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ADVOCATE SHERMAN HOSPITAL: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
ADVOCATE SHERMAN HOSPITAL (EIN 36-2167920)
Tax period
2011-05-01 to 2012-04-30
Filed
2013-03-12
IRS object ID
201320719349300802
Schema version
2011v1.5
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-03-12T16:15:08-05:00Timestamp
Tax Period End Date2012-04-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN420714325EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MCGLADREY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11 S WACKER DRIVE STE 800AddressLine1
CityCHICAGOCity
StateILState
ZIP Code60606ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-05-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN362167920EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Sherman HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSHERNameControl
Phone8477429800Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11425 N Randall RoadAddressLine1
CityElginCity
StateILState
ZIP Code60123ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameEric KruegerName
TitleChief Financial OfficerTitle
Phone8477429800Phone
Date Signed2013-03-06DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameZack FortschName
PTINP00052725PTIN
Phone3126343400Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonRichard B FloydNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11425 N Randall RoadAddressLine1
CityElginCity
StateILState
ZIP Code60123ZIPCode
FieldValueIRS element (for citing)
Gross Receipts286965221GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteHTTP://WWW.SHERMANHEALTH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1887YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionTo serve the community by consistently providing quality healthcare with compassion.ActivityOrMissionDescription
Nbr Voting Members Governing Body20NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees2389TotalNbrEmployees
Total Nbr Volunteers430TotalNbrVolunteers
Total Gross UBI333221TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year890153ContributionsGrantsPriorYear
Contributions Grants Current Year453629ContributionsGrantsCurrentYear
Program Service Revenue Prior Year267101674ProgramServiceRevenuePriorYear
Program Service Revenue CY278421060ProgramServiceRevenueCY
Investment Income Prior Year6653889InvestmentIncomePriorYear
Investment Income Current Year815501InvestmentIncomeCurrentYear
Other Revenue Prior Year4539613OtherRevenuePriorYear
Other Revenue Current Year6969727OtherRevenueCurrentYear
Total Revenue Prior Year279185329TotalRevenuePriorYear
Total Revenue Current Year286659917TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year5000GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY5000GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year110921740SalariesEtcPriorYear
Salaries Etc Current Year114189306SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year168621047OtherExpensePriorYear
Other Expenses Current Year175907766OtherExpensesCurrentYear
Total Expenses Prior Year279547787TotalExpensesPriorYear
Total Expenses Current Year290102072TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-362458RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-3442155RevenuesLessExpensesCY
Total Assets BOY488691902TotalAssetsBOY
Total Assets EOY488443266TotalAssetsEOY
Total Liabilities BOY335511238TotalLiabilitiesBOY
Total Liabilities EOY342089060TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY153180664NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY146354206NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTo make a positive difference through outstanding healthcare and service--every life, every moment, every day.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense210858484Expense
Revenue247227518Revenue
DescriptionSherman Hospital is a not-for-profit healthcare organization that provides acute inpatient and outpatient care to residents of the Elgin, IL community. Founded in 1888, Sherman Hospital has expanded services and has several immediate care centers to better serve its patients, their families and numerous communities. In fiscal year 2012, Sherman treated 14,519 inpatients and had 225,916 outpatient visits. There were 57,681 emergency room visits and 86,416 visits to three immediate care centers. Sherman also delivered 2,803 newborns over the same time period. The Hospital has provided more than $48,000,000 of community benefits as identified below: -Charity care (at cost) $2,719,569 -Language assistant services $535,007* -Government sponsored indigent health care $36,676,417 -Volunteer services $449,815* -Education $409,406 -Research $307,982 -Subsidized health services $181,353 -Bad debts (at cost) $6,587,375*These community benefits were pulled from the Illinois Community Benefit Report.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense26520100Expense
Revenue20062770Revenue
DescriptionCardiac Services: Sherman Health has more than 30 years of cardiovascular excellence focusing on proactively preventing, diagnosing and treating an array of heart conditions. As an accredited Chest Pain Center through the Society of Cardiovascular Patient Care, Sherman is dedicated to the care of our cardiac patients. This accreditation means that we integrate the industry's best practices to provide the best possible outcomes in cardiac care. In 2012 we also received Platinum recognition from the American College of Cardiology/American Heart Association. This recognition is achieved by receiving a 90 percent or above performance rating for four consecutive quarters.Sherman's Heart Failure program has achieved Advanced Certification in Heart Failure designation for our best practices in caring for heart failure patients. Additionally, we have received gold level recognition from the American Heart Association's "Get With the Guidelines-Heart Failure" program for our commitment to improving quality care.For fiscal year 2012, Sherman performed nearly 800 inpatient cardiac cath procedures and over 400 inpatient cardiovascular surgical procedures.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense15796775Expense
Revenue14221050Revenue
DescriptionOrthopedic Services: Sherman Hospital is recognized as a center of excellence in treating diseases and injuries of muscles, bones and joints and is a leader in state-of-the-art orthopedic diagnostic and treatment options. Depending on the injury or illness, treatment can range from non-surgical options such as casts, splints and physical therapy to surgical options from minimally invasive arthroscopy to total joint replacement. For fiscal year 2012, Sherman performed nearly 1,000 inpatient orthopedic surgeries.Description
FieldValueIRS element (for citing)
Total Program Service Expense253175359TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds1InvestTaxExemptBonds
Escrow Account1EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096247NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees2389NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members20NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Eric KruegerBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2247838718TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11425 N Randall RoadAddressLine1
CityElginCity
StateILState
ZIP Code60123ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (33 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Richard Floyd
President/CEO31.50XX5578820133243
Terry Dunning
Chairman4.00XX600000
Charles Burnidge
Vice Chairman4.00XX275000
Audrey Reed
Secretary4.00XX600000
Robert Cormier
Treasurer4.00XX600000
David Bear
Director4.00X575000
Roger Bielinski MD
Director4.00X550000
Nathaniel Edmond
Director4.00X625000
William Hoffer
Director4.00X600000
Lane B Hoffman
Director4.00X50000
Richard Jakle
Director4.00X800000
Joy Jensen
Director4.00X25937015425
Pamela Jensen
Director4.00X600000
Kenneth Koehler
Director4.00X600000
Lawrence Kosinski MD
Director4.00X635000
Dorothea Poulos MD
Director4.00X1900000
Solomon Secemsky MD
Director4.00X600000
Shujauddin Valika MD
Director4.00X3300000
Linda Wallace
Director4.00X600000
Brian Ziegler
Director4.00X525000
Eric Krueger
Chief Financial Officer31.50X309907060598
Linda Deering
Chief Operating Officer34.00X346105064265
Ian Jones
VP Clinical Performance40.00370973066575X
Katie Bata
VP Human Resources33.00209348044703X
Jane Bradford
Exec Dir. Physician Svcs20.00159625013682X
Mary Martini
VP Business Development40.00196142040849X
Judith Balcitis
Chief Nursing Officer40.00186651022495X
Thomas Nitz
VP Ancillary Services39.00189664041425X
Jean Lowe
Patient Care Coord.50.00137035012227X
Sharon McGregor
Pharmacist41.00136629030367X
Michael Mulay
Controller40.00136474026572X
Debra Howell
CV Patient Care Coord.66.0013402204972X
Patrick Uplegger
Director of Pharmacy40.00142458014156X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3379202TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation591554TotalOtherCompensation
Number Individuals GT100 K83NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Lamp Incorporated
460 North Grove AvenueElginIL60120Construction1681627
GE Medical Systems
PO Box 96483ChicagoIL60693Equipment Maintenance/Repairs1606631
Siemens Medical Solutions
Dept CH14195PalatineIL600554195Equipment Maintenance/Repairs1466302
Cerner Corporation
2800 Rockcreek ParkwayKansas CityMO64117Information Technology1464399
McKesson Technologies Inc
PO Box 98347ChicagoIL606938347Information Technology1399304
FieldValueIRS element (for citing)
Number Of Contractors GT100 K91NumberOfContractorsGT100K
Fundraising Events118365FundraisingEvents
Government Grants335264GovernmentGrants
Total Contributions453629TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Net Patient Services621110189454144189454144
Medicare/Medicaid6211108815936188159361
Algonquin Road Surgery900099593278593278
Medical Records621110106547106547
Paramedic Training6211107723077230

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column30500TotalRevenueColumn
Related Or Exempt Function Income30500RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue278421060TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column831515TotalRevenueColumn
Exclusion$831,515ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other208071Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other224085Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-16014Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-16014TotalRevenueColumn
Exclusion-$16,014ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events35535GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events118365CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses81219FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-45684TotalRevenueColumn
Exclusion-$45,684ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
EHR Incentive62150030249813024981
Cafeteria Revenue7210002206320$2,206,320
Other Auxiliary Revenu900099349897$349,897

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column1434213TotalRevenueColumn
Related Or Exempt Function Income65297RelatedOrExemptFunctionIncome
Unrelated Business Revenue333221UnrelatedBusinessRevenue
Exclusion$1,035,695ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue7015411TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column286659917TotalRevenueColumn
Related Or Exempt Function Income281511338RelatedOrExemptFunctionIncome
Unrelated Business Revenue333221UnrelatedBusinessRevenue
Exclusion$5,010,695ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total5000Total
Program Services5000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total3114134Total
Management And General3114134ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total93552766Total
Program Services83619182ProgramServices
Management And General9933584ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2927153Total
Program Services2927153ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total8296098Total
Program Services8296098ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total6299155Total
Program Services6299155ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total177084Total
Program Services177084ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total826617Total
Program Services826617ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total161431Total
Program Services161431ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total14669963Total
Program Services11760531ProgramServices
Management And General2909432ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1774503Total
Program Services52841ProgramServices
Management And General1721662ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1326619Total
Program Services523985ProgramServices
Management And General802634ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total4820299Total
Program Services4735122ProgramServices
Management And General85177ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total13931794Total
Program Services6212733ProgramServices
Management And General7719061ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total208669Total
Program Services129591ProgramServices
Management And General79078ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total14724565Total
Program Services14724565ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total24898030Total
Program Services23209285ProgramServices
Management And General1688745ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total7566624Total
Program Services6730620ProgramServices
Management And General836004ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Medical Supplies48503576474349451068631
Bad Debt Expense2571008325710083
IL Medicaid Tax76373987637398
Intercompany Mgmt Fees47904274790427

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total4180084Total
Program Services2001940ProgramServices
Management And General2178144ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total290102072Total
Program Services253175359ProgramServices
Management And General36926713ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY31353392BOY
EOY32182076EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY47699724BOY
EOY58925655EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY4595034BOY
EOY4502167EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY3416146BOY
EOY2938439EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis610854679LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec247817297LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY385749817BOY
EOY363037382EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY4003262BOY
EOY3001620EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY11874527BOY
EOY23855927EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY488691902BOY
EOY488443266EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY35897453BOY
EOY31277071EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY2116777BOY
EOY2116777EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY264180693BOY
EOY260670052EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY33316315BOY
EOY48025160EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY335511238BOY
EOY342089060EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY152167405BOY
EOY145995503EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1013259BOY
EOY358703EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY153180664BOY
EOY146354206EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY488691902BOY
EOY488443266EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-3442155ReconcilationRevenueExpenses
Reconcilation Other Changes-3384303ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$28,582OtherActivitiesAmount
Total Lobbying Expenditures IIB28582TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1:ReturnReference
ExplanationPercentage of annual IHA and MCHC dues allocable to lobbying activities.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis15177055OtherCostOrOtherBasis
Book Value15177055BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis411891219OtherCostOrOtherBasis
Depreciation114267179Depreciation
Book Value297624040BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis2868783OtherCostOrOtherBasis
Depreciation1079753Depreciation
Book Value1789030BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis171913711OtherCostOrOtherBasis
Depreciation128668047Depreciation
Book Value43245664BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis9003911OtherCostOrOtherBasis
Depreciation3802318Depreciation
Book Value5201593BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings363037382TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Estimated Third-Party Payor Settlements$25,455,631
Accrued Medical Malpractice and Other$22,155,167
Construction Payable$414,362
FieldValueIRS element (for citing)
Total Of Amounts48025160TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDescription of Uncertain Tax Positions Under FIN 48:Identifier
Return ReferencePart X:ReturnReference
ExplanationSherman is primarily comprised of not-for-profit corporations as described in Section 501 (c)(3) of the Internal Revenue Code (Code). Section 501 (c)(3) organizations are exempt from federal income taxes on related income on those entities pursuant to Section 501(a) of the Code. None of Sherman's not-for-profit organizations have significant unrelated business activities. Sherman uses an asset and liability approach for financial accounting and reporting purposes as it relates to income taxes. Deferred tax liabilities and assets are determined based upon the difference between the financial statement and tax basis of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. Sherman Health Systems and its not-for-profit affiliates file the applicable Form 990s (Return of Organization Exempt from Income Tax) annually. When these returns are filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Examples of tax positions common to health systems include such matters as the following: the tax-exempt status of each entity, the continued tax-exempt status of bonds issued by the obligated group, the nature, characterization and taxability of joint venture income and various positions relative to potential sources of unrelated business taxable income (UBIT). UBIT is reported on Form 990T, as appropriate. The benefit of a tax position is recognized in the consolidated financial statements in the period during which, based on all available evidence, management believes that it is more likely than not that the position will be sustained upon examination, including the resolution of appeals or litigation processes, if any. At April 30 2012 and 2011, there were no unrecognized tax benefits identified or recorded as liabilities.Explanation

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Benefit BallNameOfEvent1
Gross Receipts Event1153900GrossReceiptsEvent1
Charitable Contributions Event1118365CharitableContributionsEvent1
Gross Revenue Event135535GrossRevenueEvent1
Rent Facility Costs Event158482RentFacilityCostsEvent1
Other Direct Expenses Event122737OtherDirectExpensesEvent1
Gross Receipts Total153900GrossReceiptsTotal
Charitable Contributions Total118365CharitableContributionsTotal
Gross Revenue Total Events35535GrossRevenueTotalEvents
Rent Facility Costs Total Events58482RentFacilityCostsTotalEvents
Other Direct Expenses Total Events22737OtherDirectExpensesTotalEvents
Direct Expense Summary Events81219DirectExpenseSummaryEvents
Net Income Summary-45684NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage600.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense2719569TotalCommunityBenefitExpense
Net Community Benefit Expense2719569NetCommunityBenefitExpense
Percent Of Total Expense0.00940PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense39895921TotalCommunityBenefitExpense
Direct Offsetting Revenue29814044DirectOffsettingRevenue
Net Community Benefit Expense10081877NetCommunityBenefitExpense
Percent Of Total Expense0.03480PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense42615490TotalCommunityBenefitExpense
Direct Offsetting Revenue29814044DirectOffsettingRevenue
Net Community Benefit Expense12801446NetCommunityBenefitExpense
Percent Of Total Expense0.04420PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense369413TotalCommunityBenefitExpense
Direct Offsetting Revenue46588DirectOffsettingRevenue
Net Community Benefit Expense322825NetCommunityBenefitExpense
Percent Of Total Expense0.00110PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense486636TotalCommunityBenefitExpense
Direct Offsetting Revenue77230DirectOffsettingRevenue
Net Community Benefit Expense409406NetCommunityBenefitExpense
Percent Of Total Expense0.00140PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense307522TotalCommunityBenefitExpense
Direct Offsetting Revenue126173DirectOffsettingRevenue
Net Community Benefit Expense181349NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense351957TotalCommunityBenefitExpense
Direct Offsetting Revenue43975DirectOffsettingRevenue
Net Community Benefit Expense307982NetCommunityBenefitExpense
Percent Of Total Expense0.00110PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense1515528TotalCommunityBenefitExpense
Direct Offsetting Revenue293966DirectOffsettingRevenue
Net Community Benefit Expense1221562NetCommunityBenefitExpense
Percent Of Total Expense0.00420PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense44131018TotalCommunityBenefitExpense
Direct Offsetting Revenue30108010DirectOffsettingRevenue
Net Community Benefit Expense14023008NetCommunityBenefitExpense
Percent Of Total Expense0.04840PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

FieldValueIRS element (for citing)
Total Community Building Expense494235TotalCommunityBuildingExpense
Net Community Building Expense494235NetCommunityBuildingExpense
Percent Of Total Expense0.00160PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense494235TotalCommunityBuildingExpense
Net Community Building Expense494235NetCommunityBuildingExpense
Percent Of Total Expense0.00160PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$25,710,083BadDebtExpenseAmount
Amount Attributable To1981624AmountAttributableTo
Amount Reimbursed By Medicare75458699AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare99333670CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-23874971MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line11 Algonquin Road Surgery Center LLCBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityFree-standing ancillary surgery centerDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.25500OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership0.00000OfficersEtcProfitOrOwnership
Physicans Profit Or Ownership0.49000PhysicansProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Sherman HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11425 N Randall RoadAddressLine1
CityElginCity
StateILState
ZIP Code601232300ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Research FacilityXResearchFacility
Er24 HoursXEr24Hours
OtherGeneral healthcareOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent600.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed1AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities6NumberOfOtherFacilities

Other Facilities OtherFacilities (6 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Sherman Health ImagingRehabilitation
745 Fletcher Drive Suite 103ElginIL60123Imaging & PT Services
Sherman Health Resource Center
1019 E Chicago StreetElginIL60123Cardiac Rehab & PT
Sherman Immediate Care
600 S Randall RoadAlgonquinIL60102Immediate Care
Sherman Immediate Care
901 Center StreetElginIL60103Immediate Care
Sherman Immediate Care
2320 Royal BlvdElginIL60123Immediate Care
Sherman Immediate Care
2000 McDonald RoadSouth ElginIL60177Immediate Care

Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
Part I, Line 6a: Part I, Line 6a. Sherman Hospital prepares and files the Annual Non-Profit Hospital Community Benefit Plan Report with the Attorney General's Office of the State of Illinois.
Part I, L7 Col(f): The following is from the text of the footnote to the audited financial statements describing patient receivables, provision for doubtful accounts and bad debt expense. "Patient receivables due directly from the patients are carried at their original charge for the service provided less amounts covered by third-party payors and less an estimated allowance for doubtful receivables. Management estimates this allowance based on the aging of its accounts receivable and its historical collection experience for each payor type. Recoveries of receivables previously written off are recorded as a reduction of bad debt expense when received. The past due status of receivables is determined on a case-by-case basis depending on the payor responsible. Interest is not charged on past due accounts." Self pay discounts are not included in bad debt expense in the financial statements. The organization's bad debt expense (at cost) as reported on lines 2 and 3 above were determined using a cost to charge ratio.
Part I, line 3a. Sherman provides emergent and medically necessary services to all patients without regard to the patient's ability to pay. Sherman's financial assistance policy applies to all Sherman facilities, and the amount of free care provided under the policy is determined by need and is not limited or rationed by budgeted amounts. Under the policy, Sherman will provide free care to individuals without insurance with incomes up to 200% of the Federal Poverty Level. Part I, Line 3b. For uninsured patients who do not qualify for charity care, Sherman provides a discount regardless of their ability to pay or income level. Under this program, Sherman provides a 30% discount off charges at the time of service. Consistent with the Hospital Uninsured Patient Discount Act (Illinois), uninsured patients may also be entitled to a 66% discount off charges based on their income level. Under this policy, Sherman provides a discount (up to 66%) on a sliding scale up to 600% of the Federal Poverty Level. Of the remaining balance, the patient's liability is capped at 25% of the family annual income.
Part II: Sherman Hospital serves as the Regional Hospital Coordinating Center (RHCC) for Emergency Medical Services Regional Planning Area IX, which is the Illinois Department of Public Health (IDPH) designation for the lead disaster planning hospital. The Region includes 12 full service hospitals and serves a population of approximately 1.4 million people. As the RHCC, Sherman Hospital is a recipient of the ASPR Hospital Preparedness Program grants through IDPH. We are responsible for meeting federally identified capabilities to prepare for all hazardous community health emergencies. One of our primary tasks is to build relationships and resources with municipal, county and state agencies to plan for multidisciplinary response to a community disaster or other healthcare emergency. Our activities seek to improve the resiliency of the population we serve.
Part III, Line 8: The costing methodology used to determine the amount reported on line 6 above was determined using a cost to charge ratio calculated using the IRS worksheets.
Part III, Line 9b: Part III, Line 9b. It is the policy of Sherman to offer patients a payment plan and/or charity assistance when it becomes known or even suspected that a patient needs financial assistance. Financial counselors are notified and every attempt is made to work with the patient or their family to help them complete an application. Financial counselors work with the patient to help determine if they are eligible for any federal programs, including Medicaid, or other third party payors. In the event no third party programs are identified, we then work with the patient to help them apply for charity discounts and payment plans. If a patient is known to qualify for charity care, it is our policy not to pursue collections against them.
Part V, Section B, Line 19d: For uninsured patients who do not qualify for charity care, Sherman provides a discount regardless of their ability to pay or income level. Under this program, Sherman provides a 30% discount off charges at the time of service. Consistent with the Hospital Uninsured Patient Discount Act (Illinois), uninsured patients may also be entitled to a 66% discount off charges based on their income level. Under this policy, Sherman provides a discount (up to 66%) on a sliding scale up to 600% of the Federal Poverty Level. Of the remaining balance, the patient's liability is capped at 25% of the family annual income.N/A
Part V, Section B, Line 20: See Part V, Section B, Line 19d explanation above.N/A
Part VI, Line 2: The Community Health Needs Assessment for 2012 will be conducted in collaboration with area hospitals and the Kane County Health Department. Hospitals participating include Delnor Community Hospital in Geneva, Provena St. Joseph's Hospital in Elgin, Rush Copley in Aurora and Provena Mercy Medical Center in Aurora in addition to Sherman Hospital.Northern Illinois University Public Opinion Lab will be responsible for the survey using telephone and focus group methodology. The 2012 Illinois Behavioral Risk Factor Surveillance Systems (BRFSS) questionnaire will be administered so that it will be possible to compare Kane County results with Illinois and national estimates for adults aged 18 and older, as well as children. Results will include a comprehensive assessment that identifies local public health strengths, weaknesses and unmet health-related needs. Results will be utilized to mobilize the Community Wellness Department at Sherman Health to identify and act on strategic health issues in collaboration with other health agencies in our surrounding service areas.
Part VI, Line 3: Informing the public that charity care is available is an important element of Sherman's charity care program. Information about the policy is posted on the Sherman Health website. Patient bills include detailed information regarding the charity care policy is also provided to patients. A summary description of the financial assistance policy is available in patient registration areas and from financial counselors who are present on-site at the Hospital to assist patients in qualifying for governmental assistance programs and charity care.
Part VI, Line 4: Sherman Hospital is located in Elgin, Illinois which is approximately 40 miles northwest of Chicago. The Hospital's primary and secondary service areas, defined as those zip codes contributing approximately 60% of Hospital's total inpatients, cover portions of Kane, McHenry, DuPage, Lake and Cook counties and are comprised of the following communities:60014 Crystal Lake, IL60102 Algonquin, IL60103 Bartlett, IL60107 Streamwood, IL60110 Carpentersville, IL60118 Dundee, IL60120 Elgin, IL60123 Elgin, IL60124 Elgin, IL60136 Gilberts, IL60142 Huntley, IL60156 Lake in the Hills, IL60177 South Elgin, IL60010 Barrington, IL60012 Crystal Lake, IL60013 Cary, IL60021 Fox River Grove, IL60047 Lake Zurich, IL60050 McHenry, IL60084 Wauconda, IL60098 Woodstock, IL60133 Hanover Park, IL60134 Geneva, IL60140 Hampshire, IL60152 Marengo, IL60174 Saint Charles, IL60175 Saint Charles, IL60180 Union, IL60192 Schaumburg, IL60194 Schaumburg, IL60510 Batavia, ILFor FY12, the adult Hospital admissions were from the following age groups: pediatrics 3%15-44 35%45-64 23%65-74 16%>75 23%The gender of these admissions was 61% female and 39% male.
ILReports Filed With StatesPart VI, Line 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Richard Floyd
4773500739230660901102810229620691125000
Eric Krueger
26861704066406260386880219090370504000
Linda Deering
296142039042010921055951083140410370000
Ian Jones
323460043020044930463770201980437548000
Katie Bata
18062902834803710269750177280254051000
Jane Bradford
158520000110506472072100173307000
Mary Martini
16848202727803820245100163390236991000
Judith Balcitis
171902014018073102191805770209146000
Thomas Nitz
16168302706809130211170203080231089000
Sharon McGregor
1297280006901058340245340166997000
Michael Mulay
1284810007993055430210290163046000
Patrick Uplegger
139421000303705776083790156613000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 1aSherman Hospital pays for dues and other expenses incurred at Elgin Country Club, which is used to entertain physician and board groups. Because Rick Floyd uses the club periodically, he reimburses Sherman for any time or expense deemed personal. None of the expenses are included in his taxable compensation.
Part I, Lines 4a-bSeverance Payment Recipient: Bonnie Wolinski - $17,024 Supplemental Executive Retirement Plan Participants: Richard Floyd - $98,031 Linda Deering - $44,616 Ian Jones - $34,330 Eric Krueger - $27,881 Katie Bata - $18,948 Mary Martini - $17,046 Thomas Nitz - $15,860 Judith Balcitis - $15,434
Part I, Line 7Payment of other incentive compensation was based on meeting or exceeding various corporate goals.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1Illinois Finance AuthorityBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN861091967IssuerEIN
CUSIP Number45200FBB4CUSIPNumber
Date Issued2007-10-31DateIssued
Issue Price168752200IssuePrice
Description Of PurposeConstruct and equip facilityDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds175445169TotalProceeds
Amount In Reserve Fund17496408AmountInReserveFund
Issuance Costs From Proceeds2395571IssuanceCostsFromProceeds
Working Capital Expenditures7956935WorkingCapitalExpenditures
Capital Expenditures147596255CapitalExpenditures
Year Of Subst Completion2009YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made0FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.01000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.01000TotalPrivateBusinessUse
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC1GrossProceedsInvestedInGIC

Name Of GIC Provider NameOfGICProvider

FieldValueIRS element (for citing)
Business Name Line1Royal Bank ofBusinessNameLine1
Business Name Line2CanadaBusinessNameLine2
FieldValueIRS element (for citing)
Term Of GIC30.000000000000TermOfGIC
Regulatory Safe Harbor Satisfied1RegulatorySafeHarborSatisfied
Gross Proceeds Invested1GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonJuliet DunningNamePerson
FieldValueIRS element (for citing)
RelationshipDaughter of Terry Dunning, ChairmanRelationship
Amount Of Transaction32501AmountOfTransaction
Description Of TransactionGross wagesDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 6The sole member of Hospital is Sherman Health Systems (SHS).
Form 990, Part VI, Section A, line 7aSee Part VI, Section A, Line 7b explanation.
Form 990, Part VI, Section A, line 7bThe following decisions of Hospital's board of directors requires approval from SHS, as its sole member: -To appoint the directors of the Corporation; -To remove a director of the Corporation at any time, with or without cause; -To appoint the Chairman and Vice Chairman of the Corporation, and all officers of the Corporation who are not also employees of the Corporation; -To unilaterally approve and amend the articles of incorporation and bylaws of the Corporation before the same become effective; -To approve, interpret or change the statement of the Corporation's purpose before the same becomes effective; -To approve each annual operating and capital budget and long-range plan of the Corporation before expenditures may be made therefrom; -To approve the appointment of independent auditors, all accounting policies, internal auditors (if any) and all investment guidelines; -To approve all contracts obligating the Corporation to expend or repay an amount in excess of $100,000, and which was not included in a previously approved annual budget; -To approve all plans of merger, consolidation or voluntary dissolution of the Corporation; -To approve the sale, lease, exchange, mortgage, pledge or other diposition of more than $100,000 in value of property and assets of the Corporation in any one year which is not within an approved budget; -To approve the creation of majority controlled or owned subsidiaries or affiliates by the Corporation; -To approve the Corporation's incurring debt, including intra-system debt, or obligating its assets in excess of an amount designated by the Member, unless such debt or obligation was included in a budget previously approved by the Member; -To approve corporate acquisitions by the Corporation of any joint venture; -To approve investments by the Corporation in excess of an amount designated by the Member, unless such investment was included in a budget previously approved by the Member
Form 990, Part VI, Section B, line 11The organization's tax advisor prepares Form 990. Management reviews Form 990 with the tax advisor and submits the completed form to the Audit Committee for review and approval. The Audit Committee meets with the tax advisor to discuss and approve Form 990 for filing. A copy of Form 990 is distributed to the organization's governing body prior to filing.
Form 990, Part VI, Section B, line 12cEach director, principal officer and member of a committee with board-delegated powers shall annually sign a statement, which affirms that such person: a) has received a copy of the conflict of interest policy, b) has read and understands the policy, c) has agreed to comply with the policy, and d) understands that Sherman is a charitable organization and that in order to maintain federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes. To ensure that Sherman operates in a manner consistent with its charitable purposes and that it does not engage in activities that could jeopardize its status as an organization exempt from federal income tax, periodic reviews are conducted.
Form 990, Part VI, Section B, line 15Market evaluations will be conducted on a periodic basis for all positions within Sherman. The evaluation process consists of review of established salary benchmarks for market competitiveness, and evaluation of turnover and retention. The independent salary and executive compensation committee is responsible for evaluating the performance of and establishing the compensation and benefits for the senior management of the parent corporation and its affiliates. Contemporaneous documentation is maintained for all decisions and deliberations.
Form 990, Part VI, Section C, line 19All organization governing documents, the conflict of interest policy, and financial statements are made available to the public upon request.
Form 990, Part VII, Hours Per Week Worked at Related Organizations:Richard Floyd: Sherman Health Systems - 6 hrs; Sherman West Court - 1 hr; Sherman Home Health Care Corporation - 1 hr; Sherman Health Foundation - 0.5 hrs Eric Krueger: Sherman Health Systems - 6 hrs; Sherman West Court - 1 hr; Sherman Home Health Care Corporation - 1 hr; Sherman Health Foundation - 0.5 hrs Linda Deering: Sherman Health Systems - 6 hrs Katie Bata: Sherman Health Systems - 6 hrs; Sherman Home Health Care Corporation - 1 hr Thomas Nitz: Sherman West Court - 1 hr Joy Jensen: Sherman Health Foundation - 20 hrs Jane Bradford: Health Visions, Inc. - 20 hrs
Form 990, Part XI, line 5:Book/Tax Difference Relating to Partnership Investments -61,007. Net Transfers to Affiliates -2,788,585. Net Assets Released from Restriction -1,100,081. Interest in Contributions of Sherman Health Foundation 565,370. Total to Form 990, Part XI, Line 5: -3,384,303.Changes in Net Assets or Fund Balances:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
Sherman Health Foundation
1425 N Randall RoadElginIL60123320106211Provide Charitable Support to Healthcare OrganizationIL501(c)(3)Line 11a, ISherman Health Systems1
Sherman Health Systems
1425 N Randall RoadElginIL60123363673380Maintain Health Service Institutions serving the Surrounding CommunityIL501(c)(3)Line 11a, I0N/A
Sherman Home Health Care Corporation
901 Center Street Suite 2001AElginIL60120363330085Services Include Skilled and Unskilled General NursingIL501(c)(3)Line 9Sherman Health Systems1
Sherman West Court
1950 Larkin AvenueElginIL60123363725580Provide Long-Term Nursing CareIL501(c)(3)Line 9Sherman Health Systems1

Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityAddress Line1AddressForeign/AddressLine1Province Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryPostal CodeAddressForeign/PostalCodeLegal Domicile Foreign CountryLegalDomicileForeignCountry
Health Visions Inc
1425 N Randall RoadElginIL60123363780082Physician Practice ManagementILN/AC
Sherman Group Practice Inc
1435 N Randall RoadElginIL60123262891035Physician GroupILN/AC
Sherman Health Insurance Company Ltd
980703036Insurance ProviderN/ACPO Box 1159Grand CaymanCJKY1-1102CJ
Sherman Physician Group Inc
1435 N Randall RoadElginIL60123264800497Physician GroupILN/AC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (16 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Sherman Health Systems
A496Cash
Health Visions Inc
N3979996Cash
Sherman Health Foundation
N258046Cash
Sherman Home Health Care Corporation
N2335717Cash
Sherman West Court
N4536091Cash
Health Visions Inc
P1567867Cash
Sherman Health Foundation
P229986Cash
Sherman Home Health Care Corporation
P1288105Cash
Sherman West Court
P5073433Cash
Sherman Health Foundation
Q355460Cash
Sherman Home Health Care Corporation
Q1776428Cash
Sherman West Court
Q3193522Cash
Health Visions Inc
R10755200Cash
Sherman West Court
R11015000Cash
Sherman Health Foundation
R1349759Cash
Sherman Home Health Care Corporation
R4265000Cash