2024-05-14T11:33:45-05:00 2023-06-30 346565596 ERNST & YOUNG US LLP 155 N WACKER DRIVE CHICAGO IL 60606 990 2022-07-01 370646367 MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS MENT 2177883922 701 NORTH FIRST STREET SPRINGFIELD IL 62781 JAMESON ROSZHART SENIOR VP AND CFO 2177883830 2024-05-14 1 JAMESON ROSZHART 999009999 1 JESSICA A WAGENER P01622613 3128792000 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MEMORIAL BEHAVIORAL HEALTH KATHRYN J KEIM 701 NORTH FIRST STREET SPRINGFIELD IL 62781 20930436 0 5670 X WWW.MEMORIALBEHAVIORALHEALTH.ORG X 1962 IL TO IMPROVE LIVES AND BUILD STRONGER COMMUNITIES THROUGH BETTER HEATLH. 16 13 292 13 0 0 5900053 4999651 9948858 13254745 1633886 152234 443921 682807 17926718 19089437 19522 64204 0 0 14454949 16649660 0 0 0 3182476 3041383 17656947 19755247 269771 -665810 19820134 19652884 2143752 1908683 17676382 17744201 X TO IMPROVE LIVES AND BUILD STRONGER COMMUNITIES THROUGH BETTER HEALTH. 0 0 3042093 2043499 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 11,708 CLIENT CONTACTS RELATED TO THIS PROGRAM IN FISCAL YEAR 2023. 2093241 2135614 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 16,251 CLIENT CONTACTS DURING FISCAL YEAR 2023. 1807954 2686667 MBH - BEHAVIORAL THERAPY SERVICES (MBH-BTS) IS THE OUTPATIENT BEHAVIORAL HEALTH PROVIDER OF CHOICE FOR BOTH PEDIATRIC AND ADULT MEDICAID RECIPIENTS FOR SANGAMON AND MENARD COUNTIES. MBH-BTS THERAPISTS PROVIDE OFFICE-BASED AND TELEHEALTH SERVICES AND ARE COMMITTED TO THE DEVELOPMENT OF COORDINATED NETWORKS OF COMPREHENSIVE SERVICES, WHICH PROVIDES CARE IN THE LEAST RESTRICTIVE, MOST NORMATIVE ENVIRONMENT CLINICALLY APPROPRIATE. THERAPISTS ALSO PROVIDE AFTER-HOURS AND WEEKEND ON-CALL COVERAGE FOR THE SASS (SCREENING, ASSESSMENT, AND SUPPORT SERVICES) PROGRAM TO MEET THE CONTRACTUAL REQUIREMENTS SET BY THE STATE OF ILLINOIS FOR CRISIS INTERVENTION. MBH PROVIDED 23,714 CLIENT CONTACTS RELATED TO THIS PROGRAM IN FISCAL YEAR 2023. 8543244 64204 6857717 OTHER DEVELOPMENTAL DISABILITY PROGRAMS:EXPENSES $2,340,970; INCLUDING GRANTS OF $374; REVENUE $481,439OTHER MENTAL HEALTH PROGRAMS:EXPENSES $6,184,739; INCLUDING GRANTS OF $63,830; REVENUE $6,364,266HOUSING SERVICES:EXPENSES $17,535; INCLUDING GRANTS OF $0; REVENUE $12,012 8543244 64204 6857717 15486532 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 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 25 0 1 292 1 0 0 0 0 0 0 0 0 0 0 0 0 X 16 13 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 TIFFANY NIELSON PHD VICE CHAIR(THRU2/23)/CHAIR(FROM3/23) 0.70 0.00 X X 0 0 0 VEA CRAWFORD DIR(THRU 2/23)/VICE CHAIR(FROM 3/23) 0.70 0.00 X X 0 0 0 JOSHUA SABO SECRETARY 0.70 0.00 X X 0 0 0 EVAN WESTLAKE DIR(THRU 2/23)/TREASURER(FROM 3/23) 0.70 0.00 X X 0 0 0 LEIGH STEINER PHD CHAIR(THRU2/23)/DIRECTOR(FROM3/23) 0.70 0.00 X X 0 0 0 DR VIRGINIA DOLAN DIRECTOR & MMG PHYSICIAN 0.70 49.30 X 0 478838 59942 DR NICOLE FLORENCE DIRECTOR & MMG PHYSICIAN 0.70 49.30 X 0 289885 43998 FAYE LEWIS DIRECTOR 0.70 0.00 X 0 0 0 ANNE MORGAN PHD DIRECTOR 0.70 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 0.70 0.00 X 0 0 0 JONNA COOLEY PHD DIRECTOR (THRU FEB 23) 0.50 0.00 X 0 0 0 WANDA LEE ROHLFS TREASURER (THRU FEB 23) 0.50 0.00 X X 0 0 0 KENNETH WINSLOW DIRECTOR (THRU FEB 23) 0.50 0.00 X 0 0 0 DIANA KNAEBE SYSTEM ADMIN MBH/BOARD PRST 47.50 2.50 X X 0 197983 35268 KATIE KEIM SENIOR VICE PRESIDENT & CFO 5.00 45.00 X 0 774590 140444 JAMESON ROSZHART PRESIDENT MH AMBULATORY GROUP 5.00 45.00 X 0 670745 125719 DR BRAD HUGHES PSYCHIATRIC MEDICAL DIRECTOR 50.00 0.00 X 222656 0 24816 EMILY LEGNER REG DIR,MNTL HLTH CRISIS SYS OF CARE 50.00 0.00 X 150895 0 31489 AMBER OLSON REG DIR, BHVRL HLTH CLINICAL OPS 50.00 0.00 X 139598 0 21319 MONICA FARQUHAR DIRECTOR, MBH 50.00 0.00 X 115160 0 20512 HEATHER SWEET REG DIR, BHVRL HLTH OPS&PRAC TRNSFRM 50.00 0.00 X 103546 0 45758 731855 2412041 549265 5 0 1 0 THE ECHO GROUP INC 15 WASHINGTON ST CONWAY NH 03818 EHR SYSTEM 133156 1 1772 314754 4618165 64960 4999651 MENTAL HEALTH SERVICES 621400 10851397 10851397 DVLPMENT DISABLED SVCS 621400 2391336 2391336 HOUSING SERVICES 621400 12012 12012 13254745 226859 226859 265933 51878 214055 214055 214055 1590523 1665148 -74625 -74625 -74625 361865 123973 237892 237892 CAPITATION REVENUE 900099 184807 184807 COMMISSIONS 900099 10428 10428 PROMPT PAY INTEREST 900099 3141 3141 32484 32484 230860 19089437 13723497 0 366289 64204 64204 193910 73055 120855 12560367 10399540 2160827 764692 682047 82645 2133495 1711994 421501 997196 860377 136819 193 193 39250 5495 33755 883 883 118938 104528 14410 352893 225850 127043 380352 261896 118456 526558 449690 76868 196094 188063 8031 15122 2485 12637 228377 192058 36319 131802 129946 1856 MANAGEMENT FEES 900456 900456 PROVISION FOR UNCOLLECT 74618 74618 FOOD & DIETARY SUPPLIES 59834 58310 1524 16013 2376 13637 19755247 15486532 4268715 0 415 365 1273616 872149 1997864 2559244 144646 158382 10787803 8104884 2788922 2682919 13566287 13335170 40000 40000 8384 4655 19820134 19652884 1965302 1713811 173653 193983 4797 889 2143752 1908683 X 17676382 17744201 17676382 17744201 19820134 19652884 -665810 733629 0 X 0 1 X 1 1 1 X 3312794 3135125 3616776 5900053 4999651 20964399 3312794 3135125 3616776 5900053 4999651 20964399 1107354 19857045 255255 342783 270731 280444 492792 1642005 70557 25535 173372 89986 230860 590310 23196714 51414628 0.85600 0.84880 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MENTAL HEALTH TRAINING - REGISTRATION FEES - 2018 AMOUNT: $ 13,323. 2019 AMOUNT: $ 9,385. 2020 AMOUNT: $ 3,390. 2021 AMOUNT: $ 4,304. 2022 AMOUNT: $ 1,003. RECORD COPY FEES - 2018 AMOUNT: $ 18,525. 2019 AMOUNT: $ 5,784. 2020 AMOUNT: $ 5,341. 2021 AMOUNT: $ 596. 2022 AMOUNT: $ 2,916. OTHER REVENUE - 2018 AMOUNT: $ 35,371. 2019 AMOUNT: $ 26,301. 2020 AMOUNT: $ 31,884. 2021 AMOUNT: $ 48,353. 2022 AMOUNT: $ 28,693. PROMPT PAY INTEREST - 2018 AMOUNT: $ 12,835. 2019 AMOUNT: $ 5,377. 2020 AMOUNT: $ 6,293. 2021 AMOUNT: $ 10,833. 2022 AMOUNT: $ 3,141. PARTNERSHIP INCOME - 2018 AMOUNT: $ -9,497. 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 883 0 0 0 883 0 PART II-B, LINE 1: MBH IS A DUES PAYING MEMBER OF THE ILLINOIS ASSOCIATION OF REHABILITATION FACILITIES, INC. (IARF) & COMMUNITY BEHAVIOR HEALTHCARE ASSOCIATION (CBHA). A PERCENTAGE OF MBH'S DUES TO IARF & CBHA GO TOWARDS LOBBYING ACTIVITIES. 996667 996667 7821209 6373035 1448174 11753 4933 6820 1620186 1439772 180414 337988 287144 50844 2682919 RENTAL PROPERTY - NON-CURRENT 889 889 X PART X, LINE 2: MBH IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE UNITED STATE INTERNAL REVENUE CODE. MBH IS NOT CONSIDERED A PRIVATE FOUNDATION. IN ACCORDANCE WITH FASB ACS 740-10 WHICH ADDRESSES INCOME TAXES, MBH BELIEVES THERE ARE NO SIGNIFICANT UNCERTAIN TAX POSITIONS RESULTING IN LIABILITIES THAT WOULD HAVE BEEN REQUIRED FOR THE YEAR ENDED JUNE 30, 2023. MBH'S FORM 990 FOR 2020, 2021, AND 2022 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS), GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. 1 EDUCATIONAL GRANTS 7 63830 SPECIFIC ASSISTANCE 374 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. 0 1 0 0 0 0 0 0 0 KATIE KEIM SENIOR VICE PRESIDENT & CFO 0 567805 0 162530 0 44255 0 105436 0 35008 0 915034 0 0 JAMESON ROSZHART PRESIDENT MH AMBULATORY GROUP 0 467927 0 133865 0 68953 0 93148 0 32571 0 796464 0 22288 DR VIRGINIA DOLAN DIRECTOR & MMG PHYSICIAN 0 408697 0 12325 0 57816 0 25387 0 34555 0 538780 0 0 DR NICOLE FLORENCE DIRECTOR & MMG PHYSICIAN 0 257730 0 0 0 32155 0 8003 0 35995 0 333883 0 0 DR BRAD HUGHES PSYCHIATRIC MEDICAL DIRECTOR 171995 0 50250 0 411 0 4688 0 20128 0 247472 0 0 0 DIANA KNAEBE SYSTEM ADMIN MBH/BOARD PRST 0 178371 0 18566 0 1046 0 12346 0 22922 0 233251 0 0 EMILY LEGNER REG DIR,MNTL HLTH CRISIS SYS OF CARE 121752 0 29048 0 95 0 3553 0 27936 0 182384 0 0 0 AMBER OLSON REG DIR, BHVRL HLTH CLINICAL OPS 130186 0 9318 0 94 0 9887 0 11432 0 160917 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, 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, $81,601 AND JAMESON ROSZHART, $66,598. 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, $57,060, DR. NICOLE FLORENCE, $31,837, KATIE KEIM, $35,867, AND JAMESON ROSZHART $60,550 PART V, LINE 1A 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 EMPLOYEES 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, DIANA'S (OFFICER) AND JAMESON'S (KEY EMPLOYEE) COMPENSATION EXPENSE IS ALLOCATED TO MBH ACCORDING TO THE TIME SPENT IN LEADERSHIP TO MBH AND THEREFORE INCLUDED ON PART IX, LINE 5. 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 25621 FMV SPRINGFIELD RESIDENTIAL SERVICES L 23003 FMV SPRINGFIELD RESIDENTIAL SERVICES Q 18118 FMV