2025-05-14T15:21:57-05:00 2024-06-30 346565596 ERNST & YOUNG US LLP 155 N WACKER DRIVE CHICAGO IL 60606 990 2023-07-01 370646367 MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS MENT 2177883922 701 NORTH FIRST STREET SPRINGFIELD IL 62781 JAMESON ROSZHART SENIOR VP AND CFO 2177883830 2025-05-14 1 0 JESSICA A WAGENER P01622613 3128792000 2023 2025-03-06 01:10:19Z MEMORIAL BEHAVIORAL HEALTH KATHRYN J KEIM 701 NORTH FIRST STREET SPRINGFIELD IL 62781 20652135 0 5670 X WWW.MEMORIALBEHAVIORALHEALTH.ORG X 1962 IL TO IMPROVE LIVES AND BUILD STRONGER COMMUNITIES THROUGH BETTER HEATLH. 13 11 0 11 0 0 4999651 5334733 13254745 12880926 152234 267723 682807 619814 19089437 19103196 64204 38757 0 0 16649660 14617755 0 0 0 3041383 3077966 19755247 17734478 -665810 1368718 19652884 21988785 1908683 1726621 17744201 20262164 X TO IMPROVE LIVES AND BUILD STRONGER COMMUNITIES THROUGH BETTER HEALTH. 0 0 2646082 2138727 THE CRISIS/ACCESS PROGRAM PROVIDES RAPID RESPONSE TO INDIVIDUALS IN MENTAL HEALTH CRISIS, TO MEMBERS OF HIS/HER SUPPORT SYSTEM, AND THE COMMUNITY 24-HOURS/DAY. THE PROGRAM PROVIDES CRISIS INTERVENTION SERVICES, WALK-INS, & MOBILE SERVICES. SHORT-TERM CRISIS INTERVENTION OF THERAPY/COUNSELING AND PSYCHIATRIC CARE IS DESIGNED TO ADDRESS THE PRESENTING SYMPTOMS OF A PSYCHIATRIC EMERGENCY & TO AMELIORATE A CLIENT'S DISTRESS SO THAT RESOURCES & SUPPORTS CAN BE MOBILIZED & PLANNING FOR FURTHER TREATMENT CAN OCCUR. CRISIS WALK-IN IS SUPPORT & INTERVENTION OFFERED AT AN IDENTIFIED LOCATION ON AN UNSCHEDULED BASIS FOR THE PURPOSE OF STABILIZING OR RESOLVING A CRISIS SITUATION. MOBILE CRISIS SERVICE IS DELIVERED WHERE & WHEN THE CRISIS OCCURS TO ASSURE SERVICE BY MENTAL HEALTH PROFESSIONALS. MBH PROVIDED 11,015 CLIENT CONTACTS RELATED TO THIS PROGRAM IN FISCAL YEAR 2024. 1974961 2657765 LINCOLN CENTER FOR DEVELOPMENTAL REHABILITATION (LCDR) PROVIDES DEVELOPMENTAL TRAINING SERVICES FOR DEVELOPMENTALLY DISABLED ADULTS. THE SERVICES ARE DESIGNED TO ENHANCE THE INDIVIDUAL'S SKILLS IN ACTIVITIES OF DAILY LIVING, TO LEAD THE INDIVIDUAL TO INDEPENDENCE AND ECONOMIC SELF-SUFFICIENCY THROUGH INSTRUCTION AND TRAINING. THE INDIVIDUAL IS PREPARED FOR LESS RESTRICTIVE INSTRUCTIONAL AND WORK SETTINGS. DEVELOPMENTAL TRAINING PROVIDES A THREE-FOLD APPROACH TO MEETING THE NEEDS OF THE DEVELOPMENTALLY DISABLED ADULT. THESE OBJECTIVES ARE (1) THERAPEUTIC DEVELOPMENTAL, (2) HUMAN INTERACTION DEVELOPMENT, AND (3) VOCATIONAL SKILLS. SERVICE UNITS ARE MEASURED BY CLIENT HOURS. LCDR OPERATED 240DAYS AND PROVIDED 99,929 CLIENT HOURS OF SERVICE IN FISCAL YEAR 2024. 1924455 1981023 MEMORIAL BEHAVIORAL HEALTH-COUNSELING ASSOCIATES (MBH-CA) IS A TRADITIONAL COUNSELING PRACTICE HOUSING EIGHTEEN LICENSED CLINICIANS. SERVICES ARE OFFERED TO PATIENTS WITH PRIVATE INSURANCE AND THOSE INVOLVED WITH EMPLOYEE ASSISTANCE PROGRAMS. MBH-CA CLINICIANS ASSIST PATIENTS IN ADDRESSING STRESS, LIFE TRANSITIONS, AND BEHAVIORAL HEALTH DISORDERS, INCLUDING SUBSTANCE USE. MBH-CA OPERATES FIVE DAYS A WEEK, MONDAY THROUGH FRIDAY FROM 7:30 AM TO 6:30 PM, EXCEPT ON HEALTH SYSTEM HOLIDAYS. MBH-CA PROVIDED 15,289 CLIENT CONTACTS DURING FISCAL YEAR 2024. 7187682 38757 6655182 OTHER DEVELOPMENTAL DISABILITY PROGRAMS EXPENSES $596,076 INCLUDING GRANTS OF $0 REVENUE $303,421OTHER MENTAL HEALTH PROGRAMS EXPENSES $6,578,638 INCLUDING GRANTS OF $38,757 REVENUE $6,335,540HOUSING SERVICES EXPENSES $12,968 INCLUDING GRANTS OF $0 REVENUE $16,221 7187682 38757 6655182 13733180 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 X 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 X 13 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X KATHRYN KEIM SR VICE PRESIDENT & CHIEF FINANCIAL OFFICER 2175887759 701 NORTH FIRST STREET SPRINGFIELD IL 62781 X LEIGH STEINER PHD DIRECTOR 0.70 0.00 X 0 0 0 DR VIRGINIA DOLAN DIRECTOR (THRU FEB 24) & MMG PHYSICIAN 0.50 49.50 X 0 474528 73922 DR NICOLE FLORENCE DIRECTOR & MMG PHYSICIAN 0.70 49.30 X 0 289454 76496 FAYE LEWIS DIRECTOR 0.70 0.00 X 0 0 0 ANNE MORGAN PHD DIRECTOR (THRU FEB 24) 0.50 0.00 X 0 0 0 DARCELLA SPEED DIRECTOR 0.70 0.00 X 0 0 0 MARQUITTA THOMAS DIRECTOR 0.70 0.00 X 0 0 0 LISA VINSON DIRECTOR 0.70 0.00 X 0 0 0 IRIS WESLEY DIRECTOR 0.70 0.00 X 0 0 0 DR KARI WOLF DIRECTOR 0.70 0.00 X 0 0 0 DANIEL WRIGHT DIRECTOR (THRU FEB 24) 0.50 0.00 X 0 0 0 TIFFANY NIELSON PHD CHAIR 0.70 0.00 X X 0 0 0 VEA CRAWFORD VICE CHAIR 0.70 0.00 X X 0 0 0 JOSHUA SABO SECRETARY 0.70 0.00 X X 0 0 0 EVAN WESTLAKE TREASURER 0.70 0.00 X X 0 0 0 DIANA KNAEBE SYSTEM ADMIN MBH/BOARD PRST (THRU SEP 23) 47.50 2.50 X X 0 195984 27996 JAMESON ROSZHART PRST MH AMB. GRP/BRD PRST (FRMOCT 23) 5.00 45.00 X X 0 554864 125137 KATIE KEIM SENIOR VICE PRESIDENT & CFO 5.00 45.00 X 0 646710 140043 DR BRAD HUGHES PSYCHIATRIC MEDICAL DIRECTOR 50.00 0.00 X 299404 0 52415 AMBER OLSON REG DIR, BHVRL HLTH CLINICAL OPS 50.00 0.00 X 136342 0 23208 MONICA FARQUHAR DIRECTOR, MBH 50.00 0.00 X 134212 0 16841 EMILY LEGNER REG DIR,MNTL HLTH CRISIS SYS OF CARE 50.00 0.00 X 128540 0 40886 PEGGY ROSS-JONES REG DIR, DEVELOPMENTAL REHAB 50.00 0.00 X 120315 0 10532 818813 2161540 587476 6 0 1 0 SIU - BOARD OF TRUSTEES 401 N WALNUT ST SPRINGFIELD IL 62702 OVERPAYMENT ON SERVICES 117587 HOLMAN (FORMERLY ARI) 4001 LEADENHALL RD MT LAUREL NJ 08054 FLEET MANAGEMENT SOLUTIONS 117382 THE ECHO GROUP INC 15 WASHINGTON ST CONWAY NH 03818 EHR SYSTEM 101182 3 949 177746 5117863 38175 5334733 MENTAL HEALTH SERVICES 621400 9960753 9960753 DVLPMENT DISABLED SVCS 621400 2903952 2903952 HOUSING SERVICES 621400 16221 16221 12880926 379974 379974 149888 81845 68043 68043 68043 1221712 1333963 -112251 -112251 -112251 359984 133131 226853 226853 DC PENSION OFFSET 900099 302231 302231 COMMISSIONS 900099 12066 12066 PROMPT PAY INTEREST 900099 8734 8734 1887 1887 324918 19103196 13432697 0 335766 38757 38757 211963 71481 140482 10952912 9092279 1860633 634448 633214 1234 1950118 1542150 407968 868314 756492 111822 40600 40600 973 973 132555 102894 29661 286129 177732 108397 309854 224660 85194 512608 426441 86167 191819 184364 7455 15266 1766 13500 207360 171524 35836 184785 168776 16009 MANAGEMENT FEES 1046321 1046321 PROVISION FOR UNCOLLECT 91343 91343 FOOD & DIETARY SUPPLIES 47757 47420 337 10596 1887 8709 17734478 13733180 4001298 0 365 265 872149 334637 2559244 2129258 158382 178090 10967982 8296514 2682919 2671468 13335170 16635067 40000 40000 4655 0 19652884 21988785 1713811 1676867 193983 49754 889 0 1908683 1726621 X 17744201 20262164 17744201 20262164 19652884 21988785 X 1368718 944331 204914 X 0 1 X 1 1 1 X 3135125 3616776 5900053 4999651 5334733 22986338 3135125 3616776 5900053 4999651 5334733 22986338 962917 22023421 342783 270731 280444 492792 529862 1916612 25535 173372 89986 230860 324918 844671 25747621 54609226 0.85540 0.85600 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MENTAL HEALTH TRAINING - REGISTRATION FEES - 2019 AMOUNT: $ 9,385. 2020 AMOUNT: $ 3,390. 2021 AMOUNT: $ 4,304. 2022 AMOUNT: $ 1,003. RECORD COPY FEES - 2019 AMOUNT: $ 5,784. 2020 AMOUNT: $ 5,341. 2021 AMOUNT: $ 596. 2022 AMOUNT: $ 2,916. 2023 AMOUNT: $ 4,728. OTHER REVENUE - 2019 AMOUNT: $ 26,301. 2020 AMOUNT: $ 31,884. 2021 AMOUNT: $ 48,353. 2022 AMOUNT: $ 28,693. 2023 AMOUNT: $ 9,226. PROMPT PAY INTEREST PENALTY - 2019 AMOUNT: $ 5,377. 2020 AMOUNT: $ 6,293. 2021 AMOUNT: $ 10,833. 2022 AMOUNT: $ 3,141. 2023 AMOUNT: $ 8,734. PARTNERSHIP INCOME - 2019 AMOUNT: $ -21,312. CAPITATION REVENUE - 2021 AMOUNT: $ 25,900. 2022 AMOUNT: $ 184,807. RENOVATION REIMBURSEMENT - 2020 AMOUNT: $ 126,464. IHPA INCENTIVE - 2022 AMOUNT: $ 10,300. DC PENSION OFFSET - 2023 AMOUNT: $ 302,230. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 973 0 0 0 973 0 PART II-B, LINE 1: MBH IS A DUES PAYING MEMBER OF THE COMMUNITY BEHAVIOR HEALTHCARE ASSOCIATION (CBHA). A PERCENTAGE OF MBH'S DUES TO CBHA GO TOWARDS LOBBYING ACTIVITIES. 996667 996667 7804276 6544917 1259359 11753 5344 6409 1616884 1449551 167333 538402 296702 241700 2671468 X PART X, LINE 2: MBH IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C )(3) OF THE UNITED STATES INTERNAL REVENUE CODE. MBH FILES FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. MBH IS NO LONGER SUBJECT TO U.S. FEDERAL OR STATE EXAMINATIONS BY TAX AUTHORITIES FOR TAX YEARS PRIOR TO 2020. 1 EDUCATIONAL GRANTS 6 38331 SPECIFIC ASSISTANCE 426 PART I, LINE 2: EDUCATIONAL GRANTS - MEMORIAL BEHAVIORAL HEALTH'S EDUCATIONAL GRANT PROGRAM PROVIDES THE OPPORTUNITY FOR EMPLOYEES TO PURSUE ADDITIONAL EDUCATION IN EXCHANGE FOR A WORK COMMITMENT ONCE THE EDUCATION IS COMPLETED. EDUCATIONAL GRANTS ARE AVAILABLE TO THOSE PURSUING HEALTH CARE CAREERS THAT ARE DEEMED CRITICAL TO THE ORGANIZATION'S PRESENT OR PROJECTED STAFFING NEEDS. GRANT APPLICATIONS FOR ALL OTHER CAREERS WILL BE REVIEWED ON A CASE-BY-CASE BASIS WITH A FINAL DETERMINATION TO BE MADE BY THE MEMORIAL HEALTH WORKFORCE STRATEGIES ADVISORY COUNCIL. SPECIFIC ASSISTANCE - MBH PROVIDES ASSISTANCE TO CLIENTS CURRENTLY RECEIVING SERVICES IN ONE OF THE FOLLOWING PROGRAMS: CARE COORDINATION, SUPPORTED EMPLOYMENT, PROJECTS IN ASSISTANCE FOR TRANSITION FROM HOMELESSNESS (PATH), COMMUNITY INTEGRATED LIVING ARRANGEMENTS (CILA). THIS INCLUDES BUT IS NOT LIMITED TO, MEDICATIONS, CLOTHING, DOCTOR VISITS, AND DENTAL VISITS. TO BE ELIGIBLE FOR THE ASSISTANCE, THE CLIENT MUST HAVE BEEN DIAGNOSED WITH A MENTAL ILLNESS OR A DEVELOPMENTAL DISABILITY, AND CURRENTLY BE RECEIVING SERVICES AT MBH. THE CLIENT IS ASSIGNED A CASE MANAGER WHO IS RESPONSIBLE FOR DETERMINATION OF THE TYPE OF ASSISTANCE NEEDED. BEFORE THE ASSISTANCE IS PROVIDED, THE SUPERVISOR OF THE CASE MANAGER MUST PRE-APPROVE THE ASSISTANCE TO BE PURCHASED. THE CASE MANAGER INITIATES THE PURCHASE. THE CHECK IS MADE PAYABLE DIRECTLY TO THE VENDOR AND/OR LANDLORD. THE CLIENT IS REQUIRED TO SIGN THE VENDOR RECEIPT TO ACKNOWLEDGE THAT HE OR SHE RECEIVED THE GOODS, SERVICES, OR RENTAL ASSISTANCE. CLIENTS DO NOT DIRECTLY RECEIVE CASH. 1 1 0 0 0 0 0 0 0 KATIE KEIM SENIOR VICE PRESIDENT & CFO 0 597929 0 0 0 48781 0 105250 0 34793 0 786753 0 0 JAMESON ROSZHART PRST MH AMB. GRP/BRD PRST (FRMOCT 23 0 486620 0 0 0 68244 0 91308 0 33829 0 680001 0 25420 DR VIRGINIA DOLAN DIRECTOR (THRU FEB 24) & MMG PHYSICI 0 404362 0 12535 0 57631 0 34606 0 39316 0 548450 0 0 DR NICOLE FLORENCE DIRECTOR & MMG PHYSICIAN 0 248229 0 6004 0 35221 0 8093 0 68403 0 365950 0 0 DR BRAD HUGHES PSYCHIATRIC MEDICAL DIRECTOR 298702 0 0 0 702 0 16200 0 36215 0 351819 0 0 0 DIANA KNAEBE SYSTEM ADMIN MBH/BOARD PRST (THRU SE 0 140898 0 0 0 55086 0 10806 0 17190 0 223980 0 0 EMILY LEGNER REG DIR,MNTL HLTH CRISIS SYS OF CARE 128429 0 0 0 111 0 9197 0 31689 0 169426 0 0 0 AMBER OLSON REG DIR, BHVRL HLTH CLINICAL OPS 133540 0 0 0 2802 0 11416 0 11792 0 159550 0 0 0 MONICA FARQUHAR DIRECTOR, MBH 71205 0 0 0 63007 0 10092 0 6749 0 151053 0 0 0 PART I, LINE 3 MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION OF MEMORIAL BEHAVIORAL HEALTH, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S SYSTEM ADMINISTRATOR/BOARD PRESIDENT (EQUIVALENT TO CEO/EXECUTIVE DIRECTOR): 1) COMPENSATION COMMITTEE; 2) INDEPENDENT COMPENSATION CONSULTANT; 3) COMPENSATION SURVEY OR STUDY; AND 4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINES 4A-B PART 1 LINE 4A: THE FOLLOWING LISTED INDIVIDUALS RECEIVED THE FOLLOWING AMOUNTS IN THE FORM OF SEVERANCE BENEFITS, IN CONNECTION WITH A QUALIFIED TERMINATION OF EMPLOYMENT DURING OR PRIOR TO THE YEAR BEING REPORTS: DIANA KNAEBE $43,915 AND MONICA FARQUHAR $34,246. ALL SEVERANCE PAY AMOUNTS WERE PROVIDED UNDER THE PREVIOUSLY APPROVED SEVERANCE PAY AGREEMENTS, AND ARE TRIGGERED ONLY BY CERTAIN TYPES OF EMPLOYMENT TERMINATION. PART 1 LINE 4B: MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION OF MEMORIAL BEHAVIORAL HEALTH, PROVIDES CERTAIN SUPPLEMENTAL RETIREMENT BENEFITS TO THE FOLLOWING OFFICER AND KEY EMPLOYEES: KATIE KEIM, $77,202 AND JAMESON ROSZHART, $63,108. THESE BENEFITS ARE PROVIDED THROUGH A NONQUALIFIED DEFERRED COMPENSATION PLAN, UNDER WHICH THE BENEFITS BEING EARNED ARE SUBJECT TO A "SUBSTANTIAL RISK OF FORFEITURE". THE SUPPLEMENTAL RETIREMENT BENEFITS ARE STRUCTURED TO PROVIDE A RETENTION INCENTIVE THAT HAS BEEN DETERMINED BY THE LEADERSHIP COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF MEMORIAL HEALTH SYSTEM TO BE OF SUBSTANTIAL VALUE TO THE ORGANIZATION. THE FOLLOWING DIRECTORS, OFFICER, & KEY EMPLOYEE RECEIVED DEFERRED COMPENSATION PAYOUTS IN THE CALENDAR YEAR FROM A RELATED ORGANIZATION: DR. VIRGINIA DOLAN, $56,807, DR. NICOLE FLORENCE, $29,877, KATIE KEIM, $39,420, AND JAMESON ROSZHART $59,697 FORM 990, PART V, LINE 3B MBH'S CORPORATE PARENT (A RELATED ORGANIZATION OF MBH) (MEMORIAL HEALTH SYSTEM 37-1110690) ISSUES ALL VENDOR PAYMENTS FOR MBH AND INCLUDES MBH AMOUNTS IN ITS FORM 1096 REPORTING UNDER ITS EIN. PART V, LINE 2A MEMORIAL HEALTH SYSTEM IS A COMMON PAY AGENT FOR ALL THE AFFILIATES AND REPORTS ALL EMPLOYES UNDER ITS EIN. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERSHIP OF THE CORPORATION CONSISTS OF ONE CORPORATE MEMBER, MEMORIAL HEALTH SYSTEM D/B/A MEMORIAL HEALTH. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBER OF THE CORPORATION ELECTS THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE BYLAWS OF THE CORPORATION REQUIRE THE ADVANCE APPROVAL OF THE CORPORATE MEMBER FOR CORPORATE, ADMINISTRATIVE AND OPERATIONAL ACTIONS WHICH INCLUDE, BUT ARE NOT LIMITED TO, THE APPROVAL OF ANY ANNUAL OR LONG-TERM CAPITAL OR OPERATING BUDGET, AMENDMENT, ALTERATION OR REPEAL OF THE ARTICLES OF INCORPORATION OR BYLAWS, CREATION OR ELIMINATION OF A PROGRAM OR SERVICE, APPROVAL OF BORROWING WHICH EXCEEDS $250,000, APPROVAL OF ANY QUANTITY OF DEBT WHICH EXCEEDS $250,000, APPROVAL OF ANY DISSOLUTION, MERGER OR CONSOLIDATION OR SALE OF THE ASSETS OF THE CORPORATION WHICH EXCEED $250,000, APPROVAL OF THE ORGANIZATION OF AN AFFILIATE/SUBSIDIARY, APPROVAL FOR APPLICATION OF CERTIFICATE OF NEED, APPROVAL TO ADOPT ANY LONG-TERM OR MASTER INSTITUTIONAL PLAN, APPROVAL TO SELL OR PURCHASE REAL PROPERTY WHICH EXCEEDS $250,000, APPROVAL TO CHANGE INSURANCE SPECIFICATIONS OR LIMITS, APPROVAL TO SELECT OR CHANGE INDEPENDENT AUDITORS AND LEGAL COUNSEL, APPROVAL TO ENTER INTO, RENEW OR MODIFY CONTRACTS TO PROVIDE COVERED MENTAL HEALTH CARE SERVICES TO BENEFICIARIES OF HEALTH MAINTENANCE ORGANIZATIONS, HEALTH CARE SERVICE PLANS, INDEPENDENT PRACTICE ASSOCIATIONS, PREFERRED PROVIDER ORGANIZATIONS, INSURANCE COMPANIES AND OTHER PURCHASERS OF HEALTH SERVICES, APPROVAL TO ENTER INTO ANY CONTRACT OR AGREEMENT WHICH I) PROVIDES FOR THE PAYMENT OR PERFORMANCE BY EITHER PARTY EXCEEDING AN AGGREGATE VALUE OF $250,000, II) IS NOT TERMINABLE WITHOUT PAYMENT OR PENALTY OF 60 DAYS OR LESS NOTICE III)IS BETWEEN THE CORPORATION OR AN AFFILIATE AND AN OFFICER, DIRECTOR OR KEY EMPLOYEE THEREOF. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT PREPARES AND REVIEWS THE RETURN. AN OUTSIDE TAX ADVISOR THEN REVIEWS THE RETURN, PROVIDING COMMENTS AND GUIDANCE AS NEEDED. MBH BOARD MEMBERS ARE THEN PROVIDED WITH AN ELECTRONIC COPY OF THE FINAL FORM 990 AND ITS SUPPORTING SCHEDULES FOR REVIEW. A HIGH LEVEL DISCUSSION OF THE RETURN TAKES PLACE AT THE MBH BOARD MEETING, WITH A MORE FORMAL PRESENTATION TAKING PLACE AT THE FINANCE COMMITTEE MEETING. FORM 990, PART VI, SECTION B, LINE 12C MBH BOARD MEMBERS RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY ANNUALLY. BOARD MEMBERS COMPLETE CONFLICT OF INTEREST STATEMENTS ON AN ANNUAL BASIS; BOARD MEMBERS ARE REMINDED TO UPDATE THEIR STATEMENTS IF CIRCUMSTANCES CHANGE. BOARD MEMBERS ARE REMINDED OF THE NEED TO ABSTAIN FROM VOTING WHEN BOARD RESOLUTIONS REQUIRE SUCH ACTION. BOARD MEMBERS ARE APPRAISED BY MANAGEMENT OF POTENTIAL CONFLICTS WITH MEETING AGENDA ITEMS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION DETERMINATIONS OF MBH'S PRESIDENT AND OTHER OFFICERS WERE CONDUCTED BY MEMORIAL HEALTH SYSTEM'S MANAGEMENT, A RELATED ORGANIZATION OF THE FILING ORGANIZATION. MBH'S PRESIDENT IS AN EMPLOYEE OF MEMORIAL HEALTH SYSTEM D/B/A MEMORIAL HEALTH (MH). MH ANNUALLY ENGAGES A CONSULTING FIRM TO CONDUCT A COMPENSATION REVIEW, WHICH INCLUDES A COMPARABILITY STUDY FOR ALL EXECUTIVES. MH'S LEADERSHIP COMPENSATION COMMITTEE, A PART OF ITS BOARD OF DIRECTORS, REVIEWS THE CONSULTANT REPORT. COMPENSATION COMMITTEE DECISIONS AND REPORTS ARE CONTEMPORANEOUSLY DOCUMENTED IN THE BOARD OF DIRECTOR AND COMPENSATION COMMITTEE MINUTES AS APPROPRIATE. TWO OFFICERS ARE EMPLOYEES OF AN AFFILIATED ORGANIZATION, MEMORIAL PHYSICIANS SERVICES D/B/A MEMORIAL MEDICAL GROUP (MMG). THEIR COMPENSATION IS REVIEWED BY THE SAME OUTSIDE CONSULTING FIRM THAT REVIEWS THE COMPENSATION OF MBH'S PRESIDENT. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS OF MBH, SUCH AS ARTICLES OF INCORPORATION AND ANY AMENDMENTS THERETO, ARE AVAILABLE TO THE GENERAL PUBLIC THROUGH THE ILLINOIS SECRETARY OF STATE'S OFFICE. THESE GOVERNING DOCUMENTS, AS WELL AS THE BYLAWS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS, ARE AVAILABLE UPON REQUEST FROM THE CORPORATION. THESE DOCUMENTS ARE AVAILABLE FOR THE SAME PERIOD OF TIME AS SET FORTH IN IRC SECTION 6104(D). PART VII, SECTION A DIANA KNAEBE, AND JAMESON ROSZHART WERE EMPLOYED BY A RELATED ORGANIZATION, MEMORIAL HEALTH SYSTEM (MBH'S CORPORATE PARENT ORGANIZATION), AND THEREFORE ARE REPORTED AS A MEMORIAL HEALTH SYSTEM EMPLOYEE FOR TAX REPORTING PURPOSES (W-2). HOWEVER, THESE TWO OFFICER'S COMPENSATION EXPENSE IS ALLOCATED TO MBH ACCORDING TO THE TIME SPENT IN LEADERSHIP TO MBH AND THEREFORE INCLUDED ON PART IX, LINE 5. FORM 990, PART XI, LINE 9: TRANSFER FROM AFFILIATES 150,680. CONTRIBUTION INCOME 54,234. SPRINGFIELD RESIDENTIAL SERVICES 710 NORTH EIGHTH STREET SPRINGFIELD IL 62702 371298589 RESIDENTIAL HUD HOUSING PROJECT FOR MENTALLY ILL IL 501(C)(3) LINE 7 MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS 1 MEMORIAL HEALTH SYSTEM 701 NORTH FIRST ST SPRINGFIELD IL 627810001 371110690 PARENT IL 501(C)(3) LINE 12B, II N/A 0 MEMORIAL MEDICAL CENTER 701 NORTH FIRST ST SPRINGFIELD IL 627810001 370661220 HOSPITAL SERVICES IL 501(C)(3) LINE 3 MEMORIAL HEALTH SYSTEM 0 MEMORIAL HEALTH VENTURES 701 NORTH FIRST ST SPRINGFIELD IL 627810001 363492266 HEALTHCARE ACTIVITIES IL 501(C)(3) LINE 10 MEMORIAL HEALTH SYSTEM 0 ABRAHAM LINCOLN MEMORIAL HOSPITAL 315 EIGHTH ST LINCOLN IL 62656 370723793 HOSPITAL SERVICES IL 501(C)(3) LINE 3 MEMORIAL HEALTH SYSTEM 0 TAYLORVILLE MEMORIAL HOSPITAL 201 EAST PLEASANT TAYLORVILLE IL 62568 370661250 HOSPITAL SERVICES IL 501(C)(3) LINE 3 MEMORIAL HEALTH SYSTEM 0 MEMORIAL HOME SERVICES 720 NORTH BOND SPRINGFIELD IL 627024915 370714225 HOME HEALTH, HOSPICE, AND CONTINUOUS CARE SERVICES IL 501(C)(3) LINE 7 MEMORIAL HEALTH SYSTEM 0 MEMORIAL PHYSICIAN SERVICES 701 NORTH FIRST ST SPRINGFIELD IL 627810001 371181194 HEALTH CLINICS IL 501(C)(3) LINE 10 MEMORIAL HEALTH SYSTEM 0 MEMORIAL MEDICAL CENTER FOUNDATION 1 MEMORIAL PLAZA SPRINGFIELD IL 62781 371110301 GRANTS TO HOSPITALS, OTHER CHARITABLE ORGANIZATIONS, AND SCHOLARSHIPS IL 501(C)(3) LINE 7 MEMORIAL MEDICAL CENTER 0 TAYLORVILLE MEMORIAL HOSPITAL FOUNDATION INC 201 EAST PLEASANT TAYLORVILLE IL 62568 371337485 GRANTS TO OTHER CHARITABLE ORGANIZATIONS AND HOSPITALS IL 501(C)(3) LINE 7 TAYLORVILLE MEMORIAL HOSPITAL 0 ABRAHAM LINCOLN HEALTHCARE FOUNDATION 315 EIGHTH ST LINCOLN IL 62656 363492268 GRANTS TO OTHER CHARITABLE ORGANIZATIONS AND HOSPITALS IL 501(C)(3) LINE 7 MEMORIAL HEALTH SYSTEM 0 PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION 1600 WEST WALNUT STREET JACKSONVILLE IL 62650 370661230 HOSPITAL SERVICES IL 501(C)(3) LINE 3 MEMORIAL HEALTH SYSTEM 0 PASSAVANT AREA HOSPITAL FOUNDATION 1600 WEST WALNUT STREET JACKSONVILLE IL 62650 461037396 SUPPORTING THE HOSPITAL IL 501(C)(3) LINE 7 PASSAVANT MEMORIAL AREA HOSPITAL 0 JACKSONVILLE CRNA'S INC 1600 WEST WALNUT STREET JACKSONVILLE IL 62650 273093265 CRNA SERVICES IL 501(C)(3) LINE 10 PASSAVANT MEMORIAL AREA HOSPITAL 0 DECATUR MEMORIAL HOSPITAL 2300 NORTH EDWARD STREET DECATUR IL 625264163 370661199 HOSPITAL SERVICES IL 501(C)(3) LINE 3 MEMORIAL HEALTH SYSTEM 0 DECATUR MEMORIAL HEALTH FOUNDATION 2300 NORTH EDWARD STREET DECATUR IL 625264163 371169605 SUPPORTING THE HOSPITAL IL 501(C)(3) LINE 12A, I DECATUR MEMORIAL HOSPITAL 0 MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS 701 NORTH FIRST STREET SPRINGFIELD IL 62781 371190216 PROVIDE DURABLE MEDICAL EQUIPMENT AND SUPPLIES TO PATIENTS IL N/A C 0 0 0 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 0 0 SPRINGFIELD RESIDENTIAL SERVICES O 21203 FMV SPRINGFIELD RESIDENTIAL SERVICES L 33032 FMV SPRINGFIELD RESIDENTIAL SERVICES Q 22680 FMV