ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (EIN 55-0809159)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-08-27
- IRS object ID
- 202002409349300800
- Schema version
- 2019v5.1
- 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 | 2020-08-27T07:49:49-05:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550809159 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ILLINOIS CRITICAL ACCESS HOSPITAL | BusinessNameLine1Txt |
| Business Name Line2 | NETWORK | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ILLI | BusinessNameControlTxt |
| Phone | 8158752999 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1945 VANS WAY | AddressLine1Txt |
| City | PRINCETON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61356 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PATRICIA SCHOU | PersonNm |
| Person Title | EXECUITVE DIRECTOR | PersonTitleTxt |
| Phone | 8158752999 | PhoneNum |
| Signature | 2020-08-21 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2020-08-20 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 216.54.158.12 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-08-21 | IPDt |
| IP Tm | 11:40:34 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 05365E77D662BDC17E2AAA2C6021CC7EC3235B8D | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2020-11-06 18:47:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PATRICIA SCHOU | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1945 VANS WAY | AddressLine1Txt |
| City | PRINCETON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61356 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $5,092,771 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.ICAHN.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2002 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF ICAHN IS TO STRENGTHEN CRITICAL ACCESS AND SMALL, RURAL HOSPITALS THROUGH COLLABORATION. BETTER TOGETHER, ICAHN AND ITS 57 MEMBER HOSPITALS MAKE IT THEIR OVERARCHING GOAL TO PRESERVE ACCESS TO RURAL HEALTHCARE WHILE IMPROVING THE VIBRANCY AND VIABILITY OF THE COMMUNITIES SERVED. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 24 | TotalEmployeeCnt |
| Total Volunteers | 56 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,971,791 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,471,371 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $3,310,679 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $2,582,631 | CYProgramServiceRevenueAmt |
| PY Investment Income | $32,656 | PYInvestmentIncomeAmt |
| CY Investment Income | $34,279 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $4,490 | CYOtherRevenueAmt |
| PY Total Revenue | $5,315,126 | PYTotalRevenueAmt |
| CY Total Revenue | $5,092,771 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,050,036 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,581,872 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,803,097 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,755,983 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,489,722 | PYOtherExpensesAmt |
| CY Other Expenses | $1,746,915 | CYOtherExpensesAmt |
| PY Total Expenses | $4,342,855 | PYTotalExpensesAmt |
| CY Total Expenses | $5,084,770 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $972,271 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $8,001 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,815,469 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,931,481 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,250,895 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,317,084 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,564,574 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,614,397 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | ICAHN IS A NOT-FOR-PROFIT 501(C)(3) CORPORATION ESTABLISHED IN 2003 FOR THE PURPOSES OF SHARING RESOURCES, EDUCATION, PROMOTING EFFICIENCY AND BEST PRACTICE AND IMPROVING HEALTH CARE SERVICES FOR MEMBER CRITICAL ACCESS HOSPITALS AND THEIR RURAL COMMUNITIES. ICAHN, WITH 56 MEMBER HOSPITALS, IS AN INDEPENDENT NETWORK GOVERNED BY A NINE-MEMBER BOARD OF DIRECTORS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $3,384,153 | ExpenseAmt |
| Grant | $1,581,872 | GrantAmt |
| Revenue | $1,817,575 | RevenueAmt |
| Desc | ICAHN PROVIDES TECHNICAL ASSISTANCE TO SMALL RURAL HOSPITALS:1) TO HELP THEM WITH ADMINISTRATIVE PROCESSES FOR CRITICAL ACCESS HOSPITALS2) TO SHARE RESOURCES WITH MEMBERS3) TO IMPLEMENT PROGRAMS TO IMPROVE QUALITY AND EFFICIENCIES OF MEDICAL SERVICES PROVIDED BY RURAL HEALTH CARE FACILITIES.4) TO PROVIDE CODING SUPPORT WHEN HOSPITALS NEED COVERAGE FOR UNANTICIPATED CERTIFIED CODE ABSENCES, VACANCIES, OR BACKLOGSERVES APPROXIMATELY 57 HOSPITALS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $376,192 | ExpenseAmt |
| Revenue | $529,767 | RevenueAmt |
| Desc | ICAHN PROVIDES INFORMATION TECHNOLOGY ASSISTANCE TO SMALL RURAL HOSPITALS ACROSS THE STATE, SERVING APPROXIMATELY 56 HOSPITAL. SERVICES ARE AVAILABLE TO ALL 56 HOSPITALS IF THE CHOOSE TO UTILIZE THEM. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $255,570 | ExpenseAmt |
| Revenue | $235,289 | RevenueAmt |
| Desc | ICAHN PROVIDES QUALITY EDUCATIONAL OPPORTUNITIES TO MEMBER HOSPITALS FOCUSING ON RURAL HEALTH ISSUES AND STRATEGIES FOR SUCCESS THROUGH ONSITE MEETINGS, VIDOECONFERENCING, AND WEB-BASED TRAINING. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $4,015,915 | 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 | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | 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 | Yes (1) | DisregardedEntityInd |
| Related Entity | 0 | 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 | 22 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 24 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | 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 | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | 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 | Yes (1) | 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 | 0 | 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 | DIANE GARLAND | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8158752999 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1945 VANS WAY | AddressLine1Txt |
| City | PRINCETON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61356 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| KATHY HULL | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KEN REID | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TED ROGALSKI | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PAUL SKOWRON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| OLLIE SMITH | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DOUG FLORKOWSKI | |||||||
| PRESIDENT | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| JOANNE EMGE | |||||||
| PRESIDENT - ELECT | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| TRACY BAUER | |||||||
| PAST PRESIDENT | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| ALISA COLEMAN | |||||||
| SECRETARY/TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| PATRICIA SCHOU | |||||||
| EXECUTIVE DIRECTOR | 40.00 | $245,170 | $0 | $22,673 | Yes (X) | ||
| DIANE GARLAND | |||||||
| DIRECTOR OF FINANCE | 40.00 | $91,969 | $0 | $12,944 | Yes (X) | ||
| CURTIS ZIMMERMAN | |||||||
| DIRECTOR BUSINESS SERVICES | 40.00 | $121,034 | $0 | $32,349 | Yes (X) | ||
| ANGELA CHARLET | |||||||
| DIRECTOR QUALITY SERVICES | 40.00 | $123,523 | $0 | $14,097 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $581,696 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $82,063 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | 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 | GREG DAVIS MD LTD | PersonNm |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 204 PARK AVENUE EAST | AddressLine1Txt |
| City | PRINCETON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61356 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | MEDICAL CONSULTING | ServicesDesc |
| Compensation | $150,000 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Membership Dues | $456,600 | MembershipDuesAmt |
| Government Grants | $2,014,771 | GovernmentGrantsAmt |
| Total Contributions | $2,471,371 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| IL RURAL COMMUNITY CAR | 900099 | $571,497 | $571,497 |
| IT SERVICES | 541519 | $529,767 | $529,767 |
| CONSULTING REVENUE | 541610 | $238,992 | $238,992 |
| PROFESSIONAL EDUCATION | 611710 | $116,473 | $116,473 |
| WORKSHOP/MEETING FEES | 900099 | $50,107 | $50,107 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,075,795 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,075,795 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $2,582,631 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $34,279 | TotalRevenueColumnAmt |
| Exclusion | $34,279 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RECOVERY OF BAD DEBT | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $4,490 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,490 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $4,490 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,092,771 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,587,121 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $34,279 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,581,872 | TotalAmt |
| Program Services | $1,581,872 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $372,756 | TotalAmt |
| Program Services | $260,929 | ProgramServicesAmt |
| Management And General | $111,827 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,073,292 | TotalAmt |
| Program Services | $751,305 | ProgramServicesAmt |
| Management And General | $321,987 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,299 | TotalAmt |
| Program Services | $24,709 | ProgramServicesAmt |
| Management And General | $10,590 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $158,326 | TotalAmt |
| Program Services | $110,828 | ProgramServicesAmt |
| Management And General | $47,498 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $116,310 | TotalAmt |
| Program Services | $81,417 | ProgramServicesAmt |
| Management And General | $34,893 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $151,924 | TotalAmt |
| Program Services | $123,199 | ProgramServicesAmt |
| Management And General | $28,725 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,732 | TotalAmt |
| Management And General | $20,732 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,208 | TotalAmt |
| Program Services | $1,280 | ProgramServicesAmt |
| Management And General | $25,928 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $666,201 | TotalAmt |
| Program Services | $540,241 | ProgramServicesAmt |
| Management And General | $125,960 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $482,762 | TotalAmt |
| Program Services | $289,657 | ProgramServicesAmt |
| Management And General | $193,105 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,213 | TotalAmt |
| Program Services | $12,749 | ProgramServicesAmt |
| Management And General | $5,464 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,204 | TotalAmt |
| Program Services | $25,304 | ProgramServicesAmt |
| Management And General | $5,900 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $234,515 | TotalAmt |
| Program Services | $140,709 | ProgramServicesAmt |
| Management And General | $93,806 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,231 | TotalAmt |
| Program Services | $22,562 | ProgramServicesAmt |
| Management And General | $9,669 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,925 | TotalAmt |
| Program Services | $49,154 | ProgramServicesAmt |
| Management And General | $32,771 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,084,770 | TotalAmt |
| Program Services | $4,015,915 | ProgramServicesAmt |
| Management And General | $1,068,855 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $644,585 | BOYAmt |
| EOY | $905,571 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $402,763 | BOYAmt |
| EOY | $411,924 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,028 | BOYAmt |
| EOY | $247,466 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $935,491 | BOYAmt |
| EOY | $268,872 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $180,604 | BOYAmt |
| EOY | $173,219 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,485,069 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $202,133 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,323,066 | BOYAmt |
| EOY | $1,282,936 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $277,932 | BOYAmt |
| EOY | $641,493 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,815,469 | BOYAmt |
| EOY | $3,931,481 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $137,747 | BOYAmt |
| EOY | $129,975 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $113,148 | BOYAmt |
| EOY | $283,327 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,000,000 | BOYAmt |
| EOY | $903,782 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,250,895 | BOYAmt |
| EOY | $1,317,084 | 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 | $2,513,546 | BOYAmt |
| EOY | $2,588,275 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,028 | BOYAmt |
| EOY | $26,122 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,564,574 | BOYAmt |
| EOY | $2,614,397 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,815,469 | BOYAmt |
| EOY | $3,931,481 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $8,001 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $41,822 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Community Trust | Yes (X) | CommunityTrustInd |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,804,695 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,893,972 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,915,004 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,971,791 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,471,371 | CurrentTaxYearAmt |
| Total | $10,056,833 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,804,695 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,893,972 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,915,004 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,971,791 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,471,371 | CurrentTaxYearAmt |
| Total | $10,056,833 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $10,056,833 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,284 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,632 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $16,495 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $32,656 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $34,279 | CurrentTaxYearAmt |
| Total | $100,346 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $10,157,179 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $12,389,258 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.99010 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99280 | 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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,501 | OtherCostOrOtherBasisAmt |
| Book Value | $25,501 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,099,024 | OtherCostOrOtherBasisAmt |
| Depreciation | $47,033 | DepreciationAmt |
| Book Value | $1,051,991 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $360,544 | OtherCostOrOtherBasisAmt |
| Depreciation | $155,100 | DepreciationAmt |
| Book Value | $205,444 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,282,936 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $5,130,103 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $41,822 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$4,490 | OtherRevenueAmt |
| Revenue Not Reported | $37,332 | RevenueNotReportedAmt |
| Revenue Subtotal | $5,092,771 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $5,092,771 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $5,080,280 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | -$4,490 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$4,490 | ExpensesNotReportedAmt |
| Expenses Subtotal | $5,084,770 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $5,084,770 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE -4,490. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE -4,490. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (56 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| ABRAHAM LINCOLN MEMORIAL HOSPITAL | |||||||
| 200 STAHLHUT DRIVE | LINCOLN | IL | 62656 | 370723793 | 501(C)(3) | $9,296 | SHIP GRANT |
| ADVOCATE EUREKA HOSPITAL | |||||||
| 108 S MAJOR ST | EUREKA | IL | 61530 | 376031894 | 501(C)(3) | $20,162 | SHIP GRANT |
| CARLINVILLE AREA HOSPITAL | |||||||
| 20733 N BROAD STREET | CARLINVILLE | IL | 62626 | 370645239 | 501(C)(3) | $31,162 | SHIP GRANT; CUSTOMER SERVICE IMPROVEMENT; OUTPATIENT SERVICES |
| CLAY COUNTY HOSPITAL | |||||||
| 911 STACY BURKE DRIVE | FLORA | IL | 62839 | 010686913 | 501(C)(3) | $41,662 | SHIP GRANT; CUSTOMER SERVICE IMPROVEMENT; FINANCIAL ASSESSMENT/REVENUE CYCLE |
| COMMUNITY HOSPITAL OF STAUNTON | |||||||
| 400 NORTH CALDWELL STREET | STAUNTON | IL | 62088 | 370624255 | 501(C)(3) | $14,296 | SHIP GRANT; FINANCIAL ASSESSMENT/REVENUE CYCLE |
| CRAWFORD MEMORIAL HOSPITAL | |||||||
| 1000 NORTH ALLEN STREET | ROBINSON | IL | 62454 | 371241849 | 501(C)(3) | $13,796 | SHIP GRANT; CHF/COPD |
| CROSSROADS COMMUNITY HOSPITAL | |||||||
| 8 DOCTORS PARK RD | MT VERNON | IL | 62864 | 581622971 | 501(C)(3) | $22,662 | SHIP GRANT; EMS EDUCATION |
| FAIRFIELD MEMORIAL HOSPITAL | |||||||
| 303 NW 11TH ST | FAIRFIELD | IL | 62837 | 370661202 | 501(C)(3) | $30,296 | SHIP GRANT; CUSTOMER SERVICE IMPROVEMENT; OUTPATIENT SERVICES; PATIENT CENTE |
| FAYETTE COUNTY HOSPITAL AND LONG TERM CARE | |||||||
| 650 WEST TAYLOR ST | VANDALIA | IL | 62471 | 371255150 | 501(C)(3) | $10,866 | SHIP GRANT |
| FERRELL HOSPITAL | |||||||
| 1201 PINE ST | ELDORADO | IL | 62930 | 201244058 | 501(C)(3) | $25,296 | SHIP GRANT; CUSTOMER SERVICE IMPROVEMENT; OUTPATIENT SERVICES |
| FRANKLIN HOSPITAL | |||||||
| 201 BAILEY LANE | BENTON | IL | 62812 | 376058530 | 501(C)(3) | $30,162 | SHIP GRANT; FINANCIAL ASSESSMENT/REVENUE CYCLE; CUSTOMER SERVICE IMPROVEMENT |
| GENESIS MEDICAL CENTER | |||||||
| 409 NW 9TH AVENUE | ALEDO | IL | 61231 | 454475683 | 501(C)(3) | $45,162 | SHIP GRANT; CUSTOMER SERVICE IMPROVEMENT; OUTPATIENT SERVICES; FINANCIAL ASSESSMENT/REVENUE CYCLE; DISEASE MANAGEMNET/POPULATION HEALTH; EMS EDUCATION |
| GIBSON AREA HOSPITAL & HEALTH SERVICES | |||||||
| 1120 N MELVIN ST | GIBSON CITY | IL | 60936 | 364311943 | 501(C)(3) | $25,662 | SHIP GRANT; EMS EDUCATION |
| GRAHAM HOSPITAL | |||||||
| 210 WEST WALNUT STREET | CANTON | IL | 61520 | 370673506 | 501(C)(3) | $20,162 | SHIP GRANT |
| HAMILTON MEMORIAL HOSPITAL DISTRICT | |||||||
| 611 S MARSHALL AVE | MCLEANSBORO | IL | 62859 | 473192014 | 501(C)(3) | $9,296 | SHIP GRANT |
| HAMMOND HENRY HOSPITAL | |||||||
| 600 NORTH COLLEGE AVENUE | GENESEO | IL | 61254 | 366008003 | HENRY HOSPITAL DIST | $37,162 | SHIP GRANT |
| HARDIN COUNTY GENERAL HOSPITAL | |||||||
| 6 FERRELL ROAD | ROSICLARE | IL | 62982 | 370702309 | 501(C)(3) | $25,162 | SHIP GRANT; FINANCIAL ASSESSMENT/REVENUE CYCLE |
| HILLSBORO AREA HOSPITAL | |||||||
| 1200 EAST TREMONT ST | HILLSBORO | IL | 62049 | 370661208 | 501(C)(3) | $26,162 | SHIP GRANT; OUTPATIENT SERVICES |
| HOPEDALE MEDICAL CENTER | |||||||
| 107 TREMONT ST | HOPEDALE | IL | 61747 | 370808925 | 501(C)(3) | $20,162 | SHIP GRANT |
| HORIZON HEALTH | |||||||
| 721 EAST COURT ST | PARIS | IL | 61944 | 370860281 | 501(C)(3) | $27,796 | SHIP GRANT; CUSTOMER SERVICE IMPROVEMENT; OUTPATIENT SERVICES; CHF/COPD; EMS EDUCATION |
| HSHS GOOD SHEPHERD HOSPITAL | |||||||
| 200 SOUTH CEDAR STREET | SHELBYVILLE | IL | 62565 | 376006672 | 501(C)(3) | $20,162 | SHIP GRANT; CUSTOMER SERVICE IMPROVEMENT; OUTPATIENT SERVICES; CHF/COPD; EMS EDUCATION |
| ILLINI COMMUNITY HOSPITAL | |||||||
| 640 WEST WASHINGTON ST | PITTSFIELD | IL | 62363 | 371396010 | 501(C)(3) | $29,937 | SHIP GRANT; CUSTOMER SERVICE IMPROVEMENT; OUTPATIENT SERVICES; CHF/COPD; EMS EDUCATION |
| IROQUOIS MEMORIAL HOSPITAL | |||||||
| 200 FAIRMAN | WATSEKA | IL | 60970 | 370673512 | 501(C)(3) | $24,662 | SHIP GRANT; CHF/COPD |
| JERSEY COMMUNITY HOSPITAL | |||||||
| 400 MAPLE SUMMIT | JERSEYVILLE | IL | 62052 | 376013958 | 501(C)(3) | $20,162 | SHIP GRANT |
| KIRBY MEDICAL CENTER | |||||||
| 1000 MEDICAL CENTER DRIVE | MONTICELLO | IL | 61856 | 370661215 | 501(C)(3) | $23,162 | SHIP GRANT; EMS EDUCATION |
| LAWRENCE COUNTY MEMORIAL HOSPITAL | |||||||
| 2200 WEST STATE ST | LAWRENCEVILLE | IL | 62439 | 800618988 | 501(C)(3) | $30,796 | SHIP GRANT; CUSTOMER SERVICE IMPROVEMENT; OUTPATIENT SERVICES; DISEASE MANAGEMENT/POPULATION HEALTH; CHF/COPD |
| MARSHALL BROWNING HOSPITAL | |||||||
| 900 N WASHINGTON ST | DUQUOIN | IL | 62832 | 370661218 | 501(C)(3) | $14,296 | SHIP GRANT; FINANCIAL ASSESSMENT/REVENUE CYCLE |
| MASON DISTRICT HOSPITAL | |||||||
| 615 N PROMENADE ST | HAVANA | IL | 62644 | 376017857 | MASON DISTRICT | $22,377 | SHIP GRANT; EMS EDUCATION |
| MASSAC MEMOIRAL HOSPITAL | |||||||
| 28 CHICK ST | METROPOLIS | IL | 62960 | 370857853 | MASSAC HOSPITAL DIST | $12,031 | SHIP GRANT; EMS EDUCATION |
| MEMORIAL HOSPITAL - CARTHAGE | |||||||
| 1454 N COUNTY ROAD 2050 | CARTHAGE | IL | 62321 | 370662570 | 501(C)(3) | $41,162 | SHIP GRANT; OUTPATIENT SERVICES; FINANCIAL ASSESSMENT/REVENUE CYCLE; PATIENT CENTERED MEDICAL HOME; DISEASE MANAGEMENT/POPULATION HEALTH |
| MEMORIAL HOSPITAL - CHESTER | |||||||
| 1900 STATE STREET | CHESTER | IL | 62233 | 020222156 | 501(C)(3) | $9,296 | SHIP GRANT |
| MERCY HARVARD HOSPITAL | |||||||
| 901 GRANT STREET | HARVARD | IL | 60033 | 311551871 | 501(C)(3) | $37,162 | SHIP GRANT; CUSTOMER SERVICE IMPROVEMENT; OUTPATIENT SERVICES; DISEASE MANAGEMENT/POPULATION HEALTH |
| MIDWEST MEDICAL CENTER | |||||||
| 1 MEDICAL CENTER DRIVE | GALENA | IL | 61036 | 204560540 | 501(C)(3) | $25,162 | SHIP GRANT; FINANCIAL ASSESSMENT/REVENUE CYCLE |
| MORRISON COMMUNITY HOSPITAL | |||||||
| 303 N JACKSON ST | MORRISON | IL | 61270 | 366008167 | MORRISON, IL | $32,662 | SHIP GRANT; FINANCIAL ASSESSMENT/REVENUE CYCLE; CHF/COPD; EMS EDUCATION |
| NORTHWESTERN MEDICINE VALLEY WEST HOSPITAL | |||||||
| 1302 NORTH MAIN STREET | SANDWICH | IL | 60548 | 364244337 | 501(C)(3) | $9,296 | SHIP GRANT |
| OSF HOLY FAMILY MEDICAL CENTER | |||||||
| 1000 W HARLEM AVE | MONMOUTH | IL | 61462 | 370813229 | 501(C)(3) | $26,162 | SHIP GRANT; DISEASE MANAGEMENT/POPULATION HEALTH |
| OSF ST JAMES W ALBRECHT MEDICAL CENTER | |||||||
| 2500 W REYNOLD ST | PONTIAC | IL | 61764 | 362167767 | 501(C)(3) | $20,162 | SHIP GRANT |
| OSF ST LUKE MEDICAL CENTER | |||||||
| 1051 WEST SOUTH ST | KEWANEE | IL | 61443 | 362167767 | 501(C)(3) | $20,162 | SHIP GRANT |
| OSF ST PAUL MEDICAL CENTER | |||||||
| 1401 EAST 12TH STREET | MENDOTA | IL | 61342 | 362167785 | 501(C)(3) | $20,162 | SHIP GRANT |
| PANA COMMUNITY HOSPITAL | |||||||
| 101 EAST NINTH ST | PANA | IL | 62557 | 376062326 | 501(C)(3) | $24,662 | SHIP GRANT; CHF/COPD |
| PERRY MEMORIAL HOSPITAL | |||||||
| 530 PARK AVENUE EAST | PRINCETON | IL | 61356 | 366006955 | PRINCETON, IL | $31,296 | SHIP GRANT; OUTPATIENT SERVICES; FINANCIAL ASSESSMENT/REVENUE CYCLE; PATIENT CENTERED MEDICAL HOME; EMS EDUCATION; CHF/COPD |
| PINCKNEYVILLE COMMUNITY HOSPITAL | |||||||
| 101 NORTH WALNUT STREET | PINCKNEYVILLE | IL | 62274 | 376006955 | PINCKNEYVILLE DISTR | $33,662 | SHIP GRANT; CUSTOMER SERVICE IMPROVEMENT; OUTPATIENT SERVICES; EMS EDUCATION |
| RED BUD REGIONAL HOSPITAL | |||||||
| 325 SPRING ST | RED BUD | IL | 62278 | 364443919 | 501(C)(3) | $26,296 | SHIP GRANT; CUSTOMER SERVICE IMPROVEMENT; OUTPATIENT SERVICES; DISEASE MANAGEMENT/POPULATION HEALTH |
| RICHLAND MEMORIAL HOSPITAL | |||||||
| 800 EAST LOCUST | OLNEY | IL | 62450 | 371363001 | 501(C)(3) | $9,296 | SHIP GRANT |
| SALEM TOWNSHIP HOSPITAL | |||||||
| 1201 RICKER DRIVE | SALEM | IL | 62881 | 370925318 | SALEM, IL | $9,296 | SHIP GRANT |
| SARAH D CULBERTSON MEMORIAL HOSPITAL | |||||||
| 238 SOUTH CONGRESS AVE | RUSHVILLE | IL | 62681 | 376006672 | SCHUYLER CO DISTR | $9,296 | SHIP GRANT |
| SPARTA COMMUNITY HOSPITAL DISTRICT | |||||||
| 818 EAST BROADWAY | SPARTA | IL | 62286 | 376014817 | SPARTA HOSPITAL DIST | $26,497 | SHIP GRANT; OUTPATIENT SERVICES; PATIENT CENTERED MEDICAL HOME |
| ST FRANCIS HOSPITAL | |||||||
| 1215 FRANCISCAN DRIVE | LITCHFIELD | IL | 62056 | 370661236 | 501(C)(3) | $29,162 | SHIP GRANT; OUTPATIENT SERVICES; DISEASE MANAGEMENT/POPULATION HEALTH |
| ST JOSEPH MEMORIAL HOSPITAL | |||||||
| 2 SOUTH HOSPITAL DRIVE | MURPHYSBORO | IL | 62966 | 370618939 | 501(C)(3) | $20,162 | SHIP GRANT |
| ST JOSEPH'S HOSPITAL | |||||||
| 12866 TROXLER AVE | HIGHLAND | IL | 62249 | 370663568 | 501(C)(3) | $9,296 | SHIP GRANT |
| TAYLORVILLE MEMORIAL HOSPITAL | |||||||
| 201 EAST PLEASANT ST | TAYLORVILLE | IL | 62568 | 370661250 | 501(C)(3) | $9,296 | SHIP GRANT |
| THOMAS H BOYD MEMORIAL HOSPITAL | |||||||
| 800 SCHOOL ST | CARROLTON | IL | 62016 | 370673461 | 501(C)(3) | $42,662 | SHIP GRANT; OUTPATIENT SERVICES; FINANCIAL ASSESSMENT/REVENUE CYCLE; DISEASE MANAGEMENT/POPULATION HEALTH; EMS EDUCATION |
| UNION COUNTY HOSPITAL DISTRICT | |||||||
| 517 NORTH MAIN ST | ANNA | IL | 62906 | 586025393 | 501(C)(3) | $14,296 | SHIP GRANT; FINANCIAL ASSESSMENT/REVENUE CYCLE |
| WABASH GENERAL HOSPITAL | |||||||
| 1418 COLLEGE DR | MT CARMEL | IL | 62863 | 376013625 | WABASH HOPSITAL DIST | $12,296 | SHIP GRANT; EMS EDUCATION |
| WARNER HOSPITAL & HEALTH SERVICES | |||||||
| 422 WEST WHITE ST | CLINTON | IL | 61727 | 371380376 | 501(C)(3) | $22,796 | SHIP GRANT; CUSTOMER SERVICE IMPROVEMENT; DISEASE MANAGEMENT/POPULATION HEALTH; EMS EDUCATION |
| WASHINGTON COUNTY HOSPITAL | |||||||
| 705 S GRAND | NASHVILLE | IL | 62263 | 376020408 | 501(C)(3) | $14,296 | SHIP GRANT; FINANCIAL ASSESSMENT/REVENUE CYCLE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 57 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ONCE IT IS DETERMINED THAT AN INDIVIDUAL OR ORGANIZATION WILL BE RECEIVING A GRANT AWARD, THEY ARE ISSUED A TRACKING NUMBER AND ENTERED INTO THE GRANT MONITORING DATABASE. THE DATABASE INCLUDES CONTACT INFORMATION FOR THE RECIPIENT, AS WELL AS PAYMENT TERMS, DATE, CHECK NUMBER, AND PAYMENT AMOUNT. AT THE END OF THE GRANT TERM OUTLINED IN THE GRANT AGREEMENT PROVIDED TO THE RECIPIENT A FINAL REPORT IS COMPLETED BY THE RECIPIENT AND SENT BACK TO ICAHN THROUGH THE MAIL OR ELECTRONICALLY WITH A SIGNATURE. ICAHN THEN REVIEWS THE REPORT AND COMPARES IT TO THE AGREEMENT TO ENSURE GRANT FUNDS WERE SPENT AS OUTLINED ON OCCASION. IF A RECIPIENT'S PROJECT IS NEEDED TO CHANGE DUE TO UNFORESEEN CIRCUMSTANCES, THE GRANTEE IS INSTRUCTED TO REQUEST WRITTEN PERMISSION FROM ICAHN AUTHORIZING THE CHANGE. A COPY OF THIS CORRESPONDENCE IS PLACED IN THE RECIPIENT'S GRANT FILE DOCUMENTING THE CHANGE TO THE GRANT PROJECT WHEN THE GRANT REPORT IS RECEIVED BY ICAHN. IT CAN THEN BE NOTED THAT THERE WAS AN AUTHORIZED CHANGE TO THE GRANT PROJECT. IN ADDITION TO THESE TRACKING PROCESSES, THE OPERATIONS COORDINATOR PERFORMS ONSITE VISITS TO GRANT RECIPIENTS OVER THE COURSE OF THE YEAR. DURING THESE VISITS, DOCUMENTATION SUCH AS INVOICES, RECEIPTS, AND FINANCIAL STATEMENTS ARE REVIEWED WITH COPIES OBTAINED, TO ENSURE GRANT FUNDS HAVE BEEN SPENT ON OUTLINED PROJECTS. THE OPERATIONS COORDINATOR PERFORMS ABOUT 12 ONSITE GRANT REVIEW VISITS PER YEAR. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| 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 | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | 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 (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PATRICIA SCHOU | ||||||||||||||
| EXECUTIVE DIRECTOR | $245,170 | $0 | $0 | $0 | $0 | $0 | $7,318 | $0 | $15,355 | $0 | $267,843 | $0 | $0 | $0 |
| CURTIS ZIMMERMAN | ||||||||||||||
| DIRECTOR BUSINESS SERVICES | $121,034 | $0 | $0 | $0 | $0 | $0 | $3,877 | $0 | $28,472 | $0 | $153,383 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 5 | FormAndLineReferenceDesc |
| Explanation | THE SENIOR DIRECTOR OF BUSINESS DEVELOPMENT IS PAID AN INCENTIVE ON A PERCENTAGE OF THE INSURANCE REVENUES PAID TO ICAHN DURING THE YEAR. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE MEMBERS OF THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK ARE CRITICAL ACCESS HOSPITALS AND NECESSARY PROVIDER HOSPITALS RESIDING IN THE STATE OF ILLINOIS WHO HAVE PAID AN INITIAL MEMBERSHIP FEE OF FIVE THOUSAND DOLLARS ($5,000). EACH HOSPITAL MEMBER HAS ONE VOTE AND IS REPRESENTED BY ITS CHIEF EXECUTIVE OFFICER. MEMBERS HAVE THE RIGHT TO VOTE FOR THE BOARD OF DIRECTORS. AS OF 2019 THE MEMBERSHIP DUES FOR THE YEAR ARE $8,300. |
| FORM 990, PART VI, SECTION A, LINE 7A | EACH HOSPITAL MEMBER HAS ONE VOTE AND IS REPRESENTED BY ITS CHIEF EXECUTIVE OFFICER. MEMBERS HAVE THE RIGHT TO VOTE FOR THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE BYLAWS MAY BE AMENDED AT ANY MEETING OF THE MEMBERSHIP PROVIDED A NOTICE SETTING FORTH THE AMENDMENT OR A SUMMARY OF THE CHANGES TO BE AFFECTED THEREBY IS GIVEN TO EACH MEMBER ENTITLED TO VOTE THEREON IN THE MANNER AND WITHIN THE TIME PROVIDED IN THE BYLAWS FOR THE NOTICE OF THE MEETING. NO AMENDMENT INCONSISTENT WITH THE ARTICLES OF INCORPORATION SHALL BE EFFECTIVE PRIOR TO AMENDMENT OF THE ARTICLES OF INCORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE FORM 990 IS PROVIDED TO BOTH THE FINANCE COMMITTEE AND BOARD OF DIRECTORS VIA E-MAIL FOR REVIEW. THE GOAL IS TO PROVIDE THE REPORT TO BOTH PRIOR TO THE FILING, SO IF DISCREPANCIES ARE DISCOVERED, THERE IS TIME FOR CORRECTIONS IF DEEMED NECESSARY AFTER REVIEW, A MEETING WILL BE SCHEDULED FOR DISCUSSION AND FURTHER REVIEW OF THE 990. |
| FORM 990, PART VI, LINE 1 | THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE PRESIDENT, PRESIDENT-ELECT, SECRETARY/TREASURER, AND IMMEDIATE PAST PRESIDENT IF THE IMMEDIATE PAST PRESIDENT REMAINS ON THE BOARD OF DIRECTORS WHEN THE IMMEDIATE PAST PRESIDENT SERVES ON THE EXECUTIVE COMMITTEE, THE PRESIDENT SHALL NOT VOTE EXCEPT TO END A TIE VOTE THE PRESIDENT OF THE BOARD OF DIRECTORS SHALL SERVE AS THE CHAIR OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL HAVE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE INTERIM BETWEEN MEETINGS OF THE BOARD OF DIRECTORS PROVIDED THAT ANY ACTION TAKEN SHALL NOT CONFLICT WITH ANY RULE AND REGULATION ESTABLISHED BY THE BOARD OF DIRECTORS OR EXPRESSED WISHES OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK REQUIRES THEIR BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES TO COMPLETE A CONFLICT OF INTEREST ACTIVITY QUESTIONNAIRE ANNUALLY. ANY QUESTION OF WHETHER A CONFLICT EXISTS SHALL BE DECIDED UPON BY A MAJORITY VOTE OF THE DIRECTORS OR COMMITTEE MEMBERS, EXCLUDING THE DIRECTOR OR COMMITTEE MEMBER WITH A POSSIBLE CONFLICT IN THE CASE AN ACTUAL CONFLICT EXISTS, THE DIRECTOR OR MEMBER WITH THE CONFLICT MUST ABSTAIN FROM VOTING ON SUCH MATTER. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE FINANCE COMMITTEE OF THE ORGANIZATION RECOMMENDS TO THE BOARD THE APPROVAL OF THE FISCAL YEAR BUDGET WHICH INCLUDES SALARY INCREASES. INCREASES ARE THEN MADE BY THE EXECUTIVE DIRECTOR PRIOR TO THE START OF THE NEXT FISCAL YEAR. THE EXECUTIVE DIRECTOR'S CONTRACT ALLOWS FOR A YEARLY INCREASE PER BUDGET. THE EXECUTIVE DIRECTOR'S CONTRACT IS NEGOTIATED EVERY THREE YEARS AND SALARY IS SET AT THAT TIME. THIS COMPENSATION IS SET BASED ON A COMPARISON REVIEW OF OTHER NETWORK DIRECTOR'S SALARIES AND COMPENSATION. OTHER ICAHN POSITIONS ARE BASED ON SIMILAR POSITIONS IN OTHER ORGANIZATIONS INCLUDED IN THE BUDGET PRESENTATION ARE BUDGET ASSUMPTIONS WHICH IDENTIFIES THE SALARY INCREASES. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | MANAGED CARE: PROGRAM SERVICE EXPENSES 433,116. MANAGEMENT AND GENERAL EXPENSES 100,983. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 534,099. OTHER FEES: PROGRAM SERVICE EXPENSES 103,939. MANAGEMENT AND GENERAL EXPENSES 24,234. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 128,173. EDUCATION: PROGRAM SERVICE EXPENSES 3,186. MANAGEMENT AND GENERAL EXPENSES 743. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,929. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ILLINOIS RURAL COMMUNITY CARE ORGANIZATION LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1945 VANS WAY | AddressLine1Txt |
| City | PRINCETON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61356 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 465654316 | EIN |
| Primary Activities | DEVELOP SYSTEMS OF CLINICAL INTEGRATION & EFFICIENCIES FOR MEMBER HOSPITALS | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Total Income | $631,142 | TotalIncomeAmt |
| End Of Year Assets | $814,462 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK | BusinessNameLine1Txt |