2021-05-13T08:32:41-05:00 2020-06-30 346565596 ERNST & YOUNG US LLP 155 N WACKER DRIVE CHICAGO IL 60606 990 2019-07-01 370646367 MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS MENT 2177883922 701 NORTH FIRST STREET SPRINGFIELD IL 62781 DIANA KNAEBE SYSTEM ADMIN BEHAVIORAL HEALTH 2175887704 2021-05-13 1 JESSICA A WAGENER P01622613 3128792000 2019 2022-09-23 18:48:47Z MEMORIAL BEHAVIORAL HEALTH DIANA KNAEBE 701 NORTH FIRST STREET SPRINGFIELD IL 62781 14296111 0 5670 X WWW.MEMORIALBEHAVIORALHEALTH.ORG X 1962 IL TO IMPROVE THE HEALTH OF THE PEOPLE AND THE COMMUNITIES WE SERVE. 16 13 360 13 0 0 3312794 3135125 9686328 10024721 362556 210344 261294 368976 13622972 13739166 23053 19440 0 0 10971054 10581741 0 0 0 2515798 2455250 13509905 13056431 113067 682735 18990586 19762092 1864114 1607196 17126472 18154896 X TO IMPROVE THE HEALTH OF THE PEOPLE AND THE COMMUNITIES WE SERVE. 0 0 1705494 2374903 LINCOLN CENTER FOR DEVELOPMENTAL REHABILITATION (LCDR) PROVIDES DEVELOPMENTAL TRAINING SERVICES FOR DEVELOPMENTALLY DISABLED ADULTS. THE SERVICES ARE DESIGNED TO ENHANCE THE INDIVIDUAL'S SKILLS IN ACTIVITIES OF DAILY LIVING, TO LEAD THE INDIVIDUAL TO INDEPENDENCE AND ECONOMIC SELF-SUFFICIENCY THROUGH INSTRUCTION AND TRAINING. THE INDIVIDUAL IS PREPARED FOR LESS RESTRICTIVE INSTRUCTIONAL AND WORK SETTINGS. DEVELOPMENTAL TRAINING PROVIDES A THREE-FOLD APPROACH TO MEETING THE NEEDS OF THE DEVELOPMENTALLY DISABLED ADULT. THESE OBJECTIVES ARE (1) THERAPEUTIC DEVELOPMENTAL, (2) HUMAN INTERACTION DEVELOPMENT, AND (3) VOCATIONAL SKILLS. SERVICE UNITS ARE MEASURED BY CLIENT HOURS. LCDR OPERATED 167 DAYS AND PROVIDED 142,852 CLIENT HOURS OF SERVICE IN FISCAL YEAR 2020. 1376567 1442073 THE CRISIS/ACCESS PROGRAM PROVIDES RAPID RESPONSE TO INDIVIDUALS IN MENTAL HEALTH CRISIS, TO MEMBERS OF HIS/HER SUPPORT SYSTEM, AND THE COMMUNITY 24-HOURS/DAY. THE PROGRAM PROVIDES CRISIS INTERVENTION SERVICES, WALK-INS, & MOBILE SERVICES. SHORT-TERM CRISIS INTERVENTION OF THERAPY/COUNSELING AND PSYCHIATRIC CARE IS DESIGNED TO ADDRESS THE PRESENTING SYMPTOMS OF A PSYCHIATRIC EMERGENCY & TO AMELIORATE A CLIENT'S DISTRESS SO THAT RESOURCES & SUPPORTS CAN BE MOBILIZED & PLANNING FOR FURTHER TREATMENT CAN OCCUR. CRISIS WALK-IN IS SUPPORT & INTERVENTION OFFERED AT AN IDENTIFIED LOCATION ON AN UNSCHEDULED BASIS FOR THE PURPOSE OF STABILIZING OR RESOLVING A CRISIS SITUATION. MOBILE CRISIS SERVICE IS DELIVERED WHERE & WHEN THE CRISIS OCCURS TO ASSURE SERVICE BY MENTAL HEALTH PROFESSIONALS. MBH PROVIDED 5,388 CLIENT HOURS IN FISCAL YEAR 2020. 1107667 1403773 MBH-CHILD BEHAVIORAL THERAPY (MBH-CBT) IS THE OUTPATIENT BEHAVIORAL HEALTH PROVIDER OF CHOICE FOR PEDIATRIC MEDICAID RECIPIENTS FOR SANGAMON AND MENARD COUNTIES. MBH-CBT THERAPISTS PROVIDE OFFICE-BASED SERVICES AND ARE COMMITTED TO THE DEVELOPMENT OF COORDINATED NETWORKS OF COMPREHENSIVE SERVICES, WHICH PROVIDES CARE IN THE LEAST RESTRICTIVE, MOST NORMATIVE ENVIRONMENT CLINICALLY APPROPRIATE. THERAPISTS ALSO PROVIDE AFTER-HOURS AND WEEKEND ON-CALL COVERAGE FOR THE SASS (SCREENING, ASSESSMENT, AND SUPPORT SERVICES) PROGRAM TO MEET THE CONTRACTUAL REQUIREMENTS SET BY THE STATE OF ILLINOIS FOR CRISIS INTERVENTION. MBH PROVIDED 12,868 CLIENT HOURS IN FISCAL YEAR 2020. 477071 604 634273 OTHER DEVELOPMENTAL DISABILITY PROGRAMS 5680057 18836 4321031 OTHER MENTAL HEALTH PROGRAMS 19328 13937 HOUSING SERVICES 6176456 19440 4969241 10366184 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 17 0 1 360 1 0 0 0 0 0 0 0 0 0 1 0 0 0 X 16 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X LAURA RAPAPORT DIRECTOR AMBULATORY ACCOUNTING 2175887759 701 NORTH FIRST STREET SPRINGFIELD IL 62781 X SANDY ROBINSON II DIRECTOR (THRU FEB 20) 0.50 X 0 0 0 DR VIRGINIA DOLAN DIRECTOR & MPS PHYSICIAN 0.70 49.30 X 0 515542 87907 VEA CRAWFORD DIRECTOR (FROM MAR 20) 0.20 X 0 0 0 ANNE MORGAN PHD DIRECTOR 0.70 X 0 0 0 ERICA SMITH DIRECTOR 0.70 X 0 0 0 SCOTT SABIN DIRECTOR 0.70 X 0 0 0 JANET S STOVER DIRECTOR (THRU FEB 20) 0.50 X 0 0 0 DANIEL WRIGHT DIRECTOR 0.70 X 0 0 0 SAIF MOUILISH DIRECTOR 0.70 X 0 0 0 DR NICOLE FLORENCE DIRECTOR & MPS PHYSICIAN 0.70 49.30 X 0 502781 105538 IRIS WESLEY DIRECTOR 0.70 X 0 0 0 KENNETH WINSLOW DIRECTOR 0.70 X 0 0 0 DR KARI WOLF DIRECTOR 0.70 X 0 0 0 LEIGH STEINER PHD CHAIR 0.35 0.35 X X 0 0 375 BRENT BORAH VICE CHAIR 0.35 0.35 X X 0 0 0 WANDA LEE ROHLFS TREASURER 0.35 0.35 X X 0 0 0 TIFFANY NIELSON PHD SECRETARY 0.35 0.35 X X 0 0 0 JANICE GAMBACH PRESIDENT (THRU DEC 19) 47.50 2.50 X 0 222235 27438 DIANA KNAEBE SYSTEM ADMINISTRATOR (FROM MAR 20) 47.50 2.50 X 0 0 0 KATIE KEIM CHIEF FINANCIAL OFFICER 5.00 45.00 X 0 616905 106609 JAMESON ROSZHART PRESIDENT MHS AMBULATORY GROUP 5.00 45.00 X 0 460078 90502 CYNTHIA A BUTLER ADMINISTRATOR CLINICAL SERVICES 50.00 X 138925 0 25866 CYNTHIA MESTER SYSTEM DIRECTOR 50.00 X 118787 0 26639 ROBYN LUKE ADMINISTRATOR ADMINISTRATIVE SERVICES 50.00 X 116079 0 13977 373791 2317541 484851 3 0 1 0 0 15569 319055 2632105 168396 92655 3135125 MENTAL HEALTH SERVICES 621400 7303370 7303370 DD SERVICES 621400 2707414 2707414 HOUSING SERVICES 621400 13937 13937 10024721 135931 135931 206852 8522 198330 198330 198330 562053 487640 74413 74413 74413 205894 60783 145111 145111 TRAINING REIMBURSEMENT 900099 9385 9385 RECORD FEES 900099 5784 5784 PROMPT PAY INTEREST PE 900099 5377 5377 4989 4989 25535 13739166 10189990 0 414051 19440 19440 245097 100984 144113 7787613 6621729 1165884 373898 324172 49726 1555184 1290801 264383 619949 542404 77545 4109 4109 38571 10019 28552 1415 1415 85423 83111 2312 348 348 270357 210456 59901 104097 81957 22140 429953 363180 66773 171731 155331 16400 11198 365 10833 338885 308962 29923 88098 88098 MANAGEMENT FEES 724005 724005 PROVISION FOR UNCOLLECT 82636 82636 FOOD & DIETARY SUPPLIES 65758 61128 4630 MEMBERSHIP DUES 25147 3435 21712 13519 13519 13056431 10366184 2690247 0 415 415 1720069 1230000 1320401 1990490 160615 144541 11166582 8197675 2990316 2968907 12737458 13320133 61312 40000 0 67606 18990586 19762092 1791683 1421093 72431 165667 0 20436 1864114 1607196 X 17126472 18154896 17126472 18154896 18990586 19762092 682735 345689 0 X 0 1 X 1 1 1 X 3630471 3593354 3334466 3312794 3135125 17006210 3630471 3593354 3334466 3312794 3135125 17006210 2075459 14930751 257036 257485 238855 255255 342783 1351414 33744 245155 136824 70557 25535 511815 18869439 50874131 0.79130 0.81410 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: REIMBURSEMENT FROM SUBSIDIARY - 2016 AMOUNT: $ 182,273. MENTAL HEALTH TRAINING - REGISTRATION FEES - 2015 AMOUNT: $ 7,770. 2016 AMOUNT: $ 11,952. 2017 AMOUNT: $ 47,483. 2018 AMOUNT: $ 13,323. 2019 AMOUNT: $ 9,385. RECORD COPY FEES - 2015 AMOUNT: $ 12,002. 2016 AMOUNT: $ 11,576. 2017 AMOUNT: $ 8,220. 2018 AMOUNT: $ 18,525. 2019 AMOUNT: $ 5,784. OTHER REVENUE - 2015 AMOUNT: $ 3,772. 2016 AMOUNT: $ 3,504. 2017 AMOUNT: $ 17,585. 2018 AMOUNT: $ 35,371. 2019 AMOUNT: $ 26,301. PROMPT PAY INTEREST - 2015 AMOUNT: $ 6,657. 2016 AMOUNT: $ 25,232. 2017 AMOUNT: $ 12,067. 2018 AMOUNT: $ 12,835. 2019 AMOUNT: $ 5,377. PARTNERSHIP INCOME - 2015 AMOUNT: $ -11,645. 2016 AMOUNT: $ -17,500. 2017 AMOUNT: $ 18,935. 2018 AMOUNT: $ -9,497. 2019 AMOUNT: $ -21,312. NON-RECORD FEES - 2015 AMOUNT: $ 8,578. 2016 AMOUNT: $ 12,577. 2017 AMOUNT: $ 13,297. TRAINING CONFERENCES - 2015 AMOUNT: $ 6,610. 2016 AMOUNT: $ 15,541. 2017 AMOUNT: $ 19,237. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 1415 0 0 0 1415 0 PART II-B, LINE 1: MBH IS A DUES PAYING MEMBER OF THE ILLINOIS ASSOCIATION OF REHABILITATION FACILITIES, INC. (IARF). A PERCENTAGE OF MBH'S DUES TO IARF GO TOWARDS LOBBYING ACTIVITIES. 996667 996667 7368452 5920407 1448045 11753 3700 8053 2290655 1985815 304840 499055 287753 211302 2968907 RENTAL PROPERTY - NON-CURRENT 20436 20436 X PART X, LINE 2: MBH IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE UNITED STATE INTERNAL REVENUE CODE. MBH IS NOT CONSIDERED A PRIVATE FOUNDATION. IN ACCORDANCE WITH FASB ACS 740-10 WHICH ADDRESSES INCOME TAXES, MBH BELIEVES THERE ARE NO SIGNIFICANT UNCERTAIN TAX POSITIONS RESULTING IN LIABILITIES THAT WOULD HAVE BEEN REQUIRED FOR THE YEAR ENDED JUNE 30, 2020. MBH'S FORM 990 FOR 2017, 2018, AND 2019 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS), GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. 1 EDUCATIONAL GRANTS 1 3500 TUITION REIMBURSEMENT 2 15286 SPECIFIC ASSISTANCE 1 654 PART I, LINE 2: EDUCATIONAL GRANTS - MEMORIAL BEHAVIORAL HEALTH'S EDUCATIONAL GRANT PROGRAM PROVIDES THE OPPORTUNITY FOR EMPLOYEES TO PURSUE ADDITIONAL EDUCATION IN EXCHANGE FOR A WORK COMMITMENT ONCE THE EDUCATION IS COMPLETED. EDUCATIONAL GRANTS ARE AVAILABLE TO THOSE PURSUING HEALTH CARE CAREERS THAT ARE DEEMED CRITICAL TO THE ORGANIZATION'S PRESENT OR PROJECTED STAFFING NEEDS. GRANT APPLICATIONS FOR ALL OTHER CAREERS WILL BE REVIEWED ON A CASE-BY-CASE BASIS WITH A FINAL DETERMINATION TO BE MADE BY THE MHS WORKFORCE STRATEGIES ADVISORY COUNCIL. TUITION REIMBURSEMENT - FUNDING FOR THE EDUCATION OF MBH'S EMPLOYEES IS BASED UPON THE NEEDS OF THE ORGANIZATION AS WELL AS THE EMPLOYEE'S EDUCATIONAL GOALS. EMPLOYEES WILL BE AWARDED TUITION REIMBURSEMENT BASED ON THE EMPLOYEE'S PRESENT JOB SKILL NEEDS OR TO PREPARE THE EMPLOYEE FOR FUTURE ADVANCEMENT WITHIN MEMORIAL HEALTH SYSTEM. THE TUITION REIMBURSEMENT PROCESS REQUIRES EMPLOYEES TO RECEIVE PRIOR APPROVAL FROM THEIR MANAGERS FOR THE COURSEWORK. SPECIFIC ASSISTANCE - MBH PROVIDES ASSISTANCE TO CLIENTS CURRENTLY RECEIVING SERVICES IN ONE OF THE FOLLOWING PROGRAMS: SUPPORTED EMPLOYMENT, PROJECTS IN ASSISTANCE FOR TRANSITION FROM HOMELESSNESS (PATH), COMMUNITY INTEGRATED LIVING ARRANGEMENTS (CILA). THIS INCLUDES BUT IS NOT LIMITED TO, MEDICATIONS, CLOTHING, DOCTOR VISITS, AND DENTAL VISITS. TO BE ELIGIBLE FOR THE ASSISTANCE, THE CLIENT MUST HAVE BEEN DIAGNOSED WITH A MENTAL ILLNESS OR A DEVELOPMENTAL DISABILITY, AND CURRENTLY BE RECEIVING SERVICES AT MBH. THE CLIENT IS ASSIGNED A CASE MANAGER WHO IS RESPONSIBLE FOR DETERMINATION OF THE TYPE OF ASSISTANCE NEEDED. BEFORE THE ASSISTANCE IS PROVIDED, THE SUPERVISOR OF THE CASE MANAGER MUST PRE-APPROVE THE ASSISTANCE TO BE PURCHASED. THE CASE MANAGER INITIATES THE PURCHASE. THE CHECK IS MADE PAYABLE DIRECTLY TO THE VENDOR AND/OR LANDLORD. THE CLIENT IS REQUIRED TO SIGN THE VENDOR RECEIPT TO ACKNOWLEDGE THAT HE OR SHE RECEIVED THE GOODS, SERVICES, OR RENTAL ASSISTANCE. CLIENTS DO NOT DIRECTLY RECEIVE CASH. 0 1 0 0 0 0 0 0 0 DR VIRGINIA DOLAN DIRECTOR & MPS PHYSICIAN 0 416723 0 13745 0 85074 0 27312 0 60595 0 603449 0 28245 DR NICOLE FLORENCE DIRECTOR & MPS PHYSICIAN 0 348474 0 32666 0 121641 0 24900 0 80638 0 608319 0 0 JANICE GAMBACH PRESIDENT (THRU DEC 19) 0 190741 0 24927 0 6567 0 16364 0 11074 0 249673 0 0 KATIE KEIM CHIEF FINANCIAL OFFICER 0 443391 0 162807 0 10707 0 74674 0 31935 0 723514 0 0 JAMESON ROSZHART PRESIDENT MHS AMBULATORY GROUP 0 320570 0 129155 0 10353 0 60107 0 30395 0 550580 0 0 CYNTHIA A BUTLER ADMINISTRATOR CLINICAL SERVICES 122203 0 16191 0 531 0 13414 0 12452 0 164791 0 0 0 PART I, LINE 3 MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION OF MEMORIAL BEHAVIORAL HEALTH, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: 1) COMPENSATION COMMITTEE; 2) INDEPENDENT COMPENSATION CONSULTANT; 3) COMPENSATION SURVEY OR STUDY; AND 4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION OF MEMORIAL BEHAVIORAL HEALTH, PROVIDES CERTAIN SUPPLEMENTAL RETIREMENT BENEFITS TO THE FOLLOWING OFFICER AND KEY EMPLOYEES: KATIE KEIM, $52,631, AND JAMESON ROSZHART, $37,957. THESE BENEFITS ARE PROVIDED THROUGH A NONQUALIFIED DEFERRED COMPENSATION PLAN, UNDER WHICH THE BENEFITS BEING EARNED ARE SUBJECT TO A "SUBSTANTIAL RISK OF FORFEITURE". THE SUPPLEMENTAL RETIREMENT BENEFITS ARE STRUCTURED TO PROVIDE A RETENTION INCENTIVE THAT HAS BEEN DETERMINED BY THE LEADERSHIP COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF MEMORIAL HEALTH SYSTEM TO BE OF SUBSTANTIAL VALUE TO THE ORGANIZATION. THE FOLLOWING DIRECTOR AND KEY EMPLOYEES RECEIVED DEFERRED COMPENSATION PAYOUTS IN THE CALENDAR YEAR FROM A RELATED ORGANIZATION: DR. VIRGINIA DOLAN, $84,514, AND DR. NICOLE FLORENCE, $121,388. PART I, LINE 7 MEMBERS OF SENIOR MANAGEMENT OF MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION OF MEMORIAL BEHAVIORAL HEALTH, RECEIVE COMPENSATION UNDER PLANS SPONSORED BY MEMORIAL HEALTH SYSTEM. THESE AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II COLUMN (B) (II). THE PLANS ARE DESIGNED TO CONDITION A PORTION OF COMPENSATION ON PERFORMANCE AGAINST PREDETERMINED FINANCIAL, MISSION, AND INDIVIDUAL GOALS APPROVED IN ADVANCE BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS OF MEMORIAL HEALTH SYSTEM. THE LEADERSHIP COMPENSATION COMMITTEE OF THE BOARD HAS REVIEWED THE REASONABLENESS OF ALL SUCH PAYMENTS, AND HAS CONCLUDED, AS THE RESULT OF A PROCESS THAT IS DESIGNED TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER FEDERAL TAX LAW, THAT ALL SUCH AMOUNTS ARE REASONABLE AND DID NOT EXCEED FAIR MARKET VALUE FOR THE SERVICES RENDERED. X 1 92655 FMV 0 0 1 0 PART I, COLUMN (B): THE NUMBER OF ITEMS RECEIVED = 1 MULTI-PASSENGER VAN FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERSHIP OF THE CORPORATION CONSISTS OF ONE CORPORATE MEMBER, MEMORIAL HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBER OF THE CORPORATION ELECTS THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE BYLAWS OF THE CORPORATION REQUIRE THE ADVANCE APPROVAL OF THE CORPORATE MEMBER FOR CORPORATE, ADMINISTRATIVE AND OPERATIONAL ACTIONS WHICH INCLUDE, BUT ARE NOT LIMITED TO, THE APPROVAL OF ANY ANNUAL OR LONG-TERM CAPITAL OR OPERATING BUDGET, AMENDMENT, ALTERATION OR REPEAL OF THE ARTICLES OF INCORPORATION OR BYLAWS, CREATION OR ELIMINATION OF A PROGRAM OR SERVICE, APPROVAL OF BORROWING WHICH EXCEEDS $250,000, APPROVAL OF ANY QUANTITY OF DEBT WHICH EXCEEDS $250,000, APPROVAL OF ANY DISSOLUTION, MERGER OR CONSOLIDATION OR SALE OF THE ASSETS OF THE CORPORATION WHICH EXCEED $250,000, APPROVAL OF THE ORGANIZATION OF AN AFFILIATE/SUBSIDIARY, APPROVAL FOR APPLICATION OF CERTIFICATE OF NEED, APPROVAL TO ADOPT ANY LONG-TERM OR MASTER INSTITUTIONAL PLAN, APPROVAL TO SELL OR PURCHASE REAL PROPERTY WHICH EXCEEDS $250,000, APPROVAL TO CHANGE INSURANCE SPECIFICATIONS OR LIMITS, APPROVAL TO SELECT OR CHANGE INDEPENDENT AUDITORS AND LEGAL COUNSEL, APPROVAL TO ENTER INTO, RENEW OR MODIFY CONTRACTS TO PROVIDE COVERED MENTAL HEALTH CARE SERVICES TO BENEFICIARIES OF HEALTH MAINTENANCE ORGANIZATIONS, HEALTH CARE SERVICE PLANS, INDEPENDENT PRACTICE ASSOCIATIONS, PREFERRED PROVIDER ORGANIZATIONS, INSURANCE COMPANIES AND OTHER PURCHASERS OF HEALTH SERVICES, APPROVAL TO ENTER INTO ANY CONTRACT OR AGREEMENT WHICH I) PROVIDES FOR THE PAYMENT OR PERFORMANCE BY EITHER PARTY EXCEEDING AN AGGREGATE VALUE OF $250,000, II) IS NOT TERMINABLE WITHOUT PAYMENT OR PENALTY OF 60 DAYS OR LESS NOTICE III)IS BETWEEN THE CORPORATION OR AN AFFILIATE AND AN OFFICER, DIRECTOR OR KEY EMPLOYEE THEREOF. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT PREPARES AND REVIEWS THE RETURN. AN OUTSIDE TAX ADVISOR THEN REVIEWS THE RETURN, PROVIDING COMMENTS AND GUIDANCE AS NEEDED. MBH BOARD MEMBERS ARE THEN PROVIDED WITH A FINAL COPY OF FORM 990 AND ITS SUPPORTING SCHEDULES FOR REVIEW AT A REGULARLY SCHEDULED BOARD MEETING. REVIEW, DISCUSSION, AND RATIFICATION OF THE FORM ARE AN AGENDA ITEM. FORM 990, PART VI, SECTION B, LINE 12C MBH BOARD MEMBERS RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY ANNUALLY. BOARD MEMBERS COMPLETE CONFLICT OF INTEREST STATEMENTS ON AN ANNUAL BASIS; BOARD MEMBERS ARE REMINDED TO UPDATE THEIR STATEMENTS IF CIRCUMSTANCES CHANGE. BOARD MEMBERS ARE REMINDED OF THE NEED TO ABSTAIN FROM VOTING WHEN BOARD RESOLUTIONS REQUIRE SUCH ACTION. BOARD MEMBERS ARE APPRAISED BY MANAGEMENT OF POTENTIAL CONFLICTS WITH MEETING AGENDA ITEMS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION DETERMINATIONS OF MBH'S PRESIDENT AND OTHER OFFICERS WERE CONDUCTED BY MEMORIAL HEALTH SYSTEM'S MANAGEMENT, A RELATED ORGANIZATION OF THE FILING ORGANIZATION. MBH'S PRESIDENT IS AN EMPLOYEE OF MEMORIAL HEALTH SYSTEM (MHS). MHS ANNUALLY ENGAGES A CONSULTING FIRM TO CONDUCT A COMPENSATION REVIEW, WHICH INCLUDES A COMPARABILITY STUDY FOR ALL EXECUTIVES. MHS'S LEADERSHIP COMPENSATION COMMITTEE, A PART OF ITS BOARD OF DIRECTORS, REVIEWS THE CONSULTANT REPORT. COMPENSATION COMMITTEE DECISIONS AND REPORTS ARE CONTEMPORANEOUSLY DOCUMENTED IN THE BOARD OF DIRECTOR AND COMPENSATION COMMITTEE MINUTES AS APPROPRIATE. TWO OFFICERS ARE EMPLOYEES OF AN AFFILIATED ORGANIZATION, MEMORIAL PHYSICIANS SERVICES. THEIR COMPENSATION IS REVIEWED BY THE SAME OUTSIDE CONSULTING FIRM THAT REVIEWS THE COMPENSATION OF MBH'S PRESIDENT. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS OF MBH, SUCH AS ARTICLES OF INCORPORATION AND ANY AMENDMENTS THERETO, ARE AVAILABLE TO THE GENERAL PUBLIC THROUGH THE ILLINOIS SECRETARY OF STATE'S OFFICE. THESE GOVERNING DOCUMENTS, AS WELL AS THE BYLAWS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS, ARE AVAILABLE UPON REQUEST FROM THE CORPORATION. THESE DOCUMENTS ARE AVAILABLE FOR THE SAME PERIOD OF TIME AS SET FORTH IN IRC SECTION 6104(D). PART VII, SECTION A JAN GAMBACH, DIANA KNAEBE AND JAMESON ROSZHART WERE EMPLOYED BY A RELATED ORGANIZATION, MEMORIAL HEALTH SYSTEM (MBH'S CORPORATE PARENT ORGANIZATION), AND THEREFORE ARE REPORTED AS A MEMORIAL HEALTH SYSTEM EMPLOYEE FOR TAX REPORTING PURPOSES (W-2). HOWEVER, THESE THREE OFFICER'S COMPENSATION EXPENSE IS ALLOCATED TO MBH ACCORDING TO THE TIME SPENT IN LEADERSHIP TO MBH AND THEREFORE INCLUDED ON PART IX, LINE 5. SPRINGFIELD RESIDENTIAL SERVICES 710 NORTH EIGHTH STREET SPRINGFIELD IL 62702 371298589 RESIDENTIAL HUD HOUSING PROJECT FOR MENTALLY ILL IL 501(C)(3) LINE 7 MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS 1 MEMORIAL HEALTH SYSTEM 701 NORTH FIRST ST SPRINGFIELD IL 627810001 371110690 PARENT IL 501(C)(3) LINE 12B, II N/A 0 MEMORIAL MEDICAL CENTER 701 NORTH FIRST ST SPRINGFIELD IL 627810001 370661220 HOSPITAL SERVICES IL 501(C)(3) LINE 3 MEMORIAL HEALTH SYSTEM 0 MEMORIAL HEALTH VENTURES 701 NORTH FIRST ST SPRINGFIELD IL 627810001 363492266 HEALTHCARE ACTIVITIES IL 501(C)(3) LINE 10 MEMORIAL HEALTH SYSTEM 0 ABRAHAM LINCOLN MEMORIAL HOSPITAL 315 EIGHTH ST LINCOLN IL 62656 370723793 HOSPITAL SERVICES IL 501(C)(3) LINE 3 MEMORIAL HEALTH SYSTEM 0 TAYLORVILLE MEMORIAL HOSPITAL 201 EAST PLEASANT TAYLORVILLE IL 62568 370661250 HOSPITAL SERVICES IL 501(C)(3) LINE 3 MEMORIAL HEALTH SYSTEM 0 MEMORIAL HOME SERVICES 720 NORTH BOND SPRINGFIELD IL 627024915 370714225 HOME HEALTH, HOSPICE, AND CONTINUOUS CARE SERVICES IL 501(C)(3) LINE 7 MEMORIAL HEALTH SYSTEM 0 MEMORIAL PHYSICIAN SERVICES 701 NORTH FIRST ST SPRINGFIELD IL 627810001 371181194 HEALTH CLINICS IL 501(C)(3) LINE 10 MEMORIAL HEALTH SYSTEM 0 MEMORIAL MEDICAL CENTER FOUNDATION 1 MEMORIAL PLAZA SPRINGFIELD IL 62781 371110301 GRANTS TO HOSPITALS, OTHER CHARITABLE ORGANIZATIONS, AND SCHOLARSHIPS IL 501(C)(3) LINE 7 MEMORIAL MEDICAL CENTER 0 TAYLORVILLE MEMORIAL HOSPITAL FOUNDATION INC 201 EAST PLEASANT TAYLORVILLE IL 62568 371337485 GRANTS TO OTHER CHARITABLE ORGANIZATIONS AND HOSPITALS IL 501(C)(3) LINE 7 TAYLORVILLE MEMORIAL HOSPITAL 0 ABRAHAM LINCOLN HEALTHCARE FOUNDATION 315 EIGHTH ST LINCOLN IL 62656 363492268 GRANTS TO OTHER CHARITABLE ORGANIZATIONS AND HOSPITALS IL 501(C)(3) LINE 7 MEMORIAL HEALTH SYSTEM 0 PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION 1600 WEST WALNUT STREET JACKSONVILLE IL 62650 370661230 HOSPITAL SERVICES IL 501(C)(3) LINE 3 MEMORIAL HEALTH SYSTEM 0 PASSAVANT AREA HOSPITAL FOUNDATION 1600 WEST WALNUT STREET JACKSONVILLE IL 62650 461037396 SUPPORTING THE HOSPITAL IL 501(C)(3) LINE 7 PASSAVANT MEMORIAL AREA HOSPITAL 0 JACKSONVILLE CRNA'S INC 1600 WEST WALNUT STREET JACKSONVILLE IL 62650 273093265 CRNA SERVICES IL 501(C)(3) LINE 10 PASSAVANT MEMORIAL AREA HOSPITAL 0 DECATUR MEMORIAL HOSPITAL 2300 NORTH EDWARD STREET DECATUR IL 625264163 370661199 HOSPITAL SERVICES IL 501(C)(3) LINE 3 MEMORIAL HEALTH SYSTEM 0 DECATUR MEMORIAL HEALTH FOUNDATION 2300 NORTH EDWARD STREET DECATUR IL 625264163 371169605 SUPPORTING THE HOSPITAL IL 501(C)(3) LINE 12A, I DECATUR MEMORIAL HOSPITAL 0 HEARTLAND RISK MANAGEMENT 2300 NORTH EDWARD STREET DECATUR IL 625264163 454256254 SUPPORTING THE HOSPITAL IL 501(C)(3) LINE 12A, I DECATUR MEMORIAL HOSPITAL 0 MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS 701 NORTH FIRST STREET SPRINGFIELD IL 62781 371190216 PROVIDE DURABLE MEDICAL EQUIPMENT AND SUPPLIES TO PATIENTS IL N/A C 0 PASSAVANT PHYSICIAN ASSOCIATION 1600 WEST WALNUT STREET JACKSONVILLE IL 62650 261200566 PHYSICIAN SERVICES IL N/A C 0 0 0 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 0 0 SPRINGFIELD RESIDENTIAL SERVICES O 30133 FMV SPRINGFIELD RESIDENTIAL SERVICES L 14014 FMV SPRINGFIELD RESIDENTIAL SERVICES Q 14819 FMV