MIDWEST MEDICAL CENTER: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
MIDWEST MEDICAL CENTER (EIN 20-4560540)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-13
IRS object ID
201312259349301251
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-13T09:26:16-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN390758449EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1WIPFLI LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line13703 OAKWOOD HILLS PARKWAYAddressLine1
CityEAU CLAIRECity
StateWIState
ZIP Code54701ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN204560540EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MIDWEST MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMIDWNameControl
Phone8157771340Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1ONE MEDICAL CENTER DRIVEAddressLine1
CityGALENACity
StateILState
ZIP Code61036ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTRACY BAUERName
TitleCEOTitle
Phone8157771340Phone
Date Signed2013-08-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NamePAUL M TRACZEK CPAName
PTINP01368830PTIN
Phone7158323407Phone
Date Prepared2013-08-13DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTRACY BAUERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1ONE MEDICAL CENTER DRIVEAddressLine1
CityGALENACity
StateILState
ZIP Code61036ZIPCode
FieldValueIRS element (for citing)
Gross Receipts18896755GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.MIDWESTMEDICALCENTER.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2006YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HEALTHCARE SERVICES TO THE RESIDENTS OF THE CITY OF GALENA, ILLINOIS AND THE SURROUNDING AREA REGARDLESS OF A PATIENT'S ABILITY TO PAY.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees226TotalNbrEmployees
Total Nbr Volunteers10TotalNbrVolunteers
Total Gross UBI28619TotalGrossUBI
Net Unrelated Business Txbl Income-9690NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year46282ContributionsGrantsPriorYear
Contributions Grants Current Year141373ContributionsGrantsCurrentYear
Program Service Revenue Prior Year16616417ProgramServiceRevenuePriorYear
Program Service Revenue CY18561798ProgramServiceRevenueCY
Investment Income Prior Year104222InvestmentIncomePriorYear
Investment Income Current Year168942InvestmentIncomeCurrentYear
Other Revenue Prior Year-67469OtherRevenuePriorYear
Other Revenue Current Year-54585OtherRevenueCurrentYear
Total Revenue Prior Year16699452TotalRevenuePriorYear
Total Revenue Current Year18817528TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year28543GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY8523GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6902999SalariesEtcPriorYear
Salaries Etc Current Year7830686SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year11683326OtherExpensePriorYear
Other Expenses Current Year12530635OtherExpensesCurrentYear
Total Expenses Prior Year18614868TotalExpensesPriorYear
Total Expenses Current Year20369844TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-1915416RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1552316RevenuesLessExpensesCY
Total Assets BOY48041559TotalAssetsBOY
Total Assets EOY47106686TotalAssetsEOY
Total Liabilities BOY49548167TotalLiabilitiesBOY
Total Liabilities EOY50165610TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-1506608NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-3058924NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionMIDWEST MEDICAL CENTER, INCLUDING THE GALENA-STAUSS SENIOR CARE COMMUNITY, WILL PROVIDE TO THE MEMBERS OF THE COMMUNITY CARING, COMPETENT, AND COST EFFECTIVE HEALTHCARE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense13034413Expense
Grants8523Grants
Revenue13727659Revenue
DescriptionMIDWEST MEDICAL CENTER OWNS AND OPERATES A 25-BED CRITICAL ACCESS HOSPITAL, AND LEADS IN THE DELIVERY OF HEALTHCARE SERVICES TO ITS REGION WITH OVER 200 ASSOCIATES, INCLUDING 17 PHYSICIANS AND ONE MID-LEVEL PRACTITIONER, WHICH COORDINATE PATIENT CARE AS AN INTEGRATED UNIT. THE HOSPITAL AND ITS ASSOCIATES WORK SEAMLESSLY TO MEET THE NEEDS OF THE COMMUNITIES THEY SERVE. THE ACCOMPLISHMENTS WHICH FOLLOW ARE ATTRIBUTABLE TO THE HOSPITAL AND ALL OF ITS DEPARTMENTS AS A WHOLE.REQUIREMENTS OF THE IRS COMMUNITY BENEFIT STANDARD FOR TAX-EXEMPT ORGANIZATIONS ARE A KEY COMPONENT TO THE HOSPITAL'S LARGER CHARITABLE MISSION OF IMPROVING HEALTH AND QUALITY OF LIFE. SPECIFICALLLY, THE ORGANIZATION IS GOVERNED BY AN INDEPENDENT BOARD OF DIRECTORS, WHICH INCLUDES COMMUNITY LEADERS, CONSUMER REPRESENTATIVES, AND BUSINESS AND CLINICAL HEALTHCARE EXPERTS. THE BOARD OF DIRECTORS IS COMMITTED TO ACTING WITH THE HIGHEST INTEGRITY AND HAS BEEN PROACTIVELY EVALUATING OPPORTUNITIES TO VOLUNTARILY ADOPT GOVERNANCE BEST PRACTICES TO ENSURE THE HOSPITAL CONTINUES TO OPERATE SOLELY FOR THE BENEFIT OF THE COMMUNITY. DURING THE YEAR, THE BOARD WORKED WITH MANAGEMENT TO OVERSEE CRITICAL FUNCTIONS OF THE ORGANIZATION. FOR EXAMPLE:-THE COMPLIANCE COMMITTEE OF THE BOARD WAS ASSIGNED RESPONSIBILITY FOR OVERSIGHT OF THE CORPORATE COMPLIANCE PLAN AND FOR OVERSIGHT OF DEFINED COMPONENTS OF THE HOSPITAL'S INTERNAL CONTROL FUNCTIONS.-POLICIES CURRENTLY EXIST THAT REGULATE DOCUMENT RETENTION/DESTRUCTION AND WHISTLEBLOWER PROTECTION.-POLICIES ON CONFIDENTIALITY OF PATIENT AND CORPORATE INFORMATION ARE REVIEWED ANNUALLY AS A COMPONENT OF MANDATORY EDUCATION, AND A CONFIDENTIALITY STATEMENT IS SIGNED ANNUALLY BY ALL EMPLOYEES AND BOARD MEMBERS.-THE HOSPITAL'S CODE OF ETHICS/CODE OF CONDUCT IS PUBLISHED IN THE EMPLOYEE AND PHYSICIAN HANDBOOKS AND INCLUDED IN THE GENERAL ORIENTATION OF ALL NEW EMPLOYEES AND VOLUNTEERS.THE HOSPITAL ALSO MAKES MEDICAL CARE ACCESSIBLE TO THE ENTIRE REGION IT SERVES. THE HOSPITAL OPERATES A FULL-TIME EMERGENCY ROOM AND PROVIDES EMERGENCY CARE REGARDLESS OF ABILITY TO PAY. THE HOSPITAL HAD OVER 3,900 EMERGENCY CENTER VISITS DURING FISCAL YEAR 2012. THE HOSPITAL PROVIDES CLINICAL AND ANCILLARY SERVICES REQUIRED TO SUPPORT THE EMERGENCY CENTER INCLUDING DIAGNOSTIC TESTING SUCH AS LABORATORY, RADIOLOGY, CT SCANNING, AND MRI SCANNING SERVICES. FULL-TIME ON-SITE EMERGENCY MEDICAL PHYSICIANS ARE PROVIDED THROUGH AN ARRANGEMENT WITH THE UNIVERSITY OF ILLINOIS-CHICAGO PHYSICIANS.IN ADDITION, MIDWEST MEDICAL CENTER PROVIDES NON-EMERGENCY SERVICES TO THE REGION IT SERVES. IT MAKES THESE SERVICES ACCESSIBLE TO THE REGION THROUGH PARTICIPATION IN GOVENMENT PROGRAMS LIKE MEDICARE AND MEDICAID AND BY OFFERING ASSISTANCE THROUGH THE HOSPITAL'S CHARITY CARE PROGRAM.THE HOSPITAL'S CHARITY CARE POLICY PROVIDES DISCOUNTED AND FREE SERVICES TO PATIENTS WHO LACK THE RESOURCES TO BE FULLY RESPONSIBLE FOR THE HEALTH CARE THEY RECEIVE. THE HOSPITAL'S CHARITY CARE POLICY IS DESIGNED TO ENSURE THAT THE ENTIRE REGION IS SERVED BY THE HOSPITAL AND HAS ACCESS TO NEEDED HEALTHCARE SERVICES. THE HOSPITAL'S BOARD OF DIRECTORS OVERSEES THE SERVICES DELIVERED UNDER THE HOSPITAL'S CHARITY CARE POLICY, INCLUDING ASSESSING HEALTH NEEDS OF THE REGION, APPROVING ELIGIBILITY CRITERIA, AND MONITORING THE EFFECTIVENESS OF THE PROGRAM IN PROVIDING REGIONAL ACCESS TO MEDICAL CARE.ELIGIBILITY FOR DISCOUNTED OR FREE SERVICES UNDER THE CHARITY CARE POLICY IS BASED ON INCOME LEVELS AND FAMILY SIZE. GENERALLY, INDIVIDUALS EARNING INCOME OF UP TO 300% OF THE FEDERAL POVERTY INCOME GUIDELINES ARE ELIGIBLE FOR VARYING LEVELS OF DISCOUNTS, INCLUDING FULL DISCOUNTS FOR CERTAIN INCOME LEVELS. IN ADDITION, AN AUTOMATIC DISCOUNT OF CHARGES IS PROVIDED TO ANY PATIENT THAT IS DETERMINED TO NOT HAVE INSURANCE OF ANY TYPE. APPLICATIONS FOR COVERAGE UNDER THE PROGRAM MAY BE OBTAINED AT ANY DESIGNATED HOSPITAL PATIENT REGISTRATION AREA OR BY CALLING THE HOSPITAL'S BUSINESS OFFICE.THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CARE PROVIDED UNDER THE CHARITY CARE PROGRAM. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. THE HOSPITAL REDUCED CHARGES TO PATIENTS UNDER THE CHARITY CARE PROGRAM FOR THE YEAR ENDED 2012 BY APPROXIMATELY $100,550. (SEE ADDITIONAL INFORMATION REGARDING THE COST OF PROVIDING CHARITY CARE IN SCHEDULE H TO THE FORM 990.)THE HOSPITAL TAKES ITS MISSION TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE PEOPLE IT SERVES A STEP FURTHER BY REACHING OUT TO MEET THE BROAD HEALTH NEEDS OF THE REGION IT SERVES. THE HOSPITAL STRIVES TO IDENTIFY THE NEEDS OF THE REGION BEYOND BASIC HEALTHCARE, AND THEN RESPONDS TO THEM BY AIMING TO MAKE A POSITIVE, LIFE-ENHANCING DIFFERENCE IN THE REGION. THE HOSPITAL TAKES A STRATEGIC, REGIONAL NEEDS BASED APPROACH TO DELIVERING BENEFITS TO THE REGION. THE HOSPITAL HAS RESPONSIBILITY FOR LEADING THE ORGANIZATION TO ACHIEVE THESE OBJECTIVES:1. COLLABORATE WITH COMMUNITIES TO IDENTIFY UNMET COMMUNITY HEALTH NEEDS AND UNDERSERVED POPULATIONS.2. ADDRESS UNDERSERVED POPULATIONS AND UNMET NEEDS.3. IMPROVE THE HEALTH OF THE COMMUNITIES.THIS POSITION LINKS ALL COMMUNITY BENEFITS ACTIVITIES UNDER ONE MANAGEMENT UMBRELLA WITH A CONSISTENT CONTACT POINT. ORGANIZATIONAL FOCUS ON COMMUNITY BENEFIT HAS BEEN ELEVATED BY STRENGTHENING INFRASTRUCTURE TO SUPPORT AND COMMUNICATE COMMUNITY BENEFIT WORK.THE HOSPITAL DEMONSTRATES ITS COMMITMENT TO PROVIDING COMMUNITY BENEFIT THROUGH THE FOLLOWING SPECIFIC ACCOMPLISHMENTS:THE ORGANIZATION IS A NON-PROFIT CORPORATION PROVIDING HEALTHCARE AND RESIDENTIAL SERVICES IN GALENA, ILLINOIS AND NEIGHBORING COMMUNITIES. ALL OF THESE SERVICES ARE OFFERED UNDER THE MISSION OF THE ORGANIZATION, WHICH STATES THAT "MIDWEST MEDICAL CENTER, INCLUDING THE GALENA-STAUSS SENIOR CARE COMMUNITY, WILL PROVIDE TO THE MEMBERS OF THE COMMUNITY CARING, COMPETENT, AND COST EFFECTIVE HEALTHCARE." IN FISCAL YEAR 2012 THE HOSPITAL PROVIDED 528 ACUTE INPATIENT DAYS, 1,351 SWING BED DAYS, 3,939 EMERGENCY ROOM VISITS, 6,000 RADIOLOGY SERVICES, 96,652 LABORATORY TESTS, 9,142 PHYSICAL THERAPY TREATMENTS, AND 292 SURGICAL PROCEDURES AMONG MANY OF THE PATIENT SERVICES PROVIDED DURING THE YEAR.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense3113582Expense
Revenue3575771Revenue
DescriptionMIDWEST MEDICAL CENTER RECOGNIZES THAT THE AGING AND DISABLED POPULATION OF PATIENTS ARE OFTEN AN UNDERSERVED DEMOGRAPHIC OF THE POPULATION AND TO MEET THE HEALTHCARE NEEDS OF THESE PATIENTS THE ORGANIZATION OPERATES THE GALENA-STAUSS SENIOR CARE COMMUNITY. THIS SENIOR CARE CAMPUS PROVIDES SENIOR CARE SERVICES THROUGH ITS 57-BED LONG-TERM CARE FACILITY, AN ASSISTED LIVING FACILITY, AS WELL AS ADULT DAY CARE SERVICES. THE SENIOR CARE CAMPUS PROVIDED 18,180 DAYS OF SKILLED NURSING AND INTERMEDIATE NURSING HOME CARE DAYS IN ADDITION TO THE ASSISTED LIVING AND ADULT DAY CARE SERVICES. THE SENIOR CARE CAMPUS OFFERS SKILLED NURSING TO RESIDENTS AND PATIENTS IN BOTH SHORT TERM REHABILITATION PROGRAMS AND LONG-TERM CARE RESIDENT PROGRAMS. SOME OF THE SPECIALIZED CARE SERVICES OFFERED INCLUDE IV THERAPY, WOUND CARE, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH THERAPY AMONG MANY OF THE CARE PROGRAMS PROVIDED. THE SENIOR CARE CAMPUS OPERATES IN CONJUNCTION WITH THE MIDWEST MEDICAL CENTER HOSPITAL TO PROVIDE A SMOOTH TRANSITION FOR PATIENTS NEEDING EXTENDED REHABILITATION OR LONG-TERM CARE SERVICES. THE COORDINATION OF FACILITIES ALSO ALLOWS THE ORGANIZATION TO SHARE MANY DEPARTMENTS AND SERVICES IN MIDWEST MEDICAL CENTER'S CONTINUED EFFORT TO PROVIDE HIGH QUALITY AND LOW COST CARE TO THE COMMUNITY.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense2559044Expense
Revenue1229749Revenue
DescriptionMIDWEST MEDICAL CENTER ALSO OPERATES A PHYSICIAN CLINIC KNOWN AS THE MIDWEST HEALTH CLINIC. A TOTAL OF 9,624 CLINIC VISITS WERE PROVIDED DURING FISCAL YEAR 2012. THE CARE IN THE MIDWEST HEALTH CLINIC IS COORDINATED WITH THE CARE OF MIDWEST MEDICAL CENTER'S HOSPITAL IN AN EFFORT TO CONTINUE TO PROVIDE LOW COST AND HIGH QUALITY PATIENT CARE FOR THE RESIDENTS OF GALENA, ILLINOIS AND THE SURROUNDING AREAS. THE HEALTH CLINIC OPERATES AS A PROVIDER-BASED RURAL HEALTH CLINIC TO MIDWEST MEDICAL CENTER'S HOSPITAL AND THE PRACTICE IS MADE UP OF THREE FAMILY PRACTICE PHYSICIANS, AN INTERNAL MEDICINE PHYSICIAN, AND ONE MID-LEVEL PRACTITIONER. ADDITIONAL SERVICES ARE ALSO PROVIDED IN THE CLINIC BY OUTREACH DOCTORS THAT PROVIDE SERVICES ON A LIMITED BASIS IN THE AREAS OF ORTHOPEDIC SURGERY, GENERAL SURGERY, PODIATRY, AND PLASTIC SURGERY.THE CLINIC PROVIDERS ALSO ENGAGE IN MANY ACTIVITIES WHICH PROMOTE THE WELL-BEING OF THE COMMUNITY AND PROVIDE HEALTH EDUCATION TO THE COMMUNITY. AN EXAMPLE OF THESE SERVICES IS DR. WELLS, WHO IS ON STAFF AT THE UNIVERSITY OF ILLINOIS ROCKFORD MEDICAL SCHOOL AND PROVIDES EDUCATIONAL EXPERIENCES AND TRAINING TO MEDICAL STUDENTS AT THE MIDWEST HEALTH CLINIC FOR THOSE STUDENTS INTERESTED IN LEARNING ABOUT RURAL MEDICINE. ANOTHER EXAMPLE IS DR. MATT GULLONE, WHO SPECIALIZES IN SPORTS MEDICINE AND PROVIDES FREE CARE TO LOCAL ATHLETES DURING SPORTING EVENTS. DR. BETH GULLONE AND PEG DITTMAR, ANP, ALSO PROVIDE BREAST CANCER EDUCATION TO SEVERAL GROUPS WITHIN JO DAVIESS COUNTY.Description
FieldValueIRS element (for citing)
Total Program Service Expense18707039TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest1ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109637NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees226NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1TRACY BAUERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8157771340TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1ONE MEDICAL CENTER DRIVEAddressLine1
CityGALENACity
StateILState
ZIP Code61036ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
JOHN COOKE
BOARD MEMBER (THROUGH 12/31/11)2.00X000
CAROL SOAT
BOARD MEMBER (EFFECTIVE 1/1/12)2.00X000
CHERYL FARRUGGIA
VICE CHAIR2.00X000X
DALE HENZE
BOARD MEMBER2.00X000
HELEN KILGORE
BOARD MEMBER2.00X000
BOB MILLER
SECRETARY2.00X000X
BILL MORDEN
TREASURER2.00X000X
FRANK WAITES
BOARD MEMBER2.00X000
VINCE TOEPFER
BOARD MEMBER2.00X000
CAROL WRABL
BOARD MEMBER2.00X000
ROY CLINGMAN
BOARD MEMBER2.00X000
MARY ROONEY-SHEAHEN RN
CEO (THROUGH 6/30/11)/CHAIR28.00X11523304002X
TRACY BAUER
CEO (EFFECTIVE 7/1/11)50.00142249018098X
JENNIFER STEINES
CONTROLLER (EFFECTIVE 7/11/11)50.004084703102X
DEBRA HOPPMAN
CNO50.0011885306221X
MICHAEL WELLS MD
PHYSICIAN36.00173042019114X
ELIZABETH GULLONE MD
PHYSICIAN36.00159709015822X
MATTHEW GULLONE MD
PHYSICIAN36.00188603014562X
DEBBIE CIHAK MD
PHYSICIAN40.0010764806021X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1046184TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation86942TotalOtherCompensation
Number Individuals GT100 K6NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MICHAEL GREEN MD
1340 W NEWPORTCHICAGOIL60657ER PHYSICIAN COVERAGE206626
BIKRAM DHILLON MD
432 JASON COURTSCHAUMBURGIL60173ER PHYSICIAN COVERAGE186113
JOSEPH COLLA MD
41 EAST 8TH STREET APT 3304CHICAGOIL60605ER PHYSICIAN COVERAGE178855
RALPH LOSEY MD
207 SOUTH PROSPECT STREETGALENAIL61036ER PHYSICIAN COVERAGE137145
ELIZABETH RASPANTI MD
721 PATRICK RDGASTONIANC28056ER PHYSICIAN COVERAGE112995
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Fundraising Events150FundraisingEvents
Government Grants44790GovernmentGrants
All Other Contributions96433AllOtherContributions
Total Contributions141373TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
HOSPITAL PATIENT REVEN6219901337774613377746
SENIOR CARE REVENUE62300035757713575771
CLINIC REVENUE6211101258368122974928619
CAFETERIA REVENUE621990227684227684
FITNESS CENTER REVENUE621990122229122229
FieldValueIRS element (for citing)
Total Program Service Revenue18561798TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column100242TotalRevenueColumn
Exclusion$100,242ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real1046Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real69087Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-68041Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-68041TotalRevenueColumn
Exclusion-$68,041ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other68700Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other68700Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column68700TotalRevenueColumn
Exclusion$68,700ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events23596GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events150CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses10140FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column13456TotalRevenueColumn
Exclusion$13,456ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column18817528TotalRevenueColumn
Related Or Exempt Function Income18533179RelatedOrExemptFunctionIncome
Unrelated Business Revenue28619UnrelatedBusinessRevenue
Exclusion$114,357ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total8523Total
Program Services8523ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total330691Total
Management And General330691ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total6101270Total
Program Services5862703ProgramServices
Management And General238567ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total164638Total
Program Services158201ProgramServices
Management And General6437ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total800098Total
Program Services768814ProgramServices
Management And General31284ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total433989Total
Program Services399825ProgramServices
Management And General34164ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1324700Total
Program Services1324700ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1286417Total
Program Services264755ProgramServices
Management And General1021662ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total3562807Total
Program Services3562807ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total36164Total
Program Services36164ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2611469Total
Program Services2611469ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total227368Total
Program Services227368ProgramServices

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
MEDICAL SUPPLIES26080082608008
PROVISION FOR BAD DEBT873702873702

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total20369844Total
Program Services18707039ProgramServices
Management And General1662805ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1629875BOY
EOY1592769EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2576105BOY
EOY3269698EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY3469BOY
EOY18684EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY338463BOY
EOY327426EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY285077BOY
EOY358154EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY4465BOY
EOY58880EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis52501508LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec19382603LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY35234351BOY
EOY33118905EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY7113730BOY
EOY7536457EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY9496BOY
EOY3256EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY846528BOY
EOY822457EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY48041559BOY
EOY47106686EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2638117BOY
EOY2778237EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY45485000BOY
EOY45485000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1425050BOY
EOY1902373EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY49548167BOY
EOY50165610EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-2962977BOY
EOY-4512380EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1257720BOY
EOY1254807EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY198649BOY
EOY198649EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-1506608BOY
EOY-3058924EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY48041559BOY
EOY47106686EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-1552316ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

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)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$6,808OtherActivitiesAmount
Total Lobbying Expenditures IIB6808TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationMIDWEST MEDICAL CENTER PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE ILLINOIS HOSPITAL ASSOCIATION (IHA) AND THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (ICAHN). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING AND MATERIALS. THE ORGANIZATIONS RECOGNIZE THAT A PORTION OF THE ACTIVITIES CONDUCTED BY BOTH IHA AND ICAHN ARE FUNDED IN CONJUNCTION WITH THE TOTAL ANNUAL DUES PAID. MIDWEST MEDICAL CENTER ESTIMATED THAT APPROXIMATELY $6,808 OUT OF THE TOTAL DUES PAID TO IHA AND ICAHN WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT IN ILLINOIS.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance342707BeginningOfYearBalance
Investment Earnings Or Losses650InvestmentEarningsOrLosses
Grants Or Scholarships1860GrantsOrScholarships
End Of Year Balance341497EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance345853BeginningOfYearBalance
Investment Earnings Or Losses439InvestmentEarningsOrLosses
Grants Or Scholarships3585GrantsOrScholarships
End Of Year Balance342707EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance354096BeginningOfYearBalance
Investment Earnings Or Losses1314InvestmentEarningsOrLosses
Grants Or Scholarships9557GrantsOrScholarships
End Of Year Balance345853EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance349405BeginningOfYearBalance
Investment Earnings Or Losses6191InvestmentEarningsOrLosses
Grants Or Scholarships1500GrantsOrScholarships
End Of Year Balance354096EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance0.58170PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.41830TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis559916OtherCostOrOtherBasis
Book Value559916BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis42844206OtherCostOrOtherBasis
Depreciation12709426Depreciation
Book Value30134780BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis9060333OtherCostOrOtherBasis
Depreciation6673177Depreciation
Book Value2387156BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis37053OtherCostOrOtherBasis
Book Value37053BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings33118905TotalOfBookValueLandBuildings

Investments Program Related InvestmentsProgramRelated (4 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
BOARD DESIGNATED INVESTMENTS FOR CAP. IMPROVEMENTS1094320C
UNDER BOND AGREEMENT-RESERVE FUNDS3420414F
UNDER BOND AGREEMENT-PRINCIPAL/INTEREST FUNDS1885174F
DONOR RESTRICTED-MEDICAL SCHOLARSHIPS1136549C
FieldValueIRS element (for citing)
Total Of Book Value Program Related7536457TotalOfBookValueProgramRelated

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
ESTIMATED AMOUNTS PAYABLE TO THIRD-PARTY REIMBURSEMENT PROGRAMS$1,806,260
SECURITY DEPOSITS HELD$96,113
FieldValueIRS element (for citing)
Total Of Amounts1902373TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:THE EARNINGS DERIVED FROM THE ENDOWMENT FUNDS ARE TO BE USED FOR SCHOLARSHIPS RELATED TO FIELDS IN THE MEDICAL PROFESSION.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:THE SYSTEM AND ITS AFFILIATES ARE NONPROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SYSTEM AND ITS AFFILIATES ARE ALSO EXEMPT FROM STATE INCOME TAXES PURSUANT TO SIMILAR STATE OF ILLINOIS TAX LAWS. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE SYSTEM DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM IS ALSO ENGAGED, TO A LIMITED EXTENT, IN ACTIVITIES WHICH THE INTERNAL REVENUE SERVICE CONSIDERS UNRELATED TO THE SYSTEM'S EXEMPT PURPOSE AND, THEREFORE, TAXABLE. THESE ACTIVITIES, HOWEVER, ARE ANTICIPATED TO ANNUALLY RESULT IN NET OPERATING LOSSES FOR INCOME TAX PURPOSES. THE SYSTEM DOES NOT PRESENTLY ANTICIPATE THAT A TAX BENEFIT FROM THESE NET OPERATING LOSSES WILL BE REALIZED IN THE FUTURE. ACCORDINGLY, ANY POTENTIAL DEFERRED TAX ASSET RESULTING FROM THE AVAILABILITY OF NET OPERATING LOSS CARRYFORWARDS IS OFFSET BY A VALUATION ALLOWANCE OF EQUAL AMOUNT. NO DEFERRED TAX ASSETS AND LIABILITIES HAVE BEEN RECOGNIZED SINCE NO OTHER DIFFERENCES EXIST BETWEEN THE FINANCIAL AND TAX BASES OF REPORTING THE SYSTEM'S ASSETS AND LIABILITIES. THE SYSTEM'S POLICY IS TO RECOGNIZE INTEREST AND ANY PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE WHEN INCURRED. AS OF AND FOR THE YEARS ENDING SEPTEMBER 30, 2012 AND 2011, THERE WAS NO INCOME TAX EXPENSE, TAX PENALTIES, OR INTEREST RELATED TO TAX PENALTIES RECORDED BY THE SYSTEM IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM RECORDED NO ASSETS OR LIABILITIES FOR UNRECOGNIZED TAX BENEFITS FROM UNCERTAIN TAX POSITIONS IN 2012 OR 2011. FEDERAL RETURNS FOR THE TAX YEARS SEPTEMBER 30, 2008, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF OUTINGNameOfEvent1
Gross Receipts Event123746GrossReceiptsEvent1
Charitable Contributions Event1150CharitableContributionsEvent1
Gross Revenue Event123596GrossRevenueEvent1
Non Cash Prizes Event1900NonCashPrizesEvent1
Rent Facility Costs Event13500RentFacilityCostsEvent1
Food And Beverage Event12840FoodAndBeverageEvent1
Other Direct Expenses Event12900OtherDirectExpensesEvent1
Gross Receipts Total23746GrossReceiptsTotal
Charitable Contributions Total150CharitableContributionsTotal
Gross Revenue Total Events23596GrossRevenueTotalEvents
Non Cash Prizes Total Events900NonCashPrizesTotalEvents
Rent Facility Costs Total Events3500RentFacilityCostsTotalEvents
Food And Beverage Total Events2840FoodAndBeverageTotalEvents
Other Direct Expenses Total Events2900OtherDirectExpensesTotalEvents
Direct Expense Summary Events10140DirectExpenseSummaryEvents
Net Income Summary13456NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense87190TotalCommunityBenefitExpense
Net Community Benefit Expense87190NetCommunityBenefitExpense
Percent Of Total Expense0.00450PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense3228429TotalCommunityBenefitExpense
Direct Offsetting Revenue1414447DirectOffsettingRevenue
Net Community Benefit Expense1813982NetCommunityBenefitExpense
Percent Of Total Expense0.09300PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense3315619TotalCommunityBenefitExpense
Direct Offsetting Revenue1414447DirectOffsettingRevenue
Net Community Benefit Expense1901172NetCommunityBenefitExpense
Percent Of Total Expense0.09750PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense4856384TotalCommunityBenefitExpense
Direct Offsetting Revenue2696825DirectOffsettingRevenue
Net Community Benefit Expense2159559NetCommunityBenefitExpense
Percent Of Total Expense0.11080PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense12265TotalCommunityBenefitExpense
Net Community Benefit Expense12265NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense4868649TotalCommunityBenefitExpense
Direct Offsetting Revenue2696825DirectOffsettingRevenue
Net Community Benefit Expense2171824NetCommunityBenefitExpense
Percent Of Total Expense0.11140PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense8184268TotalCommunityBenefitExpense
Direct Offsetting Revenue4111272DirectOffsettingRevenue
Net Community Benefit Expense4072996NetCommunityBenefitExpense
Percent Of Total Expense0.20890PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$757,610BadDebtExpenseAmount
Amount Attributable To378805AmountAttributableTo
Amount Reimbursed By Medicare7724843AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare7708553CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall16290MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
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 Line1MIDWEST MEDICAL CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1ONE MEDICAL CENTER DRIVEAddressLine1
CityGALENACity
StateILState
ZIP Code61036ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours
OtherPROVIDER BASED RURAL HEALTH CLINICOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MIDWEST MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent150.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent300.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit LawsuitXPermitLawsuit
Permit Lien On ResidenceXPermitLienOnResidence
Collection Activities1CollectionActivities
Report To Credit AgencyXReportToCreditAgency
LawsuitXLawsuit
Lien On ResidenceXLienOnResidence
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Other Actions TakenXOtherActionsTaken
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities1NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

FieldValueIRS element (for citing)
Business Name Line1GALENA-STAUSS SENIOR CARE CAMPUSBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1215 SUMMIT STREETAddressLine1
CityGALENACity
StateILState
ZIP Code61036ZIPCode
FieldValueIRS element (for citing)
Facility TypeSKILLED NURSING FACILITY, ASSISTED LIVING, AND ADULT DAY CAREFacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)

ExplanationExplanationIdentifierIdentifier
PART I, LINE 3C: MIDWEST MEDICAL CENTER PRIMARILY USES FEDERAL POVERTY GUIDELINES TO ESTABLISH CHARITY OR DISCOUNTED CARE TO THOSE IN NEED OF CARE IN THE COMMUNITY, HOWEVER THERE ARE OTHER CONSIDERATIONS GIVEN TO PATIENTS TO AVOID HAVING PATIENTS BE IN FINANCIAL DISTRESS DUE TO CONCERNS OVER THEIR MEDICAL BILLS. BELOW ARE THE GENERAL GUIDELINES AS DEFINED IN MIDWEST MEDICAL CENTER'S CHARITY CARE POLICY WHICH ARE FOLLOWED BY THE ORGANIZATION:PATIENT ACCOUNT GUARANTORS WITH AN ADJUSTED GROSS INCOME AT OR BELOW 150% OF THE FEDERAL POVERTY GUIDELINES FOR THE NUMBER OF DEPENDENTS IN THE DEBTOR'S HOUSEHOLD WILL BE ELIGIBLE FOR 100% CHARITY CARE.PATIENT ACCOUNT GUARANTORS WITH AN ADJUSTED GROSS INCOME GREATER THAN 150%, BUT EQUAL TO OR LESS THAN 300% OF THE FEDERAL POVERTY GUIDELINES FOR THE NUMBER OF DEPENDENTS IN THE DEBTOR'S HOUSEHOLD, WILL BE ELIGIBLE FOR PARTIAL FINANCIAL ASSISTANCE.PATIENT ACCOUNT GUARANTORS WITH INSUFFICIENT ASSETS TO PAY THE AMOUNT DUE, AND WHO DO NOT QUALIFY FOR CHARITY CARE ON THE BASIS OF THE FEDERAL POVERTY GUIDELINES, WILL BE ELIGIBLE FOR A CATASTROPHIC CHARITY ADJUSTMENT WHEN THE TOTAL AMOUNT DUE TO MIDWEST MEDICAL CENTER EQUALS AT LEAST 20% OF THE DEBTOR'S ADJUSTED GROSS INCOME. CATASTROPHIC CHARITY IS AN EIGHTY PERCENT (80%) ADJUSTMENT OFF BILLED CHARGES FOR MEDICALLY NECESSARY SERVICES.
PART I, LINE 7: THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICES REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. (THE COSTING METHODOLOGY FOR SUBSIDIZED HEALTH SERVICES FOR LINE 7G ON THE FIRST PAGE OF SCHEDULE H OF THE FORM 990 IS BASED ON COST ALLOCATIONS FROM THE MEDICARE COST REPORT. THIS ALLOCATION METHOD AND PRINCIPLES OF ALLOCATION WERE USED TO DERIVE A SPECIFIC AMOUNT OF COST ALLOCATION TO THE VARIOUS PROGRAMS AND COST CENTERS OPERATED BY THE ORGANIZATION.)
PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT MIDWEST MEDICAL CENTER INCLUDES THE OPERATION OF SEVERAL DEPARTMENTS. THESE DEPARTMENTS AND SERVICES INCLUDE: THE ADULTS AND PEDIATRICS HOSPITAL INPATIENT UNIT AND THE EMERGENCY ROOM UNIT. A MAJORITY OF THESE DEPARTMENTS ARE OPERATED, OR ARE KEPT AT MINIMAL STAFFING LEVELS, IN ORDER TO PROVIDE ACCESS TO THE EMERGENCY ROOM OR EMERGENCY INPATIENT CARE OR CRITICAL CARE SERVICES WHICH SUPPLEMENT OTHER SERVICES AT THE HOSPITAL OR ARE BASED ON NEEDS IN THE COMMUNITY. THE EMERGENCY ROOM AND INPATIENT UNIT ARE STAFFED 24 HOURS PER DAY TO PROVIDE NEEDED ACCESS TO EMERGENCY CARE IN THE GALENA, ILLINOIS COMMUNITY OR AS REQUIRED BY REGULATIONS TO BE ON-CALL AND AVAILABLE TO PROVIDE ACCESS TO EMERGENCY INPATIENT CARE AS A PART OF OPERATING A HOSPITAL IN THE STATE OF ILLINOIS. THE INPATIENT UNIT ALSO PROVIDES CARE TO OVERNIGHT OBSERVATION PATIENTS WHICH ARE KEPT FOR OBSERVATION IN FOLLOW UP CARE FROM THE EMERGENCY ROOM AS WELL AS PROVIDING A SIGNIFICANT NUMBER OF SWING BED SERVICES. IN THE PAST, THERE WAS NO MEDICARE CERTIFIED NURSING HOME IN THE CITY OF GALENA, ILLINOIS OR IN THE IMMEDIATE SURROUNDING AREA AND AS OF FISCAL YEAR 2012 THERE ARE ONLY 5 MEDICARE CERTIFIED SKILLED NURSING BEDS IN JO DAVIESS COUNTY, ILLINOIS. IN RESPONSE TO THE NEED IN THE SURROUNDING AREA, THE HOSPITAL PARTICIPATES IN THE MEDICAL RURAL HOSPITAL SWING BED PROGRAM WHICH PROVIDES SKILLED NURSING CARE IN AVAILABLE BEDS IN THE HOSPITAL INPATIENT UNIT. IT IS THE GOAL OF MIDWEST MEDICAL CENTER TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY.
PART I, L7 COL(F): THE COSTING METHOD AND CALCULATIONS USED ON FORM 990 ARE BASED ON TOTAL OPERATING EXPENSES EXCLUDING BAD DEBT EXPENSE. THE COMMUNITY BENEFIT EXPENSE PERCENTAGES ARE CALCULATED BY DIVIDING THE COMMUNITY BENEFIT EXPENSE FOR EACH CATEGORY OF COMMUNITY SERVICES PROVIDED BY MIDWEST MEDICAL CENTER REPORTED IN THE TABLE ON LINE 7 PART I OF THE SCHEDULE H BY THE TOTAL OPERATING EXPENSES OF THE HOSPITAL LESS THE PROVISION FOR BAD DEBTS OF $873,702.
PART II: WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT," THESE EFFORTS CONTINUE TO BE A WORK IN PROGRESS. MIDWEST MEDICAL CENTER PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE ORGANIZATION BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT BENEFIT WHICH IS NOT QUANTIFIED. MIDWEST MEDICAL CENTER, LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY.
PART III, LINE 4: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE ORGANIZATION HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES PATIENTS DO NOT COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE ORGANIZATION PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTANCE WITH THE APPLICATIONS. DUE TO NO RESPONSES FROM SOME PATIENTS, A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE AND THE HOSPITAL HAS REFLECTED AN ESTIMATED AMOUNT OF THESE ADDITIONAL BAD DEBTS IN PART III OF SCHEDULE H OF THE 990.THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE ORGANIZATION'S TOTAL OPERATING EXPENSES LESS PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE ORGANIZATION. THE ORGANIZATION ALSO RECOGNIZES THAT IT PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE INCLUDED IN THE CONTRACTUAL ADJUSTMENTS ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE ORGANIZATION.
PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H TO THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION, AND ALSO DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS HOSPITAL INPATIENT PHYSICIAN PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, RADIOLOGY PHYSICIAN PROFESSIONAL SERVICES, AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN PROFESSIONAL SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENTS AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY AND PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT MIDWEST MEDICAL CENTER PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED SEPTEMBER 30, 2012, AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES, AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). THE MEDICAL CENTER ALSO SUFFERS A LARGER MEDICARE LOSS NOTED ON THE FORM 990 THAN MANY OTHER CRITICAL ACCESS HOSPITALS DUE TO A REGULATION WHICH AFFECTS LAB REIMBURSEMENT FOR CRITICAL ACCESS HOSPITALS. DUE TO THIS REGULATION, THE HOSPITAL DOES NOT RECEIVE THE FULL COST OF PROVIDING LAB SERVICES TO MEDICARE BENEFICIARIES.WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.
PART III, LINE 9B: UNDER THE ORGANIZATION'S COLLECTION AND CHARITY CARE POLICIES, MIDWEST MEDICAL CENTER MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE ORGANIZATION'S CHARITY CARE POLICY IT IS NOTED THAT PATIENTS MAY QUALIFY FOR CHARITY CARE EITHER PRIOR TO ADMISSION OR FOLLOWING DISCHARGE. ALL INPATIENT SELF-PAY ADMISSIONS ARE SCREENED BY THE HOSPITAL'S BUSINESS OFFICE OR SOCIAL WORKERS TO ALLOW THESE PATIENTS THE ABILITY TO COMPLETE THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL, DEPENDING UPON THE PATIENT'S CONDITION, OR THE PATIENT'S RESPONSIBLE PARTY MAY BE CONTACTED TO COMPLETE AND RETURN THE FORMS AT A LATER TIME WHEN THEIR CARE ALLOWS THIS COMPLETION. DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICIES AS WELL AS THE CHARITY CARE PROGRAM TO ALLOW PATIENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM.
PART V, SECTION B, LINE 13G: THE POLICY IS OFFERED IF A PATIENT STATES ANY PROBLEM IN REGARDS TO PAYING THEIR BILL. THERE IS ALSO A REFERENCE ON ALL PATIENT STATEMENTS THAT STATES FINANCIAL ASSISTANCE IS AVAILABLE.MIDWEST MEDICAL CENTER
PART V, SECTION B, LINE 17E: PATIENTS ARE GIVEN THE OPPORTUNITY TO APPLY FOR CHARITY CARE PRIOR TO ANY COLLECTION PRACTICES NOTED EARLIER UNDER POLICIES OF THE MEDICAL CENTER. THE POLICY AND APPLICATION ARE OFFERED IF A PATIENT STATES ANY PROBLEM IN REGARDS TO PAYING THEIR BILL. THERE IS ALSO A REFERENCE ON ALL PATIENT STATEMENTS THAT STATES FINANCIAL ASSISTANCE IS AVAILABLE.MIDWEST MEDICAL CENTER
PART V, SECTION B, LINE 19D: THE HOSPITAL FOLLOWS ITS NORMAL PROCEDURES FOR COLLECTIONS OF THESE ACCOUNTS, INCLUDING DISCOUNTS BASED ON INCOME/ASSET LEVELS AND CATASTROPHIC CHARITY DISCOUNTS. PATIENT ACCOUNT GUARANTORS WITH INSUFFICIENT ASSETS TO PAY THE AMOUNT DUE, AND WHO DO NOT QUALIFY FOR CHARITY CARE ON THE BASIS OF THE FEDERAL POVERTY GUIDELINES, WILL BE ELIGIBLE FOR A CATASTROPHIC CHARITY ADJUSTMENT WHEN THE TOTAL AMOUNT DUE TO MIDWEST MEDICAL CENTER EQUALS AT LEAST 20% OF THE DEBTOR'S ADJUSTED GROSS INCOME. CATASTROPHIC CHARITY IS AN EIGHTY PERCENT (80%) ADJUSTMENT OFF BILLED CHARGES FOR MEDICALLY NECESSARY SERVICES.MIDWEST MEDICAL CENTER
PART VI, LINE 2: MIDWEST MEDICAL CENTER ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES AND AREAS IT SERVES BY REVIEWING LOCAL DEMOGRAPHICS AND TRENDS IN PATIENT SERVICE UTILIZATION TO DETERMINE WHICH SERVICES COULD AND SHOULD BE MADE AVAILABLE TO THE COMMUNITY IN A COST-EFFECTIVE MANNER TO BE CONSISTENT WITH MIDWEST MEDICAL CENTER'S MISSION IN THE COMMUNITY. MIDWEST MEDICAL CENTER ALSO REVIEWS STATISTICS IN THE HOSPITAL, CLINIC, AND OTHER ORGANIZATIONAL DEPARTMENTS TO REVIEW THE CURRENT SERVICES BEING OFFERED AND ENSURE THAT RESOURCES ARE BEING APPROPRIATELY ALLOCATED TO AREAS IN NEED BY COMMUNITY MEMBERS AND PATIENTS. THE ORGANIZATION ALSO MEETS WITH LOCAL COMMUNITY MEMBERS AND IT'S PHYSICIAN GROUP TO DETERMINE WHICH SERVICES MAY BENEFIT THE COMMUNITY.
PART VI, LINE 3: UNINSURED AND UNDER INSURED PATIENTS ARE ASKED TO MEET WITH THE ORGANIZATION'S BUSINESS OFFICE EITHER AT THE TIME SERVICE IS PROVIDED OR WHEN THE PATIENT'S BILL IS GENERATED. A HOSPITAL REPRESENTATIVE WILL EXPLAIN THE VARIOUS PAYMENT OPTIONS AVAILABLE TO THE PATIENT AS WELL AS THE HOSPITAL'S CHARITY CARE PROGRAM AND OFFERS THE CHARITY CARE APPLICATION WHEN APPROPRIATE. IF OTHER PROGRAMS ARE AVAILABLE TO THE PATIENT, SUCH AS THE ILLINOIS PUBLIC AID PROGRAMS, THESE PATIENTS ARE REFERRED TO THE APPROPRIATE GOVERNMENT AGENCY FOR FURTHER ASSISTANCE.
PART VI, LINE 4: THE PRIMARY SERVICE AREA FOR MIDWEST MEDICAL CENTER ENCOMPASSES ALL PERSONS LIVING WITHIN A 20 TO 30 MILE RADIUS OF THE HOSPITAL.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantNOTES RECEIVABLE FOR SCHOLARSHIPS FORGIVENTypeOfGrant
Number Of Recipients0NumberOfRecipients
Amount Of Cash Grant0AmountOfCashGrant
Amount Of Non Cash Assistance8523AmountOfNonCashAssistance
Method Of ValuationCURRENT NOTE RECEIVABLE BALANCEMethodOfValuation
Description Of Non Cash AssistanceFORGIVENESS OF NOTES RECEIVABLE IS GOVERNED BY THE HOSPITAL'S MEDICAL EDUCATION SCHOLARSHIP PROGRAM AND FORGIVENESS IS GRANTED IF INDIVIDUALS FULFILL FUTURE SERVICE REQUIREMENTS WITH MIDWEST MEDICAL CENTER IN HEALTH PROFESSIONAL RELATED FIELDS. THE HOSPITAL TRACKS THIS INFORMATION ANNUALLY AND AWARDS THE FORGIVENESS BASED ON THE COMPLETION OF THE REQUIRED CRITERIA OF THE PROGRAM.DescriptionOfNonCashAssistance

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: MIDWEST MEDICAL CENTER TRACKS THE GRANTS PROVIDED THROUGH THE USE OF NOTES RECEIVABLE AS THE SCHOLARSHIP PROGRAMS ARE INTENDED TO SUPPLEMENT AND BE A FORM OF STUDENT LOANS FOR MEMBERS OF THE COMMUNITY PURSUING ADDITIONAL EDUCATION IN HEALTH RELATED FIELDS. PRIOR TO APPROVING A NOTE TO A PERSPECTIVE STUDENT, AN APPLICATION IS REVIEWED FOR APPROVAL BY THE ORGANIZATION'S CONTROLLER TO ENSURE THAT ALL BACKGROUND INFORMATION ON THE CANDIDATE WAS PROVIDED. AFTER REVIEW BY THE CONTROLLER, THIS INFORMATION IS PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL. EACH STUDENT MUST SIGN A PROMISSORY NOTE WITH MIDWEST MEDICAL CENTER THAT THEY COMMIT TO COMPLETE THE EDUCATIONAL PROGRAM AND THAT UPON GRADUATION THEY WILL PERFORM SERVICES FOR MIDWEST MEDICAL CENTER (PENDING AN AVAILABLE POSITION IN THE ORGANIZATION AT THE TIME) OR THEY WILL REPAY THE NOTE WITH INTEREST. (THE REPAYMENT TERMS ENSURE THAT THE ENDOWED AND DONATED FUNDS ARE AVAILABLE IN FUTURE YEARS TO OTHER MEMBERS OF THE COMMUNITY OR THAT SERVICES ARE RETURNED TO THE COMMUNITY THROUGH SERVICE TO THE MEDICAL CENTER.) SERVICES PERFORMED AT MIDWEST MEDICAL CENTER RESULT IN FORGIVENESS OF NOTES RECEIVABLE AMOUNTS BASED ON HOURS WORKED.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation Required1SubstantiationRequired
Written Employment ContractXWrittenEmploymentContract
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org1CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 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
TRACY BAUER
1422490000057470123510160347000
MICHAEL WELLS MD
16021601282600065060126080192156000
ELIZABETH GULLONE MD
159709000006325094970175531000
MATTHEW GULLONE MD
188603000007104074580203165000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 5SOME PHYSICIANS, UNDER THE TERMS OF THEIR CONTRACTUAL AGREEMENT WITH MIDWEST MEDICAL CENTER, RECEIVE ADDITIONAL COMPENSATION IF A HIGH VOLUME OF PATIENTS ARE PROVIDED SERVICES BY THE PHYSICIAN IN AN EMPLOYMENT YEAR. THE FOLLOWING PHYSICIANS HAVE SUCH CONTRACTUAL TERMS: MICHAEL WELLS, MD; ELIZABETH GULLONE, MD; MATTHEW GULLONE, MD. DURING FISCAL YEAR 2012, DR. WELLS ACHIEVED THESE GOALS AND WAS PAID AN ADDITIONAL AMOUNT BASED ON PATIENT VOLUMES AS NOTED IN THE INCENTIVE PAYMENT COLUMN ON PAGE 2 OF SCHEDULE J OF THE 990. THESE AMOUNTS ARE NOT ACCRUED BASED ON REVENUES OF THE ORGANIZATION BUT BASED ON PATIENT STATISTICS AND ACUITY OF PATIENTS PROVIDED SERVICES.
PART I, LINE 7SEE ADDITIONAL COMMENTS ABOVE REGARDING PHYSICIANS THAT RECEIVE ADDITIONAL COMPENSATION IF A HIGH VOLUME OF PATIENTS ARE PROVIDED SERVICES BY THE PHYSICIAN IN AN EMPLOYMENT YEAR.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1ILLINOIS FINANCE AUTHORITYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN861091967IssuerEIN
CUSIP Number45200BJ66CUSIPNumber
Date Issued2006-10-01DateIssued
Issue Price45485000IssuePrice
Description Of PurposeCONSTRUCTION OF NEW HOSPITAL FACILITYDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds45485000TotalProceeds
Amount In Reserve Fund3420238AmountInReserveFund
Issuance Costs From Proceeds909700IssuanceCostsFromProceeds
Capital Expenditures41155062CapitalExpenditures
Year Of Subst Completion2007YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name PersonTRACY BAUERNamePerson
Loan From OrganizationXLoanFromOrganization
Original Principal$18,684OriginalPrincipalAmount
Balance Due18684BalanceDue
Default0Default
Approved By Board1ApprovedByBoard
Written Agreement1WrittenAgreement
FieldValueIRS element (for citing)
Total Balance Due18684TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
PAMELA SMITH
FAMILY MEMBER OF TRACY BAUER, OFFICER OF ORGANIZATION33619EMPLOYMENT0
PATRICIA BAUER
FAMILY MEMBER OF TRACY BAUER, OFFICER OF ORGANIZATION20201EMPLOYMENT0
CONNIE TRAVIS
FAMILY MEMBER OF TRACY BAUER, OFFICER OF ORGANIZATION16395EMPLOYMENT0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 7BTHE BOARD OF DIRECTORS OF MIDWEST MEDICAL CENTER PREVIOUSLY ISSUED TAX-EXEMPT BONDS THROUGH THE ILLINOIS FINANCE AUTHORITY TO FINANCE THE CONSTRUCTION OF A REPLACEMENT HOSPITAL. UNDER THE TERMS OF THE BOND AGREEMENTS, THE ORGANIZATION IS LIMITED AS TO ISSUING NEW DEBT, PURCHASING SIGNIFICANT CAPITAL ASSETS, DISPOSING OF SIGNIFICANT ASSETS, AND/OR SETTING UP NEW CORPORATIONS OR SUBSTANTIALLY RESTRUCTURING THE CURRENT ORGANIZATION WITHOUT FIRST OBTAINING APPROVAL OF THE BOND TRUSTEES.
FORM 990, PART VI, SECTION B, LINE 11THE BOARD OF DIRECTORS RECEIVED A COPY OF THE FINAL 990 FOR REVIEW AND APPROVAL THROUGH POSTING TO AN ELECTRONIC SECURE WEBSITE BY MANAGEMENT OF MIDWEST MEDICAL CENTER PRIOR TO ITS SUBMISSION TO THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CSINCE MIDWEST MEDICAL CENTER IS PART OF A SMALL COMMUNITY, CONFLICTS OF INTEREST ARE GENERALLY KNOWN. THE BOARD OF DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE ANNUAL DISCLOSURE STATEMENTS. THESE ARE KEPT ON FILE AT THE HOSPITAL AND ALL MEMBERS OF THE BOARD OF DIRECTORS, INCLUDING MANAGEMENT WHICH ATTEND MEETINGS, ARE TOLD OF THE CONFLICTS. ANY MEMBERS WITH KNOWN CONFLICTS ABSTAIN FROM VOTING ON THESE CONFLICTS DURING MEETINGS AND ENGAGE IN ONLY LIMITED DISCUSSIONS ON THESE TOPICS. THE BOARD AND MANAGEMENT HOLD EACH OTHER ACCOUNTABLE THROUGH OBSERVATION AND ENFORCEMENT OF THE POLICY DURING MEETINGS AND AT ORGANIZATION FUNCTIONS.
FORM 990, PART VI, SECTION B, LINE 15THE BOARD OF DIRECTORS REVIEWS EVALUATIONS FOR THESE INDIVIDUALS, COMPARES DATA TO COMPETITIVE MARKET DATA OBTAINED FROM SALARY SURVEYS, AND CONSULTS WITH OUTSIDE ORGANIZATIONS AS NEEDED IN REVIEWING CONTRACTS. LEGAL AND OUTSIDE VALUATION SERVICES ARE OBTAINED IN ENSURING THE KEY EMPLOYEES, EXECUTIVES, AND PHYSICIANS SALARIES ARE IN LINE WITH REASONABLE AND PRUDENT BUYER CONCEPTS AS WELL.
FORM 990, PART VI, SECTION C, LINE 19THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 2C:THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR SELECTION OF AN INDEPENDENT ACCOUNTANT, AND THE CEO OVERSEES THE AUDIT PROCESS. THE BOARD CHAIR TAKES TIME ANNUALLY TO MEET PRIVATELY WITH THE INDEPENDENT ACCOUNTANT WITHOUT MANAGEMENT PRESENT AND THE ENTIRE BOARD IS ALSO GIVEN THIS OPPORTUNITY DURING THE IN PERSON PRESENTATION OF THE AUDIT RESULTS BY THE INDEPENDENT ACCOUNTANT. NO CHANGES IN THE OVERSIGHT OR SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE OCCURRED IN THE PAST YEAR.
FORM 990, PART VII, SECTION ATHE BOARD OF DIRECTORS OF MIDWEST MEDICAL CENTER ALSO SERVES AS THE BOARD OF DIRECTORS FOR THE MIDWEST REGIONAL HEALTH SYSTEM. NO ADDITIONAL HOURS OF SERVICE ARE DEDICATED TO THE BOARD POSITIONS ON THE MIDWEST REGIONAL HEALTH SYSTEM. THE MIDWEST REGIONAL HEALTH SYSTEM WAS ORGANIZED TO SERVE AS A SUPPORTING ORGANIZATION FOR MIDWEST MEDICAL CENTER AND MIDWEST REGIONAL HEALTH FOUNDATION. THE FOLLOWING BOARD MEMBERS OF MIDWEST MEDICAL CENTER ALSO SERVE AS BOARD MEMBERS OF MIDWEST REGIONAL HEALTH FOUNDATION: MARY ROONEY-SHEAHEN, RN CHERYL FARRUGGIA BILL MORDEN BOB MILLER DALE HENZE CAROL SOAT FRANK WAITES THE HOURS OF SERVICE PROVIDED TO THESE TWO ORGANIZATIONS ARE APPROXIMATELY AS FOLLOWS: MIDWEST MEDICAL CENTER: 2.0 HOURS PER WEEK MIDWEST REGIONAL HEALTH FOUNDATION: 0.5 HOURS PER WEEKEXPLANATION OF HOURS WORKED

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
MIDWEST REGIONAL HEALTH FOUNDATION
ONE MEDICAL CENTER DRIVEGALENAIL61036204560639FUNDRAISINGIL501(C)311 TYPE IMIDWEST REGIONAL HEALTH SYSTEM0
MIDWEST REGIONAL HEALTH SYSTEM
ONE MEDICAL CENTER DRIVEGALENAIL61036204560381SUPPORTINGIL501(C)311 TYPE III0N/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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