2012-06-01T13:51:02-05:00 2011-07-31 EIDE BAILLY LLP 3999 PENNSYLVANIA AVE SUITE 100 DUBUQUE IA 52002 990 2010-08-01 371193348 CARLINVILLE AREA HOSPITAL FOUNDATION CARL 2178543141 20733 NORTH BROAD STREET CARLINVILLE IL 62626 KENNETH REID 2178543141 2012-05-15 1 CARMEN KRANTZ 5635561790 2012-05-15 2010 2016-02-24 21:20:13Z KENNETH REID 20733 NORTH BROAD STREET CARLINVILLE IL 62626 153501 0 X WWW.CAHCARE.COM X 1944 IL SUPPORT PRIMARY AND EMERGENCY HEALTH CARE SERVICES FOR PERSONS LIVING IN THE CARLINVILLE AREA 14 14 0 15 0 0 1841615 19944 0 0 51585 16385 -4009 -4014 1889191 32315 5086304 1876157 0 0 0 0 532 0 14855 97517 14895 5184353 1891052 -3295162 -1858737 2896485 1019029 117883 54613 2778602 964416 X 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. 0 0 1876197 1876157 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 2011 CARLINVILLE AREA HOSPITAL FOUNDATION HELD ITS ANNUAL FUNDRAISING GOLF TOURNAMENT AND PROVIDED FUNDING TO CARLINVILLE AREA HOSPITAL IN THE AMOUNT OF $1,716,159 TO BE USED FOR CAPITAL IMPROVEMENTS RELATED TO THE CONSTRUCTION OF A REPLACEMENT HOSPITAL. THE FOUNDATION ALSO PROVIDED $159,998 TO THE HOSPITAL FOR PHYSICIAN SUPPORT. 1876197 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X GREG WARD 2178543141 20733 NORTH BROAD STREET CARLINVILLE IL 62626 X X RICHARD WALDEN 0.50 X X 0 0 0 JAMES ASHWORTH 0.50 X X 0 0 0 BETTY STAR 0.50 X X 0 0 0 TAMMY DUGAN 0.50 X X 0 0 0 STEVEN BOENTE DMD 0.30 X 0 0 0 PEGGY DENBY 0.30 X 0 0 0 CHARLENE GENTA 0.30 X 0 0 0 ELISABETH HERNDON 0.30 X 0 0 0 RALPH MARCH 0.30 X 0 0 0 DENNIS PICKREL 0.30 X 0 0 0 ED TAWFALL 0.30 X 0 0 0 DAWN CHERRY 0.30 X 0 0 0 BRENT DAVIS 0.30 X 0 0 0 MARY JO REICHMANN 0.30 X 0 0 0 KENNETH REID 1.00 X 0 0 0 GREG WARD 1.00 X 0 0 0 0 0 0 0 0 0 0 0 11037 8907 19944 13809 13809 114302 111726 2576 2576 2576 5446 11037 9460 -4014 -4014 32315 0 0 12371 1876157 1876157 14855 14855 40 40 1891052 1876197 0 14855 239812 107350 2276169 541552 380504 370127 2896485 1019029 117883 54613 117883 54613 X 254258 147324 2524344 817092 2778602 964416 2896485 1019029 X -1858737 44551 X X 0 1 0 X 0 X X X 0 0 0 CARLINVILLE AREA HOSPITAL ASSOCIATION 370645239 3 1 1876157 MIDDLE MACOUPIN HEALTHCARE SYSTEMS 371193396 11A, I 1 0 2 1876157 SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: FORM 990, SCHEDULE A, PART I, LINE 11I: THE SUPPORT OF MIDDLE MACOUPIN HEALTH SYSTEM IS PROVIDED THROUGH CARLINVILLE AREA HOSPITAL FOUNDATION PROVIDING GRANTS TO CARLINVILLE AREA HOSPITAL ASSOCIATION. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DUE TO AFFILIATE 54613 54613 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE MEMBERS OF THE ORGANIZATION BELIEVE THAT THEY HAVE APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING THEIR ANNUAL FILING REQUIREMENTS, AND AS SUCH, DO NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE MEMBERS OF THE ORGANIZATION 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. GOLF OUTING 16483 11037 5446 1800 1996 1850 3596 218 16483 11037 5446 1800 1996 1850 3596 218 9460 -4014 1 CARLINVILLE AREA HOSPITAL ASSOCIATION 20733 NORTH BROAD STREET CARLINVILLE IL 62626 370645239 501(C)(3) 1876157 HOSPITAL BUILDING AND PHYSICIAN SUPPORT 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: 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. CASH 2011-07-31 1876157 370645239 CARLINVILLE AREA HOSPITAL ASSOCIATION 20733 NORTH BROAD STREET CARLINVILLE IL 62626 501(C)(3) 1 1 0 0 PART II, LINE 2E: KENNETH REID IS THE CEO OF CARLINVILLE AREA HOSPITAL AND CARLINVILLE AREA HOSPITAL FOUNDATION. HE IS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY TO THE HOSPITAL FOR SERVICES TO THE HOSPITAL. PART II, LINE 2E: GREG WARD IS THE CFO OF CARLINVILLE AREA HOSPITAL AND CARLINVILLE AREA HOSPITAL FOUNDATION. HE IS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY TO THE HOSPITAL FOR SERVICES TO THE HOSPITAL. PART II, LINE 2E: RALPH MARCH IS A BOARD MEMBER FOR CARLINVILLE AREA HOSPITAL FOUNDATION AND CARLINVILLE AREA HOSPITAL. PART II, LINE 2E: RICHARD WALDEN IS A BOARD MEMBER FOR CARLINVILLE AREA HOSPITAL FOUNDATION AND CARLINVILLE AREA HOSPITAL. FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS APPOINTS THREE OR MORE DIRECTORS TO SERVE WITH THE PRESIDENT ON THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE HAS POWER AND AUTHORITY TO MANAGE AND CONTROL THE BUSINESS AND AFFAIRS OF THE FOUNDATION AS THE BOARD OF DIRECTORS. IN NO EVENT SHOULD THE EXECUTIVE COMMITTEE EXERCISE THOSE POWERS 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, CEO AND GREG WARD, CFO ARE OFFICERS OF CARLINVILLE AREA HOSPITAL. CERTAIN MEMBERS OF THE HOSPITAL BOARD ARE ALSO MEMBERS OF CARLINVILLE AREA HOSPITAL FOUNDATION'S BOARD. THEREFORE, BUSINESS RELATIONSHIPS EXIST BETWEEN THESE INDIVIDUALS. 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, CFO, AND DIRECTOR OF FINANCE 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. FORM 990, PART VI, SECTION B, LINE 15: 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, PAGE 7, PART VII: THE CEO, KENNETH REID, AND CFO, GREG WARD, ARE EMPLOYEES OF HEALTHTECH MANAGEMENT SERVICES, INC., AN UNRELATED MANAGEMENT COMPANY OF CARLINVILLE AREA HOSPITAL. KENNETH REID AND GREG WARD ARE NOT COMPENSATED FOR SERVICES PROVIDED TO CARLINVILLE AREA HOSPITAL FOUNDATION. FORM 990, PAGE 7, PART VII: THE FOLLOWING INDIVIDUALS DEVOTED TIME PROVIDING SERVICES TO THE FOLLOWING RELATED ORGANIZATIONS. CARLINVILLE AREA HOSPITAL ASSOCIATION KENNETH REID, CEO 40 HOURS PER WEEK GREG WARD, CFO 40 HOURS PER WEEK RICHARD WALDEN .5 HOURS PER WEEK RALPH MARCH .5 HOURS PER WEEK MIDDLE MACOUPIN HEALTHCARE SYSTEMS KENNETH REID, CEO .25 HOURS PER WEEK GREG WARD, CFO .25 HOURS PER WEEK RICHARD WALDEN .25 HOURS PER WEEK RALPH MARCH .25 HOURS PER WEEK CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 44,551. FORM 990, PART XII, LINE 2C: CARLINVILLE AREA HOSPITAL ASSOCIATION, A RELATED ORGANIZATION, IS RESPONSIBLE FOR OVERSIGHT OF THE AUDIT. 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 N/A 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0