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NORTHWESTERN MEMORIAL HEALTHCARE: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
NORTHWESTERN MEMORIAL HEALTHCARE (EIN 36-2338884)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-14
IRS object ID
201101349349300005
Schema version
2009v1.7
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-05-14T07:28:24-07:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN362338884EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Northern Illinois Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlNORTNameControl
Phone8157885800Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line14201 Medical Center DriveAddressLine1
CityMcHenryCity
StateILState
ZIP Code60050ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRobert RosenbergerName
TitleCFO & SR VPTitle
Date Signed2011-05-14DateSigned
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMichael EesleyNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1385 Millenium DriveAddressLine1
CityCrystal LakeCity
StateILState
ZIP Code60012ZIPCode
FieldValueIRS element (for citing)
Gross Receipts284955589GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501cXOrganization501c
Web Sitewww.centegra.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1956YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionThe primary mission of Northern Illinois Medical Center is to provide quality health care services with innovative and responsible use of resources and promote wellness for the greater McHenry County area.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees1399TotalNbrEmployees
Total Nbr Volunteers256TotalNbrVolunteers
Total Gross UBI421349TotalGrossUBI
Net Unrelated Business Txbl Income-28319NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year595236ContributionsGrantsPriorYear
Contributions Grants Current Year413674ContributionsGrantsCurrentYear
Program Service Revenue Prior Year234604710ProgramServiceRevenuePriorYear
Program Service Revenue CY231275528ProgramServiceRevenueCY
Investment Income Prior Year-29243946InvestmentIncomePriorYear
Investment Income Current Year4214977InvestmentIncomeCurrentYear
Other Revenue Prior Year2645090OtherRevenuePriorYear
Other Revenue Current Year2726363OtherRevenueCurrentYear
Total Revenue Prior Year208601090TotalRevenuePriorYear
Total Revenue Current Year238630542TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year87926651SalariesEtcPriorYear
Salaries Etc Current Year86583586SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year131386453OtherExpensePriorYear
Other Expenses Current Year128404373OtherExpensesCurrentYear
Total Expenses Prior Year219313104TotalExpensesPriorYear
Total Expenses Current Year214987959TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-10712014RevenuesLessExpensesPriorYear
Revenues Less Expenses CY23642583RevenuesLessExpensesCY
Total Assets BOY212861218TotalAssetsBOY
Total Assets EOY228966603TotalAssetsEOY
Total Liabilities BOY102589596TotalLiabilitiesBOY
Total Liabilities EOY102344661TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY110271622NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY126621942NetAssetsOrFundBalancesEOY
Mission DescriptionThe primary mission of Northern Illinois Medical Center is to provide quality health care services with innovative and responsible use of resources and promote wellness for the greater McHenry County area.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense194109183Expense
Revenue233580542Revenue
DescriptionNorthern Illinois Medical Center provides comprehensive health care services to the greater McHenry County service area. For a detailed description of the Medical Center's program services accomplishments, please see supplemental Part III Program Service Accomplishments, Schedule O.Description
Total Program Service Expense194109183TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Balance Sheet Amounts ReportedtrueBalanceSheetAmountsReported
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096120NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1399NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProceduretrueWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonRobert RosenbergerNamePerson
Telephone Number8157885800TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1385 Millennium DriveAddressLine1
CityCrystal LakeCity
StateILState
ZIP Code60012ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (35 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationIndividual Trustee Or DirectorIndividualTrusteeOrDirectorHighest Compensated EmployeeHighestCompensatedEmployeeKey EmployeeKeyEmployeeFormerFormer
Zbigniew Lorenc
Physician1.00X021454319043
William Cox
Secretary2.00X000X
Wanasinghe M Jayasena
Physical Therapist40.00153652023074X
Tom Carey
Director1.00000X
Terrence Bugno
Director1.00000X
Susan Murphy
V.P. & C.N.O.1.00X018598319046
Susan Milford
Vice President1.00X019712825059
Robert Turngren
Vice President1.00X034206627139
Robert Rosenberger
CFO & SR VP1.00X035055767568
Rachel Sebastian
Vice President1.00X01259144373
Paula M Adamson
Physical Therapist0.128328012221X
Paul Hills
Director1.00000X
Pat Morehead
Treasurer2.00X000X
Parmod Narang
Director1.00150000X
Mike Curran
Director1.00000X
Michael Eesley
CEO2.00X0758227261432X
Luke Johnsos
Director1.00000X
Laura Walczak
Director, ED1.00015349016801X
Kathy Powell
Director1.00000X
John G Geinopolos
Med Physicist40.0015677605520X
Joe Hurshe
Vice President0.02233916690X
Jason Sciarro
President &COO1.00X044536162087
Jack Porter
Director1.00000X
Gail Rudolph
Vice President1.00X017582916822
Doris Hendrickson
Vice President1.00X01924913332
Debra A Brasier
Coordinater, Pharm40.00129874022365X
David Tomlinson
Vice President1.00X022309726120
D Michael Splitt
Director1.00000X
Chris Newkirk
Chairman1.00000X
Charles Ruth
Director1.00000X
Charie Zanck
Vice Chair2.00X000X
Barbara Johnson
Sr. V.P.1.00X029245570836
Angela McAuley
Director2.00X026903721116X
Amy Moerschbaecher
Exec Director SCC40.00135411022698X
Aaron Shepley
SR VP1.00X030287853724
FieldValueIRS element (for citing)
Total Reportable Comp From Org705541TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs4452447TotalReportableCompFrmRltdOrgs
Total Other Compensation787066TotalOtherCompensation
Number Individuals GT100 K45NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Superior Health Linens
2905 Syene RoadMadisonWI53713Laundry Services592574
Specialty Laboratories
PO Box 54920Los AngelesCA900540920Laboratory Services557186
Sodexo Inc & Affiliates
4880 Paysphere CircleChicagoIL60674Management Services2510206
Dell Marketing LP
7489 Collection Center DriveChicagoIL60693Computer Support1505253
Cardiac Surgery Associates
PO Box 153ChannahonIL60410Physician Services696847
FieldValueIRS element (for citing)
Number Of Contractors GT100 K10NumberOfContractorsGT100K
Related Organizations355781RelatedOrganizations
Government Grants57893GovernmentGrants
Total Contributions413674TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Routine Patient Services6221107033957370339573
IDPA Provider Tax Revenue62211051955265195526
Charity Care/Admin Allowa622110-12462478-12462478
Ancillary Outpatient Serv622110141434869141434869
Ancillary Inpatient Servi6221102676803826768038
FieldValueIRS element (for citing)
Total Program Service Revenue231275528TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column8771825TotalRevenueColumn
Exclusion$8,771,825ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column-1097786TotalRevenueColumn
Exclusion-$1,097,786ExclusionAmount

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities13192000Securities
Other29673985Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities16321093Securities
Other30003954Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-3129093Securities
Other-329969Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-3459062TotalRevenueColumn
Exclusion-$3,459,062ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
Related Company Revenue900099514135514135
Child Day Care Center624410692216270867421349
Cafeteria Services & Educ722210906744906744

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column613268TotalRevenueColumn
Related Or Exempt Function Income613268RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue2726363TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column238630542TotalRevenueColumn
Related Or Exempt Function Income233580542RelatedOrExemptFunctionIncome
Unrelated Business Revenue421349UnrelatedBusinessRevenue
Exclusion$4,214,977ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1500Total
Program Services1500ProgramServices

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total69836828Total
Program Services61377586ProgramServices
Management And General8459242ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1170450Total
Program Services1023749ProgramServices
Management And General146701ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total10646891Total
Program Services9312437ProgramServices
Management And General1334454ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total4927917Total
Program Services4310265ProgramServices
Management And General617652ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total743461Total
Management And General743461ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total28873Total
Management And General28873ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total6003907Total
Program Services5469208ProgramServices
Management And General534699ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total43788Total
Program Services43788ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total36906257Total
Program Services36356789ProgramServices
Management And General549468ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total7109Total
Program Services5859ProgramServices
Management And General1250ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2249380Total
Program Services904690ProgramServices
Management And General1344690ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total202660Total
Program Services166296ProgramServices
Management And General36364ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total102249Total
Program Services83527ProgramServices
Management And General18722ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total4034731Total
Program Services3529028ProgramServices
Management And General505703ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total10938158Total
Program Services9567198ProgramServices
Management And General1370960ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total3847063Total
Program Services3364882ProgramServices
Management And General482181ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Repairs & Maintenance37203213295947424374
Related Company32781264286725464108718
IDPA Provider Tax49502364950236
Bad Debt1971063419710634
All Other21323651963018169347

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1917Total
Management And General1917ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total214987959Total
Program Services194109183ProgramServices
Management And General20878776ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY50053BOY
EOY109506EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY15098652BOY
EOY17297401EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY25987386BOY
EOY24604093EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY3606406BOY
EOY4182732EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1981189BOY
EOY2132553EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis156844197LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec95938096LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY67752880BOY
EOY60906101EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY60771214BOY
EOY68801071EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY2913979BOY
EOY4396915EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY34699459BOY
EOY46536231EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY212861218BOY
EOY228966603EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY26311738BOY
EOY27624027EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY75303120BOY
EOY74035132EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY974738BOY
EOY685502EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY102589596BOY
EOY102344661EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY109797266BOY
EOY124861598EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY474356BOY
EOY1760344EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY110271622BOY
EOY126621942EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY212861218BOY
EOY228966603EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired
Federal Grant Audit PerformedfalseFederalGrantAuditPerformed

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)
Form4720 Filed4955 TaxfalseForm4720Filed4955Tax
Correction MadefalseCorrectionMade
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$28,873OtherActivitiesAmount
Total Lobbying Expenditures IIB28873TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart II-B, Line 1iIdentifier
Return ReferencePart II-B, Line 1i - Other Activities DescriptionReturnReference
ExplanationAs a part of our payment of Illinois Hospital Association dues, approximately 35% are allocable to lobbying activities.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis65000OtherCostOrOtherBasis
Book Value65000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis64651213OtherCostOrOtherBasis
Depreciation27743263Depreciation
Book Value36907950BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1763289OtherCostOrOtherBasis
Depreciation1301893Depreciation
Book Value461396BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis87422725OtherCostOrOtherBasis
Depreciation66892940Depreciation
Book Value20529785BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2941970OtherCostOrOtherBasis
Book Value2941970BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings60906101TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
Other Receivables8331
Intercompany Receivables46527900
FieldValueIRS element (for citing)
Total Book Value Other Assets46536231TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionProfessional LiabilityDescription
Amount$685,502Amount
FieldValueIRS element (for citing)
Total Of Amounts685502TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart XIdentifier
Return ReferencePart X : FIN48 FootnoteReturnReference
ExplanationASC Topic 740, Income Taxes, addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded in the consolidated financial statements. Under ASC Topic 740, the Health System must recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured based on the largest benefit that has a greater than fifty percent likelihood of being realized upon ultimate settlement. ASC Topic 740 also provides guidance on derecognition, classification, interest and penalties on income taxes, and accounting in interim periods and requires increased disclosures. At the date of adoption, and as of June 30, 2010, the Health System does not have a liability for unrecognized tax benefits. The adoption of ASC Topic 740 had no impact on the consolidated financial statements of the Health System.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage600.000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense2983368TotalCommunityBenefitExpense
Net Community Benefit Expense2983368NetCommunityBenefitExpense
Percent Of Total Expense0.01390PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense16331439TotalCommunityBenefitExpense
Direct Offsetting Revenue8151132DirectOffsettingRevenue
Net Community Benefit Expense8180307NetCommunityBenefitExpense
Percent Of Total Expense0.03810PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense19314807TotalCommunityBenefitExpense
Direct Offsetting Revenue8151132DirectOffsettingRevenue
Net Community Benefit Expense11163675NetCommunityBenefitExpense
Percent Of Total Expense0.05190PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs20NumberOfActivitiesOrPrograms
Persons Served10816PersonsServed
Total Community Benefit Expense464904TotalCommunityBenefitExpense
Direct Offsetting Revenue8990DirectOffsettingRevenue
Net Community Benefit Expense455914NetCommunityBenefitExpense
Percent Of Total Expense0.00210PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served187PersonsServed
Total Community Benefit Expense218268TotalCommunityBenefitExpense
Net Community Benefit Expense218268NetCommunityBenefitExpense
Percent Of Total Expense0.00100PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Net Community Benefit Expense1NetCommunityBenefitExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs23NumberOfActivitiesOrPrograms
Persons Served11003PersonsServed
Total Community Benefit Expense683172TotalCommunityBenefitExpense
Direct Offsetting Revenue8990DirectOffsettingRevenue
Net Community Benefit Expense674183NetCommunityBenefitExpense
Percent Of Total Expense0.00310PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs23NumberOfActivitiesOrPrograms
Persons Served11003PersonsServed
Total Community Benefit Expense19997979TotalCommunityBenefitExpense
Direct Offsetting Revenue8160122DirectOffsettingRevenue
Net Community Benefit Expense11837858NetCommunityBenefitExpense
Percent Of Total Expense0.05510PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$5,992,033BadDebtExpenseAmount
Amount Attributable To4635774AmountAttributableTo
Amount Reimbursed By Medicare64379319AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare73414179CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-9034860MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

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

Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnership
ARSC Real Estate
Property Management0.25000
Algonquin Road Surgery Ctr
Outpatient Surgical Service0.12750

Form990 Schedule H Part V Form990ScheduleHPartV (7 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeOtherOtherLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalCritical Access HospitalCriticalAccessHospitalEr24 HoursEr24Hours
Centegra CLMA Imaging Ctr
360 Station Drive Ste 150Crystal LakeIL60014Medical Imaging Center
Crystal Lake Imaging Center
360 N Terra Cotta RoadCrystal LakeIL60012Medical Imaging Center
NIMC Therapy Services
3739 W Elm StreetMcHenryIL60050Physical Rehabilitation Clinic
NIMC Neurotrauma Day Treatment
500 Coventry LaneCrystal LakeIL60014Neurotrauma Day Treatment Center
NIMC Rehab and Sports Clinic
200 Congress ParkwayCrystal LakeIL60014Sports Medicine & Rehab Clinic
NIMC Back to Work Program
200 Congress ParkwayCrystal LakeIL60014Physical Rehabiliation Clinic
Northern Illinois Medical Ctr
4201 Medical Center DriveMcHenryIL60050Cancer CenterXXXX

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Bad Debt FootnoteThe estimated amount of bad debt expense (at cost) which could be reasonably attributable to patients who would likely qualify for financial assistance under the organization's charity care policy if sufficient information had been available to make a determination of their eligibility was based on the self pay patient accounts which were written off as bad debts. These amounts were then multiplied by the cost to charge ratio. Any payments received during the fiscal year on these accounts were deducted from the cost.BadDebtFootnote
Shortfall As Community BenefitThe shortfall in Part III, line 7 was calculated using the Medicare cost-to-charge ratio. The amount of cost that exceeds reimbursement is actual cost to treat patients and is therefore treated as a community benefit.ShortfallAsCommunityBenefit
Debt Collection PolicyCentegra provides patients with consistent information on payment expectations and assists them in meeting their financial obligations. A written explanation of the payment requirements categorized by type of payor is given prior to admission/registration or upon admission/registration of each Centegra Health System (CHS) patient.Centegra will bill the patient's insurance carrier. Procedures will be implemented over time and by area to collect as much as possible of the time of service unless payor contracts require billing (i.e., no assignments).1. Admission reservation/outpatient appointment made by physician/patient. Walk-in and Emergency Department patients present for service.2. Perform the patient pre-registration for applicable scheduled registrations.3. Patient verbal consent obtained and annotated except where prohibited by law."On (date) at about (time), (patient or representative) orally authorized (Site Name) to release information concerning the patient's medical care, treatment and diagnosis to employers, insurance companies, government agencies or third-party payors and their agents, for verification of benefits and pre-certification. I (the Pre-Registrar) did not obtain a written consent signed by the patient, due to the patient not being physically present and limited time constraints."This statement would be signed and dated by the Pre-Registrar. Patient refusal to provide oral consent requires patient notification of potential penalties and places the burden on the patient to complete payor requirements.4. Complete insurance verification and initiate pre-certification.5. Estimate the approximate cost of services and advise the responsible party. Explanation of the cost will fluctuate based on services ordered by the physicians.6. Discuss the financial requirements, including payment expectations with the patient/guarantor prior to admission/registration when applicable.7. Interview conducted by Financial Counselor of patients who express difficulty in meeting Centegra's payment requirements.8. Admission/registration of patient is completed. Patient/guarantor signature for the Consent to Release Information obtained.9. Collect the estimated patient share. The deductible and co-payments and any non-covered amounts quoted by the carrier are due from inpatients prior to discharge and where possible, for outpatients prior to or at the time of registration.10. Self-Pay accounts are to be paid in full or screened by the Financial Counselor for potential State or Federal Program, Financial Assistance application or payment plan.11. Policy regarding non-compliance with respect to payment arrangements or plans:Self-Pay: Patients who have not completed arrangements for one of the payment options within 120 days of the billing date will be automatically turned over to a collection agency.Broken Promise/Defaults: Patients with delinquent payments, 15 or more days late, will be turned over to a collection agency.After Insurance: Processing patients who have not made payments or enrolled in one of the payment options for co-insurance and deductible amounts within 120 days of insurance payment will be turned over to a collection agency.DebtCollectionPolicy
Number Of Facility Type ExplnNorthern Illinois Medical Center is a 172 bed facility with a Level II nursery and a center for cancer care, Sage Cancer Center. In addition, NIMC operates four off-site physical rehabilitation centers offering therapy services, as noted in Part V. NIMC also operates two sites where medical imaging services are offered, as noted in Part V.NumberOfFacilityTypeExpln
General ExplanationSchedule H, Part I, Line 7a-7c dollars are calculated using the Medicare cost to charge ratio. Line 7e-7i dollars are calculated from community benefit reports that are submitted by the Hospital departments for various activities and support groups that benefit the community. Schedule H, Line 7, column f percentages are automatically calculated by the software based on total functional expenses. If bad debt expense were removed from the functional expense total, then the percent of total expense would be 6.05%.GeneralExplanation
Needs AssessmentCentegra Health System is an active participant in the McHenry County Health Departments on-going MAPP (Mobilizing for Action through Planning & Partnerships) process. MAPP priorities include the following:1) Increase Access to Medical, Dental and Mental Health care * Provide increased access to follow up care (medical, dental, mental) for the under/uninsured residents of McHenry County. * Increase access to (medical, dental, mental) prevention, education, and screening programs available for all residents of McHenry County.2) Information & Referral * Centralize and update Information and Referral located on Crisis Services website * Market Crisis Line #/Website (future 2-1-1) to community to increase visibility * 2-1-1 Information and Referral System3) Cardiovascular Care * By 2017, reduce the death rate from cardiovascular disease by 20%Cemtegra Health System identifies community health care priorities and develops activities and strategies to meet the health care needs of at risk populations within its service area. These community benefit programs promote community wellness and disease prevention, enhance community health education, and improve the quality of clinical education.NeedsAssessment
Patient Education AssistanceUninsured patients arriving at our emergency department and/or direct admits are screened at time of service by either an Emergency Department Financial Counselor or the Health Systems In-Patient Financial Counseling Team, Public Aid Representatives, and a Medication Assistance Coordinator to identify eligibility guidelines for federal, state and local government programs, as well as charity care. CHSs Self Pay Process includes a screening which is completed by using hospital form C910050 03-09 prompting an interview offering payment options and eligibility guidelines. It is at this time that a patient becomes aware of the Hospital Uninsured Patient Discount Act, Medicaid, Medication Assistance Programs, Crime Victims, Section 1011, IBCCP, Cash Pay Fee Schedules, and other hospital discount incentives. Patients are advised of time lines for completing application processes at time of service in person. Appropriate scripting is followed by CHS Associates. Discounts were established following the 200%, 350% and 600% federal poverty guidelines to assist in determining charity adjustments. Applications were designed by CHS Self Pay Committee in accordance to our Financial Policy (Policy Number 9850-2)identifying qualifications for the medically needy/catastrophic aid. Uninsured patients opting for elective services are contacted by phone prior to their date of service by the CHS Out-Patient Financial Counseling Team. CHSs Self Pay Process is followed and includes a screening for federal, state and local government programs as well charity care. An interview offering payment options and eligibility guidelines using hospital form C910050 03/09 prompts a quick eligibility determination. It is at this time that a patient becomes aware of the Uninsured Patient Discount Act, Medicaid, Medication Assistance Programs, Crime Victims, Section 1011, IBCCP, Cash Pay Fee Schedules, and other hospital discount incentives. Patients are advised of time lines for completing application processes prior to their elective services via phone. Appropriate scripting is followed by CHS Associates. Discounts were established following the 200%, 350% and 600% federal poverty guidelines to assist in determining charity adjustments. Applications were designed by CHS Self Pay Committee in accordance to our Financial Policy (Policy Number 9850-2) identifying qualifications for the medically needy/catastrophic aid. Our health systems website offers FAQs and answers as well as encourages patients to contact our Customer Service Team when they are unable to pay for services. Our health systems statements also identify detailed account and billing information encouraging the patient to contact our Customer Service Team and inquire about Financial Assistance options. Documentation is essential in effective communication. Follow up teams will then move forward in a timely manner with the appropriate actions to insure all necessary documents (if applicable) are received for eligibility determinations. CHS advertises a Price Line encouraging patients to inquire about estimated costs for future services. The Price is manned by our Out-Patient Financial Counselors from 8:00am 7:00pm. When calls are returned with estimated costs, a conversation ensues to identify a possible financial hardship. Our Self Pay Process is put into effect at this time. Site Registrars will notify the CHS Financial Counseling Team when a financial hardship is identified. Emergency Department Financial Counseling positions have been created to meet the needs of our ED patients. In addition to these new roles, a full time Financial Counselor position was created to meet the special needs of our cancer patients. A Financial Assistance Coordinator reviews all financial applications, gathers needed documents, determines financial assistance and prepares each patient file for leadership approval.PatientEducationAssistance
Community InformationCentegra Health System defines its primary service area as Greater McHenry County, an area of approximately 612 square miles and 341,000 residents. This county is among the fastest growing counties in Illinois with growth seen in all age categories. The population is projected to increase by 13% over the next 5 years. For 2007, the age distribution of the population is as follows: 27% 0-17, 38% 18-44, 25% 45-64, and 10% 65+. McHenry County has a relatively high socioeconomic status compared to the rest of Illinois. Median household income for 2007 was 52% higher than the rest of the state. The 2006 annual average unemployment rate was 24% below the state average. The percentage of families below the poverty level for 2006 was 52% below the rest of the state. For 2006, the percentage of the county's population holding a high school diploma was 7% greater than rest of the state, while the percentage holding a bachelor's degree or higher was 6% higher and the rest of the state. The median household income (in 2008 inflation-adjusted dollars) was $77,681 with an unemployment rate of 5.8%. 4.2% of families fell below the poverty level.CommunityInformation
Other InformationPlease see Schedule O for a detailed description of the Medical Center's program service accomplishments.OtherInformation
Affiliated Health Care SystemNorthern Illinois Medical Center of McHenry, IL is affliated with Memorial Medical Center of Woodstock, IL. Both Hospitals are acute care facilities serving the greater McHenry County area. Centegra Health System is the parent of both Northern Illinois Medical Center and Memorial Medical Center. Northern Illinois Medical Center is affiliated with Health Bridge Fitness Centers in Crystal Lake, and the Medical Center provides outpatient physical rehabilitation services to the community from a clinic within that location. The Centegra Health System Foundation supports Hospital operations through fundraising activities.Please see schedule R for complete listing of all affiliated organizations.AffiliatedHealthCareSystem
Reports Filed With StatesILReportsFiledWithStates

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (19 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsBase Compensation Filing OrgBaseCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Zbigniew Lorenc
205187935691509893233586
Wanasinghe M Jayasena
153652649316581176726
Susan Murphy
1779778006756811478205029
Susan Milford
1887118417822216837222187
Robert Turngren
328256138101003817101369205
Robert Rosenberger
336164143935050917059418125
Michael Eesley
7558352500231140910196592392
Laura Walczak
146342714816801170291
John G Geinopolos
1567765520162296
Joe Hurshe
2233917515939230081
Jason Sciarro
4235731801245121169665074483776
Gail Rudolph
168201762816822192651
Doris Hendrickson
18431481772657675195823
Debra A Brasier
129874551516850152239
David Tomlinson
2146228475927916841249217
Barbara Johnson
242576103736468361533632913950639506
Angela McAuley
256769102689773113432901532000
Amy Moerschbaecher
135411584816850158109
Aaron Shepley
290726121523665017074356602

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (4 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
American Community Bank
Board Member100000Investment Servicesfalse
Home State Bank
Board Treasurer100000Investment Servicesfalse
American Community Bank
Board Vice Chair100000Investment Servicesfalse
Home State Bank
Board Member100000Investment Servicesfalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableAll governing documents, policies, and financial statements are available upon request.
Form 990, Part VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesThe Board of Directors of Centegra Health System, through the Compensation Committee comprised of independent members free of conflict, reviewed executive compensation levels and other features of the compensation plan in accordance with the organization's approved compensation philosophy and strategy: The Committee is comprised of members of the Board of Directors, who are independent of Centegra management, have no personal interest in the compensation arrangements, are not related to, or under the control of any individual whose compensation arrangement is being reviewed and have no material business relationship with Centegra.The Chief Executive Officer's compensation is determined by the Compensation Committee in relation to appropriate comparability data. Compensation for other members of the executive staff are developed by the CEO, reviewed by the Committee, evaluated against market data, and approved by the Committee. The Committee approves all compensation decisions in advance of their implementation and documents its determinations and discussions. Its decisions and deliberations are thoroughly documented and meeting minutes are kept and distributed to the Committee members (for historical reference). The Compensation Committee uses a number of external resources and comparisons, and their review includes total compensation (cash compensation, plus benefits provided by Centegra) in relation to organizational performance and prevailing industry practices of comparably-sized organizations. They have engaged the services of a compensation consulting firm (Sullivan Cotter) specializing in the not-for-profit sector that has worked with Centegra and reports directly to the Compensation Committee.
Form 990, Part VI, Line 12cForm 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsAs stated in Centegra's Bylaws, the Bylaws recognize that both real and apparent conflicts of interest sometimes naturally occur in the course of conducting daily affairs. Conflicts occur because the many persons associated with Centegra should be expected to have and do, in fact, generally have multiple interests and affiliations and various positions of responsibility within the community. The long-range interests of Centegra do not require the termination of all association with persons who may have real or apparent conflicts if a prescribed and effective method can render such conflicts harmless to all concerned. Centegra Health System has a conflict of interest policy that is intended to address such matters. 1. Duty to Disclose: In connection with any actual or possible conflicts of interest, an interested person or other person subject to this policy must disclose the existence and nature of his or her financial interest in writing to the President of Centegra or the Chief Corporate Responsibility Officer or designee, who shall provide such written disclosure to the Governors Affairs Committee of Centegra, which shall consider all conflicts of interest issues and, if appropriate, to the directors and members of committees with board-delegated powers considering the proposed transaction or arrangement. The disclosure must occur, at minimum, annually, with a Conflict of Interest Disclosure Statement being submitted no later than January 31st of each year. Copies of disclosure statements filed by Board members shall be distributed to the Board annually at the February Board meeting.2. Determining Whether a Conflict of Interest Exists: When a conflict of interest is disclosed at meeting of the board or committee thereof, after disclosure of the financial interest, the interested person shall leave the board or committee meeting while the financial interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists. The interested person's leaving such meeting shall not affect whether a quorum exists at such meeting.3. Procedures for Addressing the Transaction or Arrangement From Which the Conflict Arose: A. The chairperson of the board or committee shall, if appropriate, appoint a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement.B. After exercising due diligence, the board or committee shall determine whether Centegra can obtain a more advantageous transaction or arrangement with reasonable efforts from a person or entity that would not give rise to a conflict of interest.C. If a more advantageous transaction or arrangement is not reasonably attainable under circumstances that would not give rise to a conflict of interest, the board or committee shall determine by a majority vote of the disinterested directors whether the transaction or arrangement is in Centegra's best interest and for its own benefit and whether the transaction is fair and reasonable to Centegra and shall make its decision as to whether to enter into the transaction or arrangement in conformity with such determination.4. Violations of the Conflicts of Interest Policy: A. If the administration, the board, or a committee has a reasonable cause to believe that a member has failed to disclose actual or possible conflicts of interest, it shall inform the member of the basis for such belief and afford the member an opportunity to explain the alleged failure to disclose.B. If, after hearing the response of the member and making such further investigation as may be warranted in the circumstances, the board or committee determines that the member has, in fact, failed to disclose an actual or possible conflict of interest, it shall refer the matter to the Governors Affairs Committee for consideration, which shall subsequently recommend appropriate disciplinary and corrective action to such board or committee.
Form 990, Part VI, Line 11Form 990, Part VI, Line 11: Form 990 Review ProcessThe review process for the 990 included review by the Director of Accounting and Chief Financial Officer. The 990 also was sent to an outside auditor for review before submission to the IRS.
Form 990, Part VI, Line 6Form 990, Part VI, Line 6: Explanation of Classes of Members or ShareholderCentegra Health System has a single class of members.
Form 990, Part VI, Line 3Form 990, Part VI, Line 3: Description of Delegated Duties to Management CompanyManagement companies were used for the daily operations and management of the following services for the health system. Sodexho was used for Food & Nutrition, Plant Operations and Maintenance, and Environmental Services work. ACS was used for the management of the Information Systems area for part of the fiscal year. For the remaining part of the fiscal year, Perot (Dell) was used for the Information Systems area. Professional Business Consultants is used for the management of the Managed Care department.
Form 990, Part VI, Line 2Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, EtNorthern Illinois Medical Center, (NIMC), adopted specific conflict of interest policies for its governing and management staff. The policy includes, but is not limited to, when an individual, governor, committee member, officer, agent or employee believes that he or she, or a member of his or her immediate family might have or does have a real or apparent conflict, he or she should in addition to filing the disclosure notice required, abstain from making motions, voting, executing agreements, or taking any other similar direct action on behalf of the Medical Center.During fiscal year 2010, Northern Illinois Medical Center purchased certain goods and/or services from organizations with director affiliation. All transactions were competitively bid and were conducted at arms length. The fees paid were at fair market value. Director Kathy Powell is an employee and Vice President of Home State Bank. Director Patrick Morehead is on the Board of Directors and a 1% owner of Home State Bank. Vice Chairman Charie Zanck is a Director of American Community Bank & Trust. Director Charles Ruth is the Board Chairman of American Community Bank & Trust.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (4 entries)

Address Line1AddressForeign/AddressLine1CityAddressForeign/CityProvince Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryPostal CodeAddressForeign/PostalCodePrimary ActivitiesPrimaryActivitiesLegal Domicile Foreign CountryLegalDomicileForeignCountryBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINLegal Domicile StateLegalDomicileState
Centegra Insurance Services Ltd
PO Box 1051George TownGrand CaymanCJKY1-1102Provide Malpractice InsuranceCJCentegra Health System
DIS Holdings
Imaging ServicesCentegra Health System385 Millennium DriveCrystal LakeIL60012363196559DE
Centegra Health Bridge Fitness Center
Health & Fitness CenterNIMED10450 Algonquin RoadHuntleyIL60142261277524DE
Centegra Primary Care LLC
Physician PracticeCentegra Health System385 Millennium DriveCrystal LakeIL60012364085398DE

Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Direct Controlling Entity NADirectControllingEntityNA
Oak Creek Lodge
385 Millenium DriveCrystal LakeIL60012363591359Hospital OperationsIL501(c)33Centegra Health System
NIMED Corporation
385 Millenium DriveCrystal LakeIL60012363199111Property Management ServicesIL501(c)(3)11cCentegra Health System
Memorial Medical Center
3701 Doty RoadWoodstockIL60098362179764Hospital OperationsIL501(c)(3)3Centegra Health System
Health Bridge Corporation
200 Congress ParkwayCrystal LakeIL60014363196550Health & Fitness CenterIL501(c)(3)11cCentegra Health System
Centegra Health System Foundation
385 Millenium DriveCrystal LakeIL60012363726310Charitable FoundationIL501(c)(3)11aCentegra Health System
Centegra Health System
385 Millenium DriveCrystal LakeIL60012363196559Support for Hospital OperationsIL501(c)(3)11cN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Centegra Management ServicesBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1385 Millenium DriveAddressLine1
CityCrystal LakeCity
StateILState
ZIP Code60012ZIPCode
FieldValueIRS element (for citing)
EIN364028114EIN
Primary ActivityManagement services for physician practicePrimaryActivity
Legal Domicile StateILLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Centegra Health SystemBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityC CorpTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg