CARLINVILLE AREA HOSPITAL FOUNDATION: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- CARLINVILLE AREA HOSPITAL FOUNDATION (EIN 37-1193348)
- Tax period
- 2009-08-01 to 2010-07-31
- Filed
- 2011-03-14
- IRS object ID
- 201120739349300412
- Schema version
- 2009v1.7
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule N
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-03-14T14:13:11-05:00 | Timestamp |
| Tax Period End Date | 2010-07-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
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 | 2009-08-01 | 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 | 2011-03-08 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Carmen Krantz | Name |
| Phone | 5635561790 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | X | AddressChange |
| 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 | 1968149 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| 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 | 1566748 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1841615 | ContributionsGrantsCurrentYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 58335 | InvestmentIncomePriorYear |
| Investment Income Current Year | 51585 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -3613 | OtherRevenuePriorYear |
| Other Revenue Current Year | -4009 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1621470 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1889191 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 1537934 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 5086304 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 47000 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 532 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 68916 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 21448 | OtherExpensePriorYear |
| Other Expenses Current Year | 97517 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 1606382 | TotalExpensesPriorYear |
| Total Expenses Current Year | 5184353 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 15088 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -3295162 | RevenuesLessExpensesCY |
| Total Assets BOY | 6002850 | TotalAssetsBOY |
| Total Assets EOY | 2896485 | TotalAssetsEOY |
| Total Liabilities EOY | 117883 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 6002850 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 2778602 | 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 | 5113827 | Expense |
| Grants | 5086304 | Grants |
| Revenue | 0 | Revenue |
| 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.1. September 18, 2009; Annual Fundraising Golf Tournament 2. July 25th 2010: Ribbon Cutting Ceremony for New Facility3. Raised an additional $ 560,000 in contributions and pledges for the new facilityDuring fiscal year 2010 Carlinville Area Hospital Foundation also provided funding to Carlinville Area Hospital in the amount of $5,086,304 for the building of a new hospital. The Foundation also provided $20,000 in funding to support a general surgeon. | Description |
| Total Program Service Expense | 5113827 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| 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 | 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 | 1 | PartialLiquidation |
| Disregarded Entity | 0 | 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 |
| 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 | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Excess Business Holdings | 0 | ExcessBusinessHoldings |
| 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 | 0 | 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 | Greg Ward | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2178543141 | 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) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| Richard Walden | ||||||
| Chairman | 0.50 | X | X | 0 | 0 | 0 |
| James Ashworth | ||||||
| Vice Chairman | 0.50 | X | X | 0 | 0 | 0 |
| Betty Star | ||||||
| Secretary | 0.50 | X | X | 0 | 0 | 0 |
| Tammy Dugan | ||||||
| Treasurer | 0.50 | X | X | 0 | 0 | 0 |
| Steven Boente DMD | ||||||
| Member | 0.30 | X | 0 | 0 | 0 | |
| Kenneth Breitwiser | ||||||
| Member until 12/31/09 | 0.30 | X | 0 | 0 | 0 | |
| Don B Denby Jr | ||||||
| Member until 12/31/09 | 0.30 | X | 0 | 0 | 0 | |
| Peggy Denby | ||||||
| Member | 0.30 | X | 0 | 0 | 0 | |
| Alice Drury | ||||||
| Member until 12/31/09 | 0.30 | X | 0 | 0 | 0 | |
| Charlene Genta | ||||||
| Member | 0.30 | X | 0 | 0 | 0 | |
| Elisabeth Herndon | ||||||
| Member | 0.30 | X | 0 | 0 | 0 | |
| Ralph March | ||||||
| Member | 0.30 | X | 0 | 0 | 0 | |
| Dennis Pickrel | ||||||
| Member | 0.30 | X | 0 | 0 | 0 | |
| Ed Tawfall | ||||||
| Member | 0.30 | X | 0 | 0 | 0 | |
| Dawn Cherry | ||||||
| Member commenced 1/1/10 | 0.30 | X | 0 | 0 | 0 | |
| Brent Davis | ||||||
| Member commenced 1/1/10 | 0.30 | X | 0 | 0 | 0 | |
| Mary Jo Reichmann | ||||||
| Member commenced 1/1/10 | 0.30 | X | 0 | 0 | 0 | |
| Kenneth Reid | ||||||
| CEO Carlinville Hospital | 1.00 | X | 0 | 180345 | 12624 | |
| Greg Ward | ||||||
| CFO Carlinville Hospital | 1.00 | X | 0 | 122846 | 8599 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 303191 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 21223 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Fundraising Events | 16012 | FundraisingEvents |
| All Other Contributions | 1825603 | AllOtherContributions |
| Total Contributions | 1841615 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 64060 | TotalRevenueColumn |
| Exclusion | $64,060 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 58373 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 70848 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -12475 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -12475 | TotalRevenueColumn |
| Exclusion | -$12,475 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 4101 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 16012 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 8110 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -4009 | TotalRevenueColumn |
| Exclusion | -$4,009 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1889191 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $47,576 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5086304 | Total |
| Program Services | 5086304 | ProgramServices |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 532 | Total |
| Fundraising | 532 | Fundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1610 | Total |
| Management And General | 1610 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20000 | Total |
| Program Services | 20000 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2500 | Total |
| Fundraising | 2500 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65884 | Total |
| Fundraising | 65884 | Fundraising |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| Doubtful pledges | 7494 | 7494 |
| Miscellaneous expense | 29 | 29 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5184353 | Total |
| Program Services | 5113827 | ProgramServices |
| Management And General | 1610 | ManagementAndGeneral |
| Fundraising | 68916 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4430929 | BOY |
| EOY | 239812 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1226610 | BOY |
| EOY | 2276169 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 268566 | BOY |
| EOY | 380504 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76745 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6002850 | BOY |
| EOY | 2896485 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 117883 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 117883 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 200580 | BOY |
| EOY | 254258 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5802270 | BOY |
| EOY | 2524344 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6002850 | BOY |
| EOY | 2778602 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6002850 | BOY |
| EOY | 2896485 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 0 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| 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 | $5,086,304 |
| Middle Macoupin Healthcare Systems | |||
| 371193396 | 11a | 1 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 2 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 5086304 | 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) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Due to affiliate | Description |
| Amount | $117,883 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 117883 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part X: | Identifier |
| Return Reference | Description of Uncertain Tax Positions Under FIN 48: | ReturnReference |
| Explanation | The Organization has adopted the provisions of FASB Accounting Standards Codification Topic ASC 740-10 (previously Financial Interpretation No. 48, Accounting for the Uncertainty in Income Taxes) on August 1, 2009. The implementation of this standard had no impact on the consolidated financial statements. As of both the date of adoption, and as of July 31, 2010, the unrecognized tax benefit accrual was zero. The Organization will recognize future accrued interest and penalties related to unrecognized tax benefits in income tax expense if incurred. The Organization is no longer subject to Federal or state tax examinations by tax authorities for years before 2006. | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Golf Outing | NameOfEvent1 |
| Gross Receipts Event1 | 20113 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 16012 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 4101 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 1400 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 1500 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 1878 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 2223 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 1109 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 20113 | GrossReceiptsTotal |
| Charitable Contributions Total | 16012 | CharitableContributionsTotal |
| Gross Revenue Total Events | 4101 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 1400 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 1500 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 1878 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 2223 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 1109 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 8110 | DirectExpenseSummaryEvents |
| Net Income Summary | -4009 | 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 | 5086304 | AmountOfCashGrant |
| Purpose Of Grant | Provide assistance for improved acute and preventative health care benefits and general surgeon funding | 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 J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kenneth Reid | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Base Compensation Filing Org | 0 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 180345 | 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 | 0 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 7214 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 0 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 5410 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 0 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 192969 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Supplemental Information | Part III | Part I, Question 3: Carlinville Area Hospital Foundation does not pay compensation to Kenneth Reid, CEO. This individual is an employee of Brim Healthcare Inc., an unrelated management company. Carlinville Area Hospital Association, a related organization, pays management fees for his services at the Hospital. Carlinville Area Hospital Association and Brim Healthcare, Inc. use these methods to determine his compensation. |
| Supplemental Information | Part III | Part II: Kenneth Reid is an employee of Brim Healthcare Inc., an unrelated management company. Carlinville Area Hospital Association pays management fees to Brim Healthcare Inc. for his services provided to the Hospital. |
Schedule N IRS990ScheduleN
Disposition Table DispositionTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Asset | Cash | DescriptionOfAsset |
| Date Of Distribution | 2010-06-30 | DateOfDistribution |
| FMV Of Asset | 5086304 | FMVOfAsset |
| EIN | 370645239 | EIN |
Name Business NameBusiness
| 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) |
|---|---|---|
| IRC Section | 501(c)(3) | IRCSection |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor2 | 0 | DirectorOfSuccessor2 |
| Employee Of Successor2 | 0 | EmployeeOfSuccessor2 |
| Owner Of Successor2 | 0 | OwnerOfSuccessor2 |
| Receive Compensation2 | 0 | ReceiveCompensation2 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (13 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 2 | Don B. Denby, Jr. and Elisabeth Herndon have a family relationship. Richard Walden, Chairman, and James Ashworth, Vice Chairman, have a business relationship. |
| 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 shall 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 shall not vote or use his or her personal influence on the matter. The minutes of the meeting shall 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, Part XI, Line 2C: | Carlinville Area Hospital Association, a related organization, is responsible for oversight of the audit. |
| Form 990, Page 7, Part VII | The CEO, Kenneth Reid, and CFO, Greg Ward, were employees of Brim Healthcare Inc. The reportable compensation reported on Form 990, Part VII and Schedule J was paid to Brim Healthcare Inc. by Carlinville Area Hospital Association, a related organization, for CEO and CFO services provided to Carlinville Area Hospital Association. The services provided by Kenneth Reid and Greg Ward for Carlinville Area Hospital Foundation are not compensated. |
| Form 990, Page 7, Part VII | The following individual devoted time providing services to the following related organizations. Carlinville Area Hospital Association, a related organization. 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 Richard Walden .25 hours per week |
| Form 990, Part VI, Section A, Line 1a: | 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, Schedule A, Part I, line 11i: | The support of Middle Macoupin is provided through Carlinville Area Hospital Foundation providing grants to Carlinville Area Hospital Association. |
Schedule R IRS990ScheduleR
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 | 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) | 3 | N/A |
| Middle Macoupin Healthcare Systems | |||||||||
| 20733 North Broad Street | Carlinville | IL | 62626 | 371193396 | Provide support and benefit Carlinville Area Hospital Association | IL | 501(c)(3) | 11a | 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 |
| 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 | 0 | 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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