Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2011 and ending 12-31-2011
BCheck if applicable:
CName of organization
METHODIST MEDICAL CENTER OF ILLINOIS
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
221 NE GLEN OAK AVE
 
Room/suite
City or town, state or country, and ZIP + 4
PEORIA, IL616360002
D Employer identification number

37-0661223
E Telephone number

G Gross receipts $ 427,948,799
F Name and address of principal officer:
DEBBIE SIMON
221 NE GLEN OAK AVE
PEORIA,IL616360002
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.MYMETHODIST.NET
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1898
M State of legal domicile: IL
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: WE ARE COMMITTED TO DELIVERING OUTSTANDING HEALTHCARE. PERIOD.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 10
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 4
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 3,595
6 Total number of volunteers (estimate if necessary) .... 6 240
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 4,085,867
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 648,476
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,441,759 1,115,092
9 Program service revenue (Part VIII, line 2g) ......... 362,131,206 374,216,858
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... -6,957,243 6,073,820
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 3,167,780 7,444,979
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 359,783,502 388,850,749
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 650,000 1,229,963
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 168,178,915 178,149,213
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 185,980,469 205,135,403
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 354,809,384 384,514,579
19 Revenue less expenses. Subtract line 18 from line 12....... 4,974,118 4,336,170
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 463,563,224 433,984,380
21 Total liabilities (Part X, line 26)............. 293,639,417 314,870,159
22 Net assets or fund balances. Subtract line 21 from line 20..... 169,923,807 119,114,221
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: WE ARE COMMITTED TO DELIVERING OUTSTANDING HEALTHCARE. PERIOD.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 355,214,966 including grants of $ 1,229,963 ) (Revenue $ 381,661,837 )
PLEASE SEE COMMUNITY BENEFIT STATEMENT IN SCHEDULE O.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 355,214,966
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II
Click to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment
...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IV
Click to see attachment
...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
Yes
 
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II.. Click to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III.. Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see attachment
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?
......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II
......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV
................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I
...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
 
No
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
3,595
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
10
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
4
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
CA , IL
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
TONY MOORE
221 NORTHEAST GLEN OAK AVE
PEORIA,IL61636
(309) 672-5914
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (describe hours for related organizations in Schedule O)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(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
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) BRUCE ALKIRE
DIRECTOR
1.00 X           0 0 0
(2) W MICHAEL BRYANT TO 072011
DIRECTOR/PRESIDENT & CEO
40.00 X   X       547,073 0 139,174
(3) BRIAN COHEN MD
DIRECTOR
1.00 X           419,193 0 58,001
(4) JOHN ERWIN PHD
DIRECTOR
1.00 X           0 0 0
(5) PETER JOHNSEN PHD FR 062011
DIRECTOR
1.00 X           0 0 0
(6) ALEXIS KHAZZAM
BOARD CHAIR
1.00 X   X       0 0 0
(7) KEITH KNEPP MD FR 062011
DIRECTOR
1.00 X           245,390 0 14,665
(8) THOMAS MULVEY MD TO 052011
DIRECTOR
1.00 X           0 0 0
(9) MARK PETERSEN TO 052011
DIRECTOR
1.00 X           0 0 0
(10) SCOTT REID DO
DIRECTOR
1.00 X           0 0 0
(11) DEBORAH SIMON FR 072011
DIRECTOR/PRESIDENT & CEO
40.00 X   X       434,149 0 146,051
(12) DEVENDRA TRIVEDI MD
BOARD VICE CHAIR
1.00 X   X       0 3,688 0
(13) CALVIN MACKAY TO 072011
SECRETARY/TREASURER/CFO
40.00     X       511,771 0 78,421
(14) ROBERT QUIN FR 072011
SECRETARY/TREASURER/CFO
40.00     X       254,512 0 49,330
(15) RICK ANDERSON
SENIOR VP MEDICAL AFFAIRS
40.00       X     372,503 0 82,040
(16) ERICK LAINE
SENIOR VP
40.00       X     311,128 0 39,284
(17) ALEXANDER ADLER
PHYSICIAN
40.00         X   663,591 0 43,324
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (describe hours for related organizations in Schedule O)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(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
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) CHARLES EGLEY
PHYSICIAN
40.00         X   647,268 0 45,707
(19) KISHORE KARAMCHANDANI
PHYSICIAN
40.00         X   621,802 0 11,094
(20) JOEL KUPFER
PHYSICIAN
40.00         X   672,313 0 16,576
(21) DWAYNE MCQUITTY
PHYSICIAN
40.00         X   930,722 0 20,600


















1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 6,631,415 3,688 744,267
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet234
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
METHODIST PHYSICIAN SERVICES
PO BOX 87
PEORIA,IL61650
CONTRACT EMPLOYEES 11,908,671
MCKESSON TECHNOLOGIES INC
PO BOX 98347
CHICAGO,IL606938347
IT SUPPLIER 5,323,936
PROFESSIONAL THERAPY SERVICES INC
2810 FRANK SCOTT PRKWAY WEST SUITE
BELLEVILLE,IL62223
PHYSICAL THERAPY 3,426,483
PHILIPS MEDICAL SYSTEMS
PO BOX 100355
ATLANTA,GA303840355
MAINTENANCE CONTRACT 2,817,296
U OF I COLLEGE OF MEDICINE AT PEORIA
PO BOX 4196
SPRINGFIELD,IL62708
PHYSICIAN SERVICES 2,432,051
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet33
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 639,574
e Government grants (contributions)1e 92,085
f All other contributions, gifts, grants, and
similar amounts not included above
1f
383,433
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 1,115,092
 Program Service Revenue Business Code
2a NET PATIENT REVENUE 621,990 244,348,434 244,348,434    
b LABORATORY SERVICES 621,510 113,898,235 111,184,110 2,714,125  
c EDUCATION REVENUE 900,099 7,783,725 7,783,725    
d SUBS & JOINT VENTURES 900,099 3,727,096 3,695,186 31,910  
e MANAGEMENT, IT AND SUP 561,000 1,623,281 1,623,281    
f All other program service revenue . 2,836,087 1,472,521 916,659 446,907
g Total. Add lines 2a–2f........MediumBullet 374,216,858
 Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 5,053,194     5,053,194
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 40,020,757 59,300
b Less: cost or other basis and sales expenses 38,985,343 74,088
c Gain or (loss) 1,035,414 -14,788
d Net gain or (loss)..........MediumBullet 1,020,626     1,020,626
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..MediumBullet      
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...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a 42,284
b Less: cost of goods sold ..b 38,619
c Net income or (loss) from sales of inventory..MediumBullet 3,665 3,665    
Miscellaneous Revenue Business Code
11a FMV PURCHASE ACCOUNTIN 900,001 3,999,911 3,999,911    
b MISCELLANEOUS REVENUE 900,099 1,696,765 1,577,217 119,548  
c CAFETERIA 722,210 984,382 984,382    
d All other revenue .... 760,256 456,631 303,625  
e Total. Add lines 11a–11d ......MediumBullet 7,441,314
12 Total revenue. See Instructions....MediumBullet 388,850,749 377,129,063 4,085,867 6,520,727
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
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 United States. See Part IV, line 21 1,229,963 1,229,963
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 2,693,889   2,693,889  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 1,393,634   1,393,634  
7 Other salaries and wages 134,655,500 126,102,128 8,553,372  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 8,740,086 8,184,912 555,174  
9 Other employee benefits ....... 21,823,758 20,437,503 1,386,255  
10 Payroll taxes ........... 8,842,346 8,280,676 561,670  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 776,819   776,819  
c Accounting ........... 210,788   210,788  
d Lobbying ........... 71,880   71,880  
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ...... 326,715   326,715  
g Other .......... 53,274,343 46,455,918 6,818,425  
12 Advertising and promotion .... 1,503,453 153,666 1,349,787  
13 Office expenses ....... 34,976,304 34,011,267 965,037  
14 Information technology ...... 4,291,272 2,972,365 1,318,907  
15 Royalties ..        
16 Occupancy ........... 11,448,215 11,075,091 373,124  
17 Travel ............ 791,744 504,322 287,422  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings ....        
20 Interest ........... 3,331,714 3,331,714    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 22,559,277 21,924,078 635,199  
23 Insurance .............. 9,225,980 9,225,980    
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a INCOME TAXES 896,817   896,817  
b BAD DEBT EXPENSE 23,340,515 23,340,515    
c MEDICAL SUPPLIES 19,456,834 19,456,834    
d MEDICAID PROVIDER ASSES 9,314,563 9,314,563    
e
f All other expenses 9,338,170 9,213,471 124,699  
25 Total functional expenses. Add lines 1 through 24f 384,514,579 355,214,966 29,299,613 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year
(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 42,770,819 1 17,420,123
2 Savings and temporary cash investments .......   2  
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 47,489,944 4 56,662,570
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 ............. 1,257,735 7 9,570,726
8 Inventories for sale or use .............. 2,926,623 8 3,166,168
9 Prepaid expenses and deferred charges ............ 6,949,638 9 7,010,411
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 177,508,730
b Less: accumulated depreciation. ..... 10b 5,364,992 181,458,105 10c 172,143,738
11 Investments—publicly traded securities .......... 148,528,088 11 130,444,371
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 .. 23,626,158 13 29,068,326
14 Intangible assets ......... 1,681,997 14 1,500,750
15 Other assets. See Part IV, line 11 ........... 6,874,117 15 6,997,197
16 Total assets. Add lines 1 through 15 (must equal line 34)... 463,563,224 16 433,984,380
Liabilities 17 Accounts payable and accrued expenses . 32,604,005 17 33,398,819
18 Grants payable ..........   18  
19 Deferred revenue .......... 14,327,262 19 13,427,931
20 Tax-exempt bond liabilities .......... 54,400,640 20 109,180,000
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 .. 49,565,003 23 896,645
24 Unsecured notes and loans payable to unrelated third parties .... 25,666,897 24 27,934,212
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 117,075,610 25 130,032,552
26 Total liabilities. Add lines 17 through 25..... 293,639,417 26 314,870,159
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 156,493,661 27 106,203,404
28 Temporarily restricted net assets ..... 9,523,186 28 8,990,848
29 Permanently restricted net assets ..... 3,906,960 29 3,919,969
Organizations that do not follow SFAS 117, check here MediumBullet 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 ..... 169,923,807 33 119,114,221
34 Total liabilities and net assets/fund balances ..... 463,563,224 34 433,984,380
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
388,850,749
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
384,514,579
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
4,336,170
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
169,923,807
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-55,145,756
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
119,114,221
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
Yes
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
METHODIST MEDICAL CENTER OF ILLINOIS
 
Employer identification number

37-0661223
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.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
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.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
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)
 
 
h
(i)
Name of supported organization
(ii)
EIN
(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(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?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
METHODIST MEDICAL CENTER OF ILLINOIS
 
Employer identification number

37-0661223
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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
Special Rules
......................... 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 on line H of its
Form 990-EZ or on Part I, 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) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
METHODIST MEDICAL CENTER OF ILLINOIS
 
Employer identification number

37-0661223
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
METHODIST MEDICAL CENTER OF ILLINOIS
 
Employer identification number

37-0661223
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(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) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
METHODIST MEDICAL CENTER OF ILLINOIS
 
Employer identification number

37-0661223
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total 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 $  

Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I
(b)
Purpose of gift
(c)
Use 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
(c)
Use 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
(c)
Use 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
(c)
Use 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) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
METHODIST MEDICAL CENTER OF ILLINOIS
 
Employer identification number

37-0661223
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2011

Schedule C (Form 990 or 990-EZ) 2011
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.
   
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in)
(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e))
         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))
         
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
71,880
j
Total. Add lines 1c through 1i ...............................
71,880
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: FEES PAID FOR LOBBYING FOR HOSPITAL RELATED ISSUES.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
METHODIST MEDICAL CENTER OF ILLINOIS
 
Employer identification number

37-0661223
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 .......    
5
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? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can 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? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the 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, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? ....................................
9
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.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), 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.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), 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 $  
2
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 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
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?........
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
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 (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 13,430,146 12,893,992 11,526,661 15,826,355
b Contributions ........ 875,797 907,320 887,757 1,478,221
c Net investment earnings, gains, and losses ... -485,319 1,009,081 1,625,606 -4,720,647
d Grants or scholarships ..... 887,357 1,380,247 1,146,032 1,057,268
e Other expenditures for facilities
and programs ........
22,449      
f Administrative expenses ....        
g End of year balance ...... 12,910,818 13,430,146 12,893,992 11,526,661
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet0 %
b
Permanent endowment SchDMd Bullet30.360 %
c
Temporarily restricted endowment SchDMd Bullet69.640 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   1,458,352 1,458,352
b Buildings ................   106,019,629 1,410,217 104,609,412
c Leasehold improvements ............   745,530 19,016 726,514
d Equipment ................   54,909,768 3,021,610 51,888,158
e Other .................   14,375,451 914,149 13,461,302
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 172,143,738
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other 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) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program 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
(1) METHODIST MEDICAL CENTER FOUNDATION 15,774,707 F
(2) AMERICAN HEALTHCARE SYSTEM 1,226,000 F
(3) CENTRAL ILLINOIS WORK INJURY RESOURCE 650,396 F
(4) GREATER PEORIA SPECIALTY HOSPITAL 3,974,796 F
(5) CENTRAL ILLINOIS ENDOSCOPY CENTER 3,699,454 F
(6) CENTRAL ILLINOIS CANCER CARE CENTER 2,347,764 F
(7) REHABILITATION THERAPY SERVICES 1,395,209 F


Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet 29,068,326
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes  
DUE TO AFFILIATES 137,774
SELF-INSURANCE RESERVE 18,967,790
LONG-TERM RETENTION INCENTIVES 3,240,781
ASBESTOS REMOVAL LIABILITY 1,023,680
DEFINED BENEFIT RETIREMENT PLAN LIA 106,662,527




Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 130,032,552
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) 2011

Schedule D (Form 990) 2011
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) .................... 1 388,850,749
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 384,514,579
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 4,336,170
4 Net unrealized gains (losses) on investments .......................... 4 -8,519,067
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8 -46,626,689
9 Total adjustments (net). Add lines 4 through 8 ......................... 9 -55,145,756
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 -50,809,586
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  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
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  
b Other (Describe in Part XIV.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
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  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
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  
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
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
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE PERMANENT ENDOWMENTS ARE MAINTAINED TO PROVIDE A PERMANENT SOURCE OF INCOME, WITH THE STIPULATION THAT THE PRINCIPAL BALANCE MUST BE INVESTED AND KEPT INTACT IN PERPETUITY, WHILE ONLY THE INCOME GENERATED CAN BE USED BY THE ORGANIZATION. THE TEMPORARY ENDOWMENTS ARE MAINTAINED TO PROVIDE A SOURCE OF INCOME FOR EITHER A SPECIFIC PERIOD OF TIME OR UNTIL A SPECIFIC EVENT OCCURS. THE MAJORITY OF METHODIST'S ENDOWMENTS HAVE DESIGNATIONS FOR USE FOR HOSPICE, MEDICAL EQUIPMENT AND PEDIATRIC CARE.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: IOWA HEALTH SYSTEM AND MOST OF ITS SUBSIDIARIES ARE CLASSIFIED AS TAX-EXEMPT ORGANIZATIONS AS DESCRIBED IN SECTIONS 501(C)(3) AND 501(C)(2) OF THE INTERNAL REVENUE CODE (THE CODE). TAX-EXEMPT ORGANIZATIONS ARE NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES ON RELATED INCOME, PURSUANT TO SECTION 501(A) OF THE CODE. THESE ORGANIZATIONS ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES TO THE EXTENT THEY HAVE UNRELATED BUSINESS INCOME AS DESCRIBED UNDER PROVISIONS OF SECTION 511 OF THE CODE. THE HEALTH SYSTEM FILES FORM 990 FOR SUBSTANTIALLY ALL OF ITS OPERATING ENTITIES IN THE U.S. FEDERAL JURISDICTION AND IS NO LONGER SUBJECT TO EXAMINATION BY TAX AUTHORITIES FOR THE YEARS BEFORE 2008. THE HEALTH SYSTEM HAS NO MATERIAL UNCERTAIN TAX POSITIONS. CERTAIN SUBSIDIARIES ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. SOME OF THESE CORPORATIONS HAVE ACCUMULATED NET OPERATING LOSS CARRYFORWARDS THAT ARE AVAILABLE TO OFFSET FUTURE TAXABLE INCOME DURING THE CARRYFORWARD PERIOD. NO INCOME TAX BENEFIT HAS BEEN RECOGNIZED FOR THE NET OPERATING LOSS CARRYFORWARDS OR OTHER POTENTIAL DEFERRED TAX ASSETS IN THE CONSOLIDATED FINANCIAL STATEMENTS BECAUSE THE HEALTH SYSTEM BELIEVES REALIZATION OF THESE BENEFITS IS UNLIKELY.
PART XI, LINE 8 - OTHER ADJUSTMENTS:   PENSION FUNDING LIABILITY -29,545,070. FOUNDATION INVESTMENT 59,699. CHANGE IN BARKER TRUST -654,840. FUND BALANCE TRANSFERS -16,486,478. TOTAL TO SCHEDULE D, PART XI, LINE 8: -46,626,689.
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
METHODIST MEDICAL CENTER OF ILLINOIS
 
Employer identification number

37-0661223
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants
and other assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? ..............................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other
assistance outside the United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region
(f) Total
expenditures for region/investments
in region
CENTRAL AMERICA/CARIBBEAN 0 0 INVESTMENTS   19,452,963
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 0 0 19,452,963
b Total from continuation sheets to Part I ... 0 0 0
c Totals (add lines 3a and 3b) 0 0 19,452,963
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)
(c) Region (d) Purpose of
grant
(e) Amount of
cash grant
(f) Manner of
cash
disbursement
(g) Amount of
of non-cash
assistance
(h) Description
of non-cash
assistance
(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
 
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant
(e) Manner of cash
disbursement
(f) Amount of
non-cash
assistance
(g) Description
of non-cash
assistance
(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2011
Additional Data


Software ID:  
Software Version:  



SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet 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
2011
Open to Public Inspection
Name of the organization
METHODIST MEDICAL CENTER OF ILLINOIS
 
Employer identification number

37-0661223
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did 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 used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) ..
    7,179,784   7,179,784 1.990 %
b Medicaid (from Worksheet 3, column a) .....     59,582,618 41,837,179 17,745,439 4.910 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .            
dTotal Financial Assistance and
Means-Tested Government Programs .....
    66,762,402 41,837,179 24,925,223 6.900 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) ....
    4,211,263 2,327,415 1,883,848 0.520 %
f Health professions education
(from Worksheet 5) ..
    5,317,227 4,338,503 978,724 0.270 %
g Subsidized health services
(from Worksheet 6) ..
    9,406,160 7,536,712 1,869,448 0.520 %
h Research (from Worksheet 7)     0      
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....     1,711,021 0 1,711,021 0.470 %
jTotal Other Benefits ...     20,645,671 14,202,630 6,443,041 1.780 %
kTotal. Add lines 7d and 7j. ..     87,408,073 56,039,809 31,368,264 8.680 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(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     152,000   152,000 0.040 %
3 Community support     50,000   50,000 0.010 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building     277,125   277,125 0.080 %
7 Community health improvement advocacy     10,000   10,000 0 %
8 Workforce development            
9 Other            
10 Total     489,125   489,125 0.130 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense........
2
3,499,315
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
8,748,287
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
80,065,047
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
109,143,528
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-29,078,481
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(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) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?2
Name and address
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 METHODIST MEDICAL CENTER OF ILLINOIS
221 NE GLEN OAK AVENUE
PEORIA,IL61636
X X       X X    
2 GREATER PEORIA SPECIALTY HOSPITAL
500 W ROMEO B GARRETT AVE
PEORIA,IL61605
X               LONG TERM ACUTE CARE
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
METHODIST MEDICAL CENTER OF ILLINOIS
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 200.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21 Yes  
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
GREATER PEORIA SPECIALTY HOSPITAL
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):2

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 200.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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   No
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21 Yes  
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?29
Name and address Type of Facility (describe)
1 METHODIST EAST CAMPUS
415 ST MARKS COURT
PEORIA,IL61603
COLLGE OF NURSING; DAYCARE; ADMINISTRATION
2 METHODIST PHYSICIANS MEDICAL PLAZA
214 NE GLEN OAK AVE
PEORIA,IL61636
PHYSICIAN OFFICES; SLEEP LAB
3 METHODIST HEART LUNG AND VASCULAR INST
112 CRESCENT AVE
PEORIA,IL61603
PHYSICIAN OFFICES; MEDICAL IMAGING; CARDIOLOGY
4 METHODIST ATRIUM
900 MAIN STREET
PEORIA,IL61602
PHYSICIAN OFFICES; REHABILITATION
5 METHODIST FAMILY MEDICAL CENTER
815 MAIN STREET
PEORIA,IL61602
PHYSICIAN OFFICES
6 MMG AT FARMINGTON
158 E FULTON AVENUE
FARMINGTON,IL61531
PHYSICIAN OFFICES
7 METHODIST CENTER FOR INTEGRATIVE MED
9101 N ALLEN ROAD
PEORIA,IL61615
PHYSICIAN OFFICES
8 MMG AT CHILLICOTHE
525 SWEETBRIAR
CHILLICOTHE,IL61523
PHYSICIAN OFFICES; REHABILITATION
9 MMG AT METAMORA
901 W WALNUT
METAMORA,IL61548
PHYSICIAN OFFICES
10 MMG AT PRINCEVILLE
223 EAST MAIN STREET
PRINCEVILLE,IL61559
PHYSICIAN OFFICES
11 METHODIST NORTH
2338 WEST SUDS PKWY
PEORIA,IL61615
PHYSICIAN OFFICES; REHABILITATION; MEDICAL IMAGING; CARDIOLOGY
12 MMG AT CANTON
2076 N MAIN STREET
CANTON,IL61520
PHYSICIAN OFFICES
13 MMG AT LACON
1112 E FIFTH STREET
LACON,IL61540
PHYSICIAN OFFICES
14 MMG AT MT HAWLEY - FAMILY MEDICINE
7725 N KNOXVILLE AVE
PEORIA,IL61614
PHYSICIAN OFFICES
15 MMG AT EAST PEORIA
200 RIVER ROAD
EAST PEORIA,IL61611
PHYSICIAN OFFICES
16 MMG AT KNOXVILLE
2709 N KNOXVILLE AVE
PEORIA,IL61604
PHYSICIAN OFFICES
17 METHODIST GLEN OAK MEDICAL CENTER
120 NE GLEN OAK AVE
PEORIA,IL61602
ADMINISTRATION
18 MMG AT STERLING
3335 N STERLING AVE
PEORIA,IL61615
PHYSICIAN OFFICES
19 METHODIST MEDPOINTE AT PEORIA
8914 N KNOXVILLE AVE
PEORIA,IL61615
PHYSICIAN OFFICES
20 METHODIST AT MORTON
1909 N MORTON AVE
MORTON,IL61550
PHYSICIAN OFFICES; REHABILITATION
21 METHODIST AT PEKIN
1800 BROADWAY
PEKIN,IL61554
PHYSICIAN OFFICES
22 MMG AT PEARTREE
6831 N PEAR TREE LANE
PEORIA,IL61615
PHYSICIAN OFFICES
23 MMG ON SOUTH JEFFERSON
2127 SE JEFFERSON
PEORIA,IL61605
PHYSICIAN OFFICES
24 MMG CARDIOLOGY
765 KELLOGG STREET
GALESBURG,IL61401
PHYSICIAN OFFICES
25 CENTRAL ILLINOIS CANCER CARE CENTER
7309 N KNOXVILLE AVE
PEORIA,IL61614
OUTPATIENT RADIATION THERAPY
26 CENTRAL ILLINOIS ENDOSCOPY CENTER
1001 MAIN ST SUITE 500B
PEORIA,IL61606
OCCUPATIONAL ENDOSCOPY SERVICES
27 ILLINOIS WORK INJURY RESOURCE CENTER
736 SW WASHINGTON ST SUITE 2
PEORIA,IL61602
OCCUPATIONAL MEDICINE
28 MMG AT WASHINGTON
205 CUMMINGS LANE
WASHINGTON,IL61571
PHYSICIAN OFFICES; REHABILITATION
29 REHABILITATION THERAPY SERVICES
2988 COURT STREET
PEKIN,IL61554
REHABILITATION
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions 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, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any 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 6A: THE HOSPITALS'S COMMUNITY BENEFIT REPORT IS CONTAINED WITHIN THE IOWA HEALTH SYSTEM COMMUNITY BENEFIT REPORT WHICH CAN BE LOCATED AT WWW.IHS.ORG. THIS SYSTEM-WIDE REPORT IS COMPLETED IN ADDITION TO THE COMMUNITY BENEFIT REPORT FOR THE HOSPITAL AND ITS REGIONAL AFFILIATES. METHODIST PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT TO THE STATE OF ILLINOIS. IT IS MADE AVAILABLE ON METHODIST'S WEBSITE.
    PART I, LINE 7: A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS WAS USED TO CALCULATE THE AMOUNT IN LINES 7A-7C. THE AMOUNTS FOR LINES 7E, 7F, 7G AND 7I ARE DERIVED FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND ARE BASED ON COST. THE AMOUNTS ON 7G ARE DERIVED IN PART BY A COST ACCOUNTING SYSTEM OF APPLICABLE PATIENT SEGMENTS WHILE OTHERS THAT ROLL UP FOR THIS CALCULATION ARE DERVIED FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND ARE BASED ON COST.
    PART I, LINE 7G: METHODIST SUBSIDIZES SEVERAL PEDIATRIC HEALTH SERVICES INCLUDING PEDIATRIC GASTROENTEROLOGY ALONG WITH CHILD AND ADOLESCENT PSYCHIATRY INPATIENT HEALTH SERVICES AT THE MEDICAL CENTER. THE MEDICAL CENTER ALSO SUBSIDIZED HOSPICE AND REHABILITATION SERVICES IN 2011.
    PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $23,340,515.
    PART II: COMMUNITY BUILDING ACTIVITIES ARE ESSENTIAL ROLES FOR HEALTH-CARE ORGANIZATIONS IN THAT THEY ADDRESS MANY OF THE UNDERLYING DETERMINANTS OF HEALTH. RESEARCH HAS CONTINUALLY SHOWN THAT WHEN THE FACTORS INFLUENCING HEALTH ARE EXPLORED, HEALTH CARE ACTUALLY PLAYS THE SMALLEST ROLE PROPORTIONATELY. A REPORT IN THE JOURNAL OF AMERICAN MEDICAL ASSOCIATION AND THE CENTER FOR DISEASE CONTROL (MCGINNIS, 1996) SUGGESTS THAT THE FACTORS IMPACTING HEALTH ARE AS FOLLOWS: LIFESTYLE AND BEHAVIORS, 50%, ENVIRONMENT (HUMAN AND NATURAL), 20%, GENETICS AND HUMAN BIOLOGY, 20%, AND HEALTH CARE, 10%. COMMUNITY BUILDING ACTIVITIES HELP TO ADDRESS THE OTHER INDICATORS OUTSIDE OF THE ROLE TRADITIONALLY PLAYED BY HEALTH-CARE ORGANIZATIONS. THESE ACTIVITIES ARE ALMOST EXCLUSIVELY DONE IN SOME FORM OF PARTNERSHIP IN WHICH THE COMMUNITY OR OTHER ORGANIZATIONS ARE BETTER SUITED TO ADDRESS. HEALTH-CARE ORGANIZATIONS GENERALLY PROVIDE TIMELY AND SPECIFIC RESOURCES TO HELP THESE ISSUES. HEALTH-CARE ORGANIZATIONS CAN BE A RICH AND VALUABLE COMMUNITY RESOURCE IN WAYS NOT TYPICALLY CONSIDERED. OFTEN THE MOST EFFECTIVE WAY TO HELP IMPACT AND IMPROVE THE COMMUNITY HEALTH STATUS IS TO SUPPORT OTHER AGENCIES AND ORGANIZATIONS IN A VARIETY OF WAYS OUTSIDE OF HEALTH SERVICES. THIS IS OFTEN DONE THROUGH CASH OR IN-KIND SERVICES TO SUPPORT OTHER NON-PROFITS, DONATIONS OF DURABLE MEDICAL EQUIPMENT AND SUPPLIES TO CERTAIN AGENCIES, OR THROUGH LEADERSHIP AND EDUCATIONAL EXPERTISE. METHODIST CONTRIBUTES TO MANY AREA COMMUNITY BUILDING ACTIVITIES IN CENTRAL ILLINOIS. THESE ORGANIZATIONS HELP BUILD ACTIVITIES IN THE AREAS OF ECONOMIC AND HEALTHCARE IMPROVEMENT. THESE TYPES OF ACTIVITIES SPEAK TO THE BREADTH AND CAPACITY THAT THE HOSPITAL HAS IN IMPACTING THE HEALTH STATUS OF THE COMMUNITY IN A COMPREHENSIVE AND INTENTIONAL APPROACH.
    PART III, LINE 4: THE HEALTH SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HEALTH SYSTEM BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.
    PART III, LINE 8: METHODIST IS PAID BELOW LEVELS THAT FULLY COMPENSATE IT FOR THE UNDERLYING COSTS OF CARE TO MEDICARE BENEFICIARIES. METHODIST TREATS ITS MEDICARE SHORTFALL AS A COMMUNITY BENEFIT DUE TO THE LARGE POPULATION OF SENIORS THE HOSPITAL SERVES. THE POPULATION AT AGE 65 OR ABOVE IS MUCH HIGHER FOR METHODIST'S SERVICE AREA COMPARED TO THE REST OF ILLINOIS. THE MEDICARE SHORTFALL IS CALCULATED USING A COST ACCOUNTING SYSTEM.
    PART III, LINE 9B: AFTER THE PATIENT MEETS THE QUALIFICATIONS FOR FINANCIAL ASSISTANCE, THE ACCOUNT BALANCE IS PARTIALLY OR ENTIRELY WRITTEN OFF, AS APPROPRIATE. ANY REMAINING BALANCE, IF ANY, WOULD BE COLLECTED UNDER THE NORMAL DEBT COLLECTION POLICY.IT IS THE POLICY OF METHODIST MEDICAL CENTER TO WRITE OFF ACCOUNTS AS BAD DEBT/ UNCOLLECTIBLE WHEN CRITERIA FOR FINANCIAL/CHARITY ASSISTANCE IS NOT MET. METHODIST REVIEWS PATIENT BALANCES AT A NUMBER OF DIFFERENT CHECK POINTS IN THE COLLECTION PROCESS. INITIAL REVIEWS CAN OCCUR DURING THE REGISTRATION PROCESS AND OR AT THE POINT OF ADMISSION. THE FINANCIAL COUNSELOR IS AVAILABLE TO ASSIST PATIENTS WITH FINANCIAL QUESTIONS AT THE POINT OF REGISTRATION. SUBSEQUENT REVIEWS OF PATIENT BALANCES OCCUR DURING THE BACK END COLLECTION PROCESS THROUGH INTERNAL LETTER CAMPAIGNS, ASSIGNMENT TO A PRE-COLLECT AGENCY AND THEN FINALLY THROUGH INTERNAL CREDIT SCORING MECHANISMS. OUR WEBSITE ALSO HAS DETAILED INFORMATION ON OUR BILLING POLICIES AS WELL.ONCE A PATIENT IS IN THE FINANCIAL/CHARITY ASSISTANCE PROCESS, ALL COLLECTION ACTIVITY IS PLACED ON HOLD WHILE THE REVIEW PROCESS TAKES PLACE. THE PATIENT THEN RECEIVES A WRITTEN STATEMENT ONCE FINAL DETERMINATION IS REACHED. HOWEVER, IF AN INDIVIDUAL HAS CHOSEN NOT TO HONOR THEIR FINANCIAL OBLIGATION FOR RENDERED SERVICES, THOSE ACCOUNTS ARE PLACED WITH A PROFESSIONAL COLLECTION RECOVERY SERVICE.
METHODIST MEDICAL CENTER OF ILLINOIS   PART V, SECTION B, LINE 9: LESS THAN 200% OF FPG (UNLESS THEY MEET THE ASSET EXCLUSION).
METHODIST MEDICAL CENTER OF ILLINOIS   PART V, SECTION B, LINE 10: LESS THAN 200% OF FPG (UNLESS THEY MEET THE ASSET EXCLUSION).
GREATER PEORIA SPECIALTY HOSPITAL   PART V, SECTION B, LINE 18D: IF THE INDIVIDUAL APPLIES AND QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE FACILITY'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL FACILITY USES THE AVERAGE OF THE THREE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES FOR THOSE SERVICES AT THE HOSPITAL FACILITY TO DETERMINE THE AMOUNTS BILLED FOR ALL SERVICES, INCLUDING EMERGENCY OR MEDICALLY NECESSARY CARE. THIS OCCURS REGARDLESS WHETHER THE INDIVIDUAL HAS INSURANCE COVERAGE. ALSO, IF THE INDIVIDUAL HAS INSURANCE COVERAGE AND DOES NOT APPLY OR QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE FACILITY'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL FACILITY USES THE INSURER'S NEGOTIATED RATE FOR THOSE SERVICES AT THE HOSPITAL FACILITY. HOWEVER, IF THE INDIVIDUAL DOES NOT HAVE INSURANCE COVERAGE AND EITHER DOES NOT APPLY OR DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE FACILITY'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL FACILITY USES THE GROSS RATES FOR THOSE SERVICES TO DETERMINE THE AMOUNTS BILLED. IF THE UNINSURED INDIVIDUAL AGREES TO PAY THE BILL IN FULL, THE HOSPITAL FACILITY WILL PROVIDE A 20%-30% DISCOUNT FROM THE GROSS RATES FOR THOSE INDIVIDUALS. INSERT STATISTICS PROVIDED BY SUSAN EYRICH ON % OF SELF PAYS (UNINSURED) WITH NO DISCOUNT CODES, ETC.
METHODIST MEDICAL CENTER OF ILLINOIS   PART V, SECTION B, LINE 19D: IF THE INDIVIDUAL APPLIES AND QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE FACILITY'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL FACILITY USES THE AVERAGE OF THE THREE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES FOR THOSE SERVICES AT THE HOSPITAL FACILITY TO DETERMINE THE AMOUNTS BILLED FOR ALL SERVICES, INCLUDING EMERGENCY OR MEDICALLY NECESSARY CARE. THIS OCCURS REGARDLESS WHETHER THE INDIVIDUAL HAS INSURANCE COVERAGE. ALSO, IF THE INDIVIDUAL HAS INSURANCE COVERAGE AND DOES NOT APPLY OR QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE FACILITY'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL FACILITY USES THE INSURER'S NEGOTIATED RATE FOR THOSE SERVICES AT THE HOSPITAL FACILITY. HOWEVER, IF THE INDIVIDUAL DOES NOT HAVE INSURANCE COVERAGE AND EITHER DOES NOT APPLY OR DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE FACILITY'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL FACILITY USES THE GROSS RATES FOR THOSE SERVICES TO DETERMINE THE AMOUNTS BILLED. IF THE UNINSURED INDIVIDUAL AGREES TO PAY THE BILL IN FULL, THE HOSPITAL FACILITY WILL PROVIDE A 20%-30% DISCOUNT FROM THE GROSS RATES FOR THOSE INDIVIDUALS. INSERT STATISTICS PROVIDED BY SUSAN EYRICH ON % OF SELF PAYS (UNINSURED) WITH NO DISCOUNT CODES, ETC.
GREATER PEORIA SPECIALTY HOSPITAL   PART V, SECTION B, LINE 19D: IF THE INDIVIDUAL APPLIES AND QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE FACILITY'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL FACILITY USES THE AVERAGE OF THE THREE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES FOR THOSE SERVICES AT THE HOSPITAL FACILITY TO DETERMINE THE AMOUNTS BILLED FOR ALL SERVICES, INCLUDING EMERGENCY OR MEDICALLY NECESSARY CARE. THIS OCCURS REGARDLESS WHETHER THE INDIVIDUAL HAS INSURANCE COVERAGE. ALSO, IF THE INDIVIDUAL HAS INSURANCE COVERAGE AND DOES NOT APPLY OR QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE FACILITY'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL FACILITY USES THE INSURER'S NEGOTIATED RATE FOR THOSE SERVICES AT THE HOSPITAL FACILITY. HOWEVER, IF THE INDIVIDUAL DOES NOT HAVE INSURANCE COVERAGE AND EITHER DOES NOT APPLY OR DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE FACILITY'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL FACILITY USES THE GROSS RATES FOR THOSE SERVICES TO DETERMINE THE AMOUNTS BILLED. IF THE UNINSURED INDIVIDUAL AGREES TO PAY THE BILL IN FULL, THE HOSPITAL FACILITY WILL PROVIDE A 20%-30% DISCOUNT FROM THE GROSS RATES FOR THOSE INDIVIDUALS. INSERT STATISTICS PROVIDED BY SUSAN EYRICH ON % OF SELF PAYS (UNINSURED) WITH NO DISCOUNT CODES, ETC.
METHODIST MEDICAL CENTER OF ILLINOIS   PART V, SECTION B, LINE 21: AS DESCRIBED IN SCHEDULE H, PART V, LINE 19, IF THE PATIENT DOES NOT APPLY OR QUALIFY FOR FINANCIAL ASSISTANCE AND ALSO IS UNINSURED OR RECEIVES NO BENEFIT FROM THEIR INSURANCE ON A SERVICE PROVIDED BY THE HOSPITAL FACILITY, THEY WOULD BE CHARGED AMOUNTS EQUAL TO GROSS CHARGES FOR THE SERVICES PROVIDED TO THE PATIENT. HOWEVER, IF THE PATIENT AGREES TO PAY IN FULL, THEY WILL RECEIVE A 20%-30% DISCOUNT FROM THE GROSS CHARGES. INSERT STATISTICS PROVIDED BY SUSAN EYRICH ON % OF SELF PAYS (UNINSURED) WITH NO DISCOUNT CODES, ETC.
GREATER PEORIA SPECIALTY HOSPITAL   PART V, SECTION B, LINE 21: AS DESCRIBED IN SCHEDULE H, PART V, LINE 19, IF THE PATIENT DOES NOT APPLY OR QUALIFY FOR FINANCIAL ASSISTANCE AND ALSO IS UNINSURED OR RECEIVES NO BENEFIT FROM THEIR INSURANCE ON A SERVICE PROVIDED BY THE HOSPITAL FACILITY, THEY WOULD BE CHARGED AMOUNTS EQUAL TO GROSS CHARGES FOR THE SERVICES PROVIDED TO THE PATIENT. HOWEVER, IF THE PATIENT AGREES TO PAY IN FULL, THEY WILL RECEIVE A 20%-30% DISCOUNT FROM THE GROSS CHARGES. INSERT STATISTICS PROVIDED BY SUSAN EYRICH ON % OF SELF PAYS (UNINSURED) WITH NO DISCOUNT CODES, ETC.
    PART VI, LINE 2: THE COMMUNITY BENEFITS PLAN ADOPTED BY METHODIST IS ABOUT IMPROVING HEALTH; THE HEALTH OF EACH INDIVIDUAL, AND THE HEALTH OF THE COMMUNITY. IN DEVELOPING THE PLAN, SEVERAL SOURCES OF INFORMATION WERE UTILIZED TO HELP IDENTIFY SPECIFIC HEALTHCARE NEEDS. FIRST, ONE OF THE MORE COMPREHENSIVE LOCAL ASSESSMENTS IS LED BY THE DEPARTMENT OF PUBLIC HEALTH. THE PEORIA COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED LOCAL HEALTH PRIORITIES AS CEREBROVASCULAR DISEASE (STROKE), HIP FRACTURES AND INFANT MORTALITY. THE LEADING CAUSES OF MORTALITY WERE IDENTIFIED AS HEART DISEASES. THE SECOND SOURCE WAS HEALTHY PEOPLE 2010. HEALTHY PEOPLE 2010 SET OUT NATIONAL OBJECTIVES FOR HEALTH IMPROVEMENT AND ARE BUILT AROUND THE CONCEPTS OF DISEASE PREVENTION AND HEALTH PROMOTION. OTHER SOURCES OF DATA WERE REVIEWED, HEARTLAND ALLIANCE MID-AMERICA INSTITUTE ON POVERTY, UNITED STATES CENSUS BUREAU DATA, ILLINOIS BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY DATA, METHODIST ACCESS DATA AND CENSUS BUREAU DATA. COLLECTIVELY, THESE DATA SOURCES HAVE SUPPORTED OUR ASSESSMENT OF THE COMMUNITIES NEEDS.
    PART VI, LINE 3: AS A SERVICE TO OUR COMMUNITY, METHODIST MEDICAL CENTER PROVIDES CARE AT A REDUCED RATE OR WITHOUT CHARGE TO ELIGIBLE PERSONS DEMONSTRATING FINANCIAL NEED AND THE INABILITY TO PAY. THE "PATIENT GUIDE TO UNDERSTANDING YOUR BILL" IS MADE AVAILABLE TO EACH PATIENT DURING THE REGISTRATION PROCESS AND THIS GUIDE CONTAINS INFORMATION ON THE FINANCIAL ASSISTANCE PROGRAMS AVAILABLE AT METHODIST AS WELL INFORMATION ON HOW TO APPLY FOR STATE FUNDED PROGRAMS. THE GUIDE ALSO CONTAINS BOTH LOCAL AND TOLL FREE PHONES NUMBERS TO OUR BILLING OFFICES ALONG WITH OUR HOURS OF OPERATION SO THE PATIENT IS FULLY INFORMED OF WHAT INFORMATION IS AVAILABLE AND WHO THEY CAN CONTACT WITH QUESTIONS. INFORMATION ABOUT OUR FINANCIAL ASSISTANCE PROGRAMS IS POSTED ON OUR METHODIST INTERNET HOME PAGE AND ON OUR PATIENT BILLING STATEMENTS.
    PART VI, LINE 4: METHODIST IS THE SECOND LARGEST HEALTHCARE PROVIDER IN CENTRAL ILLINOIS. THE HOSPITAL IS LICENSED FOR 329 BEDS. ALONG WITH METHODIST THERE ARE TWO OTHER HOSPITALS IN THE PEORIA AREA, ALONG WITH FOUR SMALLER HOSPITALS IN OUR SERVICE AREA. IN 2011, METHODIST SERVED 17,388 INPATIENTS, 126,761 OUTPATIENTS, 58,210 EMERGENCY PATIENTS, 51,300 HOME CARE AND 303,656 PHYSICIAN VISITS. METHODIST'S PRIMARY SERVICE AREA CONSISTS OF FULTON, PEORIA, TAZEWELL AND WOODFORD COUNTIES. THIS GEOGRAPHIC REGION REPRESENTS 85% OF ALL HOSPITAL ADMISSIONS. THE SECONDARY SERVICE AREA INCLUDES 14 CENTRAL ILLINOIS COUNTIES, MOSTLY RURAL IN NATURE. COMBINED, METHODIST SERVES A POPULATION OF NEARLY ONE MILLION PEOPLE. METHODIST IS CLASSIFIED AS AN URBAN, TEACHING HOSPITAL. AS COMPARED TO THE DEMOGRAPHIC CHARACTERISTICS OF THE PEKIN/PEORIA MSA (METROPOLITAN STATISTICAL AREA), METHODIST SERVES A LARGER MINORITY AND SENIOR POPULATION. THE DEMOGRAPHICS OF METHODIST'S PATIENT POPULATION ARE A FUNCTION OF SEVERAL VARIABLES SUCH AS THE INCIDENCE AND PREVALENCE OF DISEASE AMONG AGE COHORTS, AND RACES, GEOGRAPHIC PROXIMITY TO MINORITY POPULATIONS AND OUTREACH EFFORTS TO IMPROVE ACCESS TO MEDICAL SERVICES. METHODIST'S INPATIENTS ARE: WHITE 80.4%, BLACK 15.8%, ASIAN 0.3%, HISPANIC 0.5% AND OTHER 3.0%. THIS IS COMPARED TO THE PEKIN/PEORIA MSA OF: WHITE 85.5%, BLACK 9.1%, ASIAN 1.6%, HISPANIC 2.3% AND OTHER 1.5%. METHODIST HAS THE LEAST FAVORABLE PAYOR MIX IN OUR PRIMARY SERVICE AREA. METHODIST HAS THE LARGEST MEDICAID MARKET SHARE BECAUSE OF OUR BEHAVIORAL HEALTH AND EMERGENCY PROGRAMS. THE MEDIAN AGE IN OUR SERVICE AREA IS 36.0 AS COMPARED TO 34.7 YEARS STATEWIDE. THE MEDIAN AGE IS HIGHER DUE TO A GREATER PERCENTAGE OF THE POPULATION AT AGE 65 OR ABOVE.
    PART VI, LINE 5: THE HOSPITAL IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES WITH THE GOAL OF PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. THE HOSPITAL SUPPORTS THIS MISSION WITH A COMMUNITY BOARD, OPEN MEDICAL STAFF, AND AN EMERGENCY ROOM AVAILABLE TO PATIENTS REGARDLESS OF ABILITY TO PAY. THE BOARD OF DIRECTORS OF THE HOSPITAL IS COMPOSED OF CIVIC LEADERS WHO RESIDE IN THE SERVICE AREA OF THE HOSPITAL. THE BOARD ACTIVELY DEBATES AND SETS POLICY AND STRATEGIC DIRECTION FOR THE HOSPITAL BUT DOES NOT GET INVOLVED IN ISSUES RELATED TO THE DIRECT OPERATIONS OF THE HOSPITAL. THE BOARD TAKES A BALANCED APPROACH WHEN ADDRESSING COMMUNITY AND BUSINESS/FINANCIAL CONCERNS. THE BOARD IS ALSO THE PRIMARY GROUP FOR DETERMINING THE USE OF HOSPITAL SURPLUS FUNDS, WHICH ARE ALL USED TO FURTHER OUR CHARITABLE PURPOSE.PHYSICIAN OFFICES ARE SPREAD ACROSS THE REGION TO PROVIDE BETTER ACCESS TO A WIDE NUMBER OF PATIENTS. SEE ATTACHED COMPREHENSIVE COMMUNITY BENEFIT STATEMENT (SCHEDULE O).
    PART VI, LINE 6: THE HOSPITAL IS PART OF IOWA HEALTH SYSTEM. INITIALLY FORMED IN 1995, IOWA HEALTH SYSTEM IS THE STATE'S FIRST AND LARGEST INTEGRATED HEALTH SYSTEM, SERVING NEARLY ONE OF EVERY THREE PATIENTS IN IOWA. THROUGH RELATIONSHIPS WITH 25 HOSPITALS IN METROPOLITAN AND RURAL COMMUNITIES AND MORE THAN 140 PHYSICIAN CLINICS, IOWA HEALTH SYSTEM PROVIDES CARE THROUGHOUT IOWA AND WESTERN ILLINOIS.IOWA HEALTH SYSTEM ENTITIES EMPLOY THE STATE'S LARGEST NONPROFIT WORKFORCE, WITH NEARLY 20,000 EMPLOYEES WORKING TOWARD INNOVATIVE ADVANCEMENTS TO DELIVER THE BEST OUTCOME FOR EVERY PATIENT EVERY TIME. EACH YEAR, THROUGH MORE THAN 2.5 MILLION PATIENT VISITS, IOWA HEALTH SYSTEM HOSPITALS AND CLINICS PROVIDE A FULL RANGE OF CARE TO PATIENTS AND FAMILIES. WITH ANNUAL REVENUES OF $2.3 BILLION, IOWA HEALTH SYSTEM IS THE SIXTH LARGEST NONDENOMINATIONAL HEALTH SYSTEM IN AMERICA AND PROVIDES COMMUNITY BENEFIT PROGRAMS AND SERVICES TO IMPROVE THE HEALTH OF PEOPLE IN ITS COMMUNITIES. IOWA HEALTH SYSTEM AND ITS AFFILIATES ENGAGE IN COMMUNITY HEALTH PROGRAMS AND SERVICES THROUGHOUT IOWA, AND WORK WITH VOLUNTEER AND CIVIC ORGANIZATIONS, SCHOOLS, BUSINESSES, INSURERS AND INDIVIDUALS TO SUPPORT ACTIVITIES THAT BENEFIT PEOPLE THROUGHOUT THE STATE. IN 2010, IOWA HEALTH SYSTEM AND ITS AFFILIATES PROVIDED MORE THAN $152 MILLION OF COMMUNITY BENEFIT. THE CONTRIBUTIONS TO THEIR COMMUNITIES BY IOWA HEALTH SYSTEM AND ITS AFFILIATES ARE REPORTED IN DETAIL IN STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS (PART III) OF THE IRS FORM 990 OF THOSE AFFILIATES.
REPORTS FILED WITH STATES PART VI, LINE 7 IL
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
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
2011
Open to Public
Inspection
Name of the organization
METHODIST MEDICAL CENTER OF ILLINOIS
 
Employer identification number
37-0661223
Part I
General Information on Grants and Assistance
1
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? ....................................
2
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 (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
non-cash assistance
(h) Purpose of grant
or assistance
(1) BRADLEY UNIVERSITY1501 WEST BRADLEY
PEORIA,IL61625
37-0661494 501(C)(3) 200,000       CAPITAL BUILDING CAMPAIGN
(2) HEARTLAND COMMUNITY HEALTH CLINIC1701 WEST GARDEN ST
PEORIA,IL61605
37-1270794 501(C)(3) 10,000       PROGRAM SUPPORT
(3) HEARTLAND COMMERCE & ECONOMIC DEVELOPMENT FOUNDATION100 SW WATER ST
PEORIA,IL61602
37-1271212 501(C)(3) 152,000       PROGRAM SUPPORT
(4) MORTON ECONOMIC DEVELOPMENT COUNCIL415 W JEFFERSON ST
MORTON,IL61550
26-1927395 501(C)(6) 25,000       PROGRAM SUPPORT
(5) PEORIA CHARTER SCHOOL INITIATIVE100 SW WATER ST
PEORIA,IL61602
27-0681058 501(C)(3) 25,000       PROGRAM SUPPORT
(6) PEORIA DISTRICT 150 FOUNDATION3202 N WISCONSIN AVE
PEORIA,IL61603
36-4200821 501(C)(3) 15,000       PROGRAM SUPPORT
(7) UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINEPO BOX 1649
PEORIA,IL61656
37-6000511 501(C)(3) 100,000       PROGRAM SUPPORT
(8) QUALITY QUEST FOR HEALTH416 MAIN ST SUITE 717
PEORIA,IL61602
26-3896631 501(C)(3) 250,000       PROGRAM SUPPORT
(9) HEART OF ILLINOIS UNITED WAY509 W HIGH STREET
PEORIA,IL61605
37-0661504 501(C)(3) 79,000       PROGRAM SUPPORT
(10) BRADLEY UNIVERSITY1501 WEST BRADLEY
PEORIA,IL61625
37-0661494 501(C)(3) 142,060       PROGRAM SUPPORT
(11) EASTER SEALS UCP501 E ARMSTRONG AVE
PEORIA,IL61603
37-0686250 501(C)(3) 26,000       PROGRAM SUPPORT
(12) ICC EDUCATIONAL FOUNDATION1 COLLEGE DRIVE
EAST PEORIA,IL61635
37-1207827 501(C)(3) 9,400       PROGRAM SUPPORT
(13) KOMEN PEORIA RACE FOR THE CURE4700 N UNIVERSITY AVE
PEORIA,IL61614
37-1286285 501(C)(3) 8,500       EVENT SPONSOR
(14) LINCOLN FOUNDATION FOR PERFORMANCE EXCELLANCE1415 W DIEHL RD
NAPERVILLE,IL60563
36-3952696 501(C)(3) 5,000       EVENT SPONSOR
(15) PEORIA ART GUILD203 HARRISON CT
PEORIA,IL61602
23-7063821 501(C)(3) 5,000       EVENT SPONSOR
(16) PEORIA PROMISE FOUNDATION331 FULTON ST
PEORIA,IL61602
13-4353454 501(C)(3) 25,000       PROGRAM SUPPORT
(17) WD BOYCE COUNCIL1014 NE MADISON AVE
PEORIA,IL61603
37-0661188 501(C)(3) 19,500       PROGRAM SUPPORT
(18) ILLINOIS CANCER CARE FOUNDATION8940 N WOOD SAGE RD
PEORIA,IL61615
37-1331017 501(C)(3) 5,000       EVENT SPONSOR
(19) JUVENILE DIABETES RESEARCH FOUNDATION11 S LASALLE ST
CHICAGO,IL60603
23-1907729 501(C)(3) 8,000       EVENT SPONSOR
(20) COMMUNITY FOUNDATION OF ILLINOIS331 FULTON ST SUITE 310
PEORIA,IL61602
37-1283245 501(C)(3) 5,000       EVENT SPONSOR
(21) PUBLIC EMPLOYEES - COMMUNITY CONCERNS419 FULTON ST SUITE 207
PEORIA,IL61602
37-6001761 501(C)(3) 5,000       EVENT SPONSOR
(22) WASHINGTON COMMUNITY HIGH SCHOOL115 BONDURANT ST
WASHINGTON,IL61571
37-6004693 501(C)(3) 12,500       PROGRAM SUPPORT
(23) HEART OF ILLINOIS SENIOR GAMES2218 N PROSPECT
PEORIA,IL61603
37-6001768 501(C)(3) 5,000       EVENT SPONSOR
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
22
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
1
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
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
PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: RECIPIENTS WERE GIVEN GRANTS BASED ON THE NEEDS OF THE MEDICAL COMMUNITY AND THE LOCAL COMMUNITY AT LARGE. COMMUNITY BENEFITS COMMITTEE AND CEO REVIEW ASSISTANCE REQUESTS AND APPROVE BASED ON NEED.
Schedule I (Form 990) 2011


Additional Data


Software ID:  
Software Version:  


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
2011
Open to Public Inspection
Name of the organization
METHODIST MEDICAL CENTER OF ILLINOIS
 
Employer identification number

37-0661223
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
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? ....
2
 
 
3
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. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
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:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
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.
5
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:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
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:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
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 ............
7
 
No
8
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 Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(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 as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) W MICHAEL BRYANT TO 072011 (i)
(ii)
417,845
0
0
0
129,228
0
123,386
0
15,788
0
686,247
0
79,088
0
(2) BRIAN COHEN MD (i)
(ii)
396,025
0
0
0
23,168
0
43,346
0
14,655
0
477,194
0
0
0
(3) KEITH KNEPP MD FR 062011 (i)
(ii)
227,645
0
0
0
17,745
0
225
0
14,440
0
260,055
0
0
0
(4) DEBORAH SIMON FR 072011 (i)
(ii)
329,949
0
0
0
104,200
0
134,809
0
11,242
0
580,200
0
0
0
(5) CALVIN MACKAY TO 072011 (i)
(ii)
300,710
0
0
0
211,061
0
67,425
0
10,996
0
590,192
0
103,700
0
(6) ROBERT QUIN FR 072011 (i)
(ii)
193,533
0
0
0
60,979
0
40,572
0
8,758
0
303,842
0
0
0
(7) RICK ANDERSON (i)
(ii)
311,920
0
0
0
60,583
0
66,814
0
15,226
0
454,543
0
0
0
(8) ERICK LAINE (i)
(ii)
269,920
0
0
0
41,208
0
24,125
0
15,159
0
350,412
0
0
0
(9) ALEXANDER ADLER (i)
(ii)
645,671
0
0
0
17,920
0
28,849
0
14,475
0
706,915
0
0
0
(10) CHARLES EGLEY (i)
(ii)
607,336
0
0
0
39,932
0
31,232
0
14,475
0
692,975
0
0
0
(11) KISHORE KARAMCHANDANI (i)
(ii)
599,687
0
0
0
22,115
0
6,125
0
4,969
0
632,896
0
0
0
(12) JOEL KUPFER (i)
(ii)
648,845
0
0
0
23,468
0
6,125
0
10,451
0
688,889
0
0
0
(13) DWAYNE MCQUITTY (i)
(ii)
891,414
0
0
0
39,308
0
6,125
0
14,475
0
951,322
0
0
0



Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
  PART I, LINE 1A  
  PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN 457(F): W.MICHAEL BRYANT $95,124, DEBORAH SIMON $52,755, CALVIN MACKAY $189,603, RICK ANDERSON $55,315, AND ROBERT QUIN $42,719. THE PLAN'S FUNDS ARE VESTED QUARTERLY TWO YEARS AFTER EACH CONTRIBUTION OR EARLIER BASED ON THE PARTICIPANT'S AGE AND YEARS OF SERVICE.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
METHODIST MEDICAL CENTER OF ILLINOIS
 
Employer identification number
37-0661223
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
Yes No Yes No Yes No
A ILLINOIS FINANCE AUTHORITY
 
86-1091967   05-12-2011 63,780,000 SEE PART VI   X   X   X
B ILLINOIS FINANCE AUTHORITY
 
86-1091967 45203HAE2 05-12-2011 51,220,000 SEE PART VI   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . .        
2 Amount of bonds legally defeased . . . . . . . . . .        
3 Total proceeds of issue . . . . . . . . . . . . . 72,506,422 62,036,639    
4 Gross proceeds in reserve funds . . . . . . . .        
5 Capitalized interest from proceeds . . . . . . . . . .        
6 Proceeds in refunding escrows . . . . . . . . . . . 55,540,033      
7 Issuance costs from proceeds . . . . . . . . . . . 471,772 661,528    
8 Credit enhancement from proceeds . . . . . . . . . . 16,494,617 13,293,368    
9 Working capital expenditures from proceeds . . . . . . .        
10 Capital expenditures from proceeds . . . . . . . . . . 48,081,744 48,081,744    
11 Other spent proceeds . . . . . . . . . . .        
12 Other unspent proceeds . . . . . . . . . . .        
13 Year of substantial completion . . . . . . . . . . . 2011 2011
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . X     X        
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X        
16 Has the final allocation of proceeds been made? . . . . . . X   X          
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   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? . . . . . . .   X   X        
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X        
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
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 of bond-financed property? . . . . . . . . . X   X          
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X   X          
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .   X   X        
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any 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 . . SchKMediumBullet 0.00000% 0.00000%   %   %
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 . . . . . . . SchKMediumBullet 0.00000% 0%   %   %
6 Total of lines 4 and 5 . . .. . . . . . . . . 0.00000% 0%   %   %
7 Does the bond issue meet the private security or payment test? . . . X   X          
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X          
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   X        
2 Is the bond issue a variable rate issue?   X X          
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue? X   X          
b Name of provider . . . . . . . . MORGAN STANLEY
CAPITAL SECURITIES
MORGAN STANLEY
CAPITAL SECURITIES
 
 
 
 
c Term of hedge . . . . . . . . 33.500000000000 33.500000000000    
d Was the hedge superintegrated? . . . .   X   X        
e Was a hedge terminated? . . . . . X   X          
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X   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   X        
6 Did the bond issue qualify for an exception to rebate? . X   X          
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X   X          
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
PART I, COLUMN (F) DESCRIPTION OF PURPOSE LINE A - REFUND THE ILLINOIS FINANCE AUTHORITY'S HOSPITAL FACILITIES REVENUE BONDS, (METHODIST MEDICAL CENTER) SERIES 1998. LINE B - REFINANCE BANK LINE OF CREDIT.
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet 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. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
METHODIST MEDICAL CENTER OF ILLINOIS
 
Employer identification number

37-0661223
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?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
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?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
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) 2011
Schedule L (Form 990 or 990-EZ) 2011
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?
Yes No
(1) DEBBIE ANDERSON FAMILY MEMBER OF KEY EMPLOYEE RICK ANDERSON 39,171 EMPLOYEE OF METHODIST MEDICAL CENTER OF ILLINOIS   No
(2) ELYSE BRYANT FAMILY MEMBER OF OFFICER W. MICHAEL BRYANT 10,446 EMPLOYEE OF METHODIST MEDICAL CENTER OF ILLINOIS   No
(3) MARION WILLEMSEN-REID FAMILY MEMBER OF BOARD MEMBER SCOTT REID 67,578 EMPLOYEE OF METHODIST MEDICAL CENTER OF ILLINOIS   No
(4) MID ILLINI SURGICAL ASSOCIATES
 
COMMON BOARD MEMBER/OFFICER 483,194 PURCHASED SERVICES   No
(5) PEORIA METRO CONSTRUCTION
 
COMMON BOARD MEMBER/OFFICER 336,312 CONTRACTOR SERVICES   No
(6) PEORIA-TAZEWELL PATHOLOGY GROUP
 
COMMON BOARD MEMBER/OFFICER 534,511 PURCHASED SERVICES   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) 2011

Additional Data


Software ID:  
Software Version:  




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
2011
Open to Public
Inspection
Name of the organization
METHODIST MEDICAL CENTER OF ILLINOIS
 
Employer identification number

37-0661223
Identifier Return Reference Explanation
PROGRAM SERVICE ACCOMPLISHMENTS PART III, LINE 4A THE METHODIST MEDICAL CENTER OF ILLINOIS IS A NON-PROFIT ORGANIZATION FOUNDED IN 1900. THE MEDICAL CENTER IS LICENSED FOR 329 BEDS. METHODIST IS A FULLY-INTEGRATED HEALTHCARE ORGANIZATION OFFERING ACUTE CARE, POST-ACUTE CARE, WELLNESS AND PREVENTION, PHYSICIAN OFFICES, OUTPATIENT CLINICS, HOME CARE AND HOSPICE. WITH 2,979 FULL AND PART-TIME EMPLOYEES, METHODIST IS THE THIRD LARGEST EMPLOYER IN THE PEORIA/PEKIN MSA. AS MEASURED BY BOTH REVENUE AND ACTIVITY, METHODIST IS THE SECOND LARGEST HEALTHCARE PROVIDER IN CENTRAL ILLINOIS. IN 2011, METHODIST SERVED 17,388 INPATIENTS; 126,761 OUTPATIENT VISITS; 58,210 EMERGENCY VISITS; 51,300 HOME CARE VISITS; AND 303,656 PHYSICIAN VISITS. THE MEDICAL CENTER'S PRIMARY SERVICE AREA CONSISTS OF FULTON, PEORIA, TAZEWELL, AND WOODFORD COUNTIES. THIS GEOGRAPHIC REGION REPRESENTS 85% OF ALL HOSPITAL ADMISSIONS. THE SECONDARY SERVICE AREA INCLUDES 14 CENTRAL ILLINOIS COUNTIES. COMBINED, METHODIST SERVES A POPULATION OF NEARLY 1.0 MILLION PEOPLE. AS COMPARED TO THE DEMOGRAPHIC CHARACTERISTICS OF THE PEKIN/PEORIA MSA, METHODIST SERVES A LARGER MINORITY AND SENIOR POPULATION. THE DEMOGRAPHICS OF METHODIST'S PATIENT POPULATION ARE A FUNCTION OF SEVERAL VARIABLES SUCH AS THE INCIDENCE AND PREVALENCE OF DISEASE AMONG AGE COHORTS AND RACES, GEOGRAPHIC PROXIMITY TO MINORITY POPULATIONS AND OUTREACH EFFORTS TO IMPROVE ACCESS TO MEDICAL SERVICES. METHODIST INPATIENTS PEKIN-PEORIA MSA WHITE 80.4% 85.5% BLACK 15.8% 9.1% ASIAN 0.3% 1.6% HISPANIC 0.5% 2.3% OTHER 3.0% 1.5% CHARITY CARE PROVISION OF CHARITY CARE IS IDENTIFIED THROUGH CAREFUL MONITORING OF ECONOMIC TRENDS AND AVAILABILITY OF INSURANCE FROM VARIOUS SOURCES. SCREENING OF INDIVIDUALS IDENTIFIED AS UNABLE TO PAY THE FULL COST OF SERVICES IS INITIATED BY FINANCIAL COUNSELORS. IN ADDITION, ANY EMPLOYEE MAY IDENTIFY A POTENTIAL CHARITY NEED AS A RESULT OF UNANTICIPATED MEDICAL CARE COMBINED WITH THE INABILITY TO PAY. COMMUNICATION OF THE AVAILABILITY OF THIS PROGRAM OCCURS THROUGH BROCHURES DISTRIBUTED TO PATIENTS AT VARIOUS LOCATIONS WITHIN METHODIST, SIGNS AT CERTAIN LOCATIONS, PATIENT STATEMENTS, TELEPHONE COMMUNICATIONS, METHODIST WEBSITE AND FINANCIAL SCREENING ACTIVITIES. IN ADDITION, IDENTIFICATION MAY OCCUR DURING BILLING AND COLLECTION FUNCTIONS THAT IDENTIFY INABILITY TO PAY. ACCESS TO THIS PROGRAM IS AVAILABLE THROUGH EVERY POINT OF ENTRY INTO METHODIST INCLUDING THE EMERGENCY DEPARTMENT, OUTPATIENT SERVICES AREAS, INPATIENT REGISTRATION AND THROUGH VARIOUS HOSPITAL-OPERATED CLINICS AND PHYSICIAN OFFICES. DURING THE CHARITY CARE APPLICATION PROCESS, THE PATIENT IS ASKED TO DOCUMENT THEIR CURRENT ECONOMIC STATUS. THE PATIENT OR RESPONSIBLE PARTY MAY REQUEST A FINANCE ASSISTANCE FORM AND GUIDELINES FOR CHARITABLE CONSIDERATION AT ANY TIME, AND AT ANY POINT OF ENTRY INTO THE METHODIST SYSTEM, I.E. PRIOR TO OR AT THE TIME OF ADMISSION/REGISTRATION, UPON RECEIPT OF FINAL BILL OR FIRST STATEMENT, AND AT ANY POINT DURING THE COLLECTION PROCESS. METHODIST WILL WAIVE SOME OR ALL CHARGES BASED ON THE COMPARISON OF THE PATIENT'S CURRENT ECONOMIC STATUS TO THE CURRENT FEDERAL POVERTY GUIDELINES AND/OR REVIEW OF CREDIT RATING REPORTS. IN 2011, METHODIST'S TOTAL COST OF UNCOMPENSATED CHARITY CARE PROVIDED WAS $7,179,784. LANGUAGE ASSISTANCE SERVICES METHODIST PROVIDES INTERPRETERS OR THE USE OF A LANGUAGE ASSISTANCE TELEPHONE SERVICE FOR IT'S NON ENGLISH SPEAKING PATIENTS. IN 2011, METHODIST PROVIDED $13,582 IN LANGUAGE ASSISTANCE SERVICES TO ITS PATIENTS. EXCESS OF COSTS OVER REIMBURSEMENT FOR GOVERNMENT SPONSORED PROGRAMS METHODIST PROVIDES CARE TO CERTAIN PATIENTS UNDER PAYMENT ARRANGEMENTS WITH MEDICARE, MEDICAID, AND CERTAIN OTHER GOVERNMENT-SPONSORED PROGRAMS. SERVICES PROVIDED UNDER THESE ARRANGEMENTS ARE PAID AT PREDETERMINED RATES AS DEFINED BY THE PROGRAMS. THE MEDICARE AND MEDICAID PROGRAMS ACCOUNTED FOR 62% OF METHODIST'S GROSS PATIENT REVENUE IN 2011. METHODIST IS PAID BELOW LEVELS THAT FULLY COMPENSATE IT FOR THE UNDERLYING COSTS TO PROVIDE CARE TO MEDICARE AND MEDICAID BENEFICIARIES. IN 2011, THE EXCESS OF COST OVER REIMBURSEMENT WAS $29,078,481 FOR MEDICARE AND WAS $17,745,439 FOR MEDICAID. DONATIONS SPONSORSHIPS & COMMUNITY BENEFIT - METHODIST PROVIDED DIRECT FINANCIAL SUPPORT TO VARIOUS COMMUNITY ORGANIZATIONS IN 2011, IN ADDITION TO SPONSORING SPECIFIC ACTIVITIES WITHIN CHARITABLE ORGANIZATIONS. THE TOTAL AMOUNT OF THIS SUPPORT WAS $1,646,047. EXAMPLES OF ORGANIZATIONS THAT BENEFITED FROM THIS SUPPORT INCLUDE THE KOMEN FOUNDATION, HEART OF ILLINOIS UNITED WAY, AND EASTER SEAL. WELLMOBILE - THE METHODIST WELLMOBILE IS A VAN THAT PROVIDES COMMUNITY EDUCATION AND FREE OR LOW COST HEALTH SCREENINGS THROUGHOUT CENTRAL ILLINOIS. IN 2011, THE WELLMOBILE SERVED APPROXIMATELY 6,600 PARTICIPANTS. THESE SCREENINGS IDENTIFIED 2,189 PEOPLE WITH ABNORMAL BLOOD PRESSURE, 958 WITH ABNORMAL BLOOD GLUCOSE SCORES AND 1,387 WITH ABNORMAL CHOLESTEROL RATIO. PARTICIPANTS ARE INFORMED ABOUT THE WELLMOBILE LOCATIONS THROUGH PUBLIC SERVICE ANNOUNCEMENTS, WWW.WELLMOBILE.ORG, COMMUNITY SCREENING BROCHURES THAT ARE AVAILABLE IN DOCTOR OFFICES, AND HEALTH FAIRS. UNITED WAY - METHODIST WAS THE SECOND LARGEST FINANCIAL SUPPORTER OF THE HEART OF ILLINOIS UNITED WAY CAMPAIGN IN 2011, WHICH PROVIDES FINANCIAL SUPPORT ANNUALLY TO 47 AREA HEALTH AND SOCIAL SERVICES PROGRAMS IN A CENTRAL ILLINOIS. HEART OF ILLINOIS UNITED WAY (2011 CAMPAIGN AMBASSADOR) - THE HEART OF ILLINOIS UNITED WAY CAMPAIGN FUNCTIONS WITH A SMALL CORE STAFF, AND A RECRUITED GROUP OF VOLUNTEER CAMPAIGN AMBASSADORS THAT SUPPLEMENT THE COMPLETION OF ANNUAL CAMPAIGN-RELATED TASKS. CAMPAIGN AMBASSADORS ARE "LOANED" TO THE UNITED WAY OFFICE FOR THREE MONTHS. THE CAMPAIGN AMBASSADOR PROVIDES FULL-TIME ASSISTANCE WITH THE UNITED WAY'S ANNUAL CAMPAIGN IN CENTRAL ILLINOIS, AND SERVES AS A VITAL LINK BETWEEN THE UNITED WAY AND AREA COMPANIES WITH FUND-RAISING CAMPAIGNS. METHODIST FINANCIALLY SPONSORED A 2011 CAMPAIGN AMBASSADOR. UNITED WAY DAY OF CARING - THE DAY OF CARING IS AN EVENT SPONSORED BY THE HEART OF ILLINOIS UNITED WAY WITH COORDINATION FROM THE UNITED WAY MARKETING & COMMUNICATIONS COMMITTEE, WHERE A METHODIST LEADER IS A MEMBER. AGENCIES IDENTIFY HOME PROJECTS FOR NEEDY FAMILIES SUCH AS PAINTING OR YARD WORK. VOLUNTEERS FOR THE PROJECTS ARE RECRUITED FROM AREA BUSINESSES, INCLUDING METHODIST. INSTITUTIONAL REVIEW BOARD - THE IRB IS MADE UP OF LOCAL HEALTH CARE ENTITIES, WHICH SET PROTOCOLS AND REVIEW MEDICAL RESEARCH PROJECTS FOR THE LOCAL AREA. METHODIST'S MEDICAL RESEARCH FUNDING FOR IRB WAS $27,125 IN 2011. DONATED OFFICE SPACE - METHODIST DONATED THE USE OF OFFICE SPACE TO CENTRAL ILLINOIS FRIENDS OF PEOPLE WITH AIDS. THE AMOUNT OF SUPPORT FOR THE CIFPWA OFFICE SPACE WAS $19,610 IN 2011. VOLUNTEER SERVICES FOR 2011, NON-EMPLOYEE VOLUNTEERS CONTRIBUTED 42,839 HOURS OR APPROXIMATELY $353,422 OF LABOR DOLLARS AT METHODIST. IN ADDITION, METHODIST EMPLOYEES VOLUNTEERED 16,130 HOURS OR APPROXIMATELY $133,073 OF LABOR DOLLARS FOR VARIOUS CHARITABLE CAUSES THROUGHOUT OUR COMMUNITY. EDUCATION RESIDENCY PROGRAM - IN 2011, METHODIST MEDICAL CENTER'S FAMILY PRACTICE RESIDENCY PROGRAM EMPLOYED 30 RESIDENTS AND FELLOWS THROUGHOUT THE YEAR WHILE METHODIST'S PSYCHOLOGY RESIDENCY EMPLOYED 3 RESIDENTS. METHODIST HAS AGREEMENTS WITH SEVERAL AREA CLINICS AND ORGANIZATIONS TO ROTATE RESIDENTS TO PROVIDE SERVICES FOR THE COMMUNITY AT NO COST. THE NET UNREIMBURSED COST INCURRED BY METHODIST FOR THE 2011 RESIDENCY PROGRAM WAS $939,021. INTERNSHIPS - IN 2011, METHODIST PROVIDED 13 INTERNSHIPS IN FIELDS VARYING FROM STUDENT NURSES TO PHARMACISTS. THE UNREIMBURSED COST TO METHODIST TO PROVIDE THESE INTERNSHIPS WAS $32,910. SUBSIDIZED HEALTH SERVICES METHODIST PROVIDES SUBSIDIZED HEALTHCARE TO PATIENTS IN ITS REHABILITATION, BEHAVIORAL HEALTH, PEDIATRIC, AND EMERGENCY SERVICES. THE UNREIMBURSED COST TO METHODIST IN 2011 WAS $3,205,050 FOR THE SERVICES LISTED BELOW (OF THIS, $1,335,602 IS REPORTED UNDER COMMUNITY HEALTH IMPROVEMENT SERVICES ON THE FORM 990 SCHEDULE H): PEDIATRICS, PEDIATRIC GI, CHILD & ADOLESCENT PSYCHIATRY, REHABILITATION, MENTAL HEALTH CLINIC, GERIATRIC SERVICES, HOSPICE AND IN SCHOOL HEALTH. BAD DEBT FOR A VARIETY OF REASONS, INCLUDING, BUT NOT LIMITED TO, INCOME LEVEL AND LACK OF ADEQUATE INSURANCE COVERAGE, METHODIST MAY WRITE OFF PATIENT CHARGES IT DEEMS TO BE UNCOLLECTIBLE. IN 2011, THE COST OF THIS UNCOMPENSATED CARE, EXCLUSIVE OF AMOUNTS INCLUDED IN CHARITY CARE, WAS $8,748,287.
    OTHER COMMUNITY BENEFITS METHODIST INN - THE METHODIST INN PROVIDES NO-COST OVERNIGHT ACCOMMODATIONS IN A "HOTEL-LIKE" SETTING WITHIN THE HOSPITAL FOR PATIENTS' FAMILIES, PATIENTS, AND LOVED ONES. THE INN WAS STARTED AS A SERVICE TO PATIENTS AND THEIR FAMILIES SEVERAL YEARS AGO. THE INN'S ROOMS ARE FULLY FURNISHED WITH TWIN BEDS AND OTHER AMENITIES. A LOUNGE IS LOCATED IN THE INN AREA FOR THE GUEST'S USE. A SMALL BREAKFAST NOOK HAS A MICROWAVE AND VENDING MACHINES. A CONTINENTAL BREAKFAST IS PROVIDED EACH MORNING FOR THE GUESTS OF THE METHODIST INN. IN 2011, METHODIST PROVIDED 1,873 NIGHTS OF LODGING IN THE METHODIST INN WITHOUT CHARGE. USING COMPARABLE AREA HOTEL RATES, THESE NIGHTS HAD A VALUE OF $116,551. SENIOR SERVICES - METHODIST'S SENIOR SERVICE DEPARTMENT OFFERS ENCORE!, WHICH IS A FREE MEMBERSHIP PROGRAM FOR PEOPLE 55 YEARS OF AGE AND OLDER REGARDLESS OF WHAT HOSPITAL THEY USE OR INSURANCE THEY HAVE. THE PURPOSE OF THE PROGRAM IS TO DEMONSTRATE IN REAL TERMS THE COMMITMENT OF METHODIST MEDICAL CENTER TO THE OVERALL HEALTH AND WELLNESS OF THE SENIOR POPULATION IN A 5 COUNTY REGION AROUND PEORIA. TO ACCOMPLISH THIS, ENCORE! PROVIDES EDUCATIONAL EVENTS AND SEMINARS ON A WIDE VARIETY OF TOPICS WHICH ARE PERTINENT TO THE MATURE ADULT, SUCH AS: MEDICARE EDUCATION, FINANCIAL PLANNING, UNDERSTANDING MEDICAL DIRECTIVES, NUTRITION, MEDICAL/CHRONIC DISEASE EDUCATION, HOME SAFETY, EXERCISE AND AGING, FALL PREVENTION, AND MUCH MORE. ADDITIONALLY, METHODIST MEDICAL CENTER PROVIDES FREE MEDICAL SCREENING TESTS AND PRESCRIPTION REVIEWS. FINALLY, ENCORE! AIDS THE MATURE ADULT IN FINDING RESOURCES TO MEET THEIR PERSONAL HEALTH AND WELLNESS NEEDS AND TO ENCOURAGE AND PROMOTE THE USE OF PROGRAMS, BOTH STATE AND FEDERAL, THAT HELP WITH PREVENTION AND AWARENESS. THE MEMBERSHIP OF ENCORE! GREW TO 3008 MEMBERS BY THE END OF 2011. OVER THE COURSE OF THE YEAR 110 EVENTS AND SEMINARS WERE OFFERED. ATTENDANCE AT THESE EVENTS HAS CONTINUALLY INCREASED AND THE HIGH RATINGS ON EVALUATIONS DEMONSTRATE THAT MEMBERS FIND THE PROGRAM TO BE OUTSTANDING AND HELPFUL. OUR WELLMOBILE OFFERED NUMEROUS SCREENING OPPORTUNITIES AND OUR PHARMACIST CONTINUED OFFERING THE PRESCRIPTION REVIEWS FOR MEMBERS. STRATEGIC PARTNERSHIPS WITH SENIOR NET, THE PEORIA PARK DISTRICT AND BRADLEY UNIVERSITY'S OSHER LIFE-LONG LEARNING INSTITUTE WERE DEVELOPED IN 2011 PROVIDING A DIRECT CONNECTION TO THE BEST COMPUTER TRAINING FOR SENIORS, THE BEST FITNESS AND EXERCISE OFFERINGS FOR SENIORS AND THE BEST LIFE-LONG LEARNING PROGRAM IN OUR AREA. 2011 SAW THE INAUGURATION OF A NEW PROGRAM WHICH MATCHED ENCORE! MEMBERS WITH METHODIST COLLEGE NURSING STUDENTS. THE GOAL OF THE PROGRAM IS FOR NURSING STUDENTS TO BE MORE AWARE OF THE WHOLE SPECTRUM OF MATURE ADULTS PHYSICALLY, MENTALLY AND MEDICALLY THROUGH REGULAR CONTACT WITH THE MEMBER AND , FOR MATURE ADULTS TO HELP EDUCATE NURSING STUDENTS ABOUT AGING. 90 MEMBERS AND NURSING STUDENTS WERE PAIRED AND WE HAVE RECEIVED MUCH POSITIVE FEEDBACK ON THE VALUE OF THIS PROGRAM. ADDITIONALLY, METHODIST ENCORE! WAS A MAJOR FINANCIAL SPONSOR AND PROVIDER OF VOLUNTEERS AND PARTICIPANTS FOR THE HEART OF ILLINOIS SENIOR GAMES AND FINE ARTS FESTIVAL. IN 2011, THE DEPARTMENT HAD UNREIMBURSED COSTS OF $92,229. PASTORAL CARE - METHODIST MEDICAL CENTER PROVIDES A COMPREHENSIVE PASTORAL CARE DEPARTMENT STAFFED BY AN INTERFAITH TEAM OF CLERGY WHO ARE TRAINED IN HOSPITAL MINISTRY. PASTORAL CARE SERVICES ARE AVAILABLE 24 HOURS A DAY 7 DAYS A WEEK. IN 2011, THE PASTORAL CARE DEPARTMENT HAD UNREIMBURSED COSTS OF $346,755. CHAPLAIN ASSISTANT VOLUNTEER TRAINING - THE CHAPLAIN ASSISTANT VOLUNTEER TRAINING PROGRAM WAS STARTED BY THE METHODIST PASTORAL CARE DEPARTMENT TO TRAIN PEOPLE FROM AREA CONGREGATIONS TO PROMOTE HEALTH IN OUR COMMUNITIES AND CONGREGATIONS AND TO INVITE CHURCH MEMBERS TO BECOME PART OF OUR METHODIST PASTORAL COMMUNITY VISITING AND SUPPORTING PATIENTS, THEIR FAMILIES, AND OUR STAFF. THE DIRECTOR OF THE DEPARTMENT OVERSEES THE TRAINING AND COORDINATES THE VOLUNTEERS' CLINICAL WORK. COMMUNITY PASTORAL CARE PROGRAM - THE PURPOSE OF THIS PROGRAM IS TO: MAKE HEALTH CARE RESOURCES CONSISTENTLY AVAILABLE TO THE POOR AND UNDER-SERVED NEIGHBORHOODS OF PEORIA; MAKE THESE RESOURCES AVAILABLE THROUGH THE COMPASSIONATE CARING OF AREA CHURCHES TO THOSE PEOPLE LIVING IN PROXIMITY TO THOSE CONGREGATIONS; TO PROMOTE HEALTH IN OUR COMMUNITY THROUGH AREA CHURCH AND FAITH GROUPS; TO IMPROVE LIVES THROUGH CARING AND THROUGH HEALTH CARE RESOURCES; TO IMPROVE RELATIONSHIPS BETWEEN METHODIST AND AREA FAITH COMMUNITIES; TO TRAIN CONGREGATIONS TO MINISTER EFFECTIVELY TO PEOPLE WITH HEALTH CARE CONCERNS; TO GIVE THE CHURCHES THE RESOURCES TO ACTIVELY PROVIDE SPIRITUAL/EMOTIONAL SUPPORT TO PEOPLE GOING THROUGH DIFFICULT TIMES; TO PROVIDE AND PROMOTE, WITHIN THE COMMUNITY, HEALTH FAIRS, HEALTH SCREENINGS, AND CLINIC USE TO IMPROVE LIFE; TO HEIGHTEN THE AWARENESS AND EMPOWER PEOPLE TO BECOME HEALTH RESPONSIBLE FOR THEMSELVES AND THEIR FAMILIES. PARTNERING WITH METHODIST HOME HEALTH - IN 2012, THE PASTORAL CARE DEPARTMENT HAS PARTNERED WITH HOME HEALTH TO ATTEND TO THE SPIRITUAL AND EMOTIONAL NEEDS OF HOME HEALTH PATIENTS; THE GOAL OF THIS PARTNERSHIP IS TO BEGIN ADDRESSING THE ISOLATION MANY OF OUR HOME HEALTH PATIENTS EXPERIENCE; THIS EFFORT IS ALSO AIMED AT ADDRESSING THE EMOTIONAL AND SPIRITUAL NEEDS OF PATIENTS COPING WITH LONGER TERM HEALTH CONCERNS; THIS SERVICE IS INTENDED AS A BRIDGE TO RE-LINKING PATIENTS WITH CARING CHURCHES, WHEN THIS IS DESIRABLE TO THE PATIENT; THIS IS ALSO ANOTHER WAY IN WHICH WE CAN VALIDATE THE VALUE AND DIGNITY OF EACH PERSON'S LIFE AND ENCOURAGE COMPLIANCE WITH TREATMENT PLANS THAT HELP PATIENT'S MANAGE THEIR HEALTH AND THEIR LIVES. PASTORAL CARE DEPARTMENT EDUCATION - THE PASTORAL CARE DEPARTMENT EDUCATION PROGRAM TRAINING HAS BEEN PROVIDED FOR PEOPLE IN OVER 90 AREA CHURCHES. SINCE THE INCEPTION OF THE PROGRAM, OVER 300 INDIVIDUALS HAVE PARTICIPATED IN THE TRAINING PROVIDED BY THE PASTORAL CARE PROGRAM. COMMUNITY OUTREACH AMBULANCE EDUCATION - EACH AMBULANCE SQUAD IN THE PEORIA AREA EMS SYSTEM PREDETERMINES WHAT EMERGENCY MEDICAL SERVICES (EMS) EDUCATION IS NEEDED FOR THEIR AGENCY ANNUALLY. THE PLANS ARE SUBMITTED TO THE ILLINOIS DEPARTMENT OF PUBLIC HEALTH FOR APPROVAL OR REVISION. EACH AGENCY IS RESPONSIBLE FOR OBTAINING THE EDUCATION RESOURCES. METHODIST PROVIDED 56 HOURS OF COMMUNITY EDUCATION IN 2011 FOR VARIOUS EMS AGENCIES. THIS EDUCATION WAS PROVIDED AT NO COST TO THE AGENCIES BEHAVIORAL HEALTH - METHODIST HAS IDENTIFIED BEHAVIORAL HEALTH AS ONE OF THE MOST CRITICAL ISSUES IN HEALTHCARE FOR THE LOCAL AREA. PROGRAMS ARE AVAILABLE FOR CHILDREN, ADOLESCENTS, ADULTS AND SENIORS, THROUGH INPATIENT, OUTPATIENT, PARTIAL HOSPITALIZATION, AND PHYSICIAN SERVICES. THE METHODIST MENTAL HEALTH CLINIC SERVES INDIVIDUALS AND FAMILIES WHO MAY NOT QUALIFY FINANCIALLY FOR OTHER BEHAVIORAL HEALTH SERVICES IN THE COMMUNITY. IN 2011, THERE WERE 2,493 INPATIENT MENTAL HEALTH ADMISSIONS RESULTING IN 21,207 DAYS OF CARE. THERE WERE 7,518 VISITS FOR OUTPATIENT BEHAVIORAL HEALTH SERVICES. CLINICAL STAFFING FOR BEHAVIORAL HEALTH SERVICES - METHODIST'S INPATIENT STAFF MEETS WITH COMMUNITY PROVIDERS AND LOCAL SCHOOL DISTRICT PERSONNEL TO DISCUSS CLINICAL ISSUES FOR SPECIFIC PATIENTS. THIS IS DONE ON A WEEKLY BASIS AND INVOLVES A MINIMUM OF THREE STAFF. TIME SPENT VARIES, BUT THE AVERAGE IS 60-90 MINUTES A WEEK, DISCUSSING CLINICAL ISSUES AND DISCHARGE ISSUES. THERE IS NO CHARGE TO PATIENTS, FAMILIES OR OTHER FACILITIES. SCHOOL TUTORING PROGRAM (CHILD/ADOLESCENT UNIT) - METHODIST PROVIDES TUTORING FOR CHILD AND ADOLESCENT PATIENTS HOSPITALIZED IN A METHODIST BEHAVIORAL HEALTH UNIT. THIS SERVICE ENSURES STUDENTS DO NOT FALL BEHIND IN THEIR CLASS WORK WHILE THEY ARE UNABLE TO ATTEND CLASS. ALTHOUGH METHODIST CHARGES THE HOME SCHOOL DISTRICT FOR THESE SERVICES, APPROXIMATELY 50% OF THE SERVICES ARE NOT REIMBURSED. BEHAVIORAL HEALTH SCREENINGS - PATIENTS ARE ALSO SCREENED IN THE DIABETES CARE CENTER AND CARDIOPULMONARY REHABILITATION AREAS FOR DEPRESSION OR OTHER POTENTIAL MENTAL DISORDERS. ALL PATIENTS COMPLETE A QUESTIONNAIRE, WHICH IS REVIEWED BY STAFF AND IF APPROPRIATE, FOLLOW UP APPOINTMENTS ARE SCHEDULED WITH A MENTAL HEALTH PROVIDER TO FURTHER ASSESS AND MAKE APPROPRIATE REFERRALS.
    BASIC LIFE SUPPORT/CARDIO-PULMONARY RESUSCITATION; HEARTSAVER AUTOMATED EXTERNAL DEFIBRILLATOR & FIRST AID TRAINING METHODIST CONTINUES TO PROVIDE CLASSES FOR ALL LEVELS OF TRAINING FOR AMERICAN HEART ASSOCIATION'S APPROVED CARDIO-PULMONARY RESUSCITATION (CPR), WITH OR WITHOUT HEARTSAVER AUTOMATED EXTERNAL DEFIBRILLATOR (AED) & FIRST AID TRAINING WITH OR WITHOUT CPR/ AED FOR THE ADULT, CHILD, AND INFANT POPULATION. MONTHLY CPR INITIAL PROVIDER COURSES AND RENEWAL COURSES ARE CURRENTLY OFFERED AT METHODIST. AN INSTRUCTOR COURSE FOR CPR THAT INCLUDES FIRST AID COMPONENTS IS OFFERED ONCE EACH YEAR. ADDITIONAL ADVANCED AMERICAN HEART ASSOCIATION COURSES FOR HEALTHCARE PROFESSIONALS SUCH AS ADVANCED CARDIAC LIFE SUPPORT (ACLS) AND PEDIATRIC LIFE SUPPORT (PALS) COURSES USING THE MOST CURRENT EMERGENCY CARDIAC CARE GUIDELINES ALSO ARE OFFERED THROUGH THE COMMUNITY TRAINING CENTER. OVER THE PAST 5 YEARS, METHODIST HAS BEEN RESPONSIBLE FOR TRAINING OVER 3,200 SCOUTS, STUDENTS, SCHOOL TEACHERS, AND SCHOOL DISTRICT STAFF IN CPR AND AED. METHODIST HAS PROVIDED THIS TRAINING AT NO COST.
  FORM 990, PART VI, SECTION A, LINE 6 METHODIST HEALTH SERVICES CORPORATION, A TAX-EXEMPT ILLINOIS NOT-FOR-PROFIT CORPORATION, IS THE SOLE MEMBER.
  FORM 990, PART VI, SECTION A, LINE 7A METHODIST HEALTH SERVICES CORPORATION, AS THE SOLE MEMBER, MAY APPOINT AND REMOVE ALL BOARD MEMBERS.
  FORM 990, PART VI, SECTION A, LINE 7B METHODIST HEALTH SERVICES CORPORATION, AS SOLE MEMBER, DIRECTS, APPROVES AND RECOMMENDS MERGERS, CONSOLIDATIONS, ACQUISITONS, DISSOLUTION, LIQUIDATION OR DISPOSITION, INIATES AND APPROVES BUDGETS AND LONG-RANGE STRATEGIC PLANS, INITIATES AND APPROVES THE FORMATION OF ANY PERSON CONTROLLED BY A SUBSIDIARY, APPROVES CONFLICT OF INTEREST POLICY, AND AMENDMENTS TO ARTICLES AND BYLAWS.
  FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED INTERNALLY BY THE IOWA HEALTH SYSTEM TAX DEPARTMENT USING INFORMATION GATHERED FROM VARIOUS FUNCTIONAL AREAS OF THE ORGANIZATION. EACH SECTION OF THE RETURN IS REVIEWED BY THE RESPONSIBLE FUNCTIONAL AREA ALONG WITH THE TAX DEPARTMENT. A DRAFT COPY OF THE RETURN IS PROVIDED TO THE CFO FOR REVIEW. A FULL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS.
  FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY. ANNUALLY ALL OFFICERS, DIRECTORS, KEY EMPLOYEES AND REPORTING PHYSICIANS ARE REQUESTED TO COMPLETE A QUESTIONNAIRE TO REPORT POTENTIAL CONFLICTS OF INTEREST. PERSONS WHO HAVE NOT RETURNED QUESTIONNAIRES ARE CONTACTED ADDITIONAL TIMES IN AN EFFORT TO RECEIVE COMPLETE AND ACCURATE RESPONSES FROM ALL PERSONS. THE ANNUAL QUESTIONNAIRES INCLUDE AN ACKNOWLEDGEMENT THAT THE OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN: 1) HAS ACCESS TO A COPY OF THE CONFLICT OF INTEREST POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) AGREES TO COMPLY WITH THE POLICY; 4) UNDERSTANDS THAT THE POLICY APPLIES TO ALL COMMITTEES AND SUBCOMMITTEES HAVING BOARD-DELEGATED POWERS; AND 5) UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS TAX-EXEMPT STATUS, IT MUST CONTINUOUSLY ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. SENIOR ADMINISTRATIVE STAFF AT ALL RELATED ORGANIZATIONS PROVIDE INFORMATION TO A CENTRAL COORDINATOR RELATED TO THE IDENTIFICATION OF WHICH INDIVIDUALS SHOULD RECEIVE THE QUESTIONNAIRE FOR COMPLETION. THE RESULTS ARE COMPILED CENTRALLY AND REVIEWED BY THE IOWA HEALTH SYSTEM COMPLIANCE OFFICER AND DIRECTOR OF INTERNAL AUDIT. THE DETAIL RESULTS ARE REPORTED TO A COMMITTEE OF THE SYSTEM BOARD. THE RESULTS RELATED TO SPECIFIC REGIONAL PARENT COMPANIES, THEIR HOSPITALS AND RELATED ORGANIZATIONS, ARE DISTRIBUTED IN DETAIL TO THE CHAIRPERSON OF THE REGIONAL PARENT ORGANIZATION, THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER AND COMPLIANCE MANAGER. THESE INDIVIDUALS ARE ALSO REMINDED OF THE APPROPRIATE PROCESS TO BE FOLLOWED DURING THE YEAR TO ADDRESS POTENTIAL CONFLICTS OF INTEREST THAT RELATE TO MATTERS THAT ARE BROUGHT TO THE BOARD OF DIRECTORS FOR ACTION. THE INFORMATION DISCLOSED IS USED TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST AND TO ASSIST IN COMPLETING IRS AND MEDICAID QUESTIONNAIRES. ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY ORGANIZATIONAL OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN TOGETHER WITH ALL MATERIAL FACTS, SHOULD BE DISCLOSED TO THE BOARD OF DIRECTORS AND MADE A MATTER OF RECORD, EITHER THROUGH AN ANNUAL PROCEDURE OR WHEN THE INTEREST OCCURS OR BECOMES A MATTER OF BOARD ACTION. ANY ORGANIZATIONAL OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN HAVING A CONFLICT OF INTEREST IN ANY MATTER SHOULD NOT BE PRESENT DURING GENERAL DISCUSSION NOR VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER, AND HE OR SHE SHOULD NOT BE COUNTED IN DETERMINING THE EXISTENCE OF A QUORUM FOR PURPOSES OF THE MATTER OR ITEM AS TO WHICH A CONFLICT EXISTS. THE BOARD SHOULD EXCLUDE THE INDIVIDUAL FROM ANY DISCUSSION OR VOTE IN WHICH THE BOARD DECIDES WHETHER OR NOT A CONFLICT OF INTEREST EXISTS. IN CASES IN WHICH AN OFFICER, DIRECTOR, KEY EMPLOYEE, REPORTING PHYSICIAN OR THE INDIVIDUAL'S HOUSEHOLD MEMBER HAS A CONFLICT OF INTEREST IN AN ARRANGEMENT OR TRANSACTION, THE FOLLOWING ADDITIONAL STEPS MAY BE TAKEN AT THE DIRECTION OF THE BOARD OF DIRECTORS: 1) AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE OR SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL 1) DECIDE IF A CONFLICT OF INTEREST EXISTS, 2) A DISINTERESTED PERSON OR COMMITTEE MAY BE APPOINTED TO INVESTIGATE ALTERNATIVES TO THE PROPOSED ARRANGEMENT OR TRANSACTION; 3) IN ORDER TO APPROVE THE ARRANGEMENT OR TRANSACTION, THE BOARD MUST FIRST FIND, BY MAJORITY VOTE OF DISINTERESTED MEMBERS, THAT THE ARRANGEMENT OR TRANSACTION IS IN THE ORGANIZATION'S BEST INTEREST, IS FAIR AND REASONABLE TO THE ORGANIZATION, AND, AFTER REASONABLE INVESTIGATION, THE DISINTERESTED MEMBERS HAVE DETERMINED THAT A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT CANNOT BE OBTAINED WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES; THE MINUTES OF THE BOARD AND ALL COMMITTEES WITH BOARD-DELEGATED POWERS SHALL CONTAIN: 1) THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED; 2) THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH; IN ORDER TO PROTECT THE ORGANIZATION'S BEST INTERESTS, APPROPRIATE DISCIPLINARY ACTION MAY BE TAKEN WITH RESPECT TO AN OFFICER, DIRECTOR, KEY EMPLOYEE OR REPORTING PHYSICIAN WHO VIOLATES THE CONFLICT OF INTEREST POLICY.
  FORM 990, PART VI, SECTION B, LINE 15 THE PROFESSIONAL RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS IS CHARGED WITH THE OVERSIGHT OF THE EXECUTIVE COMPENSATION PACKAGE. IN DETERMINING AN EXECUTIVE COMPENSATION PROGRAM THAT ALIGNS A DESIRE TO RECRUIT AND RETAIN EXECUTIVES WITH THE MISSION OF MHSC, THIS COMMITTEE CONSIDERS SUCH FACTORS AS: THE ORGANIZATION'S TOTAL COMPENSATION PHILOSOPHY FOR ALL IT'S EMPLOYEES, THE COMPETITIVE MARKETPLACE, INCLUDING ORGANIZATION SIZE, COMPLEXITY AND SCOPE FACTORS CONSIDERED IN MARKET COMPARISONS, AND THE DESIRED MARKET POSITIONING OF ALL COMPENSATION AND BENEFITS COMPONENTS. THE METHODIST HEALTH SERVICES CORPORATION WANTS TO ENSURE THAT ALL EXECUTIVE COMPENSATION DECISIONS ARE COMPETITIVE, FAIR AND EQUITABLE, AS WELL AS COMPLIANT WITH APPROPRIATE REGULATORY GUIDELINES AND REPRESENTATIVE OF BEST MARKET PRACTICES. IT IS THE DESIRE OF MHSC AND THIS COMMITTEE TO HAVE PROPER DISCLOSURE, TO ENSURE THAT EXECUTIVE COMPENSATION DECISIONS DO NOT JEOPARDIZE CHARITABLE MISSION AND TAX-EXEMPT STATUS AND TO ESTABLISH A REBUTTABLE PRESUMPTION OF REASONABLENESS. THE TOTAL COMPENSATION PROGRAM FOR EXECUTIVES OF THE METHODIST HEALTH SERVICES CORPORATION CONSISTS OF: *BASE COMPENSATION *SHORT TERM INCENTIVE PAY *EXECUTIVE BENEFITS, INCLUDING PENSION *EXECUTIVE SEVERANCE OTHER FACTORS, SUCH AS COMPETITIVE MARKET FORCES, INDIVIDUAL JOB PERFORMANCE, EACH INDIVIDUAL'S UNIQUE SKILLS AND EFFORTS, AND/OR INDIVIDUAL'S JOB RESPONSIBILITIES, ARE ALSO CONSIDERED IN THE MHSC TOTAL COMPENSATION DECISIONS. THE COMMITTEE ALSO RETAINS THE SERVICES OF INDEPENDENT OUTSIDE CONSULTANTS AND LEGAL ADVISORS TO ASSIST IN THE STRATEGIC REVIEW OF PROGRAMS AND ARRANGEMENTS RELATING TO EXECUTIVE COMPENSATION AND PERFORMANCE. THE EXECUTIVE COMPENSATION IS REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS. THE CEO'S COMPENSATION IS APPROVED BY THE BOARD OF DIRECTORS.
  FORM 990, PART VI, SECTION C, LINE 19 IOWA HEALTH SYSTEM, OUR PARENT ORGANIZATION, HAS VOLUNTARILY ADOPTED MANY OF OUR INDUSTRY'S GOVERNANCE "BEST PRACTICES." IOWA HEALTH SYSTEM HAS DONE SO TO FURTHER ASSURE OUR STAKEHOLDERS THAT OUR GOVERNANCE AND MANAGEMENT IS CONDUCTED RESPONSIBLY AND WARRANTS THE TRUST YOU PLACE IN US. IN SEPTEMBER 2003, THE IOWA HEALTH SYSTEM BOARD OF DIRECTORS VOLUNTARILY ADOPTED OVER 40 CHANGES TO ITS GOVERNANCE STRUCTURE TO BETTER COMPLY WITH GOVERNANCE BEST PRACTICES AND THE INTENT AND APPLICABLE REQUIREMENTS OF THE SARBANES-OXLEY ACT OF 2003. IN ADDITION, GOVERNANCE POLICIES AND RELATED INFORMATION HAS BEEN ADDED TO THE IOWA HEALTH SYSTEM WEBSITE, WWW.IHS.ORG, INCLUDING BUT NOT LIMITED TO: OVER 130 CORPORATE COMPLIANCE POLICIES, INCLUDING CHARITY CARE AND CONFLICTS OF INTEREST POLICIES; GOVERNANCE BEST PRACTICE POLICIES; THE IDENTIFICATION OF BOARD MEMBERS AND BOARD COMMITTEES; COMPENSATION FOR HOSPITAL CEO'S; AND FINANCIAL INFORMATION FOR THE PAST SEVEN YEARS. COPIES OF THE DOCUMENTS ARE ALSO AVAILABLE TO THE PUBLIC UPON REQUEST.
CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -8,519,067. PENSION FUNDING LIABILITY -29,545,070. FOUNDATION INVESTMENT 59,699. CHANGE IN BARKER TRUST -654,840. FUND BALANCE TRANSFERS -16,486,478. TOTAL TO FORM 990, PART XI, LINE 5: -55,145,756.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
METHODIST MEDICAL CENTER OF ILLINOIS
 
Employer identification number

37-0661223
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



(e)
End-of-year assets


(f)
Direct controlling
entity



















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
Yes No
(1) ALLEN COLLEGE

1825 LOGAN AVENUE

WATERLOO,IA50703
42-1351526
EDUCATE AND DEVELOP HEALTHCARE PROFESSIONALS IA 501(C)(3) 170(B)(1) (A)(II) ALLEN HEALTH SYSTEMS INC
 
Yes
 
(2) ALLEN HEALTH SYSTEMS INC

1825 LOGAN AVENUE

WATERLOO,IA50703
42-1201924
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM
 
Yes
 
(3) ALLEN MEMORIAL HOSPITAL CORPORATION

1825 LOGAN AVENUE

WATERLOO,IA50703
42-0698265
HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) ALLEN HEALTH SYSTEMS INC
 
Yes
 
(4) ANAMOSA AREA AMBULANCE SERVICE

101 GRANT WOOD DRIVE

ANAMOSA,IA52205
42-1466284
PROVIDE AMBULANCE SERVICES IA 501(C)(3) 509(A)(2) ST LUKE'SJONES REGIONAL MEDICAL CENTER
 
Yes
 
(5) CENTRAL IOWA HEALTH PROPERTIES CORPORATION

1200 PLEASANT STREET

DES MOINES,IA50309
42-1233759
PROPERTY HOLDING COMPANY IA 501(C)(2)   CENTRAL IOWA HEALTH SYSTEM
 
Yes
 
(6) CENTRAL IOWA HEALTH SYSTEM

1200 PLEASANT STREET

DES MOINES,IA50309
42-1189791
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM
 
Yes
 
(7) CENTRAL IOWA HOSPITAL CORPORATION

1200 PLEASANT STREET

DES MOINES,IA50309
42-0680452
HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) CENTRAL IOWA HEALTH SYSTEM
 
Yes
 
(8) FINLEY TRI-STATES HEALTH GROUP INC

350 NORTH GRANDVIEW AVENUE

DUBUQUE,IA52001
42-1307495
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM
 
Yes
 
(9) HNC SERVICES

1200 PLEASANT STREET

DES MOINES,IA50309
27-0987243
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(2) IOWA HEALTH SYSTEM
 
Yes
 
(10) INTEGRATED CARE ORGANIZATION

1200 PLEASANT STREET

DES MOINES,IA50309
27-4665007
PROMOTE, SUPPPORT THE INTERESTS AND PURPOSES OF AFFILIATES' HOSPITALS IA 501(C)(3) 509(A)(2) IOWA HEALTH SYSTEM
 
Yes
 
(11) INTRUST

11333 AURORA AVENUE

URBANDALE,IA50322
42-1477471
HOME HEALTH CARE IA 501(C)(3) 509(A)(2) IOWA HEALTH SYSTEM
 
Yes
 
(12) IOWA HEALTH FOUNDATION

2700 GRAND AVE SUITE 109

DES MOINES,IA50312
42-1467682
CHARITABLE FUNDRAISING IA 501(C)(3) 509(A)(3), TYPE III CENTRAL IOWA HEALTH SYSTEM
 
Yes
 
(13) IOWA HEALTH SYSTEM

1200 PLEASANT STREET

DES MOINES,IA50309
42-1435199
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE III  
Yes
 
(14) IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION

8101 BIRCHWOOD COURT

JOHNSTON,IA50131
42-1411630
PRIMARY HEALTH CARE SERVICES IA 501(C)(3) 170(B)(1) (A)(III) IOWA HEALTH SYSTEM
 
Yes
 
(15) MEMORIAL FOUNDATION OF ALLEN HOSPITAL

1825 LOGAN AVENUE

WATERLOO,IA50703
42-1201138
CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) ALLEN HEALTH SYSTEMS INC
 
Yes
 
(16) METHODIST HEALTH SERVICES CORPORATION

221 NORTHEAST GLEN OAK AVENUE

PEORIA,IL61636
37-1111135
HEALTHCARE IL 501(C)(3) 509(A)(3), TYPE III IOWA HEALTH SYSTEM
 
Yes
 
(17) METHODIST MEDICAL CENTER FOUNDATION

221 NORTHEAST GLEN OAK AVENUE

PEORIA,IL61636
51-0186460
FUNDRAISING IL 501(C)(3) 170(B)(1) (A)(VI) METHODIST HEALTH SERVICES CORPORATION
 
Yes
 
(18) METHODIST MEDICAL CENTER OF ILLINOIS

221 NORTHEAST GLEN OAK AVENUE

PEORIA,IL61636
37-0661223
HEALTHCARE IL 501(C)(3) 170(B)(1) (A)(III) METHODIST HEALTH SERVICES CORPORATION
 
Yes
 
(19) METHODIST SERVICES INC

221 NORTHEAST GLEN OAK AVENUE

PEORIA,IL61636
37-1111134
OFFICE RENTAL IL 501(C)(3) 509(A)(2) METHODIST HEALTH SERVICES CORPORATION
 
Yes
 
(20) NELLIE R SHERWOOD TRUST

1026 A AVENUE NE

CEDAR RAPIDS,IA52402
42-6061621
PAY MEDICAL BILLS OF RETIRED TEACHERS UNABLE TO PAY IA 501(C)(3) 509(A)(3), TYPE I ST LUKE'S METHODIST HOSPITAL
 
Yes
 
(21) NORTH CENTRAL IOWA MENTAL HEALTH CENTER INCORPORATED

720 KENYON DRIVE

FORT DODGE,IA50501
42-0937390
MENTAL HEALTH CARE IA 501(C)(3) 170(B)(1) (A)(III) TRINITY HEALTH SYSTEMS INC
 
Yes
 
(22) NORTHWEST IOWA HOSPITAL CORPORATION

2720 STONE PARK BLVD

SIOUX CITY,IA51104
42-1019872
HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) IOWA HEALTH SYSTEM
 
Yes
 
(23) SELF INSURANCE TRUST AGREEMENT EST BY METHODIST MEDICAL CENTER OF ILLINOIS

221 NORTHEAST GLEN OAK AVENUE

PEORIA,IL61636
37-6181831
FUND SELF-INSURANCE PLAN IL 501(C)(3) 509(A)(3), TYPE III METHODIST MEDICAL CENER OF ILLINOIS
 
Yes
 
(24) SIOUXLAND PACE INC

313 COOK STREET

SIOUX CITY,IA51103
26-1120134
ALL-INCLUSIVE CARE FOR THE ELDERLY IA 501(C)(3) 170(B)(1) (A)(III) ST LUKE'S HEALTH SYSTEM INC
 
Yes
 
(25) ST LUKE'S HEALTH RESOURCES

2720 STONE PARK BLVD

SIOUX CITY,IA51104
42-1059182
OUTPATIENT CLINICS AND HEALTHCARE SERVICES IA 501(C)(3) 509(A)(2) ST LUKE'S HEALTH SYSTEM INC
 
Yes
 
(26) ST LUKE'S HEALTH SYSTEM INC

2720 STONE PARK BLVD

SIOUX CITY,IA51104
42-1294091
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE III IOWA HEALTH SYSTEM
 
Yes
 
(27) ST LUKE'S HEALTHCARE

1026 A AVENUE NE

CEDAR RAPIDS,IA52402
42-1487968
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM
 
Yes
 
(28) ST LUKE'S METHODIST HOSPITAL

1026 A AVENUE NE

CEDAR RAPIDS,IA52402
42-0504780
HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) ST LUKE'S HEALTHCARE
 
Yes
 
(29) ST LUKE'SJONES REGIONAL MEDICAL CENTER

1795 HIGHWAY 64 EAST

ANAMOSA,IA52205
42-1487967
HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) ST LUKE'S HEALTHCARE
 
Yes
 
(30) STL CARE COMPANY

1026 A AVENUE NE

CEDAR RAPIDS,IA52402
42-1276632
IMPROVE PUBLIC HEALTH SERVICES IA 501(C)(3) 509(A)(2) ST LUKE'S HEALTHCARE
 
Yes
 
(31) THE DUBUQUE VISITING NURSE ASSOCIATION

350 NORTH GRANDVIEW AVENUE

DUBUQUE,IA52001
42-0680410
PUBLIC HEALTH SERVICES/HOME CARE IA 501(C)(3) 509(A)(2) FINLEY TRI-STATES HEALTH GROUP INC
 
Yes
 
(32) THE FINLEY HOSPITAL

350 NORTH GRANDVIEW AVENUE

DUBUQUE,IA52001
42-0680354
HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) FINLEY TRI-STATES HEALTH GROUP INC
 
Yes
 
(33) THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH

2701 17TH STREET

ROCK ISLAND,IL61201
36-3678909
MENTAL HEALTH CARE IL 501(C)(3) 170(B)(1) (A)(VI) TRINITY REGIONAL HEALTH SYSTEM
 
Yes
 
(34) TPG HEALTH

802 KENYON ROAD

FORT DODGE,IA50501
45-3791448
SUPPORT SERVICES FOR MEDICAL CARE AND HEALTH SERVICES IA 501(C)(3) 170(B)(1) (A)(III) TRINITY HEALTH SYSTEMS INC
 
Yes
 
(35) TRINITY BUILDING CORPORATION

802 KENYON ROAD

FORT DODGE,IA50501
42-1376187
PROPERTY HOLDING COMPANY IA 501(C)(2)   TRINITY HEALTH SYSTEMS INC
 
Yes
 
(36) TRINITY HEALTH FOUNDATION

802 KENYON ROAD

FORT DODGE,IA50501
42-1222381
CHARITABLE FUNDRAISING IA 501(C)(3) 170(B)(1) (A)(VI) TRINITY HEALTH SYSTEMS INC
 
Yes
 
(37) TRINITY HEALTH FOUNDATION

2701 17TH STREET

ROCK ISLAND,IL61201
36-3321751
CHARITABLE FUNDRAISING IL 501(C)(3) 170(B)(1) (A)(VI) TRINITY REGIONAL HEALTH SYSTEM
 
Yes
 
(38) TRINITY HEALTH SYSTEMS INC

802 KENYON ROAD

FORT DODGE,IA50501
42-1222877
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IA 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM
 
Yes
 
(39) TRINITY MEDICAL CENTER

2701 17TH STREET

ROCK ISLAND,IL61201
36-2739299
HOSPITAL IL 501(C)(3) 170(B)(1) (A)(III) TRINITY REGIONAL HEALTH SYSTEM
 
Yes
 
(40) TRINITY REGIONAL HEALTH SYSTEM

2701 17TH STREET

ROCK ISLAND,IL61201
36-3351952
SUPPORT AFFILIATES' MISSION TO IMPROVE HEALTH CARE IL 501(C)(3) 509(A)(3), TYPE II IOWA HEALTH SYSTEM
 
Yes
 
(41) TRINITY REGIONAL HOSPITAL AUXILIARY

802 KENYON ROAD

FORT DODGE,IA50501
42-6081474
CHARITABLE FUNDRAISING AND VOLUNTEER SERVICES IA 501(C)(3) 509(A)(2) TRINITY REGIONAL MEDICAL CENTER
 
Yes
 
(42) TRINITY REGIONAL MEDICAL CENTER

802 KENYON ROAD

FORT DODGE,IA50501
42-1009175
HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) TRINITY HEALTH SYSTEMS INC
 
Yes
 
(43) UNITY HEALTHCARE

1518 MULBERRY AVENUE

MUSCATINE,IA52761
42-0680337
HOSPITAL IA 501(C)(3) 170(B)(1) (A)(III) TRINITY REGIONAL HEALTH SYSTEM
 
Yes
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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 V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?



(k)
Percentage
ownership


Yes No Yes No
(1) 1776 WESTLAKES PARKWAY LC

4949 WESTOWN PARKWAY SUITE 200
WEST DES MOINES,IA50266
20-5031651
OWNERSHIP/RENTAL OF 2 COMMERCIAL OFFICE BUILDINGS IA N/A
UNRELATED 229,642 12,309,952   No   Yes   33.330 %
(2) ALLEN MEMORIAL HOSPITAL ORTHOPEDIC CO-MANAGEMENT CO LLC

1825 LOGAN AVE
WATERLOO,IA50703
45-3237125
ORTHOPEDIC MANAGEMENT & ADMINISTRATIVE SERVICES IA N/A
RELATED 22,920 39,683   No     No 20.000 %
(3) CENTRAL ILLINOIS CANCER CARE CENTER LLC

7309 N KNOXVILLE
PEORIA,IL61614
26-1128108
RADIATION THERAPY IL N/A
RELATED 1,031,613 1,886,570   No   Yes   50.000 %
(4) CENTRAL IOWA CARDIOVASCULAR CO-MANAGEMENT CO LLC

1200 PLEASANT ST
DES MOINES,IA50309
27-3625869
CARDIOVASCULAR MANAGEMENT & ADMINISTRATIVE SERVICES IA N/A
RELATED 281,022 87,957   No     No 20.000 %
(5) DES MOINES PARKING ASSOCIATES

1200 PLEASANT ST
DES MOINES,IA50309
38-2622972
PARKING DECK OPERATIONS IA CENTRAL IA HEALTH PROP CORP
 
RELATED 540,801 3,772,221   No   Yes   100.000 %
(6) DUBUQUE ENDOSCOPY CENTER LC

1515 DELHI STREET SUITE 500
DUBUQUE,IA52001
20-1597161
AMBULATORY SURGERY CENTER IA THE FINLEY HOSPITAL
 
RELATED 660,133 210,769   No   Yes   51.000 %
(7) ENSEVA - HIAWATHA LLC

524 PARK ROAD
WATERLOO,IA50704
45-3437363
COLLOCATION FACILITY IA IOWA HEALTH SYSTEM
 
RELATED 2,624 2,203,353   No     No 52.000 %
(8) FINLEY DEPT OF SURGERY CO-MGMT CO LLC

350 N GRANDVIEW AVE
DUBUQUE,IA52001
42-2808785
SURGERY DEPARTMENT MANAGEMENT SERVICES IA N/A
RELATED 101,716 208,966   No     No 50.000 %
(9) FINLEYHARTIG HOMECARE LLC

703 MAIN ST
DUBUQUE,IA52001
42-1487138
SALE/RENTAL OF MEDICAL EQUIPMENT IA N/A
RELATED 132,479 842,404   No   Yes   50.000 %
(10) HEALTH CARE AFFILIATES OF THE TRI-STATES LLC

350 N GRANDVIEW AVE
DUBUQUE,IA52001
42-1428503
PROVIDE ACCESS TO LICENSED SOFTWARE IA N/A
RELATED   14,037   No   Yes   50.000 %
(11) HEALTH ENTERPRISES VENTURES LC

4250 GLASS ROAD NE
CEDAR RAPIDS,IA52402
39-1894290
INVESTMENT VEHICLE OWNING CLINICAL JVS IA N/A
UNRELATED 89,797 817,011   No 57,299   No 55.670 %
(12) HY-VEEIOWA HEALTH LC

5820 WESTOWN PARKWAY
WEST DES MOINES,IA50266
26-3293530
PRIMARY CARE CLINIC IA N/A
RELATED -175,705 44,300   No   Yes   50.000 %
(13) IOWA DIAGNOSTIC IMAGING AND PROCEDURE CENTER LC

1200 PLEASANT STREET
DES MOINES,IA50309
03-0482623
OUTPATIENT DIAGNOSTIC IMAGING IA N/A
RELATED 1,323,429 2,917,182   No   Yes   50.000 %
(14) IOWA HEALTH SYSTEM CONTRACTING SERVICES LC

1200 PLEASANT STREET
DES MOINES,IA50309
42-1511142
GROUP PURCHASING IA N/A
RELATED 4,775,894 15,888,961   No   Yes   100.000 %
(15) LAKEVIEW SURGERY CENTER LC

1200 PLEASANT STREET
DES MOINES,IA50309
42-1516120
SURGERY CENTER IA N/A
RELATED 3,443,692 4,825,696   No   Yes   50.000 %
(16) MEDICAL LABORATORIES OF EASTERN IOWA LC

1026 A AVE NE
CEDAR RAPIDS,IA52402
42-1359640
MEDICAL LABORATORY SERVICES IA N/A
RELATED 664,320 870,817   No   Yes   50.000 %
(17) METRO MRI CENTER LIMITED PARTNERSHIP

615 VALLEY VIEW DRIVE SUITE 102
MOLINE,IL61265
36-3710164
PROVIDE MRI AND OTHER MEDICAL SERVICES IL N/A
RELATED 600,876 1,499,952   No   Yes   33.970 %
(18) MR ASSOCIATES LLP

1455 SHERMAN ROAD
HIAWATHA,IA52233
42-1260463
OWN AND OPERATE MR UNIT IA N/A
RELATED 2,540,143 1,416,839   No   Yes   33.330 %
(19) NE IA PHYSICAL THERAPY AND SPORTS MEDICINE LLC

1825 LOGAN AVE
WATERLOO,IA50703
20-2124978
ATHLETIC TRAINING AND SPORTS MEDICINE IA N/A
RELATED -41,070     No   Yes    
(20) ORTHOPAEDIC OUTPATIENT SURGERY CENTER LC

1200 PLEASANT STREET
DES MOINES,IA50309
42-1508092
AMBULATORY SURGERY CENTER IA N/A
RELATED 3,314,858 3,461,181   No   Yes   50.000 %
(21) PIERCE STREET SAME DAY SURGERY LC

2730 PIERCE STREET
SIOUX CITY,IA51104
20-5895205
AMBULATORY SURGERY CENTER IA N/A
RELATED 931,816 3,357,708   No   Yes   50.000 %
(22) QUAD CITY AMBULATORY SURGERY CENTER LLC

520 VALLEY VIEW DRIVE SUITE 300
MOLINE,IL61265
36-4471903
AMBULATORY SURGERY CENTER. IL N/A
RELATED 255,765 3,500,259   No   Yes   50.000 %
(23) REHABILITATION THERAPY SERVICES LLC

416 ST MARKS CT 110
PEORIA,IL61603
81-0584193
REHABILATION THERAPY IL METHODIST MEDICAL CENTER OF ILLINOIS
 
RELATED 448,732 1,397,476   No   Yes   60.030 %
(24) THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS LLC

1075 FIRST AVENUE SE
CEDAR RAPIDS,IA52403
72-1550812
AMBULATORY SURGERY CENTER. IA N/A
RELATED 3,310,383 7,115,889   No   Yes   50.000 %
(25) TRINITY BETTENDORF ORTHOPEDIC CO-MANAGEMENT COMPANY LLC

4500 UTICA RIDGE RD
BETTENDORF,IA52722
27-2562753
ORTHOPEDIC SERVICE LINES ADMINISTRATIVE SERVICES IA N/A
RELATED 175,377 118,891   No   Yes   50.000 %
(26) TRI-WEBSTER LC

1610 COLLINS ST
WEBSTER CITY,IA50595
01-0740062
MEDICAL BUILDING AND SURROUNDING PROPERTY IA N/A
RELATED 110,738 1,715,230   No   Yes   50.000 %
(27) WEST HOSPITAL ORTHOPEDIC CO-MANAGEMENT COMPANY LLC

1660 60TH STREET
WEST DES MOINES,IA50266
27-1414600
ORTHOPEDIC SERVICE LINES MANAGEMENT IA N/A
RELATED 244,306 26,600   No   Yes   20.000 %
(28) WEST LAKES MEDICAL EQUIPMENT LLC

5950 UNIVERSITY AVENUE SUITE 321
WEST DES MOINES,IA50266
26-3300536
MEDICAL EQUIPMENT SALES AND RENTAL IA N/A
UNRELATED 59,770 171,967   No 59,770 Yes   50.000 %
(29) WEST LAKES SLEEP CENTER LLC

5950 UNIVERSITY AVENUE SUITE 2
WEST DES MOINES,IA50266
26-3193923
SLEEP DISORDER DIAGNOSTIC TESTING FACILITY IA N/A
RELATED 92,541 318,508   No   Yes   50.000 %
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) BROADBAND INC
1200 PLEASANT ST
DES MOINES,IA50309
27-3819741
INFORMATION TECHNOLOGY MGMT. IA IHS
 
C 338,870 13,238,641 100.000 %
(2) CHARITABLE REMAINDER UNITRUST #1
 
 
INVESTMENT IA SLHCF
 
T      
(3) CHARITABLE REMAINDER UNITRUST #2
 
 
INVESTMENT IA SLHCF
 
T      
(4) CHARITABLE REMAINDER UNITRUST #3
 
 
INVESTMENT IA SLHCF
 
T      
(5) CHARITABLE REMAINDER UNITRUST #6
 
 
INVESTMENT IA SLHCF
 
T      
(6) IOWA HEALTH SYSTEM 457 DEF COMP PLAN
1415 WOODLAND AVE 2ND FL
DES MOINES,IA50309
42-1435199
INVESTMENT IA IHS
 
T 266,087 4,546,270 100.000 %
(7) METHODIST HEALTH VENTURES INC
PO BOX 87
PEORIA,IL61650
37-1140939
PHARMACY/OFFICE STAFFING IL MHSC
 
C 868,566 2,437,393 100.000 %
(8) MEDIMORE INC
1200 PLEASANT ST
DES MOINES,IA50309
42-1414390
MANAGED CARE IA IHS
 
C 210,170   100.000 %
(9) METHODIST PHYSICIAN SERVICES INC
PO BOX 87
PEORIA,IL61650
36-3858550
MEDICAL SERVICES IL MHVI
 
C 11,908,671 1,305,915 100.000 %
(10) PRECEDENCE INC
4622 PROGRESS DRIVE STE A
DAVENPORT,IA52807
37-1288604
MANAGED MENTAL CARE IA RYC
 
C 506,534 435,657 100.000 %
(11) PROVIDER RESOURCE MANAGEMENT INC
PO BOX 87
PEORIA,IL61650
37-1223550
RESOURCE MANAGEMENT IL MHSC
 
C   57,427 100.000 %
(12) RURAL IOWA SPECIALTY PHYSICIAN CONSORTIUM INC
700 E UNIVERSITY AVE
DES MOINES,IA50316
26-1271143
SPECIALTY PHYSICIANS MEDICAL CARE IA CIHC
 
C 481,860 198,055 57.000 %
(13) STL HEALTH RESOURCES CO
1026 A AVE NE
CEDAR RAPIDS,IA52402
42-1193499
PHYSICIAN OFFICE RENTAL IA SLMH
 
C 322,129 5,577,505 100.000 %
(14) TRIMARK PHYSICIANS GROUP INC
802 KENYON ROAD
FORT DODGE,IA50501
42-1335554
MEDICAL CLINICS IA THS
 
C 44,216,247   100.000 %
(15) TRINITY HEALTH ENTERPRISES INC
2701 17TH ST
ROCK ISLAND,IL61201
36-3320141
RETAIL DURABLE MEDICAL EQUIPMENT & PHARMACY IL TRHS
 
C 3,295,832 2,957,465 100.000 %
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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
No
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 . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
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) CENTRAL ILLINOIS CANCER CARE CENTER LLC

R 950,000 BASED ON GAAP, CASH, AND/OR FMV.
(2) REHABILITATION THERAPY SERVICES LLC

R 240,000 BASED ON GAAP, CASH, AND/OR FMV.
(3) SELF INSURANCE TRUST AGREEMENT EST BY MMCI

C 3,000,000 BASED ON GAAP, CASH, AND/OR FMV.
(4)

(5)

(6)

Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations?
(f)
Share of total income




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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
SECTION 512(B)(13) CONTROLLED ENTITY SCHEDULE R, PART II, COLUMN (G) THE ORGANIZATION IS A MEMBER OF A CONSOLIDATED HEALTH SYSTEM AND HAS A COMMON PARENT ORGANIZATION, "IOWA HEALTH SYSTEM." FOR ENTITIES THAT ARE PART OF THE CONSOLIDATED HEALTH SYSTEM (WITH COMMON CONTROL) THE ATTRIBUTION RULES OF IRC SECTION 318 APPLY; MEANING THAT ALL ORGANIZATIONS ARE DEEMED TO HAVE CONTROL OF THE ORGANIZATIONS OWNED BY THE CONTROLLING ORGANIZATION. AS SUCH, WE ARE REPORTING ALL RELATED ORGANIZATIONS OF THE HEALTH SYSTEM IN PARTS II, III & IV. FOR PART V REPORTING, THE TRANSACTIONS DISCLOSED ARE THOSE BETWEEN THE DIRECTLY CONTROLLED PARENT-SUBSIDIARY ONLY.
Additional Data


Software ID:  
Software Version: