NORTHWESTERN MEMORIAL HEALTHCARE: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
NORTHWESTERN MEMORIAL HEALTHCARE (EIN 36-2179764)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-15
IRS object ID
201231369349303818
Schema version
2010v3.2
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)
Timestamp2012-05-15T10:28:17-07:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN362179764EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Memorial Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMEMONameControl
Phone8157885800Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line13701 Doty RoadAddressLine1
CityWoodstockCity
StateILState
ZIP Code60098ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRobert RosenbergerName
TitleCFO & Senior VPTitle
Date Signed2012-05-15DateSigned
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMichael EesleyNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1385 Millennium DriveAddressLine1
CityCrystal LakeCity
StateILState
ZIP Code60012ZIPCode
FieldValueIRS element (for citing)
Gross Receipts155078986GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web Sitewww.centegra.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1914YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionThe 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees1154TotalNbrEmployees
Total Nbr Volunteers156TotalNbrVolunteers
Total Gross UBI846TotalGrossUBI
Contributions Grants Prior Year207975ContributionsGrantsPriorYear
Contributions Grants Current Year1092897ContributionsGrantsCurrentYear
Program Service Revenue Prior Year139660402ProgramServiceRevenuePriorYear
Program Service Revenue CY140816193ProgramServiceRevenueCY
Investment Income Prior Year809434InvestmentIncomePriorYear
Investment Income Current Year3352073InvestmentIncomeCurrentYear
Other Revenue Prior Year2762208OtherRevenuePriorYear
Other Revenue Current Year2853804OtherRevenueCurrentYear
Total Revenue Prior Year143440019TotalRevenuePriorYear
Total Revenue Current Year148114967TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year62071877SalariesEtcPriorYear
Salaries Etc Current Year62482421SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year81649626OtherExpensePriorYear
Other Expenses Current Year82776555OtherExpensesCurrentYear
Total Expenses Prior Year143721503TotalExpensesPriorYear
Total Expenses Current Year145258976TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-281484RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2855991RevenuesLessExpensesCY
Total Assets BOY102195985TotalAssetsBOY
Total Assets EOY104146919TotalAssetsEOY
Total Liabilities BOY66698072TotalLiabilitiesBOY
Total Liabilities EOY63113076TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY35497913NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY41033843NetAssetsOrFundBalancesEOY
Mission DescriptionThe 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.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense125695069Expense
Revenue141991680Revenue
DescriptionSee Schedule ODescription
Total Program Service Expense125695069TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
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 AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
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 RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109685NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1154NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Form720 FiledfalseForm720Filed
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProceduretrueWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonRobert RosenbergerNamePerson
Telephone Number8157885800TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1385 Millennium DriveAddressLine1
CityCrystal LakeCity
StateILState
ZIP Code60012ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (34 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationIndividual Trustee Or DirectorIndividualTrusteeOrDirectorHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Zbigniew Lorenc
Vice President1.00X028383525065
William Cox
Secretary2.00X000X
Tom Carey
Director1.00000X
Terrence J Bugno
Director1.00000X
Susan Murphy
CNO1.00X021209823551
Susan Milford
Vice President1.00X023237874256
Suellen D Aus-Der-Au
Pharmacist35.00139950026331X
Robert Turngren
Vice President1.00X0998619454
Robert Rosenberger
Sr. VP & CFO1.00X039827778547
Richard A Parsons
Resp/Neuro/Sleep40.0012014007580X
Rachel Sebastian
Vice President1.00X017212527729
Paul Hills
Director1.00000X
Patrick Morehead
Treasurer2.00X000X
Parmod Narang
Director1.00000X
Mike Curran
Director1.00000X
Michael Eesley
President & CEO1.00X02022334299496X
Luke Johnsos
Director1.00000X
Lisa Evan
Pharmacist35.0013374809723X
Laura Walczak
CNO1.00X018228927633
Kathy Powell
Director1.00000X
Jason Sciarro
Exec VP & COO1.00X055970476003
Jack Porter
Director1.00000X
Gail Rudolph
Vice President1.00X019209326651
Doris Hendrickson
Vice President1.00X0680264332X
Deborah J Golden
Ultrasonographer40.00143640014581X
David Tomlinson
Vice President1.00X028524932261
Christian Newkirk
Chairman2.00X000X
Charles Ruth
Director1.00000X
Charie Zanck
Vice Chairman2.00X000X
Barbara Johnson
Senior VP1.00X035739791449
Anthony K Leung
Pharmacist40.00126058025358X
Angela McAuley
Director & VP1.00000X
Angela C McAuley
Senior Vice President0.00055775244067X
Aaron Shepley
Sr VP/CQO Couns1.00X037610965633
FieldValueIRS element (for citing)
Total Reportable Comp From Org663536TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs5999527TotalReportableCompFrmRltdOrgs
Total Other Compensation989700TotalOtherCompensation
Number Individuals GT100 K17NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Ventana Medical Systems Inc
PO Box 409476AtlantaGA303849476Pathology Services350040
Total Renal Care Inc
PO Box 403008AtlantaGA303843008Hemodialysis Service433329
Specialty Laboratories Inc
PO Box 54920Los AngelesCA900540920Laboratory Services360173
Sodexo Inc & Affiliates
4880 Paysphere CircleChicagoIL60674Food, ES & POM Mgmt2730028
LakeMcHenry Pathology Assoc
520 E 22nd StreetLombardIL60148Laboratory Services423447
FieldValueIRS element (for citing)
Number Of Contractors GT100 K10NumberOfContractorsGT100K
Related Organizations631548RelatedOrganizations
Government Grants461349GovernmentGrants
Total Contributions1092897TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Routine Patient Services6219905703099157030991
IDPA Provider Tax Revenue62211065428486542848
Charity Care/Admin Allow621990-13813064-13813064
Ancillary O/P Services6219908427780284277802
Ancillary I/P Services62199067776166777616
FieldValueIRS element (for citing)
Total Program Service Revenue140816193TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3989014TotalRevenueColumn
Exclusion$3,989,014ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column-292TotalRevenueColumn
Exclusion-$292ExclusionAmount

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real711490Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real711490Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column711490TotalRevenueColumn
Exclusion$711,490ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities5232838Securities
Other1094532Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities6024904Securities
Other939115Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-792066Securities
Other155417Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-636649TotalRevenueColumn
Exclusion-$636,649ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Related Party Revenue900099200422$200,422
Reference Lab Fees62150011055031105503
Cafeteria Sales722210544390$544,390

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column291999TotalRevenueColumn
Related Or Exempt Function Income69984RelatedOrExemptFunctionIncome
Unrelated Business Revenue846UnrelatedBusinessRevenue
Exclusion$221,169ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue2142314TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column148114967TotalRevenueColumn
Related Or Exempt Function Income141991680RelatedOrExemptFunctionIncome
Unrelated Business Revenue846UnrelatedBusinessRevenue
Exclusion$5,029,544ExclusionAmount

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)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total50317225Total
Program Services42136783ProgramServices
Management And General8180442ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total334178Total
Program Services279848ProgramServices
Management And General54330ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total8378891Total
Program Services7016673ProgramServices
Management And General1362218ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3452127Total
Program Services2890889ProgramServices
Management And General561238ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total641333Total
Program Services296040ProgramServices
Management And General345293ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total25639Total
Management And General25639ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total6155760Total
Program Services4206694ProgramServices
Management And General1949066ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total13845Total
Program Services13845ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total24009543Total
Program Services23227636ProgramServices
Management And General781907ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total4428Total
Program Services1178ProgramServices
Management And General3250ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2756006Total
Program Services2307942ProgramServices
Management And General448064ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total88977Total
Program Services73578ProgramServices
Management And General15399ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total91423Total
Program Services62607ProgramServices
Management And General28816ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2401968Total
Program Services2011462ProgramServices
Management And General390506ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total5667025Total
Program Services4745695ProgramServices
Management And General921330ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total2396461Total
Program Services2006851ProgramServices
Management And General389610ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Purch Srvs Rltd Prty (Sch O)24415911204464373969474
Provision for Bad Debts97432899743289
Other misc. expenses14955912234137325
IDPA Provider Tax Assessment42153884215388

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total0Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total145258976Total
Program Services125695069ProgramServices
Management And General19563907ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY15073BOY
EOY12414EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4255871BOY
EOY4490597EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY13468329BOY
EOY14344820EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2124784BOY
EOY2084705EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1233633BOY
EOY1052094EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis118851004LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec78863866LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY42859481BOY
EOY39987138EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY21766758BOY
EOY26337749EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY4627707BOY
EOY4913293EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY11844349BOY
EOY10924109EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY102195985BOY
EOY104146919EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY18262024BOY
EOY16755822EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY47934200BOY
EOY45686921EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY501848BOY
EOY670333EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY66698072BOY
EOY63113076EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY32813391BOY
EOY38357086EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2684522BOY
EOY2676757EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY35497913BOY
EOY41033843EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY102195985BOY
EOY104146919EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses2855991ReconcilationRevenueExpenses
Reconcilation Other Changes2679939ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired
Federal Grant Audit PerformedfalseFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Form4720 Filed4955 TaxfalseForm4720Filed4955Tax
Correction MadefalseCorrectionMade
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$25,639OtherActivitiesAmount
Total Lobbying Expenditures IIB25639TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart II-B, Line 1iIdentifier
Return ReferencePart II-B, Line 1i - Other Activities DescriptionReturnReference
ExplanationAs part of our payment of Illinois Hospital Association dues, approximately 32% are allocable to lobbying activities. As part of our payment of Metropolitan Chicago Healthcare Council dues, approximately 25% are allocable to lobbying activities.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis482785OtherCostOrOtherBasis
Book Value482785BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis71548165OtherCostOrOtherBasis
Depreciation43044960Depreciation
Book Value28503205BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis3212830OtherCostOrOtherBasis
Depreciation1669417Depreciation
Book Value1543413BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis43364138OtherCostOrOtherBasis
Depreciation34149489Depreciation
Book Value9214649BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis243086OtherCostOrOtherBasis
Book Value243086BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings39987138TotalOfBookValueLandBuildings

Investments Program Related InvestmentsProgramRelated (3 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
Interest in Foundation4093929C
Invest in ARSC Real Estate Holdings677167C
Invest in Algonquin Rd Surgery Center142197C

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
Other Receivables218498
Due from Affiliates10705611
FieldValueIRS element (for citing)
Total Book Value Other Assets10924109TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Self-Insured Professional Liability$598,109
Rounding$2
Other Long-Term Liabilities$72,222
FieldValueIRS element (for citing)
Total Of Amounts670333TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part XPart X : FIN48 FootnoteASC 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, 2011, 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 8Part XI, Line 8: Other Changes in Net Assets or Fund BalancesNet Unrealized Gains on Investments $2687704 Interest in Foundation (non-capital, temp restricted) $235202 Transfers to Affiliates $ -242967

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage600.000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense4039853TotalCommunityBenefitExpense
Net Community Benefit Expense4039853NetCommunityBenefitExpense
Percent Of Total Expense0.02780PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense14760153TotalCommunityBenefitExpense
Direct Offsetting Revenue8354440DirectOffsettingRevenue
Net Community Benefit Expense6405713NetCommunityBenefitExpense
Percent Of Total Expense0.04410PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense18800006TotalCommunityBenefitExpense
Direct Offsetting Revenue8354440DirectOffsettingRevenue
Net Community Benefit Expense10445566NetCommunityBenefitExpense
Percent Of Total Expense0.07190PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs38NumberOfActivitiesOrPrograms
Persons Served9496PersonsServed
Total Community Benefit Expense54882TotalCommunityBenefitExpense
Direct Offsetting Revenue11120DirectOffsettingRevenue
Net Community Benefit Expense43762NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs6NumberOfActivitiesOrPrograms
Persons Served206PersonsServed
Total Community Benefit Expense214214TotalCommunityBenefitExpense
Direct Offsetting Revenue1100DirectOffsettingRevenue
Net Community Benefit Expense213114NetCommunityBenefitExpense
Percent Of Total Expense0.00150PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served74PersonsServed
Total Community Benefit Expense6878TotalCommunityBenefitExpense
Net Community Benefit Expense6878NetCommunityBenefitExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served20PersonsServed
Total Community Benefit Expense1100TotalCommunityBenefitExpense
Direct Offsetting Revenue240DirectOffsettingRevenue
Net Community Benefit Expense860NetCommunityBenefitExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs48NumberOfActivitiesOrPrograms
Persons Served9796PersonsServed
Total Community Benefit Expense277074TotalCommunityBenefitExpense
Direct Offsetting Revenue12460DirectOffsettingRevenue
Net Community Benefit Expense264614NetCommunityBenefitExpense
Percent Of Total Expense0.00180PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs48NumberOfActivitiesOrPrograms
Persons Served9796PersonsServed
Total Community Benefit Expense19077080TotalCommunityBenefitExpense
Direct Offsetting Revenue8366900DirectOffsettingRevenue
Net Community Benefit Expense10710180NetCommunityBenefitExpense
Percent Of Total Expense0.07370PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense1002TotalCommunityBuildingExpense
Net Community Building Expense1002NetCommunityBuildingExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense576930TotalCommunityBuildingExpense
Net Community Building Expense576930NetCommunityBuildingExpense
Percent Of Total Expense0.00400PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served387PersonsServed
Total Community Building Expense3365TotalCommunityBuildingExpense
Net Community Building Expense3365NetCommunityBuildingExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Number Of Activities Or Programs8NumberOfActivitiesOrPrograms
Persons Served410PersonsServed
Total Community Building Expense11696TotalCommunityBuildingExpense
Net Community Building Expense11696NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs13NumberOfActivitiesOrPrograms
Persons Served797PersonsServed
Total Community Building Expense592993TotalCommunityBuildingExpense
Net Community Building Expense592993NetCommunityBuildingExpense
Percent Of Total Expense0.00410PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$3,273,745BadDebtExpenseAmount
Amount Attributable To2157318AmountAttributableTo
Amount Reimbursed By Medicare36896889AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare47905941CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-11009052MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnership
ARSC Real Estate Holdings
Real Estate Holding Company0.25000
Algonquin Road Surgery Cen
Outpatient Surgery Center0.12750
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number0FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Memorial Medical CenterBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line13701 Doty RoadAddressLine1
CityWoodstockCity
StateILState
ZIP Code60098ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Memorial Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities3NumberOfOtherFacilities

Other Facilities OtherFacilities (3 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Centegra Rehab & Sports Medicine
10450 Algonquin RdHuntleyIL60142Rehabiliation & Sports Medicine Clinic
Centegra Wound & Hyberbaric Center
11650 S Route 47HuntleyIL60142Wound Care & Hyperbaric Center
Centegra Health Center-Huntley
10350 Haligus RdHuntleyIL60142Laboratory and Medical Imaging Services

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part VI - Additional InformationPart 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 $9,743,289 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 TypeMemorial 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 FiledIL
Part VI - Affilated Health Care System Roles and PromotionSee Schedule O for response to Form 990, Part III, Line 4a.
Part VI - Explanation Of How Organization Furthers Its Exempt PurposeSee Schedule O for response to Form 990, Part III, Line 4a.
Part VI - Community Building ActivitiesRepresentatives 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 11.3% 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 InformationCentegra 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 2007, the age distribution of the population is as follows: 27% 0-17, 38% 18-44, 25% 45-64, and 10% 65+. McHenry County has a relatively high socioeconomic status compared to the rest of Illinois. Median household income for 2010 was 37.2% higher than the rest of the state. The 2006 annual average unemployment rate was 24% below the state average. The percentage of families below the poverty level for 2006 was 52% below the rest of the state. For 2006, the percentage of the county's population holding a high school diploma was 7% greater than rest of the state, while the percentage holding a bachelor's degree or higher was 6% higher than the rest of the state.
Part VI - Patient Education of Eligibility for Assistance1. 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 AssessmentCentegra 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.
Part V, Line 19d - Other Billing Determination of Individuals Without InsuranceSee detailed description of financial policy in narrative reponse for Schedule H, Part III, Line 9b.Number of Hospital Faciltiy - 0
Part III, Line 9b - Provisions On Collection Practices For Qualified PatientsIf 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 BenefitThe 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 ExpenseThe 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.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
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 PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (16 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsBase Compensation Filing OrgBaseCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Zbigniew Lorenc
234913489221470010365308900
Susan Murphy
174864372341289510656235649
Susan Milford
193117392615670817548306634
Suellen D Aus-Der-Au
139950883517496166281
Robert Rosenberger
344539537386076317784476824
Rachel Sebastian
152510196151059517134199854
Michael Eesley
764544125495328764011856232183028371152245
Laura Walczak
150343319461014317490209922
Jason Sciarro
5035035410458349176546357072097
Gail Rudolph
15786234231913517516218744
Deborah J Golden
14364087785803158221
David Tomlinson
242160430891470017561317510
Barbara Johnson
25693810045985044640544884629681
Anthony K Leung
126058786317495151416
Angela C McAuley
2179443398083315510912601819339808
Aaron Shepley
296544795654785917774441742

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (6 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Curran Group Inc
Vice Chairman144073Contract Servicesfalse
Carey Electric
Director221284Electrical Contractorfalse
American Community Bank
Chairman106282Certificate of Depositfalse
American Community Bank
Director106282Certificate of Depositfalse
Home State Bank
Director100000Certificate of Depositfalse
Home State Bank
Treasurer100000Certificate of Depositfalse

Form990 Schedule L Part V Form990ScheduleLPartV

FieldValueIRS element (for citing)
ExplanationAll business transactions with interested persons are arms length transactions, see Conflict of Interest disclosure for Form 990, Part VI, Line 2.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (19 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part XI, Lines 2b, 2c and 2dMemorial 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 12c1. 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 7hMemorial Medical Center did not receive any contributions of this kind.
Form 990, Part V, Line 1cMemorial Medical Center did not issue any Forms W-2G.
Form 990, Part IX, Line 24aIt 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 $7,980,009; Benefits $2,593,910; Purchased Services $11,659,633; Supplies $423,721; Utilities $172,457; Other Misc. Expenses $1,586,181.
Form 990, Part IV, Line 12Memorial 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'tWhat'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'tTogether 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 $12.00 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'tThe 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'tMemorial 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'tEach 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 4aThe 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 (37,665 patient days in fiscal year 2011), 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 $29,438,136 in fiscal year 2011. During that year, the Medical Center provided in excess of 37,665 inpatient days of service, which included over 19,934 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: Other Organization Documents Publicly AvailableAll documents are available upon request.Form 990, Part VI, Line 19
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesThe 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 15b
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsContinued 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 12c
Form 990, Part VI, Line 11: Form 990 Review ProcessThe 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 11
Form 990, Part VI, Line 6: Explanation of Classes of Members or ShareholderCentegra Health System has a single class of members.Form 990, Part VI, Line 6
Form 990, Part VI, Line 3: Description of Delegated Duties to Management CompanyManagement 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 3
Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, EtMemorial 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 2011, 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. Director Mike Curran is the Co-President and Director of the Curran Group.Form 990, Part VI, Line 2

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (3 entries)

Address Line1AddressForeign/AddressLine1CityAddressForeign/CityCountryAddressForeign/CountryPostal CodeAddressForeign/PostalCodePrimary ActivitiesPrimaryActivitiesBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEIN
Centegra Insurance Services LTD
PO Box 1051Grand CaymanCJKY1-1102Malpractice Insurance ProviderCentegra Health System
Centegra Primary Care LLC
Physician PracticeCentegra Health System385 Millennium DriveCrystal LakeIL60012364085398
Centegra Health Bridge Fitness Center
Health & Fitness CenterHealth Bridge Corporation385 Millennium DriveCrystal LakeIL60012261277524

Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
Oak Creek Lodge
385 Millennium DriveCrystal LakeIL60012363591359Hospital OperationsIL501(c)(3)3Centegra Health Systemfalse
Health Bridge Corporation
385 Millennium DriveCrystal LakeIL60012363196550Health & Fitness CenterIL501(c)(3)11cCentegra Health Systemfalse
NIMED Corporation
385 Millennium DriveCrystal LakeIL60012363119911Property ManagementIL501(c)(3)11cCentegra Health Systemfalse
Centegra Health System Foundation
385 Millennium DriveCrystal LakeIL60012363723610Fundraising for Medical CentersIL501(c)(3)11aCentegra Health Systemfalse
Northern Illinois Medical Center
4201 Medical Center DriveMcHenryIL60050362338884Hospital OperationsIL501(c)(3)3Centegra Health Systemfalse
Centegra Health System
385 Millennium DriveCrystal LakeIL60012363196559Hospital Operations SupportIL501(c)(3)11cfalseN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

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Business Name Line1Centegra Management ServicesBusinessNameLine1

Address US AddressUS

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Address Line1385 Millennium DriveAddressLine1
CityCrystal LakeCity
StateILState
ZIP Code60012ZIPCode
FieldValueIRS element (for citing)
EIN364028114EIN
Primary ActivityPhysician Practice MgmtPrimaryActivity
Legal Domicile StateILLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Centegra Health SystemBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityC corpTypeOfEntity
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Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
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 OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

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