MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
MEMORIAL HOSPITAL ASSOCIATION (EIN 37-0684691)
Tax period
2014-07-01 to 2015-06-30
Filed
2016-05-12
IRS object ID
201621339349303622
Schema version
2014v6.0
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 ReturnHeader

FieldValueIRS element (for citing)
Return2016-05-12T13:41:33-05:00ReturnTs
Tax Period End2015-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN450250958PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11545 ASSOCIATES DR STE 101AddressLine1Txt
CityDUBUQUECityNm
State AbbreviationIAStateAbbreviationCd
ZIP52002ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN370684691EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Memorial Hospital AssociationBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMEMOBusinessNameControlTxt
Phone2173573131PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 160AddressLine1Txt
CityCarthageCityNm
State AbbreviationILStateAbbreviationCd
ZIP62321ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTeresa SmithPersonNm
Person TitleCFOPersonTitleTxt
Phone2173573131PhoneNum
Signature2016-05-10SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonCarmen KrantzPreparerPersonNm
PTINP00031958PTIN
Phone5635561790PhoneNum
Preparation2016-05-09PreparationDt
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-08-17 19:52:53ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerAda BairPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 160AddressLine1Txt
CityCarthageCityNm
State AbbreviationILStateAbbreviationCd
ZIP62321ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$26,177,501GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.mhtlc.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1947FormationYr
Legal Domicile StateILLegalDomicileStateCd
Activity Or MissionMemorial Hospital provides clinical care, diagnostic, treatment, and wellness servicesActivityOrMissionDesc
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee245TotalEmployeeCnt
Total Volunteers100TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$395,795PYContributionsGrantsAmt
CY Contributions Grants$372,373CYContributionsGrantsAmt
PY Program Service Revenue$22,489,896PYProgramServiceRevenueAmt
CY Program Service Revenue$23,279,164CYProgramServiceRevenueAmt
PY Investment Income$356,784PYInvestmentIncomeAmt
CY Investment Income$317,766CYInvestmentIncomeAmt
PY Other Revenue$25,560PYOtherRevenueAmt
CY Other Revenue$35,246CYOtherRevenueAmt
PY Total Revenue$23,268,035PYTotalRevenueAmt
CY Total Revenue$24,004,549CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$10,465,034PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$11,443,292CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$11,955,393PYOtherExpensesAmt
CY Other Expenses$11,985,751CYOtherExpensesAmt
PY Total Expenses$22,420,427PYTotalExpensesAmt
CY Total Expenses$23,429,043CYTotalExpensesAmt
PY Revenues Less Expenses$847,608PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$575,506CYRevenuesLessExpensesAmt
Total Assets BOY$35,319,847TotalAssetsBOYAmt
Total Assets EOY$40,236,205TotalAssetsEOYAmt
Total Liabilities BOY$21,379,153TotalLiabilitiesBOYAmt
Total Liabilities EOY$25,821,980TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$13,940,694NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$14,414,225NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionMemorial Hospital is committed to improving health by providing education and wellness programs and innovative services at all the stages of life.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$17,957,890ExpenseAmt
Revenue$23,279,164RevenueAmt
DescMemorial Hospital is dedicated to maintaining and improving the health of all people in the Hancock County area. Governed by a Board of Directors, we serve as a vital safety net, serving our communities with access to quality healthcare services. Memorial Hospital provides many types of community benefit care. Community benefit care includes charity care, community health fairs, lectures, and free health screenings, demonstrating our commitment to improving the overall health of the residents of the Hancock County area.In FY 2015, the Hospital had 2,362 patient days with 739 admissions and 738 discharges. There were 4,493 emergency room visits, 17,156 provider based physician clinic visits, and 13,695 rural health physician clinic visits.We are always committed to providing compassionate care to every member of our community regardless of their ability to pay.To fulfill its mission of community service, the Organization provides care to patients and residents who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Revenue from services to these patients and residents is recorded in the accounting system at the established rates, but the Organization does not pursue collection of the amounts. The resulting adjustments are recorded as adjustments to patient and resident service revenue, depending on the timing of the charity determination.The Illinois legislature passed a bill titled the "Hospital Uninsured Patient Discount Act." Effective April 1, 2009, this Act requires hospitals to provide certain mandated discounts from charges to the uninsured in Illinois. Charges are to be discounted at 135% of cost. Furthermore, a hospital may not collect more than 25% of an uninsured family's gross income in any one year.The Organization provides care to patients and residents who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the Organization does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The amounts of charges foregone, based on established rates was $333,236 for the year ended June 30, 2015. The estimated costs of the charges foregone, based upon an overall cost-to-charge ratio calculation, for the year end June 30, 2015 was $174,000.In addition, the Organization provides services to other medically indigent patients under certain government-reimbursed public aid programs. Such programs pay providers amounts which are less than established charges for the services provided to the recipients, and for some services the payments are less than the cost of rendering the services provided. The Organization also commits significant time and resources to endeavors and critical services which meet otherwise unfulfilled community needs. Many of these activities are sponsored with the knowledge that they will not be self-supporting or financially viable.Desc
Total Program Service Expenses$17,957,890TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit CounselingYes (1)CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (1)BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document66IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee245EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members13GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint VentureYes (1)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (1)WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldILStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Kim ByersBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone2173576571PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 160AddressLine1Txt
CityCarthageCityNm
State AbbreviationILStateAbbreviationCd
ZIP62321ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
Dan Asbury
President3.001.00Yes (X)Yes (X)$0$0$0
Matt Dickinson
Vice President3.001.00Yes (X)Yes (X)$0$0$0
Dennis Rankin
Secretary/Treasurer3.001.00Yes (X)Yes (X)$0$0$0
Terry Pope
Director3.001.00Yes (X)$0$0$0
Carol Gronewold
Director3.001.00Yes (X)$0$0$0
LuAnn Haas
Director4.001.00Yes (X)$0$0$0
Kathy Holst
Director3.001.00Yes (X)$0$0$0
Larry McClintock
Director5.001.00Yes (X)$0$0$0
Christopher Jones MD
Director3.001.00Yes (X)$342,373$0$32,546
Sharon Morrison
Director4.001.00Yes (X)$0$0$0
Peggy Latherow
Director3.001.00Yes (X)$0$0$0
Charles Gilbert
Director3.001.00Yes (X)$0$0$0
Edward McKenney DO
Director3.001.00Yes (X)$30,800$0$0
Ada Bair
CEO40.003.00Yes (X)$194,364$0$13,276
Teresa Smith
CFO40.003.00Yes (X)$120,780$0$19,709
Aaron Wesp MD
Family Practice Physician40.000.00$221,280$0$30,534Yes (X)
Randall Peters MD
Surgeon40.000.00$390,270$0$24,347Yes (X)
Kurtis Davis MD
Family Practice Physician40.000.00$256,703$0$28,839Yes (X)
Stephen Bergman
CRNA20.000.00$202,877$0$23,745Yes (X)
Douglas Heighton MD
Family Practice Physician40.000.00$194,348$0$29,034Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,953,795TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$202,030TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K9IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Gerald A Maas & Gerald S Maas
3615 St Anthony RdQuincyIL62305Construction company$2,130,926
Aimes of Carthage LLC
12533 W Lakeview DrOrland ParkIL604671071ER physician service$1,733,152
Consociate Group
PO Box 1068DecaturIL62525Group health insurance TPA$259,067
Diamond Healthcare Corp
PO Box 85050RichmondVA23262Gerophys & Cardio Rehab services$247,762
Cell Dox
PO Box 916HannibalMO63401Pathology services$216,485
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K6CntrctRcvdGreaterThan100KCnt
Fundraising$36,518FundraisingAmt
Government Grants$84,468GovernmentGrantsAmt
All Other Contributions$251,387AllOtherContributionsAmt
Total Contributions$372,373TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Patient & resident service revenu622110$22,948,140$22,948,140
Meaningful use revenue900099$237,189$237,189
Supporting revenue900099$101,582$101,582
Equity in Advance Phys Therapy900099$37,137$37,137
Equity in Sherrick Home Health900099-$44,884-$44,884
FieldValueIRS element (for citing)
Total Program Service Revenue$23,279,164TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$130,442TotalRevenueColumnAmt
Exclusion$130,442ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$51,959RealAmt
Personal$2,200PersonalAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$10,747RealAmt
Personal$0PersonalAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$41,212RealAmt
Personal$2,200PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$43,412TotalRevenueColumnAmt
Exclusion$43,412ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$2,337,383SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$2,145,193SecuritiesAmt
Other$4,866OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$192,190SecuritiesAmt
Other-$4,866OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$187,324TotalRevenueColumnAmt
Exclusion$187,324ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$3,980FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$36,518ContriRptFundraisingEventAmt
Fundraising Direct Expenses$12,146FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column-$8,166TotalRevenueColumnAmt
Exclusion-$8,166ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$24,004,549TotalRevenueColumnAmt
Related Or Exempt Func Income$23,279,164RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$353,012ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$776,871TotalAmt
Program Services$418,920ProgramServicesAmt
Management And General$357,951ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$91,430TotalAmt
Program Services$91,430ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$8,629,984TotalAmt
Program Services$7,472,453ProgramServicesAmt
Management And General$1,157,531ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$90,023TotalAmt
Program Services$66,770ProgramServicesAmt
Management And General$23,253ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,241,860TotalAmt
Program Services$1,162,242ProgramServicesAmt
Management And General$79,618ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$613,124TotalAmt
Program Services$499,065ProgramServicesAmt
Management And General$114,059ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$25,434TotalAmt
Management And General$25,434ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$60,627TotalAmt
Management And General$60,627ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$4,756,326TotalAmt
Program Services$3,228,838ProgramServicesAmt
Management And General$1,527,488ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$162,441TotalAmt
Management And General$162,441ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$620,489TotalAmt
Program Services$425,192ProgramServicesAmt
Management And General$195,297ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$505,945TotalAmt
Program Services$333,846ProgramServicesAmt
Management And General$172,099ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$68,277TotalAmt
Program Services$53,780ProgramServicesAmt
Management And General$14,497ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$72,081TotalAmt
Program Services$54,788ProgramServicesAmt
Management And General$17,293ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,102,393TotalAmt
Management And General$1,102,393ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,674,774TotalAmt
Program Services$1,674,774ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$252,295TotalAmt
Program Services$178,488ProgramServicesAmt
Management And General$73,807ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Medical supplies$1,495,722$1,495,722
Bad debt expense$775,281$775,281
Provider tax$335,378$335,378
Dues, fees, subscriptio$78,288$26,301$51,987

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$23,429,043TotalAmt
Program Services$17,957,890ProgramServicesAmt
Management And General$5,471,153ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$4,388,848BOYAmt
EOY$4,462,326EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$63,369BOYAmt
EOY$78,697EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,905,166BOYAmt
EOY$3,266,564EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
EOY$33,398EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$284,686BOYAmt
EOY$350,323EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$111,046BOYAmt
EOY$159,875EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$34,963,195LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$12,961,327LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$17,970,742BOYAmt
EOY$22,001,868EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$8,235,305BOYAmt
EOY$8,758,261EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$637,631BOYAmt
EOY$668,659EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$38,917BOYAmt
EOY$93,854EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$359,504BOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$324,633BOYAmt
EOY$362,380EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$35,319,847BOYAmt
EOY$40,236,205EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,535,061BOYAmt
EOY$1,488,400EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$56,107BOYAmt
EOY$18,764EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$18,430,000BOYAmt
EOY$17,995,000EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$681,867BOYAmt
EOY$4,765,894EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$278,703BOYAmt
EOY$215,606EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$397,415BOYAmt
EOY$1,338,316EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$21,379,153BOYAmt
EOY$25,821,980EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$13,872,607BOYAmt
EOY$14,309,215EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$44,721BOYAmt
EOY$81,644EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$23,366BOYAmt
EOY$23,366EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$13,940,694BOYAmt
EOY$14,414,225EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$35,319,847BOYAmt
EOY$40,236,205EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$575,506ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$161,215NetUnrlzdGainsLossesInvstAmt
Donated Services And Use Fclts-$12,502DonatedServicesAndUseFcltsAmt
Other Changes In Net Assets$71,742OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$9,622OtherActivitiesAmt
Total Lobbying Expenditures$9,622TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart II-B, Line 1:FormAndLineReferenceDesc
ExplanationMemorial Hospital Association paid dues to the Illinois Hospital Association of which a portion of the dues are used for lobbying.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee EtcYes (1)AgentTrusteeEtcInd
Beginning Balance$2,617BeginningBalanceAmt
Additions During Year$5,165AdditionsDuringYearAmt
Distributions During Year$3,132DistributionsDuringYearAmt
Ending Balance$4,650EndingBalanceAmt
Incl Escrow Custodial Acct Liab0InclEscrowCustodialAcctLiabInd

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$4,347,365BeginningYearBalanceAmt
Contributions$10,468ContributionsAmt
Investment Earnings Or Losses$110,116InvestmentEarningsOrLossesAmt
Grants Or Scholarships$1,000GrantsOrScholarshipsAmt
Other Expenditures$288,764OtherExpendituresAmt
Administrative Expenses$20,893AdministrativeExpensesAmt
End Year Balance$4,157,292EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$4,122,446BeginningYearBalanceAmt
Investment Earnings Or Losses$520,010InvestmentEarningsOrLossesAmt
Other Expenditures$274,389OtherExpendituresAmt
Administrative Expenses$20,702AdministrativeExpensesAmt
End Year Balance$4,347,365EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,980,678BeginningYearBalanceAmt
Investment Earnings Or Losses$386,316InvestmentEarningsOrLossesAmt
Other Expenditures$244,548OtherExpendituresAmt
End Year Balance$4,122,446EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$4,160,911BeginningYearBalanceAmt
Investment Earnings Or Losses$106,105InvestmentEarningsOrLossesAmt
Other Expenditures$286,338OtherExpendituresAmt
End Year Balance$3,980,678EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,468,333BeginningYearBalanceAmt
Investment Earnings Or Losses$936,413InvestmentEarningsOrLossesAmt
Other Expenditures$243,835OtherExpendituresAmt
End Year Balance$4,160,911EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.99440BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.00560PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$139,335InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$504,757OtherCostOrOtherBasisAmt
Book Value$644,092BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$24,661,443OtherCostOrOtherBasisAmt
Depreciation$6,983,801DepreciationAmt
Book Value$17,677,642BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$23,098OtherCostOrOtherBasisAmt
Depreciation$9,624DepreciationAmt
Book Value$13,474BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$8,245,124OtherCostOrOtherBasisAmt
Depreciation$5,856,109DepreciationAmt
Book Value$2,389,015BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,389,438OtherCostOrOtherBasisAmt
Depreciation$111,793DepreciationAmt
Book Value$1,277,645BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$22,001,868TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
Estimated health claims$215,000
Construction payable$534,241
Estimated third-party payor settlements$589,075
FieldValueIRS element (for citing)
Total Liability$1,338,316TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$22,835,097TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$161,215NetUnrealizedGainsInvstAmt
Other Revenue-$762,778OtherRevenueAmt
Revenue Not Reported-$923,993RevenueNotReportedAmt
Revenue Subtotal$23,759,090RevenueSubtotalAmt
Other Revenues Not Included$245,459OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$245,459RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$24,004,549TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$22,673,879TotExpnsEtcAuditedFinclStmtAmt
Donated Services Use Fclts$12,502DonatedServicesUseFcltsAmt
Other Expenses Included$10,747OtherExpensesIncludedAmt
Expenses Not Reported$23,249ExpensesNotReportedAmt
Expenses Subtotal$22,650,630ExpensesSubtotalAmt
Other Expenses Not Included$778,413OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$778,413ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$23,429,043TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part IV, Line 1b:Memorial Hospital Auxiliary uses the Hospital's FEIN but has its own checking account. The Auxiliary account balances were not included in the financial statements.
Part V, Line 4:An endowment fund with the income to be used for the benefit of Memorial Hospital Association. $23,366 is required to be retained permanently, either by explicit donor stipulation or by UPMIFA. Board designated funds are to be used for facility and equipment upgrades.
Part X, Line 2:The Hospital is organized as an Illinois nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to their exempt purposes. The Hospital has determined they are not subject to unrelated business income tax and have not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Hospital believes they have appropriate support for any tax positions taken affecting their annual filing requirements, and as such, do not have any uncertain tax positions that are material to the consolidated financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred.
Part XI, Line 2d - Other Adjustments:Net assets released from restrictions included in revenue for financial stmt 12,503. Provision for bad debts included in revenue for financial statements -775,281.
Part XI, Line 4b - Other Adjustments:Rent expenses included in revenue for Form 990 -10,747. Contributions and grants for long-lived assets incl in fund balance for F/S 276,679. Auxiliary revenue included in revenue on Form 990 5,165. Book/tax adjustment for Advance Physical Therapy -25,638.
Part XII, Line 2d - Other Adjustments:Rent expenses included in revenue for Form 990 10,747.
Part XII, Line 4b - Other Adjustments:Provision for bad debts included in revenue for financial statements 775,281. Auxiliary expenses included in expenses for Form 990 3,132.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1GalaEvent1Nm
Gross Receipts Event1$28,258GrossReceiptsEvent1Amt
Charitable Contri Event1$24,278CharitableContriEvent1Amt
Gross Revenue Event1$3,980GrossRevenueEvent1Amt
Food And Beverage Event1$3,980FoodAndBeverageEvent1Amt
Entertainment Event1$3,300EntertainmentEvent1Amt
Other Direct Expenses Event1$1,135OtherDirectExpensesEvent1Amt
Event2Barn DanceEvent2Nm
Gross Receipts Event2$12,240GrossReceiptsEvent2Amt
Charitable Contri Event2$12,240CharitableContriEvent2Amt
Food And Beverage Event2$1,700FoodAndBeverageEvent2Amt
Other Direct Expenses Event2$2,031OtherDirectExpensesEvent2Amt
Gross Receipts Total$40,498GrossReceiptsTotalAmt
Charitable Contributions Tot$36,518CharitableContributionsTotAmt
Gross Revenue Total Events$3,980GrossRevenueTotalEventsAmt
Food And Beverage Total Events$5,680FoodAndBeverageTotalEventsAmt
Entertainment Total Events$3,300EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events$3,166OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$12,146DirectExpenseSummaryEventsAmt
Net Income Summary-$8,166NetIncomeSummaryAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent150Yes (X)Percent150Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically Indigent0FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (1)ExpensesExceedBudgetInd
Unable To Provide Care0UnableToProvideCareInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$174,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$174,000NetCommunityBenefitExpnsAmt
Total Expense0.00770TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$7,541,519TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,103,695DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,437,824NetCommunityBenefitExpnsAmt
Total Expense0.19590TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$7,715,519TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,103,695DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,611,824NetCommunityBenefitExpnsAmt
Total Expense0.20360TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,685,264TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,617,271DirectOffsettingRevenueAmt
Net Community Benefit Expns$67,993NetCommunityBenefitExpnsAmt
Total Expense0.00300TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,685,264TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,617,271DirectOffsettingRevenueAmt
Net Community Benefit Expns$67,993NetCommunityBenefitExpnsAmt
Total Expense0.00300TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$12,400,783TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,720,966DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,679,817NetCommunityBenefitExpnsAmt
Total Expense0.20660TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReportedInd
Bad Debt Expense$775,281BadDebtExpenseAmt
Bad Debt Expense Attributable$77,528BadDebtExpenseAttributableAmt
Reimbursed By Medicare$5,434,522ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$5,489,724CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$55,202MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Memorial Hospital AssociationBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11454 North County Road 2050AddressLine1Txt
CityCarthageCityNm
State AbbreviationILStateAbbreviationCd
ZIP62321ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.mhtlc.orgWebsiteAddressTxt
State License0005611StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
Other4 RHCs - Memorial Medical Clinic Bowen, Memorial Medical Clinic LaHarpe, MemOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Memorial Hospital AssociationBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted12CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts0CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLwww.mhtlc.org/pages/reportsOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt12ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLwww.mhtlc.org/pages/reportsStrategyWebsiteURLTxt
Strategy Attached0StrategyAttachedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care150.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.000000000000FPGFamilyIncmLmtDscntCarePct
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLwww.mhtlc.com/pages/financialassistanceFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLwww.mhtlc.com/pages/financialassistanceFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLwww.mhtlc.com/pages/financialassistanceFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross ChargesYes (1)GrossChargesInd

Supplemental Information SupplementalInformationGrp (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Memorial Hospital AssociationPart V, Section B, Line 5: Local residents were asked to note what they perceived the problems and needs to be in the community. An online survey was developed within the local population for any resident to complete. 160 area residents provided community input. Local experts were interviewed throughout the data collection phase and asked to agree or disagree with the summary conclusions. The local experts answered questionnaires and participated in interviews, resulting in a supportive collection of needs and guided the hospital in developing its implementation response.
Memorial Hospital AssociationPart V, Section B, Line 11: 1. Monitor clinic physician availability, wait times for appointments and in office wait times. a. Increased physician availability, lower wait times, increased doctors who take calls and increased the supply of primary care physicians. b. Still investigating eMD capability for reports versus manual process. c. Took over the provider records when the urology provider in a nearby town retired and increased the clinic frequency from every-other week to every week.2. Develop outreach initiatives focused on areas of the county with the lowest market share. a. Still evaluating possible site locations for Hamilton and Sutter. b. We promoted clinics and hospital services through health fairs and community events. c. We conduct sports physicals in Hamilton and Carthage. Co-sponsor the family fair with the Health Department for kids, and held a health screening day in conjunction with the Farm Bureau for members. d. We are including the schedule for the specialty clinics in the paper monthly. Households receive a mailing for walk in hours and availability.3. Develop a business plan to see if other clinic sites within Hancock County are viable. a. OB and surgery - evaluating having a clinic in Hamilton. b. Opened clinic in Augusta.4. Strategic opportunities to align with joint physician recruiting a. Recruited new surgeon for our facility to replace retiring provider who was previously shared with another local hospital.5. Explore telemedicine opportunities to increase inpatient clinical consult availability a. Acuity levels of patient mix and telemedicine ICU is not something we are ready to take on.6. Recruit for General Surgeon, Family Practice and Internal Medicine or General Practitioner a. Recruited general surgeon and added full time Physician Assistant in Nauvoo. Recruited a full time midlevel provider in place of part-time physician at Nauvoo clinic location.7. Adverse Habits a. Started partnership with local schools for daily health tips and quarterly newsletter for distribution on health habits for students.8. Prevention a. Increased prevention service use through community wellness and prevention seminars. b. Continued to do more in the community focusing on offering events on site to meet health needs. c. The specialty calendar is posted on the health department website. d. Currently looking at possibilities through the Illinois Critical Access Hospital Network to collaborate with other CAH hospitals for collaborative care. e. Increased use of cancer detection services and support educational services. Sent annual reminders to patients for required screenings.9. Improve access to Urgent Care. a. Increased urgent care resources. b. Started after hour program at Rural Health Clinic for walk-in appointments in evenings and Saturday mornings.10. Diabetes a. Increased diabetic education services availability from part time to full time. b. Developed Diabetic Spotlight annual program held offsite location for attendees to learn diabetic nutrition and managing care. c. Promoted diabetic education services.
Memorial Hospital AssociationPart V, Section B, Line 13h: PRESUMPTIVE ELIGIBILITY: A patient may appear eligible for charity care discounts but there is no financial assistance form and a lack of supporting documentation. Often there is adequate information provided by the patient through other sources which could provide sufficient evidence to provide the patient with charity care assistance.In the event there is no evidence to support a patient's eligibility for charity care, Memorial Hospital and Memorial Medical Clinics could use outside agencies in determining estimate income amounts for the basis of determining charity care eligibility and potential discount amounts.Presumptive eligibility may be determined on the basis of individual life circumstance. In these situations, a patient is deemed to be eligible for 100% write off. A patient in this situation is presumed to be eligible and therefore does not need to complete a financial assistance applicationif they can provide proof that they meet one of the following criteria:a. Patient states that he/she is homeless. The due diligence efforts must be documented.b. Patient is deceased with no known estate.c. Patient is mentally incapacitated with no one to act on their behalf.d. Patient is currently eligible for Medicaid, but was not eligible on a prior date of service or for non-covered services. Instead of making the patient duplicate the required paperwork Memorial Hospital will rely on the financial assistance determination process from Medicaid.e. Accounts deemed uncollectible by a contracted collection agency.f. In the event of "special" circumstances where the income exceeds the poverty guidelines but medical bills are high, the Patient Account Director and/or Chief Financial Officer may determine partial or full eligibility provided proper documentation is available.PROPENSITY TO PAY: Propensity to pay may be determined by obtaining a healthcare score from an outside vendor.
Memorial Hospital AssociationPart V, Section B, Line 22d: The Hospital calculates the amounts generally billed using the Look-Back Method. This method takes into account all commercial insurance and Medicare. All individuals without insurance receive the Illinois Uninsured Discount Act discount. Also, prompt pay discounts are offered to all patients.
Memorial Hospital AssociationPart V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures.
Part V, Section B, Line 16Financial Assistance Policy Website Availability
Memorial Hospital Association Part V, Section B, line 16a website:www.mhtlc.com/pages/financialassistance
Memorial Hospital Association Part V, Section B, line 16b website:www.mhtlc.com/pages/financialassistance
Memorial Hospital Association Part V, Section B, line 16c website:www.mhtlc.com/pages/financialassistance
FieldValueIRS element (for citing)
Facility3FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
Advance Physical Therapy
620 Wabash StreetCarthageIL62321Physical therapy rehabilitation
Memorial Medical Clinic Augusta
204 Center StreetAugustaIL62311Physician clinic
Sherrick Home Health
1204 Buchanan Street 2CarthageIL62321Home health care services

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 6a:The community benefit report information is shared in Memorial Hospital's annual report and available on their website www.mhtlc.org.
Part I, Line 7:Charity care expense was converted to cost on line 7a based on an overall cost to charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report.
Part I, Line 7g:Memorial Medical Augusta Clinic is a physician clinic included as a subsidized service on the 990. Direct and indirect costs were $187,258.
Part I, Ln 7 Col(f):The amount of bad debt expense removed from total expenses to determine the percentage was $775,281.
Part III, Line 2:Accounts are not written off to bad debt until all payments on the account are applied including all third party payments, contractual allowances, and discounts. Any financial assistance or charity care is recorded as an adjustment to patient service revenue and is not written off to bad debt. We realize some patients may qualify for financial assistance but do not complete the required paperwork. We try to work with these patients to provide them with some form of financial assistance or other payment arrangements, but when patients are able to pay and do not, their balances are written off to bad debt. Payments received on an account previously written off to bad debt reduces bad debt expense.Bad debt expense on line 2 is reported at charges as presented on the financial statements.
Part III, Line 3:The estimated amount of the Organization's bad debt expense attributable to patients eligible under the Organization's charity care policy is calculated based on a percentage of applications denied for failure to complete required information.
Part III, Line 4:The footnote to the Organization's financial statements can be found on page 9 of the attached audited financial statements.
Part III, Line 8:Memorial Hospital Association is a critical access hospital and in prior years has not shown a Medicare shortfall. There was a shortfall for fiscal year 2014 due to sequestration. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit.Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. These amounts do not include fee schedule amounts.
Part III, Line 9b:Memorial Hospital does not pursue collection activities for patients that qualify for charity care or patients that have set up payment arrangements for their accounts. Memorial Hospital does not charge interest on patients with payment arrangements. Also, collection activities are not pursued for patients that are in the process of applying for charity care and patients waiting for approval or denial from public aid. Any personal portion due after financial assistance is established would follow normal collection procedures.
Part VI, Line 2:Memorial Hospital, based on its mission, wants to ensure that the health care needs of the community it serves are met. The Hospital has medical clinics located throughout Hancock County to improve access to health care services to our patients. The Board also has four committees; Finance, Planning, Quality and Community Health, and Marketing Committees that have community representation to ensure that input is obtained from the community when considering the health care needs of those we serve. Community input on desired services is obtained through patient satisfaction surveys that are initiated by the inpatient unit, emergency department, and medical clinics that provide a line of communication to identify additional health care services that community desires. The Community Health Needs Assessment is completed and posted to our website at www.mhtlc.com.
Part VI, Line 3:Memorial Hospital strives to provide a rewarding and healing process to our patients, plus an affordable, comfortable process to meet their financial obligations. Memorial Hospital informs their patients individually upon admission about the eligibility for assistance under federal, state or local government programs, and provides the patient with information regarding the Organization's charity care policy.Our Collection and Financial Assistance Policies and applications are on our website. We also provide financial counseling to any patient. We post our Charity Care Policy and information regarding federal, state, and local programs at all our registration areas. Brochures are distributed regarding financial assistance with all admission packages.Billing statements have financial assistance support telephone numbers at the bottom of each statement. Our third party billing service provides counseling to our patients regarding available financial assistance if there is a need.
Part VI, Line 4:Memorial Hospital Association is an 18-bed critical access hospital located in Carthage, IL. Carthage is a city in Hancock County, Illinois. It is located in western Illinois along the Mississippi River. The nearest city with a population > 50,000 is Peoria, IL. Its primary service area from its most recently completed community health needs assessment is defined as Hancock County, with Colchester, Lomax, Keokuk, Tennessee and Blandinsville as the secondary service area. The 2011 population for this area is estimated at 35,758 and is expected to decrease approximately 5.2%, to achieve a 2015 population of 33,863 contrary to the state growth average of 1.6% and national growth rate of 4.0%. The 2015 median age for the population is projected to be 43 years of age, slightly older than both the Illinois and national median ages. The 2011 median household income is approximately $41,000, significantly lower than the Illinois and national median. The unemployment rate as of August 2011 was 9.3%, lower than the Michigan rate and in line with the national rate of unemployment.The most common industries are agriculture, transportation, and health care. The nearest hospital is Keokuk Area Hospital about 15 miles away on the Iowa side of the Mississippi River.
Part VI, Line 5:Memorial Hospital is dedicated to improving health by providing education and wellness programs and innovative services at all the stages of life for residents of Hancock County. The Hospital is governed by a 13-member, volunteer Board of Directors that represent key areas within Hancock County as well as the medical staff. As a critical access hospital, Memorial Hospital is an 18-bed facility that provides general medical, surgical services along with obstetrics and an array of outpatient services for the community. Specialty clinics are also provided locally in the areas of cardiology, oncology, neurology, ophthalmology, podiatry, orthopedic, pulmonology, and sleep apnea so that our patients don't have to travel far to receive needed health care services. These specialty physicians are members of the Hospital's medical staff along with other providers that desire to serve members of our service area. The Hospital extends medical staff privileges to all qualified physicians in the community. With the support of the community, Memorial Hospital built a new 18-bed hospital that was occupied in August 2009. The facility provides up-to-date, diagnostic equipment and services with a capital budget also presented and approved on an annual basis to ensure that needed equipment is obtained to meet the expectations of our patients. Memorial Hospital operates an emergency room available to all regardless of ability to pay.The Hospital also participates in several health care events throughout the year providing free services as well as a listing of services that are offered through the Hospital, clinics, and specialty clinics. This includes, but is not limited to, health fairs, blood pressure screenings, and diabetic education. Memorial Hospital sponsors the bloodmobile and provides language assistance services.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Christopher Jones MD
Director$342,103$0$0$0$270$0$3,513$0$29,124$0$375,010$0$0$0
Ada Bair
CEO$192,078$0$0$0$2,286$0$1,990$0$11,376$0$207,730$0$0$0
Aaron Wesp MD
Family Practice Physician$220,866$0$0$0$414$0$0$0$30,624$0$251,904$0$0$0
Randall Peters MD
Surgeon$379,496$0$10,000$0$774$0$3,731$0$20,706$0$414,707$0$0$0
Kurtis Davis MD
Family Practice Physician$256,559$0$0$0$144$0$0$0$28,929$0$285,632$0$0$0
Stephen Bergman
CRNA$200,591$0$0$0$2,286$0$2,175$0$21,660$0$226,712$0$0$0
Douglas Heighton MD
Family Practice Physician$193,574$0$0$0$774$0$0$0$29,124$0$223,472$0$0$0

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
Western Illinois Economic Development Authority
A352256539958362AT22008-08-22$9,972,195Facility/equip upgrades & refund Revenue Bonds Series 2007 issued 12/27/07000
Western Illinois Economic Development Authority
B352256539958362AU92008-09-16$10,385,000New facility and equipment upgrades000

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtTotal ProceedsTotalProceedsAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtOther Spent ProceedsOtherSpentProceedsAmtSubstantial CompletionSubstantialCompletionYrCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintIndCapitalized InterestCapitalizedInterestAmtCapital ExpendituresCapitalExpendituresAmt
A$2,362,195$9,972,195$193,445$9,778,7502009Yes (1)0Yes (1)Yes (1)
B$10,385,000$207,014200900Yes (1)Yes (1)$392,128$10,177,986

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndPrivate Bus Use By OthersPrivateBusUseByOthersPctPrivate Bus Concerning UBIPrivateBusConcerningUBIPctTotal Private Business UseTotalPrivateBusinessUsePctBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A00000.000000.000000.0000000Yes (1)
B00000.000000.000000.0000000Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A000Yes (1)Yes (1)000Yes (1)
B000Yes (1)00000

Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (1)
BYes (1)

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Date Rebate Computation PerformedIssuer Name: Western Illinois Economic Development Authority Date the Rebate Computation was Performed: 07/15/2013 Issuer Name: Western Illinois Economic Development Authority Date the Rebate Computation was Performed: 07/15/2013
Schedule K, Part II, Line 11:The other spent proceeds were used to currently refund bonds on August 22, 2008.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
Mallory Holst
Family member to Kathy Holst, Director of board$26,184Employee compensation and benefits0
Roxanne Rankin
Family member to Dennis Rankin, Secretary/Treasure of board$35,745Employee compensation and benefits0
Danielle Gronewold
Family member to Carol Gronewold, Director of board$29,501Employee compensation and benefits0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 1The Executive Committee consists of the President, Vice President, Secretary-Treasurer, additional members as the Board appoints, the Chief Executive Officer and any other leadership team members deemed appropriate by the officers of the Board. The Chief Executive Officer and any Leadership Team members do not have the right to vote upon any action being taken. The Executive Committee meets only in the event that the Board is unable to take necessary action, has an agenda for each meeting, keeps minutes of its meetings, and mails a copy of the minutes of each meeting to each member of the Board of Directors within twenty-four (24) hours of the adjournment of the meeting. The primary purpose of the Executive Committee is to carry out critical tasks for effective Board functioning, including, but not limited to, Chief Executive Officer Management performance, management company performance, if applicable, and providing assistance to the Board in situations requiring action when it is impossible or impractical to convene a full Board meeting.
Form 990, Part VI, Section A, line 6The Corporation has one class of members. Any individual or organization that contributes one hundred dollars ($100) or more, upon application is entitled to receive life membership in the Corporation. Such memberships are not transferable. The membership of this Corporation is unlimited.
Form 990, Part VI, Section A, line 7aMemorial Hospital Association has Association Members who are presented with a slate of officers and Board members at the annual meeting. The Association votes by proxy to elect these officers and Board members. Each Member is entitled to one vote on each matter submitted to a vote of the Members. No person whose name does not appear on the list of Members kept by the Secretary-Treasurer is entitled to vote and there is no cumulative voting.
Form 990, Part VI, Section B, line 11The Form 990 is reviewed by the Finance Committee and then by the Board of Directors before it is filed. The final return is reviewed and signed by the CFO.
Form 990, Part VI, Section B, line 12cOfficers, Board members, and key employees are required to sign a conflict of interest statement upon hiring or becoming a Board member. The disclosure is updated at the annual Association meeting. Any possible conflict of interest is disclosed to the other Board members and made a matter of record through an annual procedure and also when the interest becomes a matter of Board action. Disclosures are reviewed by the Board of Directors and any Member for whom conflicts have been identified leaves and abstains from voting. Appropriate documentation of the handling of the conflict is kept to protect the interested party and Memorial Hospital Association. Additionally, the Compliance Officer meets with the Compliance Committee of the board. Any issues identified are logged and followed up by the Compliance Officer.
Form 990, Part VI, Section B, line 15aSalary surveys are reviewed annually to ensure all positions individually are within the market rate. Surveys are used from the local area (Blessing survey) and LSN & QHR (comparable organization surveys). The Executive Committee determines the salary for the CEO. Each Board member does an independent performance review of the CEO, which is compiled and used by the Executive Committee. The Executive Committee uses the Illinois Hospital Association salary survey as a guide for compensation using the high, middle, and low ranges for similar size organizations. Measures such as revenue, performance of the CEO, and budgetary constraints are all factors that are considered when reviewing the CEO's salary. The most recent review of salary occurred in January 2015. The salary for the CFO is determined by the CEO using the Blessing Survey and the Illinois Hospital Association survey as a guide for similar organizations based on the local area. The most recent review of salary occurred in January 2015.
Form 990, Part VI, Section C, line 19The Organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request. The financial statements are also required to be attached to the Form 990.
Form 990, Part IX, line 11gRepairs and maintenance: Program service expenses 207,862. Management and general expenses 120,938. Fundraising expenses 0. Total expenses 328,800. Purchased services: Program service expenses 2,983,227. Management and general expenses 999,551. Fundraising expenses 0. Total expenses 3,982,778. Professional fees: Program service expenses 37,749. Management and general expenses 406,999. Fundraising expenses 0. Total expenses 444,748.
Form 990, Part XI, line 9:Change in Memorial Hospital Auxiliary's assets -2,033. Book/tax difference for Advance Physical Therapy 25,638. Change in interest in net assets of Memorial Hospital Foundation 48,137.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1Hancock County Nursing Home AssociationBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 160AddressLine1Txt
CityCarthageCityNm
State AbbreviationILStateAbbreviationCd
ZIP62321ZIPCd
FieldValueIRS element (for citing)
EIN370902248EIN
Primary ActivitiesProvide education and wellness programs and innovative servicesPrimaryActivitiesTxt
Legal Domicile StateILLegalDomicileStateCd
Exempt Code Section501(c)(3)ExemptCodeSectionTxt
Public Charity StatusLine 3PublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Memorial Hospital AssociationBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationYes (1)ControlledOrganizationInd

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerIndOwnershipOwnershipPctDirect Controlling NADirectControllingNACd
Advance Physical Therapy of Hancock County
620 Wabash StreetCarthageIL62321113655886Physical therapy rehabilitationILMemorial Hospital AssociationRelated$37,137$31,1810Yes (1)0.50000
Hancock County SLF LLP
403 S AdamsCarthageIL62321204445121Assisted living facilityILN/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1Hancock Area Medical Supply dba Sherrick Home HealthBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11204 Buchanan St Ste 2AddressLine1Txt
CityCarthageCityNm
State AbbreviationILStateAbbreviationCd
ZIP62321ZIPCd
FieldValueIRS element (for citing)
EIN371180373EIN
Primary ActivitiesHome healthPrimaryActivitiesTxt
Legal Domicile StateILLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Memorial Hospital AssociationBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeCEntityTypeTxt
Share Of Total Income$542,605ShareOfTotalIncomeAmt
Share Of EOY Assets$511,054ShareOfEOYAssetsAmt
Ownership1.00000OwnershipPct
Controlled OrganizationYes (1)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1Hancock County Nursing Home AssociationBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeKTransactionTypeTxt
Involved$102,264InvolvedAmt
Method Of Amount DeterminationGeneral ledgerMethodOfAmountDeterminationTxt

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