2026-04-24T12:34:00-05:00 2023-05-18 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2023-01-01 273846820 KSB HOSPITAL VEBA HEALTH SAVINGS TRUST KSBH 3096552850 124 SW ADAMS STREET PEORIA IL 61602 KIRSTEN LARGENT OSF HEALTHCARE SYSTEM PLAN SPONSOR 3096552850 2026-04-08 1 1 LAURA SCHWEITZER CPA P01760010 6086628600 2026-04-08 2023 2025-03-06 01:10:19Z X X KIRSTEN LARGENT 124 SW ADAMS STREET PEORIA IL 61602 483 0 X N/A X 2010 IL TO FUND REIMBURSEMENT OF MEDICAL EXPENSES UNDER A HEALTH REIMBURSEMENT ARRANGEMENT. X 1 1 0 0 0 0 0 0 36710 0 179 483 0 0 36889 483 0 0 281725 1699596 0 0 0 0 0 4634 844 286359 1700440 -249470 -1699957 1699957 0 0 0 1699957 0 TO FUND REIMBURSEMENT OF MEDICAL EXPENSES UNDER A HEALTH REIMBURSEMENT ARRANGEMENT. 0 0 HEALTH REIMBURSEMENT ARRANGEMENT BY ORGANIZATION THAT HAD APPROXIMATELY 356 PARTICIPANTS WHO RECEIVED MEDICAL CARE IN THE AMOUNT OF $1,699,596. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 1 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 1 0 0 0 X MATRIX TRUST COMPANY 8889473472 717 17TH STREET SUITE 1300 DENVER CO 80202 X MATRIX TRUST COMPANY TRUSTEE 1.00 0.00 X 0 0 0 0 0 0 0 0 0 0 0 483 483 483 0 0 483 1699596 718 126 1700440 191861 0 1508096 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1699957 0 0 0 X 1699957 0 0 0 0 0 1699957 0 1699957 0 -1699957 0 X 0 1 X 0 0 0 X PART X, LINE 2: THE TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS IS INTENDED TO QUALIFY PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC), AND ACCORDINGLY, THE TRUST'S NET INVESTMENT INCOME IS EXEMPT FROM INCOME TAXES. THE IRS HAS DETERMINED AND INFORMED THE COMPANY BY LETTER DATED JANUARY 10, 2010, THAT THE TRUST IS DESIGNED IN ACCORDANCE WITH APPLICABLE SECTIONS OF THE IRC. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. NO UNCERTAIN TAX POSITIONS HAVE BEEN NOTED TO DATE. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. KATHERINE SHAW BETHEA HOSPITAL 2023-05-18 1667896 ACTUAL PARTICIPANT ACCOUNT TOTALS 361000540 KATHERINE SHAW BETHEA HOSPITAL 403 EAST FIRST STREET DIXON IL 61021 501(C)(3) 0 0 0 0 1 1 0 1 0 FORM 990, PART VI, SECTION A, LINE 7B THE TRUSTEE, WHICH IS THE GOVERNING BODY OF THE TRUST, IS A DIRECTED TRUSTEE WHO TAKES CERTAIN DIRECTION REGARDING THE TRUST FROM THE PLAN ADMINISTRATOR (OR ITS DESIGNEE) AND THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 8A THERE WERE NO MEETINGS. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11B THE TRUSTEE REVIEWS THE FORM 990 BASED UPON THE FINANCIAL RECORDS FOR THE ORGANIZATION AND EXECUTES IT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST TO THE ORGANIZATION. THE INFORMATION IS THEN MAILED TO THE REQUESTING PARTY. FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC MATRIX TRUST COMPANY - 717 17TH STREET, SUITE 1300, DENVER, CO 80202. KATHERINE SHAW BETHEA HOSPITAL 403 EAST FIRST STREET DIXON IL 61021 361000540 HEALTH CARE IL 501(C)(3) LINE 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 BACKGROUND:THE KSB HOSPITAL VEBA HEALTH SAVINGS TRUST (THE "TRUST") WAS ESTABLISHED BY KATHERINE SHAW BETHEA HOSPITAL ("KSB") TO BE THE FUNDING MEDIUM FOR THE KSB HOSPITAL VEBA HEALTH SAVINGS PLAN (THE "PLAN"), WHICH WAS EFFECTIVE JANUARY 1, 2010. KSB APPOINTED MATRIX TRUST COMPANY ("MATRIX") TO BE THE TRUSTEE OF THE TRUST. KSB WAS THE ORIGINAL SPONSOR AND ADMINISTRATOR OF THE PLAN. ON JANUARY 1, 2025, BY VIRTUE OF THE MERGER OF KSB WITH AND INTO OSF HEALTHCARE SYSTEM ("OSF"), OSF BECAME THE SPONSOR AND ADMINISTRATOR OF THE PLAN. FACTS:KSB ENGAGED TOTAL ADMINISTRATIVE SERVICES CORPORATION ("TASC") TO ADMINISTER THE BENEFITS UNDER THE PLAN. AS PART OF ITS RESPONSIBILITIES, TASC OVERSAW THE PREPARATION OF THE FORMS 990 FOR THE TRUST. FOR THE FISCAL YEARS PRIOR TO 2023, ONCE THE FORM 990 HAD BEEN EXECUTED BY MATRIX AND FILED WITH THE IRS, A COPY OF THE FORM 990 WAS PROVIDED TO KSB. IN 2023, KSB NOTIFIED TASC AND THE TRUSTEE, MATRIX, OF ITS INTENT TO TERMINATE THE PLAN. KSB ALSO DIRECTED MATRIX TO DISTRIBUTE THE ASSETS FROM THE TRUST TO IMPLEMENT THE TERMINATION. MATRIX COMPLETED THE DISTRIBUTION OF THE TRUST'S ASSETS ON MAY 18, 2023 BY TRANSFERRING THEM TO KSB. THE ASSETS WERE THEN DISTRIBUTED TO THE PARTICIPANTS ON JUNE 2, 2023 AS PAYROLL PAYMENTS. BECAUSE THE END OF THE FISCAL YEAR OF THE TRUST OCCURRED ON MAY 18, 2023, THE FORM 990 FOR THE FINAL YEAR OF THE TRUST WAS DUE ON OR BEFORE OCTOBER 15, 2023. KSB ENGAGED THE ST. LOUIS OFFICE OF A NATIONAL ACCOUNTING FIRM (THE "ACCOUNTING FIRM") TO AUDIT THE FINANCIAL STATEMENTS OF THE TRUST FOR THE YEAR 2023. DUE TO DIFFICULTIES IN OBTAINING INFORMATION FROM TASC, THE ACCOUNTING FIRM WAS UNABLE TO COMPLETE THE AUDIT OF THE FINANCIAL STATEMENTS OF THE TRUST PRIOR TO THE TIME THE FORM 990 WAS REQUIRED TO BE FILED. THE ACCOUNTING FIRM THEREAFTER CONTINUED TO WORK TOGETHER WITH TASC TO COMPLETE THE AUDIT OF THE TRUST'S FINANCIAL STATEMENTS. THE COMPLETION OF THE AUDIT WOULD HELP ENSURE THE ACCURACY OF THE FORM 990. FOLLOWING THE MERGER OF KSB WITH AND INTO OSF, THE ACCOUNTING FIRM ADVISED OSF ON MAY 30, 2025 THAT ONLY ONE MATTER REMAINED FOR RESOLUTION PRIOR TO THE COMPLETION OF THE AUDIT OF THE TRUST'S FINANCIAL STATEMENTS FOR THE YEAR 2023. IN PARTICULAR, THE ACCOUNTING FIRM NEEDED TO UNDERTAKE FURTHER INVESTIGATION IN ORDER TO CHARACTERIZE THE FINAL DISTRIBUTION FROM THE TRUST THAT OCCURRED ON MAY 18, 2023. ON JUNE 26, 2025, FURTHER INVESTIGATION BY THE ACCOUNTING FIRM YIELDED SUFFICIENT INFORMATION TO PERMIT IT TO CHARACTERIZE THE FINAL DISTRIBUTION FROM THE TRUST AND TO COMPLETE THE AUDIT FOR THE 2023 YEAR. THE PREPARATION OF THE INDEPENDENT AUDITOR'S REPORT BY THE ACCOUNTING FIRM SOON FOLLOWED. THE ACCOUNTING FIRM THEN TURNED ITS ATTENTION TO THE PREPARATION OF THE FORM 990 FOR THE TRUST FOR THE YEAR 2023, WHICH HAS NOW BEEN COMPLETED.REASONABLE CAUSE/CONCLUSION:KSB TIMELY ENGAGED THE ST LOUIS OFFICE OF THE ACCOUNTING FIRM TO AUDIT THE TRUST'S FINANCIAL STATEMENTS AND TO SECURE AN OPINION OF AN ACCOUNTANT AS TO THOSE STATEMENTS IN CONNECTION WITH ITS ANNUAL FORM 5500 REPORTING OBLIGATIONS. KSB ACTED REASONABLY (I) IN TIMELY ENGAGING THE ACCOUNTING FIRM TO AUDIT THE TRUST'S FINANCIAL STATEMENTS FOR THE YEAR 2023, AND (II) IN CONTINUING TO WORK WITH THE ACCOUNTING FIRM TO COMPLETE THE AUDIT OF THE TRUST'S FINANCIAL STATEMENTS FOR THE YEAR 2023, WHICH WOULD HELP ENSURE THE ACCURACY OF THE FORM 990 TO BE FILED FOR THAT YEAR. THESE CIRCUMSTANCES CONSTITUTE REASONABLE CAUSE FOR KSB'S FAILURE TO TIMELY FILE THE FORM 990 FOR THE YEAR 2023. KSB'S FAILURE TO FILE THE FORM 990 FOR THE YEAR 2023 BY THE DUE DATE WAS DUE TO REASONABLE CAUSE AND NOT TO WILLFUL NEGLECT. ACCORDINGLY, NO PENALTIES FOR FAILURE TO FILE THE TRUST'S 2023 FORM 990 AND NO PENALTIES FOR FAILURE TO PAY THE TAXES SHOWN ON THAT RETURN SHOULD BE ASSESSED. TO THE EXTENT ANY PENALTIES ARE ASSESSED, THEY SHOULD BE ABATED.