TY 2011 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) James WBreckenridge Director	1.00	X		454,003	37,875
(2) Thomas DBudd Director	.30	X		0	0
(3) John WChadwick Director	.30	X		0	0
(4) Eleanor FDoar Director	1.00	X		0	0
(5) John TDorsey Director	.10	X		326,375	51,104
(6) Pamela SFox Director	.10	X		0	0
(7) Jos LGonzalez Director	.70	X		397,162	54,899
(8) Alphonso NGoode Director	1.00	X		0	0
(9) Jack WPackard Director	.50	X		0	0
(10) Dennis TUehara Director	20.50	X		469,530	71,890
(11) Connie MVitali Director	2.00	X		0	0
(12) Curtis DWorden Director	.50	X		0	0
(13) Paul AGreen Chairman	1.00	X	X	0	0
(14) Duane RBach Treas/Vice-Chair	.10	X	X	0	0
(15) Gary EKaatz President	1.00	X	X	1,065,011	210,096
(16) Henry MSeybold Treasurer	3.00		X	494,320	104,980
(17) Julie APeterson Secretary	1.00		X	77,262	34,984

(A) Name and business address	(B) Description of services	(C) Compensation
Philips Medical System PO Box 100355 Atlanta,GA30384	Contract Maintenance	2,066,730
Cardiac Surgery Associates PO Box 1285 Joliet,IL604341285	Healthcare Provider	1,200,000
Schmeling Construction Co 315 Harrison Ave Rockford,IL61104	General Contractors	2,391,554
HLS Wheeling LLC 45 W Hintz Wheeling,IL600906073	Laundry Services	1,112,330
Air Methods Corp PO Box 676592 Dallas,TX752676592	Helicopter Pilot/Services	1,213,288
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 69

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	580,004	580,004
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	369,086		369,086
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	107,475,700	85,795,649	21,680,051
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	7,875,308	3,433,571	4,441,737
9	Other employee benefits .......	21,494,708	19,799,336	1,695,372
10	Payroll taxes ...........	7,209,596	6,243,896	965,700
11	Fees for services (non-employees):
a	Management ......	4,028,495	18,688	4,009,807
b	Legal .........	170,195		170,195
c	Accounting ...........	177,702		177,702
d	Lobbying ...........	0
e	Professional fundraising. See Part IV, line 17..
f	Investment management fees ......	722,261		722,261
g	Other ..........	869,474	376,209	493,264
12	Advertising and promotion ....	984,572	3,305	981,267
13	Office expenses .......	9,968,619	6,234,613	3,734,006
14	Information technology ......	8,878,695	3,733,206	5,145,489
15	Royalties ..	0
16	Occupancy ...........	9,665,537	6,233,824	3,431,713
17	Travel ............	161,014	129,975	31,039
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	625,743	181,816	443,927
20	Interest ...........	2,664,447	2,664,447
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	16,035,682	10,308,375	5,727,307
23	Insurance ..............	5,401,312	4,274,318	1,126,994
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	Medicaid Assessment Tax	9,947,850	9,947,850
b	Supplies/Drugs	47,898,838	47,653,459	245,379
c	Healthcare Services	12,069,966	12,069,966
d	Bad Debt Expense	15,733,857	15,733,857
e
f	All other expenses	7,450,564	6,600,011	850,553
25	Total functional expenses. Add lines 1 through 24f	298,459,225	242,016,375	56,442,849	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 if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	3,500	1	4,300
2	Savings and temporary cash investments .......	56,353,959	2	24,657,024
3	Pledges and grants receivable, net .........	494,476	3	393,042
4	Accounts receivable, net .........	44,815,243	4	63,598,137
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 .............	12,713	7	8,339
8	Inventories for sale or use ..............	6,056,539	8	6,499,050
9	Prepaid expenses and deferred charges ............	6,805,891	9	6,476,302
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	285,367,409
b	Less: accumulated depreciation. .....	10b	196,889,444	79,293,676	10c	88,477,965
11	Investments—publicly traded securities ..........	158,236,077	11	153,262,728
12	Investments—other securities. See Part IV, line 11 ......		12
13	Investments—program-related. See Part IV, line 11 ..		13
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........	20,795,777	15	20,416,514
16	Total assets. Add lines 1 through 15 (must equal line 34)...	372,867,851	16	363,793,401
	17	Accounts payable and accrued expenses .	108,410,765	17	113,099,756
18	Grants payable ..........		18
19	Deferred revenue ..........		19
20	Tax-exempt bond liabilities ..........	70,987,769	20	67,936,205
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 ..	685,072	23	174,834
24	Unsecured notes and loans payable to unrelated third parties ....		24
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.....	28,256,473	25	25,408,276
26	Total liabilities. Add lines 17 through 25.....	208,340,079	26	206,619,071
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	156,330,922	27	148,928,034
28	Temporarily restricted net assets .....	5,571,691	28	5,621,137
29	Permanently restricted net assets .....	2,625,159	29	2,625,159
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	164,527,772	33	157,174,330
34	Total liabilities and net assets/fund balances .....	372,867,851	34	363,793,401

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SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

Rockford Memorial Hospital

Employer identification number

36-2167847

Part I

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Type I

Type II

Type III - Functionally integrated

Type III - Other

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

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

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

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

Yes

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

11g(i)

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

11g(ii)

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

11g(iii)

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 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).

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

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

Section C. Computation of Public Support Percentage

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

0 %

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

16a

33 1/3% support test—2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2010. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

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

Schedule A (Form 990 or 990-EZ) 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.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

0 %

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

0 %

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 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:	11000218
Software Version:	2011.0.0

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

OMB No. 1545-0047

2011

Name of organization

Rockford Memorial Hospital

Employer identification number

36-2167847

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

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

Name of organization Rockford Memorial Hospital
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
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	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization Rockford Memorial Hospital
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
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
Rockford Memorial Hospital

Employer identification number

36-2167847

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
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

(d)
Description of how gift is held

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:	11000218
Software Version:	2011.0.0

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SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 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

Rockford Memorial Hospital

Employer identification number

36-2167847

Part I

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

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

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

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds 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? ...................................

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

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

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

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

Yes No

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

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

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

Yes No

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

Part III

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

If the organization elected, as permitted under SFAS 116 (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.

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

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:

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No

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


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

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

Yes No

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

Part V

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

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back
1a	Beginning of year balance ....	4,630,241	4,309,770	3,472,212	4,463,526
b	Contributions ........	857,889	748,599	555,556	800,219
c	Net investment earnings, gains, and losses ...	-82,645	347,198	938,002	-1,259,075
d	Grants or scholarships .....	170,000	190,000	250,000	200,000
e	Other expenditures for facilities and programs ........	687,889	558,599	381,821	305,881
f	Administrative expenses ....	28,254	26,727	24,179	26,577
g	End of year balance ......	4,519,342	4,630,241	4,309,770	3,472,212

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

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

Yes

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

3a(i)

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

3a(ii)

Yes

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

Yes

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

Part VI

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 .................	468,730	2,111,708		2,580,438
b	Buildings ................	5,460,891	48,690,900	37,693,422	16,458,369
c	Leasehold improvements ............		99,060	91,690	7,370
d	Equipment ................		212,480,448	153,714,230	58,766,218
e	Other .................		16,055,672	5,390,102	10,665,570
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......					88,477,965

Schedule D (Form 990) 2011

Page 3

Part VII

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

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








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

Part VIII

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

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









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

Part IX

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

(a) Description				(b) Book value
(1) Deferred Financing Costs				591,145
(2) Other				5,113,654
(3) Land Held for Future Use				6,422,260
(4) Partnerships				8,289,455
(5) Deposits




Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				20,416,514

Part X

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

1.(a) Description of Liability		(b) Book value
Federal Income Taxes
Post Retirement		5,379,032
Basic Pension		19,706,195
Capital Lease		323,049






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		25,408,276
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

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
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3
4	Net unrealized gains (losses) on investments ..........................	4
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV.) .................................	8
9	Total adjustments (net). Add lines 4 through 8 .........................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10

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
X	2	- Rockford Memorial Hospital as a part of RHS Rockford Health System adopted FIN 48 in 2007 and the impact was not material. Therefore there was no audit footnote in 2011.

Schedule D (Form 990) 2011

Additional Data

Software ID:	11000218
Software Version:	2011.0.0

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Rockford Memorial Hospital

Employer identification number

36-2167847

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....

Yes

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

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

Yes

100% 150% 200% Other 17500.0000000000 %

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: ............

Yes

200% 250% 300% 350% 400% Other

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.

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"? ..............

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......

Yes

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

Did the organization prepare a community benefit report during the tax year?...........

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Financial Assistance at cost (from Worksheet 1) ..	8,668,477		8,668,477	2.820 %
b Medicaid (from Worksheet 3, column a) .....	75,103,382	83,356,760	-8,253,378
c Costs of other means-tested government programs (from Worksheet 3, column b) .
dTotal Financial Assistance and Means-Tested Government Programs .....	83,771,859	83,356,760	415,099	2.820 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	1,660,967	734,255	926,712	0.310 %
f Health professions education (from Worksheet 5) ..	1,854,173	179,627	1,674,546	0.560 %
g Subsidized health services (from Worksheet 6) ..	25,696,858	22,760,647	2,936,211	0.980 %
h Research (from Worksheet 7)
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....	485,891		485,891	0.160 %
jTotal Other Benefits ...	29,697,889	23,674,529	6,023,360	2.010 %
kTotal. Add lines 7d and 7j. ..	113,469,748	107,031,289	6,438,459	4.830 %

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
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

Enter the amount of the organization's bad debt expense........

15,761,729

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....

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

Section B. Medicare

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

82,677,418

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

84,499,414

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

-1,821,996

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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.......................

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 %
1VanMatre Health South	Rehab Hospital	50.000 %
2
3
4
5
6
7
8
9
10
11
12
13

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		Other (Describe)
1	Rockford Memorial Hospital 2400 N Rockton Avenue Rockford,IL61103	X	X	X	X	X	X
2	VanMatre Health South 950 S Mulford Rockford,IL61108	X						Rehabilitation

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)

Name of Hospital Facility:

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

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 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
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?.......		9
	If “Yes,” indicate the FPG family income limit for eligibility for free care: %

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: % If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted 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
15	Check all of the following 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	DDid 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
	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

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
	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
	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
	If “Yes,” explain in Part VI.

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?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

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 3c		Rockford Memorial Hospital RMH offers two charity care programs - HUPDA and our traditional charity care program. We will process charity care for whichever provides the highest percentage of discount. These criteria are determined as early as possible, preferably before or at the time of service. HUPDA is the Illinois Hospital Uninsured Patient Discount Act for all uninsured patients. Eligibility consists of being an uninsured Illinois resident, income below 600 of FPG, being
Part I line 3c		continued treated for a medically necessary condition or event, limited to 25 of annual income. Patients submit proof of income including tax returns/pay stubs within 60 days of discharge. Traditional discounts follow our internal traditional charity care program for those who are uninsured or are insured with a patient liability. This income limit is 300 of FPG. Patient must submit proof of income that includes tax returns. Underinsured patients may be eligible for other
Part I line 3c		continued discounts towards the patient liability. There are also potential discounts for Catastrophic Financial Assistance and/or Prompt Pay. Extenuating circumstances may also be taken into account. Our partner hospital VMHS is a for-profit hospital that is part of a larger health organization. Therefore most of the responses concern only the RMH process and procedures.
Part I line 6a		Rockford Health System prepares an annual Hospital Community Benefit Report as required by the State of Illinois. The report includes data for Rockford Memorial Hospital RMH as well as the other four related tax-exempt organizations. The report is distributed within the health system and is also available upon request.
Part I line 6a		continued Our partner hospital VMHS is a for-profit hospital that is part of a larger health organization. As such, they do not prepare a community benefit report. This and most of the following responses concern only the RMH process and procedures.
Part I line 7		The hospital utilized both the Medicare Cost Report CCR cost-to-charge ratio and our cost accounting system to determine the cost of charges, bad debt and charity care expense included in Line 7. The subsidized programs also include the costs based on a calculated CCR from our physician clinic because there are no physicians costs included in the hospital cost accounting analysis. Bad debt and charity at cost have been removed from lines 7e/7f/7g since those costs were previously included.
Part III line 4		Rockford Health System Consolidated Audit reports The Systems policy is to provide medically necessary health care services regardless of the patients ability to pay for such care. RHS maintains records to identify and monitor the charity, uncompensated care and community benefit it provides. These records include the cost for services and supplies furnished under its policies as well as the estimated difference between the cost of the services provided to Medicaid patients and the reimbursement received from the state for this care. The costs of service are estimated using the annual cost-to-charge ratio.
Part III line 4		cont During the years ended December 31, 2011 and 2010, the following levels of charity care and community service, including serviced for which the System received no reimbursement or was reimbursed below cost, were provided. Estimated costs and expenses incurred for charity care in 000s 2011 -10,185 2010 - 10,772. Estimated cost over reimbursement for Medicaid patients care 2011 - 9,388 2010 - 4,299. Cost of other Charity Care and Community Benefits 2011 - 25,385 2010 - 21,668.
Part III line 4		cont In addition to the above, the System received no reimbursement or is reimbursed below cost for these services, for the years ended December 31, 2011 and 2010 Estimated cost over reimbursement for Medicare patients care 2011 - 32,608 2010 - 26,273. Estimated costs for bad debt 2011 - 9,029 2010 - 7,847.
Part III line 4		cont Total cost of Charity, Uncompensated Care Other Community Services 2011 - 67,022 2010 - 55,788 community service, research and education 2011 - 5,812 2010 - 6,597. The System actively sponsors community benefits that respond to community needs. These programs focus on the underserved with the intention of improving the overall health of the entire community. Examples of this outreach include mobile clinics, partnering with local schools and employers to provide health
Part III line 4		cont screenings, support and health education providing social services, such as multi-faith ministry, intepreters and support groups providing emergency medical training to other providers across the region and serving as the regions emergency disaster response center. Our 24 hour emergency room, mental health services, and multiple convenient care locations provide for various
Part III line 4		cont and timely health care needs throughout the region. Since bad debt is often difficult to distinguish from charity care due to insufficient data provided by the patient, RMH continues to provide superior care to all patients as a part of its mission and considers the cost of bad debt writeoffs as a substantial benefit to the community.
Part III line 4		continued Van Matre Health South is a partnership 50 owned by Rockford Health System Ventures LLC, a disregarded entity owned 100 by Rockford Memorial Hospital. It is a for-profit organization that does not report any separate footnote regarding charity care or bad debt.
Part III line 8		The data reported for Medicare charges and payments is from the final Management Report produced by the firm that prepared the 2011 Cost Report as submitted to the Fiscal Intermediary in 2012 in compliance with all current regulations. Reported on Line 6 are allowable Medicare Costs provided by the Cost Report. Medicare costs are eliminated from the Subsidized Programs on Part 1 Ln 7g as calculated by our cost accounting analysis.
Part III line 8		continued A combination of cost accounting and the Medicare CCR was used for the computation of subsidized programs. This Section B-Medicare also includes 50 of the Medicare activity from Van Matre Health South VMHS and the corresponding cost based entirely on their Medicare CCR.
Part III line 9b		Rockford Memorial Hospital has a strong commitment to provide quality patient care for all individuals. Our mission is to provide health care to everyone who comes to our door, regardless of their ability to pay. We will submit a claim to all 3rd party payors on behalf of the patient. We help patients apply for all possible insurance or assistance such as crime victims, an automobile accident, workers compensation, Medicaid, COBRA, local assistance and/or hospital financial assistance.
Part III line 9b		cont If they do not qualify for any of these, we can extend payment options such as monthly payments, credit card payments or financial assistance. This is offered to patients who are experiencing legitimate financial hardships and are unable to pay for all or part of the patients medical care. Forgiveness may apply to an amount after applying all payments such as any insurance company, health plan or personal payments, any negotiated discounts or any uninsured discounts.
Part III line 9b		cont If a patient eligible for charity care or partial financial assistance still has a portion of the outstanding balance due, other arrangements are made. RMH accepts a variety of payments and alternative payment plans. Monthly statements are sent as payment reminders for contracted arrangements. In case of default, additional letters and calls are made to bring it to a current status. An account is turned over to a collection agency only after non-payment or no contact in 120 days.
Part III line 9b		Our partner hospital VMHS is a for-profit hospital that is part of a larger health organization. Much of the information that would normally be required for a non-profit is not pertinent. Therefore most of the responses concern only the RMH process and procedures.
Part V		Line 3 - In 2011 The Rockford Health Council produced a regional health needs assessment with extensive interviews and surveys taken during 2010. Contacts included Focus groups, health care providers, Community analysis, Household surveys all of which included local and state government organizations, local businesses, and local educators pre-school through college.
Part V		Line 3 cont The survey was done with funding, cooperation, participation and assistance from all three Rockford hospitals - RMH, SwedishAmerican Hospital and St. Anthonys Medical Center. Survey is available and was promulgated within the community by the Rockford Health Council, survey participants and was made available on several websites.
Part V		Line 19 d - All patient accounts are reviewed for insurance, for other potential providers or government assistance. Then all discounts available to either insured, self-pay, underinsured or uninsured people are applied. After determining the liability for each person at the time of billing,
Part V		Line 19 d cont - other requests for financial assistance are processed, further assistance may be offered and discounts applied, payment plans are set up, and payment agreements reached. Then, after 120 days of no contact or inactivity on a past due balance, the account may be turned over to a collection agency.
Part V		Line 20 - All charges for any service provided by Rockford Memorial Hospital are the very same for every individual, regardless of whether it is for emergent or standard care and regardless of the patients ability to pay. Once a patient is determined to be eligible for financial assistance, the applicable discounts are applied to his/her account.
Part V		Line 21 - The charges billed are always uniform, the amount collected amounts may vary depending on applicable discounts.
Part V		General information regarding Hospital 2 - Our partner hospital VMHS is a for-profit hospital that is part of a larger health organization. Much of the information that would normally be required for a non-profit is not pertinent. Therefore most of the detailed responses concern only the RMH process and procedures.
Part VI Line 2		In 2010 the Rockford Health Council began to gather data from the Northern Illinois region encompassing Winnebago and Boone Counties. RHS support was financial, technical and included significant representation on both the Rockford Health Council Board of Directors and the surveying staff. This collaborative effort, partnering healthcare and education, gathered, analyzed and reported on the health needs of the community. The other two area hospitals both supported and participated
Part VI Line 2		to produce a major effort which was released to the community in July 2011. It revealed trends, changes and unmet needs. The survey is available on the Rockford Health Council website. This assessment serves as a blueprint for future health care initiatives and points toward growth in our region.The priorities identified were used as the framework in the development of the RHS Community Benefit Plan. Each priority has a specific overriding strategy with stated detailed tactics
Part VI Line 2		and measureable objectives. An executive summary detailing the process and findings, the RHS Community Plan document, and a partial inventory detailing many of the significant programs and initiatives that support RHS commitment to improving the overall health and well-being of the community residents were included. In December 2011, the Board of Directors approved the resolution to adopt of the Rockford Health System Community Benefit
Part VI Line 2		Plan and subsequent implementation of its recommendations. RHS is continuing with development and implementation of a comprehensive multifaceted community benefit plan to improve the overall health and well-being of residents in the primary service area.
Part VI Line 3		RMH posts signs in all general registration areas and the emergency department in both Spanish and English to indicate that financial assistance is available for those who qualify. The organizations web site states Patients throughout Rockford Health System are treated regardless of their ability to pay. Click on the entity above to learn more. The RMH link to Financial Assistance and Discount Programs explains the process in this manner Rockford Health System provides health
Part VI Line 3		care regardless of the patients ability to pay for such care. These guidelines are intended to provide a framework to offer assistance to patients and families with legitimate financial hardship, who are unable to pay for all or a portion of their medical care. Covered services are those which are determined medically necessary by a physician. Our Financial Assistance Programs are based on whether you have insurance coverage of any kind or are uninsured.
Part VI Line 4		RMH is located in Rockford, IL Winnebago County with a defined primary service area that includes Winnebago, Boone and Ogle counties. 2010 US Census Bureau data places the population for this service area at approximately 403,000 individuals with close to 3/4 living in Winnebago County approximately 295,000. This represents a drop in population of approximately 6000 individuals from 2009 Census information and 2011 US Census estimates project another decrease to 401,500 residents.
Part VI Line 4		Located in northern Illinois, the primary service area is characterized as largely rural and populated with very small communities with the exception of the neighboring cities of Rockford, Loves Park, and Machesney Park which comprise more than 200,000 individuals. The hospital also serves the secondary service area which includes DeKalb, McHenry, Whiteside, Lee, LaSalle, Stephenson and Rock counties for select tertiary services.
Part VI Line 4		The next largest community is Belvidere, located in Boone County, where the entire county has just over 54,000 residents. More than 86 of hospital inpatients are from the Primary Service Area. As a community that relies heavily on manufacturing companies and small businesses, the area continues to experience difficult economic times. Currently the largest employers include Chrysler Boone County, the Rockford school district, and the three Rockford health care providers.
Part VI Line 4		Median household income in 2010 inflation adjusted dollars per the U.S. Census Bureau in Winnebago County was 43,792 representing a drop from 2009 median income levels of 47,600. In comparison, the states 2009 median household income was approximately 53,974. These disparities are also reflected in unemployment, education and poverty rates. Rockford April 2012 unemployment rate was 10.7 significantly higher than the overall state rate of 8.7.
Part VI Line 4		Most recent census figures estimate 20 of Winnebago County residents attain a bachelors degree while in the state more than 29 attain one. Poverty levels continue to rise with approximately 18 of Winnebago County residents below the poverty level compared to state levels of 13. The 2010 Illinois Kids Count report stated 34 of children in Rockford live at or below the federal poverty rate, placing Rockford with the highest rate in the state of Illinois.
Part VI Line 4		These conditions have resulted in increasing pressures on the community. RMH is located in the older, western portion of the city and serves a significant indigent and elderly population. This is evident when looking at income levels for households located in zip codes in western Rockford where the hospital resides. U.S. Census Bureau profile for individual zip codes lists median household income for west side zip codes as follows 61103 - 37,000 61102 - 34,000 61101 - 31,700. Bad debts from these zip codes accounted for more than7.6 million - 42 of the hospital total.
Part VI Line 4		The geographic disparities are evident, compared to households on the east side of Rockford. The 3 largest east side zip codes have median household incomes of 61107 - 49,000 61108 - 44,700 61114 - 67,000. As the only northern Illinois hospital with Level III neonatal intensive care, comprehensive pediatric and pediatric intensive care, RMH is committed to children
Part VI Line 4		as the main provider of childrens services in the immediate and greater tertiary service area. With 1 in 3 children currently at or below federal poverty levels in the county and the overall economic condition of the community, the hospital has seen increases in uninsured and public aid patients and this trend continues to grow.
Part VI Line 5		Led by Community Boards of Directors, Rockford Memorial Hospital RMH and its affiliates are extremely involved in promoting a healthier community. As one of Rockfords largest employers, the organization takes a leading role in financially supporting not only health-related initiatives, but also community-building activities across the region. It includes providing financial support and talent for economic development and business-related activities, as well as quality of life and
Part VI Line 5		and educational initiatives. Employees participate in community boards and are actively involved in promoting the region and its assets. Whether it was active participation in the Keep Northern Illinois Beautiful Medication Collection to protect the environment, donations for Gigis Playhouse supporting Down syndrome families, or providing an on-going educational program for seniors at a neighborhood independent living facility, the hospitals presence is broad in our community.
Part VI Line 5		In 2011, RMH and its affiliates promoted community health in many ways. One way was to continue to raise the bar on clinical quality across services. In doing so, we also helped to boost the local economy working with over 200 local vendors and supported 76 full-time construction-related jobs in the region. An investment of 15.2 million went toward major improvements at its facilities. The largest construction projects were the 4.5 million development of the
Part VI Line 5		Womens Center, and the 2.9-million MRI Addition at Rockford Memorial Hospital. Other significant projects include the renovations to Interventional Radiology, enhancements to A2 Mother Baby, development of an IV Infusion area within the hospitals Cancer Center, introduction of Advanced Tele-medicine in the ICU.
Part VI Line 5		Our support, including both experienced staff and fiscal resources, led to the community health needs assessment for the Rockford region that was produced by the Rockford Health Council. The priorities include 1 improving access to care, 2 creating partnerships to improve basic needs for residents at the poverty level, 3 improving the health status of the chronically ill and promoting healthy lifestyles, 4 providing comprehensive prenatal and maternal services for excellent outcomes, 5 improving
Part VI Line 5		the behavioral health status of the community, 6 ensuring equitable health services to all, 7 partnering with local law enforcement to reduce crime and violence, and 8 supporting community efforts to improve educational efforts and the labor force. Based upon that assessment, the Board of Directors approved community benefit plan aimed at improving the overall health and well-being of residents in the primary service area. The RMH plan outlines initiatives to address the key priorities identified in the study and was
Part VI Line 5		developed to ensure that RHS along with RMH allocates resources, time and talent in strategies that will directly impact community health needs. Some significant examples of the ways the organization addressed health needs was to enhance access to medical and dental care for uninsured and underinsured adults and children with programs such as the Bridge Clinic a joint partnership with a local church that brought health care to almost 600 people in their neighborhood and through the Ronald McDonald
Part VI Line 5		cont CareMobile that provided medical and dental care for over 500 needy children-representing over 181,000 in free care. In partnership with other community organizations, RMH sought to support families at poverty level in many ways, such as supporting a school breakfast program at Northwest Community Center, where many underpriviledged children are served, adopting a neighborhood school where nearly 90 of the children line in a family at or below the poverty level.
Part VI Line 5		cont RMH and its employees donate both food and dollars to local food banks and support of the United Way as a Golden Campaign Leader. We provided external community grants for like purposes by partnering with A Silver Lining Foundation that provide free mammograms and breast diagnostic services for uninsured women supporting other non-profit, health-related organizations that also address the health needs of chronically-ill patients in our community. Coupled with internal clinical teams
Part VI Line 5		working to manage of diseases such as diabetes and congestive heart failure, RHS professionals serve as educators, not only for patients and their families, but also for caregivers outside our walls. Our clinicians work with local nursing homes to establish appropriate monitoring and treatment once our patients are discharged to other settings. As the regions leading provider of
Part VI Line 5		comprehensive prenatal and maternal services for mothers and infants, RMH caregivers help connect at-risk patients to appropriate services across the community. Besides having a premier maternity service and the only Level III Neonatal Intensive Care Unit in the region, our obstetricians and midwives provide comprehensive care to many low income mothers and help educate teens on pregnancy and on developing parenting skills.
Part VI Line 5		Addressing another reagional health priority, the behavioral health status of the community, RMH has long been a lead provider of inpatient behavioral health services. Through primary care and specialty physician offices, the organization seeks to screen and identify at risk individuals at early stages where intervention and treatment are most successful. In all clinical programs, we seek to ensure that we are providing equitable care for all patients. Recognizing that there is a low
Part VI Line 5		level of awareness of health disparities, RMH participates in community dialogue, supports community initiatives such as the Black Healthcare Coalition, promotes diversity and cultural educational programs internally and is working to identify internal disparities in relation to patient outcomes. To address crime and violence issues in the community, RMH hosts neighborhood meetings on violence in partnership with the Rockford Police Department and Rockford Neighborhood Network.
Part VI Line 5		RMH also represents one of Rockfords largest employers. As such, the organization is committed to supporting community initiatives to prepare an excellent labor force to help in providing continuing health education opportunities for residents, as well as employees. Besides offering a medical science elective course for high school students, the organization participates in
Part VI Line 5		the Northern Illinois Healthcare Collaborative, sends professionals into the schools to volunteer and share knowledge and each year grants nursing scholarships to minorities in our region. Rockford Memorial Hospital continues to use these identified community needs as the blueprint for its community benefit efforts.
Part VI Line 6		All of Rockford Health System RHS entities work closely with the community and Rockford Memorial Hospital RMH to address important health needs of the community. In 2011, volunteers from the Visiting Nurses Association VNA, Rockford Health Physicians RHPH, Rockford Memorial Development Foundation RMDF and RMH donated their time and talents to volunteer on behalf of the community. The affiliates also continued or launched new and innovative programming to reach out into the community
Part VI Line 6		with health education and support. The outreach addresses needs identified in the regional health assessment done by the Rockford Health Council. In 2011, RMH and RHPH began using a new video interpretation system to ensure that all residents receive quality care and understand their diagnosis and course of treatment. Video interpretation was introduced for the Deaf and Hard of Hearing, as well as Spanish-speaking patients.
Part VI Line 6		Laptop computers, with video cameras, in both the hospital and physician offices, quickly link skilled interpreters with patients and caregivers. It enables an accurate exchange of information for purposes of diagnosis and treatment. The video system compliments a language line service. Here are just some examples of how specific entities served unique community health needs. In 2011, the VNAs Older Adult Care program reached the 25th anniversary
Part VI Line 6		of operation with its Elder Abuse, Neglect and Exploitation Services. VNA was originally selected as one of the five demonstration sites for the program in 1986. Today, VNAs Elder Abuse program is a program of excellence, one that others in the state benchmark against. Over the course of 25 years, strong relationships have emerged between the elder abuse staff and those within our regional and local law enforcement offices and legal and judicial systems.
Part VI Line 6		These ties lead to the recent development of the Winnebago/Boone County Elder Abuse Fatality Review Team. Purpose of the board is to review questionable deaths of seniors. And, if necessary, recommend a more intense investigation into the cause of death. In 2011, VNAs Older Adult Care also continued its Money Follows the Person Program. The program is designed to help older adults who have lived in the nursing home for more than three months, move out, and back into their communities.
Part VI Line 6		Qualified care coordinators determine eligibility. Mental and physical health are assessed, finances reviewed and existing and potential support systems evaluated. The care coordinator helps develop a plan for living. RHPH, the employed physicians group participates in and supports numerous initiatives on behalf of the communities it serves. These physicians support the hospitals clinical programs, such as the hospitalist program in obstetrics and in pediatrics,
Part VI Line 6		where the majority of patients are indigent as well as providing critical staff for the 24-hr. emergency department. Physicians also actively participate in community outreach efforts. The Bridge Clinic, which serves the immediate medical needs of underinsured adults is staffed by RHPH physicians, the Centering Pregnancy Program, a support group initiated by our midwives for primarily low income pregnant women and significant continuing financial and physician support for a
Part VI Line 6		local child abuse program called MERIT. Throughout the region, the physician group helps to support initiatives with schools and village government services. Our physicians and employees also provided community education. CPR training, financial support and volunteers for a pediatric diabetes camp and an educational partnership with the Golden Apple Foundation are a few of the other initiatives by the medical group.
Part VI Line 6		In 2011, the external grants program of the RMDF provided nearly 100,000 in support to other community not-for-profits. Among the organizations, programs and services supported by those grants were RAMP a non-profit, non-residential Center for Independent Living that partners and empowers people with disabilities Remedies, a non-profit organization assisting those fleeing violent relationships a parent academy at a local school serving low income children
Part VI Line 6		perinatal bereavement services a summer camp for children with Muscular Dystrophy and an exercise program through the YMCA to name a few. The Foundation also supported the Ronald McDonald Care Mobile and provided automatic external defibrillators AED to organizations that serve a wide variety of citizens.
Part VI Line 7		Part VI Line 7, IL

Schedule H (Form 990) 2011

Additional Data

Software ID:	11000218
Software Version:	2011.0.0

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

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

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

Attach to Form 990

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
Rockford Memorial Hospital

Employer identification number
36-2167847

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

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

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) The Rosecrance Foundation1021 N Mulford Road Rockford,IL611073877	36-4167891	501c3	5,000	Community Program
(2) Univ of IL-College of Medicine1601 Parkview Rockford,IL61107	37-6000511	501c3	90,000	Support healthcare
(3) Rockford Symphony Orchestra711 N Main St Rockford,IL61103	26-1180940	501c3	17,500	Support Fine Arts
(4) Community Foundation of No IL946 N Second St Rockford,IL61107	36-4402089	501c3	5,000	General support
(5) Easter Seals Metropolitan Chicago233 South Wacker Drive Suite 2400 Chicago,IL60616	36-2171729	501c3	11,500	Support Handicapped
(6) Rock Valley College3301 N Mulford Rd Rockford,IL61114	36-3037232	501c3	30,000	Community Education
(7) The Haven Network for Perinatal Death and Bereavement124 N WATER ST STE 303B Rockford,IL611073975	20-0620800	501c3	5,000	Support healthcare
(8) Rock River Valley Pantry1080 Short Elm St Rockford,IL611022217	36-3135643	501c3	5,500	Community Program
(9) Growth Dimensions200 S State St Belvidere,IL61008	36-3196645	501c6	7,500	Community Development
(10) Epilepsy Found North Central IL3815 Harrison Ave Rockford,IL61101	36-2741730	501c3	5,000	Support healthcare
(11) Retreat & Refresh Stroke Camp425 W Giles Ln Peoria,IL61614	64-0954851	501c3	5,000	Support healthcare
(12) Coalition to Protect America's Health CarePO Box 30211 Bethesda,MD208240211	52-2253225	501c4	5,000	General support
(13) Gigi's Playhouse8801 N Second St Suite 2 Machesney Park,IL61115	27-2251844	501c3	25,150	Support healthcare
(14) Crusaders Health Foundation1200 West State Street Rockford,IL61102	36-3259761	501c3	5,000	Support healthcare
(15) Boys and Girls Club1275 Peachtree Street Atlanta,GA30309	13-5562976	501c3	5,000	Community Program
(16) United Way of Rock River Valley612 N Main St Rockford,IL61103	36-2167843	501c3	30,000	Community Program
(17) March of Dimes1275 Mammaroneck Ave White Plains,NY10605	13-1846366	501c3	5,000	Support infant healthcare
(18) OSF St Anthony Medical CenterPO Box 6087 Rockford,IL61125	37-0813229	501c3	13,300	Support healthcare
(19) American Heart Association7272 Greenville Ave Dallas,TX752315129	13-5613797	501c3	7,500	Support healthcare
(20) Midwest Fdn for Orthopaedic Research & Education (MFORE)324 Roxbury Road Rockford,IL61107	36-2691111	501c3	6,000	Support healthcare

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image

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

Cat. No. 50055P

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

Schedule I (Form 990) 2011

Additional Data

Software ID:	11000218
Software Version:	2011.0.0

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Rockford Memorial Hospital

Employer identification number

36-2167847

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

Yes

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

Yes

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

Yes

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

Yes

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 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
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) James WBreckenridge	(i) (ii)	409,662	42,793	1,548	20,000	17,875	491,878
(2) John TDorsey	(i) (ii)	323,591	1,650	1,134	42,000	9,104	377,479
(3) Jos LGonzalez	(i) (ii)	394,428	1,600	1,134	36,500	18,399	452,061
(4) Dennis TUehara	(i) (ii)	455,767	12,215	1,548	58,500	13,390	541,420
(5) Gary EKaatz	(i) (ii)	627,315	369,197	68,499	84,178	125,919	1,275,108	89,051
(6) Henry MSeybold	(i) (ii)	357,107	128,327	8,886	41,536	63,444	599,300	24,857
(7) Gordon Langejans	(i) (ii)	229,261	72,918	10,823	26,954	26,658	366,614	22,829
(8) Kerry Hill	(i) (ii)	196,865	44,801	2,259	51,383	35,880	331,188	8,353
(9) Carolyn Bengtson	(i) (ii)	266,774	63,941	1,134	34,415	37,063	403,327	11,742
(10) Michael Tyrkus	(i) (ii)	202,574	13,926	10,373	34,966	19,408	281,247
(11) Susan Schreier	(i) (ii)	197,290	53,498	1,655	32,654	34,633	319,730	5,180
(12) Curt Lesher	(i) (ii)	168,255	11,076	7,237	20,347	18,581	225,496
(13) Lawrence Verfurth	(i) (ii)	291,854	51,600	1,170	11,708	58,900	415,232
(14) Dan Parod	(i) (ii)	276,968	120,303	1,170	44,319	45,833	488,593	32,720

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
I	1a	- By policy Membership to the YMCA is paid for the CEO. Two social club memberships are paid for by the organization for the CEO and any personal use of these facilities is reimbursed in full. The actual cost of these memberships are prorated for personal vs business use and that percentage is added to taxable wages.
I	4b	- The executive team receives annual additions to a non-qualified retirement plan. These amounts, accrued for 2011, are included in compensation and listed in detail in Part II for Carolyn Bengtson 12,104 Gary Kaatz 97,196 Sue Schreier 8,369 Henry Seybold 37168 Kerry Hill, 9,932 Lawrence Verfurth 23,592.
I	7	- Short term incentive opportunities, designating threshold, target and maximum annual awards are established for all executives, driven by the strategic initiatives and priorities of RHS. If incentive thresholds are not met, CEO may grant discretionary bonuses for outstanding performance within certain parameters.
I	3	The board of directors has a compensation committee that reviews executive compensation. They also authorize an independent firm to provide data for analysis of the industry and the market to our Compensation Department. The department and committee reviews the results and make a recommendation to the board who then acts upon this information to set compensation for executives.

Schedule J (Form 990) 2011

Additional Data

Software ID:	11000218
Software Version:	2011.0.0

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
Rockford Memorial Hospital

Employer identification number
36-2167847

Part I

Bond Issues

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

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . .
2 Amount of bonds legally defeased . . . . . . . . . .
3 Total proceeds of issue . . . . . . . . . . . . .	31,008,000
4 Gross proceeds in reserve funds . . . . . . . .
5 Capitalized interest from proceeds . . . . . . . . . .
6 Proceeds in refunding escrows . . . . . . . . . . .
7 Issuance costs from proceeds . . . . . . . . . . .	483,711
8 Credit enhancement from proceeds . . . . . . . . . .	16,125
9 Working capital expenditures from proceeds . . . . . . .
10 Capital expenditures from proceeds . . . . . . . . . .
11 Other spent proceeds . . . . . . . . . . .	30,508,164
12 Other unspent proceeds . . . . . . . . . . .
13 Year of substantial completion . . . . . . . . . . .	2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . .	X
15 Were the bonds issued as part of an advance refunding issue? . . . .		X
16 Has the final allocation of proceeds been made? . . . . . .	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . .	X

Part III

Private Business Use

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

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

Cat. No. 50193E

Schedule K (Form 990) 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? . . . . . . . . .
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? . . . . .
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .
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 . .	%		%		%		%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	%		%		%		%
6 Total of lines 4 and 5 . . .. . . . . . . . .	%		%		%		%
7 Does the bond issue meet the private security or payment test? . . .
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?

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .		X
2 Is the bond issue a variable rate issue?	X
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?	X
b Name of provider . . . . . . . .	JP Morgan Chase
c Term of hedge . . . . . . . .	0000000010.300000000000
d Was the hedge superintegrated? . . . .		X
e Was a hedge terminated? . . . . .		X
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .		X
b Name of provider . . . . . .
c Term of GIC . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .		X
6 Did the bond issue qualify for an exception to rebate? .		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X

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? . . . . . . . . . . . . . . YesNo

Part VI

Supplemental Information

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

Identifier	Return Reference	Explanation

Schedule K (Form 990) 2011

Additional Data

Software ID:	11000218
Software Version:	2011.0.0

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Rockford Memorial Hospital

Employer identification number

36-2167847

Part I

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

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

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

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

Part II

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

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






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

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Connie Vitale RMH Board member	Partner, RMH Pathologists Ltd	290,117	Contract for pathology 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:	11000218
Software Version:	2011.0.0

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

Rockford Memorial Hospital

Employer identification number

36-2167847

Identifier	Return Reference	Explanation
Form 990 Part XI	5	Other changes in Net Assets Unrealized gain/loss on investments 6,694,029, pension-related changes other than net periodic pension cost 2,157,503, Postretirement medical benefit cost 283,252, Net assets released from restrictions used for capital 224,610, transfers to affiliates 53,819,357, change in FAS 124 valuation 23,573, change in termporarily restricted net assets 106,730, UPMIFA 156,175.
Form 990 Part VI	12C	The RHS conflict of interest policy says that all board members will be asked annually to fill out a document concerning any conflict of interest they might have. Due to an oversight, only the new board members were asked to do so in 2011, but all board members have been requested to do so in 2012.
Form 990 Part VII	1a	- These members of the board were compensated by related organizations for other duties as well as unpaid service as board members James Breckenridge 41 hrs Anesthesiologist with Rockford Health Physicians RHPH and service to RHPH and RHS boards, John Dorsey 61 hrs RHPH Internal Medicine physician and RHPH and RHS boards, Jose Gonzalez 51 RHPH Neonatologist and RHPH and RHS boards, Dennis Uehara 35 hrs RHPH Emergency Services physician, RHPH and RHS and Foundation RMDF boards. Gary Kaatz had 42 additional hrs as President and CEO, Julie Peterson had 41 hrs as executive secretary, and Henry Seybold had 42.5 hrs as CFO Sr VP of Finance these employees compensation includes duties within RMH organization and for supporting all of the related entities RHS/RHPH/RMDF/VNA.
Form 990 Part VI	11a	- The data was gathered by the accounting staff with input from RMH and RHS executive staffs. The data was reviewed and the Form 990 prepared by the RMH tax analyst. During the process, there were ongoing meetings held with a group consisting of the RHS CFO, the VP of Finance, the Controller, and the tax analyst. Once the Form 990 was completed, it was reviewed by an independent accounting firm. A copy of the Form 990 was made available to all board members on a secure intracompany website. A presentation of the return was made to the RMH Finance Committee and at a meeting of the Board of Directors prior to filing.
Form 990 Part VI	15 a,b	- RHS is the sole corporate member.
Form 990 Part VI	19	- Financial statements are available through the Illinois Attorney Generals Office. Governing documents are available by request from the board secretary.
Form 990 Part III Program Service Accomplishments	Line 4d Other Activities	Program Service Expenses 820,140, Grants and allocations 160,000, Revenue 388,931 Through Rockford Memorial Hospital Auxiliary, RMH is able to provide extra funds and services to support its mission. The Auxiliary has 368 volunteers who logged 35,381 hours while assisting with greeting visitors, transporting patients, floral or gift deliveries, thrift shop and gift shop activities, and other services as requested. The volunteers efforts provide extra funds and enhance the overall hospital experience for patients, visitors and staff.
		Form 990, Part III, Line 4d Program Service Expenses 820,140, Grants and allocations 160,000, Revenue 388,931 Through Rockford Memorial Hospital Auxiliary, RMH is able to provide extra funds and services to support its mission. The Auxiliary has 368 volunteers who logged 35,381 hours while assisting with greeting visitors, transporting patients, floral or gift deliveries, thrift shop and gift shop activities, and other services as requested. The volunteers efforts provide extra funds and enhance the overall hospital experience for patients, visitors and staff. Form 990 Part XI Line 5 Other changes in Net Assets Unrealized gain/loss on investments 6,694,029, pension-related changes other than net periodic pension cost 2,157,503, Postretirement medical benefit cost 283,252, Net assets released from restrictions used for capital 224,610, transfers to affiliates 53,819,357, change in FAS 124 valuation 23,573, change in termporarily restricted net assets 106,730, UPMIFA 156,175. Form 990 Part VI Section B Line 12C The RHS conflict of interest policy says that all board members will be asked annually to fill out a document concerning any conflict of interest they might have. Due to an oversight, only the new board members were asked to do so in 2011, but all board members have been requested to do so in 2012. Form 990 Part VII Section A Line 1a - These members of the board were compensated by related organizations for other duties as well as unpaid service as board members James Breckenridge 41 hrs Anesthesiologist with Rockford Health Physicians RHPH and service to RHPH and RHS boards, John Dorsey 61 hrs RHPH Internal Medicine physician and RHPH and RHS boards, Jose Gonzalez 51 RHPH Neonatologist and RHPH and RHS boards, Dennis Uehara 35 hrs RHPH Emergency Services physician, RHPH and RHS and Foundation RMDF boards. Gary Kaatz had 42 additional hrs as President and CEO, Julie Peterson had 41 hrs as executive secretary, and Henry Seybold had 42.5 hrs as CFO Sr VP of Finance these employees compensation includes duties within RMH organization and for supporting all of the related entities RHS/RHPH/RMDF/VNA. Form 990 Part VI Section A Line 11a - The data was gathered by the accounting staff with input from RMH and RHS executive staffs. The data was reviewed and the Form 990 prepared by the RMH tax analyst. During the process, there were ongoing meetings held with a group consisting of the RHS CFO, the VP of Finance, the Controller, and the tax analyst. Once the Form 990 was completed, it was reviewed by an independent accounting firm. A copy of the Form 990 was made available to all board members on a secure intracompany website. A presentation of the return was made to the RMH Finance Committee and at a meeting of the Board of Directors prior to filing. Form 990 Part VI Section B Line 15 a,b - RHS is the sole corporate member. Form 990 Part VI Section C Line 19 - Financial statements are available through the Illinois Attorney Generals Office. Governing documents are available by request from the board secretary.

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:	11000218
Software Version:	2011.0.0

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Rockford Memorial Hospital

Employer identification number

36-2167847

Part I

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

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

Part II

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

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

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Van Matre Rehabilitation Center LLC 3660 Grandview Parkway Ste 200 Birmingham,AL35243 36-4397130	Healthcare	IL	NA	Related	2,524,675	7,608,987		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) Rockford Health Insurance LTD Wellesley House So 2nd Flr 90 Pitts Pembrooke,HM08 BD	Insurance	BD	NA	C Corp	48,256	533,960	100.000 %

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

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

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

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

Yes

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

Yes

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

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

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

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

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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

Yes

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

Yes

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

Yes

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

Yes

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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

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

Yes

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

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved
(1) VanMatre Rehabilitation Center LLC	j	155,959
(2) VanMatre Rehabilitation Center LLC	k	568,055
(3) VanMatre Rehabilitation Center LLC	l	77,710
(4)
(5)
(6)

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)	(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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

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

Additional Data

Software ID:	11000218
Software Version:	2011.0.0

1	Briefly describe the organization’s mission or most significant activities: To improve and protect the health and welfare of the community in accordance with our mission Superior Care, Every Day, For all our patients. A 396-bed hospital with a Level 1 Trauma Center, Level III Neonatal Intensive Care Unit, regions only Pediatric Intensive Care Unit designated Disaster POD hospital.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	7
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	2,808
6	Total number of volunteers (estimate if necessary) ....	6	368
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	686,584
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	-67,770

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	4,003,677	5,435,291
9	Program service revenue (Part VIII, line 2g) .........	349,978,108	339,566,034
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	6,026,508	2,459,256
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	164,128	1,986,709
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	360,172,421	349,447,290
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	845,017	580,004
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	137,556,563	144,424,398
16a	Professional fundraising fees (Part IX, column (A), line 11e).....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	146,852,556	153,454,823
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	285,254,136	298,459,225
19	Revenue less expenses. Subtract line 18 from line 12.......	74,918,285	50,988,065
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	372,867,851	363,793,401
21	Total liabilities (Part X, line 26).............	208,340,079	206,619,071
22	Net assets or fund balances. Subtract line 21 from line 20.....	164,527,772	157,174,330

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	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 162,083,950 including grants of $ ) (Revenue $ 207,940,086 )
	Rockford Memorial Hospital is a not-for-profit charitable healthcare institution that functions in accordance with all applicable laws and regulations. In the course of operations, RMH is committed to provide superior care every day for all its patients. RMH is a 396-bed regional referral hospital which includes a Level I Trauma Center, Level III Neonatal Intensive Care Unit and the regions only Pediatric Intensive Care Unit. In 2011 patient care was rendered to 12,849 individuals who presented themselves for service including 1,529 deliveries and 3,673 inpatient surgeries along with supporting 50,800 emergency visits.

4b	(Code: ) (Expenses $ 74,655,776 including grants of $ ) (Revenue $ 128,814,607 )
	RMH is designated by the IL Dept of Health as the Disaster POD hospital for the Northern IL EMS region. As a Level I Trauma Center, RMH provides patient care, diagnostic and therapeutic services 24/7 to all who present themselves for service. In 2011 that included 1,261 visits to the sleep lab 89,946 diagnostic radiology procedures or tests 8,029 Radiation Oncology treatments 35,044 cardiac prodcures or tests 5,089 visits to the Pain Clinic and 200,374 respiratory therapy treatments. Through the outreach services of Rockford Health Medical Laboratories RHML, RMH has provided timely and responsive lab services to other hospitals, physicians offices, and government agencies, while the in-house laboratory provides testing for all who present themselves at the hospital for treatment. In 2011, RHML performed 1,474,737 tests.

4c	(Code: ) (Expenses $ 4,456,509 including grants of $ 420,004 ) (Revenue $ 64,642 )
	RMH has provided health education and putreach in a variety of forms within the eleven country area that includes several school partnerships, mentoring, health programs, teaching, job shadowing and volunteering. RMH hosts support groups, training classses, and lectures series for health and safety related topics. Employees staff community health fairs and open health screenings. In a program jointly sponsored with Ronald McDonald Charities, RMH staffs the Caremobiles which provided 711 health and dental checkups and basic health services to 496 underinsured and uninsured chilldren. RMH also provides both foreign language and hearing impaired assistance to patients and their families to help them communicate with medical personnal for treatment. Funds were also used to improve general healthcare conditions throughout the state.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 820,140 including grants of $ 160,000 ) (Revenue $ 388,931 )
4e	Total program service expenses$ 242,016,375

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)				(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Gordon Langejans VP Med Affairs	31.30	X			313,003	0	53,612
(19) Kerry Hill VP Finance	40.00			X	0	243,925	87,263
(20) Carolyn Bengtson VP Utilization Management	40.00		X		331,849	0	71,478
(21) Michael Tyrkus Director of Cytogentics	40.00		X		226,874	0	54,374
(22) Susan Schreier Chief Nursing Officer	40.00		X		252,442	0	67,288
(23) Curt Lesher Pharmacy Manager	40.00		X		186,569	0	38,928
(24) Lawrence Verfurth VP Clinical Integration	40.00		X		344,624	0	70,608
(25) Dan Parod VP Hospital Admin COO	40.00	X			0	398,441	90,152

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	1,655,361	3,926,029	1,099,531

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		855,610
e	Government grants (contributions)1e		4,577,402

f	All other contributions, gifts, grants, and similar amounts not included above1f		2,279
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			5,435,291
			Business Code
2a	Inpatient Routine Ancillary		900,099	95,781,125	95,781,125
b	Outpatient Emergency		621,400	77,980,458	77,980,458
c	Diagnostic Medical Laboratory		621,500	11,592,548	10,922,229	670,319
d	Medicare/Medicaid		900,099	149,839,565	149,839,565
e
f	All other program service revenue .			4,372,338	1,856,087	11,425	2,493,400
g	Total. Add lines 2a–2f........			339,566,034
3	Investment income (including dividends, interest
	and other similar amounts).....			942,146			942,146
4	Income from investment of tax-exempt bond proceeds..
5	Royalties............
		(i) Real	(ii) Personal
6a	Gross rents	501,884
b	Less: rental expenses	328,376
c	Rental income or (loss)	173,508
d	Net rental income or (loss).......			173,508	142,218		31,290
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	124,164,954	13,075
b	Less: cost or other basis and sales expenses	122,630,955	29,964
c	Gain or (loss)	1,533,999	-16,889
d	Net gain or (loss)..........			1,517,110			1,517,110
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	Cafeteria/Food Service/Catering		722,320	1,813,201		4,840	1,808,361
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			1,813,201
12	Total revenue. See Instructions....			349,447,290	336,521,682	686,584	6,792,307


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			3,500	1	4,300
2	Savings and temporary cash investments .......			56,353,959	2	24,657,024
3	Pledges and grants receivable, net .........			494,476	3	393,042
4	Accounts receivable, net .........			44,815,243	4	63,598,137
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 .............			12,713	7	8,339
8	Inventories for sale or use ..............			6,056,539	8	6,499,050
9	Prepaid expenses and deferred charges ............			6,805,891	9	6,476,302
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	285,367,409
b	Less: accumulated depreciation. .....	10b	196,889,444	79,293,676	10c	88,477,965
11	Investments—publicly traded securities ..........			158,236,077	11	153,262,728
12	Investments—other securities. See Part IV, line 11 ......				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			20,795,777	15	20,416,514
16	Total assets. Add lines 1 through 15 (must equal line 34)...			372,867,851	16	363,793,401
17	Accounts payable and accrued expenses .			108,410,765	17	113,099,756
18	Grants payable ..........				18
19	Deferred revenue ..........				19
20	Tax-exempt bond liabilities ..........			70,987,769	20	67,936,205
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 ..			685,072	23	174,834
24	Unsecured notes and loans payable to unrelated third parties ....				24
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.....			28,256,473	25	25,408,276
26	Total liabilities. Add lines 17 through 25.....			208,340,079	26	206,619,071
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			156,330,922	27	148,928,034
28	Temporarily restricted net assets .....			5,571,691	28	5,621,137
29	Permanently restricted net assets .....			2,625,159	29	2,625,159
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			164,527,772	33	157,174,330
34	Total liabilities and net assets/fund balances .....			372,867,851	34	363,793,401