Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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. | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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 | ||||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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.) | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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 on 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.).. | ||||||
| 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 0.015 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 0.035 | 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 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2024 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2024 |
(iii) Distributable Amount for 2024 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2024 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI).
See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2024: | ||||
| a From 2019....... | ||||
| b From 2020....... | ||||
| c From 2021....... | ||||
| d From 2022....... | ||||
| e From 2023....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2024 distributable amount | ||||
|
i
Carryover from 2019 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2024 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2024 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2024, 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 2024. 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 2025. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2020..... | ||||
| b Excess from 2021..... | ||||
| c Excess from 2022..... | ||||
| d Excess from 2023..... | ||||
| e Excess from 2024..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
|---|---|
| PART III LINE 1 | FHN IS REGIONAL HEALTHCARE SYSTEM COMMITTED TO THE HEALTH AND WELL-BEING OF THE PEOPLE OF NORTHWEST ILLINOIS AND SOUTHERN WISCONSIN. WE HAVE SERVICES FOR ALL AGES, SO EVERY MEMBER OF YOUR FAMILY CAN RECEIVE CARING, PERSONAL, PROFESSIONAL HEALTHCARE. AN AVERAGE OF 1,494 PEOPLE VISIT FHN EACH DAY FOR THEIR HEALTHCARE NEEDS (THAT'S MORE THAN 547,000 PATIENTS PER YEAR). FHN IS THE ONLY HEALTHCARE PROVIDER IN OUR SERVICE AREA THAT OFFERS AFFILIATIONS WITH THREE MAJOR HOSPITALS IN ROCKFORD, ILLINOIS, AS WELL AS WITH THE UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS IN MADISON, WISCONSIN. WE SEE EACH PATIENT INTERACTION AS A SERIOUS RESPONSIBILITY THAT REQUIRES CLINICAL EXPERTISE, ACCESS TO THE LATEST IN MEDICAL TECHNOLOGY AND A LEVEL OF TRUST AND COMMITMENT THAT IS EARNED BY OUR PEOPLE, OUR PRODUCTS AND OUR PROCESS. ABOUT FHN MEMORIAL HOSPITAL: 100 LICENSED BED. 24-HOUR EMERGENCY CARE. EICU UNIT, LINKING OUR EXPERIENCED, CARING STAFF ROUND-THE-CLOCK WITH THE UNIVERSITY OF WISCONSIN E-CARE TEAM OF PROFESSIONAL INTENSIVISTS AND CRITICAL CARE NURSES. SATELLITE EDUCATION CENTER FOR THE ILLINOIS POISON CONTROL CENTER (ONE OF ONLY 12 IN THE STATE OF ILLINOIS). OVER 75 PHYSICIANS ON THE ACTIVE AND ASSOCIATED MEDICAL STAFF - 100% ARE BOARD-CERTIFIED OR BOARD-ELIGIBLE. UP-TO-THE-MINUTE EQUIPMENT AND SERVICES, INCLUDING A CARDIOVASCULAR CENTER. SURGERY CAPABILITIES FOR PROCEDURES RANGING FROM A SIMPLE TONSILLECTOMY TO SOPHISTICATED VASCULAR SURGERY. SPECIALTY SERVICE AREAS SUCH AS SLEEP CENTER, PAIN CLINIC, SPINE CENTER AND FAMILY BIRTHING CENTER. AS PART OF YOUR COMMUNITY, WE WILL PROVIDE PERSONAL, PROFESSIONAL AND CARING HEALTHCARE FOR YOUR ENTIRE FAMILY. WE WILL PROVIDE OR FIND SERVICES YOU NEED TO MAKE YOUR LIFE BETTER. WE WILL FOLLOW THROUGH AND MAKE SURE YOU ARE SATISFIED. WE ARE COMMITTED TO EXCELLENCE AND YOUR WELL-BEING IS THE REASON FOR OUR EXISTENCE. WE ARE PART OF YOUR COMMUNITY. AND WE WANT TO KEEP IT HEALTHY, BOTH ECONOMICALLY AND PHYSICALLY, AT WORK, AT PLAY, ON THE FARM, AT SCHOOL AND AT HOME. IN 2006, WE FORMED A PARTNERSHIP WITH THE STEPHENSON COUNTY HEALTH DEPARTMENT TO PROVIDE HEALTHCARE SERVICES FOR THE UNINSURED, UNDERINSURED AND MEDICALLY INDIGENT AT THE FHN COMMUNITY HEALTHCARE CENTER, LOCATED AT THE FORMER CRUSADER COMMUNITY CLINIC INSIDE THE HEALTH DEPARTMENT BUILDING. AND IN SUPPORT OF THE LOCAL UNITED WAY, EACH YEAR OUR EMPLOYEES MAKE THEIR PERSONAL CONTRIBUTIONS, AVERAGING OVER $15,000, AND ALSO SERVE IN LEADERSHIP POSITIONS FOR MANY COMMUNITY ORGANIZATIONS AND BOARDS. FHN IS A COMMUNITY HEALTHCARE SYSTEM, COMPRISED OF LOCAL EXPERTS, INSPIRED BY GLOBAL INNOVATION AND GROUNDED BY ETHICAL LEADERSHIP. FREEPORT MEMORIAL HOSPITAL COORDINATES AND INTEGRATES MEDICAL CARE SERVICES AND PROVIDES INDIVIDUALS IMPARTIAL ACCESS TO MEDICAL CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, OR SOURCE OF PAYMENT. THE HOSPITAL PROVIDES MEDICALLY NECESSARY CARE TO PATIENTS REGARDLESS OF ABILITY TO PAY. THE HOSPITAL QUALIFIES AS A MEDICARE DISPROPORTIONATE SHARE HOSPITAL BECAUSE IT SERVES A DISPROPORTIONATELY HIGH NUMBER OF LOW INCOME PATIENTS. INSURED AND UNDERINSURED PATIENTS, WHO MEET CERTAIN FEDERAL POVERTY GUIDELINES AND/OR OTHER UNIQUE CIRCUMSTANCES, ARE PROVIDED FREE OR DISCOUNTED CARE AFTER A NOMINAL CO-PAYMENT. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE AMOUNT OF CHARITY CARE IT PROVIDES. DURING 2024, THE CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THE HOSPITAL'S CHARITY CARE POLICY WAS $2,659,632 AT A COST OF $596,150. FREEPORT MEMORIAL HOSPITAL IS A LICENSED MEDICARE AND MEDICAID PROVIDER WITH APPROXIMATELY 75% OF ITS PATIENT BASE QUALIFYING FOR AT LEAST ONE OF THESE PROGRAMS. AT PRESENT, THE REIMBURSEMENT RATES FOR BOTH PROGRAMS DO NOT FULLY COVER THE COST OF CARE TO THESE PATIENTS. THE ESTIMATED UNFUNDED COSTS OF SERVICES FOR MEDICAID PATIENTS WERE APPROXIMATELY $9,694,045 FOR THE YEAR ENDING 12/31/2024. MEDICARE PAYMENTS WERE APPROXIMATELY $13,424,896 LESS THAN THE HOSPITAL'S COST TO PROVIDE CARE DURING THE SAME PERIOD. IN ADDITION, THE COST OF CARE PROVIDED TO PEOPLE WHO DID NOT PAY WAS $2,741,058 IN 2024. FREEPORT MEMORIAL HOSPITAL PROVIDES DISCOUNTS TO UNINSURED PATIENTS WITHOUT REGARD TO THEIR INCOME. THE ESTIMATED COSTS ATTRIBUTABLE TO THE DISCOUNTED PORTION OF THESE SERVICES WERE $384,131 FOR 2024. FREEPORT MEMORIAL HOSPITAL AND ITS RELATED ORGANIZATIONS SUPPORT AND PARTICIPATE IN MANY COMMUNITY SERVICES AND OUTREACH PROGRAMS, INCLUDING SUPPORT FOR COMMUNITY HEALTH EDUCATION PROGRAMS, COMMUNITY-BASED CLINICAL SERVICES, HEALTH PROFESSIONAL EDUCATION, RESEARCH, SPONSORSHIP OF COMMUNITY EVENTS, AND COMMUNITY-BUILDING ACTIVITIES. THE HOSPITAL CONTRIBUTED $653,000 TOWARDS THESE PROGRAMS IN 2024. PROGRAM SERVICE EXPENSES: $153,141,018. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION'S AUDIT COMMITTEE REVIEWS THE FORM 990 BEFORE THE TAX RETURN IS FILED. QUESTIONS AND EXPLANATIONS ARE ANSWERED BY THE FINANCE DEPARTMENT TO THE COMMITTEE'S SATSIFACTION. THE BOARD REVIEWS ALL TRANSACTIONS THAT AFFECT THE FILING OF THE ORGANIZATION'S FORM 990 AND EQUIVALENT STATE RETURNS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION HAS A DEDICATED CORPORATE COMPLIANCE OFFICER. ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE ANNUALLY A CONFLICT OF INTEREST QUESTIONNAIRE. THESE DOCUMENTS ARE REVIEWED BY THE CCO TO DETERMINE IF ANY INDIVIDUAL HAS A CONFLICT OF INTEREST THAT NEEDS TO BE ADDRESSED. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION HAS AN EXECUTIVE COMPENSATION COMMITTEE THAT REVIEWS THE CEO, TOP MANAGEMENT AND EXECUTIVE DIRECTORS COMPENSATION. THE COMMITTEE RELIES ON INTERNAL AND EXTERNAL INFORMATION TO DETERMINE THE APPROPRIATE COMPENSATION AND EMPLOYS AN INDEPENDENT THIRD PARTY TO CONDUCT THE ANNUAL EXECUTIVE COMPENSATION ANALYSIS. THIS ANALYSIS IS USED TO DETERMINE IF THE BOARD'S WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY HAS BEEN MET. THE EXECUTIVE COMPENSATION COMMITTEE ALSO RECEIVES A REASONABLENESS LETTER FROM THE THIRD PARTY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 24E | BAD DEBTS: PROGRAM SERVICE EXPENSES 11,292,455. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,292,455. SUPPLIES: PROGRAM SERVICE EXPENSES 10,552,442. MANAGEMENT AND GENERAL EXPENSES 204,264. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,756,706. PROVIDER TAX: PROGRAM SERVICE EXPENSES 6,087,260. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,087,260. AGENCY STAFFING: PROGRAM SERVICE EXPENSES 4,872,702. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,872,702. MAINTENANCE & REPAIRS: PROGRAM SERVICE EXPENSES 3,408,619. MANAGEMENT AND GENERAL EXPENSES 213,090. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,621,709. EQUIPMENT RENTALS: PROGRAM SERVICE EXPENSES 1,121,794. MANAGEMENT AND GENERAL EXPENSES 20,389. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,142,183. COLLECTION FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 857,391. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 857,391. FOOD: PROGRAM SERVICE EXPENSES 206,225. MANAGEMENT AND GENERAL EXPENSES 13,391. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 219,616. BANK AND CREDIT CARD FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 102,619. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 102,619. MISC OTHER EXPENSES: PROGRAM SERVICE EXPENSES -237,422. MANAGEMENT AND GENERAL EXPENSES 46,875. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -190,547. |
| FORM 990, PART XI, LINE 9: | TRANSFERS FROM AFFILIATE -24,472,251. NET ASSETS RELEASED FROM TEMP RESTRICTIONS -698,029. CONTRIBUTIONS TEMPORARY RESTRICTED 819,915. |
| Software ID: | |
| Software Version: |