2016-09-15T00:00:00-05:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 114 E EVERETT DIXON IL 61021 990 2015-01-01 550809159 THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK ILLI 8158752999 245 BACKBONE ROAD EAST PRINCETON IL 61356 PATRICIA SCHOU EXECUTIVE DIRECTOR 8158752999 2016-09-12 1 TODD M ETHERIDGE P00233050 8152859300 2015 2017-02-10 21:41:12Z PATRICIA SCHOU 245 BACKBONE ROAD EAST PRINCETON IL 61356 3277103 0 X WWW.ICAHN.ORG X 2002 IL THE MISSION OF ICAHN IS TO STRENGTHEN ILLINOIS CRITICAL ACCESS HOSPITALS THROUGH COLLABORATION. 9 9 19 9 0 0 1961112 1804695 1376604 1462124 3278 10284 0 0 3340994 3277103 1390274 1208728 0 0 1004327 1121068 0 0 0 856786 931709 3251387 3261505 89607 15598 1010499 1024022 211328 216621 799171 807401 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 53 MEMBER HOSPITALS, IS AN INDEPENDENT NETWORK GOVERNED BY A NINE-MEMBER BOARD OF DIRECTORS. 0 0 2142350 1208728 1031223 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. SERVES APPROXIMATELY 53 HOSPITALS. 189811 47361 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. 242366 383540 ICAN PROVIDES INFORMATION TECHNOLOGY ASSISTANCE TO SMALL RURAL HOSPITALS ACROSS THE STATE SERVING APPROXIMATELY 53 HOSPITALS. SERVICES ARE AVAILABLE TO ALL 53 HOSPITALS AND ALL CHOSE TO UTILIZE THEM. 2574527 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 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 1 1 1 0 0 1 12 0 19 1 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 MATT COMERFORD 8158752999 245 BACKBONE ROAD EAST PRINCETON IL 61356 GREG STARNES DIRECTOR 0.50 X 0 0 0 DOUG FLORKOWSKI DIRECTOR 0.50 X 0 0 0 KEN REID DIRECTOR 0.50 X 0 0 0 JOANN EMGE DIRECTOR 0.50 X 0 0 0 OLLIE SMITH DIRECTOR 0.50 X 0 0 0 KATHY HULL DIRECTOR 0.50 X 0 0 0 MARK ROSSI PRESIDENT 0.50 X X 0 0 0 TRINA CASNER PRESIDENT ELECT 0.50 X X 0 0 0 TRACY BAUER SECRETARY/TREASURER 0.50 X X 0 0 0 PATRICIA SCHOU EXECUTIVE DIRECTOR 40.00 X 200619 0 26405 200619 0 26405 1 0 1 0 HART LLC 3001 MARKWOOD LANE SPRINGFIELD IL 62712 CONSULTING SERVICES 179714 1 409425 1360270 35000 1804695 IT SERVICES 541519 383540 383540 CONSULTING REVENUE 541610 142160 142160 IL RURAL COMMUNITY CAR 900099 93411 93411 WORKSHOP/MEETING FEES 900099 47361 47361 ICAHN RURAL RECRUITMEN 900099 14000 14000 781652 781652 1462124 10284 10284 3277103 1462124 0 10284 1208728 1208728 227024 158917 68107 759482 531637 227845 22794 15956 6838 43739 30617 13122 68029 47620 20409 29284 29284 21298 21298 146957 146810 147 61743 37046 24697 26429 15857 10572 300400 180240 120160 57549 34529 23020 59792 35875 23917 198561 119137 79424 13188 7913 5275 15900 9540 6360 MEMBERSHIP DUES EXPENSE 14134 8480 5654 BAD DEBT RECOVERY -15647 -15647 2121 1272 849 3261505 2574527 686978 0 0 599682 810526 53883 154369 115860 11781 35912 79156 56137 33823 23019 195666 1010499 1024022 107718 84967 103610 131654 211328 216621 X 777425 783640 21746 23761 799171 807401 1010499 1024022 15598 -7368 0 X 0 1 X 1 1 1 X 1547848 1551197 1990425 1961112 1804695 8855277 1547848 1551197 1990425 1961112 1804695 8855277 8855277 11091 2964 4330 3278 10284 31947 8887224 6103037 0.99640 0.99580 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 79156 56137 23019 23019 X PART X, LINE 2: ICAHN AND AHEC ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND AS SUCH, ARE NOT LIABLE FOR INCOME TAXES. IRRS AND IRCCO ARE SOLE MEMBER LIMITED LIABILITY COMPANIES AND THEREFORE ARE DISREGARDED ENTITIES FOR FEDERAL INCOME TAX PURPOSES. FOR 990 REPORTING PURPOSES IRRS'S AND IRCCO'S ACTIVITIES ARE INCLUDED IN ICAHN'S 990. ICAHN AND AHEC, AS EXEMPT ORGANIZATIONS, ARE SUBJECT TO TAX ON ANY UNRELATED BUSINESS INCOME. ICAHN AND AHEC ARE CLASSIFIED BY THE INTERNAL REVENUE SERVICE AS OTHER THAN A PRIVATE FOUNDATION. DUE TO AHEC BEING DISSOLVED INTO ICAHN A FINAL 990 WAS FILED WITH THE INTERNAL REVENUE SERVICE. 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 ADDRESSES DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE, AND TRANSITION. THE ORGANIZATION CONDUCTS 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 ABRAHAM LINCOLN MEMORIAL HOSPITAL 200 STALHUT DRIVE LINCOLN IL 62656 370723793 501(C)(3) 13550 N/A N/A SHIP GRANT, REHAB SERVICES GRANT ADVOCATE EUREKA HOSPITAL 101 S MAJOR ST EUREKA IL 61530 370662542 501(C)(3) 13550 N/A N/A SHIP GRANT CARLE HOOPESTON REGIONAL HEALTH CENTER 701 E ORANGE ST HOOPESTON IL 60942 261503640 501(C)(3) 8550 SHIP GRANT CARLINVILLE AREA HOSPITAL 20733 N BROAD STREET CARLINVILLE IL 62626 370645239 501(C)(3) 18550 N/A N/A SHIP GRANT, FINANCIAL ASSESSMENT GRANT CLAY COUNTY HOSPITAL 911 STACY BURK DRIVE FLORA IL 62839 376000605 CLAY COUNTY 20550 N/A N/A SHIP GRANT, ILHIE WHITE SPACE GRANT, TRANSITION MODEL/POPULATION HEALTH GRANT, HOSPITAL BOARD GRANT COMMUNITY MEMORIAL HOSPITAL 400 CALDWELL ST STAUNTON IL 62088 370624255 501(C)(3) 8550 N/A N/A SHIP GRANT, ILHIE WHITE SPACE GRANT, TRANSITION MODEL/POPULATION HEALTH GRANT, FINANCIAL ASSESSMENT GRANT CRAWFORD MEMORIAL HOSPITAL 1000 NORTH ALLEN STREET ROBINSON IL 62454 370793762 501(C)(3) 13550 N/A N/A SHIP GRANT, ILHIE WHITE SPACE GRANT, TRANSITION/MODEL POPULATION HEALTH GRANT DR JOHN WARNER HOSPITAL 422 WEST WHITE ST CLINTON IL 61727 376000695 CLINTON, IL 8550 N/A N/A SHIP GRANT, TRANSITION/MODEL POPULATION HEALTH GRANT FAIRFIELD MEMORIAL HOSPITAL 303 NW 11TH ST FAIRFIELD IL 62837 370661202 501(C)(3) 18511 N/A N/A SHIP GRANT, ILHIE WHITE SPACE GRANT, TRANSITION MODEL/POPULATION HEALTH GRANT, EMS EDUCATION & EQUIPMENT GRANT FAYETTE COUNTY HOSPITAL AND LONG TERM CARE 650 WEST TAYLOR ST VANDALIA IL 62471 201890414 FAYETTE COUNTY 12610 N/A N/A SHIP GRANT FERRELL HOSPITAL 1201 PINE ST ELDORADO IL 62930 201244058 501(C)(3) 13550 N/A N/A SHIP GRANT, FINANCIAL ASSESSMENT GRANT, HOSPITAL BOARD EDUCATION GRANT FRANKLIN HOSPITAL 201 BAILEY LANE BENTON IL 62812 376006885 FRANKLIN CO. DISTR. 21550 N/A N/A SHIP GRANT, ILHIE WHITE SPACE GRANT, TRANSITION MODEL/POPULATION HEALTH GRANT GENESIS MEDICAL CENTER 409 NW 9TH AVENUE ALEDO IL 61231 454475683 501(C)(3) 15550 N/A N/A SHIP GRANT GIBSON AREA HOSPITAL & HEALTH SERVICES 1120 N MELVIN ST GIBSON CITY IL 60936 370647938 501(C)(3) 13550 N/A N/A SHIP GRANT, ILHIE WHITE SPACE GRANT, TRANSITION MODEL/POPULATION HEALTH GRANT GREENVILLE REGIONAL HOSPITAL 200 HEALTHCARE DR GREENVILLE IL 62246 370792770 501(C)(3) 9265 N/A N/A SHIP GRANT HAMILTON MEMORIAL HOSPITAL DISTRICT 611 S MARSHALL AVENUE PO BOX 429 MCLEANSBORO IL 62859 376019589 HAMILTON HOSP. DISTR 13517 N/A N/A SHIP GRANT, ILHIE WHITE SPACE GRANT, TRANSITION MODEL/POPULATION HEALTH GRANT, EMS EDUCATION & EQUIPMENT GRANT HAMMOND HENRY HOSPITAL 600 NORTH COLLEGE AVENUE GENESEO IL 61254 366008003 HENRY HOSP. DISTR. 15550 N/A N/A SHIP GRANT, TRANSITION MODEL/POPULATION HEALTH GRANT HARDIN COUNTY GENERAL HOSPITAL 6 FERRELL ROAD BOX 2467 ROSICLARE IL 62982 370702309 501(C)(3) 16550 N/A N/A SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT, ILHIE WHITE SPACE GRANT, TRANSITION MODEL/POPULATION HEALTH GRANT HEALTHTECH MANAGEMENT SERVICES INC 5110 MARYLAND WAY SUITE 200 BRENTWOOD TN 37027 930972947 15000 N/A N/A RURAL HOSPITAL FLEX GRANT HILLSBORO AREA HOSPITAL 1200 EAST TREMONT ST HILLSBORO IL 62049 370661208 501(C)(3) 18550 N/A N/A SHIP GRANT, PREVENTION/REHAB SERVICES GRANT, EMS EDUCATION & EQUIPMENT GRANT HOPEDALE MEDICAL COMPLEX 107 TREMONT ST HOPEDALE IL 61747 370808925 501(C)(3) 13550 N/A N/A SHIP GRANT, PREVENTION/REHAB SERVICES GRANT ILLINI COMMUNITY HOSPITAL 640 WEST WASHINGTON ST PITTSFIELD IL 62363 371396010 501(C)(3) 11550 N/A N/A SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT, EMS EDUCATION & EQUIPMENT GRANT ILLINOIS HOSPITAL ASSOCIATION 1151 EAST WARRENVILLE ROAD NAPERVILLE IL 60566 362352486 501(C)(3) 70000 N/A N/A MEDICARE RURAL HOSPITAL FLEX PROGRAM GRANT IROQUOIS MEMORIAL HOSPITAL 200 FAIRMAN WATSEKA IL 60970 370673512 501(C)(3) 18374 N/A N/A SHIP GRANT, TRANSITION MODEL/POPULATION HEALTH GRANT, FINANCIAL ASSESSMENT GRANT JERSEY COMMUNITY HOSPITAL 400 MAPLE SUMMIT JERSEYVILLE IL 62052 376013958 501(C)(3) 13550 N/A N/A SHIP GRANT KIRBY MEDICAL CENTER 1000 MEDICAL CENTER DRIVE MONTICELLO IL 61856 370661215 501(C)(3) 20550 N/A N/A SHIP GRANT, EMS EDUCATION & EQUIPMENT GRANT LAWRENCE COUNTY MEMORIAL HOSPITAL 2200 WEST STATE ST LAWRENCEVILLE IL 62439 800618988 501(C)(3) 8550 N/A N/A SHIP GRANT MARSHALL BROWNING HOSPITAL 900 N WASHINGTON ST DUQUOIN IL 62832 370661218 501(C)(3) 22525 N/A N/A SHIP GRANT, PREVENTION/REHAB SERVICES GRANT MASON DISTRICT HOSPITAL 615 N PROMENADE ST HAVANA IL 62644 376017857 MASON DISTRICT 12050 N/A N/A SHIP GRANT, FINANCIAL ASSESSMENT GRANT MASSAC MEMORIAL HOSPITAL 28 CHICK ST PO BOX 850 METROPOLIS IL 62960 370857853 MASSAC HOSP. DISTR. 16550 N/A N/A SHIP GRANT, FINANCIAL ASSESSMENT GRANT MEMORIAL HOSPITAL CARTHAGE 1454 N COUNTY ROAD 2050 PO BOX 160 CARTHAGE IL 62321 370662570 501(C)(3) 30550 N/A N/A SHIP GRANT, FINANCIAL ASSESSMENT GRANT, PREVENTION/REHAB SERVICES GRANT, HOSPITAL BOARD EDUCATION GRANT MEMORIAL HOSPITAL CHESTER 1900 STATE ST CHESTER IL 62233 376020801 RANDOLPH COUNTY 13550 N/A N/A SHIP GRANT MENDOTA COMMUNITY HOSPITAL 1401 EAST 12TH ST MENDOTA IL 61342 362167785 501(C)(3) 8550 N/A N/A SHIP GRANT, ILHIE WHITE SPACE GRANT, PREVENTION/REHAB SERVICES GRANT MIDWEST MEDICAL CENTER 1 MEDICAL CENTER DRIVE GALENA IL 61036 204560540 501(C)(3) 15550 N/A N/A SHIP GRANT, EMS GRANT, FINANCIAL ASSESSMENT GRANT MORRISON COMMUNITY HOSPITAL 303 N JACKSON ST MORRISON IL 61270 366008167 MORRISON, IL 17550 N/A N/A SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT OSF HOLY FAMILY MEDICAL CENTER 1000 W HARLEM AVE MONMOUTH IL 61462 370813229 501(C)(3) 15550 N/A N/A SHIP GRANT, PREVENTION/REHAB SERVICES GRANT, TRANSITION MODEL/POPULATION HEALTH GRANT OSF ST JAMES W ALBRECHT MEDICAL CENTER 2500 W REYNOLDS ST PONTIAC IL 61764 370662570 501(C)(3) 8550 N/A N/A SHIP GRANT, EMS EDUCATION & EQUIPMENT GRANT OSF ST LUKE MEDICAL CENTER 1051 WEST SOUTH ST PO BOX 747 KEWANEE IL 61443 362167767 501(C)(3) 6850 N/A N/A TRANSITION MODELS/REHABILITATION SERVICES GRANT PANA COMMUNITY HOSPITAL 101 EAST NINTH ST PANA IL 62557 376062326 501(C)(3) 17050 N/A N/A SHIP GRANT, FINANCIAL ASSESSMENT GRANT, EMS EDUCATION & EQUIPMENT GRANT, PREVENTION/REHAB SERVICES GRANT PARIS COMMUNITY HOSPITAL 721 EAST COURT ST PARIS IL 61944 370860281 501(C)(3) 13550 N/A N/A SHIP GRANT, ILHIE WHITE SPACE GRANT, HOSPITAL BOARD EDUCATION GRANT, EMS EDUCATION & EQUIPMENT GRANT PERRY MEMORIAL HOSPITAL 530 PARK AVENUE EAST PRINCETON IL 61356 366006057 PRINCETON, IL 18550 N/A N/A SHIP GRANT, EMS EDUCATION & EQUIPMENT GRANT PINCKNEYVILLE COMMUNITY HOSPITAL 101 NORTH WALNUT STREET PINCKNEYVILLE IL 62274 376006955 PINCKNEYVILLE DISTR. 20550 N/A N/A SHIP GRANT, FINANCIAL ASSESSMENT GRANT, HOSPITAL BOARD EDUCATION GRANT RED BUD REGIONAL HOSPITAL 325 SPRING ST RED BUD IL 62278 364443919 501(C)(3) 18550 N/A N/A SHIP GRANT, PREVENTION/REHAB SERVICES GRANT RICHLAND MEMORIAL HOSPITAL 800 EAST LOCUST OLNEY IL 62450 371363001 501(C)(3) 11534 N/A N/A SHIP GRANT, EMS EDUCATION & EQUIPMENT GRANT ROCHELLE COMMUNITY HOSPITAL 900 N SECOND ST ROCHELLE IL 61068 362548549 501(C)(3) 13550 N/A N/A SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT SALEM TOWNSHIP HOSPITAL 1201 RICKER DRIVE SALEM IL 62881 370925318 SALEM, IL 11550 N/A N/A SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT, ILHIE WHITE SPACE GRANT, TRANSITION MODEL/POPULATION HEALTH GRANT, PREVENTION/REHAB SERVICES GRANT SARAH D CULBERTSON MEMORIAL HOSPITAL 238 SOUTH CONGRESS AVE RUSHVILLE IL 62681 376006672 SCHUYLER CO. DISTR. 13550 N/A N/A SHIP GRANT, ILHIE WHITE SPACE GRANT, TRANSITION MODEL/POPULATION HEALTH GRANT SHELBY MEMORIAL HOSPITAL 200 SOUTH CEDAR SHELBYVILLE IL 62565 370512290 501(C)(3) 8550 N/A N/A SHIP GRANT, PREVENTION/REHAB SERVICES GRANT SPARTA COMMUNITY HOSPITAL DISTRICT 818 EAST BROADWAY SPARTA IL 62286 376014817 SPARTA HOSP. DISTR. 16550 N/A N/A SHIP GRANT, FINANCIAL ASSESSMENT GRANT, ILHIE WHITE SPACE GRANT, TRANSITION MODEL/POPULATION HEALTH GRANT ST FRANCIS HOSPITAL 1215 FRANCISCAN DRIVE LITCHFIELD IL 62056 370661236 501(C)(3) 13550 N/A N/A SHIP GRANT, FINANCIAL ASSESSMENT GRANT ST JOSEPH'S HOSPITAL 1515 MAIN ST HIGHLAND IL 62249 370663568 501(C)(3) 13550 N/A N/A SHIP GRANT, TRANSITION MODEL/POPULATION HEALTH GRANT, HOSPITAL BOARD EDUCATION GRANT, FINANCIAL ASSESSMENT GRANT ST JOSEPH MEMORIAL HOSPITAL 2 SOUTH HOSPITAL DRIVE MURPHYSBORO IL 62966 370618939 501(C)(3) 14345 N/A N/A SHIP GRANT, PREVENTION/REHAB SERVICES GRANT TAYLORVILLE MEMORIAL HOSPITAL 201 EAST PLEASANT ST TAYLORVILLE IL 62568 370661250 501(C)(3) 8550 N/A N/A SHIP GRANT THOMAS H BOYD MEMORIAL HOSPITAL 800 SCHOOL ST CARROLTON IL 62016 370673461 501(C)(3) 17900 N/A N/A SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT UNION COUNTY HOSPITAL 517 NORTH MAIN ST ANNA IL 62906 364431843 UNION COUNTY 8550 N/A N/A SHIP GRANT VALLEY WEST COMMUNITY HOSPITAL 11 E PLEASANT AVE SANDWICH IL 60548 364244337 501(C)(3) 8550 N/A N/A SHIP GRANT WABASH GENERAL HOSPITAL 1418 COLLEGE DR MT CARMEL IL 62863 376013625 WABASH HOSP. DISTR. 8550 N/A N/A SHIP GRANT, EMS EDUCATION & EQUIPMENT GRANT WASHINGTON COUNTY HOSPITAL 705 S GRAND NASHVILLE IL 62263 376020408 WASHINGTON COUNTY 18550 N/A N/A SHIP GRANT, ILHIE WHITE SPACE GRANT, HOSPITAL BOARD EDUCATION GRANT WESTERN ILLINOIS AHEC BROADWAY AT 14TH ST QUINCY IL 62305 262145452 501(C)(3) 12000 N/A N/A RURAL HOSPITAL FLEXIBILITY GRANT 40 19 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 200619 0 0 0 0 0 5969 0 20436 0 227024 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 11 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. ICAHN RURAL RECRUITMENT SERVICES LLC 245 BACKBONE RD EAST PRINCETON IL 61356 208045884 RECRUITING SERVICES FOR MEMBER HOSPITALS IL 14015 0 ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK ILLINOIS RURAL COMMUNITY CARE ORGANIZATION LLC 245 BACKBONE RD EAST PRINCETON IL 61356 465654316 DEVELOP SYSTEMS OF CLINICAL INTEGRATION & EFFICIENCIES FOR MEMBER HOSPITALS IL 93411 37971 ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK WESTERN ILLINOIS AREA HEALTH EDUCATION CENTER 245 BACKBONE ROAD EAST PRINCETON IL 61356 262145452 IMPROVE HEALTH CARE IN UNDERSERVED AREAS OF IL THROUGH EDUC. OF PROVIDERS IL 501(C)(3) LINE 9 THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK 1 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 WESTERN ILLINOIS AREA HEALTH EDUCATION CENTER B 9124 ACTUAL DOLLAR AMOUNT