RICHLAND MEMORIAL HOSPITAL INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- RICHLAND MEMORIAL HOSPITAL INC (EIN 37-1363001)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-03-27
- IRS object ID
- 201310869349300006
- 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 D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-03-27T11:11:00-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KERBER ECK & BRAECKEL LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1116 W MAIN ST | AddressLine1 |
| City | CARBONDALE | City |
| State | IL | State |
| ZIP Code | 629012335 | 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 | 371363001 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RICHLAND MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | RICH | NameControl |
| Phone | 6183952131 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 EAST LOCUST STREET | AddressLine1 |
| City | OLNEY | City |
| State | IL | State |
| ZIP Code | 624502598 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MIKE STOVERINK | Name |
| Title | CFO | Title |
| Phone | 6183952131 | Phone |
| Date Signed | 2013-03-27 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID SCHNAKE | Name |
| Phone | 6185291040 | Phone |
| Date Prepared | 2013-03-27 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAVID ALLEN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 EAST LOCUST STREET | AddressLine1 |
| City | OLNEY | City |
| State | IL | State |
| ZIP Code | 62450 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 43221403 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.RICHLANDMEMORIAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1953 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE EXCELLENT HEALTHCARE, PROMOTE WELLNESS, AND EDUCATE PATIENTS, STAFF, AND THE COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 568 | TotalNbrEmployees |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 191901 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1367758 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 37906513 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 38963162 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 83839 | InvestmentIncomePriorYear |
| Investment Income Current Year | 50615 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1038132 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2839868 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 39220385 | TotalRevenuePriorYear |
| Total Revenue Current Year | 43221403 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 23565857 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 24844856 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 14437121 | OtherExpensePriorYear |
| Other Expenses Current Year | 16391987 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 38002978 | TotalExpensesPriorYear |
| Total Expenses Current Year | 41236843 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1217407 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1984560 | RevenuesLessExpensesCY |
| Total Assets BOY | 29921886 | TotalAssetsBOY |
| Total Assets EOY | 31747672 | TotalAssetsEOY |
| Total Liabilities BOY | 12394948 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 12223352 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 17526938 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 19524320 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE EXCELLENT HEALTHCARE, PROMOTE WELLNESS, AND EDUCATE PATIENTS, STAFF, AND THE COMMUNITY. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 41236843 | Expense |
| Revenue | 43221403 | Revenue |
| Description | RICHLAND MEMORIAL HOSPITAL, INC., D/B/A RICHLAND MEMORIAL HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF RICHLAND MEMORIAL HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. THE MISSION OF RMH IS TO SERVE OUR COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH THE COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, WE OFFER > FREE CARE > CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST; AND > HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT AND EDUCATE THE COMMUNITY. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, PROFESSIONAL EDUCATION PROGRAMS, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. DURING FISCAL YEAR 2012, RICHLAND MEMORIAL HOSPITAL RECORDED 19,003 PATIENT DAYS. RICHLAND MEMORIAL HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST. THE HOSPITAL ALSO PROVIDES CARE TO PERSONS COVERED BY COMMERCIAL INSURANCE AT BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, RICHLAND MEMORIAL HOSPITAL RECOGNIZES THESE AMOUNTS AS COSTS INCURRED IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. CHARITY CARE IS ALSO PROVIDED THROUGH THE HOSPITAL'S INTERNAL POLICY OFFERED IN FY 2012. RICHLAND MEMORIAL HOSPITAL ALSO OFFERS AND PARTICIPATES IN PROGRAMS THROUGHOUT THE COMMUNITY. THESE INCLUDE: 1. AMBULANCE COVERAGE 2. MEETINGS/CONFERENCE FACILITIES 3. SCHOLARSHIPS 4. SUPPORT OF COMMUNITY ORGANIZATIONS/EVENTS/ACTIVITIES: > AINAD SHRINE TEMPLE > AMATEUR SPORTS PROMOTION > ABASSADOR COMPANY > AMERICAN HEART ASSOCIATION > BIG BROTHERS BIG SISTERS > BLUE KNIGHT TIP OFF CLUB > BUILD COMMUNITY > BUSINESS AFTER HOURS EVENTS > CHRISTMAS TREE / SANTA PRETZEL - 100 > EAST RICHLAND POST PROM > EDWARDS COUNTY FAIR > ERHS TIGER BASEBALL > FIRST PRESBYTERIAN CHURCH > HOLIDAY TOUR OF HOMES > HOME / BUSINESS EXPO > HSEI MEMORY MILES > IL HIGH SCHOOL RODEO > IL SOCIETY OF HEALTHCARE > LAGALA BOARD MEETING AND EVENT > LINCOLNLAND DISTRICT > MUSCULAR DYSTROPHY ASSN > NATIONAL MULTIPLE SCHLEROSIS > NEWTON ROTARY CLUB > OCC FOUNDATION > OCC MUSIC DEPT > OLNEANS YEARBOOK > OLNEY ARTS COUNCIL > OLNEY CENTRAL COLLEGE > OLNEY CHAMBER OF COMMERCE > OLNEY CHRISTMAS PARADE > OLNEY CITY COUNCIL > OLNEY ELKS CLUB > OLNEY FFA > OLNEY LADY TIGERS SOFTBALL > OLNEY LITTLE LEAGUE > OLNEY TIGER FOOTBALL > OLNEY TIGERS ATHLETICS > OLNEY TIGERSHARKS SWIM TEAM > OLNEY WHITE SQUIRREL COUNT > OUTREACH MISSION > RCRC WHITE SQUIRREL TRIATHLON > RICHLAND COUNTY 4-H > RICHLAND COUNTY CTA > RICHLAND COUNTY DEVELOPMENT CORP > RICHLAND COUNTY FARM & FAIR WEEK > RICHLAND COUNTY RECREATION COUNCIL > RICHLAND COUNTY COUNTY WALK AND ROLL > RICHLAND COUNTY YOUTH SOCCER (RCYS) > RIDGWAY CHAPTER IL AUDUBON SOCIETY > RMH & COMMUNITY GOLF OUTINGS > ROTARY CLUB OF OLNEY > RUCKERS WHOLESALE > SHRINE CLUB > SOUTHEASTEN ILLINOIS CONCERT ASSN > ST JOSEPH SCHOOL > ST THOMAS GOLF OUTING > SWAN > U.S. RT 50 FOUR-LANE COALITION > WEST RICHLAND HIGH SCHOOL > WEST RICHLAND POST PROM > WEST RICHLAND PTO 5. WELLNESS EVENTS/COMMUNITY CLINICS/SUPPORT GROUPS/ OUTREACH/EDUCATION > BLOOD PRESSURE SCREENING CLINICS > DIABETIC EDUCATION DAY > HEALTHFEST > NATIONAL HOSPITAL WEEK CHOLESTEROL/PSA SCREENING CLINIC > OLNEY SENIOR EXPO > SUPPORT GROUPS/EDUCATION A. BREAST CANCER SUPPORT GROUP - TICKET FOR THE CURE B. BREAST HEALTH OUTREACH/EDUCATION - TICKET FOR THE CURE C. CPR CLASSES D. DIABETES SUPPORT GROUP E. FIRST AID CLASSES F. INFECTION CONTROL IN-SERVICES TO LOCAL SCHOOLS G. LIFE SMART FOR WOMEN EDUCATIONAL CLASSES H. PREPARED CHILDBIRTH CLASSES I. REGIONAL PSYCHIATRIC CENTER PATIENT SUPPORT GROUP 6. SPECIAL ASSISTANCE PROGRAMS > MAMMOGRAPHY ASSISTANCE - IL BREAST AND CERVICAL CANCER PROGRAM SERVICE PROVIDER (LITTLE EGYPT & EAST CENTRAL REGION) > MAMMOGRAPHY ASSISTANCE - SUSAN G. KOMEN FOR THE CURE GRANT | Description |
| Total Program Service Expense | 41236843 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | true | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 32 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 568 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MIKE STOVERINK | NamePerson |
| Telephone Number | 6183952131 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 EAST LOCUST ST | AddressLine1 |
| City | OLNEY | City |
| State | IL | State |
| ZIP Code | 62450 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| PAT BURKE | |||||||
| CHAIRMAN | 2.00 | X | 0 | 0 | 0 | ||
| ANDY SCHUETZ | |||||||
| VICE CHAIR | 8.00 | X | 0 | 0 | 0 | ||
| RICK BUSSARD | |||||||
| BOARD MEMBER | 0.20 | X | 0 | 0 | 0 | ||
| DENNIS GRAVES | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| HERBERT BROKHOF | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| HARRY GARRETT MD | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| JESSICA SLATER | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| DON HATTEN MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| BRAD HOUSTON MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DOUG TOMPSON | |||||||
| SEC/TREAS | 3.00 | X | 0 | 0 | 0 | ||
| KRISTI URFER | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| HERMAN ZUBER | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| ROB ANNISS | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DAVE ALLEN | |||||||
| CEO | 40.00 | 151195 | 0 | 10382 | X | ||
| MIKE STOVERINK | |||||||
| CFO | 40.00 | 107153 | 0 | 8432 | X | ||
| MARY WALLER | |||||||
| PHYSICIAN | 40.00 | 340018 | 0 | 11085 | X | ||
| NIRANAT DEJTIRANUKUL | |||||||
| ENT DOCTOR | 40.00 | 323333 | 0 | 15229 | X | ||
| PAUL SUTHERLAND | |||||||
| PHYSICIAN | 40.00 | 274127 | 0 | 13153 | X | ||
| JOHN WALL | |||||||
| CRNA | 40.00 | 193792 | 0 | 12332 | X | ||
| BILLY ROSS | |||||||
| CRNA | 40.00 | 193367 | 0 | 10385 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1582985 | TotalReportableCompFromOrg |
| Total Other Compensation | 80998 | TotalOtherCompensation |
| Number Individuals GT100 K | 13 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation | Address Line2AddressOfContractor/AddressUS/AddressLine2 |
|---|---|---|---|---|---|---|
| SODEXHO | ||||||
| 4880 PAYSPHERE CIRCLE | CHICAGO | IL | 60674 | FOOD SERVICE PR | 827596 | |
| DR ANTONIO RODRIGUEZ | ||||||
| 4988 N WHITEWATER RD | OLNEY | IL | 62450 | ER PHYSICIAN | 311538 | |
| DR DIRK V ROSENBERG | ||||||
| PO BOX 457 | OLNEY | IL | 62450 | ER PHYSICIAN | 261724 | |
| PHARMACY SYSTEMS INC | ||||||
| PO BOX 71-0716 | COLUMBUS | OH | 43217 | PHARMACY MANAGE | 220364 | |
| SAJJAN K NEMANI MD MRCP | ||||||
| 1054 ML KING DRIVE | CENTRALIA | IL | 62801 | SLEEP STUDIES | 190500 | SUITE 124 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Government Grants | 373905 | GovernmentGrants |
| All Other Contributions | 993853 | AllOtherContributions |
| Total Contributions | 1367758 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PAT REVENUE LESS MED/MEDC | Description |
| Total Revenue Column | 38963162 | TotalRevenueColumn |
| Related Or Exempt Function Income | 38963162 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 38963162 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 50615 | TotalRevenueColumn |
| Related Or Exempt Function Income | 50615 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| EHR MEANINGFUL USE INCENTIVE | 900099 | 1850951 | $1,850,951 |
| MISC. OTHER REVENUE | 900099 | 390627 | $390,627 |
| PROPERTY TAX | 900099 | 384177 | $384,177 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 214113 | TotalRevenueColumn |
| Exclusion | $214,113 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2839868 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 43221403 | TotalRevenueColumn |
| Related Or Exempt Function Income | 39013777 | RelatedOrExemptFunctionIncome |
| Exclusion | $2,839,868 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 261877 | Total |
| Program Services | 261877 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18527028 | Total |
| Program Services | 18527028 | ProgramServices |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 607785 | Total |
| Program Services | 607785 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4146528 | Total |
| Program Services | 4146528 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1301638 | Total |
| Program Services | 1301638 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63436 | Total |
| Program Services | 63436 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4482959 | Total |
| Program Services | 4482959 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 233826 | Total |
| Program Services | 233826 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3888774 | Total |
| Program Services | 3888774 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 590942 | Total |
| Program Services | 590942 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 142382 | Total |
| Program Services | 142382 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 97317 | Total |
| Program Services | 97317 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 336433 | Total |
| Program Services | 336433 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1802879 | Total |
| Program Services | 1802879 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 413822 | Total |
| Program Services | 413822 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| PURCHASE OF DRUGS | 1268466 | 1268466 |
| PROVIDER TAX ASSESSMENT | 1252657 | 1252657 |
| REPAIRS/MAINTENANCE | 1064313 | 1064313 |
| OTHER EXPENSES | 753781 | 753781 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41236843 | Total |
| Program Services | 41236843 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8605681 | BOY |
| EOY | 10308868 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5825912 | BOY |
| EOY | 6103436 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 433211 | BOY |
| EOY | 456385 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 988317 | BOY |
| EOY | 706659 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 42789228 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 29780341 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13199056 | BOY |
| EOY | 13008887 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 869709 | BOY |
| EOY | 1163437 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29921886 | BOY |
| EOY | 31747672 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4201860 | BOY |
| EOY | 4569726 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8193088 | BOY |
| EOY | 7653626 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12394948 | BOY |
| EOY | 12223352 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17327644 | BOY |
| EOY | 19312204 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 199294 | BOY |
| EOY | 212116 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17526938 | BOY |
| EOY | 19524320 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29921886 | BOY |
| EOY | 31747672 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1984560 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 12822 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disclosed Orgs Legal Control | false | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | false | DisclosedForCharitablePurposes |
| Written Policy Monitoring | false | WrittenPolicyMonitoring |
| Sect170h Requirements Satisfied | false | Sect170hRequirementsSatisfied |
| Solicited Assets For Sale | false | SolicitedAssetsForSale |
| Agent Trustee Etc | false | AgentTrusteeEtc |
| Included On FS | false | IncludedOnFS |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 39983 | OtherCostOrOtherBasis |
| Book Value | 39983 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 24206336 | OtherCostOrOtherBasis |
| Depreciation | 16176163 | Depreciation |
| Book Value | 8030173 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 510497 | OtherCostOrOtherBasis |
| Depreciation | 459692 | Depreciation |
| Book Value | 50805 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 18032412 | OtherCostOrOtherBasis |
| Depreciation | 13144486 | Depreciation |
| Book Value | 4887926 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 13008887 | TotalOfBookValueLandBuildings |
| Total Revenue | 43221403 | TotalRevenue |
| Total Expenses | 41236843 | TotalExpenses |
| Excess Or Deficit For Year | 1984560 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 1984560 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 43221403 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 43221403 | RevenueSubtotal |
| Total Revenue Per Form990 | 43221403 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 41236843 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 41236843 | ExpensesSubtotal |
| Total Expenses Per Form990 | 41236843 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | LIABILITY UNDER FIN 48 FOOTNOTE | Identifier |
| Return Reference | SCHEDULE D, PAGE 3, PART X | ReturnReference |
| Explanation | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM INCOME TAXES. THERE WERE NO UNCERTAIN TAX BENEFITS IDENTIFIED AND RECORDED AS A LIABILITY UPON THE ADOPTION OF ASC TOPIC 740-10-25 OR AT SEPTEMBER 30, 2012. AT SEPTEMBER 30, 2012, NO INTEREST OR PENALTIES WERE ATTRIBUTED TO THE HOSPITAL. TAX RETURNS FILED BY THE HOSPITAL ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. TAX RETURNS FILED BY THE HOSPITAL ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEARS ENDED SEPTEMBER 30, 2008 AND PRIOR. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1430000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1430000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03470 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8477623 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6555339 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1922284 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04660 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9907623 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6555339 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3352284 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08130 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 251000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 251000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00610 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4239233 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2319333 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1919900 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04660 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4490233 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2319333 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2170900 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05260 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14397856 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8874672 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5523184 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.13390 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $766,637 | BadDebtExpenseAmount |
| Amount Attributable To | 383319 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 11997949 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 16847800 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -4849851 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | 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 | RICHLAND MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 EAST LOCUST | AddressLine1 |
| City | OLNEY | City |
| State | IL | State |
| ZIP Code | 62450 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RICHLAND MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | false | CHNAConducted |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200.0 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 300.0 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Permit Other Actions | X | PermitOtherActions |
| Collection Activities | false | CollectionActivities |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | true | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 7 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (7 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| OUTPATIENT THERAPY | ||||
| 800 E LOCUST STREET | OLNEY | IL | 62450 | OUTPATIENT THERAPY |
| HOME HEALTH | ||||
| 800 E LOCUST STREET | OLNEY | IL | 62450 | HOME HEALTH AGENCY |
| RMH PROFESSIONAL SERVICES | ||||
| 1200 NORTH EAST STREET | OLNEY | IL | 62450 | PHYSICIAN PRACTICE (GENERAL SURGERY) |
| HOSPICE | ||||
| 800 E LOCUST STREET | OLNEY | IL | 62450 | HOSPICE SERVICES |
| RMH PROFESSIONAL SERVICES-ENT | ||||
| 800 E LOCUST STREET | OLNEY | IL | 62450 | PHYSICIAN PRACTICE (EAR, NOSE,THROAT) |
| RMH PROFESSIONAL SERVICES-UROLOGY | ||||
| 1200 NORTH EAST STREET | OLNEY | IL | 62450 | PHYSICIAN PRACTICE (UROLOGY) |
| RMH PROFESSIONAL SERVICES - PRIMARY | ||||
| 800 E LOCUST STREET | OLNEY | IL | 62450 | PRIMARY CARE PHYSICIANS |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SUBSIDIZED HEALTH SERVICES EXPLANATION | PART I LINE 7G | WE INCLUDED AS SUBSIDIZED HEALTH SERVICES672692 IN COSTS ATTRIBUTABLE TO PHYSICIAN CLINIC |
| COSTING METHODOLOGY EXPLANATION | PART I LINE 7 | WE USED A COSTTOCHARGE RATIO AS CALCULATED UTILIZING DATA FROM AN INTERNAL COST ACCOUNTING SYSTEM AND USING A METHODOLOGY CONSISTENT WITH SCEDULE H INSTRUCTIONS TO DETERMINE THE AMOUNTS ON LINES 7A AND 7B OF PART I OF SCHEDULE H WE USED ACTUAL COSTS AS REPORTED IN THE GENERAL LEDGER SYSTEM TO DETERMINE THE AMOUNTS ON LINES 7E AND 7I OF SCHEDULE H PART I SCHEDULE H PART I LINE 7G WAS DETERMINED USING BOTH ACTUAL AMOUNTS FROM THE GENERAL LEDGER AND A COSTTOCHARGE RATIO SPECIFIC TO EACH PROGRAM |
| BAD DEBT EXPENSE EXPLANATION | PART III LINE 4 | WE CALCULATED BAD DEBT EXPENSE AT COST USING A COSTTOCHARGE RATIO AS CALCULATED UTILIZING DATA FROM AN INTERNAL COST ACCOUNTING SYSTEM AND USING A METHODOLOGY CONSISTENT WITH SCEDULE H INSTRUCTIONS AFTER EXHAUSTING ALL COLLECTION PROCEDURES PATIENT ACCOUNTS ARE THEN WRITTEN OFF TO BAD DEBT EXPENSE WE ESTIMATE THAT 50 OF OUR PATIENT ACCOUNTS WRITTEN OFF TO BAD DEBT WOULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE BUT THE PATIENTS CHOSE NOT TO APPLY THE FOLLOWING IS THE FOOTNOTE RELATING TO BAD DEBT EXPENSE EXACTLY AS IT APPEARS IN THE FOOTNOTES TO OUR AUDITED FINANCIAL STATEMENTS THE HOSPITAL ALSO PROVIDES A SIGNIFICANT AMOUNT OF UNCOMPENSATED CARE FOR PATIENTS WHICH IS NOT INCLUDED ABOVE BUT IS REPORTED ON THE STATEMENT OF OPERATIONS AS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS MANY OF THOSE PATIENTS ARE UNINSURED OR UNDERINSURED BUT DID NOT APPLY FOR OR QUALIFY FOR CHARITY CARE DURING THE YEAR ENDED SEPTEMBER 30 2012 THE HOSPITAL REPORTED PROVISIONS FOR UNCOLLECTIBLE ACCOUNTS OF 2384563 |
| MEDICARE EXPLANATION | PART III LINE 8 | TOTAL TOTAL UNREIMBURSED REIMBURSEMENT COST COST PER MEDICARE COST REPORT 12023451 17383347 5359896 OTHER MEDICARE REVENUESCOSTS 25502 535547 510045 TOTAL MEDICARE SHORTFALL 11997949 16847800 4849851 THE HOSPITAL UTILIZED THE INTERNAL COST ACCOUNTING SYSTEM TO CALCULATE UNREIMBURSED MEDICARE COSTS SOME MEDICARE CHARGES NOT ASSOCIATED WITH ITEMS PAID ON THE COST REPORT THE COSTS ASSOCIATED WITH THOSE CHARGES AND OTHER COST PER THE HOSPITALS COST ACCOUNTING SYSTEM HAVE BEEN INCLUDED |
| COLLECTION PRACTICES EXPLANATION | PART III LINE 9B | RICHLAND MEMORIAL HOSPITAL RMH APPLIES ITS COLLECTION PRACTICES EQUALLY TO ALL PATIENTS BOTH CHARITY CARE ELIGIBLE AND NONCHARITY CARE PATIENTS THE PROCEDURES ARE AS FOLLOWS 1 WE WILL SEND 2 STATEMENTS AND 2 COLLECTION LETTERS IN A 28 DAY CYCLE WE WILL SEND STATEMENTS BASED UPON PATIENT PORTION OF 10 OR GREATER 2 THE PATIENTS ACCOUNT WILL AGE THROUGH THE STATEMENT PROCESS BEFORE BEING WRITTEN OFF TO BAD DEBT APRIVATE PAY ACCOUNTS WILL RECEIVE A STATEMENT WITHIN 9 DAYS OF THE DISCHARGE DATE BACCOUNTS WITH A PATIENT PORTION AFTER INSURANCE WILL BE ELIGIBLE TO RECEIVE A STATEMENT APPROXIMATELY 14 DAYS AFTER THE INSURANCE PAYMENT HAS BEEN POSTED C28 DAYS LATER THE PATIENT IS MAILED A THIRD STATEMENT D28 DAYS LATER THE PATIENT IS MAILED THE FIRST COLLECTION LETTER E28 DAYS LATER THE PATIENT IS MAILED THE FINAL COLLECTION LETTER FAPPROXIMATELY 15 DAYS LATER THE PATIENT IS WRITTEN OFF TO BAD DEBT 3 RMH WILL ATTEMPT TO CONTACT THE GUARANTOR VIA PHONE AFTER THEY RECEIVE THE FIRST STATEMENT ON BALANCES GREATER THAN 1000 4 RMH WILL ATTEMPT TO CONTACT THE GUARANTOR VIA PHONE AFTER THE SECOND STATEMENT ON BALANCES LESS THAN 1000 5 RMH WILL MAKE A SECOND ATTEMPT TO CONTACT THE GUARANTOR VIA PHONE IF PAYMENT OR CONTACT HAS NOT BEEN MADE USUALLY AROUND THE SAME TIME THE SECOND COLLECTION LETTER IS SENT 6 RMH WILL SEND 2 COLLECTION LETTERS TO THE PATIENT PATIENT HAS 15 DAYS AFTER THE FINAL LETTER TO PAY BEFORE BEING WRITTEN OFF TO BAD DEBT |
| NEEDS ASSESSMENT | PART VI | THE DETERMINATION OF CURRENT AND FUTURE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED ARE BASED ON THE FOLLOWING FACTORS EXISTENCE OR NONEXISTENCE OF SERVICES OPPORTUNITY SUPPLY DEMONSTRATED NEED REQUESTS FROM PATIENTS ANDOR COMBINED EFFORTS WITH OUTSIDE ENTITIES THAT WOULD HELP FILL A NEED OR STRENGTHEN A CURRENT SERVICE WE ARE CONSTANTLY COLLECTING DATA THAT WOULD HELP MAKE THESE DECISIONS AND OFTEN CONSULT WITH VARIOUS DEPARTMENTS WITHIN THE HOSPITAL INCLUDING NURSING INFORMATION TECHNOLOGY FINANCE AND PHYSICIANS THIS INFORMATION IS THEN REVIEWED AND THE HOSPITALS ADMINISTRATIVE TEAM WOULD INCORPORATE THE NEWLY IDENTIFIED HEALTH CARE NEEDS INTO THE STRATEGIC PLAN |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | PART VI | ALL PATIENT BILLING STATEMENTS INCLUDE A STATEMENT THAT MENTIONS CONTACTING THE HOSPITAL IF THEY WISH TO APPLY FOR FINANCIAL ASSISTANCE OR WOULD LIKE TO SET UP PAYMENTS ON THE ACCOUNT IF A PATIENT CONTACTS THE PATIENT FINANCIAL SERVICES DEPARTMENT ABOUT THE INABILITY TO PAY THEY ARE INFORMED OF THE AVAILABLE OPTIONS INCLUDING FINANCIAL ASSISTANCE MEDICARE AND MEDICAID APPLICATIONS THEY WILL ALSO EXPLAIN HOW THE PATIENT CAN APPLY FOR ASSISTANCE |
| COMMUNITY INFORMATION | PART VI | RICHLAND MEMORIAL HOSPITALS PRIMARY SERVICE AREA INCLUDES PORTIONS OF EIGHT SOUTHEASTERN ILLINOIS COUNTIES WITH A TOTAL PATIENT POPULATION OF ABOUT 60000 THERE ARE EIGHT COUNTIES WITHIN THE HOSPITALS PRIMARY SERVICE AREA RMH FURTHER EXTENDS HOME HEALTH AND HOSPICE SERVICES TO INDIVIDUALS LIVING IN FIVE ADDITIONAL COUNTIES WE PROVIDE SERVICES TO PATIENTS WITHOUT REGARD TO AGE SEX RACE COLOR NATIONAL ORIGIN RELIGIOUS CREED GENDER IDENTITY SEXUAL ORIENTATION DISABILITY INSURANCE COVERAGE OR ABILITY TO PAY THE POPULATION OF RICHLAND MEMORIAL HOSPITALS SERVICE AREA IS ECONOMICALLY DISADVANTAGED MAKING IT MORE DIFFICULT TO AFFORD HEALTHCARE FURTHERMORE THERE IS NO HEALTH DEPARTMENT IN RICHLAND COUNTY MAKING THE HOSPITAL THE PRIMARY SOURCE FOR HEALTHCARE SERVICES AND HEALTH EDUCATION ACCORDING TO THE 2011 UNITED STATES CENSUS THE MEDIAN HOUSEHOLD INCOME IN THE HOSPITALS SERVICE AREA FALLS WELL BELOW THE STATE MEDIAN OF 56576 WHERE RICHLAND COUNTYS MEDIAN INCOME IS 42305 THE ILLINOIS DEPARTMENT OF PUBLIC HEALTH CENTER FOR RURAL HEALTH INDICATES ON ITS WEB SITE THAT ALL OF THE COUNTIES IN THE HOSPITALS SERVICE AREA HAVE AT LEAST A PARTIAL FEDERAL HPSA DESIGNATION WITH THE LOWINCOME POPULATION BEING A PRIMARY CONCERN |
| RICHLAND MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 15E | PART V LINE 15E | OUTSOURCED TO A COLLECTION AGENCY |
| RICHLAND MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 19D | PART V LINE 19D | THE HOSPITAL CHARGES ALL PATIENTS THE SAME REGARDLESS OF FINANCIAL CLASS ANDOR ABILITY TO PAY |
| RICHLAND MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 21 | PART V LINE 21 | THE HOSPITAL CHARGES ALL PATIENTS THE SAME REGARDLESS OF FINANCIAL CLASS ANDOR ABILITY TO PAY |
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 | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg |
|---|---|---|---|
| DAVE ALLEN | |||
| 151195 | 6192 | 4190 | 161577 |
| MARY WALLER | |||
| 340018 | 10323 | 762 | 351103 |
| NIRANAT DEJTIRANUKUL | |||
| 323333 | 12800 | 2429 | 338562 |
| PAUL SUTHERLAND | |||
| 274127 | 5731 | 7422 | 287280 |
| JOHN WALL | |||
| 193792 | 7903 | 4429 | 206124 |
| BILLY ROSS | |||
| 193367 | 7837 | 2548 | 203752 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| RICK BUSSARD | |||
| INSURANCE AGENT | 771170 | INSURANCE PREMIUM | false |
| HERMAN ZUBER | |||
| FAMILY MEMBER | 39257 | REPORTABLE COMPENSA | false |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| FIRST ACCOMPLISHMENT DESCRIPTION | FORM 990, PAGE 2, PART III, LINE 4A | OFFER > FREE CARE > CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST; AND > HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT AND EDUCATE THE COMMUNITY. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, PROFESSIONAL EDUCATION PROGRAMS, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. DURING FISCAL YEAR 2012, RICHLAND MEMORIAL HOSPITAL RECORDED 19,003 PATIENT DAYS. RICHLAND MEMORIAL HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST. THE HOSPITAL ALSO PROVIDES CARE TO PERSONS COVERED BY COMMERCIAL INSURANCE AT BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, RICHLAND MEMORIAL HOSPITAL RECOGNIZES THESE AMOUNTS AS COSTS INCURRED IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. CHARITY CARE IS ALSO PROVIDED THROUGH THE HOSPITAL'S INTERNAL POLICY OFFERED IN FY 2012. RICHLAND MEMORIAL HOSPITAL ALSO OFFERS AND PARTICIPATES IN PROGRAMS THROUGHOUT THE COMMUNITY. THESE INCLUDE: 1. AMBULANCE COVERAGE 2. MEETINGS/CONFERENCE FACILITIES 3. SCHOLARSHIPS 4. SUPPORT OF COMMUNITY ORGANIZATIONS/EVENTS/ACTIVITIES: > AINAD SHRINE TEMPLE > AMATEUR SPORTS PROMOTION > ABASSADOR COMPANY > AMERICAN HEART ASSOCIATION > BIG BROTHERS BIG SISTERS > BLUE KNIGHT TIP OFF CLUB > BUILD COMMUNITY > BUSINESS AFTER HOURS EVENTS > CHRISTMAS TREE / SANTA PRETZEL - 100 > EAST RICHLAND POST PROM > EDWARDS COUNTY FAIR > ERHS TIGER BASEBALL > FIRST PRESBYTERIAN CHURCH > HOLIDAY TOUR OF HOMES > HOME / BUSINESS EXPO > HSEI MEMORY MILES > IL HIGH SCHOOL RODEO > IL SOCIETY OF HEALTHCARE > LAGALA BOARD MEETING AND EVENT > LINCOLNLAND DISTRICT > MUSCULAR DYSTROPHY ASSN > NATIONAL MULTIPLE SCHLEROSIS > NEWTON ROTARY CLUB > OCC FOUNDATION > OCC MUSIC DEPT > OLNEANS YEARBOOK > OLNEY ARTS COUNCIL > OLNEY CENTRAL COLLEGE > OLNEY CHAMBER OF COMMERCE > OLNEY CHRISTMAS PARADE > OLNEY CITY COUNCIL > OLNEY ELKS CLUB > OLNEY FFA > OLNEY LADY TIGERS SOFTBALL > OLNEY LITTLE LEAGUE > OLNEY TIGER FOOTBALL > OLNEY TIGERS ATHLETICS > OLNEY TIGERSHARKS SWIM TEAM > OLNEY WHITE SQUIRREL COUNT > OUTREACH MISSION > RCRC WHITE SQUIRREL TRIATHLON > RICHLAND COUNTY 4-H > RICHLAND COUNTY CTA > RICHLAND COUNTY DEVELOPMENT CORP > RICHLAND COUNTY FARM & FAIR WEEK > RICHLAND COUNTY RECREATION COUNCIL > RICHLAND COUNTY COUNTY WALK AND ROLL > RICHLAND COUNTY YOUTH SOCCER (RCYS) > RIDGWAY CHAPTER IL AUDUBON SOCIETY > RMH & COMMUNITY GOLF OUTINGS > ROTARY CLUB OF OLNEY > RUCKERS WHOLESALE > SHRINE CLUB > SOUTHEASTEN ILLINOIS CONCERT ASSN > ST JOSEPH SCHOOL > ST THOMAS GOLF OUTING > SWAN > U.S. RT 50 FOUR-LANE COALITION > WEST RICHLAND HIGH SCHOOL > WEST RICHLAND POST PROM > WEST RICHLAND PTO 5. WELLNESS EVENTS/COMMUNITY CLINICS/SUPPORT GROUPS/ OUTREACH/EDUCATION > BLOOD PRESSURE SCREENING CLINICS > DIABETIC EDUCATION DAY > HEALTHFEST > NATIONAL HOSPITAL WEEK CHOLESTEROL/PSA SCREENING CLINIC > OLNEY SENIOR EXPO > SUPPORT GROUPS/EDUCATION A. BREAST CANCER SUPPORT GROUP - TICKET FOR THE CURE B. BREAST HEALTH OUTREACH/EDUCATION - TICKET FOR THE CURE C. CPR CLASSES D. DIABETES SUPPORT GROUP E. FIRST AID CLASSES F. INFECTION CONTROL IN-SERVICES TO LOCAL SCHOOLS G. LIFE SMART FOR WOMEN EDUCATIONAL CLASSES H. PREPARED CHILDBIRTH CLASSES I. REGIONAL PSYCHIATRIC CENTER PATIENT SUPPORT GROUP 6. SPECIAL ASSISTANCE PROGRAMS > MAMMOGRAPHY ASSISTANCE - IL BREAST AND CERVICAL CANCER PROGRAM SERVICE PROVIDER (LITTLE EGYPT & EAST CENTRAL REGION) > MAMMOGRAPHY ASSISTANCE - SUSAN G. KOMEN FOR THE CURE GRANT |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | 990 IS REVIEWED BY ALL BOARD MEMBERS DURING SCHEDULED MEETINGS BEFORE IT IS FILED. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | 1. ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY BOARD MEMBER SHOULD BE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD BY THE BOARD MEMBER WHO HAS THE CONFLICT, AND MADE A MATTER OF RECORD, THROUGH THE BOARD'S ANNUAL FILING OF CONFLICT OF INTEREST STATEMENTS OR WHEN THE INTERET BECOMES A MATTER OF BOARD ACTION. 2. ANY BOARD MEMBER HAVING A DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHOULD NOT VOTE OR USE HIS/HER PERSONAL INFLUENCE ON THE MATTER, AND HE/SHE SHOULD NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING, EVEN WHERE PERMITTED BY LAW. THE MINUTES OF THE MEETING SHOULD REFLECT THAT A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING, AND THE QUORUM SITUATION. 3. THE FOREGOING REQUIREMENTS SHOULD NOT BE CONSTRUED AS PREVENTING THE BOARD MEMBER FROM ANSWERING PERTINENT QUESTIONS OF OTHER BOARD MEMBERS, SINCE HIS/HER KNOWLEDGE MAY BE OF GREAT ASSISTANCE. HOWEVER, THE MEMBER WITH A CONFLICT MUST ABSTAIN FROM MAKING MOTIONS, PARTICIPATING IN RELEVANT DELIBERATIOINS, VOTING, EXECUTING AGREEMENTS, ATTEMPTING TO INFLUENCE OTHERS VOTES, OR TAKING ANY SIMILAR DIRECT ACTION ON BEHALF OF THE CORPORATION WHERE THE CONFLICT OF INTEREST MIGHT PERTAIN. 4. ALL MEMBERS OF THE BOARD (INCLUDING EX-OFFICIO MEMBERS) ARE REQUIRED TO COMPLETE AND RETURN THE CONFLICT OF INTEREST DISCLOSURE STATEMENT NO LATER THAN NOVEMBER 30TH OF EACH YEAR OR WITHIN 30 DAYS OF THE CREATION OR OCCURRENCE OF ANY NEW CONFLICT. MEMBER(S) WHO DO NOT RETURN THE CONFLICT OF INTEREST STATEMENT WILL BE ADDRESSED IN ACCORDANCE WITH THE BYLAWS. 5. RESPONSES MAY BE COMPILED INTO PACKETS FOR DISTRIBUTION AND DISCUSSION ANNUALLY - AT THE NEXT BOARD MEETING FOLLOWING THE DUE DATE SEMI-ANNUALLY - SIX MONTHS FOLLOWING THE INITIAL REVIEW; AND, AS ANY NEW CONFLICT IS IDENTIFIED. 6. THE POLICY ON CONFLICT OF INTEREST WILL BE DISCUSSED WITH CANDIDATES FOR BOARD POSITIONS DURING THEIR INTERVIEW WITH THE NOMINATING COMMITTEE. THE IMPORATANCE OF AVOIDING CONFLICT OF INTEREST SITUATIONS WILL BE EMPHASIZED. 7. WHEN A CONFLICT OF INTEREST SITUATION IS IDENTIFIED: THE INDIVIDUAL BOARD MEMBER HAS THE PRIMARY RESPONSIBILITY TO BRING A POTENTIAL OR ACTUAL CONFLICT OF INTEREST SITUATION TO THE ATTENTION OF THE BOARD A CONFLICT OF INTEREST SITUATION MAY ALSO COME TO THE ATTENTION OF THE BOARD DUE TO THE CONCERNS OF A BOARD MEMBER WHO MAY NOT BE INVOLVED IN THE SITUATION. THAT BOARD MEMBER SHOULD NOTIFY THE CHAIRPERSON OF THE CONFLICT OF INTEREST CONCERN AND THE BOARD CHAIRPERSON SHOULD BRING THE SITUATION TO THE ATTENTION OF THE FULL BOARD. REGARDLESS OF THE METHOD BY WHICH THE CONFLICT IS BROUGHT UP, THERE SHOULD BE FULL AND OPEN DISCUSSION BY BOARD MEMBERS OF THE POTENTIAL OR ACTUAL CONFLICT OF INTEREST SITUATION. THE FURTHER PARTICIPATION OF THE BOARD MEMBER IN THE DISCUSSION SHOULD BE AGREED UPON AND APPROVED BY THE BOARD. 8. AS A RESULT OF DISCUSSIONS ON CONFLICT OF INTEREST SITUATIONS, THERE MAY BE CONSIDERATIONS FOR A BOARD MEMBER'S RESIGNATION. THE BOARD MEMBER MAY WISH TO RESIGN TO AVOID A FUTURE CONFLICT OF INTEREST SITUATION DUE TO A DESIRE TO BID ON A PARTICULAR BOARD PROJECT OR TO AVOID A FURTHER CONFLICT OF INTEREST CONCERN. IN THE EVENT THAT THE BOARD MEMBER DOES NOT LEAVE AND A CONFLICT OF INTEREST SITUATION EXISTS, IN ACCORDANCE WITH BYLAWS SECTION III.11 "REMOVAL OF DIRECTORS" THE BOARD MAY ASK THE BOARD MEMBER TO RESIGN IF NINE OF THE THIRTEEN VOTING MEMBERS VOTE AFFIRMATIVELY ON A MOTION OF REMOVAL. 9. THIS POLICY WILL BE REVIEWED ANNUALLY FOR THE INFORMATION AND GUIDANCE OF BOARD MEMBERS. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | THE HR DEPARTMENT USES AN EXECUTIVE SURVEY FROM THE ILLINOIS HOSPITAL ASSOCIATION (IHA) TO GET A STARTING POINT FOR THE SALARY. THEN THEY FACTOR IN YEARS OF EXPERIENCE AND NEGOTIATIONS ON BOTH ENDS. ULTIMATELY THE BOARD DETERMINES THE SALARY AND THE CONTRACT IS SET ANNUALLY. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | SALARIES ARE BASED OFF OF THE SOUTHERN ILLINOIS HUMAN RESOURCE SURVEY. YEARS OF EXPERIENCE AND NEGOTIATION ARE FACTORS THAT ARE CONSIDERED. ONCE A SALARY IS SET A % INCREASE IS GIVEN ANNUALLY DETERMINED BY THE CEO. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | RICHLAND MEMORIAL HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AFTER A REQUEST IS MADE TO ADMINISTRATION. |
| OTHER CHANGES IN NET ASSETS EXPLANATION | FORM 990, PART XI, LINE 5 | CHANGE IN THE INTEREST IN NET ASSETS OF RICHLAND MEMORIAL FOUNDATION |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RMH FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 EAST LOCUST STREET | AddressLine1 |
| City | OLNEY | City |
| State | IL | State |
| ZIP Code | 62450 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 371178290 | EIN |
| Primary Activities | FUNDRAISIN | PrimaryActivities |
| Exempt Code Section | 501C3 | ExemptCodeSection |
| Public Charity Status | 9 | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | false | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RMH FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | R | TransactionType |
| Amount Involved | 20000 | AmountInvolved |
| Method Of Amt Determination | GAAP | MethodOfAmtDetermination |
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