CARLINVILLE AREA HOSPITAL ASSOCATION: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- CARLINVILLE AREA HOSPITAL ASSOCATION (EIN 37-0645239)
- Tax period
- 2010-08-01 to 2011-07-31
- Filed
- 2012-06-01
- IRS object ID
- 201201539349300515
- Schema version
- 2010v3.4
- 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) |
|---|---|---|
| Timestamp | 2012-06-01T13:51:02-05:00 | Timestamp |
| Tax Period End Date | 2011-07-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3999 PENNSYLVANIA AVE SUITE 100 | AddressLine1 |
| City | DUBUQUE | City |
| State | IA | State |
| ZIP Code | 52002 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-08-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 370645239 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARLINVILLE AREA HOSPITAL ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CARL | NameControl |
| Phone | 2178543141 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20733 NORTH BROAD STREET | AddressLine1 |
| City | CARLINVILLE | City |
| State | IL | State |
| ZIP Code | 62626 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KENNETH REID | Name |
| Title | CEO | Title |
| Phone | 2178543141 | Phone |
| Date Signed | 2012-05-08 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CARMEN KRANTZ | Name |
| Phone | 5635561790 | Phone |
| Date Prepared | 2012-04-23 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | KENNETH REID | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20733 NORTH BROAD STREET | AddressLine1 |
| City | CARLINVILLE | City |
| State | IL | State |
| ZIP Code | 62626 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 21404531 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CAHCARE.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1947 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | PROVIDE QUALITY ACUTE AND PREVENTATIVE HEALTH CARE BENEFITS | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 202 | TotalNbrEmployees |
| Total Nbr Volunteers | 7 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 5169276 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1941015 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 14891049 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 19257118 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 53184 | InvestmentIncomePriorYear |
| Investment Income Current Year | -220898 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 58376 | OtherRevenuePriorYear |
| Other Revenue Current Year | 56895 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 20171885 | TotalRevenuePriorYear |
| Total Revenue Current Year | 21034130 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 250 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 7201608 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 7761222 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 7051117 | OtherExpensePriorYear |
| Other Expenses Current Year | 12147286 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 14252975 | TotalExpensesPriorYear |
| Total Expenses Current Year | 19908508 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 5918910 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1125622 | RevenuesLessExpensesCY |
| Total Assets BOY | 36167440 | TotalAssetsBOY |
| Total Assets EOY | 33277325 | TotalAssetsEOY |
| Total Liabilities BOY | 24415448 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 20342066 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 11751992 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 12935259 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 16867468 | Expense |
| Revenue | 19257118 | Revenue |
| Description | DURING FISCAL YEAR 2011, WE CARRIED OUT OUR EXEMPT PURPOSE IN THE FOLLOWING WAYS: 1) PROVIDED QUALITY SHORT TERM ACUTE CARE MEDICAL SERVICES TO 573 INPATIENTS, OF WHICH 79% 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 188 PATIENTS IN OUR SWING BED UNIT, WITH AN AVERAGE LENGTH OF STAY OF 9.0 DAYS. 3) PROVIDED 24 HOUR A DAY EMERGENCY ROOM SERVICES. OUR EMERGENCY ROOM TREATED 6,692 PATIENTS DURING FISCAL YEAR 2011. 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 THE RESIDENCY OF 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 21,349 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 5,812 VISITS TO THEIR SPECIALTY CLINICS. THESE CLINICS BRING SPECIALIST FROM METROPOLITAN AREAS TO CARLINVILLE ON A ROTATING BASIS. THIS PROVIDES ACCESS TO SPECIALTY SERVICES NOT OTHERWISE OFFERED IN THE AREA. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. THE AMOUNTS OF CHARGES FOREGONE WERE $556,288 FOR THE YEAR ENDED JULY 31, 2011. THE ESTIMATED COSTS OF THE CHARGES FOREGONE, BASED UPON AN OVERALL COST-TO-CHARGE RATIO CALCULATION, FOR THE YEAR ENDED JULY 31, 2011 WERE $299,000.IN ADDITION, THE HOSPITAL PROVIDES SERVICES TO OTHER MEDICALLY INDIGENT PATIENTS UNDER CERTAIN GOVERNMENT-REIMBURSED PUBLIC AID PROGRAMS. SUCH PROGRAMS PAY PROVIDERS AMOUNTS WHICH ARE LESS THAN ESTABLISHED CHARGES FOR THE SERVICES PROVIDED TO THE RECIPIENTS, AND FOR SOME SERVICES THE PAYMENTS ARE LESS THAN THE COST OF RENDERING THE SERVICES PROVIDED.THE HOSPITAL ALSO COMMITS SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND CRITICAL SERVICES WHICH MEET OTHERWISE UNFULFILLED COMMUNITY NEEDS. MANY OF THESE ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE SELF-SUPPORTING OR FINANCIALLY VIABLE. | Description |
| Total Program Service Expense | 16867468 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 35 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 202 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRIAN ENGELKE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2178543851 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20733 NORTH BROAD STREET | AddressLine1 |
| City | CARLINVILLE | City |
| State | IL | State |
| ZIP Code | 62626 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| J RICHARD SCHIEN | |||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| JAMES SALSKE | |||||||
| VICE CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| RALPH MARCH | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| SHIRLEY BOENTE | |||||||
| SECRETARY - PARTIAL YEAR | 1.00 | X | X | 0 | 0 | 0 | |
| PHILIP WILLIAMS | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| STEVE GOURLEY | |||||||
| MEMBER | 0.50 | X | 0 | 0 | 0 | ||
| TRACEY SMITH | |||||||
| MEMBER | 0.50 | X | 0 | 0 | 0 | ||
| RICHARD WALDEN | |||||||
| MEMBER | 0.50 | X | 0 | 0 | 0 | ||
| KENNETH REID | |||||||
| CEO | 40.00 | X | 0 | 0 | 0 | ||
| GREG WARD | |||||||
| CFO | 40.00 | X | 0 | 0 | 0 | ||
| JON ANDERSEN DO | |||||||
| PHYSICIAN | 40.00 | 272528 | 0 | 16182 | X | ||
| CURTIS CRAVENS | |||||||
| CRNA | 40.00 | 190415 | 0 | 21155 | X | ||
| CAROL BENNING | |||||||
| DIRECTOR OF PHARMACY | 40.00 | 109109 | 0 | 15023 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 572052 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 52360 | TotalOtherCompensation |
| Number Individuals GT100 K | 5 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ILLINOIS EMERGENCY PHYSICIANS | |||||
| 4075 COPPER RIDGE DRIVE | TRAVERSE CITY | MI | 496840793 | EMERGENCY ROOM PHYSICIANS | 1331449 |
| HEALTHTECH MANAGEMENT SERVICES INC | |||||
| PO BOX 636426 | CINCINNATI | OH | 452636426 | MANAGEMENT SERVICES | 676122 |
| ALBERICI CONSTRUCTORS | |||||
| 800 PAGE AVENUE | ST LOUIS | MO | 631146106 | CONSTRUCTION | 279372 |
| CPSI | |||||
| 6600 WALL ST | MOBILE | AL | 36695 | INFORMATION TECHNOLOGY SERVICES | 175097 |
| PRECISE SPECIALTIES | |||||
| PO BOX 572 | HILLSBORO | IL | 62049 | RADIOLOGY SERVICES | 123695 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Related Organizations | 1876157 | RelatedOrganizations |
| Government Grants | 39342 | GovernmentGrants |
| All Other Contributions | 25516 | AllOtherContributions |
| Total Contributions | 1941015 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE REVENU | 622110 | 18750681 | 18750681 |
| CLINIC REVENUE | 621110 | 400419 | 400419 |
| SUPPORTING REVENUE | 900099 | 106018 | 106018 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 19257118 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 91078 | TotalRevenueColumn |
| Exclusion | $91,078 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 56895 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 56895 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 56895 | TotalRevenueColumn |
| Exclusion | $56,895 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 58425 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 370401 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -311976 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -311976 | TotalRevenueColumn |
| Exclusion | -$311,976 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 21034130 | TotalRevenueColumn |
| Related Or Exempt Function Income | 19257118 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | -$164,003 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6353885 | Total |
| Program Services | 5306139 | ProgramServices |
| Management And General | 1047746 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 186562 | Total |
| Program Services | 155798 | ProgramServices |
| Management And General | 30764 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 765604 | Total |
| Program Services | 639356 | ProgramServices |
| Management And General | 126248 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 455171 | Total |
| Program Services | 374114 | ProgramServices |
| Management And General | 81057 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 680494 | Total |
| Management And General | 680494 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56588 | Total |
| Management And General | 56588 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58260 | Total |
| Management And General | 58260 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2755513 | Total |
| Program Services | 2625934 | ProgramServices |
| Management And General | 129579 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 107188 | Total |
| Management And General | 107188 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3017983 | Total |
| Program Services | 2539697 | ProgramServices |
| Management And General | 478286 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2108 | Total |
| Management And General | 2108 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 393932 | Total |
| Program Services | 396408 | ProgramServices |
| Management And General | -2476 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18714 | Total |
| Program Services | 7007 | ProgramServices |
| Management And General | 11707 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 70728 | Total |
| Program Services | 25429 | ProgramServices |
| Management And General | 45299 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1563171 | Total |
| Program Services | 1563171 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2043145 | Total |
| Program Services | 2043145 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 165937 | Total |
| Program Services | 1712 | ProgramServices |
| Management And General | 164225 | ManagementAndGeneral |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | BAD DEBT EXPENSE | Description |
| Total | 1178131 | Total |
| Program Services | 1178131 | ProgramServices |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35394 | Total |
| Program Services | 11427 | ProgramServices |
| Management And General | 23967 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19908508 | Total |
| Program Services | 16867468 | ProgramServices |
| Management And General | 3041040 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4769595 | BOY |
| EOY | 3314708 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1922228 | BOY |
| EOY | 2908720 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 193250 | BOY |
| EOY | 209967 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 165548 | BOY |
| EOY | 171970 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 27084616 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 3061375 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28186787 | BOY |
| EOY | 24023241 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 348714 | BOY |
| EOY | 643031 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 444510 | BOY |
| EOY | 502155 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 136808 | BOY |
| EOY | 1503533 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36167440 | BOY |
| EOY | 33277325 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2001815 | BOY |
| EOY | 1206108 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 129112 | BOY |
| EOY | 63338 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17610145 | BOY |
| EOY | 18941235 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4674376 | BOY |
| EOY | 131385 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24415448 | BOY |
| EOY | 20342066 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8551780 | BOY |
| EOY | 12353104 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2675702 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 524510 | BOY |
| EOY | 582155 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11751992 | BOY |
| EOY | 12935259 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36167440 | BOY |
| EOY | 33277325 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1125622 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 57645 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 524510 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 57645 | InvestmentEarningsOrLosses |
| End Of Year Balance | 582155 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 492838 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 31672 | InvestmentEarningsOrLosses |
| End Of Year Balance | 524510 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 570417 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -77579 | InvestmentEarningsOrLosses |
| End Of Year Balance | 492838 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.00000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 602527 | OtherCostOrOtherBasis |
| Book Value | 602527 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 20446181 | OtherCostOrOtherBasis |
| Depreciation | 1900725 | Depreciation |
| Book Value | 18545456 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4662299 | OtherCostOrOtherBasis |
| Depreciation | 1047562 | Depreciation |
| Book Value | 3614737 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1373609 | OtherCostOrOtherBasis |
| Depreciation | 113088 | Depreciation |
| Book Value | 1260521 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 24023241 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| EMPLOYEE HEALTH CLAIMS | $93,091 |
| CAPITALIZED LEASE OBLIGATION | $38,294 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 131385 | TotalOfAmounts |
| Total Revenue | 21034130 | TotalRevenue |
| Total Expenses | 19908508 | TotalExpenses |
| Excess Or Deficit For Year | 1125622 | ExcessOrDeficitForYear |
| Other | $57,645 | OtherAmount |
| Total Adjustments | 57645 | TotalAdjustments |
| Excess Or Deficit Per FS | 1183267 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 19317971 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 19317971 | RevenueSubtotal |
| Other Revenues Not Included | 1716159 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 1716159 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 21034130 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 19908508 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 19908508 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 19908508 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | $80,000 IS IN THE POSSESSION OF THE ORGANIZATION FOR HOSPICE CARE. $502,155 IS A BENEFICIAL INTEREST IN A TRUST NOT IN THE POSSESSION OF THE ORGANIZATION AND REPRESENTS CONTRIBUTIONS RECEIVED, WHICH ARE PERMANENTLY RESTRICTED. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | 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 8 - OTHER ADJUSTMENTS: | CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST 57,645. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | FOUNDATION TRANSFER RECORDED AS CONTRIBUTION ON FORM 990 1,716,159. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 299000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 299000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01600 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2029574 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1307844 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 721730 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03850 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2328574 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1307844 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1020730 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05450 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1071 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1071 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 448036 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 176772 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 271264 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01450 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 494 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 494 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 449601 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 176772 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 272829 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01460 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2778175 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1484616 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1293559 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06910 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 200 | PersonsServed |
| Total Community Building Expense | 2030 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2030 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 600 | PersonsServed |
| Total Community Building Expense | 266 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 266 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 14 | PersonsServed |
| Total Community Building Expense | 119 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 119 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 814 | PersonsServed |
| Total Community Building Expense | 2415 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2415 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $571,151 | BadDebtExpenseAmount |
| Amount Attributable To | 9298 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 9919323 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 9821110 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 98213 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARLINVILLE AREA HOSPITAL ASSOCIATION | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20733 NORTH BROAD STREET | AddressLine1 |
| City | CARLINVILLE | City |
| State | IL | State |
| ZIP Code | 62626 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NOT REQUIRED | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAH OUTPATIENT SPECIALTY CLINIC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20733 NORTH BROAD STREET | AddressLine1 |
| City | CARLINVILLE | City |
| State | IL | State |
| ZIP Code | 62626 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | SPECIALTY CLINIC | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 6A: THE ANNUAL COMMUNITY BENEFIT REPORT IS MAILED TO 15,000 RESIDENTS IN OUR SERVICE AREA. | ||
| 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. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, HEALTH PROFESSIONS EDUCATION, LINE 7F, AND CASH AND IN-KIND CONTRIBUTIONS, LINE 7I ARE REPORTED BASED ON ACTUAL EXPENSE AND REVENUE AMOUNTS RECORDED FROM THE EVENTS IN THE GENERAL LEDGER. THE COST FOR SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. | ||
| PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES TO DETERMINE THE PERCENTAGE WAS $1,178,131. | ||
| PART II: CARLINVILLE AREA HOSPITAL WAS INVOLVED IN SEVERAL COMMUNITY BUILDING ACTIVITIES THIS YEAR. WE PARTICIPATED IN THE MACOUPIN ECONOMIC DEVELOPMENT PARTNERSHIP. WORKED WITH THE LOCAL COLLEGE IN PROVIDING MOCK INTERVIEWS TO HELP LOCAL STUDENTS SHARPEN THEIR INTERVIEW SKILLS AND BETTER THEIR CHANCES OF GETTING QUALITY JOBS. BY WORKING WITH THESE OTHER GROUPS, WE HOPE TO IMPROVE THE OVERALL ECONOMIC CONDITION OF OUR SERVICES AREA. WE BELIEVE THAT THE ECONOMIC CONDITIONS OF A COMMUNITY HAVE A DIRECT EFFECT ON THE HEALTH OF A COMMUNITY. | ||
| PART III, LINE 4: THE ORGANIZATION'S BAD DEBT EXPENSE WAS CONVERTED TO COST USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. THE BAD DEBT EXPENSE DOES NOT INCLUDE CHARITY CARE WRITE OFFS. PATIENTS THAT ARE ELIGIBLE FOR CHARITY CARE ARE WRITTEN OFF AS A REDUCTION IN REVENUE. 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. 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 AN ESTIMATE OF CHARGES FOREGONE TO GROSS PATIENT CHARGES.FINANCIAL STATEMENT FOOTNOTE: THE CARRYING AMOUNT OF PATIENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS AND THIRD-PARTY PAYORS. MANAGEMENT REVIEWS PATIENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS DUE TO BAD DEBTS. MANAGEMENT CONSIDERS HISTORICAL WRITE OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION. MANAGEMENT ALSO REVIEWS ACCOUNTS TO DETERMINE IF CLASSIFICATION AS CHARITY CARE IS APPROPRIATE. | ||
| PART III, LINE 8: BOTH THE TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. | ||
| PART III, LINE 9B: CARLINVILLE AREA HOSPITAL ASSOCIATION WILL GIVE THE CHARITY CARE APPLICANT AT LEAST 60 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. SUCH AN OPPORTUNITY SHALL BE MADE AVAILABLE FOR THE 30 DAYS FOLLOWING THE DATE OF THE INITIAL BILL. IF THE PATIENT REQUESTS A REASONABLE PAYMENT PLAN, BUT FAILS TO AGREE TO A PLAN WITHIN 30 DAYS OF THE REQUEST THE HOSPITAL MAY PROCEED WITH COLLECTION ACTION AGAINST THE PATIENT.NO COLLECTION EFFORTS WILL BE PURSUED IF THE UNINSURED PATIENT HAS AGREED TO A REASONABLE PAYMENT PLAN AND THE PATIENT KEEPS TO THE AGREEMENT. IF THE PATIENT FAILS TO MAKE THE PAYMENTS AGREED UPON, REGULAR COLLECTION EFFORTS WILL BE PURSUED.CARLINVILLE AREA HOSPITAL ASSOCIATION WILL NOT PURSUE LEGAL ACTION FOR NON-PAYMENT OF A HOSPITAL BILL AGAINST UNINSURED PATIENTS WHO HAVE CLEARLY DEMONSTRATED THAT THEY HAVE NEITHER SUFFICIENT INCOME NOR ASSETS TO MEET THEIR FINANCIAL OBLIGATIONS. | ||
| 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. THE HOSPITAL ALSO FORMED A PARTNERSHIP WITH ILLINOIS EMERGENCY PHYSICIANS, LLP. THE PHYSICIANS OF THE PARTNERSHIP SERVE IN A DUAL ROLE AT CARLINVILLE AREA HOSPITAL. THEY HAVE IMPROVED THE SERVICE IN THE GROWING EMERGENCY DEPARTMENT, AND ACT AS HOSPITALIST PHYSICIANS. THIS MEANS THEY CAN ADMIT AND CARE FOR PATIENTS WHO DO NOT HAVE A PHYSICIAN THAT REGULARLY ADMITS PATIENTS TO THE HOSPITAL. SOME OF THE STAFF PHYSICIANS AT CARLINVILLE AREA HOSPITAL MAY ALSO ELECT TO USE THE PHYSICIANS IN THE PARTNERSHIP TO ASSIST IN MANAGING THE CARE OF THEIR OWN ADMITTED PATIENTS. | ||
| PART VI, LINE 3: THE FULL CHARITY CARE POLICY IS POSTED ON THE HOSPITAL'S WEB SITE. 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 EMPLOYEES 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.CARLINVILLE HAD A POPULATION OF 5,912 IN JULY 2009 WITH AN ESTIMATED MEDIAN HOUSEHOLD INCOME OF $42,489. CARLINVILLE RESIDENTS WITH INCOME BELOW THE POVERTY LEVEL IN 2009 WAS 12.5% AND RESIDENTS WITH INCOME BELOW 50% OF THE POVERTY LEVEL WAS 3.1%. | ||
| PART VI, LINE 6: 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. DURING THIS FISCAL YEAR CARLINVILLE AREA HOSPITAL FINISHED CONSTRUCTION OF NEW HOSPITAL. THE NEW FACILITY REPLACES A STRUCTURE THAT WAS BUILT IN THE 1950S AND WAS NO LONGER MEETING HEALTH SAFETY CODES. 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 $12 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. | ||
| IL | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JON ANDERSEN DO | |||||||||||||
| 270000 | 0 | 0 | 0 | 2528 | 0 | 9450 | 0 | 7222 | 0 | 289200 | 0 | 0 | 0 |
| CURTIS CRAVENS | |||||||||||||
| 187836 | 0 | 0 | 0 | 2579 | 0 | 11221 | 0 | 10261 | 0 | 211897 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | PART I, QUESTION 3: CARLINVILLE AREA HOSPITAL ASSOCIATION DOES NOT PAY COMPENSATION TO THE CEO DIRECTLY. THE CEO IS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY, HEALTHTECH MANAGEMENT SERVICES, INC. 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. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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, PRESIDENT, SECRETARY AND TREASURER OF THE ASSOCIATION. THE EXECUTIVE COMMITTEE HAS POWER AND AUTHORITY TO MANAGE AND CONTROL THE BUSINESS AND AFFAIRS OF THE ASSOCIATION AS THE BOARD OF DIRECTORS DETERMINES. HOWEVER, IN NO EVENT SHOULD THE EXECUTIVE COMMITTEE EXERCISE THOSE POWERS PROHIBITED BY ILLINOIS LAW WHICH INCLUDE AMONG OTHERS: TO AMEND THE ASSOCIATION'S ARTICLES OF INCORPORATION OR BYLAWS; TO SELL, TRANSFER OR OTHERWISE DISPOSE OF SUBSTANTIALLY ALL OF THE ASSOCIATION'S ASSETS; OR TO ADOPT ARTICLES OF MERGER OR CONSOLIDATION. | |
| FORM 990, PART VI, SECTION A, LINE 2 | J. RICHARD SCHIEN, CHAIRMAN, AND RICHARD WALDEN, BOARD MEMBER HAVE A BUSINESS RELATIONSHIP. JAMES SALSKE, VICE CHAIRMAN, AND RICHARD WALDEN, BOARD MEMBER HAVE A BUSINESS RELATIONSHIP. | |
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION'S CEO AND CFO ARE EMPLOYEES OF HEALTHTECH MANAGEMENT SERVICES, INC., AN UNRELATED MANAGEMENT COMPANY. | |
| 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 A MEMBER OF THE BOARD OF DIRECTORS, AND BY RESOLUTION TO APPOINT ALL SUCH DIRECTORS OR TO REMOVE THEM FROM THE BOARD OF DIRECTORS. | |
| 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, CFO AND DIRECTOR OF FINANCE REVIEW THE FORM 990. | |
| 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 12C | |
| THE CEO AND CFO ARE COMPENSATED THROUGH HEALTHTECH MANAGEMENT SERVICES, INC., AN UNRELATED MANAGEMENT COMPANY. THEY ARE CONSIDERED COMMON LAW EMPLOYEES OF HEALTHTECH MANAGEMENT SERVICES, INC. HEALTHTECH MANAGEMENT SERVICES, INC. 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. THE LAST COMPLETION WAS IN FY 2011. | FORM 990, PART VI, SECTION B, LINE 15 | |
| 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 VI, SECTION C, LINE 19 | |
| THE FOLLOWING INDIVIDUALS DEVOTED TIME PROVIDING SERVICES TO THE FOLLOWING RELATED ORGANIZATIONS. CARLINVILLE AREA HOSPITAL FOUNDATION KENNETH REID, CEO 1 HOUR PER WEEK GREG WARD, CFO 1 HOUR PER WEEK RICHARD WALDEN .5 HOURS PER WEEK RALPH MARCH .3 HOURS PER WEEK MIDDLE MACOUPIN HEALTHCARE SYSTEMS KENNETH REID .25 HOURS PER WEEK GREG WARD .25 HOURS PER WEEK RICHARD WALDEN .25 HOURS PER WEEK J. RICHARD SCHIEN .25 HOURS PER WEEK JAMES SALSKE .25 HOURS PER WEEK SHIRLEY BOENTE .25 HOURS PER WEEK PHILIP WILLIAMS .25 HOURS PER WEEK RALPH MARCH .25 HOURS PER WEEK | FORM 990, PART VII, SECTION A: | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST 57,645. TOTAL TO FORM 990, PART XI, LINE 5: 57,645. | FORM 990, PART XI, LINE 5: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 11A, I | 0 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |