CARLINVILLE AREA HOSPITAL ASSOCATION: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- CARLINVILLE AREA HOSPITAL ASSOCATION (EIN 37-0645239)
- Tax period
- 2015-08-01 to 2016-07-31
- Filed
- 2017-03-13
- IRS object ID
- 201740729349300324
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-03-13T10:19:23-05:00 | ReturnTs |
| Tax Period End | 2016-07-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1545 ASSOCIATES DR STE 101 | AddressLine1Txt |
| City | DUBUQUE | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52002 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-08-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 370645239 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carlinville Area Hospital Association | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CARL | BusinessNameControlTxt |
| Phone | 2178543141 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20733 North Broad Street | AddressLine1Txt |
| City | Carlinville | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62626 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Kenneth Reid | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 2178543141 | PhoneNum |
| Signature | 2017-03-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Carmen Krantz | PreparerPersonNm |
| PTIN | P00031958 | PTIN |
| Phone | 5635561790 | PhoneNum |
| Preparation | 2017-03-09 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Kenneth Reid | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20733 North Broad Street | AddressLine1Txt |
| City | Carlinville | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62626 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $24,677,480 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.cahcare.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1947 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | Provide quality acute and preventative health care benefits | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 211 | TotalEmployeeCnt |
| Total Volunteers | 160 | TotalVolunteersCnt |
| Total Gross UBI | -$14,833 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$14,833 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,203,020 | PYContributionsGrantsAmt |
| CY Contributions Grants | $84,109 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $20,963,459 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $24,359,325 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$258,491 | PYInvestmentIncomeAmt |
| CY Investment Income | $73,199 | CYInvestmentIncomeAmt |
| PY Other Revenue | $23,693 | PYOtherRevenueAmt |
| CY Other Revenue | -$18,421 | CYOtherRevenueAmt |
| PY Total Revenue | $23,931,681 | PYTotalRevenueAmt |
| CY Total Revenue | $24,498,212 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,093,348 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,676,372 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,525,035 | PYOtherExpensesAmt |
| CY Other Expenses | $12,906,492 | CYOtherExpensesAmt |
| PY Total Expenses | $21,618,383 | PYTotalExpensesAmt |
| CY Total Expenses | $23,582,864 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,313,298 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $915,348 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $36,154,486 | TotalAssetsBOYAmt |
| Total Assets EOY | $39,846,388 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $20,507,015 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $23,313,588 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $15,647,471 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,532,800 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | To maintain a professional medical community, a primary care hospital and other health care services, in order to provide quality acute and preventative health care for the benefit of those persons living in the service area. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $18,610,308 | ExpenseAmt |
| Revenue | $24,359,325 | RevenueAmt |
| Desc | Carlinville Area Hospital Association is a 25-bed acute care hospital located in Carlinville, Illinois. The Hospital provides inpatient, outpatient and emergency care services for residents of central Illinois.During fiscal year 2016, we carried out our exempt purpose in the following ways: 1) Provided quality short term acute care medical services to 485 inpatients, of which 82% were eligible for Medicare. Without our services these elderly patients would have had to travel over 20 miles to receive similar services. 2) Provided quality short term skilled care to 218 patients in our swing bed unit, with an average length of stay of 10.3 days. 3) Provided 24 hour a day emergency room services. Our emergency room treated 6,594 patients during fiscal year 2016. We treat everyone who presents themselves to our emergency room regardless of their medical condition or ability to pay. We provided 24 hour physician service so people residing in the Carlinville area do not have to travel long distances for emergency medical care. 4) In addition to the inpatient and emergency services we provide, we also had 22,487 visits in our outpatient departments. These services range from preventative care items such as mammograms and lab tests to rehabilitative services such as Physical and Occupational therapy. 5) The hospital also had 5,862 visits to their specialty clinics. These clinics bring specialists from metropolitan areas to Carlinville on a rotating basis. This provides access to specialty services not otherwise offered in the area. 6) The hospital also had 5,901 visits in our Rural Health Clinics. These clinics allow for patients to stay closer to home and get in to see a medical provider.The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The amounts of charges foregone were $326,000 for the year ended July 31, 2016. The estimated costs of the charges foregone, based upon an overall cost-to-charge ratio calculation, for the year ended July 31, 2016 were $160,000. | Desc |
| Total Program Service Expenses | $18,610,308 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 19 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 211 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Michael Brown | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2178543857 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20733 North Broad Street | AddressLine1Txt |
| City | Carlinville | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62626 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| J Richard Schien | ||||||||
| Chair | 1.00 | 0.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Richard Walden | ||||||||
| Vice Chair | 1.00 | 0.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Ralph March | ||||||||
| Secretary | 1.00 | 0.60 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Dennis Pickrel | ||||||||
| Treasurer | 1.00 | 0.60 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| James Salske | ||||||||
| Member | 1.00 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| Steve Gourley | ||||||||
| Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Tracey Smith | ||||||||
| Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Therese Polo MD | ||||||||
| Ex-officio Member | 41.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Kate Wilkens MD | ||||||||
| Ex-officio Member until 12/31/15 | 41.00 | 0.00 | Yes (X) | $137,944 | $0 | $9,944 | ||
| Elizabeth O'Brien MD | ||||||||
| Ex-officio Member until 12/31/15 | 41.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Kenneth Reid | ||||||||
| CEO | 40.00 | 1.30 | Yes (X) | $0 | $0 | $0 | ||
| Michael Brown | ||||||||
| CFO | 40.00 | 1.30 | Yes (X) | $0 | $0 | $0 | ||
| Curtis Cravens CRNA | ||||||||
| Nurse Anesthesiology | 40.00 | 0.00 | $153,307 | $0 | $13,943 | Yes (X) | ||
| Sara McPeak | ||||||||
| Chief Nurse Executive | 40.00 | 0.00 | $156,827 | $0 | $8,432 | Yes (X) | ||
| Kathleen Laboray PT | ||||||||
| Physical Therapy | 40.00 | 0.00 | $110,240 | $0 | $8,867 | Yes (X) | ||
| Dr Meta Jo Floyd | ||||||||
| Pharmacist | 40.00 | 0.00 | $130,840 | $0 | $4,635 | Yes (X) | ||
| Dr Anne Borwick | ||||||||
| Internal Medicine & Pediatrics | 40.00 | 0.00 | $194,539 | $0 | $4,015 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $883,697 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $49,836 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| The Korte Company | |||||
| 12441 US Highway 40 | Highland | IL | 62249 | General contractor | $4,981,836 |
| Illinois Emergency Physicians | |||||
| 4075 Copper Ridge Drive | Traverse City | MI | 496840793 | Emergency room physicians | $1,503,064 |
| HealthTechS3 | |||||
| PO Box 636426 | Cincinnati | OH | 452636426 | Management services | $310,701 |
| Irgens Partners LLC | |||||
| 618 N Plankinton | Milwaukee | WI | 53203 | Development management | $258,393 |
| Numed Inc | |||||
| PO Box 1098 | Denton | TX | 76202 | Nuclear medicine services | $250,444 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 14 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $16,622 | RelatedOrganizationsAmt |
| Government Grants | $35,783 | GovernmentGrantsAmt |
| All Other Contributions | $31,704 | AllOtherContributionsAmt |
| Total Contributions | $84,109 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 622110 | $23,919,011 | $23,919,011 |
| EHR Medicare incentive | 900099 | $272,925 | $272,925 |
| Supporting revenue | 900099 | $167,389 | $167,389 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $24,359,325 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $73,199 | TotalRevenueColumnAmt |
| Exclusion | $73,199 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $160,847 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $179,268 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$18,421 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$18,421 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | -$14,833 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$3,588 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,498,212 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,359,325 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$14,833 | UnrelatedBusinessRevenueAmt |
| Exclusion | $69,611 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $146,131 | TotalAmt |
| Program Services | $146,131 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,360,039 | TotalAmt |
| Program Services | $6,957,780 | ProgramServicesAmt |
| Management And General | $1,402,259 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $225,465 | TotalAmt |
| Program Services | $187,361 | ProgramServicesAmt |
| Management And General | $38,104 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,337,773 | TotalAmt |
| Program Services | $1,116,908 | ProgramServicesAmt |
| Management And General | $220,865 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $606,964 | TotalAmt |
| Program Services | $506,828 | ProgramServicesAmt |
| Management And General | $100,136 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $782,036 | TotalAmt |
| Management And General | $782,036 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,376 | TotalAmt |
| Management And General | $66,376 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,145 | TotalAmt |
| Management And General | $67,145 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,125,232 | TotalAmt |
| Program Services | $2,818,370 | ProgramServicesAmt |
| Management And General | $306,862 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $325,476 | TotalAmt |
| Management And General | $325,476 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,451,260 | TotalAmt |
| Program Services | $736,640 | ProgramServicesAmt |
| Management And General | $714,620 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $256,683 | TotalAmt |
| Program Services | $256,683 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,683 | TotalAmt |
| Program Services | $11,993 | ProgramServicesAmt |
| Management And General | $5,690 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $90,723 | TotalAmt |
| Program Services | $44,870 | ProgramServicesAmt |
| Management And General | $45,853 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $730,948 | TotalAmt |
| Program Services | $730,948 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,035,412 | TotalAmt |
| Program Services | $2,035,412 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $352,935 | TotalAmt |
| Program Services | $18,981 | ProgramServicesAmt |
| Management And General | $333,954 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Dues and subscriptions | $1,314,415 | $763,923 | $550,492 |
| Medical supplies | $1,298,609 | $1,298,609 | |
| Bad debt expense | $770,223 | $770,223 | |
| Food | $194,400 | $194,400 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,936 | TotalAmt |
| Program Services | $14,248 | ProgramServicesAmt |
| Management And General | $12,688 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,582,864 | TotalAmt |
| Program Services | $18,610,308 | ProgramServicesAmt |
| Management And General | $4,972,556 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,360,218 | BOYAmt |
| EOY | $5,839,603 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,823,744 | BOYAmt |
| EOY | $4,379,695 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $365 | BOYAmt |
| EOY | $7,426 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $188,895 | BOYAmt |
| EOY | $191,814 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $221,381 | BOYAmt |
| EOY | $239,899 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $35,881,384 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,748,806 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,836,361 | BOYAmt |
| EOY | $23,132,578 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,758,265 | BOYAmt |
| EOY | $2,066,025 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,092,996 | BOYAmt |
| EOY | $2,454,633 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,872,261 | BOYAmt |
| EOY | $1,534,715 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,154,486 | BOYAmt |
| EOY | $39,846,388 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,101,257 | BOYAmt |
| EOY | $1,595,459 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $296,664 | BOYAmt |
| EOY | $63,846 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,921,069 | BOYAmt |
| EOY | $19,223,283 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,188,025 | BOYAmt |
| EOY | $2,431,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,507,015 | BOYAmt |
| EOY | $23,313,588 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,974,242 | BOYAmt |
| EOY | $15,889,590 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $673,229 | BOYAmt |
| EOY | $643,210 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,647,471 | BOYAmt |
| EOY | $16,532,800 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,154,486 | BOYAmt |
| EOY | $39,846,388 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $915,348 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$30,019 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $517,172 | OtherCostOrOtherBasisAmt |
| Book Value | $517,172 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,551,127 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,548,434 | DepreciationAmt |
| Book Value | $15,002,693 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,502,034 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,704,224 | DepreciationAmt |
| Book Value | $5,797,810 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,311,051 | OtherCostOrOtherBasisAmt |
| Depreciation | $496,148 | DepreciationAmt |
| Book Value | $1,814,903 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $23,132,578 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Mortgage escrow funds | Desc |
| Book Value | $2,454,633 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $2,454,633 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Employee health claims | $185,000 |
| Estimated third-party payor settlements | $2,246,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,431,000 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $23,883,511 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$770,223 | OtherRevenueAmt |
| Revenue Not Reported | -$770,223 | RevenueNotReportedAmt |
| Revenue Subtotal | $24,653,734 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$155,522 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$155,522 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $24,498,212 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $22,991,909 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $179,268 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $179,268 | ExpensesNotReportedAmt |
| Expenses Subtotal | $22,812,641 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $770,223 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $770,223 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $23,582,864 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | The Hospital is organized as an Illinois nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
| Part XI, Line 2d - Other Adjustments: | Provision for bad debts included in total expenses for Form 990 -770,223. |
| Part XI, Line 4b - Other Adjustments: | Transfer from related party included in fund balance for financial statement 16,622. Contributions for Long-Lived Assets recorded in revenue for Form 990 7,124. Rental expenses recorded in revenue for Form 990 -179,268. |
| Part XII, Line 2d - Other Adjustments: | Rental expenses recorded in revenue for Form 990 179,268. |
| Part XII, Line 4b - Other Adjustments: | Provision for bad debts included in total expenses for Form 990 770,223. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 125.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $160,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $160,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00700 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,988,698 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,731,692 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $257,006 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01130 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,148,698 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,731,692 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $417,006 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01830 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,320,965 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,397,454 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,923,511 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08430 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,320,965 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,397,454 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,923,511 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08430 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,469,663 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,129,146 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,340,517 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10260 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 4110 | PersonsServedCnt |
| Total Community Benefit Expns | $18,636 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $18,636 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 4110 | PersonsServedCnt |
| Total Community Benefit Expns | $18,636 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $18,636 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $770,223 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $157,125 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,293,086 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,369,106 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$76,020 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carlinville Area Hospital Association | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20733 North Broad Street | AddressLine1Txt |
| City | Carlinville | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62626 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.cahcare.com | WebsiteAddressTxt |
| State License | 0005686 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | 2 provider based RHCs and 1 provider based clinic | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carlinville Area Hospital Association | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.cahcare.com/community-outreach/community-health-needs-assessment/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.cahcare.com/community-outreach/community-health-needs-assessment/ | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 125.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.cahcare.com/financial-information/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.cahcare.com/financial-information/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.cahcare.com/financial-information | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Carlinville Area Hospital Association | Part V, Section B, Line 5: Two focus groups were formed for input. Medical professionals and partners and key community leaders were the groups. After the groups met, a prioritization process identified several potential health needs that were chosen for the needs assessment. |
| Carlinville Area Hospital Association | Part V, Section B, Line 11: From the completion of the Community Health Needs Assessment in fiscal year 2016, Carlinville Area Hospital Association identified five areas to work on. 1. Mental Health - the group identified significant access to care issues as a problem due to lack of psychiatrists and counselors in the area. The hospital is exploring options for providing or supporting additional psychiatric care.2. Obesity and Diabetes - Education and local opportunities for recreation and exercise were the main objectives here. The hospital is looking into a walking path around the facility for people to walk and exercise.3. Local Access to Specialists and Specialty Services - the services here were dermatology and oncology services. The hospital is starting an infusion clinic to address the oncology issue. The hospital is also looking to recruit a dermatologist to do an outreach clinic on campus.4. Expanded hours for Primary Care - the issue here is expanded hours to include evenings and possibly weekends. The hospital is looking to expand our rural health clinic to provide these hours.5. Food Security for Youth - in areas outside of Carlinville. The hospital provides food for the summer youth program here in town. This need will have to have additional resources from the surrounding towns. |
| Carlinville Area Hospital Association | Part V, Section B, Line 16i: Financial assistance contact information is provided on each bill. A notice about the availability of charity care is posted in the admitting areas, including the ER. The Hospital also employs a full time financial counselor to discuss the availability of various government services and charity care with patients. |
| Carlinville Area Hospital Association | Part V, Section B, Line 22d: Carlinville Area Hospital has chosen to use the look-back method in order to determine the Amount Generally Billed (AGB). Carlinville Area Hospital calculated the AGB based on all claims allowed by Medicare and private health insurers over a specified 12-month period, divided by the associated gross charges for those claims. This calculation is performed annually and any changes that are made to the AGB percentage will go into effect within 120 days after the end of the 12-month period used in calculating the AGB percentage. |
| Carlinville Area Hospital Association | Part V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 6a: | The annual community benefit report is mailed to 15,000 residents in our service area and can be found on its website at www.cahcare.com. |
| Part I, Line 7: | Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. |
| Part I, Ln 7 Col(f): | The amount of bad debt expense removed from total expenses to determine the percentage was $770,223. |
| Part II, Community Building Activities: | The Lunch Bunch Program provides healthy meals for children from low income households at no cost during the summer when meals are not available through the district. The service ran from June 1 through August 1 and served 1,756 adults and 2,354 children. The total cost to the Hospital was over $14,636.The Third Day Project serves underprivileged children by providing food to children on long weekends from school where they may otherwise not have food available to them. Approximately 50 children from Carlinville Primary School, selected by school administration, are provided with a free healthy sack of food the day prior to long weekends from school. The Hospital Dietary Department orders all the food and helps the group of volunteers inventory the food that goes into the bags. The cost to provide the food bags was over $4,000. |
| Part III, Line 2: | The bad debt expense is only the uncollected portion of the patient account. Any discounts would be treated as a reduction in revenue. All forms of payment, including self-pay, insurance, contractual allowances, and discounts reduce the patient's account prior to the account being classified as bad debt. A payment received on an account previously written off as bad debt reduces bad debt expense. Bad debt expense reported on line 2 is at charges as reported on the financial statements. |
| Part III, Line 3: | The estimated amount of the Organization's bad debt expense attributable to patients eligible under the Organization's charity care policy is calculated based on the percentage of individuals living below the poverty level in 2015. The 20.4% can reasonably be considered a community benefit as it would have been written off to charity care. |
| Part III, Line 4: | The footnote to the Organization's financial statements can be found on page 9 of the attached audited financial statements. |
| Part III, Line 8: | Carlinville Area Hospital Association is a critical access hospital with a Medicare shortfall. The shortfall is due to sequestration. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit.Both the total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. |
| Part III, Line 9b: | Carlinville Area Hospital Association will give the charity care applicant at least 120 days from the date of service to apply for financial assistance without any collection efforts. If the applicant has applied for health care coverage under Medicaid, Kidcare, or other government sponsored health care programs, Carlinville Area Hospital will await the approval or denial of the application without additional collection efforts.Carlinville Area Hospital Association will not refer a bill to collection without first offering the patient the opportunity to request a reasonable payment plan for the amount personally owed by the patient. |
| Part VI, Line 2: | The Hospital works with physicians, the health department, nursing homes and other health care providers in the community to determine the health care needs. A formal community health needs assessment was completed in FY2013 and posted to the Hospital's website to meet one of the 501r requirements. The Hospital completed a second CHNA and Implementation Strategy in FY2016 and both are posted to the Hospital's website. |
| Part VI, Line 3: | Financial assistance contact information is provided on each bill. A notice about the availability of charity care is posted in the admitting areas, including the ER. The Hospital also employs a full time financial counselor to discuss the availability of various government services and charity care with patients. |
| Part VI, Line 4: | Carlinville Area Hospital Association is a 25-bed acute care hospital located in Carlinville, Illinois. The Hospital serves the residents of Macoupin County. Carlinville Area Hospital is the only hospital within a 20 mile radius of Carlinville Illinois, a small rural community in central Illinois. Illinois Route 4 passes through Carlinville. Interstate 55 is also within 12 miles of the city. The community is mostly agricultural.Other hospitals and medical centers near Carlinville are St. Francis Hospital, a Critical Access Hospital in Litchfield, IL, approximately 14 miles away, Community Memorial Hospital, a Critical Access Hospital in Staunton, IL, approximately 20 miles away and Hillsboro Area Hospital, a Critical Access Hospital in Hillsboro, IL, approximately 24 miles away.Carlinville had a population of 5,665 in 2015. Unemployment was 5.7% compared to 5.6% in the state of Illinois in 2016. Carlinville residents with income below the poverty level was 23.6% and residents with income below 50% of the poverty level was 3.7%. |
| Part VI, Line 5: | Carlinville Area Hospital Association's core purpose is "Excellent healthcare close to home." This is very important to our board as all of our members live in our service area and use our facility. The Hospital extends medical staff privileges to all qualified physicians in the community. Carlinville Area Hospital invests in improvements in the community and continues to minimize long-term debt. The Hospital also provides the following services that would not otherwise be available within the Hospital's service area: Twenty-four hour a day emergency room that treats all patients regardless of ability to pay Specialty Clinic - The Hospital has an arrangement with a physician group out of Springfield, IL that brings specialists to the Carlinville Area that would not otherwise be available.Throughout the year, Carlinville Area Hospital offered CPR training to the community for a special rate of $15 per participant.The Hospital provided free blood pressure checks in Carlinville and Palmyra on a monthly basis.Carlinville Area Hospital's Imaging Department hosted a free community presentation in observance of National Breast Cancer Awareness Month in October. Early detection, benefits of digital mammography, and how the advanced technology aids in early detection were discussed.Approximately 16 churches throughout Macoupin County received first aid supply bags from Carlinville Area Hospital. The bags included a pillow, blanket, stethoscope, blood pressure cuff, gloves, disposable washcloths, ice packs, pocket CPR mask, band aids, various dressings, peroxide, alcohol wipes, and cotton balls. These basic supplies were provided to help the churches during services or activities when church members may become ill or injured.Carlinville Area Hospital participated in the Illinois Cooperative Work Study Program. The program offered opportunities for college students to gain hands-on experience in their field of study. The Hospital also served as a clinical site for students in Radiology from Southwestern Illinois College and Pharmacy from St. Louis College of Pharmacy. |
| Part VI, Line 7, Reports Filed With States | IL |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Curtis Cravens CRNA | ||||||||||||||
| Nurse Anesthesiology | $152,602 | $0 | $0 | $0 | $705 | $0 | $6,029 | $0 | $7,914 | $0 | $167,250 | $0 | $0 | $0 |
| Sara McPeak | ||||||||||||||
| Chief Nurse Executive | $155,893 | $0 | $0 | $0 | $934 | $0 | $6,122 | $0 | $2,310 | $0 | $165,259 | $0 | $0 | $0 |
| Dr Anne Borwick | ||||||||||||||
| Internal Medicine & Pediatrics | $194,226 | $0 | $0 | $0 | $313 | $0 | $0 | $0 | $4,015 | $0 | $198,554 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule J, Part I, Question 3: | FormAndLineReferenceDesc |
| Explanation | Carlinville Area Hospital Association does not pay compensation to the CEO directly. The CEO is compensated by an unrelated management company, HealthTech S3. The Hospital Board of Directors uses the processes described in Part I, Question 3 to determine appropriate compensation for the CEO. The Board of Directors also approves the Organization's contract with the Management Company. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 2 | The hospital completed a 28,000 medical office building and opened it on November 1, 2015. The building allowed the hospital to expand therapy services, offer a community room for the public to hold meetings and expanded the hospital rural health clinic. The larger clinic has allowed additional medical providers to the community. |
| Form 990, Part VI, Section A, line 1 | The Executive Committee is composed of the elected officers of the Board and includes the Chairman, Vice Chairman, Secretary, and Treasurer of the Association. The Executive Committee has the power and authority to manage and control the business and affairs of the Association as the Board of Directors; however, the Executive Committee is not allowed to exercise those powers prohibited by Illinois law which include: amending the Articles or Bylaws; sell, transfer, or otherwise dispose of substantially all of the Association's assets; or adopt Articles of Merger or Consolidation. |
| Form 990, Part VI, Section A, line 2 | J. Richard Schien, Chair, and Richard Walden, Vice Chair, have a business relationship. James Salske, board member, and Richard Walden, Vice Chair have a business relationship. |
| Form 990, Part VI, Section A, line 3 | Kenneth Reid, CEO, and Michael Brown, CFO, are common law employees of HealthTech S3, an unrelated management company. The CEO has the responsibility of supervising the management, administration and operation of the Organization. The CFO has the responsibility for managing the Organization's finances. Kenneth Reid was compensated $230,857 for services to Carlinville Area Hospital Association. Michael Brown was compensated $153,673 for services to Carlinville Area Hospital Association. |
| Form 990, Part VI, Section A, line 6 | The Organization's sole member is Middle Macoupin Health Care Systems. |
| Form 990, Part VI, Section A, line 7a | The Member has the exclusive right and power to designate three of its Directors to serve as members of the Board of Directors, and by resolution has authority to appoint and remove all Directors from the Board. |
| Form 990, Part VI, Section A, line 7b | The Member has the exclusive right and power to approve or reject the following actions prior to the Board of Directors taking any action: 1. the annual operating budget, capital budget, long-range plan and any action which will result in a substantial change in the expenditures or revenue forecast; 2. the undertaking of or substantive amendments to a contractual obligation in excess of $50,000, or the guaranteeing of any obligation in excess of $50,000; 3. the purchase, lease, transfer, mortgage or sale of any asset or property with a value in excess of $50,000, except with respect to transactions specified and previously approved within the capital budget; 4. any plan of construction or remodeling involving an expenditure in excess of $50,000, except with respect to transactions specified and previously approved within the capital budget; 5. any borrowing; 6. any application for a government grant; 7. any general plan for the solicitation of charitable contributions or the solicitation or acceptance as a gift of any real property or any interest; 8. any proposal to adopt Articles of Dissolution, Merger, or Consolidation; 9. any selection, removal or change in the compensation or other terms of employment of the operating officers; 10. any substantial change in employee fringe benefits or personnel policies; and 11. any other matters as may be required by law to be submitted to the Member or as to which the Member determines, by resolution, that submission is advisable. |
| Form 990, Part VI, Section B, line 11 | The Form 990 is distributed to the governing body before it is filed. The CEO and CFO review the Form 990. |
| Form 990, Part VI, Section B, line 12c | Any duality of interest or possible conflict of interest on the part of any Board member should be disclosed to the other members of the Board and made a matter of record through an annual procedure and also when the interest becomes a matter of Board action. Any Board member having a duality of interest or possible conflict of interest on any matter should not vote or use his or her personal influence on the matter. The minutes of the meeting must reflect the disclosure, the abstention from voting, and the quorum situation. Any new member of the Board will be advised of this policy upon entering on the duties of office. The governing Board, CEO, and CFO complete and sign the conflict of interest form yearly. The forms are reviewed by the CEO of the Organization and if a potential conflict is identified the CEO follows up. |
| Form 990, Part VI, Section B, line 15 | The CEO and CFO are compensated through HealthTechS3, an unrelated management company. They are considered common law employees of the management company. HealthTechS3 gives the Board of Directors a recommended salary range for the CEO and CFO and the Board sets the compensation within this range after review of performance evaluations and comparability data. The process is documented and is completed on an annual basis. |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents, conflict of interest policy, and financial statements are not available to the public. Financial information is available through the public disclosure copy of the 990. |
| Form 990, Part IX, line 11g | Repairs and maintenance: Program service expenses 15,807. Management and general expenses 6,200. Fundraising expenses 0. Total expenses 22,007. Purchased services and contract labor: Program service expenses 1,773,531. Management and general expenses 58,003. Fundraising expenses 0. Total expenses 1,831,534. Professional fees: Program service expenses 1,029,032. Management and general expenses 242,659. Fundraising expenses 0. Total expenses 1,271,691. |
| Form 990, Part XI, line 9: | Change in beneficial interest in perpetual trust -30,019. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Carlinville Area Hospital Foundation | |||||||||||
| 20733 North Broad Street | Carlinville | IL | 62626 | 371193348 | Support Carlinville Area Hospital Association | IL | 501(c)(3) | Line 11a, I | Middle Macoupin Healthcare Systems | 0 | |
| Middle Macoupin Healthcare Systems | |||||||||||
| 20733 North Broad Street | Carlinville | IL | 62626 | 371193396 | Provide support and benefit Carlinville Area Hospital Association | IL | 501(c)(3) | Line 11c, III-FI | 0 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |