MENDOTA COMMUNITY HOSPITAL: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- MENDOTA COMMUNITY HOSPITAL (EIN 36-2167785)
- Tax period
- 2013-04-01 to 2014-03-31
- Filed
- 2014-11-06
- IRS object ID
- 201403109349300730
- Schema version
- 2013v3.1
- 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 G
- Schedule H
- Schedule J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-06T11:11:06-06:00 | ReturnTs |
| Tax Period End | 2014-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 211 N BROADWAY SUITE 600 | AddressLine1 |
| City | ST LOUIS | City |
| State | MO | State |
| ZIP Code | 631022733 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 362167785 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MENDOTA COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % GARY EICH CFO | InCareOfNm |
| Business Name Control | MEND | BusinessNameControlTxt |
| Phone | 8155397461 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 E 12TH STREET | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | MENDOTA | City |
| State | IL | State |
| ZIP Code | 61342 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GARY EICH | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 8155397461 | PhoneNum |
| Signature | 2014-11-05 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Donna J Larson | PreparerPersonNm |
| PTIN | P00043751 | PTIN |
| Phone | 8155397461 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JUDY CHRISTIANSEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 E 12TH STREET | AddressLine1 |
| City | MENDOTA | City |
| State | IL | State |
| ZIP Code | 61342 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $35,602,036 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | mendotahospital.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1944 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | MENDOTA COMMUNITY HOSPITAL'S MISSION IS TO WORK FOR THE HEALTH AND WELL-BEING OF THE CITIZENS OF OUR AREA THROUGH A BROAD RANGE OF HIGH-QUALITY, EFFICIENT HEALTH SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 390 | TotalEmployeeCnt |
| Total Volunteers | 75 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $135,251 | PYContributionsGrantsAmt |
| CY Contributions Grants | $80,429 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $32,596,729 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $34,366,710 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,127,184 | PYInvestmentIncomeAmt |
| CY Investment Income | $88,563 | CYInvestmentIncomeAmt |
| PY Other Revenue | $130,789 | PYOtherRevenueAmt |
| CY Other Revenue | $139,233 | CYOtherRevenueAmt |
| PY Total Revenue | $33,989,953 | PYTotalRevenueAmt |
| CY Total Revenue | $34,674,935 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $13,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $5,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $18,095,047 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $17,745,727 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $73,717 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $18,558,396 | PYOtherExpensesAmt |
| CY Other Expenses | $18,635,816 | CYOtherExpensesAmt |
| PY Total Expenses | $36,666,443 | PYTotalExpensesAmt |
| CY Total Expenses | $36,386,543 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,676,490 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,711,608 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $50,809,287 | TotalAssetsBOYAmt |
| Total Assets EOY | $46,993,908 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $40,112,290 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $37,943,530 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,696,997 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,050,378 | NetAssetsOrFundBalancesEOYAmt |
| Mission | MENDOTA COMMUNITY HOSPITAL'S MISSION IS TO WORK FOR THE HEALTH AND WELL-BEING OF THE CITIZENS OF OUR AREA THROUGH A BROAD RANGE OF HIGH-QUALITY, EFFICIENT HEALTH SERVICES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $29,142,801 | ExpenseAmt |
| Grant | $5,000 | GrantAmt |
| Revenue | $34,366,710 | RevenueAmt |
| Desc | MENDOTA COMMUNITY HOSPITAL PROVIDED 25 BEDS IN FISCAL YEAR 2014. THIS HOSPITAL GAVE $1,222,192.21 IN CHARITY CARE, AND PROVIDED 7514 MEALS ON WHEELS TO MEMBERS OF OUR COMMUNITY. THE NET COMMUNITY BENEFIT EXPENSE WAS $47,940.51. MENDOTA COMMUNITY HOSPITAL OFFERS FLU & IMMUNIZATION CLINICS ALONG WITH MANY OTHER CLINICS IN MENDOTA AND OTHER OUTREACH COMMUNITIES. THE HOSPITAL HELD CPR CLASSES, DIABETIC SUPPORT GROUPS, PROVIDED FREE DIABETIC AND NUTRITION EDUCATION CLASSES, AND OFFERED SEVERAL OTHER PROGRAMS THROUGHOUT THE YEAR. THE NET COMMUNITY BENEFIT EXPENSE WAS $19,946.04. | Desc |
| Total Program Service Expenses | $29,142,801 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 49 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 390 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | Yes (true) | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | 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 | GARY EICH CFO | PersonNm |
| Phone | 8155397461 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 E 12TH STREET | AddressLine1 |
| City | MENDOTA | City |
| State | IL | State |
| ZIP Code | 61342 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| STEVEN F GAHAN | |||||||
| DIRECTOR | 2.0 | Yes (X) | $0 | $0 | $0 | ||
| DAVID SCHOLL MD | |||||||
| PHYSICIAN | 40.0 | Yes (X) | $198,473 | $0 | $27,605 | ||
| MARGO GALLAGHER SCHMITZ RN | |||||||
| PRESIDENT | 2.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| P DANIEL DOYLE OD | |||||||
| TREASURER | 2.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| ROBERT F STACHLEWITZ JR | |||||||
| SECRETARY | 2.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| ERIC ANDERSON | |||||||
| DIRECTOR | 2.0 | Yes (X) | $0 | $0 | $0 | ||
| JOSEPH BEETZ | |||||||
| PAST PRESIDENT | 2.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| KERI SUNDBERG DDS | |||||||
| DIRECTOR | 2.0 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL PHALEN | |||||||
| 1ST VICE PRESIDENT | 2.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| MARY CHINN MD | |||||||
| PHYSICIAN | 40.0 | Yes (X) | $199,199 | $0 | $20,635 | ||
| KATHLEEN STEVENSON | |||||||
| DIRECTOR | 2.0 | Yes (X) | $0 | $0 | $0 | ||
| JOSE DE J ARTEAGA | |||||||
| DIRECTOR | 2.0 | Yes (X) | $0 | $0 | $0 | ||
| CHRISTINE KLEIN | |||||||
| DIRECTOR | 2.0 | Yes (X) | $0 | $0 | $0 | ||
| LYNN E KLEIN | |||||||
| CEO | 40.0 | $184,244 | $0 | $24,555 | Yes (X) | ||
| JUDY CHRISTIANSEN | |||||||
| CEO | 40.0 | $684 | $0 | $0 | Yes (X) | ||
| HOWARD SCHOU | |||||||
| CFO | 40.0 | $65,389 | $0 | $4,065 | Yes (X) | ||
| GARY EICH | |||||||
| CFO | 40.0 | $4,300 | $0 | $0 | Yes (X) | ||
| KENNETH K POTTS | |||||||
| NURSE ANESTHETIST | 20.0 | $304,076 | $0 | $21,675 | Yes (X) | ||
| AMY MATHEIS-SOLIMAN MD | |||||||
| PHYSICIAN | 40.0 | $198,186 | $0 | $27,605 | Yes (X) | ||
| KEITH MINIHANE MD | |||||||
| ORTHOPEDIC SURGEON | 40.0 | $600,603 | $0 | $17,407 | Yes (X) | ||
| RICHARD BAKER | |||||||
| NURSE ANESTHETIST | 20.0 | $198,491 | $0 | $21,604 | Yes (X) | ||
| ERIC KIVISTO MD | |||||||
| GENERAL SURGEON | 40.0 | $243,868 | $0 | $14,403 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,197,513 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $179,554 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 16 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (true) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ER DOCTORS LTD | |||||
| 7 WOOD DUCK LANE | OTTAWA | IL | 61350 | MEDICAL PHYSICIANS | $1,686,566 |
| MEDICAL STAFFING NETWORK | |||||
| 4525 WEAVER PARKWAY SUITE 310 | WARRENVILLE | IL | 605554031 | NURSING AGENCY | $126,095 |
| MEDICAL OUTSOURCING SOLUTIONS INC | |||||
| 2060 ABERDEEN COURT SUITE D | SYCAMORE | IL | 60178 | RADIOLOGY SERVICE | $519,700 |
| READY LINK HEALTHCARE | |||||
| 72030 METROPLEX DR PO BOX 1047 | THOUSAND PALMS | CA | 92276 | NURSING AGENCY | $127,114 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $11,800 | FundraisingAmt |
| All Other Contributions | $68,629 | AllOtherContributionsAmt |
| Total Contributions | $80,429 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PROGRAM SERVICE REVENUE | 621110 | $33,559,872 | $33,559,872 |
| OTHER OPERATING REVENUE | 621110 | $806,838 | $806,838 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $34,366,710 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $63,285 | TotalRevenueColumnAmt |
| Exclusion | $63,285 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $69,511 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $7,521 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $61,990 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $61,990 | TotalRevenueColumnAmt |
| Exclusion | $61,990 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $933,050 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $906,901 | SecuritiesAmt |
| Other | $871 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $26,149 | SecuritiesAmt |
| Other | -$871 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,278 | TotalRevenueColumnAmt |
| Exclusion | $25,278 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $14,771 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $11,800 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $11,808 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,963 | TotalRevenueColumnAmt |
| Exclusion | $2,963 | ExclusionAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA | Desc |
| Business | 722210 | BusinessCd |
| Total Revenue Column | $74,280 | TotalRevenueColumnAmt |
| Exclusion | $74,280 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $74,280 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $34,674,935 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $34,366,710 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $227,796 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,000 | TotalAmt |
| Program Services | $5,000 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $789,164 | TotalAmt |
| Program Services | $447,470 | ProgramServicesAmt |
| Management And General | $341,694 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,795,398 | TotalAmt |
| Program Services | $12,240,841 | ProgramServicesAmt |
| Management And General | $1,519,846 | ManagementAndGeneralAmt |
| Fundraising | $34,711 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $210,047 | TotalAmt |
| Program Services | $186,157 | ProgramServicesAmt |
| Management And General | $23,346 | ManagementAndGeneralAmt |
| Fundraising | $544 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,976,641 | TotalAmt |
| Program Services | $1,731,105 | ProgramServicesAmt |
| Management And General | $240,680 | ManagementAndGeneralAmt |
| Fundraising | $4,856 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $974,477 | TotalAmt |
| Program Services | $848,642 | ProgramServicesAmt |
| Management And General | $123,504 | ManagementAndGeneralAmt |
| Fundraising | $2,331 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,708 | TotalAmt |
| Management And General | $25,708 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $114,297 | TotalAmt |
| Management And General | $114,297 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,613,692 | TotalAmt |
| Program Services | $2,501,240 | ProgramServicesAmt |
| Management And General | $112,452 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $175,888 | TotalAmt |
| Program Services | $20,055 | ProgramServicesAmt |
| Management And General | $155,833 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,107,706 | TotalAmt |
| Program Services | $3,607,200 | ProgramServicesAmt |
| Management And General | $1,491,836 | ManagementAndGeneralAmt |
| Fundraising | $8,670 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $386,244 | TotalAmt |
| Program Services | $348,491 | ProgramServicesAmt |
| Management And General | $37,753 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,364 | TotalAmt |
| Program Services | $54,205 | ProgramServicesAmt |
| Management And General | $15,159 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,165,158 | TotalAmt |
| Management And General | $2,165,158 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,641,724 | TotalAmt |
| Program Services | $3,641,724 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $818,252 | TotalAmt |
| Program Services | $753,302 | ProgramServicesAmt |
| Management And General | $64,950 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BLOOD BANK | $99,625 | $99,625 | |
| PROVISION FOR BAD DEBT | $1,249,811 | $1,249,811 | |
| COLLECTION | $82,632 | $82,632 | |
| CONTRACTS/REPAIRS | $1,875,576 | $1,300,193 | $575,383 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $210,139 | TotalAmt |
| Program Services | $107,740 | ProgramServicesAmt |
| Management And General | $79,794 | ManagementAndGeneralAmt |
| Fundraising | $22,605 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,386,543 | TotalAmt |
| Program Services | $29,142,801 | ProgramServicesAmt |
| Management And General | $7,170,025 | ManagementAndGeneralAmt |
| Fundraising | $73,717 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,711 | BOYAmt |
| EOY | $3,353 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,790,227 | BOYAmt |
| EOY | $3,231,463 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,873,178 | BOYAmt |
| EOY | $3,611,590 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $705,529 | BOYAmt |
| EOY | $753,120 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $504,584 | BOYAmt |
| EOY | $443,465 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $51,873,578 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $14,834,437 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,424,566 | BOYAmt |
| EOY | $37,039,141 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,506,873 | BOYAmt |
| EOY | $1,806,629 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $619 | BOYAmt |
| EOY | $105,147 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,809,287 | BOYAmt |
| EOY | $46,993,908 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,247,940 | BOYAmt |
| EOY | $3,275,696 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,839,350 | BOYAmt |
| EOY | $34,642,834 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,000 | BOYAmt |
| EOY | $25,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,112,290 | BOYAmt |
| EOY | $37,943,530 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,036,038 | BOYAmt |
| EOY | $8,389,375 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,824 | BOYAmt |
| EOY | $41,868 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $619,135 | BOYAmt |
| EOY | $619,135 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,696,997 | BOYAmt |
| EOY | $9,050,378 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,809,287 | BOYAmt |
| EOY | $46,993,908 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,711,608 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $64,989 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | 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) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $11,633 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $11,633 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1F | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION'S LOBBYING ACTIVITIES INCLUDE PAYING MEMBERSHIP DUES TO THE ILLINOIS HOSPITAL ASSOCIATION AND NATIONAL RURAL HEALTH ASSOCIATION, BOTH OF WHICH PARTICIPATE IN LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,797,903 | BeginningYearBalanceAmt |
| Contributions | $0 | ContributionsAmt |
| Investment Earnings Or Losses | $154,423 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $0 | GrantsOrScholarshipsAmt |
| Other Expenditures | $43,760 | OtherExpendituresAmt |
| Administrative Expenses | $0 | AdministrativeExpensesAmt |
| End Year Balance | $3,908,566 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,638,248 | BeginningYearBalanceAmt |
| Contributions | $0 | ContributionsAmt |
| Investment Earnings Or Losses | $170,921 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $0 | GrantsOrScholarshipsAmt |
| Other Expenditures | $1,011,266 | OtherExpendituresAmt |
| Administrative Expenses | $0 | AdministrativeExpensesAmt |
| End Year Balance | $3,797,903 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,386,687 | BeginningYearBalanceAmt |
| Contributions | $0 | ContributionsAmt |
| Investment Earnings Or Losses | $190,366 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $0 | GrantsOrScholarshipsAmt |
| Other Expenditures | $1,938,805 | OtherExpendituresAmt |
| Administrative Expenses | $0 | AdministrativeExpensesAmt |
| End Year Balance | $4,638,248 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,915,223 | BeginningYearBalanceAmt |
| Contributions | $1,311,605 | ContributionsAmt |
| Investment Earnings Or Losses | $159,859 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $0 | GrantsOrScholarshipsAmt |
| Other Expenditures | $0 | OtherExpendituresAmt |
| Administrative Expenses | $0 | AdministrativeExpensesAmt |
| End Year Balance | $6,386,687 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,628,180 | BeginningYearBalanceAmt |
| Contributions | $0 | ContributionsAmt |
| Investment Earnings Or Losses | $452,043 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $0 | GrantsOrScholarshipsAmt |
| Other Expenditures | $2,165,000 | OtherExpendituresAmt |
| Administrative Expenses | $0 | AdministrativeExpensesAmt |
| End Year Balance | $4,915,223 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.83080 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.15880 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.01040 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $40,478 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $1,272,124 | OtherCostOrOtherBasisAmt |
| Book Value | $1,312,602 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $30,822,579 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,518,053 | DepreciationAmt |
| Book Value | $26,304,526 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $0 | OtherCostOrOtherBasisAmt |
| Depreciation | $0 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $14,761,296 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,434,742 | DepreciationAmt |
| Book Value | $5,326,554 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $4,977,101 | OtherCostOrOtherBasisAmt |
| Depreciation | $881,642 | DepreciationAmt |
| Book Value | $4,095,459 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $37,039,141 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | LEGAL CLAIMS RESERVE | Desc |
| Amt | $25,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $25,000 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $33,509,442 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $64,989 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $19,329 | OtherRevenueAmt |
| Revenue Not Reported | $84,318 | RevenueNotReportedAmt |
| Revenue Subtotal | $33,425,124 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,249,811 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,249,811 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $34,674,935 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $35,156,061 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $19,329 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $19,329 | ExpensesNotReportedAmt |
| Expenses Subtotal | $35,136,732 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,249,811 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,249,811 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $36,386,543 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| INTENDED USES OF ENDOWMENT FUNDS | PART V, LINE 4 PROCEEDS OF FUNDED DEPRECIATION ENDOWMENT, AS DICTATED BY THE DONORS, ARE USED AS BEST DETERMINED BY ADMINISTRATION OF THE HOSPITAL. |
| OTHER REVENUE INCLUDED ON BOOKS BUT NOT ON RETURN | PART XI, LINE 2D SPECIAL EVENTS DIRECT EXPENSE $11,808 RENTAL EXPENSE $ 7,521 ------------------------------------------ TOTAL $19,329 |
| OTHER EXPENSES ON BOOKS BUT NOT ON RETURN | PART XII, LINE 2D SPECIAL EVENTS DIRECT EXPENSE $11,808 RENTAL EXPENSE $ 7,521 ------------------------------------------ TOTAL $19,329 |
| UNCERTAIN TAX POSITIONS | PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
| OTHER REVENUE INCLUDED ON RETURN BUT NOT ON BOOKS | PART XI, LINE 4B PROVISION FOR BAD DEBT $1,249,811 |
| OTHER EXPENSES ON RETURN BUT NOT ON BOOKS | PART XII, LINE 4B PROVISION FOR BAD DEBT $1,249,811 |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | FORE THE HOSPIT | NameOfEvent1Amt |
| Gross Receipts Event1 | $15,005 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $7,450 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $7,555 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $2,192 | NonCashPrizesEvent1Amt |
| Food And Beverage Event1 | $2,302 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $100 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $1,521 | OtherDirectExpensesEvent1Amt |
| Name Of Event2 | CORNAPALOOZA | NameOfEvent2Amt |
| Gross Receipts Event2 | $11,566 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $4,350 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $7,216 | GrossRevenueEvent2Amt |
| Non Cash Prizes Event2 | $857 | NonCashPrizesEvent2Amt |
| Food And Beverage Event2 | $117 | FoodAndBeverageEvent2Amt |
| Entertainment Event2 | $100 | EntertainmentEvent2Amt |
| Other Direct Expenses Event2 | $4,619 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 0 | OtherEventsTotalCnt |
| Gross Receipts Total | $26,571 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $11,800 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $14,771 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $3,049 | NonCashPrizesTotalEventsAmt |
| Food And Beverage Total Events | $2,419 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $200 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $6,140 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $11,808 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $2,963 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $613,497 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $613,497 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01750 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,160,169 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,377,550 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $782,619 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02230 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,616 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,616 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,787,282 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,377,550 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,409,732 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04020 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $117,607 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $35,005 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $82,602 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $47,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $47,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,049 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,049 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $170,656 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $35,005 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $135,651 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00390 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,957,938 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,412,555 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,545,383 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04410 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,249,811 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $14,556,055 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $14,882,549 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$326,494 | 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 (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | 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 | MENDOTA COMMUNITY HOSPITAL | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 E 12TH STREET | AddressLine1 |
| City | MENDOTA | City |
| State | IL | State |
| ZIP Code | 61342 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MENDOTAHOSPITAL.ORG | WebsiteAddressTxt |
| State License | 5819 | 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 | MENDOTA COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (true) | 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 (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| 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 | false | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 100 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 200. | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| State Regulation | Yes (X) | StateRegulationInd |
| Residency | Yes (X) | ResidencyInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit Other Actions | Yes (X) | PermitOtherActionsInd |
| Collection Activities | false | 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 |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY | PART V, SECTION B, LINE 3 THE FOCUS GROUP AND INTERVIEW PARTICIPANTS THAT HELPED US WITH OUR CHNA CAME FROM A VARIETY OF BACKGROUNDS IN THE COMMUNITY. WE HAD PARTICIPANTS SUCH AS THE SCHOOL NURSE, THE DIRECTORS AND NURSES FROM THE COMMUNITIES' FREE CLINICS, NURSE PRACTITIONER OF A READY CARE CLINIC, DIRECTORS OF SENIOR SERVICES AND LIVING FACILITIES, COUNSELORS, ATTORNEYS, PASTORS OF AREA CHURCHES, PRESIDENTS OF AREA BANKS, ACCOUNTANTS/CPA'S, CHIEFS OF AREA FIRE DEPARTMENTS, MAYORS AND CLERKS FROM AREA COMMUNITIES, AND MANAGERS FROM AREA BUSINESSES. THE HOSPITAL SOUGHT INPUT FROM THESE PERSONS WHEN GATHERING PRIMARY DATA FOR THE CHNA. |
| HOSPITAL FACILITY WEBBSITE (URL) | PART V, SECTION B, LINE 5A HTTP://WWW.MENDOTAHOSPITAL.ORG/IMAGES/PDFS/MCHNEEDSASSESMENT.PDF |
| NEEDS NOT ADDRESSED | PART V, SECTION B, LINE 7 THE ONLY ISSUE THAT WAS NOT IDENTIFIED AS A PRIORITIZED NEED WAS THAT MENDOTA COMMUNITY HOSPITAL DOES NOT HAVE A MATERNITY DEPARTMENT. THE COSTS OF PROVIDING THIS SERVICE AND LACK OF LOCAL PROVIDERS PERFORMING DELIVERIES MAKE THIS NEED IMPRACTICAL IN THE NEAR FUTURE SINCE MATERNITY DEPARTMENTS ARE LOCATED IN OTHER FACILITIES IN CLOSE GEOGRAPHIC PROXIMITY. |
| PUBLISHING OF FINANCIAL ASSISTANCE POLICY | PART V, SECTION B, LINE 14G THERE IS A FULL PARAGRAPH ON THE BACKSIDE OF THE PATIENT STATEMENTS AND ITEMIZED BILLS EXPLAINING OUR FINANCIAL ASSISTANCE PROGRAM AND PHONE NUMBERS TO CALL FOR FURTHER INFORMATION. |
| COLLECTIONS POLICIES AGAINST PATIENTS | PART V, SECTION B, LINE 16E LIENS (NOT ON RESIDENCES) ARE SENT OUT FOR ONLY GENERAL AUTOMOBILE AND GENERAL LIABILITY CLAIMS. THESE ARE SENT TO THE PATIENT, THE INSURANCE COMPANY, AND THE ATTORNEY (IF THERE IS ONE) TO LET THE INSURANCE COMPANY KNOW TO PAY THE HOSPITAL AND NOT THE PATIENT. |
| DETERMINING MAXIMUM AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS | PART V, SECTION B, LINE 20D WE USE THE AVERAGE OF NEGOTIATED COMMERCIAL INSURANCE RATES FOR THOSE SERVICES AT THE FACILITY. |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FINANCIAL ASISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST | PART I, LINE 7, COLUMN F THE COSTS REPORTED IN THE TABLE IN PART I, LINE 7, USED A RATIO OF PATIENT CARE COSTS TO CHARGES AS COMPUTED IN WORKSHEET 2 OF THE FORM INSTRUCTIONS. THIS METHODOLOGY WAS USED FOR ALL PATIENT SEGMENTS. |
| PERCENT OF TOTAL EXPENSE | PART I, LINE 7, COLUMN F THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $1,249,811 REPORTED ON PART IX, LINE 25, HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. |
| METHODOLOGY USED TO ESTIMATE BAD DEBT EXPENSE | PART III, LINE 2 FOR LINE 2, WE PROVIDED OUR FISCAL YEAR EXPENSE AMOUNT FOR BAD DEBT. |
| METHODOLOGY USED TO ESTIMATE BAD DEBT EXPENSE FOR FAP ELIGIBLE PATIENTS | PART III, LINE 3 FOR LINE 3, THE HOSPITAL ACKNOWLEDGES THE FACT THAT SOME PATIENTS DO NOT TURN IN ALL THE NECESSARY PAPERWORK TO DETERMINE IF THEY ARE ELIGIBLE FOR CHARITY CARE, BUT WE CANNOT MAKE ANY ASSUMPTIONS AS TO WHAT THEIR INCOME IS, OR IF THEY WOULD HAVE QUALIFIED FOR CHARITY CARE. THEREFORE, WE HAVE NO CHOICE BUT TO PUT ZERO IN LINE 3. |
| FINANCIAL STATEMENTS BAD DEBT EXPENSE | PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| SHORTFALL TREATED AS A COMMUNITY BENEFIT | PART III, LINE 8 THIS SHORTFALL IS DUE TO HOME HEALTH THAT IS A NECESSARY OUTREACH SERVICE PROVIDED TO THE COMMUNITY FOR THOSE PATIENTS RESTRICTED TO THEIR HOMES. |
| DEBT COLLECTION POLICY | PART III, LINE 9B: THE HOSPITAL'S DEBT COLLECTION POLICY STATES PATIENT FINANCIAL SERVICES WILL ASSIST PATIENTS IN FINDING OTHER SOURCES FOR PAYING BILLS SUCH AS FINANCIAL ASSISTANCE. WE ALSO HAVE A SEPARATE POLICY FOR CHARITY CARE THAT THE FINANCIAL COUNSELORS FOLLOW. THIS POLICY LISTS THE ITEMS NEEDED TO VERIFY ELIGIBILITY AND DESCRIBES THE PROCESS OF HOW THE FINANCIAL COUNSELORS DETERMINE IF THE PATIENT IS ELIGIBLE TO RECEIVE CHARITY CARE. |
| NEEDS ASSESSMENT | PART VI, LINE 2 WE LOOK AT OUR TOP DIAGNOSES TO DETERMINE WHAT TYPE OF PROGRAMS WE SHOULD BE OFFERING TO OUR PATIENTS. WE HAVE ROUTINE BLOOD PRESSURE PROGRAMS, A DIABETIC SUPPORT GROUP AS WELL AS OTHER SCREENINGS THAT ARE OFFERED BASED ON STAFF EXPERTISE AND PATIENT NEEDS. WE WORK CLOSELY WITH AREA BUSINESSES ON LOSS PREVENTION AND INSTITUTE PROGRAMS TO MEET THEIR PARTICULAR NEEDS. WE ALSO HAVE DRUG AND ALCOHOL TEST PROGRAMS AVAILABLE FOR OUR BUSINESS COMMUNITY. WE HAVE SPECIALTY CLINICS FOR CARDIOLOGY, ONCOLOGY, PODIATRY, ORTHOPEDICS, RHEUMATOLOGY, PULMONOLOGY, ETC. SO THAT OUR PATIENTS WHO NEED THESE SPECIALTIES CAN BE SEEN LOCALLY VERSUS DRIVING TO A METROPOLITAN AREA FOR THESE SERVICES. THIS YEAR WE ALSO CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT WHICH LEADS US TO WHAT OUR COMMUNITY NEEDS US TO OFFER TO THEM. |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | PART VI, LINE 3 AT THE TIME OF REGISTRATION, PATIENTS RECEIVE HANDOUTS REGARDING SELF-PAY UNINSURED DISCOUNTS. ALSO, WHEN A PATIENT RECEIVES A BILL, THERE IS INFORMATION ON THE BACK REGARDING WHERE THEY CAN GET MORE INFORMATION ABOUT FINANCIAL ASSISTANCE, SUCH AS CHARITY CARE, BY GOING ON THE HOSPITAL WEBSITE OR CALLING THE FINANCIAL COUNSELORS, WHOSE NUMBERS ARE LISTED. |
| COMMUNITY INFORMATION: | PART VI, LINE 4 MCH IS LOCATED IN NORTH-CENTRAL ILLINOIS. WE SERVE A POPULATION OF APPROXIMATELY 25,000 RESIDENTS. WE ARE A FARMING COMMUNITY WITH SOME MANUFACTURING PLANTS. MANY OF OUR RESIDENTS ARE SELF-EMPLOYED. WE ALSO SERVE A LARGE HISPANIC POPULATION. OUR MEDICARE POPULATION REPRESENTS OVER 50% OF THE PATIENTS WE SERVE. WE ARE DESIGNATED AS A CRITICAL ACCESS HOSPITAL. |
| PROMOTION OF COMMUNITY HEALTH | PART VI, LINE 5 MCH HAS A BOARD OF DIRECTORS THAT IS REPRESENTATIVE OF THE COMMUNITIES WE SERVE. THEY SERVE ON A VOLUNTEER BASIS AND REPRESENT ALL AREAS OF OUR SERVICE AREA. MCH HAS IMPLEMENTED A CHARITY CARE PROGRAM WITH GUIDELINES THAT ARE CONSISTENT WITH THOSE OF OTHER HOSPITALS IN THE STATE OF IL. WE SUPPORT OUR LOCAL FREE CARE CLINIC -- TRINITY HEALTH CARE -- BY PROVIDING ESTABLISHED LAB TESTS AT NO CHARGE. MCH IS INVOLVED WITH COMMUNITY PROGRAMS BY PROVIDING HEALTH SCREENING BOOTHS, SPEAKER'S BUREAU AND INVOLVEMENT AT THE COMMITTEE LEVEL IN MANY ORGANIZATIONS. |
| AFFILIATED HEALTH CARE SYSTEM | PART VI, LINE 6 NOT APPLICABLE |
| STATE FILING OF COMMUNITY BENEFIT REPORT | PART VI, LINE 7 NOT APPLICABLE |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LYNN E KLEIN | ||||||||||||||
| CEO | $136,678 | $0 | $0 | $0 | $47,566 | $0 | $6,551 | $0 | $18,004 | $0 | $208,799 | $0 | $0 | $0 |
| DAVID SCHOLL MD | ||||||||||||||
| PHYSICIAN | $177,876 | $0 | $0 | $0 | $20,597 | $0 | $6,000 | $0 | $21,605 | $0 | $226,078 | $0 | $0 | $0 |
| KENNETH K POTTS | ||||||||||||||
| NURSE ANESTHETIST | $298,505 | $0 | $0 | $0 | $5,571 | $0 | $7,650 | $0 | $14,025 | $0 | $325,751 | $0 | $0 | $0 |
| MARY CHINN MD | ||||||||||||||
| PHYSICIAN | $176,646 | $0 | $0 | $0 | $22,553 | $0 | $6,000 | $0 | $14,635 | $0 | $219,834 | $0 | $0 | $0 |
| AMY MATHEIS-SOLIMAN MD | ||||||||||||||
| PHYSICIAN | $195,572 | $0 | $0 | $0 | $2,614 | $0 | $6,000 | $0 | $21,605 | $0 | $225,791 | $0 | $0 | $0 |
| KEITH MINIHANE MD | ||||||||||||||
| ORTHOPEDIC SURGEON | $554,149 | $0 | $0 | $0 | $46,454 | $0 | $7,650 | $0 | $9,757 | $0 | $618,010 | $0 | $0 | $0 |
| RICHARD BAKER | ||||||||||||||
| NURSE ANESTHETIST | $197,031 | $0 | $0 | $0 | $1,460 | $0 | $0 | $0 | $21,604 | $0 | $220,095 | $0 | $0 | $0 |
| ERIC KIVISTO MD | ||||||||||||||
| GENERAL SURGEON | $241,841 | $0 | $0 | $0 | $2,027 | $0 | $0 | $0 | $14,403 | $0 | $258,271 | $0 | $0 | $0 |
| GARY EICH | ||||||||||||||
| CFO | $4,300 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $4,300 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | COMPENSATION PAID BY AN UNRELATED MANAGEMENT COMPANY | FormAndLineReferenceDesc |
| Explanation | FORM 990, PART VII, LINE 5 THE CFO, GARY EICH, IS PAID BY AN UNRELATED MANAGEMENT COMPANY, OSF. OSF PROVIDED GARY EICH WITH COMPENSATION IN THE AMOUNT OF $4,300. ALL FEES ARE PAID TO OSF BY MENDOTA COMMUNITY HOSPITAL. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| JOELLYN GAHAN | |||
| SPOUSE OF BOARD MEMBER | $43,083 | EMPLOYEE | false |
| JARED WISE | |||
| SON-IN-LAW OF BOARD MEMBE | $73,444 | EMPLOYEE | false |
| BRIGITTE KLEIN | |||
| DAUGHTER OF CEO | $15,695 | EMPLOYEE | false |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| OFFICERS WHO CANNOT BE REACHED AT THE ORGANIZATION'S ADDRESS | FORM 990, PART VI, SECTION A, LINE 9 LYNNE KLEIN PO BOX 246 CHERRY, IL 61317 HOWARD SCHOU 1420 DEERFIELD ROAD PRINCETON, IL 61356 |
| COPY OF 990 PROVIDED TO GOVERNING BODY | FORM 990, PART VI, LINE 11 MENDOTA COMMUNITY HOSPITAL EMAILS THE GOVERNING BODY A COPY OF THE FORM 990 BEFORE IT IS FILED SO THEY CAN REVIEW IT. IN ADDITION, THE CEO AND CFO REVIEW THE FORM 990 BEFORE IT IS FILED WITH THE GOVERNMENT. |
| COMPLIANCE WITH WRITTEN CONFLICT OF INTEREST POLICY | FORM 990, PART VI, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS THE GOVERNING BODY. ADMINISTRATION REQUIRES THE GOVERNING BODY TO FILL OUT AN ANNUAL CONFLICT OF INTEREST POLICY. ADMINISTRATION REVIEWS THE FORMS. IF A PROBLEM ARISES, THE CEO WILL CONTACT THE PRESIDENT OF THE GOVERNING BODY TO DISCUSS HOW TO HANDLE THE ISSUE. THE PERSON INVOLVED IN THE CONFLICT OF INTEREST WOULD NOT BE INVOLVED IN THE DELIBERATIONS HELD ON THE ISSUE IN QUESTION. |
| COMPENSATION DETERMINATION | FORM 990, PART VI, LINE 15A THE EXECUTIVE BOARD CONDUCTED A REVIEW OF THE COMPENSATION FOR THE CEO ON APRIL 1, 2013. |
| AVAILABLE TO THE PUBLIC | FORM 990, PART VI, LINE 19 THE ORGANIZATION DOES NOT MAKE THESE DOCUMENTS AVAILABLE TO THE PUBLIC. HOWEVER, THE AUDITED FINANCIAL STATEMENTS ARE INCLUDED IN THE COPY OF FORM 990 THAT IS MADE AVAILABLE TO THE PUBLIC. |