DEKALB MEMORIAL HOSPITAL INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- DEKALB MEMORIAL HOSPITAL INC (EIN 35-1064295)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-08-13
- IRS object ID
- 201322259349302222
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-13T13:42:41-05:00 | 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 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 E Main St Suite 700 | AddressLine1 |
| City | Fort Wayne | City |
| State | IN | State |
| ZIP Code | 46802 | 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 | 351064295 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEKALB MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % AMY CROUCH | InCareOfName |
| Name Control | DEKA | NameControl |
| Phone | 2609254600 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1316 EAST SEVENTH STREET | AddressLine1 |
| City | AUBURN | City |
| State | IN | State |
| ZIP Code | 46706 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY CROUCH | Name |
| Title | CFO | Title |
| Date Signed | 2013-08-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Joyce A Dulworth | Name |
| Phone | 2604604000 | Phone |
| 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 | FRED PRICE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1316 EAST SEVENTH STREET | AddressLine1 |
| City | AUBURN | City |
| State | IN | State |
| ZIP Code | 46706 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 67242645 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.DEKALBMEMORIAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1964 | YearFormation |
| State Legal Domicile | IN | StateLegalDomicile |
| Activity Or Mission Description | DEKALB MEMORIAL HOSPITAL WAS ESTABLISHED TO PROVIDE A VARIETY OF ACUTE, SUBACUTE AND OUTPATIENT MEDICAL SERVICES TO THE RESIDENTS OF NORTHEASTERN INDIANA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 591 | TotalNbrEmployees |
| Total Nbr Volunteers | 48 | TotalNbrVolunteers |
| Total Gross UBI | 154934 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -9326 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 217959 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 135233 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 48010105 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 59683726 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 700799 | InvestmentIncomePriorYear |
| Investment Income Current Year | 621375 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1390736 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1326050 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 50319599 | TotalRevenuePriorYear |
| Total Revenue Current Year | 61766384 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 40000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 77646 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 25570049 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 30517482 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 24635 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 24715163 | OtherExpensePriorYear |
| Other Expenses Current Year | 29718274 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 50325212 | TotalExpensesPriorYear |
| Total Expenses Current Year | 60313402 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -5613 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1452982 | RevenuesLessExpensesCY |
| Total Assets BOY | 63926199 | TotalAssetsBOY |
| Total Assets EOY | 68069935 | TotalAssetsEOY |
| Total Liabilities BOY | 16854681 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 17637023 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 47071518 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 50432912 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | PROMOTE, PRESERVE, RESTORE HEALTH | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 54908173 | Expense |
| Grants | 77646 | Grants |
| Revenue | 60384692 | Revenue |
| Description | THE 47 BED HOSPITAL OPERATES IN A RURAL AREA. FOR FISCAL YEAR ENDED SEPTEMBER 30, 2011, THE TOTAL NUMBER OF ADMISSIONS WAS 2,527. THE TOTAL NUMBER OF EMERGENCY ROOM VISITS WAS 15,197. THE TOTAL NUMBER OF EMERGENCY MEDICAL SERVICES TRIPS WAS 3,578. THE TOTAL NUMBER OF HOME HEALTH CARE VISITS WAS 4,480. THE HOSPITAL PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY. THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE CHARITY CARE. | Description |
| Total Program Service Expense | 54908173 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | 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 | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | 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 | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | true | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | true | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| 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 | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | true | 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 |
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Number Forms Transmitted With1096 | 60 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 591 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| 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 | true | QuidProQuoContributions |
| Quid Pro Quo Disclosure | true | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | 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 | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | 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 | false | CompensationProcessOther |
| Investment In Joint Venture | true | InvestmentInJointVenture |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | IN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | AMY CROUCH | NamePerson |
| Telephone Number | 2609254600 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1316 E 7TH STREET | AddressLine1 |
| City | AUBURN | City |
| State | IN | State |
| ZIP Code | 46706 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| ALAN MIDDLETON | |||||||
| CHAIRPERSON | 1.0 | X | X | 0 | 0 | 0 | |
| ROBERT MENZIE | |||||||
| VICE CHAIRPERSON | 1.0 | X | X | 0 | 0 | 0 | |
| RICHARD ALLEN | |||||||
| SECRETARY | 1.0 | X | X | 0 | 0 | 0 | |
| STACEY HEFTY | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| DEB LINSTROMBERG | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| MITCHELL TRAVIS | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| BRIAN NUGENT | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| MARK MILLET | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| JEFF JUSTICE | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| BETH FREIDENBERGER | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| MATT FETTER | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| MARK FOGT | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| KIRK RAY | |||||||
| EXECUTIVE DIRECTOR/CEO | 40.0 | X | 281321 | 0 | 30766 | ||
| PAMELA CASSARA | |||||||
| CFO - LEFT DECEMBER 2011 | 40.0 | X | 149538 | 0 | 13312 | ||
| AMY CROUCH | |||||||
| CFO - HIRED NOVEMBER 2011 | 40.0 | X | 7500 | 0 | 300 | ||
| KENNETH CHAFFEE | |||||||
| PHYSICIAN | 40.0 | 295315 | 0 | 18117 | X | ||
| EMILIO VAZQUEZ | |||||||
| PHYSICIAN | 40.0 | 246211 | 0 | 20825 | X | ||
| BRET KUEBER | |||||||
| PHYSICIAN | 40.0 | 215117 | 0 | 16198 | X | ||
| NICHOLAS FINLEY | |||||||
| PHYSICIAN | 40.0 | 190495 | 0 | 25227 | X | ||
| JOSEPH PUTMAN | |||||||
| PHYSICIAN | 40.0 | 178013 | 0 | 13206 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1563510 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 137951 | TotalOtherCompensation |
| Number Individuals GT100 K | 17 | 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 |
|---|---|---|---|---|---|
| ALLIED MEDICAL SERVICES | |||||
| 6444 MONROE ST | SYLVANIA | OH | 43560 | RT SERVICES | 476065 |
| EMERGENCY PHYSICIANS OF IN PC | |||||
| 4560 SOLUTIONS CENTER | CHICAGO | IL | 60677 | PHYSICIAN SERVICES | 467137 |
| APRN SLEEP INC | |||||
| 6444 MONROE ST | SYLVANIA | OH | 43560 | REFERENCE LAB | 241497 |
| PSI SUPPLY CHAIN SOLUTIONS LLC | |||||
| 5050 BRADENTEN AVE | DUBLIN | OH | 43017 | SUPPLY SERVICES | 187594 |
| BKD LLP | |||||
| 200 E MAIN STREET SUITE 700 | FORT WAYNE | IN | 46802 | ACCOUNTING SERVICES | 183876 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Fundraising Events | 31993 | FundraisingEvents |
| All Other Contributions | 103240 | AllOtherContributions |
| Total Contributions | 135233 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERVICE REVENUE | 900099 | 52847956 | 52847956 | |
| CAFETERIA SALES | 900099 | 284758 | 213704 | 71054 |
| DRUGS & SUPPLIES | 900099 | 169244 | 169244 | |
| LAB - NON PATIENT REVENUE | 621500 | 35246 | 35246 | |
| PHARMACARE | 621500 | 3927480 | 3846040 | 81440 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2419042 | TotalRevenueColumn |
| Related Or Exempt Function Income | 2419042 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 59683726 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 434220 | TotalRevenueColumn |
| Exclusion | $434,220 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 162 | TotalRevenueColumn |
| Exclusion | $162 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 711720 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 237180 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 474540 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 474540 | TotalRevenueColumn |
| Exclusion | $474,540 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 5412878 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 5225885 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 186993 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 186993 | TotalRevenueColumn |
| Exclusion | $186,993 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 8806 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 31993 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 13196 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -4390 | TotalRevenueColumn |
| Exclusion | -$4,390 | ExclusionAmount |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 855900 | TotalRevenueColumn |
| Related Or Exempt Function Income | 853460 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 2440 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 855900 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 61766384 | TotalRevenueColumn |
| Related Or Exempt Function Income | 60384692 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 154934 | UnrelatedBusinessRevenue |
| Exclusion | $1,091,525 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 57646 | Total |
| Program Services | 57646 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20000 | Total |
| Program Services | 20000 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 395665 | Total |
| Management And General | 395665 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22707202 | Total |
| Program Services | 20665138 | ProgramServices |
| Management And General | 2025074 | ManagementAndGeneral |
| Fundraising | 16990 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 947252 | Total |
| Program Services | 861999 | ProgramServices |
| Management And General | 84590 | ManagementAndGeneral |
| Fundraising | 663 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4740041 | Total |
| Program Services | 4313437 | ProgramServices |
| Management And General | 423286 | ManagementAndGeneral |
| Fundraising | 3318 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1727322 | Total |
| Program Services | 1571863 | ProgramServices |
| Management And General | 154250 | ManagementAndGeneral |
| Fundraising | 1209 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 108632 | Total |
| Program Services | 108632 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46548 | Total |
| Program Services | 1848 | ProgramServices |
| Management And General | 44700 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 94629 | Total |
| Management And General | 94629 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4936 | Total |
| Management And General | 4936 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5128183 | Total |
| Program Services | 4689812 | ProgramServices |
| Management And General | 438371 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 307372 | Total |
| Program Services | 2314 | ProgramServices |
| Management And General | 305058 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5540089 | Total |
| Program Services | 5200640 | ProgramServices |
| Management And General | 337408 | ManagementAndGeneral |
| Fundraising | 2041 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1153077 | Total |
| Program Services | 1099171 | ProgramServices |
| Management And General | 53906 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1034056 | Total |
| Program Services | 959389 | ProgramServices |
| Management And General | 74667 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 289398 | Total |
| Program Services | 258594 | ProgramServices |
| Management And General | 30390 | ManagementAndGeneral |
| Fundraising | 414 | Fundraising |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 54468 | Total |
| Program Services | 35058 | ProgramServices |
| Management And General | 19410 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 453184 | Total |
| Program Services | 453184 | ProgramServices |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4140062 | Total |
| Program Services | 3767456 | ProgramServices |
| Management And General | 372606 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 584120 | Total |
| Program Services | 531549 | ProgramServices |
| Management And General | 52571 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT | 4525485 | 4525485 | |
| RECRUITMENT | 91498 | 91498 | |
| COLLECTION FEES | 284754 | 284754 | |
| LICENSE, ACCRED FEES & MISC | 650004 | 272425 | 377579 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5227779 | Total |
| Program Services | 5227779 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60313402 | Total |
| Program Services | 54908173 | ProgramServices |
| Management And General | 5380594 | ManagementAndGeneral |
| Fundraising | 24635 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2050 | BOY |
| EOY | 2750 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4223983 | BOY |
| EOY | 1235665 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7159342 | BOY |
| EOY | 7325062 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 903158 | BOY |
| EOY | 1324144 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 779746 | BOY |
| EOY | 1040979 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 79633399 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 39275626 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36986222 | BOY |
| EOY | 40357773 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12948021 | BOY |
| EOY | 15392864 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 923677 | BOY |
| EOY | 1390698 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 63926199 | BOY |
| EOY | 68069935 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4833222 | BOY |
| EOY | 6077934 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6550065 | BOY |
| EOY | 5351775 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5317493 | BOY |
| EOY | 3763376 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 153901 | BOY |
| EOY | 2443938 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16854681 | BOY |
| EOY | 17637023 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46958621 | BOY |
| EOY | 50324022 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 112897 | BOY |
| EOY | 108890 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47071518 | BOY |
| EOY | 50432912 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 63926199 | BOY |
| EOY | 68069935 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1452982 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 1908412 | 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | true | RalliesDemonstrations |
| Rallies Demonstrations | $5,112 | RalliesDemonstrationsAmount |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 5112 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
| Form4720 Filed4912 Tax | false | Form4720Filed4912Tax |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | FORM 990, SCHEDULE C | Identifier |
| Explanation | LINE 1H: WE CONTRIBUTE TO A NATIONAL AND STATE HOSPITAL ASSOCIATION AND A HHC & HOSPITAL ASSOCIATION WITH A PERCENT GOING TOWARDS LOBBYING. AHA IS 24.42 PERCENT OF DUES ($3,820). IHA IS 5.29 PERCENT OF DUES ($1,116). IAHHC FOR HHC AND HOSPICE IS 12 PERCENT OF DUES (176). | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 393118 | OtherCostOrOtherBasis |
| Book Value | 393118 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 53782651 | OtherCostOrOtherBasis |
| Depreciation | 22515722 | Depreciation |
| Book Value | 31266929 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 23277251 | OtherCostOrOtherBasis |
| Depreciation | 15266159 | Depreciation |
| Book Value | 8011092 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2180379 | OtherCostOrOtherBasis |
| Depreciation | 1493745 | Depreciation |
| Book Value | 686634 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 40357773 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CAPITAL LEASE OBLIGATIONS | Description |
| Amount | $2,443,938 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2443938 | TotalOfAmounts |
| Total Revenue | 61766384 | TotalRevenue |
| Total Expenses | 60313402 | TotalExpenses |
| Excess Or Deficit For Year | 1452982 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 1908412 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 1908412 | TotalAdjustments |
| Excess Or Deficit Per FS | 3361394 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 63925172 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 1908412 | NetUnrealizedGainsInvestments |
| Other Revenues | 250376 | OtherRevenues |
| Revenue Not Rptd F990 | 2158788 | RevenueNotRptdF990 |
| Revenue Subtotal | 61766384 | RevenueSubtotal |
| Total Revenue Per Form990 | 61766384 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 60563778 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 250376 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 250376 | ExpensesNotRptdF990 |
| Expenses Subtotal | 60313402 | ExpensesSubtotal |
| Total Expenses Per Form990 | 60313402 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| FORM 990, SCHEDULE D | ASC 740: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
| FORM 990, SCHEDULE D | PART XII, LINE 2D RENTAL EXPENSE $237,180 SPECIAL EVENT EXPENSE 13,196 TOTAL: $250,376 PART XIII, LINE 2D RENTAL EXPENSE $237,180 SPECIAL EVENT EXPENSE 13,196 TOTAL: $250,376 |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF OUTING | NameOfEvent1 |
| Gross Receipts Event1 | 40799 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 31993 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 8806 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 2194 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 3872 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 5270 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 1860 | OtherDirectExpensesEvent1 |
| Total Number Of Other Events | 0 | TotalNumberOfOtherEvents |
| Gross Receipts Total | 40799 | GrossReceiptsTotal |
| Charitable Contributions Total | 31993 | CharitableContributionsTotal |
| Gross Revenue Total Events | 8806 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 2194 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 3872 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 5270 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 1860 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 13196 | DirectExpenseSummaryEvents |
| Net Income Summary | -4390 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| 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 | false | ExpensesExceededBudget |
| 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 | 537157 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 537157 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00960 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8948075 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3109785 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5838290 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10470 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9485232 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3109785 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6375447 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11430 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 318253 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 318253 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00570 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 318253 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 318253 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00570 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9803485 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3109785 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6693700 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.12000 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $5,157,065 | BadDebtExpenseAmount |
| Amount Attributable To | 515707 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 6503495 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 8339191 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1835696 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 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 | DEKALB MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1316 E 7TH STREET | AddressLine1 |
| City | AUBURN | City |
| State | IN | State |
| ZIP Code | 46706 | 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 | DEKALB MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 150. | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 300. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (5 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART III, LINE 4A | ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. AN AGGREGATE COST TO CHARGE RATIO WAS USED TO PROVIDE BAD DEBT AT COST. THE ESTIMATED AMOUNT OF THE HOSPITAL'S BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS THAT MIGHT HAVE BEEN ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY WAS DETERMINED BY COMPUTING A PERCENTAGE OF DOLLAR AMOUNT TOTALS OF ACCOUNTS APPROVED FOR ASSISTANCE TO TOTAL APPLICATIONS AND THEN APPLIED THE PERCENTAGE TO THE APPLICATIONS THAT WERE DENIED DUE TO INCOMPLETE INFORMATION TO COME UP WITH AN ESTIMATE OF WHAT WOULD HAVE QUALIFIED IF THE INFORMATION HAD BEEN RECEIVED. THE RATIONALE BEING THAT HAD THE INFORMATION BEEN RECEIVED,THOSE ACCOUNTS WOULD HAVE BEEN APPROVED. PART III, LINE 8A MEDICARE SHORTFALL IS NOT TREATED AS COMMUNITY BENEFIT. THE METHODOLOGY USES THE DEPARTMENT COST TO CHARGE RATIO GENERATED BY THE MEDICARE COST REPORT. PART III, LINE 9B ACCOUNTS QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE DESIGNATED AS SUCH IN THE ACCOUNTS RECEIVABLE SYSTEM AND ARE NOT WRITTEN OFF TO BAD DEBT OR SENT TO A COLLECTION AGENCY. PART V, SECTION B, LINE 13 THE STATEMENT REGARDING AVAILABLE ASSISTANCE IS POSTED IN THE FOLLOWING AREAS OF THE HOSPITAL, BUT NOT THE ENTIRE POLICY: HOSPITAL FACILITY'S EMERGENCY ROOMS OR WAITING ROOMS HOSPITAL FACILITY'S ADMISSIONS OFFICES |
| NEEDS ASSESSMENT | PERIODIC FOCUS GROUP SURVEYS BY OUTSIDE CONSULTANTS ARE PREPARED EVERY 3-5 YEARS TO ASSESS THE NEEDS OF THE COMMUNITY. THESE SURVEYS INCLUDE INPUT FROM INDIVIDUALS, HEALTH PROFESSIONALS, GOVERNMENTAL HEALTH CARE OFFICIALS AS WELL AS REPRESENTATIVES FROM DEKALB HOSPITAL. THE SURVEY SOLICITS INPUT ON THE HEALTH CARE NEEDS INCLUDING OBESITY, PREVENTIVE MEDICINE, VACCINATIONS, CARDIOVASCULAR,ETC. THESE NEEDS AND CONCERNS ARE EVALUATED AND APPROPRIATE PLANS ARE PUT INTO ACTION TO DEAL WITH THE MOST PRESSING ISSUES. CUSTOMER SATISFACTION SURVEYS ARE ALSO USED TO IDENTIFY UNMET HEALTHCARE NEEDS OF THE COMMUNITY. |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | UPON ADMITTANCE TO DEKALB HOSPITAL, PATIENTS ARE PROVIDED INFORMATION REGARDING THE CHARITY CARE POLICIES. FINANCIAL AID GUIDELINES ARE ALSO INCLUDED WITH THE BILLING STATEMENTS. SIGNS OUTLINING THE FINANCIAL AID POLICIES AND APPLICATIONS ARE ALSO LOCATED IN NUMEROUS AREAS THROUGHOUT THE HOSPITAL. ALL NON-INSURED PATIENTS ARE STRONGLY ENCOURAGED TO MEET WITH A FINANCIAL COUNSELOR TO REVIEW ALL OPTIONS AVAILABLE TO THEM INCLUDING MEDICARE, MEDICAID, CHARITY CARE, LOAN AND PAYMENT PROGRAMS. DEKALB HOSPITAL STAFF WILLINGLY ASSIST PATIENTS WITH QUALIFICATION CRITERIA AND COMPLETION OF APPLICATIONS FOR SUCH PROGRAMS, WHERE APPLICABLE. |
| COMMUNITY INFORMATION | DEKALB MEMORIAL HOSPITAL IS THE SOLE COMMUNITY HOSPITAL LOCATED IN DEKALB COUNTY, SERVING DEKALB, PORTIONS OF STEUBEN, NOBLE AND ALLEN COUNTIES AND THE TOWNS OF HICKSVILLE AND EDGERTON IN NORTHWEST OHIO. THE POPULATION OF DEKALB MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA IS APPROXIMATELY 42,000 AND POPULATION GROWTH HAS REMAINED AT 3-4% ANNUALLY. DUE TO THE 2008 ECONOMIC DOWNTURN, DEKALB HAS SEEN AN INCREASE IN THE UNINSURED AND UNDERINSURED AND QUALIFIES FOR DISPROPORTIONATE SHARE PAYMENT ON THE MEDICARE COST REPORT DUE TO THE LARGER THAN NORMAL SHARE OF MEDICAID PATIENT VOLUME SERVED BY THE HOSPITAL. THE DEMOGRAPHIC AREA SERVED BY DEKALB MEMORIAL HOSPITAL IS MADE UP OF A MEDIAN HOUSEHOLD INCOME OF APPROXIMATELY $45,000, THE MEDIAN AGE IS 40 AND CONTAINS PRIMARILY A BLUE COLLAR AND AGRICULTURAL WORKFORCE. |
| PROMOTION OF COMMUNITY HEALTH | THE HOSPITAL GIVES BACK FINANCIALLY, EDUCATIONALLY, AND THROUGH VOLUNTEERISM, AWARENESS INITIATIVES AND SUPPORT GROUPS. SOME OF THE MANY COMMUNITY EDUCATION PROGRAMS FOR CHILDREN AND ADULTS INCLUDE:PRENATAL EDUCATION, ACLS, CPR, AND FIRST AID TRAINING, DIABETES EDUCATION, SMOKING CESSATION AND WEIGHT MANAGEMENT. SOME OF THE COMMUNITY OUTREACH ACTIVITIES INCLUDE INVOLVEMENT IN: COMMUNITY AND WORKPLACE HEALTH & WELLNESS FAIRS, ROTARY PRESENTATIONS, BACK TO SCHOOL SPORTS PHYSICALS, GRIEF CARE, HEART CARE AND ORGAN DONATION DISCUSSION SERIES, SHOTS FOR TOTS, UNITED WAY DAY OF CARING,PROVIDING EMS STANDBY FOR 20+ COMMUNITY EVENTS AND DISASTER PREPAREDNESS. ADDITIONALLY, THE HOSPITAL PROVIDES FINANCIAL DONATIONS TO OVER 50 NON-PROFIT ORGANIZATIONS IN THE COMMUNITY TOTALING OVER $100,000 ANNUALLY. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable (4 entries)
| Address Line1AddressUS/AddressLine1 | Address Line2AddressUS/AddressLine2 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance |
|---|---|---|---|---|---|---|---|---|---|---|---|
| NORTHEAST INDIANA REGIONAL PARTNERSHIP | |||||||||||
| 200 E MAIN STREET | SUITE 910 | FORT WAYNE | IN | 46802 | 351984702 | 501(c)(6) | 10000 | PROGRAM SUPPORT | |||
| DEKALB COUNTY ECONOMIC DEVELOPMENT PARTNERSHIP | |||||||||||
| 4483 COUNTY ROAD 19 | SUITE C | AUBURN | IN | 46706 | 364577514 | 501(C)(3) | 10000 | COMMUNITY SUPPORT | |||
| FORT WAYNE MEDICAL EDUCATION PROGRAM | |||||||||||
| 50 BROADWAY | SUITE 250 | FORT WAYNE | IN | 46802 | 356049685 | 501(C)(3) | 25000 | PROGRAM SUPPORT | |||
| JUDY A MORRILL CENTER | |||||||||||
| 1200 E HOUSTON STREET | GARRETT | IN | 46738 | 352010882 | 501(C)(3) | FITNESS PROGRAM | 12646 | FMV | 4 TREADMILLS | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 3 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 1 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | SCHOLARSHIPS | TypeOfGrant |
| Number Of Recipients | 18 | NumberOfRecipients |
| Amount Of Cash Grant | 20000 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | FORM 990, SCHEDULE I | Identifier |
| Explanation | THE SCHOLARSHIPS ARE GRANTED TO DEKALB COUNTY STUDENTS PURSUING HEALTHCARE COURSES. THERE IS NO DISCRIMINATION BASED ON RACE, RELIGION, OR SEX IN AWARDING ANY OF THE SCHOLARSHIPS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | true | WrittenPolicyReTAndEExpenses |
| Substantiation Required | true | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| 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 (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KIRK RAY | |||||||||||||
| 242602 | 0 | 38719 | 0 | 0 | 0 | 26520 | 0 | 4246 | 0 | 312087 | 0 | 0 | 0 |
| PAMELA CASSARA | |||||||||||||
| 149538 | 0 | 0 | 0 | 0 | 0 | 7543 | 0 | 5769 | 0 | 162850 | 0 | 0 | 0 |
| KENNETH CHAFFEE | |||||||||||||
| 295315 | 0 | 0 | 0 | 0 | 0 | 12654 | 0 | 5463 | 0 | 313432 | 0 | 0 | 0 |
| EMILIO VAZQUEZ | |||||||||||||
| 203317 | 0 | 42894 | 0 | 0 | 0 | 18473 | 0 | 2352 | 0 | 267036 | 0 | 0 | 0 |
| BRET KUEBER | |||||||||||||
| 187252 | 0 | 27865 | 0 | 0 | 0 | 15343 | 0 | 855 | 0 | 231315 | 0 | 0 | 0 |
| NICHOLAS FINLEY | |||||||||||||
| 162073 | 0 | 28422 | 0 | 0 | 0 | 22629 | 0 | 2598 | 0 | 215722 | 0 | 0 | 0 |
| JOSEPH PUTMAN | |||||||||||||
| 174097 | 0 | 3916 | 0 | 0 | 0 | 9009 | 0 | 4197 | 0 | 191219 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | FORM 990, SCHEDULE J | Identifier |
| Explanation | LINE 1: SOCIAL CLUB DUES ARE PROVIDED TO THE CEO SOLELY FOR BUSINESS PURPOSES. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| HOSPITAL AUTHORITY OF DEKALB COUNTY INDIANA | |||||||
| 351064295 | 240732bq9 | 2006-12-29 | 2725000 | CONSTRUCTION | false | false | false |
| HOSPITAL AUTHORITY OF DEKALB COUNTY INDIANA | |||||||
| 351064295 | 240732BLC | 2006-12-29 | 9275000 | CONSTRUCTION | false | false | false |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Amount RetiredAmountRetired | Amount Bond DefeasedAmountBondDefeased | Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Capitalized InterestCapitalizedInterest | Refunding EscrowRefundingEscrow | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Credit EnhancementCreditEnhancement | Working Capital ExpendituresWorkingCapitalExpenditures | Capital ExpendituresCapitalExpenditures | Other Spent ProceedsOtherSpentProceeds | Amount UnspentAmountUnspent | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2725000 | 0 | 2725000 | 750000 | 0 | 0 | 47553 | 0 | 0 | 0 | 0 | 0 | 2011 | true | false | true | true |
| 0 | 0 | 9354438 | 927500 | 0 | 0 | 149931 | 0 | 0 | 9000000 | 0 | 0 | 2011 | false | false | true | true |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Engage Bond Counsel ResearchEngageBondCounselResearch | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|
| false | false | false | false | true | 0 | true |
| false | false | false | false | true | 0 | true |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Business Name Line1NameOfGICProvider/BusinessNameLine1 | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|---|
| 0 | ||||||
| false | false | false | false | 0 | false | false |
| 0 | ||||||
| false | false | false | false | 0 | false | false |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| FORM 990, PART VI | LINE 6: THE ORGANIZATION HAS A CORPORATE BOARD MEETING CONSISTING OF 30 COMMUNITY MEMBERS. TWELVE MEMBERS OF THE CORPORATE BOARD ARE ELECTED AND SERVE AS THE ORGANIZATION'S GOVERNING BOARD OF DIRECTORS. |
| FORM 990, PART VI | LINE 7A: THE ORGANIZATION HAS A CORPORATE BOARD MEETING CONSISTING OF 30 COMMUNITY MEMBERS. TWELVE MEMBERS OF THE CORPORATE BOARD ARE ELECTED AND SERVE AS THE ORGANIZATIONS GOVERNING BOARD OF DIRECTORS. |
| FORM 990, PART VI | LINE 7B: NOMINATIONS AND APPROVAL FOR VACANCIES ON THE GOVERNING BOARD ARE SUBJECT TO APPROVAL BY CORPORATE MEMBERS. ALL BUSINESS DECISIONS OF THE BOARD OF DIRECTORS ARE RATIFIED BY ANNUAL RESOLUTION OF THE CORPORATE BOARD. |
| FORM 990, PART VI | LINE 11B: THE FORM 990 IS PREPARED BY AN OUTSIDE CPA FIRM AND REVIEWED BY THE CHIEF FINANCIAL OFFICER AFTER WHICH IT IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI | LINE 12C: The conflict of interest policies are completed annually by all board members and staff. The policy statements are reviewed annually by the board of directors. When organization business is being conducted and there is a conflict, the board or staff members abstain from voting on related matters. This is documented in the board minutes. |
| FORM 990, PART VI | LINE 15A: THE COMPENSATION COMMITTEE, A SUB-COMMITTEE OF THE BOARD, IS INVOLVED IN DETERMINING THE COMPENSATION OF THE CEO UTILIZING THIRD PARTY AND MARKET DATA. |
| FORM 990, PART VI | LINE 19: THE CONFLICT OF INTEREST STATEMENTS AND GOVERNING DOCUMENTS ARE KEPT WITH THE EXECUTIVE SECRETARY AND ARE AVAILABLE TO BE VIEWED WHEN REQUESTED. THE FINANCIAL STATEMENTS ARE KEPT IN THE FINANCE AREA AND ARE ALSO AVAILABLE UPON REQUEST. |
| FORM 990, PART VII | SECTION A, LINE 1A A COMMON PAYMASTER IS USED BY DEKALB MEMORIAL HOSPITAL AND DEKALB HEALTH FOUNDATION. DEKALB HEALTH FOUNDATION CONTRACTED EMPLOYEES ARE PAID THROUGH THE COMMON PAYMASTER. |
| FORM 990, PART XI | LINE 5 UNREALIZED GAIN ON TRADING SECURITIES $1,908,412 LOSS ON EQUITY INVESTEE (10,491) TOTAL: $1,897,921 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEKALB MEMORIAL PHARMACARE LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1314 E 7TH STREET | AddressLine1 |
| City | AUBURN | City |
| State | IN | State |
| ZIP Code | 46706 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 273514342 | EIN |
| Primary Activities | RETAIL PHARM | PrimaryActivities |
| Legal Domicile State | IN | LegalDomicileState |
| Total Income | 3927480 | TotalIncome |
| EOY Assets | 591961 | EOYAssets |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REDIMED DEKALB LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7950 W JEFFERSON BLVD | AddressLine1 |
| City | FORT WAYNE | City |
| State | IN | State |
| ZIP Code | 468044160 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 352046411 | EIN |
| Primary Activity | OCC HEALTH | PrimaryActivity |
| Legal Domicile State | IN | LegalDomicileState |
| Predominant Income Type | RELATED | PredominantIncomeType |
| Share Of Total Income | -23175 | ShareOfTotalIncome |
| Share Of EOY Assets | 67722 | ShareOfEOYAssets |
| Disproportionate Allocations | false | DisproportionateAllocations |
| General Or Managing Partner | false | GeneralOrManagingPartner |
| Percentage Ownership | 0.50000 | PercentageOwnership |
| 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 | true | 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 | false | 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 | false | OtherTransferFromOtherOrg |