Shelby Memorial Hospital in Shelbyville, Illinois (IL)

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Shelby Memorial Hospital
Employer Identification Number (EIN)370512290
Name of OrganizationShelby Memorial Hospital
In Care of NamePhilip Miller
Address200 S Cedar St, Shelbyville, IL 62565-1838
ActivitiesHospital
SubsectionCharitable Organization
Ruling Date10/1947
DeductibilityContributions are deductible
FoundationHospital or medical research organization
OrganizationAssociation
Exempt Organization StatusUnconditional Exemption
Tax Period08/2014
Assets$10,000,000 to $49,999,999
Income$10,000,000 to $49,999,999
Filing Requirement990 (all other) or 990EZ return
Asset Amount$34,787,432
Amount of Income$24,557,011
Form 990 Revenue Amount$18,744,549
National Taxonomy of Exempt Entities (NTEE)Health - General and Rehabilitative: Hospital, General


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Amount of income in 2014: $24,557,011 (it was $15,067,231 in 2013)
Shelby Memorial Hospital: 

 $24,557,011
Other organizations performing similar types of work: 

 $17,721,162

Assets in 2014: $34,787,432 (it was $36,712,554 in 2013)
This organization: 

 $34,787,432
Other organizations performing similar types of work: 

 $15,703,352

Expenses in 2013: $18,219,756
This organization: 

 $18,219,756
Other organizations performing similar types of work: 

 $16,206,641

Income to expenses ratio in 2013: 1.3
Shelby Memorial Hospital: 

 1.3
Other organizations performing similar types of work: 

 1.2

Number of employees in 2013: 233
This organization: 

 233
Other organizations performing similar types of work: 

 197

Employees paid over $100,000 in 2013: 4.3%
This organization: 

 4.3%
Other organizations performing similar types of work: 

 0.0%

Grants share in income in 2013: 1.7%
Shelby Memorial Hospital: 

 1.7%
Other organizations performing similar types of work: 

 0.5%

Financial snapshot ($)

Revenue for 2013

Assets at the end of 2013

Functional expenses for 2013

Checklist
20122013
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)?NoNo
Is the organization required to complete Schedule B, Schedule of Contributors?YesYes
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office?NoNo
Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year?NoNo
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19?NoNo
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts?NoNo
Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or historic structures?NoNo
Did the organization maintain collections of works of art, historical treasures, or other similar assets?NoNo
Did the organization report an amount for escrow or custodial account liability; serve as a custodian or provide credit counseling, debt management, credit repair, or debt negotiation services?NoNo
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments?NoNo
Did the organization report an amount for land, buildings, and equipment?YesYes
Did the organization report an amount for investments-other securities that is 5% or more of its total assets?NoNo
Did the organization report an amount for investments-program related that is 5% or more of its total assets?NoNo
Did the organization report an amount for other assets that is 5% or more of its total assets?NoNo
Did the organization report an amount for other liabilities?YesYes
Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses the organization's liability for uncertain tax positions under FIN 48 (ASC 740)?NoNo
Did the organization obtain separate, independent audited financial statements for the tax year?NoNo
Was the organization included in consolidated, independent audited financial statements for the tax year?YesYes
Is the organization a school described in section 170(b)(1)(A)(ii)?NoNo
Did the organization maintain an office, employees, or agents outside of the United States?NoNo
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more?NoNo
Did the organization report more than $5,000 of grants or other assistance to or for any foreign organization?NoNo
Did the organization report more than $5,000 of aggregate grants or other assistance to or for foreign individuals?NoNo
Did the organization report a total of more than $15,000 of expenses for professional fundraising services?NoNo
Did the organization report more than $15,000 total of fundraising event gross income and contributions?NoNo
Did the organization report more than $15,000 of gross income from gaming activities?NoNo
Did the organization operate one or more hospital facilities?YesYes
Did the organization attach a copy of its audited financial statements?YesYes
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government?NoNo
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals?NoNo
Did the organization answer 'Yes' about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees?YesYes
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002?YesYes
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?NoNo
Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bonds?NoNo
Did the organization act as an 'on behalf of' issuer for bonds outstanding at any time during the year?NoNo
Did the organization engage in an excess benefit transaction with a disqualified person during the year?NoNo
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ?NoNo
Did the organization report any amount for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons?NoNo
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons?NoNo
Was the organization a party to a business transaction with one of the following parties
A current or former officer, director, trustee, or key employee?NoNo
A family member of a current or former officer, director, trustee, or key employee?NoNo
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner?NoNo
Did the organization receive more than $25,000 in non-cash contributions?NoNo
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions?NoNo
Did the organization liquidate, terminate, or dissolve and cease operations?NoNo
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets?NoNo
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3?NoNo
Was the organization related to any tax-exempt or taxable entity?YesYes
Did the organization have a controlled entity within the meaning of section 512(b)(13)?YesYes
Did the organization make any transfers to an exempt non-charitable related organization?NoNo
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes?NoNo
Statements Regarding Other IRS Filings and Tax Compliance
201120122013
The number reported in Box 3 of Form 10962020
The number of Forms W-2G00
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners?YesYes
The number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, filed for the calendar year ending with or within the year covered by this return224233
Did the organization file all required federal employment tax returns?YesYes
Did the organization have unrelated business gross income of $1,000 or more during the year?YesYesYes
Has it filed a Form 990-T for this year?YesYes
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?NoNo
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?NoNo
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?NoNo
Did the organization file Form 8886-T?NoNo
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?NoNo
Did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?NoNo
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?NoNo
Did the organization notify the donor of the value of the goods or services provided?NoNo
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?NoNo
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?NoNo
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?NoNo
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?NoNo
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?NoNo
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?NoNo
Did the sponsoring organization make any taxable distributions under section 4966?NoNo
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?NoNo
Initiation fees and capital contributions$0$0$0
Gross receipts for public use of club facilities $0$0$0
Gross income from members or shareholders$0$0$0
Gross income from other sources$0$0$0
Is the organization filing Form 990 in lieu of Form 1041?NoNo
The amount of tax-exempt interest received or accrued during the year$0$0
Is the organization licensed to issue qualified health plans in more than one state?NoNo
The amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans$0$0
The amount of reserves on hand$0$0
Did the organization receive any payments for indoor tanning services during the tax year?NoNo
Has it filed a Form 720 to report these payments?NoNo
Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
20122013
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
Total reportable compensation from the organization$905,861$1,071,037
Total reportable compensation from related organizations$0$0
Total estimated amount of other compensation from the organization and related organizations$70,632$65,028
Total number of individuals who received more than $100,000 of reportable compensation from the organization56
Total number of independent contractors who received more than $100,000 of compensation from the organization44
Statement of Revenue
201120122013
Total revenue$18,578,360$18,135,816$15,067,231
Contributions, Gifts, Grants and Other Similar Amounts$58,636$479,669$260,553
Program Service Revenue$17,172,953$16,837,398$14,008,447
621110$15,630,521$13,194,582
All Other Health and Personal Care Stores $54,937$93,704
900099$56,753$56,074
900099$1,095,187$664,087
All other program service revenue$0$0
Other Revenue
Investment income (including dividends, interest, and other similar amounts)$550,942$571,144$513,217
Income from investment of tax-exempt bond proceeds$0$0$0
Royalties$0$0$0
Net rental income$161,238$174,803$188,700
Gross rents (Real / Personal)$175,178 / $0$175,069 / $0$188,700 / $0
Less: rental expenses (Real / Personal)$13,940 / $0$266 / $0$0 / $0
Rental income or (loss) (Real / Personal)$161,238 / $0$174,803 / $0$188,700 / $0
Net gain/loss from sales of assets other than inventory$595,458$28,745$30,183
Gross amount from sales of assets other than inventory (Securities / Other)$3,652,784 / $2,900$6,013,217 / $0$4,777,804 / $0
Less: cost or other basis and sales expenses (Securities / Other)$3,060,226 / $0$5,983,807 / $665$4,747,621 / $0
Gain or (loss) (Securities / Other)$592,558 / $2,900$29,410 / $-665$30,183 / $0
Net income/loss from fundraising events$0$0$0
Net income/loss from gaming activities$0$0$0
Net income/loss from sales of inventory$0$0$0
Miscellaneous Revenue$39,133$44,057$66,131
Caterers$1,401$1,890
722100$40,894$64,241
All other revenue$0$0
Statement of Functional Expenses
201120122013
Total functional expenses$16,906,535$17,675,063$18,219,756
Grants and other assistance to domestic organizations and domestic governments$0$0
Grants and other assistance to domestic individuals$0$0
Grants and other assistance to foreign organizations, foreign governments, and foreign individuals$0$0
Benefits paid to or for members$0$0
Compensation of current officers, directors, trustees, and key employees$516,866$343,200$309,371
Compensation not included above, to disqualified persons$0$0
Other salaries and wages$5,975,096$6,454,017$6,591,852
Pension plan accruals and contributions$217,695$237,046
Other employee benefits$644,808$1,496,266
Payroll taxes$447,096$441,868$474,503
Fees for services (non-employees)
Management$0$0
Legal$14,240$10,076
Accounting$80,668$107,885
Lobbying$0$0
Professional fundraising services$0$0$0
Investment management fees$0$0
Other$2,104,402$2,202,562
Advertising and promotion$222,718$185,318
Office expenses$2,103,837$2,001,896
Information technology$0$0
Royalties$0$0
Occupancy$294,210$292,257
Travel$57,756$59,751
Payments of travel or entertainment expenses for any federal, state, or local public officials$0$0
Conferences, conventions, and meetings$0$0
Interest$243,155$455,244
Payments to affiliates$0$0
Depreciation, depletion, and amortization$948,780$1,303,937
Insurance$265,976$276,371
Other expenses$2,391,438$1,401,223
Other expenses$251,526$276,358
Other expenses$132,123$108,997
Other expenses$137,654$67,172
Other expenses$324,992$361,671
Balance Sheet
201120122013
Total assets$36,837,824$38,678,995$36,712,554
Cash - non-interest-bearing$66,362$68,417
Savings and temporary cash investments$6,857$0
Pledges and grants receivable, net$178,325$0
Accounts receivable, net$4,315,608$3,261,933
Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees$0$0
Loans and other receivables from other disqualified persons, persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations$0$0
Notes and loans receivable, net$432,000$246,004
Inventories for sale or use$164,502$154,670
Prepaid expenses and deferred charges$254,281$283,267
Land, buildings, and equipment: cost or other basis$12,215,816$11,596,789
Investments - publicly traded securities$20,690,473$20,676,298
Investments - other securities$4,356$4,356
Investments - program-related$21,719$20,000
Intangible assets$0$0
Other assets$328,696$400,820
Total liabilities$11,175,834$11,406,938$11,226,849
Accounts payable and accrued expenses$1,365,610$1,770,845
Grants payable$0$0
Deferred revenue$0$0
Tax-exempt bond liabilities$9,000,000$8,700,000$8,400,000
Escrow or custodial account liability$0$0
Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified persons$0$0
Secured mortgages and notes payable to unrelated third parties$0$0$0
Unsecured notes and loans payable to unrelated third parties$0$432,000$500,000
Other liabilities (including federal income tax, payables to related third parties, and other liabilities)$909,328$556,004
Total net assets or fund balances$25,661,990$27,272,057$25,485,705
Unrestricted net assets$27,172,057$25,385,705
Temporarily restricted net assets$60,000$60,000
Permanently restricted net assets$40,000$40,000
Capital stock or trust principal, or current funds$0$0
Paid-in or capital surplus, or land, building, or equipment fund$0$0
Retained earnings, endowment, accumulated income, or other funds$0$0$0
Reason for Public Charity Status (for 2013)
The organization is not a private foundation because it is:A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii)
Number of organizations supported0
Sum of amounts of support$0
Unrelated Trade or Business Income (for 2009)
IncomeExpensesNet
Total$96,857$0$96,857
Gross receipts or sales less returns and allowances$204,642$0$0
Cost of goods sold$107,785$0$0
Gross profit$96,857$0$96,857
Capital gain net income$0$0$0
Net gain$0$0$0
Capital loss deduction for trusts$0$0$0
Income (loss) from partnerships and S corporations$0$0$0
Rent income$0$0$0
Unrelated debt-financed income$0$0$0
Interest, annuities, royalties, and rents from controlled organizations$0$0$0
Investment income of a section 501(c)(7), (9), or (17) organization$0$0$0
Exploited exempt activity income$0$0$0
Advertising income$0$0$0
Other income$0$0$0
Deductions Not Taken Elsewhere (for 2009)
Total deductions$159,795
Compensation of officers, directors, and trustees$32,050
Salaries and wages$77,535
Repairs and maintenance$0
Bad debts$5,129
Interest$0
Taxes and licenses$0
Charitable contributions$0
Depreciation$0
Depletion$0
Contributions to deferred compensation plans$0
Employee benefit programs$0
Excess exempt expenses$0
Excess readership costs$0
Other deductions$45,081
Unrelated business taxable income$-62,938
Unrelated business taxable income before net operating loss deduction$-62,938
Net operating loss deduction$0
Unrelated business taxable income before specific deduction$-62,938
Specific deduction$0
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1Rush University Medical Center1700 W Van Buren Room 150, Chicago, IL 60612-5500IL1960-03$3,329,482,073
2Northwestern Memorial Healthcare, Northwestern Memorial Hospital251 E Huron St, Chicago, IL 60611-2908IL2011-06$1,292,955,049
3Northwestern Memorial Healthcare, Northwestern Lake Forest Hospital660 N Westmoreland Rd, Lake Forest, IL 60045-1659IL2011-06$223,254,140
4St Lukes - St Vincents Healthcareinc4205 Belfort Rd Ste 4015, Jacksonville, FL 32216-3623FL1946-03$180,178,901
5Illinois Valley Community Hospital925 West St, Peru, IL 61354-2757IL2015-02$79,781,655
6Northwestern Memorial Healthcare, Northwestern Memorial Foundation251 E Huron 541 N Fairbanks, Chicago, IL 60611-3309IL2011-06$69,709,701
7Rochelle Community Hospital Association900 N 2nd St, Rochelle, IL 61068-1764IL1967-08$32,358,140
8Sharp Healthcare Foundation8695 Spectrum Center Blvd, San Diego, CA 92123-1489CA1980-07$27,646,995
9Tioga Medical CenterPO BOX 159, Tioga, ND 58852-0159ND1960-07$11,541,525
10San Gorgonio Pass Memorial Hospital District600 N Hglnd Spgs Ave, Banning, CA 92220-3090CA1985-03$10,551,951
11Northwestern Memorial Healthcare, Group251 E Huron 541 N Fairbanks, Chicago, IL 60611IL2011-06$1,885,329,845
12Northwestern Memorial Healthcare251 E Huron 541 Fairbanks Ste 2500, Chicago, IL 60611IL2011-06$861,879,702
13Advocate Health Care Network, Advocate Condell Medical Center3075 Highland Pkwy Fl 6, Downers Grove, IL 60515-5563IL1988-09$362,812,415
14Genesis Medical Center Aledo409 Nw 9th Avenue, Aledo, IL 61231IL2014-04$7,789,761
15Lake Tanganyika Floating Health Clinic1646 N Leavitt St, Chicago, IL 60647-5410IL2010-12$1,304,246
16North Chicago Health Center1809 Sheridan Rd, North Chicago, IL 60064IL2010-05$35,990
17Chicago Plastic Surgery Research Foundation9000 Waukegan, Morton Grove, IL 60053IL2009-05$1,500
18Brain Empowerment Inc2747 Wendy Dr Box 4, Naperville, IL 60565-5318IL2009-06$0
19Himalayan Health Center5 S Wabash Ave Ste 1320, Chicago, IL 60603-3116IL2007-01$0
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Number of organizations performing similar types of work
Alaska1
Alabama5
Arkansas8
Arizona6
California42
Colorado11
Connecticut7
District of Columbia1
Delaware1
Florida25
Georgia14
Hawaii3
Iowa10
Idaho2
Illinois25
Indiana21
Kansas10
Kentucky8
Louisiana4
Massachusetts13
Maryland8
Maine7
Michigan15
Minnesota12
Missouri15
Mississippi14
Montana9
North Carolina23
North Dakota10
Nebraska10
New Jersey10
New Mexico2
Nevada4
New York36
Ohio13
Oklahoma10
Oregon11
Pennsylvania22
Rhode Island1
South Carolina6
South Dakota6
Tennessee8
Texas24
Utah4
Virginia13
Vermont4
Washington15
Wisconsin24
West Virginia6
Wyoming2
International5
Total566

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