JANE ADDAMS COMMUNITY MENTAL HEALTH CENTER: Form 990, tax year 2023

View the entire original 990 at ProPublica ↗

Organization
JANE ADDAMS COMMUNITY MENTAL HEALTH CENTER (EIN 36-2879689)
Tax period
2023-01-01 to 2023-12-31
Filed
2024-11-20
IRS object ID
202433259349300508
Schema version
2023v5.1
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

FieldValueIRS element (for citing)
Return2024-11-20T07:44:47-06:00ReturnTs
Tax Period End2023-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2023-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN362879689EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JANE ADDAMS INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlJANEBusinessNameControlTxt
Phone8155996209PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11045 WEST STEPHENSON STREETAddressLine1Txt
CityFREEPORTCityNm
State AbbreviationILStateAbbreviationCd
ZIP61032ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMICHAEL C CLARKPersonNm
Person TitleCHIEF FINANCIAL OFFICERPersonTitleTxt
Phone8155996361PhoneNum
Signature2024-11-20SignatureDt
Discuss With Paid Preparer0DiscussWithPaidPreparerInd
FieldValueIRS element (for citing)
IRS Responsible Prty Info Curr0IRSResponsiblePrtyInfoCurrInd
Tax2023TaxYr
Build TS2024-10-15 13:58:12ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1FHN FAMILY COUNSELINGBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerMARK S GRIDLEYPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11045 W STEPHENSON STAddressLine1Txt
CityFREEPORTCityNm
State AbbreviationILStateAbbreviationCd
ZIP61032ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$2,613,464GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.FHN.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1976FormationYr
Legal Domicile StateILLegalDomicileStateCd
Activity Or MissionTO PROVIDE AND PROMOTE SOCIAL, PSYCHOLOGICAL, AND PSYCHIATRIC SERVICES.ActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent10VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$807,228PYContributionsGrantsAmt
CY Contributions Grants$616,106CYContributionsGrantsAmt
PY Program Service Revenue$1,922,201PYProgramServiceRevenueAmt
CY Program Service Revenue$1,997,252CYProgramServiceRevenueAmt
PY Investment Income$1,739PYInvestmentIncomeAmt
CY Investment Income$106CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$2,731,168PYTotalRevenueAmt
CY Total Revenue$2,613,464CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$2,439,309PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$2,232,662CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$843,586PYOtherExpensesAmt
CY Other Expenses$864,590CYOtherExpensesAmt
PY Total Expenses$3,282,895PYTotalExpensesAmt
CY Total Expenses$3,097,252CYTotalExpensesAmt
PY Revenues Less Expenses-$551,727PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$483,788CYRevenuesLessExpensesAmt
Total Assets BOY$658,613TotalAssetsBOYAmt
Total Assets EOY$809,133TotalAssetsEOYAmt
Total Liabilities BOY$2,287,586TotalLiabilitiesBOYAmt
Total Liabilities EOY$1,527,358TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$1,628,973NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$718,225NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO IMPROVE THE HEALTH OF OUR COMMUNITIES, WORKING TOGETHER WITH THOSE WE SERVE. JAI COORDINATES AND INTERGRATES BEHAVIORAL HEALTH SERVICES AND PROVIDES IMPARTIAL ACCESS TO BEHAVIORAL HEALTH SERVICES REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, OR SOURCE OF PAYMENT.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$556,744ExpenseAmt
Revenue$633,840RevenueAmt
DescADULT OUTPATIENT SERVICES PROVIDES ASSESSMENT AND COUNSELING FOR INDIVIDUALS, COUPLES, FAMILIES, AND GROUPS. TYPICAL ISSUES WORKED WITH ENCOMPASS GRIEF, DEPRESSION, ANXIETY, MARITAL AND FAMILY CONFLICT, DIVORCE MEDIATION, AND EDUCATION CLASSES. THE OBJECTIVE OF THIS SERVICE IS TO ADDRESS AND CHALLENGE DYSFUNCTIONAL PATTERNS OF COPING WITH STRESSORS AND REALIGN STRENGTHS TOWARD ACHIEVING INDIVIDUAL GOALS. IN 2023. SERVICES WERE PROVIDED TO 2996 PEOPLE.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$1,384,183ExpenseAmt
Revenue$1,878,863RevenueAmt
DescFHN FAMILY COUSELING CENTER'S CASE MANAGEMENT SERVICES HELP PLAN, COORDINATE AND ADVOCATE FOR CLIENTS WHO NEED MULTIPLE SERVICES AND REQUIRE ASSISTANCE IN GAINING ACCESS TO AND IN USING MEDICAL, MENTAL HEALTH, SOCIAL, VOCATIONAL, EDUCATIONAL,HOUSING, PUBLIC INCOME AND OTHER COMMUNITY SERVICES TO ASSIST THE CLIENT IN THE COMMUNITY.IN 2023, SERVICES WERE PROVIDED TO 1621 PEOPLE.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$316,945ExpenseAmt
Revenue$272,039RevenueAmt
DescOUTPATIENT CRISIS SERVICES ARE PROVIDED 24/7/365 TO CHILDREN, ADOLESCENTS, ADULTS AND INCLUDE ASSESSMENTS, LINKAGE AND REFERRAL & REPLACEMENT SERVICES FOR THOSE REQUIRING EMERGENCY INTERVENTION. THE OBJECTIVE OF THIS SERVICE IS TO AMELIORATE THE EMERGENCY NATURE OF THE MENTAL HEALTH ISSUE AND ENHANCE STABILITY IN THE LIVES OF THOSE SERVED. IN 2023, SERVICES WERE PROVIDED TO 282 PEOPLE.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Expense$208,803ExpenseAmt
Revenue$171,278RevenueAmt
DescTHE SUBSTANCE USE PREVENTION TEAM WORKS WITH MIDDLE SCHOOL AND HIGH SCHOOL YOUTH TO MAKE DECISIONS THAT DO NOT TURN TO DRUG AND ALCOHOL USE THROUGH EDUCATIONAL CURRICULUMS. THE TEAM SUPPORTS THE SCHOOLS IN STEPHENSON AND JO DAVIESS COUNTIES IN COMPLETING THE ILLINOIS YOUTH SURVEY EVERY TWO YEARS. THEY COORDINATE AND PROVIDE CUMMUNICATION CAMPAIGNS WITHIN BOTH COUNTIES TO EDUCATE ON MAKING GOOD CHOICES.Desc
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$208,803TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Revenue$171,278TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses$2,466,675TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members10GoverningBodyVotingMembersCnt
Independent Voting Member10IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldILStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MICHAEL CLARK CFOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone8155996209PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11045 WEST STEPHENSON STAddressLine1Txt
CityFREEPORTCityNm
State AbbreviationILStateAbbreviationCd
ZIP61032ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
NEAL RICHARDSON
CHAIRMEN0.30Yes (X)$0$0$0
HEATHER MCPHERSON
VICE CHAIRMAN0.30Yes (X)$0$0$0
MARK WRIGHT
TREASURER0.30Yes (X)$0$0$0
RICH CHANG
SECRETARY0.30Yes (X)$0$0$0
GARY QUINN
BOARD MEMBER0.30Yes (X)$0$0$0
SHOKRY TAWFIK MD
BOARD MEMBER0.30Yes (X)$0$0$0
BRUCE BALDWIN
BOARD MEMBER0.30Yes (X)$0$0$0
GLENDA KOELLER
BOARD MEMBER0.30Yes (X)$0$0$0
DAN SCHMITT
BOARD MEMBER0.30Yes (X)$0$0$0
AMY BAKER
BOARD MEMBER0.30Yes (X)$0$0$0
MARK S GRIDLEY
CHIEF EXECUTIVE OFFICER4.00$7,341$726,707$64,20336.00Yes (X)
MICHAEL CLARK
CHIEF FINANCIAL OFFICER4.00$3,521$348,610$60,15436.00Yes (X)
LEONARD CARTER
CHIEF HUMAN RESOURCE OFFICER4.00$2,397$237,309$38,83836.00Yes (X)
CLARENCE PARKS
PRESIDENT MEDICAL STAFF4.00$0$509,041$20,23036.00Yes (X)
REBECCA L PEDERSON MD
CHIEF QUALITY OFFICER4.00$0$394,510$36,66336.00Yes (X)
TIMOTHY JESSEN MD
CHAIR PHYSICIAN COUNCIL4.00$0$297,480$38,96936.00Yes (X)
KATHRYN MARTINEZ
COO/CNO4.00$0$273,206$35,12136.00Yes (X)
BETH KALNINS MD
PHYSICIAN4.00$0$272,722$27,64936.00Yes (X)
ROBERT GELLER MD
HEAD OF INFECTIOUS DISEASES4.00$0$224,442$27,96236.00Yes (X)
CLAYTON CUNNINGHAM
EXECUTIVE DIRECTOR40.00$156,032$0$34,701Yes (X)
MISTY DEHAVEN
EMPLOYEE40.00$117,360$0$34,590Yes (X)
ANGELA HEUERMAN
EMPLOYEE40.00$116,193$0$12,389Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$402,844TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$3,284,027TotReportableCompRltdOrgAmt
Total Other Compensation$431,469TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K3IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

FieldValueIRS element (for citing)
PersonDR JAMES DALYPersonNm

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line13133 BROOK HARBOUR DRIVEAddressLine1Txt
CityROCKFORDCityNm
State AbbreviationILStateAbbreviationCd
ZIP61114ZIPCd
FieldValueIRS element (for citing)
ServicesPHYSICIANServicesDesc
Compensation$320,213CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
Government Grants$611,915GovernmentGrantsAmt
All Other Contributions$4,191AllOtherContributionsAmt
Total Contributions$616,106TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT REVENUE624100$1,836,683$1,836,683
MISCELLANEOUS621400$160,569$160,569
FieldValueIRS element (for citing)
Total Program Service Revenue$1,997,252TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$106TotalRevenueColumnAmt
Exclusion$106ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,613,464TotalRevenueColumnAmt
Related Or Exempt Func Income$1,997,252RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$106ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$14,567TotalAmt
Management And General$14,567ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$1,718,763TotalAmt
Program Services$1,302,984ProgramServicesAmt
Management And General$415,779ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$371,511TotalAmt
Program Services$282,880ProgramServicesAmt
Management And General$88,631ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$127,821TotalAmt
Program Services$96,052ProgramServicesAmt
Management And General$31,769ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$3,386TotalAmt
Management And General$3,386ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$195,647TotalAmt
Program Services$185,305ProgramServicesAmt
Management And General$10,342ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$5,295TotalAmt
Program Services$4,870ProgramServicesAmt
Management And General$425ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$6,443TotalAmt
Program Services$4,975ProgramServicesAmt
Management And General$1,468ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$27,598TotalAmt
Program Services$27,598ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SEPCIALIST FEES$320,993$320,993
CORPORATE ALLOCATION$199,573$199,573
CONTRACTED SERVICES$58,774$17,826$40,948
SUPPLIES$19,597$17,268$2,329

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$27,284TotalAmt
Program Services$6,351ProgramServicesAmt
Management And General$20,933ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$3,097,252TotalAmt
Program Services$2,466,675ProgramServicesAmt
Management And General$630,577ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$118,833BOYAmt
EOY$235,202EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$539,350BOYAmt
EOY$572,075EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$430BOYAmt
EOY$1,856EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$658,613BOYAmt
EOY$809,133EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$21,470BOYAmt
EOY$23,055EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$363,766BOYAmt
EOY$307,621EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,902,350BOYAmt
EOY$1,196,682EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,287,586BOYAmt
EOY$1,527,358EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$1,628,973BOYAmt
EOY-$718,225EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$1,628,973BOYAmt
EOY-$718,225EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$658,613BOYAmt
EOY$809,133EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$483,788ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$1,394,536OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,383,483CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,362,297CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$641,760CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$807,228CurrentTaxYearMinus1YearAmt
Current Tax Year$616,106CurrentTaxYearAmt
Total$4,810,874TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,383,483CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,362,297CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$641,760CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$807,228CurrentTaxYearMinus1YearAmt
Current Tax Year$616,106CurrentTaxYearAmt
Total$4,810,874TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$4,810,874PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$973CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$562CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,124CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,739CurrentTaxYearMinus1YearAmt
Current Tax Year$106CurrentTaxYearAmt
Total$6,504TotalAmt
FieldValueIRS element (for citing)
Total Support$4,817,378TotalSupportAmt
Public Support CY1700.99860PublicSupportCY170Pct
Public Support PY1700.99850PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
DUE TO FMH$729,985
DUE TO FRHCF$166,712
DUE TO JAHS$299,985
FieldValueIRS element (for citing)
Total Liability$1,196,682TotalLiabilityAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
MARK S GRIDLEY
CHIEF EXECUTIVE OFFICER$6,806$673,784$0$0$535$52,923$211$20,894$431$42,667$7,983$790,268$0$0
MICHAEL CLARK
CHIEF FINANCIAL OFFICER$2,592$256,615$0$0$929$91,995$225$22,275$377$37,277$4,123$408,162$0$0
LEONARD CARTER
CHIEF HUMAN RESOURCE OFFICER$2,093$207,238$0$0$304$30,071$0$0$388$38,450$2,785$275,759$0$0
CLARENCE PARKS
PRESIDENT MEDICAL STAFF$0$456,596$0$17,833$0$34,612$0$17,717$0$2,513$0$529,271$0$0
REBECCA L PEDERSON MD
CHIEF QUALITY OFFICER$0$354,480$0$9,253$0$30,777$0$0$0$36,663$0$431,173$0$0
TIMOTHY JESSEN MD
CHAIR PHYSICIAN COUNCIL$0$232,688$0$29,477$0$35,315$0$20,769$0$18,200$0$336,449$0$0
KATHRYN MARTINEZ
COO/CNO$0$242,831$0$0$0$30,375$0$0$0$35,121$0$308,327$0$0
BETH KALNINS MD
PHYSICIAN$0$264,228$0$3,750$0$4,744$0$0$0$27,649$0$300,371$0$0
ROBERT GELLER MD
HEAD OF INFECTIOUS DISEASES$0$170,684$0$20,515$0$33,243$0$0$0$27,962$0$252,404$0$0
CLAYTON CUNNINGHAM
EXECUTIVE DIRECTOR$147,662$0$0$0$8,370$0$0$0$34,701$0$190,733$0$0$0
MISTY DEHAVEN
EMPLOYEE$109,021$0$8,200$0$139$0$0$0$34,590$0$151,950$0$0$0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BTHE BOARD REVIEWS ALL TRANSACTIONS THAT AFFECT THE FILING OF THE ORGANIZATION'S FORM 990 AND EQUIVALENT STATE RETURNS. THE FORM 990 WAS REVIEWED AND SIGNED BY THE CHIEF FINANCIAL OFFICER.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION HAS A DEDICATED CORPORATE COMPLIANCE OFFICER. ALL MEMBERS OF THE BOARD, OFFICERS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE EACH YEAR A CONFLICT OF INTEREST QUESTIONNAIRE. THESE DOCUMENTS ARE REVIEWED BY THE CCO TO DETERMINE IF ANY INDIVIDUAL HAS A CONFLICT OF INTEREST THAT NEEDS TO BE ADDRESSED.
FORM 990, PART VI, SECTION B, LINE 15THE ORGANIZATION HAS AN EXECUTIVE COMPENSATION COMMITTEE THAT REVIEWS THE CEO, TOP MANAGAMENT AND EXECUTIVE DIRECTORS COMPENSATION. THE COMMITTEE RELIES ON INTERNAL AND EXTERNAL INFORMATION TO DETERMINE THE APPROPRIATE COMPENSATION AND EMPLOYS AN INDEPENDENT THIRD PARTY TO CONDUCT THE ANNUAL EXECUTIVE COMPENSATION ANALYSIS. THIS ANALYSIS IS USED TO DETERMINE IF THE BOARD'S WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY HAS BEEN MET. THE EXECUTIVE COMPENSATION COMMITTEE RECEIVES A REASONABLENESS LETTER FROM THE THIRD PARTY.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION DOES NOT MAKE THESE AVAILABLE TO THE PUBLIC.
FORM 990, PART XI, LINE 9:TRANSFER FROM JAHS A TAX EXEMPT AFFILIATE. 1,394,536.
PART XII LINES 2CNO CHANGES HAVE BEEN MADE TO THE PROCESS OF THE SELECTION OF THE INDEPENDENT AUDITORS.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
FREEPORT REGIONAL HEALTH CARE FOUNDATION
1045 WEST STEPHENSON STREETFREEPORTIL61032363290904HEALTH CAREIL501(C)(3)LINE 12N/A0
FREEPORT MEMORIAL HOSPITAL
1045 WEST STEPHENSON STREETFREEPORTIL61032362181997HEALTH CAREIL501(C)(3)LINE 30FREEPORT REGIONAL HEALTH CARE FOUNDATION
JANE ADDAMS HEALTHCARE SERVICES INC
1045 WEST STEPHENSON STREETFREEPORTIL61032363677357HEALTH CAREIL501(C)(3)LINE 120FREEPORT REGIONAL HEALTH CARE FOUNDATION

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1MEMORIAL ENTERPRISES INBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11045 WEST STEPHENSON STREETAddressLine1Txt
CityFREEPORTCityNm
State AbbreviationILStateAbbreviationCd
ZIP61032ZIPCd
FieldValueIRS element (for citing)
EIN363353871EIN
Primary ActivitiesHEALTH CAREPrimaryActivitiesTxt
Legal Domicile StateILLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1FREEPORT REGIONAL HEALTH CARE FOUNDATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeCEntityTypeTxt
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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