Attach to Form 990 or Form 990-EZ.
See separate instructions.| (i) Name of supported organization |
(ii) EIN |
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) |
(iv) Is the organization in col. (i) listed in your governing document? |
(v) Did you notify the organization in col. (i) of your support? |
(vi) Is the organization in col. (i) organized in the U.S.? |
(vii) Amount of support? |
|||
|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
| 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. | ||||||
| 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). | ||||||






| 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.") . | 0 | |||||
| 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...... | 4,538,153 | 4,817,169 | 5,241,741 | 8,303,829 | 8,739,187 | 31,640,079 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | 157,105 | 123,698 | 92,655 | 127,975 | 179,998 | 681,431 |
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 6 | Total. Add lines 1 through 5. | 4,695,258 | 4,940,867 | 5,334,396 | 8,431,804 | 8,919,185 | 32,321,510 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| 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. | 226,454 | 215,469 | 239,675 | 183,195 | 182,950 | 1,047,743 |
| c | Add lines 7a and 7b.. | 226,454 | 215,469 | 239,675 | 183,195 | 182,950 | 1,047,743 |
| 8 | Public Support (Subtract line 7c from line 6.) | 31,273,767 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 4,695,258 | 4,940,867 | 5,334,396 | 8,431,804 | 8,919,185 | 32,321,510 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 135,373 | 34,401 | 5,837 | 4,504 | 1,365 | 181,480 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 2,205 | 2,205 | ||||
| c | Add lines 10a and 10b. | 135,373 | 34,401 | 5,837 | 4,504 | 3,570 | 183,685 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | 1,381,528 | 1,070,663 | 928,845 | 1,850,122 | 2,164,273 | 7,395,431 |
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 6,212,159 | 6,045,931 | 6,269,078 | 10,286,430 | 11,087,028 | 39,900,626 |




| Facts And Circumstances Test |
|---|
| Explanation |
|---|
| Software ID: | 11000144 |
| Software Version: | 2011v1.5 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Form 990, Part VI, Line 12c | 1. In connection with any actual or possible conflicts of interest, an interested person or other person subject to this policy must disclose the existence and nature of his or her financial interest in writing to the President of Centegra or the Chief Corporate Responsibility Officer or designee, who shall provide such written disclosure to the Govemors Affairs Committee of Centegra, which shall consider all conflicts of interest issues and, if appropriate, to the directors and members of committees with board-delegated powers considering the proposed transaction or arrangement. The disclosure must occur, at minimum, annually, with a Conflict of Interest Disclosure Statement being submitted no later than January 31 st of each year. Copies of disclosure statements filed by Board members shall be distributed to the Board annually at the February Board meeting. 2. When a conflict of interest is disclosed at meeting of the board or committee thereof, after disclosure of the financial interest, the interested person shall leave the board or committee meeting while the financial interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists. The interested person's leaving such meeting shall not affect whether a quorum exists at such meeting. 3. Procedures for Addressing the Transaction or Arrangement From Which the Conflict Arose. The chairperson of the board or committee shall, if appropriate, appoint a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement. After exercising due diligence, the board or committee shall determine whether Centegra can obtain a more advantageous transaction or arrangement with reasonable efforts from a person or entity that would not give rise to a conflict of interest. If a more advantageous transaction or arrangement is not reasonably attainable under circumstances that would not give rise to a conflict of interest, the board or committee shall determine by a majority vote of the disinterested directors whether the transaction or arrangement is in Centegra's best interest and for its own benefit and whether the transaction is fair and reasonable to Centegra and shall make its decision as to whether to enter into the transaction or arrangement in conformity with such determination. 4. Violations of the Conflicts of Interest Policy: If the administration, the board, or a committee has a reasonable cause to believe that a member has failed to disclose actual or possible conflicts of interest, it shall inform the member of the basis for such belief and afford the member an opportunity to explain the alleged failure to disclose. If, after hearing the response of the member and making such further investigation as may be warranted in the circumstances, the board or committee determines that the member has, in fact, failed to disclose an actual or possible conflict of interest, it shall refer the matter to the Governors Affairs Committee for consideration, which shall subsequently recommend appropriate disciplinary and corrective action to such board or committee. 5. The minutes of the board and all committees with board-delegated powers shall contain the names of the persons who disclosed or otherwise were found to have a financial interest in connection with an actual or possible conflict of interest, the nature of the financial interest, any action taken to determine whether a conflict of interest was present, and the board's or committee's decision as to whether a conflict of interest, in fact, existed. The names of the persons who were present for discussions and votes relating to the transaction or arrangement, the content of the discussion, including any alternatives to the proposed transaction or arrangement, and a record of any votes taken in connection therewith. Continued below. | |
| Form 990, Part V, Line 1c | There were no W2-G forms issued by the organization. | |
| Form 990, Part III, Line 4a, Con't. | Health Bridge services include, but are not limited to- Health Fitness facility, indoor and outdoor pools, instructors, and fitness classes Back to Work Program for Industrial Injury Prevention and Rehabilitation Sports Medicine clinic Physical Rehabilitation Occupational Health Community Educational Programs Support ProgramsRehabilitation and Sports Medicine Clinic at Health Bridge Fitness Center provides sports medicine, aquatics, outpatient physical and occupational therapy programs. The Back to Work Program, an industrial injury prevention and rehabilitation program, provides physical therapy, ergonomic consultation and back safety programs. This program also uses the aquatic pool located at the Rehabilitation and Sports Medicine Clinic.Health Bridge Corporation, as part of Centegra Health System, believes in total care that embraces the physical, psychological, spiritual, social and economic needs of the public served. In order to provide this care, Health Bridge supports a variety of services and educational programs. The organization sponsors many programs. In sponsoring programs, Health Bridge provides facilities as well as employees who act as facilitators for the group. In hosting programs, Health Bridge provides space free of charge or at a reduced or nominal fee to the group.SCREENINGSHealth Bridge held free screenings for:DiabetesSports Injuries: Sports Injury screenings allow participants to meet with a Physical Therapist to have their injuries analyzed and then receive information on how to improve the injury. Health Bridge also offers reduced fee lipid screenings.LECTURES/WORKSHOPSFamily health and wellness programs presented by Health Bridge are designed to promote a healthier community. Educational programs are offered to assist members of the community to take charge of special needs in their lives and their changing lifestyles, for healthier lives. Community lectures are offered between one and three times per month. Topics are chosen from ideas received from the community. Educational programs held at Health Bridge that are free to the community consisted of the following:Fall FoodsFreedom from Smoking LectureGardening LectureLove and Logic ParentingMaximize Your ExerciseOrganics and Whole GrainsQuick Family MealsVeggie Garden Your Way to 5-a-DayEXERCISE PROGRAMSIn addition to providing the facilities, equipment and professional staff, Health Bridge offers specialized exercise programs which help participants get moving and stay active for a healthier lifestyle. These include-Arthritis Water Exercise Program focuses on progressive improvement in strength, endurance and range of motion. Multiple Sclerosis Water Exercise helps to improve muscle strength, balance and coordination Low Back Water Exercise classes were offered to improve flexibility, strength and enduranceSenior Exercise classes were offered to improve flexibility, strength and enduranceYoga, Meditation and Tai Chi classes are offered to help reduce stress and increase flexibility.A Health Bridge certified fitness professional guided and educated persons on how to develop a safe and effective fitness plan. The Crossed the Bridge Support Group is offered at no charge to graduates of the following programs and services: Bridge to Weight Loss; Lifestyle Therapy & Lifestyle Therapy for Teens; nutrition consultations. Facilitators rotate each month and include a Registered Dietitian and Wellness Coach. | |
| Form 990, Part III, Line 4a Con't. | The purpose of the group is to offer ongoing support, motivation, accountabilityand education to those who have successfully completed a lifestyle change program. The Crossed the Bridge Support Group is offered at no charge to graduates of the following programs and services: Bridge to Weight Loss, Lifestyle Therapy, Lifestyle Therapy for Teens and nutrition consultations. Facilitators rotate each month and include a Registered Dietitician and Wellness Coach. The purpose of the group is to offer ongoing support, motiviation, accountability, and education to those who have successfully completed a lifestyle change program. Free tennis activities and classes were offered throughout the year and included; Pickleball Mixer, USTA Play Day Event and Tennis in 4 Weeks. Seniors in Motion and Fit over Fifty are exercise classes designed for the senior population and are available to the community.The Pre-Natal exercise class is a land and water exercise program designed to meet the special needs of mothers and mothers-to-be. There are a variety of Swim Lessons provided to the community-There are adult swim programs including, Masters Swim Workout, Adult Beginner Swim Lesson, and Adult Swim Stroke Improvement. These programs offer assistance on the basics of swimming up to training with a coach. There were 46 participants in adult swim lessons during this fiscal year. Children's Group Swim Lessons and Private Swim Lessons are offered and are Red Cross Certified. During this fiscal year, there were 6,447 participants in group lessons and 1,534 participants in private lessons. Free swim evaluations were held for the community.OFF-SITE PROGRAMSCommunity workshops and community outreach programs offered free of charge include: Girls on the Run and an Ask the Dietitian Booth at the Women's Care Fair at McHenry County College. Health Bridge provided massages at the Girls on the Run 5K and twice a month at Sage Cancer Center. A group fitness instructor led a class of Hannah Beardsley students through a Body Vive class. Health Bridge participates in various health fairs and various community fairs in order to promote health and awareness in the community. Health Bridge staff was able to have direct contact with the community to answer fitness questions and offer ways to increase activity. Health Bridge also offers assistance with corporate health fairs. A registered dietician took community members on a tour of a local grocery store and gave them information on how to locate products and bring home foods that enhance a healthy lifestyle. A personal trainer led a guided nature hike at a McHenry County Conservation District location. Exercises for strength and flexibility were integrated into the hike. A registered dietician presented a Fueling for Sport lecture to athletes and coaches at Huntley, Hampshire, McHenry and Woodstock high schools. Topics of discussion involved the importance of carbohydrates, fat and protein for better performance and how to structure meals, snacks and fluids around sports, practices and games. An exercise class was held at Prairie Ridge High School. A Careers as a Registered Dietician lecture was held at a Healthcare Forum where a registered dietician spoke to a group of Girl Scouts and their parents. COMMUNITY OUTREACHHealth Bridge held a 5K Run-Walk for the Centegra Cardiac Care. There were 313 participants. During the planning and implementation of this event, Health Bridge used approximately 100 manager hours for the 5K race at an average rate of $20 per hour. Health Bridge staff participated in the holiday bell ringing for the Salvation Army in order to collect donations for needy families. Health Bridge provided free flu shots to members and associates of Centegra Health System. Child care staff had a card-making activity for the children being looked after. The cards were for elderly persons at nursing homes. A Health Bridge associate read a story to a preschool class. He also spoke about his role at Health Bridge and the importance of exercise. Gift certificates for Health Bridge services were donated to other organizations for fundraising purposes with an associated cost of $8,744. | |
| Form 990, Part III, Line 4a Con't. | Food drives were held at Health Bridge to collect items for the Algonquin Lake in the Hills Food Pantry. Child care staff created and donated holiday treats to the Grafton Township Food Pantry. Several service desk and locker room associates volunteered at the Centegra Breakfast with Santa assisting with activities. These same associates also volunteered at the 5K community event and also spent the fifth Saturday of every month distributing food at the local Food Pantry. Health Bridge participated in the McHenry County Wrap-Around Family Holiday gift giving program. Health Bridge sponsored two (2) families and employees bought everything on the families "wish lists". In partnering with Wellness Place of Palatine, Health Bridge offered free lectures to men concerned about prostate health. In order to train new leaders, a conference room and studio space was donated to the Girls on the Run program. The facilities of Health Bridge were made available for a local police department to conduct their physical readiness testing of their officers. Fitness coaching and fitness staff held an event and lecture in order to help a group of Boy Scouts and Girl Scouts earn their Physical Fitness badge. A Big Brothers/Big Sisters pool party was held at Health Bridge. Child care staff supervised children going through an obstacle couse for a Heart Walk event. Child care staff also provided babysitting services to parents attending a Love and Logic Parenting lecture.CHBFC held a Community Day where the outdoor pool was open to the community free of charge. Personal Training Seminars were offered throughout the year and topics included exercise programming, fitness concepts and personal training. School supplies were collected at CHBFC for children in need in the community. A registered dietician spoke to a group of women about healthy nutrition tips for meal preparation, dining out, and stats and tips on nutrition for children, with a focus on obesity among our youth. The American Association of University Women is a non-for- profit group whose mission is to promote education among women. A presentation was held at a Leadership of Greater McHenry County meeting where leaders are working on a Youth Empowerment Program. Part of this program focuses on health and wellness. Information presented included statistics on rates of obesity in children and teens of McHenry County, health consequences and simple strategies for parents and kids to improve health.McHenry County College students visited Health Bridge for an orientation of the facility and to gain insight on careers in the fitness field. This visit helped to fulfill a class requirement in the fitness program at McHenry County College. A registered dietician met with individuals who were participating in the Freedom from Smoking class. Information was provided to help participants make healthy snack choices and to combat weight gain related to smoking cessation. For National Nutrition Month a registered dietician created a community nutrition newsletter with nutrition challenges. Also a booth was held with samples of healthier food options and nutrition pamphlets were distributed. A nutrition consultation with a Registered Dietician was raffled off as part of the Healthy Huntley Days event. A Health Bridge Registered Dietician sat on a panel of dietetic specialists to discuss her role as a Board Certified Specialist in Sports Dietetics to a group of Northern Illinois University dietetic interns. | |
| Form 990, Part III, Line 4a | The primary mission of Health Bridge Corporation is to assist individuals of the community in the achievement of a greater quality of life through health and fitness in a professional, customer-focused and state of the art environment. Health Bridge Corporation is an instrument and wholly owned subsidiary of Centegra Health System. HBC exists as a community benefit to improve the community's overall health status. Its presence in McHenry County will enhance Centegra Health System's image and diversify its services. The organization provides wellness and fitness services to, and makes wellness and fitness facilities available to, a significant and broad segment of the community served by Centegra Health System and its tax-exempt affiliates, including Northern Illinois Medical Center-(NIMC) and Memorial Medical Center - Woodstock-(Memorial). NIMC and Memorial are both tax-exempt hospitals that provide acute care services to the Chicago northwest suburban metropolitan area. The organization believes that its dues and rate structure permits a significant or broad segment of the community to utilize the organization's programs and facilities. The organization also offers charitable memberships based on evidence of hardship and need, consistent with the financial assistance policy applicable to all organizations within Centegra Health System. The organization also offers a variety of educational programs for free or at low fees to help defray costs, which is waived for those participants who are unable to pay. There were 119 charitable memberships provided during fiscal year.The organization promotes the health of the community served by Centegra Health System and its tax-exempt affiliates through patient rehabilitation programs, including sports medicine, aquatics, outpatient physical and occupational therapy programs, industrial injury prevention and rehabilitation programs, specialized exercise programs and health screenings for various injuries, diseases and disorders. These programs are offered directly by the organization or indirectly through NIMC, which leases space at the organization's facility in Crystal Lake, Illinois. The organization also offers a variety of bridge memberships for rehabilitation, bariatric and cancer patients who receive care through Centegra Health System and its affiliated physicians. Bridge memberships are free 60-day memberships that allow rehabilitation, bariatric and cancer patients the opportunity to bridge the gap between therapy and or treatment and lifestyle modification. A total of 280 60-day bridge memberships were provided during fiscal year.The organization provides health education for the community served by Centegra Health System and its tax-exempt affiliates through programs designed to promote community wellness and to educate the community on the benefits of total health wellness. Community lectures are offered to the public and several of these lectures and programs are offered without charge. The organization participates in various health fairs and community affairs in order to promote health and awareness in the community. The operations and programs of the organization are integrated into and are an important component of the community benefits provided by Centegra Health System and its tax-exempt affiliates. Several of the community healthcare priorities set forth in the Centegra community benefits plan are furthered directly by the organization. These priorities include access to health care, accident prevention and treatment, cancer prevention, detection, treatment and support, heart disease screenings, immunization clinics, lung cancer, respiratory disease, tobacco use cessation, weight and obesity education, support and activities, physical activity-lectures, screenings, activities, fairs and workshops; and community development and support. | |
| Form 990, Part VI, Line 19 | Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | All documents are available upon request. |
| Form 990, Part VI, Line 15b | Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | . The Board of Directors of Centegra Health System, through the Compensation Committee comprised of independent members free of conflict, reviewed executive compensation levels and other features of the compensation plan in accordance with the organization's approved compensation philosophy and strategy: oThe Committee is comprised of members of the Board of Directors, who are independent of Centegra management, have no personal interest in the compensation arrangements, are not related to, or under the control of any individual whose compensation arrangement is being reviewed and have no material business relationship with Centegra.oThe Chief Executive Officer's compensation is determined by the Compensation Committee in relation to appropriate comparability data. Compensation for other members of the executive staff are developed by the CEO, reviewed by the Committee, evaluated against market data, and approved by the Committee. oThe Committee approves all compensation decisions in advance of their implementation and documents its determinations and discussions. Its decisions and deliberations are thoroughly documented and meeting minutes are kept and distributed to the Committee members (for historical reference). The Compensation Committee uses a number of external resources and comparisons, and their review includes total compensation (cash compensation, plus benefits provided by Centegra) in relation to organizational performance and prevailing industry practices of comparably-sized organizations. They have engaged the services of a compensation consulting firm (Sullivan Cotter) specializing in the not-for-profit sector that has worked with Centegra and reports directly to the Compensation Committee. |
| Form 990, Part VI, Line 12c | Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | Continued from above. 6. A voting member of any committee whose jurisdiction includes compensation matters and who receives compensation, directly or indirectly, from Centegra for services is precluded from voting on matters pertaining to that member's compensation, Physicians who receive compensation, directly or indirectly, from Centegra, whether as employees or independent contractors, are precluded from membership on any committee whose jurisdiction includes compensation matters and in which such physician may have a direct or indirect interest. 7. Each director, principal officer, and member of a committee with board-delegated powers shall annually sign a statement which affirms that such person has received a copy of the conflicts of interest policy; has read and understands the policy; has agreed to comply with the policy; and understands that Centegra is a charitable organization and that in order to maintain its federal tax exemption, it must engage primarily in activities which accomplish one or more of its tax exempt purposes. 8. To ensure that Centegra operates in a manner consistent with its charitable purposes and that it does not engage in activities that could jeopardize its status as an organization exempt from federal income tax, periodic reviews shall be conducted by the Governors Affairs Committee of Centegra. The periodic reviews shall, at a minimum, include the following subjects: Whether acquisition of physician practices and other provider services result in inurement or impermissible private benefit. Whether partnership and joint venture arrangements and arrangements with management service organizations and physician hospital organizations conform to written policies, are properly recorded, reflect reasonable payment for goods and services, further Centegra's charitable purposes and do not result in inurement or impermissible private benefit. Whether agreements to provide healthcare and agreements with other healthcare providers, employees, and third party payors further Centegra's charitable purposes and do not result in inurement or impermissible private benefit. Whether business transactions on behalf of Centegra or an entity controlled by it are the result of arms-length dealing and are no less advantageous than competitively available goods and services of like grade and quality. 9.In conducting the periodic reviews provided for in Article VII, Centegra may, but need not, use outside advisors. If outside experts are used, their use shall not relieve the board of its responsibility for ensuring that periodic reviews are conducted. |
| Form 990, Part VI, Line 11 | Form 990, Part VI, Line 11: Form 990 Review Process | The review process for the 990 return included review by the Director of Accounting of the health system. |
| Form 990, Part VI, Line 6 | Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder | Centegra Health System has a single class of members. |
| Software ID: | 11000144 |
| Software Version: | 2011v1.5 |