2024-04-30T11:15:04-05:00 2023-06-30 410746749 CLIFTONLARSONALLEN LLP 475 REGENCY PARK SUITE 175 OFALLON IL 62269 990 2022-07-01 061836473 THE KIRBY FOUNDATION KIRB 2177622115 1000 MEDICAL CENTER DRIVE MONTICELLO IL 618561151 STEVEN D TENHOUSE CHIEF EXECUTIVE OFFICER 2177622115 2024-04-29 1 STEVEN TENHOUSE 999009999 0 ERIKA MARTINEZ P02297196 6182331200 2024-04-29 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z STEVEN D TENHOUSE 1000 MEDICAL CENTER DRIVE MONTICELLO IL 618561151 635988 0 X WWW.KIRBYHEALTH.ORG/FOUNDATION X 2008 IL CHARITABLE FUNDRAISING FOR THE SOLE PURPOSE OF SUPPORTING THE OPERATIONS OF KIRBY MEDICAL CENTER. 12 11 1 14 0 0 206709 209170 0 0 37245 23372 -21203 -27246 222751 205296 62024 136670 0 0 84954 94161 0 0 0 38118 71294 185096 302125 37655 -96829 6716570 14641836 5540542 13534139 1176028 1107697 THE KIRBY FOUNDATION WILL BUILD COMMUNITY RELATIONSHIPS THAT LEAD TO THE COMMITMENT OF PRIVATE GIFTS IN SUPPORT OF PATIENT CARE; COMMUNITY HEALTH RESOURCES AND EDUCATION; AND MEDICAL CAMPUS IMPROVEMENTS. 0 0 207290 136670 0 SOLICITATION AND CONTRIBUTION (FUNDRAISING) OF FUNDS TO SUPPORT THE MISSION OF KIRBY MEDICAL CENTER.THE KIRBY FOUNDATION PLAYS A VITAL ROLE IN SUSTAINING KIRBY MEDICAL CENTER'S DEDICATION TO EXCELLENCE THROUGH ITS GENEROUS CHARITABLE GIFTS AND STRONG COMMUNITY TIES.PHILANTHROPIC SUPPORT ALLOWS THE KIRBY FOUNDATION TO PROVIDE DIRECT, IMPACTFUL, AND MEANINGFUL SUPPORT FOR COMMUNITY HEALTH RESOURCES, PATIENT CARE, AND MEDICAL CAMPUS IMPROVEMENTS. 207290 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 12 11 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 IL X STEVEN D TENHOUSE 2177622115 1000 MEDICAL CENTER DRIVE MONTICELLO IL 61856 BILL HAWORTH BOARD MEMBER 0.50 0.00 X 0 0 0 BRANDON J HISSONG BOARD MEMBER (TERM ENDED) 0.50 0.00 X 0 0 0 DAVID S BROWN TREASURER (TERM ENDED) 0.50 0.00 X X 0 0 0 JAY TIMMONS BOARD MEMBER 0.50 0.00 X 0 0 0 JOHN FRERICHS BOARD MEMBER 0.50 0.00 X 0 0 0 KATHY PLUNK BOARD MEMBER (TERM ENDED) 0.50 0.00 X 0 0 0 LUKE M FEENEY CHAIR 0.50 0.00 X X 0 0 0 RORY W WRIGHT TREASURER 0.50 0.00 X X 0 0 0 STEVEN D TENHOUSE SECRETARY/CEO 0.50 40.00 X X 0 385392 102123 TONY KIRKMAN BOARD MEMBER 0.50 0.00 X 0 0 0 TONY POMONIS BOARD MEMBER (TERM ENDED) 0.50 0.00 X 0 0 0 VERONICA SEEVERS VICE CHAIR 0.50 0.00 X X 0 0 0 LAURIE RUMERY BOARD MEMBER 0.50 0.00 X 0 0 0 MO TRACY BOARD MEMBER 0.50 0.00 X 0 0 0 KEN WRIGHT BOARD MEMBER 0.50 0.00 X 0 0 0 SARAH ROSS FOUNDATION DIRECTOR 20.00 0.00 X 0 81262 4545 0 466654 106668 0 0 1 0 PETRY-KUHNE COMPANY PO BOX 3757 CHAMPAIGN IL 618263757 GENERAL CONTRACTOR 6752994 EARL SWENSSON ASSOCIATES INC PO BOX 5341 CAROL STREAM IL 601975341 ARCHITECTS 163798 CONCORD HEALTHCARE DEVELOPMENT 535 MARRIOT DR SUITE 625 NASHVILLE TN 37214 PROJECT MANAGEMENT 156443 3 27225 24000 157945 7236 209170 23768 23768 212566 239025 -26459 -26459 -26459 155594 155990 -396 -396 -396 34890 27225 35677 -787 -787 205296 0 0 -3874 136670 136670 83142 62356 20786 4691 3518 1173 6328 4746 1582 2556 2556 6188 6188 10104 10104 52271 52271 EDUCATION 175 175 302125 207290 94835 0 1965704 185436 309937 28738 1269 17521 13958414 178981 4007832 13779433 431828 630708 6716570 14641836 768860 50000 3750300 0 9681693 2800569 0 1971113 52146 5540542 13534139 X 792841 708261 383187 399436 1176028 1107697 6716570 14641836 -96829 28498 0 X X 0 1 X 1 1 1 X 203431 81555 168889 206709 209170 869754 203431 81555 168889 206709 209170 869754 123248 746506 14408 15090 13964 20454 23768 87684 957438 344140 0.77970 0.57370 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 381918 52168 434086 8853126 103022 8750104 4340413 68664 4271749 330789 7295 323494 13779433 DUE TO AFFILIATE 52146 52146 X PART X, LINE 2: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE CONSOLIDATED FINANCIAL STATEMENTS. PAINT PIATT PINK 20048 8817 11231 250 4530 1255 1070 KIRBY DERBY 24760 11353 13407 604 6266 1550 2730 6147 1 17307 7055 10252 6762 870 3643 62115 27225 34890 854 17558 1550 4855 10860 35677 -787 1 KIRBY MEDICAL CENTER 1000 MEDICAL CENTER DRIVE MONTICELLO IL 61856 370661215 501(C)(3) 136670 0 EXPENSES INCURRED TO MAINTAIN AND EXTEND TRAIL SURROUNDING THE HOSPITAL AS WELL AS SUPPLEMENTING HOSPITAL PROGRAMS SUPPORTING AND COMFORTING BREAST CANCER PATIENTS. 1 0 PART I, LINE 2: THE FOUNDATION'S ONLY GRANTS DURING THE FISCAL YEAR WERE TO KIRBY MEDICAL CENTER. THE FOUNDATION AND THE HOSPITAL ARE UNDER COMMON MANAGEMENT THAT OVERSEES THE SPENDING OF ALL FUNDS TO ENSURE THAT CHARITABLE PURPOSES AND ANY RESTRICTIONS ARE MET. 0 1 0 0 0 0 0 0 0 STEVEN D TENHOUSE SECRETARY/CEO 0 293848 0 76115 0 15429 0 59100 0 43023 0 487515 0 0 PART I, LINE 3 KIRBY MEDICAL CENTER, A RELATED ORGANIZATION, USED THE FOLLOWING ITEMS TO ESTABLISH COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: (1) WRITTEN EMPLOYMENT CONTRACT, (2) COMPENSATION SURVEY OR STUDY (3) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE (4) COMPENSATION COMMITTEE AND (5) FORM 990 OF OTHER ORGANIZATIONS. PART I, LINE 4B IN 2016, THE MEDICAL CENTER ENTERED INTO A SUPPLEMENTAL COMPENSATION AGREEMENT COVERING STEVEN TENHOUSE, CEO, WHICH PROVIDES FOR HIM TO RECEIVE, UPON TERMINATION OF EMPLOYMENT, PAYMENTS IN MONTHLY INSTALLMENTS OVER A TWO YEAR PERIOD FOLLOWING TERMINATION. THE BENEFIT TO WHICH STEVEN IS ENTITLED TO RECEIVE IS IN ACCORDANCE WITH A VESTING SCHEDULE PROVIDED FOR IN THE AGREEMENT WITH VESTING SET TO BEGIN IN 2021 PROGRESSING TO 100% VESTING IN 2026. IF DEATH OR DISABILITY OCCURS DURING THE PERIOD COVERED BY THE AGREEMENT, THE BALANCE OF THE ACCOUNT BECOMES 100% VESTED WITH THE BENEFIT PAYMENTS MADE TO THE BENEFICIARY. THE MEDICAL CENTER'S FUNDING OF THIS BENEFIT IS BEING RECOGNIZED AS COMPENSATION COST ON AN ANNUAL BASIS. THE MEDICAL CENTER INTENDS TO USE CASH FROM OPERATIONS TO FUND THIS OBLIGATION. ALL FUNDS OF THE DEFERRED COMPENSATION ACCOUNT ARE SUBJECT TO THE MEDICAL CENTER'S CREDITORS UNTIL SUCH TIME AS THE FUNDS ARE DISTRIBUTED IN ACCORDANCE WITH THE AGREEMENTS. THE ASSETS, WHICH ARE CLASSIFIED AS ASSETS LIMITED AS TO USE, TOTAL $273,035 AS OF JUNE 30, 2023. THE LIABILITIES, WHICH ARE CLASSIFIED AS OTHER LONG-TERM LIABILITIES, TOTAL $273,035 AS OF JUNE 30, 2023. A CITY OF MONTICELLO ILLINOIS 376001815 2022-12-15 10000000 SEE PART VI 0 0 0 A 185149 10000000 2047371 7952629 2023 0 1 0 0 A 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 PART I COLUMN F REFUND PRIOR TAXABLE BONDS AND FUND CONSTRUCTION PROJECT FORM 990, PART VI, SECTION A, LINE 6 PER THE ORGANIZATION'S BY-LAWS, THE CORPORATION SHALL HAVE ONE VOTING MEMBER WHICH WILL BE KIRBY MEDICAL CENTER, AN ILLINOIS NOT-FOR-PROFIT CORPORATION. THE PRESIDENT OF KIRBY MEDICAL CENTER SHALL BE AN EX OFFICIO MEMBER OF THE KIRBY FOUNDATION BOARD WITH FULL VOTING PRIVILEGES. FORM 990, PART VI, SECTION A, LINE 7A PER THE BY-LAWS THE SOLE MEMBER MAY ELECT THE BOARD OF DIRECTORS AT ITS ANNUAL MEETING OR A SPECIAL MEETING OF THE BOARD OF DIRECTORS OF KIRBY MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7B PER THE BY-LAWS THE BOARD OF DIRECTORS MAY NOT TAKE ANY OF THE FOLLOWING ACTIONS WITHOUT CONSENT OF THE SOLE MEMBER. 1) EXCEPT AS PROVIDED TO THE CONTRARY IN SECTION 6.2 OF ARTICLE 6 OF THESE BY-LAWS, AGREE TO ANY CONTRACT OR ENGAGE IN ANY TRANSACTION, OR MAKE ANY DISTRIBUTION WHERE THE AMOUNT INVOLVED EXCEEDS TWENTY-FIVE THOUSAND DOLLARS ($25,000) (OR SEVERAL RELATED PAYMENTS TOTALING OR EXCEEDING $25,000) OR TEN PERCENT (10%) OF THE FOUNDATION'S APPROVED BUDGET WHICHEVER IS THE GREATER AMOUNT; 2) APPROVE ANY ANNUAL OR LONG-TERM CAPITAL OR OPERATING BUDGETS; 3) APPROVE ANY NEW, OR ANY CHANGES TO, THE EXISTING LONG-TERM PLANS OF THE FOUNDATION; OR 4) AMEND OR REVISE THE ARTICLES OF INCORPORATION OR THE BY-LAWS OF THE FOUNDATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 FINANCIAL INFORMATION IS REVIEWED BY KIRBY MEDICAL CENTER'S INTERNAL ACCOUNTING STAFF FOR ACCURACY TO THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. OTHER 990 INFORMATION IS REVIEWED BY KIRBY MEDICAL CENTER'S CFO AND CEO. COPIES OF THE FINAL REPORT ARE PROVIDED TO THE GOVERNING BOARD'S AUDIT AND COMPLIANCE COMMITTEE FOR THEIR REVIEW AND TO SOLICIT COMMENTS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY ALL BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICTS AND TO SIGN A CONFLICT OF INTEREST STATEMENT, STATING SITUATIONS OF POTENTIAL CONFLICTS. GENERALLY, THE BOARD ASSESSES THE CONFLICTS THAT EXIST WITH ITS MEMBERS AND REQUESTS THAT MEMBERS WITH THESE CONFLICTS BE EXCUSED FROM ANY DISCUSSION RELATED TO THEM AND ARE RESTRICTED FROM VOTING ON THOSE ISSUES. BECAUSE OF THE FAMILIARITY OF BOARD MEMBERS WITH ONE ANOTHER AND THE SIZE OF THE COMMUNITY, THE BOARD'S SELF ASSESSMENT OF CONFLICTS CAN BE MADE WITH RELATIVE EASE. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION TO THE ORGANIZATION'S EMPLOYEES IS PAID BY KIRBY MEDICAL CENTER, A RELATED ORGANIZATION. THE CEO OF KIRBY MEDICAL CENTER EVALUATES THE FOUNDATION DIRECTOR'S COMPENSATION ANNUALLY AND USES COMPARABLE COMPENSATION DATA IN THE EVALUATION PROCESS. FORM 990, PART VI, SECTION C, LINE 19 AT THIS TIME NONE OF THE ORGANIZATION'S GOVERNING DOCUMENTS NOR THEIR FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE GENERAL PUBLIC. PART VI, SECTION B, LINE 13 THE ORGANIZATION DOES NOT HAVE ITS OWN WRITTEN WHISTLEBLOWER POLICY. HOWEVER, THE ORGANIZATION IS SUBJECT TO THIS WRITTEN POLICY THAT IS IN PLACE AT KIRBY MEDICAL CENTER, A RELATED ORGANIZATION. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED IN THE CURRENT YEAR. FOUNDATION THERAPY AND WELLNESS CAPITAL LLC 1000 MEDICAL CENTER DRIVE MONTICELLO IL 61856 881573914 TO SUPPORT THE ACTIVITY OF THE KIRBY FOUNDATION IL 212566 13507702 THE KIRBY FOUNDATION KIRBY MEDICAL CENTER 1000 MEDICAL CENTER DRIVE MONTICELLO IL 61856 370661215 HEALTH CARE IL 501(C)(3) LINE 3 N/A 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0