2019-12-10T10:01:29-06:00 2019-04-30 363168081 SIKICH LLP 13400 BISHOPS LANE SUITE 300 BROOKFIELD WI 53005 990 2018-05-01 363572331 NORTHERN ILLINOIS CANCER TREATMENT CENTER NORT 8152841111 327 IL ROUTE 2 DIXON IL 61021 CYNTHIA ZANDER TREASURER 8152841111 2019-12-04 1 JILL M BOYLE CPA P01246734 2627549400 2019-11-12 209.170.231.5 2019-12-04 15:17:10 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 4EEC376E0009DD82B8C158C84BF413102525094C 2018 2020-04-17 16:48:07Z DIRK MEMINGER 327 IL ROUTE 2 DIXON IL 61021 2328699 0 X WWW.NICANCER.COM X 1988 IL OPERATE A CANCER CENTER WITH HIGHLY SOPHISTICATED DIAGNOSTIC AND TREATMENT PROCEDURES. 7 7 0 7 0 0 8165 721 2430191 2313803 9427 13854 357 321 2448140 2328699 19285 16550 0 0 0 0 0 0 0 2713007 2627017 2732292 2643567 -284152 -314868 8068973 7720345 163362 129602 7905611 7590743 TO OPERATE A CANCER CENTER WHICH WILL ENCOMPASS HIGHLY SOPHISTICATED & EXPENSIVE DIAGNOSTIC & TREATMENT PROCEDURES IN ORDER TO CARRY OUT CANCER TREATMENT & RESEARCH. 0 0 2486522 16550 2313803 PROVIDED HIGH QUALITY CANCER TREATMENT WITH THE LATEST COMPREHENSIVE CANCER TREATMENT TECHNOLOGY IN A WELCOMING, COMFORTABLE AND FRIENDLY ENVIRONMENT. 11,500 PROCEDURES WERE PERFORMED DURING THE YEAR. THE CENTER ALSO PROVIDED $16,000 OF CHARITY CARE DURING THE YEAR TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY. 2486522 1 0 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 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X CYNTHIA ZANDER 8152841111 327 IL ROUTE 2 DIXON IL 61021 X ANDY MOORE BOARD MEMBER 2.00 X 0 0 0 COLLEEN HENKEL BOARD MEMBER 2.00 X 0 0 0 CYNTHIA ZANDER TREASURER 4.00 X X 0 0 0 DIRK MEMINGER CHAIRMAN/PRESIDENT 4.00 X X 0 0 0 KEVIN MARX SECRETARY 4.00 X X 0 0 0 THOMAS MCGLONE MD BOARD MEMBER 2.00 X 0 0 0 TOM GEHLBACH MD BOARD MEMBER 2.00 X 0 0 0 JON BERENS ADMINISTRATIVE DIRECTOR 40.00 X 0 0 0 EDWARD F MILES MD RADIATION ONCOLOGIST 40.00 X 0 0 0 0 0 0 0 0 0 1 CGH MEDICAL CENTER 100 E LEFEVRE ROAD STERLING IL 61081 LEASED EMPLOYEES 1547176 VARIAN MEDICAL SYSTEMS INC 70140 NETWORK PLACE CHICAGO IL 60673 HARDWARE / SOFTWARE SUPPORT SERVICES 354373 2 721 721 PATIENT TREATMENT REVE 621400 2313803 2313803 2313803 13854 13854 ILLINOIS REIMBURSEMENT 900099 310 310 CLASS ACTION LAWSUIT I 900099 11 11 321 2328699 2313803 0 14175 X 16550 16550 775858 675039 100819 720 720 750492 722277 28215 62493 62493 15718 15718 70955 70955 57772 54710 3062 292937 284426 8511 74784 74784 REPAIRS & MAINTENANCE 479701 479701 OTHER 31955 31955 MEDICAL SUPPLIES 13632 13632 2643567 2486522 157045 0 500 51 2284103 2288992 328701 237560 171054 169860 11288387 6264505 5284615 5023882 8068973 7720345 50217 13875 113145 115727 163362 129602 X 7905611 7590743 0 0 7905611 7590743 8068973 7720345 -314868 0 X 0 1 X 1 0 X 4027 4565 381 8165 721 17859 3538009 2938778 2262284 2430191 2313803 13483065 12035 14065 8079 34179 3554071 2957408 2270744 2438356 2314524 13535103 0 0 0 13535103 9779 8842 7480 9427 13854 49382 9779 8842 7480 9427 13854 49382 357 321 678 3563850 2966250 2278224 2448140 2328699 13585163 0.99630 0.99700 0.00360 0.00300 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: CLASS ACTION LAWSUIT - INCOME - 2018 AMOUNT: $ 11. ILLINOIS REIMBURSEMENT - MEDICAL RECORD HANDLING - 2018 AMOUNT: $ 310. OTHER INCOME - 2017 AMOUNT: $ 357. 25115 25115 6663853 2094893 4568960 4487842 4060234 427608 111577 109378 2199 5023882 DUE TO CGH MEDICAL CENTER 115727 115727 X 2328699 0 2328699 0 2328699 2643567 0 2643567 0 2643567 PART X, LINE 2: THE CENTER IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AS OTHER THAN A PRIVATE FOUNDATION AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. 1 HOME OF HOPE CANCER WELLNESS CENTERS 1637 PLOCK RD DIXON IL 61021 010743626 501(C)(3) 15375 DONATION TO SUPPORT THE NOT-FOR-PROFIT ORGANIZATION WHO PROVIDES SUPPORT SERVICES TO CANCER PATIENTS 1 PART I, LINE 2: THE GRANT IS FOR A NON-PROFIT ORGANIZATION WHICH PROVIDES INDIVIDUAL EMOTIONAL SERVICES AND VARIOUS SUPPORT GROUPS FOR CANCER PATIENTS IN THE AREA. WE PROVIDE FOUR REGULAR PAYMENTS EACH YEAR. 0 0 0 0 0 0 0 0 0 FORM 990, PART VII, LINE 5 JON BERENS RECEIVED COMPENSATION OF $200,079, RETIREMENT BENEFITS OF $46,344 AND OTHER BENEFITS OF $22,775 FROM CGH MEDICAL CENTER, AN UNRELATED ORGANIZATION, FOR SERVICES AS ADMINISTRATIVE DIRECTOR AND MEDICAL PHYSICIST FOR NORTHERN ILLINOIS CANCER TREATMENT CENTER. FORM 990, PART VII, LINE 5 EDWARD MILES RECEIVED COMPENSATION OF $518,432, RETIREMENT BENEFITS OF $19,250 AND OTHER BENEFITS OF $8,448 FROM CGH MEDICAL CENTER, AN UNRELATED ORGANIZATION, FOR SERVICES AS A RADIATION ONCOLOGIST FOR NORTHERN ILLINOIS CANCER TREATMENT CENTER. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION HAS TWO MEMBERS CGH MEDICAL CENTER AND KATHERINE SHAW BETHEA HOSPITAL FORM 990, PART VI, SECTION A, LINE 7A THE GOVERNING BODY CONSISTS OF 7 DIRECTORS, 3 OF WHICH ARE CHOSEN BY THE BOARD OF DIRECTORS OF CGH MEDICAL CENTER AND 3 OF WHICH ARE CHOSEN BY THE BOARD OF DIRECTORS OF KATHERINE SHAW BETHEA HOSPITAL. THE 7TH DIRECTOR IS ELECTED BY A MAJORITY VOTE OF THE TOTAL COMBINED MEMBERSHIP. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT COPY OF FORM 990 IS PROVIDED TO THE EXECUTIVE DIRECTOR AND THE TREASURER OF THE BOARD TO REVIEW. ONCE APPROVED, THEY MAKE COPIES AVAILABLE TO ALL DIRECTORS OF THE BOARD FOR REVIEW. UPON APPROVAL BY THE BOARD, THE RETURN IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANY POSSIBLE CONFLICT OF INTEREST ON THE PART OF A DIRECTOR SHALL BE DISCLOSED TO THE BOARD. WHEN ANY SUCH INTEREST BECOMES A MATTER OF BOARD ACTION, SUCH DIRECTOR SHALL NOT VOTE OR USE PERSONAL INFLUENCE ON THE MATTER, AND SHALL NOT BE COUNTED IN THE QUORUM FOR A MEETING AT WHICH BOARD ACTION IS TO BE TAKEN ON THE MATTER. THE DIRECTOR MAY, HOWEVER, BRIEFLY STATE A POSITION ON THE MATTER, AND ANSWER PERTINENT QUESTIONS OF BOARD MEMBERS. THE MINUTES OF ALL ACTIONS TAKEN ON SUCH MATTERS SHALL CLEARLY REFLECT THAT THESE REQUIREMENTS HAVE BEEN MET. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 37,024. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 37,024. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 685,253. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 685,253. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 28,215. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,215.