2025-08-14T09:03:46-05:00 2023-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-10-01 370673512 IROQUOIS MEMORIAL HOSPITAL & RESIDENT HOME IROQ 8154324444 200 E FAIRMAN AVENUE WATSEKA IL 60970 MICHAEL TILSTRA PRESIDENT & CEO 8154324444 2025-08-13 1 0 MICHAEL J PETERSON CPA P01833529 2187224705 2025-08-10 2022 2025-03-06 01:10:19Z MICHAEL TILSTRA 200 E FAIRMAN AVENUE WATSEKA IL 60970 45494945 0 X HTTPS://IROQUOISMEMORIAL.COM/ X 1914 IL IROQUOIS MEMORIAL HOSPITAL & RESIDENT HOME IS COMMITTED TO PROVIDING QUALITY HEALTHCARE SERVICES. 6 6 418 83 0 0 2463620 2738849 34508177 42280346 10662 122834 235268 344573 37217727 45486602 0 0 0 0 18601594 18532415 0 0 0 19382738 19426554 37984332 37958969 -766605 7527633 22062135 27293312 14718172 12206911 7343963 15086401 X IROQUOIS MEMORIAL HOSPITAL & RESIDENT HOME IS COMMITTED TO PROVIDING QUALITY HEALTHCARE SERVICES FOR THE REGION IN A CONVENIENT, CARING ENVIRONMENT. 0 0 27595402 0 37795207 IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME PROVIDES HIGH QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. THEREFORE, IN KEEPING WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF OUR COMMUNITY, SOME CARE IS PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST. THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR AN INDIVIDUAL'S INABILITY TO PAY EXIST. THESE ACTIVITIES INCLUDE PREVENTION AND WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, AND THE MEDICAL UNDERSERVED INCLUDING A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES.THE HOSPITAL IS LOCATED IN WATSEKA, ILLINOIS AND SERVES THE SURROUNDING COMMUNITIES IN IROQUOIS COUNTY AND WEST-CENTRAL INDIANA. THERE ARE OUTPATIENT CLINICS MAINTAINED IN GILMAN, MILFORD, ST ANNE, AND WATSEKA, ILLINOIS AS WELL AS KENTLAND, INDIANA. THE HOSPITAL PROVIDES BEDS FOR ACUTE CARE, INTENSIVE CARE, NURSERY, AND LONG-TERM CARE. THE HOSPITAL ALSO PROVIDES AMBULANCE SERVICES TO MOST OF IROQUOIS COUNTY WITH STATIONS IN GILMAN AND WATSEKA. HOME HEALTH AND HOSPICE PROVIDE SERVICES TO WATSEKA AND SURROUNDING COMMUNITIES IN THE HOSPITAL'S SERVICE AREA. THE IROQUOIS REGIONAL HEALTH CENTER HOUSES PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPIES. THE HOSPITAL IS CERTIFIED TO PROVIDE CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICE ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE HOSPITAL RECORDS THESE AMOUNTS AS UNCOMPENSATED CARE IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY.IROQUOIS MEMORIAL HOSPITAL PROVIDES NON-TRADITIONAL HOSPITAL BASED SERVICES SUCH AS AMBULANCE COVERAGE TO WATSEKA AND THE SURROUNDING IROQUOIS COUNTY COMMUNITIES. IN ADDITION TO THE COSTS OF UNCOMPENSATED CARE AND OTHER NON-TRADITIONAL SERVICES, IROQUOIS MEMORIAL HOSPITAL & RESIDENT HOME COMMITTED SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND OTHER CRITICAL SERVICES WHICH MEET OTHERWISE UNFILLED COMMUNITY NEEDS. SOME OF THOSE PROGRAMS THAT FURTHER THE HOSPITAL'S MISSION INCLUDE: - AMBULANCE SUPPORT FOR SPORTING EVENTS AND SURROUNDING VOLUNTEERS- AMBULANCE DEPARTMENTS- BLOOD DRIVES- BREAST CANCER AWARENESS EVENT- BREAST-FEEDING CLASSES FOR EXPECTANT MOTHERS- CAMP 911 SAFETY PROGRAMS FOR AREA SCHOOL CHILDREN- FARM SAFETY EDUCATION- FIRST AID FOR LOCALLY COMMUNITY EVENTS- FREE AND REDUCED FEE HEALTH SCREENINGS- FREE BLOOD PRESSURE SCREENINGS- FREE CPR TRAINING FOR THE PUBLIC- GO RED HEALTHY HEART EVENT- HEALTH-RELATED ARTICLES IN LOCAL PUBLICATIONS- BIRTHING CLASSES- LIFELINE- MEALS ON WHEELS- SPEAKER'S BUREAU- TOURS FOR AREA SCHOOL CHILDREN 27595402 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 53 0 418 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 6 6 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 IL X ROBYN MEMENGA 8154324444 200 E FAIRMAN AVENUE WATSEKA IL 60970 ROGER DITTRICH CHAIR 3.00 1.00 X X 0 0 0 DOUG GEIGER VICE CHAIR 3.00 1.00 X X 0 0 0 RHONDA PENCE TREASURER 3.00 1.00 X X 0 0 0 PHILIP ZUMWALT MD SECRETARY 3.00 1.00 X X 0 0 0 SARA MIKUTA DIRECTOR 3.00 1.00 X 0 0 0 DAN TINCHER DIRECTOR 3.00 1.00 X 0 0 0 SHAWN BRANSKY CFO 40.00 1.00 X 169991 0 0 MICHAEL TILSTRA CEO 40.00 1.00 X 222054 0 0 THOMAS MCCANN VP OF ANCILLARY SERVICES 40.00 1.00 X 121170 0 32508 MICHELLE FAIRLEY CNO 40.00 X 120398 0 41720 GONZOLO RLORIDO PHYSICIAN 40.00 X 338666 0 31661 M HYTHAM BECK PHYSICIAN 40.00 X 330074 0 43918 CRISTANTO REYES PHYSICIAN 40.00 X 207379 0 45099 RODNEY ALFORD PHYSICIAN 40.00 X 171777 0 32017 TERESITA TORRES PHYSICIAN 40.00 X 197429 0 11375 1878938 0 238298 16 0 1 0 STATERA 2250 N ILLINOIS CARBONDALE IL 62901 EMERGENCY ROOM SERVICES 766000 ATHENA 311 ARSENAL STREET WATERTOWN MA 02472 HEALTH CARE SYSTEM 523654 AVANT PO BOX 744554 ATLANTA GA 30374 CONTRACT LABOR 438802 CPSITRUBRIDGE PO BOX 850309 MOBILE AL 36685 BILLING 421513 JOBOT PO BOX 102357 PASADENA CA 91189 CONTRACT LABOR 384607 35 18600 1812549 907700 2738849 NET PATIENT REVENUE 621400 34256534 34256534 IDPA PROGRAM 621400 3515268 3515268 4508544 414 4508130 42280346 122834 122834 105686 0 105686 105686 105686 71298 18600 8343 62955 62955 2285 0 2285 2285 INCENTIVE PAYMENTS 900099 22991 22991 150656 150656 173647 45486602 37795207 0 4952546 X 707839 315794 392045 14419763 12658353 1761410 2356391 2008680 347711 1048422 898440 149982 20430 20430 8545 8545 6714291 3230927 3483364 128606 61330 67276 607077 289507 317570 935246 446006 489240 3745 1786 1959 285457 235547 49910 793361 654647 138714 854161 407338 446823 BAD DEBT EXPENSE 3952940 3952940 MEDICAL SUPPLIES 2123704 1012765 1110939 PROVIDER TAX EXPENSE 1167135 556590 610545 REPAIRS & MAINTENANCE 890650 424739 465911 941206 440013 501193 37958969 27595402 10363567 0 3330242 156393 100244 3622944 3257655 8097364 1035322 1817812 344654 129889 44244800 37846032 7177610 6398768 6816408 7070142 22062135 27293312 5492974 5565670 4096803 2475133 4623694 3678304 504701 487804 14718172 12206911 X 783601 8311234 6560362 6775167 7343963 15086401 22062135 27293312 X 7527633 214805 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8545 8545 0 PART II-B, LINE 1: A PORTION OF MEMBERSHIP DUES TO PROFESSIONAL HEALTHCARE ASSOCIATIONS IS USED FOR LOBBYING ACTIVITIES TO SUPPORT THE ADVOCATION EFFORTS OF THE MEMBER HOSPITALS SERVING THEIR COMMUNITIES. 6510362 610995 396190 6725167 8321487 -1377033 434092 6510362 7196915 1124572 8321487 7282282 -13122 72245 7196915 7896691 -18989 595420 7282282 0.00800 0.99200 0.00000 1 0 526825 526825 26022446 21561823 4460623 16809265 16284209 525056 886264 886264 6398768 INVESTMENT IN UNCONSOLIDATED AFFILIATE 55000 ASSETS LIMITED AS TO USE - DONOR RESTRICTED 289975 ASSETS LIMITED AS TO USE - BENEFICIAL INTEREST IN PERPETUAL TRUST 6725167 7070142 AMOUNTS PAYABLE TO THIRD-PARTY REIMBURSEMENT PROGRAMS 225511 ASSET RETIREMENT OBLIGATION 262293 487804 PART V, LINE 4: THE ENDOWMENT FUNDS ARE USED TO SUPPORT THE ONGOING OPERATIONAL AND CAPITAL NEEDS OF THE ORGANIZATION IN MEETING THE COMMUNITY NEEDS AND SERVICES. WRITE A CHECK CAMPAIGN 65312 65312 2000 IMH GOLF OUTING 24586 18600 5986 364 4444 1535 89898 18600 71298 364 4444 1535 2000 8343 62955 1 1 1 X 125.000000000000 1 X 1 1 0 0 96782 96782 0.00280 5963992 1543012 4420980 0.13000 6060774 1543012 4517762 0.13280 6060774 1543012 4517762 0.13280 1 1376338 0 2975790 3343646 -367856 X 1 1 1 1 IROQUOIS MEMORIAL HOSPITAL 200 E FAIRMAN AVENUE WATSEKA IL 60970 HTTPS://IROQUOISMEMORIAL.COM/ X X X X IROQUOIS MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 21 1 0 0 1 X SEE SUPPLEMENTAL INFORMATION X 1 21 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 125.000000000000 300.000000000000 1 1 X X X X 1 X HTTPS://IROQUOISMEMORIAL.COM/FINANCIAL-ASSISTANCE X HTTPS://IROQUOISMEMORIAL.COM/FINANCIAL-ASSISTANCE X HTTPS://IROQUOISMEMORIAL.COM/FINANCIAL-ASSISTANCE X X X X X 1 X 0 X X X X 1 X 0 0 IROQUOIS MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE DEVELOPMENT OF THE PLAN COMPRISED OF A MULTITUDE OF REPRESENTATIVES FROM COMMUNITY LEADERS, HEALTH PROFESSIONALS, FAITH LEADERS, BUSINESS LEADERS, LOCAL OFFICIALS, AND THE LOCAL SCHOOLS. IROQUOIS MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: PART V, SECTION B, LINE 7A & 10A:HTTPS://IROQUOISMEMORIAL.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT IROQUOIS MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: PRIORITY 1 - CLINIC GROWTHIMH IS COMMITTED TO MEETING THE NEEDS OF ALL PATIENTS IN THE COMMUNITIES THAT WE SERVE AND RECOGNIZE THE VITAL ROLE THESE POPULATIONS SERVE TO OUR HEALTHCARE SYSTEM AS WELL AS THE ECONOMIC DEVELOPMENT OF THE COMMUNITIES WE LIVE WITHIN. IMH CURRENTLY PROVIDES FOUR CLINIC SITES THROUGHOUT OUR COMMUNITIES, AND WE ARE PLANNING TO EXPAND THAT NUMBER TO REACH ADDITIONAL RURAL COMMUNITIES. OUR VISION FOR THE FAMILY PRACTICE CLINICS WILL BE TO EXPAND THE PATIENT OPPORTUNITIES TO SEE OTHER SPECIALTY PROVIDERS WITHIN OUR CLINIC.PRIORITY 2 - ADDICTION SERVICESIROQUOIS COUNTY IS NOT ALONE IN THE STRUGGLE WITH ADDICTION. WE FACE AN EVER-CHANGING CRISIS BY THE USE OF DIFFERENT SUBSTANCE SHIFTS. IN ILLINOIS, OPIOID OVERDOSE DEATHS HAVE BEEN ON THE RISE SINCE 2019. IROQUOIS COUNTY IS RATED 6TH IN ILLINOIS OPIOID FATALITY WITH 33.7 PERCENT (OPIOID FATALITY RATE PER 100,000 CAPITA). SOME OF OUR PRIORITIES WILL BE FOCUSED ON PREVENTION, TREATMENT AND RECOVERY, HARM REDUCTION AND JUSTICE-INVOLVED POPULATION.PRIORITY 3 - SURGICAL SPECIALTY EXPANSIONMANY RESIDENTS IN OUR COMMUNITY FACE TRANSPORTATION BARRIERS TO ACHIEVING OPTIMAL HEALTH AND WELLNESS. THESE CHALLENGES MAKE IT DIFFICULT FOR THE PEOPLE OF OUR COMMUNITY TO ACCESS THE SPECIALTY SURGEONS THEY NEED WHICH THEN NEGATIVELY IMPACTS THEIR HEALTH. AS A HEALTHCARE LEADER IN OUR AREA, IMH IS COMMITTED TO THE EXPANSION OF SPECIALTY SURGICAL SERVICES AT OUR FACILITIES IN ORDER TO ENSURE THE MEMBERS OF OUR COMMUNITY GET THE TREATMENT AND SURGERIES THAT THEY NEED. 6 1 - IROQUOIS REGIONAL HEALTH CENTER 200 LAIRD LANE WATSEKA IL 60970 REHAB SERVICES, HOME HEALTH, HOSPICE 2 - MULTI-SPECIALTY CLINIC 200 E FAIRMAN AVENUE WATSEKA IL 60970 PHYSICIAN OFFICE 3 - KENTLAND CLINIC 303 N 7TH STREET KENTLAND IL 47951 PHYSICIAN OFFICE 4 - GILMAN CLINIC 508 E CRESCENT STREET GILMAN IL 60938 PHYSICIAN OFFICE 5 - MILFORD CLINIC 34 EAST JONES MILFORD IL 60953 PHYSICIAN OFFICE 6 - ST ANNE CLINIC 135 WEST STATION STREET ST ANNE IL 60964 PHYSICIAN OFFICE PART I, LINE 7: A COST-TO-CHARGE RATIO AS CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, INCLUDED IN THE SCHEDULE H INSTRUCTIONS WAS USED TO DETERMINE THE AMOUNTS ON LINE 7B OF PART I OF SCHEDULE H. ACTUAL COSTS WERE USED TO DETERMINE THE BENEFIT EXPENSES ON LINES 7A, 7E, 7F, 7G, AND7I OF SCHEDULE H, PART I. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 3,952,940. PART III, LINE 2: THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINE 2 WAS A RATIO OF PATIENT CARE COSTS TO CHARGES AS COMPUTED IN WORKSHEET 2 OF THE FORM 990, SCHEDULE H INSTRUCTIONS. PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES, PATIENTS DO NOT COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE HOSPITAL PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTS PATIENTS WITH THE APPLICATION. DUE TO NO RESPONSES FROM SOME PATIENTS, A PORTION OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE IS REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE ORGANIZATION EXPECTS TO BE ENTITLED, IN EXCHANGE FOR PROVIDING PATIENT CARE SERVICES. PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND IMPLICIT PRICE CONCESSIONS WHICH REFLECTS MANAGEMENT'S ESTIMATE OF THE TRANSACTION PRICE. THE ORGANIZATION ESTIMATES THE TRANSACTION PRICE BASED ON NEGOTIATED CONTRACTUAL AGREEMENTS, HISTORICAL EXPERIENCE, AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS AND IS RECORDED THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. THE ORGANIZATION DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS.THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: MEDICARE COST WAS DETERMINED USING AN OVERALL COST-TO-CHARGE RATIO. PART III, LINE 9B: QUALIFICATIONS ARE BASED ON POVERTY GUIDELINES PUBLISHED. NO COLLECTION EFFORTS FOR QUALIFYING PATIENTS. PATIENTS WHO DO NOT QUALIFY RECEIVE AT LEAST 3 STATEMENTS AND GENERALLY ARE TURNED TO COLLECTIONS IF NO PAYMENTS ARE RECEIVED. PART VI, LINE 2: PARTNERED WITH ILLINOIS DEPARTMENT OF PUBLIC HEALTH TO ASSESS THE HEATH NEEDS OF THE COMMUNITIES SERVED BY IROQUOIS MEMORIAL HOSPITAL. EXECUTIVE MEMBERS ARE ON THE LOCAL PUBLIC HEALTH BOARD. PART VI, LINE 3: INFORMATION REGARDING THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY IS DISTRIBUTED AT TIME OF THE PATIENT ADMISSION. THE ORGANIZATION ALSO HAS SIGNAGE IN THE ADMISSIONS AREA. STAFF ARE TRAINED TO EDUCATE PATIENTS THAT EXPRESS CONCERNS ABOUT ABILITY TO PAY FOR SERVICES. PART VI, LINE 4: THE COMMUNITY IS RURAL WITH OVERALL LOW INCOME LEVELS AND HIGH LEVELS OF UNINSURED PATIENTS. MANY PATIENTS WOULD HAVE PROBLEMS WITH ACCESS TO CARE WITHOUT THE ORGANIZATION SUBSIDIZED PHYSICIAN CLINICS AND OTHER SERVICES. PART VI, LINE 5: IROQUOIS MEMORIAL HOSPITAL PARTICIPATES IN NUMEROUS HEALTH FAIRS AND COMMUNITY EVENTS ON AN ANNUAL BASIS, EDUCATING SCHOOL AGE CHILDREN TO SENIORS ABOUT HEALTHCARE ISSUES RELATIVE TO THEIR AGE GROUP. IROQUOIS MEMORIAL HOSPITAL PROVIDES HEALTH CARE SCREENINGS BY WAY OF BLOOD DRAWS AND CARDIAC EXAMS AT A SUBSTANTIALLY REDUCED RATE TO IDENTIFY AND RESOLVE HEALTH ISSUES EARLY. ADDITIONALLY, IROQUOIS MEMORIAL PROVIDES VACCINATIONS AND OTHER HEALTH RELATED INFORMATION TO LOCAL INDUSTRY EMPLOYEES AT THEIR PLACE OF EMPLOYMENT. X X 0 1 0 0 0 0 0 0 0 M HYTHAM BECK PHYSICIAN 330074 0 0 0 0 0 0 0 43918 0 373992 0 0 0 GONZOLO RLORIDO PHYSICIAN 338666 0 0 0 0 0 0 0 31661 0 370327 0 0 0 CRISTANTO REYES PHYSICIAN 207379 0 0 0 0 0 0 0 45099 0 252478 0 0 0 MICHAEL TILSTRA CEO 221538 0 0 0 516 0 0 0 0 0 222054 0 0 0 TERESITA TORRES PHYSICIAN 197429 0 0 0 0 0 0 0 11375 0 208804 0 0 0 RODNEY ALFORD PHYSICIAN 171579 0 0 0 198 0 0 0 32017 0 203794 0 0 0 SHAWN BRANSKY CFO 169991 0 0 0 0 0 0 0 0 0 169991 0 0 0 MICHELLE FAIRLEY CNO 120398 0 0 0 0 0 0 0 41720 0 162118 0 0 0 THOMAS MCCANN VP OF ANCILLARY SERVICES 121170 0 0 0 0 0 0 0 32508 0 153678 0 0 0 FORM 990, PART VI, SECTION A, LINE 7A THE MAYOR, COUNTY BOARD CHAIRPERSON, AND DISTRICT JUDGE EACH APPOINT THREE MEMBERS OF THE ORGANIZATION'S BOARD OF TRUSTEES TO THREE YEAR TERMS. FORM 990, PART VI, SECTION B, LINE 11B THE STAFF MEMBERS THAT PROVIDE THE INFORMATION TO THE OUTSIDE RETURN PREPARER CONDUCT A THOROUGH REVIEW OF A DRAFT OF THE RETURN. PRIOR TO FILING, THE 990 IS DISTRIBUTED TO THE BOARD OF TRUSTEES FOR REVIEW AND COMMENT. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY COVERS DIRECTORS, OFFICERS, MANAGERS, MEDICAL STAFF MEMBERS, PHYSICIANS, EXECUTIVE STAFF MEMBERS, DEPARTMENT DIRECTORS, AND COORDINATORS. CONFLICT OF INTEREST STATEMENTS ARE REQUIRED TO BE COMPLETED ANNUALLY BY DIRECTORS, OFFICERS, AND HIGHLY COMPENSATED EMPLOYEES AND ARE REVIEWED BY ADMINISTRATION. INDIVIDUALS WITH CONFLICTS OF INTEREST ARE REQUIRED TO DISCLOSE THEM AND TO REFRAIN FROM PARTICIPATION IN ANY DECISION THAT COULD BENEFIT THEM PERSONALLY. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF TRUSTEES CONDUCTED A COMPENSATION REVIEW. CEO HAS A TWO YEAR CONTRACT. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL DOCUMENTS ARE AVAILABLE UPON REQUEST. CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE NOT PUBLIC INFORMATION AT THIS TIME. HOWEVER, IF REQUESTED, THE BOARD WOULD BE NOTIFIED TO DETERMINE RESPONSE. FORM 990, PART IX, LINE 11G EMERGENCY ROOM FEES: PROGRAM SERVICE EXPENSES 1,069,835. MANAGEMENT AND GENERAL EXPENSES 1,173,542. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,243,377. OTHER CONTRACTED LABOR: PROGRAM SERVICE EXPENSES 1,907,786. MANAGEMENT AND GENERAL EXPENSES 2,092,720. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,000,506. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 253,306. MANAGEMENT AND GENERAL EXPENSES 217,102. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 470,408. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST 214,805. IROQUOIS MEMORIAL HOSPITAL FOUNDATION INC 200 E FAIRMAN AVENUE WATSEKA IL 60970 453834535 SUPPORTING ORGANIZATION IL 501(C)(3) LINE 12A, I IROQUOIS MEMORIAL HOSPITAL & RESIDENT HOME 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 THE TAXPAYER HAS A HISTORY OF MEETING THE TIMELY FILING REQUIREMENTS FOR FORM 990 AND INFORMATION REPORTING ON A TIMELY BASIS. THE LATE FILING OF FORM 990 FOR THE YEAR ENDED SEPTEMBER 30, 2023 WAS DUE TO UNUSUAL CIRCUMSTANCES. THE ORGANIZATION IS REQUIRED TO HAVE THEIR FINANCIAL STATEMENTS AUDITED BY AN INDEPENDENT CPA FIRM PRIOR TO THEN PREPARING AND SUBMITTING THEIR IRS FORM 990. THE AMOUNT OF TIME AND COMPLIANCE THAT GOES INTO THIS IS SIGNIFICANT AND THERE ARE OTHER SIGNIFICANT OPERATION NEEDS TO MEET TO ENSURE THE CARE OF THE COMMUNITY THE HOSPITAL SERVES. THE ORGANIZATION EXPERIENCED UNTIMELY TURNOVER WITHIN THEIR OWN ORGANIZATION AND CONTRACTED ACCOUNTING SERVICES WHICH DELAYED THEIR ABILITY TO PREPARE FOR THE AUDITED FINANCIAL STATEMENTS AND FORM 990. IN ADDITION, THEY EXPERIENCED TURNOVER AT THEIR CPA FIRM TYPICALLY UTILIZED. THE ORGANIZATION OVER THE PAST FEW YEARS HAS STABILIZED THEIR INTERNAL TEAM AND SOUGHT A NEW CPA FIRM AND HAS COMPLETED THEIR AUDITED FINANCIAL STATEMENTS AND IRS FORM 990. THE RELATIONSHIP BUILD DURING THE PROCESS GIVES THE ORGANIZATION CONFIDENCE THAT THERE WILL BE ONGOING TIMELY COMPLIANCE. BASED ON THE HISTORY OF ROUTINE COMPLIANCE AND THE SPECIFIC FACTS AND CIRCUMSTANCES PROVIDED, WE RESPECTFULLY REQUEST THAT ANY PROPOSED INTEREST AND PENALTIES ABATED AND THE IRS RECOGNIZE REASONABLE CAUSE IN DOING SO. ADDITIONALLY, THE PROPOSED LATE FILING PENALTY WOULD HAVE A MATERIAL IMPACT ON THE ORGANIZATIONS ABILITY TO PROVIDE THE NECESSARY HEALTH SERVICES TO THE COMMUNITY THEY SERVE.