MEMORIAL HOSPITAL FOUNDATION: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL HOSPITAL FOUNDATION (EIN 47-3010424)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-04-13
- IRS object ID
- 201721039349301167
- Schema version
- 2015v3.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-04-13T17:12:43-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1545 ASSOCIATES DR STE 101 | AddressLine1Txt |
| City | DUBUQUE | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52002 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 473010424 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MEMO | BusinessNameControlTxt |
| Phone | 2173573131 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 160 | AddressLine1Txt |
| City | CARTHAGE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62321 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TERESA SMITH | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 2173573131 | PhoneNum |
| Signature | 2017-04-05 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | CARMEN KRANTZ | PreparerPersonNm |
| PTIN | P00031958 | PTIN |
| Phone | 5635561790 | PhoneNum |
| Preparation | 2017-04-05 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ADA BAIR | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 160 | AddressLine1Txt |
| City | CARTHAGE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62321 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $114,172 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2014 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | SUPPORT MEMORIAL HOSPITAL ASSOC AND THE GENERAL HEALTH OF THE CITIZENS OF HANCOCK COUNTY, IL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 16 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 16 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $108,126 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $148 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | -$4,262 | CYOtherRevenueAmt |
| PY Total Revenue | $0 | PYTotalRevenueAmt |
| CY Total Revenue | $104,012 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $26,350 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $8,519 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $0 | PYOtherExpensesAmt |
| CY Other Expenses | $8,919 | CYOtherExpensesAmt |
| PY Total Expenses | $0 | PYTotalExpensesAmt |
| CY Total Expenses | $35,269 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $0 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $68,743 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $48,298 | TotalAssetsBOYAmt |
| Total Assets EOY | $116,880 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $48,298 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $116,880 | NetAssetsOrFundBalancesEOYAmt |
| Mission | ENHANCING THE HEALTH AND WELLNESS OF OUR COMMUNITIES THROUGH CHARITABLE GIVING. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $26,350 | ExpenseAmt |
| Grant | $26,350 | GrantAmt |
| Desc | THE MEMORIAL HOSPITAL FOUNDATION WAS ESTABLISHED IN JANUARY OF 2015 TO SUPPORT MEMORIAL HOSPITAL, HANCOCK COUNTY SENIOR SERVICES AND THE GENERAL HEALTH AND WELL-BEING OF THE CITIZENS OF HANCOCK COUNTY, ILLINOIS. DONATIONS TO THE FOUNDATION ARE USED TO MEET SHORT AND LONG-TERM GOALS FOR THE BENEFIT OF QUALITY LOCAL HEALTHCARE, HEALTH AND WELLNESS PROVISIONS FOR OUR COMMUNITIES, AND TO BUILD STABILITY AND A FINANCIAL LEGACY FOR FUTURE GENERATIONS. | Desc |
| Total Program Service Expenses | $26,350 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | 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 | 0 | 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | 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 | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 16 | 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 | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 | 0 | 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 | TERESA SMITH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2173576571 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 160 | AddressLine1Txt |
| City | CARTHAGE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62321 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| JOE ZUMWALT | ||||||
| PRESIDENT | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| RON STARR | ||||||
| VICE PRESIDENT | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| CHARLES GILBERT | ||||||
| SECRETARY/TREASURER | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| ADA BAIR | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| KRISTA CARLE | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| CALLIE CONNOR | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| JOHN DITTMER | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| ELAINE FERGUSON | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DAVID FOX | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DON GRIFFITHS | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| MATTIE HAAS | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| MATT KRAUS | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| SHARON MORRISON | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| MAYOR JIM NIGHTINGALE | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| TERRY POPE | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| CASEY YAGER | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| ADA BAIR | ||||||
| HOSPITAL CEO | 0.50 | Yes (X) | $0 | $0 | $0 | |
| TERESA SMITH | ||||||
| HOSPITAL CFO | 0.50 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $28,909 | FundraisingAmt |
| All Other Contributions | $79,217 | AllOtherContributionsAmt |
| Total Contributions | $108,126 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $148 | TotalRevenueColumnAmt |
| Exclusion | $148 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $5,898 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $28,909 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $10,160 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$4,262 | TotalRevenueColumnAmt |
| Exclusion | -$4,262 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $104,012 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$4,114 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,250 | TotalAmt |
| Program Services | $26,250 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100 | TotalAmt |
| Program Services | $100 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $400 | TotalAmt |
| Management And General | $400 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $410 | TotalAmt |
| Fundraising | $410 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,109 | TotalAmt |
| Fundraising | $8,109 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,269 | TotalAmt |
| Program Services | $26,350 | ProgramServicesAmt |
| Management And General | $400 | ManagementAndGeneralAmt |
| Fundraising | $8,519 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,298 | BOYAmt |
| EOY | $116,880 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,298 | BOYAmt |
| EOY | $116,880 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,298 | BOYAmt |
| EOY | $116,880 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,298 | BOYAmt |
| EOY | $116,880 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,298 | BOYAmt |
| EOY | $116,880 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $68,743 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$161 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $48,328 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $108,126 | CurrentTaxYearAmt |
| Total | $156,454 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $48,328 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $108,126 | CurrentTaxYearAmt |
| Total | $156,454 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $34,340 | SubstantialContributorsTotAmt |
| Public Support Total170 | $122,114 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | $148 | CurrentTaxYearAmt |
| Total | $148 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $156,602 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $5,898 | GrossReceiptsRltdActivitiesAmt |
| First5 Years170 | Yes (X) | First5Years170Ind |
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 G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GALA | Event1Nm |
| Gross Receipts Event1 | $34,807 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $28,909 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $5,898 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $1,200 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $5,898 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $900 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $2,162 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $34,807 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $28,909 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $5,898 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $1,200 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $5,898 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $900 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $2,162 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $10,160 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$4,262 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 160 | AddressLine1Txt |
| City | CARTHAGE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62321 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 370684691 | RecipientEIN |
| Cash Grant | $25,000 | CashGrantAmt |
| Purpose Of Grant | EQUIPMENT PURCHASE | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE FOUNDATION BOARD OF DIRECTORS APPROVES AMOUNTS TO OTHER ORGANIZATIONS THAT MAY BENEFIT THE HEALTH OF THE COMMUNITY. THERE IS A CLOSE WORKING RELATIONSHIP BETWEEN THE FOUNDATION AND MEMORIAL HOSPITAL THEREFORE ENSURING THE FUNDS ARE USED APPROPRIATELY. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
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| FORM 990, PART VI, SECTION A, LINE 1 | THE CORPORATION SHALL HAVE AN EXECUTIVE COMMITTEE THAT IS COMPOSED OF THE FOLLOWING MEMBERS: THE PRESIDENT, VICE PRESIDENT, SECRETARY, AND TREASURER OF THE CORPORATION; THE CHAIRS OF THE CORPORATION'S ANNUAL GIFTS COMMITTEE, MAJOR GIFTS COMMITTEE, ESTATE GIFTS COMMITTEE, AND PERSONNEL COMMITTEE; AND THE IMMEDIATE PAST PRESIDENT OF THE CORPORATION IF SUCH PERSON IS A BOARD MEMBER OR, IF NOT, ONE ADDITIONAL BOARD MEMBER SELECTED BY THE BOARD. THE PRESIDENT OF THE CORPORATION, THE CHIEF EXECUTIVE OFFICER OF MEMORIAL HOSPITAL ASSOCIATION, AND THE CHIEF FINANCIAL OFFICER OF MEMORIAL HOSPITAL ASSOCIATION SHALL SERVE AS EX OFFICIO NON-VOTING MEMBERS OF THE EXECUTIVE COMMITTEE. EXCEPT AS OTHERWISE PROVIDED HEREIN, AND IN ANY BOARD RESOLUTION LIMITING THE POWERS OF THE EXECUTIVE COMMITTEE, SUCH COMMITTEE SHALL, DURING INTERVALS BETWEEN THE MEETINGS OF THE BOARD, POSSESS AND MAY EXERCISE ALL OF THE POWERS OF THE BOARD IN THE MANAGEMENT OF THE CORPORATION'S AFFAIRS. HOWEVER, THE EXECUTIVE COMMITTEE SHALL NOT HAVE THE AUTHORITY OF THE BOARD IN REFERENCE TO ELECTING, APPOINTING, OR REMOVING ANY MEMBER OF THE EXECUTIVE COMMITTEE, BOARD MEMBER, OR OFFICER OF THE CORPORATION; AUTHORIZING THE SALE, LEASE, EXCHANGE, OR MORTGAGE OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S PROPERTY AND ASSETS; AUTHORIZING THE VOLUNTARY DISSOLUTION OF THE CORPORATION OR REVOKING PROCEEDINGS THEREFOR; ADOPTING A PLAN FOR THE DISTRIBUTION OF THE CORPORATION'S ASSETS; OR AMENDING, ALTERING, OR REPEALING ANY RESOLUTION OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL KEEP FULL RECORDS AND ACCOUNTS OF ITS PROCEEDINGS AND TRANSACTIONS. ALL ACTION BY THE EXECUTIVE COMMITTEE SHALL BE REPORTED TO THE BOARD AT ITS MEETING NEXT SUCCEEDING SUCH ACTION AND SHALL BE SUBJECT TO CONTROL, REVISION, AND ALTERATION BY THE BOARD, PROVIDED THAT NO RIGHTS OF THIRD PARTIES SHALL BE PREJUDICIALLY AFFECTED THEREBY. SUBJECT TO THE PROVISIONS CONTAINED HEREIN, THE EXECUTIVE COMMITTEE SHALL FIX ITS OWN RULES OF PROCEDURE AND SHALL MEET AS PROVIDED BY SUCH RULES OR BY RESOLUTIONS OF THE BOARD, AND IT SHALL ALSO MEET AT THE CALL OF THE CHAIR OR ANY TWO MEMBERS OF THE EXECUTIVE COMMITTEE. UNLESS OTHERWISE PROVIDED BY SUCH RULES OR BY SUCH RESOLUTIONS, THE PROVISIONS CONTAINED HEREIN RELATING TO NOTICE REQUIRED TO BE GIVEN OF BOARD MEETINGS SHALL ALSO APPLY TO EXECUTIVE COMMITTEE MEETINGS. A MAJORITY OF THE MEMBERS OF THE EXECUTIVE COMMITTEE THEN IN OFFICE SHALL BE NECESSARY TO CONSTITUTE A QUORUM, AND APPROVAL OF ANY MATTER BY THE EXECUTIVE COMMITTEE SHALL REQUIRE THE AFFIRMATIVE VOTE OF A MAJORITY OF THE MEMBERS PRESENT AT THE MEETING. THE EXECUTIVE COMMITTEE MAY ACT IN WRITING WITHOUT A MEETING, BUT NO SUCH ACTION OF THE EXECUTIVE COMMITTEE SHALL BE EFFECTIVE UNLESS CONCURRED IN BY ALL MEMBERS OF THE EXECUTIVE COMMITTEE. |
| FORM 990, PART VI, SECTION A, LINE 7A | THREE OF THE BOARD MEMBERS MUST BE MEMBERS OF THE BOARD OF MEMORIAL HOSPITAL ASSOCIATION. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS REVIEWED BY THE BOARD OF DIRECTORS BEFORE IT IS FILED. THE FINAL RETURN IS REVIEWED AND SIGNED BY THE HOSPITAL CFO. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT UPON BECOMING A BOARD MEMBER. THE DISCLOSURE IS UPDATED ANNUALLY. ANY POSSIBLE CONFLICT OF INTEREST IS DISCLOSED TO THE OTHER BOARD MEMBERS AND MADE A MATTER OF RECORD THROUGH AN ANNUAL PROCEDURE AND ALSO WHEN THE INTEREST BECOMES A MATTER OF BOARD ACTION. DISCLOSURES ARE REVIEWED BY THE BOARD OF DIRECTORS AND ANY MEMBER FOR WHOM CONFLICTS HAVE BEEN IDENTIFIED LEAVES AND ABSTAINS FROM VOTING. APPROPRIATE DOCUMENTATION OF THE HANDLING OF THE CONFLICT IS KEPT TO PROTECT THE INTERESTED PARTY AND MEMORIAL HOSPITAL FOUNDATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE FOUNDATION PROVIDES THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENT UPON REQUEST. |
| FORM 990, PART VII: | ADA BAIR, HOSPITAL CEO, AND TERESA SMITH, HOSPITAL CFO, ARE COMPENSATED FOR THEIR SERVICES TO MEMORIAL HOSPITAL ASSOCIATION. THEY ARE NOT COMPENSATED FOR THEIR SERVICES TO THE FOUNDATION. |
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