LAWRENCE COUNTY MEMORIAL HOSPITAL: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- LAWRENCE COUNTY MEMORIAL HOSPITAL (EIN 80-0618988)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-10
- IRS object ID
- 201711309349301786
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-10T10:48:58-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 430352985 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KERBER ECK & BRAECKEL LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1116 W MAIN ST | AddressLine1Txt |
| City | CARBONDALE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 629012335 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 800618988 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAWRENCE COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LAWR | BusinessNameControlTxt |
| Phone | 6189431000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2200 STATE STREET | AddressLine1Txt |
| City | LAWRENCEVILLE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62439 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CARL ATEN | PersonNm |
| Person Title | BOARD CHAIR | PersonTitleTxt |
| Phone | 6189431000 | PhoneNum |
| Signature | 2017-05-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BRENT KOCHEL | PreparerPersonNm |
| PTIN | P01055927 | PTIN |
| Phone | 6185291040 | PhoneNum |
| Preparation | 2017-05-10 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CARL ATEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2200 STATE STREET | AddressLine1Txt |
| City | LAWRENCEVILLE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62439 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $17,355,218 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.LCMHOSP.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1950 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | AT LAWRENCE COUNTY MEMORIAL HOSPITAL, WE OFFER COMPASSIONATE, PROFESSIONAL HEALTHCARE THAT MEETS THE HIGHEST STANDARDS OF EXCELLENCE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 197 | TotalEmployeeCnt |
| Total Volunteers | 39 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $66,850 | PYContributionsGrantsAmt |
| CY Contributions Grants | $105,531 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,868,522 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $16,710,334 | CYProgramServiceRevenueAmt |
| PY Investment Income | $15,765 | PYInvestmentIncomeAmt |
| CY Investment Income | $7,411 | CYInvestmentIncomeAmt |
| PY Other Revenue | $624,135 | PYOtherRevenueAmt |
| CY Other Revenue | $531,942 | CYOtherRevenueAmt |
| PY Total Revenue | $16,575,272 | PYTotalRevenueAmt |
| CY Total Revenue | $17,355,218 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,972,018 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,082,174 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,584,021 | PYOtherExpensesAmt |
| CY Other Expenses | $8,085,847 | CYOtherExpensesAmt |
| PY Total Expenses | $15,556,039 | PYTotalExpensesAmt |
| CY Total Expenses | $17,168,021 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,019,233 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $187,197 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $12,434,966 | TotalAssetsBOYAmt |
| Total Assets EOY | $13,047,774 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,574,231 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,999,842 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,860,735 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,047,932 | NetAssetsOrFundBalancesEOYAmt |
| Mission | AT LAWRENCE COUNTY MEMORIAL HOSPITAL WE OFFER COMPASSIONATE, PROFESSIONAL HEALTHCARE THAT MEETS THE HIGHEST STANDARDS OF EXCELLENCE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $12,049,878 | ExpenseAmt |
| Revenue | $17,242,276 | RevenueAmt |
| Desc | THE HOSPITPAL'S MISSION IS TO PROVIDE HIGH QUALITY CARE AND COST EFFECTIVE HEALTHCARE, WHICH INCLUDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO THE RESIDENTS OF LAWRENCE COUNTY, IL. ALL EXPENSES RELATE TO COSTS ASSOCIATED WITH PROVIDING THESE SERVICES, AND MAINLY INCLUDE SALARY AND WAGES TO STAFF AND COST OF SUPPLIES. | Desc |
| Total Program Service Expenses | $12,049,878 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 39 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 197 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
| Other | Yes (X) | OtherInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LARRY SPOUR | PersonNm |
| Phone | 6189437202 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2200 STATE STREET | AddressLine1Txt |
| City | LAWRENCEVILLE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62439 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| CARL ATEN | ||||||||
| BOARD CHAIR | 3.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RON WALDROP | ||||||||
| VICE CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| REBECCA NESTLEROAD | ||||||||
| TRUSTEE | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MIKE SHEPPARD | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| STANLEY WILLIAMS | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BJ SHAFFER | ||||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| CURT BENSON | ||||||||
| TRUSTEE/BEG | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DR GARY CARR | ||||||||
| TRUSTEE /PHY | 40.00 | Yes (X) | $228,417 | $0 | $0 | |||
| DOUG FLORKOWSKI | ||||||||
| CEO | 40.00 | Yes (X) | $210,000 | $0 | $63,313 | |||
| LARRY SPOUR | ||||||||
| CFO | 40.00 | Yes (X) | $110,436 | $0 | $13,036 | |||
| RITA GARVEY | ||||||||
| CNO | 40.00 | Yes (X) | $92,175 | $0 | $0 | |||
| VALERIE BURNS | ||||||||
| PHYSICAN | 40.00 | $206,002 | $0 | $4,185 | Yes (X) | |||
| STEVEN RAMSARAN | ||||||||
| PHYSICAN | 40.00 | $338,613 | $0 | $21,495 | Yes (X) | |||
| CHARLES CLAGETT | ||||||||
| PHYSICAN | 40.00 | $195,572 | $0 | $18,865 | Yes (X) | |||
| KEVIN STRANGE | ||||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| RODNEY FINCH | ||||||||
| PHYSICAN | 40.00 | $186,781 | $0 | $18,865 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,567,996 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $139,759 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt | Address Line2ContractorAddress/USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|
| HEALTHCARE SERVICE CORP | ||||||
| 25551 NETWORK PLACE | CHICAGO | IL | 606731255 | EMPL HEALTH INS | $901,705 | |
| QUORUM HEALTH RESOURCES LLC | ||||||
| 1573 MALLORY LANE | BRENTWOOD | TN | 37027 | CONTRACT MGT SV | $649,165 | |
| WISCONSIN PHYSICIANS SERVICE | ||||||
| 912 NORTH PENTECOST DRIVE | MARION | IL | 62959 | CONTRACTED PHYS | $516,437 | |
| CPSI | ||||||
| PO BOX 850309 | MOBILE | AL | 366850309 | HOSP COMP SOFTW | $367,800 | 6600 WALL STREET |
| MARTIN GOLDSTONE MD | ||||||
| 3926 W TOUHY STE 369 | LINCOLNWOOD | IL | 60712 | CONTRACTED PHYS | $326,280 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 23 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $74,326 | RelatedOrganizationsAmt |
| Government Grants | $31,205 | GovernmentGrantsAmt |
| Total Contributions | $105,531 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Total Revenue Column | $16,710,334 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $16,710,334 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $16,710,334 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,411 | TotalRevenueColumnAmt |
| Exclusion | $7,411 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $28,883 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $28,883 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $28,883 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $28,883 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| MEANINGFUL REVENUE | $334,350 | $334,350 |
| CAFETERIA INCOME | $120,492 | $120,492 |
| OTHER REVENUE | $48,217 | $48,217 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $503,059 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,355,218 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,242,276 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $7,411 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,567,996 | TotalAmt |
| Management And General | $1,567,996 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,768,679 | TotalAmt |
| Program Services | $4,326,509 | ProgramServicesAmt |
| Management And General | $1,442,170 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $113,320 | TotalAmt |
| Program Services | $84,990 | ProgramServicesAmt |
| Management And General | $28,330 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,146,185 | TotalAmt |
| Program Services | $859,639 | ProgramServicesAmt |
| Management And General | $286,546 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $485,994 | TotalAmt |
| Program Services | $364,495 | ProgramServicesAmt |
| Management And General | $121,499 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $210,021 | TotalAmt |
| Management And General | $210,021 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,936 | TotalAmt |
| Management And General | $7,936 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,301 | TotalAmt |
| Management And General | $42,301 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,748 | TotalAmt |
| Management And General | $6,748 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,706,587 | TotalAmt |
| Program Services | $2,072,513 | ProgramServicesAmt |
| Management And General | $634,074 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,692 | TotalAmt |
| Program Services | $26,211 | ProgramServicesAmt |
| Management And General | $2,481 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $291,837 | TotalAmt |
| Program Services | $124,276 | ProgramServicesAmt |
| Management And General | $167,561 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,357 | TotalAmt |
| Program Services | $6,268 | ProgramServicesAmt |
| Management And General | $2,089 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $818,333 | TotalAmt |
| Program Services | $613,750 | ProgramServicesAmt |
| Management And General | $204,583 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,154 | TotalAmt |
| Program Services | $4,154 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,116 | TotalAmt |
| Program Services | $15,944 | ProgramServicesAmt |
| Management And General | $21,172 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,809 | TotalAmt |
| Program Services | $36,809 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $960,263 | TotalAmt |
| Program Services | $720,197 | ProgramServicesAmt |
| Management And General | $240,066 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $212,723 | TotalAmt |
| Program Services | $159,542 | ProgramServicesAmt |
| Management And General | $53,181 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| UNCOLLECTABLE ACCOUNTS | $1,252,450 | $1,252,450 | |
| MEDICAL SUPPLY | $670,293 | $670,293 | |
| MISCELLANEOUS | $317,555 | $238,166 | $79,389 |
| DRUG EXPENSE | $288,370 | $288,370 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $185,302 | TotalAmt |
| Program Services | $185,302 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,168,021 | TotalAmt |
| Program Services | $12,049,878 | ProgramServicesAmt |
| Management And General | $5,118,143 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,164,196 | BOYAmt |
| EOY | $1,968,367 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,789,988 | BOYAmt |
| EOY | $2,567,529 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $289,377 | BOYAmt |
| EOY | $289,940 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $118,262 | BOYAmt |
| EOY | $701,611 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $18,073,292 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,552,965 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,073,143 | BOYAmt |
| EOY | $7,520,327 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,434,966 | BOYAmt |
| EOY | $13,047,774 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,312,572 | BOYAmt |
| EOY | $1,577,106 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $261,835 | BOYAmt |
| EOY | $432,350 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $618,575 | BOYAmt |
| EOY | $1,080,235 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,381,249 | BOYAmt |
| EOY | $910,151 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,574,231 | BOYAmt |
| EOY | $3,999,842 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,860,735 | BOYAmt |
| EOY | $9,047,932 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,860,735 | BOYAmt |
| EOY | $9,047,932 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,434,966 | BOYAmt |
| EOY | $13,047,774 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $187,197 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,150 | OtherCostOrOtherBasisAmt |
| Book Value | $20,150 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,514,110 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,635,190 | DepreciationAmt |
| Book Value | $5,878,920 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,539,032 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,917,775 | DepreciationAmt |
| Book Value | $1,621,257 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,520,327 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| THIRD - PARTY REIMBURSEMENT | $716,093 |
| LINE OF CREDIT | $194,058 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $910,151 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $16,102,768 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$1,252,450 | OtherRevenueAmt |
| Revenue Not Reported | -$1,252,450 | RevenueNotReportedAmt |
| Revenue Subtotal | $17,355,218 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $17,355,218 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,915,571 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | -$1,252,450 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$1,252,450 | ExpensesNotReportedAmt |
| Expenses Subtotal | $17,168,021 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $17,168,021 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | PROVISION FOR UNCOLLECTABLE -1,252,450 |
| SCHEDULE D, PAGE 4, PART XII, LINE 2D | PROVISION FOR UNCOLLECTABLE -1,252,450 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 1.100000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $622,194 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $622,194 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03620 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,521,198 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,775,067 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $746,131 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04350 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,143,392 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,775,067 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,368,325 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07970 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,143,392 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,775,067 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,368,325 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07970 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $469,543 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $6,602,051 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,612,639 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$10,588 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAWRENCE COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2200 STATE STREET | AddressLine1Txt |
| City | LAWRENCEVILLE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62439 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTPS://LCMHOSP.ORG | WebsiteAddressTxt |
| State License | 0005769 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAWRENCE COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://LCMHOSP.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | false | StrategyPostedWebsiteInd |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 110.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPSLCMHOSPORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPSLCMHOSPORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | Yes (true) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 5 | LCMH CONTRACTED WITH QHR CONSULTING SERVICES AS IT PRETAINED TO THE PREPARATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE FIRM PERFORMS SEVERAL INDEPENDENT DATA, AND RESOLVES ANY DATA INCONSISTENCIES OR DISCREPANCIES FROM THE COMBINED OPINIONS FORMED FROM LOCAL EXPERTS. ADDITIONALLY, QHR RELIES ON SECONDARY SOURCE DATA, AND MOST SECONDARY SOURCES USE THE COUNTY AS THE SMALLEST UNIT OF ANALYSIS. FINALLY, QHR ASKED OUR LOCAL EXPERT AREA RESIDENTS TO NOTE IF THEY PRECEIVED THE PROBLEMS OR NEEDS IDENTIFIED BY SECONDARY SOURCES TO EXIST IN THEIR PORTION OF THE COUNTY. MOST DATA USED IN THE ANALYSIS IS AVAILABLE FROM PUBLIC INTERNET SOURCES. IN ADDITION, WE DEPLOYED A CHNA "ROUND 1" SURVEY TO OUR LOCAL EXPERT ADVISORS TO GAIN LOCAL INPUT AS TO LOCAL HEALTH NEEDS AND THE NEEDS OF PRIORITY POPULATIONS. LOCAL EXPERT ADVISORS WERE LOCAL INDIVIDUALS SELECTED TO CONFORM TO THE INPUT REQUIRED BY THE FEDERAL GUIDELINES AND REGULATIONS. WE RECEIVED COMMUNITY INPUT FROM 19 LOCAL EXPERT ADVISORS. INFORMATION ANALYSIS AUGMENTED BY LOCAL OPINIONS SHOWED HOW LAWRENCE COUNTY RELATES TO ITS PEERS IN TERMS OF PRIMARY AND CHRONIC NEEDS AND OTHER ISSUES OF UNINSURED PERSONS, LOW-INCOME PERSONS, AND MINORITY GROUPS. RESPONDENTS COMMENTED ON IF THEY BELIEVE CERTAIN POPULATION GROUPS (OR PEOPLE WITH CERTAIN SITUATIONS) NEED HELP TO IMPROVE THEIR CONDITION, AND IF SO, WHO NEEDS TO DO WHAT. WHEN THE ANALYSIS WAS COMPLETE, WE PUT THE INFORMATION AND SUMMARY CONCLUSIONS BEFORE OUR LOCAL GROUP OF EXPERTS, WHO WERE ASKED TO AGREE OR DISAGREE WITH THE SUMMARY CONCLUSIONS. THEY WERE FREE TO AUGMENT POTENTIAL CONCLUSIONS WITH ADDITIONAL STATEMENTS OF NEED, AND NEW NEEDS DID EMERGE FROM THE EXCHANGE. CONSULTATION WITH 13 LOCAL EXPERTS OCCURRED AGAIN VIA AN INTERNET-BASED SURVEY. WITH THE PRIOR STEPS IDENTIFYING POTENTIAL COMMUNITY NEEDS, THE LOCAL EXPERTS PARTICIPATED IN A STRUCTURED COMMUNICATION TECHNIQUE CALLED A "WISDOM OF CROWDS" METHOD. THE PREMISE OF THIS APPROACH RELIES ON A PANEL OF EXPERTS WITH THE ASSUMPTION THAT THE COLLECTIVE WISDOM OF PARTICIPANTS IS SUPERIOR TO THE OPINION OF ANY ONE INDIVIDUAL, REGARDLESS OF THEIR PROFESSIONAL CREDENTIALS. IN THE LCMH PROCESS, EACH LOCAL EXPERT HAD THE OPPORTUNITY TO INTRODUCE NEEDS PREVIOUSLY UNIDENTIFIED AND TO CHALLENGE CONCLUSIONS DEVELOPED FROM THE DATA ANALYSIS. WHILE THERE WERE A FEW OPINIONS OF THE DATA CONCLUSIONS NOT BEING COMPLETELY ACCURATE, THE VAST MAJORITY OF COMMENTS AGREED WITH OUR FINDINGS. WE DEVELOPED A SUMMARY OF ALL NEEDS IDENTIFIED BY ANY OF THE ANALYZED DATA SETS. THE LOCAL EXPERTS THEN ALLOCATED 100 POINTS AMONG THE POTENTIAL SIGNIFICANT NEED CANDIDATES, INCLUDING THE OPPORTUNITY TO AGAIN PRESENT ADDITIONAL NEEDS THAT WERE NOT IDENTIFIED FROM THE DATA. A RANK ORDER OF PRIORITIES EMERGED, WITH SOME NEEDS RECEIVING NONE OR VIRTUALLY NO SUPPORT, AND OTHER NEEDS RECEIVING IDENTICAL POINT ALLOCATIONS. WE DICHOTOMIZED THE RANK ORDER OF PRIORITIZED NEEDS INTO TWO GROUPS: "SIGNIFICANT- AND "OTHER IDENTIFIED NEEDS." OUR CRITERIA FOR IDENTIFYING AND PRIORITIZING SIGNIFICANT NEEDS WAS BASED ON A DESCENDING FREQUENCY RANK ORDER OF THE NEEDS BASED ON TOTAL POINTS CAST BY THE LOCAL EXPERTS, FURTHER RANKED BY A DESCENDING FREQUENCY COUNT OF THE NUMBER OF LOCAL EXPERTS CASTING ANY POINTS FOR THE NEED. BY OUR DEFINITION, A SIGNIFICANT NEED HAD TO INCLUDE ALL RANK ORDERED NEEDS UNTIL AT LEAST FIFTY PERCENT (50%) OF ALL POINTS WERE INCLUDED AND TO THE EXTENT POSSIBLE, REPRESENTED POINTS ALLOCATED BY A MAJORITY OF VOTING LOCAL EXPERTS. THE DETERMINATION OF THE BREAK POINT - "SIGNIFICANT" AS OPPOSED TO "OTHER" - WAS A QUALITATIVE INTERPRETATION BY QUORUM AND THE LCMH EXECUTIVE TEAM WHERE A REASONABLE BREAK POINT IN RANK ORDER OCCURRED. |
| FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 11 | CHNA SIGNIFICANT NEEDS ARE: 1.MENTAL HEALTH/SUICIDE/SUBSTANCE ABUSE LCMH SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: A.PROVIDE FRONT-LINE STAFFING NEEDS (PRIMARY CARE SERVICES/EMERGENCY DEPARTMENT SERVICES) FOR INITIAL TREATMENT, IDENTIFICATION, AND REFERRAL TO THE APPROPRIATE MENTAL HEALTH/SUBSTANCE ABUSE SERVICE B.FACILITY SPACE PROVIDED BI-WEEKLY TO LOCAL SUBSTANCE ABUSE SUPPORT GROUPS C.FINANCIAL SUPPORT PROVIDED TO LOCAL LAW ENFORCEMENT AGENCIES (DRUG AWARENESS PROGRAMS) FOR THE LOCAL SCHOOL DISTRICT D.DINE WITH A DOC EDUCATION SEMINAR ON DEPRESSION PREVENTION/DIAGNOSIS/TREATMENT FOR SENIOR CITIZENS ADDITIONALLY, LCMH PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: A.CONTINUE ABOVE ACTIONS B.INITIATING STEPS TO DEVELOP LOCAL SUBSTANCE ABUSE COALITION (LOCAL SCHOOLS/HOSPITAL/LAW ENFORCEMENT/EMS/PUBLIC HEALTH) C.BRINGING IN NATIONAL SUBSTANCE ABUSE EXPERT (AWARENESS/TREATMENT/EDUCATION) D.LOOKING INTO DEVELOPING DETOX BEDS E.DEVELOPING TELE-PSYCH SERVICES F.PROMOTE EDUCATION/PREVENTION OPPORTUNITIES THROUGH LOCAL MEDIA CHANNELS 2.CORONARY HEART DISEASE LCMH SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: A.VISITING CARDIOLOGY CLINIC IN LAWRENCE MEDICAL CENTER B.LCMH PRIMARY CARE CLINIC SERVICES C.LCMH DIAGNOSTIC IMAGING D.LCMH LABORATORY SERVICES E.STRESS TEST SERVICES F.HOLTER/EVENT MONITORS G.LCMH CARDIAC REHAB PROGRAM H.PROMOTE GO RED FOR WOMEN (NATIONAL MOVEMENT TO END HEART DISEASE/STROKE AMONG WOMEN) I.PROMOTE HEART HEALTH MONTH J.PROVIDE FREE CHOLESTEROL SCREENINGS AT COMMUNITY EVENTS AND HEALTH FAIRS K.REFER PATIENTS TO HEALTH DEPARTMENT SMOKING CESSATION PROGRAM L.DINE WITH A DOC EDUCATION SEMINAR ON HEART DISEASE PREVENTION/DIAGNOSIS/TREATMENT FOR SENIOR CITIZENS ADDITIONALLY, LCMH PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: A.CONTINUE ABOVE ACTIONS B.INCREASE CARDIOLOGY COVERAGE 3.CANCER LCMH SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: A.LCMH DIAGNOSTIC IMAGING B.LCMH LABORATORY SERVICES C.LCMH SCREENING COLONOSCOPY D.WEEKLY VISITING OB/GYN AT CLINIC PROVIDING CERVICAL CANCER SCREENINGS E.LCMH PRIMARY CARE SERVICES AND SURGICAL CLINIC PROVIDERS ADDRESS THIS NEED BY EDUCATION AND MEDICAL SERVICES F.LCMH SCREENING PROGRAMS AT VARIOUS COMMUNITY EVENTS G.PARTICIPATE IN RELAY FOR LIFE; PROMOTE BREAST CANCER AWARENESS MONTH H.UTILIZE MOBILE MAMMOGRAPHY UNIT TO PROVIDE ON-SITE SCREENING TO LOCAL INDUSTRIES I.PROVIDE EDUCATIONAL MATERIALS REGARDING PREVENTION/DIAGNOSIS/TREATMENT J.DINE WITH A DOC EDUCATION SEMINAR ON CANCER PREVENTION/DIAGNOSIS/TREATMENT FOR SENIOR CITIZENS ADDITIONALLY, LCMH PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: A.CONTINUE ABOVE ACTIONS B.RESEARCHING STEREOTACTIC MOBILE SERVICES C.CONTINUE TO EXPLORE OPPORTUNITIES TO DELIVER ON-SITE CLINICAL ONCOLOGY SERVICES 4.OBESITY/OVERWEIGHT LCMH DOES NOT INTEND TO DEVELOP AN IMPLEMENTATION STRATEGY FOR THIS SIGNIFICANT NEED WE ARE CHOOSING NOT TO RESPOND TO THIS NEED AT THIS TIME. WE FEEL WE CAN HAVE A GREATER IMPACT BY PUTTING ATTENTION AND RESOURCES TOWARD OTHER SIGNIFICANT NEEDS FOR WHICH WE ARE BETTER QUALIFIED TO SERVE. 5.STROKE-2013 SIGNIFICANT NEED; 3 LEADING CAUSE OF DEATH LCMH SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: A.EXPANDED REHABILITATION SERVICES TO TREAT STROKE PATIENTS B.DINE WITH A DOC EDUCATION SEMINAR ON STROKE PREVENTION/DIAGNOSIS/TREATMENT FOR SENIOR CITIZENS C.PROVIDE EDUCATIONAL MATERIALS (PREVENTION/IDENTIFICATION) D.BOARD-CERTIFIED NEURO-RADIOLOGIST READING CT SCANS AND IMPLEMENTING STAT READS FOR STROKE PATIENTS ADDITIONALLY, LCMH PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: A.CONTINUE ABOVE ACTIONS B.EXPAND TELEMEDICINE OPPORTUNITIES TO MONITOR BLOOD PRESSURE/VITAL SIGNS OTHER NEEDS WHERE HOSPITAL DID NOT DEVELOP IMPLEMENTATION STRATEGY 6.COMPLIANCE BEHAVIOR/PREDISPOSING CONDITIONS 7.DIABETES 8.PHYSICAL INACTIVITY 9.AFFORDABILITY 10.SMOKING/TOBACCO USE 11.PHYSICIAN 12.FLU/PNEUMONIA 13.CHRONIC COPD/LUNG DISEASE/PULMONARY 14.KIDNEY DISEASE 15.ALZHEIMER'S 16.MATERNAL MEASURES 17.ACCIDENTS 18.LIFE EXPECTANCY 19.CHOLESTEROL 20.DENTAL 21.SEXUALLY TRANSMITTED INFECTION 22.BLOOD POISONING 23.EDUCATION/PREVENTION |
| FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 13B | LCMH CHARGES THE SAME AMOUNT FOR ALL PATIENTS AND DISCOUNTS ARE GIVEN BASED ON FEDERAL PROVERTY GUIDELINES. |
| FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 13H | LCMH CHARGES THE SAME AMOUNT FOR ALL PATIENTS AND DISCOUNTS BASED ON FEDERAL POVERTY GUIDELINES. |
| FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 15E | LCMH CHARGES THE SAME AMOUNT FOR ALL PATIENTS AND DISCOUNTS BASED ON FEDERAL POVERTY GUIDELINES. |
| FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 19D | LCMH USES SEARCH AMERICA WHICH MEANS THAT ADDITIONAL THIRD PARTIES ARE NOT NEEDED BEFORE MAKING REASONABLE EFFORTS REGARDING ELIGIBILITY. |
| FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 20E | OUTPATIENTS ARE NOTIFIED ON THE FIRST STATEMENT THEY RECEIVE THAT SHOWS ANY PATIENT BALANCE. LCMH ATTEMPTS TO NOTIFY ALL INPATIENTS AS PART OF THEIR STAY BUT WITH ALOS OF 3.8 DAYS THIS IS NOT ALWAYS ACCOMPLISHED. THEY ALSO RECEIVE NOTICE ON THEIR FIRST STATEMENT OF THE FINANCIAL ASSISTANCE POLICY. ALL UNINSURED PATIENTS RECEIVE AN FA APPLICATION UPON REGISTRATION. |
| FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 22D | LCMH HAS NO POLICY IN PLACE TO ADJUST NORMAL CHARGES TO A LOWER AMOUNT BEFORE FAP CHARITY IS APPLIED. |
| FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 24 | CHARGES ARE ALL AT NORMAL RATES. ANY FAP DISCOUNT IS APPLIED BASED ON NORMAL CHARGES. NO FAP-ELIGIBLE PATIENT PAID ANYTHING CLOSE TO USUAL CHARGES. |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION | FormAndLineReferenceDesc |
| Explanation | COMMUNITY BUILDING ACTIVITIES FORM 990, SCH H, PART II LAWRENCE COUNTY MEMORIAL HOSPITAL DID NOT CONDUCT ANY COMMUNITY BUILDING ACTIVITIES FOR THE YEAR ENDED 6/30/2016. BAD DEBT EXPENSE FORM 990, SCH H, PART III, LINES 2-4 ACCOUNTS ARE REPORTED AS BAD DEBT ONLY IF PATIENTS ARE NOT ELIGIBLE UNDER PRESUMPTIVE CHARITY OR DO NOT COMPLETE AN APPLICATION FOR FINANCIAL ASSISTANCE IF THEY CANNOT BE QUALIFIED AS PRESUMPTIVE. BAD DEBT EXPENSES ARE ACCOUNTS FOR PATIENTS THAT HAVE NOT PAID LCMH FOR THE SERVICES PROVIDED. EVERY EFFORT IS MADE TO QUALIFY THEM AS PRESUMPTIVE IF THEY DO NOT DIRECTLY REQUEST FINANCIAL ASSISTANCE. AN ELECTRONIC RESOURCE IS USED TO QUALIFY PATIENTS AS CHARITY BEFORE THE COLLECTION PROCESS IS STARTED. THE HOSPITALS ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF PAY PATIENTS WAS 86% AT JUNE 30, 2016 AND 69% AT JUNE 30, 2015. IN ADDITION, THERE WERE NO SIGNIFICANT FLUCTUATIONS IN WRITE-OFFS FROM SELF-PAY PATIENTS DURING FISCAL YEAR 2016 COMPARED TO FISCAL YEAR 2015. THE HOSPITAL PROVIDES CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS MEETING CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT REPORTED AS NET PATIENT SERVICE REVENUE. MEDICARE INFORMATION FORM 990, SCH H PART III LINE 8 MEDICARE AMOUNTS ARE TAKEN FROM THE AUDITED FINANCIAL STATMENTS. COLLECTION PRACTICES FORM 990, SCH H, PART III LINE 9B ANY PATIENT BALANCE THAT HAS GONE THROUGH THE IN-HOUSE COLLECTION PROCESS WILL BE SUBMITTED TO SEARCH AMERICA PRIOR TO BECOMING BAD DEBT. SEARCH AMERICA WILL YIELD BACK FEDERAL POVERTY PERCENTAGES THAT CAN BE USED TO QUALITY AS PRESUMPTIVE CHARITY WITHOUT APPLICATION BY THE PATIENT OR FAMILY. PATIENT EDUCATION OF ELGIBILITY FOR ASSISTANCE FORM 990, SCH H, PART VI, LINE 3 LCHM HAS POSTERS IN ALL REGISRATION AREAS RELATED TO ANY HOSPITAL DEPARTMENT INCLUDING OUR RURAL HEALTH CLINIC INFORMING PATIENTS THAT WE SEE ANYONE REGARDLESS OF THEIR ABILITY TO PAY AND THAT FINANCIAL ASSISTANCE IS AVALABLE TO UNINSURED AND UNDERINSURED. ALL ED PATIENTS ARE SEEN BY A PRACTITIONER PRIOR TO REQUEST FOR ANY FINANCIAL INFORMATION/INSURANCE AS REQUIRED BY EMTALA. ALL PATIENTS THAT DO NOT HAVE INSURANCE OR THAT HAVE A PATIENT BALANCE AFTER INSURANCE ARE CONTACTED BY OUR PATIENT FINANICAL SERVICES REPRESENTATIVE WHO THEN PROVIDES A FINANCIAL ASSISTANCE FORM. COMMUNITY INFORMATION FORM 990, SCH H, PART VI, LINE 4 LCMH SERVES AS A PREDOMINANTLY RURAL COUNTY IN SOUTH EASTERN ILLINOIS. THE POPULATION IS MORE ELDERLY AND LESS AFFLUENT THAN MOST COUNTIES IN THE STATE. 23.4% OF THE POPULATION HAS LESS THAN A HIGH SCHOOL DIPLOMA WITH ANOTHER 34.1% HAVING ONLY A HIGH SCHOOL EDUCATION. 12.3% OF THE HOUSEHOLDS REPORT INCOME OF LESS THAN 15,000. A LARGE TERTIARY HOSPITAL IS WITHIN 12 MILES OF LCMH LOCATED IN VINCENNES, IN. MANY PATIENTS WITH INSURANCE MAKE THE DRIVE LEAVING LCHM WITH A MUCH HIGHER PERCENT OF MEDICAID BUSINESS. WITH LCMH MOVEMENT TO NOT-FOR-PROFIT STATUS IN FY 2012 A MORE CONCERTED EFFORT WAS UNDERATKEN AT THE DIRECTION OF OUR BOARD TO IDENTIFY ANY PATIENT THAT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. TO BETTER SERVE THE NEED OF THESE PATIENTS, LCMH OPENED A RURAL HEALTH CLINIC STAFFED WITH PHYSICIANS AND MID-LEVEL PRACTITIONERS TO PROVIDE A PRIMARY SOURCE OF CARE THAT IS EASILY ACCESSIBLE FOR THEM. IN FY16, LCMH RHC EXTENDED THEIR HOURS ON EVENINGS AND WEEKENDS TO PROVIDE PRIMARY CARE TO THE COMMUNITY. PROMOTION OF COMMUNITY HEALTH FORM 990, SCH H. PART V, LINE 5 LCMH PARTICIPATES IN MANY COMMUNITY GROUPS THAT ARE DESIGNED TO IMPROVE THE HEALTH OF THE COMMUNITY. LCMH PROVIDES A MEETING LOCATION FOR ALCOHOLICS ANONYMOUS TWICE PER WEEK AS WELL AS A LOCATION FOR A LOCAL BEREAVEMENT AND SUPPORT GROUP. LCMH LEADERSHIP ALSO IS ONE OF SEVERAL BOARDS IN THE AREA TO SUPPORT ECONOMIC DEVELOPMENT AS WELL AS PROVIDE LEADERSHIP ROLES IN BOARDS THAT PROVIDE RESOURCES DURING FLOODING AND PROVIDE ACTIVE LEADERSHIP IN COMMITTEES FOR ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK PROVIDING SUPPORT TO ALL CAHS IN ILLINOIS TO HELP THEM BETTER SERVE THEIR COMMUNITIES. AFFLIATED HEALTH CARE SYSTEMS FORM 990, SCH H, PART VI LINE 6 LCMH IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. STATE FILING OF COMMUNITY BENEFIT REPORT FORM 990, SCH H. PART VI, LINE 7 LCHM IS NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT IN ILLNOIS DUE TO THE FACT THAT THE HOSPITAL CONTAINS LESS THAN 100 BEDS. NEEDS ASSESSMENT FORM 990, SCH H. PART VI LINE 2 LCMH UTILIZED SERVICES FROM QHR TO PERFORM A COMMUNITY HEALTH NEEDS ASSESSEMENT (CHNA) AND THE REPORT WAS PROVIDED IN JUNE 2016. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt |
|---|---|---|---|---|---|
| DR GARY CARR | |||||
| TRUSTEE /PHYSICAN | $228,417 | $228,417 | |||
| DOUG FLORKOWSKI | |||||
| CEO | $210,000 | $273,313 | $56,053 | $7,260 | |
| VALERIE BURNS | |||||
| PHYSICAN | $206,002 | $210,187 | $4,185 | ||
| STEVEN RAMSARAN | |||||
| PHYSICAN | $206,743 | $360,108 | $21,495 | $131,870 | |
| CHARLES CLAGETT | |||||
| PHYSICAN | $195,572 | $214,437 | $18,865 | ||
| RODNEY FINCH | |||||
| PHYSICAN | $186,781 | $205,646 | $18,865 | ||
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PAGE 1, PART I, LINE 7 | FormAndLineReferenceDesc |
| Explanation | PHYSICAN COMPENSATION PAID BASED ON ANTICIPATED VOLUME (VISITS) AND RECONCILED QUARTERLY. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| STAN WLLIAMS | |||
| FAMILY MEMBER | $66,016 | W-2 WAGES | false |
| RON WALDROP | |||
| FAMILY MEMBER | $34,205 | W-2 WAGES | false |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART V | FormAndLineReferenceDesc |
| Explanation | RON WALDROP IS A VOTING OFFICER OF THE HOSPITAL BOARD. HIS DAUGHTER IN LAW IS EMPLOYED IN THE IT DEPARTMENT. THE 2015 WAGES PAID BY LAWRENCE COUNTY MEMORIAL HOSPITAL LISTED ON HER W-2 TOTALED 34,205.26. STAN WILLIAMS IS A VOTING TRUSTEE OF THE HOSPITAL BOARD. HIS SON IN LAW IS THE DIRECTOR OF THE IT DEPARTMENT. THE 2015 WAGES PAID BY LAWRENCE COUNTY MEMORIAL HOSPITAL LISTED ON HIS W-2 TOTALED 66,016.21. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 3 | QUORUM HEALTH RESOURCES, LLC HAS A MANAGEMENT CONTRACT WITH THE BOARD OF LCMH SINCE MAY OF 2006. THIS CONTRACT WAS RENEWED IN 2015 FOR 5 YEARS WHICH WILL CONTINUE UNTIL JUNE 30, 2021. QUORUM HEALTH RESOURCES PROVIDES ASSISTANCE IN THE EVALUATION OF OFFICERS, PROVIDES ADMINISTRATIVE RESOURCES, CONSULTING SERVICES, CHARGE MASTER AND COMPLIANCE SERVICES. COMPENSATION OF BOARD MEMBERS FORM 990 PART VII, SECTION A DR GARY CARR IS COMPENSATED FOR BEING A PRACTICING PHYSICIAN AT LCMH. HE IS NOT COMPENSATED AS A MEMBER OF THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE CFO AND AN INDEPENDENT ACCOUNTING FIRM REVIEWED THE FORM 990 BEFORE FILING. AN ELECTRONIC OR HARD COPY OF THE FORM 990 IS PROVIDED TO ALL BOARD MEMBERS AFTER IT IS FILED. |
| FORM 990, PAGE 6, PART VI, LINE 12C | TRUSTEES AND DEPARTMENT LEADERS SIGN ANNUAL CONFLICT OF INTEREST POLICY STATEMENTS. ANYONE WITH A CONFLICT DOES NOT PARTICIPATE IN ANY RELATED DECISION MAKING PROCESSES. STAFF AND DEPARTMENT LEADERS HAVE THIS INCLUDED AS A PART OF THEIR ANNUAL TRAINING CONDUCTED ELECTRONICALLY THROUGH HEALTH STREAM. THE SIGNED STATEMENTS ARE REVIEWED BY THE COO AND THE CEO. |
| FORM 990, PAGE 6, PART VI, LINE 15A | A REVIEW IS CONDUCTED ANNUALLY BY THE ENTIRE BOARD OF TRUSTEES ALONG WITH THE REGIONAL MANAGEMENT TEAM FROM QUORUM HEALTH RESOURCES. NATIONAL COMPARATIVE DATA IS PROVIDED BY QHR AS PART OF THE ANNUAL CEO EVALUATION AND WAGE ADJUSTMENT. OFFICER COMPENSATION DECISIONS ARE ALSO DOCUMENTED IN THE BOARD MINUTES. |
| FORM 990, PAGE 6, PART VI, LINE 15B | A REVIEW IS CONDUCTED BY THE ENTIRE BOARD OF TRUSTEES ALONG WITH THE REGIONAL MANAGEMENT TEAM FROM QUROUM HEALTH RESOURCES. NATIONAL COMPARATIVE DATA IS PROVIDED BY QHR AS PART OF THE ANNUAL CEO EVALUATION AND WAGE ADJUSTMENT. OFFICER COMPENSATION DECISIONS ARE ALSO DOCUMENTED IN THE BOARD MINUTES. |
| FORM 990, PAGE 6, PART VI, LINE 18 | FORM 1023 HAS BEEN FILED, APPROVED AND IS AVAILAVLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE DOCUMENTS ARE AVAILABLE UPON REQUEST AT THE ADMINISTRATIVE OFFICES. |
| FORM 990, PART IX, LINE 11G | ED PHYSICIAN SERVICES 769,485 0 0 CONTRACTED SURGEON 349,839 0 0 LAUNDRY/LINEN SERVICE 112,165 0 0 CPSI - SOFTWARE 0 139,329 0 DIAGNOSTIC SHARED 0 182,365 0 NUC MED ULTRASOUND 351,673 0 0 VARIOUS OTHER SERVICES 489,351 312,380 0 |
| FORM 990, PART XI, LINE 9 | PROVISION FOR UNCOLLECTABLE -1,252,450 PROVISION FOR UNCOLLECTABLE 1,252,450 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | END AND DEV FOUNDATION FOR LAWREN | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2200 STATE STREET | AddressLine1Txt |
| City | LAWRENCEVILLE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62439 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 376052607 | EIN |
| Primary Activities | FUNDRAISIN | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Exempt Code Section | 501C3 | ExemptCodeSectionTxt |
| Public Charity Status | 9 | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LCMH E&D FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $74,326 | InvolvedAmt |
| Method Of Amount Determination | FMV | MethodOfAmountDeterminationTxt |