COMMUNITY HOSPITAL OF STAUNTON: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL OF STAUNTON (EIN 37-0624255)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-03-02
- IRS object ID
- 201120619349300212
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-03-02T13:51:00-06:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kerber Eck & Braeckel LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | One Memorial Drive Ste 950 | AddressLine1 |
| City | St Louis | City |
| State | MO | State |
| ZIP Code | 63102 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 370624255 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Memorial Hospital Association | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COMM | NameControl |
| Phone | 6186352200 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 Caldwell Street | AddressLine1 |
| City | Staunton | City |
| State | IL | State |
| ZIP Code | 62088 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Susie Campbell | Name |
| Title | CEO | Title |
| Phone | 6186352200 | Phone |
| Date Signed | 2011-02-22 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Brent McClure | Name |
| Phone | 3142316232 | Phone |
| Date Prepared | 2011-02-21 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Susie Campbell | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 Caldwell Street | AddressLine1 |
| City | Staunton | City |
| State | IL | State |
| ZIP Code | 62088 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 14498096 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.STAUNTONSHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1946 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | HEALTH CARE | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 175 | TotalNbrEmployees |
| Total Nbr Volunteers | 23 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 86306 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 52268 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 13977254 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 14278971 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -72760 | InvestmentIncomePriorYear |
| Investment Income Current Year | 94649 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 99983 | OtherRevenuePriorYear |
| Other Revenue Current Year | 72208 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 14090783 | TotalRevenuePriorYear |
| Total Revenue Current Year | 14498096 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 1000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 6787162 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 6810902 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 7046084 | OtherExpensePriorYear |
| Other Expenses Current Year | 7255790 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 13833246 | TotalExpensesPriorYear |
| Total Expenses Current Year | 14067692 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 257537 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 430404 | RevenuesLessExpensesCY |
| Total Assets BOY | 11373142 | TotalAssetsBOY |
| Total Assets EOY | 12579369 | TotalAssetsEOY |
| Total Liabilities BOY | 1615219 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2391042 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 9757923 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 10188327 | NetAssetsOrFundBalancesEOY |
| Mission Description | To provide healthcare services to the community of Staunton and surrounding areas. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 11310074 | Expense |
| Revenue | 14278971 | Revenue |
| Description | THE ORGANIZATION OPERATES A FULL SERVICE HOSPITAL IN STAUNTON, ILLINOIS WITH 25 TOTAL BEDS. TOTAL PATIENT DAYS WERE 1,392 OF WHICH APPROXIMATELY 86% WERE MEDICARE DAYS AND 4% WERE MEDICAID DAYS. THE HOSPITAL ALSO PROVIDED 6,593 HOME HEALTH CARE VISITS OF WHICH 5,130 WERE PROVIDED TO MEDICARE PATIENTS AND 479 WERE PROVIDED TO MEDICAID PATIENTS. | Description |
| Total Program Service Expense | 11310074 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 19 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 175 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DONALD BRUNNWORTH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6186352200 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 CALDWELL ST | AddressLine1 |
| City | STAUNTON | City |
| State | IL | State |
| ZIP Code | 62088 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee | OfficerOfficer |
|---|---|---|---|---|---|---|---|
| DON KASUBKE | |||||||
| PRESIDENT | 1.00 | X | 0 | 0 | 0 | ||
| LARRY LUX | |||||||
| VICE-PRESIDENT | 1.00 | X | 0 | 0 | 0 | ||
| BERNICE HENKE | |||||||
| SECRETARY | 1.00 | X | 0 | 0 | 0 | ||
| HULDA BLACK | |||||||
| TREASURER | 1.00 | X | 0 | 0 | 0 | ||
| EDDY SARACCO | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| MIKE COX | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| WAYNE BROOKe | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| LARRY ZIGLAR | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| NICOLAS PINEDA MD | |||||||
| PHYSICIAN/director | 40.00 | X | 156643 | 0 | 877 | X | |
| SUSIE CAMPBELL | |||||||
| CEO | 40.00 | 131877 | 0 | 16913 | X | ||
| DONALD BRUNNWORTH | |||||||
| CFO | 40.00 | 122710 | 0 | 11411 | X | ||
| DARRELL PAPE | |||||||
| PHARMACIST | 40.00 | 107880 | 0 | 11557 | X | ||
| Joshua Poos | |||||||
| Physician | 40.00 | 179455 | 0 | 7178 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 698565 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 47936 | TotalOtherCompensation |
| Number Individuals GT100 K | 5 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| EMERGENCY DEPARTMENT SERVICES PC | |||||
| 7032 COLLECTION CENTER DRIVE | CHICAGO | IL | 60693 | ER PHYSICIANS | 765560 |
| Alton Physical Therapy Services | |||||
| 1719 Clawson | Alton | IL | 62002 | Physical Therapy Services | 382080 |
| South Central Anesthesia LTD | |||||
| 7461 leslie Drive | edwardsville | IL | 62025 | Anesthesia Services | 254200 |
| QHR LLC | |||||
| 105 Continental Place | Brentwood | TN | 37027 | Management Services | 231059 |
| Quest Diagnostics | |||||
| PO Box 14730 | St Louis | MO | 63150 | Lab Service | 186694 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Government Grants | 19360 | GovernmentGrants |
| All Other Contributions | 32908 | AllOtherContributions |
| Total Contributions | 52268 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PROGRAM SERVICE REVENU | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 14278971 | TotalRevenueColumn |
| Related Or Exempt Function Income | 14278971 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 14278971 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 94124 | TotalRevenueColumn |
| Exclusion | $94,124 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 35540 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 35540 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 35540 | TotalRevenueColumn |
| Exclusion | $35,540 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 525 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 525 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 525 | TotalRevenueColumn |
| Exclusion | $525 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CAFETERIA | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 36668 | TotalRevenueColumn |
| Exclusion | $36,668 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 36668 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 14498096 | TotalRevenueColumn |
| Related Or Exempt Function Income | 14278971 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $166,857 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1000 | Total |
| Program Services | 1000 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 395635 | Total |
| Program Services | 146143 | ProgramServices |
| Management And General | 249492 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5133353 | Total |
| Program Services | 4599872 | ProgramServices |
| Management And General | 533481 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 109274 | Total |
| Program Services | 93991 | ProgramServices |
| Management And General | 15283 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 780066 | Total |
| Program Services | 680648 | ProgramServices |
| Management And General | 99418 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 392574 | Total |
| Program Services | 337668 | ProgramServices |
| Management And General | 54906 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 138086 | Total |
| Management And General | 138086 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39374 | Total |
| Management And General | 39374 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44135 | Total |
| Management And General | 44135 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2350765 | Total |
| Program Services | 2295780 | ProgramServices |
| Management And General | 54985 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19600 | Total |
| Program Services | 9542 | ProgramServices |
| Management And General | 10058 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 276839 | Total |
| Program Services | 118436 | ProgramServices |
| Management And General | 158403 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 247594 | Total |
| Program Services | 220127 | ProgramServices |
| Management And General | 27467 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58677 | Total |
| Program Services | 46018 | ProgramServices |
| Management And General | 12659 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23768 | Total |
| Program Services | 23768 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 587789 | Total |
| Program Services | 522582 | ProgramServices |
| Management And General | 65207 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 261009 | Total |
| Program Services | 237002 | ProgramServices |
| Management And General | 24007 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Medical Supplies | 1464326 | 1464326 | |
| Provision for bad Debts | 1074830 | 1074830 | |
| equipment Rental | 402954 | 349263 | 53691 |
| Miscellaneous | 100678 | 63420 | 37258 |
| Hospital Provider Asses | 75123 | 75123 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 90243 | Total |
| Program Services | 25365 | ProgramServices |
| Management And General | 64878 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14067692 | Total |
| Program Services | 11310074 | ProgramServices |
| Management And General | 2757618 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1730191 | BOY |
| EOY | 1708683 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2405646 | BOY |
| EOY | 2464218 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1985926 | BOY |
| EOY | 1971971 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 277279 | BOY |
| EOY | 274090 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 199460 | BOY |
| EOY | 175864 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 10626127 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 7011734 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2752231 | BOY |
| EOY | 3614393 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2022409 | BOY |
| EOY | 2370150 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11373142 | BOY |
| EOY | 12579369 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1171287 | BOY |
| EOY | 1270314 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 443932 | BOY |
| EOY | 1120728 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1615219 | BOY |
| EOY | 2391042 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9757923 | BOY |
| EOY | 10188327 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9757923 | BOY |
| EOY | 10188327 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11373142 | BOY |
| EOY | 12579369 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 443004 | OtherCostOrOtherBasis |
| Book Value | 443004 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2659107 | OtherCostOrOtherBasis |
| Depreciation | 2200008 | Depreciation |
| Book Value | 459099 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 269258 | OtherCostOrOtherBasis |
| Depreciation | 143674 | Depreciation |
| Book Value | 125584 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6050508 | OtherCostOrOtherBasis |
| Depreciation | 4668052 | Depreciation |
| Book Value | 1382456 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1204250 | OtherCostOrOtherBasis |
| Book Value | 1204250 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3614393 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (3 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| CASH | 320150 | F |
| CERTIFICATES OF DEPOSIT | 375000 | F |
| REPURCHASE AGREEMENTS | 1675000 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 2370150 | TotalOfBookValueSecurities |
| Total Revenue | 14498096 | TotalRevenue |
| Total Expenses | 14067692 | TotalExpenses |
| Excess Or Deficit For Year | 430404 | ExcessOrDeficitForYear |
| Total Adjustments | 0 | TotalAdjustments |
| Excess Or Deficit Per FS | 430404 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 14497096 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -1000 | OtherRevenues |
| Revenue Not Rptd F990 | -1000 | RevenueNotRptdF990 |
| Revenue Subtotal | 14498096 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 14498096 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 14066692 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 14066692 | ExpensesSubtotal |
| Other Expenses Not Included | 1000 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 1000 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 14067692 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part XII, Line 2d - Other Adjustments: | Scholarship: -1000. |
| Part XIII, Line 4b - Other Adjustments: | Scholarship: 1000. |
| Part X, Line 2: The Hospital is a not-for-profit organization under Section 501(c)(3) of the Internal Revenue Code and is exempt from income taxes on related income under Section 501(a) of the Code and similar provisions of state law. Effective July 1, 2009, the Hospital adopted the standards for accounting for uncertainty in income taxes. These standards prescribe a comprehensive model for financial statement recognition, measurement, classification and disclosure of uncertain tax positions. The implementation of the standards had no effect on net assets as of July 1, 2009. The Hospital continually evaluates the effects of all tax positions taken including expiring statutes of limitations, tax examinations, unrelated business income and new authoritative rulings. The Hospital files federal informational returns. The statutes of limitations for informational returns filed for the years ended June 30, 2007 through 2010 have not expired and therefore are subject to examination. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 28664 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 28664 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00220 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1596905 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 807773 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 789132 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06070 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1625569 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 807773 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 817796 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06290 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 27230 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 27230 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5236 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 5236 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 32466 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 32466 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00250 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1658035 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 807773 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 850262 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06540 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $556,172 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 5069491 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 5007236 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 62255 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Memorial Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 Caldwell Street | AddressLine1 |
| City | Staunton | City |
| State | IL | State |
| ZIP Code | 62088 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Costing Method Used | Part I, Line 7: The cost to charges ratio was used as derived from Worksheet 2, Ratio of patient care cost-to-charges. | CostingMethodUsed |
| General Explanation | Part III, Line 3: The hospital believes that the community benefit obtained from its charity care is understated due to patients that could qualify for charity care but do not apply or provide incomplete information. Some care provided to patients is not classified as charity care due to patients missing documentation that proves they qualify for charity care. The hospital's bad debt does include amounts that could be classified as charity care if the patients would apply or provide the appropriate information to complete the charity care application. | GeneralExplanation |
| General Explanation | Part III, Line 4: Text of footnote from the financial statementsIn line with its mission, the Hospital provides a safety net for the communities served to access much needed health care by offering some services to patients without regard to their ability to pay for those services. For some of their patient services, the Hospital receives no payment or payment that is less than the full cost of providing the services. The Hospital voluntarily provides free care to patients who are unable to pay for all or part of their health care expenses as determined by the Hospital's criteria for financial assistance.In some cases, the Hospital does not receive the amount billed for patient services even though it did not receive information necessary to determine if the patients met the criteria for financial assistance. Bad debts expense is the estimated amount of patient revenue that the Hospital will not collect.The Costing methodology used was the ratio of patient care cost-to-charges. No Bad debt amounts were included in community benefit. | GeneralExplanation |
| General Explanation | Part III, Line 8: The costing methodology used to determine Medicare allowable cost was the cost to charge ratio from our Fiscal Year 2010 Medicare Cost Report as shown at the bottom of the Schedule H worksheet, Worksheet 2. | GeneralExplanation |
| General Explanation | Part III, Line 9B: There is no collection practice on patients who qualify for charity. Any patient who submits an application for charity and meets the guidelines set in our Charity Policy has their account written off with no further collection effort. | GeneralExplanation |
| Needs Assessment | Part VI, Line 2: The hospital has conducted two focus groups to gather information. One group consisted of health care providers and consisted of the Macoupin County Public Health Director, administrators of nursing homes and the assisted living center, pharmacists, ambulance provider and physicians. The second focus group consisted of community leaders who help provide resources to people in need and this group consisted of schoolsuperintendents, township supervisors, representative of the community college and others. A Town Hall was also hosted; however, therewas very low turnout. A survey will also be sent to approximately 10-20 patients that live in the communities that we serve asking for additionalinput in community health needs. This information is then summarized and prioritized and will be presented to the Board of Trustees for review. | NeedsAssessment |
| Patient Education Assistance | Part VI, Line 3: Information regarding the financial assistance programs that the hospital offers is listed on the hospital website, and it is printed on the bottom of the statements that are mailed to the patients. The information is also posted near the Cashier's window and the Business Office staff are trained to provide the information to patients that call into the office and do not have knowledge of the programs. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: The community that the organization serves consists of about a twelve (12) mile radius surrounding Staunton, and the communities within that radius are: Worden, Hamel, Alhambra, Livingston, New Douglas, Mt. Olive, Benld, Gillespie, Bunker Hill and Prairietown. This is a rural area with a depressed economic climate. Many of the individules are elderly, poor and indigent which results in higher numbers of Medicare and Medicaid recipients. | CommunityInformation |
| Other Information | Part VI, Line 6: The Hospital restocks the ambulances of any supplies used during the transport of patients at no cost to the ambulance service. The Hospital also commits significant time and resources to activities and services that meet unmet community needs. Many of these activities are sponsored with the knowledge that they will not be self-supporting or financially viable. Such programs include health screenings and assessments, parental education and care, support for vital community services, trauma care, community educational services and various support groups. The Hospital participates in events and health fairs in each of the communities within the service area, and it donates staff labor, supplies and other goods. | OtherInformation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NICOLAS PINEDA MD | |||||||||||||
| 156643 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 877 | 0 | 157520 | 0 | 0 | 0 |
| Joshua Poos | |||||||||||||
| 179455 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 7178 | 0 | 186633 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Supplemental Information | Identifier |
| Return Reference | Part III | ReturnReference |
| Explanation | The CEO, Susie Campbell, and CFO, Donald Brunnworth, of Community Memorial Hospital were employed by a management company, Quorum Health Resources, until March 19, 2009. The following amounts are amounts that were paid by Quorum Health Resources. Wages received by the CEO and CFO from 1/1/09 to 3/19/09 were $35,085 and $39,054, respectively. Benefits received by the CEO and CFO from 1/1/09 to 3/19/09 were $9,831 and $10,943, respectively. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Illinois Finance Authority | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 861091967 | IssuerEIN |
| CUSIP Number | NONEaVAIL | CUSIPNumber |
| Date Issued | 2010-06-25 | DateIssued |
| Issue Price | 780000 | IssuePrice |
| Description Of Purpose | 5500 sq. ft medical office building | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Proceeds | 780000 | TotalProceeds |
| Capital Expenditures | 780000 | CapitalExpenditures |
| Year Of Subst Completion | 2010 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Counsel Routinely Engaged | 0 | 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 | 1 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 1 | ExceptionToRebate |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Larry Ziglar | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | Larry Ziglar is president at first National Bank and a director of CMH | Relationship |
| Amount Of Transaction | 780000 | AmountOfTransaction |
| Description Of Transaction | First National Bank purchased the bonds that were issued to Community Memorial Hospital on June 25, 2010. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 6 | Community Memorial Hospital has one CLASS OF MEMBERS WHICH SHALL BE ENTITLED TO ONE REPRESENTATION AND ONE VOTE IN ALL MEETINGS OF COMMUNITY MEMORIAL HOSPITAL. |
| Form 990, Part VI, Section A, line 7a | THE ANNUAL MEETING OF THE MEMBERS IS HELD FOR THE PURPOSE OF ELECTING TRUSTEES AND TRANSACTING SUCH OTHER BUSINESS AS MAY COME BEFORE THE MEETING. EACH MEMBER IS ENTITLED TO ONE VOTE. |
| Form 990, Part VI, Section B, line 11 | The CEO and CFO of the organization review the form 990 prior to filing. |
| Form 990, Part VI, Section B, line 12c | The conflict of interest policy and a disclosure statement is presented to officers, directors or trustees and key employees annually. The Disclosure statement must be returned and is reviewed by financial auditors and Hospital administration. |
| Form 990, Part VI, Section B, line 15 | the Board of trustees does an annual evaluation of officers and key employees. They use comparability data received from an independent consultant and set salary based upon comparability data and their job perfomance. Decisions are documented in the board minutes. |
| Form 990, Part VI, Section C, line 19 | Community Memorial Hospital makes its governing documents, conflict of interest policy and financial statements available to the public upon written request. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Friends of Community Memorial Hospital Foundation | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 Caldwell | AddressLine1 |
| City | Staunton | City |
| State | IL | State |
| ZIP Code | 62088 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363913722 | EIN |
| Primary Activities | Donations To CMH | PrimaryActivities |
| Legal Domicile State | IL | LegalDomicileState |
| Exempt Code Section | Section 501(C)(3) | ExemptCodeSection |
| Public Charity Status | Line 9 | PublicCharityStatus |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |