MENDOTA COMMUNITY HOSPITAL: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
MENDOTA COMMUNITY HOSPITAL (EIN 36-2167785)
Tax period
2017-10-01 to 2018-09-30
Filed
2019-08-12
IRS object ID
201912249349301246
Schema version
2017v2.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2019-08-12T13:31:00-05:00ReturnTs
Tax Period End2018-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN350921680PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CROWE LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line19600 Brownsboro Road Suite 400AddressLine1Txt
CityLouisvilleCityNm
State AbbreviationKYStateAbbreviationCd
ZIP402411122ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN362167785EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Mendota Community HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMENDBusinessNameControlTxt
Phone8155397461PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11201 E 12TH STREETAddressLine1Txt
CityMENDOTACityNm
State AbbreviationILStateAbbreviationCd
ZIP61342ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMichael M AllenPersonNm
Person TitleCFOPersonTitleTxt
Signature2019-08-12SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonRachel SpurlockPreparerPersonNm
PTINP00520729PTIN
Phone5023263996PhoneNum
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1OSF Saint Paul Medical CenterBusinessNameLine1Txt

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1Michael AllenBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11201 E 12TH STREETAddressLine1Txt
CityMENDOTACityNm
State AbbreviationILStateAbbreviationCd
ZIP61342ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$36,382,154GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.osfhealthcare.org/practices/44/1217/osf-saint-paul-medical-centerWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1944FormationYr
Legal Domicile StateILLegalDomicileStateCd
Activity Or MissionIN 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 Body9VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee190TotalEmployeeCnt
Total Volunteers101TotalVolunteersCnt
Total Gross UBI$1,997TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$173,360PYContributionsGrantsAmt
CY Contributions Grants$40,196CYContributionsGrantsAmt
PY Program Service Revenue$34,424,460PYProgramServiceRevenueAmt
CY Program Service Revenue$36,040,571CYProgramServiceRevenueAmt
PY Investment Income-$3,449PYInvestmentIncomeAmt
CY Investment Income$8,945CYInvestmentIncomeAmt
PY Other Revenue$302,419PYOtherRevenueAmt
CY Other Revenue$248,927CYOtherRevenueAmt
PY Total Revenue$34,896,790PYTotalRevenueAmt
CY Total Revenue$36,338,639CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$15,192,798PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$15,432,961CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$20,004,424PYOtherExpensesAmt
CY Other Expenses$20,355,001CYOtherExpensesAmt
PY Total Expenses$35,197,222PYTotalExpensesAmt
CY Total Expenses$35,787,962CYTotalExpensesAmt
PY Revenues Less Expenses-$300,432PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$550,677CYRevenuesLessExpensesAmt
Total Assets BOY$39,016,514TotalAssetsBOYAmt
Total Assets EOY$34,342,051TotalAssetsEOYAmt
Total Liabilities BOY$37,781,164TotalLiabilitiesBOYAmt
Total Liabilities EOY$33,058,937TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,235,350NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,283,114NetAssetsOrFundBalancesEOYAmt
MissionIN 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 SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$28,644,485ExpenseAmt
Revenue$36,244,756RevenueAmt
DescMENDOTA COMMUNITY HOSPITAL PROVIDED 25 BEDS IN FISCAL YEAR 2018. THIS HOSPITAL GAVE $648,646 IN CHARITY CARE, AND PROVIDED 4,549 MEALS ON WHEELS TO MEMBERS OF OUR COMMUNITY. THE NET COMMUNITY BENEFIT EXPENSE FOR MEALS ON WHEELS WAS $28,934. MENDOTA COMMUNITY HOSPITAL OFFERS FLU AND IMMUNIZATION CLINICS ALONG WITH MANY OTHER CLINICS IN MENDOTA AND OTHER OUTREACH COMMUNITIES. THE HOSPITAL HELD CPR CLASSES, DIABETIC SUPPORT GROUPS, PROVIDED FREE DIABETIC AND NUTRITION EDUCATION CLASSES, AND OFFERED SEVERAL OTHER PROGRAMS THROUGHOUT THE YEAR. THE NET COMMUNITY BENEFIT EXPENSE FOR THESE PROGRAMS WAS $20,085.Desc
Total Program Service Expenses$28,644,485TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
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 BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
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 Document9IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee190EmployeeCnt
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 OfYes (true)Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
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 AddressYes (true)OfficerMailingAddressInd
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 CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldILStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Michael AllenBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone8155397461PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1800 NE GLEN OAK AVEAddressLine1Txt
CityPEORIACityNm
State AbbreviationILStateAbbreviationCd
ZIP61603ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (35 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Sister Diane Marie McGrew OSF
President and Treasurer1.047.0Yes (X)Yes (X)$0$5,200$0
Sister Judith Ann Duvall OSF
Chairperson1.047.0Yes (X)Yes (X)$0$5,200$0
Robert C Sehring
Vice Chairperson CEO1.047.0Yes (X)Yes (X)$0$849,531$68,240
Kevin D Schoeplein
Partial Year - Vice Chairperson CEO1.047.0Yes (X)Yes (X)$0$1,721,678$258,783
Sister Theresa Ann Brazeau OSF
Secretary1.047.0Yes (X)Yes (X)$0$5,200$0
Sister Agnes Joseph Williams OSF
Assistant Secretary1.047.0Yes (X)Yes (X)$0$5,200$0
Sister Rose Therese Mann OSF
Board Member1.047.0Yes (X)$0$0$0
Gerald J McShane MD
Board Member1.046.0Yes (X)$0$695,330$64,289
Sister M Mikela Meidl FSGM
Board Member1.047.0Yes (X)$0$0$0
Brian Silverstein MD
Board Member1.07.0Yes (X)$0$45,000$0
Michael M Allen
CFO1.046.0Yes (X)$0$560,425$53,654
Anthony M Avellino MD
Partial Year - CEO NSSL/INI1.045.0Yes (X)$0$976,761$60,536
Kenneth E Berkovitz MD
Partial Year - CEO CVSL1.045.0Yes (X)$0$722,055$42,012
Chad E Boore
Chief Executive Officer Eastern Region1.045.0Yes (X)$0$317,270$39,387
Robert L Brandfass
SVP Chief Legal Officer1.045.0Yes (X)$0$519,421$64,040
Michelle D Conger
Chief Strategy Officer1.045.0Yes (X)$0$449,874$38,959
Roxanna Crosser
Chief Executive Officer Western Region1.045.0Yes (X)$0$314,792$40,905
Michael A Cruz MD
Chief Executive Officer Central Region1.045.0Yes (X)$0$597,403$67,230
John R Evancho
SVP Chief Compliance Officer1.045.0Yes (X)$0$256,009$45,584
Thomas G Hammerton
President OSF Healthcare Foundation Chief Development Officer1.047.0Yes (X)$0$362,569$46,481
Stephen E Hippler MD
Chief Clinical Officer1.045.0Yes (X)$0$541,637$67,183
John C Horne
SVP Chief Supply Chain Officer1.045.0Yes (X)$0$345,142$51,666
Divya-Devi Joshi
CEO Children SL1.045.0Yes (X)$0$497,362$26,209
James J Mormann
Chief Information Officer1.045.0Yes (X)$0$544,589$60,270
David A Schertz
Partial Year - CEO Northern Region1.045.0Yes (X)$0$579,694$43,726
Dwight D Stapleton
Vice President Clinical Specialty Services1.045.0Yes (X)$0$400,979$27,523
Jeffry M Tillery
SVP Chief Transformation Officer1.045.0Yes (X)$0$513,402$61,306
Lori L Wiegand
Chief Nursing Officer1.045.0Yes (X)$0$382,846$61,596
Leon A Yeh MD
VP CMO Emergency Serv1.045.0Yes (X)$0$523,837$59,971
Jane A Battles
APN40.00$109,162$0$27,542Yes (X)
Marcia S Flessner
Special Projects Coordinator40.00$172,369$0$20,530Yes (X)
Kenneth K Potts MD
Physician40.00$221,963$0$31,577Yes (X)
Katherine R Riva-Foster MD
Physician40.00$212,910$0$30,428Yes (X)
Daniel E Baker
Former CFO0.00.0$0$2,154,132$160,530Yes (X)
Kenneth J Natzke
Former CEO East Region0.00.0$0$528,533$47,343Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$716,405TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$15,421,070TotReportableCompRltdOrgAmt
Total Other Compensation$1,667,499TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K4IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Emergency Physician Staffing Solutions
1504 Timber TrailWashingtonIL61571Emergency Services Physicians$1,211,146
ER Doctors LTD
7 Wood Duck LaneOttawaIL61350Emergency Room Services$711,833
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt
Info In Schedule O Part VIIIYes (X)InfoInScheduleOPartVIIIInd
Federated Campaigns$0FederatedCampaignsAmt
Membership Dues$0MembershipDuesAmt
Fundraising$0FundraisingAmt
Related Organizations$28,420RelatedOrganizationsAmt
Government Grants$0GovernmentGrantsAmt
All Other Contributions$11,776AllOtherContributionsAmt
Noncash Contributions$0NoncashContributionsAmt
Total Contributions$40,196TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
PATIENT REVENUE622110$34,383,501$34,383,501$0$0
CONTRACTED PHARMACY622110$1,620,492$1,620,492$0$0
MEDICAL DIRECTORSHIPS624200$36,578$36,578$0$0
$0$0$0$0
$0$0$0$0

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$36,040,571TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$7,109TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$7,109ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$33,677RealAmt
Personal$0PersonalAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$33,677RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$33,677TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$33,677ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$1,836OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$1,836OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,836TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$1,836ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$0ContriRptFundraisingEventAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$52,583GrossSalesOfInventoryAmt
Cost Of Goods Sold$43,515CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$9,068TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$9,068ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
CAFETERIA624200$59,377$59,377$0$0
$0$0$0$0
$0$0$0$0

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$146,805TotalRevenueColumnAmt
Related Or Exempt Func Income$144,808RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$1,997UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$206,182OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$36,338,639TotalRevenueColumnAmt
Related Or Exempt Func Income$36,244,756RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$1,997UnrelatedBusinessRevenueAmt
Exclusion$51,690ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$12,000,238TotalAmt
Program Services$9,794,371ProgramServicesAmt
Management And General$2,205,867ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$368,728TotalAmt
Program Services$300,949ProgramServicesAmt
Management And General$67,779ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,563,976TotalAmt
Program Services$2,147,816ProgramServicesAmt
Management And General$416,160ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$500,019TotalAmt
Program Services$408,107ProgramServicesAmt
Management And General$91,912ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$77,000TotalAmt
Management And General$77,000ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$14,659TotalAmt
Management And General$14,659ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,357,115TotalAmt
Program Services$2,316,652ProgramServicesAmt
Management And General$40,463ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$3,062,635TotalAmt
Program Services$2,829,042ProgramServicesAmt
Management And General$233,593ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$387,738TotalAmt
Program Services$48,892ProgramServicesAmt
Management And General$338,846ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$113,700TotalAmt
Program Services$77,166ProgramServicesAmt
Management And General$36,534ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$9,833TotalAmt
Program Services$9,432ProgramServicesAmt
Management And General$401ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$2,960,216TotalAmt
Program Services$2,350,115ProgramServicesAmt
Management And General$610,101ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$5,237,817TotalAmt
Program Services$3,620,090ProgramServicesAmt
Management And General$1,617,727ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,831,935TotalAmt
Program Services$1,454,373ProgramServicesAmt
Management And General$377,562ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$136,048TotalAmt
Program Services$23,538ProgramServicesAmt
Management And General$112,510ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
CONTRACTS AND REPAIRS$2,234,002$1,390,994$843,008
BAD DEBTS$1,131,798$1,131,798
PROVIDER TAX$628,122$628,122
COLLECTION FEES$112,161$112,161

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$60,222TotalAmt
Program Services$867ProgramServicesAmt
Management And General$59,355ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$35,787,962TotalAmt
Program Services$28,644,485ProgramServicesAmt
Management And General$7,143,477ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,031,673BOYAmt
EOY$1,192,506EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$3,510,129BOYAmt
EOY$127,936EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$6,426,526BOYAmt
EOY$5,605,973EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$721,224BOYAmt
EOY$775,070EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$439,904BOYAmt
EOY$113,426EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$52,298,191LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$38,463,259LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$14,307,096BOYAmt
EOY$13,834,932EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$52,980BOYAmt
EOY$74,420EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$12,526,982BOYAmt
EOY$12,617,788EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$39,016,514BOYAmt
EOY$34,342,051EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,264,111BOYAmt
EOY$2,890,403EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$29,909,200BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,607,853BOYAmt
EOY$30,168,534EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$37,781,164BOYAmt
EOY$33,058,937EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$473,761BOYAmt
EOY-$516,803EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,088,602BOYAmt
EOY$1,179,408EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$620,509BOYAmt
EOY$620,509EOYAmt

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,235,350BOYAmt
EOY$1,283,114EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$39,016,514BOYAmt
EOY$34,342,051EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$550,677ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$0NetUnrlzdGainsLossesInvstAmt
Donated Services And Use Fclts$0DonatedServicesAndUseFcltsAmt
Investment Expense$0InvestmentExpenseAmt
Prior Period Adjustments$0PriorPeriodAdjustmentsAmt
Other Changes In Net Assets-$502,913OtherChangesInNetAssetsAmt
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 RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$14,659OtherActivitiesAmt
Total Lobbying Expenditures$14,659TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITYTHE ORGANIZATION'S LOBBYING ACTIVITIES INCLUDE PAYING MEMBERSHIP DUES TO THE ILLINOIS HOSPITAL ASSOCIATION AND AMERICA HOSPITAL ASSOCIATION, WHO PARTICIPATE IN LOBBYING ACTIVITIES.
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITYTHE ORGANIZATION'S LOBBYING ACTIVITIES INCLUDE PAYING MEMBERSHIP DUES TO THE ILLINOIS HOSPITAL ASSOCIATION AND AMERICA HOSPITAL ASSOCIATION, WHO PARTICIPATE IN LOBBYING ACTIVITIES.

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

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

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$644,870BeginningYearBalanceAmt
Investment Earnings Or Losses$87,044InvestmentEarningsOrLossesAmt
End Year Balance$731,914EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$591,555BeginningYearBalanceAmt
Investment Earnings Or Losses$53,315InvestmentEarningsOrLossesAmt
End Year Balance$644,870EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$0BeginningYearBalanceAmt
Contributions$620,509ContributionsAmt
Investment Earnings Or Losses-$28,954InvestmentEarningsOrLossesAmt
End Year Balance$591,555EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$0BeginningYearBalanceAmt
End Year Balance$0EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.0BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.7744PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.2256TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (true)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (true)RelatedOrgListSchRInd

Land LandGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$0InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$1,927,000OtherCostOrOtherBasisAmt
Book Value$1,927,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$0InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$29,587,822OtherCostOrOtherBasisAmt
Depreciation$20,573,783DepreciationAmt
Book Value$9,014,039BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$0InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$4,928,251OtherCostOrOtherBasisAmt
Depreciation$4,477,752DepreciationAmt
Book Value$450,499BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$0InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$15,835,886OtherCostOrOtherBasisAmt
Depreciation$13,411,724DepreciationAmt
Book Value$2,424,162BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$0InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$19,232OtherCostOrOtherBasisAmt
Depreciation$0DepreciationAmt
Book Value$19,232BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$13,834,932TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDescBook ValueBookValueAmt
GOODWILL$10,817,871
RESTRICTED FOUNDATION ASSETS$1,799,917
FieldValueIRS element (for citing)
Total Book Value Other Assets$12,617,788TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
ASSET RETIREMENT OBLIGATION$24,538
ADVANCES DUE CORP-TERM$30,143,996
FieldValueIRS element (for citing)
Total Liability$30,168,534TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule D, Part I, Line 1(a) PART 1, LINE 1APrior year ENDOWMENT Balances Were REDUCED to REMOVE FUNDS Restricted UNDER A MORTGAGE AGREEMENT. THESE FUNDS ARE NOT DONOR-RESTRICTED GIFTS AND WILL NOT BE HELD IN PERPETUITY BY THE HOSPITAL TO FUND A PERMANENT SOURCE OF INCOME and have therefore been adjusted appropriately.
Schedule D, Part V, Line 4 Intended uses of endowment fundsPROCEEDS 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) footnoteOSF IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED BY SECTION 501(c)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPTED FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(C)(3) OF THE CODE. SFI AND VARIOUS SUBSIDIARIES ARE FOR-PROFIT CORPORATIONS THAT RECOGNIZE INCOME TAXES UNDER THE ASSET-AND-LIABILITY METHOD. DEFERRED TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE FUTURE TAX CONSEQUENCES ATTRIBUTABLE TO DIFFERENCES BETWEEN THE CONSOLIDATED FINANCIAL STATEMENT CARRYING AMOUNTS OF EXISTING ASSETS AND LIABILITIES AND THEIR RESPECTIVE TAX BASES AND OPERATING LOSS AND TAX CREDIT CARRYFORWARDS. DEFERRED TAX ASSETS AND LIABILITIES ARE MEASURED USING THE ENACTED TAX RATES EXPECTED TO APPLY TO TAXABLE INCOME IN THE YEARS IN WHICH THOSE TEMPORARY DIFFERENCES ARE EXPECTED TO BE RECOVERED OR SETTLED. THE EFFECT ON DEFERRED TAX ASSETS AND LIABILITIES OF A CHANGE IN TAX RATES IS RECOGNIZED IN INCOME IN THE PERIOD THAT INCLUDES THE ENACTMENT DATE. UNDER ASC SUBTOPIC 740-10,ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES -AN INTERPRETATION OF FASB STATEMENT NO.109, OSF 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, 2018 AND 2017, OSF AND SFI DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS. ON DECEMBER 22, 2017, THE PRESIDENT SIGNED INTO LAW H.R. 1, ORIGINALLY KNOWN AS THE TAX CUTS AND JOBS ACT. THE NEW LAW (PUBLIC LAW NO. 115-97) INCLUDES SUBSTANTIAL CHANGES TO THE TAXATION OF INDIVIDUALS, BUSINESSES, MULTINATIONAL ENTERPRISES, AND OTHERS. IN ADDITION TO MANY GENERALLY APPLICABLE PROVISIONS, THE LAW CONTAINS SEVERAL SPECIFIC PROVISIONS THAT RESULT IN CHANGES TO THE TAX TREATMENT OF TAX-EXEMPT ORGANIZATIONS AND THEIR DONORS. OSF HAS REVIEWED THESE PROVISIONS AND THE POTENTIAL IMPACT AND CONCLUDED THE ENACTMENT OF H.R. 1 WILL NOT HAVE A MATERIAL EFFECT OF THE OPERATIONS OF THE ORGANIZATION.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other125FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
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$648,646TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$648,646NetCommunityBenefitExpnsAmt
Total Expense0.0181TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,975,359TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,231,483DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,743,876NetCommunityBenefitExpnsAmt
Total Expense0.0487TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$5,624,005TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,231,483DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,392,522NetCommunityBenefitExpnsAmt
Total Expense0.0669TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$103,834TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$19,085DirectOffsettingRevenueAmt
Net Community Benefit Expns$84,749NetCommunityBenefitExpnsAmt
Total Expense0.0024TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$73,397TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$73,397NetCommunityBenefitExpnsAmt
Total Expense0.0021TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$4,000NetCommunityBenefitExpnsAmt
Total Expense0.0001TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$181,231TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$19,085DirectOffsettingRevenueAmt
Net Community Benefit Expns$162,146NetCommunityBenefitExpnsAmt
Total Expense0.0045TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$5,805,236TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,250,568DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,554,668NetCommunityBenefitExpnsAmt
Total Expense0.0714TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$504,103BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$14,034,972ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$14,846,695CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$811,723MedicareSurplusOrShortfallAmt

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 Line1MENDOTA COMMUNITY HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11401 E 12TH STREETAddressLine1Txt
CityMENDOTACityNm
State AbbreviationILStateAbbreviationCd
ZIP61342ZIPCd
FieldValueIRS element (for citing)
Website AddressHTTPS://WWW.OSFHEALTHCARE.ORG/SAINT-PAUL/WebsiteAddressTxt
State LicenseIL0005819StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
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 Line1MENDOTA 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
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted16CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLhttps://www.osfhealthcare.org/about/community-health/OwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt17ImplementationStrategyAdptYr
Strategy Posted WebsitefalseStrategyPostedWebsiteInd
Strategy AttachedYes (true)StrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care125.0FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.0FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Other MethodYes (X)OtherMethodInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLHTTPS://WWW.OSFHEALTHCARE.ORG/BILLING/FINANCIAL-ASSISTANCE/FAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLHTTPS://WWW.OSFHEALTHCARE.ORG/BILLING/FINANCIAL-ASSISTANCE/FAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLHTTPS://WWW.OSFHEALTHCARE.ORG/BILLING/FINANCIAL-ASSISTANCE/FAPSummaryOnWebsiteURLTxt
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 TranslatedYes (X)FAPTranslatedInd
Other PublicityYes (X)OtherPublicityInd
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 (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part V, Section B, Line 3EThe 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 , 1Facility , 1 - MENDOTA COMMUNITY HOSPITAL. FOR THE 2016 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 CHNA WAS MADE WIDELY AVAILABLE TO THE COMMUNITY AND FEEDBACK RECEIVED FROM COMMUNITY SERVICE ORGANIZATIONS WAS TAKEN INTO ACCOUNT. 4) ADDITIONAL SOURCES OF INPUT WAS RECEIVED FROM A COLLABORATIVE TEAM CREATED TO CONDUCT THE 2016 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 2016 CHNA.
Schedule H, Part V, Section B, Line 6a Facility , 1Facility , 1 - MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER - MENDOTA, IL. THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR 2016 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 , 1Facility , 1 - MENDOTA COMMUNITY HOSPITAL. MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") DURING FISCAL YEAR 2016 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 25, 2016. THIS CHNA IS EFFECTIVE FOR FISCAL YEARS 2017, 2018 AND 2019. 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. HEALTHY BEHAVIORS IS DEFINED AS ACTIVE LIVING AND HEALTHY EATING AND THEIR IMPACT ON OBESITY. BEHAVIORAL HEALTH INCLUDES MENTAL HEALTH AND SUBSTANCE ABUSE. 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. FY2016 - 2018 Healthy Behaviors defined as - Active Living, Healthy Eating and Obesity Goals Goals -Bring together community organizations providing education, increasing awareness, and engaging in health nutrition, including exercise decisions, in order to benefit community members in their everyday life and overall health. -Increase knowledge, awareness and engagement in healthy behaviors in order to improve LaSalle County residents' overall health. Healthy Behaviors Measurement and Key Accomplishments (1) Tracked number of immunizations provided and the impact on school absences. Data for Ottawa/Streator/Mendota: *8/1/2016-5/31/2017 6,574 Immunizations given *8/1/2017-4/20/2018 7,477 Immunizations given *8/1/2018 to Present 22,536 Immunizations given Note: This project has increased the immunization compliance rates of 2 year olds in the Ottawa/Streator practices from 23.2% in 2/2016 to 39.02% as of 4/2018 to 52% as of 2/2019. (2) Tracked hours spent with student athletes and the number of injuries. *2017 Streator High School - 451 hours/58 injuries *2017 Ottawa High School - 232 hours/32 injuries *2018 Streator High School - 699 hours/90 injuries *2018 Ottawa High School - 409 hours/20 injuries *2018 Earlville High School - 245 hours/20 injuries (3) Tracked number of educational events and attendance addressing health and wellness. *2016: 77 events: 4018 attendees *2017: 74 events: 4115 attendees *2018: 114 events: 7500 attendees (4) Tracked number of sports physicals provided. *2016: Streator High School - 57; Ottawa High School - 59 *2017: Streator High School - 51; Ottawa High School - 69 *2018: Streator High School - 41; Ottawa High School - 79; Earlville High School - 11 (5) Tracking of Social Media Posts. *In 2017, Saint Elizabeth Medical Center had Facebook posts reaching 1,070,284 residents. *Center for Health's Facebook posts reaching 441,387 residents. *In 2018, Saint Paul Medical Center had Facebook posts reaching local residents 437,000 times *In 2018, Saint Elizabeth Medical Center Facebook posts reached local residents 752,000 times *Center for Health's Facebook posts reached local residents 305,000 times (6) Pounds of food donated to community agencies from our Community Garden. *2017 - 1500 pounds *2018 - 1500 pounds (7) Tracked participation in OSF4Life - Increased participation. *2017 - Health Risk Assessment at Saint Elizabeth Medical Center - 39% *2017 - Health Risk Assessment at Saint Paul Medical Center - 63% *Wellness challenge Virtue at Saint Paul Medical Center had 49 participants *Wellness challenge Virtue at Saint Elizabeth Medical Center had 35 participants *Take the first Step challenge at Saint Paul Medical Center had 83 participants *Take the first Step challenge at Saint Elizabeth Medical Center had 53 participants *2018 Health Risk Assessment at Saint Elizabeth Medical Center - 42% *2018 Health Risk Assessment at Saint Paul Medical Center - 66.5% (8) Tracked participation in pounds with the Healthy You program for Saint Paul Medical Center. *2016: 259 participants; 2300 pounds *2017: 251 participants; 2339 pounds *2018: 283 participants; 2441 pounds **Began collaborative/partnership initiative - Live Well Streator; Held monthly meetings on Healthy Eating, Activity and Opioid Use Disorder **Participates in Action Walk with Greenway Trail in Streator; 100 participants walked 2.8 miles **Collaborated and rolled out Pieces Iris, case management platform that extends health system and healthy plan networks to include community based organizations to address health related social needs. Participating organizations include: Servant's Heart; Safe Journey; BEST, Inc; Ottawa/Peru Pads; LaSalle Co. Health Dept; Ottawa/Streator YMCA; Streator Elementary/High School; Salvation Army - Streator; Tri-County Opportunities Council. **Partnerships within LaSalle County include: *Penguin Plunge - Make A Wish Foundation; Labor of Love; Out of the Darkness - Suicide Prevention Walk; Walk to End Alzheimer's; Freezin For A Reezin; Meals on Wheels; Operation Snowball; Relay For Life - American Cancer Society; Illinois Brain Injury Support - meet 1x per month; Bereavement Group - meet 2x per month; Stroke Support - meet 1x per month; Blood Drive - quarterly; Breastfeeding Class - meet 6x per year; Childbirth Class - meet 1x per week; Sibling Class - meet 1x per month; Safe Sitter Class - meet 5x per year; BLS - offered 2x per month; Heartsaver CPR/AED - offered 1x per month; First Aid - offered 6x per year; Child Passenger Car Seat Safety check - offered 1x per month; Marseilles Gobble Wobble 5K; Sport Physical clinics - Ottawa High School/Streator High School; Live Well Streator Steering Committee - meet 1x per month; Healthy Eating Action Team - meet 1x per month; Activity Action Team - meet 1x per month; Opioid Use Disorder Action Team - meet 1x per month FY2016 - 2018 Behavioral Health defined as - Mental Health and Substance Abuse Goal Goals: -Increase access to and awareness of mental health services in LaSalle County. -Increase awareness of mental health services in the community. -Commit to teaching, empowering, and advocating for mental health issues. -Develop and implement strategies to facilitate access and improve community agency alignment to meet the behavioral health needs of the community. -Increase awareness and engagement to decrease instances of risky behavior and substance abuse in LaSalle County. -Provide awareness of future potential risks related to substance abuse. -Develop and implement strategies to facilitate services / access and improve community agency alignment in addressing alcohol and illicit substance abuse by youths within the community. Behavioral Health Measurement and Key Accomplishments (1) Developed a strategic system of care plan for mental health (Streator initiative). *Implemented Behavioral Health Navigator, Referral Algorithm, and Embedded Behaviorist in Primary Care practice, Tele-psych, NCBH Colocation, Live Well Streator Substance Abuse Focus. **Drug Take Back event produced. 56 pounds of pills; 20 pounds of liquid, inhalers and sharps collected (2) Monitored Counseling visits providing early intervention, depression screening and support. *Embedded a Therapist in Center for Health-Streator. (3) Tracked Patient Wisdom data. A survey tool used to ask community members questions specific to Behavioral Health. *149 respondents gave their view on how to address behavioral health in community. 20% identified Substance Abuse as needing more community attention. In 2018 the data usage continues to validate strategies. (4) Tracked unique patients for Behavioral Health services through Tele-psych. *236 Tele-psych unique Patients (5) Tracked Tele-psych Visits. *367 Tele-psych outpatient visits *105 Eco Silt Psych visits *15% of Choices Outpatients from Streator-psychiatry and therapy services **In 2018, 939 Tele-psych outpatient visits *99 of the visits were in Center for Health Tele-psych for a total of 939 Tele-psych patients *Added additional hours for tele-psych (6) Tracked the Behavioral Health Navigator calls. *Behavioral Health Navigators served over 300 community members. (7) Tracked Silver Cloud (Behavioral Health App). *200 community members joined in the past two years. **Physician monitoring for narcotics. **Currently using Aegis Labs for in-depth medication monitoring as well as working towards Medication Agreements for all patients on opioids.
Schedule H, Part V, Section B, Line 13 Facility , 1Facility , 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 , 1Facility , 1 - MENDOTA COMMUNITY HOSPITAL. PRESUMPTIVE FINANCIAL ASSISTANCE IS AVAILABLE AND PROVIDES FOR A DISCOUNT OF 100% OF BILLED CHARGES FOR MEDICALLY NECESSARY SERVICES PROVIDED TO A PATIENT WITH NO INSURANCE BENEFITS, WHEN THE PATIENT ESTABLISHES FINANCIAL NEED AT TIME OF REGISTRATION BY SATISFYING ONE OF THE FOLLOWING CATEGORIES OF PRESUMPTIVE ELIGIBILITY CRITERIA: HOMELESSNESS; DECEASED WITH NO ESTATE; MENTAL INCAPACITATION WITH NO ONE TO ACT ON THE PATIENT'S BEHALF; AND CURRENT MEDICAID ELIGIBILITY, BUT NOT ON DATE OF SERVICE OR FOR NON-COVERED SERVICE.
Schedule H, Part V, Section B, Line 15 Facility , 1Facility , 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 , 1Facility , 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.
FieldValueIRS element (for citing)
Facility0FacilityNum

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part I, Line 3c SCH H, PART I, LINE 3C-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, Line 7 Costing Methodology used to calculate financial assistanceMEDICARE COST TO CHARGE RATIO
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amountIN 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 COPAYMENT 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 1,131,798 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 504,103 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. 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 footnotePLEASE SEE PAGE 22 AND 23 OF NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistanceTHE 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 NONCOMPLIANT 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 assessmentMENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") DURING FISCAL YEAR 2016 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 FOR 2019 IS CURRENTLY BEING CREATED AND WILL BE UPDATED IN THE NEXT 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 assistanceTHE 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 WEB SITE. 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 informationMENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER IS LOCATED IN LASALLE COUNTY. DATA ESTABLISHES THAT LASALLE COUNTY IS THE RESIDENCE OF OVER 90% OF ALL PATIENTS RECEIVING SERVICES FROM SAINT PAUL MEDICAL CENTER AND SAINT ELIZABETH MEDICAL CENTER. THE HOSPTIAL IS A CRITICAL ACCESS HOSPTIAL SERVING AN AGING POPULATION. THE HISPANIC POULATION COMPRISES 9.4% OF THE POPULATION. RESIDENTS HAVE A MEDIAN HOUSEHOLD IMCOME LOWER THEN THE STATE OF ILLINOIS. UNEMPLOYMENT REMAINS SLIGHTLY HIGHER THEN THE STATE OF ILLINOIS UNEMPLOMENT RATE.
Schedule H, Part VI, Line 5 Promotion of community healthTHE CORPORATION'S SPONSORING ORGANIZATION IS A RELIGIOUS CONGREGATION OF THE ROMAN CATHOLIC CHURCH KNOWN AS THE SISTERS OF THE THIRD ORDER OF SAINT 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. EACH HOSPITAL OPERATED BY THE CORPORATION HAS A COMMUNITY ADVISORY BOARD CONSISTING OF MEMBERS OF THE COMMUNITY WHO ARE NOT DIRECTORS, OFFICERS, OR CONTRACTORS OF THE CORPORATION. THE CORPORATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITIES. THE SURPLUS FUNDS WERE USED DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2018 FOR IMPROVEMENTS IN PATIENT CARE, MEDICAL EDUCATION, AND RESEARCH. THE CORPORATION 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 A MEDICAL STAFF WHICH IS 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 COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER IS INVOLVED IN THE PROMOTION OF COMMUNITY HEALTH IN SEVERAL WAYS INCLUDING BUT NOT LIMITIED TO; ADOPTING IMPLEMENTATION STRATEGIES TO ADDRESS SIGNIFCANT HEALTH NEEDS IDENFIED IN THE 2016 CHNA; PROVIDING HEALTH SCREENING BOOTHS AT COMMUNITY EVENTS; PROVIDING BEHAVIORAL HEALTH REFERRALS; PERFORMING WELLNESS SCREENINGS AT VARIOUS BUSINESSES IN THE COMMUNITY; AND PREPARING AND DELIVERING MEALS TO COMMUNITY MEMBERS IN NEED WITH OUR MEALS ON WHEELS PROGRAM. OSF ON CALL OFFERS A 24/7 ONLINE ACCESS TO MEDICAL CARE VIA SMARTPHONE, TABLET OR COMPUTER.
Schedule H, Part VI, Line 6 Affiliated health care systemTHE CORPORATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM (THE "OSF SYSTEM") WHICH PROVIDES INTEGRATED HEALTH CARE SERVICES THROUGHOUT CENTRAL ILLINOIS, PARTS OF NORTHERN ILLINOIS, AND PARTS OF THE UPPER PENINSULA OF MICHIGAN. THE OSF SYSTEM INCLUDES THE OTHER CORPORATIONS LISTED BELOW, ALL OF WHICH ARE CONTROLLED, DIRECTLY OR INDIRECTLY, BY THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS (THE "CONGREGATION"). ALL AFFILIATED CORPORATIONS (WHETHER TAXABLE OR EXEMPT) APPLY AND FOLLOW THE CHARITY CARE POLICIES OF THE CORPORATION AND ARE OPERATED IN FURTHERANCE OF THE MISSION OF THE CONGREGATION TO PROVIDE COMPREHENSIVE, INTEGRATED, QUALITY CARE, INCLUDING PREVENTIVE, PRIMARY, ACUTE, CONTINUOUS AND REHABILITATIVE HEALTH SERVICES TO THE COMMUNITIES SERVED BY THE CORPORATION AND THE OSF SYSTEM. SPECIAL EMPHASIS IS PLACED ON MEETING THE PHYSICAL, SPIRITUAL, EMOTIONAL, AND SOCIAL NEEDS OF EVERYONE WHO IS CARED FOR IN THE OSF SYSTEM REGARDLESS OF RACE, COLOR, RELIGION AND ABILITY TO PAY. THE AFFILIATED CORPORATIONS ARE: -THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS, WHICH 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 SAINT FRANCIS, INC., AN ILLINOIS BUSINESS CORPORATION, INCORPORATED DECEMBER 23, 1986, WHICH OPERATES FOR-PROFIT BUSINESSES IN SUPPORT OF OSF HEALTHCARE SYSTEM. OSF SAINT FRANCIS, INC. IS THE SOLE SHAREHOLDER OF OSF DESIGN GROUP, INC. AND OSF ASSURANCE COMPANY AND IS THE SOLE MEMBER OF OSF AVIATION, LLC, OSF FINANCE COMPANY, LLC, STATE AND ROXBURY, LLC, AND 124 ADAMS PROPERTY MANAGEMENT, LLC. -OSF AVIATION, LLC, WHICH IS AN FAA PART CERTIFIED CARRIER PROVIDING EMS HELICOPTER SERVICES THROUGHOUT CENTRAL ILLINOIS AND PARTS OF NORTHERN ILLINOIS. -OSF LIFELINE AMBULANCE, LLC, WHICH PROVIDES GROUND AMBULANCE TRANSPORTATION SERVICES IN PARTS OF NORTHERN ILLINOIS. -OSF HEALTHCARE FOUNDATION, AN ILLINOIS NOT-FOR-PROFIT CORPORATION, INCORPORATED JULY 7, 1989, WHICH CONDUCTS FUNDRAISING AND ANY OTHER ACTIVITIES FOR THE BENEFIT OF OSF HEALTHCARE SYSTEM AND IN SUPPORT OF THE MISSION OF THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS. -OSF ASSURANCE COMPANY, A VERMONT GENERAL CORPORATION, INCORPORATED DECEMBER 8, 2004, ORGANIZED FOR THE PURPOSE OF WRITING INSURANCE AND REINSURANCE AS A CAPTIVE INSURANCE COMPANY. OSF SAINT FRANCIS, INC. IS THE SOLE MEMBER OF THIS CORPORATION. -OSF FINANCE COMPANY, LLC, AN ILLINOIS LIMITED LIABILITY COMPANY, ORGANIZED ON NOVEMBER 19, 2007, ORGANIZED TO ISSUE ADJUSTABLE RATE TAXABLE SECURITIES, WHOSE PROCEEDS WILL BE LOANED TO OSF SAINT FRANCIS, INC. FOR VARIOUS PROJECTS. OSF SAINT FRANCIS, INC. IS THE SOLE MEMBER OF THIS CORPORATION. -ILLINOIS PATHOLOGIST SERVICES, LLC, AN ILLINOIS LIMITED LIABILITY COMPANY, ORGANIZED ON JULY 9, 2009, TO PROVIDE PROFESSIONAL PATHOLOGY SERVICES IN THE ROCKFORD, ILLINOIS, AREA. -OSF DESIGN GROUP, INC., AN ILLINOIS BUSINESS CORPORATION, INCORPORATED MAY 20, 2004, WHICH PROVIDES PROFESSIONAL ARCHITECTURAL SERVICES AS A REGISTERED PROFESSIONAL DESIGN FIRM TO OSF HEALTHCARE SYSTEM AND OTHER OSF CORPORATIONS. -OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER, AN ILLINOIS NOT-FOR-PROFIT CORPORATION (FORMERLY NAMED COMMUNITY HOSPITAL OF OTTAWA), INCORPORATED ON DECEMBER 7, 1964. OSF HEALTHCARE SYSTEM BECAME THE SOLE MEMBER OF THIS CORPORATION ON APRIL 30, 2012, AND THE HOSPITAL WAS RENAMED AS D/B/A OSF SAINT ELIZABETH MEDICAL CENTER. -OSF MULTI-SPECIALTY GROUP, AN ILLINOIS NOT-FOR-PROFIT CORPORATION, CREATED ON SEPTEMBER 8, 2011, EMPLOYS PRIMARY CARE AND SPECIALTY PHYSICIANS, MID-LEVEL PROVIDERS, NURSES, AND SUPPORT PERSONNEL TO PROVIDE PROFESSIONAL HEALTH CARE SERVICES. -POINTCORE, LLC, A DELAWARE LIMITED LIABILITY COMPANY, FOUNDED ON MARCH 19, 2014, WHICH WILL IMPROVE THE QUALITY OF HEALTHCARE BY POOLING THE RESOURCES OF ITS MEMBERS TO PROVIDE SERVICES TO ITS MEMBERS AND THIRD PARTIES. -SAINT ANTHONY'S, LLC, A DELAWARE LIMITED LIABILITY COMPANY, CREATED ON APRIL 17, 2000. THE CORPORATION, WITH ITS PRINCIPAL OFFICE IN ALTON, ILLINOIS, OPERATES EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES; SPECIFICALLY, TO OWN, OPERATE OR MAINTAIN THE AFFAIRS OF INSTITUTIONS THAT FOSTER LOW INCOME HOUSING, PROVIDE AND IMPROVE HEALTH SERVICES, PROMOTE PHYSICIAN AND MENTAL WELL-BEING AND INDEPENDENCE AND MOBILIZE COMMUNITY SUPPORT AND RESOURCES TO SERVE SAID HEALTH AND HOUSING NEEDS. OSF HEALTHCARE SYSTEM BECAME THE SOLE MEMBER OF THIS CORPORATION ON NOVEMBER 1, 2014. NDC CORPORATE EQUITY FUND IV, L.P. WAS THE PARTY INVOLVED WITH SAINT ANTHONY'S, LLC IN THE SAINT CLARE'S VILLA, LIMITED PARTNERSHIP IN ALTON, ILLINOIS. ON JANUARY 1, 2017, SAINT ANTHONY'S, LLC BECAME THE SOLE MEMBER OF SAINT CLARE'S VILLA WHEN IT ACCEPTED THE ASSIGNMENT OF NDC'S SHARES ON DECEMBER 31, 2016. -SAINT CLARE'S VILLA, LIMITED PARTNERSHIP, AN ILLINOIS LIMITED PARTNERSHIP, CREATED ON APRIL 17, 2000, BETWEEN SAINT ANTHONY'S, LLC AND NDC CORPORATE EQUITY FUND IV, L.P. SAINT CLARE'S VILLA OPERATES A 64 BED LOW INCOME ASSISTED LIVING FACILITY FOR THE ELDERLY AT 915 EAST FIFTH STREET IN ALTON, ILLINOIS. SAINT ANTHONY'S, LLC BECAME THE SOLE MEMBER OF SAINT CLARE'S VILLA ON JANUARY 1, 2017. -MENDOTA COMMUNITY HOSPITAL, AN ILLINOIS NOT-FOR-PROFIT CORPORATION, CREATED ON MARCH 24, 1944, WITH THE NAME MENDOTA HOSPITAL FOUNDATION. THE NAME OF THE CORPORATION WAS CHANGED TO MENDOTA COMMUNITY HOSPITAL ON JUNE 16, 1967. OSF HEALTHCARE SYSTEM BECAME THE SOLE MEMBER OF THIS CORPORATION ON APRIL 1, 2015, AND THE HOSPITAL WAS RENAMED AS D/B/A OSF SAINT PAUL MEDICAL CENTER. -STATE AND ROXBURY, LLC, AN ILLINOIS LIMITED LIABILITY COMPANY, ESTABLISHED ON JANUARY 10, 2008, WAS ORGANIZED TO ACQUIRE AND OPERATE THE REAL ESTATE AT 5668 EAST STATE STREET, ROCKFORD, ILLINOIS. STATE AND ROXBURY, LLC WAS INITIALLY OWNED BY SAINT ANTHONY MEDICAL CENTER (51%) AND BRENT B. JOHNSON (49%). EFFECTIVE FEBRUARY 1, 2016, SAINT ANTHONY MEDICAL CENTER PURCHASED THE 49% OWNERSHIP OF BRENT B. JOHNSON. OSF SAINT FRANCIS, INC. SUBSEQUENTLY PURCHASED 100% OWNERSHIP OF STATE AND ROXBURY, LLC FROM SAINT ANTHONY MEDICAL CENTER AND BECAME THE SOLE MEMBER. STATE AND ROXBURY, LLC IS A MEMBER MANAGED COMPANY. -OSF COLLEGE OF HEALTH SCIENCES, AN ILLINOIS NOT-FOR-PROFIT CORPORATION, CREATED ON NOVEMBER 7, 2016, HAS OVERSIGHT OVER ONE OR MORE EDUCATIONAL INSTITUTIONS FOR THE TRAINING OF INDIVIDUALS FOR THE PURPOSE OF IMPROVING OR DEVELOPING THEIR CAPABILITIES AND INSTRUCTION OF THE PUBLIC ON SUBJECTS USEFUL TO INDIVIDUALS AND BENEFICIAL TO THE COMMUNITY INCLUDING AND WITHOUT LIMITATION ONE OR MORE COLLEGES OF NURSING. INITIAL DIVISIONS INCLUDE D/B/A SAINT ANTHONY COLLEGE OF NURSING, ROCKFORD, ILLINOIS, AND D/B/A SAINT FRANCIS MEDICAL CENTER COLLEGE OF NURSING, PEORIA, ILLINOIS. -124 ADAMS PROPERTY MANAGEMENT, LLC, AN ILLINOIS LIMITED LIABILITY COMPANY, ORGANIZED ON DECEMBER 11, 2017, OPERATES TO MANAGE 124 ADAMS PROPERTY HOLDINGS, LLC. OSF SAINT FRANCIS, INC. IS THE SOLE MEMBER OF THIS CORPORATION.
Schedule H, Part VI, Line 7 State filing of community benefit reportIL

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
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 (27 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Robert C Sehring
Vice Chairperson CEO$0$822,949$0$0$0$26,582$0$42,919$0$25,321$0$917,770$0$0
Kevin D Schoeplein
Partial Year - Vice Chairperson CEO$0$1,198,405$0$450,000$0$73,273$0$237,590$0$21,193$0$1,980,461$0$0
Gerald J McShane MD
Board Member$0$664,489$0$0$0$30,841$0$43,175$0$21,114$0$759,619$0$0
Daniel E Baker
Former CFO$0$498,211$0$0$0$1,655,921$0$140,112$0$20,418$0$2,314,662$0$43,175
Kenneth J Natzke
Former CEO East Region$0$512,459$0$0$0$16,074$0$30,947$0$16,396$0$575,876$0$0
Michael M Allen
CFO$0$558,835$0$0$0$1,589$0$28,482$0$25,172$0$614,079$0$0
Anthony M Avellino MD
Partial Year - CEO NSSL/INI$0$899,441$0$75,140$0$2,180$0$35,225$0$25,311$0$1,037,297$0$0
Kenneth E Berkovitz MD
Partial Year - CEO CVSL$0$718,287$0$0$0$3,768$0$23,363$0$18,649$0$764,067$0$0
Chad E Boore
Chief Executive Officer Eastern Region$0$309,513$0$0$0$7,757$0$13,033$0$26,354$0$356,657$0$0
Robert L Brandfass
SVP Chief Legal Officer$0$509,534$0$0$0$9,887$0$39,200$0$24,840$0$583,462$0$0
Michelle D Conger
Chief Strategy Officer$0$439,698$0$0$0$10,176$0$15,005$0$23,954$0$488,833$0$0
Roxanna Crosser
Chief Executive Officer Western Region$0$293,017$0$0$0$21,775$0$33,224$0$7,681$0$355,697$0$0
Michael A Cruz MD
Chief Executive Officer Central Region$0$594,265$0$0$0$3,137$0$43,175$0$24,055$0$664,633$0$0
John R Evancho
SVP Chief Compliance Officer$0$247,450$0$0$0$8,559$0$19,252$0$26,332$0$301,592$0$0
Thomas G Hammerton
President OSF Healthcare Foundation Chief Development Officer$0$323,860$0$0$0$38,708$0$28,211$0$18,270$0$409,049$0$0
Stephen E Hippler MD
Chief Clinical Officer$0$525,836$0$0$0$15,802$0$43,175$0$24,008$0$608,820$0$0
John C Horne
SVP Chief Supply Chain Officer$0$336,961$0$0$0$8,181$0$27,779$0$23,888$0$396,808$0$0
Divya-Devi Joshi
CEO Children SL$0$496,427$0$0$0$935$0$17,225$0$8,984$0$523,571$0$0
James J Mormann
Chief Information Officer$0$535,916$0$0$0$8,673$0$35,225$0$25,045$0$604,859$0$0
David A Schertz
Partial Year - CEO Northern Region$0$567,927$0$0$0$11,767$0$25,175$0$18,551$0$623,420$0$0
Dwight D Stapleton
Vice President Clinical Specialty Services$0$400,865$0$0$0$114$0$13,250$0$14,273$0$428,502$0$0
Jeffry M Tillery
SVP Chief Transformation Officer$0$500,220$0$0$0$13,182$0$42,797$0$18,509$0$574,708$0$0
Lori L Wiegand
Chief Nursing Officer$0$366,572$0$0$0$16,273$0$43,175$0$18,421$0$444,441$0$0
Leon A Yeh MD
VP CMO Emergency Serv$0$519,663$0$4,127$0$47$0$35,225$0$24,746$0$583,809$0$0
Marcia S Flessner
Special Projects Coordinator$97,878$0$0$0$74,491$0$7,783$0$12,746$0$192,899$0$0$0
Kenneth K Potts MD
Physician$221,680$0$0$0$282$0$13,501$0$18,076$0$253,539$0$0$0
Katherine R Riva-Foster MD
Physician$212,865$0$0$0$46$0$12,209$0$18,219$0$243,339$0$0$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 3 SCH J, PART I, LINE 3THE 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 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 J, Part I, Line 1a Health or social club dues or initiation feesTHE 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 paymentIn 2017 MARCIA S FLESSNER received severance in the amount of $74,432.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement planDURING 2017, OSF HEALTHCARE SYSTEM MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN THAT PLAN: KEVIN D. SCHOEPLEIN DANIEL E. BAKER DURING 2017, THE FOLLOWING CONTRIBUTIONS WERE MADE BY OSF HEALTHCARE SYSTEM TO THE PLAN: KEVIN D. SCHOEPLEIN - $194,415 BAKER - $96,937 DURING 2017, DISTRIBUTIONS WERE MADE BY OSF HEALTHCARE SYSTEM FROM THE PLAN: KEVIN D. SCHOEPLEIN - $0 DANIEL E. BAKER - $1,646,820

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part I, Line 1 PART ITHE 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 stockholdersOSF HEALTHCARE SYSTEM IS THE SOLE CORPORATE MEMBER OF MENDOTA COMMUNITY HOSPITAL.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing bodyOSF 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 stockholdersRESERVED 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 addressBRIAN SILVERSTEIN, M.D. 711 APPLE TREE LANE GLENCOE, IL 60022
Form 990, Part VI, Line 11b Review of form 990 by governing bodyTHE PROPOSED FINAL VERSION OF THE 990 IS SENT VIA E-MAIL 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 FOR FILING.
Form 990, Part VI, Line 12c Conflict of interest policyDISCLOSURES 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 ABOUT THE INTEREST. 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 officialTHE 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 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 IN NOVEMBER.
Form 990, Part VI, Line 15b Process to establish compensation of other employeesTHE 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 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 IN NOVEMBER.
Form 990, Part VI, Line 19 Required documents available to the publicTHE 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 RevenueAll Other - Total Revenue: 144808, Related or Exempt Function Revenue: 144808, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Farm Income - Total Revenue: 1997, Related or Exempt Function Revenue: , Unrelated Business Revenue: 1997, Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balancesInter-company Contributions - 36064; Net assets Released from Restrictions - 90806; Equity Transfers - -629783;

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (13 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
SISTERS OF THE THIRD ORDER OF ST FRANCIS
800 NE GLEN OAK AVEPEORIAIL61603371259286PARENT/SU ORGIL501(c)(3)Type IINAfalse
OSF HEALTHCARE FOUNDATION
800 NE GLEN OAK AVEPEORIAIL61603371259284SUPPORT ORGIL501(c)(3)Type IINAfalse
ST FRANCIS COMMUNITY CLINIC
530 NE GLEN OAK AVEPEORIAIL61637370661235FREE CLINICIL501(c)(3)7SIS 3RD OSFfalse
OTTAWA REGIONAL HOSP & HEALTHCARE CTR
1100 EAST NORRIS DRIVEOTTAWAIL61350362604009HOSPITALIL501(c)(3)3OSFfalse
OTTAWA REGIONAL HOSPITAL FOUNDATION
1100 EAST NORRIS DRIVEOTTAWAIL61350364007569SUPPORT ORGIL501(c)(3)Type IORHHCfalse
OSF MULTI-SPECIALTY GROUP
800 NE GLEN OAK AVEPEORIAIL61603383852646HLTHCARE SVCSIL501(c)(3)Type IOSFfalse
OSF HEART & VASCULAR INSTITUTE
800 NE GLEN OAK AVEPEORIAIL61603352422385HLTHCARE SVCSIL501(c)(3)Type IOSFfalse
CHILDREN'S HOSPITAL OF ILLINOIS MED GRP
800 NE GLEN OAK AVEPEORIAIL61603320353954HLTHCARE SVCSIL501(c)(3)Type IOSFfalse
ILLINOIS NEUROSCIENCE INSTITUTE
800 NE GLEN OAK AVEPEORIAIL61603364709999HLTHCARE SVCSIL501(c)(3)Type IOSFfalse
OSF HEALTHCARE SYSTEM
800 NE GLEN OAK AVEPEORIAIL61603370813229HOSPITALIL501(c)(3)3SIS 3RD OSFfalse
SAINT ANTHONY'S PHYSICIAN GROUP
PO BOX 340ALTONIL62002371365059HLTHCARE SVCSIL501(c)(3)10OSFfalse
OTTAWA REGIONAL HOSPITAL AUXILIARY
1100 EAST NORRIS DRIVEOTTAWAIL61350363854788SUPPORT ORGIL501(c)(3)Type IOSFfalse
OSF College of Health Sciences
800 NE Glen Oak AvenuePeoriaIL61603364868939COLLEGE OF NURSINGIL501(c)(3)2OSFfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerIndOwnershipOwnershipPct
CENTER FOR HEALTH AMBULATORY
8800 RTE 91 NPEORIAIL61615205557171SURGICAL CENTERILOSFRelatedfalseYes (true)0
EASTLAND MEDICAL PLAZA
1505 EASTLAND DRIVEBloomingtonIL61701371400643SURGICAL CENTERILOSFRelatedfalseYes (true)0
FORT JESSE IMAGING CENTER LLC
2200 FT JESSE ROADNORMALIL61761460515604MEDICAL IMAGINGILOSFRelatedfalseYes (true)0
SAINT CLARE'S VILLA
915 EAST 5TH STREETALTONIL62002371397289LOW INC HOUSINGILOSFRelatedfalseYes (true)0
FOX RIVER CANCER CENTER
1211 STARFISH DRIVEOTTAWAIL61350870805865ONCOLOGYILORHHCRelatedfalseYes (true)0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
OSF SAINT FRANCIS INC
800 NE GLEN OAK AVEPEORIAIL61603363484677HLTHCARE SVCSILOSFC Corporationfalse
ILLINOIS PATHOLOGST SERVICES LLC
5666 EAST STATE STREETROCKFORDIL61108800439081PATHOLOGY SVCSILOSFC Corporationfalse
Lakeview Medical Office Building
812 N Logan AveDanvilleIL61832371100761Condominium AssociationILOSFC Corporationfalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
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 ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

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