HSHS GOOD SHEPHERD HOSPITAL INC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- HSHS GOOD SHEPHERD HOSPITAL INC (EIN 37-0512290)
- Tax period
- 2022-07-01 to 2023-06-30
- Filed
- 2024-05-10
- IRS object ID
- 202441319349304394
- Schema version
- 2022v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-05-10T17:00:28+00:00 | ReturnTs |
| Tax Period End | 2023-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 350921680 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 West Wacker Drive Suite 2600 | AddressLine1Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 606061224 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 370512290 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HSHS Good Shepherd Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HSHS | BusinessNameControlTxt |
| Phone | 2177743961 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 South Cedar Street | AddressLine1Txt |
| City | Shelbyville | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62565 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Patricia Allen | PersonNm |
| Person Title | System CFO for Care Delivery | PersonTitleTxt |
| Signature | 2024-05-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Patricia | PersonFirstNm |
| Person Last | Allen | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Mallory Fairless | PreparerPersonNm |
| PTIN | P01321579 | PTIN |
| Phone | 3128997000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Chad Markham | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 South Cedar Street | AddressLine1Txt |
| City | Shelbyville | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62565 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $17,501,515 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.hshs.org/goodshepherd | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1916 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | TO MAINTAIN AND IMPROVE THE QUALITY OF LIFE OF THE PEOPLE IN THIS SERVICE AREA THROUGH THE PROVISION OF QUALITY HEALTH CARE PROGRAMS, SERVICES, EQUIPMENT AND PERSONAL CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 87 | TotalEmployeeCnt |
| Total Volunteers | 5 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,229,788 | PYContributionsGrantsAmt |
| CY Contributions Grants | $365,450 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,495,463 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $16,797,149 | CYProgramServiceRevenueAmt |
| PY Investment Income | $598,976 | PYInvestmentIncomeAmt |
| CY Investment Income | $82,747 | CYInvestmentIncomeAmt |
| PY Other Revenue | $160,825 | PYOtherRevenueAmt |
| CY Other Revenue | $255,786 | CYOtherRevenueAmt |
| PY Total Revenue | $17,485,052 | PYTotalRevenueAmt |
| CY Total Revenue | $17,501,132 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,088,446 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,101,273 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,740,098 | PYOtherExpensesAmt |
| CY Other Expenses | $11,906,050 | CYOtherExpensesAmt |
| PY Total Expenses | $18,828,544 | PYTotalExpensesAmt |
| CY Total Expenses | $19,007,323 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,343,492 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,506,191 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $24,222,787 | TotalAssetsBOYAmt |
| Total Assets EOY | $21,168,629 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,690,877 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,340,631 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $15,531,910 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $13,827,998 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO MAINTAIN AND IMPROVE THE QUALITY OF LIFE OF THE PEOPLE IN THIS SERVICE AREA THROUGH THE PROVISION OF QUALITY HEALTH CARE PROGRAMS, SERVICES, EQUIPMENT AND PERSONAL CARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $7,739,731 | ExpenseAmt |
| Revenue | $10,665,942 | RevenueAmt |
| Desc | Other: Good Shepherd Hospital provides a comprehensive range of other specialized healthcare services.The facility excels in advanced imaging, incorporating 3D mammography, and focuses on inpatient care through its swing bed program, alongside substance abuse medical detox. Equipped with a modern laboratory and dedicated rehabilitation programs in cardiac, pulmonary, and general therapy services, the hospital prioritizes high-quality patient care. Services also include a specialized sleep center. Furthermore, a specialty clinic convenes expert providers in podiatry, cardiac, general medicine, and orthopedics, fortifying local access to specialized healthcare. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,819,673 | ExpenseAmt |
| Revenue | $3,560,217 | RevenueAmt |
| Desc | Emergency Services: The Emergency Department at HSHS Good Shepherd Hospital stands as a comprehensive treatment facility, ensuring continuous care with a dedicated team of specially trained physicians, nurses, and technicians available 24/7. Our commitment to quality patient care spans a broad spectrum of concerns. Leveraging advanced telemedicine, we have access to a diverse array of specialists who contribute to diagnosis and treatment for those in need of elevated care. Equipped with cutting-edge technology, we efficiently process x-rays, CT scans, and various diagnostic tests, facilitating swift and accurate diagnosis and treatment across a spectrum of medical areas, including: stroke, heart attack, shortness of breath, motor vehicle and other accidents, broken bones, abdominal pain, lacerations, and mental health issues. During FY23 the emergency department seen 4054 patients of those 3% were admitted or placed in observation and 10% were transferred to a higher level of care. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,053,264 | ExpenseAmt |
| Revenue | $1,500,405 | RevenueAmt |
| Desc | Internal Medicine: The HSHS Good Shepherd Hospital Rural Health Clinic is home to HSHS providers, mid-level providers, and compassionate nursing staff. Serving as a central hub for primary care, the clinic also features a convenient walk-in clinic. Primary care providers play a pivotal role in residents' healthcare, conducting annual assessments to gauge overall well-being. Their comprehensive care includes tailored screenings based on patients' medical history and demographics, preventive care, treatment for acute, minor, and chronic conditions, as well as facilitating referrals to specialists. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,054,304 | ExpenseAmt |
| Revenue | $1,070,585 | RevenueAmt |
| Desc | All surgery and Main OR: At HSHS Good Shepherd Hospital, our OR services outpatients from surrounding Shelby County rural communities. Surgeons from a variety of physician groups perform procedures at our facility, from a multitude of specialties including General Surgery, Orthopedics, Ophthalmology, and Podiatry. Top 3 Services Lines by Volume from July 2022 - June 2023 * General Surgery, includes Endoscopy - 138 cases (117 Endo, 21 General) * Ophthalmology - 129cases * Orthopedics - 5 cases * Podiatry - 5 cases | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $1,054,304 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $1,070,585 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $16,666,972 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | Yes (true) | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 1200 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 87 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (true) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Linda Dace | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6182342120 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3051 Hollis Drive | AddressLine1Txt |
| City | Springfield | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62704 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Aaron Puchbauer | |||||||||
| President & CEO (UNTIL 8/6/22) | 30.0 | 30.0 | Yes (X) | Yes (X) | $166,241 | $166,240 | $70,274 | ||
| Chad Markham | |||||||||
| President & CEO | 30.0 | 30.0 | Yes (X) | Yes (X) | $187,957 | $187,956 | $82,310 | ||
| DENISE BENCE | |||||||||
| CHAIR | 1.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JOSH SHALLENBERGER | |||||||||
| VICE CHAIR | 1.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| ERIC FORLINES | |||||||||
| Board Member | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | |||
| KIM TURNER | |||||||||
| Board Member | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | |||
| PAUL KAY MD | |||||||||
| Board Member | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | |||
| Sr Marybeth Culnan OSF | |||||||||
| Board Member | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| TRAVIS BANFIELD | |||||||||
| Board Member | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | |||
| PATRICIA ALLEN | |||||||||
| Interim CFO - Illinois | 3.0 | 57.0 | Yes (X) | $0 | $541,100 | $154,396 | |||
| TODD Smart | |||||||||
| Treasurer | 0.3 | 59.8 | Yes (X) | $0 | $329,569 | $81,262 | |||
| ALLISON HAGEN | |||||||||
| Registered Nurse | 40.0 | 0 | $134,263 | $0 | $12,055 | Yes (X) | |||
| ANDREW CORZINE | |||||||||
| Pharmacist | 40.0 | 0 | $154,139 | $0 | $80,281 | Yes (X) | |||
| KARLA DIXON | |||||||||
| Director - Nursing | 40.0 | 0 | $142,998 | $0 | $37,513 | Yes (X) | |||
| Mary Theresa Thull | |||||||||
| ED House Supervisor | 40.0 | 0 | $129,117 | $0 | $3,254 | Yes (X) | |||
| Shelle Sloan | |||||||||
| Nurse Practitioner | 10.0 | 0 | $166,991 | $0 | $56,240 | Yes (X) | |||
| EVERT J KUIPER | |||||||||
| Former Division CEO - Illinois (until Jan 2022) | 0.0 | 0.0 | $0 | $526,246 | $6,227 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,081,706 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,751,111 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $583,813 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | Address Line2ContractorAddress/USAddress/AddressLine2Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|---|
| Emergency Staffing Solutions | ||||||
| 17304 Preston Road | Suite 1400 | Dallas | TX | 78252 | Emergency Dept Coverage | $1,103,429 |
| Medical Solutions | ||||||
| PO Box 850737 | Minneapolis | MN | 554850737 | Contract Labor | $817,566 | |
| Alton Physical Therapy PC | ||||||
| 1719 Clawson Street | Alton | IL | 62002 | Physical Therapy Services | $332,520 | |
| CPSI | ||||||
| PO Box 11407 | Birmingham | AL | 352466448 | Software Maintenance Services | $218,424 | |
| G&G Anesthesia | ||||||
| 2023 Vadalabene Drive | Suite 350 | Maryville | IL | 62062 | Management Services | $196,790 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $29,678 | RelatedOrganizationsAmt |
| Government Grants | $335,772 | GovernmentGrantsAmt |
| Total Contributions | $365,450 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 621990 | $16,797,044 | $16,797,044 |
| Health Programs | 621990 | $105 | $105 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $16,797,149 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $27,731 | TotalRevenueColumnAmt |
| Exclusion | $27,731 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $143,093 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $383 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $142,710 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $142,710 | TotalRevenueColumnAmt |
| Exclusion | $142,710 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $55,016 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $55,016 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $55,016 | TotalRevenueColumnAmt |
| Exclusion | $55,016 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| Other Income | 900099 | $111,562 | $111,562 |
| Cafeteria Sales | $1,514 | $1,514 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $113,076 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,501,132 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $16,797,149 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $338,533 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $430,490 | TotalAmt |
| Program Services | $388,826 | ProgramServicesAmt |
| Management And General | $41,664 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,131,291 | TotalAmt |
| Program Services | $5,023,499 | ProgramServicesAmt |
| Management And General | $107,792 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,564 | TotalAmt |
| Program Services | $117,324 | ProgramServicesAmt |
| Management And General | $3,240 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,021,843 | TotalAmt |
| Program Services | $995,442 | ProgramServicesAmt |
| Management And General | $26,401 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $397,085 | TotalAmt |
| Program Services | $386,609 | ProgramServicesAmt |
| Management And General | $10,476 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,399 | TotalAmt |
| Management And General | $1,399 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,274 | TotalAmt |
| Management And General | $86,274 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,164,095 | TotalAmt |
| Program Services | $6,037,797 | ProgramServicesAmt |
| Management And General | $1,126,298 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,819 | TotalAmt |
| Management And General | $49,819 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,615 | TotalAmt |
| Program Services | $121,678 | ProgramServicesAmt |
| Management And General | $8,937 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $257,364 | TotalAmt |
| Program Services | $257,364 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $381,088 | TotalAmt |
| Program Services | $337,918 | ProgramServicesAmt |
| Management And General | $43,170 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119,966 | TotalAmt |
| Program Services | $104,389 | ProgramServicesAmt |
| Management And General | $15,577 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,550 | TotalAmt |
| Program Services | $5,725 | ProgramServicesAmt |
| Management And General | -$175 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $121,161 | TotalAmt |
| Program Services | $90 | ProgramServicesAmt |
| Management And General | $121,071 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $460,692 | TotalAmt |
| Program Services | $763,950 | ProgramServicesAmt |
| Management And General | -$303,258 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $268,033 | TotalAmt |
| Management And General | $268,033 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $1,057,349 | $1,057,040 | $309 |
| Licens & Taxes | $620,706 | $620,706 | |
| Maint & Repair | $702,792 | $702,792 | |
| Service Contracts | $63,337 | $63,337 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $415,810 | TotalAmt |
| Program Services | $303,192 | ProgramServicesAmt |
| Management And General | $112,618 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,007,323 | TotalAmt |
| Program Services | $16,666,972 | ProgramServicesAmt |
| Management And General | $2,340,351 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,172,177 | BOYAmt |
| EOY | $1,182,468 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,829,831 | BOYAmt |
| EOY | $1,967,282 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $200,650 | BOYAmt |
| EOY | $241,669 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $215,401 | BOYAmt |
| EOY | $9,175 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $25,574,043 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $17,301,128 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,491,228 | BOYAmt |
| EOY | $8,272,915 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,934,015 | BOYAmt |
| EOY | $8,083,687 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $379,485 | BOYAmt |
| EOY | $1,411,433 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,222,787 | BOYAmt |
| EOY | $21,168,629 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,301,285 | BOYAmt |
| EOY | $1,373,217 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,023,235 | BOYAmt |
| EOY | $278,494 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,550,000 | BOYAmt |
| EOY | $5,250,000 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $816,357 | BOYAmt |
| EOY | $438,920 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,690,877 | BOYAmt |
| EOY | $7,340,631 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,531,910 | BOYAmt |
| EOY | $13,827,998 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,531,910 | BOYAmt |
| EOY | $13,827,998 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,222,787 | BOYAmt |
| EOY | $21,168,629 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,506,191 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $202,458 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$400,179 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $47,651 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $47,651 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | FormAndLineReferenceDesc |
| Explanation | HSHS GOOD SHEPHERD HOSPITAL (THE HOSPITAL) IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE ILLINOIS HOSPITAL ASSOCIATION ("IHA"), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HOSPITAL ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, WITH PART OF THESE DUES BEING ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. THE ASSOCIATIONS THE HOSPITAL PAYS ARE AS FOLLOWS: - AMERICAN HOSPITAL ASSOCIATION ("AHA") AT 27.29% LOBBYING EXPENSE - CATHOLIC HEALTH ASSOCIATION ("CHA") AT 3.00% LOBBYING EXPENSE - ILLINOIS HOSPITAL ASSOCIATION ("IHA") AT 43.50% LOBBYING EXPENSE - NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE AT 23.00% LOBBYING EXPENSE THE TOTAL AMOUNT OF ANNUAL DUES PAID TO EACH ASSOCIATION IS MULTIPLIED BY THE PERCENTAGE OF DUES ALLOCATED TO LOBBYING EXPENSE TO CALCULATE THE TOTAL LOBBYING EXPENDITURES PAID. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $965,591 | OtherCostOrOtherBasisAmt |
| Book Value | $965,591 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $19,025,359 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,850,740 | DepreciationAmt |
| Book Value | $5,174,619 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $194,613 | OtherCostOrOtherBasisAmt |
| Depreciation | $138,892 | DepreciationAmt |
| Book Value | $55,721 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,676,635 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,850,430 | DepreciationAmt |
| Book Value | $826,205 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,711,845 | OtherCostOrOtherBasisAmt |
| Depreciation | $461,066 | DepreciationAmt |
| Book Value | $1,250,779 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,272,915 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Due from third-party reimbursement programs | -$35,143 |
| Other Receivables | $1,315,514 |
| Other assets Long Term Assets | $131,062 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,411,433 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Operating lease liabilities | $131,062 |
| Accrued Benefit Liability | -$257,142 |
| Other Non Current Liabilities | $565,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $438,920 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote | FormAndLineReferenceDesc |
| Explanation | HSHS and the Foundation are Illinois not-for-profit organizations as described in Section 501(c) (3) of the Internal Revenue Code (the Code) and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Kiara, Inc. is an Illinois for-profit corporation that recognizes income taxes under the asset-and-liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the consolidated financial statement carrying amounts of existing assets and liabilities and their respective tax basis and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using the enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. The net operating loss carryforwards result in a deferred tax asset of $3,382 and $3,548 at June 30, 2023 and 2022, respectively. In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all the deferred tax assets will not be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible. Management considers projected future taxable income and tax planning strategies in making this assessment. Based upon the level of historical taxable losses and projections for future taxable losses over the periods for which the deferred tax assets are deductible, management believes it is more likely Kiara, Inc. will not realize most of the benefits of these deductible differences. Full valuation allowances have been applied against the deferred tax assets attributable to the net operating loss carryforwards not realized as of June 30, 2023 and 2022 in the accompanying consolidated financial statements due to the uncertainty of realization. HSHS recognizes the tax benefit from an uncertain tax position only if it is more likely than not the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. As of June 30, 2023 and 2022, HSHS does not have any liabilities for unrecognized tax benefits. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 600 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $58,650 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $58,650 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0031 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,610,151 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,610,151 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.1373 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $2,668,801 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,668,801 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.1404 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $98,871 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,846 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $89,025 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0047 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,819 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,819 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0007 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,524 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $12,524 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0007 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $125,214 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,846 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $115,368 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0061 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $2,794,015 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,846 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,784,169 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.1465 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $0 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $4,365,608 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,268,377 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$4,902,769 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HSHS Good Shepherd Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 SOUTH CEDAR STREET | AddressLine1Txt |
| City | SHELBYVILLE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62565 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | https://www.hshsgoodshepherd.org/ | WebsiteAddressTxt |
| State License | 0002154 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HSHS Good Shepherd Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://www.hshs.org/good-shepherd/about-us/community-health-needs-assessment | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.hshs.org/good-shepherd/about-us/community-health-needs-assessment | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 600.0 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://www.hshs.org/about-us/patient-financial-services | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.hshs.org/about-us/patient-financial-services/illinois-financial-assistance | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.hshs.org/about-us/patient-financial-services/illinois-financial-assistance | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 3E | Yes, the significant health needs are a prioritized description of the significant health needs of the community and were identified through the CHNA process. |
| Schedule H, Part V, Section B, Line 5 Facility , 1 | Facility , 1 - HSHS GOOD SHEPHERD HOSPITAL. HSHS Good Shepherd Hospital (GSS) is committed to addressing community health needs in collaboration with local organizations and other area health care institutions. In FY2022, GSS completed its second Community Health Needs Assessment (CHNA) as an affiliate of Hospital Sisters Health System (HSHS). The FY2022 assessment built on collaboration and partnerships established during the FY2019 CHNA, actively seeking input from a cross section of community stakeholders with the goal of reaching consensus on priorities to mutually focus human, material and financial resources. The external advisory committee acted as the primary stakeholder group to review and force rank data. During one virtual meeting and a series of 1:1 agency meetings, community stakeholders were asked to review the data presented and provide additional sources for priority areas not identified. The external advisory committee also helped make recommendations for the final priorities. The external advisory committee helped to identify community assets and gaps, which were weighed when considering the magnitude and feasibility of the priority areas. Lastly, the external advisory committee feedback was instrumental in developing the implementation plan. HSHS and GSS are committed to promoting and defending human dignity, caring for persons living in poverty and other vulnerable persons, promoting the common good and stewarding resources. We believe the CHNA process must be informed by input from the poor and vulnerable populations we seek to serve. To ensure the needs of these groups were adequately represented, the hospital included representatives from the following organizations representing persons living in poverty, persons with disabilities, children, elderly, persons living in food deserts, and minority populations (a complete list is noted in Part V, Line 6b): Shelbyville Housing Authority*, DOVE, Inc*. Domestic Violence, two local school districts, Shelby County Community Services*, Shelby County Health Department*, Shelby County Senior Services*, and CEFS Community Action Agency*. Representatives of these organizations have extensive knowledge and quantifiable data regarding the needs of their service populations. Actively including these organizations in the CHNA process was critical to ensure that needs of the most vulnerable persons in our communities were addressed in the CHNA. * Denotes groups representing the under resources in our community including low-income seniors, children living in poverty and families who struggle with shelter and food. |
| Schedule H, Part V, Section B, Line 6b Facility , 1 | Facility , 1 - HSHS Good Shepherd Hospital. Members of the CHNA external advisory council were chosen based on their unique expertise and experience, informed perspectives and community involvement. The CHNA external Advisory Council members were responsible for offering insight into issues affecting existing data; identifying local community assets and gaps; and offering advice on which issues are the highest priority. Below is a comprehensive list of community stakeholders that served on the external advisory committee. - Shelby County Community Services - Shelby County Health Department - Shelbyville School District - Shelbyville High School - Shelby County Senior Services - Shelby County Coroner - Shelby County Dove, Inc - UI Extension - HSHS Good Shepherd Hospital *Asterisk indicates groups representing persons living in poverty, persons with disabilities, children, elderly persons, persons living in food deserts, and minority populations. |
| Schedule H, Part V, Section B, Line 11 Facility , 1 | Facility , 1 - HSHS GOOD SHEPHERD HOSPITAL. Based on the CHNA planning and development process the following community health needs were identified: 1. Access to mental and behavioral health services 2. Chronic Conditions 3. Workforce Development In FY2022, GSS participated in an analysis of three SDOH screening platforms. The analysis continues in FY23 with colleague time developing a capital and strategy plan and operationalizing the deployment of the product through care management. The tool will provide ability to screen all patients entering the ED for determinants of health. The tool will then walk the social worker through identifying and making referrals for the patient to the appropriate community-based social / healthcare provider where they can work with the appropriate service agency to address and ultimately meet the identified need. This focus on need based referrals will help address those persons living with unmanaged chronic conditions from a management and ultimately prevention perspective. In FY2023, GSS Completed its first full year of the School Based Behavioral Telehealth program connecting nearly 30-students with crisis care, psychiatric care and general counseling. This resources allows teachers to refer students with behavioral health issues directly to care. In FY2023, GSS engaged with discussion with local behavioral and mental health stakeholders to identify linkage and referral barriers to patient care. Two community conversations and one survey has been completed to continue this dialogue in FY2024. Shelby County Behavioral Health Stakeholders will use information gleaned to partner with more than half Illinois counties in developing a policy white paper to advocate for services needed with local and state legislators. As an outcome of the prioritization process, the following community health needs were also identified and will not be addressed directly by the hospital for the reasons indicated: -Child Abuse and Neglect and Human Trafficking: These are ever-growing issues in all communities across Illinois and the nation. HSHS Good Shepherd Hospital will be represented on the Illinois Human Trafficking Task Force by the HSHS Illinois division. While not a direct priority area, HSHS and Good Shepherd Hospital will continue to raise awareness in HSHS facilities and the community on identification and response to human trafficking and child abuse and neglect. -Food Insecurity and Healthy Behaviors: While not named specifically, food insecurity and healthy behaviors will be addressed under Chronic Conditions. -Maternal and Child Health: Good Shepherd Hospital is not focusing on this need as part of the CHNA. We continue to offer some services and collaborate with those agencies that assist this population. -Senior Health: While not named specifically, senior health will be factored into all strategies looking at addressing overall health outcomes for the population. |
| Schedule H, Part V, Section B, Line 13 Facility , 1 | Facility , 1 - HSHS Good Shepherd. Presumptive eligibility is presumed under certain circumstances for uninsured patients based on their enrollment in other means-tested programs or other sources of information, not provided directly by the patient. Once determined, presumptive eligibility provides individuals participating in one of the following categories with a 100% write off. These programs are granted by outside organizations based on screening criteria of less than 200% of the FPG. 1. Homelessness 2. Deceased with no estate 3. Mental incapacitation with no one to act on patient's behalf 4. Medicaid eligibility, but not on date of service or for non-covered services 5. Incarceration in a penal institution 6. Enrollment in the following assistance programs for low-income individuals: 6a. Temporary Assistance for Needy Families (TANF) 6b. Illinois Housing Development Authority's Rental Housing Support Program 6c. Wisconsin Department of Health Services Housing Assistance Program 7. Participation in Women, Infants and Children programs (WIC); 8. Supplemental Nutrition Assistance Program (SNAP) eligibility; 9. Low Income Home Energy Assistance Program (LIHEAP); 10. Wisconsin Home Energy Assistance Program (WHEAP); 11. Enrollment in an organized community-based program providing access to medical care that assesses and documents limited low-income financial status as criteria; 12. Receipt of grant assistance for medical services |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| SHELBY HOME EQUIPMENT | ||||
| 200 SOUTH CEDAR STREET | SHELBYVILLE | IL | 62565 | durable medical equipment |
| shelby memorial home health | ||||
| 200 SOUTH CEDAR STREET | shelbyville | IL | 62565 | home health agency |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED VARY ACCORDING TO INFORMATION REQUESTED AND THE MOST ACCURATE MEANS OF GATHERING THE REQUIRED INFORMATION. THE IRS PROVIDED WORKSHEET 2 WAS USED TO CALCULATE A COST TO CHARGE RATIO USING INFORMATION FROM THE ORGANIZATION'S GENERAL LEDGER AND COST REPORTS. THAT RATIO WAS THEN USED IN CONJUNCTION WITH IRS WORKSHEET 1 TO CALCULATE THE COST OF FINANCIAL ASSISTANCE PROVIDED AND WORKSHEET 3 TO CALCULATE UNREIMBURSED MEDICAID AMOUNTS. THE COMMUNITY HEALTH IMPROVEMENT AND COMMUNITY BENEFIT PROGRAMS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH PROGRAM, AND DONATIONS ARE STATED AT ACTUAL COST (WHEN APPLICABLE). THE COST OF THESE ITEMS ARE TRACKED THROUGH THE GENERAL LEDGER PROCESS AND THROUGH OTHER ACCOUNTING SOFTWARE. |
| Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount | FOR FINANCIAL STATEMENT PURPOSES, HOSPITAL SISTERS HEALTH SYSTEM HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. |
| Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote | The text of the footnote to the organization's financial statements that describes bad debt expense can be found on pages 16-19 in the HSHS Consolidated Audit Report. |
| Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs | The Hospital continually strives to provide excellent patient care in the most cost effective fashion. Nonetheless, the Medicare program, in many cases, does not provide payment that covers the full cost of the care provided. Since it is the mission of the hospital to respond to community need, hospital leadership continually advocates for improved Medicare payment so that the cost of quality care to those patients who are not able to afford it is not compromised and is fairly subsidized by all payers. The IRS does not classify this shortfall in Medicare payments as Community Benefit. However, we believe it is an important contribution made by the hospital to the health and well-being of the community. If the Medicare program did not exist, many Medicare patients would be eligible for financial assistance or other means-tested government programs. Further, by absorbing this shortfall and providing care below cost to these individuals, the Hospital is relieving the burden of the government. Accordingly, this shortfall restricts the Hospital's ability to make funds available to provide for financial assistance and other Community Benefit. The hospital's Medicare shortfall at cost for fiscal year 2023 was $4,902,769. |
| Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance | Every effort is made prior to, during and after provision of medical services to determine whether a patient is eligible for charity/community care and to assist the patient in completing the application and provide adequate documentation. If the patient qualified for charity/community care for the full balance of their account, the entire amount is written off to charity/community care and hence no debt collection is pursued. If the patient qualified for charity/community care for a portion of their account balance, that portion is written off to charity/community care, with the patient being responsible for the remainder of the balance. Additionally, reasonable effort will be made to obtain third-party or government payer reimbursement on behalf of the patient. If those efforts are not fruitful, an offer will be extended to the patient to make installment payments on their balance. Only at such point that the patient defaults on installment payments or refuses to cooperate with the hospital's efforts to be reimbursed will the account be sent to collections. The hospital will make reasonable efforts to determine whether a patient is eligible under the financial assistance policy before it engages in an ECA. To the extent a patient is determined to be eligible for financial assistance under the FAP, the hospital will take all reasonably available measures to reverse any ECA taken against the patient to obtain payment for the care. |
| Schedule H, Part V, Section B, Line 16a FAP website | - HSHS Good Shepherd Hospital: Line 16a URL: https://www.hshs.org/about-us/patient-financial-services; |
| Schedule H, Part V, Section B, Line 16b FAP Application website | - HSHS Good Shepherd Hospital: Line 16b URL: https://www.hshs.org/about-us/patient-financial-services/illinois-financial-assistance; |
| Schedule H, Part V, Section B, Line 16c FAP plain language summary website | - HSHS Good Shepherd Hospital: Line 16c URL: https://www.hshs.org/about-us/patient-financial-services/illinois-financial-assistance; |
| Schedule H, Part VI, Line 2 Needs assessment | As indicated in Part V, Section C, HSHS Good Shepherd Hospital conducted a Community Health Needs Assessment in FY2022 (July 1, 2021 through June 30, 2022). Throughout the three-year CHNA cycle, the hospital continuously reviews updated local and state data, Illinois Comp Data, patient surveys and feedback, and local needs assessments conducted by other community groups. Additionally, the hospital receives input from public health officials, community groups and community boards on an ongoing basis, which is reviewed and used to inform ongoing strategic initiatives developed to address health priorities identified in the CHNA process as well as new areas of need that are going unmet. |
| Schedule H, Part VI, Line 3 Patient education of eligibility for assistance | Patients may learn of FAP resources online. Materials are presented in English and Spanish with translation services available in more than 25-languages. At the time of registration, patients are provided with information on financial assistance. Then again during discharge, the care management team works with patients to confirm eligibility for financial assistance and provide resources accordingly. Financial Counselors are also available to assist self-pay patients with Medicaid eligibility. |
| Schedule H, Part VI, Line 4 Community information | HSHS Good Shepherd Hospital is a not-for-profit hospital located in Shelby County, Illinois. The Hospital is located in the city of Shelbyville, Illinois, in Shelby County. Shelbyville is located along the Kaskaskia River and has a population of almost 5,000 people. It is approximately 59 miles southeast of Springfield, Illinois. Shelbyville and the surrounding geographic area are not close to any major metropolitan area. It is accessible by a state highway and other secondary roads. Shelby County is considered 22.27 percent urban and 77.73 percent rural. Based on 2019 population estimates Shelby County's population of 20,789 people is comprised of 98% Caucasians, 0.4% African-Americans, 0.3% American Indians/Alaska Natives, 0.3% Asians, 0.03% Native Hawaiians/Other Pacific Islanders and 1.2% Hispanic or Latino. Ninety-three percent of Shelby County's residents have a high school diploma, 22.8% have a Bachelor's Degree. The current unemployment rate of Shelby County is 4.3%, according to the US Bureau of Labor Statistics, and the median household income is $70,709. Within the report area 8.9% of individuals are living in households with income below the Federal Poverty Level (FPL). This indicator is relevant because poverty creates barriers to access including health services, nutritional food and other necessities that contribute to poor health status. |
| Schedule H, Part VI, Line 5 Promotion of community health | As a healing ministry of the Catholic Church and an affiliate of Hospital Sisters Health System (HSHS), HSHS Good Shepherd Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. Shelby Memorial Hospital was founded in 1916 and affiliated with HSHS in 2017. The hospital brings a healing presence and improves the health of our community, especially those persons who are sick, poor, and disadvantaged. Because of the hospital's mission and heritage, the hospital is dedicated to promoting the health of Shelbyville and surrounding areas. The hospital is governed by a Board of Directors, most of whom reside in the hospital's primary service area and who are neither employees nor independent contractors of the hospital (nor family members thereof). The Board ensures that HSHS Good Shepherd Hospital is responding to community need. In FY2023, for example, the board reviewed and approved the Community Health Improvement Plan which is an accompaniment to the FY2022 Community Health Needs Assessment. Also consistent with its exempt purpose, HSHS Good Shepherd Hospital has an open medical staff with privileges available to all qualified physicians in the area. The hospital also operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, Good Shepherd Hospital (GSS) reinvests surplus funds to support the mission of the organization and promote the health of the community rather than distributing surplus funds as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. HSHS Good Shepherd Hospital also devotes significant resources to access for patients who cannot afford care, along with other Community Benefits. In FY2023, Good Shepherd provided $2,784,169 million in Community Benefit, including financial assistance at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. HSHS Good Shepherd Hospital provides a range of Community Benefit initiatives and programs that further our mission and long-standing commitment to our community. In many cases, these Community Benefits would not exist without the leadership role played by Good Shepherd Hospital, and they often relieve a burden that would otherwise be carried by government. |
| Schedule H, Part VI, Line 6 Affiliated health care system | Headquartered in Springfield, Illinois, Hospital Sisters Health System (HSHS) is a highly integrated, multi-institutional health care system comprised of 15 hospitals and more than 200 physician practice sites in Illinois and Wisconsin. HSHS is sponsored by Hospital Sisters Ministries (HSM), which is a public juridic person of the Roman Catholic Church. HSHS continues the health care ministries begun by its founders, the Hospital Sisters of St. Francis, more than 140 years ago, in rural and midsized communities throughout Illinois and Wisconsin. HSHS provides compassionate, holistic, high quality, and cost-effective health care through its acute care hospitals, physician practices, home health programs, palliative and hospice programs, and community outreach services. In addition, HSHS affiliated hospitals include critical access facilities that offer essential health services that otherwise would not be available in many communities. Our mission calls us to reveal and embody Christ's healing love for all people, and we extend our high quality Franciscan health care ministry beyond the walls of our hospitals by providing community health improvement services with special emphasis on the poor and vulnerable. In addition to providing community health improvement services to the broader community, HSHS cares for everyone who comes to its facilities, regardless of their ability to pay. In tandem with a variety of cross sector community partners, HSHS's Community Benefit initiatives are strategically planned and professionally implemented to improve access to health care services; enhance the health of the community; advance medical or general health care knowledge; and relieve or reduce the burden of government to improve health. The COVID-19 pandemic caused an unprecedented disruption in healthcare services across the United States. HSHS responded with services that benefited our communities, including free telehealth screenings, free testing, and coordination with other healthcare providers in the communities we serve to best ensure access to needed care. In FY2023, HSHS collectively provided $222.3 million in Community Benefit (8.2% of total hospital expenses). Of the total Community Benefit provided, HSHS spent $5.8 million provided for Financial Assistance (aka Charity Care) and $146.3 million for unreimbursed care provided as part of the Medicaid program. In addition, HSHS hospitals committed significant resources to treat Medicare patients. The cost of providing services to primarily elderly beneficiaries of the Medicare program - in excess of governmental and managed care contract payments - was $304.5 million. HSHS hospitals also recorded $74.3 million in uncollectible accounts. While HSHS does not count the latter two amounts as Community Benefit, they nonetheless reflect our commitment to serving all persons in need of care. In addition to the dollars invested in our Community Benefit programs, HSHS continues to reinvest any surplus revenue from operations and investments into new medical technology, facility infrastructure and health care services in our communities. By doing so, we ensure our ability to meet the ongoing demand for high quality, efficient and easily accessible health care. |
| Schedule H, Part VI, Line 7 State filing of community benefit report | IL |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EVERT J KUIPER | ||||||||||||||
| Former Division CEO - Illinois (until Jan 2022) | $0 | $51,437 | $0 | $0 | $0 | $474,809 | $0 | $3,413 | $0 | $2,814 | $0 | $532,473 | $0 | $196,540 |
| Chad Markham | ||||||||||||||
| President & CEO | $149,996 | $149,996 | $33,767 | $33,766 | $4,194 | $4,194 | $21,895 | $21,895 | $19,260 | $19,260 | $229,112 | $229,111 | $0 | $0 |
| Aaron Puchbauer | ||||||||||||||
| President & CEO (UNTIL 8/6/22) | $105,997 | $105,996 | $15,875 | $15,875 | $44,369 | $44,369 | $14,779 | $14,779 | $20,358 | $20,358 | $201,378 | $201,377 | $0 | $0 |
| TODD Smart | ||||||||||||||
| Treasurer | $0 | $267,686 | $0 | $38,335 | $0 | $23,548 | $0 | $45,254 | $0 | $36,008 | $0 | $410,831 | $0 | $0 |
| PATRICIA ALLEN | ||||||||||||||
| Interim CFO - Illinois | $0 | $414,598 | $0 | $44,684 | $0 | $81,818 | $0 | $126,563 | $0 | $27,833 | $0 | $695,496 | $0 | $0 |
| ANDREW CORZINE | ||||||||||||||
| Pharmacist | $150,384 | $0 | $0 | $0 | $3,755 | $0 | $46,147 | $0 | $34,134 | $0 | $234,420 | $0 | $0 | $0 |
| KARLA DIXON | ||||||||||||||
| Director - Nursing | $116,214 | $0 | $8,050 | $0 | $18,734 | $0 | $1,916 | $0 | $35,597 | $0 | $180,511 | $0 | $0 | $0 |
| Shelle Sloan | ||||||||||||||
| Nurse Practitioner | $145,552 | $0 | $21,049 | $0 | $390 | $0 | $20,639 | $0 | $35,601 | $0 | $223,231 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation | PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A IN SCHEDULE O. |
| Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan | HSHS EXECUTIVES ELIGIBLE TO PARTICIPATE IN SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) ARE DEFINED IN THE SERP PLAN DOCUMENTS. THE SERP WAS ESTABLISHED TO PROVIDE ADDITIONAL RETIREMENT BENEFITS TO ENSURE REASONABLE MARKET COMPETITIVE BENEFITS IN ACCORDANCE WITH THE HSHS EXECUTIVE COMPENSATION PHILOSOPHY ESTABLISHED BY THE HSHS COMPENSATION COMMITTEE. THE PLAN PROVIDES A DEFINED RETIREMENT CONTRIBUTION TO PARTICIPANTS COMMENCING ON JANUARY 1, 2008, EQUAL TO A PERCENTAGE OF COMPENSATION AS DEFINED IN THE SERP PLAN DOCUENTS FOR THE PLAN YEAR. PARTICIPANTS CONSTRUCTIVELY RECEIVE A DISTRIBUTION FROM THE PLAN NO LATER THAN MARCH 15TH OF THE CALENDAR YEAR FOLLOWING THE CALENDAR YEAR IN WHICH AN AMOUNT IS VESTED AND TAXABLE PURSUANT TO A VESTING SCHEDULE AS SPECIFIED IN THE PLAN DOCUMENT. THE ACTUAL DISTRIBUTION OF THE VESTED BENEFIT UNDER THE PLAN IS PAID IN A SINGLE LUMP SUM TO THE PARTICIPANT OR THE PARTICIPANT'S BENEFICIARY UPON THE EARLIER OF THE PARTICIPANT'S TERMINATION OF EMPLOYMENT, DEATH, OR TOTAL AND PERMANENT DISABILITY. THE FOLLOWING INTERESTED PERSONS CONSTRUCTIVELY RECEIVED DEFERRALS TO THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2022 THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). Patricia Allen -- $37,240 Chad Markham -- $37,690 Aaron Puchbauer -- $25,396 Todd Smart -- $25,135 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2022 THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. Evert Kuiper -- $196,540 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (19 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4d Description of other program services | (Expenses $ 1,054,304 including grants of $)(Revenue $ 1,070,585) All surgery and Main OR: At HSHS Good Shepherd Hospital, our OR services outpatients from surrounding Shelby County rural communities. Surgeons from a variety of physician groups perform procedures at our facility, from a multitude of specialties including General Surgery, Orthopedics, Ophthalmology, and Podiatry. Top 3 Services Lines by Volume from July 2022 - June 2023 * General Surgery, includes Endoscopy - 138 cases (117 Endo, 21 General) * Ophthalmology - 129cases * Orthopedics - 5 cases * Podiatry - 5 cases |
| Form 990, Part IV, Line 24a Tax Exempt Bonds | HSHS GOOD SHEPHERD HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT. THIS QUESTION WAS ANSWERED AND NO, AND SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990. |
| Form 990, Part IV, Line 10 Endowment Funds | The organization maintains net assets with donor restrictions and without donor restrictions on its balance sheet. Such funds are held by Hospital Sisters of St. Francis Foundation, Inc., a related tax-exempt organization. While these funds are held to further one or more exempt purposes of the filing organization, they are not maintained exclusively for the filing organization. The board of directors of Hospital Sisters of St. Francis Foundation, Inc. maintains ownership and ultimately authority and discretion over the use of these funds. Based on the above, the related amounts have not been reported as endowment funds on Part V of Schedule D. |
| Form 990, Part V, Line 1a NUMBER REPORTED IN BOX 3 OF FORM 1096 | THE FORM 1096, ANNUAL SUMMARY AND TRANSMITTAL OF U.S. INFORMATION RETURN IS FILED BY THE ORGANIZATION'S PARENT, HOSPITAL SISTERS HEALTH SYSTEM (HSHS) ON THE ORGANIZATION'S BEHALF TO TRANSMIT TO THE IRS FORMS 1099, 1098, 5498, AND W-2G. THE ORGANIZATION IS UNABLE TO DETERMINE THE NUMBER OF FORMS 1099, 1098, 5498 AND W-2G FILED BY HSHS, ON THEIR BEHALF. HOWEVER, AS THE PARENT ORGANIZATION, HSHS ENSURES THAT THE FILING ORGANIZATION COMPLIES WITH ALL INFORMATION RETURN REPORTING REQUIREMENTS AND BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND REPORTABLE GAMING WINNINGS TO PRIZE WINNERS, AS APPLICABLE. |
| Form 990, Part VI, Line 13 Whistleblower Policy | PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES. |
| Form 990, Part VI, Line 16a Joint Venture Policy | HOSPITAL SISTERS HEALTH SYSTEM ADOPTED A JOINT VENTURE COMPLIANCE PROGRAM POLICY EFFECTIVE ON JANUARY 1, 2012 FOR ALL SYSTEM HOSPITALS, INCLUDING HSHS GOOD SHEPHERD. THE OVERALL PURPOSE OF THE POLICY IS TO PROVIDE PRACTICAL GUIDELINES FOR ETHICAL BUSINESS CONDUCT, TO ACHIEVE COMPLIANCE, AND TO DETECT AND PREVENT VIOLATIONS OF APPLICABLE LAWS. THE POLICY REQUIRES ALL HSHS HOSPITALS TO EVALUATE THEIR PARTICIPATION IN JOINT VENTURE ARRANGEMENTS, INCLUDING UNDER APPLICABLE FEDERAL TAX LAWS, AND TO SAFEGUARD THE ORGANIZATION'S TAX-EXEMPT STATUS WITH RESPECT TO ANY JOINT VENTURE ARRANGEMENTS. |
| Form 990, Part VI, Line 1a Delegate broad authority to a committee | Per Article 5.5 of the organization's By-Laws, the governing body delegates broad authority to an executive committee. The executive committee shall be vested with and may in its discretion exercise the full powers, duties, responsibilities, and authority of the board except where prohibited by law and subject to any limitations imposed by the Bylaws or the board of directors. As provided in the By-Laws, the executive committee shall consist of three to six members, including the chairperson of the board, the vice chairperson, the president and other members selected from among the directors by the boar |
| Form 990, Part VI, Line 4 Significant changes to organizational documents | The bylaws were amended with the following significant changes: 1. The member gained one additional reserved power to approve material actions with respect to employee retirement plans sponsored by the Corporation or any Affiliate. 2. The member only fills President vacancies, removing the ability to fill Secretary and Treasurer vacancies. 3. The Division President no longer serves on the board of directors. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | THE SOLE CORPORATE MEMBER OF HSHS Good Shephard Hospital (THE CORPORATION) IS HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, THE ORGANIZATION'S MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS, CHAIRPERSON OF THE BOARD AND PRESIDENT |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | RESPONSIBILITY FOR THE POLICY AND OPERATIONS OF HSHS Good Shephard Hospital (THE "CORPORATION") IS VESTED IN ITS BOARD OF DIRECTORS, EXCEPT WITH RESPECT TO SPECIFIC POWERS RESERVED IN THE CORPORATION'S BYLAWS TO THE CORPORATION'S MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBER OF HSSI IS HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE GOVERNANCE AND OPERATIONS OF THE CORPORATION ARE SUBJECT TO HSSI'S RIGHT TO EXERCISE THESE RESERVED POWERS WITH RESPECT TO THE CORPORATION AND ORGANIZATIONS OF WHICH THE CORPORATION IS EITHER, DIRECTLY OR INDIRECTLY, A CONTROLLING MEMBER OR A CONTROLLING SHAREHOLDER ("AFFILIATES"). HSSI'S RIGHT TO EXERCISE CERTAIN OF THESE RESERVED POWERS IS, IN TURN, SUBJECT TO THE APPROVAL OF HSHS AND HSHS' MEMBERS. THE RESERVED POWERS INCLUDE ALL RIGHTS GRANTED TO HSSI BY LAW AND THE RIGHT TO: (A) ADOPT, APPROVE AMENDMENTS TO, OR AMEND ANY STATEMENT OF PHILOSOPHY, MISSION, MISSION INTEGRATION OR VALUES OR ANY NAME, LOGO, OR MARK OF THE CORPORATION OR OF ANY AFFILIATE; (B) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE ARTICLES OF INCORPORATION OF THE CORPORATION OR OF ANY AFFILIATE; (C) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE BYLAWS OF THE CORPORATION OR OF ANY AFFILIATE; (D) APPOINT AND REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE OF THE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, AND THE PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE; (E) APPROVE THE RECOMMENDATION OF THE BOARD OF DIRECTORS TO APPOINT OR REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, AND THE PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE. (F) WITH RESPECT TO THE CORPORATION OR ANY AFFILIATE, APPROVE THE PURCHASE, SALE, ALIENATION, EXCHANGE, LEASE OR ENCUMBRANCE OF ANY REAL PROPERTY OF THE CORPORATION OR OF ANY AFFILIATE, WHICH PROPERTY HAS A VALUE IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (G) APPROVE DEBT INCURRED BY THE CORPORATION OR ANY AFFILIATE IN AN AMOUNT IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (H) APPROVE THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION OR OF ANY AFFILIATE, AND ANY DEVIATIONS BY THE CORPORATION OR OF ANY AFFILIATE FROM SUCH BUDGETS IN AN AMOUNT OR PERCENTAGE SPECIFIED BY HSSI FROM TIME TO TIME; (I) APPROVE THE STRATEGIC PLAN AND ANNUAL GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY AFFILIATE; (K) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (L) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (M) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (N) APPROVE THE FINANCIAL POLICIES AND PROCEDURES OF THE CORPORATION OR OF ANY AFFILIATE AND APPROVE ANY DEVIATIONS FROM SUCH POLICIES AND PROCEDURES BY THE CORPORATION OR ANY AFFILIATE; (O) APPROVE MATERIAL ACTIONS WITH RESPECT TO EMPLOYEE RETIREMENT PLANS SPONSORED BY THE CORPORATION OR ANY AFFILIATE; AND (P) ADOPT POLICIES TO IMPLEMENT THE RESERVED POWERS OF HSSI. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE HOSPITAL EMPLOYS CROWE LLP TO ASSIST IN THE OVERALL REVIEW AND ELECTRONIC SUBMISSION OF ITS FORM 990. CROWE LLP PROVIDES GUIDANCE IN IDENTIFYING CRITICAL ERRORS IN THE RETURN SUBMISSION AND FEEDBACK ON QUANTITATIVE AND QUALITATIVE RESPONSES. ADDITIONALLY, THE HOSPITAL CFO PERFORMS A THOROUGH REVIEW OF THE RETURN AND REVIEWS IT WITH THE HOSPITAL CEO AND/OR SENIOR LEADERS BEFORE PRESENTING IT IN ITS ENTIRETY TO THE HOSPITAL BOARD FOR QUESTIONING AND REVIEW PRIOR TO THE RETURN'S SIGNING AND SUBMISSION TO THE IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | THE ORGANIZATION IS SUBJECT TO THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY ("POLICY") OF HOSPITAL SISTERS HEALTH SYSTEM, AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. A REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAVE BEEN IMPLEMENTED SINCE JANUARY, 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP, OR ACTIVITY CONTEMPLATED, ENTERED INTO, OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, AND ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS, AND TOOLS) TO ALL COVERED PERSONS AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE, OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWER ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF, AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN, OR ENTER INTO A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS, OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR, AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT, AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | THE COMPENSATION COMMITTEE (COMMITTEE) IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE DEVELOPS A COMPENSATION PHILOSOPHY FOR THE SYSTEM AND ALL AFFILIATES. THE COMMITTEE SELECTS AND HIRES THE INDEPENDENT COMPENSATION CONSULTANT TO DEVELOP COMPARABILITY DATA AND ADVISE THE COMMITTEE DURING ITS DELIBERATIONS REGARDING ALL ELEMENTS OF TOTAL COMPENSATION FOR ALL HSHS EXECUTIVES, (the top management official, other officers and key employees). SULLIVAN COTTER, THE CONSULTANTS UTILIZED BY THE COMMITTEE, USE DATA FROM MULTIPLE TAX-EXEMPT PEER GROUP SOURCES TO DETERMINE SALARY RANGES, INCENTIVE OPPORTUNITY RANGES AND BENEFITS FOR THE HSHS executives. SULLIVAN COTTER THEN ASSISTS THE COMMITTEE IN PREPARING CONTEMPORANEOUS DOCUMENTATION OF ALL ACTIONS. EACH COMMITTEE MEETING IS CONDUCTED WITH THE INTENT TO CREATE A REBUTTABLE PRESUMPTION OF REASONABLENESS FOR ALL ELEMENTS OF EXECUTIVE TOTAL COMPENSATION. THE CHAIRMAN MAKES THIS DECLARATION AND ALSO INQUIRES IF THERE ARE ANY CONFLICTS OF INTEREST BY ANY ATTENDEES. ANY CONFLICTS ARE DISCLOSED AND THE COMMITTEE THEN ACTS IN A MANNER TO AVOID ANY CONFLICTED INDIVIDUAL PARTICIPATING IN ANY MANNER WHERE A CONFLICT MIGHT EXIST. AT THE END OF THE MEETING, THE COMMITTEE PREPARES CONTEMPORANEOUS MINUTES THAT RECORD ALL ACTIONS TAKEN DURING THE MEETING. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A. |
| Form 990, Part VI, Line 19 Required documents available to the public | BOARD-APPROVED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC AT THIS TIME. |
| Form 990, Part IX, Line 11g Other Fees | Professional Services - Total Expense: 1271852, Program Service Expense: 1251684, Management and General Expenses: 20168, Fundraising Expenses: ; Purchased Services - Total Expense: 5203263, Program Service Expense: 4274961, Management and General Expenses: 928302, Fundraising Expenses: ; Contract Labor - Total Expense: 511152, Program Service Expense: 511152, Management and General Expenses: , Fundraising Expenses: ; HSHS Shared Service Fee - Total Expense: 177828, Program Service Expense: , Management and General Expenses: 177828, Fundraising Expenses: ; |
| Form 990, Part X, Line 11 Pooled Investments | HSHS Good Shepard HOSPITAL CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT MAINTAINED BY HOSPITAL SISTERS HEALTH SYSTEM (HSHS). PARTICIPATION IN THE POOLED INVESTMENT FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND HEALTH SERVICES ORGANIZATIONS SPONSORED BY HSHS. THE POOLED ACCOUNT CONSISTS OF CASH, EQUITY AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF STATEMENT OF FINANCIAL ACCOUNTING STANDARDS (SFAS) NO. 124, "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS", INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE FAIR VALUES AND ALL INVESTMENTS IN DEBT SECURITIES ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE INDIVIDUAL HOSPITAL PARTICIPANTS. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Transfers to Affiliates - -753315; Pension expense -Mark to Market Adjustment - 353136; |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| KIARA CLINICAL INTEGRATION NETWORK LLC | |||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 261417684 | HEALTHCARE | IL | -$105,950 | $447,864 | HSSI |
| PHYSICIAN CLINICAL INTEGRATION NETWORK LLC | |||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371668647 | HEALTHCARE | IL | $554,315 | $15,980,466 | KCIN |
| HSHS ACO LLC | |||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 320465666 | HEALTHCARE & SOCIAL ASSISTANCE | IL | $1,805,698 | $3,189,003 | KCIN |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (28 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Business Name Line2DisregardedEntityName/BusinessNameLine2Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| HOSPITAL SISTERS HEALTH SYSTEM | |||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371058692 | HEALTHCARE | IL | 501(c)(3) | Type III-FI | NA | false | |
| HOSPITAL SISTERS HEALTHCARE-WEST INC | |||||||||||
| 2661 COUNTY HIGHWAY 1 | CHIPPEWA FALLS | WI | 54729 | 510157933 | HEALTHCARE | WI | 501(c)(3) | Type I | HSSI | Yes (true) | |
| HOSPITAL SISTERS MISSION OUTREACH CORPORATION | |||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 352271729 | RECYCLING MEDICAL SUPPLIES | IL | 501(c)(3) | HSHS | Yes (true) | ||
| HOSPITAL SISTERS OF ST FRANCIS FOUNDATION INC | |||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371186514 | HEALTHCARE | IL | 501(c)(3) | 7 | HSHS | Yes (true) | |
| HOSPITAL SISTERS SERVICES INC | |||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371163402 | HEALTHCARE | IL | 501(c)(3) | Type III-FI | HSHS | Yes (true) | |
| HSHS HOLY FAMILY HOSPITAL | |||||||||||
| 200 HEALTHCARE DRIVE | GREENVILLE | IL | 62246 | 370792770 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) | |
| HSHS MEDICAL GROUP INC | |||||||||||
| 3051 HOLLIS DRIVE | SPRINGFIELD | IL | 62704 | 263956318 | HEALTHCARE | IL | 501(c)(3) | Type III-FI | HSSI | Yes (true) | |
| HSHS WISCONSIN MEDICAL GROUP INC | |||||||||||
| 3051 HOLLIS DRIVE | SPRINGFIELD | IL | 62704 | 264515959 | HEALTHCARE | WI | 501(c)(3) | Type III-FI | HSSI | Yes (true) | |
| ORANGE CROSS AMBULANCE INC | |||||||||||
| 919 ASHLAND AVENUE | SHEBOYGAN | WI | 53081 | 391860942 | HEALTHCARE | WI | 501(c)(3) | 10 | ST NICHOLAS | Yes (true) | |
| PRAIRIE CARDIOVASCULAR CONSULTANTS LTD | |||||||||||
| 3051 HOLLIS DRIVE | SPRINGFIELD | IL | 62704 | 371071858 | HEALTHCARE | IL | 501(c)(3) | 10 | HSSI | Yes (true) | |
| PRAIRIE EDUCATION & RESEARCH COOPERATIVE | |||||||||||
| 800 E CARPENTER STREET 62 | SPRINGFIELD | IL | 62769 | 371157915 | HEALTHCARE | IL | 501(c)(3) | 4 | HSSI | Yes (true) | |
| SACRED HEART HOSPITAL OF HOSPITAL SISTERS OF THIRD ORDER OF ST FRANCIS | |||||||||||
| 990 WEST CLAIREMONT AVENUE | EAU CLAIRE | WI | 54701 | 390807060 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) | |
| SHELBY MEMORIAL HOSPITAL EMPLOYEE BENEFIT TRUST | |||||||||||
| 200 SOUTH CEDAR STREET | SHELBYVILLE | IL | 62565 | 371778753 | TRUST | IL | 501(a) | HSSI | Yes (true) | ||
| SOUTHERN ILLINOIS CARDIOVASCULAR SERVICE INC | |||||||||||
| ONE ST ELIZABETHS BLVD | OFALLON | IL | 62269 | 371276333 | HEALTHCARE | IL | 501(c)(3) | 3 | ST ELIZABETH'S HOSPITAL | false | |
| ST ANTHONY'S MEMORIAL HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER O | |||||||||||
| 503 N MAPLE STREET | EFFINGHAM | IL | 62401 | 370661233 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) | F ST FRANCIS |
| ST FRANCIS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS | |||||||||||
| 1215 FRANCISCAN DRIVE | LITCHFIELD | IL | 62056 | 370661236 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) | |
| ST JOSEPH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANC | |||||||||||
| 9515 HOLY CROSS LANE | BREESE | IL | 62230 | 371208459 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) | IS |
| ST JOSEPH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANC | |||||||||||
| 2661 COUNTY HIGHWAY 1 | CHIPPEWA FALLS | WI | 54729 | 390810545 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) | IS |
| ST JOSEPH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANC | |||||||||||
| 12866 TROXLER AVENUE | HIGHLAND | IL | 62249 | 370663568 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) | IS |
| ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC - HOSPITAL SISTERS | |||||||||||
| 1762 SHAWANO AVENUE | GREEN BAY | WI | 54303 | 390818682 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) | |
| ST VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCI | |||||||||||
| 835 S VAN BUREN | GREEN BAY | WI | 51301 | 390817529 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) | S |
| ST CLARE MEMORIAL HOSPITAL INC | |||||||||||
| 855 S MAIN STREET | OCONTO FALLS | WI | 54154 | 390848401 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) | |
| ST ELIZABETH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FR | |||||||||||
| ONE ST ELIZABETHS BLVD | OFALLON | IL | 62269 | 370663567 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) | ANCIS |
| ST JOHN'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS | |||||||||||
| 800 EAST CARPENTER STREET | SPRINGFIELD | IL | 62769 | 370661238 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) | |
| ST MARY'S HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST | |||||||||||
| 1800 E LAKE SHORE DRIVE | DECATUR | IL | 62521 | 370661244 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) | FRANCIS |
| ST NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANC | |||||||||||
| 3100 SUPERIOR AVENUE | SHEBOYGAN | WI | 53081 | 390808480 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) | IS |
| UNITY LIMITED PARTNERSHIP | |||||||||||
| 2366 OAK RIDGE CIRCLE | DE PERE | WI | 54115 | 391750729 | HEALTHCARE | WI | 501(c)(3) | 10 | HSSI | Yes (true) | |
| UTLAUT MEMORIAL FOUNDATION INC | |||||||||||
| 200 HEALTHCARE DRIVE | GREENVILLE | IL | 62246 | 371140166 | FUNDRAISING | IL | 501(c)(3) | Type II | HSSI | Yes (true) | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | OwnershipOwnershipPct | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SPRINGFIELD URGENT CARE REAL ESTATE LLC | |||||||||||||
| PO BOX 19456 | SPRINGFIELD | IL | 627949456 | 030413258 | RENTAL REAL ESTATE | IL | LASANTE INC | N/A | 0 | ||||
| PRAIRIE HEART INSTITUTE MANAGEMENT COMPANY LLC | |||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 261479945 | MEDICAL | IL | HSHS | Related | 1 | -$7,032 | $12,572 | false | Yes (true) |
| SOUTHWEST ILLINOIS HEALTH SERVICES REAL ESTATE LLP | |||||||||||||
| 4000 NORTH ILLINOIS STREET | SWANSEA | IL | 62226 | 823633320 | REAL ESTATE | IL | St John's | Related | 0.5 | -$126,650 | $1,434,911 | false | false |
| REHABILITATION HOSPITAL OF WESTERN WISCONSIN LLC | |||||||||||||
| 9001 Liberty Parkway | Birmingham | AL | 35242 | 871489748 | Medical | DE | HSHS | Related | 0.5 | -$80,505 | $4,187,830 | false | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KIARA INC | |||||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371163401 | HEALTHCARE | IL | HSHS | C Corporation | $601,904 | $18,670,450 | 1 | Yes (true) | |||||
| LASANTE WISCONSIN INC | |||||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 391572196 | HEALTHCARE | IL | KIARA INC | C Corporation | Yes (true) | ||||||||
| LASANTE INC | |||||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371163400 | HEALTHCARE | IL | KIARA INC | C Corporation | Yes (true) | ||||||||
| PREVEA HEALTH SERVICES INC | |||||||||||||||||
| 2710 EXECUTIVE DRIVE | GREEN BAY | WI | 54304 | 391839351 | HEALTHCARE | WI | HSSI | C Corporation | -$1,641,640 | $24,425,128 | 0.5 | Yes (true) | |||||
| PREVEA CLINIC INC | |||||||||||||||||
| 2710 EXECUTVE DRIVE | GREEN BAY | WI | 54304 | 391839349 | HEALTHCARE | WI | PHSI | C Corporation | Yes (true) | ||||||||
| RENAISSANCE QUALITY INSURANCE LTD | |||||||||||||||||
| 980669953 | INSURANCE | HSSI | C Corporation | $0 | $156,895,227 | 1 | Yes (true) | PO BOX 1159 | GRAND CAYMAN | CJ | KY11102 | CJ | |||||
| OJV INC | |||||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 460873384 | HEALTHCARE | IL | LASANTE INC | C Corporation | Yes (true) | ||||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule R, Part VII Related Organizations | FormAndLineReferenceDesc |
| Explanation | Due to the increasingly complex organization structure of Hospital Sisters Health System and Affiliates, the filing organization has elected to report all organizations within Hospital Sisters Health System as related, regardless of ownership interest or "control" as defined by the instructions to Schedule R. The intent of this reporting is to promote transparency and increase consistency across the numerous Form 990 submissions by Hospital Sisters Health System and Affiliates. | ExplanationTxt |