2022-07-23T10:49:23-05:00 2021-09-30 363077757 GRAY HUNTER STENN LLP 500 MAINE ST QUINCY IL 62301 990 2020-10-01 371396010 BLESSINGCARE CORPORATION BLES 2172852113 640 WEST WASHINGTON PITTSFIELD IL 62363 PATRICK M GERVELER SECRETARY/TREASURER 2172852113 2022-07-05 true PATRICK GERVELER 999009999 ERIN J WHARTON CPA P01294277 2172220304 2022-07-05 2020 2022-09-23 18:48:47Z ILLINI COMMUNITY HOSPITAL KATHLEEN E HULL 640 WEST WASHINGTON PITTSFIELD IL 62363 37689366 false X WWW.ILLINIHOSPITAL.ORG X 2000 IL TO IMPROVE THE HEALTH OF OUR COMMUNITIES. 9 5 251 22 25253 21728 1425175 2764239 29274727 32898936 87106 139213 738602 1882688 31525610 37685076 0 0 15816276 18157815 0 0 12982525 14414980 28798801 32572795 2726809 5112281 39382716 41918274 15102297 11664127 24280419 30254147 X TO IMPROVE THE HEALTH OF OUR COMMUNITIES. false false 22797532 32898936 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 22797532 true true false false false false false false false false true false false false true false false true false false false false false false false false true true false false true true false false false false false true false false true false false false false false false true false false false true 31 0 true 251 true true true false false false false false false false false false false false X 9 5 false true false false true true true true true false false true true true true true true false false true true IL X KATHY HULL 2172852113 640 WEST WASHINGTON PITTSFIELD IL 62363 MAUREEN A KAHN VICE-CHAIR 1.00 39.00 X X 0 1278999 244078 PATRICK M GERVELER SECRETARY/TR 1.00 39.00 X X 0 689023 128814 DR THOMAS A CLIATT PHYSICIAN 40.00 X 633653 0 40753 DR STUART L PYATT PHYSICIAN 40.00 X 587252 0 35684 DR ROBERT D THOMAS PRES - 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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%. 1 ILLINI COMMUNITY HOSPITAL RURAL HEA 321 WEST WASHINGTON PITTSFIELD IL 62363 RURAL HEALTH CLINIC 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 false true false false false false false false false MAUREEN A KAHN VICE-CHAIR 781661 328180 169158 209847 34231 1523077 129116 PATRICK M GERVELER SECRETARY/TREASURER 486581 176291 26151 103477 33928 817837 DR THOMAS A CLIATT PHYSICIAN 502365 101833 29455 14250 31121 674406 DR STUART L PYATT PHYSICIAN 470819 95122 21311 14250 26052 622936 DR ROBERT D THOMAS PRES - MED STAFF 338562 4000 35806 8922 23415 407888 DR CHRISTOPHER S WAGONER PRES - MED STAFF 347142 4500 2032 10330 28277 389341 KATHLEEN E HULL ADMINISTRATOR 229591 88479 9016 14250 29766 366673 HOLLY A JONES ASST ADMINISTRATOR 159536 24171 2665 9564 22889 216875 CAITLIN M HOLLAND LEAD PHARMACIST 170548 447 1754 8244 17527 196618 DR JAMES E UHLES PHYSICIAN 148541 1900 2246 7968 21255 180041 DR DAVID S GLASGOW PHYSICIAN 175000 4644 69 179644 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 A CITY OF PITTSFIELD PROJECT REVENUE BONDS SERIES 2015 370817800 2015-05-12 3000000 CONSTRUCTION CONSTRUCTION OF HOSPITAL GERIATRIC PSYCHIATRY SERVICE UNIT LOCATED ON WEST WASHINGTON S false false false A 514031 2156326 37000 2119326 2016 false false true true A false false false false true false true A false false true false true false false false true A true PURPOSE OF ISSUE DESCRIPTION CITY OF PITTSFIELD CONSTRUCTION CONSTRUCTION OF HOSPITAL GERIATRIC PSYCHIATRY SERVICE UNIT LOCATED ON WEST WASHINGTON STREET IN PITTSFIELD, ILLINOIS. DR ROBERT D THOMAS PRES-MED STAFF EDUCATIONAL LOAN X 150000 60000 false true true 60000 JOHN HULL FAMILY MEMBER 98694 EMPLOYMENT false KATHLEEN E SIDWELL FAMILY MEMBER 57205 EMPLOYMENT false 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 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 BCS INC BLESSING CORPORATE SERVICES INC false BLESSING AFFILIATES INC BROADWAY AT 11TH PO BOX 7005 QUINCY IL 623057005 371128708 INACTIVE IL 501C3 10 BCS INC BLESSING CORPORATE SERVICES INC false THE BLESSING FOUNDATION INC PO BOX 7005 QUINCY IL 62301 371128705 FUNDRAISE IL 501C3 12B BCS INC BLESSING CORPORATE SERVICES INC false BLESSING WALK-IN CLINIC LLC 1005 BROADWAY QUINCY IL 62301 814181593 MED SVCS IL 501C3 3 BCS INC false BLESSINGCARE CORPORATION - MISSOURI 1005 BROADWAY QUINCY IL 62301 431371818 INACTIVE MO 501C3 3 BCS INC BCS INC false KEOKUK AREA HOSPITAL DBA BLESSING H 1600 MORGAN STREET KEOKUK IA 52632 420710268 HOSPITAL IA 501C3 3 KHS INC false KEOKUK AREA HOSPITAL FOUNDATION 1600 MORGAN STREET KEOKUK IA 52632 421202608 FUNDRAISER IA 501C3 12B KHS INC false TRI-STATE MEDICAL GROUP INC 1600 MORGAN STREET KEOKUK IA 52632 411435525 HOSPITAL IA 501C3 3 KHS INC false KEOKUK HEALTH SYSTEMS INC 1600 MORGAN STREET KEOKUK IA 52632 421237361 MGMT SVCS IA 501C3 12B BCS INC false ILLINI HEALTH SERVICES LLC PO BOX 40 QUINCY IL 623060040 470901851 PHARMACY IL DENMAN DENMAN UNRELATED 25253 53744 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 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 PO BOX 1159 GRAND CAYMAN CAYMAN ISLANDS CJ KY1-1102 981454767 SELF-INSUR CJ BCS INC C CORP false 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 false false false false true false false false true true true false true true true true true false false