Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
DECATUR MEMORIAL HOSPITAL
Employer identification number
37-0661199
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
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
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
Provide the following information about the supported organization(s).
(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) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
DECATUR MEMORIAL HOSPITAL
Employer identification number
37-0661199
Identifier
Return Reference
Explanation
ADDITIONAL INFORMATION
FORM 990
FORM 990, PART I, ITEM 1 AND FORM 990, PART III, ITEM 1: DMH'S MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE OF CENTRAL ILLINOIS, RELYING ON ITS CORE FOUNDATIONS OF COMMITTED PHYSICIANS, CONSTRUCTIVE CULTURE, RESPONSIBLE GOVERNANCE, PROCESS INNOVATION, MANAGERIAL COMPETENCE, AND ENGAGED EMPLOYEES. WITH A HISTORY DATING BACK TO 1916, DMH TODAY ENCOMPASSES TWELVE STATE-OF-THE-ART CENTERS OF EXCELLENCE WHICH FOCUS ON THE CUTTING EDGE OF MEDICINE TODAY AND PROVIDE THE COMMUNITY WITH AWARD-WINNING HEALTH CARE. APPROXIMATELY 250,000 PERSONS RESIDE IN DMH'S SERVICE AREA, INCLUDING SUBSTANTIAL NUMBERS OF MEDICARE AND MEDICAID BENEFICIARIES, AS WELL AS PERSONS WHO DO NOT QUALIFY FOR EITHER PROGRAM AND THUS SEEK CARE PURSUANT TO DMH'S FINANCIAL ASSISTANCE (CHARITY CARE) PROGRAM. THE LOCAL COMMUNITY HAS BEEN HIT HARD BY THE RECENT ECONOMIC DECLINES. IN RESPONSE TO THESE CONDITIONS, DMH HAS EXPANDED ITS THRESHOLD FOR PROVISION OF FINANCIAL ASSISTANCE TO SIX TIMES THE FEDERAL POVERTY GUIDELINES; FOR THESE AND OTHER PATIENTS, DMH OFFERS SLIDING SCALE DISCOUNTS AND EXTENDED PAYMENT TERMS IN AN EFFORT TO ENSURE THAT PATIENTS ARE ABLE TO OBTAIN NECESSARY MEDICAL CARE. DURING THE FISCAL YEAR, DMH PROVIDED SIGNIFICANT FREE OR DISCOUNTED SERVICES TO PATIENTS QUALIFYING FOR FINANCIAL ASSISTANCE AS WELL AS OTHER FORMS OF COMMUNITY BENEFIT PROGRAMS, GRANTS AND SERVICES. SEE SCHEDULE H FOR MORE DETAIL.
SECOND ACHIEVEMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4B
INPATIENT CARE WAS PROVIDED BY DMH'S TEAM OF HIGHLY-QUALIFIED, TALENTED STAFF (TODAY NUMBERING OVER 2,300 IN ALL), INCLUDING HOSPITALISTS, NURSES, AIDES, DIETICIANS, CASE MANAGEMENT STAFF, SOCIAL WORKERS, AND CHAPLAINS.
ALL OTHER ACHIEVEMENTS DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4D
EDUCATION AND OUTREACH: DMH HAS CONCLUDED THAT, TO FULFILL ITS MISSION OF IMPROVING HEALTH, IT MUST BECOME INVOLVED IN THE EDUCATION, AWARENESS AND PREVENTION OF DISEASE AND ILLNESS THAT NEGATIVELY IMPACT HEALTH STATUS. IN AN EFFORT TO GIVE COMMUNITY RESIDENTS THE TOOLS NECESSARY TO MAKE HEALTHY LIFESTYLE DECISIONS, DMH SEEKS OUT OPPORTUNITIES AND ACTIVELY INVOLVES ITSELF IN THE LOCAL COMMUNITY, THROUGH MEASURES RANGING FROM PROGRAMS FOR LOCAL SCHOOLS TO DMH'S POPULAR "PRIME TIME" PROGRAM FOR SENIORS. IN RECENT YEARS, DMH HAS PARTICIPATED IN VARIOUS COMMUNITY HEALTH NEEDS ASSESSMENT INITIATIVES, AS A RESULT OF WHICH DMH HAS IDENTIFIED SIGNIFICANT CONCERNS SUCH AS ACCESS TO PRIMARY CARE PHYSICIANS AND SPECIALISTS, CARDIAC SCREENINGS, OBESITY, INDIGENT OUTPATIENT LONGITUDINAL CARE, DIABETES EDUCATION, AND INFANT MORTALITY. WITH THE LEADERSHIP OF A MULTIDISCIPLINARY COMMUNITY BENEFITS COMMITTEE, INCLUDING PARTICIPATION BY A DIVERSE GROUP OF COMMUNITY REPRESENTATIVES, DMH HAS TAKEN A PRIMARY ROLE IN CONFRONTING THESE ISSUES. AS JUST ONE EXAMPLE, DMH IS SPONSORING A LOCAL VERSION OF THE PREVENTION PLAN CHALLENGE, A NATIONAL WELLNESS INITIATIVE THAT FOCUSES ON PREVENTIVE CARE TO HELP PEOPLE LIVE HEALTHIER AND LOWER HEALTHCARE COSTS WITHIN THE COMMUNITY; THROUGH THIS COMPETITION AMONG LOCAL EMPLOYERS, DMH HOPES TO SPUR COMPANIES TO BUILD HEALTHIER WORKFORCES.
RELATED PARTY INFORMATION AMONG OFFICERS
FORM 990, PAGE 6, PART VI, LINE 2
KENNETH SMITHMIER ROBIN KING DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KENNETH SMITHMIER LARRY ALTENBAUMER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KENNETH SMITHMIER DAVID SMITH DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KENNETH SMITHMIER PAULA EISSFELDT DIRECTOR DIRECTOR BUSIENSS RELATIONSHIP KENNETH SMITHMIER JAMES DAHL DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KENNETH SMITHMIER WALTER SMITH DIRECTOR DIRECTOR BUSINESS RELATIONSHIP LARRY ALTENBAUMER KENNETH SMITHMIER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP LARRY ALTENBAUMER ROBIN KING DIRECTOR DIRECTOR BUSINESS RELATIONSHIP LARRY ALTENBAUMER PAULA EISSFELDT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP LARRY ALTENBAUMER JAMES DAHL DIRECTOR DIRECTOR BUSINESS RELATIONSHIP LARRY ALTENBAUMER DAVID SMITH DIRECTOR DIRECTOR BUSINESS RELATIONSHIP LARRY ALTENBAUMER WALTER SMITH DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DAVID TYROLT ROBIN KING DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DAVID TYROLT RON DRANE DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DAVID SMITH PAULA EISSFELDT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DAVID SMITH KENNETH SMITHMIER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DAVID SMITH LARRY ALTENBAUMER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DAVID SMITH JAMES DAHL DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DAVID SMITH ROBIN KING DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DAVID SMITH WALTER SMITH DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DUANE NOLAND JAMES DAHL DIRECTOR DIRECTOR BUSINESS RELATIONSHIP ROY MOSSER RON DRANE DIRECTOR DIRECTOR BUSINESS RELATIONSHIP WALTER SMITH RON DRANE DIRECTOR DIRECTOR BUSINESS RELATIONSHIP WALTER SMITH LARRY ALTENBAUMER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP WALTER SMITH JAMES DAHL DIRECTOR DIRECTOR BUSINESS RELATIONSHIP WALTER SMITH ROBIN KING DIRECTOR DIRECTOR BUSINESS RELATIONSHIP WALTER SMITH DAVID SMITH DIRECTOR DIRECTOR BUSINESS RELATIONSHIP WALTER SMITH KENNETH SMITHMIER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP RON DRANE DAVID TYROLT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP RON DRANE ROY MOSSER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP RON DRANE THOMAS KOWA DIRECTOR DIRECTOR BUSINESS RELATIONSHIP RON DRANE WALTER SMITH DIRECTOR DIRECTOR BUSINESS RELATIONSHIP THOMAS KOWA RON DRANE DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JAMES DAHL DUANE NOLAND DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JAMES DAHL LARRY ALTENBAUMER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JAMES DAHL ROBIN KING DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JAMES DAHL DAVID SMITH DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JAMES DAHL WALTER SMITH DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JAMES DAHL KENNETH SMITHMIER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP PAULA EISSFELDT KENNETH SMITHMIER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP PAULA EISSFELDT DAVID SMITH DIRECTOR DIRECTOR BUSINESS RELATIONSHIP PAULA EISSFELDT LARRY ALTENBAUMER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP ROBIN KING LARRY ALTENBAUMER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP ROBIN KING KENNETH SMITHMIER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP ROBIN KING DAVID TYROLT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP ROBIN KING JAMES DAHL DIRECTOR DIRECTOR BUSINESS REALTIONSHIP ROBIN KING DAVID SMITH DIRECTOR DIRECTOR BUSINESS RELATIONSHIP ROBIN KING WALTER SMITH DIRECTOR DIRECTOR BUSINESS RELATIONSHIP
CLASSES OF MEMBERS OR STOCKHOLDERS
FORM 990, PAGE 6, PART VI, LINE 6
THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS DMH HEALTH SYSTEMS, INC., AN ILLINOIS NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS BEING DESCRIBED IN SEC. 501(C)(3), IRC.
ELECTION OF MEMBERS AND THEIR RIGHTS
FORM 990, PAGE 6, PART VI, LINE 7A
AS THE SOLE CORPORATE MEMBER OF DMH, DMH HEALTH SYSTEMS HAS THE RIGHT TO APPROVE ALL DIRECTORS OF DMH, AND TO REMOVE ANY DIRECTOR SO APPROVED.
DECISIONS SUBJECT TO APPROVAL OF MEMBERS
FORM 990, PAGE 6, PART VI, LINE 7B
THE DMH BOARD OF DIRECTORS GENERALLY OVERSEES AND DIRECTS ALL ACTIVITIES, ASSETS AND OPERATIONS OF DMH, SUBJECT TO THE RIGHTS AND AUTHORITY SPECIFICALLY RESERVED TO DMH HEALTH SYSTEMS, AS THE SOLE CORPORATE MEMBER, IN THE DMH BYLAWS. THESE RIGHTS PERTAIN TO THE APPOINTMENT AND REMOVAL OF DIRECTORS, ELECTION OF THE PRESIDENT AND TREASURER, NOMINATION OF OTHER OFFICERS, AMENDMENT OF ARTICLES AND BYLAWS, APPROVAL OF BUDGETS AND LONG RANGE PLANS, APPROVAL OF ANY MERGER OR CONSOLIDATION, APPROVAL OF SIGNIFICANT TRANSACTIONS, APPROVAL OF DISSOLUTION, CREATION OF ANY SUBSIDIARIES OR AFFILITATES, AND APPOINTMENT OF THE INDEPENDENT AUDITOR.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
A COPY OF THE FORM 990, ALONG WITH AN EXPLANATORY NOTE, IS PROVIDED FOR REVIEW TO THE BOARD VIA AN INTRANET SITE PRIOR TO FILING. ALSO, THE FORM 990 IS REVIEWED AND DISCUSSED AT A REGULARLY SCHEDULED BOARD MEETING PRIOR TO FILING.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
ANNUALLY, ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO SUBMIT A CONFLICT OF INTEREST DISCLOSURE TO THE CEO. A LIST OF POTENTIAL CONFLICTS IS PREPARED AND IS AVAILABLE FOR REFERENCE PRIOR TO EACH BOARD AND COMMITTEE MEETING. THE CFO'S OFFICE MONITORS AND PERIODICALLY REVIEWS TRANSACTIONS BETWEEN THE ORGANIZATION AND BOARD MEMBERS OR ENTITIES WITH WHICH THEY ARE AFFILIATED.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
THE BOARD OF DIRECTORS OF DMH HEALTH SYSTEMS (THE SOLE CORPORATE MEMBER OF DMH) HAS ADOPTED AN EXECUTIVE COMPENSATION POLICY AND PROCEDURE SETTING FORTH THE AUTHORITY AND PROCESS REGARDING COMPENSATION DETERMINATIONS FOR THE TOP EXECUTIVES OF DMH AND ITS AFFILIATES (THE CEO AND FIVE OTHER EXECUTIVES). PURSUANT TO THE POLICY, THE BOARD HAS DELEGATED TO THE EXECUTIVE COMMITTEE THE RESPONSIBILITY TO REVIEW INDEPENDENT MARKET DATA, ASSESS THE COMPARABILITY OF SUCH DATA, AND MAKE RECOMMENDATIONS TO THE BOARD REGARDING COMPENSATION PROPOSED TO BE PAID. IN CARRYING OUT THEIR RESPECTIVE COMPENSATION-RELATED RESPONSIBILITIES, THE BOARD AND EXECUTIVE COMMITTEE EXCLUDE ANY PERSON DEEMED TO HAVE A CONFLICT OF INTEREST WITHIN THE MEANING OF APPLICABLE TREASURY REGULATIONS (INCLUDING ANY PHYSICIANS EMPLOYED BY DMH OR ON ITS MEDICAL STAFF). AS PROVIDED IN THE POLICY, THE EXECUTIVE COMMITTEE CONDUCTS AN IN-DEPTH TOTAL COMPENSATION ANALYSIS USUALLY EVERY TWO YEARS WITH THE ASSISTANCE OF AN INDEPENDENT NATIONALLY-RECOGNIZED COMPENSATION CONSULTING FIRM. IN THE OFF-YEARS BETWEEN IN-DEPTH REVIEWS, THE COMMITTEE TYPICALLY HAS OBTAINED FROM ITS CONSULTING FIRM AN UPDATED ASSESSMENT TO CONFIRM CONTINUED COMPARABILITY WITH MARKET DATA. CONSISTENT WITH THE FOREGOING, IN SEPTEMBER 2011, DMH OBTAINED SUCH AN UPDATE REPORT FROM ITS INDEPENDENT COMPENSATION CONSULTING FIRM, COVERING THE FOLLOWING INDIVIDUALS: SMITHMIER (CEO), STONE (COO), PEACOCK (CFO), ZIA (VPMA), AND FAHEY (CNO). ALL DETERMINATIONS OF THE BOARD AND EXECUTIVE COMMITTEE ARE THOROUGHLY AND TIMELY DOCUMENTED IN APPROPRIATE MINUTES AND SUPPORTING MATERIALS.
COMPENSATION PROCESS FOR OFFICERS
FORM 990, PAGE 6, PART VI, LINE 15B
SEE RESPONSE TO FORM 990, PART VI.B, LINE 15A ABOVE.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
THE GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL INFORMATION OF DMH ARE AVAILABLE TO THE PUBLIC UPON SPECIFIC REQUEST TO DMH ADMINISTRATION.
ADDITIONAL INFORMATION
FORM 990, PART VII
GARY PEACOCK (FORMER SENIOR VP AND CFO) RETIRED IN JANUARY 2010. DMH ENGAGED IN A CONSULTING CONTRACT WITH MR. PEACOCK FROM JANUARY 16, 2010 THROUGH DECEMBER 31, 2010. MR. PEACOCK'S CONTRACT WAS FOR 2,000 PER MONTH PLUS 150 PER HOUR FOR EACH HOUR WORKED. OVER THE COURSE OF THE CONTRACT MR. PEACOCK WAS PAID 26,024. MR. PEACOCK HANDLED A BROAD RANGE OF TRANSITION-RELATED MATTERS INCLUDING (I) THE PENDING IRS AUDIT OF DMH AND DMH FOUNDATION; (II) OTHER FINANCE OR ACCOUNTING RELATED ISSUES INCLUDING WITHOUT LIMITATION THOSE PERTAINING TO INVESTMENTS, RETIREMENT BENEFIT PLANS, AND DMH'S INDEPENDENT AUDIT FUNCTION; (III) QUESTIONS ASSOCIATED WITH DMH'S PAST AND CURRENT OUTSTANDING BONDS AND OTHER INDEBTEDNESS; AND (IV) MATTERS ASSOCIATED WITH PHYSICIAN RELATIONSHIPS HISTORICALLY UNDER HIS SUPERVISION. IN OCTOBER 2011 MR. PEACOCK WAS REHIRED AS SENIOR VP & CFO.
ADDITIONAL INFORMATION
FORM 990, PART XI
ON SEPT. 30, 2011, DECATUR MEMORIAL HOSPITAL AUXILIARY, EIN: 37-6036506, A RELATED SEC. 501(C)(3) ORGANIZATION, WAS COMBINED INTO DMH. ASSETS CONSISTING OF CASH OF 155,227 AND INVENTORY OF 248,146 WERE TRANSFERRED TO DMH PURSUANT TO A COMBINATION, ASSIGNMENT, AND ASSUMPTION AGREEMENT EFFECTIVE SEPTEMBER 30, 2011.
OTHER CHANGES IN NET ASSETS EXPLANATION
FORM 990, PART XI, LINE 5
OTHER CHANGES IN NET ASSETS CONSIST OF THE FOLLOWING: BOOK/TAX DIFFERENCES IN INCOME FROM PARTNERSHIPS (INCREASE OF 144,573); TRANSFER OF NET ASSETS FROM DECATUR MEMORIAL AUXILIARY IN CONJUNCTION WITH COMBINATION OF AUXILIARY INTO HOSPITAL (INCREASE OF 300,857); CHANGE IN MINIMUM PENSION LIABILITY (DECREASE OF 629,985); TRANSFER OF CAPITAL FROM AFFILIATE (INCREASE OF 151,301); CHANGE OF VALUE OF FUNDS HELD IN TRUST (INCREASE OF 1,183,894); AND UNREALIZED LOSSES ON INVESTMENTS (DECREASE OF 7,017,771).
ADDITIONAL INFORMATION
FORM 990, PART XII
DECATUR MEMORIAL HOSPITAL WAS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF DMH HEALTH SYSTEMS AND AFFILIATED ORGANIZATIONS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.