HSHS GOOD SHEPHERD HOSPITAL INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- HSHS GOOD SHEPHERD HOSPITAL INC (EIN 37-0512290)
- Tax period
- 2010-09-01 to 2011-08-31
- Filed
- 2012-03-20
- IRS object ID
- 201240809349300634
- Schema version
- 2010v3.7
- 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 D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-03-20T14:48:33-04:00 | Timestamp |
| Tax Period End Date | 2011-08-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 211 N BROADWAY SUITE 600 | AddressLine1 |
| City | ST LOUIS | City |
| State | MO | State |
| ZIP Code | 631022733 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-09-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 370512290 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Shelby Memorial Hospital Association Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SHEL | NameControl |
| Phone | 2177743961 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 South Cedar Street | AddressLine1 |
| City | Shelbyville | City |
| State | IL | State |
| ZIP Code | 62565 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | PHILIP MILLER | Name |
| Title | CFO | Title |
| Phone | 2177743961 | Phone |
| Date Signed | 2012-02-29 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Donna J Larson | Name |
| Phone | 3142315544 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MARILYN SEARS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 SOUTH CEDAR | AddressLine1 |
| City | SHELBYVILLE | City |
| State | IL | State |
| ZIP Code | 62565 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 21652526 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1916 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | ORGANIZATION'S UNIFIED MISSION IS TO MAINTAIN AND IMPROVE THE QUALITY OF LIFE OF THE PEOPLE IN THIS SERVICE AREA THROUGH THE PROVISION OF QUALITY HEALTH CARE PROGRAMS, SERVICES, EQUIPMENT AND PERSONAL CARE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 213 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | -21339 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -240629 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 69326 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 58636 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 14550846 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 17172953 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 322339 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1146400 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 157813 | OtherRevenuePriorYear |
| Other Revenue Current Year | 200371 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 15100324 | TotalRevenuePriorYear |
| Total Revenue Current Year | 18578360 | 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 | 6680692 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 8191486 | 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 | 8086318 | OtherExpensePriorYear |
| Other Expenses Current Year | 8715049 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 14767010 | TotalExpensesPriorYear |
| Total Expenses Current Year | 16906535 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 333314 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1671825 | RevenuesLessExpensesCY |
| Total Assets BOY | 32054721 | TotalAssetsBOY |
| Total Assets EOY | 36837824 | TotalAssetsEOY |
| Total Liabilities BOY | 9043418 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 11175834 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 23011303 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 25661990 | NetAssetsOrFundBalancesEOY |
| Mission Description | THE ASSOCIATION'S PURPOSE IS TO ESTABLISH AND MAINTAIN A FACILITY FOR THE CARE OF PERSONS SUFFERING FROM ILLNESS OR DISABILITIES, REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY; TO CARRY ON EDUCATIONAL ACTIVITIES RELATED TO RENDERING CARE TO THE SICK AND INJURED; AND TO PARTICIPATE IN ANY ACTIVITY DESIGNED AND CARRIED ON SO AS TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 14238621 | Expense |
| Revenue | 17194292 | Revenue |
| Description | OPERATION OF A 30 BED HOSPITAL FACILITY PROVIDING ALL ROUTINE AND ANCILLARY SERVICES. SERVICES INCLUDED 25,912 OUTPATIENT REGISTRATIONS, 7,697 RURAL HEALTH CLINIC VISITS, 3,569 INPATIENT DAYS & 5,234 EMERGENCY ROOM VISITS. | Description |
| Total Program Service Expense | 14238621 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | true | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 21 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 213 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | PHILIP MILLER | NamePerson |
| Telephone Number | 2177743961 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 SOUTH CEDAR | AddressLine1 |
| City | SHELBYVILLE | City |
| State | IL | State |
| ZIP Code | 62565 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| ELAINE BERRY | |||||||
| CHAIRMAN | 1.0 | X | X | 0 | 0 | 0 | |
| DR DAVID OLIGSCHLAEGER | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| SUSAN TYNAN | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| MARK LUCE | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| JACK YOCKEY | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| PAUL KARRAKER | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| TADD BRACHBILL | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| TAD MAYHALL | |||||||
| SECRETARY | 1.0 | X | X | 0 | 0 | 0 | |
| LARRY DILLEY | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| JAMES KLEPZIG | |||||||
| VICE-CHAIR | 1.0 | X | X | 0 | 0 | 0 | |
| KEVIN ROSS | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| RANDY BIEHLER | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| MARILYN SEARS | |||||||
| PRESIDENT/CEO | 40.0 | X | 135559 | 0 | 6442 | ||
| REGINA CALVERT | |||||||
| CNE | 40.0 | X | 108082 | 0 | 8527 | ||
| PHILIP MILLER | |||||||
| CFO | 40.0 | X | 91913 | 0 | 5802 | ||
| DR ARNOLD AGAPITO | |||||||
| PHYSICIAN | 40.0 | 182005 | 0 | 7485 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 517559 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 28256 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CARDINAL HEALTH | |||||
| 21377 NETWORK PLACE | CHICAGO | IL | 60673 | PHARMACY MANAGEMENT | 768288 |
| EMERGENCY STAFFING SOLUTIONS | |||||
| 17304 PRESTON ROAD SUITE 555 | DALLAS | TX | 75252 | ER PHYSICIANS | 609720 |
| MURRAY COMPANY | |||||
| 1807 PARK 270 DRIVE SUITE 460 | ST LOUIS | MO | 63146 | CONSTRUCTION | 1702085 |
| CPSI | |||||
| PO BOX 850309 | MOBILE | AL | 36685 | COMPUTER SYSTEMS | 334642 |
| IMPACT COMMUNICATIONS | |||||
| 303 N 2ND STREET SUITE 28 | ST CHARLES | IL | 60174 | MARKETING | 216938 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 18 | NumberOfContractorsGT100K |
| Related Organizations | 21276 | RelatedOrganizations |
| All Other Contributions | 37360 | AllOtherContributions |
| Total Contributions | 58636 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| CHARGE FOR MEDICAL SRVC, ROOM, CARE & OTHER | 621110 | 15540815 | 15540815 | |
| SHE ANCILLARY | 446199 | -21339 | -21339 | |
| MISCELLANEOUS INCOME | 900099 | 60477 | 60477 | |
| EHR INCENTIVE PAYMENT | 900099 | 1593000 | 1593000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 17172953 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 550942 | TotalRevenueColumn |
| Exclusion | $550,942 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Exclusion | $0 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Exclusion | $0 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 175178 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 13940 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 161238 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 161238 | TotalRevenueColumn |
| Exclusion | $161,238 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3652784 | Securities |
| Other | 2900 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3060226 | Securities |
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 592558 | Securities |
| Other | 2900 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 595458 | TotalRevenueColumn |
| Exclusion | $595,458 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Exclusion | $0 | ExclusionAmount |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Exclusion | $0 | ExclusionAmount |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Exclusion | $0 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CATERING INCOME | 722320 | 1570 | $1,570 |
| CAFETERIA SALES | 722100 | 37563 | $37,563 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 39133 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 18578360 | TotalRevenueColumn |
| Related Or Exempt Function Income | 17194292 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | -21339 | UnrelatedBusinessRevenue |
| Exclusion | $1,346,771 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 516866 | Total |
| Management And General | 516866 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5975096 | Total |
| Program Services | 5430315 | ProgramServices |
| Management And General | 544781 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 192455 | Total |
| Program Services | 162057 | ProgramServices |
| Management And General | 30398 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1059973 | Total |
| Program Services | 928806 | ProgramServices |
| Management And General | 131167 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 447096 | Total |
| Program Services | 376478 | ProgramServices |
| Management And General | 70618 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10470 | Total |
| Management And General | 10470 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 92064 | Total |
| Management And General | 92064 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2067635 | Total |
| Program Services | 2067635 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 265261 | Total |
| Program Services | 265261 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1900424 | Total |
| Program Services | 1513509 | ProgramServices |
| Management And General | 386915 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 313129 | Total |
| Program Services | 313129 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69533 | Total |
| Program Services | 43891 | ProgramServices |
| Management And General | 25642 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 198564 | Total |
| Management And General | 198564 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 918278 | Total |
| Program Services | 826450 | ProgramServices |
| Management And General | 91828 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 348934 | Total |
| Management And General | 348934 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 1767469 | 1767469 | |
| IPA ASSESSMENT FEE | 250484 | 250484 | |
| PHARMACY | 124546 | 124546 | |
| COLLECTION & ADMINISTRATION | 127841 | 127841 | |
| DUES & FEES | 108248 | 49124 | 59124 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 152169 | Total |
| Program Services | 119467 | ProgramServices |
| Management And General | 32702 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16906535 | Total |
| Program Services | 14238621 | ProgramServices |
| Management And General | 2667914 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2454034 | BOY |
| EOY | 1993911 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 845773 | BOY |
| EOY | 851577 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2323384 | BOY |
| EOY | 2744377 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 73212 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 185064 | BOY |
| EOY | 186157 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 435863 | BOY |
| EOY | 282916 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 27370024 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 17960601 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7433158 | BOY |
| EOY | 9409423 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16944038 | BOY |
| EOY | 18949721 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4356 | BOY |
| EOY | 4356 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18333 | BOY |
| EOY | 20208 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1337506 | BOY |
| EOY | 2395178 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32054721 | BOY |
| EOY | 36837824 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1068418 | BOY |
| EOY | 1625410 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7315000 | BOY |
| EOY | 9000000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 660000 | BOY |
| EOY | 550424 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9043418 | BOY |
| EOY | 11175834 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22911303 | BOY |
| EOY | 25561990 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 60000 | BOY |
| EOY | 60000 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 40000 | BOY |
| EOY | 40000 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23011303 | BOY |
| EOY | 25661990 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32054721 | BOY |
| EOY | 36837824 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1671825 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 978862 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | false | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | 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 D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1358320 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 56 | InvestmentEarningsOrLosses |
| Other Expenditures | 958779 | OtherExpenditures |
| End Of Year Balance | 399597 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1348180 | BeginningOfYearBalance |
| Contributions | 9900 | Contributions |
| Investment Earnings Or Losses | 240 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1358320 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1324418 | BeginningOfYearBalance |
| Contributions | 22970 | Contributions |
| Investment Earnings Or Losses | 792 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1348180 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.74970 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.10010 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.15020 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 473600 | InvestmentCostOrOtherBasis |
| Book Value | 473600 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 10859529 | OtherCostOrOtherBasis |
| Depreciation | 6842980 | Depreciation |
| Book Value | 4016549 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 245904 | OtherCostOrOtherBasis |
| Depreciation | 84709 | Depreciation |
| Book Value | 161195 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3863954 | OtherCostOrOtherBasis |
| Depreciation | 3321967 | Depreciation |
| Book Value | 541987 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11927037 | OtherCostOrOtherBasis |
| Depreciation | 7710945 | Depreciation |
| Book Value | 4216092 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 9409423 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DEFERRED FINANCING COSTS | 80471 |
| ASSETS LIMITED TO USE | 2314707 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 2395178 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | EST. THIRD PARTY SETTLEMENTS | Description |
| Amount | $550,424 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 550424 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| USE OF ENDOWMENT FUNDS | PART V, LINE 4 | THE FUNDS ARE TO BE USED FOR BOND RESERVE FUND, A LETTER OF CREDIT AGREEMENT, OPERATIONS, AND MAINTENANCE OF ASSOCIATION. |
| FIN 48 DISCLOSURE | PART X, LINE 2 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 525755 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 525755 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03470 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1937421 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1301805 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 635616 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04200 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2463176 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1301805 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1161371 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07670 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 38777 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 38777 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00260 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 38777 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 38777 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00260 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2501953 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1301805 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1200148 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07930 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $393,000 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 7748187 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 6403139 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 1345048 | 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 | false | WrittenDebtCollectionPolicy |
| 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 | SHELBY MEMORIAL HOSPITAL ASSOCIATIONINC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 SOUTH CEDAR STREET | AddressLine1 |
| City | SHELBYVILLE | City |
| State | IL | State |
| ZIP Code | 62565 | 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 | SHELBY MEMORIAL HOSPITAL ASSOCIATIONINC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| SHELBY HOME EQUIPMENT | ||||
| 200 SOUTH CEDAR | SHELBYVILLE | IL | 62565 | DURABLE MEDICAL EQUIPMENT |
| SHELBY MEMORIAL HOME HEALTH | ||||
| 200 SOUTH CEDAR | SHELBYVILLE | IL | 62565 | HOME HEALTH AGENCY |
| SHELBY MEM HOSP SKILLED NURSING UNIT | ||||
| 200 SOUTH CEDAR | SHELBYVILLE | IL | 62565 | LONG TERM CARE |
Form990 Schedule H Part VI Form990ScheduleHPartVI (8 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| CHARITY CARE & COMMUNITY BENEFITS AT COST | PART I, LINE 7 | THE COSTS REPORTED IN THE TABLE IN PART I, LINE 7 USED A RATIO OF PATIENT CARE COSTS TO CHARGES AS COMPUTED IN WORKSHEET 2 OF THE FORM INSTRUCTIONS. THIS METHODOLOGY WAS USED FOR ALL PATIENT SEGMENTS. |
| CHARITY CARE & COMMUNITY BENEFITS AT COST PERCENT OF TOTAL EXPENSE | PART I, LINE 7, COLUMN F | THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $1,767,469 REPORTED ON PART IX, LINE 25, HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. |
| BAD DEBT EXPENSE | PART III, LINE 4 | THE ASSOCIATION REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE ASSOCIATION PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE ASSOCIATION BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. THE AMOUNT REPORTED ON LINE 2 WAS DETERMINED USING THE COST TO CHARGE RATIO. |
| MEDICARE COSTS | PART III, LINE 8 | THE AMOUNT REPORTED ON LINE 6 WAS OBTAINED FROM THE ORGANIZATION'S MEDICARE COST REPORT. |
| NEEDS ASSESSMENT | PART VI, LINE 2 | SHELBY MEMORIAL HOSPITAL HAS CONDUCTED JOINT COMMUNITY HEALTH ASSESSMENTS THROUGH A LOCAL COMMUNITY HEALTH COMMITTEE. THE COMMITTEE CONSISTS OF EXECUTIVES OF SHELBY MEMORIAL HOSPITAL, PHYSICIAN REPRESENTATION FROM THE SHELBY COUNTY BOARD OF HEALTH, A REPRESENTATIVE FROM THE SHELBY COUNTY COMMUNITY SERVICES, A REPRESENTATIVE OF THE LOCAL COMMUNITY, AND LOCAL HEALTH DEPARTMENT OFFICIALS. DATA FROM DIFFERENT GROUPINGS WAS COLLECTED AND ANALYZED TO HELP ESTABLISH PRIORITIES. GROUPINGS INCLUDED DEMOGRAPHIC AND SOCIOECONOMIC CHARACTERISTICS, GENERAL HEALTH AND ACCESS TO CARE, MATERNAL AND CHILD HEALTH CARE, CHRONIC DISEASE, INFECTIOUS DISEASE, AND ENVIRONMENTAL/OCCUPATIONAL HEALTH AND INJURY CONTROL. |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | PART VI, LINE 3 | MULTIPLE AVENUES OF EDUCATION ARE UTILIZED TO INSURE ELIGIBLE INDIVIDUALS ARE AWARE OF AVAILABILITY OF ASSISTANCE THROUGH GOVERNMENTAL AND HOSPITAL BASED PROGRAMS. PATIENTS ARE PROVIDED WITH A PACKET OF INFORMATION THAT DETAILS THE AVAILABILITY OF UNINSURED DISCOUNTS AND CHARITY CARE PROGRAMS. ALL STATEMENTS WITH PATIENT DUE BALANCES HAVE WORDING INCLUDED TO SHOW THE AVAILABILITY OF SUCH ASSISTANCE. PRINTED MATERIALS CLEARLY IDENTIFY THE AVAILABILITY OF PROGRAMS. THE HOSPITAL WEB SITE ALSO HAS PROMINENT LANGUAGE ON ALL PAGES CONCERNING AVAILABILITY OF ASSISTANCE. |
| COMMUNITY INFORMATION | PART VI, LINE 4 | SHELBY MEMORIAL HOSPITAL PRIMARILY SERVES THE RESIDENTS OF SHELBY COUNTY, ILLINOIS. TOTAL POPULATION IS 21,874 ACCORDING TO THE 2008 CENSUS ESTIMATES AVAILABLE ON FACTFINDER.CENSUS.GOV. 22% OF RESIDENTS ARE UNDER THE AGE OF 18; 18.6% ARE 65 AND OLDER. 10.4% OF ALL PEOPLE ARE IDENTIFIED AS BEING AT OR BELOW POVERTY LEVEL. |
| PROMOTION OF COMMUNITY HEALTH | PART VI, LINE 5 | SINCE 1918, SHELBY MEMORIAL HOSPITAL HAS PROVIDED FOR THE HEALTH CARE NEEDS OF SHELBY COUNTY AND OTHER SURROUNDING COMMUNITIES. SMH IS LOCATED IN CENTRAL ILLINOIS, IT IS THE ONLY HOSPITAL IN SHELBY COUNTY. SMH IS COMMITTED TO THE HEALTH AND WELFARE OF THE PEOPLE IT SERVES. OVER THE LAST 90+ YEARS, SMH HAS PROVIDED EMERGENT AND NON-EMERGENT CARE REGARDLESS OF A PERSON'S ABILITY TO PAY. SMH WORKS CLOSELY WITH OTHER AGENCIES IN THE AREA TO PROVIDE FOR THOSE NEEDS BEYOND THE SCOPE OF THE HOSPITAL, SUCH AS TRANSPORTATION, PRESCRIPTION ASSISTANCE, SOCIAL WELFARE AND DAILY LIVING NEEDS. SMH PROVIDES THE RESOURCES TO RECRUIT HEALTHCARE WORKERS, PHYSICIAN ASSISTANTS, AND PHYSICIANS TO THE AREA. SMH HAS ESTABLISHED A RURAL HEALTH CARE CENTER TO HELP COMBAT THE PHYSICIAN SHORTAGE IN RURAL AMERICA AND PROVIDE FOR THOSE UNABLE TO PAY FOR SUCH CARE. MEMBERS OF THE SMH TEAM ARE ACTIVE MEMBERS IN THE ECONOMIC DEVELOPMENT COMMITTEE OF SHELBY COUNTY, THE CHAMBER OF COMMERCE, THE MID-ILLINOIS CHAPTER OF THE AMERICAN RED CROSS AND OTHER CIVIC AND NOT FOR PROFIT ORGANIZATIONS DEDICATED TO THE BETTERMENT OF LIVING STANDARDS FOR THE RESIDENTS OF THE AREA. THE BOARD OF DIRECTORS AND MANAGEMENT OF SMH ARE COMMITTED TO PROVIDING THE BEST IN CARE AND EQUIPMENT TO THE COMMUNITY AS IS DEMONSTRATED IN OUR MOST RECENT PURCHASE OF DIGITAL MAMMOGRAPHY EQUIPMENT, LAPAROSCOPIC SURGERY EQUIPMENT AND NEW CARDIAC MONITORING SYSTEMS IN THE PAST TWO YEARS. ADDITIONALLY, SMH HAS SPENT MONIES AND TIME IN MEETING MEANINGFUL USE FOR THE COMPUTERIZED MEDICAL RECORD. SMH'S COMMITMENT TO ELECTRONIC MEDICAL RECORDS MAKES US ONE OF THE FEW SMALL RURAL HOSPITALS IN THE NATION APPLYING TO THE FEDERAL GOVERNMENT FOR THE FUNDS AS OF JANUARY 2011 UNDER THE AMERICAN RECOVERY ACT OF 2009. ALL FUNDS ARE RETAINED BY THE CORPORATION AND REINVESTED IN THE HEALTHCARE NEEDS OF THE COMMUNITY PRESENT OR FUTURE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DR ARNOLD AGAPITO | NamePerson |
| Base Compensation Filing Org | 143405 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 0 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 38600 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 0 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 7280 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 0 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 205 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 0 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 189490 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 0 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF SHELBYVILLE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 421741646 | IssuerEIN |
| Date Issued | 2010-12-30 | DateIssued |
| Issue Price | 9000000 | IssuePrice |
| Description Of Purpose | CONSTRUCTION/RETIREMENT OF BONDS | DescriptionOfPurpose |
| Defeased | false | Defeased |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Pool Financing | false | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amount Retired | 0 | AmountRetired |
| Amount Bond Defeased | 0 | AmountBondDefeased |
| Total Proceeds | 9000000 | TotalProceeds |
| Amount In Reserve Fund | 0 | AmountInReserveFund |
| Capitalized Interest | 0 | CapitalizedInterest |
| Refunding Escrow | 7165000 | RefundingEscrow |
| Issuance Costs From Proceeds | 0 | IssuanceCostsFromProceeds |
| Credit Enhancement | 0 | CreditEnhancement |
| Working Capital Expenditures | 0 | WorkingCapitalExpenditures |
| Capital Expenditures | 0 | CapitalExpenditures |
| Amount Unspent | 1835000 | AmountUnspent |
| Year Of Subst Completion | 2015 | YearOfSubstCompletion |
| Current Refunding | true | CurrentRefunding |
| Advance Refunding | false | AdvanceRefunding |
| Final Allocation Made | false | FinalAllocationMade |
| Adequate Books And Recds Maintaind | true | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | false | OwningBondFinancedProperty |
| Any Lease Arrangements | false | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | false | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | false | AnyResearchAgreements |
| Bond Counsel Routinely Engaged | false | BondCounselRoutinelyEngaged |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | true | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | false | Form8038TFiled |
| Variable Rate Issue | false | VariableRateIssue |
| Hedge Identified In Books And Recds | false | HedgeIdentifiedInBooksAndRecds |
| Superintegrated Hedge | false | SuperintegratedHedge |
| Hedge Terminated | false | HedgeTerminated |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | false | GrossProceedsInvested |
| Exception To Rebate | false | ExceptionToRebate |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| REVIEW PROCESS | FORM 990, PART IV, SECTION A, LINE 11 | THE 990 IS REVIEWED BY THE CFO FOR ACCURACY. NO REVIEW WAS OR WILL BE CONDUCTED BY THE ORGANIZATION'S GOVERNING BODY. |
| COMPLIANCE WITH CONFLICT OF INTEREST POLICY | FORM 990, PART IV, SECTION B, LINE 12C | OFFICERS, DIRECTORS OR TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANNUALLY INTERESTS THAT COULD GIVE RISE TO CONFLICTS. THE ORGANIZATION ALSO HOLDS QUARTERLY MEETINGS WITH EMPLOYEES. THE HOSPITAL'S CEO, CFO, AND CNE ARE RESPONSIBLE FOR DETERMINING AND REVIEWING ANY CONFLICTS OF INTEREST. |
| PROCESS FOR DETERMINING COMPENSATION | FORM 990, PART VI, SECTION B, LINE 15A/B | WAGE SCALE IS PREPARED USING COMPARISON INFO FROM OTHER HOSPITALS. IT IS PREPARED BY THE HUMAN RESOURCE DIRECTOR AND ENFORCED BY THE HUMAN RESOURCE DIRECTOR AND THE CFO. |
| PROCESS FOR MAKING DOCUMENTS AVAILABLE TO PUBLIC | FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| OTHER CHANGES IN NET ASSETS | FORM 990, PART XI, LINE 5 | UNREALIZED GAIN $ 979,056 MISC. DIFFERENCE $ <194> _________ TOTAL OTHER CHANGES $ 978,862 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:ELAINE BERRY TITLE:CHAIRMAN HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:MARILYN SEARS TITLE:PRESIDENT/CEO HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:PHILIP MILLER TITLE:CFO HOURS:1 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHELBY MEMORIAL HOSPITAL FOUNDATIONINC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 SOUTH CEDAR STREET | AddressLine1 |
| City | SHELBYVILLE | City |
| State | IL | State |
| ZIP Code | 62565 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 371294401 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivities |
| Legal Domicile State | IL | LegalDomicileState |
| Exempt Code Section | 501(C)3 | ExemptCodeSection |
| Public Charity Status | 11 - I | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SMHA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHELBY MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | R | TransactionType |
| Amount Involved | 73212 | AmountInvolved |