Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 10-01-2013 , 2013, and ending 09-30-2014
BCheck if applicable:
CName of organization
DECATUR MEMORIAL HOSPITAL
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
2300 N EDWARD ST
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
DECATUR, IL625264163
D Employer identification number

37-0661199
E Telephone number

G Gross receipts $ 307,313,289
F Name and address of principal officer:
KEN SMITHMIER
2300 N EDWARD ST
DECATUR,IL625264163
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.DMHCARES.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1916
M State of legal domicile: IL
Part I
Summary
Activities & Governance 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 MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 13
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 2013 (Part V, line 2a) ...... 5 2,431
6 Total number of volunteers (estimate if necessary) ............. 6 352
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 4,672,960
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 707,976
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 3,280,671 3,574,565
9 Program service revenue (Part VIII, line 2g) ......... 241,842,558 252,800,020
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 12,422,658 9,197,007
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 14,653,712 13,405,352
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 272,199,599 278,976,944
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 932,272 1,263,671
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) 135,018,427 131,819,160
16a Professional fundraising fees (Part IX, column (A), line 11e).....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 121,288,590 133,289,463
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 257,239,289 266,372,294
19 Revenue less expenses. Subtract line 18 from line 12....... 14,960,310 12,604,650
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 391,590,668 369,934,112
21 Total liabilities (Part X, line 26)............. 80,148,738 79,008,802
22 Net assets or fund balances. Subtract line 21 from line 20..... 311,441,930 290,925,310
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2013)
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: 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
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 113,050,707 including grants of $ 1,263,671 ) (Revenue $ 160,339,734 )
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 45,000 VISITS TO DMH'S EMERGENCY CARE CENTER AND RECEIVED APPROXIMATELY 252,000 OUTPATIENT TESTS.
4b (Code:   ) (Expenses $ 48,722,989 including grants of $   ) (Revenue $ 69,103,779 )
INPATIENT SERVICES: WITH 280 BEDS CURRENTLY IN SERVICE,DMH PROVIDED 40,900 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 2,000 IN ALL), INCLUDING HOSPITALISTS, NURSES, AIDES, DIETICIANS, CASE MANAGEMENT STAFF, SOCIAL WORKERS, AND CHAPLAINS.
4c (Code:   ) (Expenses $ 47,542,010 including grants of $   ) (Revenue $ 31,884,244 )
PROFESSIONAL SERVICES: AS THE EMPLOYER OF APPROXIMATELY 58 PHYSICIANS PLUS A COMPLEMENT OF OTHER PROVIDERS (PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS), DMH OFFERS A WIDE RANGE OF PROFESSIONAL PATIENT CARE AT APPROXIMATELY 26 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 $ 180,738 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; HEART, LUNG, & STROKE SCREENINGS; CHRONIC OBSTRUCTIVE PULMONARY DISEASE; OBESITY; DIABETES; INDIGENT OUTPATIENT LONGITUDINAL CARE; ONCOLOGY SCREENINGS; WOMEN AND CHILDREN'S HEALTH; AND SENIOR HEALTH AND WELLNESS. 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.
4d Other program services (Describe in Schedule O.)
(Expenses $ 180,738 including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet209,496,444
Form 990 (2013)
Form 990 (2013)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H.... Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I........ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, complete Schedule L, Part II.................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV .......................... Click to see attachment
28a
Yes
 
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV..................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
152
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
2,431
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2013)
Form 990 (2013)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
13
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
7
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
IL
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletDEBBIE BRAGG ACCOUNTING2300 N EDWARD STDECATURIL625264163 (217) 876-2051
Form 990 (2013)
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) KENNETH SMITHMIER........................................................................
DIRECTOR/PRE
 10.00
.......................30.00 		X   X       716,504 0 17,808
(2) JACK O'RILEY........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(3) WALTER SMITH........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(4) JOHN W FUNK........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(5) JONATHON T LOCKE MD........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(6) ROY MOSSER JR........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(7) THOMAS KOWA........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(8) DAVID SMITH........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(9) ROBIN KING........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(10) BRAD WIKE........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(11) DAVID TYROLT........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(12) PAULA EISSFELDT........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(13) EDWARD ELLIOT MD........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(14) TIMOTHY D STONE JR........................................................................
EVP & ADMINI
 40.00
.......................0.00 		    X       417,423 0 9,580
(15) MICHAEL ZIA MD........................................................................
VICE PRES.
 40.00
.......................0.00 		    X       301,511 0 17,655
(16) JOHN RIDLEY........................................................................
SVP PROF. SE
 40.00
.......................2.00 		    X       253,586 0 17,981
(17) LINDA FAHEY........................................................................
VP/CHIEF NUR
 40.00
.......................0.00 		    X       250,843 0 4,686
Form 990 (2013)
Form 990 (2013)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) DEBBIE BRAGG........................................................................
SR. VP & CFO
 40.00
.......................3.00 		    X       219,001 0 4,195
(19) KEVIN HORATH........................................................................
VP HUMAN RES
 20.00
.......................20.00 		    X       140,299 0 16,918
(20) AL NAQVI........................................................................
EVP & CFO
 20.00
.......................30.00 		    X       38,373 0 0
(21) STEVEN SOBOL MD........................................................................
PHYSICIAN
 40.00
.......................   		        X   1,444,659 0 18,808
(22) MARVIN DERRICK MD........................................................................
PHYSICIAN
 40.00
.......................   		        X   859,835 0 18,808
(23) MOHAMMED HASNAIN MD........................................................................
PHYSICIAN
 40.00
.......................   		        X   859,200 0 18,808
(24) ROBERT KRAUS JR MD........................................................................
PHYSICIAN
 40.00
.......................   		        X   824,601 0 18,808
(25) JOHN WATERS MD........................................................................
PHYSICIAN
 40.00
.......................   		        X   818,519 0 9,580










1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 7,144,354   173,635
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet129
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
DECATUR EMERGENCY MEDICAL SERVICES334 W ELDORADODECATURIL62522 PHYSICIAN FEES 1,220,000
DENMAN LINEN SERVICES1801 N 43RDQUINCYIL62305 LINEN SERVICES 1,169,246
CONSOCIATE GROUPPO 1068DECATURIL62525 INSURANCE SERV 1,079,864
MIDWEST CREDIT306 W ELDORADO PO BOX 445DECATURIL62525 COLLECTIONS 993,521
EXECUTIVE HEALTH RESOURCEPO BOX 822688PHILADELPHIAPA19182 CLAIMS REVIEW 801,860
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet182
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e 2,289,819
f All other contributions, gifts, grants, and
similar amounts not included above1f 		1,284,746
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 3,574,565
Program Service RevenueAmt Business Code
2a INPATIENT, OUTPATIENT, & PHYS 900099 252,501,866 252,501,866    
b DECATUR DIGESTIVE DISEASE CTR 621990 298,154 298,154    
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 252,800,020
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 5,108,570   140,961 4,967,609
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents 840,727  
b Less: rental expenses    
c Rental income or (loss) 840,727  
d Net rental income or (loss).......MediumBullet 840,727   495,111 345,616
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 31,139,600 64,018
b Less: cost or other basis and sales expenses 27,040,702 74,479
c Gain or (loss) 4,098,898 -10,461
d Net gain or (loss)..........MediumBullet 4,088,437     4,088,437
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a 2,349,671
b Less: cost of goods sold ..b 1,221,164
c Net income or (loss) from sales of inventory..MediumBullet 1,128,507   1,128,507  
Miscellaneous Revenue Business Code
11a OTHER EXEMPT FUNCTION INC 900099 8,527,737 8,527,737    
b TAXABLE RELATED ENTITY INCOME 900099 1,205,164   1,205,164  
c WELLNESS & COSMETIC SERVICES 900099 817,241   817,241  
d All other revenue .... 885,976   885,976  
e Total. Add lines 11a–11d ...... MediumBullet 11,436,118
12 Total revenue. See Instructions......MediumBullet 278,976,944 261,327,757 4,672,960 9,401,662
Form 990 (2013)
Form 990 (2013)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 1,263,671 1,263,671
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 .... 2,835,597   2,835,597  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 4,092,652 4,092,652    
7 Other salaries and wages 102,876,083 86,773,343 16,102,740  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 1,591,558 1,342,438 249,120  
9 Other employee benefits ....... 13,550,370 11,429,390 2,120,980  
10 Payroll taxes ........... 6,872,900 5,797,115 1,075,785  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 987,458   987,458  
c Accounting ........... 1,008,228   1,008,228  
d Lobbying ........... 73,931   73,931  
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) ........ 23,649,777 11,742,501 11,907,276  
12 Advertising and promotion .... 903,055 548,802 354,253  
13 Office expenses ....... 48,317,284 45,196,318 3,120,966  
14 Information technology ...... 5,084,689 4,789,679 295,010  
15 Royalties .. 16,495 16,495    
16 Occupancy ........... 9,967,394 6,238,930 3,728,464  
17 Travel ............ 672,937 519,642 153,295  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 440,386 187,307 253,079  
20 Interest ........... 990,854 620,209 370,645  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 19,447,853 11,850,911 7,596,942  
23 Insurance .............. 3,468,141 978,372 2,489,769  
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 14,021,413 14,021,413    
b MISCELLANEOUS EXPENSE 4,239,568 2,087,256 2,152,312  
c
d
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 266,372,294 209,496,444 56,875,850 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2013)
Form 990 (2013)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 8,700 1 8,825
2 Savings and temporary cash investments ......... 24,054,347 2 19,528,191
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net ............. 37,962,067 4 36,616,836
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 ............. 2,000,000 7 15,800,678
8 Inventories for sale or use .............. 3,071,259 8 3,042,368
9 Prepaid expenses and deferred charges .......... 3,526,214 9 3,782,234
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 384,485,818
b Less: accumulated depreciation ..... 10b 282,935,414 110,268,550 10c 101,550,404
11 Investments—publicly traded securities .......... 200,205,996 11 180,621,387
12 Investments—other securities. See Part IV, line 11 ..... 696,017 12 942,947
13 Investments—program-related. See Part IV, line 11 .....   13  
14 Intangible assets ............... 1,042,705 14 1,042,705
15 Other assets. See Part IV, line 11 ........... 8,754,813 15 6,997,537
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 391,590,668 16 369,934,112
Liabilities 17 Accounts payable and accrued expenses ......... 39,514,372 17 37,506,418
18 Grants payable .................   18  
19 Deferred revenue ................ 139,553 19 826,526
20 Tax-exempt bond liabilities ............. 13,311,000 20 11,475,000
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.................... 27,183,813 25 29,200,858
26 Total liabilities. Add lines 17 through 25......... 80,148,738 26 79,008,802
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 260,167,522 27 238,706,571
28 Temporarily restricted net assets ........... 35,917,359 28 36,797,878
29 Permanently restricted net assets ........... 15,357,049 29 15,420,861
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 311,441,930 33 290,925,310
34 Total liabilities and net assets/fund balances ........ 391,590,668 34 369,934,112
Form 990 (2013)
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
278,976,944
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
266,372,294
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
12,604,650
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
311,441,930
5
Net unrealized gains (losses) on investments ...............
5
4,077,611
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-37,198,881
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
290,925,310
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2013)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


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

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
right arrow 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
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.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 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) right arrow (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) right arrow (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
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here.................................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 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) right arrow (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) right arrow (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
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 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:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Name of the organization
DECATUR MEMORIAL HOSPITAL
 
Employer identification number

37-0661199
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, 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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 2
Name of organization
DECATUR MEMORIAL HOSPITAL
  		Employer identification number

37-0661199
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, RESTRICTEDRESTRICTED

$RESTRICTED


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 3
Name of organization
DECATUR MEMORIAL HOSPITAL
  		Employer identification number

37-0661199
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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
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 (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Additional Data


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

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

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.SchCMd Bullet Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
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.

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

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

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

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










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2013

Schedule C (Form 990 or 990-EZ) 2013
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2010 (b) 2011 (c) 2012 (d) 2013 (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) 2013


Schedule C (Form 990 or 990-EZ) 2013
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
23,663
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
50,268
j
Total. Add lines 1c through 1i ...............................
73,931
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
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.
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) 2013

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions. SchDMd Bullet Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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 ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 15,357,049 14,608,812 12,369,414 11,963,360 10,910,741
b Contributions ........          
c Net investment earnings, gains, and losses 983,585 1,893,758 3,817,049 406,054 1,977,035
d Grants or scholarships ..... 294,026 366,193 504,333   75,407
e Other expenditures for facilities
and programs ........ 		625,747 779,328 1,073,318   849,009
f Administrative expenses ....          
g End of year balance ...... 15,420,861 15,357,049 14,608,812 12,369,414 11,963,360
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet100.000 %
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
Yes
 
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   1,337,264 1,337,264
b Buildings ................   181,320,824 114,088,124 67,232,700
c Leasehold improvements ............   2,280,366 20,154 2,260,212
d Equipment ................   191,013,290 163,242,626 27,770,664
e Other .................   8,534,074 5,584,510 2,949,564
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 101,550,404
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. 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.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
CAPITAL LEASE OBLIGATIONS 12,665,263
MALPRACTICE INSURANCE 7,562,325
DEFERRED TRUST 5,403,898
PENSION LIABILITY 1,971,940
FUTURE RENT PAYMENTS 1,001,399
RETIREE HEALTH PLAN 596,033
RESERVE FOR A/R NOT ON BOOKS  


Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 29,200,858
2. Liability for uncertain tax positions 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) 2013

Schedule D (Form 990) 2013
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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
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.
Return Reference Explanation
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.
SCHEDULE D, PAGE 3, PART X THE SYSTEM HAD NO UNCERTAIN POSITIONS IN INCOME TAX LIABILITIES OR EXPENSES.
Schedule D (Form 990) 2013

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    17,796,311   17,796,311 6.680 %
b Medicaid (from Worksheet 3,
column a) .... 		    32,394,463 14,545,688 17,848,775 6.700 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    50,190,774 14,545,688 35,645,086 13.380 %
Other Benefits
     417,338   417,338 0.160 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    993,604   993,604 0.370 %
g Subsidized health services
(from Worksheet 6) .. 		    1,247,973   1,247,973 0.470 %
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    14,600   14,600 0.010 %
j Total. Other Benefits ..     2,673,515   2,673,515 1.000 %
k Total. Add lines 7d and 7j .     52,864,289 14,545,688 38,318,601 14.390 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development     60,000   60,000 0.020 %
3 Community support     850   850  
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy     46,998   46,998 0.020 %
8 Workforce development            
9 Other     59,039   59,039 0.020 %
10 Total     166,887   166,887 0.060 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
3,814,998
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
3,804,137
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
78,033,955
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
71,874,042
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
6,159,913
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
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) 2013
Schedule H (Form 990) 2013
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, primary website address, and state license number 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 DECATUR MEMORIAL HOSPITAL
2300 N EDWARD ST
DECATUR,IL62526 		X X         X   ACUTE CARE & LONG TERM CARE  
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
DECATUR MEMORIAL HOSPITAL
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7 Yes  
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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: 200.000000000000%
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: 600.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.......... 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If "Yes," explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If "Yes," explain in Part VI.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference Explanation
FACILITY 1, DECATUR MEMORIAL HOSPITAL - 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 COMMUNITY'S 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, R.D., PH.D. - PROFESSOR, MILLIKIN UNIVERSITY PATRICK HOBAN - VICE PRESIDENT, ECONOMIC DEVELOPMENT CORPORATION JULIE AUBERT - ADMINISTRATOR, MACON COUNTY HEALTH DEPARTMENT DANA RAY, M.D. - PHYSICAN, CHIC CLINIC LEE HALL, PSY.D. - CLINICAL PSYCHOLOGIST, PSYCHOLOGY SPECIALISTS MICHAEL ZIA M.D. - VP OF QUALITY & MEDICAL AFFAIRS, DMH LINDA FAHEY R.N. - VP AND CHIEF NURSING EXECUTIVE, DMH KAY GOWDAR M.D. - 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.
FACILITY 1, DECATUR MEMORIAL HOSPITAL - PART V, LINE 5C THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND AT HTTP://WWW.DMHCARES.ORG/PATIENT/ASSESSMENT/COMMUNITYHEALTHNEEDSASSESSMENT20 13-2015.PDF
FACILITY 1, DECATUR MEMORIAL HOSPITAL - PART V, LINE 12I 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.
FACILITY 1, DECATUR MEMORIAL HOSPITAL - PART V, LINE 20D DMH COMPLIES WITH THE ILLINOIS HOSPITAL UNINSURED PATIENT DISCOUNT ACT AND 501(R) OF THE INTERNAL REVENUE CODE AS ENACTED BY SECTION 9007(A) 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) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section D. 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 DECATUR DIGESTIVE DISEASE CENTER
2 MEMORIAL DR PHYS PLAZA WEST
SUITE 102
DECATUR,IL62526 		AMBULATORY ENDOSCOPY CENTER
6 DMH CORPORATE HEALTH SERVICES
2122 NORTH 27TH ST
DECATUR,IL62526 		OUTPATIENT CLINIC
7 DMH HOME HEALTH CARE
3122 BRETTWOOD CIRCLE
DECATUR,IL62526 		HOME HEALTH AGENCY
8 SPORTS PERFORMANCE ENHANCEMENT CTR
2122 NORTH 27TH ST
DECATUR,IL62526 		PHYSICAL THERAPY
9 DMH HOSPICE
3122 BRETTWOOD CIRCLE
DECATUR,IL62526 		HOSPICE AGENCY
10
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.
Form and Line Reference Explanation
FACILITY 1, DECATUR MEMORIAL HOSPITAL - 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 COMMUNITY'S 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, R.D., PH.D. - PROFESSOR, MILLIKIN UNIVERSITY PATRICK HOBAN - VICE PRESIDENT, ECONOMIC DEVELOPMENT CORPORATION JULIE AUBERT - ADMINISTRATOR, MACON COUNTY HEALTH DEPARTMENT DANA RAY, M.D. - PHYSICAN, CHIC CLINIC LEE HALL, PSY.D. - CLINICAL PSYCHOLOGIST, PSYCHOLOGY SPECIALISTS MICHAEL ZIA M.D. - VP OF QUALITY & MEDICAL AFFAIRS, DMH LINDA FAHEY R.N. - VP AND CHIEF NURSING EXECUTIVE, DMH KAY GOWDAR M.D. - 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.
FACILITY 1, DECATUR MEMORIAL HOSPITAL - PART V, LINE 5C THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND AT HTTP://WWW.DMHCARES.ORG/PATIENT/ASSESSMENT/COMMUNITYHEALTHNEEDSASSESSMENT20 13-2015.PDF
FACILITY 1, DECATUR MEMORIAL HOSPITAL - PART V, LINE 12I 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.
FACILITY 1, DECATUR MEMORIAL HOSPITAL - PART V, LINE 20D DMH COMPLIES WITH THE ILLINOIS HOSPITAL UNINSURED PATIENT DISCOUNT ACT AND 501(R) OF THE INTERNAL REVENUE CODE AS ENACTED BY SECTION 9007(A) 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) 2013
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
DECATUR MEMORIAL HOSPITAL
 
Employer identification number
37-0661199
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) SIU DECATUR FAMILY PRACTICE CENTER
250 W KENWOOD
DECATUR,IL62526 		37-6005961 501C3 1,263,671       GENERAL SUPPORT






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
1
3
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) 2013

Schedule I (Form 990) 2013
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. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
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) 2013


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, line 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
DECATUR MEMORIAL HOSPITAL
 
Employer identification number

37-0661199
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)KENNETH SMITHMIERDIRECTOR/PRES & CEO (i)
(ii)		 714,350
  		 
  		2,154
  		3,825
  		13,983
  		734,312
  		 
 
(2)TIMOTHY D STONE JREVP & ADMINISTRATOR (i)
(ii)		 417,423
  		 
  		 
  		3,825
  		5,755
  		427,003
  		 
 
(3)MICHAEL ZIA MDVICE PRES. (i)
(ii)		 301,511
  		 
  		 
  		3,825
  		13,830
  		319,166
  		 
 
(4)JOHN RIDLEYSVP PROF. SERV. (i)
(ii)		 202,288
  		 
  		51,298
  		3,130
  		14,851
  		271,567
  		 
 
(5)LINDA FAHEYVP/CHIEF NURSE EXEC (i)
(ii)		 250,843
  		 
  		 
  		3,749
  		937
  		255,529
  		 
 
(6)DEBBIE BRAGGSR. VP & CFO (i)
(ii)		 219,001
  		 
  		 
  		3,300
  		895
  		223,196
  		 
 
(7)KEVIN HORATHVP HUMAN RESOURCES (i)
(ii)		 140,299
  		 
  		 
  		2,163
  		14,755
  		157,217
  		 
 
(8)STEVEN SOBOL MDPHYSICIAN (i)
(ii)		 995,471
  		449,188
  		 
  		3,825
  		14,983
  		1,463,467
  		 
 
(9)MARVIN DERRICK MDPHYSICIAN (i)
(ii)		 832,335
  		27,500
  		 
  		3,825
  		14,983
  		878,643
  		 
 
(10)MOHAMMED HASNAIN MDPHYSICIAN (i)
(ii)		 544,190
  		314,260
  		750
  		3,825
  		14,983
  		878,008
  		 
 
(11)ROBERT KRAUS JR MDPHYSICIAN (i)
(ii)		 618,301
  		197,700
  		8,600
  		3,825
  		14,983
  		843,409
  		 
 
(12)JOHN WATERS MDPHYSICIAN (i)
(ii)		 816,919
  		 
  		1,600
  		3,825
  		5,755
  		828,099
  		 
 
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
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.
Return Reference Explanation
SCHEDULE J, PAGE 1, PART I, LINE 1A DURING THE YEAR, DMH PAID FOR CHARTER TRAVEL IN ONE INSTANCE. DMH SHARED WITH ONE OTHER HOSPITAL THE COST OF A CHARTER PLANE HIRED TO PICK UP THEIR RESPECTIVE REPRESENTATIVES (IN DMH'S CASE, TIMOTHY STONE, JR.) 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. DMH PAID FOR AIRLINE TICKETS AND MEALS FOR ONE BUSINESS TRIP TAKEN BY MR. SMITHMIER, CEO, WHERE HE WAS ACCOMPANIED BY HIS SPOUSE. MR. SMITHMIER'S W-2 INCLUDED 2,154 RELATED TO HIS SPOUSE'S SHARE OF COST OF ATTENDING THE TRIP. DMH PAID HOUSING EXPENSES FOR THE FIRST SEVEN MONTHS OF EMPLOYMENT OF MR. NAQVI, EVP & CFO. MR. NAQVI'S 2013 W-2 INCLUDED 6,696 RELATED TO HIS HOUSING EXPENSES. AS A CONDITION OF MR. RIDLEY'S PROMOTION TO OFFICER, MR. RIDLEY AGREED TO OBTAIN AN ADVANCED DEGREE. IN EXCHANGE FOR MR. RIDLEY'S AGREEMENT, DMH AGREED TO PAY TUITION PLUS TAXES RELATED TO THE TUITION ON BEHALF OF MR. RIDLEY. MR. RIDLEY'S 2013 W-2 INCLUDED 51,298 OF GROSS UP PAYMENTS RELATED TO HIS TUITION ASSISTANCE. DMH DID EXEMPT 5,250 OF THE TUITION PAID ON MR. RIDLEY'S BEHALF BASED ON IRS ALLOWED EXEMPTIONS.
Schedule J (Form 990) 2013

Additional Data


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Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
SchKMediumBulletInformation about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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
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 . . . . . . . . . . . . . . 2,355,000 1,875,000 1,651,875 1,003,125
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) 2013
Schedule K (Form 990) 2013
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 . . SchKMediumBullet        
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet        
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? . . . . . . . . . . . . .                
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 the hedge terminated? . . . . . .                
Schedule K (Form 990) 2013
Schedule K (Form 990) 2013
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
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?                
Part VI
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
SCHEDULE K - ADDITIONAL INFORMATION 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 E-FILE 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) 2013

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
MediumBulletInformation about Schedule L (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
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 (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





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

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2013
Schedule L (Form 990 or 990-EZ) 2013
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) HICKORY POINT BANK SEE PART V 2,151 INTEREST INCOME   No
(2) DUNN COMPANY SEE PART V 232,664 ASPHALT SERVICES   No
(3) CANCER CARE SPECIALISTS OF CENT IL SEE PART V 160,576 MED SERVICES   No
(4) CANCER CARE SPECIALISTS OF CENT IL SEE PART V 49,694 EMR SUPPORT REV   No
(5) BAKERS DOZEN LLC SEE PART V 594,930 OFFICE SPACE RENTAL   No
(6) PRAIRIE ONCOLOGY MANAGEMENT SERVICE SEE PART V 154,399 SUPPLY SALES   No
(7) ROY MOSSER SEE PART V 1,693,555 OFFICE SPACE RENTAL   No
(8) HICKORY POINT BANK SEE PART V 494,676 BANK FEES, INTEREST   No
(9) FIRST BUSEY CORP SUBSIDIARIES SEE PART V 201,124 BANK AND BOND FEES   No
(10) FIRST BUSEY CORP SUBSIDIARIES SEE PART V 6,316 INTEREST INCOME   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
SCHEDULE L, PART V PART IV, LINES 1(B)& 8(B): DIRECTOR KENNETH SMITHMIER IS ON THE HICKORY POINT BANK BOARD OF DIRECTORS. PART IV, LINE 2(B): DIRECTOR DAVID TYROLT OWNS DUNN COMPANY. PART IV, LINES 3(B), 4(B), 5(B), 6(B): DIRECTOR EDWARD ELLIOTT IS AN OWNER OF CANCER CARE SPECIALISTS OF CENTRAL ILLINOIS, BAKER'S DOZEN, LLC., AND PRAIRIE ONCOLOGY MANAGEMENT SERVICES. PART IV, LINE 7(B): ROY MOSSER IS A DIRECTOR OF DMH. PART IV, LINE 9(B)& 10(B): 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.
Schedule L (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

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

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet 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
DECATUR MEMORIAL HOSPITAL
 
Employer identification number

37-0661199
Return Reference Explanation
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.
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; HEART, LUNG, & STROKE SCREENINGS; CHRONIC OBSTRUCTIVE PULMONARY DISEASE; OBESITY; DIABETES; INDIGENT OUTPATIENT LONGITUDINAL CARE; ONCOLOGY SCREENINGS; WOMEN AND CHILDREN'S HEALTH; AND SENIOR HEALTH AND WELLNESS. 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.
FORM 990, PAGE 6, PART VI, LINE 2 DAVID TYROLT ROY MOSSER, JR. DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DAVID TYROLT TIMOTHY STONE, JR. DIRECTOR OFFICER BUSINESS RELATIONSHIP DAVID TYROLT JOHN FUNK DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DAVID TYROLT THOMAS KOWA DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DAVID TYROLT KENNETH SMITHMIER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DAVID TYROLT JACK O'RILEY DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DAVID TYROLT JOHN RIDLEY DIRECTOR OFFICER BUSINESS RELATIONSHIP ROY MOSSER, JR. DAVID TYROLT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP ROY MOSSER, JR. TIMOTHY STONE, JR. DIRECTOR OFFICER BUSINESS RELATIONSHIP ROY MOSSER, JR. JOHN FUNK DIRECTOR DIRECTOR BUSINESS RELATIONSHIP ROY MOSSER, JR. THOMAS KOWA DIRECTOR DIRECTOR BUSINESS RELATIONSHIP ROY MOSSER, JR. KENNETH SMITHMIER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP ROY MOSSER, JR. EDWARD ELLIOT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP PAULA EISSFELDT KENNETH SMITHMIER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JOHN FUNK DAVID TYROLT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JOHN FUNK ROY MOSSER, JR. DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JOHN FUNK TIMOTHY STONE, JR. DIRECTOR OFFICER BUSINESS RELATIONSHIP JOHN FUNK THOMAS KOWA DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JOHN FUNK KENNETH SMITHMIER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JOHN FUNK EDWARD ELLIOT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP THOMAS KOWA DAVID TYROLT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP THOMAS KOWA ROY MOSSER, JR. DIRECTOR DIRECTOR BUSINESS RELATIONSHIP THOMAS KOWA TIMOTHY STONE, JR. DIRECTOR OFFICER BUSINESS RELATIONSHIP THOMAS KOWA JOHN FUNK DIRECTOR DIRECTOR BUSINESS RELATIONSHIP THOMAS KOWA KENNETH SMITHMIER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP TOMAS KOWA EDWARD ELLIOT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KENNETH SMITHMIER DAVID TYROLT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KENNETH SMITHMIER ROY MOSSER, JR. DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KENNETH SMITHMIER PAULA EISSFELDT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KENNETH SMITHMIER JOHN FUNK DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KENNETH SMITHMIER THOMAS KOWA DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KENNETH SMITHMIER ROBIN KING DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KENNETH SMITHMIER EDWARD ELLIOT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP EDWARD ELLIOT KENNETH SMITHMIER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP EDWARD ELLIOT JOHN FUNK DIRECTOR DIRECTOR BUSINESS RELATIONSHIP EDWARD ELLIOT THOMAS KOWA DIRECTOR DIRECTOR BUSINESS RELATIONSHIP EDWARD ELLIOT ROY MOSSER, JR. DIRECTOR DIRECTOR BUSINESS RELATIONSHIP ROBIN KING KENNETH SMITHMIER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JOHN RIDLEY DAVID TYROLT OFFICER DIRECTOR BUSINESS RELATIONSHIP JACK O'RILEY DAVID TYROLT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP TIMOTHY STONE, JR. JOHN FUNK OFFICER DIRECTOR BUSINESS RELATIONSHIP TIMOTHY STONE, JR. ROY MOSSER, JR. OFFICER DIRECTOR BUSINESS RELATIONSHIP TIMOTHY STONE, JR. THOMAS KOWA OFFICER DIRECTOR BUSINESS RELATIONSHIP TIMOTHY STONE, JR. EDWARD ELLIOTT, MD OFFICER DIRECTOR BUSINESS RELATIONSHIP KENNETH SMITHMIER TIMOTHY STONE, JR. DIRECTOR OFFICER BUSINESS RELATIONSHIP TIMOTHY STONE, JR. DAVID TYROLT OFFICER DIRECTOR BUSINESS RELATIONSHIP TIMOTHY STONE, JR. KENNETH SMITHMIER OFFICER DIRECTOR BUSINESS RELATIONSHIP EDWARD ELLIOTT, MD TIMOTHY STONE, JR. DIRECTOR OFFICER BUSINESS REALTIONSHIP
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.
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. ALL DIRECTORS OF ILLINOIS HEALTH AND SCIENCE ARE ALSO DIRECTORS OF DMH.
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.
FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 AND RELATED SCHEDULES ARE REVIEWED BY THE ACCOUNTING DEPARTMENT OF THE HOSPITAL AND BY THE CHIEF FINANCIAL OFFICER PRIOR TO FILING. FURTHER, A COPY OF THE FORM 990, ALONG WITH AN EXPLANATORY NOTE, IS PROVIDED FOR REVIEW TO THE BOARD VIA AN INTRANET SITE. THE FORM 990 IS ALSO REVIEWED AND DISCUSSED AT A REGULARLY SCHEDULED BOARD MEETING PRIOR TO FILING.
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.
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 (FORMER 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.
FORM 990, PAGE 6, PART VI, LINE 15B SEE RESPONSE TO FORM 990, PART VI.B, LINE 15A ABOVE.
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.
FORM 990, PART XI, LINE 9 BOOK/TAX DIFF. IN INC. FRM PARTNERSHIPS (INCREASE) 185,408 CHANGE IN VAL. OF ASSETS HELD IN TRUST (INCREASE) 552,474 TRANSFER OF CAPITAL FROM AFFILIATE (INCREASE) 39,903 TRANSFER OF CAPITAL FROM AFFILIATE (DECREASE) 36,831,437 TRANSFER OF CAPITAL FROM AFFILIATE (DECREASE) 295,000 CHANGE IN MINIMUM PENSION LIABILITY (DECREASE) 850,229 THE NET RESULT OF ALL OF THESE OTHER CHANGES IN NET ASSETS IS A DECREASE OF 37,198,881.
FORM 990, PART XII DECATUR MEMORIAL HOSPITAL WAS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF ILLINOIS HEALTH AND SCIENCE AND AFFILIATED ORGANIZATIONS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2013
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" on 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" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled 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 NA
 
 
No








For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



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

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




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



 		(k)
Percentage
ownership
Yes No Yes No
(1) DECATUR DIGESTIVE DISEASE CENTER

2 MEMORIAL DRIVE
SUITE 102
DECATUR,IL62526
16-1678954 		ENDOSCOPY IL DMH
  		RELATED 298,457 180,891   No     No 50.000 %












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) DMH WORLDWIDE LTD

2300 N EDWARD ST
DECATUR,IL62526
27-1901157 		RADIOPHARM IL N/A
         Yes  












Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
Yes
 
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) DECATUR MEMORIAL FOUNDATION

 K 1,495,266 CASH PAYMENT
(2) DECATUR MEMORIAL FOUNDATION

 O 153,893 CASH PAYMENT
(3) DECATUR DIGESTIVE DISEASE CENTER

 O 494,402 CASH PAYMENT
(4) DMH WORLDWIDE LTD

 B 295,000 CASH TRANSFER
(5) DECATUR DIGESTIVE DISEASE CTR LLC

 S 365,000 CASH TRANSFER
(6) HEARTLAND RISK MANAGEMENT

 M 1,914,000 CASH PAYMENT
(7) ILLINOIS HEALTH AND SCIENCE

 B 36,831,437 CASH & SECURITIES
(8) DMH WORLDWIDE LTD

 A 773,703 CASH PAYMENT
(9) DMH WORLDWIDE LTD

 O 1,465,933 CASH PAYMENT
(10) DMH WORLDWIDE LTD

 D 7,457,412 LOAN AMOUNT
(11) DMH WORLDWIDE LTD

 J 3,081,596 CASH PAYMENT
(12) DMH WORLDWIDE LTD

 H 1,007,160 CASH PAYMENT
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

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




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






























Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2013
Additional Data


Software ID:  
Software Version: