RICHLAND MEMORIAL HOSPITAL INC: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- RICHLAND MEMORIAL HOSPITAL INC (EIN 37-1363001)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-07-28
- IRS object ID
- 201122099349300712
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-07-28T09:20:46-05:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KERBER ECK & BRAECKEL LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1116 W MAIN ST | AddressLine1 |
| City | CARBONDALE | City |
| State | IL | State |
| ZIP Code | 629012335 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 371363001 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RICHLAND MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | RICH | NameControl |
| Phone | 6183952131 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 EAST LOCUST STREET | AddressLine1 |
| City | OLNEY | City |
| State | IL | State |
| ZIP Code | 624502598 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MIKE STOVERINK | Name |
| Title | CFO | Title |
| Phone | 6183952131 | Phone |
| Date Signed | 2011-07-19 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID SCHNAKE | Name |
| Phone | 6185291040 | Phone |
| Date Prepared | 2011-07-28 | DatePrepared |
| 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 | DAVID ALLEN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 EAST LOCUST STREET | AddressLine1 |
| City | OLNEY | City |
| State | IL | State |
| ZIP Code | 62450 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 42376879 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.RICHLANDMEMORIAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1953 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE EXCELLENT HEALTHCARE, PROMOTE WELLNESS, AND EDUCATE PATIENTS, STAFF, AND THE COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 560 | TotalNbrEmployees |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 12139 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 77228 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 36849371 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 41049311 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 123386 | InvestmentIncomePriorYear |
| Investment Income Current Year | 90959 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1263104 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1159381 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 38248000 | TotalRevenuePriorYear |
| Total Revenue Current Year | 42376879 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 20164533 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 22315744 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 16678471 | OtherExpensePriorYear |
| Other Expenses Current Year | 19184656 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 36843004 | TotalExpensesPriorYear |
| Total Expenses Current Year | 41500400 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1404996 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 876479 | RevenuesLessExpensesCY |
| Total Assets BOY | 28265080 | TotalAssetsBOY |
| Total Assets EOY | 29408545 | TotalAssetsEOY |
| Total Liabilities BOY | 12653454 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 13009013 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 15611626 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 16399532 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROVIDE EXCELLENT HEALTHCARE, PROMOTE WELLNESS, AND EDUCATE PATIENTS, STAFF, AND THE COMMUNITY. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 41500400 | Expense |
| Revenue | 42376880 | Revenue |
| Description | RICHLAND MEMORIAL HOSPITAL, INC., D/B/A RICHLAND MEMORIAL HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF RICHLAND MEMORIAL HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. THE MISSION OF RMH IS TO SERVE OUR COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH THE COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, WE OFFER > FREE CARE > CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST; AND > HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT AND EDUCATE THE COMMUNITY. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, PROFESSIONAL EDUCATION PROGRAMS, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. DURING FISCAL YEAR 2010, RICHLAND MEMORIAL HOSPITAL RECORDED 21,343 PATIENT DAYS. RICHLAND MEMORIAL HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST. THE HOSPITAL ALSO PROVIDES CARE TO PERSONS COVERED BY COMMERCIAL INSURANCE AT BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, RICHLAND MEMORIAL HOSPITAL RECOGNIZES THESE AMOUNTS AS COSTS INCURRED IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. CHARITY CARE IS ALSO PROVIDED THROUGH THE HOSPITAL'S INTERNAL POLICY OFFERED IN FY 2010. RICHLAND MEMORIAL HOSPITAL ALSO OFFERS AND PARTICIPATES IN PROGRAMS THROUGHOUT THE COMMUNITY. THESE INCLUDE: 1. AMBULANCE COVERAGE 2. MEETINGS/CONFERENCE FACILITIES 3. SCHOLARSHIPS 4. SUPPORT OF COMMUNITY ORGANIZATIONS/EVENTS/ACTIVITIES: > AMERICAN CANCER SOCIETY RELAY FOR LIFE OF RICHLAND COUNTY > AMERICAN HEART ASSOCIATION AMERICAN HEART WALK > AMERICAN RED CROSS BLOOD DRIVES > BIG BROTHERS/BIG SISTERS OF RICHLAND COUNTY > EAST RICHLAND HIGH SCHOOL ATHLETICS, YEARBOOK, HEALTH OCCUPATIONS CLASS AND AFTER PROM ACTIVITIES > EDWARDS COUNTY FAIR > FARM SAFETY FOR JUST KIDS FARM SAFETY DAY CAMP > ILLINOIS STATE UNIVERSITY LABORATORY MED. TECH TRAINING SITE > IVY TECH (TERRE HAUTE) LABORATORY MED. TECH TRAINING SITE > IMMANUEL UNITED METHODIST CHURCH OUTREACH THANKSGIVING/CHRISTMAS MEALS > KASKASKIA COLLEGE PHYSICAL THERAPY STUDENT TRAINING SITE > LAKELAND COLLEGE PHYSICAL THERAPY STUDENT TRAINING SITE > OLNEY ARTS COUNCIL > OLNEY CENTRAL COLLEGE BLUE KNIGHTS TIP OFF CLUB > OLNEY CENTRAL COLLEGE LADIES' SOFTBALL > OLNEY CENTRAL COLLEGE NURSING, RADIOGRAPHY AND PHLEBOTOMY PROGRAMS TRAINING SITE > OLNEY AND THE GREATER RICHLAND COUNTY CHAMBER OF COMMERCE > OLNEY FIRE DEPARTMENT/SCHOOL FIRE SAFETY (K-6 GRADE) > OLNEY "LIGHTS FANTASIA" CHRISTMAS PARADE > OLNEY LITTLE LEAGUE > OLNEY TIGERSHARKS SWIM TEAM > RED HILL HIGH SCHOOL YEARBOOK > RICHLAND COUNTY DEVELOPMENT CORPORATION > RICHLAND COUNTY FARM AND FAIR ASSOCIATION > RICHLAND COUNTY RECREATIONAL COUNCIL > RICHLAND COUNTY TENNIS ASSOCIATION > ROTARY CLUB OF OLNEY/RICHLAND COUNTY > STOPPING WOMEN ABUSE NOW (SWAN) > SOUTHERN ILLINOIS UNIVERSITY PHYSICIAN ASSISTANT CLINICAL HUB SITE > UNIVERSITY OF SOUTHERN INDIANA OCCUPATIONAL THERAPY STUDENT TRAINING SITE > VINCENNES UNIVERSITY PHYSICAL THERAPY TRAINING SITE > WEST RICHLAND HIGH SCHOOL YEARBOOK, PTO, AND AFTER PROM > OLNEY FFA > ARC COMMUNITY SUPPORT SYSTEMS > RICHLAND COUNTY SHERIFF'S "SHOP WITH A COP" PROGRAM > RICHLAND COUNTY FARM BUREAU > SOUTHEASTERN ILLINOIS CONCERT FOUNDATION > OLNEY CENTRAL COLLEGE FOUNDATION > EAST RICHLAND FOUNDATION FOR ACADEMIC EXCELLENCE (ERFAE) > SHRINERS > OLNEY ELK'S > DUNDAS RURITAN 5. WELLNESS EVENTS/COMMUNITY CLINICS/SUPPORT GROUPS/ OUTREACH/EDUCATION > BLOOD PRESSURE SCREENING CLINICS > DIABETIC EDUCATION DAY > HEALTHFEST > NATIONAL HOSPITAL WEEK CHOLESTEROL/PSA SCREENING CLINIC > OLNEY SENIOR EXPO > SUPPORT GROUPS/EDUCATION A. BREAST CANCER SUPPORT GROUP - TICKET FOR THE CURE B. BREAST HEALTH OUTREACH/EDUCATION - TICKET FOR THE CURE C. CPR CLASSES D. DIABETES SUPPORT GROUP E. FIRST AID CLASSES F. INFECTION CONTROL IN-SERVICES TO LOCAL SCHOOLS G. LIFE SMART FOR WOMEN EDUCATIONAL CLASSES H. PREPARED CHILDBIRTH CLASSES I. REGIONAL PSYCHIATRIC CENTER PATIENT SUPPORT GROUP 6. SPECIAL ASSISTANCE PROGRAMS > MAMMOGRAPHY ASSISTANCE - IL BREAST AND CERVICAL CANCER PROGRAM SERVICE PROVIDER (LITTLE EGYPT & EAST CENTRAL REGION) > MAMMOGRAPHY ASSISTANCE - SUSAN G. KOMEN FOR THE CURE GRANT | Description |
| Total Program Service Expense | 41500400 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | true | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | true | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 32 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 560 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MIKE STOVERINK | NamePerson |
| Telephone Number | 6183952131 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 EAST LOCUST ST | AddressLine1 |
| City | OLNEY | City |
| State | IL | State |
| ZIP Code | 62450 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| PAT BURKE | |||||||
| CHAIRMAN | 3.00 | X | 0 | 0 | 0 | ||
| ANDY SCHUETZ | |||||||
| VICE CHAIR | 6.00 | X | 0 | 0 | 0 | ||
| RICK BUSSARD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DENNIS GRAVES | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| HERBERT BROKHOF | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LUIS DE VENECIA MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JESSICA SLATER | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| DON HATTEN MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| BRAD HOUSTON MD | |||||||
| BOARD MEMBER | 7.50 | X | 0 | 0 | 0 | ||
| LOUISE LYBARGER | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| DOUG TOMPSON | |||||||
| SEC/TREAS | 4.00 | X | 0 | 0 | 0 | ||
| KRISTI URFER | |||||||
| BOARD MEMBER | 1.50 | X | 0 | 0 | 0 | ||
| HERMAN ZUBER | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| DAVE ALLEN | |||||||
| CEO | 60.00 | 135190 | 0 | 9504 | X | ||
| MIKE STOVERINK | |||||||
| CFO | 40.00 | 105264 | 0 | 7537 | X | ||
| NIRANAT DEJTIRANUKUL | |||||||
| ENT DOCTOR | 40.00 | 248574 | 0 | 9768 | X | ||
| BILLY ROSS | |||||||
| CRNA | 40.00 | 192049 | 0 | 9420 | X | ||
| JOHN WALL | |||||||
| CRNA | 40.00 | 188028 | 0 | 11543 | X | ||
| JOHN ALLEN | |||||||
| CRNA | 40.00 | 178501 | 0 | 14185 | X | ||
| MARY WALLER | |||||||
| PHYSICIAN | 40.00 | 130776 | 0 | 55 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1178382 | TotalReportableCompFromOrg |
| Total Other Compensation | 62012 | TotalOtherCompensation |
| Number Individuals GT100 K | 8 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation | Address Line2AddressOfContractor/AddressUS/AddressLine2 |
|---|---|---|---|---|---|---|
| PRAIRE EMERGENCY GROUP LTD | ||||||
| 1 JODI LANE | BLOOMINGTON | IL | 61701 | ER PHYSICIANS | 925518 | |
| SODEXHO | ||||||
| 4880 PAYSPHERE CIRCLE | CHICAGO | IL | 60674 | FOOD SERVICE PR | 787494 | |
| PHARMACY SYSTEMS INC | ||||||
| PO BOX 71-0716 | COLUMBUS | OH | 43217 | PHARMACY MANAGE | 224532 | |
| INSIGHT IMAGING | ||||||
| PO BOX 71-0716 | DALLAS | TX | 75284 | MRI SERVICE | 203610 | |
| SAJJAN K NEMANI MD MRCP | ||||||
| 1054 ML KING DRIVE | CENTRALIA | IL | 62801 | SLEEP STUDIES | 201750 | SUITE 124 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| All Other Contributions | 77228 | AllOtherContributions |
| Total Contributions | 77228 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PAT REVENUE LESS MED/MEDC | Description |
| Total Revenue Column | 41049311 | TotalRevenueColumn |
| Related Or Exempt Function Income | 41049311 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 41049311 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 90959 | TotalRevenueColumn |
| Related Or Exempt Function Income | 90959 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|
| MISC. OTHER REVENUE | 403587 | $403,587 |
| PROPERTY TAX | 349204 | $349,204 |
| LAUNDRY SERVICES | 214221 | $214,221 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 192369 | TotalRevenueColumn |
| Exclusion | $192,369 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1159381 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 42376879 | TotalRevenueColumn |
| Related Or Exempt Function Income | 41140270 | RelatedOrExemptFunctionIncome |
| Exclusion | $1,159,381 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 240454 | Total |
| Program Services | 240454 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16468132 | Total |
| Program Services | 16468132 | ProgramServices |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 541742 | Total |
| Program Services | 541742 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3892997 | Total |
| Program Services | 3892997 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1172419 | Total |
| Program Services | 1172419 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59548 | Total |
| Program Services | 59548 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4657778 | Total |
| Program Services | 4657778 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 226623 | Total |
| Program Services | 226623 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3496267 | Total |
| Program Services | 3496267 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 725873 | Total |
| Program Services | 725873 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 102319 | Total |
| Program Services | 102319 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78924 | Total |
| Program Services | 78924 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 417568 | Total |
| Program Services | 417568 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1612028 | Total |
| Program Services | 1612028 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 443309 | Total |
| Program Services | 443309 | ProgramServices |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| PROVISION FOR BAD DEBTS | 3658040 | 3658040 |
| PROVIDER TAX ASSESSMENT | 1164620 | 1164620 |
| PURCHASE OF DRUGS | 1108556 | 1108556 |
| REPAIRS/MAINTENANCE | 884725 | 884725 |
| OTHER EXPENSES | 548478 | 548478 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41500400 | Total |
| Program Services | 41500400 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2352854 | BOY |
| EOY | 618280 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5144599 | BOY |
| EOY | 6213129 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 333821 | BOY |
| EOY | 355345 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 686391 | BOY |
| EOY | 771883 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 39464711 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 26763689 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12788596 | BOY |
| EOY | 12701022 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5974297 | BOY |
| EOY | 7949842 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 984522 | BOY |
| EOY | 799044 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28265080 | BOY |
| EOY | 29408545 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3426965 | BOY |
| EOY | 4278874 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9226489 | BOY |
| EOY | 8730139 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12653454 | BOY |
| EOY | 13009013 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15233757 | BOY |
| EOY | 16110237 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 377869 | BOY |
| EOY | 289295 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15611626 | BOY |
| EOY | 16399532 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28265080 | BOY |
| EOY | 29408545 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disclosed Orgs Legal Control | false | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | false | DisclosedForCharitablePurposes |
| Written Policy Monitoring | false | WrittenPolicyMonitoring |
| Sect170h Requirements Satisfied | false | Sect170hRequirementsSatisfied |
| Solicited Assets For Sale | false | SolicitedAssetsForSale |
| Agent Trustee Etc | false | AgentTrusteeEtc |
| Included On FS | false | IncludedOnFS |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 39483 | OtherCostOrOtherBasis |
| Book Value | 39483 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 23498467 | OtherCostOrOtherBasis |
| Depreciation | 15231884 | Depreciation |
| Book Value | 8266583 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 462487 | OtherCostOrOtherBasis |
| Depreciation | 457128 | Depreciation |
| Book Value | 5359 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 15464274 | OtherCostOrOtherBasis |
| Depreciation | 11074677 | Depreciation |
| Book Value | 4389597 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 12701022 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CD'S AND MONEY MARKET ACCOUNTS | Description |
| Book Value | 7949842 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 7949842 | TotalOfBookValueSecurities |
| Total Revenue | 42376879 | TotalRevenue |
| Total Expenses | 41500400 | TotalExpenses |
| Excess Or Deficit For Year | 876479 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 876479 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 42376879 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 42376879 | RevenueSubtotal |
| Total Revenue Per Form990 | 42376879 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 41500400 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 41500400 | ExpensesSubtotal |
| Total Expenses Per Form990 | 41500400 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | LIABILITY UNDER FIN 48 FOOTNOTE | Identifier |
| Return Reference | SCHEDULE D, PAGE 3, PART X | ReturnReference |
| Explanation | FOLLOWING IS THE LIABILITY FOR UNCERTAIN TAX POSITIONS EXACTLY AS IT APPEARS IN THE FISCAL YEAR 2010 FINANCIAL STATEMENTS. THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM INCOME TAXES. THE HOSPITAL ADOPTED THE PROVISIONS OF ASC TOPIC 740-10-25, "INCOME TAXES RECOGNITION". WHEN TAX RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHER POSITIONS TAKEN OR THE AMOUNT OF THE POSITION TAKEN WOULD NOT BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HOSPITALS INCLUDE THE ENTITY TAKING A POSITION OF TAX-EXEMPT STATUS WITHOUT CORRESPONDING PROOF FROM FEDERAL AND STATE TAXING AUTHORITIES AND THERE IS MATERIAL NET INCOME GENERATED BY THE ENTITY OR PRIVATE INUREMENT THAT COULD CAUSE REVOCATION OF THE EXEMPT STATUS. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION. TAX POSITIONS TAKEN ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE-LIKELY-THAN-NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50 PERCENT LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNCERTAIN TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. THERE WERE NO UNCERTAIN TAX BENEFITS IDENTIFIED AND RECORDED AS A LIABILITY UPON THE ADOPTION OF ASC TOPIC 740-10-25 OR AT SEPTEMBER 30, 2010. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1053000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1053000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02540 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8498143 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6914143 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1584000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03820 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9551143 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6914143 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2637000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06350 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 100000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 100000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00240 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3746812 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2849200 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 897612 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02160 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3846812 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2849200 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 997612 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02400 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13397955 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9763343 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3634612 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08760 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $1,214,469 | BadDebtExpenseAmount |
| Amount Attributable To | 607235 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 13280277 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 16399482 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -3119205 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RICHLAND MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 EAST LOCUST | AddressLine1 |
| City | OLNEY | City |
| State | IL | State |
| ZIP Code | 62450 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Critical Access Hospital | X | CriticalAccessHospital |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Costing Method Used | WE USED A COST-TO-CHARGE RATIO AS CALCULATED UTILIZING DATA FROM AN INTERNAL COST ACCOUNTING SYSTEM AND USING A METHODOLOGY CONSISTENT WITH SCEDULE H INSTRUCTIONS TO DETERMINE THE AMOUNTS ON LINES 7A AND 7B OF PART I OF SCHEDULE H. WE USED ACTUAL COSTS AS REPORTED IN THE GENERAL LEDGER SYSTEM TO DETERMINE THE AMOUNTS ON LINES 7E AND 7I OF SCHEDULE H PART I. SCHEDULE H, PART I, LINE 7G WAS DETERMINED USING BOTH ACTUAL AMOUNTS FROM THE GENERAL LEDGER AND A COST-TO-CHARGE RATIO SPECIFIC TO EACH PROGRAM. | CostingMethodUsed |
| Subsidized Health Services Expln | WE INCLUDED AS SUBSIDIZED HEALTH SERVICES,14,767, IN COSTS ATTRIBUTABLE TO PHYSICIAN CLINIC. | SubsidizedHealthServicesExpln |
| Bad Debt Footnote | WE CALCULATED BAD DEBT EXPENSE AT COST USING A COST-TO-CHARGE RATIO AS CALCULATED UTILIZING DATA FROM AN INTERNAL COST ACCOUNTING SYSTEM AND USING A METHODOLOGY CONSISTENT WITH SCEDULE H INSTRUCTIONS. AFTER EXHAUSTING ALL COLLECTION PROCEDURES PATIENT ACCOUNTS ARE THEN WRITTEN OFF TO BAD DEBT EXPENSE. WE ESTIMATE THAT 50% OF OUR PATIENT ACCOUNTS WRITTEN OFF TO BAD DEBT WOULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE BUT THE PATIENTS CHOSE NOT TO APPLY. THE FOLLOWING IS THE FOOTNOTE RELATING TO BAD DEBT EXPENSE EXACTLY AS IT APPEARS IN THE FOOTNOTES TO OUR AUDITED FINANCIAL STATEMENTS: THE HOSPITAL ALSO PROVIDES A SIGNIFICANT AMOUNT OF UNCOMPENSATED CARE FOR PATIENTS WHICH IS NOT INCLUDED ABOVE, BUT IS REPORTED ON THE STATEMENT OF OPERATIONS AS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANY OF THOSE PATIENTS ARE UNINSURED OR UNDERINSURED, BUT DID NOT APPLY FOR OR QUALIFY FOR CHARITY CARE. DURING THE YEAR ENDED SEPTEMBER 30, 2010 THE HOSPITAL REPORTED PROVISIONS FOR UNCOLLECTIBLE ACCOUNTS OF 3,658,040. | BadDebtFootnote |
| Shortfall As Community Benefit | TOTAL TOTAL UNREIMBURSED REIMBURSEMENT COST COST PER MEDICARE COST REPORT 13,216,369 14,903,982 (1,687,613) OTHER MEDICARE REVENUES/COSTS 63,908 1,495,500 (1,431,592) TOTAL MEDICARE SHORTFALL 13,280,277 16,399,482 (3,119,205) THE HOSPITAL UTILIZED THE INTERNAL COST ACCOUNTING SYSTEM TO CALCULATE UNREIMBURSED MEDICARE COSTS. SOME MEDICARE CHARGES NOT ASSOCIATED WITH ITEMS PAID ON THE COST REPORT, THE COSTS ASSOCIATED WITH THOSE CHARGES, AND OTHER COST PER THE HOSPITAL'S COST ACCOUNTING SYSTEM HAVE BEEN INCLUDED. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | RICHLAND MEMORIAL HOSPITAL (RMH) APPLIES ITS COLLECTION PRACTICES EQUALLY TO ALL PATIENTS, BOTH CHARITY CARE ELIGIBLE AND NON-CHARITY CARE PATIENTS. THE PROCEDURES ARE AS FOLLOWS: 1. WE WILL SEND 3 STATEMENTS AND 2 COLLECTION LETTERS IN A 28 DAY CYCLE. WE WILL SEND STATEMENTS BASED UPON PATIENT PORTION OF 10 OR GREATER. 2. THE PATIENT'S ACCOUNT WILL AGE THROUGH THE STATEMENT PROCESS BEFORE BEING WRITTEN OFF TO BAD DEBT. A.PRIVATE PAY ACCOUNTS WILL RECEIVE A STATEMENT WITHIN 9 DAYS OF THE DISCHARGE DATE. B.ACCOUNTS WITH A PATIENT PORTION AFTER INSURANCE WILL BE ELIGIBLE TO RECEIVE A STATEMENT APPROXIMATELY 14 DAYS AFTER THE INSURANCE PAYMENT HAS BEEN POSTED. C.28 DAYS LATER THE PATIENT IS MAILED A THIRD STATEMENT D.28 DAYS LATER THE PATIENT IS MAILED A FORTH STATEMENT E.28 DAYS LATER THE PATIENT IS MAILED THE FIRST COLLECTION LETTER F.28 DAYS LATER THE PATIENT IS MAILED THE FINAL COLLECTION LETTER G.APPROXIMATELY 15 DAYS LATER THE PATIENT IS WRITTEN OFF TO BAD DEBT. 3. RMH WILL ATTEMPT TO CONTACT THE GUARANTOR VIA PHONE AFTER THEY RECEIVE THE FIRST STATEMENT ON BALANCES GREATER THAN 1,000. 4. RMH WILL ATTEMPT TO CONTACTTHE GUARANTOR VIA PHONE AFTER THE SECOND STATEMENT ON BALANCES LESS THAN 1,000 5. RMH WILL MAKE A SECOND ATTEMPT TO CONTACT THE GUARANTOR VIA PHONE IF PAYMENT OR CONTACT HAS NOT BEEN MADE USUALLY AROUND THE SAME TIME THE SECOND COLLECTION LETTER IS SENT. 6. RMH WILL SEND 2 COLLECTION LETTERS TO THE PATIENT. PATIENT HAS 15 DAYS AFTER THE FINAL LETTER TO PAY BEFORE BEING WRITTEN OFF TO BAD DEBT. | DebtCollectionPolicy |
| Needs Assessment | THE DETERMINATION OF CURRENT AND FUTURE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED ARE BASED ON THE FOLLOWING FACTORS: EXISTENCE OR NONEXISTENCE OF SERVICES, OPPORTUNITY, SUPPLY, DEMONSTRATED NEED, REQUESTS FROM PATIENTS, AND/OR COMBINED EFFORTS WITH OUTSIDE ENTITIES THAT WOULD HELP FILL A NEED OR STRENGTHEN A CURRENT SERVICE. WE ARE CONSTANTLY COLLECTING DATA THAT WOULD HELP MAKE THESE DECISIONS AND OFTEN CONSULT WITH VARIOUS DEPARTMENTS WITHIN THE HOSPITAL INCLUDING NURSING, INFORMATION TECHNOLOGY, FINANCE, AND PHYSICIANS. THIS INFORMATION IS THEN REVIEWED AND THE HOSPITAL'S ADMINISTRATIVE TEAM WOULD INCORPORATE THE NEWLY IDENTIFIED HEALTH CARE NEEDS INTO THE STRATEGIC PLAN. | NeedsAssessment |
| Patient Education Assistance | ALL PATIENT BILLING STATEMENTS INCLUDE A STATEMENT THAT MENTIONS CONTACTING THE HOSPITAL IF THEY WISH TO APPLY FOR FINANCIAL ASSISTANCE OR WOULD LIKE TO SET UP PAYMENTS ON THE ACCOUNT. IF A PATIENT CONTACTS THE PATIENT FINANCIAL SERVICES DEPARTMENT ABOUT THE INABILITY TO PAY, THEY ARE INFORMED OF THE AVAILABLE OPTIONS, INCLUDING FINANCIAL ASSISTANCE, MEDICARE, AND MEDICAID APPLICATIONS. THEY WILL ALSO EXPLAIN HOW THE PATIENT CAN APPLY FOR ASSISTANCE. | PatientEducationAssistance |
| Community Information | RICHLAND MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA INCLUDES PORTIONS OF EIGHT SOUTHEASTERN ILLINOIS COUNTIES WITH A TOTAL PATIENT POPULATION OF ABOUT 60,000. THERE ARE EIGHT COUNTIES WITHIN THE HOSPITAL'S PRIMARY SERVICE AREA. RMH FURTHER EXTENDS HOME HEALTH AND HOSPICE SERVICES TO INDIVIDUALS LIVING IN FIVE ADDITIONAL COUNTIES. WE PROVIDE SERVICES TO PATIENTS WITHOUT REGARD TO AGE, SEX, RACE, COLOR, NATIONAL ORIGIN, RELIGIOUS CREED, GENDER IDENTITY, SEXUAL ORIENTATION, DISABILITY, INSURANCE COVERAGE OR ABILITY TO PAY. THE POPULATION OF RICHLAND MEMORIAL HOSPITAL'S SERVICE AREA IS ECONOMICALLY DISADVANTAGED MAKING IT MORE DIFFICULT TO AFFORD HEALTHCARE. FURTHERMORE, THERE IS NO HEALTH DEPARTMENT IN RICHLAND COUNTY MAKING THE HOSPITAL THE PRIMARY SOURCE FOR HEALTHCARE SERVICES AND HEALTH EDUCATION. ACCORDING TO THE 2000 UNITED STATES CENSUS, THE MEDIAN HOUSEHOLD INCOME IN THE HOSPITAL'S SERVICE AREA FALLS WELL BELOW THE STATE MEDIAN OF 46,950, RANGING BETWEEN 30,361 (LOW MEDIAN) AND 34,721 (HIGH MEDIAN). THE ILLINOIS DEPARTMENT OF PUBLIC HEALTH CENTER FOR RURAL HEALTH INDICATES ON ITS WEB SITE THAT ALL OF THE COUNTIES IN THE HOSPITAL'S SERVICE AREA HAVE AT LEAST A PARTIAL FEDERAL HPSA DESIGNATION, WITH THE LOW-INCOME POPULATION BEING A PRIMARY CONCERN. | CommunityInformation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg |
|---|---|---|---|---|
| NIRANAT DEJTIRANUKUL | ||||
| 248574 | 9111 | 657 | 258342 | |
| BILLY ROSS | ||||
| 192049 | 8763 | 657 | 201469 | |
| JOHN WALL | ||||
| 187878 | 10886 | 657 | 199571 | 150 |
| JOHN ALLEN | ||||
| 178351 | 12855 | 1330 | 192686 | 150 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WAYNE SCHUETZ HBS INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | FAMILY MEMBER | Relationship |
| Amount Of Transaction | 52356 | AmountOfTransaction |
| Description Of Transaction | CONSTRUCTION | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| FIRST ACHIEVEMENT DESCRIPTION | FORM 990, PAGE 2, PART III, LINE 4A | OFFER > FREE CARE > CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST; AND > HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT AND EDUCATE THE COMMUNITY. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, PROFESSIONAL EDUCATION PROGRAMS, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. DURING FISCAL YEAR 2010, RICHLAND MEMORIAL HOSPITAL RECORDED 21,343 PATIENT DAYS. RICHLAND MEMORIAL HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST. THE HOSPITAL ALSO PROVIDES CARE TO PERSONS COVERED BY COMMERCIAL INSURANCE AT BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, RICHLAND MEMORIAL HOSPITAL RECOGNIZES THESE AMOUNTS AS COSTS INCURRED IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. CHARITY CARE IS ALSO PROVIDED THROUGH THE HOSPITAL'S INTERNAL POLICY OFFERED IN FY 2010. RICHLAND MEMORIAL HOSPITAL ALSO OFFERS AND PARTICIPATES IN PROGRAMS THROUGHOUT THE COMMUNITY. THESE INCLUDE: 1. AMBULANCE COVERAGE 2. MEETINGS/CONFERENCE FACILITIES 3. SCHOLARSHIPS 4. SUPPORT OF COMMUNITY ORGANIZATIONS/EVENTS/ACTIVITIES: > AMERICAN CANCER SOCIETY RELAY FOR LIFE OF RICHLAND COUNTY > AMERICAN HEART ASSOCIATION AMERICAN HEART WALK > AMERICAN RED CROSS BLOOD DRIVES > BIG BROTHERS/BIG SISTERS OF RICHLAND COUNTY > EAST RICHLAND HIGH SCHOOL ATHLETICS, YEARBOOK, HEALTH OCCUPATIONS CLASS AND AFTER PROM ACTIVITIES > EDWARDS COUNTY FAIR > FARM SAFETY FOR JUST KIDS FARM SAFETY DAY CAMP > ILLINOIS STATE UNIVERSITY LABORATORY MED. TECH TRAINING SITE > IVY TECH (TERRE HAUTE) LABORATORY MED. TECH TRAINING SITE > IMMANUEL UNITED METHODIST CHURCH OUTREACH THANKSGIVING/CHRISTMAS MEALS > KASKASKIA COLLEGE PHYSICAL THERAPY STUDENT TRAINING SITE > LAKELAND COLLEGE PHYSICAL THERAPY STUDENT TRAINING SITE > OLNEY ARTS COUNCIL > OLNEY CENTRAL COLLEGE BLUE KNIGHTS TIP OFF CLUB > OLNEY CENTRAL COLLEGE LADIES' SOFTBALL > OLNEY CENTRAL COLLEGE NURSING, RADIOGRAPHY AND PHLEBOTOMY PROGRAMS TRAINING SITE > OLNEY AND THE GREATER RICHLAND COUNTY CHAMBER OF COMMERCE > OLNEY FIRE DEPARTMENT/SCHOOL FIRE SAFETY (K-6 GRADE) > OLNEY "LIGHTS FANTASIA" CHRISTMAS PARADE > OLNEY LITTLE LEAGUE > OLNEY TIGERSHARKS SWIM TEAM > RED HILL HIGH SCHOOL YEARBOOK > RICHLAND COUNTY DEVELOPMENT CORPORATION > RICHLAND COUNTY FARM AND FAIR ASSOCIATION > RICHLAND COUNTY RECREATIONAL COUNCIL > RICHLAND COUNTY TENNIS ASSOCIATION > ROTARY CLUB OF OLNEY/RICHLAND COUNTY > STOPPING WOMEN ABUSE NOW (SWAN) > SOUTHERN ILLINOIS UNIVERSITY PHYSICIAN ASSISTANT CLINICAL HUB SITE > UNIVERSITY OF SOUTHERN INDIANA OCCUPATIONAL THERAPY STUDENT TRAINING SITE > VINCENNES UNIVERSITY PHYSICAL THERAPY TRAINING SITE > WEST RICHLAND HIGH SCHOOL YEARBOOK, PTO, AND AFTER PROM > OLNEY FFA > ARC COMMUNITY SUPPORT SYSTEMS > RICHLAND COUNTY SHERIFF'S "SHOP WITH A COP" PROGRAM > RICHLAND COUNTY FARM BUREAU > SOUTHEASTERN ILLINOIS CONCERT FOUNDATION > OLNEY CENTRAL COLLEGE FOUNDATION > EAST RICHLAND FOUNDATION FOR ACADEMIC EXCELLENCE (ERFAE) > SHRINERS > OLNEY ELK'S > DUNDAS RURITAN 5. WELLNESS EVENTS/COMMUNITY CLINICS/SUPPORT GROUPS/ OUTREACH/EDUCATION > BLOOD PRESSURE SCREENING CLINICS > DIABETIC EDUCATION DAY > HEALTHFEST > NATIONAL HOSPITAL WEEK CHOLESTEROL/PSA SCREENING CLINIC > OLNEY SENIOR EXPO > SUPPORT GROUPS/EDUCATION A. BREAST CANCER SUPPORT GROUP - TICKET FOR THE CURE B. BREAST HEALTH OUTREACH/EDUCATION - TICKET FOR THE CURE C. CPR CLASSES D. DIABETES SUPPORT GROUP E. FIRST AID CLASSES F. INFECTION CONTROL IN-SERVICES TO LOCAL SCHOOLS G. LIFE SMART FOR WOMEN EDUCATIONAL CLASSES H. PREPARED CHILDBIRTH CLASSES I. REGIONAL PSYCHIATRIC CENTER PATIENT SUPPORT GROUP 6. SPECIAL ASSISTANCE PROGRAMS > MAMMOGRAPHY ASSISTANCE - IL BREAST AND CERVICAL CANCER PROGRAM SERVICE PROVIDER (LITTLE EGYPT & EAST CENTRAL REGION) > MAMMOGRAPHY ASSISTANCE - SUSAN G. KOMEN FOR THE CURE GRANT |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11 | 990 IS REVIEWED BY ALL BOARD MEMBERS DURING SCHEDULED MEETINGS BEFORE IT IS FILED. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | 1. ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY BOARD MEMBER SHOULD BE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD BY THE BOARD MEMBER WHO HAS THE CONFLICT, AND MADE A MATTER OF RECORD, THROUGH THE BOARD'S ANNUAL FILING OF CONFLICT OF INTEREST STATEMENTS OR WHEN THE INTERET BECOMES A MATTER OF BOARD ACTION. 2. ANY BOARD MEMBER HAVING A DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHOULD NOT VOTE OR USE HIS/HER PERSONAL INFLUENCE ON THE MATTER, AND HE/SHE SHOULD NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING, EVEN WHERE PERMITTED BY LAW. THE MINUTES OF THE MEETING SHOULD REFLECT THAT A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING, AND THE QUORUM SITUATION. 3. THE FOREGOING REQUIREMENTS SHOULD NOT BE CONSTRUED AS PREVENTING THE BOARD MEMBER FROM ANSWERING PERTINENT QUESTIONS OF OTHER BOARD MEMBERS, SINCE HIS/HER KNOWLEDGE MAY BE OF GREAT ASSISTANCE. HOWEVER, THE MEMBER WITH A CONFLICT MUST ABSTAIN FROM MAKING MOTIONS, PARTICIPATING IN RELEVANT DELIBERATIOINS, VOTING, EXECUTING AGREEMENTS, ATTEMPTING TO INFLUENCE OTHERS VOTES, OR TAKING ANY SIMILAR DIRECT ACTION ON BEHALF OF THE CORPORATION WHERE THE CONFLICT OF INTEREST MIGHT PERTAIN. 4. ALL MEMBERS OF THE BOARD (INCLUDING EX-OFFICIO MEMBERS) ARE REQUIRED TO COMPLETE AND RETURN THE CONFLICT OF INTEREST DISCLOSURE STATEMENT NO LATER THAN NOVEMBER 30TH OF EACH YEAR OR WITHIN 30 DAYS OF THE CREATION OR OCCURRENCE OF ANY NEW CONFLICT. MEMBER(S) WHO DO NOT RETURN THE CONFLICT OF INTEREST STATEMENT WILL BE ADDRESSED IN ACCORDANCE WITH THE BYLAWS. 5. RESPONSES MAY BE COMPILED INTO PACKETS FOR DISTRIBUTION AND DISCUSSION ANNUALLY - AT THE NEXT BOARD MEETING FOLLOWING THE DUE DATE SEMI-ANNUALLY - SIX MONTHS FOLLOWING THE INITIAL REVIEW; AND, AS ANY NEW CONFLICT IS IDENTIFIED. 6. THE POLICY ON CONFLICT OF INTEREST WILL BE DISCUSSED WITH CANDIDATES FOR BOARD POSITIONS DURING THEIR INTERVIEW WITH THE NOMINATING COMMITTEE. THE IMPORATANCE OF AVOIDING CONFLICT OF INTEREST SITUATIONS WILL BE EMPHASIZED. 7. WHEN A CONFLICT OF INTEREST SITUATION IS IDENTIFIED: THE INDIVIDUAL BOARD MEMBER HAS THE PRIMARY RESPONSIBILITY TO BRING A POTENTIAL OR ACTUAL CONFLICT OF INTEREST SITUATION TO THE ATTENTION OF THE BOARD A CONFLICT OF INTEREST SITUATION MAY ALSO COME TO THE ATTENTION OF THE BOARD DUE TO THE CONCERNS OF A BOARD MEMBER WHO MAY NOT BE INVOLVED IN THE SITUATION. THAT BOARD MEMBER SHOULD NOTIFY THE CHAIRPERSON OF THE CONFLICT OF INTEREST CONCERN AND THE BOARD CHAIRPERSON SHOULD BRING THE SITUATION TO THE ATTENTION OF THE FULL BOARD. REGARDLESS OF THE METHOD BY WHICH THE CONFLICT IS BROUGHT UP, THERE SHOULD BE FULL AND OPEN DISCUSSION BY BOARD MEMBERS OF THE POTENTIAL OR ACTUAL CONFLICT OF INTEREST SITUATION. THE FURTHER PARTICIPATION OF THE BOARD MEMBER IN THE DISCUSSION SHOULD BE AGREED UPON AND APPROVED BY THE BOARD. 8. AS A RESULT OF DISCUSSIONS ON CONFLICT OF INTEREST SITUATIONS, THERE MAY BE CONSIDERATIONS FOR A BOARD MEMBER'S RESIGNATION. THE BOARD MEMBER MAY WISH TO RESIGN TO AVOID A FUTURE CONFLICT OF INTEREST SITUATION DUE TO A DESIRE TO BID ON A PARTICULAR BOARD PROJECT OR TO AVOID A FURTHER CONFLICT OF INTEREST CONCERN. IN THE EVENT THAT THE BOARD MEMBER DOES NOT LEAVE AND A CONFLICT OF INTEREST SITUATION EXISTS, IN ACCORDANCE WITH BYLAWS SECTION III.11 "REMOVAL OF DIRECTORS" THE BOARD MAY ASK THE BOARD MEMBER TO RESIGN IF NINE OF THE THIRTEEN VOTING MEMBERS VOTE AFFIRMATIVELY ON A MOTION OF REMOVAL. 9. THIS POLICY WILL BE REVIEWED ANNUALLY FOR THE INFORMATION AND GUIDANCE OF BOARD MEMBERS. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | THE HR DEPARTMENT USES AN EXECUTIVE SURVEY FROM THE ILLINOIS HOSPITAL ASSOCIATION (IHA) TO GET A STARTING POINT FOR THE SALARY. THEN THEY FACTOR IN YEARS OF EXPERIENCE AND NEGOTIATIONS ON BOTH ENDS. ULTIMATELY THE BOARD DETERMINES THE SALARY AND THE CONTRACT IS SET ANNUALLY. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | SALARIES ARE BASED OFF OF THE SOUTHERN ILLINOIS HUMAN RESOURCE SURVEY. YEARS OF EXPERIENCE AND NEGOTIATION ARE FACTORS THAT ARE CONSIDERED. ONCE A SALARY IS SET A % INCREASE IS GIVEN ANNUALLY DETERMINED BY THE CEO. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | RICHLAND MEMORIAL HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AFTER A REQUEST IS MADE TO ADMINISTRATION. |
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