DEKALB MEMORIAL HOSPITAL INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
DEKALB MEMORIAL HOSPITAL INC (EIN 35-1064295)
Tax period
2010-10-01 to 2011-09-30
Filed
2013-10-11
IRS object ID
201302849349301350
Schema version
2010v3.7
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-10-11T15:32:25-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1200 E Main St Suite 700AddressLine1
CityFort WayneCity
StateINState
ZIP Code46802ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN351064295EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1DEKALB MEMORIAL HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlDEKANameControl
Phone2609254600Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11316 EAST SEVENTH STREETAddressLine1
CityAUBURNCity
StateINState
ZIP Code46706ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameAMY CROUCHName
TitleCFOTitle
Date Signed2013-10-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJoyce A DulworthName
Phone2604604000Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Amended ReturnXAmendedReturn

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1DEKALB HEALTHBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonKIRK RAYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11316 EAST SEVENTH STREETAddressLine1
CityAUBURNCity
StateINState
ZIP Code46706ZIPCode
FieldValueIRS element (for citing)
Gross Receipts55641248GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.DEKALBHEALTH.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1964YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionDEKALB MEMORIAL HOSPITAL WAS ESTABLISHED TO PROVIDE A VARIETY OF ACUTE, SUBACUTE AND OUTPATIENT MEDICAL SERVICES TO THE RESIDENTS OF NORTHEASTERN INDIANA.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees531TotalNbrEmployees
Total Nbr Volunteers51TotalNbrVolunteers
Total Gross UBI134455TotalGrossUBI
Net Unrelated Business Txbl Income-8052NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year866110ContributionsGrantsPriorYear
Contributions Grants Current Year217959ContributionsGrantsCurrentYear
Program Service Revenue Prior Year43590342ProgramServiceRevenuePriorYear
Program Service Revenue CY48010105ProgramServiceRevenueCY
Investment Income Prior Year1148394InvestmentIncomePriorYear
Investment Income Current Year700799InvestmentIncomeCurrentYear
Other Revenue Prior Year672196OtherRevenuePriorYear
Other Revenue Current Year1390736OtherRevenueCurrentYear
Total Revenue Prior Year46277042TotalRevenuePriorYear
Total Revenue Current Year50319599TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year17000GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY40000GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year23521058SalariesEtcPriorYear
Salaries Etc Current Year25570049SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year20102761OtherExpensePriorYear
Other Expenses Current Year24715163OtherExpensesCurrentYear
Total Expenses Prior Year43640819TotalExpensesPriorYear
Total Expenses Current Year50325212TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2636223RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-5613RevenuesLessExpensesCY
Total Assets BOY60174910TotalAssetsBOY
Total Assets EOY63926199TotalAssetsEOY
Total Liabilities BOY12183175TotalLiabilitiesBOY
Total Liabilities EOY16854681TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY47991735NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY47071518NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionDEKALB MEMORIAL HOSPITAL WAS ESTABLISHED TO PROVIDE A VARIETY OF ACUTE, SUBACUTE AND OUTPATIENT MEDICAL SERVICES TO THE RESIDENTS OF NORTHEASTERN INDIANA. THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT HEALTHCARE GENERALLY TO THE RESIDENTS OF DEKALB COUNTY, INDIANA AND CONTIGUOUS COUNTIES. THE HOSPITAL ALSO PROVIDES CHARITY CARE TO PATIENTS.MissionDescription
Significant New Program ServicestrueSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense45914691Expense
Grants40000Grants
Revenue48393334Revenue
DescriptionThe 47 bed Hospital operates in a rural area. For fiscal year ended September 30, 2011, the total number of Admissions was 2,527. The total number of Emergency Room Visits was 15,197. The total number of Emergency Medical Services trips was 3,578. The total number of Home Health Care Visits was 4,480. The Hospital provides charity care to patients who meet certain criteria under its charity care policy. The Hospital does not pursue collection of amounts determined to be charity care.Description
Total Program Service Expense45914691TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccounttrueEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109645NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees531NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonAMY CROUCHNamePerson
Telephone Number2609254600TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11316 E 7TH STREETAddressLine1
CityAUBURNCity
StateINState
ZIP Code46706ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
MARK MILLETT
CHAIRPERSON1.0XX000
DEB LINSTROMBERG
VICE CHAIRPERSON1.0XX000
RICHARD ALLEN
DIRECTOR1.0X000
RON DICKE
DIRECTOR1.0X000
DON WALLACE
DIRECTOR1.0X000
STACY HEFTY
DIRECTOR1.0X000
JEFF JUSTICE
DIRECTOR1.0X000
FRANK CAPRINO
DIRECTOR1.0XX000
BRYAN NUGEN
DIRECTOR1.0X000
ROBERT MENZIE
DIRECTOR1.0X000
MITCHELL TRAVIS
DIRECTOR1.0X000
ALAN MIDDLETON
SECRETARY1.0X000
KIRK RAY
EXEC DIRECTOR/CEO40.0X24946003664
PAMELA CAVACINICASSARA
CHIEF FINANCIAL OFFICER40.0X145742014485
EMILIO VAZQUEZ
PHYSICIAN40.0238582016704X
BRET KUEBER
PHYSICIAN40.0213038017261X
NICHOLAS FINLEY
PHYSICIAN40.0178247022283X
JOSEPH PUTMAN
PHYSICIAN40.0180500017153X
LEEANN PIXLEY
PHYSICIAN40.0157636015320X
JACK M COREY
EXEC DIRECTOR/CEO0.02354720151X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1598677TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation107021TotalOtherCompensation
Number Individuals GT100 K13NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
INSIGHT HEALTH CORP
PO BOX 847689DALLASTX752847689SCAN SERVICES673006
NORTHEAST ANESTHESIA PARTNERS
601 WASHINGTON AVE STE 390NEWPORTKY41071ANESTHESIA SERVICES796843
SOUTH BEND MEDICAL FOUNDATION
530 NORTH LAFAYETTE BLVDSOUTH BENDIN46602REFERENCE LAB517634
ALLIED MEDICAL SERVICES
6444 MONROE STREET STE BSYLVANIAOH43560RT SERVICES441378
THEREX
PO BOX 2121MEMPHISTN38159PT & OT SERVICES505497
FieldValueIRS element (for citing)
Number Of Contractors GT100 K9NumberOfContractorsGT100K
Fundraising Events18310FundraisingEvents
All Other Contributions199649AllOtherContributions
Total Contributions217959TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PATIENT SERVICE REVENUE9000994439104544391045
CAFETERIA SALES90009927325021781055440
DRUGS & SUPPLIES900099206885206885
LAB - NON PATIENT REVENUE6215002443624436
PHARMACARE6215003114489306141453075
FieldValueIRS element (for citing)
Total Program Service Revenue48010105TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column442806TotalRevenueColumn
Exclusion$442,806ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column155TotalRevenueColumn
Exclusion$155ExclusionAmount

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real706749Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real273653Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real433096Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column433096TotalRevenueColumn
Related Or Exempt Function Income313562RelatedOrExemptFunctionIncome
Exclusion$119,534ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities5291990Securities
Other6000Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities5016400Securities
Other23752Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities275590Securities
Other-17752Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column257838TotalRevenueColumn
Related Or Exempt Function Income-17752RelatedOrExemptFunctionIncome
Exclusion$275,590ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events5445GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events18310CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses7844FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-2399TotalRevenueColumn
Exclusion-$2,399ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER REVENUEDescription
Business Code900099BusinessCode
Total Revenue Column960039TotalRevenueColumn
Related Or Exempt Function Income934099RelatedOrExemptFunctionIncome
Unrelated Business Revenue25940UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Other Revenue960039TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column50319599TotalRevenueColumn
Related Or Exempt Function Income49131499RelatedOrExemptFunctionIncome
Unrelated Business Revenue134455UnrelatedBusinessRevenue
Exclusion$835,686ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total20000Total
Program Services20000ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total20000Total
Program Services20000ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total360282Total
Management And General360282ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total19325136Total
Program Services17712975ProgramServices
Management And General1612161ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total869693Total
Program Services826208ProgramServices
Management And General43485ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3608698Total
Program Services3428168ProgramServices
Management And General180530ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1406240Total
Program Services1335928ProgramServices
Management And General70312ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total23681Total
Program Services5719ProgramServices
Management And General17962ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total93620Total
Management And General93620ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total5312Total
Management And General5312ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total20000Total
Management And General20000ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total4527248Total
Program Services4238311ProgramServices
Management And General288937ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total314500Total
Program Services49318ProgramServices
Management And General265182ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total5755695Total
Program Services5431785ProgramServices
Management And General323910ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total1161090Total
Program Services1101109ProgramServices
Management And General59981ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total855661Total
Program Services800308ProgramServices
Management And General55353ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total229846Total
Program Services203183ProgramServices
Management And General26663ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total36276Total
Program Services26123ProgramServices
Management And General10153ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total233109Total
Program Services233109ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3805396Total
Program Services3325237ProgramServices
Management And General480159ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total476063Total
Program Services428457ProgramServices
Management And General47606ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT37127983712798
RECRUITMENT165043165043
COLLECTION FEES231731231731
LICENSE, ACCRED FEES & MISC423579145553278026
MEDICAL SUPPLIES25837372583737

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total60778Total
Program Services54934ProgramServices
Management And General5844ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total50325212Total
Program Services45914691ProgramServices
Management And General4410521ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1750BOY
EOY2050EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY7634449BOY
EOY4223983EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY7552453BOY
EOY7159342EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY522359BOY
EOY903158EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY363595BOY
EOY779746EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis72912553LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec35926331LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY30290559BOY
EOY36986222EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY13157617BOY
EOY12948021EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY652128BOY
EOY923677EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY60174910BOY
EOY63926199EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4465230BOY
EOY4833222EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY7698353BOY
EOY6550065EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY5317493EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY19592BOY
EOY153901EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY12183175BOY
EOY16854681EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY47907517BOY
EOY46958621EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY84218BOY
EOY112897EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY47991735BOY
EOY47071518EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY60174910BOY
EOY63926199EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-5613ReconcilationRevenueExpenses
Reconcilation Other Changes-914604ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationstrueRalliesDemonstrations
Rallies Demonstrations$5,312RalliesDemonstrationsAmount
Other ActivitiesfalseOtherActivities
Total Lobbying Expenditures IIB5312TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierFORM 990, SCHEDULE CIdentifier
ExplanationLINE 1H: We contribute to a National and State Hospital Association and a HHC & Hospital Association with a percent going towards lobbying. AHA is 24.42% of dues ($3,745), IHA is 5.29% of dues ($1,261), IAHHC for HHC and Hospice is 12% of dues ($173), Society of DIagnostic Medical Sonography is 15.70% of dues ($91) and CHIME 9.26% of dues ($42).Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis220118OtherCostOrOtherBasis
Book Value220118BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis44979173OtherCostOrOtherBasis
Depreciation20549779Depreciation
Book Value24429394BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis18170159OtherCostOrOtherBasis
Depreciation13942648Depreciation
Book Value4227511BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis9543103OtherCostOrOtherBasis
Depreciation1433904Depreciation
Book Value8109199BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings36986222TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionCAPITAL LEASE OBLIGATIONSDescription
Amount$153,901Amount
FieldValueIRS element (for citing)
Total Of Amounts153901TotalOfAmounts
Total Revenue50319599TotalRevenue
Total Expenses50325212TotalExpenses
Excess Or Deficit For Year-5613ExcessOrDeficitForYear
Net Unrealized GL On Investments-914604NetUnrealizedGLOnInvestments
Total Adjustments-914604TotalAdjustments
Excess Or Deficit Per FS-920217ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt49686492TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-914604NetUnrealizedGainsInvestments
Other Revenues281497OtherRevenues
Revenue Not Rptd F990-633107RevenueNotRptdF990
Revenue Subtotal50319599RevenueSubtotal
Total Revenue Per Form99050319599TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt50606709TotExpensesEtcAuditedFinclStmt
Other Expenses Included281497OtherExpensesIncluded
Expenses Not Rptd F990281497ExpensesNotRptdF990
Expenses Subtotal50325212ExpensesSubtotal
Total Expenses Per Form99050325212TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierExplanationExplanation
FORM 990, SCHEDULE DFIN 48: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTIAN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
FORM 990, SCHEDULE DPART XII, LINE 2D & PART XIII, LINE 2D RENTAL EXPENSES $273,653 DIRECT EXPENSES RELATED TO FUNDRAISING EVENTS 7,844

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF OUTINGNameOfEvent1
Gross Receipts Event123755GrossReceiptsEvent1
Charitable Contributions Event118310CharitableContributionsEvent1
Gross Revenue Event15445GrossRevenueEvent1
Non Cash Prizes Event11280NonCashPrizesEvent1
Rent Facility Costs Event12625RentFacilityCostsEvent1
Food And Beverage Event13510FoodAndBeverageEvent1
Other Direct Expenses Event1429OtherDirectExpensesEvent1
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total23755GrossReceiptsTotal
Charitable Contributions Total18310CharitableContributionsTotal
Gross Revenue Total Events5445GrossRevenueTotalEvents
Non Cash Prizes Total Events1280NonCashPrizesTotalEvents
Rent Facility Costs Total Events2625RentFacilityCostsTotalEvents
Food And Beverage Total Events3510FoodAndBeverageTotalEvents
Other Direct Expenses Total Events429OtherDirectExpensesTotalEvents
Direct Expense Summary Events7844DirectExpenseSummaryEvents
Net Income Summary-2399NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense280212TotalCommunityBenefitExpense
Net Community Benefit Expense280212NetCommunityBenefitExpense
Percent Of Total Expense0.00600PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense5083576TotalCommunityBenefitExpense
Direct Offsetting Revenue2083525DirectOffsettingRevenue
Net Community Benefit Expense3000051NetCommunityBenefitExpense
Percent Of Total Expense0.06440PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense5363788TotalCommunityBenefitExpense
Direct Offsetting Revenue2083525DirectOffsettingRevenue
Net Community Benefit Expense3280263NetCommunityBenefitExpense
Percent Of Total Expense0.07040PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense351134TotalCommunityBenefitExpense
Net Community Benefit Expense351134NetCommunityBenefitExpense
Percent Of Total Expense0.00750PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense351134TotalCommunityBenefitExpense
Net Community Benefit Expense351134NetCommunityBenefitExpense
Percent Of Total Expense0.00750PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense5714922TotalCommunityBenefitExpense
Direct Offsetting Revenue2083525DirectOffsettingRevenue
Net Community Benefit Expense3631397NetCommunityBenefitExpense
Percent Of Total Expense0.07790PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$1,991,534BadDebtExpenseAmount
Amount Attributable To199153AmountAttributableTo
Amount Reimbursed By Medicare6088932AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare7638881CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-1549949MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line1REDIMED AT DEKALBBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityOCCUPATIONAL HEALTHDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.50000OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership0.00000OfficersEtcProfitOrOwnership
Physicans Profit Or Ownership0.00000PhysicansProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1DEKALB MEMORIAL HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11316 E 7TH STREETAddressLine1
CityAUBURNCity
StateINState
ZIP Code46706ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1DEKALB MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (5 entries)

IdentifierIdentifierExplanationExplanation
Part III, Line 4aACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. AN AGGREGATE COST TO CHARGE RATIO WAS USED TO PROVIDE BAD DEBT AT COST. THE ESTIMATED AMOUNT OF THE HOSPITAL'S BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS THAT MIGHT HAVE BEEN ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY WAS DETERMINED BY COMPUTING A PERCENTAGE OF DOLLAR AMOUNT TOTALS OF ACCOUNTS APPROVED FOR ASSISTANCE TO TOTAL APPLICATIONS AND THEN APPLIED THE PERCENTAGE TO THE APPLICATIONS THAT WERE DENIED DUE TO INCOMPLETE INFORMATION TO COME UP WITH AN ESTIMATE OF WHAT WOULD HAVE QUALIFIED IF THE INFORMATION HAD BEEN RECEIVED. THE RATIONALE BEING THAT HAD THE INFORMATION BEEN RECEIVED, THOSE ACCOUNTS WOULD HAVE BEEN APPROVED. Part III, Line 8a MEDICARE SHORTFALL IS NOT TREATED AS COMMUNITY BENEFIT. THE METHODOLOGY USES THE DEPARTMENT COST TO CHARGE RATIO GENERATED BY THE MEDICARE COST REPORT. Part III, Line 9b ACCOUNTS QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE DESIGNATED AS SUCH IN THE ACCOUNTS RECEIVABLE SYSTEM AND ARE NOT WRITTEN OFF TO BAD DEBT OR SENT TO A COLLECTION AGENCY.
NEEDS ASSESSMENTPERIODIC FOCUS GROUP SURVEYS BY OUTSIDE CONSULTANTS ARE PREPARED EVERY 3-5 YEARS TO ASSESS THE NEEDS OF THE COMMUNITY. THESE SURVEYS INCLUDE INPUT FROM INDIVIDUALS, HEALTH PROFESSIONALS, GOVERNMENTAL HEALTH CARE OFFICIALS AS WELL AS REPRESENTATIVES FROM DEKALB HOSPITAL. THE SURVEY SOLICITS INPUT ON THE HEALTH CARE NEEDS INCLUDING OBESITY, PREVENTIVE MEDICINE, VACCINATIONS, CARDIOVASCULAR, ETC. THESE NEEDS AND CONCERNS ARE EVALUATED AND APPROPRIATE PLANS ARE PUT INTO ACTION TO DEAL WITH THE MOST PRESSING ISSUES. CUSTOMER SATISFACTION SURVEYS ARE ALSO USED TO IDENTIFY UNMET HEALTH CARE NEEDS OF THE COMMUNITY.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEUPON ADMITTANCE TO DEKALB HOSPITAL, PATIENTS ARE PROVIDED INFORMATION REGARDING THE CHARITY CARE POLICIES. FINANCIAL AID GUIDELINES ARE ALSO INCLUDED WITH THE BILLING STATEMENTS. SIGNS OUTLINING THE FINANCIAL AID POLICIES AND APPLICATIONS ARE ALSO LOCATED IN NUMEROUS AREAS THROUGHOUT THE HOSPITAL. ALL NON-INSURED PATIENTS ARE STRONGLY ENCOURAGED TO MEET WITH A FINANCIAL COUNSELOR TO REVIEW ALL OPTIONS AVAILABLE TO THEM INCLUDING MEDICARE, MEDICAID, CHARITY CARE, LOAN AND PAYMENT PROGRAMS. DEKALB HOSPITAL STAFF WILLINGLY ASSIST PATIENTS WITH QUALIFICATION CRITERIA AND COMPLETION OF APPLICATIONS FOR SUCH PROGRAMS, WHERE APPLICABLE.
COMMUNITY INFORMATIONDEKALB MEMORIAL HOSPITAL IS THE SOLE COMMUNITY HOSPITAL LOCATED IN DEKALB COUNTY, SERVING DEKALB, PORTIONS OF STEUBEN, NOBLE AND ALLEN COUNTIES AND THE TOWNS OF HICKSVILLE AND EDGERTON IN NORTHWEST OHIO. THE POPULATION OF DEKALB MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA IS APPROXIMATELY 42,000 AND POPULATION GROWTH HAS REMAINED AT 3-4% ANNUALLY. DUE TO THE 2008 ECONOMIC DOWNTURN, DEKALB HAS SEEN AN INCREASE IN THE UNINSURED AND UNDERINSURED AND QUALIFIES FOR DISPROPORTIONATE SHARE PAYMENT ON THE MEDICARE COST REPORT DUE TO THE LARGER THAN NORMAL SHARE OF MEDICAID PATIENT VOLUME SERVED BY THE HOSPITAL. THE DEMOGRAPHIC AREA SERVED BY DEKALB MEMORIAL HOSPITAL IS MADE UP OF A MEDIAN HOUSEHOLD INCOME OF APPROXIMATELY $45,000, THE MEDIAN AGE IS 40 AND CONTAINS PRIMARILY A BLUE COLLAR AND AGRICULTURAL WORKFORCE.
PROMOTION OF CUMMUNITY HEALTHTHE HOSPITAL GIVES BACK FINANCIALLY, EDUCATIONALLY, AND THROUGH VOLUNTEERISM, AWARENESS INITIATIVES AND SUPPORT GROUPS. SOME OF THE MANY COMMUNITY EDUCATION PROGRAMS FOR CHILDREN AND ADULTS INCLUDE: PRENATAL EDUCATION, ACLS, CPR, AND FIRST AID TRAINING, DIABETES EDUCATION, SMOKING CESSATION AND WEIGHT MANAGEMENT. SOME OF THE COMMUNITY OUTREACH ACTIVITIES INCLUDE INVOLVEMENT IN: COMMUNITY AND WORKPLACE HEALTH & WELLNESS FAIRS, ROTARY PRESENTATIONS, BACK TO SCHOOL SPORTS PHYSICALS, GRIEF CARE, HEART CARE AND ORGAN DONATION DISCUSSION SERIES, SHOTS FOR TOTS, UNITED WAY DAY OF CARING, PROVIDING EMS STANDBY FOR 20+ COMMUNITY EVENTS AND DISASTER PREPAREDNESS. ADDITIONALLY, THE HOSPITAL PROVIDES FINANCIAL DONATIONS TO OVER 50 NON-PROFIT ORGANIZATIONS IN THE COMMUNITY TOTALING OVER $100,000 ANNUALLY.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
NORTHEAST INDIANA REGIONAL
200 EAST MAIN STREET SUITE 910FORT WAYNEIN46802351984702501(C)(6)10000JOB CREATION PROGRAM
DEKALB COUNTY ECONOMIC
4483 COUNTY ROAD 19 SUITE CAUBURNIN46706364577514501(C)(3)10000INVEST IN COMMUNITY
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants50TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIPSTypeOfGrant
Number Of Recipients23NumberOfRecipients
Amount Of Cash Grant20000AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierFORM 990, SCHEDULE IIdentifier
ExplanationTHE SCHOLARSHIPS ARE GRANTED TO DEKALB COUNTY STUDENTS PURSUING HEALTHCARE COURSES. THERE IS NO DISCRIMINATION BASED ON RACE, RELIGION, OR SEX IN AWARDING ANY OF THE SCHOLARSHIPS.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymenttrueSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
KIRK RAY
2146290278800695101323023410253124000
PAMELA CAVACINICASSARA
12475401343407554011777027080160227000
EMILIO VAZQUEZ
19735103843902792015666010380255286000
BRET KUEBER
16500004031907719016072011890230299000
NICHOLAS FINLEY
13478704132002140014905039770197129000
JOSEPH PUTMAN
14782402511507561014602025510197653000
LEEANN PIXLEY
13124601894607444012725025950172956000
JACK M COREY
00002354720001510235623000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierFORM 990, SCHEDULE JIdentifier
ExplanationLINE 1: SOCIAL CLUB DUES OF $2,000 ARE PROVIDED TO THE CEO SOLELY FOR BUSINESS PURPOSES. LINE 4: JACK COREY RECEIVED $235,623 FOR SEVERENCE PAY IN FY 2011.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
HOSPITAL AUTHORITY OF DEKALB COUNTY INDIANA
351064295240732BQ92006-12-292725000CONSTRUCTIONfalsefalsefalse
HOSPITAL AUTHORITY OF DEKALB COUNTY INDIANA
351064295240732BLO2006-12-299275000CONSTRUCTIONfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Amount RetiredAmountRetiredTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindCapital ExpendituresCapitalExpenditures
27250002725000750000475532011truefalsetruetrue
93544389275001499312011falsefalsetruetrue9000000

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsefalsefalsefalsetrue0.000000.000000.00000true
falsefalsefalsefalsetrue0.000000.000000.00000true

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
falsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
REASON FOR AMENDINGTHE NUMBERS FROM SCHEDULE H PART III LINES 5 AND 6 ARE BEING UPDATED TO REFLECT COST REPORT NUMBERS. FORM 990, PART III LINE 2: DEKALB MEMORIAL PURCHASED A RETAIL PHARMACY WHICH IS NOW NAMED PHARMACARE LLC. FORM 990, PART VI LINE 6: THE ORGANIZATION HAS A CORPORATE BOARD MEETING CONSISTING OF 30 COMMUNITY MEMBERS. TWELVE MEMBERS OF THE CORPORATE BOARD ARE ELECTED AND SERVE AS THE ORGANIZATION'S GOVERNING BOARD OF DIRECTORS. DEKALB MEMORIAL ALSO HAS MEMBERS IN A PHYSICIAN HEALTH ORGANIZATION.
FORM 990, PART VILINE 7A: THE ORGANIZATION HAS A CORPORATE BOARD MEETING CONSISTING OF 30 COMMUNITY MEMBERS. TWELVE MEMBERS OF THE CORPORATE BOARD ARE ELECTED AND SERVE AS THE ORGANIZATION'S GOVERNING BOARD OF DIRECTORS.
FORM 990, PART VILINE 7B: NOMINATIONS AND APPROVAL FOR VACANCIES ON THE GOVERNING BOARD ARE SUBJECT TO APPROVAL BY CORPORATE MEMBERS. ALL BUSINESS DECISIONS OF THE BOARD OF DIRECTORS ARE RATIFIED BY ANNUAL RESOLUTION OF THE CORPORATE BOARD.
FORM 990, PART VILINE 11B: THE FORM 990 IS PREPARED BY AN OUTSIDE CPA FIRM AND REVIEWED BY THE CHIEF FINANCIAL OFFICER AFTER WHICH IT IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS.
FORM 990, PART VILINE 12C: The conflict of interest policies are completed annually by all board members and staff. The policy statements are reviewed annually by the board of directors. When organization business is being conducted and there is a conflict, the board or staff members abstain from voting on related matters. This is documented in the board minutes.
FORM 990, PART VILINE 15A: THE COMPENSATION COMMITTEE, A SUB-COMMITTEE OF THE BOARD, IS INVOLVED IN DETERMINING THE COMPENSATION OF THE CEO UTILIZING THIRD PARTY AND MARKET DATA.
FORM 990, PART VILINE 19: THE CONFLICT OF INTEREST STATEMENTS AND GOVERNING DOCUMENTS ARE KEPT WITH THE EXECUTIVE SECRETARY AND ARE AVAILABLE TO BE VIEWED WHEN REQUESTED. THE FINANCIAL STATEMENTS ARE KEPT IN THE FINANCE AREA AND ARE ALSO AVAILABLE UPON REQUEST.
FORM 990, PART XIUNREALIZED LOSSES ON TRADING SECURITIES (914,604)LINE 5

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1DEKALB MEMORIAL PHARMACARE LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11314 E 7TH STREETAddressLine1
CityAUBURNCity
StateINState
ZIP Code46706ZIPCode
FieldValueIRS element (for citing)
EIN273514342EIN
Primary ActivitiesRETAIL PHARMPrimaryActivities
Legal Domicile StateINLegalDomicileState
Total Income-285893TotalIncome
EOY Assets736149EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1DEKALB COMMUNITY HOSPITAL FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1212 WEST 7TH STAddressLine1
CityAUBURNCity
StateINState
ZIP Code46706ZIPCode
FieldValueIRS element (for citing)
EIN356047817EIN
Primary ActivitiesSUPPORTPrimaryActivities
Legal Domicile StateINLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status11APublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1REDIMED DEKALB LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line17950 W JEFFERSON BLVDAddressLine1
CityFORT WAYNECity
StateINState
ZIP Code468044160ZIPCode
FieldValueIRS element (for citing)
EIN352046411EIN
Primary ActivityOCC HEALTHPrimaryActivity
Legal Domicile StateINLegalDomicileState
Predominant Income TypeRELATEDPredominantIncomeType
Share Of Total Income-51057ShareOfTotalIncome
Share Of EOY Assets60689ShareOfEOYAssets
Disproportionate AllocationsfalseDisproportionateAllocations
General Or Managing PartnerfalseGeneralOrManagingPartner
Percentage Ownership0.50000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

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