JANE ADDAMS HEALTH SERVICES: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
JANE ADDAMS HEALTH SERVICES (EIN 36-3677357)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-08-15
IRS object ID
202222279349300747
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

FieldValueIRS element (for citing)
Return2022-08-15T09:56:29-05:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN363677357EIN

Business Name BusinessName

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

US Address USAddress

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

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMICHAEL C CLARKPersonNm
Person TitleCHIEF FINANCIAL OFFICERPersonTitleTxt
Phone8155996361PhoneNum
Signature2022-08-01SignatureDt
Discuss With Paid Preparer0DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstMICHAELPersonFirstNm
Person LastCLARKPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerMARK S GRIDLEY CEOPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11045 W STEPHENSON STAddressLine1Txt
CityFREEPORTCityNm
State AbbreviationILStateAbbreviationCd
ZIP61032ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$215,376GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.FHN.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1989FormationYr
Legal Domicile StateILLegalDomicileStateCd
Activity Or MissionTO PROVIDE AND PROMOTE SOCIAL, PSYCHOLOGICAL, AND PSYCHIATRIC SERVICES.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent10VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$105,840PYProgramServiceRevenueAmt
CY Program Service Revenue$217,655CYProgramServiceRevenueAmt
PY Investment Income$4,808PYInvestmentIncomeAmt
CY Investment Income-$5,071CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$110,648PYTotalRevenueAmt
CY Total Revenue$212,584CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$104,606PYOtherExpensesAmt
CY Other Expenses$109,323CYOtherExpensesAmt
PY Total Expenses$104,606PYTotalExpensesAmt
CY Total Expenses$109,323CYTotalExpensesAmt
PY Revenues Less Expenses$6,042PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$103,261CYRevenuesLessExpensesAmt
Total Assets BOY$625,221TotalAssetsBOYAmt
Total Assets EOY$735,709TotalAssetsEOYAmt
Total Liabilities BOY$236,749TotalLiabilitiesBOYAmt
Total Liabilities EOY$244,480TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$388,472NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$491,229NetAssetsOrFundBalancesEOYAmt
MissionOUR MISSION IS TO IMPROVE THE HEALTH OF OUR COMMUNITIES WORKING TOGETHER WITH THOSE WE SERVE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$109,323ExpenseAmt
Revenue$214,863RevenueAmt
DescFURNISHING SERVICES TO JANE ADDAMS INC.Desc
Total Program Service Expenses$109,323TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member10IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldILStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1AMY RUNGRENBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone8155996940PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11045 W STEPHENSON STAddressLine1Txt
CityFREEPORTCityNm
State AbbreviationILStateAbbreviationCd
ZIP61032ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
NEAL RICHARDSON
CHAIRMAN0.30Yes (X)$0$0$0
HEATHER MCPHERSON
VICE CHAIRMAN0.30Yes (X)$0$0$0
MARK WRIGHT
TREASURER0.30Yes (X)$0$0$0
RICH CHANG
SECRETARY0.30Yes (X)$0$0$0
STEVEN KNEUBUEHL
PAST CHAIRMAN0.30Yes (X)$0$0$0
CAROL SCHUSTER
BOARD MEMBER0.30Yes (X)$0$0$0
GARY QUINN
BOARD MEMBER0.30Yes (X)$0$0$0
GLENDA KOELLER
BOARD MEMBER0.30Yes (X)$0$0$0
SHOKRY TAWFIK MD
BOARD MEMBER0.30Yes (X)$0$0$0
BRUCE BALDWIN
BOARD MEMBER0.30Yes (X)$0$0$0
DAN SCHMITT
BOARD MEMBER0.30Yes (X)$0$0$0
ROBERT GELLER MD
PRESIDENT MEDICAL STAFF0.30Yes (X)$0$0$0
TIMOTHY JESSEN MD
CHAIR PHYSICIAN COUNCIL0.30Yes (X)$0$0$0
MARK S GRIDLEY
PRESIDENT/CEO0.30$0$0$0Yes (X)
BETH KALNINS
EMPLOYED PHYSICIAN0.30Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
JANE ADDAMS INC624100$149,592$149,592
JANE ADDAMS INC/CARES624100$68,063$68,063
FieldValueIRS element (for citing)
Total Program Service Revenue$217,655TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column-$2,279TotalRevenueColumnAmt
Exclusion-$2,279ExclusionAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$2,792SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities-$2,792SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$2,792TotalRevenueColumnAmt
Related Or Exempt Func Income-$2,792RelatedOrExemptFuncIncomeAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$212,584TotalRevenueColumnAmt
Related Or Exempt Func Income$214,863RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion-$2,279ExclusionAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$109,308TotalAmt
Program Services$109,308ProgramServicesAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescOTHER EXPENSESDesc
Total$15TotalAmt
Program Services$15ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$109,323TotalAmt
Program Services$109,323ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$84,818BOYAmt
EOY$240,968EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,016,193LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$694,929LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$360,076BOYAmt
EOY$321,264EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$180,327BOYAmt
EOY$173,477EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$625,221BOYAmt
EOY$735,709EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$236,749BOYAmt
EOY$244,480EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$236,749BOYAmt
EOY$244,480EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$388,472BOYAmt
EOY$491,229EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$388,472BOYAmt
EOY$491,229EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$625,221BOYAmt
EOY$735,709EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$103,261ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$504OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type2Yes (X)SupportingOrgType2Ind
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1JANE ADDAMS INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN362879689EIN
Organization Type7OrganizationTypeCd
Governing Document ListedYes (1)GoverningDocumentListedInd
Support$0SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$0SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd
FieldValueIRS element (for citing)
Majority Dir Trst Supported OrgYes (1)MajorityDirTrstSupportedOrgInd

Schedule D IRS990ScheduleD

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,016,193OtherCostOrOtherBasisAmt
Depreciation$694,929DepreciationAmt
Book Value$321,264BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$321,264TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescSHORT TERM INVESTMENTSDesc
Book Value$173,477BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$173,477TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescINTERCOMPANY PAYABLEDesc
Amt$244,480Amt
FieldValueIRS element (for citing)
Total Liability$244,480TotalLiabilityAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BTHE BOARD REVIEWS ALL TRANSACTIONS THAT AFFECT THE FILING OF THE ORGANIZATION'S FORM 990 AND EQUIVELANT STATE RETURNS. THE 990 WAS REVIEWED AND SIGNED BY THE CHIEF FINANCIAL OFFICER.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION HAS A DEDICATED CORPORATE COMPLIANCE OFFICER. IN ADDITION, ALL MEMBERS OF THE BOARD OF DIRECTORS AS WELL AS KEY EMPLOYEES ARE REQUIRED TO COMPLETE EACH YEAR A CONFLICT OF INTEREST DISCLOSURE QUESTIONNAIRE. THESE DOCUMENTS ARE REVIEWED TO DETERMINE IF ANY INDIVIDUAL HAS A CONFLICT OF INTEREST THAT NEEDS TO BE ADDRESSED OR DISCLOSED.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION DOES NOT MAKE THESE DOCUMENTS AVAILABLE TO THE PUBLIC.
FORM 990, PART XI, LINE 9:CASH TRANSFER TO JAI AN RELATED TAX EXEMPT AFFILIATE INTERCOMPANY PAYABLE -504.
PART VIII LINE 2CTHERE HAVE BEEN NO CHANGES TO THE SELECTION PROCESS FOR THE INDEPENDENT AUDITOR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
JANE ADDAMS INC
1045 WEST STEPHENSON STREETFREEPORTIL61032362879689HEALTH CAREIL501(C)(3)LINE 7FREEPORT REGIONAL HEALTH CARE FOUNDATION0
FREEPORT REGIONAL HEALTHCARE SERVICES
1045 WEST STEPHENSON STREETFREEPORTIL61032363967303HEALTH CAREIL501(C)(3)LINE 3FREEPORT REGIONAL HEALTH CARE FOUNDATION0
FREEPORT REGIONAL HEALTH CARE FOUNDATION
1045 WEST STEPHENSON STREETFREEPORTIL61032363290904HEALTH CAREIL501(C)(3)LINE 110N/A
FREEPORT REGIONAL MANAGEMENT SERVICES
1045 WEST STEPHENSON STREETFREEPORTIL61032363994636HEALTH CAREIL501(C)(3)LINE 3FREEPORT REGIONAL HEALTH CARE FOUDNATION0
FREEPORT MEMORIAL HOSPITAL
1045 WEST STEPHENSON STREETFREEPORTIL61032362181997HEALTH CAREIL501(C)(3)LINE 3FREPORT REGIONAL HEALTH CARE FOUNDATION0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1MEMORIAL ENTERPRISESBusinessNameLine1Txt

US Address USAddress

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

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1FREEPORT REGIONAL HEALTH CARE FOUDNATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeCEntityTypeTxt
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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