CARLINVILLE AREA HOSPITAL FOUNDATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CARLINVILLE AREA HOSPITAL FOUNDATION (EIN 37-1193348)
- Tax period
- 2012-08-01 to 2013-07-31
- Filed
- 2014-03-11
- IRS object ID
- 201420709349300632
- Schema version
- 2012v2.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-03-11T16:30:34-05:00 | Timestamp |
| Tax Period End Date | 2013-07-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450250958 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3999 PENNSYLVANIA AVE SUITE 100 | AddressLine1 |
| City | DUBUQUE | City |
| State | IA | State |
| ZIP Code | 52002 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-08-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 371193348 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carlinville Area Hospital Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CARL | NameControl |
| Phone | 2178543141 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20733 North Broad Street | AddressLine1 |
| City | Carlinville | City |
| State | IL | State |
| ZIP Code | 62626 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Kenneth Reid | Name |
| Title | Carlinville Area Hospital CEO | Title |
| Phone | 2178543141 | Phone |
| Date Signed | 2014-03-07 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Carmen Krantz | Name |
| PTIN | P00031958 | PTIN |
| Phone | 5635561790 | Phone |
| Date Prepared | 2014-03-03 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Kenneth Reid | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20733 North Broad Street | AddressLine1 |
| City | Carlinville | City |
| State | IL | State |
| ZIP Code | 62626 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 443725 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.cahcare.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1944 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | Support primary and emergency health care services for persons living in the Carlinville area | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 14 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 60256 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 177273 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 17279 | InvestmentIncomePriorYear |
| Investment Income Current Year | 13470 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -5471 | OtherRevenuePriorYear |
| Other Revenue Current Year | 5995 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 72064 | TotalRevenuePriorYear |
| Total Revenue Current Year | 196738 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 286369 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 178654 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 6506 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 16724 | OtherExpensePriorYear |
| Other Expenses Current Year | 22992 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 303093 | TotalExpensesPriorYear |
| Total Expenses Current Year | 201646 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -231029 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -4908 | RevenuesLessExpensesCY |
| Total Assets BOY | 756858 | TotalAssetsBOY |
| Total Assets EOY | 759859 | TotalAssetsEOY |
| Total Liabilities BOY | 4836 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 246 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 752022 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 759613 | NetAssetsOrFundBalancesEOY |
| Mission Description | The purpose of the Foundation is to help support the availability of primary and emergency health care services for those persons living in the Carlinville area. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 190457 | Expense |
| Grants | 178654 | Grants |
| Description | Carlinville Area Hospital Foundation was established to support persons living in the Carlinville Area. Many small and rural communities face the threat of losing access to health care due to cuts in payment, especially through government programs such as Medicare and Medicaid. The residents of the communities served by Carlinville Area Hospital deserve the availability of a hospital which can meet as many of their needs as possible in a quality, cost-effective and convenient manner.During fiscal year 2013, Carlinville Area Hospital Foundation held its annual fundraising golf tournament and provided funding to Carlinville Area Hospital in the amount of $178,654. | Description |
| Total Program Service Expense | 190457 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 1 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 0 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Excess Business Holdings | 0 | ExcessBusinessHoldings |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Michael Brown | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2178543857 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20733 North Broad Street | AddressLine1 |
| City | Carlinville | City |
| State | IL | State |
| ZIP Code | 62626 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|---|
| Richard Walden | |||||||
| Chairman | 0.50 | 1.30 | X | X | 0 | 0 | 0 |
| James Ashworth | |||||||
| Vice Chairman | 0.50 | 0.00 | X | X | 0 | 0 | 0 |
| Charlene Genta | |||||||
| Secretary | 0.50 | 0.00 | X | X | 0 | 0 | 0 |
| Betty Star | |||||||
| Secretary until December 2012 | 0.50 | 0.00 | X | X | 0 | 0 | 0 |
| Tammy Dugan | |||||||
| Treasurer | 0.50 | 0.00 | X | X | 0 | 0 | 0 |
| Steven Boente DMD | |||||||
| Member | 0.30 | 0.00 | X | 0 | 0 | 0 | |
| Peggy Denby | |||||||
| Member | 0.30 | 0.00 | X | 0 | 0 | 0 | |
| Michelle Dyer | |||||||
| Member | 0.30 | 0.00 | X | 0 | 0 | 0 | |
| Elisabeth Herndon | |||||||
| Member | 0.30 | 0.00 | X | 0 | 0 | 0 | |
| Ralph March | |||||||
| Member | 0.30 | 1.30 | X | 0 | 0 | 0 | |
| Dennis Pickrel | |||||||
| Member | 0.30 | 1.30 | X | 0 | 0 | 0 | |
| Ed Tawfall | |||||||
| Member | 0.30 | 0.00 | X | 0 | 0 | 0 | |
| John Lanzerotte | |||||||
| Member | 0.30 | 0.00 | X | 0 | 0 | 0 | |
| Brent Davis | |||||||
| Member | 0.30 | 0.00 | X | 0 | 0 | 0 | |
| Mary Jo Reichmann | |||||||
| Member | 0.30 | 0.00 | X | 0 | 0 | 0 | |
| Dawn Cherry | |||||||
| Member until December 2012 | 0.30 | 0.00 | X | 0 | 0 | 0 | |
| Kenneth Reid | |||||||
| CEO Carlinville Hospital | 1.00 | 40.30 | X | 0 | 0 | 0 | |
| Michael Brown | |||||||
| Hosp CFO commenced April 2013 | 1.00 | 40.30 | X | 0 | 0 | 0 | |
| Greg Ward | |||||||
| Hosp CFO until Jan 2013 | 1.00 | 40.30 | X | 0 | 0 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Fundraising Events | 11301 | FundraisingEvents |
| All Other Contributions | 165972 | AllOtherContributions |
| Total Contributions | 177273 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7499 | TotalRevenueColumn |
| Exclusion | $7,499 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Personal | 23038 | Personal |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Personal | 25110 | Personal |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Personal | -2072 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -2072 | TotalRevenueColumn |
| Exclusion | -$2,072 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 187692 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 181721 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 5971 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5971 | TotalRevenueColumn |
| Exclusion | $5,971 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 4335 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 11301 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 8901 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -4566 | TotalRevenueColumn |
| Exclusion | -$4,566 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 43888 | GrossSalesOfInventory |
| Cost Of Goods Sold | 31255 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12633 | TotalRevenueColumn |
| Related Or Exempt Function Income | 12633 | RelatedOrExemptFunctionIncome |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 196738 | TotalRevenueColumn |
| Related Or Exempt Function Income | 12633 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $6,832 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 178654 | Total |
| Program Services | 178654 | ProgramServices |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4683 | Total |
| Management And General | 4683 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17597 | Total |
| Program Services | 11803 | ProgramServices |
| Fundraising | 5794 | Fundraising |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 712 | Total |
| Fundraising | 712 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 201646 | Total |
| Program Services | 190457 | ProgramServices |
| Management And General | 4683 | ManagementAndGeneral |
| Fundraising | 6506 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 223760 | BOY |
| EOY | 111180 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 311780 | BOY |
| EOY | 152882 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 221318 | BOY |
| EOY | 495797 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 756858 | BOY |
| EOY | 759859 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4836 | BOY |
| EOY | 246 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4836 | BOY |
| EOY | 246 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 216149 | BOY |
| EOY | 402394 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 535873 | BOY |
| EOY | 357219 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 752022 | BOY |
| EOY | 759613 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 756858 | BOY |
| EOY | 759859 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -4908 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 26787 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -14288 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (2 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | AmountAmount |
|---|---|---|---|
| Carlinville Area Hospital Association | |||
| 370645239 | 3 | 1 | $178,654 |
| Middle Macoupin Healthcare Systems | |||
| 371193396 | 11a, I | 1 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 2 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 178654 | SumOfAmounts |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 1 | AgentTrusteeEtc |
| Beginning Balance | 21062 | BeginningBalance |
| Additions During Year | 91956 | AdditionsDuringYear |
| Distributions During Year | 77668 | DistributionsDuringYear |
| Ending Balance | 35350 | EndingBalance |
| Included On FS | 0 | IncludedOnFS |
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Due to affiliate | Description |
| Amount | $246 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 246 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part IV, Line 1b: | Carlinville Area Hospital Auxiliary operates under the Foundation's FEIN but has its own checking account. The Auxiliary's account balances were not reported on the Foundation's financial statements, however the revenues and expenses were recorded on the Form 990 with a change in the Auxiliary's net assets recorded in other adjustments. | |
| Part X, Line 2: | Carlinville Area Hospital Foundation is organized as an Illinois nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Foundation is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Foundation is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. Carlinville Area Hospital Foundation believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Foundation would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. | Description of Uncertain Tax Positions Under FIN 48: |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | CAH Golf Tourney | NameOfEvent1 |
| Gross Receipts Event1 | 15636 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 11301 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 4335 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 1500 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 1000 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 1960 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 2375 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 2066 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 15636 | GrossReceiptsTotal |
| Charitable Contributions Total | 11301 | CharitableContributionsTotal |
| Gross Revenue Total Events | 4335 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 1500 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 1000 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 1960 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 2375 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 2066 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 8901 | DirectExpenseSummaryEvents |
| Net Income Summary | -4566 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carlinville Area Hospital Association | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20733 North Broad Street | AddressLine1 |
| City | Carlinville | City |
| State | IL | State |
| ZIP Code | 62626 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 370645239 | EINOfRecipient |
| IRC Section | 501(c)(3) | IRCSection |
| Amount Of Cash Grant | 178654 | AmountOfCashGrant |
| Purpose Of Grant | Hospital building and physician support | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: Carlinville Area Hospital Foundation's purpose is to support primary and emergency health care services for persons living in the Carlinville area and in particular Carlinville Area Hospital Association. The Foundation is a supporting organization of the Hospital and all grants and support are given to the Hospital to assist in their exempt purpose of providing health care services. The Hospital provides the Foundation with proofs of purchase to ensure the money is used appropriately. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (14 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part V, Line 7b: | The Foundation received payments as part of their fundraising event in excess of $75 made partly as contributions and partly for goods and services provided to payors and did not notify donors of the value of the goods or services provided. This was immediately corrected when discovered and donors will be informed of the value of the good or services provided in the future. | |
| Form 990, Part VI, Section A, line 1 | The Board of Directors shall appoint 3 or more Directors to serve with the President on the Executive Committee. The Executive Committee has the power and authority to manage and control the business and affairs of the Foundation as the Board of Directors determines but has no authority to amend the Articles of Incorporation or Bylaws; sell, transfer or otherwise dispose of substantially all of the Foundation's assets; or adopt Articles of Merger or Consolidation. | |
| Form 990, Part VI, Section A, line 2 | Richard Walden, Chairman, and James Ashworth, Vice Chairman, have a business relationship. Kenneth Reid, Greg Ward, Michael Brown, Dennis Pickrel and Ralph March have business relationships with each other. | |
| Form 990, Part VI, Section A, line 4 | The Bylaws were amended to incorporate the operation of Carlinville Area Hospital Auxiliary under the Foundation's federal identification number. The Board of Directors of the Foundation may establish a Divisional Board to operate the Auxiliary. The Board of Directors have authority to appoint and remove the members of the Divisional Board and approve the governing documents of the Divisional Board, all within guidelines established by the Member. The Divisional Board may be delegated responsibility for performance assessment and improvement and for providing input into the strategic, financial and human resources plan with respect to the Carlinville Area Hospital Auxiliary. | |
| Form 990, Part VI, Section A, line 6 | Carlinville Area Hospital Foundation has one member, Middle Macoupin Health Care Systems. | |
| Form 990, Part VI, Section A, line 7a | The Member has the exclusive right and power to designate two of its Directors to serve as Directors of the Foundation and to appoint all persons to or remove them from the Board of Directors except vacancies on the Board caused by death, resignation or removal shall be filled at any meeting by a majority vote of the remaining Directors. | |
| Form 990, Part VI, Section A, line 7b | The Member has the exclusive right and power to approve or reject the following proposed actions prior to the Board of Directors taking any action on: 1. the annual operating budget, capital budget, long-range plan and any action which will result in a substantial change in the expenditures or revenue forecast in any such plan or budget; 2. the undertaking of or substantive amendments to a contractual obligation in excess of $250,000, or the guaranteeing of an obligation in excess of $250,000; 3. the purchase, lease, transfer, mortgage or sale of any asset or property with a value in excess of $250,000, except with respect to transactions specified and previously approved within the capital budget; 4. any plan of construction or remodeling involving an expenditure in excess of $250,000 except with respect to transactions specified and previously approved within the capital budget; 5. any borrowing; 6. any application for a government grant; 7. any general plan for the solicitation of charitable contributions or the solicitation or acceptance as a gift of any real property or any interest; 8. any amendments to these Bylaws and any amendment or restatement of the Articles of Incorporation; any proposal to adopt Articles of Dissolution, Merger or Consolidation; 9. any selection, removal or change in the compensation or other terms of employment of the Corporation's operating officers; 10. any substantial change in employee fringe benefits or personnel policies; and 11. any other matters as may be required by law to be submitted to the Member or as to which the Member determines, by resolution, that submission is advisable. | |
| Form 990, Part VI, Section B, line 11 | The Form 990 will be distributed to the governing body before it is filed. The CEO and CFO of Carlinville Area Hospital Association, a related organization, review the Form 990. | |
| Form 990, Part VI, Section B, line 12c | Any duality of interest or possible conflict of interest on the part of any Board Member should be disclosed to the other Members of the Board and made a matter of record through an annual procedure and also when the interest becomes a matter of Board action. Any Board member having a duality of interest or possible conflict of interest on any matter should not vote or use his or her personal influence on the matter. The minutes of the meeting reflect the disclosure, the abstention from voting, and the quorum situation. Any new Member of the Board will be advised of this policy upon entering on the duties of office. The Board Members complete and sign the conflict of interest form yearly. The forms are reviewed by the Chairman of the Board and if a potential conflict is identified the Chairman of the Board follows up. | |
| The CEO and CFO are not compensated by Carlinville Area Hospital Foundation. The CEO and CFO are compensated by an unrelated management company through Carlinville Area Hospital Association, a related organization, for services provided to the Hospital. The unrelated management company and the Hospital use these methods to determine compensation. | ||
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents, conflict of interest policy, and financial statements are not available to the public. However, financial information is available through the public disclosure copy of the 990. | |
| Form 990, Part VII: | Kenneth Reid, CEO, Greg Ward, CFO until January 2013 and Michael Brown, current CFO are employees of HealthTech Management Services, Inc., an unrelated management company of Carlinville Area Hospital. Kenneth Reid, Greg Ward and Michael Brown are not compensated for services provided to Carlinville Area Hospital Foundation. | |
| Form 990, Part XI, line 9: | Change in Carlinville Area Hospital Auxiliary's net assets -14,288. | Changes in Net Assets or Fund Balances: |
| Form 990, Part XII, Line 2c: | Carlinville Area Hospital Association, a related organization, is responsible for oversight of the audit. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carlinville Area Hospital Auxiliary | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20733 North Broad Street | AddressLine1 |
| City | Carlinville | City |
| State | IL | State |
| ZIP Code | 62626 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 371193348 | EIN |
| Primary Activities | Assist the Carlinville Hospital, Foundation and community | PrimaryActivities |
| Legal Domicile State | IL | LegalDomicileState |
| Total Income | 82456 | TotalIncome |
| EOY Assets | 35350 | EOYAssets |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carlinville Area Hospital Foundation | BusinessNameLine1 |
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Carlinville Area Hospital Association | |||||||||||
| 20733 North Broad Street | Carlinville | IL | 62626 | 370645239 | Provision of health care services | IL | 501(c)(3) | Line 3 | Middle Macoupin Healthcare Systems | 0 | |
| Middle Macoupin Healthcare Systems | |||||||||||
| 20733 North Broad Street | Carlinville | IL | 62626 | 371193396 | Provide support and benefit Carlinville Area Hospital Association | IL | 501(c)(3) | Line 11a, I | 0 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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