MENDOTA COMMUNITY HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MENDOTA COMMUNITY HOSPITAL (EIN 36-2167785)
- Tax period
- 2012-04-01 to 2013-03-31
- Filed
- 2013-11-13
- IRS object ID
- 201313179349305471
- Schema version
- 2012v2.1
- 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 I
- Schedule J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-13T15:31:57-06:00 | Timestamp |
| Tax Period End Date | 2013-03-31 | 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 | 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 | ReturnType |
| Tax Period Begin Date | 2012-04-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 362167785 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MENDOTA COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % HOWARD SCHOU CFO | InCareOfName |
| Name Control | MEND | NameControl |
| Phone | 8155397461 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | HOWARD SCHOU | Name |
| Title | CFO | Title |
| Phone | 8155397461 | Phone |
| Date Signed | 2013-11-13 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Donna J Larson | Name |
| Phone | 3142315544 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | LYNN KLEIN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 34636136 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | mendotahospital.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1944 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | 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 CARE SERVICES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 381 | TotalNbrEmployees |
| Total Nbr Volunteers | 75 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 366731 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 135251 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 30524989 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 32596729 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 166770 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1127184 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 128770 | OtherRevenuePriorYear |
| Other Revenue Current Year | 130789 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 31187260 | TotalRevenuePriorYear |
| Total Revenue Current Year | 33989953 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 8675 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 13000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 17863060 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 18095047 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 99144 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 15165930 | OtherExpensePriorYear |
| Other Expenses Current Year | 18558396 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 33037665 | TotalExpensesPriorYear |
| Total Expenses Current Year | 36666443 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1850405 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -2676490 | RevenuesLessExpensesCY |
| Total Assets BOY | 55624565 | TotalAssetsBOY |
| Total Assets EOY | 50809287 | TotalAssetsEOY |
| Total Liabilities BOY | 41294695 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 40112290 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 14329870 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 10696997 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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 CARE SERVICES. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 29881391 | Expense |
| Grants | 13000 | Grants |
| Revenue | 32596729 | Revenue |
| Description | MENDOTA COMMUNITY HOSPITAL PROVIDED 25 BEDS IN FISCAL YEAR 2013. THIS HOSPITAL GAVE $1,603,018 IN CHARITY CARE, AND PROVIDED 7,831 MEALS ON WHEELS TO MEMBERS OF OUR COMMUNITY. THE NET COMMUNITY BENEFIT EXPENSE WAS $50,175. 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 THROUGH OUT THE YEAR. THE NET COMMUNITY BENEFIT EXPENSE WAS $21,689. | Description |
| Total Program Service Expense | 29881391 | 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 | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | 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 | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | true | 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 | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 60 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 381 | 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 | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | 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 | true | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | 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 | HOWARD SCHOU CFO | NamePerson |
| Telephone Number | 8155397461 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 E 12TH STREET | AddressLine1 |
| City | MENDOTA | City |
| State | IL | State |
| ZIP Code | 61342 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| STEVEN F GAHAN | ||||||||
| DIRECTOR | 2.0 | X | 0 | 0 | 0 | |||
| DAVID SCHOLL MD | ||||||||
| DIRECTOR | 40.0 | X | 195970 | 0 | 24293 | |||
| MARGO GALLAGHER SCHMITZ RN | ||||||||
| 1ST VICE PRESIDENT | 2.0 | X | 0 | 0 | 0 | X | ||
| CURTIS ZIMMERMAN | ||||||||
| DIRECTOR | 2.0 | X | 0 | 0 | 0 | |||
| P DANIEL DOYLE OD | ||||||||
| TREASURER | 2.0 | X | 0 | 0 | 0 | X | ||
| ROBERT F STACHLEWITZ JR | ||||||||
| SECRETARY | 2.0 | X | 0 | 0 | 0 | X | ||
| ERIC ANDERSON | ||||||||
| DIRECTOR | 2.0 | X | 0 | 0 | 0 | |||
| JOSEPH BEETZ | ||||||||
| PRESIDENT | 2.0 | X | 0 | 0 | 0 | X | ||
| KERI SUNDBERG DDS | ||||||||
| DIRECTOR | 2.0 | X | 0 | 0 | 0 | |||
| MICHAEL PHALEN | ||||||||
| 2ND VICE PRESIDENT | 2.0 | X | 0 | 0 | 0 | X | ||
| KATI STEVENSON | ||||||||
| PAST PRESIDENT | 2.0 | X | 0 | 0 | 0 | X | ||
| JOSE DE J ARTEAGA | ||||||||
| DIRECTOR | 2.0 | X | 0 | 0 | 0 | |||
| CHRISTINE KLEIN | ||||||||
| DIRECTOR | 2.0 | X | 0 | 0 | 0 | |||
| LYNN E KLEIN | ||||||||
| CEO | 40.0 | 155338 | 0 | 23678 | X | |||
| LARRY D PEACH | ||||||||
| CFO | 40.0 | 166780 | 0 | 23253 | X | |||
| KEITH MINIHANE MD | ||||||||
| ORTHOPEDIC SURGEON | 40.0 | 750728 | 0 | 21263 | X | |||
| KENNETH K POTTS | ||||||||
| NURSE ANESTHETIST | 20.0 | 325240 | 19762 | X | ||||
| MARY CHINN MD | ||||||||
| PHYSICIAN | 40.0 | 197023 | 0 | 19128 | X | |||
| AMY MATHEIS-SOLIMAN MD | ||||||||
| PHYSICIAN | 40.0 | 194563 | 0 | 24293 | X | |||
| TIMOTHY O MINUS MD | ||||||||
| PHYSICIAN | 40.0 | 338177 | 0 | 19838 | X | |||
| IRAM MINUS MD | ||||||||
| PHYSICIAN | 40.0 | 176748 | 0 | 5221 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2500567 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 180729 | TotalOtherCompensation |
| Number Individuals GT100 K | 17 | 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 |
|---|---|---|---|---|---|
| ER DOCTORS LTD | |||||
| 7 WOOD DUCK LANE | OTTAWA | IL | 61350 | MEDICAL PHYSICIANS | 1606477 |
| MEDICAL STAFFING NETWORK | |||||
| 4525 WEAVER PARKWAY SUITE 310 | WARRENVILLE | IL | 605554031 | NURSING AGENCY | 183715 |
| MEDICAL OUTSOURCING SOLUTIONS INC | |||||
| 2060 ABERDEEN COURT SUITE D | SYCAMORE | IL | 60178 | RADIOLOGY SERVICE | 561750 |
| READY LINK HEALTHCARE | |||||
| 72030 METROPLEX DR PO BOX 1047 | THOUSAND PALMS | CA | 92276 | NURSING AGENCY | 159250 |
| BKD LLP | |||||
| 211 N BROADWAY SUITE 600 | ST LOUIS | MO | 631022733 | AUDITORS | 114720 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Fundraising Events | 13850 | FundraisingEvents |
| All Other Contributions | 121401 | AllOtherContributions |
| Total Contributions | 135251 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PROGRAM SERVICE REVENUE | 621110 | 31607057 | 31607057 |
| OTHER OPERATING REVENUE | 621110 | 989672 | 989672 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 32596729 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 83606 | TotalRevenueColumn |
| Exclusion | $83,606 | 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 | 64015 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 7503 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 56512 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 56512 | TotalRevenueColumn |
| Exclusion | $56,512 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1669418 | Securities |
| Other | 0 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 625720 | Securities |
| Other | 120 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1043698 | Securities |
| Other | -120 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1043578 | TotalRevenueColumn |
| Exclusion | $1,043,578 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 12708 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 12840 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -132 | TotalRevenueColumn |
| Exclusion | -$132 | ExclusionAmount |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| OTHER NON OPERATING REVENUE | 900099 | 80 | $80 |
| CAFETERIA | 722210 | 74329 | $74,329 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 74409 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 33989953 | TotalRevenueColumn |
| Related Or Exempt Function Income | 32596729 | RelatedOrExemptFunctionIncome |
| Exclusion | $1,257,973 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13000 | Total |
| Program Services | 13000 | ProgramServices |
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 | 1331315 | Total |
| Program Services | 996453 | ProgramServices |
| Management And General | 334862 | 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 | 13412833 | Total |
| Program Services | 11925303 | ProgramServices |
| Management And General | 1447383 | ManagementAndGeneral |
| Fundraising | 40147 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 340953 | Total |
| Program Services | 312332 | ProgramServices |
| Management And General | 27607 | ManagementAndGeneral |
| Fundraising | 1014 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2040293 | Total |
| Program Services | 1855810 | ProgramServices |
| Management And General | 178613 | ManagementAndGeneral |
| Fundraising | 5870 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 969653 | Total |
| Program Services | 869551 | ProgramServices |
| Management And General | 97400 | ManagementAndGeneral |
| Fundraising | 2702 | Fundraising |
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 | 52014 | Total |
| Management And General | 52014 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 85805 | Total |
| Management And General | 85805 | 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 | 2573121 | Total |
| Program Services | 2528447 | ProgramServices |
| Management And General | 44674 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 218991 | Total |
| Program Services | 113561 | ProgramServices |
| Management And General | 105430 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5024525 | Total |
| Program Services | 3579731 | ProgramServices |
| Management And General | 1418098 | ManagementAndGeneral |
| Fundraising | 26696 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 408103 | Total |
| Program Services | 368389 | ProgramServices |
| Management And General | 39714 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71874 | Total |
| Program Services | 50343 | ProgramServices |
| Management And General | 21531 | 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 | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2202160 | Total |
| Management And General | 2202160 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3591345 | Total |
| Program Services | 3591345 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 512967 | Total |
| Program Services | 464274 | ProgramServices |
| Management And General | 48693 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BLOOD BANK | 120842 | 120842 | |
| PROVISION FOR BAD DEBT | 2046533 | 2046533 | |
| LINENS & OUTSIDE SERVICES | 88038 | 88038 | |
| CONTRACTS/REPAIRS | 1361449 | 932206 | 429243 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 200629 | Total |
| Program Services | 25233 | ProgramServices |
| Management And General | 152681 | ManagementAndGeneral |
| Fundraising | 22715 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36666443 | Total |
| Program Services | 29881391 | ProgramServices |
| Management And General | 6685908 | ManagementAndGeneral |
| Fundraising | 99144 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3603 | BOY |
| EOY | 3711 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3387737 | BOY |
| EOY | 1790227 | 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 | 6197564 | BOY |
| EOY | 4873178 | 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 | 735837 | BOY |
| EOY | 705529 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 570828 | BOY |
| EOY | 504584 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 51929222 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 11504656 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42774095 | BOY |
| EOY | 40424566 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1943141 | BOY |
| EOY | 2506873 | 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 | 11760 | BOY |
| EOY | 619 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55624565 | BOY |
| EOY | 50809287 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3234286 | BOY |
| EOY | 3247940 | 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 | 37705409 | BOY |
| EOY | 36839350 | 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 | 355000 | BOY |
| EOY | 25000 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41294695 | BOY |
| EOY | 40112290 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13657538 | BOY |
| EOY | 10036038 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41780 | BOY |
| EOY | 41824 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 630552 | BOY |
| EOY | 619135 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14329870 | BOY |
| EOY | 10696997 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55624565 | BOY |
| EOY | 50809287 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -2676490 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | -956383 | ReconciliationUnrealizedInvest |
| 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 Separate | X | FinancialStatementSeparate |
| 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 |
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 | true | GrantsOtherOrganizations |
| Grants Other Organizations | $11,953 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Total Lobbying Expenditures IIB | 11953 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
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 | 4638248 | BeginningOfYearBalance |
| Contributions | 0 | Contributions |
| Investment Earnings Or Losses | 170921 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 1011266 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 3797903 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 6386687 | BeginningOfYearBalance |
| Contributions | 0 | Contributions |
| Investment Earnings Or Losses | 190366 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 1938805 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 4638248 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 4915223 | BeginningOfYearBalance |
| Contributions | 1311605 | Contributions |
| Investment Earnings Or Losses | 159859 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 0 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 6386687 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 6628180 | BeginningOfYearBalance |
| Contributions | 0 | Contributions |
| Investment Earnings Or Losses | 452043 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 2165000 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 4915223 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 7871246 | BeginningOfYearBalance |
| Contributions | 0 | Contributions |
| Investment Earnings Or Losses | -53066 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 1190000 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 6628180 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.82600 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.16340 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.01060 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 40478 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 1272124 | OtherCostOrOtherBasis |
| Book Value | 1312602 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 30855360 | OtherCostOrOtherBasis |
| Depreciation | 3068285 | Depreciation |
| Book Value | 27787075 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 0 | Depreciation |
| Book Value | 0 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 14784159 | OtherCostOrOtherBasis |
| Depreciation | 7916291 | Depreciation |
| Book Value | 6867868 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 4977101 | OtherCostOrOtherBasis |
| Depreciation | 520080 | Depreciation |
| Book Value | 4457021 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 40424566 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | LEGAL CLAIMS RESERVE | Description |
| Amount | $25,000 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 25000 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 31018797 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -956383 | NetUnrealizedGainsInvestments |
| Other Revenues | 31760 | OtherRevenues |
| Revenue Not Rptd F990 | -924623 | RevenueNotRptdF990 |
| Revenue Subtotal | 31943420 | RevenueSubtotal |
| Other Revenues Not Included | 2046533 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 2046533 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 33989953 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 34640253 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 20343 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 20343 | ExpensesNotRptdF990 |
| Expenses Subtotal | 34619910 | ExpensesSubtotal |
| Other Expenses Not Included | 2046533 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 2046533 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 36666443 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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 $12,840 RENTAL EXPENSE $ 7,503 CHANGE IN DONOR RESTRICTION $11,417 ------------------------------------------ TOTAL $31,760 |
| OTHER EXPENSES ON BOOKS BUT NOT ON RETURN | PART XII, LINE 2D | SPECIAL EVENTS DIRECT EXPENSE $12,840 RENTAL EXPENSE $ 7,503 ------------------------------------------ TOTAL $20,343 |
| 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 $2,046,533 |
| OTHER EXPENSES ON RETURN BUT NOT ON BOOKS | PART XII, LINE 4B | PROVISION FOR BAD DEBT $2,043,533 |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | FORE THE HOSPIT | NameOfEvent1 |
| Gross Receipts Event1 | 15676 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 9650 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 6026 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 0 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 2947 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 0 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 1862 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 200 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 1166 | OtherDirectExpensesEvent1 |
| Name Of Event2 | CORNAPALOOZA | NameOfEvent2 |
| Gross Receipts Event2 | 10882 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 4200 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 6682 | GrossRevenueEvent2 |
| Cash Prizes Event2 | 0 | CashPrizesEvent2 |
| Non Cash Prizes Event2 | 806 | NonCashPrizesEvent2 |
| Rent Facility Costs Event2 | 0 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 140 | FoodAndBeverageEvent2 |
| Entertainment Event2 | 100 | EntertainmentEvent2 |
| Other Direct Expenses Event2 | 5619 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 0 | TotalNumberOfOtherEvents |
| Gross Receipts Total | 26558 | GrossReceiptsTotal |
| Charitable Contributions Total | 13850 | CharitableContributionsTotal |
| Gross Revenue Total Events | 12708 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 0 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 3753 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 0 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 2002 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 300 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 6785 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 12840 | DirectExpenseSummaryEvents |
| Net Income Summary | -132 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| 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 | false | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 852713 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 852713 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02460 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3784193 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1734307 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2049886 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05920 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17910 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 17910 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4654816 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1734307 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2920509 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08430 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 133398 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 32341 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 101057 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00290 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 47102 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 47102 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13427 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 13427 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 193927 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 32341 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 161586 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00470 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4848743 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1766648 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3082095 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08900 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $2,046,533 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 14650705 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 14937422 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -286717 | 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 | MENDOTA COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| 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) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| 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 | MENDOTA COMMUNITY HOSPITAL | 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 | 12 | 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 |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | false | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 100 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 200. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Permit Other Actions | X | PermitOtherActions |
| 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 (18 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PERCENT OF TOTAL EXPENSE | PART I, LINE 7, COLUMN F | THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $2,046,533 REPORTED ON PART IX, LINE 25, HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. |
| FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST | 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. |
| 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, WHO'S 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, SPEAKERS BUREAU AND INVOLVEMENT AT THE COMMITTEE LEVEL IN MANY ORGANIZATIONS. |
| 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 | MCH UTILIZES NON-RESIDENTIAL LIENS TO COLLECT FROM PATIENTS. 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. |
| 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. |
| AFFILIATED HEALTH CARE SYSTEM | PART VI, LINE 6 | N/A |
| STATE FILING OF COMMUNITY BENEFIT REPORT | PART VI, LINE 7 | N/A |
| INPUT FROM PERSONS WHO REPRSENT 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. |
| 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. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES | Identifier |
| Return Reference | PART I, LINE 2 | ReturnReference |
| Explanation | THE ORGANIZATION ONLY MAKES GRANTS TO PRE-SELECTED ORGANIZATIONS IN SUPPORT OF HEALTH CARE SERVICES. DURING THE CURRENT YEAR, NO ONE RECIPIENT RECEIVED MORE THAN $5,000. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LYNN E KLEIN | ||||||||||||||
| CEO | 152240 | 0 | 0 | 0 | 3098 | 0 | 4739 | 0 | 18939 | 0 | 179016 | 0 | 0 | 0 |
| LARRY D PEACH | ||||||||||||||
| CFO | 125780 | 0 | 0 | 0 | 41000 | 0 | 5103 | 0 | 18150 | 0 | 190033 | 0 | 0 | 0 |
| DAVID SCHOLL MD | ||||||||||||||
| DIRECTOR | 175194 | 0 | 0 | 0 | 20776 | 0 | 5354 | 0 | 18939 | 0 | 220263 | 0 | 0 | 0 |
| KENNETH K POTTS | ||||||||||||||
| NURSE ANESTHETIST | 319343 | 0 | 5897 | 5999 | 13763 | 345002 | 0 | |||||||
| MARY CHINN MD | ||||||||||||||
| PHYSICIAN | 175880 | 0 | 0 | 0 | 21143 | 0 | 5365 | 0 | 13763 | 0 | 216151 | 0 | 0 | 0 |
| AMY MATHEIS-SOLIMAN MD | ||||||||||||||
| PHYSICIAN | 191804 | 0 | 0 | 0 | 2759 | 0 | 5354 | 0 | 18939 | 0 | 218856 | 0 | 0 | 0 |
| KEITH MINIHANE MD | ||||||||||||||
| ORTHOPEDIC SURGEON | 724833 | 0 | 0 | 0 | 25895 | 0 | 7500 | 0 | 13763 | 0 | 771991 | 0 | 0 | 0 |
| TIMOTHY O MINUS MD | ||||||||||||||
| PHYSICIAN | 335799 | 0 | 0 | 0 | 2378 | 0 | 6075 | 0 | 13763 | 0 | 358015 | 0 | 0 | 0 |
| IRAM MINUS MD | ||||||||||||||
| PHYSICIAN | 175165 | 0 | 0 | 0 | 1583 | 0 | 5221 | 0 | 0 | 0 | 181969 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (4 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| JOELLYN GAHAN | |||
| SPOUSE OF BOARD MEMBER | 40148 | EMPLOYEE | false |
| JARED WISE | |||
| SON-IN-LAW OF BOARD MEMBE | 69597 | EMPLOYEE | false |
| KELLY MINIHANE | |||
| SPOUSE OF KEY EMPLOYEE | 33688 | EMPLOYEE | false |
| BRIGITTE KLEIN | |||
| DAUGHTER OF CEO | 10972 | EMPLOYEE | false |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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, 2012. |
| 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. |
| OFFICERS WHO CANNOT BE REACHED AT THE ORGANIZATION'S ADDRESS | FORM 990, PART VI, SECTION A, LINE 9 | LARRY PEACH 902 CAROLYN STREET MENDOTA, IL 61342 |