2012-11-07T15:32:45-00:00 2011-12-31 PricewaterhouseCoopers 2001 Market St Ste 1700 Philadelphia PA 19103 990 2011-01-01 363197918 Rockford Memorial Development Foundation ROCK 8159714141 2400 N Rockton Ave Rockford IL 61103 Henry M Seybold Jr 2012-11-06 true Matthew Petroski 2673303000 2012-11-06 2011 2016-02-24 21:20:13Z Gary Kaatz President CEO 2400 N Rockton Ave Rockford IL 61103 97088007 false X www.rhsnet.org X 1982 IL To support the operations of all entities of Rockford Health System provide assistance to these other 501c3 non-profit organizations by receiving, maintaining, and administering funds received from the public and other available sources to further the exempt purposes of these organizations. 17 12 5 195 0 1427149 1524646 0 4151869 2018524 152142 -18532 5731160 3524638 1064883 1361232 0 528426 553812 0 179034 763524 802422 2356833 2717466 3374327 807172 108988211 106074709 859071 1145594 108129140 104929115 The mission of Rockford Health System RHS is Superior Care. Everyday. For All Our Patients. Rockford Memorial Development Foundation RMDF assists this mission specifically by applying resources to the vision of RHS which is To fulfill this Committment through Performance Excellence, Lifelong Learning, and Innovation. false false 1135680 845928 - Restricted gifts and endowments to Rockford Health System help departments fund equipment, facilities projects, and care and comfort items to benefit patients and their families. In 2011, endowment proceeds supported education and training opportunities for RHS employees to help them enhance the care they provide to patients. For example, endowed funds provided training to pilot a contemplative care initiative on the inpatient oncology unit. Additionally, the Foundation provided a final payment in the amount of 150,000 from a multi-year gift from Cedric W. Blazer for renovations to the Orthopedic and Surgical Unit. This unit serves patients who have had significant surgeries including spine, knee, hip, abdominal and more. These expenditures are just a few examples of what was funded with restricted gifts and endowments in 2011. 262099 262099 The Family Giving Campaign raised funds in 2011 for three uses an Employee Crisis Fund, the Wishbook catalogue of care and comfort items, and the Employee Education Fund. The crisis fund provides assistance to employees who have experienced a crisis such as a fire or flood in their homes or the severe illness, traumatic injury or death of a spouse or child. The Wishbook provides small items for caregiving departments throughout Rockford Health System. The Employee Education Fund expands opportunities for employees to attend training and skills development seminars. RMDF donations were also used to assist Visiting Nurses Association to care for the elderly, the homebound, the recovering and those facing end of life. 256899 256899 Through charitable contributions, RMDF supports the Ronald McDonald Care Mobile, staffed and operated by RMH, which provides free medical and dental care to uninsured and underinsured children in five counties at numerous sites in Northern Illinois. The Care Mobile visits included vaccinations, lead and/or blood screenings, medical diagnoses, preventative and restorative dental care and treatment/care to avoid an emergency room visit. The Foundation replaced lighting in the Helen M. Howell Lobby with dollars from an estate gift given by Ms. Howell. Donations from the Auxiliary to the Foundation provided some of the Care Mobile funding as well as supplies and education materials for Neonatal Intensive Care Unit library and renovations in the NICU family room, health and wellness resources for patients, nursing scholarships for minority students, the Healing Harp program that creates an atmosphere of care and comfort of hospitalized patients, and a video program in both English and Spanish that helps parents provide care for their newborn babies and other support for the system. 1654678 true true false false false false false true true true false false true true true false true false false false false false false true false false true false true false false false false false false false false false false false false false true false false false false true 15 0 true 5 false false false false false true true false false false false X 17 12 false false false false true true true true true false false true true true false true true true true false false IL X David E Vola Controller 8159715000 2400 N Rockton Ave Rockford IL 61103 X Carol Armstrong 000.10 X 0 0 0 Marc LBarbeau 001.00 X 0 0 0 John J Holevas 000.10 X 0 0 0 W Walter Boothe 001.50 X 0 0 0 Julie Bosma 002.00 X 0 0 0 George Bates 000.10 X 0 0 0 Paul AGreen 001.00 X 0 0 0 Hollis AHanson 000.50 X 0 0 0 Linda Heckert 001.00 X 0 0 0 Phillip ADHiggins 001.00 X 0 432677 83848 Gary EKaatz 003.00 X X 0 1065012 210096 Scott KLaue 002.00 X X 0 0 0 John JMorrissey 000.50 X 0 0 0 Jay Maddox 001.00 X 0 0 0 Jeffrey RSmith 001.00 X X 0 429230 52932 Dennis TUehara 001.00 X 0 469530 71890 Mark DZarnke 002.00 X 0 140800 0 Helen Brooks 040.00 X 206807 0 67935 Henry MSeybold 000.25 X 0 494320 104980 Vicki Woodhouse 040.00 X 42656 0 13465 249463 3031569 605146 1 false true true NA 1 218793 170000 1135853 1524646 1868376 1868376 93573820 93423672 150148 150148 150148 121089 218793 139697 -18608 -18608 Miscellaneous 900099 76 76 76 3524638 1999992 1361232 1361232 0 0 0 337460 134984 121486 80990 0 143493 57397 51658 34438 19487 8783 5698 5006 41945 19070 12044 10831 11427 4571 4114 2742 60000 60000 0 8592 8592 0 589908 589908 1236 1236 6716 3500 3216 96124 54070 15506 26548 3364 3364 0 3358 3358 2501 1000 901 600 0 3299 1319 1188 792 0 0 421 421 0 Food 12914 7748 2583 2583 Other Purchased Services 13661 161 13500 328 1004 -1680 1004 2717466 1654678 883754 179034 31933 10693 1215235 1405822 653864 589587 72 978 4491 14395 153405 149674 3731 3731 96946793 94296913 10132092 9752590 108988211 106074709 797820 1079355 61251 66239 859071 1145594 X 93493455 90760806 9269834 8911007 5365851 5257302 108129140 104929115 108988211 106074709 X 807172 -4007197 X false true true X false X X X X false false false Rockford Memorial Hospital 362167847 3 true 0 Visiting Nurses Assn 362167945 9 true 0 Rockford Health Physicians 363907436 3 true 0 3 0.00000 0.00000 0.00000 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false 97751872 1645735 -1457092 1361232 635634 596213 95347436 88668632 1738649 9948265 1064883 985990 552801 97751872 72939613 1572227 17349427 1990984 724771 476880 88668632 99000446 2008929 -25700856 1309396 491317 568193 72939613 0.96000 0.03000 0.01000 false false 60859 60859 83301 83301 9245 5514 3731 3731 Employee Rec-Supplemental Survivor Premium 42392 Interest in Beneficial Trust 9643959 Life Insurance and others 66239 9752590 Life Insurance Value 54743 Capital Accumulation Account 11318 CAA Fas 124 Valuation 178 66239 V 4 - Funds were used to provide a lecture series, for continuing education for employees wanting to improve their credentials or to focus on a new skill or some technology not currently available in the Rockford community. There were also miscellaneous projects designated by the foundation board in accordance with the specific endowment. All funds were expended per the specific direction of each endowment. X 2 - FIN48 ASC 740 was adopted by the Rockford Health System board of directors in 2007. As there was, and has been, no material impact since that time, there was no footnote included in the audit. Gala 271136 181316 89820 112727 Golf 40439 16810 23629 1948 13912 2094 1 28307 20667 7640 9016 339882 218793 121089 1948 13912 123837 139697 -18608 true Rockford Health Council 1601 Parkview Ave Rockford IL 61107 363229371 501c3 20000 Other Community Program Metropolitan Chicago Healthcare Council 222 S Riverside Plaza Chicago IL 60606 362167008 501c3 13642 Other Community Poison Control March of Dimes Foundation 5411 E State Rockford IL 61108 131846366 501c3 10000 Other Community Event Regional Access & Mobilization Project (RAMP) 202 Market Street Rockford IL 61107 363149827 501c3 7500 Other Community Program Milestone Inc 4060 McFarland Road Rockford IL 61111 362769801 501c3 5000 Other Community Program The Haven Network 124 N Water Street Ste 303B Rockford IL 61107 200620800 501c3 5000 Other Community Program GiGi's Playhouse 8801 N 2nd Street Ste 2 Machesney Park IL 61115 272251844 501c3 5000 Other Community Program 6 1 X true true X X X X true true false false false false false true false Phillip ADHiggins 422025 1600 9052 58500 25348 516525 Gary EKaatz 627315 369197 68499 84178 125919 1275108 89051 Jeffrey RSmith 413485 1600 14145 36500 16432 482162 Dennis TUehara 455767 12215 1548 58500 13390 541420 Helen Brooks 164646 41472 689 35681 32254 274742 5668 Henry MSeybold 357107 128327 8886 41536 63444 599300 24857 I 1a - By policy Membership to the YWCA is paid for the CEO. Two social club memberships are paid for by the organization for the CEO and any personal use of these facilities is reimbursed in full. The actual cost of these memberships is prorated for personal vs business use and that percentage is added to taxable wages. The organization also pays for half of a social club membership for the Executive Director. If personal use exceeds business use, the additional prorated cost is added to taxable I 4a - A future increase in severance this year for Gary Kaatz was 26,082 by contract. I 4b - The executive team receives annual additions to a non-qualified retirement plan. These amounts, accrued for 2010, are included in compensation and listed in detail in Part II for Gary Kaatz 97,196 Henry Seybold 37,168 and Helen Brooks 6,668. I 7 - Short term incentive opportunities, designating threshold, target and maximum annual awards are established for all executives, driven by the strategic initiatives and priorities of RHS. If incentive thresholds are not met, CEO may grant discretionary bonuses for outstanding performance within certain parameters. Form 990 Part VI 1a - Rockford Health System RHS is the sole corporate member of the Foundation and has the authority to elect members to the board and ultimately has the authority to approve or deny all RMDF board actions. Form 990 Part VI 11a - The data was gathered by the accounting staff with input from RMDF and RHS executive staffs. The data was reviewed and the Form 990 prepared by the RHS tax analyst. Once the Form 990 was completed, it was reviewed by an independent accounting firm. A copy of the Form 990 was made available to all board members on a secure intracompany website. A presentation of the return was made to the RHS Finance Committee and at a meeting of the RMDF Board of Directors before filing. Form 990 Part VI 12c - RHS Compliance Department acting on behalf of RMDF and following guidelines set forth in the policy generally sends out a copy of the policy with the Conflict of Interest form included. Each member completes the Financial Interest Disclosure Statement which is a part of the policy. The RHS Compliance Department reviews and retains these statements. If a conflict is identified, all affected parties are informed, potential conflicts reviewed and appropriate actions are taken as a result of the review. Employees are usually given the policy and a statement to complete at the beginning of the year or as a new party is hired or joins the RMDF board. The process was delayed during 2011 notices did not go out until 2012. Form 990 Part VI 15b - Compensation for executives is governed by the RHS Board of Directors. The RHS Board has established a total compensation philosophy that directs the compensation practices for executives from related entities including RMDF. This Board has established a Compensation Committee to establish and review all executive compensation annually based on the established philosophy. An independent external executive compensation firm provides consulting on RHS including RMDF salary ranges and compensation philosophy. The appropriate peer group for compensation comparison purposes is other not-for-profit healthcare systems similar in size and complexity. RHS generally conducts an analysis of total compensation every three years but may vary from this schedule as directed by the Compensation Committee. The RMDF board concedes the authority to set compensation to RHS, the sole corporate member. Form 990 Part VI 19 - Financial statements are available through the Illinois Attorney Generals Office. Governing documents are available by request from Board Secretary. Form 990 Part VII 1 - Some members of the board were compensated by related organizations for other duties as follows Mark Zarnke Independent surgeon who provides Emergency Trauma coverage and a Medical Staff director was compensated by RMH Phillip Higgins worked 60 hrs Medical Director OB-GYN and active physician, Jeffery Smith 57 hrs Medical Director-General Medicine and active physician, and Dennis Uehara 56 hrs Chair of Emergency Department, practicing physician, and corporate board member and they were compensated by RHPH Rockford Health Physicians and RMH Rockford Memorial Hospital Gary Kaatz as President and CEO also worked an additional 42 hrs. and Henry Seybold an additional 44.25 hrs as CFO Sr VP of Finance they spent most of their time and received compensation for those duties and as board officers for and in support of the other related entities RMH/RHPH/RHS/VNA. Form 990 Part XI 5 The change in fund balances for permanent and temporarily restricted net asset was the result of Unrealized gains/losses 4,247,041 Reduction in Pledges Receivables 75,000 Mkt Value Chg in Externally Managed Restricted Funds 388,627 UPMIFA Valuation 6,658 Chg in Unexpended Restricted Funds 35,342 Mkt Value Chg in Endowments 24,936 and endowments expended 707,219. Form 990 Part VI Section A Line 1a - Rockford Health System RHS is the sole corporate member of the Foundation and has the authority to elect members to the board and ultimately has the authority to approve or deny all RMDF board actions. Form 990 Part VI Section B Line 11a - The data was gathered by the accounting staff with input from RMDF and RHS executive staffs. The data was reviewed and the Form 990 prepared by the RHS tax analyst. Once the Form 990 was completed, it was reviewed by an independent accounting firm. A copy of the Form 990 was made available to all board members on a secure intracompany website. A presentation of the return was made to the RHS Finance Committee and at a meeting of the RMDF Board of Directors before filing. Form 990 Part VI Section B Line 12c - RHS Compliance Department acting on behalf of RMDF and following guidelines set forth in the policy generally sends out a copy of the policy with the Conflict of Interest form included. Each member completes the Financial Interest Disclosure Statement which is a part of the policy. The RHS Compliance Department reviews and retains these statements. If a conflict is identified, all affected parties are informed, potential conflicts reviewed and appropriate actions are taken as a result of the review. Employees are usually given the policy and a statement to complete at the beginning of the year or as a new party is hired or joins the RMDF board. The process was delayed during 2011 notices did not go out until 2012. Form 990 Part VI Section B Line 15b - Compensation for executives is governed by the RHS Board of Directors. The RHS Board has established a total compensation philosophy that directs the compensation practices for executives from related entities including RMDF. This Board has established a Compensation Committee to establish and review all executive compensation annually based on the established philosophy. An independent external executive compensation firm provides consulting on RHS including RMDF salary ranges and compensation philosophy. The appropriate peer group for compensation comparison purposes is other not-for-profit healthcare systems similar in size and complexity. RHS generally conducts an analysis of total compensation every three years but may vary from this schedule as directed by the Compensation Committee. The RMDF board concedes the authority to set compensation to RHS, the sole corporate member. Form 990 Part VI Section C Line 19 - Financial statements are available through the Illinois Attorney Generals Office. Governing documents are available by request from Board Secretary. Form 990 Part VII Section A Line 1 - Some members of the board were compensated by related organizations for other duties as follows Mark Zarnke Independent surgeon who provides Emergency Trauma coverage and a Medical Staff director was compensated by RMH Phillip Higgins worked 60 hrs Medical Director OB-GYN and active physician, Jeffery Smith 57 hrs Medical Director-General Medicine and active physician, and Dennis Uehara 56 hrs Chair of Emergency Department, practicing physician, and corporate board member and they were compensated by RHPH Rockford Health Physicians and RMH Rockford Memorial Hospital Gary Kaatz as President and CEO also worked an additional 42 hrs. and Henry Seybold an additional 44.25 hrs as CFO Sr VP of Finance they spent most of their time and received compensation for those duties and as board officers for and in support of the other related entities RMH/RHPH/RHS/VNA. Form 990 Part XI Line 5 The change in fund balances for permanent and temporarily restricted net asset was the result of Unrealized gains/losses 4,247,041 Reduction in Pledges Receivables 75,000 Mkt Value Chg in Externally Managed Restricted Funds 388,627 UPMIFA Valuation 6,658 Chg in Unexpended Restricted Funds 35,342 Mkt Value Chg in Endowments 24,936 and endowments expended 707,219. Rockford Memorial Hospital 2400 N Rockton Ave Rockford IL 61103 362167847 Healthcare IL 501c3 3 Rockford Health System true Rockford Health System 2400 N Rockton Ave Rockford IL 61103 363197915 Support of Healthcare IL 501c3 11c N/A false Rockford Health Physicians 2300 N Rockton Ave Rockford IL 61103 363097436 Healthcare IL 501c3 3 Rockford Health System true Visiting Nurses Assn of the Rockford Area 2400 N Rockton Ave Rockford IL 61103 362167945 Healthcare IL 501c3 9 Rockford Health System true Van Matre Rehab Center LLC 3660 Grandview Birmingham AL 35243 364397130 Healthcare IL NA NA false false Rockford Health Insurance LTD Wellesley House So 2nd Flr 90 Pitts Pembrooke HM BD 08 Insurance BD NA C Corp false true true false false false false false false false false false false true false false false false Rockford Memorial Hospital b 529507 Financial Analysis Visiting Nurses Association b 168752 Financial Analysis Rockford Memorial Hospital c 160000 Financial Analysis Rockford Memorial Hospital c 79395 Financial Analysis Rockford Memorial Hospital n 408125 Financial Analysis