MENDOTA COMMUNITY HOSPITAL: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- MENDOTA COMMUNITY HOSPITAL (EIN 36-2167785)
- Tax period
- 2020-10-01 to 2021-09-30
- Filed
- 2022-08-10
- IRS object ID
- 202242229349301444
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-08-10T12:31:19-05:00 | ReturnTs |
| Tax Period End | 2021-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 350921680 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 West Wacker Drive Suite 2600 | AddressLine1Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 606061224 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 362167785 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mendota Community Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MEND | BusinessNameControlTxt |
| Phone | 3096557708 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 124 SW Adams St | AddressLine1Txt |
| City | Peoria | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61602 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Michael M Allen | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Signature | 2022-08-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Michael M | PersonFirstNm |
| Person Last | Allen | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Jennifer Burke | PreparerPersonNm |
| PTIN | P01342224 | PTIN |
| Phone | 3128997000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OSF Saint Paul Medical Center | BusinessNameLine1Txt |
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Michael Allen | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 124 SW Adams St | AddressLine1Txt |
| City | Peoria | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61602 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $37,721,249 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.osfhealthcare.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1944 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | IN THE SPIRIT OF CHRIST AND THE EXAMPLE OF FRANCIS OF ASSISI, THE MISSION OF OSF HEALTHCARE IS TO SERVE PERSONS WITH THE GREATEST CARE AND LOVE IN A COMMUNITY THAT CELEBRATES THE GIFT OF LIFE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 146 | TotalEmployeeCnt |
| Total Volunteers | 19 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,453,876 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,313,058 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $33,525,666 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $36,130,541 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,791 | PYInvestmentIncomeAmt |
| CY Investment Income | $5,114 | CYInvestmentIncomeAmt |
| PY Other Revenue | $123,140 | PYOtherRevenueAmt |
| CY Other Revenue | $250,484 | CYOtherRevenueAmt |
| PY Total Revenue | $37,104,473 | PYTotalRevenueAmt |
| CY Total Revenue | $37,699,197 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $14,484,740 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $14,837,686 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $17,318,559 | PYOtherExpensesAmt |
| CY Other Expenses | $17,982,076 | CYOtherExpensesAmt |
| PY Total Expenses | $31,803,299 | PYTotalExpensesAmt |
| CY Total Expenses | $32,819,762 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,301,174 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,879,435 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $33,605,582 | TotalAssetsBOYAmt |
| Total Assets EOY | $32,137,344 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $25,357,726 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $19,296,078 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,247,856 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $12,841,266 | NetAssetsOrFundBalancesEOYAmt |
| Mission | IN THE SPIRIT OF CHRIST AND THE EXAMPLE OF FRANCIS OF ASSISI, THE MISSION OF OSF HEALTHCARE IS TO SERVE PERSONS WITH THE GREATEST CARE AND LOVE IN A COMMUNITY THAT CELEBRATES THE GIFT OF LIFE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $25,048,114 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $36,296,717 | RevenueAmt |
| Desc | MENDOTA COMMUNITY HOSPITAL is licensed to operate 25 patient beds. The hospital provided $2,148,826 in charity care to the community during FISCAL YEAR 2021. The Hospital's services provided during fiscal year 2021 are as follows: Patient days of 2,724 Outpatient visits of 34,640 patient visits to the emergency room of 4,795 | Desc |
| Total Program Service Expenses | $25,048,114 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (true) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 5 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 146 | 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | Yes (true) | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Michael Allen | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3096557708 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 124 SW Adams St | AddressLine1Txt |
| City | PEORIA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61602 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (38 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Robert C Sehring | |||||||||
| Vice Chairperson Chief Executive Officer | 1.0 | 43.0 | Yes (X) | Yes (X) | $0 | $1,944,604 | $44,624 | ||
| Sister Agnes Joseph Williams OSF | |||||||||
| Assistant Secretary | 1.0 | 43.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Sister Diane Marie McGrew OSF | |||||||||
| President and Treasurer | 1.0 | 43.0 | Yes (X) | Yes (X) | $0 | $5,640 | $0 | ||
| Sister Judith Ann Duvall OSF | |||||||||
| Chairperson | 1.0 | 43.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Sister Theresa Ann Brazeau OSF | |||||||||
| Secretary | 1.0 | 43.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Brian J Silverstein MD | |||||||||
| Board Member | 1.0 | 42.0 | Yes (X) | $0 | $45,000 | $0 | |||
| Gerald J McShane MD | |||||||||
| Board Member | 1.0 | 42.0 | Yes (X) | $0 | $273,859 | $39,591 | |||
| Sister M Angelica Neumann FSGM | |||||||||
| Board Member (Beginning Jan 2021) | 1.0 | 42.0 | Yes (X) | $0 | $0 | $0 | |||
| Sister M Beata Ziegler FSGM | |||||||||
| Board Member (Beginning Jan 2021) | 1.0 | 42.0 | Yes (X) | $0 | $0 | $0 | |||
| Sister M Mikela Meidl FSGM | |||||||||
| Board Member | 1.0 | 43.0 | Yes (X) | $0 | $0 | $0 | |||
| Sister Rose Therese Mann OSF | |||||||||
| Board Member | 1.0 | 43.0 | Yes (X) | $0 | $0 | $0 | |||
| August J Querciagrossa | |||||||||
| Chief Executive Officer Metro Region | 1.0 | 41.0 | Yes (X) | $0 | $377,236 | $30,900 | |||
| Carol A Friesen | |||||||||
| Chief Executive Officer Northern Region | 1.0 | 41.0 | Yes (X) | $0 | $545,425 | $46,012 | |||
| Chad E Boore | |||||||||
| Chief Executive Officer Eastern Region | 1.0 | 41.0 | Yes (X) | $0 | $521,783 | $47,626 | |||
| David M Hall | |||||||||
| SVP Info Systems/Chief Information Officer | 1.0 | 41.0 | Yes (X) | $0 | $434,075 | $47,038 | |||
| James J Mormann | |||||||||
| Chief Information Officer | 1.0 | 41.0 | Yes (X) | $0 | $724,943 | $47,781 | |||
| Jeffry M Tillery | |||||||||
| SVP Chief Transformation Officer | 1.0 | 41.0 | Yes (X) | $0 | $699,958 | $44,457 | |||
| John R Evancho | |||||||||
| SVP Chief Compliance Officer | 1.0 | 41.0 | Yes (X) | $0 | $320,188 | $42,972 | |||
| Leon A Yeh MD | |||||||||
| VP Chief Medical Officer Emergency Serv | 1.0 | 41.0 | Yes (X) | $0 | $537,519 | $45,952 | |||
| Lori L Wiegand | |||||||||
| Chief Nursing Officer | 1.0 | 41.0 | Yes (X) | $0 | $506,606 | $23,993 | |||
| Michael A Cruz MD | |||||||||
| Chief Operating Officer | 1.0 | 41.0 | Yes (X) | $0 | $820,480 | $49,358 | |||
| Michael A Wells | |||||||||
| President CHOI | 1.0 | 41.0 | Yes (X) | $0 | $227,993 | $25,961 | |||
| Michael M Allen | |||||||||
| Chief Financial Officer | 1.0 | 42.0 | Yes (X) | $0 | $775,229 | $47,696 | |||
| Michelle D Conger | |||||||||
| Chief Strategy Officer | 1.0 | 41.0 | Yes (X) | $0 | $664,325 | $34,170 | |||
| Ralph Velazquez MD | |||||||||
| System Chief Medical Officer | 1.0 | 42.0 | Yes (X) | $0 | $626,231 | $42,748 | |||
| Robert L Brandfass | |||||||||
| SVP Chief Legal Officer | 1.0 | 41.0 | Yes (X) | $0 | $651,487 | $40,488 | |||
| Roxanna Crosser | |||||||||
| Chief Executive Officer Western Region | 1.0 | 41.0 | Yes (X) | $0 | $490,298 | $28,560 | |||
| Stephen E Hippler MD | |||||||||
| Chief Clinical Officer | 1.0 | 41.0 | Yes (X) | $0 | $835,513 | $48,891 | |||
| Thomas G Hammerton | |||||||||
| President OSF Healthcare Foundation Chief Development Officer | 1.0 | 43.0 | Yes (X) | $0 | $430,315 | $47,453 | |||
| Dawn C Trompeter | |||||||||
| President of OSF HealthCare | 40.0 | 0 | $276,785 | $0 | $21,873 | Yes (X) | |||
| Jodie L Borchelt | |||||||||
| Director Surgical/Inpatient Services, Medical/Surgical Acute | 40.0 | 0 | $102,911 | $0 | $38,073 | Yes (X) | |||
| Katherine R Riva-Foster MD | |||||||||
| Physician | 40.0 | 0 | $236,520 | $0 | $10,817 | Yes (X) | |||
| Kenneth K Potts MD | |||||||||
| Physician | 40.0 | 0 | $234,672 | $0 | $30,853 | Yes (X) | |||
| Stacy A Piller | |||||||||
| Advanced Practice Nurse | 40.0 | 0 | $113,944 | $0 | $27,544 | Yes (X) | |||
| David A Schertz | |||||||||
| Former - Chief Executive Officer Northern Region | 0.0 | 0.0 | $0 | $135,173 | $0 | Yes (X) | |||
| Divya-Devi Joshi | |||||||||
| Former Chief Executive Officer Children SL | 0.0 | 0.0 | $0 | $119,054 | $7,584 | Yes (X) | |||
| Dwight D Stapleton | |||||||||
| Former Vice President Clinical Specialty Services | 0.0 | 0.0 | $0 | $128,501 | $7,954 | Yes (X) | |||
| Mark A Nafziger | |||||||||
| Former Chief Executive Officer Ambulatory Care | 0.0 | 40.0 | $0 | $1,010,202 | $11,171 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $964,832 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $13,851,638 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $982,141 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Emergency Physician Staffing Solutions | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1504 Timber Trail | AddressLine1Txt |
| City | Washington | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61571 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | Emergency Services Physicians | ServicesDesc |
| Compensation | $2,102,972 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $91,928 | RelatedOrganizationsAmt |
| Government Grants | $1,210,297 | GovernmentGrantsAmt |
| All Other Contributions | $10,833 | AllOtherContributionsAmt |
| Total Contributions | $1,313,058 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT REVENUE | 622110 | $34,404,120 | $34,404,120 |
| CONTRACTED PHARMACY | 622110 | $1,678,609 | $1,678,609 |
| MEDICAL DIRECTORSHIPS | 624200 | $47,812 | $47,812 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $36,130,541 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,114 | TotalRevenueColumnAmt |
| Exclusion | $5,114 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $24,210 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $24,210 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,210 | TotalRevenueColumnAmt |
| Exclusion | $24,210 | ExclusionAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $33,357 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $22,052 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,305 | TotalRevenueColumnAmt |
| Exclusion | $11,305 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| CAFETERIA | 624200 | $48,793 | $48,793 | |
| Affiliate Services | 621300 | $104,444 | $104,444 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $61,732 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $61,732 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $214,969 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $37,699,197 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $36,296,717 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $89,422 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,470,862 | TotalAmt |
| Program Services | $9,153,708 | ProgramServicesAmt |
| Management And General | $2,317,154 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $423,236 | TotalAmt |
| Program Services | $272,548 | ProgramServicesAmt |
| Management And General | $150,688 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,331,038 | TotalAmt |
| Program Services | $1,770,405 | ProgramServicesAmt |
| Management And General | $560,633 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $612,550 | TotalAmt |
| Program Services | $473,500 | ProgramServicesAmt |
| Management And General | $139,050 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,398 | TotalAmt |
| Management And General | $13,398 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,293,732 | TotalAmt |
| Program Services | $2,203,307 | ProgramServicesAmt |
| Management And General | $90,425 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,192,761 | TotalAmt |
| Program Services | $3,623,057 | ProgramServicesAmt |
| Management And General | $569,704 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $401,003 | TotalAmt |
| Program Services | $59,062 | ProgramServicesAmt |
| Management And General | $341,941 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,047 | TotalAmt |
| Program Services | $23,801 | ProgramServicesAmt |
| Management And General | $5,246 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,447 | TotalAmt |
| Program Services | $18,146 | ProgramServicesAmt |
| Management And General | $12,301 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,336,953 | TotalAmt |
| Program Services | $3,566,548 | ProgramServicesAmt |
| Management And General | $1,770,405 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $741,977 | TotalAmt |
| Program Services | $287,502 | ProgramServicesAmt |
| Management And General | $454,475 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,840 | TotalAmt |
| Program Services | $22,950 | ProgramServicesAmt |
| Management And General | $70,890 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| CONTRACTS AND REPAIRS | $2,941,077 | $1,698,009 | $1,243,068 |
| BAD DEBTS | $749,741 | $749,741 | |
| PROVIDER TAX | $935,446 | $935,446 | |
| COLLECTION AGENCIES | $15,448 | $15,448 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $207,206 | TotalAmt |
| Program Services | $190,384 | ProgramServicesAmt |
| Management And General | $16,822 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,819,762 | TotalAmt |
| Program Services | $25,048,114 | ProgramServicesAmt |
| Management And General | $7,771,648 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,256,119 | BOYAmt |
| EOY | $900 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,629 | BOYAmt |
| EOY | $129,235 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,652,378 | BOYAmt |
| EOY | $4,261,925 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $718,557 | BOYAmt |
| EOY | $728,976 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $2,056 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $34,151,097 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $20,156,294 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,064,027 | BOYAmt |
| EOY | $13,994,803 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $194,574 | BOYAmt |
| EOY | $165,007 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,656,298 | BOYAmt |
| EOY | $12,854,442 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,605,582 | BOYAmt |
| EOY | $32,137,344 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,725,085 | BOYAmt |
| EOY | $4,658,203 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,632,641 | BOYAmt |
| EOY | $14,637,875 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,357,726 | BOYAmt |
| EOY | $19,296,078 | 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 | $6,409,428 | BOYAmt |
| EOY | $10,804,694 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,838,428 | BOYAmt |
| EOY | $2,036,572 | EOYAmt |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,247,856 | BOYAmt |
| EOY | $12,841,266 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,605,582 | BOYAmt |
| EOY | $32,137,344 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $4,879,435 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $8,515 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$294,540 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $13,398 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $13,398 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION'S LOBBYING ACTIVITIES INCLUDE PAYING MEMBERSHIP DUES TO THE ILLINOIS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION, WHO PARTICIPATE IN LOBBYING ACTIVITIES ON BEHALF OF HEALTHCARE ORGANIZATIONS. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $854,817 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $225,552 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $45,495 | GrantsOrScholarshipsAmt |
| End Year Balance | $1,034,874 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $805,217 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $49,600 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $854,817 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $801,256 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $3,961 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $805,217 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $731,914 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $69,342 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $801,256 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $644,870 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $87,044 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $731,914 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.0 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.5996 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.4004 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (true) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (true) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,927,000 | OtherCostOrOtherBasisAmt |
| Book Value | $1,927,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,249,923 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,531,701 | DepreciationAmt |
| Book Value | $8,718,222 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,056,749 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,477,498 | DepreciationAmt |
| Book Value | $579,251 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,904,880 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,147,095 | DepreciationAmt |
| Book Value | $2,757,785 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,545 | OtherCostOrOtherBasisAmt |
| Depreciation | $0 | DepreciationAmt |
| Book Value | $12,545 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $13,994,803 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| GOODWILL | $10,817,871 |
| RESTRICTED FOUNDATION ASSETS | $2,036,571 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $12,854,442 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)
| DescDesc | AmtAmt |
|---|---|
| ASSET RETIREMENT OBLIGATION | $24,538 |
| ADVANCES DUE CORP-TERM | $9,709,840 |
| OTHER NOTES - LOANS PAYABLE | |
| MEDICARE ADVANCE PAYMENTS | $4,703,497 |
| DEFERRED INCOME - BLUE CROSS | |
| DEFERRED INCOME - OTHER | |
| Federal Pandemic Funds | $200,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $14,637,875 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule D, Part V, Line 4 Intended uses of endowment funds | THE ENDOWMENT IS HELD BY OSF HEALTHCARE FOUNDATION, A RELATED 501(c)(3) ENTITY. PROCEEDS OF THE ENDOWMENT, AS DICTATED BY THE DONORS, ARE USED AS BEST DETERMINED BY THE FOUNDATION COUNCIL. |
| Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote | OSF is a not-for-profit corporation as described by Section 501(c)(3) of the Internal Revenue Code (the Code) and is exempt from federal income taxes on related income pursuant to Section 501(c)(3) of the Code. Under ASC Subtopic 740-10, Accounting for Uncertainty in Income Taxes - An Interpretation of FASB Statement No. 109, OSF and PCI must recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured based on the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement. As of September 30, 2021 or 2020, OSF and PCI do not have any uncertain tax positions. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 125 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $757,328 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $757,328 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0231 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,172,749 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,807,775 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,364,974 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0416 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $5,930,077 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,807,775 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,122,302 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0647 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $132,583 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $24,649 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $107,934 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0033 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $102,668 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $102,668 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0031 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $917,629 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $727,177 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $190,452 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0058 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,599 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,599 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0004 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $1,166,479 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $751,826 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $414,653 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0126 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $7,096,556 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,559,601 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,536,955 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0773 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $262,776 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $12,269,977 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,453,194 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $816,783 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MENDOTA COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 E 12TH STREET | AddressLine1Txt |
| City | MENDOTA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61342 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTPS://WWW.OSFHEALTHCARE.ORG/SAINT-PAUL/ | WebsiteAddressTxt |
| State License | IL0005819 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MENDOTA COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://www.osfhealthcare.org/about/community-health/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | false | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (true) | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 125.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.0 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://www.osfhealthcare.org/billing/financial-assistance/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.osfhealthcare.org/billing/financial-assistance/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.osfhealthcare.org/billing/financial-assistance/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 3E | The significant health needs were prioritized as significant health needs of the community and identified through the CHNA. See CHNA for further information. |
| Schedule H, Part V, Section B, Line 5 Facility , 1 | Facility , 1 - MENDOTA COMMUNITY HOSPITAL. FOR THE 2019 CHNA, MENDOTA COMMUNITY HOSPITAL d/b/a SAINT PAUL MEDICAL CENTER SOLICITED AND TOOK INTO ACCOUNT INPUT FROM THE FOLLOWING SOURCES: 1) CURRENT PUBLIC HEALTH ADMINISTRATOR AT THE LASALLE COUNTY HEALTH DEPT. and CURRENT HEALTH EDUCATOR AND PUBLIC INFORMATION FROM THE LASALLE COUNTY HEALTH DEPT. 2) PRIMARY DATA WAS COLLECTED FROM THE AT-RISK AND ECONOMICALLY DISADVANTAGED POPULATION BY COLLECTING A STRATIFIED SAMPLE OF SURVEYS DISTRIBUTED IN ENGLISH AND SPANISH AT ALL HOMELESS SHELTERS, FOOD PANTRIES AND SOUP KITCHENS. 3) THE 2013 & 2016 CHNA ARE MADE WIDELY AVAILABLE TO THE COMMUNITY AND FEEDBACK RECEIVED FROM COMMUNITY SERVICE ORGANIZATIONS WAS TAKEN INTO ACCOUNT. 4) ADDITIONAL SOURCES OF INPUT WAS RECEIVED FROM A COLLABORATIVE TEAM CREATED TO CONDUCT THE 2019 CHNA, WHICH INCLUDED CONSUMER ADVOCATES, REPRESENTATIVES FROM NONPROFIT AND COMMUNITY-BASED ORGANIZATIONS, ACADEMIC EXPERTS AND HEALTH EDUCATORS, LOCAL GOVERNMENT OFFICIALS, ADMINISTRATORS FROM LOCAL SCHOOL DISTRICTS, HEALTH CARE PROVIDERS AND COMMUNITY HEALTH CENTERS, EXECUTIVE DIRECTOR OF IL VALLEY PADS HOMELESS SHELTER PROGRAM, PROGRAM COORDINATOR FOR THE YOUTH SERVICE BUREAU OF IL VALLEY SERVING THE LATINO POPULATION ENROLLED IN PUBLIC BENEFITS, EXECUTIVE DIRECTOR OF UNITED WAY, AND EXECUTIVE DIRECTOR OF MENDOTA AREA SENIOR SERVICES. MEMBERS OF THE COLLABORATIVE TEAM BY NAME, AFFILIATIONS, TITLE AND EXPERTISE ARE LISTED IN APPENDIX 1 OF THE 2019 CHNA. |
| Schedule H, Part V, Section B, Line 6a Facility , 1 | Facility , 1 - MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER - MENDOTA, IL. THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR 2019 FOR LASALLE COUNTY WAS A COLLABORATIVE UNDERTAKING BY OTTAWA REGIONAL HOSPITAL AND HEALTHCARE CENTER DBA OSF SAINT ELIZABETH MEDICAL CENTER AND MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER. THE CHNA HIGHLIGHTS THE HEALTH NEEDS AND WELL-BEING OF RESIDENTS IN LASALLE COUNTY. |
| Schedule H, Part V, Section B, Line 11 Facility , 1 | Facility , 1 - MENDOTA COMMUNITY HOSPITAL. MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") DURING FISCAL YEAR 2019 AS REQUIRED BY INTERNAL REVENUE CODE SECTION 501(R)(3). THE FINAL CHNA FOR THE HOSPITAL WAS APPROVED AND ADOPTED BY THE SYSTEM'S BOARD OF DIRECTORS ON JULY 29, 2019. THIS CHNA IS EFFECTIVE FOR FISCAL YEARS 2020, 2021 AND 2022. THE LASALLE COUNTY CHNA WAS DONE AS A COLLABORATIVE UNDERTAKING BY OSF SAINT ELIZABETH AND OSF SAINT PAUL MEDICAL CENTERS TO HIGHLIGHT THE HEALTH NEEDS AND WELL BEING OF RESIDENTS IN LASALLE COUNTY. THE COLLABORATIVE TEAM IDENTIFIED THE FOLLOWING SIGNIFICANT COMMUNITY HEALTH NEEDS AS A PRIORITY: HEALTHY BEHAVIORS AND BEHAVIORAL HEALTH. IN RESPONSE TO THESE PRIORITY HEALTH NEEDS, THE HOSPITALS DEVELOPED AN IMPLEMENTATION STRATEGY DESCRIBING THE ACTIONS THE HOSPITALS INTEND TO TAKE TO ADDRESS BOTH PRIORITY HEALTH NEEDS, THE RESOURCES THE HOSPITALS PLAN TO COMMIT TO ADDRESS THE HEALTH NEEDS, AND ANY PLANNED COLLABORATIONS WITH OTHER ORGANIZATIONS TO ADDRESS THE HEALTH NEEDS. THE HOSPITALS REVIEW THEIR IMPLEMENTATION STRATEGY AT LEAST ANNUALLY AND MAKE REVISIONS AS NEEDED TO MAXIMIZE THE IMPACT ON IDENTIFIED PRIORITY HEALTH NEEDS. A SUMMARY OF HOW THE HOSPITALS HAVE ADDRESSED THE PRIORITY HEALTH NEEDS IS PROVIDED BELOW. HEALTHY BEHAVIORS DEFINED AS - ACTIVE LIVING, HEALTHY EATING AND OBESITY GOALS ACTIVE LIVING - A HEALTHY LIFESTYLE, COMPRISED OF REGULAR PHYSICAL ACTIVITY, HAS BEEN SHOWN TO INCREASE PHYSICAL, MENTAL, AND EMOTIONAL WELL-BEING. GOAL 1: INCREASE ACTIVE LIVING IN LASALLE COUNTY OVER THE NEXT THREE YEARS AS EVIDENCED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY. OUTCOME METRIC: INCREASE ACTIVE LIVING IN LASALLE COUNTY BY INCREASING THE NUMBER OF RESPONDENTS EXERCISING (HEALTHY ACTIVITY) 1 - 5 TIMES PER WEEK FROM 60% TO 62% AND DECREASING THOSE REPORTING THEY DO NOT EXERCISE AT ALL FROM 28% TO 25%. TACTICS AND PROGRESS FOR FY 2021 (1) Promote the use of Bike Routes/Walking Paths in Mendota, Ottawa and Streator The Live Well Streator Activity Maps posted on our website. It has been promoted on the Live Well Streator Facebook page and was handed out at our 3/11/20 Move Your Way kickoff event at the Streator Business Incubator. University of Illinois finished the walking guide for Ottawa, Streator, and Mendota. (2) INCREASE OFFERING OF THE HEALTHY KIDS U PROGRAM: PROGRESS FY 2021 North lawn Jun. High School, Streator, IL = 145 kits; St. Michael Archangel School - Streator, IL = 18 kits; Woodland Comm. Sch. District - Streator, IL = 32 kits; Ransom Grade School, Ransom, IL = 9 kits; Grand Ridge Grade School, Grand Ridge, IL = 25 kits; Northbrook Middle School, Mendota IL = 110 kits; Holy Cross, Mendota IL = 17 kits; Wallace Grade School, Ottawa = 38; Waltham Grade School, Utica IL= 33; Dimmick Grade School, Peru IL = 25; Northbrook Middle School, Mendota IL = 24 Scavenger Hunts completed, 1 Fitbit donated by CHOI; Wallace Grade School, Ottawa = 12 Scavenger Hunts completed, 1 Fitbit donated by CHOI; Waltham Grade School, Utica IL= 12 Scavenger Hunts completed, 1 Fitbit donated by CHOI. (3) IMPLEMENT JOURNEY TO HEALTH - REDESIGNED PROGRAM. PROGRESS FY 2021 - Reset Program - locally 350 people participate LaSalle County. 90% complete all 6 weeks. July 12 - Summer Out Loud - 3 week summer family program. Fall Session - 9 participants HEALTHY EATING - A HEALTHY LIFESTYLE, COMPRISED OF A PROPER DIET, HAS BEEN SHOWN TO INCREASE PHYSICAL, MENTAL, AND EMOTIONAL WELL-BEING. OBESITY - A HEALTH OUTCOME, WHICH IS DIRECTLY RELATED TO HEALTHY BEHAVIORS. GOAL 2: INCREASE COMMUNITY CONSUMPTION OF FRUITS/VEGETABLES TO MORE THAN 2 SERVINGS PER DAY. OUTCOME METRIC 2: INCREASE THE RATE FROM 44% TO 48% OF THE COMMUNITY THAT REPORTED THAT THEY CONSUME MORE THAN 2 SERVINGS OF FRUITS/VEGETABLES PER DAY ON THE 2022 CHNA SURVEY. BASELINE: PER THE 2019 CHNA, 44% OF THE COMMUNITY REPORTED THAT THEY CONSUME MORE THAN 2 SERVICES OF FRUITS/VEGETABLES PER DAY. TACTICS AND PROGRESS FOR FY 2021 (1) PROMOTE AWARENESS OF COMMUNITY GARDENS AT OSF HEALTHCARE, OTTAWA COMMUNITY GARDENS, SHS EDIBLE GARDEN, NORTHLAWN JR. HIGH SCHOOL GARDEN AND THE DISTRIBUTION LOCATIONS TO ADDRESS LOCAL FOOD DISPARITIES AND ACCESS TO HEALTHY FOODS. PROGRESS FY2021 - * Ottawa partnered with U of I extension. Working with master gardener. Purchasing and planting in the month of May. Ottawa - 12 beds and herbs planted. Mendota - 26 beds. Streator - 3 garden bed areas, south lot garden divided into 4 sections, transportation center 12 raised beds. The Ottawa Community Garden harvested 347 pounds and donated the produce to a Servant's Heart. Streator donated 563.5 pounds to the Streator land Food Pantry, Grace Community Church Food Pantry and New Beginnings Baptist Church Food Pantry. The Mendota garden donated 946.69 pounds to the SPMC Cafe, Mission Partners, and the Mendota Area Christian Food Pantry. Total of 1857.19 pounds of produce this season (2) INCREASE OFFERINGS OF THE HEALTHY KIDS U PROGRAM. HOST A HEALTHY KIDS U SESSION QUARTERLY PROGRESS FY2021 - See tactic above. ((3) Develop and Promote Live Well Streator Health Eating Restaurant Menu Guide PROGRESS FY2021: The Live Well Streator Restaurant Guide has been developed. 6 pilot restaurants. 2021 - 1. Do to COVID, supplier and staffing short. (4) Conduct the Illinois Jr. Chef's Cooking School in three communities PROGRESS FY2021: Due to the COVID-19 pandemic, the University of Illinois Extension Junior Chef program was cancelled in Streator. (5) Promote healthier school lunchroom environments PROGRESS FY2021: Due to the COVID-19 pandemic, our fruit and veggie taste testing is at Kimes & Centennial Schools in Streator were cancelled. Spoke with Well Streator to a group of teachers and school foodservice employees on the University of Illinois Extensions' Serve It Safely virtual training call. (6) King Care-A-Van client nutrition education and food demonstrations within OSF Service area through mobile King Care-A-Van service PROGRESS FY2021: Nutrition education 4/20, Marshall Putnam Fair Healthy Eating Education- 7/15 BEHAVIORAL HEALTH MENTAL HEALTH - THE CHNA SURVEY ASKED RESPONDENTS TO INDICATE PREVALENCE OF SPECIFIC MENTAL-HEALTH ISSUES, NAMELY DEPARESSION AND STRESS/ANXIETY. OF RESPONDENTS, 41% INDICATED THEY FELT DEPRESSED IN THE LAST 30 DAYS AND 39% INDICATED THEY FELT ANXIOUS OR STRESSED. GOAL1: INCREASE THE OVERALL COMMUNITY UNDERSTANDING OF MENTAL HEALTH NEEDS AND ACCESS TO MENTAL HEALTH SERVICES. OUTCOME METRIC 1: DECREASE SELF-REPORTS OF DEPRESSION AND ANXIETY TO SEE A REDUCTION OF INDIVIDUALS REPORTING DEPRESSION AND ANXIETY WITHIN THE LAST 30 DAYS FROM 35% TO 32% BY 2022. (PER CHNA SURVEY, 2019) TACTICS FOR PROGRESS IN 2021 (1) CONDUCT MENTAL HEALTH FIRST AID TRAINING, GROUPS/PROGRAMS FOR BEHAVIORAL/MENTAL HEALTH FOR SPECIFIC AGES FROM YOUTH, 18-35 AND SENIOR. PROGRESS FY2021 - North Central trained staff from IVCIL - 8 participants - 8hr - 2 dates June 8th and 10th (2) EMBED BILINGUAL BEHAVIORAL HEALTH PROVIDER AT OSF MULTI-SPECIALTY GROUP MENDOTA, BILINGUAL PROGRAMMING'S AND COMMUNICATIONS. PROGRESS FY2021: Another bilingual providers starting next September, 2022 - full time NP. Using Globo which has been a big improvement with translation that in demand; Current bilingual Providers Dr. Lopez/Joy (3) ENGAGE FAITH COMMUNITY NURSE TO WORK WITH SCHOOL NURSES REGARDING STUDENTS NOT HAVING MEDICATIONS NEEDED PROGRESS FY2021 - DELAYED DUE TO STAFF TURNOVER. (4) PROVIDE FREE ACCESS TO DIGITAL BEHAVIORAL HEALTH SOLUTION - SILVERCLOUD PROGRESS FY2021 - 116 UTILIZING APP. (5) PROVIDE FREE BEHAVIORAL HEALTH NAVIGATION SERVICE PROGRESS FY2021 - 63 USING SERVICE. GOAL 2: USE SOCIAL DETERMINATES OF HEALTH (SDOH) TO IDENTIFY PATIENTS AT INCREASED RISK OF POOR MENTAL HEALTH AND CONNECT THEM TO COMMUNITY ORGANIZATIONS IN ORDER TO IMPROVE MENTAL HEALTH OUTCOMES. OUTCOME MEASURE 2: DECREASE THE PERCENTAGE OF RESPONDENTS STATING THEY HAVE POOR OVERALL MENTAL HEALTH BY 1%. BASELINE: PER THE 2019 CHNA SURVEY, 8% OF RESPONDENTS STATED THEY HAVE POOR OVERALL MENTAL HEALTH. NOT HAVING BASIC HUMAN NEEDS IS LIKELY LINKED TO POOR MENTAL HEALTH. IF A SURVEY RESPONDENT DOES NOT HAVE HOUSING, FOOD, TRANSPORTATION (ETC.), THEIR OVERALL STATE OF MENTAL HEALTH WOULD LIKELY BE RATED LOWER. TACTICS FOR PROGRESS IN 2021 (1) IMPLEMENT SCREENING OF PATIENTS FOR SDOH. SCREEN AND CONNECT. NUMBER OF PATIENTS SCREENED. PROGRESS FY2021 - 4,400 (2) TRACK NUMBER OF PATIENTS REFERRED TO COMMUNITY BASED ORGANIZATIONS (CBO) PROGRESS FY2021 - 1,006 (3) TRACK NUMBER OF MISSION PARTNERS EDUCATED FOR CONTINUED ROLL-OUT - PROGRESS FY2021 - 23 (4) TRACK NUMBER OF PATIENT REFERRALS TO OSF CARE MANAGEMENT AND SOCIAL WORKERS PROGRESS FY2021 - 40 |
| Schedule H, Part V, Section B, Line 13 Facility , 1 | Facility , 1 - MENDOTA COMMUNITY HOSPITAL. CATASTROPHIC FINANCIAL ASSISTANCE IS AVAILABLE WHEN CHARGES EXCEED 25% OF ANNUAL FAMILY INCOME. THE AMOUNT BILLED IS ADJUSTED TO 25% OF FAMILY INCOME WHEN OSF DETERMINES THIS ADJUSTMENT IS THE MOST GENERAL ASSISTANCE. |
| Schedule H, Part V, Section B, Line 13 Facility , 1 | Facility , 1 - MENDOTA COMMUNITY HOSPITAL. PRESUMPTIVE FINANCIAL ASSISTANCE IS AVAILABLE AND PROVIDES FOR A DISCOUNT OF 100% OF BILLED CHARGES FOR MEDICALLY NECESSARY SERVICES PROVIDED TO A PATIENT WITH NO INSURANCE BENEFITS, WHEN THE PATIENT ESTABLISHES FINANCIAL NEED AT TIME OF REGISTRATION BY SATISFYING ONE OF THE FOLLOWING CATEGORIES OF PRESUMPTIVE ELIGIBILITY CRITERIA: HOMELESSNESS; DECEASED WITH NO ESTATE; MENTAL INCAPACITATION WITH NO ONE TO ACT ON THE PATIENT'S BEHALF; AND CURRENT MEDICAID ELIGIBILITY, BUT NOT ON DATE OF SERVICE OR FOR NON-COVERED SERVICE. IN ADDITION, ENROLLMENT IN ANY ONE OF THE FOLLOWING PROGRAMS WITH CRITERIA AT OR BELOW 200% OF THE FEDERAL POVERTY INCOME GUIDELINES ESTABLISHES ELIGIBILITY FOR PRESUMPTIVE CHARITY: WIC; SNAP; LIHEAP, IL FREE LUNCH AND BREAKFAST PROGRAM; RECEIPT OF GRANT ASSISTANCE FOR MEDICAL SERVICES; OR ENROLLMENT IN AN ORGANIZED COMMUNITY BASED PROGRAM PROVIDING ACCESS TO MEDICAL CARE THAT ASSESSES AND DOCUMENTS LIMITED LOW INCOME FINANCIAL STATUS AS CRITERION FOR MEMBERSHIP. |
| Schedule H, Part V, Section B, Line 15 Facility , 1 | Facility , 1 - MENDOTA COMMUNITY HOSPITAL. THE FINANCIAL ASSISTANCE POLICY DIRECTS PATIENTS TO STAFF IN THE PATIENT FINANCIAL SERVICES AND ADMITTING AREAS AT OSF HOSPITALS FOR ASSISTANCE IN OBTAINING ANSWERS TO QUESTIONS REGARDING THE POLICY. |
| Schedule H, Part V, Section B, Line 16 Facility , 1 | Facility , 1 - MENDOTA COMMUNITY HOSPITAL. A PLAIN LANGUAGE SUMMARY OF THE FAP IS OFFERED TO PATIENTS AS PART OF THE INTAKE OR DISCHARGE PROCESS, INFORMATION ABOUT FINANCIAL ASSISTANCE AND THE APPLICATION PROCESS IS INCLUDED ON OR WITH THE OSF PATIENT BILLING STATEMENT, AND OSF PROVIDES COPIES OF THE PLAIN LANGUAGE SUMMARY AND THE FAP APPLICATION FORM TO REFERRING STAFF PHYSICIANS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 0 | FacilityNum |
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part I, Line 3c Criteria for Free or Discounted Care | CATASTROPHIC CHARITY ASSISTANCE REGARDLESS OF INCOME OR ASSET LEVELS FOR MEDICALLY NECESSARY SERVICES WHICH EXCEED 25% OF ANNUAL FAMILY INCOME. THE AMOUNT DUE IS ADJUSTED TO 25% OF FAMILY INCOME WHEN OSF DETERMINES CATASTROPHIC CHARITY IS MORE GENEROUS. PRESUMPTIVE CHARITY: CHARGES MAY BE ADJUSTED TO PROVIDE FOR A CHARITY DISCOUNT OF 100% OF BILLED CHARGES FOR MEDICALLY NECESSARY SERVICES PROVIDED TO AN UNINSURED PATIENT WHO ESTABLISHES FINANCIAL NEED AT TIME OF REGISTRATION BY SATISFYING ONE OF THE FOLLOWING CATEGORIES OF PRESUMPTIVE ELIGIBILITY CRITERIA. PRESUMPTIVE CHARITY CATEGORIES FOR ALL OSF HOSPITALS: -HOMELESSNESS; - DECEASED WITH NO ESTATE; - MENTAL INCAPACITATION WITH NO ONE TO ACT ON PATIENT'S BEHALF; OR - CURRENT MEDICAID ELIGIBILITY, BUT NOT ON DATE OF SERVICE OR FOR NON-COVERED SERVICE. ALL PATIENTS RECEIVE THE GREATEST REQUESTED DISCOUNT AVAILABLE UNDER ANY OF THE OSF PROGRAMS. NO ASSET TESTS ARE USED. EXCEPT AS OTHERWISE NOTED, THESE POLICIES APPLY BOTH TO UNINSURED PATIENTS AND TO INSURED PATIENTS WITH RESPECT TO THE PATIENT RESPONSIBILITY AMOUNT. |
| Schedule H, Part I Coronavirus Pandemic | On March 11, 2020, the World Health Organization designated COVID-19 as a global pandemic. Patient activity and related revenues for most services were significantly impacted starting in mid-March 2020, as various policies were implemented by federal, state, and local governments in response to the COVID-19 pandemic. OSF's pandemic response plan has multiple facets and continues to evolve as the pandemic continues. Precautionary steps to enhance operational and financial flexibility, and react to the risks the COVID-19 pandemic presents to the business, included the following: * Implemented certain cost reduction initiatives; * Continued to monitor economic pressures such as supply availability and costs, as well as labor demand and costs; * Assessed the various federal stimulus options available to OSF as noted in the audited financial statements. |
| Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance | Medicare Cost to Charge Ratio |
| Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount | IN GENERAL, AND IN ACCORDANCE WITH MEDICARE REGULATIONS, PATIENT ACCOUNT BALANCES ARE WRITTEN OFF TO BAD DEBT EXPENSE AFTER REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED AND THE ACCOUNT HAS BEEN SENT TO A COLLECTION AGENCY OR LAW FIRM. PATIENTS' ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENTS' ACCOUNTS RECEIVABLE, OSF ANALYZES PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, OSF ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH PATIENT RESPONSIBILITY (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE PATIENTS ARE SCREENED AGAINST THE OSF FINANCIAL ASSISTANCE POLICY AND UNINSURED DISCOUNT POLICY. FOR ANY REMAINING PATIENT RESPONSIBILITY BALANCE, OSF RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. BAD DEBT EXPENSE OF 749,741 ON FORM 990, PART IX, LINE 24B IS BASED UPON ACCRUAL ACCOUNTING REQUIRED BY GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. THIS AMOUNT CONSEQUENTLY DIFFERS FROM THE BAD DEBT EXPENSE OF 262,776 ON SCHEDULE H, PART III, LINE 2 WHICH REQUIRES THE ORGANIZATION TO REPORT AGGREGATE BAD DEBT AT COST. BAD DEBT EXPENSE REPORTED ON PART III, LINE 2 IS THEREFORE CALCULATED BY MULTIPLYING GROSS CHARGES WRITTEN OFF TO BAD DEBT EXPENSE TIMES THE MEDICARE COST-TO-CHARGE RATIO DERIVED FROM THE MEDICARE COST REPORT. |
| Schedule H, Part III, Line 3 Bad Debt Expense Methodology | DISCOUNTS, INCLUDING ANY APPLICABLE THIRD PARTY PAYER CONTRACTUAL ALLOWANCES AND ANY CHARITY CARE DISCOUNTS (VALUED AT GROSS CHARGES), ARE APPLIED TO PATIENT ACCOUNT GROSS CHARGES TO DETERMINE THE ACCOUNT BALANCE BEFORE PATIENT PAYMENTS. THE AGGREGATE AMOUNT OF ALL PATIENT PAYMENTS IS THEN APPLIED TO THE ACCOUNT BALANCE. WHEN DETERMINATION IS MADE THAT NO FURTHER AMOUNTS CAN BE COLLECTED IN ACCORDANCE WITH THE CORPORATION'S BAD DEBT POLICY, THE REMAINING BALANCE IS WRITTEN OFF TO BAD DEBT EXPENSE. PRESUMPTIVE CHARITY: CHARGES MAY BE ADJUSTED TO PROVIDE FOR A CHARITY DISCOUNT OF 100% OF BILLED CHARGES FOR MEDICALLY NECESSARY SERVICES PROVIDED TO AN UNINSURED PATIENT WHO ESTABLISHES FINANCIAL NEED AT TIME OF REGISTRATION BY SATISFYING ONE OF THE FOLLOWING CATEGORIES OF PRESUMPTIVE ELIGIBILITY CRITERIA. PRESUMPTIVE CHARITY CATEGORIES FOR ALL OSF HOSPITALS: -HOMELESSNESS; -DECEASED WITH NO ESTATE; -MENTAL INCAPACITATION WITH NO ONE TO ACT ON PATIENT'S BEHALF; OR -CURRENT MEDICAID ELIGIBILITY, BUT NOT ON DATE OF SERVICE OR FOR NON-COVERED SERVICE. THEREFORE, THE CORPORATION DOES NOT BELIEVE THAT BAD DEBT EXPENSE REPORTED ON PART III, LINE 2 INCLUDES ANY AMOUNTS THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY QUALIFY UNDER THE CORPORATION'S FINANCIAL ASSISTANCE POLICY. |
| Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote | PLEASE SEE PAGE 25 OF NOTES TO CONSOLIDATED FINANCIAL STATEMENTS |
| Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs | OSF IS COMMITTED TO SERVING PATIENTS, REGARDLESS OF ABILITY TO PAY OR IF THE PAYMENTS TO BE RECEIVED WILL BE LESS THAN THE COST TO PROVIDE THE SERVICE, WHICH IS THE CASE FOR MEDICARE AND MEDICAID PATIENTS. THE MEDICARE ALLOWABLE COSTS ON LINE 6 PART III HAVE BEEN CALCULATED BY USING THE MEDICARE COST TO CHARGE RATIO. THE AMOUNT IS COMPARED TO TOTAL MEDICARE PAYMENTS RECEIVED INCLUDING DSH AND IME PAYMENTS. SHOULD THERE BE A SHORTFALL, IT WOULD BE TREATED AS A COMMUNITY BENEFIT SINCE IT REFLECTS UN-REIMBURSED COSTS FOR PROVIDING MEDICAL SERVICES TO THE MEDICARE RESIDENTS OF THE COMMUNITY. |
| Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance | THE CORPORATION HAS A FAIR BILLING/COLLECTION POLICY WHICH APPLIES FOR ALL PATIENTS. THE POLICY INCLUDES: -REQUIRED INFORMATION PROVIDED IN BILLS TO PATIENTS (INCLUDING A REQUIREMENT THAT INFORMATION BE PROVIDED ON HOW THE PATIENT MAY APPLY FOR FINANCIAL ASSISTANCE). -PROCESS FOR PATIENTS TO INQUIRE ABOUT OR DISPUTE A BILL, INCLUDING TOLL-FREE TELEPHONE NUMBER, ADDRESS, CONTACT NAME AND E-MAIL ADDRESS. -REQUIREMENTS FOR TIMELY RESPONSE TO PATIENT INQUIRIES. -CONDITIONS WHICH MUST BE SATISFIED BEFORE PATIENT MAY BE SENT TO A COLLECTION AGENCY OR ATTORNEY. -LEGAL ACTION FOR NON-PAYMENT OF A PATIENT BILL MAY NOT BE INITIATED UNTIL AN AUTHORIZED HOSPITAL OFFICIAL HAS DETERMINED THAT ALL CONDITIONS IN THE CORPORATION'S POLICY (INCLUDING ALL THE FOREGOING POLICY PROVISIONS) HAVE BEEN SATISFIED FOR INITIATING LEGAL ACTION. -LEGAL ACTION MAY NOT BE PURSUED AGAINST UNINSURED PATIENTS WHO HAVE CLEARLY DEMONSTRATED THAT THEY HAVE NEITHER SUFFICIENT INCOME NOR ASSETS TO MEET THEIR FINANCIAL OBLIGATIONS - EVEN IF SUCH PATIENTS DO NOT APPLY FOR FINANCIAL ASSISTANCE. -THE CORPORATION SHALL NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS, SUCH AS SUBMITTING REPORTS TO CREDIT AGENCIES BEFORE REASONABLE ATTEMPTS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE HAVE BEEN COMPLETED. -IF A PATIENT RECEIVES AN APPLICATION FOR FINANCIAL ASSISTANCE BUT FAILS TO RETURN IT, OSF WILL TRY TO USE SECONDARY SOURCES TO DETERMINE THE PATIENT'S ELIGIBILITY FOR NON COMPLIANT CHARITY BEFORE PURSUING LEGAL ACTION FOR NONPAYMENT. IF A COMPLETE APPLICATION IS RECEIVED DURING THE APPLICATION PERIOD, OSF WILL SUSPEND EXTRAORDINARY COLLECTION ACTIONS AND MAKE A DETERMINATION OF ELIGIBILITY FOR ASSISTANCE. IF THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, OSF WILL ISSUE APPROPRIATE REFUNDS AND REVERSE ANY EXTRAORDINARY COLLECTION ACTIONS TAKEN, AS MORE FULLY DESCRIBED IN THE OSF FAIR BILLING - COLLECTION POLICY. |
| Schedule H, Part V, Section B, Line 16a FAP website | - MENDOTA COMMUNITY HOSPITAL: Line 16a URL: https://www.osfhealthcare.org/billing/financial-assistance/; |
| Schedule H, Part V, Section B, Line 16b FAP Application website | - MENDOTA COMMUNITY HOSPITAL: Line 16b URL: https://www.osfhealthcare.org/billing/financial-assistance/; |
| Schedule H, Part V, Section B, Line 16c FAP plain language summary website | - MENDOTA COMMUNITY HOSPITAL: Line 16c URL: https://www.osfhealthcare.org/billing/financial-assistance/; |
| Schedule H, Part VI, Line 2 Needs assessment | MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") DURING FISCAL YEAR 2019 AS PREVIOUSLY STATED. THE CHNA IS UPDATED EVERY 3 YEARS AND CORRESPONDING IMPLEMENTATION STRATEGY IS REFRESHED YEARLY. NOT ONLY DOES THE PLAN GET REFRESHED YEARLY, BUT EACH ACTION ITEM HAS A RESPONSIBLE PARTY INVOLVED TO GET THE WORK ASSOCIATED WITH THE NEED ACCOMPLISHED. THE NEW CHNA WAS APPROVED AND ADOPTED BY THE OSF BOARD OF DIRECTORS ON JULY 29, 2019 AND THE CORRESPONDING IMPLEMENTATION STRATEGY WAS APPROVED JANUARY 27, 2020. THE ASSOCIATED PLAN GOALS AND ACCOMPLISHMENTS ARE LISTED IN THIS YEARS FILING. LEADERSHIP WITHIN OSF SIT ON VARIOUS COMMUNITY ADVISORY BOARDS TO STAY CONNECTED TO THE OTHER AGENCIES WITHIN THE COMMUNITY. THIS WORK ALIGNS WITH OUR MISSION STATEMENT TO SERVE PERSONS WITH THE GREATEST CARE AND LOVE IN A COMMUNITY THAT CELEBRATES THE GIFT OF LIFE. |
| Schedule H, Part VI, Line 3 Patient education of eligibility for assistance | THE CORPORATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO ARE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER GOVERNMENT PROGRAMS AND THE CORPORATION'S FINANCIAL ASSISTANCE POLICY, IN ENGLISH AND IN ANY OTHER LANGUAGE SPOKEN BY POPULATIONS WITH LIMITED ENGLISH PROFICIENCY THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE COMMUNITY OF THE HOSPITAL, IN THE FOLLOWING WAYS: -SIGNS ARE POSTED IN PATIENT REGISTRATION AREAS (INCLUDING EMERGENCY DEPARTMENT REGISTRATION) INFORMING PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE, THE AVAILABILITY OF FINANCIAL ASSISTANCE COUNSELORS, AND HOW TO OBTAIN A COPY OF THE OSF FINANCIAL ASSISTANCE POLICY AND APPLICATION. -A PLAIN LANGUAGE SUMMARY OF THE OSF FINANCIAL ASSISTANCE POLICY IS OFFERED TO PATIENTS AS PART OF THE INTAKE OR DISCHARGE PROCESS AND INCLUDED IN THE BILLING STATEMENT MAILED PRIOR TO INITIATING EXTRAORDINARY COLLECTION ACTIONS. IN ADDITION, THE PLAIN LANGUAGE SUMMARY AND APPLICATION ARE PROVIDED TO REFERRING STAFF PHYSICIANS. -OSF MAKES REASONABLE EFFORTS TO ORALLY NOTIFY PATIENTS ABOUT THE FINANCIAL ASSISTANCE POLICY AND HOW TO OBTAIN ASSISTANCE IN APPLYING. -A NOTICE OF AVAILABILITY OF THE CORPORATION'S FINANCIAL ASSISTANCE AND UNINSURED PATIENT DISCOUNT POLICIES IS PROMINENTLY AVAILABLE ON THE CORPORATION'S WEBSITE. THE APPLICATION FORM WITH INSTRUCTIONS AND THE PLAIN LANGUAGE SUMMARY IS AVAILABLE FOR DOWNLOAD. -A NOTE REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE (TOGETHER WITH CONTACT PHONE NUMBERS) APPEARS ON EVERY PATIENT BILLING STATEMENT AS WELL AS THE WEBSITE WHERE COPIES OF THE POLICY, APPLICATION AND PLAIN LANGUAGE SUMMARY MAY BE OBTAINED. -FINANCIAL ASSISTANCE COUNSELORS ARE AVAILABLE IN PERSON AND BY PHONE TO ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION AND IN DETERMINING ELIGIBILITY AND APPLYING FOR GOVERNMENT PROGRAM BENEFITS, INCLUDING MEDICAID. -THE CORPORATION'S FINANCIAL ASSISTANCE POLICY IS FILED WITH THE ILLINOIS ATTORNEY GENERAL AND IS AVAILABLE TO THE PUBLIC. |
| Schedule H, Part VI, Line 4 Community information | MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER IS LOCATED IN LASALLE COUNTY. THE OSF SAINT PAUL MEDICAL CENTER SERVICE COMMUNITY IS LOCATED PRIMARILY IN LASALLE COUNTY BUT EXTENDS INTO PORTIONS OF LEE, BUREAU, AND DEKALB COUNTIES. THE RACE AND ETHNICITY MAKEUP OF THE SERVICE AREA INDICATES THAT MORE THAN 12.6% OF THE POPULATION IS OF HISPANIC ORIGIN. OTHER RACE AND ETHNICITY NUMBERS ARE TYPICAL OF RURAL ILLINOIS. THERE ARE NO LARGE CHANGES IN THE PROFILE OVER THE PAST FIVE YEARS. THE POVERTY RATE FOR LASALLE COUNTY WAS 13.6 PERCENT IN 2017. THE POPULATION USED FOR THE CALCULATION WAS 110,067 YIELDING 14,969 RESIDENTS LIVING IN POVERTY IN THE LASALLE COUNTY AREA. DATA FROM THE LAST CENSUS INDICATE THE POPULATION OF LASALLE COUNTY HAS SLIGHTLY DECREASED (2.1%) BETWEEN 2013 AND 2017. THE POPULATION IN LASALLE COUNTY HAS DECREASED FROM 112,424 IN 2013 TO 110,067 IN 2017. |
| Schedule H, Part VI, Line 5 Promotion of community health | MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER SPONSORING ORGANIZATION IS A RELIGIOUS CONGREGATION OF THE ROMAN CATHOLIC CHURCH KNOWN AS THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS. IN ACCORDANCE WITH CANON LAW OF THE ROMAN CATHOLIC CHURCH AND FEDERAL TAX LAW APPLICABLE TO SUPPORTING ORGANIZATIONS, A MAJORITY OF THE MEMBERS OF THE BOARD OF DIRECTORS OF THE CORPORATION ARE PROFESSED MEMBERS OF THE SPONSORING RELIGIOUS CONGREGATION. THEY HAVE A COMMUNITY ADVISORY BOARD CONSISTING OF MEMBERS OF THE COMMUNITY WHO ARE NOT DIRECTORS, OFFICERS, OR CONTRACTORS OF MENDOTA. EXCEPT FOR HOSPITAL DEPARTMENTS WHICH HAVE BEEN CLOSED, OR IN WHICH CLINICAL PRIVILEGES HAVE BEEN RESTRICTED, FOR CLINICAL OR QUALITY OF CARE REASONS BY ACTIONS OF THE HOSPITAL'S MEDICAL STAFF AND THE BOARD OF DIRECTORS, MENDOTA EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITIES. THE MENDOTA SURPLUS FUNDS WERE USED DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2019 FOR IMPROVEMENTS IN PATIENT CARE, MEDICAL EDUCATION, AND RESEARCH. MENDOTA HOSPITAL MEETS THE REQUIREMENTS OF REVENUE RULING 69-545 BY: -OPERATING AN EMERGENCY DEPARTMENT WHICH IS STAFFED 24 HOURS PER DAY BY QUALIFIED PHYSICIANS AND OTHER MEDICAL PERSONNEL AND WHICH IS OPEN TO ALL PERSONS WITHOUT REGARD TO ABILITY TO PAY. -HAVING MEDICAL STAFFS WHICH ARE OPEN TO ALL QUALIFIED PHYSICIANS, MID-LEVEL PROVIDERS, PODIATRISTS, AND DENTISTS IN THE COMMUNITY (EXCEPT WHERE RESTRICTED IN RARE CASES FOR CLINICAL QUALITY REASONS BY ACTION OF THE MEDICAL STAFF AND THE BOARD OF DIRECTORS). -ACCEPTING MEDICARE, MEDICAID AND OTHER GOVERNMENT PROGRAM PATIENTS. -ACCEPTING ALL PATIENTS, INCLUDING UNINSURED PATIENTS, WITHOUT REGARD TO THEIR ABILITY TO PAY. -USING SURPLUS FUNDS TO IMPROVE THEIR FACILITIES, EQUIPMENT, PATIENT CARE, MEDICAL TRAINING, EDUCATION, AND RESEARCH AS DESCRIBED ABOVE. MENDOTA HOSPITAL PARTNERS WITH OTHER LOCAL SERVICE AGENCIES TO ENSURE ACCESS FOR RURAL HEALTHCARE INCLUDING OFFERING SPACE TO OTHER AGENCIES TO CO-LOCATE UNDER ONE ROOF. OSF ON CALL OFFERS A 24/7 ONLINE ACCESS TO MEDICAL CARE VIA SMARTPHONE, TABLET OR COMPUTER. THE HOSPITAL FORMED A TRANSIT PARTNERSHIP UNDER THE CITY OF OTTAWA AND NORTH CENTRAL AREA TRANSIT (NCAT) AND DONATED ANOTHER VAN TO THE NCAT FLEET TO EXPAND TRANSPORTATION OPTIONS FOR MEDICAL PATIENTS. |
| Schedule H, Part VI, Line 6 Affiliated health care system | The Corporation is part of an affiliated health care system (the "OSF System"), which is an integrated health system that operates acute care hospitals, home health care services, two colleges of nursing, a medical training simulation center, emergency medical transportation, and other health care facilities in Illinois and Michigan. The OSF System includes many other entities which are controlled, directly or indirectly by the Sisters of the Third Order of St. Francis (the "Congregation"). All affiliated entities apply and follow the charity care policies of the Corporation and are operated in furtherance of the mission to provide comprehensive, integrated quality care to the communities served by the Corporation. The OSF System's corporate office in Peoria, Illinois (the "Corporate Office"), provides corporate management services as well as direction, consultation and assistance to the administration of the OSF System's health care facilities and subsidiary corporations. The primary affiliated corporations of the OSF System are the following: The Congregation, which works exclusively in the health care apostolate, holds the assets of the religious congregation and directs all other corporations in the affiliated health care system through board representation and the exercise of reserved powers. OSF Multi-Specialty Group was incorporated in 2011. Virtually all physicians and advance practice providers providing professional services through the OSF System's acute care hospital facilities and ambulatory practice settings (with a few limited exceptions) provide services pursuant to employment agreements or professional service agreements with the Multi-Specialty Group. OSF Medical Group is a d/b/a of Multi-Specialty Group. Pointcore, Inc., formerly known as OSF Saint Francis, Inc., was originally incorporated in 1986 and is engaged in the following lines of business: retail pharmacies, retail shops, a mobile medical system, durable medical equipment, home therapeutics, real estate, equipment technology services, telecommunications, electronic health records, telehealth services, and consulting services. Pointcore, Inc. also participates in various health related joint ventures. OSF Healthcare Foundation was incorporated in 1989 to conduct fundraising and other activities for the benefit of OSF Healthcare System and in support of the mission of the Congregation. Ottawa Regional Hospital & Healthcare Center, formerly known as Community Hospital of Ottawa was incorporated in 1964. OSF Healthcare System became the sole member of Ottawa Regional Hospital & Healthcare Center in 2012, and the hospital was renamed as d/b/a/ OSF Saint Elizabeth Medical Center. Mendota Community Hospital, formerly known as Mendota Hospital Foundation, was incorporated in 1944. OSF Healthcare System became the sole member of Mendota Community Hospital in 2015, and the hospital was renamed as d/b/a/ OSF Saint Paul Medical Center. |
| Schedule H, Part VI, Line 7 State filing of community benefit report | IL |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (27 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Robert C Sehring | ||||||||||||||
| Vice Chairperson Chief Executive Officer | $0 | $1,437,099 | $0 | $321,477 | $0 | $186,028 | $0 | $14,171 | $0 | $30,453 | $0 | $1,989,229 | $0 | $0 |
| Gerald J McShane MD | ||||||||||||||
| Board Member | $0 | $272,724 | $0 | $0 | $0 | $1,135 | $0 | $14,153 | $0 | $25,438 | $0 | $313,450 | $0 | $0 |
| Divya-Devi Joshi | ||||||||||||||
| Former Chief Executive Officer Children SL | $0 | $111,270 | $0 | $7,774 | $0 | $10 | $0 | $5,979 | $0 | $1,605 | $0 | $126,638 | $0 | $0 |
| Mark A Nafziger | ||||||||||||||
| Former Chief Executive Officer Ambulatory Care | $0 | $176,996 | $0 | $0 | $0 | $833,206 | $0 | $7,116 | $0 | $4,055 | $0 | $1,021,373 | $0 | $37,352 |
| David A Schertz | ||||||||||||||
| Former - Chief Executive Officer Northern Region | $0 | $0 | $0 | $0 | $0 | $135,173 | $0 | $0 | $0 | $0 | $0 | $135,173 | $0 | $0 |
| Dwight D Stapleton | ||||||||||||||
| Former Vice President Clinical Specialty Services | $0 | $128,483 | $0 | $0 | $0 | $18 | $0 | $6,451 | $0 | $1,503 | $0 | $136,455 | $0 | $0 |
| Michael M Allen | ||||||||||||||
| Chief Financial Officer | $0 | $660,595 | $0 | $95,206 | $0 | $19,428 | $0 | $14,250 | $0 | $33,446 | $0 | $822,925 | $0 | $0 |
| Chad E Boore | ||||||||||||||
| Chief Executive Officer Eastern Region | $0 | $453,891 | $0 | $62,279 | $0 | $5,613 | $0 | $14,250 | $0 | $33,376 | $0 | $569,409 | $0 | $0 |
| Robert L Brandfass | ||||||||||||||
| SVP Chief Legal Officer | $0 | $567,863 | $0 | $55,255 | $0 | $28,370 | $0 | $14,250 | $0 | $26,238 | $0 | $691,974 | $0 | $0 |
| Michelle D Conger | ||||||||||||||
| Chief Strategy Officer | $0 | $562,032 | $0 | $76,763 | $0 | $25,530 | $0 | $7,777 | $0 | $26,393 | $0 | $698,495 | $0 | $0 |
| Roxanna Crosser | ||||||||||||||
| Chief Executive Officer Western Region | $0 | $406,796 | $0 | $57,637 | $0 | $25,865 | $0 | $3,537 | $0 | $25,023 | $0 | $518,859 | $0 | $0 |
| Michael A Cruz MD | ||||||||||||||
| Chief Operating Officer | $0 | $695,478 | $0 | $99,706 | $0 | $25,295 | $0 | $14,250 | $0 | $35,108 | $0 | $869,838 | $0 | $0 |
| John R Evancho | ||||||||||||||
| SVP Chief Compliance Officer | $0 | $286,974 | $0 | $27,563 | $0 | $5,651 | $0 | $12,271 | $0 | $30,701 | $0 | $363,160 | $0 | $0 |
| Carol A Friesen | ||||||||||||||
| Chief Executive Officer Northern Region | $0 | $485,439 | $0 | $39,345 | $0 | $20,640 | $0 | $11,151 | $0 | $34,860 | $0 | $591,436 | $0 | $0 |
| David M Hall | ||||||||||||||
| SVP Info Systems/Chief Information Officer | $0 | $396,684 | $0 | $36,512 | $0 | $878 | $0 | $14,250 | $0 | $32,788 | $0 | $481,113 | $0 | $0 |
| Thomas G Hammerton | ||||||||||||||
| President OSF Healthcare Foundation Chief Development Officer | $0 | $345,956 | $0 | $52,840 | $0 | $31,519 | $0 | $14,008 | $0 | $33,446 | $0 | $477,769 | $0 | $0 |
| Stephen E Hippler MD | ||||||||||||||
| Chief Clinical Officer | $0 | $664,525 | $0 | $95,009 | $0 | $75,979 | $0 | $14,250 | $0 | $34,641 | $0 | $884,404 | $0 | $0 |
| James J Mormann | ||||||||||||||
| Chief Information Officer | $0 | $607,195 | $0 | $90,640 | $0 | $27,108 | $0 | $14,250 | $0 | $33,531 | $0 | $772,724 | $0 | $0 |
| August J Querciagrossa | ||||||||||||||
| Chief Executive Officer Metro Region | $0 | $322,715 | $0 | $26,093 | $0 | $28,428 | $0 | $6,801 | $0 | $24,100 | $0 | $408,136 | $0 | $0 |
| Jeffry M Tillery | ||||||||||||||
| SVP Chief Transformation Officer | $0 | $589,069 | $0 | $86,561 | $0 | $24,327 | $0 | $14,016 | $0 | $30,440 | $0 | $744,415 | $0 | $0 |
| Ralph Velazquez MD | ||||||||||||||
| System Chief Medical Officer | $0 | $517,495 | $0 | $75,217 | $0 | $33,520 | $0 | $14,250 | $0 | $28,498 | $0 | $668,979 | $0 | $0 |
| Michael A Wells | ||||||||||||||
| President CHOI | $0 | $227,357 | $0 | $0 | $0 | $636 | $0 | $6,995 | $0 | $18,967 | $0 | $253,954 | $0 | $0 |
| Lori L Wiegand | ||||||||||||||
| Chief Nursing Officer | $0 | $418,579 | $0 | $60,982 | $0 | $27,046 | $0 | $14,250 | $0 | $9,743 | $0 | $530,599 | $0 | $0 |
| Leon A Yeh MD | ||||||||||||||
| VP Chief Medical Officer Emergency Serv | $0 | $517,970 | $0 | $0 | $0 | $19,548 | $0 | $14,250 | $0 | $31,702 | $0 | $583,471 | $0 | $0 |
| Kenneth K Potts MD | ||||||||||||||
| Physician | $228,299 | $0 | $6,081 | $0 | $293 | $0 | $5,909 | $0 | $24,945 | $0 | $265,526 | $0 | $0 | $0 |
| Katherine R Riva-Foster MD | ||||||||||||||
| Physician | $226,317 | $0 | $5,885 | $0 | $4,318 | $0 | $6,573 | $0 | $4,244 | $0 | $247,337 | $0 | $0 | $0 |
| Dawn C Trompeter | ||||||||||||||
| President of OSF HealthCare | $252,028 | $0 | $22,021 | $0 | $2,735 | $0 | $7,228 | $0 | $14,645 | $0 | $298,658 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 1a Health or social club dues or initiation fees | THE CORPORATION REIMBURSES CERTAIN EXECUTIVES FOR SOCIAL CLUB DUES PAID BY SUCH EXECUTIVES. ELIGIBILITY FOR CLUB DUES REIMBURSEMENT IS DETERMINED BY THE HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS AND IS TAKEN INTO CONSIDERATION BY THE COMMITTEE IN DETERMINING FAIR MARKET COMPENSATION. SEE FORM 990 - SCHEDULE O - PART VI - LINES 15A AND 15B FOR AN EXPLANATION OF THE ROLE OF THE HUMAN RESOURCES COMMITTEE AND THE MANNER IN WHICH FAIR MARKET COMPENSATION IS DETERMINED. CLUB DUES ARE NOT ELIGIBLE FOR REIMBURSEMENT IF THE CLUB IN QUESTION DISCRIMINATES ON THE BASIS OF RACE, RELIGION, SEX, NATIONAL ORIGIN, OR OTHER PROHIBITED FACTORS. DUES REIMBURSEMENT IS TREATED AND REPORTED AS TAXABLE COMPENSATION. |
| Schedule J, Part I, Line 4a Severance or change-of-control payment | During calendar year 2020, Mark Nafziger received a severance payment in the amount of $792,948 and David Schertz received a severance payment in the amount of $135,173. |
| Schedule J, Part I, Line 3 SCH J, PART I, LINE 3 | THE BOARD OF DIRECTORS HAS ESTABLISHED A BOARD COMMITTEE KNOWN AS THE HUMAN RESOURCES COMMITTEE WHOSE MEMBERS ARE ALL PROFESSED MEMBERS OF A RELIGIOUS CONGREGATION THAT OWNS OR IS ASSOCIATED WITH THE HEALTHCARE SYSTEM WHO HAVE TAKEN A VOW OF POVERTY. HENCE, THEY DO NOT PERSONALLY BENEFIT FROM DECISIONS OF THE COMMITTEE. THE COMMITTEE DETERMINES WHICH OFFICERS, KEY EMPLOYEES AND OTHER EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN THE EXECUTIVE COMPENSATION PLAN. BASED ON PERFORMANCE REVIEWS BY THE SUPERVISORS OF SUCH PERSONS, COMPENSATION SURVEY DATA AND RECOMMENDATIONS FROM A NATIONALLY KNOWN INDEPENDENT COMPENSATION CONSULTANT, THE COMMITTEE APPROVES ANY EXECUTIVE COMPENSATION PLAN APPLICABLE TO KEY EMPLOYEES AND ESTABLISHES THE BASE SALARY AND BENEFITS FOR PLAN PARTICIPANTS. PRIOR TO PAYMENT OF ANY BONUS OR INCENTIVE COMPENSATION, THE TOTAL COMPENSATION FOR EACH KEY EMPLOYEE, INCLUDING BASE SALARY, BENEFITS, AND PROPOSED BONUS OR INCENTIVE COMPENSATION, IS AGAIN REVIEWED BY A NATIONALLY RECOGNIZED COMPENSATION CONSULTANT TO ENSURE THAT NO EXCESS BENEFIT AMOUNT IS PAID OR FURNISHED. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part I, Line 1 PART I | THE TAX LAW REQUIRES THAT EACH LEGAL ENTITY WITHIN THE OSF HEALTHCARE SYSTEM COMPLETE A SEPARATE TAX RETURN WHICH APPROPRIATELY REFLECTS THE ACTIVITIES AND FINANCIAL POSITION OF THE PARTICULAR ORGANIZATION. THIS REPORTING, HOWEVER, IS NOT REFLECTIVE OF THE OSF HEALTHCARE SYSTEM AS A WHOLE. PLEASE SEE THE ATTACHED AUDITED FINANCIAL STATEMENTS OF OSF HEALTHCARE SYSTEM AND SUBSIDIARIES FOR A COMPLETE OVERVIEW OF THE SYSTEM. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | OSF HEALTHCARE SYSTEM IS THE SOLE CORPORATE MEMBER OF MENDOTA COMMUNITY HOSPITAL. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | OSF HEALTHCARE SYSTEM AS A SOLE CORPORATE MEMBER OF MENDOTA COMMUNITY HOSPITAL HAS THE POWER TO ELECT MEMBERS OF THE BOARD. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | RESERVED POWERS: THE FOLLOWING POWERS ARE RESERVED FOR THE MEMBER: A) TO ESTABLISH, APPROVE, OR MODIFY THE PHILOSOPHY, VISION, VALUES, AND MISSION ACCORDING TO WHICH THE CORPORATION OPERATES. (B) TO AMEND THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS. (C) TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE DIRECTORS OF THE CORPORATION. (D) TO MERGE OR CONSOLIDATE THE CORPORATION WITH OTHER ENTITIES OR TO DISSOLVE THE CORPORATION. (E) TO ACQUIRE AN INTEREST IN AN EXISTING ENTITY OR TO ESTABLISH A NEW ENTITY. (F) TO LEASE, SELL, ENCUMBER OR OTHERWISE ALIENATE ANY REAL PROPERTY OR INTEREST IN REAL PROPERTY OF THE CORPORATION. (G) TO APPROVE ANY TRANSFER, LEASE, SALE OR ENCUMBRANCE OF PERSONAL PROPERTY OF THE CORPORATION EXCEPT IN THE ORDINARY COURSE OF BUSINESS. (H) TO APPROVE ANY BORROWING OR DEBT FINANCING ON BEHALF OF THE CORPORATION. (I) TO APPOINT, DISCIPLINE, TERMINATE AND REMOVE THE CORPORATION'S OPERATING DIVISION PRESIDENT. (J) TO APPOINT AND REMOVE THE CORPORATION'S CHAIRPERSON, VICE CHAIRPERSON(S), CHIEF EXECUTIVE OFFICER, PRESIDENT, SECRETARY, AND TREASURER, AND THE ASSISTANT SECRETARY AND ASSISTANT TREASURER, IF ANY. (K) TO APPROVE OR AMEND STRATEGIC PLANS, MANAGEMENT OBJECTIVES, AND CAPITAL AND OPERATING BUDGETS OF THE CORPORATION. (L) TO APPROVE ANY PURCHASE OR OTHER AQUISITION BY THE CORPORATION THAT IS NOT INCLUDED IN ITS CAPITAL BUDGET AND EXCEEDS ONE MILLION DOLLARS ($1,000,000) PER ITEM. (M) TO NAME OR RENAME ANY HOSPITAL OR MEDICAL CENTER OWNED AND OPERATED BY THE CORPORATION. (N) TO REQUIRE A CERTIFIED AUDIT OF FINANCES OF THE CORPORATION AND TO APPOINT THE CERTIFIED PUBLIC ACCOUNTANT TO PERFORM THE AUDIT. (O) TO APPROVE THE ENGAGEMENT OF AND TO DISMISS ANY OUTSIDE LEGAL COUNSEL TO REPRESENT THE CORPORATION ON A REGULAR BASIS OR IN CONNECTION WITH ANY MATTER DEEMED BY THE MEMBER, IN GOOD FAITH, TO HAVE SIGNIFICANCE FOR THE CORPORATION AS A WHOLE. (P) TO GIVE PRELIMINARY APPROVAL PRIOR TO THE DEVELOPMENT OF, AND TO GIVE FINAL APPROVAL PRIOR TO THE EXECUTION OF, ALL DOCUMENTS TO WHICH THE CORPORATION IS OR WILL BE A PARTY AND WHICH RELATE TO THE CREATION, FORMATION, ORGANIZATION, OR TERMINATION OF ANY OTHER LEGAL ENTITY (WHETHER A CORPORATION, LIMITED LIABILITY COMPANY, PARTNERSHIP, OR ANY OTHER ENTITY) IN WHICH THE CORPORATION WILL HAVE ANY OWNERSHIP INTEREST, MEMBERSHIP INTEREST, POWER TO ELECT OR APPOINT BOARD MEMBERS OR OFFICERS, OR ANY OTHER FORMAL PARTICIPATION ARRANGEMENT, WHETHER ACTING ALONE OR IN CONJUNCTION WITH ANY OTHER PERSON OR ENTITY. (Q) TO TAKE ANY AND ALL ACTIONS DEEMED NECESSARY, IN THE SOLE JUDGEMENT OF THE MEMBER BOARD TO PROTECT AND PRESERVE THE TAX-EXEMPT STATUS AND PUBLIC CHARITY STATUS OF THE CORPORATION OR THE MEMBER AND ANY TAX-EXEMPT AFFILIATE OF THE CORPORATION OR THE MEMBER (INCLUDING FEDERAL AND STATE INCOME TAX EXEMPTIONS, PROPERTY TAX EXEMPTIONS, AND SALES TAX EXEMPTIONS); PROVIDED THE MEMBER BOARD HAS GIVEN A WRITTEN REQUEST TO THE BOARD TO TAKE ACTION OR REFRAIN FROM TAKING ACTION, WHICH WOULD HAVE SUFFICIENTLY PROTECTED AND PRESERVED SUCH TAX-EXEMPT AND PUBLIC CHARITY STATUS, AND THE BOARD HAS FAILED TO PROMPTLY TAKE SUCH ACTION OR REFRAIN FROM TAKING SUCH ACTION. |
| Form 990, Part VI, Line 9 Interested person not at organization's address | BRIAN SILVERSTEIN, M.D. 711 APPLE TREE LANE GLENCOE, IL 60022 |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE PROPOSED FINAL VERSION OF THE 990 IS PROVIDED VIA AN ONLINE PORTAL TO ALL OFFICERS AND MEMBER OF THE BOARD OF DIRECTORS FOR THEIR REVIEW PRIOR TO FILING. ANY APPROPRIATE CHANGES REQUESTED BY THE OFFICERS AND DIRECTORS ARE THEN INCORPORATED INTO THE FINAL FORM 990 AND ALL SCHEDULES BEFORE FILING. |
| Form 990, Part VI, Line 12c Conflict of interest policy | DISCLOSURES BY OFFICERS, DIRECTORS AND TRUSTEES, AS WELL AS KEY EMPLOYEES AND EMPLOYEES CHARGED WITH PURCHASING, PROCUREMENT AND CONTRACTION DECISION-MAKING ARE MADE THROUGH AN ELECTRONIC REPORTING SYSTEM ON AN ANNUAL BASIS. DISCLOSURES ARE RECEIVED AND REVIEWED BY THE CORPORATE COMPLIANCE DIVISION ON AN ANNUAL BASIS. IF A POTENTIAL CONFLICT OF INTEREST IS IDENTIFIED, THEN THE DISCLOSING EMPLOYEE IS NOTIFIED OF THE POTENTIAL CONFLICT AND MAY BE ASKED FOR ADDITIONAL INFORMATION. THE CORPORATE COMPLIANCE DIVISION DETERMINES WHETHER A PLAN TO MANAGE A POSSIBLE OR ACTUAL CONFLICT OF INTEREST IS NEEDED, DISCUSSES THE MANGEMENT PLAN WITH THE EMPLOYEE AND MONITORS THE EMPLOYEE'S COMPLIANCE WITH THE PLAN. PLANS TO MANAGE CONFLICTS ARE TRACKED THROUGH THE ELECTRONIC DISCLOSURE SYSTEM. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | THE BOARD OF DIRECTORS HAS ESTABLISHED A BOARD COMMITTEE KNOWN AS THE HUMAN RESOURCES COMMITTEE WHOSE MEMBERS ARE ALL PROFESSED MEMBERS OF THE RELIGIOUS CONGREGATION KNOWN AS THE SISTERS OF THE THIRD ORDER OF SAINT FRANCIS who are all professed members of a religious congregation that owns or is associated with the healthcare system who have taken a vow of poverty. HENCE, THEY DO NOT PERSONALLY BENEFIT FROM DECISION OF THE COMMITTEE. THE PERFORMANCE OF THE CEO AND HIS ACHIEVEMENT OF ANNUAL GOALS IS EVALUATED EACH YEAR BY THE FULL BOARD OF DIRECTORS, AND THIS PERFORMANCE REVIEW IS PROVIDED TO THE COMMITEE. THE COMMITEE ALSO OBTAINS COMPENSATION SURVEY DATA AND RECOMMENDATION FROM A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTANT. BASED ON ALL OF THESE FACTORS, THE COMMITTEE SETS BASE SALARY AND BENEFITS OF THE CEO AND APPROVES THE EXECUTIVE COMPENSATION PLAN APPLICABLE TO THE CEO. PRIOR TO PAYMENT OF ANY BONUS OR INCENTIVE COMPENSATION, THE TOTAL COMPENSATION FOR THE CEO, INCLUDING BASE SALARY, BENEFITS, AND PROPOSED BONUS OR INCENTIVE COMPENSATION, IS AGAIN REVEIWED BY A NATIONALLY RECOGNIZED COMPENSATION CONSULTANT TO ENSURE THAT NO EXESS BENEFIT AMOUNT IS PAID OR FURNISHED. THE COMPENSATION REVIEW IS DONE ANNUALLY. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | THE BOARD OF DIRECTORS HAS ESTABLISHED A BOARD COMMITTEE KNOWN AS THE HUMAN RESOURCES COMMITTEE WHOSE MEMBERS ARE ALL PROFESSED MEMBER OF THE RELIGIOUS CONGREGATION KNOWN AS THE SISTERS OF THE THIRD ORDER OF SAINT FRANCIS who are all professed members of a religious congregation that owns or is associated with the healthcare system who have taken a vow of poverty. HENCE, THEY DO NOT PERSONALLY BENEFIT FROM DECISIONS OF THE COMMITTEE. THE COMMITTEE DETERMINES WHICH OFFICERS, KEY EMPLOYEES AND OTHER EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN THE EXECUTIVE COMPENSATION PLAN. BASED ON PERFORMANCE REVIEWS BY THE SUPERVISORS OF SUCH PERSONS AND COMPENSATION SURVEY DATA AND RECOMMENDATIONS FROM A NATIONALLY KNOWN INDEPENDENT COMPENSATION CONSULTANT, THE COMMITTEE APPROVES ANY EXECUTIVE COMPENSATION PLAN APPLICABLE TO KEY EMPLOYEES AND ESTABLISHED THE BASE SALARY AND BENEFITS FOR PLAN PARTICIPANTS. PRIOR TO PAYMENT OF ANY BONUS OR INCENTIVE COMPENSATION, THE TOTAL COMPENSATION FOR EACH KEY EMPLOYEE, INCLUDING BASE SALARY, BENEFITS, AND PROPOSED BONUS OR INCENTIVE COMPENSATION, IS AGAIN REVIEWED BY A NATIONALLY RECOGNIZED COMPENSATION CONSULTANT TO ENSURE THAT NO EXCESS BENEFIT AMOUNT IS PAID OR FURNISHED. THE COMPENSATION REVIEW IS DONE ANNUALLY. |
| Form 990, Part VI, Line 19 Required documents available to the public | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| Form 990, Part VIII, Line 11d Other Miscellaneous Revenue | Other - Total Revenue: 61732, Related or Exempt Function Revenue: 61732, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Inter-company Transfers - -103275; Net assets Released from Restrictions - 198144; Equity Transfers - -389409; |
| Form 990 Coronavirus Pandemic | On March 11, 2020, the World Health Organization designated COVID-19 as a global pandemic. Patient activity and related revenues for most services were significantly impacted starting in mid-March 2020, as various policies were implemented by federal, state, and local governments in response to the COVID-19 pandemic. OSF's pandemic response plan has multiple facets and continues to evolve as the pandemic continues. Precautionary steps to enhance operational and financial flexibility, and react to the risks the COVID-19 pandemic presents to the business, included the following: * Implemented certain cost reduction initiatives; * Continued to monitor economic pressures such as supply availability and costs, as well as labor demand and costs; * Assessed the various federal stimulus options available to OSF as noted in the audited financial statements. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| SISTERS OF THE THIRD ORDER OF ST FRANCIS | ||||||||||
| 124 SW Adams St | PEORIA | IL | 61602 | 371259286 | PARENT/SU ORG | IL | 501(c)(3) | 1 | NA | false |
| OSF HEALTHCARE FOUNDATION | ||||||||||
| 124 SW Adams St | PEORIA | IL | 61602 | 371259284 | SUPPORT ORG | IL | 501(c)(3) | Type II | SIS 3RD OSF | false |
| OTTAWA REGIONAL HOSP & HEALTHCARE CTR | ||||||||||
| 124 SW ADAMS ST | Peoria | IL | 61602 | 362604009 | HOSPITAL | IL | 501(c)(3) | 3 | OSF | false |
| OTTAWA REGIONAL HOSPITAL FOUNDATION | ||||||||||
| 124 SW ADAMS ST | Peoria | IL | 61602 | 364007569 | SUPPORT ORG | IL | 501(c)(3) | Type I | ORHHC | false |
| OSF MULTI-SPECIALTY GROUP | ||||||||||
| 124 SW Adams St | PEORIA | IL | 61602 | 383852646 | HLTHCARE SVCS | IL | 501(c)(3) | Type I | OSF | false |
| OSF HEALTHCARE SYSTEM | ||||||||||
| 124 SW Adams St | PEORIA | IL | 61602 | 370813229 | HOSPITAL | IL | 501(c)(3) | 3 | SIS 3RD OSF | false |
| OTTAWA REGIONAL HOSPITAL AUXILIARY | ||||||||||
| 124 SW ADAMS ST | Peoria | IL | 61602 | 363854788 | SUPPORT ORG | IL | 501(c)(3) | Type I | OSF | false |
| OSF COLLEGE OF HEALTH SCIENCES | ||||||||||
| 124 SW Adams St | PEORIA | IL | 61602 | 364868939 | College of nursing | IL | 501(c)(3) | 2 | OSF | false |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CENTER FOR HEALTH AMBULATORY | |||||||||||||
| 8800 RTE 91 N | PEORIA | IL | 61615 | 205557171 | SURGICAL CENTER | IL | OSF | Related | $0 | $0 | false | false | 0 |
| EASTLAND MEDICAL PLAZA | |||||||||||||
| 1505 EASTLAND DRIVE | Bloomington | IL | 61701 | 371400643 | SURGICAL CENTER | IL | OSF | Related | $0 | $0 | false | false | 0 |
| FORT JESSE IMAGING CENTER LLC | |||||||||||||
| 2200 FT JESSE ROAD | NORMAL | IL | 61761 | 460515604 | MEDICAL IMAGING | IL | OSF | Related | $0 | $0 | false | false | 0 |
| SAINT CLARE'S VILLA | |||||||||||||
| 915 EAST 5TH STREET | ALTON | IL | 62002 | 371397289 | LOW INC HOUSING | IL | OSF | Related | $0 | $0 | false | false | 0 |
| FOX RIVER CANCER CENTER | |||||||||||||
| 1211 STARFISH DRIVE | OTTAWA | IL | 61350 | 870805865 | ONCOLOGY | IL | ORHHC | Related | $0 | $0 | false | false | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line2USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|---|---|---|---|
| POINTCORE INC | ||||||||||
| 124 SW Adams St | PEORIA | IL | 61602 | 363484677 | HLTHCARE SVCS | IL | OSF | C Corporation | false | |
| ILLINOIS PATHOLOGST SERVICES LLC | ||||||||||
| 5666 EAST STATE STREET | ROCKFORD | IL | 61108 | 800439081 | PATHOLOGY SVCS | IL | OSF | C Corporation | false | |
| Lakeview Medical Office Building | ||||||||||
| 812 N Logan Ave | Danville | IL | 61832 | 371100761 | Condominium Association | IL | OSF | C Corporation | false | |
| SOUTHWEST HEALTH SYSTEMS INC | ||||||||||
| 2800 WEST 95TH STREET | EVERGREEN PARK | IL | 60805 | 363425830 | HEALTHCARE SERVICES | IL | OSF | C Corporation | false | |
| MARY CAP INSURANCE INC | ||||||||||
| 75 ST PAUL STREET | BURLINGTON | VT | 05401 | 030304812 | INSURANCE COMPANY | VT | OSF | C Corporation | false | SUITE 500 |
| OSF AVIATION LLC | ||||||||||
| 124 SW Adams St | PEORIA | IL | 61602 | 300032408 | Medical Transportation | IL | Pointcore Inc | C Corporation | false | |
| OSF ASSURANCE COMPANY | ||||||||||
| 76 ST PAUL STREET | BURLINGTON | VT | 05401 | 202015375 | Insurance company | VT | Pointcore Inc | C Corporation | false | Suite 500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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