2021-06-14T13:45:31-05:00 2020-07-31 450250958 Eide Bailly LLP 1545 Associates Dr Ste 101 Dubuque IA 520022299 990 2019-08-01 371193348 Carlinville Area Hospital Foundation CARL 2178543141 20733 North Broad Street Carlinville IL 62626 Brian Burnside Carlinville Area Hospital CEO 2178543141 2021-06-11 1 Kim Hunwardsen CPA P00484560 5635561790 2021-06-10 2019 2022-09-23 18:48:47Z Brian Burnside 20733 North Broad Street Carlinville IL 62626 132188 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 18 0 0 1221479 8799 0 0 51944 52197 -7332 13368 1266091 74364 1039427 209414 0 0 0 0 0 0 15324 20275 16537 1059702 225951 206389 -151587 1651993 1434699 17576 0 1634417 1434699 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 209414 209414 16921 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. 209414 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 1 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 1 1 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 Patrick Nudo 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 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 Mary Jo Reichmann Member 0.30 0.00 X 0 0 0 Chad Bowker Member 0.30 0.00 X 0 0 0 Heather DeNeve Member 0.30 0.00 X 0 0 0 Susan LeVora Member 0.30 0.00 X 0 0 0 Katie Goodman-Thomas OD Member 0.30 0.00 X 0 0 0 Tom Denby Member 0.30 0.00 X 0 0 0 Kenneth Reid CEO Carlinville Hosp until 1/31/20 1.00 40.30 X 0 0 0 Michael Brown CFO Carlinville Hospital 1.00 40.30 X 0 0 0 Michael Layfield -Interim CEO Carlinville Hosp starting 1/27/20 1.00 40.30 X 0 0 0 0 0 0 0 0 0 0 0 8799 8799 34026 34026 18171 0 18171 18171 18171 4187 8799 7740 -3553 -3553 67005 50084 16921 16921 74364 16921 0 48644 186914 186914 22500 22500 1213 1213 6694 6694 Uncollectible pledges 7502 7502 Donor relations 1048 1048 80 80 225951 209414 1213 15324 415783 216827 7502 1228708 1217872 1651993 1434699 17576 0 17576 0 X 1260971 1248167 373446 186532 1634417 1434699 1651993 1434699 X -151587 -31210 -16921 X X 0 1 X 0 0 X 34912 39452 16613 1221479 8799 1321255 34912 39452 16613 1221479 8799 1321255 1170836 150419 18013 16761 20863 47296 34026 136959 1458214 404074 0.10320 0.10570 X Carlinville Area Hospital Foundation fails to meet the public support test for the fiscal years ending July 31, 2016 through July 31, 2020. Based on the following facts and circumstances, the organization should continue to be recognized as a publicly supported organization under Internal Revenue Code Section 509(a)(1).Ten-Percent of Support:The total amount of public support for the organization during the above-mentioned period is 10.32%. Therefore, the total public support is greater than the required 10%.Attraction of Public Support and Sources of Support:The Foundation does not receive more than 33 1/3% of its support from government units or from contributions from the general public because one donor gave two large contributions in separate years. The first donation was received in fiscal year end July 31, 2015 and was reported as an unusual contribution. The second donation was received in fiscal year end July 31, 2019 and was not reported as an unusual contribution. The donation was intended for Carlinville Hospital but was given to the Foundation. The public support percentage without the large donation would have been 46.96%. The Foundation actively seeks contributions from the general public. These targeted efforts are aimed at increasing overall public support of the organization.Representative Governing Body:Carlinville Area Hospital Foundation is served by a governing body that represents the broad interest of the public and is comprised of community leaders residing or working in the Carlinville, Illinois area. The Foundation's mission and program service accomplishments are structured to support Carlinville Area Hospital and persons living in the Carlinville area with the availability of primary and emergency health care services. Schedule A, Part VI, List of Unusual Grants: Description: Cash contribution Date: 07/31/18 Amount: 492309. 1 24158 67005 50084 41079 0 0 X 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. 1 Carlinville Area Hospital Association 20733 North Broad Street Carlinville IL 62626 370645239 501(c)(3) 186914 Hospital building and physician support 1 0 Educational medical scholarships 9 22500 Part I, Line 2: Carlinville Area Hospital Foundation's purpose is to support primary and emergency health care services for persons living in the Carlinville area and in particular Carlinville Area Hospital Association. The Foundation's grants and support are given to the Hospital to assist in their exempt purpose of providing health care services. The Hospital provides the Foundation with proofs of purchase to ensure the money is used appropriately. The Carlinville Area Hospital Foundation started 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. Kenneth Reid, Michael Layfield, and Michael Brown have a business relationship with Dennis Pickrel, Richard Walden, and Ralph March. 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: Kenneth Reid, CEO, Michael Brown, CFO, and Michael Layfield, Interim CFO, are employees of HealthTech Management Services, Inc., an unrelated management company of Carlinville Area Hospital. Kenneth Reid and Michael Brown 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 -16,921. 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