IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME (EIN 37-0673512)
- Tax period
- 2017-10-01 to 2018-09-30
- Filed
- 2019-02-21
- IRS object ID
- 201910529349301006
- Schema version
- 2017v2.3
- 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 K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-02-21T17:40:44-06:00 | ReturnTs |
| Tax Period End | 2018-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 430352985 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KERBER ECK & BRAECKEL LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3401 OFFICE PARK DRIVE | AddressLine1Txt |
| City | MARION | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62959 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 370673512 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | IROQUOIS MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Business Name Line2 | & RESIDENT HOME | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | IROQ | BusinessNameControlTxt |
| Phone | 8154325841 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 E FAIRMAN AVENUE | AddressLine1Txt |
| City | WATSEKA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 609701644 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TIM SMITH | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 8154325841 | PhoneNum |
| Signature | 2019-02-21 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARK DALLAS | PreparerPersonNm |
| PTIN | P00187265 | PTIN |
| Phone | 6189938724 | PhoneNum |
| Preparation | 2019-02-21 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 64.83.254.138 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-02-21 | IPDt |
| IP Tm | 17:19:28 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 03690DDF2CC8DAF5F58E5446F3CD9FF125C7F3FE | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TIM SMITH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 E FAIRMAN AVENUE | AddressLine1Txt |
| City | WATSEKA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60970 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $35,554,096 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.IMHRH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1914 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | IROQUOIS MEMORIAL HOSPITAL & RESIDENT HOME IS COMMITTED TO PROVIDING QUALITY HEALTHCARE SERVICES FOR THE REGION IN A CONVENIENT CARING ENVIRONMENT. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,052,412 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,191,920 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $32,542,993 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $31,923,018 | CYProgramServiceRevenueAmt |
| PY Investment Income | $203,551 | PYInvestmentIncomeAmt |
| CY Investment Income | $289,892 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,488,615 | PYOtherRevenueAmt |
| CY Other Revenue | $1,149,266 | CYOtherRevenueAmt |
| PY Total Revenue | $35,287,571 | PYTotalRevenueAmt |
| CY Total Revenue | $35,554,096 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $13,850 | 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 | $20,675,379 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $19,006,508 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $15,903,559 | PYOtherExpensesAmt |
| CY Other Expenses | $17,006,122 | CYOtherExpensesAmt |
| PY Total Expenses | $36,592,788 | PYTotalExpensesAmt |
| CY Total Expenses | $36,012,630 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,305,217 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$458,534 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $28,163,500 | TotalAssetsBOYAmt |
| Total Assets EOY | $27,512,837 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,947,061 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,291,174 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $17,216,439 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,221,663 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | IROQUOIS MEMORIAL HOSPITAL & RESIDENT HOME IS COMMITTED TO PROVIDING QUALITY HEALTHCARE SERVICES FOR THE REGION IN A CONVENIENT CARING ENVIRONMENT. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $32,026,340 | ExpenseAmt |
| Revenue | $31,923,018 | RevenueAmt |
| Desc | IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME PROVIDES HIGH QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. THEREFORE, IN KEEPING WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF OUR COMMUNITY, SOME CARE IS PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST. THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR AN INDIVIDUAL'S INABILITY TO PAY EXIST. THESE ACTIVITIES INCLUDE PREVENTION AND WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, AND THE MEDICALLY UNDER SERVED INCLUDING A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES.THE HOSPITAL IS LOCATED IN WATSEKA, ILLINOIS AND SERVES THE SURROUNDING COMMUNITIES IN IROQUOIS COUNTY AND WEST-CENTRAL INDIANA. THERE ARE OUTPATIENT CLINICS MAINTAINED IN GILMAN, MILFORD, AND WATSEKA, ILLINOIS AS WELL AS KENTLAND, INDIANA. THE HOSPITAL PROVIDES BEDS FOR ACUTE CARE, INTENSIVE CARE, NURSERY, AND LONG-TERM CARE. THE HOSPITAL ALSO PROVIDES AMBULANCE SERVICES TO MOST OF IROQUOIS COUNTY WITH STATIONS IN GILMAN AND WATSEKA. HOME HEALTH AND HOSPICE PROVIDE SERVICES TO WATSEKA AND SURROUNDING COMMUNITIES IN THE HOSPITAL'S SERVICE AREA. THE IROQUOIS REGIONAL HEALTH CENTER HOUSES PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPIES. THE HOSPITAL IS CERTIFIED TO PROVIDE CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE HOSPITAL RECORDS THESE AMOUNTS AS UNCOMPENSATED CARE IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. THE COST IN EXCESS OF CHARGES FOR PROVIDING CARE TO ILLINOIS MEDICAID AND OTHER PUBLIC AID PROGRAMS WAS $1,785,000 DURING FISCAL YEAR 2017. THIS COST WAS MITIGATED BY ILLINOIS HOSPITAL MEDICAID ASSESSMENT PROGRAM PAYMENTS AND HOSPITAL ACCESS IMPROVEMENT PAYMENTS, NET OF TAXES ASSESSED, IN THE AMOUNT OF $2,699,716. WITH THE BOARD'S PARTICIPATION AND APPROVAL, THE HOSPITAL VOLUNTARILY PROVIDES CARE TO PATIENTS AT LESS THAN ITS ESTABLISHED CHARGES FOR PATIENTS WHO ARE IN NEED AND MEET THE HOSPITAL'S CHARITY CARE CRITERIA. CHARGES EXCLUDED FROM REVENUE UNDER THE HOSPITAL'S CHARITY CARE POLICY WERE APPROXIMATELY $480,000 FOR FISCAL YEAR 2017, WHILE THE COST OF PROVIDING THOSE SERVICES WAS APPROXIMATELY $229,000.IN ADDITION, THE HOSPITAL IS NOT ABLE TO COLLECT FOR ALL OF THE CARE THAT WAS CHARGED TO PATIENTS. DURING FISCAL YEAR 2017 THE HOSPITAL HAD TO WRITE-OFF $2,128,507 IN UNCOLLECTIBLE ACCOUNTS. THE COST OF PROVIDING THAT BENEFIT TO OUR PATIENTS TOTALED $1,016,000.IROQUOIS MEMORIAL HOSPITAL PROVIDES NON-TRADITIONAL HOSPITAL BASED SERVICES SUCH AS AMBULANCE COVERAGE TO WATSEKA AND THE SURROUNDING IROQUOIS COUNTY COMMUNITIES. IN ADDITION TO THE COSTS OF UNCOMPENSSATED CARE AND OTHER NON-TRADITIONAL SERVICES, IROQUOIS MEMORIAL HOSPITAL & RESIDENT HOME COMMITTED SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND OTHER CRITICAL SERVICES WHICH MEET OTHERWISE UNFILLED COMMUNITY NEEDS. SOME OF THOSE PROGRAMS THAT FURTHER THE HOSPITAL'S MISSION INCLUDE:AMBULANCE SUPPORT FOR SPORTING EVENTS AND SURROUNDING VOLUNTEER AMBULANCE DEPARTMENTSBLOOD DRIVESBREAST CANCER AWARENESS EVENTBREAST-FEEDING CLASSES FOR EXPECTANT MOTHERSCAMP 911 SAFETY PROGRAMS FOR AREA SCHOOL CHILDRENFARM SAFETY EDUCATIONFIRST AID FOR LOCAL COMMUNITY EVENTSFREE AND REDUCED FEE HEALTH SCREENINGSFREE BLOOD PRESSURE SCREENINGSFREE CPR TRAINING FOR THE PUBLICGO RED HEALTHY HEART EVENTHEALTH-RELATED ARTICLES IN LOCAL PUBLICATIONSBIRTHING CLASSESLIFELINEMEALS ON WHEELSSPEAKER'S BUREAUTOURS FOR AREA SCHOOL CHILDREN | Desc |
| Total Program Service Expenses | $32,026,340 | 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 |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| 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 |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | 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 | Yes (1) | 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 | 0 | 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 | IROQUOIS MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8154325841 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 EAST FAIRMAN AVE | AddressLine1Txt |
| City | WATSEKA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60970 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| ROGER DITTRICH | |||||||
| CHAIR | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| STEVEN KNAPP | |||||||
| VICE-CHAIR | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| DANIEL TINCHER | |||||||
| SECRETARY | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| MEL WARD | |||||||
| TREASURER | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| RHONDA PENCE | |||||||
| DIRECTOR | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| DOUG GEIGER | |||||||
| DIRECTOR | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| PHILIP ZUMWALT MD | |||||||
| DIRECTOR | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| TIM SMITH | |||||||
| CEO | 40.00 | $105,451 | $0 | $0 | Yes (X) | ||
| LORI YELENICK | |||||||
| CFO | 40.00 | $82,135 | $0 | $0 | Yes (X) | ||
| JUN KIM | |||||||
| PHYSICIAN | 40.00 | $362,865 | $0 | $2,604 | Yes (X) | ||
| GONZALO FLORIDO | |||||||
| PHYSICIAN | 40.00 | $273,035 | $0 | $9,970 | Yes (X) | ||
| RODNEY ALFORD | |||||||
| PHYSICIAN | 40.00 | $238,825 | $0 | $11,320 | Yes (X) | ||
| NARAN DODIA | |||||||
| PHYSICIAN | 40.00 | $235,813 | $0 | $4,925 | Yes (X) | ||
| CRISANTO REYES | |||||||
| PHYSICIAN | 40.00 | $222,944 | $0 | $6,720 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,521,068 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $35,539 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | 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 |
|---|---|---|---|---|---|
| EMERGENCY DEPARTMENT ASSOC | |||||
| 7032 COLLECTION CENTER DR | CHICAGO | IL | 60693 | PHYSICIAN SERVICES | $506,808 |
| COMPUTER PROGRAMS AND SYSTEMS | |||||
| PO BOX 850309 | MOBILE | AL | 36685 | COMPUTER SERVICES | $492,384 |
| AMERICAN ANESTHESIA | |||||
| PO BOX 281034 | ATLANTA | GA | 30384 | CRNA SERVICES | $383,037 |
| COMPHEALTH ASSOCIATES INC | |||||
| PO BOX 972670 | DALLAS | TX | 75397 | STAFFING SERVICES | $349,954 |
| MEDEFIS CONSOLIDATED | |||||
| PO BOX 5068 | NEW YORK | NY | 10087 | STAFFING SERVICES | $310,076 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $1,900,000 | RelatedOrganizationsAmt |
| All Other Contributions | $291,920 | AllOtherContributionsAmt |
| Total Contributions | $2,191,920 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| NET PATIENT SERVICE REVENUE | $31,757,086 | $31,757,086 |
| CLINIC & PHYSICIAN RENTAL | $165,932 | $165,932 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $31,923,018 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $289,892 | TotalRevenueColumnAmt |
| Exclusion | $289,892 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|
| OUTSIDE SERVICES | $875,903 | $875,903 |
| CAFETERIA | $145,417 | $145,417 |
| MISCELLANEOUS | $127,946 | $127,946 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,149,266 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,554,096 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $31,923,018 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,439,158 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $187,586 | TotalAmt |
| Management And General | $187,586 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,426,094 | TotalAmt |
| Program Services | $14,619,224 | ProgramServicesAmt |
| Management And General | $1,806,870 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,392,828 | TotalAmt |
| Program Services | $2,129,617 | ProgramServicesAmt |
| Management And General | $263,211 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,027 | TotalAmt |
| Management And General | $67,027 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,000 | TotalAmt |
| Management And General | $45,000 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,529,152 | TotalAmt |
| Program Services | $3,140,945 | ProgramServicesAmt |
| Management And General | $388,207 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $132,679 | TotalAmt |
| Management And General | $132,679 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,862,558 | TotalAmt |
| Program Services | $4,327,677 | ProgramServicesAmt |
| Management And General | $534,881 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $814,798 | TotalAmt |
| Program Services | $725,170 | ProgramServicesAmt |
| Management And General | $89,628 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $231,760 | TotalAmt |
| Program Services | $206,266 | ProgramServicesAmt |
| Management And General | $25,494 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,556,294 | TotalAmt |
| Program Services | $1,385,102 | ProgramServicesAmt |
| Management And General | $171,192 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $792,000 | TotalAmt |
| Program Services | $704,880 | ProgramServicesAmt |
| Management And General | $87,120 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBTS | $2,023,568 | $2,023,568 | |
| AGENCY SERVICES | $1,703,592 | $1,516,197 | $187,395 |
| IDPA PROVIDER TAX | $1,115,825 | $1,115,825 | |
| RECRUITING | $74,211 | $74,211 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,658 | TotalAmt |
| Program Services | $57,658 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,012,630 | TotalAmt |
| Program Services | $32,026,340 | ProgramServicesAmt |
| Management And General | $3,986,290 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,502 | BOYAmt |
| EOY | $822,425 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,265,038 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,237,577 | BOYAmt |
| EOY | $4,930,377 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,006,921 | BOYAmt |
| EOY | $987,401 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $326,775 | BOYAmt |
| EOY | $434,904 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $43,539,226 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $32,519,578 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,970,133 | BOYAmt |
| EOY | $11,019,648 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,338,554 | BOYAmt |
| EOY | $9,318,082 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,163,500 | BOYAmt |
| EOY | $27,512,837 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,181,414 | BOYAmt |
| EOY | $6,884,378 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,790,000 | BOYAmt |
| EOY | $2,380,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,538,604 | BOYAmt |
| EOY | $1,759,484 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $437,043 | BOYAmt |
| EOY | $267,312 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,947,061 | BOYAmt |
| EOY | $11,291,174 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,901,185 | BOYAmt |
| EOY | $8,447,661 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,315,254 | BOYAmt |
| EOY | $7,774,002 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,216,439 | BOYAmt |
| EOY | $16,221,663 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,163,500 | BOYAmt |
| EOY | $27,512,837 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$458,534 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$536,242 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | Yes (1) | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (1) | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | Yes (1) | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $0 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1F | FormAndLineReferenceDesc |
| Explanation | A PORTION OF MEMBERSHIP DUES TO PROFESSIONAL HEALTHCARE ASSOCIATIONS IS USED FOR LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $9,616,693 | BeginningYearBalanceAmt |
| End Year Balance | $9,616,693 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $9,636,792 | BeginningYearBalanceAmt |
| Contributions | $693,013 | ContributionsAmt |
| Investment Earnings Or Losses | $1,858 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $714,970 | OtherExpendituresAmt |
| End Year Balance | $9,616,693 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $9,654,406 | BeginningYearBalanceAmt |
| Contributions | $666,442 | ContributionsAmt |
| Investment Earnings Or Losses | $159,340 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $843,396 | OtherExpendituresAmt |
| End Year Balance | $9,636,792 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $9,343,664 | BeginningYearBalanceAmt |
| Contributions | $769,811 | ContributionsAmt |
| Investment Earnings Or Losses | $690,576 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,149,645 | OtherExpendituresAmt |
| End Year Balance | $9,654,406 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $9,104,956 | BeginningYearBalanceAmt |
| Contributions | $1,582,760 | ContributionsAmt |
| Investment Earnings Or Losses | $2,070 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,346,122 | OtherExpendituresAmt |
| End Year Balance | $9,343,664 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $319,450 | InvestmentCostOrOtherBasisAmt |
| Book Value | $319,450 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $25,855,712 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $18,091,232 | DepreciationAmt |
| Book Value | $7,764,480 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $483,750 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $478,418 | DepreciationAmt |
| Book Value | $5,332 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $16,795,348 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $13,949,928 | DepreciationAmt |
| Book Value | $2,845,420 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $84,966 | InvestmentCostOrOtherBasisAmt |
| Book Value | $84,966 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $11,019,648 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| BENEFICIAL INTEREST IN TRUST | $7,714,002 |
| OTHER ASSET | $1,036,568 |
| BOND ISSUE COST | $42,509 |
| INTERCOMPANY | $525,003 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $9,318,082 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO THIRD PARTY | Desc |
| Amt | $267,312 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $267,312 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE ENDOWMENT FUNDS ARE USED TO SUPPORT THE ONGOING OPERATIONAL AND CAPITAL NEEDS OF THE ORGANIZATION IN MEETING THE COMMUNITY NEEDS AND SERVICES. |
| PART X, LINE 2: | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITION UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
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 |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 125.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 0 | AnnualCommunityBnftReportInd |
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
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 | IROQUOIS MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 E FAIRMAN AVE | AddressLine1Txt |
| City | WATSEKA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60970 | 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 | IROQUOIS 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 |
| CHNA Conducted | 15 | 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.IMHRH.ORG | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.IMHRH.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 |
| 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.IMHRH.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.IMHRH.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.IMHRH.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 |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| 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 SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| IROQUOIS MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: IN CONDUCTING THE CHNA, INPUT WAS GATHERED FROM FOCUS GROUPS. SEVEN FOCUS GROUPS WERE CONDUCTED AND INCLUDED THE HOSPITAL'S EXECUTIVE TEAM, MANAGEMENT TEAM, MEDICAL PROVIDERS, BOARD OF TRUSTEES, FARMERS AND FAITH LEADERS, YOUNG ADULT EMPLOYERS, AND CIVIC AND BUSINESS LEADERS. |
| IROQUOIS MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: PRIORITY 1--MENTAL HEALTHIROQUOIS MEMORIAL HOSPITAL HAS RE-ESTABLISHED ITS RELATIONSHIP WITH THE IROQUOIS MENTAL HEALTH CENTER TO BETTER ADDRESS THE NEEDS OF PATIENTS WITH MENTAL HEALTH NEEDS. IROQUOIS MEMORIAL HOSPITAL HIRED A CARE COORDINATOR IN 2017 TO DEVELOP CARE PLANS FOR OUR PATIENTS TO ADDRESS MEDICAL, MENTAL, AND NUTRITIONAL NEEDS.PRIORITY 2--DRUG AND ALCOHOL ABUSEIROQUOIS MEMORIAL HOSPITAL HIRED A CARE COORDINATOR IN 2017 TO DEVELOP CARE PLANS FOR OUR PATIENTS TO ADDRESS MEDICAL, MENTAL, AND NUTRITIONAL NEEDS.PRIORITY 3--DIABETESIROQUOIS MEMORIAL HOSPITAL HIRED A CARE COORDINATOR IN 2017 TO DEVELOP CARE PLANS FOR OUR PATIENTS TO ADDRESS MEDICAL, MENTAL, AND NUTRITIONAL NEEDS. IN 2017, THE HOSPITAL HIRED A NURSE PRACTITIONER WHO SPECIALIZES IN CHRONIC DISEASE MANAGEMENT. THE NURSE PRACTITIONER HAS BEEN ABLE TO PROVIDE ADDITIONAL TEACHING FOR DIABETIC PATIENTS.PRIORITY 4--OBESITYIROQUOIS MEMORIAL HOSPITAL HIRED A CARE COORDINATOR IN 2017 TO DEVELOP CARE PLANS FOR OUR PATIENTS TO ADDRESS MEDICAL, MENTAL, AND NUTRITIONAL NEEDS. IN 2017, THE HOSPITAL HIRED A NURSE PRACTITIONER WHO SPECIALIZES IN CHRONIC DISEASE MANAGEMENT. IMH ALSO EMPLOYES A DIETICIAN TO PROVIDE COUNSELING FOR CONDITIONS SUCH AS OBESITY.ALL NEEDS IDENTIFIED WERE ADDRESSED |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 7 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - IROQUOIS REGIONAL HEALTH CENTER | ||||
| 200 LAIRD LANE | WATSEKA | IL | 60970 | REHAB SERVICES, HOME HEALTH, HOSPICE |
| 2 - IROQUOIS HOME CARE INC | ||||
| 200 LAIRD LANE | WATSEKA | IL | 60970 | DURABLE MEDICAL EQUIPMENT |
| 3 - MULTI-SPECIALTY CLINIC | ||||
| 200 E FAIRMAN AVENUE | WATSEKA | IL | 60970 | PHYSICIAN OFFICE |
| 4 - KENTLAND CLINIC | ||||
| 303 N 7TH STREET | KENTLAND | IN | 47951 | PHYSICIAN OFFICE |
| 5 - MILFORD CLINIC | ||||
| 34 EAST JONES | MILFORD | IL | 60953 | PHYSICIAN OFFICE |
| 6 - GILMAN CLINIC | ||||
| 508 E CRESCENT STREET | GILMAN | IL | 60938 | PHYSICIAN OFFICE |
| 7 - IROQUOIS WOMEN'S HEALTH CENTER | ||||
| 625 S 5TH STREET | WATSEKA | IL | 60970 | PHYSICIAN OFFICE |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | A COST-TO-CHARGE RATIO AS CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, INCLUDED IN THE SCHEDULE H INSTRUCTIONS WAS USED TO DETERMINE THE AMOUNTS ON LINE 7B OF PART I OF SCHEDULE H. ACTUAL COSTS WERE USED TO DETERMINE THE BENEFIT EXPENSES ON LINES 7A, 7E, 7F, 7G, AND 7I OF SCHEDULE H, PART I. |
| PART I, LINE 7G: | THE ORGANIZATION INCLUDED COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC, OB, AND RESIDENT HOME IN ITS SUBSIDIZED HEALTH SERVICES. |
| PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE | THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $2,128,507, HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES APPICABLE TO COMMUNITY BENEFITS. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | IN ORDER TO PROMOTE THE WELL-BEING OF THE COMMUNITIES IT SERVES, THE ORGANIZATION PROMOTES ECONOMIC AND WORK FORCE DEVELOPMENT INCLUDING RECRUITING PROVIDERS TO A MEDICALLY UNDERSERVED AREA AND PROVIDING CLINICAL EXPOSURE TO LOCAL STUDENTS PURSUING CAREERS IN HEALTHCARE. |
| PART III, LINE 2: | FOOTNOTE FROM AUDITED FINANCIAL STATEMENTS:THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYORS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECITON INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD-PARTY PAYORS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.THE HOSPITAL USES AN OVERALL HOSPITAL COST-TO-CHARGE RATIO TO CALCULATE THE UNPAID COST OF BAD DEBT EXPENSE.IN ADDITION TO THE ABOVE COST OF UNCOMPENSATED CARE, THE HOSPITAL ALSO COMMITS SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND CRITICAL SERVICES WHICH MEET OTHERWISE UNFILLED COMMUNITY NEEDS. MANY OF THESE ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE SELF-SUPPORTING OR FINANCIALLY VIABLE.DESCRIPTION OF COSTING METHODOLOGY USED:THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINE 2 WAS A RATIO OF PATIENT CARE COSTS TO CHARGES AS COMPUTED IN WORKSHEET 2 OF THE FORM 990, SCHEDULE H INSTRUCTIONS. |
| PART III, LINE 8: | MEDICARE COST WAS DETERMINED USING AN OVERALL COST-TO-CHARGE RATIO. |
| PART III, LINE 9B: | QUALIFICATIONS ARE BASED ON POVERTY GUIDELINES PUBLISHED. NO COLLECTION EFFORTS FOR QUALIFYING PATIENTS. PATIENTS WHO DO NOT QUALIFY RECEIVE AT LEAST 3 STATEMENTS AND GENERALLY ARE TURNED TO COLLECTIONS IF NO PAYMENTS ARE RECEIVED. |
| PART VI, LINE 2: | IN PREVIOUS YEARS, THE ORGANIZATION HIRED A CONSULTANT TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. |
| PART VI, LINE 3: | INFORMATION REGARDING THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY IS DISTRIBUTED AT TIME OF THE PATIENT ADMISSION. THE ORGANIZATION ALSO HAS SIGNAGE IN THE ADMISSIONS AREA. |
| PART VI, LINE 4: | THE COMMUNITY IS RURAL WITH OVERALL LOW INCOME LEVELS AND HIGH LEVELS OF UNINSURED PATIENTS. MANY PATIENTS WOULD HAVE PROBLEMS WITH ACCESS TO CARE WITHOUT THE ORGANIZATION SUBSIDIZED PHYSICIAN CLINICS AND OTHER SERVICES. |
| PART VI, LINE 5: | THE ORGANIZATION PROVIDES AN OPEN MEDICAL STAFF TO PROMOTE ACCESS TO CARE FOR THE COMMUNITY. THE BOARD SUPPORTS PROVIDING LARGE AMOUNTS OF UNCOMPENSATED OR SUBSIDIZED CARE TO THE COMMUNITY. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | 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 | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JUN KIM | ||||||||||||||
| PHYSICIAN | $289,716 | $0 | $73,122 | $0 | $27 | $0 | $0 | $0 | $2,604 | $0 | $365,469 | $0 | $0 | $0 |
| GONZALO FLORIDO | ||||||||||||||
| PHYSICIAN | $251,453 | $0 | $21,384 | $0 | $198 | $0 | $0 | $0 | $9,970 | $0 | $283,005 | $0 | $0 | $0 |
| RODNEY ALFORD | ||||||||||||||
| PHYSICIAN | $238,696 | $0 | $0 | $0 | $129 | $0 | $5,320 | $0 | $6,000 | $0 | $250,145 | $0 | $0 | $0 |
| NARAN DODIA | ||||||||||||||
| PHYSICIAN | $173,232 | $0 | $62,200 | $0 | $381 | $0 | $0 | $0 | $4,925 | $0 | $240,738 | $0 | $0 | $0 |
| CRISANTO REYES | ||||||||||||||
| PHYSICIAN | $206,375 | $0 | $16,188 | $0 | $381 | $0 | $0 | $0 | $6,720 | $0 | $229,664 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 7 | FormAndLineReferenceDesc |
| Explanation | PROVIDERS ARE ELIGIBLE FOR QUARTERLY INCENTIVE COMPENSATION BASED UPON WORK RVU'S OR VISITS. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COUNTY OF IROQUOIS ILLINOIS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issued | 2003-07-29 | BondIssuedDt |
| Issue Price | $7,000,000 | IssuePriceAmt |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Substantial Completion | 2005 | SubstantialCompletionYr |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 7A | MAYOR, COUNTY BOARD CHAIRPERSON, AND DISTRICT JUDGE EACH APPOINT THREE MEMBERS OF THE ORGANIZATION'S BOARD OF TRUSTEES TO THREE YEAR TERMS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE STAFF MEMBERS THAT PROVIDE THE INFORMATION TO THE OUTSIDE RETURN PREPARER CONDUCT A THOROUGH REVIEW OF A DRAFT OF THE RETURN. PRIOR TO FILING, THE 990 IS DISTRIBUTED TO THE BOARD OF TRUSTEES FOR REVIEW AND COMMENT. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATIONS CONFLICT OF INTEREST POLICY COVERS DIRECTORS, OFFICERS, MANAGERS, MEDICAL STAFF MEMBERS, PHYSICIANS, EXECUTIVE STAFF MEMBERS, DEPARTMENT DIRECTORS, AND COORDINATORS. CONFLICT OF INTEREST STATEMENTS ARE REQUIRED TO BE COMPLETED ANNUALLY BY DIRECTORS, OFFICERS, AND HIGHLY-COMPENSATED EMPLOYEES AND ARE REVIEWED BY ADMINISTRATION. INDIVIDUALS WITH CONFLICTS OF INTEREST ARE REQUIRED TO DISCLOSE THEM AND TO REFRAIN FROM PARTICIPATION IN ANY DECISION THAT COUND BENEFIT THEM PERSONALLY. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE BOARD OF TRUSTEES CONDUCTED A COMPENSATION REVIEW IN 2017. CEO HAS A TWO YEAR CONTRACT. |
| FORM 990, PART VI, SECTION C, LINE 19 | FINANCIAL DOCUMENTS ARE AVAILABLE UPON REQUEST. CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE NOT PUBLIC INFORMATION AT THIS TIME. HOWEVER, IF REQUESTED, THE BOARD WOULD BE NOTIFIED TO DETERMINE RESPONSE. |
| FORM 990, PART XI, LINE 9: | CHANGE IN FMV OF ASSETS -536,242. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | IMH FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 E FAIRMAN | AddressLine1Txt |
| City | WATSEKA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60970 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 453834535 | EIN |
| Primary Activities | SUPPORTING | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12A, I | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | IROQUOIS HOME CARE INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 LAIRD LANE | AddressLine1Txt |
| City | WATSEKA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60970 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | SALES/RENT | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | 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 | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|
| IMH FOUNDATION | |
| C | CASH VALUE |
| IROQUOIS HOME CARE INC | |
| A | RENT - AVG COMMRCIAL MV |
| IROQUOIS HOME CARE INC | |
| M | RETAIL PRICE |
| IROQUOIS HOME CARE INC | |
| Q | ACTUAL COST |
| IROQUOIS HOME CARE INC | |
| S | FAIR MARKET VALUE |