2018-09-14T14:42:31-05:00 2018-04-30 363168081 SIKICH LLP 13400 BISHOPS LANE SUITE 300 BROOKFIELD WI 53005 990 2017-05-01 363572331 NORTHERN ILLINOIS CANCER TREATMENT CENTER NORT 8152841111 327 IL ROUTE 2 DIXON IL 61021 CYNTHIA ZANDER TREASURER 8152841111 2018-08-29 1 JILL M BOYLE CPA P01246734 2627549400 2018-08-28 2017 2022-09-23 18:48:47Z DIRK MEMINGER 327 IL ROUTE 2 DIXON IL 61021 2448140 0 X WWW.NICANCER.COM X 1988 IL OPERATE A CANCER CENTER WITH HIGHLY SOPHISTICATED DIAGNOSTIC AND TREATEMENT PROCEDURES. 7 7 0 7 0 0 381 8165 2262284 2430191 7480 9427 8079 357 2278224 2448140 12375 19285 0 0 0 0 0 0 0 2899396 2713007 2911771 2732292 -633547 -284152 8336385 8068973 146622 163362 8189763 7905611 TO OPERATE A CANCER CENTER WHICH WILL ENCOMPASS HIGHLY SOPHISTICATED & EXPENSIVE DIAGNOSTIC & TREATMENT PROCEDURES IN ORDER TO CARRY OUT CANCER TREATMENT & RESEARCH. 0 0 2597187 19285 2430191 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. 2597187 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 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 TOM GEHLBACH MD BOARD MEMBER 2.00 X 0 0 0 COLLEEN HENKEL BOARD MEMBER 2.00 X 0 0 0 THOMAS MCGLONE MD BOARD MEMBER 2.00 X 0 0 0 ANDY MOORE BOARD MEMBER 2.00 X 0 0 0 DIRK MEMINGER CHAIRMAN 4.00 X X 0 0 0 KEVIN MARX SECRETARY 4.00 X X 0 0 0 CYNTHIA ZANDER TREASURER 4.00 X X 0 0 0 JON BERENS ADMINISTRATIVE DIRECTOR 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 1255350 VARIAN MEDICAL SYSTEMS INC 70140 NETWORK PLACE CHICAGO IL 60673 HARDWARE / SOFTWARE SUPPORT SERVICES 360168 2 8165 8165 PATIENT TREATMENT REVE 621400 2430191 2430191 2430191 9427 9427 OTHER REVENUE 900099 357 357 357 2448140 2430191 0 9784 X 19285 19285 872637 774251 98386 2572 2572 614403 614403 85011 85011 10134 10134 66192 66192 506299 503550 2749 7360 7360 446465 437544 8921 83096 83096 MEDICAL SUPPLIES 8498 8498 DUES AND SUBSCRIPTIONS 4983 4983 BAD DEBT 3506 3506 ALL OTHER EXPENSES 719 719 1132 1132 2732292 2597187 135105 0 500 500 1799638 2284103 393647 328701 151983 171054 11256183 5971568 5590617 5284615 400000 0 8336385 8068973 44200 50217 102422 113145 146622 163362 X 8189763 7905611 8189763 7905611 8336385 8068973 -284152 0 X 0 1 X 1 0 X 100 4027 4565 381 8165 17238 3804531 3538009 2938778 2262284 2430191 14973793 414 12035 14065 8079 357 34950 3805045 3554071 2957408 2270744 2438713 15025981 0 0 0 15025981 8944 9779 8842 7480 9427 44472 8944 9779 8842 7480 9427 44472 3813989 3563850 2966250 2278224 2448140 15070453 0.99700 0.99680 0.00300 0.00320 X 25115 25115 6663853 1934828 4729025 4455638 3928718 526920 111577 108022 3555 5284615 DUE TO CGH MEDICAL CENTER 113145 113145 X 2448140 0 2448140 0 2448140 2732292 0 2732292 0 2732292 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) 19285 DONATION TO SUPPORT THE NON-FOR-PROFIT ORGANIZATION WHO PROVIDE 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 $195,102, RETIREMENT BENEFITS OF BENEFITS OF $45,889 AND OTHER BENEFITS OF $22,776 FROM CGH MEDICAL CENTER, AN UNRELATED ORGANIZATION, FOR SERVICES AS ADMINISTRATIVE DIRECTOR AND MEDICAL PHYSICIST FOR NORTHERN ILLINOIS CANCER TREATMENT CENTER. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION HAS TWO MEMBERS CHG 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 BOARDS 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. ANY POSSIBLE CONFLICT OF INTEREST ON THE PART OF A DIRECTOR SHALL BE DISCLOSED TO THE BOARD. WHEN ANY SUCH INTERST 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. 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 CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 535,192. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 535,192. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 40,169. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,169. BILLING AND COLLECTIONS FEES: PROGRAM SERVICE EXPENSES 3,528. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,528. CONSULTING EXPENSE: PROGRAM SERVICE EXPENSES 7,500. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,500. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 28,014. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,014.