MEMORIAL HEALTH SYSTEM: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL HEALTH SYSTEM (EIN 37-0661230)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-07-09
- IRS object ID
- 201301909349301250
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-07-09T16:06:17-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390758449 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10000 INNOVATION DRIVE SUITE 250 | AddressLine1 |
| City | MILWAUKEE | City |
| State | WI | State |
| ZIP Code | 532264837 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 370661230 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PASSAVANT MEMORIAL AREA HOSPITAL ASSOC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PASS | NameControl |
| Phone | 2172459541 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1600 WEST WALNUT | AddressLine1 |
| City | JACKSONVILLE | City |
| State | IL | State |
| ZIP Code | 62650 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID BOLEN | Name |
| Title | VICE PRESIDENT AND CFO | Title |
| Phone | 2172459541 | Phone |
| Date Signed | 2013-07-09 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAY ADKISSON CPA | Name |
| PTIN | P01360892 | PTIN |
| Phone | 4144319300 | Phone |
| Date Prepared | 2013-07-08 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CHESTER WYNN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1600 WEST WALNUT | AddressLine1 |
| City | JACKSONVILLE | City |
| State | IL | State |
| ZIP Code | 62650 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 87847368 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.PASSAVANTHOSPITAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1906 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | OUR MISSION IS TO PROVIDE EXCELLENT CARE WITH COMPASSION AND COMMITMENT. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 975 | TotalNbrEmployees |
| Total Nbr Volunteers | 203 | TotalNbrVolunteers |
| Total Gross UBI | 179606 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 85612 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 209902 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1437107 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 82649387 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 81724489 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1997283 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2647096 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1662265 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1972691 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 86518837 | TotalRevenuePriorYear |
| Total Revenue Current Year | 87781383 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 28770 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 16617 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 43679570 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 43979625 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 21472 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 35084372 | OtherExpensePriorYear |
| Other Expenses Current Year | 32605503 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 78792712 | TotalExpensesPriorYear |
| Total Expenses Current Year | 76601745 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 7726125 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 11179638 | RevenuesLessExpensesCY |
| Total Assets BOY | 151532337 | TotalAssetsBOY |
| Total Assets EOY | 169211387 | TotalAssetsEOY |
| Total Liabilities BOY | 47837408 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 47051773 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 103694929 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 122159614 | NetAssetsOrFundBalancesEOY |
| Mission Description | OUR MISSION IS TO PROVIDE EXCELLENT CARE WITH COMPASSION AND COMMITMENT. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 61150358 | Expense |
| Grants | 16617 | Grants |
| Revenue | 81724489 | Revenue |
| Description | DELIVERY OF MEDICAL AND HOSPITAL SERVICES WITH APPROXIMATELY 55,666 OUTPATIENT PROCEDURES PERFORMED, 3,290 INPATIENT ADMISSIONS AND 28,905 EMERGENCY DEPARTMENT VISITS. | Description |
| Total Program Service Expense | 61150358 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 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 | 0 | 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 | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 78 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 975 | 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 | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | 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 | 1 | 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 | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| 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 | DAVID BOLEN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2172459541 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1600 WEST WALNUT STREET | AddressLine1 |
| City | JACKSONVILLE | City |
| State | IL | State |
| ZIP Code | 62650 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (26 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| GINNY FANNING | |||||||
| CHAIR | 2.00 | X | X | 0 | 0 | 0 | |
| JAN TERRY | |||||||
| VICE CHAIR | 2.00 | X | X | 0 | 0 | 0 | |
| DONALD HEADEN | |||||||
| TREASURER | 2.00 | X | X | 0 | 0 | 0 | |
| GILBERT JOEHL | |||||||
| SECRETARY | 2.00 | X | X | 0 | 0 | 0 | |
| KEITH BRADBURY | |||||||
| PAST CHAIR | 2.00 | X | X | 0 | 0 | 0 | |
| RICHARD JOHNSON | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| STEVEN LILLPOP MD | |||||||
| DIRECTOR | 2.00 | X | 12000 | 0 | 0 | ||
| GREG MAY | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| NANCY SPANGENBERG | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| MICHAEL MOLYNEAUX MD | |||||||
| DIRECTOR | 2.00 | X | 0 | 237609 | 47561 | ||
| REG BENTON | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| GREG LEPPER | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| ERIC GIEBENHAUSEN MD | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| GARY SCOTT | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| TOM VEITH | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| PHYLLIS LAPE PHD | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| CHESTER A WYNN | |||||||
| PRESIDENT AND CEO | 50.00 | X | 246815 | 0 | 35970 | ||
| DAVID A BOLEN | |||||||
| VICE PRESIDENT AND CFO | 50.00 | X | 178517 | 0 | 23814 | ||
| KAREN DAUM | |||||||
| VICE PRESIDENT & CNO | 50.00 | X | 128618 | 0 | 28351 | ||
| STEPHEN LEE | |||||||
| CHIEF PHYSICIAN OFFICER | 50.00 | X | 127117 | 0 | 28350 | ||
| REBECCA GOODMAN | |||||||
| CHIEF QUALITY & RISK OFFICER | 50.00 | X | 95256 | 0 | 18656 | ||
| MARK RUFF | |||||||
| STAFF ANESTHETIST | 40.00 | 307559 | 0 | 37075 | X | ||
| DAVID C TONRY | |||||||
| STAFF ANESTHETIST | 40.00 | 250738 | 0 | 36288 | X | ||
| JOHN D GREGORY | |||||||
| STAFF ANESTHETIST | 40.00 | 240602 | 0 | 35568 | X | ||
| DEBORAH K TOMKO | |||||||
| STAFF ANESTHETIST | 40.00 | 192503 | 0 | 23858 | X | ||
| TAMARA C MCDONALD | |||||||
| STAFF ANESTHETIST | 40.00 | 226395 | 0 | 34462 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2006120 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 237609 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 349953 | TotalOtherCompensation |
| Number Individuals GT100 K | 24 | 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 |
|---|---|---|---|---|---|
| JOHN C DAILEY MDSC | |||||
| 1572 CONCORD ROAD | JACKSONVILLE | IL | 62650 | PHYSICIAN SERVICES | 543640 |
| NHEED BASHIR MD | |||||
| 1440 WEST WALNUT | JACKSONVILLE | IL | 62650 | PHYSICIAN SERVICES | 299276 |
| SPI HEALTHCARE | |||||
| 2960 PROFESSIONAL DRIVE | SPRINGFIELD | IL | 62703 | BILLING SERVICE | 269290 |
| CENTURION INVESTIGATORS INC | |||||
| 1711 SOUTH WEST ST | JACKSONVILLE | IL | 62650 | SECURITY | 182289 |
| BKD LLP | |||||
| 211 N BROADWAY SUITE 600 | ST LOUIS | MO | 63102 | ACCOUNTING SERVICES | 116983 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| All Other Contributions | 1437107 | AllOtherContributions |
| Total Contributions | 1437107 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE REVENU | 621110 | 81350986 | 81350986 |
| BAD DEBT RECOVERY | 900099 | 373503 | 373503 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 81724489 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2712281 | TotalRevenueColumn |
| Exclusion | $2,712,281 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 639851 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 639851 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 639851 | TotalRevenueColumn |
| Exclusion | $639,851 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 800 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 40958 | Securities |
| Other | 25027 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -40958 | Securities |
| Other | -24227 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -65185 | TotalRevenueColumn |
| Exclusion | -$65,185 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| CAFETERIA | 722100 | 580125 | $580,125 | |
| OTHER | 900099 | 573109 | $573,109 | |
| LIFE LINE | 812900 | 179606 | 179606 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1332840 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 87781383 | TotalRevenueColumn |
| Related Or Exempt Function Income | 81724489 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 179606 | UnrelatedBusinessRevenue |
| Exclusion | $4,440,181 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16617 | Total |
| Program Services | 16617 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 911464 | Total |
| Program Services | 729536 | ProgramServices |
| Management And General | 181928 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31260321 | Total |
| Program Services | 25020761 | ProgramServices |
| Management And General | 6239560 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1560264 | Total |
| Program Services | 1248835 | ProgramServices |
| Management And General | 311429 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7822433 | Total |
| Program Services | 6261075 | ProgramServices |
| Management And General | 1561358 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2425143 | Total |
| Program Services | 1941084 | ProgramServices |
| Management And General | 484059 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 122754 | Total |
| Management And General | 122754 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 61909 | Total |
| Management And General | 61909 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2934008 | Total |
| Program Services | 2348380 | ProgramServices |
| Management And General | 585628 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 366807 | Total |
| Program Services | 293592 | ProgramServices |
| Management And General | 73215 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11923167 | Total |
| Program Services | 9543303 | ProgramServices |
| Management And General | 2379864 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 388197 | Total |
| Program Services | 310713 | ProgramServices |
| Management And General | 77484 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1349873 | Total |
| Program Services | 1080438 | ProgramServices |
| Management And General | 269435 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 87488 | Total |
| Program Services | 70025 | ProgramServices |
| Management And General | 17463 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1564480 | Total |
| Program Services | 1252210 | ProgramServices |
| Management And General | 312270 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6121865 | Total |
| Program Services | 4899941 | ProgramServices |
| Management And General | 1221924 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1490085 | Total |
| Program Services | 1192664 | ProgramServices |
| Management And General | 297421 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| REPAIRS AND MAINTENANCE | 2994748 | 2396996 | 597752 | |
| MEDICAID TAXES | 1099546 | 880077 | 219469 | |
| FOOD | 1024400 | 819930 | 204470 | |
| MISCELLANEOUS EXPENSE | 606704 | 468416 | 116816 | 21472 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 469472 | Total |
| Program Services | 375765 | ProgramServices |
| Management And General | 93707 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 76601745 | Total |
| Program Services | 61150358 | ProgramServices |
| Management And General | 15429915 | ManagementAndGeneral |
| Fundraising | 21472 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5679 | BOY |
| EOY | 5635 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7219733 | BOY |
| EOY | 7532508 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13197978 | BOY |
| EOY | 15467679 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14769284 | BOY |
| EOY | 19284702 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 687856 | BOY |
| EOY | 746200 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1816047 | BOY |
| EOY | 1608437 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 130348299 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 81619515 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50586028 | BOY |
| EOY | 48728784 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44937260 | BOY |
| EOY | 54539334 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 642227 | BOY |
| EOY | 732983 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17670245 | BOY |
| EOY | 20565125 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 151532337 | BOY |
| EOY | 169211387 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18133283 | BOY |
| EOY | 17147986 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29704125 | BOY |
| EOY | 29903787 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47837408 | BOY |
| EOY | 47051773 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 86275019 | BOY |
| EOY | 101678675 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 743592 | BOY |
| EOY | 723036 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16676318 | BOY |
| EOY | 19757903 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 103694929 | BOY |
| EOY | 122159614 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 151532337 | BOY |
| EOY | 169211387 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 11179638 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 7285047 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 1 | GrantsOtherOrganizations |
| Grants Other Organizations | $26,523 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 0 | OtherActivities |
| Total Lobbying Expenditures IIB | 26523 | 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 | 27% OF ILLINOIS HOSPITAL ASSOCIATION MEMBERSHIP DUES ARE ALLOCABLE TO LOBBYING ACTIVITIES. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 58899464 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 10026577 | InvestmentEarningsOrLosses |
| Other Expenditures | 478582 | OtherExpenditures |
| End Of Year Balance | 68447459 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 58790267 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 1821901 | InvestmentEarningsOrLosses |
| Other Expenditures | 1712704 | OtherExpenditures |
| End Of Year Balance | 58899464 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 66023041 | BeginningOfYearBalance |
| Contributions | 50000 | Contributions |
| Investment Earnings Or Losses | 2714136 | InvestmentEarningsOrLosses |
| Other Expenditures | 9996910 | OtherExpenditures |
| End Of Year Balance | 58790267 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.68000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.25000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.07000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 242737 | OtherCostOrOtherBasis |
| Book Value | 242737 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 85701307 | OtherCostOrOtherBasis |
| Depreciation | 51634140 | Depreciation |
| Book Value | 34067167 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 38705419 | OtherCostOrOtherBasis |
| Depreciation | 27258691 | Depreciation |
| Book Value | 11446728 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5698836 | OtherCostOrOtherBasis |
| Depreciation | 2726684 | Depreciation |
| Book Value | 2972152 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 48728784 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| BENEFICIAL INTERESTS IN TRUSTS | 16991019 |
| OTHER ASSETS | 475497 |
| FARMLAND | 3098609 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 20565125 | TotalBookValueOtherAssets |
| Total Revenue | 87781383 | TotalRevenue |
| Total Expenses | 76601745 | TotalExpenses |
| Excess Or Deficit For Year | 11179638 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 4331132 | NetUnrealizedGLOnInvestments |
| Other | $2,953,915 | OtherAmount |
| Total Adjustments | 7285047 | TotalAdjustments |
| Excess Or Deficit Per FS | 18464685 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 96957375 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 4331132 | NetUnrealizedGainsInvestments |
| Other Revenues | 4844860 | OtherRevenues |
| Revenue Not Rptd F990 | 9175992 | RevenueNotRptdF990 |
| Revenue Subtotal | 87781383 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 87781383 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 86189579 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 9587834 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 9587834 | ExpensesNotRptdF990 |
| Expenses Subtotal | 76601745 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 76601745 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | THE ORGANIZATION INTENDS TO USE THE ENDOWMENT FUNDS FOR CAPITAL PURCHASES, OPERATIONS, SCHOLARSHIPS, AND INDIGENT CARE. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE ASSOCIATION DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION ON THE TECHNICAL MERITS OF THE POSITION ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE ASSOCIATION RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS IN 2012 OR 2011 AS MANAGEMENT BELIEVES THE ASSOCIATION HAS NO MATERIAL UNRECOGNIZED INCOME TAX POSITIONS. FEDERAL TAX RETURNS FOR TAX YEARS 2008 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | CHANGE IN BOND INTEREST RATE SWAP -107,114. CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS 3,081,585. DECREASE IN TEMP RESTRICTED ASSETS -20,556. TOTAL TO SCHEDULE D, PART XI, LINE 8: 2,953,915. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | PASSAVANT PHYSICIAN MEMORIAL HOSPITAL REVENUE 3,425,524. JACKSONVILLE CRNAS REVENUE 1,419,336. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | PASSAVANT PHYSICIAN MEMORIAL HOSPITAL EXPENSES 6,174,293. JACKSONVILLE CRNAS EXPENSES 3,413,541. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent350 | X | Pcent350 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4831434 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4831434 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06310 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10381951 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8851359 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1530592 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 15213385 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8851359 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6362026 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08310 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 204291 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 204291 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00270 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 15675 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 15675 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 219966 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 219966 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00290 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 15433351 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8851359 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6581992 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08600 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 413043 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 413043 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00540 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 9685 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 9685 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 422728 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 422728 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00550 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $11,616 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 20772257 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 27585949 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -6813692 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PASSAVANT MEMORIAL AREA HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1600 WEST WALNUT ST | AddressLine1 |
| City | JACKSONVILLE | City |
| State | IL | State |
| ZIP Code | 62650 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Childrens Hospital | X | ChildrensHospital |
| 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 | PASSAVANT MEMORIAL AREA HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 350.000000000000 | FPGDiscountPercent |
| Explains Basis | 0 | ExplainsBasis |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Notify Upon Admission | X | NotifyUponAdmission |
| 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 | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, L7 COL(F): THE ASSOCIATION REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE ASSOCIATION PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE ASSOCIATION BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.FOR THE YEAR ENDED SEPTEMBER 30, 2012 THE ASSOCIATION IS REPORTING A BAD DEBT RECOVERY AND THEREFORE NO ADJUSTMENT IS NEEDED FOR BAD DEBT EXPENSE. | |
| PART II: PAH EXPANDED THE EMERGENCY DEPARTMENT TO SERVE AN INCREASING NUMBER OF PATIENTS. THE HOSPITAL'S PANDEMIC FLU COMMITTEE WORKED WITH THE COMMUNITY PANDEMIC TASK FORCE TO PUT A PLAN IN PLACE TO HANDLE H1N1 FLU. PAH HAS RECEIVED TRACTS OF FARM LAND, THE INCOME FROM WHICH ASSISTS WITH NURSING SCHOLARSHIPS AND WITH PATIENTS WHO CAN'T AFFORD TO PAY. WE FARM THE LAND AS THE DONORS HAVE REQUESTED. PAH IS ASSOCIATED WITH THE MORGAN-SCOTT VOLUNTEER HEALTH CLINIC IN AN EFFORT TO ASSIST THOSE WHO ARE UNINSURED. PAH DONATES OFFICE SPACE, LAB AND IMAGING SERVICES PLUS OTHER SERVICES AND CARE TO ELIGIBLE PERSONS THROUGH THE "FREE CLINIC" (MORGAN-SCOTT VOLUNTEER HEALTH CLINIC). PAH OFFERS FREE MAMMOGRAM SCREENINGS AS PART OF ITS ASSOCIATION WITH THE MIA WARE FOUNDATION. THIS FOUNDATION DONATED FUNDS TOWARDS THE PURCHASE OF DIGITAL MAMMOGRAPHY EQUIPMENT AT PASSAVANT. REGARDLESS OF ABILITY TO PAY, NO ONE NEEDING PASSAVANT'S SERVICES IS TURNED AWAY. HEALTH EDUCATION PROGRAMS AND FREE SCREENINGS ARE AVAILABLE TO THE COMMUNITIES THE HOSPITAL SERVES (I.E. PROSTRATE SCREENINGS, COLORECTAL SCREENINGS, DIABETES CLASSES, THE KIDNEY MOBILE, "WALKING FOR WELLNESS" PROGRAM, "COMMUNITY HEALTH CHECK", PROGRAMS ON HEART DISEASE, STROKES, BREAST CANCER, ETC.) PAH, THE MIA WARE FOUNDATION AND THE JACKSONVILLE CHAMBER OF COMMERCE SPONSOR A COMMUNITY HEALTH FAIR EACH YEAR CALLED "THE BE AWARE WELLNESS FAIR." THIS FAIR TAKES PLACE AT COMMUNITY PARK AND PROVIDES PREVENTATIVE HEALTH INFORMATION FOR ALL AGES AND ALSO EMPHASIZES BREAST CANCER AWARENESS. IT'S AN EVENT FOR EVERYONE IN THE FAMILY. PAH ALSO PROVIDES FREE PROGRAMS FOR SCHOOL AGE CHILDREN. SECOND-GRADE CHILDREN COME TO THE HOSPITAL TO ATTEND MINI-MEDICAL DAYS, WHERE INFORMATION IS PRESENTED TO HELP THEM UNDERSTAND WHAT THEY MIGHT ENCOUNTER IF THEY HAVE TO VISIT THE EMERGENCY DEPARTMENT, HAVE BLOOD WORK, HAVE X-RAYS, ETC. SIXTH GRADE STUDENTS ARE INVITED TO GO THROUGH THE "FANTASTIC BODY VOYAGE." THIS PROGRAM TAKES THEM ON A JOURNEY THROUGH THE HUMAN BODY AND LETS THEM EXPLORE VARIOUS BODY SYSTEMS IN A FUN AND EDUCATIONAL WAY. PAH PARTICIPATES IN THE COMMUNITY CHILDHOOD WELLNESS COALITION. RECOGNIZING THE HEALTH OF OUR CHILDREN IS AT RISK FOR MANY HEALTH PROBLEMS BECAUSE OF OBESITY, THE COALITION WORKS TO CREATE AWARENESS, EDUCATION AND PROGRAMS DEVOTED TO PHYSICAL FITNESS, NUTRITION AND WEIGHT MANAGEMENT FOR CHILDREN, AND THEIR PARENTS. IN 2011, A COMMUNITY GARDEN WAS PLANTED ON LAND DONATED BY AN ILLINOIS COLLEGE PROFESSOR. STUDENTS PLANTED AND MAINTAINED THE GARDEN AND THE HARVEST WAS AVAILABLE TO ANYONE INTERESTED. | |
| PART III, LINE 8: THE AMOUNT REPORTED ON LINE 6 WAS OBTAINED FOR THE MEDICARE COST REPORT FILED BY THE ORGANIZATION. ALTHOUGH THE AMOUNT ON LINE 7 HAS NOT BEEN INCLUDED IN PART I, LINE 7, THE AMOUNT SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE IT REPRESENTS CARE TO MEMBERS OF THE COMMUNITY WHICH HAS NOT BEEN REIMBURSED TO THE ORGANIZATION. | |
| PART III, LINE 9B: OUR COLLECTION POLICY STATES "HOSPITAL MAY PURSUE COLLECTION ACTIVITY ONLY AFTER THE HOSPITAL HAS GIVEN THE PATIENT THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE". OUR FINANCIAL ASSISTANCE POLICY STATES "THERE ARE INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR CHARITY CARE DISCOUNTS, BUT THERE IS NO FINANCIAL ASSISTANCE FORM ON FILE DUE TO LACK OF SUPPORTING DOCUMENTATION. OFTEN THERE IS ADEQUATE INFORMATION PROVIDED BY THE PATIENT OR THROUGH OTHER SOURCES, WHICH SHOWS SUFFICIENT EVIDENCE TO PROVIDE THE PATIENT WITH CHARITY CARE ASSISTANCE. IF THERE IS NO EVIDENCE TO SUPPORT A PATIENT'S ELIGIBILITY FOR CHARITY CARE, THE HOSPITAL CAN USE OUTSIDE AGENCIES IN DETERMINING ESTIMATED INCOME AMOUNTS FOR THE BASIS OF DETERMINING CHARITY CARE ELIGIBILITY AND POTENTIAL DISCOUNT AMOUNTS. ONCE DETERMINED, DUE TO THE INHERENT NATURE OF THE PRESUMPTIVE CIRCUMSTANCES, THE ONLY DISCOUNT THAT CAN BE GRANTED IS A 100% WRITE OFF OF THE ACCOUNT BALANCE. PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE 1) STATE-FUNDED PRESCRIPTION PROGRAMS; 2) HOMELESS OR RECEIVED CARE FROM A HOMELESS CLINIC; 3) PARTICIPATION IN WOMEN, INFANTS AND CHILDREN'S PROGRAMS (WIC); 4) FOOD STAMP ELIGIBILITY; 5) SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY; 6) ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED (E.G., MEDICAID SPEND-DOWN); 7) LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; AND 8) PATIENT IS DECEASED WITH NO KNOWN ESTATE." | |
| PART V, SECTION B, LINE 13G: ALL STATEMENTS TO THE PATIENT INDICATE OUR FINANCIAL ASSISTANCE CONTACT INFORMATION. INFORMATION IS ALSO LISTED ON THE CONSENT FOR TREATMENT FORM. | PASSAVANT MEMORIAL AREA HOSPITAL |
| PART V, SECTION B, LINE 19D: AMOUNT PROVIDED BY ATTORNEY GENERAL STATE OF ILLINOIS HOSPITAL UNINSURED PATIENT DISCOUNT ACT. | PASSAVANT MEMORIAL AREA HOSPITAL |
| PART V, SECTION B, LINE 21: PATIENTS ARE CHARGED THE GROSS CHARGE AND THEN THE UNINSURED PATIENT DISCOUNT IS APPLIED. THE REMAINING AMOUNT OF THE BILL IS THEN ELIGIBLE FOR FINANCIAL ASSISTANCE, UNDER THE FINANCIAL ASSISTANCE POLICY. | PASSAVANT MEMORIAL AREA HOSPITAL |
| PART VI, LINE 2: PASSAVANT AREA HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES IN MANY DIFFERENT MANNERS. THE HOSPITAL WORKS WITH THE MORGAN COUNTY HEALTH DEPARTMENT IN DEVELOPING THE MORGAN COUNTY HEALTH PLAN. THE HOSPITAL THEN USES THE RESULTS OF THE HEALTH PLAN TO DETERMINE WHAT PROGRAMS AND SERVICES NEED TO BE OFFERED. ANOTHER SOURCE OF INFORMATION ON HEALTH CARE NEEDS IS THE MEDICAL STAFF. MEMBERS OF THE HOSPITAL'S ADMINISTRATIVE TEAM MEET REGULARLY WITH THE PHYSICIANS TO DETERMINE WHAT NEW SERVICES SHOULD BE IMPLEMENTED. THE SIXTEEN MEMBERS OF THE BOARD OF DIRECTORS, WHO REPRESENT THE DIFFERENT GEOGRAPHIC AREAS SERVED BY THE HOSPITAL, ALSO PROVIDE INPUT ON HEALTH CARE NEEDS, ALONG WITH THE VOLUNTEERS AND THE HOSPITAL'S EMPLOYEES. LASTLY, THE HOSPITAL ASKS THE PUBLIC ABOUT SERVICES THROUGH PATIENT SURVEYS AND FOCUS GROUPS. | |
| PART VI, LINE 3: THERE ARE SIGNS IN THE REGISTRATION AREAS (IN ENGLISH & SPANISH)WHICH INDICATE THE HOSPITAL TREATS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. GUIDELINES FOR PAYMENTS ON PATIENT ACCOUNTS BROCHURES ARE AT EACH REGISTRATION BOOTH FOR PATIENTS AND THE GENERAL PUBLIC. THESE BROCHURES PROVIDE PAYMENT AND FINANCIAL ASSISTANCE INFORMATION (ENGLISH & SPANISH). OUR GENERAL CONSENT FOR TREATMENT HAS A SECTION ABOUT OUR FINANCIAL ASSISTANCE PROGRAM (ENGLISH & SPANISH). THERE IS INFORMATION AVAILABLE ON THE HOSPITAL WEBSITE ABOUT OUR FINANCIAL ASSISTANCE PROGRAM. INFORMATION ABOUT BILLING AND FINANCIAL ASSISTANCE IS AVAILABLE AT BEDSIDE FOR OVERNIGHT AND SURGERY PATIENTS. PATIENT BILLING STATEMENTS ADVISE OF OUR FINANCIAL ASSISTANCE PROGRAMS AND HOW TO CONTACT US TO APPLY. SELF-PAY OVERNIGHT PATIENTS ARE CONTACTED BY SOCIAL SERVICES AND/OR PFS STAFF AND PROVIDED WITH INFORMATION ON FINANCIAL ASSISTANCE PROGRAMS. STAFF RECEIVED EDUCATION TO DIRECT PATIENT TO SOCIAL SERVICE OR PATIENT FINANCIAL SERVICE IF A PATIENT INDICATES THEY NEED ASSISTANCE WITH A BILL. | |
| PART VI, LINE 4: THE MAIN COUNTIES THAT PAH SERVES ARE CASS, MORGAN, SCOTT, MACOUPIN AND GREENE COUNTIES (PAH HAS AT LEAST 25% OF THE MARKET IN THESE ZIP CODES). THERE IS A SMALLER, SECONDARY MARKET WHERE PAH HAS AT LEAST 5%, BUT LESS THAN 25% OF THE MARKET. THE SECONDARY MARKET INCLUDES ZIP CODES IN BROWN, SCHUYLER, FULTON, PIKE, AND CALHOUN COUNTIES. OVER 90% OF CASES COMES FROM THE PRIMARY MARKET. | |
| PART VI, LINE 5: PAH EMPLOYEES ARE VOLUNTEERS IN NON-PROFIT ORGANIZATIONS, SUCH AS ROTARY CLUB, KIWANIS, CHAMBER OF COMMERCE, HABITAT FOR HUMANITY, ETC. THEY ALSO SUPPORT THE UNITED WAY AND PARTICIPATE IN THE AMERICAN CANCER SOCIETY'S RELAY FOR LIFE. PAH PROVIDES CASH AND IN-KIND DONATIONS TO AREA NON-PROFIT ORGANIZATIONS AND TO AREA SCHOOLS' POST-PROM PARTIES. PAH ALSO PROVIDES DISEASE-RELATED SUPPORT GROUPS, FREE COMMUNITY HEALTH PROGRAMS AND SCREENINGS, USE OF MEETING ROOMS, CHAPLAIN SERVICES AND LANGUAGE ASSISTANCE SERVICES. WITH THE SUPPORT GROUPS, PAH STAFF FACILITATES SOME OF THOSE GROUPS. PAH PROVIDES FREE MEDICARE CONSULTING SERVICES TO SENIORS. PAH PROMOTES AND SUPPORTS THE JACKSONVILLE AREA SENIOR CENTER, WHICH OFFERS MANY ACTIVITIES FOR SENIORS. PASSAVANT PROVIDES SPEAKERS, SCREENINGS AND HEALTH FAIRS FOR FREE AT THE CENTER. IT ALSO CONDUCTS A "COMMUNITY HEALTH CHECK" AT THE CENTER THE FIRST WEDNESDAY OF EACH MONTH. IN FISCAL YEAR 2012, PAH PROVIDED $11.6 MILLION IN CHARITY CARE AND BAD DEBT CHARGES PLUS $915,000 OF FREE CHARGES AT THE VOLUNTEER HEALTH CLINIC (TOTALING $12.5 MILLION) |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ILLINOIS HOSPITAL RESEARCH AND EDUCATIONAL ASSOCIATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1151 EAST WARRENVILLE ROAD | AddressLine1 |
| City | NAPERVILLE | City |
| State | IL | State |
| ZIP Code | 60566 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 237421930 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 16617 | AmountOfCashGrant |
| Amount Of Non Cash Assistance | 0 | AmountOfNonCashAssistance |
| Purpose Of Grant | TO ADDRESS THE DISPARATE AND NEGATIVE EFFECTS OF THE ILLINOIS MEDICAID PROGRAM EXPERIENCED BY HOSPITALS AND HEALTHCARE SYSTEMS IN ILLINOIS. | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: GRANTS PAID TO ILLINOIS HOSPITAL RESEARCH AND EDUCATIONAL ASSOCIATION ARE PAID AS PART OF A VOLUNTARY STATE MEDICAID REALLOCATION PROGRAM KNOWN AS THE HOSPITAL MUTUAL ASSISTANCE PROGRAM. NO FORMAL POLICY EXISTS TO MONITOR THE USE OF THESE GRANTS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MICHAEL MOLYNEAUX MD | |||||||||||||
| 0 | 237609 | 0 | 0 | 0 | 0 | 0 | 11911 | 0 | 35650 | 0 | 285170 | 0 | 0 |
| CHESTER A WYNN | |||||||||||||
| 246815 | 0 | 0 | 0 | 0 | 0 | 14700 | 0 | 21270 | 0 | 282785 | 0 | 0 | 0 |
| DAVID A BOLEN | |||||||||||||
| 178517 | 0 | 0 | 0 | 0 | 0 | 5456 | 0 | 18358 | 0 | 202331 | 0 | 0 | 0 |
| KAREN DAUM | |||||||||||||
| 128618 | 0 | 0 | 0 | 0 | 0 | 7836 | 0 | 20515 | 0 | 156969 | 0 | 0 | 0 |
| STEPHEN LEE | |||||||||||||
| 127117 | 0 | 0 | 0 | 0 | 0 | 7836 | 0 | 20514 | 0 | 155467 | 0 | 0 | 0 |
| MARK RUFF | |||||||||||||
| 307559 | 0 | 0 | 0 | 0 | 0 | 15625 | 0 | 21450 | 0 | 344634 | 0 | 0 | 0 |
| DAVID C TONRY | |||||||||||||
| 250738 | 0 | 0 | 0 | 0 | 0 | 15185 | 0 | 21103 | 0 | 287026 | 0 | 0 | 0 |
| JOHN D GREGORY | |||||||||||||
| 240602 | 0 | 0 | 0 | 0 | 0 | 14490 | 0 | 21078 | 0 | 276170 | 0 | 0 | 0 |
| DEBORAH K TOMKO | |||||||||||||
| 192503 | 0 | 0 | 0 | 0 | 0 | 10575 | 0 | 13283 | 0 | 216361 | 0 | 0 | 0 |
| TAMARA C MCDONALD | |||||||||||||
| 226395 | 0 | 0 | 0 | 0 | 0 | 13500 | 0 | 20962 | 0 | 260857 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| CITY OF JACKSONVILLE IL | |||||||
| 376001700 | 469590AB9 | 2006-12-01 | 12485000 | FUNDING FOR CONSTRUCTION AND DEVELOPMENT | 0 | 0 | 0 |
| CITY OF JACKSONVILLE IL | |||||||
| 376001700 | 469590AA1 | 2006-12-01 | 19905000 | ADVANCE REFUNDING AND DEFEASANCE OF PREVIOUS BORROWINGS | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Credit EnhancementCreditEnhancement | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|---|
| 1815000 | 12485000 | 173127 | 27560 | 12843313 | 2007 | 0 | 0 | 0 | 1 |
| 2530000 | 19905000 | 276018 | 43940 | 806055 | 2007 | 0 | 1 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 |
| 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Term Of HedgeTermOfHedge | Superintegrated HedgeSuperintegratedHedge | Hedge TerminatedHedgeTerminated | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|---|---|---|
| MORGAN STANLEY | ||||||||
| 0 | 1 | 1 | 24.000000000000 | 0 | 0 | 0 | 0 | 0 |
| MORGAN STANLEY | ||||||||
| 0 | 1 | 1 | 22.000000000000 | 0 | 0 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 7A | REPRESENTATIVES OF 139 CHURCHES IN THE PASSAVANT SERVICE AREA MAKE UP THE BOARD OF GOVERNORS. THE BOARD OF DIRECTORS IS ELECTED BY THE BOARD OF GOVERNORS AT THE GOVERNORS' ANNUAL MEETING. | |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE FORM 990 IS REVIEWED BY THE CEO AND THE CFO PRIOR TO FILING. A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD FOR REVIEW PRIOR TO FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE CONFLICTS OF INTERESTS BY FILING SIGNED STATEMENTS WITH THE ORGANIZATION. THE BOARD MEMBERS COMPLETE THE CONFLICT OF INTEREST POLICY ON A YEARLY BASIS. THEY ARE REQUIRED TO DISCLOSE ANY CONFLICTS WHEN INFORMATION IS GATHERED TO PREPARE FORM 990. IF THEY HAVE A CONFLICT, THE BOARD MEMBERS EXCUSE THEMSELVES FROM ANY APPLICABLE VOTES. IF THERE IS A QUESTION OF WHETHER OR NOT THEY HAVE A CONFLICT, EITHER THE CEO OR THE CFO WILL INVESTIGATE THE ISSUE AND CONSULT WITH THE BOARD CHAIR, WHO WILL MAKE THE FINAL DETERMINATION. EMPLOYEES SIGN A CODE OF CONDUCT STATEMENT ANNUALLY, WHICH INCLUDES A SECTION ON CONFLICT OF INTEREST. EMPLOYEES ARE ALSO REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST. IF THEY HAVE A CONFLICT, THEY CANNOT HAVE ANY DECISION-MAKING POWERS REGARDING ANY OF THEIR AREAS OF CONFLICT. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION PARTICIPATES IN SEVERAL NATIONAL AND REGIONAL SURVEYS WHERE DATA IS OBTAINED ON VARIOUS POSITIONS SUCH AS CEO, CFO, CNO, ETC. THIS INFORMATION IS THEN PROVIDED TO THE BOARD EXECUTIVE COMMITTEE FOR REVIEW AND APPROVAL. FOR OTHER OFFICERS AND KEY EMPLOYEES, A CUSTOMIZED SURVEY CONDUCTED BY INTEGRATED HEALTHCARE STRATEGIES COMPARES THE COMPENSATION DATA PROVIDED BY THE ORGANIZATION TO THE STATISTICAL INFORMATION THEY HAVE. INTEGRATED HEALTHCARE STRATEGIES GENERATES A TRUE MARKET AVERAGE REPORT THAT COMPARES THE ORGANIZATION'S SALARY FOR A POSITION AND ASSOCIATED MINIMUM, 1ST QUARTILE, MIDPOINT, 3RD QUARTILE AND MAXIMUM SALARY POINTS. THE KEY EMPLOYEE DATA IS REVIEWED BY OUR CEO, CFO AND HR DIRECTOR AND MARKET COMPARATIVE SALARY ADJUSTMENTS ARE MADE AS NECESSARY. | |
| FORM 990, PART VI, SECTION C, LINE 19 | COPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON INDIVIDUAL REQUEST. THE AUDITED FINANCIAL STATEMENTS ARE POSTED ON THE HOSPITAL'S WEBSITE. | |
| FORM 990, PART VII: COMPENSATION | DR. MOLYNEAUX EARNED WAGES AS A PHYSICIAN AT PASSAVANT PHYSICIAN ASSOCIATION, A RELATED ORGANIZATION, AND WORKED ON AVERAGE 40 HOURS PER WEEK RELATED TO THIS POSITION. | COMPENSATION PAID BY RELATED ORGANIZATIONS: |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED GAINS ON INVESTMENTS: 4,331,132. CHANGE IN BOND INTEREST RATE SWAP -107,114. CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS 3,081,585. DECREASE IN TEMP RESTRICTED ASSETS -20,556. TOTAL TO FORM 990, PART XI, LINE 5: 7,285,047. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| JACKSONVILLE CRNA'S INC | ||||||||||
| 1600 WEST WALNUT STREET | JACKSONVILLE | IL | 62650 | 273083265 | CRNA SERVICES | IL | 501(C)(3) | LINE 11B, II | PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION | 1 |
| PASSAVANT MEMORIAL AREA AUXILIARY | ||||||||||
| 1600 WEST WALNUT STREET | JACKSONVILLE | IL | 62650 | 370890067 | SUPPORTING THE HOSPITAL | IL | 501(C)(3) | LINE 11C, III-FI | 0 | |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JACKSONVILLE JOINT VENTURE | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 644 N 2ND STRRET | AddressLine1 |
| City | SPRINGFIELD | City |
| State | IL | State |
| ZIP Code | 62702 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 364180270 | EIN |
| Primary Activity | MEDICAL EQUIPMENT | PrimaryActivity |
| Legal Domicile State | IL | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Predominant Income Type | RELATED | PredominantIncomeType |
| Share Of Total Income | 70586 | ShareOfTotalIncome |
| Share Of EOY Assets | 732986 | ShareOfEOYAssets |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 0 | GeneralOrManagingPartner |
| Percentage Ownership | 0.50000 | PercentageOwnership |
Form990 Schedule R Part IV Form990ScheduleRPartIV (11 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|
| PASSAVANT PHYSICIAN ASSOCIATION | ||||||||||
| 1600 WEST WALNUT STREET | JACKSONVILLE | IL | 62650 | 261200566 | PHYSICIAN SERVICES | IL | C | 3508323 | 943453 | 1.00000 |
| LELAND CAPPS CO US BANK NA | ||||||||||
| 205 S FIFTH STREET | SPRINGFIELD | IL | 62701 | 376023527 | INVESTMENT | IL | T | 14769 | 173606 | 1.00000 |
| IRMA BARSNES CO FARMERS STATE BANK & TRUST | ||||||||||
| 205 S FIFTH STREET | SPRINGFIELD | IL | 62701 | 376026493 | INVESTMENT | IL | T | 12437 | 140869 | 0.80000 |
| BEILSCHMIDT FARM FBO BEREA CHURCH | ||||||||||
| 200 W STATE STREET | JACKSONVILLE | IL | 62651 | 376365758 | INVESTMENT | IL | T | -64374 | 1556185 | 1.00000 |
| BEILSCHMIDT FARM FBO PASSAVANT HOSPITAL | ||||||||||
| 200 W STATE STREET | JACKSONVILLE | IL | 62651 | 376365760 | INVESTMENT | IL | T | 4489 | 1302201 | 1.00000 |
| FRANCES CORRINGTON CO US BANK NA | ||||||||||
| 205 S FIFTH STREET | SPRINGFIELD | IL | 62701 | 376135460 | INVESTMENT | IL | T | 12472 | 2141121 | 1.00000 |
| MILDRED DINWIDDIE CO US BANK NA | ||||||||||
| 205 S FIFTH STREET | SPRINGFIELD | IL | 62701 | 376227814 | INVESTMENT | IL | T | -1366 | 2119407 | 1.00000 |
| ELIZABETH SHEKELTON CO US BANK NA | ||||||||||
| 205 S FIFTH STREET | SPRINGFIELD | IL | 62701 | 376124484 | INVESTMENT | IL | T | -15578 | 883283 | 1.00000 |
| THOMAS TISSINGTON FARM CO FARMERS STATE BANK & TRUST | ||||||||||
| 200 W STATE STREET | JACKSONVILLE | IL | 62651 | 376022909 | INVESTMENT | IL | T | -8243 | 2487221 | 1.00000 |
| FRED VANBEBBER CO FARMERS STATE BANK & TRUST | ||||||||||
| 200 W STATE STREET | JACKSONVILLE | IL | 62651 | 376118658 | INVESTMENT | IL | T | 24751 | 464417 | 1.00000 |
| JANE H WILSON CO US BANK NA | ||||||||||
| 205 S FIFTH STREET | SPRINGFIELD | IL | 62701 | 900513371 | INVESTMENT | IL | T | 39460 | 407513 | 1.00000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| PASSAVANT PHYSICIAN ASSOCIATION | ||
| D | 15394037 | FMV |
| JACKSONVILLE CRNA'S INC | ||
| P | 3462272 | FMV |
| JACKSONVILLE CRNA'S INC | ||
| R | 1493000 | FMV |