Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
SOUTHERN ILLINOIS HOSPITAL SERVICES INC |
370618939 | 3 | No | 0 | 0 | |
| (B)
Southern Illinois Medical Services |
205521741 | 3 | No | 0 | 0 | |
Total 2
|
0 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part IV, Section A, Line 1 Supported Orgs Listed By Name | SOUTHERN ILLINOIS HEALTHCARE ENTERPRISES, INC. ("SIHE") HAS A HISTORIC AND CONTINUING RELATIONSHIP WITH ITS SUPPORTED ORGANIZATIONS, SOUTHERN ILLINOIS HOSPITAL SERVICES, INC. ("SIHS") AND SOUTHERN ILLINOIS MEDICAL SERVICES ("SIMS") -SPANNING OVER A 30-YEAR PERIOD. AS DESCRIBED BELOW, THERE IS A SUBSTANTIAL IDENTITY OF INTERESTS BETWEEN THE ORGANIZATIONS. THEREFORE, SIHE MEETS THE ORGANIZATIONAL REQUIREMENTS OF A TYPE II SUPPORTING ORGANIZATION. SIHE WAS FORMED IN 1983 TO, AMONG OTHER THINGS, PROMOTE AND FURTHER THE GENERAL PHYSICAL HEALTH OF THE COMMUNITY. SIHS IS NAMED AS A SUPPORTED ORGANIZATION OF SIHE IN THE APPLICATION FOR RECOGNITION OF EXEMPTION FILED BY SIHE AND APPROVED BY THE INTERNAL REVENUE SERVICE. SIMS WAS FORMED LATER IN 2006 AS A CONTROLLED ORGANIZATION OF SIHS TO PROVIDE HEALTHCARE SERVICES TO THE COMMUNITY. SIHE'S ONLY ACTIVITIES HAVE BEEN SUPPORTING THE EXEMPT PURPOSES OF SIHS AND SIMS BY OWING AND MAINTAINING FACILITIES THAT ARE USED TO DELIVER HEALTHCARE SERVICES BY OR IN CONJUNCTION WITH SIHS AND SIMS. THE DELIVERY OF HEALTHCARE SERVICES PROVIDED BY SIHS AND SIMS THROUGH SIHE FACILITIES HAS, ON A LONG- STANDING BASIS, BEEN PERCEIVED BY THE COMMUNITY TO BE SERVICES PROVIDED BY ONE "SOUTHERN ILLINOIS HEALTHCARE" ORGANIZATION. IT IS ASSURED THAT A SUBSTANTIAL IDENTITY OF INTERESTS BETWEEN THE ORGANIZATIONS IS MAINTAINED AND WILL CONTINUE BECAUSE THE ORGANIZATIONS SHARE COMMON BOARD MEMBERS AND MANAGEMENT TEAM AS WELL. |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 1 ORGANIZATION'S MISSION | (CONTINUED FROM PART III) SIHE'S APPROXIMATELY 121,000 SQUARE FEET OF MEDICAL SPACE IS USED TO DELIVER HEALTHCARE THROUGHOUT SOUTHERN ILLINOIS REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. SIHE'S VALUES REFLECT THE PHILOSOPHY OF ITS FOUNDERS AND GUIDE THE WORK OF ALL WHO SERVE WITHIN THE ORGANIZATION: RESPECT - RECOGNIZING AND VALUING THE DIGNITY AND UNIQUENESS OF EACH PERSON; INTEGRITY - ADHERING TO STRONG MORAL AND ETHICAL PRINCIPLES IN ALL WE DO; COMPASSION - RESPONDING TO THE FEELINGS AND NEEDS OF EACH PERSON WITH KINDNESS, CONCERN AND EMPATHY; COLLABORATION - COMMUNICATING AND WORKING WITH OTHERS FOR THE BENEFIT OF ALL; STEWARDSHIP - RESPONSIBLY USING, PRESERVING AND ENHANCING OUR HUMAN AND MATERIAL RESOURCES AS A NOT-FOR-PROFIT COMMUNITY CONTROLLED ORGANIZATION; ACCOUNTABILITY - HOLDING OURSELVES AND THOSE AROUND US RESPONSIBLE FOR LIVING THE VALUES AND ACHIEVING THE VISION OF SOUTHERN ILLINOIS HEALTHCARE; AND QUALITY - STRIVING FOR EXCELLENCE IN ALL WE DO. |
| Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS | (CONTINUED FROM PART III) THE SEVEN COUNTY SERVICE AREA IS VERY RURAL WITH A COMBINED POPULATION OF APPROXIMATELY 245,000. MEDIAN HOUSEHOLD INCOMES IN THE AREA ARE SUBSTANTIALLY LESS THAN THE STATEWIDE AVERAGE. ALL SEVEN COUNTIES HAVE MORE RESIDENTS LIVING IN POVERTY THAN THE STATE AVERAGE. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | COMPENSATION FOR THE ORGANIZATION'S PRESIDENT AND OTHER OFFICERS IS PAID BY SOUTHERN ILLINOIS HOSPITAL SERVICES, INC. (SIHS), A RELATED TAX-EXEMPT ORGANIZATION. THE BOARD OF TRUSTEES SETS THE EXECUTIVE COMPENSATION POLICY AND IS RESPONSIBLE FOR APPROVAL OF THE COMPENSATION. THE GOVERNANCE COMMITTEE IS DESIGNATED BY THE BOARD TO ACT AS THE COMPENSATION COMMITTEE FOR MATTERS CONCERNING EXECUTIVE COMPENSATION. EACH MEMBER OF THE COMMITTEE, WHILE CONSIDERING EXECUTIVE COMPENSATION ISSUES, MUST BE AN INDEPENDENT DIRECTOR, FREE FROM ANY CONFLICT OF INTEREST. THE COMMITTEE SEEKS OUT AND CONTRACTS THE SERVICES OF AN OUTSIDE, INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT TO ADVISE THE COMMITTEE IN MATTERS OF MARKET VALUES OF COMPARABLE EXECUTIVE POSITIONS. THE COMMITTEE ANNUALLY REVIEWS ALL COMPARABILITY DATA AND PREPARES A RECOMMENDATION AS TO THE COMPENSATION PACKAGE OF THE PRESIDENT/CEO FOR THE FULL BOARD. ONLY THE FULL BOARD HAS THE AUTHORITY TO APPROVE THE COMPENSATION OF THE PRESIDENT/CEO. THE DECISIONS AND DELIBERATIONS ARE DOCUMENTED IN THE GOVERNANCE COMMITTEE MINUTES. THIS PROCESS WAS LAST UNDERTAKEN IN JUNE 2013. BECAUSE THE ORGANIZATION'S PRESIDENT AND OTHER OFFICERS ARE NOT PAID BY THE FILING ORGANIZATION, THE FORM 990 INSTRUCTIONS REQUIRE THIS TO BE ANSWERED "NO". |
| Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER EMPLOYEES | COMPENSATION FOR THE ORGANIZATION'S PRESIDENT AND OTHER OFFICERS IS PAID BY SOUTHERN ILLINOIS HOSPITAL SERVICES, INC. (SIHS), A RELATED TAX-EXEMPT ORGANIZATION. THE BOARD OF TRUSTEES SETS THE EXECUTIVE COMPENSATION POLICY AND IS RESPONSIBLE FOR APPROVAL OF THE COMPENSATION. THE GOVERNANCE COMMITTEE IS DESIGNATED BY THE BOARD TO ACT AS THE COMPENSATION COMMITTEE FOR MATTERS CONCERNING EXECUTIVE COMPENSATION. EACH MEMBER OF THE COMMITTEE, WHILE CONSIDERING EXECUTIVE COMPENSATION ISSUES, MUST BE AN INDEPENDENT DIRECTOR, FREE FROM ANY CONFLICT OF INTEREST. THE COMMITTEE SEEKS OUT AND CONTRACTS THE SERVICES OF AN OUTSIDE, INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT TO ADVISE THE COMMITTEE IN MATTERS OF MARKET VALUES OF COMPARABLE EXECUTIVE POSITIONS. THE COMMITTEE ANNUALLY REVIEWS ALL COMPARABILITY DATA AND PREPARES A RECOMMENDATION AS TO THE COMPENSATION PACKAGE OF ALL OFFICERS FOR THE FULL BOARD. ONLY THE COMMITTEE WILL HAVE THE AUTHORITY TO APPROVE THE COMPENSATION OF ALL SENIOR MANAGEMENT AND WILL REPORT ITS ACTIONS TO THE BOARD. THE DECISIONS AND DELIBERATIONS ARE DOCUMENTED IN THE GOVERNANCE COMMITTEE MINUTES. THIS PROCESS WAS LAST UNDERTAKEN IN JUNE 2013. BECAUSE THE ORGANIZATION'S PRESIDENT AND OTHER OFFICERS ARE NOT PAID BY THE FILING ORGANIZATION, THE FORM 990 INSTRUCTIONS REQUIRE THIS TO BE ANSWERED "NO". |
| Form 990, Part VI, Line 1a Delegate broad authority to a committee | AUTHORITY OF GOVERNANCE COMMITTEE The Board has a Governance Committee consisting of 5 trustees. The purpose of the Governance Committee is to assure the Board of Trustees that the respective programs are functional to fulfill the responsibilities of the Board of Trustees: * Develop and maintain effective compensation and benefit policies and practices; review and recommend in advance all executive compensation arrangements; provide for the evaluation of the performance of the CEO and other System Officers; review and recommend annual performance objectives for System Officers; provide for conduct of a periodic self-evaluation of the Board of Trustees. * Assure that the programs which address new board member orientation, continuing education, mentoring, and facilitate understanding of current trends in healthcare and medical terminology, are functional. * Identify competent, highly qualified individuals to serve as members of the Board of Trustees; recommend individuals to serve in leadership positions on the Board; and facilitate and interview potential Board members. * Act for the Board of Trustees in all matters as specifically authorized by resolution of the Board or when the Board of Trustees in not in session. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | A draft of the Form 990 and supplemental schedules was distributed to the CEO, CFO and certain Vice-Presidents of the corporation for their review and comments. A draft copy was presented to the Finance Committee by the CFO and the organization's tax advisors for review and comments. After this review and comment period, all suggestions and comments were considered and the Form 990 was updated as appropriate. The finalized Form 990 and supplemental schedules was then presented to the Board of Trustees and a copy of the return was made available to every member of the governing body before it was filed with the IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | Annually, the General Counsel sends out a Conflict of Interest Questionnaire to each Trustee, Director, Officer, Manager and Key Employee to complete and return. The General Counsel then reviews these Questionnaires to determine what conflicts, real or perceived, exist. As a standing agenda item for each board meeting, the General Counsel reminds the Trustees that the Board has a conflict of interest policy, that the General Counsel has reviewed the agenda for any conflicts, but that the Trustees are obligated to give notice if a conflict has been over-looked or if a discussion or action comes before the Board which may involve or create a conflict of interest for someone. If a Trustee has a conflict of interest, the Trustee or the General Counsel discloses the conflict. The Trustee with the conflict is allowed to remain in the meeting to answer any question the conflicted Trustee may need to answer and then the conflicted Trustee is excused from the meeting. The remaining Trustees can then discuss the matter further and action is taken on the matter. The conflicted Trustee is then invited back into the meeting. Conflicted Trustees may also be asked, in rare situations, to resign their position on the Board. |
| Form 990, Part VI, Line 19 Required documents available to the public | The organization makes its conflict of interest policy available to the public on its website and upon request. Governing documents and financial statements are not required disclosures pursuant to Internal Revenue Code (IRC) Section 6104. These documents are not available to the public at this time. |
| Form 990, Part IX, Line 11g Other Fees | Engineering Fees - Total Expense: 212196, Program Service Expense: 212196, Management and General Expenses: 0, Fundraising Expenses: 0; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | EQUITY IN EARNINGS OF JOINT VENTURE (HSSI) - -71051; |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |