FREEPORT MEMORIAL HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- FREEPORT MEMORIAL HOSPITAL (EIN 36-2181997)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-08-07
- IRS object ID
- 201332199349300723
- 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 H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-07T10:57:13-05:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 362181997 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FREEPORT MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FREE | NameControl |
| Phone | 8155996209 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1045 W STEPHENSON ST | AddressLine1 |
| City | FREEPORT | City |
| State | IL | State |
| ZIP Code | 61032 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MICHAEL C CLARK | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 8155996361 | Phone |
| Date Signed | 2013-08-07 | DateSigned |
| Authorize Third Party | 0 | AuthorizeThirdParty |
| 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 | MICHAEL R PERRY MD PRES | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1045 W STEPHENSON ST | AddressLine1 |
| City | FREEPORT | City |
| State | IL | State |
| ZIP Code | 61032 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 133942723 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.FHN.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1964 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | OUR MISSION IS TO IMPROVE THE HEALTH OF OUR COMMUNITIES, WORKING TOGETHER WITH THOSE WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1295 | TotalNbrEmployees |
| Total Nbr Volunteers | 514 | TotalNbrVolunteers |
| Total Gross UBI | 43542 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -3223 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 237411 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 191173 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 124966015 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 133450207 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 282968 | InvestmentIncomePriorYear |
| Investment Income Current Year | 223389 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 125486394 | TotalRevenuePriorYear |
| Total Revenue Current Year | 133864769 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 39472675 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 38353831 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 69405383 | OtherExpensePriorYear |
| Other Expenses Current Year | 68929205 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 108878058 | TotalExpensesPriorYear |
| Total Expenses Current Year | 107283036 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 16608336 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 26581733 | RevenuesLessExpensesCY |
| Total Assets BOY | 71249362 | TotalAssetsBOY |
| Total Assets EOY | 73410812 | TotalAssetsEOY |
| Total Liabilities BOY | 34585535 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 32319478 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 36663827 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 41091334 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | SEE SCHEDULE O | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 45054881 | Expense |
| Revenue | 92298965 | Revenue |
| Description | FREEPORT MEMORIAL HOSPITAL PROVIDES INPATIENT AND OUTPATIENT HOSPITAL SERVICES TO PATIENTS IN FIVE NORTHWESTERN ILLINOIS COUNTIES. THE HOSPITAL ENSURES CONTINIUED ACCESS TO CARE BY SERVING PATIENTS IN MEDICALLY UNDERSERVED AREAS. THE HOSPITAL QUALIFIES AS A MEDICARE DISPROPORTIONATE SHARE HOSPITAL BECAUSE IT SERVES A DISPROPORTIONATELY HIGH NUMBER OF LOW-INCOME PATIENTS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 55090652 | Expense |
| Revenue | 41107700 | Revenue |
| Description | OTHER UNCOMPENSATED CARE: THE HOSPITAL IS A LICENSED MEDICARE AND MEDICAID PROVIDER WITH APPROXIMATELLY 67% OF ITS' PATIENT BASE QUALIFYING FOR AT LEAST ONE OF THESE PROGRAMS. AT PRESENT THE REIMBURSEMENT RATES OF THESE PROGRAMS DO NOT FULLY COVER THE COST OF CARE TO THESE PATIENTS. THE ESTIMATED UNFUNDED COST OF SERVICE FOR MEDICARE PATIENTS WAS APPROXIMATELY $7,498,847 AND MEDICAID PATIENTS WAS APPROXIMATELY $6,487,105 FOR THE YEAR ENDING 12/31/2012. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1976417 | Expense |
| Revenue | 0 | Revenue |
| Description | CHARITY CARE: THE HOSPITAL PROVIDED CHARITY CARE BENEFITS FOR PATIENTS WHOSE INCOME WAS UP TO 300% OF THE FEDERALLY DETERMINED PROVERTY LEVEL. CHARGES FOREGONE FOR CHARITY CARE AMOUNTED TO APPROXIMATELY $7,101,820 IN 2012. ESTIMATED COSTS OF PROVIDING THESE SERVICES AMOUNTED TO APPROXIMATELY $1,976,417 IN 2012. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 784655 | Expense |
| Revenue | 0 | Revenue |
| Description | OTHER COMMUNITY BENEFITS: THE HOSPITAL OPERATES AND SUPPORTS A NUMBER OF COMMUNITY BENEFIT PROGRAMS THAT INCLUDE BUT ARE NOT LIMITED TO COMMUNITY HEALTH EDUCATION, HEALTH CARE SUPPORT SERVICES AND HEALTH PROFESSIONAL EDUCATION. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 784655 | TotalOfOtherProgramServiceExp |
| Total Program Service Expense | 102906605 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 71 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1295 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLIAM SPANGLER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8155996376 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1045 W STEPEHNSON ST | AddressLine1 |
| City | FREEPORT | City |
| State | IL | State |
| ZIP Code | 61032 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (29 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 | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| CAROL SCHUSTER | |||||||||
| CHAIRMAN | 0.50 | X | 0 | 0 | 0 | ||||
| DARIN DOAK | |||||||||
| VICE CHAIRMAN | 0.50 | X | 0 | 0 | 0 | ||||
| ELLEN POPPEN | |||||||||
| TREASURER | 0.50 | X | 0 | 0 | 0 | ||||
| LARRY MAIN | |||||||||
| SECRETARY | 0.50 | X | 0 | 0 | 0 | ||||
| MARTIN CLEARY MD | |||||||||
| BOARD MEMBER | 0.50 | X | 0 | 443247 | 68463 | ||||
| GARY FONTANA | |||||||||
| BOARD MEMBER | 0.50 | X | 0 | 0 | 0 | ||||
| DOUG FREIDAG | |||||||||
| BOARD MEMBER | 0.50 | X | 0 | 0 | 0 | ||||
| DICK DROGOSZ | |||||||||
| BOARD MEMBER | 0.50 | X | 0 | 0 | 0 | ||||
| BHADRESH PATEL MD | |||||||||
| BOARD MEMBER | 0.50 | X | 0 | 474308 | 69651 | ||||
| REBECCA PEDERSON MD | |||||||||
| BOARD MEMBER | 0.50 | X | 0 | 316231 | 54801 | ||||
| STEVEN KNEUBUEHL | |||||||||
| BOARD MEMBER | 0.50 | X | 0 | 0 | 0 | ||||
| NEAL RICHARDSON | |||||||||
| BOARD MEMBER | 0.50 | X | 0 | 0 | 0 | ||||
| ALLEN WORKMAN MD | |||||||||
| CHAIR PHYSICIANS COUNCIL | 0.50 | X | 0 | 305222 | 42599 | ||||
| JOHN SCHEUB MD | |||||||||
| BOARD MEMBER | 0.50 | X | 0 | 0 | 0 | ||||
| ZACHARY FULTON MD | |||||||||
| PRESIDENT MEDICAL STAFF | 0.50 | X | 0 | 258132 | 43329 | ||||
| MICHAEL PERRY MD | |||||||||
| PRESIDENT/CEO | 24.00 | 327721 | 192470 | 77953 | X | ||||
| MICHAEL C CLARK | |||||||||
| EXECUTIVE VP/CFO | 24.00 | 144962 | 85136 | 70203 | X | ||||
| SHARON SUMMERS | |||||||||
| EXECUTIVE VP/COO | 24.00 | 149493 | 87796 | 69708 | X | ||||
| LEONARD CARTER | |||||||||
| HUMAN RESOURCES | 24.00 | 106449 | 62517 | 26446 | X | ||||
| ROBERT GELLER MD | |||||||||
| VP OF MEDICAL AFFAIRS | 40.00 | 0 | 265913 | 86509 | X | ||||
| NANCY V CUTLER | |||||||||
| VP OF NURSING CNO | 40.00 | 177656 | 0 | 53654 | X | ||||
| WILLIAM SPANGLER | |||||||||
| ASST. VP FINANCE | 41.00 | 121493 | 0 | 41898 | X | ||||
| MICHAEL G WEAVER | |||||||||
| PHARMACY DIRECTOR | 40.00 | 135851 | 0 | 49641 | X | ||||
| THOMAS WAGNER | |||||||||
| PHARMACIST | 43.00 | 120385 | 0 | 39743 | X | ||||
| ROBIN SCALISE | |||||||||
| IMAGING DIRECTOR | 40.00 | 132814 | 0 | 23720 | X | ||||
| YOUNG J ROH | |||||||||
| PHARMACIST CLINICAL | 40.00 | 121401 | 0 | 696 | X | ||||
| WENDY LAWLER | |||||||||
| FORMER LABORATORY DIRECTOR | 48.00 | 108724 | 0 | 32436 | X | ||||
| WILLIAM PALMQUIST | |||||||||
| FORMER PHARMACIST | 44.00 | 118841 | 0 | 47593 | X | ||||
| RAYMOND D SALAZAR | |||||||||
| ER CLINICAL LEADER | 40.00 | 115995 | 0 | 25465 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1881785 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2490972 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 924508 | TotalOtherCompensation |
| Number Individuals GT100 K | 14 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| MEA-FREEPORT LLC | |||||
| 1 TRNSAM PLAZA DR SUITE 360 | OAK BROOK | IL | 60181 | EMERGENCY DEPT | 4550135 |
| CAMELOT RADIOLOGY DBA N ILLINOIS RADIOL | |||||
| 3849 PERRYVILLE RD | ROCKFORD | IL | 61114 | RADIOLOGY PHYSICIANS | 2234221 |
| MEDQUEST TRANSCRIPTION SERVICES LTD | |||||
| 1000 BISHOPS GATES BLVD | MT LAUREL | NJ | 08054 | TRANSCRIPTION SERVICES | 1126925 |
| ALLIANCE HEALTHCARE SERVICES | |||||
| PO BOX 6600 | NEWPORT BEACH | CA | 92658 | IMAGING SERVICES | 945631 |
| SODEXHO HEALTH CARE SERVICES | |||||
| 100 AVON MEADOW | AVON | CT | 06001 | CONSTRUCTION SERVICES | 660558 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 13 | NumberOfContractorsGT100K |
| Government Grants | 28228 | GovernmentGrants |
| All Other Contributions | 162945 | AllOtherContributions |
| Total Contributions | 191173 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERV. REVENUE | 621400 | 124173623 | 124130081 | 43542 |
| PROVIDER TAX REVENUE | 621400 | 4769126 | 4769126 | |
| EHR INCENTIVE PAYMENT | 621400 | 2412275 | 2412275 | |
| GOVERNMENT PAYMENT | 621400 | 1422524 | 1422524 | |
| CAFETERIA REVENUE | 621400 | 453520 | 453520 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 219139 | TotalRevenueColumn |
| Related Or Exempt Function Income | 219139 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 133450207 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 301343 | TotalRevenueColumn |
| Exclusion | $301,343 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 72215 | Securities |
| Other | 5739 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -72215 | Securities |
| Other | -5739 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -77954 | TotalRevenueColumn |
| Exclusion | -$77,954 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 133864769 | TotalRevenueColumn |
| Related Or Exempt Function Income | 133406665 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 43542 | UnrelatedBusinessRevenue |
| Exclusion | $223,389 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 882542 | Total |
| Management And General | 882542 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27857265 | Total |
| Program Services | 26454777 | ProgramServices |
| Management And General | 1402488 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 790493 | Total |
| Program Services | 585750 | ProgramServices |
| Management And General | 204743 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6805641 | Total |
| Program Services | 6805641 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2017890 | Total |
| Program Services | 1895567 | ProgramServices |
| Management And General | 122323 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2592 | Total |
| Management And General | 2592 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50000 | Total |
| Management And General | 50000 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10281164 | Total |
| Program Services | 9965094 | ProgramServices |
| Management And General | 316070 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4670796 | Total |
| Program Services | 4470197 | ProgramServices |
| Management And General | 200599 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 96002 | Total |
| Program Services | 89957 | ProgramServices |
| Management And General | 6045 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 277337 | Total |
| Program Services | 72885 | ProgramServices |
| Management And General | 204452 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4275375 | Total |
| Program Services | 3927288 | ProgramServices |
| Management And General | 348087 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2186943 | Total |
| Program Services | 2186943 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| CONTRACTED SERVICES | 11012438 | 10454365 | 558073 |
| MEDICAL SPECIALIST | 10022268 | 9997021 | 25247 |
| CORPORATE ALLOCATION | 9319719 | 9319719 | |
| BAD DEBTS | 9215231 | 9215231 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7519340 | Total |
| Program Services | 7466170 | ProgramServices |
| Management And General | 53170 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 107283036 | Total |
| Program Services | 102906605 | ProgramServices |
| Management And General | 4376431 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16262791 | BOY |
| EOY | 20463753 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21916730 | BOY |
| EOY | 22644482 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1237390 | BOY |
| EOY | 1741478 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1324201 | BOY |
| EOY | 1453047 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3442178 | BOY |
| EOY | 3212826 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 77600599 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 55792180 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24974751 | BOY |
| EOY | 21808419 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1519853 | BOY |
| EOY | 1500063 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 571468 | BOY |
| EOY | 586744 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 71249362 | BOY |
| EOY | 73410812 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16120940 | BOY |
| EOY | 16239161 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2427036 | BOY |
| EOY | 390348 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16037559 | BOY |
| EOY | 15689969 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34585535 | BOY |
| EOY | 32319478 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35601627 | BOY |
| EOY | 40076783 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1062200 | BOY |
| EOY | 1014551 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36663827 | BOY |
| EOY | 41091334 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 71249362 | BOY |
| EOY | 73410812 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 26581733 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 36734 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -22190960 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
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) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $45,103 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 45103 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | PORTION OF 2012 ILLINOIS HOSPITAL ASSOCIATION DUES USED FOR LOBBYING - $30,257. PORTION OF 2012 AMERICAN HOSPITAL ASSOCIATION DUES USED FOR LOBBYING - $6,096. PORTION OF 2012 MDH COALITION USED FOR LOBBYING - $8,750. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 944945 | OtherCostOrOtherBasis |
| Book Value | 944945 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 47024910 | OtherCostOrOtherBasis |
| Depreciation | 32995554 | Depreciation |
| Book Value | 14029356 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 27039141 | OtherCostOrOtherBasis |
| Depreciation | 21134766 | Depreciation |
| Book Value | 5904375 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2591603 | OtherCostOrOtherBasis |
| Depreciation | 1661860 | Depreciation |
| Book Value | 929743 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 21808419 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| PENSION LIABILITY | $13,398,630 |
| ACCRUED MALPRACTICE LIABILITY | $605,562 |
| ASSET RETIREMENT OBLIGATION | $1,685,777 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 15689969 | TotalOfAmounts |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1976417 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1976417 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02020 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17931658 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11444553 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6487105 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06620 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 19908075 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11444553 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8463522 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08640 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 340133 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 252 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 339881 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00350 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 219248 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 219248 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00220 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 563451 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 563451 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00570 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 55490 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 55490 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1178322 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 252 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1178070 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01190 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 21086397 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11444805 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 9641592 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09830 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 169784 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 169784 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 169784 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 169784 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $2,518,508 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 29663147 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 37158994 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -7495847 | 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 | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | 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 | FREEPORT MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1045 WEST STEPHENSON STREET | AddressLine1 |
| City | FREEPORT | City |
| State | IL | State |
| ZIP Code | 61032 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| 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 | FREEPORT MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | 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 | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Permit Lien On Residence | X | PermitLienOnResidence |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notified All Patients | X | NotifiedAllPatients |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (6 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7: SCHEDULE H PART I LINE 7 COLUMN(F): OUR TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, COLUMN(A) WAS $107,283,036. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS $9,215,231. THIS LEFT US WITH A TOTAL EXPENSE OF $98,067,805 FOR PURPOSES OF CALCULATING LINE 7, COLUMN(F). | ||
| PART I, L7 COL(F): SCHEDULE H PART I LINE 7: OUR TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, COLUMN(A) $107,283,036. THE BAD DEBT EXPENSES INCLUDED IN THIS AMOUNT WAS $9,215,231. THIS LEFT US WITH A TOTAL EXPENSES OF $98,067,805 FOR THE PURPOSES OF CALCULATING LINE 7, COLUMN(F). | ||
| PART III, LINE 4: LINE #2: THE RATIO OF PATIENT CARE COST TO CHARGES AS DETERMINED ON WORKSHEET 2 IS APPLIED TO THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TO CALCULATE THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS THAT IS REPORTED ON LINE 2.LINE # 3: NO BAD DEBT IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE CHARITY CARE POLICY. | ||
| PART III, LINE 8: COSTING METHODOLOGY: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING THE MEDICARE COST-TO-CHARGE RATIO FROM OUR FILED 12/31/12 MEDICARE COST REPORT.COMMUNITY BENEFIT: WE BELIEVE THAT ALL OF THE 7,498 MILLION SHORTFALL SHOULD BE CONSIDERED AS COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE OF THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORDED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. THIS YEAR, MEDICARE ACCOUNTED FOR 51% OF HOSPITAL REVENUES. THE HOSPITAL PROVIDES CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVES THE GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST OF MEDICARE BENEFICIARIES.0 | ||
| PART III, LINE 9B: INDIVIDUALS APPROVED FOR ASSISTED CARE ARE GIVEN A CARD WHICH IS TYPICALLY VALID FOR 6 MONTHS. THEY PRESENT THE CARD WHEN THEY RECEIVE SERVICES. INDIVIDUALS APPROVED FOR ASSISTED CARE WILL BE ASKED TO MAKE A MODEST CO-PAY AT THE TIME OF SERVICE, BASED ON THE FOLLOWING SCHEDULE:HOSPITAL INPATIENT SERVICES: $50HOSPITAL EMERGENCY DEPARTMENT: $35HOSPITAL OUTPATIENT SERVICES: $25OUR COLLECTION POLICIES ARE THE SAME FOR ALL OF OUR PATIENTS. PATIENTS ARE SCREENED FOR ELIGIBILITY FOR FINANCIAL ASSISTANCE BEFORE COLLECTION PROCEDURES BEGIN. IF AT ANY POINT IN THE COLLECTION PROCESS, DOCUMENTATION IS RECEIVED THAT INDICATES THE PATIENT IS POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAS NOT APPLIED FOR IT, AN APPLICATION FOR ASSISTED CARE IS SENT TO THE PATIENT. AFTER A PATIENT MEETS THE QUALIFICATIONS FOR FINANCIAL ASSISTANCE, THE ACCOUNT BALANCE IS EITHER PARTIALLY OR ENTIRELY WRITTEN OFF. ANY REMAINING BALANCE WOULD BE COLLECTED UNDER THE EXISTING DEBT COLLECTION POLICY. COVERAGE FOR THE ASSISTED CARE PROGRAM IS FOR 6 MONTHS AFTER WHICH TIME PATIENTS CAN REAPPLY IF THEY CONTINUE TO MEET THE GUIDELINES ESTABLISHED. | ||
| IL | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | X | TravelForCompanions |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (19 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARTIN CLEARY MD | ||||||||||||||
| BOARD MEMBER | 0 | 402425 | 0 | 27354 | 0 | 13468 | 0 | 39900 | 0 | 28563 | 0 | 511710 | 0 | 0 |
| BHADRESH PATEL MD | ||||||||||||||
| BOARD MEMBER | 0 | 430728 | 0 | 17655 | 0 | 25925 | 0 | 29500 | 0 | 40151 | 0 | 543959 | 0 | 0 |
| REBECCA PEDERSON MD | ||||||||||||||
| BOARD MEMBER | 0 | 295299 | 0 | 17156 | 0 | 3776 | 0 | 24000 | 0 | 30801 | 0 | 371032 | 0 | 0 |
| ALLEN WORKMAN MD | ||||||||||||||
| CHAIR PHYSICIANS COUNCIL | 0 | 269676 | 0 | 20878 | 0 | 14668 | 0 | 17000 | 0 | 25599 | 0 | 347821 | 0 | 0 |
| ZACHARY FULTON MD | ||||||||||||||
| PRESIDENT MEDICAL STAFF | 0 | 242078 | 0 | 15352 | 0 | 702 | 0 | 16999 | 0 | 26330 | 0 | 301461 | 0 | 0 |
| MICHAEL PERRY MD | ||||||||||||||
| PRESIDENT/CEO | 273276 | 160495 | 15750 | 9250 | 38695 | 22725 | 29295 | 17205 | 19817 | 11636 | 376833 | 221311 | 0 | 0 |
| MICHAEL C CLARK | ||||||||||||||
| EXECUTIVE VP/CFO | 141614 | 83171 | 32 | 18 | 3316 | 1947 | 29295 | 17205 | 14933 | 8770 | 189190 | 111111 | 0 | 0 |
| SHARON SUMMERS | ||||||||||||||
| EXECUTIVE VP/COO | 143240 | 84125 | 32 | 18 | 6221 | 3653 | 29295 | 17205 | 14621 | 8587 | 193409 | 113588 | 0 | 0 |
| LEONARD CARTER | ||||||||||||||
| HUMAN RESOURCES | 100837 | 59222 | 0 | 0 | 5612 | 3295 | 0 | 0 | 16661 | 9785 | 123110 | 72302 | 0 | 0 |
| ROBERT GELLER MD | ||||||||||||||
| VP OF MEDICAL AFFAIRS | 0 | 250992 | 0 | 50 | 0 | 14871 | 0 | 44350 | 0 | 42159 | 0 | 352422 | 0 | 0 |
| NANCY V CUTLER | ||||||||||||||
| VP OF NURSING CNO | 177322 | 0 | 50 | 0 | 284 | 0 | 28714 | 0 | 24940 | 0 | 231310 | 0 | 0 | 0 |
| WILLIAM SPANGLER | ||||||||||||||
| ASST. VP FINANCE | 119137 | 0 | 0 | 0 | 2356 | 0 | 19669 | 0 | 22229 | 0 | 163391 | 0 | 0 | 0 |
| MICHAEL G WEAVER | ||||||||||||||
| PHARMACY DIRECTOR | 134614 | 0 | 50 | 0 | 1187 | 0 | 27401 | 0 | 22240 | 0 | 185492 | 0 | 0 | 0 |
| THOMAS WAGNER | ||||||||||||||
| PHARMACIST | 118565 | 0 | 50 | 0 | 1770 | 0 | 16419 | 0 | 23324 | 0 | 160128 | 0 | 0 | 0 |
| ROBIN SCALISE | ||||||||||||||
| IMAGING DIRECTOR | 132614 | 0 | 50 | 0 | 150 | 0 | 21676 | 0 | 2044 | 0 | 156534 | 0 | 0 | 0 |
| YOUNG J ROH | ||||||||||||||
| PHARMACIST CLINICAL | 119846 | 0 | 50 | 0 | 1505 | 0 | 696 | 0 | 0 | 0 | 122097 | 0 | 0 | 0 |
| WENDY LAWLER | ||||||||||||||
| FORMER LABORATORY DIRECTOR | 107116 | 0 | 50 | 0 | 1558 | 0 | 12571 | 0 | 19865 | 0 | 141160 | 0 | 0 | 0 |
| WILLIAM PALMQUIST | ||||||||||||||
| FORMER PHARMACIST | 117059 | 0 | 50 | 0 | 1732 | 0 | 26673 | 0 | 20920 | 0 | 166434 | 0 | 0 | 0 |
| RAYMOND D SALAZAR | ||||||||||||||
| ER CLINICAL LEADER | 111682 | 0 | 1000 | 0 | 3313 | 0 | 3511 | 0 | 21954 | 0 | 141460 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | FREEPORT MEMORIAL HOSPITAL REIMBURSED A DIRECTOR/TRUSTEE FOR BUSINESS TRAVEL EXPENSES INCLUDING TRAVEL EXPENSES FOR A SPOUSE. |
| PART I, LINE 4B | (MARTIN CLEARY M.D. 457F DIST.-$8,519),(BHADRESH PATEL M.D.457F DIST.-$19,432),(ALLEN WORKMAN M.D. 457F DIST.-$8,753). |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| DARIN DOAK | |||
| DIRECTOR/TRUSTEE | 197987 | DARIN DOAK HAS A FAMILY MEMBER THAT RECEIVED MORE THAT $10,000 FROM FMH. | 0 |
| DOUG FREIDAG | |||
| DIRECTOR/TRUSTEE | 18817 | DOUG FREIDAG HAS A FAMILY MEMBER THAT RECEIVED MORE THAN $10,000 FROM FMH. | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION MISSION STATEMENT | FORM 990, PART I, LINE 1 | FREEPORT MEMORIAL HOSPITAL COORDINATES AND INTEGRATES MEDICAL CARE SERVICES AND PROVIDES INDIVIDUALS IMPARTIAL ACCESS TO MEDICAL CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, OR SOURCE OF PAYMENT. THE HOSPITAL PROVIDES MEDICALLY NECESSARY CARE TO PATIENTS REGARDLESS OF ABILITY TO PAY. THE HOSPITAL QUALIFIES AS A MEDICARE DISPROPORTIONATE SHARE HOSPITAL BECAUSE IT SERVES A DISPROPORTIONATELY HIGH NUMBER OF LOW INCOME PATIENTS. INSURED AND UNDERINSURED PATIENTS, WHO MEET CERTAIN FEDERAL POVERTY GUIDELINES AND/OR OTHER UNIQUE CIRCUMSTANCES, ARE PROVIDED FREE OR DISCOUNTED CARE AFTER A NOMINAL CO-PAYMENT. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE AMOUNT OF CHARITY CARE IT PROVIDES. DURING 2012, THE CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THE HOSPITAL'S CHARITY CARE POLICY WAS $7,101,820 AT A COST OF $1,976,417 . FREEPORT MEMORIAL HOSPITAL IS A LICENSED MEDICARE AND MEDICAID PROVIDER WITH APPROXIMATELY 67% OF ITS PATIENT BASE QUALIFYING FOR AT LEAST ONE OF THESE PROGRAMS. AT PRESENT, THE REIMBURSEMENT RATES FOR BOTH PROGRAMS DO NOT FULLY COVER THE COST OF CARE TO THESE PATIENTS. THE ESTIMATED UNFUNDED COSTS OF SERVICES FOR MEDICAID PATIENTS WERE APPROXIMATELY $6,487,105 FOR THE YEAR ENDING 12/31/2012. MEDICARE PAYMENTS WERE APPROXIMATELY $7,498,847 LESS THAN THE HOSPITAL'S COST TO PROVIDE CARE DURING THE SAME PERIOD. IN ADDITION, THE COST OF CARE PROVIDED TO PEOPLE WHO DID NOT PAY WAS $2,518,508 IN 2012. FREEPORT MEMORIAL HOSPITAL PROVIDES DISCOUNTS TO UNINSURED PATIENTS WITHOUT REGARD TO THEIR INCOME. FOR 2012 THESE DISCOUNTS TOTALED $2,024,617 . THE ESTIMATED COSTS ATTRIBUTABLE TO THE DISCOUNTED PORTION OF THESE SERVICES WERE $563,451 FOR 2012. FREEPORT MEMORIAL HOSPITAL AND ITS RELATED ORGANIZATIONS SUPPORT AND PARTICIPATE IN MANY COMMUNITY SERVICES AND OUTREACH PROGRAMS, INCLUDING SUPPORT FOR COMMUNITY HEALTH EDUCATION PROGRAMS, COMMUNITY-BASED CLINICAL SERVICES, HEALTH PROFESSIONAL EDUCATION, RESEARCH, SPONSORSHIP OF COMMUNITY EVENTS, AND COMMUNITY-BUILDING ACTIVITIES. THE HOSPITAL CONTRIBUTED $784,655 TOWARDS THESE PROGRAMS IN 2012. PROGRAM SERVICE EXPENSES: $102,906,605 |
| FORM 990, PART VI, SECTION B, LINE 11 | THE ORGANIZATION'S BOARD OF DIRECTORS REVIEWS THE FORM 990 BEFORE THE TAX RETURN IS FILED. QUESTIONS AND EXPLANATIONS ARE ANSWERED BY THE FINANCE DEPARTMENT TO THE BOARD'S SATSIFACTION. THE BOARD REVIEWS ALL TRANSACTIONS THAT AFFECT THE FILING OF THE ORGANIZATION'S FORM 990 AND EQUIVALENT STATE RETURNS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION HAS A DEDICATED CORPORATE COMPLIANCE OFFICER. ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE ANNUALLY A CONFLICT OF INTEREST QUESTIONNAIRE. THESE DOCUMENTS ARE REVIEWED BY THE CCO TO DETERMINE IF ANY INDIVIDUAL HAS A CONFLICT OF INTEREST THAT NEEDS TO BE ADDRESSED. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION HAS AN EXECUTIVE COMPENSATION COMMITTEE THAT REVIEWS THE CEO, TOP MANAGEMENT AND EXECUTIVE DIRECTORS COMPENSATION. THE COMMITTEE RELIES ON INTERNAL AND EXTERNAL INFORMATION TO DETERMINE THE APPROPRIATE COMPENSATION AND EMPLOYS AN INDEPENDENT THIRD PARTY TO CONDUCT THE ANNUAL EXECUTIVE COMPENSATION ANALYSIS. THIS ANALYSIS IS USED TO DETERMINE IF THE BOARD'S WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY HAS BEEN MET. THE EXECUTIVE COMPENSATION COMMITTEE ALSO RECEIVES A REASONABLENESS LETTER FROM THE THIRD PARTY. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 9: | CHANGE IN MINIMUM PENSION LIABILITY -1,039,210. TRANSFERS TO AFFILIATE -21,104,102. NET ASSETS RELEASED FROM RESTRICTION -210,950. CONTRIBUTIONS TEMPORARY RESTRICTED 163,302. |
| FORM 990 PART XII LINE 2C | NO CHANGES HAVE BEEN MADE TO THE OVERSIGHT/SELECTION PROCESS FOR THE INDEPENDENT ACCOUNTING FIRM. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| FREEPORT REGIONAL HEALTH CARE FOUNDATION | |||||||||||
| 1045 WEST STEPHENSON STREET | FREEPORT | IL | 61032 | 363994636 | HEALTH CARE | IL | 501(C)(3) | LINE 11 | N/A | 0 | |
| FREEPORT REGIONAL HEALTHCARE SERVICES | |||||||||||
| 1045 WEST STEPHENSON STREET | FREEPORT | IL | 61032 | 363967303 | HEALTH CARE | IL | 501(C)(3) | LINE 3 | 0 | FREEPORT REGIONAL HEALTH CARE FOUNDATION | |
| FREEPORT REGIONAL MANAGEMENT SERVICES | |||||||||||
| 1045 WEST STEPHENSON STREET | FREEPORT | IL | 61032 | 363994636 | HEALTH CARE | IL | 501(C)(3) | LINE 3 | 0 | FREEPORT REGIONAL HEALTH CARE FOUNDATION | |
| JANE ADDAMS INC | |||||||||||
| 1045 WEST STEPHENSON STREET | FREEPORT | IL | 61032 | 362879689 | HEALTH CARE | IL | 501(C)(3) | LINE 11 | 0 | FREEPORT REGIONAL HEALTH CARE FOUNDATION | |
| JANE ADDAMS HEALTHCARE SERVICES INC | |||||||||||
| 1045 WEST STEPHENSON STREET | FREEPORT | IL | 61032 | 363677357 | HEALTH CARE | IL | 501(C)(3) | LINE 7 | 0 | FREEPORT REGIONAL HEALTH CARE FOUNDATION | |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL ENTERPRISES INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1045 WEST STEPHENSON STREET | AddressLine1 |
| City | FREEPORT | City |
| State | IL | State |
| ZIP Code | 61032 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363353871 | EIN |
| Primary Activity | HEALTH CARE | PrimaryActivity |
| Legal Domicile State | IL | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FREEPORT REGIONAL HEALTH CARE FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |