MEMORIAL HEALTH SYSTEM: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization: MEMORIAL HEALTH SYSTEM (EIN 37-0661230)
Tax period: 2014-10-01 to 2015-09-30
Filed: 2016-08-05
IRS object ID: 201622189349300777
Schema version: 2014v6.0
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 K
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2016-08-05T13:43:09-05:00	ReturnTs
Tax Period End	2015-09-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	420714325	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	RSM US LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	1 SOUTH WACKER SUITE 800	AddressLine1Txt
City	CHICAGO	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	60606	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2014-10-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	370661230	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	PASSAVANT MEMORIAL AREA HOSPITAL ASN	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	PASS	BusinessNameControlTxt
Phone	2172459541	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1600 WEST WALNUT STREET	AddressLine1Txt
City	JACKSONVILLE	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	62650	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	DAVID A BOLEN	PersonNm
Person Title	VICE PRESIDENT & CFO	PersonTitleTxt
Phone	2172459541	PhoneNum
Signature	2016-08-05	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	ZACHARY A FORTSCH	PreparerPersonNm
PTIN	P00052725	PTIN
Phone	3126343400	PhoneNum

Field	Value	IRS element (for citing)
Tax	2014	TaxYr
Build TS	2016-12-15 16:53:06Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	DAVID A BOLEN	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1600 WEST WALNUT STREET	AddressLine1Txt
City	JACKSONVILLE	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	62650	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$127,128,962	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.PASSAVANTHOSPITAL.COM	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1906	FormationYr
Legal Domicile State	IL	LegalDomicileStateCd
Activity Or Mission	OUR MISSION IS TO PROVIDE EXCELLENT CARE WITH COMPASSION AND COMMITMENT.	ActivityOrMissionDesc
Voting Members Governing Body	18	VotingMembersGoverningBodyCnt
Voting Members Independent	15	VotingMembersIndependentCnt
Total Employee	988	TotalEmployeeCnt
Total Volunteers	171	TotalVolunteersCnt
Total Gross UBI	$618,973	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$41,039	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$1,625,310	PYContributionsGrantsAmt
CY Contributions Grants	$972,468	CYContributionsGrantsAmt
PY Program Service Revenue	$82,376,378	PYProgramServiceRevenueAmt
CY Program Service Revenue	$91,550,703	CYProgramServiceRevenueAmt
PY Investment Income	$5,385,776	PYInvestmentIncomeAmt
CY Investment Income	$3,203,683	CYInvestmentIncomeAmt
PY Other Revenue	$1,719,947	PYOtherRevenueAmt
CY Other Revenue	$1,691,440	CYOtherRevenueAmt
PY Total Revenue	$91,107,411	PYTotalRevenueAmt
CY Total Revenue	$97,418,294	CYTotalRevenueAmt
PY Grants And Similar Paid	$61,648	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$32,772	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$45,140,378	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$46,789,290	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$35,037,651	PYOtherExpensesAmt
CY Other Expenses	$34,110,414	CYOtherExpensesAmt
PY Total Expenses	$80,239,677	PYTotalExpensesAmt
CY Total Expenses	$80,932,476	CYTotalExpensesAmt
PY Revenues Less Expenses	$10,867,734	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$16,485,818	CYRevenuesLessExpensesAmt
Total Assets BOY	$174,435,302	TotalAssetsBOYAmt
Total Assets EOY	$156,520,865	TotalAssetsEOYAmt
Total Liabilities BOY	$50,958,367	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$50,257,417	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$123,476,935	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$106,263,448	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	OUR MISSION IS TO PROVIDE EXCELLENT CARE WITH COMPASSION AND COMMITMENT.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$6,724,701	ExpenseAmt
Revenue	$17,044,433	RevenueAmt
Desc	SURGERYTHE SURGICAL DEPARTMENT AT PASSAVANT AREA HOSPITAL IS A STATE OF THE ART COMBINE SURGICAL AREA THAT SERVICES INPATIENT AND OUTPATIENT CASE VOLUME. THE CASE VOLUME FOR THE SURGICAL DEPARTMENT IS APPROXIMATELY 6000 CASES PER YEAR WHICH INCLUDES A VOLUME OF APPROXIMATELY 2200 UPPER AND LOWER GASTROINTESTINAL SCOPES. THE UNIT HAS 7 MULTISPECIALTY SURGICAL SUITES, 1 OBSTETRICAL SURGICAL SUITE, AND 2 DEDICATED GI SUITES. THE SCOPE OF THE SURGICAL PROCEDURES PROVIDED IN THE DEPARTMENT INCLUDES GENERAL, ORTHOPEDIC, UROLOGY, EAR, NOSE AND THROAT, OPHTHALMOLOGY, AND GYNECOLOGY. EIGHTY PERCENT OF THE CASE VOLUME IN THE SURGICAL DEPARTMENT IS AMBULATORY SURGICAL PROCEDURES. THE DEPARTMENT'S HOURS OF OPERATION ARE FROM 7:00 A.M. TO 5:00 P.M. MONDAY THRU FRIDAY. THE DEPARTMENT PROVIDES ON CALL COVERAGE AFTER HOURS ON WEEKDAYS, WEEKENDS AND HOLIDAYS. THE ON CALL STAFF IS AVAILABLE TO RESPOND TO EMERGENCY CASE AND BEGIN THE CASE WITHIN 20 MINUTES OF THE DECISION TO PERFORM THE OPERATION. THE SURGICAL DEPARTMENT IS SUPPORTED BY A 23 BED AMBULATORY SURGERY SUITE LOCATED ADJACENT TO THE SURGERY DEPARTMENT WHICH PROVIDES PRE ADMISSION ASSESSMENT AND PRE-OPERATIVE TEACHING, PHASE II POST-OPERATIVE CARE, AND COMPREHENSIVE POST-OPERATIVE DISCHARGE TEACHING. PHASE I POST-OPERATIVE CARE IS PROVIDED IN THE POST ANESTHESIA CARE UNIT LOCATED WITHIN THE SURGICAL DEPARTMENT.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$4,565,091	ExpenseAmt
Revenue	$10,382,942	RevenueAmt
Desc	LABORATORYTHE DEPARTMENT OF LABORATORY MEDICINE AT PASSAVANT HOSPITAL IS DEDICATED TO THE PROVISION OF INDIVIDUALIZED, EFFICIENT, AND HIGH QUALITY CARE TO ALL PATIENTS. LABORATORY PROCESSES INCLUDES THE COLLECTION, MONITORING, AND EVALUATION OF IMPORTANT ASPECTS OF CARE: SPECIMEN COLLECTION, SPECIMEN EVALUATION (TESTING), LABORATORY VALUES REPORTING AND ANATOMICAL PATHOLOGY SERVICES. APPROXIMATELY 500 VARIOUS TEST PROCEDURES OR COMBINATIONS OF TEST PROCEDURES ARE PERFORMED IN THE CLINICAL LABORATORY. ANY PROCEDURE NOT PERFORMED ON SITE IS REFERRED TO AN ACCREDITED REFERENCE LABORATORY. DURING FISCAL YEAR 2015, PASSAVANT HOSPITAL LABORATORY REPORTED 323,965 TESTS.PASSAVANT HOSPITAL LABORATORY PERFORMS TESTS IN THE FOLLOWING FIELDS: BLOOD BANK, CHEMISTRY, COAGULATION, CYTOLOGY, HEMATOLOGY, HISTOPATHOLOGY, MICROBIOLOGY, SEROLOGY, AND URINALYSIS. THE LABORATORY DIRECTOR PROVIDES CONSULTATIONS REGARDING THE ORDERING OF APPROPRIATE TESTS AND THE MEDICAL SIGNIFICANCE OF THE LABORATORY DATA REPORTED. THE LABORATORY IS EQUIPPED WITH THE LATEST INSTRUMENTATION AND TECHNOLOGIES TO ASSIST IN THE ANALYSIS OF BODY FLUIDS, CELLS AND TISSUE.PATIENTS ARE SERVED ON BOTH AN INPATIENT AND OUTPATIENT BASIS. ADDITIONALLY, SPECIMENS ARE DELIVERED OR PICKED UP FROM PHYSICIAN'S OFFICES AND NURSING HOMES. IN FISCAL YEAR 2015, THERE WERE 106,007 INPATIENT TESTS, 217,958 OUTPATIENT TESTS AND 23,090 TESTS FROM OFFICES AND NURSING HOMES.THE PASSAVANT HOSPITAL LABORATORY ALSO PARTICIPATES IN TESTING SPECIMENS FOR THE KIDNEY MOBILE DURING THEIR ONCE A YEAR ONSITE VISIT. THE LABORATORY TESTS SPECIMENS FROM THE FECAL BLOOD SCREENING PROGRAM FOR THE DETECTION OF CANCER HOSTED BY THE MIA WARE FOUNDATION. ANY TESTS ORDERED BY PHYSICIANS STAFFING A COMMUNITY BENEFIT SERVICE AREA WERE OBTAINED AND PROCESSED BY THE LABORATORY.	Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

Field	Value	IRS element (for citing)
Expense	$4,496,176	ExpenseAmt
Revenue	$6,273,475	RevenueAmt
Desc	EMERGENCY SERVICESTHE EMERGENCY DEPARTMENT AT PASSAVANT AREA HOSPITAL CONSISTS OF 22 BEDS, PROVIDING EMERGENCY MEDICAL CARE AND TREATMENT 24/7 TO PATIENTS FROM SURROUNDING COMMUNITIES. PATIENT VOLUME FOR FISCAL YEAR 2015 WAS 28,989 PATIENTS. DESIGN OF THE ED INCLUDES TRIAGE, ED FAST TRACK, TWO CRITICAL CARE BAYS, BOTH EQUIPPED WITH IMAGING, ONE SECURITY ROOM, TWO PROCEDURE ROOMS, TWO NEGATIVE AIR ISOLATION ROOMS, EMS COMMUNICATION ROOM, AND DECONTAMINATION AREA. EMERGENCY RESUSCITATIVE EQUIPMENT IS LOCATED IN KEY AREAS TO SUPPORT THE CARE PROVIDED.PATIENTS PRESENT WITH A WIDE RANGE OF SYMPTOMS AND VARYING LEVELS OF ACUITY. PATIENT PLACEMENT OCCURS THROUGH UTILIZATION OF THE ESI LEVEL SYSTEM. TRACKING OF PATIENTS OCCURS THROUGH THE EDIS TRACKING BOARD. CARE PROVIDERS INCLUDE BOTH ERP'S AND APN'S, WITH NURSING CARE PROVIDED BY ED RN'S, LPN'S, AND TECHNICIANS. CARE AND TREATMENT IS PROVIDED FOR A VARIETY OF SYMPTOMS INDICATIVE OF MEDICAL AND / OR SURGICAL CONDITIONS REQUIRING URGENT OR EMERGENT INTERVENTION INCLUDING BUT NOT LIMITED TO: AMI, CARDIAC ARRHYTHMIAS, CHF, ACUTE EXACERBATION COPD, CARDIO-RESPIRATORY ARREST, RESPIRATORY FAILURE, ABDOMINAL PAIN, ACUTE BOWEL OBSTRUCTION, UTI, URINARY DISORDERS, DIABETES, SEPSIS, INFECTIOUS DISEASES, DECLARED TRAUMA, MENTAL HEALTH DISORDERS, SORE THROAT, EAR INFECTIONS, DENTAL, EENT, ORTHOPEDIC INJURIES, ETC. PAH'S EMERGENCY DEPARTMENT SERVES IN THE FOLLOWING CAPACITIES:REGIONAL SANE CENTER FOR REGION 3EDAP, "EMERGENCY DEPARTMENT APPROVED FOR PEDIATRICS"STAT HEARTEMERGENT STROKE CENTER (DESIGNATED JANUARY 2015)	Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

Field	Value	IRS element (for citing)
Expense	$48,749,352	ExpenseAmt
Grant	$32,772	GrantAmt
Revenue	$57,849,853	RevenueAmt
Desc	PASSAVANT PROVIDES HEALTHCARE SERVICES TO THE RESIDENTS OF MORGAN, CASS, SCOTT, AND PARTS OF BROWN, GREENE, MACOUPIN, AND PIKE COUNTIES IN WEST CENTRAL ILLINOIS. IN FISCAL YEAR 2015, PASSAVANT PERFORMED 89,541 OUTPATIENT PROCEDURES AND HAD 3,022 INPATIENT ADMISSIONS. ADDITIONALLY, PASSAVANT PROVIDED $3.8 MILLION IN CHARITY CARE. PASSAVANT ALSO PROVIDED ACLS PARAMEDIC SERVICE AND SUPPORT TO THE OUTLYING BLS AMBULANCE PROVIDERS IN THE SURROUNDING COMMUNITIES, AND PROVIDES FREE HEALTH SCREENINGS TO THE VULNERABLE POPULATION, FREE EDUCATION PROGRAMS AND INSURANCE CONSULTATION AT NO CHARGE TO THE COMMUNITY AT LARGE.	Desc

Field	Value	IRS element (for citing)
Total Other Prog Srvc Expense	$48,749,352	TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Grant	$32,772	TotalOtherProgSrvcGrantAmt
Total Other Prog Srvc Revenue	$57,849,853	TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses	$64,535,320	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	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	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	Yes (1)	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	83	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	988	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	18	GoverningBodyVotingMembersCnt
Independent Voting Member	15	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	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	IL	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	DAVID A BOLEN	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	2172459541	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1600 WEST WALNUT STREET	AddressLine1Txt
City	JACKSONVILLE	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	62650	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
KEITH BRADBURY
BOARD MEMBER	0.70	0.70	Yes (X)	$0	$0	$0
DON HEADEN
BOARD MEMBER	0.70	0.70	Yes (X)	$0	$0	$0
JAMES HINCHEN MD
BOARD MEMBER	0.70		Yes (X)	$0	$0	$0
GILBERT JOEHL
BOARD MEMBER	0.70	0.70	Yes (X)	$0	$0	$0
PHYLLIS LAPE PHD
BOARD MEMBER	0.70		Yes (X)	$0	$0	$0
ERIC GIEBELHAUSEN MD
BOARD MEMBER	0.70		Yes (X)	$0	$0	$0
DOUG AWE
BOARD MEMBER	0.70		Yes (X)	$0	$0	$0
STEVEN LILLPOP MD
BOARD MEMBER	0.70	50.00	Yes (X)	$0	$596,758	$244,991
NANCY SPANGENBERG
BOARD MEMBER	0.70		Yes (X)	$0	$0	$0
KELLY STAAKE
BOARD MEMBER	0.70		Yes (X)	$0	$0	$0
GINNY FANNING
BOARD MEMBER	0.70	0.70	Yes (X)	$0	$0	$0
GREG LEPPER
BOARD MEMBER/CHAIRMAN (EFF JAN 15)	0.70	0.70	Yes (X)	$0	$0	$0
BABU ELADASARI MD
BOARD MEMBER (EFF JAN 15)	0.70	50.00	Yes (X)	$0	$304,782	$33,264
CHARLES SHEAFF MD
BOARD MEMBER (THRU DEC 14)	0.70	50.00	Yes (X)	$0	$374,976	$26,734
TOM VEITH
TREASURER (EFF JAN 15)	0.70	0.70	Yes (X)	$0	$0	$0	Yes (X)
JAN TERRY
CHAIRMAN (THRU DEC 14)/BOARD MEMBER (EFF JAN 15)	0.70	1.40	Yes (X)	$0	$0	$0	Yes (X)
GARY SCOTT
SECRETARY	0.70	1.40	Yes (X)	$0	$0	$0	Yes (X)
REGINALD BENTON
VICE CHAIRMAN (EFF JAN 15)/TREASURER (THRU DEC 14)	0.70	1.40	Yes (X)	$0	$0	$0	Yes (X)
DOUGLAS RAHN DBA
PRESIDENT & CEO	55.00	5.00	Yes (X)	$0	$672,165	$291,895	Yes (X)
DAVID BOLEN
VICE PRESIDENT & CFO	55.00	5.00		$202,737	$0	$27,496	Yes (X)
MARK RUFF
STAFF ANESTHETIST	50.00			$302,182	$0	$55,923		Yes (X)
DAVID TONRY
STAFF ANESTHETIST	50.00			$275,373	$0	$51,880		Yes (X)
MICHAEL DUNSETH
STAFF ANESTHETIST	50.00			$261,061	$0	$40,322		Yes (X)
JON GREGORY
STAFF ANESTHETIST	50.00			$252,655	$0	$51,906		Yes (X)
RANDALL MOORE
DIRECTOR PERIOPERATIVE SERVICES	50.00			$244,305	$0	$51,731		Yes (X)
CHESTER WYNN
PRESIDENT & CEO	55.00	5.00		$118,576	$0	$11,518			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$1,656,889	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$1,948,681	TotReportableCompRltdOrgAmt
Total Other Compensation	$887,660	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	28	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
AEF MANAGEMENT
1800 E LAKESHORE DRIVE	DECATUR	IL	62521	ANESTHESIOLOGIST SERVICES	$871,045
JOHN C DAILEY MDSC
1572 CONCORD RD	JACKSONVILLE	IL	62650	PHYSICIAN SERVICES	$594,050
PROSKAUER ROSE LLP
ELEVENT TIMES SQUARE	NEW YORK	NY	10036	LEGAL SERVICES	$504,258
COGENT HEALTHCARE OF IL LLC
1005 BROADWAY ST	QUINCY	IL	62301	HOSPITALIST SERVICES	$463,579
SPI HEALTHCARE
2960 PROFESSIONAL DRIVE	SPRINGFIELD	IL	62703	PHYSICIAN BILLING SERVICES	$397,993

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	6	CntrctRcvdGreaterThan100KCnt
Related Organizations	$7,954	RelatedOrganizationsAmt
Government Grants	$950,743	GovernmentGrantsAmt
All Other Contributions	$13,771	AllOtherContributionsAmt
Total Contributions	$972,468	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

Field	Value	IRS element (for citing)
Desc	PATIENT SERVICE REV	Desc
Business	621110	BusinessCd
Total Revenue Column	$91,550,703	TotalRevenueColumnAmt
Related Or Exempt Func Income	$91,550,703	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$91,550,703	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,483,851	TotalRevenueColumnAmt
Exclusion	$1,483,851	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$352,305	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$23,814	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$328,491	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$328,491	TotalRevenueColumnAmt
Exclusion	$328,491	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$31,406,686	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$29,676,573	SecuritiesAmt
Other	$10,281	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$1,730,113	SecuritiesAmt
Other	-$10,281	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,719,832	TotalRevenueColumnAmt
Exclusion	$1,719,832	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
CAFETERIA	722100	$529,989	$529,989
REFERENCE LAB	621500	$479,991		$479,991
LIFELINE	812900	$138,982		$138,982

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$213,987	TotalRevenueColumnAmt
Exclusion	$213,987	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$1,362,949	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$97,418,294	TotalRevenueColumnAmt
Related Or Exempt Func Income	$91,550,703	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$618,973	UnrelatedBusinessRevenueAmt
Exclusion	$4,276,150	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$32,772	TotalAmt
Program Services	$32,772	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$2,412,726	TotalAmt
Program Services	$1,930,181	ProgramServicesAmt
Management And General	$482,545	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$31,819,535	TotalAmt
Program Services	$25,455,628	ProgramServicesAmt
Management And General	$6,363,907	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$1,582,611	TotalAmt
Program Services	$1,266,089	ProgramServicesAmt
Management And General	$316,522	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$8,458,279	TotalAmt
Program Services	$6,766,623	ProgramServicesAmt
Management And General	$1,691,656	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$2,516,139	TotalAmt
Program Services	$2,012,911	ProgramServicesAmt
Management And General	$503,228	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$225,441	TotalAmt
Management And General	$225,441	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$46,078	TotalAmt
Management And General	$46,078	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$5,129,521	TotalAmt
Program Services	$4,103,617	ProgramServicesAmt
Management And General	$1,025,904	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$204,344	TotalAmt
Program Services	$163,475	ProgramServicesAmt
Management And General	$40,869	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,740,134	TotalAmt
Program Services	$1,392,107	ProgramServicesAmt
Management And General	$348,027	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$402,404	TotalAmt
Program Services	$321,923	ProgramServicesAmt
Management And General	$80,481	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,271,639	TotalAmt
Program Services	$1,017,311	ProgramServicesAmt
Management And General	$254,328	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$96,017	TotalAmt
Program Services	$76,814	ProgramServicesAmt
Management And General	$19,203	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$1,414,095	TotalAmt
Program Services	$1,131,276	ProgramServicesAmt
Management And General	$282,819	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$2,722,407	TotalAmt
Program Services	$2,177,926	ProgramServicesAmt
Management And General	$544,481	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$1,144,869	TotalAmt
Program Services	$915,895	ProgramServicesAmt
Management And General	$228,974	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES	$6,436,115	$5,148,892	$1,287,223
REPAIRS AND MAINTENANCE	$3,193,666	$2,554,933	$638,733
PHARMACEUTICAL SUPPLIES	$2,930,608	$2,344,486	$586,122
ILLINOIS PROVIDER TAX	$2,141,651	$1,713,321	$428,330

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$5,011,425	TotalAmt
Program Services	$4,009,140	ProgramServicesAmt
Management And General	$1,002,285	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$80,932,476	TotalAmt
Program Services	$64,535,320	ProgramServicesAmt
Management And General	$16,397,156	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$16,482	BOYAmt
EOY	$13,773	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$5,179,633	BOYAmt
EOY	$4,459,934	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$12,243,646	BOYAmt
EOY	$13,119,245	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$31,210,705	BOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$766,180	BOYAmt
EOY	$1,340,387	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$1,458,610	BOYAmt
EOY	$1,173,428	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$29,336,230	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$4,548,103	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$18,392,806	BOYAmt
EOY	$24,788,127	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$65,434,008	BOYAmt
EOY	$65,038,775	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$39,733,232	BOYAmt
EOY	$46,587,196	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$174,435,302	BOYAmt
EOY	$156,520,865	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$16,423,463	BOYAmt
EOY	$10,843,777	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$26,075,000	BOYAmt
EOY	$25,035,000	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$2,156,171	BOYAmt
EOY	$2,199,871	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$6,303,733	BOYAmt
EOY	$12,178,769	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$50,958,367	BOYAmt
EOY	$50,257,417	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$99,492,057	BOYAmt
EOY	$81,798,905	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$553,203	BOYAmt
EOY	$1,445,746	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$23,431,675	BOYAmt
EOY	$23,018,797	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$123,476,935	BOYAmt
EOY	$106,263,448	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$174,435,302	BOYAmt
EOY	$156,520,865	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$16,485,818	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$203,780	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$33,495,525	OtherChangesInNetAssetsAmt
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	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	Yes (1)	GrantsOtherOrganizationsInd
Grants Other Organizations	$30,004	GrantsOtherOrganizationsAmt
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	0	OtherActivitiesInd
Total Lobbying Expenditures	$30,004	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	39% OF ILLINOIS HOSPITAL ASSOCIATION MEMBERSHIP DUES ARE ALLOCABLE TO LOBBYING ACTIVITIES.	ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$53,399,234	BeginningYearBalanceAmt
Contributions	$692	ContributionsAmt
Investment Earnings Or Losses	-$335,081	InvestmentEarningsOrLossesAmt
Administrative Expenses	$226,482	AdministrativeExpensesAmt
End Year Balance	$52,838,363	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$75,538,797	BeginningYearBalanceAmt
Contributions	$35,000	ContributionsAmt
Investment Earnings Or Losses	$3,627,985	InvestmentEarningsOrLossesAmt
Other Expenditures	$25,580,104	OtherExpendituresAmt
Administrative Expenses	$222,444	AdministrativeExpensesAmt
End Year Balance	$53,399,234	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$68,447,459	BeginningYearBalanceAmt
Investment Earnings Or Losses	$7,579,029	InvestmentEarningsOrLossesAmt
Other Expenditures	$487,691	OtherExpendituresAmt
End Year Balance	$75,538,797	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$58,899,464	BeginningYearBalanceAmt
Investment Earnings Or Losses	$10,026,577	InvestmentEarningsOrLossesAmt
Other Expenditures	$478,582	OtherExpendituresAmt
End Year Balance	$68,447,459	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$58,790,267	BeginningYearBalanceAmt
Investment Earnings Or Losses	$1,821,901	InvestmentEarningsOrLossesAmt
Other Expenditures	$1,712,704	OtherExpendituresAmt
End Year Balance	$58,899,464	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.93600	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.05400	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.01000	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (1)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	Yes (1)	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$604,700	OtherCostOrOtherBasisAmt
Book Value	$604,700	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$15,267,356	OtherCostOrOtherBasisAmt
Depreciation	$2,105,205	DepreciationAmt
Book Value	$13,162,151	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$8,750,870	OtherCostOrOtherBasisAmt
Depreciation	$2,384,576	DepreciationAmt
Book Value	$6,366,294	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$4,713,304	OtherCostOrOtherBasisAmt
Depreciation	$58,322	DepreciationAmt
Book Value	$4,654,982	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$24,788,127	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (7 entries)

DescDesc	Book ValueBookValueAmt
MALPRACTICE RECEIVABLE	$3,775,712
BENEFICIAL INTEREST IN TRUSTS	$19,776,398
FARMLAND	$16,818,584
PHYSICIAN LOANS	$263,938
INTEREST IN NET ASSETS OF PAHF	$5,071,946
MEANINGFUL USE RECEIVABLE	$863,448
MEDICARE SETTLEMENT	$17,170

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$46,587,196	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)

DescDesc	AmtAmt
ACCRUED PROFESSIONAL LIABILITY	$4,796,883
HEALTH INSURANCE RETIREE	$592,011
CHARITABLE GIFT ANNUITIES	$126,837
MARKET VALUE OF SWAPS	$2,625,492
DUE TO AFFILIATES	$21,873
PAYABLE TO THIRD PARTY PAYORS-BLUE CROSS	$3,685,487
DEFERRED COMPENSATION AND BENEFITS	$330,186

Field	Value	IRS element (for citing)
Total Liability	$12,178,769	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

PART V, LINE 4:

PAH'S ENDOWMENT CONSISTS OF 10 DONOR-RESTRICTED FUNDS WITH INCOME TO BE USED FOR CAPITAL PURCHASES, OPERATIONS, SCHOLARSHIPS, AND INDIGENT CARE.

PART X, LINE 2:

THE AUTHORITATIVE GUIDANCE IN ASC 740, INCOME TAXES, CREATES A SINGLE MODEL TO ADDRESS UNCERTAINTY IN TAX POSITIONS AND CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING THE MINIMUM RECOGNITION THRESHOLD A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. UNDER THE REQUIREMENTS OF THIS GUIDANCE, TAX-EXEMPT ORGANIZATIONS COULD BE REQUIRED TO RECORD AN OBLIGATION AS THE RESULT OF A TAX POSITION THEY HAVE HISTORICALLY TAKEN ON VARIOUS TAX EXPOSURE ITEMS. EACH OF MHS'S SUBSIDIARIES, EXCLUDING THOSE DESCRIBED IN THE FOLLOWING PARAGRAPH, IS A SEPARATELY INCORPORATED NOT-FOR-PROFIT CORPORATION AS DESCRIBED UNDER SECTION 501(C)(3) OF THE CODE AND IS TAX-EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THEY DO, HOWEVER, OPERATE CERTAIN PROGRAMS THAT MAY RESULT IN UNRELATED BUSINESS INCOME. UPON REVIEW AS REQUIRED BY ASC 740, INCOME TAX NO TAX PROVISION WAS RECORDED FOR THE YEARS ENDED SEPTEMBER 30, 2015 OR 2014. MP AND MHP ARE CONSIDERED DISREGARDED ENTITIES FOR TAX PURPOSES AND ARE EXEMPT FROM INCOME TAX. MHSCI IS A TAXABLE FOR-PROFIT CORPORATION AND PPA IS A TAXABLE NOT-FOR-PROFIT CORPORATION. BOTH ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES.

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	300.000000000000	FreeCareOtherPct

Field	Value	IRS element (for citing)
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	301.000000000000	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	$3,124,189	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$3,124,189	NetCommunityBenefitExpnsAmt
Total Expense	0.04030	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$16,328,743	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$14,404,738	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,924,005	NetCommunityBenefitExpnsAmt
Total Expense	0.02480	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$19,452,932	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$14,404,738	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,048,194	NetCommunityBenefitExpnsAmt
Total Expense	0.06510	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$199,013	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$199,013	NetCommunityBenefitExpnsAmt
Total Expense	0.00260	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$74,999	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$74,999	NetCommunityBenefitExpnsAmt
Total Expense	0.00100	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$67,177	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$67,177	NetCommunityBenefitExpnsAmt
Total Expense	0.00090	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$341,189	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$341,189	NetCommunityBenefitExpnsAmt
Total Expense	0.00450	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$19,794,121	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$14,404,738	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,389,383	NetCommunityBenefitExpnsAmt
Total Expense	0.06960	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,396	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,396	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,396	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,396	NetCommunityBenefitExpnsAmt

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$867,837	BadDebtExpenseAmt
Reimbursed By Medicare	$23,951,964	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$22,503,617	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$1,448,347	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	PASSAVANT MEMORIAL AREA HOSPITAL ASSOC	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1600 WEST WALNUT STREET	AddressLine1Txt
City	JACKSONVILLE	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	62650	ZIPCd

Field	Value	IRS element (for citing)
Website Address	WWW.PASSAVANTHOSPITAL.COM	WebsiteAddressTxt
State License	HF107104	StateLicenseNum
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	PASSAVANT MEMORIAL AREA HOSPITAL ASSOC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	Yes (1)	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
Information Gaps	Yes (X)	InformationGapsInd
CHNA Conducted	14	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	WWW.PASSAVANTHOSPITAL.COM	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	14	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	WWW.PASSAVANTHOSPITAL.COM	StrategyWebsiteURLTxt
Strategy Attached	0	StrategyAttachedInd
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	300.000000000000	FPGFamilyIncmLmtFreeCarePct
Income Level Criteria	Yes (X)	IncomeLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
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.PASSAVANTHOSPITAL.COM	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	WWW.PASSAVANTHOSPITAL.COM	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	WWW.PASSAVANTHOSPITAL.COM	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
FAP Notice Displayed	Yes (X)	FAPNoticeDisplayedInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Collection Activities	0	CollectionActivitiesInd
FAP Notified Upon Admission	Yes (X)	FAPNotifiedUponAdmissionInd
FAP Notified All Patients	Yes (X)	FAPNotifiedAllPatientsInd
Documented Elig Determination	Yes (X)	DocumentedEligDeterminationInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Other Method Used	Yes (X)	OtherMethodUsedInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (11 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PASSAVANT MEMORIAL AREA HOSPITAL ASSOC	PART V, SECTION B, LINE 5: DURING THE CHNA PROCESS, WE MET AND RECEIVED INPUT FROM MANY INDIVIDUALS/ORGANIZATIONS IN OUR COMMUNITY WHO HAVE KNOWLEDGE AND EXPERTISE IN THE AREAS OF OUR IDENTIFIED NEEDS. WE COLLABORATED WITH PUBLIC HEALTH, PROBATION, LAW ENFORCEMENT, SUBSTANCE ABUSE COUNSELORS, COLLEGE HEALTH OFFICIALS, HIGH SCHOOL ADMINISTRATORS, AND NURSES, TEENS, AND OUR OWN HOSPITAL PERSONNEL.
PASSAVANT MEMORIAL AREA HOSPITAL ASSOC	PART V, SECTION B, LINE 6B: PAH COLLABORATED WITH 12 COMMUNITY ORGANIZATIONS. THEY WERE: MORGAN COUNTY HEALTH DEPARTMENT, ILLINOIS SCHOOL FOR THE DEAF, ILLINOIS SCHOOL FOR THE VISUALLY IMPAIRED, JACKSONVILLE SCHOOL DISTRICT #117, THE WELLS CENTER, PRAIRIELAND UNITED WAY, HEAD START, MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS, MACMURRAY COLLEGE, ILLINOIS COLLEGE, LINCOLN LAND COMMUNITY COLLEGE, AND JACKSONVILLE AREA CENTER FOR INDEPENDENT LIVING.
PASSAVANT MEMORIAL AREA HOSPITAL ASSOC	PART V, SECTION B, LINE 2: IN APRIL 2014, PASSAVANT AREA HOSPITAL (PAH) BECAME AN AFFILIATE OF MEMORIAL HEALTH SYSTEM (MHS) OF SPRINGFIELD, IL. THE TRANSACTION WAS ACCOUNTED FOR AS AN ACQUISITION, AND ACQUIRED ASSETS AND LIABILITIES WERE RECORDED AT FAIR VALUE. PAH AND MHS HAVE THE SAME FISCAL YEAR OF OCTOBER 1 - SEPTEMBER 30. PAH AND MHS ALSO SHARE A MISSION OF PROVIDING THE HIGHEST QUALITY HEALTH CARE SERVICES TO THE COMMUNITIES EACH SERVES IN CENTRAL ILLINOIS. AFFILIATION WILL RESULT IN ALL PARTIES BEING IN THE BEST POSITION TO CONTINUE AND STRENGTHEN THE HIGH-QUALITY HEALTH CARE SERVICES EACH DELIVERS, AND TO MEET THE CLINICAL, FINANCIAL, AND TECHNOLOGICAL DEMANDS OF DELIVERING HEALTH CARE IN CENTRAL ILLINOIS, BY EXPLORING INITIATIVES THAT ENHANCE THE MISSIONS AND CLINICAL, OPERATIONAL, MANAGEMENT, AND FINANCIAL STRENGTHS OF EACH PARTY.
PASSAVANT MEMORIAL AREA HOSPITAL ASSOC	PART V, SECTION B, LINE 11: IN REVIEW OF THE SURVEY DATA, 9 PRIORITIES WERE IDENTIFIED. THEY WERE: ACCESS TO CARE, MENTAL HEALTH, EARLY SEXUAL ACTIVITY/TEEN PREGNANCY, OBESITY, DENTAL CARE, SUBSTANCE MISUSE, COLON CANCER, SEXUALLY TRANSMITTED DISEASES, AND TOBACCO. ACCESS TO CARE, MENTAL HEALTH, AND OBESITY WERE CHOSEN AS THE FINAL PRIORITIES. MENTAL HEALTH WAS IDENTIFIED AS THE TOP PRIORITY. THE HOSPITAL WILL OPEN A 10-BED INPATIENT PSYCHIATRIC UNIT. THIS WILL INCREASE THE AVAILABILITY OF LOCAL PSYCHIATRIC SERVICES, REDUCING LONG DRIVES TO OTHER COMMUNITIES AND REDUCE LONG WAIT TIMES FOR THE NUMBER OF AVAILABLE PSYCHIATRIC BEDS. THE HOSPITAL WILL ALSO SUPPORT COMMUNITY EFFORTS TO REDUCE THE STIGMA OF MENTAL HEALTH AND IMPROVE UNDERSTANDING OF REFERRALS TO AVAILABLE COMMUNITY RESOURCES. OBESITY WAS IDENTIFIED AS A HIGH PRIORITY. MEMORIAL AND PASSAVANT WILL WORK TOGETHER TO DEVELOP A STRATEGY TO IMPLEMENT THE MEMORIAL WEIGHT LOSS AND WELLNESS CENTER PROGRAM AT PASSAVANT, IN ORDER TO EXPAND ACCESS TO THE PROGRAM INTO MORGAN COUNTY. THE HOSPITAL WILL WORK TO IMPROVE ATTITUDES ABOUT HEALTHY LIFESTYLES THROUGH MONTHLY EDUCATION PROGRAMS AND A HEALTH AWARENESS MARKETING CAMPAIGN FOR SELECTED SAMPLE GROUPS COVERING A WIDE RANGE OF AGE RANGES AND INCOMES. IN ADDITION, THE HOSPITAL WILL FINANCIALLY SUPPORT PROGRAMS THAT PROVIDE OPPORTUNITIES FOR RESIDENTS TO PRACTICE HEALTHY BEHAVIORS.ACCESS TO CARE WAS IDENTIFIED AS A TOP PRIORITY. PASSAVANT, IN COLLABORATION WITH THE MORGAN COUNTY HEALTH DEPARTMENT AND SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE WILL SECURE APPROVAL FOR AND OPEN A FEDERALLY QUALIFIED HEALTH CENTER (FQHC). PASSAVANT WILL PROVIDE LEADERSHIP AND FINANCIAL SUPPORT TOWARDS THE EFFORT TO ESTABLISH A FQHC IN MORGAN COUNTY. IN ADDITION, THE HOSPITAL WILL FINANCIALLY SUPPORT THE REOPENING AND OPERATIONS OF A WALK-IN STD CLINIC RUN BY THE MORGAN COUNTY HEALTH DEPARTMENT, WHICH WAS CLOSED IN 2008. WITHOUT PASSAVANT'S SUPPORT, THE CLINIC WOULD NOT BE ABLE TO OFFER SERVICES.ACCESS TO DENTAL CARE WAS NOT CHOSEN BECAUSE THE HOSPITAL DOES NOT HAVE THE EXPERTISE TO ADDRESS THE ISSUE. COLON CANCER WAS NOT CHOSEN BECAUSE IT CONSISTENTLY RANKED AS A LOW PRIORITY AMONG COMMUNITY MEMBERS. THE HOSPITAL CURRENTLY OFFERS ADVANCED COLONOSCOPY SERVICES, ANNUAL COLORECTAL CANCER EDUCATION FOR THE COMMUNITY, AND PARTNERS WITH A LOCAL CANCER FOUNDATION TO PROVIDE FREE COLORECTAL SCREENINGS TO COMMUNITY MEMBERS EACH YEAR. SUBSTANCE MISUSE WAS NOT CHOSEN BECAUSE IT DID NOT RANK AS A HIGH PRIORITY AMONG THE ADVISORY COMMITTEE, IN THE COMMUNITY FORUM, OR ON THE SURVEY. IT WAS PERCEIVED BY THE ADVISORY COMMITTEE THAT THERE WOULD BE LITTLE OPPORTUNITY TO MAKE ADDITIONAL IMPACT BEYOND WHAT IS BEING DONE THROUGH THE PARTNERSHIP FOR A HEALTHY COMMUNITY, WHICH IS A COLLABORATION OF LOCAL LAW ENFORCEMENT, EDUCATION INSTITUTIONS, HEALTH PROVIDERS, AND THE WELLS CENTER - A DRUG AND ALCOHOL TREATMENT FACILITY. EARLY SEXUAL ACTIVITY/TEEN PREGNANCY WAS NOT CHOSEN BECAUSE THE MORGAN COUNTY HEALTH DEPARTMENT IS ALREADY ADDRESSING THIS DISPARITY IN THE SCHOOLS, AND IT WOULD BE A DUPLICATION OF SERVICES. TOBACCO RANKED SIGNIFICANTLY LOWER THAN OTHER PRIORITIES IN THE FORUM AND THE SURVEY. IT WAS COMMUNICATED THAT IT WOULD BE DIFFICULT TO MAKE A SIGNIFICANT IMPACT AS THE MORGAN COUNTY HEALTH DEPARTMENT IS PARTNERING WITH THE ILLINOIS QUITLINE TO OFFER SMOKING CESSATION PRODUCTS. SEXUALLY TRANSMITTED DISEASES WILL BE ADDRESSED AS AN ACCESS TO CARE INITIATIVE IN PARTNERSHIP WITH THE HEALTH DEPARTMENT, RATHER THAN A STAND-ALONE PRIORITY. THE HOSPITAL WILL CONTINUE TO SUPPORT THE HEALTH DEPARTMENT'S STD CLINIC WHICH WAS REOPENED IN 2014 USING FUNDS ALLOCATED BY THE HOSPITAL. THIS NEED CONTINUES TO BE MET THROUGH THIS PARTNERSHIP ESTABLISHED AS A RESULT OF THE 2012 CHNA.
PASSAVANT MEMORIAL AREA HOSPITAL ASSOC	PART V, SECTION B, LINE 13B: PASSAVANT AREA HOSPITAL USES AN AMOUNT UP TO 300% OF THE FPG AS A FACTOR IN DETERMINING ELIGIBILITY FOR PROVING DISCOUNTED CARE.
PASSAVANT MEMORIAL AREA HOSPITAL ASSOC	PART V, SECTION B, LINE 16I: ALL BILLING STATEMENTS TO THE PATIENTS INDICATE OUR FINANCIAL ASSISTANCE CONTACT INFORMATION. INFORMATION IS ALSO LISTED ON THE CONSENT TREATMENT FORM.
PASSAVANT MEMORIAL AREA HOSPITAL ASSOC	PART V, SECTION B, LINE 22D: AMOUNT PROVIDED BY THE ATTORNEY GENERAL STATE OF ILLINOIS HOSPITAL UNINSURED PATIENT DISCOUNT ACT.
PART V, SECTION B, LINE 16	FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY
PASSAVANT MEMORIAL AREA HOSPITAL ASSOC PART V, SECTION B, LINE 16A WEBSITE:	WWW.PASSAVANTHOSPITAL.COM
PASSAVANT MEMORIAL AREA HOSPITAL ASSOC PART V, SECTION B, LINE 16B WEBSITE:	WWW.PASSAVANTHOSPITAL.COM
PASSAVANT MEMORIAL AREA HOSPITAL ASSOC PART V, SECTION B, LINE 16C WEBSITE:	WWW.PASSAVANTHOSPITAL.COM

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 3C:	PASSAVANT AREA HOSPITAL USES AN AMOUNT IN EXCESS OF 300% OF THE FPG AS A FACTOR IN DETERMINING ELIGIBILITY FOR PROVIDING DISCOUNTED CARE. THE VALUE OF 301% WAS ENTERED TO SATISFY A MANDATORY FIELD ENTRY REQUIREMENT TO QUALIFY FOR AN ELECTRONIC FILING.
PART I, LINE 7:	BAD DEBT EXPENSE OF $ 3,392,870 HAS BEEN EXCLUDED. COST METHODOLOGY USED WAS COST-TO-CHARGE RATIO, WHICH WAS DEVELOPED USING WORKSHEET 2.
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 $ 3,392,870.
PART II, COMMUNITY BUILDING ACTIVITIES:	PASSAVANT'S COMMUNITY BUILDING ACTIVITIES INCLUDE PROMOTING ECONOMIC DEVELOPMENT BY SUPPORTING OUR AREA CHAMBER OF COMMERCE AND MAIN STREET ORGANIZATIONS, SUPPORTING ORGANIZATIONS WHO PROMOTE AND ADVOCATE FOR COMMUNITY HEALTH IMPROVEMENT, AND SUPPORTS THE COMMUNITY BY HELPING FUND TRANSPORTATION TO AND FROM THE HOSPITAL AND PROVIDER OFFICES, ALONG WITH SUPPORTING OUR LOCAL SCHOOLS AND OTHER LOCAL NON-PROFIT ORGANIZATIONS.
PART III, LINE 2:	PAH REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE ASSOCIATION PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE ASSOCIATION BILLS THIRD-PARTY PAYERS 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.
PART III, LINE 4:	THE DESCRIPTION CAN BE FOUND ON PAGE 14 OF THE AUDITED FINANCIAL STATEMENTS.
PART III, LINE 8:	THE AMOUNT REPORTED ON LINE 6 WAS OBTAINED FROM THE MEDICARE COST REPORT FILED BY THE ORGANIZATION.
PART III, LINE 9B:	PASSAVANT'S COLLECTION POLICY STATES "PASSAVANT AREA HOSPITAL WILL NOT PURSUE COLLECTION ACTION AGAINST A FINANCIALLY QUALIFIED CHARITY CARE PATIENT WHO HAS CLEARLY DEMONSTRATED THAT HE OR SHE DOES NOT HAVE SUFFICIENT INCOME OR ASSETS TO MEET ANY PART OF THEIR FINANCIAL OBLIGATION TO THE HOSPITAL. PASSAVANT AREA HOSPITAL WILL NOT USE FORCED COURT APPEARANCE TO REQUIRE THE FINANCIALLY QUALIFIED CHARITY CARE PATIENT OR RESPONSIBLE PARTY TO APPEAR IN COURT. PASSAVANT AREA HOSPITAL WILL NOT GARNISH WAGES FOR THE FINANCIALLY QUALIFIED CHARITY CARE PATIENT. ONCE CHARITY CARE STATUS IS DETERMINED, IT WILL BE APPLIED RETROACTIVELY TO ALL QUALIFYING ACCOUNTS. FOR AT LEAST 70 DAYS AFTER AN UNINSURED PATIENT'S DISCHARGE, PASSAVANT AREA HOSPITAL WILL NOT FILE A LAWSUIT TO COLLECT PAYMENT ON PATIENT'S BILL. IF AN UNINSURED PATIENT HAS REQUESTED CHARITY ASSISTANCE AND/OR APPLIED FOR OTHER COVERAGE AND IS COOPERATING WITH THE HOSPITAL, THE HOSPITAL WILL NOT PURSUE COLLECTION ACTION UNTIL A DECISION HAS BEEN MADE THAT THERE IS NO LONGER A REASONABLE BASIS TO BELIEVE PATIENT MAY QUALIFY FOR COVERAGE. WHEN THE PATIENT HAS BEEN APPROVED UNDER THE CHARITY CARE POLICY FOR A PARTIAL DISCOUNT, PASSAVANT AREA HOSPITAL WILL WORK WITH THE PATIENT OR THE RESPONSIBLE PARTY TO ESTABLISH A REASONABLE PAYMENT OPTION. IF AN UNINSURED PATIENT COMPLIES WITH A PAYMENT PLAN THAT HAS BEEN AGREED UPON BY THE HOSPITAL, PASSAVANT AREA HOSPITAL WILL NOT PURSUE COLLECTION ACTION. IF PASSAVANT AREA HOSPITAL HAS SUFFICIENT REASON TO BELIEVE THAT THE PATIENT HAS INCOME OR ASSETS TO MEET HIS OR HER OBLIGATION BUT CONTINUES WITH NON-PAYMENT, COLLECTION ACTION INCLUDING THE GARNISHMENT OF WAGES MAY BE TAKEN BY PASSAVANT AREA HOSPITAL TO ENFORCE THE TERMS OF THE PAYMENT PLAN. ONCE CHARITY CARE STATUS IS DETERMINED, IT WILL BE APPLIED RETROACTIVELY TO ALL OPEN ACCOUNTS."
PART VI, LINE 2:	IN ADDITION TO THE CHNA PROCESS, PASSAVANT AREA HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES IN MANY DIFFERENT MANNERS. THE HOSPITAL WORKS WITH THE MORGAN COUNTY HEALTH DEPARTMENT IN DEVELOPING THE MORGAN COUNTY HEALTH PLAN. THE HOSPITAL THEN USES THE RESULTS OF THE HEALTH PLAN TO DETERMINE WHAT PROGRAMS AND SERVICES NEED TO BE OFFERED. ANOTHER SOURCE OF INFORMATION ON HEALTH CARE NEEDS IS THE MEDICAL STAFF. MEMBERS OF THE HOSPITAL'S ADMINISTRATIVE TEAM MEET REGULARLY WITH THE PHYSICIANS TO DETERMINE WHAT NEW SERVICES SHOULD BE IMPLEMENTED. THE SIXTEEN MEMBERS OF THE BOARD OF DIRECTORS, WHO REPRESENT THE DIFFERENT GEOGRAPHIC AREAS SERVED BY THE HOSPITAL, ALSO PROVIDE INPUT ON HEALTH CARE NEEDS, ALONG WITH THE VOLUNTEERS AND THE HOSPITAL'S EMPLOYEES. LASTLY, THE HOSPITAL ASKS THE PUBLIC ABOUT SERVICES THROUGH PATIENT SURVEYS AND FOCUS GROUPS.
PART VI, LINE 3:	THERE ARE SIGNS IN THE REGISTRATION AREAS (IN ENGLISH & SPANISH) WHICH INDICATE THE HOSPITAL TREATS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. GUIDELINES FOR PAYMENTS ON PATIENT ACCOUNTS BROCHURES ARE AT EACH REGISTRATION BOOTH FOR PATIENTS AND THE GENERAL PUBLIC. THESE BROCHURES PROVIDE PAYMENT AND FINANCIAL ASSISTANCE INFORMATION (ENGLISH & SPANISH). OUR GENERAL CONSENT FOR TREATMENT HAS A SECTION ABOUT OUR FINANCIAL ASSISTANCE PROGRAM (ENGLISH & SPANISH). THERE IS INFORMATION AVAILABLE ON THE HOSPITAL WEBSITE ABOUT OUR FINANCIAL ASSISTANCE PROGRAM. INFORMATION ABOUT BILLING AND FINANCIAL ASSISTANCE IS AVAILABLE AT BEDSIDE FOR OVERNIGHT AND SURGERY PATIENTS. PATIENT BILLING STATEMENTS ADVISE OF OUR FINANCIAL ASSISTANCE PROGRAMS AND HOW TO CONTACT US TO APPLY. SELF-PAY OVERNIGHT PATIENTS ARE CONTACTED BY SOCIAL SERVICES AND/OR PFS STAFF AND PROVIDED WITH INFORMATION ON FINANCIAL ASSISTANCE PROGRAMS. STAFF RECEIVED EDUCATION TO DIRECT PATIENT TO SOCIAL SERVICE OR PATIENT FINANCIAL SERVICE IF A PATIENT INDICATES THEY NEED ASSISTANCE WITH A BILL.
PART VI, LINE 4:	THE MAIN COUNTIES THAT PAH SERVES ARE CASS, MORGAN, SCOTT, MACOUPIN AND GREENE COUNTIES (PAH HAS AT LEAST 25% OF THE MARKET IN THESE ZIP CODES). THERE IS A SMALLER, SECONDARY MARKET WHERE PAH HAS AT LEAST 5%, BUT LESS THAN 25% OF THE MARKET. THE SECONDARY MARKET INCLUDES ZIP CODES IN BROWN, SCHUYLER, AND PIKE COUNTIES. OVER 90% OF CASES COME FROM THE PRIMARY MARKET.OF THE TOTAL PATIENTS SERVED BY PASSAVANT AREA HOSPITAL, 1.5 % ARE UNINSURED/RECEIVING CHARITY CARE AND 20.4 % ARE ON MEDICAID. IN THE PAH SERVICE AREA, ONE PRECINCT IN MORGAN COUNTY IS A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED POPULATION, THREE TOWNSHIPS IN MACOUPIN ARE MEDICALLY UNDERSERVED AREAS (MUA), WHILE CASS, GREENE, BROWN AND SCOTT COUNTIES ARE ALL MUA'S. PATIENTS IN THE PASSAVANT AREA HOSPITAL SERVICE AREA SOMETIMES TRAVEL FOR SERVICE TO OTHER HOSPITALS IN THE AREA, THE CLOSEST BEING MEMORIAL MEDICAL CENTER AND ST. JOHN'S HOSPITAL IN SPRINGFIELD, IL, WHICH ARE 30 MILES FROM PASSAVANT'S PHYSICAL LOCATION IN JACKSONVILLE, IL. THE COUNTIES WHICH MAKE UP PASSAVANT'S SERVICE AREA ARE ALL RURAL AREAS. DEMOGRAPHICS OF THE PRIMARY SERVICE AREAS ARE (ESTIMATED AS OF 2014):MORGAN COUNTY - POPULATION APPROX. 34,929; PER CAPITA INCOME $24,822; MEDIAN HOUSEHOLD INCOME $46,524; PERCENTAGE OF PERSONS BELOW THE POVERTY LEVEL 15.1%CASS COUNTY - POPULATION APPROX. 13,156; PER CAPITA INCOME $23,423; MEDIAN HOUSEHOLD INCOME $47,443; PERCENTAGE OF PERSONS BELOW THE POVERTY LEVEL 13.2%SCOTT COUNTY - POPULATION APPROX. 5,300; PER CAPITA INCOME $24,395; MEDIAN HOUSEHOLD INCOME $48,500; PERCENTAGE OF PERSONS BELOW THE POVERTY LEVEL 12.0%MACOUPIN COUNTY - POPULATION APPROX. 47,700; PER CAPITA INCOME $25,402; MEDIAN HOUSEHOLD INCOME $50,911; PERCENTAGE OF PERSONS BELOW THE POVERTY LEVEL 12.9%GREENE COUNTY - POPULATION APPROX. 13,800; PER CAPITA INCOME $22,483; MEDIAN HOUSEHOLD INCOME $43,178; PERCENTAGE OF PERSONS BELOW THE POVERTY LEVEL 16.2%
PART VI, LINE 5:	PASSAVANT AREA HOSPITAL HAS A BOARD OF DIRECTORS MADE UP OF MEDICAL, BUSINESS, AGRICULTURE AND COMMUNITY LEADERS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THESE VOLUNTEERS DONATE THEIR TIME IN THEIR OVERSIGHT ROLE AND ARE INVOLVED IN THE DECISION-MAKING PROCESS FOR THE HOSPITAL. PAH HAS A TASK FORCE THAT LEADS THE COMMUNITY NEEDS ASSESSMENT PROCESS. MORE THAN 200 PEOPLE VOLUNTEER AT THE HOSPITAL AS AMBASSADORS, MESSENGERS, AND A WIDE RANGE OF OTHER VOLUNTEER ROLES. PAH HAS AN OPEN MEDICAL STAFF THAT ALLOWS MEMBERSHIP TO ANYONE WHO MEETS CREDENTIALING REQUIREMENTS. THE HOSPITAL PARTICIPATES IN MEDICARE, MEDICAID, CHAMPUS, TRICARE AND OTHER GOVERNMENT PROGRAMS AND PROVIDES FINANCIAL ASSISTANCE AND SLIDING SCALE DISCOUNTS ACCORDING TO BOARD-APPROVED CHARITY CARE POLICIES. PAH HAS A 24/7 EMERGENCY DEPARTMENT PROVIDING SERVICE TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY. THE HOSPITAL ALSO PROVIDES A MEDICARE/INSURANCE CONSULTANT TO HELP PATIENTS UNDERSTAND AND COPE WITH PAPERWORK AND BILLING THAT FOLLOWS A HOSPITAL STAY. THE CONSULTANT IS AVAILABLE TO ASSIST DISCHARGED PATIENTS WITH THE FILING OF MEDICARE/INSURANCE FORMS AND HELPS CLIENTS UNDERSTAND THE COMPREHENSIVE PROCESS OF FILING CLAIMS. THERE IS NO CHARGE FOR THIS SERVICE.PASSAVANT AREA HOSPITAL IS A SOLE COMMUNITY HOSPITAL WITH 93 STAFFED BEDS, IS STAFFED BY 900 FULL AND PART-TIME EMPLOYEES, AND AN ACTIVE MEDICAL STAFF OF 70 PHYSICIANS. SERVICES OFFERED INCLUDE 24-HOUR EMERGENCY MEDICINE, GENERAL ACUTE INPATIENT CARE, WOUND CARE, ORTHOPEDICS, AND SURGERY, AS WELL AS A FULL RANGE OF OUTPATIENT REHABILITATION AND THERAPY AND DIAGNOSTIC TESTING. A FIXED MRI UNIT AND UPGRADED CT SCAN OFFER COMMUNITY MEMBERS LOCAL AND CONVENIENT ACCESS TO MANY DIAGNOSTIC TESTS. PAH'S EMERGENCY DEPARTMENT HAS TRADITIONALLY SERVED AS A SAFETY NET HEALTHCARE PROVIDER FOR THE UNINSURED AND UNDERINSURED WHO DO NOT HAVE PRIMARY CARE PHYSICIANS.PASSAVANT AREA HOSPITAL USED SURPLUS FUNDS TO IMPROVE COMMUNITY HEALTH BY PURCHASING A NEW MRI MACHINE WHICH IS A BETTER DIAGNOSTIC TOOL THAN THE PREVIOUS MACHINE; AND SUPPORTING A MOBILE FOOD PANTRY MULTIPLE TIMES THROUGH THE YEAR. PAH EXPANDED SERVICES IN CARDIOLOGY, MAMMOGRAPHY, AND INTERVENTIONAL RADIOLOGY CAPABILITIES. PAH ALSO COLLABORATED WITH THE MIA WARE FOUNDATION IN PROVIDING FREE MAMMOGRAMS FOR THOSE WHO CANNOT AFFORD THEM. RECOGNIZING THE NEED FOR INCREASED NEED FOR PSYCHIATRIC CARE IN OUR COMMUNITY PAH IS EXPANDING PSYCHIATRIC SERVICES. PASSAVANT PHYSICIAN ASSOCIATION RECRUITED A NEW PSYCHIATRIST AND PAH BEGAN CONSTRUCTION ON AN INPATIENT PSYCHIATRIC UNIT. PAH INCREASED THE COMMUNITY ACCESS TO CANCER SCREENINGS BY PARTNERING WITH THE NATIONAL KIDNEY FOUNDATION TO OFFER THE KIDNEY MOBILE SCREENINGS. PAH ALSO SPONSORED A SKIN CANCER SCREENING EVENING IN COOPERATION WITH A LOCAL DERMATOLOGIST, PROVIDING FREE SKI CANCER SCREENINGS. PAH PROVIDES CASH AND IN-KIND DONATIONS TO AREA NON-PROFIT ORGANIZATIONS. PAH PROVIDES FREE MEDICARE CONSULTING SERVICES TO SENIORS. PASSAVANT PROVIDES SPEAKERS, SCREENINGS AND HEALTH FAIRS FOR FREE AT THE JACKSONVILLE AREA SENIOR CENTER. IT ALSO CONDUCTS A "COMMUNITY HEALTH CHECK" AT THE CENTER THE FIRST WEDNESDAY OF EACH MONTH. IN FISCAL YEAR 2015, PAH PROVIDED $7.2 MILLION IN CHARITY CARE AND BAD DEBT CHARGES.PASSAVANT AREA HOSPITAL HAS ALSO COLLABORATED WITH THE MORGAN COUNTY HEALTH DEPARTMENT IN REOPENING A CLINIC TO DIAGNOSE AND TREAT SEXUALLY TRANSMITTED DISEASES, WHICH THE PUBLIC HEALTH DEPARTMENT HAD TO CLOSE DUE TO LACK OF FUNDING. PAH PROVIDES FINANCIAL SUPPORT TO THIS CLINIC, AS WELL AS PHYSICIANS AND NURSES VOLUNTEERING THEIR TIME TO SEE PATIENTS AT THE CLINIC. PAH ALSO WORKS WITH LOCAL SCHOOLS TO IMPROVE CURRICULUM ON REPRODUCTIVE HEALTH, AND SUPPORTS THE PARTNERSHIP FOR SUBSTANCE MISUSE, A LOCAL COALITION, IN ITS WORK TO ADDRESS ADOLESCENT SUBSTANCE ABUSE. PAH HOSTS SEVERAL SUPPORT GROUPS FOR THE COMMUNITY: BEREAVED PARENTS, AUTISM, ALZHEIMER'S, BREASTFEEDING, DIABETES, GRIEF, GRANDPARENTS RAISING CHILDREN, PARKINSON'S AND NEUROMUSCULAR DISORDERS, STROKE AND EPILEPSY.
PART VI, LINE 6:	PASSAVANT AREA HOSPITAL IS AN AFFILIATE OF MEMORIAL HEALTH SYSTEM.PASSAVANT AREA HOSPITAL, A 501(C)(3) CORPORATION, IS THE SOLE CORPORATE MEMBER OF PASSAVANT PHYSICIAN ASSOCIATION, A PHYSICIAN GROUP. PASSAVANT PHYSICIAN ASSOCIATION (PPA) IS A GROUP OF 6 PHYSICIAN OFFICES THAT OFFER A VARIETY OF SERVICES: SURGERY; EAR, NOSE & THROAT; PSYCHIATRIC; INTERNAL MEDICINE; WOUND CARE; AND OBSTETRICS/GYNECOLOGY. COMPRISED OF MORE THAN 17 PHYSICIANS AND MID-LEVEL PROVIDERS, IT EMPLOYS MORE THAN 50 PEOPLE AND PROVIDES 25,000+ PATIENT VISITS EACH YEAR. PPA PROVIDES COMMUNITY BENEFITS BY PROVIDING COMMUNITY EDUCATION PROGRAMS ON VARIOUS TOPICS, SUCH AS STROKE, DIABETES, DEPRESSION, HOSPICE CARE, AND PATIENT SAFETY.
PART VI, LINE 7, REPORTS FILED WITH STATES	IL

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (1)	GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ILLINOIS HOSPITAL RESEARCH AND EDUCATION FOUNDATION	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1151 EAST WARRENVILLE ROAD	AddressLine1Txt
City	NAPERVILLE	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	60566	ZIPCd

Field	Value	IRS element (for citing)
Recipient EIN	237421930	RecipientEIN
IRC Section	501(C)(3)	IRCSectionDesc
Cash Grant	$32,772	CashGrantAmt
Purpose Of Grant	TO ADDRESS THE DISPARATE AND NEGATIVE EFFECTS OF THE ILLINOIS MEDICAID PROGRAM EXPERIENCED BY HOSPITALS AND HEALTHCARE SYSTEMS IN ILLINOIS.	PurposeOfGrantTxt

Field	Value	IRS element (for citing)
Total501c3 Org	1	Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 2:	FormAndLineReferenceDesc
Explanation	GRANTS PAID TO ILLINOIS HOSPITAL RESEARCH AND EDUCATIONAL ASSOCIATION ARE PAID AS PART OF A VOLUNTARY STATE MEDICAID REALLOCATION PROGRAM KNOWN AS THE HOSPITAL MUTUAL ASSISTANCE PROGRAM. NO FORMAL POLICY EXISTS TO MONITOR THE USE OF THESE GRANTS.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
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 (11 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 LILLPOP MD
BOARD MEMBER	$0	$430,505	$0	$47,221	$0	$119,032	$0	$130,350	$0	$77,712	$0	$804,820	$0	$36,929
BABU ELADASARI MD
BOARD MEMBER (EFF JAN 15)	$0	$304,782	$0	$0	$0	$0	$0	$15,600	$0	$17,664	$0	$338,046	$0	$0
CHARLES SHEAFF MD
BOARD MEMBER (THRU DEC 14)	$0	$374,976	$0	$0	$0	$0	$0	$15,600	$0	$11,134	$0	$401,710	$0	$0
DOUGLAS RAHN DBA
PRESIDENT & CEO	$0	$443,840	$0	$188,757	$0	$39,568	$0	$271,383	$0	$20,512	$0	$964,060	$0	$0
DAVID BOLEN
VICE PRESIDENT & CFO	$202,737	$0	$0	$0	$0	$0	$12,357	$0	$15,139	$0	$230,233	$0	$0	$0
MARK RUFF
STAFF ANESTHETIST	$302,182	$0	$0	$0	$0	$0	$15,032	$0	$40,891	$0	$358,105	$0	$0	$0
DAVID TONRY
STAFF ANESTHETIST	$275,373	$0	$0	$0	$0	$0	$15,600	$0	$36,280	$0	$327,253	$0	$0	$0
MICHAEL DUNSETH
STAFF ANESTHETIST	$261,061	$0	$0	$0	$0	$0	$8,205	$0	$32,117	$0	$301,383	$0	$0	$0
JON GREGORY
STAFF ANESTHETIST	$252,655	$0	$0	$0	$0	$0	$15,518	$0	$36,388	$0	$304,561	$0	$0	$0
RANDALL MOORE
DIRECTOR PERIOPERATIVE SERVICES	$244,305	$0	$0	$0	$0	$0	$14,928	$0	$36,803	$0	$296,036	$0	$0	$0
CHESTER WYNN
PRESIDENT & CEO	$71,505	$0	$0	$0	$47,071	$0	$7,092	$0	$4,426	$0	$130,094	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

PART I, LINE 3

COMPENSATION AND BENEFITS RECEIVED BY DOUGLAS RAHN, PRESIDENT AND CEO OF PASSAVANT MEMORIAL AREA HOSPITAL, WAS COMPRISED OF THE FOLLOWING COMPONENTS; BASE COMPENSATION, INCENTIVE COMPENSATION, OTHER COMPENSATION, RETIREMENT/DEFERRED COMPENSATION AND OTHER NONTAXABLE BENEFITS. COMPENSATION FOR MR. RAHN IS DETERMINED BY MEMORIAL HEALTH SYSTEM. BASE COMPENSATION LEVELS WERE SET BY THE MHS BOARD AT THE 50TH PERCENTILE OF THE RELEVANT COMPENSATION RANGE, AS DETERMINED BY INDEPENDENT COMPENSATION CONSULTANTS. INCENTIVE COMPENSATION WAS CONTINGENT ON THE ACHIEVEMENT OF SPECIFIC PERFORMANCE METRICS OF MHS, AS DEFINED BY THE MHS BOARD. OTHER COMPENSATION IS COMPRISED PRIMARILY OF DEFERRED COMPENSATION PAYOUTS MADE DURING THE YEAR FOR COMPENSATION PREVIOUSLY EARNED IN PRIOR YEARS. RETIREMENT COMPENSATION REFLECTS AN INCREASE IN RETIREMENT BENEFITS OWED BY MHS UPON RETIREMENT OF MR. RAHN. THIS INCREASE WAS DRAMATICALLY IMPACTED BY ACTUARIAL ASSUMPTIONS OF THE RETIREMENT PLAN, WHICH HAS HISTORICALLY INCLUDED DRAMATIC CHANGES IN THE DISCOUNT RATE. NONTAXABLE BENEFITS REFLECT THE VALUE OF HEALTH (MEDICAL, DENTAL, LIFE INSURANCE) BENEFITS RECEIVED DURING THE YEAR AS WELL AS CHANGES IN ACTUARIAL VALUE OF THE POSTRETIREMENT HEALTH CARE INSURANCE REIMBURSEMENT PLAN.

PART I, LINE 4B

THE ORGANIZATION, OR A RELATED ORGANIZATION, MEMORIAL HEALTH SYSTEM, PROVIDES CERTAIN SUPPLEMENTAL RETIREMENT BENEFITS TO THE FOLLOWING OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES: STEVEN LILLPOP, M.D., $41,913 AND DOUGLAS RAHN, D.B.A., $253,383. THESE BENEFITS ARE PROVIDED THROUGH A NONQUALIFIED DEFERRED COMPENSATION PLAN, UNDER WHICH THE BENEFITS BEING EARNED ARE SUBJECT TO A "SUBSTANTIAL RISK OF FORFEITURE." THE SUPPLEMENTAL RETIREMENT BENEFITS ARE STRUCTURED TO PROVIDE A RETENTION INCENTIVE THAT HAS BEEN DETERMINED BY THE LEADERSHIP COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF MEMORIAL HEALTH SYSTEM TO BE OF SUBSTANTIAL VALUE TO THE ORGANIZATION. THE FOLLOWING CURRENT OR FORMER OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES RECEIVED DEFERRED COMPENSATION PAYOUTS IN THE CALENDAR YEAR FROM THE ORGANIZATION OR A RELATED ORGANIZATION, MEMORIAL HEALTH SYSTEM: STEVEN LILLPOP, M.D., $98,422 AND DOUGLAS RAHN, D.B.A, $12,055. TO BECOME ENTITLED TO THE BENEFITS PROVIDED, EACH COVERED EMPLOYEE MUST MEET SUBSTANTIAL REQUIREMENTS RELATING TO FURTHER EMPLOYMENT. UNTIL THOSE REQUIREMENTS ARE SATISFIED, IF EVER, THE EMPLOYEE IS NOT ENTITLED TO THESE AMOUNTS. IF THE EMPLOYEE WERE TO HAVE TERMINATED EMPLOYMENT VOLUNTARILY IN THE YEAR TO WHICH THIS RETURN APPLIES AND NOT MET THESE SUBSTANTIAL REQUIREMENTS, THESE SUPPLEMENTAL RETIREMENT BENEFITS WOULD HAVE BEEN FORFEITED. THESE SUPPLEMENTAL RETIREMENT BENEFITS ARE PART OF A RETIREMENT PROGRAM THAT PROVIDES RETIREMENT INCOME FOR ALL YEARS OF SERVICE THAT THE EMPLOYEE PROVIDES TO THE ORGANIZATION. ACCORDINGLY, ANY RETIREMENT BENEFITS SHOULD BE VIEWED AS APPLYING TO THE ENTIRE LENGTH OF THE EMPLOYEE'S SERVICE. THE LEADERSHIP COMPENSATION COMMITTEE OF THE MHS BOARD APPROVES ALL RETIREMENT BENEFITS, TOGETHER WITH ALL OTHER FORMS OF COMPENSATION AND BENEFITS FOR THESE AND OTHER SENIOR LEADERS, IN A MANNER INTENDED TO QUALIFY FOR THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER FEDERAL INCOME TAX LAW.

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	CITY OF JACKSONVILLE ILLINOIS	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	376001700	BondIssuerEIN
CUSIP	469590AA1	CUSIPNum
Bond Issued	2010-12-01	BondIssuedDt
Issue Price	$28,980,000	IssuePriceAmt
Purpose	SEE PART IV	PurposeDesc
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
Retired	$3,945,000	RetiredAmt
Total Proceeds	$28,980,000	TotalProceedsAmt
Refunding Escrow	$28,980,000	RefundingEscrowAmt
Current Refunding	Yes (1)	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	Yes (1)	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	Yes (1)	MgmtContractBondFincdPropInd
Engage Bond Counsel Contracts	Yes (1)	EngageBondCounselContractsInd
Any Research Agreements	0	AnyResearchAgreementsInd
Private Bus Use By Others	0.02650	PrivateBusUseByOthersPct
Total Private Business Use	0.02650	TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test	0	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	Yes (1)	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	Yes (1)	Form8038TFiledInd
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	Yes (1)	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	Yes (1)	ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE K, PART 1, BOND ISSUES	FormAndLineReferenceDesc
Explanation	DESCRIPTION OF PURPOSE: REISSUANCE RESULTING IN CURRENT REFUNDING OF PREVIOUSLY ISSUED $28,980,000 CITY OF JACKSONVILLE, ILLINOIS ADJUSTABLE RATE DEMAND INDUSTRIAL REVENUE BONDS,SERIES 2006A AND SERIES 2006B (THE PASSAVANT MEMORIAL HOSPITAL ASSOCIATION PROJECT).	ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
JAKE HURWITZ
SON OF MMC AND MHS BOARD MEMBER	$43,117	EMPLOYMENT	0
LEANNA WYNN
WIFE OF FORMER BOARD MEMBER	$130,887	EMPLOYMENT	0
SHERYL ROBERTS
DAUGHTER OF PAH BOARD MEMBER	$82,088	EMPLOYMENT	0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6	MEMORIAL HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION. MEMORIAL HEALTH SYSTEM CORPORATION CONTAINS 105 INDIVIDUAL MEMBERS WHO ELECT THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7A	THE CORPORATE MEMBER OF THE CORPORATION ELECTS THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B	PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION'S BYLAWS STATE THE CORPORATE MEMBER SHALL ELECT THE DIRECTORS OF THE CORPORATION IN CONJUNCTION WITH THE BOARD OF GOVERNORS AND BOARD OF DIRECTORS. THE CORPORATE MEMBER WILL WORK WITH THE BOARD OF DIRECTORS TO ELECT THE PRESIDENT AND CHIEF EXECUTIVE OFFICER. THE CORPORATE MEMBER WILL APPROVE CAPITAL AND OPERATING BUDGETS, STRATEGIC PLANS, AND APPROVE ANY VOLUNTARY DISSOLUTION, MERGER, OR CONSOLIDATION. THE CORPORATE MEMBER SHALL APPROVE ANY AMENDMENT TO BYLAWS OR ARTICLES OF INCORPORATION. IN ADDITION, THE CORPORATE MEMBER HAS THE POWER TO REMOVE THE PRESIDENT WITH MUTUAL AGREEMENT OF THE BOARD OF DIRECTORS OR THE REMOVAL OF ANY DIRECTOR WITH CAUSE. THE CORPORATE MEMBER HAS APPROVAL POWER FOR THE CAPITAL EXPENDITURES OVER $1,000,000, GUARANTY OF DEBT GREATER THAN $250,000, WITH OR WITHOUT A MORTGAGE, OR OTHER TRANSACTIONS MATERIAL IN NATURE WITH AFFILIATE CORPORATIONS. CORPORATE MEMBERS HAVE THE POWER TO APPROVE INDEPENDENT AUDITORS, APPROVE CONTRACTS PROVIDING HEALTHCARE SERVICES TO BENEFICIARIES OF MANAGED CARE CONTRACTS AND APPROVAL OF APPLICATIONS TO THE IL HEALTH FACILITIES PLANNING BOARD. MEMBERS ALSO APPROVE SALES/TRANSFERS OF ASSETS TO NON-AFFILIATE ENTITIES, IF ASSETS ARE OVER $500,000. THE CORPORATE MEMBER SHALL APPROVE SIGNIFICANT CHANGES IN THE CORPORATION'S INSURANCE AND CONTRACTS INVOLVING GOODS/SERVICES WITH A VALUE OVER $1,000,000 FOR CAPITAL OR $1,500,000 IN AGGREGATE FOR OPERATING AND CAPITAL BUDGETS, NOT PREVIOUSLY APPROVED. THE CORPORATE MEMBER SHALL APPROVE OF PHYSICIAN SERVICE CONTRACTS OVER $400,000, APPROVE REAL ESTATE TRANSACTIONS, AND APPROVE ANY CHANGES TO MASTER OR LONG-TERM INSTITUTIONAL PLANS.
FORM 990, PART VI, SECTION B, LINE 11	A FINAL DRAFT COPY OF THE PAH FORM 990 AND ALL ATTACHMENTS IS PROVIDED TO ALL OF THE PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION BOARD OF DIRECTORS PRIOR TO FILING. AT THE BOARD MEETING, A PRESENTATION IS MADE BY THE CFO TO THE BOARD, FOLLOWED BY A QUESTION AND ANSWER SESSION. ALL QUESTIONS AND COMMENTS ARISING FROM THIS REVIEW ARE ADDRESSED PRIOR TO SUBMISSION OF THE RETURN TO THE APPROPRIATE TAXING AUTHORITIES.
FORM 990, PART VI, SECTION B, LINE 12C	BOARD MEMBERS AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE CONFLICTS OF INTEREST BY FILING SIGNED STATEMENTS WITH THE ORGANIZATION. THE BOARD MEMBERS COMPLETE THE CONFLICT OF INTEREST POLICY ON A YEARLY BASIS. THEY ARE REQUIRED TO DISCLOSE ANY CONFLICTS WHEN INFORMATION IS GATHERED TO PREPARE FORM 990. IF THEY HAVE A CONFLICT, THE BOARD MEMBERS EXCUSE THEMSELVES FROM ANY APPLICABLE VOTES. IF THERE IS A QUESTION OF WHETHER OR NOT THEY HAVE A CONFLICT, EITHER THE CEO OR THE CFO WILL INVESTIGATE THE ISSUE AND CONSULT WITH THE BOARD CHAIR, WHO WILL MAKE THE FINAL DETERMINATION. EMPLOYEES SIGN A CODE OF CONDUCT STATEMENT ANNUALLY, WHICH INCLUDES A SECTION ON CONFLICT OF INTEREST. EMPLOYEES ARE ALSO REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST. IF THEY HAVE A CONFLICT, THEY CANNOT HAVE ANY DECISION-MAKING POWERS REGARDING ANY OF THEIR AREAS OF CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15	THE ORGANIZATION PARTICIPATES IN SEVERAL NATIONAL AND REGIONAL SURVEYS WHERE DATA IS OBTAINED ON VARIOUS POSITIONS SUCH AS CEO, CFO, CNO, ETC. THIS INFORMATION IS THEN PROVIDED TO THE BOARD EXECUTIVE COMMITTEE FOR REVIEW AND APPROVAL. FOR OTHER OFFICERS AND KEY EMPLOYEES, A CUSTOMIZED SURVEY CONDUCTED BY INTEGRATED HEALTHCARE STRATEGIES COMPARES THE COMPENSATION DATA PROVIDED BY THE ORGANIZATION TO THE STATISTICAL INFORMATION THEY HAVE. INTEGRATED HEALTHCARE STRATEGIES GENERATES A TRUE MARKET AVERAGE REPORT THAT COMPARES THE ORGANIZATIONS SALARIES FOR A POSITION AND ASSOCIATED MINIMUM, 1ST QUARTILE, MIDPOINT, 3RD QUARTILE, AND MAXIMUM SALARY POINTS. THE KEY EMPLOYEE DATA IS REVIEWED BY OUR CEP, CFO, AND HR DIRECTOR AND MARKET COMPARATIVE SALARY ADJUSTMENTS ARE MADE AS NECESSARY.
FORM 990, PART VI, SECTION C, LINE 19	COPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON INDIVIDUAL REQUEST. THE AUDITED FINANCIAL STATEMENTS ARE POSTED ON THE HOSPITAL'S WEBSITE. THESE DOCUMENTS ARE AVAILABLE FOR THE SAME PERIOD OF TIME AS SET FORTH IN IRC SECTION 6104(D).
FORM 990, PART XI, LINE 9:	CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS -237,237. CONTRIBUTIONS & OTHER 660,789. DECREASE IN PERMANENTLY RESTRICTED NET ASSETS -412,879. INCREASE IN TEMPORARILY RESTRICTED NET ASSETS 892,543. EQUITY IN INCOME OF AFFILIATE-URNA 3,772,188. NONOPERATING CHANGES -708,342. EQUITY TRANSFERS TO RELATED ORGANIZATIONS -37,462,587.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Direct Controlling NADirectControllingNACd	Controlled OrganizationControlledOrganizationInd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
MEMORIAL HEALTH SYSTEM
701 NORTH FIRST STREET	SPRINGFIELD	IL	627810001	371110690	UMBRELLA	IL	501(C)(3)	509 (A) (3) TYPE II	N/A	0
MEMORIAL MEDICAL CENTER
701 NORTH FIRST STREET	SPRINGFIELD	IL	627810001	370661220	HOSPITAL SERVICES	IL	501(C)(3)	170(B) (1) (A) (III)		0	MEMORIAL HEALTH SYSTEM
MEMORIAL HEALTH VENTURES
701 NORTH FIRST STREET	SPRINGFIELD	IL	627810001	363492266	HEALTHCARE ACTIVITIES	IL	501(C)(3)	509 (A) (2)		0	MEMORIAL HEALTH SYSTEM
ABRAHAM LINCOLN MEMORIAL HOSPITAL
200 STAHLHUT DRIVE	LINCOLN	IL	62656	370723793	HOSPITAL SERVICES	IL	501(C)(3)	170(B) (1) (A) (III)		0	MEMORIAL HEALTH SYSTEM
TAYLORVILLE MEMORIAL HOSPITAL
201 EAST PLEASANT	TAYLORVILLE	IL	62568	370661250	HOSPITAL SERVICES	IL	501(C)(3)	170(B) (1) (A) (III)		0	MEMORIAL HEALTH SYSTEM
MEMORIAL HOME SERVICES
720 NORTH BOND STREET	SPRINGFIELD	IL	627024915	370714225	HOME HEALTH AND HOSPICE	IL	501(C)(3)	509 (C) (2)		0	MEMORIAL HEALTH SYSTEM
MEMORIAL PHYSICIAN SERVICES
701 NORTH FIRST STREET	SPRINGFIELD	IL	627810001	371181194	HEALTH CLINICS	IL	501(C)(3)	509 (A) (2)		0	MEMORIAL HEALTH SYSTEM
MEMORIAL MEDICAL CENTER FOUNDATION
701 NORTH FIRST STREET	SPRINGFIELD	IL	62781	371110301	GRANTS TO HOSPITAL, OTHER CHARITABLE ORGANIZATIONS, AND SCHOLARSHIPS	IL	501(C)(3)	170(B) (1) (A)		0	MEMORIAL MEDICAL CENTER
TAYLORVILLE MEMORIAL HOSPITAL FOUNDATION
201 EAST PLEASANT	TAYLORVILLE	IL	62568	371337485	GRANTS TO OTHER CHARITABLE ORGANIZATIOINS AND HOSPITALS	IL	501(C)(3)	170 (B) (1) (A) (VI)	N/A	0
MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS
710 NORTH EIGHTH STREET	SPRINGFIELD	IL	627026395	370646367	TRAINING, PSYCHIATRIC, AND RESIDENT SERVICES FOR MENTALLY ILL AND DISABLED	IL	501(C)(3)	170(B) (1) (A) (VI)		0	MEMORIAL HEALTH SYSTEM
ABRAHAM LINCOLN HEALTHCARE FOUNDATION
200 STAHLHUT DRIVE	LINCOLN	IL	62656	363492268	GRANTS TO OTHER CHARITABLE ORGANIZATIONS AND HOSPITALS	IL	501(C)(3)	170(B) (1) (A) (VI)		0	MEMORIAL HEALTH SYSTEM
SPRINGFIELD RESIDENTIAL SERVICES
710 NORTH EIGHTH STREET	SPRINGFIELD	IL	62702	371298589	RESIDENTIAL HUD HOUSING PROJECT FOR MENTALLY ILL	IL	501(C)(3)	170(B) (1) (A) (VI)		0	MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS
JACKSONVILLE CRNA'S INC
1600 WEST WALNUT STREET	JACKSONVILLE	IL	62650	273083265	CRNA SERVICES	IL	501(C)(3)	509 (A) (3), TYPE 1		Yes (1)	PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION
PASSAVANT AREA HOSPITAL FOUNDATION
1600 WEST WALNUT STREET	JACKSONVILLE	IL	62650	471037396	SUPPORTING THE HOSPITAL	IL	501(C)(3)	509 (A) (3) TYPE I		Yes (1)	PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION
PASSAVANT MEMORIAL AREA AUXILIARY
1600 WEST WALNUT STREET	JACKSONVILLE	IL	62650	370890067	SUPPORTING THE HOSPITAL	IL	501(C)(3)	509 (A) (3) TYPE III	N/A	0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	OwnershipOwnershipPct	Controlled OrganizationControlledOrganizationInd
PASSAVANT PHYSICIAN ASSOCIATION
1600 WEST WALNUT STREET	JACKSONVILLE	IL	62650	261200566	PHYSICIAN SERVICES	IL	PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION	C	$4,557,877	$1,107,631	1.00000	Yes (1)
CHARITABLE REMAINDER TRUSTS (12)
					INVESTMENT	IL						0
MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS INC
701 NORTH FIRST STREET	SPRINGFIELD	IL	62781	371190216	PROVIDE DURABLE MEDICAL EQUIPMENT AND SUPPLIES TO PATIENTS	IL	MEMORIAL HOME SERVICES	C				0

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	0	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	0	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (1)	SharingOfFacilitiesInd
Paid Employees Sharing	0	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (1)	TransferToOtherOrgInd
Transfer From Other Org	Yes (1)	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (5 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
PASSAVANT AREA HOSPITAL FOUNDATION
C	$328,352	FMV
PASSAVANT AREA HOSPITAL FOUNDATION
R	$409,748	FMV
PASSAVANT PHYSICIAN ASSOCIATION
R	$26,192,448	FMV
JACKSONVILLE CRNA INC
R	$12,660,390	FMV
JACKSONVILLE CRNA INC
S	$1,800,000	FMV

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART IV	PART IV, IDENTIFICATION OF REALTED ORGANIZATIONS TAXABLE AS CORP OR TRUST: NAME OF RELATED ORGANIZATION: PASSAVANT PHYSICIAN ASSOCIATION DIRECT CONTROLLING ENTITY: PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION
PART II	NAME OF RELATED ORGANIZATION: PASSAVANT AREA HOSPITAL FOUNDATION DIRECT CONTROLLING ENTITY: PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION PART II, IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS: NAME OF RELATED ORGANIZATION: JACKSONVILLE CRNA'S INC. DIRECT CONTROLLING ENTITY: PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION