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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-08-12T13:31:00-05:00 | ReturnTs |
| Tax Period End | 2018-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 350921680 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9600 Brownsboro Road Suite 400 | AddressLine1Txt |
| City | Louisville | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 402411122 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 362167785 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mendota Community Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MEND | BusinessNameControlTxt |
| Phone | 8155397461 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 E 12TH STREET | AddressLine1Txt |
| City | MENDOTA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61342 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Michael M Allen | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Signature | 2019-08-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Rachel Spurlock | PreparerPersonNm |
| PTIN | P00520729 | PTIN |
| Phone | 5023263996 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OSF Saint Paul Medical Center | BusinessNameLine1Txt |
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Michael Allen | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 E 12TH STREET | AddressLine1Txt |
| City | MENDOTA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61342 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $36,382,154 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.osfhealthcare.org/practices/44/1217/osf-saint-paul-medical-center | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1944 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | IN THE SPIRIT OF CHRIST AND THE EXAMPLE OF FRANCIS OF ASSISI, THE MISSION OF OSF HEALTHCARE IS TO SERVE PERSONS WITH THE GREATEST CARE AND LOVE IN A COMMUNITY THAT CELEBRATES THE GIFT OF LIFE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 190 | TotalEmployeeCnt |
| Total Volunteers | 101 | TotalVolunteersCnt |
| Total Gross UBI | $1,997 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $173,360 | PYContributionsGrantsAmt |
| CY Contributions Grants | $40,196 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $34,424,460 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $36,040,571 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$3,449 | PYInvestmentIncomeAmt |
| CY Investment Income | $8,945 | CYInvestmentIncomeAmt |
| PY Other Revenue | $302,419 | PYOtherRevenueAmt |
| CY Other Revenue | $248,927 | CYOtherRevenueAmt |
| PY Total Revenue | $34,896,790 | PYTotalRevenueAmt |
| CY Total Revenue | $36,338,639 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $15,192,798 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $15,432,961 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $20,004,424 | PYOtherExpensesAmt |
| CY Other Expenses | $20,355,001 | CYOtherExpensesAmt |
| PY Total Expenses | $35,197,222 | PYTotalExpensesAmt |
| CY Total Expenses | $35,787,962 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$300,432 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $550,677 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $39,016,514 | TotalAssetsBOYAmt |
| Total Assets EOY | $34,342,051 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $37,781,164 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $33,058,937 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,235,350 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,283,114 | NetAssetsOrFundBalancesEOYAmt |
| Mission | IN THE SPIRIT OF CHRIST AND THE EXAMPLE OF FRANCIS OF ASSISI, THE MISSION OF OSF HEALTHCARE IS TO SERVE PERSONS WITH THE GREATEST CARE AND LOVE IN A COMMUNITY THAT CELEBRATES THE GIFT OF LIFE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $28,644,485 | ExpenseAmt |
| Revenue | $36,244,756 | RevenueAmt |
| Desc | MENDOTA 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 | $28,644,485 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 9 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 190 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | Yes (true) | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | Yes (true) | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Michael Allen | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8155397461 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 NE GLEN OAK AVE | AddressLine1Txt |
| City | PEORIA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61603 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (35 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Sister Diane Marie McGrew OSF | |||||||||
| President and Treasurer | 1.0 | 47.0 | Yes (X) | Yes (X) | $0 | $5,200 | $0 | ||
| Sister Judith Ann Duvall OSF | |||||||||
| Chairperson | 1.0 | 47.0 | Yes (X) | Yes (X) | $0 | $5,200 | $0 | ||
| Robert C Sehring | |||||||||
| Vice Chairperson CEO | 1.0 | 47.0 | Yes (X) | Yes (X) | $0 | $849,531 | $68,240 | ||
| Kevin D Schoeplein | |||||||||
| Partial Year - Vice Chairperson CEO | 1.0 | 47.0 | Yes (X) | Yes (X) | $0 | $1,721,678 | $258,783 | ||
| Sister Theresa Ann Brazeau OSF | |||||||||
| Secretary | 1.0 | 47.0 | Yes (X) | Yes (X) | $0 | $5,200 | $0 | ||
| Sister Agnes Joseph Williams OSF | |||||||||
| Assistant Secretary | 1.0 | 47.0 | Yes (X) | Yes (X) | $0 | $5,200 | $0 | ||
| Sister Rose Therese Mann OSF | |||||||||
| Board Member | 1.0 | 47.0 | Yes (X) | $0 | $0 | $0 | |||
| Gerald J McShane MD | |||||||||
| Board Member | 1.0 | 46.0 | Yes (X) | $0 | $695,330 | $64,289 | |||
| Sister M Mikela Meidl FSGM | |||||||||
| Board Member | 1.0 | 47.0 | Yes (X) | $0 | $0 | $0 | |||
| Brian Silverstein MD | |||||||||
| Board Member | 1.0 | 7.0 | Yes (X) | $0 | $45,000 | $0 | |||
| Michael M Allen | |||||||||
| CFO | 1.0 | 46.0 | Yes (X) | $0 | $560,425 | $53,654 | |||
| Anthony M Avellino MD | |||||||||
| Partial Year - CEO NSSL/INI | 1.0 | 45.0 | Yes (X) | $0 | $976,761 | $60,536 | |||
| Kenneth E Berkovitz MD | |||||||||
| Partial Year - CEO CVSL | 1.0 | 45.0 | Yes (X) | $0 | $722,055 | $42,012 | |||
| Chad E Boore | |||||||||
| Chief Executive Officer Eastern Region | 1.0 | 45.0 | Yes (X) | $0 | $317,270 | $39,387 | |||
| Robert L Brandfass | |||||||||
| SVP Chief Legal Officer | 1.0 | 45.0 | Yes (X) | $0 | $519,421 | $64,040 | |||
| Michelle D Conger | |||||||||
| Chief Strategy Officer | 1.0 | 45.0 | Yes (X) | $0 | $449,874 | $38,959 | |||
| Roxanna Crosser | |||||||||
| Chief Executive Officer Western Region | 1.0 | 45.0 | Yes (X) | $0 | $314,792 | $40,905 | |||
| Michael A Cruz MD | |||||||||
| Chief Executive Officer Central Region | 1.0 | 45.0 | Yes (X) | $0 | $597,403 | $67,230 | |||
| John R Evancho | |||||||||
| SVP Chief Compliance Officer | 1.0 | 45.0 | Yes (X) | $0 | $256,009 | $45,584 | |||
| Thomas G Hammerton | |||||||||
| President OSF Healthcare Foundation Chief Development Officer | 1.0 | 47.0 | Yes (X) | $0 | $362,569 | $46,481 | |||
| Stephen E Hippler MD | |||||||||
| Chief Clinical Officer | 1.0 | 45.0 | Yes (X) | $0 | $541,637 | $67,183 | |||
| John C Horne | |||||||||
| SVP Chief Supply Chain Officer | 1.0 | 45.0 | Yes (X) | $0 | $345,142 | $51,666 | |||
| Divya-Devi Joshi | |||||||||
| CEO Children SL | 1.0 | 45.0 | Yes (X) | $0 | $497,362 | $26,209 | |||
| James J Mormann | |||||||||
| Chief Information Officer | 1.0 | 45.0 | Yes (X) | $0 | $544,589 | $60,270 | |||
| David A Schertz | |||||||||
| Partial Year - CEO Northern Region | 1.0 | 45.0 | Yes (X) | $0 | $579,694 | $43,726 | |||
| Dwight D Stapleton | |||||||||
| Vice President Clinical Specialty Services | 1.0 | 45.0 | Yes (X) | $0 | $400,979 | $27,523 | |||
| Jeffry M Tillery | |||||||||
| SVP Chief Transformation Officer | 1.0 | 45.0 | Yes (X) | $0 | $513,402 | $61,306 | |||
| Lori L Wiegand | |||||||||
| Chief Nursing Officer | 1.0 | 45.0 | Yes (X) | $0 | $382,846 | $61,596 | |||
| Leon A Yeh MD | |||||||||
| VP CMO Emergency Serv | 1.0 | 45.0 | Yes (X) | $0 | $523,837 | $59,971 | |||
| Jane A Battles | |||||||||
| APN | 40.0 | 0 | $109,162 | $0 | $27,542 | Yes (X) | |||
| Marcia S Flessner | |||||||||
| Special Projects Coordinator | 40.0 | 0 | $172,369 | $0 | $20,530 | Yes (X) | |||
| Kenneth K Potts MD | |||||||||
| Physician | 40.0 | 0 | $221,963 | $0 | $31,577 | Yes (X) | |||
| Katherine R Riva-Foster MD | |||||||||
| Physician | 40.0 | 0 | $212,910 | $0 | $30,428 | Yes (X) | |||
| Daniel E Baker | |||||||||
| Former CFO | 0.0 | 0.0 | $0 | $2,154,132 | $160,530 | Yes (X) | |||
| Kenneth J Natzke | |||||||||
| Former CEO East Region | 0.0 | 0.0 | $0 | $528,533 | $47,343 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $716,405 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $15,421,070 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,667,499 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Emergency Physician Staffing Solutions | |||||
| 1504 Timber Trail | Washington | IL | 61571 | Emergency Services Physicians | $1,211,146 |
| ER Doctors LTD | |||||
| 7 Wood Duck Lane | Ottawa | IL | 61350 | Emergency Room Services | $711,833 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Info In Schedule O Part VIII | Yes (X) | InfoInScheduleOPartVIIIInd |
| Federated Campaigns | $0 | FederatedCampaignsAmt |
| Membership Dues | $0 | MembershipDuesAmt |
| Fundraising | $0 | FundraisingAmt |
| Related Organizations | $28,420 | RelatedOrganizationsAmt |
| Government Grants | $0 | GovernmentGrantsAmt |
| All Other Contributions | $11,776 | AllOtherContributionsAmt |
| Noncash Contributions | $0 | NoncashContributionsAmt |
| Total Contributions | $40,196 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| PATIENT REVENUE | 622110 | $34,383,501 | $34,383,501 | $0 | $0 |
| CONTRACTED PHARMACY | 622110 | $1,620,492 | $1,620,492 | $0 | $0 |
| MEDICAL DIRECTORSHIPS | 624200 | $36,578 | $36,578 | $0 | $0 |
| $0 | $0 | $0 | $0 | ||
| $0 | $0 | $0 | $0 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $36,040,571 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,109 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $7,109 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $33,677 | RealAmt |
| Personal | $0 | PersonalAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $33,677 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $33,677 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $33,677 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $1,836 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $1,836 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,836 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,836 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $0 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $52,583 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $43,515 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,068 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $9,068 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| CAFETERIA | 624200 | $59,377 | $59,377 | $0 | $0 |
| $0 | $0 | $0 | $0 | ||
| $0 | $0 | $0 | $0 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $146,805 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $144,808 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $1,997 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $206,182 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,338,639 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $36,244,756 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $1,997 | UnrelatedBusinessRevenueAmt |
| Exclusion | $51,690 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,000,238 | TotalAmt |
| Program Services | $9,794,371 | ProgramServicesAmt |
| Management And General | $2,205,867 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $368,728 | TotalAmt |
| Program Services | $300,949 | ProgramServicesAmt |
| Management And General | $67,779 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,563,976 | TotalAmt |
| Program Services | $2,147,816 | ProgramServicesAmt |
| Management And General | $416,160 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $500,019 | TotalAmt |
| Program Services | $408,107 | ProgramServicesAmt |
| Management And General | $91,912 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,000 | TotalAmt |
| Management And General | $77,000 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,659 | TotalAmt |
| Management And General | $14,659 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,357,115 | TotalAmt |
| Program Services | $2,316,652 | ProgramServicesAmt |
| Management And General | $40,463 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,062,635 | TotalAmt |
| Program Services | $2,829,042 | ProgramServicesAmt |
| Management And General | $233,593 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $387,738 | TotalAmt |
| Program Services | $48,892 | ProgramServicesAmt |
| Management And General | $338,846 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $113,700 | TotalAmt |
| Program Services | $77,166 | ProgramServicesAmt |
| Management And General | $36,534 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,833 | TotalAmt |
| Program Services | $9,432 | ProgramServicesAmt |
| Management And General | $401 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,960,216 | TotalAmt |
| Program Services | $2,350,115 | ProgramServicesAmt |
| Management And General | $610,101 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,237,817 | TotalAmt |
| Program Services | $3,620,090 | ProgramServicesAmt |
| Management And General | $1,617,727 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,831,935 | TotalAmt |
| Program Services | $1,454,373 | ProgramServicesAmt |
| Management And General | $377,562 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $136,048 | TotalAmt |
| Program Services | $23,538 | ProgramServicesAmt |
| Management And General | $112,510 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,222 | TotalAmt |
| Program Services | $867 | ProgramServicesAmt |
| Management And General | $59,355 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,787,962 | TotalAmt |
| Program Services | $28,644,485 | ProgramServicesAmt |
| Management And General | $7,143,477 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,031,673 | BOYAmt |
| EOY | $1,192,506 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,510,129 | BOYAmt |
| EOY | $127,936 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,426,526 | BOYAmt |
| EOY | $5,605,973 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $721,224 | BOYAmt |
| EOY | $775,070 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $439,904 | BOYAmt |
| EOY | $113,426 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $52,298,191 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $38,463,259 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,307,096 | BOYAmt |
| EOY | $13,834,932 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,980 | BOYAmt |
| EOY | $74,420 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,526,982 | BOYAmt |
| EOY | $12,617,788 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,016,514 | BOYAmt |
| EOY | $34,342,051 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,264,111 | BOYAmt |
| EOY | $2,890,403 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,909,200 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,607,853 | BOYAmt |
| EOY | $30,168,534 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,781,164 | BOYAmt |
| EOY | $33,058,937 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$473,761 | BOYAmt |
| EOY | -$516,803 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,088,602 | BOYAmt |
| EOY | $1,179,408 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $620,509 | BOYAmt |
| EOY | $620,509 | EOYAmt |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,235,350 | BOYAmt |
| EOY | $1,283,114 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,016,514 | BOYAmt |
| EOY | $34,342,051 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $550,677 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $0 | NetUnrlzdGainsLossesInvstAmt |
| Donated Services And Use Fclts | $0 | DonatedServicesAndUseFcltsAmt |
| Investment Expense | $0 | InvestmentExpenseAmt |
| Prior Period Adjustments | $0 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | -$502,913 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $14,659 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $14,659 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | THE 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 ACTIVITY | THE 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $731,914 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $69,342 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $801,256 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $644,870 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $87,044 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $731,914 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $591,555 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $53,315 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $644,870 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $0 | BeginningYearBalanceAmt |
| Contributions | $620,509 | ContributionsAmt |
| Investment Earnings Or Losses | -$28,954 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $591,555 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $0 | BeginningYearBalanceAmt |
| End Year Balance | $0 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.0 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.7744 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.2256 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (true) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (true) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $1,927,000 | OtherCostOrOtherBasisAmt |
| Book Value | $1,927,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $29,587,822 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,573,783 | DepreciationAmt |
| Book Value | $9,014,039 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $4,928,251 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,477,752 | DepreciationAmt |
| Book Value | $450,499 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $15,835,886 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,411,724 | DepreciationAmt |
| Book Value | $2,424,162 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $19,232 | OtherCostOrOtherBasisAmt |
| Depreciation | $0 | DepreciationAmt |
| Book Value | $19,232 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $13,834,932 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| GOODWILL | $10,817,871 |
| RESTRICTED FOUNDATION ASSETS | $1,799,917 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $12,617,788 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ASSET RETIREMENT OBLIGATION | $24,538 |
| ADVANCES DUE CORP-TERM | $30,143,996 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $30,168,534 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule D, Part I, Line 1(a) PART 1, LINE 1A | Prior 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 funds | PROCEEDS OF THE ENDOWMENT, AS DICTATED BY THE DONORS, ARE USED AS BEST DETERMINED BY THE FOUNDATION COUNCIL. |
| Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote | OSF IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED BY SECTION 501(c)(3) OF THE INTERNAL REVENUE CODE 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 125 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $648,646 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $648,646 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0181 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,975,359 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,231,483 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,743,876 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0487 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $5,624,005 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,231,483 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,392,522 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0669 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $103,834 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,085 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $84,749 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0024 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $73,397 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $73,397 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0021 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $181,231 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,085 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $162,146 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0045 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $5,805,236 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,250,568 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,554,668 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0714 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $504,103 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $14,034,972 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $14,846,695 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$811,723 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MENDOTA COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 E 12TH STREET | AddressLine1Txt |
| City | MENDOTA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61342 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTPS://WWW.OSFHEALTHCARE.ORG/SAINT-PAUL/ | WebsiteAddressTxt |
| State License | IL0005819 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MENDOTA COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://www.osfhealthcare.org/about/community-health/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | false | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (true) | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 125.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.0 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.OSFHEALTHCARE.ORG/BILLING/FINANCIAL-ASSISTANCE/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.OSFHEALTHCARE.ORG/BILLING/FINANCIAL-ASSISTANCE/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.OSFHEALTHCARE.ORG/BILLING/FINANCIAL-ASSISTANCE/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 3E | The significant health needs were prioritized as significant health needs of the community and identified through the CHNA. See CHNA for further information. |
| Schedule H, Part V, Section B, Line 5 Facility , 1 | Facility , 1 - MENDOTA COMMUNITY HOSPITAL. FOR THE 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 , 1 | Facility , 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 , 1 | Facility , 1 - MENDOTA COMMUNITY HOSPITAL. MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") DURING FISCAL YEAR 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 , 1 | Facility , 1 - MENDOTA COMMUNITY HOSPITAL. CATASTROPHIC FINANCIAL ASSISTANCE IS AVAILABLE WHEN CHARGES EXCEED 25% OF ANNUAL FAMILY INCOME. THE AMOUNT BILLED IS ADJUSTED TO 25% OF FAMILY INCOME WHEN OSF DETERMINES THIS ADJUSTMENT IS THE MOST GENERAL ASSISTANCE. |
| Schedule H, Part V, Section B, Line 13 Facility , 1 | Facility , 1 - MENDOTA COMMUNITY HOSPITAL. PRESUMPTIVE FINANCIAL ASSISTANCE IS AVAILABLE AND PROVIDES FOR A DISCOUNT OF 100% OF BILLED CHARGES FOR MEDICALLY NECESSARY SERVICES PROVIDED TO A PATIENT WITH NO INSURANCE BENEFITS, WHEN THE PATIENT ESTABLISHES FINANCIAL NEED AT TIME OF REGISTRATION BY SATISFYING ONE OF THE FOLLOWING CATEGORIES OF PRESUMPTIVE ELIGIBILITY CRITERIA: HOMELESSNESS; DECEASED WITH NO ESTATE; MENTAL INCAPACITATION WITH NO ONE TO ACT ON THE PATIENT'S BEHALF; AND CURRENT MEDICAID ELIGIBILITY, BUT NOT ON DATE OF SERVICE OR FOR NON-COVERED SERVICE. |
| Schedule H, Part V, Section B, Line 15 Facility , 1 | Facility , 1 - MENDOTA COMMUNITY HOSPITAL. THE FINANCIAL ASSISTANCE POLICY DIRECTS PATIENTS TO STAFF IN THE PATIENT FINANCIAL SERVICES AND ADMITTING AREAS AT OSF HOSPITALS FOR ASSISTANCE IN OBTAINING ANSWERS TO QUESTIONS REGARDING THE POLICY. |
| Schedule H, Part V, Section B, Line 16 Facility , 1 | Facility , 1 - MENDOTA COMMUNITY HOSPITAL. A PLAIN LANGUAGE SUMMARY OF THE FAP IS OFFERED TO PATIENTS AS PART OF THE INTAKE OR DISCHARGE PROCESS, INFORMATION ABOUT FINANCIAL ASSISTANCE AND THE APPLICATION PROCESS IS INCLUDED ON OR WITH THE OSF PATIENT BILLING STATEMENT, AND OSF PROVIDES COPIES OF THE PLAIN LANGUAGE SUMMARY AND THE FAP APPLICATION FORM TO REFERRING STAFF PHYSICIANS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 0 | FacilityNum |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 assistance | MEDICARE COST TO CHARGE RATIO |
| Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount | IN GENERAL, AND IN ACCORDANCE WITH MEDICARE REGULATIONS, PATIENT ACCOUNT BALANCES ARE WRITTEN OFF TO BAD DEBT EXPENSE AFTER REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED AND THE ACCOUNT HAS BEEN SENT TO A COLLECTION AGENCY OR LAW FIRM. PATIENTS' ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENTS' ACCOUNTS RECEIVABLE, OSF ANALYZES PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, OSF ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH PATIENT RESPONSIBILITY (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND 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 footnote | PLEASE SEE PAGE 22 AND 23 OF NOTES TO CONSOLIDATED FINANCIAL STATEMENTS |
| Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance | THE CORPORATION HAS A FAIR BILLING/COLLECTION POLICY WHICH APPLIES FOR ALL PATIENTS. THE POLICY INCLUDES: -REQUIRED INFORMATION PROVIDED IN BILLS TO PATIENTS (INCLUDING A REQUIREMENT THAT INFORMATION BE PROVIDED ON HOW THE PATIENT MAY APPLY FOR FINANCIAL ASSISTANCE). -PROCESS FOR PATIENTS TO INQUIRE ABOUT OR DISPUTE A BILL, INCLUDING TOLL-FREE TELEPHONE NUMBER, ADDRESS, CONTACT NAME AND E-MAIL ADDRESS. -REQUIREMENTS FOR TIMELY RESPONSE TO PATIENT INQUIRIES. -CONDITIONS WHICH MUST BE SATISFIED BEFORE PATIENT MAY BE SENT TO A COLLECTION AGENCY OR ATTORNEY. -LEGAL ACTION FOR NON-PAYMENT OF A PATIENT BILL MAY NOT BE INITIATED UNTIL AN AUTHORIZED HOSPITAL OFFICIAL HAS DETERMINED THAT ALL CONDITIONS IN THE CORPORATION'S POLICY (INCLUDING ALL THE FOREGOING POLICY PROVISIONS) HAVE BEEN SATISFIED FOR INITIATING LEGAL ACTION. -LEGAL ACTION MAY NOT BE PURSUED AGAINST UNINSURED PATIENTS WHO HAVE CLEARLY DEMONSTRATED THAT THEY HAVE NEITHER SUFFICIENT INCOME NOR ASSETS TO MEET THEIR FINANCIAL OBLIGATIONS - EVEN IF SUCH PATIENTS DO NOT APPLY FOR FINANCIAL ASSISTANCE. -THE CORPORATION SHALL NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS, SUCH AS SUBMITTING REPORTS TO CREDIT AGENCIES BEFORE REASONABLE ATTEMPTS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE HAVE BEEN COMPLETED. -IF A PATIENT RECEIVES AN APPLICATION FOR FINANCIAL ASSISTANCE BUT FAILS TO RETURN IT, OSF WILL TRY TO USE SECONDARY SOURCES TO DETERMINE THE PATIENT'S ELIGIBILITY FOR 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 assessment | MENDOTA 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 assistance | THE CORPORATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO ARE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER GOVERNMENT PROGRAMS AND THE CORPORATION'S FINANCIAL ASSISTANCE POLICY, IN ENGLISH AND IN ANY OTHER LANGUAGE SPOKEN BY POPULATIONS WITH LIMITED ENGLISH PROFICIENCY THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE COMMUNITY OF THE HOSPITAL, IN THE FOLLOWING WAYS: -SIGNS ARE POSTED IN PATIENT REGISTRATION AREAS (INCLUDING EMERGENCY DEPARTMENT REGISTRATION) INFORMING PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE, THE AVAILABILITY OF FINANCIAL ASSISTANCE COUNSELORS, AND HOW TO OBTAIN A COPY OF THE OSF FINANCIAL ASSISTANCE POLICY AND APPLICATION. -A PLAIN LANGUAGE SUMMARY OF THE OSF FINANCIAL ASSISTANCE POLICY IS OFFERED TO PATIENTS AS PART OF THE INTAKE OR DISCHARGE PROCESS AND INCLUDED IN THE BILLING STATEMENT MAILED PRIOR TO INITIATING EXTRAORDINARY COLLECTION ACTIONS. IN ADDITION, THE PLAIN LANGUAGE SUMMARY AND APPLICATION ARE PROVIDED TO REFERRING STAFF PHYSICIANS. -OSF MAKES REASONABLE EFFORTS TO ORALLY NOTIFY PATIENTS ABOUT THE FINANCIAL ASSISTANCE POLICY AND HOW TO OBTAIN ASSISTANCE IN APPLYING. -A NOTICE OF AVAILABILITY OF THE CORPORATION'S FINANCIAL ASSISTANCE AND UNINSURED PATIENT DISCOUNT POLICIES IS PROMINENTLY AVAILABLE ON THE CORPORATION'S 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 information | MENDOTA 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 health | THE 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 system | THE 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 report | IL |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (27 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Robert C Sehring | ||||||||||||||
| Vice Chairperson 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 ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 3 SCH J, PART I, LINE 3 | THE BOARD OF DIRECTORS HAS ESTABLISHED A BOARD COMMITTEE KNOWN AS THE HUMAN RESOURCES COMMITTEE WHOSE MEMBERS ARE ALL PROFESSED MEMBERS OF 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 fees | THE CORPORATION REIMBURSES CERTAIN EXECUTIVES FOR SOCIAL CLUB DUES PAID BY SUCH EXECUTIVES. ELIGIBILITY FOR CLUB DUES REIMBURSEMENT IS DETERMINED BY THE HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS AND IS TAKEN INTO CONSIDERATION BY THE COMMITTEE IN DETERMINING FAIR MARKET COMPENSATION. SEE FORM 990 - SCHEDULE O - PART VI - LINES 15A AND 15B FOR AN EXPLANATION OF THE ROLE OF THE HUMAN RESOURCES COMMITTEE AND THE MANNER IN WHICH FAIR MARKET COMPENSATION IS DETERMINED. CLUB DUES ARE NOT ELIGIBLE FOR REIMBURSEMENT IF THE CLUB IN QUESTION DISCRIMINATES ON THE BASIS OF RACE, RELIGION, SEX, NATIONAL ORIGIN, OR OTHER PROHIBITED FACTORS. DUES REIMBURSEMENT IS TREATED AND REPORTED AS TAXABLE COMPENSATION. |
| Schedule J, Part I, Line 4a Severance or change-of-control payment | In 2017 MARCIA S FLESSNER received severance in the amount of $74,432. |
| Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan | DURING 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 ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part I, Line 1 PART I | THE TAX LAW REQUIRES THAT EACH LEGAL ENTITY WITHIN THE OSF HEALTHCARE SYSTEM COMPLETE A SEPARATE TAX RETURN WHICH APPROPRIATELY REFLECTS THE ACTIVITIES AND FINANCIAL POSITION OF THE PARTICULAR ORGANIZATION. THIS REPORTING, HOWEVER, IS NOT REFLECTIVE OF THE OSF HEALTHCARE SYSTEM AS A WHOLE. PLEASE SEE THE ATTACHED AUDITED FINANCIAL STATEMENTS OF OSF HEALTHCARE SYSTEM AND SUBSIDIARIES FOR A COMPLETE OVERVIEW OF THE SYSTEM. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | OSF HEALTHCARE SYSTEM IS THE SOLE CORPORATE MEMBER OF MENDOTA COMMUNITY HOSPITAL. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | OSF HEALTHCARE SYSTEM AS A SOLE CORPORATE MEMBER OF MENDOTA COMMUNITY HOSPITAL HAS THE POWER TO ELECT MEMBERS OF THE BOARD. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | RESERVED POWERS: THE FOLLOWING POWERS ARE RESERVED FOR THE MEMBER: A) TO ESTABLISH, APPROVE, OR MODIFY THE PHILOSOPHY, VISION, VALUES, AND MISSION ACCORDING TO WHICH THE CORPORATION OPERATES. (B) TO AMEND THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS. (C) TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE DIRECTORS OF THE CORPORATION. (D) TO MERGE OR CONSOLIDATE THE CORPORATION WITH OTHER ENTITIES OR TO DISSOLVE THE CORPORATION. (E) TO ACQUIRE AN INTEREST IN AN EXISTING ENTITY OR TO ESTABLISH A NEW ENTITY. (F) TO LEASE, SELL, ENCUMBER OR OTHERWISE ALIENATE ANY REAL PROPERTY OR INTEREST IN REAL PROPERTY OF THE CORPORATION. (G) TO APPROVE ANY TRANSFER, LEASE, SALE OR ENCUMBRANCE OF PERSONAL PROPERTY OF THE CORPORATION EXCEPT IN THE ORDINARY COURSE OF BUSINESS. (H) TO APPROVE ANY BORROWING OR DEBT FINANCING ON BEHALF OF THE CORPORATION. (I) TO APPOINT, DISCIPLINE, TERMINATE AND REMOVE THE CORPORATION'S OPERATING DIVISION PRESIDENT. (J) TO APPOINT AND REMOVE THE CORPORATION'S CHAIRPERSON, VICE CHAIRPERSON(S), CHIEF EXECUTIVE OFFICER, PRESIDENT, SECRETARY, AND TREASURER, AND THE ASSISTANT SECRETARY AND ASSISTANT TREASURER, IF ANY. (K) TO APPROVE OR AMEND STRATEGIC PLANS, MANAGEMENT OBJECTIVES, AND CAPITAL AND OPERATING BUDGETS OF THE CORPORATION. (L) TO APPROVE ANY PURCHASE OR OTHER AQUISITION BY THE CORPORATION THAT IS NOT INCLUDED IN ITS CAPITAL BUDGET AND EXCEEDS ONE MILLION DOLLARS ($1,000,000) PER ITEM. (M) TO NAME OR RENAME ANY HOSPITAL OR MEDICAL CENTER OWNED AND OPERATED BY THE CORPORATION. (N) TO REQUIRE A CERTIFIED AUDIT OF FINANCES OF THE CORPORATION AND TO APPOINT THE CERTIFIED PUBLIC ACCOUNTANT TO PERFORM THE AUDIT. (O) TO APPROVE THE ENGAGEMENT OF AND TO DISMISS ANY OUTSIDE LEGAL COUNSEL TO REPRESENT THE CORPORATION ON A REGULAR BASIS OR IN CONNECTION WITH ANY MATTER DEEMED BY THE MEMBER, IN GOOD FAITH, TO HAVE SIGNIFICANCE FOR THE CORPORATION AS A WHOLE. (P) TO GIVE PRELIMINARY APPROVAL PRIOR TO THE DEVELOPMENT OF, AND TO GIVE FINAL APPROVAL PRIOR TO THE EXECUTION OF, ALL DOCUMENTS TO WHICH THE CORPORATION IS OR WILL BE A PARTY AND WHICH RELATE TO THE CREATION, FORMATION, ORGANIZATION, OR TERMINATION OF ANY OTHER LEGAL ENTITY (WHETHER A CORPORATION, LIMITED LIABILITY COMPANY, PARTNERSHIP, OR ANY OTHER ENTITY) IN WHICH THE CORPORATION WILL HAVE ANY OWNERSHIP INTEREST, MEMBERSHIP INTEREST, POWER TO ELECT OR APPOINT BOARD MEMBERS OR OFFICERS, OR ANY OTHER FORMAL PARTICIPATION ARRANGEMENT, WHETHER ACTING ALONE OR IN CONJUNCTION WITH ANY OTHER PERSON OR ENTITY. (Q) TO TAKE ANY AND ALL ACTIONS DEEMED NECESSARY, IN THE SOLE JUDGEMENT OF THE MEMBER BOARD TO PROTECT AND PRESERVE THE TAX-EXEMPT STATUS AND PUBLIC CHARITY STATUS OF THE CORPORATION OR THE MEMBER AND ANY TAX-EXEMPT AFFILIATE OF THE CORPORATION OR THE MEMBER (INCLUDING FEDERAL AND STATE INCOME TAX EXEMPTIONS, PROPERTY TAX EXEMPTIONS, AND SALES TAX EXEMPTIONS); PROVIDED THE MEMBER BOARD HAS GIVEN A WRITTEN REQUEST TO THE BOARD TO TAKE ACTION OR REFRAIN FROM TAKING ACTION, WHICH WOULD HAVE SUFFICIENTLY PROTECTED AND PRESERVED SUCH TAX-EXEMPT AND PUBLIC CHARITY STATUS, AND THE BOARD HAS FAILED TO PROMPTLY TAKE SUCH ACTION OR REFRAIN FROM TAKING SUCH ACTION. |
| Form 990, Part VI, Line 9 Interested person not at organization's address | BRIAN SILVERSTEIN, M.D. 711 APPLE TREE LANE GLENCOE, IL 60022 |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE PROPOSED FINAL VERSION OF THE 990 IS 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 policy | DISCLOSURES BY OFFICERS, DIRECTORS AND TRUSTEES, AS WELL AS KEY EMPLOYEES AND EMPLOYEES CHARGED WITH PURCHASING, PROCUREMENT AND CONTRACTION DECISION-MAKING ARE MADE THROUGH AN ELECTRONIC REPORTING SYSTEM ON AN ANNUAL BASIS. DISCLOSURES ARE RECEIVED AND REVIEWED BY THE CORPORATE COMPLIANCE DIVISION ON AN ANNUAL BASIS. IF A POTENTIAL CONFLICT OF INTEREST IS IDENTIFIED, THEN THE DISCLOSING EMPLOYEE IS NOTIFIED OF THE POTENTIAL CONFLICT AND MAY BE ASKED FOR ADDITIONAL INFORMATION 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 official | THE BOARD OF DIRECTORS HAS ESTABLISHED A BOARD COMMITTEE KNOWN AS THE HUMAN RESOURCES COMMITTEE WHOSE MEMBERS ARE ALL PROFESSED MEMBERS OF THE RELIGIOUS CONGREGATION KNOWN AS THE SISTERS OF THE THIRD ORDER OF SAINT FRANCIS WHO 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 employees | THE BOARD OF DIRECTORS HAS ESTABLISHED A BOARD COMMITTEE KNOWN AS THE HUMAN RESOURCES COMMITTEE WHOSE MEMBERS ARE ALL PROFESSED MEMBER OF THE RELIGIOUS CONGREGATION KNOWN AS THE SISTERS OF THE THIRD ORDER OF SAINT FRANCIS WHO 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 public | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| Form 990, Part VIII, Line 11d Other Miscellaneous Revenue | All 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 balances | Inter-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/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| SISTERS OF THE THIRD ORDER OF ST FRANCIS | ||||||||||
| 800 NE GLEN OAK AVE | PEORIA | IL | 61603 | 371259286 | PARENT/SU ORG | IL | 501(c)(3) | Type II | NA | false |
| OSF HEALTHCARE FOUNDATION | ||||||||||
| 800 NE GLEN OAK AVE | PEORIA | IL | 61603 | 371259284 | SUPPORT ORG | IL | 501(c)(3) | Type II | NA | false |
| ST FRANCIS COMMUNITY CLINIC | ||||||||||
| 530 NE GLEN OAK AVE | PEORIA | IL | 61637 | 370661235 | FREE CLINIC | IL | 501(c)(3) | 7 | SIS 3RD OSF | false |
| OTTAWA REGIONAL HOSP & HEALTHCARE CTR | ||||||||||
| 1100 EAST NORRIS DRIVE | OTTAWA | IL | 61350 | 362604009 | HOSPITAL | IL | 501(c)(3) | 3 | OSF | false |
| OTTAWA REGIONAL HOSPITAL FOUNDATION | ||||||||||
| 1100 EAST NORRIS DRIVE | OTTAWA | IL | 61350 | 364007569 | SUPPORT ORG | IL | 501(c)(3) | Type I | ORHHC | false |
| OSF MULTI-SPECIALTY GROUP | ||||||||||
| 800 NE GLEN OAK AVE | PEORIA | IL | 61603 | 383852646 | HLTHCARE SVCS | IL | 501(c)(3) | Type I | OSF | false |
| OSF HEART & VASCULAR INSTITUTE | ||||||||||
| 800 NE GLEN OAK AVE | PEORIA | IL | 61603 | 352422385 | HLTHCARE SVCS | IL | 501(c)(3) | Type I | OSF | false |
| CHILDREN'S HOSPITAL OF ILLINOIS MED GRP | ||||||||||
| 800 NE GLEN OAK AVE | PEORIA | IL | 61603 | 320353954 | HLTHCARE SVCS | IL | 501(c)(3) | Type I | OSF | false |
| ILLINOIS NEUROSCIENCE INSTITUTE | ||||||||||
| 800 NE GLEN OAK AVE | PEORIA | IL | 61603 | 364709999 | HLTHCARE SVCS | IL | 501(c)(3) | Type I | OSF | false |
| OSF HEALTHCARE SYSTEM | ||||||||||
| 800 NE GLEN OAK AVE | PEORIA | IL | 61603 | 370813229 | HOSPITAL | IL | 501(c)(3) | 3 | SIS 3RD OSF | false |
| SAINT ANTHONY'S PHYSICIAN GROUP | ||||||||||
| PO BOX 340 | ALTON | IL | 62002 | 371365059 | HLTHCARE SVCS | IL | 501(c)(3) | 10 | OSF | false |
| OTTAWA REGIONAL HOSPITAL AUXILIARY | ||||||||||
| 1100 EAST NORRIS DRIVE | OTTAWA | IL | 61350 | 363854788 | SUPPORT ORG | IL | 501(c)(3) | Type I | OSF | false |
| OSF College of Health Sciences | ||||||||||
| 800 NE Glen Oak Avenue | Peoria | IL | 61603 | 364868939 | COLLEGE OF NURSING | IL | 501(c)(3) | 2 | OSF | false |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|
| CENTER FOR HEALTH AMBULATORY | |||||||||||
| 8800 RTE 91 N | PEORIA | IL | 61615 | 205557171 | SURGICAL CENTER | IL | OSF | Related | false | Yes (true) | 0 |
| EASTLAND MEDICAL PLAZA | |||||||||||
| 1505 EASTLAND DRIVE | Bloomington | IL | 61701 | 371400643 | SURGICAL CENTER | IL | OSF | Related | false | Yes (true) | 0 |
| FORT JESSE IMAGING CENTER LLC | |||||||||||
| 2200 FT JESSE ROAD | NORMAL | IL | 61761 | 460515604 | MEDICAL IMAGING | IL | OSF | Related | false | Yes (true) | 0 |
| SAINT CLARE'S VILLA | |||||||||||
| 915 EAST 5TH STREET | ALTON | IL | 62002 | 371397289 | LOW INC HOUSING | IL | OSF | Related | false | Yes (true) | 0 |
| FOX RIVER CANCER CENTER | |||||||||||
| 1211 STARFISH DRIVE | OTTAWA | IL | 61350 | 870805865 | ONCOLOGY | IL | ORHHC | Related | false | Yes (true) | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| OSF SAINT FRANCIS INC | |||||||||
| 800 NE GLEN OAK AVE | PEORIA | IL | 61603 | 363484677 | HLTHCARE SVCS | IL | OSF | C Corporation | false |
| ILLINOIS PATHOLOGST SERVICES LLC | |||||||||
| 5666 EAST STATE STREET | ROCKFORD | IL | 61108 | 800439081 | PATHOLOGY SVCS | IL | OSF | C Corporation | false |
| Lakeview Medical Office Building | |||||||||
| 812 N Logan Ave | Danville | IL | 61832 | 371100761 | Condominium Association | IL | OSF | C Corporation | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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