Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
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 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 (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No









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

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance 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) 2014
Page 2
Schedule L (Form 990 or 990-EZ) 2014
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) HICKORY POINT BANK SEE PART V 2,131 INTEREST INCOME   No
(2) PEERLESS CLEANERS SEE PART V 110,422 CLEANING SERVICES   No
(3) CANCER CARE SPECIALISTS OF CENT IL SEE PART V 172,877 MED SERVICES   No
(4) CANCER CARE SPECIALISTS OF CENT IL SEE PART V 46,320 EMR SUPPORT REV   No
(5) BAKERS DOZEN LLC SEE PART V 584,973 OFFICE SPACE RENTAL   No
(6) PRAIRIE ONCOLOGY MANAGEMENT SERVICE SEE PART V 162,394 SUPPLY SALES   No
(7) ROY MOSSER SEE PART V 1,742,014 OFFICE SPACE RENTAL   No
(8) HICKORY POINT BANK SEE PART V 598,407 BANK FEES, INTEREST   No
(9) FIRST BUSEY CORP SUBSIDIARIES SEE PART V 193,722 BANK AND BOND FEES   No
(10) FIRST BUSEY CORP SUBSIDIARIES SEE PART V 8,696 INTEREST INCOME   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
SCHEDULE L, PART V PART IV, LINES 1(B)& 8(B): DIRECTOR KENNETH SMITHMIER IS ON THE HICKORY POINT BANK BOARD OF DIRECTORS. PART IV, LINE 2(B): DIRECTOR BRAD WIKE OWNS PEERLESS CLEANERS. PART IV, LINES 3(B), 4(B), 5(B), 6(B): DIRECTOR EDWARD ELLIOTT IS AN OWNER OF CANCER CARE SPECIALISTS OF CENTRAL ILLINOIS, BAKER'S DOZEN, LLC., AND PRAIRIE ONCOLOGY MANAGEMENT SERVICES. PART IV, LINE 7(B): ROY MOSSER IS A DIRECTOR OF DMH. PART IV, LINE 9(B)& 10(B): DIRECTOR JOHN FUNK IS A DIRECTOR OF FIRSTECH, INC WHICH IS A SUBSIDIARY OF BUSEY BANK AND BUSEY BANK IS A SUBSIDIARY OF FIRST BUSEY CORPORATION.
Schedule L (Form 990 or 990-EZ) 2014


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