2017-03-13T10:19:23-05:00 2016-07-31 450250958 EIDE BAILLY LLP 1545 ASSOCIATES DR STE 101 DUBUQUE IA 52002 990 2015-08-01 371193396 Middle Macoupin Healthcare Systems MIDD 2178543141 20733 North Broad Street Carlinville IL 62626 Kenneth Reid Carlinville Area Hospital CEO 2178543141 2017-03-09 1 Carmen Krantz P00031958 5635561790 2017-03-07 2015 2021-01-29 14:40:06Z Kenneth Reid 20733 North Broad Street Carlinville IL 62626 80 0 X N/A X 1944 IL Provide support and benefit Carlinville Area Hospital Association 5 5 0 0 0 0 0 0 0 80 0 0 0 0 0 80 0 0 0 0 0 0 0 0 0 5 0 5 0 -5 80 404 7545 365 7426 39 119 None 0 0 80 To operate for the benefit of, support, promote, advance and strengthen Carlinville Area Hospital Association, Carlinville Area Hospital Foundation and other non-profit organizations in the promotion of wellness and in charitable fundraising in and around the greater Carlinville area and the Association's service area. 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 1 0 0 0 0 0 0 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 J Richard Schien Chairman 0.30 1.00 X X 0 0 0 Richard Walden Vice Chairman 0.30 1.00 X X 0 0 0 James Salske Vice Chairman until 1/1/16 0.30 1.00 X X 0 0 0 Ralph March Secretary 0.30 1.30 X X 0 0 0 Dennis Pickrel Treasurer 0.30 1.30 X X 0 0 0 Kenneth Reid CEO-Carlinville Hospital 0.30 41.00 X X 0 0 0 Michael Brown CFO-Carlinville Hospital 0.30 41.00 X 0 0 0 0 0 0 0 0 0 0 0 80 80 80 80 80 0 0 0 0 0 0 39 119 365 7426 404 7545 365 7426 365 7426 X 39 119 39 119 404 7545 80 0 X 0 1 X 1 0 X X 1 Carlinville Area Hospital Association 370645239 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 Part IV, Section D, Line 3: Middle Macoupin Healthcare Systems has regular discussions with the supported organization regarding the needs of the supported organization. Middle Macoupin Healthcare Systems receives recommendations from the supported organization with respect to items that require Middle Macoupin's approval. Part VI, Section E, Line 3a: Middle Macoupin Healthcare Systems is the sole member of the supported organization. Middle Macoupin Healthcare Systems has the authority to designate three of its directors to serve as directors of the supported organization's Board of Directors, and has overall authority to appoint all of the supported organization's directors or to remove them from the Board of Directors. In addition, Middle Macoupin Healthcare System has the authority to designate a successor in the event of a vacancy. Part VI, Section E, Line 3b: Middle Macoupin Healthcare System has the authority to approve or reject the operating budget, capital budget and any actions resulting in substantial change in the expenditures or revenue forecast in those budgets; the undertaking of substantive amendments to a contractual obligation in excess of $50,000 or the guaranteeing of any obligation in in excess of $50,000; the purchase, lease, transfer, mortgage or sale of any asset or property with a value in excess of $50,000; any plan of construction or remodeling involving an expenditure in excess of $50,000; any borrowing; any applicaiton for a government grant; any general plan for the solicitation of charitable contributions or the solicitation or acceptance as a gift of any real property or any interest therein; any proposal to adopt Articles of Dissolution, Merger or Consolidation; any selection, removal or change in the compensation or other terms of employment of the operating officers; and ay substantial change in employee fringe benefits or personnel policies. 0 Due to affiliate 7426 7426 X Part X, Line 2: Middle Macoupin Healthcare Systems 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 Organization is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, Middle Macoupin Healthcare Systems is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. Middle Macoupin Healthcare Systems believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Organization 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. Form 990, Part VI, Section A, line 1 The Board of Directors shall, by resolution, appoint five (5) or more members of the Board to serve on the Executive Committee. The President serves on this Committee ex officio with voting power. The Executive Committee has the power and authority to manage and control the business and affairs of the Corporation as the Board of Directors from time to time determines; however, in no event shall the Executive Committee exercise those powers prohibited by Illinois law, which include among others: to amend the Articles of Incorporation or Bylaws; to sell, transfer or otherwise dispose of substantially all of the Corporation's assets; or to adopt Articles of Merger or Consolidation. Form 990, Part VI, Section A, line 2 The officers and board members have a business relationship. Form 990, Part VI, Section B, line 11 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 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. 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 Middle Macoupin Healthcare System. 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 1 Carlinville Area Hospital Foundation 20733 North Broad Street Carlinville IL 62626 371193348 Support Carlinville Area Hospital Association IL 501(c)(3) Line 7 Middle Macoupin Healthcare Systems 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0