2013-05-15T12:19:48-07:00 2012-06-30 990 2011-07-01 362179764 Memorial Medical Center MEMO 8157885800 3701 Doty Road Woodstock IL 60098 Robert T Green 2013-05-15 2011 2016-02-24 21:20:13Z Michael S Eesley 385 Millennium Drive Crystal Lake IL 60012 150247049 false false X www.centegra.org X 1914 IL The mission of Memorial Medical Center is to provide quality healthcare services with innovative and responsible use of resources and promote wellness for the greater McHenry County area. 14 6 1149 156 514 1092897 301669 140816193 142560130 3352073 242958 2853804 1782543 148114967 144887300 0 0 62482421 61928279 0 0 82776555 87578161 145258976 149506440 2855991 -4619140 104146919 99636157 63113076 65282827 41033843 34353330 The mission of Memorial Medical Center is to provide quality healthcare services with innovative and responsible use of resources and promote wellness for the greater McHenry County area. false false 130602318 142631844 See Schedule O 130602318 true true false true false 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LakeMcHenry Pathology Assoc 4201 Medical Center Drive McHenry IL 60050 Laboratory Services 344941 Executive Health Resources PO Box 822688 Philadelphia PA 191822688 Compliance Consultan 267413 Diversified Clinical Services PO Box 636981 Cincinnati OH 452636981 Wound Care Provider 278217 Aon Risk Service Central Inc 75 Remittance Drive Suite 1926 Chicago IL 606751926 Insurance 349650 14 -64452 366121 301669 Routine Patient Services 621990 57130809 57130809 IDPA Provider Tax Revenue 622110 6345490 6345490 Charity Care/Admin Allow 621990 -14343045 -14343045 Ancillary O/P Services 621990 86860305 86860305 Ancillary I/P Services 621990 6566571 6566571 142560130 1018702 1018702 2892 2892 0 712746 712746 712746 712746 4581113 5359749 -778636 -778636 -778636 0 0 0 Related Party Revenue 900099 161165 161165 Other Misc Income 621990 168601 168601 Cafeteria Sales 722210 541063 541063 198968 71714 514 126740 1069797 144887300 142631844 514 1953273 0 0 0 0 0 0 50088505 41850508 8237997 745624 622992 122632 7629418 6374617 1254801 3464732 2894892 569840 738133 351505 386628 0 0 25431 25431 0 0 6386158 5384623 1001535 16214 16214 22382067 21494121 887946 3901 879 3022 0 2683376 2242044 441332 91791 82096 9695 0 62271 53261 9010 2286370 1910334 376036 0 5323706 4448122 875584 2266044 1893350 372694 IDPA Provider Tax Assessment 4215382 4215382 Extraordinary Loss on GE 4655772 4655772 Provision for Bad Debts 10744089 10744089 Purch Srvs Rltd Prty (Sch O) 25581338 21374006 4207332 116118 -6489 122607 149506440 130602318 18904122 0 12414 71217 4490597 4413128 0 14344820 18855273 0 0 0 2084705 2143966 1052094 923510 120994781 84232272 39987138 36762509 26337749 26457995 0 4913293 4421540 0 10924109 5587019 104146919 99636157 16755822 16159498 45686921 46148409 670333 2974920 63113076 65282827 X 38357086 31698965 2676757 2654365 41033843 34353330 104146919 99636157 X -4619140 -2061373 X false true true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false true 25431 25431 false false Part II-B, Line 1i Part II-B, Line 1i - Other Activities Description As part of our payment of Illinois Hospital Association dues, approximately 32% in calendar year 2011 and 27% in calendar year 2012 are allocable to lobbying activities. As part of our payment of Metropolitan Chicago Healthcare Council dues, approximately 25% are allocable to lobbying activities. 482785 482785 71689077 45092281 26596796 3212830 1761817 1451013 45587377 37378174 8209203 22712 22712 36762509 Rounding 2 Other Receivables 2995372 Due from Affiliates 2591645 5587019 Self-Insured Professional Liability 2903869 Other Long-Term Liabilities 71051 2974920 Part X Part X : FIN48 Footnote ASC Topic 740, Income Taxes, addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded in the consolidated financial statements. Under ASC Topic 740, the Health System must recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured based on the largest benefit that has a greater than fifty percent likelihood of being realized upon ultimate settlement. ASC Topic 740 also provides guidance on derecognition, classification, interest and penalties on income taxes, accounting in interim periods and requires increased disclosures. At the date of adoption, and as of June 30, 2012, the organization does not have a liability for unrecognized tax benefits. The adoption of ASC Topic 740 had no impact on the consolidated financial statements of the Health System. Part XI, Line 8 Part XI, Line 8: Other Changes in Net Assets or Fund Balances Interest in Foundation (non-capital, temp restricted) $0 Contributions Received - Flouro Room Grant $205015 Transfers to Affiliates $ -0 Interest in Foundation (non-capital, temp restricted) $ -227406 true true X true X true X 600.000000000 true true true false true true 4118150 4118150 0.02750 14498515 8198228 6300287 0.04210 18616665 8198228 10418437 0.06960 34 15517 191573 9920 181653 0.00120 6 350 195734 195734 0.00130 1 51 4981 4981 4 175 1278 1278 45 16093 393566 9920 383646 0.00250 45 16093 19010231 8208148 10802083 0.07210 1 1 1070 1070 1 526938 526938 0.00350 1 120 676 676 1 2 892 892 11 1124 16908 16908 0.00010 1 1 250 250 16 1248 546734 546734 0.00360 true 3491829 2265687 38325139 48113873 -9788734 X true true ARSC Real Estate Holdings Real Estate Holding Company 0.25000 Algonquin Road Surgery Cen Outpatient Surgery Center 0.12750 1 0 Memorial Medical Center

3701 Doty Road Woodstock IL 60098

X X X Memorial Medical Center 1 true true 200.0000 true 600.0000 true X X X X X X X true true X X true false true X false false 3 Centegra Wound & Hyberbaric Center

11650 S Route 47 Huntley IL 60142

Wound Care & Hyperbaric Center Centegra Rehab & Sports Medicine

10450 Algonquin Rd Huntley IL 60142

Rehabiliation & Sports Medicine Clinic Centegra Health Center-Huntley

10350 Haligus Rd Huntley IL 60142

Laboratory and Medical Imaging Services Part VI - Additional Information Part I, Line 7The amounts in Lines 7a-7d were calculated by applying the Medicare cost-to-charge ratio to the net patient revenue for each category. The amounts in Lines 7e-7k were calculated based on actual expenses for each community benefit activity category.Part I, Line 7, Column (f)Form 990, Part IX, line 25 includes $10,744,089 for Bad Debt Expense. This amount cannot be subtracted from total expenses in order to calculate the column (f) percentages in lines 7a-7k due to software limitations.Part I, Line 7, Line (g)This is the amount reported in Community Benefits for Medication Assistance for those Living in Poverty. Part V - Explanation of Number of Facility Type Memorial Medical Center is comprised of one licensed hospital, one center housing laboratory and medical imaging services, one center housing a rehabilitation and sports medicine clinic, and one location housing a wound care and hyberbaric center. Part VI - States Where Community Benefit Report Filed IL Part VI - Affilated Health Care System Roles and Promotion See Schedule O for response to Form 990, Part III, Line 4a. Part VI - Explanation Of How Organization Furthers Its Exempt Purpose See Schedule O for response to Form 990, Part III, Line 4a. Part VI - Community Building Activities Representatives of Memorial Medical Center participated in many different community groups and committees, such as the Fire/EMS Chief Association, the Police Chief Association, the Health and Human Services Network, the Child Advocacy Board, and the Family Violence Coordinating Council. Through these meetings, representatives of Memorial Medical Center can promote the health system's role in improving the health of the individuals that these different groups serve. Also included Part II are expenses related to our Spanish language interpreters. Hispanics comprise 11.7% of the population of McHenry County and our Spanish language interpreters are imperative to the effort to improve the health of this traditionally underserved population. Part VI - Community Information Centegra Health System defines its primary service area as Greater McHenry County, an area of approximately 612 square miles and 309,000 residents. This county is among the fastest growing counties in Illinois with growth seen in all age categories. The population is projected to increase by 13% over the next 5 years. For 2010, the age distribution of the population is as follows: 29.8% 0-19, 31.6% 20-44, 28.4% 45-64, and 10.2% 65+. McHenry County has a relatively high socioeconomic status compared to the rest of Illinois. Median household income for 2011 was 35.9% higher than the rest of the state. The 2011 annual average unemployment rate was 5% below the state average. The percentage of families below the poverty level for 2011 was 47.3% below the rest of the state. For 2011, the percentage of the county's population holding a high school diploma was 6% greater than rest of the state, while the percentage holding a bachelor's degree or higher was 4% higher than the rest of the state. Part VI - Patient Education of Eligibility for Assistance 1. Uninsured patients arriving at our emergency department and/or direct admits are screened at time of service by either an Emergency Department Financial Counselor or the health system's In-Patient Financial Counseling Team, Public Aid Representatives and a Medication Assistance Coordinator to identify eligibility guidelines for federal, state and local government programs as well as charity care. Centegra Health System's Self Pay Process includes a screening which is completed by using hospital form C910050 03-09 prompting an interview offering payment options and eligibility guidelines. It is at this time that a patient becomes aware of the Hospital Uninsured Patient Discount Act, Medicaid, Medication Assistance Programs, Crime Victims, Section 1011, IBCCP, Cash Pay Fee Schedules, and other hospital discount incentives. Patients are advised of time lines for completing application processes at time of service in person. Appropriate scripting is followed by Centegra Health System (CHS) Associates. Discounts were established following the 200%, 350% and 600% federal poverty guidelines to assist in determining charity adjustments. Applications were designed by Centegra Health System Self Pay Committee in accordance to our Financial Policy (Policy Number 9850-2) identifying qualifications for the medically needy/catastrophic aid.2. Uninsured patients opting for elective services are contacted by phone prior to their date of service by the CHS Out-Patient Financial Counseling Team. CHS's Self Pay Process is followed and includes a screening for federal, state and local government programs as well charity care. An interview offering payment options and eligibility guidelines using hospital form C910050 03/09 prompts a quick eligibility determination. It is at this time that a patient becomes aware of the Uninsured Patient Discount Act, Medicaid, Medication Assistance Programs, Crime Victims, Section 1011, IBCCP, Cash Pay Fee Schedules, and other hospital discount incentives. Patients are advised of time lines for completing application processes prior to their elective services via phone. Appropriate scripting is followed by CHS Associates. Discounts were established following the 200%, 350% and 600% federal poverty guidelines to assist in determining charity adjustments. Applications were designed by CHS Self Pay Committee in accordance to our Financial Policy (Policy Number 9850-2) identifying qualifications for the medically needy/catastrophic aid.3. Our health system's web site offers FAQ's and answers as well as encourages patients to contact our Customer Service Team when they are unable to pay for services.4. Our health system's statements also identify detailed account and billing information encouraging the patient to contact our Customer Service Team and inquire about Financial Assistance options.5. Documentation is essential in effective communication. Follow up teams will then move forward in a timely manner with the appropriate actions to insure all necessary documents (if applicable) are received for eligibility determinations.6. CHS advertises a Price Line encouraging patients to inquire about estimated costs for future services. The Price Line is manned by our Out-Patient Financial Counselors from 8:00am - 7:00pm. When calls are returned with estimated costs, a conversation ensues to identify a possible financial hardship. Our Self Pay Process is put into effect at this time.7. Site Registrars will notify the CHS Financial Counseling Team when a financial hardship is identified.8. Emergency Department Financial Counseling positions were created to meet the needs of our ED patients. In addition, a full time Financial Counselor position was created to meet the special needs of our cancer patients.9. A Financial Assistance Coordinator reviews all financial applications, gathers needed documents, determines financial assistance and prepares each patient file for leadership approval. Part VI - Needs Assessment Centegra Health System worked with the McHenry County Department of Public Health and other participating organizations to conduct a community health assessment and identify leading indicators to help highlight the health needs of the county. Those indicators identified include percentage of physically inactive people, percentage of obese people, percentage of current smokers over the age of 18, percentage of binge drinkers, reported new aids cases, suicide rate, mortality rate from unintentional injuries, firearm-related mortality rate, homicide rate, percentage of children with elevated lead levels age 1-6, percentage of children 19 to 35 months of age in full immunization compliance, percentage of people with no health insurance, and percentage of pregnant women who begin prenatal care in the 1st trimester. Centegra Health System has been an active participant in the McHenry County Health Department's MAPP process (Mobilizing for Action through Planning & Partnerships), which is an ongoing effort: Phase 1: Organize for Success/ Partnership Development; Phase 2: Vision, Value Statements; Phase 3: Conducting MAPP Assessments; Phase 4: Identify Strategic Issues; Phase 5: Formulate Goals and Strategies; Phase 6: Action Cycle (current stage). MAPP priorities have been defined as: 1) Increase Access to Medical, Dental and Mental Health care: Goal 1: Provide increased access to follow up care (medical, dental, mental) for the under/uninsured residents of McHenry County; Goal 2: Increase access to (medical, dental, mental) prevention, education, and screening programs available for all residents of McHenry County; 2) Information & Referral: Goal 1: Centralize and update Information and Referral located on Crisis Services web site; Goal 2: Market Crisis Line #/Web site (future 2-1-1) to community to increase visibility; Goal 3: 2-1-1 Information and Referral System; 3) Cardiovascular Care: Goal: By 2017, reduce the death rate from cardiovascular disease by 20%. Centegra's initiatives will target the following defined community needs as priorities: Access to Care, Information & Referral Services, and Clinical Areas of Cardiovascular and Cancer-related programs and services. Centegra's Community Benefits programming will continue to target: community wellness and prevention programs, community health education, community health advocacy and assistance, clinical education, community collaborations, and community-based clinical initiatives. Number of Hospital Faciltiy - 0 Part V, Line 19d - Other Billing Determination of Individuals Without Insurance Patients without insurance are given a 25% discount off of the standard charge for service. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients If a patient qualifies for a 100% charity/financial assistance discount, collection of the account is not pursued as a bad debt. The account is written off in full at the time of the decision. If a patient receives a partial discount for Financial Assistance, any remaining balances will be treated in accordance with the Financial Policy regarding self pay balances and may be offered a payment plan option. The payment plan is in installments ($25 minimum), with the first payment due at discharge. Payment plans are not to exceed 36 months without documentation or verbal communication of ability to pay. Documentation may include a completed financial statement. Patients who have not completed arrangements for one of the payment options within 120 days of the billing date will be automatically turned over to a collection agency. Patients with delinquent payments, 15 or more days late, will be turned over to a collection agency. After insurance processing, patients who have not made payments or enrolled in one of the payment options for co-insurance and deductible amounts within 120 days of insurance payment will be turned over to a collection agency. As an exception, the Director of Patient Financial Services may review and recommend further discounts. No interest charges will accrue on account balances in which payments are being made. Part III, Line 8 - Explanation Of Shortfall As Community Benefit The amount shown in line 6 represents the actual costs incurred to treat Medicare patients and is calculated by applying the Medicare cost-to-charge ratio. Therefore, the entire amount of line 7 constitutes a community benefit. Part III, Line 4 - Bad Debt Expense The estimated amount of bad debt expense (at cost) which could be reasonably attributable to patients who would likely qualify for financial assistance under the organizations charity care policy if sufficient information had been available to make a determination of their eligibility was based on the self pay patient accounts which were written off as bad debts. These amounts were then multiplied by the cost to charge ratio. Any payments received during the fiscal year on these accounts were deducted from the cost. X X X X X true true false false false false false false false false Zbigniew Lorenc 234253 24215 26510 8780 293758 Susan Milford 237787 26762 20 63200 21555 349324 Suellen D Aus-Der-Au 139720 8873 15407 164000 Robert Rosenberger 384585 58195 6770 66687 21886 538123 Rachel Sebastian 177030 18738 20229 15697 231694 Pasquale Bernardi 248718 11001 11102 15916 286737 Michael S Eesley 783098 352926 3795 393378 10884 1544081 256440 Laura J Walczak 88656 5447 9746 103849 Jason Sciarro 538495 68235 2763 64549 21997 696039 Gail Rudolph 166911 16829 20 11443 21320 216523 David Tomlinson 248581 24149 24907 21715 319352 Bernadette Szczepanski 180119 6323 18708 5070 210220 Barbara Johnson 263209 66981 16825 10622 357637 35419 Anthony K Leung 126731 7879 15404 150014 Angela C McAuley 45999 2809 9389 58197 Aaron Shepley 306968 36232 44996 21852 410048 Carey Electric Director 294754 Electrical Contractor false American Community Bank Chairman 106282 Certificate of Deposit false American Community Bank Director 106282 Certificate of Deposit false Home State Bank Director 100000 Certificate of Deposit false Home State Bank Treasurer 100000 Certificate of Deposit false All business transactions with interested persons are arms length transactions, see Conflict of Interest disclosure for Form 990, Part VI, Line 2. Form 990, Part XI, Lines 2b, 2c and 2d Memorial Medical Center is a part of Centegra Health System and, as such, is audited on a consolidated basis. Centegra Health System does have a Finance and Audit Committee that provides oversight of the consolidated audit. Form 990, Part VI, Line 12c 1. In connection with any actual or possible conflicts of interest, an interested person or other person subject to this policy must disclose the existence and nature of his or her financial interest in writing to the President of Centegra or the Chief Corporate Responsibility Officer or designee, who shall provide such written disclosure to the Governors Affairs Committee of Centegra, which shall consider all conflicts of interest issues and, if appropriate, to the directors and members of committees with board-delegated powers considering the proposed transaction or arrangement. The disclosure must occur, at minimum, annually, with a Conflict of Interest Disclosure Statement being submitted no later than January 31 st of each year. Copies of disclosure statements filed by Board members shall be distributed to the Board annually at the February Board meeting. 2. When a conflict of interest is disclosed at meeting of the board or committee thereof, after disclosure of the financial interest, the interested person shall leave the board or committee meeting while the financial interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists. The interested person's leaving such meeting shall not affect whether a quorum exists at such meeting. 3. Procedures for Addressing the Transaction or Arrangement From Which the Conflict Arose. The chairperson of the board or committee shall, if appropriate, appoint a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement. After exercising due diligence, the board or committee shall determine whether Centegra can obtain a more advantageous transaction or arrangement with reasonable efforts from a person or entity that would not give rise to a conflict of interest. If a more advantageous transaction or arrangement is not reasonably attainable under circumstances that would not give rise to a conflict of interest, the board or committee shall determine by a majority vote of the disinterested directors whether the transaction or arrangement is in Centegra's best interest and for its own benefit and whether the transaction is fair and reasonable to Centegra and shall make its decision as to whether to enter into the transaction or arrangement in conformity with such determination. 4. Violations of the Conflicts of Interest Policy: If the administration, the board, or a committee has a reasonable cause to believe that a member has failed to disclose actual or possible conflicts of interest, it shall inform the member of the basis for such belief and afford the member an opportunity to explain the alleged failure to disclose. If, after hearing the response of the member and making such further investigation as may be warranted in the circumstances, the board or committee determines that the member has, in fact, failed to disclose an actual or possible conflict of interest, it shall refer the matter to the Governors Affairs Committee for consideration, which shall subsequently recommend appropriate disciplinary and corrective action to such board or committee. 5. The minutes of the board and all committees with board-delegated powers shall contain the names of the persons who disclosed or otherwise were found to have a financial interest in connection with an actual or possible conflict of interest, the nature of the financial interest, any action taken to determine whether a conflict of interest was present, and the board's or committee's decision as to whether a conflict of interest, in fact, existed. The names of the persons who were present for discussions and votes relating to the transaction or arrangement, the content of the discussion, including any alternatives to the proposed transaction or arrangement, and a record of any votes taken in connection therewith. Continued below. Form 990, Part V, Lines 7g and 7h Memorial Medical Center did not receive any contributions of this kind. Form 990, Part V, Line 1c Memorial Medical Center did not issue any Forms W-2G. Form 990, Part IX, Line 24a It should be noted that these expenses are allocated at 40% of total expense of a related company (Centegra Health System, FEIN 36-3196559). The allocation method is reviewed annually. Expense detail is as follows: Salaries $9,678,698; Benefits $2,588,406; Purchased Services $11,025,037; Supplies $477,610; Utilities $217,493; Other Misc. Expenses $1,594,094. Form 990, Part IV, Line 12 Memorial Medical Center is a part of Centegra Health System, and, as such, is audited on a consolidated basis. Form 990, Part III, Line 4a Con't What's Aphasia? is a group for stroke survivors and family members who have an impairment of their ability to speak or comprehend words; Wingspan is a group that provides the opportunity for open discussions, question and answer sessions, lectures, and social events for people recovering from strokes as well as their families; Y-Me Breast Cancer Support Program is a national program designed to let participants listen to physicians, survivors, social workers, and nurses who have been invited to speak on topics such as handling anger, considered prostheses, and recent concerns about breast implant risks. Memorial Medical Center participates in various community projects such as Meals on Wheels, Immunization Clinics, National Depression/Anxiety Screening Day, and county and business health fairs in order to promote health and awareness in the community. Memorial Medical Center also sponsors shadowing opportunities for area students. The Medical Center provides free blood pressure, skin cancer, colorectal cancer, glaucoma, hearing and other screenings and displays for health fairs, trade shows and county fairs; as well as lipid and mammogram screenings and free flu shots. The Medical Center also distributes thousands of informational brochures, service listings, and flyers at the request of area schools, churches, and organizations on an ongoing basis. Centegra S.H.I.P. (Senior Health Insurance Program) provides trained volunteers on a weekly basis to answer questions regarding insurance coverage. Silver Key Club is the senior citizens group for Centegra Health System. It is a free membership group for people 55 years of age and older, which provides: four issues of a senior newsletter each year, a health diary for members to list their medications and health history, and a discount in the hospital cafeterias at both MMC and NIMC. At certain times of the year, there are discounted screenings and/or special services available for members. Community education is also made available to Silver Key members through early bird reservations, or through general news releases. Memorial Medical Center, in conjunction with Centegra Health System and Northern Illinois Medical Center, works in cooperation with McHenry County College and Health Bridge Fitness Center to provide a complete series of specialized training for those interested in developing their knowledge of emergency basics, or in pursuing a career in the emergency health care field. Local fire and police departments use these programs extensively. Form 990, Part III, Line 4a Con't Together with the American Cancer Society, Gavers Community Cancer Foundation, Sage Cancer Center, and McHenry County College, Centegra Health System sponsors Cancer Awareness Programs including Skin Cancer Screening, Colorectal Cancer Screening, Cancer Survivors Day, Breast Cancer, and Prostate Cancer: Early Detection & Treatment Programs. "Once and For All" Quit Smoking Clinic approaches quitting smoking with wellness in mind. The Medical Center sponsors several programs specializing in issues of concern for women as well as reduced fee mammograms. Making Peace with Your Body is a program to teach women body acceptance with an emphasis on what you can realistically change with diet and exercise. Additional behavioral health programs include: depression and anxiety screenings, What To Do When Your Loved One Is Depressed, Relationship Addiction, Step Families: Steps to Harmonious Living, and Mind/Body Medicine: An Introduction. Other programs include a Critical Care Class, You're In Control Diabetic Education Program, Men and Depression and a variety of ophthalmology programs. Still more educational programs are offered to assist members of the community in taking charge of the special needs in their lives, in their changing lifestyles for healthier lives, as well as programs to inform the community about Advance Medical Directives including living wills, durable power of attorney issues and organ donations and Understanding Medicare. Eye programs may include: Refractive Surgery-correcting your vision with surgery, Understanding Childhood Eye Diseases, Diabetes And Your Eyes, and glaucoma education programs. Memorial Medical Center, in conjunction with Centegra Health System, Northern Illinois Medical Center, and Health Bridge Fitness Center, offers specialized exercise programs that help participants get moving and stay active for a healthier lifestyle. These include: Low Back Water Class, Basketball League, Racquetball League, Arthritis Water Exercise Class, Seniors in Motion, Senior Citizen's Exercise Group, The Get Off Your Rocker Program designed for individuals at least 55 years of age to improve flexibility, strength, and endurance; and the Stroke Exercise Program which is a general physical conditioning exercise program for stroke patients to improve coordination and increase range of motion. Yoga, Tai Chi, relaxation management, weight management, and a variety of other classes are offered through Health Bridge Fitness Center. Together We Can Immunization Partnership Clinics were instituted at Memorial Medical Center, Northern Illinois Medical Center and other medical office buildings to provide immunizations for the unvaccinated children (under age 18) of McHenry County. Clinics are held once per month at both medical centers providing Hepatitis B, DTP, Hib, OPV, MMR, and TB immunizations. Fees are based upon ability to pay with a maximum charge of $15.00 per immunization. The Rehabilitation and Sports Medicine Clinic at Health Bridge Fitness Center provides sports medicine, aquatics, outpatient physical and occupational therapy programs. The Back to Work Program, an industrial injury prevention and rehabilitation program provides physical therapy, ergonomic consultation and back safety programs. The program also uses the aquatic pool located at the Rehabilitation and Sports Medicine Clinic at the Health Bridge Fitness Center. Form 990, Part III, Line 4a Con't The Centegra Pain Management Center specializes in providing advanced, innovative treatments that succeed in relieving most types of pain. The physicians, pain psychologist, nurses, and staff are specially trained and experienced in the field of pain management. Educational materials on chronic pain were developed and made available to the community at trade/health fairs. Centegra Health System is a learning center (clinical site) for students from a multitude of colleges and universities. Students have completed internships in programs such as nurse practitioner, nursing, nurse aide, physician assistant, social work, speech therapy, phlebotomy, diagnostic medical sonography, medical imaging, medical records, pharmacy, medical physics, surgical technology, professional counselor, substance abuse counselor, and medical assistant. Centegra Health System is also a learning site for 3rd and 4th year medical students from the University of Illinois at Rockford. Form 990, Part III, Line 4a Con't Memorial Medical Center offers a variety of classes that can help people save lives. By sponsoring these classes, the Medical Center is helping the community in two ways; first, by building skills and confidence levels of the class participants; and second, by making trained help available for the community in case of emergencies. There are three levels of training available. The First Responder is designed to instruct laymen in the following skills: identifying the emergency situation, stabilizing the victim, and providing basic emergency care until emergency medical personnel arrive. The Emergency Medical Technician - Basic provides a more in-depth study of the recognition and management of victims of traumatic injuries or medical emergencies, and includes hospital clinical experience. This course enables the participant to become a State of Illinois licensed EMT-Basic. The Emergency Medical Technician - Paramedic program provides an intensive learning experience in the use of advanced life support procedures for the management of traumatic injuries and medical emergencies prior to the arrival at the hospital. This course enables the participant to become a State of Illinois licensed Paramedic. An Emergency Medical Dispatcher Course, designed to prepare individuals for employment as dispatchers for a public service agency providing dispatch to law enforcement, fire service, and or Emergency Medical Service, is also offered. Memorial Medical Center, in conjunction with Centegra Health System and Northern Illinois Medical Center, makes available a variety of educational programs designed to promote the wellness of all members of the community. Although many of these programs are offered for a nominal fee to help defray costs, this fee may be waived if the participant does not possess the ability to pay. Memorial Medical Center offers a variety of classes that can help people save lives. The Medical Center offers American Red Cross first aid classes that include First Aid/CPR and a CPR Instructor Course. Cardiopulmonary resuscitation (CPR) classes help community members learn CPR prior to certification or brush up on skills for re-certification. The Medical Center also provided International Trauma Life Support training, Advanced Cardiac Life Support training, and Pediatric Advanced Life Support training. The American Heart Association has recognized Centegra Health System as one of the top ten A.H.A. training sites in the Chicago Metro area. Family health and wellness programs presented by the Medical Center are designed to promote a healthier community. Emergency Room Treatment Forms are available for parent/guardian permission to administer emergency treatment to minors in their absence. Supersitters is a class which teaches the responsibilities of being a babysitter and includes basic first aid and accident prevention, as well as the importance of tender loving care. The Medical Center offers education classes for expectant families including prenatal, grandparents and cesarean birth as well as sibling classes and low rent pagers. At discharge, all new parents are presented with the video, "Baby's First Months: What Do We Do Now". The Medical Center provides various classes to assist with our busy life styles. Relaxation Training teaches techniques to bring the mind and body in balance. Nutrition related offerings include Food and Feelings, Healthy Heart Nutrition and a Weight Management program. Cholesterol Commitment and Improving Your Blood Pressure are programs that assist participants in recognizing the factors that affect your blood pressure, early warning signs of heart attack and offer tips for better control as well as the importance of early intervention. Lipid screening is offered twice each year. Form 990, Part III, Line 4a Con't Each of the following ongoing support groups is held at the Medical Center or in the community and is free of charge. By supporting these groups the Medical Center is able to provide one or all of the following three things: 1.) Staff who either act as facilitators of the group or function as "Guest Speakers". 2.) Space offered free of charge. 3.) Free marketing to educate the community about these services. Support groups include: Alcoholics Anonymous is a twelve-step program for individuals recovering from alcohol dependence; Al-Anon is a twelve-step program for codependent individuals; Arthritis Support Group meets the first Tuesday of every month for individuals with arthritis; Bariatric Support Group is for individuals who have had weight loss surgery; Better Breathers Club is for those individuals with pulmonary disease and their families; Caregivers Support Group is for those who are caring for someone with a chronic or life threatening illness; Diabetes Support Group is for individuals with diabetes and their families; Epilepsy Support Group is for parents of children with epilepsy; Families Anonymous is a support group for family members of chemically dependent people; Fibromyalgia Support Group is for those suffering from Fibromyalgia; Get Help Live Longer is a smoking cessation education and support group; Hat's Off is a group for women diagnosed with any type of cancer meeting every month; Headwinds is a support group offered to survivors of traumatic brain injury and their family members and caregivers. This group hosts speakers including medical professionals who specialize in traumatic brain injuries. The Medical Center participates in conjunction with the Pioneer Center. Participants receive information on topics such as dealing with behavioral problems and the financial issues of long-term care; Infertility Support Group is a group for couples or individuals experiencing infertility problems; Living with Grief, sponsored by Centegra pastoral care, offers support for adults grieving the loss of a loved one; Looking Beyond is for people diagnosed with cancer, their family members, and friends; Make Today Count is a group for anyone with a life-threatening illness as well as their family and friends. The purpose of the program is to help members cope and gain emotional strength. The Group also puts participants in touch with professional resources available to help them; McHenry County Crisis Line for 24-hour mental health information, referral service, and crisis assistance; Multiple Sclerosis (MS) Support Group is under the greater Illinois Chapter of the National Multiple Sclerosis Society. The group is open to persons with MS, their family members and others interested in treatment and management of the disease. Specialists are often invited to speak to the group regarding the symptoms of the disease; Narcotics Anonymous is a twelve-step support program for those recovering from narcotic dependence; Nuts and Bolts is a unique support group for stroke survivors who are 55 years of age or younger. The emphasis of this group is on assisting the families as they adapt to the special lifestyle changes of the young stroke survivor. The group has earned attention from the National Stroke Conference leaders, as it is one of the first support groups of its type; Perinatal Grief Support Group is for anyone who has experienced the loss of a newborn or infant through miscarriage, ectopic pregnancy or sudden infant death syndrome; St. Peregrine's Cancer Support Group is a non-denominational support group for patients and their family and friends; Form 990, Part III, Line 4a The primary mission of Memorial Medical Center is to provide quality health care services with innovative and responsible use of resources and promote wellness for the greater McHenry County area. Memorial Medical Center uses a holistic approach to providing health care services with honesty and integrity, an attitude of respect and caring, teamwork and education throughout its organization and the community. It is the Medical Center's objective to serve the community with respect to providing health care services and education. The Medical Center provides quality health care regardless of race, creed, sex, national origin, handicap, age or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of Memorial Medical Center, it is recognized that not all individuals possess the ability to purchase essential medical services. Therefore, in keeping with the Medical Center's commitment to serve all members of its community, free care and/or subsidized care will be considered where the need and/or an individual's inability to pay exist. Medical services are provided in a dignified manner to Medicare, Medicaid and indigent patients. Memorial Medical Center is affiliated with Northern Illinois Medical Center through their common parent, Centegra Health System. Memorial Medical Center's services include, but are not limited to 170 licensed-bed acute care medical center (35,855 patient days in fiscal year 2012), Level II Trauma Center, Emergency Medicine and Physicians, 24-hours a day, On-site heliport, Surgery and Ambulatory Treatment Services, Intensive and Intermediate Care Unit, Respiratory Therapy, Physical Medicine and Rehab, Obstetrics, including Level II Nursery facility, Pediatrics, Full-body CT Scanner and Magnetic Resonance Imaging (MRI), Mammography screening at two sites, Extended Care Unit, Behavioral Health Unit: Adult, and Chemical Dependency/Detox Programs, Sleep Disorders Center, First Step Substance Abuse Center: 800-675-8448, TDD for the hearing impaired: 815-338-0008, Poison Control Hotline: 815-338-5975, McHenry County Crisis Line: 800-892-8900, Pharmacy Information Line: 815-338-9090, Associate Health Program: 815-334-3944, Pastoral Care, Social Services, Community Education Programs, Support Programs. Recognizing its mission to enhance the health of the community, services are provided to Medicare, Medicaid and indigent patients. The Medical Center may partially recognize these amounts as charity care. Charity Care includes care provided to persons covered by governmental programs at below cost, as well as health activities and programs to support the community. These activities include wellness programs, community education programs, and special programs for the elderly, handicapped, mentally under served, and a variety of broad community support activities. The unreimbursed value of providing charity care was approximately $29,768,155 in fiscal year 2012. During that year, the Medical Center provided in excess of 35,855 inpatient days of service, which included over 18,980 days of Medicare inpatient service. The Medical Center is cognizant of the significant need for high quality, yet cost effective health care services. The Medical Center recognizes the ongoing need to be good stewards of Medicare and Medicaid dollars. As such, the Medical Center has implemented Service Excellence programs designed to reduce health care costs while maintaining high quality standards. Memorial Medical Center believes in a holistic approach to health care that embraces the physical, psychological, spiritual, social and economic needs of the entire public served. In order to provide this care, Memorial Medical Center supports a variety of services, educational programs and support groups. Memorial Medical Center, in conjunction with Centegra Health System and Northern Illinois Medical Center, sponsors or hosts many support groups for its patients as well as the community. Form 990, Part VI, Line 19 Form 990, Part VI, Line 19: Other Organization Documents Publicly Available All documents are available upon request. Form 990, Part VI, Line 15b Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees The Board of Directors of Centegra Health System, through the Compensation Committee comprised of independent members free of conflict, reviewed executive compensation levels and other features of the compensation plan in accordance with the organization's approved compensation philosophy and strategy: The Committee is comprised of members of the Board of Directors, who are independent of Centegra management, have no personal interest in the compensation arrangements, are not related to, or under the control of any individual whose compensation arrangement is being reviewed and have no material business relationship with Centegra.The Chief Executive Officer's compensation is determined by the Compensation Committee in relation to appropriate comparability data. Compensation for other members of the executive staff are developed by the CEO, reviewed by the Committee, evaluated against market data, and approved by the Committee. The Committee approves all compensation decisions in advance of their implementation and documents its determinations and discussions. Its decisions and deliberations are thoroughly documented and meeting minutes are kept and distributed to the Committee members (for historical reference). The Compensation Committee uses a number of external resources and comparisons, and their review includes total compensation (cash compensation, plus benefits provided by Centegra) in relation to organizational performance and prevailing industry practices of comparably-sized organizations. They have engaged the services of a compensation consulting firm (Sullivan Cotter) specializing in the not-for-profit sector that has worked with Centegra and reports directly to the Compensation Committee. Form 990, Part VI, Line 12c Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts Continued from above. 6. A voting member of any committee whose jurisdiction includes compensation matters and who receives compensation, directly or indirectly, from Centegra for services is precluded from voting on matters pertaining to that member's compensation, Physicians who receive compensation, directly or indirectly, from Centegra, whether as employees or independent contractors, are precluded from membership on any committee whose jurisdiction includes compensation matters and in which such physician may have a direct or indirect interest. 7. Each director, principal officer, and member of a committee with board-delegated powers shall annually sign a statement which affirms that such person has received a copy of the conflicts of interest policy; has read and understands the policy; has agreed to comply with the policy; and understands that Centegra is a charitable organization and that in order to maintain its federal tax exemption, it must engage primarily in activities which accomplish one or more of its tax exempt purposes. 8. To ensure that Centegra operates in a manner consistent with its charitable purposes and that it does not engage in activities that could jeopardize its status as an organization exempt from federal income tax, periodic reviews shall be conducted by the Governors Affairs Committee of Centegra. The periodic reviews shall, at a minimum, include the following subjects: Whether acquisition of physician practices and other provider services result in inurement or impermissible private benefit. Whether partnership and joint venture arrangements and arrangements with management service organizations and physician hospital organizations conform to written policies, are properly recorded, reflect reasonable payment for goods and services, further Centegra's charitable purposes and do not result in inurement or impermissible private benefit. Whether agreements to provide healthcare and agreements with other healthcare providers, employees, and third party payors further Centegra's charitable purposes and do not result in inurement or impermissible private benefit. Whether business transactions on behalf of Centegra or an entity controlled by it are the result of arms-length dealing and are no less advantageous than competitively available goods and services of like grade and quality. 9.In conducting the periodic reviews provided for in Article VII, Centegra may, but need not, use outside advisors. If outside experts are used, their use shall not relieve the board of its responsibility for ensuring that periodic reviews are conducted. Form 990, Part VI, Line 11 Form 990, Part VI, Line 11: Form 990 Review Process The review process for the 990 included review by the Director of Accounting and Chief Financial Officer. The 990 also was sent to an outside auditor for review before submission to the IRS. Form 990, Part VI, Line 6 Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder Centegra Health System has a single class of members. Form 990, Part VI, Line 3 Form 990, Part VI, Line 3: Description of Delegated Duties to Management Company Management companies were used for the daily operations and management of the following services for the health system. Sodexho was used for Food & Nutrition, Plant Operations and Maintenance, and Environmental Services work. Dell Marketing LP was used for the management of the Information Systems area. Professional Business Consultants is used for the management of the Managed Care department. Form 990, Part VI, Line 2 Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et Memorial Medical Center, (MMC), adopted specific conflict of interest policies for its governing and management staff. The policy includes, but is not limited to, when an individual, governor, committee member, officer, agent or employee believes that he or she, or member of his or her immediate family might have or does have a real or apparent conflict, he or she should in addition to filing the disclosure notice required, abstain from making motions, voting, executing agreements, or taking any other similar direct action on behalf of MMC. Not with standing, it is realized that both real and apparent conflicts of interest sometimes naturally occur in the course of conducting daily affairs. Conflicts occur because the many persons associated with MMC should be expected to have, and do in fact generally have multiple interests and affiliations, and various positions of responsibility with the community. The long-range interests of MMC do not require the termination of an association with persons who have real or apparent conflicts, if an effective method can render such conflicts harmless to all concerned. During fiscal year 2012, MMC purchased certain goods and/or services from organizations with director's affiliation. All transactions were competitively bid and conducted at arms length. The fees paid were at fair market value. Rachel Sebastian, Vice President, is the daughter of Michael Eesley, CEO. Director Kathy Powell is an employee and vice president of Home State Bank. Treasurer Patrick Morehead is on the Board of Directors and a 1% owner of Home State Bank. Chairman Charie Zanck is a Director of American Community Bank & Trust. Director Charles Ruth is the Board Chairman of American Community Bank & Trust. Director Tom Carey is the Vice President and Majority Owner of Carey Electric. 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