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ADVOCATE SHERMAN HOSPITAL: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
ADVOCATE SHERMAN HOSPITAL (EIN 36-2167920)
Tax period
2010-05-01 to 2011-04-30
Filed
2012-03-15
IRS object ID
201240759349300519
Schema version
2010v3.4
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)
Timestamp2012-03-15T10:17:12-05:00Timestamp
Tax Period End Date2011-04-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MCGLADREY & PULLEN 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 Date2010-05-01TaxPeriodBeginDate

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
TitleVP FinanceTitle
Phone8477429800Phone
Date Signed2012-03-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameZack FortschName
Phone3126343400Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

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 Receipts279831696GrossReceipts
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 Body21NbrVotingMembersGoverningBody
Nbr Independent Voting Members17NbrIndependentVotingMembers
Total Nbr Employees2356TotalNbrEmployees
Total Nbr Volunteers417TotalNbrVolunteers
Total Gross UBI344032TotalGrossUBI
Net Unrelated Business Txbl Income-149085NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1384962ContributionsGrantsPriorYear
Contributions Grants Current Year890153ContributionsGrantsCurrentYear
Program Service Revenue Prior Year222632053ProgramServiceRevenuePriorYear
Program Service Revenue CY267101674ProgramServiceRevenueCY
Investment Income Prior Year856240InvestmentIncomePriorYear
Investment Income Current Year6653889InvestmentIncomeCurrentYear
Other Revenue Prior Year3661064OtherRevenuePriorYear
Other Revenue Current Year4539613OtherRevenueCurrentYear
Total Revenue Prior Year228534319TotalRevenuePriorYear
Total Revenue Current Year279185329TotalRevenueCurrentYear
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 Year99700526SalariesEtcPriorYear
Salaries Etc Current Year110921740SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year141810424OtherExpensePriorYear
Other Expenses Current Year168621047OtherExpensesCurrentYear
Total Expenses Prior Year241515950TotalExpensesPriorYear
Total Expenses Current Year279547787TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-12981631RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-362458RevenuesLessExpensesCY
Total Assets BOY499595524TotalAssetsBOY
Total Assets EOY488691902TotalAssetsEOY
Total Liabilities BOY327935351TotalLiabilitiesBOY
Total Liabilities EOY335511238TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY171660173NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY153180664NetAssetsOrFundBalancesEOY
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 Change1SignificantChange
Expense245437054Expense
Grants5000Grants
Revenue267747206Revenue
DescriptionWhile the Sherman Hospital ("Sherman") facility is a community hospital, it is also a regional heart center. In 1972, when the first open-heart surgery was performed at its facilities, the hospital facility became one of the first community hospitals in the nation performing open heart surgery. Today, the hospital facility is a recognized regional heart center for the far northwest suburbs of Chicago. According to the Illinois Hospital Association/Compdata statistics, the hospital consistently sees some of the most complex open heart cases in the state of Illinois (the "state"), and the hospital's mortality rate in cardiac surgery is consistently one of the lowest in the state. Sherman has received numerous national awards and recognition for excellence in quality.Description
Total Program Service Expense245437054TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
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 Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
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 With1096223NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees2356NumberOfEmployees
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 Members21NbrVotingGoverningBodyMembers
Number Independent Voting Members17NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
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 (34 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Richard Floyd
President/CEO34.00XX5632130126112
Terry Dunning
Chairman4.00XX600000
Charles Burnidge
Vice Chairman4.00XX600000
Audrey Reed
Secretary4.00XX600000
Robert Cormier
Treasurer4.00XX600000
David Bear
Director4.00X200000
Roger Bielinski MD
Director4.00X600000
Nathaniel Edmond
Director4.00X300000
William Hoffer
Director4.00X600000
Lane B Hoffman
Director4.00X550000
Sharon Jakle
Director4.00X300000
Richard Jakle
Director4.00X200000
Joy Jensen
Director4.00X24829014393
Pamela Jensen
Director4.00X550000
Kenneth Koehler
Director4.00X808000
Lawrence Kosinski MD
Director4.00X275000
Dorothea Poulos MD
Director4.00X1735000
Solomon Secemsky MD
Director4.00X600000
Shujauddin Valika MD
Director4.00X500000
Linda Wallace
Director4.00X275000
Brian Ziegler
Director4.00X225000
Eric Krueger
VP Finance/CFO34.00X305241056470
Linda Deering
Executive VP/COO34.00X345158060209
Ian Jones
VP Clinical Performance34.00387180061160X
Katie Bata
VP Human Resources34.00214402038571X
Jane Bradford
Exec Dir. Physician Svcs20.00160891012455X
Mary Martini
VP Business Development34.00188600033863X
Judith Balcitis
Chief Nursing Officer34.00176343019677X
Thomas Nitz
VP Ancillary Services34.00175536033834X
Sharon McGregor
Pharmacist41.00146165027393X
Michael Mulay
Controller30.00139327022600X
Patrick Uplegger
Director of Pharmacy40.00139536013264X
Donnis Boggs
Pharmacy Clinical Coord.42.0013884205142X
Barbara Scott
Patient Care Coord.50.00137391010945X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3343834TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation536088TotalOtherCompensation
Number Individuals GT100 K89NumberIndividualsGT100K
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
GE Medical Systems
PO Box 96483ChicagoIL60693Medical Equipment Repairs1779108
Alliance Rehab
1520 Kensington Road Ste 105Oak BrookIL60523Occupational, Physical & Speech Therapy1176953
Cerner Corporation
2800 Rockcreek ParkwayKansas CityMO64117Information Technology980565
Demi & Cooper
18 Villa CourtElginIL60120Advertising902757
Transolutions Inc
1541 S Waukegan RdWaukeganIL60085Medical Transcription899087
FieldValueIRS element (for citing)
Number Of Contractors GT100 K82NumberOfContractorsGT100K
Fundraising Events139190FundraisingEvents
Related Organizations353915RelatedOrganizations
Government Grants397048GovernmentGrants
Total Contributions890153TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Net Patient Services621110160116008160116008
Medicare/Medicaid Paym6211109403638594036385
Medicaid Assessment6211101270066212700662
Paramedic Training621110109142109142
Medical Records621110102105102105

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column37372TotalRevenueColumn
Related Or Exempt Function Income37372RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue267101674TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column838135TotalRevenueColumn
Exclusion$838,135ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other6389984Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other574230Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other5815754Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column5815754TotalRevenueColumn
Exclusion$5,815,754ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events48300GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events139190CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses72137FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-23837TotalRevenueColumn
Exclusion-$23,837ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Cafeteria Revenue7210002028746$2,028,746
Algonquin Road Surgery900099573112573112
Laboratory Revenue621500465974$465,974

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column1495618TotalRevenueColumn
Related Or Exempt Function Income72420RelatedOrExemptFunctionIncome
Unrelated Business Revenue344032UnrelatedBusinessRevenue
Exclusion$1,079,166ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue4563450TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column279185329TotalRevenueColumn
Related Or Exempt Function Income267747206RelatedOrExemptFunctionIncome
Unrelated Business Revenue344032UnrelatedBusinessRevenue
Exclusion$10,203,938ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total5000Total
Program Services5000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2651315Total
Management And General2651315ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total89652390Total
Program Services80568627ProgramServices
Management And General9083763ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total3059062Total
Program Services3059062ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total9606697Total
Program Services9606697ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total5952276Total
Program Services5952276ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total747650Total
Program Services747650ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total172945Total
Program Services172945ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total18210955Total
Program Services11127452ProgramServices
Management And General7083503ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1250180Total
Program Services53835ProgramServices
Management And General1196345ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1330909Total
Program Services521123ProgramServices
Management And General809786ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total3516293Total
Program Services3389317ProgramServices
Management And General126976ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total14035192Total
Program Services5718147ProgramServices
Management And General8317045ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total254925Total
Program Services187182ProgramServices
Management And General67743ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total14868248Total
Program Services14868248ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total25923144Total
Program Services24182097ProgramServices
Management And General1741047ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total6813898Total
Program Services5947289ProgramServices
Management And General866609ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Supplies47176976459879211189055
Bad Debt Expense2280386722803867
IL Medicaid Tax76819477681947
Equipment Rental19979911882240115751
Gift Shop/Coffee Shop318839318839

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1517088Total
Program Services655293ProgramServices
Management And General861795ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total279547787Total
Program Services245437054ProgramServices
Management And General34110733ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY24999917BOY
EOY31353392EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY39967383BOY
EOY47699724EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY3843785BOY
EOY4595034EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY3426889BOY
EOY3416146EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis625461001LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec239711184LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY405227927BOY
EOY385749817EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY7912288BOY
EOY4003262EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY14217335BOY
EOY11874527EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY499595524BOY
EOY488691902EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY28549431BOY
EOY35897453EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
EOY2116777EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY267555803BOY
EOY264180693EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY31830117BOY
EOY33316315EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY327935351BOY
EOY335511238EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY170971782BOY
EOY152167405EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY688391BOY
EOY1013259EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY171660173BOY
EOY153180664EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY499595524BOY
EOY488691902EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-362458ReconcilationRevenueExpenses
Reconcilation Other Changes-18117051ReconcilationOtherChanges
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$32,141OtherActivitiesAmount
Total Lobbying Expenditures IIB32141TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Other Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1i: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 Basis15177056OtherCostOrOtherBasis
Book Value15177056BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis410238240OtherCostOrOtherBasis
Depreciation103191387Depreciation
Book Value307046853BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis2780933OtherCostOrOtherBasis
Depreciation885987Depreciation
Book Value1894946BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis185569975OtherCostOrOtherBasis
Depreciation132145697Depreciation
Book Value53424278BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis11694797OtherCostOrOtherBasis
Depreciation3488113Depreciation
Book Value8206684BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings385749817TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Estimated Third-Party Payor Settlements$23,776,280
Accrued Medical Malpractice and Other$8,886,582
Construction Payable$653,453
FieldValueIRS element (for citing)
Total Of Amounts33316315TotalOfAmounts

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.Explanation

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Benefit BallNameOfEvent1
Gross Receipts Event1187490GrossReceiptsEvent1
Charitable Contributions Event1139190CharitableContributionsEvent1
Gross Revenue Event148300GrossRevenueEvent1
Cash Prizes Event11587CashPrizesEvent1
Rent Facility Costs Event11130RentFacilityCostsEvent1
Food And Beverage Event146433FoodAndBeverageEvent1
Entertainment Event17800EntertainmentEvent1
Other Direct Expenses Event115187OtherDirectExpensesEvent1
Gross Receipts Total187490GrossReceiptsTotal
Charitable Contributions Total139190CharitableContributionsTotal
Gross Revenue Total Events48300GrossRevenueTotalEvents
Cash Prizes Total Events1587CashPrizesTotalEvents
Rent Facility Costs Total Events1130RentFacilityCostsTotalEvents
Food And Beverage Total Events46433FoodAndBeverageTotalEvents
Entertainment Total Events7800EntertainmentTotalEvents
Other Direct Expenses Total Events15187OtherDirectExpensesTotalEvents
Direct Expense Summary Events72137DirectExpenseSummaryEvents
Net Income Summary-23837NetIncomeSummary

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 Expense2808795TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense2808795NetCommunityBenefitExpense
Percent Of Total Expense0.01090PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense42550373TotalCommunityBenefitExpense
Direct Offsetting Revenue33496247DirectOffsettingRevenue
Net Community Benefit Expense9054126NetCommunityBenefitExpense
Percent Of Total Expense0.03530PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense45359168TotalCommunityBenefitExpense
Direct Offsetting Revenue33496247DirectOffsettingRevenue
Net Community Benefit Expense11862921NetCommunityBenefitExpense
Percent Of Total Expense0.04620PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense374575TotalCommunityBenefitExpense
Direct Offsetting Revenue56443DirectOffsettingRevenue
Net Community Benefit Expense318132NetCommunityBenefitExpense
Percent Of Total Expense0.00120PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense475468TotalCommunityBenefitExpense
Direct Offsetting Revenue109142DirectOffsettingRevenue
Net Community Benefit Expense366326NetCommunityBenefitExpense
Percent Of Total Expense0.00140PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense314313TotalCommunityBenefitExpense
Direct Offsetting Revenue121966DirectOffsettingRevenue
Net Community Benefit Expense192347NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense322904TotalCommunityBenefitExpense
Direct Offsetting Revenue92285DirectOffsettingRevenue
Net Community Benefit Expense230619NetCommunityBenefitExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense1487260TotalCommunityBenefitExpense
Direct Offsetting Revenue379836DirectOffsettingRevenue
Net Community Benefit Expense1107424NetCommunityBenefitExpense
Percent Of Total Expense0.00420PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense46846428TotalCommunityBenefitExpense
Direct Offsetting Revenue33876083DirectOffsettingRevenue
Net Community Benefit Expense12970345NetCommunityBenefitExpense
Percent Of Total Expense0.05040PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

FieldValueIRS element (for citing)
Total Community Building Expense498380TotalCommunityBuildingExpense
Net Community Building Expense498380NetCommunityBuildingExpense
Percent Of Total Expense0.00190PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense498380TotalCommunityBuildingExpense
Net Community Building Expense498380NetCommunityBuildingExpense
Percent Of Total Expense0.00190PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense$6,177,568BadDebtExpenseAmount
Amount Attributable To514250AmountAttributableTo
Amount Reimbursed By Medicare72931238AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare96154631CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-23223393MedicareSurplusOrShortfall

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
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

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 Imaging & Rehabilitation
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
934 Center StreetElginIL60103Immediate Care
Sherman Immediate Care
2320 Royal BlvdElginIL60123Immediate Care
Sherman Immediate Care
2000 McDonald RoadSouth ElginIL60177Immediate Care

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 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 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 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 60% discount off charges based on their income level. Under this policy, Sherman provides a discount (up to 60%) 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 VI, Line 2: The Community Health Needs Assessment for 2011 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 2011 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 FY11, the adult Hospital admissions were from the following age groups: pediatrics 4%15-44 35%45-64 23%65-74 15%>75 23%The gender of these admissions was 64% female and 36% 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 Payment0SeverancePayment
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
4815070756220608401056130211800690006000
Eric Krueger
27106903349706750362520207740362267000
Linda Deering
294348039945010865053027078640406049000
Ian Jones
334710048069044010439080185420449630000
Katie Bata
18377103018904420259330130780253413000
Jane Bradford
16003000086106344068680174103000
Mary Martini
16593502239702680226880166320227920000
Judith Balcitis
160233015510060001967706120196632000
Thomas Nitz
15589501902606150177080167380209982000
Sharon McGregor
1395450006620054940222360173895000
Michael Mulay
1334330005894055360174050162268000
Patrick Uplegger
136187000334905606080410153183000

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, Line 4bSupplemental Executive Retirement Plan Participants: Richard Floyd - $93,363 Linda Deering - $42,491 Ian Jones - $32,696 Eric Krueger - $26,033 Katie Bata - $17,692 Mary Martini - $15,610 Thomas Nitz - $14,664 Judith Balcitis - $13,998
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 Proceeds174623008TotalProceeds
Amount In Reserve Fund16875220AmountInReserveFund
Issuance Costs From Proceeds2395571IssuanceCostsFromProceeds
Working Capital Expenditures7755962WorkingCapitalExpenditures
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
Bond Counsel Routinely Engaged0BondCounselRoutinelyEngaged
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00590PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00590TotalPrivateBusinessUse
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 Transaction36558AmountOfTransaction
Description Of TransactionGross wagesDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Changes in Program ServicesForm 990, Part III, line 3The Hospital sold its hemodialysis operations and related assets and therefore have ceased providing such services.
Form 990, Part VI, Section A, line 2Sharon Jakle and Richard Jakle have a family relationship.
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 shall be 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 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 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 Corporation - 1 hr; Sherman Health Foundation - 0.5 hrs Eric Krueger: Sherman Health Systems - 6 hrs; Sherman Home Health Care Corporation - 1 hr; Sherman Health Foundation - 0.5 hrs Linda Deering: Sherman Health Systems - 6 hrs Ian Jones: Sherman Health Systems - 6 hrs Katie Bata: Sherman Health Systems - 6 hrs; Sherman Home Health Care Corporation - 0.5 hrs Judith L. Balcitis: Sherman Health Systems - 6 hrs; Sherman Home Health Care Corporation - 0.5 hrs Thomas Nitz: Sherman Health Systems - 6 hrs; Sherman West Court - 1 hr Joy Jensen: Sherman Health Foundation - 20 hrs Jane Bradford: Health Visions, Inc. - 20 hrs Mary Martini: Sherman Health Systems - 6 hrs Michael Mulay: Sherman Health Systems - 10 hrs
Changes in Net Assets or Fund Balances:Form 990, Part XI, line 5:Book/Tax Difference Relating to Partnership Investments 7,949. Net Transfers to Affiliates -18,125,000. Total to Form 990, Part XI, Line 5: -18,117,051.

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 Physicians Group Inc
1435 N Randall RoadElginIL60123264800497Physician GroupILN/AC
Sherman Health Insurance Company Ltd
980703036Insurance ProviderN/ACPO Box 1159Grand CaymanCJKY1-1102CJ
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 Org1GiftGrantOrCapContrFrOtherOrg
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 Assets1ExchangeOfAssets
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 (13 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Sherman Health Systems
A2000Interest on indemnity agreement
Health Visions Inc
N3367747Salaries & Benefit Allocations
Sherman Health Foundation
N315493Salaries & Benefit Allocations
Sherman Home Health Care Corporation
N2234037Salaries & Benefit Allocations
Sherman West Court
N4574162Salaries & Benefit Allocations
Health Visions Inc
P1097461Vendor Payments
Sherman Health Foundation
P225411Vendor Payments
Sherman Home Health Care Corporation
P1351180Vendor Payments
Sherman West Court
P4845192Vendor Payments
Health Visions Inc
R3180000Cash Transfers
Sherman Health Foundation
R469094Cash & Net Asset Transfers
Sherman West Court
R11045000Cash Transfers
Sherman Home Health Care Corporation
R4415000Cash Transfers