2022-06-14T10:42:02-05:00 2021-07-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2020-08-01 371193348 Carlinville Area Hospital Foundation CARL 2178543141 20733 North Broad Street Carlinville IL 62626 Brian Burnside Carlinville Area Hospital CEO 2178543141 2022-06-09 1 Brian Burnside 999009999 Kim Hunwardsen CPA P00484560 6122536500 2022-06-07 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z Brian Burnside 20733 North Broad Street Carlinville IL 62626 82138 0 X www.cahcare.com X 1944 IL Support primary and emergency health care services for persons living in the Carlinville area 18 18 0 19 0 0 8799 15465 0 0 52197 46219 13368 5374 74364 67058 209414 12500 0 0 0 0 0 0 12615 16537 13112 225951 25612 -151587 41446 1434699 1613204 0 0 1434699 1613204 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. 0 0 12500 12500 5374 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. 12500 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 18 18 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X Paul Courtney 2178543141 20733 North Broad Street Carlinville IL 62626 X X Richard Walden Chairman 0.50 1.30 X X 0 0 0 James Ashworth Vice Chairman 0.50 0.00 X X 0 0 0 Charlene Genta Secretary until Dec 2020 0.50 0.00 X X 0 0 0 Mary Jo Reichmann - Director until 12/20-Secr. starting 01/21 0.50 0.00 X X 0 0 0 Tammy Dugan Treasurer 0.50 0.00 X X 0 0 0 Steven Boente DMD Member 0.30 0.00 X 0 0 0 Michelle Dyer Member 0.30 0.00 X 0 0 0 Greg Boente Member 0.30 0.00 X 0 0 0 Ralph March Member 0.30 1.30 X 0 0 0 Dennis Pickrel Member 0.30 1.30 X 0 0 0 Ed Tawfall Member 0.30 0.00 X 0 0 0 John Lanzerotte Member 0.30 0.00 X 0 0 0 Brent Davis Member 0.30 0.00 X 0 0 0 Chad Bowker Member until 12/2020 0.30 0.00 X 0 0 0 Heather DeNeve Member 0.30 1.00 X 0 0 0 Susan LeVora Member 0.30 0.00 X 0 0 0 Katie Goodman-Thomas OD Member 0.30 1.00 X 0 0 0 Tom Denby Member 0.30 0.00 X 0 0 0 J Richard Schien Member 0.30 1.30 X 0 0 0 Michael Layfield -Interim CEO Carlinville Hosp until 8/2020 1.00 40.30 X 0 0 0 Brian Burnside CEO Carlinville Hosp as of 8/2020 1.00 40.30 X 0 0 0 Michael Brown CFO Carlinville Hosp until 12/2020 1.00 40.30 X 0 0 0 Patrick Nudo - CFO Carlinville Hosp starting 12/2020 1.00 40.30 X 0 0 0 0 0 0 0 0 0 0 0 15465 15465 59486 59486 13267 -13267 -13267 -13267 7187 1813 5374 5374 67058 5374 0 46219 12500 12500 497 497 8888 8888 Fundraising expenses 1560 1560 2167 2167 25612 12500 497 12615 216827 235306 1217872 1375154 0 2744 1434699 1613204 0 0 X 1248167 1426672 186532 186532 1434699 1613204 1434699 1613204 X 41446 142433 -5374 X X 0 1 X 0 0 X 39452 16613 21479 8799 15465 101808 39452 16613 21479 8799 15465 101808 101808 16761 20863 47296 34026 59486 178432 280240 325766 0.36330 0.10320 X Schedule A, Part VI, List of Unusual Grants: Description: Cash contribution Date: 07/31/18 Amount: 492309. Description: Cash contribution Date: 07/31/19 Amount: 1200000. 1 41079 7187 1813 46453 0 0 X 202557 142433 -6934 135499 67058 0 67058 24052 0 24052 1560 1560 25612 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. 1 Educational medical scholarships 7 12500 Part I, Line 2: 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. 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. 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 N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0