2023-12-14T09:20:12-06:00 2023-04-30 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2022-05-01 363719223 ROCHELLE COMMUNITY HOSPITAL FOUNDATION ROCH 8155622181 900 NORTH SECOND STREET ROCHELLE IL 61068 LORI GUTIERREZ CFO 8155622181 2023-12-12 1 LORI GUTIERREZ XXX-XX-XXXX 0 AMBER ROGNAN-HAMILTON P01251012 3149254300 2023-12-12 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z GREGG OLSON 900 NORTH SECOND STREET ROCHELLE IL 61068 77863 0 X WWW.ROCHELLEHOSPITAL.COM/FOUNDATION/ X 1990 IL PROVIDE SUPPORT FOR HEALTH CARE SERVICES OF ROCHELLE COMMUNITY HOSPITAL AND ITS CLINICS. 11 10 1 35 0 0 60988 54030 0 0 9054 13713 -9017 -692 61025 67051 9520 8000 0 0 20165 19011 0 0 0 8911 20743 38596 47754 22429 19297 815587 813964 38128 18244 777459 795720 DEVELOP AND GROW FINANCIAL RESOURCES TO SUPPORT ROCHELLE COMMUNITY HOSPITAL IN PROVIDING EXCELLENCE IN HEALTHCARE FOR OUR COMMUNITY. 0 0 8000 8000 0 ROCHELLE COMMUNITY HOSPITAL FOUNDATION WAS INCORPORATED FOR CHARITABLE BENEVOLENT EDUCATIONAL AND SCIENTIFIC PURPOSES AND TO SUPPORT AND ENCOURAGE HEALTH CARE SERVICES. ASSURING THAT QUALITY HEALTH AND WELLNESS SERVICES ARE AVAILABLE TO THE PEOPLE IN THE EASTERN OGLE AND NORTHERN LEE COUNTIES IS WHAT ROCHELLE COMMUNITY HOSPITAL IS ALL ABOUT. WE EDUCATE PEOPLE, GROUPS AND ORGANIZATIONS REGARDING THE AVAILABILITY AND APPROPRIATE USE OF THESE HEALTHCARE SERVICES. 8000 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 2 0 1 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 11 10 0 0 1 0 0 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 IL X LORI GUTIERREZ 8155622181 900 NORTH SECOND STREET ROCHELLE IL 61068 REED HARRIS PRESIDENT 0.50 0.00 X X 0 0 0 EARL FLEMING TREASURER 0.50 0.00 X X 0 0 0 DEBBIE KERSTEN TRUSTEE 0.50 0.00 X 0 0 0 PAT ZILM TRUSTEE 0.50 0.00 X 0 0 0 DARLYNE KELLER TRUSTEE 0.50 0.00 X 0 0 0 WILL MCLACHLAN TRUSTEE 0.50 0.00 X 0 0 0 STEPHANIE CRAWFORD TRUSTEE 0.50 0.00 X 0 0 0 CAROL ELLIOTT AUXILIARY REPRESENTATIVE 0.50 0.00 X 0 0 0 ROBERT JOHNS TRUSTEE 0.50 0.00 X 0 0 0 TONYA SARVER TRUSTEE 0.50 0.00 X 0 0 0 GREGORY A OLSON CEO & TRUSTEE 5.00 40.00 X X 0 330349 42260 LORI GUTIERREZ CFO 5.00 40.00 X 0 194343 5485 MICHELLE LAPAGE FOUNDATION COORDINATOR 10.00 30.00 X 0 97667 20611 0 622359 68356 0 0 1 0 0 24090 29940 54030 13713 13713 10120 24090 10812 -692 -692 67051 0 0 13021 X 8000 8000 19011 19011 12529 12529 8214 8214 47754 8000 39754 0 367130 813964 201 0 448256 0 815587 813964 38128 18244 38128 18244 X 777459 795720 777459 795720 815587 813964 19297 -1036 0 X X 0 1 X 1 0 X X 1 ROCHELLE COMMUNITY HOSPITAL ASSOCIATION 362548549 3 1 0 47754 1 0 47754 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PART IV, SECTION A, LINE 2 ROCHELLE COMMUNITY HOSPITAL FOUNDATION SUPPORTS ROCHELLE COMMUNITY HOSPITAL ASSOCIATION, A 501(C)(3) ORGANIZATION CLASSIFIED AS A PUBLIC CHARITY UNDER IRC SECTION 170(B)(1)(A)(III). ROCHELLE COMMUNITY HOSPITAL FOUNDATION COMPLETED THE CALCULATIONS FOR THE 509(A)(2) PUBLIC SUPPORT TEST FOR ROCHELLE COMMUNITY HOSPITAL ASSOCIATION FOR THE PERIOD 5/1/18 - 4/30/23 AND DETERMINED THAT ROCHELLE COMMUNITY HOSPITAL ASSOCIATION WOULD QUALIFY AS A PUBLIC CHARITY UNDER IRC SECTION 509(A)(2). PART IV, SECTION B, LINE 1 THE NUMBER OF DIRECTORS OF THE BOARD SHALL BE NO LESS THAN NINE (9) NOR GREATER THAN TWELVE (12) PERSONS ("DIRECTORS") AS DETERMINED BY THE BOARD FROM TIME TO TIME. A MAJORITY OF DIRECTORS SHALL BE APPOINTED BY THE HOSPITAL BOARD THROUGH A YEARLY NOMINATION PROCESS, WITH THE EXCEPTION OF HOSPITAL'S PRESIDENT AND CHIEF EXECUTIVE OFFICER ("CEO") WHO SHALL BE DESIGNATED AS A DIRECTOR OF THE CORPORATION BY VIRTUE OF HIS OR HER ROLE HELD WITH THE HOSPITAL. FOR THE NOMINATION PROCESS, THE CORPORATION BOARD SHALL COMPILE A LIST OF REQUISITE POTENTIAL DIRECTORS TO ESTABLISH AND MAINTAIN A MAJORITY OF HOSPITAL-APPOINTED CORPORATION DIRECTORS ("DIRECTOR NOMINATIONS"), WHICH THE HOSPITAL BOARD SHALL APPROVE OR DENY, IN ACCORDANCE WITH ITS BYLAWS, AT THE MEETING IMMEDIATELY PRIOR TO THE ANNUAL MEETING OF THE CORPORATION. THE CORPORATION BOARD SHALL PROVIDE THE DIRECTOR NOMINATIONS TO THE HOSPITAL BOARD AT LEAST TWO (2) WEEKS PRIOR TO SUCH MEETING. IF THE HOSPITAL BOARD DENIES THE DIRECTOR NOMINATIONS, THEN THE CORPORATION BOARD SHALL PROVIDE NEW DIRECTOR NOMINATIONS TO THE HOSPITAL BOARD AS SOON AS REASONABLY POSSIBLE. FOR CLARITY PURPOSES, A MAJORITY OF HOSPITAL-APPOINTED CORPORATION DIRECTORS INCLUDES THE CEO. EXCEPT FOR THE DIRECTORS THAT ARE APPOINTED BY THE HOSPITAL AS SET FORTH ABOVE, THE REMAINING DIRECTORS SHALL BE ELECTED BY THE BOARD AT THE ANNUAL MEETING OF THE CORPORATION. DIRECTORS SHALL BE SELECTED BY THE BOARD FROM PERSONS WHO POSSESS THE ABILITY TO PARTICIPATE EFFECTIVELY IN THE DISCHARGE OF THE BOARD'S RESPONSIBILITIES, AND MAY INCLUDE PERSONS WHO ARE RESIDENTS OF THE COMMUNITY SERVED BY THE CORPORATION. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DUE TO HOSPITAL 18244 18244 X PART X, LINE 2: TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF FINANCIAL POSITION ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. PRESENTLY THERE ARE NO ONGOING INCOME TAX AUDITS OR UNRESOLVED DISPUTES WITH TAX AUTHORITIES THAT THE HOSPITAL CURRENTLY FILES OR HAS FILED WITH. GOLF OUTING 34210 24090 10120 375 259 2592 6276 0 1310 34210 24090 10120 375 259 2592 6276 1310 10812 -692 1 SCHOLARSHIPS 16 8000 PART I, LINE 2: THE FOUNDATION AND THE HOSPITAL ARE UNDER COMMON MANAGEMENT THAT OVERSEES THE SPENDING OF ALL FUNDS TO ENSURE THAT CHARITABLE PURPOSES AND ANY RESTRICTIONS ARE MET. 0 0 0 0 0 0 0 0 0 GREGORY A OLSON CEO & TRUSTEE 0 309849 0 18547 0 1953 0 10074 0 32186 0 372609 0 0 LORI GUTIERREZ CFO 0 181852 0 11190 0 1301 0 3574 0 1911 0 199828 0 0 PART I, LINE 3 THE FOLLOWING METHODS WERE USED BY ROCHELLE COMMUNITY HOSPITAL ASSOCIATION, A RELATED 501(C)(3) PUBLIC CHARITY, TO DETERMINE THE CEO'S COMPENSATION: 1. COMPENSATION COMMITTEE 2. WRITTEN EMPLOYMENT CONTRACT 3. COMPENSATION SURVEY OR STUDY 4. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 4 SECTION 13. ATTENDANCE. A DIRECTOR MUST ATTEND AT LEAST SEVENTY-FIVE (75%) OF THE REGULARLY SCHEDULED MEETINGS. FAILURE TO DO SO OR THE UNEXCUSED ABSENCE OF THREE (3) CONSECUTIVE REGULAR MEETINGS SHALL RESULT IN AN AUTOMATIC RESIGNATION BY THE DIRECTOR FROM THE BOARD. ANY OR ALL DIRECTORS MAY PARTICIPATE IN A REGULAR OR SPECIAL MEETING BY, OR CONDUCT THE MEETING THROUGH THE USE OF, ANY MEANS OF COMMUNICATION BY WHICH ALL DIRECTORS PARTICIPATING MAY SIMULTANEOUSLY HEAR AND SPEAK TO EACH OTHER DURING THE MEETING. A DIRECTOR PARTICIPATING IN A MEETING BY THIS MEANS IS DEEMED TO BE PRESENT IN PERSON AT THE MEETING. SECTION 2. ELECTION AND TERM OF OFFICE FOR OFFICERS. EACH OFFICER POSITION WILL HOLD OFFICE FOR A PERIOD OF ONE (1) YEAR WITH NO TERM LIMITS. FORM 990, PART VI, SECTION A, LINE 7A THE NUMBER OF DIRECTORS OF THE BOARD SHALL BE NO LESS THAN NINE (9) NOR GREATER THAN TWELVE (12) PERSONS ("DIRECTORS") AS DETERMINED BY THE BOARD FROM TIME TO TIME. A MAJORITY OF DIRECTORS SHALL BE APPOINTED BY THE HOSPITAL BOARD THROUGH A YEARLY NOMINATION PROCESS, WITH THE EXCEPTION OF HOSPITAL'S PRESIDENT AND CHIEF EXECUTIVE OFFICER ("CEO") WHO SHALL BE DESIGNATED AS A DIRECTOR OF THE CORPORATION BY VIRTUE OF HIS OR HER ROLE HELD WITH THE HOSPITAL. FOR THE NOMINATION PROCESS, THE CORPORATION BOARD SHALL COMPILE A LIST OF REQUISITE POTENTIAL DIRECTORS TO ESTABLISH AND MAINTAIN A MAJORITY OF HOSPITAL-APPOINTED CORPORATION DIRECTORS ("DIRECTOR NOMINATIONS"), WHICH THE HOSPITAL BOARD SHALL APPROVE OR DENY, IN ACCORDANCE WITH ITS BYLAWS, AT THE MEETING IMMEDIATELY PRIOR TO THE ANNUAL MEETING OF THE CORPORATION. THE CORPORATION BOARD SHALL PROVIDE THE DIRECTOR NOMINATIONS TO THE HOSPITAL BOARD AT LEAST TWO (2) WEEKS PRIOR TO SUCH MEETING. IF THE HOSPITAL BOARD DENIES THE DIRECTOR NOMINATIONS, THEN THE CORPORATION BOARD SHALL PROVIDE NEW DIRECTOR NOMINATIONS TO THE HOSPITAL BOARD AS SOON AS REASONABLY POSSIBLE. FOR CLARITY PURPOSES, A MAJORITY OF HOSPITAL-APPOINTED CORPORATION DIRECTORS INCLUDES THE CEO. EXCEPT FOR THE DIRECTORS THAT ARE APPOINTED BY THE HOSPITAL AS SET FORTH ABOVE, THE REMAINING DIRECTORS SHALL BE ELECTED BY THE BOARD AT THE ANNUAL MEETING OF THE CORPORATION. DIRECTORS SHALL BE SELECTED BY THE BOARD FROM PERSONS WHO POSSESS THE ABILITY TO PARTICIPATE EFFECTIVELY IN THE DISCHARGE OF THE BOARD'S RESPONSIBILITIES, AND MAY INCLUDE PERSONS WHO ARE RESIDENTS OF THE COMMUNITY SERVED BY THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B HOSPITAL APPOINTED DIRECTORS MAY BE REMOVED BY ACTION OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES THAT HAVE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. A DRAFT COPY OF FORM 990 IS PROVIDED TO THE GOVERNING BODY (BOARD OF DIRECTORS) AND THE GOVERANCE COMMITTEE FOR REVIEW BY THE RETURN PREPARER PRIOR TO FILING. THE ORGANIZATION'S CEO, CFO, AND OTHER MEMBERS OF THE ACCOUNTING DEPARTMENT ALSO REVIEW A COPY OF THE RETURN. IF CHANGES ARE NECESSARY, THEY ARE REPORTED TO THE RETURN PREPARER AND INCORPORATED INTO THE FINAL RETURN. FORM 990, PART VI, SECTION B, LINE 12C CONFLICTS OF INTEREST ARE INVESTIGATED BY APPOINTED MEMBERS OF THE GOVERANCE COMMITTEE ON AN ONGOING BASIS. IF IT IS DETERMINED THAT AN INDIVIDUAL FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL INFORM THE INDIVIDUAL OF SUCH A BELIEF AND AFFORD HIM AN OPPORTUNITY TO EXPLAIN. AFTER SAID EXPLANATION, THE BOARD SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION AS DEEMED NECESSARY. THE CONFLICT OF INTEREST POLICY IS REVIEWED BY THE BOARD ANNUALLY AND UPDATED AS NEEDED. FORM 990, PART VI, SECTION B, LINE 15 NO BOARD MEMBERS RECEIVE PAY FROM THE FOUNDATION FOR THEIR DUTIES AS BOARD MEMBERS OF THE FOUNDATION. CERTAIN BOARD MEMBERS ARE PAID BY THE PARENT ORGANIZATION FOR THEIR DUTIES TO THE PARENT, AND THEIR PAY IS DETERMINED BY THE PARENT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST IN WRITING TO THE BUSINESS OFFICE. FORM 990, PART IX, LINE 11G FOUNDATION PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 12,529. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,529. FORM 990, PAGE 12, PART XII, LINE 2C PROCESSES HAVE NOT CHANGED FROM THE PRIOR YEAR. ROCHELLE COMMUNITY HOSPITAL ASSOCIATION 900 N 2ND ST ROCHELLE IL 61068 362548549 HOSPITAL IL 501(C)(3) LINE 3 N/A 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 1 1 0 0