Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
Morris Hospital
Employer identification number
36-2170155
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
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
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
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) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
Morris Hospital
Employer identification number
36-2170155
Return Reference
Explanation
FORM 990, PAGE 2, PART III, PROGRAM SERVICE ACCOMPLISHMENTS
The mission of Morris Hospital & Healthcare Centers is to improve the health of area residents. This is the focal point that steers strategy and decision making and gives meaning and focus to staff as they go about their daily work. As long as our actions and activities are focused on improving the health of area residents, we know that we are doing what's right for our community. Delivering quality patient care remains the highest priority at Morris Hospital & Healthcare Centers, as event by a number of significant accomplishments in 2013 including the hospital's re-designation as a Level II perinatal care provider by the Illinois Department of Public Health. This means Morris Hospital has the necessary qualifications to care for women who have the potential or likelihood for complicated or high risk deliveries, as well as newborns who may require specialized services. The hospital also achieved accreditation as a Certified Diabetes Center from the American Association of Diabetes Educators for the first time, verification that the hospital uses an approved diabetes education curriculum that meets a high standard of care. Morris Hospital added a number of new services in 2013, including a Phase 3 Pulmonary Rehabilitation program for individuals who want to continue exercising after the completion of Phase 2 Pulmonary Rehab. Morris Hospital also opened a new cardiology practice, Morris Hospital Cardiovascular Specialists, with two cardiologists and two office locations. In addition, Morris Hospital and Toussaint Obstetrics completed an affiliation agreement that resulted in the creation of Morris Hospital Obstetrics & Gynecology Specialists, a new Morris Hospital service providing obstetrician/gynecologists at office locations in Channahon, Morris and Ottawa. Another service expansion in 2013 included the opening of outpatient physical therapy at the Ridge Road Campus, complementing the availability of physical, occupational and speech therapy at the Diagnostic & Rehabilitative Center in Morris. Fourteen new physicians joined the medical staff in 2013, including two immediate care physicians, three cardiologists, two orthopedic spine surgeons, an emergency medicine physician, neurologist, obstetrician/gynecologist, hospitalist, psychiatrist, rheumatologist and allergist. In late 2013, Morris Hospital began renovation of an 11,888 square foot existing facility in Yorkville for the purpose of offering immediate care, laboratory, and diagnostic imaging services in the spring of 2014, followed by primary care and physician specialty offerings later in 2014. In 2013, Kimberly Landers became the Vice President of Patient Care at Morris Hospital & Healthcare Centers, succeeding Carol Havel who retired after 42 years of service. In the patient care area, Morris Hospital is focused on using evidence-based medicine to assure the community is being served with the highest quality of care. The most significant quality activities in 2013 included instituting a re-admission screening on all inpatients which resulted in a reduction in the readmission rate from 13% to 10%, forming core measure teams lead by clinical leaders, improving medication education by providing a pharmacist at the patient bedside, transforming the case management model to one that focuses on effectively orchestrating the patient's progression of care from admission to post-discharge, and launching the transition to electronic progress notes, an important patient care initiative that supports the move to a full electronic medical record. Because an excellent workforce is key to helping us carry out our mission, we are committed to retention of our outstanding staff and ongoing development of leaders as evident through a new nursing preceptor program and continued development of our current and potential future leaders through formal leadership development training. Other significant activities include recognition received from other organizations. This verifies the exemplary manner in which we carry out our mission. In 2013, Morris Hospital twice received national recognition for its commitment to quality, including being named in the September 2013 issue of Consumer Reports as one of the top 20 hospitals in Illinois for surgery safety. Also in 2013, Morris Hospital received an "A" rating on the Leapfrog Group's Hospital Safety Scorecard for the fourth consecutive time. 5 Star Patient Perception awards were also received from Professional Research Consultants for overall quality of care in the Laboratory (on and off campus), Imaging Services, Minooka Healthcare Center, Emergency Department, and Marseilles Healthcare Center in 2013.
REGARDING PART VI, SECTION A
QUESTION 8A MINUTES AND AGENDA OF THE FULL BOARD OF MORRIS HOSPITAL ARE MAINTAINED. THE FULL BOARD MEETS EVERY MONTH. MEETING DATES APPLICABLE TO 2013 ARE AS FOLLOWS: 01/28/2013 02/25/2013 03/25/2013 05/20/2013 06/24/2013 07/17/2013 07/22/2013 08/26/2013 09/30/2013 10/28/2013 11/25/2013 12/16/2013 PART VI, SECTION A, QUESTION 8B MINUTES AND AGENDA OF THE FOLLOWING COMMITTEES OF MORRIS HOSPITAL HAVE BEEN AND ARE MAINTAINED. EXECUTIVE/FINANCE/COMPENSATION COMMITTEE 01/21/2013 02/07/2013 02/19/2013 02/20/2013 03/11/2013 03/14/2013 03/18/2013 05/13/2013 05/17/2013 06/17/2013 07/10/2013 07/22/2013 08/19/2013 08/29/2013 09/19/2013 10/21/2013 11/18/2013 12/04/2013 12/16/2013 LONG RANGE PLANNING COMMITTEE 04/04/2013 06/26/2013 07/03/2013 07/10/2013 08/08/2013 09/26/2013 10/23/2013 12/02/2013 PI/QUALITY COMMITTEE 01/17/2013 02/18/2013 03/18/2013 04/18/2013 06/17/2013 07/15/2013 08/19/2013 09/16/2013 10/21/2013 11/18/2013 12/16/2013 RECRUITING/RETENTION COMMITTEE 03/05/2013 03/26/2013 04/23/2013 05/30/2013 08/15/2013
PART VI, SECTION B
QUESTION 11B A DRAFT OF THE 990, AS PREPARED BY BDO USA, LLP, WAS REVIEWED BY MEMBERS OF THE FINANCE COMMITTEE ALONG WITH THE CFO AND ACCOUNTING MANAGER OF MORRIS HOSPITAL. A JOINT SPECIAL BOARD MEETING OF THE MORRIS HOSPITAL, MORRIS HOSPITAL FOUNDATION AND MORRIS HOSPITAL AUXILIARY BOARDS WAS HELD TO PROVIDE A FORMAL PRESENTATION OF THE FINAL 990'S OF EACH RESPECTIVE ORGANIZATION PRIOR TO THE FILING. QUESTION 12B DIRECTORS, OFFICERS, MEMBERS OF THE BOARD, KEY AGENTS, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A STATEMENT WHICH REQUIRES THE FOLLOWING: (1) DISCLOSE FOR IN THE PRIOR TWO YEARS, ANY PRODUCTS OR SERVICES THAT HE/SHE MAY HAVE PROVIDED PERSONALLY TO MORRIS HOSPITAL AND HEALTHCARE CENTERS OR ANY OF ITS AFFILIATES OTHER THAN IN HIS/HER CAPACITY AS A DIRECTOR, CIOMMITTEE MEMBER, OFFICER, OR OTHER SENIOR MANAGEMENT POSITION. (2) DISCLOSE FOR IN THE PRIOR TWO YEARS, ANY DIRECT OR INDIRECT OWNERSHIP INTEREST THAT HE/SHE MAY HAVE IN ANY COMPANY WITH WHICH MORRIS HOSPITAL AND HEALTHCARE CENTERS OR ANY OF ITS AFFILIATES CONDUCTS BUSINESS, INCLUDING THE PURCHASE OR SALE OF PRODUCTS AND SERVICES (EXCEPT OWNERSHIP OF LESS THAN 1% INTEREST IN A PUBLICLY TRADED COMPANY) (3) DISCLOSE FOR IN THE PRIOR TWO YEARS, WHETHER HE/SHE MAY HAVE SERVED AS A BOARD MEMBER, EMPLOYEE , CONSULTANT OR IN ANY OTHER CAPACITY TO A BUSINESS OR COMPANY THAT PROVIDES PRODUCTS OR SERVICES TO MORRIS HOSPITAL AND HEALTHCARE CENTERS OR ANY OF ITS AFFILIATES (4) DISCLOSE FOR IN THE PRIOR TWO YEARS, WHETHER HE/SHE HAS BEEN INVOLVED IN ANY LEGAL OR ADMINISTRATIVE PROCEEDING, REAL ESTATE OR OTHER BUSINESS TRANSACTION, INCLUDING THE PURCHASE OF GOODS OR SERVICES, INVOLVING MORRIS HOSPITAL AND HEALTHCARE CENTERS OR ANY OF ITS AFFILIATES EITHER PERSONALLY OR THROUGH A COMPANY IN WHICH HE/SHE HAS A DIRECT OR INDIRECT OWNERSHIP OR FOR WHICH HE/SHE HAS SERVED AS A BOARD MEMBER, EMPLOYEE, CONSULTANT OR IN ANY OTHER CAPACITY (5) DISCLOSE FOR IN THE PRIOR TWO YEARS, WHETHER HE/SHE HAS SERVED AS A BOARD MEMBER, EMPLOYEE, CONSULTANT OR IN ANY OTHER CAPACITY WITH RESPECT TO A BUSINESS OR COMPANY THAT PROVIDES SERVICCES IN COMPETITION WITH MORRIS HOSPITAL AND HEALTHCARE CENTERS OR ANY OF ITS AFFILIATES. COMPETITION MEANING PROVIDING A PRODUCT OR SERVICE WHICH IS THE SAME AS (MATERIALLY SIMILIAR TO) A PRODUCT OR SERVICE PROVIDED BY MORRIS HOSPITAL AND HEALTHCARE CENTERS OR ANY OF ITS AFFILIATES SAME GEOGRAPHIC AREA, OR TO PATIENTS IN THE SAME GEOGRAHPIC AREA. (6) DISCLOSE FOR IN THE PRIOR TWO YEARS, WHETHER HE/SHE HAS HAD ANY EMPLOYMENT , APPOINTMENT OR OTHER RELATIONSHIP WITH A GOVERNMENT ENTITY HAVING REGULATORY AUTHORITY OVER A MORRIS HOSPITAL AND HEALTHCARE CENTERS OR ANY OF ITS AFFILIATES. (7) DISCLOSE FOR IN THE PRIOR TWO YEARS, WHETHER TO THE BEST OF HIS/HER KNOWLEDGE, ANY MEMBER OF HIS/HER IMMEDIATE FAMILY HAVE PERSONALLY, OR COMPANY WITH WHICH THAT INDIVIDUAL HAD A OWNERSHIP,EMPLOYMENT, CONSULTING OR BOARD RELATIONSHIP, PROVIDED GOODS OR SERVICES TO, OR OTHERWISE CONDUCTED A BUSINESS RELATIONSHIP WITH MORRIS HOSPITAL AND HEALTHCARE CENTERS OR ANY OF ITS AFFILIATES. (8) DISCLOSE FOR IN THE PRIOR YEAR, WHETHER HE/SHE HAS HAD ANY MEMBER OF HIS/HER IMMEDIATE FAMILY EMPLOYED BY MORRIS HOSPITAL AND HEALTHCARE CENTERS OR ANY OF ITS AFFILIATES. (IMMEDIATE FAMILY MEMBERS WOULD INCLUDE SPOUSE, ANCESTORS, CHILDREN, GRANDCHILDREN, GREAT-GRAND CHILDREN, SIBLINGS (WHETHER BY WHOLE OR HALF-BLOOD), AND THE SPOUSES OF CHILDREN, GRANDCHILDREN, GREAT-GHRAND CHILDREN AND SIBLINGS). (9) DISCLOSE FOR IN THE PRIOR TWO YEARS, WHETHER HE/SHE HAS BEEN AWARE OF ANY OTHER EVENTS, TRANSACTIONS, ARRANGEMENTS OR OTHER SITUATIONS THAT HAVE OCCURRED OR THAT MAY OCCUR IN THE FUTURE, INCLUDING PENDING OR CONTEMPLATED TRANSACTIONS OR ARRANGEMENTS, THAT COULD BE PERCEIVED AS A CONFLICT OR DUALITY OF INTEREST OR THAT BELIEVE SHOULD BE EXAMINED BY MORRIS HOPSITAL AND HEALTHCARE CENTER'S BOARD OF DIRECTORS IN ACCORDANCE WITH THE TERMS AND INTENT OF THE MORRIS HOSPITAL AND HEALTHCARE CENTER'S CONFLICTS AND DUALITIES OF INTEREST POLICY Question 12C PERIODIC REVIEWS ARE MADE THAT AT A MINIMUM INCLUDE: (1) WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE AND ARE THE RESULT OF ARM'S LENGTH BARGAINING (2) WHETHER ACQUISITIONS OF PHYSICIAN PRACTICES AND OTHER PROVIDER SERVICES RESULT IN INUREMENT OR IMPERMISSABLE PRIVATE BENEFIT (3) WHETHER PARTNERSHIP AND JOINT VENTURE ARRANGEMENTS AND ARRANGEMENTS WITH MANAGEMENT SERVICE ORGANIZATIONS AND PHYSICIAN HOSPITAL ORGANIZATIONS CONFORM TO WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE PAYMENTS FOR GOODS AND SERVICES, FURTHER THE CORPORATION'S CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT OR IMPERMISSABLE PRIVATE BENEFIT (4) WHETHER AGREEMENTS TO PROVIDE HEALTHCARE AND AGREEMENTS WITH OTHER HEALTH CARE PROVIDERS, EMPLOYEES AND THIRD PARTY PAYORS FURTHER CORPORATION'S CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT OR IMPERMISSABLE PRIVATE BENEFIT PART VI, SECTION B, QUESTION 15A & B THE HOSPITAL HAS A COMPENSATION COMMITTEE WHICH MEETS SEVERAL TIMES PER YEAR THAT WITH THE ASSISTANCE OF INTERNAL SOURCES (HUMAN RESOURCES) AND EXTERNAL ADVISORS; ASSESSES AND EVALUATES THE APPROPRIATENESS OF THE COMPENSATION AND BENEFITS OF UPPER MANAGEMENT WHICH INCLUDES CEO, CFO AND OTHER TOP MANAGEMENT OFFICIALS WHICH INCLUDES KEY EMPLOYEES. PART VI, SECTION C, QUESTION 19 THE DOCUMENTS ARE MADE AVAILABLE UPON REQUEST.
PART XI, LINE 9
change in fair value of derivative instruments $3,157,331
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.