2024-10-23T10:56:53-05:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2023-01-01 841787288 KSB HOSPITAL FOUNDATION KSBH 8152855901 403 EAST FIRST STREET DIXON IL 61021 DAVID SCHREINER FOUNDATION DIRECTOR 8152855901 2024-10-17 1 0 AMBER ROGNAN-HAMILTON P01251012 3149254300 2024-10-17 2023 2024-10-15 13:58:12Z DAVID SCHREINER 403 EAST FIRST STREET DIXON IL 61021 542299 0 X HTTPS://WWW.KSBHOSPITAL.COM/FOUNDATION/ X 2019 IL TO RAISE FUNDS TO SUPPORT KSB HOSPITAL'S MISSION TO RESTORE, MAINTAIN AND ENHANCE HEALTH BY PROVIDING SUPERIOR CARE NOW AND IN THE FUTURE. 8 8 0 8 0 0 359329 375958 0 100 0 11989 -1054 70280 358275 458327 106889 99145 0 0 0 85004 0 0 0 41994 53716 148883 237865 209392 220462 588992 809454 0 0 588992 809454 X TO RAISE FUNDS TO SUPPORT KSB HOSPITAL'S MISSION TO RESTORE, MAINTAIN AND ENHANCE HEALTH BY PROVIDING SUPERIOR CARE NOW AND IN THE FUTURE. 0 1 14158 14158 100 EARLY LEARNING LITERACY PROGRAM: INITIATIVE TO IMPROVE KINDERGARTEN READINESS IN OUR COMMUNITIES BY PROVIDING PARENTS EDUCATION IN UNDERSTANDING THE POWER OF LANGUAGE AND INTERACTION IN THE FIRST THREE YEARS OF A CHILD'S LIFE. 174005 84987 0 TO RAISE FUNDS TO SUPPORT KSB'S MISSION TO RESTORE, MAINTAIN AND ENHANCE HEALTH BY PROVIDING SUPERIOR CARE NOW AND IN THE FUTURE. 188163 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 0 0 0 0 IL X RYAN MILLER 8152855901 403 EAST FIRST STREET DIXON IL 61021 DAVID SCHREINER PRESIDENT/CEO 1.00 40.00 X X 0 1049137 35884 DAVID HELLMICH MD VICE PRESIDENT 1.00 1.30 X X 0 0 0 RICK CURIA TREASURER 1.00 0.90 X X 0 0 0 RYAN MILLER FDTN SECRETARY/HOSPITAL VP 2.00 40.00 X X 0 234820 25580 AUSTIN FRAZIER HOSPITAL CFO 2.00 40.00 X X 0 352455 45640 EMILY KRUGER DIRECTOR/HOSPITAL EE 1.00 40.00 X 0 46059 13237 RAY NEISEWANDER III DIRECTOR 1.00 0.90 X 0 0 0 PETER SHAW FOUNDATION DIRECTOR 20.00 0.00 X X 0 88196 24366 0 1770667 144707 0 0 1 0 0 91892 284066 375958 EARLY LEARNING LITERAC 624110 100 100 100 11989 11989 154252 91892 83972 70280 70280 458327 100 0 82269 82107 82107 17038 17038 65388 65388 14612 14612 5004 5004 5027 5027 4014 4014 30225 30225 497 497 SUBSCRIPTIONS 13953 13953 237865 188163 49702 0 553992 172399 558176 35000 0 78879 588992 809454 0 0 X 588992 809454 588992 809454 588992 809454 220462 0 X 0 1 X 1 0 X X X 1 KATHERINE SHAW BETHEA HOSPITAL 361000540 3 1 82107 0 1 82107 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DUE FROM KSB HOSPITAL 78879 78879 X PART X, LINE 2: THE ORGANIZATION IS INCLUDED IN CONSOLIDATED FINANCIAL STATEMENTS OF KATHERINE SHAW BETHEA HOSPITAL AND SUBSIDIARIES (THE HOSPITAL). THE HOSPITAL APPLIES THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE HOSPITAL DOES NOT CURRENTLY INCLUDE AN INCOME TAX PROVISION IN THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT MONITORS THE REPORTING OF UNCERTAIN TAX POSITIONS, WHICH COULD RESULT IN RECORDING OF AN INCOME TAX PROVISION IN THE FUTURE. A NIGHT OF RHYTHM 75000 64000 11000 72000 AN EVENING ON THE FARM 27892 27892 200 31 575 5045 300 1046 102892 91892 11000 200 31 575 5045 300 73046 79197 -68197 1 KATHERINE SHAW BETHEA HOSPITAL 403 EAST FIRST STREET DIXON IL 61021 361000540 501(C)(3) 82107 0 EARLY LITERACY PROGRAM AND FUNDING FOR HOSPITAL EQUIPMENT AND OTHER OPERATIONS 1 PATIENT SUPPORT 1444 17038 PART I, LINE 2: KSB HOSPITAL IS A RELATED ORGANIZAITON UNDER COMMON MANAGEMENT. AS A RESULT, MANAGEMENT MONTIORS THE USE THE THESE FUNDS ACCORDINGLY. THE SUDER COMMUNITY GRANT WAS ISSUED FOR EARLY CHILDHOOD DEVELOPMENT EXPENSES. OB HANDLES OVERSIGHT OF THOSE FUNDS. KSB HOSPITAL FOUNDATION PROVIDES PATIENT SUPPORT TO PATIENTS OF THE HOSPITAL. MANAGEMENT MONTIORS THE USE THE THESE FUNDS ACCORDINGLY. 0 0 0 0 0 0 0 0 0 DAVID SCHREINER PRESIDENT/CEO 0 785283 0 475 0 263379 0 1620 0 34264 0 1085021 0 0 AUSTIN FRAZIER HOSPITAL CFO 0 336980 0 15475 0 0 0 1350 0 44290 0 398095 0 0 RYAN MILLER FDTN SECRETARY/HOSPITAL VP 0 234345 0 475 0 0 0 843 0 24737 0 260400 0 0 PART I, LINE 3 KATHERINE SHAW BETHEA HOSPITAL, A RELATED ORGANIZATION, USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART III, LINE 3 THE FLU SHOT DRIVE THRU CLINIC WAS NOT HELD IN 2023. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION SHALL HAVE ONE MEMBER, WHICH SHALL BE KATHERINE SHAW BETHEA HOSPITAL (THE "CORPORATE MEMBER"). FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBER SHALL APPOINT NEW DIRECTORS FOR THE CORPORATION PRIOR TO THE ANNUAL MEETING OF THE CORPORATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B ONLY WITH THE APPROVAL OF THE CORPORATE MEMBER SHALL THE CORPORATION TAKE ANY OF THE FOLLOWING ACTS: MAKE CONTRIBUTIONS OR TRANSFERS OF CORPORATION ASSETS TO ANY PERSON OTHER THAN KATHERINE SHAW BETHEA HOSPITAL; APPROVE UNBUDGETED EXPENDITURES BY THE CORPORATION; SELECT INDEPENDENT AUDITORS, ATTORNEYS AND/OR OTHER MAJOR CONSULTANTS FOR THE CORPORATION; ADOPT OR AMEND THE CORPORATION'S ARTICLES OF INCORPORATION OR THESE BYLAWS; ADOPT OR AMEND STATEMENTS OF MISSION, PHILOSOPHY, OR PURPOSE; ADOPT ANY RESOLUTION REGARDING THE DISSOLUTION, MERGER OR CONSOLIDATION OF THE CORPORATION; CREATE ANY SUBSIDIARY, AFFILIATED ORGANIZATION OR OTHER LEGAL ENTITY; ADOPT AN ANNUAL BUDGET FOR OPERATIONAL EXPENSES; ADOPT POLICIES ON BEHALF OF THE CORPORATION, OR APPROVE OR DIRECT THE APPLICATION OF CORPORATE MEMBER POLICIES WITH RESPECT TO THE CORPORATION; ENTER INTO THE PURCHASE, SALE, TRANSFER OR LEASE OF PROPERTY, OTHER THAN IN THE ORDINARY COURSE OF THE CORPORATION'S BUSINESS; EXECUTE ANY LOAN, OR MORTGAGE ANY PROPERTY; ESTABLISH ANY BOARD-RESTRICTED FUNDS; APPOINT THE DIRECTORS OF THE CORPORATION; OR REMOVE, WITH OR WITHOUT CAUSE, THE DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED AND APPROVED BY THE FOUNDATION BOARD OF DIRECTORS BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT HE FOUNDATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION DOES NOT COMPENSATE ANY EMPLOYEES, DIRECTORS, OR OFFICERS. A RELATED ORGANIZATION, KATHERINE SHAW BETHEA HOSPITAL, COMPENSATES ALL EMPLOYEES AND OFFICERS. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC BY CONTACTING FOUNDATION STAFF. KATHERINE SHAW BETHEA HOSPITAL 403 EAST FIRST STREET DIXON IL 61021 361000540 HOSPITAL IL 501(C)(3) LINE 3 N/A 0 KSB HOSPITAL CARING FRIENDS 403 EAST FIRST STREET DIXON IL 61021 841976356 SUPPORTING ORGANIZATION IL 501(C)(3) LINE 7 N/A 0 KSB VENTURES INC 403 EAST FIRST STREET DIXON IL 61021 465278274 HOLD PARTNERSHIP INVESTMENT IL N/A C 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0