KIRBY MEDICAL CENTER: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- KIRBY MEDICAL CENTER (EIN 37-0661215)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-15
- IRS object ID
- 201431359349307463
- Schema version
- 2012v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-15T15:08:03-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 NORTH WATER ST SUITE 400 | AddressLine1 |
| City | DECATUR | City |
| State | IL | State |
| ZIP Code | 62523 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 370661215 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kirby Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % MR STEVEN TENHOUSE | InCareOfName |
| Name Control | KIRB | NameControl |
| Phone | 2177622115 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 Medical Center Drive | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | Monticello | City |
| State | IL | State |
| ZIP Code | 61856 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Steven D Tenhouse | Name |
| Title | Chief Executive Officer | Title |
| Phone | 2177622115 | Phone |
| Date Signed | 2014-05-14 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2174292411 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | STEVEN D TENHOUSE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 35149761 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.KIRBYHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1939 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | Kirby Medical Center is committed to providing progressive hospital, outpatient, and specialty services to those who are served, in a convenient compassionate setting, regardless of their ability to pay. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 291 | TotalNbrEmployees |
| Total Nbr Volunteers | 250 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 462093 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 6988554 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 21130037 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 23319030 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 228742 | InvestmentIncomePriorYear |
| Investment Income Current Year | 762313 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 413203 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2679397 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 22234075 | TotalRevenuePriorYear |
| Total Revenue Current Year | 33749294 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 13020624 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 11792431 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 12545200 | OtherExpensePriorYear |
| Other Expenses Current Year | 13832765 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 25565824 | TotalExpensesPriorYear |
| Total Expenses Current Year | 25625196 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -3331749 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 8124098 | RevenuesLessExpensesCY |
| Total Assets BOY | 57187437 | TotalAssetsBOY |
| Total Assets EOY | 66512145 | TotalAssetsEOY |
| Total Liabilities BOY | 35667098 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 36164566 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 21520339 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 30347579 | NetAssetsOrFundBalancesEOY |
| Mission Description | KIRBY MEDICAL CENTER IS COMMITTED TO PROVIDING QUALITY AND COMPASSIONATE CARE TO ALL. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 18497697 | Expense |
| Revenue | 25564530 | Revenue |
| Description | THE HOSPITAL PROVIDES QUALITY INPATIENT AND OUTPATIENT SERVICES TO ITS COMMUNITY. FREE, SUBSIDIZED, AND GOVERNMENT ASSISTED CARE ARE PROVIDED AT A REDUCED RATE WHEN NEEDED. SERVICES PROVIDED DURING THE YEAR INCLUDE APPROXIMATELY 22,214 PATIENTS SERVED THROUGH THE KIRBY MEDICAL CLINIC, 1,961 NURSING CARE INPATIENT DAYS, AND 86,233 LABORATORY PROCEDURES. | Description |
| Total Program Service Expense | 18497697 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | true | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | true | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 41 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 291 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MR STEVEN TENHOUSE | NamePerson |
| Telephone Number | 2177622115 | TelephoneNumber |
Address US AddressUS
| 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 Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| CRAIG WEBB | ||||||||
| VICE CHAIRMAN | 1.0 | 0.0 | X | X | 11700 | 0 | 0 | |
| STEPHEN AYERS | ||||||||
| CHAIRMAN | 1.0 | 0.0 | X | X | 7500 | 0 | 0 | |
| GARY HUISINGA | ||||||||
| TREASURER | 1.0 | 0.0 | X | X | 9000 | 0 | 0 | |
| STEVEN MILLS | ||||||||
| HON. EMERITUS BOARD MEMBER | 1.0 | 0.0 | X | 1500 | 0 | 0 | ||
| STEVEN TENHOUSE | ||||||||
| CEO - SECRETARY | 40.0 | 0.5 | X | X | 188758 | 0 | 38657 | |
| EDWARD EWALD | ||||||||
| BOARD MEMBER | 1.0 | 0.5 | X | 4650 | 0 | 0 | ||
| JAMES BALLSRUD | ||||||||
| BOARD MEMBER | 1.0 | 0.0 | X | 5400 | 0 | 0 | ||
| NAT RASSI | ||||||||
| BOARD MEMBER | 1.0 | 0.0 | X | 6000 | 0 | 0 | ||
| DYKE PIATT | ||||||||
| BOARD MEMBER | 1.0 | 0.5 | X | 7650 | 0 | 0 | ||
| BILL TRACY | ||||||||
| BOARD MEMBER | 1.0 | 0.0 | X | 3900 | 0 | 0 | ||
| NARAIN DAS MANDHAN | ||||||||
| CMO | 40.0 | 0.0 | X | 380270 | 0 | 48998 | ||
| DAVE HARMS | ||||||||
| FORMER CFO | 40.0 | 0.0 | X | 116043 | 0 | 9825 | ||
| JENNIFER MOSS | ||||||||
| CCO | 40.0 | 0.0 | X | 94852 | 0 | 26700 | ||
| ALEXANDER NAZARIAN | ||||||||
| CFO | 40.0 | 0.0 | X | 0 | 0 | 0 | ||
| JAMES MANINT | ||||||||
| PHYSICIAN | 40.0 | 0.0 | 168577 | 0 | 34280 | X | ||
| JOSEPH LAMB | ||||||||
| PHYSICIAN'S ASSISTANT | 40.0 | 0.0 | 106908 | 0 | 34529 | X | ||
| LAURIE LEE | ||||||||
| PHYSICIAN'S ASSISTANT | 40.0 | 0.0 | 112913 | 0 | 25575 | X | ||
| CHUNLING GONG | ||||||||
| FORMER PHYSICIAN | 40.0 | 0.0 | 130754 | 0 | 14473 | X | ||
| DIANNE GEISSAL | ||||||||
| CCO | 40.0 | 0.0 | 103079 | 0 | 17496 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1459454 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 250533 | TotalOtherCompensation |
| Number Individuals GT100 K | 8 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CARLE PHYSICIAN GROUP | |||||
| 611 W PARK ST | URBANA | IL | 61801 | PHYSICIAN SERVICES | 2158631 |
| CARLE FOUNDATION HOSPITAL | |||||
| 611 W PARK ST | URBANA | IL | 61801 | DRUG & PHARM CONSULT | 654332 |
| MEDICAL INFORMATION TECHNOLOGY | |||||
| MEDITECH CIRCLE | WESTWOOD | MA | 02090 | OP SYSTEM & SUPPORT | 302273 |
| FOLEY LARDNER ATTY AT LAW | |||||
| 321 N CLARK ST SUITE 2800 | CHICAGO | IL | 60610 | LEGAL SERVICES | 256754 |
| GE HEALTHCARE | |||||
| PO BOX 641419 | PITTSBURG | PA | 152641419 | CT MACHINE | 227462 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 18 | NumberOfContractorsGT100K |
| Government Grants | 158726 | GovernmentGrants |
| All Other Contributions | 6829828 | AllOtherContributions |
| Noncash Contributions | 6829828 | NoncashContributions |
| Total Contributions | 6988554 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE REVENUE | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 23319030 | TotalRevenueColumn |
| Related Or Exempt Function Income | 23319030 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 23319030 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 183211 | TotalRevenueColumn |
| Exclusion | $183,211 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 453131 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 25472 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 427659 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 427659 | TotalRevenueColumn |
| Exclusion | $427,659 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1366092 | Securities |
| Other | 574410 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1262280 | Securities |
| Other | 99120 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 103812 | Securities |
| Other | 475290 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 579102 | TotalRevenueColumn |
| Exclusion | $579,102 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 19833 | GrossSalesOfInventory |
| Cost Of Goods Sold | 13595 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6238 | TotalRevenueColumn |
| Exclusion | $6,238 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| EMR INCENTIVE REIMBURSEMENT | 900099 | 1698694 | 1698694 |
| GOVT STIPEND - AMB | 900099 | 57460 | 57460 |
| PHYSICAL THERAPY INCOME | 621110 | 48404 | 48404 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 440942 | TotalRevenueColumn |
| Related Or Exempt Function Income | 440942 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2245500 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 33749294 | TotalRevenueColumn |
| Related Or Exempt Function Income | 25564530 | RelatedOrExemptFunctionIncome |
| Exclusion | $1,196,210 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 972389 | Total |
| Management And General | 972389 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8146674 | Total |
| Program Services | 5702672 | ProgramServices |
| Management And General | 2444002 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 420765 | Total |
| Program Services | 294536 | ProgramServices |
| Management And General | 126229 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1610260 | Total |
| Program Services | 1127182 | ProgramServices |
| Management And General | 483078 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 642343 | Total |
| Program Services | 417523 | ProgramServices |
| Management And General | 224820 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 380640 | Total |
| Program Services | 243610 | ProgramServices |
| Management And General | 137030 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 89286 | Total |
| Program Services | 57143 | ProgramServices |
| Management And General | 32143 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3049734 | Total |
| Program Services | 2897247 | ProgramServices |
| Management And General | 152487 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 191694 | Total |
| Program Services | 122684 | ProgramServices |
| Management And General | 69010 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 436721 | Total |
| Program Services | 331908 | ProgramServices |
| Management And General | 104813 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 109842 | Total |
| Program Services | 70299 | ProgramServices |
| Management And General | 39543 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 371943 | Total |
| Program Services | 238044 | ProgramServices |
| Management And General | 133899 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 70148 | Total |
| Program Services | 44895 | ProgramServices |
| Management And General | 25253 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71430 | Total |
| Program Services | 30001 | ProgramServices |
| Management And General | 41429 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1896326 | Total |
| Program Services | 1896326 | ProgramServices |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3331943 | Total |
| Program Services | 2132444 | ProgramServices |
| Management And General | 1199499 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 468101 | Total |
| Program Services | 299585 | ProgramServices |
| Management And General | 168516 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 2155668 | 1724534 | 431134 |
| REPAIRS AND MAINTENANCE | 664715 | 412123 | 252592 |
| EQUIPMENT RENTAL | 300522 | 282491 | 18031 |
| DUES AND SUBSCRIPTIONS | 54147 | 34654 | 19493 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 189905 | Total |
| Program Services | 137796 | ProgramServices |
| Management And General | 52109 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25625196 | Total |
| Program Services | 18497697 | ProgramServices |
| Management And General | 7127499 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3058 | BOY |
| EOY | 600 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1143702 | BOY |
| EOY | 4117045 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4318837 | BOY |
| EOY | 5133943 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 274824 | BOY |
| EOY | 275255 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 389384 | BOY |
| EOY | 531164 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 43342088 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 7551024 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38176829 | BOY |
| EOY | 35791064 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12080741 | BOY |
| EOY | 18527604 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 800062 | BOY |
| EOY | 2135470 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 57187437 | BOY |
| EOY | 66512145 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3650900 | BOY |
| EOY | 2945729 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32016198 | BOY |
| EOY | 30380656 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 2838181 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35667098 | BOY |
| EOY | 36164566 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11660520 | BOY |
| EOY | 14520020 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 487246 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9859819 | BOY |
| EOY | 15340313 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21520339 | BOY |
| EOY | 30347579 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 57187437 | BOY |
| EOY | 66512145 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 8124098 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 147604 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 555538 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | true | FederalGrantAuditRequired |
| Federal Grant Audit Performed | true | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
| Contrib By Controlling Individual | false | ContribByControllingIndividual |
| Contribution By Related Party | false | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | false | ContribBy35ControlledEntity |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $6,936 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 6936 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | OTHER LOBBYING ACTIVITIES | Identifier |
| Return Reference | PART II-B, LINE 1I | ReturnReference |
| Explanation | THE AMOUNT REPORTED ON THIS LINE REPRESENTS THE PORTION OF DUES PAID BY KIRBY MEDICAL CENTER TO HOSPITAL ASSOCIATIONS THAT WERE USED FOR LOBBYING ACTIVITIES. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 15594288 | BeginningOfYearBalance |
| Contributions | 7189877 | Contributions |
| Investment Earnings Or Losses | 683374 | InvestmentEarningsOrLosses |
| Other Expenditures | 988050 | OtherExpenditures |
| Administrative Expenses | 40541 | AdministrativeExpenses |
| End Of Year Balance | 22438948 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 15987486 | BeginningOfYearBalance |
| Contributions | 1234605 | Contributions |
| Investment Earnings Or Losses | 525859 | InvestmentEarningsOrLosses |
| Other Expenditures | 2112809 | OtherExpenditures |
| Administrative Expenses | 40853 | AdministrativeExpenses |
| End Of Year Balance | 15594288 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 11769155 | BeginningOfYearBalance |
| Contributions | 201691 | Contributions |
| Investment Earnings Or Losses | 4513189 | InvestmentEarningsOrLosses |
| Other Expenditures | 465369 | OtherExpenditures |
| Administrative Expenses | 31180 | AdministrativeExpenses |
| End Of Year Balance | 15987486 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 9869103 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 3730121 | InvestmentEarningsOrLosses |
| Other Expenditures | 1796537 | OtherExpenditures |
| Administrative Expenses | 33532 | AdministrativeExpenses |
| End Of Year Balance | 11769155 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 10804326 | BeginningOfYearBalance |
| Contributions | 189054 | Contributions |
| Investment Earnings Or Losses | 741931 | InvestmentEarningsOrLosses |
| Other Expenditures | 1822726 | OtherExpenditures |
| Administrative Expenses | 43482 | AdministrativeExpenses |
| End Of Year Balance | 9869103 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.31640 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.68360 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | true | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 520000 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 349650 | OtherCostOrOtherBasis |
| Book Value | 869650 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 3884909 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 15743095 | OtherCostOrOtherBasis |
| Depreciation | 2675817 | Depreciation |
| Book Value | 16952187 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 15242008 | OtherCostOrOtherBasis |
| Depreciation | 3435806 | Depreciation |
| Book Value | 11806202 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7602426 | OtherCostOrOtherBasis |
| Depreciation | 1439401 | Depreciation |
| Book Value | 6163025 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 35791064 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO MEDICARE | $2,805,427 |
| USE INTEREST OF BENEFICIARY | $32,754 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2838181 | TotalOfAmounts |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PART V LINE 4 | USE OF ORGANIZATION'S ENDOWMENT FUNDS | 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 OF DEFRAYING CHARITY CARE. |
| UNCERTAIN TAX POSITIONS | PART X, LINE 2 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE UNCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANACIAL STATEMENTS. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 280. | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 280. | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | false | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1517954 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1517954 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05930 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2985116 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1448151 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1536965 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06010 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4503070 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1448151 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3054919 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11940 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14965 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1237 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 13728 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 911430 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 750119 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 161311 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00630 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 25720 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 25720 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 952115 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 751356 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 200759 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00780 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5455185 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2199507 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3255678 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.12720 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2850 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2850 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1225 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1225 | NetCommunityBuildingExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 58 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 58 | NetCommunityBuildingExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 4133 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 4133 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $45,158 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 6814021 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 6844615 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -30594 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KIRBY MEDICAL CENTER | BusinessNameLine1 |
Address Address
| 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) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KIRBY MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 13 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | false | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | true | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 280. | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 280. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| CHARITY CARE PERCENTAGE | PART I, LINE 7, COLUMN F | THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $45,158 REPORTED IN PART IX, LINE 25, HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. |
| COST METHODOLOGY | PART I, LINE 7 | 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. |
| COMMUNITY BUILIDNG ACTIVITIES | PART II | ECONOMIC DEVELOPMENT ACTIVITIES INCLUDED ROTARY, CHAMBER OF COMMERCE, AND MONTICELLO MAIN STREET ACTIVITIES. COALITION BUILDING ACTIVITIES INCLUDED 911 & CRISIS TEAM MEETINGS. |
| BAD DEBT METHODOLOGY | PART III, SECTION A, LINE 2 | IN 2013, THE MEDICAL CENTER CHANGED ITS METHOD OF PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR UNCOLLECTIBLE ACCOUNTS AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN ACCORDANCE WITH ACCOUNTING STANDARDS UPDATE (ASU) 2011-07, PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTH CARE ENTITIES. THE MAJOR CHANGES ASSOCIATED WITH ASU 2011-07 ARE TO RECLASSIFY THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS RELATED TO PATIENT SERVICE REVENUE TO A DEDUCTION FROM PATIENT SERVICE REVENUE AND TO PROVIDE ENHANCED DISCLOSURES OF THE MEDICAL CENTER'S POLICIES RELATED TO UNCOLLECTIBLE ACCOUNTS. THE BAD DEBT AMOUNT INCLUDED ON LINE 2 IS THE BAD DEBT EXPENSE THAT WAS REPORTED ON THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS. |
| BAD DEBT FOOTNOTE | PART III, SECTION A, LINE 4 | PATIENT ACCOUNTS RECEIVABLE ARE STATED AT NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYERS AND OTHERS FOR SERVICES RENDERED PLUS ANY ACCRUED AND UNPAID INTEREST. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, WHICH IS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. PATIENT ACCOUNTS RECEIVABLE ARE ORDINARILY DUE 30 DAYS AFTER THE ISSUANCE OF THE INVOICE. BALANCES PAST DUE MORE THAN 120 DAYS ARE CONSIDERED DELINQUENT. DELINQUENT ACCOUNTS PAST DUE MORE THAN ONE YEAR ARE WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT OR THIRD-PARTY PAYER. |
| MEDICARE | PART III, SECTION B, LINE 8 | UNDER THE CURRENT MEDICARE RULES CAH HOSPITALS RECEIVE THEIR ALLOWABLE COST OF PATIENT CARE ADJUSTED FOR SEQUESTRATION REDUCTION FOR THE REIMBURSEMENT OF ALLOWABLE HOSPITAL COSTS AND 100% OF CLINIC ALLOWABLE COSTS. |
| COLLECTION PRACTICES | PART III, SECTION C, LINE 9B | THIS POLICY AND RELATED PRACTICES HAVE SUBSEQUENTLY BEEN REVISED TO INCLUDE THE REVIEW OF THE PATIENT'S FINANCIAL STATUS AND QUALIFICATIONS AT THE TIME OF ADMISSION. PRACTICES RELATED TO THE COLLECTION OF BAD DEBT HAVE ALSO SUBSEQUENTLY BEEN REVISED TO ALLOW FOR THE SCREENING OF THE HOSPITAL'S FINANCIAL ASSISTANCE GUIDELINES. |
| COMMUNITY INPUT IN CHNA PROCESS | PART V, SECTION B, LINE 3 | THE ORGANIZATION'S CONSULTANT PERFORMING THE ASSESSMENT MET WITH VARIOUS COMMUNITY GROUPS, PHYSICIANS, REPRESENTATIVES THE LOCAL SCHOOL DISTRICT AND OF LOCAL HEALTH AGENCIES TO DISCUSS THE HEALTH NEEDS OF MONTICELLO AND PIATT COUNTY. |
| FINANCIAL ASSISTANCE POLICY | PART V, SECTION B, LINES 9 - 14 | KIRBY MEDICAL CENTER OFFERS A PROGRAM CALLED "KIRBY CARE ASSISTANCE PROGRAM". THE PROGRAM PROVIDES A DISCOUNT TO GROSS CHARGES BASED ON FINANCIAL NEED. THE PROGRAM IS PUBLICIZED ON THE HOSPITAL WEBSITE AND IS ALSO NOTED ON ALL PATIENT INVOICES. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON THE APPLICATION WHICH IS USED TO DETERMINE A PERSON'S ABILITY TO PAY WITHIN THE INCOME CRITERIA OUTLINED IN THE ASSISTANCE PROGRAM. KIRBY MEDICAL CENTER ALSO 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 UNDER THE KIRBY CARE ASSISTANCE PROGRAM AS IT IS ASSUMED THE PATIENT IS MEDICALLY FINANCIALLY INDIGENT. |
| CHARGES FOR MEDICAL CARE | PART V, SECTION B, LINES 20-22 | MEDICARE REIMBURSEMENT REGULATIONS REQUIRE A UNIFORM CHARGE STRUCTURE. SINCE KIRBY MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL, MEDICARE REIMBURSES THE HOSPITAL ON THE BASIS OF COST. THE MEDICARE PROGRAM REQUIRES THE HOSPITAL TO FILE AN ANNUAL MEDICARE COST REPORT TO DETERMINE THE FINAL AMOUNT OF PAYMENT FOR SERVICES TRADITIONAL MEDICARE FEE FOR SERVICE PATIENTS. THROUGH THE ANNUAL COST REPORT, MEDICARE ULTIMATELY APPORTIONS COSTS BASED ON THE PREMISE THAT ALL CHARGES ARE THE SAME FOR EACH PATIENT, THEREFORE REQUIRING ALL CHARGES BE THE SAME FOR ALL PATIENTS. THE CONCEPT FOR DISCOUNTING CHARGES AT KIRBY MEDICAL CENTER IS MADE ON THE PATIENT'S ABILITY TO PAY THE CHARGE, DISCOUNTING THE RECEIVABLE, RATHER THAN THE CHARGE ITSELF. KIRBY MEDICAL CENTER OFFERS A PROGRAM CALLED "KIRBY CARE ASSISTANCE PROGRAM". THE PROGRAM PROVIDES A DISCOUNT TO GROSS CHARGES BASED ON FINANCIAL NEED. THE PROGRAM IS PUBLICIZED ON THE HOSPITAL WEBSITE AND IS ALSO NOTED ON ALL PATIENT INVOICES. KIRBY MEDICAL CENTER ALSO HAS A "PRESUMPTIVE ELIGIBILITY" POLICY THAT REDUCES ALL CHARGES TO ZERO. |
| NEEDS ASSESSMENT | IN CONCERT WITH THE LOCAL COMMUNITY HEALTH AGENCIES, KIRBY MEDICAL COLLABORATES TO ASSESS THE HEALTH NEEDS OF THE LOCAL COMMUNITY AND THE IMMEDIATELY SURROUNDING COUNTY. | |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | INFORMATION REGARDING ELIGIBILITY FOR FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS AND THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM IS PUBLISHED ON THE HOSPITAL'S WEB SITE AND IS AVAILABLE VIA LITERATURE THAT IS PLACED AT THE VARIOUS LOCATIONS IN THE HOSPITAL WHERE PATIENTS ARE REGISTERED FOR ADMISSION. INFORMATION IS ALSO PROVIDED BY THE PATIENT FINANCIAL SERVICES STAFF AND IS ALSO REFERENCED IN NEWSPAPER AND BILLBOARD ADVERTISING. | |
| COMMUNITY INFORMATION | KIRBY MEDICAL CENTER SERVES THE IMMEDIATE COMMUNITY OF MONTICELLO WHICH HAS A POPULATION OF ROUGHLY 6,000 AND A MUCH LARGER SERVICE AREA OF APPROXIMATELY 16,000 THAT INCLUDES THE SURROUNDING COMMUNITIES OF BEMENT, CISCO, ATWOOD, WHITE HEATH, IVESDALE AND WELDON, TO NAME A FEW. | |
| PROMOTION OF COMMUNITY HEALTH | KIRBY MEDICAL CENTER CONTINUES TO PROMOTE HEALTH EDUCATION VIA HEALTH FAIRS AND VIA THEIR PRESENCE AT VARIOUS COMMUNITY EVENTS WITH HEALTH EDUCATION MATERIALS. KIRBY PROVIDES READY ACCESS TO VACCINES BY SETTING UP SPECIAL VACCINE LOCATIONS IN THE COMMUNITY PRIOR TO THE FLU SEASON. THE KIRBY AMBULANCE STAFF PROVIDES ON CALL COVERAGE AT LOCAL ATHLETIC EVENTS AND PROVIDES EDUCATION TO ELEMENTARY SCHOOL KIDS THROUGH THEIR ADOPT A MEDIC PROGRAM. | |
| STATE FILING OF COMMUNITY BENEFIT REPORT | 990 SCHEDULE H, PART VI | IL, |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | true | WrittenPolicyReTAndEExpenses |
| Substantiation Required | true | SubstantiationRequired |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | true | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STEVEN TENHOUSE | ||||||||||||||
| CEO - SECRETARY | 156768 | 0 | 25500 | 0 | 6490 | 0 | 14796 | 0 | 23861 | 0 | 227415 | 0 | 0 | 0 |
| NARAIN DAS MANDHAN | ||||||||||||||
| CMO | 296835 | 0 | 74853 | 0 | 8582 | 0 | 21438 | 0 | 27560 | 0 | 429268 | 0 | 0 | 0 |
| JAMES MANINT | ||||||||||||||
| PHYSICIAN | 126883 | 0 | 40244 | 0 | 1450 | 0 | 13137 | 0 | 21143 | 0 | 202857 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| NON-FIXED PAYMENTS | SCHEDULE J, 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 CHUNLING GONG JAMES MANINT JOSEPH LAMB THE BONUS AMOUNTS ARE DETERMINED BASED ON A FUNCTION OF BASE SALARY AND NATIONAL SURVEYS ON PHYSICIAN COMPENSATION AND PRODUCTION. |
| HEALTH OR SOCIAL CLUB DUES | SCHEDULE J, PART 1, LINE 1 | 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 INTERESTS OF THE MEDICAL CENTER. ANY PERSONAL USE ASSOCIATED WITH THE GOLF CLUB DUES IS INCLUDED IN THE TAXABLE COMPENSATION OF THE CEO. |
Schedule M IRS990ScheduleM
| Field | Value | IRS element (for citing) |
|---|---|---|
| Works Of Art | WorksOfArt | |
| Art Historical Treasures | ArtHistoricalTreasures | |
| Art Fractional Interest | ArtFractionalInterest | |
| Books And Publications | BooksAndPublications | |
| Clothing And Household Goods | ClothingAndHouseholdGoods | |
| Cars And Other Vehicles | CarsAndOtherVehicles | |
| Boats And Planes | BoatsAndPlanes | |
| Intellectual Property | IntellectualProperty |
Securities Publicly Traded SecuritiesPubliclyTraded
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 2 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 1423442 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | FAIR MARKET VALUE | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities Closely Held Stock | SecuritiesCloselyHeldStock |
Securities Prtnrshp Trust Intrsts SecuritiesPrtnrshpTrustIntrsts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 2 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 5406386 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | APPRAISAL | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities Miscellaneous | SecuritiesMiscellaneous | |
| Qualified Contrib Hist Struct | QualifiedContribHistStruct | |
| Qualified Contrib Other | QualifiedContribOther | |
| Real Estate Residential | RealEstateResidential | |
| Real Estate Commercial | RealEstateCommercial | |
| Real Estate Other | RealEstateOther | |
| Collectibles | Collectibles | |
| Food Inventory | FoodInventory | |
| Drugs And Medical Supplies | DrugsAndMedicalSupplies | |
| Taxidermy | Taxidermy | |
| Historical Artifacts | HistoricalArtifacts | |
| Scientific Specimens | ScientificSpecimens | |
| Archaeological Artifacts | ArchaeologicalArtifacts | |
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGifts |
| Third Parties Used | false | ThirdPartiesUsed |
Form990 Schedule M Part II Form990ScheduleMPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | NUMBER OF CONTRIBUTIONS | Identifier |
| Return Reference | SCHEDULE M, PART I, COLUMN B | ReturnReference |
| Explanation | THE AMOUNTS REPORTED ON COLUMN B OF PART I REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED DURING THE YEAR. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROCESS TO REVIEW 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. |
| CONFLICT OF INTEREST POLICY | PART VI, SECTION B, LINE 12 | 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. |
| COMPENSATION REVIEW PROCESS | 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 2012. |
| GOVERNING DOCUMENTS | PART VI, SECTION C, LINE 19 | AT THIS TIME NONE OF KIRBY'S GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE GENERAL PUBLIC. |
| OTHER FEE FOR SERVICES | PART IX, LINE 11G | MEDICAL SERVICES FEES $2,897,247 ADMINISTRATIVE SERVICE FEES $152,487 ---------- TOTAL OTHER FEES FOR SERVICES $3,049,734 |
| OTHER CHANGES IN NET ASSETS | PART XI, LINE 9 | CHANGE IN INTEREST IN PERPETUAL TRUST $74,108 PRIOR YEAR ADJUSTMENT FOR RESTRICTED LAND 487,246 ADJUSTMENT FOR GIFT SHOP (5,816) -------- TOTAL OTHER CHANGES TO NET ASSETS $555,538 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE KIRBY FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| 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) |
|---|---|---|
| EIN | 061836473 | EIN |
| Primary Activities | CHARITABLE | PrimaryActivities |
| Legal Domicile State | IL | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 7 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KIRBY MED CR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | true | ControlledOrg |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PERPETUAL TRUSTS - 4 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activity | FARMING | PrimaryActivity |
| Legal Domicile State | IL | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KIRBY MED CR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | TRUST | TypeOfEntity |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |