RICHLAND MEMORIAL HOSPITAL INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- RICHLAND MEMORIAL HOSPITAL INC (EIN 37-1363001)
- Tax period
- 2014-10-01 to 2015-09-30
- Filed
- 2016-04-25
- IRS object ID
- 201641169349301124
- 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
- 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 | 2016-04-25T15:27:11-05:00 | ReturnTs |
| Tax Period End | 2015-09-30 | 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 | 2014-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 371363001 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RICHLAND MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | RICH | BusinessNameControlTxt |
| Phone | 6183952131 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 EAST LOCUST STREET | AddressLine1Txt |
| City | OLNEY | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62450 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MIKE STOVERINK | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 6183952131 | PhoneNum |
| Signature | 2016-04-25 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARK DALLAS | PreparerPersonNm |
| PTIN | P00187265 | PTIN |
| Phone | 6185291040 | PhoneNum |
| Preparation | 2016-04-25 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-08-17 19:52:53Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID ALLEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 EAST LOCUST STREET | AddressLine1Txt |
| City | OLNEY | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62450 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $52,259,774 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.RICHLANDMEMORIAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1953 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE EXCELLENT HEALTHCARE, PROMOTE WELLNESS, AND EDUCATE PATIENTS, STAFF, AND THE COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 641 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $196,797 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,836,956 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $44,395,229 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $48,418,213 | CYProgramServiceRevenueAmt |
| PY Investment Income | $89,172 | PYInvestmentIncomeAmt |
| CY Investment Income | $278,954 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,101,728 | PYOtherRevenueAmt |
| CY Other Revenue | $1,725,651 | CYOtherRevenueAmt |
| PY Total Revenue | $46,782,926 | PYTotalRevenueAmt |
| CY Total Revenue | $52,259,774 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $27,681,712 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $30,667,459 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $17,832,740 | PYOtherExpensesAmt |
| CY Other Expenses | $17,772,959 | CYOtherExpensesAmt |
| PY Total Expenses | $45,514,452 | PYTotalExpensesAmt |
| CY Total Expenses | $48,440,418 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,268,474 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,819,356 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $35,258,665 | TotalAssetsBOYAmt |
| Total Assets EOY | $39,087,946 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $12,607,883 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $13,124,313 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $22,650,782 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $25,963,633 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE EXCELLENT HEALTHCARE, PROMOTE WELLNESS, AND EDUCATE PATIENTS, STAFF, AND THE COMMUNITY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $48,440,418 | ExpenseAmt |
| Revenue | $52,259,774 | RevenueAmt |
| Desc | RICHLAND MEMORIAL HOSPITAL, INC., D/B/A RICHLAND MEMORIAL HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF RICHLAND MEMORIAL HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. THE MISSION OF RMH IS TO SERVE OUR COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH THE COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, WE OFFER > FREE CARE > CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST; AND > HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT AND EDUCATE THE COMMUNITY. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, PROFESSIONAL EDUCATION PROGRAMS, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. DURING FISCAL YEAR 2015, RICHLAND MEMORIAL HOSPITAL RECORDED 17,888 PATIENT DAYS. RICHLAND MEMORIAL HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST. THE HOSPITAL ALSO PROVIDES CARE TO PERSONS COVERED BY COMMERCIAL INSURANCE AT BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, RICHLAND MEMORIAL HOSPITAL RECOGNIZES THESE AMOUNTS AS COSTS INCURRED IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. CHARITY CARE IS ALSO PROVIDED THROUGH THE HOSPITAL'S INTERNAL POLICY OFFERED IN FY 2015. RICHLAND MEMORIAL HOSPITAL ALSO OFFERS AND PARTICIPATES IN PROGRAMS THROUGHOUT THE COMMUNITY. THESE INCLUDE: 1. AMBULANCE COVERAGE 2. MEETINGS/CONFERENCE FACILITIES 3. SCHOLARSHIPS 4. SUPPORT OF COMMUNITY ORGANIZATIONS/EVENTS/ACTIVITIES: > AINAD SHRINE TEMPLE > AMATEUR SPORTS PROMOTION > ABASSADOR COMPANY > AMERICAN HEART ASSOCIATION > BIG BROTHERS BIG SISTERS > BLUE KNIGHT TIP OFF CLUB > BUILD COMMUNITY > BUSINESS AFTER HOURS EVENTS > CHRISTMAS TREE / SANTA PRETZEL - 100 > EAST RICHLAND POST PROM > EDWARDS COUNTY FAIR > ERHS TIGER BASEBALL > FIRST PRESBYTERIAN CHURCH > HOLIDAY TOUR OF HOMES > HOME / BUSINESS EXPO > HSEI MEMORY MILES > IL HIGH SCHOOL RODEO > IL SOCIETY OF HEALTHCARE > LAGALA BOARD MEETING AND EVENT > LINCOLNLAND DISTRICT > MUSCULAR DYSTROPHY ASSN > NATIONAL MULTIPLE SCHLEROSIS > NEWTON ROTARY CLUB > OCC FOUNDATION > OCC MUSIC DEPT > OLNEANS YEARBOOK > OLNEY ARTS COUNCIL > OLNEY CENTRAL COLLEGE > OLNEY CHAMBER OF COMMERCE > OLNEY CHRISTMAS PARADE > OLNEY CITY COUNCIL > OLNEY ELKS CLUB > OLNEY FFA > OLNEY LADY TIGERS SOFTBALL > OLNEY LITTLE LEAGUE > OLNEY TIGER FOOTBALL > OLNEY TIGERS ATHLETICS > OLNEY TIGERSHARKS SWIM TEAM > OLNEY WHITE SQUIRREL COUNT > OUTREACH MISSION > RCRC WHITE SQUIRREL TRIATHLON > RICHLAND COUNTY 4-H > RICHLAND COUNTY CTA > RICHLAND COUNTY DEVELOPMENT CORP > RICHLAND COUNTY FARM & FAIR WEEK > RICHLAND COUNTY RECREATION COUNCIL > RICHLAND COUNTY COUNTY WALK AND ROLL > RICHLAND COUNTY YOUTH SOCCER (RCYS) > RIDGWAY CHAPTER IL AUDUBON SOCIETY > RMH & COMMUNITY GOLF OUTINGS > ROTARY CLUB OF OLNEY > RUCKERS WHOLESALE > SHRINE CLUB > SOUTHEASTEN ILLINOIS CONCERT ASSN > ST JOSEPH SCHOOL > ST THOMAS GOLF OUTING > SWAN > U.S. RT 50 FOUR-LANE COALITION > WEST RICHLAND HIGH SCHOOL > WEST RICHLAND POST PROM > WEST RICHLAND PTO 5. WELLNESS EVENTS/COMMUNITY CLINICS/SUPPORT GROUPS/ OUTREACH/EDUCATION > BLOOD PRESSURE SCREENING CLINICS > DIABETIC EDUCATION DAY > HEALTHFEST > NATIONAL HOSPITAL WEEK CHOLESTEROL/PSA SCREENING CLINIC > OLNEY SENIOR EXPO > SUPPORT GROUPS/EDUCATION A. BREAST CANCER SUPPORT GROUP - TICKET FOR THE CURE B. BREAST HEALTH OUTREACH/EDUCATION - TICKET FOR THE CURE C. CPR CLASSES D. DIABETES SUPPORT GROUP E. FIRST AID CLASSES F. INFECTION CONTROL IN-SERVICES TO LOCAL SCHOOLS G. LIFE SMART FOR WOMEN EDUCATIONAL CLASSES H. PREPARED CHILDBIRTH CLASSES I. REGIONAL PSYCHIATRIC CENTER PATIENT SUPPORT GROUP 6. SPECIAL ASSISTANCE PROGRAMS > MAMMOGRAPHY ASSISTANCE - IL BREAST AND CERVICAL CANCER PROGRAM SERVICE PROVIDER (LITTLE EGYPT & EAST CENTRAL REGION) > MAMMOGRAPHY ASSISTANCE - SUSAN G. KOMEN FOR THE CURE GRANT | Desc |
| Total Program Service Expenses | $48,440,418 | 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 | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | 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 | Yes (true) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (true) | 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 | 40 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 641 | 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 |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | 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 | Yes (true) | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MIKE STOVERINK | PersonNm |
| Phone | 6183952131 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 EAST LOCUST ST | AddressLine1Txt |
| City | OLNEY | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62450 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| PAT BURKE | |||||||
| SECRETARY/TR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| ANDY SCHUETZ | |||||||
| VICE CHAIR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| RICK BUSSARD | |||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| DENNIS GRAVES | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| HERBERT BROKHOF | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| HARRY GARRETT MD | |||||||
| BOARD MEMBER | 30.00 | Yes (X) | $0 | $0 | $0 | ||
| JESSICA SLATER | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CAROL SCHAFER | |||||||
| BOARD MEMBER | 0.25 | Yes (X) | $0 | $0 | $0 | ||
| DAN EICHELBERGER | |||||||
| BOARD MEMBER | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| HERMAN ZUBER | |||||||
| CHAIRMAN | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| ROBERT ANNISS | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVE ALLEN | |||||||
| CEO | 40.00 | $180,689 | $0 | $12,319 | Yes (X) | ||
| MIKE STOVERINK | |||||||
| CFO | 40.00 | $122,162 | $0 | $8,106 | Yes (X) | ||
| PRASHANTH ANAND | |||||||
| PHYSICIAN | 40.00 | $395,631 | $0 | $19,906 | Yes (X) | ||
| MARY WALLER | |||||||
| PHYSICIAN | 40.00 | $355,044 | $0 | $762 | Yes (X) | ||
| NIRANAT DEJTIRANUKUL | |||||||
| ENT DOCTOR | 40.00 | $323,237 | $0 | $15,521 | Yes (X) | ||
| STEPHEN REID | |||||||
| PHYSICIAN | 40.00 | $298,708 | $0 | $14,311 | Yes (X) | ||
| PAUL SUTHERLAND MD | |||||||
| PHYSICIAN | 40.00 | $293,269 | $0 | $20,841 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,968,740 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $91,766 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 21 | 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 |
|---|---|---|---|---|---|
| SODEXHO | |||||
| 4880 PAYSPHERE CIRCLE | CHICAGO | IL | 60674 | FOOD SERVICE PR | $868,607 |
| EMERGENCY DEPARTMENT ASSOCIATION PC | |||||
| 7032 COLLECTION CENTER DRIVE | CHICAGO | IL | 60693 | ER PHYSICIANS | $660,073 |
| PHARMACY SYSTEMS INC | |||||
| 5050 BRADENTON AVE | DUBLIN | OH | 43017 | PHARMACY DIRECT | $244,552 |
| SAJJAN K NAMANI MD MRCP | |||||
| 1054 ML KING DRIVE STE 124 | CENTRALIA | IL | 62801 | SLEEP STUDIES | $176,250 |
| TRI-STATE FIRE PROTECTION | |||||
| PO BOX 70 | NEWBURGH | IN | 476290070 | MAINTENANCE | $150,822 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $196,398 | RelatedOrganizationsAmt |
| Government Grants | $16,952 | GovernmentGrantsAmt |
| All Other Contributions | $1,623,606 | AllOtherContributionsAmt |
| Total Contributions | $1,836,956 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Total Revenue Column | $48,418,213 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $48,418,213 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $48,418,213 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $278,954 | TotalRevenueColumnAmt |
| Exclusion | $278,954 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|
| EHR MEANINGFUL USE INCENTIVE | $648,122 | $648,122 |
| MISC. OTHER REVENUE | $440,877 | $440,877 |
| PROPERTY TAX | $399,996 | $399,996 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $236,656 | TotalRevenueColumnAmt |
| Exclusion | $236,656 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,725,651 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $52,259,774 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $48,418,213 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $2,004,605 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $302,851 | TotalAmt |
| Program Services | $302,851 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,986,776 | TotalAmt |
| Program Services | $21,986,776 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $658,676 | TotalAmt |
| Program Services | $658,676 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,203,050 | TotalAmt |
| Program Services | $6,203,050 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,516,106 | TotalAmt |
| Program Services | $1,516,106 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,445 | TotalAmt |
| Program Services | $33,445 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,776,824 | TotalAmt |
| Program Services | $4,776,824 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $340,238 | TotalAmt |
| Program Services | $340,238 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,131,767 | TotalAmt |
| Program Services | $4,131,767 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $817,071 | TotalAmt |
| Program Services | $817,071 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,127 | TotalAmt |
| Program Services | $98,127 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $150,234 | TotalAmt |
| Program Services | $150,234 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $310,370 | TotalAmt |
| Program Services | $310,370 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,851,659 | TotalAmt |
| Program Services | $1,851,659 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $636,143 | TotalAmt |
| Program Services | $636,143 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| PROVIDER TAX ASSESSMENT | $1,653,814 | $1,653,814 |
| PURCHASE OF DRUGS | $1,480,226 | $1,480,226 |
| REPAIRS/MAINTENANCE | $1,199,613 | $1,199,613 |
| OTHER EXPENSES | $293,428 | $293,428 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,440,418 | TotalAmt |
| Program Services | $48,440,418 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,504,270 | BOYAmt |
| EOY | $8,873,121 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,932,251 | BOYAmt |
| EOY | $5,934,066 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $795,065 | BOYAmt |
| EOY | $821,516 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $360,476 | BOYAmt |
| EOY | $956,055 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $44,814,495 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $31,252,377 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,778,385 | BOYAmt |
| EOY | $13,562,118 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,375,406 | BOYAmt |
| EOY | $6,204,475 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,512,812 | BOYAmt |
| EOY | $2,736,595 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,258,665 | BOYAmt |
| EOY | $39,087,946 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,553,738 | BOYAmt |
| EOY | $6,347,611 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,054,145 | BOYAmt |
| EOY | $6,776,702 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,607,883 | BOYAmt |
| EOY | $13,124,313 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,319,837 | BOYAmt |
| EOY | $25,709,205 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $330,945 | BOYAmt |
| EOY | $254,428 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,650,782 | BOYAmt |
| EOY | $25,963,633 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,258,665 | BOYAmt |
| EOY | $39,087,946 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $3,819,356 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$429,988 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$76,517 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $39,983 | OtherCostOrOtherBasisAmt |
| Book Value | $39,983 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,009,932 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,348,574 | DepreciationAmt |
| Book Value | $7,661,358 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $385,022 | OtherCostOrOtherBasisAmt |
| Depreciation | $353,886 | DepreciationAmt |
| Book Value | $31,136 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $19,379,558 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,549,917 | DepreciationAmt |
| Book Value | $5,829,641 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $13,562,118 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (7 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| MISCELLANEOUS RECEIVABLES | $1,384,553 |
| DUE FROM MEDICAID ASSESMENT | $405,848 |
| DUE TO THRID PARTY PAYORS | $310,074 |
| INTEREST IN NET ASSETS OF FOUNDATION | $254,428 |
| DUE FROM COUNTY-AMBULANCE SUBSIDY | $218,594 |
| EST. MEDICAL MALPRACTICE RECIEVABLE | $150,000 |
| DUE FROM PHYSICIANS | $13,098 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,736,595 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $51,829,786 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$429,988 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$429,988 | RevenueNotReportedAmt |
| Revenue Subtotal | $52,259,774 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $52,259,774 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $48,440,418 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $48,440,418 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $48,440,418 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 3, PART X | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM INCOME TAXES. THERE WERE NO UNCERTAIN TAX BENEFITS IDENTIFIED AND RECORDED AS A LIABILITY UPON THE ADOPTION OF ASC TOPIC 740-10-25 ON SEPTEMBER 30, 2012. AT SEPTEMBER 30, 2015 NO INTEREST OR PENALTIES WERE ATTRIBUTED TO THE HOSPITAL. TAX RETURNS FILED BY THE HOSPITAL ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. TAX RETURNS FILED BY THE HOSPITAL ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEARS ENDED SEPTEMBER 30, 2011 AND PRIOR. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| 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 | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $669,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $669,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01380 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,559,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,075,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,484,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05130 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,228,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,075,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,153,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06510 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $255,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $255,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00530 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,853,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,640,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,213,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06630 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,108,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,640,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,468,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07160 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,336,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,715,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,621,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13670 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $893,328 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $446,664 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $16,727,000 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $22,001,000 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$5,274,000 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| 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 | RICHLAND MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 EAST LOCUST | AddressLine1Txt |
| City | OLNEY | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62450 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RICHLAND 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 | 12 | 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 | WWW.RICHLANDMEMORIAL.COM | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.RICHLANDMEMORIAL.COM | StrategyWebsiteURLTxt |
| 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 | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| 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 |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPWWWRICHLANDMEMORIALCOM | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPWWWRICHLANDMEMORIALCOM | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit Other Actions | Yes (X) | PermitOtherActionsInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| Other Actions | Yes (X) | OtherActionsInd |
| 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 (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, RICHLAND MEMORIAL HOSPITAL - PART V, LINE 5 | INPUT RECEIVED THROUGH FOCUS GROUPS CONSISTING OF INDIVIDUALS FROM OUR SURROUNDING COMMUNITIES. |
| FACILITY 1, RICHLAND MEMORIAL HOSPITAL - PART V, LINE 11 | COMPLETED IMPLMENTATION ACTIONS: HEALTH NEED 1: MENTAL HEALTH AND RELATED SOCIAL ISSUES -DISCUSSIONS WITH SIHF REGARDING RECRUITMENT STRATEGIES/INTENTIONS FOR MENTAL HEALTH SERVICES -RMH OUTREACH SPECIALIST INITIATING RESEARCH INTO VARIOUS OPTIONS FOR THE INCREASED PROVISION OF MENTAL HEALTH SERVICES: -RMH ACTED AS A LIASON TO LOCAL SCHOOL SYSTEM FOR LINK TO LAWRENCE COUNTY HEALTH DEPARTMENT BEHAVIORAL HEALTH SERVICES FOR ON-SITE,AT- RISK PROGRAMMING. -DISCUSSIONS WITH CENTERPOINTE HOSPITAL FOR PROVISION OF MENTAL HEALTH SERVICES (INPATIENT AND OUTPATIENT) -DISCUSSION WITH LOCAL MENTAL HEALTH PROVIDERS FOR IDEAS/LEADS ON RECRUITMENT OF PROVIDERS. -ONGOING EXPLORATION OF VIABLE OPTIONS TO INCREASE MENTAL HEALTH SERVICES. HEALTH NEED 2: ACCESS TO HEALTH SERVICES -RECRUITED SEVERAL NEW PROVIDERS AND INCEASED NUMBER OF ATHLETIC TRAINERS IN REHAB SERVIES. -AFFILIATION AGREEMENT WITH CARLE CLINIC IN CHAMPAIGN-URBANA -CONTINUED INVESTMENT IN MEDICAL SCHOOL STUDENTS TO PROVIDE FOR FUTURE RMH STAFFING. -PARTICIPATED IN RICHLAND COUNTY INTERAGENCY STEERING COMMITTE - DISCUSSION ON THE DEVELOPMENT OF A LOCAL HEALTH DEPARTMENT HEALTH NEET 3: CHRONIC DISEASE MANAGEMENT -PROVIDE SPACE FOR MEDASSIST PROGRAM TO ASSIST WITH MEDICATION AQUISITION -PROVIDE DIABETES EDUCATION AND SUPPORT GROUP, LEAD BY RMH CERTIFIED DIABETIC EDUCATOR -COLLABORATE WITH SIHF TO PROVIDE CERTIFIED APPLICATION COUNSELORS TO ASSIST WITH ACA DIRECTED INSURANCE MARKETPLACE -PROVIDE SODIUM REDUCTION PROGRAM TO RMH PATIENTS, STAFF, AND COMMUNITY -HIRED TRANSITIONAL CARE SPECIALIST TO PROVIDE FOLLOW-UP/PREVENTION EDUCATION WITH PATIENTS AT HIGHER RISK OF READMISSION DUE TO CHRONIC ILLNESS. -DEVELOP SMOKING CESSATION PROGRAM TO BE OFFERED TO PATIENTS, COMMUNITY MEMBER, AND AREA CORPORATIONS. NO COMMUNITY NEEDS WERE LEFT UNADRESSED. |
| FACILITY 1, RICHLAND MEMORIAL HOSPITAL - PART V, LINE 18D | OUTSOURCED TO OUTSIDE COLLECTION AGENCY |
| FACILITY 1, RICHLAND MEMORIAL HOSPITAL - PART V, LINE 22D | THE HOSPITAL CHARGES ALL PATIENTS THE SAME REGARDLESS OF FINANCIAL CLASS AND/OR ABILITY TO PAY. |
| FACILITY 1, RICHLAND MEMORIAL HOSPITAL - PART V, LINE 24 | THE HOSPITAL CHARGES ALL PATIENTS THE SAME REGARDLESS OF FINANCIAL CLASS AND/OR ABILITY TO PAY. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 7 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| OUTPATIENT THERAPY | ||||
| 800 E LOCUST STREET | OLNEY | IL | 62450 | OUTPATIENT THERAPY |
| HOME HEALTH | ||||
| 800 E LOCUST STREET | OLNEY | IL | 62450 | HOME HEALTH AGENCY |
| RMH PROFESSIONAL SERVICES | ||||
| 1200 NORTH EAST STREET | OLNEY | IL | 62450 | PHYSICIAN PRACTICE (GENERAL SURGERY) |
| HOSPICE | ||||
| 800 E LOCUST STREET | OLNEY | IL | 62450 | HOSPICE SERVICES |
| RMH PROFESSIONAL SERVICES-ENT | ||||
| 800 E LOCUST STREET | OLNEY | IL | 62450 | PHYSICIAN PRACTICE (EAR, NOSE,THROAT) |
| RMH PROFESSIONAL SERVICES-UROLOGY | ||||
| 1200 NORTH EAST STREET | OLNEY | IL | 62450 | PHYSICIAN PRACTICE (UROLOGY) |
| RMH PROFESSIONAL SERVICES - PRIMARY | ||||
| 800 E LOCUST STREET | OLNEY | IL | 62450 | PRIMARY CARE PHYSICIANS |
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION | SUBSIDIZED HEALTH SERVICES ARE NET COSTS FOR BILLED SERVICES THAT ARE SUBSIDIZED BY THE HOSPITAL. THESE INCLUDE SERVICES OFFERED DESPITE A FINANCIAL LOSS BECAUSE THEY ARE NEEDED IN THE COMMUNITY AND EITHER OTHER PROVIDERS ARE UNWILLING TO PROVIDE THE SERVICES OR THE SERVICES WOULD OTHERWISE NOT BE AVAILABLE IN SUFFICIENT AMOUNT.WE INCLUDED AS UNREIMBURSED COSTS OF SUBSIDIZED HEALTH SERVICES, 1,846,000 FOR PHYSICIAN CLINICS 843,000 FOR EMERGENCY ROOM, 395,000 FOR PSYCHIATRIC CENTER, AND 130,000 FOR AMBULANCE SERVICE. |
| PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION | WE USED A COST-TO-CHARGE RATIO AS CALCULATED UTILIZING DATA FROM AN INTERNAL COST ACCOUNTING SYSTEM AND USING A METHODOLOGY CONSISTENT WITH SCEDULE H INSTRUCTIONS TO DETERMINE THE AMOUNTS ON LINES 7A AND 7B OF PART I OF SCHEDULE H. WE USED ACTUAL COSTS AS REPORTED IN THE GENERAL LEDGER SYSTEM TO DETERMINE THE AMOUNTS ON LINES 7E AND 7I OF SCHEDULE H PART I. SCHEDULE H, PART I, LINE 7G WAS DETERMINED USING BOTH ACTUAL AMOUNTS FROM THE GENERAL LEDGER AND A COST-TO-CHARGE RATIO SPECIFIC TO EACH PROGRAM. |
| PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY | WE CALCULATED BAD DEBT EXPENSE AT COST USING A COST-TO-CHARGE RATIO AS CALCULATED UTILIZING DATA FROM AN INTERNAL COST ACCOUNTING SYSTEM AND USING A METHODOLOGY CONSISTENT WITH SCEDULE H INSTRUCTIONS. AFTER EXHAUSTING ALL COLLECTION PROCEDURES PATIENT ACCOUNTS ARE THEN WRITTEN OFF TO BAD DEBT EXPENSE. WE ESTIMATE THAT 50% OF OUR PATIENT ACCOUNTS WRITTEN OFF TO BAD DEBT WOULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE BUT THE PATIENTS CHOSE NOT TO APPLY. THE FOLLOWING IS THE FOOTNOTE RELATING TO BAD DEBT EXPENSE EXACTLY AS IT APPEARS IN THE FOOTNOTES TO OUR AUDITED FINANCIAL STATEMENTS: FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE HOSPITAL RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED (OR ON THE BASIS OF DISCOUNTED RATES, IF NEGOTIATED OR PROVIDED BY POLICY). ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE HOSPITAL'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. DURING THE YEAR ENDED SEPTEMBER 30, 2015 THE HOSPITAL REPORTED PROVISIONS FOR UNCOLLECTIBLE ACCOUNTS OF 3,074,081. |
| PART III, LINE 8 - MEDICARE EXPLANATION | THE HOSPITAL UTILIZED THE INTERNAL COST ACCOUNTING SYSTEM TO CALCULATE UNREIMBURSED MEDICARE COSTS. SOME MEDICARE CHARGES NOT ASSOCIATED WITH ITEMS PAID ON THE COST REPORT, THE COSTS ASSOCIATED WITH THOSE CHARGES, AND OTHER COST PER THE HOSPITAL'S COST ACCOUNTING SYSTEM HAVE BEEN INCLUDED. |
| PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION | RICHLAND MEMORIAL HOSPITAL (RMH) APPLIES ITS COLLECTION PRACTICES EQUALLY TO ALL PATIENTS, BOTH CHARITY CARE ELIGIBLE AND NON-CHARITY CARE PATIENTS. THE PROCEDURES ARE AS FOLLOWS: 1. WE WILL SEND 2 STATEMENTS AND 2 COLLECTION LETTERS IN A 28 DAY CYCLE. WE WILL SEND STATEMENTS BASED UPON PATIENT PORTION OF 10 OR GREATER. 2. THE PATIENT'S ACCOUNT WILL AGE THROUGH THE STATEMENT PROCESS BEFORE BEING WRITTEN OFF TO BAD DEBT. A.PRIVATE PAY ACCOUNTS WILL RECEIVE A STATEMENT WITHIN 9 DAYS OF THE DISCHARGE DATE. B.ACCOUNTS WITH A PATIENT PORTION AFTER INSURANCE WILL BE ELIGIBLE TO RECEIVE A STATEMENT APPROXIMATELY 14 DAYS AFTER THE INSURANCE PAYMENT HAS BEEN POSTED. C.28 DAYS LATER THE PATIENT IS MAILED A THIRD STATEMENT D.28 DAYS LATER THE PATIENT IS MAILED THE FIRST COLLECTION LETTER E.28 DAYS LATER THE PATIENT IS MAILED THE FINAL COLLECTION LETTER F.APPROXIMATELY 15 DAYS LATER THE PATIENT IS WRITTEN OFF TO BAD DEBT. 3. RMH WILL ATTEMPT TO CONTACT THE GUARANTOR VIA PHONE AFTER THEY RECEIVE THE FIRST STATEMENT ON BALANCES GREATER THAN 1,000. 4. RMH WILL ATTEMPT TO CONTACT THE GUARANTOR VIA PHONE AFTER THE SECOND STATEMENT ON BALANCES LESS THAN 1,000 5. RMH WILL MAKE A SECOND ATTEMPT TO CONTACT THE GUARANTOR VIA PHONE IF PAYMENT OR CONTACT HAS NOT BEEN MADE USUALLY AROUND THE SAME TIME THE SECOND COLLECTION LETTER IS SENT. 6. RMH WILL SEND 2 COLLECTION LETTERS TO THE PATIENT. PATIENT HAS 15 DAYS AFTER THE FINAL LETTER TO PAY BEFORE BEING WRITTEN OFF TO BAD DEBT. |
| PART VI, LINE 2 - NEEDS ASSESSMENT | THE DETERMINATION OF CURRENT AND FUTURE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED ARE BASED ON THE FOLLOWING FACTORS: EXISTENCE OR NONEXISTENCE OF SERVICES, OPPORTUNITY, SUPPLY, DEMONSTRATED NEED, REQUESTS FROM PATIENTS, AND/OR COMBINED EFFORTS WITH OUTSIDE ENTITIES THAT WOULD HELP FILL A NEED OR STRENGTHEN A CURRENT SERVICE. WE ARE CONSTANTLY COLLECTING DATA THAT WOULD HELP MAKE THESE DECISIONS AND OFTEN CONSULT WITH VARIOUS DEPARTMENTS WITHIN THE HOSPITAL INCLUDING NURSING, INFORMATION TECHNOLOGY, FINANCE, AND PHYSICIANS. THIS INFORMATION IS THEN REVIEWED AND THE HOSPITAL'S ADMINISTRATIVE TEAM WOULD INCORPORATE THE NEWLY IDENTIFIED HEALTH CARE NEEDS INTO THE STRATEGIC PLAN. |
| PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | ALL PATIENT BILLING STATEMENTS INCLUDE A STATEMENT THAT MENTIONS CONTACTING THE HOSPITAL IF THEY WISH TO APPLY FOR FINANCIAL ASSISTANCE OR WOULD LIKE TO SET UP PAYMENTS ON THE ACCOUNT. IF A PATIENT CONTACTS THE PATIENT FINANCIAL SERVICES DEPARTMENT ABOUT THE INABILITY TO PAY, THEY ARE INFORMED OF THE AVAILABLE OPTIONS, INCLUDING FINANCIAL ASSISTANCE, MEDICARE, AND MEDICAID APPLICATIONS. THEY WILL ALSO EXPLAIN HOW THE PATIENT CAN APPLY FOR ASSISTANCE. |
| PART VI, LINE 4 - COMMUNITY INFORMATION | RICHLAND MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA INCLUDES PORTIONS OF EIGHT SOUTHEASTERN ILLINOIS COUNTIES WITH A TOTAL PATIENT POPULATION OF ABOUT 60,000. THERE ARE EIGHT COUNTIES WITHIN THE HOSPITAL'S PRIMARY SERVICE AREA. RMH FURTHER EXTENDS HOME HEALTH AND HOSPICE SERVICES TO INDIVIDUALS LIVING IN FIVE ADDITIONAL COUNTIES. WE PROVIDE SERVICES TO PATIENTS WITHOUT REGARD TO AGE, SEX, RACE, COLOR, NATIONAL ORIGIN, RELIGIOUS CREED, GENDER IDENTITY, SEXUAL ORIENTATION, DISABILITY, INSURANCE COVERAGE OR ABILITY TO PAY. THE POPULATION OF RICHLAND MEMORIAL HOSPITAL'S SERVICE AREA IS ECONOMICALLY DISADVANTAGED MAKING IT MORE DIFFICULT TO AFFORD HEALTHCARE. FURTHERMORE, THERE IS NO HEALTH DEPARTMENT IN RICHLAND COUNTY MAKING THE HOSPITAL THE PRIMARY SOURCE FOR HEALTHCARE SERVICES AND HEALTH EDUCATION. ACCORDING TO THE 2013 UNITED STATES CENSUS, THE MEDIAN HOUSEHOLD INCOME IN THE HOSPITAL'S SERVICE AREA FALLS WELL BELOW THE STATE MEDIAN OF 56,797, WHERE RICHLAND COUNTY'S MEDIAN INCOME IS 44,070. THE ILLINOIS DEPARTMENT OF PUBLIC HEALTH CENTER FOR RURAL HEALTH INDICATES ON ITS WEB SITE THAT ALL OF THE COUNTIES IN THE HOSPITAL'S SERVICE AREA HAVE AT LEAST A PARTIAL FEDERAL HPSA DESIGNATION, WITH THE LOW-INCOME POPULATION BEING A PRIMARY CONCERN. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|
| DAVE ALLEN | ||||
| CEO | $180,689 | $7,400 | $4,919 | $193,008 |
| PRASHANTH ANAND | ||||
| PHYSICIAN | $395,631 | $14,722 | $5,184 | $415,537 |
| MARY WALLER | ||||
| PHYSICIAN | $355,044 | $762 | $355,806 | |
| NIRANAT DEJTIRANUKUL | ||||
| ENT DOCTOR | $323,237 | $13,000 | $2,521 | $338,758 |
| STEPHEN REID | ||||
| PHYSICIAN | $298,708 | $12,010 | $2,301 | $313,019 |
| PAUL SUTHERLAND MD | ||||
| PHYSICIAN | $293,269 | $12,933 | $7,908 | $314,110 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| RICK BUSSARD | |||
| INSURANCE AGENT | $728,405 | INSURANCE PREMIUM | false |
| HERMAN ZUBER | |||
| FAMILY MEMBER | $43,128 | REPORTABLE COMPENSAT | false |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4A | OFFER > FREE CARE > CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST; AND > HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT AND EDUCATE THE COMMUNITY. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, PROFESSIONAL EDUCATION PROGRAMS, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. DURING FISCAL YEAR 2015, RICHLAND MEMORIAL HOSPITAL RECORDED 17,888 PATIENT DAYS. RICHLAND MEMORIAL HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST. THE HOSPITAL ALSO PROVIDES CARE TO PERSONS COVERED BY COMMERCIAL INSURANCE AT BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, RICHLAND MEMORIAL HOSPITAL RECOGNIZES THESE AMOUNTS AS COSTS INCURRED IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. CHARITY CARE IS ALSO PROVIDED THROUGH THE HOSPITAL'S INTERNAL POLICY OFFERED IN FY 2015. RICHLAND MEMORIAL HOSPITAL ALSO OFFERS AND PARTICIPATES IN PROGRAMS THROUGHOUT THE COMMUNITY. THESE INCLUDE: 1. AMBULANCE COVERAGE 2. MEETINGS/CONFERENCE FACILITIES 3. SCHOLARSHIPS 4. SUPPORT OF COMMUNITY ORGANIZATIONS/EVENTS/ACTIVITIES: > AINAD SHRINE TEMPLE > AMATEUR SPORTS PROMOTION > ABASSADOR COMPANY > AMERICAN HEART ASSOCIATION > BIG BROTHERS BIG SISTERS > BLUE KNIGHT TIP OFF CLUB > BUILD COMMUNITY > BUSINESS AFTER HOURS EVENTS > CHRISTMAS TREE / SANTA PRETZEL - 100 > EAST RICHLAND POST PROM > EDWARDS COUNTY FAIR > ERHS TIGER BASEBALL > FIRST PRESBYTERIAN CHURCH > HOLIDAY TOUR OF HOMES > HOME / BUSINESS EXPO > HSEI MEMORY MILES > IL HIGH SCHOOL RODEO > IL SOCIETY OF HEALTHCARE > LAGALA BOARD MEETING AND EVENT > LINCOLNLAND DISTRICT > MUSCULAR DYSTROPHY ASSN > NATIONAL MULTIPLE SCHLEROSIS > NEWTON ROTARY CLUB > OCC FOUNDATION > OCC MUSIC DEPT > OLNEANS YEARBOOK > OLNEY ARTS COUNCIL > OLNEY CENTRAL COLLEGE > OLNEY CHAMBER OF COMMERCE > OLNEY CHRISTMAS PARADE > OLNEY CITY COUNCIL > OLNEY ELKS CLUB > OLNEY FFA > OLNEY LADY TIGERS SOFTBALL > OLNEY LITTLE LEAGUE > OLNEY TIGER FOOTBALL > OLNEY TIGERS ATHLETICS > OLNEY TIGERSHARKS SWIM TEAM > OLNEY WHITE SQUIRREL COUNT > OUTREACH MISSION > RCRC WHITE SQUIRREL TRIATHLON > RICHLAND COUNTY 4-H > RICHLAND COUNTY CTA > RICHLAND COUNTY DEVELOPMENT CORP > RICHLAND COUNTY FARM & FAIR WEEK > RICHLAND COUNTY RECREATION COUNCIL > RICHLAND COUNTY COUNTY WALK AND ROLL > RICHLAND COUNTY YOUTH SOCCER (RCYS) > RIDGWAY CHAPTER IL AUDUBON SOCIETY > RMH & COMMUNITY GOLF OUTINGS > ROTARY CLUB OF OLNEY > RUCKERS WHOLESALE > SHRINE CLUB > SOUTHEASTEN ILLINOIS CONCERT ASSN > ST JOSEPH SCHOOL > ST THOMAS GOLF OUTING > SWAN > U.S. RT 50 FOUR-LANE COALITION > WEST RICHLAND HIGH SCHOOL > WEST RICHLAND POST PROM > WEST RICHLAND PTO 5. WELLNESS EVENTS/COMMUNITY CLINICS/SUPPORT GROUPS/ OUTREACH/EDUCATION > BLOOD PRESSURE SCREENING CLINICS > DIABETIC EDUCATION DAY > HEALTHFEST > NATIONAL HOSPITAL WEEK CHOLESTEROL/PSA SCREENING CLINIC > OLNEY SENIOR EXPO > SUPPORT GROUPS/EDUCATION A. BREAST CANCER SUPPORT GROUP - TICKET FOR THE CURE B. BREAST HEALTH OUTREACH/EDUCATION - TICKET FOR THE CURE C. CPR CLASSES D. DIABETES SUPPORT GROUP E. FIRST AID CLASSES F. INFECTION CONTROL IN-SERVICES TO LOCAL SCHOOLS G. LIFE SMART FOR WOMEN EDUCATIONAL CLASSES H. PREPARED CHILDBIRTH CLASSES I. REGIONAL PSYCHIATRIC CENTER PATIENT SUPPORT GROUP 6. SPECIAL ASSISTANCE PROGRAMS > MAMMOGRAPHY ASSISTANCE - IL BREAST AND CERVICAL CANCER PROGRAM SERVICE PROVIDER (LITTLE EGYPT & EAST CENTRAL REGION) > MAMMOGRAPHY ASSISTANCE - SUSAN G. KOMEN FOR THE CURE GRANT |
| FORM 990, PAGE 6, PART VI, LINE 11B | 990 IS REVIEWED BY ALL BOARD MEMBERS DURING SCHEDULED MEETINGS BEFORE IT IS FILED. |
| FORM 990, PAGE 6, PART VI, LINE 12C | 1. ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY BOARD MEMBER SHOULD BE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD BY THE BOARD MEMBER WHO HAS THE CONFLICT, AND MADE A MATTER OF RECORD, THROUGH THE BOARD'S ANNUAL FILING OF CONFLICT OF INTEREST STATEMENTS OR WHEN THE INTEREST BECOMES A MATTER OF BOARD ACTION. 2. ANY BOARD MEMBER HAVING A DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHOULD NOT VOTE OR USE HIS/HER PERSONAL INFLUENCE ON THE MATTER, AND HE/SHE SHOULD NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING, EVEN WHERE PERMITTED BY LAW. THE MINUTES OF THE MEETING SHOULD REFLECT THAT A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING, AND THE QUORUM SITUATION. 3. THE FOREGOING REQUIREMENTS SHOULD NOT BE CONSTRUED AS PREVENTING THE BOARD MEMBER FROM ANSWERING PERTINENT QUESTIONS OF OTHER BOARD MEMBERS, SINCE HIS/HER KNOWLEDGE MAY BE OF GREAT ASSISTANCE. HOWEVER, THE MEMBER WITH A CONFLICT MUST ABSTAIN FROM MAKING MOTIONS, PARTICIPATING IN RELEVANT DELIBERATIOINS, VOTING, EXECUTING AGREEMENTS, ATTEMPTING TO INFLUENCE OTHERS VOTES, OR TAKING ANY SIMILAR DIRECT ACTION ON BEHALF OF THE CORPORATION WHERE THE CONFLICT OF INTEREST MIGHT PERTAIN. 4. ALL MEMBERS OF THE BOARD (INCLUDING EX-OFFICIO MEMBERS) ARE REQUIRED TO COMPLETE AND RETURN THE CONFLICT OF INTEREST DISCLOSURE STATEMENT NO LATER THAN NOVEMBER 30TH OF EACH YEAR OR WITHIN 30 DAYS OF THE CREATION OR OCCURRENCE OF ANY NEW CONFLICT. MEMBER(S) WHO DO NOT RETURN THE CONFLICT OF INTEREST STATEMENT WILL BE ADDRESSED IN ACCORDANCE WITH THE BYLAWS. 5. RESPONSES MAY BE COMPILED INTO PACKETS FOR DISTRIBUTION AND DISCUSSION ANNUALLY - AT THE NEXT BOARD MEETING FOLLOWING THE DUE DATE SEMI-ANNUALLY - SIX MONTHS FOLLOWING THE INITIAL REVIEW; AND, AS ANY NEW CONFLICT IS IDENTIFIED. 6. THE POLICY ON CONFLICT OF INTEREST WILL BE DISCUSSED WITH CANDIDATES FOR BOARD POSITIONS DURING THEIR INTERVIEW WITH THE NOMINATING COMMITTEE. THE IMPORATANCE OF AVOIDING CONFLICT OF INTEREST SITUATIONS WILL BE EMPHASIZED. 7. WHEN A CONFLICT OF INTEREST SITUATION IS IDENTIFIED: THE INDIVIDUAL BOARD MEMBER HAS THE PRIMARY RESPONSIBILITY TO BRING A POTENTIAL OR ACTUAL CONFLICT OF INTEREST SITUATION TO THE ATTENTION OF THE BOARD A CONFLICT OF INTEREST SITUATION MAY ALSO COME TO THE ATTENTION OF THE BOARD DUE TO THE CONCERNS OF A BOARD MEMBER WHO MAY NOT BE INVOLVED IN THE SITUATION. THAT BOARD MEMBER SHOULD NOTIFY THE CHAIRPERSON OF THE CONFLICT OF INTEREST CONCERN AND THE BOARD CHAIRPERSON SHOULD BRING THE SITUATION TO THE ATTENTION OF THE FULL BOARD. REGARDLESS OF THE METHOD BY WHICH THE CONFLICT IS BROUGHT UP, THERE SHOULD BE FULL AND OPEN DISCUSSION BY BOARD MEMBERS OF THE POTENTIAL OR ACTUAL CONFLICT OF INTEREST SITUATION. THE FURTHER PARTICIPATION OF THE BOARD MEMBER IN THE DISCUSSION SHOULD BE AGREED UPON AND APPROVED BY THE BOARD. 8. AS A RESULT OF DISCUSSIONS ON CONFLICT OF INTEREST SITUATIONS, THERE MAY BE CONSIDERATIONS FOR A BOARD MEMBER'S RESIGNATION. THE BOARD MEMBER MAY WISH TO RESIGN TO AVOID A FUTURE CONFLICT OF INTEREST SITUATION DUE TO A DESIRE TO BID ON A PARTICULAR BOARD PROJECT OR TO AVOID A FURTHER CONFLICT OF INTEREST CONCERN. IN THE EVENT THAT THE BOARD MEMBER DOES NOT LEAVE AND A CONFLICT OF INTEREST SITUATION EXISTS, IN ACCORDANCE WITH BYLAWS SECTION III.11 "REMOVAL OF DIRECTORS" THE BOARD MAY ASK THE BOARD MEMBER TO RESIGN IF NINE OF THE TWELVE VOTING MEMBERS VOTE AFFIRMATIVELY ON A MOTION OF REMOVAL. 9. THIS POLICY WILL BE REVIEWED ANNUALLY FOR THE INFORMATION AND GUIDANCE OF BOARD MEMBERS. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE HR DEPARTMENT USES AN EXECUTIVE SURVEY FROM THE ILLINOIS HOSPITAL ASSOCIATION (IHA) TO GET A STARTING POINT FOR THE SALARY. THEN THEY FACTOR IN YEARS OF EXPERIENCE AND NEGOTIATIONS ON BOTH ENDS. ULTIMATELY THE BOARD DETERMINES THE SALARY AND THE CONTRACT IS SET ANNUALLY. |
| FORM 990, PAGE 6, PART VI, LINE 15B | SALARIES ARE BASED OFF OF THE SOUTHERN ILLINOIS HUMAN RESOURCE SURVEY. YEARS OF EXPERIENCE AND NEGOTIATION ARE FACTORS THAT ARE CONSIDERED. ONCE A SALARY IS SET A % INCREASE IS GIVEN ANNUALLY DETERMINED BY THE CEO. |
| FORM 990, PAGE 6, PART VI, LINE 19 | RICHLAND MEMORIAL HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AFTER A REQUEST IS MADE TO ADMINISTRATION. |
| FORM 990, PART XI, LINE 9 | CHANGE IN INTEREST IN NET ASSETS OF RMH FOUNDATION -76,517 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RMH FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 EAST LOCUST STREET | AddressLine1Txt |
| City | OLNEY | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62450 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 371178290 | EIN |
| Primary Activities | FUNDRAISIN | PrimaryActivitiesTxt |
| 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 | Yes (true) | 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 | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RMH FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $196,398 | InvolvedAmt |
| Method Of Amount Determination | ACTUAL COST | MethodOfAmountDeterminationTxt |
Comments