2019-03-27T11:18:21-05:00 2018-07-31 450250958 EIDE BAILLY LLP 1545 ASSOCIATES DR STE 101 DUBUQUE IA 52002 990 2017-08-01 371193348 Carlinville Area Hospital Foundation CARL 2178543141 20733 North Broad Street Carlinville IL 62626 Kenneth Reid Carlinville Area Hospital CEO 2178543141 2019-03-25 1 Kim Hunwardsen CPA P00484560 5635561790 2019-03-23 74.84.124.22 2019-03-25 15:23:40 CD P B602D594AFD2B0B327E07A06F36CA6A7E42546D0 330E77A2EC15986A2DC713C7FDB26B906589BB96 2017 2019-02-21 02:37:17Z Kenneth Reid 20733 North Broad Street Carlinville IL 62626 703461 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 39452 508922 0 0 15326 28892 -21765 723 33013 538537 14200 14150 0 0 0 0 0 0 22151 20538 23465 34738 37615 -1725 500922 836506 1372179 9013 13108 827493 1359071 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 14150 14150 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. 14150 1 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 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 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 Michael Brown 2178543857 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 Elizabeth Herndon Member 0.30 0.00 X 0 0 0 Kenneth Reid CEO Carlinville Hospital 1.00 40.30 X 0 0 0 Michael Brown CFO Carlinville Hospital 1.00 40.30 X 0 0 0 0 0 0 0 0 0 0 0 12800 496122 508922 20863 20863 94004 85975 8029 8029 8029 6585 12800 7283 -698 -698 73087 71666 1421 1421 538537 1421 0 28194 14150 14150 1314 1314 6440 6440 Donor relations 14640 14640 1071 1071 37615 14150 1314 22151 145720 635012 17602 7502 673184 729665 836506 1372179 9013 13108 9013 13108 X 627170 1172898 200323 186173 827493 1359071 836506 1372179 X 500922 32077 -1421 X X 0 1 X 0 0 X 37945 16225 34912 39452 16613 145147 37945 16225 34912 39452 16613 145147 18457 126690 57257 69090 18013 16761 20863 181984 327131 323655 0.38730 0.38320 X Schedule A, Part VI, List of Unusual Grants: Description: Cash contribution for construction of MOB clinic Date: 07/31/15 Amount: 3000000. Description: Cash contribution Date: 07/31/18 Amount: 492309. 1 27863 73087 71666 29284 0 0 Due to affiliate 13108 13108 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: Carlinville Area Hospital Foundation is organized as an Illinois nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Foundation is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Foundation is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose, if applicable. 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. CAH Golf Tourney 19385 12800 6585 1200 1500 1250 2795 538 19385 12800 6585 1200 1500 1250 2795 538 7283 -698 1 Carlinville Area Hospital Association 20733 North Broad Street Carlinville IL 62626 370645239 501(c)(3) 14150 Hospital building and physician support 1 0 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. 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 Brown, Dennis Pickrel, and Ralph March have business relationships with each other. 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, and Michael Brown, 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 -1,421. 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