GRAHAM HOSPITAL ASSOCIATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- GRAHAM HOSPITAL ASSOCIATION (EIN 37-0673506)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-15
- IRS object ID
- 201441359349305829
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-15T15:17:47-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420714325 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCGLADREY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 201 N HARRISON STREET SUITE 300 | AddressLine1 |
| City | DAVENPORT | City |
| State | IA | State |
| ZIP Code | 528011999 | 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 | 370673506 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAHAM HOSPITAL ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GRAH | NameControl |
| Phone | 3096475240 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 210 WEST WALNUT | AddressLine1 |
| City | CANTON | City |
| State | IL | State |
| ZIP Code | 615202444 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ROBERT G SENNEFF | Name |
| Title | PRESIDENT AND CEO | Title |
| Phone | 3096475240 | Phone |
| Date Signed | 2014-05-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN J ROMANO | Name |
| PTIN | P00227323 | PTIN |
| Phone | 5638884000 | 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 | ROBERT G SENNEFF | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 210 WEST WALNUT | AddressLine1 |
| City | CANTON | City |
| State | IL | State |
| ZIP Code | 615202444 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 125419928 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.GRAHAMHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1905 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES, IN A RESPONSIBLE AND CHARITABLE MANNER, TO THE PEOPLE AND COMMUNITIES WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 879 | TotalNbrEmployees |
| Total Nbr Volunteers | 102 | TotalNbrVolunteers |
| Total Gross UBI | 102019 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -107580 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 732354 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 683103 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 72812698 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 69768423 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 3707917 | InvestmentIncomePriorYear |
| Investment Income Current Year | 6657877 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1026986 | OtherRevenuePriorYear |
| Other Revenue Current Year | 998110 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 78279955 | TotalRevenuePriorYear |
| Total Revenue Current Year | 78107513 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 4950 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 4950 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 36486753 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 36700431 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 38221551 | OtherExpensePriorYear |
| Other Expenses Current Year | 33409038 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 74713254 | TotalExpensesPriorYear |
| Total Expenses Current Year | 70114419 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3566701 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 7993094 | RevenuesLessExpensesCY |
| Total Assets BOY | 129750620 | TotalAssetsBOY |
| Total Assets EOY | 136551074 | TotalAssetsEOY |
| Total Liabilities BOY | 46697379 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 45354081 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 83053241 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 91196993 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES, IN A RESPONSIBLE AND CHARITABLE MANNER, TO THE PEOPLE AND COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 31815118 | Expense |
| Grants | 4950 | Grants |
| Revenue | 36160620 | Revenue |
| Description | GRAHAM HOSPITAL IS A PROVIDER OF HEALTHCARE SERVICES IN FULTON COUNTY AND SURROUNDING AREAS. DURING THIS REPORTING PERIOD, 2,213 ADULTS AND CHILDREN WERE ADMITTED AND 269 BABIES WERE BORN. THEY RECEIVED INPATIENT SERVICES IN THE ACUTE CARE FACILITY. 311 PATIENTS WERE ADMITTED FOR 11,110 DAYS OF SERVICE IN THE EXTENDED CARE FACILITY. 66,015 OUTPATIENT SERVICES WERE PROVIDED. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 11844313 | Expense |
| Revenue | 14257237 | Revenue |
| Description | GRAHAM MEDICAL GROUP WHICH PROVIDES PHYSICIAN AND PROFESSIONAL HEALTH CARE SERVICES TO THE PATIENTS IN FULTON COUNTY, ILLINOIS. THIS INCLUDES CHARITY CARE TO QUALIFIED INDIVIDUALS AND 86,753 OFFICE VISITS AND 9,957 NURSING HOME AND HOSPITAL VISITS. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 8873190 | Expense |
| Revenue | 10680836 | Revenue |
| Description | SURGICAL SERVICES - THE HOSPITAL PERFORMED 722 INPATIENT SURGERIES AND 2,639 OUTPATIENT SURGERIES IN FISCAL YEAR 2013. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 7743119 | Expense |
| Revenue | 9320548 | Revenue |
| Description | THE HOSPITAL OPERATES A 24-HOUR EMERGENCY DEPARTMENT WHICH HAD 15,683 PATIENTS REGISTERED TO THE ED IN FISCAL YEAR 2013. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 7743119 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 9320548 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 60275740 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 119 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 879 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROBERT G SENNEFF | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3096475240 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 210 WEST WALNUT | AddressLine1 |
| City | CANTON | City |
| State | IL | State |
| ZIP Code | 61520 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (27 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| JEFF JOCHUMS | ||||||||
| VICE CHAIRMAN | 2.00 | X | X | 0 | 0 | 0 | ||
| MIKE WALTERS | ||||||||
| CHAIRMAN | 2.00 | X | X | 0 | 0 | 0 | ||
| WARREN WOLF | ||||||||
| MEMBER AT LARGE | 2.00 | X | 0 | 0 | 0 | |||
| GORDON JAMES | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| PAULA GRIGSBY | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| KATHY TABER | ||||||||
| SECRETARY | 2.00 | X | X | 0 | 0 | 0 | ||
| ALAN DILTS | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| MIKE RENNER | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| SUZANNE HOLTHAUS MD | ||||||||
| FORMER TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| BRAD ANDERSON | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| MARK PIRTLE | ||||||||
| TREASURER | 2.00 | X | X | 0 | 0 | 0 | ||
| ROBERT BOBELL OD | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| JULIE MELLERT | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| PATRICK RENICK MD | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| KENNETH KROCK MD | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| CAROLYN JACOBUS | ||||||||
| VP CLINIC OPERATIONS | 40.00 | X | 122900 | 0 | 31710 | |||
| JAMES T STRATTON | ||||||||
| VP FINANCE/CFO | 40.00 | X | 216959 | 0 | 55560 | |||
| SARA KIMBLE | ||||||||
| FORMER VP PATIENT SERVICES | 40.00 | X | 218376 | 0 | 31246 | |||
| ROBERT G SENNEFF | ||||||||
| PRESIDENT AND CEO | 40.00 | X | 457239 | 0 | 71142 | |||
| JEDEDIAH CANTRELL | ||||||||
| VP ANCILLARY SERVICES | 40.00 | X | 153213 | 0 | 37799 | |||
| TERESA MCCONKEY | ||||||||
| VP NURSING/CNE | 40.00 | X | 101699 | 0 | 25184 | |||
| JOHN QUINONES DO | ||||||||
| MEDICAL DIRECTOR ED | 40.00 | 352831 | 0 | 36753 | X | |||
| JEFFREY HEMP MD | ||||||||
| PHYSICIAN | 44.00 | 345326 | 0 | 56387 | X | |||
| DWAYNE BERNARD MD | ||||||||
| PHYSICIAN | 50.00 | 460603 | 0 | 55160 | X | |||
| JULIO ANTONIO RAMOS MD | ||||||||
| PHYSICIAN | 45.00 | 363133 | 0 | 25230 | X | |||
| ANGELA HOLTHAUS | ||||||||
| CRNA | 65.00 | 234950 | 0 | 33088 | X | |||
| GERRI DELOST | ||||||||
| CRNA | 65.00 | 229688 | 0 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3256917 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 459259 | TotalOtherCompensation |
| Number Individuals GT100 K | 26 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| COLEMAN MEDICAL ASSOCIATES | |||||
| 175 SOUTH MAIN STREET | CANTON | IL | 61520 | PHYSICIAN GROUP | 6817096 |
| PJ HOERR INC | |||||
| 107 W COMMERCE | PEORIA | IL | 61604 | BUILDING CONTRACTOR | 1856347 |
| PEORIA SURGICAL GROUP LTD | |||||
| 1001 MAIN ST SUITE 300 | PEORIA | IL | 61606 | SURGERY PHYSICIAN GROUP | 666000 |
| MEDICAL INFORMATION TECHNOLOGY INC | |||||
| PO BOX 74569 | CHICAGO | IL | 60696 | INFORMATION TECHNOLOGY SERVICES | 524970 |
| ENDURACARE ACUTE CARE SERVICES LLC | |||||
| 3765 A GOVERNMENT BLVD | MOBILE | AL | 36693 | PHYSICAL, OCCUPATIONAL, & SPEECH THERAPY | 454633 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 19 | NumberOfContractorsGT100K |
| Government Grants | 222897 | GovernmentGrants |
| All Other Contributions | 460206 | AllOtherContributions |
| Total Contributions | 683103 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERVICES | 621110 | 70936233 | 70936233 | |
| OTHER PROGRAM SERVICE | 900099 | 2315913 | 2315913 | |
| SCHOOL OF NURSING | 611600 | 794469 | 794469 | |
| LABORATORY SERVICES | 621500 | 237228 | 170260 | 66968 |
| LESS: PROVISION FOR UNCOLLECTIBLE | 900099 | -4515420 | -4515420 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 69768423 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1874926 | TotalRevenueColumn |
| Exclusion | $1,874,926 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 270273 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 25000 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 245273 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 245273 | TotalRevenueColumn |
| Exclusion | $245,273 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 52070366 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 47262222 | Securities |
| Other | 25193 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4808144 | Securities |
| Other | -25193 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4782951 | TotalRevenueColumn |
| Exclusion | $4,782,951 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| CAFETERIA | 722210 | 443714 | 443714 | |
| EMPLOYEE PHARMACY | 446110 | 274072 | 274072 | |
| DURABLE EQUIPMENT | 446199 | 35051 | 35051 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 752837 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 78107513 | TotalRevenueColumn |
| Related Or Exempt Function Income | 70419241 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 102019 | UnrelatedBusinessRevenue |
| Exclusion | $6,903,150 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4950 | Total |
| Program Services | 4950 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1912610 | Total |
| Program Services | 711689 | ProgramServices |
| Management And General | 1200921 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27244133 | Total |
| Program Services | 24264829 | ProgramServices |
| Management And General | 2979304 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 590792 | Total |
| Program Services | 520957 | ProgramServices |
| Management And General | 69835 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4964201 | Total |
| Program Services | 4368257 | ProgramServices |
| Management And General | 595944 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1988695 | Total |
| Program Services | 1696357 | ProgramServices |
| Management And General | 292338 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18122 | Total |
| Management And General | 18122 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 108034 | Total |
| Management And General | 108034 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22776 | Total |
| Management And General | 22776 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8371000 | Total |
| Program Services | 8343685 | ProgramServices |
| Management And General | 27315 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 234039 | Total |
| Program Services | 1371 | ProgramServices |
| Management And General | 232668 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9409132 | Total |
| Program Services | 8612936 | ProgramServices |
| Management And General | 796196 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1035214 | Total |
| Program Services | 861887 | ProgramServices |
| Management And General | 173327 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 53952 | Total |
| Program Services | 41997 | ProgramServices |
| Management And General | 11955 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1303647 | Total |
| Program Services | 1112011 | ProgramServices |
| Management And General | 191636 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5030566 | Total |
| Program Services | 4291073 | ProgramServices |
| Management And General | 739493 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1073857 | Total |
| Program Services | 894093 | ProgramServices |
| Management And General | 179764 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PURCHASED SERVICES | 4447124 | 3283307 | 1163817 |
| MEDICAID ASSESSMENT | 978695 | 978695 | |
| OTHER | 570398 | 118383 | 452015 |
| MISCELLANEOUS EXPENSES | 464779 | 116102 | 348677 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 287703 | Total |
| Program Services | 53161 | ProgramServices |
| Management And General | 234542 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 70114419 | Total |
| Program Services | 60275740 | ProgramServices |
| Management And General | 9838679 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 587652 | BOY |
| EOY | 2605896 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1624118 | BOY |
| EOY | 3371311 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14289158 | BOY |
| EOY | 9508853 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1424957 | BOY |
| EOY | 1429932 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 890900 | BOY |
| EOY | 687852 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 109292489 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 56039075 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54355589 | BOY |
| EOY | 53253414 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46410421 | BOY |
| EOY | 55131608 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9769364 | BOY |
| EOY | 9772631 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 398461 | BOY |
| EOY | 789577 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 129750620 | BOY |
| EOY | 136551074 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6140455 | BOY |
| EOY | 7358603 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29085000 | BOY |
| EOY | 28345000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11471924 | BOY |
| EOY | 9650478 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46697379 | BOY |
| EOY | 45354081 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 75135419 | BOY |
| EOY | 83008228 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 161473 | BOY |
| EOY | 202954 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7756349 | BOY |
| EOY | 7985811 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 83053241 | BOY |
| EOY | 91196993 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 129750620 | BOY |
| EOY | 136551074 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 7993094 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | -2505956 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 2656614 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $22,776 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 22776 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED: 34% OF MEMBERSHIP DUES PAID TO THE ILLINOIS HOSPITAL ASSOCIATION, OR $20,785; 38.83% OF MEMBERSHIP DUES PAID TO THE ILLINOIS HEALTH CARE ASSOCIATION, OR $1,018; 50% OF MEMBERSHIP DUES PAID TO THE ILLINOIS HOME CARE & HOSPICE COUNCIL, OR $973. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 54282312 | BeginningOfYearBalance |
| Contributions | 32416479 | Contributions |
| Investment Earnings Or Losses | 4277745 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 4950 | GrantsOrScholarships |
| Other Expenditures | 27923841 | OtherExpenditures |
| End Of Year Balance | 63047745 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 55402455 | BeginningOfYearBalance |
| Contributions | 5002957 | Contributions |
| Investment Earnings Or Losses | 1395193 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 4950 | GrantsOrScholarships |
| Other Expenditures | 7513343 | OtherExpenditures |
| End Of Year Balance | 54282312 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 54498646 | BeginningOfYearBalance |
| Contributions | 2368195 | Contributions |
| Investment Earnings Or Losses | 8389005 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 4450 | GrantsOrScholarships |
| Other Expenditures | 9848941 | OtherExpenditures |
| End Of Year Balance | 55402455 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 56079016 | BeginningOfYearBalance |
| Contributions | 2547372 | Contributions |
| Investment Earnings Or Losses | 4063090 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 3885 | GrantsOrScholarships |
| Other Expenditures | 8186947 | OtherExpenditures |
| End Of Year Balance | 54498646 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 43214801 | BeginningOfYearBalance |
| Contributions | 23485459 | Contributions |
| Investment Earnings Or Losses | -3422251 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 4005 | GrantsOrScholarships |
| Other Expenditures | 7194988 | OtherExpenditures |
| End Of Year Balance | 56079016 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.87440 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.12560 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2213040 | OtherCostOrOtherBasis |
| Book Value | 2213040 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 61347539 | OtherCostOrOtherBasis |
| Depreciation | 23804588 | Depreciation |
| Book Value | 37542951 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 42762106 | OtherCostOrOtherBasis |
| Depreciation | 30931637 | Depreciation |
| Book Value | 11830469 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2969804 | OtherCostOrOtherBasis |
| Depreciation | 1302850 | Depreciation |
| Book Value | 1666954 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 53253414 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (3 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| PERPETUAL TRUSTS | 8145652 | C |
| DEFERRED FINANCING COSTS | 197480 | C |
| LONG TERM NOTES RECEIVABLE | 1429499 | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 9772631 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ESTIMATED SELF-INSURANCE COSTS | $3,811,394 |
| ASSET RETIREMENT OBLIGATION | $266,162 |
| FAIR MARKET VALUE OF SWAP OPTION | $3,737,156 |
| DUE TO THIRD PARTY PAYORS | $1,835,766 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 9650478 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 78283171 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -2505956 | NetUnrealizedGainsInvestments |
| Other Revenues | 2656614 | OtherRevenues |
| Revenue Not Rptd F990 | 150658 | RevenueNotRptdF990 |
| Revenue Subtotal | 78132513 | RevenueSubtotal |
| Other Revenues Not Included | -25000 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -25000 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 78107513 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 70139419 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 25000 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 25000 | ExpensesNotRptdF990 |
| Expenses Subtotal | 70114419 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 70114419 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | PROVIDE SCHOLARSHIPS BASED ON STUDENT NEEDS FROM THE INCOME OF THE DONOR-RESTRICTED ENDOWMENT FUNDS. THE PERMANENT ENDOWMENT IS USED FOR THE PURCHASE OF PROPERTY AND EQUIPMENT. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | THE HOSPITAL IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL FILES A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE TAX POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO NONPROFIT ORGANIZATIONS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF EACH ENTITY AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS INCOME (UBI). UBI IS REPORTED ON FORM 990-T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESS, IF ANY. TAX POSITIONS ARE OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNCERTAIN TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. AS OF JUNE 30, 2013 AND 2012, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED AS A LIABILITY. FORMS 990 FILED BY THE HOSPITAL ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. FORMS 990 FILED BY THE HOSPITAL ARE GENERALLY NO LONGER SUBJECT TO EXAMINATION FOR THE YEARS ENDED JUNE 30, 2009 AND PRIOR. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 2,382,855. CHANGE IN INTEREST IN NET ASSETS OF THE FOUNDATION 44,297. CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS 229,462. | |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | RENTAL EXP INCLUDED WITH REVENUE ON RETURN -25,000. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES NETTED WITH REVENUE 25,000. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 180.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 0 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2678118 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2678118 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03820 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13078382 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9194157 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3884225 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05540 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 15756500 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9194157 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6562343 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09360 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 191883 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8034 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 183849 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00260 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 21406 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 21406 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 213289 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8034 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 205255 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00290 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 15969789 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9202191 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6767598 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09650 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 5000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 5000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 5000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 5000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $4,515,420 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 18361000 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 18171764 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 189236 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 0 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAHAM HOSPITAL ASSOCIATION | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 210 WEST WALNUT STREET | AddressLine1 |
| City | CANTON | City |
| State | IL | State |
| ZIP Code | 61520 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.GRAHAMHOSPITAL.ORG | WebsiteAddress |
| Licensed Hospital | X | LicensedHospital |
| 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 | GRAHAM HOSPITAL ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 180.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 0 | UsesFPGDiscounted |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 9 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (9 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| GRAHAM HOSPITAL PHARMACY | ||||
| 210 WEST WALNUT STREET | CANTON | IL | 61520 | PHARMACY FOR PATIENTS & RETAIL FOR EMPLOYEES |
| GRAHAM MEDICAL GROUP | ||||
| 180 SOUTH MAIN STREET | CANTON | IL | 61520 | MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC |
| GRAHAM HOSPITAL EXTENDED CARE UNIT | ||||
| 210 WEST WALNUT STREET | CANTON | IL | 61520 | SKILLED NURSING & LONG TERM CARE UNITS |
| GRAHAM HOSPITAL HOME HEALTHHOSPICE | ||||
| 225 WEST WALNUT | CANTON | IL | 61520 | HOME HEALTH AND HOSPICE PROVIDER |
| GRAHAM HOME MEDICAL EQUIPMENT STORE | ||||
| 101 SOUTH MAIN STREET | CANTON | IL | 61520 | HOME MEDICAL EQUIPMENT RETAIL STORE |
| GRAHAM MEDICAL GROUP - FARMINGTON | ||||
| 601 EAST FORT STREET | FARMINGTON | IL | 61531 | MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC |
| GRAHAM HOSPITAL SCHOOL OF NURSING | ||||
| 210 WEST WALNUT STREET | CANTON | IL | 61520 | SCHOOL OF NURSING |
| GRAHAM MEDICAL GROUP - LEWISTOWN | ||||
| 2001 NORTH MAIN STREET | LEWISTOWN | IL | 61542 | MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC |
| GRAHAM MEDICAL GROUP - CUBA | ||||
| 114 SOUTH 4TH STREET | CUBA | IL | 61427 | OUTPATIENT PHYSICIAN CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (20 entries)
| ExplanationExplanation | Return ReferenceReturnReference | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 3C: ILLINOIS PATIENTS WITH LOW INCOME AND WITHOUT SIGNIFICANT ASSETS WHO ARE UNINSURED RECEIVING MEDICALLY NECESSARY SERVICES IN EXCESS OF $300 MAY QUALIFY FOR CHARITY CARE, AND THOSE WITH HIGHER INCOMES MAY BE CHARGED A MAXIMUM OF 25% OF THEIR ANNUAL FAMILY INCOME OVER A PERIOD OF ONE YEAR. ASSETS EXEMPT FROM CONSIDERATION ARE: A PRIMARY RESIDENCE AND CERTAIN PROTECTED PERSONAL PROPERTY, PENSION AND RETIREMENT PLANS, AND OTHER ASSETS WITH A VALUE OF UP TO 300% OF THE FEDERAL POVERTY LEVEL. PATIENTS WITH SIGNIFICANT ASSETS MAY BE EXCLUDED FROM THE UNINSURED DISCOUNT REGARDLESS OF THEIR INCOME LEVEL. | ||
| PART I, LINE 6A: NOT APPLICABLE | ||
| PART I, LINE 7: GRAHAM HOSPITAL ASSOCIATION UTILIZED WORKSHEET 2 TO CALCULATE ITS COST-TO-CHARGE RATIO. TOTAL EXPENSES REPORTED IN THE FINANCIAL REPORT FOR THE YEAR ENDED 06/30/13 LESS NONPATIENT CARE ACTIVITIES, THE MEDICAID ASSESSMENT PROVIDER TAX OF $978,695 AND THE COMMUNITY BENEFIT EXPENSES FOR VARIOUS PROGRAMS OF $205,255 ARE DIVIDED BY GROSS PATIENT CHARGES OF $166,140,953 TO REACH A COST TO CHARGE RATIO OF 40.1%.DURING EACH FISCAL YEAR VARIOUS COMMUNITY HEALTH IMPROVEMENT SERVICES ARE HELD AT A FACILITY OWNED BY GRAHAM HOSPITAL ASSOCIATION OR GRAHAM HOSPITAL ASSOCIATION EMPLOYEES ASSIST WITH SERVICES HELD AT VARIOUS LOCATIONS WITHIN THE CATCHMENT AREA. AN ACTUAL COUNT OF COMMUNITY MEMBERS SERVED IS RECORDED IF AVAILABLE OR ESTIMATED IF NOT AVAILABLE. COST FOR EACH ACTIVITY IS RECORDED AT THE ACTUAL COST OF SUPPLIES, AND STAFF TIME IS CALCULATED USING ACTUAL TIME SPENT MULTIPLIED BY AVERAGE WAGES FOR THE EMPLOYEES INVOLVED. ANY OFFSETTING REVENUE IS SUBTRACTED FROM THE COST OF THE ACTIVITY TO REACH A NET COST OF EACH EVENT. WHEN COMMUNITY GROUPS USE A ROOM IN ONE OF THE GRAHAM HOSPITAL ASSOCIATION FACILITIES, THERE IS NO CHARGE FOR THE COMMUNITY GROUP AND THE COST OF THE ROOM USE IS ESTIMATED AT A NOMINAL FLAT RATE FEE AND RECORDED HERE AS AN IN-KIND CONTRIBUTION. THESE ACTIVITES REPRESNT THE COMMUNITY BENEFIT EXPENSES NOTED ABOVE. | ||
| PART I, LINE 7G: NOT APPLICABLE | ||
| PART I, L7 COL(F): NO BAD DEBT EXPENSE WAS INCLUDED IN THE DENOMINATOR BECAUSE BAD DEBT WAS REPORTED IN LINE 2E OF PART VIII, STATEMENT OF REVENUE. THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE AS A PERCENTAGE OF TOTAL EXPENSES IS 22.78%, AND THE PERCENTAGE INCREASES TO 48.69% IF MEDICARE ALLOWABLE COSTS ARE INCLUDED IN TOTAL COMMUNTY BENEFIT EXPENSE. | ||
| PART II: NOT APPLICABLE | ||
| PATIENT RECEIVABLES ARE WRITTEN OFF AS BAD DEBT EXPENSE BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. | PART III, LINE 2: | |
| NOT APPLICABLE | PART III, LINE 3: | |
| PART III, LINE 4: PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. THE HOSPITAL DOES NOT CHARGE INTEREST ON RECEIVABLES. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED PAST DUE WHEN AN AMOUNT IS PAST DUE ACCORDING TO THE PAYORS AGREED-UPON TERMS. PATIENT RECEIVABLES ARE WRITTEN OFF AS BAD DEBT EXPENSE BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. | ||
| PART III, LINE 8: MEDICARE ALLOWABLE COSTS ARE TAKEN FROM WORKSHEET D-1 AS REPORTED IN THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED 6/30/2013. THE ORGANIZATION DOES NOT HAVE A MEDICARE SHORTFALL. | ||
| PART III, LINE 9B: THE COLLECTION POLICY DESCRIBES THE STEPS TAKEN TO COLLECT SELF PAY BALANCES OUTSTANDING INCLUDING NOTIFICATIONS TO THE PATIENT THROUGH STATEMENTS, FOLLOW-UP PHONE CALLS, VERIFICATION OF INSURANCE ELIGIBILITY AND ULTIMATELY AT WHAT POINT THE UNPAID BALANCE IS WRITTEN OFF AS UNCOLLECTIBLE. IN PRACTICE, WHEN A PATIENT IS IDENTIFIED AS QUALIFYING FOR FINANCIAL ASSISTANCE, A SEARCH OF ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE IS DONE AND THOSE ACCOUNTS ARE REPROCESSED. | ||
| WWW.GRAHAMHOSPITAL.ORG | PART V, SECTION B, LINE 5A: | |
| ILLINOIS PATIENTS WITH LOW INCOME AND WITHOUT SIGNIFICANT ASSETS WHO ARE UNINSURED AND RECEIVING MEDICALLY NECESSARY SERVICES IN EXCESS OF $300 MAY QUALIFY FOR CHARITY CARE AND THOSE WITH HIGER INCOMES MAY BE CHARGED A MAXIMUM OF 25% OF THEIR ANNUAL FAMILY INCOME OVER A PERIOD OF ONE YEAR. ASSETS EXEMPT FROM CONSIDERATION ARE A PRIMARY RESIDENCE AND CERTAIN PROTECTED PERSONAL PROPERTY, PENSION AND RETIREMENT PLANS, AND OTHER ASSETS WITH A VALUE OF UP TO 300% OF THE FEDERAL POVERTY LEVEL. PATIENTS WITH SIGNIFICANT ASSETS MAY BE EXCLUDED FROM THE UNINSURED DISCOUNT REGARDLESS OF THEIR INCOME LEVEL. | PART V, SECTION B, LINE 11: | |
| PART V, SECTION B, LINE 3: GRAHAM HOSPITAL ASSOCIATION CREATED THE FOLLOWING FOCUS GROUPS TO GATHER INPUT FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT:FOCUS GROUP #1 INCLUDED THE FULTON COUNTY SHERIFF, THE CANTON FIRE CHIEF, A SCHOOL SUPERINTENDENT, A BANK EXECUTIVE, THE DIRECTOR OF A FOOD PANTRY, A LOCAL BUSINESS LEADER, THE DIRECTOR OF THE YMCA, A LIBRARIAN AND A COMMUNITY VOLUNTEER. THEY MET ON MAY 15, 2012.FOCUS GROUP #2 INCLUDED THE MAYOR OF CANTON, A VICE-PRESIDENT AT SPOON RIVER COLLEGE, A SCHOOL SUPERINTENDENT, A RETIRED PHYSICIAN, THE EXECUTIVE DIRECTOR OF THE YWCA AND THE PRESIDENT OF GRAHAM HOSPITAL SERVICE LEAGUE. THIS GROUP ALSO MET ON MAY 15, 2012.FOCUS GROUP #3 INCLUDED THE ADMINISTRATOR OF THE FULTON COUNTY HEALTH DEPARTMENT, THE DIRECTOR OF THE NURSING SCHOOL, THE ADMINISTRATOR OF A NURSING HOME, A PEDIATRIC PHYSICIAN, A PATHOLOGIST, A CHIROPRACTOR, A GENERAL SURGEON, NURSING HOME REPRESENTATIVES AND PHARMACISTS. THIS GROUP ALSO MET ON MAY 15, 2012. | GRAHAM HOSPITAL ASSOCIATION | |
| PART V, SECTION B, LINE 20D: GRAHAM HOSPITAL FOLLOWS THE ILLINOIS HOSPITAL UNINSURED PATIENT DISCOUNT ACT THAT REQUIRES ILLINOIS HOSPITALS TO PROVIDE DISCOUNTS TO UNINSURED PATIENTS MEETING CERTAIN ELIGIBILITY CRITERIA. THE DISCOUNTS MUST RESULT IN BILLS OF NO MORE THAN 135% OF COST AND THE MAXIMUM COLLECTIBLE AMOUNT IS 25% OF THE ANNUAL FAMILY INCOME FOR THOSE WHO MEET THE ELIGIBILITY CRITERIA AND DO NOT HAVE SIGNIFICANT ASSETS. COST IS DETERMINED BY USING THE COST TO CHARGE RATIO FROM THE MOST RECENTLY FILED MEDICARE COST REPORT. | GRAHAM HOSPITAL ASSOCIATION | |
| PART VI, LINE 2: IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTED DURING 2012, A PHYSICIAN NEEDS ASSESSMENT IS DONE TO IDENTIFY NEEDS FOR SPECIFIC SPECIALTY SERVICES BASED ON THE SIZE OF THE CATCHMENT AREA, DATA IS ANALYZED TO IDENTIFY SERVICES THAT ARE PROVIDED TO COUNTY RESIDENTS BY OTHER FACILITIES THAT WOULD BE MORE ACCESSIBLE TO PATIENTS IF PROVIDED AT GRAHAM HOSPITAL. INPUT IS GAINED FROM PHYSICIANS AND OTHER HEALTHCARE WORKERS PROVIDING SERVICE IN THE AREA ALONG WITH INPUT PROVIDED BY THE BOARD OF DIRECTORS WHO REPRESENT THE COMMUNITY AND PROVIDE A COMMUNICATION LINK BETWEEN GRAHAM HOSPITAL AND THE COMMUNITIES WE SERVE. | ||
| PART VI, LINE 3: THE CHARITY CARE/FINANCIAL ASSISTANCE PROGRAM IS MADE AVAILABLE TO PATIENTS UPON REGISTRATION. FINANCIAL ASSISTANCE APPLICATIONS ARE AVAILABLE TO PATIENTS UPON REGISTRATION OR TO ANYONE REQUESTING THE APPLICATION AT ANYTIME FOR CLAIMS EXCEEDING $300. THE APPLICATIONS ARE AVAILABLE ON GRAHAM HEALTH SYSTEM'S WEBSITE AT HTTP://WWW.GRAHAMHOSPITAL.ORG/FINANCIALASSISTANCE. APPOINTMENTS MAY BE MADE WITH A FINANCIAL COUNSELOR IF ASSISTANCE IS NEEDED. MEDICAID SERVICES APPLICATION ASSISTANCE IS AVAILABLE. | ||
| PART VI, LINE 4: THE GRAHAM HOSPITAL ASSOCIATION PRIMARY CATCHMENT AREA IS LOCATED PRIMARILY IN FULTON COUNTY AND INCLUDES ALL OR PORTIONS OF THE TOWNS OF CANTON, LEWISTOWN, CUBA, FARMINGTON, HAVANA, ST. DAVID, ASTORIA, DUNFERMLINE AND BRYANT. THE RACE AND ETHNICITY MAKEUP ARE TYPICAL OF RURAL ILLINOIS BASED ON US CENSUS BUREAU DATA AND INCLUDES 92.5% WHITE, 3.7% BLACK, 2.6% HISPANIC ORIGIN, AND 1.2% OTHER. ACCORDING TO THE US CENSUS BUREAU MEDIAN HOUSEHOLD INCOME 2012 WAS $41,899. FULTON COUNTY'S OCT 2013 UNEMPLOYMENT RATE WAS 9.4%. | ||
| PART VI, LINE 5: DURING EACH FISCAL YEAR VARIOUS COMMUNITY HEALTH IMPROVEMENT SERVICES ARE HELD AT A FACILITY OWNED BY GRAHAM HOSPITAL ASSOCIATION OR GRAHAM HOSPITAL ASSOCIATION EMPLOYEES ASSIST WITH SERVIES HELD AT VARIOUS LOCATIONS WITHIN THE CATCHMENT AREA. EXAMPLES OF THESE ACTIVITIES INCLUDE SPONSORSHIP OF AN ANNUAL WOMEN'S HEALTH FAIR HELD IN THE HOSPITAL LOBBY THAT IS OPEN TO THE PUBLIC WHERE EDUCATIONAL BOOTHS, FREE HEALTH SCREENINGS, HEALTHY LUNCHES, PRESENTATIONS BY LOCAL PHYSICIANS ARE AVAILABLE TO ATTENDEES DURING THE DAY; ANNUAL SPONSORSHIP OF A COMMUNITY TALK AND DINNER THAT IS FREE TO THE PUBLIC COVERING HEART HEALTH; FREE BLOOD PRESSURE CLINICS OFFERED THROUGHOUT THE COUNTY ON A REGULAR BASIS. GRAHAM HOSPITAL PROVIDES THE SPACE FOR OPERATION OF AN OUTPATIENT CLINIC THAT PROVIDES FREE HEALTHCARE SERVICES TO FULTON COUNTY RESIDENTS. CLINIC SERVICES ARE PROVIDED BY COMMUNITY VOLUNTEERS. | ||
| PART VI, LINE 6: NOT APPLICABLE |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CAROLYN JACOBUS | ||||||||||||||
| VP CLINIC OPERATIONS | 113970 | 0 | 7919 | 0 | 1011 | 0 | 15105 | 0 | 16605 | 0 | 154610 | 0 | 0 | 0 |
| JAMES T STRATTON | ||||||||||||||
| VP FINANCE/CFO | 195585 | 0 | 20266 | 0 | 1108 | 0 | 26790 | 0 | 28770 | 0 | 272519 | 0 | 0 | 0 |
| SARA KIMBLE | ||||||||||||||
| FORMER VP PATIENT SERVICES | 161717 | 0 | 14249 | 0 | 42410 | 0 | 15595 | 0 | 15651 | 0 | 249622 | 0 | 29090 | 0 |
| ROBERT G SENNEFF | ||||||||||||||
| PRESIDENT AND CEO | 408572 | 0 | 47776 | 0 | 891 | 0 | 62418 | 0 | 8724 | 0 | 528381 | 0 | 0 | 0 |
| JEDEDIAH CANTRELL | ||||||||||||||
| VP ANCILLARY SERVICES | 137699 | 0 | 14866 | 0 | 648 | 0 | 19460 | 0 | 18339 | 0 | 191012 | 0 | 0 | 0 |
| JOHN QUINONES DO | ||||||||||||||
| MEDICAL DIRECTOR ED | 305157 | 0 | 43750 | 0 | 3924 | 0 | 7500 | 0 | 29253 | 0 | 389584 | 0 | 0 | 0 |
| JEFFREY HEMP MD | ||||||||||||||
| PHYSICIAN | 289860 | 0 | 53015 | 0 | 2451 | 0 | 7500 | 0 | 48887 | 0 | 401713 | 0 | 0 | 0 |
| DWAYNE BERNARD MD | ||||||||||||||
| PHYSICIAN | 388239 | 0 | 71398 | 0 | 966 | 0 | 7500 | 0 | 47660 | 0 | 515763 | 0 | 0 | 0 |
| JULIO ANTONIO RAMOS MD | ||||||||||||||
| PHYSICIAN | 307748 | 0 | 54143 | 0 | 1242 | 0 | 7500 | 0 | 17730 | 0 | 388363 | 0 | 0 | 0 |
| ANGELA HOLTHAUS | ||||||||||||||
| CRNA | 215948 | 0 | 50 | 0 | 18952 | 0 | 7160 | 0 | 25928 | 0 | 268038 | 0 | 0 | 0 |
| GERRI DELOST | ||||||||||||||
| CRNA | 229638 | 0 | 50 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 229688 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINES 4A-B | THE FOLLOWING INDIVIDUAL RECEVIED A SEVERANCE PAYMENT FROM THE ORGANIZATION IN 2012: SARA KIMBLE - $47,272. THIS AMOUNT IS INCLUDED IN REPORTABLE COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) PLAN IN 2012 SPONSORED BY GRAHAM HOSPITAL ASSOCIATION: ROBERT G. SENNEFF - $54,918, JAMES T. STRATTON - $20,100, SARA KIMBLE - $11,025, JEDEDIAH CANTRELL - $14,743, AND CAROLYN JACOBUS - $11,346. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GRAHAM HOSPITAL ASSOCIATION ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2012. THIS INFORMATION IS INCLUDED IN DEFERRED COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. | |
| PART I, LINE 7 | INCENTIVE AWARDS ARE BASED ON THE ATTAINMENT OF HOSPITAL AND INDIVIDUAL TARGETS AND ARE CALCULATED AS A PERCENTAGE OF WAGES. PAYMENT OF INCENTIVE AWARDS IS DEPENDENT ON THE ACHIEVEMENT OF ORGANIZATIONAL KEY INDICATORS. | |
| PART III | PART II, COLUMN F: THE FOLLOWING INDIVIDUAL ALSO PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN IN 2009, 2010, 2011 AND 2012 SPONSORED BY GRAHAM HOSPITAL ASSOCIATION: SARA KIMBLE - $29,090. THE DOLLAR AMOUNT REPRESENTS PRIOR YEAR CONTRIBUTIONS MADE BY GRAHAM HOSPITAL ASSOCIATION ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2009, 2010 AND 2011. THIS INFORMATION WAS INCLUDED IN DEFERRED COMPENSATION ON THE PRIOR YEARS' FORM 990, PART VII AND SCHEDULE J, PART II. THIS INDIVIDUAL REACHED A SPECIFIED LEVEL OF VESTING IN 2012, SO THE DOLLAR AMOUNT IS NOW INCLUDED IN REPORTABLE COMPENSATION ON THE CURRENT YEAR FORM 990, PART VII AND SCHEDULE J, PART II. THE DOLLAR AMOUNT IS ALSO LISTED AS COMPENSATION REPORTED IN A PRIOR FORM 990 ON THE CURRENT YEAR FORM 990, SCHEDULE J, PART II. | SUPPLEMENTAL INFORMATION |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF CANTON IL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 376000876 | IssuerEIN |
| CUSIP Number | 138206AA5 | CUSIPNumber |
| Date Issued | 2009-06-30 | DateIssued |
| Issue Price | 31085000 | IssuePrice |
| Description Of Purpose | PHYSICIAN CLINIC & FARMINGTON CLINIC CONSTRUCTION, OB RENOVATION | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | 31085000 | TotalProceeds |
| Issuance Costs From Proceeds | 476622 | IssuanceCostsFromProceeds |
| Working Capital Expenditures | 30608378 | WorkingCapitalExpenditures |
| Year Of Subst Completion | 2011 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 0 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 1 | NoRebateDue |
| Variable Rate Issue | 1 | VariableRateIssue |
| Hedge Identified In Books And Recds | 1 | HedgeIdentifiedInBooksAndRecds |
Name Of Hedge Provider NameOfHedgeProvider
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MORGAN STANLEY & | BusinessNameLine1 |
| Business Name Line2 | HARRIS NA | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Of Hedge | 25.000000000000 | TermOfHedge |
| Superintegrated Hedge | 0 | SuperintegratedHedge |
| Hedge Terminated | 0 | HedgeTerminated |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 0 | ProcToUndertkCorrectiveAction |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCHEDULE K PART IV, ARBITRAGE, LINE 2C | Identifier |
| Return Reference | DATE REBATE COMPUTATION PERFORMED | ReturnReference |
| Explanation | ISSUER NAME: CITY OF CANTON, IL DATE THE REBATE COMPUTATION WAS PERFORMED: 05/08/2014 | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| MIDAMERICA NATIONAL BANK | |||
| SEE BELOW FOR DESCRIPTION OF RELATIONSHIP | 485660 | INTEREST, DIVIDENDS, AND REALIZED GAINS EARNED ON THE ORGANIZATION'S INVESTMENTS WITH MIDAMERICA NATIONAL BANK. | 0 |
| MIDAMERICA NATIONAL BANK | |||
| SEE BELOW FOR DESCRIPTION OF RELATIONSHIP | 71159 | BANK FEES PAID BY THE ORGANIZATION TO MIDAMERICA NATIONAL BANK | 0 |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | FORM 990, SCHEDULE L, PART IV: | Identifier |
| Return Reference | RELATIONSHIP BETWEEN INTEREST PERSON AND THE ORGANIZATION | ReturnReference |
| Explanation | WARREN WOLF, A TRUSTEE OF GRAHAM HOSPITAL ASSOCIATION, IS A DIRECTOR ON THE BOARD OF MIDAMERICA NATIONAL BANK. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART I, LINE 6: | THE GRAHAM HOPSITAL SERVICE LEAGUE VOLUNTEERS OPERATE AND MANAGE THEIR OWN GIFT SHOP WHICH IS LOCATED WITHIN GRAHAM HOSPITAL. A PORTION OF THE PROCEEDS FROM THE GIFT SHOP AND ALL OTHER FUND-RAISING EVENTS IS GIVEN TO THE HOSPITAL ANNUALLY TO PROVIDE FOR MUCH NEEDED EQUIPMENT. VOLUNTEERS ALSO PERFORM VARIOUS OTHER SERVICES WITHIN THE HOSPITAL; PATIENT ESCORT, SURGERY HOSTESS, PHARMACY, AND THE RED CROSS INFORMATION DESK. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE PREPARED FORM 990 IS REVIEWED BY THE CFO, DIRECTOR OF ACCOUNTING AND SENIOR ACCOUNTANT BEFORE FILING WITH THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | GRAHAM HOSPITAL REQUIRES THAT ALL TRUSTEES AND ADMINISTRATIVE OFFICERS KEEP THE BOARD OF TRUSTEES INFORMED OF POTENTIAL CONFLICTS OF INTEREST, AND THAT EACH PERSON MAKE AN ANNUAL DECLARATION OF SUCH INTEREST. A CONFLICT OF INTEREST MIGHT EXIST WHEN ORGANIZATIONS IN WHICH TRUSTEES OR OFFICERS HAVE A MATERIAL FINANCIAL INTEREST ARE EITHER DOING BUSINESS WITH, COMPETING WITH, OR HAVE A FINANCIAL INTEREST IN GRAHAM HOSPITAL. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION OF THE ADMINISTRATIVE OFFICERS ARE REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. THE ORGANIZATION UTILIZES AN OUTSIDE FIRM, SULLIVAN, COTTER AND ASSOCIATES, INC. TO PROVIDE OUTSIDE EXECUTIVE COMPENSATION INFORMATION. THE LAST REVIEW WAS COMPLETED IN JUNE, 2013. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. | |
| FORM 990, PART IX, LINE 11G | OTHER FEES: PROGRAM SERVICE EXPENSES 8,343,685. MANAGEMENT AND GENERAL EXPENSES 27,315. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,371,000. | OTHER FEES |
| FORM 990, PART XI, LINE 9: | CHANGE IN FAIR VALUE OF SWAP OPTION 2,382,855. CHANGE IN NET ASSETS OF GRAHAM HOSPITAL FOUNDATION 44,297. CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS 229,462. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C: | THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR TAX YEAR. |