2011-08-31T08:50:30-05:00 2011-03-31 BKD LLP 211 N BROADWAY SUITE 600 ST LOUIS MO 631022733 990 2010-04-01 362167785 MENDOTA COMMUNITY HOSPITAL MEND 8155397461 1315 MEMORIAL DRIVE MENDOTA IL 61342 LARRY PEACH 2011-08-29 true 3142315544 2010 2016-02-24 21:20:13Z LYNN KLEIN 1315 MEMORIAL DRIVE MENDOTA IL 61342 31943224 false X mendotahospital.org X 1944 IL MENDOTA COMMUNITY HOSPITAL'S MISSION IS TO WORK FOR THE HEALTH AND WELL-BEING OF THE CITIZENS OF OUR AREA THROUGH A BROAD RANGE OF HIGH-QUALITY, EFFICIENT HEALTH CARE SERVICES. 12 10 347 79 0 214738 125952 27808093 28235739 265351 107331 55518 40766 28343700 28509788 0 0 0 0 16112451 16085901 0 0 87815 12437734 15760909 28550185 31846810 -206485 -3337022 30069165 45640488 10681641 29514548 19387524 16125940 MENDOTA COMMUNITY HOSPITAL'S MISSION IS TO WORK FOR THE HEALTH AND WELL-BEING OF THE CITIZENS OF OUR AREA THROUGH A BROAD RANGE OF HIGH-QUALITY, EFFICIENT HEALTH CARE SERVICES. false false 27886788 28235739 MENDOTA COMMUNITY HOSPITAL PROVIDED 25 BEDS FOR THE SERVICE OF 3,535 PATIENT DAYS IN FISCAL YEAR 2011. THIS HOSPITAL GAVE $960,592 IN CHARITY CARE, AND PROVIDED 7,512 MEALS ON WHEELS TO MEMBERS OF OUR COMMUNITY. MENDOTA COMMUNITY HOSPITAL OFFERS FLU & IMMUNIZATION CLINICS ALONG WITH MANY OTHER CLINICS IN MENDOTA AND OTHER OUTREACH COMMUNITIES. THE HOSPITAL HELD CPR CLASSES, DIABETIC SUPPORT GROUPS, PROVIDED FREE DIABETIC AND NUTRITION EDUCATION CLASSES, AND OFFERED SEVERAL OTHER PROGRAMS THROUGH OUT THE YEAR. 27886788 true true false true false false false false true true false false false true false true false false false false false false false true false true true false false true false false false false false false true true false false false false false false false false false false true 43 0 true 347 true false false false false false false false false false false X 12 10 false false false false false false false true true false false true true true true true true true false false IL X LARRY PEACH CFO 8155397461 1315 MEMORIAL DRIVE MENDOTA IL 613421497 STEVEN F GAHAN 2.0 X 0 0 0 DAVID SCHOLL MD 40.0 X 197338 0 21727 MARGO GALLAGHER SCHMITZ RN 2.0 X 0 0 0 CURTIS ZIMMERMAN 2.0 X 0 0 0 P DANIEL DOYLE OD 2.0 X X 0 0 0 ROBERT F STACHLEWITZ JR 2.0 X X 0 0 0 ERIC ANDERSON 2.0 X X 0 0 0 JOSEPH BEETZ 2.0 X X 0 0 0 KERI SUNDBERG DDS 2.0 X X 0 0 0 WILLIAM GEHANT 2.0 X 0 0 0 SARA ESCATEL 2.0 X 0 0 0 KATHLEEN STEVENSON 2.0 X X 0 0 0 LYNN KLEIN 40.0 X 145102 0 21727 LARRY PEACH 40.0 X 117685 0 21155 KENNETH K POTTS 20.0 X 314580 0 15441 MARY M CHINN 40.0 X 210380 0 15441 KENNETH J BEGGS 20.0 X 172793 0 14036 KEITH P MINIHANE 40.0 X 750917 0 12225 JENNIFER J TAYLOR 40.0 X 184655 0 11241 2093450 0 132993 14 false true false ER DOCTORS LTD 7 WOOD DUCK LANE OTTAWA IL 61350 MEDICAL PHYSICIANS 1468794 MEDICAL STAFFING NETWORK PO BOX 840416 DALLAS TX 75284 NURSING AGENCY 261696 2 14225 111727 125952 PROGRAM SERVICE REVENUE 621110 27400147 27400147 OTHER OPERATING REVENUE 621110 835592 835592 28235739 134777 134777 0 0 51854 13670 38184 38184 38184 3376201 4200 3376201 31646 -27446 -27446 -27446 12661 14225 11919 742 742 0 0 OTHER NON OPERATING REVENUE 900099 240 240 VENDING MACHINE REVENUE 900099 1600 1600 1840 28509788 28235739 148097 0 0 0 0 524734 219065 305669 0 12727499 11336396 1356701 34402 276548 246833 28980 735 1681627 1536878 140109 4640 875493 781422 91745 2326 0 5019 5019 104572 104572 0 0 0 2358912 2303447 55465 186846 101098 85748 4989287 3923021 1021863 44403 0 0 498176 445217 51650 1309 104409 76350 28059 0 0 3294 3294 0 3916991 3916991 388407 349566 38841 PROVISION FOR BAD DEBT 1529221 1529221 CONTRACTS/REPAIRS 1257305 855964 401341 DUES & SUBSCRIPTIONS 77760 77760 LINENS & OUTSIDE SERVICES 77718 77718 BLOOD BANK 165764 165764 97228 21837 75391 31846810 27886788 3872207 87815 3850 4200 6972762 6406663 4199495 4484980 0 0 341878 685957 327101 619953 50292102 18867861 16456802 31424241 1751614 2001975 15663 12519 30069165 45640488 3480864 3313002 7023398 26028689 177379 172857 10681641 29514548 X 18715278 15453650 41694 41738 630552 630552 19387524 16125940 30069165 45640488 X -3337022 75438 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 12618 false false 12618 false 4915223 1311605 159859 0 0 6386687 6628180 0 452043 0 2165000 0 4915223 7871246 0 -53066 0 1190000 0 6628180 0.89480 0.09890 0.00630 false false 40478 1272124 1312602 0 9144885 8787456 357429 0 0 0 0 0 11293911 9588319 1705592 0 28540704 492086 28048618 31424241 0 LEGAL CLAIMS RESERVE 25000 ASBESTOS REMEDIATION LIABILITY 147857 172857 28509788 31846810 -3337022 75441 75441 -3261581 28610818 75441 25589 101030 28509788 28509788 31872399 25589 25589 31846810 31846810 INTENDED USES OF ENDOWMENT FUNDS PART V, LINE 4 PROCEEDS OF ENDOWMENT, AS DICTATED BY THE DONORS, ARE USED AS BEST DETERMINED BY ADMINISTRATION OF THE HOSPITAL. BOARD DESIGNATED FUNDS ARE TO BE USED FOR CAPITAL ACQUISITIONS. OTHER REVENUE INCLUDED ON BOOKS BUT NOT ON RETURN PART XII, LINE 2D SPECIAL EVENTS DIRECT EXPENSE $11,919 RENTAL EXPENSE $13,670 --------------------------------------- TOTAL $25,589 OTHER EXPENSES ON BOOKS BUT NOT ON RETURN PART XIII, LINE 2D SPECIAL EVENTS DIRECT EXPENSE $11,919 RENTAL EXPENSE $13,670 --------------------------------------- TOTAL $25,589 UNCERTAIN TAX POSITIONS PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. GOLF OUTING 17841 9975 7866 2742 3066 100 1665 CORNAPALOOZA 9045 4250 4795 575 100 3671 0 26886 14225 12661 3317 3066 200 5336 11919 742 true true true X true X true true false false 509755 509755 0.01680 3698405 1885150 1813255 0.05980 15459 15459 0.00050 4223619 1885150 2338469 0.07710 37025 15125 21900 0.00070 18440 18440 0.00060 10492 363 10130 0.00030 65957 15488 50470 0.00160 4289576 1900638 2388939 0.07870 true 817827 0 11067731 11102809 -35078 X true true 1 1 MENDOTA COMMUNITY HOSPITAL

1315 MEMORIAL DRIVE MENDOTA IL 61342

X X X X MENDOTA COMMUNITY HOSPITAL 1 false true true 200. true 300. true X X X true true X X X X X X true X X true X X X X X X X true X false false PERCENT OF TOTAL EXPENSE PART I, LINE 7, COLUMN F THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $1,529,221 REPORTED ON PART IX, LINE 25, HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST PART I, LINE 7 THE COSTS REPORTED IN THE TABLE IN PART I, LINE 7, USED A RATIO OF PATIENT CARE COSTS TO CHARGES AS COMPUTED IN WORKSHEET 2 OF THE FORM INSTRUCTIONS. THIS METHODOLOGY WAS USED FOR ALL PATIENT SEGMENTS. FINANCIAL STATEMENTS BAD DEBT EXPENSE PART III, LINE 4 THE HOSPITAL REPORTS PATIENTS ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS, AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. FOR LINE 2, WE USED THE RATIO OF PATIENT CARE COST TO CHARGES FROM WORKSHEET 2 TO CALCULATE THE HOSPITAL'S BAD DEBT EXPENSE AT COST. FOR LINE 3, THE HOSPITAL ACKNOWLEDGES THE FACT THAT SOME PATIENTS DO NOT TURN IN ALL OF THE NECESSARY PAPERWORK TO DETERMINE IF THEY ARE ELIGIBLE FOR CHARITY CARE, BUT WE CANNOT MAKE ANY ASSUMPTIONS AS TO WHAT THEIR INCOME IS, OR IF THEY WOULD HAVE QUALIFIED FOR CHARITY CARE. THEREFORE, WE HAVE NO CHOICE BUT TO PUT ZERO IN LINE 3. SHORTFALL TREATED AS A COMMUNITY BENEFIT PART III, LINE 8 THIS SHORTFALL IS DUE TO HOME HEALTH THAT IS A NECESSARY OUTREACH SERVICE PROVIDED TO THE COMMUNITY FOR THOSE PATIENTS RESTRICTED TO THEIR HOMES. DEBT COLLECTION POLICY PART III, LINE 9B THE HOSPITAL'S DEBT COLLECTION POLICY STATES PATIENT FINANCIAL SERVICES COLLECTION DEPARTMENT WILL ASSIST PATIENTS IN FINDING OTHER SOURCES FOR PAYING BILLS SUCH AS FINANCIAL ASSISTANCE. WE ALSO HAVE A SEPARATE POLICY FOR CHARITY CARE THAT THE COLLECTORS FOLLOW. THIS POLICY LISTS THE ITEMS NEEDED TO VERIFY ELIGIBILITY AND DESCRIBES THE PROCESS OF HOW THE COLLECTORS DETERMINE IF THE PATIENT IS ELIGIBLE TO RECEIVE CHARITY CARE. NEEDS ASSESSMENT PART VI, LINE 2 WE LOOK AT OUR TOP DIAGNOSES AND DETERMINE WHAT TYPE OF PROGRAMS WE SHOULD BE OFFERING TO OUR PATIENTS. WE HAVE ROUTINE BLOOD PRESSURE PROGRAMS, A DIABETIC SUPPORT GROUP AS WELL AS OTHER SCREENINGS THAT ARE OFFERRED BASED ON STAFF EXPERTISE AND PATIENT NEEDS. WE OFFER A "BROWN BAG" DRUG REVIEW WHERE THE PUBLIC CAN BRING IN THEIR MEDICATIONS WHICH ARE REVIEWED BY OUR REGISTERED PHARMACIST FOR POTENTIAL INTERACTIONS AND INAPPROPRIATE TAKING OF THESE MEDICATIONS BY THE PATIENT. WE WORK CLOSELY WITH AREA BUSINESSES ON LOSS PREVENTION AND INSTITUTE PROGRAMS TO MEET THEIR PARTICULAR NEEDS. WE ALSO HAVE DRUG AND ALCOHOL TEST PROGRAMS AVAILABLE FOR OUR BUSINESS COMMUNITY. WE HAVE SPECIALTY CLINICS FOR CARDIOLOGY, ONCOLOGY, PODIATRY, ORTHOPEDICS, RHEUMATOLOGY, PULMONOLOGY, ETC. SO THAT OUR PATIENTS WHO NEED THESE SPECIALTIES CAN BE SEEN LOCALLY VERSUS DRIVING TO METROPOLITAN AREAS FOR THESE SERVICES. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 AT THE TIME OF REGISTRATION PATIENTS RECEIVE HANDOUTS REGARDING SELF PAY UNINSURED DISCOUNTS. ALSO, WHEN A PATIENT RECEIVES A BILL, THERE IS INFORMATION ON THE BACK REGARDING WHERE THEY CAN GET MORE INFORMATION ABOUT FINANCIAL ASSISTANCE SUCH AS CHARITY CARE, BY GOING ON THE HOSPITAL WEBSITE OR CALLING THE COLLECTORS WHOSE NUMBERS ARE LISTED. COMMUNITY INFORMATION PART VI, LINE 4 MCH IS LOCATED IN NORTH-CENTAL ILLINOIS. WE SERVE A POPULATION OF APPROXIMATELY 25,000 RESIDENTS. WE ARE A FARMING COMMUNITY WITH SOME MANUFACTURING PLANTS. MANY OF OUR RESIDENTS ARE SELF-EMPLOYED. WE ALSO SERVE A LARGE HISPANIC POPULATION. OUR MEDICARE POPULATION REPRESENTS OVER 50% OF THE PATIENTS WE SERVE. WE ARE DESIGNATED AS A CRITICAL ACCESS HOSPITAL. PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 MCH HAS A BOARD OF DIRECTORS THAT IS REPRESENTATIVE OF THE COMMUNITIES WE SERVE. THEY SERVE ON A VOLUNTEER BASIS AND REPRESENT ALL AREAS OF OUR SERVICE AREA. MCH HAS IMPLEMENTED A CHARITY CARE PROGRAM WITH GUIDELINES THAT ARE CONSISTENT WITH THOSE OF OTHER HOSPITALS IN THE STATE OF IL. WE WORK CLOSELY WITH OUR AREA EMS PROVIDERS AND REGULARLY REPLACE THEIR STOCK AT NO CHARGE TO THEM. WE SUPPORT OUR LOCAL FREE CARE CLINIC - TRINITY HEALTH CARE - BY PROVIDING ESTABLISHED LAB TESTS AT NO CHARGE. MCH IS INVOLVED WITH COMMUNITY PROGRAMS BY PROVIDING HEALTH SCREENING BOOTHS, SPEAKERS BUREAU AND INVOLVEMENT AT THE COMMITTEE LEVEL IN MANY ORGANIZATIONS. FACTORS USED TO DETERMINE DISCOUNTED OR FREE CARE PART V, SECTION B, LINE 11 THE COLLECTORS REQUEST EXPENSES AND FAMILY SIZE FROM OUR PATIENTS THAT ARE APPLYING FOR FINANCIAL ASSISTANCE. PUBLISHING OF FINANCIAL ASSISTANCE POLICY PART V, SECTION B, LINE 13 THE POLICY IS NOT ATTACHED TO BILLING INVOICES, BUT THE BACK OF THE BILL LISTS THE PHONE NUMBERS OF OUR COLLECTORS WHO WILL HELP WITH FINANCIAL ASSISTANCE. COLLECTIONS POLICIES AGAINST PATIENTS PART V, SECTION B, LINE 15 MCH ALSO UTILIZES NON-RESIDENTIAL LIENS TO COLLECT FROM PATIENTS. X false false false false false false false false false LYNN KLEIN 142220 0 0 0 2882 0 4200 0 17527 0 166829 0 0 0 DAVID SCHOLL MD 177013 0 0 0 20325 0 4200 0 17527 0 219065 0 0 0 KENNETH K POTTS 308000 0 0 0 6580 0 4200 0 11241 0 330021 0 0 0 MARY M CHINN 189263 0 0 0 21117 0 4200 0 11241 0 225821 0 0 0 KENNETH J BEGGS 153148 0 0 0 19645 0 4200 0 9836 0 186829 0 0 0 KEITH P MINIHANE 740310 0 0 0 10607 0 4200 0 8025 0 763142 0 0 0 JENNIFER J TAYLOR 181179 0 0 0 3476 0 0 0 11241 0 195896 0 0 0 JOELLYN GAHAN SPOUSE OF BOARD MEMBER 33521 EMPLOYEE false WILLIAM GEHANT DIRECTOR SEE BELOW false BUSINESS RELATIONSHIPS BETWEEN INTERESTED PARTIES SCHEDULE L, PART IV, LINE 2 WILLIAM GEHANT, A DIRECTOR OF MENDOTA COMMUNITY HOSPITAL, IS AN OFFICER OF A BANK WITH WHICH MENDOTA HAS ACCOUNTS. INTEREST RECEIVED FROM ACCOUNTS WAS BELOW THE REPORTING THRESHOLD. COPY OF 990 PROVIDED TO GOVERNING BODY FORM 990, PART VI, LINE 11 MENDOTA COMMUNITY HOSPITAL EMAILS THE GOVERNING BODY A COPY OF THE FORM 990 BEFORE IT IS FILED SO THEY CAN REVIEW IT. IN ADDITION, THE CEO AND CFO REVIEW THE FORM 990 BEFORE IT IS FILED WITH THE GOVERNMENT. COMPLIANCE WITH WRITTEN CONFLICT OF INTEREST POLICY FORM 990, PART VI, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS THE GOVERNING BODY. ADMINISTRATION REQUIRES THE GOVERNING BODY TO FILL OUT AN ANNUAL CONFLICT OF INTEREST POLICY. ADMINISTRATION REVIEWS THE FORMS. IF A PROBLEM ARISES, THE CEO WILL CONTACT THE PRESIDENT OF THE GOVERNING BODY TO DISCUSS HOW TO HANDLE THE ISSUE. THE PERSON INVOLVED IN THE CONFLICT OF INTEREST WOULD NOT BE INVOLVED IN THE DELIBERATIONS HELD ABOUT THE ISSUE IN QUESTION. COMPENSATION DETERMINATION FORM 990, PART VI, LINE 15A THE EXECUTIVE BOARD CONDUCTED A REVIEW OF THE COMPENSATION FOR THE CEO IN APRIL 2010. AVAILABLE TO THE PUBLIC FORM 990, PART VI, LINE 19 THE ORGANIZATION DOES NOT MAKE THESE DOCUMENTS AVAILABLE TO THE PUBLIC. HOWEVER, THE AUDITED FINANCIAL STATEMENTS ARE INCLUDED IN THE COPY OF FORM 990 THAT IS MADE AVAILABLE TO THE PUBLIC. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 UNREALIZED GAINS ON INVESTMENTS $75,441 OTHER ADJUSTMENTS (3) ---------------------------------------- TOTAL $75,438