KIRBY MEDICAL CENTER: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- KIRBY MEDICAL CENTER (EIN 37-0661215)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-04-29
- IRS object ID
- 201511199349300101
- Schema version
- 2013v4.0
- 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 O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-04-29T07:37:30-05:00 | ReturnTs |
| Tax Period End | 2014-06-30 | 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 | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 114 E EVERETT | AddressLine1 |
| City | DIXON | City |
| State | IL | State |
| ZIP Code | 61021 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-07-01 | 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 | BusinessNameLine1 |
| 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 | AddressLine1 |
| City | MONTICELLO | City |
| State | IL | State |
| ZIP Code | 61856 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STEVEN TENHOUSE | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Phone | 2177622115 | PhoneNum |
| Signature | 2015-04-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TODD M ETHERIDGE | PreparerPersonNm |
| PTIN | P00233050 | PTIN |
| Phone | 8152859300 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-03-07 17:11:31Z | 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 | AddressLine1 |
| City | MONTICELLO | City |
| State | IL | State |
| ZIP Code | 61856 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $31,289,398 | 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 | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 283 | TotalEmployeeCnt |
| Total Volunteers | 240 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $6,988,554 | PYContributionsGrantsAmt |
| CY Contributions Grants | $62,324 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $23,319,030 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $28,606,182 | CYProgramServiceRevenueAmt |
| PY Investment Income | $762,313 | PYInvestmentIncomeAmt |
| CY Investment Income | $263,734 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,679,397 | PYOtherRevenueAmt |
| CY Other Revenue | $962,497 | CYOtherRevenueAmt |
| PY Total Revenue | $33,749,294 | PYTotalRevenueAmt |
| CY Total Revenue | $29,894,737 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $72,811 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,792,431 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,278,239 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $13,832,765 | PYOtherExpensesAmt |
| CY Other Expenses | $14,695,884 | CYOtherExpensesAmt |
| PY Total Expenses | $25,625,196 | PYTotalExpensesAmt |
| CY Total Expenses | $27,046,934 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $8,124,098 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,847,803 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $66,512,145 | TotalAssetsBOYAmt |
| Total Assets EOY | $74,255,072 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $36,164,566 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $34,910,578 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $30,347,579 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $39,344,494 | NetAssetsOrFundBalancesEOYAmt |
| Mission | KIRBY MEDICAL CENTER IS COMMITTED TO PROVIDING PROGRESSIVE HOSPITAL, OUTPATIENT, AND SPECIALTY SERVICES, IN A CONVENIENT AND COMPASSIONATE SETTING, REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $18,384,631 | ExpenseAmt |
| Grant | $72,811 | GrantAmt |
| Revenue | $28,606,182 | 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 20,383 PATIENTS SERVED THROUGH THE KIRBY MEDICAL CLINIC, 1,684 NURSING CARE INPATIENT DAYS, AND 79,775 LABORATORY PROCEDURES. | Desc |
| Total Program Service Expenses | $18,384,631 | 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 | 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 32 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 283 | 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | 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 | 0 | 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 | AddressLine1 |
| City | MONTICELLO | City |
| State | IL | State |
| ZIP Code | 61856 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| STEPHEN AYERS | ||||||||
| CHAIR & DIRECTOR | 1.00 | 0.00 | Yes (X) | Yes (X) | $6,750 | $0 | $0 | |
| CRAIG WEBB | ||||||||
| VICE CHAIR & CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $13,650 | $0 | $0 | |
| GARY HUISINGA | ||||||||
| TREASURER & VICE CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $9,900 | $0 | $0 | |
| JAMES BALLSRUD | ||||||||
| DIRECTOR & TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $7,350 | $0 | $0 | |
| KARLA BRADLEY | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| EDWARD EWALD | ||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $4,800 | $0 | $0 | ||
| STEVEN MILLS | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DYKE PIATT | ||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $6,300 | $0 | $0 | ||
| JAMES RASSI RESIGNED APRIL 2014 | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $7,500 | $0 | $0 | ||
| WILLIAM TRACY II | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $4,200 | $0 | $0 | ||
| STEVEN TENHOUSE | ||||||||
| SECRETARY & CEO | 40.00 | 0.50 | Yes (X) | $188,678 | $0 | $37,991 | ||
| ALEXANDER A NAZARIAN | ||||||||
| CFO | 40.00 | 0.00 | Yes (X) | $68,482 | $0 | $3,275 | ||
| NARAIN DAS MANDHAN | ||||||||
| CMO | 40.00 | 0.00 | Yes (X) | $311,054 | $0 | $42,313 | ||
| JENNIFER MOSS | ||||||||
| CCO | 40.00 | 0.00 | Yes (X) | $89,830 | $0 | $26,366 | ||
| GAYLA HISLOPE | ||||||||
| COO | 40.00 | 0.00 | Yes (X) | $92,430 | $0 | $38,080 | ||
| JOSHUA SAWLAW | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $161,700 | $0 | $31,211 | Yes (X) | ||
| JAMES MANINT | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $137,557 | $0 | $29,535 | Yes (X) | ||
| LAURIE LEE | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | $105,998 | $0 | $25,024 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,216,179 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $233,795 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | 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/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| DOUGHERTY MORTGAGE LLC | |||||
| 90 S 7TH ST STE 4300 | MINNEAPOLIS | MN | 55402 | MORTGAGE BROKER | $2,662,560 |
| CARLE PHYSICIAN GROUP | |||||
| 611 W PARK ST | URBANA | IL | 61801 | PHYSICIAN SERVICES | $2,564,241 |
| CARLE FOUNDATION HOSPITAL | |||||
| 611 W PARK ST | URBANA | IL | 61801 | PHYSICIAN SERVICES | $677,521 |
| MEDICAL INFORMATION TECHNOLOGY | |||||
| MEDITECH CIRCLE | WESTWOOD | MA | 02090 | OPERATING SYSTEMS SUPPORT | $238,240 |
| ABBOTT LABORATORIES | |||||
| PO BOX 92679 | CHICAGO | IL | 606752679 | LAB CONTRACTED MAINTENANCE | $226,905 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 16 | CntrctRcvdGreaterThan100KCnt |
| Membership Dues | $2,730 | MembershipDuesAmt |
| Government Grants | $35,750 | GovernmentGrantsAmt |
| All Other Contributions | $23,844 | AllOtherContributionsAmt |
| Total Contributions | $62,324 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621110 | $27,774,973 | $27,774,973 |
| EMR INCENTIVE REIMBURSEMENT | 900099 | $760,219 | $760,219 |
| PHYSICAL THERAPY INCOME | 621110 | $70,990 | $70,990 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $28,606,182 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $158,599 | TotalRevenueColumnAmt |
| Exclusion | $158,599 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $720,256 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $78,434 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $641,822 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $641,822 | TotalRevenueColumnAmt |
| Exclusion | $641,822 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,421,362 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,300,874 | SecuritiesAmt |
| Other | $15,353 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $120,488 | SecuritiesAmt |
| Other | -$15,353 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $105,135 | TotalRevenueColumnAmt |
| Exclusion | $105,135 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| MISCELLANEOUS INC | 900099 | $263,215 | $263,215 |
| GOVT STIPEND - AMB | 900099 | $57,460 | $57,460 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $320,675 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $29,894,737 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $28,606,182 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,226,231 | 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 | $37,811 | TotalAmt |
| Program Services | $37,811 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,000 | TotalAmt |
| Program Services | $35,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,166,154 | TotalAmt |
| Management And General | $1,166,154 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,579,400 | TotalAmt |
| Program Services | $6,401,687 | ProgramServicesAmt |
| Management And General | $2,177,713 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $364,645 | TotalAmt |
| Program Services | $261,817 | ProgramServicesAmt |
| Management And General | $102,828 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,491,233 | TotalAmt |
| Program Services | $927,782 | ProgramServicesAmt |
| Management And General | $563,451 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $676,807 | TotalAmt |
| Program Services | $452,453 | ProgramServicesAmt |
| Management And General | $224,354 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,067 | TotalAmt |
| Management And General | $19,067 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,587,223 | TotalAmt |
| Program Services | $3,073,522 | ProgramServicesAmt |
| Management And General | $513,701 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,750 | TotalAmt |
| Management And General | $111,750 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $288,580 | TotalAmt |
| Program Services | $184,347 | ProgramServicesAmt |
| Management And General | $104,233 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $357,655 | TotalAmt |
| Program Services | $340,323 | ProgramServicesAmt |
| Management And General | $17,332 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,797 | TotalAmt |
| Program Services | $28,045 | ProgramServicesAmt |
| Management And General | $32,752 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,066 | TotalAmt |
| Program Services | $60,462 | ProgramServicesAmt |
| Management And General | $68,604 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,709,171 | TotalAmt |
| Management And General | $1,709,171 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,394,570 | TotalAmt |
| Program Services | $3,394,570 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $441,265 | TotalAmt |
| Management And General | $441,265 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,421,274 | $1,421,274 | |
| MISCELLANEOUS | $1,274,022 | $535,035 | $738,987 |
| BAD DEBT | $695,110 | $695,110 | |
| REPAIRS AND MAINTENANCE | $461,810 | $281,347 | $180,463 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $744,524 | TotalAmt |
| Program Services | $254,046 | ProgramServicesAmt |
| Management And General | $490,478 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,046,934 | TotalAmt |
| Program Services | $18,384,631 | ProgramServicesAmt |
| Management And General | $8,662,303 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $600 | BOYAmt |
| EOY | $875,310 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,117,045 | BOYAmt |
| EOY | $6,672,821 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,133,943 | BOYAmt |
| EOY | $5,029,683 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $275,255 | BOYAmt |
| EOY | $230,497 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $531,164 | BOYAmt |
| EOY | $849,620 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $42,761,187 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $9,629,282 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,791,064 | BOYAmt |
| EOY | $33,131,905 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,187,291 | BOYAmt |
| EOY | $5,757,246 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,340,313 | BOYAmt |
| EOY | $20,850,926 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,135,470 | BOYAmt |
| EOY | $857,064 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $66,512,145 | BOYAmt |
| EOY | $74,255,072 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,945,729 | BOYAmt |
| EOY | $3,519,163 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,380,656 | BOYAmt |
| EOY | $29,327,943 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,838,181 | BOYAmt |
| EOY | $2,063,472 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,164,566 | BOYAmt |
| EOY | $34,910,578 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,520,020 | BOYAmt |
| EOY | $17,994,624 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $487,246 | BOYAmt |
| EOY | $498,944 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,340,313 | BOYAmt |
| EOY | $20,850,926 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,347,579 | BOYAmt |
| EOY | $39,344,494 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $66,512,145 | BOYAmt |
| EOY | $74,255,072 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,847,803 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $336,801 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $5,812,311 | 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 | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $7,075 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,075 | 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 | LOBBY EXPENSES ARE ALLOCATED THROUGH MEMBERSHIP DUES WITH THE ILLINOIS HOSPITAL ASSOCIATION. NO OTHER LOBBY ACTIVITIES WERE CONDUCTED. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $22,438,948 | BeginningYearBalanceAmt |
| Contributions | $2,993,464 | ContributionsAmt |
| Investment Earnings Or Losses | $6,752,754 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $444,082 | OtherExpendituresAmt |
| Administrative Expenses | $60,592 | AdministrativeExpensesAmt |
| End Year Balance | $31,680,492 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $15,594,288 | BeginningYearBalanceAmt |
| Contributions | $7,189,877 | ContributionsAmt |
| Investment Earnings Or Losses | $683,374 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $988,050 | OtherExpendituresAmt |
| Administrative Expenses | $40,541 | AdministrativeExpensesAmt |
| End Year Balance | $22,438,948 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $15,987,486 | BeginningYearBalanceAmt |
| Contributions | $1,234,605 | ContributionsAmt |
| Investment Earnings Or Losses | $525,859 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $2,112,809 | OtherExpendituresAmt |
| Administrative Expenses | $40,853 | AdministrativeExpensesAmt |
| End Year Balance | $15,594,288 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $11,769,155 | BeginningYearBalanceAmt |
| Contributions | $201,691 | ContributionsAmt |
| Investment Earnings Or Losses | $4,513,189 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $465,369 | OtherExpendituresAmt |
| Administrative Expenses | $31,180 | AdministrativeExpensesAmt |
| End Year Balance | $15,987,486 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $9,869,103 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $3,730,121 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,796,537 | OtherExpendituresAmt |
| Administrative Expenses | $33,532 | AdministrativeExpensesAmt |
| End Year Balance | $11,769,155 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.34180 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.65820 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $520,000 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $349,650 | OtherCostOrOtherBasisAmt |
| Book Value | $869,650 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $2,785,226 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $15,743,096 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,525,819 | DepreciationAmt |
| Book Value | $16,002,503 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,449,604 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,333,592 | DepreciationAmt |
| Book Value | $12,116,012 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,913,611 | OtherCostOrOtherBasisAmt |
| Depreciation | $769,871 | DepreciationAmt |
| Book Value | $4,143,740 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $33,131,905 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | BENEFICIAL INTERST IN TRUSTS | Desc |
| Book Value | $20,850,926 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $20,850,926 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO MEDICARE | $2,042,416 |
| USE INTEREST OF BENEFICIARY | $21,056 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,063,472 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE PERMANENT ENDOWMENT AND THE BOARD DESIGNATED QUASI-ENDOWMENT FUNDS PROVIDE INCOME TO SUPPORT CURRENT HOSPITAL OPERATIONS. ANY TERM ENDOWMENT FUND ALSO SUPPORTS CURRENT OPERATIONS THROUGH ITS SPECIFIED PURPOSE. |
| PART X, LINE 2: | KIRBY MEDICAL FILE FORM 990 ANNUALLY. WHEN THIS RETURN IS FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF THE ENTITY AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). UBIT IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING STATEMENTS OF FINANCIAL POSITION ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. AT JUNE 30, 2014 AND 2013, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED. AT JUNE 30, 2014, THE 2012, 2011, AND 2010 TAX RETURN YEARS ARE OPEN FOR EXAMINATION BY TAXING AUTHORITIES. |
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 | 0 | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,202,679 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,202,679 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04560 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,287,275 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,751,882 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $535,393 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02030 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,489,954 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,751,882 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,738,072 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06590 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,671 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $750 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,921 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $999,241 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $57,635 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $941,606 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03570 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $36,034 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $36,034 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,047,946 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $58,385 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $989,561 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03760 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,537,900 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,810,267 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,727,633 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10350 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,562 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,562 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,228 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,228 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,790 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,790 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $695,110 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,212,479 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,200,743 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $11,736 | 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 | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 MEDICAL CENTER DRIVE | AddressLine1 |
| City | MONTICELLO | City |
| State | IL | State |
| ZIP Code | 61856 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.KIRBYHOSPITAL.ORG | WebsiteAddressTxt |
| State License | 005785 | 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 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| 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 | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.KIRBYHOSPITAL.ORG | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Include Operational Plan | Yes (X) | IncludeOperationalPlanInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 280.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| State Regulation | Yes (X) | StateRegulationInd |
| Other Factors | Yes (X) | OtherFactorsInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| 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 Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| 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 (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| KIRBY MEDICAL CENTER | PART V, SECTION B, LINE 3: THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDED DISCUSSIONS WITH AREA HEALTH CARE PARTNERS, COMMUNITY LEADERS, AND REPRESENTATIVES OF THE MANY GROUPS SERVED BY THE HOSPITAL. INPUT INCLUDED THREE FOCUS GROUPS COMPRISED OF AREA HEALTH CARE PROFESSIONALS/ PARTNERS, COMMUNITY OFFICIALS, AND COMMUNITY LEADERS AND GROUPS. 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, INCLUDING SCHOOL OFFICIALS DEALING WITH YOUTH AND FAMILIES ON A DAILY BASIS. |
| KIRBY MEDICAL CENTER | PART V, SECTION B, LINE 5D: THE FULL WEBSITE ADDRESS OF KIRBY MEDICAL CENTER'S COMMUNITY HEALTH NEEDS ASSESSMENT REPORT IS: HTTP://WWW.KIRBYHOSPITAL.ORG/PDF/2013KIRBYMEDICALCENTERCHNA.PDF |
| KIRBY MEDICAL CENTER | PART V, SECTION B, LINE 7: BECAUSE OF LIMITED RESOURCES, WE CANNOT RESPOND EFFECTIVELY TO EVERY IDENTIFIED COMMUNITY HEALTH NEED. WE HAVE CHOSEN OUR RESPONSES BASED ON ANALYSIS OF OUR RESOURCES, OUR MISSION, OUR EXISTING SPECIALTIES, COMMUNITY PRIORITIES, AND EXISTING COMMUNITY RESOURCES. WE HAVE CHOSEN TO FOCUS OUR RESOURCES ON ADDRESSING THE FOLLOWING HEALTH NEEDS:1. WELLNESS EDUCATION AND BASIC WELLNESS SERVICES FOR ALL AGES2. MENTAL HEALTH SERVICES3. SUPPORTING UNREIMBURSED CARE FOR UNDERINSURED AND UNINSURED PATIENTSWE ARE NOT ACTIVELY PLANNING TO RESPOND TO ANY OTHER IDENTIFIED HEALTH NEEDS. |
| KIRBY MEDICAL CENTER | PART V, SECTION B, LINE 12I: KIRBY MEDICAL CENTER HAS A "PRESUMPTIVE ELIGIBILITY" POLICY THAT REDUCES ALL CHARGES TO ZERO, A FULL WRITE-OFF OF CHARGES, IF A PATIENT IS ELIGIBLE FOR A VARIETY OF STATE-FUNDED SUPPORT PROGRAMS. UNDER THE PRESUMPTIVE ELIGIBILITY POLICY, THERE IS NO NEED FOR A PATIENT TO APPLY FOR FINANCIAL ASSISTANCE BECAUSE THE PATIENT IS ASSUMED TO BE MEDICALLY FINANCIALLY INDIGENT. |
| KIRBY MEDICAL CENTER | PART V, SECTION B, LINE 14G: FINANCIAL ASSISTANCE INFORMATION IS PROVIDED BY THE PATIENT FINANCIAL SERVICES STAFF AND IS REFERENCED IN NEWSPAPER AND BILLBOARD ADVERTISING. |
| KIRBY MEDICAL CENTER | PART V, SECTION B, LINE 18E: BEFORE AN ACCOUNT IS SENT TO COLLECTIONS, KIRBY MEDICAL CENTER CHECKS THE INDIVIDUAL'S STATUS WITH VARIOUS STATE-FUNDED SUPPORT PROGRAMS, SUCH AS FOOD STAMPS, WIC, AND MEDICAID. IF AN INDIVIDUAL QUALIFIES TO PARTICIPATE IN ANY OF THESE PROGRAMS, THEY ARE PRESUMPTIVELY DETERMINED TO QUALIFY FOR A FULL WRITE-OFF OF CHARGES UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. |
| KIRBY MEDICAL CENTER | PART V, SECTION B, LINE 20D: WE USE THE AVERAGE OF ALL COMMERCIAL INSURANCE RATES WHEN CALCULATING THE MAXIMUM AMOUNT THAT CAN BE CHARGED AS AMOUNTS GENERALLY BILLED. WE ARE CURRENTLY IN THE PROCESS OF EVALUATING WHETHER INDIVIDUALS WHO QUALIFIED FOR FINANCIAL ASSISTANCE PAID MORE THAN AMOUNTS GENERALLY BILLED. IF ANY INDIVIDUALS PAID MORE THAN AMOUNTS GENERALLY BILLED, THE EXCESS AMOUNT IS BEING REFUNDED. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| KIRBY MEDICAL GROUP | ||||
| 1000 MEDICAL CENTER DRIVE | MONTICELLO | IL | 61856 | RURAL HEALTH CLINIC |
| KIRBY MEDICAL CENTER ATWOOD | ||||
| 108 NORTH MAIN STREET | ATWOOD | IL | 61913 | 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 $ 695,110. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | ECONOMIC DEVELOPMENT ACTIVITIES INCLUDED ROTARY, CHAMBER OF COMMERCE, AND MONTICELLO MAIN STREET ACTIVITIES. COALITION BUILDING ACTIVITIES INCLUDED 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 EXLANATION OF HOW BAD DEBT EXPENSE WAS ESTIMATED. |
| PART III, LINE 3: | THE ORGANIZATION HAS NOT IDENTIFIED A REASONABLE METHOD OF ESTIMATING THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE HAD THEY COMPLETED AN APPLICATION. |
| PART III, LINE 4: | SEE THE "ACCOUNTS RECEIVABLE AND CREDIT POLICIES" SECTION OF NOTE 1, ON PAGE 11, IN THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR AN EXLANATION 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. BECAUSE OF THESE REIMBURSEMENT RATES, KIRBY MEDICAL CENTER DOES NOT HAVE A MEDICARE SHORTFALL. IN THE CURRENT YEAR, THE REIMURSEMENTS WERE SLIGHTLY LOWER DUE TO THE FEDERAL GOVERNMENT'S SEQUESTRATION IN THE SUMMER OF 2013. THE MEDICARE ALLOWABLE COSTS REPORTED IN LINE 6 WERE CALCULATED USING THE 2014 FILED MEDICARE COST REPORT. |
| PART III, LINE 9B: | TO QUALIFY FOR FINANCIAL ASSISTANCE, INDIVIDUALS ARE REQUIRED TO SUBMIT A COMPLETED APPLICATION WITHIN 60 DAYS FOLLOWING THE DATE OF DISCHARGE OR RECEIPT OF OUTPATIENT CARE. FOR APPROXIMATELY 120 DAYS AFTER THE DATE OF SERVICE, BILLING ACTIVITIES ARE LIMITED TO SENDING BILLING STATEMENTS AND A COLLECTION LETTER. THE ORGANIZATION'S PRACTICES RELATED TO THE COLLECTION OF BAD DEBT INCLUDE THE REVIEW OF THE PATIENT'S FINANCIAL STATUS AND QUALIFICATIONS FOR FINANCIAL ASSISTANCE. |
| 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, 2013, A COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED THROUGH A CONSULTING ARRANGEMENT WITH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK. TERRY MADSEN, A COMMUNITY DEVELOPMENT SPECIALIST AND UNIVERSITY OF ILLINOIS EXTENSION EDUCATOR, 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 INCLUDED DISCUSSIONS WITH AREA HEALTH CARE PARTNERS, COMMUNITY LEADERS, AND REPRESENTATIVES OF THE MANY GROUPS SERVED BY THE HOSPITAL. INPUT INCLUDED THREE FOCUS GROUPS COMPRISED OF AREA HEALTH CARE PROFESSIONALS/ PARTNERS, COMMUNITY OFFICIALS, AND COMMUNITY LEADERS AND GROUPS. 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, INCLUDING SCHOOL OFFICIALS DEALING WITH YOUTH AND FAMILIES ON A DAILY BASIS. |
| 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. |
| PART VI, LINE 4: | KIRBY MEDICAL CENTER'S COMMUNITY IS NEARLY CONTIGUOUS TO PIATT COUNTY, ILLINOIS. IT INCLUDES THE AREAS SURROUNDING MONTICELLO, BEMENT, ATWOOD, HAMMOND, WHITE HEATH, DELAND AND MANSFIELD. THE AREA'S SOCIAL AND ECONOMIC PICTURE IS INFLUENCED BY THE FACT THAT 95% OF THE LAND AREA IN PIATT COUNTY CONSISTS OF FARMS. THE COMMUNITY IS MARKED BY SMALL COMMUNITIES RELYING PRIMARILY ON SMALL BUSINESSES AND INDUSTRIES, AGRICULTURE, AND SERVICE PROVIDERS FOR ITS LOCAL EMPLOYEMNT. THE COMMUNITY IS EXPERIENCING RECOVERING EMPLOYMENT NUMBERS. THE NUMBER OF CHILDREN ELIGIBLE FOR FREE OR REDUCED LUNCH IS INCREASING, BUT IS STILL BELOW THE STATEWIDE AVERAGE. WHILE MOST OF OUR COMMUNITY IS IN A SIMILAR ECONOMIC POSITION TO MANY RURAL COMMUNITIES IN ILLINOIS, THE CITY OF MONTICELLO IS GENERALLY IN A BETTER ECONOMIC POSITION. THE UNEMPLOYMENT RATE IN OUR COMMUNITY IS BELOW THE STATEWIDE AVERAGE. OVER 30% OF THE ADULTS IN OUR COMMUNITY DO NOT HAVE A HIGH SCHOOL DIPLOMA. |
| 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 | DEWITT-PIATT BI-COUNTY HEALTH DEPARTMENT | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1020 SOUTH MARKET STREET | AddressLine1 |
| City | MONTICELLO | City |
| State | IL | State |
| ZIP Code | 61856 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash Grant | $18,000 | CashGrantAmt |
| Purpose Of Grant | GENERAL OPERATING SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 13 | RecipientCnt |
| Cash Grant | $35,000 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | KIRBY MEDICAL CENTER 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 |
| 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 | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 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 & CEO | $162,363 | $0 | $21,360 | $0 | $4,955 | $0 | $12,100 | $0 | $25,891 | $0 | $226,669 | $0 | $0 | $0 |
| NARAIN DAS MANDHAN | ||||||||||||||
| CMO | $274,329 | $0 | $31,173 | $0 | $5,552 | $0 | $15,300 | $0 | $27,013 | $0 | $353,367 | $0 | $0 | $0 |
| JOSHUA SAWLAW | ||||||||||||||
| PHYSICIAN | $153,858 | $0 | $7,588 | $0 | $254 | $0 | $7,715 | $0 | $23,496 | $0 | $192,911 | $0 | $0 | $0 |
| JAMES MANINT | ||||||||||||||
| PHYSICIAN | $113,369 | $0 | $22,772 | $0 | $1,416 | $0 | $8,236 | $0 | $21,299 | $0 | $167,092 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 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 GOLF 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 GOLF CLUB DUES IS INCLUDED IN THE TAXABLE COMPENSATION OF THE CEO. |
| PART I, LINE 7 | THE CEO, STEVEN TENHOUSE, RECEIVES A BONUS OF UP TO 15% OF BASED 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 JOSHUA SAWLAW LAURIE LEE THE BONUS AMOUNTS ARE DETERMINED BASED ON A FUNCTION OF BASE SALARY AND NATIONAL SURVEYS ON PHYSICIAN COMPENSATION AND PRODUCTION |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | 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. |
| 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 2013. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST IN WRITING TO ADMINISTRATION. |
| FORM 990, PART IX, LINE 11G | OTHER FEES: PROGRAM SERVICE EXPENSES 3,073,522. MANAGEMENT AND GENERAL EXPENSES 513,701. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,587,223. |
| FORM 990, PART XI, LINE 9: | INCREASE IN VALUE OF LIFE INSURANCE 290,000. CHANGE IN INTEREST IN PERPETUAL TRUST 5,510,613. CHANGE IN VALUE OF LIFE INTEREST 11,698. |
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 | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 MEDICAL CENTER DR | AddressLine1 |
| City | MONTICELLO | City |
| State | IL | State |
| ZIP Code | 61856 | ZIPCode |
| 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 | BusinessNameLine1 |
| 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 |
|---|---|---|---|---|
| PERPETUAL TRUSTS (4) | ||||
| KIRBY MEDICAL CENTER IS AN INCOME BENEFICIARY OF THE TRUSTS | IL | N/A | T | 0 |
| CHARITABLE REMAINDER TRUST (1) | ||||
| CONTRIBUTION TO KIRBY MEDICAL CENTER UPON DEATH OF THE DONOR | IL | N/A | T | 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 | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |