COMMUNITY HEALTH FOUNDATION OF WARREN AND HENDERSON COUNTIES: Form 990PF, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HEALTH FOUNDATION OF WARREN AND HENDERSON COUNTIES (EIN 20-8070870)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-10-06
- IRS object ID
- 201712799349100001
- Schema version
- 2016v3.0
- 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
- Form 990-PF
- Accounting Fees Schedule
- Other Assets Schedule
- Other Decreases Schedule
- Other Expenses Schedule
- Other Professional Fees Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-10-06T07:22:27-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 300031703 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAVANAUGH DAVIES BLACKMAN & CRAMBLET | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1021 N MAIN ST PO BOX 318 | AddressLine1Txt |
| City | MONMOUTH | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 614620318 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 208070870 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTH FOUNDATION OF WARR | BusinessNameLine1Txt |
| Business Name Line2 | D RICKETTS | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 3097349333 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 EAST BROADWAY | AddressLine1Txt |
| City | MONMOUTH | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61462 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GREG MCCLINTOCK | PersonNm |
| Person Title | DIRECTOR | PersonTitleTxt |
| Phone | 3097345214 | PhoneNum |
| Signature | 2017-10-10 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | R CRAIG CAVANAUGH | PreparerPersonNm |
| PTIN | P00057393 | PTIN |
| Phone | 3097342330 | PhoneNum |
| Preparation | 2017-10-05 | PreparationDt |
Filing Security Information FilingSecurityInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| At Submission Creation Device Id | 939A26FAD04C23FB154564E38688CD185ECF74A1 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 0535E06005234005782C54672F9E8122D6FA29B2 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $13,984,347 | FMVAssetsEOYAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Interest On Sav Rev And Expnss | $668 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $668 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $259,274 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $259,274 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | -$170,162 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $12,988,620 | GrossSalesPriceAmt |
| Total Rev And Expnss | $89,780 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $259,942 | TotalNetInvstIncmAmt |
| Accounting Fees Rev And Expnss | $1,400 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $1,400 | AccountingFeesNetInvstIncmAmt |
| Other Prof Fees Rev And Expnss | $63,557 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $63,557 | OtherProfFeesNetInvstIncmAmt |
| Other Expenses Rev And Expnss | $1,428 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $1,428 | OtherExpensesNetInvstIncmAmt |
| Tot Opr Expenses Rev And Expnss | $66,385 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $66,385 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $0 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $900,835 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $900,835 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $967,220 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $66,385 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $900,835 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | -$877,440 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $193,557 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sav And Temp Cash Invst BOY | $354,969 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $257,533 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $257,533 | SavAndTempCashInvstEOYFMVAmt |
| Other Assets BOY | $14,554,196 | OtherAssetsBOYAmt |
| Other Assets EOY | $13,765,719 | OtherAssetsEOYAmt |
| Other Assets EOYFMV | $13,726,814 | OtherAssetsEOYFMVAmt |
| Total Assets BOY | $14,909,165 | TotalAssetsBOYAmt |
| Total Assets EOY | $14,023,252 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $13,984,347 | TotalAssetsEOYFMVAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
| Unrestricted BOY | $14,909,165 | UnrestrictedBOYAmt |
| Unrestricted EOY | $14,023,252 | UnrestrictedEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $14,909,165 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $14,023,252 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $14,909,165 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $14,023,252 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $14,909,165 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | -$877,440 | ExcessRevenueOverExpensesAmt |
| Subtotal | $14,031,725 | SubtotalAmt |
| Other Decreases | $8,473 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $14,023,252 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (30 entries)
| PropertyPropertyDesc | How AcquiredHowAcquiredCd | AcquiredAcquiredDt | SoldSoldDt | Gross Sales PriceGrossSalesPriceAmt | Cost Or Other BasisCostOrOtherBasisAmt | Gain Or LossGainOrLossAmt | Gains Minus Excess Or LossesGainsMinusExcessOrLossesAmt |
|---|---|---|---|---|---|---|---|
| BHMS LARGE CAP-208.372 UNITS | P | 2007-08-16 | 2016-01-27 | $4,641 | $4,567 | $74 | $74 |
| 2257.133 SHS HARBOR CAP APPREC FD | P | 2009-11-24 | 2016-06-28 | $124,970 | $72,815 | $52,155 | $52,155 |
| BHMS LARGE CAP-173.920 UNITS | P | 2007-08-16 | 2016-04-20 | $4,308 | $3,812 | $496 | $496 |
| 1155.242 SHS HARBOR CAP APPREC FD | P | 2015-12-17 | 2016-08-04 | $69,855 | $70,504 | -$649 | -$649 |
| BHMS LARGE CAP-179.885 UNITS | P | 2007-08-16 | 2016-07-27 | $4,608 | $3,943 | $665 | $665 |
| 1554.713 SHS HARBOR GLOBAL RE FD | P | 2015-12-29 | 2016-05-27 | $12,873 | $11,769 | $1,104 | $1,104 |
| 5898.367 SHS BAIRD INTERMEDIATE BD F | P | 2015-09-29 | 2016-11-28 | $64,970 | $65,592 | -$622 | -$622 |
| 118399.835 SHS HARBOR GLOBAL RE FD | P | 2016-05-27 | $980,321 | $1,349,850 | -$369,529 | -$369,529 | |
| 3918.495 SHS JOHN HANCOCK INCOME FD | P | 2015-09-29 | 2016-11-28 | $24,970 | $25,189 | -$219 | -$219 |
| 8810.854 SHS HARBOR INTER GROWTH FD | P | 2013-11-08 | 2016-05-27 | $110,370 | $112,606 | -$2,236 | -$2,236 |
| 4749.267 SHS DODGE & COX INCOME FD | P | 2016-05-31 | $64,636 | $63,840 | $796 | $796 | |
| 1647.870 SHS HARBOR INTER GROWTH FD | P | 2015-12-17 | 2016-08-03 | $21,406 | $20,153 | $1,253 | $1,253 |
| 2985.760 SHS VANGUARD INTER GOVT BD | P | 2016-06-01 | 2016-11-28 | $64,970 | $66,345 | -$1,375 | -$1,375 |
| 1178.498 SHS DODGE & COX INTL STK FD | P | 2015-12-21 | 2016-08-02 | $42,520 | $42,544 | -$24 | -$24 |
| 1102.887 VANGUARD INDEX 500 FD | P | 2016-08-02 | 2016-11-28 | $224,970 | $219,777 | $5,193 | $5,193 |
| BHMS LARGE CAP-100465.441 UNITS | P | 2016-08-09 | $2,589,200 | $3,198,552 | -$609,352 | -$609,352 | |
| 13032.146 SHS VANGUARD DEVELOPED MKT | P | 2016-08-02 | 2016-11-28 | $149,970 | $151,958 | -$1,988 | -$1,988 |
| 80038.378 SHS DODGE & COX INCOME FD | P | 2016-05-31 | $1,089,294 | $1,114,002 | -$24,708 | -$24,708 | |
| 14027.58 SHS ARTISAN MID CAP VALUE F | P | 2015-07-01 | 2016-08-01 | $294,970 | $346,636 | -$51,666 | -$51,666 |
| 11831.442 SHS LONG LEAF SMALL CAP FD | P | 2016-08-01 | $364,970 | $298,590 | $66,380 | $66,380 | |
| 1596.715 SHS ARTISON MID CAP VALUE F | P | 2015-07-01 | 2016-11-28 | $34,970 | $39,456 | -$4,486 | -$4,486 |
| 1267.198 SHS LONG LEAF SMALL CAP FD | P | 2016-11-28 | $34,970 | $28,641 | $6,329 | $6,329 | |
| 7052.897 ASTON MONTAG & CALDWELL FD | P | 2009-11-24 | 2016-05-27 | $139,970 | $157,914 | -$17,944 | -$17,944 |
| 28169.889 ASTON MONTAG & CALDWELL FD | P | 2016-08-01 | $579,153 | $693,119 | -$113,966 | -$113,966 | |
| 6459.948 ASTON MONTAG & CALDWELL FD | P | 2009-11-24 | 2016-06-28 | $124,970 | $144,638 | -$19,668 | -$19,668 |
| 12307.302 SHS HARBOR CAP APPREC FD | P | 2016-08-04 | $744,195 | $456,441 | $287,754 | $287,754 | |
| 14209.761 ASTON MONTAG & CALDWELL FD | P | 2015-12-30 | 2016-08-01 | $292,143 | $288,032 | $4,111 | $4,111 |
| 151928.09 SHS HARBOR INTER GROWTH FD | P | 2016-08-03 | $1,973,516 | $1,994,406 | -$20,890 | -$20,890 | |
| 2401.372 SHS HARBOR CAP APPREC FD | P | 2009-11-24 | 2016-05-27 | $139,970 | $77,468 | $62,502 | $62,502 |
| 50647.34 SHS DODGE & COX INTL STK FD | P | 2016-08-02 | $1,827,327 | $2,035,623 | -$208,296 | -$208,296 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | -$170,162 | CapitalGainNetIncomeAmt |
| Net Short Term Capital Gain Loss | $7,625 | NetShortTermCapitalGainLossAmt |
Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liable Section4942 Tax | false | LiableSection4942TaxInd |
| Adjusted Qlfy Distri Yr1 | $858,630 | AdjustedQlfyDistriYr1Amt |
| Net Vl Noncharitable Assets Yr1 | $14,996,361 | NetVlNoncharitableAssetsYr1Amt |
| Distribution Yr1 | 0.057256 | DistributionYr1Rt |
| Adjusted Qlfy Distri Yr2 | $812,892 | AdjustedQlfyDistriYr2Amt |
| Net Vl Noncharitable Assets Yr2 | $15,836,069 | NetVlNoncharitableAssetsYr2Amt |
| Distribution Yr2 | 0.051332 | DistributionYr2Rt |
| Adjusted Qlfy Distri Yr3 | $891,731 | AdjustedQlfyDistriYr3Amt |
| Net Vl Noncharitable Assets Yr3 | $14,954,184 | NetVlNoncharitableAssetsYr3Amt |
| Distribution Yr3 | 0.059631 | DistributionYr3Rt |
| Adjusted Qlfy Distri Yr4 | $605,913 | AdjustedQlfyDistriYr4Amt |
| Net Vl Noncharitable Assets Yr4 | $13,582,427 | NetVlNoncharitableAssetsYr4Amt |
| Distribution Yr4 | 0.044610 | DistributionYr4Rt |
| Adjusted Qlfy Distri Yr5 | $527,749 | AdjustedQlfyDistriYr5Amt |
| Net Vl Noncharitable Assets Yr5 | $13,613,473 | NetVlNoncharitableAssetsYr5Amt |
| Distribution Yr5 | 0.038767 | DistributionYr5Rt |
| Total Distribution | 0.251596 | TotalDistributionRt |
| Average Distribution | 0.050319 | AverageDistributionRt |
| Net Vl Noncharitable Assets | $13,884,788 | NetVlNoncharitableAssetsAmt |
| Adj Net Vl Noncharitable Assets | $698,669 | AdjNetVlNoncharitableAssetsAmt |
| Net Investment Income Pct | $1,936 | NetInvestmentIncomePctAmt |
| Adj Nonchrtbl Net Invst Incm Pct | $700,605 | AdjNonchrtblNetInvstIncmPctAmt |
| Qualifying Distributions | $900,835 | QualifyingDistributionsAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Domestic Org Meeting Sect4940e | Yes (X) | DomesticOrgMeetingSect4940eInd |
| Investment Income Excise Tax | $1,936 | InvestmentIncomeExciseTaxAmt |
| Subtotal | $1,936 | SubtotalAmt |
| Tax Based On Investment Income | $1,936 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $9,200 | EstimatedPlusOvpmtIncmTxAmt |
| Total Payments And Credits | $9,200 | TotalPaymentsAndCreditsAmt |
| Overpayment | $7,264 | OverpaymentAmt |
| Applied To ES Tax | $7,264 | AppliedToESTaxAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | false | LegislativePoliticalActyInd |
| More Than100 Spent | false | MoreThan100SpentInd |
| Form1120 POL Filed | false | Form1120POLFiledInd |
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | false | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Organization Dissolved Etc | false | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | Yes (true) | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (true) | AtLeast5000InAssetsInd |
| Org Report Or Register State | IL | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (true) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | false | PrivateOperatingFoundationInd |
| New Substantial Contributors | false | NewSubstantialContributorsInd |
| Own Controlled Entity | false | OwnControlledEntityInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (true) | ComplyWithPublicInspRqrInd |
| Website Address | N/A | WebsiteAddressTxt |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | R CRAIG CAVANAUGH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3097342330 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1021 NORTH MAIN STREET | AddressLine1Txt |
| City | MONMOUTH | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61462 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | false | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | false | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | false | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | false | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | false | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | false | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | false | PaymentToGovernmentOfficialInd |
| Undistributed Income PY | false | UndistributedIncomePYInd |
| Business Holdings | false | BusinessHoldingsInd |
| Jeopardy Investments | false | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | false | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | false | InfluenceLegislationInd |
| Influence Election | false | InfluenceElectionInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Noncharitable Purpose | false | NoncharitablePurposeInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (11 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|---|---|---|---|
| GREG MCCLINTOCK | ||||||||
| 707 NORTH 11TH ST | MONMOUTH | IL | 61462 | DIRECTOR | 000.00 | $0 | $0 | $0 |
| GARY HEATON | ||||||||
| 715 NORTH 9TH ST | MONMOUTH | IL | 61462 | SECRETARY | 000.00 | $0 | $0 | $0 |
| DOROTHY RICKETTS | ||||||||
| 202 NORTH G | MONMOUTH | IL | 61462 | CHAIRPERSON | 000.00 | $0 | $0 | $0 |
| DR JAMES BATTENBURG | ||||||||
| 2028 62ND ST | MONMOUTH | IL | 61462 | DIRECTOR | 000.00 | $0 | $0 | $0 |
| DON GLADFELTER | ||||||||
| 861 210TH AVE | MONMOUTH | IL | 61462 | DIRECTOR | 000.00 | $0 | $0 | $0 |
| MIKE CONNELL | ||||||||
| 1150 WARREN SCHOOL RD | MONMOUTH | IL | 61462 | VICE CHAIRPE | 000.00 | $0 | $0 | $0 |
| SPUD RILEY | ||||||||
| 1361 EAST BROADWAY | MONMOUTH | IL | 61462 | DIRECTOR | 000.00 | $0 | $0 | $0 |
| CAROL SHAW | ||||||||
| 1008 HWY 116 | ROSEVILLE | IL | 61473 | DIRECTOR | 000.00 | $0 | $0 | $0 |
| JON FERGUSON | ||||||||
| 17 FAIRWAY DRIVE | MONMOUTH | IL | 61462 | DIRECTOR | 000.00 | $0 | $0 | $0 |
| PATTY LUKER | ||||||||
| OSF HOLY FAMILY MD CTR 1000 W HARLE | MONMOUTH | IL | 61462 | EX-OFFICIO | 000.00 | $0 | $0 | $0 |
| LYNNE HAASE | ||||||||
| RR 1 BOX 112 | BIGGSVILLE | IL | 61418 | DIRECTOR | 000.00 | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Comp Of Hghst Pd Empl Or NONE | NONE | CompOfHghstPdEmplOrNONETxt |
| Comp Of Hghst Pd Cntrct Or NONE | NONE | CompOfHghstPdCntrctOrNONETxt |
Sum Of Program Related Invst SumOfProgramRelatedInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description1 | N/A | Description1Txt |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $13,708,006 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $388,225 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $14,096,231 | TotalFMVOfUnusedAssetsAmt |
| Adjusted Total FMV Of Unused Ast | $14,096,231 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $211,443 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $13,884,788 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $694,239 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $694,239 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $1,936 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $1,936 | TotalTaxAmt |
| Distributable Before Adj | $692,303 | DistributableBeforeAdjAmt |
| Distributable Before Ded | $692,303 | DistributableBeforeDedAmt |
| Distributable As Adjusted | $692,303 | DistributableAsAdjustedAmt |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $900,835 | ExpensesAndContributionsAmt |
| Qualifying Distributions | $900,835 | QualifyingDistributionsAmt |
| Pct Sect4940e Org Net Invst Incm | $1,936 | PctSect4940eOrgNetInvstIncmAmt |
| Adjusted Qualifying Distri | $898,899 | AdjustedQualifyingDistriAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $692,303 | DistributableAsAdjustedAmt |
| Excess Distribution Cyov Yr2 | $36,662 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $126,552 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $163,214 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $900,835 | QualifyingDistributionsAmt |
| Applied To Current Year | $692,303 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $208,532 | RemainingDistriFromCorpusAmt |
| Total Corpus | $371,746 | TotalCorpusAmt |
| Undistributed Income CY | $0 | UndistributedIncomeCYAmt |
| Excess Distri Cyov To Next Yr | $371,746 | ExcessDistriCyovToNextYrAmt |
| Excess From Year2 | $36,662 | ExcessFromYear2Amt |
| Excess From Year1 | $126,552 | ExcessFromYear1Amt |
| Excess From Current Year | $208,532 | ExcessFromCurrentYearAmt |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Only Contri To Preselected | Yes (X) | OnlyContriToPreselectedInd |
Application Submission Info ApplicationSubmissionInfoGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Person | DOROTHY RICKETTS | RecipientPersonNm |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 EAST BROADWAY | AddressLine1Txt |
| City | MONMOUTH | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61462 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Phone | 3097349333 | RecipientPhoneNum |
| Recipient Email Address | NONE | RecipientEmailAddressTxt |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (4 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|---|
| HENDERSON COUNTY HEALTH DEPT | |||||||
| 1204 HIGHWAY 164 | OQUAWKA | IL | 61469 | NONE | GOVERNMENTAL | GRANT FOR EQUIPMENT | $9,335 |
| OSF HEALTHCARE SYSTEMS FO | |||||||
| 1000 WEST HARLEM AVENUE | MONMOUTH | IL | 61462 | NONE | NOT FOR PROF | GRANT FOR EXPANSION | $500,000 |
| OSF HOLY FAMILY MEDICAL CTR | |||||||
| 1000 WEST HARLEM AVENUE | MONMOUTH | IL | 61462 | NONE | NOT FOR PROF | GRANT FOR EQUIPMENT | $100,000 |
| WARREN COUNTY HEALTH DEPT | |||||||
| SOUTH MAIN STREET | MONMOUTH | IL | 61462 | NONE | GOVT | EQUIPMENT AND OPERATIONS | $291,500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $900,835 | TotalGrantOrContriPdDurYrAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $668 | ExclusionAmt |
Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $259,274 | ExclusionAmt |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | -$170,162 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | $89,780 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $89,780 | TotalIncomeProducingActyAmt |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | false | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | false | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | false | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | false | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | false | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | false | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | false | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | false | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | false | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | false | RelationshipsNonchrtblEOInd |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | PREPARATION OF 990'S | CategoryTxt |
| Amt | $1,400 | Amt |
| Net Investment Income | $1,400 | NetInvestmentIncomeAmt |
Other Assets Schedule OtherAssetsSchedule
Other Assets Schedule OtherAssetsScheduleGrp (20 entries)
| DescDesc | BOY Book ValueBOYBookValueAmt | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|---|
| LONGLEAF PARTNERS SMALL CAP FD | $761,720 | $514,899 | $491,957 |
| DODGE & COX INTL STK FD | $2,078,166 | ||
| BHMS LARGE VALUE FD | $2,483,871 | ||
| HARBOR CAPITAL APPRECIATION FD | $677,229 | ||
| ASTON M&C GROWTH FD | $1,283,703 | ||
| HARTFORD GLOBAL REAL | $1,361,619 | ||
| DODGE & COX INCOME FD | $1,166,593 | ||
| HARBOR INTERNATIONAL FD | $2,127,165 | ||
| ARTISAN MID CAP FD | $892,652 | $521,025 | $498,774 |
| BAIRD INTERMEDIATE BONDS | $1,150,164 | $1,254,734 | $1,237,353 |
| J HANCOCK INCOME FD | $571,314 | $571,314 | $561,801 |
| DODGE & COX GLOBAL STK FD | $1,237,014 | $1,329,489 | |
| LAUDUS MONDRIAN EMERGING MKTS FD | $537,883 | $499,931 | |
| PRINCIPAL DIVERSIFIED RE FD | $564,324 | $563,344 | |
| SANDS CAPITAL GLOBAL STK FD | $1,150,000 | $1,091,373 | |
| VANGUARD 500 INDEX FD | $3,883,351 | $3,998,795 | |
| VANGUARD DEVELOPED MKTS FD | $1,290,531 | $1,299,135 | |
| VANGUARD INTERMEDIATE GOVT BD FD | $1,244,063 | $1,209,370 | |
| WASATCH INTERNATIONAL GROWTH FD | $440,009 | $381,395 | |
| WELLS FARGO ABSOLUTE FD | $556,572 | $564,097 |
Other Decreases Schedule OtherDecreasesSchedule
Other Decreases Detail OtherDecreasesDetail (2 entries)
| DescDesc | AmtAmt |
|---|---|
| FEDERAL INCOME TAXES PAID | $8,470 |
| ROUNDING | $3 |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (3 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt |
|---|---|---|
| EXPENSES | ||
| INSURANCE | $1,262 | $1,262 |
| FEES AND BANK CHARGES | $166 | $166 |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt |
|---|---|---|
| INVESTMENT ADVISORY AND FILING | $50,000 | $50,000 |
| BHMS LARGE CAP VALUE K-1 | $13,557 | $13,557 |
Comments