2018-08-31T10:34:21-05:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 1614 S GALENA AVENUE DIXON IL 61021 990 2017-01-01 550809159 THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK ILLI 8158752999 245 BACKBONE ROAD EAST PRINCETON IL 61356 PATRICIA SCHOU EXECUTIVE DIRECTOR 8158752999 2018-08-28 1 TODD M ETHERIDGE P00233050 8152859300 2018-08-28 2017 2022-09-23 18:48:47Z PATRICIA SCHOU 245 BACKBONE ROAD EAST PRINCETON IL 61356 4496142 0 X WWW.ICAHN.ORG X 2002 IL THE MISSION OF ICAHN IS TO STRENGTHEN ILLINOIS CRITICAL ACCESS HOSPITALS THROUGH COLLABORATION. 9 9 22 9 0 0 1893972 1915004 2469181 2564643 6632 16495 0 0 4369785 4496142 1106426 1123391 0 0 1471508 1686700 0 0 0 1381987 1308929 3959921 4119020 409864 377122 2398218 3879536 1170917 2247885 1227301 1631651 X 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 54 MEMBER HOSPITALS, IS AN INDEPENDENT NETWORK GOVERNED BY A NINE-MEMBER BOARD OF DIRECTORS. 0 0 3036259 1123391 2151802 ICAHN PROVIDES TECHNICAL ASSISTANCE TO SMALL RURAL HOSPITALS1) TO HELP THEM WITH ADMINISTRATIVE PROCESSES FOR CRITICAL ACCESS HOSPITALS.2) TO SHARE RESOURCES WITH MEMBERS.3) TO IMPLEMENT PROGRAMS TO IMPROVE QUALITY AND EFFICIENCES 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 55 HOSPITALS. 112775 49167 ICAHN PROVIDES QUALITY EDUCATIONAL OPPORTUNITIES TO MEMBER HOSPITALS FOCUSING ON RURAL HEALTH ISSUES AND STRATEGIES FOR SUCCESS THROUGH ONSITE MEETINGS, VIDEOCONFERENCES, AND WEB-BASED TRAINING. 40109 363674 ICAN PROVIDES INFORMATION TECHNOLOGY ASSISTANCE TO SMALL RURAL HOSPITALS ACROSS THE STATE SERVING APPROXIMATELY 55 HOSPITALS. SERVICES ARE AVAILABLE TO ALL 55 HOSPITALS AND ALL CHOSE TO UTILIZE THEM. 3189143 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 8 0 1 22 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 IL X DIANE GARLAND 8158752999 245 BACKBONE ROAD EAST PRINCETON IL 61356 TRACY BAUER PRESIDENT-ELECT 1.00 X X 0 0 0 TRINA CASNER PRESIDENT 1.00 X X 0 0 0 DOUG FLORKOWSKI SECRETARY/TREASURER 1.00 X X 0 0 0 KEN REID DIRECTOR 1.00 X 0 0 0 GREG STARNES DIRECTOR 1.00 X 0 0 0 JOANN EMGE DIRECTOR 1.00 X 0 0 0 OLLIE SMITH DIRECTOR 1.00 X 0 0 0 KATHY HULL DIRECTOR 1.00 X 0 0 0 MARK ROSSI PAST PRESIDENT 1.00 X X 0 0 0 PATRICIA SCHOU EXECUTIVE DIRECTOR 40.00 X 212730 0 19848 212730 0 19848 1 0 1 0 0 442800 1344636 127568 1915004 IL RURAL COMMUNITY CAR 900099 1115630 1115630 IT SERVICES 541519 363674 363674 CONSULTING REVENUE 541610 191476 191476 PROFESSIONAL EDUCATION 611710 88034 88034 WORKSHOP/MEETING FEES 900099 49167 49167 756662 756662 2564643 16495 16495 4496142 2564643 0 16495 1123391 1123391 232578 162805 69773 1222594 855816 366778 26867 18807 8060 101878 71315 30563 102783 71948 30835 293 176 117 29855 29855 27461 27461 344174 343830 344 92063 55238 36825 279327 167595 111732 66848 40109 26739 58778 35267 23511 57312 34387 22925 187958 112775 75183 24523 14714 9809 24069 14441 9628 AIM EXPENSES 110590 66354 44236 MEMBERSHIP DUES 13757 8254 5503 BAD DEBT EXPENSE -8079 -8079 4119020 3189143 929877 0 1513490 29493 3000603 243487 249834 284995 157200 297204 97605 93344 199599 233409 272300 2398218 3879536 32773 226286 1138144 2021599 1170917 2247885 X 1225832 1631651 1469 0 1227301 1631651 2398218 3879536 377122 27228 0 X 0 1 X 1 1 1 X 1990425 1961112 1804695 1893972 1915004 9565208 1990425 1961112 1804695 1893972 1915004 9565208 9565208 4330 3278 10284 6632 16495 41019 9606227 8858987 0.99570 0.99700 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 25501 25501 166426 97605 68821 105277 105277 199599 X 4523370 27228 27228 4496142 0 4496142 4119020 0 4119020 0 4119020 PART X, LINE 2: ICAHN IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC), AND AS SUCH, ARE NOT LIABLE FOR INCOME TAXES. IRCCO IS A SOLE MEMBER LIMITED LIABILITY COMPANY AND THEREFORE IS A DISREGARDED ENTITY FOR FEDERAL INCOME TAX PURPOSES. FOR 990 REPORTING PURPOSES, IRCCO'S ACTIVITIES ARE INCLUDED IN ICAHN'S 990. ICAHN, AS AN EXEMPT ORGANIZATION, IS SUBJECT TO TAX ON ANY UNRELATED BUSINESS INCOME. ICAHN IS CLASSIFIED BY THE INTERNAL REVENUE SERVICE AS OTHER THAN A PRIVATE FOUNDATION. THE ORGANIZATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES UNDER THE AUTHORITATIVE GUIDANCE ISSUED BY FINANCIAL ACCOUNTING STANDARDS BOARD (FASB). THE ORGANIZATION USES A THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION TO ACCOUNT FOR UNCERTAINTY INCOME TAXES. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS NOT BEEN MET. THIS GUIDANCE ALSO ADDRESSESS DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE, AND TRANSITION. THE ORGANIZATION CONDUCTS ITS BUSINESS SOLELY IN THE U.S. AND, AS A RESULT, FILES FEDERAL AND ILLINOIS TAX RETURNS. IN THE NORMAL COURSE OF BUSINESS, THE ORGANIZATION IS SUBJECT TO EXAMINATION BY TAXING AUTHORITIES. PRESENTLY, THERE ARE NO ONGOING INCOME TAX AUDITS OR UNRESOLVED DISPUTES WITH THE TAX AUTHORITIES THAT THE ORGANIZATION CURRENTLY FILES OR HAS FILED WITH. 1 ADVOCATE EUREKA HOSPITAL 101 S MAJOR ST EUREKA IL 61530 376031894 501(C)(4) 8346 N/A N/A SHIP GRANT CARLE HOOPESTON REGIONAL HEALTH CENTER 701 E ORANGE ST HOOPESTON IL 60942 261503640 501(C)(3) 4431 N/A N/A DISEASE MANAGEMENT/POPULATION HEALTH CARLINVILLE AREA HOSPITAL 20733 N BROAD STREET CARLINVILLE IL 62626 370645239 501(C)(3) 15646 N/A N/A SHIP GRANT; CHF/COPD GRANT; CUSTOMER SERVICE IMPROVEMENT GRANT CLAY COUNTY HOSPITAL 911 STACY BURKE DRIVE FLORA IL 62839 010686913 501(C)(3) 11346 N/A N/A SHIP GRANT; EMS STEMI RESPONSE TIME GRANT COMMUNITY HOSPITAL OF STAUNTON 400 NORTH CALDWELL STREET STAUNTON IL 62088 370624255 501(C)(3) 13256 N/A N/A SHIP GRANT; DISEASE MANAGEMENT/POPULATION HEALTH; CHF/COPD GRANT; FLEX TRANSFER GRANT CRAWFORD MEMORIAL HOSPITAL 1000 NORTH ALLEN STREET ROBINSON IL 62454 371241849 501(C)(3) 10646 N/A N/A SHIP GRANT; CHF/COPD GRANT WARNER HOSPITAL & HEALTH SERVICES 422 WEST WHITE ST CLINTON IL 61727 371380376 501(C)(3) 18381 N/A N/A SHIP GRANT; CHF/COPD GRANT; EMS STEMI RESPONSE TIME GRANT; OUTPATIENT SERVICES GRANT FAIRFIELD MEMORIAL HOSPITAL 303 NW 11TH ST FAIRFIELD IL 62837 370661202 501(C)(3) 16346 N/A N/A SHIP GRANT; DISEASE MANAGEMENT/POPULATION HEALTH GRANT; EMS STEMI RESPONSE TIME GRANT FAYETTE COUNTY HOSPITAL AND LONG TERM CARE 650 WEST TAYLOR ST VANDALIA IL 62471 371255150 501(C)(3) 3300 N/A N/A FLEX TRANSFER GRANT; CHF/COPD AND TRANSFER GRANT FERRELL HOSPITAL 1201 PINE ST ELDORADO IL 62930 201244058 501(C)(3) 13346 N/A N/A SHIP GRANT; CUSTOMER SERVICE IMPROVEMENT GRANT FRANKLIN HOSPITAL 201 BAILEY LANE BENTON IL 62812 376058530 501(C)(3) 13346 N/A N/A SHIP GRANT; DISEASE MANAGEMENT/POPULATION HEALTH GRANT GENESIS MEDICAL CENTER 409 NW 9TH AVENUE ALEDO IL 61231 454475683 501(C)(3) 18346 N/A N/A SHIP GRANT; DISEASE MANAGEMENT/POPULATION HEALTH GRANT; OUTPATIENT SERVICES GRANT GIBSON AREA HOSPITAL & HEALTH SERVICES 1120 N MELVIN ST GIBSON CITY IL 60936 364311943 501(C)(3) 21646 N/A N/A SHIP GRANT; FLEX TRANSFER GRANT; DISEASE MANAGEMENT/POPULATION HEALTH GRANT; OUTPATIENT SERVICES GRANT; CHF/COPD GRANT HSHS HOLY FAMILY HOSPITAL 200 HEALTHCARE DR GREENVILLE IL 62246 371139987 501(C)(3) 8346 N/A N/A SHIP GRANT HAMILTON MEMORIAL HOSPITAL DISTRICT 611 S MARSHALL AVENUE PO BOX 429 MCLEANSBORO IL 62859 473192014 501(C)(3) 13346 N/A N/A SHIP GRANT; FINANCIAL ASSESSMENT/REVENUE CYCLE GRANT HAMMOND HENRY HOSPITAL 600 NORTH COLLEGE AVENUE GENESEO IL 61254 366008003 HENRY HOSP. DISTR. 5000 N/A N/A OUTPATIENT SERVICES GRANT HARDIN COUNTY GENERAL HOSPITAL 6 FERRELL ROAD BOX 2467 ROSICLARE IL 62982 370702309 501(C)(3) 13346 N/A N/A SHIP GRANT; DISEASE MANAGEMENT/POPULATION HEALTH GRANT HILLSBORO AREA HOSPITAL 1200 EAST TREMONT ST HILLSBORO IL 62049 370661208 501(C)(3) 20646 N/A N/A SHIP GRANT; CHF/COPD GRANT; FINANCIAL ASSESSMENT/REVENUE CYCLE GRANT; OUTPATIENT SERVICES GRANT HOPEDALE MEDICAL COMPLEX 107 TREMONT ST HOPEDALE IL 61747 370808925 501(C)(3) 12146 N/A N/A SHIP GRANT; DISEASE MANAGEMENT/POPULATION HEALTH GRANT ILLINI COMMUNITY HOSPITAL 640 WEST WASHINGTON ST PITTSFIELD IL 62363 371396010 501(C)(3) 13346 N/A N/A SHIP GRANT; FINANCIAL ASSESSMENT/REVENUE CYCLE GRANT IROQUOIS MEMORIAL HOSPITAL 200 FAIRMAN WATSEKA IL 60970 370673512 501(C)(3) 18346 N/A N/A SHIP GRANT; CUSTOMER SERVICE IMPROVEMENT GRANT; OUTPATIENT SERVICES GRANT JERSEY COMMUNITY HOSPITAL 400 MAPLE SUMMIT JERSEYVILLE IL 62052 376013958 501(C)(3) 13346 N/A N/A SHIP GRANT; OUTPATIENT SERVICES GRANT KIRBY MEDICAL CENTER 1000 MEDICAL CENTER DRIVE MONTICELLO IL 61856 370661215 501(C)(3) 14646 N/A N/A SHIP GRANT; CHF/COPD GRANT; CUSTOMER SERVICE IMPROVEMENT GRANT LAWRENCE COUNTY MEMORIAL HOSPITAL 2200 WEST STATE ST LAWRENCEVILLE IL 62439 800618988 501(C)(3) 11146 N/A N/A SHIP GRANT; CHF/COPD GRANT; TRANSFER COMMUNICATION GRANT MARSHALL BROWNING HOSPITAL 900 N WASHINGTON ST DUQUOIN IL 62832 370661218 501(C)(3) 13346 N/A N/A SHIP GRANT; FINANCIAL ASSESSMENT/REVENUE CYCLE GRANT MASON DISTRICT HOSPITAL 615 N PROMENADE ST HAVANA IL 62644 376017857 MASON DISTRICT 14346 N/A N/A SHIP GRANT; DISEASE MANAGEMENT/POPULATION HEALTH GRANT; CHF/COPD GRANT MASSAC MEMORIAL HOSPITAL 28 CHICK ST PO BOX 850 METROPOLIS IL 62960 370857853 MASSAC HOSP. DISTR. 2300 N/A N/A CHF/COPD GRANT MEMORIAL HOSPITAL CARTHAGE 1454 N COUNTY ROAD 2050 PO BOX 160 CARTHAGE IL 62321 370662570 501(C)(3) 25913 N/A N/A SHIP GRANT; FLEX TRANSFER GRANT; FINANCIAL ASSESSMENT/REVENUE CYCLE GRANT; OUTPATIENT SERVICES GRANT; DISEASE MANAGEMENT/POPULATION HEALTH GRANT; CHF/COPD GRANT OSF ST PAUL MEDICAL CENTER 1401 EAST 12TH ST MENDOTA IL 61342 362167785 501(C)(3) 8346 N/A N/A SHIP GRANT MIDWEST MEDICAL CENTER 1 MEDICAL CENTER DRIVE GALENA IL 61036 204560540 501(C)(3) 20646 N/A N/A SHIP GRANT; CHF/COPD GRANT; CUSTOMER SERVICE IMPROVEMENT GRANT; OUTPATIENT SERVICES GRANT MORRISON COMMUNITY HOSPITAL 303 N JACKSON ST MORRISON IL 61270 366008167 MORRISON, IL 18646 N/A N/A SHIP GRANT; CHF/COPD GRANT; DISEASE MANAGEMENT/POPULATION HEALTH; EMS STEMI RESPONSE TIME GRANT OSF HOLY FAMILY MEDICAL CENTER 1000 W HARLEM AVE MONMOUTH IL 61462 370813229 501(C)(3) 8346 N/A N/A SHIP GRANT OSF ST JAMES W ALBRECHT MEDICAL CENTER 2500 W REYNOLDS ST PONTIAC IL 61764 370662570 501(C)(3) 8346 N/A N/A SHIP GRANT OSF ST LUKE MEDICAL CENTER 1051 WEST SOUTH ST PO BOX 747 KEWANEE IL 61443 362167767 501(C)(3) 8346 N/A N/A SHIP GRANT PANA COMMUNITY HOSPITAL 101 EAST NINTH ST PANA IL 62557 376062326 501(C)(3) 14599 N/A N/A SHIP GRANT; FLEX TRANSFER GRANT; EMS STEMI RESPONSE TIME GRANT; CHF/COPD GRANT PARIS COMMUNITY HOSPITAL 721 EAST COURT ST PARIS IL 61944 370860281 501(C)(3) 21338 N/A N/A SHIP GRANT; FLEX TRANSFER GRANT; DISEASE MANAGEMENT/POPULATION GRANT; FINANCIAL ASSESSMENT/REVENUE CYCLE GRANT; CHF/COPD AND TRANSFER GRANT PERRY MEMORIAL HOSPITAL 530 PARK AVENUE EAST PRINCETON IL 61356 366006057 PRINCETON, IL 16300 N/A N/A FLEX TRANSFER GRANT; DISEASE MANAGEMENT/POPULATION HEALTH GRANT; EMS STEMI RESPONSE TIME GRANT; CUSTOMER SERVICE IMPROVEMENT GRANT; CHF/COPD AND TRANSFER GRANT PINCKNEYVILLE COMMUNITY HOSPITAL 101 NORTH WALNUT STREET PINCKNEYVILLE IL 62274 376006955 PINCKNEYVILLE DISTR. 20646 N/A N/A SHIP GRANT; CHF/COPD GRANT; CUSTOMER SERVICE IMPROVEMENT GRANT; DISEASE MANAGEMENT/POPULATION HEALTH GRANT RED BUD REGIONAL HOSPITAL 325 SPRING ST RED BUD IL 62278 364443919 501(C)(3) 15376 N/A N/A SHIP GRANT; CUSTOMER SERVICE IMPROVEMENT GRANT; EMS STEMI RESPONSE TIME GRANT RICHLAND MEMORIAL HOSPITAL 800 EAST LOCUST OLNEY IL 62450 371363001 501(C)(3) 8346 N/A N/A SHIP GRANT ROCHELLE COMMUNITY HOSPITAL 900 N SECOND ST ROCHELLE IL 61068 362548549 501(C)(3) 10000 N/A N/A DISEASE MANAGEMENT/POPULATION HEALTH GRANT; FINANCIAL ASSESSMENT/REVENUE CYCLE GRANT SALEM TOWNSHIP HOSPITAL 1201 RICKER DRIVE SALEM IL 62881 370925318 SALEM, IL 8300 N/A N/A FLEX TRANSFER GRANT; CUSTOMER SERVICE IMPROVEMENT GRANT; CHF/COPD AND TRANSFER GRANT SARAH D CULBERTSON MEMORIAL HOSPITAL 238 SOUTH CONGRESS AVE RUSHVILLE IL 62681 376006672 SCHUYLER CO. DISTR. 10646 N/A N/A SHIP GRANT; CHF/COPD GRANT SHELBY MEMORIAL HOSPITAL 200 SOUTH CEDAR SHELBYVILLE IL 62565 370512290 501(C)(3) 8346 N/A N/A SHIP GRANT SPARTA COMMUNITY HOSPITAL DISTRICT 818 EAST BROADWAY SPARTA IL 62286 376014817 SPARTA HOSP. DISTR. 15646 N/A N/A SHIP GRANT; CHF/COPD GRANT; DISEASE MANAGEMENT/POPULATION HEALTH GRANT ST FRANCIS HOSPITAL 1215 FRANCISCAN DRIVE LITCHFIELD IL 62056 370661236 501(C)(3) 18346 N/A N/A SHIP GRANT; CUSTOMER SERVICE IMPROVEMENT GRANT; OUTPATIENT SERVICES GRANT ST JOSEPH'S HOSPITAL 12866 TROXLER AVE HIGHLAND IL 62249 370663568 501(C)(3) 18346 N/A N/A SHIP GRANT; FINANCIAL ASSESSMENT/REVENUE CYCLE GRANT; OUTPATIENT SERVICES GRANT ST JOSEPH MEMORIAL HOSPITAL 2 SOUTH HOSPITAL DRIVE MURPHYSBORO IL 62966 370618939 501(C)(3) 13346 N/A N/A SHIP GRANT; OUTPATIENT SERVICES GRANT THOMAS H BOYD MEMORIAL HOSPITAL 800 SCHOOL ST CARROLTON IL 62016 370673461 501(C)(3) 18646 N/A N/A SHIP GRANT; CHF/COPD GRANT; EMS STEMI RESPONSE TIME GRANT; OUTPATIENT SERVICES GRANT WABASH GENERAL HOSPITAL 1418 COLLEGE DR MT CARMEL IL 62863 376013625 WABASH HOSP. DISTR. 9000 N/A N/A DISEASE MANAGEMENT/POPULATION HEALTH GRANT; OUTPATIENT SERVICES GRANT WASHINGTON COUNTY HOSPITAL 705 S GRAND NASHVILLE IL 62263 376020408 WASHINGTON COUNTY 18346 N/A N/A SHIP GRANT; DISEASE MANAGEMENT/POPULATION HEALTH GRANT; FINANCIAL ASSESSMENT/REVENUE CYCLE GRANT MERCY HARVARD HOSPITAL 901 GRANT STREET HARVARD IL 60033 311551871 501(C)(3) 8346 N/A N/A SHIP GRANT ILLINOIS VALLEY COMMUNITY HOSPITAL 925 WEST STREET PERU IL 61354 362852553 501(C)(3) 1300 N/A N/A CHF/COPD GRANT UNION COUNTY HOSPITAL 517 NORTH MAIN STREET ANNA IL 62906 364431843 UNION COUNTY 3000 N/A N/A EMS STEMI RESPONSE TIME GRANT GRAHAM HOSPITAL 210 WEST WALNUT CANTON IL 61520 370673506 501(C)(3) 8346 N/A N/A SHIP GRANT MEMORIAL HOSPITAL CHESTER 1900 STATE ST CHESTER IL 62233 376020801 CHESTER 8346 N/A N/A SHIP GRANT 56 0 PART I, LINE 2: 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 SIGNATURE. ICAHN THEN REVIEWS THE REPORT AND COMPARES IT TO THE AGREEMENT TO ENSURE GRANT FUNDS WERE SPENT AS OUTLINED. ON OCCASION, A RECIPIENT'S PROJECT WILL NEED TO CHANGE DUE TO UNFORESEEN CIRCUMSTANCES. IN THESE INSTANCES, 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 AS OUTLINED. THE OPERATIONS COORDINATOR PERFORMS ABOUT 12 ONSITE GRANT REVIEW VISITS PER YEAR. X X X X 0 0 0 0 0 0 0 0 0 PATRICIA SCHOU EXECUTIVE DIRECTOR 212730 0 0 0 0 0 6332 0 13516 0 232578 0 0 0 FORM 990, PART VI, SECTION A, 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 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. 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. 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 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, 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 QUESTIONAIRE 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 EXECTUVE 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. ILLINOIS RURAL COMMUNITY CARE ORGANIZATION LLC 245 BACKBONE RD EAST PRINCETON IL 61356 465654316 DEVELOP SYSTEMS OF CLINICAL INTEGRATION & EFFICIENCIES FOR MEMBER HOSPITALS IL 122037 1276266 ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK