MENDOTA COMMUNITY HOSPITAL: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization: MENDOTA COMMUNITY HOSPITAL (EIN 36-2167785)
Tax period: 2021-10-01 to 2022-09-30
Filed: 2023-08-11
IRS object ID: 202342239349301799
Schema version: 2021v4.2
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	2023-08-11T19:31:27+00:00	ReturnTs
Tax Period End	2022-09-30	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	2021-10-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	362167785	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Mendota Community Hospital	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	MEND	BusinessNameControlTxt
Phone	3096552850	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	124 SW Adams St	AddressLine1Txt
City	Peoria	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	61602	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	MICHAEL M ALLEN	PersonNm
Person Title	CFO	PersonTitleTxt
Phone	3096552850	PhoneNum
Signature	2023-08-11	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	Michael M	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	Jennifer Burke	PreparerPersonNm
PTIN	P01342224	PTIN
Phone	3128997000	PhoneNum

Field	Value	IRS element (for citing)
Tax	2021	TaxYr
Build TS	2023-04-26 12:10:37Z	BuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	OSF Saint Paul Medical Center	BusinessNameLine1Txt

Principal Ofcr Business Name PrincipalOfcrBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Michael M Allen	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	124 SW Adams St	AddressLine1Txt
City	Peoria	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	61602	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$38,641,995	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	www.osfhealthcare.org	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1944	FormationYr
Legal Domicile State	IL	LegalDomicileStateCd
Activity Or Mission	IN THE SPIRIT OF CHRIST AND THE EXAMPLE OF FRANCIS OF ASSISI, THE MISSION OF OSF HEALTHCARE IS TO SERVE PERSONS WITH THE GREATEST CARE AND LOVE IN A COMMUNITY THAT CELEBRATES THE GIFT OF LIFE.	ActivityOrMissionDesc
Voting Members Governing Body	11	VotingMembersGoverningBodyCnt
Voting Members Independent	8	VotingMembersIndependentCnt
Total Employee	157	TotalEmployeeCnt
Total Volunteers	11	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$1,313,058	PYContributionsGrantsAmt
CY Contributions Grants	$1,557,349	CYContributionsGrantsAmt
PY Program Service Revenue	$36,130,541	PYProgramServiceRevenueAmt
CY Program Service Revenue	$36,548,492	CYProgramServiceRevenueAmt
PY Investment Income	$5,114	PYInvestmentIncomeAmt
CY Investment Income	$6,937	CYInvestmentIncomeAmt
PY Other Revenue	$250,484	PYOtherRevenueAmt
CY Other Revenue	$498,244	CYOtherRevenueAmt
PY Total Revenue	$37,699,197	PYTotalRevenueAmt
CY Total Revenue	$38,611,022	CYTotalRevenueAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$14,837,686	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$15,217,232	CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$17,982,076	PYOtherExpensesAmt
CY Other Expenses	$16,279,562	CYOtherExpensesAmt
PY Total Expenses	$32,819,762	PYTotalExpensesAmt
CY Total Expenses	$31,496,794	CYTotalExpensesAmt
PY Revenues Less Expenses	$4,879,435	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$7,114,228	CYRevenuesLessExpensesAmt
Total Assets BOY	$32,137,344	TotalAssetsBOYAmt
Total Assets EOY	$32,792,778	TotalAssetsEOYAmt
Total Liabilities BOY	$19,296,078	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$13,724,107	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$12,841,266	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$19,068,671	NetAssetsOrFundBalancesEOYAmt
Mission	IN THE SPIRIT OF CHRIST AND THE EXAMPLE OF FRANCIS OF ASSISI, THE MISSION OF OSF HEALTHCARE IS TO SERVE PERSONS WITH THE GREATEST CARE AND LOVE IN A COMMUNITY THAT CELEBRATES THE GIFT OF LIFE.	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$24,388,982	ExpenseAmt
Revenue	$36,977,923	RevenueAmt
Desc	MENDOTA COMMUNITY HOSPITAL is licensed to operate 25 patient beds. The hospital provided $1,887,326 in financial assistance to the community during FISCAL YEAR 2022. The Hospital's services provided during fiscal year 2022 are as follows: Patient days of 2,556, Outpatient visits of 35,699, Patient visits to the emergency room of 6,058.	Desc
Total Program Service Expenses	$24,388,982	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	Yes (true)	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	false	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
IRP Document	5	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	157	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	11	GoverningBodyVotingMembersCnt
Independent Voting Member	8	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	false	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	Yes (true)	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	false	InvestmentInJointVentureInd
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	Michael M Allen	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	3096552850	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	124 SW Adams St	AddressLine1Txt
City	PEORIA	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	61602	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (48 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
Robert C Sehring
Vice Chairperson Chief Executive Officer	1.0	43.0	Yes (X)	Yes (X)	$0	$2,650,545	$42,606
Sister Agnes Joseph Williams OSF
Assistant Secretary	1.0	43.0	Yes (X)	Yes (X)	$0	$0	$0
Sister Diane Marie McGrew OSF
President and Treasurer	1.0	43.0	Yes (X)	Yes (X)	$0	$0	$0
Sister Judith Ann Duvall OSF
Chairperson	1.0	43.0	Yes (X)	Yes (X)	$0	$0	$0
Sister Theresa Ann Brazeau OSF
Secretary	1.0	43.0	Yes (X)	Yes (X)	$0	$0	$0
Brian J Silverstein MD
Board Member	1.0	42.0	Yes (X)		$0	$45,000	$0
Gerald J McShane MD
Board Member	1.0	42.0	Yes (X)		$0	$183,578	$29,878
Sister M Angelica Neumann FSGM
Board Member	1.0	42.0	Yes (X)		$0	$0	$0
Sister M Beata Ziegler FSGM
Board Member	1.0	42.0	Yes (X)		$0	$0	$0
Sister M Mikela Meidl FSGM
Board Member	1.0	43.0	Yes (X)		$0	$0	$0
Sister Rose Therese Mann OSF
Board Member	1.0	43.0	Yes (X)		$0	$0	$0
August J Querciagrossa
Chief Executive Officer Western Region	1.0	41.0		Yes (X)	$0	$562,037	$40,856
Bradley V Solberg
President, OSF HealthCare Saint James- John W. Albrecht MC	1.0	41.0		Yes (X)	$0	$473,668	$44,167
Carol A Friesen
Chief Executive Officer Eastern Region	1.0	41.0		Yes (X)	$0	$772,415	$50,315
Chad E Boore
Chief Executive Officer Eastern Region (Through Aug 2022)	1.0	41.0		Yes (X)	$0	$713,662	$47,689
David M Hall
SVP Info Systems/Chief Information Officer	1.0	41.0		Yes (X)	$0	$614,445	$46,225
Dawn C Trompeter
President, OSF Healthcare St. Elizabeth MC/ St. Paul MC	40.0	2.0		Yes (X)	$399,396	$0	$38,232
Jacqueline D Kernan
President, OSF HealthCare St Clare Medical Center & St Luke MC	1.0	41.0		Yes (X)	$0	$349,542	$35,713
James J Mormann
Chief Information Officer	1.0	41.0		Yes (X)	$0	$989,677	$48,832
Jared C Rogers
President, OSF HealthCare Heart of Mary Medical Center	1.0	41.0		Yes (X)	$0	$547,842	$37,511
Jason R Rodeghero
President, OSF Home Care and Rehab Services	1.0	41.0		Yes (X)	$0	$351,552	$40,237
Jeffry M Tillery
President, OSF Medical Group	1.0	41.0		Yes (X)	$0	$942,742	$40,704
Jerry W Rumph
President, OSF HealthCare Saint Anthony's Health Center	1.0	41.0		Yes (X)	$0	$337,803	$16,128
John R Evancho
SVP Chief Compliance Officer	1.0	41.0		Yes (X)	$0	$433,915	$42,434
Kathleen M Kinsella
President, OSF HealthCare Little Company of Mary Medical Center	1.0	41.0		Yes (X)	$0	$510,038	$28,658
Kelly A Jefferson
President, OSF HealthCare St. Francis Hospital & Medical Group	1.0	41.0		Yes (X)	$0	$226,816	$34,247
Leon A Yeh MD
VP Chief Medical Officer Emergency Serv	1.0	41.0		Yes (X)	$0	$720,064	$25,269
Lisa DeKezel
President, OSF HealthCare Holy Family MC and St. Mary MC	1.0	41.0		Yes (X)	$0	$377,167	$29,413
Lori L Wiegand
Chief Nursing Officer	1.0	41.0		Yes (X)	$0	$673,410	$24,691
Lynn A Fulton
President, OSF HealthCare St. Joseph Medical Center	1.0	41.0		Yes (X)	$0	$486,071	$40,570
Michael A Cruz MD
Chief Operating Officer	1.0	41.0		Yes (X)	$0	$1,119,188	$48,596
Michael A Wells
President CHOI	1.0	41.0		Yes (X)	$0	$340,691	$30,146
Michael M Allen
Chief Financial Officer	1.0	42.0		Yes (X)	$0	$1,112,574	$42,879
Michelle D Conger
Chief Strategy Officer, OSF Healthcare/ CEO OnCall Digital Health	1.0	41.0		Yes (X)	$0	$906,223	$35,892
Ned Hill
President, OSF HealthCare Sacred Heart Medical Center	1.0	41.0		Yes (X)	$0	$156,173	$15,096
Paula A Carynski
President, OSF HealthCare Saint Anthony Medical Center	1.0	41.0		Yes (X)	$0	$595,645	$41,762
Ralph Velazquez MD
System Chief Medical Officer	1.0	41.0		Yes (X)	$0	$853,298	$43,644
Robert G Anderson
Chief Executive Officer Central Region	1.0	41.0		Yes (X)	$0	$729,059	$34,907
Robert L Brandfass
SVP Chief Legal Officer	1.0	41.0		Yes (X)	$0	$862,096	$36,626
Roxanna Crosser
Chief Executive Officer Western Region	1.0	41.0		Yes (X)	$0	$680,825	$29,894
Shelley A Nguyen
Chief Human Resources Officer	1.0	41.0		Yes (X)	$0	$268,708	$24,519
Stephen E Hippler MD
Chief Clinical Officer	1.0	41.0		Yes (X)	$0	$1,065,555	$50,320
Thomas G Hammerton
President OSF Healthcare Foundation Chief Development Officer	1.0	42.0		Yes (X)	$0	$604,139	$42,145
Denise M Bickett
Registered Nurse Hospital	40.0	0			$100,418	$0	$30,661	Yes (X)
Jodie L Borchelt
Director Surgical/Inpatient Services, Medical/Surgical Acute	40.0	0			$119,053	$0	$33,728	Yes (X)
Katherine R Riva-Foster MD
Physician	40.0	0			$248,557	$0	$28,238	Yes (X)
Kenneth K Potts MD
Physician	40.0	0			$253,004	$0	$31,393	Yes (X)
Stacy A Piller
Advanced Practice Nurse	40.0	0			$119,851	$0	$30,001	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$1,240,279	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$22,256,163	TotReportableCompRltdOrgAmt
Total Other Compensation	$1,414,822	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	6	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	false	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (true)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Emergency Physician Staffing Solutions	BusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1504 Timber Trail	AddressLine1Txt
City	Washington	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	61571	ZIPCd

Field	Value	IRS element (for citing)
Services	Emergency Services Physicians	ServicesDesc
Compensation	$2,170,918	CompensationAmt

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	1	CntrctRcvdGreaterThan100KCnt
Federated Campaigns	$0	FederatedCampaignsAmt
Membership Dues	$0	MembershipDuesAmt
Fundraising	$0	FundraisingAmt
Related Organizations	$182,118	RelatedOrganizationsAmt
Government Grants	$1,099,031	GovernmentGrantsAmt
All Other Contributions	$276,200	AllOtherContributionsAmt
Noncash Contributions	$0	NoncashContributionsAmt
Total Contributions	$1,557,349	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT REVENUE	622110	$35,729,666	$35,729,666
CONTRACTED PHARMACY	622110	$737,915	$737,915
MEDICAL DIRECTORSHIPS	624200	$80,911	$80,911

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	$36,548,492	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$6,937	TotalRevenueColumnAmt
Exclusion	$6,937	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$19,872	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$19,872	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$19,872	TotalRevenueColumnAmt
Exclusion	$19,872	ExclusionAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	$0	OtherAmt

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	$33,657	GrossSalesOfInventoryAmt
Cost Of Goods Sold	$30,973	CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,684	TotalRevenueColumnAmt
Exclusion	$2,684	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
CAFETERIA	624200	$46,257	$46,257
AFFILIATE SERVICES	621300	$378,998		$378,998

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$50,433	TotalRevenueColumnAmt
Related Or Exempt Func Income	$50,433	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$475,688	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$38,611,022	TotalRevenueColumnAmt
Related Or Exempt Func Income	$36,977,923	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$75,750	ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$442,649	TotalAmt
Program Services	$354,119	ProgramServicesAmt
Management And General	$88,530	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$11,617,951	TotalAmt
Program Services	$9,670,627	ProgramServicesAmt
Management And General	$1,947,324	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$419,033	TotalAmt
Program Services	$296,967	ProgramServicesAmt
Management And General	$122,066	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$2,032,426	TotalAmt
Program Services	$1,565,503	ProgramServicesAmt
Management And General	$466,923	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$705,173	TotalAmt
Program Services	$547,610	ProgramServicesAmt
Management And General	$157,563	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$12,017	TotalAmt
Management And General	$12,017	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$2,487,461	TotalAmt
Program Services	$2,417,785	ProgramServicesAmt
Management And General	$69,676	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$898	TotalAmt
Program Services	$898	ProgramServicesAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$4,307,431	TotalAmt
Program Services	$3,985,919	ProgramServicesAmt
Management And General	$321,512	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$408,557	TotalAmt
Program Services	$49,766	ProgramServicesAmt
Management And General	$358,791	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$48,750	TotalAmt
Program Services	$34,317	ProgramServicesAmt
Management And General	$14,433	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$29,031	TotalAmt
Program Services	$20,656	ProgramServicesAmt
Management And General	$8,375	ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

Field	Value	IRS element (for citing)
Total	$5,118,807	TotalAmt
Program Services	$3,259,867	ProgramServicesAmt
Management And General	$1,858,940	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$666,892	TotalAmt
Program Services	$312,547	ProgramServicesAmt
Management And General	$354,345	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$53,938	TotalAmt
Program Services	$16,125	ProgramServicesAmt
Management And General	$37,813	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
CONTRACTS AND REPAIRS	$1,632,152	$365,909	$1,266,243
BAD DEBTS	$396,385	$396,385
PROVIDER TAX	$877,030	$877,030
COLLECTION AGENCIES	$4,425		$4,425

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$235,788	TotalAmt
Program Services	$216,952	ProgramServicesAmt
Management And General	$18,836	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$31,496,794	TotalAmt
Program Services	$24,388,982	ProgramServicesAmt
Management And General	$7,107,812	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$900	BOYAmt
EOY	$615	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$129,235	BOYAmt
EOY	$235,627	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
EOY	$0	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$4,261,925	BOYAmt
EOY	$4,276,840	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

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
EOY	$0	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$728,976	BOYAmt
EOY	$854,165	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$2,056	BOYAmt
EOY	$93,202	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$34,960,584	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$20,499,295	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$13,994,803	BOYAmt
EOY	$14,461,289	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$165,007	BOYAmt
EOY	$222,320	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

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
EOY	$0	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$12,854,442	BOYAmt
EOY	$12,648,720	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$32,137,344	BOYAmt
EOY	$32,792,778	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$4,658,203	BOYAmt
EOY	$2,114,301	EOYAmt

Grants Payable GrantsPayableGrp

Field	Value	IRS element (for citing)
EOY	$0	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
EOY	$0	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
EOY	$0	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
EOY	$0	EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
EOY	$0	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
EOY	$0	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$14,637,875	BOYAmt
EOY	$11,609,806	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$19,296,078	BOYAmt
EOY	$13,724,107	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	$10,804,694	BOYAmt
EOY	$17,237,822	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$2,036,572	BOYAmt
EOY	$1,830,849	EOYAmt

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

Field	Value	IRS element (for citing)
EOY	$0	EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

Field	Value	IRS element (for citing)
EOY	$0	EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

Field	Value	IRS element (for citing)
EOY	$0	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$12,841,266	BOYAmt
EOY	$19,068,671	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$32,137,344	BOYAmt
EOY	$32,792,778	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$7,114,228	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$50,742	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$836,081	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	$12,017	OtherActivitiesAmt
Total Lobbying Expenditures	$12,017	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	THE ORGANIZATION'S LOBBYING ACTIVITIES INCLUDE PAYING MEMBERSHIP DUES TO THE ILLINOIS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION, WHO PARTICIPATE IN LOBBYING ACTIVITIES ON BEHALF OF HEALTHCARE ORGANIZATIONS.	ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,034,874	BeginningYearBalanceAmt
Investment Earnings Or Losses	-$172,177	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$30,984	GrantsOrScholarshipsAmt
End Year Balance	$831,713	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$854,817	BeginningYearBalanceAmt
Investment Earnings Or Losses	$225,552	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$45,495	GrantsOrScholarshipsAmt
End Year Balance	$1,034,874	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$805,217	BeginningYearBalanceAmt
Investment Earnings Or Losses	$49,600	InvestmentEarningsOrLossesAmt
End Year Balance	$854,817	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$801,256	BeginningYearBalanceAmt
Investment Earnings Or Losses	$3,961	InvestmentEarningsOrLossesAmt
End Year Balance	$805,217	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$731,914	BeginningYearBalanceAmt
Investment Earnings Or Losses	$69,342	InvestmentEarningsOrLossesAmt
End Year Balance	$801,256	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.0	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.5996	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.4004	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	false	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (true)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	Yes (true)	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,927,000	OtherCostOrOtherBasisAmt
Book Value	$1,927,000	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$16,249,923	OtherCostOrOtherBasisAmt
Depreciation	$7,508,497	DepreciationAmt
Book Value	$8,741,426	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$2,056,749	OtherCostOrOtherBasisAmt
Depreciation	$1,356,803	DepreciationAmt
Book Value	$699,946	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$14,636,255	OtherCostOrOtherBasisAmt
Depreciation	$11,633,995	DepreciationAmt
Book Value	$3,002,260	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$90,657	OtherCostOrOtherBasisAmt
Depreciation	$0	DepreciationAmt
Book Value	$90,657	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$14,461,289	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDesc	Book ValueBookValueAmt
GOODWILL	$10,817,871
RESTRICTED FOUNDATION ASSETS	$1,830,849

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$12,648,720	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (9 entries)

DescDesc	AmtAmt
ASSET RETIREMENT OBLIGATION	$24,538
ADVANCES DUE CORP-TERM
OTHER NOTES - LOANS PAYABLE
MEDICARE ADVANCE PAYMENTS
DEFERRED INCOME - BLUE CROSS
DEFERRED INCOME - OTHER
Federal Pandemic Funds
Due to OSF	$11,092,755
Due to PCI	$492,513

Field	Value	IRS element (for citing)
Total Liability	$11,609,806	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

Schedule D, Part V, Line 4 Intended uses of endowment funds

THE ENDOWMENT IS HELD BY OSF HEALTHCARE FOUNDATION, A RELATED 501(c)(3) ENTITY. PROCEEDS OF THE ENDOWMENT, AS DICTATED BY THE DONORS, ARE USED AS BEST DETERMINED BY THE FOUNDATION COUNCIL.

Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote

OSF is a not-for-profit corporation as described by Section 501(c)(3) of the Internal Revenue Code (the Code) and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Under ASC Subtopic 740-10, Accounting for Uncertainty in Income Taxes - An Interpretation of FASB Statement No. 109, OSF and PCI must recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured based on the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement. As of September 30, 2022 or 2021, OSF and PCI do not have any uncertain tax positions.

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

Free Care Oth Percentage FreeCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Free Care Other	250	FreeCareOtherPct

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	Yes (true)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
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	$613,381	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$613,381	NetCommunityBenefitExpnsAmt
Total Expense	0.0195	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,721,492	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$4,588,772	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$132,720	NetCommunityBenefitExpnsAmt
Total Expense	0.0042	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	$5,334,873	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$4,588,772	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$746,101	NetCommunityBenefitExpnsAmt
Total Expense	0.0237	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$136,002	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$14,695	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$121,307	NetCommunityBenefitExpnsAmt
Total Expense	0.0039	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$102,668	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$102,668	NetCommunityBenefitExpnsAmt
Total Expense	0.0033	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,040,349	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,297,783	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$742,566	NetCommunityBenefitExpnsAmt
Total Expense	0.0236	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	$6,298	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$6,298	NetCommunityBenefitExpnsAmt
Total Expense	0.0002	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$3,285,317	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,312,478	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$972,839	NetCommunityBenefitExpnsAmt
Total Expense	0.0309	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$8,620,190	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$6,901,250	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,718,940	NetCommunityBenefitExpnsAmt
Total Expense	0.0546	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	$290,097	BadDebtExpenseAmt
Bad Debt Expense Attributable	$0	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$12,982,115	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$11,190,323	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$1,791,792	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	MENDOTA COMMUNITY HOSPITAL	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1401 E 12TH STREET	AddressLine1Txt
City	MENDOTA	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	61342	ZIPCd

Field	Value	IRS element (for citing)
Website Address	HTTPS://WWW.OSFHEALTHCARE.ORG/SAINT-PAUL/	WebsiteAddressTxt
State License	IL0005819	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	MENDOTA COMMUNITY 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	Yes (true)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	false	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	https://www.osfhealthcare.org/about/community-health/	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (true)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	22	ImplementationStrategyAdptYr
Strategy Posted Website	false	StrategyPostedWebsiteInd
Strategy Attached	Yes (true)	StrategyAttachedInd
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	250.0	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	400.0	FPGFamilyIncmLmtDscntCarePct
Income Level Criteria	Yes (X)	IncomeLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
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
Other Method	Yes (X)	OtherMethodInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	https://www.osfhealthcare.org/billing/financial-assistance/	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	https://www.osfhealthcare.org/billing/financial-assistance/	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	https://www.osfhealthcare.org/billing/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
Other Publicity	Yes (X)	OtherPublicityInd
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 (8 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part V, Section B, Line 3E	The significant health needs were prioritized as significant health needs of the community and identified through the CHNA. See CHNA for further information.
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - MENDOTA COMMUNITY HOSPITAL. FOR THE 2022 CHNA, MENDOTA COMMUNITY HOSPITAL d/b/a SAINT PAUL MEDICAL CENTER SOLICITED AND TOOK INTO ACCOUNT INPUT FROM THE FOLLOWING SOURCES: 1) CURRENT PUBLIC HEALTH ADMINISTRATOR AT THE LASALLE COUNTY HEALTH DEPT. and CURRENT HEALTH EDUCATOR AND PUBLIC INFORMATION FROM THE LASALLE COUNTY HEALTH DEPT. 2) PRIMARY DATA WAS COLLECTED FROM THE AT-RISK AND ECONOMICALLY DISADVANTAGED POPULATION BY COLLECTING A STRATIFIED SAMPLE OF SURVEYS DISTRIBUTED IN ENGLISH AND SPANISH AT ALL HOMELESS SHELTERS, FOOD PANTRIES AND SOUP KITCHENS. 3) THE PRIOR AND NEW 2022 CHNA WAS MADE WIDELY AVAILABLE TO THE COMMUNITY AND FEEDBACK RECEIVED FROM COMMUNITY SERVICE ORGANIZATIONS WAS TAKEN INTO ACCOUNT. 4) ADDITIONAL SOURCES OF INPUT WAS RECEIVED FROM A COLLABORATIVE TEAM CREATED TO CONDUCT THE CHNA, WHICH INCLUDED CONSUMER ADVOCATES, REPRESENTATIVES FROM NONPROFIT AND COMMUNITY-BASED ORGANIZATIONS, ACADEMIC EXPERTS AND HEALTH EDUCATORS, LOCAL GOVERNMENT OFFICIALS, ADMINISTRATORS FROM LOCAL SCHOOL DISTRICTS, HEALTH CARE PROVIDERS AND COMMUNITY HEALTH CENTERS, EXECUTIVE DIRECTOR OF IL VALLEY PADS HOMELESS SHELTER PROGRAM, PROGRAM COORDINATOR FOR THE YOUTH SERVICE BUREAU OF IL VALLEY SERVING THE LATINO POPULATION ENROLLED IN PUBLIC BENEFITS, EXECUTIVE DIRECTOR OF UNITED WAY, AND EXECUTIVE DIRECTOR OF MENDOTA AREA SENIOR SERVICES. MEMBERS OF THE COLLABORATIVE TEAM BY NAME, AFFILIATIONS, TITLE AND EXPERTISE ARE LISTED IN APPENDIX 1 TO THE 2022 CHNA.
Schedule H, Part V, Section B, Line 6a Facility , 1	Facility , 1 - MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER - MENDOTA, IL. THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR 2022 FOR LASALLE COUNTY WAS A COLLABORATIVE UNDERTAKING BY OTTAWA REGIONAL HOSPITAL AND HEALTHCARE CENTER DBA OSF SAINT ELIZABETH MEDICAL CENTER AND MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER. THE CHNA HIGHLIGHTS THE HEALTH NEEDS AND WELL-BEING OF RESIDENTS IN LASALLE COUNTY.
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - MENDOTA COMMUNITY HOSPITAL. MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") DURING FISCAL YEAR 2019 AS REQUIRED BY INTERNAL REVENUE CODE SECTION 501(R)(3). THE FINAL CHNA FOR THE HOSPITAL WAS APPROVED AND ADOPTED BY THE SYSTEM'S BOARD OF DIRECTORS ON JULY 29, 2019. THIS CHNA IS EFFECTIVE FOR FISCAL YEARS 2020, 2021 AND 2022. THE LASALLE COUNTY CHNA WAS DONE AS A COLLABORATIVE UNDERTAKING BY OSF SAINT ELIZABETH AND OSF SAINT PAUL MEDICAL CENTERS TO HIGHLIGHT THE HEALTH NEEDS AND WELL BEING OF RESIDENTS IN LASALLE COUNTY. THE COLLABORATIVE TEAM IDENTIFIED THE FOLLOWING SIGNIFICANT COMMUNITY HEALTH NEEDS AS A PRIORITY: HEALTHY BEHAVIORS AND BEHAVIORAL HEALTH. IN RESPONSE TO THESE PRIORITY HEALTH NEEDS, THE HOSPITALS DEVELOPED AN IMPLEMENTATION STRATEGY DESCRIBING THE ACTIONS THE HOSPITALS INTEND TO TAKE TO ADDRESS BOTH PRIORITY HEALTH NEEDS, THE RESOURCES THE HOSPITALS PLAN TO COMMIT TO ADDRESS THE HEALTH NEEDS, AND ANY PLANNED COLLABORATIONS WITH OTHER ORGANIZATIONS TO ADDRESS THE HEALTH NEEDS. THE HOSPITALS REVIEW THEIR IMPLEMENTATION STRATEGY AT LEAST ANNUALLY AND MAKE REVISIONS AS NEEDED TO MAXIMIZE THE IMPACT ON IDENTIFIED PRIORITY HEALTH NEEDS. A SUMMARY OF HOW THE HOSPITALS HAVE ADDRESSED THE PRIORITY HEALTH NEEDS IS PROVIDED BELOW. HEALTHY BEHAVIORS DEFINED AS - ACTIVE LIVING, HEALTHY EATING AND OBESITY GOALS. ACTIVE LIVING - A HEALTHY LIFESTYLE, COMPRISED OF REGULAR PHYSICAL ACTIVITY, HAS BEEN SHOWN TO INCREASE PHYSICAL, MENTAL, AND EMOTIONAL WELL-BEING. GOAL 1: INCREASE ACTIVE LIVING IN LASALLE COUNTY OVER THE NEXT THREE YEARS AS EVIDENCED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY. OUTCOME METRIC: INCREASE ACTIVE LIVING IN LASALLE COUNTY BY INCREASING THE NUMBER OF RESPONDENTS EXERCISING (HEALTHY ACTIVITY) 1 - 5 TIMES PER WEEK FROM 60% TO 62% AND DECREASING THOSE REPORTING THEY DO NOT EXERCISE AT ALL FROM 28% TO 25%. TACTICS AND PROGRESS FOR FY 2022 (1) Promoted the University of Illinois walking guide for Ottawa, Streator, and Mendota virtually in Live Well Streator's 20 in 21 social media campaign, daily on the OSF Center for Health Streator's waiting room digital screens, on April 13 at Illinois Valley Community College Student Wellness Fair, April 29 at Streator YMCA Healthy Kids Day, and May 7 at Mendota YMCA Healthy Kids Day. In addition, Live Well Streator partnered with the Streator Chamber for a Poker Walk on October 1 (2) INCREASE OFFERING OF THE HEALTHY KIDS U PROGRAM: PROGRESS FY 2022 HKU to launch in May 2022. Due to low enrollment class cancelled. Participated in April 29 Streator YMCA's Healthy Kids Day, May 7 Mendota YMCA's Healthy Kids Day, July 2 Streator 4th of July Celebration's Kids Korner and July 14-15 LaSalle County 4-H Fair. Co-sponsored and participated in the University of Illinois Extension's Illinois Junior Chef program in Streator June 20-24. (3) IMPLEMENT JOURNEY TO HEALTH - REDESIGNED PROGRAM. PROGRESS FY 2022 - Reset Program - locally 350 people participate LaSalle County. 90% complete all 6 weeks. July 12 - Summer Out Loud - 3 week summer family program. Fall Session - 9 participants HEALTHY EATING - A HEALTHY LIFESTYLE, COMPRISED OF A PROPER DIET, HAS BEEN SHOWN TO INCREASE PHYSICAL, MENTAL, AND EMOTIONAL WELL-BEING. OBESITY - A HEALTH OUTCOME, WHICH IS DIRECTLY RELATED TO HEALTHY BEHAVIORS. GOAL 2: INCREASE COMMUNITY CONSUMPTION OF FRUITS/VEGETABLES TO MORE THAN 2 SERVINGS PER DAY. OUTCOME METRIC 2: INCREASE THE RATE FROM 44% TO 48% OF THE COMMUNITY THAT REPORTED THAT THEY CONSUME MORE THAN 2 SERVINGS OF FRUITS/VEGETABLES PER DAY ON THE 2022 CHNA SURVEY. BASELINE: PER THE 2019 CHNA, 44% OF THE COMMUNITY REPORTED THAT THEY CONSUME MORE THAN 2 SERVICES OF FRUITS/VEGETABLES PER DAY. TACTICS AND PROGRESS FOR FY 2022 (1) PROMOTE AWARENESS OF COMMUNITY GARDENS AT OSF HEALTHCARE, OTTAWA COMMUNITY GARDENS, SHS EDIBLE GARDEN, NORTHLAWN JR. HIGH SCHOOL GARDEN AND THE DISTRIBUTION LOCATIONS TO ADDRESS LOCAL FOOD DISPARITIES AND ACCESS TO HEALTHY FOODS. PROGRESS FY2022 Micropantry installed at Reading Township Hall, Streator. Ottawa - 12 beds and herbs planted. Mendota - 26 beds. Streator - 3 garden bed areas, south lot garden divided into 4 sections, transportation center 12 raised beds. The Ottawa Community Garden harvested 640 pounds and donated the produce to A Servant's Heart. Streator donated 713.75 pounds to the Streatorland Food Pantry, Grace Community Church Food Pantry, New Beginnings Baptist Church Food Pantry and the Streator Salvation Army Food Pantry. The Mendota garden donated 1,175 pounds to the OSF Saint Paul Cafe, Mission Partners, and the Mendota Area Christian Food Pantry. Total of 2,528.75 pounds of produce this season. PROGRESS FY2022 - HKU to launch in May 2022. Due to low enrollment class cancelled. Participated in April 29 Streator YMCA's Healthy Kids Day, May 7 Mendota YMCA's Healthy Kids Day, July 2 Streator 4th of July Celebration's Kids Korner and July 14-15 LaSalle County 4-H Fair. Co-sponsored and participated in the University of Illinois Extension's Illinois Junior Chef program in Streator June 20-24. (2) Develop and Promote Live Well Streator Health Eating Restaurant Menu Guide PROGRESS FY2022: 1 restaurant, due to COVID, supplier and staffing challenges. Content on Live Well Streator Facebook page highlighted 12 restaurants with healthy options, 4 posts with 100-calorie swap outs and 20 fruit/vegetable features. (3) Conduct the Illinois Jr. Chef's Cooking School in three communities PROGRESS FY2022: 30 students participated in Streator June 20-24. (4) Promote healthier school lunchroom environments PROGRESS FY2022: Due to COVID restrictions with limited access for visitors at schools, community implementation was identified including Illinois Junior Chef at Northlawn Junior High School in Streator, Safety Town at Central Elementary School in Ottawa, Illinois Valley Community College Student Wellness Fair. (5) King Care-A-Van client nutrition education and food demonstrations within OSF Service area through mobile King Care-A-Van service PROGRESS FY2022: Nutrition education - Habitat Restore Peru, Streator Salvation Army, Ottawa Homeless Shelter/IV PADS MENTAL HEALTH - THE CHNA SURVEY ASKED RESPONDENTS TO INDICATE PREVALENCE OF SPECIFIC MENTAL-HEALTH ISSUES, NAMELY DEPARESSION AND STRESS/ANXIETY. OF RESPONDENTS, 41% INDICATED THEY FELT DEPRESSED IN THE LAST 30 DAYS AND 39% INDICATED THEY FELT ANXIOUS OR STRESSED. GOAL1: INCREASE THE OVERALL COMMUNITY UNDERSTANDING OF MENTAL HEALTH NEEDS AND ACCESS TO MENTAL HEALTH SERVICES. OUTCOME METRIC 1: DECREASE SELF-REPORTS OF DEPRESSION AND ANXIETY TO SEE A REDUCTION OF INDIVIDUALS REPORTING DEPRESSION AND ANXIETY WITHIN THE LAST 30 DAYS FROM 35% TO 32% BY 2022. (PER CHNA SURVEY, 2019) TACTICS FOR PROGRESS IN 2022 (1) North Central trained 12 participants at Park Presbyterian Church/Streator March 12th and 14 staff from Peru & Ottawa homeless shelters (IV PADS) July 19th (2) EMBED BILINGUAL BEHAVIORAL HEALTH PROVIDER AT OSF MULTI-SPECIALTY GROUP MENDOTA, BILINGUAL PROGRAMMING'S AND COMMUNICATIONS. PROGRESS FY2022: Implementation delayed due to staff turnover. Currently using Globo for translation services. (3) ENGAGE FAITH COMMUNITY NURSE TO WORK WITH SCHOOL NURSES REGARDING STUDENTS NOT HAVING MEDICATIONS NEEDED PROGRESS FY2022 - DELAYED DUE TO STAFF TURNOVER. (4) PROVIDE FREE ACCESS TO DIGITAL BEHAVIORAL HEALTH SOLUTION - SILVERCLOUD PROGRESS FY2022 - 64 UTILIZING APP. (5) PROVIDE FREE BEHAVIORAL HEALTH NAVIGATION SERVICE PROGRESS FY2022 - 231 USING SERVICE. GOAL 2: USE SOCIAL DETERMINATES OF HEALTH (SDOH) TO IDENTIFY PATIENTS AT INCREASED RISK OF POOR MENTAL HEALTH AND CONNECT THEM TO COMMUNITY ORGANIZATIONS IN ORDER TO IMPROVE MENTAL HEALTH OUTCOMES. OUTCOME MEASURE 2: DECREASE THE PERCENTAGE OF RESPONDENTS STATING THEY HAVE POOR OVERALL MENTAL HEALTH BY 1%. BASELINE: PER THE 2019 CHNA SURVEY, 8% OF RESPONDENTS STATED THEY HAVE POOR OVERALL MENTAL HEALTH. NOT HAVING BASIC HUMAN NEEDS IS LIKELY LINKED TO POOR MENTAL HEALTH. IF A SURVEY RESPONDENT DOES NOT HAVE HOUSING, FOOD, TRANSPORTATION (ETC.), THEIR OVERALL STATE OF MENTAL HEALTH WOULD LIKELY BE RATED LOWER. TACTICS FOR PROGRESS IN 2022 (1) IMPLEMENT SCREENING OF PATIENTS FOR SDOH. SCREEN AND CONNECT. NUMBER OF PATIENTS SCREENED. PROGRESS FY2022 - 8,047 (2) TRACK NUMBER OF PATIENTS REFERRED TO COMMUNITY BASED ORGANIZATIONS (CBO) PROGRESS FY2022 - 273 (3) TRACK NUMBER OF MISSION PARTNERS EDUCATED FOR CONTINUED ROLL-OUT - PROGRESS FY2022 - completed (4) TRACK NUMBER OF PATIENT REFERRALS TO OSF CARE MANAGEMENT AND SOCIAL WORKERS PROGRESS FY2022 - 22
Schedule H, Part V, Section B, Line 13 Facility , 1	Facility , 1 - MENDOTA COMMUNITY HOSPITAL. CATASTROPHIC FINANCIAL ASSISTANCE IS AVAILABLE WHEN CHARGES EXCEED 25% OF ANNUAL FAMILY INCOME. THE AMOUNT BILLED IS ADJUSTED TO 25% OF FAMILY INCOME WHEN OSF DETERMINES THIS ADJUSTMENT IS THE MOST GENERAL ASSISTANCE.
Schedule H, Part V, Section B, Line 13 Facility , 1	Facility , 1 - MENDOTA COMMUNITY HOSPITAL. PRESUMPTIVE FINANCIAL ASSISTANCE IS AVAILABLE AND PROVIDES FOR A DISCOUNT OF 100% OF BILLED CHARGES FOR MEDICALLY NECESSARY SERVICES PROVIDED TO A PATIENT WITH NO INSURANCE BENEFITS, WHEN THE PATIENT ESTABLISHES FINANCIAL NEED AT TIME OF REGISTRATION BY SATISFYING ONE OF THE FOLLOWING CATEGORIES OF PRESUMPTIVE ELIGIBILITY CRITERIA: HOMELESSNESS; DECEASED WITH NO ESTATE; MENTAL INCAPACITATION WITH NO ONE TO ACT ON THE PATIENT'S BEHALF; AND CURRENT MEDICAID ELIGIBILITY, BUT NOT ON DATE OF SERVICE OR FOR NON-COVERED SERVICE.
Schedule H, Part V, Section B, Line 15 Facility , 1	Facility , 1 - MENDOTA COMMUNITY HOSPITAL. THE FINANCIAL ASSISTANCE POLICY IS AVAIABLE BY WEBSITE, FAX, POSTAL ADDRESS AND PATIENTS ARE DIRECTED TO STAFF IN THE PATIENT FINANCIAL SERVICES AND ADMITTING AREAS AT OSF HOSPITALS FOR ASSISTANCE IN OBTAINING ANSWERS TO QUESTIONS REGARDING THE POLICY.
Schedule H, Part V, Section B, Line 16 Facility , 1	Facility , 1 - MENDOTA COMMUNITY HOSPITAL. A PLAIN LANGUAGE SUMMARY OF THE FAP IS OFFERED TO PATIENTS AS PART OF THE INTAKE OR DISCHARGE PROCESS, INFORMATION ABOUT FINANCIAL ASSISTANCE AND THE APPLICATION PROCESS IS INCLUDED ON OR WITH THE OSF PATIENT BILLING STATEMENT, AND OSF PROVIDES COPIES OF THE PLAIN LANGUAGE SUMMARY AND THE FAP APPLICATION FORM TO REFERRING STAFF PHYSICIANS.

Field	Value	IRS element (for citing)
Facility	0	FacilityNum

Supplemental Information Detail SupplementalInformationDetail (18 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part I, Line 3c Criteria for Free or Discounted Care	CATASTROPHIC CHARITY ASSISTANCE REGARDLESS OF INCOME OR ASSET LEVELS FOR MEDICALLY NECESSARY SERVICES WHICH EXCEED 25% OF ANNUAL FAMILY INCOME. THE AMOUNT DUE IS ADJUSTED TO 25% OF FAMILY INCOME WHEN OSF DETERMINES CATASTROPHIC CHARITY IS MORE GENEROUS. PRESUMPTIVE CHARITY: CHARGES MAY BE ADJUSTED TO PROVIDE FOR A CHARITY DISCOUNT OF 100% OF BILLED CHARGES FOR MEDICALLY NECESSARY SERVICES PROVIDED TO AN UNINSURED PATIENT WHO ESTABLISHES FINANCIAL NEED AT TIME OF REGISTRATION BY SATISFYING ONE OF THE FOLLOWING CATEGORIES OF PRESUMPTIVE ELIGIBILITY CRITERIA. PRESUMPTIVE CHARITY CATEGORIES FOR ALL OSF HOSPITALS: -HOMELESSNESS; - DECEASED WITH NO ESTATE; - MENTAL INCAPACITATION WITH NO ONE TO ACT ON PATIENT'S BEHALF; OR - CURRENT MEDICAID ELIGIBILITY, BUT NOT ON DATE OF SERVICE OR FOR NON-COVERED SERVICE. ALL PATIENTS RECEIVE THE GREATEST REQUESTED DISCOUNT AVAILABLE UNDER ANY OF THE OSF PROGRAMS. NO ASSET TESTS ARE USED. EXCEPT AS OTHERWISE NOTED, THESE POLICIES APPLY BOTH TO UNINSURED PATIENTS AND TO INSURED PATIENTS WITH RESPECT TO THE PATIENT RESPONSIBILITY AMOUNT.
Schedule H, Part I Coronavirus Pandemic	On March 11, 2020, the World Health Organization designated COVID-19 as a global pandemic. Patient activity and related revenues for most services were significantly impacted starting in mid-March 2020, as various policies were implemented by federal, state, and local governments in response to the COVID-19 pandemic. In March 2020, the CARES Act was signed into law, providing temporary and limited relief to hospitals during the COVID-19 outbreak. Under the CARES Act, appropriations were made for hospitals to cover expenses and lost revenue associated with the treatment of COVID-19 patients, the Medicare Accelerated and Advanced payment program was expanded, employee retention tax credits to employers affected by COVID-19 were provided, the 2% reduction in Medicare payments from sequestration through December 2021 has been eliminated, add-on payments for inpatient hospitals treating COVID-19 patients were created, and a reduction in Medicaid funding for Medicare disproportionate share hospitals was delayed.
Schedule H, Part I, Line 7g Subsidized Health Services	NET COSTS (TOTAL EXPENSE LESS REVENUE) OF PHYSICIAN CLINICS ARE INCLUDED AS SUBSIDIZED HEALTH SERVICES ON PART 1, LINE 7G.
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	Medicare cost to charge ratio
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	IN GENERAL, AND IN ACCORDANCE WITH MEDICARE REGULATIONS, PATIENT ACCOUNT BALANCES ARE WRITTEN OFF TO BAD DEBT EXPENSE AFTER REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED AND THE ACCOUNT HAS BEEN SENT TO A COLLECTION AGENCY OR LAW FIRM. PATIENTS' ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENTS' ACCOUNTS RECEIVABLE, OSF ANALYZES PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, OSF ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH PATIENT RESPONSIBILITY (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE PATIENTS ARE SCREENED AGAINST THE OSF FINANCIAL ASSISTANCE POLICY AND UNINSURED DISCOUNT POLICY. FOR ANY REMAINING PATIENT RESPONSIBILITY BALANCE, OSF RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. BAD DEBT EXPENSE OF 396,385 ON FORM 990, PART IX, LINE 24B IS BASED UPON ACCRUAL ACCOUNTING REQUIRED BY GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. THIS AMOUNT CONSEQUENTLY DIFFERS FROM THE BAD DEBT EXPENSE OF 290,097 ON SCHEDULE H, PART III, LINE 2 WHICH REQUIRES THE ORGANIZATION TO REPORT AGGREGATE BAD DEBT AT COST. BAD DEBT EXPENSE REPORTED ON PART III, LINE 2 IS THEREFORE CALCULATED BY MULTIPLYING GROSS CHARGES WRITTEN OFF TO BAD DEBT EXPENSE TIMES THE MEDICARE COST-TO-CHARGE RATIO DERIVED FROM THE MEDICARE COST REPORT.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	DISCOUNTS, INCLUDING ANY APPLICABLE THIRD PARTY PAYER CONTRACTUAL ALLOWANCES AND ANY FINANCIAL ASSISTANCE DISCOUNTS (VALUED AT GROSS CHARGES), ARE APPLIED TO PATIENT ACCOUNT GROSS CHARGES TO DETERMINE THE ACCOUNT BALANCE BEFORE PATIENT PAYMENTS. THE AGGREGATE AMOUNT OF ALL PATIENT PAYMENTS IS THEN APPLIED TO THE ACCOUNT BALANCE. WHEN DETERMINATION IS MADE THAT NO FURTHER AMOUNTS CAN BE COLLECTED IN ACCORDANCE WITH THE CORPORATION'S BAD DEBT POLICY, THE REMAINING BALANCE IS WRITTEN OFF TO BAD DEBT EXPENSE. PRESUMPTIVE CHARITY: CHARGES MAY BE ADJUSTED TO PROVIDE FOR A CHARITY DISCOUNT OF 100% OF BILLED CHARGES FOR MEDICALLY NECESSARY SERVICES PROVIDED TO AN UNINSURED PATIENT WHO ESTABLISHES FINANCIAL NEED AT TIME OF REGISTRATION BY SATISFYING ONE OF THE FOLLOWING CATEGORIES OF PRESUMPTIVE ELIGIBILITY CRITERIA. PRESUMPTIVE CHARITY CATEGORIES FOR ALL OSF HOSPITALS: -HOMELESSNESS; -DECEASED WITH NO ESTATE; -MENTAL INCAPACITATION WITH NO ONE TO ACT ON PATIENT'S BEHALF; OR -CURRENT MEDICAID ELIGIBILITY, BUT NOT ON DATE OF SERVICE OR FOR NON-COVERED SERVICE. THEREFORE, THE CORPORATION DOES NOT BELIEVE THAT BAD DEBT EXPENSE REPORTED ON PART III, LINE 2 INCLUDES ANY AMOUNTS THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY QUALIFY UNDER THE CORPORATION'S FINANCIAL ASSISTANCE POLICY.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	PLEASE SEE PAGE 22 OF NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	OSF IS COMMITTED TO SERVING PATIENTS, REGARDLESS OF ABILITY TO PAY OR IF THE PAYMENTS TO BE RECEIVED WILL BE LESS THAN THE COST TO PROVIDE THE SERVICE, WHICH IS THE CASE FOR MEDICARE AND MEDICAID PATIENTS. THE MEDICARE ALLOWABLE COSTS ON LINE 6 PART III HAVE BEEN CALCULATED BY USING THE MEDICARE COST TO CHARGE RATIO. THE AMOUNT IS COMPARED TO TOTAL MEDICARE PAYMENTS RECEIVED INCLUDING DSH AND IME PAYMENTS. SHOULD THERE BE A SHORTFALL, IT WOULD BE TREATED AS A COMMUNITY BENEFIT SINCE IT REFLECTS UN-REIMBURSED COSTS FOR PROVIDING MEDICAL SERVICES TO THE MEDICARE RESIDENTS OF THE COMMUNITY.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	THE CORPORATION HAS A self-pay BILLING COLLECTION POLICY WHICH APPLIES FOR ALL PATIENTS. THE POLICY INCLUDES: -REQUIRED INFORMATION PROVIDED IN BILLS TO PATIENTS (INCLUDING A REQUIREMENT THAT INFORMATION BE PROVIDED ON HOW THE PATIENT MAY APPLY FOR FINANCIAL ASSISTANCE). -PROCESS FOR PATIENTS TO INQUIRE ABOUT OR DISPUTE A BILL, INCLUDING TOLL-FREE TELEPHONE NUMBER, ADDRESS, CONTACT NAME AND E-MAIL ADDRESS. -REQUIREMENTS FOR TIMELY RESPONSE TO PATIENT INQUIRIES. -CONDITIONS WHICH MUST BE SATISFIED BEFORE PATIENT MAY BE SENT TO A COLLECTION AGENCY OR ATTORNEY. -LEGAL ACTION FOR NON-PAYMENT OF A PATIENT BILL MAY NOT BE INITIATED UNTIL AN AUTHORIZED HOSPITAL OFFICIAL HAS DETERMINED THAT ALL CONDITIONS IN THE CORPORATION'S POLICY (INCLUDING ALL THE FOREGOING POLICY PROVISIONS) HAVE BEEN SATISFIED FOR INITIATING LEGAL ACTION. -LEGAL ACTION MAY NOT BE PURSUED AGAINST UNINSURED PATIENTS WHO HAVE CLEARLY DEMONSTRATED THAT THEY HAVE NEITHER SUFFICIENT INCOME NOR ASSETS TO MEET THEIR FINANCIAL OBLIGATIONS - EVEN IF SUCH PATIENTS DO NOT APPLY FOR FINANCIAL ASSISTANCE. -THE CORPORATION SHALL NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS, SUCH AS SUBMITTING REPORTS TO CREDIT AGENCIES BEFORE REASONABLE ATTEMPTS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE HAVE BEEN COMPLETED. -IF A PATIENT RECEIVES AN APPLICATION FOR FINANCIAL ASSISTANCE BUT FAILS TO RETURN IT, OSF WILL TRY TO USE SECONDARY SOURCES TO DETERMINE THE PATIENT'S ELIGIBILITY FOR NON COMPLIANT CHARITY BEFORE PURSUING LEGAL ACTION FOR NONPAYMENT. IF A COMPLETE APPLICATION IS RECEIVED DURING THE APPLICATION PERIOD, OSF WILL SUSPEND EXTRAORDINARY COLLECTION ACTIONS AND MAKE A DETERMINATION OF ELIGIBILITY FOR ASSISTANCE. IF THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, OSF WILL ISSUE APPROPRIATE REFUNDS AND REVERSE ANY EXTRAORDINARY COLLECTION ACTIONS TAKEN, AS MORE FULLY DESCRIBED IN THE OSF FAIR BILLING - COLLECTION POLICY.
Schedule H, Part V, Section B, Line 16a FAP website	- MENDOTA COMMUNITY HOSPITAL: Line 16a URL: https://www.osfhealthcare.org/billing/financial-assistance/;
Schedule H, Part V, Section B, Line 16b FAP Application website	- MENDOTA COMMUNITY HOSPITAL: Line 16b URL: https://www.osfhealthcare.org/billing/financial-assistance/;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- MENDOTA COMMUNITY HOSPITAL: Line 16c URL: https://www.osfhealthcare.org/billing/financial-assistance/;
Schedule H, Part VI, Line 2 Needs assessment	MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") DURING FISCAL YEAR 2019 AS PREVIOUSLY STATED. THE CHNA IS UPDATED EVERY 3 YEARS AND CORRESPONDING IMPLEMENTATION STRATEGY IS REFRESHED YEARLY. NOT ONLY DOES THE PLAN GET REFRESHED YEARLY, BUT EACH ACTION ITEM HAS A RESPONSIBLE PARTY INVOLVED TO GET THE WORK ASSOCIATED WITH THE NEED ACCOMPLISHED. THE 2021 TAX YEAR REPRESENTS THE FINAL YEAR OF THE NEEDS ASSESSMENT ADOPTED AS PART OF THE 2019 CHNA. THE NEW CHNA WAS APPROVED AND ADOPTED BY THE OSF BOARD OF DIRECTORS ON JULY 29, 2019 AND THE CORRESPONDING IMPLEMENTATION STRATEGY WAS APPROVED JANUARY 27, 2020. THE ASSOCIATED PLAN GOALS AND ACCOMPLISHMENTS ARE LISTED IN THIS YEARS FILING. LEADERSHIP WITHIN OSF SIT ON VARIOUS COMMUNITY ADVISORY BOARDS TO STAY CONNECTED TO THE OTHER AGENCIES WITHIN THE COMMUNITY. THIS WORK ALIGNS WITH OUR MISSION STATEMENT TO SERVE PERSONS WITH THE GREATEST CARE AND LOVE IN A COMMUNITY THAT CELEBRATES THE GIFT OF LIFE.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	THE CORPORATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO ARE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER GOVERNMENT PROGRAMS AND THE CORPORATION'S FINANCIAL ASSISTANCE POLICY, IN ENGLISH AND IN ANY OTHER LANGUAGE SPOKEN BY POPULATIONS WITH LIMITED ENGLISH PROFICIENCY THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE COMMUNITY OF THE HOSPITAL, IN THE FOLLOWING WAYS: -SIGNS ARE POSTED IN PATIENT REGISTRATION AREAS (INCLUDING EMERGENCY DEPARTMENT REGISTRATION) INFORMING PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE, THE AVAILABILITY OF FINANCIAL ASSISTANCE COUNSELORS, AND HOW TO OBTAIN A COPY OF THE OSF FINANCIAL ASSISTANCE POLICY AND APPLICATION. -A PLAIN LANGUAGE SUMMARY OF THE OSF FINANCIAL ASSISTANCE POLICY IS OFFERED TO PATIENTS AS PART OF THE INTAKE OR DISCHARGE PROCESS AND INCLUDED IN THE BILLING STATEMENT MAILED PRIOR TO INITIATING EXTRAORDINARY COLLECTION ACTIONS. IN ADDITION, THE PLAIN LANGUAGE SUMMARY AND APPLICATION ARE PROVIDED TO REFERRING STAFF PHYSICIANS. -OSF MAKES REASONABLE EFFORTS TO ORALLY NOTIFY PATIENTS ABOUT THE FINANCIAL ASSISTANCE POLICY AND HOW TO OBTAIN ASSISTANCE IN APPLYING. -A NOTICE OF AVAILABILITY OF THE CORPORATION'S FINANCIAL ASSISTANCE AND UNINSURED PATIENT DISCOUNT POLICIES IS PROMINENTLY AVAILABLE ON THE CORPORATION'S WEBSITE. THE APPLICATION FORM WITH INSTRUCTIONS AND THE PLAIN LANGUAGE SUMMARY IS AVAILABLE FOR DOWNLOAD. -A NOTE REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE (TOGETHER WITH CONTACT PHONE NUMBERS) APPEARS ON EVERY PATIENT BILLING STATEMENT AS WELL AS THE WEBSITE WHERE COPIES OF THE POLICY, APPLICATION AND PLAIN LANGUAGE SUMMARY MAY BE OBTAINED. -FINANCIAL ASSISTANCE COUNSELORS ARE AVAILABLE IN PERSON AND BY PHONE TO ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION AND IN DETERMINING ELIGIBILITY AND APPLYING FOR GOVERNMENT PROGRAM BENEFITS, INCLUDING MEDICAID. -THE CORPORATION'S FINANCIAL ASSISTANCE POLICY IS FILED WITH THE ILLINOIS ATTORNEY GENERAL AND IS AVAILABLE TO THE PUBLIC.
Schedule H, Part VI, Line 4 Community information	MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER IS LOCATED IN LASALLE COUNTY. THE OSF SAINT PAUL MEDICAL CENTER SERVICE COMMUNITY IS LOCATED PRIMARILY IN LASALLE COUNTY BUT EXTENDS INTO PORTIONS OF LEE, BUREAU, AND DEKALB COUNTIES. THE RACE AND ETHNICITY MAKEUP OF THE SERVICE AREA INDICATES THAT MORE THAN 12.6% OF THE POPULATION IS OF HISPANIC ORIGIN. OTHER RACE AND ETHNICITY NUMBERS ARE TYPICAL OF RURAL ILLINOIS. THERE ARE NO LARGE CHANGES IN THE PROFILE OVER THE PAST FIVE YEARS. THE POVERTY RATE FOR LASALLE COUNTY WAS 13.6 PERCENT IN 2017. THE POPULATION USED FOR THE CALCULATION WAS 110,067 YIELDING 14,969 RESIDENTS LIVING IN POVERTY IN THE LASALLE COUNTY AREA. DATA FROM THE LAST CENSUS INDICATE THE POPULATION OF LASALLE COUNTY HAS SLIGHTLY DECREASED (2.1%) BETWEEN 2013 AND 2017. THE POPULATION IN LASALLE COUNTY HAS DECREASED FROM 112,424 IN 2013 TO 110,067 IN 2017.
Schedule H, Part VI, Line 5 Promotion of community health	MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER SPONSORING ORGANIZATION IS A RELIGIOUS CONGREGATION OF THE ROMAN CATHOLIC CHURCH KNOWN AS THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS. IN ACCORDANCE WITH CANON LAW OF THE ROMAN CATHOLIC CHURCH AND FEDERAL TAX LAW APPLICABLE TO SUPPORTING ORGANIZATIONS, A MAJORITY OF THE MEMBERS OF THE BOARD OF DIRECTORS OF THE CORPORATION ARE PROFESSED MEMBERS OF THE SPONSORING RELIGIOUS CONGREGATION. THEY HAVE A COMMUNITY ADVISORY BOARD CONSISTING OF MEMBERS OF THE COMMUNITY WHO ARE NOT DIRECTORS, OFFICERS, OR CONTRACTORS OF MENDOTA. EXCEPT FOR HOSPITAL DEPARTMENTS WHICH HAVE BEEN CLOSED, OR IN WHICH CLINICAL PRIVILEGES HAVE BEEN RESTRICTED, FOR CLINICAL OR QUALITY OF CARE REASONS BY ACTIONS OF THE HOSPITAL'S MEDICAL STAFF AND THE BOARD OF DIRECTORS, MENDOTA EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITIES. THE MENDOTA SURPLUS FUNDS WERE USED DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2021 FOR IMPROVEMENTS IN PATIENT CARE, MEDICAL EDUCATION, AND RESEARCH. MENDOTA HOSPITAL MEETS THE REQUIREMENTS OF REVENUE RULING 69-545 BY: -OPERATING AN EMERGENCY DEPARTMENT WHICH IS STAFFED 24 HOURS PER DAY BY QUALIFIED PHYSICIANS AND OTHER MEDICAL PERSONNEL AND WHICH IS OPEN TO ALL PERSONS WITHOUT REGARD TO ABILITY TO PAY. -HAVING MEDICAL STAFFS WHICH ARE OPEN TO ALL QUALIFIED PHYSICIANS, MID-LEVEL PROVIDERS, PODIATRISTS, AND DENTISTS IN THE COMMUNITY (EXCEPT WHERE RESTRICTED IN RARE CASES FOR CLINICAL QUALITY REASONS BY ACTION OF THE MEDICAL STAFF AND THE BOARD OF DIRECTORS). -ACCEPTING MEDICARE, MEDICAID AND OTHER GOVERNMENT PROGRAM PATIENTS. -ACCEPTING ALL PATIENTS, INCLUDING UNINSURED PATIENTS, WITHOUT REGARD TO THEIR ABILITY TO PAY. -USING SURPLUS FUNDS TO IMPROVE THEIR FACILITIES, EQUIPMENT, PATIENT CARE, MEDICAL TRAINING, EDUCATION, AND RESEARCH AS DESCRIBED ABOVE. MENDOTA HOSPITAL PARTNERS WITH OTHER LOCAL SERVICE AGENCIES TO ENSURE ACCESS FOR RURAL HEALTHCARE INCLUDING OFFERING SPACE TO OTHER AGENCIES TO CO-LOCATE UNDER ONE ROOF. OSF ON CALL OFFERS A 24/7 ONLINE ACCESS TO MEDICAL CARE VIA SMARTPHONE, TABLET OR COMPUTER. THE HOSPITAL FORMED A TRANSIT PARTNERSHIP UNDER THE CITY OF OTTAWA AND NORTH CENTRAL AREA TRANSIT (NCAT).
Schedule H, Part VI, Line 6 Affiliated health care system	The Corporation is part of an affiliated health care system (the "OSF System"), which is an integrated health system that operates acute care hospitals, home health care services, two colleges of nursing, a medical training simulation center, and other health care facilities in Illinois and Michigan. The OSF System includes many other entities which are controlled, directly or indirectly by the Sisters of the Third Order of St. Francis (the "Congregation"). All affiliated entities apply and follow the financial assistance policies of the Corporation and are operated in furtherance of the mission to provide comprehensive, durable medical equipment, integrated quality care to the communities served by the Corporation. The OSF System's corporate office in Peoria, Illinois (the "Corporate Office"), provides corporate management services as well as direction, consultation and assistance to the administration of the OSF System's health care facilities and subsidiary corporations. The primary affiliated corporations of the OSF System are the following: The Congregation, which works exclusively in the health care apostolate, holds the assets of the religious congregation and directs all other corporations in the affiliated health care system through board representation and the exercise of reserved powers. OSF Multi-Specialty Group was incorporated in 2011. Virtually all physicians and advance practice providers providing professional services through the OSF System's acute care hospital facilities and ambulatory practice settings (with a few limited exceptions) provide services pursuant to employment agreements or professional service agreements with the Multi-Specialty Group. OSF Medical Group is a d/b/a of Multi-Specialty Group. Pointcore, Inc., formerly known as OSF Saint Francis, Inc., was originally incorporated in 1986 and is engaged in the following lines of business: retail pharmacies, retail shops, a mobile medical system, emergency medical transportation, home therapeutics, real estate, equipment technology services, telecommunications, electronic health records, telehealth services, and consulting services. Pointcore, Inc. also participates in various health related joint ventures. OSF Healthcare Foundation was incorporated in 1989 to conduct fundraising and other activities for the benefit of OSF Healthcare System and in support of the mission of the Congregation. Ottawa Regional Hospital & Healthcare Center, formerly known as Community Hospital of Ottawa was incorporated in 1964. OSF Healthcare System became the sole member of Ottawa Regional Hospital & Healthcare Center in 2012, and the hospital was renamed as d/b/a/ OSF Saint Elizabeth Medical Center. Mendota Community Hospital, formerly known as Mendota Hospital Foundation, was incorporated in 1944. OSF Healthcare System became the sole member of Mendota Community Hospital in 2015, and the hospital was renamed as d/b/a/ OSF Saint Paul Medical Center
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
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	false	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	false	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 (37 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
Robert C Sehring
Vice Chairperson Chief Executive Officer	$0	$1,553,315	$0	$983,702	$0	$113,528	$0	$14,250	$0	$28,356	$0	$2,693,151	$0	$0
Gerald J McShane MD
Board Member	$0	$183,578	$0	$0	$0	$0	$0	$8,026	$0	$21,852	$0	$213,456	$0	$0
Michael M Allen
Chief Financial Officer	$0	$706,904	$0	$373,634	$0	$32,036	$0	$14,250	$0	$28,629	$0	$1,155,453	$0	$0
Robert G Anderson
Chief Executive Officer Central Region	$0	$491,993	$0	$213,559	$0	$23,507	$0	$14,250	$0	$20,657	$0	$763,966	$0	$0
Chad E Boore
Chief Executive Officer Eastern Region (Through Aug 2022)	$0	$475,127	$0	$217,483	$0	$21,052	$0	$14,250	$0	$33,439	$0	$761,351	$0	$0
Robert L Brandfass
SVP Chief Legal Officer	$0	$583,708	$0	$254,163	$0	$24,225	$0	$14,250	$0	$22,376	$0	$898,722	$0	$0
Paula A Carynski
President, OSF HealthCare Saint Anthony Medical Center	$0	$394,889	$0	$176,412	$0	$24,344	$0	$14,250	$0	$27,512	$0	$637,407	$0	$0
Michelle D Conger
Chief Strategy Officer, OSF Healthcare/ CEO OnCall Digital Health	$0	$610,475	$0	$274,252	$0	$21,496	$0	$10,599	$0	$25,293	$0	$942,115	$0	$0
Roxanna Crosser
Chief Executive Officer Western Region	$0	$443,307	$0	$201,819	$0	$35,699	$0	$4,828	$0	$25,066	$0	$710,719	$0	$0
Michael A Cruz MD
Chief Operating Officer	$0	$747,881	$0	$337,760	$0	$33,547	$0	$14,250	$0	$34,346	$0	$1,167,784	$0	$0
Lisa DeKezel
President, OSF HealthCare Holy Family MC and St. Mary MC	$0	$258,274	$0	$105,642	$0	$13,251	$0	$3,849	$0	$25,564	$0	$406,580	$0	$0
John R Evancho
SVP Chief Compliance Officer	$0	$303,026	$0	$129,348	$0	$1,541	$0	$14,500	$0	$27,934	$0	$476,349	$0	$0
Carol A Friesen
Chief Executive Officer Eastern Region	$0	$516,780	$0	$234,927	$0	$20,708	$0	$14,250	$0	$36,065	$0	$822,730	$0	$0
Lynn A Fulton
President, OSF HealthCare St. Joseph Medical Center	$0	$340,332	$0	$144,725	$0	$1,014	$0	$14,500	$0	$26,070	$0	$526,641	$0	$0
David M Hall
SVP Info Systems/Chief Information Officer	$0	$422,743	$0	$178,464	$0	$13,238	$0	$14,250	$0	$31,975	$0	$660,670	$0	$0
Thomas G Hammerton
President OSF Healthcare Foundation Chief Development Officer	$0	$377,680	$0	$176,711	$0	$49,748	$0	$14,250	$0	$27,895	$0	$646,284	$0	$0
Ned Hill
President, OSF HealthCare Sacred Heart Medical Center	$0	$116,015	$0	$20,000	$0	$20,158	$0	$5,676	$0	$9,420	$0	$171,269	$0	$0
Stephen E Hippler MD
Chief Clinical Officer	$0	$716,326	$0	$323,758	$0	$25,471	$0	$14,250	$0	$36,070	$0	$1,115,875	$0	$0
Kelly A Jefferson
President, OSF HealthCare St. Francis Hospital & Medical Group	$0	$170,763	$0	$52,420	$0	$3,633	$0	$9,038	$0	$25,209	$0	$261,063	$0	$0
Jacqueline D Kernan
President, OSF HealthCare St Clare Medical Center & St Luke MC	$0	$232,104	$0	$101,978	$0	$15,460	$0	$14,500	$0	$21,213	$0	$385,255	$0	$0
Kathleen M Kinsella
President, OSF HealthCare Little Company of Mary Medical Center	$0	$348,458	$0	$139,333	$0	$22,247	$0	$14,500	$0	$14,158	$0	$538,696	$0	$0
James J Mormann
Chief Information Officer	$0	$648,289	$0	$295,900	$0	$45,488	$0	$14,250	$0	$34,582	$0	$1,038,509	$0	$0
Shelley A Nguyen
Chief Human Resources Officer	$0	$206,461	$0	$62,193	$0	$54	$0	$6,698	$0	$17,821	$0	$293,227	$0	$0
August J Querciagrossa
Chief Executive Officer Western Region	$0	$372,725	$0	$167,775	$0	$21,537	$0	$8,939	$0	$31,917	$0	$602,893	$0	$0
Jason R Rodeghero
President, OSF Home Care and Rehab Services	$0	$242,434	$0	$103,427	$0	$5,691	$0	$14,500	$0	$25,737	$0	$391,789	$0	$0
Jared C Rogers
President, OSF HealthCare Heart of Mary Medical Center	$0	$373,142	$0	$169,411	$0	$5,289	$0	$14,500	$0	$23,011	$0	$585,353	$0	$0
Jerry W Rumph
President, OSF HealthCare Saint Anthony's Health Center	$0	$243,028	$0	$80,548	$0	$14,227	$0	$14,500	$0	$1,628	$0	$353,931	$0	$0
Bradley V Solberg
President, OSF HealthCare Saint James- John W. Albrecht MC	$0	$332,551	$0	$133,728	$0	$7,389	$0	$14,500	$0	$29,667	$0	$517,835	$0	$0
Jeffry M Tillery
President, OSF Medical Group	$0	$632,733	$0	$285,300	$0	$24,709	$0	$14,250	$0	$26,454	$0	$983,446	$0	$0
Dawn C Trompeter
President, OSF Healthcare St. Elizabeth MC/ St. Paul MC	$259,648	$0	$118,294	$0	$21,454	$0	$13,265	$0	$24,967	$0	$437,628	$0	$0	$0
Ralph Velazquez MD
System Chief Medical Officer	$0	$561,365	$0	$255,943	$0	$35,990	$0	$14,250	$0	$29,394	$0	$896,942	$0	$0
Michael A Wells
President CHOI	$0	$241,929	$0	$98,072	$0	$690	$0	$10,385	$0	$19,761	$0	$370,837	$0	$0
Lori L Wiegand
Chief Nursing Officer	$0	$446,455	$0	$203,868	$0	$23,087	$0	$14,278	$0	$10,413	$0	$698,101	$0	$0
Leon A Yeh MD
VP Chief Medical Officer Emergency Serv	$0	$532,381	$0	$168,135	$0	$19,548	$0	$14,250	$0	$11,019	$0	$745,333	$0	$0
Jodie L Borchelt
Director Surgical/Inpatient Services, Medical/Surgical Acute	$107,971	$0	$11,028	$0	$54	$0	$6,390	$0	$27,338	$0	$152,781	$0	$0	$0
Kenneth K Potts MD
Physician	$252,968	$0	$0	$0	$36	$0	$7,678	$0	$23,715	$0	$284,397	$0	$0	$0
Katherine R Riva-Foster MD
Physician	$216,542	$0	$27,696	$0	$4,319	$0	$6,577	$0	$21,661	$0	$276,795	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule J, Part I, Line 3 SCH J, PART I, LINE 3	FormAndLineReferenceDesc
Explanation	THE BOARD OF DIRECTORS HAS ESTABLISHED A BOARD COMMITTEE KNOWN AS THE HUMAN RESOURCES COMMITTEE WHOSE MEMBERS ARE ALL PROFESSED MEMBERS OF A RELIGIOUS CONGREGATION THAT OWNS OR IS ASSOCIATED WITH THE HEALTHCARE SYSTEM WHO HAVE TAKEN A VOW OF POVERTY. HENCE, THEY DO NOT PERSONALLY BENEFIT FROM DECISIONS OF THE COMMITTEE. THE COMMITTEE DETERMINES WHICH OFFICERS, KEY EMPLOYEES AND OTHER EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN THE EXECUTIVE COMPENSATION PLAN. BASED ON PERFORMANCE REVIEWS BY THE SUPERVISORS OF SUCH PERSONS, COMPENSATION SURVEY DATA AND RECOMMENDATIONS FROM A NATIONALLY KNOWN INDEPENDENT COMPENSATION CONSULTANT, THE COMMITTEE APPROVES ANY EXECUTIVE COMPENSATION PLAN APPLICABLE TO KEY EMPLOYEES AND ESTABLISHES THE BASE SALARY AND BENEFITS FOR PLAN PARTICIPANTS. PRIOR TO PAYMENT OF ANY BONUS OR INCENTIVE COMPENSATION, THE TOTAL COMPENSATION FOR EACH KEY EMPLOYEE, INCLUDING BASE SALARY, BENEFITS, AND PROPOSED BONUS OR INCENTIVE COMPENSATION, IS AGAIN REVIEWED BY A NATIONALLY RECOGNIZED COMPENSATION CONSULTANT TO ENSURE THAT NO EXCESS BENEFIT AMOUNT IS PAID OR FURNISHED.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part I, Line 1 PART I	THE TAX LAW REQUIRES THAT EACH LEGAL ENTITY WITHIN THE OSF HEALTHCARE SYSTEM COMPLETE A SEPARATE TAX RETURN WHICH APPROPRIATELY REFLECTS THE ACTIVITIES AND FINANCIAL POSITION OF THE PARTICULAR ORGANIZATION. THIS REPORTING, HOWEVER, IS NOT REFLECTIVE OF THE OSF HEALTHCARE SYSTEM AS A WHOLE. PLEASE SEE THE ATTACHED AUDITED FINANCIAL STATEMENTS OF OSF HEALTHCARE SYSTEM AND SUBSIDIARIES FOR A COMPLETE OVERVIEW OF THE SYSTEM.
Form 990, Part VI, Line 6 Classes of members or stockholders	OSF HEALTHCARE SYSTEM IS THE SOLE CORPORATE MEMBER OF MENDOTA COMMUNITY HOSPITAL.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	OSF HEALTHCARE SYSTEM AS A SOLE CORPORATE MEMBER OF MENDOTA COMMUNITY HOSPITAL HAS THE POWER TO ELECT MEMBERS OF THE BOARD.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	RESERVED POWERS: THE FOLLOWING POWERS ARE RESERVED FOR THE MEMBER: A) TO ESTABLISH, APPROVE, OR MODIFY THE PHILOSOPHY, VISION, VALUES, AND MISSION ACCORDING TO WHICH THE CORPORATION OPERATES. (B) TO AMEND THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS. (C) TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE DIRECTORS OF THE CORPORATION. (D) TO MERGE OR CONSOLIDATE THE CORPORATION WITH OTHER ENTITIES OR TO DISSOLVE THE CORPORATION. (E) TO ACQUIRE AN INTEREST IN AN EXISTING ENTITY OR TO ESTABLISH A NEW ENTITY. (F) TO LEASE, SELL, ENCUMBER OR OTHERWISE ALIENATE ANY REAL PROPERTY OR INTEREST IN REAL PROPERTY OF THE CORPORATION. (G) TO APPROVE ANY TRANSFER, LEASE, SALE OR ENCUMBRANCE OF PERSONAL PROPERTY OF THE CORPORATION EXCEPT IN THE ORDINARY COURSE OF BUSINESS. (H) TO APPROVE ANY BORROWING OR DEBT FINANCING ON BEHALF OF THE CORPORATION. (I) TO APPOINT, DISCIPLINE, TERMINATE AND REMOVE THE CORPORATION'S OPERATING DIVISION PRESIDENT. (J) TO APPOINT AND REMOVE THE CORPORATION'S CHAIRPERSON, VICE CHAIRPERSON(S), CHIEF EXECUTIVE OFFICER, PRESIDENT, SECRETARY, AND TREASURER, AND THE ASSISTANT SECRETARY AND ASSISTANT TREASURER, IF ANY. (K) TO APPROVE OR AMEND STRATEGIC PLANS, MANAGEMENT OBJECTIVES, AND CAPITAL AND OPERATING BUDGETS OF THE CORPORATION. (L) TO APPROVE ANY PURCHASE OR OTHER AQUISITION BY THE CORPORATION THAT IS NOT INCLUDED IN ITS CAPITAL BUDGET AND EXCEEDS ONE MILLION DOLLARS ($1,000,000) PER ITEM. (M) TO NAME OR RENAME ANY HOSPITAL OR MEDICAL CENTER OWNED AND OPERATED BY THE CORPORATION. (N) TO REQUIRE A CERTIFIED AUDIT OF FINANCES OF THE CORPORATION AND TO APPOINT THE CERTIFIED PUBLIC ACCOUNTANT TO PERFORM THE AUDIT. (O) TO APPROVE THE ENGAGEMENT OF AND TO DISMISS ANY OUTSIDE LEGAL COUNSEL TO REPRESENT THE CORPORATION ON A REGULAR BASIS OR IN CONNECTION WITH ANY MATTER DEEMED BY THE MEMBER, IN GOOD FAITH, TO HAVE SIGNIFICANCE FOR THE CORPORATION AS A WHOLE. (P) TO GIVE PRELIMINARY APPROVAL PRIOR TO THE DEVELOPMENT OF, AND TO GIVE FINAL APPROVAL PRIOR TO THE EXECUTION OF, ALL DOCUMENTS TO WHICH THE CORPORATION IS OR WILL BE A PARTY AND WHICH RELATE TO THE CREATION, FORMATION, ORGANIZATION, OR TERMINATION OF ANY OTHER LEGAL ENTITY (WHETHER A CORPORATION, LIMITED LIABILITY COMPANY, PARTNERSHIP, OR ANY OTHER ENTITY) IN WHICH THE CORPORATION WILL HAVE ANY OWNERSHIP INTEREST, MEMBERSHIP INTEREST, POWER TO ELECT OR APPOINT BOARD MEMBERS OR OFFICERS, OR ANY OTHER FORMAL PARTICIPATION ARRANGEMENT, WHETHER ACTING ALONE OR IN CONJUNCTION WITH ANY OTHER PERSON OR ENTITY. (Q) TO TAKE ANY AND ALL ACTIONS DEEMED NECESSARY, IN THE SOLE JUDGEMENT OF THE MEMBER BOARD TO PROTECT AND PRESERVE THE TAX-EXEMPT STATUS AND PUBLIC CHARITY STATUS OF THE CORPORATION OR THE MEMBER AND ANY TAX-EXEMPT AFFILIATE OF THE CORPORATION OR THE MEMBER (INCLUDING FEDERAL AND STATE INCOME TAX EXEMPTIONS, PROPERTY TAX EXEMPTIONS, AND SALES TAX EXEMPTIONS); PROVIDED THE MEMBER BOARD HAS GIVEN A WRITTEN REQUEST TO THE BOARD TO TAKE ACTION OR REFRAIN FROM TAKING ACTION, WHICH WOULD HAVE SUFFICIENTLY PROTECTED AND PRESERVED SUCH TAX-EXEMPT AND PUBLIC CHARITY STATUS, AND THE BOARD HAS FAILED TO PROMPTLY TAKE SUCH ACTION OR REFRAIN FROM TAKING SUCH ACTION.
Form 990, Part VI, Line 9 Interested person not at organization's address	BRIAN SILVERSTEIN, M.D. 1000 ELM RIDGE DRIVE GLENCOE, IL 60022
Form 990, Part VI, Line 11b Review of form 990 by governing body	THE PROPOSED FINAL VERSION OF THE 990 IS PROVIDED VIA AN ONLINE PORTAL TO ALL OFFICERS AND MEMBER OF THE BOARD OF DIRECTORS FOR THEIR REVIEW PRIOR TO FILING. ANY APPROPRIATE CHANGES REQUESTED BY THE OFFICERS AND DIRECTORS ARE THEN INCORPORATED INTO THE FINAL FORM 990 AND ALL SCHEDULES BEFORE FILING.
Form 990, Part VI, Line 12c Conflict of interest policy	DISCLOSURES BY OFFICERS, DIRECTORS AND TRUSTEES, AS WELL AS KEY EMPLOYEES AND EMPLOYEES CHARGED WITH PURCHASING, PROCUREMENT AND CONTRACTION DECISION-MAKING ARE MADE THROUGH AN ELECTRONIC REPORTING SYSTEM ON AN ANNUAL BASIS. DISCLOSURES ARE RECEIVED AND REVIEWED BY THE CORPORATE COMPLIANCE DIVISION ON AN ANNUAL BASIS. IF A POTENTIAL CONFLICT OF INTEREST IS IDENTIFIED, THEN THE DISCLOSING EMPLOYEE IS NOTIFIED OF THE POTENTIAL CONFLICT AND MAY BE ASKED FOR ADDITIONAL INFORMATION. THE CORPORATE COMPLIANCE DIVISION DETERMINES WHETHER A PLAN TO MANAGE A POSSIBLE OR ACTUAL CONFLICT OF INTEREST IS NEEDED, DISCUSSES THE MANGEMENT PLAN WITH THE EMPLOYEE AND MONITORS THE EMPLOYEE'S COMPLIANCE WITH THE PLAN. PLANS TO MANAGE CONFLICTS ARE TRACKED THROUGH THE ELECTRONIC DISCLOSURE SYSTEM.
Form 990, Part VI, Line 15a Process to establish compensation of top management official	THE BOARD OF DIRECTORS HAS ESTABLISHED A BOARD COMMITTEE KNOWN AS THE HUMAN RESOURCES COMMITTEE WHOSE MEMBERS ARE ALL PROFESSED MEMBERS OF THE RELIGIOUS CONGREGATION KNOWN AS THE SISTERS OF THE THIRD ORDER OF SAINT FRANCIS THAT OWNS OR IS ASSOCIATED WITH THE HEALTHCARE SYSTEM WHO HAVE TAKEN A VOW OF POVERTY. HENCE, THEY DO NOT PERSONALLY BENEFIT FROM DECISIONS OF THE COMMITTEE. THE PERFORMANCE OF THE CEO AND HIS ACHIEVEMENT OF ANNUAL GOALS IS EVALUATED EACH YEAR BY THE FULL BOARD OF DIRECTORS, AND THIS PERFORMANCE REVIEW IS PROVIDED TO THE COMMITEE. THE COMMITEE ALSO OBTAINS COMPENSATION SURVEY DATA AND RECOMMENDATION FROM A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTANT. BASED ON ALL OF THESE FACTORS, THE COMMITTEE SETS BASE SALARY AND BENEFITS OF THE CEO AND APPROVES THE EXECUTIVE COMPENSATION PLAN APPLICABLE TO THE CEO. PRIOR TO PAYMENT OF ANY BONUS OR INCENTIVE COMPENSATION, THE TOTAL COMPENSATION FOR THE CEO, INCLUDING BASE SALARY, BENEFITS, AND PROPOSED BONUS OR INCENTIVE COMPENSATION, IS AGAIN REVEIWED BY A NATIONALLY RECOGNIZED COMPENSATION CONSULTANT TO ENSURE THAT NO EXESS BENEFIT AMOUNT IS PAID OR FURNISHED. THE COMPENSATION REVIEW IS DONE ANNUALLY.
Form 990, Part VI, Line 15b Process to establish compensation of other employees	THE BOARD OF DIRECTORS HAS ESTABLISHED A BOARD COMMITTEE KNOWN AS THE HUMAN RESOURCES COMMITTEE WHOSE MEMBERS ARE ALL PROFESSED MEMBERS OF THE RELIGIOUS CONGREGATION KNOWN AS THE SISTERS OF THE THIRD ORDER OF SAINT FRANCIS THAT OWNS OR IS ASSOCIATED WITH THE HEALTHCARE SYSTEM WHO HAVE TAKEN A VOW OF POVERTY. HENCE, THEY DO NOT PERSONALLY BENEFIT FROM DECISIONS OF THE COMMITTEE. THE COMMITTEE DETERMINES WHICH OFFICERS, KEY EMPLOYEES AND OTHER EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN THE EXECUTIVE COMPENSATION PLAN. BASED ON PERFORMANCE REVIEWS BY THE SUPERVISORS OF SUCH PERSONS AND COMPENSATION SURVEY DATA AND RECOMMENDATIONS FROM A NATIONALLY KNOWN INDEPENDENT COMPENSATION CONSULTANT, THE COMMITTEE APPROVES ANY EXECUTIVE COMPENSATION PLAN APPLICABLE TO KEY EMPLOYEES AND ESTABLISHED THE BASE SALARY AND BENEFITS FOR PLAN PARTICIPANTS. PRIOR TO PAYMENT OF ANY BONUS OR INCENTIVE COMPENSATION, THE TOTAL COMPENSATION FOR EACH KEY EMPLOYEE, INCLUDING BASE SALARY, BENEFITS, AND PROPOSED BONUS OR INCENTIVE COMPENSATION, IS AGAIN REVIEWED BY A NATIONALLY RECOGNIZED COMPENSATION CONSULTANT TO ENSURE THAT NO EXCESS BENEFIT AMOUNT IS PAID OR FURNISHED. THE COMPENSATION REVIEW IS DONE ANNUALLY.
Form 990, Part VI, Line 19 Required documents available to the public	THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue	OTHER REVENUE - Total Revenue: 50433, Related or Exempt Function Revenue: 50433, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	Inter-company Transfers - -39872; Net assets Released from Restrictions - -205721; Equity Transfers - -590488;
Form 990 Coronavirus Pandemic and CARES Act Funding	On March 11, 2020, the World Health Organization designated COVID-19 as a global pandemic. Patient activity and related revenues for most services were significantly impacted starting in mid-March 2020, as various policies were implemented by federal, state, and local governments in response to the COVID-19 pandemic. In March 2020, the CARES Act was signed into law, providing temporary and limited relief to hospitals during the COVID-19 outbreak. Under the CARES Act, appropriations were made for hospitals to cover expenses and lost revenue associated with the treatment of COVID-19 patients, the Medicare Accelerated and Advanced payment program was expanded, employee retention tax credits to employers affected by COVID-19 were provided, the 2% reduction in Medicare payments from sequestration through December 2021 has been eliminated, add-on payments for inpatient hospitals treating COVID-19 patients were created, and a reduction in Medicaid funding for Medicare disproportionate share hospitals was delayed.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 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
SISTERS OF THE THIRD ORDER OF ST FRANCIS
124 SW Adams St	PEORIA	IL	61602	371259286	PARENT/SU ORG	IL	501(c)(3)	1	NA	false
OSF HEALTHCARE FOUNDATION
124 SW Adams St	PEORIA	IL	61602	371259284	SUPPORT ORG	IL	501(c)(3)	Type II	SIS 3RD OSF	false
OTTAWA REGIONAL HOSP & HEALTHCARE CTR
124 SW ADAMS ST	Peoria	IL	61602	362604009	HOSPITAL	IL	501(c)(3)	3	OSF	false
OTTAWA REGIONAL HOSPITAL FOUNDATION
124 SW ADAMS ST	Peoria	IL	61602	364007569	SUPPORT ORG	IL	501(c)(3)	Type I	ORHHC	false
OSF MULTI-SPECIALTY GROUP
124 SW Adams St	PEORIA	IL	61602	383852646	HLTHCARE SVCS	IL	501(c)(3)	Type I	OSF	false
OSF HEALTHCARE SYSTEM
124 SW Adams St	PEORIA	IL	61602	370813229	HOSPITAL	IL	501(c)(3)	3	SIS 3RD OSF	false
OTTAWA REGIONAL HOSPITAL AUXILIARY
124 SW ADAMS ST	Peoria	IL	61602	363854788	SUPPORT ORG	IL	501(c)(3)	Type I	OSF	false

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (6 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Predominant Income TypePredominantIncomeTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd	OwnershipOwnershipPct
CENTER FOR HEALTH AMBULATORY
8800 RTE 91 N	PEORIA	IL	61615	205557171	SURGICAL CENTER	IL	OSF	Related	$0	$0	false	false	0
EASTLAND MEDICAL PLAZA
1505 EASTLAND DRIVE	Bloomington	IL	61701	371400643	SURGICAL CENTER	IL	OSF	Related	$0	$0	false	false	0
FORT JESSE IMAGING CENTER LLC
2200 FT JESSE ROAD	NORMAL	IL	61761	460515604	MEDICAL IMAGING	IL	OSF	Related	$0	$0	false	false	0
SAINT CLARE'S VILLA
915 EAST 5TH STREET	ALTON	IL	62002	371397289	LOW INC HOUSING	IL	OSF	Related	$0	$0	false	false	0
FOX RIVER CANCER CENTER
1211 STARFISH DRIVE	OTTAWA	IL	61350	870805865	ONCOLOGY	IL	ORHHC	Related	$0	$0	false	false	0
GREATER PEORIA SPECIALTY HOSPITAL LLC
680 S 4TH STREET	LOUISVILLE	KY	40202	261579585	LONG TERM ACUTE CARE HOSPITAL	DE	OSF	Related	$0	$0	false	false	0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd	Address Line2USAddress/AddressLine2Txt
POINTCORE INC
124 SW Adams St	PEORIA	IL	61602	363484677	HLTHCARE SVCS	IL	OSF	C Corporation	false
ILLINOIS PATHOLOGST SERVICES LLC
5666 EAST STATE STREET	ROCKFORD	IL	61108	800439081	PATHOLOGY SVCS	IL	OSF	C Corporation	false
SOUTHWEST HEALTH SYSTEMS INC
2800 WEST 95TH STREET	EVERGREEN PARK	IL	60805	363425830	HEALTHCARE SERVICES	IL	OSF	C Corporation	false
OSF AVIATION LLC
124 SW Adams St	PEORIA	IL	61602	300032408	Medical Transportation	IL	Pointcore Inc	C Corporation	false
OSF ASSURANCE COMPANY
76 ST PAUL STREET	BURLINGTON	VT	05401	202015375	Insurance company	VT	Pointcore Inc	C Corporation	false	Suite 500

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	Yes (true)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	Yes (true)	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (true)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (true)	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	false	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	false	TransferToOtherOrgInd
Transfer From Other Org	false	TransferFromOtherOrgInd