BLESSINGCARE CORPORATION: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
BLESSINGCARE CORPORATION (EIN 37-1396010)
Tax period
2019-10-01 to 2020-09-30
Filed
2021-08-11
IRS object ID
202122239349300022
Schema version
2019v5.0
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 ReturnHeader

FieldValueIRS element (for citing)
Return2021-08-11T09:21:25-05:00ReturnTs
Tax Period End2020-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN363077757PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1GRAY HUNTER STENN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1500 MAINE STAddressLine1Txt
CityQUINCYCityNm
State AbbreviationILStateAbbreviationCd
ZIP62301ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN371396010EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1BLESSINGCARE CORPORATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlBLESBusinessNameControlTxt
Phone2172852113PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1640 WEST WASHINGTONAddressLine1Txt
CityPITTSFIELDCityNm
State AbbreviationILStateAbbreviationCd
ZIP62363ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonPATRICK M GERVELERPersonNm
Person TitleTREASURERPersonTitleTxt
Phone2172852113PhoneNum
Signature2021-08-09SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonERIN J WHARTON CPAPreparerPersonNm
PTINP01294277PTIN
Phone2172220304PhoneNum
Preparation2021-08-04PreparationDt
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1ILLINI COMMUNITY HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerKATHLEEN E HULLPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1640 WEST WASHINGTONAddressLine1Txt
CityPITTSFIELDCityNm
State AbbreviationILStateAbbreviationCd
ZIP62363ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$31,529,452GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.ILLINIHOSPITAL.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2000FormationYr
Legal Domicile StateILLegalDomicileStateCd
Activity Or MissionTO IMPROVE THE HEALTH OF OUR COMMUNITY.ActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee251TotalEmployeeCnt
Total Volunteers36TotalVolunteersCnt
Total Gross UBI$3,118TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$1,807NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$171,629PYContributionsGrantsAmt
CY Contributions Grants$1,425,175CYContributionsGrantsAmt
PY Program Service Revenue$30,050,511PYProgramServiceRevenueAmt
CY Program Service Revenue$29,274,727CYProgramServiceRevenueAmt
PY Investment Income$12,136PYInvestmentIncomeAmt
CY Investment Income$87,106CYInvestmentIncomeAmt
PY Other Revenue$501,435PYOtherRevenueAmt
CY Other Revenue$738,602CYOtherRevenueAmt
PY Total Revenue$30,735,711PYTotalRevenueAmt
CY Total Revenue$31,525,610CYTotalRevenueAmt
PY Grants And Similar Paid$5,000PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$13,604,359PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$15,816,276CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$14,482,326PYOtherExpensesAmt
CY Other Expenses$12,982,525CYOtherExpensesAmt
PY Total Expenses$28,091,685PYTotalExpensesAmt
CY Total Expenses$28,798,801CYTotalExpensesAmt
PY Revenues Less Expenses$2,644,026PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$2,726,809CYRevenuesLessExpensesAmt
Total Assets BOY$29,496,751TotalAssetsBOYAmt
Total Assets EOY$39,382,716TotalAssetsEOYAmt
Total Liabilities BOY$8,045,766TotalLiabilitiesBOYAmt
Total Liabilities EOY$15,102,297TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$21,450,985NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$24,280,419NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO IMPROVE THE HEALTH OF OUR COMMUNITY.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$21,032,751ExpenseAmt
Revenue$29,274,727RevenueAmt
DescILLINI COMMUNITY HOSPITAL TREATED PATIENTS THROUGH THE FOLLOWING SERVICES DURING FISCAL YEAR 2020: INPATIENT ADMISSIONS 515 OBSERVATION ADMISSIONS 216 OUTPATIENT VISITS 73,009 TOTAL SURGERIES 212 EMERGENCY VISITS 4,871 LABORATORY TESTS 65,002 RESPIRATORY TREATMENTS 1,843 RADIOLOGY PROCEDURES 9,302 RURAL HEALTH CLINIC & XPRESS VISITS 13,828 IN ADDITION TO THESE HEALTHCARE SERVICES, ILLINI COMMUNITY HOSPITAL PROVIDED 587,585 IN CHARITY CARE AND INCURRED MEDICARE SHORTFALLS OF 770,355. THE HOSPITAL PROVIDED ADDITIONAL BENEFITS DURING FISCAL YEAR 2020 AS FOLLOWS: 1)HEALTH PROFESSIONALS EDUCATION - 79,326 HEALTHCARE STUDENT INTERNSHIPS NURSE PRACTITIONER CLINICALS RADIOLOGY CLINICALS 2)IN-KIND CONTRIBUTIONS AND DONATIONS - 21,830 COURTESY BLOOD DRAWS FOR AREA PUBLIC AGENCIES PIKE CEO PROGRAM PIKE COUNTY MINISTERIAL ALLIANCE DONATED MEETING ROOM SPACE HEALTH FAIRS HEALTH SCREENINGS GED PARTNERS BARRY YMCA 3)COMMUNITY HEALTH IMPROVEMENT PROGRAMS AND SERVICES - 30,648 FLU CLINICS PIKELAND WELLNESS COMMITTEE BLOOD AND PLATELET DRIVES SPORTS INJURY CLINIC UNREIMBURSED PATIENT TRANSPORTATION DRUG TAKE BACK KIOSK 4)COMMUNITY EDUCATIONAL PROGRAMS AND SERVICES - 30,567 DESTRUCTIVE DECISIONS EDUCATIONAL PROGRAM ALCS AND BLS CLASSES DIABETES COACHINGDesc
Total Program Service Expenses$21,032,751TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (true)BusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document29IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee251EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members10GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (true)DelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VentureYes (true)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (true)WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldILStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonKATHY HULLPersonNm
Phone2172852113PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1640 WEST WASHINGTONAddressLine1Txt
CityPITTSFIELDCityNm
State AbbreviationILStateAbbreviationCd
ZIP62363ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
MAUREEN A KAHN
SECRETARY1.0039.00Yes (X)Yes (X)$0$1,041,516$108,845
PATRICK M GERVELER
TREASURER1.0039.00Yes (X)Yes (X)$0$610,758$122,537
KATHLEEN E HULL
ADMINISTRATO40.00Yes (X)Yes (X)$0$303,857$37,537
CHRISTOPHER S WAGONER MD
PRES - MED S40.00Yes (X)$0$283,531$32,233
HOLLY A JONES
ASST ADMINIS40.00$168,132$0$28,080Yes (X)
LYNDELL LOMAX
NURSE PRACTI40.00$149,614$0$28,091Yes (X)
CAITLIN M HOLLAND
LEAD PHARMAC40.00$159,532$0$17,367Yes (X)
GINGER L TORREZ
NURSE PRACTI40.00$127,322$0$30,022Yes (X)
KAYLA L HILL
PHARMACIST40.00$134,185$0$16,468Yes (X)
JOANNA M BUNCH
NURSE PRACTI40.00$117,936$0$12,383Yes (X)
DAMAN EMRICK
TRUSTEE1.00Yes (X)$0$0$0
K JEANNIE GOODMAN
BOARD CHAIR1.00Yes (X)Yes (X)$0$0$0
LAURA KENT-DONAHUE
TRUSTEE1.00Yes (X)$0$0$0
AMY RUEBUSH
TRUSTEE1.00Yes (X)$0$0$0
JASON STRATTON
TRUSTEE1.00Yes (X)$0$0$0
DIANE VOSE
BOARD VICE-C1.00Yes (X)Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$856,721TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,239,662TotReportableCompRltdOrgAmt
Total Other Compensation$433,563TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K6IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmtAddress Line2ContractorAddress/USAddress/AddressLine2Txt
AIMS OF PITTSFIELD LLC
8657 WEDGEWOOD DRIVEBURR RIDGEIL60527PHYSICIAN SVCS$1,399,388
O'SHEA BUILDERS
3401 CONSTITUTION DRIVESPRINGFIELDIL62711CONSTRUCTION$296,683
CROSS COUNTRY STAFFING-EAST
PO BOX 40674ATLANTAGA30384NURSING SVCS$283,638
KOMPLETE 340B LLC
10200 INDEPENDENCE PKWYPLANOTX75025PHYSICIAN SVCS$203,963SUITE 103
SHARED MEDICAL SERVICES INC
209 LIMESTONE PASSCOTTAGE GROVEWI53527MRI/RAD SVCS$183,775
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
Government Grants$1,041,901GovernmentGrantsAmt
All Other Contributions$383,274AllOtherContributionsAmt
Total Contributions$1,425,175TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT REVENUE$67,730,996$67,730,996
CONTRACTUAL ALLOWANCE-$38,456,269-$38,456,269
FieldValueIRS element (for citing)
Total Program Service Revenue$29,274,727TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$87,106TotalRevenueColumnAmt
Exclusion$87,106ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$99,086RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$3,842RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$95,244RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$95,244TotalRevenueColumnAmt
Exclusion$95,244ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$55,482GrossSalesOfInventoryAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$55,482TotalRevenueColumnAmt
Exclusion$55,482ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
OTHER900099$492,731$492,731
EQUITY IN SUB'S EARNINGS900099$92,027$92,027
ILLINI HEALTH SERVICES, LLC531120$3,118$3,118
FieldValueIRS element (for citing)
Other Revenue Total$587,876OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$31,525,610TotalRevenueColumnAmt
Related Or Exempt Func Income$29,274,727RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$3,118UnrelatedBusinessRevenueAmt
Exclusion$822,590ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$11,962,107TotalAmt
Program Services$8,971,236ProgramServicesAmt
Management And General$2,990,871ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$449,985TotalAmt
Program Services$337,476ProgramServicesAmt
Management And General$112,509ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,603,502TotalAmt
Program Services$1,936,932ProgramServicesAmt
Management And General$666,570ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$800,682TotalAmt
Program Services$600,488ProgramServicesAmt
Management And General$200,194ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$15,820TotalAmt
Management And General$15,820ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$59,051TotalAmt
Management And General$59,051ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$448,660TotalAmt
Program Services$289,095ProgramServicesAmt
Management And General$159,565ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$39,950TotalAmt
Program Services$19,569ProgramServicesAmt
Management And General$20,381ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$74,307TotalAmt
Management And General$74,307ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,140,344TotalAmt
Program Services$733,241ProgramServicesAmt
Management And General$407,103ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$131,277TotalAmt
Management And General$131,277ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
OUTSIDE FEES$3,205,477$1,306,430$1,899,047
PATIENT SUPPLIES$2,702,521$2,604,636$97,885
PHYSICIAN FEES$2,171,461$2,171,461
BAD DEBTS$921,428$921,428

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$2,072,229TotalAmt
Program Services$1,140,759ProgramServicesAmt
Management And General$931,470ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$28,798,801TotalAmt
Program Services$21,032,751ProgramServicesAmt
Management And General$7,766,050ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$8,945,087BOYAmt
EOY$1,871,145EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,675,523BOYAmt
EOY$13,998,521EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,945,656BOYAmt
EOY$3,302,625EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$647,846BOYAmt
EOY$1,021,420EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$184,933BOYAmt
EOY$218,081EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$26,848,546LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$13,504,902LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$13,591,851BOYAmt
EOY$13,343,644EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
EOY$4,325,410EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$140,419BOYAmt
EOY$836,953EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$365,436BOYAmt
EOY$464,917EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$29,496,751BOYAmt
EOY$39,382,716EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,304,862BOYAmt
EOY$585,479EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$3,755BOYAmt
EOY$7,302,034EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,163,239BOYAmt
EOY$2,615,801EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,573,910BOYAmt
EOY$4,598,983EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$8,045,766BOYAmt
EOY$15,102,297EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$21,412,653BOYAmt
EOY$24,231,448EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$38,332BOYAmt
EOY$48,971EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$21,450,985BOYAmt
EOY$24,280,419EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$29,496,751BOYAmt
EOY$39,382,716EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$2,726,809ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$105,743NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$3,118OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$279,691OtherCostOrOtherBasisAmt
Book Value$279,691BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$18,005,450OtherCostOrOtherBasisAmt
Depreciation$7,517,067DepreciationAmt
Book Value$10,488,383BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$606,751OtherCostOrOtherBasisAmt
Depreciation$436,233DepreciationAmt
Book Value$170,518BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,889,833OtherCostOrOtherBasisAmt
Depreciation$5,551,602DepreciationAmt
Book Value$2,338,231BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$66,821OtherCostOrOtherBasisAmt
Book Value$66,821BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$13,343,644TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)

DescDescAmtAmt
ESTIMATED THIRD-PARTY SETTLEMENTS$2,699,849
ACCRUED SALARIES$1,323,548
DUE TO BLESSING HOSPITAL$414,704
NONCURRENT ACCRUED MALPRACTICE$117,320
PAYROLL TAXES & WITHHOLDING$30,363
ACCRUED EMPLOYEE BENEFITS$8,090
ACCRUED INTEREST$5,109
FieldValueIRS element (for citing)
Total Liability$4,598,983TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$30,710,630TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$105,743NetUnrealizedGainsInvstAmt
Other Revenue-$921,428OtherRevenueAmt
Revenue Not Reported-$815,685RevenueNotReportedAmt
Revenue Subtotal$31,526,315RevenueSubtotalAmt
Other Revenues Not Included-$705OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt-$705RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$31,525,610TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$27,881,196TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$27,881,196ExpensesSubtotalAmt
Other Expenses Not Included$917,605OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$917,605ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$28,798,801TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PAGE 4, PART XI, LINE 2DBAD DEBT REDUCTION OF REVENUE ON FS -921,428
SCHEDULE D, PAGE 4, PART XI, LINE 4BRENTAL EXPENSES -3,842 IHS K1 3,118 INTEREST 19
SCHEDULE D, PAGE 4, PART XII, LINE 4BBAD DEBT REDUCTION OF REVENUE ON F/S 921,428 RENTAL EXPENSES -3,842 INTEREST EXPENSE 19

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent150Yes (X)Percent150Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent250Yes (X)Percent250Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$587,585TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$587,585NetCommunityBenefitExpnsAmt
Total Expense0.02110TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,374,920TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$6,374,920DirectOffsettingRevenueAmt

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,962,505TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$6,374,920DirectOffsettingRevenueAmt
Net Community Benefit Expns$587,585NetCommunityBenefitExpnsAmt
Total Expense0.02110TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$60,245TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$60,245NetCommunityBenefitExpnsAmt
Total Expense0.00220TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$97,327TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$97,327NetCommunityBenefitExpnsAmt
Total Expense0.00350TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$31,030TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$31,030NetCommunityBenefitExpnsAmt
Total Expense0.00110TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$188,602TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$188,602NetCommunityBenefitExpnsAmt
Total Expense0.00680TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$7,151,107TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$6,374,920DirectOffsettingRevenueAmt
Net Community Benefit Expns$776,187NetCommunityBenefitExpnsAmt
Total Expense0.02790TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$921,428BadDebtExpenseAmt
Bad Debt Expense Attributable$43,031BadDebtExpenseAttributableAmt
Reimbursed By Medicare$10,459,068ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$11,229,423CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$770,355MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ILLINI COMMUNITY HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1640 WEST WASHINGTON STREETAddressLine1Txt
CityPITTSFIELDCityNm
State AbbreviationILStateAbbreviationCd
ZIP62363ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.BLESSINGHEALTH.ORGWebsiteAddressTxt
State LicenseHF110395StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ILLINI COMMUNITY HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted18CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.BLESSINGHEALTH.ORGOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt20ImplementationStrategyAdptYr
Strategy Posted WebsitefalseStrategyPostedWebsiteInd
Strategy AttachedfalseStrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care150.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care250.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLWWW.BLESSINGHEALTH.ORGFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLWWW.BLESSINGHEALTH.ORGFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLWWW.BLESSINGHEALTH.ORGFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 3ETHE CHNA PROCESS HAS IDENTIFIED THE FOLLOWING COMMUNITY HEALTH NEEDS AS A PRIORITY: ADVANCING EDUCATION, SUPPORTING FINANCIAL STABILITY, AND PROMOTING GOOD HEALTH.
FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 5THE CHNA WAS CONDUCTED FOR ILLINI COMMUNITY HOSPITAL THROUGH A CONSULTING ARRANGEMENT WITH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (ICAHN). MULTIPLE METHODS WERE USED TO COLLECT DATA FOR THE PROJECT. SURVEY QUESTIONS AND PROTOCOLS WERE DEVELOPED IN PARTNERSHIP WITH THE ICAHN. ILLINI COMMUNITY HOSPITAL UNDERTOOK A THREE-MONTH PLANNING AND IMPLEMENTATION EFFORT TO DEVELOP THE CHNA, AND TO IDENTIFY AND PRIORITIZE COMMUNITY HEALTH NEEDS FOR ITS SERVICE AREA. THESE PLANNING AND DEVELOPMENT ACTIVITIES INCLUDED THE FOLLOWING STEPS: THE PROJECT WAS OVERSEEN AT THE OPERATIONAL LEVEL BY THE CEO. ARRANGEMENTS WERE MADE WITH ICAHN TO FACILITATE TWO FOCUS GROUPS AND A MEETING TO IDENTIFY AND PRIORITIZE SIGNIFICANT NEEDS. ICAHN WAS ALSO ENGAGED TO COLLECT, ANALYZE, AND PRESENT SECONDARY DATA AND TO PREPARE A FINAL REPORT FOR SUBMISSION TO ILLINI COMMUNITY HOSPITAL. THE CEO WORKED CLOSELY WITH ICAHN'S CONSULTANT TO IDENTIFY AND ENGAGE KEY COMMUNITY PARTNERS AND TO COORDINATE LOCAL MEETINGS AND GROUP ACTIVITIES. ILLINI COMMUNITY HOSPITAL ALSO LEVERAGED EXISTING RELATIONSHIPS THAT PROVIDED DIVERSE INPUT FOR A COMPREHENSIVE REVIEW AND ANALYSIS OF COMMUNITY HEALTH NEEDS IN THE HOSPITAL'S SERVICE AREA. THESE STEPS INCLUDED: THE CEO SECURED THE PARTICIPATION OF A DIVERSE GROUP OF REPRESENTATIVES FROM THE COMMUNITY AND THE HEALTH PROFESSION. ICAHN'S CONSULTANT PROVIDED SECONDARY DATA FROM MULTIPLE SOURCES. PARTICIPATION INCLUDED REPRESENTATIVES OF COUNTY HEALTH DEPARTMENTS SERVING THE AREA SERVED BY THE HOSPITAL.
FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 6BYES, THE CHNA INCLUDED THE SCHOOL NURSES OF PIKE COUNTY AS WELL AS REPRESENTATIVES FROM THE PIKE COUNTY HEALTH DEPARTMENT.
FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 11THE NEEDS IDENTIFIED AND PRIORITIZED THROUGH THE CHNA CARRIED FORWARD VARIANTS OF PREVIOUS CHNAS AND ADDED OTHERS. THE IDENTIFIED AND PRIORITIZED NEEDS SELECTED INCLUDE: 1. IMPROVE AWARENESS OF THE AVAILABILITY OF LOCAL HEALTHCARE, HEALTH- RELATED SERVICES AND OPPORTUNITIES, AND HOW TO ACCESS THEM: - BETTER CONNECT THE COMMUNITY TO NUTRITION INFORMATION AND HEALTHY FOODS. - IMPROVE TRANSPORTATION TO MEDICAL APPOINTMENTS AND SERVICES OUTSIDE OF THE SERVICE AREA 2. IMPROVE COMMUNICATION AND COLLABORATION AMONG HEALTHCARE PROVIDERS, COMMUNITY SERVICE PROVIDERS, FAITH-BASED COMMUNITY LEADERS, AND COMMUNITY GROUPS IN ORDER TO MAXIMIZE USE OF LOCAL RESOURCES. 3. ADDRESS ISSUES RELATED TO MENTAL HEALTH, INCLUDING: - IMPROVING LOCAL ACCESS TO MENTAL HEALTH SERVICES FOR YOUTH AND FAMILIES - ADDRESSING SUBSTANCE USE/MISUSE/ABUSE PREVENTION AND RECOVERY SERVICES REDUCE SMOKING - ADDRESSING THE CULTURE OF POVERTY IN LOCAL COMMUNITIES - ADDRESSING THE STIGMA ASSOCIATED WITH SEEKING OR RECEIVING MENTAL HEALTHCARE 4. ADDRESSING SERVICES FOR THE HOMELESS, BOTH TRANSIENT HOMELESS AND YOUTH AND YOUNG ADULTS, INCLUDING FINDING SHELTER WITH UNRELATED PERSONS. THE IMPLEMENTATION PLAN DEVELOPED BY THE SENIOR STAFF AT ILLINI COMMUNITY HOSPITAL IS SPECIFIC AND THOROUGH. THE PLAN, SET OUT IN THIS REPORT, INCLUDES THESE HIGHLIGHTS: ILLINI COMMUNITY HOSPITAL WORKED WITH COMMUNITY PARTNER ORGANIZATIONS TO BUILD, PLACE, AND STOCK "LITTLE PANTRIES" IN 4 COMMUNITIES THROUGHOUT PIKE COUNTY. ILLINI COMMUNITY HOSPITAL CREATED INSTRUCTIONAL VIDEOS FOR LOCAL BROADCAST TO EXPLAIN BASIC PREPARATION OF VEGETABLES AND OTHER HEALTHY FOODS AND SNACKS. ILLINI COMMUNITY HOSPITAL EXPANDED WEB-BASED AND SOCIAL MEDIA INFORMATION SHARING. ILLINI COMMUNITY HOSPITAL SPONSORED A MOBILE FOOD PANTRY IN CONJUNCTION WITH THE ILLINOIS FOOD BANK AND FEEDING AMERICA. A SECOND MOBILE PANTRY DATE IS PLANNED FOR SPRING 2021. ILLINI COMMUNITY HOSPITAL WILL ESTABLISH A HOSPITAL-BASED, NON-EMERGENCY MEDICAL TRANSPORTATION SERVICE FOR PERSONS REQUIRED TO TRAVEL TO LOCAL OR OUT-OF-AREA SERVICES. ILLINI COMMUNITY HOSPITAL WILL EXPLORE PARTNERSHIPS WITH SCHOOL DISTRICTS TO IDENTIFY THE MENTAL HEALTH SERVICE NEEDS OF YOUTH, DETERMINE HOW TO ADDRESS THOSE NEEDS, AND THEN ADDRESS THEM. THIS WAS DELAYED DUE TO THE COVID-19 PANDEMIC. ILLINI COMMUNITY HOSPITAL WILL ARRANGE FOR AND PRESENT CULTURE OF POVERTY EDUCATION AND AWARENESS PROGRAMS FOR ITS STAFF AND THE COMMUNITY. THIS WAS DELAYED DUE TO THE COVID-19 PANDEMIC. ILLINI COMMUNITY HOSPITAL WILL CONVENE MEETINGS AND DISCUSSIONS AMONG POTENTIAL LOCAL RESOURCES TO IDENTIFY THE SCOPE OF AVAILABLE SERVICES AND THEN MOVE FORWARD FROM THERE. THIS WAS DELAYED DUE TO THE COVID-19 PANDEMIC. ILLINI COMMUNITY HOSPITAL CREATED A COMMUNITY SOCIAL MEDIA CAMPAIGN PROMOTING MENTAL HEALTH SERVICES AWARENESS, TARGETING THE STIGMA OF SEEKING OR RECEIVING MENTAL HEALTHCARE. ILLINI COMMUNITY HOSPITAL WILL CONVENE AND HOST MEETINGS AT LEAST TWICE PER YEAR TO BRING TOGETHER COMMUNITY ORGANIZATIONS, AGENCIES, HEALTH SERVICES AND OTHERS TO IDENTIFY WHAT INITIATIVES ARE GOING ON IN THE COMMUNITY AND TO DISCUSS HOW THE GROUPS CAN HELP EACH OTHER. THIS WAS DELAYED DUE TO THE COVID-19 PANDEMIC.
FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 13BPATIENTS ARE ELIGIBLE FOR CATASTROPHIC FINANCIAL ASSISTANCE IF THEIR INCOME EXCEEDS 250% OF THE FEDERAL POVERTY GUIDELINES AND THEIR MEDICAL BILLS EXCEED 20% OF THEIR TOTAL REPORTED FAMILY INCOME. ELIGIBILITY IS BASED ON AN INDIVIDUAL'S FAMILY'S TOTAL INCOME, FAMILY SIZE, AND ASSETS. PATIENTS EXPERIENCING CATASTROPHIC MEDICAL INDIGENCE ARE ELIGIBLE FOR A DISCOUNT OF 85%.
FieldValueIRS element (for citing)
Facility1FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ILLINI COMMUNITY HOSPITAL RURAL HEABusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1321 WEST WASHINGTONAddressLine1Txt
CityPITTSFIELDCityNm
State AbbreviationILStateAbbreviationCd
ZIP62363ZIPCd
FieldValueIRS element (for citing)
FacilityRURAL HEALTH CLINICFacilityTxt

Supplemental Information Detail SupplementalInformationDetail (16 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART I, LINE 3CPATIENTS ARE ELIGIBLE FOR CATASTROPHIC FINANCIAL ASSISTANCE IF THEIR INCOME EXCEEDS 250% OF THE FEDERAL POVERTY GUIDELINES AND THEIR MEDICAL BILLS EXCEED 20% OF THEIR TOTAL REPORTED FAMILY INCOME. ELIGIBILITY IS BASED ON AN INDIVIDUAL'S OR FAMILY'S TOTAL INCOME, FAMILY SIZE AND ASSETS. PATIENTS EXPERIENCING CATASTROPHIC MEDICAL INDIGENCE ARE ELIGIBLE FOR AN 85% DISCOUNT.
SCHEDULE H, PART I, LINE 7GILLINI COMMUNITY HOSPITAL DOES NOT INCLUDE AS SUBSIDIZED HEALTH SERVICES ANY COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC.
SCHEDULE H, PART I, LINE 7, COLUMN (F)BAD DEBT EXPENSE OF 921,428 IS SUBTRACTED FROM TOTAL EXPENSES OF 28,798,801 REPORTED ON LINE 25, COLUMN A OF FORM 990, PART IX, FOR A NET TOTAL EXPENSE OF 27,877,373.
SCHEDULE H, PART I, LINE 7WHEN POSSIBLE, CALCULATIONS OF DIRECT AND INDIRECT COSTS ASSOCIATED WITH THE SERVICES PROVIDED ARE REPORTED. IF NOT AVAILABLE, A COST-TO-CHARGE RATIO IS USED TO CALCULATE THE COST AMOUNTS. THIS RATIO IS COMPUTED USING ILLINI COMMUNITY HOSPITAL'S AS-FILED MEDICARE COST REPORT. THESE COSTS AND CHARGES ARE ADJUSTED TO ACCOUNT FOR ITEMS NOT REIMBURSED THROUGH THE COST REPORT SUCH AS PROVIDER-BASED PHYSICIAN SERVICES.
SCHEDULE H, PART III, LINE 2METHODOLOGY USED TO DETERMINE BAD DEBT EXPENSE - BAD DEBT EXPENSE IS CALCULATED ON THE NET PATIENT ACCOUNT BALANCE AFTER THE BALANCE HAS BEEN REDUCED FOR ANY PAYMENTS RECEIVED OR DISCOUNTS/ADJUSTMENTS THAT ARE KNOWN. PATIENTS QUALIFYING FOR FINANCIAL ASSISTANCE ARE RECOGNIZED AS CHARITY CARE ACCOUNTS WHEN SUFFICIENT INFORMATION IS RECEIVED TO DETERMINE THEIR ELIGIBILITY. PRIOR TO THIS POINT, AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IS CALCULATED ON UNINSURED ACCOUNTS. THIS ALLOWANCE IS REVERSED IF THE ACCOUNT IS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE.
SCHEDULE H, PART III, LINE 3METHODOLOGY OF ESTIMATED AMOUNT & RATIONALE FOR INCLUDING IN COMMUNITY BENEFIT - A NUMBER OF PATIENTS ARE TRULY UNABLE TO PAY FOR THEIR MEDICAL EXPENDITURES BUT DO NOT COMPLETE THE PROCESS REQUIRED TO APPLY FOR FINANCIAL ASSISTANCE. THE HOSPITAL PERFORMS AN ASSESSMENT USING FINANCIAL AND OTHER INFORMATION OF SUCH PATIENTS OTHERWISE AVAILABLE TO THE HOSPITAL TO IDENTIFY THOSE PATIENTS THAT WOULD QUALIFY FOR CHARITY CARE IF THEY COMPLETED THE PAPERWORK. THIS INFORMATION IS USED TO ESTIMATE THE AMOUNT OF THE HOSPITAL'S BAD DEBT EXPENSE THAT WILL BE FOUND TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE. THE BAD DEBT EXPENSE WITH SUCH PATIENTS ACCOUNTS ARE TREATED AS COMMUNITY BENEFIT.
SCHEDULE H, PART III, LINE 4SEE NOTE (3) ON PAGE 17 OF THE ATTACHED AUDITED CONSOLIDATED FINANCIAL STATEMENTS.
SCHEDULE H, PART III, LINE 8THE HOSPITAL USES A COST-TO-CHARGE RATIO TO CALCULATE COST AMOUNTS. THIS RATIO IS COMPUTED USING ILLINI COMMUNITY HOSPITAL'S AS-FILED MEDICARE COST REPORT. THESE COSTS AND CHARGES ARE ADJUSTED TO ACCOUNT FOR ITEMS NOT REIMBURSED THROUGH THE COST REPORT SUCH AS PROVIDER-BASED PHYSICIAN SERVICES. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT.
SCHEDULE H, PART III, LINE 9BCOLLECTION PRACTICES ARE NOT PURSUED IF A COMPLETED FINANCIAL ASSISTANCE APPLICATION HAS BEEN RETURNED AND APPROVED.
SCHEDULE H, PART VI, LINE 2THE CHNA WAS CONDUCTED WITH ILLINI COMMUNITY HOSPITAL THROUGH A CONSULTING ARRANGEMENT WITH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (ICAHN). A LARGE CROSS SECTION OF COMMUNITY PARTNERS WERE REPRESENTED (GEOGRAPHIC, AGE, SOCIOECONOMIC, ETC.) THAT INCLUDED THE SCHOOL NURSES OF PIKE COUNTY AS WELL AS REPRESENTATIVES FROM THE PIKE COUNTY HEALTH DEPARTMENT.
SCHEDULE H, PART VI, LINE 3BLESSING HOSPITAL FINANCIAL ACCOUNT SPECIALISTS (FAS) ATTEMPT TO CONTACT SELF-PAY INPATIENTS WITHIN 24 HOURS OF ADMISSION. IF THIS ATTEMPT TO MEET WITH THE PATIENT IS UNSUCCESSFUL, FURTHER ATTEMPTS ARE MADE LATER DURING THEIR STAY OR AT THEIR HOME. THE PATIENT IS SCREENED FOR GOVERNMENT PROGRAMS AND ELIGIBILITY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. OUTPATIENTS ARE CONTACTED ONCE THE PATIENT'S CONDITION HAS BEEN STABILIZED AND ARE SCREENED IN THE SAME MANNER AS INPATIENTS. FOR SCHEDULED TESTING, FAS CONTACT UNINSURED PATIENTS PRIOR TO THEIR SERVICE AND PROVIDE ESTIMATES OF CHARGES AND EDUCATION ON AVAILABLE PROGRAMS. IF THE FAS ARE NOT AVAILABLE TO MEET WITH THE PATIENT PRIOR TO SERVICE, CONTACT INFORMATION IS GIVEN TO THE PATIENT IF ASSISTANCE IS NEEDED.
SCHEDULE H, PART VI, LINE 4ILLINI COMMUNITY HOSPITAL OPENED ITS DOORS ON JANUARY 26, 1942 TO SERVE THE PEOPLE RESIDING WITHIN A 25 MILE RADIUS OF PITTSFIELD, ILLINOIS, WHICH IS PRIMARILY PIKE COUNTY BUT INCLUDES PARTS OF SCOTT, GREEN, CALHOUN, BROWN, AND ADAMS COUNTY. PIKE COUNTY HAS 831 SQUARE MILES OF LAND AREA AND A POPULATION OF APPROXIMATELY 15,561 PEOPLE. PIKE COUNTY AGE DEMOGRAPHICS INCLUDE 22.5% UNDER 18 YEARS OLD, AND 21.3% OVER 65 YEARS OLD. 50.0% OF THE RESIDENTS ARE FEMALE, 97.0% CAUCASIAN AND 1.5% AFRICAN-AMERICAN. 88.7% OF THE POPULATION HAVE GRADUATED FROM HIGH SCHOOL AND 17.8% HAVE A BACHELORS DEGREE OR HIGHER. THE MEDIAN HOUSEHOLD INCOME IS 47,492 AND 14.4% OF THE POPULATION IS BELOW THE POVERTY LEVEL. PIKE COUNTY IS DESIGNATED AS A HEALTH PROFESSIONALS SHORTAGE AREA AND MEDICALLY UNDERSERVED AREA. THE UNEMPLOYMENT RATE IN PIKE COUNTY WAS 4.2% IN JANUARY 2020. THE REGIONS ECONOMY IS HEAVILY AGRICULTURAL WITH RETAIL AND TOURISM ASSOCIATED WITH DEER HUNTING. ILLINI COMMUNITY HOSPITAL IS ONE OF THE LARGEST EMPLOYERS IN THE COUNTY WITH 251 EMPLOYEES.
SCHEDULE H, PART VI, LINE 5ILLINI COMMUNITY HOSPITAL OFFERS A WIDE RANGE OF SERVICES IMPORTANT TO PROMOTING THE HEALTH AND WELL-BEING OF PIKE COUNTY AND THE SURROUNDING AREA. ILLINI COMMUNITY HOSPITAL OPERATES AN EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF THE ABILITY TO PAY. THE FINANCIAL ASSISTANCE POLICY OF ILLINI COMMUNITY HOSPITAL ENABLES PATIENTS TO HAVE ACCESS TO AREA RESOURCES TO ASSIST THEM WITH PAYMENT OF MEDICAL EXPENSES. ILLINI COMMUNITY HOSPITAL IS THE LARGEST EMPLOYER IN THE AREA WITH 251 EMPLOYEES. OF SIGNIFICANT IMPORTANCE IS THE VOLUNTEERS THAT SERVE THE HOSPITAL. IN FISCAL YEAR 2020, ILLINI COMMUNITY HOSPITAL HAD 36 ACTIVE VOLUNTEERS. IN ADDITION TO THE VOLUNTEERS ACTIVELY WORKING IN THE HOSPITAL, ILLINI COMMUNITY HOSPITAL'S BOARD OF TRUSTEES IS COMPRISED OF VOLUNTEERS THAT INCLUDES BUSINESS LEADERS, PHYSICIANS, AND OTHER COMMUNITY LEADERS.
SCHEDULE H, PART VI, LINE 6BLESSING CORPORATE SERVICES, INC. IS THE PARENT ORGANIZATION OF A GROUP OF RELATED ORGANIZATIONS AND PROVIDES OVERALL DIRECTION TO ALL ENTITIES WITHIN THE STRUCTURE. DURING THE YEAR ENDED SEPTEMBER 30, 2005, BLESSING CORPORATE SERVICES, INC. BEGAN OPERATING A DIVISION COMPRISED OF PRACTICING PHYSICIANS. THE GROUP IS RELATED BY BLESSING CORPORATE SERVICES, INC. CONTROL OVER THE RELATED ORGANIZATION'S BOARD. THE FOLLOWING IS A BRIEF DESCRIPTION OF EACH MEMBER OF THE GROUP: ORGANIZATION - BLESSING HOSPITAL (HOSPITAL), LOCATED IN QUINCY, ILLINOIS, IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF WESTERN ILLINOIS, NORTHEASTERN MISSOURI, AND SOUTHEASTERN IOWA. THE HOSPITAL WAS INCORPORATED IN ILLINOIS IN 1875. ORGANIZATION - THE BLESSING FOUNDATION, INC. SERVES BLESSING CORPORATE SERVICES AND ITS AFFILIATED ENTITIES BY PROVIDING FINANCIAL SUPPORT FOR SERVICES AND PROGRAMS PROMOTING THE IMPROVEMENT AND AVAILABILITY OF HEALTHCARE SERVICES WITHIN THE GENERAL COMMUNITY. ORGANIZATION - DENMAN SERVICES, INC. (A TAXABLE CORPORATION) ENGAGES PRIMARILY IN THE BUSINESS OF SELLING AND RENTING MEDICAL EQUIPMENT AND OPERATING A COMMERCIAL LAUNDRY. DENMAN SERVICES, INC. IS A WHOLLY OWNED SUBSIDIARY OF BLESSING CORPORATE SERVICES, INC. ORGANIZATION - BLESSINGCARE CORPORATION DBA ILLINI COMMUNITY HOSPITAL, LOCATED IN PITTSFIELD, ILLINOIS, IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF WESTERN ILLINOIS. THE HOSPITAL WAS INCORPORATED ON JANUARY 20, 2000. ORGANIZATION - ILLINI HEALTH SERVICES, LLC CONDUCTS A PHARMACY BUSINESS IN PITTSFIELD, ILLINOIS. THE PHARMACY IS OWNED NINETY-FIVE PERCENT (95%) BY DENMAN SERVICES, INC. AND FIVE PERCENT (5%) BY BLESSINGCARE CORPORATION DBA ILLINI COMMUNITY HOSPITAL. ORGANIZATION - CHS HOLDING COMPANY (A TAXABLE ORGANIZATION) PROVIDES HEALTH INSURANCE PRODUCTS AND SERVICES. ORGANIZATION - BLESSING WALK-IN CLINIC, LLC DBA BLESSING CONVENIENT CARE OPERATES HEALTH CLINICS IN RETAIL FACILITIES. ORGANIZATION - CROSSRIVER QUALITY HEALTH PARTNERS IS A CLINICALLY INTEGRATED NETWORK FOCUSED ON IMPROVING QUALITY AND EFFICENCY OF PATIENT CARE ACROSS ILLINOIS, MISSOURI, AND IOWA. IT IS A WHOLLY OWNED SUBSIDIARY OF BLESSING CORPORATE SERVICES, INC. ORGANIZATION - BLESSING ASSURANCE COMPANY IS A WHOLLY OWNED FOREIGN SUBSIDIARY OF BLESSING CORPORATE SERIVCES, INC. AND IS A PROVIDER OF SELF- INSURANCE TO THE AFFILIATED GROUP. ORGANIZATION - THE HANNIBAL CLINIC, INC. IS A GROUP OF HEALTH CARE PROVIDERS SERVING NORTHEAST MISSOURI AND WEST CENTRAL ILLINOIS. IT IS A WHOLLY OWNED SUBSIDIARY OF BLESSING CORPORATE SERVICES, INC. ORGANIZATION - THE BROWN DRUG COMPANY (A TAXABLE ORGANIZATION) OPERATES A RETAIL PHARMACY.
SCHEDULE H, PART VI, LINE 7ILLINOIS
SCHEDULE H, PART VIPART I, LINE 6B - ILLINI COMMUNITY HOSPITAL'S COMMUNITY BENEFIT REPORT IS PUBLISHED IN THE LOCAL NEWSPAPER AS AN INSERT AND IS AVAILABLE ON THE HOSPITAL'S WEBSITE @ WWW.BLESSINGHEALTH.ORG

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)

TitleTitleTxtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtBase Compensation Filing OrgBaseCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountOther Compensation Filing OrgOtherCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmt
MAUREEN A KAHN
SECRETARY$705,745$292,151$43,620$76,000$32,845$1,150,361
PATRICK M GERVELER
TREASURER$431,863$154,971$23,924$99,000$31,625$733,295
KATHLEEN E HULL
ADMINISTRATOR$214,885$81,162$7,810$14,000$27,764$341,394
CHRISTOPHER S WAGONER MD
PRES - MED STAFF$273,750$8,000$1,781$8,696$26,193$315,764
HOLLY A JONES
ASST ADMINISTRATOR$147,699$18,029$2,404$8,628$21,248$196,212
LYNDELL LOMAX
NURSE PRACTITIONER$140,716$2,853$6,045$4,554$25,087$177,705
CAITLIN M HOLLAND
LEAD PHARMACIST$158,306$360$866$8,106$11,054$176,899
GINGER L TORREZ
NURSE PRACTITIONER$120,327$348$6,647$6,485$24,998$157,344
KAYLA L HILL
PHARMACIST$131,863$345$1,977$6,510$11,659$150,653

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE J, PAGE 1, PART I, LINE 3FormAndLineReferenceDesc
ExplanationRELATED ORG METHODS USED FOR COMPENSATION EXPLANATION COMPENSATION OF ORGANIZATION'S CEO - EXECUTIVE DIRECTOR - KATHLEEN HULL IS AN EMPLOYEE OF BLESSING CORPORATE SERVICES, INC., THE PARENT COMPANY OF BLESSINGCARE CORPORATION. COMPARABILITY DATA PROVIDED BY A THIRD PARTY IS USED TO ESTABLISH A MARKET RANGE OF COMPENSATION. THIS INFORMATION IS SUBMITTED TO THE PRESIDENT OF BLESSING CORPORATE SERVICES FOR REVIEW AND TO THE BLESSING CORPORATE SERVICES BOARD OF TRUSTEES COMPENSATION COMMITTEE FOR APPROVAL. COMPENSATION OF ORGANIZATION'S BOARD MEMBERS - MAUREEN KAHN AND PATRICK GERVELER ARE EMPLOYEES OF BLESSING CORPORATE SERVICES, INC., THE PARENT COMPANY OF BLESSINGCARE CORPORATION DBA ILLINI COMMUNITY HOSPITAL. COMPARABILITY DATA PROVIDED BY A THIRD PARTY IS USED TO ESTABLISH A MARKET RANGE OF COMPENSATION. THIS INFORMATION IS SUBMITTED TO THE BLESSING CORPORATE SERVICES BOARD OF TRUSTEES COMPENSATION COMMITEE FOR APPROVAL.ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF PITTSFIELDBusinessNameLine1Txt
Business Name Line2PROJECT REVENUE BONDS SERIES 2015BusinessNameLine2Txt
FieldValueIRS element (for citing)
Bond Issuer EIN370817800BondIssuerEIN
Bond Issued2015-05-12BondIssuedDt
Issue Price$3,000,000IssuePriceAmt
PurposeCONSTRUCTION CONSTRUCTION OF HOSPITAL GERIATRIC PSYCHIATRY SERVICE UNIT LOCATED ON WEST WASHINGTON SPurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingfalsePoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$415,015RetiredAmt
Total Proceeds$2,156,326TotalProceedsAmt
Issuance Costs From Proceeds$37,000IssuanceCostsFromProceedsAmt
Capital Expenditures$2,119,326CapitalExpendituresAmt
Substantial Completion2016SubstantialCompletionYr
Refunding Tax Exempt BondsfalseRefundingTaxExemptBondsInd
Refunding Taxable BondsfalseRefundingTaxableBondsInd
Final Allocation MadeYes (true)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsfalseAnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropfalseMgmtContractBondFincdPropInd
Any Research AgreementsfalseAnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt TestYes (true)BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed PropfalseChangeInUseBondFinancedPropInd
Procs Nonqualified Bond RemdtdYes (true)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetfalseRebateNotDueYetInd
Exception To RebateYes (true)ExceptionToRebateInd
No Rebate DuefalseNoRebateDueInd
Variable Rate IssueYes (true)VariableRateIssueInd
Hedge Identified In Bks And RecfalseHedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (true)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (true)ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePURPOSE OF ISSUE DESCRIPTIONFormAndLineReferenceDesc
ExplanationCITY OF PITTSFIELD CONSTRUCTION CONSTRUCTION OF HOSPITAL GERIATRIC PSYCHIATRY SERVICE UNIT LOCATED ON WEST WASHINGTON STREET IN PITTSFIELD, ILLINOIS.ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
JOHN HULL
FAMILY MEMBER$63,202EMPLOYMENTfalse
JESSICA L HULL
FAMILY MEMBER$50,520EMPLOYMENTfalse
KATHLEEN E SIDWELL
FAMILY MEMBER$51,967EMPLOYMENTfalse

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 2, PART III, LINE 4AILLINI COMMUNITY HOSPITAL TREATED PATIENTS THROUGH THE FOLLOWING SERVICES DURING FISCAL YEAR 2020: INPATIENT ADMISSIONS 515 OBSERVATION ADMISSIONS 216 OUTPATIENT VISITS 73,009 TOTAL SURGERIES 212 EMERGENCY VISITS 4,871 LABORATORY TESTS 65,002 RESPIRATORY TREATMENTS 1,843 RADIOLOGY PROCEDURES 9,302 RURAL HEALTH CLINIC & XPRESS VISITS 13,828 IN ADDITION TO THESE HEALTHCARE SERVICES, ILLINI COMMUNITY HOSPITAL PROVIDED 587,585 IN CHARITY CARE AND INCURRED MEDICARE SHORTFALLS OF 770,355. THE HOSPITAL PROVIDED ADDITIONAL BENEFITS DURING FISCAL YEAR 2020 AS FOLLOWS: 1)HEALTH PROFESSIONALS EDUCATION - 79,326 HEALTHCARE STUDENT INTERNSHIPS NURSE PRACTITIONER CLINICALS RADIOLOGY CLINICALS 2)IN-KIND CONTRIBUTIONS AND DONATIONS - 21,830 COURTESY BLOOD DRAWS FOR AREA PUBLIC AGENCIES PIKE CEO PROGRAM PIKE COUNTY MINISTERIAL ALLIANCE DONATED MEETING ROOM SPACE HEALTH FAIRS HEALTH SCREENINGS GED PARTNERS BARRY YMCA 3)COMMUNITY HEALTH IMPROVEMENT PROGRAMS AND SERVICES - 30,648 FLU CLINICS PIKELAND WELLNESS COMMITTEE BLOOD AND PLATELET DRIVES SPORTS INJURY CLINIC UNREIMBURSED PATIENT TRANSPORTATION DRUG TAKE BACK KIOSK 4)COMMUNITY EDUCATIONAL PROGRAMS AND SERVICES - 30,567 DESTRUCTIVE DECISIONS EDUCATIONAL PROGRAM ALCS AND BLS CLASSES DIABETES COACHING
FORM 990, PAGE 6, PART VI, LINE 3BLESSING CORPORATE SERVICES PROVIDES GENERAL MANAGEMENT SERVICES.
FORM 990, PAGE 6, PART VI, LINE 6BLESSING CORPORATE SERVICES, INC., AN ILLINOIS NOT FOR PROFIT CORPORATION, IS THE SOLE VOTING MEMBER OF BLESSINGCARE CORPORATION, DBA ILLINI COMMUNITY HOSPITAL.
FORM 990, PAGE 6, PART VI, LINE 7ABLESSING CORPORATE SERVICES, INC., THE SOLE VOTING MEMBER OF BLESSINGCARE CORPORATION, SHALL POSSESS THE RIGHTS AND RESPONSIBILITIES TO APPOINT AND/OR REMOVE ALL THE TRUSTEES OF THE CORPORATION, AND APPOINT THE CORPORATION'S PRESIDENT.
FORM 990, PAGE 6, PART VI, LINE 7BBLESSING CORPORATE SERVICES, INC., THE SOLE VOTING MEMBER OF BLESSINGCARE CORPORATION, SHALL POSSESS THE RIGHTS AND RESPONSIBILITIES TO APPROVE EXPRESSLY ALL AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS BEFORE THEY MAY BECOME EFFECTIVE; APPROVE CAPITAL AND OPERATING BUDGETS, LONG-TERM DEBT, LONG-RANGE PLANS, THE SALE OR PURCHASE OF REAL ESTATE AND CONTRACTS ENTERED INTO BY THE CORPORATION, THE REASONABLE VALUE OF WHICH EXCEEDS AN AMOUNT SPECIFIED IN THE BYLAWS OF THE MEMBER; APPROVE MATERIAL INVESTMENT DECISIONS, INCLUDING WITHOUT LIMITATION ESTABLISHMENT AND MODIFICATION OF INVESTMENT POLICIES, ENGAGEMENT AND REMOVAL OF INVESTMENT MANAGERS AND ADVISORS, AND CHANGES IN INVESTMENT ALLOCATIONS NOT PERMITTED BY AN EXISTING INVESTMENT POLICY; APPROVE THE PARAMETERS FOR TERMS OF EMPLOYMENT OF PHYSICIANS, INCLUDING PHYSICIAN COMPENSATION PLANS, AND ANY MATERIAL VARIANCES FROM SUCH PARAMETERS FOR INDIVIDUAL PHYSICIANS; APPROVE THE SELECTION OF AUDITORS AND LEGAL COUNSEL; APPROVE CHARITY CARE AND COMMUNITY BENEFITS-RELATED POLICIES; APPROVE THE FORMATION OF SUBSIDIARY ENTITIES AND/OR JOINT VENTURES; APPROVE THE FILING OF A PETITION IN BANKRUPTCY, MAKING AN ASSIGNMENT FOR THE BENEFIT OF CREDITORS, OR APPLYING FOR PROTECTION UNDER ANY INSOLVENCY LAWS; APPROVE THE PARTICIPATION IN ANY MERGER, COMBINATION, CONSOLIDATION, LIQUIDATION, DISSOLUTION OR OTHER CORPORATE OR BUSINESS ENTITY RESTRUCTURING, AND HAVE THE POWER TO COMPEL THE CORPORATION TO ENFORCE AND/OR PERFORM ANY CONTRACTUAL OBLIGATION.
FORM 990, PAGE 6, PART VI, LINE 11BFOLLOWING MANAGEMENT AND LEGAL REVIEW, THE FORM 990 WAS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW AND COMMENT PRIOR TO FILING.
FORM 990, PAGE 6, PART VI, LINE 12CA COPY OF THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED ANNUALLY TO OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES TO BE READ, SIGNED, AND RETURNED TO THE ORGANIZATION. THE SIGNED POLICIES ARE RETAINED IN THE CORPORATE ADMINISTRATIVE FILES. IN ADDITION, EACH OFFICER, DIRECTOR, OR TRUSTEE IS REQUIRED TO DECLARE NO CONFLICT OF INTEREST IN REGARDS TO AGENDA ITEMS BEING PRESENTED AT THE START OF EACH MONTHLY BOARD MEETING.
FORM 990, PAGE 6, PART VI, LINE 19THESE DOCUMENTS ARE LOCATED IN THE HOSPITAL'S ADMINISTRATIVE OFFICES AND ARE AVAILABLE UPON REQUEST FOR PUBLIC INSPECTION.
FORM 990, PART XI, LINE 9990-T DEPRECIATION 0 ILLINI HEALTH SERVICES K1 -3,118 TOTAL -3,118

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtBusiness Name Line2DirectControllingEntityName/BusinessNameLine2Txt
BLESSING CORPORATE SERVICES INC
BROADWAY AT 11TH PO BOX 7005QUINCYIL623057005371128706MGMT SVCSIL501C310N/Afalse
BLESSING HOSPITAL
1005 BROADWAYQUINCYIL62301370661183NON-PROFITIL501C33falseBCS INCBLESSING CORPORATE SERVICES INC
BLESSING AFFILIATES INC
BROADWAY AT 11TH PO BOX 7005QUINCYIL623057005371128708INACTIVEIL501C310falseBCS INCBLESSING CORPORATE SERVICES INC
THE BLESSING FOUNDATION INC
PO BOX 7005QUINCYIL62301371128705FUNDRAISEIL501C312BfalseBCS INCBLESSING CORPORATE SERVICES INC
BLESSING WALK-IN CLINIC LLC
1005 BROADWAYQUINCYIL62301814181593MED SVCSIL501C33falseBCS INC
BLESSINGCARE CORPORATION - MISSOURI
1005 BROADWAYQUINCYIL62301431371818INACTIVEMO501C33falseBCS INCBCS INC

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtBusiness Name Line2DirectControllingEntityName/BusinessNameLine2TxtPredominant Income TypePredominantIncomeTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerIndOwnershipOwnershipPct
ILLINI HEALTH SERVICES LLC
PO BOX 40QUINCYIL623060040470901851PHARMACYILDENMANDENMANUNRELATED$3,118$56,069falsefalse0.05000
CURRENT HEALTH NETWORK LLC
1005 BROADWAYQUINCYIL62301811681509PRVDR NTWKILCHS HLDGSfalsefalse
NORTHEAST MISSOURI AMBULATORY SURGE
98 MEDICAL DRIVEHANNIBALMO634010511431857277MED SVCSMOHANNIBALfalsefalse

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmProvince Or StateForeignAddress/ProvinceOrStateNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
DENMAN SERVICES INC
BROADWAY AT 11TH PO BOX 40QUINCYIL62306371132117MED EQUIPILBCS INCC CORPfalse
CHS HOLDING COMPANY
1005 BROADWAYQUINCYIL62301320481381GRP HLTHILBCS INCC CORPfalse
HANNIBAL CLINIC INC
100 MEDICAL DRIVEHANNIBALMO63401431033473MED SVCSMOBCS INCC CORPfalse
BLESSING ASSURANCE COMPANY
981454767SELF-INSURBCS INCC CORPfalsePO BOX 1159GRAND CAYMANCAYMAN ISLANDSCJKY1-1102CJ
BROWN DRUG COMPANY
1121 MAINE STQUINCYIL62301370193505PHARMACYILBCS INCS CORPfalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (true)LoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangeYes (true)AssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

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