2025-02-28T16:10:31-06:00 2024-04-30 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2023-05-01 363719223 ROCHELLE COMMUNITY HOSPITAL FOUNDATION ROCH 8155622181 900 NORTH SECOND STREET ROCHELLE IL 61068 LORI GUTIERREZ CFO 8155622181 2025-02-27 1 0 AMBER ROGNAN-HAMILTON P01251012 3149254300 2025-02-27 2023 2025-03-06 01:10:19Z KAREN TRACY 900 NORTH SECOND STREET ROCHELLE IL 61068 87933 0 X WWW.ROCHELLEHOSPITAL.COM/FOUNDATION/ X 1990 IL CULTIVATE RESOURCES AND A COMMUNITY OF DONORS OF CONTRIBUTIONS TO SUPPORT ROCHELLE COMMUNITY HOSPITAL. 10 9 1 10 0 0 54030 59950 0 0 13713 17973 -692 -1712 67051 76211 8000 9404 0 0 19011 23189 0 0 0 20743 23107 47754 55700 19297 20511 813964 894511 18244 38731 795720 855780 CULTIVATE RESOURCES AND A COMMUNITY OF DONORS BY ACTING AS GOOD STEWARDS OF ALL CONTRIBUTIONS TO SUPPORT ROCHELLE COMMUNITY HOSPITAL. 0 0 9404 9404 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. 9404 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 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 0 0 1 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 10 9 0 0 0 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 SECRETARY 0.50 0.00 X 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 VICE PRESIDENT 0.50 0.00 X X 0 0 0 STEPHANIE CRAWFORD TRUSTEE (TERM ENDED) 0.50 0.00 X 0 0 0 CAROL ELLIOTT AUX REPRESENTATIVE (TERM ENDED) 0.50 0.00 X 0 0 0 ROBERT JOHNS TRUSTEE (TERM ENDED) 0.50 0.00 X 0 0 0 TONYA SARVER TRUSTEE 0.50 0.00 X 0 0 0 KAREN TRACY CEO 5.00 40.00 X X 0 275079 35592 DORIS DICKEY TRUSTEE 0.50 0.00 X 0 0 0 NANCY WILLIAMS TRUSTEE 0.50 0.00 X 0 0 0 LORI GUTIERREZ CFO 5.00 40.00 X 0 207671 7441 MICHELLE LAPAGE FOUNDATION COORDINATOR 10.00 30.00 X 0 97292 15806 0 580042 58839 0 0 1 0 0 27350 32600 59950 17973 17973 10010 27350 11722 -1712 -1712 76211 0 0 16261 X 9404 9404 23189 23189 8133 8133 14566 14566 408 408 55700 9404 46296 0 360066 382101 11086 408 0 10678 453898 501732 813964 894511 18244 38731 18244 38731 X 795720 855780 795720 855780 813964 894511 20511 39549 0 X X 0 1 X 1 0 X X 1 ROCHELLE COMMUNITY HOSPITAL ASSOCIATION 362548549 3 1 0 55700 1 0 55700 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 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 5/1/19 - 4/30/24 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. A NEW DIRECTOR'S TERM WILL COMMENCE ON THE FIRST REGULAR BOARD MEETING THAT IS HELD AFTER THE ANNUAL MEETING OF THE CORPORATION AND A DIRECTOR SHALL SERVE FOR THREE (3) YEAR TERMS WITH NO TERM LIMITS, UNLESS A DIRECTOR OTHERWISE RESIGNS OR IS REMOVED IN ACCORDANCE WITH THESE BYLAWS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11086 408 10678 10678 DUE TO HOSPITAL 38731 38731 GOLF OUTING 37360 27350 10010 718 2484 7558 0 962 37360 27350 10010 718 2484 7558 962 11722 -1712 1 SCHOLARSHIPS 13 9404 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 KAREN TRACY CEO 0 255642 0 636 0 18801 0 8332 0 27260 0 310671 0 0 LORI GUTIERREZ CFO 0 199301 0 636 0 7734 0 4960 0 2481 0 215112 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 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. A NEW DIRECTOR'S TERM WILL COMMENCE ON THE FIRST REGULAR BOARD MEETING THAT IS HELD AFTER THE ANNUAL MEETING OF THE CORPORATION AND A DIRECTOR SHALL SERVE FOR THREE (3) YEAR TERMS WITH NO TERM LIMITS, UNLESS A DIRECTOR OTHERWISE RESIGNS OR IS REMOVED IN ACCORDANCE WITH THESE BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B THE HOSPITAL PRESIDENT & CHIEF EXECUTIVE OFFICER 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 8,133. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,133. 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 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 0 0