078. 2020 AMOUNT: $ 135,035. SUPPLEMENTAL INFORMATION IN 2021, OTHER INCOME WAS $135,035 FROM MISCELLANEOUS SOURCES AND DERIVED WITHOUT PROFIT MOTIVE. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 721324 721324 17222314 4204894 13017420 3632299 2247653 1384646 20621 20621 15144011 REFUNDABLE ADVANCE 4101476 4101476 X 34190493 1818370 1818370 32372123 0 32372123 29037525 0 29037525 0 29037525 PART X, LINE 2: CHRISTOPHER RURAL HEALTH PLANNING CORPORATION IS A NOT-FOR-PROFIT CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER CODE SEC. 501(C)(3) FOR ACTIVITIES DIRECTLY RELATED TO ITS TAX-EXEMPT FUNCTIONS. UNRELATED BUSINESS INCOME IS SUBJECT TO INCOME TAX. THE CORPORATION HAS RECOGNIZED IN THE FINANCIAL STATEMENTS THE EFFECTS OF ALL TAX POSITIONS AND CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, CHANGES IN TAX LAW, AND NEW AUTHORITATIVE RULINGS. THE CORPORATION IS NOT AWARE OF ANY SIGNIFICANT CIRCUMSTANCES OR EVENTS THAT MAKE IT REASONABLY POSSIBLE THAT UNRECOGNIZED TAX BENEFITS MAY INCREASE OR DECREASE WITHIN 12 MONTHS OF THE STATEMENT OF FINANCIAL POSITION DATE. PENALTIES AND INTEREST ASSESSED BY TAXING AUTHORITIES ARE INCLUDED IN GENERAL AND ADMINISTRATIVE EXPENSES, IF APPLICABLE. THERE WERE NO INTEREST OR PENALTIES PAID DURING FISCAL YEARS 2021 AND 2020. X X X 0 0 0 0 0 0 0 0 0 KIMBERLY MITROKA CEO 205768 0 1379 0 38435 0 4643 0 20394 0 270619 0 0 0 DAVID ISRAEL PHYSICIAN 274430 0 25294 0 2036 0 5000 0 26900 0 333660 0 0 0 MICHAEL BLAIN PHYSICIAN 198800 0 58985 0 61396 0 1019 0 23543 0 343743 0 0 0 BENJAMIN RATHERT PHYSICIAN 143303 0 174856 0 22836 0 5000 0 12287 0 358282 0 0 0 STEVEN MITCHELL PHYSICIAN 280975 0 1281 0 30774 0 5000 0 43365 0 361395 0 0 0 DAVID DELOSO PHYSICIAN 143303 0 174856 0 22836 0 5000 0 12287 0 358282 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED AT A BOARD MEETING. THE BOARD REVIEWS THE RETURN BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE CORPORATION REQUIRES THAT ALL DIRECTORS, OFFICERS, COMMITTEE MEMBERS, AND CANDIDATES FOR BOARD SEATS DISCLOSE IN WRITING, AND UPDATE THE WRITTEN DISCLOSURE IF CONDITIONS CHANGE, BUSINESS AND FAMILY RELATIONSHIPS WHICH WOULD CREATE A CONFLICT OF INTEREST AND, WHERE APPLICABLE, PROVIDE A STATEMENT SUGGESTING HOW SUCH CONFLICT COULD BE AVOIDED OR MITIGATED. IN ORDER TO FACILITATE SUCH FULL DISCLOSURE, THE CORPORATION REQUIRES DIRECTORS, OFFICERS, AND COMMITTEE MEMBERS TO COMPLETE A DISCLOSURE FORM. COMPLETION OF A DISCLOSURE FORM DOES NOT RELIEVE INDIVIUALS OF THE OBLIGATION TO COMPLY WITH THESE STANDARDS OF CONDUCT WITH REGARD TO CONFLICTS THAT OCCUR AFTER THE FILING OF THE DISCLOSURE FORM. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A) COMPENSATION PROCESS FOR TOP OFFICIAL - THE BOARD OF DIRECTORS SETS THE CEO SALARY WITH A VOTE. SOURCES WHICH ARE USED AS A GUIDE INCLUDE THE ILLINOIS TRADE ASSOCIATION COMPENSATION SURVEY AND THE NATIONAL TRADE ASSOCIATION COMPENSATION SURVEY. LINE 15B) COMPENSATION PROCESS FOR OFFICERS - THE COMPANY CEO AND HR DIRECTOR MEET TO REVIEW COMPENSATION. SOURCES WHICH ARE USED AS A GUIDE INCLUDE THE ILLINOIS TRADE COMPENSATION SURVEY AND THE NATIONAL TRADE ASSOCIATION COMPENSATION SURVEY. THE CEO MAKES RECOMMENDATIONS TO THE BOARD OF DIRECTORS WHO THEN SET THE CFO AND COO SALARIES BY A VOTE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC THROUGH A FREEDOM OF INFORMATION ACT REQUEST. ADDITIONALLY, A SUMMARY OF THE FINANCIAL INFORMATION IS AVAILABLE ANNUALLY ON THE GUIDESTAR.ORG WEBSITE IN CONJUNCTION WITH ALL UNIFORM GUIDANCE AUDITS. THE ORGANIZATION MAINTAINS A WEBSITE (WWW.CRHPC.ORG) TO PROVIDE THE PUBLIC WITH INFORMATION ON ALL ASPECTS OF ITS OPERATIONS.