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

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 07-01-2012 , 2012, and ending 06-30-2013
BCheck if applicable:
CName of organization
Sarah Bush Lincoln Health Center
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
PO BOX 372
Suite
Room/suite
City or town, state or country, and ZIP + 4
Mattoon, IL61938
D Employer identification number

23-7098532
E Telephone number

G Gross receipts $ 299,438,804
F Name and address of principal officer:
TIMOTHY A OLS
1000 HEALTH CENTER DRIVE
MATTOON,IL61938
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.sarahbush.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1977
M State of legal domicile: IL
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: THE MISSION OF SARAH BUSH LINCOLN HEALTH CENTER IS TO PROVIDE EXCEPTIONAL CARE FOR ALL AND CREATE HEALTHY COMMUNITIES.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 19
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 11
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 1,973
6 Total number of volunteers (estimate if necessary) ............. 6 212
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 4,403,772
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b -128,579
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,832,937 975,742
9 Program service revenue (Part VIII, line 2g) ......... 181,887,410 193,339,755
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 2,210,549 9,318,480
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 14,668,989 14,506,904
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 200,599,885 218,140,881
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 61,598 56,140
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 115,342,915 123,556,391
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 67,135,862 72,178,294
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 182,540,375 195,790,825
19 Revenue less expenses. Subtract line 18 from line 12....... 18,059,510 22,350,056
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 315,364,003 345,534,207
21 Total liabilities (Part X, line 26)............. 117,204,059 121,748,903
22 Net assets or fund balances. Subtract line 21 from line 20..... 198,159,944 223,785,304
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: THE MISSION OF SARAH BUSH LINCOLN HEALTH CENTER IS TO PROVIDE EXCEPTIONAL CARE FOR ALL AND CREATE HEALTHY COMMUNITIES. SARAH BUSH LINCOLN HEALTH CENTER PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO THE RESIDENTS OF MATTOON AND CHARLESTON, ILLINOIS AND SURROUNDING COUNTIES.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 170,828,836 including grants of $ 45,140 ) (Revenue $ 197,743,527 )
SEE SCHEDULE O
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet170,828,836
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IVClick to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV... Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see list of attachments
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV..................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
 
No
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
128
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
1,973
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletCJ , BD
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
19
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
11
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
IL
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletCRAIG W SHEAGREN CPA1000 HEALTH CENTER DRIVEMATTOONIL61938 (217) 258-2514
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) MR JIM LITTLEFORD........................................................................
DIRECTOR
 1.0
.......................1.0 		X           0 0 0
(2) MR STEVE HONSELMAN........................................................................
DIRECTOR
 1.0
.......................2.0 		X           0 0 0
(3) MR SCOTT LENSINK........................................................................
CHAIRPERSON
 1.0
.......................4.0 		X   X       0 0 0
(4) DR GARY MIKEL........................................................................
DIRECTOR
 53.0
.......................2.0 		X           370,265 0 27,605
(5) MR CHRIS CONSIDINE........................................................................
DIRECTOR
 1.0
.......................1.0 		X           0 0 0
(6) MS ANN BACON........................................................................
DIRECTOR
 1.0
.......................2.0 		X           0 0 0
(7) DR ALDO RUFFOLO........................................................................
DIRECTOR
 1.0
.......................1.0 		X           0 0 0
(8) MS JEANNE DAU........................................................................
SECRETARY
 1.0
.......................1.0 		X   X       0 0 0
(9) MR TIM MOONEY........................................................................
DIRECTOR
 1.0
.......................1.0 		X           0 0 0
(10) MR STEVE WENTE........................................................................
TREASURER
 1.0
.......................1.0 		X   X       0 0 0
(11) DR KIRAN JOAG........................................................................
DIRECTOR
 54.0
.......................1.0 		X           437,638 0 30,545
(12) MR WILLIAM PERRY........................................................................
DIRECTOR
 1.0
.......................2.0 		X           0 0 0
(13) MR MICHAEL SMITH........................................................................
CHAIRPERSON ELECT
 1.0
.......................3.0 		X   X       0 0 0
(14) MS JILL NILSEN........................................................................
DIRECTOR
 1.0
.......................1.0 		X           0 0 0
(15) MS LAUREL ALLENBAUGH........................................................................
DIRECTOR
 1.0
.......................1.0 		X           0 0 0
(16) DR SHERYL ARTMANN........................................................................
DIRECTOR
 54.0
.......................1.0 		X           509,400 0 30,990
(17) MS LYLA MCGUIRE........................................................................
DIRECTOR
 1.0
.......................1.0 		X           0 0 0
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) MR MICHAEL STANFIELD........................................................................
DIRECTOR
 1.0
.......................1.0 		X           0 0 0
(19) MR SCOTT WILSON........................................................................
DIRECTOR
 1.0
.......................1.0 		X           0 0 0
(20) MR TIMOTHY A OLS........................................................................
PRESIDENT & CEO
 40.0
.......................15.0 		    X       616,299 0 27,406
(21) MR CRAIG SHEAGREN........................................................................
VP FINANCE
 52.0
.......................3.0 		    X       400,855 0 21,868
(22) MR DENNIS J PLUARD........................................................................
VP OPERATIONS
 55.0
.......................0.0 		      X     382,693 0 24,760
(23) MR JERRY E ESKER........................................................................
VP PRACTICE MANAGEMENT
 55.0
.......................0.0 		      X     329,604 0 19,505
(24) MS MARY LOU WILD........................................................................
VP PATIENT CARE
 55.0
.......................0.0 		      X     325,916 0 15,829
(25) MR ERIC G BENSON........................................................................
VP HUMAN RESOURCES
 55.0
.......................0.0 		      X     247,426 0 22,632
(26) MS KIMBERLY A UPHOFF........................................................................
VP DEVELOPMENT
 27.0
.......................28.0 		      X     189,572 0 22,695
(27) AARON C EUBANKS MD........................................................................
PHYSICIAN
  
.......................   		        X   1,467,773 0 33,569
(28) LOUIS B MENDELLA MD........................................................................
PHYSICIAN
  
.......................   		        X   1,380,270 0 34,981
(29) CHARLEY T NGUYEN MD........................................................................
PHYSICIAN
  
.......................   		        X   1,207,060 0 33,838
(30) MICHAEL S SMITH MD........................................................................
PHYSICIAN
  
.......................   		        X   978,407 0 33,432
(31) CURTIS R GREEN MD........................................................................
PHYSICIAN
  
.......................   		        X   961,260 0 35,141
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 9,804,438 0 414,796
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet130
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
SM WILSON COMPANY, 2185 HAMPTON AVEST LOUISMO62249 BLDG CONTRACTORS 21,949,567
PRAIRIE CARDIOVASCULAR CONSULTANTS, 619 EAST MASON STSPRINGFIELDIL62701 MED SPECIALIST FEES 1,153,622
GE HEALTHCARE, PO BOX 843553DALLASTX782843553 PREV MAINT AGREEMENT 929,745
SOUTH BEND MEDICAL FDTN INC, PO BOX 2030MISHAWAKAIN465462030 LABORATORY SERVICES 855,334
DR CLAUDE SADOVSKY PC, 360 EAST RANDOLPHCHICAGOIL60601 ER MED SPECIALIST 596,292
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet39
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 490,045
e Government grants (contributions)1e 463,125
f All other contributions, gifts, grants, and
similar amounts not included above1f 		22,572
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 975,742
Program Service Revenue Business Code
2a NET PATIENT REV. 621110 157,785,835 157,785,835    
b OUTREACH REVENUE 541900 31,375 31,375    
c NET PROVIDER REVENUE 621110 35,522,545 35,522,545    
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 193,339,755
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 1,934,446     1,934,446
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 291,436  
b Less: rental expenses    
c Rental income or (loss) 291,436 0
d Net rental income or (loss).......MediumBullet 291,436     291,436
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 88,601,496 80,461
b Less: cost or other basis and sales expenses 80,870,635 427,288
c Gain or (loss) 7,730,861 -346,827
d Net gain or (loss)..........MediumBullet 7,384,034     7,384,034
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
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..MediumBullet 0      
Miscellaneous Revenue Business Code
11a REFERENCE LAB. 621500 8,733,341   4,366,893 4,366,448
b CAFETERIA & CATERING 722320 703,185   36,879 666,306
c MEANINGFUL USE PAYMENT 900099 2,654,408     2,654,408
d All other revenue .... 2,124,534     2,124,534
e Total. Add lines 11a–11d ...... MediumBullet 14,215,468
12 Total revenue. See Instructions......MediumBullet 218,140,881 193,339,755 4,403,772 19,421,612
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 56,140 56,140
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 .... 4,265,777   4,265,777  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 48,653   48,653  
7 Other salaries and wages 94,572,433 87,298,712 7,273,721  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 3,290,710 3,037,616 253,094  
9 Other employee benefits ....... 15,819,090 14,602,418 1,216,672  
10 Payroll taxes ........... 5,559,728 5,132,120 427,608  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 309,812   309,812  
c Accounting ........... 131,239   131,239  
d Lobbying ........... 38,006   38,006  
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 10,061,010 9,538,323 522,687  
12 Advertising and promotion .... 748,122 748,122    
13 Office expenses ....... 29,437,445 27,173,363 2,264,082  
14 Information technology ...... 1,844,361 1,702,508 141,853  
15 Royalties .. 0      
16 Occupancy ........... 2,828,245 2,610,720 217,525  
17 Travel ............ 1,069,808 987,527 82,281  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 872,197 805,115 67,082  
20 Interest ........... 1,003,533 1,003,533    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 9,982,057 9,214,321 767,736  
23 Insurance .............. 6,677,150   6,677,150  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MAINTENANCE/PREVENTATIVE MAINT 2,719,533 2,510,369 209,164  
b IL HOSPITAL TAX ASSESSMENT 2,617,068 2,617,068    
c DUES AND SUBSCRIPTIONS 368,541 368,541    
d RECRUITMENT EXPENSES 848,067 848,067    
e All other expenses 622,100 574,253 47,847  
25 Total functional expenses. Add lines 1 through 24e 195,790,825 170,828,836 24,961,989 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 5,670 1 6,220
2 Savings and temporary cash investments ......... 89,599,328 2 72,995,764
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 31,150,762 4 30,725,772
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 3,131,064 8 3,685,501
9 Prepaid expenses and deferred charges .......... 2,670,893 9 2,788,296
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 215,410,326
b Less: accumulated depreciation ..... 10b 110,757,517 81,022,541 10c 104,652,809
11 Investments—publicly traded securities .......... 54,811,183 11 68,742,942
12 Investments—other securities. See Part IV, line 11 ..... 45,703,046 12 55,869,658
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 7,269,516 15 6,067,245
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 315,364,003 16 345,534,207
Liabilities 17 Accounts payable and accrued expenses ......... 32,636,623 17 38,933,076
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 42,245,000 20 39,845,000
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 356,004 23 177,308
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
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.................... 41,966,432 25 42,793,519
26 Total liabilities. Add lines 17 through 25......... 117,204,059 26 121,748,903
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 198,159,944 27 223,785,304
28 Temporarily restricted net assets ........... 0 28 0
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 198,159,944 33 223,785,304
34 Total liabilities and net assets/fund balances ........ 315,364,003 34 345,534,207
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
218,140,881
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
195,790,825
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
22,350,056
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
198,159,944
5
Net unrealized gains (losses) on investments ...............
5
3,024,071
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
251,233
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
223,785,304
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Sarah Bush Lincoln Health Center
 
Employer identification number

23-7098532
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
Sarah Bush Lincoln Health Center
 
Employer identification number

23-7098532
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
Sarah Bush Lincoln Health Center
  		Employer identification number

23-7098532
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
Sarah Bush Lincoln Health Center
  		Employer identification number

23-7098532
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
Sarah Bush Lincoln Health Center
  		Employer identification number

23-7098532
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


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

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

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Sarah Bush Lincoln Health Center
 
Employer identification number

23-7098532
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

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

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

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

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










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2012


Schedule C (Form 990 or 990-EZ) 2012
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
38,006
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
 
No
 
j
Total. Add lines 1c through 1i ...............................
38,006
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
POLITICAL CAMPAIGN AND LOBBYING ACTIVITIES SCHEDULE C, PART IV THIS IS THE PORTION OF THE IHHA/AHA DUES THAT IS OFFSET AND ALLOCATED TO LOBBYING PURPOSES. THE LOBBYING PERCENTAGE THAT WAS PUBLISHED BY THE AMERICAN HOSPITAL ASSOCIATION WAS DETERMINED TO BE 23.98% OF THE ANNUAL MEMBERSHIP DUES AND THE PERCENTAGE BY IHHA WAS DETERMINED TO BE 39.0%.
Schedule C (Form 990 or 990EZ) 2012

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Sarah Bush Lincoln Health Center
 
Employer identification number

23-7098532
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 3,157,288 65,660,868 44,179,288 38,975,241 42,423,175
b Contributions ........ 10 6,860 18,233,631 5,800,500 5,589,131
c Net investment earnings, gains, and losses 283,096 8,519 6,968,167 3,288,311 -5,482,375
d Grants or scholarships .....     502,922 658,806 326,818
e Other expenditures for facilities
and programs ........ 		  62,518,959 3,217,296 3,225,958 3,227,872
f Administrative expenses ....          
g End of year balance ...... 3,440,394 3,157,288 65,660,868 44,179,288 38,975,241
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet1.106 %
b
Permanent endowment SchDMd Bullet72.309 %
c
Temporarily restricted endowment SchDMd Bullet26.584 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII 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 .................   3,194,269 3,194,269
b Buildings ................   85,451,487 38,792,354 46,659,133
c Leasehold improvements ............   479,836 115,851 363,985
d Equipment ................   89,954,808 68,160,159 19,794,649
e Other .................   38,329,926 3,689,153 34,640,773
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 104,652,809
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
(3)Other
(A) SUPPLEMENTAL PENSION 		22,346,508 F

(B) DEFERRED COMPENSATION 		9,253,206 F

(C) HEDGE FUNDS 		24,269,944 F






Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 55,869,658
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
SUPPLEMENTAL PENSION 22,189,707
DEFERRED COMPENSATION 9,253,205
EST PROFESSIONAL LIABILITY CLA 11,350,607






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 42,793,519
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI 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 XIII.) ............ 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 XIII.) ........... 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 XII 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 XIII.) ............ 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 XIII.) ............ 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 XIII
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
ENDOWMENT FUNDS PART VI ALL FUNDS ARE HELD BY A RELATED ORGANIZATION, SARAH BUSH LINCOLN HEALTH FOUNDATION. PER THE DONORS SPECIFIED INTENTIONS, PERMANENT AND TERM ENDOWMENT FUNDS MAY BE USED FOR CHARITABLE, BENEVOLENT, EDUCATIONAL, AND SCIENTIFIC PURPOSES TO SUPPORT SARAH BUSH LINCOLN HEALTH CENTER. THE PURPOSE OF THE BOARD DESIGNATED FUNDS IS TO PROVIDE FINANCIAL SUPPORT FOR ACTIVITIES OF THE SARAH BUSH LINCOLN HEALTH SYSTEM OR EXPENSES ASSOCIATED WITH MANAGING THE FOUNDATION.
FIN 48 FOOTNOTE PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
Schedule D (Form 990) 2012

Additional Data


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Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Sarah Bush Lincoln Health Center
 
Employer identification number

23-7098532
Part I
General Information on Activities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of the grants or
assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used to award
the grants or assistance? ...................................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside
the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in region (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total expenditures
for and investments
in region
Central America and the Caribbean     Investments   18,890,083
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .....     18,890,083
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b)     18,890,083
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter ....MediumBullet
 
3
Enter total number of other organizations or entities .......................MediumBullet
 
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If “Yes,”the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926)......................................
2 Did the organization have an interest in a foreign trust during the tax year? If “Yes,” the organizationmay be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A).......................................
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see Instructions for Form 5713)................................................
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
INVESTMENTS & EXPENDITURES PART I, COLUMN F INVESTMENTS IN REGION: $ 18,890,083 EXPENDITURES IN REGION: 0 (INVESTMENT EXPENSES)
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2012
Additional Data


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SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Sarah Bush Lincoln Health Center
 
Employer identification number

23-7098532
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
%
c
If the organization used factors other than FPG in determining 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, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    10,168,102   10,168,102 5.540 %
b Medicaid (from Worksheet 3,
column a) .... 		    36,575,360 30,461,087 6,114,273 3.340 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    46,743,462 30,461,087 16,282,375 8.880 %
Other Benefits
     433,296   433,296 0.240 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		           
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    331,592   331,592 0.180 %
j Total. Other Benefits ..     764,888   764,888 0.420 %
k Total. Add lines 7d and 7j .     47,508,350 30,461,087 17,047,263 9.300 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
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     41,970   41,970 0.020 %
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     41,970   41,970 0.020 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
4,557,306
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
40,968,702
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
59,080,888
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-18,112,186
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, and primary website address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 SARAH BUSH LINCOLN HEALTH CENTER
1000 HEALTH CENTER DRIVE
MATTOON,IL61938 		X                  
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
SARAH BUSH LINCOLN HEALTH CENTER
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 130.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15 Yes  
16 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
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
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?10
Name and address Type of Facility (describe)
1 SBL ARCOLA CLINIC
241 W SPRINGFIELD RD
ARCOLA,IL61920 		CLINIC
2 SBL ARTHUR CLINIC
211 S WALNUT
ARTHUR,IL61911 		CLINIC
3 SBL CASEY CLINIC
412 NW 3RD ST
CASEY,IL62420 		CLINIC
4 SBL CHARLESTON FAMILY PRACTICE
116 WEST BUCHANAN AVE
CHARLESTON,IL61920 		CLINIC
5 SBL FAMILY MEDICAL CENTER
200 RICHMOND AVE E
MATTOON,IL61928 		CLINIC
6 SBL NEOGA CLINIC
650 OAK AVE PO BOX 640
NEGOA,IL62447 		CLINIC
7 SBL SULLIVAN CLINIC
7 HAWTHORNE LANE
SULLIVAN,IL61951 		CLINIC
8 SBL TOLEDO CLINIC
168 COURTHOUSE SQUARE PO BOX 99
TOLEDO,IL62468 		CLINIC
9 SBL EFFINGHAM CLINIC
905 N MAPLE
EFFINGHAM,IL62401 		CLINIC
10 MATTOON WALK-IN CLINIC
144 DETTRO DRIVE
MATTOON,IL61938 		CLINIC
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
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; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
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.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
PART I, LINE 6A   IT IS PUBLISHED ON OUR WEBSITE (WWW.SARAHBUSH.ORG).
PART I, LINE 7, COLUMN F   THE ORGANIZATION INCURRED BAD DEBT EXPENSE IN THE AMOUNT OF $12,350,424, HOWEVER, IT HAS BEEN DISREGARDED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN.
PART I, LINE 7   THE COSTING METHODOLOGY THAT WAS USED TO CALCULATE THESE AMOUNTS WAS THE RATIO OF PATIENT CARE COST TO CHARGES CALCULATED ON WORKSHEET 2 OF THE WORKING PAPERS.
PART II   COLES TOGETHER, IS A NOT-FOR-PROFIT CORPORATION FOUNDED FOR AND TO PROMOTE ECONOMIC DEVELOPMENT FOR NEW AND EXISTING INDUSTRY IN OUR COUNTY, COLES COUNTY, ILLINOIS. OUR HOSPITAL BOARD HAS MADE A COMMITMENT TO SUPPORT THIS ORGANIZATION WHOSE COMMUNITY DEVELOPMENT EFFORTS BENEFIT OUR ORGANIZATION AS WELL AS OTHER ORGANIZATIONS IN OUR COMMUNITY THAT WOULD ULTIMATELY IMPACT AND KEEP OUR HOSPITAL A VIABLE ORGANIZATION. SUPPORT IS PROVIDED FINANCIALLY AND THROUGH PARTICIPATION ON THEIR BOARD.
PART III, LINE 2   USED THE RATIO OF PATIENT CARE COST TO CHARGES (0.3690) AS COMPUTED ON WORKSHEET 2 OF THE ACCOUNTING WORK PAPERS TO CALCULATE THE BAD DEBT EXPENSE (12,350,424) AT COST (4,557,306). WE REDUCE BAD DEBT EXPENSE BY THE DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS.
PART III, LINE 4   SEE THE PATIENT ACCOUNTS RECEIVABLE NOTE ON PAGE 8 OF THE ATTACHED FINANCIAL STATEMENTS.
PART III, LINE 8   ALTHOUGH SBL DOES NOT TREAT SHORTFALL FOR MEDICARE AS A COMMUNITY BENEFIT, THERE COULD BE A CASE MADE THAT NOT BEING FULLY REIMBURSED FOR TREATING THE ELDERLY IS CONSIDERED TO BE THE PROVISION OF A BENEFIT TO THE COMMUNITY.
PART III, LINE 9B   ACCOUNTS, WHICH HAVE BEEN WRITTEN OFF AS A BAD DEBT AND REFERRED TO A COLLECTION AGENCY, WILL BE PLACED ON HOLD AT THE COLLECTION AGENCY AND ADDED TO THE BALANCES CONSIDERED FOR FINANCIAL ASSISTANCE.
PART V, SECTION B, LINE 3   AS PART OF THE COMMUNITY HEALTH ASSESSMENT, TWO FOCUS GROUPS WERE HELD ON JULY 24-25, 2012. FOCUS GROUPS WERE COMPRISED OF 14 KEY INFORMANTS, INCLUDING REPRESENTATIVES OF PUBLIC HEALTH, PHYSICIANS AND OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND OTHER COMMUNITY LEADERS. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. PARTICIPANTS INCLUDED A REPRESENTATIVE OF PUBLIC HEALTH, AS WELL AS SEVERAL INDIVIDUALS WHO WORK WITH LOW-INCOME, MINORITY OR OTHER MEDICALLY UNDERSERVED POPULATIONS, AND THOSE WHO WORK WITH PERSONS WITH CHRONIC DISEASE CONDITIONS. SPECIFIC NAMES/TITLES OF THOSE PARTICIPATING ARE AVAILABLE UPON REQUEST.
PART V, SECTION B, LINE 5A   HOSPITAL FACILITY WEBSITE: http://www.sarahbush.org/about/community-health-needs-assessment/ OTHER WEBSITE: http://Mattoon.HealthForecast.net
PART V, SECTION B, LINE 7   1) DIABETES: SBLHC FEELS THAT EFFORTS OUTLINED TO ADDRESS HEART DISEASE & STROKE WILL HAVE A POSITIVE IMPACT ON ADDRESSING DIABETES DEATHS AS WELL. THE AGE-ADJUSTED MORTALITY RATE FOR DIABETES IS LOWER THAN THE OTHER HEALTH NEEDS IDENTIFIED, THEREFORE, WE ARE FOCUSING OUR RESOURCES ON THE NEEDS WITH THE HIGHER MAGNITUDE. 2) MENTAL HEALTH: SBLHC HAS LIMITED RESOURCES AND SERVICES AVAILABLE TO ADDRESS MENTAL HEALTH, SPECIFICALLY SUICIDE DEATHS. THE LIMITED RESOURCES EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. 3) MATERNAL, INFANT & CHILD HEALTH: SBLHC FEELS THAT OTHER HEALTH NEEDS IDENTIFIED ARE OF HIGHER PRIORITY THAN THE INFANT DEATH RATE DUE TO LOWER NUMBER OF ANNUAL INFANT DEATHS AND THE SMALL VARIANCE FROM THE BENCHMARK DATA. 4) CHRONIC KIDNEY DISEASE: SBLHC FEELS THAT EFFORTS OUTLINED TO ADDRESS HEART DISEASE & STROKE WILL HAVE A POSITIVE IMPACT ON ADDRESSING CHRONIC KIDNEY DISEASE DEATHS AS WELL. THE AGE-ADJUSTED MORTALITY RATE FOR CHRONIC KIDNEY DISEASE IS LOWER THAN THE OTHER HEALTH NEEDS IDENTIFIED, THEREFORE, WE ARE FOCUSING OUR RESOURCES ON THE NEEDS WITH THE HIGHER MAGNITUDE. 5)INJURY & VIOLENCE PREVENTION: SBLHC HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS INJURY AND VIOLENCE PREVENTION. OTHER COMMUNITY RESOURCES, SUCH AS LOCAL LAW ENFORCEMENT, HAVE THE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER SUPPORT THIS HEALTH NEED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION.
PART V, SECTION B, LINE 20D   PATIENTS WITHOUT INSURANCE AND WHO QUALIFY FOR FINANCIAL ASSISTANCE (OR HAVE PREVIOUSLY QUALIFIED FOR FINANCIAL ASSISTANCE) ARE GIVEN A DISCOUNT IN ACCORDANCE WITH HOSPITAL POLICY.
2. NEEDS ASSESSMENT   EVERY THREE YEARS, SARAH BUSH LINCOLN ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES THROUGH A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT. THIS ASSESSMENT INCORPORATES DATA FROM BOTH QUANTITATIVE AND QUALITATIVE SOURCES. QUANTITATIVE DATA INPUT INCLUDES PRIMARY RESEARCH (COMMUNITY HEALTH SURVEY THAT IS BASED LARGELY ON THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS)) AND SECONDARY RESEARCH (VITAL STATISTICS AND OTHER EXISTING HEALTH-RELATED DATA); THESE QUANTITATIVE COMPONENTS ALLOW FOR COMPARISON TO BENCHMARK DATA AT THE STATE AND NATIONAL LEVELS. QUALITATIVE DATA INPUT INCLUDES PRIMARY RESEARCH GATHERED THROUGH A SERIES OF KEY INFORMANT FOCUS GROUPS. BASED ON THE RESULTS OF THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT, SBL DETERMINED TO FOCUS ON DEVELOPING AND/OR SUPPORTING STRATEGIES AND INITIATIVES TO IMPROVE ACCESS TO HEALTH SERVICES, HEART DISEASE & STROKE, CANCER, TOBACCO USE AND ORAL HEALTH.
3. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE   WHEN A PATIENT IS PRIVATE PAY (OR SHOWS CONCERN ABOUT PAYING THE BILL) OUR REGISTRATION CLERK INFORMS THEM OF OUR FINANCIAL ASSISTANCE POLICY AT THE TIME OF REGISTRATION. ALL STAFF ARE ORIENTED AS TO HOW THE PROGRAM WORKS DURING NEW EMPLOYEE ORIENTATION. WE ALSO HAVE FINANCIAL ASSISTANCE REPRESENTATIVES AVAILABLE DURING NORMAL BUSINESS HOURS TO SPEAK WITH THE PATIENT IF THERE ARE QUESTIONS BEYOND THE REGISTRATION CLERK'S KNOWLEDGE. PATIENTS ARE INFORMED (NOT NECESSARILY AT REGISTRATION) THEY NEED TO APPLY FOR MEDICAID SHOULD THEY HAVE ANY PRE-QUALIFIERS FOR THE PROGRAM (IE: BLIND, DISABLED, DEPENDENT CHILDREN IN THE HOME, ETC). THIS INFORMATION IS IN THE FINANCIAL ASSISTANCE BROCHURE WITH THE APPLICATION AS WELL. IF A PATIENT NEEDS TO APPLY FOR MEDICAID PRIOR TO FINANCIAL ASSISTANCE, WE PROVIDE THEM THE INFORMATION AND ASSISTANCE TO APPLY AT THE PUBLIC AID OFFICE. ADDITIONALLY, OUR SBL FINANCIAL ASSISTANCE PROGRAM BROCHURES ARE IN EVERY DEPARTMENT AND CLINIC IN THE SYSTEM AND WIDELY AVAILABLE THROUGHOUT THE FACILITY. THE INFORMATION IS ALSO AVAILABLE ON OUR WEBSITE (INCLUDING THE APPLICATION) WITH A DEDICATED PHONE NUMBER.
4. COMMUNITY INFORMATION   SARAH BUSH LINCOLN SERVES RURAL COMMUNITIES IN EAST CENTRAL ILLINOIS. SBL'S MARKET AREA ENCOMPASSES 7 COUNTIES INCLUDING: CLARK, COLES, CUMBERLAND, DOUGLAS, EDGAR, MOULTRIE, AND SHELBY. THE POPULATION OF THE HOSPITAL'S SERVICE AREA IS ESTIMATED AT 157,198. THE REGION IS PREDOMINANTLY WHITE, WITH FEWER THAN 4 PERCENT OF THE POPULATION IDENTIFYING THEMSELVES AS MEMBERS OF RACIAL MINORITY GROUPS. THE REGION IS RURAL, WITH MORE THAN 53 PERCENT OF THE POPULATION LIVING IN COMMUNITIES OF LESS THAN 2,500. AS THROUGHOUT THE STATE AND NATION, OUR POPULATION IS AGING, WITH 16.3% CURRENTLY AGE 65 AND OLDER. THIS IS PROJECTED TO INCREASE IN COMING YEARS, AS IS THE DEMAND FOR SERVICES TO MEET THE HEALTH NEEDS OF THIS OLDER POPULATION. MEDIAN HOUSEHOLD INCOME FOR OUR PRIMARY SERVICE AREA IS BELOW THE STATE AVERAGE AT $36,457 AND 20.3% OF THE PRIMARY SERVICE AREA POPULATION REMAINS BELOW THE POVERTY LEVEL.
5. PROMOTION OF COMMUNITY HEALTH   SARAH BUSH LINCOLN HEALTH CENTER HAS AN OPEN MEDICAL STAFF AS WELL AS A COMMUNITY BOARD.
Schedule H (Form 990) 2012
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Sarah Bush Lincoln Health Center
 
Employer identification number
23-7098532
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) COLES TOGETHER
400 AIRPORT ROAD
MATTOON,IL61938 		37-1243664 501(C)(6) 27,500       SEE PART IV
(2) ILLINOIS PERFORMANCE EXCELLENCE
1415 W DIEHL RD
NAPERVILLE,IL60563 		36-3952696 501(C)(3) 7,500       SEE PART IV
(3) COLES COUNTY COUNCIL ON AGING
11021 E CO RD 800N
CHARLESTON,IL619208632 		23-7414779 501(C)(3) 11,000       SEE PART IV


















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
2
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
1
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
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.
Part III can be duplicated 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, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
PURPOSE OF GRAND OR ASSISTANCE PART II, COLUMN H COLES TOGETHER IS A NOT-FOR-PROFIT CORPORATION FOUNDED FOR AND TO PROMOTE ECONOMIC DEVELOPMENT FOR NEW AND EXISTING INDUSTRY IN OUR COUNTY, COLES COUNTY, ILLINOIS. OUR HOSPITAL BOARD HAS MADE A COMMITMENT TO SUPPORT THIS ORGANIZATION WHOSE COMMUNITY DEVELOPMENT EFFORTS BENEFIT OUR ORGANIZATION AS WELL AS OTHER ORGANIZATIONS IN OUR COMMUNITY THAT WOULD UTIMATELY IMPACT THE UTILIZATION AND VIABILITY OF OUR HOSPITAL ORGANIZATION. ILLINOIS PERFORMANCE EXCELLENCE IS A NOT-FOR-PROFIT ORGANIZATION FOUNDED IN 1994 TO ASSIST ORGANIZATIONS IN USING THE BALDRIGE CRITERIA FOR PERFORMANCE EXCELLENCE TO LEARN AND SHARE WITH OTHER ORGANIZATIONS BEST PRACTICES FOR CHANGE AND PROCESS IMPROVEMENT. OUT PARTICIPATION AND COMMITMENT TO THIS PROCESS ENABLES US TO IMPROVE PROCESSES AND PERFORMANCE. COLES COUNTY COUNCIL ON AGING WAS ESTABLISHED IN 1973 AND INCORPORATED IN 1974 AS A NOT-FOR-PROFIT 501(C)(3). IT INITIALLY SPONSORED THE TELECARE PROGRAM AND RESEARCHED THE NEEDS OF COLES COUNTY'S OLDER ADULTS. ITS SERVICES HAVE GROWN TO INCLUDE THE LIFESPAN CENTER, DIAL-A-RIDE, RSVP, TELECARE, TRIP, AND THE FAMILY CAREGIVER RESOURCE CENTER. ITS MISSION IS TO ENHANCE QUALITY OF LIFE BY PROMOTING INDEPENDENCE, DIGNITY, SELF-FULFILLMENT, AND HEALTH FOR OLDER ADULTS IN COLES COUNTY THROUGH ADVOCACY, EDUCATION, AND PROVISION OF APPROPRIATE COMMUNITY-BASED SERVICES.
Schedule I (Form 990) 2012


Additional Data


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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
2012
Open to Public Inspection
Name of the organization
Sarah Bush Lincoln Health Center
 
Employer identification number

23-7098532
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
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 (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)DR GARY MIKELDIRECTOR (i)
(ii)		 217,757
0 		125,429
0 		27,079
0 		8,500
0 		19,105
0 		397,870
0 		0
0
(2)DR KIRAN JOAGDIRECTOR (i)
(ii)		 324,998
0 		73,761
0 		38,879
0 		8,500
0 		22,045
0 		468,183
0 		0
0
(3)MR DENNIS J PLUARDVP OPERATIONS (i)
(ii)		 243,441
0 		110,284
0 		28,968
0 		8,500
0 		16,260
0 		407,453
0 		0
0
(4)MR TIMOTHY A OLSPRESIDENT & CEO (i)
(ii)		 386,955
0 		225,202
0 		4,142
0 		4,250
0 		23,156
0 		643,705
0 		0
0
(5)MR CRAIG SHEAGRENVP FINANCE (i)
(ii)		 213,464
0 		111,408
0 		75,983
0 		8,500
0 		13,368
0 		422,723
0 		0
0
(6)MR JERRY E ESKERVP PRACTICE MANAGEMENT (i)
(ii)		 209,409
0 		96,488
0 		23,707
0 		8,251
0 		11,254
0 		349,109
0 		0
0
(7)MS MARY LOU WILDVP PATIENT CARE (i)
(ii)		 247,166
0 		52,415
0 		26,335
0 		8,406
0 		7,423
0 		341,745
0 		0
0
(8)MR ERIC G BENSONVP HUMAN RESOURCES (i)
(ii)		 153,304
0 		74,542
0 		19,580
0 		6,608
0 		16,024
0 		270,058
0 		0
0
(9)DR SHERYL ARTMANNDIRECTOR (i)
(ii)		 455,026
0 		1,196
0 		53,178
0 		8,500
0 		22,490
0 		540,390
0 		0
0
(10)MS KIMBERLY A UPHOFFVP DEVELOPMENT (i)
(ii)		 121,660
0 		54,268
0 		13,644
0 		5,090
0 		17,605
0 		212,267
0 		0
0
(11)AARON C EUBANKS MDPHYSICIAN (i)
(ii)		 849,992
0 		611,001
0 		6,780
0 		8,500
0 		25,069
0 		1,501,342
0 		0
0
(12)LOUIS B MENDELLA MDPHYSICIAN (i)
(ii)		 849,992
0 		521,813
0 		8,465
0 		8,500
0 		26,481
0 		1,415,251
0 		0
0
(13)CHARLEY T NGUYEN MDPHYSICIAN (i)
(ii)		 823,992
0 		290,739
0 		92,329
0 		8,500
0 		25,338
0 		1,240,898
0 		0
0
(14)MICHAEL S SMITH MDPHYSICIAN (i)
(ii)		 742,997
0 		148,419
0 		86,991
0 		8,500
0 		24,932
0 		1,011,839
0 		0
0
(15)CURTIS R GREEN MDPHYSICIAN (i)
(ii)		 650,176
0 		239,478
0 		71,606
0 		8,500
0 		26,641
0 		996,401
0 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
COMPENSATION INFORMATION SCHEDULE J, LINE 7 ADDITIONAL COMPENSATION TO OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION ARE DEPENDENT ON SPECIFIC ORGANIZATIONAL AND INDIVIDUAL GOALS. THESE GOALS INCLUDE FINANCIAL, QUALITY, CUSTOMER SERVICE, AND OTHER GOALS RELATED TO THE ORGANIZATION'S STRATEGIC PLAN.
HEALTH OR SOCIAL CLUB DUES AND COMPANION TRAVEL SCHEDULE J, LINE 1A COUNTRY CLUB DUES ARE REPORTED AS TAXABLE COMPENSATION FOR OUR PRESIDENT AND CEO, MR. TIMOTHY A OLS. TRAVEL FOR COMPANIONS IS PROVIDED PER THE EMPLOYMENT AGREEMENT WITH THE PRESIDENT & CEO, TIM OLS. ANY PERSONAL ITEMS, EXTRA DAYS, AND MEALS FOR BOTH ARE PAID FOR USING HIS PERSONAL CREDIT CARD.
SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, LINE 4B SARAH BUSH LINCOLN HEALTH CENTER CURRENTLY MAINTAINS A NONQUALIFIED, UNFUNDED, DEFINED CONTRIBUTION SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN, ON BEHALF OF CERTAIN DESIGNATED MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES. THE PLAN IS INTENDED TO BE AN UNFUNDED DEFERRED COMPENSATION PLAN FOR A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES, AS DESCRIBED IN THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974, AS AMENDED ("ERISA"). THE FOLLOWING PERSONS LISTED IN FORM 990, PART VII ARE PARTICIPANTS IN THE PLAN: GARY MIKEL, MD CRAIG SHEAGREN JERRY ESKER AARON EUBANKS, MD MICHAEL SMITH, MD KIRAN JOAG,MD DENNIS PLUARD ERIC BENSON CURTIS GREEN,MD LOUIS MENDELLA, MD SHERYL ARTMANN,MD MARY LOU WILD TIMOTHY OLS CHARLEY NGUYEN, MD KIMBERLY UPHOFF THE FOLLOWING PERSONS RECEIVED DISTRIBUTIONS FROM THE PLAN DURING THE TAX YEAR: DENNIS PLUARD $10,070
Schedule J (Form 990) 2012

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Sarah Bush Lincoln Health Center
 
Employer identification number
23-7098532
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A ILLINOIS FINANCE AUTHORITY
  		86-1091967   03-18-2011 45,000,000 SEE PART VI   X X     X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0      
2 Amount of bonds legally defeased . . . . . . . . . . . 0      
3 Total proceeds of issue . . . . . . . . . . . . . . 45,000,000      
4 Gross proceeds in reserve funds . . . . . . . . . . . . 0      
5 Capitalized interest from proceeds . . . . . . . . . . . 0      
6 Proceeds in refunding escrows . . . . . . . . . . . . 10,402,120      
7 Issuance costs from proceeds . . . . . . . . . . . . 517,777      
8 Credit enhancement from proceeds . . . . . . . . . . . 0      
9 Working capital expenditures from proceeds . . . . . . . . . 0      
10 Capital expenditures from proceeds . . . . . . . . . . . 16,042,311      
11 Other spent proceeds . . . . . . . . . . . . . . 18,037,792      
12 Other unspent proceeds . . . . . . . . . . . . . . 0      
13 Year of substantial completion . . . . . . . . . . . . 2014
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? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X            
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .   X            
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? . . . . . . . . . . . . . . .   X            
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.00000%   %   %   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000%   %   %   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0.00000%   %   %   %
7 Does the bond issue meet the private security or payment test? . . . . .   X            
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.   %   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X            
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . . X              
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .                
b Exception to rebate? . . . . . . . .                
c No rebate due? . . . . . . . . . .
               
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . . X              
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . . 0
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . . . .                
e Was a hedge terminated? . . . . . . .                
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X            
b Name of provider . . . . . . . . . 0
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X            
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 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? X              
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
DESCRIPTION OF PURPOSE PART I, LINE A, COLUMN F REFINANCE OLD BONDS AND CONSTRUCTION OF MASTER FACILITY PLAN
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Sarah Bush Lincoln Health Center
 
Employer identification number

23-7098532
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) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Schedule L (Form 990 or 990-EZ) 2012
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) MAGGIE R WENTE SISTER-IN-LAW-STEVE WENTE 14,215 M WENTE EMPLOYED BY HLTH CNTR   No
(2) RHONDA WILSON SISTER OF SCOTT WILSON 34,438 R WILSON EMPLOYED BY HLTH CTR   No
(3) SBL MANAGEMENT SERVICES DIRECTORS SEE PART V 220,943 RENT INCOME   No
(4) SBL MANAGEMENT SERVICES DIRECTORS SEE PART V 1,511,080 PHARMACEUTICAL SERVICES EXP   No
(5) SBL MANAGEMENT SERVICES DIRECTORS SEE PART V 497,832 ADMINISTRATIVE SVCS INCOME   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
SBL HEALTH MANAGEMENT SERVICES RELATIONSHIP PART IV SBL HEALTH MANAGEMENT SERVICES IS A TAXABLE ENTITY RELATED TO SBL HEALTH CENTER. SCOTT LENSINK, WILLIAM PERRY, DR. GARY MIKEL AND ANN BACON ARE BOARD MEMBERS OF BOTH SBL HEALTH CENTER AND SBL HEALTH MANAGEMENT SERVICES. NONE OF THE BOARD MEMBERS HAVE A FINANCIAL INTEREST IN SBL HEALTH MANAGEMENT SERVICES.
Schedule L (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Sarah Bush Lincoln Health Center
 
Employer identification number

23-7098532
Identifier Return Reference Explanation
PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4A AS A NOT-FOR-PROFIT PROVIDER OF HEALTHCARE, SARAH BUSH LINCOLN HEALTH CENTER LEADERSHIP AND STAFF HAPPILY SHOULDER THE SOCIAL RESPONSIBILITY TO PROVIDE CARE AND RESOURCES TO MEMBERS OF THE COMMUNITY WHO ARE IN NEED-REGARDLESS OF THEIR PERSONAL CIRCUMSTANCES. THE PUBLIC TRUSTS US TO CONSERVE OUT RESOURCES AND USE THEM WISELY, WHILE IT LOOKS TO USE FOR LEADERSHIP, PARTNERSHIP, AND COLLABORATION ON A VARIETY OF PROJECTS. TO THAT END, WE PROVIDE HIGH QUALITY HEALTHCARE TO PEOPLE REGARDLESS OF THEIR RACE, CREED, SEC, NATION ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES IS CRITICAL TO THE OPERATION AND STABILITY OF SBLHC, WE RECOGNIZE THAT NOT EXERYONE IS ABLE TO AFFORD ESSENTIAL MEDICAL SERVICES. SINCE IT IS OUR MISSION TO PROVIDE HEALTHCARE AND EDUCATION TO ALL MEMBES OF THE COMMUNITY, WE PROVIDE: " BOTH FREE AND SUBSIDIZED CARE, " CARE TO PERSONS COVERED BY GOVERNMENT PROGRAMS AT BELOW-COST REIMBURSEMENT AND, " HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY AT LARGE DURING THE FISCAL YEAR THAT ENDED JUNE 30, 2013, WE SERVED 6,628 INPATIENTS AND PROVIDED 447,890 OUTPATIENT SERVICES. WE SPONSORED NUMEROUS WELLNESS AND COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGRAMS FOR OLDER RESIDENTS AND THE MEDICALLY UNDERSERVED, AND A WIDE VARIETY OF COMMUNITY SUPPORT ACTIVITIES. THIS INFORMATION OUTLINES THE MANY PROGRAMS AND SERVICES PROVIDED BY SBLHC DURING FISCAL YEAR 2013, MOST OF WHICH ARE ON-GOING. WE MAKE THIS INFORMATION AVAILABLE TO YOU SO YOU HAVE A BETTER UNDERSTANDING OF OUR MISSION, INCLUDING THE WAYS IN WHICH OUR RESOURCES ARE USED WITHIN THE COMMUNITY. WE ARE FIRMLY COMMITTED TO PROVIDING EXCEPTIONAL CARE AND CREATING HEALTHY COMMUNITIES, AND WE TRUST YOU'LL SEE THAT OUR ACTIONS MATCH OUR WORDS. SUMMARY WE HAVE CATEGORIZED OUR COMMUNITY SOCIAL RESPONSIBILITY STATEMENT TO CORRESPOND WITH OUR STRATEGIC GOALS. THE FOLLOWING IS A SNAPSHOT OF OUR ACTIVITIES FOR FISCAL YEAR 2013. EACH PROGRAM IS FURTHER DESCRIBED THROUGHOUT THIS BOOKLET. IMPROVE PATIENT EXPERIENCE AND LOYALTY $9,252 o ADVANTAGE 50 IMPROVE CLINICAL AND OPERATIONAL QUALITY $567,061 o COMMUNITY HEALTH SCREENS o EAST CENTRAL ILLINOIS BREAST & CERVICAL CANCER PROGRAM o HEALTH EDUCATION o METS PHASE III AT EIU o NOURISHMENT o OH, BABY! o REGIONAL BEHAVIORAL HEALTH NETWORK o SARAH BUSH LINCOLN WEBSITE o STEP IN THE RIGHT DIRECTION & LIVING WITH DIABETES o SUPPORT GROUPS ENHANCE HUMAN CAPITAL $15,349 o HEALTH OCCUPATIONS CREATE HEALTHY COMMUNITIES $215,195 o COMMUNITY AID o I SING THE BODY ELECTRIC o MOBILE MAMMOGRAPHY o ORGANIZATIONAL SUPPORT o ROTARY HIGH SCHOOL ATHLETIC HEART SCAN o YOUTH EDUCATION o SPORTS PHYSICALS MAINTAIN FINANCIAL VIABILITY $16,282,375 o FINANCIAL ASSISTANCE o GOVERNMENTAL INSURANCE PROGRAMS IMPROVE PATIENT EXPERIENCE AND LOYALTY ADVANTAGE 50 THIS FREE MEMBERSHIP GROUP IS OPEN TO ANYONE 50 YEARS OLD OR BETTER. IT PROVIDES HEALTH INFORMATION AND SOCIAL OUTINGS, AS WELL AS A VARIETY OF DISCOUNTS. THE NON-REIMBURSED COST TO SBLHC IS $9,252. IMPROVE CLINICAL AND OPERATIONAL QUALITY COMMUNITY HEALTH SCREENS PREVENTIVE HEALTH SCREENS ARE AVAILABLE FOR FREE AND AT REDUCED COSTS BOTH AT THE HEALTH CENTER AND AT OUTREACH LOCATIONS. TESTS SCREEN FOR VARIOUS CANCERS AND MEASURE CHOLESTEROL LEVELS, PULMONARY FUNCTION, BONE DENSITY, BLOOD PRESSURE AND BODY FAT. BLOOD SUGAR ANALYSIS AND VISION/GLAUCOMA SCREENINGS ARE ALSO PROVIDED, AS ARE WORKSHOPS FOCUSED ON LIFESTYLE MODIFICATION. THE NET NON-REIMBURSED COST OF THESE SERVICES AFTER DISCOUNTED FEES AND GRANT FUNDING WAS APPROXIMATELY $88,407. EAST CENTRAL ILLINOIS BREAST AND CERVICAL CANCER PROGRAM THE EAST CENTRAL ILLINOIS BREAST AND CERVICAL CANCER PROGRAM (ECIBCCP) PROVIDES MAMMOGRAMS AND CERVICAL CANCER SCREENS TO WOMEN. SBLHC PROMOTES THE PROGRAM AND WORKS WITH WOMEN IN NEED IN A NINE-COUNTY AREA BY SCHEDULING THEIR APPOINTMENTS. IN FY 2013 ECIBCCP PROVIDED SERVICES TO 932 WOMEN. THE NON-REIMBURSED COST WAS APPROXIMATELY $208,952. HEALTH EDUCATION HEALTH-RELATED EDUCATIONAL PROGRAMS ARE OFFERED IN MANY SETTINGS THROUGHOUT THE COMMUNITY ON SUCH TOPICS AS NUTRITION, DIABETES, DEPRESSION, EATING DISORDERS, SLEEP DISORDERS, OSTEOPOROSIS, HYPERTENSION, EXERCISE, CARDIAC HEALTH, CANCER, BEREAVEMENT, LIVING WILLS AND PRE- AND POST-NATAL CARE OF MOTHERS AND INFANTS. HEALTH STYLES, THE HEALTH CENTER'S QUARTERLY OUTREACH MAGAZINE, PROVIDES HEALTH INFORMATION AND IS DISTRIBUTED TO 68,000 HOUSEHOLDS IN AN EIGHT-COUNTY AREA AT A COST OF $57,400. METS PHASE III AT EIU EXERCISE AND CARDIOVASCULAR EDUCATION ARE COMBINED TO HELP PEOPLE WITH CARDIAC EVENTS REHABILITATE. THE NON-REIMBURSED COST TO SBLHS IS $17,091. NOURISHMENT SBLHC PROVIDES MEALS AT A SUBSIDIZED RATE FOR COMMUNITY RESIDENTS UNABLE TO PREPARE MEALS FOR THEMSELVES. RECIPIENT'S SPECIFIC DIETARY NEEDS MADE IT DIFFICULT, IF NOT IMPOSSIBLE, FOR THEM TO PARTICIPATE IN OTHER COMMUNITY MEAL PROGRAMS. THE NON-REIMBURSED COST WAS $4,249. OH, BABY! OH, BABY! CLASSES ENHANCE THE PRENATAL CARE OF NEW MOTHERS, HELP THEM UNDERSTAND THE MANY CHANGES THEIR BODIES UNDERGO, AND PREPARE THEM FOR THE BIRTH AND CARE OF THEIR NEWBORNS. ADDITIONALLY, LACTATION SUPPORT SERVICES ARE PROVIDED FREE TO ALL WOMEN WHO DELIVER THEIR BABIES AT THE HEALTH CENTER FOR AN UNLIMITED PERIOD OF TIME. A BREASTFEEDING WARMLINE PAGER GIVES MOTHERS FREE ACCESS TO INTERNATIONALLY BOARD-CERTIFIED LACTATION CONSULTANTS DEDICATED TO ANSWERING BREASTFEEDING QUESTIONS AND CONCERNS. THESE SERVICES ASSIST WOMEN IN NURSING THEIR BABIES LONGER, THUS IMPROVING THE LONG-TERM HEALTH OF THEIR INFANTS. THE NON-REIMBURSED COST TO PROVIDE THESE SERVICES IS $340. REGIONAL BEHAVIORAL HEALTH NETWORK SARAH BUSH LINCOLN, THE COLES COUNTY MENTAL HEALTH CENTER (NOW LIFE LINKS) AND THE HUMAN RESOURCES CENTER OF EDGAR AND CLARK COUNTIES JOINED FORCES TO CREATE THE REGIONAL BEHAVIORAL HEALTH NETWORK, AN ORGANIZATION THAT STREAMLINES ACCESS TO MENTAL HEALTHCARE FOR PEOPLE IN CRISIS. TOGETHER, THE THREE ORGANIZATIONS ESTIMATE THEY RESPOND TO ABOUT 3,000 CRISES INQUIRES FOR BEHAVIORAL HEALTH SERVICES ANNUALLY. THE COLLABORATIVE EFFORT IS PARTIALLY FUNDED BY GRANTS. THE HEALTH CENTER'S DIRECT AND IN-KIND NON-REIMBURSED COST WAS $74,000. SARAH BUSH LINCOLN WEBSITE THE HEALTH CENTER'S WEBSITE, WWW.SARAHBUSH.ORG, PROVIDES AREA RESIDENTS WITH ACCESS TO ACCURATE MEDICAL INFORMATION ABOUT ILLNESSES, TESTS AND TREATMENTS, AND IT OFFERS THEM A PLACE TO STORE THEIR OWN HEALTH INFORMATION. THE COST OF MAINTAINING THE SITE WAS $73,540. STEP IN THE RIGHT DIRECTION AND LIVING WITH DIABETES THIS SIX-MONTH LIFESTYLE MODIFICATION PROGRAM IS FREE TO AREA RESIDENTS WHO ARE AT RISK FOR DIABETES. PARTICIPANTS EXERCISE TWICE WEEKLY IN A CLASS SETTING, WHILE LEARNING ABOUT THEIR HEALTH AND WAYS TO IMPROVE IT. IT IS DESIGNED TO ASSIST PARTICIPANTS WITH WEIGHT LOSS, ESTABLISH REGULAR AND APPROPRIATE EXERCISE AND DIET CHANGES. THE PROGRAM HAS SERVED MORE THAN 50 COMMUNITY MEMBERS WITH BLOOD GLUCOSE LEVELS OF 100 TO 125. THE NON-REIMBURSED COST WAS $39,104. SUPPORT GROUPS SUPPORT GROUPS ASSIST THOSE AFFECTED BY CANCER, OSTOMY, STROKE, ADD, ADHD, POOR PULMONARY FUNCTION, LOSS OF A CHILD THROUGH MISCARRIAGE AND STILLBIRTH, NUTRITION AND CERTAIN CARDIAC EVENTS. THE NON-REIMBURSED COST OF PROVIDING EDUCATION AND RESOURCES WAS APPROXIMATELY $3,168.
ENHANCE HUMAN CAPITAL HEALTH OCCUPATIONS THE HEALTH OCCUPATIONS PROGRAM PROVIDES AREA HIGH SCHOOL STUDENTS WITH THE OPPORTUNITY TO LEARN MORE ABOUT HEALTHCARE. THE COLLABORATIVE PROGRAM RUNS THROUGHOUT THE SCHOOL YEAR, PROVIDES JOB SHADOWING FOR STUDENTS AND FREQUENT INTERACTION WITH PRACTICING PROFESSIONALS. STUDENTS GRADUATE WITH A CERTIFIED NURSE ASSISTANT CERTIFICATE. SEVENTY-FIVE STUDENTS WERE INVOLVED IN THE PROGRAM DURING FY13. THE NON-REIMBURSED COST OF PROVIDING CLASSROOM SPACE FOR TRAINING WAS $15,349. CREATE HEALTH COMMUNITIES COMMUNITY AID SBLHC ASSISTED MISSIONS IN VARIOUS AREAS AND LOCAL PROJECTS WITH HEALTHCARE NEEDS BY DONATING MEDICAL SUPPLIES AND EQUIPMENT. THE COST WAS APPROXIMATELY $98,174. I SING THE BODY ELECTRIC THROUGH I SING THE BODY ELECTRIC, HIGH SCHOOL YOUTH IN A SEVEN-COUNTY AREA USE THE ARTS TO ENCOURAGE THEIR PEERS TO MAKE HEALTHY CHOICES. THE BODY ELECTRIC COALITION INCLUDES SBLHC, THE REGIONAL OFFICE OF EDUCATION, EASTERN ILLINOIS UNIVERSITY, LAKE LAND COLLEGE, PARIS COMMUNITY HOSPITAL, AND WEIU-TV. APPROXIMATELY 65 PERCENT OF HIGH SCHOOL STUDENTS IN THE TARGETED REGION PARTICIPATE IN THE BIENNIAL YOUTH RISK BEHAVIOR SURVEY, AND AGGREGATE RESULTS ARE BROADLY SHARED TO INCREASE AWARENESS. STUDENTS WHO PARTICIPATE IN BODY ELECTRIC CREATE ARTS-BASED PROJECTS, WHICH FORM THE BASIS OF THE BODY ELECTRIC ARTS & HEALTH TOUR. IN ADDITION, THE PROGRAM TRAINS UNIVERSITY INTERNS, WHO GAIN EXPERIENCE IN COMMUNITY-BASED PREVENTION EDUCATION. IN FY 2013, THE NON-REIMBURSED COST OF BODY ELECTRIC WAS $63,400. MOBILE MAMMOGRAPHY BRINGING BREAST CANCER SCREENING SERVICES TO AREA TOWNS HAS INCREASED ACCESSIBILITY TO MAMMOGRAPHY FOR THOUSANDS OF WOMEN. A COLLABORATIVE PROGRAM WITH AREA HEALTH DEPARTMENTS AND BANKS, MOBILE MAMMOGRAPHY HAS SERVED 17,761 WOMEN. IN FY13, 1,285 MAMMOGRAMS WERE PERFORMED ON THE VAN WITH THE HELP OF A GRANT FROM THE WABASH VALLEY AFFILIATE OF THE SUSAN G. KOMEN FOR THE CURE FOUNDATION. THE NON-REIMBURSED COST TO SBLHS WAS $3,051. ORGANIZATIONAL SUPPORT (CASH AND IN-KIND GIFTS) BEING A GOOD NEIGHBOR MEANS SUPPORTING THE EFFORTS OF LOCAL AND REGIONAL ORGANIZATIONS WITH SIMILAR MISSIONS. THE HEALTH SYSTEM GAVE DIRECT FINANCIAL SUPPORT, STAFF TIME, THE USE OF HEALTH CENTER FACILITIES, AND OTHER RESOURCES IN EXCESS OF $40,596 TO COMMUNITY ORGANIZATIONS AND/OR PROJECTS, INCLUDING BUT NOT LIMITED TO: COLES COUNTY DIAL-A-RIDE, A SERVICE THAT TRANSPORTS LOCAL RESIDENTS TO THEIR PHYSICIANS' OFFICES AMERICAN HEART ASSOCIATION HEART WALK, TO SUPPORT CARDIOVASCULAR RESEARCH AMERICAN CANCER SOCIETY'S RELAY FOR LIFE, TO SUPPORT CANCER RESEARCH COLES COUNTY 4-H AUCTION, TO SUPPORT EDUCATION HOPE HOUSE, HOMELESS SHELTERS AND FOOD PANTRIES, AN AREA SCHOOL THROUGH OUR ADOPT-A-SCHOOL PROGRAM TO SUPPORT EDUCATION, MULTIPLE SPORTS TEAMS IN CHARLESTON, MATTOON, NEOGA, AND CASEY TO HELP FOSTER ACTIVE LIFESTYLES IN OUR YOUTH YMCA RUN FOR BAGEL, TO SUPPORT HEALTH AND TOURISM CHARLESTON COMMUNITY THEATRE, TO SUPPORT THE ARTS AMERICAN DIABETES ASSOCIATION WALK, TO SUPPORT RESEARCH MARCH OF DIMES WALK, TO SUPPORT RESEARCH HABITAT FOR HUMANITY, TO HELP BUILD AFFORDABLE, QUALITY HOMES VARIOUS COMMUNITY FESTIVALS, TO SUPPORT FITNESS AND TOURISM WE ALSO LEND SUPPORT TO COLES COUNTY UNITED WAY, ROTARY INTERNATIONAL, CCAR INDUSTRIES, COLES TOGETHER, COLES COMMUNITY HEALTH PLAN, AREA CHAMBERS OF COMMERCE, AND OTHER AGENCIES BY PARTICIPATING IN THEIR FUNDRAISING EVENTS, BOARDS AND COMMITTEES. IN ADDITION, SBLHC SUPPORTS A WIDE VARIETY OF SCHOOL ACTIVITIES BY SPONSORING PROGRAMS AND NEWSLETTERS SO STUDENTS HAVE A MORE FULFILLING SCHOOL EXPERIENCE. ROTARY HIGH SCHOOL ATHLETIC HEART SCAN AREA ROTARY CLUBS FORMED A UNIQUE PARTNERSHIP WITH THE SARAH BUSH LINCOLN HEALTH FOUNDATION TO HELP PREVENT PREMATURE DEATHS OF SEEMINGLY HEALTHY YOUNG ATHLETES. IN PAST YEARS THE CLUBS RAISED FUNDS TO PROVIDE FREE ULTRASOUND HEART SCANS TO AREA HIGH SCHOOL SOPHOMORE ATHLETES TO UNCOVER CARDIOMYOPATHY, WHICH MAY PRODUCE SUDDEN HEART ATTACKS DURING STRENUOUS ACTIVITIES. TWICE A YEAR, SARAH BUSH LINCOLN PROVIDES FREE ECHOCARDIOGRAMS TO HIGH SCHOOL SOPHOMORE ATHLETES. SO FAR, 3,351 HIGH SCHOOL ATHLETES FROM 20 AREA SCHOOLS HAVE TAKEN ADVANTAGE OF THIS LIFE-SAVING AND PAINLESS TEST. THE NON-REIMBURSED COST OF THESE SCANS IS APPROXIMATELY $2,280. YOUTH EDUCATION SBLHC SPONSORS YOUTH AND CHILDREN'S PROGRAMS FOCUSED ON THE IMPORTANCE OF HEALTHY LIFESTYLES, STAYING SAFE AND WAYS TO PROVIDE SAFE BABYSITTING. THE NON-REIMBURSED COST OF THESE EFFORTS IS APPROXIMATELY $255. SPORTS PHYSICALS ORTHOPEDIC SURGEONS AND FAMILY PRACTICE PHYSICIANS PARTNER WITH AREA SCHOOLS TO PROVIDE SPORTS PHYSICALS FOR ATHLETES. STUDENTS PAY $20 PER PHYSICAL, A FEE THAT IS THEN DONATED TO THEIR SCHOOLS' BOOSTER CLUBS BY SBLHC. SOME 372 SPORTS PHYSICALS WERE PROVIDED AT A COST OF $7,440. MAINTAIN FINANCIAL VIABILITY FINANCIAL ASSISTANCE TRADITIONAL CHARITY CARE COVERS SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD TO PAY FOR THEIR HEALTHCARE. THE HEALTH SYSTEM PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER THE FINANCIAL ASSISTANCE POLICIES WITHOUT CHARGE OR AT AMOUNTS LESS THAN THEIR ESTABLISHED RATES. EFFECTIVE JANUARY 1, 2005, THE HEALTH SYSTEM ADOPTED A NEW CHARITY CARE POLICY THAT SIGNIFICANTLY EXPANDED THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR PATIENTS OF THE SYSTEM. THE POLICY GIVES FINANCIAL ASSISTANCE IN SOME CASES AT FOUR TIMES THE FEDERAL POVERTY GUIDELINES. THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED WAS $27,557,386 FOR THE YEAR AND THE COST OF THOSE SERVICES AFTER CONTRIBUTIONS AND OTHER DIRECT ASSISTANCE WAS $10,168,102. IN FY 2013, 3,374 PEOPLE RECEIVED FINANCIAL ASSISTANCE. GOVERNMENTAL INSURANCE PROGRAM UNPAID COST OF PUBLIC PROGRAMS FOR TREATING MEDICARE, MEDICAID, AND OTHER GOVERNMENTAL PROGRAMS IN EXCESS OF GOVERNMENT PAYMENTS WAS $6,114,273 DURING THE YEAR.
BUSINESS RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 SCOTT LENSINK, WILLIAM PERRY, DR. GARY MIKEL AND ANN BACON HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER AS A RESULT OF ALL SERVING AS BOARD MEMBERS OF SARAH BUSH LINCOLN HEALTH MANAGEMENT SERVICES, A FOR-PROFIT AFFILIATE OF THE ORGANIZATION.
MEMBERS FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS SARAH BUSH LINCOLN HEALTH SYSTEM.
ELECTION OF GOVERNING BODY PART VI, SECTION A, LINE 7A BOARD MEMBERS WILL AID IN THE SELECTION FOR THE NOMINATION OF NEW BOARD MEMBERS WHEN VACANCIES OCCUR OR WHEN TERMS WILL EXPIRE, BUT THE FINAL APPROVAL OF THE CANDIDATES IS MADE BY THE SOLE MEMBER OF THE CORPORATION, SARAH BUSH LINCOLN HEALTH SYSTEM.
DECISIONS OF THE GOVERNING BODY PART VI, SECTION A, LINE 7B THE SARAH BUSH HEALTH SYSTEM BOARD, THE SOLE MEMBER OF THE HEALTH CENTER BOARD, RETAINS CERTAIN RESERVED POWERS INCLUDING AMENDING ARTICLES OF INCORPORATION OR BYLAWS, APPROVING THE ANNUAL OPERATING BUDGET AND LONG RANGE STRATEGIC PLAN, APPROVAL OF ANY TRANSACTIONS REQUIRING A CERTIFICATE OF NEED, APPROVAL OF THE BORROWING OF FUNDS AND INCURRING DEBT, APPROVAL OF MERGERS, CONSOLIDATIONS, SALE, OF ALL OR SUBSTANTIALLY ALL ASSETS, SELECTING AUDITORS, CREATING OR ACQUIRING SUBSIDIARY OR AFFILIATE CORPORATIONS, DISSOLVING THE CORPORATION, APPOINTING, EVALUATING AND REMOVAL OF PRESIDENT/CEO, AND ELECTING BOARD MEMBERS.
FORM 990 REVIEW FORM 990 PART VI, SECTION B, LINE 11A THE SENIOR ACCOUNTING STAFF REVIEWS ALL ELEMENTS OF THE 990 BASED ON PRIOR KNOWLEDGE AND INTERVIEWS WITH OTHER INDIVIDUALS IN THE ORGANIZATION. IN ADDITION, BOARD MEMBERS SUBMIT DETAILED QUESTIONNAIRES WITH REGARDS TO THEIR RELATIONSHIPS WITH THE ORGANIZATION. THE FINAL FORM 990 IS MADE AVAILABLE TO THEM ONLINE VIA A WEB PORTAL AND AT THEIR BOARD MEETING FOR REVIEW AND QUESTIONS.
CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12A-C MEMBERS OF THE BOARD OF DIRECTORS ANNUALLY COMPLETE A CERTIFICATION STATEMENT WHICH IDENTIFIES POSSIBLE CONFLICTS OF INTEREST RELATED TO THEIR PROFESSIONAL AND PERSONAL LIVES. DURING DELIBERATIONS AND DECISIONS ON WHICH THERE APPEARS TO BE A CONFLICT OF INTEREST, THE BOARD MEMBER IS EXCUSED FROM THE DISCUSSION AND DELIBERATION, SHALL NOT VOTE ON, NOR USE HIS PERSONAL INFLUENCE ON OR BE COUNTED IN DETERMINING THE EXISTENCE OF A QUORUM IN RESPECT TO THE TRANSACTION OR CONTRACT.
PROCESS FOR DETERMINING COMPENSATION FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION IS DETERMINED FOR THE CEO, VP OPERATIONS, VP SYSTEM PRACTICES, VP FINANCE, VP PATIENT CARE SERVICES, VP INFORMATION SERVICES, VP HUMAN RESOURCES, AND VP FOUNDATION BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE COMMITTEE IS COMPRISED OF MEMBERS OF THE SBL BOARD. AN INDEPENDENT CONSULTANT, HAY GROUP, INC., REVIEWED CURRENT COMPENSATION FOR EACH POSITION AND COMPARED IT TO SIMILAR POSITIONS IN LIKE ORGANIZATIONS. THE COMMITTEE APPROVED COMPENSATION CONSISTENT WITH THE BOARD-APPROVED EXECUTIVE COMPENSATION PHILOSOPHY. THIS PROCESS IS DONE ANNUALLY, BETWEEN JUNE AND AUGUST, FOR ALL THE LISTED POSITIONS.
PUBLIC DISCLOSURE FORM 990, PART VI, SECTION C, LINE 19 CURRENTLY, SARAH BUSH LINCOLN HEALTH CENTER POSTS THEIR COMMUNITY BENEFITS STATEMENT ON OUR PUBLIC WEB-SITE. NO OTHER GOVERNING DOCUMENTS ARE ROUTINELY MADE AVAILABLE.
INDEPENDENT VOTING MEMBERS PART VI, LINE 1B FOUR BOARD MEMBERS ARE NOT CONSIDERED INDEPENDENT DUE TO THE FACT THAT THEY ARE LISTED IN A TRANSACTION REPORTED ON SCHEDULE L INVOLVING A TAXABLE RELATED ENTITY. IF NOT FOR THE REQUIREMENT TO REPORT THIS TRANSACTION, THERE WOULD BE 14 INDEPENDENT VOTING MEMBERS.
OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 9 EQUITY TRANSFERS FROM AFFILIATE.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


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

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Sarah Bush Lincoln Health Center
 
Employer identification number

23-7098532
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to 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 entity?
Yes No
(1) SARAH BUSH LINCOLN HEALTH SYSTEM

1000 HEALTH CENTER DRIVE

MATTOON,IL61938
37-1136714 		PARENT CO IL 501(C)(3) 11-I NA
 
 
No
(2) SARAH BUSH LINCOLN HEALTH CTR FOUNDATION

1000 HEALTH CENTER DRIVE

MATTOON,IL61938
37-1136713 		FUNDRAISING IL 501(C)(3) 11-I SBLHS
 
 
No










For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to 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
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) SARAH BUSH LINCOLN HEALTH MGMT SERVICES

1000 HEALTH CENTER DRIVE
MATTOON,IL61938
37-1136614 		RETAIL DME/RX IL SBLHS
  		C CORP 0 0     No
(2) SARAH BUSH LINCOLN CAPTIVE INSURANCE LTD

 
 
INSURANCE CJ SBLHS
  		C CORP 0 0     No










Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

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




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
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


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