TY 2010 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) Jack JBecherer Director	.66	X		0	0
(2) James WBreckenridge Director	1.00	X		478,500	103,356
(3) Thomas DBudd Director	.30	X		0	0
(4) John WChadwick Director	.30	X		0	0
(5) Eleanor FDoar Director	1.00	X		0	0
(6) John TDorsey Director	.10	X		273,716	69,563
(7) Pamela SFox Director	.10	X		0	0
(8) Jos LGonzalez Director	.70	X		374,511	68,096
(9) Alphonso NGoode Director	1.00	X		0	0
(10) Jack WPackard Director	.50	X		0	0
(11) Dennis TUehara Director	20.50	X		412,499	70,487
(12) Connie MVitali Director	2.00	X		0	0
(13) Curtis DWorden Director	.50	X		0	0
(14) Paul AGreen Chairman	1.00	X	X	0	0
(15) Duane RBach Treas/Vice-Chair	.10	X	X	0	0
(16) Gary EKaatz President	1.00	X	X	969,051	150,705
(17) Henry MSeybold Treasurer	3.00		X	439,582	59,187

(A) Name and business address	(B) Description of services	(C) Compensation
Philips Medical System PO Box 100355 Atlanta,GA30384	Contract Maintenance	1,965,286
Cardiac Surgery Associates PO Box 1285 Joliet,IL604341285	Healthcare Provider	1,175,010
Schmeling Construction Co 315 Harrison Ave Rockford,IL61104	General Contractors	1,632,604
Mayo Collaborative Services dba Mayo Med Laboratories PO Box 9146 Minneapolis,MN554809146	Healthcare Services	1,001,970
Air Methods Corp PO Box 676592 Dallas,TX752676592	Helicopter Pilot/Services	1,242,546
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization 5

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21	845,017	845,017
2	Grants and other assistance to individuals in the U.S. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	363,375		363,375
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	102,983,050	77,568,229	25,414,821
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....	7,786,257	5,883,646	1,902,611
9	Other employee benefits .......	19,536,961	14,748,603	4,788,358
10	Payroll taxes ...........	6,886,920	5,190,534	1,696,386
11	Fees for services (non-employees):
a	Management ......	4,178,837	12,942	4,165,895
b	Legal .........	436,701		436,701
c	Accounting ...........	223,141		223,141
d	Lobbying ...........	0
e	Professional fundraising. See Part IV, line 17..
f	Investment management fees ......	659,508		659,508
g	Other ..........	811,853	180,406	631,447
12	Advertising and promotion ....	1,042,306	4,865	1,037,441
13	Office expenses .......	10,061,371	6,182,983	3,878,388
14	Information technology ......	7,952,986	7,391,582	561,404
15	Royalties ..	0
16	Occupancy ...........	9,710,275	7,070,321	2,639,954
17	Travel ............	117,372	93,094	24,278
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	535,854	176,351	359,503
20	Interest ...........	2,855,379	2,855,379
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	15,511,908	14,296,987	1,214,921
23	Insurance ..............	5,122,129	3,273,276	1,848,853
24	Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a	Medicaid Assessment Tax	9,983,148	9,983,148
b	Supplies/Drugs	47,447,818	47,228,358	219,460
c	Healthcare Services	9,752,387	9,752,387
d	Bad Debt Expense	13,528,770	13,528,770
e	Other purchased services	5,203,761	4,979,283	224,478
f	All other expenses	1,717,052	935,113	781,939
25	Total functional expenses. Add lines 1 through 24f	285,254,136	232,181,274	53,072,862	0
26	Joint costs. Check here if following SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	3,500	1	3,500
2	Savings and temporary cash investments .......	22,717,768	2	56,353,959
3	Pledges and grants receivable, net .........	1,446,236	3	494,476
4	Accounts receivable, net .........	41,106,559	4	44,815,243
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........		5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........		6
7	Notes and loans receivable, net .............	15,595	7	12,713
8	Inventories for sale or use ..............	5,807,024	8	6,056,539
9	Prepaid expenses and deferred charges ............	2,842,703	9	6,805,891
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	266,186,116
b	Less: accumulated depreciation. .....	10b	186,892,440	89,268,023	10c	79,293,676
11	Investments—publicly traded securities ..........	149,081,455	11	158,236,077
12	Investments—other securities. See Part IV, line 11 ......		12
13	Investments—program-related. See Part IV, line 11 ..		13
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........	21,359,215	15	20,795,777
16	Total assets. Add lines 1 through 15 (must equal line 34)...	333,648,078	16	372,867,851
	17	Accounts payable and accrued expenses .	93,437,415	17	108,410,765
18	Grants payable ..........		18
19	Deferred revenue ..........		19
20	Tax-exempt bond liabilities ..........	73,537,769	20	70,987,769
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	1,174,595	23	685,072
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities. Complete Part X of Schedule D.....	26,798,141	25	28,256,473
26	Total liabilities. Add lines 17 through 25.....	194,947,920	26	208,340,079
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	131,376,914	27	156,330,922
28	Temporarily restricted net assets .....	4,698,085	28	5,571,691
29	Permanently restricted net assets .....	2,625,159	29	2,625,159
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	138,700,158	33	164,527,772
34	Total liabilities and net assets/fund balances .....	333,648,078	34	372,867,851

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SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

Rockford Memorial Hospital

Employer identification number

36-2167847

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2010

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

0 %

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2010. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2009. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2009. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f)) .........

0 %

Public support percentage from 2009 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f)) ......

0 %

Investment income percentage from 2009 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2010. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2009. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2010

Additional Data

Software ID:	10000149
Software Version:	2010.2.15

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Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2010

Name of organization

Rockford Memorial Hospital

Employer identification number

36-2167847

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ, that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, aggregate contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not aggregate to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization Rockford Memorial Hospital
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part I
Part I	Contributors (see Instructions)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization Rockford Memorial Hospital
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part II
Part II	Noncash Property (see Instructions)
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Page 1 of 1 of Part III

Name of organization
Rockford Memorial Hospital

Employer identification number

36-2167847

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data

Software ID:	10000149
Software Version:	2010.2.15

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SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

Rockford Memorial Hospital

Employer identification number

36-2167847

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or pleasure) Preservation of an historically importantly land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06 ........	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2010

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back
1a	Beginning of year balance ....	4,309,770	3,472,212	4,463,526
b	Contributions ........	748,599	555,556	800,219
c	Investment earnings or losses ...	347,198	938,002	-1,259,075
d	Grants or scholarships .....	190,000	250,000	200,000
e	Other expenditures for facilities and programs ........	558,599	381,821	305,881
f	Administrative expenses ....	26,727	24,179	26,577
g	End of year balance ......	4,630,241	4,309,770	3,472,212

Provide the estimated percentage of the year end balance held as:

Board designated or quasi-endowment: SchDMd Bullet

Permanent endowment: SchDMd Bullet

100.000 %

Term endowment: SchDMd Bullet

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

Yes

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

InvestmentsLand, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of investment		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	468,730	2,111,708		2,580,438
b	Buildings ................	5,455,293	48,166,766	36,634,871	16,987,188
c	Leasehold improvements ............		99,060	84,305	14,755
d	Equipment ................		201,797,181	145,024,814	56,772,367
e	Other .................		8,087,378	5,148,450	2,938,928
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........					79,293,676

Schedule D (Form 990) 2010

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) Deferred Financing Costs				669,533
(2) Other				4,961,948
(3) Land Held for Future Use				6,422,260
(4) Partnerships				8,742,036
(5) Deposits




Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........				20,795,777

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Amount
Federal Income Taxes
Post Retirement		4,616,801
Basic Pension		23,076,820
Capital Lease		562,852






Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		28,256,473
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2010

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1	360,172,421
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	285,254,136
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	74,918,285
4	Net unrealized gains (losses) on investments ..........................	4	6,416,488
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV) .................................	8	-56,380,074
9	Total adjustments (net). Add lines 4 - 8 .............................	9	-49,963,586
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	24,954,699

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	366,264,489
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	6,416,488
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV): ............	2d	335,087
e	Add lines 2a through 2d .....................			2e	6,751,575
3	Subtract line 2e from line 1.....................			3	359,512,914
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a	659,507
b	Other (Describe in Part XIV): ...........	4b
c	Add lines 4a and 4b.......................			4c	659,507
5	Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ......			5	360,172,421

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............			1	284,929,717
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV): ............	2d	335,087
e	Add lines 2a through 2d......................			2e	335,087
3	Subtract line 2e from line 1.....................			3	284,594,630
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a	659,507
b	Other (Describe in Part XIV): ............	4b
c	Add lines 4a and 4b.......................			4c	659,507
5	Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ......			5	285,254,137

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
X	2	- Rockford Memorial Hospital as a part of RHS Rockford Health System adopted FIN 48 in 2007 and the impact was not material. The System did not record any additional liabilities due to the implementation of FIN 48 for the years ended December 31, 2008 or 2009 or 2010
XI	8	- The following were adjusting items in the Audited Income Statement Pension related changes other than net periodic pension cost 588,711. Post-retirement medical benefit-related charges other than net post retirement medical benefit cost 328,785. Net assets released from restr used for capital 61,000. Transfer to/from affiliates 56,660,000. Change in FAS124 Valuation 41,000.
XII	2d	- Rental expenses recorded in expenses section for the financial statements, shown net on tax return.
XIII	2d	- Rental expenses recorded in expenses section for the financial statements, shown net on tax return.

Schedule D (Form 990) 2010

Additional Data

Software ID:	10000149
Software Version:	2010.2.15

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

Rockford Memorial Hospital

Employer identification number

36-2167847

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Does the organization have a charity care policy? If "No," skip to question 6a...........

Yes

If "Yes," is it a written policy? .......................

Yes

If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.

Applied uniformly to all hospitals Applied uniformly to most hospitals Generally tailored to individual hospitals

Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.

Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low

income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 17500.0000000000 %

Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If

"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....

Yes

200% 250% 300% 350% 400% Other 60000.0000000000 %

If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Does the organization's policy provide free or discounted care to the "medically indigent"? ......

Yes

Does the organization budget amounts for free or discounted care provided under its charity care policy? ...

Yes

If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............

Does the organization prepare an annual community benefit report?.............

Yes

If "Yes," does the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Charity Care and Certain Other Community Benefits at Cost

	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Charity care at cost (from Worksheets 1 and 2) ..	8,887,880		8,887,880	3.120 %
b Unreimbursed Medicaid (from Worksheet 3, column a) .	70,008,407	84,770,481	-14,762,074
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....
dTotal Charity Care and Means-Tested Government Programs .....	78,896,287	84,770,481	-5,874,194	3.120 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	1,091,969	273,737	818,232	0.290 %
f Health professions education (from Worksheet 5) ..	1,531,254	174,373	1,356,881	0.480 %
g Subsidized health services (from Worksheet 6) ..	23,283,370	21,442,736	1,840,634	0.650 %
h Research (from Worksheet 7)
i Cash and in-kind contributions to community groups (from Worksheet 8) ..	841,755		841,755	0.300 %
jTotal Other Benefits ...	26,748,348	21,890,846	4,857,502	1.720 %
kTotal. Add lines 7d and 7j. ..	105,644,635	106,661,327	-1,016,692	4.840 %

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010

Schedule H (Form 990) 2010

Page 2

Part II

Community Building Activities Complete this table if the organization conducted any community building activities.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense (at cost).....

4,288,620

Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

76,956,364

Enter Medicare allowable costs of care relating to payments on line 5.....

70,550,020

Subtract line 6 from line 5. This is the surplus or (shortfall)........

6,406,344

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Does the organization have a written debt collection policy? ...............

Yes

If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......

Yes

Part IV

Management Companies and Joint Ventures

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2010

Page 3

Part VFacility Information

Section A. Hospital Facilities (list in order of size, measured by total revenue per facility, from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	Rockford Memorial Hospital 2400 N Rockton Avenue Rockford,IL61103	X	X	X	X	X	X

Schedule H (Form 990) 2010

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Name of Hospital Facility:

Line Number of Hospital Facility (from Schedule H, Part V, Section A):

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet those needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Development of a community benefit plan for the facility
	d	Participation in community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the CHNA
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs.		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?..		9
	If “Yes,” indicate the FPG family income limit for eligibility for free care: %

Schedule H (Form 990) 2010

Page 5

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care to low income individuals?.........		10
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: %
11	Explained the basis for calculating amounts charged to patients?.................		11
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted at all times on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........		14
15	Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments or arrests
	e	Other (describe in Part VI)
16	Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?...................................		16
	If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other (describe in Part VI)
17	Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
	e	Other (describe in Part VI)

Schedule H (Form 990) 2010

Page 6

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18
	If “No,” indicate the reasons why (check all that apply):
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility did not have a policy relating to emergency medical care
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Charges for Medical Care
19	Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
	a	The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
	b	The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
	c	The hospital facility used the Medicare rate for those services
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?...................................		21
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2010

Page 7

Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, measured by total revenue per facility, from largest to smallest) How many non-hospital facilities did the organization operate during the tax year?
Name and address		Type of Facility (Describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2010

Page 8

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2	Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
Part I line 3c		- Rockford Memorial Hospital RMH offers two charity care programs - HUPDA and our traditional charity care program. We will process charity care for whichever provides the highest percentage of discount. These criteria are determined as early as possible, preferably before or at the time of service. HUPDA is the Illinois Hospital Uninsured Patient Discount Act for all uninsured patients. Eligibility consists of being an Illinois resident, income less than 600 of FPG, and medically
Part I line 3c		continued necessary, limited to 25 of annual income. Patients submit proof of income including tax returns/pay stubs within 60 days of discharge. Traditional discounts follow our internal traditional charity care program for those who are uninsured or are insured with a patient liability. This income limit is 300 of FPG. Patient must submit proof of income that includes tax returns. Underinsured patients may be eligible for other discounts for the patient liability - and
Part I line 3c		continued there are potential discounts for Catastrophic Financial Assistance and/or Prompt Pay. Extenuating circumstances may also be taken into account.
Part I line 6a		- Rockford Health System prepares an annual Hospital Community Benefit Report as required by the State of Illinois. The report includes data for Rockford Memorial Hospital RMH as well as the other four related tax-exempt organizations. The report is distributed within the health system and is also available upon request.
Part I line 7g		- The subsidized health services included are our psychiatric care, pulmonology, endocrinology and neurosurgery. These programs are operated with a subsidy from the hospital using the cost accounting system to define direct and variable expense and the cost-to charge ratio to evaluate the cost of both bad debts and charity write off. Physicians costs from affiliated organization are included in these programs
Part I line 7		- Overall explanation of inclusion of RHPH - The hospital used the 990 worksheet to determine the cost-to-charge that was used for the bad debt and charity care expense included in all parts of Line 7. The subsidized programs also include the costs from our physician clinic because there are no physicians costs included in the hospital cost accounting analysis. Bad debt and charity expenses have been removed. Medicaid has also been removed from the charges except for the provider tax expense included with the cost to charge ratio. This is due to the fact that RMH has NO unreimbursed Medicaid and therefore did not include any part of the dollars from Line 7b.
Part III line 4		- The Systems policy is to provide medically necesary health care services regardless of the patients ability to pay for such care. RHS maintains records to identify and monitor the charity, uncompensated care and community benefit it provides. These records include the cost for services and supplies furnished under its policies as well as the estimated difference between the cost of the services provided to Medicaid patients and the reimbursement received from the state for this care.
Part III line 4		cont During the years ended December 31, 2010 and 2009, the following levels of charity care and community service, including serviced for which the System received no reimbursement or was reimbursed below cost, were provided. Estimated costs and expenses incurred for charity care in 000s 2009 - 8,146 2010 - 10,772. Estimated cost over reimbursement for Medicaid patients care 2009 - 11,421 2010 - 4,299. Cost of other Charity Care and Community Benefits 2009 - 22,962 2010 - 21,668.
Part III line 4		cont In addition to the above, the System received no reimbursement or is reimbursed below cost for these services, for the years ended December 31, 2010 and 2009 Estimated cost over reimbursement for Medicare patients care 2009 - 35,795 2010 - 26,273. Estimated costs for bad debt 2009 - 10,787 2010 - 7,847.
Part III line 4		cont Total cost of Charity, Uncompensated Care Other Community Services 2009 - 69,544 2010 - 55,788 community service, research and education 2009 - 3,395 2010 - 6,597. The System actively sponsors community benefits that respond to community needs. These programs focus on the underserved with the intention of improving the overall health of the entire community. Examples of this outreach include mobile clinics, partnering with local schools and employers to provide health
Part III line 4		cont screenings, support and health education providing social services, such as multi-faith ministry, intepreters and support groups providing emergency medical training to other providers across the region and serving as the regions emergency disaster response center. Our 24 hour emergency room, mental health services, and multiple convenient care locations provide for various
Part III line 4		cont and timely health care needs throughout the region. The costing methodology used for determining the cost of bad debt is the Medicare CCR. Since bad debt is often difficult to distinguish from charity care due to insufficient data provided by the patient, RMH continues to provide the care as a part of its mission and considers it a substantial benefit to the community.
Part III line 8		- The data reported for Medicare charges and payments is from the final Management Report produced by the firm that prepared the 2010 Cost Report as submitted to the Fiscal Intermediary in 2011 in compliance with all current regulations. Reported are allowable Medicare Costs provided by the Cost Report less Medicare costs included in Subsidized Programs on Line 1,7g as calculated by our cost accounting analysis.
Part III line 9b		- Rockford Memorial Hospital has a strong commitment to provide quality patient care for all individuals. Our mission is to provide health care to everyone who comes to our door, regardless of their ability to pay. We will submit a claim to all 3rd party payors on behalf of the patient. We help patients apply for all possible insurance or assistance such as crime victims, an automobile accident, workers compensation, Medicaid, COBRA, local assistance and/or hospital financial assistance.
Part III line 9b		cont If they do not qualify for any of these, we can extend payment options such as monthly payments, credit card payments or financial assistance. This is offered to patients who are experiencing legitimate financial hardships and are unable to pay for all or part of the patients medical care. Forgiveness may apply to an amount after applying all payments such as any insurance company, health plan or personal payments, any negotiated discounts or any uninsured discounts.
Part III line 9b		cont If a patient eligible for charity care or partial financial assistance still has a portion of the outstanding balance due, other arrangements are made. RMH accepts a variety of payments and alternative payment plans. Monthly statements are sent as payment reminders for contracted arrangements. In case of default, additional letters and calls are made to bring it to a current status. An account is turned over to a collection agency only after non-payment or no contact in 120 days.
Part VI Line 2		- Rockford Memorial Hospital through RHS - Rockford Health System was one of the local hospitals that helped to fund and produce the 2010 Healthy Community Survey. The study addresses quality of life issues in Winnebago and Boone Counties, identifying trends and changes in the demographics and the health care environments.
Part VI Line 2		cont It includes four components 1 Community Analysis - a comprehensive analysis of data from many sources, providing an overview of community health, demographic and socioeconomic characteristics, with comparisons to state and U.S. measures using these Data Sources - U.S. Census Bureau, Vital Statistics, Education, Employment, Income, Social Indicators, Crime, Abuse.
Part VI Line 2		cont 2 Household Survey - Gathered data on health conditions experienced, health behaviors, other problems/needs experienced, perceptions of community problems related to health and human services and other community needs. A total of 13,775 surveys were distributed, with a return rate of 16.8. There was a three tiered Distribution, with mailings to 8000 homes 13 response, online surveys-the Chamber of Commerce 14, and distribution in Rockford School District 205 24.
Part VI Line 2		cont 3 Key Informants Interviews - In-depth interviews with 60 key individuals in the community investigated community health and human services needs, both met and unmet and local experts in education, government, human services, or business which was direct to these topics Best aspects of living in Winnebago and Boone Counties Target populations in need of services Health and human services systems Changes for the future in the counties.
Part VI Line 2		cont4 Focus Groups - 22 focus groups were held approx. 160 participants to gain knowledge about their views and experiences with health and human services, particularly within the specific population group they represent. The Prioritization Process identified issues for collaborative action Access to CareBasic Needs, Behavioral Health, Crime and Violence/Public Safety, Chronic Disease, Dental Care, Education/Employment, Health Equity, Infectious Disease, Maternal/Prenatal/Early Childhood.
Part VI Line 2		cont The results were rolled out to the public by Rockford Health Council to the public and interested providers within the Winnebago/Boone County region in July 2011. RHS not only collaborated with RHC but provided expertise from personnel to produce the Survey.
Part VI Line 2		cont Dr Norem is a Rockford Health Physicians employee and RHC Chairman of the Board. Gary Kaatz, CEO of RHS is Vice Chair and Evelyn Pagan, Vice President Quality Performance Measurement for RHS serves on the board and chaired the Health Equity study. John Rudzinski and Ray Davis, employed RHPH physicians and Dena Hobbs, an employee with RHS also contributed their time and talent to the process.
Part VI Line 3		-The process of informing patients varies due to individual circumstances. If they indicate they have no insurance, they are considered to be self-pay. With routine admission to the hospital, a patient representative visits the patient to determine if they may be eligible for third party assistance . The patient or his representative must provide enough information to determine eligibility and if any assistance may be available to the patient from the IL Dept of Healthcare
Part VI Line 3		cont and Family Services, the United States Social Security Office or other available funding sources. These must be pursued in good faith before the RHS application will be considered. Financial Assistance will not be considered by RHS until all available third party payors have been billed and payments from such payors have been received or denied. This requirement includes the submission and processing of a state Medicaid application and/or a federal Social Security application.
Part VI Line 3		cont RMH follows the Illinois Hospital Uninsured Patient Discount Act for all uninsured patients. Eligibility consists of being an Illinois resident, with income less than 600 of FPG, and medically necessary treatment. Payment is limited to 25 of annual income from eligible patients. Patients must submit required documentation when requested. The patient is then considered self-pay/uninsured and is eligible for discounts/financial assistance under either HUDPA regulations or RHS policy.
Part VI Line 3		cont For traditional assistance the uninsured patients who do not qualify under HUDPA use the FPG to determine the amount of discount to be applied. A patient who is underinsured and may have some personal liability for their medical expenses may also apply for financial assistance. A financial aid counselor will provide the application and assist them with the process.
Part VI Line 3		cont If a patient that presents himself/herself for treatment in the emergency room, a review will be done to determine what insurance or eligibility for other aid may be available. Admissions will provide them with a financial aid assistance packet for charity care if they are uninsured or underinsured. If any other circumstances apply, they would be directed to other available third party financial aid, for example, a crime victim may be eligible to apply through a victim assistance program.
Part VI Line 4		- RMH is located in Rockford, IL Winnebago County with a defined primary service area that includes Winnebago, Boone and Ogle counties. 2010 US Census Bureau estimates project the population for the entire primary service area at approximately 403,000 individuals with close to three-quarters living in Winnebago County approximately 295,000. This represents a drop in population of approximately 6000 individuals from 2009 US Census projections.
Part VI Line 4		continued The hospital also serves the secondary service area which includes DeKalb, McHenry, Whiteside, Lee, LaSalle, Stephenson and Rock counties for select tertiary services. Located in northern Illinois, the primary service area is characterized as largely rural and populated with very small communities with the exception of the neighboring cities of Rockford, Loves Park, and Machesney Park which comprise more than 200,000 individuals.
Part VI Line 4		cont The next largest is Belvidere, in Boone County, where the entire county has a population of just over 54,000 individuals. More than 86 of hospital inpatients are from the Primary Service Area. As a community that relies heavily on manufacturing companies and small businesses, the area continues to experience difficult economic times. Currently the largest employers include Chrysler Boone County, the Rockford school district, and the three Rockford healthcare providers.
Part VI Line 4		cont Median household income in 2010 inflation-adjusted dollars U.S. Census Bureau in Winnebago County was 43,792 representing a drop from 2009 median income levels of 47,600.In comparison, the states 2009 median household income was 53,974.These disparities are also reflected in unemployment, education and poverty rates. While unemployment has dropped in Rockford from nearly 18 in March, 2010 to 15.1 in August, 2010, the community is still significantly
Part VI Line 4		cont higher than the overall State rate of slightly more than 10. Most recent census figures estimate 20 of Winnebago County residents attain a bachelors degree while in the state more than 29 do. Poverty levels continue to rise with approximately 18 of Winnebago County residents below the poverty level compared to state levels of 13. In February, the 2010 Illinois Kids Count report stated 34 and one in three children in Rockford live at or below the federal poverty rate
Part VI Line 4		cont placing Rockford with the highest rate in the entire state of Illinois. All of these conditions have resulted in increasing pressures on the community. RMH is located in the older, western portion of the community and serves a significant indigent and elderly population. This is evident when looking at income levels for households located in zip codes in western Rockford where the hospital resides. For example, the U.S. Census Bureau 2000 profile for individual zip codes
Part VI Line 4		cont lists median household income for west side zip codes as follows 61103-approximately 37,000 61102-34,000 61101-31,700. Bad debts from these zip codes accounted for more than 7.6 million and 42 of the hospital total. The geographic disparities are evident, comparing these numbers to households in the eastern portion of Rockford. In comparison, the 3 largest eastside zip codes have the following median household incomes 61107-49,000 61108-44,700 61114-67,000.
Part VI Line 4		contAs the only northern Illinois hospital with Level III neonatal intensive care, comprehensive pediatric and pediatric intensive care, RMH is committed to children as the main provider of childrens services in the immediate and greater tertiary service area. With 1 in 3 children currently at or below federal poverty levels in the county and with the overall economic condition, the hospital has seen increases in uninsured and public aid patients. This trend continues to grow.
Part VI Line 5		- In 2010, RMH, integral part of Rockford Health System RHS, continued to invest thousands of dollars and hours in promoting a stronger, healthier community. As one of Rockfords largest employers, the organization takes a leading role in financially supporting not only health-related initiatives, but also community-building activities across the region. It includes providing financial support and talent for economic development and business-related activities, as well as quality of
Part VI Line 5		continued life and educational initiatives, to name just a few. RHS professionals participate on many community boards and are actively involved in promoting and protecting the Rockford region and its assets. Two of the more significant community projects funded by RMH in 2010 include the Sharefest project, which helped to renovate an aging middle school in the hospitals neighborhood and the support of a new Science and Math Center at our local community college.
Part VI Line 5		cont RHS is a leading funder of nonprofit organizations and their missions in the region. And, the need for support has grown significantly in 2010, as the community continues to be hard hit by difficult economic times. Whether it is helping to fund Gigis Playhouse for children and adults with Down syndrome, stocking the local food bank or supporting the survival of the arts by funding the Rockford Symphony Orchestra and the Rockford Ballet, the reach of the organization is wide and deep.
Part VI Line 5		cont Donations to local causes amounted to hundreds of thousands of dollars in 2010. To promote a healthier community, RHS supported the Rockford Health Council in completing its 2010 Healthy Community Study for Winnebago and Boone Counties. The support was financial, as well as technical, with RHS represented on the Rockford Health Council Board of Directors. This collaborative effort, partnering healthcare and education, gathered, analyzed and reported on the health needs of the community.
Part VI Line 5		cont It revealed trends, changes and unmet needs. This assessment serves as a blueprint for future health care initiatives and growth in our region. While RHS professionals take a role locally in community-building activities related to healthcare, it also takes a similar role in Illinois. The RHS President and CEO is a member of the Illinois Hospital Associations Board and in 2011 became its chair. RHS professionals are leading advocates for the healthcare needs of the Rockford region.
Part VI Line 5		cont With local unemployment rates among the highest in Illinois, health care providers continue to see a rise in underinsured and uninsured individuals in our community. Besides a proactive charity care program, RHS invests in safety net programs to assist residents in accessing health care and other needed services. That support includes Ronald McDonald Care Mobile, which provides free medical and dental services and our Bridge Clinic partnership provides free care for underinsured adults.
Part VI Line 5		cont The RMH Auxiliary presented six minority women scholarships to attend nursing school. Each of the students received 2,000 for pursuing their careers at local colleges. Two were given to Hispanic students who speak Spanish. The goal is to help remove financial barriers for minority students and thus create a more diverse workforce. It is also hoped that additional Spanish-speaking nurses in local health care facilities will help remove barriers for patients who do not speak English.
Part VI Line 5		cont The organization makes additional significant financial and manpower commitments to organizations such as local chambers of commerce, Boone County Growth Dimensions, area colleges, the United Way, Black Healthcare Coalition, La Voz Latina, local public schools and quality of life initiatives which are intended to maintain Rockfords strengths in difficult times.
Part VI Line 5		cont As the largest employer in Rockford, the health system is a major economic force in the region, providing a positive impact on the local economy. The workforce provides not only a broad range of employment opportunities, but also makes other spending and financial contributions possible. During 2010, RHS worked with over 200 local vendors and supported 46 full-time construction-related jobs in the region. An investment of 9.2- million went toward major improvements at its facilities.
Part VI Line 5		cont The largest construction project was the 4.4-million renovation of the Emergency Department at Rockford Memorial Hospital. Rockford Health Physicians-Mulford location received renovations for implementation of digital mammography and the expansion of the Obstetrics and Gynecology program. We also developed a Dermatology program at Rockford Health Physicians-Perryville.
Part VI Line 5		cont Playing a key role in keeping the community safe and prepared in the event of a disaster, Rockford Memorial Hospital has been designated by the Illinois Department of Public Health as the Disaster POD hospital for the northern Illinois EMS region. In that role, the hospital, which is a Level 1 Trauma Center, serves as the designated resource hospital for regional disaster planning and response maintains an established disaster plan
Part VI Line 6		-Each of Rockford Health Systems entities work closely with the community and Rockford Memorial Hospital RMH to address health needs. In 2010, volunteers from the Visiting Nurses Association VNA gave 5,000 hours of their time to help care for, educate and serve residents of the Rock River Valley. The VNA provides support services for end of life patients, protecting the elderly from abuse and helping them stay in their own homes as long as possible.
Part VI Line 6		continued In 2010, VNA Hospice teamed up with Northern Illinois Hospice to host the 8th Annual Talking Hospice Conference, Cultural Diversity Difference in the Delivery of End-of-Life Care. To date, more than 1700 individuals have attended the conferences. Also this year, VNAs Older Adult Care was one of six sites selected to receive grant funding to pilot the Money Follows the Person Program. The program is designed to help older adults who have lived in the nursing home for more than
Part VI Line 6		continued three months, move out, and back into their communities. Many elderly residing in nursing facilities are unaware of the community resources available to support a choice of community living. Ten former nursing home residents including a married couple have benefitted from this program. Also in 2010, VNA Elder Abuse Neglect and Exploitation staff was instrumental in forming the Winnebago and Boone Counties Elder Fatality Review Board, a multidisciplinary team comprised of
Part VI Line 6		continued coroners, lawyers, police officials, and elder abuse staff. The purpose of the board is to review questionable deaths of area seniors that may potentially be attributed to abuse. Input from individuals who intervene in elder abuse can actually close the door on a questionable death or open it to further investigation. Review boards such as this have helped with the prosecution of those who abuse senior citizens. VNA is also very involved in providing community outreach
Part VI Line 6		continued at area health and wellness fairs. Home care professionals participated in a number of these events in 2010. VNA introduced Pet Therapy as a complement to their more medically traditional services. All dogs and owners are certified as Pet Therapists and receive specialized training prior to being accepted into the program. Therapy dogs help patients physically, socially and emotionally and have become a welcome addition to VNA Hospice Program.
Part VI Line 6		continued Rockford Health Physicians RHPH, the employed physicians group that is part of RHS, participates in numerous initiatives on behalf of the communities it serves. These physicians support the hospitals clinical programs, such as the hospitalist program in obstetrics and in pediatrics, where the majority of patients are indigent as well as providing critical staff for the 24 hr. emergency department.
Part VI Line 6		continued The doctors also actively participate in community outreach efforts. The Bridge Clinic, which serves the immediate medical needs of underinsured adults is staffed by RHPH physicians, the Centering Pregnancy Program, a support group initiated by our midwives for primarily low income pregnant women and significant continuing financial support for a local child abuse program called MERIT, were among many initiatives at RHPH.
Part VI Line 6		continued Throughout the region, the physician group helps to support initiatives with local schools and village government services. Our physicians and employees also provided community education on heart, neck and back pain, cosmetic surgery and hearing loss issues. CPR training, financial support and volunteers for a pediatric diabetes camp and an educational partnership with the Golden Apple Foundation are other 2010 initiatives by the medical group.
Part VI Line 6		continued In 2010, the external grants program of the Rockford Memorial Development Foundation RMDF provided 100,000 in support to community not-for-profits that serve as an extension of Rockford Health Systems healthcare mission. RMDF also provides support for the Ronald McDonald Care Mobile, which provides free medical and dental services to children in the region. In addition, the Foundation provided automatic external defibrillators AED to organizations that serve a wide variety of citizens. They included Roscoe Police Dept., Milestone, Inc., Remedies formerly PHASE/WAVE, Village of Machesney Park, IL and Rockford Park District. The Foundations AED grant program has provided nearly 109 of the lifesaving devices to community organizations since 1999.
Part VI Line 6		continued RHS also proactively responds to diverse community need. Whether it is, support for an open heart program in neighboring Wisconsin, a VIP Program that assists local employers with wellness initiatives, comprehensive pediatric support services for children and parents, or nursing scholarships for minorities, the organization invests money, time and talents in supporting community health initiatives that provide immediate needs and long lasting benefits to the community. RHS is a leading funder of nonprofit organizations and their missions in the region. Whether it is helping to fund Gigis Playhouse for children and adults with Down syndrome, stocking the local food bank or supporting the survival of the arts through funding the Rockford Symphony Orchestra and the Rockford Ballet, the organization reaches wide and deep. Donations to local causes amounted to hundreds of thousands of dollars in 2010.
Part VI Line 6		continued To promote a healthier community, RHS supported the Rockford Health Council in completing its 2010 Healthy Community Study for Winnebago and Boone Counties. The support was both financial, as well as technical, with RHS represented on the Rockford Health Council Board of Directors. This collaborative effort, partnering health care and education, gathered, analyzed and reported on the health needs of the community. This can serve as a blueprint for future health care initiatives. RHS professionals are leading advocates for the health care needs of the Rockford region. The system through RMH Auxiliary presented six minority women scholarships to attend nursing school. Each of the students received 2,000 for pursuing their careers at local colleges. Two were given to Hispanic students who speak Spanish. The goal is to help remove financial barriers for minority students and thus create a more diverse workforce. It is also hoped that more Spanish-speaking nurses in local health care facilities will remove barriers for patients who do not speak English.
Part VI Line 7		Part VI Line 7, IL

Schedule H (Form 990) 2010

Additional Data

Software ID:	10000149
Software Version:	2010.2.15

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization
Rockford Memorial Hospital

Employer identification number
36-2167847

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) Rkfd Area Economic Council100 Park Ave Rockford,IL61101	36-3055858	501c6	120,000	Community building
(2) Univ of IL-College of Medicine1601 Parkview Rockford,IL61107	37-6000511	501c3	80,000	Support healthcare
(3) Rockford Symphony Orchestra711 N Main St Rockford,IL61103	26-1180940	501c3	11,000	Support Fine Arts
(4) Community Foundation of No IL946 N Second St Rockford,IL61107	36-4402089	501c3	30,000	General support
(5) Easter Seals Metropolitan Chicago233 South Wacker Drive Suite 2400 Chicago,IL60616	36-2171729	501c3	5,940	Support Handicapped
(6) Rock Valley College3301 N Mulford Rd Rockford,IL61114	36-3037232	501c3	34,520	Community Education
(7) Janet Wattles526 W State St Rockford,IL61101	36-3636657	501c3	31,050	Support healthcare
(8) American Cancer Society4312 E State St Rockford,IL61108	23-7040934	501c3	10,000	Support healthcare
(9) Growth Dimensions200 S State St Belvidere,IL61008	36-3196645	501c6	7,420	Community Development
(10) Epilepsy Found North Central IL3815 Harrison Ave Rockford,IL61101	36-2741730	501c3	4,800	Support healthcare
(11) Retreat & Refresh Stroke Camp425 W Giles Ln Peoria,IL61614	64-0954851	501c3	7,000	Support healthcare
(12) YMCA200 Y Blvd Rockford,IL611073019	36-2174838	501c3	5,094	Youth Services
(13) Golden Apple Foundation5050 E State Street Rockford,IL61108	36-3890062	501c3	9,920	Community Education
(14) Crusaders Health Foundation1200 West State Street Rockford,IL61102	36-3259761	501c3	4,500	Support healthcare
(15) Boys and Girls Club1275 Peachtree Street Atlanta,GA30309	13-5562976	501c3	5,000	Community Program
(16) United Way of Rock River Valley612 N Main St Rockford,IL61103	36-2167843	501c3	15,000	Community Program
(17) Boy ScoutsPO Box 4085 Rockford,IL61110	36-2169127	501c3	5,000	Community Program
(18) Girl Scouts2101 Auburn St Rockford,IL61103	36-2358083	501c3	6,000	Community Program
(19) Regional Access & Mobilization Project (RAMP)202 Market Street Rockford,IL61107	36-3149827	501c3	15,750	Support Handicapped
(20) Rockford Sharefest1280 S Alpine Rd Rockford,IL61108	26-2931796	501c3	25,000	Community Coalition
(21) March of Dimes1275 Mammaroneck Ave White Plains,NY10605	13-1846366	501c3	10,000	Support infant healthcare
(22) Rockford Chamber of Commerce308 W State St Ste 190 Rockford,IL61101	36-1695170	501c6	10,000	Community Development
(23) Midwest Fdn for Orthopaedic Research & Education (MFORE)324 Roxbury Road Rockford,IL61107	36-2691111	501c3	6,000	Support healthcare
(24) Kantorei415 N Church St Rockford,IL61103	36-2603214	501c3	5,000	Community Program
(25) OSF St Anthony Medical CenterPO Box 6087 Rockford,IL61125	37-0813229	501c3	9,220	Support healthcare

Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image

Enter total number of other organizations ................................ . Bullet Image

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2010

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

Identifier	Return Reference	Explanation

Schedule I (Form 990) 2010

Additional Data

Software ID:	10000149
Software Version:	2010.2.15

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

Rockford Memorial Hospital

Employer identification number

36-2167847

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Yes

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2010

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported in prior Form 990 or Form 990-EZ
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
(1) James WBreckenridge	(i) (ii)	290,192	187,174	1,134	86,160	17,196	581,856	79,750
(2) John TDorsey	(i) (ii)	261,149	11,434	1,134	41,396	8,469	323,582	31,409
(3) Jos LGonzalez	(i) (ii)	351,014	22,364	1,134	52,356	15,740	442,608	25,212
(4) Dennis TUehara	(i) (ii)	387,409	23,543	1,548	53,266	17,220	482,986
(5) Gary EKaatz	(i) (ii)	552,287	304,971	111,792	124,719	25,986	1,119,755	76,766
(6) Henry MSeybold	(i) (ii)	316,687	115,387	7,509	47,878	11,310	498,771	25,145
(7) Gordon Langejans	(i) (ii)	230,232	72,542	12,140	22,932	25,528	363,374
(8) Earl Tamar	(i) (ii)		42,397	6,249	10,200	692	59,538	4,100
(9) Carolyn Bengtson	(i) (ii)	253,556	59,372	1,104	33,269	22,768	370,069	18,417
(10) Michael Tyrkus	(i) (ii)	194,477	5,847	9,981	19,344	20,516	250,165
(11) Susan Schreier	(i) (ii)	180,583	41,274	1,528	23,323	20,341	267,049	6,208
(12) Curt Lesher	(i) (ii)	153,433	14,650	5,466	10,940	17,308	201,797
(13) Jeffrey Campbell	(i) (ii)	137,228	10,350	254	9,644	23,569	181,045
(14) Kerry Hill	(i) (ii)	171,328	43,421	6,589	25,972	24,194	271,504	8,333

Schedule J (Form 990) 2010

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
I	1a	- By policy Membership to the YMCA 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 are prorated for personal vs business use and that percentage is added to taxable wages.
1	4b	- 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 Carolyn Bengtson 13,123 Gary Kaatz 93,816 Gordon Langejans 4,756.00 Sue Schreier 9,198 Henry Seybold 38,800 Kerry Hill, 8,774.
1	7	- 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.

Schedule J (Form 990) 2010

Additional Data

Software ID:	10000149
Software Version:	2010.2.15

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization
Rockford Memorial Hospital

Employer identification number
36-2167847

Part I

Bond Issues

(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	(g) Defeased		(h) On Behalf of Issuer		(i) Pool financing
(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	Yes	No	Yes	No	Yes	No
A	Illinois Finance Authority	86-1091967	45000GFS5	12-11-2008	31,008,000	Refund 1994 Series Bonds, Issuance Costs, SWAP Payment		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired. . . . .
2 Amount of bonds defeased . . . .
3 Total proceeds of issue . . . .	31,008,000
4 Gross proceeds in reserve funds . .
5 Capitalized interest from proceeds.
6 Proceeds in refunding escrow. . . . .
7 Issuance costs from proceeds . . .	483,711
8 Credit enhancement from proceeds.
9 Working capital expenditures from proceeds . .
10 Capital expenditures from proceeds . .
11 Other spent proceeds . .
12 Other unspent proceeds. . .
13 Year of substantial completion . . .	2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue?	X
15 Were the bonds issued as part of an advance refunding issue?		X
16 Has the final allocation of proceeds been made? . .	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .	X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2010

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use?
b Are there any research agreements that may result in private business use of bond-financed property? . .
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? .
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . .
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .
6 Total of lines 4 and 5 . . .. . . . . .
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities?

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .		X
2 Is the bond issue a variable rate issue?	X
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?	X
b Name of provider .	JP Morgan Chase
c Term of hedge . .	0000000009.600000000000
d Was the hedge superintegrated? .
e Was a hedge terminated? .
4a Were gross proceeds invested in a GIC? .		X
b Name of provider .
c Term of GIC . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .
5 Were any gross proceeds invested beyond an available temporary period? .		X
6 Did the bond issue qualify for an exception to rebate? . . .		X

Schedule K (Form 990) 2010

Page 3

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation

Schedule K (Form 990) 2010

Additional Data

Software ID:	10000149
Software Version:	2010.2.15

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

Rockford Memorial Hospital

Employer identification number

36-2167847

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(b) Description of transaction	(c) Corrected?
1(a) Name of disqualified person	(b) Description of transaction	Yes	No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose	(b) Loan to or from the organization?		(c)Original principal amount	(d)Balance due	(e) In default?		(f) Approved by board or committee?		(g)Written agreement?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b)Relationship between interested person and the organization	(c)Amount of grant or type of assistance

For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2010

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Connie Vitali RMH Board Member	Partner, RMH Pathologists Ltd.	271,388	Contract for exclusive pathology		No

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2010

Additional Data

Software ID:	10000149
Software Version:	2010.2.15

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

Rockford Memorial Hospital

Employer identification number

36-2167847

Identifier	Return Reference	Explanation
Form 990 Part XI	5	-Other Changes in Net Assets Unrealized gain/loss on investments 6,416,488, Pension related changes other than net periodic pension cost 588,711, Postretirement medical benefit cost 328,785, Net assets released from restrictions used for capital 60,987, transfers to affiliates 56,660,704, change in FAS124 valuation 40,972, UPMIFA 248,743, change in temporarily restricted net assets 624,863
Form 990 Part VI	1a	- These members of the board were compensated by related organizations for other duties as well as unpaid service as board members James Breckenridge 48 hrs Anesthesiologist with Rockford Health Physicians RHPH and service to RHPH and RHS boards, John Dorsey 61 hrs RHPH Internal Medicine physician and RHPH and RHS boards, Jose Gonzalez 52.3 RHPH Neonatologist and RHPH and RHS boards, Dennis Uehara 31.6 hrs RHPH Emergency Services physician, RHPH and RHS and Foundation RMDF boards. Gary Kaatz had 42 additional hrs as President and CEO, Julie Peterson had 44 hrs as executive secretary, and Henry Seybold had 42.9 hrs as CFO Sr VP of Finance these employees compensation includes duties within RMH organization and for supporting all of the related entities RHS/RHPH/RMDF/VNA.
Form 990 Part VI	11a	- The data was gathered by the accounting staff with input from RMH and RHS executive staffs. The data was reviewed and the Form 990 prepared by the RMH tax analyst. During the process, there were ongoing meetings held with a group consisting of the RHS CFO, the VP of Finance, the Controller, and the 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 Board of Directors prior to filing.
Form 990 Part VI	12	- RHS Compliance Department acting on behalf of RMH 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 actinsare taken as a result fo the review. Employees are given the policy and a statement to complete at teh beginning of the year or as a new party is hired or joins the RMH board.
Form 990 Part VI	15a,b	- RHS is the sole corporate member.
Form 990 Part VI	19	- Financial statements are available through the Illinois Attorney Generals Office. Governing documents are available by request from the board secretary.
Form 990 Part IV	20b	No audited financials were attached or were required to be attached. The box was incorrectly checked Yes. This is the only part of the document that was modified.
Form 990 Part III Program Service Accomplishments	Line 4d Other Activities	Program Service Expenses 647,110, Grants and allocations 510,057, Revenue 394,465 Through Rockford Memorial Hospital Auxiliary, RMH is able to provide extra funds and services to support its mission. The Auxiliary has 354 volunteers who logged 35,847 hours while assisting with greeting visitors, transporting patients, floral or gift deliveries, thrift shop and gift shop activities, and other services as requested. The volunteers efforts provide extra funds and enhance the overall hospital experience for patients, visitors and staff.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2010

Additional Data

Software ID:	10000149
Software Version:	2010.2.15

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

Rockford Memorial Hospital

Employer identification number

36-2167847

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(f) Direct controlling entity
(1) Rockford Health System Ventures LLC 2400 N Rockton Ave Rockford,IL61103 36-4366881	Healthcare	IL	2,174,322	NA

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) Visiting Nurses Assn of the Rockford Area 2400 N Rockton Ave Rockford,IL61103 36-2167945	Healthcare	IL	501c3	9	Rockford Health System		No
(2) Rockford Health System 2400 N Rockton Ave Rockford,IL61103 36-3197915	Support of Healthcare	IL	501c3	11	N/A		No
(3) Rockford Health Physicians 2300 N Rockton Ave Rockford,IL61103 36-3097436	Healthcare	IL	501c3	3	Rockford Health System		No
(4) Rockford Memorial Development Foundation 2400 N Rockton Ave Rockford,IL61103 36-2197918	Support of Healthcare	IL	501c3	11	Rockford Health System		No

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2010

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Van Matre Rehabilitation Center LLC 3660 Grandview Parkway Ste 200 Birmingham,AL35243 36-4397130	Healthcare	IL	NA	Related	2,174,322	9,115,116		No		Yes		100.000 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership
(1) Rockford Health Insurance LTD Wellesley House So 2nd Flr 90 Pitts Pembrooke,HM08 BD	Insurance	BD	NA	C Corp	26,130	1,927,420	100.000 %

Schedule R (Form 990) 2010

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .

Yes

m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1) Rockford Memorial Development Foundation	b	190,000	Payment
(2) Rockford Memorial Development Foundation	c	745,824	Financial Analysis
(3) Rockford Health System	h	8,214,446	Asset listing review
(4) VanMatre Rehabilitation Center LLC	j	149,129	Per contract
(5) Rockford Health Physicians	k	226,659	Financial Analysis
(6) VanMatre Rehabilitation Center LLC	k	549,797	Financial Analysis
(7) Rockford Health Physicians	l	4,868,113	Financial Analysis
(8) VanMatre Rehabilitation Center LLC	l	860,837	Financial Analysis
(9) Rockford Health Physicians	m	406,730	Financial Analysis
(10) Rockford Health Physicians	n	5,685,246	Financial Analysis
(11) Visiting Nurses Association	n	926,434	Financial Analysis
(12) Rockford Memorial Development Foundation	n	381,123	Financial Analysis
(13) Visiting Nurses Association	p	788,728	Payment
(14) Rockford Health Physicians	p	2,504,191	Financial Analysis
(15) Rockford Memorial Development Foundation	p	247,661	Financial Analysis

Schedule R (Form 990) 2010

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Are all partners section 501(c)(3) organizations?		(e) Share of end-of-year assets	(f) Disproprtionate allocations?		(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(h) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(e) Share of end-of-year assets	Yes	No	(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2010

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:	10000149
Software Version:	2010.2.15

1	Briefly describe the organization’s mission or most significant activities: To improve and protect the health and welfare of the community in accordance with our mission: Superior Care, Every Day, For all our patients. A 396-bed hospital includes a Level 1 Trauma Center, Level III Neonatal Intensive Care Unit, region's only Pediatric Intensive Care Unit and the designated Disaster POD hospital To improve and protect the health and welfare of the community in accordance with our mission Superior Care, Every Day, For all our patients. A 396-bed hospital includes a Level 1 Trauma Center, Level III Neonatal Intensive Care Unit, regions only Pediatric Intensive Care Unit and the designated Disaster POD hospital
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	8
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	2,693
6	Total number of volunteers (estimate if necessary) ....	6	365
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	1,205,464
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	-185,653

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	4,329,740	4,003,677
9	Program service revenue (Part VIII, line 2g) .........	330,016,655	349,978,108
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	2,121,066	6,026,508
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	166,422	164,128
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	336,633,883	360,172,421
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	279,570	845,017
14	Benefits paid to or for members (Part IX, column (A), line 4) ....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	134,796,549	137,556,563
16a	Professional fundraising fees (Part IX, column (A), line 11e)....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	153,805,071	146,852,556
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	288,881,190	285,254,136
19	Revenue less expenses. Subtract line 18 from line 12......	47,752,693	74,918,285
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	333,648,078	372,867,851
21	Total liabilities (Part X, line 26)............	194,947,920	208,340,079
22	Net assets or fund balances. Subtract line 21 from line 20 .....	138,700,158	164,527,772

Sign Here

	Signature of officer	Date

	Type or print name and title.

Paid Preparer's Use Only	Preparer's signature	Date	Check if self- employed	Preparer’s taxpayer identification number (see instructions)
	Firm’s name (or yours if self-employed), address, and ZIP + 4			EIN
				Phone no.


4a	(Code: ) (Expenses $ 152,432,645 including grants of $ ) (Revenue $ 196,168,796 )
	Rockford Memorial Hospital is a not-for-profit charitable healthcare institution that functions in accordance with all applicable laws and regulations. In the course of operations, RMH is committed to provide superior care every day for all its patients. RMH is a 396-bed regional referral hospital which includes a Level I Trauma Center, Level III Neonatal Intensive Care Unit and the regions only Pediatric Intensive Care Unit. In 2010 inpatient care and diagnostic services were rendered to 15,520 individuals who presented themselves for service including 1,667 deliveries and 4,006 inpatient surgeries.

4b	(Code: ) (Expenses $ 76,337,558 including grants of $ ) (Revenue $ 147,456,558 )
	RMH is designated by the IL Dept of Health as the Disaster POD hospital for the Northern IL EMS region. As a Level I Trauma Center, RMH provides patient care, diagnostic and therapeutic services 24/7 to all who present themselves for service. In 2010 that included 47,507 persons in the Emergency room 1,254 visits to the Sleep Lab 96,700 diagnostic radiology procedures 9,614 Radiation Oncology treatments 36,948 cardiac procedures or tests 7,999 visits to the Pain Clinic 212,920 respiratory therapy treatments and 8,090 outpatient surgeries. RMH provides the only medical genetics services in the area with 1,774 visits in 2010. RMH also has the only regional cytogenetics medical laboratory, and processed 7,451 tests in 2010. Through the outreach services of Rockford Health Medical Laboratories RHML , RMH has provides timely and responsive lab services to other hospitals, physicians offices, and government agencies, while the in-house laboratory provides testing for all who present themselves at the hospital for treatment. In 2010 RHML performed 1,510,156 tests.

4c	(Code: ) (Expenses $ 2,763,961 including grants of $ 334,960 ) (Revenue $ 493,711 )
	RMH has provided health education and outreach in a variety of forms within the eleven county area that includes several school partnerships, mentoring, health programs, teaching, job shadowing and volunteering. RMH hosts support groups, training classes and lectures series for health and safety related topics. Employees staff community health fairs and open health screenings. In a program jointly sponsored with Ronald McDonald Charities, RMH staffs the Caremobile which provided 711 health and dental checkups and basic health services to 496 underinsured and uninsured children. RMH also provides language assistance to patients and their families who need to communicate with medical personnel for treatment, and meeting space for various medical and social service support groups. Funds were also used to support healthcare conditions throughout the state of Illinois.

4d	Other program services. (Describe in Schedule O.)
	(Expenses $ 647,110 including grants of $ 510,057 ) (Revenue $ 394,465 )
4e	Total program service expenses$ 232,181,274

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)				(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Julie APeterson Secretary	1.00	X			0	71,646	27,194
(19) Gordon Langejans VP Med Affairs	31.30	X			314,915	0	48,460
(20) Earl Tamar COO	000.00			X	48,646	0	10,893
(21) Carolyn Bengtson VP Utilization Management	40.00		X		314,032	0	56,037
(22) Michael Tyrkus Director of Cytogentics	40.00		X		210,305	0	39,860
(23) Susan Schreier Chief Nursing Officer	40.00		X		223,385	0	43,664
(24) Curt Lesher Pharmacy Manager	40.00		X		173,549	0	28,248
(25) Jeffrey Campbell Pharmacy Clinical Coordinator	40.00		X		147,832	0	33,213
(26) Kerry Hill VP Finance	40.00			X	0	221,339	50,166

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	1,432,664	3,240,844	859,129

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		745,824
e	Government grants (contributions)1e		3,255,078

f	All other contributions, gifts, grants, and similar amounts not included above1f		2,775
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			4,003,677
			Business Code
2a	Inpatient Routine Ancillary		900,099	101,765,210	101,765,210
b	Outpatient Emergency		621,400	76,916,744	76,916,744
c	Diagnostic Medical Laboratory		621,500	11,286,307	10,130,314	1,155,993
d	Cafeteria/Food Service/Catering		722,320	1,769,263		3,581	1,765,682
e	Medicare/Medicaid		900,099	155,584,560	155,584,560
f	All other program service revenue .			2,656,024		10,251	2,645,773
g	Total. Add lines 2a–2f........			349,978,108
3	Investment income (including dividends, interest
	and other similar amounts).....			1,698,928			1,698,928
4	Income from investment of tax-exempt bond proceeds..
5	Royalties............
		(i) Real	(ii) Personal
6a	Gross Rents	499,215
b	Less: rental expenses	335,087
c	Rental income or (loss)	164,128
d	Net rental income or (loss).......			164,128	116,702	35,639	11,787
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	209,308,037	106,700
b	Less: cost or other basis and sales expenses	204,947,478	139,679
c	Gain or (loss)	4,360,559	-32,979
d	Net gain or (loss)..........			4,327,580			4,327,580
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See Instructions....			360,172,421	344,513,530	1,205,464	10,449,750


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			3,500	1	3,500
2	Savings and temporary cash investments .......			22,717,768	2	56,353,959
3	Pledges and grants receivable, net .........			1,446,236	3	494,476
4	Accounts receivable, net .........			41,106,559	4	44,815,243
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........				5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6
7	Notes and loans receivable, net .............			15,595	7	12,713
8	Inventories for sale or use ..............			5,807,024	8	6,056,539
9	Prepaid expenses and deferred charges ............			2,842,703	9	6,805,891
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	266,186,116
b	Less: accumulated depreciation. .....	10b	186,892,440	89,268,023	10c	79,293,676
11	Investments—publicly traded securities ..........			149,081,455	11	158,236,077
12	Investments—other securities. See Part IV, line 11 ......				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			21,359,215	15	20,795,777
16	Total assets. Add lines 1 through 15 (must equal line 34)...			333,648,078	16	372,867,851
17	Accounts payable and accrued expenses .			93,437,415	17	108,410,765
18	Grants payable ..........				18
19	Deferred revenue ..........				19
20	Tax-exempt bond liabilities ..........			73,537,769	20	70,987,769
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			1,174,595	23	685,072
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities. Complete Part X of Schedule D.....			26,798,141	25	28,256,473
26	Total liabilities. Add lines 17 through 25.....			194,947,920	26	208,340,079
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			131,376,914	27	156,330,922
28	Temporarily restricted net assets .....			4,698,085	28	5,571,691
29	Permanently restricted net assets .....			2,625,159	29	2,625,159
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			138,700,158	33	164,527,772
34	Total liabilities and net assets/fund balances .....			333,648,078	34	372,867,851