Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (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 | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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)
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(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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)
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(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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 on 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) |
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| 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) |
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| 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): |
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| 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 0.015 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 0.035 | 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 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2024 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2024 |
(iii) Distributable Amount for 2024 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2024 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2024: | ||||
| a From 2019....... | ||||
| b From 2020....... | ||||
| c From 2021....... | ||||
| d From 2022....... | ||||
| e From 2023....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2024 distributable amount | ||||
|
i
Carryover from 2019 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2024 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2024 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2024, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2024. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2025. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2020..... | ||||
| b Excess from 2021..... | ||||
| c Excess from 2022..... | ||||
| d Excess from 2023..... | ||||
| e Excess from 2024..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Return Reference | Explanation |
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| Form 990, Part VI, Section A, line 3 | William Davis, Regional President Deaconess Illinois, Amber Lipe, CFO, Jennifer Gregson, CAO, are employed by Deaconess Health System, an unrelated organization. Amanda Throgmorton, COO was employed by Deaconess IL Specialty Clinic and Deaconess Health System, both unrelated organizations. Compensation is provided by Deaconess Health System through a management agreement for services to Deaconess Illinois Red Bud Regional Hospital, Deaconess Illinois Union County Hospital, Deaconess Illinois Crossroads, and Deaconess Regional Healthcare Services Illinois. All four are related entities. The Regional President Deaconess Illinois position has the responsibility of supervising the management, administration, and operation of the organizations. The CFO has the responsibility of managing the financial operations of the organizations. The CAO is responsible for overseeing non-clinical operationssuch as finance, human resources, compliance, and strategyto ensure efficient, compliant, and high-quality organizational performance. The COO oversees daily operations to ensure efficient, high-quality patient care while managing staff, resources, and performance outcomes. Compensation Benefits William Davis 475,253 45,846 Amber Lipe 338,795 5,785 Jennifer Gregson 297,158 3,350 Amanda Throgmorton 187,180 27,059 |
| Form 990, Part VI, Section A, line 6 | The Sole Member is Deaconess Regional Healthcare Services Illinois, Inc., an Illinois not for profit corporation that is exempt from federal income taxation under Section 501(a) of the Code as an organization described in Section 501(c)(3) of the Code. |
| Form 990, Part VI, Section A, line 7a | All Directors shall be appointed by the Member. |
| Form 990, Part VI, Section A, line 7b | The actions set forth below shall be reserved solely to the Member. Governance 1. Appointment and removal of the Corporation's Directors. Financial 1. Approval of any capital and operating budgets for the Corporation (subject to the right of the Member, as part of the approval process, to make modifications as the Member deems necessary or appropriate); 2. Approval of any financial commitment, obligation or expenditure by the Corporation of an amount that exceeds a financial limit for capital expenditures or otherwise that may be established from time to time by the Member; 3. Approval of borrowing or lending of money or the incurrence or guarantee of any debt or other financial obligation, directly or indirectly, by the Corporation that exceeds a financial threshold (whether or not strictly monetary) that may be established from time to time by the Member; 4. Approval of any charitable contributions in excess of, or outside of, policies previously established and approved by the Member; 5. Making of any distribution to the Member or any Affiliate, provided that the Member or the Affiliate shall be, at the time of such distribution, a nonprofit organization duly qualified under Section 501(c)(3) of the Code. 6. Approval of any compensation or reimbursement of expenses for Directors of the Corporation beyond that allowed by policies adopted from time to time by the Member. Operations 1. Approval of any strategic plan, business plan, or mission plan of the Corporation, including without limitation authorization of any material changes in the scope of services offered by the Corporation, or any amendments thereto (subject in each case to the right of the Member, as part of the approval process, to make modifications as the Member deems necessary or appropriate); 2. The initiation of any studies, audits, and other periodic reviews as are deemed necessary by the Member with respect to the existing or planned operations of the Corporation; 3. Adoption and amendment of compensation plans or methodologies, salaries and other compensation (including the awarding of any incentive compensation) and benefits; and 4. Approval of the other terms of employment or engagement of the officers and employees, including, but not limited to, physician employees of the Corporation, and physicians who are independent contractors to the Corporation (subject in each case to the right of the Member, as part of the approval process, to make modifications as the Member deems necessary or appropriate). Legal 1. Creation, ownership, or acquisition (whether in whole or in part) and dissolution of any subsidiary or affiliate of the Corporation; 2. Any acquisition, purchase, sale, lease, mortgage, or other transfer or encumbrance ("Transfers") of (i) any property in excess of a financial threshold (whether or not strictly monetary) established by the Member from time to time or (ii) any real property of the Corporation, irrespective of the value; 3. Any Transfer of any personal property of the Corporation, if the sum of the value of such Transferred personal property and the aggregate value of all prior Transfers of personal property during the fiscal year is greater than a financial threshold (whether or not strictly monetary) that may be established from time to time by the Member; 4. Any dissolution, merger, consolidation, sale, or other corporate restructuring of the Corporation; 5. Any creation, modification or termination by the Corporation of any corporate compliance program different from the program maintained by Deaconess Regional Healthcare Services Illinois, Inc.; 6. The amendment, modification or restatement of the Corporation's policies addressing the provision of charity or uncompensated care or the process for collecting amounts due from patients; 7. Selection, retention or termination of the Corporation's auditors or legal counsel; 8. Establishment, adoption or amendment of any indemnification rights, obligations, or agreements affecting the Corporation; 9. Purchase, adoption, amendment, cancellation, or replacement of any insurance coverage for the Corporation or its Directors, officers, employees, and agents; 10. The commencement, settlement or termination of litigation or other claims, or alternative dispute resolution, including, but not limited to, mediation or arbitration that exceeds a financial limit (whether or not strictly monetary) that may be established from time to time by the Member; 11. The filing of any voluntary petition in bankruptcy or any other petition or pleading seeking any reorganization, receivership or similar relief under federal or state law; 12. Any of the foregoing reserve powers with respect to any subsidiary or affiliate of the Corporation; and 13. Any other matters with respect to which authority is granted to the Member by the Articles of Incorporation, these Bylaws, or applicable law. |
| Form 990, Part VI, Section A, line 8b | The Organization does not have committees with authority to act on behalf of the governing body. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is provided to the Illinois governing board before it is filed. The Finance and Management team of Deaconess Health System review the Form 990 before providing to the Illinois governing Board of Directors. |
| Form 990, Part VI, Section B, line 12c | The Board of Directors are required to comply with the Conflict of Interest Policy and individually disclose to the Member and to the Board of Directors, at times of nomination and appointment, the identity of each potential conflict known to the Director. Conflicts are considered with respect to outside interest, investments, outside activities, and business interests among the interested persons as well as their family members. If a conflict is identified, the interested person is not allowed to vote on the matter and may be asked to leave the meeting. |
| Form 990, Part VI, Section C, line 19 | The governing documents, conflict of interest policy, and financial statements are available to the public upon request. |
| Form 990, Part IX, line 11g | Purchased Services: Program service expenses 3,551,979. Management and general expenses 3,664,277. Fundraising expenses 0. Total expenses 7,216,256. Medical Professional Fees: Program service expenses 402,130. Management and general expenses 0. Fundraising expenses 0. Total expenses 402,130. |
| Form 990, Part IX, line 11a: | Management fees consist of officer salaries and benefits, swing bed liaison billings, and other services paid to Deaconess Health System. |
| Form 990, Part XI, line 8 | During the year ended September 30, 2025, an overstatement of amounts previously reported for patient accounts receivable and patient service revenue as of and for the year ended September 30, 2024, were discovered by management of the Hospital. This resulted in an overstatement of patient receivables, patient service revenue, and net assets in the amount of $486,712. |
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