ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (EIN 55-0809159)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-08-28
- IRS object ID
- 201222419349300002
- Schema version
- 2011v1.2
- 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 | 2012-08-28T08:38:43-05:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410746749 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 114 E EVERETT | AddressLine1 |
| City | DIXON | City |
| State | IL | State |
| ZIP Code | 61021 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550809159 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | ILLI | NameControl |
| Phone | 8158752999 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 245 BACKBONE ROAD EAST | AddressLine1 |
| City | PRINCETON | City |
| State | IL | State |
| ZIP Code | 61356 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | PATRICIA SCHOU | Name |
| Title | EXECUTIVE DIRECTOR | Title |
| Phone | 8158752999 | Phone |
| Date Signed | 2012-08-22 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KELLY JACKSON HARDY | Name |
| PTIN | P00747242 | PTIN |
| Phone | 8152842285 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | PATRICIA SCHOU | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 245 BACKBONE ROAD EAST | AddressLine1 |
| City | PRINCETON | City |
| State | IL | State |
| ZIP Code | 61356 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 2665593 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.ICAHN.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2002 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | THE MISSION OF ICAHN IS TO STRENGTHEN ILLINOIS CRITICAL ACCESS HOSPITALS THROUGH COLLABORATION. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 8 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1316892 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1547848 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 914645 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 1106654 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 13325 | InvestmentIncomePriorYear |
| Investment Income Current Year | 11091 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 2244862 | TotalRevenuePriorYear |
| Total Revenue Current Year | 2665593 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 1159916 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 1273831 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 443471 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 559752 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 626935 | OtherExpensePriorYear |
| Other Expenses Current Year | 687067 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2230322 | TotalExpensesPriorYear |
| Total Expenses Current Year | 2520650 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 14540 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 144943 | RevenuesLessExpensesCY |
| Total Assets BOY | 516737 | TotalAssetsBOY |
| Total Assets EOY | 711081 | TotalAssetsEOY |
| Total Liabilities BOY | 77497 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 126898 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 439240 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 584183 | NetAssetsOrFundBalancesEOY |
| Mission Description | THE MISSION OF ICAHN IS TO STRENGTHEN ILLINOIS CRITICAL ACCESS HOSPITALS THROUGH COLLABORATION. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 2077285 | Expense |
| Grants | 1273832 | Grants |
| Revenue | 856278 | Revenue |
| Description | 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 51 HOSPITALS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 100537 | Expense |
| Revenue | 50040 | Revenue |
| Description | 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. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 4298 | Expense |
| Revenue | 200336 | Revenue |
| Description | ICAN PROVIDES INFORMATION TECHNOLOGY ASSISTANCE TO SMALL RURAL HOSPITALS ACROSS THE STATE SERVING APPROXIMATELY 51 HOSPITALS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 2182120 | 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 | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | 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 | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | 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 | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 12 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 8 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| 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 | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | 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 | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 0 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MATT COMERFORD | NamePerson |
| Telephone Number | 8158752999 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 245 BACKBONE ROAD EAST | AddressLine1 |
| City | PRINCETON | City |
| State | IL | State |
| ZIP Code | 61356 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (10 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| STEVEN HAYES | ||||||
| PRESIDENT-ELECT | 0.50 | X | X | 0 | 0 | 0 |
| LYNN KLEIN | ||||||
| PRESIDENT | 0.50 | X | X | 0 | 0 | 0 |
| GREG STARNES | ||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | |
| RANDY DAUBY | ||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | |
| MARK ROSSI | ||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | |
| STEVE TENHOUSE | ||||||
| SECRETARY/TREASURER | 0.50 | X | X | 0 | 0 | 0 |
| TOM HUDGINS | ||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | |
| SUSIE CAMPBELL | ||||||
| PAST PRESIDENT | 0.50 | X | X | 0 | 0 | 0 |
| ADA BAIR | ||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | |
| PATRICIA SCHOU | ||||||
| EXECUTIVE DIRECTOR | 40.00 | X | 145000 | 0 | 9846 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 145000 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 9846 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HART LLC | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3001 MARKWOOD LANE | AddressLine1 |
| City | SPRINGFIELD | City |
| State | IL | State |
| ZIP Code | 62712 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | CONSULTING SERVICES | DescriptionOfServices |
| Compensation | 131543 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Government Grants | 1497848 | GovernmentGrants |
| All Other Contributions | 50000 | AllOtherContributions |
| Total Contributions | 1547848 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MEMBERSHIP DUES | 900099 | 353500 | 353500 |
| IT SERVICES | 541519 | 200336 | 200336 |
| CARS REVENUE | 900099 | 122664 | 122664 |
| CONSULTING REVENUE | 541610 | 69774 | 69774 |
| WORKSHOP/MEETING FEES | 900099 | 50040 | 50040 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 310340 | TotalRevenueColumn |
| Related Or Exempt Function Income | 310340 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 1106654 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 11091 | TotalRevenueColumn |
| Exclusion | $11,091 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2665593 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1106654 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $11,091 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1265331 | Total |
| Program Services | 1265331 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8500 | Total |
| Program Services | 8500 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 175000 | Total |
| Program Services | 122500 | ProgramServices |
| Management And General | 52500 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 326720 | Total |
| Program Services | 228704 | ProgramServices |
| Management And General | 98016 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9285 | Total |
| Program Services | 6500 | ProgramServices |
| Management And General | 2785 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13181 | Total |
| Program Services | 9227 | ProgramServices |
| Management And General | 3954 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35566 | Total |
| Program Services | 24896 | ProgramServices |
| Management And General | 10670 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12698 | Total |
| Management And General | 12698 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17180 | Total |
| Management And General | 17180 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 296111 | Total |
| Program Services | 295815 | ProgramServices |
| Management And General | 296 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26769 | Total |
| Program Services | 16062 | ProgramServices |
| Management And General | 10707 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20930 | Total |
| Program Services | 12558 | ProgramServices |
| Management And General | 8372 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7163 | Total |
| Program Services | 4298 | ProgramServices |
| Management And General | 2865 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39551 | Total |
| Program Services | 23731 | ProgramServices |
| Management And General | 15820 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39390 | Total |
| Program Services | 23634 | ProgramServices |
| Management And General | 15756 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 167562 | Total |
| Program Services | 100537 | ProgramServices |
| Management And General | 67025 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6941 | Total |
| Program Services | 4164 | ProgramServices |
| Management And General | 2777 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12725 | Total |
| Program Services | 7635 | ProgramServices |
| Management And General | 5090 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| JOB POSTING EXPENSE | 13869 | 8321 | 5548 |
| MEMBERSHIP DUES EXPENSE | 13650 | 8190 | 5460 |
| BAD DEBT EXPENSE | 10000 | 10000 | |
| MISCELLANEOUS EXPENSE | 2528 | 1517 | 1011 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2520650 | Total |
| Program Services | 2182120 | ProgramServices |
| Management And General | 338530 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15523 | BOY |
| EOY | 42698 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 415475 | BOY |
| EOY | 482693 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 57731 | BOY |
| EOY | 140675 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15489 | BOY |
| EOY | 9382 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 49734 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 14101 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12519 | BOY |
| EOY | 35633 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 516737 | BOY |
| EOY | 711081 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47914 | BOY |
| EOY | 86343 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29583 | BOY |
| EOY | 40555 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 77497 | BOY |
| EOY | 126898 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 439240 | BOY |
| EOY | 558695 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 25488 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 439240 | BOY |
| EOY | 584183 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 516737 | BOY |
| EOY | 711081 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 144943 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | 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 |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 3245683 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 4040008 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 2111009 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1316892 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1547848 | CurrentTaxYear |
| Total | 12261440 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 3245683 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 4040008 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 2111009 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1316892 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1547848 | CurrentTaxYear |
| Total | 12261440 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | 12261440 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 71852 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 46187 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 17250 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 13325 | CurrentTaxYearMinus1Year |
| Current Tax Year | 11091 | CurrentTaxYear |
| Total | 159705 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 102155 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 108964 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 136283 | CurrentTaxYearMinus2Years |
| Total | 347402 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 12768547 | TotalSupport |
| Gross Receipts From Admissions Etc | 2692968 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.96030 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.95760 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
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
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 49734 | OtherCostOrOtherBasis |
| Depreciation | 14101 | Depreciation |
| Book Value | 35633 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 35633 | TotalOfBookValueLandBuildings |
| Total Revenue | 2665593 | TotalRevenue |
| Total Expenses | 2520650 | TotalExpenses |
| Excess Or Deficit For Year | 144943 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 144943 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 2665593 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 2665593 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 2665593 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 2520650 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 2520650 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 2520650 | TotalExpensesPerForm990 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (62 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| ABRAHAM LINCOLN MEMORIAL HOSPITAL | |||||||
| 200 STALHUT DRIVE | LINCOLN | IL | 62656 | 370723793 | 501(C)(3) | 9655 | SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT |
| ADVOCATE EUREKA HOSPITAL | |||||||
| 101 S MAJOR ST | EUREKA | IL | 61530 | 370662542 | 501(C)(3) | 13055 | SHIP GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT. |
| BOARD OF TRUSTEES OF THE UNIVERSITY OF IL | |||||||
| 1901 S FIRST STREET SUITE A | CHAMPAIGN | IL | 61820 | 376000511 | GOVERNMENTAL UNIT | 137331 | WORKFORCE DEVELOPMENT GRANT |
| CARLINVILLE AREA HOSPITAL | |||||||
| 20733 N BROAD STREET | CARLINVILLE | IL | 62626 | 370645239 | 501(C)(3) | 13055 | SHIP GRANT AND FINANCIAL ASSESSMENT GRANT. |
| CLAY COUNTY HOSPITAL | |||||||
| 911 STACY BURK DRIVE | FLORA | IL | 62839 | 376000605 | GOVERNMENTAL UNIT | 13055 | SHIP GRANT, RECRUITMENT AND RETENTION GRANT |
| COMMUNITY MEMORIAL HOSPITAL | |||||||
| 400 CALDWELL ST | STAUNTON | IL | 62088 | 370624255 | 501(C)(3) | 15455 | SHIP GRANT, EMS GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT. |
| CRAWFORD MEMORIAL HOSPITAL | |||||||
| 1000 NORTH ALLEN ST | ROBINSON | IL | 62454 | 370793762 | GOVERNMENTAL UNIT | 13055 | SHIP GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT. |
| CROSSROADS COMMUNITY HOSPITAL | |||||||
| 8 DOCTORS PARK ROAD | MT VERNON | IL | 62864 | 581622971 | 501(C)(3) | 8055 | SHIP GRANT |
| DR JOHN WARNER HOSPITAL | |||||||
| 422 WEST WHITE ST | CLINTON | IL | 61727 | 376000695 | GOVERNMENTAL UNIT | 22055 | SHIP GRANT, CHRONIC DISEASE GRANT, EMS GRANT, RECRUITMENT AND RETENTION GRANT. |
| FAIRFIELD MEMORIAL HOSPITAL | |||||||
| 303 NW 11TH ST | FAIRFIELD | IL | 62837 | 370661202 | GOVERNMENTAL UNIT | 18055 | SHIP GRANT, RECRUITMENT AND RETENTION GRANT, AND HOSPITAL SERVICES IMPROVEMENT GRANT. |
| FAYETTE COUNTY HOSPITAL AND LONG TERM CARE | |||||||
| 650 WEST TAYLOR ST | VANDALIA | IL | 62471 | 201890414 | GOVERNMENTAL UNIT | 8055 | SHIP GRANT |
| FERRELL HOSPITAL | |||||||
| 1201 PINE ST | ELDORADO | IL | 62930 | 201244058 | 501(C)(3) | 13055 | SHIP GRANT AND CHRONIC DISEASE GRANT. |
| FRANKLIN HOSPITAL | |||||||
| 201 BAILEY LANE | BENTON | IL | 62812 | 376006885 | GOVERNMENTAL UNIT | 22055 | SHIP GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT, EMS GRANT, AND CHRONIC DISEASE GRANT. |
| GIBSON AREA HOSPITAL & HEALTH SERVICES | |||||||
| 1120 N MELVIN ST | GIBSON CITY | IL | 60936 | 370647938 | 501(C)(3) | 13055 | SHIP GRANT AND CHRONIC DISEASE GRANT |
| GREENVILLE REGIONAL HOSPITAL | |||||||
| 200 HEALTHCARE DR | GREENVILLE | IL | 62246 | 370792770 | 501(C)(3) | 8055 | SHIP GRANT |
| HAMILTON MEMORIAL HOSPITAL DISTRICT | |||||||
| 611 S MARSHALL AVENUE PO BOX 429 | MCLEANSBORO | IL | 62859 | 376019589 | GOVERNMENTAL UNIT | 45239 | SHIP GRANT, WORKFORCE DEVELOPMENT GRANT, FINANCIAL ASSESSSMENT GRANT, HOSPITAL BOARD EDUCATION GRANT, RECRUITMENT AND RETENTION GRANT. |
| HAMMOND HENRY HOSPITAL | |||||||
| 600 NORTH COLLEGE AVENEUE | GENESEO | IL | 61254 | 366008003 | GOVERNMENTAL UNIT | 13055 | SHIP GRANT, RECRUITMENT AND RETENTION GRANT. |
| HARDIN COUNTY GENERAL HOSPITAL | |||||||
| 6 FERRELL ROAD BOX 2467 | ROSICLARE | IL | 62982 | 370702309 | 501(C)(3) | 21055 | SHIP GRANT, FINANCIAL ASSESSMENT GRANT, CHRONIC DISEASE GRANT, AND HOSPITAL BOARD EDUATION GRANT. |
| HILLSBORO AREA HOSPITAL | |||||||
| 1200 EAST TREMONT ST | HILLSBORO | IL | 62049 | 370661208 | 501(C)(3) | 21006 | SHIP GRANT, CHRONIC DISEASE GRANT, HOSPITAL BOARD EDUCATION GRANT, AND FINANCIAL ASSESSMENT GRANT. |
| HOOPESTON REGIONAL HEALTH CENTER | |||||||
| 701 EAST ORANGE ST | HOOPESTON | IL | 60942 | 363637465 | 501(C)(3) | 12055 | SHIP GRANT AND EMS GRANT |
| HOPEDALE MEDICAL COMPLEX | |||||||
| 107 TREMONT ST | HOPEDALE | IL | 61747 | 370808925 | 501(C)(3) | 8055 | SHIP GRANT |
| ILLINI COMMUNITY HOSPITAL | |||||||
| 640 WEST WASHINGTON ST | PITTSFIELD | IL | 62363 | 371396010 | 501(C)(3) | 18030 | SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT, CHRONIC DISEASE GRANT, AND EMS GRANT. |
| ILLINOIS HOSPITAL ASSOCIATION | |||||||
| 1151 EAST WARRENVILLE ROAD | NAPERVILLE | IL | 60566 | 362352486 | 501(C)(3) | 73000 | FLEX GRANT. |
| IROQUOIS MEMORIAL HOSPITAL | |||||||
| 200 FAIRMAN | WATSEKA | IL | 60970 | 370673512 | 501(C)(3) | 8055 | SHIP GRANT |
| JERSEY COMMUNITY HOSPITAL | |||||||
| 400 MAPLE SUMMIT | JERSEYVILLE | IL | 62052 | 376013958 | 501(C)(3) | 8055 | SHIP GRANT |
| JOHN AND MARY E KIRBY HOSPITAL | |||||||
| 1111 N STATE ST PO BOX 20 | MONTICELLO | IL | 61856 | 370661215 | 501(C)(3) | 16459 | SHIP GRANT, EMS GRANT, AND CHRONIC DISEASE GRANT. |
| KEWANEE HOSPITAL | |||||||
| 1051 WEST SOUTH ST PO BOX 747 | KEWANEE | IL | 61443 | 362167767 | 501(C)(3) | 16055 | SHIP GRANT, CHRONIC DISEASE GRANT, AND HOSPITAL BOARD EDUCATION GRANT. |
| LAWRENCE COUNTY MEMORIAL HOSPITAL | |||||||
| 2200 WEST STATE ST | LAWRENCEVILLE | IL | 62439 | 371080256 | GOVERNMENTAL UNIT | 18055 | SHIP GRANT, RECRUITMENT AND RETENTION GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT. |
| MARSHALL BROWNING HOSPITAL | |||||||
| 900 N WASHINGTON ST | DUQUOIN | IL | 62832 | 370661218 | 501(C)(3) | 9795 | SHIP GRANT, HOPSITAL SERVICES IMPROVEMENT GRANT. |
| MASON DISTRICT HOSPITAL | |||||||
| 615 N PROMENADE ST | HAVANA | IL | 62644 | 376017857 | GOVERNMENTAL UNIT | 8055 | SHIP GRANT |
| MASSAC MEMORIAL HOSPITAL | |||||||
| 28 CHICK ST PO BOX 850 | METROPOLIS | IL | 62960 | 370857853 | GOVERNMENTAL UNIT | 13055 | SHIP GRANT, RECRUITMENT AND RETENETION GRANT |
| MEMORIAL HOSPITAL CARTHAGE | |||||||
| 1454 N COUNTY ROAD 2050 PO BOX 160 | CARTHAGE | IL | 62321 | 370662570 | 501(C)(3) | 21055 | SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT, FINANCIAL ASSESSMENT GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT. |
| MEMORIAL HOSPITAL CHESTER | |||||||
| 1900 STATE ST | CHESTER | IL | 62233 | 376020801 | GOVERNMENTAL UNIT | 11458 | SHIP GRANT, CHRONIC DISEASE GRANT. |
| MENDOTA COMMUNITY HOSPITAL | |||||||
| 1315 MEMORIAL DR | MENDOTA | IL | 61342 | 362167785 | 501(C)(3) | 11055 | SHIP GRANT, EMS GRANT. |
| MERCER COUNTY HOSPITAL | |||||||
| 409 NW 9TH ST | ALEDO | IL | 61231 | 366007544 | GOVERNMENTAL UNIT | 15005 | SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT, EMS GRANT. |
| MERCY HARVARD HOSPITAL | |||||||
| 901 GRANT STREET | HARVARD | IL | 60033 | 311551871 | 501(C)(3) | 13055 | SHIP GRANT, RECRUITMENT AND RETENTION GRANT. |
| MIDWEST MEDICAL CENTER | |||||||
| 1 MEDICAL CENTER DRIVE | GALENA | IL | 61036 | 204560540 | 501(C)(3) | 11055 | SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT. |
| MORRISON COMMUNITY HOSPITAL | |||||||
| 303 N JACKSON ST | MORRISON | IL | 61270 | 366008167 | GOVERNMENTAL UNIT | 22055 | SHIP GRANT, RECRUITMENT AND RETENTION GRANT, EMS GRANT, AND HOSPITAL SERVICES IMPROVEMENT GRANT. |
| NORTHERN ILLINOIS UNIVERSITY | |||||||
| 148 N 3RD ST | DEKALB | IL | 60115 | 366008480 | GOVERNMENTAL UNIT | 8500 | FLEX GRANT |
| OSF ST JAMES W ALBRECHT MEDICAL CENTER | |||||||
| 2500 W REYNOLDS ST | PONTIAC | IL | 61764 | 370662570 | 501(C)(3) | 8055 | SHIP GRANT. |
| PANA COMMUNITY HOSPITAL | |||||||
| 101 EAST NINTH ST | PANA | IL | 62557 | 376062326 | 501(C)(3) | 18892 | SHIP GRANT, FINANCIAL ASSESSMENT GRANT, EMS GRANT, AND HOSPITAL BOARD EDUATION GRANT. |
| PARIS COMMUNITY HOSPITAL | |||||||
| 721 EAST COURT ST | PARIS | IL | 61944 | 370860281 | 501(C)(3) | 22055 | SHIP GRANT, CHRONIC DISEASE GRANT, FINANCIAL ASSESSMENT GRANT, AND EMS GRANT. |
| PERRY MEMORIAL HOSPITAL | |||||||
| 530 PARK AVENUE EAST | PRINCETON | IL | 61356 | 366006057 | GOVERNMENTAL UNIT | 17904 | SHIP GRANT, EMS GRANT, CHRONIC DISEASE GRANT, AND HOSPITAL BOARD EDUCATION GRANT. |
| PINCKNEYVILLE COMMUNITY HOSPITAL | |||||||
| 101 NORTH WALNUT STREET | PINCKNEYVILLE | IL | 62274 | 376006955 | GOVERNMENTAL UNIT | 16000 | SHIP GRANT, FINANCIAL ASSESSMENT GRANT, AND HOSPITAL SERVICES IMPROVEMENT GRANT. |
| RED BUD REGIONAL HOSPITAL | |||||||
| 325 SPRING ST | RED BUD | IL | 62278 | 364443919 | 501(C)(3) | 12055 | SHIP GRANT, EMS GRANT. |
| RICHLAND MEMORIAL HOSPITAL | |||||||
| 800 EAST LOCUST | OLNEY | IL | 62450 | 371363001 | 501(C)(3) | 12055 | SHIP GRANT, EMS GRANT. |
| ROCHELLE COMMUNITY HOSPITAL | |||||||
| 900 N SECOND ST | ROCHELLE | IL | 61068 | 362548549 | 501(C)(3) | 11055 | SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT. |
| SALEM TOWNSHIP HOSPITAL | |||||||
| 1201 RICKER DRIVE | SALEM | IL | 62881 | 370925318 | GOVERNMENTAL UNIT | 12055 | SHIP GRANT, RECRUITMENT AND RETENTION GRANT. |
| SARAH D CULBERTSON MEMORIAL HOSPITAL | |||||||
| 238 SOUTH CONGRESS AVE | RUSHVILLE | IL | 62681 | 376006672 | GOVERNMENTAL UNIT | 22055 | SHIP GRANT, EMS GRANT, FINANCIAL ASSESSMENT GRANT, CHRONIC DISEASE GRANT. |
| SHELBY MEMORIAL HOSPITAL | |||||||
| 200 SOUTH CEDAR | SHELBYVILLE | IL | 62565 | 370512290 | 501(C)(3) | 8055 | SHIP GRANT. |
| SPARTA COMMUNITY HOSPITAL DISTRICT | |||||||
| 818 EAST BROADWAY | SPARTA | IL | 62286 | 376014817 | GOVERNMENTAL UNIT | 11055 | SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT. |
| ST FRANCIS HOSPITAL | |||||||
| 1215 FRANCISCAN DRIVE | LITCHFIELD | IL | 62056 | 370661236 | 501(C)(3) | 11055 | SHIP GRANT, HOSPITAL BOARD EDUCATION GRANT. |
| ST JOSEPH'S HOSPITAL | |||||||
| 1515 MAIN ST | HIGHLAND | IL | 62249 | 370663568 | 501(C)(3) | 13055 | SHIP GRANT, RECRUITMENT AND RETENTION GRANT. |
| TAYLORVILLE MEMORIAL HOSPITAL | |||||||
| 201 EAST PLEASANT ST | TAYLORVILLE | IL | 62568 | 370661250 | 501(C)(3) | 12055 | SHIP GRANT, EMS GRANT. |
| THOMAS H BOYD MEMORIAL HOSPITAL | |||||||
| 800 SCHOOL ST | CARROLTON | IL | 62016 | 370673461 | GOVERNMENTAL UNIT | 13055 | SHIP GRANT, FINANCIAL ASSESSMENT GRANT. |
| UNION COUNTY HOSPITAL | |||||||
| 517 NORTH MAIN ST | ANNA | IL | 62906 | 364431843 | GOVERNMENTAL UNIT | 8055 | SHIP GRANT. |
| VALLEY WEST COMMUNITY HOSPITAL | |||||||
| 11 E PLEASANT AVE | SANDWICH | IL | 60548 | 364244337 | 501(C)(3) | 12358 | SHIP GRANT, CHRONIC DISEASE GRANT. |
| WABASH GENERAL HOSPITAL | |||||||
| 1418 COLLEGE DR | MT CARMEL | IL | 62863 | 376013625 | GOVERNMENTAL UNIT | 13055 | SHIP GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT. |
| WASHINGTON COUNTY HOSPITAL | |||||||
| 705 S GRAND | NASHVILLE | IL | 62263 | 376020408 | GOVERNMENTAL UNIT | 21055 | SHIP GRANT, FINANCIAL ASSESSMENT GRANT, HOSPITAL BOARD EDUCATION GRANT, HOSPITAL SERVICES IMPROVEMENT GRANT. |
| WESTERN ILLINOIS AHEC | |||||||
| BROADWAY AT 14TH ST | QUINCY | IL | 62305 | 262145452 | 501(C)(3) | 10000 | FLEX GRANT. |
| ST JOSEPH MEMORIAL HOSPITAL | |||||||
| 2 SOUTH HOSPITAL DRIVE | MURPHYSBORO | IL | 62966 | 370618939 | 501(C)(3) | 12920 | SHIP GRANT, HOSPITAL SERVIES IMPROVEMENT GRANT. |
| OSF HOLY FAMILY MEDICAL CENTER | |||||||
| 1000 W HARLEM AVE | MONMOUTH | IL | 61462 | 370813229 | 501(C)(3) | 13015 | SHIP GRANT, RECRUITMENT AND RETENTION GRANT. |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | FLEX GRANT AND SPECIAL PROJECT GRANT. | TypeOfGrant |
| Number Of Recipients | 1 | NumberOfRecipients |
| Amount Of Cash Grant | 8500 | AmountOfCashGrant |
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: 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | PATRICIA SCHOU | NamePerson |
| Base Compensation Filing Org | 145000 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 0 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 0 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 4650 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 0 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 5196 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 0 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 154846 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 0 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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. |
| FORM 990, PART XII, LINE 2C | THE BOARD OF DIRECTORS FOR THE ILLINOIS CRITICAL ACCESS HOSPTIAL NETWORK ENGAGES THE INDEPENDENT ACCOUNTANTS TO PERFORM THE AUDIT. ONCE COMPLETE THE BOARD OF DIRECTORS MEET WITH THE AUDITORS TO REIVEW THE AUDIT REPORT AND MANAGEMENT LETTER. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CRITICAL ACCESS RECRUITMENT SERVICES LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 245 BACKBONE RD EAST | AddressLine1 |
| City | PRINCETON | City |
| State | IL | State |
| ZIP Code | 61356 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 208045884 | EIN |
| Primary Activities | RECRUITING SERVICES FOR MEMBER HOSPITALS | PrimaryActivities |
| Legal Domicile State | IL | LegalDomicileState |
| Total Income | 42021 | TotalIncome |
| EOY Assets | 113963 | EOYAssets |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |