KIRBY MEDICAL CENTER: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- KIRBY MEDICAL CENTER (EIN 37-0661215)
- Tax period
- 2017-07-01 to 2018-06-30
- Filed
- 2019-03-25
- IRS object ID
- 201930849349301453
- 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 I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-03-25T18:09:12-05:00 | ReturnTs |
| Tax Period End | 2018-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 WASHINGTON AVE SUITE 1800 | AddressLine1Txt |
| City | ST LOUIS | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 370661215 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KIRBY MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | KIRB | BusinessNameControlTxt |
| Phone | 2177622115 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 MEDICAL CENTER DRIVE | AddressLine1Txt |
| City | MONTICELLO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61856 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STEVEN TENHOUSE | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Phone | 2177622115 | PhoneNum |
| Signature | 2019-03-25 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JEFF PARKER | PreparerPersonNm |
| PTIN | P00970069 | PTIN |
| Phone | 3149254300 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.137.57.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-03-25 | IPDt |
| IP Tm | 07:32:46 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 2D2ADA08DFBCD9CE63D4D49722A5A80C8B448248 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | AE419FF41DEE4B5733E7E5F8E31ABE2574D75352 | 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 | MR STEVEN TENHOUSE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 MEDICAL CENTER DRIVE | AddressLine1Txt |
| City | MONTICELLO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61856 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $45,829,855 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.KIRBYHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1939 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | KIRBY MEDICAL CENTER IS COMMITTED TO PROVIDING QUALITY AND COMPASSIONATE CARE TO ALL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 342 | TotalEmployeeCnt |
| Total Volunteers | 246 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $138,478 | PYContributionsGrantsAmt |
| CY Contributions Grants | $116,317 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $37,121,853 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $39,220,277 | CYProgramServiceRevenueAmt |
| PY Investment Income | $637,297 | PYInvestmentIncomeAmt |
| CY Investment Income | $838,723 | CYInvestmentIncomeAmt |
| PY Other Revenue | $889,441 | PYOtherRevenueAmt |
| CY Other Revenue | $851,191 | CYOtherRevenueAmt |
| PY Total Revenue | $38,787,069 | PYTotalRevenueAmt |
| CY Total Revenue | $41,026,508 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $117,965 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $110,020 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $15,094,421 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $16,268,938 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $17,660,013 | PYOtherExpensesAmt |
| CY Other Expenses | $19,129,926 | CYOtherExpensesAmt |
| PY Total Expenses | $32,872,399 | PYTotalExpensesAmt |
| CY Total Expenses | $35,508,884 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,914,670 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,517,624 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $85,337,413 | TotalAssetsBOYAmt |
| Total Assets EOY | $92,458,758 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $31,192,783 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $32,555,647 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $54,144,630 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $59,903,111 | NetAssetsOrFundBalancesEOYAmt |
| Mission | KIRBY MEDICAL CENTER IS COMMITTED TO PROVIDING QUALITY AND COMPASSIONATE CARE TO ALL. EVERY CHANGE AND ADVANCEMENT WE MAKE IN OUR HEALTHCARE SERVICES IS MOTIVATED BY OUR VISION STATEMENT, CORE VALUES AND NOT-FOR-PROFIT CULTURE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $25,559,329 | ExpenseAmt |
| Grant | $110,020 | GrantAmt |
| Revenue | $40,343,001 | RevenueAmt |
| Desc | THE HOSPITAL PROVIDES QUALITY INPATIENT AND OUTPATIENT SERVICES TO ITS COMMUNITY. FREE, SUBSIDIZED, AND GOVERNMENT ASSISTED CARE ARE PROVIDED AT A REDUCED RATE WHEN NEEDED. SERVICES PROVIDED DURING THE YEAR INCLUDE APPROXIMATELY 22,466 PATIENT VISITS THROUGH THE KIRBY MEDICAL CLINIC, 1,912 NURSING CARE INPATIENT DAYS, AND 74,687 LABORATORY PROCEDURES. SERVICES INCLUDE, BUT ARE NOT LIMITED TO, 24-HOUR EMERGENCY HEALTHCARE, AMBULANCE SERVICE, BONE HEALTH, CARDIAC REHABILITATION, COLONOSCOPY, COSMETIC SURGERY, CT SCANNING, DIAGNOSTIC IMAGING, DIGITAL MAMMOGRAPHY, DOT PHYSICALS, FAA PHYSICALS, FAMILY MEDICINE, MENTAL HEALTH COUNSELING, MRI, NUCLEAR MEDICINE, OCCUPATIONAL THERAPY, ONCOLOGY CLINIC, ORTHOPEDICS, PATIENT CENTERED MEDICAL HOME, PET/CT, PHYSICAL THERAPY, PRIMARY CARE DOCTORS, AND PULMONARY REHABILITATION. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Revenue | -$1,122,724 | RevenueAmt |
| Desc | KIRBY MEDICAL CENTER UNDERSTAND THAT NOT ALL PEOPLE ARE ABLE TO PAY THEIR HOSPITAL BILLS DUE TO A VARIETY OF FINANCIAL REASON. AS PART OF OUR MISSION STATEMENT AND NOT-FOR-PROFIT PURPOSE, WE OFFER A SPECIAL CHARITY CARE PROGRAM (OR KIRBY FINANCIAL ASSISTANCE PROGRAM) TO ASSIST THOSE WHO ARE UNABLE TO PAY THEIR HOSPITAL BILLS. THE MEDICAL CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THIS IS REPORTED AS AN OFFSET TO REVENUE. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $25,559,329 | 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 | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | 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 | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | 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 | 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 | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 44 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 342 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | 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 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MR STEVEN TENHOUSE | PersonNm |
| Phone | 2177622115 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 MEDICAL CENTER DRIVE | AddressLine1Txt |
| City | MONTICELLO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61856 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| CRAIG WEBB | ||||||||
| CHAIRMAN OF THE BOARD | 4.80 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| GARY HUISINGA | ||||||||
| VICE CHAIRMAN OF THE BOARD | 2.90 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JAMES BALLSRUD | ||||||||
| TREASURER OF THE BOARD | 1.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| STEPHEN AYERS | ||||||||
| BOARD MEMBER | 1.60 | Yes (X) | $0 | $0 | $0 | |||
| ED EWALD | ||||||||
| BOARD MEMBER | 1.50 | Yes (X) | $0 | $0 | $0 | 0.50 | ||
| DYKE PIATT | ||||||||
| BOARD MEMBER | 2.10 | Yes (X) | $0 | $0 | $0 | 0.50 | ||
| WILLIAM TRACY II | ||||||||
| BOARD MEMBER | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| KARLA BRADLEY | ||||||||
| BOARD MEMBER | 1.10 | Yes (X) | $0 | $0 | $0 | |||
| MICHELLE GROSS | ||||||||
| BOARD MEMBER | 1.10 | Yes (X) | $0 | $0 | $0 | 0.50 | ||
| MICHAEL ATWOOD | ||||||||
| BOARD MEMBER | 1.10 | Yes (X) | $0 | $0 | $0 | 0.50 | ||
| STEVEN TENHOUSE | ||||||||
| SECRETARY OF THE BOARD / CEO | 40.00 | Yes (X) | $244,134 | $0 | $79,683 | 0.50 | ||
| DR NARAIN MANDHAN | ||||||||
| CHIEF MEDICAL OFFICER | 40.00 | Yes (X) | $369,998 | $0 | $43,687 | |||
| ALEXANDER NAZARIAN | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | Yes (X) | $137,929 | $0 | $7,345 | |||
| JENNIFER MOSS | ||||||||
| CHIEF CLINICAL OFFICER | 40.00 | Yes (X) | $136,625 | $0 | $29,392 | |||
| MARK FRED | ||||||||
| CHIEF OPERATING OFFICER | 40.00 | Yes (X) | $141,950 | $0 | $29,118 | |||
| ANDREW BUFFENBARGER | ||||||||
| CHIEF COMPLIANCE OFFICER | 40.00 | Yes (X) | $119,018 | $0 | $32,764 | |||
| DR JAMES MANINT | ||||||||
| PHYSICIAN | 40.00 | $252,004 | $0 | $14,748 | Yes (X) | |||
| SHARON BANGERT | ||||||||
| CRNA | 40.00 | $203,686 | $0 | $18,461 | Yes (X) | |||
| DR BRIAN YOCKS | ||||||||
| PHYSICIAN | 40.00 | $284,265 | $0 | $42,608 | Yes (X) | |||
| JOSEPH LAMB | ||||||||
| PHYSICIAN'S ASSISTANT | 40.00 | $125,080 | $0 | $36,011 | Yes (X) | |||
| ELLEN NORTH | ||||||||
| CONTROLLER | 40.00 | $106,505 | $0 | $16,400 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,121,194 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $350,217 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 11 | 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 |
|---|---|---|---|---|---|
| CARLE PHYSICIAN GROUP | |||||
| 611 W PARK STREET | URBANA | IL | 61801 | PHYSICIAN SERVICES | $2,440,009 |
| MEDICAL INFORMATION TECHNOLOGY | |||||
| PO BOX 74569 | CHICAGO | IL | 60696 | OPERATING SYSTEMS SUPPORT | $530,472 |
| FEUTZ CONTRACTORS | |||||
| PO BOX 130 | PARIS | IL | 61944 | CONSTRUCTION CONTRACTORS | $519,869 |
| CLOUDWAVE | |||||
| DEPT CH 19800 | PALATINE | IL | 60055 | SERVER BACKUP CONTRACTED SERVICES | $516,530 |
| EARL SWENSSON ASSOCIATES | |||||
| PO BOX 410628 | NASHVILLE | TN | 37241 | ARCHITECT SERVICES | $469,320 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 14 | CntrctRcvdGreaterThan100KCnt |
| Membership Dues | $2,070 | MembershipDuesAmt |
| Related Organizations | $79,139 | RelatedOrganizationsAmt |
| Government Grants | $20,793 | GovernmentGrantsAmt |
| All Other Contributions | $14,315 | AllOtherContributionsAmt |
| Total Contributions | $116,317 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621110 | $38,635,747 | $38,635,747 |
| PHARMACY INCOME | 900099 | $319,972 | $319,972 |
| CROSSFIT INCOME | 900099 | $125,431 | $125,431 |
| AMBULANCE SERVICE INCOME | 621910 | $56,835 | $56,835 |
| EMR INCENTIVE REIMBURSEMENT | 900099 | $47,028 | $47,028 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,264 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $35,264 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $39,220,277 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $740,219 | TotalRevenueColumnAmt |
| Exclusion | $740,219 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $586,614 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $586,614 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $586,614 | TotalRevenueColumnAmt |
| Exclusion | $586,614 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,774,400 | SecuritiesAmt |
| Other | $87,991 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,761,201 | SecuritiesAmt |
| Other | $2,686 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $13,199 | SecuritiesAmt |
| Other | $85,305 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $98,504 | TotalRevenueColumnAmt |
| Exclusion | $98,504 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $7,520 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $2,827 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,693 | TotalRevenueColumnAmt |
| Exclusion | $4,693 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $47,094 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $36,633 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,461 | TotalRevenueColumnAmt |
| Exclusion | $10,461 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA INCOME | 900009 | $169,801 | $169,801 |
| MISCELLANEOUS INC | 900099 | $46,483 | $46,483 |
| TIF INCOME | 900009 | $33,139 | $33,139 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $249,423 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $41,026,508 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $39,220,277 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,689,914 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,020 | TotalAmt |
| Program Services | $58,020 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,000 | TotalAmt |
| Program Services | $52,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,317,443 | TotalAmt |
| Program Services | $858,354 | ProgramServicesAmt |
| Management And General | $459,089 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,770,868 | TotalAmt |
| Program Services | $8,555,772 | ProgramServicesAmt |
| Management And General | $3,215,096 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $537,382 | TotalAmt |
| Program Services | $347,215 | ProgramServicesAmt |
| Management And General | $190,167 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,755,421 | TotalAmt |
| Program Services | $1,203,429 | ProgramServicesAmt |
| Management And General | $551,992 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $887,824 | TotalAmt |
| Program Services | $637,604 | ProgramServicesAmt |
| Management And General | $250,220 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $261,624 | TotalAmt |
| Management And General | $261,624 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,311 | TotalAmt |
| Management And General | $56,311 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,226 | TotalAmt |
| Management And General | $39,226 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,693,579 | TotalAmt |
| Program Services | $4,509,906 | ProgramServicesAmt |
| Management And General | $183,673 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $269,326 | TotalAmt |
| Management And General | $269,326 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,282,910 | TotalAmt |
| Program Services | $1,073,345 | ProgramServicesAmt |
| Management And General | $209,565 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $710,893 | TotalAmt |
| Management And General | $710,893 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $356,895 | TotalAmt |
| Program Services | $338,791 | ProgramServicesAmt |
| Management And General | $18,104 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $166,983 | TotalAmt |
| Program Services | $100,271 | ProgramServicesAmt |
| Management And General | $66,712 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $155,389 | TotalAmt |
| Program Services | $89,529 | ProgramServicesAmt |
| Management And General | $65,860 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,528,855 | TotalAmt |
| Management And General | $1,528,855 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,172,339 | TotalAmt |
| Program Services | $3,172,339 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $546,030 | TotalAmt |
| Management And General | $546,030 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT | $2,079,539 | $2,079,539 | |
| MEDICAL SUPPLIES | $1,433,065 | $1,433,050 | $15 |
| MISCELLANEOUS | $1,026,798 | $446,355 | $580,443 |
| REPAIRS AND MAINTENANCE | $803,372 | $572,684 | $230,688 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $546,792 | TotalAmt |
| Program Services | $31,126 | ProgramServicesAmt |
| Management And General | $515,666 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,508,884 | TotalAmt |
| Program Services | $25,559,329 | ProgramServicesAmt |
| Management And General | $9,949,555 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,031 | BOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,003,227 | BOYAmt |
| EOY | $12,322,055 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,837,479 | BOYAmt |
| EOY | $5,340,723 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $256,290 | BOYAmt |
| EOY | $317,252 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $787,653 | BOYAmt |
| EOY | $889,115 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $58,575,041 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $20,265,201 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,376,811 | BOYAmt |
| EOY | $38,309,840 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,704,241 | BOYAmt |
| EOY | $13,924,092 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,814,776 | BOYAmt |
| EOY | $20,878,787 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $494,905 | BOYAmt |
| EOY | $476,894 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85,337,413 | BOYAmt |
| EOY | $92,458,758 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,941,255 | BOYAmt |
| EOY | $4,432,474 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,788,079 | BOYAmt |
| EOY | $27,811,212 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,463,449 | BOYAmt |
| EOY | $311,961 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,192,783 | BOYAmt |
| EOY | $32,555,647 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,329,854 | BOYAmt |
| EOY | $39,024,324 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,814,776 | BOYAmt |
| EOY | $20,878,787 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $54,144,630 | BOYAmt |
| EOY | $59,903,111 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85,337,413 | BOYAmt |
| EOY | $92,458,758 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $5,517,624 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $176,848 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $64,009 | 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
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 | $10,229 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $10,229 | 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 | LOBBYING EXPENSES ARE ALLOCATED THROUGH MEMBERSHIP DUES WITH THE ILLINOIS AND AMERICAN HOSPITAL ASSOCIATION. NO OTHER LOBBY ACTIVITIES WERE CONDUCTED. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $2,003,501 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $389,780 | OtherCostOrOtherBasisAmt |
| Book Value | $2,393,281 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $728,739 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $21,842,332 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,236,244 | DepreciationAmt |
| Book Value | $16,334,827 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,207,314 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,088,708 | DepreciationAmt |
| Book Value | $4,118,606 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,941,378 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,940,249 | DepreciationAmt |
| Book Value | $14,001,129 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,461,997 | OtherCostOrOtherBasisAmt |
| Book Value | $1,461,997 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $38,309,840 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | BENEFICIAL INTEREST IN TRUSTS | Desc |
| Book Value | $20,878,787 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $20,878,787 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO MEDICARE | $204,522 |
| ACCRUED 457 PLAN LIABILITY | $107,270 |
| INTERCOMPANY PAYABLE | $169 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $311,961 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS 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 CONSOLIDATED FINANCIAL STATEMENTS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 280.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | $429,199 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $429,199 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01210 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,588,558 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,806,863 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $781,695 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02210 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,017,757 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,806,863 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,210,894 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03420 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,745 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,745 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,394,623 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,102,080 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,292,543 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09310 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $35,811 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $35,811 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,444,179 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,102,080 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,342,099 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09450 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,461,936 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,908,943 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,552,993 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12870 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $64 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $64 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $331 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $331 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $395 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $395 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,079,539 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,852,085 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,878,501 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$26,416 | 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 | KIRBY MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 MEDICAL CENTER DRIVE | AddressLine1Txt |
| City | MONTICELLO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61856 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.KIRBYHOSPITAL.ORG | WebsiteAddressTxt |
| State License | 5785 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KIRBY MEDICAL CENTER | 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 | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V | 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 | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 280.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| 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 |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| 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.KIRBYHEALTH.ORG/DOCUMENTS/KIRBY-FINANCIAL-ASSISTANCE-POLICY.PDF | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.KIRBYHEALTH.ORG/DOCUMENTS/KIRBY-FINANACIAL-ASSISTANCE-APPLICATION.PDF | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE NOTE ON FOLLOWING PAGES FOR FULL URL OF FAP PLAIN LANGUAGE SUMMARY | 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 |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| KIRBY MEDICAL CENTER | PART V, SECTION B, LINE 5: THE PROCESS INVOLVED FOCUS GROUPS COMPRISED OF AREA HEALTHCARE PROVIDERS, PARTNERS, AND PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF, OR EXPERTISE IN PUBLIC HEALTH. MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS SERVED BY THE HOSPITAL OR INDIVIDUALS OR ORGANIZATIONS REPRESENTING THE INTERESTS OF SUCH POPULATIONS ALSO PROVIDED INPUT. FOR THESE PURPOSES, THE MEDICALLY UNDERSERVED ARE MEMBERS OF A POPULATION WHO EXPERIENCE HEALTH DISPARITIES, ARE AT-RISK OF NOT RECEIVING ADEQUATE MEDICAL CARE AS A RESULT OF BEING UNINSURED OR UNDERINSURED, AND/OR EXPERIENCING BARRIERS TO HEALTHCARE DUE TO GEOGRAPHIC, LANGUAGE, FINANCIAL, OR OTHER BARRIERS. |
| KIRBY MEDICAL CENTER | PART V, SECTION B, LINE 6B: ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK |
| KIRBY MEDICAL CENTER | PART V, SECTION B, LINE 11: IN ADDRESSING THE NEEDS IDENTIFIED IN THE MOST CURRENT CHNA, KIRBY MEDICAL CENTER CONTINUES TO HAVE SUCCESS STORIES RELATED TO OUR EFFORTS CONCERNING MENTAL HEALTH AND CHRONIC DISEASE MANAGEMENT, THE TWO MOST IMPORTANT NEEDS IDENTIFIED IN THE ASSESSMENT. OUR FULL- TIME SOCIAL WORKER IS AVAILABLE IN THE PRIMARY CARE SETTING TO COUNSEL PATIENTS WITH MENTAL HEALTH NEEDS THEREBY CREATING A "ONE-STOP-SHOP" SCENARIO FOR PATIENTS WHO HAVE OVERLAPPING CLINICAL AND MENTAL HEALTH ISSUES. THROUGH A PARTNERSHIP WITH PIATT COUNTY MENTAL HEALTH KIRBY JOINTLY PROVIDES LICENSED CLINICAL SOCIAL WORKER (LCSW) SERVICES WITHIN THE KIRBY MEDICAL GROUP RURAL HEALTH CLINICS IN MONTICELLO, ATWOOD AND CERRO GORDO. DR. MANDHAN'S SUBSTANCE ABUSE CLINIC CONTINUES ITS SUCCESSFUL PARTNERSHIP WITH THE IMPACT COALITION BY PROVIDING IMPORTANT INFORMATION TO THE COMMUNITY REGARDING HEROIN AND ADDICTION. IN ORDER TO ADDRESS CHRONIC DISEASE MANAGEMENT, OUR NURSE NAVIGATOR, WHO WAS HIRED LAST YEAR FOR THE SOLE PURPOSE OF LEADING A UNIQUE PROGRAM TO ADDRESS THE EDUCATIONAL AND RESOURCE NEEDS OF THE CHRONICALLY ILL, WORKS WITH PATIENTS TO MANAGE THEIR CHRONIC HEALTH NEEDS AND MAINTAIN COMPLIANCE WITH THE CARE INSTRUCTIONS PRESCRIBED BY THEIR PRIMARY CARE PRACTITIONERS AND/OR ANY INSTRUCTIONS RELATED TO HOSPITALIZATIONS WHILE BRIDGING MANY GAPS RELATED TO TRANSITIONS IN CARE. KIRBY COLLABORATES WITH OUR COMMUNITY PARTNERS TO ADDRESS OTHER NEEDS IDENTIFIED ON THE LATEST CHNA, AN EXAMPLE BEING A JOINT EFFORT WITH KIRBY MEDICAL CENTER, THE ILLINOIS DEPARTMENT OF PUBLIC HEALTH AND PIATT COUNTY MENTAL HEALTH TO DEVELOP A PROGRAM USING DATA DRIVEN, RISK STRATIFICATION TO IDENTIFY AT RISK POPULATIONS IN PIATT COUNTY TO PARTNER WITH CLIENTS AND FAMILIES HELPING THEM BRIDGE GAPS RELATED TO FINANCIAL NEEDS, PHYSICAL HEALTH AND MENTAL HEALTH THROUGH OUR INSTITUTIONS SHARING OF RESOURCES AND INFORMATION AND INCENTIVIZING LEARNED, HEALTHY BEHAVIORS. WE PLAN TO EXPAND THIS PROGRAM TO INCLUDE COOPERATION/PARTICIPATION WITH THE SCHOOL DISTRICT AND LOCAL GOVERNMENT. |
| KIRBY MEDICAL CENTER | PART V, SECTION B, LINE 13H: THE FOLLOWING ARE OTHER CRITERIA USED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: STATE FUNDED PRESCRIPTION PROGRAMS, WIC, FOOD STAMPS, SUBSIDIZED SCHOOL LUNCH, SUBSIDIZED HOUSING. |
| KIRBY MEDICAL CENTER | PART V, SECTION B, LINE 16J: FINANCIAL ASSISTANCE INFORMATION IS PROVIDED BY THE PATIENT FINANCIAL SERVICES STAFF AND IS REFERENCED IN BILLBOARDS, NEWSPAPER, TABLE TOPPERS, AND OTHER STATEMENTS. |
| PART V, SECTION B (KIRBY MEDICAL CENTER), LINES 7A & 10A: | THE MOST RECENTLY CONDUCTED CHNA & ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND ON THE ORGANIZATION'S WEBSITE AT:HTTP://WWW.KIRBYHEALTH.ORG/PATIENTS-VISITORS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ |
| PART V, SECTION B (KIRBY MEDICAL CENTER), LINE 16C: | THE ORGANIZATION'S PLAIN LANGUAGE SUMMARY OF THE FAP CAN BE FOUND ON ITS WEBSITE AT:WWW.KIRBYHEALTH.ORG/DOCUMENTS/KIRBY-FINANCIAL-ASSISTANCE-PROGRAM-PLAIN-LANGUAGE.PDF |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - KIRBY MEDICAL GROUP-MONTICELLO | ||||
| 1000 MEDICAL CENTER DRIVE | MONTICELLO | IL | 61856 | RURAL HEALTH CLINIC |
| 2 - KIRBY MEDICAL GROUP-ATWOOD | ||||
| 108 N MAIN STREET | ATWOOD | IL | 61913 | RURAL HEALTH CLINIC |
| 3 - KIRBY MEDICAL GROUP-CERRO GORDO | ||||
| 407 S JACKSON ST | CERRO GORDO | IL | 61818 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON THE INDIVIDUAL'S INCOME AND ON CASH OR INVESTMENT ASSETS HELD BY THE INDIVIDUAL. EQUITY IN THE INDIVIDUAL'S HOME AND AUTOMOBILE ARE NOT CONSIDERED IN THE ELIGIBILITY CALCULATION. KIRBY MEDICAL CENTER MAY PRESUMPTIVELY DETERMINE AN INDIVIDUAL TO BE ELIGIBLE FOR A FULL WRITE-OFF, 100% FINANCIAL ASSISTANCE, IF THEY MEET ONE OR MORE OF THE FOLLOWING CRITERIA:1. PARTICIPATION IN STATE FUNDED PRESCRIPTION PROGRAMS;2. PARTICIPATION IN THE WOMEN, INFANTS, AND CHILDREN (WIC) PROGRAM;3. FOOD STAMP ELIGIBILITY;4. SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY;5. LOW-INCOME / SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS;6. PATIENT IS DECEASED WITH NO KNOWN ESTATE;7. PATIENT STATES THAT THEY ARE HOMELESS, ALTHOUGH DUE DILIGENCE EFFORTS WILL BE TAKEN TO CONFIRM;8. PATIENT IS ELIGIBLE FOR MEDICAID, BUT WAS NOT ELIGIBLE ON A PRIOR DATE OF SERVICE;9. PATIENT DOES NOT COMPLETE AN APPLICATION, BUT THERE IS ADEQUATE INFORMATION TO SUPPORT THE PATIENT'S INABILITY TO PAY; OR10. PATIENT IS MENTALLY INCAPACITATED WITH NO ONE TO REPRESENT THEM. |
| PART I, LINE 7: | THE COSTS REPORTED IN SCHEDULE H, PART I, LINE 7 USED A RATIO OF PATIENT CARE COSTS TO CHARGES AS COMPUTED IN WORKSHEET 2 OF THE INSTRUCTIONS TO SCHEDULE H. THIS METHODOLOGY WAS USED FOR ALL PATIENT SEGMENTS. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2,079,539. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | ECONOMIC DEVELOPMENT INCLUDES CHAMBER OF COMMERCE. COMMUNITY SUPPORT IS DISASTER READINESS OVER AND ABOVE REQUIREMENTS. LEADERSHIP DEVELOPMENT IS SUPPORT FOR ILLINOIS PROMISE PROGRAM. COALITION BUILDING INCLUDES 911 AND CRISIS TEAM MEETINGS. |
| PART III, LINE 2: | THE BAD DEBT AMOUNT INCLUDED ON LINE 2 IS THE BAD DEBT EXPENSE THAT WAS REPORTED IN THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS. SEE THE "ACCOUNTS RECEIVABLE AND CREDIT POLICIES" SECTION OF NOTE 1, ON PAGE 11, IN THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR AN EXPLANATION OF HOW BAD DEBT EXPENSE WAS ESTIMATED. |
| PART III, LINE 3: | THE ORGANIZATION UTILIZES PRESUMPTIVE CHARITY WHEN NO INFORMATION IS AVAILABLE. AS A RESULT, ALL BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE. |
| PART III, LINE 4: | SEE THE "ACCOUNTS RECEIVABLE AND CREDIT POLICIES" SECTION OF NOTE 1, ON PAGES 10 AND 11, IN THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR AN EXPLANATION OF HOW BAD DEBT EXPENSE WAS ESTIMATED. |
| PART III, LINE 8: | UNDER THE CURRENT MEDICARE RULES, CRITICAL ACCESS HOSPITALS RECEIVE A REIMBURSEMENT OF 101 PERCENT OF ALLOWABLE HOSPITAL COSTS AND 100 PERCENT OF CLINIC ALLOWABLE COSTS. DESPITE THE REIMBURSEMENT RATES, KIRBY MEDICAL CENTER STILL HAD A MEDICARE SHORTFALL, NONE OF WHICH WAS TREATED AS COMMUNITY BENEFIT. THE REIMBURSEMENTS WERE SLIGHTLY LOWER DUE TO THE FEDERAL GOVERNMENT'S SEQUESTRATION IN THE SUMMER OF 2014. THE MEDICARE ALLOWABLE COSTS REPORTED IN LINE 6 WERE CALCULATED USING THE 2018 FILED MEDICARE COST REPORT. |
| PART III, LINE 9B: | ALL PATIENTS WHO FAIL TO MAKE PAYMENTS RECEIVE THREE BILLING STATEMENTS THAT INCLUDE INFORMATION REGARDING FINANCIAL ASSISTANCE. WHEN THE FOURTH BILLING STATEMENT IS SENT TO THE INDIVIDUAL, THE ACCOUNT IS SENT TO COLLECTIONS, IF NO CORRESPONDENCE IS RECEIVED FROM PATIENT DURING THAT TIME AND AFTER CHECKING WHETHER OR NOT THEY PRESUMPTIVELY QUALIFY FOR THE FINANCIAL ASSISTANCE PROGRAM. IF A PATIENT CONTACTS THE ORGANIZATION, THE PATIENT'S PRESUMPTIVE ELIGIBILITY IS CHECKED AS WELL AS THEIR ELIGIBILITY FOR MEDICAID. THE ORGANIZATION ALSO DISCUSS KFA WITH THE PATIENT. |
| PART VI, LINE 2: | KIRBY MEDICAL CENTER WORKS IN CONCERT WITH LOCAL COMMUNITY HEALTH AGENCIES TO ASSESS THE HEALTH NEEDS OF THE LOCAL COMMUNITY AND THE IMMEDIATELY SURROUNDING COUNTY. IN THE YEAR ENDED JUNE 30, 2017, A COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED THROUGH A CONSULTING ARRANGEMENT WITH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK. TERRY MADSEN, AN ICAHN CONSULTANT, ATTORNEY AND FORMER EDUCATOR, AND COMMUNITY DEVELOPMENT SPECIALIST, MET WITH HOSPITAL EXECUTIVE STAFF TO DEFINE THE COMMUNITY, THE SCOPE OF THE PROJECT, AND SPECIAL NEEDS AND CONCERNS. AN INTERNAL WORKING GROUP, POSSIBLE LOCAL SOURCES FOR SECONDARY DATA, AND KEY EXTERNAL CONTACTS WERE IDENTIFIED, AND A TIMELINE WAS ESTABLISHED.THE COMMUNITY HEALTH NEEDS ASSESSMENT INVOLVED THE REVIEW OF SEVERAL HUNDRED PAGES OF DEMOGRAPHIC AND HEALTH DATA SPECIFIC TO THE KIRBY MEDICAL CENTER SERVICE AREA. INPUT INCLUDED FOCUS GROUPS COMPRISED OF AREA HEALTH CARE PROVIDERS, PARTNERS, AND PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF, OR EXPERTISE IN PUBLIC HEALTH. THE ASSESSMENT EXPLORED THE INSULAR NEEDS OF RESIDENTS LIVING IN POVERTY BY SPECIFICALLY SEEKING INPUT FROM PERSONS WITH KNOWLEDGE OF THE SPECIFIC HEALTH CONCERNS OF YOUTH AND ADULTS LIVING IN POVERTY IN THE COMMUNITY. INPUT WAS ALSO SOUGHT FROM PROFESSIONALS WITHIN THE COMMUNITY AND ALL ITS MEMBERS. |
| PART VI, LINE 3: | INFORMATION REGARDING ELIGIBILITY FOR FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS, AS WELL AS THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM, IS PUBLISHED ON THE HOSPITAL'S WEBSITE AND IS AVAILABLE VIA LITERATURE AT THE VARIOUS ADMISSIONS AREAS IN THE HOSPITAL. INFORMATION IS ALSO PROVIDED BY THE PATIENT FINANCIAL SERVICES STAFF AND IS REFERENCED IN NEWSPAPER AND BILLBOARD ADVERTISING. THE HOSPITAL ALSO HOSTED PRESENTATIONS TO THE COMMUNITY THAT FEAUTURED EXPERTS IN THE FIELD. |
| PART VI, LINE 4: | KIRBY MEDICAL CENTER'S COMMUNITY IS A GEOGRAPHIC AREA THAT INCLUDES ALL OR PORTIONS OF THE ZIP CODE SERVICE AREAS SURROUNDING MONTICELLO, BEMENT, ATWOOD, HAMMOND, WHITE HEATH, DELAND AND MANSFIELD IN IL. THIS GEOGRAPHIC AREA DEFINITION OF COMMUNITY IS WELL-SUITED TO KIRBY MEDICAL CENTER, A DESIGNATED CRITICAL ACCESS HOSPITAL PROVIDING BASIC, PRIMARY CARE THROUGH INPATIENT CARE, ANCILLARY SERVICES, CLINICS, AND SPECIALTY CLINICS TO RESIDENTS OF THIS UNDERSERVED RURAL AREA. THE KIRBY MEDICAL CENTER SERVICE COMMUNITY IS NEARLY CONTIGUOUS TO PIATT COUNTY. MAJOR MEDICAL CENTERS IN CHAMPAIGN-URBANA, BLOOMINGTON, AND DECATUR RECEIVE PATIENTS FROM THE SERVICE AREA. THE PRIMARY SERVICE AREA AND POPULATIONS ARE THE ZIP CODES WITHIN A GEOGRAPHIC AREA SLIGHTLY SMALLER THAN THE GEOGRAPHIC AREAS OF PIATT COUNTY. THE PRIMARY SERVICE AREA IS COMPRISED OF APPROXIMATELY 390.08 SQUARE MILES WITH A POPULATION OF APPROXIMATELY 15,547 AND A POPULATION DENSITY OF 39.86 PER SQUARE MILE. THE NUMBER OF CHILDREN ELIGIBLE FOR FREE OR REDUCED LUNCH IS BELOW THE STATEWIDE AVERAGE. THE UNEMPLOYMENT RATE IN OUR COMMUNITY IS BELOW THE STATEWIDE AVERAGE. TEEN BIRTH RATE PER 1,000 POPULATION IS BELOW THE STATE AVERAGE. OVER 7% OF THE ADULTS IN OUR COMMUNITY DO NOT HAVE A HIGH SCHOOL DIPLOMA. |
| PART VI, LINE 5: | EVERY YEAR, KIRBY MEDICAL CENTER OFFERS NUMEROUS COMMUNITY-BASED SERVICES TO THOSE IN THE LOCAL AREA. COMMUNITY-BASED SERVICES PROVIDED BY KIRBY MEDICAL CENTER INCLUDE: SPORTS PHYSICAL CLINIC FOR STUDENT ATHLETES, SCHOOL-BASED HEALTH EDUCATION PROGRAMS, CPR TRAINING, SENIOR CITIZEN OUTREACH, DIABETES EDUCATION, WEEKLY FREE BLOOD PRESSURE SCREENINGS, AND A BACK TO SCHOOL HEALTH FAIR PROVIDING SCHOOL SUPPLIES. ANNUALLY, WE PROVIDE THE THOMAS DIXON MEMORIAL SCHOLARSHIPS TO AREA STUDENTS THAT HAVE AN INTEREST IN PURSUING A CAREER IN A MEDICAL FIELD. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| DEWITT-PIATT BI-COUNTY HEALTH DEPARTMENT | |||||||
| 1020 SOUTH MARKET STREET | MONTICELLO | IL | 61856 | 320196168 | 501(C)(3) | $9,000 | GENERAL OPERATING SUPPORT |
| THE KIRBY FOUNDATION | |||||||
| 1000 MEDICAL CENTER DRIVE | MONTICELLO | IL | 61856 | 061836473 | 501(C)(3) | $22,000 | GENERAL OPERATING SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 18 | RecipientCnt |
| Cash Grant | $52,000 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | KIRBY MEDICAL CENTER PROVIDES GRANT FUNDS TO A COUNTY AGENCY TO SUPPORT HAVING A NURSE IN THE LOCAL SCHOOL DISTRICT. KIRBY MEDICAL CENTER TRACKS THE USE OF SCHOLARSHIP FUNDS. SCHOLARSHIP RECIPIENTS ARE REQUIRED TO SHOW THAT THEIR FIELD OF STUDY IS HEALTH CARE AND THAT THEY MEET MINIMUM GRADE/GRADE POINT AVERAGE THRESHOLDS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STEVEN TENHOUSE | ||||||||||||||
| SECRETARY OF THE BOARD / CEO | $197,741 | $0 | $40,369 | $0 | $6,024 | $0 | $51,947 | $0 | $27,736 | $0 | $323,817 | $0 | $0 | $0 |
| DR NARAIN MANDHAN | ||||||||||||||
| CHIEF MEDICAL OFFICER | $297,814 | $0 | $64,658 | $0 | $7,526 | $0 | $16,200 | $0 | $27,487 | $0 | $413,685 | $0 | $0 | $0 |
| JENNIFER MOSS | ||||||||||||||
| CHIEF CLINICAL OFFICER | $123,387 | $0 | $11,846 | $0 | $1,392 | $0 | $7,200 | $0 | $22,192 | $0 | $166,017 | $0 | $0 | $0 |
| MARK FRED | ||||||||||||||
| CHIEF OPERATING OFFICER | $123,384 | $0 | $15,146 | $0 | $3,420 | $0 | $8,679 | $0 | $20,439 | $0 | $171,068 | $0 | $0 | $0 |
| ANDREW BUFFENBARGER | ||||||||||||||
| CHIEF COMPLIANCE OFFICER | $105,343 | $0 | $11,146 | $0 | $2,529 | $0 | $7,033 | $0 | $25,731 | $0 | $151,782 | $0 | $0 | $0 |
| DR JAMES MANINT | ||||||||||||||
| PHYSICIAN | $183,695 | $0 | $63,549 | $0 | $4,760 | $0 | $12,381 | $0 | $2,367 | $0 | $266,752 | $0 | $0 | $0 |
| SHARON BANGERT | ||||||||||||||
| CRNA | $199,045 | $0 | $340 | $0 | $4,301 | $0 | $10,495 | $0 | $7,966 | $0 | $222,147 | $0 | $0 | $0 |
| DR BRIAN YOCKS | ||||||||||||||
| PHYSICIAN | $272,993 | $0 | $10,597 | $0 | $675 | $0 | $15,713 | $0 | $26,895 | $0 | $326,873 | $0 | $0 | $0 |
| JOSEPH LAMB | ||||||||||||||
| PHYSICIAN'S ASSISTANT | $119,781 | $0 | $2,605 | $0 | $2,694 | $0 | $7,808 | $0 | $28,203 | $0 | $161,091 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | KIRBY MEDICAL CENTER PAYS PROFESSIONAL AND OTHER DUES FOR THE CEO, STEVEN TENHOUSE, INCLUDING A CLUB MEMBERSHIP. ANY DUES MUST BE APPROVED BY THE CHAIRMAN OF THE BOARD BEFORE THEY ARE PAID AS BEING IN THE BEST INTEREST OF THE MEDICAL CENTER. ANY PERSONAL USE ASSOCIATED WITH CLUB DUES IS INCLUDED IN THE TAXABLE COMPENSATION OF THE CEO. |
| PART I, LINE 4B | IN 2016, THE MEDICAL CENTER ENTERED INTO A SUPPLEMENTAL COMPENSATION AGREEMENT COVERING STEVEN TENHOUSE WHICH PROVIDES FOR HIM TO RECEIVE, UPON TERMINATION OF EMPLOYMENT, PAYMENTS IN MONTHLY INSTALLMENTS OVER A TWO YEAR PERIOD FOLLOWING TERMINATION. THE BENEFIT TO WHICH STEVEN IS ENTITLED TO RECEIVE IS IN ACCORDANCE WITH A VESTING SCHEDULE PROVIDED FOR IN THE AGREEMENT WITH VESTING SET TO BEGIN IN 2021 PROGRESSING TO 100% VESTING IN 2026. IF DEATH OR DISABILITY OCCURS DURING THE PERIOD COVERED BY THE AGREEMENT, THE BALANCE OF THE ACCOUNT BECOMES 100% VESTED WITH THE BENEFIT PAYMENTS MADE TO THE BENEFICIARY. THE MEDICAL CENTER'S FUNDING OF THIS BENEFIT IS BEING RECOGNIZED AS COMPENSATION COST ON AN ANNUAL BASIS. THE MEDICAL CENTER INTENDS TO USE CASH FROM OPERATIONS TO FUND THIS OBLIGATION. ALL FUNDS OF THE DEFERRED COMPENSATION ACCOUNT ARE SUBJECT TO THE MEDICAL CENTER'S CREDITORS UNTIL SUCH TIME AS THE FUNDS ARE DISTRIBUTED IN ACCORDANCE WITH THE AGREEMENTS. THE ASSETS, WHICH ARE CLASSIFIED AS "ASSETS LIMITED AS TO USE", TOTAL $107,270 AS OF JUNE 30, 2018. THE LIABILITIES, WHICH ARE CLASSIFIED AS "OTHER LONG-TERM LIABILITIES", TOTAL $107,270 AS OF JUNE 30, 2018. |
| PART I, LINE 7 | THE CEO, STEVEN TENHOUSE, RECEIVES A BONUS OF UP TO 15% OF BASE COMPENSATION BASED ON SUCCESSFUL FINANCIAL, OPERATIONAL, AND QUALITY INDICATORS OF THE KIRBY ORGANIZATION. THE FOLLOWING INDIVIDUALS RECEIVED A BONUS BASED ON THEIR CLINIC PATIENT PRODUCTION AND QUALITY INDICATORS SUCH AS CHART REVIEW, CHART AUDITS, AND PATIENT SATISFACTION: NARAIN DAS MANDHAN JAMES MANINT JAY LAMB BRIAN YOCKS THE BONUS AMOUNTS ARE DETERMINED BASED ON A FUNCTION OF BASE SALARY AND NATIONAL SURVEYS ON PHYSICIAN COMPENSATION AND PRODUCTION. THE FOLLOWING INDIVIDUALS RECEIVE A BONUS OF APPROXIMATELY 12% OF BASE COMPENSATION BASED ON SUCCESSFUL ACHIEVEMENT OF PRE-DETERMINED STRATEGIC AND OPERATIONAL GOALS ALIGNED WITH THEIR JOB DUTIES AND THE DEPARTMENTS THEY MANAGE: ALEX NAZARIAN JENNIFER MOSS MARK FRED ANDREW BUFFENBARGER |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | MEMBERS OF ALL COMMITTEES ARE APPOINTED BY THE CHAIRMAN OF THE BOARD; PROVIDED, HOWEVER, THAT A MAJORITY OF EACH COMMITTEE MEMBERSHIP SHALL BE BOARD MEMBERS. SPECIAL COMMITTEES MAY BE APPOINTED BY THE CHAIRMAN WITH CONCURRENCE OF THE BOARD FOR SUCH SPECIAL TASKS AS CIRCUMSTANCES WARRANT. A SPECIAL COMMITTEE SHALL LIMIT ITS ACTIVITIES TO THE ACCOMPLISHMENT OF THE TASK FOR WHICH IT IS APPOINTED AND SHALL HAVE NO POWER TO ACT EXCEPT SUCH AS IS SPECIFICALLY CONFERRED BY ACTION OF THE BOARD. UPON COMPLETION OF THE TASK FOR WHICH APPOINTED, SUCH SPECIAL COMMITTEE SHALL STAND DISCHARGED. BOARD COMMITTEES SHALL HOLD MEETINGS WHEN NECESSARY AND SHALL KEEP A FULL RECORD OF THEIR PROCEEDINGS, WHICH SHALL BE ENTERED IN A BOOK OF MINUTES. EACH COMMITTEE SHALL HAVE A CHARTER, APPROVED BY THE BOARD, DELINEATING ITS ORGANIZATION/MEMBERSHIP, RESPONSIBILITIES, AND MEETING FREQUENCY. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 FINANCIAL INFORMATION IS REVIEWED BY THE INTERNAL ACCOUNTING STAFF FOR ACCURACY TO THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS. OTHER FORM 990 INFORMATION IS REVIEWED BY THE CFO AND CEO. THE FINAL VERSION OF THE FORM 990 IS REVIEWED BY THE GOVERNING BOARD'S AUDIT AND COMPLIANCE COMMITTEE BEFORE THE FORM IS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | GENERALLY THE BOARD ASSESSES THE CONFLICTS THAT EXIST WITH ITS MEMBERS AND REQUESTS THAT MEMBERS WITH THESE CONFLICTS BE EXCUSED FROM ANY DISCUSSION RELATED TO THEM. BECAUSE OF THE FAMILIARITY OF BOARD MEMBERS WITH ONE ANOTHER AND THE SIZE OF THE COMMUNITY, THE BOARD'S SELF ASSESSMENT OF CONFLICTS CAN BE MADE WITH RELATIVE EASE. AN INTERESTED PERSON INCLUDES ANY PERSON ASSOCIATED WITH KMC WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST IN THE MATTER AT HAND. IF THE INTERESTED PERSON IS IN A SENIOR LEADERSHIP POSITION, IS A BOARD OR COMMITTEE MEMBER, THE APPLICABLE BOARD OR COMMITTEE SHALL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. IF THE INTERESTED PERSON IS NOT A BOARD OR COMMITTEE MEMBER, THE CEO, IN CONSULTATION WITH BOARD MEMBERS AND/OR OTHER MANAGEMENT PERSONNEL, SHALL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. IF IT IS DETERMINED THAT AN INTERESTED PERSON HAS A CONFLICT, THE INTERESTED PERSON MAY BE EXCLUDED FROM ALL DISCUSSIONS REGARDING THAT AGREEMENT, TRANSACTION, OR ARRANGEMENT. PROCEEDINGS RESULTING FROM CONFLICTS OF INTEREST ARE DOCUMENTED IN THE BOARD MINUTES. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE KIRBY BOARD UTILIZES THE BI-ANNUAL IHA COMPENSATION SURVEY RESULTS TO SET AND COMPARE THE CEO'S COMPENSATION. THE LATEST REVIEW WAS DONE IN THE SPRING OF 2016. THIS PROCESS IS PRESENTED TO THE FULL BOARD FOR APPROVAL AND IS DOCUMENTED IN THE BOARD MINUTES. OTHER OFFICER'S COMPENSATION IS DETERMINED USING SALARY SURVEY DATA PROMULGATED ANNUALLY BY ASHHRA. IT IS THEN REVIEWED BY THE CHIEF COMPLIANCE OFFICER AND CEO. |
| FORM 990, PART VI, SECTION C, LINE 19 | AT THIS TIME NONE OF THE ORGANIZATION'S GOVERNING DOCUMENTS NOR THEIR FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE GENERAL PUBLIC. |
| FORM 990, PART IX, LINE 11G | ER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,072,332. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,072,332. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 1,314,314. MANAGEMENT AND GENERAL EXPENSES 183,673. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,497,987. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,123,260. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,123,260. |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN PERPETUAL TRUST 64,009. |
| FORM 990, PART XII, LINE 2C: | THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE KIRBY FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 MEDICAL CENTER DR | AddressLine1Txt |
| City | MONTICELLO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61856 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 061836473 | EIN |
| Primary Activities | SUPPORT OF KIRBY MEDICAL CENTER | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 7 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KIRBY MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PERPETUAL TRUSTS (4) | |||||||||||||
| INCOME BENEFICIARY | IL | N/A | T | 0 | |||||||||
| JEFFERSON PARKWAY PROPERTY OWNERS ASSOCIATION | |||||||||||||
| PROPERTY OWNERS ASSOCIATION | IL | C | Yes (1) | 1000 MEDICAL CENTER DRIVE | MONTICELLO | IL | 61856 | 452767397 | KIRBY MEDICAL CENTER | $11,403 | $5,226 | 1.00000 | |
| 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 | 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 | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | 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 | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE KIRBY FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $79,139 | InvolvedAmt |
| Method Of Amount Determination | CASH TRANSFERRED | MethodOfAmountDeterminationTxt |