FURP.ORG / PUBLIC DATA EXPLORER

Rockford Health System: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
Rockford Health System (EIN 36-3197915)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-07
IRS object ID
201213139349300716
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-07T15:44:53-00:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PricewaterhouseCoopersBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line12001 Market St Ste 1700AddressLine1
CityPhiladelphiaCity
StatePAState
ZIP Code19103ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN363197915EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Rockford Health SystemBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlROCKNameControl
Phone8159715000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12400 N Rockton AveAddressLine1
CityRockfordCity
StateILState
ZIP Code61103ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameHenry M SeyboldName
TitleSenior Vice President Finance CFOTitle
Date Signed2012-11-06DateSigned
Authorize Third PartyfalseAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMatthew PetroskiName
Phone2673303000Phone
Date Prepared2012-11-06DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonGary KaatzNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12400 N Rockton AveAddressLine1
CityRockfordCity
StateILState
ZIP Code61103ZIPCode
FieldValueIRS element (for citing)
Gross Receipts6077648GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.rhsnet.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1982YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionThe mission is to improve and protect the health and welfare of the community, with superior care, everyday, for all patients.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees305TotalNbrEmployees
Total Nbr Volunteers11TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year484065ContributionsGrantsPriorYear
Contributions Grants Current Year195935ContributionsGrantsCurrentYear
Program Service Revenue Prior Year5967391ProgramServiceRevenuePriorYear
Program Service Revenue CY5881713ProgramServiceRevenueCY
Investment Income Prior Year-1207InvestmentIncomePriorYear
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year6450249TotalRevenuePriorYear
Total Revenue Current Year6077648TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year57574GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4715086SalariesEtcPriorYear
Salaries Etc Current Year4879633SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3963123OtherExpensePriorYear
Other Expenses Current Year8700142OtherExpensesCurrentYear
Total Expenses Prior Year8735783TotalExpensesPriorYear
Total Expenses Current Year13579775TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-2285534RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-7502127RevenuesLessExpensesCY
Total Assets BOY19531913TotalAssetsBOY
Total Assets EOY19011931TotalAssetsEOY
Total Liabilities BOY7638731TotalLiabilitiesBOY
Total Liabilities EOY9434363TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY11893182NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY9577568NetAssetsOrFundBalancesEOY
Mission DescriptionRockford Health System is responsible for supporting the entities that comprise the system Rockford Memorial Hospital, Rockford Health Physicians the Visiting Nurses Assn. of the Rockford Area, and Rockford Memorial Development Foundation-to support and enable them to fulfill their commitment to the RHS vision with performance excellence, innovation, and lifelong learning.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense3988564Expense
Revenue4004722Revenue
DescriptionRHS provides support for Rockford Memorial Hospital RMH, which cared for 12,849 inpatients in 2011, with 1,579 deliveries, 380,441outpatients treated, including 50,980 who visited the emergency room, and processed close to 1.5 million laboratory tests. RMH is the Regional Disaster Preparedness Center for northern Illinois and provides training and education for community preparedness and assists 14 other hospitals with their emergency preparedness. RMH has a Level I Trauma Center, operates a state-designated Perinatal Center with the only Level III Neonatal Intensive Care Unit in northern Illinois with 46 beds, plus an 8 bed Pediatric Intensive Care Unit. Through the Auxiliary, RMH is able to provide extra funds and services to support its mission. The Auxiliary has 368 volunteers who logged 35,381 hours to enhance RMH experience for patients. RHM provides outreach lab services, has state-of-the-art robotic surgery available, and the only regional genetic services and cytogenetics laboratory.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense1756991Expense
Revenue1756991Revenue
DescriptionRHS provides support for Rockford Health Physicians RHPH which includes staffing for RMHs specialized units such as the NICU and the PICU, adult and pediatric hospitalists, as well as neurologists, neuro and trauma surgeons. RHPH also provides anesthesiologists to assist the RMH surgical program. RHPH physicians, with specialties in brain, spine, and orthopedics as well as trained Emergency Medicine specialists are available 24/7 to staff the Emergency Department and fill immediate needs in the Level I Trauma Center. RHPH employs over 150 physicians of varying specialties and continues to assess and respond to the community needs when recruiting new physicians. RHPH had a total of 402,006 office visits in 2011 and provided 325,386 ancillary procedures and 251,212 clinical tests in areas such as pulmonary function, bone scans, Radiology, CT scans, mammography and physical therapy.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense120000Expense
Revenue120000Revenue
DescriptionThe RHS commitment to support the entities within the system includes collaboration with community partners in both time staff volunteers and money to improve the quality of life. To fulfill the vision, RHS provides support for the Visiting Nurses Association of the Rockford Area VNA serving the community with hospice care 12,453 days, elder adult counseling/services over 7,000, and home health care 28,500 visits and therapists/aides 11,824 visits for care that allows people to stay in their own home to recover and recuperate. 63 VNA volunteers gave 3,641 hrs to meet needs of the elderly. Staff participated in community health/wellness events to bring awareness, education and medical screenings to over 100 events. RHS also provides support for Rockford Memorial Development Foundation which, through fundraising activities, provides resources to enhance all areas of RHS. RMDF funds are used for special capital projects, assisting VNA in hospice and home care, adding comfort and extended care items for RMH and RHPH, as well as crisis support and education for employees.Description
FieldValueIRS element (for citing)
Total Program Service Expense5865555TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109690NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Excess Business HoldingsfalseExcessBusinessHoldings
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementfalseRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDavid E Vola ControllerNamePerson
Telephone Number8159715000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12400 N Rockton AvenueAddressLine1
CityRockfordCity
StateILState
ZIP Code61103ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
Jack J Becherer
Director000.25X000
James WBreckenridge
Director002.00X045400337875
Thomas DBudd
Director000.50X000
John WChadwick
Director000.01X000
Eleanor FDoar
Director002.80X000
John TDorsey
Director000.60X032637551104
Pamela SFox
Director000.01X000
Jos LGonzalez
Director001.00X039716254899
Alphonso NGoode
Director000.01X000
Duane RBach
Treas/Vice-Chair001.00X000X
Dennis TUehara
Director004.00X046953071890
Connie MVitali
Director000.75X000
Curtis DWorden
Director001.80X000
Paul AGreen
Chairman001.00X000X
James Evans
VP Legal Affairs030.00353231078819X
Milton G Schmitt Jr
CMO010.00278233050776X
Gary EKaatz
President035.00X10650110210096X
Henry MSeybold
Treasurer041.004943200104980X
Julie APeterson
Secretary038.2577262034984X
Kerry Hill
RMH VP Finance007.50243925087263X
Al Mowbray
Internal Consultant IMS Applications034.00289246038710X
Dan Parod
Sr VP Hospital Admin Affairs001.00398441090152X
Dennis L'Heureux
VP Planning CIO055.003348010102236X
Steven Strode
VP Ambulatory Services040.00347919076330X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3882389TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1647070TotalReportableCompFrmRltdOrgs
Total Other Compensation1090114TotalOtherCompensation
Number Individuals GT100 K72NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcestrueCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Datamation Imaging
PO Box 98347ChicagoIL60693IT Support Services477183
McDermott Will & Emery
227 W Monroe StChicagoIL60606Legal Services4258193
Epic Systems Corp
1979 Milky WayVeronaWI53593License/Maintenance3297582
MAXIT Healthcare LLC
PO Box 643600PittsburghPA15264IT Support Services720030
Oxford Global Resources
PO Box 3256BostonMA002413256IT Support Services576908
FieldValueIRS element (for citing)
Number Of Contractors GT100 K31NumberOfContractorsGT100K
Government Grants195935GovernmentGrants
Total Contributions195935TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionCoordinate and support affiliate activitiesDescription
Business Code561000BusinessCode
Total Revenue Column5881713TotalRevenueColumn
Related Or Exempt Function Income5881713RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue5881713TotalProgramServiceRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column6077648TotalRevenueColumn
Related Or Exempt Function Income5881713RelatedOrExemptFunctionIncome

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2785796Total
Management And General2785796ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total1631940Total
Management And General1631940ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total36365Total
Management And General36365ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total323279Total
Management And General323279ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total102253Total
Management And General102253ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total128Total
Management And General128ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Fees For Services Prof FundraisingFeesForServicesProfFundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total8185419Total
Management And General8185419ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total39225Total
Management And General39225ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total110484Total
Management And General110484ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total15788Total
Management And General15788ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total78985Total
Management And General78985ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total25928Total
Management And General25928ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total46205Total
Management And General46205ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneral
Recruiting/Retention/Employee appreciation8858688586
Supplies51215121
Equipment Rental47394739
Miscellaneous9953499534

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total0Total
Program Services5865555ProgramServices
Management And General-5865555ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total13579775Total
Program Services5865555ProgramServices
Management And General7714220ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3700128BOY
EOY4600425EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY313769BOY
EOY44417EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY157780BOY
EOY160736EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2435937BOY
EOY2325498EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis43154713LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec31939512LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY12214043BOY
EOY11215201EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY710256BOY
EOY665654EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY19531913BOY
EOY19011931EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY6953435BOY
EOY8795564EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY685296BOY
EOY638799EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY7638731BOY
EOY9434363EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY11893182BOY
EOY9577568EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11893182BOY
EOY9577568EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY19531913BOY
EOY19011931EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-7502127ReconcilationRevenueExpenses
Reconcilation Other Changes5186513ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type3 Func IntXSupportingOrg509a3Type3FuncInt
Certification CheckboxXCertificationCheckbox
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation (3 entries)

EINEINType Of OrganizationTypeOfOrganizationListed In Governing DocListedInGoverningDocSupported Organization NotifiedSupportedOrganizationNotifiedOrganized In USOrganizedInUSAmountAmount
Rockford Memorial Hospital
3621678473truetruetrue$3,988,564
Rockford Health Physicians
3630974363truetruetrue$1,756,991
Visiting Nurses Assn of the Rockford Area
3621679459truetruetrue$60,000
FieldValueIRS element (for citing)
Total Number Of Supported Orgs3TotalNumberOfSupportedOrgs
Sum Of Amounts5805555SumOfAmounts
Public Support Pertcentage1700.00000PublicSupportPertcentage170
Public Support Percentage5090.00000PublicSupportPercentage509
Investment Income Percentage0.00000InvestmentIncomePercentage

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Included On FSfalseIncludedOnFS

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis592271OtherCostOrOtherBasis
Depreciation202102Depreciation
Book Value390169BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis37945319OtherCostOrOtherBasis
Depreciation31326671Depreciation
Book Value6618648BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4617123OtherCostOrOtherBasis
Depreciation410739Depreciation
Book Value4206384BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings11215201TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Capital Accumulation Liability$482,675
Life Insurance Liability$156,124
FieldValueIRS element (for citing)
Total Of Amounts638799TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierXIdentifier
Return Reference2ReturnReference
ExplanationFIN48 ASC 740 was adopted by Rockford Health System board of directors in 2007. There was then and is now, no material impact and therefore no footnote was included in 2011.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymenttrueSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (13 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsBase Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgComp Report Prior990 Filing OrgCompReportPrior990FilingOrg
James WBreckenridge
4096624279315482000017875491878
John TDorsey
32359116501134420009105377480
Jos LGonzalez
394428160011343650018399452061
Dennis TUehara
4557671221515485850013390541420
James Evans
2809297062916743430644513432051
Milton G Schmitt Jr
2006336601411586350171576032901015185
Gary EKaatz
6273153691976849984178125918127510789051
Henry MSeybold
3571071283278886415366344459930024857
Kerry Hill
19686544801225951383358813311898353
Al Mowbray
2192946844615062000018711327957
Dan Parod
2769681203031170443194583248859232720
Dennis L'Heureux
251595807152491580964414143703838500
Steven Strode
255399914411080319154441442424915798

Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
I1a- 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.
I4a- Future increase in severance for Gary Kaatz was 26,082 by contract.
I4b- The executive team receives annual additions to a non-qualified retirement plan. These amounts, accrued for 2011, are included in compensation and listed in detail in Part II for Gary Kaatz 97,196 Dennis LHeureux 9,527 Dan Parod 29,168 Steven Strode 17,542 Kerry Hill 9,932 Jim Evans 25,444 and Henry Seybold 37,168.
I7- 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.
I3The board of directors has a compensation committee that reviews executive compensation. They also authorize an independent firm to provide data for analysis of the industry and the market to our Compensation committee. The committee reviews the results and makes a recommendation to the board who then acts upon this information to set compensation for teh CEO. Then the Director of Compensation Benefits produces an employment contract for the CEO.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990 Part VI11a- The data was gathered by the accounting staff with input from the executive staff. 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 Board of Directors before filing
Form 990 Part VI12c- RHS Compliance Department generally sends out a copy of the policy with the Conflict of Interest form included each year. 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. Employees are given the policy and a statement to complete at the beginning of the year or as a new party is hired or joins the board. The procedure was inadvertently overlooked in 2011 and notices were sent in 2012.
Form 990 Part VI15 a,b- 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 all executives. This Board has established a Compensation Committee to establish and review all executive compensation annually based on the established philosophy. An external executive compensation firm provides consulting on RHS 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 choose to vary from this schedule as determined by the Compensation Committee.
Form 990 Part VI19c- Financial statements are available through the Illinois Attorney Generals Office. Policies including the Conflict of Interest policy are available on our Intracompany Website and are not accessible to the general public. Governing documents are available by request from Board Secretary.
Form 990 Part VII1- Some members of the board were also compensated by related organizations James Breckenridge 40 hrs physician/Chair Anesthesiology, John Dorsey 61 hrs physician/Lead Physician for Quality Internal Medicine, Jose Gonzalez 52.5 physician/Medical Director-Neonatology Alan Mowbray 17 hrs practicing physican /IT and EMR Implementation, and Dennis Uehara 53 hrs physician/Chair Emergency Dept and RMDF Rockford Memorial Development Foundation board member they were compensated as physicians by RHPH Rockford Health Physiciansand for administrative duties by RMH Rockford Memorial Hospital. Gary Kaatz as President and CEO11 hrs for related organizations, Julie Peterson - 3.8 hrs as executive secretary, Henry Seybold -3.5 hrs as CFO/Sr VP of Finance, Milt Schmitt - 10 hrs as board liason on multiple RMH and RHPH committees, as well as VanMatre Partnerships governing Chair.
Form 990 Part XI5- This amount 5,186,513 is net transfers from affiliated organizations.
Form 990 Part VI Section B Line 11a - The data was gathered by the accounting staff with input from the executive staff. 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 Board of Directors before filing Form 990 Part VI Section B Line 12c - RHS Compliance Department generally sends out a copy of the policy with the Conflict of Interest form included each year. 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. Employees are given the policy and a statement to complete at the beginning of the year or as a new party is hired or joins the board. The procedure was inadvertently overlooked in 2011 and notices were sent in 2012. Form 990 Part VI Section B Line 15 a,b - 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 all executives. This Board has established a Compensation Committee to establish and review all executive compensation annually based on the established philosophy. An external executive compensation firm provides consulting on RHS 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 choose to vary from this schedule as determined by the Compensation Committee. Form 990 Part VI Section C Line 19c - Financial statements are available through the Illinois Attorney Generals Office. Policies including the Conflict of Interest policy are available on our Intracompany Website and are not accessible to the general public. Governing documents are available by request from Board Secretary. Form 990 Part VII Section A Line 1 - Some members of the board were also compensated by related organizations James Breckenridge 40 hrs physician/Chair Anesthesiology, John Dorsey 61 hrs physician/Lead Physician for Quality Internal Medicine, Jose Gonzalez 52.5 physician/Medical Director-Neonatology Alan Mowbray 17 hrs practicing physican /IT and EMR Implementation, and Dennis Uehara 53 hrs physician/Chair Emergency Dept and RMDF Rockford Memorial Development Foundation board member they were compensated as physicians by RHPH Rockford Health Physiciansand for administrative duties by RMH Rockford Memorial Hospital. Gary Kaatz as President and CEO11 hrs for related organizations, Julie Peterson - 3.8 hrs as executive secretary, Henry Seybold -3.5 hrs as CFO/Sr VP of Finance, Milt Schmitt - 10 hrs as board liason on multiple RMH and RHPH committees, as well as VanMatre Partnerships governing Chair. Form 990 Part XI Line 5 - This amount 5,186,513 is net transfers from affiliated organizations.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Rockford Memorial Hospital
2400 N Rockton AveRockfordIL61103362167847HealthcareIL501c33Rockford Health Systemtrue
Rockford Health Physicians
2300 N Rockton AveRockfordIL61103363097436HealthcareIL501c33Rockford Health Systemtrue
Rockford Memorial Development Foundation
2400 N Rockton AveRockfordIL61103363197918Support of HealthcareIL501c311aRockford Health Systemtrue
Visiting Nurses Assn of the Rockford Area
2400 N Rockton AveRockfordIL61103362167945HealthcareIL501c39Rockford Health Systemtrue

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Van Matre Rehabilitation Center LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13660 Grandview Ste 200AddressLine1
CityBirminghamCity
StateALState
ZIP Code35243ZIPCode
FieldValueIRS element (for citing)
EIN364397130EIN
Primary ActivityHealthcarePrimaryActivity
Legal Domicile StateILLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Rockford Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Disproportionate AllocationsfalseDisproportionateAllocations
General Or Managing PartnerfalseGeneralOrManagingPartner

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Rockford Health Insurance LTDBusinessNameLine1

Address Foreign AddressForeign

FieldValueIRS element (for citing)
Address Line1Wellesley House So 2nd Flr 90 PittsAddressLine1
CityPembrookeCity
Province Or StateHMProvinceOrState
CountryBDCountry
Postal Code08PostalCode
FieldValueIRS element (for citing)
Primary ActivityInsurancePrimaryActivity
Legal Domicile Foreign CountryBDLegalDomicileForeignCountry

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Rockford Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (11 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Rockford Memorial Hospital
n14133655Financial Analysis
Rockford Memorial Hospital
p13789292Financial Analysis
Rockford Memorial Hospital
r19000000Financial Analysis
Rockford Memorial Development Foundation
n89077Financial Analysis
Rockford Health Physicians
m110484Financial Analysis
Rockford Health Physicians
n4943722Financial Analysis
Rockford Health Physicians
p4589644Financial Analysis
Rockford Health Physicians
q19000000Financial Analysis
Visiting Nurses Association
n404942Financial Analysis
Visiting Nurses Association
p307808Financial Analysis
Visiting Nurses Association
r492540Financial Analysis