JANE ADDAMS COMMUNITY MENTAL HEALTH CENTER: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- JANE ADDAMS COMMUNITY MENTAL HEALTH CENTER (EIN 36-2879689)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-08-15
- IRS object ID
- 202212279349301911
- Schema version
- 2021v4.2
- 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 | 2022-08-15T09:56:29-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 362879689 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JANE ADDAMS COMMUNITY MENTAL HEALTH CENT | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | JANE | BusinessNameControlTxt |
| Phone | 8155996209 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1045 WEST STEPHENSON STREET | AddressLine1Txt |
| City | FREEPORT | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61032 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL C CLARK | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 8155996361 | PhoneNum |
| Signature | 2022-08-10 | SignatureDt |
| Discuss With Paid Preparer | 0 | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MICHAEL | PersonFirstNm |
| Person Last | CLARK | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
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 | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JANE ADDAMS INCFHN FAMILY COUNSELING | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MARK S GRIDLEY CEO | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1045 W STEPHENSON ST | AddressLine1Txt |
| City | FREEPORT | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61032 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $3,134,062 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FHN.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1976 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE AND PROMOTE SOCIAL, PSYCHOLOGICAL, AND PSYCHIATRIC SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,362,297 | PYContributionsGrantsAmt |
| CY Contributions Grants | $641,760 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $2,238,517 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $2,489,178 | CYProgramServiceRevenueAmt |
| PY Investment Income | $562 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,124 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $3,601,376 | PYTotalRevenueAmt |
| CY Total Revenue | $3,134,062 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,514,290 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $2,777,093 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,023,624 | PYOtherExpensesAmt |
| CY Other Expenses | $1,056,730 | CYOtherExpensesAmt |
| PY Total Expenses | $3,537,914 | PYTotalExpensesAmt |
| CY Total Expenses | $3,833,823 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $63,462 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$699,761 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,374,738 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,103,593 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,746,544 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,175,158 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$371,806 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$1,071,565 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO 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 Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $1,392,520 | ExpenseAmt |
| Revenue | $616,706 | RevenueAmt |
| Desc | ADULT 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 2021 APPROXIMATELY 13750 HOURS OF SERVICE WERE PROVIDED TO 1165 PEOPLE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,135,957 | ExpenseAmt |
| Revenue | $1,603,842 | RevenueAmt |
| Desc | FHN 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 2021, APPROXIMATELY 9663 HOURS OF SERVICE WERE PROVIDED TO 1707 PEOPLE. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $163,574 | ExpenseAmt |
| Revenue | $97,352 | RevenueAmt |
| Desc | OUTPATIENT 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 2021, APPROXIMATELLY HOURS 1100 OF SERVICE WERE PROVIDED TO 456 PEOPLE. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $239,988 | ExpenseAmt |
| Revenue | $171,278 | RevenueAmt |
| Desc | THE 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. IN 2021, APPROXIMATELY 4835 YOUTH WERE SERVED OR EXPOSED TO EDUCATIONAL INFORMATION. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $239,988 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $171,278 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $2,932,039 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | 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 | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | 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 | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | 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 |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 | 0 | 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 | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | 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
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMY RUNGREN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8155996940 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1045 WEST STEPHENSON STREET | AddressLine1Txt |
| City | FREEPORT | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61032 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| CAROL SCHUSTER | |||||||||
| BOARD MEMBER | 0.30 | Yes (X) | $0 | $0 | $0 | ||||
| STEVEN KNEUBUEHL | |||||||||
| PAST CHAIRMEN | 0.30 | Yes (X) | $0 | $0 | $0 | ||||
| HEATHER MCPHERSON | |||||||||
| VICE CHAIRMAN | 0.30 | Yes (X) | $0 | $0 | $0 | ||||
| GARY QUINN | |||||||||
| BOARD MEMBER | 0.30 | Yes (X) | $0 | $0 | $0 | ||||
| NEAL RICHARDSON | |||||||||
| CHAIRMEN | 0.30 | Yes (X) | $0 | $0 | $0 | ||||
| MARK WRIGHT | |||||||||
| TREASURER | 0.30 | Yes (X) | $0 | $0 | $0 | ||||
| SHOKRY TAWFIK MD | |||||||||
| BOARD MEMBER | 0.30 | Yes (X) | $0 | $136,690 | $28,875 | ||||
| BRUCE BALDWIN | |||||||||
| BOARD MEMBER | 0.30 | Yes (X) | $0 | $0 | $0 | ||||
| RICH CHANG | |||||||||
| SECRETARY | 0.30 | Yes (X) | $0 | $0 | $0 | ||||
| GLENDA KOELLER | |||||||||
| BOARD MEMBER | 0.30 | Yes (X) | $0 | $0 | $0 | ||||
| DAN SCHMITT | |||||||||
| BOARD MEMBER | 0.30 | Yes (X) | $0 | $0 | $0 | ||||
| BETH KALNINS MD | |||||||||
| EMPLOYED PHYSICIAN | 0.30 | Yes (X) | $0 | $248,491 | $35,530 | ||||
| MARK S GRIDLEY | |||||||||
| CHIEF EXECUTIVE OFFICER | 4.00 | $5,569 | $551,329 | $55,586 | 36.00 | Yes (X) | |||
| MICHAEL C CLARK | |||||||||
| CHIEF FINANCIAL OFFICER | 4.00 | $3,235 | $320,299 | $53,509 | 36.00 | Yes (X) | |||
| LEONARD CARTER | |||||||||
| CHIEF HUMAN RESOURCES OFFICER | 4.00 | $2,216 | $219,423 | $35,626 | 36.00 | Yes (X) | |||
| ROBERT GELLER MD | |||||||||
| PRESIDENT MEDICAL STAFF | 4.00 | $0 | $355,811 | $26,330 | 36.00 | Yes (X) | |||
| REBECCA L PEDERSON MD | |||||||||
| CHIEF QUALITY OFFICER | 4.00 | $0 | $376,989 | $32,311 | 36.00 | Yes (X) | |||
| TIMOTHY JESSEN MD | |||||||||
| CHAIR PHYSICIAN COUNCIL | 4.00 | $0 | $278,059 | $50,204 | 36.00 | Yes (X) | |||
| KATHRYN MARTINEZ | |||||||||
| COO/CNO | 4.00 | $0 | $241,411 | $45,940 | 36.00 | Yes (X) | |||
| ANGELA HEUERMAN | |||||||||
| EMPLOYEE | 40.00 | $113,289 | $0 | $14,247 | Yes (X) | ||||
| MISTY DEHAVEN | |||||||||
| EMPLOYEE | 40.00 | $120,172 | $0 | $31,330 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $244,481 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,728,502 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $409,488 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR JAMES DALY | PersonNm |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1746 SHAW WOODS DRIVE | AddressLine1Txt |
| City | ROCKFORD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61107 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | PHYSICIAN | ServicesDesc |
| Compensation | $352,274 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $641,734 | GovernmentGrantsAmt |
| All Other Contributions | $26 | AllOtherContributionsAmt |
| Total Contributions | $641,760 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT REVENUE | 624100 | $2,173,661 | $2,173,661 |
| MISCELLANOUS | 624100 | $315,517 | $315,517 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $2,489,178 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,124 | TotalRevenueColumnAmt |
| Exclusion | $3,124 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,134,062 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,489,178 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,124 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,467 | TotalAmt |
| Management And General | $12,467 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,095,400 | TotalAmt |
| Program Services | $1,606,330 | ProgramServicesAmt |
| Management And General | $489,070 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $516,785 | TotalAmt |
| Program Services | $411,766 | ProgramServicesAmt |
| Management And General | $105,019 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $152,441 | TotalAmt |
| Program Services | $117,414 | ProgramServicesAmt |
| Management And General | $35,027 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $246,378 | TotalAmt |
| Program Services | $236,415 | ProgramServicesAmt |
| Management And General | $9,963 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,508 | TotalAmt |
| Program Services | $5,462 | ProgramServicesAmt |
| Management And General | $46 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,703 | TotalAmt |
| Program Services | $1,703 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,931 | TotalAmt |
| Management And General | $11,931 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SPECIALIST FEES | $439,316 | $439,316 | |
| CORPORATE ALLOCATIONS | $186,502 | $186,502 | |
| CONTRACTED SERVICES | $78,392 | $41,739 | $36,653 |
| SUPPLIES | $60,890 | $60,876 | $14 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,110 | TotalAmt |
| Program Services | $11,018 | ProgramServicesAmt |
| Management And General | $15,092 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,833,823 | TotalAmt |
| Program Services | $2,932,039 | ProgramServicesAmt |
| Management And General | $901,784 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,674 | BOYAmt |
| EOY | $382,436 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,352,064 | BOYAmt |
| EOY | $721,157 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $49,110 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $49,110 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,374,738 | BOYAmt |
| EOY | $1,103,593 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,733 | BOYAmt |
| EOY | $63,832 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $691,708 | BOYAmt |
| EOY | $338,240 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,022,103 | BOYAmt |
| EOY | $1,773,086 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,746,544 | BOYAmt |
| EOY | $2,175,158 | 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 | -$371,806 | BOYAmt |
| EOY | -$1,071,565 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$371,806 | BOYAmt |
| EOY | -$1,071,565 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,374,738 | BOYAmt |
| EOY | $1,103,593 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$699,761 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $2 | 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 | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
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 | $1,345,735 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,188,671 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,383,483 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,362,297 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $641,760 | CurrentTaxYearAmt |
| Total | $5,921,946 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,345,735 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,188,671 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,383,483 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,362,297 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $641,760 | CurrentTaxYearAmt |
| Total | $5,921,946 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $5,921,946 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | -$2,140 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,586 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $973 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $562 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,124 | CurrentTaxYearAmt |
| Total | $4,105 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $5,926,051 | TotalSupportAmt |
| Public Support CY170 | 0.99930 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99980 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $49,110 | OtherCostOrOtherBasisAmt |
| Depreciation | $49,110 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO FMH | $347,950 |
| DUE TO FRHCF | $1,425,136 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,773,086 | TotalLiabilityAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SHOKRY TAWFIK MD | ||||||||||||||
| BOARD MEMBER | $0 | $121,983 | $0 | $0 | $0 | $14,707 | $0 | $0 | $0 | $28,875 | $0 | $165,565 | $0 | $0 |
| BETH KALNINS MD | ||||||||||||||
| EMPLOYED PHYSICIAN | $0 | $237,646 | $0 | $0 | $0 | $10,845 | $0 | $0 | $0 | $35,530 | $0 | $284,021 | $0 | $0 |
| MARK S GRIDLEY | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $4,991 | $494,085 | $0 | $0 | $578 | $57,244 | $195 | $19,305 | $361 | $35,725 | $6,125 | $606,359 | $0 | $0 |
| MICHAEL C CLARK | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $2,764 | $273,662 | $0 | $0 | $471 | $46,637 | $195 | $19,305 | $340 | $33,669 | $3,770 | $373,273 | $0 | $0 |
| LEONARD CARTER | ||||||||||||||
| CHIEF HUMAN RESOURCES OFFICER | $1,981 | $196,181 | $0 | $0 | $235 | $23,242 | $0 | $0 | $356 | $35,270 | $2,572 | $254,693 | $0 | $0 |
| ROBERT GELLER MD | ||||||||||||||
| PRESIDENT MEDICAL STAFF | $0 | $322,539 | $0 | $0 | $0 | $33,272 | $0 | $0 | $0 | $26,330 | $0 | $382,141 | $0 | $0 |
| REBECCA L PEDERSON MD | ||||||||||||||
| CHIEF QUALITY OFFICER | $0 | $366,522 | $0 | $0 | $0 | $10,467 | $0 | $0 | $0 | $32,311 | $0 | $409,300 | $0 | $0 |
| TIMOTHY JESSEN MD | ||||||||||||||
| CHAIR PHYSICIAN COUNCIL | $0 | $251,920 | $0 | $0 | $0 | $26,139 | $0 | $17,524 | $0 | $32,680 | $0 | $328,263 | $0 | $0 |
| KATHRYN MARTINEZ | ||||||||||||||
| COO/CNO | $0 | $239,481 | $0 | $0 | $0 | $1,930 | $0 | $14,610 | $0 | $31,330 | $0 | $287,351 | $0 | $0 |
| ANGELA HEUERMAN | ||||||||||||||
| EMPLOYEE | $113,217 | $0 | $0 | $0 | $72 | $0 | $3,451 | $0 | $10,796 | $0 | $127,536 | $0 | $0 | $0 |
| MISTY DEHAVEN | ||||||||||||||
| EMPLOYEE | $120,052 | $0 | $0 | $0 | $120 | $0 | $0 | $0 | $31,330 | $0 | $151,502 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE 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 12C | THE 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 15 | THE 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 19 | THE ORGANIZATION DOES NOT MAKE THESE AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 9: | TRANSFER FROM JAHS A TAX EXEMPT AFFILIATE. ROUNDING 2. |
| PART VII LINE 2C | THERE HAVE BEEN NO CHANGES THE PROCEDURES FOR THE SELECTION OF THE INDEPENDENT AUDITORS. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| FREEPORT REGIONAL HEALTH CARE FOUNDATION | |||||||||||
| 1045 WEST STEPHENSON STREET | FREEPORT | IL | 61032 | 363290904 | HEALTH CARE | IL | 501(C)(3) | LINE 11 | N/A | 0 | |
| FREEPORT MEMORIAL HOSPITAL | |||||||||||
| 1045 WEST STEPHENSON STREET | FREEPORT | IL | 61032 | 362181997 | HEALTH CARE | IL | 501(C)(3) | LINE 3 | 0 | FREEPORT REGIONAL HEALTH CARE FOUNDATION | |
| FREEPORT REGIONAL MANAGEMENT SERVICES | |||||||||||
| 1045 WEST STEPHENSON STREET | FREEPORT | IL | 61032 | 363994636 | HEALTH CARE | IL | 501(C)(3) | LINE 3 | 0 | FREEPORT REGIONAL HEALTH CARE FOUNDATION | |
| FREEPORT REGIONAL HEALTHCARE SERVICES | |||||||||||
| 1045 WEST STEPHENSON STREET | FREEPORT | IL | 61032 | 363967303 | HEALTH CARE | IL | 501(C)(3) | LINE 11 | 0 | FREEPORT REGIONAL HEALTH CARE FOUNDATION | |
| JANE ADDAMS HEALTHCARE SERVICES INC | |||||||||||
| 1045 WEST STEPHENSON STREET | FREEPORT | IL | 61032 | 363677357 | HEALTH CARE | IL | 501(C)(3) | LINE 11 | 0 | FREEPORT REGIONAL HEALTH CARE FOUNDATION | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL ENTERPRISES IN | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1045 WEST STEPHENSON STREET | AddressLine1Txt |
| City | FREEPORT | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61032 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363353871 | EIN |
| Primary Activities | HEALTH CARE | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FREEPORT REGIONAL HEALTH CARE FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | 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 | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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