COMMUNITY HEALTH FOUNDATION OF WARREN AND HENDERSON COUNTIES: Form 990PF, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HEALTH FOUNDATION OF WARREN AND HENDERSON COUNTIES (EIN 20-8070870)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-09-12
- IRS object ID
- 201622569349100462
- Schema version
- 2015v2.1
- 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
- Gain Loss Sale Other Assets Sch
- Other Assets Schedule
- Other Decreases Schedule
- Other Expenses Schedule
- Other Professional Fees Schedule
- Reasonable Cause Explanation
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-09-12T12:49:22-05:00 | ReturnTs |
| Tax Period End | 2015-12-31 | 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 | 2015-01-01 | 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 | G MCCLINTOCK | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 3097345214 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 717 NORTH 11TH STREET | 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 | 2016-09-07 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | R CRAIG CAVANAUGH | PreparerPersonNm |
| PTIN | P00057393 | PTIN |
| Phone | 3097342330 | PhoneNum |
| Preparation | 2016-09-01 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $14,063,445 | 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 | $738 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $738 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $237,631 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $237,631 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | $780,718 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $4,313,630 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $713,815 | CapGainNetIncmNetInvstIncmAmt |
| Total Rev And Expnss | $1,019,087 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $952,184 | TotalNetInvstIncmAmt |
| Accounting Fees Rev And Expnss | $1,625 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $1,625 | AccountingFeesNetInvstIncmAmt |
| Other Prof Fees Rev And Expnss | $62,119 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $62,119 | OtherProfFeesNetInvstIncmAmt |
| Other Expenses Rev And Expnss | $1,419 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $1,419 | OtherExpensesNetInvstIncmAmt |
| Tot Opr Expenses Rev And Expnss | $65,163 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $65,163 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $0 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $867,500 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $867,500 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $932,663 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $65,163 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $867,500 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | $86,424 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $887,021 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sav And Temp Cash Invst BOY | $176,072 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $354,969 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $354,969 | SavAndTempCashInvstEOYFMVAmt |
| Other Assets BOY | $14,654,378 | OtherAssetsBOYAmt |
| Other Assets EOY | $14,554,196 | OtherAssetsEOYAmt |
| Other Assets EOYFMV | $13,708,476 | OtherAssetsEOYFMVAmt |
| Total Assets BOY | $14,830,450 | TotalAssetsBOYAmt |
| Total Assets EOY | $14,909,165 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $14,063,445 | TotalAssetsEOYFMVAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
| Unrestricted BOY | $14,830,450 | UnrestrictedBOYAmt |
| Unrestricted EOY | $14,909,165 | UnrestrictedEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $14,830,450 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $14,909,165 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $14,830,450 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $14,909,165 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $14,830,450 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | $86,424 | ExcessRevenueOverExpensesAmt |
| Subtotal | $14,916,874 | SubtotalAmt |
| Other Decreases | $7,709 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $14,909,165 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $713,815 | CapitalGainNetIncomeAmt |
Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liable Section4942 Tax | false | LiableSection4942TaxInd |
| Adjusted Qlfy Distri Yr1 | $812,892 | AdjustedQlfyDistriYr1Amt |
| Net Vl Noncharitable Assets Yr1 | $15,836,069 | NetVlNoncharitableAssetsYr1Amt |
| Distribution Yr1 | 0.051332 | DistributionYr1Rt |
| Adjusted Qlfy Distri Yr2 | $891,731 | AdjustedQlfyDistriYr2Amt |
| Net Vl Noncharitable Assets Yr2 | $14,954,184 | NetVlNoncharitableAssetsYr2Amt |
| Distribution Yr2 | 0.059631 | DistributionYr2Rt |
| Adjusted Qlfy Distri Yr3 | $605,913 | AdjustedQlfyDistriYr3Amt |
| Net Vl Noncharitable Assets Yr3 | $13,582,427 | NetVlNoncharitableAssetsYr3Amt |
| Distribution Yr3 | 0.044610 | DistributionYr3Rt |
| Adjusted Qlfy Distri Yr4 | $527,749 | AdjustedQlfyDistriYr4Amt |
| Net Vl Noncharitable Assets Yr4 | $13,613,473 | NetVlNoncharitableAssetsYr4Amt |
| Distribution Yr4 | 0.038767 | DistributionYr4Rt |
| Adjusted Qlfy Distri Yr5 | $543,301 | AdjustedQlfyDistriYr5Amt |
| Net Vl Noncharitable Assets Yr5 | $12,663,233 | NetVlNoncharitableAssetsYr5Amt |
| Distribution Yr5 | 0.042904 | DistributionYr5Rt |
| Total Distribution | 0.237244 | TotalDistributionRt |
| Average Distribution | 0.047449 | AverageDistributionRt |
| Net Vl Noncharitable Assets | $14,996,361 | NetVlNoncharitableAssetsAmt |
| Adj Net Vl Noncharitable Assets | $711,562 | AdjNetVlNoncharitableAssetsAmt |
| Net Investment Income Pct | $8,870 | NetInvestmentIncomePctAmt |
| Adj Nonchrtbl Net Invst Incm Pct | $720,432 | AdjNonchrtblNetInvstIncmPctAmt |
| Qualifying Distributions | $867,500 | 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 | $8,870 | InvestmentIncomeExciseTaxAmt |
| Subtotal | $8,870 | SubtotalAmt |
| Tax Based On Investment Income | $8,870 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $12,400 | EstimatedPlusOvpmtIncmTxAmt |
| Total Payments And Credits | $12,400 | TotalPaymentsAndCreditsAmt |
| Overpayment | $3,530 | OverpaymentAmt |
| Applied To ES Tax | $3,530 | 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 |
| Individual With Books | R CRAIG CAVANAUGH | IndividualWithBooksNm |
| 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 | 0.00 | $0 | $0 | $0 |
| GARY HEATON | ||||||||
| 715 NORTH 9TH ST | MONMOUTH | IL | 61462 | SECRETARY | 0.00 | $0 | $0 | $0 |
| DOROTHY RICKETTS | ||||||||
| 202 NORTH G | MONMOUTH | IL | 61462 | CHAIRPERSON | 0.00 | $0 | $0 | $0 |
| DR JAMES BATTENBURG | ||||||||
| 2028 62ND ST | MONMOUTH | IL | 61462 | DIRECTOR | 0.00 | $0 | $0 | $0 |
| DON GLADFELTER | ||||||||
| 861 210TH AVE | MONMOUTH | IL | 61462 | DIRECTOR | 0.00 | $0 | $0 | $0 |
| MIKE CONNELL | ||||||||
| 1150 WARREN SCHOOL RD | MONMOUTH | IL | 61462 | VICE CHAIRPE | 0.00 | $0 | $0 | $0 |
| SPUD RILEY | ||||||||
| 1361 EAST BROADWAY | MONMOUTH | IL | 61462 | DIRECTOR | 0.00 | $0 | $0 | $0 |
| CAROL SHAW | ||||||||
| 1008 HWY 116 | ROSEVILLE | IL | 61473 | DIRECTOR | 0.00 | $0 | $0 | $0 |
| JON FERGUSON | ||||||||
| 17 FAIRWAY DRIVE | MONMOUTH | IL | 61462 | DIRECTOR | 0.00 | $0 | $0 | $0 |
| PATTY LUKER | ||||||||
| OSF HOLY FAMILY MD CTR 1000 W HARLE | MONMOUTH | IL | 61462 | EX-OFFICIO | 0.00 | $0 | $0 | $0 |
| LYNNE HAASE | ||||||||
| RR 1 BOX 112 | BIGGSVILLE | IL | 61418 | DIRECTOR | 0.00 | $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 | $14,942,872 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $281,860 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $15,224,732 | TotalFMVOfUnusedAssetsAmt |
| Adjusted Total FMV Of Unused Ast | $15,224,732 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $228,371 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $14,996,361 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $749,818 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $749,818 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $8,870 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $8,870 | TotalTaxAmt |
| Distributable Before Adj | $740,948 | DistributableBeforeAdjAmt |
| Distributable Before Ded | $740,948 | DistributableBeforeDedAmt |
| Distributable As Adjusted | $740,948 | DistributableAsAdjustedAmt |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $867,500 | ExpensesAndContributionsAmt |
| Qualifying Distributions | $867,500 | QualifyingDistributionsAmt |
| Pct Sect4940e Org Net Invst Incm | $8,870 | PctSect4940eOrgNetInvstIncmAmt |
| Adjusted Qualifying Distri | $858,630 | AdjustedQualifyingDistriAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $740,948 | DistributableAsAdjustedAmt |
| Excess Distribution Cyov Yr1 | $36,662 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $36,662 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $867,500 | QualifyingDistributionsAmt |
| Applied To Current Year | $740,948 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $126,552 | RemainingDistriFromCorpusAmt |
| Total Corpus | $163,214 | TotalCorpusAmt |
| Undistributed Income CY | $0 | UndistributedIncomeCYAmt |
| Excess Distri Cyov To Next Yr | $163,214 | ExcessDistriCyovToNextYrAmt |
| Excess From Year1 | $36,662 | ExcessFromYear1Amt |
| Excess From Current Year | $126,552 | 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 | GREG MCCLINTOCK | RecipientPersonNm |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 707 NORTH 11TH STREET | AddressLine1Txt |
| City | MONMOUTH | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61462 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Phone | 3097345214 | 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 |
|---|---|---|---|---|---|---|---|
| CITY OF MONMOUTH | |||||||
| 100 EAST BROADWAY | MONMOUTH | IL | 61462 | NONE | GOVERNMENTAL | GRANT FOR EQUIPMENT | $50,000 |
| 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 | $217,500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $867,500 | TotalGrantOrContriPdDurYrAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $738 | ExclusionAmt |
Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $237,631 | ExclusionAmt |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | $775,459 | ExclusionAmt |
| Related Or Exempt Function Incm | $5,259 | RelatedOrExemptFunctionIncmAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | $1,013,828 | ExclusionAmt |
| Related Or Exempt Function Incm | $5,259 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $1,019,087 | 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 | $1,625 | Amt |
| Net Investment Income | $1,625 | NetInvestmentIncomeAmt |
Gain Loss Sale Other Assets Sch GainLossSaleOtherAssetsSch
Gain Loss Sale Other Asset GainLossSaleOtherAssetGrp (14 entries)
| AssetAssetDesc | AcquiredAcquiredDt | How AcquiredHowAcquiredTxt | SoldSoldDt | Gross Sales PriceGrossSalesPriceAmt | BasisBasisAmt | Total NetTotalNetAmt |
|---|---|---|---|---|---|---|
| 3816.794 SHS ASTON MONTAG & CALDWELL | 2009-11 | PURCHASE | 2015-06 | $99,970 | $85,458 | $14,512 |
| 2278.423 SHS DODGE & COX INTL FUND | 2007-12 | PURCHASE | 2015-06 | $99,970 | $100,478 | -$508 |
| 3174.603 SHS HARBOR CAPITAL APPRECIA | 2009-11 | PURCHASE | 2015-06 | $199,970 | $102,413 | $97,557 |
| 7616.146 SHS HARBOR INTERNATIONAL FD | 2013-11 | PURCHASE | 2015-06 | $99,970 | $99,834 | $136 |
| 39405.370 SHS PERKINS MID CAP VALUE | 2008-01 | PURCHASE | 2015-06 | $776,286 | $830,106 | -$53,820 |
| 27428.999 SHS DODGE & COX INCOME | 2014-10 | PURCHASE | 2015-09 | $1,704,970 | $1,771,503 | -$66,533 |
| 6102.522 SHS ASTON MONTAG & CALDWELL | 2009-11 | PURCHASE | 2015-09 | $149,970 | $136,635 | $13,335 |
| 2544.098 SHS HARBOR CAPITAL APPRECIA | 2009-11 | PURCHASE | 2015-09 | $149,970 | $82,073 | $67,897 |
| 11094.675 DODGE & COX INCOME FD | 2014-10 | PURCHASE | 2015-11 | $149,970 | $154,237 | -$4,267 |
| 11709.602 HARBOR INTERNATIONAL FD | 2009-11 | PURCHASE | 2015-11 | $149,970 | $153,493 | -$3,523 |
| 203.805 SHS BHM&S LARGE CAP | 2007-08 | PURCHASE | 2015-01 | $4,828 | $4,467 | $361 |
| 183.162 SHS BHM&S LARGE CAP | 2007-08 | PURCHASE | 2015-04 | $4,570 | $4,015 | $555 |
| 188.109 SHS BHM&S LARGE CAP | 2007-08 | PURCHASE | 2015-07 | $4,765 | $4,123 | $642 |
| 185.984 SHS BHM&S LARGE CAP | 2007-08 | PURCHASE | 2015-10 | $4,636 | $4,077 | $559 |
Other Assets Schedule OtherAssetsSchedule
Other Assets Schedule OtherAssetsScheduleGrp (12 entries)
| DescDesc | BOY Book ValueBOYBookValueAmt | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|---|
| PERKINS MID CAP VALUE FD | $830,106 | ||
| LONGLEAF PARTNERS SMALL CAP FD | $719,435 | $761,720 | $756,561 |
| DODGE & COX INTL STK FD | $2,136,100 | $2,078,166 | $1,890,607 |
| BHMS LARGE VALUE FD | $2,231,100 | $2,483,871 | $2,429,133 |
| HARBOR CAPITAL APPRECIATION FD | $791,210 | $677,229 | $1,101,941 |
| ASTON M&C GROWTH FD | $1,217,765 | $1,283,703 | $1,121,762 |
| HARTFORD GLOBAL REAL | $1,349,850 | $1,361,619 | $899,659 |
| DODGE & COX INCOME FD | $3,018,473 | $1,166,593 | $1,115,671 |
| HARBOR INTERNATIONAL FD | $2,360,339 | $2,127,165 | $1,997,358 |
| ARTISAN MID CAP FD | $892,652 | $698,342 | |
| BAIRD INTERMEDIATE BONDS | $1,150,164 | $1,130,594 | |
| J HANCOCK INCOME FD | $571,314 | $566,848 |
Other Decreases Schedule OtherDecreasesSchedule
Other Decreases Detail OtherDecreasesDetail (2 entries)
| DescDesc | AmtAmt |
|---|---|
| FEDERAL INCOME TAXES PAID | $7,708 |
| ROUNDING | $1 |
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 | $157 | $157 |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt |
|---|---|---|
| INVESTMENT ADVISORY AND FILING | $43,324 | $43,324 |
| BHMS LARGE CAP VALUE K-1 | $18,795 | $18,795 |
Reasonable Cause Explanation ReasonableCauseExplanation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | THE TAXPAYER FILED AN EXTENSION ON FORM 8868 BECAUSE INVESTMENT INCOME INFORMATION WAS NOT RECEIVED BY THE ORIGINAL DUE DATE OF THE RETURN. THE TAXPAYER CONSIDERED THE EXTENSION WAS ALLOWED UNTIL NOVEMBER 15, 2016 UNDER REG 1.6081-9(A) AND DID NOT FILE FOR AN ADDITIONAL 3 MONTH EXTENSION AS IS ALLOWED. THE RETURN HAS BEEN FILED AS SOON AS THE REQUIRED INFORMATION WAS RECEIVED AND IS TECHNICALLY LATE BY APPROXIMATELY 3 WEEKS. ALL TAXES REQUIRED ON THE INVESTMENT INCOME WERE TIMELY SUBMITTED AND AN OVERPAYMENT IS SHOWN ON THE ENCLOSED RETURN. THE TAXPAYER ASKS THAT ANY LATE FILING FEES BE WAVED DUE TO REASONABLE CAUSE AS IT WAS ASSUMED THAT THE EXTENSION WAS UNTIL NOVEMBER 15, 2016 AND THE TAXPAYER'S HISTORY OF TIMELY FILING AND THE TIMELY SUBMISSION OF TAXES DUE AND ESTIMATE PAYMENTS SINCE THE FORMATION OF THE FOUNDATION. | ExplanationTxt |
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