Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990.

SchKMediumBulletInformation about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
MEMORIAL HEALTH SYSTEM
 
Employer identification number
37-1110690
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer
(i) Pool
financing
Yes No Yes No Yes No
A ILLINOIS HEALTH FACILITIES AUTHORITY
 
36-2780046 45200P2U4 12-17-2003 31,000,000 SEE PART VI   X   X   X
B ILLINOIS FINANCE AUTHORITY
 
86-1091967 45200FJ59 12-22-2009 147,401,639 SEE PART VI   X   X   X
C ILLINOIS FINANCE AUTHORITY
 
86-1091967 45203HYQ9 01-30-2014 60,465,495 SEE PART VI   X   X   X
D ILLINOIS FINANCE AUTHORITY
 
86-1091967   05-15-2014 60,000,000 SEE PART VI   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired .................. 9,730,000 3,765,000    
2 Amount of bonds legally defeased ..............        
3 Total proceeds of issue .................. 31,100,606 147,556,074 60,471,350 60,000,000
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds .............        
6 Proceeds in refunding escrows ...............        
7 Issuance costs from proceeds ............... 329,438 1,350,000    
8 Credit enhancement from proceeds ............. 110,306      
9 Working capital expenditures from proceeds .............        
10 Capital expenditures from proceeds ............. 19,254,302 146,206,074 60,471,350 60,000,000
11 Other spent proceeds ............. 11,406,560      
12 Other unspent proceeds .............        
13 Year of substantial completion ............. 2004 2011 2015 2015
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? .... X     X   X   X
15 Were the bonds issued as part of an advance refunding issue? .....   X   X   X   X
16 Has the final allocation of proceeds been made? .......... X   X     X   X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ............... X   X     X   X
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2014
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Schedule K (Form 990) 2014
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? X   X          
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? X   X          
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet 0 % 0 % 0 % 0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet 0.340 % 1.840 % 0 % 0 %
6 Total of lines 4 and 5 ............. 0.340 % 1.840 % 0 % 0 %
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 .......... US BANCORP PIPER
JAFFRAY FINANCIAL
 
 
 
 
 
 
c Term of hedge ......... 1880.0000000000 %      
d Was the hedge superintegrated? ......   X            
e Was the hedge terminated? ........   X            
Schedule K (Form 990) 2014
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Schedule K (Form 990) 2014
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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 SUPPLENTAL INFORMATION SCHEDULE K: ONE SCHEDULE K WAS COMPLETED AT THE PARENT LEVEL ONLY. HOWEVER, EACH AFFILIATE IS STILL SHOWING ITS ALLOCATION OF THE LIABILITY ON THE BALANCE SHEET, AS CAN BE SEEN ON THE GROUP RETURN. SCHEDULE K PART I, COLUMN (F) CONTINUATIONS: ONE PURPOSE OF THE 2003 ISSUE WAS TO CURRENT REFUND $10,980,000 OF THE 1993 SERIES BONDS ISSUED ON 8/5/93 IN THE AMOUNT OF $21,245,000. PROCEEDS WERE ALSO USED TO PAY ISSUANCE EXPENSES AND TO PURCHASE EQUIPMENT AND SOFTWARE FOR MEMORIAL HEALTH SYSTEM. PROCEEDS WERE ALSO USED FOR CONSTRUCTION AND HEALTHCARE BUILDING IMPROVEMENTS AND TO CONSTRUCT AND EQUIP AN OUTPATIENT PSYCHIATRIC FACILITY. THE PURPOSE OF THE 2009 ISSUE WAS TO PAY ISSUANCE COSTS, CONSTRUCT AND EQUIP A REPLACEMENT HOSPITAL FACILITY FOR ABRAHAM LINCOLN MEMORIAL HOSPITAL, RENOVATE AND REMODEL TAYLORVILLE MEMORIAL HOSPITAL, RENOVATE, REMODEL, AND EQUIP MEMORIAL MEDICAL CENTER, CONSTRUCT A PARKING GARAGE ADJACENT TO MEMORIAL MEDICAL CENTER, CONSTRUCT AND EQUIP A WOUND CARE CENTER, RENOVATE A PAIN CLINIC, CONSTRUCT AND EQUIP A CONSOLIDATED IMAGING SERVICES AREA, PURCHASE VARIOUS PARCELS OF REAL PROPERTY IN SPRINGFIELD, IL AND TAYLORVILLE, IL FOR FUTURE EXPANSION OF EXISTING FACILITIES, CONSTRUCT AND EQUIP A SPACE FOR PHYSICAL THERAPY OWNED BY MEMORIAL MEDICAL CENTER AND LOCATED WITHIN THE NEW YMCA IN SPRINGFIELD, IL, AND ROUTINE CAPITAL EXPENDITURES. THE PURPOSE OF THE 2014A ISSUE WAS (A) TO REPAY TAXABLE DEBT IN THE AMOUNT OF $25,057,493 USED FOR PAYMENT OF THE COST OF ACQUIRING, CONSTRUCTING, RENOVATING, REMODELING AND EQUIPPING HEALTH FACILITIES AT MEMORIAL MEDICAL CENTER, AND (B) FOR PAYING ADDITIONAL COSTS OF THOSE PROJECTS NOT PREVIOUSLY FINANCED WITH THE TAXABLE DEBT. THE PURPOSE OF THE 2014B ISSUE WAS FOR THE PAYMENT OF ACQUIRING, CONSTRUCTING, RENOVATING, REMODELING AND EQUIPPING HEALTH FACILTIES AT MEMORIAL MEDICAL CENTER. SCHEDULE K PART II, LINE 3: TOTAL PROCEEDS ISSUED AMOUNT IN COLUMNS A, B, & C DOESN'T TIE TO PART I COLUMN (E) DUE TO INVESTMENT EARNINGS INCLUDED IN PART II, LINE 3. SCHEDULE K PART III, LINE 3B & 3D: MEMORIAL HEALTH SYSTEM'S INTERNAL COUNSEL, AS WELL AS EXTERNAL BOND COUNSEL, ROUTINELY REVIEWS MANAGEMENT AND SERVICE CONTRACTS AND RESEARCH AGREEMENTS RELATING TO FINANCED PROPERTY . SCHEDULE K PART IV, LINE 1: THE ARBITRAGE REBATE FILING IS ONLY REQUIRED EVERY 5 YEARS, AND NO REBATABLE ARBITRAGE HAS BEEN EARNED FOR ISSUES AT SUCH 5 YEAR ANNIVERSARIES. SCHEDULE K PART IV, LINE 2C: THE REBATE COMPUTATION FOR COLUMN A WAS PERFORMED ON 12/17/2013. THE REBATE COMPUTATION FOR COLUMN B WAS PERFORMED ON 12/22/2014, AND NO REBATABLE ARBITRAGE HAS BEEN EARNED FOR THESE ISSUES AT SUCH 5 YEAR ANNIVERSARIES. SCHEDULE K PART IV, LINE 4B: THE PROVIDER'S FULL NAME FOR COLUMN A IS U.S. BANCORP PIPER JAFFRAY FINANCIAL PRODUCTS INC.
Schedule K (Form 990) 2014

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