TY 2017 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) TIMOTHY D STONE JR...................................................................... DIRECTOR/PRE	30.00 ................. 12.50	X	X	48,200	489,455	9,985
(2) JACK O'RILEY...................................................................... DIRECTOR	2.00 .................	X		0	0	0
(3) WILLIAM MACLEOD...................................................................... DIRECTOR	2.00 .................	X		0	0	0
(4) AIMEE FYKE...................................................................... DIRECTOR	2.00 .................	X		0	0	0
(5) JONATHAN T LOCKE MD...................................................................... DIRECTOR	2.00 .................	X		0	0	0
(6) THOMAS BAYER...................................................................... DIRECTOR	2.00 .................	X		0	0	0
(7) KELLY EVANS...................................................................... DIRECTOR	2.00 .................	X		0	0	0
(8) LARRY ALTENBAUMER...................................................................... 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) GUSSIE REED...................................................................... DIRECTOR	2.00 .................	X		0	0	0
(12) JAMES STECK...................................................................... DIRECTOR	2.00 .................	X		0	0	0
(13) DENNIS WHALEN...................................................................... DIRECTOR	2.00 .................	X		0	0	0
(14) JOHN WADDOCK...................................................................... DIRECTOR	2.00 .................	X		0	0	0
(15) EDWARD ELLIOTT MD...................................................................... DIRECTOR	2.00 .................	X		0	0	0
(16) ANTHONY RISPOLI...................................................................... EVP & CFO	40.00 ................. 2.00		X	397,278	0	0
(17) DAVID BAUMBERGER MD...................................................................... VP CMO	40.00 ................. 0.20		X	393,041	0	18,423

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(18) MARK BURMESTER........................................................................ SVP STRATEGY	40.00 .......................0.00	X		353,833	0	25,049
(19) LINDA FAHEY........................................................................ SVP COO	40.00 .......................0.00	X		286,219	0	5,759
(20) KATHERINE ANDERSON........................................................................ VP LEGAL AFF	30.00 .......................25.00	X		28,979	222,202	8,606
(21) JOHN RIDLEY........................................................................ VP PROF SERV	40.00 .......................0.00	X		234,931	0	22,994
(22) ROBYN REISING........................................................................ VP CNO	40.00 .......................0.00	X		221,070	0	4,023
(23) DEBORAH L BRAGG........................................................................ SVP FINANCE	42.00 .......................3.00	X		220,231	0	4,842
(24) KEVIN HORATH........................................................................ VP HUMAN RES	20.00 .......................20.00	X		204,768	0	4,879
(25) DAVID SAMPLES........................................................................ VP SUPPORT S	40.00 .......................0.00	X		153,738	0	21,382
(26) JIM BLACKWELL........................................................................ VP INFO TECH	40.00 .......................0.00	X		137,857	0	13,782
(27) JULIE BRILLEY........................................................................ VP PHYSICIAN	40.00 .......................0.00	X		116,518	0	19,368
(28) GREG PAGLIUZZA........................................................................ SVP & CFO	40.00 .......................2.00	X		29,891	0	0
(29) MIKE EDWARDS........................................................................ VP REV CYCLE	40.00 .......................0.00	X		10,673	0	5,528
(30) LARRY HEGLAND MD........................................................................ CMO	40.00 .......................0.00	X		0	0	0
(31) STEVEN SOBOL MD........................................................................ PHYSICIAN	40.00 .......................0.00		X	1,316,403	0	13,599
(32) MOHAMMED HASNAIN MD........................................................................ PHYSICIAN	40.00 .......................0.00		X	1,065,267	0	23,677
(33) MARVIN DERRICK MD........................................................................ PHYSICIAN	40.00 .......................0.00		X	1,024,994	0	22,677
(34) JOHN WATERS MD........................................................................ PHYSICIAN	40.00 .......................0.00		X	821,336	0	12,565
(35) MADHU JYOTHANAGARAM MD........................................................................ PHYSICIAN	40.00 .......................0.00		X	769,019	0	23,677

(A) Name and business address	(B) Description of services	(C) Compensation
POINTCORE 800 NE GLEN OAK PEORIA,IL61603	COMPUTER SUPP	2,969,747
WEATHERBY LOCUMS INC PO BOX 972633 DALLAS,TX75397	PHYSICIAN FEES	2,178,129
SURGICAL SPECIALISTS OF CENTRAL IL ONE MEMORIAL DR SUITE 300 DECATUR,IL62526	PHYSICIAN FEES	1,447,110
CONSOCIATE GROUP PO 1068 DECATUR,IL62525	INSURANCE SERV	1,368,581
SHEARWATER HEALTH 20 BURTON HILLS BLVD SUITE 400 NASHVILLE,TN372156177	STAFFING	1,325,865
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 197

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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 12, check only one box.)

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

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

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

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

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

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

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

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

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

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

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 VI.)..
11	Total support. Add lines 7 through 10

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

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

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

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

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

DECATUR MEMORIAL HOSPITAL

Employer identification number

37-0661199

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

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

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization DECATUR MEMORIAL HOSPITAL

Part I Contributors	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
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization DECATUR MEMORIAL HOSPITAL			Employer identification number 37-0661199
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

DECATUR MEMORIAL HOSPITAL

Employer identification number

37-0661199

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

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

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

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2016	(b) 2017	(c) 2018	(d) 2019	(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) 2019

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

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

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

Yes

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

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

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

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

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

Yes

38,202

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

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

Yes

51,189

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

89,391

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

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

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

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

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

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

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

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

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

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

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

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

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

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

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

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

Part IV

Supplemental Information

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, lines 1 and 2 (see instructions), 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) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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" on Form 990, Part IV, line 6.

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

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

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

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

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

Yes No

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

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

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

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB 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)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

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

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

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

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

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

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

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	14,996,073	14,956,170	15,056,012	15,420,861	15,357,049
b	Contributions ...
c	Net investment earnings, gains, and losses	-418,573	860,660	-99,842	-364,849	983,585
d	Grants or scholarships ...		262,374			294,026
e	Other expenditures for facilities and programs ...		558,383			625,747
f	Administrative expenses ....
g	End of year balance ......	14,577,500	14,996,073	14,956,170	15,056,012	15,420,861

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Term endowment SchDMd Bullet

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

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

Yes

(i) Unrelated organizations .................

3a(i)

Yes

(ii) Related organizations .................

3a(ii)

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

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on 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 .....	1,379,068		1,379,068
b	Buildings ....	196,397,785	140,097,740	56,300,045
c	Leasehold improvements	3,178,994	39,644	3,139,350
d	Equipment ....	239,640,550	203,904,612	35,735,938
e	Other .....	9,818,376	7,448,625	2,369,751
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				98,924,152

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on 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........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on 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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)INSURANCE RECEIVABLE				10,560,169
(2)OTHER				8,578,323
(3)PHYSICIANS RECEIVABLE				1,286,170
(4)NURSE ASSISTANCE PROGRAM				190,172
(5)DUE FROM AFFILIATES				55,416
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				20,670,250

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	42,287,963
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) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on 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 (losses) 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' on 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. THE ENDOWMENT FUNDS USED FOR THE MAKING OF SUCH EXPENDITURES DID NOT GENERATE POSITIVE INCOME FOR THE FISCAL YEAR. THEREFORE, NO FUNDS WERE RELEASED FOR SUCH EXPENDITURES FROM THE ENDOWMENT DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2018.
SCHEDULE D, PAGE 3, PART X	THE SYSTEM HAD NO MATERIAL UNCERTAIN POSITIONS IN INCOME TAX LIABILITIES OR EXPENSES.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

DECATUR MEMORIAL HOSPITAL

Employer identification number

37-0661199

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other 600.0000000000 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

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

Yes

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	13,203,613		13,203,613	3.960 %
b	Medicaid (from Worksheet 3, column a) . . . . .	43,881,295	37,470,633	6,410,662	1.920 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	57,084,908	37,470,633	19,614,275	5.880 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	360,355		360,355	0.110 %
f	Health professions education (from Worksheet 5) . . .	3,868,273		3,868,273	1.160 %
g	Subsidized health services (from Worksheet 6) . . . .	1,678,696		1,678,696	0.500 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	17,225		17,225	0.010 %
j	Total. Other Benefits . .	5,924,549		5,924,549	1.780 %
k	Total. Add lines 7d and 7j .	63,009,457	37,470,633	25,538,824	7.660 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	60,000	60,000	0.020 %
3	Community support	2,250	2,250
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	60,873	60,873	0.010 %
8	Workforce development
9	Other
10	Total	123,123	123,123	0.030 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

5,562,806

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. ......

1,313,723

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

90,828,870

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

95,812,765

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

-4,983,895

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

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?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)					Other (describe)
1	DECATUR MEMORIAL HOSPITAL 2300 N EDWARD ST DECATUR,IL62526 WWW.DMHCARES.COM ILLINOIS 0000471	X	X	X	ACUTE CARE & LONG TERM CARE

Schedule H (Form 990) 2019

Page 4

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 letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

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 12......................

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

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 Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

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

Yes

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

Hospital facility’s website (list url): WWW.DMHCARES.COM (SEE SECTION C)

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, 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) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	DECATUR MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 600.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE SECTION C

The FAP application form was widely available on a website (list url):

SEE SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE SECTION C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	DECATUR MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized 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?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

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

	DECATUR MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
FACILITY 1, DECATUR MEMORIAL HOSPITAL - PART V, LINE 3E	ADDRESSING COMMUNITY HEALTH NEEDS THE FOLLOWING STRATEGIES HAVE BEEN DEVELOPED TO ADDRESS THE IDENTIFIED TOP THREE HEALTH NEEDS OF THE COMMUNITY. 1.ACCESS TO PRIMARY CARE PHYSICIANS ACCESS TO PRIMARY CARE PHYSICIANS IS VITAL TO OUR COMMUNITY MEMBERS. PRIMARY CARE PHYSICIANS ARE GENERALLY THE ENTRYWAY INTO THE HEALTHCARE SYSTEM. THIS LEADS TO PREVENTION OF DISEASE AND DISABILITY, DETECTION AND TREATMENT OF HEALTH CONDITIONS, BETTER QUALITY OF LIFE, PREVENTABLE DEATH AND A GREATER LIFE EXPECTANCY. DMH ACTIVELY WORKS TO INCREASE ACCESS TO PRIMARY CARE PHYSICIANS THROUGH RECRUITMENT AND STRONG COLLABORATIVE RELATIONSHIPS. RECRUITMENT EFFORT: ..ACTIVITY: DMH AND THE DMH MEDICAL GROUP WILL PROACTIVELY RECRUIT PRIMARY CARE PHYSICIANS AND ADVANCED PRACTITIONER PROVIDERS (IE. NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS) TO JOIN THE DMH MEDICAL GROUP. ..GOAL: THE DMH MEDICAL GROUP WILL RECRUIT 2-3 ADDITIONAL PRIMARY CARE PROVIDERS TO THE SERVICE AREA BY 2021. PRIMARY CARE PROVIDERS MAY INCLUDE INTERNAL MEDICINE, FAMILY MEDICINE, PEDIATRICS AND/OR OB/GYN PHYSICIANS, AS WELL AS NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS. COLLABORATIVE EFFORT: ..ACTIVITY: DMH AND THE DMH MEDICAL GROUP WILL CONTINUE TO COLLABORATE WITH LOCAL AND REGIONAL HEALTHCARE ORGANIZATIONS TO IMPROVE PRIMARY CARE ACCESS FOR ALL AGE GROUPS THROUGHOUT DMH'S PRIMARY AND SECONDARY SERVICE AREAS. ..GOALS: 1. PARTNER WITH SIU SCHOOL OF MEDICINE IN EXPANDING DMH'S RURAL PRIMARY CARE CLINIC HOURS OF OPERATIONS AND SERVICES IN ARTHUR, SHELBYVILLE, MONTICELLO AND SULLIVAN. 2. CONTINUE TO PARTNER WITH THE TWO EXISTING FEDERALLY QUALIFIED HEALTH CENTERS (FQHC) IN THE PRIMARY SERVICE AREA, CROSSING HEALTHCARE FQHC AND SIU SCHOOL OF MEDICINE'S FQHC, TO INCREASE ON-CAMPUS PATIENT VISIT VOLUMES BY 3% - 5% 2021. 3. DMH WILL PARTNER WITH SIU SCHOOL OF MEDICINE AND SPRINGFIELD CLINIC IN ESTABLISHING A COMPREHENSIVE REGIONAL DIABETES CENTER, STAFFED WITH ENDOCRINOLOGISTS, DIABETIC EDUCATORS, PHARMACISTS AND NURSE PRACTITIONERS. DIABETES CENTER WILL BE OPEN IN LATE 2019/EARLY 2020. 2. ACCESS TO MEDICAL SPECIALISTS IN AN EFFORT TO MAINTAIN AND GROW APPROPRIATE HEALTHCARE SERVICES, DMH CONTINUES TO RECRUIT PROVIDERS IN A VARIETY OF SPECIALTIES AND COLLABORATES WITH OTHER HEALTHCARE ORGANIZATIONS TO INCREASE CARE OPTIONS FOR THE COMMUNITY. DMH FULLY UNDERSTANDS AND SUPPORTS THE NEED TO OFFER CARE LOCALLY. DMH HAS INVESTED IN SPECIALTY SERVICES TO ENSURE THE AVAILABILITY OF HIGH QUALITY CARE CLOSE TO HOME FOR ITS PATIENTS. WITH A MEDICAL STAFF OF NEARLY 350 PROVIDERS, DMH OFFERS 45+ SPECIALTIES. ..ACTION: DMH WILL CONTINUE TO PROVIDE A COMPREHENSIVE CONTINUUM OF MEDICAL SPECIALTY SERVICES TO MEET THE GROWING HEALTHCARE NEEDS OF THE COMMUNITIES SERVED. ADDITIONALLY, DMH WILL COLLABORATE WITH OTHER REGIONAL HEALTHCARE PROVIDERS TO ENSURE ACCESS TO SPECIALTY SERVICES WITHIN THE PRIMARY SERVICE AREA. ..GOALS: 1. DMH WILL INCREASE MEDICAL SUB-SPECIALTY SERVICES ACCESS THROUGH PHYSICIAN RECRUITMENT EFFORTS, EXPANDING OFFICE HOURS FOR CERTAIN SUB- SPECIALTIES, COLLABORATION WITH OTHER REGIONAL HEALTHCARE PROVIDERS, AND/OR IMPLEMENTING VIRTUAL TECHNOLOGY HEALTHCARE APPLICATIONS, (I.E. TELEHEALTH, VIRTUAL HEALTH VISITS, E-VISITS). 2. INCREASE SPECIALTY VISITS BY 10% BY 2021. 3. ACCESS TO MENTAL HEALTH PROVIDERS AND SERVICES ON OCTOBER 1, 2015 DMH OPENED A 20-BED GERIATRIC PSYCHIATRY UNIT. WITH A MISSION IS TO IMPROVE THE MENTAL HEALTH OF INDIVIDUALS AGES 55 AND OLDER IN CENTRAL ILLINOIS, THE UNIT PROVIDES QUALITY MENTAL HEALTH SERVICES WITH STAFF WHO ARE EDUCATED ON THE MOST CURRENT TREATMENT INTERVENTIONS FOR BOTH PATIENTS AND THEIR FAMILIES. THE DIRECT ADMISSION PROCESS PREVENTS PATIENTS FROM EXPERIENCING LONG WAIT TIMES IN EMERGENCY ROOMS WHEN SUFFERING FROM CONFUSION, DEPRESSION OR OTHER FORMS OF MENTAL ILLNESS. THE UNIT'S STAFF WORK WITH A TEAM OF EXPERTS COMPOSED OF PSYCHIATRISTS, HOSPITALISTS, MEDICAL SPECIALISTS, NUTRITIONISTS, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPISTS TO PROVIDE A MULTIDISCIPLINARY TEAM APPROACH. THE UNIT IS STAFFED 24 HOURS SEVEN DAYS A WEEK WITH REGISTERED NURSES. TWO LICENSED SOCIAL WORKERS AND A CERTIFIED RECREATIONAL THERAPIST ARE ALSO ON STAFF. DISCHARGED PATIENTS HAVE THE OPPORTUNITY TO ATTEND DMH'S INTENSIVE OUTPATIENT PROGRAM FOR CONTINUED CARE. ..ACTION: DMH WILL PROVIDE SPECIFIC EDUCATIONAL INFORMATION TO AREA PROVIDERS ON MENTAL HEALTH ISSUES IMPACTING SENIORS AGE 55 AND OLDER AND HOW PROVIDERS CAN EASILY MAKE A REFERRAL TO THE PROGRAM. ALL ASSESSMENTS ARE FREE REGARDLESS IF THE PATIENT IS ADMITTED TO THE PROGRAM. TYPICALLY, INDIVIDUALS WILL ACTIVELY PARTICIPATE IN GROUP THERAPY SESSION FOR 3-6 MONTHS DEPENDING ON INDIVIDUAL NEEDS. ALL PATIENTS IN THE PROGRAM ARE SEEN FOR MEDICATION MANAGEMENT BY A PSYCHIATRIST ON A MONTHLY BASIS. ..GOALS: 1. INCREASE AWARENESS OF THE INTENSIVE OUTPATIENT PROGRAM AND PROVIDE BOTH MORNING AND AFTERNOON GROUP SESSIONS. 2. CONSISTENTLY RUN AT 80% CAPACITY 3. HIRE ADDITIONAL PROVIDERS TO PROVIDE MEDICATION MANAGEMENT TO DISCHARGED PATIENTS IN AREA NURSING HOMES.
FACILITY 1, DECATUR MEMORIAL HOSPITAL - PART V, LINE 5	THE HOSPITAL AND MACON COUNTY HEALTH DEPARTMENT 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. DARIN BUTTZ - DIRECTOR, HEALTH AND WELLNESS JOHN RIDLEY - EXECUTIVE VICE PRESIDENT AND CHIEF OPERATING OFFICER JULIE BRILLEY - ADMINISTRATIVE DIRECTOR, MEDICAL STAFF MIKE CASSELL - DIRECTOR OF MARKETING MARSHA CORDTS - DIRECTOR OF SURGERY CENTER DON HENDRIAN - DECISION SUPPORT ANALYST BETTY HUGHES - EXECUTIVE DIRECTOR OF DMH MEDICAL GROUP CAROL PEARSON - PATIENT CENTERED MEDICAL HOME COORDINATOR FRANCES SPERRY - ANALYTICS AND PERFORMANCE MANAGER PAIGE TOTH - DIRECTOR OF LEGAL AFFAIRS REV. BROHARD - EXECUTIVE DIRECTOR, THE GOOD SMARITAN INN SIGNE KIMMEL - DECATUR MEMORIAL HOSPITAL JERRY BAUER - ASSISTANT CITY MANAGER, CITY OF DECATUR TANYA ANDRICKS - EXECUTIVE DIRECTOR, CROSSING HEALTHCARE DANA COIT - DIRECTOR, EVERGREEN SENIOR LIVING SHELITH HANSBRO - WARDEN, DECATUR CORRECTIONAL CENTER BRUCE JEFFERY - EXECUTIVE DIRECTOR, BOYS AND GIRLS CLUB BILL CLEVENGER - EXECUTIVE DIRECTOR, DECATUR PARK DISTRICT JONATAN LOCKE, MD - MEDICAL STAFF PRESIDENT, DMH JOHN BRADLEY, MD - SIU SCHOOL OF MEDICINE LISA MCGREGORY - EXECUTIVE DIRECTOR OF PUBLIC INFORMATION, RICHLAND COMMUNITY COLLEGE JULIE MOORE - MAYOR, CITY OF DECATUR WOLE ADEOYE - PRESIDENT, VICTORY PHARMACY LINDA REED-THOMPSON, SOCIAL SERVICES DIRECTOR, SALVATION ARMY KIM WOLPERT - ONOCOLOGY SERVICE LINE LEADER JIM GETZ - LIEUTENANT, DECATUR POLICE DEPARTMENT TIMOTHY STONE, JR - PRESIDENT AND CEO, DMH
FACILITY 1, DECATUR MEMORIAL HOSPITAL - PART V, LINE 6B	MACON COUNTY HEALTH DEPARTMENT
FACILITY 1, DECATUR MEMORIAL HOSPITAL - PART V, LINE 7D	THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND AT: HTTPS://WWW.DMHCARES.COM/PUBLIC-INFORMATION/QUALITY-DATA/COMMUNITY-HEALTH- NEEDS-ASSESSMENT/ SCHEDULE H, PART V, SECTION B, LINE 10A: THE COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION CAN BE FOUND AT: HTTPS://WWW.DMHCARES.COM/PUBLIC-INFORMATION/QUALITY-DATA/COMMUNITY-HEALTH- NEEDS-ASSESSMENT-IMPLEMENTATION-PLAN/ SCHEDULE H, PART V, SECTION B, LINE 16A: THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY CAN BE FOUND AT: HTTPS://WWW.DMHCARES.COM/PATIENT-AND-VISITOR-INFORMATION/FINANCIAL- ASSISTANCE/SUMMARY-FINANCIAL-ASSISTANCE-POLICY/ THEN SEE FINANCIAL ASSISTANCE POLICY PDF LINE 16B: THE HOSPITAL'S FINANCIAL ASSISTANCE APPLICATION FORM CAN BE FOUND AT: HTTPS://WWW.DMHCARES.COM/PATIENT-AND-VISITOR-INFORMATION/FINANCIAL- ASSISTANCE/SUMMARY-FINANCIAL-ASSISTANCE-POLICY/ THEN SEE FINANCIAL ASSISTANCE APPLICATION LINK TO PDF LINE 16C: THE HOSPITAL'S PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY CAN BE FOUND AT: HTTPS://WWW.DMHCARES.COM/PATIENT-AND-VISITOR-INFORMATION/FINANCIAL- ASSISTANCE/SUMMARY-FINANCIAL-ASSISTANCE-POLICY/
FACILITY 1, DECATUR MEMORIAL HOSPITAL - PART V, LINE 11	ADDRESSING COMMUNITY HEALTH NEEDS THE FOLLOWING STRATEGIES HAVE BEEN DEVELOPED TO ADDRESS THE IDENTIFIED TOP THREE HEALTH NEEDS OF THE COMMUNITY. 1.ACCESS TO PRIMARY CARE PHYSICIANS ACCESS TO PRIMARY CARE PHYSICIANS IS VITAL TO OUR COMMUNITY MEMBERS. PRIMARY CARE PHYSICIANS ARE GENERALLY THE ENTRYWAY INTO THE HEALTHCARE SYSTEM. THIS LEADS TO PREVENTION OF DISEASE AND DISABILITY, DETECTION AND TREATMENT OF HEALTH CONDITIONS, BETTER QUALITY OF LIFE, PREVENTABLE DEATH AND A GREATER LIFE EXPECTANCY. DMH ACTIVELY WORKS TO INCREASE ACCESS TO PRIMARY CARE PHYSICIANS THROUGH RECRUITMENT AND STRONG COLLABORATIVE RELATIONSHIPS. RECRUITMENT EFFORT: ..ACTIVITY: DMH AND THE DMH MEDICAL GROUP WILL PROACTIVELY RECRUIT PRIMARY CARE PHYSICIANS AND ADVANCED PRACTITIONER PROVIDERS (IE. NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS) TO JOIN THE DMH MEDICAL GROUP. ..GOAL: THE DMH MEDICAL GROUP WILL RECRUIT 2-3 ADDITIONAL PRIMARY CARE PROVIDERS TO THE SERVICE AREA BY 2021. PRIMARY CARE PROVIDERS MAY INCLUDE INTERNAL MEDICINE, FAMILY MEDICINE, PEDIATRICS AND/OR OB/GYN PHYSICIANS, AS WELL AS NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS. COLLABORATIVE EFFORT: ..ACTIVITY: DMH AND THE DMH MEDICAL GROUP WILL CONTINUE TO COLLABORATE WITH LOCAL AND REGIONAL HEALTHCARE ORGANIZATIONS TO IMPROVE PRIMARY CARE ACCESS FOR ALL AGE GROUPS THROUGHOUT DMH'S PRIMARY AND SECONDARY SERVICE AREAS. ..GOALS: 1. PARTNER WITH SIU SCHOOL OF MEDICINE IN EXPANDING DMH'S RURAL PRIMARY CARE CLINIC HOURS OF OPERATIONS AND SERVICES IN ARTHUR, SHELBYVILLE, MONTICELLO AND SULLIVAN. 2. CONTINUE TO PARTNER WITH THE TWO EXISTING FEDERALLY QUALIFIED HEALTH CENTERS (FQHC) IN THE PRIMARY SERVICE AREA, CROSSING HEALTHCARE FQHC AND SIU SCHOOL OF MEDICINE'S FQHC, TO INCREASE ON-CAMPUS PATIENT VISIT VOLUMES BY 3% - 5% 2021. 3. DMH WILL PARTNER WITH SIU SCHOOL OF MEDICINE AND SPRINGFIELD CLINIC IN ESTABLISHING A COMPREHENSIVE REGIONAL DIABETES CENTER, STAFFED WITH ENDOCRINOLOGISTS, DIABETIC EDUCATORS, PHARMACISTS AND NURSE PRACTITIONERS. DIABETES CENTER WILL BE OPEN IN LATE 2019/EARLY 2020. 2. ACCESS TO MEDICAL SPECIALISTS IN AN EFFORT TO MAINTAIN AND GROW APPROPRIATE HEALTHCARE SERVICES, DMH CONTINUES TO RECRUIT PROVIDERS IN A VARIETY OF SPECIALTIES AND COLLABORATES WITH OTHER HEALTHCARE ORGANIZATIONS TO INCREASE CARE OPTIONS FOR THE COMMUNITY. DMH FULLY UNDERSTANDS AND SUPPORTS THE NEED TO OFFER CARE LOCALLY. DMH HAS INVESTED IN SPECIALTY SERVICES TO ENSURE THE AVAILABILITY OF HIGH QUALITY CARE CLOSE TO HOME FOR ITS PATIENTS. WITH A MEDICAL STAFF OF NEARLY 350 PROVIDERS, DMH OFFERS 45+ SPECIALTIES. ..ACTION: DMH WILL CONTINUE TO PROVIDE A COMPREHENSIVE CONTINUUM OF MEDICAL SPECIALTY SERVICES TO MEET THE GROWING HEALTHCARE NEEDS OF THE COMMUNITIES SERVED. ADDITIONALLY, DMH WILL COLLABORATE WITH OTHER REGIONAL HEALTHCARE PROVIDERS TO ENSURE ACCESS TO SPECIALTY SERVICES WITHIN THE PRIMARY SERVICE AREA. ..GOALS: 1. DMH WILL INCREASE MEDICAL SUB-SPECIALTY SERVICES ACCESS THROUGH PHYSICIAN RECRUITMENT EFFORTS, EXPANDING OFFICE HOURS FOR CERTAIN SUB- SPECIALTIES, COLLABORATION WITH OTHER REGIONAL HEALTHCARE PROVIDERS, AND/OR IMPLEMENTING VIRTUAL TECHNOLOGY HEALTHCARE APPLICATIONS, (I.E. TELEHEALTH, VIRTUAL HEALTH VISITS, E-VISITS). 2. INCREASE SPECIALTY VISITS BY 10% BY 2021. 3. ACCESS TO MENTAL HEALTH PROVIDERS AND SERVICES ON OCTOBER 1, 2015 DMH OPENED A 20-BED GERIATRIC PSYCHIATRY UNIT. WITH A MISSION IS TO IMPROVE THE MENTAL HEALTH OF INDIVIDUALS AGES 55 AND OLDER IN CENTRAL ILLINOIS, THE UNIT PROVIDES QUALITY MENTAL HEALTH SERVICES WITH STAFF WHO ARE EDUCATED ON THE MOST CURRENT TREATMENT INTERVENTIONS FOR BOTH PATIENTS AND THEIR FAMILIES. THE DIRECT ADMISSION PROCESS PREVENTS PATIENTS FROM EXPERIENCING LONG WAIT TIMES IN EMERGENCY ROOMS WHEN SUFFERING FROM CONFUSION, DEPRESSION OR OTHER FORMS OF MENTAL ILLNESS. THE UNIT'S STAFF WORK WITH A TEAM OF EXPERTS COMPOSED OF PSYCHIATRISTS, HOSPITALISTS, MEDICAL SPECIALISTS, NUTRITIONISTS, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPISTS TO PROVIDE A MULTIDISCIPLINARY TEAM APPROACH. THE UNIT IS STAFFED 24 HOURS SEVEN DAYS A WEEK WITH REGISTERED NURSES. TWO LICENSED SOCIAL WORKERS AND A CERTIFIED RECREATIONAL THERAPIST ARE ALSO ON STAFF. DISCHARGED PATIENTS HAVE THE OPPORTUNITY TO ATTEND DMH'S INTENSIVE OUTPATIENT PROGRAM FOR CONTINUED CARE. ..ACTION: DMH WILL PROVIDE SPECIFIC EDUCATIONAL INFORMATION TO AREA PROVIDERS ON MENTAL HEALTH ISSUES IMPACTING SENIORS AGE 55 AND OLDER AND HOW PROVIDERS CAN EASILY MAKE A REFERRAL TO THE PROGRAM. ALL ASSESSMENTS ARE FREE REGARDLESS IF THE PATIENT IS ADMITTED TO THE PROGRAM. TYPICALLY, INDIVIDUALS WILL ACTIVELY PARTICIPATE IN GROUP THERAPY SESSION FOR 3-6 MONTHS DEPENDING ON INDIVIDUAL NEEDS. ALL PATIENTS IN THE PROGRAM ARE SEEN FOR MEDICATION MANAGEMENT BY A PSYCHIATRIST ON A MONTHLY BASIS. ..GOALS: 1. INCREASE AWARENESS OF THE INTENSIVE OUTPATIENT PROGRAM AND PROVIDE BOTH MORNING AND AFTERNOON GROUP SESSIONS. 2. CONSISTENTLY RUN AT 80% CAPACITY 3. HIRE ADDITIONAL PROVIDERS TO PROVIDE MEDICATION MANAGEMENT TO DISCHARGED PATIENTS IN AREA NURSING HOMES.
FACILITY 1, DECATUR MEMORIAL HOSPITAL - PART V, LINE 13H	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.

Schedule H (Form 990) 2019

Page 9

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?10
Name and address		Type of Facility (describe)
1	DMH MEDICAL GROUP 2300 N EDWARD ST DECATUR,IL62526	OUTPATIENT CLINICS
2	DMH ENDOSCOPY CENTER 2 MEMORIAL DR PHYS PLAZA WEST SUITE 102 DECATUR,IL62526	AMBULATORY ENDOSCOPY 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	SOUTH SHORES IMAGING CENTER 1689 S FRANKLIN ST DECATUR,IL62521	DIAGNOSTIC CENTER
6	SPORTS PERFORMANCE ENHANCEMENT CTR 2122 NORTH 27TH ST DECATUR,IL62526	PHYSICAL THERAPY
7	DMH HOME HEALTH CARE 2870 NORTH MAIN ST DECATUR,IL62526	HOME HEALTH AGENCY
8	DMH OCC HEALTH & WELLNESS PARTNERS 2122 NORTH 27TH ST DECATUR,IL62526	OUTPATIENT CLINIC
9	DMH HOSPICE 2870 NORTH MAIN ST DECATUR,IL62526	HOSPICE AGENCY
10	DMH HEALTH AND WELLNESS CENTER 2122 NORTH 27TH ST DECATUR,IL62526	WELLNESS CENTER

Schedule H (Form 990) 2019

Page 10

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
PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE	AS INDICATED, THE HOSPITAL USES FEDERAL POVERTY GUIDELINES. ADDITIONALLY, THERE MAY BE INSTANCES WHERE PATIENTS HAVE INCURRED A FINANCIAL HARDSHIP, BUT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE GUIDELINES. SUCH CASES ARE REVIEWED INDIVIDUALLY AND, WHERE DEEMED APPROPRIATE, EARNINGS ON RESTRICTED FUNDS ARE USED TO PAY THE PATIENT'S BILLS.
PART I, LINE 6A - RELATED ORGANIZATION INFORMATION	THE HOSPITAL PREPARES THE ANNUAL COMMUNITY BENEFIT REPORT UNDER ITS OWN NAME.
PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION	THE HOSPITAL DID NOT INCLUDE AS SUBSIDIZED HEALTH SERVICES ANY COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC.
PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE	NONE. PER NEWLY ISSUED GAAP, DMH INCLUDES BAD DEBT EXPENSE AS PART OF PROGRAM SERVICE REVENUE ON PAGE 9, LINE 2A.
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION	THE HOSPITAL DERIVED ALL NUMBERS IN LINE 7 FROM THE APPLICABLE IRS WORKSHEETS, USING THE RATIO OF PATIENT COST-TO-CHARGES.
PART II - COMMUNITY BUILDING ACTIVITIES	PART VI, LINE 5 ECONOMIC DEVELOPMENT - DMH SUPPORTS THE ECONOMIC DEVELOPMENT CORPORATION OF DECATUR AND MACON COUNTY (EDC). EDC IS A NON-PROFIT PUBLIC-PRIVATE PARTNERSHIP RESPONSIBLE FOR NON-RETAIL BUSINESS ATTRACTION, EXPANSION AND RETENTION EFFORTS IN DECATUR & MACON COUNTY. COMPOSED OF A COMBINATION OF LEADING PRIVATE SECTOR EMPLOYERS, LABOR, EDUCATIONAL INSTITUTIONS AND A VARIETY OF GOVERNMENTAL BODIES, THE EDC IS UNIQUELY POSITIONED TO ADDRESS THE NEEDS OF MACON COUNTY'S EXISTING BUSINESS AND EMPLOYER BASE ALONG WITH PROSPECTIVE BUSINESSES LOOKING TO LOCATE IN AND AROUND THE DECATUR, ILLINOIS AREA. PRESIDENT & CEO TIM STONE IS CHAIRMAN OF THE EDC. COMMUNITY HEALTH IMPROVEMENT ADVOCACY - DMH SUPPORTS A PROGRAM WHEREBY INDIGENT OR QUALIFYING PATIENTS WHO COULD NOT AFFORD TRANSPORTATION FOR HEALTH CARE ARE PROVIDED TAXI AND DECATUR AMBULANCE SERVICE TRANSPORTATION AT NO COST. IN ADDITION, DMH PROVIDES PHARMACY FOR THE INDIGENT AND/OR THOSE THAT QUALIFY. CROSSING HEALTHCARE ACCESS CLINIC IS LOCATED WITHIN THE HOSPITAL'S EMERGENCY ROOM AREA. THE CLINIC PROVIDES HEALTH CARE TO LOW INCOME FAMILIES. COMMUNITY SUPPORT - DMH SUPPORTED THE GIRL SCOUT DIAMONDS AND DESSERTS FUNDRAISER, RICHLAND COMMUNITY COLLEGE'S KITCHEN WARRIORS FUNDRAISER, AND HOLY FAMILY CATHOLIC SCHOOL.
PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY	LINE 2 OF PART III WAS CALCULATED USING THE HOSPITAL WIDE COST-TO-CHARGE RATIO FROM THE APPLICABLE IRS WORKSHEET. PROVISIONS FOR BAD DEBT EXPENSE ARE CALCULATED BY TAKING THE NET ACCOUNTS RECEIVABLE BY PAYOR CLASS WHICH IS SEGREGATED INTO 10 TIME PERIOD BUCKETS AND MULTIPLYING EACH BUCKET BY A CALCULATED PRIOR YEAR ACTUAL BAD DEBT EXPENSE PERCENT.
PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE	LINE 3 OF PART III WAS CALCULATED AS FOLLOWS: THE HOSPITAL USED 2010-2018 AMERICAN COMMUNITY 5 YEAR ESTIMATES DATA FROM THE CENSUS BUREAU TO ESTIMATE THE PERCENTAGE OF ITS PATIENT POPULATION WHOSE HOUSEHOLD INCOME WAS UNDER ITS FULL CHARITY CARE ELIGIBILITY CRITERIA OF 200% OF THE FEDERAL POVERTY GUIDELINES (FPG). ADDED TO THIS PERCENTAGE WAS AN ESTIMATED PERCENTAGE OF THE POPULATION THAT IS ABOVE THE 200% POVERTY LEVEL AND LESS THAN 600% OF THE POVERTY LEVEL. THIS COMBINED PERCENTAGE WAS THEN DECREASED BY THE PERCENTAGE OF ILLINOIS RESIDENTS WHO HAVE GAINED INSURANCE THROUGH THE AFFORDABLE CARE ACT. THIS ADJUSTED PERCENTAGE WAS APPLIED TO THE HOSPITAL'S CHARGES TO ESTIMATE THE AMOUNT OF GROSS CHARGES THAT MET ITS FINANCIAL ASSISTANCE GUIDELINES. THE HOSPITAL THEN SUBTRACTED THE CHARGES RELATED TO THE PATIENTS THAT WERE ELIGIBLE FOR GOVERNMENTAL ASSISTANCE PROGRAMS SUCH AS MEDICAID. HOSPITAL CHARITY CARE ADJUSTMENTS WERE ALSO REMOVED BECAUSE THEY TOO WOULD NOT HAVE RESULTED IN BAD DEBTS. THE REMAINING CHARGES RELATED TO UNINSURED PATIENTS WITH HOUSEHOLD INCOMES BELOW 600% OF FPG, AND IT IS REASONABLE TO ASSUME THAT THEY RESULTED IN BAD DEBTS. THIS TOTAL WAS THEN MULTIPLIED BY THE RATIO OF COSTS-TO-CHARGES FROM THE APPLICABLE IRS WORKSHEET TO CALCULATE THE COST OF PROVIDING THESE SERVICES.
BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS	FOOTNOTE DESCRIBING BAD DEBT (NOTE THAT THE AUDITED FINANCIAL STATEMENTS DID NOT INCLUDE A SEPARATE FOOTNOTE WHICH APPLIED SOLELY TO BAD DEBT. THE FOLLOWING IS AN EXCERPT FROM A BROADER FOOTNOTE CONTAINED IN THE FINANCIAL STATEMENTS): THE SYSTEM CONSIDERS CRITICAL ACCOUNTING POLICIES TO BE THOSE THAT REQUIRE MORE SIGNIFICANT JUDGMENTS AND ESTIMATES IN THE PREPARATION OF ITS CONSOLIDATED FINANCIAL STATEMENTS, INCLUDING PROVISIONS FOR BAD DEBT. MANAGEMENT RELIES ON HISTORICAL EXPERIENCE, ON OTHER ASSUMPTIONS BELIEVED TO BE REASONABLE UNDER THE CIRCUMSTANCES, AND RECOMMENDATIONS MADE BY THE SYSTEM'S EXTERNAL ADVISORS AND ACTUARIES IN MAKING JUDGMENTS AND ESTIMATES. ACTUAL RESULTS COULD DIFFER FROM THOSE ESTIMATES. THE ABOVE WORDING CAN BE FOUND IN FOOTNOTE 1, USE OF ESTIMATES SUB TITLE, ON PAGE 7 AS NOTED AT THE BOTTOM OF THE PDF PAGE OF THE AUDITED FINANCIAL STATEMENTS.
PART III, LINE 8 - MEDICARE EXPLANATION	THE HOSPITAL USED THE COST TO CHARGE RATIO FROM THE MEDICARE COST REPORT IN CALCULATING LINE 6 OF PART III. THE HOSPITAL DID RECOGNIZE THE SHORTFALL REPORTED IN PART III, LINE 7, IN ITS COMMUNITY BENEFIT REPORT. THE SHORTFALL IS INCLUDED IN THE GOVERNMENT-SPONSORED PROGRAM SERVICES LINE OF THE COMMUNITY BENEFIT REPORT. THE SHORTFALL AMOUNT WAS CALCULATED USING INTERNAL RECORDS.
PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION	THE HOSPITAL WILL NOT SEND A PATIENT'S ACCOUNT TO A THIRD-PARTY COLLECTION AGENCY PRIOR TO MAKING GOOD FAITH EFFORTS TO DETERMINE A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE. THE HOSPITAL WILL USE GOOD FAITH EFFORTS TO DETERMINE WHETHER A PATIENT IS INSURED PRIOR TO INITIATING ANY COLLECTION ACTION. THE HOSPITAL WILL NOT PURSUE LEGAL ACTION FOR NONPAYMENT OF BILLS FOR ANY PATIENT RECEIVING FINANCIAL ASSISTANCE SO LONG AS SUCH PATIENT IS MAKING PAYMENTS IN ACCORDANCE WITH HIS/HER ESTABLISHED PAYMENT PLAN AS SET FORTH IN A PAYMENT AGREEMENT. IN THE EVENT THE PATIENT IS UNABLE TO MAINTAIN SUCH PAYMENTS, THE HOSPITAL WILL CONTACT THE PATIENT TO DETERMINE WHETHER AN ADJUSTMENT IS APPROPRIATE. NOTWITHSTANDING THE FOREGOING, THE HOSPITAL MAY TAKE LEGAL ACTION AGAINST PATIENTS RECEIVING FINANCIAL ASSISTANCE TO ENFORCE THE TERMS OF AN EXISTING PAYMENT PLAN WHERE THERE IS EVIDENCE THAT THE PATIENT (OR HIS/HER FAMILY AND/OR GUARANTOR, IF APPLICABLE) HAS SUFFICIENT INCOME AND ASSETS TO MEET HIS/HER OBLIGATIONS UNDER THE EXISTING PAYMENT PLAN; PROVIDED HOWEVER, THE HOSPITAL WILL NOT PURSUE LEGAL ACTION FOR NON-PAYMENT OF BILLS AGAINST ANY PATIENT RECEIVING FINANCIAL ASSISTANCE WHO HAS CLEARLY DEMONSTRATED THAT HE/SHE DOES NOT HAVE SUFFICIENT INCOME AND ASSETS TO MEET HIS/HER FINANCIAL OBLIGATIONS TO THE HOSPITAL. NOTWITHSTANDING THE FOREGOING, THE HOSPITAL'S DEBT COLLECTION POLICY PLACES A MAXIMUM AMOUNT, BASED UPON ANNUAL HOUSEHOLD PRE-TAX INCOME AND CASH BENEFITS FROM ALL SOURCES WITH CERTAIN ADJUSTMENTS, THAT THE HOSPITAL (OR ITS DESIGNATED THIRD-PARTY COLLECTION AGENCY) MAY COLLECT IN ANY TWELVE (12) MONTH PERIOD FOR HOSPITAL SERVICES FROM A PATIENT WHO IS ELIGIBLE FOR FINANCIAL ASSISTANCE.
PART VI, LINE 2 - NEEDS ASSESSMENT	DECATUR MEMORIAL HOSPITAL CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS TO EVALUATE THE HEALTH OF THE COMMUNITY, IDENTIFY HIGH PRIORITY HEALTH NEEDS, AND DEVELOP STRATEGIES TO ADDRESS THE NEEDS OF THE COMMUNITY. THE 2016-2018 DECATUR MEMORIAL HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT REPRESENT A COMBINATION OF QUANTITATIVE AND QUALITATIVE INFORMATION FROM REPUTABLE STATISTICAL SOURCES AND FOCUS GROUP FEEDBACK PROVIDED BY COMMUNITY LEADERS, AND INFORMATION FROM A COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY. THE ASSESSMENT PROCESS INCLUDED A COMBINATION OF SECONDARY DATA, INCLUDING IPLAN, U.S. CENSUS DATA, AND REFERENCE TO HEALTHY PEOPLE 2020, AMONG OTHER SOURCES. VALUABLE INPUT FROM FOCUS GROUP PARTICIPANTS PROVIDED PRIMARY DATA FOR THE ASSESSMENT. DECATUR MEMORIAL HOSPITAL UTILIZED THE SIX STEP ASSESSMENT PROCESS OUTLINED BELOW. STEP 1: ESTABLISHING THE ASSESSMENT INFRASTRUCTURE PARTICIPANTS IN THE COMMUNITY LEADER FOCUS GROUP AND FOCUS GROUP SURVEY INCLUDED DECATUR MEMORIAL HOSPITAL, RICHLAND COMMUNITY COLLEGE, MACON COUNTY HEALTH DEPARTMENT, SOUTHERN ILLINOIS UNIVERSITY, CITY OF DECATUR, BOYS AND GIRLS CLUB, CROSSING HEALTHCARE, DMH MEDICAL STAFF PHYSICIANS, GOOD SAMARITAN INN, DECATUR POLICE DEPARTMENT, VICTORY PHARMACY, EVERGREEN SENIOR LIVING, DECATUR CORRECTIONAL CENTER, DECATUR PARK DISTRICT AND SALVATION ARMY. DECATUR MEMORIAL HOSPITAL'S ROLE: -COORDINATE THE OVERALL ASSESSMENT PROCESS -PROVIDE THE MEETING SPACE FOR THE COMMUNITY LEADER FOCUS GROUP -MOTIVATE OTHER COMMUNITY ORGANIZATIONS TO PARTICIPATE -COLLECT AND ORGANIZE SECONDARY DATA -CONDUCT A COMMUNITY LEADER FOCUS GROUP TO COLLECT PRIMARY DATA -DESIGN, IMPLEMENT AND ANALYZE A COMMUNITY MEMBER SURVEY -IDENTIFY PRIORITY ISSUES -DEVELOP AND IMPLEMENT INITIATIVES TO ADDRESS PRIORITY ISSUES PARTNER ORGANIZATIONS, CONTRIBUTIONS, AND ROLES: -ALL ORGANIZATIONS PROVIDE PARTICIPANTS AND INPUT KEY FACTORS IN DEVELOPING AND MAINTAINING PARTNERSHIPS: -MAINTAINING MUTUAL RESPECT AND A COMMON LANGUAGE -FOLLOWING THROUGH ON COMMITMENTS STEP 2: DEFINING PURPOSE AND SCOPE (DEFINING THE COMMUNITY) THE PURPOSE OF THE ASSESSMENT WAS TO EVALUATE THE CURRENT HEALTH NEEDS OF THE COMMUNITY, THE RESOURCES CURRENTLY IN PLACE TO MEET THOSE NEEDS AS WELL AS IDENTIFYING MAJOR GAPS BETWEEN THE TWO. DATA FROM THE ASSESSMENT IS USED TO DEVELOP AN ACTION PLAN TO BRIDGE THE GAP AND BETTER MEET THE HEALTH NEEDS OF THE COMMUNITY. THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT FOCUSES ON PRIMARY AND SECONDARY INFORMATION FOR MACON COUNTY, ILLINOIS, INCLUDING THE CITY OF DECATUR AND NEARBY TOWNS. THIS WAS DETERMINED BECAUSE THE MAJORITY OF PATIENTS RESIDE IN MACON COUNTY (MORE THAN 70% OF PATIENTS). IN SOME INSTANCES, DATA WAS NOT AVAILABLE FOR MACON COUNTY, SO CITY OF DECATUR DATA WAS USED. STEP 3: COLLECTING AND ANALYZING DATA PRIMARY DATA CONSISTS OF A COMMUNITY SURVEY AND A FOCUS GROUP SURVEY. THE PRIMARY DATA COLLECTION OF THE COMMUNITY SURVEY DATA BEGAN ON JULY 7, 2015 AND EXTENDED THROUGH OCTOBER 5, 2015. FURTHERMORE, ON NOVEMBER 10, 2015, DECATUR MEMORIAL HOSPITAL AND MACON COUNTY HEALTH DEPARTMENT HOSTED A COMMUNITY LEADER FOCUS GROUP TO DISCUSS COMMUNITY HEALTH NEEDS. AFTER REVIEWING LOCAL DATA WITH THE FOCUS GROUP ATTENDEES, THE SURVEY PREVIOUSLY SENT TO COMMUNITY MEMBERS, WAS ADMINISTERED. SECONDARY DATA WAS COLLECTED THROUGH SEVERAL SOURCES. THE ILLINOIS PROJECT FOR LOCAL ASSESSMENT OF NEEDS (IPLAN) IS A COMMUNITY HEALTH ASSESSMENT AND PLANNING PROCESS THAT IS CONDUCTED EVERY FIVE YEARS BY LOCAL HEALTH JURISDICTIONS IN ILLINOIS. BASED ON THE ASSESSMENT PROTOCOL FOR EXCELLENCE IN PUBLIC HEALTH (APEX-PH) MODEL, IPLAN IS GROUNDED IN THE CORE FUNCTIONS OF PUBLIC HEALTH AND ADDRESSES PUBLIC HEALTH PRACTICE STANDARDS. ADDITIONAL RESOURCES WERE UTILIZED THROUGHOUT THE PROCESS, INCLUDING BUT NOT LIMITED TO, U. S. CENSUS BUREAU AMERICAN FACT FINDER, SOCIAL IMPACT RESEARCH CENTER AT HEARTLAND ALLIANCE, ILLINOIS DISTRICT REPORT CARD, AND ILLINOIS COUNTY BEHAVIORAL RISK FACTOR SURVEY. STEP 4: SELECTING PRIORITIES THE FOCUS GROUP PARTICIPANTS DISCUSSED THE PRIORITY IN WHICH COMMUNITY HEALTH NEEDS SHOULD BE ADDRESSED AND DETERMINED IT BEST TO FOCUS ON SERVICES THAT IMPACTED THE COMMUNITY AS A WHOLE VS. PATIENT SPECIFIC SERVICES. STEP 5: DOCUMENTING AND COMMUNICATING RESULTS THE FINAL REPORT, INCLUDING RESULTS, WILL BE COMMUNICATED TO ATTENDEES AND THE GENERAL PUBLIC THROUGH BOUND COPIES OF THE REPORT AND ONLINE ACCESS. ONLINE ACCESS INCLUDES POSTING TO THE DECATUR MEMORIAL HOSPITAL WEBSITE. STEP 6: PLANNING FOR ACTION AND MONITORING PROGRESS FOLLOWING THE COMPLETION OF THE 2016-2018 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT, AN IMPLEMENTATION PLAN WAS CREATED TO MEET THE APPLICABLE IDENTIFIED NEEDS. EFFORTS WILL BE MEASURED APPROPRIATELY AND PROGRESS WILL BE REPORTED REGULARLY. ACCESS TO PRIMARY CARE AND SPECIALISTS EVALUATION OF THE PHYSICIAN POPULATION RATIOS IN MACON COUNTY INDICATED THAT DECATUR WAS UNDERSERVED BOTH IN TERMS OF PRIMARY CARE PHYSICIANS AND SPECIALISTS. THE WAITING TIME FOR A NEW PATIENT TO SEE A PRIMARY CARE PHYSICIAN IN THE COMMUNITY WAS AS LONG AS TWO TO THREE MONTHS. BASED ON THIS INFORMATION, DECATUR MEMORIAL HOSPITAL HAS RECRUITED, AND CONTINUES TO RECRUIT, PRIMARY AND SPECIALIST PHYSICIANS TO THE COMMUNITY. COSTS OF RECRUITMENT WERE GENERALLY BORN BY THE HOSPITAL AND AMOUNTED TO MORE THAN 893,336 DURING THE LAST FISCAL YEAR. DMH ALSO SIGNIFICANTLY SUPPORTS THE SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE FAMILY PRACTICE RESIDENCY PROGRAM, WHICH GRADUATES UP TO SIX FAMILY PRACTITIONERS PER YEAR. THE RETENTION RATE OF THE GRADUATES WITHIN CENTRAL ILLINOIS HAS BEEN VERY HIGH. SUPPORT FOR THE RESIDENCY PROGRAM COSTS IN EXCESS OF 4,500,000 A YEAR. OUR EMPLOYED PHYSICIANS CONTRIBUTE VOLUNTEER TEACHING HOURS TOWARDS RESIDENT TRAINING. IN ADDITION TO PHYSICIANS, IT HAS BECOME APPARENT THAT OTHER HEALTH CARE PROFESSIONALS ARE ALSO IN VERY SHORT SUPPLY. PROVISION OF ADEQUATE COMMUNITY HEALTH DEPENDS ON AN ADEQUATE SUPPLY OF SUCH PROFESSIONALS. AS SUCH, DECATUR MEMORIAL HOSPITAL (DMH) HAS VOLUNTEERED HOURS ON PLANNING AND CURRICULUM DESIGN AT OUR TWO NURSING SCHOOLS AND CONTRIBUTES MORE THAN 2,500 HOURS OF UNCOMPENSATED TEACHING AND CLINICAL EXPERIENCE TO NURSING STUDENTS IN THE DECATUR NURSING PROGRAMS. OUR MEDICAL STAFF AND PERSONNEL ALSO PARTICIPATE IN CLINICAL TRAINING AND SUPPORT FOR RESIDENT PHYSICIANS IN FAMILY MEDICINE AS WELL AS PHYSICIAN ASSISTANT STUDENTS. ADDITIONAL TRAINING PROGRAMS FOR OTHER ALLIED HEALTH PROFESSIONALS HAVE ALSO BEEN UNDERTAKEN AND SUPPORTED BY DMH. THE HOSPITAL ALSO SUPPORTS THE PARISH NURSE PROGRAM. THIS PROGRAM HAS SUBSTANTIALLY IMPROVED THE ABILITY OF COMMUNITY MEMBERS TO OBTAIN BASIC HEALTH INFORMATION AND SCREENING FROM TRAINED PARISH NURSES. HEART, LUNG AND STROKE HEART: RECOGNIZING THAT CORONARY HEART DISEASE IS THE NUMBER ONE CAUSE OF DEATH IN MACON COUNTY; DECATUR MEMORIAL HOSPITAL (DMH) OFFERS A WIDE VARIETY OF EDUCATION TO THE COMMUNITY TO PROMOTE HEART HEALTHY LIVING. THE CARDIAC REHABILITATION DEPARTMENT OFFERS A FREE MONTHLY EDUCATIONAL PROGRAM THAT IS OPEN TO THE PUBLIC. DMH OFFERS CARDIAC INFORMATION AT MULTIPLE HEALTH FAIRS IN THE AREA WHICH ALSO INCLUDES FREE BLOOD PRESSURE SCREENINGS. THE EDUCATIONAL FOCUS IS ON HEART DISEASE PREVENTION, INCLUDING EXERCISE, SMOKING CESSATION, HEART HEALTHY DIET AND MEDICATION MANAGEMENT. COMMUNITY EVENTS INCLUDE THE ANNUAL HEART WALK AND HEARTS AROUND THE WORLD, BOTH WITH THE FOCUS ON RAISING FUNDS TO SUPPORT THE PREVENTION OF HEART DISEASE. LUNG: THE LUNG CENTER IS CONVENIENTLY LOCATED ON THE CAMPUS OF DECATUR MEMORIAL HOSPITAL AND PROVIDES A COMPREHENSIVE PULMONARY PROGRAM. THESE SERVICES INCLUDE PULMONARY FUNCTION TESTING, SLEEP STUDIES, PULMONARY REHABILITATION AND A JCAHO ACCREDITED COPD PROGRAM. THE FOCUS OF THE COPD PROGRAM IS TO MAINTAIN A HEALTHIER LIFESTYLE WITH A CHRONIC DISEASE AND PREVENT READMISSIONS TO THE HOSPITAL. PATIENT EDUCATION IS PROVIDED FOR BOTH INPATIENTS AND OUTPATIENTS FOCUSED ON SMOKING CESSATION AND LIFESTYLE CHANGES THAT PROMOTE AN IMPROVED QUALITY OF LIFE. STROKE: IDENTIFICATION OF THE NEED TO EDUCATE THE COMMUNITY WE SERVE ABOUT STROKE RISK FACTORS, OPTIONS FOR TREATMENT, AND INTERVENTIONS THAT WILL HELP TO MITIGATE LONG TERM DISABILITY AFTER STROKE, HAS RESULTED IN INCREASED EFFORTS TO PROVIDE INFORMATION REGARDING GOOD LIFESTYLE AND TREATMENT CHOICES. INFORMATION IS PROVIDED AT HEALTH FAIRS ABOUT SMOKING CESSATION, HEALTHY DIET, DIABETES MONITORING, WEIGHT CONTROL, BLOOD PRESSURE CONTROL, ALONG WITH BLOOD PRESSURE SCREENING. ALL THIS COMES TOGETHER TO FORM A SOLID EDUCATIONAL FOUNDATION FOR PROMOTION OF HEALTHY LIFESTYLE ADJUSTMENTS TARGETED AT DECREASING THE CHANCE OF STROKE. ADDITIONALLY, A "KIDS CAN BE HEROES" PROGRAM FOR 4-5-6 GRADERS TEACHES THESE CHILDREN ABOUT STROKE RISK FACTORS AND THE FAST (FACE, ARM, SPEECH, TIME) ACRONYM, WHICH WILL HELP THEM TO IDENTIFY SYMPTOMS OF STROKE. THESE CHILDREN ARE GIVEN THE 'ASSIGNMENT' OF GOING HOME AND TEACHING TW
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	THE HOME PAGE OF THE HOSPITAL'S WEBSITE, WWW.DMHCARES.COM, CONTAINS LINKS TO ALL INFORMATION CONCERNING THE CHARITY CARE / FINANCIAL ASSISTANCE PROGRAM, INCLUDING THE POLICIES AND PATIENT FINANCIAL APPLICATON FORMS. POSTERS ARE PLACED IN OUR PATIENT REGISTRATION AREA IN VISIBLE LOCATIONS WHERE PATIENTS AND THEIR FAMILIES CAN SEE THEM. THESE POSTERS ARE 24" BY 31". PATIENT BROCHURES ARE PLACED IN THE PATIENT REGISTRATION BOOTHS, ACCESSIBLE TO ALL PATIENTS AND THEIR FAMILIES. PATIENT ACCOUNT STATEMENTS INCLUDE THE PHONE NUMBER FOR "FINANCIAL ASSISTANCE."
PART VI, LINE 4 - COMMUNITY INFORMATION	PART VI, LINE 4 POPULATIONS AND COMMUNITIES SERVED -- DECATUR MEMORIAL HOSPITAL (DMH) IS LOCATED IN DECATUR, ILLINOIS. THE CITY HAS A 2010 CENSUS POPULATION OF 76,000, WHICH REPRESENTS A POPULATION DECLINE OF 5.8% SINCE 2000. MACON COUNTY, WITHIN WHICH IT RESIDES, HAS A POPULATION OF APPROXIMATELY 105,801. THE OVERALL MARKET AREA FOR DECATUR MEMORIAL HOSPITAL INCLUDES APPROXIMATELY 250,000 RESIDENTS. THE DEMOGRAPHICS OF MACON COUNTY INDICATE AN AGING POPULATION. PROJECTIONS FOR THE NEXT TEN YEARS SUGGEST RELATIVELY FLAT POPULATION GROWTH WITH A CONTINUED GRADUAL INCREASE IN THE AGED POPULATION. THE POVERTY RATE FOR MACON COUNTY IS 14.3%. THE 2018 AVERAGE UNEMPLOYMENT RATE FOR DECATUR/MACON COUNTY WAS 5.3% UP FROM 5.2% IN 2017.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH	BACKGROUND -- DECATUR MEMORIAL HOSPITAL, SINCE IT'S INCEPTION IN 1916, HAS CONTINUOUSLY RESPONDED TO THE HEALTH CARE NEEDS OF COMMUNITIES IT SERVES. AS AN INDEPENDENT COMMUNITY HOSPITAL WITH A LOCAL BOARD OF DIRECTORS, THE HOSPITAL HAS ALWAYS HAD AS ITS PRIMARY FOCUS THE HEALTH CARE NEEDS OF DECATUR, MACON COUNTY AND SURROUNDING COUNTIES. AS PART OF ITS OVERALL MISSION, DECATUR MEMORIAL HOSPITAL HAS CONTINUOUSLY PROVIDED BOTH INTELLECTUAL AND FINANCIAL RESOURCES TO OUR COMMUNITIES FOR EXPERTISE AND ASSISTANCE IN ASSESSMENT OF HEALTH CARE NEEDS, SUPPORT OF VARIOUS COMMUNITY SERVICES AND AGENCIES IN ADDRESSING THE IDENTIFIED NEEDS, AND THE CONTINUAL HEALTH EDUCATION OF PATIENTS, THE COMMUNITY, AND THE OTHER RELEVANT PUBLICS. DECATUR MEMORIAL HOSPITAL HAS PARTICIPATED DIRECTLY IN CHARITY AND INDIGENT CARE FOR A SIGNIFICANT SEGMENT OF OUR COMMUNITY. GOALS AND OBJECTIVES FOR PROVIDING COMMUNITY BENEFITS -- DECATUR MEMORIAL HOSPITAL HAS EMBRACED THE PHILOSOPHY THAT TO IMPROVE THE HEALTH OF PEOPLE IN CENTRAL ILLINOIS, AN ORGANIZATION MUST BECOME INVOLVED IN THE EDUCATION, AWARENESS, AND PREVENTION OF DISEASE AND ILLNESS THAT NEGATIVELY IMPACT A PERSON'S HEALTH STATUS. WE STRIVE TO GIVE COMMUNITY RESIDENTS TOOLS TO EMPOWER THEM TO MAKE LIFESTYLE DECISIONS THAT WILL MAINTAIN AND ENHANCE A DESIRABLE QUALITY OF LIFE. TO HELP PEOPLE REACH THIS GOAL, DECATUR MEMORIAL HOSPITAL SEEKS OUT OPPORTUNITIES AND ACTIVELY INVOLVES ITSELF IN THE COMMUNITY. WE ACTIVELY SUPPORT LOCAL HEALTH CARE EDUCATION PROGRAMS, HEALTH FAIRS, SCREENINGS, AND LOCAL ACCESS TO ADVANCED CARE. DECATUR MEMORIAL HOSPITAL IS, AND ALWAYS HAS BEEN, VERY MINDFUL OF ITS MISSION REGARDING CHARITY CARE. BY HOSPITAL POLICY, THE THRESHOLD FOR THE PROVISION OF CHARITY CARE IS VERY LIBERAL, AND WAS FURTHER EXPANDED IN FISCAL 2009 TO SIX TIMES THE FEDERAL POVERTY GUIDELINES. FOR PATIENTS WHOSE INCOME IS ABOVE THESE THRESHOLDS, WE REVIEW THE PERTINENT FACTORS INCLUDING THE MAGNITUDE OF THE BILL AND THE INDIVIDUAL'S FINANCIAL SITUATION, AND OFFER A SLIDING SCALE DISCOUNT AND EXTENDED PAYMENT TERMS TO THOSE INDIVIDUALS. APPROVAL OR DENIAL OF THESE GUIDELINES IS MADE WITHOUT REGARD TO RACE, CREED, NATIONAL ORIGIN, SEX OR AGE. THE HOSPITAL DOES NOT PLACE LIMITS ON THE AGGREGATE AMOUNTS OF CHARITY CARE PROVIDED IN ANY YEAR. SEE ALSO RESPONSE TO PART VI, LINE 2 ABOVE FOR EXAMPLES OF MANY WAYS IN WHICH THE HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY.
PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM	AS INDICATED, THE HOSPITAL AND ITS RELATED FACILITIES PROVIDE COMPREHENSIVE INPATIENT, OUTPATIENT AND PHYSICIAN SERVICES ALL OF WHICH BENEFIT AND PROMOTE THE HEALTH OF THE COMMUNITY. THE HOSPITAL IS AFFILIATED WITH ILLINOIS HEALTH AND SCIENCE WHICH SUPPORTS AND BENEFITS THE HOSPITAL BY PROVIDING FINANCIAL AND MANAGEMENT ASSISTANCE IN CONNECTION WITH THE ACTIVITIES OF THE HOSPITAL AND ITS AFFILIATES, AND BY HOLDING TITLE TO CERTAIN ASSETS USED IN CONNECTION WITH HOSPITAL ACTIVITIES. THE HOSPITAL IS ALSO AFFILIATED WITH DECATUR MEMORIAL FOUNDATION WHOSE MISSION IS TO SUPPORT AND BENEFIT THE HOSPITAL BY CONDUCTING FUND DEVELOPMENT ACTIVITIES, HOLDING TITLE TO CERTAIN ASSETS, AND OVERSEEING THEIR PRUDENT AND EFFECTIVE INVESTMENT AND MANAGEMENT. TOGETHER, THE ACTIVITIES OF THE HOSPITAL AND ITS AFFILIATES EFFECTIVELY AND EFFICIENTLY ADDRESS THE HEALTH NEEDS OF THE COMMUNITY IT SERVES.
PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT	ILLINOIS

Schedule H (Form 990) 2019

Additional Data

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- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
DECATUR MEMORIAL HOSPITAL

Employer identification number
37-0661199

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 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 noncash assistance	(h) Purpose of grant or assistance
(1) SIU DECATUR FAMILY PRACTICE CENTER 102 W KENWOOD DECATUR,IL62526	37-6005961	501C3	4,527,973				GENERAL SUPPORT

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

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) 2019

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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

DECATUR MEMORIAL HOSPITAL

Employer identification number

37-0661199

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

Yes

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

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

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

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

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

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

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

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

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

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

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

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

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

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

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2019

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 on 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 in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1TIMOTHY D STONE JR DIRECTOR/PRES. & CEO	(i) (ii)	48,200 ------------- 489,455	-------------	-------------	726 ------------- 3,249	1,365 ------------- 4,645	50,291 ------------- 497,349	-------------
2ANTHONY RISPOLI EVP & CFO	(i) (ii)	397,278 -------------	-------------	-------------	-------------	-------------	397,278 -------------	-------------
3DAVID BAUMBERGER MD VP CMO	(i) (ii)	392,791 -------------	250 -------------	-------------	4,050 -------------	14,373 -------------	411,464 -------------	-------------
4MARK BURMESTER SVP STRATEGY	(i) (ii)	325,293 -------------	-------------	28,540 -------------	-------------	25,049 -------------	378,882 -------------	-------------
5LINDA FAHEY SVP COO	(i) (ii)	272,238 -------------	13,981 -------------	-------------	4,050 -------------	1,709 -------------	291,978 -------------	-------------
6KATHERINE ANDERSON VP LEGAL AFFAIRS	(i) (ii)	28,979 ------------- 222,202	-------------	-------------	------------- 2,612	1,349 ------------- 4,645	30,328 ------------- 229,459	-------------
7JOHN RIDLEY VP PROF SERVICES	(i) (ii)	233,546 -------------	1,385 -------------	-------------	3,575 -------------	19,419 -------------	257,925 -------------	-------------
8ROBYN REISING VP CNO	(i) (ii)	207,009 -------------	14,061 -------------	-------------	3,080 -------------	943 -------------	225,093 -------------	-------------
9DEBORAH L BRAGG SVP FINANCE	(i) (ii)	220,131 -------------	100 -------------	-------------	3,300 -------------	1,542 -------------	225,073 -------------	-------------
10KEVIN HORATH VP HUMAN RESOURCES	(i) (ii)	204,142 -------------	626 -------------	-------------	3,055 -------------	1,824 -------------	209,647 -------------	-------------
11DAVID SAMPLES VP SUPPORT SERVICES	(i) (ii)	152,853 -------------	885 -------------	-------------	2,360 -------------	19,022 -------------	175,120 -------------	-------------
12JIM BLACKWELL VP INFO TECH	(i) (ii)	137,857 -------------	-------------	-------------	2,113 -------------	11,669 -------------	151,639 -------------	-------------
13STEVEN SOBOL MD PHYSICIAN	(i) (ii)	1,146,795 -------------	169,608 -------------	-------------	4,050 -------------	9,549 -------------	1,330,002 -------------	-------------
14MOHAMMED HASNAIN MD PHYSICIAN	(i) (ii)	804,310 -------------	260,957 -------------	-------------	4,050 -------------	19,627 -------------	1,088,944 -------------	-------------
15MARVIN DERRICK MD PHYSICIAN	(i) (ii)	863,076 -------------	161,918 -------------	-------------	4,050 -------------	18,627 -------------	1,047,671 -------------	-------------
16JOHN WATERS MD PHYSICIAN	(i) (ii)	821,136 -------------	200 -------------	-------------	4,050 -------------	8,515 -------------	833,901 -------------	-------------
17MADHU JYOTHANAGARAM MD PHYSICIAN	(i) (ii)	705,994 -------------	63,025 -------------	-------------	4,050 -------------	19,627 -------------	792,696 -------------	-------------

Schedule J (Form 990) 2019

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 THREE INSTANCES. DMH SHARED WITH ONE OTHER HOSPITAL THE COST OF A CHARTER PLANE HIRED TO PICK UP THEIR RESPECTIVE REPRESENTATIVE (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 PAID HOUSING EXPENSES FOR THE FIRST SEVEN MONTHS OF EMPLOYMENT FOR MR. BURMESTER, SENIOR VICE PRESIDENT STRATEGY AND PERFORMANCE IMPROVEMENT. MR. BURMESTER'S 2017 W-2 INCLUDED 28,540 RELATED TO HIS HOUSING EXPENSES AND IS REPORTED IN PART II (B) COLUMN III ON SCHEDULE J. DMH ALSO PAID 10,676 IN MOVING EXPENSES ON BEHALF OF MR. BURMESTER. MOVING EXPENSES ARE NOT TAXABLE FOR EXPENSES INCURRED IN 2017, BUT ARE INCLUDED IN PART II COLUMN D ON SCHEDULE J. DMH PAID MOVING EXPENSES OF 5,528 ON BEHALF OF MR EDWARDS, VICE PRESIDENT REVENUE CYCLE. MOVING EXPENSES ARE NOT TAXABLE FOR EXPENSES INCURRED IN 2017, BUT WOULD HAVE BEEN INCLUDED IN PART II COLUMN D ON SCHEDULE J IF MR. EDWARDS' SALARY HAD MET THE SCHEDULE J THRESHOLD IN 2017. DMH PAID HOUSING EXPENSES FOR THE FIRST MONTH OF EMPLOYMENT OF MR. PAGLIUZZA, SENIOR VICE PRESIDENT & CHIEF FINANCIAL OFFICER. MR. PAGLIUZZA'S 2017 W-2 BOX 5 INCLUDED 3,738 RELATED TO HIS HOUSING EXPENSES AND WOULD HAVE BEEN INCLUDED IN PART II COLUMN B ON SCHEDULE J IF MR. PAGLIUZZA'S SALARY HAD MET THE SCHEDULE J THRESHOLD IN 2017.

Schedule J (Form 990) 2019

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

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

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
DECATUR MEMORIAL HOSPITAL

Employer identification number
37-0661199

Part Ⅰ

Bond Issues

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

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	4,867,000		3,875,000		3,413,875		2,073,125
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 of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
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) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
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, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		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 "Yes" to 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) 2019

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?		X		X		X		X

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) 2019

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Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

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

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

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

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting 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) 2019

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) CANCER CARE SPECIALISTS OF CENT IL	SEE PART V	201,134	MED SERVICES		No
(2) CANCER CARE SPECIALISTS OF CENT IL	SEE PART V	2,081	TELEPHONE SERV REV		No
(3) BAKERS DOZEN LLC	SEE PART V	632,919	OFFICE SPACE RENTAL		No
(4) PRAIRIE ONCOLOGY MANAGEMENT SERVICE	SEE PART V	281,055	SUPPLY SALES/STORAGE		No
(5) PRAIRIE ONCOLOGY MANAGEMENT SERVICE	SEE PART V	387	COURIER SERVICES		No
(6) EDWARD ELLIOTT MD	SEE PART V	225,000	COMPENSATION		No
(7) AMEREN ILLINOIS	SEE PART V	1,611,740	ELEC/GAS UTILITIES		No
(8) KATHLEEN FAHEY	SEE PART V	48,482	COMPENSATION		No
(9) MEGHAN SAMPLES	SEE PART V	19,769	COMPENSATION		No
(10) SARAH REISING	SEE PART V	82,653	COMPENSATION		No
(11) BUSEY BANK	SEE PART V	187,492	BANK & FARM FEES		No
(12) BUSEY BANK	SEE PART V	1,718	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 IV

BUSEY BANK 187,492 SEE PART V BANK & FARM FEES BUSEY BANK 1,718 SEE PART V INTEREST INCOME

SCHEDULE L, PART V

PART IV, LINES 1(B), 2(B), 3(B), 4(B), 5(B): DIRECTOR EDWARD ELLIOTT IS AN OWNER OF CANCER CARE SPECIALISTS OF CENTRAL ILLINOIS, BAKER'S DOZEN, LLC., AND PRAIRIE ONCOLOGY MANAGEMENT SERVICE. PART IV, LINE 6(B): DIRECTOR EDWARD ELLIOTT'S SON. PART IV, LINE 7(B): DIRECTOR GUSSIE REED IS DIRECTOR OF OPERATIONS FOR DIVISION III OF AMEREN ILLINOIS. PART IV, LINE 8 (B): OFFICER LINDA FAHEY'S DAUGHTER. PART IV, LINE 9 (B): OFFICER DAVID SAMPLES' DAUGHTER. PART IV, LINE 10(B): OFFICER ROBYN REISING'S DAUGHTER-IN-LAW. PART IV, LINE 11(B), 12(B): DIRECTOR JOHN WADDOCK IS EVP MARKET PRESIDENT OF BUSEY BANK.

Schedule L (Form 990 or 990-EZ) 2019

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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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

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; HEALTH FAIRS; AND WOMEN AND CHILDREN'S HEALTH. 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	LARRY ALTENBAUMER ROBIN KING DIRECTOR DIRECTOR BUSINESS RELATIONSHIP EDWARD ELLIOTT JONATHAN LOCKE DIRECTOR DIRECTOR BUSINESS RELATIONSHIP ROBIN KING LARRY ALTENBAUMER DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JONATHAN LOCKE EDWARD ELLIOTT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP TIMOTHY STONE, JR. DEBORAH BRAGG OFFICER OFFICER BUSINESS RELATIONSHIP TIMOTHY STONE, JR. KEVIN HORATH OFFICER OFFICER BUSINESS RELATIONSHIP TIMOTHY STONE, JR. DENNIS WHALEN DIRECTOR DIRECTOR BUSINESS RELATIONSHIP TIMOTHY STONE, JR. GUSSIE REED DIRECTOR DIRECTOR BUSINESS RELATIONSHIP TIMOTHY STONE, JR. JOHN WADDOCK DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DENNIS WHALEN TIMOTHY STONE, JR. DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DENNIS WHALEN GUSSIE REED DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DENNIS WHALEN JOHN WADDOCK DIRECTOR DIRECTOR BUSINESS RELATIONSHIP GUSSIE REED TIMOTHY STONE, JR. DIRECTOR DIRECTOR BUSINESS RELATIONSHIP GUSSIE REED DENNIS WHALEN DIRECTOR DIRECTOR BUSINESS RELATIONSHIP GUSSIE REED JOHN WADDOCK DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JOHN WADDOCK TIMOTHY STONE, JR. DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JOHN WADDOCK DENNIS WHALEN DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JOHN WADDOCK GUSSIE REED DIRECTOR DIRECTOR BUSINESS RELATIONSHIP DEBORAH BRAGG TIMOTHY STONE, JR. OFFICER OFFICER BUSINESS RELATIONSHIP DEBORAH BRAGG DAVID SAMPLES OFFICER OFFICER BUSINESS RELATIONSHIP DEBORAH BRAGG KEVIN HORATH OFFICER OFFICER BUSINESS RELATIONSHIP DEBORAH BRAGG ROBYN REISING OFFICER OFFICER BUSINESS RELATIONSHIP DAVID SAMPLES DEBORAH BRAGG OFFICER OFFICER BUSINESS RELATIONSHIP DAVID SAMPLES KEVIN HORATH OFFICER OFFICER BUSINESS RELATIONSHIP DAVID SAMPLES ROBYN REISING OFFICER OFFICER BUSINESS RELATIONSHIP KEVIN HORATH DEBORAH BRAGG OFFICER OFFICER BUSINESS RELATIONSHIP KEVIN HORATH DAVID SAMPLES OFFICER OFFICER BUSINESS RELATIONSHIP KEVIN HORATH ROBYN REISING OFFICER OFFICER BUSINESS RELATIONSHIP KEVIN HORATH TIMOTHY STONE, JR. OFFICER DIRECTOR BUSINESS RELATIONSHIPS ROBYN REISING DEBORAH BRAGG OFFICER OFFICER BUSINESS RELATIONSHIP ROBYN REISING DAVID SAMPLES OFFICER OFFICER BUSINESS RELATIONSHIP ROBYN REISING KEVIN HORATH OFFICER OFFICER BUSINESS RELATIONSHIP KATHERINE ANDERSON JULIE BRILLEY OFFICER OFFICER BUSINESS RELATIONSHIP JULIE BRILLEY KATHERINE ANDERSON OFFICER OFFICER BUSINESS RELATIONSHIP
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 SENIOR VICE PRESIDENT FINANCE 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. 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 TEN 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 2017, DMH OBTAINED SUCH AN UPDATE REPORT FROM ITS INDEPENDENT COMPENSATION CONSULTING FIRM, COVERING THE FOLLOWING INDIVIDUALS: STONE (CEO), RIDLEY (COO), BAUMBERGER (CMO), FAHEY (CIO), BRAGG(SVP FINANCE), ANDERSON (VP LEGAL), SAMPLES (VP SUPPORT SERVICES), REISING (CNO), BRILLEY (VP PHYSICIANS), BURMESTER (SVP STRATEGY), AND HORATH (VP HR). THE COMMITTEE USED AN UPDATED ASSESSMENT WHEN OFFERING POSITIONS TO HEGLAND (CMO), PAGLIUZZA (SVP & CFO), FAHEY (COO), RIDLEY (VP PROF SERVICES), MIKE EDWARDS (VP REV CYCLE), AND JIM BLACKWELL (VP OF IT). ALL DETERMINATIONS OF THE BOARD AND EXECUTIVE COMMITTEE ARE THROROUGHLY 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 IX, LINE 11G	OTHER FEES FOR SERVICES 2,154,696 6,616,240 0 OUTSIDE PURCHASED SERVICES 12,016,876 8,074,161 0 PHYSICIAN FEES 12,231,245 0 0 TOTAL 26,402,817 14,690,401 0
FORM 990, PART XI, LINE 9	CHANGE IN MINIMUM PENSION LIABILITY (INCREASE) 752,102 BOOK/TAX DIFF. IN INC. FRM PARTNERSHIPS (DECREASE) -2,261,436 TRANSFER GRADY FARM TO DMF FOUNDATION (DECREASE) -10,305,316 VALUE OF FUNDS HELD IN TRUST (DECREASE) -67,673 TOTAL -11,882,323 THE NET RESULT OF ALL OF THESE OTHER CHANGES IN NET ASSETS IS A DECREASE OF 11,882,323.
FORM 990, PART XII	DECATUR MEMORIAL HOSPITAL WAS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF DECATUR MEMORIAL HOSPITAL AND AFFILIATED ORGANIZATION.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: DMH SERVES THE HEALTHCARE NEEDS OF THE PEOPLE OF CENTRAL ILLINOIS THROUGH OPERATION OF A 280-BED ACUTE CARE HOSPITAL AND RELATED FACILITIES PROVIDING COMPREHENSIVE INPATIENT, OUTPATIENT AND PHYSICIAN SERVICES. (SCHEDULE 0).
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	2,652
6	Total number of volunteers (estimate if necessary) .............	6	372
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	5,019,544
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	-5,493,318

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	5,208,353	4,533,258
9	Program service revenue (Part VIII, line 2g) .........	274,852,692	295,624,345
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	9,858,860	9,120,774
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	10,613,414	14,548,622
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	300,533,319	323,826,999
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	4,021,169	4,527,973
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)	152,055,195	162,213,451
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	171,031,812	167,051,102
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	327,108,176	333,792,526
19	Revenue less expenses. Subtract line 18 from line 12.......	-26,574,857	-9,965,527
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	327,107,746	304,698,433
21	Total liabilities (Part X, line 26).............	87,269,005	87,197,627
22	Net assets or fund balances. Subtract line 21 from line 20.....	239,838,741	217,500,806

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 133,419,865 including grants of $ 4,527,973 ) (Revenue $ 189,478,906 )
	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 38,000 VISITS TO DMH'S EMERGENCY CARE CENTER AND RECEIVED APPROXIMATELY 251,000 OUTPATIENT TESTS.

4b	(Code: ) (Expenses $ 61,285,879 including grants of $ ) (Revenue $ 87,036,374 )
	INPATIENT SERVICES: WITH 280 BEDS CURRENTLY IN SERVICE,DMH PROVIDED 42,776 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 2,600 IN ALL), INCLUDING HOSPITALISTS, NURSES, AIDES, DIETICIANS, CASE MANAGEMENT STAFF, SOCIAL WORKERS, AND CHAPLAINS.

4c	(Code: ) (Expenses $ 56,622,529 including grants of $ ) (Revenue $ 30,442,564 )
	PROFESSIONAL SERVICES: AS THE EMPLOYER OF 79 PHYSICIANS PLUS A COMPLEMENT OF OTHER PROVIDERS (PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS), DMH OFFERS A WIDE RANGE OF PROFESSIONAL PATIENT CARE AT APPROXIMATELY 30 OFFICES LOCATED THROUGHOUT THE SERVICE AREA. THESE SITES INCLUDE TWO "EXPRESS CARE" LOCATIONS OFFERING CARE FOR CASES THAT ARE TIME-SENSITIVE BUT NOT LIFE-THREATENING OR EMERGENT.

	(Code: ) (Expenses $ 128,047 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; HEALTH FAIRS; AND WOMEN AND CHILDREN'S HEALTH. 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 $ 128,047 including grants of $ ) (Revenue $ )
4e	Total program service expenses251,456,320

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	7,834,246	711,657	260,815

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	25,500
e	Government grants (contributions)		1e	3,093,018

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,414,740

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		4,533,258

		Business Code
2a	INPATIENT, OUTPATIENT, & PHYS	900099	295,624,345	295,624,345
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		295,624,345

3 Investment income (including dividends, interest, and othersimilar amounts) ......			5,467,449		2,613,680	2,853,769
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		1,262,641	6a
b	Less: rental expenses			6b
c	Rental income or (loss)		1,262,641	6c
d	Net rental income or (loss).......			1,262,641		453,382	809,259
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	26,945	9,105,980	7a
b	Less: cost or other basis and sales expenses	1,861	5,477,739	7b
c	Gain or (loss)	25,084	3,628,241	7c
d	Net gain or (loss).........			3,653,325			3,653,325
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a	774,682
b	Less: cost of goods sold ..		10b	461,555
c	Net income or (loss) from sales of inventory..			313,127		313,127
Business Code			Miscellaneous Revenue
11a	OTHER EXEMPT FUNCTION INCOME		900099	11,333,499	11,333,499
b	WELLNESS & COSMETIC SERVICES		900099	946,655		946,655
c	REFERENCE LABORATORY		541380	323,045		323,045
d	All other revenue ....			369,655		369,655
e	Total. Add lines 11a–11d ......			12,972,854
12	Total revenue. See instructions.....			323,826,999	306,957,844	5,019,544	7,316,353

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	4,527,973	4,527,973
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	2,891,813		2,891,813
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	3,218,304	3,218,304
7	Other salaries and wages........	125,553,720	101,181,520	24,372,200
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,885,667	1,519,626	366,041
9	Other employee benefits .......	20,239,781	16,310,881	3,928,900
10	Payroll taxes ...........	8,424,166	6,788,886	1,635,280
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	307,685		307,685
c	Accounting ...........	911,207		911,207
d	Lobbying ...........	89,391		89,391
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)	41,093,218	26,402,817	14,690,401
12	Advertising and promotion ....	892,784	568,764	324,020
13	Office expenses .......	55,509,253	52,294,686	3,214,567
14	Information technology ......	5,716,999	4,949,047	767,952
15	Royalties ..	10,445	10,445
16	Occupancy ...........	12,870,448	8,066,072	4,804,376
17	Travel ............	596,183	403,892	192,291
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	424,434	227,237	197,197
20	Interest ...........	744,023	466,289	277,734
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	17,387,767	10,179,626	7,208,141
23	Insurance ...	5,807,317	1,095,067	4,712,250
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	10,364,254	10,364,254
b	RELATED PARTY BAD DEBT	8,420,686		8,420,686
c	MISCELLANEOUS EXPENSE	5,905,008	2,880,934	3,024,074
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	333,792,526	251,456,320	82,336,206	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			8,555	1	8,330
2	Savings and temporary cash investments .........			7,938,127	2	7,491,930
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			50,486,105	4	44,074,402
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........			61,060,905	7	60,319,602
8	Inventories for sale or use ............			3,249,490	8	3,123,027
9	Prepaid expenses and deferred charges ......			2,848,863	9	3,224,123
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	450,414,773
b	Less: accumulated depreciation	10b	351,490,621	108,176,939	10c	98,924,152
11	Investments—publicly traded securities .			69,553,678	11	61,100,164
12	Investments—other securities. See Part IV, line 11 .....			371,504	12	262,991
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			5,499,462	14	5,499,462
15	Other assets. See Part IV, line 11 ...........			17,914,118	15	20,670,250
16	Total assets. Add lines 1 through 15 (must equal line 33)...			327,107,746	16	304,698,433

17	Accounts payable and accrued expenses .....	39,611,606	17	40,458,918
18	Grants payable ...		18
19	Deferred revenue .........	504,253	19	319,746
20	Tax-exempt bond liabilities .........	5,967,000	20	4,131,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	5,000,000	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	36,186,146	25	42,287,963
26	Total liabilities. Add lines 17 through 25..	87,269,005	26	87,197,627

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	239,838,741	32	217,500,806
33	Total liabilities and net assets/fund balances ........	327,107,746	33	304,698,433

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)ILLINOIS HEALTH AND SCIENCE 2300 N EDWARD ST DECATUR,IL625264163 37-1169606	SUPP. DMH	IL	501C3	12A	DMH		No
(2)DECATUR MEMORIAL FOUNDATION 2300 N EDWARD ST DECATUR,IL625264163 37-1169605	SUPP. DMH	IL	501C3	12A	DMH		No
(3)HEARTLAND RISK MANAGEMENT 2300 N EDWARD ST DECATUR,IL625264163 45-4256254	SUPP. DMH	AZ	501C3	12A	DMH		No

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) DECATUR MEMORIAL FOUNDATION	K	1,669,590	CASH PAYMENT
(2) DECATUR MEMORIAL FOUNDATION	O	223,843	CASH PAYMENT
(3) DECATUR MEMORIAL FOUNDATION	B	10,305,316	CASH PAYMENT
(4) HEARTLAND RISK MANAGEMENT	F	1,000,000	CASH PAYMENT
(5) HEARTLAND RISK MANAGEMENT	M	4,390,758	CASH PAYMENT
(6) DMH WORLDWIDE LTD	A	3,817,060	ACCRUED INTEREST
(7) DMH WORLDWIDE LTD	O	164,180	CASH PAYMENT
(8) DMH WORLDWIDE LTD	D	9,973,116	LOAN AMOUNT
(9) DMH WORLDWIDE LTD	J	741,304	CASH PAYMENT
(10) DMH WORLDWIDE LTD	P	2,298,755	CASH PAYMENT
(11) DMH WORLDWIDE LTD	S	24,000,000	LOAN CHARGE-OFF

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