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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
HOOPESTON COMMUNITY MEMORIAL HOSPITAL
 
Employer identification number
36-3637465
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government
(b) EIN (c) IRC section
(if applicable)
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
noncash assistance
(h) Purpose of grant
or assistance
(1) HOOPESTON AREA COMMUNITY UNIT SCHL DIST #11
615 EAST ORANGE ST
HOOPESTON,IL60942
36-2774495 501(c)(3) 10,000       CUSD #11 ALL-WEATHER TRACK
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
1
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2019
Page 2

Schedule I (Form 990) 2019
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients
(c) Amount of
cash grant
(d) Amount of
noncash assistance
(e) Method of valuation (book,
FMV, appraisal, other)
(f) Description of noncash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
Form 990, Schedule I, Part 1, Question 2 DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS ANY CHARITABLE ORGANIZATION WISHING TO REQUEST FUNDS IS ASKED TO SUBMIT THEIR REQUEST IN WRITING. EMAILED REQUESTS ARE ACCEPTABLE. THE REQUEST MUST INCLUDE A DESCRIPTION OF THE PURPOSE OF THE CONTRIBUTION AND OTHER RELEVANT INFORMATION SUCH AS REQUESTORS NAME, AMOUNT OF THE REQUEST, ETC. THE REQUESTS ARE REVIEWED, EVALUATED, AND ADMINISTERED BY THE MARKETING AND COMMUNICATIONS (PUBLIC RELATIONS) DEPARTMENT, SEEKING ADDITIONAL INFORMATION FROM THE REQUESTOR, AS NEEDED, AND INPUT FROM ANY APPROPRIATE CARLE ADMINISTRATOR OR DIRECTOR. A SET OF ESTABLISHED GUIDELINES DRIVE THESE DECISIONS WHILE MOST ARE MADE TO IMPROVE HEALTHCARE/ACCESS TO HEALTHCARE OR ARE IN LINE WITH OUR ROLE AS A CORPORATE CITIZEN. ASSESSED NEED IS A COMMON CRITERIA. IN THE CASE OF MOST DONATIONS OF $5,000 OR MORE, SUCH AS TO COLLEGES AND UNIVERSITIES OR COMMUNITY CLINICS, WRITTEN AGREEMENTS ARE IN PLACE AND WE HAVE REGULAR CONTACT WITH THOSE ORGANIZATIONS, OFTENTIMES THROUGH A CARLE CONTACT PERSON TO ASSURE THAT THE DONATIONS ARE BEING USED AS AGREED UPON. THE RECORDS ARE EITHER MAINTAINED IN ADMINISTRATION OR PUBLIC RELATIONS.
Schedule I (Form 990) 2019



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