FURP.ORG / PUBLIC DATA EXPLORER

BLESSINGCARE CORPORATION: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
BLESSINGCARE CORPORATION (EIN 37-1396010)
Tax period
2017-10-01 to 2018-09-30
Filed
2019-07-17
IRS object ID
201921989349301022
Schema version
2017v2.3
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2019-07-17T15:55:31-05:00ReturnTs
Tax Period End2018-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN363077757PreparerFirmEIN

Preparer Firm Name PreparerFirmName

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

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1500 MAINE STAddressLine1Txt
CityQUINCYCityNm
State AbbreviationILStateAbbreviationCd
ZIP62301ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN371396010EIN

Business Name BusinessName

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

US Address USAddress

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

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonPATRICK M GERVELERPersonNm
Person TitleTREASURERPersonTitleTxt
Phone2172852113PhoneNum
Signature2019-07-09SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonSTEPHEN C KOESTER CPAPreparerPersonNm
PTINP00342386PTIN
Phone2172220304PhoneNum
Preparation2019-07-09PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address216.138.22.18IPv4AddressTxt
FieldValueIRS element (for citing)
IP2019-07-17IPDt
IP Tm15:55:31IPTm
IP TimezoneCDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdD9F7B9C00988B757A5D07124BE82F17F71C0FA3DAtSubmissionCreationDeviceId
At Submission Filing Device Id2BE353FB2307F31039FDCCB65331A33EA6E48E3AAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

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

US Address USAddress

FieldValueIRS element (for citing)
Address Line1640 WEST WASHINGTONAddressLine1Txt
CityPITTSFIELDCityNm
State AbbreviationILStateAbbreviationCd
ZIP62363ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$31,229,847GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.ILLINIHOSPITAL.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2000FormationYr
Legal Domicile StateILLegalDomicileStateCd
Activity Or MissionTO IMPROVE THE HEALTH OF OUR COMMUNITY.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee262TotalEmployeeCnt
Total Volunteers41TotalVolunteersCnt
Total Gross UBI$23,279TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$19,951NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$107,469PYContributionsGrantsAmt
CY Contributions Grants$126,879CYContributionsGrantsAmt
PY Program Service Revenue$26,887,599PYProgramServiceRevenueAmt
CY Program Service Revenue$30,345,074CYProgramServiceRevenueAmt
PY Investment Income$6,697PYInvestmentIncomeAmt
CY Investment Income$7,680CYInvestmentIncomeAmt
PY Other Revenue$551,455PYOtherRevenueAmt
CY Other Revenue$711,922CYOtherRevenueAmt
PY Total Revenue$27,553,220PYTotalRevenueAmt
CY Total Revenue$31,191,555CYTotalRevenueAmt
PY Grants And Similar Paid$5,350PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$7,213CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$13,629,161PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$13,473,847CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$12,706,754PYOtherExpensesAmt
CY Other Expenses$13,881,213CYOtherExpensesAmt
PY Total Expenses$26,341,265PYTotalExpensesAmt
CY Total Expenses$27,362,273CYTotalExpensesAmt
PY Revenues Less Expenses$1,211,955PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$3,829,282CYRevenuesLessExpensesAmt
Total Assets BOY$23,659,760TotalAssetsBOYAmt
Total Assets EOY$27,073,327TotalAssetsEOYAmt
Total Liabilities BOY$8,677,676TotalLiabilitiesBOYAmt
Total Liabilities EOY$8,266,369TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$14,982,084NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$18,806,958NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO IMPROVE THE HEALTH OF OUR COMMUNITY.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$19,566,413ExpenseAmt
Grant$7,213GrantAmt
Revenue$30,345,074RevenueAmt
DescILLINI COMMUNITY HOSPITAL TREATED PATIENTS THROUGH THE FOLLOWING SERVICES DURING FISCAL YEAR 2018: INPATIENT ADMISSIONS 530 OBSERVATION ADMISSIONS 153 OUTPATIENT VISITS 79,954 TOTAL SURGERIES 295 EMERGENCY VISITS 5,830 LABORATORY TESTS 66,979 RESPIRATORY TREATMENTS 5,398 RADIOLOGY PROCEDURES 10,280 RURAL HEALTH CLINIC & XPRESS VISITS 12,978 IN ADDITION TO THESE HEALTHCARE SERVICES, ILLINI COMMUNITY HOSPITAL PROVIDED 679,348 IN CHARITY CARE. MEDICARE SHORTFALLS WERE 691,273. THE HOSPITAL PROVIDED ADDITIONAL BENEFITS OF 187,415 DURING FISCAL YEAR 2018 AS FOLLOWS: 1)HEALTH PROFESSIONALS EDUCATION - 63,167 HEALTHCARE STUDENT INTERNSHIPS NURSE PRACTITIONER CLINICALS RADIOLOGY CLINICALS 2)IN-KIND CONTRIBUTIONS AND DONATIONS - 45,270 COURTESY BLOOD DRAWS FOR AREA PUBLIC AGENCIES PIKE CEO PROGRAM PITTSFIELD FIRE DEPARTMENT PIKE COUNTY MINISTERIAL ALLIANCE DONATED MEETING ROOM SPACE HEALTH FAIRS HEALTH SCREENINGS GED PARTNERS BARRY YMCA PIKE YOUTH FOOTBALL UIC RMED PROGRAM 3)COMMUNITY HEALTH IMPROVEMENT PROGRAMS AND SERVICES - 68,517 FLU CLINICS PIKELAND WELLNESS COMMITTEE FOOD DRIVE READY, SET, GLOW RUN BLOOD AND PLATELET DRIVES SPORTS INJURY CLINIC UNREIMBURSED PATIENT TRANSPORTATION WALK TO SCHOOL DAY 4)COMMUNITY EDUCATIONAL PROGRAMS AND SERVICES - 10,461 COFFEE BREAK EDUCATIONAL RADIO PROGRAMS DESTRUCTIVE DECISIONS EDUCATIONAL PROGRAM HEALTH OCCUPATIONS JOB SHADOWING ALCS AND BLS CLASSES SELF-DEFENSE CLASSES DIABETES COACHINGDesc
Total Program Service Expenses$19,566,413TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsYes (true)GrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (true)BusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document31IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee262EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (true)DelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VentureYes (true)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (true)WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldILStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonKATHY HULLPersonNm
Phone2172852113PhoneNum

US Address USAddress

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

Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
JAN BLEICH
CHAIRPERSON1.000.00Yes (X)Yes (X)$0$0$0
PATRICK M GERVELER
TREASURER1.0039.00Yes (X)Yes (X)$0$539,224$82,814
K JEANNIE GOODMAN
TRUSTEE1.000.00Yes (X)$0$0$0
KATHLEEN E HULL
PRESIDENT/CE40.000.00Yes (X)Yes (X)$0$266,281$31,767
MAUREEN A KAHN
SECRETARY1.0039.00Yes (X)Yes (X)$0$806,735$145,338
LAURA KENT-DONAHUE
TRUSTEE1.000.00Yes (X)$0$0$0
CHRISTOPHER S WAGONER MD
PRES - MED S40.000.00Yes (X)$0$276,673$26,408
ERIC MILLER
VICE CHAIRPE1.000.00Yes (X)Yes (X)$0$0$0
JASON STRATTON
TRUSTEE1.000.00Yes (X)$0$0$0
DIANE VOSE
TRUSTEE1.000.00Yes (X)$0$0$0
CAITLIN M BARTON
PHARMACIST40.000.00$136,999$0$14,133Yes (X)
HOLLY A JONES
VP OPERATION40.000.00$127,221$0$25,007Yes (X)
VERNA D O'ROURKE
NP/DIR. GERI40.000.00$116,651$0$12,513Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$380,871TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,888,913TotReportableCompRltdOrgAmt
Total Other Compensation$337,980TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K3IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
AIMS OF PITTSFIELD LLC
8657 WEDGEWOOD DRIVEBURR RIDGEIL60527ER PHYSICIANS$2,074,615
EL PRUITT CO
PO BOX 3306SPRINGFIELDIL62708CONSTRUCTION$1,351,414
QUINCY MEDICAL GROUP
1025 MAINE STQUINCYIL62301MEDICAL SVCS$263,500
TOTAL MSP LLC
221 W COLLEGE AVEAPPLETONWI54911NURSING SVCS$257,132
SHARED MEDICAL SERVICES INC
209 LIMESTONE PASSCOTTAGE GROVEWI53527MRI/RAD SVCS$147,065
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
Related Organizations$83,004RelatedOrganizationsAmt
All Other Contributions$43,875AllOtherContributionsAmt
Total Contributions$126,879TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT REVENUE$66,668,004$66,668,004
CONTRACTUAL ALLOWANCE-$36,322,930-$36,322,930
FieldValueIRS element (for citing)
Total Program Service Revenue$30,345,074TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$7,680TotalRevenueColumnAmt
Exclusion$7,680ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$138,467RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$38,292RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$100,175RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$100,175TotalRevenueColumnAmt
Unrelated Business Revenue-$2,743UnrelatedBusinessRevenueAmt
Exclusion$102,918ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$47,920GrossSalesOfInventoryAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$47,920TotalRevenueColumnAmt
Exclusion$47,920ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
OTHER900099$289,886$289,886
EQUITY IN SUB'S EARNINGS900099$247,919$247,919
ILLINI HEALTH SERVICES, LLC446110$21,614$21,614

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,408TotalRevenueColumnAmt
Unrelated Business Revenue$4,408UnrelatedBusinessRevenueAmt
FieldValueIRS element (for citing)
Other Revenue Total$563,827OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$31,191,555TotalRevenueColumnAmt
Related Or Exempt Func Income$30,345,074RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$23,279UnrelatedBusinessRevenueAmt
Exclusion$696,323ExclusionAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$7,213TotalAmt
Program Services$7,213ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$9,475,698TotalAmt
Program Services$6,688,700ProgramServicesAmt
Management And General$2,786,998ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$368,090TotalAmt
Program Services$259,909ProgramServicesAmt
Management And General$108,181ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,956,200TotalAmt
Program Services$2,083,792ProgramServicesAmt
Management And General$872,408ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$673,859TotalAmt
Program Services$475,814ProgramServicesAmt
Management And General$198,045ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$21,489TotalAmt
Management And General$21,489ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$83,303TotalAmt
Management And General$83,303ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$333,416TotalAmt
Program Services$137,313ProgramServicesAmt
Management And General$196,103ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$71,218TotalAmt
Program Services$29,301ProgramServicesAmt
Management And General$41,917ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$100,367TotalAmt
Management And General$100,367ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,087,490TotalAmt
Program Services$394,799ProgramServicesAmt
Management And General$692,691ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$157,218TotalAmt
Management And General$157,218ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
PATIENT SUPPLIES$3,296,588$3,235,044$61,544
OUTSIDE FEES$3,070,274$1,402,126$1,668,148
PHYSICIAN FEES$2,649,170$2,649,170
BAD DEBTS$946,122$946,122

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$2,064,558TotalAmt
Program Services$1,257,110ProgramServicesAmt
Management And General$807,448ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$27,362,273TotalAmt
Program Services$19,566,413ProgramServicesAmt
Management And General$7,795,860ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,980,699BOYAmt
EOY$8,131,649EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,659,012BOYAmt
EOY$1,663,467EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$5,071,340BOYAmt
EOY$3,594,274EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$608,538BOYAmt
EOY$696,543EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$176,482BOYAmt
EOY$174,374EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$24,476,133LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$11,965,900LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$12,859,874BOYAmt
EOY$12,510,233EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$123,636BOYAmt
EOY$123,041EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$180,179BOYAmt
EOY$179,746EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$23,659,760BOYAmt
EOY$27,073,327EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$748,265BOYAmt
EOY$520,691EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,211,993BOYAmt
EOY$3,691,945EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,717,418BOYAmt
EOY$4,053,733EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$8,677,676BOYAmt
EOY$8,266,369EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$14,906,362BOYAmt
EOY$18,754,854EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$75,722BOYAmt
EOY$52,104EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$14,982,084BOYAmt
EOY$18,806,958EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$23,659,760BOYAmt
EOY$27,073,327EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$3,829,282ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$4,408OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Schedule D IRS990ScheduleD

Land LandGrp

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

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$15,889,561OtherCostOrOtherBasisAmt
Depreciation$6,142,729DepreciationAmt
Book Value$9,746,832BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$606,751OtherCostOrOtherBasisAmt
Depreciation$376,667DepreciationAmt
Book Value$230,084BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,588,489OtherCostOrOtherBasisAmt
Depreciation$5,446,504DepreciationAmt
Book Value$2,141,985BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$111,641OtherCostOrOtherBasisAmt
Book Value$111,641BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$12,510,233TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)

DescDescAmtAmt
ESTIMATED THIRD-PARTY SETTLEMENTS$2,543,605
ACCRUED SALARIES$967,549
DUE TO BLESSING HOSPITAL$275,366
PAYROLL TAXES & WITHHOLDING$121,819
NONCURRENT ACCRUED MALPRACTICE$100,033
ACCRUED EMPLOYEE BENEFITS$37,172
ACCRUED INTEREST$8,189
FieldValueIRS element (for citing)
Total Liability$4,053,733TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$30,302,940TotalRevEtcAuditedFinclStmtAmt
Other Revenue-$800,756OtherRevenueAmt
Revenue Not Reported-$800,756RevenueNotReportedAmt
Revenue Subtotal$31,103,696RevenueSubtotalAmt
Other Revenues Not Included$87,859OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$87,859RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$31,191,555TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$26,454,443TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$26,454,443ExpensesSubtotalAmt
Other Expenses Not Included$907,830OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$907,830ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$27,362,273TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PAGE 4, PART XI, LINE 2DNA RELEASED FROM RESTRICTIONS FOR OPERATIONS 145,366 BAD DEBT REDUCTION OF REVENUE ON FS -946,122
SCHEDULE D, PAGE 4, PART XI, LINE 4BRESTRICTED CONTRIBUTIONS 121,748 RENTAL EXPENSES -38,292 FRINGE PARKING 4,408 IHS ALLOCABLE EXPENSES -5
SCHEDULE D, PAGE 4, PART XII, LINE 4BBAD DEBT REDUCTION OF REVENUE ON F/S 946,122 RENTAL EXPENSES -38,292 990-T DEPRECIATION -1,610 BOOK / TAX DEPRECIATION DIFFERENCE 1,610

Schedule H IRS990ScheduleH

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

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$679,348TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$679,348NetCommunityBenefitExpnsAmt
Total Expense0.02570TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$7,293,595TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,293,595DirectOffsettingRevenueAmt

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$7,972,943TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,293,595DirectOffsettingRevenueAmt
Net Community Benefit Expns$679,348NetCommunityBenefitExpnsAmt
Total Expense0.02570TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$78,978TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$78,978NetCommunityBenefitExpnsAmt
Total Expense0.00300TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$63,167TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$63,167NetCommunityBenefitExpnsAmt
Total Expense0.00240TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$45,270TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$45,270NetCommunityBenefitExpnsAmt
Total Expense0.00170TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$187,415TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$187,415NetCommunityBenefitExpnsAmt
Total Expense0.00710TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$8,160,358TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,293,595DirectOffsettingRevenueAmt
Net Community Benefit Expns$866,763NetCommunityBenefitExpnsAmt
Total Expense0.03280TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$946,122BadDebtExpenseAmt
Bad Debt Expense Attributable$44,184BadDebtExpenseAttributableAmt
Reimbursed By Medicare$10,750,191ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$11,441,464CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$691,273MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

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

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ILLINI COMMUNITY HOSPITALBusinessNameLine1Txt

US Address USAddress

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

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ILLINI COMMUNITY HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted18CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.BLESSINGHEALTH.ORGOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt15ImplementationStrategyAdptYr
Strategy Posted WebsitefalseStrategyPostedWebsiteInd
Strategy AttachedfalseStrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care150.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care250.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLWWW.BLESSINGHEALTH.ORGFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLWWW.BLESSINGHEALTH.ORGFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLWWW.BLESSINGHEALTH.ORGFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 3ETHE CHNA PROCESS HAS IDENTIFIED THE FOLLOWING COMMUNITY HEALTH NEEDS AS A PRIORITY: ADVANCING EDUCATION, SUPPORTING FINANCIAL STABILITY, AND PROMOTING GOOD HEALTH.
FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 5THE CHNA WAS CONDUCTED FOR ILLINI COMMUNITY HOSPITAL THROUGH A CONSULTING ARRANGEMENT WITH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (ICAHN). MULTIPLE METHODS WERE USED TO COLLECT DATA FOR THE PROJECT. SURVEY QUESTIONS AND PROTOCOLS WERE DEVELOPED IN PARTNERSHIP WITH THE ICAHN. ILLINI COMMUNITY HOSPITAL UNDERTOOK A THREE-MONTH PLANNING AND IMPLEMENTATION EFFORT TO DEVELOP THE CHNA, AND TO IDENTIFY AND PRIORITIZE COMMUNITY HEALTH NEEDS FOR ITS SERVICE AREA. THESE PLANNING AND DEVELOPMENT ACTIVITIES INCLUDED THE FOLLOWING STEPS: THE PROJECT WAS OVERSEEN AT THE OPERATIONAL LEVEL BY THE CEO. ARRANGEMENTS WERE MADE WITH ICAHN TO FACILITATE TWO FOCUS GROUPS AND A MEETING TO IDENTIFY AND PRIORITIZE SIGNIFICANT NEEDS. ICAHN WAS ALSO ENGAGED TO COLLECT, ANALYZE, AND PRESENT SECONDARY DATA AND TO PREPARE A FINAL REPORT FOR SUBMISSION TO ILLINI COMMUNITY HOSPITAL. THE CEO WORKED CLOSELY WITH ICAHN'S CONSULTANT TO IDENTIFY AND ENGAGE KEY COMMUNITY PARTNERS AND TO COORDINATE LOCAL MEETINGS AND GROUP ACTIVITIES. ILLINI COMMUNITY HOSPITAL ALSO LEVERAGED EXISTING RELATIONSHIPS THAT PROVIDED DIVERSE INPUT FOR A COMPREHENSIVE REVIEW AND ANALYSIS OF COMMUNITY HEALTH NEEDS IN THE HOSPITAL'S SERVICE AREA. THESE STEPS INCLUDED: THE CEO SECURED THE PARTICIPATION OF A DIVERSE GROUP OF REPRESENTATIVES FROM THE COMMUNITY AND THE HEALTH PROFESSION. ICAHN'S CONSULTANT PROVIDED SECONDARY DATA FROM MULTIPLE SOURCES. PARTICIPATION INCLUDED REPRESENTATIVES OF COUNTY HEALTH DEPARTMENTS SERVING THE AREA SERVED BY THE HOSPITAL.
FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 6BYES, THE CHNA INCLUDED THE SCHOOL NURSES OF PIKE COUNTY AS WELL AS REPRESENTATIVES FROM THE PIKE COUNTY HEALTH DEPARTMENT.
FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 11THE NEEDS IDENTIFIED AND PRIORITIZED THROUGH THE CHNA CARRIED FORWARD VARIANTS OF PREVIOUS CHNAS AND ADDED OTHERS. THE IDENTIFIED AND PRIORITIZED NEEDS SELECTED INCLUDE: 1. IMPROVE AWARENESS OF THE AVAILABILITY OF LOCAL HEALTHCARE, HEALTH- RELATED SERVICES AND OPPORTUNITIES, AND HOW TO ACCESS THEM: - BETTER CONNECT THE COMMUNITY TO NUTRITION INFORMATION AND HEALTHY FOODS. - IMPROVE TRANSPORTATION TO MEDICAL APPOINTMENTS AND SERVICES OUTSIDE OF THE SERVICE AREA 2. IMPROVE COMMUNICATION AND COLLABORATION AMONG HEALTHCARE PROVIDERS, COMMUNITY SERVICE PROVIDERS, FAITH-BASED COMMUNITY LEADERS, AND COMMUNITY GROUPS IN ORDER TO MAXIMIZE USE OF LOCAL RESOURCES. 3. ADDRESS ISSUES RELATED TO MENTAL HEALTH, INCLUDING: - IMPROVING LOCAL ACCESS TO MENTAL HEALTH SERVICES FOR YOUTH AND FAMILIES - ADDRESSING SUBSTANCE USE/MISUSE/ABUSE PREVENTION AND RECOVERY SERVICES REDUCE SMOKING - ADDRESSING THE CULTURE OF POVERTY IN LOCAL COMMUNITIES - ADDRESSING THE STIGMA ASSOCIATED WITH SEEKING OR RECEIVING MENTAL HEALTHCARE 4. ADDRESSING SERVICES FOR THE HOMELESS, BOTH TRANSIENT HOMELESS AND YOUTH AND YOUNG ADULTS, INCLUDING FINDING SHELTER WITH UNRELATED PERSONS. THE IMPLEMENTATION PLAN DEVELOPED BY THE SENIOR STAFF AT ILLINI COMMUNITY HOSPITAL IS SPECIFIC AND THOROUGH. THE PLAN, SET OUT IN THIS REPORT, INCLUDES THESE HIGHLIGHTS: ILLINI COMMUNITY HOSPITAL WILL WORK WITH CHURCHES AND OTHER FAITH-BASED ORGANIZATIONS TO BUILD, PLACE, AND STOCK "LITTLE PANTRIES" IN COMMUNITIES THROUGHOUT PIKE COUNTY. ILLINI COMMUNITY HOSPITAL WILL CREATE INSTRUCTIONAL VIDEOS FOR LOCAL BROADCAST TO EXPLAIN BASIC PREPARATION OF VEGETABLES AND OTHER HEALTHY FOODS AND SNACKS. ILLINI COMMUNITY HOSPITAL WILL EXPAND WEB-BASED AND SOCIAL MEDIA INFORMATION SHARING. ILLINI COMMUNITY HOSPITAL WILL EXPLORE SPONSORING OR CO-SPONSORING PERIODIC MOBILE FOOD PANTRIES IN SMALL COMMUNITIES ILLINI COMMUNITY HOSPITAL WILL ESTABLISH A HOSPITAL-BASED, NON-EMERGENCY MEDICAL TRANSPORTATION SERVICE FOR PERSONS REQUIRED TO TRAVEL TO LOCAL OR OUT-OF-AREA SERVICES. ILLINI COMMUNITY HOSPITAL WILL EXPLORE PARTNERSHIPS WITH SCHOOL DISTRICTS TO IDENTIFY THE MENTAL HEALTH SERVICE NEEDS OF YOUTH, DETERMINE HOW TO ADDRESS THOSE NEEDS, AND THEN ADDRESS THEM. ILLINI COMMUNITY HOSPITAL WILL ARRANGE FOR AND PRESENT CULTURE OF POVERTY EDUCATION AND AWARENESS PROGRAMS FOR ITS STAFF AND THE COMMUNITY. ILLINI COMMUNITY HOSPITAL WILL CONVENE MEETINGS AND DISCUSSIONS AMONG POTENTIAL LOCAL RESOURCES TO IDENTIFY THE SCOPE OF AVAILABLE SERVICES AND THEN MOVE FORWARD FROM THERE. ILLINI COMMUNITY HOSPITAL WILL CREATE CAMPAIGNS PROMOTING MENTAL HEALTH SERVICES AWARENESS, TARGETING THE STIGMA OF SEEKING OR RECEIVING MENTAL HEALTHCARE. ILLINI COMMUNITY HOSPITAL WILL CONVENE AND HOST MEETINGS AT LEAST TWICE PER YEAR TO BRING TOGETHER COMMUNITY ORGANIZATIONS, AGENCIES, HEALTH SERVICES AND OTHERS TO IDENTIFY WHAT INITIATIVES ARE GOING ON IN THE COMMUNITY AND TO DISCUSS HOW THE GROUPS CAN HELP EACH OTHER.
FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 13BPATIENTS ARE ELIGIBLE FOR CATASTROPHIC FINANCIAL ASSISTANCE IF THEIR INCOME EXCEEDS 250% OF THE FEDERAL POVERTY GUIDELINES AND THEIR MEDICAL BILLS EXCEED 20% OF THEIR TOTAL REPORTED FAMILY INCOME. ELIGIBILITY IS BASED ON AN INDIVIDUAL'S FAMILY'S TOTAL INCOME, FAMILY SIZE, AND ASSETS. PATIENTS EXPERIENCING CATASTROPHIC MEDICAL INDIGENCE ARE ELIGIBLE FOR A DISCOUNT OF 80%.
FieldValueIRS element (for citing)
Facility1FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

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

US Address USAddress

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

Supplemental Information Detail SupplementalInformationDetail (16 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CAREPATIENTS ARE ELIGIBLE FOR CATASTROPHIC FINANCIAL ASSISTANCE IF THEIR INCOME EXCEEDS 250% OF THE FEDERAL POVERTY GUIDELINES AND THEIR MEDICAL BILLS EXCEED 20% OF THEIR TOTAL REPORTED FAMILY INCOME. ELIGIBILITY IS BASED ON AN INDIVIDUAL'S OR FAMILY'S TOTAL INCOME, FAMILY SIZE AND ASSETS. PATIENTS EXPERIENCING CATASTROPHIC MEDICAL INDIGENCE ARE ELIGIBLE FOR AN 80% DISCOUNT.
PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATIONILLINI COMMUNITY HOSPITAL DOES NOT INCLUDE AS SUBSIDIZED HEALTH SERVICES ANY COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC.
PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSEBAD DEBT EXPENSE OF 946,122 IS SUBTRACTED FROM TOTAL EXPENSES OF 27,362,273 REPORTED ON LINE 25, COLUMN A OF FORM 990, PART IX, FOR A NET TOTAL EXPENSE OF 26,416,151.
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATIONWHEN POSSIBLE, CALCULATIONS OF DIRECT AND INDIRECT COSTS ASSOCIATED WITH THE SERVICES PROVIDED ARE REPORTED. IF NOT AVAILABLE, A COST-TO-CHARGE RATIO IS USED TO CALCULATE THE COST AMOUNTS. THIS RATIO IS COMPUTED USING ILLINI COMMUNITY HOSPITAL'S AS-FILED MEDICARE COST REPORT. THESE COSTS AND CHARGES ARE ADJUSTED TO ACCOUNT FOR ITEMS NOT REIMBURSED THROUGH THE COST REPORT SUCH AS PROVIDER-BASED PHYSICIAN SERVICES.
PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGYMETHODOLOGY USED TO DETERMINE BAD DEBT EXPENSE - BAD DEBT EXPENSE IS CALCULATED ON THE NET PATIENT ACCOUNT BALANCE AFTER THE BALANCE HAS BEEN REDUCED FOR ANY PAYMENTS RECEIVED OR DISCOUNTS/ADJUSTMENTS THAT ARE KNOWN. PATIENTS QUALIFYING FOR FINANCIAL ASSISTANCE ARE RECOGNIZED AS CHARITY CARE ACCOUNTS WHEN SUFFICIENT INFORMATION IS RECEIVED TO DETERMINE THEIR ELIGIBILITY. PRIOR TO THIS POINT, AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IS CALCULATED ON UNINSURED ACCOUNTS. THIS ALLOWANCE IS REVERSED IF THE ACCOUNT IS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE.
PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCEMETHODOLOGY OF ESTIMATED AMOUNT & RATIONALE FOR INCLUDING IN COMMUNITY BENEFIT - A NUMBER OF PATIENTS ARE TRULY UNABLE TO PAY FOR THEIR MEDICAL EXPENDITURES BUT DO NOT COMPLETE THE PROCESS REQUIRED TO APPLY FOR FINANCIAL ASSISTANCE. THE HOSPITAL PERFORMS AN ASSESSMENT USING FINANCIAL AND OTHER INFORMATION OF SUCH PATIENTS OTHERWISE AVAILABLE TO THE HOSPITAL TO IDENTIFY THOSE PATIENTS THAT WOULD QUALIFY FOR CHARITY CARE IF THEY COMPLETED THE PAPERWORK. THIS INFORMATION IS USED TO ESTIMATE THE AMOUNT OF THE HOSPITAL'S BAD DEBT EXPENSE THAT WILL BE FOUND TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE. THE BAD DEBT EXPENSE WITH SUCH PATIENTS ACCOUNTS ARE TREATED AS COMMUNITY BENEFIT.
BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTSSEE NOTE (3) ON PAGE 14 OF THE ATTACHED AUDITED CONSOLIDATED FINANCIAL STATEMENTS.
PART III, LINE 8 - MEDICARE EXPLANATIONTHE HOSPITAL USES A COST-TO-CHARGE RATIO TO CALCULATE COST AMOUNTS. THIS RATIO IS COMPUTED USING ILLINI COMMUNITY HOSPITAL'S AS-FILED MEDICARE COST REPORT. THESE COSTS AND CHARGES ARE ADJUSTED TO ACCOUNT FOR ITEMS NOT REIMBURSED THROUGH THE COST REPORT SUCH AS PROVIDER-BASED PHYSICIAN SERVICES. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT.
PART III, LINE 9B - COLLECTION PRACTICES EXPLANATIONCOLLECTION PRACTICES ARE NOT PURSUED IF A COMPLETED FINANCIAL ASSISTANCE APPLICATION HAS BEEN RETURNED AND APPROVED.
PART VI, LINE 2 - NEEDS ASSESSMENTTHE CHNA WAS CONDUCTED WITH ILLINI COMMUNITY HOSPITAL THROUGH A CONSULTING ARRANGEMENT WITH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (ICAHN). A LARGE CROSS SECTION OF COMMUNITY PARTNERS WERE REPRESENTED (GEOGRAPHIC, AGE, SOCIOECONOMIC, ETC.) THAT INCLUDED THE SCHOOL NURSES OF PIKE COUNTY AS WELL AS REPRESENTATIVES FROM THE PIKE COUNTY HEALTH DEPARTMENT.
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEBLESSING HOSPITAL FINANCIAL ACCOUNT SPECIALISTS (FAS) ATTEMPT TO CONTACT SELF-PAY INPATIENTS WITHIN 24 HOURS OF ADMISSION. IF THIS ATTEMPT TO MEET WITH THE PATIENT IS UNSUCCESSFUL, FURTHER ATTEMPTS ARE MADE LATER DURING THEIR STAY OR AT THEIR HOME. THE PATIENT IS SCREENED FOR GOVERNMENT PROGRAMS AND ELIGIBILITY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. OUTPATIENTS ARE CONTACTED ONCE THE PATIENT'S CONDITION HAS BEEN STABILIZED AND ARE SCREENED IN THE SAME MANNER AS INPATIENTS. FOR SCHEDULED TESTING, FAS CONTACT UNINSURED PATIENTS PRIOR TO THEIR SERVICE AND PROVIDE ESTIMATES OF CHARGES AND EDUCATION ON AVAILABLE PROGRAMS. IF THE FAS ARE NOT AVAILABLE TO MEET WITH THE PATIENT PRIOR TO SERVICE, CONTACT INFORMATION IS GIVEN TO THE PATIENT IF ASSISTANCE IS NEEDED.
PART VI, LINE 4 - COMMUNITY INFORMATIONILLINI COMMUNITY HOSPITAL OPENED ITS DOORS ON JANUARY 26, 1942 TO SERVE THE PEOPLE RESIDING WITHIN A 25 MILE RADIUS OF PITTSFIELD, ILLINOIS, WHICH IS PRIMARILY PIKE COUNTY BUT INCLUDES PARTS OF SCOTT, GREEN, CALHOUN, BROWN, AND ADAMS COUNTY. PIKE COUNTY HAS 831 SQUARE MILES OF LAND AREA AND A POPULATION OF APPROXIMATELY 15,611 PEOPLE. PIKE COUNTY AGE DEMOGRAPHICS INCLUDE 22.2% UNDER 18 YEARS OLD, AND 20.4% OVER 65 YEARS OLD. 49.6% OF THE RESIDENTS ARE FEMALE, 96.7% WHITE AND 1.9% BLACK. 88.2% OF THE POPULATION HAVE GRADUATED FROM HIGH SCHOOL AND 16.1% HAVE A BACHELORS DEGREE OR HIGHER. THE MEDIAN HOUSEHOLD INCOME IS 41,387 AND 15.9% OF THE POPULATION IS BELOW THE POVERTY LEVEL. PIKE COUNTY IS DESIGNATED AS A HEALTH PROFESSIONALS SHORTAGE AREA AND MEDICALLY UNDERSERVED AREA. THE UNEMPLOYMENT RATE IN PIKE COUNTY WAS 4.9% IN JANUARY 2018. THE REGIONS ECONOMY IS HEAVILY AGRICULTURAL WITH RETAIL AND TOURISMS ASSOCIATED WITH DEER HUNTING. ILLINI COMMUNITY HOSPITAL IS ONE OF THE LARGEST EMPLOYERS IN THE COUNTY WITH 262 EMPLOYEES.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTHILLINI COMMUNITY HOSPITAL OFFERS A WIDE RANGE OF SERVICES IMPORTANT TO PROMOTING THE HEALTH AND WELL-BEING OF PIKE COUNTY AND THE SURROUNDING AREA. ILLINI COMMUNITY HOSPITAL OPERATES AN EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF THE ABILITY TO PAY. THE FINANCIAL ASSISTANCE POLICY OF ILLINI COMMUNITY HOSPITAL ENABLES PATIENTS TO HAVE ACCESS TO AREA RESOURCES TO ASSIST THEM WITH PAYMENT OF MEDICAL EXPENSES. ILLINI COMMUNITY HOSPITAL IS THE LARGEST EMPLOYER IN THE AREA WITH 262 EMPLOYEES. OF SIGNIFICANT IMPORTANCE IS THE VOLUNTEERS THAT SERVE THE HOSPITAL. IN FISCAL YEAR 2018, ILLINI COMMUNITY HOSPITAL HAD 41 ACTIVE VOLUNTEERS. IN ADDITION TO THE VOLUNTEERS ACTIVELY WORKING IN THE HOSPITAL, ILLINI COMMUNITY HOSPITAL'S BOARD OF TRUSTEES IS COMPRISED OF VOLUNTEERS THAT INCLUDES BUSINESS LEADERS, PHYSICIANS, AND OTHER COMMUNITY LEADERS.
PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEMBLESSING CORPORATE SERVICES, INC. IS THE PARENT ORGANIZATION OF A GROUP OF RELATED ORGANIZATIONS AND PROVIDES OVERALL DIRECTION TO ALL ENTITIES WITHIN THE STRUCTURE. DURING THE YEAR ENDED SEPTEMBER 30, 2005, BLESSING CORPORATE SERVICES, INC. BEGAN OPERATING A DIVISION COMPRISED OF PRACTICING PHYSICIANS. THE GROUP IS RELATED THROUGH BOARD CONTROL. THE FOLLOWING IS A BRIEF DESCRIPTION OF EACH MEMBER OF THE GROUP. ORGANIZATION - BLESSING HOSPITAL (HOSPITAL), LOCATED IN QUINCY, ILLINOIS, IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF WESTERN ILLINOIS, NORTHEASTERN MISSOURI, AND SOUTHEASTERN IOWA. THE HOSPITAL WAS INCORPORATED IN ILLINOIS IN 1875. ORGANIZATION - THE BLESSING FOUNDATION, INC. SERVES BLESSING CORPORATE SERVICES AND ITS AFFILIATED ENTITIES BY PROVIDING FINANCIAL SUPPORT FOR SERVICES AND PROGRAMS PROMOTING THE IMPROVEMENT AND AVAILABILITY OF HEALTHCARE SERVICES WITHIN THE GENERAL COMMUNITY. ORGANIZATION - DENMAN SERVICES, INC. (A TAXABLE CORPORATION) ENGAGES PRIMARILY IN THE BUSINESS OF SELLING AND RENTING MEDICAL EQUIPMENT AND OPERATING A COMMERCIAL LAUNDRY. DENMAN SERVICES, INC. IS A WHOLLY OWNED SUBSIDIARY OF BLESSING CORPORATE SERVICES, INC. ORGANIZATION - BLESSINGCARE CORPORATION DBA ILLINI COMMUNITY HOSPITAL, LOCATED IN PITTSFIELD, ILLINOIS, IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF WESTERN ILLINOIS. THE HOSPITAL WAS INCORPORATED ON JANUARY 20, 2000. ORGANIZATION - ILLINI HEALTH SERVICES, LLC CONDUCTS A PHARMACY BUSINESS IN PITTSFIELD, ILLINOIS. THE PHARMACY IS OWNED NINETY-FIVE PERCENT (95%) BY DENMAN SERVICES, INC. AND FIVE PERCENT (5%) BY BLESSINGCARE CORPORATION DBA ILLINI COMMUNITY HOSPITAL. ORGANIZATION - CHS HOLDING COMPANY (A TAXABLE ORGANIZATION) PROVIDES HEALTH INSURANCE PRODUCTS AND SERVICES. ORGANIZATION - BLESSING WALK-IN CLINIC, LLC DBA BLESSING CONVENIENT CARE OPERATES HEALTH CLINICS IN RETAIL FACILITIES.
PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORTILLINOIS
ADDITIONAL INFORMATIONPART I, LINE 6B - ILLINI COMMUNITY HOSPITAL'S COMMUNITY BENEFIT REPORT IS PUBLISHED IN THE LOCAL NEWSPAPER AS AN INSERT AND IS AVAILABLE ON THE HOSPITAL'S WEBSITE @ WWW.BLEASINGHEALTH.ORG

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeEMPLOYEE ASSISTANCEGrantTypeTxt
Recipient7RecipientCnt
Cash Grant$7,213CashGrantAmt
Valuation Method UsedBOOKValuationMethodUsedDesc

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE I, PAGE 1, PART I, LINE 2FormAndLineReferenceDesc
ExplanationEMPLOYEE ASSISTANCE THE EMPLOYEE CRISIS FUND IS FOR FINANCIAL ASSISTANCE FOR EMPLOYEES IN GOOD EMPLOYMENT STANDING WHO MEET A REQUIRED LENGTH OF SERVICE. EMPLOYEES MAKE REQUESTS FOR ASSISTANCE THROUGH THEIR DEPARTMENT LEADERS. THE APPLICATIONS GO TO A COMMITTEE WHO REVIEWS THEM FOR APPROVAL. THE BALANCE OF THE FUND REMAINS IN A GENERAL LEDGER ACCOUNT ON THE BOOKS OF BLESSINGCARE CORPORATION AND IS MONITORED BY BLESSINGCARE CORPORATION ACCOUNTANTS.ExplanationTxt

Schedule J IRS990ScheduleJ

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

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)

TitleTitleTxtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtBase Compensation Filing OrgBaseCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountOther Compensation Filing OrgOtherCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmt
PATRICK M GERVELER
TREASURER$378,997$115,357$44,870$64,500$25,652$622,038
KATHLEEN E HULL
PRESIDENT/CEO$197,614$62,787$5,880$13,452$22,969$298,048
MAUREEN A KAHN
SECRETARY$572,591$202,886$31,258$129,500$24,945$952,073
CHRISTOPHER S WAGONER MD
PRES - MED STAFF$274,995$1,678$8,094$21,102$303,081
CAITLIN M BARTON
PHARMACIST$136,298$260$441$6,928$8,816$151,132
HOLLY A JONES
VP OPERATIONS$120,268$2,603$4,350$6,693$19,869$152,228

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE J, PAGE 1, PART I, LINE 3FormAndLineReferenceDesc
ExplanationCOMPENSATION OF ORGANIZATION'S CEO - EXECUTIVE DIRECTOR - KATHLEEN HULL IS AN EMPLOYEE OF BLESSING CORPORATE SERVICES, INC., THE PARENT COMPANY OF BLESSINGCARE CORPORATION. COMPARABILITY DATA PROVIDED BY A THIRD PARTY IS USED TO ESTABLISH A MARKET RANGE OF COMPENSATION. THIS INFORMATION IS SUBMITTED TO THE PRESIDENT OF BLESSING CORPORATE SERVICES FOR REVIEW AND TO THE BLESSING CORPORATE SERVICES BOARD OF TRUSTEES COMPENSATION COMMITTEE FOR APPROVAL.ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
JOHN HULL
FAMILY MEMBER$73,718EMPLOYMENTfalse
JESSICA L HULL
FAMILY MEMBER$33,170EMPLOYMENTfalse

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 2, PART III, LINE 4AIN ADDITION TO THESE HEALTHCARE SERVICES, ILLINI COMMUNITY HOSPITAL PROVIDED 679,348 IN CHARITY CARE. MEDICARE SHORTFALLS WERE 691,273. THE HOSPITAL PROVIDED ADDITIONAL BENEFITS OF 187,415 DURING FISCAL YEAR 2018 AS FOLLOWS: 1)HEALTH PROFESSIONALS EDUCATION - 63,167 HEALTHCARE STUDENT INTERNSHIPS NURSE PRACTITIONER CLINICALS RADIOLOGY CLINICALS 2)IN-KIND CONTRIBUTIONS AND DONATIONS - 45,270 COURTESY BLOOD DRAWS FOR AREA PUBLIC AGENCIES PIKE CEO PROGRAM PITTSFIELD FIRE DEPARTMENT PIKE COUNTY MINISTERIAL ALLIANCE DONATED MEETING ROOM SPACE HEALTH FAIRS HEALTH SCREENINGS GED PARTNERS BARRY YMCA PIKE YOUTH FOOTBALL UIC RMED PROGRAM 3)COMMUNITY HEALTH IMPROVEMENT PROGRAMS AND SERVICES - 68,517 FLU CLINICS PIKELAND WELLNESS COMMITTEE FOOD DRIVE READY, SET, GLOW RUN BLOOD AND PLATELET DRIVES SPORTS INJURY CLINIC UNREIMBURSED PATIENT TRANSPORTATION WALK TO SCHOOL DAY 4)COMMUNITY EDUCATIONAL PROGRAMS AND SERVICES - 10,461 COFFEE BREAK EDUCATIONAL RADIO PROGRAMS DESTRUCTIVE DECISIONS EDUCATIONAL PROGRAM HEALTH OCCUPATIONS JOB SHADOWING ALCS AND BLS CLASSES SELF-DEFENSE CLASSES DIABETES COACHING
FORM 990, PAGE 6, PART VI, LINE 3BLESSING CORPORATE SERVICES PROVIDES GENERAL MANAGEMENT SERVICES.
FORM 990, PAGE 6, PART VI, LINE 6BLESSING CORPORATE SERVICES, INC., AN ILLINOIS NOT FOR PROFIT CORPORATION, IS THE SOLE VOTING MEMBER OF BLESSINGCARE CORPORATION, DBA ILLINI COMMUNITY HOSPITAL.
FORM 990, PAGE 6, PART VI, LINE 7ABLESSING CORPORATE SERVICES, INC., THE SOLE VOTING MEMBER OF BLESSINGCARE CORPORATION, SHALL POSSESS THE RIGHTS AND RESPONSIBILITIES TO APPOINT AND/OR REMOVE ALL THE TRUSTEES OF THE CORPORATION, AND APPOINT THE CORPORATION'S PRESIDENT.
FORM 990, PAGE 6, PART VI, LINE 7BBLESSING CORPORATE SERVICES, INC., THE SOLE VOTING MEMBER OF BLESSINGCARE CORPORATION, SHALL POSSESS THE RIGHTS AND RESPONSIBILITIES TO APPROVE EXPRESSLY ALL AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS BEFORE THEY MAY BECOME EFFECTIVE; APPROVE CAPITAL AND OPERATING BUDGETS, LONG-TERM DEBT, LONG-RANGE PLANS, THE SALE OR PURCHASE OF REAL ESTATE AND CONTRACTS ENTERED INTO BY THE CORPORATION, THE REASONABLE VALUE OF WHICH EXCEEDS AN AMOUNT SPECIFIED IN THE BYLAWS OF THE MEMBER; APPROVE MATERIAL INVESTMENT DECISIONS, INCLUDING WITHOUT LIMITATION ESTABLISHMENT AND MODIFICATION OF INVESTMENT POLICIES, ENGAGEMENT AND REMOVAL OF INVESTMENT MANAGERS AND ADVISORS, AND CHANGES IN INVESTMENT ALLOCATIONS NOT PERMITTED BY AN EXISTING INVESTMENT POLICY; APPROVE THE PARAMETERS FOR TERMS OF EMPLOYMENT OF PHYSICIANS, INCLUDING PHYSICIAN COMPENSATION PLANS, AND ANY MATERIAL VARIANCES FROM SUCH PARAMETERS FOR INDIVIDUAL PHYSICIANS; APPROVE THE SELECTION OF AUDITORS AND LEGAL COUNSEL; APPROVE CHARITY CARE AND COMMUNITY BENEFITS-RELATED POLICIES; APPROVE THE FORMATION OF SUBSIDIARY ENTITIES AND/OR JOINT VENTURES; APPROVE THE FILING OF A PETITION IN BANKRUPTCY, MAKING AN ASSIGNMENT FOR THE BENEFIT OF CREDITORS, OR APPLYING FOR PROTECTION UNDER ANY INSOLVENCY LAWS; APPROVE THE PARTICIPATION IN ANY MERGER, COMBINATION, CONSOLIDATION, LIQUIDATION, DISSOLUTION OR OTHER CORPORATE OR BUSINESS ENTITY RESTRUCTURING, AND HAVE THE POWER TO COMPEL THE CORPORATION TO ENFORCE AND/OR PERFORM ANY CONTRACTUAL OBLIGATION.
FORM 990, PAGE 6, PART VI, LINE 11BFOLLOWING MANAGEMENT AND LEGAL REVIEW, THE FORM 990 WAS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW AND COMMENT PRIOR TO FILING.
FORM 990, PAGE 6, PART VI, LINE 12CA COPY OF THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED ANNUALLY TO OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES TO BE READ, SIGNED, AND RETURNED TO THE ORGANIZATION. THE SIGNED POLICIES ARE RETAINED IN THE CORPORATE ADMINISTRATIVE FILES. IN ADDITION, EACH OFFICER, DIRECTOR, OR TRUSTEE IS REQUIRED TO DECLARE NO CONFLICT OF INTEREST IN REGARDS TO AGENDA ITEMS BEING PRESENTED AT THE START OF EACH MONTHLY BOARD MEETING.
FORM 990, PAGE 6, PART VI, LINE 15ATHE PRESIDENT/CEO OF BLESSING CORPORATE SERVICES, INC. USES SULLIVAN AND COTTER TO IDENTIFY APPROPRIATE COMPENSATION. SHE TAKES HER RECOMMENDATIONS TO THE BCS BOARD COMPENSATION COMMITTEE. SHE LEAVES AND THE COMMITTEE DECIDES.
FORM 990, PAGE 6, PART VI, LINE 15BTHE PRESIDENT/CEO OF BLESSING CORPORATE SERVICES, INC. USES SULLIVAN AND COTTER TO IDENTIFY APPROPRIATE COMPENSATION. SHE TAKES HER RECOMMENDATIONS TO THE BCS BOARD COMPENSATION COMMITTEE. SHE LEAVES AND THE COMMITTEE DECIDES.
FORM 990, PAGE 6, PART VI, LINE 19THESE DOCUMENTS ARE LOCATED IN THE HOSPITAL'S ADMINISTRATIVE OFFICES AND ARE AVAILABLE UPON REQUEST FOR PUBLIC INSPECTION.
FORM 990, PART XI, LINE 9990-T DEPRECIATION 0 FRINGE PARKING -4,408 TOTAL -4,408

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)

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

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtBusiness Name Line2DirectControllingEntityName/BusinessNameLine2TxtPredominant Income TypePredominantIncomeTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerIndOwnershipOwnershipPct
ILLINI HEALTH SERVICES LLC
PO BOX 40QUINCYIL623060040470901851PHARMACYILDENMANDENMANUNRELATED$21,619$56,930falsefalse0.05000
CURRENT HEALTH NETWORK LLC
1005 BROADWAYQUINCYIL62301811681509PRVDR NTWKILCHS HLDGSfalsefalse
NORTHEAST MISSOURI AMBULATORY SURGE
98 MEDICAL DRIVEHANNIBALMO634010511431857277MED SVCSMOHANNIBALfalsefalse

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
DENMAN SERVICES INC
BROADWAY AT 11TH PO BOX 40QUINCYIL62306371132117MED EQUIPILBCS INCC CORPfalse
CHS HOLDING COMPANY
1005 BROADWAYQUINCYIL62301320481381GRP HLTHILBCS INCC CORPfalse
HANNIBAL CLINIC INC
100 MEDICAL DRIVEHANNIBALMO63401431033473MED SVCSMOBCS INCC CORPfalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (true)LoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangeYes (true)AssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd