2013-07-08T11:33:49-05:00 2012-12-31 410746749 CLIFTONLARSONALLEN LLP 114 E EVERETT DIXON IL 61021 990 2012-01-01 550809159 THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK ILLI 8158752999 245 BACKBONE ROAD EAST PRINCETON IL 61356 PATRICIA SCHOU 8158752999 2013-06-25 1 TODD M ETHERIDGE P00233050 8152842285 2012 2016-02-24 21:20:13Z PATRICIA SCHOU 245 BACKBONE ROAD EAST PRINCETON IL 61356 2725381 0 X WWW.ICAHN.ORG X 2002 IL 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 52 MEMBER HOSPITALS, IS AN INDEPENDENT NETWORK GOVERNED BY A NINE-MEMBER BOARD OF DIRECTORS. 9 9 10 0 0 0 1547848 1551197 1106654 1171220 11091 2964 0 0 2665593 2725381 1273831 1249900 0 0 559752 723539 0 0 0 687067 682541 2520650 2655980 144943 69401 711081 706884 126898 53300 584183 653584 THE MISSION OF ICAHN IS TO STRENGTHEN ILLINOIS CRITICAL ACCESS HOSPITALS THROUGH COLLABORATION. 0 0 2156510 1249900 860323 ICAHN PROVIDES TECHNICAL ASSISTANCE TO SMALL RURAL HOSPITALS1) TO HELP THEM WITH ADMINISTRATIVE PROCESSES FOR CRITICAL ACCESS HOSPITALS.2) SHARE RESOURCES WITH MEMBERS AND3) IMPLEMENT PROGRAMS TO IMPROVE QUALITY AND EFFICIENCES OF MEDICAL SERVICES PROVIDED BY RURAL HEALTH CARE FACILITIES. SERVES APPROXIMATELY 52 HOSPITALS. 93893 35863 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. 7210 275034 ICAN PROVIDES INFORMATION TECHNOLOGY ASSISTANCE TO SMALL RURAL HOSPITALS ACROSS THE STATE SERVING APPROXIMATELY 41 HOSPITALS. SERVICES ARE AVAILABLE TO ALL 52 HOSPITALS, THOUGH ONLY 41 CHOSE TO UTILIZE THEM IN 2012. 2257613 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 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 0 0 0 0 1 13 0 1 10 1 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 0 1 1 0 0 IL X MATT COMERFORD 8158752999 245 BACKBONE ROAD EAST PRINCETON IL 61356 GREG STARNES 0.50 X 0 0 0 RANDY DAUBY 0.50 X 0 0 0 MARK ROSSI 0.50 X 0 0 0 TOM HUDGINS 0.50 X 0 0 0 ADA BAIR 0.50 X 0 0 0 STEVEN HAYES 0.50 X 0 0 0 LYNN KLEIN 0.50 X 0 0 0 STEVEN TENHOUSE 0.50 X 0 0 0 SUSIE CAMPBELL 0.50 X 0 0 0 PATRICIA SCHOU 40.00 X 190501 0 12525 190501 0 12525 1 0 1 0 HART LLC 3001 MARKWOOD LANE SPRINGFIELD IL 62712 CONSULTING SERVICES 144896 1 1479197 72000 1551197 MEMBERSHIP DUES 900099 357000 357000 IT SERVICES 541519 275034 275034 CARS REVENUE 900099 98792 98792 CONSULTING REVENUE 541610 48969 48969 WORKSHOP/MEETING FEES 900099 35863 35863 355562 355562 1171220 2964 2964 2725381 1171220 0 2964 X 1249900 1249900 203026 142118 60908 445310 311718 133592 8937 6256 2681 19456 13619 5837 46810 32767 14043 21705 21705 18160 18160 274700 274425 275 38883 23330 15553 18188 10913 7275 12017 7210 4807 38873 23324 15549 49150 29490 19660 156488 93893 62595 10272 6163 4109 12103 7262 4841 BAD DEBT EXPENSE 15060 15060 MEMBERSHIP DUES EXPENSE 14115 8469 5646 JOB POSTING EXPENSE 1793 1076 717 MISCELLANEOUS EXPENSE 1034 620 414 2655980 2257613 398367 0 42698 25695 482693 456817 140675 174482 9382 8087 66175 24372 35633 41803 711081 706884 86343 30066 40555 23234 126898 53300 X 558695 607606 25488 45978 584183 653584 711081 706884 69401 0 X 0 1 X 1 1 1 X 4040008 2111009 1316892 1547848 1551197 10566954 4040008 2111009 1316892 1547848 1551197 10566954 10566954 46187 17250 13325 11091 2964 90817 108964 136283 245247 10903018 3683411 0.96920 0.96030 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 66175 24372 41803 41803 X 2725381 0 2725381 0 2725381 2655980 0 2655980 0 2655980 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: 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 EXANIMATION 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. THE ORGANIZATION'S TAX RETURNS FOR YEARS SUBSEQUENT TO 2008 ARE OPEN, BY STATUE, FOR REVIEW BY AUTHORITIES. HOWEVER, AT PRESENT, 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) 14551 SHIP GRANT, CHRONIC DISEASE PREVENTION ADVOCATE EUREKA HOSPITAL 101 S MAJOR ST EUREKA IL 61530 370662542 501(C)(3) 8033 SHIP GRANT CARLINVILLE AREA HOSPITAL 20733 N BROAD STREET CARLINVILLE IL 62626 370645239 501(C)(3) 16033 SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT, IMMUNIZATION OUTREACH AND EDUCATION GRANT. CLAY COUNTY HOSPITAL 911 STACY BURK DRIVE FLORA IL 62839 376000605 GOVERNMENTAL UNIT 20457 SHIP GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT,AND SPECIAL PROJECTS GRANT. COMMUNITY MEMORIAL HOSPITAL 400 CALDWELL ST STAUNTON IL 62088 370624255 501(C)(3) 13033 SHIP GRANT AND PSO GRANT. CRAWFORD MEMORIAL HOSPITAL 1000 NORTH ALLEN ST ROBINSON IL 62454 370793762 GOVERNMENTAL UNIT 11033 SHIP GRANT AND HOSPITAL BOARD EDUCATION GRANT DR JOHN WARNER HOSPITAL 422 WEST WHITE ST CLINTON IL 61727 376000695 GOVERNMENTAL UNIT 21849 SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT, IMMUNIZATION OUTREACH AND EDUCATION GRANT, AND HOSPITAL SERVICES IMPROVEMENT GRANT. FAIRFIELD MEMORIAL HOSPITAL 303 NW 11TH ST FAIRFIELD IL 62837 370661202 GOVERNMENTAL UNIT 21033 SHIP GRANT, RECRUITMENT AND RETENTION GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT, AND HOSPITAL BOARD EDUCATION GRANT. FAYETTE COUNTY HOSPITAL AND LONG TERM CARE 650 WEST TAYLOR ST VANDALIA IL 62471 201890414 GOVERNMENTAL UNIT 11533 SHIP GRANT AND CHRONIC DISEASE GRANT. FERRELL HOSPITAL 1201 PINE ST ELDORADO IL 62930 201244058 501(C)(3) 16033 SHIP GRANT, RECRUITMENT AND RETENTION GRANT, AND HOSPITAL BOARD EDUCATION GRANT. FRANKLIN HOSPITAL 201 BAILEY LANE BENTON IL 62812 376006885 GOVERNMENTAL UNIT 22665 SHIP GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT, PSO GRANT, AND IMMUNIZATION OUTREACH AND EDUCATION GRANT. GIBSON AREA HOSPITAL & HEALTH SERVICES 1120 N MELVIN ST GIBSON CITY IL 60936 370647938 501(C)(3) 20331 SHIP GRANT, RECRUITMENT AND RETENTION GRANT, PSO GRANT AND EMS GRANT. GREENVILLE REGIONAL HOSPITAL 200 HEALTHCARE DR GREENVILLE IL 62246 370792770 501(C)(3) 8033 SHIP GRANT HAMILTON MEMORIAL HOSPITAL DISTRICT 611 S MARSHALL AVENUE PO BOX 429 MCLEANSBORO IL 62859 376019589 GOVERNMENTAL UNIT 84843 SHIP GRANT, WORKFORCE DEVELOPMENT GRANT, IMMUNIZATION OUTREACH AND EDUCATION GRANT, AND SPECIAL PROJECTS GRANT. HAMMOND HENRY HOSPITAL 600 NORTH COLLEGE AVENEUE GENESEO IL 61254 366008003 GOVERNMENTAL UNIT 13033 SHIP GRANT, CHRONIC DISEASE GRANT, AND HOSPITAL BOARD EDUATION GRANT. HARDIN COUNTY GENERAL HOSPITAL 6 FERRELL ROAD BOX 2467 ROSICLARE IL 62982 370702309 501(C)(3) 18033 SHIP GRANT, CHRONIC DISEASE GRANT, AND HOSPITAL BOARD EDUATION GRANT. HILLSBORO AREA HOSPITAL 1200 EAST TREMONT ST HILLSBORO IL 62049 370661208 501(C)(3) 25033 SHIP GRANT, CHRONIC DISEASE GRANT, EMS GRANT, AND IMMUNIZATION OUTREACH AND EDUCATION GRANT HOOPESTON REGIONAL HEALTH CENTER 701 EAST ORANGE ST HOOPESTON IL 60942 363637465 501(C)(3) 11533 SHIP GRANT AND HOSPITAL SERVICES IMPROVEMENT GRANT HOPEDALE MEDICAL COMPLEX 107 TREMONT ST HOPEDALE IL 61747 370808925 501(C)(3) 5000 EMS GRANT ILLINI COMMUNITY HOSPITAL 640 WEST WASHINGTON ST PITTSFIELD IL 62363 371396010 501(C)(3) 16033 SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT, AND RECRUITMENT AND RETENTION GRANT. ILLINOIS HOSPITAL ASSOCIATION 1151 EAST WARRENVILLE ROAD NAPERVILLE IL 60566 362352486 501(C)(3) 57600 FLEX GRANT. IROQUOIS MEMORIAL HOSPITAL 200 FAIRMAN WATSEKA IL 60970 370673512 501(C)(3) 12998 SHIP GRANT AND EMS GRANT JERSEY COMMUNITY HOSPITAL 400 MAPLE SUMMIT JERSEYVILLE IL 62052 376013958 501(C)(3) 8033 FLEX GRANT. JOHN AND MARY E KIRBY HOSPITAL 1111 N STATE ST PO BOX 20 MONTICELLO IL 61856 370661215 501(C)(3) 15033 SHIP GRANT, CHRONIC DISEASE GRANT. KEWANEE HOSPITAL 1051 WEST SOUTH ST PO BOX 747 KEWANEE IL 61443 362167767 501(C)(3) 13849 SHIP GRANT AND IMMUNIZATION OUTREACH AND EDUCATION GRANT. LAWRENCE COUNTY MEMORIAL HOSPITAL 2200 WEST STATE ST LAWRENCEVILLE IL 62439 371080256 GOVERNMENTAL UNIT 16333 SHIP GRANT, FINANCIAL ASSESSMENT GRANT, AND RECRUITMENT AND RETENTION GRANT. MARSHALL BROWNING HOSPITAL 900 N WASHINGTON ST DUQUOIN IL 62832 370661218 501(C)(3) 20033 SHIP GRANT AND SPECIAL PROJECTS GRANT. MASON DISTRICT HOSPITAL 615 N PROMENADE ST HAVANA IL 62644 376017857 GOVERNMENTAL UNIT 13849 SHIP GRANT AND IMMUNIZATION OUTREACH AND EDUCATION GRANT. MASSAC MEMORIAL HOSPITAL 28 CHICK ST PO BOX 850 METROPOLIS IL 62960 370857853 GOVERNMENTAL UNIT 13033 SHIP GRANT, RECRUITMENT AND RETENETION GRANT MEMORIAL HOSPITAL CARTHAGE 1454 N COUNTY ROAD 2050 PO BOX 160 CARTHAGE IL 62321 370662570 501(C)(3) 27665 SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT, PSO GRANT AND HOSPITAL SERVICES IMPROVEMENT GRANT. MEMORIAL HOSPITAL CHESTER 1900 STATE ST CHESTER IL 62233 376020801 GOVERNMENTAL UNIT 13033 SHIP GRANT AND HOSPITAL SERVICES IMPROVEMENT GRANT MENDOTA COMMUNITY HOSPITAL 1315 MEMORIAL DR MENDOTA IL 61342 362167785 501(C)(3) 18033 SHIP GRANT, PSO GRANT AND IMMUNIZATION OUTREACH AND EDUCATION GRANT. MERCER COUNTY HOSPITAL 409 NW 9TH ST ALEDO IL 61231 366007544 GOVERNMENTAL UNIT 18033 SHIP GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT, EMS GRANT. MERCY HARVARD HOSPITAL 901 GRANT STREET HARVARD IL 60033 311551871 501(C)(3) 8033 SHIP GRANT MIDWEST MEDICAL CENTER 1 MEDICAL CENTER DRIVE GALENA IL 61036 204560540 501(C)(3) 13033 SHIP GRANT AND EMS GRANT MORRISON COMMUNITY HOSPITAL 303 N JACKSON ST MORRISON IL 61270 366008167 GOVERNMENTAL UNIT 18033 SHIP GRANT, PSO GRANT AND FINANCIAL ASSESSMENT GRANT. OSF ST JAMES W ALBRECHT MEDICAL CENTER 2500 W REYNOLDS ST PONTIAC IL 61764 370662570 501(C)(3) 8033 SHIP GRANT. PANA COMMUNITY HOSPITAL 101 EAST NINTH ST PANA IL 62557 376062326 501(C)(3) 19768 SHIP GRANT, FINANCIAL ASSESSMENT GRANT, EMS GRANT, AND HOSPITAL SERVICES IMPROVEMENT GRANT PARIS COMMUNITY HOSPITAL 721 EAST COURT ST PARIS IL 61944 370860281 501(C)(3) 28849 SHIP GRANT, FINANCIAL ASSESSMENT GRANT, EMS GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT AND IMMUNIZATION OUTREACH AND EDUCATION GRANT. PERRY MEMORIAL HOSPITAL 530 PARK AVENUE EAST PRINCETON IL 61356 366006057 GOVERNMENTAL UNIT 14673 SHIP GRANT, CHRONIC DISEASE GRANT. PINCKNEYVILLE COMMUNITY HOSPITAL 101 NORTH WALNUT STREET PINCKNEYVILLE IL 62274 376006955 GOVERNMENTAL UNIT 13033 SHIP GRANT AND FINANCIAL ASSESSMENT GRANT. RED BUD REGIONAL HOSPITAL 325 SPRING ST RED BUD IL 62278 364443919 501(C)(3) 18849 SHIP GRANT, PSO GRANT, AND IMMUNIZATION OUTREACH AND EDUCATION GRANT RICHLAND MEMORIAL HOSPITAL 800 EAST LOCUST OLNEY IL 62450 371363001 501(C)(3) 12231 SHIP GRANT, EMS GRANT. ROCHELLE COMMUNITY HOSPITAL 900 N SECOND ST ROCHELLE IL 61068 362548549 501(C)(3) 13207 SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT, AND EMS GRANT SALEM TOWNSHIP HOSPITAL 1201 RICKER DRIVE SALEM IL 62881 370925318 GOVERNMENTAL UNIT 20077 SHIP GRANT, CHRONIC DISEASE PREVENTION GRANT, AND IMMUNIZATION OUTREACH AND EDUCATION GRANT. SARAH D CULBERTSON MEMORIAL HOSPITAL 238 SOUTH CONGRESS AVE RUSHVILLE IL 62681 376006672 GOVERNMENTAL UNIT 20849 SHIP GRANT, EMS GRANT, FINANCIAL ASSESSMENT GRANT, IMMUNIZATION OUTREACH AND EDUCATION GRANT. SHELBY MEMORIAL HOSPITAL 200 SOUTH CEDAR SHELBYVILLE IL 62565 370512290 501(C)(3) 8033 SHIP GRANT. SPARTA COMMUNITY HOSPITAL DISTRICT 818 EAST BROADWAY SPARTA IL 62286 376014817 GOVERNMENTAL UNIT 13033 SHIP GRANT AND FINANCIAL ASSESSMENT GRANT. ST FRANCIS HOSPITAL 1215 FRANCISCAN DRIVE LITCHFIELD IL 62056 370661236 501(C)(3) 25033 SHIP GRANT, CHRONIC DISEASE PREVENTION GRANT, FINANCIAL ASSESSMENT GRANT, IMMUNIZATION OUTREACH AND EDUCATION GRANT. ST JOSEPH'S HOSPITAL 1515 MAIN ST HIGHLAND IL 62249 370663568 501(C)(3) 13033 SHIP GRANT, FINANCIAL ASSESSMENT GRANT. TAYLORVILLE MEMORIAL HOSPITAL 201 EAST PLEASANT ST TAYLORVILLE IL 62568 370661250 501(C)(3) 11533 SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT. THOMAS H BOYD MEMORIAL HOSPITAL 800 SCHOOL ST CARROLTON IL 62016 370673461 GOVERNMENTAL UNIT 18033 SHIP GRANT, PSO GRANT, AND HOSPITAL SERVICES IMPROVEMENT GRANT. UNION COUNTY HOSPITAL 517 NORTH MAIN ST ANNA IL 62906 364431843 GOVERNMENTAL UNIT 8033 SHIP GRANT. VALLEY WEST COMMUNITY HOSPITAL 11 E PLEASANT AVE SANDWICH IL 60548 364244337 501(C)(3) 8033 SHIP GRANT. WABASH GENERAL HOSPITAL 1418 COLLEGE DR MT CARMEL IL 62863 376013625 GOVERNMENTAL UNIT 8033 SHIP GRANT. WASHINGTON COUNTY HOSPITAL 705 S GRAND NASHVILLE IL 62263 376020408 GOVERNMENTAL UNIT 16033 SHIP GRANT, RECRUITMENT & RETENTION, AND HOSPITAL BOARD EDUCATION GRANT. WESTERN ILLINOIS AHEC BROADWAY AT 14TH ST QUINCY IL 62305 262145452 501(C)(3) 12000 FLEX GRANT. ST JOSEPH MEMORIAL HOSPITAL 2 SOUTH HOSPITAL DRIVE MURPHYSBORO IL 62966 370618939 501(C)(3) 23030 SHIP GRANT, RECRUITMENT AND RETENTION GRANT, EMS GRANT, AND HOSPITAL SERVICES IMPROVEMENT GRANT. OSF HOLY FAMILY MEDICAL CENTER 1000 W HARLEM AVE MONMOUTH IL 61462 370813229 501(C)(3) 13033 SHIP GRANT AND FINANCIAL ASSESSMENT GRANT. SHIP GRANT, CHRONIC DISEASE PREVENTION SHIP GRANT SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT, IMMUNIZATION OUTREACH AND EDUCATION GRANT. SHIP GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT,AND SPECIAL PROJECTS GRANT. SHIP GRANT AND PSO GRANT. SHIP GRANT AND HOSPITAL BOARD EDUCATION GRANT SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT, IMMUNIZATION OUTREACH AND EDUCATION GRANT, AND HOSPITAL SERVICES IMPROVEMENT GRANT. SHIP GRANT, RECRUITMENT AND RETENTION GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT, AND HOSPITAL BOARD EDUCATION GRANT. SHIP GRANT AND CHRONIC DISEASE GRANT. SHIP GRANT, RECRUITMENT AND RETENTION GRANT, AND HOSPITAL BOARD EDUCATION GRANT. SHIP GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT, PSO GRANT, AND IMMUNIZATION OUTREACH AND EDUCATION GRANT. SHIP GRANT, RECRUITMENT AND RETENTION GRANT, PSO GRANT AND EMS GRANT. SHIP GRANT SHIP GRANT, WORKFORCE DEVELOPMENT GRANT, IMMUNIZATION OUTREACH AND EDUCATION GRANT, AND SPECIAL PROJECTS GRANT. SHIP GRANT, RECRUITMENT AND RETENTION GRANT. SHIP GRANT, CHRONIC DISEASE GRANT, AND HOSPITAL BOARD EDUATION GRANT. SHIP GRANT, CHRONIC DISEASE GRANT, EMS GRANT, AND IMMUNIZATION OUTREACH AND EDUCATION GRANT. SHIP GRANT AND HOSPITAL SERVICES IMPROVEMENT GRANT EMS GRANT SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT, AND RECRUITMENT AND RETENTION GRANT. FLEX GRANT. SHIP GRANT AND EMS GRANT SHIP GRANT SHIP GRANT, CHRONIC DISEASE GRANT. SHIP GRANT AND IMMUNIZATION OUTREACH AND EDUCATION GRANT. SHIP GRANT, FINANCIAL ASSESSMENT GRANT, AND RECRUITMENT AND RETENTION GRANT. SHIP GRANT AND SPECIAL PROJECTS GRANT. SHIP GRANT AND IMMUNIZATION OUTREACH AND EDUCATION GRANT. SHIP GRANT, RECRUITMENT AND RETENETION GRANT SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT, PSO GRANT AND HOSPITAL SERVICES IMPROVEMENT GRANT. SHIP GRANT AND HOSPITAL SERVICES IMPROVEMENT GRANT SHIP GRANT, PSO GRANT AND IMMUNIZATION OUTREACH AND EDUCATION GRANT. SHIP GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT, EMS GRANT. SHIP GRANT SHIP GRANT AND EMS GRANT SHIP GRANT, PSO GRANT AND FINANCIAL ASSESSMENT GRANT. SHIP GRANT. SHIP GRANT, FINANCIAL ASSESSMENT GRANT, EMS GRANT, AND HOSPITAL SERVICES IMPROVEMENT GRANT SHIP GRANT, FINANCIAL ASSESSMENT GRANT, EMS GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT AND IMMUNIZATION OUTREACH AND EDUCATION GRANT. SHIP GRANT, CHRONIC DISEASE GRANT. SHIP GRANT AND FINANCIAL ASSESSMENT GRANT. SHIP GRANT, PSO GRANT, AND IMMUNIZATION OUTREACH AND EDUCATION GRANT SHIP GRANT, EMS GRANT. SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT, AND EMS GRANT SHIP GRANT, CHRONIC DISEASE PREVENTION GRANT, AND IMMUNIZATION OUTREACH AND EDUCATION GRANT. SHIP GRANT, EMS GRANT, FINANCIAL ASSESSMENT GRANT, IMMUNIZATION OUTREACH AND EDUCATION GRANT. SHIP GRANT. SHIP GRANT AND FINANCIAL ASSESSMENT GRANT. SHIP GRANT, CHRONIC DISEASE PREVENTION GRANT, FINANCIAL ASSESSMENT GRANT, IMMUNIZATION OUTREACH AND EDUCATION GRANT. SHIP GRANT AND HOSPITAL SERVICES IMPROVEMENT GRANT. SHIP GRANT, FINANCIAL ASSESSMENT GRANT. SHIP GRANT, PSO GRANT, AND HOSPITAL SERVICES IMPROVEMENT GRANT SHIP GRANT. SHIP GRANT. SHIP GRANT. SHIP GRANT, RECRUITMENT & RETENTION, AND HOSPITAL BOARD EDUCATION GRANT. FLEX GRANT. SHIP GRANT, RECRUITMENT AND RETENTION GRANT, EMS GRANT, AND HOSPITAL SERVICES IMPROVEMENT GRANT. SHIP GRANT AND FINANCIAL ASSESSMENT GRANT. IMMUNIZATION OUTREACH AND EDUCATION GRANT PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 UNFOESEEN CIRCUMSTANCES. IN THESE INSTANCES, THE GRANTEE IS INSTRUCTED TO REQUEST WRITTTEN 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 0 0 0 0 0 0 0 0 0 PATRICIA SCHOU 190501 0 0 0 0 0 5115 0 7410 0 203026 0 0 0 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 B, LINE 11 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 DIRECTORS' 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 DOCUMENTS ARE AVAILABLE UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 274,425. MANAGEMENT AND GENERAL EXPENSES 275. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 274,700. CRITICAL ACCESS RECRUITMENT SERVICES LLC 245 BACKBONE RD EAST PRINCETON IL 61356 208045884 RECRUITING SERVICES FOR MEMBER HOSPITALS IL -12796 95446 N/A