MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL HOSPITAL ASSOCIATION (EIN 37-0684691)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-04-18
- IRS object ID
- 201101089349300020
- Schema version
- 2009v1.7
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-04-18T13:57:25-05:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3999 PENNSYLVANIA AVE SUITE 100 | AddressLine1 |
| City | DUBUQUE | City |
| State | IA | State |
| ZIP Code | 52002 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 370684691 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Memorial Hospital Association | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MEMO | NameControl |
| Phone | 2173573131 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 160 | AddressLine1 |
| City | Carthage | City |
| State | IL | State |
| ZIP Code | 62321 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Teresa Smith | Name |
| Title | CFO | Title |
| Phone | 2173573131 | Phone |
| Date Signed | 2011-04-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Carmen Krantz | Name |
| Phone | 5635561790 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Ada Bair | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 160 | AddressLine1 |
| City | Carthage | City |
| State | IL | State |
| ZIP Code | 62321 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 20411544 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.mhtlc.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1947 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | Memorial Hospital provides clinical care, diagnostic, treatment, and wellness services | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 265 | TotalNbrEmployees |
| Total Nbr Volunteers | 62 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 687153 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 737913 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 17190310 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 19429798 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -101663 | InvestmentIncomePriorYear |
| Investment Income Current Year | 161942 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 66561 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 17775800 | TotalRevenuePriorYear |
| Total Revenue Current Year | 20396214 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 443219 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10112868 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 10494603 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 3868 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 7796446 | OtherExpensePriorYear |
| Other Expenses Current Year | 10038834 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 17909314 | TotalExpensesPriorYear |
| Total Expenses Current Year | 20976656 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -133514 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -580442 | RevenuesLessExpensesCY |
| Total Assets BOY | 38693986 | TotalAssetsBOY |
| Total Assets EOY | 34939495 | TotalAssetsEOY |
| Total Liabilities BOY | 27032826 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 23781442 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 11661160 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 11158053 | NetAssetsOrFundBalancesEOY |
| Mission Description | Memorial Hospital is committed to improving health by providing education and wellness programs and innovative services at all the stages of life. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 14466361 | Expense |
| Grants | 443219 | Grants |
| Revenue | 19427498 | Revenue |
| Description | Memorial Hospital is dedicated to maintaining and improving the health of all people in the Hancock County area. Governed by a Board of Directors, we serve as a vital safety net, serving our communities with access to quality healthcare services. Memorial Hospital provides many types of community benefit care. Community benefit care includes charity care, community health fairs, lectures, and free health screenings, demonstrating our commitment to improving the overall health of the residents of the Hancock County area.We are always committed to providing compassionate care to every member of our community regardless of their ability to pay.We participate in community health-fairs county-wide. These events feature health information, screenings, and presentations. Memorial Hospital sponsors the bloodmobile and provides language assistance services.Memorial Hospital employees serve a vital role in local workforce development and youth mentoring in the health careers. In total, our employees provided over 6,000 hours of hands-on mentoring with area students, some interested in health careers, and some through our involvement with the school co-op program. Memorial Hospital also has partnerships with Kirksville School of Osteopathic Medicine and Carl Sandburg school of Nursing. In addition, we also host high school Leadership groups.Our employees volunteer many hours each year to many worthy community programs including serving on community coordinated coalition committees offering educational events to the community, participating in many local walks/events such as the Relay for Life and supporting disaster readiness planning, among hundreds of other activities.Memorial Hospital provides necessary meeting space for many area support groups and community programs, including HUGS, Hancock County Red Cross and many more.The Organization maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy. The amounts of charges foregone, based on established rates, were $345,040 for the year ended June 30, 2010. The estimated costs of the charges foregone, based upon an overall cost-to-charge ratio calculation, for the year end June 30, 2010, were $204,000. In addition, the Organization provides services to other medically indigent patients under certain government-reimbursed public aid programs. Such programs pay providers amounts which are less than established charges for the services provided to the recipients, and for some services the payments are less than the cost of rendering the services provided. The Organization also commits significant time and resources to endeavors and critical services which meet otherwise unfulfilled community needs. Many of these activities are sponsored with the knowledge that they will not be self-supporting or financially viable. | Description |
| Total Program Service Expense | 14466361 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 88 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 265 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Janet Fleming | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2173573131 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 160 | AddressLine1 |
| City | Carthage | City |
| State | IL | State |
| ZIP Code | 62321 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Terry Pope | |||||||
| President | 3.00 | X | X | 0 | 0 | 0 | |
| Matt Dickinson | |||||||
| Vice President | 3.00 | X | X | 0 | 0 | 0 | |
| Peggy Latherow | |||||||
| Secretary/Treasurer | 3.00 | X | X | 0 | 0 | 0 | |
| Dan Asbury | |||||||
| Director | 3.00 | X | 0 | 0 | 0 | ||
| Carol Gronewold | |||||||
| Director | 3.00 | X | 0 | 0 | 0 | ||
| LuAnn Haas | |||||||
| Director | 3.00 | X | 0 | 0 | 0 | ||
| Kathy Holst | |||||||
| Director | 3.00 | X | 0 | 0 | 0 | ||
| Larry McClintock | |||||||
| Director | 3.00 | X | 0 | 0 | 0 | ||
| Edward McKenney | |||||||
| Director | 3.00 | X | 0 | 4800 | 0 | ||
| Sharon Morrison | |||||||
| Director | 3.00 | X | 0 | 0 | 0 | ||
| Dennis Rankin | |||||||
| Director | 3.00 | X | 0 | 0 | 0 | ||
| Angela Pollock | |||||||
| Director | 3.00 | X | 0 | 0 | 0 | ||
| Ada Bair | |||||||
| CEO | 40.00 | X | 174792 | 0 | 13839 | ||
| Teresa Smith | |||||||
| CFO | 37.00 | X | 106508 | 0 | 26151 | ||
| Philip A Caropreso MD | |||||||
| Surgeon | 40.00 | 268951 | 0 | 18280 | X | ||
| Patrick D Lynch MD | |||||||
| Family Practice Physician | 40.00 | 253944 | 0 | 25617 | X | ||
| Christopher M Jones MD | |||||||
| Family Practice Physician | 40.00 | 298371 | 0 | 18274 | X | ||
| Michael R Hambrick MD | |||||||
| Family Practice Physician | 40.00 | 240030 | 0 | 22856 | X | ||
| Rachel Rahman MD | |||||||
| Physician | 40.00 | 172062 | 0 | 27545 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1514658 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 4800 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 152562 | TotalOtherCompensation |
| Number Individuals GT100 K | 11 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Robins & Morton | |||||
| 5500 Maryland Way Suite 100 | Brentwood | TN | 37027 | General contractor | 2867967 |
| Emcare Inc | |||||
| 7032 Collection Center Drive | Chicago | IL | 60693 | ER Physician coverage | 464093 |
| McDonough District Hospital | |||||
| 525 E Grant Street | Macomb | IL | 61455 | Laboratory services | 412934 |
| Diamond Healthcare Corp | |||||
| 701 East Byrd Street | Richmond | VA | 23219 | Gerophych contract service | 200538 |
| Quorum Health Resources | |||||
| 105 Continental Place | Brentwood | TN | 37027 | Hospital support services | 176558 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 10 | NumberOfContractorsGT100K |
| Government Grants | 474737 | GovernmentGrants |
| All Other Contributions | 263176 | AllOtherContributions |
| Total Contributions | 737913 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient service revenu | 622110 | 16728992 | 16728992 |
| Clinic revenue | 621111 | 2452440 | 2452440 |
| Other supporting reven | 900099 | 215768 | 215768 |
| Equity in earnings of | 900099 | 102742 | 102742 |
| Equity in earnings of | 900099 | -70144 | -70144 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 19429798 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 173635 | TotalRevenueColumn |
| Exclusion | $173,635 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 70198 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 3637 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 66561 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 66561 | TotalRevenueColumn |
| Exclusion | $66,561 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 11693 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -11693 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -11693 | TotalRevenueColumn |
| Exclusion | -$11,693 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 20396214 | TotalRevenueColumn |
| Related Or Exempt Function Income | 19429798 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $228,503 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 443219 | Total |
| Program Services | 443219 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 324651 | Total |
| Management And General | 324651 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7876840 | Total |
| Program Services | 7094461 | ProgramServices |
| Management And General | 782379 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 130469 | Total |
| Program Services | 107264 | ProgramServices |
| Management And General | 23205 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1616397 | Total |
| Program Services | 1433485 | ProgramServices |
| Management And General | 182912 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 546246 | Total |
| Program Services | 475899 | ProgramServices |
| Management And General | 70347 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60000 | Total |
| Management And General | 60000 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6950 | Total |
| Management And General | 6950 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 83311 | Total |
| Management And General | 83311 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3070601 | Total |
| Program Services | 2421334 | ProgramServices |
| Management And General | 649267 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63104 | Total |
| Program Services | 17839 | ProgramServices |
| Management And General | 45265 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1902869 | Total |
| Program Services | 1683302 | ProgramServices |
| Management And General | 215699 | ManagementAndGeneral |
| Fundraising | 3868 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 475067 | Total |
| Program Services | 474917 | ProgramServices |
| Management And General | 150 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 53171 | Total |
| Program Services | 50348 | ProgramServices |
| Management And General | 2823 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52647 | Total |
| Program Services | 48086 | ProgramServices |
| Management And General | 4561 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1096287 | Total |
| Management And General | 1096287 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1735960 | Total |
| Management And General | 1735960 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 383558 | Total |
| Program Services | 206250 | ProgramServices |
| Management And General | 177308 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | Program ServicesProgramServices |
|---|---|---|---|
| Bad debt expense | 854938 | 854938 | |
| Provider tax | 168153 | 168153 | |
| Miscellaneous expense | 32218 | 22261 | 9957 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20976656 | Total |
| Program Services | 14466361 | ProgramServices |
| Management And General | 6506427 | ManagementAndGeneral |
| Fundraising | 3868 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18519 | BOY |
| EOY | 176015 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 816015 | BOY |
| EOY | 354801 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2626055 | BOY |
| EOY | 2708550 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39282 | BOY |
| EOY | 50544 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 286829 | BOY |
| EOY | 253896 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 151755 | BOY |
| EOY | 150940 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 27465711 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 3899491 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24685597 | BOY |
| EOY | 23566220 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8480108 | BOY |
| EOY | 5609589 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1120097 | BOY |
| EOY | 547705 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 469729 | BOY |
| EOY | 1521235 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38693986 | BOY |
| EOY | 34939495 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2150475 | BOY |
| EOY | 2204283 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20385000 | BOY |
| EOY | 20020000 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 984952 | BOY |
| EOY | 950317 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 501842 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3512399 | BOY |
| EOY | 105000 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27032826 | BOY |
| EOY | 23781442 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11606191 | BOY |
| EOY | 10639025 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31603 | BOY |
| EOY | 495662 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23366 | BOY |
| EOY | 23366 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11661160 | BOY |
| EOY | 11158053 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38693986 | BOY |
| EOY | 34939495 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 23366 | BeginningOfYearBalance |
| End Of Year Balance | 23366 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 23366 | BeginningOfYearBalance |
| End Of Year Balance | 23366 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.00000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 189215 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 504757 | OtherCostOrOtherBasis |
| Book Value | 693972 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 23033720 | OtherCostOrOtherBasis |
| Depreciation | 1155093 | Depreciation |
| Book Value | 21878627 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3517168 | OtherCostOrOtherBasis |
| Depreciation | 2718886 | Depreciation |
| Book Value | 798282 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 220851 | OtherCostOrOtherBasis |
| Depreciation | 25512 | Depreciation |
| Book Value | 195339 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 23566220 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Estimated health claims payable | Description |
| Amount | $105,000 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 105000 | TotalOfAmounts |
| Total Revenue | 20396214 | TotalRevenue |
| Total Expenses | 20976656 | TotalExpenses |
| Excess Or Deficit For Year | -580442 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 77335 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 77335 | TotalAdjustments |
| Excess Or Deficit Per FS | -503107 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 20153369 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 20153369 | RevenueSubtotal |
| Other Revenues Not Included | 242845 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 242845 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 20396214 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 20537074 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 3637 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 3637 | ExpensesNotRptdF990 |
| Expenses Subtotal | 20533437 | ExpensesSubtotal |
| Other Expenses Not Included | 443219 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 443219 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 20976656 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part V, Line 4: | Description of Intended Use of Endowment Funds: | An endowment fund with the income to be used for the benefit of Memorial Hospital Association |
| Part X: | Description of Uncertain Tax Positions Under FIN 48: | The Organization has adopted the provisions of FASB Accounting Standards Codification Topic 740-10 (previously Financial Interpretation No. 48, Accounting for Uncertainty in Income Taxes) on July 1, 2009. The implementation of this standard had no impact on the consolidated financial statements. As of both the date of adoption, and as of June 30, 2010, the unrecognized tax benefit accrual was zero. The Organization will recognize future accrued interest and penalties related to unrecognized tax benefits in income tax expense if incurred. The Organization is no longer subject to Federal or state tax examinations by tax authorities for years before 2006. |
| Part XII, Line 4b - Other Adjustments: | Capital contributions included in fund balance for financial statements: 137224. Rental expenses included in expenses for financial statements: -3637. Restricted contributions recorded in fund balance per financial statements: 109258. | |
| Part XIII, Line 2d - Other Adjustments: | Rental expenses included in revenue on Form 990: 3637. | |
| Part XIII, Line 4b - Other Adjustments: | Donations included in fund balance for financial statements: 443219. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 204000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 204000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01040 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4777050 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1218530 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3558520 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.16400 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4981050 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1218530 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3762520 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.17440 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 307 | PersonsServed |
| Total Community Benefit Expense | 41680 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 41680 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 4 | PersonsServed |
| Total Community Benefit Expense | 17585 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 17585 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 924249 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 642343 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 281906 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01430 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 311 | PersonsServed |
| Total Community Benefit Expense | 983514 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 642343 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 341171 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01730 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 311 | PersonsServed |
| Total Community Benefit Expense | 5964564 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1860873 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4103691 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.19170 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $501,796 | BadDebtExpenseAmount |
| Amount Attributable To | 5369 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 7075329 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 7005276 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 70053 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Memorial Hospital Association | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1454 North County Road 2050 | AddressLine1 |
| City | Carthage | City |
| State | IL | State |
| ZIP Code | 62321 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Costing Method Used | Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost to charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. Community health improvement services and health professions education, lines 7e and 7f, are reported based on actual expenses recorded in the organization's general ledger. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report.Total community benefit expense as a percentage of total expenses is 26%. | CostingMethodUsed |
| Subsidized Health Services Expln | Part I, Line 7g: Costs of $1,580,853 were included in subsidized health services reported on line g. These are the costs to operate two rural health clinics. | SubsidizedHealthServicesExpln |
| Percent Of Total Expense Expln | Part I, Line 7f: The amount of bad debt expense removed from total expenses to determine the percentage was $854,938. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: The organization's bad debt expense was converted to cost using the cost-to-charge ratio derived from Worksheet 2.Accounts are not written off to bad debt until all payments on the account are applied including all third party payments, contractual allowances, and discounts. Any financial assistance or charity care is recorded as an adjustment to patient service revenue and is not written off to bad debt. We realize some patients may qualify for financial assistance but do not complete the required paperwork. We try to work with these patients to provide them with some form of financial assistance or other payment arrangements, but when patients are able to pay and do not, their balances are written off to bad debt. Payments received on an account previously written off to bad debt reduces bad debt expense.The estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's charity care policy is calculated based on the ratio of charity care to gross charges. Financial Statement Footnote: The carrying amount of patient and resident receivables is reduced by a valuation allowance that reflects management's estimate of amounts that will not be collected from patients, residents, and third-party payors. Management reviews patient and resident receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients and residents due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision. Management also reviews accounts to determine if classification as charity care is appropriate. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: Memorial Hospital Association did not have a Medicare shortfall for fiscal year 2010. If the organization were to have a Medicare shortfall this would be considered a community benefit. Memorial Hospital provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services.Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. These amounts do not include fee schedule amounts. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Part III, Line 9b: Memorial Hospital does not pursue collection activities for patients that qualify for charity care or patients that have set up payment arrangements for their accounts. Also, collection activities are not pursued for patients that are in the process of applying for charity care and patients waiting for approval or denial from public aid. Any personal portion due after financial assistance is established would follow normal collection procedures.After all third-party payments have been made on an account, a statement generates through the CPSI system. The patient has 30 days to pay the account in full. If the account is not paid in full within 30 days, another statement is sent to the patient. If the account is not paid in full within the next 10 days, the account is referred to Healthcare Billing Service (HCBS), the contracted professional medical billing company used by Memorial Hospital. HCBS assists patients with payment options for their account balances. Memorial Hospital does not charge patients interest. HCBS works all accounts for a minimum of 90 days. As accounts fall outside of the guidelines, HCBS prepares a listing of accounts that have gone through the standard collection activity and submit the listing to the Director of Patient Financial Services to be reviewed for approval to forward to the collection agency. The CFO and CEO approve all accounts to be forwarded to the collection agency and written off to bad debt. Memorial Hospital does not refuse services to patients that generate bad debt. | DebtCollectionPolicy |
| Number Of Facility Type Expln | Part V: The organization also has the following types of facilities other than those required to be licensed separately as healthcare facilities in the state of Illinois:2 rural health clinics2 family medical clinics1 Behavioral health center | NumberOfFacilityTypeExpln |
| Needs Assessment | Part VI, Line 2: Memorial Hospital, based on its mission, wants to ensure that the health care needs of the communities we serve are met. The hospital has medical clinics located throughout Hancock County to improve access to health care services to our patients. The Board also has four committees; finance, planning, quality and community health, and marketing committees that have community representation to ensure that input is obtained from the community when considering the health care needs of those we serve. Community input on desired services is obtained through patient satisfaction surveys that are initiated by the inpatient unit, emergency department, and medical clinics that provide a line of communication to identify additional health care services that community desires. | NeedsAssessment |
| Patient Education Assistance | Part VI, Line 3: Memorial Hospital strives to provide a rewarding and healing process to our patients, plus an affordable, comfortable process to meet their financial obligations. Memorial Hospital informs their patients individually upon admission about the eligibility for assistance under federal, state or local government programs, and provides the patient with information regarding the organization's charity care policy.When our organization contacts a patient to preregister we explain the charity care and financial assistance. Our collection and financial assistance policies and applications are on our website. We also provide financial counseling to any patient.We post our charity care policy and information regarding federal, state, and local programs at all our registration areas. Brochures are distributed regarding financial assistance with all admission packages.Billing statements have financial assistance support telephone numbers at the bottom of each statement.Our third party billing service provides counseling to our patients regarding available financial assistance if there is a need. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: Carthage is a city in Hancock County, Illinois. It is located in western Illinois along the Mississippi River. The nearest city with a population > 50,000 is Peoria, IL. The population of Carthage was 2,725 at the 2000 census. Memorial Hospital serves the county of Hancock in the State of Illinois. Hancock County is a rural community with the median income of $42,732 compared to $53,966 in the state of Illinois. In the years 2005-2009 13% of the population was in poverty. The unemployment rate is 11.3%, compared to 10.2% for the U.S. average. The most common industries are agriculture, transportation, and health care. The nearest hospital is Keokuk Area Hospital about 15 miles away. | CommunityInformation |
| Other Information | Part VI, Line 6: Memorial Hospital is dedicated to improving health by providing education and wellness programs and innovative services at all the stages of life for residents of Hancock County. The hospital is governed by a 12-member, volunteer Board of Directors that represent key areas within Hancock County as well as the medical staff. Our employees volunteer each year to many worthy community programs including serving on community coordinated coalition committees offering educational events to the community, participating in many local walks/events such as the Relay for Life, and supporting disaster readiness planning, among hundreds of other activities. As a critical access hospital, Memorial Hospital is an 18-bed facility that provides general medical, surgical services along with obstetrics and an array of outpatient services for the community. Specialty clinics are also provided locally in the areas of cardiology, oncology, neurology, ophthalmology, podiatry, orthopedic, pulmonology, and sleep apnea so that our patients don't have to travel far to receive needed health care services. These specialty physicians are members of the hospital's medical staff along with other providers that desire to serve members of our service area. With the support of the community, Memorial Hospital built a new 18-bed hospital that was occupied in August, 2009. The facility provides up-to-date, diagnostic equipment and services with a capital budget also presented and approved on an annual basis to ensure that needed equipment is obtained to meet the expectations of our patients. The hospital also participates in several health care events throughout the year providing free services as well as a listing of services that are offered through the hospital, clinics, and specialty clinics. This includes, but is not limited to, health fairs, blood pressure screenings, and diabetic education. | OtherInformation |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|---|---|
| Hancock County Nursing Home Association | |||||||||
| PO Box 160 | Carthage | IL | 62321 | 370902248 | 501(c)(3) | 413765 | Book value | Land improvements and building | Additional medical space for improved health and wellness |
| Hickory Grove Apartments (Hancock County Supportive Living Facility LLP) | |||||||||
| 403 S Adams | Carthage | IL | 62321 | 204445121 | 29454 | Book value | Equipment | Medical equipment for seniors | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 1 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: Memorial Hospital was located in a building that was attached to Hancock County Nursing Home. The Hospital built a new facility and donated the old building, equipment, and land improvements to Hancock County Nursing Home and Hickory Grove Apartments (Hancock Co. Supportive Living Facility, LLP.) | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ada Bair | |||||||||||||
| 174792 | 0 | 0 | 0 | 0 | 0 | 5345 | 0 | 8520 | 0 | 188657 | 0 | 0 | 0 |
| Philip A Caropreso MD | |||||||||||||
| 268951 | 0 | 0 | 0 | 0 | 0 | 3739 | 0 | 14583 | 0 | 287273 | 0 | 0 | 0 |
| Patrick D Lynch MD | |||||||||||||
| 253944 | 0 | 0 | 0 | 0 | 0 | 3154 | 0 | 22501 | 0 | 279599 | 0 | 0 | 0 |
| Christopher M Jones MD | |||||||||||||
| 298371 | 0 | 0 | 0 | 0 | 0 | 8250 | 0 | 10069 | 0 | 316690 | 0 | 0 | 0 |
| Michael R Hambrick MD | |||||||||||||
| 240030 | 0 | 0 | 0 | 0 | 0 | 856 | 0 | 22037 | 0 | 262923 | 0 | 0 | 0 |
| Rachel Rahman MD | |||||||||||||
| 172062 | 0 | 0 | 0 | 0 | 0 | 4995 | 0 | 22577 | 0 | 199634 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer |
|---|---|---|---|---|---|---|
| Western Illinois Development Authority | ||||||
| 352256539 | 958362AT2 | 2008-08-22 | 9972195 | New facility and equipment upgrades | 0 | 0 |
| Western Illinois Development Authority | ||||||
| 352256539 | 958362AU9 | 2008-09-16 | 10385000 | New facility and equipment upgrades | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Total ProceedsTotalProceeds | Amount DefeasedAmountDefeased | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Capital ExpendituresCapitalExpenditures |
|---|---|---|---|---|---|---|---|---|
| 9972195 | 9778750 | 193445 | 2009 | 1 | 0 | 1 | 1 | |
| 10385000 | 207014 | 2009 | 0 | 0 | 1 | 1 | 10177986 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Bond Counsel Routinely EngagedBondCounselRoutinelyEngaged | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 |
| 0 | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 0 | 1 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 1 | The President only votes when there is a tie. |
| Form 990, Part VI, Section A, line 6 | The corporation has one class of members. Any individual or organization that contributes One Hundred Dollars ($100.00) or more, upon application is entitled to receive life membership in the corporation. Such memberships are not transferable. The membership of this corporation is unlimited. |
| Form 990, Part VI, Section A, line 7a | Memorial Hospital Association has association members who are presented with a slate of officers and board members at the annual meeting. The association votes by proxy to elect these officers and board members. Each member is entitled to one vote on each matter submitted to a vote of the members. No person whose name does not appear on the list of members kept by the Secretary-Treasurer is entitled to vote and there is no cumulative voting. |
| Form 990, Part VI, Section B, line 11 | The Form 990 is reviewed by the Board of Directors' Finance Committee and recommended for approval by the Board of Directors. The final return is reviewed and signed by the CFO. |
| Form 990, Part VI, Section B, line 12c | Officers, board members, and key employees are required to sign a conflict of interest statement upon hiring or becoming a board member. The disclosure is updated at the annual association meeting. Any possible conflict of interest is disclosed to the other board members and made a matter of record through an annual procedure and also when the interest becomes a matter of board action. Disclosures are reviewed by the Board of Directors and any member for whom conflicts have been identified leave the room and abstain from voting. Appropriate documentation of the handling of the conflict is kept to protect the interested party and Hancock County Nursing Home. Additionally, the Compliance Officer meets with the Compliance Committee of the board. Any issues identified are logged and followed up by the Compliance Officer. |
| Form 990, Part VI, Section B, line 15a | Salary surveys are reviewed annually to ensure all positions individually are within the market rate. Surveys are used from the local area (Blessing survey) and LSN & QHR (comparable organization surveys). The Executive Committee determines the salary for the CEO. Each board member does an independent performance review of the CEO, which is compiled and used by the Executive Committee. The Executive Committee uses the Illinois Hospital Association salary survey as a guide for compensation using the high, middle, and low ranges for similar size organizations. Measures such as revenue, performance of the CEO, and budgetary constraints are all factors that are considered when reviewing the CEO's salary. The most recent review of salary occurred in December 2009 and January 2010. The salary for the CFO is determined by the CEO using the Blessing Survey and the Illinois Hospital Association survey as a guide for similar organizations based on the local area. |
| Form 990, Part VI, Section C, line 19 | The organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request. |
| Form 990, Schedule R, Part V, line 2: | The method used to determine the amount on line 2(1) was fund equity transfer noted in the financial statements. This was the value of the land and building given to Hancock County Nursing Home. The method used to determine the amount on line 2(2) and 2(3) was the amount of the services provided from the general ledger. |
| Form 990, Page 7, Part VII: | The following individuals devoted time providing services to these related organizations: Hancock County Nursing Home Association Dan Asbury 1 hour per week LuAnn Haas 1 hour per week Peggy Latherow 1 hour per week Matt Dickinson 1 hour per week Carol Gronewold 1 hour per week Kathy Holst 1 hour per week Larry McClintock 1 hour per week Edward McKenney 1 hour per week Sharon Morrison 1 hour per week Terry Pope 1 hour per week Dennis Rankin 1 hour per week Angela Pollock 1 hour per week Ada Bair 3 hours per week Teresa Smith 3 hours per week Advance Physical Therapy Larry McClintock 1 hour per week Sherrick Home Health Larry McClintock 1 hour per week Hickory Grove Apartments (Hancock County Supportive Living Facility, LLP) Dan Asbury 1 hour per week Peggy Latherow 1 hour per week LuAnn Haas 1 hour per week |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hancock County Nursing Home | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 160 | AddressLine1 |
| City | Carthage | City |
| State | IL | State |
| ZIP Code | 62321 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 370902248 | EIN |
| Primary Activities | Provide nursing home care in a 57 bed home | PrimaryActivities |
| Legal Domicile State | IL | LegalDomicileState |
| Exempt Code Section | 501(c)(3) | ExemptCodeSection |
| Public Charity Status | 3 | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Advance Physical Therapy | ||||||||||||
| 620 Wabash Street | Carthage | IL | 62321 | 113655886 | Physical therapy rehabilitation | IL | N/A | Related | 131512 | 26813 | 0 | 1 |
| Hickory Grove Apartments (Hancock County Supportive Living Facility LLP) | ||||||||||||
| 403 S Adams | Carthage | IL | 62321 | 204445121 | Assisted living facility | IL | N/A | |||||
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sherrick Home Health | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 525 Main St | AddressLine1 |
| City | Carthage | City |
| State | IL | State |
| ZIP Code | 62321 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 371180373 | EIN |
| Primary Activity | Home health | PrimaryActivity |
| Legal Domicile State | IL | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 7707 | ShareOfTotalIncome |
| Share Of EOY Assets | 424411 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| Hancock County Nursing Home Association | |
| B | 413765 |
| Hancock County Nursing Home Association | |
| J | 89026 |
| Hancock County Nursing Home Association | |
| K | 163027 |
| Advance Physical Therapy | |
| Sherrick Home Health | |
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