2023-05-11T15:25:23-05:00 2022-06-30 346565596 ERNST & YOUNG US LLP 155 N WACKER DRIVE CHICAGO IL 60606 990 2021-07-01 370646367 MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS MENT 2177883922 701 NORTH FIRST STREET SPRINGFIELD IL 62781 DIANA KNAEBE SYSTEM ADMIN BEHAVIORAL HEALTH 2175887704 2023-05-11 1 DIANA KNAEBE 999009999 JESSICA A WAGENER P01622613 3128792000 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z X MEMORIAL BEHAVIORAL HEALTH DIANA KNAEBE 701 NORTH FIRST STREET SPRINGFIELD IL 62781 19514588 0 5670 X WWW.MEMORIALBEHAVIORALHEALTH.ORG X 1962 IL TO IMPROVES LIVES AND BUILD STRONGER COMMUNITIES THROUGH BETTER HEALTH. 19 16 385 14 0 0 3616776 5900053 8499976 9948858 986106 1633886 487174 443921 13590032 17926718 1565 19522 0 10003773 14454949 0 0 2711604 3182476 12716942 17656947 873090 269771 23178318 19820134 1745463 2143752 21432855 17676382 X TO IMPROVE LIVES AND BUILD STRONGER COMMUNITIES THROUGH BETTER HEALTH. 0 0 2127735 0 1409101 THE CRISIS/ACCESS PROGRAM PROVIDES RAPID RESPONSE TO INDIVIDUALS IN MENTAL HEALTH CRISIS, TO MEMBERS OF HIS/HER SUPPORT SYSTEM, AND THE COMMUNITY 24-HOURS/DAY. THE PROGRAM PROVIDES CRISIS INTERVENTION SERVICES, WALK-INS, & MOBILE SERVICES. SHORT-TERM CRISIS INTERVENTION OF THERAPY/COUNSELING AND PSYCHIATRIC CARE IS DESIGNED TO ADDRESS THE PRESENTING SYMPTOMS OF A PSYCHIATRIC EMERGENCY & TO AMELIORATE A CLIENT'S DISTRESS SO THAT RESOURCES & SUPPORTS CAN BE MOBILIZED & PLANNING FOR FURTHER TREATMENT CAN OCCUR. CRISIS WALK-IN IS SUPPORT & INTERVENTION OFFERED AT AN IDENTIFIED LOCATION ON AN UNSCHEDULED BASIS FOR THE PURPOSE OF STABILIZING OR RESOLVING A CRISIS SITUATION. MOBILE CRISIS SERVICE IS DELIVERED WHERE & WHEN THE CRISIS OCCURS TO ASSURE SERVICE BY MENTAL HEALTH PROFESSIONALS. MBH PROVIDED 6,754 CLIENT HOURS RELATED TO THIS PROGRAM IN FISCAL YEAR 2022. 1987413 0 1717637 MBH- BEHAVIORAL HEALTH THERAPY (MBH-BHT) IS THE OUTPATIENT BEHAVIORAL HEALTH PROVIDER OF CHOICE FOR BOTH PEDIATRIC AND ADULT MEDICAID RECIPIENTS FOR SANGAMON AND MENARD COUNTIES. MBH-BHT THERAPISTS PROVIDE OFFICE-BASED AND TELEHEALTH SERVICES AND ARE COMMITTED TO THE DEVELOPMENT OF COORDINATED NETWORKS OF COMPREHENSIVE SERVICES, WHICH PROVIDES CARE IN THE LEAST RESTRICTIVE, MOST NORMATIVE ENVIRONMENT CLINICALLY APPROPRIATE. THERAPISTS ALSO PROVIDE AFTER-HOURS AND WEEKEND ON-CALL COVERAGE FOR THE SASS (SCREENING, ASSESSMENT, AND SUPPORT SERVICES) PROGRAM TO MEET THE CONTRACTUAL REQUIREMENTS SET BY THE STATE OF ILLINOIS FOR CRISIS INTERVENTION. MBH PROVIDED 14,724 CLIENT HOURS RELATED TO THIS PROGRAM IN FISCAL YEAR 2022. 1738141 0 2047481 MEMORIAL BEHAVIORAL HEALTH-COUNSELING ASSOCIATES (MBH-CA) IS A TRADITIONAL COUNSELING PRACTICE HOUSING EIGHTEEN LICENSED CLINICIANS. SERVICES ARE OFFERED TO PATIENTS WITH PRIVATE INSURANCE AND THOSE INVOLVED WITH EMPLOYEE ASSISTANCE PROGRAMS. MBH-CA CLINICIANS ASSIST PATIENTS IN ADDRESSING STRESS, LIFE TRANSITIONS, AND BEHAVIORAL HEALTH DISORDERS, INCLUDING SUBSTANCE USE. MBH-CA OPERATES FIVE DAYS A WEEK, MONDAY THROUGH FRIDAY FROM 7:30 AM TO 6:30 PM, EXCEPT ON HEALTH SYSTEM HOLIDAYS. MBH-CA PROVIDED 14,724 DUPLICATED PATIENT SERVICES DURING FISCAL YEAR 2022. 8280354 19521 5059003 OTHER DEVELOPMENTAL DISABILITY PROGRAMS: EXPENSES $2,100,163, INCLUDING GRANTS OF $279, AND REVENUE $401,264.OTHER MENTAL HEALTH PROGRAMS: EXPENSES $5,664,700, INCLUDING GRANTS OF $19,242, AND REVENUE $4,644,572.HOUSING SERVICES: EXPENSES $515,491, INCLUDING GRANTS OF $0, AND REVENUE $13,167. 8280354 19521 5059003 14133643 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 X 23 0 1 385 1 0 0 0 0 0 0 0 0 0 0 0 0 X 19 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X KATHRYN KEIM SR VICE PRESIDENT & CHIEF FINANCIAL OFFICER 2175887759 701 NORTH FIRST STREET SPRINGFIELD IL 62781 DR VIRGINIA DOLAN DIRECTOR & MPS PHYS 0.70 49.30 X 0 482255 51152 DR NICOLE FLORENCE DIRECTOR & MPS PHYS. 0.70 49.30 X 0 316036 94312 DIANA KNAEBE SYSADMINMBH/BOARD PRES. 47.50 2.50 X X 0 201504 24054 VEA CRAWFORD DIRECTOR 0.70 0.00 X 0 0 0 ANNE MORGAN PHD DIRECTOR 0.70 0.00 X 0 0 0 DANIEL WRIGHT DIRECTOR 0.70 0.00 X 0 0 0 IRIS WESLEY DIRECTOR 0.70 0.00 X 0 0 0 KENNETH WINSLOW DIRECTOR 0.70 0.00 X 0 0 0 DR KARI WOLF DIRECTOR 0.70 0.00 X 0 0 0 ERICA SMITH DIRECTOR (THRU FEB 22) 0.50 0.00 X 0 0 0 SCOTT SABIN DIRECTOR (THRU FEB 22) 0.50 0.00 X 0 0 0 JONNA COOLEY PHD DIRECTOR(FROM MARCH 22) 0.20 0.00 X 0 0 0 FAYE LEWIS DIRECTOR(FROM MARCH 22) 0.20 0.00 X 0 0 0 DARCELLA SPEED DIRECTOR(FROM MARCH 22) 0.20 0.00 X 0 0 0 MARQUITTA THOMAS DIRECTOR(FROM MARCH 22) 0.20 0.00 X 0 0 0 LISA VINSON DIRECTOR(FROM MARCH 22) 0.20 0.00 X 0 0 0 EVAN WESTLAKE DIRECTOR(FROM MARCH 22) 0.20 0.00 X 0 0 0 JOSHUA SABO SECRETARY 0.35 0.35 X X 0 0 0 LEIGH STEINER PHD CHAIR 0.35 0.35 X X 0 0 0 WANDA LEE ROHLFS TREASURER 0.35 0.35 X X 0 0 0 TIFFANY NIELSON PHD VICE CHAIR 0.35 0.35 X X 0 0 0 KATIE KEIM SVP & CFO 5.00 45.00 X 0 795373 101242 JAMESON ROSZHART PRESIDENT MHS AMBULATORY GROUP 5.00 45.00 X 0 666947 92321 MONICA FARQUHAR DIR.-MEM. BEHAVL. HLTH 50.00 0.00 X 112079 0 11353 AMBER OLSON RGNLDIR-BHVLHLTHCLINOP 50.00 0.00 X 107224 0 12686 219303 2462115 387120 2 0 1 0 0 3117 365280 5492536 39120 5900053 MENTAL HEALTH SERVICES 621400 7641866 7641866 DVLPMNTL DISABLED SVCS 621400 2293825 2293825 HOUSING SERVICES 621400 13167 13167 9948858 120887 120887 187726 28169 159557 159557 159557 2941273 9771 1438045 0 1503228 9771 1512999 1512999 316034 121656 194378 194378 CAPITATION REVENUE 900099 25900 25900 COMMISSIONS 900099 12314 12314 PROMPT PAY INTEREST PE 900099 10833 10833 40939 40939 89986 17926718 10233222 0 1793443 19522 19522 231013 84101 146912 11071869 9533428 1538441 534616 534616 1718293 1392766 325527 899158 774884 124274 5156 5156 36250 5068 31182 709 709 127836 119860 7976 337301 227754 109547 333113 276396 56717 498145 430149 67996 209447 199738 9709 22831 16427 6404 236214 220459 15755 89446 89446 MANAGEMENT FEES 1060293 1060293 PROVISION FOR UNCOLLECT 145931 145931 FOOD & DIETARY SUPPLIES 58234 55579 2655 21570 7519 14051 17656947 14133643 3523304 0 415 415 1631323 1273616 1661595 1997864 136246 144646 10690581 7901659 2697149 2788922 16991290 13566287 40000 40000 20300 8384 23178318 19820134 1448613 1965302 292790 173653 4060 4797 1745463 2143752 X 21432855 17676382 21432855 17676382 23178318 19820134 269771 -4026244 0 X 0 1 X 1 1 1 X 3334466 3312794 3135125 3616776 5900053 19299214 3334466 3312794 3135125 3616776 5900053 19299214 1317673 17981541 238855 255255 342783 270731 280444 1388068 136824 70557 25535 173372 89986 496274 21183556 48247792 0.84880 0.80450 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MENTAL HEALTH TRAINING - REGISTRATION FEES - 2017 AMOUNT: $ 47,483. 2018 AMOUNT: $ 13,323. 2019 AMOUNT: $ 9,385. 2020 AMOUNT: $ 3,390. 2021 AMOUNT: $ 4,304. RECORD COPY FEES - 2017 AMOUNT: $ 8,220. 2018 AMOUNT: $ 18,525. 2019 AMOUNT: $ 5,784. 2020 AMOUNT: $ 5,341. 2021 AMOUNT: $ 596. OTHER REVENUE - 2017 AMOUNT: $ 17,585. 2018 AMOUNT: $ 35,371. 2019 AMOUNT: $ 26,301. 2020 AMOUNT: $ 31,884. 2021 AMOUNT: $ 74,253. PROMPT PAY INTEREST - 2017 AMOUNT: $ 12,067. 2018 AMOUNT: $ 12,835. 2019 AMOUNT: $ 5,377. 2020 AMOUNT: $ 6,293. 2021 AMOUNT: $ 10,833. PARTNERSHIP INCOME - 2017 AMOUNT: $ 18,935. 2018 AMOUNT: $ -9,497. 2019 AMOUNT: $ -21,312. NON-RECORD FEES - 2017 AMOUNT: $ 13,297. TRAINING CONFERENCES - 2017 AMOUNT: $ 19,237. RENOVATION REIMBURSEMENT - 2020 AMOUNT: $ 126,464. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 709 0 0 0 709 0 PART II-B, LINE 1: MBH IS A DUES PAYING MEMBER OF THE ILLINOIS ASSOCIATION OF REHABILITATION FACILITIES, INC. (IARF) & COMMUNITY BEHAVIOR HEALTHCARE ASSOCIATION (CBHA). A PERCENTAGE OF MBH'S DUES TO IARF & CBHA GO TOWARDS LOBBYING ACTIVITIES. 996667 996667 7637902 6176449 1461453 11753 4522 7231 1623806 1447602 176204 420453 273086 147367 2788922 RENTAL PROPERTY - NON-CURRENT 4797 4797 X PART X, LINE 2: MBH IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE UNITED STATE INTERNAL REVENUE CODE. MBH IS NOT CONSIDERED A PRIVATE FOUNDATION. IN ACCORDANCE WITH FASB ACS 740-10 WHICH ADDRESSES INCOME TAXES, MBH BELIEVES THERE ARE NO SIGNIFICANT UNCERTAIN TAX POSITIONS RESULTING IN LIABILITIES THAT WOULD HAVE BEEN REQUIRED FOR THE YEAR ENDED JUNE 30, 2022. MBH'S FORM 990 FOR 2019, 2020, AND 2021 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS), GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. 1 EDUCATIONAL GRANTS 3 17622 SPECIFIC ASSISTANCE 1 1900 PART I, LINE 2: EDUCATIONAL GRANTS - MEMORIAL BEHAVIORAL HEALTH'S EDUCATIONAL GRANT PROGRAM PROVIDES THE OPPORTUNITY FOR EMPLOYEES TO PURSUE ADDITIONAL EDUCATION IN EXCHANGE FOR A WORK COMMITMENT ONCE THE EDUCATION IS COMPLETED. EDUCATIONAL GRANTS ARE AVAILABLE TO THOSE PURSUING HEALTH CARE CAREERS THAT ARE DEEMED CRITICAL TO THE ORGANIZATION'S PRESENT OR PROJECTED STAFFING NEEDS. GRANT APPLICATIONS FOR ALL OTHER CAREERS WILL BE REVIEWED ON A CASE-BY-CASE BASIS WITH A FINAL DETERMINATION TO BE MADE BY THE MEMORIAL HEALTH WORKFORCE STRATEGIES ADVISORY COUNCIL. SPECIFIC ASSISTANCE - MBH PROVIDES ASSISTANCE TO CLIENTS CURRENTLY RECEIVING SERVICES IN ONE OF THE FOLLOWING PROGRAMS: SUPPORTED EMPLOYMENT, PROJECTS IN ASSISTANCE FOR TRANSITION FROM HOMELESSNESS (PATH), COMMUNITY INTEGRATED LIVING ARRANGEMENTS (CILA). THIS INCLUDES BUT IS NOT LIMITED TO, MEDICATIONS, CLOTHING, DOCTOR VISITS, AND DENTAL VISITS. TO BE ELIGIBLE FOR THE ASSISTANCE, THE CLIENT MUST HAVE BEEN DIAGNOSED WITH A MENTAL ILLNESS OR A DEVELOPMENTAL DISABILITY, AND CURRENTLY BE RECEIVING SERVICES AT MBH. THE CLIENT IS ASSIGNED A CASE MANAGER WHO IS RESPONSIBLE FOR DETERMINATION OF THE TYPE OF ASSISTANCE NEEDED. BEFORE THE ASSISTANCE IS PROVIDED, THE SUPERVISOR OF THE CASE MANAGER MUST PRE-APPROVE THE ASSISTANCE TO BE PURCHASED. THE CASE MANAGER INITIATES THE PURCHASE. THE CHECK IS MADE PAYABLE DIRECTLY TO THE VENDOR AND/OR LANDLORD. THE CLIENT IS REQUIRED TO SIGN THE VENDOR RECEIPT TO ACKNOWLEDGE THAT HE OR SHE RECEIVED THE GOODS, SERVICES, OR RENTAL ASSISTANCE. CLIENTS DO NOT DIRECTLY RECEIVE CASH. 0 1 0 0 0 0 0 0 0 KATIE KEIM SVP & CFO 0 550719 0 235549 0 9105 0 70376 0 30866 0 896615 0 0 JAMESON ROSZHART PRESIDENT MHS AMBULATORY GROUP 0 435966 0 187911 0 43070 0 60082 0 32239 0 759268 0 20080 DR VIRGINIA DOLAN DIRECTOR & MPS PHYS 0 424547 0 10963 0 46745 0 0 0 51152 0 533407 0 0 DR NICOLE FLORENCE DIRECTOR & MPS PHYS. 0 275884 0 0 0 40152 0 3612 0 90700 0 410348 0 0 DIANA KNAEBE SYSADMINMBH/BOARD PRES. 0 173473 0 27038 0 993 0 3099 0 20955 0 225558 0 0 PART I, LINE 3 MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION OF MEMORIAL BEHAVIORAL HEALTH, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S SYSTEM ADMINISTRATOR/BOARD PRESIDENT (EQUIVALENT TO CEO/EXECUTIVE DIRECTOR): 1) COMPENSATION COMMITTEE; 2) INDEPENDENT COMPENSATION CONSULTANT; 3) COMPENSATION SURVEY OR STUDY; AND 4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION OF MEMORIAL BEHAVIORAL HEALTH, PROVIDES CERTAIN SUPPLEMENTAL RETIREMENT BENEFITS TO THE FOLLOWING OFFICER AND KEY EMPLOYEES: KATIE KEIM, $70,376, AND JAMESON ROSZHART, $55,952. THESE BENEFITS ARE PROVIDED THROUGH A NONQUALIFIED DEFERRED COMPENSATION PLAN, UNDER WHICH THE BENEFITS BEING EARNED ARE SUBJECT TO A "SUBSTANTIAL RISK OF FORFEITURE". THE SUPPLEMENTAL RETIREMENT BENEFITS ARE STRUCTURED TO PROVIDE A RETENTION INCENTIVE THAT HAS BEEN DETERMINED BY THE LEADERSHIP COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF MEMORIAL HEALTH SYSTEM TO BE OF SUBSTANTIAL VALUE TO THE ORGANIZATION. THE FOLLOWING DIRECTORS, OFFICER, & KEY EMPLOYEE RECEIVED DEFERRED COMPENSATION PAYOUTS IN THE CALENDAR YEAR FROM A RELATED ORGANIZATION: DR. VIRGINIA DOLAN, $46,054, DR. NICOLE FLORENCE, $39,853, KATIE KEIM, $875, AND JAMESON ROSZHART $34,893. PART I, LINE 7 MEMBERS OF SENIOR MANAGEMENT OF MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION OF MEMORIAL BEHAVIORAL HEALTH, RECEIVE COMPENSATION UNDER PLANS SPONSORED BY MEMORIAL HEALTH SYSTEM. THESE AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II COLUMN (B) (II). THE PLANS ARE DESIGNED TO CONDITION A PORTION OF COMPENSATION ON PERFORMANCE AGAINST PREDETERMINED FINANCIAL, MISSION, AND INDIVIDUAL GOALS APPROVED IN ADVANCE BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS OF MEMORIAL HEALTH SYSTEM. THE LEADERSHIP COMPENSATION COMMITTEE OF THE BOARD HAS REVIEWED THE REASONABLENESS OF ALL SUCH PAYMENTS, AND HAS CONCLUDED, AS THE RESULT OF A PROCESS THAT IS DESIGNED TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER FEDERAL TAX LAW, THAT ALL SUCH AMOUNTS ARE REASONABLE AND DID NOT EXCEED FAIR MARKET VALUE FOR THE SERVICES RENDERED. PART V, LINE 1A MBH'S CORPORATE PARENT (A RELATED ORGANIZATION OF MBH) (MEMORIAL HEALTH SYSTEM 37-1110690) ISSUES ALL VENDOR PAYMENTS FOR MBH AND INCLUDES MBH AMOUNTS IN ITS FORM 1096 REPORTING UNDER ITS EIN. PART V, LINE 2A MEMORIAL HEALTH SYSTEM IS A COMMON PAY AGENT FOR ALL THE AFFILIATES AND REPORTS ALL EMPLOYEES UNDER ITS EIN. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERSHIP OF THE CORPORATION CONSISTS OF ONE CORPORATE MEMBER, MEMORIAL HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBER OF THE CORPORATION ELECTS THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE BYLAWS OF THE CORPORATION REQUIRE THE ADVANCE APPROVAL OF THE CORPORATE MEMBER FOR CORPORATE, ADMINISTRATIVE AND OPERATIONAL ACTIONS WHICH INCLUDE, BUT ARE NOT LIMITED TO, THE APPROVAL OF ANY ANNUAL OR LONG-TERM CAPITAL OR OPERATING BUDGET, AMENDMENT, ALTERATION OR REPEAL OF THE ARTICLES OF INCORPORATION OR BYLAWS, CREATION OR ELIMINATION OF A PROGRAM OR SERVICE, APPROVAL OF BORROWING WHICH EXCEEDS $250,000, APPROVAL OF ANY QUANTITY OF DEBT WHICH EXCEEDS $250,000, APPROVAL OF ANY DISSOLUTION, MERGER OR CONSOLIDATION OR SALE OF THE ASSETS OF THE CORPORATION WHICH EXCEED $250,000, APPROVAL OF THE ORGANIZATION OF AN AFFILIATE/SUBSIDIARY, APPROVAL FOR APPLICATION OF CERTIFICATE OF NEED, APPROVAL TO ADOPT ANY LONG-TERM OR MASTER INSTITUTIONAL PLAN, APPROVAL TO SELL OR PURCHASE REAL PROPERTY WHICH EXCEEDS $250,000, APPROVAL TO CHANGE INSURANCE SPECIFICATIONS OR LIMITS, APPROVAL TO SELECT OR CHANGE INDEPENDENT AUDITORS AND LEGAL COUNSEL, APPROVAL TO ENTER INTO, RENEW OR MODIFY CONTRACTS TO PROVIDE COVERED MENTAL HEALTH CARE SERVICES TO BENEFICIARIES OF HEALTH MAINTENANCE ORGANIZATIONS, HEALTH CARE SERVICE PLANS, INDEPENDENT PRACTICE ASSOCIATIONS, PREFERRED PROVIDER ORGANIZATIONS, INSURANCE COMPANIES AND OTHER PURCHASERS OF HEALTH SERVICES, APPROVAL TO ENTER INTO ANY CONTRACT OR AGREEMENT WHICH I) PROVIDES FOR THE PAYMENT OR PERFORMANCE BY EITHER PARTY EXCEEDING AN AGGREGATE VALUE OF $250,000, II) IS NOT TERMINABLE WITHOUT PAYMENT OR PENALTY OF 60 DAYS OR LESS NOTICE III)IS BETWEEN THE CORPORATION OR AN AFFILIATE AND AN OFFICER, DIRECTOR OR KEY EMPLOYEE THEREOF. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT PREPARES AND REVIEWS THE RETURN. AN OUTSIDE TAX ADVISOR THEN REVIEWS THE RETURN, PROVIDING COMMENTS AND GUIDANCE AS NEEDED. MBH BOARD MEMBERS ARE THEN PROVIDED WITH AN ELECTRONIC COPY OF THE FINAL FORM 990 AND ITS SUPPORTING SCHEDULES FOR REVIEW. A HIGH LEVEL DISCUSSION OF THE RETURN TAKES PLACE AT THE MBH BOARD MEETING, WITH A MORE FORMAL PRESENTATION TAKING PLACE AT THE FINANCE COMMITTEE MEETING. FORM 990, PART VI, SECTION B, LINE 12C MBH BOARD MEMBERS RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY ANNUALLY. BOARD MEMBERS COMPLETE CONFLICT OF INTEREST STATEMENTS ON AN ANNUAL BASIS; BOARD MEMBERS ARE REMINDED TO UPDATE THEIR STATEMENTS IF CIRCUMSTANCES CHANGE. BOARD MEMBERS ARE REMINDED OF THE NEED TO ABSTAIN FROM VOTING WHEN BOARD RESOLUTIONS REQUIRE SUCH ACTION. BOARD MEMBERS ARE APPRAISED BY MANAGEMENT OF POTENTIAL CONFLICTS WITH MEETING AGENDA ITEMS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION DETERMINATIONS OF MBH'S PRESIDENT AND OTHER OFFICERS WERE CONDUCTED BY MEMORIAL HEALTH SYSTEM'S MANAGEMENT, A RELATED ORGANIZATION OF THE FILING ORGANIZATION. MBH'S PRESIDENT IS AN EMPLOYEE OF MEMORIAL HEALTH SYSTEM (MHS). MHS ANNUALLY ENGAGES A CONSULTING FIRM TO CONDUCT A COMPENSATION REVIEW, WHICH INCLUDES A COMPARABILITY STUDY FOR ALL EXECUTIVES. MHS'S LEADERSHIP COMPENSATION COMMITTEE, A PART OF ITS BOARD OF DIRECTORS, REVIEWS THE CONSULTANT REPORT. COMPENSATION COMMITTEE DECISIONS AND REPORTS ARE CONTEMPORANEOUSLY DOCUMENTED IN THE BOARD OF DIRECTOR AND COMPENSATION COMMITTEE MINUTES AS APPROPRIATE. TWO OFFICERS ARE EMPLOYEES OF AN AFFILIATED ORGANIZATION, MEMORIAL PHYSICIANS SERVICES. THEIR COMPENSATION IS REVIEWED BY THE SAME OUTSIDE CONSULTING FIRM THAT REVIEWS THE COMPENSATION OF MBH'S PRESIDENT. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS OF MBH, SUCH AS ARTICLES OF INCORPORATION AND ANY AMENDMENTS THERETO, ARE AVAILABLE TO THE GENERAL PUBLIC THROUGH THE ILLINOIS SECRETARY OF STATE'S OFFICE. THESE GOVERNING DOCUMENTS, AS WELL AS THE BYLAWS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS, ARE AVAILABLE UPON REQUEST FROM THE CORPORATION. THESE DOCUMENTS ARE AVAILABLE FOR THE SAME PERIOD OF TIME AS SET FORTH IN IRC SECTION 6104(D). SPRINGFIELD RESIDENTIAL SERVICES 710 NORTH EIGHTH STREET SPRINGFIELD IL 62702 371298589 RESIDENTIAL HUD HOUSING PROJECT FOR MENTALLY ILL IL 501(C)(3) LINE 7 MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS 1 MEMORIAL HEALTH SYSTEM 701 NORTH FIRST ST SPRINGFIELD IL 627810001 371110690 PARENT IL 501(C)(3) LINE 12B, II N/A 0 MEMORIAL MEDICAL CENTER 701 NORTH FIRST ST SPRINGFIELD IL 627810001 370661220 HOSPITAL SERVICES IL 501(C)(3) LINE 3 MEMORIAL HEALTH SYSTEM 0 MEMORIAL HEALTH VENTURES 701 NORTH FIRST ST SPRINGFIELD IL 627810001 363492266 HEALTHCARE ACTIVITIES IL 501(C)(3) LINE 10 MEMORIAL HEALTH SYSTEM 0 ABRAHAM LINCOLN MEMORIAL HOSPITAL 315 EIGHTH ST LINCOLN IL 62656 370723793 HOSPITAL SERVICES IL 501(C)(3) LINE 3 MEMORIAL HEALTH SYSTEM 0 TAYLORVILLE MEMORIAL HOSPITAL 201 EAST PLEASANT TAYLORVILLE IL 62568 370661250 HOSPITAL SERVICES IL 501(C)(3) LINE 3 MEMORIAL HEALTH SYSTEM 0 MEMORIAL HOME SERVICES 720 NORTH BOND SPRINGFIELD IL 627024915 370714225 HOME HEALTH, HOSPICE, AND CONTINUOUS CARE SERVICES IL 501(C)(3) LINE 7 MEMORIAL HEALTH SYSTEM 0 MEMORIAL PHYSICIAN SERVICES 701 NORTH FIRST ST SPRINGFIELD IL 627810001 371181194 HEALTH CLINICS IL 501(C)(3) LINE 10 MEMORIAL HEALTH SYSTEM 0 MEMORIAL MEDICAL CENTER FOUNDATION 1 MEMORIAL PLAZA SPRINGFIELD IL 62781 371110301 GRANTS TO HOSPITALS, OTHER CHARITABLE ORGANIZATIONS, AND SCHOLARSHIPS IL 501(C)(3) LINE 7 MEMORIAL MEDICAL CENTER 0 TAYLORVILLE MEMORIAL HOSPITAL FOUNDATION INC 201 EAST PLEASANT TAYLORVILLE IL 62568 371337485 GRANTS TO OTHER CHARITABLE ORGANIZATIONS AND HOSPITALS IL 501(C)(3) LINE 7 TAYLORVILLE MEMORIAL HOSPITAL 0 ABRAHAM LINCOLN HEALTHCARE FOUNDATION 315 EIGHTH ST LINCOLN IL 62656 363492268 GRANTS TO OTHER CHARITABLE ORGANIZATIONS AND HOSPITALS IL 501(C)(3) LINE 7 MEMORIAL HEALTH SYSTEM 0 PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION 1600 WEST WALNUT STREET JACKSONVILLE IL 62650 370661230 HOSPITAL SERVICES IL 501(C)(3) LINE 3 MEMORIAL HEALTH SYSTEM 0 PASSAVANT AREA HOSPITAL FOUNDATION 1600 WEST WALNUT STREET JACKSONVILLE IL 62650 461037396 SUPPORTING THE HOSPITAL IL 501(C)(3) LINE 7 PASSAVANT MEMORIAL AREA HOSPITAL 0 JACKSONVILLE CRNA'S INC 1600 WEST WALNUT STREET JACKSONVILLE IL 62650 273093265 CRNA SERVICES IL 501(C)(3) LINE 10 PASSAVANT MEMORIAL AREA HOSPITAL 0 DECATUR MEMORIAL HOSPITAL 2300 NORTH EDWARD STREET DECATUR IL 625264163 370661199 HOSPITAL SERVICES IL 501(C)(3) LINE 3 MEMORIAL HEALTH SYSTEM 0 DECATUR MEMORIAL HEALTH FOUNDATION 2300 NORTH EDWARD STREET DECATUR IL 625264163 371169605 SUPPORTING THE HOSPITAL IL 501(C)(3) LINE 12A, I DECATUR MEMORIAL HOSPITAL 0 MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS 701 NORTH FIRST STREET SPRINGFIELD IL 62781 371190216 PROVIDE DURABLE MEDICAL EQUIPMENT AND SUPPLIES TO PATIENTS IL N/A C 0 0 0 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 0 0 SPRINGFIELD RESIDENTIAL SERVICES O 31533 FMV SPRINGFIELD RESIDENTIAL SERVICES L 13167 FMV SPRINGFIELD RESIDENTIAL SERVICES Q 13536 FMV