BLESSINGCARE CORPORATION: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- BLESSINGCARE CORPORATION (EIN 37-1396010)
- Tax period
- 2020-10-01 to 2021-09-30
- Filed
- 2022-07-23
- IRS object ID
- 202202049349300600
- Schema version
- 2020v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-07-23T10:49:23-05:00 | ReturnTs |
| Tax Period End | 2021-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 363077757 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAY HUNTER STENN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 MAINE ST | AddressLine1Txt |
| City | QUINCY | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62301 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 371396010 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLESSINGCARE CORPORATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BLES | BusinessNameControlTxt |
| Phone | 2172852113 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 640 WEST WASHINGTON | AddressLine1Txt |
| City | PITTSFIELD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62363 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PATRICK M GERVELER | PersonNm |
| Person Title | SECRETARY/TREASURER | PersonTitleTxt |
| Phone | 2172852113 | PhoneNum |
| Signature | 2022-07-05 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | PATRICK | PersonFirstNm |
| Person Last | GERVELER | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ERIN J WHARTON CPA | PreparerPersonNm |
| PTIN | P01294277 | PTIN |
| Phone | 2172220304 | PhoneNum |
| Preparation | 2022-07-05 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ILLINI COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KATHLEEN E HULL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 640 WEST WASHINGTON | AddressLine1Txt |
| City | PITTSFIELD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62363 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $37,689,366 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.ILLINIHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2000 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | TO IMPROVE THE HEALTH OF OUR COMMUNITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 251 | TotalEmployeeCnt |
| Total Volunteers | 22 | TotalVolunteersCnt |
| Total Gross UBI | $25,253 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $21,728 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,425,175 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,764,239 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $29,274,727 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $32,898,936 | CYProgramServiceRevenueAmt |
| PY Investment Income | $87,106 | PYInvestmentIncomeAmt |
| CY Investment Income | $139,213 | CYInvestmentIncomeAmt |
| PY Other Revenue | $738,602 | PYOtherRevenueAmt |
| CY Other Revenue | $1,882,688 | CYOtherRevenueAmt |
| PY Total Revenue | $31,525,610 | PYTotalRevenueAmt |
| CY Total Revenue | $37,685,076 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $15,816,276 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $18,157,815 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,982,525 | PYOtherExpensesAmt |
| CY Other Expenses | $14,414,980 | CYOtherExpensesAmt |
| PY Total Expenses | $28,798,801 | PYTotalExpensesAmt |
| CY Total Expenses | $32,572,795 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,726,809 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,112,281 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $39,382,716 | TotalAssetsBOYAmt |
| Total Assets EOY | $41,918,274 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $15,102,297 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,664,127 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $24,280,419 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $30,254,147 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO IMPROVE THE HEALTH OF OUR COMMUNITIES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $22,797,532 | ExpenseAmt |
| Revenue | $32,898,936 | RevenueAmt |
| Desc | ILLINI COMMUNITY HOSPITAL TREATED PATIENTS THROUGH THE FOLLOWING SERVICES DURING FISCAL YEAR 2021: INPATIENT ADMISSIONS 559 OBSERVATION ADMISSIONS 137 OUTPATIENT VISITS 77,324 TOTAL SURGERIES 305 EMERGENCY VISITS 5,747 LABORATORY TESTS 71,148 RESPIRATORY TREATMENTS 1,353 RADIOLOGY PROCEDURES 9,755 RURAL HEALTH CLINIC & XPRESS VISITS 14,851 IN ADDITION TO THESE HEALTHCARE SERVICES, ILLINI COMMUNITY HOSPITAL PROVIDED 531,941 IN CHARITY CARE AND INCURRED MEDICARE SHORTFALLS OF 547,769. THE HOSPITAL PROVIDED ADDITIONAL BENEFITS DURING FISCAL YEAR 2021 AS FOLLOWS: 1)HEALTH PROFESSIONALS EDUCATION - 2,000 HEALTHCARE STUDENT INTERNSHIPS NURSE PRACTITIONER CLINICALS 2)IN-KIND CONTRIBUTIONS AND DONATIONS - 23,121 PIKE CEO PROGRAM PIKE COUNTY MINISTERIAL ALLIANCE DONATED MEETING ROOM SPACE HEALTH FAIRS HEALTH SCREENINGS SUPPORT TO LOCAL SCHOOLS FOOD BANK SUPPORT LOCAL FAIRS SUPPORT TWO RIVERS FARM BUREAU - AG IN THE CLASSROOM SUPPORT 3)COMMUNITY HEALTH IMPROVEMENT PROGRAMS AND SERVICES - 65,769 COVID AND FLU CLINICS PIKELAND WELLNESS COMMITTEE BLOOD AND PLATELET DRIVES UNREIMBURSED PATIENT TRANSPORTATION DRUG TAKE BACK KIOSK BIKE HELMETS FOR LOCAL CHILDREN PATIENT CLOTHING/SUPPLIES CLOSET COURTESY BLOOD DRAWS FOR AREA PUBLIC AGENCIES 4)COMMUNITY EDUCATIONAL PROGRAMS AND SERVICES - 32,904 PIKE COUNTY ECONOMIC DEVELOPMENT CORPORATION - WIFI HOTSPOTS DIABETES COACHING | Desc |
| Total Program Service Expenses | $22,797,532 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | 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 | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (true) | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | 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 | 31 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 251 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | 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 | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KATHY HULL | PersonNm |
| Phone | 2172852113 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 640 WEST WASHINGTON | AddressLine1Txt |
| City | PITTSFIELD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62363 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 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 | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| MAUREEN A KAHN | |||||||||
| VICE-CHAIR | 1.00 | 39.00 | Yes (X) | Yes (X) | $0 | $1,278,999 | $244,078 | ||
| PATRICK M GERVELER | |||||||||
| SECRETARY/TR | 1.00 | 39.00 | Yes (X) | Yes (X) | $0 | $689,023 | $128,814 | ||
| DR THOMAS A CLIATT | |||||||||
| PHYSICIAN | 40.00 | $633,653 | $0 | $40,753 | Yes (X) | ||||
| DR STUART L PYATT | |||||||||
| PHYSICIAN | 40.00 | $587,252 | $0 | $35,684 | Yes (X) | ||||
| DR ROBERT D THOMAS | |||||||||
| PRES - MED S | 40.00 | Yes (X) | $378,368 | $0 | $29,520 | ||||
| DR CHRISTOPHER S WAGONER | |||||||||
| PRES - MED S | 40.00 | Yes (X) | $353,674 | $0 | $35,667 | ||||
| KATHLEEN E HULL | |||||||||
| ADMINISTRATO | 40.00 | Yes (X) | $0 | $327,086 | $39,587 | ||||
| HOLLY A JONES | |||||||||
| ASST ADMINIS | 40.00 | $186,372 | $0 | $30,503 | Yes (X) | ||||
| CAITLIN M HOLLAND | |||||||||
| LEAD PHARMAC | 40.00 | $172,749 | $0 | $23,869 | Yes (X) | ||||
| DR JAMES E UHLES | |||||||||
| PHYSICIAN | 40.00 | $152,687 | $0 | $27,354 | Yes (X) | ||||
| DR DAVID S GLASGOW | |||||||||
| PHYSICIAN | 40.00 | $175,000 | $0 | $4,644 | Yes (X) | ||||
| DAMAN EMRICK | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| K JEANNIE GOODMAN | |||||||||
| BOARD CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| LAURA KENT-DONAHUE | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| AMY RUEBUSH | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| JASON STRATTON | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,639,755 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,295,108 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $640,473 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt | Address Line2ContractorAddress/USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|
| AIMS OF PITTSFIELD LLC | ||||||
| 8657 WEDGEWOOD DRIVE | BURR RIDGE | IL | 60527 | PHYSICIAN SVCS | $1,399,388 | |
| O'SHEA BUILDERS | ||||||
| 3401 CONSTITUTION DRIVE | SPRINGFIELD | IL | 62711 | CONSTRUCTION | $296,683 | |
| CROSS COUNTRY STAFFING-EAST | ||||||
| PO BOX 40674 | ATLANTA | GA | 30384 | STAFFING AGENCY | $283,638 | |
| LABORATORY CORPORATION OF AMERICA | ||||||
| PO BOX 12140 | BURLINGTON | NC | 27216 | LABORATORY | $243,818 | |
| KOMPLETE 340B LLC | ||||||
| 10200 INDEPENDENCE PKWY | PLANO | TX | 75025 | CONSULTING SVCS | $203,963 | SUITE 103 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,728,740 | GovernmentGrantsAmt |
| All Other Contributions | $35,499 | AllOtherContributionsAmt |
| Total Contributions | $2,764,239 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| PATIENT REVENUE | $72,976,187 | $72,976,187 |
| CONTRACTUAL ALLOWANCE | -$40,077,251 | -$40,077,251 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $32,898,936 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $139,213 | TotalRevenueColumnAmt |
| Exclusion | $139,213 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $124,853 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $4,290 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $120,563 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $120,563 | TotalRevenueColumnAmt |
| Exclusion | $120,563 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $68,514 | GrossSalesOfInventoryAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $68,514 | TotalRevenueColumnAmt |
| Exclusion | $68,514 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| OTHER | 900099 | $1,547,198 | $1,547,198 | |
| EQUITY IN SUB'S EARNINGS | 900099 | $121,160 | $121,160 | |
| ILLINI HEALTH SERVICES, LLC | 531120 | $25,253 | $25,253 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,693,611 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $37,685,076 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $32,898,936 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $25,253 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,996,648 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,467,304 | TotalAmt |
| Program Services | $10,220,457 | ProgramServicesAmt |
| Management And General | $3,246,847 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $488,778 | TotalAmt |
| Program Services | $370,938 | ProgramServicesAmt |
| Management And General | $117,840 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,317,524 | TotalAmt |
| Program Services | $2,500,848 | ProgramServicesAmt |
| Management And General | $816,676 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $884,209 | TotalAmt |
| Program Services | $671,034 | ProgramServicesAmt |
| Management And General | $213,175 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,030 | TotalAmt |
| Management And General | $28,030 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,007 | TotalAmt |
| Management And General | $71,007 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $613,719 | TotalAmt |
| Program Services | $245,817 | ProgramServicesAmt |
| Management And General | $367,902 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,860 | TotalAmt |
| Program Services | $11,073 | ProgramServicesAmt |
| Management And General | $35,787 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,863 | TotalAmt |
| Management And General | $67,863 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,191,407 | TotalAmt |
| Program Services | $463,696 | ProgramServicesAmt |
| Management And General | $727,711 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,993 | TotalAmt |
| Management And General | $89,993 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| OUTSIDE FEES | $3,958,477 | $1,831,138 | $2,127,339 |
| PATIENT SUPPLIES | $2,751,023 | $2,508,803 | $242,220 |
| BAD DEBTS | $1,433,252 | $1,433,252 | |
| PHYSICIAN FEES | $1,363,634 | $1,363,634 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,799,715 | TotalAmt |
| Program Services | $1,176,842 | ProgramServicesAmt |
| Management And General | $1,622,873 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,572,795 | TotalAmt |
| Program Services | $22,797,532 | ProgramServicesAmt |
| Management And General | $9,775,263 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,871,145 | BOYAmt |
| EOY | $1,503,745 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,998,521 | BOYAmt |
| EOY | $13,989,644 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,302,625 | BOYAmt |
| EOY | $3,595,718 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $60,000 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,021,420 | BOYAmt |
| EOY | $1,263,688 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $218,081 | BOYAmt |
| EOY | $217,930 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $28,439,043 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $14,434,580 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,343,644 | BOYAmt |
| EOY | $14,004,463 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,325,410 | BOYAmt |
| EOY | $5,474,296 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $836,953 | BOYAmt |
| EOY | $740,575 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $464,917 | BOYAmt |
| EOY | $1,068,215 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,382,716 | BOYAmt |
| EOY | $41,918,274 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $585,479 | BOYAmt |
| EOY | $1,233,121 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,302,034 | BOYAmt |
| EOY | $4,224,280 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,615,801 | BOYAmt |
| EOY | $2,048,850 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,598,983 | BOYAmt |
| EOY | $4,157,876 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,102,297 | BOYAmt |
| EOY | $11,664,127 | 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 | $24,231,448 | BOYAmt |
| EOY | $30,173,323 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,971 | BOYAmt |
| EOY | $80,824 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,280,419 | BOYAmt |
| EOY | $30,254,147 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,382,716 | BOYAmt |
| EOY | $41,918,274 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $5,112,281 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $886,700 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$25,253 | 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 D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $297,566 | OtherCostOrOtherBasisAmt |
| Book Value | $297,566 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,195,389 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,219,676 | DepreciationAmt |
| Book Value | $9,975,713 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $606,751 | OtherCostOrOtherBasisAmt |
| Depreciation | $462,470 | DepreciationAmt |
| Book Value | $144,281 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,546,710 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,752,434 | DepreciationAmt |
| Book Value | $2,794,276 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $792,627 | OtherCostOrOtherBasisAmt |
| Book Value | $792,627 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,004,463 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (9 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED THIRD-PARTY SETTLEMENTS | $1,615,136 |
| ACCRUED SALARIES | $1,389,265 |
| DEFERRED COMPENSATION | $600,723 |
| DUE TO BLESSING HOSPITAL | $263,488 |
| RETAINAGE AND CONSTRUCTION AP | $123,898 |
| NONCURRENT ACCRUED MALPRACTICE | $117,109 |
| PAYROLL TAXES & WITHHOLDING | $32,524 |
| ACCRUED EMPLOYEE BENEFITS | $12,330 |
| ACCRUED INTEREST | $3,403 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,157,876 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $37,117,522 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $886,700 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$1,433,252 | OtherRevenueAmt |
| Revenue Not Reported | -$546,552 | RevenueNotReportedAmt |
| Revenue Subtotal | $37,664,074 | RevenueSubtotalAmt |
| Other Revenues Not Included | $21,002 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $21,002 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $37,685,076 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $31,143,794 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $31,143,794 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,429,001 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,429,001 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $32,572,795 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | BAD DEBT REDUCTION OF REVENUE ON FS -1,433,252 |
| SCHEDULE D, PAGE 4, PART XI, LINE 4B | RENTAL EXPENSES -4,290 IHS K1 25,253 INTEREST 39 |
| SCHEDULE D, PAGE 4, PART XII, LINE 4B | BAD DEBT REDUCTION OF REVENUE ON F/S 1,433,252 RENTAL EXPENSES -4,290 INTEREST EXPENSE 39 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| 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 | $531,941 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $531,941 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01710 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,674,581 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,674,581 | DirectOffsettingRevenueAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,206,522 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,674,581 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $531,941 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01710 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $98,673 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $98,673 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00320 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,121 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,121 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $123,794 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $123,794 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00400 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,330,316 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,674,581 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $655,735 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02110 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,433,252 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $66,933 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $10,509,263 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,057,032 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$547,769 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ILLINI COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 640 WEST WASHINGTON STREET | AddressLine1Txt |
| City | PITTSFIELD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62363 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.BLESSINGHEALTH.ORG | WebsiteAddressTxt |
| State License | HF110395 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| 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 | ILLINI 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 |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.BLESSINGHEALTH.ORG | 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 | false | 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 | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.BLESSINGHEALTH.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.BLESSINGHEALTH.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.BLESSINGHEALTH.ORG | 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 Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 3E | THE CHNA PROCESS HAS IDENTIFIED THE FOLLOWING CCOMMUNITY HEALTH NEEDS AS A PRIORITY: 1) ADDRESS THE NEEDS TO TAKE HEALTHCARE TO THE PATIENTS 2) BETTER ACCESS TO SCREENINGS FOR YOUTH AND ADULTS 3) IDENTIFY AND ADDRESS THE MENTAL HEALTH IMPLICATIONS OF CHRONIC ILLNESS 4) ADDRESS MENTAL HEALTH ISSUES RELATED TO THE COVID PANDEMIC. |
| FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 5 | THE CHNA WAS CONDUCTED FOR ILLINI COMMUNITY HOSPITAL THROUGH A CONSULTING ARRANGEMENT WITH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (ICAHN). MULTIPLE METHODS WERE USED TO COLLECT DATA FOR THE PROJECT. SURVEY QUESTIONS AND PROTOCOLS WERE DEVELOPED IN PARTNERSHIP WITH THE ICAHN. ILLINI COMMUNITY HOSPITAL UNDERTOOK A THREE-MONTH PLANNING AND IMPLEMENTATION EFFORT TO DEVELOP THE CHNA, AND TO IDENTIFY AND PRIORITIZE COMMUNITY HEALTH NEEDS FOR ITS SERVICE AREA. THESE PLANNING AND DEVELOPMENT ACTIVITIES INCLUDED THE FOLLOWING STEPS: THE PROJECT WAS OVERSEEN AT THE OPERATIONAL LEVEL BY THE CEO. ARRANGEMENTS WERE MADE WITH ICAHN TO FACILITATE TWO FOCUS GROUPS AND A MEETING TO IDENTIFY AND PRIORITIZE SIGNIFICANT NEEDS. ICAHN WAS ALSO ENGAGED TO COLLECT, ANALYZE, AND PRESENT SECONDARY DATA AND TO PREPARE A FINAL REPORT FOR SUBMISSION TO ILLINI COMMUNITY HOSPITAL. THE CEO WORKED CLOSELY WITH ICAHN'S CONSULTANT TO IDENTIFY AND ENGAGE KEY COMMUNITY PARTNERS AND TO COORDINATE LOCAL MEETINGS AND GROUP ACTIVITIES. ILLINI COMMUNITY HOSPITAL ALSO LEVERAGED EXISTING RELATIONSHIPS THAT PROVIDED DIVERSE INPUT FOR A COMPREHENSIVE REVIEW AND ANALYSIS OF COMMUNITY HEALTH NEEDS IN THE HOSPITAL'S SERVICE AREA. THESE STEPS INCLUDED: THE CEO SECURED THE PARTICIPATION OF A DIVERSE GROUP OF REPRESENTATIVES FROM THE COMMUNITY AND THE HEALTH PROFESSION. ICAHN'S CONSULTANT PROVIDED SECONDARY DATA FROM MULTIPLE SOURCES. PARTICIPATION INCLUDED REPRESENTATIVES OF COUNTY HEALTH DEPARTMENTS SERVING THE AREA SERVED BY THE HOSPITAL. |
| FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 6B | YES, THE CHNA INCLUDED THE SCHOOL NURSES OF PIKE COUNTY AS WELL AS REPRESENTATIVES FROM THE PIKE COUNTY HEALTH DEPARTMENT. |
| FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 11 | BELOW IS A LIST OF THE NEEDS IDENTIFIED IN ILLINI COMMUNITY HOSPITAL'S MOST RECENT CHNA ALONG WITH THE ACTIONS THAT WILL BE TAKEN BY THE HOSPITAL: 1) ADDRESS THE NEED TO TAKE HEALTHCARE TO THE PATIENTS - PURSUE OBTAINING AND OPERATING A MOBILE CLINIC FOR SCREENING, TESTING, BEHAVIORAL HEALTH, AND PRIMARY CARE, INCLUDING VACCINE AT REGULAR CLINICS IN REMOTE LOCATIONS IN THE SERVICE AREA, AND PROVIDE SERVICES AT EVENTS AND DISASTERS - EXPAND MENTAL HEALTH SERVICES BY RETAINING A PSYCHIATRIST FOR INPATIENT, OUTPATIENT, AND POSSIBLY TELEHEALTH SERVICES 2) BETTER ACCESS TO SCREENINGS FOR YOUTH AND ADULTS - EXPLORE A PARTNERSHIP WITH PIKE COUNTY HEALTH DEPARTMENT TO PROVIDE SCREENINGS - ENGAGE SERVICE LINE LEADERSHIP AT BLESSING HEALTH SYSTEM FOR ASSISTANCE WITH INCREASING SCREENING - EXPLORE INCREASED OUTREACH FOR SCREENINGS THROUGH EXTERNAL PARTNERS AND PROVIDERS 3) IDENTIFY AND ADDRESS THE MENTAL HEALTH IMPLICATIONS OF CHRONIC ILLNESS - INITIATE DISCUSSIONS WITH PROVIDERS TO DETERMINING HOW BEST TO APPROACH THIS ISSUE - EDUCATE PROVIDERS ABOUT THE RANGE OF SERVICES FROM THE PALLIATIVE CARE PROGRAM - EXPLORE MAKING SOCIAL WORK SERVICES AVAILABLE TO PATIENTS THROUGH SPECIALTY CARE AND CARE COORDINATION 4) ADDRESS MENTAL HEALTH ISSUES RELATED TO THE COVID PANDEMIC - EXPLORE WAYS TO MAINTAIN THE EMOTIONAL HEALTH OF STAFF - INCREASE SOCIAL MEDIA AWARENESS ABOUT ISOLATION, ANXIETY, AND DEPRESSION OF YOUTH AND ADULTS AND LOCAL SERVICES AVAILABLE TO HELP ADDRESS THOSE CONDITIONS - CONTINUE TO SUPPORT LOCAL FOOD RESOURCES AND DRIVE-THROUGH FOOD DISTRIBUTION PROGRAMS |
| FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 13B | PATIENTS ARE ELIGIBLE FOR CATASTROPHIC FINANCIAL ASSISTANCE IF THEIR INCOME EXCEEDS 250% OF THE FEDERAL POVERTY GUIDELINES AND THEIR MEDICAL BILLS EXCEED 20% OF THEIR TOTAL REPORTED FAMILY INCOME. ELIGIBILITY IS BASED ON AN INDIVIDUAL'S FAMILY'S TOTAL INCOME, FAMILY SIZE, AND ASSETS. PATIENTS EXPERIENCING CATASTROPHIC MEDICAL INDIGENCE ARE ELIGIBLE FOR A DISCOUNT OF 85%. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ILLINI COMMUNITY HOSPITAL RURAL HEA | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 WEST WASHINGTON | AddressLine1Txt |
| City | PITTSFIELD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62363 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | RURAL HEALTH CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 3C | PATIENTS ARE ELIGIBLE FOR CATASTROPHIC FINANCIAL ASSISTANCE IF THEIR INCOME EXCEEDS 250% OF THE FEDERAL POVERTY GUIDELINES AND THEIR MEDICAL BILLS EXCEED 20% OF THEIR TOTAL REPORTED FAMILY INCOME. ELIGIBILITY IS BASED ON AN INDIVIDUAL'S OR FAMILY'S TOTAL INCOME, FAMILY SIZE AND ASSETS. PATIENTS EXPERIENCING CATASTROPHIC MEDICAL INDIGENCE ARE ELIGIBLE FOR AN 85% DISCOUNT. |
| SCHEDULE H, PART I, LINE 7G | ILLINI COMMUNITY HOSPITAL DOES NOT INCLUDE AS SUBSIDIZED HEALTH SERVICES ANY COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC. |
| SCHEDULE H, PART I, LINE 7, COLUMN (F) | BAD DEBT EXPENSE OF 1,433,252 IS SUBTRACTED FROM TOTAL EXPENSES OF 32,572,795 REPORTED ON LINE 25, COLUMN A OF FORM 990, PART IX, FOR A NET TOTAL EXPENSE OF 31,139,543. |
| SCHEDULE H, PART I, LINE 7 | WHEN POSSIBLE, CALCULATIONS OF DIRECT AND INDIRECT COSTS ASSOCIATED WITH THE SERVICES PROVIDED ARE REPORTED. IF NOT AVAILABLE, A COST-TO-CHARGE RATIO IS USED TO CALCULATE THE COST AMOUNTS. THIS RATIO IS COMPUTED USING ILLINI COMMUNITY HOSPITAL'S AS-FILED MEDICARE COST REPORT. THESE COSTS AND CHARGES ARE ADJUSTED TO ACCOUNT FOR ITEMS NOT REIMBURSED THROUGH THE COST REPORT SUCH AS PROVIDER-BASED PHYSICIAN SERVICES. |
| SCHEDULE H, PART III, LINE 2 | METHODOLOGY USED TO DETERMINE BAD DEBT EXPENSE - BAD DEBT EXPENSE IS CALCULATED ON THE NET PATIENT ACCOUNT BALANCE AFTER THE BALANCE HAS BEEN REDUCED FOR ANY PAYMENTS RECEIVED OR DISCOUNTS/ADJUSTMENTS THAT ARE KNOWN. PATIENTS QUALIFYING FOR FINANCIAL ASSISTANCE ARE RECOGNIZED AS CHARITY CARE ACCOUNTS WHEN SUFFICIENT INFORMATION IS RECEIVED TO DETERMINE THEIR ELIGIBILITY. PRIOR TO THIS POINT, AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IS CALCULATED ON UNINSURED ACCOUNTS. THIS ALLOWANCE IS REVERSED IF THE ACCOUNT IS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE. |
| SCHEDULE H, PART III, LINE 3 | METHODOLOGY OF ESTIMATED AMOUNT & RATIONALE FOR INCLUDING IN COMMUNITY BENEFIT - A NUMBER OF PATIENTS ARE TRULY UNABLE TO PAY FOR THEIR MEDICAL EXPENDITURES BUT DO NOT COMPLETE THE PROCESS REQUIRED TO APPLY FOR FINANCIAL ASSISTANCE. THE HOSPITAL PERFORMS AN ASSESSMENT USING FINANCIAL AND OTHER INFORMATION OF SUCH PATIENTS OTHERWISE AVAILABLE TO THE HOSPITAL TO IDENTIFY THOSE PATIENTS THAT WOULD QUALIFY FOR CHARITY CARE IF THEY COMPLETED THE PAPERWORK. THIS INFORMATION IS USED TO ESTIMATE THE AMOUNT OF THE HOSPITAL'S BAD DEBT EXPENSE THAT WILL BE FOUND TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE. THE BAD DEBT EXPENSE WITH SUCH PATIENTS ACCOUNTS ARE TREATED AS COMMUNITY BENEFIT. |
| SCHEDULE H, PART III, LINE 4 | SEE NOTE (3) ON PAGE 17 OF THE ATTACHED AUDITED CONSOLIDATED FINANCIAL STATEMENTS. |
| SCHEDULE H, PART III, LINE 8 | THE HOSPITAL USES A COST-TO-CHARGE RATIO TO CALCULATE COST AMOUNTS. THIS RATIO IS COMPUTED USING ILLINI COMMUNITY HOSPITAL'S AS-FILED MEDICARE COST REPORT. THESE COSTS AND CHARGES ARE ADJUSTED TO ACCOUNT FOR ITEMS NOT REIMBURSED THROUGH THE COST REPORT SUCH AS PROVIDER-BASED PHYSICIAN SERVICES. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. |
| SCHEDULE H, PART III, LINE 9B | COLLECTION PRACTICES ARE NOT PURSUED IF A COMPLETED FINANCIAL ASSISTANCE APPLICATION HAS BEEN RETURNED AND APPROVED. |
| SCHEDULE H, PART VI, LINE 2 | THE CHNA WAS CONDUCTED WITH ILLINI COMMUNITY HOSPITAL THROUGH A CONSULTING ARRANGEMENT WITH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (ICAHN). A LARGE CROSS SECTION OF COMMUNITY PARTNERS WERE REPRESENTED (GEOGRAPHIC, AGE, SOCIOECONOMIC, ETC.) THAT INCLUDED THE SCHOOL NURSES OF PIKE COUNTY AS WELL AS REPRESENTATIVES FROM THE PIKE COUNTY HEALTH DEPARTMENT. |
| SCHEDULE H, PART VI, LINE 3 | BLESSING HOSPITAL FINANCIAL ACCOUNT SPECIALISTS (FAS) ATTEMPT TO CONTACT SELF-PAY INPATIENTS WITHIN 24 HOURS OF ADMISSION. IF THIS ATTEMPT TO MEET WITH THE PATIENT IS UNSUCCESSFUL, FURTHER ATTEMPTS ARE MADE LATER DURING THEIR STAY OR AT THEIR HOME. THE PATIENT IS SCREENED FOR GOVERNMENT PROGRAMS AND ELIGIBILITY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. OUTPATIENTS ARE CONTACTED ONCE THE PATIENT'S CONDITION HAS BEEN STABILIZED AND ARE SCREENED IN THE SAME MANNER AS INPATIENTS. FOR SCHEDULED TESTING, FAS CONTACT UNINSURED PATIENTS PRIOR TO THEIR SERVICE AND PROVIDE ESTIMATES OF CHARGES AND EDUCATION ON AVAILABLE PROGRAMS. IF THE FAS ARE NOT AVAILABLE TO MEET WITH THE PATIENT PRIOR TO SERVICE, CONTACT INFORMATION IS GIVEN TO THE PATIENT IF ASSISTANCE IS NEEDED. |
| SCHEDULE H, PART VI, LINE 4 | ILLINI COMMUNITY HOSPITAL OPENED ITS DOORS ON JANUARY 26, 1942 TO SERVE THE PEOPLE RESIDING WITHIN A 25 MILE RADIUS OF PITTSFIELD, ILLINOIS, WHICH IS PRIMARILY PIKE COUNTY BUT INCLUDES PARTS OF SCOTT, GREEN, CALHOUN, BROWN, AND ADAMS COUNTY. PIKE COUNTY HAS 831 SQUARE MILES OF LAND AREA AND A POPULATION OF APPROXIMATELY 14,618 PEOPLE. PIKE COUNTY AGE DEMOGRAPHICS INCLUDE 22.5% UNDER 18 YEARS OLD, AND 21.3% OVER 65 YEARS OLD. 50.0% OF THE RESIDENTS ARE FEMALE, 97.0% CAUCASIAN AND 1.5% AFRICAN-AMERICAN. 89.7% OF THE POPULATION HAVE GRADUATED FROM HIGH SCHOOL AND 17.8% HAVE A BACHELORS DEGREE OR HIGHER. THE MEDIAN HOUSEHOLD INCOME IS 46,605 AND 13.5% OF THE POPULATION IS BELOW THE POVERTY LEVEL. PIKE COUNTY IS DESIGNATED AS A HEALTH PROFESSIONALS SHORTAGE AREA AND MEDICALLY UNDERSERVED AREA. THE UNEMPLOYMENT RATE IN PIKE COUNTY WAS 3.2% IN SEPTEMBER 2021. THE REGIONS ECONOMY IS HEAVILY AGRICULTURAL WITH RETAIL AND TOURISM ASSOCIATED WITH DEER HUNTING. ILLINI COMMUNITY HOSPITAL IS ONE OF THE LARGEST EMPLOYERS IN THE COUNTY WITH 258 EMPLOYEES. |
| SCHEDULE H, PART VI, LINE 5 | ILLINI COMMUNITY HOSPITAL OFFERS A WIDE RANGE OF SERVICES IMPORTANT TO PROMOTING THE HEALTH AND WELL-BEING OF PIKE COUNTY AND THE SURROUNDING AREA. ILLINI COMMUNITY HOSPITAL OPERATES AN EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF THE ABILITY TO PAY. THE FINANCIAL ASSISTANCE POLICY OF ILLINI COMMUNITY HOSPITAL ENABLES PATIENTS TO HAVE ACCESS TO AREA RESOURCES TO ASSIST THEM WITH PAYMENT OF MEDICAL EXPENSES. ILLINI COMMUNITY HOSPITAL IS THE LARGEST EMPLOYER IN THE AREA WITH 258 EMPLOYEES. OF SIGNIFICANT IMPORTANCE ARE THE VOLUNTEERS THAT SERVE THE HOSPITAL. IN FISCAL YEAR 2021, VOLUNTEER ACTIVITY WAS SUSPENDED DUE TO THE COVID-19 PANDEMIC. ILLINI COMMUNITY HOSPITAL'S BOARD OF TRUSTEES IS COMPRISED OF VOLUNTEERS THAT INCLUDES BUSINESS LEADERS, PHYSICIANS, AND OTHER COMMUNITY LEADERS. |
| SCHEDULE H, PART VI, LINE 6 | BLESSING CORPORATE SERVICES, INC. IS THE PARENT ORGANIZATION OF A GROUP OF RELATED ORGANIZATIONS AND PROVIDES OVERALL DIRECTION TO ALL ENTITIES WITHIN THE STRUCTURE. DURING THE YEAR ENDED SEPTEMBER 30, 2005, BLESSING CORPORATE SERVICES, INC. BEGAN OPERATING A DIVISION COMPRISED OF PRACTICING PHYSICIANS. THE GROUP IS RELATED BY BLESSING CORPORATE SERVICES, INC. CONTROL OVER THE RELATED ORGANIZATION'S BOARD. THE FOLLOWING IS A BRIEF DESCRIPTION OF EACH MEMBER OF THE GROUP: ORGANIZATION - BLESSING HOSPITAL (HOSPITAL), LOCATED IN QUINCY, ILLINOIS, IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF WESTERN ILLINOIS, NORTHEASTERN MISSOURI, AND SOUTHEASTERN IOWA. THE HOSPITAL WAS INCORPORATED IN ILLINOIS IN 1875. ORGANIZATION - THE BLESSING FOUNDATION, INC. SERVES BLESSING CORPORATE SERVICES AND ITS AFFILIATED ENTITIES BY PROVIDING FINANCIAL SUPPORT FOR SERVICES AND PROGRAMS PROMOTING THE IMPROVEMENT AND AVAILABILITY OF HEALTHCARE SERVICES WITHIN THE GENERAL COMMUNITY. ORGANIZATION - DENMAN SERVICES, INC. (A TAXABLE CORPORATION) ENGAGES PRIMARILY IN THE BUSINESS OF SELLING AND RENTING MEDICAL EQUIPMENT AND OPERATING A COMMERCIAL LAUNDRY. DENMAN SERVICES, INC. IS A WHOLLY OWNED SUBSIDIARY OF BLESSING CORPORATE SERVICES, INC. ORGANIZATION - BLESSINGCARE CORPORATION DBA ILLINI COMMUNITY HOSPITAL, LOCATED IN PITTSFIELD, ILLINOIS, IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF WESTERN ILLINOIS. THE HOSPITAL WAS INCORPORATED ON JANUARY 20, 2000. ORGANIZATION - ILLINI HEALTH SERVICES, LLC CONDUCTS A PHARMACY BUSINESS IN PITTSFIELD, ILLINOIS. THE PHARMACY IS OWNED NINETY-FIVE PERCENT (95%) BY DENMAN SERVICES, INC. AND FIVE PERCENT (5%) BY BLESSINGCARE CORPORATION DBA ILLINI COMMUNITY HOSPITAL. ORGANIZATION - CHS HOLDING COMPANY (A TAXABLE ORGANIZATION) PROVIDES HEALTH INSURANCE PRODUCTS AND SERVICES. ORGANIZATION - BLESSING WALK-IN CLINIC, LLC DBA BLESSING CONVENIENT CARE OPERATES HEALTH CLINICS IN RETAIL FACILITIES. ORGANIZATION - CROSSRIVER QUALITY HEALTH PARTNERS IS A CLINICALLY INTEGRATED NETWORK FOCUSED ON IMPROVING QUALITY AND EFFICENCY OF PATIENT CARE ACROSS ILLINOIS, MISSOURI, AND IOWA. IT IS A WHOLLY OWNED SUBSIDIARY OF BLESSING CORPORATE SERVICES, INC. ORGANIZATION - BLESSING ASSURANCE COMPANY IS A WHOLLY OWNED FOREIGN SUBSIDIARY OF BLESSING CORPORATE SERIVCES, INC. AND IS A PROVIDER OF SELF- INSURANCE TO THE AFFILIATED GROUP. ORGANIZATION - THE HANNIBAL CLINIC, INC. IS A GROUP OF HEALTH CARE PROVIDERS SERVING NORTHEAST MISSOURI AND WEST CENTRAL ILLINOIS. IT IS A WHOLLY OWNED SUBSIDIARY OF BLESSING CORPORATE SERVICES, INC. ORGANIZATION - THE BROWN DRUG COMPANY (A TAXABLE ORGANIZATION) OPERATES A RETAIL PHARMACY. ORGANIZATION - KEOKUK HEALTH SYSTEMS, INC. IS A PARENT COMPANY TO FOUR ENTITIES: KEOKUK AREA HOSPITAL DBA BLESSING HEALTH KEOKUK, KEOKUK AREA MEDICAL EQUIPMENT AND SUPPLY INC., KEOKUK AREA HOSPITAL FOUNDATION, AND TRI-STATE MEDICAL GROUP INC. |
| SCHEDULE H, PART VI, LINE 7 | ILLINOIS |
| SCHEDULE H, PART VI | PART I, LINE 6B - ILLINI COMMUNITY HOSPITAL'S COMMUNITY BENEFIT REPORT IS PUBLISHED IN THE LOCAL NEWSPAPER AS AN INSERT AND IS AVAILABLE ON THE HOSPITAL'S WEBSITE @ WWW.BLESSINGHEALTH.ORG |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MAUREEN A KAHN | |||||||||||||
| VICE-CHAIR | $781,661 | $328,180 | $169,158 | $209,847 | $34,231 | $1,523,077 | $129,116 | ||||||
| PATRICK M GERVELER | |||||||||||||
| SECRETARY/TREASURER | $486,581 | $176,291 | $26,151 | $103,477 | $33,928 | $817,837 | |||||||
| DR THOMAS A CLIATT | |||||||||||||
| PHYSICIAN | $502,365 | $101,833 | $29,455 | $14,250 | $31,121 | $674,406 | |||||||
| DR STUART L PYATT | |||||||||||||
| PHYSICIAN | $470,819 | $95,122 | $21,311 | $14,250 | $26,052 | $622,936 | |||||||
| DR ROBERT D THOMAS | |||||||||||||
| PRES - MED STAFF | $338,562 | $4,000 | $35,806 | $8,922 | $23,415 | $407,888 | |||||||
| DR CHRISTOPHER S WAGONER | |||||||||||||
| PRES - MED STAFF | $347,142 | $4,500 | $2,032 | $10,330 | $28,277 | $389,341 | |||||||
| KATHLEEN E HULL | |||||||||||||
| ADMINISTRATOR | $229,591 | $88,479 | $9,016 | $14,250 | $29,766 | $366,673 | |||||||
| HOLLY A JONES | |||||||||||||
| ASST ADMINISTRATOR | $159,536 | $24,171 | $2,665 | $9,564 | $22,889 | $216,875 | |||||||
| CAITLIN M HOLLAND | |||||||||||||
| LEAD PHARMACIST | $170,548 | $447 | $1,754 | $8,244 | $17,527 | $196,618 | |||||||
| DR JAMES E UHLES | |||||||||||||
| PHYSICIAN | $148,541 | $1,900 | $2,246 | $7,968 | $21,255 | $180,041 | |||||||
| DR DAVID S GLASGOW | |||||||||||||
| PHYSICIAN | $175,000 | $4,644 | $69 | $179,644 | |||||||||
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PAGE 1, PART I, LINE 3 | COMPENSATION OF ORGANIZATION'S CEO - EXECUTIVE DIRECTOR - KATHLEEN HULL IS AN EMPLOYEE OF BLESSING CORPORATE SERVICES, INC., THE PARENT COMPANY OF BLESSINGCARE CORPORATION. COMPARABILITY DATA PROVIDED BY A THIRD PARTY IS USED TO ESTABLISH A MARKET RANGE OF COMPENSATION. THIS INFORMATION IS SUBMITTED TO THE PRESIDENT OF BLESSING CORPORATE SERVICES FOR REVIEW AND TO THE BLESSING CORPORATE SERVICES BOARD OF TRUSTEES COMPENSATION COMMITTEE FOR APPROVAL. COMPENSATION OF ORGANIZATION'S BOARD MEMBERS - MAUREEN KAHN AND PATRICK GERVELER ARE EMPLOYEES OF BLESSING CORPORATE SERVICES, INC., THE PARENT COMPANY OF BLESSINGCARE CORPORATION DBA ILLINI COMMUNITY HOSPITAL. COMPARABILITY DATA PROVIDED BY A THIRD PARTY IS USED TO ESTABLISH A MARKET RANGE OF COMPENSATION. THIS INFORMATION IS SUBMITTED TO THE BLESSING CORPORATE SERVICES BOARD OF TRUSTEES COMPENSATION COMMITTEE FOR APPROVAL. |
| SCHEDULE J, PAGE 1, PART I, LINE 4 | MAUREEN A. KAHN 0 195,597 0 PATRICK M. GERVELER 0 89,227 0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF PITTSFIELD | BusinessNameLine1Txt |
| Business Name Line2 | PROJECT REVENUE BONDS SERIES 2015 | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 370817800 | BondIssuerEIN |
| Bond Issued | 2015-05-12 | BondIssuedDt |
| Issue Price | $3,000,000 | IssuePriceAmt |
| Purpose | CONSTRUCTION CONSTRUCTION OF HOSPITAL GERIATRIC PSYCHIATRY SERVICE UNIT LOCATED ON WEST WASHINGTON S | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $514,031 | RetiredAmt |
| Total Proceeds | $2,156,326 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $37,000 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $2,119,326 | CapitalExpendituresAmt |
| Substantial Completion | 2016 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | false | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | false | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (true) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | false | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | false | MgmtContractBondFincdPropInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | Yes (true) | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (true) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| Rebate Not Due Yet | false | RebateNotDueYetInd |
| Exception To Rebate | Yes (true) | ExceptionToRebateInd |
| No Rebate Due | false | NoRebateDueInd |
| Variable Rate Issue | Yes (true) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | false | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (true) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (true) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PURPOSE OF ISSUE DESCRIPTION | FormAndLineReferenceDesc |
| Explanation | CITY OF PITTSFIELD CONSTRUCTION CONSTRUCTION OF HOSPITAL GERIATRIC PSYCHIATRY SERVICE UNIT LOCATED ON WEST WASHINGTON STREET IN PITTSFIELD, ILLINOIS. | ExplanationTxt |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR ROBERT D THOMAS | PersonNm |
| Relationship With Org | PRES-MED STAFF | RelationshipWithOrgTxt |
| Loan Purpose | EDUCATIONAL LOAN | LoanPurposeTxt |
| Loan From Organization | Yes (X) | LoanFromOrganizationInd |
| Original Principal | $150,000 | OriginalPrincipalAmt |
| Balance Due | $60,000 | BalanceDueAmt |
| Default | false | DefaultInd |
| Board Or Committee Approval | Yes (true) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (true) | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $60,000 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| JOHN HULL | |||
| FAMILY MEMBER | $98,694 | EMPLOYMENT | false |
| KATHLEEN E SIDWELL | |||
| FAMILY MEMBER | $57,205 | EMPLOYMENT | false |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4A | ILLINI COMMUNITY HOSPITAL TREATED PATIENTS THROUGH THE FOLLOWING SERVICES DURING FISCAL YEAR 2021: INPATIENT ADMISSIONS 559 OBSERVATION ADMISSIONS 137 OUTPATIENT VISITS 77,324 TOTAL SURGERIES 305 EMERGENCY VISITS 5,747 LABORATORY TESTS 71,148 RESPIRATORY TREATMENTS 1,353 RADIOLOGY PROCEDURES 9,755 RURAL HEALTH CLINIC & XPRESS VISITS 14,851 IN ADDITION TO THESE HEALTHCARE SERVICES, ILLINI COMMUNITY HOSPITAL PROVIDED 531,941 IN CHARITY CARE AND INCURRED MEDICARE SHORTFALLS OF 547,769. THE HOSPITAL PROVIDED ADDITIONAL BENEFITS DURING FISCAL YEAR 2021 AS FOLLOWS: 1)HEALTH PROFESSIONALS EDUCATION - 2,000 HEALTHCARE STUDENT INTERNSHIPS NURSE PRACTITIONER CLINICALS 2)IN-KIND CONTRIBUTIONS AND DONATIONS - 23,121 PIKE CEO PROGRAM PIKE COUNTY MINISTERIAL ALLIANCE DONATED MEETING ROOM SPACE HEALTH FAIRS HEALTH SCREENINGS SUPPORT TO LOCAL SCHOOLS FOOD BANK SUPPORT LOCAL FAIRS SUPPORT TWO RIVERS FARM BUREAU - AG IN THE CLASSROOM SUPPORT 3)COMMUNITY HEALTH IMPROVEMENT PROGRAMS AND SERVICES - 65,769 COVID AND FLU CLINICS PIKELAND WELLNESS COMMITTEE BLOOD AND PLATELET DRIVES UNREIMBURSED PATIENT TRANSPORTATION DRUG TAKE BACK KIOSK BIKE HELMETS FOR LOCAL CHILDREN PATIENT CLOTHING/SUPPLIES CLOSET COURTESY BLOOD DRAWS FOR AREA PUBLIC AGENCIES 4)COMMUNITY EDUCATIONAL PROGRAMS AND SERVICES - 32,904 PIKE COUNTY ECONOMIC DEVELOPMENT CORPORATION - WIFI HOTSPOTS DIABETES COACHING |
| FORM 990, PART VI | BLESSINGCARE CORPORATION CONTRACTS WITH BLESSING CORPORATE SERVICES TO EXECUTE THE DUTIES NORMALLY PERFORMED BY MANAGEMENT. THE MANAGEMENT COMPANY CARRIES OUT THE GOVERNING DECISIONS OF THE BOARD OF DIRECTORS, SIMILAR TO THE ROLE AND FUNCTIONS OF AN EMPLOYEE-OFFICER. BLESSING CORPORATE SERVICES PAID COMPENSATION TO VARIOUS EMPLOYEES COLLECTIVELY ACTING AS MANAGEMENT. THE COMPENSATION PAID TO THREE OF THOSE EMPLOYEES WHO SERVE ON BLESSINGCARE CORPORATION BOARD OF DIRECTORS IS DISCLOSED ON PART VII. |
| FORM 990, PAGE 6, PART VI, LINE 3 | IN ORDER TO ACHIEVE COST EFFICIENCIES, BLESSINGCARE CORPORATION AND ITS SOLE MEMBER, BLESSING CORPORATE SERVICES, INC. HAVE ENTERED AN INTERCOMPANY MANAGEMENT SERVICES AGREEMENT WHEREBY BLESSING CORPORATE SERVICES PROVIDES MANAGEMENT SERVICES TO BLESSINGCARE CORPORATION |
| FORM 990, PAGE 6, PART VI, LINE 6 | BLESSING CORPORATE SERVICES, INC., AN ILLINOIS NOT FOR PROFIT CORPORATION, IS THE SOLE VOTING MEMBER OF BLESSINGCARE CORPORATION, DBA ILLINI COMMUNITY HOSPITAL. |
| FORM 990, PAGE 6, PART VI, LINE 7A | BLESSING CORPORATE SERVICES, INC., THE SOLE VOTING MEMBER OF BLESSINGCARE CORPORATION, SHALL POSSESS THE RIGHTS AND RESPONSIBILITIES TO APPOINT AND/OR REMOVE ALL THE TRUSTEES OF THE CORPORATION, AND APPOINT THE CORPORATION'S PRESIDENT. |
| FORM 990, PAGE 6, PART VI, LINE 7B | BLESSING CORPORATE SERVICES, INC., THE SOLE VOTING MEMBER OF BLESSINGCARE CORPORATION, SHALL POSSESS THE RIGHTS AND RESPONSIBILITIES TO APPROVE EXPRESSLY ALL AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS BEFORE THEY MAY BECOME EFFECTIVE; APPROVE CAPITAL AND OPERATING BUDGETS, LONG-TERM DEBT, LONG-RANGE PLANS, THE SALE OR PURCHASE OF REAL ESTATE AND CONTRACTS ENTERED INTO BY THE CORPORATION, THE REASONABLE VALUE OF WHICH EXCEEDS AN AMOUNT SPECIFIED IN THE BYLAWS OF THE MEMBER; APPROVE MATERIAL INVESTMENT DECISIONS, INCLUDING WITHOUT LIMITATION ESTABLISHMENT AND MODIFICATION OF INVESTMENT POLICIES, ENGAGEMENT AND REMOVAL OF INVESTMENT MANAGERS AND ADVISORS, AND CHANGES IN INVESTMENT ALLOCATIONS NOT PERMITTED BY AN EXISTING INVESTMENT POLICY; APPROVE THE PARAMETERS FOR TERMS OF EMPLOYMENT OF PHYSICIANS, INCLUDING PHYSICIAN COMPENSATION PLANS, AND ANY MATERIAL VARIANCES FROM SUCH PARAMETERS FOR INDIVIDUAL PHYSICIANS; APPROVE THE SELECTION OF AUDITORS AND LEGAL COUNSEL; APPROVE CHARITY CARE AND COMMUNITY BENEFITS-RELATED POLICIES; APPROVE THE FORMATION OF SUBSIDIARY ENTITIES AND/OR JOINT VENTURES; APPROVE THE FILING OF A PETITION IN BANKRUPTCY, MAKING AN ASSIGNMENT FOR THE BENEFIT OF CREDITORS, OR APPLYING FOR PROTECTION UNDER ANY INSOLVENCY LAWS; APPROVE THE PARTICIPATION IN ANY MERGER, COMBINATION, CONSOLIDATION, LIQUIDATION, DISSOLUTION OR OTHER CORPORATE OR BUSINESS ENTITY RESTRUCTURING, AND HAVE THE POWER TO COMPEL THE CORPORATION TO ENFORCE AND/OR PERFORM ANY CONTRACTUAL OBLIGATION. |
| FORM 990, PAGE 6, PART VI, LINE 11B | FOLLOWING MANAGEMENT AND LEGAL REVIEW, THE FORM 990 WAS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW AND COMMENT PRIOR TO FILING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | A COPY OF THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED ANNUALLY TO OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES TO BE READ, SIGNED, AND RETURNED TO THE ORGANIZATION. THE SIGNED POLICIES ARE RETAINED IN THE CORPORATE ADMINISTRATIVE FILES. IN ADDITION, EACH OFFICER, DIRECTOR, OR TRUSTEE IS REQUIRED TO DECLARE NO CONFLICT OF INTEREST IN REGARDS TO AGENDA ITEMS BEING PRESENTED AT THE START OF EACH MONTHLY BOARD MEETING. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THESE DOCUMENTS ARE LOCATED IN THE HOSPITAL'S ADMINISTRATIVE OFFICES AND ARE AVAILABLE UPON REQUEST FOR PUBLIC INSPECTION. |
| FORM 990, PART XI, LINE 9 | 990-T DEPRECIATION 0 ILLINI HEALTH SERVICES K1 -25,253 TOTAL -25,253 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Business Name Line2DirectControllingEntityName/BusinessNameLine2Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BLESSING CORPORATE SERVICES INC | ||||||||||||
| BROADWAY AT 11TH PO BOX 7005 | QUINCY | IL | 623057005 | 371128706 | MGMT SVCS | IL | 501C3 | 10 | N/A | false | ||
| BLESSING HOSPITAL | ||||||||||||
| 1005 BROADWAY | QUINCY | IL | 62301 | 370661183 | NON-PROFIT | IL | 501C3 | 3 | false | BCS INC | BLESSING CORPORATE SERVICES INC | |
| BLESSING AFFILIATES INC | ||||||||||||
| BROADWAY AT 11TH PO BOX 7005 | QUINCY | IL | 623057005 | 371128708 | INACTIVE | IL | 501C3 | 10 | false | BCS INC | BLESSING CORPORATE SERVICES INC | |
| THE BLESSING FOUNDATION INC | ||||||||||||
| PO BOX 7005 | QUINCY | IL | 62301 | 371128705 | FUNDRAISE | IL | 501C3 | 12B | false | BCS INC | BLESSING CORPORATE SERVICES INC | |
| BLESSING WALK-IN CLINIC LLC | ||||||||||||
| 1005 BROADWAY | QUINCY | IL | 62301 | 814181593 | MED SVCS | IL | 501C3 | 3 | false | BCS INC | ||
| BLESSINGCARE CORPORATION - MISSOURI | ||||||||||||
| 1005 BROADWAY | QUINCY | IL | 62301 | 431371818 | INACTIVE | MO | 501C3 | 3 | false | BCS INC | BCS INC | |
| KEOKUK AREA HOSPITAL DBA BLESSING H | ||||||||||||
| 1600 MORGAN STREET | KEOKUK | IA | 52632 | 420710268 | HOSPITAL | IA | 501C3 | 3 | false | KHS INC | ||
| KEOKUK AREA HOSPITAL FOUNDATION | ||||||||||||
| 1600 MORGAN STREET | KEOKUK | IA | 52632 | 421202608 | FUNDRAISER | IA | 501C3 | 12B | false | KHS INC | ||
| TRI-STATE MEDICAL GROUP INC | ||||||||||||
| 1600 MORGAN STREET | KEOKUK | IA | 52632 | 411435525 | HOSPITAL | IA | 501C3 | 3 | false | KHS INC | ||
| KEOKUK HEALTH SYSTEMS INC | ||||||||||||
| 1600 MORGAN STREET | KEOKUK | IA | 52632 | 421237361 | MGMT SVCS | IA | 501C3 | 12B | false | BCS INC | ||
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Business Name Line2DirectControllingEntityName/BusinessNameLine2Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ILLINI HEALTH SERVICES LLC | ||||||||||||||
| PO BOX 40 | QUINCY | IL | 623060040 | 470901851 | PHARMACY | IL | DENMAN | DENMAN | UNRELATED | $25,253 | $53,744 | false | false | 0.05000 |
| CURRENT HEALTH NETWORK LLC | ||||||||||||||
| 1005 BROADWAY | QUINCY | IL | 62301 | 811681509 | PRVDR NTWK | IL | CHS HLDGS | false | false | |||||
| NORTHEAST MISSOURI AMBULATORY SURGE | ||||||||||||||
| 98 MEDICAL DRIVE | HANNIBAL | MO | 634010511 | 431857277 | MED SVCS | MO | HANNIBAL | false | false | |||||
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 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 Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DENMAN SERVICES INC | |||||||||||||||
| BROADWAY AT 11TH PO BOX 40 | QUINCY | IL | 62306 | 371132117 | MED EQUIP | IL | BCS INC | C CORP | false | ||||||
| CHS HOLDING COMPANY | |||||||||||||||
| 1005 BROADWAY | QUINCY | IL | 62301 | 320481381 | GRP HLTH | IL | BCS INC | C CORP | false | ||||||
| HANNIBAL CLINIC INC | |||||||||||||||
| 100 MEDICAL DRIVE | HANNIBAL | MO | 63401 | 431033473 | MED SVCS | MO | BCS INC | C CORP | false | ||||||
| BLESSING ASSURANCE COMPANY | |||||||||||||||
| 981454767 | SELF-INSUR | BCS INC | C CORP | false | PO BOX 1159 | GRAND CAYMAN | CAYMAN ISLANDS | CJ | KY1-1102 | CJ | |||||
| BROWN DRUG COMPANY | |||||||||||||||
| 1121 MAINE ST | QUINCY | IL | 62301 | 370193505 | PHARMACY | IL | BCS INC | S CORP | false | ||||||
| KEOKUK AREA MEDICAL EQUIP & SUPPLY | |||||||||||||||
| 420 NORTH 17TH STREET | KEOKUK | IA | 52632 | 421237312 | MED EQUIP | IL | KHS INC | C CORP | false | ||||||
| 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 | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (true) | 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 | false | 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 | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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