NORTHWESTERN MEMORIAL HEALTHCARE: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
NORTHWESTERN MEMORIAL HEALTHCARE (EIN 36-2179764)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-13
IRS object ID
201141339349300244
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)
Timestamp2011-05-13T06:46:48-07:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN362179764EIN

Name Name

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

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameRobert RosenbergerName
TitleCFOTitle
Date Signed2011-05-13DateSigned
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

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

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1385 Millennium DriveAddressLine1
CityCrystal LakeCity
StateILState
ZIP Code60012ZIPCode
FieldValueIRS element (for citing)
Gross Receipts154066985GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501cXOrganization501c
Web Sitewww.centegra.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1914YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionThe mission of Memorial Medical Center is to provide quality healthcare services with innovative and responsible use of resources and promote wellness for the greater McHenry County area.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees1221TotalNbrEmployees
Total Nbr Volunteers122TotalNbrVolunteers
Total Gross UBI6TotalGrossUBI
Contributions Grants Prior Year101563ContributionsGrantsPriorYear
Contributions Grants Current Year207975ContributionsGrantsCurrentYear
Program Service Revenue Prior Year137415842ProgramServiceRevenuePriorYear
Program Service Revenue CY139660402ProgramServiceRevenueCY
Investment Income Prior Year-9950152InvestmentIncomePriorYear
Investment Income Current Year809434InvestmentIncomeCurrentYear
Other Revenue Prior Year2451480OtherRevenuePriorYear
Other Revenue Current Year2762208OtherRevenueCurrentYear
Total Revenue Prior Year130018733TotalRevenuePriorYear
Total Revenue Current Year143440019TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year64288148SalariesEtcPriorYear
Salaries Etc Current Year62071877SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year78550901OtherExpensePriorYear
Other Expenses Current Year81649626OtherExpensesCurrentYear
Total Expenses Prior Year142839049TotalExpensesPriorYear
Total Expenses Current Year143721503TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-12820316RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-281484RevenuesLessExpensesCY
Total Assets BOY100698954TotalAssetsBOY
Total Assets EOY102195985TotalAssetsEOY
Total Liabilities BOY66331211TotalLiabilitiesBOY
Total Liabilities EOY66698072TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY34367743NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY35497913NetAssetsOrFundBalancesEOY
Mission DescriptionThe mission of Memorial Medical Center is to provide quality healthcare services with innovative and responsible use of resources and promote wellness for the greater McHenry County area.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense126142401Expense
Revenue140678294Revenue
DescriptionSee Schedule ODescription
Total Program Service Expense126142401TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Balance Sheet Amounts ReportedtrueBalanceSheetAmountsReported
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109669NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1221NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProceduretrueWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonRobert RosenbergerNamePerson
Telephone Number8157885800TelephoneNumber

Address US AddressUS

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

Form990 Part VII Section A Form990PartVIISectionA (35 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekFormerFormerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerIndividual Trustee Or DirectorIndividualTrusteeOrDirectorHighest Compensated EmployeeHighestCompensatedEmployee
Joseph P Hurshe
Vice President0.X02233916690
Rachel Sebastian
Vice President1.0001259144373X
David Tomlinson
Vice President1.00022309726120X
Doris Hendrickson
Vice President1.0001924913332X
Zbigniew Lorenc
Vice President1.00021454319044X
Gail Rudolph
Vice President1.00017582916822X
Susan Milford
Vice President1.00019712825058X
Robert Turngren
Vice President0.034206627048
Laura Walczak
CNO1.00015349016801X
Susan Murphy
CNO1.00018598319046X
Barbara Johnson
Senior VP1.00029245570836X
Aaron Shepley
Sr VP/CQO Couns1.00030287853724X
Jason Sciarro
Exec VP & COO1.00044535162087X
Robert Rosenberger
Sr. VP & CFO1.00040106634025X
Michael Eesley
President & CEO1.000758227261432X
D Michael Splitt
Director1.00000XX
Charles Ruth
Director1.00000X
Kathy Powell
Director1.00000X
Jack Porter
Director1.00000X
Parmod Narang
Director1.00000X
Angela McAuley
Director & VP1.00026903721116XX
Luke Johnsos
Director1.00000X
Paul Hills
Director1.00000X
Mike Curran
Director1.00000X
Tom Carey
Director1.00000X
Terrence J Bugno
Director1.00000X
Patrick Morehead
Treasurer2.00000XX
William Cox
Secretary2.00000XX
Charie Zanck
Vice Chairman2.00000XX
Christian Newkirk
Chairman2.00000XX
Melissa J Rangel
Manager, Pharmacy0.118529021734X
Deborah J Golden
Ultrasonographer40.00119995010647X
Anthony K Leung
Pharmacist40.00131223022265X
Suellen D Aus-Der-Au
Pharmacist35.00134650022546X
Lisa Evan
Pharmacist35.0013833807020X
FieldValueIRS element (for citing)
Total Reportable Comp From Org642735TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs4502946TotalReportableCompFrmRltdOrgs
Total Other Compensation751766TotalOtherCompensation
Number Individuals GT100 K22NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Towne Square Anesthesia LLC
3703 Doty Road Suite 7WoodstockIL60098Anesthesia Services235000
Speciality Laboratories Inc
27027 Tourney RoadValenciaCA91355Laboratory Services361198
LakeMcHenry Pathology
4309 Medical Center DriveMcHenryIL60050Laboratory Services411618
Superior Health Linens
2905 Syene RoadMadisonWI53713Laundry Services468356
Sodexo Inc & Affiliates
9801 Washingtonian BoulevardGaithersburgMD20878Food, ES & POM Mgmt2062397
FieldValueIRS element (for citing)
Number Of Contractors GT100 K8NumberOfContractorsGT100K
Related Organizations168157RelatedOrganizations
Government Grants37124GovernmentGrants
All Other Contributions2694AllOtherContributions
Total Contributions207975TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Charity Care/Admin Allow621990-10361982-10361982
IDPA Provider Tax Revenue62211063454906345490
Ancillary I/P Services62199078570227857022
Routine Patient Services6219905444041254440412
Ancillary O/P Services6219908137946081379460
FieldValueIRS element (for citing)
Total Program Service Revenue139660402TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1719695TotalRevenueColumn
Exclusion$1,719,695ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column44285TotalRevenueColumn
Exclusion$44,285ExclusionAmount

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real669780Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real669780Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column669780TotalRevenueColumn
Exclusion$669,780ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities3623751Securities
Other6048669Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities4437811Securities
Other6189155Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-814060Securities
Other-140486Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-954546TotalRevenueColumn
Exclusion-$954,546ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Related Party Revenue900099193303$193,303
Cafeteria Sales722210529219$529,219
Reference Lab Fees621500956562956562

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column413344TotalRevenueColumn
Related Or Exempt Function Income61330RelatedOrExemptFunctionIncome
Unrelated Business Revenue6UnrelatedBusinessRevenue
Exclusion$352,008ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue2092428TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column143440019TotalRevenueColumn
Related Or Exempt Function Income140678294RelatedOrExemptFunctionIncome
Unrelated Business Revenue6UnrelatedBusinessRevenue
Exclusion$2,553,744ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total49852801Total
Program Services42116804ProgramServices
Management And General7735997ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total874020Total
Program Services738392ProgramServices
Management And General135628ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total7855113Total
Program Services6636182ProgramServices
Management And General1218931ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3489943Total
Program Services2948385ProgramServices
Management And General541558ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total586385Total
Program Services235526ProgramServices
Management And General350859ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total27000Total
Management And General27000ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total4740402Total
Program Services3683158ProgramServices
Management And General1057244ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total3091Total
Program Services3091ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total23342664Total
Program Services22540460ProgramServices
Management And General802204ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total5577Total
Program Services4327ProgramServices
Management And General1250ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2502301Total
Program Services2114002ProgramServices
Management And General388299ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total75841Total
Program Services63558ProgramServices
Management And General12283ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total58283Total
Program Services47958ProgramServices
Management And General10325ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2505316Total
Program Services2116549ProgramServices
Management And General388767ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total6362409Total
Program Services5375111ProgramServices
Management And General987298ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total2382174Total
Program Services2012516ProgramServices
Management And General369658ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Other misc. expenses148163-12379160541
IDPA Provider Tax Assessment42153894215389
Provision for Bad Debts1284045612840456
Purch Srvs Rltd Prty (Sch O)21854175184629163391260

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total0Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total143721503Total
Program Services126142401ProgramServices
Management And General17579102ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY14945BOY
EOY15073EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3589916BOY
EOY4255871EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY14026583BOY
EOY13468329EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2080782BOY
EOY2124784EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1247656BOY
EOY1233633EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis116891541LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec74032060LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY47314376BOY
EOY42859481EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY19608342BOY
EOY21766758EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY4369718BOY
EOY4627707EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY8446636BOY
EOY11844349EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY100698954BOY
EOY102195985EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY17059410BOY
EOY18262024EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY48587510BOY
EOY47934200EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY684291BOY
EOY501848EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY66331211BOY
EOY66698072EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY31773580BOY
EOY32813391EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2594163BOY
EOY2684522EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY34367743BOY
EOY35497913EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY100698954BOY
EOY102195985EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired
Federal Grant Audit PerformedfalseFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Form4720 Filed4955 TaxfalseForm4720Filed4955Tax
Correction MadefalseCorrectionMade
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$27,000OtherActivitiesAmount
Total Lobbying Expenditures IIB27000TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart II-B, Line 1iIdentifier
Return ReferencePart II-B, Line 1i - Other Activities DescriptionReturnReference
ExplanationAs part of our payment of Illinois Hospital Association dues, approximately 34% are allocable to lobbying activities. As part of our payment of Metropolitan Chicago Healthcare Council dues, approximately 25% are allocable to lobbying activities.Explanation

Schedule D IRS990ScheduleD

Land Land

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

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis70781460OtherCostOrOtherBasis
Depreciation40971801Depreciation
Book Value29809659BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis3209655OtherCostOrOtherBasis
Depreciation1577811Depreciation
Book Value1631844BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis40749446OtherCostOrOtherBasis
Depreciation31482448Depreciation
Book Value9266998BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1668195OtherCostOrOtherBasis
Book Value1668195BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings42859481TotalOfBookValueLandBuildings

Investments Program Related InvestmentsProgramRelated (3 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
Interest in Foundation3875593C
Invest in ARSC Real Estate Holdings640674C
Invest in Algonquin Rd Surgery Center111440C

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
Due from Affiliates11529628
Other Receivables314721
FieldValueIRS element (for citing)
Total Book Value Other Assets11844349TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Other Long-Term Liabilities$72,222
Self-Insured Professional Liability$429,626
FieldValueIRS element (for citing)
Total Of Amounts501848TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart XIdentifier
Return ReferencePart X : FIN48 FootnoteReturnReference
ExplanationASC Topic 740, Income Taxes, addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded in the consolidated financial statements. Under ASC Topic 740, the Health System must recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured based on the largest benefit that has a greater than fifty percent likelihood of being realized upon ultimate settlement. ASC Topic 740 also provides guidance on derecognition, classification, interest and penalties on income taxes, accounting in interim periods and requires increased disclosures. At the date of adoption, and as of June 30, 2010, the organization does not have a liability for unrecognized tax benefits. The adoption of ASC Topic 740 had no impact on the consolidated financial statements of the Health System.Explanation

Schedule H IRS990ScheduleH

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

Discounted Other DiscountedOther

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

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense2896279TotalCommunityBenefitExpense
Net Community Benefit Expense2896279NetCommunityBenefitExpense
Percent Of Total Expense0.02210PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense14229682TotalCommunityBenefitExpense
Direct Offsetting Revenue8909402DirectOffsettingRevenue
Net Community Benefit Expense5320280NetCommunityBenefitExpense
Percent Of Total Expense0.04060PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense17125961TotalCommunityBenefitExpense
Direct Offsetting Revenue8909402DirectOffsettingRevenue
Net Community Benefit Expense8216559NetCommunityBenefitExpense
Percent Of Total Expense0.05720PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs29NumberOfActivitiesOrPrograms
Persons Served7696PersonsServed
Total Community Benefit Expense28110TotalCommunityBenefitExpense
Net Community Benefit Expense28110NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms
Persons Served176PersonsServed
Total Community Benefit Expense196718TotalCommunityBenefitExpense
Direct Offsetting Revenue300DirectOffsettingRevenue
Net Community Benefit Expense196418NetCommunityBenefitExpense
Percent Of Total Expense0.00150PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served63PersonsServed
Total Community Benefit Expense6786TotalCommunityBenefitExpense
Net Community Benefit Expense6786NetCommunityBenefitExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms
Persons Served47PersonsServed
Total Community Benefit Expense1140TotalCommunityBenefitExpense
Direct Offsetting Revenue180DirectOffsettingRevenue
Net Community Benefit Expense960NetCommunityBenefitExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs38NumberOfActivitiesOrPrograms
Persons Served7982PersonsServed
Total Community Benefit Expense232754TotalCommunityBenefitExpense
Direct Offsetting Revenue480DirectOffsettingRevenue
Net Community Benefit Expense232274NetCommunityBenefitExpense
Percent Of Total Expense0.00160PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs38NumberOfActivitiesOrPrograms
Persons Served7982PersonsServed
Total Community Benefit Expense17358715TotalCommunityBenefitExpense
Direct Offsetting Revenue8909882DirectOffsettingRevenue
Net Community Benefit Expense8448833NetCommunityBenefitExpense
Percent Of Total Expense0.05880PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense1771TotalCommunityBuildingExpense
Net Community Building Expense1771NetCommunityBuildingExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served14000PersonsServed
Total Community Building Expense642892TotalCommunityBuildingExpense
Net Community Building Expense642892NetCommunityBuildingExpense
Percent Of Total Expense0.00490PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs8NumberOfActivitiesOrPrograms
Persons Served676PersonsServed
Total Community Building Expense7393TotalCommunityBuildingExpense
Net Community Building Expense7393NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Number Of Activities Or Programs17NumberOfActivitiesOrPrograms
Persons Served1315PersonsServed
Total Community Building Expense35775TotalCommunityBuildingExpense
Net Community Building Expense35775NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs27NumberOfActivitiesOrPrograms
Persons Served15991PersonsServed
Total Community Building Expense687831TotalCommunityBuildingExpense
Net Community Building Expense687831NetCommunityBuildingExpense
Percent Of Total Expense0.00480PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$4,404,276BadDebtExpenseAmount
Amount Attributable To3028290AmountAttributableTo
Amount Reimbursed By Medicare35293423AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare44024409CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-8730986MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

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

Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnership
ARSC Real Estate Holdings
Real Estate Holding Company0.25000
Algonquin Road Surgery Cen
Outpatient Surgery Center0.12750

Form990 Schedule H Part V Form990ScheduleHPartV (3 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeOtherOtherLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalEr24 HoursEr24Hours
Centegra Rehab&Sports Medicine
10450 Algonquin RdHuntleyIL60142Rehabilitation & Sports Medicine Clinic
Centegra Health Center-Huntley
10350 Haligus RdHuntleyIL60142Laboratory and Medical Imaging Services
Memorial Medical Center
3701 Doty RoadWoodstockIL60098XXX

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Bad Debt FootnoteThe estimated amount of bad debt expense (at cost) which could be reasonably attributable to patients who would likely qualify for financial assistance under the organizations charity care policy if sufficient information had been available to make a determination of their eligibility was based on the self pay patient accounts which were written off as bad debts. These amounts were then multiplied by the cost to charge ratio. Any payments received during the fiscal year on these accounts were deducted from the cost.BadDebtFootnote
Shortfall As Community BenefitThe amount shown in line 6 represents the actual costs incurred to treat Medicare patients and is calculated by applying the Medicare cost-to-charge ratio. Therefore, the entire amount of line 7 constitutes a community benefit.ShortfallAsCommunityBenefit
Debt Collection PolicyIf a patient qualifies for a 100% charity/financial assistance discount, collection of the account is not pursued as a bad debt. The account is written off in full at the time of the decision. If a patient receives a partial discount for Financial Assistance, any remaining balances will be treated in accordance with the Financial Policy regarding self pay balances and may be offered a payment plan option. The payment plan is in installments ($25 minimum), with the first payment due at discharge. Payment plans are not to exceed 36 months without documentation or verbal communication of ability to pay. Documentation may include a completed financial statement. Patients who have not completed arrangements for one of the payment options within 120 days of the billing date will be automatically turned over to a collection agency. Patients with delinquent payments, 15 or more days late, will be turned over to a collection agency. After insurance processing, patients who have not made payments or enrolled in one of the payment options for co-insurance and deductible amounts within 120 days of insurance payment will be turned over to a collection agency. As an exception, the Director of Patient Financial Services may review and recommend further discounts. No interest charges will accrue on account balances in which payments are being made.DebtCollectionPolicy
Number Of Facility Type ExplnMemorial Medical Center is comprised of one licensed hospital, one center housing laboratory and medical imaging services and one center housing a rehabilitation and sports medicine clinic.NumberOfFacilityTypeExpln
General ExplanationPart I, Line 7The amounts in Lines 7a-7d were calculated by applying the Medicare cost-to-charge ratio to the net patient revenue for each category. The amounts in Lines 7e-7k were calculated based on actual expenses for each community benefit activity category.Part I, Line 7, Column (f)Form 990, Part IX, line 25 includes $12,840,456 for Bad Debt Expense. This amount cannot be subtracted from total expenses in order to calculate the column (f) percentages in lines 7a-7k due to software limitations.GeneralExplanation
Needs AssessmentCentegra Health System worked with the McHenry County Department of Public Health and other participating organizations to conduct a community health assessment and identify leading indicators to help highlight the health needs of the county. Those indicators identified include percentage of physically inactive people, percentage of obese people, percentage of current smokers over the age of 18, percentage of binge drinkers, reported new aids cases, suicide rate, mortality rate from unintentional injuries, firearm-related mortality rate, homicide rate, percentage of children with elevated lead levels age 1-6, percentage of children 19 to 35 months of age in full immunization compliance, percentage of people with no health insurance, and percentage of pregnant women who begin prenatal care in the 1st trimester. Centegra Health System has been an active participant in the McHenry County Health Department's MAPP process (Mobilizing for Action through Planning & Partnerships), which is an ongoing effort: Phase 1: Organize for Success/ Partnership Development; Phase 2: Vision, Value Statements; Phase 3: Conducting MAPP Assessments; Phase 4: Identify Strategic Issues; Phase 5: Formulate Goals and Strategies; Phase 6: Action Cycle (current stage). MAPP priorities have been defined as: 1) Increase Access to Medical, Dental and Mental Health care: Goal 1: Provide increased access to follow up care (medical, dental, mental) for the under/uninsured residents of McHenry County; Goal 2: Increase access to (medical, dental, mental) prevention, education, and screening programs available for all residents of McHenry County; 2) Information & Referral: Goal 1: Centralize and update Information and Referral located on Crisis Services web site; Goal 2: Market Crisis Line #/Web site (future 2-1-1) to community to increase visibility; Goal 3: 2-1-1 Information and Referral System; 3) Cardiovascular Care: Goal: By 2017, reduce the death rate from cardiovascular disease by 20%. Centegra's initiatives will target the following defined community needs as priorities: Access to Care, Information & Referral Services, and Clinical Areas of Cardiovascular and Cancer-related programs and services. Centegra's Community Benefits programming will continue to target: community wellness and prevention programs, community health education, community health advocacy and assistance, clinical education, community collaborations, and community-based clinical initiatives.NeedsAssessment
Patient Education Assistance1. Uninsured patients arriving at our emergency department and/or direct admits are screened at time of service by either an Emergency Department Financial Counselor or the health system's In-Patient Financial Counseling Team, Public Aid Representatives and a Medication Assistance Coordinator to identify eligibility guidelines for federal, state and local government programs as well as charity care. Centegra Health System's Self Pay Process includes a screening which is completed by using hospital form C910050 03-09 prompting an interview offering payment options and eligibility guidelines. It is at this time that a patient becomes aware of the Hospital Uninsured Patient Discount Act, Medicaid, Medication Assistance Programs, Crime Victims, Section 1011, IBCCP, Cash Pay Fee Schedules, and other hospital discount incentives. Patients are advised of time lines for completing application processes at time of service in person. Appropriate scripting is followed by Centegra Health System (CHS) Associates. Discounts were established following the 200%, 350% and 600% federal poverty guidelines to assist in determining charity adjustments. Applications were designed by Centegra Health System Self Pay Committee in accordance to our Financial Policy (Policy Number 9850-2) identifying qualifications for the medically needy/catastrophic aid.2. Uninsured patients opting for elective services are contacted by phone prior to their date of service by the CHS Out-Patient Financial Counseling Team. CHS's Self Pay Process is followed and includes a screening for federal, state and local government programs as well charity care. An interview offering payment options and eligibility guidelines using hospital form C910050 03/09 prompts a quick eligibility determination. It is at this time that a patient becomes aware of the Uninsured Patient Discount Act, Medicaid, Medication Assistance Programs, Crime Victims, Section 1011, IBCCP, Cash Pay Fee Schedules, and other hospital discount incentives. Patients are advised of time lines for completing application processes prior to their elective services via phone. Appropriate scripting is followed by CHS Associates. Discounts were established following the 200%, 350% and 600% federal poverty guidelines to assist in determining charity adjustments. Applications were designed by CHS Self Pay Committee in accordance to our Financial Policy (Policy Number 9850-2) identifying qualifications for the medically needy/catastrophic aid.3. Our health system's web site offers FAQ's and answers as well as encourages patients to contact our Customer Service Team when they are unable to pay for services.4. Our health system's statements also identify detailed account and billing information encouraging the patient to contact our Customer Service Team and inquire about Financial Assistance options.5. Documentation is essential in effective communication. Follow up teams will then move forward in a timely manner with the appropriate actions to insure all necessary documents (if applicable) are received for eligibility determinations.6. CHS advertises a Price Line encouraging patients to inquire about estimated costs for future services. The Price Line is manned by our Out-Patient Financial Counselors from 8:00am - 7:00pm. When calls are returned with estimated costs, a conversation ensues to identify a possible financial hardship. Our Self Pay Process is put into effect at this time.7. Site Registrars will notify the CHS Financial Counseling Team when a financial hardship is identified.8. Emergency Department Financial Counseling positions were created this year and will be rolled out 12/1/09 to meet the needs of our ED patients. In addition to these new roles, a full time Financial Counselor position was created to meet the special needs of our cancer patients.9. A Financial Assistance Coordinator reviews all financial applications, gathers needed documents, determines financial assistance and prepares each patient file for leadership approval.PatientEducationAssistance
Community InformationCentegra Health System defines its primary service area as Greater McHenry County, an area of approximately 612 square miles and 341,000 residents. This county is among the fastest growing counties in Illinois with growth seen in all age categories. The population is projected to increase by 13% over the next 5 years. For 2007, the age distribution of the population is as follows: 27% 0-17, 38% 18-44, 25% 45-64, and 10% 65+. McHenry County has a relatively high socioeconomic status compared to the rest of Illinois. Median household income for 2007 was 52% higher than the rest of the state. The 2006 annual average unemployment rate was 24% below the state average. The percentage of families below the poverty level for 2006 was 52% below the rest of the state. For 2006, the percentage of the county's population holding a high school diploma was 7% greater than rest of the state, while the percentage holding a bachelor's degree or higher was 6% higher and the rest of the state.CommunityInformation
Community Building ActivitiesRepresentatives of Memorial Medical Center participated in many different community groups and committees, such as the Fire/EMS Chief Association, the Police Chief Association, the Health and Human Services Network, the Child Advocacy Board, and the Family Violence Coordinating Council. Through these meetings, representatives of Memorial Medical Center can promote the health system's role in improving the health of the individuals that these different groups serve. Also included Part II are expenses related to our Spanish language interpreters. Hispanics comprise 11.3% of the population of McHenry County and our Spanish language interpreters are imperative to the effort to improve the health of this traditionally underserved population.CommunityBuildingActivities
Other InformationSee Schedule O for response to Form 990, Part III, Line 4a.OtherInformation
Affiliated Health Care SystemSee Schedule O for response to Form 990, Part III, Line 4a.AffiliatedHealthCareSystem
Reports Filed With StatesILReportsFiledWithStates

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymenttrueSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (17 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgsBase Compensation Filing OrgBaseCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
David Tomlinson
2146228475927916841249217
Doris Hendrickson
18431481772657675195823
Zbigniew Lorenc
205187935691519893233587
Gail Rudolph
168201762816822192651
Susan Milford
1887118417822116837222186
Robert Turngren
328256138101003817010369114
Laura Walczak
146342714816801170291
Susan Murphy
1779778006756811478205029
Barbara Johnson
242576103736468361533632913950639506
Aaron Shepley
290726121523665017074356602
Jason Sciarro
4235631801245121169665074383776
Robert Rosenberger
33616414393170591696643509150509
Michael Eesley
7558352500231140910196592392
Angela McAuley
256769102689773113432901532000
Anthony K Leung
131223552516740153488
Suellen D Aus-Der-Au
134650577316773157196
Joseph P Hurshe
2233917515939230081

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (5 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Carey Electric
Director35507Electrical Contractorfalse
American Community Bank
Vice Chairman100000Certificate of Depositfalse
American Community Bank
Director100000Certificate of Depositfalse
Home State Bank
Director100000Certificate of Depositfalse
Home State Bank
Treasurer100000Certificate of Depositfalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableAll documents are available upon request.
Form 990, Part VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesThe Board of Directors of Centegra Health System, through the Compensation Committee comprised of independent members free of conflict, reviewed executive compensation levels and other features of the compensation plan in accordance with the organization's approved compensation philosophy and strategy: The Committee is comprised of members of the Board of Directors, who are independent of Centegra management, have no personal interest in the compensation arrangements, are not related to, or under the control of any individual whose compensation arrangement is being reviewed and have no material business relationship with Centegra.The Chief Executive Officer's compensation is determined by the Compensation Committee in relation to appropriate comparability data. Compensation for other members of the executive staff are developed by the CEO, reviewed by the Committee, evaluated against market data, and approved by the Committee. The Committee approves all compensation decisions in advance of their implementation and documents its determinations and discussions. Its decisions and deliberations are thoroughly documented and meeting minutes are kept and distributed to the Committee members (for historical reference). The Compensation Committee uses a number of external resources and comparisons, and their review includes total compensation (cash compensation, plus benefits provided by Centegra) in relation to organizational performance and prevailing industry practices of comparably-sized organizations. They have engaged the services of a compensation consulting firm (Sullivan Cotter) specializing in the not-for-profit sector that has worked with Centegra and reports directly to the Compensation Committee.
Form 990, Part VI, Line 12cForm 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsContinued from above. 6. A voting member of any committee whose jurisdiction includes compensation matters and who receives compensation, directly or indirectly, from Centegra for services is precluded from voting on matters pertaining to that member's compensation, Physicians who receive compensation, directly or indirectly, from Centegra, whether as employees or independent contractors, are precluded from membership on any committee whose jurisdiction includes compensation matters and in which such physician may have a direct or indirect interest. 7. Each director, principal officer, and member of a committee with board-delegated powers shall annually sign a statement which affirms that such person has received a copy of the conflicts of interest policy; has read and understands the policy; has agreed to comply with the policy; and understands that Centegra is a charitable organization and that in order to maintain its federal tax exemption, it must engage primarily in activities which accomplish one or more of its tax exempt purposes. 8. To ensure that Centegra operates in a manner consistent with its charitable purposes and that it does not engage in activities that could jeopardize its status as an organization exempt from federal income tax, periodic reviews shall be conducted by the Governors Affairs Committee of Centegra. The periodic reviews shall, at a minimum, include the following subjects: Whether acquisition of physician practices and other provider services result in inurement or impermissible private benefit. Whether partnership and joint venture arrangements and arrangements with management service organizations and physician hospital organizations conform to written policies, are properly recorded, reflect reasonable payment for goods and services, further Centegra's charitable purposes and do not result in inurement or impermissible private benefit. Whether agreements to provide healthcare and agreements with other healthcare providers, employees, and third party payors further Centegra's charitable purposes and do not result in inurement or impermissible private benefit. Whether business transactions on behalf of Centegra or an entity controlled by it are the result of arms-length dealing and are no less advantageous than competitively available goods and services of like grade and quality. 9.In conducting the periodic reviews provided for in Article VII, Centegra may, but need not, use outside advisors. If outside experts are used, their use shall not relieve the board of its responsibility for ensuring that periodic reviews are conducted.
Form 990, Part VI, Line 11Form 990, Part VI, Line 11: Form 990 Review ProcessThe review process for the 990 included review by the Director of Accounting and Chief Financial Officer. The 990 also was sent to an outside auditor for review before submission to the IRS.
Form 990, Part VI, Line 6Form 990, Part VI, Line 6: Explanation of Classes of Members or ShareholderCentegra Health System has a single class of members.
Form 990, Part VI, Line 3Form 990, Part VI, Line 3: Description of Delegated Duties to Management CompanyManagement companies were used for the daily operations and management of the following services for the health system. Sodexho was used for Food & Nutrition, Plant Operations and Maintenance, and Environmental Services work. Dell Marketing LP was used for the management of the Information Systems area. Professional Business Consultants is used for the management of the Managed Care department.
Form 990, Part VI, Line 2Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, EtMemorial Medical Center, (MMC), adopted specific conflict of interest policies for its governing and management staff. The policy includes, but is not limited to, when an individual, governor, committee member, officer, agent or employee believes that he or she, or member of his or her immediate family might have or does have a real or apparent conflict, he or she should in addition to filing the disclosure notice required, abstain from making motions, voting, executing agreements, or taking any other similar direct action on behalf of MMC. Not with standing, it is realized that both real and apparent conflicts of interest sometimes naturally occur in the course of conducting daily affairs. Conflicts occur because the many persons associated with MMC should be expected to have, and do in fact generally have multiple interests and affiliations, and various positions of responsibility with the community. The long-range interests of MMC do not require the termination of an association with persons who have real or apparent conflicts, if an effective method can render such conflicts harmless to all concerned. During fiscal year 2010, MMC purchased certain goods and/or services from organizations with director's affiliation. All transactions were competitively bid and conducted at arms length. The fees paid were at fair market value. Rachel Sebastian, Vice President, is the daughter of Michael Eesley, President and CEO. Director Kathy Powell is an employee and vice president of Home State Bank. Director Patrick Morehead is on the Board of Directors and a 1% owner of Home State Bank. Vice Chairman Charie Zanck is a Director of American Community Bank & Trust. Director Charles Ruth is the Board Chairman of American Community Bank & Trust. Director Tom Carey is the Vice President and Majority Owner of Carey Electric.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (4 entries)

Address Line1AddressForeign/AddressLine1CityAddressForeign/CityCountryAddressForeign/CountryPostal CodeAddressForeign/PostalCodePrimary ActivitiesPrimaryActivitiesBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEIN
Centegra Insurance Services LTD
PO Box 1051Grand CaymanCJKY1-1102Malpractice Insurance ProviderCentegra Health System
DIS Holdings LLC
Medical Imaging ServicesCentegra Health Systems385 Millennium DriveCrystal LakeIL60012363196559
Centegra Primary Care LLC
Physician PracticeCentegra Health System385 Millennium DriveCrystal LakeIL60012364085398
Centegra Health Bridge Fitness Center
Health & Fitness CenterNIMED Corporation385 Millennium DriveCrystal LakeIL60012261277524

Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Direct Controlling Entity NADirectControllingEntityNA
Oak Creek Lodge
385 Millennium DriveCrystal LakeIL60012363591359Hospital OperationsIL501(c)(3)3Centegra Health System
Health Bridge Corporation
385 Millennium DriveCrystal LakeIL60012363196550Health & Fitness CenterIL501(c)(3)11cCentegra Health System
NIMED Corporation
385 Millennium DriveCrystal LakeIL60012363119911Property ManagementIL501(c)(3)11cCentegra Health System
Centegra Health System Foundation
385 Millennium DriveCrystal LakeIL60012363723610Fundraising for Medical CentersIL501(c)(3)11aCentegra Health System
Northern Illinois Medical Center
4201 Medical Center DriveMcHenryIL60050362338884Hospital OperationsIL501(c)(3)3Centegra Health System
Centegra Health System
385 Millennium DriveCrystal LakeIL60012363196559Hospital Operations SupportIL501(c)(3)11cN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Centegra Management ServicesBusinessNameLine1

Address US AddressUS

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

Direct Controlling Entity Name DirectControllingEntityName

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

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