NORTHWESTERN MEMORIAL HEALTHCARE: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- NORTHWESTERN MEMORIAL HEALTHCARE (EIN 36-2179764)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-15
- IRS object ID
- 201401359349308440
- Schema version
- 2012v2.0
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-15T14:27:40-07:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 191 W Nationwide Blvd Suite 500 | AddressLine1 |
| City | Columbus | City |
| State | OH | State |
| ZIP Code | 43215 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 362179764 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Memorial Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MEMO | NameControl |
| Phone | 8157885800 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3701 Doty Road | AddressLine1 |
| City | Woodstock | City |
| State | IL | State |
| ZIP Code | 60098 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | David Tomlinson | Name |
| Title | Exec VP, CFO & CIO | Title |
| Date Signed | 2014-05-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Mollie Longhouse | Name |
| PTIN | P00294881 | PTIN |
| Phone | 6142492300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Michael S Eesley | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 385 Millennium Drive | AddressLine1 |
| City | Crystal Lake | City |
| State | IL | State |
| ZIP Code | 60012 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 146713032 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| All Affiliates Included | false | AllAffiliatesIncluded |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.centegra.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1914 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | The mission of Memorial Medical Center is to provide quality healthcare services with innovative and responsible use of resources and promote wellness for the greater McHenry County area. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 910 | TotalNbrEmployees |
| Total Nbr Volunteers | 112 | TotalNbrVolunteers |
| Total Gross UBI | 13042 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -19526 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 301669 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1049541 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 142560130 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 135525699 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 242958 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2622367 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1782543 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2017005 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 144887300 | TotalRevenuePriorYear |
| Total Revenue Current Year | 141214612 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 61928279 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 55892100 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 87578161 | OtherExpensePriorYear |
| Other Expenses Current Year | 76099310 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 149506440 | TotalExpensesPriorYear |
| Total Expenses Current Year | 131991410 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -4619140 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 9223202 | RevenuesLessExpensesCY |
| Total Assets BOY | 99636157 | TotalAssetsBOY |
| Total Assets EOY | 122545695 | TotalAssetsEOY |
| Total Liabilities BOY | 65282827 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 79344065 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 34353330 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 43201630 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | The mission of Memorial Medical Center is to provide quality healthcare services with innovative and responsible use of resources and promote wellness for the greater McHenry County area. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 114593412 | Expense |
| Revenue | 135586760 | Revenue |
| Description | See Schedule O | Description |
| Total Program Service Expense | 114593412 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | true | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | true | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | true | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 85 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 910 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Number Of8282 Filed | 0 | NumberOf8282Filed |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Filed Lieu1041 | false | FiledLieu1041 |
| Licensed More Than One State | false | LicensedMoreThanOneState |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | true | InvestmentInJointVenture |
| Written Policy Or Procedure | true | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | David Tomlinson | NamePerson |
| Telephone Number | 8157885800 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 385 Millennium Drive | AddressLine1 |
| City | Crystal Lake | City |
| State | IL | State |
| ZIP Code | 60012 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (37 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| Parmod Narang | ||||||||
| Director | 0.33 | 1.67 | X | 0 | 0 | 0 | ||
| Michael S Eesley | ||||||||
| CEO | 13.00 | 27.00 | X | 0 | 1277730 | 446911 | X | |
| Kathy Powell | ||||||||
| Director | 0.33 | 3.67 | X | 0 | 0 | 0 | ||
| Jack Porter | ||||||||
| Director | 0.33 | 0.67 | X | 0 | 0 | 0 | ||
| Angela McAuley | ||||||||
| Director & VP | 0.33 | 1.67 | X | 0 | 0 | 0 | ||
| Luke Johnsos | ||||||||
| Director | 0.33 | 1.67 | X | 0 | 0 | 0 | ||
| Micheal Luecht | ||||||||
| Director | 0.33 | 1.67 | X | 0 | 0 | 0 | ||
| Charles Ruth | ||||||||
| Director | 0.33 | 2.67 | X | 0 | 0 | 0 | ||
| Tom Carey | ||||||||
| Director | 0.33 | 4.67 | X | 0 | 0 | 0 | ||
| Terrence J Bugno | ||||||||
| Director | 0.33 | 0.67 | X | 0 | 0 | 0 | ||
| Patrick Morehead | ||||||||
| Treasurer | 0.33 | 1.67 | X | 0 | 0 | 0 | X | |
| William Cox | ||||||||
| Secretary | 0.33 | 1.67 | X | 0 | 0 | 0 | X | |
| Mike Curran | ||||||||
| Vice Chairman | 0.33 | 0.67 | X | 0 | 0 | 0 | X | |
| Charie Zanck | ||||||||
| Chairman | 0.66 | 1.34 | X | 0 | 0 | 0 | X | |
| Matthew Towler | ||||||||
| Vice President | 19.50 | 20.50 | 0 | 229090 | 22461 | X | ||
| Mattias Carlen | ||||||||
| Vice President | 3.33 | 36.67 | 0 | 130801 | 25775 | X | ||
| Christopher Westerkamp | ||||||||
| Vice President | 13.33 | 26.67 | 0 | 177279 | 6284 | X | ||
| Robin K Purdy | ||||||||
| Vice President | 13.33 | 26.67 | 0 | 300194 | 30787 | X | ||
| Neil Murphy | ||||||||
| Senior VP, CNO | 13.33 | 26.67 | 0 | 284790 | 5394 | X | ||
| Kumar Nathan | ||||||||
| Vice President | 13.33 | 26.67 | 0 | 224423 | 31838 | X | ||
| Bernadette Szczepanski | ||||||||
| Vice President | 13.33 | 26.67 | 0 | 219911 | 18963 | X | ||
| Gail Rudolph | ||||||||
| Vice President | 0.50 | 39.50 | 0 | 178816 | 21597 | X | ||
| Rachel Sebastian | ||||||||
| Vice President | 0.50 | 39.50 | 0 | 280727 | 40770 | X | ||
| Pasquale Bernardi | ||||||||
| Vice President | 13.33 | 26.67 | 0 | 383404 | 23129 | X | ||
| Zbigniew Lorenc | ||||||||
| Vice President | 13.33 | 26.67 | 0 | 301170 | 24289 | X | ||
| Sheila Senn | ||||||||
| Vice President | 40.00 | 0.00 | 150138 | 0 | 32254 | X | ||
| Susan Milford | ||||||||
| Senior VP | 13.33 | 26.67 | 0 | 286937 | 89719 | X | ||
| Barbara Johnson | ||||||||
| Senior VP | 13.33 | 26.67 | 0 | 369160 | 20728 | X | ||
| Aaron Shepley | ||||||||
| Sr VP/CQO Couns | 13.33 | 26.67 | 0 | 428888 | 75450 | X | ||
| Robert Rosenberger | ||||||||
| Sr. VP & CFO | 13.00 | 27.00 | 0 | 627306 | 39398 | X | ||
| David Tomlinson | ||||||||
| Senior VP, CIO | 13.33 | 26.67 | 0 | 331725 | 38118 | X | ||
| Jason Sciarro | ||||||||
| President & COO | 13.00 | 27.00 | 0 | 724714 | 96798 | X | ||
| Suellen D Aus-Der-Au | ||||||||
| Pharmacist | 35.00 | 0.00 | 140493 | 0 | 19665 | X | ||
| Deborah J Golden | ||||||||
| Ultrasonographer | 40.00 | 0.00 | 135507 | 0 | 13621 | X | ||
| Lisa Evan | ||||||||
| Pharmacist | 35.00 | 0.00 | 132943 | 0 | 9832 | X | ||
| Anthony K Leung | ||||||||
| Pharmacist | 40.00 | 0.00 | 127843 | 0 | 24718 | X | ||
| Laurie M Parisi | ||||||||
| Emergency Manager | 40.00 | 0.00 | 120250 | 0 | 23885 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 807174 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 6757065 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1182384 | TotalOtherCompensation |
| Number Individuals GT100 K | 18 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Town Square Anesthia LLC | |||||
| 3703 Doty Road Suite 7 | Woodstock | IL | 60098 | Anesthesia Services | 235000 |
| Sodexo Inc & Affiliates | |||||
| 4880 Paysphere Circle | Chicago | IL | 60674 | Food, ES & POM Mgmt | 2513669 |
| Hearthstone Management Service | |||||
| 920 North Seminary Ave | Woodstock | IL | 600982996 | Extended Care Servic | 223114 |
| Executive Health Resources | |||||
| PO Box 822688 | Philadelphia | PA | 191822688 | Compliance Consultan | 338450 |
| Diversified Clinical Services | |||||
| PO Box 636981 | Cincinnati | OH | 452636981 | Wound Care Services | 365762 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 9 | NumberOfContractorsGT100K |
| Related Organizations | 240177 | RelatedOrganizations |
| Government Grants | 809364 | GovernmentGrants |
| Total Contributions | 1049541 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Routine Patient Services | 621990 | 53638101 | 53638101 |
| IDPA Provider Tax Revenue | 622110 | 6123398 | 6123398 |
| Charity Care/Admin Allow | 621990 | -14988850 | -14988850 |
| Ancillary O/P Services | 621990 | 81338238 | 81338238 |
| Ancillary I/P Services | 621990 | 9414812 | 9414812 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 135525699 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2117083 | TotalRevenueColumn |
| Exclusion | $2,117,083 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7468 | TotalRevenueColumn |
| Exclusion | $7,468 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 808983 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 808983 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 808983 | TotalRevenueColumn |
| Exclusion | $808,983 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 5996236 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 5498420 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 497816 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 497816 | TotalRevenueColumn |
| Exclusion | $497,816 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| Other Misc Income | 621990 | 163694 | $163,694 |
| Other Income | 621990 | 309693 | $309,693 |
| Cafeteria Sales | 722210 | 527800 | $527,800 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 206835 | TotalRevenueColumn |
| Related Or Exempt Function Income | 61061 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 13042 | UnrelatedBusinessRevenue |
| Exclusion | $132,732 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1208022 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 141214612 | TotalRevenueColumn |
| Related Or Exempt Function Income | 135586760 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 13042 | UnrelatedBusinessRevenue |
| Exclusion | $4,565,269 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 190571 | Total |
| Management And General | 190571 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 45325403 | Total |
| Program Services | 38048739 | ProgramServices |
| Management And General | 7276664 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 845056 | Total |
| Program Services | 706418 | ProgramServices |
| Management And General | 138638 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6302981 | Total |
| Program Services | 5268930 | ProgramServices |
| Management And General | 1034051 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3228089 | Total |
| Program Services | 2698497 | ProgramServices |
| Management And General | 529592 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 727206 | Total |
| Program Services | 254535 | ProgramServices |
| Management And General | 472671 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26196 | Total |
| Management And General | 26196 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8057554 | Total |
| Program Services | 6848921 | ProgramServices |
| Management And General | 1208633 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15195 | Total |
| Program Services | 15195 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20674475 | Total |
| Program Services | 19877481 | ProgramServices |
| Management And General | 796994 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11243 | Total |
| Program Services | 8243 | ProgramServices |
| Management And General | 3000 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2650900 | Total |
| Program Services | 2216000 | ProgramServices |
| Management And General | 434900 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 95923 | Total |
| Program Services | 90884 | ProgramServices |
| Management And General | 5039 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65925 | Total |
| Program Services | 54342 | ProgramServices |
| Management And General | 11583 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2316830 | Total |
| Program Services | 1936737 | ProgramServices |
| Management And General | 380093 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5790934 | Total |
| Program Services | 4840888 | ProgramServices |
| Management And General | 950046 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1740333 | Total |
| Program Services | 1454818 | ProgramServices |
| Management And General | 285515 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Other Misc. Expenses | 130324 | -33944 | 164268 |
| IDPA Provider Tax Assessment | 4215389 | 4215389 | |
| Provision for Bad Debts | 8310629 | 8310629 | |
| Purch Srvs Rltd Prty (Sch O) | 21270254 | 17780710 | 3489544 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 131991410 | Total |
| Program Services | 114593412 | ProgramServices |
| Management And General | 17397998 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 71217 | BOY |
| EOY | 146602 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4413128 | BOY |
| EOY | 6673666 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18855273 | BOY |
| EOY | 18642999 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2143966 | BOY |
| EOY | 1937420 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 923510 | BOY |
| EOY | 1048808 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 132849037 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 90066247 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36762509 | BOY |
| EOY | 42782790 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26457995 | BOY |
| EOY | 26934735 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4421540 | BOY |
| EOY | 4782763 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5587019 | BOY |
| EOY | 19595912 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 99636157 | BOY |
| EOY | 122545695 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16159498 | BOY |
| EOY | 14592913 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46148409 | BOY |
| EOY | 62481669 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2974920 | BOY |
| EOY | 2269483 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 65282827 | BOY |
| EOY | 79344065 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31698965 | BOY |
| EOY | 40391223 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2654365 | BOY |
| EOY | 2810407 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34353330 | BOY |
| EOY | 43201630 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 99636157 | BOY |
| EOY | 122545695 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 9223202 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | -108640 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -266262 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | 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) |
|---|---|---|
| Form4720 Filed4955 Tax | false | Form4720Filed4955Tax |
| Correction Made | false | CorrectionMade |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $26,196 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 26196 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
| Form4720 Filed4912 Tax | false | Form4720Filed4912Tax |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i | Identifier |
| Return Reference | Part II-B, Line 1i - Other Activities Description | ReturnReference |
| Explanation | As part of our payment of Illinois Hospital Association dues, approximately 27% in calendar year 2012 and 34% in calendar year 2013 are allocable to lobbying activities. As part of our payment of Metropolitan Chicago Healthcare Council dues, approximately 25% are allocable to lobbying activities. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 223785 | OtherCostOrOtherBasis |
| Book Value | 223785 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 72321558 | OtherCostOrOtherBasis |
| Depreciation | 47098949 | Depreciation |
| Book Value | 25222609 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3212830 | OtherCostOrOtherBasis |
| Depreciation | 1848155 | Depreciation |
| Book Value | 1364675 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 57510391 | OtherCostOrOtherBasis |
| Depreciation | 41119143 | Depreciation |
| Book Value | 16391248 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | -419527 | OtherCostOrOtherBasis |
| Book Value | -419527 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 42782790 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Other Receivables | 2678748 |
| Due from Affiliates | 16917164 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 19595912 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Self-Insured Professional Liability | $2,198,927 |
| Other Long-Term Liabilities | $70,556 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2269483 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part X | Identifier |
| Return Reference | Part X : FIN48 Footnote | ReturnReference |
| Explanation | ASC Topic 740, Income Taxes, addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded in the consolidated financial statements. Under ASC Topic 740, the Health System must recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured based on the largest benefit that has a greater than fifty percent likelihood of being realized upon ultimate settlement. ASC Topic 740 also provides guidance on derecognition, classification, interest and penalties on income taxes, accounting in interim periods and requires increased disclosures. As of June 30, 2013 and 2012, the Health System does not have a liability for unrecognized tax benefits. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 600.000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4403571 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4403571 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03340 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14070747 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7223934 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6846813 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05190 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 18474318 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7223934 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 11250384 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08530 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 20 | NumberOfActivitiesOrPrograms |
| Persons Served | 16088 | PersonsServed |
| Total Community Benefit Expense | 170635 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8434 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 162201 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00120 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 288 | PersonsServed |
| Total Community Benefit Expense | 160985 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 160985 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00120 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 31 | PersonsServed |
| Total Community Benefit Expense | 4179 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4179 | NetCommunityBenefitExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 382 | PersonsServed |
| Total Community Benefit Expense | 1343 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1343 | NetCommunityBenefitExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 29 | NumberOfActivitiesOrPrograms |
| Persons Served | 16789 | PersonsServed |
| Total Community Benefit Expense | 337142 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8434 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 328708 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00240 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 29 | NumberOfActivitiesOrPrograms |
| Persons Served | 16789 | PersonsServed |
| Total Community Benefit Expense | 18811460 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7232368 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 11579092 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08770 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 1 | PersonsServed |
| Total Community Building Expense | 1069 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1069 | NetCommunityBuildingExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 502639 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 502639 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00380 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 175 | PersonsServed |
| Total Community Building Expense | 19716 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 19716 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 400 | PersonsServed |
| Total Community Building Expense | 916 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 916 | NetCommunityBuildingExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 7 | NumberOfActivitiesOrPrograms |
| Persons Served | 768 | PersonsServed |
| Total Community Building Expense | 7894 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 7894 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 1 | PersonsServed |
| Total Community Building Expense | 381 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 381 | NetCommunityBuildingExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 13 | NumberOfActivitiesOrPrograms |
| Persons Served | 1345 | PersonsServed |
| Total Community Building Expense | 532615 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 532615 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00400 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $8,310,629 | BadDebtExpenseAmount |
| Amount Attributable To | 2253047 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 35374278 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 42986724 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -7612446 | 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 | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership |
|---|---|
| ARSC Real Estate Holdings | |
| Real Estate Holding Company | 0.25000 |
| Algonquin Road Surgery Cen | |
| Outpatient Surgery Center | 0.12750 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | Memorial Medical Center | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3701 Doty Road | AddressLine1 |
| City | Woodstock | City |
| State | IL | State |
| ZIP Code | 60098 | 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 | Memorial Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | 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 | 10 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | true | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Other Method | X | OtherMethod |
| 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 |
| Other Needs Addressed | X | OtherNeedsAddressed |
| All Needs Addressed | true | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| File Form4720 Report Excise Tax | false | FileForm4720ReportExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200.0000 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 600.0000 | FPGDiscountPercent |
| Explains Basis | true | 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 |
| State Regulation | X | StateRegulation |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| Centegra Rehab & Sports Medicine | ||||
| 10450 Algonquin Rd | Huntley | IL | 60142 | Rehabiliation & Sports Medicine Clinic |
| Centegra Wound & Hyberbaric Center | ||||
| 11650 S Route 47 | Huntley | IL | 60142 | Wound Care & Hyperbaric Center |
| Centegra Health Center-Huntley | ||||
| 10350 Haligus Rd | Huntley | IL | 60142 | Laboratory and Medical Imaging Services |
Form990 Schedule H Part VI Form990ScheduleHPartVI (19 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part VI - Additional Information | Part I, Line 7The amounts in Lines 7a-7d were calculated by applying the Medicare cost-to-charge ratio to the net patient revenue for each category. The amounts in Lines 7e-7k were calculated based on actual expenses for each community benefit activity category.Part I, Line 7, Column (f)Form 990, Part IX, line 25 includes $8,310,629 for Bad Debt Expense. This amount cannot be subtracted from total expenses in order to calculate the column (f) percentages in lines 7a-7k due to software limitations.Part I, Line 7, Line (g)This is the amount reported in Community Benefits for Medication Assistance for those Living in Poverty. | |
| Part V - Explanation of Number of Facility Type | Memorial Medical Center is comprised of one licensed hospital, one center housing laboratory and medical imaging services, one center housing a rehabilitation and sports medicine clinic, and one location housing a wound care and hyberbaric center. | |
| Part VI - States Where Community Benefit Report Filed | IL | |
| Part VI - Affilated Health Care System Roles and Promotion | See Schedule O for response to Form 990, Part III, Line 4a. | |
| Part VI - Explanation Of How Organization Furthers Its Exempt Purpose | See Schedule O for response to Form 990, Part III, Line 4a. | |
| Part VI - Community Building Activities | Representatives of Memorial Medical Center participated in many different community groups and committees, such as the Fire/EMS Chief Association, the Police Chief Association, the Health and Human Services Network, the Child Advocacy Board, and the Family Violence Coordinating Council. Through these meetings, representatives of Memorial Medical Center can promote the health system's role in improving the health of the individuals that these different groups serve. Also included Part II are expenses related to our Spanish language interpreters. Hispanics comprise 11.7% of the population of McHenry County and our Spanish language interpreters are imperative to the effort to improve the health of this traditionally underserved population. | |
| Part VI - Community Information | Centegra Health System defines its primary service area as McHenry County, an area of approximately 603 square miles and 327,142 residents. This county is among the fastest growing counties in Illinois with an 18.7% population growth from 2000-2010. The age groups with projected population growth from 2012 to 2017 are the 0-19 with 0.6% and the 65+ age group with 15.3% growth. The county's overall population is projected to increase by 1.4% in the next five years (2012 to 2017). For 2010, the age distribution of the population was as follows: 30% 0-19, 32% 20-44, 28% 45-64, and 10% 65+. McHenry County has relatively high socioeconomic status compared to the rest of Illinois. Median household income for 2011 was $76,909 compared to the IL state median income of $56,576. The 2013 unemployment rate was 9.3% which is lower than the state average of 9.4%. The McHenry County uninsured in 2011 was 9.1%, compared to the state uninsured rate of 13.1% | |
| Part VI - Patient Education of Eligibility for Assistance | 1. Uninsured patients arriving at our emergency department and/or direct admits are screened at time of service by either an Emergency Department Financial Counselor or the health system's In-Patient Financial Counseling Team, Public Aid Representatives and a Medication Assistance Coordinator to identify eligibility guidelines for federal, state and local government programs as well as charity care. Centegra Health System's Self Pay Process includes a screening which is completed by using hospital form C910050 03-09 prompting an interview offering payment options and eligibility guidelines. It is at this time that a patient becomes aware of the Hospital Uninsured Patient Discount Act, Medicaid, Medication Assistance Programs, Crime Victims, IBCCP, Cash Pay Fee Schedules, and other hospital discount incentives. Patients are advised of time lines for completing application processes at time of service in person. Appropriate scripting is followed by Centegra Health System (CHS) Associates. Discounts were established following the 200%, 350% and 600% federal poverty guidelines to assist in determining charity adjustments. Applications were designed by Centegra Health System Self Pay Committee in accordance to our Financial Policy (Policy Number 9850-2) identifying qualifications for the medically needy/catastrophic aid.2. Uninsured patients opting for elective services are contacted by phone prior to their date of service by the CHS Out-Patient Financial Counseling Team. CHS's Self Pay Process is followed and includes a screening for federal, state and local government programs as well charity care. An interview offering payment options and eligibility guidelines using hospital form C910050 03/09 prompts a quick eligibility determination. It is at this time that a patient becomes aware of the Uninsured Patient Discount Act, Medicaid, Medication Assistance Programs, Crime Victims, IBCCP, Cash Pay Fee Schedules, and other hospital discount incentives. Patients are advised of time lines for completing application processes prior to their elective services via phone. Appropriate scripting is followed by CHS Associates. Discounts were established following the 200%, 350% and 600% federal poverty guidelines to assist in determining charity adjustments. Applications were designed by CHS Self Pay Committee in accordance to our Financial Policy (Policy Number 9850-2) identifying qualifications for the medically needy/catastrophic aid.3. Our health system's web site offers FAQ's and answers as well as encourages patients to contact our Customer Service Team when they are unable to pay for services.4. Our health system's statements also identify detailed account and billing information encouraging the patient to contact our Customer Service Team and inquire about Financial Assistance options.5. Documentation is essential in effective communication. Follow up teams will then move forward in a timely manner with the appropriate actions to insure all necessary documents (if applicable) are received for eligibility determinations.6. CHS advertises a Price Line encouraging patients to inquire about estimated costs for future services. The Price Line is manned by our Out-Patient Financial Counselors from 8:00am - 7:00pm. When calls are returned with estimated costs, a conversation ensues to identify a possible financial hardship. Our Self Pay Process is put into effect at this time.7. Site Registrars will notify the CHS Financial Counseling Team when a financial hardship is identified.8. Emergency Department Financial Counseling positions were created to meet the needs of our ED patients. In addition, a full time Financial Counselor position was created to meet the special needs of our cancer patients.9. A Financial Assistance Coordinator reviews all financial applications, gathers needed documents, determines financial assistance and prepares each patient file for leadership approval. | |
| Part VI - Needs Assessment | Centegra Health System worked with the McHenry County Department of Public Health and other participating organizations to conduct a community health assessment and identify leading indicators to help highlight the health needs of the county. Those indicators identified include percentage of physically inactive people, percentage of obese people, percentage of current smokers over the age of 18, percentage of binge drinkers, reported new aids cases, suicide rate, mortality rate from unintentional injuries, firearm-related mortality rate, homicide rate, percentage of children with elevated lead levels age 1-6, percentage of children 19 to 35 months of age in full immunization compliance, percentage of people with no health insurance, and percentage of pregnant women who begin prenatal care in the 1st trimester. Centegra Health System has been an active participant in the McHenry County Health Department's MAPP process (Mobilizing for Action through Planning & Partnerships), which is an ongoing effort: Phase 1: Organize for Success/ Partnership Development; Phase 2: Vision, Value Statements; Phase 3: Conducting MAPP Assessments; Phase 4: Identify Strategic Issues; Phase 5: Formulate Goals and Strategies; Phase 6: Action Cycle (current stage). MAPP priorities have been defined as: 1) Increase Access to Medical, Dental and Mental Health care: Goal 1: Provide increased access to follow up care (medical, dental, mental) for the under/uninsured residents of McHenry County; Goal 2: Increase access to (medical, dental, mental) prevention, education, and screening programs available for all residents of McHenry County; 2) Information & Referral: Goal 1: Centralize and update Information and Referral located on Crisis Services web site; Goal 2: Market Crisis Line #/Web site (future 2-1-1) to community to increase visibility; Goal 3: 2-1-1 Information and Referral System; 3) Cardiovascular Care: Goal: By 2017, reduce the death rate from cardiovascular disease by 20%. Centegra's initiatives will target the following defined community needs as priorities: Access to Care, Information & Referral Services, and Clinical Areas of Cardiovascular and Cancer-related programs and services. Centegra's Community Benefits programming will continue to target: community wellness and prevention programs, community health education, community health advocacy and assistance, clinical education, community collaborations, and community-based clinical initiatives. | |
| Part V, Line 20d - Other Billing Determination of Individuals Without Insurance | Patients without insurance are given a 25% discount off of the standard charge for service. | Number of Hospital Faciltiy - 1 |
| Part V, Line 6i - Describe Other Needs Identified | Using information and analysis from the Household Survey, Focus Groups, Key Informant Interviews and Community Analysis, priorities were identified based on their prominence as community needs. As part of the priority selection process, issues were weighted based on their magnitude defined by size and severity, significance to the community,and whether current activities were adequate and effective in addressing the problem.The four primary priorities were:INFORMATION AND REFERRAL SYSTEMACCESS TO DENTAL CARE FOR LOW-INCOME POPULATIONACCESS TO MENTAL HEALTH AND SUBSTANCE ABUSE SERVICESOBESITY AND NUTRITIONSecondary priorities include:Cardiovascular DiseaseDiversity of Population/Lack of IntegrationEnvironment - Open Space and Groundwater ProtectionLack of Public TransportationCentegra Health System is an active participant in the McHenry County Health Departments on-going MAPP (Mobilizing for Action through Planning and Partnerships) process. Teams were formed to work on the priorities identified above. Representatives from Centegra Health System have participated as part of the core team leading the process, as well as all of the healthcare related workgroups: Information & Referral Workgroup, Obesity and Nutrition Workgroup, Cardiovascular Workgroup and Access to Mental Health and Substance Abuse Services Workgroup. | Number of Hospital Faciltiy - 1 |
| Part V, Line 5c - Description of Making Needs Assessment Widely Available | A community presentation highlighting the results of the study was held April 13, 2011 at McHenry County College. The meeting was open to the public. | Number of Hospital Faciltiy - 1 |
| Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment | The 2010 McHenry County Healthy Community Study was led and directed by representatives from 19 partner organizations who served as steering committee members. Those organizations were:Centegra Health System, Advocate Good Shepherd Hospital, League of United Latin Amer. Citizens, McHenry County Mental Health Board, Crystal Lake Chamber of Commerce, Pioneer Center, Environmental Defenders, Sherman Hospital, 1st Congregational Church of Crystal Lake, Senior Services Associates Inc., Leadership Greater McHenry County, United Way of Greater McHenry County, McHenry County College, Woodstock Christian Life (Hearthstone), McHenry County Community Foundation, Woodstock Community Unit School District 200, McHenry County Conservation District, Village of Prairie Grove, and the McHenry County Department of Health.The Core Team included Centegra Health System, Advocate Good Shepherd Hospital, McHenry County Community Foundation, McHenry County Department of Health and United Way of Greater McHenry County. | Number of Hospital Faciltiy - 1 |
| Part V, Line 3 - Account Input from Person Who Represent the Community | Input from representatives of the community served by the hospital facility was received through three main types of input:HOUSEHOLD SURVEY. Description of community issues and problems based on a random sample of McHenry County households. Surveys were sent to 8,000, one in thirteen households, proportional to zip codes within the county.FOCUS GROUPS. Discussions with small groups of persons who represent target populations likely to use or need health and human services. Discussion topics addressed positive and negative aspects of living in McHenry County, needed services, service gaps and barriers, and experiences with local agencies.The eleven focus groups as identified by the Steering Committee reflect similar groups included in 2006. The 2010 focus groups were: at risk youth, homeless persons, Latino adults, low income adults, parents of children/youth with mental illness, persons with a developmental disability, persons with mental illness, seniors, unemployed and dislocated workers, veterans, and young adults ages 18-24.KEY INFORMANTS. Interviews with 34 community leaders, agency directors, and other persons considered experts in their field based on professional expertise, knowledge of local human services system, or position of influence. These interviewees include:Pam Althoff (Illinois State Senator), Sandy Lewis (McHenry County Mental Health Board), David Barber (United Way of Greater McHenry County), Carol Louise (Family Alliance), Kay Bates (McHenry County Chamber of Commerce), Richard Mack (Metra), Cort Carlson (McHenry County Convention & Visitors Bureau), Carl Martens (McHenry County Workforce Investment Board), Julie Biel Claussen (Corporation for Affordable Homes of McHenry County (CAHMCO)), Patrick McNulty and Andy Andresky (McHenry County Department of Health), Michael Eesley (Centegra Health System), Mary Miller (McHenry County College Trustees), Pedro Enriquez (Illinois Migrant Council), Keith Nygren (McHenry County Sheriffs Department), Jane Farmer (Turning Point), Jason Osborn (McHenry County Department of Transportation), Dr. Bud Friend-Jones (Faith Bridge-First Congregational Church of Crystal Lake), Sandy Oslance (Algonquin/Lake in the Hills Chamber of Commerce), Suzanne Hoban (Family Health Partnership Clinic),Maggie Rivera (League of United Latin American Citizens (LULAC)), Mike Iwanicki (Veterans Assistance), John Rung (Northwest Herald), Catherine Jones (McHenry County College-SHAH Center), Dennis Sandquist (McHenry County Planning and Development 48), Patrick Kerin (McHenry County Pride), Mary Lu Seidel (Corporation for Affordable Homes of McHenry County (CAHMCO)), Elizabeth Kessler (McHenry County Conservation District), Astrid Larsen (McHenry County Crisis Line), Cindy Sullivan (Options and Advocacy), Brian Shahinian (Northern Illinois Special Recreation Association (NISRA)), Mike Tryon (Illinois State Representative), Joe Small and Jo Williams (McHenry County Community Foundation), Dan Volkers (McHenry County Farm Bureau), and Joe Williams (Regional Office of Education) | Number of Hospital Faciltiy - 1 |
| Part III, Line 9b - Provisions On Collection Practices For Qualified Patients | If a patient qualifies for a 100% charity/financial assistance discount, collection of the account is not pursued as a bad debt. The account is written off in full at the time of the decision. If a patient receives a partial discount for Financial Assistance, any remaining balances will be treated in accordance with the Financial Policy regarding self pay balances and may be offered a payment plan option. The payment plan is in installments ($25 minimum), with the first payment due at discharge. Payment plans are not to exceed 36 months without documentation or verbal communication of ability to pay. Documentation may include a completed financial statement. Patients who have not completed arrangements for one of the payment options within 120 days of the billing date will be automatically turned over to a collection agency. Patients with delinquent payments, 15 or more days late, will be turned over to a collection agency. After insurance processing, patients who have not made payments or enrolled in one of the payment options for co-insurance and deductible amounts within 120 days of insurance payment will be turned over to a collection agency. As an exception, the Director of Patient Financial Services may review and recommend further discounts. No interest charges will accrue on account balances in which payments are being made. | |
| Part III, Line 8 - Explanation Of Shortfall As Community Benefit | The amount shown in line 6 represents the actual costs incurred to treat Medicare patients and is calculated by applying the Medicare cost-to-charge ratio. Therefore, the entire amount of line 7 constitutes a community benefit. | |
| Part III, Line 4 - Bad Debt Expense | The footnote discussing the organizations bad debt expense is on page 16 and 17 of the attached audited statements. | |
| Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit | The estimated amount of bad debt expense (at cost) which could be reasonably attributable to patients who would likely qualify for financial assistance under the organizations charity care policy if sufficient information had been available to make a determination of their eligibility was based on the self pay patient accounts which were written off as bad debts. These amounts were then multiplied by the cost to charge ratio. Any payments received during the fiscal year on these accounts were deducted from the cost. | |
| Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense | The organization uses an analysis based on history of the type of payer and the days outstanding of the receivable to determine an estimate of the amount that will be uncollectible. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
| Rebuttable Presumption Procedure | false | RebuttablePresumptionProcedure |
Form990 Schedule J Part II Form990ScheduleJPartII (21 entries)
| TitleTitle | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs | Base Compensation Filing OrgBaseCompensationFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Zbigniew Lorenc | ||||||||||||
| Vice President | 249763 | 48001 | 3406 | 14700 | 9589 | 325459 | ||||||
| Susan Milford | ||||||||||||
| Senior VP | 223295 | 63642 | 66549 | 23170 | 376656 | 5506 | ||||||
| Suellen D Aus-Der-Au | ||||||||||||
| Pharmacist | 140493 | 19665 | 160158 | |||||||||
| Sheila Senn | ||||||||||||
| Vice President | 133314 | 22762 | 182392 | 16824 | 9492 | |||||||
| Robin K Purdy | ||||||||||||
| Vice President | 271332 | 28862 | 14700 | 16087 | 330981 | |||||||
| Robert Rosenberger | ||||||||||||
| Sr. VP & CFO | 469516 | 122154 | 35636 | 15893 | 23505 | 666704 | 19889 | |||||
| Rachel Sebastian | ||||||||||||
| Vice President | 243577 | 37150 | 17520 | 23250 | 321497 | |||||||
| Pasquale Bernardi | ||||||||||||
| Vice President | 322584 | 60820 | 23129 | 406533 | ||||||||
| Neil Murphy | ||||||||||||
| Senior VP, CNO | 225156 | 59634 | 5394 | 290184 | ||||||||
| Michael S Eesley | ||||||||||||
| CEO | 822323 | 451843 | 3564 | 435234 | 11677 | 1724641 | 261678 | |||||
| Mattias Carlen | ||||||||||||
| Vice President | 124601 | 6200 | 25775 | 156576 | ||||||||
| Matthew Towler | ||||||||||||
| Vice President | 193312 | 35778 | 22461 | 251551 | ||||||||
| Kumar Nathan | ||||||||||||
| Vice President | 213992 | 10431 | 13925 | 17913 | 256261 | |||||||
| Jason Sciarro | ||||||||||||
| President & COO | 564364 | 156422 | 3928 | 73224 | 23574 | 821512 | 19515 | |||||
| Gail Rudolph | ||||||||||||
| Vice President | 178816 | 5056 | 16541 | 200413 | ||||||||
| David Tomlinson | ||||||||||||
| Senior VP, CIO | 276560 | 55165 | 14700 | 23418 | 369843 | |||||||
| Christopher Westerkamp | ||||||||||||
| Vice President | 162609 | 14670 | 4786 | 1498 | 183563 | |||||||
| Bernadette Szczepanski | ||||||||||||
| Vice President | 194954 | 24957 | 13327 | 5636 | 238874 | |||||||
| Barbara Johnson | ||||||||||||
| Senior VP | 312899 | 56261 | 9966 | 10762 | 389888 | 56261 | ||||||
| Anthony K Leung | ||||||||||||
| Pharmacist | 127843 | 24718 | 152561 | |||||||||
| Aaron Shepley | ||||||||||||
| Sr VP/CQO Couns | 333458 | 95430 | 52000 | 23450 | 504338 | 14724 | ||||||
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (6 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Rachel Sebastian | |||
| Family Membe | 321497 | Employee | false |
| Carey Electric | |||
| Director | 488932 | Electrical Contractor | false |
| American Community Bank | |||
| Chairman | 106282 | Certificate of Deposit | false |
| American Community Bank | |||
| Director | 106282 | Certificate of Deposit | false |
| Home State Bank | |||
| Director | 100000 | Certificate of Deposit | false |
| Home State Bank | |||
| Treasurer | 100000 | Certificate of Deposit | false |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | All business transactions with interested persons are arms length transactions, see Conflict of Interest disclosure for Form 990, Part VI, Line 2. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (19 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Line 12c | 1. In connection with any actual or possible conflicts of interest, an interested person or other person subject to this policy must disclose the existence and nature of his or her financial interest in writing to the President of Centegra or the Chief Corporate Responsibility Officer or designee, who shall provide such written disclosure to the Governors Affairs Committee of Centegra, which shall consider all conflicts of interest issues and, if appropriate, to the directors and members of committees with board-delegated powers considering the proposed transaction or arrangement. The disclosure must occur, at minimum, annually, with a Conflict of Interest Disclosure Statement being submitted no later than January 31 st of each year. Copies of disclosure statements filed by Board members shall be distributed to the Board annually at the February Board meeting. 2. When a conflict of interest is disclosed at meeting of the board or committee thereof, after disclosure of the financial interest, the interested person shall leave the board or committee meeting while the financial interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists. The interested person's leaving such meeting shall not affect whether a quorum exists at such meeting. 3. Procedures for Addressing the Transaction or Arrangement From Which the Conflict Arose. The chairperson of the board or committee shall, if appropriate, appoint a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement. After exercising due diligence, the board or committee shall determine whether Centegra can obtain a more advantageous transaction or arrangement with reasonable efforts from a person or entity that would not give rise to a conflict of interest. If a more advantageous transaction or arrangement is not reasonably attainable under circumstances that would not give rise to a conflict of interest, the board or committee shall determine by a majority vote of the disinterested directors whether the transaction or arrangement is in Centegra's best interest and for its own benefit and whether the transaction is fair and reasonable to Centegra and shall make its decision as to whether to enter into the transaction or arrangement in conformity with such determination. 4. Violations of the Conflicts of Interest Policy: If the administration, the board, or a committee has a reasonable cause to believe that a member has failed to disclose actual or possible conflicts of interest, it shall inform the member of the basis for such belief and afford the member an opportunity to explain the alleged failure to disclose. If, after hearing the response of the member and making such further investigation as may be warranted in the circumstances, the board or committee determines that the member has, in fact, failed to disclose an actual or possible conflict of interest, it shall refer the matter to the Governors Affairs Committee for consideration, which shall subsequently recommend appropriate disciplinary and corrective action to such board or committee. 5. The minutes of the board and all committees with board-delegated powers shall contain the names of the persons who disclosed or otherwise were found to have a financial interest in connection with an actual or possible conflict of interest, the nature of the financial interest, any action taken to determine whether a conflict of interest was present, and the board's or committee's decision as to whether a conflict of interest, in fact, existed. The names of the persons who were present for discussions and votes relating to the transaction or arrangement, the content of the discussion, including any alternatives to the proposed transaction or arrangement, and a record of any votes taken in connection therewith. Continued below. | |
| Form 990, Part IV, Line 24 | Memorial Medical Center holds a liability on its books for tax-exempt bonds, which is an allocation from its sole corporate member, Centegra Health System. As a result, the question was answered no, and Shedule K will be completed ib Centegra Health System's Form 990. | |
| Form 990, Part III, Line 4a Con't | What's Aphasia? is a group for stroke survivors and family members who have an impairment of their ability to speak or comprehend words; Wingspan is a group that provides the opportunity for open discussions, question and answer sessions, lectures, and social events for people recovering from strokes as well as their families; Y-Me Breast Cancer Support Program is a national program designed to let participants listen to physicians, survivors, social workers, and nurses who have been invited to speak on topics such as handling anger, considered prostheses, and recent concerns about breast implant risks. Memorial Medical Center participates in various community projects such as Meals on Wheels, Immunization Clinics, National Depression/Anxiety Screening Day, and county and business health fairs in order to promote health and awareness in the community. Memorial Medical Center also sponsors shadowing opportunities for area students. The Medical Center provides free blood pressure, skin cancer, colorectal cancer, glaucoma, hearing and other screenings and displays for health fairs, trade shows and county fairs; as well as lipid and mammogram screenings and free flu shots. The Medical Center also distributes thousands of informational brochures, service listings, and flyers at the request of area schools, churches, and organizations on an ongoing basis. Centegra S.H.I.P. (Senior Health Insurance Program) provides trained volunteers on a weekly basis to answer questions regarding insurance coverage. Silver Key Club is the senior citizens group for Centegra Health System. It is a free membership group for people 55 years of age and older, which provides: four issues of a senior newsletter each year, a health diary for members to list their medications and health history, and a discount in the hospital cafeterias at both MMC and NIMC. At certain times of the year, there are discounted screenings and/or special services available for members. Community education is also made available to Silver Key members through early bird reservations, or through general news releases. Memorial Medical Center, in conjunction with Centegra Health System and Northern Illinois Medical Center, works in cooperation with McHenry County College and Health Bridge Fitness Center to provide a complete series of specialized training for those interested in developing their knowledge of emergency basics, or in pursuing a career in the emergency health care field. Local fire and police departments use these programs extensively. | |
| Form 990, Part III, Line 4a Con't | Together with the American Cancer Society, Gavers Community Cancer Foundation, Sage Cancer Center, and McHenry County College, Centegra Health System sponsors Cancer Awareness Programs including Skin Cancer Screening, Colorectal Cancer Screening, Cancer Survivors Day, Breast Cancer, and Prostate Cancer: Early Detection & Treatment Programs. "Once and For All" Quit Smoking Clinic approaches quitting smoking with wellness in mind. The Medical Center sponsors several programs specializing in issues of concern for women as well as reduced fee mammograms. Making Peace with Your Body is a program to teach women body acceptance with an emphasis on what you can realistically change with diet and exercise. Additional behavioral health programs include: depression and anxiety screenings, What To Do When Your Loved One Is Depressed, Relationship Addiction, Step Families: Steps to Harmonious Living, and Mind/Body Medicine: An Introduction. Other programs include a Critical Care Class, You're In Control Diabetic Education Program, Men and Depression and a variety of ophthalmology programs. Still more educational programs are offered to assist members of the community in taking charge of the special needs in their lives, in their changing lifestyles for healthier lives, as well as programs to inform the community about Advance Medical Directives including living wills, durable power of attorney issues and organ donations and Understanding Medicare. Eye programs may include: Refractive Surgery-correcting your vision with surgery, Understanding Childhood Eye Diseases, Diabetes And Your Eyes, and glaucoma education programs. Memorial Medical Center, in conjunction with Centegra Health System, Northern Illinois Medical Center, and Health Bridge Fitness Center, offers specialized exercise programs that help participants get moving and stay active for a healthier lifestyle. These include: Low Back Water Class, Basketball League, Racquetball League, Arthritis Water Exercise Class, Seniors in Motion, Senior Citizen's Exercise Group, The Get Off Your Rocker Program designed for individuals at least 55 years of age to improve flexibility, strength, and endurance; and the Stroke Exercise Program which is a general physical conditioning exercise program for stroke patients to improve coordination and increase range of motion. Yoga, Tai Chi, relaxation management, weight management, and a variety of other classes are offered through Health Bridge Fitness Center. Together We Can Immunization Partnership Clinics were instituted at Memorial Medical Center, Northern Illinois Medical Center and other medical office buildings to provide immunizations for the unvaccinated children (under age 18) of McHenry County. Clinics are held once per month at both medical centers providing Hepatitis B, DTP, Hib, OPV, MMR, and TB immunizations. Fees are based upon ability to pay with a maximum charge of $15.00 per immunization. The Rehabilitation and Sports Medicine Clinic at Health Bridge Fitness Center provides sports medicine, aquatics, outpatient physical and occupational therapy programs. The Back to Work Program, an industrial injury prevention and rehabilitation program provides physical therapy, ergonomic consultation and back safety programs. The program also uses the aquatic pool located at the Rehabilitation and Sports Medicine Clinic at the Health Bridge Fitness Center. | |
| Form 990, Part III, Line 4a Con't | The Centegra Pain Management Center specializes in providing advanced, innovative treatments that succeed in relieving most types of pain. The physicians, pain psychologist, nurses, and staff are specially trained and experienced in the field of pain management. Educational materials on chronic pain were developed and made available to the community at trade/health fairs. Centegra Health System is a learning center (clinical site) for students from a multitude of colleges and universities. Students have completed internships in programs such as nurse practitioner, nursing, nurse aide, physician assistant, social work, speech therapy, phlebotomy, diagnostic medical sonography, medical imaging, medical records, pharmacy, medical physics, surgical technology, professional counselor, substance abuse counselor, and medical assistant. Centegra Health System is also a learning site for 3rd and 4th year medical students from the University of Illinois at Rockford. | |
| Form 990, Part III, Line 4a Con't | Memorial Medical Center offers a variety of classes that can help people save lives. By sponsoring these classes, the Medical Center is helping the community in two ways; first, by building skills and confidence levels of the class participants; and second, by making trained help available for the community in case of emergencies. There are three levels of training available. The First Responder is designed to instruct laymen in the following skills: identifying the emergency situation, stabilizing the victim, and providing basic emergency care until emergency medical personnel arrive. The Emergency Medical Technician - Basic provides a more in-depth study of the recognition and management of victims of traumatic injuries or medical emergencies, and includes hospital clinical experience. This course enables the participant to become a State of Illinois licensed EMT-Basic. The Emergency Medical Technician - Paramedic program provides an intensive learning experience in the use of advanced life support procedures for the management of traumatic injuries and medical emergencies prior to the arrival at the hospital. This course enables the participant to become a State of Illinois licensed Paramedic. An Emergency Medical Dispatcher Course, designed to prepare individuals for employment as dispatchers for a public service agency providing dispatch to law enforcement, fire service, and or Emergency Medical Service, is also offered. Memorial Medical Center, in conjunction with Centegra Health System and Northern Illinois Medical Center, makes available a variety of educational programs designed to promote the wellness of all members of the community. Although many of these programs are offered for a nominal fee to help defray costs, this fee may be waived if the participant does not possess the ability to pay. Memorial Medical Center offers a variety of classes that can help people save lives. The Medical Center offers American Red Cross first aid classes that include First Aid/CPR and a CPR Instructor Course. Cardiopulmonary resuscitation (CPR) classes help community members learn CPR prior to certification or brush up on skills for re-certification. The Medical Center also provided International Trauma Life Support training, Advanced Cardiac Life Support training, and Pediatric Advanced Life Support training. The American Heart Association has recognized Centegra Health System as one of the top ten A.H.A. training sites in the Chicago Metro area. Family health and wellness programs presented by the Medical Center are designed to promote a healthier community. Emergency Room Treatment Forms are available for parent/guardian permission to administer emergency treatment to minors in their absence. Supersitters is a class which teaches the responsibilities of being a babysitter and includes basic first aid and accident prevention, as well as the importance of tender loving care. The Medical Center offers education classes for expectant families including prenatal, grandparents and cesarean birth as well as sibling classes and low rent pagers. At discharge, all new parents are presented with the video, "Baby's First Months: What Do We Do Now". The Medical Center provides various classes to assist with our busy life styles. Relaxation Training teaches techniques to bring the mind and body in balance. Nutrition related offerings include Food and Feelings, Healthy Heart Nutrition and a Weight Management program. Cholesterol Commitment and Improving Your Blood Pressure are programs that assist participants in recognizing the factors that affect your blood pressure, early warning signs of heart attack and offer tips for better control as well as the importance of early intervention. Lipid screening is offered twice each year. | |
| Form 990, Part III, Line 4a Con't | Each of the following ongoing support groups is held at the Medical Center or in the community and is free of charge. By supporting these groups the Medical Center is able to provide one or all of the following three things: 1.) Staff who either act as facilitators of the group or function as "Guest Speakers". 2.) Space offered free of charge. 3.) Free marketing to educate the community about these services. Support groups include: Alcoholics Anonymous is a twelve-step program for individuals recovering from alcohol dependence; Al-Anon is a twelve-step program for codependent individuals; Arthritis Support Group meets the first Tuesday of every month for individuals with arthritis; Bariatric Support Group is for individuals who have had weight loss surgery; Better Breathers Club is for those individuals with pulmonary disease and their families; Caregivers Support Group is for those who are caring for someone with a chronic or life threatening illness; Diabetes Support Group is for individuals with diabetes and their families; Epilepsy Support Group is for parents of children with epilepsy; Families Anonymous is a support group for family members of chemically dependent people; Fibromyalgia Support Group is for those suffering from Fibromyalgia; Get Help Live Longer is a smoking cessation education and support group; Hat's Off is a group for women diagnosed with any type of cancer meeting every month; Headwinds is a support group offered to survivors of traumatic brain injury and their family members and caregivers. This group hosts speakers including medical professionals who specialize in traumatic brain injuries. The Medical Center participates in conjunction with the Pioneer Center. Participants receive information on topics such as dealing with behavioral problems and the financial issues of long-term care; Infertility Support Group is a group for couples or individuals experiencing infertility problems; Living with Grief, sponsored by Centegra pastoral care, offers support for adults grieving the loss of a loved one; Looking Beyond is for people diagnosed with cancer, their family members, and friends; Make Today Count is a group for anyone with a life-threatening illness as well as their family and friends. The purpose of the program is to help members cope and gain emotional strength. The Group also puts participants in touch with professional resources available to help them; McHenry County Crisis Line for 24-hour mental health information, referral service, and crisis assistance; Multiple Sclerosis (MS) Support Group is under the greater Illinois Chapter of the National Multiple Sclerosis Society. The group is open to persons with MS, their family members and others interested in treatment and management of the disease. Specialists are often invited to speak to the group regarding the symptoms of the disease; Narcotics Anonymous is a twelve-step support program for those recovering from narcotic dependence; Nuts and Bolts is a unique support group for stroke survivors who are 55 years of age or younger. The emphasis of this group is on assisting the families as they adapt to the special lifestyle changes of the young stroke survivor. The group has earned attention from the National Stroke Conference leaders, as it is one of the first support groups of its type; Perinatal Grief Support Group is for anyone who has experienced the loss of a newborn or infant through miscarriage, ectopic pregnancy or sudden infant death syndrome; St. Peregrine's Cancer Support Group is a non-denominational support group for patients and their family and friends; | |
| Form 990, Part III, Line 4a | The primary mission of Memorial Medical Center is to provide quality health care services with innovative and responsible use of resources and promote wellness for the greater McHenry County area. Memorial Medical Center uses a holistic approach to providing health care services with honesty and integrity, an attitude of respect and caring, teamwork and education throughout its organization and the community. It is the Medical Center's objective to serve the community with respect to providing health care services and education. The Medical Center provides quality health care 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 Memorial Medical Center, it is recognized that not all individuals possess the ability to purchase essential medical services. Therefore, in keeping with the Medical Center's commitment to serve all members of its community, free care and/or subsidized care will be considered where the need and/or an individual's inability to pay exist. Medical services are provided in a dignified manner to Medicare, Medicaid and indigent patients. Memorial Medical Center is affiliated with Northern Illinois Medical Center through their common parent, Centegra Health System. Memorial Medical Center's services include, but are not limited to 170 licensed-bed acute care medical center (29,879 patient days in fiscal year 2013), Level II Trauma Center, Emergency Medicine and Physicians, 24-hours a day, On-site heliport, Surgery and Ambulatory Treatment Services, Intensive and Intermediate Care Unit, Respiratory Therapy, Physical Medicine and Rehab, Obstetrics, including Level II Nursery facility, Pediatrics, Full-body CT Scanner and Magnetic Resonance Imaging (MRI), Mammography screening at two sites, Extended Care Unit, Behavioral Health Unit: Adult, and Chemical Dependency/Detox Programs, Sleep Disorders Center, First Step Substance Abuse Center: 800-675-8448, TDD for the hearing impaired: 815-338-0008, Poison Control Hotline: 815-338-5975, McHenry County Crisis Line: 800-892-8900, Pharmacy Information Line: 815-338-9090, Associate Health Program: 815-334-3944, Pastoral Care, Social Services, Community Education Programs, Support Programs. Recognizing its mission to enhance the health of the community, services are provided to Medicare, Medicaid and indigent patients. The Medical Center may partially recognize these amounts as charity care. Charity Care includes care provided to persons covered by governmental programs at below cost, as well as health activities and programs to support the community. These activities include wellness programs, community education programs, and special programs for the elderly, handicapped, mentally under served, and a variety of broad community support activities. The unreimbursed value of providing charity care was approximately $35,032,712 in fiscal year 2013. During that year, the Medical Center provided in excess of 29,879 inpatient days of service, which included over 13,984 days of Medicare inpatient service. The Medical Center is cognizant of the significant need for high quality, yet cost effective health care services. The Medical Center recognizes the ongoing need to be good stewards of Medicare and Medicaid dollars. As such, the Medical Center has implemented Service Excellence programs designed to reduce health care costs while maintaining high quality standards. Memorial Medical Center believes in a holistic approach to health care that embraces the physical, psychological, spiritual, social and economic needs of the entire public served. In order to provide this care, Memorial Medical Center supports a variety of services, educational programs and support groups. Memorial Medical Center, in conjunction with Centegra Health System and Northern Illinois Medical Center, sponsors or hosts many support groups for its patients as well as the community. | |
| Other Changes In Net Assets Or Fund Balances - Other Increases | Interest in Foundation (non-capital, temp restricted) = $156042 | Form 990, Part XI, Line 9 |
| Other Changes In Net Assets Or Fund Balances - Other Decreases | Extraordinary Loss on GE = -$482450 | Form 990, Part XI, Line 9 |
| Other Changes In Net Assets Or Fund Balances - Other Increases | Change in Fair Value of Derivative = $57871 | Form 990, Part XI, Line 9 |
| Other Changes In Net Assets Or Fund Balances - Other Increases | Capital Grant from Foundation = $2275 | Form 990, Part XI, Line 9 |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | All documents are available upon request. | Form 990, Part VI, Line 19 |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | The Board of Directors of Centegra Health System, through the Compensation Committee comprised of independent members free of conflict, reviewed executive compensation levels and other features of the compensation plan in accordance with the organization's approved compensation philosophy and strategy: The Committee is comprised of members of the Board of Directors, who are independent of Centegra management, have no personal interest in the compensation arrangements, are not related to, or under the control of any individual whose compensation arrangement is being reviewed and have no material business relationship with Centegra.The Chief Executive Officer's compensation is determined by the Compensation Committee in relation to appropriate comparability data. Compensation for other members of the executive staff are developed by the CEO, reviewed by the Committee, evaluated against market data, and approved by the Committee. The Committee approves all compensation decisions in advance of their implementation and documents its determinations and discussions. Its decisions and deliberations are thoroughly documented and meeting minutes are kept and distributed to the Committee members (for historical reference). The Compensation Committee uses a number of external resources and comparisons, and their review includes total compensation (cash compensation, plus benefits provided by Centegra) in relation to organizational performance and prevailing industry practices of comparably-sized organizations. They have engaged the services of a compensation consulting firm (Sullivan Cotter) specializing in the not-for-profit sector that has worked with Centegra and reports directly to the Compensation Committee. | Form 990, Part VI, Line 15b |
| Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | Continued from above. 6. A voting member of any committee whose jurisdiction includes compensation matters and who receives compensation, directly or indirectly, from Centegra for services is precluded from voting on matters pertaining to that member's compensation, Physicians who receive compensation, directly or indirectly, from Centegra, whether as employees or independent contractors, are precluded from membership on any committee whose jurisdiction includes compensation matters and in which such physician may have a direct or indirect interest. 7. Each director, principal officer, and member of a committee with board-delegated powers shall annually sign a statement which affirms that such person has received a copy of the conflicts of interest policy; has read and understands the policy; has agreed to comply with the policy; and understands that Centegra is a charitable organization and that in order to maintain its federal tax exemption, it must engage primarily in activities which accomplish one or more of its tax exempt purposes. 8. To ensure that Centegra operates in a manner consistent with its charitable purposes and that it does not engage in activities that could jeopardize its status as an organization exempt from federal income tax, periodic reviews shall be conducted by the Governors Affairs Committee of Centegra. The periodic reviews shall, at a minimum, include the following subjects: Whether acquisition of physician practices and other provider services result in inurement or impermissible private benefit. Whether partnership and joint venture arrangements and arrangements with management service organizations and physician hospital organizations conform to written policies, are properly recorded, reflect reasonable payment for goods and services, further Centegra's charitable purposes and do not result in inurement or impermissible private benefit. Whether agreements to provide healthcare and agreements with other healthcare providers, employees, and third party payors further Centegra's charitable purposes and do not result in inurement or impermissible private benefit. Whether business transactions on behalf of Centegra or an entity controlled by it are the result of arms-length dealing and are no less advantageous than competitively available goods and services of like grade and quality. 9.In conducting the periodic reviews provided for in Article VII, Centegra may, but need not, use outside advisors. If outside experts are used, their use shall not relieve the board of its responsibility for ensuring that periodic reviews are conducted. | Form 990, Part VI, Line 12c |
| Form 990, Part VI, Line 11b: Form 990 Review Process | The review process for the 990 include compilation by internal staff, detailed review by an outside auditor, bond counsel, the Controller and Chief Financial Officer, prior to submission to the IRS. The tax return will be made available for the Board to review after submission to the IRS. | Form 990, Part VI, Line 11b |
| Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder | Centegra Health System is the sole member of MMC. Centegra Health System has a single class of members. | Form 990, Part VI, Line 6 |
| Form 990, Part VI, Line 3: Description of Delegated Duties to Management Company | Management companies were used for the daily operations and management of the following services for the health system. Sodexho was used for Food & Nutrition, Plant Operations and Maintenance, and Environmental Services work. Dell Marketing LP was used for the management of the Information Systems area. Professional Business Consultants is used for the management of the Managed Care department. Hearthstone Management Services was used for daily operations of the Skilled Nursing Facility. These companies were responsible for staffing decisions, personnel supervision, and financial planning. None of the organization's current of former officers, directors, trustees, key employees or highest compensated employees were compensated by the management companies during the calendar year 2012. | Form 990, Part VI, Line 3 |
| Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et | Memorial Medical Center, (MMC), adopted specific conflict of interest policies for its governing and management staff. The policy includes, but is not limited to, when an individual, governor, committee member, officer, agent or employee believes that he or she, or member of his or her immediate family might have or does have a real or apparent conflict, he or she should in addition to filing the disclosure notice required, abstain from making motions, voting, executing agreements, or taking any other similar direct action on behalf of MMC. Not with standing, it is realized that both real and apparent conflicts of interest sometimes naturally occur in the course of conducting daily affairs. Conflicts occur because the many persons associated with MMC should be expected to have, and do in fact generally have multiple interests and affiliations, and various positions of responsibility with the community. The long-range interests of MMC do not require the termination of an association with persons who have real or apparent conflicts, if an effective method can render such conflicts harmless to all concerned. During fiscal year 2013, MMC purchased certain goods and/or services from organizations with director's affiliation. All transactions were competitively bid and conducted at arms length. The fees paid were at fair market value. Rachel Sebastian, Vice President, is the daughter of Michael Eesley, CEO. Director Kathy Powell is an employee and vice president of Home State Bank. Treasurer Patrick Morehead is on the Board of Directors and a 2% owner of Home State Bank. Chairman Charie Zanck is CEO and Vice Chairman of American Community Bank & Trust. Director Charles Ruth is the Board Chairman of American Community Bank & Trust. Director Tom Carey is the Vice President and Majority Owner of Carey Electric. | Form 990, Part VI, Line 2 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (5 entries)
| Address Line1AddressForeign/AddressLine1 | CityAddressForeign/City | CountryAddressForeign/Country | Postal CodeAddressForeign/PostalCode | Primary ActivitiesPrimaryActivities | Legal Domicile Foreign CountryLegalDomicileForeignCountry | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Centegra Insurance Services LTD | |||||||||||||
| PO Box 1051 | Grand Cayman | CJ | KY1-1102 | Malpractice Insurance Provider | CJ | Centegra Health System | |||||||
| Centegra Health & Wellness Network LLC | |||||||||||||
| Clinically Integrated Healthcare Network | Centegra Health System | 385 Millennium Drive | Crystal Lake | IL | 60012 | 364740459 | IL | ||||||
| Centegra Clinical Laboratories LLC | |||||||||||||
| Laboratory and pathology services | 385 Millennium Drive | Crystal Lake | IL | 60012 | 364706465 | DE | N/A | ||||||
| Centegra Primary Care LLC | |||||||||||||
| Physician Practice | Centegra Health System | 385 Millennium Drive | Crystal Lake | IL | 60012 | 364085398 | IL | ||||||
| Centegra Health Bridge Fitness Center | |||||||||||||
| Health & Fitness Center | Health Bridge Corporation | 385 Millennium Drive | Crystal Lake | IL | 60012 | 261277524 | IL | ||||||
Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Centegra Hospital-Huntley | |||||||||||
| 10400 Haligus Road | Huntley | IL | 60142 | 453449737 | Hospital Operations | IL | 501(c)(3) | 3 | Centegra Health System | false | |
| Oak Creek Lodge | |||||||||||
| 385 Millennium Drive | Crystal Lake | IL | 60012 | 363591359 | Hospital Operations | IL | 501(c)(3) | 3 | Centegra Health System | false | |
| Health Bridge Corporation | |||||||||||
| 385 Millennium Drive | Crystal Lake | IL | 60012 | 363196550 | Health & Fitness Center | IL | 501(c)(3) | 11c | Centegra Health System | false | |
| NIMED Corporation | |||||||||||
| 385 Millennium Drive | Crystal Lake | IL | 60012 | 363119911 | Property Management | IL | 501(c)(3) | 11c | Centegra Health System | false | |
| Centegra Health System Foundation | |||||||||||
| 385 Millennium Drive | Crystal Lake | IL | 60012 | 363723610 | Fundraising for Medical Centers | IL | 501(c)(3) | 11a | Centegra Health System | false | |
| Northern Illinois Medical Center | |||||||||||
| 4201 Medical Center Drive | McHenry | IL | 60050 | 362338884 | Hospital Operations | IL | 501(c)(3) | 3 | Centegra Health System | false | |
| Centegra Health System | |||||||||||
| 385 Millennium Drive | Crystal Lake | IL | 60012 | 363196559 | Hospital Operations Support | IL | 501(c)(3) | 11c | false | N/A | |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Centegra Management Services | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 385 Millennium Drive | AddressLine1 |
| City | Crystal Lake | City |
| State | IL | State |
| ZIP Code | 60012 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 364028114 | EIN |
| Primary Activity | Physician Practice Mgmt | PrimaryActivity |
| Legal Domicile State | IL | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Centegra Health System | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C corp | TypeOfEntity |
| Controlled Org | false | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | true | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | true | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
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