FREEPORT MEMORIAL HOSPITAL: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- FREEPORT MEMORIAL HOSPITAL (EIN 36-2181997)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-08-31
- IRS object ID
- 202212439349301001
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-08-31T10:02:35-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 362181997 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FREEPORT MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FREE | BusinessNameControlTxt |
| Phone | 8155996209 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1045 W STEPHENSON ST | AddressLine1Txt |
| City | FREEPORT | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61032 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL C CLARK | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 8155996361 | PhoneNum |
| Signature | 2022-08-29 | SignatureDt |
| Discuss With Paid Preparer | 0 | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MICHAEL | PersonFirstNm |
| Person Last | CLARK | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MARK S GRIDLEY CEO | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1045 W STEPHENSON ST | AddressLine1Txt |
| City | FREEPORT | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61032 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $169,840,576 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FHN.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1964 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | OUR MISSION IS TO IMPROVE THE HEALTH OF OUR COMMUNITIES, WORKING TOGETHER WITH THOSE WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 1097 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $37,294 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $30,997 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $377,035 | PYContributionsGrantsAmt |
| CY Contributions Grants | $210,921 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $162,177,867 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $168,398,949 | CYProgramServiceRevenueAmt |
| PY Investment Income | $507,372 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,230,706 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $163,062,274 | PYTotalRevenueAmt |
| CY Total Revenue | $169,840,576 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $45,646,606 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $50,258,270 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $84,650,796 | PYOtherExpensesAmt |
| CY Other Expenses | $88,722,373 | CYOtherExpensesAmt |
| PY Total Expenses | $130,297,402 | PYTotalExpensesAmt |
| CY Total Expenses | $138,980,643 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $32,764,872 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $30,859,933 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $124,710,345 | TotalAssetsBOYAmt |
| Total Assets EOY | $127,271,445 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $40,343,224 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $36,970,099 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $84,367,121 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $90,301,346 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SEE SCHEDULE O | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $64,463,948 | ExpenseAmt |
| Revenue | $134,028,197 | RevenueAmt |
| Desc | FREEPORT MEMORIAL HOSPITAL PROVIDES INPATIENT AND OUTPATIENT HOSPITAL SERVICES TO PATIENTS IN FIVE NORTHWESTERN ILLINOIS COUNTIES. THE HOSPITAL ENSURES CONTINIUED ACCESS TO CARE BY SERVING PATIENTS IN MEDICALLY UNDERSERVED AREAS. THE HOSPITAL QUALIFIES AS A MEDICARE DISPROPORTIONATE SHARE HOSPITAL BECAUSE IT SERVES A DISPROPORTIONATELY HIGH NUMBER OF LOW-INCOME PATIENTS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $67,636,265 | ExpenseAmt |
| Revenue | $31,882,896 | RevenueAmt |
| Desc | OTHER UNCOMPENSATED CARE: THE HOSPITAL IS A LICENSED MEDICARE AND MEDICAID PROVIDER WITH APPROXIMATELLY 72% OF ITS' PATIENT BASE QUALIFYING FOR AT LEAST ONE OF THESE PROGRAMS. AT PRESENT THE REIMBURSEMENT RATES OF THESE PROGRAMS DO NOT FULLY COVER THE COST OF CARE TO THESE PATIENTS. THE ESTIMATED UNFUNDED COST OF SERVICE FOR MEDICARE PATIENTS WAS APPROXIMATELY $25,870,591 AND MEDICAID PATIENTS WAS APPROXIMATELY $9,882,778 FOR THE YEAR ENDING 12/31/2021. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $821,385 | ExpenseAmt |
| Revenue | $3,922,078 | RevenueAmt |
| Desc | CHARITY CARE: THE HOSPITAL PROVIDED CHARITY CARE BENEFITS FOR PATIENTS WHOSE INCOME WAS UP TO 300% OF THE FEDERALLY DETERMINED PROVERTY LEVEL. CHARGES FOREGONE FOR CHARITY CARE AMOUNTED TO APPROXIMATELY $3,922,078 IN 2021. ESTIMATED COSTS OF PROVIDING THESE SERVICES AMOUNTED TO APPROXIMATELY $821,385 IN 2021. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER COMMUNITY BENEFITS: THE HOSPITAL OPERATES AND SUPPORTS A NUMBER OF COMMUNITY BENEFIT PROGRAMS THAT INCLUDE BUT ARE NOT LIMITED TO COMMUNITY HEALTH EDUCATION, HEALTH CARE SUPPORT SERVICES AND HEALTH PROFESSIONAL EDUCATION. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $132,921,598 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 72 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1097 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMY RUNGREN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8155996940 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1045 W STEPEHNSON ST | AddressLine1Txt |
| City | FREEPORT | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61032 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| NEAL RICHARDSON | |||||||||
| CHAIRMAN | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| HEATHER MCPHERSON | |||||||||
| VICE CHAIRMAN | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| MARK WRIGHT | |||||||||
| TREASURER | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| RICHARD CHANG | |||||||||
| SECRETARY | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| STEVEN KNEUBUEHL | |||||||||
| PAST CHAIRMAN | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| CAROL SCHUSTER | |||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| BRUCE BALDWIN | |||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| GARY QUINN | |||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| GLENDA KOELLER | |||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| DAN SCHMITT | |||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| SHOKRY TAWFIK MD | |||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $136,690 | $28,876 | ||||
| BETH KALNINS MD | |||||||||
| MEDICAL STAFF | 40.00 | Yes (X) | $248,491 | $0 | $35,530 | 0.00 | |||
| MARK S GRIDLEY | |||||||||
| PRESIDENT/CEO | 25.00 | $345,277 | $211,621 | $55,586 | 15.00 | Yes (X) | |||
| MICHAEL C CLARK | |||||||||
| EXECUTIVE VP/CFO | 25.00 | $200,591 | $122,943 | $53,509 | 15.00 | Yes (X) | |||
| LEONARD CARTER | |||||||||
| CHIEF HUMAN RESOURCES OFFICER | 25.00 | $137,416 | $84,224 | $35,626 | 15.00 | Yes (X) | |||
| REBECCA PEDERSON MD | |||||||||
| CHIEF QUALITY OFFICER | 0.00 | $0 | $376,988 | $32,311 | 40.00 | Yes (X) | |||
| ROBERT GELLER MD | |||||||||
| PRESIDENT MEDICAL STAFF | 0.00 | $0 | $355,811 | $26,330 | 40.00 | Yes (X) | |||
| TIMOTHY JESSEN MD | |||||||||
| CHAIR PHYSICIANS COUNCEL | 0.50 | $0 | $278,059 | $50,204 | Yes (X) | ||||
| KATHRYN J MARTINEZ | |||||||||
| VP OF PATIENT SERVICE | 40.00 | $241,411 | $0 | $45,940 | Yes (X) | ||||
| ARSHAD SHAIKH MD | |||||||||
| PHYSICIAN | 40.00 | $765,175 | $0 | $22,860 | Yes (X) | ||||
| KEITH MARTIN MD | |||||||||
| PHYSICIAN | 40.00 | $439,010 | $0 | $46,644 | Yes (X) | ||||
| CLARENCE PARKS MD | |||||||||
| PHYSICIAN | 40.00 | $406,734 | $0 | $28,864 | Yes (X) | ||||
| MOHAMAD SALAMA MD | |||||||||
| PHYSICIAN | 40.00 | $297,798 | $0 | $11,525 | Yes (X) | ||||
| IRENA MARKOVIC MD | |||||||||
| PHYSICIAN | 40.00 | $285,619 | $0 | $19,464 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,367,522 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,566,336 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $493,269 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 60 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| FREEPORT EMERGENCY SPECIALISTS | |||||
| 1200 HARGER RD STE 408 | OAK BROOK | IL | 60523 | MEDICAL SERVICE | $4,509,244 |
| CAMOLOT RADIOLOGY | |||||
| 3849 N PERRYVBILLE RD | ROCKFORD | IL | 61108 | RADIOLOGY PHYSICIANS | $3,150,141 |
| POG MANAGEMENT LLC | |||||
| 795 W 7TH STREET | DUBUQUE | IA | 52001 | MANAGEMENT | $1,488,068 |
| MAYO MEDICAL LABORATORIES | |||||
| 3050 SUPERIOR DR | MINNEAPOLIS | MN | 55480 | PHYSICIAN SERVICES | $1,162,497 |
| LABORATORY CORPORATION OF AMERICA | |||||
| 1447 YORK COURT | BURLINGTON | NC | 27215 | MEDICAL SERVICE | $324,573 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 32 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $210,921 | AllOtherContributionsAmt |
| Total Contributions | $210,921 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT REVENUE | 621400 | $155,665,365 | $155,628,071 | $37,294 |
| PROVIDER TAX REVENUE | 621400 | $8,562,436 | $8,562,436 | |
| GOVERNMENT PAYMENT | 621400 | $4,106,602 | $4,106,602 | |
| OTHER INCOME | 621400 | $50,266 | $50,266 | |
| CAFETERIA REVENUE | 621400 | $13,839 | $13,839 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $441 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $441 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $168,398,949 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,187,738 | TotalRevenueColumnAmt |
| Exclusion | $1,187,738 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $42,968 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $42,968 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $42,968 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $42,968 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $169,840,576 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $168,404,623 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $37,294 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,187,738 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,060,362 | TotalAmt |
| Program Services | $287,351 | ProgramServicesAmt |
| Management And General | $773,011 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,292,098 | TotalAmt |
| Program Services | $36,029,927 | ProgramServicesAmt |
| Management And General | $2,262,171 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,670,581 | TotalAmt |
| Program Services | $7,670,581 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,235,229 | TotalAmt |
| Program Services | $2,531,008 | ProgramServicesAmt |
| Management And General | $704,221 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,524 | TotalAmt |
| Management And General | $70,524 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,344 | TotalAmt |
| Management And General | $99,344 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,180,643 | TotalAmt |
| Program Services | $1,180,643 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,157 | TotalAmt |
| Program Services | $73,100 | ProgramServicesAmt |
| Management And General | $57 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,605 | TotalAmt |
| Program Services | $76,026 | ProgramServicesAmt |
| Management And General | $91,579 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,180,053 | TotalAmt |
| Program Services | $4,076,768 | ProgramServicesAmt |
| Management And General | $103,285 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $801,268 | TotalAmt |
| Program Services | $801,268 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| CORPORATE ALLOCATION | $13,494,758 | $13,494,758 | |
| MEDICAL SPECIALIST | $12,397,220 | $12,397,220 | |
| DRUGS | $11,718,261 | $11,718,261 | |
| SUPPLIES | $11,548,077 | $11,139,551 | $408,526 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,991,463 | TotalAmt |
| Program Services | $31,445,136 | ProgramServicesAmt |
| Management And General | $1,546,327 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,980,643 | TotalAmt |
| Program Services | $132,921,598 | ProgramServicesAmt |
| Management And General | $6,059,045 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,347,674 | BOYAmt |
| EOY | $64,974,007 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,419,103 | BOYAmt |
| EOY | $24,902,926 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$228,609 | BOYAmt |
| EOY | $759,280 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,430,711 | BOYAmt |
| EOY | $3,085,204 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,819,720 | BOYAmt |
| EOY | $3,600,575 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $101,301,808 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $80,743,952 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,781,332 | BOYAmt |
| EOY | $20,557,856 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,931,963 | BOYAmt |
| EOY | $4,314,953 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,208,451 | BOYAmt |
| EOY | $5,076,644 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $124,710,345 | BOYAmt |
| EOY | $127,271,445 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,373,889 | BOYAmt |
| EOY | $30,587,514 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,969,335 | BOYAmt |
| EOY | $6,382,585 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,343,224 | BOYAmt |
| EOY | $36,970,099 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $81,902,319 | BOYAmt |
| EOY | $87,714,653 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,464,802 | BOYAmt |
| EOY | $2,586,693 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $84,367,121 | BOYAmt |
| EOY | $90,301,346 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $124,710,345 | BOYAmt |
| EOY | $127,271,445 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $30,859,933 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$482,507 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$24,443,201 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $28,625 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $28,625 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | PORTION OF 2021 ILLINOIS HOSPITAL ASSOCIATION DUES USED FOR LOBBYING - $20,919. PORTION OF 2021 AMERICAN HOSPITAL ASSOCIATION DUES USED FOR LOBBYING - $7,706. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $944,945 | OtherCostOrOtherBasisAmt |
| Book Value | $944,945 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $55,473,059 | OtherCostOrOtherBasisAmt |
| Depreciation | $45,734,933 | DepreciationAmt |
| Book Value | $9,738,126 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $42,217,314 | OtherCostOrOtherBasisAmt |
| Depreciation | $34,266,058 | DepreciationAmt |
| Book Value | $7,951,256 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,666,490 | OtherCostOrOtherBasisAmt |
| Depreciation | $742,961 | DepreciationAmt |
| Book Value | $1,923,529 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $20,557,856 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED MALPRACTICE LIABILITY | $882,444 |
| ASSET RETIREMENT OBLIGATION | $1,685,777 |
| MALPRACTICE LIABILITY LONG TERM | $3,135,980 |
| OTHER LIABILITIES | $1,645 |
| LT LEASE LIABILITY | $341,752 |
| ST LEASE LIABILITY | $334,987 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,382,585 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $881,022 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $881,022 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00630 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $28,977,513 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,094,735 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,882,778 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07110 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $29,858,535 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,094,735 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,763,800 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07740 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $240,096 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,673 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $238,423 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $322,442 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $322,442 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00230 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $241,231 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $241,231 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $39,498 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $39,498 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $843,267 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,673 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $841,594 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00600 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,701,802 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,096,408 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,605,394 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08340 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $33,885 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $33,885 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $33,885 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $33,885 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,107,207 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $12,788,161 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $38,658,752 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$25,870,591 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FREEPORT MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1045 WEST STEPHENSON STREET | AddressLine1Txt |
| City | FREEPORT | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61032 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FREEPORT MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.FHN.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.FHN.ORG | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 125.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.FHN.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.FHN.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.FHN.ORG | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Permit Legal Judicial Process | Yes (X) | PermitLegalJudicialProcessInd |
| Collection Activities | Yes (1) | CollectionActivitiesInd |
| Reporting To Credit Agency | Yes (X) | ReportingToCreditAgencyInd |
| Engaged Legal Judicial Process | Yes (X) | EngagedLegalJudicialProcessInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | SCHEDULE H PART I LINE 7 COLUMN(F): OUR TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, COLUMN(A) WAS $138,980,643. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS $9,382,042 THIS LEFT US WITH A TOTAL EXPENSE OF $129,598,601 FOR PURPOSES OF CALCULATING LINE 7, COLUMN(F). |
| PART I, LN 7 COL(F): | SCHEDULE H PART I LINE 7: OUR TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, COLUMN(A) $138,980,643. THE BAD DEBT EXPENSES INCLUDED IN THIS AMOUNT WAS $9,382,042. THIS LEFT US A TOTAL EXPENSES OF $129,598,601 FOR THE PURPOSES OF CALCULATING LINE 7, COLUMN(F). |
| PART III, LINE 4: | LINE #2: THE RATIO OF PATIENT CARE COST TO CHARGES AS DETERMINED ON WORKSHEET 2 IS APPLIED TO THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TO CALCULATE THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS THAT IS REPORTED ON LINE 2.LINE # 3: NO BAD DEBT IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE CHARITY CARE POLICY. |
| PART III, LINE 8: | COSTING METHODOLOGY: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING THE MEDICARE COST-TO-CHARGE RATIO FROM OUR FILED 12/31/21 MEDICARE COST REPORT.COMMUNITY BENEFIT: WE BELIEVE THAT ALL OF THE 25.87 MILLION SHORTFALL SHOULD BE CONSIDERED AS COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE OF THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORDED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. THIS YEAR, MEDICARE ACCOUNTED FOR 54% OF HOSPITAL REVENUES. THE HOSPITAL PROVIDES CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVES THE GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST OF MEDICARE BENEFICIARIES.0 |
| PART III, LINE 9B: | INDIVIDUALS APPROVED FOR ASSISTED CARE ARE GIVEN A CARD WHICH IS TYPICALLY VALID FOR 6 MONTHS. THEY PRESENT THE CARD WHEN THEY RECEIVE SERVICES. INDIVIDUALS APPROVED FOR ASSISTED CARE WILL BE ASKED TO MAKE A MODEST CO-PAY AT THE TIME OF SERVICE, BASED ON THE FOLLOWING SCHEDULE:HOSPITAL INPATIENT SERVICES: $50HOSPITAL EMERGENCY DEPARTMENT: $35HOSPITAL OUTPATIENT SERVICES: $25OUR COLLECTION POLICIES ARE THE SAME FOR ALL OF OUR PATIENTS. PATIENTS ARE SCREENED FOR ELIGIBILITY FOR FINANCIAL ASSISTANCE BEFORE COLLECTION PROCEDURES BEGIN. IF AT ANY POINT IN THE COLLECTION PROCESS, DOCUMENTATION IS RECEIVED THAT INDICATES THE PATIENT IS POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAS NOT APPLIED FOR IT, AN APPLICATION FOR ASSISTED CARE IS SENT TO THE PATIENT. AFTER A PATIENT MEETS THE QUALIFICATIONS FOR FINANCIAL ASSISTANCE, THE ACCOUNT BALANCE IS EITHER PARTIALLY OR ENTIRELY WRITTEN OFF. ANY REMAINING BALANCE WOULD BE COLLECTED UNDER THE EXISTING DEBT COLLECTION POLICY. COVERAGE FOR THE ASSISTED CARE PROGRAM IS FOR 6 MONTHS AFTER WHICH TIME PATIENTS CAN REAPPLY IF THEY CONTINUE TO MEET THE GUIDELINES ESTABLISHED. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IL |
| SCHEDULE H PART I LINE 6A: | ANNUAL COMMUNITY BENEFIT REPORT - OUR ANNUAL COMMUNITY BENEFIT REPORT IS PREPARED FOR THE FHN NETWORK AS A WHOLE AND IS INCLUDED AS A NON-AUDITED SCHEDULE ON THE AUDITED FINANCIAL STATEMENTS. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (14 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SHOKRY TAWFIK MD | ||||||||||||||
| BOARD MEMBER | $0 | $121,983 | $0 | $0 | $0 | $14,707 | $0 | $0 | $0 | $28,876 | $0 | $165,566 | $0 | $0 |
| BETH KALNINS MD | ||||||||||||||
| MEDICAL STAFF | $237,646 | $0 | $0 | $0 | $10,845 | $0 | $0 | $0 | $35,530 | $0 | $284,021 | $0 | $0 | $0 |
| MARK S GRIDLEY | ||||||||||||||
| PRESIDENT/CEO | $309,427 | $189,649 | $0 | $0 | $35,850 | $21,972 | $12,090 | $7,410 | $22,373 | $13,713 | $379,740 | $232,744 | $0 | $0 |
| MICHAEL C CLARK | ||||||||||||||
| EXECUTIVE VP/CFO | $171,384 | $105,042 | $0 | $0 | $29,207 | $17,901 | $12,090 | $7,410 | $21,086 | $12,923 | $233,767 | $143,276 | $0 | $0 |
| LEONARD CARTER | ||||||||||||||
| CHIEF HUMAN RESOURCES OFFICER | $122,860 | $75,302 | $0 | $0 | $14,556 | $8,922 | $0 | $0 | $22,088 | $13,538 | $159,504 | $97,762 | $0 | $0 |
| REBECCA PEDERSON MD | ||||||||||||||
| CHIEF QUALITY OFFICER | $0 | $366,522 | $0 | $0 | $0 | $10,466 | $0 | $0 | $0 | $32,311 | $0 | $409,299 | $0 | $0 |
| ROBERT GELLER MD | ||||||||||||||
| PRESIDENT MEDICAL STAFF | $0 | $322,539 | $0 | $0 | $0 | $33,272 | $0 | $0 | $0 | $26,330 | $0 | $382,141 | $0 | $0 |
| TIMOTHY JESSEN MD | ||||||||||||||
| CHAIR PHYSICIANS COUNCEL | $0 | $251,920 | $0 | $0 | $0 | $26,139 | $0 | $17,524 | $0 | $32,680 | $0 | $328,263 | $0 | $0 |
| KATHRYN J MARTINEZ | ||||||||||||||
| VP OF PATIENT SERVICE | $239,481 | $0 | $0 | $0 | $1,930 | $0 | $14,610 | $0 | $31,330 | $0 | $287,351 | $0 | $0 | $0 |
| ARSHAD SHAIKH MD | ||||||||||||||
| PHYSICIAN | $643,369 | $0 | $0 | $0 | $121,806 | $0 | $19,500 | $0 | $3,360 | $0 | $788,035 | $0 | $0 | $0 |
| KEITH MARTIN MD | ||||||||||||||
| PHYSICIAN | $412,409 | $0 | $0 | $0 | $26,601 | $0 | $31,551 | $0 | $15,093 | $0 | $485,654 | $0 | $0 | $0 |
| CLARENCE PARKS MD | ||||||||||||||
| PHYSICIAN | $386,239 | $0 | $0 | $0 | $20,495 | $0 | $26,000 | $0 | $2,864 | $0 | $435,598 | $0 | $0 | $0 |
| MOHAMAD SALAMA MD | ||||||||||||||
| PHYSICIAN | $297,319 | $0 | $0 | $0 | $479 | $0 | $6,145 | $0 | $5,380 | $0 | $309,323 | $0 | $0 | $0 |
| IRENA MARKOVIC MD | ||||||||||||||
| PHYSICIAN | $285,139 | $0 | $0 | $0 | $480 | $0 | $13,419 | $0 | $6,045 | $0 | $305,083 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 1A | FormAndLineReferenceDesc |
| Explanation | FREEPORT MEMORIAL HOSPITAL REIMBURSED A DIRECTOR/TRUSTEE FOR BUSINESS TRAVEL EXPENSES INCLUDING TRAVEL EXPENSES FOR A SPOUSE. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (6 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| GARY QUINN | |||
| BOARD OF DIRECTORS | $24,772 | GARY QUINN DAUGHTER-IN-LAW WORKS FOR THE ORGANIZATION. | 0 |
| MICHAEL CLARK | |||
| CHIEF FINANCIAL OFFICER | $15,281 | MICHAEL C. CLARK DAUGHTER WORKS FOR THE ORGANIZATION. | 0 |
| BRUCE BALDWIN | |||
| BOARD OF DIRECTORS | $35,083 | BRUCE BALDWIN SPOUSE IS EMPLOYED BY THE ORGANIZATION. | 0 |
| BRUCE BALDWIN | |||
| BOARD OF DIRECTORS | $30,080 | BRUCE BALDWIN SISTER IS EMPLOYED BY THE ORGANIZATION. | 0 |
| KATHRYN MARTINEZ | |||
| CHIEF OPERATING OFFICER/CHIEF NURSING OFFICER | $78,516 | SPOUSE WORKS FOR THE ORGANIZATION | 0 |
| BRUCE BALDWIN | |||
| BOARD OF DIRECTORS | $16,912 | BRUCE BALDWIN NIECE IS EMPLOYED BY THE ORGANIZATION | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART III LINE 1 | FHN IS REGIONAL HEALTHCARE SYSTEM COMMITTED TO THE HEALTH AND WELL-BEING OF THE PEOPLE OF NORTHWEST ILLINOIS AND SOUTHERN WISCONSIN. WE HAVE SERVICES FOR ALL AGES, SO EVERY MEMBER OF YOUR FAMILY CAN RECEIVE CARING, PERSONAL, PROFESSIONAL HEALTHCARE. AN AVERAGE OF 1,400 PEOPLE VISIT FHN EACH DAY FOR THEIR HEALTHCARE NEEDS (THAT'S MORE THAN 525,000 PATIENTS PER YEAR). FHN IS THE ONLY HEALTHCARE PROVIDER IN OUR SERVICE AREA THAT OFFERS AFFILIATIONS WITH THREE MAJOR HOSPITALS IN ROCKFORD, ILLINOIS, AS WELL AS WITH THE UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS IN MADISON, WISCONSIN. WE SEE EACH PATIENT INTERACTION AS A SERIOUS RESPONSIBILITY THAT REQUIRES CLINICAL EXPERTISE, ACCESS TO THE LATEST IN MEDICAL TECHNOLOGY AND A LEVEL OF TRUST AND COMMITMENT THAT IS EARNED BY OUR PEOPLE, OUR PRODUCTS AND OUR PROCESS. ABOUT FHN MEMORIAL HOSPITAL: 146 LICENSED BED. 24-HOUR EMERGENCY CARE. EICU UNIT, LINKING OUR EXPERIENCED, CARING STAFF ROUND-THE-CLOCK WITH THE UNIVERSITY OF WISCONSIN E-CARE TEAM OF PROFESSIONAL INTENSIVISTS AND CRITICAL CARE NURSES. SATELLITE EDUCATION CENTER FOR THE ILLINOIS POISON CONTROL CENTER (ONE OF ONLY 12 IN THE STATE OF ILLINOIS). OVER 75 PHYSICIANS ON THE ACTIVE AND ASSOCIATED MEDICAL STAFF - 100% ARE BOARD-CERTIFIED OR BOARD-ELIGIBLE. UP-TO-THE-MINUTE EQUIPMENT AND SERVICES, INCLUDING A CARDIOVASCULAR CENTER. SURGERY CAPABILITIES FOR PROCEDURES RANGING FROM A SIMPLE TONSILLECTOMY TO SOPHISTICATED VASCULAR SURGERY. SPECIALTY SERVICE AREAS SUCH AS SLEEP CENTER, PAIN CLINIC, SPINE CENTER AND FAMILY BIRTHING CENTER. AS PART OF YOUR COMMUNITY, WE WILL PROVIDE PERSONAL, PROFESSIONAL AND CARING HEALTHCARE FOR YOUR ENTIRE FAMILY. WE WILL PROVIDE OR FIND SERVICES YOU NEED TO MAKE YOUR LIFE BETTER. WE WILL FOLLOW THROUGH AND MAKE SURE YOU ARE SATISFIED. WE ARE COMMITTED TO EXCELLENCE AND YOUR WELL-BEING IS THE REASON FOR OUR EXISTENCE. WE ARE PART OF YOUR COMMUNITY. AND WE WANT TO KEEP IT HEALTHY, BOTH ECONOMICALLY AND PHYSICALLY, AT WORK, AT PLAY, ON THE FARM, AT SCHOOL AND AT HOME. IN 2006, WE FORMED A PARTNERSHIP WITH THE STEPHENSON COUNTY HEALTH DEPARTMENT TO PROVIDE HEALTHCARE SERVICES FOR THE UNINSURED, UNDERINSURED AND MEDICALLY INDIGENT AT THE FHN COMMUNITY HEALTHCARE CENTER, LOCATED AT THE FORMER CRUSADER COMMUNITY CLINIC INSIDE THE HEALTH DEPARTMENT BUILDING. AND IN SUPPORT OF THE LOCAL UNITED WAY, EACH YEAR OUR EMPLOYEES MAKE THEIR PERSONAL CONTRIBUTIONS, AVERAGING OVER $40,000, AND ALSO SERVE IN LEADERSHIP POSITIONS FOR MANY COMMUNITY ORGANIZATIONS AND BOARDS. FHN IS A COMMUNITY HEALTHCARE SYSTEM, COMPRISED OF LOCAL EXPERTS, INSPIRED BY GLOBAL INNOVATION AND GROUNDED BY ETHICAL LEADERSHIP. FREEPORT MEMORIAL HOSPITAL COORDINATES AND INTEGRATES MEDICAL CARE SERVICES AND PROVIDES INDIVIDUALS IMPARTIAL ACCESS TO MEDICAL CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, OR SOURCE OF PAYMENT. THE HOSPITAL PROVIDES MEDICALLY NECESSARY CARE TO PATIENTS REGARDLESS OF ABILITY TO PAY. THE HOSPITAL QUALIFIES AS A MEDICARE DISPROPORTIONATE SHARE HOSPITAL BECAUSE IT SERVES A DISPROPORTIONATELY HIGH NUMBER OF LOW INCOME PATIENTS. INSURED AND UNDERINSURED PATIENTS, WHO MEET CERTAIN FEDERAL POVERTY GUIDELINES AND/OR OTHER UNIQUE CIRCUMSTANCES, ARE PROVIDED FREE OR DISCOUNTED CARE AFTER A NOMINAL CO-PAYMENT. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE AMOUNT OF CHARITY CARE IT PROVIDES. DURING 2021, THE CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THE HOSPITAL'S CHARITY CARE POLICY WAS $3,922,078 AT A COST OF $821,385 . FREEPORT MEMORIAL HOSPITAL IS A LICENSED MEDICARE AND MEDICAID PROVIDER WITH APPROXIMATELY 72% OF ITS PATIENT BASE QUALIFYING FOR AT LEAST ONE OF THESE PROGRAMS. AT PRESENT, THE REIMBURSEMENT RATES FOR BOTH PROGRAMS DO NOT FULLY COVER THE COST OF CARE TO THESE PATIENTS. THE ESTIMATED UNFUNDED COSTS OF SERVICES FOR MEDICAID PATIENTS WERE APPROXIMATELY $9,882,778 FOR THE YEAR ENDING 12/31/2021. MEDICARE PAYMENTS WERE APPROXIMATELY $25,870,591 LESS THAN THE HOSPITAL'S COST TO PROVIDE CARE DURING THE SAME PERIOD. IN ADDITION, THE COST OF CARE PROVIDED TO PEOPLE WHO DID NOT PAY WAS $2,107,207 IN 2021. FREEPORT MEMORIAL HOSPITAL PROVIDES DISCOUNTS TO UNINSURED PATIENTS WITHOUT REGARD TO THEIR INCOME. THE ESTIMATED COSTS ATTRIBUTABLE TO THE DISCOUNTED PORTION OF THESE SERVICES WERE $241,231 FOR 2021. FREEPORT MEMORIAL HOSPITAL AND ITS RELATED ORGANIZATIONS SUPPORT AND PARTICIPATE IN MANY COMMUNITY SERVICES AND OUTREACH PROGRAMS, INCLUDING SUPPORT FOR COMMUNITY HEALTH EDUCATION PROGRAMS, COMMUNITY-BASED CLINICAL SERVICES, HEALTH PROFESSIONAL EDUCATION, RESEARCH, SPONSORSHIP OF COMMUNITY EVENTS, AND COMMUNITY-BUILDING ACTIVITIES. THE HOSPITAL CONTRIBUTED $ 614,411 TOWARDS THESE PROGRAMS IN 2021. PROGRAM SERVICE EXPENSES: $132,921,598. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION'S BOARD OF DIRECTORS REVIEWS THE FORM 990 BEFORE THE TAX RETURN IS FILED. QUESTIONS AND EXPLANATIONS ARE ANSWERED BY THE FINANCE DEPARTMENT TO THE BOARD'S SATSIFACTION. THE BOARD REVIEWS ALL TRANSACTIONS THAT AFFECT THE FILING OF THE ORGANIZATION'S FORM 990 AND EQUIVALENT STATE RETURNS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION HAS A DEDICATED CORPORATE COMPLIANCE OFFICER. ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE ANNUALLY A CONFLICT OF INTEREST QUESTIONNAIRE. THESE DOCUMENTS ARE REVIEWED BY THE CCO TO DETERMINE IF ANY INDIVIDUAL HAS A CONFLICT OF INTEREST THAT NEEDS TO BE ADDRESSED. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION HAS AN EXECUTIVE COMPENSATION COMMITTEE THAT REVIEWS THE CEO, TOP MANAGEMENT AND EXECUTIVE DIRECTORS COMPENSATION. THE COMMITTEE RELIES ON INTERNAL AND EXTERNAL INFORMATION TO DETERMINE THE APPROPRIATE COMPENSATION AND EMPLOYS AN INDEPENDENT THIRD PARTY TO CONDUCT THE ANNUAL EXECUTIVE COMPENSATION ANALYSIS. THIS ANALYSIS IS USED TO DETERMINE IF THE BOARD'S WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY HAS BEEN MET. THE EXECUTIVE COMPENSATION COMMITTEE ALSO RECEIVES A REASONABLENESS LETTER FROM THE THIRD PARTY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 24E | CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 10,863,896. MANAGEMENT AND GENERAL EXPENSES 404,116. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,268,012. BAD DEBTS: PROGRAM SERVICE EXPENSES 9,382,042. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,382,042. PROVIDER TAX: PROGRAM SERVICE EXPENSES 5,097,848. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,097,848. MAINTENANCE/REPAIRS: PROGRAM SERVICE EXPENSES 3,756,095. MANAGEMENT AND GENERAL EXPENSES 281,712. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,037,807. AGENCY STAFFING: PROGRAM SERVICE EXPENSES 1,989,918. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,989,918. COLLECTION FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 812,112. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 812,112. FOOD: PROGRAM SERVICE EXPENSES 230,460. MANAGEMENT AND GENERAL EXPENSES 8,095. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 238,555. MISC. OTHER EXPENSES: PROGRAM SERVICE EXPENSES 124,877. MANAGEMENT AND GENERAL EXPENSES 40,292. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 165,169. |
| FORM 990, PART XI, LINE 9: | CHANGE IN MINIMUM PENSION LIABILITY TRANSFERS FROM AFFILIATE -24,565,093. NET ASSETS RELEASED FROM TEMP. RESTRICTION -925,753. CONTRIBUTIONS TEMPORARY RESTRICTED 1,047,645. |
| PART XII LINE 2C | NO CHANGES HAVE BEEN MADE TO THE SELECTION PROCESS FOR THE INDEPENDENT AUDITOR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| FREEPORT REGIONAL HEALTH CARE FOUNDATION | |||||||||||
| 1045 WEST STEPHENSON STREET | FREEPORT | IL | 61032 | 363290904 | HEALTH CARE | IL | 501(C)(3) | LINE 11 | N/A | 0 | |
| FREEPORT REGIONAL HEALTHCARE SERVICES | |||||||||||
| 1045 WEST STEPHENSON STREET | FREEPORT | IL | 61032 | 363967303 | HEALTH CARE | IL | 501(C)(3) | LINE 3 | 0 | FREEPORT REGIONAL HEALTH CARE FOUNDATION | |
| FREEPORT REGIONAL MANAGEMENT SERVICES | |||||||||||
| 1045 WEST STEPHENSON STREET | FREEPORT | IL | 61032 | 363994636 | HEALTH CARE | IL | 501(C)(3) | LINE 3 | 0 | FREEPORT REGIONAL HEALTH CARE FOUNDATION | |
| JANE ADDAMS INC | |||||||||||
| 1045 WEST STEPHENSON STREET | FREEPORT | IL | 61032 | 362879689 | HEALTH CARE | IL | 501(C)(3) | LINE 7 | 0 | FREEPORT REGIONAL HEALTH CARE FOUNDATION | |
| JANE ADDAMS HEALTHCARE SERVICES INC | |||||||||||
| 1045 WEST STEPHENSON STREET | FREEPORT | IL | 61032 | 363677357 | HEALTH CARE | IL | 501(C)(3) | LINE 11 | 0 | FREEPORT REGIONAL HEALTH CARE FOUNDATION | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL ENTERPRISES INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1045 WEST STEPHENSON STREET | AddressLine1Txt |
| City | FREEPORT | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61032 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363353871 | EIN |
| Primary Activities | HEALTH CARE | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FREEPORT REGIONAL HEALTH CARE FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |