DEKALB MEMORIAL HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- DEKALB MEMORIAL HOSPITAL INC (EIN 35-1064295)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-03-29
- IRS object ID
- 201400889349300105
- Schema version
- 2012v2.1
- 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 C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-03-29T10:24:39-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351178661 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE AMERICAN SQUARE 2200 | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46282 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351064295 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEKALB MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DEKA | NameControl |
| Phone | 2609254600 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1316 EAST SEVENTH STREET | AddressLine1 |
| City | AUBURN | City |
| State | IN | State |
| ZIP Code | 46706 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY CROUCH | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 2609254600 | Phone |
| Date Signed | 2014-03-24 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMBER KOCHER CPA | Name |
| PTIN | P01286298 | PTIN |
| Phone | 3176334705 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEKALB HEALTH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | AMY CROUCH | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1316 EAST SEVENTH STREET | AddressLine1 |
| City | AUBURN | City |
| State | IN | State |
| ZIP Code | 46706 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 63127968 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.DEKALBHEALTH.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1964 | YearFormation |
| State Legal Domicile | IN | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE ACUTE, SUBACUTE AND OUTPATIENT MEDICAL SERVICES TO RURAL NORTHEASTERN INDIANA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 670 | TotalNbrEmployees |
| Total Nbr Volunteers | 50 | TotalNbrVolunteers |
| Total Gross UBI | 69488 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -1668 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 135233 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 103983 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 59683726 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 57084955 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 621375 | InvestmentIncomePriorYear |
| Investment Income Current Year | 451741 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1326050 | OtherRevenuePriorYear |
| Other Revenue Current Year | 641181 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 61766384 | TotalRevenuePriorYear |
| Total Revenue Current Year | 58281860 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 77646 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 107509 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 30517482 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 31538961 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 37360 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 29718274 | OtherExpensePriorYear |
| Other Expenses Current Year | 27486171 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 60313402 | TotalExpensesPriorYear |
| Total Expenses Current Year | 59132641 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1452982 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -850781 | RevenuesLessExpensesCY |
| Total Assets BOY | 68069935 | TotalAssetsBOY |
| Total Assets EOY | 67490054 | TotalAssetsEOY |
| Total Liabilities BOY | 17637023 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 16350782 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 50432912 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 51139272 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | PROMOTE, PRESERVE, RESTORE HEALTH | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 54142413 | Expense |
| Grants | 107509 | Grants |
| Revenue | 57656648 | Revenue |
| Description | DEKALB HEALTH IS A 47 BED HOSPITAL IN RURAL INDIANA PROVIDING ACUTE, SUBACUTE AND OUTPATIENT SERVICES. FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2013, THERE WERE 2,438 TOTAL ADMISSIONS; 18,197 TOTAL EMERGENCY ROOM VISITS; AND 7,833 TOTAL HOME HEALTH CARE VISITS. THE HOSPITAL PROVIDES CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY. THE HOSPITAL DOES NOT PURSUE COLLECTION OF QUALIFIED CHARITY CARE AMOUNTS. THE DIRECT AND INDIRECT COSTS FURNISHED UNDER ITS CHARITY CARE POLICY DURING THE YEAR WERE APPROXIMATELY $1,155,000.AT DEKALB HEALTH, OUR INVESTMENTS IN STATE-OF-THE-ART FACILITIES AND PARTNERSHIPS WITH TOP FAMILY PHYSICIANS AND SPECIALTY GROUPS MEAN THAT | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | YOU NEVER HAVE TO LOOK PAST DEKALB COUNTY FOR THE VERY BEST CARE. OUR COMMITMENT IS ALSO REFLECTED IN OUR INVESTMENTS OF TIME, TALENTS AND RESOURCES IN LOCAL SCHOOLS, BUSINESSES, CHARITABLE ORGANIZATIONS AND OTHER WORTHY CAUSES TO HELP ENSURE A HEALTHIER COMMUNITY. WE'RE PROUD TO BE YOUR NEIGHBOR, AND YOU CAN BE SURE WE'LL BE HERE, TAKING CARE OF YOU FOR GENERATIONS TO COME. THANKS TO THE VISION OF OUR LEADERSHIP, DEKALB HEALTH HAS TAKEN NUMEROUS STEPS FORWARD. WHILE MANY OF OUR MILESTONES ARE IN PLAIN SIGHT SUCH AS THE NEW ER, EICU, REGISTRATION AREA, IMAGING, LABORATORY, AND RESPIRATORY CENTERS, BUT MANY OF OUR ACHIEVEMENTS ARE BEHIND THE SCENES. WE HAVE FORGED NEW PARTNERSHIPS WITH PHYSICIAN GROUPS, SO THAT | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PEOPLE IN OUR REGION NOW HAVE ACCESS TO ALMOST EVERY MEDICAL SPECIALTY RIGHT HERE ON OUR CAMPUS. WE HAVE ALSO MADE SIGNIFICANT INVESTMENTS IN NEW TECHNOLOGY, SUCH AS A STATE-OF-THE-ART MONITORING SYSTEM FOR CRITICALLY ILL PATIENTS AND THE MOVE TO ELECTRONIC MEDICAL RECORDS. MOST IMPORTANTLY, OUR PEOPLE CONTINUE TO DISTINGUISH THEMSELVES AS THE MOST COMPASSIONATE CAREGIVERS YOU'LL FIND ANYWHERE, AND WE CONTINUE TO DONATE TIME AND RESOURCES IN SUPPORT OF SCHOOLS, BUSINESSES, AND ORGANIZATIONS TO ENSURE A STRONG, HEALTHY COMMUNITY. AT DEKALB HEALTH, WE HAVE REARMED OUR COMMITMENT TO BEING YOUR INDEPENDENT, NOT-FOR-PROFIT COMMUNITY HOSPITAL. WITH EVERY NEW INVESTMENT, WE'RE BRINGING WORLD-CLASS HEALTHCARE HOME TO YOU. (CONTINUATION FROM PROGRAM SERVICE ACCOMPLISHMENT PAGE 2) WE CELEBRATE THE UNIQUE BOND THAT EXISTS BETWEEN THE HOSPITAL AND ITS COMMUNITY. OURS IS A RICH HERITAGE OF INDEPENDENCE, DETERMINATION AND A COMMITMENT TO TAKING CARE OF THE INDIVIDUALS AND FAMILIES WE SERVE. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 54142413 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 60 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 670 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | IN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMY CROUCH - CHIEF FINANCIAL OFFICER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2609254600 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1316 E 7TH STREET | AddressLine1 |
| City | AUBURN | City |
| State | IN | State |
| ZIP Code | 46706 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (22 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|---|
| ALAN MIDDLETON | ||||||||||
| CHAIRPERSON | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |||
| ROBERT MENZIE | ||||||||||
| VICE CHAIRPERSON | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |||
| RICHARD ALLEN | ||||||||||
| SECRETARY | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |||
| DEB LINSTROMBERG | ||||||||||
| PAST BOARD CHAIRPERSON | 1.00 | 0.00 | X | 0 | 0 | 0 | ||||
| CAROLINE DERROW DDS | ||||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||||
| MATT FETTER | ||||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||||
| MARK FOGT | ||||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||||
| BETH FREIDENBERGER | ||||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||||
| JEFF JUSTICE MD | ||||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||||
| MARK MILLET | ||||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||||
| DOUGLAS MORROW OD | ||||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||||
| BRIAN NUGEN | ||||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||||
| MITCHELL TRAVIS MD | ||||||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | ||||
| FRED PRICE | ||||||||||
| EXECUTIVE DIRECTOR/CEO, BEG JAN'13 | 40.00 | 0.00 | X | 0 | 0 | 0 | ||||
| AMY CROUCH | ||||||||||
| CHIEF FINANACIAL OFFICER | 40.00 | 0.00 | X | 145792 | 0 | 288 | ||||
| EMILIO VAZQUEZ | ||||||||||
| CHIEF MEDICAL OFFICER | 40.00 | 0.00 | 269795 | 0 | 12931 | X | ||||
| KENNETH CHAFFEE | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | 301831 | 0 | 28759 | X | ||||
| BRET KUEBER | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | 224374 | 0 | 28560 | X | ||||
| SCOTT ARMSTRONG | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | 223404 | 0 | 34539 | X | ||||
| PHILIP CHASE | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | 209187 | 0 | 14223 | X | ||||
| RICHARD TOUPIN | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | 198252 | 0 | 14414 | X | ||||
| KIRK RAY | ||||||||||
| EXECUTIVE DIRECTOR/CEO, END JUL'12 | 40.00 | 0.00 | 249832 | 0 | 26584 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1822467 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 160298 | TotalOtherCompensation |
| Number Individuals GT100 K | 24 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ALLIED MEDICAL SERVICES | |||||
| 6444 MONROE STREET SUITE 201 | SYLVANIA | OH | 43560 | RT SERVICES | 476065 |
| EMERGENCY PHYSICIANS OF IN PC | |||||
| 4560 SOLUTIONS CENTER | CHICAGO | IL | 60677 | PHYSICIAN SERVICES | 467137 |
| APRN SLEEP INC | |||||
| 6444 MONROE STREET SUITE 5 | SYLVANIA | OH | 43560 | REFERENCE LAB | 241497 |
| PSI SUPPLY CHAIN SOLUTIONS LLC | |||||
| 5050 BRADENTON AVENUE | DUBLIN | OH | 43017 | SUPPLY SERVICES | 187594 |
| BKD LLP | |||||
| 200 E MAIN STREET SUITE 700 | FORT WAYNE | IN | 46802 | ACCOUNTING SERVICES | 183873 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| All Other Contributions | 103983 | AllOtherContributions |
| Total Contributions | 103983 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERVICE REVENUE | 623990 | 51132306 | 51132306 | |
| PHARMACARE | 621500 | 4242933 | 4242933 | |
| FINANCIAL SERVICES | 900099 | 1432301 | 1432301 | |
| CAFETERIA SALES | 722320 | 277415 | 217358 | 60057 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 57084955 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 505539 | TotalRevenueColumn |
| Exclusion | $505,539 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 709433 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 258199 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 451234 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 451234 | TotalRevenueColumn |
| Related Or Exempt Function Income | 451234 | RelatedOrExemptFunctionIncome |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4534111 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4587909 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -53798 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -53798 | TotalRevenueColumn |
| Exclusion | -$53,798 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|
| CLEANING | 812300 | 8155 | 8155 |
| LAUNDRY | 812300 | 1276 | 1276 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 180516 | TotalRevenueColumn |
| Related Or Exempt Function Income | 180516 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 189947 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 58281860 | TotalRevenueColumn |
| Related Or Exempt Function Income | 57656648 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 69488 | UnrelatedBusinessRevenue |
| Exclusion | $451,741 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 107509 | Total |
| Program Services | 107509 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 696147 | Total |
| Program Services | 342118 | ProgramServices |
| Management And General | 354029 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22941487 | Total |
| Program Services | 21322074 | ProgramServices |
| Management And General | 1597024 | ManagementAndGeneral |
| Fundraising | 22389 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 991184 | Total |
| Program Services | 911889 | ProgramServices |
| Management And General | 79295 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5194342 | Total |
| Program Services | 5022869 | ProgramServices |
| Management And General | 157821 | ManagementAndGeneral |
| Fundraising | 13652 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1715801 | Total |
| Program Services | 1578537 | ProgramServices |
| Management And General | 137264 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 114288 | Total |
| Program Services | 114288 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 75703 | Total |
| Program Services | 11860 | ProgramServices |
| Management And General | 63843 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 123866 | Total |
| Management And General | 123866 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5177442 | Total |
| Program Services | 4866214 | ProgramServices |
| Management And General | 311228 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 457970 | Total |
| Program Services | 73125 | ProgramServices |
| Management And General | 384845 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1588070 | Total |
| Program Services | 1349902 | ProgramServices |
| Management And General | 236852 | ManagementAndGeneral |
| Fundraising | 1316 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1523305 | Total |
| Program Services | 1480920 | ProgramServices |
| Management And General | 42385 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1021393 | Total |
| Program Services | 940657 | ProgramServices |
| Management And General | 80736 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 321058 | Total |
| Program Services | 285318 | ProgramServices |
| Management And General | 35737 | ManagementAndGeneral |
| Fundraising | 3 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52192 | Total |
| Program Services | 33645 | ProgramServices |
| Management And General | 18547 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 343044 | Total |
| Management And General | 343044 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4873292 | Total |
| Program Services | 4585940 | ProgramServices |
| Management And General | 287352 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 590074 | Total |
| Program Services | 241743 | ProgramServices |
| Management And General | 348331 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 8163380 | 8163380 | |
| H.A.F. ASSESSMENT | 2304619 | 2304619 | |
| LICENSE, ACCRED FEE & M | 385626 | 73404 | 312222 |
| COLLECTION FEES | 332402 | 332402 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38447 | Total |
| Management And General | 38447 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59132641 | Total |
| Program Services | 54142413 | ProgramServices |
| Management And General | 4952868 | ManagementAndGeneral |
| Fundraising | 37360 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2750 | BOY |
| EOY | 104588 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1235665 | BOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7325062 | BOY |
| EOY | 9422823 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 8294 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 626749 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1324144 | BOY |
| EOY | 1399437 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1040979 | BOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 75806725 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 38263812 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 40357773 | BOY |
| EOY | 37542913 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15392864 | BOY |
| EOY | 17207351 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1390698 | BOY |
| EOY | 1177899 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68069935 | BOY |
| EOY | 67490054 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6077934 | BOY |
| EOY | 6609350 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5351775 | BOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3763376 | BOY |
| EOY | 8331936 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2443938 | BOY |
| EOY | 1409496 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17637023 | BOY |
| EOY | 16350782 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50324022 | BOY |
| EOY | 51137455 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 108890 | BOY |
| EOY | 1817 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50432912 | BOY |
| EOY | 51139272 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68069935 | BOY |
| EOY | 67490054 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -850781 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 1339837 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 217304 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $6,116 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 6116 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | THE HOSPITAL PAID MEMBERSHIP DUES TO INDIANA HOSPITAL ASSOCIATION "IHA" AND AMERICAN HOSPITAL ASSOCIATION "AHA" IN ADDITION TO INDIANA ASSOCIATION FOR HOME & HOSPICE CARE "IAHHC". IHA ATTRIBUTED 5.26% ($1,224); AHA ATTRIBUTED 23.98% ($4,706); AND IAHHC ATTRIBUTED 12% ($186) OF THE DUES TO LOBBYING EXPENSES TO TOTAL $6,116 ABOVE. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 108890 | BeginningOfYearBalance |
| Contributions | 33375 | Contributions |
| Grants Or Scholarships | 34016 | GrantsOrScholarships |
| Other Expenditures | 106432 | OtherExpenditures |
| End Of Year Balance | 1817 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 112897 | BeginningOfYearBalance |
| Contributions | 76699 | Contributions |
| Other Expenditures | 80706 | OtherExpenditures |
| End Of Year Balance | 108890 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 28679 | BeginningOfYearBalance |
| Contributions | 84218 | Contributions |
| End Of Year Balance | 112897 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 0 | BeginningOfYearBalance |
| Contributions | 28679 | Contributions |
| End Of Year Balance | 28679 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment EOY Balance | 1.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 393118 | OtherCostOrOtherBasis |
| Book Value | 393118 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 54425960 | OtherCostOrOtherBasis |
| Depreciation | 24604697 | Depreciation |
| Book Value | 29821263 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 20880721 | OtherCostOrOtherBasis |
| Depreciation | 13659115 | Depreciation |
| Book Value | 7221606 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 106926 | OtherCostOrOtherBasis |
| Book Value | 106926 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 37542913 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| CAPITAL LEASE OBLIGATIONS | $1,397,696 |
| ESTIMATED THIRD PARTY SETTLEMENT | $11,800 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1409496 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 60097200 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 1339837 | NetUnrealizedGainsInvestments |
| Other Revenues | 475503 | OtherRevenues |
| Revenue Not Rptd F990 | 1815340 | RevenueNotRptdF990 |
| Revenue Subtotal | 58281860 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 58281860 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 59390840 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 258199 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 258199 | ExpensesNotRptdF990 |
| Expenses Subtotal | 59132641 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 59132641 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES REPORTED IN REVENUE 258,199. INCREASE IN INVESTMENT IN EQUITY INVESTEE 217,304. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES REPORTED IN REVENUE 258,199. |
| PART X, LINE 2, FIN 48 FOOTNOTE: NOT APPLICABLE. THE AUDITED FINANCIAL STATEMENTS DID NOT INCLUDE A FOOTNOTE REGARDING UNCERTAIN TAX POSITIONS UNDER FIN 48. HOWEVER, MANAGEMENT HAS EVALUTAED THE INCOME TAX POSITIONS UNDER THIS GUIDANCE AND BASED ON REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE REPORTED OR DISCLOSED ON THE AUDITED FINANCIAL STATEMENTS ENDING SEPTEMBER 30, 2013. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent350 | X | Pcent350 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 548241 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 548241 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00930 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8168405 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3932712 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4235693 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07160 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8716646 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3932712 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4783934 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08090 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 93985 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 93985 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 25000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 25000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 30243 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 30243 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 149228 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 149228 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00250 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8865874 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3932712 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4933162 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08340 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 20459 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 20459 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 36757 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 36757 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 5000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 5000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 24447 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 24447 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 585 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 585 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 87248 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 87248 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $4,443,148 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 6688465 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 8279955 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1591490 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEKALB MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1316 E 7TH STREET | AddressLine1 |
| City | AUBURN | City |
| State | IN | State |
| ZIP Code | 46706 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEKALB MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 350.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: THE ORGANIZATION USES THE FEDERAL POVERTY GUIDELINES WHEN DETERMINING ELIGIBILITY FOR DISCOUNTED CARE BETWEEN 200% AND 350% OF THE FEDERAL POVERTY LIMIT (FPL) AS FOLLOWS: PATIENTS WITH INCOME BETWEEN 200% AND 250% OF THE FPL ARE ELIGIBLE FOR A 75% WRITE-OFF; PATIENTS WITH INCOME BETWEEN 250% AND 300% OF THE FPL ARE ELIGIBLE FOR A 50% WRITE-OFF; AND PATIENTS WITH INCOME BETWEEN 300% AND 350% OF THE FPT ARE ELIGIBLE FOR A 30% WRITE-OFF. | ||
| PART II: COMMUNITY BUILDING ACTIVITIES.THE HOSPITAL GIVES BACK THROUGH FINANCIAL AND EDUCATIONAL EFFORTS AND THROUGH VOLUNTEERING, AWARENESS INITIATIVES AND SUPPORT GROUPS. SOME OF THE MANY COMMUNITY EDUCATION PROGRAMS FOR CHILDREN AND ADULTS INCLUDE: PRENATAL EDUCATION, ACLS, CPR, AND FIRST AID TRAINING, DIABETES EDUCATION, SMOKING CESSATION AND WEIGHT MANAGEMENT. SOME OF THE COMMUNITY OUTREACH ACTIVITIES INCLUDE INVOLVEMENT IN: COMMUNITY AND WORKPLACE HEALTH & WELLNESS FAIRS, PRESENTATIONS TO COMMUNITY GROUPS, SPORTS PHYSICALS, ORGAN DONATION, AND EMS STANDBY FOR MULTIPLE PUBLIC EVENTS. MANY OF THE PROGRAMS FINANCIALLY SUPPORTED PROVIDE INCREASED OPPORTUNITIES TO HELP PARTICIPANTS BE PHYSICALLY ACTIVE AND HEALTHY. | ||
| PART III, LINE 4: SECTION A. BAD DEBT EXPENSE. METHOD FOR ESTIMATING BAD DEBT EXPENSE AMOUNT ON PART III, LINE 2: HOSPITAL MANAGEMENT ANALYZES PAST HISTORY AND IDENTIFIES TRENDS FOR EACH MAJOR PAYER SOURCE OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBT EXPENSE. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. AN AGGREGATE COST TO CHARGE RATIO WAS USED TO PROVIDE BAD DEBT AT COST. THE ESTIMATED AMOUNT OF THE HOSPITAL'S BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS THAT MIGHT HAVE BEEN ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY WAS DETERMINED BY COMPUTING A PERCENTAGE OF DOLLAR AMOUNT TOTALS OF ACCOUNTS APPROVED FOR ASSISTANCE TO TOTAL APPLICATIONS AND THEN APPLIED THE PERCENTAGE TO THE APPLICATIONS THAT WERE DENIED DUE TO INCOMPLETE INFORMATION TO COME UP WITH AN ESTIMATE OF WHAT WOULD HAVE QUALIFIED IF THE INFORMATION HAD BEEN RECEIVED. THE RATIONALE BEING THAT HAD THE INFORMATION BEEN RECEIVED, THOSE ACCOUNTS WOULD HAVE BEEN APPROVED.EXPLANATION FOR RATIONAL FOR INCLUDING OTHER BAD DEBT AMOUNT IN COMMUNITY BENEFIT ON PART III, LINE 3: NO OTHER BAD DEBT AMOUNTS HAVE BEEN INCLUDED AS COMMUNITY BENEFIT. THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY. IN ADDITION, THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON, THE ORGANIZATION BELIEVES IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. THE TEXT TO THE AUDITED FINANCIAL STATEMENT FOOTNOTE DESCRIBING BAD DEBT EXPENSE AND ITS PRESENTATION IS INCLUDED IN FOOTNOTE 1 "CHANGE IN ACCOUNTING PRINCIPLE" AND "PATIENT ACCOUNTS RECEIVABLE" ON PAGES 8 AND 9. | ||
| PART III, LINE 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED SEPTEMBER 30, 2013: HOSPITAL STATEMENT OF REIMBURSABLE COST | ||
| PART III, LINE 9B: THE HOSPITAL'S COLLECTION PRACTICES FOR THOSE QUALIFYING FOR FINANCIAL ASSISTANCE INCLUDE: (1) DESIGNATING THE ACCOUNTS QUALIFYING FOR FINANCIAL ASSISTANCE IN THE ACCOUNTS RECEIVABLE SYSTEM AS CHARITY CARE; (2)EXCLUDING THE ACCOUNTS FROM BAD DEBT WRITE OFFS; AND (3) EXCLUDING THE ACCOUNTS FROM BEING REPORTED TO ANY COLLECTION AGENCIES. | ||
| PART V, SECTION B, LINE 3: THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY THROUGH COMMUNITY SURVEYS SENT TO HOUSEHOLDS IN DEKALB COUNTY, PROVIDER SURVEYS SENT, AND FEEDBACK COLLECTED FROM KEY CONSTITUENTS. | DEKALB MEMORIAL HOSPITAL, INC. | |
| PART V, SECTION B, LINE 4: THE ASSESSMENT WAS NOT CONDUCTED WITH OTHER HOSPITALS, BUT WAS PART OF A COLLABORATIVE EFFORT WITH DEKALB COUNTY HEALTH DEPT AND IPFW CENTER FOR SOCIAL RESEARCH. | DEKALB MEMORIAL HOSPITAL, INC. | |
| PART V, SECTION B, LINE 5C: THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE AT WWW.DEKALBHEALTH.COM LOCATED UNDER THE DROP DOWN MENU "COMMUNITY". | DEKALB MEMORIAL HOSPITAL, INC. | |
| PART V, SECTION B, LINE 11: THE ORGANIZATION USES THE FEDERAL POVERTY GUIDELINES WHEN DETERMINING ELIGIBILITY FOR DISCOUNTED CARE BETWEEN 200% AND 350% OF THE FEDERAL POVERTY LIMIT (FPL) AS FOLLOWS: PATIENTS WITH INCOME BETWEEN 200% AND 250% OF THE FPL ARE ELIGIBLE FOR A 75% WRITE-OFF; PATIENTS WITH INCOME BETWEEN 250% AND 300% OF THE FPL ARE ELIGIBLE FOR A 50% WRITE-OFF; AND PATIENTS WITH INCOME BETWEEN 300% AND 350% OF THE FPT ARE ELIGIBLE FOR A 30% WRITE-OFF. | DEKALB MEMORIAL HOSPITAL, INC. | |
| PART VI, LINE 2: ASSESSING COMMUNITY NEED.THE HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY THROUGH PERIODIC FOCUS GROUP SURVEYS BY OUTSIDE CONSULTANTS WHICH ARE PREPARED EVERY 3 YEARS TO ASSESS THE NEEDS OF THE COMMUNITY. THESE SURVEYS INCLUDE INPUT FROM INDIVIDUALS, HEALTH PROFESSIONALS, GOVERNMENTAL HEALTH CARE OFFICIALS AS WELL AS REPRESENTATIVES FROM DEKALB HOSPITAL. THE SURVEY SOLICITS INPUT ON THE HEALTH CARE NEEDS INCLUDING OBESITY, PREVENTIVE MEDICINE, VACCINATIONS, CARDIOVASCULAR, ETC. THESE NEEDS AND CONCERNS ARE EVALUATED AND APPROPRIATE PLANS ARE PUT INTO ACTION TO DEAL WITH THE MOST PRESSING ISSUES. CUSTOMER SATISFACTION SURVEYS ARE ALSO USED TO IDENTIFY UNMET HEALTHCARE NEEDS OF THE COMMUNITY.RECENTLY, IN THE FALL OF 2012, IPFW CENTER FOR SOCIAL RESEARCH FINALIZED AND REPORTED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT THEY CONDUCTED ON BEHALF OF THE DEKALB COUNTY HEALTH DEPARTMENT AND DEKALB HEALTH. THIS SURVEY IS A TOOL THE HOSPITAL IS USING AS ONE OF THE KEY COMPONENETS FOR COMMUNITY OUTREACH STRATEGIES. THIS SURVEY IN ADDITION TO FEEBACK RECEIVED FROM KEY CONSTITUENTS I.E. THE UNITED WAY OF DEKALB COUNTY, COMMUNITY FOUNDATION OF DEKALB COUNTY, CHILDREN FIRST CENTER, PURDUE EXTENSION OFFICE, SCHOOLS, PHYSICIAN OFFICES, HOSPITAL DEPARTMENT MANAGERS, AND OTHERS HELPED TO IDENTIFY THE HEALTH CARE NEEDS OF THE COMMUNITY. | ||
| PART VI, LINE 3: PATIENT EDUCATION OF ASSISTANCE ELIGIBILITY.PATIENTS ARE PROVIDED INFORMATION REGARDING THE CHARITY CARE POLICIES WHEN ADMITTED TO DEKALB HOSPITAL. FINANCIAL AID GUIDELINES ARE ALSO INCLUDED WITH THE BILLING STATEMENTS. SIGNS OUTLINING THE FINANCIAL AID POLICIES AND APPLICATIONS ARE ALSO LOCATED IN NUMEROUS AREAS THROUGHOUT THE HOSPITAL. ALL NON-INSURED PATIENTS ARE STRONGLY ENCOURAGED TO MEET WITH A FINANCIAL COUNSELOR TO REVIEW ALL OPTIONS AVAILABLE TO THEM INCLUDING MEDICARE, MEDICAID, CHARITY CARE, LOAN AND PAYMENT PROGRAMS. DEKALB HOSPITAL STAFF WILLINGLY ASSIST PATIENTS WITH QUALIFICATION CRITERIA AND COMPLETION OF APPLICATIONS FOR SUCH PROGRAMS, WHERE APPLICABLE. | ||
| PART VI, LINE 4: COMMUNITY DESCRIPTION.DEKALB MEMORIAL HOSPITAL IS THE SOLE COMMUNITY HOSPITAL LOCATED IN DEKALB COUNTY, SERVING DEKALB, PORTIONS OF STEUBEN, LAGRANGE, NOBLE, AND ALLEN COUNTIES IN ADDITION TO SEVERAL BORDER TOWNS OF HICKSVILLE AND EDGERTON IN NORTHWEST OHIO. THE PRIMARY SERVICE AREA POPULATION OF DEKALB MEMORIAL HOSPITAL IS APPROXIMATELY 42,000 WITH APPROXIMATELY 98% RECORDED AS WHITE. DEKALB HAS SEEN AN INCREASE IN THE UNINSURED AND UNDERINSURED WITH A REPORTED AMOUNT OF 12.1% OF RESIDENTS LIVING BELOW THE POVERTY LEVEL. THE DEMOGRAPHIC AREA SERVED BY DEKALB MEMORIAL HOSPITAL IS MADE UP OF A MEDIAN HOUSEHOLD INCOME OF APPROXIMATELY $46,000, THE MEDIAN AGE IS 38 AND CONTAINS PRIMARILY A BLUE COLLAR AND AGRICULTURAL WORKFORCE. | ||
| PART VI, LINE 5: COMMUNITY HEALTH PROMOTION.THE ORGANIZATION FURTHERS ITS EXEMPT PURPOSE BY PROMOTING HEALTH OF THE COMMUNITY THROUGH THE FOLLOWING: AN OPEN MEDICAL STAFF, CORPORATE BOARD MADE UP OF 30 COMMUNITY MEMBERS THAT SELECT THE BOARD OF DIRECTORS, AND THE USE OF SURPLUS FUNDS TO PROVIDE HIGH QUALITY HEALTHCARE SERVICES TO THE CITIZENS RESIDING IN ITS SERVICE AREAIN ADDITION, MANY OF THE HOSPITAL'S MANAGERS AND STAFF DONATE THEIR TIME TO SUPPORT ST. MARTIN'S HEALTHCARE CLINIC (FOR UNINSURED) AS WELL AS SERVE ON UNITED WAY, CHAMBER OF COMMERCE, ECONOMIC DEVELOPMENT BOARDS, AND JUNIOR ACHIEVEMENT. NONPERISHABLE FOOD ITEMS THAT ARE LEFT OVER AFTER THE HEATLHY HALLOWEEN FAIR AND/OR PLAY-LEARN-SOAR ARE DONATED TO A LOCAL FOOD BANK OR BOOMERANG BACKPACK PROGRAM. | ||
| PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM.THE ORGANIZATNION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. | ||
| IN | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (7 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| DEKALB HEALTH COMMUNITY FOUNDATION | |||||||
| 212 WEST 7TH STREET | AUBURN | IN | 46706 | 356047817 | 501C3 | 44359 | PROGRAM SUPPORT |
| FORT WAYNE MEDICAL EDUCATION PROGRAM | |||||||
| 50 BROADWAY | FORT WAYNE | IN | 46802 | 356049685 | 501C3 | 25000 | PROGRAM SUPPORT |
| DEKALB COUNTY ECONOMIC DEVELOPMENT PARTNERS | |||||||
| 4483 COUNTY ROAD 19 | AUBURN | IN | 46706 | 364577514 | 501C3 | 10000 | COMMUNITY SUPPORT |
| NORTHEAST INDIANA REGIONAL PARTNERSHIP | |||||||
| 200 E MAIN STREET | FORT WAYNE | IN | 46802 | 351984702 | 501C6 | 10000 | PROGRAM SUPPORT |
| KRAMER ENTERTAINMENT | |||||||
| 3849 LAKE MICHIGAN DRIVE NW | GRAND RAPIDS | IN | 49534 | 453972742 | 8150 | DISTRACTED DRIVING PROGRAM | |
| FORT WAYNE MAD ANTS | |||||||
| 1910 ST JOE CENTER ROAD | FORT WAYNE | IN | 46825 | 208684500 | 5000 | FITNESS PROGRAM | |
| DEKALB ALUMNI FUND | |||||||
| 3424 CR 427 | WATERLOO | IN | 46793 | 351097343 | 5000 | STUDENT LEADERSHIP PROGRAM | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 3 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 4 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: THE AMOUNT OF ASSISTANCE LISTED IN PART II ARE GENERAL CONTRIBUTIONS FOR GENERAL PROGRAM SUPPORT. THE HOSPITAL DOES NOT MONITOR THE USE OF FUNDS ONCE DISTRIBUTED TO THESE ORGANIZATIONS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EMILIO VAZQUEZ | ||||||||||||||
| CHIEF MEDICAL OFFICER | 192456 | 0 | 59904 | 0 | 17435 | 0 | 12931 | 0 | 0 | 0 | 282726 | 0 | 0 | 0 |
| KENNETH CHAFFEE | ||||||||||||||
| PHYSICIAN | 295597 | 0 | 0 | 0 | 6234 | 0 | 15000 | 0 | 13759 | 0 | 330590 | 0 | 0 | 0 |
| BRET KUEBER | ||||||||||||||
| PHYSICIAN | 177868 | 0 | 34055 | 0 | 12451 | 0 | 10452 | 0 | 18108 | 0 | 252934 | 0 | 0 | 0 |
| SCOTT ARMSTRONG | ||||||||||||||
| PHYSICIAN | 209917 | 0 | 0 | 0 | 13487 | 0 | 11419 | 0 | 23120 | 0 | 257943 | 0 | 0 | 0 |
| PHILIP CHASE | ||||||||||||||
| PHYSICIAN | 191232 | 0 | 0 | 0 | 17955 | 0 | 0 | 0 | 14223 | 0 | 223410 | 0 | 0 | 0 |
| RICHARD TOUPIN | ||||||||||||||
| PHYSICIAN | 181454 | 0 | 0 | 0 | 16798 | 0 | 0 | 0 | 14414 | 0 | 212666 | 0 | 0 | 0 |
| KIRK RAY | ||||||||||||||
| EXECUTIVE DIRECTOR/CEO, END JUL'12 | 223788 | 0 | 0 | 0 | 26044 | 0 | 8191 | 0 | 18393 | 0 | 276416 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | SCOTT ARMSTRONG | NamePerson |
| Relationship With Organization | PART V | RelationshipWithOrganization |
| Purpose Of Loan | PART V | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $20,000 | OriginalPrincipalAmount |
| Balance Due | 8294 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 8294 | TotalBalanceDue |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCHEDULE L, PART II, LOAN TO/ FROM INTERESTED PERSONS: | Identifier |
| Explanation | (A) NAME OF PERSION: SCOTT ARMSTRONG(B) RELATIONSHIP WITH ORGANIZATION: HIGHEST COMPENSATED EMPLOYEE(C) PURPOSE OF LOAN: PHYSICIAN RECRUITMENT LOAN | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART I, DOING BUSINESS AS: | DEKALB HEALTH DEKALB HEALTH HOME CARE DEKALB HEALTH HOSPICE DEKALB HEALTH MEDICAL GROUP DEKALB HEALTH MEDICAL GROUP - BUTLER DEKALB HEALTH MEDICAL GROUP - GARRETT DEKALB HEALTH MEDICAL GROUP - ARMSTRONG DEKALB HEALTH MEDICAL GROUP - PEDIATRICS | |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS CORPORATE BOARD MEMBERS CONSISTING OF 30 COMMUNITY MEMBERS. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE ORANIZATION HAS CORPORATE BOARD MEMBERS CONSISTING OF 30 COMMUNITY MEMBERS. FOURTEEN MEMBERS WERE ELECTED BY THE CORPORATE BOARD AND SERVED AS THE ORGANIZATIONS GOVERNING BODY DURING FISCAL YEAR 2013. | |
| FORM 990, PART VI, SECTION A, LINE 7B | NOMINATIONS AND APPROVAL FOR VACANCIES ON THE GOVERNING BOARD ARE SUBJECT TO APPROVAL BY CORPORATE MEMBERS. ALL BUSINESS DECISIONS OF THE GOVERNING BODY ARE RATIFIED BY ANNUAL RESOLUTION OF THE CORPORATE BOARD. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 PROCESS INCLUDES A DETAIL REVIEW BY THE ACCOUNTING MANAGER, CHIEF FINANCIAL OFFICER AND CHIEF EXECUTIVE OFFICER. A COPY OF THE FORM 990 IS PROVIDED TO THE AUDIT AND FINANCE COMMITTEE FOR REVIEW. A REPORT OF THE COMMITTEE'S REVIEW AND COPY OF THE FORM 990 INCLUDING REQUESTED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, ARE PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST STATEMENTS ARE COMPLETED ANNUALLY BY ALL BOARD MEMBERS AND STAFF. THE ANNUAL STATEMENTS ARE REVIEWED BY THE BOARD CHAIR. WHEN CONDUCTING ORGANIZATION BUSINESS AND A CONFLICT ARISES, THE BOARD OR STAFF MEMBER INVOLVED ABSTAINS FROM VOTING ON RELATED MATTERS. DOCUMENTATION ON THIS MATTER IS KEPT IN THE BOARD MINUTES. | |
| FORM 990, PART VI, SECTION B, LINE 15 | AN INDEPENDENT COMPENSATION COMMITTEE, A SUB-COMMITTEE OF THE BOARD, REVIEWS AND APPROVES THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER AND OTHER KEY EMPLOYEES; THIRD PARTY AND MARKET DATA ARE UTILIZED AS COMPARABLE DATA; AND, DELIBERATION OF THESE DECISIONS ARE DOCUMENTED IN THE COMMITTEE'S MINUTES. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. IN ADDITION, THE ARTICLES OF INCORPORATION CAN BE VIEWED ON THE WEBSITE FOR THE INDIANA SECRETARY OF STATE AND THE MOST CURRENT FINANCIAL STATEMENTS ARE ATTACHED TO THIS FORM 990. | |
| FORM 990, PART XI, LINE 9: | GAIN ON INVESTMENT IN EQUITY INVESTEE 217,304. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C | THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT; AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. | OVERSIGHT OF AUDIT |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEKALB MEMORIAL PHARMACARE LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1314 E 7TH STREET | AddressLine1 |
| City | AUBURN | City |
| State | IN | State |
| ZIP Code | 46706 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 273514342 | EIN |
| Primary Activities | RETAIL PHARMACY | PrimaryActivities |
| Legal Domicile State | IN | LegalDomicileState |
| Total Income | 280297 | TotalIncome |
| EOY Assets | 668506 | EOYAssets |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEKALB MEMORIAL HOSPITAL | BusinessNameLine1 |
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEKALB COMM HOSPITAL FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 212 WEST 7TH STREET | AddressLine1 |
| City | AUBURN | City |
| State | IN | State |
| ZIP Code | 46706 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 356047817 | EIN |
| Primary Activities | FOUNDATION | PrimaryActivities |
| Legal Domicile State | IN | LegalDomicileState |
| Exempt Code Section | 501(C)3 | ExemptCodeSection |
| Public Charity Status | LINE 11 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEKALB MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |