2012-03-15T10:17:12-05:00 2011-04-30 MCGLADREY & PULLEN LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2010-05-01 363673380 Sherman Health Systems SHER 2247838718 1425 N Randall Road Elgin IL 60123 Eric Krueger 2247838718 2012-03-12 1 Zack Fortsch 3126343400 2010 2016-02-24 21:20:13Z Richard Floyd 1425 N Randall Road Elgin IL 60123 12258749 0 X HTTP://WWW.SHERMANHOSPITAL.ORG X 1989 IL Maintain health service institutions serving the surrounding community. 16 15 0 0 2080769 -312928 0 0 4206092 6460416 6223711 2247666 -2060309 1048849 8369494 9756931 0 0 0 0 2992244 2752843 0 0 0 5867745 5181400 8859989 7934243 -490495 1822688 96741715 121129425 20958721 22004225 75782994 99125200 Provide community health education and wellness programs and provide charitable support on behalf of Sherman Hospital and its affiliates. 0 0 7934243 4379647 Establish and maintain institutions which provide comprehensive health services to meet the health needs of the community surrounding Elgin, IL. 7934243 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X 16 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X Eric Krueger 2247838718 1425 N Randall Road Elgin IL 60123 X Richard Floyd 6.00 X X 0 563213 126112 Richard Jakle 1.00 X X 0 2000 0 Terry Dunning 1.00 X X 0 6000 0 Robert Cormier 1.00 X X 0 6000 0 William Hoffer 1.00 X X 0 6000 0 Audrey Reed 1.00 X 0 6000 0 Brian Ziegler 1.00 X 0 2250 0 Charles Burnidge 1.00 X 0 6000 0 David Bear 1.00 X 0 2000 0 Kenneth Koehler 1.00 X 0 8080 0 Lane B Hoffman 1.00 X 0 5500 0 Linda Wallace 1.00 X 0 2750 0 Nathaniel Edmond 1.00 X 0 3000 0 Pamela Jensen 1.00 X 0 5500 0 Roger Bielinski MD 1.00 X 0 6000 0 Solomon Secemsky MD 1.00 X 0 6000 0 Eric Krueger 6.00 X 0 305241 56470 Linda Deering 6.00 X 0 345158 60209 Katie Bata 6.00 X 0 214402 38571 R Keith Golden 40.00 X 0 147635 12575 Patricia Turner 40.00 X 0 112649 10123 0 1761378 304060 0 0 1 0 0 Admin. Cost Sharing 541900 4377645 4377645 Patient Services 621500 1090435 1090435 Sherman Choice 561000 990334 990334 Other Income 900099 2002 2002 6460416 2023599 2023599 3534043 2485194 1048849 1048849 1048849 240691 16624 224067 224067 224067 9756931 4379647 2080769 3296515 301060 301060 1999932 1999932 451851 451851 339135 339135 125600 125600 21276 21276 111987 111987 1154810 1154810 46136 46136 916459 916459 707160 707160 1346782 1346782 169152 169152 Bad Debt 193527 193527 49376 49376 7934243 7934243 0 0 413740 490300 595703 470518 385987 380232 65341020 18414415 48333729 46926605 42595717 67704854 4416839 5156916 96741715 121129425 1308571 1276182 13096455 12611118 6553695 8116925 20958721 22004225 X 75782994 99125200 75782994 99125200 96741715 121129425 X 1822688 21519518 X 0 1 1 X 0 X X X X 0 0 0 Sherman Hospital 362167920 3 1 1 1 0 Sherman West Court 363725580 9 1 1 1 0 Sherman Home Health Care Corporation 363330085 9 1 1 1 0 3 0 29788750 29788750 31677618 15827323 15850295 3874652 2587092 1287560 46926605 Accrued Medical Malpractice & Liabilities 128079 Due to Affiliates 7988846 8116925 Description of Uncertain Tax Positions Under FIN 48: Part X: Sherman 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. X X X X 0 1 0 0 0 0 0 0 0 Richard Floyd 0 481507 0 75622 0 6084 0 105613 0 21180 0 690006 0 0 Eric Krueger 0 271069 0 33497 0 675 0 36252 0 20774 0 362267 0 0 Linda Deering 0 294348 0 39945 0 10865 0 53027 0 7864 0 406049 0 0 Katie Bata 0 183771 0 30189 0 442 0 25933 0 13078 0 253413 0 0 R Keith Golden 0 128437 0 17746 0 1452 0 2113 0 11531 0 161279 0 0 Part I, Line 4b Supplemental Executive Retirement Plan Participants: Richard Floyd - $93,363 Eric Krueger - $26,033 Linda Deering - $42,491 Katie Bata - $17,692 Form 990, Part VI, Section B, line 11 The 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 12c Each 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 Health Systems ("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 shall be conducted. Form 990, Part VI, Section B, line 15 Market 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 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. Form 990, Part VI, Section C, line 19 All 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 Hospital-34 hrs; Sherman West Court-1hr; Sherman Home Health Care Corporation-1hr; Sherman Health Foundation-0.5hrs Eric Krueger: Sherman Hospital-34 hrs; Sherman Home Health Care Corporation-1 hr; Sherman Health Foundation-0.5hrs Linda Deering: Sherman Hospital-34hrs Katie Bata: Sherman Hospital-34hrs; Sherman Home Health Care Corporation-0.5 hrs Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 5,162,046. Loss from Health Visions -1,642,528. Net Asset Transfer from Sherman Hospital 18,000,000. Total to Form 990, Part XI, Line 5: 21,519,518. Sherman Health Foundation 1425 N Randall Road Elgin IL 60123 320106211 Provide charitable support to healthcare organization IL 501(c)(3) Line 11a, I Sherman Health Systems 1 Sherman Home Health Care Corporation 901 Center Street Suite 2001A Elgin IL 60120 363330085 Services include skilled and unskilled general nursing IL 501(c)(3) Line 9 Sherman Health Systems 1 Sherman Hospital 1425 N Randall Road Elgin IL 60123 362137920 Serve the community's healthcare needs IL 501(c)(3) Line 3 Sherman Health Systems 1 Sherman West Court 1950 Larkin Avenue Elgin IL 60123 363725580 Provide long-term nursing care IL 501(c)(3) Line 9 Sherman Health Systems 1 Health Visions Inc 1425 N Randall Road Elgin IL 60123 363780082 Physician practice management IL N/A C -1703043 908359 1.00000 The Delphi Group IV Inc 1425 N Randall Road Elgin IL 60123 364017279 Health cost management IL N/A C 0.83000 Sherman Group Practice Inc 1435 N Randall Road Elgin IL 60123 262891035 Physician group IL N/A C 1.00000 Sherman Physician Group Inc 1435 N Randall Road Elgin IL 60123 264800497 Physician group IL N/A C 1.00000 Sherman Health Insurance Company Ltd PO Box 1159 Grand Cayman CJ KY1-1102 980703036 Insurance Provider CJ N/A C 1.00000 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 1 1 Health Visions Inc I 403598 MOBs & Timeshare Sherman Home Health Care Corporation I 71163 Resource Center Sherman Hospital I 2153216 Co 1/50 & Timeshare Health Visions Inc N 97267 Management Fees Sherman Home Health Care Corporation N 95806 Management Fees Sherman Hospital N 1054650 Management Fees Net PR Sherman West Court N 54133 Management Fees Sherman Hospital O 5422503 Vendor Payments Sherman Hospital Q 1130920 Cash Transfers Sherman Health Insurance Company Ltd Q 120000 Purchase of Shares Sherman Hospital R 18000000 Investment Transfers Sherman Hospital R 1140899 UBI Transfers