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MERCYHEALTH DEVELOPMENT FOUNDATION INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
MERCYHEALTH DEVELOPMENT FOUNDATION INC (EIN 36-3197918)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-10-25
IRS object ID
201123049349300907
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-10-25T16:27:03-00:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PriceWaterhouseCoopers LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line12001 Market St Ste 1700AddressLine1
CityPhiladelphiaCity
StatePAState
ZIP Code19103ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN363197918EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Rockford Memorial Development FoundationBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlROCKNameControl
Phone8159714141Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12400 N Rockton AveAddressLine1
CityRockfordCity
StateILState
ZIP Code61103ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameHenry M Seybold JrName
TitleSenior VP Finance CFOTitle
Date Signed2011-10-20DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMatthew PetroskiName
Phone2673303000Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonGary Kaatz President CEONameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12400 N Rockton AveAddressLine1
CityRockfordCity
StateILState
ZIP Code61103ZIPCode
FieldValueIRS element (for citing)
Gross Receipts112818240GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.rhsnet.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1982YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionTo support the operations of all entities of Rockford Health System & provide assistance to these other 501(c)(3) non-profit organizations by receiving, maintaining, and administering funds received from the public and other available sources to further the exempt purposes of these organizations. To support the operations of all entities of Rockford Health System provide assistance to these other 501c3 non-profit organizations by receiving, maintaining, and administering funds received from the public and other available sources to further the exempt purposes of these organizations.ActivityOrMissionDescription
Nbr Voting Members Governing Body17NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers195TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year1295533ContributionsGrantsPriorYear
Contributions Grants Current Year1427149ContributionsGrantsCurrentYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year16378997InvestmentIncomePriorYear
Investment Income Current Year4151869InvestmentIncomeCurrentYear
Other Revenue Prior Year158354OtherRevenuePriorYear
Other Revenue Current Year152142OtherRevenueCurrentYear
Total Revenue Prior Year17832884TotalRevenuePriorYear
Total Revenue Current Year5731160TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1990984GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1064883GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year520137SalariesEtcPriorYear
Salaries Etc Current Year528426SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year406940TotalFundrsngExpCurrentYear
Other Expense Prior Year723159OtherExpensePriorYear
Other Expenses Current Year763524OtherExpensesCurrentYear
Total Expenses Prior Year3234280TotalExpensesPriorYear
Total Expenses Current Year2356833TotalExpensesCurrentYear
Revenues Less Expenses Prior Year14598604RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3374327RevenuesLessExpensesCY
Total Assets BOY99272833TotalAssetsBOY
Total Assets EOY108988211TotalAssetsEOY
Total Liabilities BOY916090TotalLiabilitiesBOY
Total Liabilities EOY859071TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY98356743NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY108129140NetAssetsOrFundBalancesEOY
Mission DescriptionThe mission of Rockford Health System RHS is Superior Care. Everyday. For All Our Patients. Rockford Memorial Development Foundation RMDF assists this mission specifically by applying resources to the vision of RHS which is To fulfill this Committment through Performance Excellence, Lifelong Learning, and Innovation.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense870771Expense
Grants98984Grants
DescriptionRestricted gifts and endowments at Rockford Health System help departments fund equipment, facilities projects and care and comfort items to benefit patients and their families. In 2010, endowment proceeds supported education and training opportunities for RHS employees to help them enhance the care they provide to patients. Additionally, the Foundation provided significant support for the renovation of the Emergency Department at Rockford Memorial Hospital. These expenditures are just a few examples of what was funded with restricted gifts and endowments in 2010.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense202229Expense
DescriptionThe Rockford Health System employee Family Giving Campaign raised funds in 2010 for three uses an Employee Crisis Fund, the Wishbook catalogue of care and comfort items, and the Employee Education Fund. The crisis fund provides assistance to employees who have experienced a crisis such as a fire or flood in their homes or the severe illness, traumatic injury or death of a spouse or child. The Wishbook provides small items for care-giving departments throughout Rockford Health System. The Employee Education Fund expands opportunities for employees to attend training and skills development seminars. RMDF donations were also used to assist Visiting Nurses Association to care for the elderly, the homebound, the recovering, and the dying. In 2010 some specific donations were also made for hospice care.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense105853Expense
DescriptionThrough charitable contributions, RMDF supports the Ronald McDonald Care Mobile, staffed and operated by RMH, which provides free medical and dental care to uninsured and underinsured children in five counties at 12 different sites in Northern Illinois. The Care Mobile visits included vaccinations, lead and/or blood screenings, medical diagnoses, preventative and restorative dental care and treatment/care to avoid an emergency room visit. RMDF donations from the Auxiliary provided some of the Care Mobile funding as well as funds for supplies and education materials for the pediatric and pediatric intensive care units, health and wellness resources for patients, nursing scholarships for minority students, the Healing Harp program that creates an atmosphere of care and comfort for hospitalized patients, a video program in both English and Spanish that helps parents provide care for their newborn babies, and other support for the system.Description
FieldValueIRS element (for citing)
Total Program Service Expense1178853TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingtrueCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
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 ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
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 RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109617NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members17NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
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 VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDavid E Vola ControllerNamePerson
Telephone Number8159715000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12400 N Rockton AveAddressLine1
CityRockfordCity
StateILState
ZIP Code61103ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
Carol Armstrong
Director001.00X000
Marc LBarbeau
Director001.00X000
John J Holevas
Director000.10X000
W Walter Boothe
Director001.00X000
Julie Bosma
Director002.00X000
John Van Landingham
Director000.10X000
Paul AGreen
Director001.00X000
Hollis AHanson
Director000.50X000
Linda Heckert
Director000.50X000
Phillip ADHiggins
Director001.00X044106794389
Gary EKaatz
President003.00X0969051150705X
Scott KLaue
Chairman002.00X000X
John JMorrissey
Director000.70X000
Jay Maddox
Director001.00X000
Jeffrey RSmith
Vice-Chairman001.00X038594398022X
Dennis TUehara
Director000.40X041249970487
Mark DZarnke
Director002.00X01348100
Helen Brooks
Executive Director040.00188164032601X
Henry MSeybold
Treasurer000.30043958259187X
Vicki Woodhouse
Secretary040.004182109261X
FieldValueIRS element (for citing)
Total Reportable Comp From Org229985TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2782952TotalReportableCompFrmRltdOrgs
Total Other Compensation514652TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

FieldValueIRS element (for citing)
Name PersonNANamePerson
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Fundraising Events48146FundraisingEvents
Related Organizations190000RelatedOrganizations
All Other Contributions1189003AllOtherContributions
Total Contributions1427149TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1409585TotalRevenueColumn
Exclusion$1,409,585ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities109669904Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities106927620Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities2742284Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column2742284TotalRevenueColumn
Exclusion$2,742,284ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events311500GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events48146CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses159460FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column152040TotalRevenueColumn
Exclusion$152,040ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMiscellaneousDescription
Business Code900099BusinessCode
Total Revenue Column102TotalRevenueColumn
Exclusion$102ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue102TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column5731160TotalRevenueColumn
Exclusion$4,304,011ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1064883Total
Program Services1064883ProgramServices

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)
Total271846Total
Program Services54369ProgramServices
Management And General54369ManagementAndGeneral
Fundraising163108Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total170092Total
Program Services34018ProgramServices
Management And General34018ManagementAndGeneral
Fundraising102056Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total30875Total
Program Services6175ProgramServices
Management And General6175ManagementAndGeneral
Fundraising18525Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total45418Total
Program Services9084ProgramServices
Management And General9084ManagementAndGeneral
Fundraising27250Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total10195Total
Program Services2039ProgramServices
Management And General2039ManagementAndGeneral
Fundraising6117Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total60000Total
Management And General60000ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total6519Total
Management And General6519ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Fees For Services Prof FundraisingFeesForServicesProfFundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total552360Total
Management And General552360ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total6007Total
Management And General6007ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total7505Total
Program Services824ProgramServices
Management And General5445ManagementAndGeneral
Fundraising1236Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total92380Total
Program Services4083ProgramServices
Management And General5973ManagementAndGeneral
Fundraising82324Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total3084Total
Program Services771ProgramServices
Management And General1542ManagementAndGeneral
Fundraising771Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total3297Total
Management And General3297ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total1990Total
Program Services398ProgramServices
Management And General1194ManagementAndGeneral
Fundraising398Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total2900Total
Management And General2900ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total678Total
Management And General678ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Food14729220973655155
Other Purchased Services1207512075

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total0Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2356833Total
Program Services1178853ProgramServices
Management And General771040ManagementAndGeneral
Fundraising406940Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1595850BOY
EOY31933EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4207760BOY
EOY1215235EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY768258BOY
EOY653864EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
EOY72EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
EOY4491EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis153405LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec149674LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3748BOY
EOY3731EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY82446482BOY
EOY96946793EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY10250735BOY
EOY10132092EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY99272833BOY
EOY108988211EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY866844BOY
EOY797820EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY49246BOY
EOY61251EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY916090BOY
EOY859071EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY84920362BOY
EOY93493455EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY8625461BOY
EOY9269834EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY4810920BOY
EOY5365851EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY98356743BOY
EOY108129140EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY99272833BOY
EOY108988211EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses3374327ReconcilationRevenueExpenses
Reconcilation Other Changes6398070ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Certification CheckboxXCertificationCheckbox
Written IRS DeterminationXWrittenIRSDetermination
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation (3 entries)

EINEINType Of OrganizationTypeOfOrganizationListed In Governing DocListedInGoverningDocSupported Organization NotifiedSupportedOrganizationNotifiedOrganized In USOrganizedInUSAmountAmount
Rockford Memorial Hospital
3621678473truetruetrue$0
Visiting Nurses Assn
3621679459truetruetrue$0
Rockford Health Physicians
3639074363truetruetrue$0
FieldValueIRS element (for citing)
Total Number Of Supported Orgs3TotalNumberOfSupportedOrgs
Public Support Pertcentage1700.00000PublicSupportPertcentage170
Public Support Percentage5090.00000PublicSupportPercentage509
Investment Income Percentage0.00000InvestmentIncomePercentage

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 D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance88668632BeginningOfYearBalance
Contributions1738649Contributions
Investment Earnings Or Losses9948265InvestmentEarningsOrLosses
Grants Or Scholarships1064883GrantsOrScholarships
Other Expenditures985990OtherExpenditures
Administrative Expenses552801AdministrativeExpenses
End Of Year Balance97751872EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance72939613BeginningOfYearBalance
Contributions1572227Contributions
Investment Earnings Or Losses17349427InvestmentEarningsOrLosses
Grants Or Scholarships1990984GrantsOrScholarships
Other Expenditures724771OtherExpenditures
Administrative Expenses476880AdministrativeExpenses
End Of Year Balance88668632EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance99000446BeginningOfYearBalance
Contributions2008929Contributions
Investment Earnings Or Losses-25700856InvestmentEarningsOrLosses
Grants Or Scholarships1309396GrantsOrScholarships
Other Expenditures491317OtherExpenditures
Administrative Expenses568193AdministrativeExpenses
End Of Year Balance72939613EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.03160BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.00360PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.96480TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis60859OtherCostOrOtherBasis
Depreciation60859Depreciation

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis83301OtherCostOrOtherBasis
Depreciation83301Depreciation

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis9245OtherCostOrOtherBasis
Depreciation5514Depreciation
Book Value3731BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings3731TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescriptionBook ValueBookValue
Restricted Endowment Funds
Interest in Beneficial Trust10032586
Life Insurance and others61251
Due from RMH/RHPH/RHS
Employee Rec-Supplemental Survivor Premium38255
FieldValueIRS element (for citing)
Total Book Value Other Assets10132092TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Life Insurance Value$50,445
Capital Accumulation Account$10,304
CAA Fas 124 Valuation$502
FieldValueIRS element (for citing)
Total Of Amounts61251TotalOfAmounts
Total Revenue5731160TotalRevenue
Total Expenses2356833TotalExpenses
Excess Or Deficit For Year3374327ExcessOrDeficitForYear
Net Unrealized GL On Investments4683841NetUnrealizedGLOnInvestments
Other$1,714,228OtherAmount
Total Adjustments6398069TotalAdjustments
Excess Or Deficit Per FS9772396ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt10022101TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments4683841NetUnrealizedGainsInvestments
Other Revenues159460OtherRevenues
Revenue Not Rptd F9904843301RevenueNotRptdF990
Revenue Subtotal5178800RevenueSubtotal
Investment Expenses Not Included552360InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt552360RevenueNotRptdOnFinStmt
Total Revenue Per Form9905731160TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt1451228TotExpensesEtcAuditedFinclStmt
Other Expenses Included159460OtherExpensesIncluded
Expenses Not Rptd F990159460ExpensesNotRptdF990
Expenses Subtotal1291768ExpensesSubtotal
Investment Expenses Not Included2552360InvestmentExpensesNotIncluded2
Other Expenses Not Included512705OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt1065065ExpensesNotRptdOnFinStmt
Total Expenses Per Form9902356833TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
V4- Funds were used to provide for a lecture series for continuing education for employees to improve their credentials or to focus on a new skill or technology not currently available in the Rockford community and for miscellaneous projects according to the wishes of RMDF. All funds were expended per the specific direction of each endowment.
XI8-The change in Net Assets during the year include transfers from permanently restricted net assets 512,705 reduction in pledges receivables -75,000 chg in UPMIFA valuation 10,834 chg in unexpended restricted funds 159,897 mkt value chg in endowed funds 415,585 and mkt value change in externally managed restricted funds 690,207.
XII2d-159,460 is the amount of direct expenses for Special Events
XII4a-552,360 is the amount of investment fees included on Part VIII line 12
XIII2d-159,460 is the amount of direct expenses for Special Events
XIII4a-552,360 is the amount of investment fees included on Part IX line 25
XIII4b-512,705 is the amount of restricted funds transferrred and expended

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GalaNameOfEvent1
Gross Receipts Event1286707GrossReceiptsEvent1
Charitable Contributions Event148146CharitableContributionsEvent1
Gross Revenue Event1238561GrossRevenueEvent1
Other Direct Expenses Event1120175OtherDirectExpensesEvent1
Name Of Event2GolfNameOfEvent2
Gross Receipts Event244179GrossReceiptsEvent2
Gross Revenue Event244179GrossRevenueEvent2
Cash Prizes Event24272CashPrizesEvent2
Rent Facility Costs Event218001RentFacilityCostsEvent2
Other Direct Expenses Event22366OtherDirectExpensesEvent2
Total Number Of Other Events1TotalNumberOfOtherEvents
Gross Receipts Other Events28760GrossReceiptsOtherEvents
Gross Revenue Other Events28760GrossRevenueOtherEvents
Other Direct Expenses Other Events14646OtherDirectExpensesOtherEvents
Gross Receipts Total359646GrossReceiptsTotal
Charitable Contributions Total48146CharitableContributionsTotal
Gross Revenue Total Events311500GrossRevenueTotalEvents
Cash Prizes Total Events4272CashPrizesTotalEvents
Rent Facility Costs Total Events18001RentFacilityCostsTotalEvents
Other Direct Expenses Total Events137187OtherDirectExpensesTotalEvents
Direct Expense Summary Events159460DirectExpenseSummaryEvents
Net Income Summary152040NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantMethod Of ValuationMethodOfValuationPurpose Of GrantPurposeOfGrant
Rockford Health Council
1601 Parkview AveRockfordIL61107363229371501c320000OtherCommunity Program
MCHC Service Corporation
PO Box 95468ChicagoIL60694546836216700813500OtherCommunity Poison Control
March of Dimes Foundation
5411 E StateRockfordIL61108131846366501c310000OtherCommunity Event
St Elizabeth Center
1536 S Main StRockfordIL61102362171737501c35000OtherCapital Project
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants3TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations1TotalNbrOfOtherOrganizations

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymenttrueSeverancePayment
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 PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgsBase Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgComp Report Prior990 Filing OrgCompReportPrior990FilingOrg
Phillip ADHiggins
3088581304351774697862460253545525356
Gary EKaatz
55228730497111179212471925986111975576766
Jeffrey RSmith
34668038632630831571486548396427536
Dennis TUehara
3874092354315485326617220482986
Helen Brooks
1516143592962116075165262207655870
Henry MSeybold
3166871153877509478781131049877125145

Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
I1a- By policy Membership to the YWCA is paid for the CEO. Two social club memberships are paid for by the organization for the CEO and any personal use of these facilities is reimbursed in full. The actual cost of these memberships is prorated for personal vs business use and that percentage is added to taxable wages. The organization also pays for half of a social club membership for the Executive Director. If personal use exceeds business use, the additional prorated cost is added to taxable wages.
I4a- A future increase in severance this year for Gary Kaatz was 7,971 by contract.
I7a- The executive team receives annual additions to a non-qualified retirement plan. These amounts, accrued for 2010, are included in compensation and listed in detail in Part II for Gary Kaatz 93,816 Henry Seybold 29,736 and Helen Brooks 6,200.
I7a- Short term incentive opportunities, designating threshold, target and maximum annual awards are established for all executives, driven by the strategic initiatives and priorities of RHS. If incentive thresholds are not met, CEO may grant discretionary bonuses for outstanding performance within certain parameters.
I3- Compensation for executives is governed by the RHS Board of Directors. The RHS Board has established a total compensation philosophy that directs the compensation practices for all executives from all related entities including RMDF. This Board has established a Compensation Committee to establish and review all executive compensation annually based on the established philosophy. An independent external executive compensation firm provides consulting on RHS including RMDF salary ranges and compensation philosophy. The appropriate peer group for compensation comparison purposes is other not-for-profit healthcare systems similar in size and complexity. RHS generally conducts an analysis of total compensation every three years but may choose to vary from this schedule as determined by the Compensation Committee. The RMDF board of directors concedes the authority to set compensation to RHS as the sole corporate member.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990 Part VI6,7 a-b- Rockford Health System RHS is the sole corporate member of the Foundation and has the authority to elect members to the board and ultimately has the authority to approve or deny all RMDF board actions.
Form 990 Part IV11a- The data was gathered by the accounting staff with input from RMDF and RHS executive staffs. The data was reviewed and the Form 990 prepared by the RHS tax analyst. Once the Form 990 was completed, it was reviewed by an independent accounting firm. A copy of the Form 990 was made available to all board members on a secure intracompany website. A presentation of the return was made to the RMH Finance Committee and at a meeting of the RMDF Board of Directors before filing.
Form 990 Part VI12- RHS Compliance Department acting on behalf of RMDF annually sends out a copy of the policy with the Conflict of Interest form included. Each member completes the Financial Interest Disclosure Statement which is a part of the policy. The RHS Compliance Department reviews and retains these statements. If a conflict is identified, all affected parties are informed, potential conflicts reviewed and appropriate actions are taken as a result of the review. Employees are given the policy and a statement to complete at the beginning of the year or as a new party is hired or joins the RMDF board.
Form 990 Part VI15a- Compensation for executives is governed by the RHS Board of Directors. The RHS Board has established a total compensation philosophy that directs the compensation practices for executives from related entities including RMDF. This Board has established a Compensation Committee to establish and review all executive compensation annually based on the established philosophy. An independent external executive compensation firm provides consulting on RHS including RMDF salary ranges and compensation philosophy. The appropriate peer group for compensation comparison purposes is other not-for-profit healthcare systems similar in size and complexity. RHS generally conducts an analysis of total compensation every three years but may vary from this schedule as directed by the Compensation Committee. The RMDF board concedes the authority to set compensation to RHS, the sole corporate member.
Form 990 Part VI19- Financial statements are available through the Illinois Attorney Generals Office. Governing documents are available by request from Board Secretary.
Form 990 Part VII1- Some members of the board were compensated by related organizations for other duties as follows Mark Zarnke Independent surgeon who provides Emergency Trauma coverage and a Medical Staff director was compensated by RMH Phillip Higgins 60 hrs Medical Director OB-GYN and active physician, Jeffery Smith 56 hrs Medical Director-General Medicine and active physician, and Dennis Uehara 51.7 hrs Chair of Emergency Department and active physician were compensated by RHPH Rockford Health Physicians Gary Kaatz as President and CEO also worked an additional 40 hrs. and Henry Seybold an additional 45.6 hrs as CFO Sr VP of Finance they spent most of their time and received compensation for those duties in support of the other related entities RMH/RHPH/RHS/VNA.
Form 990 Part XI5The change in fund balances for permanent and temporarily restricted net asset was 1,199,303 the transfer from Restricted Funds was 512,705 and the transfer to restricted net assets was 2,221 and the unrealized gains on investments was 4,683,841

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
Rockford Memorial Hospital
2400 N Rockton AveRockfordIL61103362167847HealthcareIL501c33Rockford Health Systemtrue
Rockford Health System
2400 N Rockton AveRockfordIL61103363197915Support of HealthcareIL501c311falseN/A
Rockford Health Physicians
2300 N Rockton AveRockfordIL61103363097436HealthcareIL501c33Rockford Health Systemtrue
Visiting Nurses Assn of the Rockford Area
2400 N Rockton AveRockfordIL61103362167945HealthcareIL501c39Rockford Health Systemtrue

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Van Matre Rehab Center LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13660 GrandviewAddressLine1
CityBirminghamCity
StateALState
ZIP Code35243ZIPCode
FieldValueIRS element (for citing)
EIN364397130EIN
Primary ActivityHealthcarePrimaryActivity
Legal Domicile StateILLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Predominant Income TypeNAPredominantIncomeType
Disproportionate AllocationsfalseDisproportionateAllocations
General Or Managing PartnerfalseGeneralOrManagingPartner

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Rockford Health Insurance LTDBusinessNameLine1

Address Foreign AddressForeign

FieldValueIRS element (for citing)
Address Line1Wellesley House So 2nd Flr 90 PittsAddressLine1
CityPembrookeCity
Province Or StateHMProvinceOrState
CountryBDCountry
Postal Code08PostalCode
FieldValueIRS element (for citing)
Primary ActivityInsurancePrimaryActivity
Legal Domicile Foreign CountryBDLegalDomicileForeignCountry

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
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 OrgtrueGiftGrantOrCapContrToOtherOrg
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 OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Rockford Memorial Hospital
b745824Financial Analysis
Visiting Nurses Association
b108456Financial Analysis
Rockford Memorial Hospital
c190000Payment
Rockford Memorial Hospital
n381123Financial Analysis
Rockford Memorial Hospital
o247661Financial Analysis