TY 2012 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) STEVEN SOBOL MD........................................................................ DIRECTOR/PHY	40.00 .......................	X		1,619,481	20,613
(2) KENNETH SMITHMIER........................................................................ DIRECTOR/PRE	40.00 ........................20	X	X	718,615	19,613
(3) LARRY ALTENBAUMER........................................................................ DIRECTOR	2.00 .......................	X		0	0
(4) WALTER SMITH........................................................................ DIRECTOR	2.00 .......................	X		0	0
(5) JOHN W FUNK........................................................................ DIRECTOR	2.00 .......................	X		0	0
(6) JONATHON T LOCKE MD........................................................................ DIRECTOR	2.00 .......................	X		0	0
(7) ROY MOSSER JR........................................................................ DIRECTOR	2.00 .......................	X		0	0
(8) THOMAS KOWA........................................................................ DIRECTOR	2.00 .......................	X		0	0
(9) DAVID SMITH........................................................................ DIRECTOR	2.00 .......................	X		0	0
(10) ROBIN KING........................................................................ DIRECTOR	2.00 .......................	X		0	0
(11) BRAD WIKE........................................................................ DIRECTOR	2.00 .......................	X		0	0
(12) SCOTT G STRIGLOS........................................................................ DIRECTOR	2.00 .......................	X		0	0
(13) DAVID TYROLT........................................................................ DIRECTOR	2.00 .......................	X		0	0
(14) RON DRANE........................................................................ DIRECTOR	2.00 .......................	X		0	0
(15) PAULA EISSFELDT........................................................................ DIRECTOR	2.00 .......................	X		0	0
(16) EDWARD ELLIOT MD........................................................................ DIRECTOR	2.00 .......................	X		0	0
(17) TIMOTHY D STONE JR........................................................................ EVP & ADMINI	40.00 ........................20		X	415,662	17,373

(A) Name and business address	(B) Description of services	(C) Compensation
DECATUR EMERGENCY MEDICAL SERVICES334 W ELDORADODECATURIL62522	PHYSICIAN FEES	1,220,000
DENMAN LINEN SERVICES1801 N 43RDQUINCYIL62305	LINEN SERVICES	1,209,021
CONSOCIATE GROUPPO 1068DECATURIL62525	INSURANCE SERV	862,176
ALLSCRIPTS LLC24630 NETWORK PLACECHICAGOIL606731246	SOFTWARE SUPPRT	700,583
EXECUTIVE HEALTH RESOURCEPO BOX 822688PHILADELPHIAPA19182	CLAIMS REVIEW	657,788
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 186

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	932,272	932,272
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	3,705,703	1,522,829	2,182,874
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	2,732,131	2,708,660	23,471
7	Other salaries and wages	103,078,135	86,592,781	16,485,354
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,507,720	1,266,589	241,131
9	Other employee benefits .......	17,157,972	14,413,886	2,744,086
10	Payroll taxes ...........	6,836,766	5,743,358	1,093,408
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	884,921		884,921
c	Accounting ...........	1,103,867		1,103,867
d	Lobbying ...........	72,057		72,057
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	21,269,511	11,233,877	10,035,634
12	Advertising and promotion ....	1,006,255	658,821	347,434
13	Office expenses .......	48,085,049	44,744,856	3,340,193
14	Information technology ......	5,202,542	4,800,515	402,027
15	Royalties ..	16,307	16,307
16	Occupancy ...........	9,019,353	5,859,417	3,159,936
17	Travel ............	786,893	680,502	106,391
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	372,503	202,449	170,054
20	Interest ...........	1,181,496	767,558	413,938
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	21,316,587	13,387,011	7,929,576
23	Insurance ..............	3,428,690	944,015	2,484,675
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	STATE MEDICAID TAX	5,193,642	5,193,642
b	MISCELLANEOUS EXPENSE	2,348,917	969,053	1,379,864
c
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	257,239,289	202,638,398	54,600,891	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	9,347	1	8,700
2	Savings and temporary cash investments .........	7,859,163	2	24,054,347
3	Pledges and grants receivable, net ...........		3
4	Accounts receivable, net .............	43,967,363	4	37,962,067
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
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
			6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	3,127,753	8	3,071,259
9	Prepaid expenses and deferred charges ..........	3,674,503	9	3,526,214
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	377,033,260
b	Less: accumulated depreciation .....	10b	266,764,710	120,176,803	10c	110,268,550
11	Investments—publicly traded securities ..........	182,904,905	11	200,205,996
12	Investments—other securities. See Part IV, line 11 .....		12
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	6,773,714	15	12,493,535
16	Total assets. Add lines 1 through 15 (must equal line 34)......	368,493,551	16	391,590,668
	17	Accounts payable and accrued expenses .........	35,013,222	17	39,514,372
18	Grants payable .................		18
19	Deferred revenue ................	146,195	19	139,553
20	Tax-exempt bond liabilities .............	15,147,000	20	13,311,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
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..........		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	30,818,140	25	27,183,813
26	Total liabilities. Add lines 17 through 25.........	81,124,557	26	80,148,738
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	236,946,363	27	260,167,522
28	Temporarily restricted net assets ...........	35,813,819	28	35,917,359
29	Permanently restricted net assets ...........	14,608,812	29	15,357,049
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	287,368,994	33	311,441,930
34	Total liabilities and net assets/fund balances ........	368,493,551	34	391,590,668

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

DECATUR MEMORIAL HOSPITAL

Employer identification number

37-0661199

Part I

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

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

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

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

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

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

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

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

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

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

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

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

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

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

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

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

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

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

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

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

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

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

Yes

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

11g(i)

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

11g(ii)

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

11g(iii)

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

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


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

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)		(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)		(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).

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2011. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2011. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

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

Schedule A (Form 990 or 990-EZ) 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:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

OMB No. 1545-0047

2012

Name of the organization

DECATUR MEMORIAL HOSPITAL

Employer identification number

37-0661199

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

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

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 2

Name of organization DECATUR MEMORIAL HOSPITAL

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 3

Name of organization DECATUR MEMORIAL HOSPITAL

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
DECATUR MEMORIAL HOSPITAL

Employer identification number

37-0661199

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data

Software ID:
Software Version:

- TIN:

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.
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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
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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

DECATUR MEMORIAL HOSPITAL

Employer identification number

37-0661199

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

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

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 Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(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? ......................................	Yes No

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

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

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:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Yes

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Yes

22,759

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

49,298

Total. Add lines 1c through 1i ...............................

72,057

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

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

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

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."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

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
	SCHEDULE C, PART II-B, LINE 1	A PORTION OF THE MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, THE ILLINOIS HOMECARE AND HOSPICE COUNCIL, AND THE ILLINOIS HOSPITAL ASSOCIATION ARE DESIGNATED AS LOBBYING EXPENSES. THE AMOUNT REPORTED ON SCHEDULE C, PART II-B, LINE 1I REPRESENTS THE AMOUNTS SO DESIGNATED.

Schedule C (Form 990 or 990EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

DECATUR MEMORIAL HOSPITAL

Employer identification number

37-0661199

Part I

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

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

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

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

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

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

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

Yes No

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

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

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

Yes No

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.

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.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

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

(ii)

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

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 2012

Page 2

Part III

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

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No

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


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

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

Yes No

If “Yes,” explain the arrangement in Part 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 ....	14,608,812	12,369,414	11,963,360	10,910,741	17,589,403
b	Contributions ........
c	Net investment earnings, gains, and losses	1,893,758	3,817,049	406,054	1,977,035	505,233
d	Grants or scholarships .....	366,193	504,333		75,407	50,010
e	Other expenditures for facilities and programs ........	779,328	1,073,318		849,009	7,133,885
f	Administrative expenses ....
g	End of year balance ......	15,357,049	14,608,812	12,369,414	11,963,360	10,910,741

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

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

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

Yes

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

3a(i)

Yes

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

3a(ii)

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

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		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	1,337,264		1,337,264
b	Buildings ................	177,888,419	108,285,594	69,602,825
c	Leasehold improvements ............	2,184,936	15,693	2,169,243
d	Equipment ................	186,513,951	152,378,600	34,135,351
e	Other .................	9,108,690	6,084,823	3,023,867
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				110,268,550

Schedule D (Form 990) 2012

Page 3

Part VII

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

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








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

Part VIII

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

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









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

Part IX

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

(a) Description				(b) Book value









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

Part X

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

1.(a) Description of liability		(b) Book value
Federal income taxes
CAPITAL LEASE OBLIGATIONS		13,361,268
MALPRACTICE INSURANCE		6,247,291
DEFERRED TRUST		4,671,205
PENSION LIABILITY		1,220,726
FUTURE RENT PAYMENTS		956,331
RETIREE HEALTH PLAN		626,124
RESERVE FOR A/R NOT ON BOOKS		100,868


Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		27,183,813
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

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
INTENDED USES FOR ENDOWMENT FUNDS	SCHEDULE D, PAGE 2, PART V, LINE 4	THE ENDOWMENT FUNDS ARE USED FOR CAPITAL PURCHASES, SCHOLARSHIPS, AND ASSISTING INDIGENT PEOPLE WITH THEIR HOSPITAL BILLS.
LIABILITY UNDER FIN 48 FOOTNOTE	SCHEDULE D, PAGE 3, PART X	THE SYSTEM HAD NO UNCERTAIN POSITIONS IN INCOME TAX LIABILITIES OR EXPENSES.

Schedule D (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

DECATUR MEMORIAL HOSPITAL

Employer identification number

37-0661199

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

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

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) 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:

Yes

100% 150% 200% Other %

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: .........

Yes

200% 250% 300% 350% 400% Other 600.000 %

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.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) ..	12,148,459		12,148,459	4.720 %
b	Medicaid (from Worksheet 3, column a) ....	28,051,375	8,701,669	19,349,706	7.520 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	40,199,834	8,701,669	31,498,165	12.240 %
Other Benefits		530,590		530,590	0.210 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	530,590		530,590	0.210 %
f	Health professions education (from Worksheet 5) ..	612,333		612,333	0.240 %
g	Subsidized health services (from Worksheet 6) ..	1,247,973		1,247,973	0.490 %
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	23,375		23,375	0.010 %
j	Total. Other Benefits ..	2,414,271		2,414,271	0.950 %
k	Total. Add lines 7d and 7j .	42,614,105	8,701,669	33,912,436	13.190 %

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.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	250	250
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other	66,592	66,592	0.030 %
10	Total	66,842	66,842	0.030 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

5,306,089

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. ......

2,937,176

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

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

79,757,683

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

72,062,993

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

7,694,690

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(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 %	(e) Physicians' profit % or stock ownership %
1DECATUR DIG DISEASE	AMBULATORY ENDOSCOPY CENTER	50.000 %	50.000 %
2
3
4
5
6
7
8
9
10
11
12
13

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					Other (Describe)
1	DECATUR MEMORIAL HOSPITAL 2300 N EDWARD ST DECATUR,IL62526	X	X	X	ACUTE CARE & LONG TERM CARE

Schedule H (Form 990) 2012

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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)

	DECATUR MEMORIAL HOSPITAL
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

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

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

Yes

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

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

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

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 ........

Yes

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)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

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

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: 200.0% 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: 600.0% 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	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Other (describe in Part VI)
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	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
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	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
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	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

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?..........

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

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? ............................

If “Yes,” explain in Part VI.

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? .........................

If “Yes,” explain in Part VI.

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?9
Name and address		Type of Facility (describe)
1	DMH MEDICAL GROUP 2300 N EDWARD ST DECATUR,IL62526	OUTPATIENT CLINICS
2	SOUTH SHORES IMAGING CENTER 1689 S FRANKLIN ST DECATUR,IL62521	DIAGNOSTIC CENTER
3	DMH SURGERY CENTER 304 W HAY SUITE 114 DECATUR,IL62526	AMBULATORY SURGERY CENTER
4	FORSYTH IMAGING CENTER 389 W WEAVER ROAD FORSYTH,IL62535	DIAGNOSTIC CENTER
5	DMH CORPORATE HEALTH SERVICES 2122 NORTH 27TH ST DECATUR,IL62526	OUTPATIENT CLINIC
6	DECATUR DIGESTIVE DISEASE CENTER 2 MEMORIAL DR PHYS PLAZA WEST SUITE 102 DECATUR,IL62526	AMBULATORY ENDOSCOPY CENTER
7	DMH HOME HEALTH CARE 3122 BRETTWOOD CIRCLE DECATUR,IL62526	HOME HEALTH AGENCY
8	SPORTS ENHANCEMENT CENTER 2122 NORTH 27TH ST DECATUR,IL62526	PHYSICAL THERAPY
9	DMH HOSPICE 3122 BRETTWOOD CIRCLE DECATUR,IL62526	HOSPICE AGENCY
10

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
OTHER TESTING METHODS FOR FREE OR DISCOUNTED CARE	PART I LINE 3C	AS INDICATED THE HOSPITAL USES FEDERAL POVERTY GUIDELINES ADDITIONALLY THERE MAY BE INSTANCES WHERE PATIENTS HAVE INCURRED A FINANCIAL HARDSHIP BUT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE GUIDELINES SUCH CASES ARE REVIEWED INDIVIDUALLY AND WHERE DEEMED APPROPRIATE EARNINGS ON RESTRICTED FUNDS ARE USED TO PAY THE PATIENTS BILLS
RELATED ORGANIZATION INFORMATION	PART I LINE 6A	THE HOSPITAL PREPARES THE ANNUAL COMMUNITY BENEFIT REPORT UNDER ITS OWN NAME
SUBSIDIZED HEALTH SERVICES EXPLANATION	PART I LINE 7G	THE HOSPITAL DID NOT INCLUDE AS SUBSIDIZED HEALTH SERVICES ANY COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC
EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE	PART I LINE 7 COLUMN F	NONE PER NEWLY ISSUED GAAP DMH INCLUDES BAD DEBT EXPENSE AS PART OF PROGRAM SERVICE REVENUE ON PAGE 9 LINE 2A
COSTING METHODOLOGY EXPLANATION	PART I LINE 7	THE HOSPITAL DERIVED ALL NUMBERS IN LINE 7 FROM THE APPLICABLE IRS WORKSHEETS USING THE RATIO OF PATIENT COSTTOCHARGES
COMMUNITY BUILDING ACTIVITIES	PART II	PART VI LINE 5 COMMUNITY SUPPORT DMH DONATED CAR SEATS TO THE NEW LIFE PREGNANCY CENTER WHICH OFFERS COMPASSIONATE SUPPORT TO WOMEN IN THE COMMUNITY WHO ARE FACING AN UNPLANNED PREGNANCY OTHER DMH SUPPORTS THE LOCAL HOMELESS SHELTER BY PROVIDING 66592 IN FOOD CONTRIBUTIONS OVER THE FISCAL YEAR DMH UNDERSTANDS THAT FEEDING THE HUNGRY SUPPORTS THE HEALTH OF THE INDIVIDUALS SERVED BY THE HOMELESS SHELTER
BAD DEBT EXPENSE EXPLANATION	PART III LINE 4	FOOTNOTE DESCRIBING BAD DEBT NOTE THAT THE AUDITED FINANCIAL STATEMENTS DID NOT INCLUDE A SEPARATE FOOTNOTE WHICH APPLIED SOLELY TO BAD DEBT THE FOLLOWING IS AN EXCERPT FROM A BROADER FOOTNOTE CONTAINED IN THE FINANCIAL STATEMENTS THE SYSTEM CONSIDERS CRITICAL ACCOUNTING POLICIES TO BE THOSE THAT REQUIRE MORE SIGNIFICANT JUDGMENTS AND ESTIMATES IN THE PREPARATION OF ITS CONSOLIDATED FINANCIAL STATEMENTS INCLUDING PROVISIONS FOR BAD DEBT MANAGEMENT RELIES ON HISTORICAL EXPERIENCE ON OTHER ASSUMPTIONS BELIEVED TO BE REASONABLE UNDER THE CIRCUMSTANCES AND RECOMMENDATIONS MADE BY THE SYSTEMS EXTERNAL ADVISORS AND ACTUARIES IN MAKING JUDGMENTS AND ESTIMATES ACTUAL RESULTS COULD DIFFER FROM THOSE ESTIMATES THE ABOVE WORDING CAN BE FOUND IN FOOTNOTE 1 USE OF ESTIMATES SUB TITLE ON PAGE 7 AS NOTED AT THE BOTTOM OF THE PDF PAGE OF THE AUDITED FINANCIAL STATEMENTS LINE 2 OF PART III WAS CALCULATED USING THE HOSPITAL WIDE COSTTOCHARGE RATIO FROM THE APPLICABLE IRS WORKSHEET PROVISIONS FOR BAD DEBT EXPENSE ARE CALCULATED BY TAKING THE NET ACCOUNTS RECEIVABLE BY PAYOR CLASS WHICH IS SEGREGATED INTO 10 TIME PERIOD BUCKETS AND MULTIPLYING EACH BUCKET BY A CALCULATED PRIOR YEAR ACTUAL BAD DEBT EXPENSE PERCENT LINE 3 OF PART III WAS CALCULATED AS FOLLOWS THE HOSPITAL USED 20082012 AMERICAN COMMUNITY 5 YEAR ESTIMATES DATA FROM THE CENSUS BUREAU TO ESTIMATE THE PERCENTAGE OF ITS PATIENT POPULATION WHOSE HOUSEHOLD INCOME WAS UNDER ITS FULL CHARITY CARE ELIGIBILITY CRITERIA OF 200 OF THE FEDERAL POVERTY GUIDELINES FPG THIS PERCENTAGE WAS APPLIED TO THE HOSPITALS CHARGES TO ESTIMATE THE AMOUNT OF GROSS CHARGES THAT MET ITS FINANCIAL ASSISTANCE GUIDELINES THE HOSPITAL THEN SUBTRACTED THE CHARGES RELATED TO THE PATIENTS THAT WERE ELIGIBLE FOR GOVERNMENTAL ASSISTANCE PROGRAMS SUCH AS MEDICAID HOSPITAL CHARITY CARE ADJUSTMENTS WERE ALSO REMOVED BECAUSE THEY TOO WOULD NOT HAVE RESULTED IN BAD DEBTS THE REMAINING CHARGES RELATED TO UNINSURED PATIENTS WITH HOUSEHOLD INCOMES BELOW 200 OF FPG AND IT IS REASONABLE TO ASSUME THAT THEY RESULTED IN BAD DEBTS THIS TOTAL WAS THEN MULTIPLIED BY THE RATIO OF COSTSTOCHARGES FROM THE APPLICABLE IRS WORKSHEET TO CALCULATE THE COST OF PROVIDING THESE SERVICES THE HOSPITALS METHODOLOGY MOST LIKELY RESULTED IN A VERY CONSERVATIVE ESTIMATE FOR A NUMBER OF REASONS FIRST IT EXCLUDES THE PATIENTS ABOVE 200 OF THE FPG THAT WERE ELIGIBLE FOR PARTIAL CHARITY ASSISTANCE FURTHERMORE THE ACTUAL 2012 PERCENTAGE OF THE HOSPITALS PATIENT BASE BELOW THE 200 OF FPG WAS LIKELY HIGHER THAN CENSUS ESTIMATES USED IN THIS CALCULATION DUE TO THE IMPACT OF THE RECENT RECESSION THEREFORE THE AMOUNT REPORTED IN PART III LINE 3 IS VERY CONSERVATIVE AND LIKELY LESS THAN THE THE ACTUAL AMOUNT OF BAD DEBT EXPENSE THAT COULD HAVE QUALIFIED FOR CHARITY ASSISTANCE HAD THE HOSPITAL RECEIVED A CHARITY CARE APPLICATION
MEDICARE EXPLANATION	PART III LINE 8	THE HOSPITAL USED THE COST TO CHARGE RATIO FROM THE MEDICARE COST REPORT IN CALCULATING THE AMOUNT ON LINE 6 OF PART III
COLLECTION PRACTICES EXPLANATION	PART III LINE 9B	THE HOSPITAL WILL NOT SEND A PATIENTS ACCOUNT TO A THIRDPARTY COLLECTION AGENCY PRIOR TO MAKING GOOD FAITH EFFORTS TO DETERMINE A PATIENTS ELIGIBILITY FOR FINANCIAL ASSISTANCE THE HOSPITAL WILL USE GOOD FAITH EFFORTS TO DETERMINE WHETHER A PATIENT IS INSURED PRIOR TO INITIATING ANY COLLECTION ACTION THE HOSPITAL WILL NOT PURSUE LEGAL ACTION FOR NONPAYMENT OF BILLS FOR ANY PATIENT RECEIVING FINANCIAL ASSISTANCE SO LONG AS SUCH PATIENT IS MAKING PAYMENTS IN ACCORDANCE WITH HISHER ESTABLISHED PAYMENT PLAN AS SET FORTH IN A PAYMENT AGREEMENT IN THE EVENT THE PATIENT IS UNABLE TO MAINTAIN SUCH PAYMENTS THE HOSPITAL WILL CONTACT THE PATIENT TO DETERMINE WHETHER AN ADJUSTMENT IS APPROPRIATE NOTWITHSTANDING THE FOREGOING THE HOSPITAL MAY TAKE LEGAL ACTION AGAINST PATIENTS RECEIVING FINANCIAL ASSISTANCE TO ENFORCE THE TERMS OF AN EXISTING PAYMENT PLAN WHERE THERE IS EVIDENCE THAT THE PATIENT OR HISHER FAMILY ANDOR GUARANTOR IF APPLICABLE HAS SUFFICIENT INCOME AND ASSETS TO MEET HISHER OBLIGATIONS UNDER THE EXISTING PAYMENT PLAN PROVIDED HOWEVER THE HOSPITAL WILL NOT PURSUE LEGAL ACTION FOR NONPAYMENT OF BILLS AGAINST ANY PATIENT RECEIVING FINANCIAL ASSISTANCE WHO HAS CLEARLY DEMONSTRATED THAT SHE DOES NOT HAVE SUFFICIENT INCOME AND ASSETS TO MEET HISHER FINANCIAL OBLIGATIONS TO THE HOSPITAL NOTWITHSTANDING THE FOREGOING THE HOSPITALS DEBT COLLECTION POLICY PLACES A MAXIMUM AMOUNT BASED UPON ANNUAL HOUSEHOLD PRETAX INCOME AND CASH BENEFITS FROM ALL SOURCES WITH CERTAIN ADJUSTMENTS THAT THE HOSPITAL OR ITS DESIGNATED THIRDPARTY COLLECTION AGENCY MAY COLLECT IN ANY TWELVE 12 MONTH PERIOD FOR HOSPITAL SERVICES FROM A PATIENT WHO IS ELIGIBLE FOR FINANCIAL ASSISTANCE
NEEDS ASSESSMENT	PART VI	PART VI LINE 2 NEEDS ASSESSMENT DECATUR MEMORIAL HOSPITAL CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS TO EVALUATE THE HEALTH OF THE COMMUNITY IDENTIFY HIGH PRIORITY HEALTH NEEDS AND DEVELOP STRATEGIES TO ADDRESS THE NEEDS OF THE COMMUNITY THE 20132015 DECATUR MEMORIAL HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT REPRESENT A COMBINATION OF QUANTITATIVE AND QUALITATIVE INFORMATION FROM REPUTABLE STATISTICAL SOURCES AND FOCUS GROUP FEEDBACK PROVIDED BY COMMUNITY LEADERS THE ASSESSMENT PROCESS INCLUDED A COMBINATION OF SECONDARY DATA INCLUDING IPLAN US CENSUS DATA AND REFERENCE TO HEALTHY PEOPLE 2020 AMONG OTHER SOURCES VALUABLE INPUT FROM FOCUS GROUP PARTICIPANTS PROVIDED PRIMARY DATA FOR THE ASSESSMENT DECATUR MEMORIAL HOSPITAL UTILIZED THE SIX STEP ASSESSMENT PROCESS OUTLINED BELOW STEP 1 ESTABLISHING THE ASSESSMENT INFRASTRUCTURE PARTICIPANTS IN THE ASSESSMENT INCLUDED DECATUR MEMORIAL HOSPITAL MILLIKIN UNIVERSITY MACON COUNTY HEALTH DEPARTMENT DECATUR TRADES AND LABOR PSYCHOLOGY SPECIALISTS ECONOMIC DEVELOPMENT CORPORATION CITY OF DECATUR DECATUR CITY COUNCIL DMH MEDICAL GROUP PHYSICIANS CHIC CLINIC CARPENTERS LOCAL UNION 742 AND DECATUR CHURCHES DECATUR MEMORIAL HOSPITALS ROLE IN THE ASSESSMENT PROCESS WAS TO COORDINATE THE OVERALL ASSESSMENT PROCESS PROVIDE MEETING SPACE MOTIVATE COMMUNITY ORGANIZATIONS TO PARTICIPATE IN THE ASSESSMENT PROCESS COLLECT AND ANALYZE SECONDARY DATA CONDUCT A FOCUS GROUP TO COLLECT PRIMARY DATA MOTIVATE COMMUNITY ORGANIZATIONS TO ACT ON THE IDENTIFIED PRIORITY HEALTH ISSUES IDENTIFY PRIORITY HEALTH ISSUES AND DEVELOP AND IMPLEMENT INITIATIVES TO ADDRESS PRIORITY ISSUES PARTNERING ORGANIZATIONS PROVIDED FOCUS GROUP PARTICIPANTS AND INPUT STEP 2 DEFINING PURPOSE AND SCOPE DEFINING THE COMMUNITY THE PURPOSE OF THE ASSESSMENT WAS TO EVALUATE THE CURRENT HEALTH NEEDS OF THE COMMUNITY THE RESOURCES CURRENTLY IN PLACE TO MEET THOSE NEEDS AS WELL AS IDENTIFYING MAJOR GAPS BETWEEN THE TWO DATA FROM THE ASSESSMENT IS USED TO DEVELOP AN ACTION PLAN TO BRIDGE THE GAP AND BETTER MEET THE HEALTH NEEDS OF THE COMMUNITY THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT FOCUSES ON PRIMARY AND SECONDARY INFORMATION FOR MACON COUNTY ILLINOIS INCLUDING THE CITY OF DECATUR AND NEARBY TOWNS THIS WAS DETERMINED BECAUSE THE MAJORITY OF PATIENTS RESIDE IN MACON COUNTY MORE THAN 70 OF PATIENTS IN SOME INSTANCES DATA WAS NOT AVAILABLE FOR MACON COUNTY SO CITY OF DECATUR DATA WAS USED STEP 3 COLLECTING AND ANALYZING DATA PRIMARY DATA WAS COLLECTED ON SEPTEMBER 4 2012 BY HOLDING A COMMUNITY HEALTH NEEDS ASSESSMENT FOCUS GROUP WHERE COMMUNITY LEADERS PROVIDED INPUT REGARDING COMMUNITY HEALTH STRENGTHS AND CONCERNS AS WELL AS TOP HEALTH CONCERNS SEEN THROUGHOUT THE MACON COUNTY AREA THIS DIVERSE GROUP OF INDIVIDUALS WAS CHOSEN TO PARTICIPATE IN THE 2012 COMMUNITY HEALTH NEEDS ASSESSMENT FOCUS GROUP BECAUSE OF THEIR INSIGHT TO THE COMMUNITYS POPULATION INCLUDING HEALTH NEEDS SECONDARY DATA WAS COLLECTED THROUGH SEVERAL SOURCES THE ILLINOIS PROJECT FOR LOCAL ASSESSMENT OF NEEDS IPLAN IS A COMMUNITY HEALTH ASSESSMENT AND PLANNING PROCESS THAT IS CONDUCTED EVERY FIVE YEARS BY LOCAL HEALTH JURISDICTIONS IN ILLINOIS BASED ON THE ASSESSMENT PROTOCOL FOR EXCELLENCE IN PUBLIC HEALTH APEXPH MODEL IPLAN IS GROUNDED IN THE CORE FUNCTIONS OF PUBLIC HEALTH AND ADDRESSES PUBLIC HEALTH PRACTICE STANDARDS ADDITIONAL RESOURCES WERE UTILIZED THROUGHOUT THE PROCESS INCLUDING BUT NOT LIMITED TO U S CENSUS BUREAU AMERICAN FACT FINDER SOCIAL IMPACT RESEARCH CENTER AT HEARTLAND ALLIANCE ILLINOIS DISTRICT REPORT CARD AND ILLINOIS COUNTY BEHAVIORAL RISK FACTOR SURVEY STEP 4 SELECTING PRIORITIES THE FOCUS GROUP PARTICIPANTS DISCUSSED THE PRIORITY IN WHICH COMMUNITY HEALTH NEEDS SHOULD BE ADDRESSED AND DETERMINED IT BEST TO FOCUS ON SERVICES THAT IMPACTED THE COMMUNITY AS A WHOLE VS PATIENT SPECIFIC SERVICES STEP 5 DOCUMENTING AND COMMUNICATING RESULTS THE 2012 COMMUNITY HEALTH NEEDS ASSESSMENT FOCUS GROUP WAS RECORDED FOR FUTURE REFERENCE AND RESULTS WERE TALLIED TO DETERMINE THE AREAS TOP STRENGTHSVALUES BARRIERSCONCERNS AND THE TOP 3 HEALTH NEEDS THESE RESULTS WILL BE PRESENTED TO EACH FOCUS GROUP PARTICIPANT AS WELL AS DECATUR MEMORIAL HOSPITALS SENIOR LEADERSHIP TEAM STEP 6 PLANNING FOR ACTION AND MONITORING PROGRESS FOLLOWING THE COMPLETION OF THE 20132015 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AN IMPLEMENTATION PLAN WAS CREATED TO MEET THE APPLICABLE IDENTIFIED NEEDS EFFORTS ARE MEASURED APPROPRIATELY AND PROGRESS WILL BE REPORTED REGULARLY THE HEALTH ASSESSMENTS WE HAVE PERFORMED OVER THE PAST SEVERAL YEARS HAVE ALL INDICATED THE FOLLOWING SIGNIFICANT HEALTH CARE ACCESS AND PROVISION NEEDS WITHIN THE COMMUNITY ACCESS TO PRIMARY CARE PHYSICIANS AND SPECIALISTS EVALUATION OF THE PHYSICIAN POPULATION RATIOS IN MACON COUNTY INDICATED THAT DECATUR WAS UNDERSERVED BOTH IN TERMS OF PRIMARY CARE PHYSICIANS AND SPECIALISTS THE WAITING TIME FOR A NEW PATIENT TO SEE A PRIMARY CARE PHYSICIAN IN THE COMMUNITY WAS AS LONG AS TWO TO THREE MONTHS BASED ON THIS INFORMATION DECATUR MEMORIAL HOSPITAL HAS RECRUITED AND CONTINUES TO RECRUIT PRIMARY AND SPECIALIST PHYSICIANS TO THE COMMUNITY COSTS OF RECRUITMENT WERE GENERALLY BORN BY THE HOSPITAL AND AMOUNTED TO MORE THAN 300000 DURING THE LAST FISCAL YEAR DECATUR MEMORIAL HOSPITAL ALSO SIGNIFICANTLY SUPPORTS THE SOUTHERN ILLINOIS UNIVERSITY FAMILY PRACTICE RESIDENCY PROGRAM WHICH GRADUATES UP TO SIX FAMILY PRACTITIONERS PER YEAR THE RETENTION RATE OF THE GRADUATES WITHIN CENTRAL ILLINOIS HAS BEEN VERY HIGH SUPPORT FOR THE RESIDENCY PROGRAM COSTS IN EXCESS OF 3000000 A YEAR OUR EMPLOYED PHYSICIANS CONTRIBUTE VOLUNTEER TEACHING HOURS TOWARDS RESIDENT TRAINING IN ADDITION TO PHYSICIANS IT HAS BECOME APPARENT THAT OTHER HEALTH CARE PROFESSIONALS ARE ALSO IN VERY SHORT SUPPLY PROVISION OF ADEQUATE COMMUNITY HEALTH DEPENDS ON AN ADEQUATE SUPPLY OF SUCH PROFESSIONALS AS SUCH DECATUR MEMORIAL HOSPITAL HAS VOLUNTEERED HOURS ON PLANNING AND CURRICULUM DESIGN AT OUR TWO NURSING SCHOOLS AND CONTRIBUTES MORE THAN 2500 HOURS OF UNCOMPENSATED TEACHING AND CLINICAL EXPERIENCE TO NURSING STUDENTS IN THE DECATUR NURSING PROGRAMS OUR MEDICAL STAFF AND PERSONNEL ALSO PARTICIPATE IN CLINICAL TRAINING AND SUPPORT FOR RESIDENT PHYSICIANS IN FAMILY MEDICINE AS WELL AS PHYSICIAN ASSISTANT STUDENTS ADDITIONAL TRAINING PROGRAMS FOR OTHER ALLIED HEATH PROFESSIONALS HAVE ALSO BEEN UNDERTAKEN AND SUPPORTED BY DECATUR MEMORIAL HOSPITAL THE HOSPITAL ALSO SUPPORTS THE PARISH NURSE PROGRAM THIS PROGRAM HAS SUBSTANTIALLY IMPROVED THE ABILITY OF COMMUNITY MEMBERS TO OBTAIN BASIC HEALTH INFORMATION AND SCREENING FROM TRAINED PARISH NURSES CARDIAC SCREENINGS RECOGNIZING THAT CORONARY HEART DISEASE IS THE NUMBER ONE CAUSE OF DEATH IN MACON COUNTY DECATUR MEMORIAL HOSPITAL OFFERS FREE BLOOD PRESSURE AND CHOLESTEROL SCREENINGS TO THE COMMUNITY FURTHER TO ASSIST THOSE PATIENTS WHO ARE LIVING WITH THE DIAGNOSIS OF HEART FAILURE DMH PROVIDES A FREE HEART FAILURE TELEMONITORING PROGRAM THIS PROGRAM ASSISTS PATIENTS AND THEIR CAREGIVERS IN MONITORING DAILY VITAL SIGNS OF HEART FAILURE PATIENTS ALLOWING THEM BETTER ONGOING STABILITY AND PROACTIVE MANAGEMENT OF THEIR CONDITION OBESITY MACON COUNTY HAS THE HIGHEST OBESITY STATISTICS IN THE STATE OF ILLINOIS THE INCIDENCE OF OBESITY IN MACON COUNTY AS WELL AS THROUGHOUT THE COUNTRY IS ON THE RISE DECATUR MEMORIAL HOSPITAL PROVIDES EDUCATIONAL PROGRAMS RELATED TO WEIGHT AND WEIGHT CONTROL AND HAS INSTITUTED A COMPREHENSIVE WEIGHT MANAGEMENT AND BARIATRIC PROGRAM TO ASSIST THE MEMBERS OF THE COMMUNITY IN APPROPRIATE WEIGHT LOSS METHODS PROFESSIONAL DMH STAFF MEMBERS ATTEND NUMEROUS HEALTH FAIR EVENTS THROUGHOUT THE YEAR AND ARE AVAILABLE TO PROVIDE INFORMATIONAL TOPICS ON WEIGHT MANAGEMENT AND HEALTHY LIFESTYLES TO AREA RESIDENTS DMH OFFERS SUPPORT GROUPS FOR WEIGHT MANAGEMENT AND BARIATRIC CLIENTS TO THE COMMUNITY MONTHLY THE DMH WELLNESS CENTER HOLDS A 5K RACE FOR WEIGHT MANAGEMENT CLIENTS AND COMMUNITY MEMBERS AS AN ANNUAL EXERCISE EVENT DIABETES LIFETIME RISK FOR DEVELOPING DIABETES IN THIS COUNTRY IS NOW APPROACHING 40 LOWER SOCIAL ECONOMIC GROUPS HAVE ADDITIONAL CHALLENGES IN TERMS OF APPROPRIATE DIET CONTROL AND EDUCATION DECATUR MEMORIAL HOSPITAL PROVIDES DIABETIC EDUCATION AND COMMUNITY PROGRAMS DMH OFFERS A 10HOUR COMPREHENSIVE DIABETES EDUCATION PROGRAM THAT IS ACCREDITED BY THE AMERICAN DIABETES ASSOCIATION OUR DIABETES EDUCATORS ARE AVAILABLE TO OFFER EDUCATIONAL PRESENTATIONS TO COMMUNITY MEMBERS AND ATTEND NUMEROUS HEALTH FAIRS IN THE COMMUNITY TO SHARE INFORMATION ABOUT DIABETES AND TO GIVE INFORMATION OUT ABOUT PROGRAMS THAT ARE AVAILABLE FOR DIABETES EDUCATION THE DIABETES EDUCATORS HAVE DEVELOPED A PREDIABETES EDUCATION PROGRAM AND HAVE PARTNERED WITH THE DECATUR YMCA TO OFFER THIS 6WEEK PROGRAM THERE AS WELL AS AT DMH DMH ALSO OFFERS A MONTHLY DIABETES SUPPORT GROUP FOR COMMUNITY MEMBERS INDIGENT OUTPATIENT LONGITUDINAL CARE DECATUR MEMORIAL HOSPITAL HAS SUPPORTED THE COMMUNITY HEALTH
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	PART VI	PART VI LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE DECATUR MEMORIAL HOSPITALS BUSINESS OFFICE HAS FIVE FINANCIAL COUNSELORS WHO REVIEW PATIENT ACCOUNTS FOR POSSIBLE CHARITYFINANCIAL ASSISTANCE CONSIDERATION THE HOME PAGE OF THE HOSPITALS WEBSITE WWWDMHCARESCOM CONTAINS LINKS TO ALL INFORMATION CONCERNING THE CHARITY CARE FINANCIAL ASSISTANCE PROGRAM INCLUDING THE POLICIES AND PATIENT FINANCIAL APPLICATON FORMS POSTERS ARE PLACED IN OUR PATIENT REGISTRATION AREA IN VISIBLE LOCATIONS WHERE PATIENTS AND THEIR FAMILIES CAN SEE THEM THESE POSTERS ARE 24 BY 31 IN ADDITION TO OUR PATIENT REGISTRATION AREA IN KIRKLAND LOBBY WE ALSO PLACED POSTERS IN OUR EMERGENCY CARE CENTER AND IN OUR IMAGING CENTERS IN SOUTH SHORES AND FORSYTH TENT CARDS AND PATIENT BROCHURES ARE PLACED IN THE PATIENT REGISTRATION BOOTHS ACCESSIBLE TO ALL PATIENTS AND THEIR FAMILIES PATIENT ACCOUNT STATEMENTS INCLUDE THE PHONE NUMBER FOR FINANCIAL ASSISTANCE
COMMUNITY INFORMATION	PART VI	PART VI LINE 4 POPULATIONS AND COMMUNITIES SERVED DECATUR MEMORIAL HOSPITAL IS LOCATED IN DECATUR ILLINOIS THE CITY HAS A 2010 CENSUS POPULATION OF 76000 WHICH REPRESENTS A POPULATION DECLINE OF 58 SINCE 2000 MACON COUNTY WITHIN WHICH IT RESIDES HAS A POPULATION OF APPROXIMATELY 110750 THE OVERALL MARKET AREA FOR DECATUR MEMORIAL HOSPITAL INCLUDES APPROXIMATELY 250000 RESIDENTS THE DEMOGRAPHICS OF MACON COUNTY INDICATE AN AGING POPULATION PROJECTIONS FOR THE NEXT TEN YEARS SUGGEST RELATIVELY FLAT POPULATION GROWTH WITH A CONTINUED GRADUAL INCREASE IN THE AGED POPULATION THERE ARE APPROXIMATELY 20000 MEDICAID RECIPIENTS LOCATED IN MACON COUNTY MEDICARE IS THE LARGEST INPATIENT CARE PAYOR CATEGORY THE UNEMPLOYMENT RATE IN THE DECATUR METRO AREA TENDS TO BE HIGHER THAN THE US AVERAGE RECENT JOB GROWTH WAS 034 THE POVERTY RATE FOR MACON COUNTY IS 162 AND 209 FOR DECATUR THE 2013 AVERAGE UNEMPLOYMENT RATE FOR DECATURMACON COUNTY WAS 122
HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE	PART VI	PART VI LINE 5 BACKGROUND DECATUR MEMORIAL HOSPITAL SINCE ITS INCEPTION IN 1916 HAS CONTINUOUSLY RESPONDED TO THE HEALTH CARE NEEDS OF COMMUNITIES IT SERVES AS AN INDEPENDENT COMMUNITY HOSPITAL WITH A LOCAL COMMUNITY BOARD OF DIRECTORS THE HOSPITAL HAS ALWAYS HAD AS ITS PRIMARY FOCUS THE HEALTH CARE NEEDS OF DECATUR MACON COUNTY AND SURROUNDING COUNTIES AS PART OF ITS OVERALL MISSION DECATUR MEMORIAL HOSPITAL HAS CONTINUOUSLY PROVIDED BOTH INTELLECTUAL AND FINANCIAL RESOURCES TO OUR COMMUNITIES FOR EXPERTISE AND ASSISTANCE IN ASSESSMENT OF HEALTH CARE NEEDS SUPPORT OF VARIOUS COMMUNITY SERVICES AND AGENCIES IN ADDRESSING THE IDENTIFIED NEEDS AND THE CONTINUAL HEALTH EDUCATION OF PATIENTS THE COMMUNITY AND THE OTHER RELEVANT PUBLICS DECATUR MEMORIAL HOSPITAL HAS PARTICIPATED DIRECTLY IN CHARITY AND INDIGENT CARE FOR A SIGNIFICANT SEGMENT OF OUR COMMUNITY GOALS AND OBJECTIVES FOR PROVIDING COMMUNITY BENEFITS DECATUR MEMORIAL HOSPITAL HAS EMBRACED THE PHILOSOPHY THAT TO IMPROVE THE HEALTH OF PEOPLE AN ORGANIZATION MUST BECOME INVOLVED IN THE EDUCATION AWARENESS AND PREVENTION OF DISEASE AND ILLNESS THAT NEGATIVELY IMPACT A PERSONS HEALTH STATUS WE STRIVE TO GIVE COMMUNITY RESIDENTS TOOLS TO EMPOWER THEM TO MAKE LIFESTYLE DECISIONS THAT WILL MAINTAIN AND ENHANCE A DESIRABLE QUALITY OF LIFE TO HELP PEOPLE REACH THIS GOAL DECATUR MEMORIAL HOSPITAL SEEKS OUT OPPORTUNITIES AND ACTIVELY INVOLVES ITSELF IN THE COMMUNITY WE ACTIVELY SUPPORT LOCAL HEALTH CARE EDUCATION PROGRAMS HEALTH FAIRS SCREENINGS AND LOCAL ACCESS TO ADVANCED CARE DECATUR MEMORIAL HOSPITAL IS AND ALWAYS HAS BEEN VERY MINDFUL OF ITS MISSION REGARDING CHARITY CARE BY HOSPITAL POLICY THE THRESHOLD FOR THE PROVISION OF CHARITY CARE IS VERY LIBERAL AND WAS FURTHER EXPANDED IN FISCAL 2009 TO SIX TIMES THE FEDERAL POVERTY GUIDELINES FOR PATIENTS WHOSE INCOME IS ABOVE THESE THRESHOLDS WE REVIEW THE PERTINENT FACTORS INCLUDING THE MAGNITUDE OF THE BILL AND THE INDIVIDUALS FINANCIAL SITUATION AND OFFER A SLIDING SCALE DISCOUNT AND EXTENDED PAYMENT TERMS TO THOSE INDIVIDUALS APPROVAL OR DENIAL OF THESE GUIDELINES IS MADE WITHOUT REGARD TO RACE CREED NATIONAL ORIGIN SEX OR AGE THE HOSPITAL DOES NOT PLACE LIMITS ON THE AGGREGATE AMOUNTS OF CHARITY CARE PROVIDED IN ANY YEAR SEE ALSO RESPONSE TO PART VI LINE 2 ABOVE FOR EXAMPLES OF MANY WAYS IN WHICH THE HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY
AFFILIATED HEALTH CARE INFORMATION	PART VI	PART VI LINE 6 AS INDICATED THE HOSPITAL AND ITS RELATED FACILITIES PROVIDE COMPREHENSIVE INPATIENT OUTPATIENT AND PHYSICIAN SERVICES ALL OF WHICH BENEFIT AND PROMOTE THE HEALTH OF THE COMMUNITY THE HOSPITAL IS AFFILIATED WITH ILLINOIS HEALTH AND SCIENCE WHICH SUPPORTS AND BENEFITS THE HOSPITAL BY PROVIDING FINANCIAL AND MANAGEMENT ASSISTANCE IN CONNECTION WITH THE ACTIVITIES OF THE HOSPITAL AND ITS AFFILIATES AND BY HOLDING TITLE TO CERTAIN ASSETS USED IN CONNECTION WITH HOSPITAL ACTIVITIES THE HOSPITAL IS ALSO AFFILIATED WITH DECATUR MEMORIAL FOUNDATION WHOSE MISSION IS TO SUPPORT AND BENEFIT THE HOSPITAL BY CONDUCTING FUND DEVELOPMENT ACTIVITIES HOLDING TITLE TO CERTAIN ASSETS AND OVERSEEING THEIR PRUDENT AND EFFECTIVE INVESTMENT AND MANAGEMENT TOGETHER THE ACTIVITIES OF THE HOSPITAL AND ITS AFFILIATES EFFECTIVELY AND EFFICIENTLY ADDRESS THE HEALTH NEEDS OF THE COMMUNITY IT SERVES
LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILED	PART VI	ILLINOIS
DECATUR MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 3	PART V LINE 3	THE HOSPITAL HOSTED A COMMUNITY HEALTH NEEDS ASSESSMENT FOCUS GROUP WHERE THE FOLLOWING ATTENDEES PROVIDED INPUT REGARDING COMMUNITY HEALTH STRENGTHS AND CONCERNS AS WELL AS TOP HEALTH CONCERNS SEEN THROUGHOUT THE MACON COUNTY AREA THESE INDIVIDUALS WERE CHOOSEN TO PARTICIPATE IN THE FOCUS GROUP BECAUSE OF THEIR INSIGHT TO THE COMMUNITYS POPULATION INCLUDING HEALTH NEEDS TANYA ANDRICKS ADMINISTRATIVE DIRECTOR DMH HOME HEALTH SERVICES JULIE BRILLEY ADMINISTRATIVE DIRECTOR MEDICAL STAFF MIKE CASSELL DMH DIRECTOR OF MARKETING NIKKI DAMERY COORDINATOR CANCER CARE INSTITUTE JULIE MOORE DIRECTOR OF COMMUNITY RELATIONS FRANCES SPERRY ANALYTICS AND PERFORMANCE MANAGER PAIGE TOTH DIRECTOR OF LEGAL AFFAIRS PAUL STANZIONE EXECUTIVE DIRECTOR GREATER DECATUR YMCA JULIE MOORE COUNCILWOMAN CITY OF DECATUR RYAN MCCRADY CITY MANAGER CITY OF DECATUR BILL CLEVENGER EXECUTIVE DIRECTOR DECATUR PARK DISTRICT TINA CLONEY RD PHD PROFESSOR MILLIKIN UNIVERSITY PATRICK HOBAN VICE PRESIDENT ECONOMIC DEVELOPMENT CORPORATION JULIE AUBERT ADMINISTRATOR MACON COUNTY HEALTH DEPARTMENT DANA RAY MD PHYSICAN CHIC CLINIC LEE HALL PSYD CLINICAL PSYCHOLOGIST PSYCHOLOGY SPECIALISTS MICHAEL ZIA MD VP OF QUALITY MEDICAL AFFAIRS DMH LINDA FAHEY RN VP AND CHIEF NURSING EXECUTIVE DMH KAY GOWDAR MD PEDIATRICIAN DMH TIMOTHY STONE JR EXECUTIVE VP AND COO DMH SIX ADDITIONAL COMMUNITY LEADERS WERE INVITED TO ATTEND THE FOCUS GROUP BUT WERE UNABLE TO ATTEND THESE INDIVIDUALS WERE ENCOURAGED TO COMPLETE A SHORT SURVEY OF TOP COMMUNITY HEALTH NEEDS
DECATUR MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 5C	PART V LINE 5C	THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND AT WWWDMHCARESORGPATIENTASSESSMENTCNASSESSMENT20132015PDF
DECATUR MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 12H	PART V LINE 12H	DMH USES INCOME LEVEL AND FAMILY SIZE TO DETERMINE ELIGIBILITY FOR DISCOUNTED CARE THE MAXIMUM QUALIFYING INCOME LEVEL INCREASES WITH THE SIZE OF THE FAMILY
DECATUR MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 20D	PART V LINE 20D	DMH COMPLIES WITH THE ILLINOIS HOSPITAL UNINSURED PATIENT DISCOUNT ACT AND 501R OF THE INTERNAL REVENUE CODE AS ENACTED BY SECTION 9007A OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT BY PROVIDING FINANCIAL ASSISTANCE EITHER FREE CARE OR REDUCED PATIENT FINANCIAL OBLIGATIONS FOR HOSPITAL SERVICES TO PATIENTS WHO I ARE NOT COVERED UNDER A POLICY OF HEALTH INSURANCE AND ARE NOT BENEFICIARIES UNDER A PUBLIC OR PRIVATE HEALTH INSURANCE HEALTH BENEFIT OR OTHER COVERAGE PROGRAM INCLUDING HIGH DEDUCTIBLE HEALTH INSURANCE PLANS WORKERS COMPENSATION ACCIDENT LIABILITY INSURANCE OR OTHER THIRD PARTY LIABILITY II FAIL TO QUALIFY FOR GOVERNMENTAL ASSISTANCE FOR EXAMPLE MEDICARE OR MEDICAID AND III COOPERATE WITH THE HOSPITAL IN PROVIDING THE REQUESTED INFORMATION REGARDING INCOME ASSETS AND RESIDENCY

Schedule H (Form 990) 2012

Additional Data

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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
DECATUR MEMORIAL HOSPITAL

Employer identification number
37-0661199

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. 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	(h) Purpose of grant or assistance
(1) SIU DECATUR FAMILY PRACTICE CENTER 250 W KENWOOD DECATUR,IL62526	37-6005961	501C3	932,272	GENERAL SUPPORT

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

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

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

Cat. No. 50055P

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
PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES	SCHEDULE I, PAGE 1, PART I, LINE 2	SOUTHERN ILLINOIS UNIVERSITY (SIU) SCHOOL OF MEDICINE SPONSORS AN ACGME-ACCREDITED FAMILY RESIDENCY PROGRAM FOR WHICH DMH SERVES AS A PRIMARY PARTICIPATING INSTITUTION. AS PART OF THE PROGRAM, SIU OPERATES A FAMILY MEDICINE CLINIC ADJACENT TO THE DMH CAMPUS. THE EXISTENCE AND OPERATION OF THE CLINIC BENEFITS DMH AND ITS SERVICE AREA BY ENHANCING THE RECRUITMENT OF APPROPRIATELY-TRAINED PHYSICIANS TO THE COMMUNITY, ASSISTING DMH IN PROVIDING UNDERSERVED POPULATIONS WITH ACCESS TO PRIMARY CARE MEDICAL SERVICES, AND PROVIDING OTHER SERVICES TO AND FOR THE BENEFIT OF DMH'S PATIENT POPULATION. IN RECOGNITION OF THE ABOVE, DMH SUPPORTS THE PROGRAM BY PROVIDING A BUDGETED, AGREED-UPON AMOUNT FOR EACH ACADEMIC YEAR TO FUND MEDICAL EDUCATION AND RESEARCH THROUGH THE PROGRAM, INCLUDING COSTS INCURRED BY SIU TO SUPERVISE AND TEACH THE RESIDENTS ON-SITE AT THE CLINIC AND AT DMH. THE AMOUNT IS AGREED UPON PRIOR TO THE START OF EACH YEAR. UPON COMPLETION OF EACH ACADEMIC YEAR, SIU REPORTS BACK TO DMH REGARDING HOW FUNDS WERE ACTUALLY EXPENDED IN CONNECTION WITH THE PROGRAM.

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

DECATUR MEMORIAL HOSPITAL

Employer identification number

37-0661199

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

Yes

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

Yes

Indicate which, if any, of the following the 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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cat. No. 50053T

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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1)STEVEN SOBOL MDDIRECTORPHYSICIAN	(i) (ii)	996,250	623,231		3,750	16,863	1,640,094
(2)KENNETH SMITHMIERDIRECTORPRES & CEO	(i) (ii)	718,615			3,750	15,863	738,228
(3)TIMOTHY D STONE JREVP & ADMINISTRATOR	(i) (ii)	415,662			3,750	13,623	433,035
(4)MICHAEL ZIA MDVICE PRES	(i) (ii)	303,016			3,750	15,691	322,457
(5)LINDA FAHEYVPCHIEF NURSE EXEC	(i) (ii)	250,726			3,745	613	255,084
(6)JOHN RIDLEYSVP PROF SERV	(i) (ii)	184,527			2,858	16,677	204,062
(7)STEVEN WEBER MDPHYSICIAN	(i) (ii)	896,574	447,402		3,750	16,863	1,364,589
(8)MARVIN DERRICK MDPHYSICIAN	(i) (ii)	795,296	27,500		1,808	15,863	840,467
(9)MOHAMMED HASNAIN MDPHYSICIAN	(i) (ii)	544,702	273,660		3,750	16,863	838,975
(10)JOHN WATERS MDPHYSICIAN	(i) (ii)	816,290			3,750	8,196	828,236
(11)ROBERT KRAUS JR MDPHYSICIAN	(i) (ii)	619,462	143,606	9,150	3,750	16,863	792,831
(12)GARY G PEACOCKSR VP & CFO	(i) (ii)	242,397	23,471		3,750	11,565	281,183

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
FRINGE OR EXPENSE EXPLANATION	SCHEDULE J, PAGE 1, PART I, LINE 1A	DURING THE YEAR, DMH PAID FOR CHARTER TRAVEL IN ONE INSTANCE. DMH SHARED WITH SEVERAL OTHER HOSPITALS THE COST OF A CHARTER PLANE HIRED TO PICK UP THEIR RESPECTIVE REPRESENTATIVES (IN DMH'S CASE, TIMOTHY STONE, JR., AND KENNETH SMITHMIER) TO TRAVEL TO A VHA BOARD MEETING IN KANSAS CITY, MO; THE DECISION TO USE THIS MEANS OF TRAVEL WAS BASED UPON COST AND AVAILABILITY OF COMMERCIAL FLIGHTS. DMH MAINTAINS A CORPORATE MEMBERSHIP IN THE DECATUR CLUB, IN THE NAME OF DMH. THE INVOICE FOR ANNUAL DUES IS SENT TO DMH. THE INVOICE FOR MONTHLY DUES IS SENT TO DMH, ATTN: KEN SMITHMIER (CEO). DMH PAYS THE MONTHLY DUES DIRECTLY. ALL USAGE OF THE DECATUR CLUB MEMBERSHIP IS FOR BUSINESS PURPOSES, WHETHER BY MR. SMITHMIER OR OTHER EXECUTIVES, WITH MONTHLY STATEMENTS DOCUMENTING ACTUAL USAGE. NEITHER MR. SMITHMIER NOR ANY OTHER DMH EXECUTIVE MAKE ANY PERSONAL USE OF THE DECATUR CLUB MEMBERSHIP.

Schedule J (Form 990) 2012

Additional Data

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization
DECATUR MEMORIAL HOSPITAL

Employer identification number
37-0661199

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	CITY OF DECATUR MACON COUNTY IL	37-6001308		12-22-2010	6,280,000	REFUND 1996 ISSUE		X		X		X
B	CITY OF DECATUR MACON COUNTY IL	37-6001308		12-22-2010	5,000,000	REFUND 1996 ISSUE		X		X		X
C	CITY OF DECATUR MACON COUNTY IL	37-6001308		12-22-2010	4,405,000	REFUND 1996 ISSUE		X		X		X
D	CITY OF DECATUR MACON COUNTY IL	37-6001308		12-22-2010	2,675,000	REFUND 1996 ISSUE		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	1,727,000		1,375,000		1,211,375		735,625
2 Amount of bonds legally defeased . . . . . . . . . . .
3 Total proceeds of issue . . . . . . . . . . . . . .	6,280,000		5,000,000		4,405,000		2,675,000
4 Gross proceeds in reserve funds . . . . . . . . . . . .
5 Capitalized interest from proceeds . . . . . . . . . . .
6 Proceeds in refunding escrows . . . . . . . . . . . .
7 Issuance costs from proceeds . . . . . . . . . . . .
8 Credit enhancement from proceeds . . . . . . . . . . .
9 Working capital expenditures from proceeds . . . . . . . . .
10 Capital expenditures from proceeds . . . . . . . . . . .
11 Other spent proceeds . . . . . . . . . . . . . .	6,280,000		5,000,000		4,405,000		2,675,000
12 Other unspent proceeds . . . . . . . . . . . . . .
13 Year of substantial completion . . . . . . . . . . . .
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .	X		X		X		X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X		X		X		X
16 Has the final allocation of proceeds been made? . . . . . . . .	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X		X		X		X

Part III

Private Business Use

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

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

Cat. No. 50193E

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		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	%		%		%		%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	%		%		%		%
6 Total of lines 4 and 5 . . . . . . . . . . . . . . .	%		%		%		%
7 Does the bond issue meet the private security or payment test? . . . . .		X		X		X		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		X		X		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		X		X		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		X		X		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		X		X		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .		X		X		X		X
b Exception to rebate? . . . . . . . .		X		X		X		X
c No rebate due? . . . . . . . . . .		X		X		X		X
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		X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider . . . . . . . . .
c Term of hedge . . . . . . . . . .
d Was the hedge superintegrated? . . . . . .
e Was a hedge terminated? . . . . . . .

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		X		X		X
b Name of provider . . . . . . . . .
c Term of GIC . . . . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X		X		X		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
ADDITIONAL INFORMATION	SCHEDULE K	CITY OF DECATUR MACON COUNTY IL PART I COLUMN C NONE OF THE BOND ISSUES IN PART I HAD A CUSIP NUMBER AND THEREFORE THE RESPONSE IN COLUMN C FOR EACH IS NONE ACCORDING TO IRS INSTRUCTIONS HOWEVER ENTERING NONE IN COLUMN C CREATES AN EFILE ERROR THEREFORE COLUMN C HAS BEEN LEFT BLANK BUT AS INDICATED SHOULD BE NONE FOR EACH ISSUE SCHEDULE K OTHER INFORMATION AS INDICATED IN COLUMN G EACH ISSUE IN PART I WAS A CURRENT REFUNDING ISSUE USED TO REFINANCE 1996 BONDS ALL PROCEEDS OF EACH ISSUE WERE USED EXCLUSIVELY FOR THIS PURPOSE

Schedule K (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

DECATUR MEMORIAL HOSPITAL

Employer identification number

37-0661199

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

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

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

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-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?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ...... $

Part III

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of 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

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) HICKORY POINT BANK	SEE PART V	1,233	INTEREST INCOME		No
(2) STRIGLOS COMPANIES	SEE PART V	260,098	OFFICE SUPPLIES		No
(3) CANCER CARE SPECIALISTS OF CENT IL	SEE PART V	153,578	MED SERVICES		No
(4) CANCER CARE SPECIALISTS OF CENT IL	SEE PART V	45,342	EMR SUPPORT REV		No
(5) BAKERS DOZEN LLC	SEE PART V	594,398	OFFICE SPACE RENTAL		No
(6) ROY MOSSER	SEE PART V	1,654,596	OFFICE SPACE RENTAL		No
(7) HICKORY POINT BANK	SEE PART V	529,368	BANK FEES, INTEREST		No
(8) FIRST BUSEY CORP SUBSIDIARIES	SEE PART V	170,116	BANK AND BOND FEES		No
(9) FIRST BUSEY CORP SUBSIDIARIES	SEE PART V	4,048	INTEREST INCOME		No
(10) JOHN FAHEY MD	SEE PART V	15,577	COMPENSATION/BENEFIT		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
ADDITIONAL INFORMATION	SCHEDULE L PART V	PART IV LINES 1B 7B DIRECTOR KENNETH SMITHMIER IS ON THE HICKORY POINT BANK BOARD OF DIRECTORS PART IV LINE 2B DIRECTOR SCOTT STRIGLOS OWNS STRIGLOS COMPANIES INC PART IV LINES 3B 4B 5B DIRECTOR EDWARD ELLIOTT IS AN OWNER OF CANCER CARE SPECIALISTS OF CENTRAL ILLINOIS HE IS ALSO AN OWNER OF BAKERS DOZEN LLC PART IV LINE 6B ROY MOSSER IS A DIRECTOR OF DMH PART IV LINE 8B 9B DIRECTOR RON DRANE IS EVP MANAGING DIRECTOR WITH BUSEY WEALTH MANAGEMENT WHICH IS A SUBSIDIARY OF FIRST BUSEY CORPORATION DIRECTOR JOHN FUNK IS A DIRECTOR OF FIRSTECH INC WHICH IS A SUBSIDIARY OF BUSEY BANK AND BUSEY BANK IS A SUBSIDIARY OF FIRST BUSEY CORPORATION DIRECTOR DAVID TYROLT IS A DIRECTOR OF BUSEY WEALTH MANAGEMENT WHICH IS A SUBSIDIARY OF FIRST BUSEY CORPORATION PART IV LINE 10B JOHN FAHEY MD IS THE SPOUSE OF DMH OFFICER LINDA FAHEY

Schedule L (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

DECATUR MEMORIAL HOSPITAL

Employer identification number

37-0661199

Identifier	Return Reference	Explanation
ADDITIONAL INFORMATION	FORM 990	FORM 990, PART I, ITEM 1 AND FORM 990, PART III, ITEM 1: DMH'S MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE OF CENTRAL ILLINOIS, RELYING ON ITS CORE FOUNDATIONS OF COMMITTED PHYSICIANS, CONSTRUCTIVE CULTURE, RESPONSIBLE GOVERNANCE, PROCESS INNOVATION, MANAGERIAL COMPETENCE, AND ENGAGED EMPLOYEES. WITH A HISTORY DATING BACK TO 1916, DMH TODAY ENCOMPASSES TWELVE STATE-OF-THE-ART CENTERS OF EXCELLENCE WHICH FOCUS ON THE CUTTING EDGE OF MEDICINE TODAY AND PROVIDE THE COMMUNITY WITH AWARD-WINNING HEALTH CARE. APPROXIMATELY 250,000 PERSONS RESIDE IN DMH'S SERVICE AREA, INCLUDING SUBSTANTIAL NUMBERS OF MEDICARE AND MEDICAID BENEFICIARIES, AS WELL AS PERSONS WHO DO NOT QUALIFY FOR EITHER PROGRAM AND THUS SEEK CARE PURSUANT TO DMH'S FINANCIAL ASSISTANCE (CHARITY CARE) PROGRAM. THE LOCAL COMMUNITY HAS BEEN HIT HARD BY THE RECENT ECONOMIC DECLINES. IN RESPONSE TO THESE CONDITIONS, DMH HAS EXPANDED ITS THRESHOLD FOR PROVISION OF FINANCIAL ASSISTANCE TO SIX TIMES THE FEDERAL POVERTY GUIDELINES; FOR THESE AND OTHER PATIENTS, DMH OFFERS SLIDING SCALE DISCOUNTS AND EXTENDED PAYMENT TERMS IN AN EFFORT TO ENSURE THAT PATIENTS ARE ABLE TO OBTAIN NECESSARY MEDICAL CARE. DURING THE FISCAL YEAR, DMH PROVIDED SIGNIFICANT FREE OR DISCOUNTED SERVICES TO PATIENTS QUALIFYING FOR FINANCIAL ASSISTANCE AS WELL AS OTHER FORMS OF COMMUNITY BENEFIT PROGRAMS, GRANTS AND SERVICES. SEE SCHEDULE H FOR MORE DETAIL.
ALL OTHER ACCOMPLISHMENT DESCRIPTION	FORM 990, PAGE 2, PART III, LINE 4D	EDUCATION AND OUTREACH: DMH HAS CONCLUDED THAT, TO FULFILL ITS MISSION OF IMPROVING HEALTH, IT MUST BECOME INVOLVED IN THE EDUCATION, AWARENESS AND PREVENTION OF DISEASE AND ILLNESS THAT NEGATIVELY IMPACT HEALTH STATUS. IN AN EFFORT TO GIVE COMMUNITY RESIDENTS THE TOOLS NECESSARY TO MAKE HEALTHY LIFESTYLE DECISIONS, DMH SEEKS OUT OPPORTUNITIES AND ACTIVELY INVOLVES ITSELF IN THE LOCAL COMMUNITY, THROUGH MEASURES RANGING FROM PROGRAMS FOR LOCAL SCHOOLS TO DMH'S POPULAR "PRIME TIME" PROGRAM FOR SENIORS. IN RECENT YEARS, DMH HAS PARTICIPATED IN VARIOUS COMMUNITY HEALTH NEEDS ASSESSMENT INITIATIVES, AS A RESULT OF WHICH DMH HAS IDENTIFIED SIGNIFICANT CONCERNS SUCH AS ACCESS TO PRIMARY CARE PHYSICIANS AND SPECIALISTS, CARDIAC SCREENINGS, OBESITY, DIABETES, INDIGENT OUTPATIENT LONGITUDINAL CARE, ONCOLOGY SCREENINGS, AND INFANT MORTALITY. WITH THE LEADERSHIP OF A MULTIDISCIPLINARY COMMUNITY BENEFITS COMMITTEE, INCLUDING PARTICIPATION BY A DIVERSE GROUP OF COMMUNITY REPRESENTATIVES, DMH HAS TAKEN A PRIMARY ROLE IN CONFRONTING THESE ISSUES. AS JUST ONE EXAMPLE, DMH IS SPONSORING A LOCAL VERSION OF THE PREVENTION PLAN CHALLENGE, A NATIONAL WELLNESS INITIATIVE THAT FOCUSES ON PREVENTIVE CARE TO HELP PEOPLE LIVE HEALTHIER AND LOWER HEALTHCARE COSTS WITHIN THE COMMUNITY; THROUGH THIS COMPETITION AMONG LOCAL EMPLOYERS, DMH HOPES TO SPUR COMPANIES TO BUILD HEALTHIER WORKFORCES.
RELATED PARTY INFORMATION AMONG OFFICERS	FORM 990, PAGE 6, PART VI, LINE 2	KENNETH SMITHMIER ROBIN KING DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KENNETH SMITHMIER LARRY ALTENBAUMER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KENNETH SMITHMIER PAULA EISSFELDT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP LARRY ALTENBAUMER KENNETH SMITHMIER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP LARRY ALTENBAUMER TIMOTHY STONE, JR. DIRECTOR OFFICER BUSINESS RELATIONSHIP LARRY ALTENBAUMER ROBIN KING DIRECTOR DIRECTOR BUSINESS RELATIONSHIP LARRY ALTENBAUMER PAULA EISSFELDT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP LARRY ALTENBAUMER JONATHON LOCKE DIRECTOR DIRECTOR BUSINESS RELATIONSHIP LARRY ALTENBAUMER JOHN FUNK DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DAVID TYROLT RON DRANE DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DAVID TYROLT JOHN RIDLEY DIRECTOR OFFICER BUSINESS RELATIONSHIP ROY MOSSER, JR. RON DRANE DIRECTOR DIRECTOR BUSINESS RELATIONSHIP RON DRANE DAVID TYROLT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP RON DRANE ROY MOSSER, JR. DIRECTOR DIRECTOR BUSINESS RELATIONSHIP RON DRANE THOMAS KOWA DIRECTOR DIRECTOR BUSINESS RELATIONSHIP RON DRANE JOHN FUNK DIRECTOR DIRECTOR BUSINESS RELATIONSHIP THOMAS KOWA RON DRANE DIRECTOR DIRECTOR BUSINESS RELATIONSHIP PAULA EISSFELDT KENNETH SMITHMIER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP PAULA EISSFELDT LARRY ALTENBAUMER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP ROBIN KING LARRY ALTENBAUMER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP ROBIN KING KENNETH SMITHMIER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JONATHON LOCKE LARRY ALTENBAUMER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JOHN FUNK LARRY ALTENBAUMER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JOHN FUNK RON DRANE DIRECTOR DIRECTOR BUSINESS RELATIONSHIP TIMOTHY STONE, JR LARRY ALTENBAUMER OFFICER DIRECTOR BUSINESS RELATIONSHIP JOHN RIDLEY DAVID TYROLT OFFICER DIRECTOR BUSINESS RELATIONSHIP
CLASSES OF MEMBERS OR STOCKHOLDERS	FORM 990, PAGE 6, PART VI, LINE 6	THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS ILLINOIS HEALTH AND SCIENCE, AN ILLINOIS NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS BEING DESCRIBED IN SEC. 501 (C)(3), IRC.
ELECTION OF MEMBERS AND THEIR RIGHTS	FORM 990, PAGE 6, PART VI, LINE 7A	AS THE SOLE CORPORATE MEMBER OF DMH, ILLINOIS HEALTH AND SCIENCE HAS THE RIGHT TO APPROVE ALL DIRECTORS OF DMH, AND TO REMOVE ANY DIRECTOR SO APPROVED.
DECISIONS SUBJECT TO APPROVAL OF MEMBERS	FORM 990, PAGE 6, PART VI, LINE 7B	THE DMH BOARD OF DIRECTORS GENERALLY OVERSEES AND DIRECTS ALL ACTIVITIES, ASSETS AND OPERATIONS OF DMH, SUBJECT TO THE RIGHTS AND AUTHORITY SPECIFICALLY RESERVED TO ILLINOIS HEALTH AND SCIENCE, AS THE SOLE CORPORATE MEMBER, IN THE DMH BYLAWS. THESE RIGHTS PERTAIN TO THE APPOINTMENT AND REMOVAL OF DIRECTORS, ELECTION OF THE PRESIDENT AND TREASURER, NOMINATION OF OTHER OFFICERS, AMENDMENT OF ARTICLES AND BYLAWS, APPROVAL OF BUDGETS AND LONG RANGE PLANS, APPROVAL OF ANY MERGER OR CONSOLIDATION, APPROVAL OF SIGNIFICANT TRANSACTIONS, APPROVAL OF DISSOLUTION, CREATION OF ANY SUBSIDIARIES OR AFFILITATES, AND APPOINTMENT OF THE INDEPENDENT AUDITOR.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11B	A COPY OF THE FORM 990, ALONG WITH AN EXPLANATORY NOTE, IS PROVIDED FOR REVIEW TO THE BOARD VIA AN INTRANET SITE PRIOR TO FILING. ALSO, THE FORM 990 IS REVIEWED AND DISCUSSED AT A REGULARLY SCHEDULED BOARD MEETING PRIOR TO FILING.
ENFORCEMENT OF CONFLICTS POLICY	FORM 990, PAGE 6, PART VI, LINE 12C	ANNUALLY, ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO SUBMIT A CONFLICT OF INTEREST DISCLOSURE TO THE CEO. A LIST OF POTENTIAL CONFLICTS IS PREPARED AND IS AVAILABLE FOR REFERENCE PRIOR TO EACH BOARD AND COMMITTEE MEETING. THE CFO'S OFFICE MONITORS AND PERIODICALLY REVIEWS TRANSACTIONS BETWEEN THE ORGANIZATION AND BOARD MEMBERS OR ENTITIES WITH WHICH THEY ARE AFFILIATED.
COMPENSATION PROCESS FOR TOP OFFICIAL	FORM 990, PAGE 6, PART VI, LINE 15A	THE BOARD OF DIRECTORS OF ILLINOIS HEALTH AND SCIENCE (THE SOLE CORPORATE MEMBER OF DMH) HAS ADOPTED AN EXECUTIVE COMPENSATION POLICY AND PROCEDURE SETTING FORTH THE AUTHORITY AND PROCESS REGARDING COMPENSATION DETERMINATIONS FOR THE TOP EXECUTIVES OF DMH AND ITS AFFILIATES (THE CEO AND FIVE OTHER EXECUTIVES). PURSUANT TO THE POLICY, THE BOARD HAS DELEGATED TO THE EXECUTIVE COMMITTEE THE RESPONSIBILITY TO REVIEW INDEPENDENT MARKET DATA, ASSESS THE COMPARABILITY OF SUCH DATA, AND MAKE RECOMMENDATIONS TO THE BOARD REGARDING COMPENSATION PROPOSED TO BE PAID. IN CARRYING OUT THEIR RESPECTIVE COMPENSATION-RELATED RESPONSIBILITIES, THE BOARD AND EXECUTIVE COMMITTEE EXCLUDE ANY PERSON DEEMED TO HAVE A CONFLICT OF INTEREST WITHIN THE MEANING OF APPLICABLE TREASURY REGULATIONS (INCLUDING ANY PHYSICIANS EMPLOYED BY DMH OR ON ITS MEDICAL STAFF). AS PROVIDED IN THE POLICY, THE EXECUTIVE COMMITTEE CONDUCTS AN IN-DEPTH TOTAL COMPENSATION ANALYSIS USUALLY EVERY TWO YEARS WITH THE ASSISTANCE OF AN INDEPENDENT NATIONALLY-RECOGNIZED COMPENSATION CONSULTING FIRM. IN THE OFF-YEARS BETWEEN IN-DEPTH REVIEWS, THE COMMITTEE TYPICALLY HAS OBTAINED FROM ITS CONSULTING FIRM AN UPDATED ASSESSMENT TO CONFIRM CONTINUED COMPARABILITY WITH MARKET DATA. CONSISTENT WITH THE FOREGOING, IN AUGUST 2012, DMH OBTAINED SUCH AN UPDATE REPORT FROM ITS INDEPENDENT COMPENSATION CONSULTING FIRM, COVERING THE FOLLOWING INDIVIDUALS: SMITHMIER (CEO), STONE (COO), PEACOCK (CFO), ZIA (VPMA), FAHEY (CNO), AND RIDLEY (VPPS). ALL DETERMINATIONS OF THE BOARD AND EXECUTIVE COMMITTEE ARE THOROUGHLY AND TIMELY DOCUMENTED IN APPROPRIATE MINUTES AND SUPPORTING MATERIALS.
COMPENSATION PROCESS FOR OFFICERS	FORM 990, PAGE 6, PART VI, LINE 15B	SEE RESPONSE TO FORM 990, PART VI.B, LINE 15A ABOVE.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	THE GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL INFORMATION OF DMH ARE AVAILABLE TO THE PUBLIC UPON SPECIFIC REQUEST TO DMH ADMINISTRATION.
OTHER CHANGES IN NET ASSETS EXPLANATION	FORM 990, PART XI, LINE 9	BOOK/TAX DIFF. IN INC. FROM PARTNERSHIPS (INCREASE 94,706 CHANGE IN MINIMUM PENSION LIAB. (INCREASE) 3,367,590 CHANGE IN VAL. OF ASSETS HELD IN TRUST (INCREASE) 2,325,046 TRANSFER OF CAPITAL FROM AFFILIATES (DECREASE) 772,655 THE NET RESULT OF ALL THESE OTHER CHANGES IN NET ASSETS IS AN INCREASE OF 5,014,687.
ADDITIONAL INFORMATION	FORM 990, PART XII	DECATUR MEMORIAL HOSPITAL WAS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF DMH HEALTH SYSTEMS AND AFFILIATED ORGANIZATIONS. DMH HEALTH SYSTEMS AND AFFILIATED ORGANIZATIONS BECAME ILLINOIS HEALTH AND SCIENCE EFFECTIVE JUNE 25, 2013.

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

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

DECATUR MEMORIAL HOSPITAL

Employer identification number

37-0661199

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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) ILLINOIS HEALTH AND SCIENCE 2300 N EDWARD ST DECATUR,IL625264163 37-1169606	SUPP. DMH	IL	501C3	11A	NA		No
(2) DECATUR MEMORIAL FOUNDATION 2300 N EDWARD ST DECATUR,IL625264163 37-1169605	SUPP. DMH	IL	501C3	11A	NA		No
(3) HEARTLAND RISK MANAGEMENT 2300 N EDWARD ST DECATUR,IL625264163 45-4256254	SUPP. DMH	AZ	501C3	11A	DMH		No

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

Cat. No. 50135Y

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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) DECATUR DIGESTIVE DISEASE CENTER 2 MEMORIAL DRIVE SUITE 102 DECATUR,IL62526 16-1678954	ENDOSCOPY	IL	DMH	RELATED	341,365	198,155		No			No	50.000 %

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?
(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		Yes	No
(1) DMH WORLDWIDE LTD 2300 N EDWARD ST DECATUR,IL62526 27-1901157	CONSULTING	IL	DMH	C CORP	-359,527	2,453,760	100.000 %	Yes

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

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

Yes

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

Yes

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

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

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

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

Yes

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

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

Yes

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

Yes

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

Yes

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

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

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

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

Yes

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

(a) Name of other organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) DECATUR MEMORIAL FOUNDATION	K	1,465,144	CASH PAYMENT
(2) DECATUR MEMORIAL FOUNDATION	O	152,957	CASH PAYMENT
(3) DECATUR DIGESTIVE DISEASE CENTER	O	476,692	CASH PAYMENT
(4) DMH WORLDWIDE LTD	B	800,000	CASH PAYMENT
(5) DECATUR DIGESTIVE DISEASE CTR LLC	S	350,000	CASH TRANSFER
(6) HEARTLAND RISK MANAGEMENT	M	1,995,688	CASH PAYMENT
(7) ILLINOIS HEALTH AND SCIENCE	B	100,000	CASH PAYMENT
(8) DMH WORLDWIDE LTD	A	75,016	CASH PAYMENT
(9) DMH WORLDWIDE LTD	O	1,006,373	CASH PAYMENT
(10) DECATUR MEMORIAL FOUNDATION	K	1,465,144	CASH PAYMENT
(11) DECATUR MEMORIAL FOUNDATION	O	152,957	CASH PAYMENT
(12) DECATUR DIGESTIVE DISEASE CENTER	O	476,692	CASH PAYMENT
(13) DMH WORLDWIDE LTD	B	800,000	CASH PAYMENT
(14) DECATUR DIGESTIVE DISEASE CTR LLC	S	350,000	CASH TRANSFER
(15) HEARTLAND RISK MANAGEMENT	M	1,995,688	CASH PAYMENT
(16) ILLINOIS HEALTH AND SCIENCE	B	100,000	CASH PAYMENT
(17) DMH WORLDWIDE LTD	A	75,016	CASH PAYMENT
(18) DMH WORLDWIDE LTD	O	1,006,373	CASH PAYMENT

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)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 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

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: DMH SERVES THE HEALTHCARE NEEDS OF THE PEOPLE OF CENTRAL ILLINOIS THROUGH OPERATION OF A 280-BED ACUTE CARE HOSPITAL AND RELATED FACILITIES PROVIDING COMPREHENSIVE INPATIENT, OUTPATIENT AND PHYSICIAN SERVICES. (SCHEDULE 0).
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	16
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	7
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	2,560
6	Total number of volunteers (estimate if necessary) .............	6	367
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	3,583,461
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-238,086

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,678,004	3,280,671
9	Program service revenue (Part VIII, line 2g) .........	264,095,992	241,842,558
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	5,240,859	12,422,658
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	13,726,430	14,653,712
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	286,741,285	272,199,599
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,400,928	932,272
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	143,951,214	135,018,427
16a	Professional fundraising fees (Part IX, column (A), line 11e).....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	145,171,786	121,288,590
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	290,523,928	257,239,289
19	Revenue less expenses. Subtract line 18 from line 12.......	-3,782,643	14,960,310
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	368,493,551	391,590,668
21	Total liabilities (Part X, line 26).............	81,124,557	80,148,738
22	Net assets or fund balances. Subtract line 21 from line 20.....	287,368,994	311,441,930

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 107,735,501 including grants of $ 932,272 ) (Revenue $ 152,021,177 )
	OUTPATIENT SERVICES: DMH PROVIDES A FULL RANGE OF OUTPATIENT SERVICES (DIAGNOSTIC TESTS AND MEDICAL PROCEDURES NOT REQUIRING AN OVERNIGHT STAY). DMH DEPARTMENTS PROVIDING THE MOST SUBSTANTIAL SERVICES DURING THE YEAR INCLUDED CARDIOLOGY, LABORATORY, RADIOLOGY, ONCOLOGY, PHYSICAL THERAPY, SLEEP DISORDERS, SURGERY, GERIATRIC AND EMERGENCY MEDICINE. DURING THE FISCAL YEAR, PATIENTS MADE APPROXIMATELY 49,500 VISITS TO DMH'S EMERGENCY CARE CENTER AND RECEIVED APPROXIMATELY 271,000 OUTPATIENT TESTS.

4b	(Code: ) (Expenses $ 47,402,313 including grants of $ ) (Revenue $ 66,887,474 )
	INPATIENT SERVICES: WITH 280 BEDS CURRENTLY IN SERVICE,DMH PROVIDED 45,343 DAYS OF INPATIENT CARE DURING THE FISCAL YEAR. DMH'S INPATIENTS INCLUDED THE YOUNG (NEWBORN INFANTS IN THE LEVEL I OR LEVEL II NURSERY), THE OLD (FOR EXAMPLE, PERSONS RECEIVING CARE THROUGH DMH'S SENIOR HEALTH AND WELLNESS CENTER OF EXCELLENCE), AND THE IN-BETWEEN. AREAS OF INPATIENT SERVICE INCLUDED GENERAL MEDICAL, SURGERY, ORTHOPEDICS, CARDIOLOGY, GERIATRICS,PEDIATRICS, INTENSIVE CARE, DIALYSIS, OBSTETRICS AND GYNECOLOGY, NURSERY, LONG-TERM CARE, AND TELEMETRY MONITORING. INPATIENT CARE WAS PROVIDED BY DMH'S TEAM OF HIGHLY-QUALIFIED, TALENTED STAFF (TODAY NUMBERING OVER 1,900 IN ALL), INCLUDING HOSPITALISTS, NURSES, AIDES, DIETICIANS, CASE MANAGEMENT STAFF, SOCIAL WORKERS, AND CHAPLAINS.

4c	(Code: ) (Expenses $ 47,348,217 including grants of $ ) (Revenue $ 33,639,265 )
	PROFESSIONAL SERVICES: AS THE EMPLOYER OF APPROXIMATELY 64 PHYSICIANS PLUS A COMPLEMENT OF OTHER PROVIDERS (PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS), DMH OFFERS A WIDE RANGE OF PROFESSIONAL PATIENT CARE AT APPROXIMATELY 28 OFFICES LOCATED THROUGHOUT THE SERVICE AREA. THESE SITES INCLUDE THREE "EXPRESS CARE" LOCATIONS OFFERING CARE FOR CASES THAT ARE TIME-SENSITIVE BUT NOT LIFE-THREATENING OR EMERGENT.

	(Code: ) (Expenses $ 152,367 including grants of $ ) (Revenue $ )
	EDUCATION AND OUTREACH: DMH HAS CONCLUDED THAT, TO FULFILL ITS MISSION OF IMPROVING HEALTH, IT MUST BECOME INVOLVED IN THE EDUCATION, AWARENESS AND PREVENTION OF DISEASE AND ILLNESS THAT NEGATIVELY IMPACT HEALTH STATUS. IN AN EFFORT TO GIVE COMMUNITY RESIDENTS THE TOOLS NECESSARY TO MAKE HEALTHY LIFESTYLE DECISIONS, DMH SEEKS OUT OPPORTUNITIES AND ACTIVELY INVOLVES ITSELF IN THE LOCAL COMMUNITY, THROUGH MEASURES RANGING FROM PROGRAMS FOR LOCAL SCHOOLS TO DMH'S POPULAR "PRIME TIME" PROGRAM FOR SENIORS. IN RECENT YEARS, DMH HAS PARTICIPATED IN VARIOUS COMMUNITY HEALTH NEEDS ASSESSMENT INITIATIVES, AS A RESULT OF WHICH DMH HAS IDENTIFIED SIGNIFICANT CONCERNS SUCH AS ACCESS TO PRIMARY CARE PHYSICIANS AND SPECIALISTS, CARDIAC SCREENINGS, OBESITY, DIABETES, INDIGENT OUTPATIENT LONGITUDINAL CARE, ONCOLOGY SCREENINGS, AND INFANT MORTALITY. WITH THE LEADERSHIP OF A MULTIDISCIPLINARY COMMUNITY BENEFITS COMMITTEE, INCLUDING PARTICIPATION BY A DIVERSE GROUP OF COMMUNITY REPRESENTATIVES, DMH HAS TAKEN A PRIMARY ROLE IN CONFRONTING THESE ISSUES. AS JUST ONE EXAMPLE, DMH IS SPONSORING A LOCAL VERSION OF THE PREVENTION PLAN CHALLENGE, A NATIONAL WELLNESS INITIATIVE THAT FOCUSES ON PREVENTIVE CARE TO HELP PEOPLE LIVE HEALTHIER AND LOWER HEALTHCARE COSTS WITHIN THE COMMUNITY; THROUGH THIS COMPETITION AMONG LOCAL EMPLOYERS, DMH HOPES TO SPUR COMPANIES TO BUILD HEALTHIER WORKFORCES.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 152,367 including grants of $ ) (Revenue $ )
4e	Total program service expenses202,638,398

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)				(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) MICHAEL ZIA MD........................................................................ VICE PRES.	40.00 ........................20	X			303,016	0	19,441
(19) LINDA FAHEY........................................................................ VP/CHIEF NUR	40.00 .......................	X			250,726	0	4,358
(20) JOHN RIDLEY........................................................................ SVP PROF. SE	40.00 ........................20	X			184,527	0	19,535
(21) DEBBIE BRAGG........................................................................ SR. VP & CFO	40.00 .......................1.00	X			138,274	0	2,906
(22) KEVIN HORATH........................................................................ VP HUMAN RES	40.00 .......................	X			99,134	0	18,065
(23) STEVEN WEBER MD........................................................................ PHYSICIAN	40.00 .......................		X		1,343,976	0	20,613
(24) MARVIN DERRICK MD........................................................................ PHYSICIAN	40.00 .......................		X		822,796	0	17,671
(25) MOHAMMED HASNAIN MD........................................................................ PHYSICIAN	40.00 .......................		X		818,362	0	20,613
(26) JOHN WATERS MD........................................................................ PHYSICIAN	40.00 .......................		X		816,290	0	11,946
(27) ROBERT KRAUS JR MD........................................................................ PHYSICIAN	40.00 .......................		X		772,218	0	20,613
(28) GARY G PEACOCK........................................................................ SR. VP & CFO	40.00 .......................			X	265,868	0	15,315

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	8,568,945	228,675

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		39,225
e	Government grants (contributions)1e		2,198,597

f	All other contributions, gifts, grants, and similar amounts not included above1f		1,042,849

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			3,280,671
			Business Code
2a	INPATIENT, OUTPATIENT, & PHYS		900099	241,501,618	241,501,618
b	DECATUR DIGESTIVE DISEASE CTR		621990	340,940	340,940
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			241,842,558
3	Investment income (including dividends, interest, and other similar amounts).......			4,028,960			4,028,960
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	364,893
b	Less: rental expenses
c	Rental income or (loss)	364,893
d	Net rental income or (loss).......			364,893			364,893
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	40,181,090	391,530
b	Less: cost or other basis and sales expenses	32,037,558	141,364
c	Gain or (loss)	8,143,532	250,166
d	Net gain or (loss)..........			8,393,698			8,393,698
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a		2,079,365
b	Less: cost of goods sold ..b		1,206,219
c	Net income or (loss) from sales of inventory..			873,146		873,146
Miscellaneous Revenue			Business Code
11a	OTHER EXEMPT FUNCTION INC		900099	10,705,358	10,705,358
b	TAXABLE RELATED ENTITY INCOME		900099	1,081,390		1,081,390
c	WELLNESS & COSMETIC SERVICES		900099	687,074		687,074
d	All other revenue ....			941,851		941,851
e	Total. Add lines 11a–11d ......			13,415,673
12	Total revenue. See Instructions......			272,199,599	252,547,916	3,583,461	12,787,551


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			9,347	1	8,700
2	Savings and temporary cash investments .........			7,859,163	2	24,054,347
3	Pledges and grants receivable, net ...........				3
4	Accounts receivable, net .............			43,967,363	4	37,962,067
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5
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
					6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			3,127,753	8	3,071,259
9	Prepaid expenses and deferred charges ..........			3,674,503	9	3,526,214
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	377,033,260
b	Less: accumulated depreciation .....	10b	266,764,710	120,176,803	10c	110,268,550
11	Investments—publicly traded securities ..........			182,904,905	11	200,205,996
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 .....				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			6,773,714	15	12,493,535
16	Total assets. Add lines 1 through 15 (must equal line 34)......			368,493,551	16	391,590,668
17	Accounts payable and accrued expenses .........			35,013,222	17	39,514,372
18	Grants payable .................				18
19	Deferred revenue ................			146,195	19	139,553
20	Tax-exempt bond liabilities .............			15,147,000	20	13,311,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
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..........				22
23	Secured mortgages and notes payable to unrelated third parties ..				23
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			30,818,140	25	27,183,813
26	Total liabilities. Add lines 17 through 25.........			81,124,557	26	80,148,738
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			236,946,363	27	260,167,522
28	Temporarily restricted net assets ...........			35,813,819	28	35,917,359
29	Permanently restricted net assets ...........			14,608,812	29	15,357,049
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			287,368,994	33	311,441,930
34	Total liabilities and net assets/fund balances ........			368,493,551	34	391,590,668