CARLINVILLE AREA HOSPITAL FOUNDATION: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- CARLINVILLE AREA HOSPITAL FOUNDATION (EIN 37-1193348)
- Tax period
- 2020-08-01 to 2021-07-31
- Filed
- 2022-06-14
- IRS object ID
- 202211659349300631
- Schema version
- 2020v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-06-14T10:42:02-05:00 | ReturnTs |
| Tax Period End | 2021-07-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Nicollet Mall Ste 1300 | AddressLine1Txt |
| City | Minneapolis | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554027033 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-08-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 371193348 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carlinville Area Hospital Foundation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CARL | BusinessNameControlTxt |
| Phone | 2178543141 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20733 North Broad Street | AddressLine1Txt |
| City | Carlinville | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62626 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Brian Burnside | PersonNm |
| Person Title | Carlinville Area Hospital CEO | PersonTitleTxt |
| Phone | 2178543141 | PhoneNum |
| Signature | 2022-06-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Brian | PersonFirstNm |
| Person Last | Burnside | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim Hunwardsen CPA | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | PhoneNum |
| Preparation | 2022-06-07 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Brian Burnside | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20733 North Broad Street | AddressLine1Txt |
| City | Carlinville | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62626 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $82,138 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.cahcare.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1944 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | Support primary and emergency health care services for persons living in the Carlinville area | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 18 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 19 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $8,799 | PYContributionsGrantsAmt |
| CY Contributions Grants | $15,465 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $52,197 | PYInvestmentIncomeAmt |
| CY Investment Income | $46,219 | CYInvestmentIncomeAmt |
| PY Other Revenue | $13,368 | PYOtherRevenueAmt |
| CY Other Revenue | $5,374 | CYOtherRevenueAmt |
| PY Total Revenue | $74,364 | PYTotalRevenueAmt |
| CY Total Revenue | $67,058 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $209,414 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $12,500 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $12,615 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $16,537 | PYOtherExpensesAmt |
| CY Other Expenses | $13,112 | CYOtherExpensesAmt |
| PY Total Expenses | $225,951 | PYTotalExpensesAmt |
| CY Total Expenses | $25,612 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$151,587 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $41,446 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,434,699 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,613,204 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,434,699 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,613,204 | NetAssetsOrFundBalancesEOYAmt |
| Mission | The purpose of the Foundation is to help support the availability of primary and emergency health care services for those persons living in the Carlinville area. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $12,500 | ExpenseAmt |
| Grant | $12,500 | GrantAmt |
| Revenue | $5,374 | RevenueAmt |
| Desc | Carlinville Area Hospital Foundation was established to support persons living in the Carlinville Area. Many small and rural communities face the threat of losing access to health care due to cuts in payment, especially through government programs such as Medicare and Medicaid. The residents of the communities served by Carlinville Area Hospital deserve the availability of a hospital which can meet as many of their needs as possible in a quality, cost-effective and convenient manner. | Desc |
| Total Program Service Expenses | $12,500 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 18 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Paul Courtney | PersonNm |
| Phone | 2178543141 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20733 North Broad Street | AddressLine1Txt |
| City | Carlinville | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62626 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| Richard Walden | |||||||
| Chairman | 0.50 | 1.30 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| James Ashworth | |||||||
| Vice Chairman | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Charlene Genta | |||||||
| Secretary until Dec 2020 | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Mary Jo Reichmann - Director | |||||||
| until 12/20-Secr. starting 01/21 | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Tammy Dugan | |||||||
| Treasurer | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Steven Boente DMD | |||||||
| Member | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Michelle Dyer | |||||||
| Member | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Greg Boente | |||||||
| Member | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Ralph March | |||||||
| Member | 0.30 | 1.30 | Yes (X) | $0 | $0 | $0 | |
| Dennis Pickrel | |||||||
| Member | 0.30 | 1.30 | Yes (X) | $0 | $0 | $0 | |
| Ed Tawfall | |||||||
| Member | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| John Lanzerotte | |||||||
| Member | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Brent Davis | |||||||
| Member | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Chad Bowker | |||||||
| Member until 12/2020 | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Heather DeNeve | |||||||
| Member | 0.30 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Susan LeVora | |||||||
| Member | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Katie Goodman-Thomas OD | |||||||
| Member | 0.30 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Tom Denby | |||||||
| Member | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| J Richard Schien | |||||||
| Member | 0.30 | 1.30 | Yes (X) | $0 | $0 | $0 | |
| Michael Layfield -Interim CEO | |||||||
| Carlinville Hosp until 8/2020 | 1.00 | 40.30 | Yes (X) | $0 | $0 | $0 | |
| Brian Burnside | |||||||
| CEO Carlinville Hosp as of 8/2020 | 1.00 | 40.30 | Yes (X) | $0 | $0 | $0 | |
| Michael Brown | |||||||
| CFO Carlinville Hosp until 12/2020 | 1.00 | 40.30 | Yes (X) | $0 | $0 | $0 | |
| Patrick Nudo - CFO | |||||||
| Carlinville Hosp starting 12/2020 | 1.00 | 40.30 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $15,465 | AllOtherContributionsAmt |
| Total Contributions | $15,465 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $59,486 | TotalRevenueColumnAmt |
| Exclusion | $59,486 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $13,267 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$13,267 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$13,267 | TotalRevenueColumnAmt |
| Exclusion | -$13,267 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $7,187 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $1,813 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,374 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,374 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $67,058 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,374 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $46,219 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,500 | TotalAmt |
| Program Services | $12,500 | ProgramServicesAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $497 | TotalAmt |
| Management And General | $497 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,888 | TotalAmt |
| Fundraising | $8,888 | FundraisingAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Fundraising expenses | Desc |
| Total | $1,560 | TotalAmt |
| Fundraising | $1,560 | FundraisingAmt |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,167 | TotalAmt |
| Fundraising | $2,167 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,612 | TotalAmt |
| Program Services | $12,500 | ProgramServicesAmt |
| Management And General | $497 | ManagementAndGeneralAmt |
| Fundraising | $12,615 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $216,827 | BOYAmt |
| EOY | $235,306 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,217,872 | BOYAmt |
| EOY | $1,375,154 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $2,744 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,434,699 | BOYAmt |
| EOY | $1,613,204 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,248,167 | BOYAmt |
| EOY | $1,426,672 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $186,532 | BOYAmt |
| EOY | $186,532 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,434,699 | BOYAmt |
| EOY | $1,613,204 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,434,699 | BOYAmt |
| EOY | $1,613,204 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $41,446 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $142,433 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$5,374 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $39,452 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $16,613 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $21,479 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,799 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,465 | CurrentTaxYearAmt |
| Total | $101,808 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $39,452 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $16,613 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $21,479 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,799 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,465 | CurrentTaxYearAmt |
| Total | $101,808 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $101,808 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $16,761 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $20,863 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $47,296 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $34,026 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $59,486 | CurrentTaxYearAmt |
| Total | $178,432 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $280,240 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $325,766 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.36330 | PublicSupportCY170Pct |
| Public Support PY170 | 0.10320 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule A, Part VI, List of Unusual Grants: | FormAndLineReferenceDesc |
| Explanation | Description: Cash contribution Date: 07/31/18 Amount: 492309. Description: Cash contribution Date: 07/31/19 Amount: 1200000. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $41,079 | BeginningBalanceAmt |
| Additions During Year | $7,187 | AdditionsDuringYearAmt |
| Distributions During Year | $1,813 | DistributionsDuringYearAmt |
| Ending Balance | $46,453 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $202,557 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $142,433 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$6,934 | OtherRevenueAmt |
| Revenue Not Reported | $135,499 | RevenueNotReportedAmt |
| Revenue Subtotal | $67,058 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $67,058 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $24,052 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $24,052 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,560 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,560 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $25,612 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 1b: | Carlinville Area Hospital Auxiliary operates under the Foundation's FEIN but has its own checking account. The Auxiliary's account balances were not reported on the Foundation's financial statements, however the revenues and expenses were recorded on the Form 990 with a change in the Auxiliary's net assets recorded in other adjustments. |
| Part X, Line 2: | The members of the Foundation believe that they have appropriate support for any tax positions taken affecting its annual filing requirements, and as such, do not have any uncertain tax positions that are material to the financial statements. The members of the Foundation would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
| Part XI, Line 2d - Other Adjustments: | Fundraising expenses included in expenses for Form 990 -1,560. Auxiliary net assets not included in revenue for Form 990 -5,374. |
| Part XII, Line 4b - Other Adjustments: | Fundraising expenses included in expenses for Form 990 1,560. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | Educational medical scholarships | GrantTypeTxt |
| Recipient | 7 | RecipientCnt |
| Cash Grant | $12,500 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | The Carlinville Area Hospital Foundation continued a scholarship program this year. Applicants had to complete an application, type a 500 word essay on what interested them to the healthcare field and get three letters of recommendation with at least one from a school official and/or employer. Scholarship checks are issued payable to the school in two increments. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | The Board of Directors shall appoint 3 or more Directors to serve with the President on the Executive Committee. The Executive Committee has the power and authority to manage and control the business and affairs of the Foundation as the Board of Directors determines but has no authority to amend the Articles of Incorporation or Bylaws; sell, transfer or otherwise dispose of substantially all of the Foundation's assets; or adopt Articles of Merger or Consolidation. |
| Form 990, Part VI, Section A, line 2 | Richard Walden, Chairman, and James Ashworth, Vice Chairman, have a business relationship. Brian Burnside, Michael Layfield, Michael Brown, and Patrick Nudo have a business relationship with Dennis Pickrel, Richard Walden, Ralph March, Heather DeNeve, Katie Goodman-Thomas, and J. Richard Schien. |
| Form 990, Part VI, Section A, line 6 | Carlinville Area Hospital Foundation has one member, Middle Macoupin Health Care Systems. |
| Form 990, Part VI, Section A, line 7a | The Member has the exclusive right and power to designate two of its Directors to serve as Directors of the Foundation and to appoint all persons to or remove them from the Board of Directors except vacancies on the Board caused by death, resignation or removal shall be filled at any meeting by a majority vote of the remaining Directors. |
| Form 990, Part VI, Section A, line 7b | The Member has the exclusive right and power to approve or reject the following proposed actions prior to the Board of Directors taking any action on: 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 in any such plan or budget; 2. the undertaking of or substantive amendments to a contractual obligation in excess of $250,000, or the guaranteeing of an obligation in excess of $250,000; 3. the purchase, lease, transfer, mortgage or sale of any asset or property with a value in excess of $250,000, 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 $250,000 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 amendments to these Bylaws and any amendment or restatement of the Articles of Incorporation; 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 Corporation's 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 11b | The Form 990 will be distributed to the governing body before it is filed. The CEO and CFO of Carlinville Area Hospital Association, a related organization, review the Form 990. |
| Form 990, Part VI, Section B, line 12c | Any duality of interest or possible conflict of interest on the part of any Board Member should be disclosed to the other Members of the Board and made a matter of record through an annual procedure and also when the interest becomes a matter of Board action. Any Board member having a duality of interest or possible conflict of interest on any matter should not vote or use his or her personal influence on the matter. The minutes of the meeting 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 Board Members complete and sign the conflict of interest form yearly. The forms are reviewed by the Chairman of the Board and if a potential conflict is identified the Chairman of the Board follows up. |
| Form 990, Part VI, Section B, line 15 | The CEO and CFO are not compensated by Carlinville Area Hospital Foundation. The CEO and CFO are compensated by an unrelated management company through Carlinville Area Hospital Association, a related organization, for services provided to the Hospital. The unrelated management company and the Hospital use these methods to determine compensation. |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents, conflict of interest policy, and financial statements are not available to the public. However, financial information is available through the public disclosure copy of the 990. |
| Form 990, Part VII: | Michael Layfield, Interim CEO, Michael Brown, CFO, Brian Burnside, CEO, and Patrick Nudo, CFO, are employees of HealthTech Management Services, Inc., an unrelated management company of Carlinville Area Hospital. They are not compensated for services provided to Carlinville Area Hospital Foundation. |
| Form 990, Part XI, line 9: | Change in Carlinville Area Hospital Auxiliary's net assets -5,374. |
| Form 990, Part XII, Line 2c: | Carlinville Area Hospital Association, a related organization, is responsible for oversight of the audit. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Carlinville Area Hospital Association | |||||||||||
| 20733 North Broad Street | Carlinville | IL | 62626 | 370645239 | Provision of health care services | IL | 501(c)(3) | Line 3 | 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 12c, III-FI | 0 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Comments