FURP.ORG / PUBLIC DATA EXPLORER

GIBSON AREA HOSPITAL: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
GIBSON AREA HOSPITAL (EIN 37-0647938)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-08-09
IRS object ID
201112219349300926
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-08-09T16:20:38-05:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ECK SCHAFER & PUNKE LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1600 East Adams StreetAddressLine1
CitySpringfieldCity
StateILState
ZIP Code627011624ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN370647938EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Gibson Community Hospital AssociationBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlGIBSNameControl
Phone2177844251Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11120 North MelvinAddressLine1
CityGibson CityCity
StateILState
ZIP Code60936ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRob SchmittName
TitleCEOTitle
Phone2177844251Phone
Date Signed2011-07-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBrent LeachName
Phone2175251111Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonRob SchmittNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11120 North MelvinAddressLine1
CityGibson CityCity
StateILState
ZIP Code60936ZIPCode
FieldValueIRS element (for citing)
Gross Receipts46529571GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitehttp://www.gibsonhospital.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1952YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionHealth care and related servicesActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees532TotalNbrEmployees
Total Nbr Volunteers207TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year136282ContributionsGrantsPriorYear
Contributions Grants Current Year50908ContributionsGrantsCurrentYear
Program Service Revenue Prior Year41267441ProgramServiceRevenuePriorYear
Program Service Revenue CY44564924ProgramServiceRevenueCY
Investment Income Prior Year24567InvestmentIncomePriorYear
Investment Income Current Year67303InvestmentIncomeCurrentYear
Other Revenue Prior Year1476203OtherRevenuePriorYear
Other Revenue Current Year1846436OtherRevenueCurrentYear
Total Revenue Prior Year42904493TotalRevenuePriorYear
Total Revenue Current Year46529571TotalRevenueCurrentYear
Grants And Similar Amnts CY17000GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year23306288SalariesEtcPriorYear
Salaries Etc Current Year27182663SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year20458840OtherExpensePriorYear
Other Expenses Current Year21677518OtherExpensesCurrentYear
Total Expenses Prior Year43765128TotalExpensesPriorYear
Total Expenses Current Year48877181TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-860635RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-2347610RevenuesLessExpensesCY
Total Assets BOY36555707TotalAssetsBOY
Total Assets EOY35525548TotalAssetsEOY
Total Liabilities BOY19252622TotalLiabilitiesBOY
Total Liabilities EOY20338922TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY17303085NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY15186626NetAssetsOrFundBalancesEOY
Mission DescriptionTo provide personalized, professional services to the residents of the communities we serve.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense40079288Expense
Grants17000Grants
Revenue46411360Revenue
DescriptionThe organization provides for inpatient and outpatient health care along with long-term care for members of the community and surrounding areas.Description
Total Program Service Expense40079288TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109648NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees532NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Rob SchmittBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2177844251TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11120 North MelvinAddressLine1
CityGibson CityCity
StateILState
ZIP Code60936ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
Jim Hood
President1.00XX000
Margo Martin
Vice-President1.00XX000
Tracy Epps
Treasurer1.00XX000
Ellen Lee
Secretary1.00XX000
Carl Hudson Jr
Director1.00X000
Steve Kelly
Director1.00X000
David J Hagan MD
Director1.00X000
Marty Nuss
Director1.00X000
Mark Spangler MD
Director1.00X000
Nancy Krumwiede
Director1.00X000
John Leonard
Director1.00X000
Michael Young
Director1.00X000
Kathy Bennett
Director1.00X000
Ted Swanson
Director1.00X000
Rob Schmitt
CEO40.00X000
Gary Abrams
CFO40.00X101129016272
Richard Foellner DO
Physician40.00524966020377X
John G Rowe
Physician40.00511382020397X
Douglas McDonald
Nurse Anes40.00197906016905X
Kathleen Antoline
Nurse Anes40.0018678306877X
Franki Crist
Nurse Anes40.00187082015666X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1709248TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation96494TotalOtherCompensation
Number Individuals GT100 K16NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
All Inclusive Medical Services
Orland Park IllinoisOrland ParkIL60462ER Hospitalist Physicians1313714
Cardinal Health Pharmacy Management
1330 Enclave ParkwayHoustonTX77077Pharmacy Management1305258
Quorum Health Resources
105 Continental PlaceBrentwoodTN37027Hospital Management495478
MCS Office Technologies
104 N Jordan DriveGibson CityIL60936Computer Services268790
CPSI
6600 Wall StMobileAL36695Computer Services233793
FieldValueIRS element (for citing)
Number Of Contractors GT100 K6NumberOfContractorsGT100K
All Other Contributions50908AllOtherContributions
Total Contributions50908TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNet Patient ServiceDescription
Business Code621990BusinessCode
Total Revenue Column44564924TotalRevenueColumn
Related Or Exempt Function Income44564924RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue44564924TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column67303TotalRevenueColumn
Exclusion$67,303ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMiscellaneousDescription
Business Code900099BusinessCode
Total Revenue Column1846436TotalRevenueColumn
Related Or Exempt Function Income1846436RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue1846436TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column46529571TotalRevenueColumn
Related Or Exempt Function Income46411360RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$67,303ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total17000Total
Program Services17000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total96585Total
Program Services79200ProgramServices
Management And General17385ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total21004306Total
Program Services17223531ProgramServices
Management And General3780775ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6081772Total
Program Services4987053ProgramServices
Management And General1094719ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2297608Total
Program Services1884039ProgramServices
Management And General413569ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total326210Total
Program Services267492ProgramServices
Management And General58718ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total569910Total
Program Services467326ProgramServices
Management And General102584ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2323655Total
Program Services1905397ProgramServices
Management And General418258ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total813066Total
Program Services666714ProgramServices
Management And General146352ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Purchased Services47405633887262853301
Supplies44483683647662800706
Other16291101332810296300
Rental Equipment15749501291459283491
Bad Debts14602641197416262848

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1493814Total
Program Services1224927ProgramServices
Management And General268887ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total48877181Total
Program Services40079288ProgramServices
Management And General8797893ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2733731BOY
EOY3865216EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6591306BOY
EOY6790613EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY145707BOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY521707BOY
EOY520794EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY314389BOY
EOY447468EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis42151871LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec21936587LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY21715921BOY
EOY20215284EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY3704500BOY
EOY3075545EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY403687BOY
EOY363318EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY424759BOY
EOY247310EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY36555707BOY
EOY35525548EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4295835BOY
EOY6318225EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY4073BOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY14952714BOY
EOY14020697EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY19252622BOY
EOY20338922EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY17185631BOY
EOY15067470EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY117454BOY
EOY119156EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY17303085BOY
EOY15186626EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY36555707BOY
EOY35525548EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

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 D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis344036OtherCostOrOtherBasis
Book Value344036BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis23632065OtherCostOrOtherBasis
Depreciation9949259Depreciation
Book Value13682806BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis17172569OtherCostOrOtherBasis
Depreciation11320016Depreciation
Book Value5852553BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1003201OtherCostOrOtherBasis
Depreciation667312Depreciation
Book Value335889BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings20215284TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionInvestmentsDescription
Book Value3075545BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities3075545TotalOfBookValueSecurities
Total Revenue46529571TotalRevenue
Total Expenses48877181TotalExpenses
Excess Or Deficit For Year-2347610ExcessOrDeficitForYear
Net Unrealized GL On Investments230857NetUnrealizedGLOnInvestments
Other$294OtherAmount
Total Adjustments231151TotalAdjustments
Excess Or Deficit Per FS-2116459ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt46760428TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments230857NetUnrealizedGainsInvestments
Revenue Not Rptd F990230857RevenueNotRptdF990
Revenue Subtotal46529571RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99046529571TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt48877181TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal48877181ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99048877181TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part X:Description of Uncertain Tax Positions Under FIN 48:Effective October 1, 2009, the GAHHS adopted the new requirements related to the accounting for uncertainty in income taxes (as initially required by Financial Accounting Standards Board Financial Interpretation No. 48 and subsequently superseded by Accounting Standards Codification 740). This guidance sets a minimum threshold for financial statement recognition of the benefit of a tax position taken or expected to be taken in a tax return. Tax positions for the open tax years as of Septemeber 30, 2010 were reviewed, and it was determined that no provision for uncertain tax positions is required.
Part XI, Line 8 - Other Adjustments:Transfer of Net Assets to Gibson Area Hospital Foundation #36-4311943

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage150.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1162856TotalCommunityBenefitExpense
Direct Offsetting Revenue627032DirectOffsettingRevenue
Net Community Benefit Expense535824NetCommunityBenefitExpense
Percent Of Total Expense0.01100PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense6811868TotalCommunityBenefitExpense
Direct Offsetting Revenue2817682DirectOffsettingRevenue
Net Community Benefit Expense3994186NetCommunityBenefitExpense
Percent Of Total Expense0.08170PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense7974724TotalCommunityBenefitExpense
Direct Offsetting Revenue3444714DirectOffsettingRevenue
Net Community Benefit Expense4530010NetCommunityBenefitExpense
Percent Of Total Expense0.09270PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense108925TotalCommunityBenefitExpense
Net Community Benefit Expense108925NetCommunityBenefitExpense
Percent Of Total Expense0.00220PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense14743114TotalCommunityBenefitExpense
Direct Offsetting Revenue9885879DirectOffsettingRevenue
Net Community Benefit Expense4857235NetCommunityBenefitExpense
Percent Of Total Expense0.09940PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense92401TotalCommunityBenefitExpense
Net Community Benefit Expense92401NetCommunityBenefitExpense
Percent Of Total Expense0.00190PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense14944440TotalCommunityBenefitExpense
Direct Offsetting Revenue9885879DirectOffsettingRevenue
Net Community Benefit Expense5058561NetCommunityBenefitExpense
Percent Of Total Expense0.10350PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense22919164TotalCommunityBenefitExpense
Direct Offsetting Revenue13330593DirectOffsettingRevenue
Net Community Benefit Expense9588571NetCommunityBenefitExpense
Percent Of Total Expense0.19620PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$791,347BadDebtExpenseAmount
Amount Attributable To39657AmountAttributableTo
Amount Reimbursed By Medicare9263960AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare11249628CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-1985668MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV (9 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalEr24 HoursEr24HoursOtherOther
Gibson Community Hospital
1120 North MelvinGibson CityIL60936XXXLong-term care
Paxton Clinic
227 N MarketPaxtonIL60957Physician clinic
Onarga Clinic
109 N ChestnutOnargaIL60955Physician clinic
Family Healthcare of Hoopeston
837 E OrangeHoopestonIL60942Physician clinic
Family Health Care of Farmer City
1230 S George Rock DrFarmer CityIL61842Physician clinic
Prairie Family Medicine and Obstetrics
122 E WabashForrestIL60936Physician clinic
Gibson Area Hospital Orthopedics
10 Doctors ParkGibson CityIL60936Physician clinic
Gibson Area Ambulance Service
1120 North MelvinGibson CityIL60936Ambulance service
Cristina Medrano MD
1 Doctors ParkGibson CityIL60936Physician clinic

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Costing Method UsedPart I, Line 7: Cost to charge ratio was obtained using Cost Accounting System. This system does address all patient segments. It is an overall cost to charge ratio for the hospital.CostingMethodUsed
Bad Debt FootnotePart III, Line 4: Cost methodology for numbers in 2, and 3: 2 - actual bad debt expenses recorded in FY 2010 times 53.7% cost to charge ratio. 3 - 5% of total bad debt expense. Patient Financial Services works towards getting charity eligible patients qualified several times during the collection process. Ultimately, unpaid patient accounts are turned over to agencies that try to collect the patient balance due, but patients accounts are never turned over to a credit reporting agency.BadDebtFootnote
Shortfall As Community BenefitPart III, Line 8: Part of the shortfall will be settled on the Cost Report. Also filed Cost Report will be reviwed by intermediary, and will be settled according to Medicare Guidelines.ShortfallAsCommunityBenefit
Debt Collection PolicyPart III, Line 9b: To the extent patients qualify for charity and financial assistance, no further collection efforts are taken on those balances qualified. No patient balances are credit reportable.DebtCollectionPolicy
Needs AssessmentPart VI, Line 2: The hospital is currently working on a community needs assessment outlined by CMS guidelines.NeedsAssessment
Patient Education AssistancePart VI, Line 3: Charity care/financial assistance is posted on the hospital website. It is also discussed during the pre-registration process for all self pay and patients with a high deductible. Informational packets are distributed from each registration area [including ED] for self pay & high deductible. The informational packets have a application, cover letter about the program, and contact info on who/where to call for more info or assistance. Each self pay patient is contacted by Financial Healthcare Resources to discuss the government programs they may be eligible for and/or charity care. Charity care is also offered on the first statement that the patient receives.PatientEducationAssistance
Community InformationPart VI, Line 4: The hospital is located Ford County, IL. The hospital also has clinics in Livingston, DeWitt, and Iroquois counties, as well as serving Vermillion County. The hospital and clinics serve areas that are all considered rural; small towns and farmland. Of the counties listed above, as of 2008, percentage of persons below poverty level: Ford, 9.8%; Livingston 11.4%; DeWitt 10.2%; Iroquois 10.8%; Vermillion 14.6%; State level is 12.2% . Median Income, 2008: Ford, $51,313; Livingston, $50,972, DeWitt, $47,645; Iroquois, $46,529; Vermillion $41,292; State level is $56,230. Percent of population enrolled with HFS for benefits as of 2009: Ford, 18.8%; Livingston, 17.2%; DeWitt 18.7%; Iroquois 19.6%; Vermillion 27.1%. Closest hospital facilities are 30 miles to the southeast in Champaign/Urbana (Carle, Provena), and 35 miles to the west in Bloomington/Normal (OSF, Advocate/BroMenn).CommunityInformation
Other InformationPart VI, Line 6: The entire Board of Directors is comprised of persons who reside in our primary service area, as do the Administrative Staff of the hospital. All of the physicians in the community have privileges at the hospital. The organization has also recruited and placed physicians in other rural communities, that also have privileges at the hospital. The hospital runs and maintains EMS services to several rural communities, which the organization runs at a loss every year. Any surplus funds are used to improve medical equipment, purchase needed supplies and pharmaceuticals, recruit providers for needed services, pay for staff to attend educational workshops, and other needed items and services for the betterment of the community. No excess of revenue over expenses are used to pay any shareholders or investors. This organization does not have either of the latter.OtherInformation
Affiliated Health Care SystemPart VI, Line 7: Gibson Hospital is not part of an affiliated healthcare system.AffiliatedHealthCareSystem
Reports Filed With StatesILReportsFiledWithStates

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
Telecare
215 E 3rd StGibson CityIL60936237353001501(c)310000Community Benefit
Community Economic Development Foundation
402 N Sangamon AveGibson CityIL60936371336454501(c)37000Community Benefit
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: Grants are made to 501 (c)(3) organizations to provide community benefit.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Richard Foellner DO
388840013612600018037023400545343000
John G Rowe
4251410862410001946109360531779000
Douglas McDonald
197906000001627506300214811000
Kathleen Antoline
186783000005447014300193660000
Franki Crist
1870820000015666000202748000

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1The City of Gibson CityBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN376000811IssuerEIN
Date Issued2005-08-01DateIssued
Issue Price12675000IssuePrice
Description Of PurposeRefinancing of prior bonds, costs associated with facility renovationDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds13797826TotalProceeds
Amount In Reserve Fund858595AmountInReserveFund
Amount Defeased7282727AmountDefeased
Amount Unspent39451AmountUnspent
Issuance Costs From Proceeds378150IssuanceCostsFromProceeds
Capital Expenditures5238903CapitalExpenditures
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind0AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name PersonMark Spangler MDNamePerson
Purpose Of LoanStart-up costs for his practicePurposeOfLoan
Loan From OrganizationXLoanFromOrganization
Original Principal$345,000OriginalPrincipalAmount
Balance Due116627BalanceDue
Default0Default
Approved By Board1ApprovedByBoard
Written Agreement1WrittenAgreement
FieldValueIRS element (for citing)
Total Balance Due116627TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonMark Spangler MDNamePerson
FieldValueIRS element (for citing)
RelationshipCurrent board member of the OrganizationRelationship
Amount Of Transaction107554AmountOfTransaction
Description Of TransactionPays the Organization a monthly fee for management services for his office.DescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section A, line 2Mark Spangler has a outstanding loan with the Hospital.
Form 990, Part VI, Section A, line 3The Chief Executive Officer (CEO) is employed by a hospital management company.
Form 990, Part VI, Section A, line 6The Hospital has association members. These members are any individual who contributed $100 or more to the Hospital during the fiscal year and Life Members - Being those who have contributed a sum of One Thousand ($1,000) dollars or more to further the objectives of the Hospital.
Form 990, Part VI, Section A, line 7aThe Association's members are allowed to vote annually at the member meeting.
Form 990, Part VI, Section A, line 7bAt the annual meeting, the members are asked to vote on the approval of the Board of Directors acting on the member's behalf.
Form 990, Part VI, Section B, line 11Form 990 is prepared by our independent accountants and provided to the governing body prior to filing. Form 990 is reviewed in detail by the Controller and CFO.
Form 990, Part VI, Section B, line 12cYearly conflict of interest agreements are signed by board members. There is also a quarterly compliance review of these agreeements.
Form 990, Part VI, Section B, line 15Top management and key employees' compensation is determined based on a review of current market comparables, experience level, and competitive compensation packages. The CEO is responsible for all compensation negotiations.
Form 990, Part VI, Section C, line 19All documents are available to the public upon request.
Form 990, Part IV, Line 12The Hospital received an unqualified GAAP opinion on financial statements that were combined with the Gibson Area Hospital Foundation.Explanation on audited financial statements

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1Gibson Area Hospital FoundationBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11120 N MelvinAddressLine1
CityGibson CityCity
StateILState
ZIP Code60936ZIPCode
FieldValueIRS element (for citing)
EIN364311943EIN
Primary ActivitiesSupport of the HospitalPrimaryActivities
Legal Domicile StateILLegalDomicileState
Exempt Code Section501(c)3ExemptCodeSection
Public Charity Status509(a)2PublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg