MENDOTA COMMUNITY HOSPITAL: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization: MENDOTA COMMUNITY HOSPITAL (EIN 36-2167785)
Tax period: 2016-10-01 to 2017-09-30
Filed: 2018-08-13
IRS object ID: 201802259349301055
Schema version: 2016v3.0
Source: Download XML · Original 990 at ProPublica

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

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2018-08-13T11:02:08-05:00	ReturnTs
Tax Period End	2017-09-30	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	2016-10-01	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	2018-08-13	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	2016	TaxYr
Build TS	2022-09-23 18:48:47Z	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	$34,933,522	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	236	TotalEmployeeCnt
Total Volunteers	102	TotalVolunteersCnt
Total Gross UBI	$3,209	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$651	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$393,476	PYContributionsGrantsAmt
CY Contributions Grants	$173,360	CYContributionsGrantsAmt
PY Program Service Revenue	$34,837,983	PYProgramServiceRevenueAmt
CY Program Service Revenue	$34,424,460	CYProgramServiceRevenueAmt
PY Investment Income	-$17,082	PYInvestmentIncomeAmt
CY Investment Income	-$3,449	CYInvestmentIncomeAmt
PY Other Revenue	$1,150,928	PYOtherRevenueAmt
CY Other Revenue	$302,419	CYOtherRevenueAmt
PY Total Revenue	$36,365,305	PYTotalRevenueAmt
CY Total Revenue	$34,896,790	CYTotalRevenueAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$17,485,759	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$15,192,798	CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$17,985,428	PYOtherExpensesAmt
CY Other Expenses	$20,004,424	CYOtherExpensesAmt
PY Total Expenses	$35,471,187	PYTotalExpensesAmt
CY Total Expenses	$35,197,222	CYTotalExpensesAmt
PY Revenues Less Expenses	$894,118	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$300,432	CYRevenuesLessExpensesAmt
Total Assets BOY	$38,658,000	TotalAssetsBOYAmt
Total Assets EOY	$39,016,514	TotalAssetsEOYAmt
Total Liabilities BOY	$36,512,465	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$37,781,164	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$2,145,535	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$1,235,350	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	$26,420,763	ExpenseAmt
Revenue	$34,676,529	RevenueAmt
Desc	MENDOTA COMMUNITY HOSPITAL PROVIDED 25 BEDS IN FISCAL YEAR 2017. THIS HOSPITAL GAVE $555,296 IN CHARITY CARE, AND PROVIDED 5,151 MEALS ON WHEELS TO MEMBERS OF OUR COMMUNITY. THE NET COMMUNITY BENEFIT EXPENSE FOR MEALS ON WHEELS WAS $28,219. MENDOTA COMMUNITY HOSPITAL OFFERS FLU AND IMMUNIZATION CLINICS ALONG WITH MANY OTHER CLINICS IN MENDOTA AND OTHER OUTREACH COMMUNITES. 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 $25,834.	Desc
Total Program Service Expenses	$26,420,763	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	Yes (true)	LobbyingActivitiesInd
Subject To Proxy Tax	false	SubjectToProxyTaxInd
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	Yes (true)	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	26	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	236	EmployeeCnt
Employment Tax Returns Filed	Yes (true)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (true)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (true)	Form990TFiledInd
Foreign Financial Account	false	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Quid Pro Quo Contributions	false	QuidProQuoContributionsInd
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	false	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	false	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	false	IndoorTanningServicesInd
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 (32 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 Theresa Ann Brazeau OSF
Secretary	1.0	47.0	Yes (X)	Yes (X)	$0	$5,040	$0
Sister Judith Ann Duvall OSF
Chairperson	1.0	47.0	Yes (X)	Yes (X)	$0	$5,040	$0
Sister Diane Marie McGrew OSF
President and Treasurer	1.0	47.0	Yes (X)	Yes (X)	$0	$5,040	$0
Kevin D Schoeplein
Vice Chairperson CEO	1.0	47.0	Yes (X)	Yes (X)	$0	$1,857,528	$262,853
Sister Agnes Joseph Williams OSF
Assistant Secretary	1.0	47.0	Yes (X)	Yes (X)	$0	$5,040	$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	$797,430	$72,789
Sister M Mikela Meidl FSGM
Board Member	1.0	47.0	Yes (X)		$0	$0	$0
Brian Silverstein MD
Board Member	1.0	46.0	Yes (X)		$0	$45,000	$0
Michael M Allen
CFO	1.0	46.0		Yes (X)	$0	$617,871	$41,692
Anthony M Avellino MD
CEO NSSL/INI	1.0	45.0		Yes (X)	$0	$1,089,331	$61,015
Kenneth E Berkovitz MD
CEO CVSL	1.0	45.0		Yes (X)	$0	$814,382	$29,051
Robert L Brandfass
SVP Chief Legal Officer	1.0	45.0		Yes (X)	$0	$578,648	$60,554
Michelle D Conger
Chief Strategy Officer	1.0	45.0		Yes (X)	$0	$472,435	$40,685
John R Evancho
SVP Chief Compliance Officer	1.0	45.0		Yes (X)	$0	$286,039	$47,024
Thomas G Hammerton
President OSF Healthcare Foundation Chief Development Officer	1.0	47.0		Yes (X)	$0	$417,901	$45,793
Stephen E Hippler MD
Chief Clinical Officer	1.0	45.0		Yes (X)	$0	$524,004	$77,859
John C Horne
SVP Chief Supply Chain Officer	1.0	45.0		Yes (X)	$0	$396,728	$49,112
Divya-Devi Joshi
CEO Children SL	1.0	45.0		Yes (X)	$0	$552,122	$22,639
James J Mormann
Chief Information Officer	1.0	45.0		Yes (X)	$0	$558,076	$60,734
Kenneth J Natzke
CEO East Region	1.0	45.0		Yes (X)	$0	$590,863	$62,762
David A Schertz
CEO Northern Region	1.0	45.0		Yes (X)	$0	$657,171	$56,719
Robert C Sehring
CEO Central Region	1.0	45.0		Yes (X)	$0	$715,477	$65,956
Jeffry M Tillery
SVP Chief Transformation Officer	1.0	45.0		Yes (X)	$0	$531,260	$73,816
Lori L Wiegand
Chief Nursing Officer	1.0	45.0		Yes (X)	$0	$408,778	$70,063
Leon A Yeh MD
VP CMO Emergency Serv	1.0	45.0		Yes (X)	$0	$568,436	$56,518
Jane A Battles
APN	40.0	0			$117,306	$0	$26,633	Yes (X)
Heather J Bomstad
CNO	40.0	0			$139,849	$0	$31,077	Yes (X)
Kenneth K Potts MD
Physician	40.0	0			$262,647	$0	$22,753	Yes (X)
Katherine R Riva-Foster MD
Physician	40.0	0			$175,179	$0	$20,304	Yes (X)
Craig D Smith
Supervisor Rehab	40.0	0			$109,182	$0	$9,803	Yes (X)
Daniel E Baker
Former CFO	1.0	45.0			$0	$607,312	$172,699		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$804,162	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$13,106,952	TotReportableCompRltdOrgAmt
Total Other Compensation	$1,540,904	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	5	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	false	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
ER Doctors LTD
7 Wood Duck Lane	Ottawa	IL	61350	Emergency Room Services	$1,732,732
Medical Oustsourcing Solutions Inc
1735 Dekalb Ave	Sycamore	IL	60178	Medical Imaging Services	$525,450

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	2	CntrctRcvdGreaterThan100KCnt
Info In Schedule O Part VIII	Yes (X)	InfoInScheduleOPartVIIIInd
Related Organizations	$141,354	RelatedOrganizationsAmt
All Other Contributions	$32,006	AllOtherContributionsAmt
Total Contributions	$173,360	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT REVENUE	622110	$32,598,026	$32,598,026
CONTRACTED PHARMACY	622110	$1,781,902	$1,781,902
MEDICAL DIRECTORSHIPS	624200	$44,532	$44,532

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	$34,424,460	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$9,570	TotalRevenueColumnAmt
Exclusion	$9,570	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$45,340	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$0	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$45,340	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$45,340	TotalRevenueColumnAmt
Exclusion	$45,340	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Other	-$13,019	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$0	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	-$13,019	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$13,019	TotalRevenueColumnAmt
Exclusion	-$13,019	ExclusionAmt

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	$38,533	GrossSalesOfInventoryAmt
Cost Of Goods Sold	$36,732	CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,801	TotalRevenueColumnAmt
Exclusion	$1,801	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	CAFETERIA	Desc
Business	624200	BusinessCd
Total Revenue Column	$58,147	TotalRevenueColumnAmt
Related Or Exempt Func Income	$58,147	RelatedOrExemptFuncIncomeAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$197,131	TotalRevenueColumnAmt
Related Or Exempt Func Income	$193,922	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$3,209	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$255,278	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$34,896,790	TotalRevenueColumnAmt
Related Or Exempt Func Income	$34,676,529	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$3,209	UnrelatedBusinessRevenueAmt
Exclusion	$43,692	ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$11,918,132	TotalAmt
Program Services	$9,163,756	ProgramServicesAmt
Management And General	$2,754,376	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$386,183	TotalAmt
Program Services	$296,972	ProgramServicesAmt
Management And General	$89,211	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$2,308,824	TotalAmt
Program Services	$1,775,471	ProgramServicesAmt
Management And General	$533,353	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$579,659	TotalAmt
Program Services	$445,754	ProgramServicesAmt
Management And General	$133,905	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$23,051	TotalAmt
Management And General	$23,051	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$74,500	TotalAmt
Management And General	$74,500	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$14,408	TotalAmt
Management And General	$14,408	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$2,193,393	TotalAmt
Program Services	$2,168,612	ProgramServicesAmt
Management And General	$24,781	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$3,056,950	TotalAmt
Program Services	$2,200,624	ProgramServicesAmt
Management And General	$856,326	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$374,756	TotalAmt
Program Services	$21,373	ProgramServicesAmt
Management And General	$353,383	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$147,615	TotalAmt
Program Services	$84,093	ProgramServicesAmt
Management And General	$63,522	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$1,970	TotalAmt
Program Services	$1,970	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$1,467,851	TotalAmt
Program Services	$1,165,327	ProgramServicesAmt
Management And General	$302,524	ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

Field	Value	IRS element (for citing)
Total	$5,112,445	TotalAmt
Program Services	$3,431,071	ProgramServicesAmt
Management And General	$1,681,374	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$1,962,825	TotalAmt
Program Services	$1,256,761	ProgramServicesAmt
Management And General	$706,064	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$811,660	TotalAmt
Program Services	$207,887	ProgramServicesAmt
Management And General	$603,773	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
CONTRACTS AND REPAIRS	$2,782,160	$2,230,444	$551,716
BAD DEBTS	$1,264,266	$1,264,266
PROVIDER TAX	$548,420	$548,420
COLLECTION FEES	$139,984	$139,984

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$28,170	TotalAmt
Program Services	$17,978	ProgramServicesAmt
Management And General	$10,192	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$35,197,222	TotalAmt
Program Services	$26,420,763	ProgramServicesAmt
Management And General	$8,776,459	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$400,074	BOYAmt
EOY	$1,031,673	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$5,029,299	BOYAmt
EOY	$3,510,129	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$4,356,029	BOYAmt
EOY	$6,426,526	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)
EOY	$0	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$810,048	BOYAmt
EOY	$721,224	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$683,260	BOYAmt
EOY	$439,904	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$53,090,582	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$38,783,486	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$14,906,001	BOYAmt
EOY	$14,307,096	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$28,878	BOYAmt
EOY	$52,980	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$12,444,411	BOYAmt
EOY	$12,526,982	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$38,658,000	BOYAmt
EOY	$39,016,514	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$5,652,365	BOYAmt
EOY	$2,264,111	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$30,835,000	BOYAmt
EOY	$29,909,200	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$25,100	BOYAmt
EOY	$5,607,853	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$36,512,465	BOYAmt
EOY	$37,781,164	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$518,993	BOYAmt
EOY	-$473,761	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,006,033	BOYAmt
EOY	$1,088,602	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$620,509	BOYAmt
EOY	$620,509	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$2,145,535	BOYAmt
EOY	$1,235,350	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$38,658,000	BOYAmt
EOY	$39,016,514	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$300,432	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$87,044	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$696,797	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)
Consol And Sep Basis Fincl Stmt	Yes (X)	ConsolAndSepBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (true)	AuditCommitteeInd
Federal Grant Audit Required	Yes (true)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	Yes (true)	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	false	VolunteersInd
Paid Staff Or Management	false	PaidStaffOrManagementInd
Media Advertisements	false	MediaAdvertisementsInd
Mailings Members	false	MailingsMembersInd
Publications Or Broadcast	false	PublicationsOrBroadcastInd
Grants Other Organizations	false	GrantsOtherOrganizationsInd
Direct Contact Legislators	false	DirectContactLegislatorsInd
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	Yes (true)	OtherActivitiesInd
Other Activities	$14,408	OtherActivitiesAmt
Total Lobbying Expenditures	$14,408	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	$644,870	BeginningYearBalanceAmt
Investment Earnings Or Losses	$87,044	InvestmentEarningsOrLossesAmt
End Year Balance	$731,914	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

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 Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$0	BeginningYearBalanceAmt
End Year Balance	$0	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
End Year Balance	$0	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.0	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.9622	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.0378	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	false	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (true)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	Yes (true)	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,927,000	OtherCostOrOtherBasisAmt
Book Value	$1,927,000	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$29,561,136	OtherCostOrOtherBasisAmt
Depreciation	$19,947,238	DepreciationAmt
Book Value	$9,613,898	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$4,928,251	OtherCostOrOtherBasisAmt
Depreciation	$4,362,162	DepreciationAmt
Book Value	$566,089	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$16,648,365	OtherCostOrOtherBasisAmt
Depreciation	$14,474,086	DepreciationAmt
Book Value	$2,174,279	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$25,830	OtherCostOrOtherBasisAmt
Book Value	$25,830	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$14,307,096	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDesc	Book ValueBookValueAmt
GOODWILL	$10,817,871
RESTRICTED FOUNDATION ASSETS	$1,709,111

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$12,526,982	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDesc	AmtAmt
ASSET RETIREMENT OBLIGATION	$25,853
ADVANCES DUE CORP-TERM	$5,582,000

Field	Value	IRS element (for citing)
Total Liability	$5,607,853	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$33,669,255	TotalRevEtcAuditedFinclStmtAmt
Other Revenue	$36,731	OtherRevenueAmt
Revenue Not Reported	$36,731	RevenueNotReportedAmt
Revenue Subtotal	$33,632,524	RevenueSubtotalAmt
Other Revenues Not Included	$1,264,266	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	$1,264,266	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$34,896,790	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$33,969,687	TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included	$36,731	OtherExpensesIncludedAmt
Expenses Not Reported	$36,731	ExpensesNotReportedAmt
Expenses Subtotal	$33,932,956	ExpensesSubtotalAmt
Other Expenses Not Included	$1,264,266	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$1,264,266	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$35,197,222	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (7 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	The Medical Center is a not-for-profit corporation as described by Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(c)(3) of the Code. The Medical Center adopted ASC Subtopic 740-10, Accounting for Uncertainty in Income Taxes - An Interpretation of FASB Statement No 109. The interpretation addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded in the financial statements. Under ASC Subtopic 740-10, the Medical Center must recognize the tax benefit form an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by taxing authorities, based on the technical merits of the positon. The tax benefits recognized in the 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. ASC Subtopic 740-10 also provides guidance on derecognition, classification, interest and penalties on income taxes, and accounting in interim periods and requires increased disclosures. As of September 30, 2017 and 2016, the Medical Center does not have any uncertain tax positions.
Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990	Cost of Goods Sold - 36731
Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements	Provision for Bad Debt - 1264266
Schedule D, Part XII, Line 2(d) Other expenses in audited financial statements not in form 990	Cost of Goods Sold - 36731
Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements	Provision for Bad Debt - 1264266

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	$555,296	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$555,296	NetCommunityBenefitExpnsAmt
Total Expense	0.0158	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,716,200	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,062,356	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,653,844	NetCommunityBenefitExpnsAmt
Total Expense	0.0754	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	$6,271,496	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,062,356	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,209,140	NetCommunityBenefitExpnsAmt
Total Expense	0.0912	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$129,039	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$26,888	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$102,151	NetCommunityBenefitExpnsAmt
Total Expense	0.0029	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$78,962	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$78,962	NetCommunityBenefitExpnsAmt
Total Expense	0.0022	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	$6,916	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$6,916	NetCommunityBenefitExpnsAmt
Total Expense	0.0002	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$214,917	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$26,888	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$188,029	NetCommunityBenefitExpnsAmt
Total Expense	0.0053	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$6,486,413	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,089,244	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,397,169	NetCommunityBenefitExpnsAmt
Total Expense	0.0965	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	$583,000	BadDebtExpenseAmt
Reimbursed By Medicare	$13,154,216	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$12,804,908	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$349,308	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
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 (7 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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 TO 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. HEALTHY BEHAVIORS 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. MEASUREMENTS AND PROGRESS FROM FY2017: (1) TRACK NUMBER OF IMMUNIZATIONS PROVIDED AND THE IMPACT ON SCHOOL ABSENCES. (I.E. DAILY, WEEKLY, MONTHLY, YEARLY) - PROGRESS FY2017: 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 (2) TRACK HOURS SPENT WITH STUDENT ATHLETES AND NUMBER OF INJURIES - PROGRESS FY2017: SHS - 451 HRS. /58 INJURIES; OHS - 232 HRS. /32 INJURIES (3) NUMBER OF EDUCATIONAL EVENTS AND ATTENDANCE ADDRESSING HEALTH AND WELLNESS. - PROGRESS FY2017: 74 EVENTS: 4115 ATTENDEES. (4) TRACK NUMBER OF SPORTS PHYSICALS PROVIDED - PROGRESS FY2017: SHS - 57; OHS - 59; 2017: SHS - 51; OHS - 69; $25 EACH DONATED BACK TO SCHOOLS (5) SOCIAL MEDIA POSTS - PROGRESS FY2017: SEMC FACEBOOK REACHED 1,070,284 INDIVIDUALS; CENTER FOR HEALTH-STREATOR FB REACHED 441,387 (6) POUNDS OF COMMUNITY GARDEN FOODS GROWN/DONATED - PROGRESS FY2017: 1500LBS (7) OSF4LIFE: PARTICIPATION/HRA/CHALLENGE - PROGRESS FY2017: OTTAWA - 39%; MENDOTA - 63%; (8) HEALTHY YOU - POUNDS LOST - PROGRESS FY2017 534 PARTICIPANTS; 4,780 LBS. NEW PARTNERSHIPS INCLUDE: PENGUIN PLUNGE - MAKE A WISH FOUNDATION; LABOR OF LOVE; OUT OF THE DARKNESS - SUICIDE PREVENTION WALK; WALK TO END ALZHEIMERS; 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 TOTAL PINTS DONATED IN 2017; 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; HEART SAVER 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 BEHAVIORAL HEALTH GOALS: INCREASED 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. MEASUREMENTS AND PROGRESS FY2017: (1) DEVELOPMENT OF A STRATEGIC SYSTEM OF CARE PLAN FOR MENTAL HEALTH (STREATOR INITIATIVE) - PROGRESS FY2017: IMPLEMENTED BH NAVIGATOR, REFERRAL ALGORITHM, AND EMBEDDED BEHAVIORIST IN PC PRACTICE, TELE-PSYCH, NCBH COLOCATION, LIVE WELL STREATOR SUBSTANCE ABUSE FOCUS. (2) MONITOR COUNSELOR VISITS PROVIDING EARLY INTERVENTION, DEPRESSION SCREENING AND SUPPORT. - PROGRESS FY2017: EMBEDDED THERAPIST IN CENTER FOR HEALTH-STREATOR IS COMPLETE. IN PROGRESS AT SAINT ELIZABETH MEDICAL CENTER. (3) PATIENT WISDOM DATA - PROGRESS FY2017: 149 RESPONDENTS GAVE VIEW ON HOW TO ADDRESS BEHAVIORAL HEALTH IN COMMUNITY. 20% IDENTIFIED SUBSTANCE ABUSE AS NEEDING MORE COMMUNITY ATTENTION. (4) UNIQUE PATIENTS FOR BH - PROGRESS FY2017: 236 TELE-PSYCH UNIQUE PATIENTS (5) TELE-PSYCH VISITS - PROGRESS FY2017: 367 TELE-PSYCH OP VISITS; 105 ECO SILT PSYCH VISITS; 15% OF CHOICES OP'S FROM STREATOR-PSYCHIATRY AND THERAPY SERVICES; 80% DECREASE IN CURRENT WORK QUEUE REFERRALS. 200 TO 40; INCREASE IN # OF TOTAL VISITS; 1ST 6 MONTHS FY17 (9923) COMPARED TO 1ST 6 MONTHS FY18 (11216); 13% INCREASE OR 1293 PATIENTS. (6) BH NAVIGATOR CALLS - PROGRESS FY2017: 143 NEW PARTNERSHIPS INCLUDE: OUT OF DARKNESS - SUICIDE PREVENTION WALK SPONSOR; NORTH CENTRAL BEHAVIORAL HEALTH COLLABORATION; PEER SUPPORT GROUP - MEETS 2X PER MONTH; TEEN SHOWCASE - ANNUAL CONFERENCE SPONSOR; PET THERAPY
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	THE CORPORATION PROVIDES: -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 1,264,266 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 583,000 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 RATIO OF PATIENT CARE COST-TO-CHARGES DERIVED FROM WORKSHEET 2. 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 13 AND 14 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. -THE HOSPITAL SHALL NOT OBTAIN A BODY ATTACHMENT AGAINST ANY PATIENT OR GUARANTOR.
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. 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 ESTABLISHED THAT LASALLE COUNTY IS THE RESIDENCE OF OVER 90% OF ALL PATIENTS RECEIVING SERVICES FROM THE HOSPTIAL. 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, 2017 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 ARE 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 COMMUNITY IN SEVERAL WAYS INCLUDING BUT NOT LIMITIED TO; 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 HEALTHCARE 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 POLICY 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., WHICH PROVIDES HOME INFUSION AND DURABLE MEDICAL EQUIPMENT SERVICES, MOBILE MEDICAL IMAGING SERVICES, MEDICAL EQUIPMENT MAINTENANCE AND REPAIR SERVICES, MEDICAL STAFFING SERVICES, BILLING SERVICES, AND OTHER SERVICES IN SUPPORT OF THE AFFILIATED HEALTH CARE SYSTEM. -OSF AVIATION, LLC, WHICH IS AN FAA PART 135 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 MULTISPECIALTY GROUP - PEORIA, LLC, WHICH PROVIDES PEDIATRIC CARDIOLOGY PHYSICIAN SERVICES IN CENTRAL ILLINOIS EFFECTIVE UNTIL DECEMBER 31, 2016. THESE PROVIDERS AND SERVICES AFTER DECEMBER 31, 2016 ARE PROVIDED UNDER OSF MULTI-SPECIALTY GROUP WHICH IS A SEPARATE CORPORATION OF WHICH OSF HEALTHCARE SYSTEM IS THE SOLE MEMBER. -ILLINOIS NEUROLOGICAL INSTITUTE - PHYSICIANS, LLC, WHICH PROVIDES PHYSICIAN NEUROSURGERY SERVICES IN CENTRAL ILLINOIS EFFECTIVE UNTIL DECEMBER 31, 2016. THESE PROVIDERS AND SERVICES AFTER DECEMBER 31, 2016 ARE PROVIDED UNDER OSF MULTI-SPECIALTY GROUP. -HEARTCARE MIDWEST, LTD., WHICH PROVIDES CARDIOLOGY AND CARDIOVASCULAR SURGERY PHYSICIAN SERVICES IN CENTRAL ILLINOIS EFFECTIVE UNTIL DECEMBER 31, 2016. THESE PROVIDERS AND SERVICES AFTER DECEMBER 31, 2016 ARE PROVIDED UNDER OSF MULTI-SPECIALTY GROUP. -CARDIOVASCULAR INSTITUTE AT OSF, LLC, WHICH PROVIDES CARDIOLOGY AND CARDIOVASCULAR SURGERY PHYSICIAN SERVICES IN PARTS OF NORTHERN ILLINOIS EFFECTIVE UNTIL DECEMBER 31, 2016. THESE PROVIDERS AND SERVICES AFTER DECEMBER 31, 2016 ARE PROVIDED UNDER OSF MULTI-SPECIALTY GROUP. -OSF MULTISPECIALTY GROUP - EASTERN REGION, LLC, WHICH PROVIDES PRIMARY AND SPECIALTY PHYSICIAN SERVICES IN PARTS OF CENTRAL ILLINOIS EFFECTIVE UNTIL DECEMBER 31, 2016. THESE PROVIDERS AND SERVICES AFTER DECEMBER 31, 2016 ARE PROVIDED UNDER OSF MULTI-SPECIALTY GROUP. -ILLINOIS PATHOLOGIST SERVICES, LLC, WHICH PROVIDES PROFESSIONAL PATHOLOGY SERVICES IN PARTS OF NORTHERN ILLINOIS. -ILLINOIS SPECIALTY PHYSICIAN SERVICES AT OSF, LLC, WHICH PROVIDES PULMONOLOGY AND CRITICAL CARE PHYSICIAN SERVICES IN CENTRAL ILLINOIS EFFECTIVE UNTIL DECEMBER 31, 2016. THESE PROVIDERS AND SERVICES AFTER DECEMBER 31, 2016 ARE PROVIDED UNDER OSF MULTI-SPECIALTY GROUP. -OSF PERINATAL ASSOCIATES, LLC, WHICH PROVIDES MATERNAL FETAL MEDICINE PHYSICIAN SERVICES IN CENTRAL ILLINOIS EFFECTIVE UNTIL DECEMBER 31, 2016. THESE PROVIDERS AND SERVICES AFTER DECEMBER 31, 2016 ARE PROVIDED UNDER OSF MULTI-SPECIALTY GROUP. -OSF MULTISPECIALTY GROUP - WESTERN REGION, LLC, WHICH PROVIDES PRIMARY AND SPECIALTY PHYSICIAN SERVICES IN WESTERN ILLINOIS EFFECTIVE UNTIL DECEMBER 31, 2016. THESE PROVIDERS AND SERVICES AFTER DECEMBER 31, 2016 ARE PROVIDED UNDER OSF MULTI-SPECIALTY GROUP. -OSF CHILDREN'S MEDICAL GROUP- CONGENITAL HEART CENTER, LLC WHICH PROVIDES PEDIATRIC CARE FOR CARDIOVASCULAR ILLNESSES IN NORTHERN ILLINOIS EFFECTIVE UNTIL DECEMBER 31, 2016. THESE PROVIDERS AND SERVICES AFTER DECEMBER 31, 2016 ARE PROVIDED UNDER OSF MULTI-SPECIALTY GROUP. -PREFERRED EMERGENCY PHYSICIANS OF ILLINOIS, LLC WHICH PROVIDES PHYSICIAN COVERAGE FOR EMERGENCY DEPARTMENTS EFFECTIVE UNTIL DECEMBER 31, 2016. THESE PROVIDERS AND SERVICES AFTER DECEMBER 31, 2016 ARE PROVIDED UNDER OSF MULTI-SPECIALTY GROUP. -SAINT ANTHONY PHYSICIAN GROUP WHICH PROVIDES A VARIETY OF GENERAL AND SPECIALTY PHYSICIANS SERVICES IN ALTON, ILLINOIS. -Institute of Physical Medicine & Rehabilitation (IPMR) which provides rehabilitation therapy services throughout Illinois.
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	false	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 (23 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
Kevin D Schoeplein
Vice Chairperson CEO	$0	$1,153,478	$0	$637,523	$0	$66,528	$0	$242,607	$0	$20,246	$0	$2,120,382	$0	$0
Gerald J McShane MD
Board Member	$0	$657,198	$0	$117,268	$0	$22,964	$0	$55,100	$0	$17,689	$0	$870,219	$0	$0
Daniel E Baker
Former CFO	$0	$521,345	$0	$74,599	$0	$11,369	$0	$148,593	$0	$24,106	$0	$780,012	$0	$0
Michael M Allen
CFO	$0	$507,450	$0	$108,966	$0	$1,455	$0	$16,294	$0	$25,399	$0	$659,563	$0	$0
Anthony M Avellino MD
CEO NSSL/INI	$0	$857,769	$0	$229,456	$0	$2,105	$0	$36,550	$0	$24,465	$0	$1,150,346	$0	$0
Kenneth E Berkovitz MD
CEO CVSL	$0	$688,458	$0	$122,329	$0	$3,595	$0	$24,621	$0	$4,430	$0	$843,433	$0	$0
Robert L Brandfass
SVP Chief Legal Officer	$0	$479,749	$0	$89,078	$0	$9,821	$0	$36,550	$0	$24,004	$0	$639,201	$0	$0
Michelle D Conger
Chief Strategy Officer	$0	$394,837	$0	$69,642	$0	$7,956	$0	$17,957	$0	$22,728	$0	$513,121	$0	$0
John R Evancho
SVP Chief Compliance Officer	$0	$235,021	$0	$43,111	$0	$7,906	$0	$21,898	$0	$25,126	$0	$333,062	$0	$0
Thomas G Hammerton
President OSF Healthcare Foundation Chief Development Officer	$0	$311,676	$0	$56,035	$0	$50,191	$0	$31,978	$0	$13,816	$0	$463,695	$0	$0
Stephen E Hippler MD
Chief Clinical Officer	$0	$443,207	$0	$78,446	$0	$2,351	$0	$55,100	$0	$22,759	$0	$601,863	$0	$0
John C Horne
SVP Chief Supply Chain Officer	$0	$329,119	$0	$59,451	$0	$8,159	$0	$26,427	$0	$22,685	$0	$445,840	$0	$0
Divya-Devi Joshi
CEO Children SL	$0	$473,984	$0	$78,103	$0	$35	$0	$13,250	$0	$9,389	$0	$574,761	$0	$0
James J Mormann
Chief Information Officer	$0	$466,145	$0	$83,399	$0	$8,532	$0	$36,550	$0	$24,184	$0	$618,809	$0	$0
Kenneth J Natzke
CEO East Region	$0	$484,869	$0	$85,959	$0	$20,035	$0	$43,685	$0	$19,078	$0	$653,625	$0	$0
David A Schertz
CEO Northern Region	$0	$547,227	$0	$98,325	$0	$11,619	$0	$37,100	$0	$19,619	$0	$713,890	$0	$0
Robert C Sehring
CEO Central Region	$0	$591,542	$0	$105,442	$0	$18,493	$0	$41,591	$0	$24,365	$0	$781,433	$0	$0
Jeffry M Tillery
SVP Chief Transformation Officer	$0	$448,552	$0	$80,335	$0	$2,373	$0	$54,860	$0	$18,956	$0	$605,075	$0	$0
Lori L Wiegand
Chief Nursing Officer	$0	$339,031	$0	$60,740	$0	$9,007	$0	$51,031	$0	$19,032	$0	$478,841	$0	$0
Leon A Yeh MD
VP CMO Emergency Serv	$0	$478,750	$0	$89,640	$0	$46	$0	$33,441	$0	$23,077	$0	$624,954	$0	$0
Heather J Bomstad
CNO	$103,099	$0	$35,851	$0	$900	$0	$6,070	$0	$25,007	$0	$170,925	$0	$0	$0
Kenneth K Potts MD
Physician	$261,209	$0	$295	$0	$1,143	$0	$5,729	$0	$17,025	$0	$285,400	$0	$0	$0
Katherine R Riva-Foster MD
Physician	$174,711	$0	$422	$0	$46	$0	$9,957	$0	$10,346	$0	$195,482	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (3 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 4b Supplemental nonqualified retirement plan	DURING 2016, 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 2016, THE FOLLOWING CONTRIBUTIONS WERE MADE BY OSF HEALTHCARE SYSTEM TO THE PLAN: KEVIN D. SCHOEPLEIN - $187,507 DANIEL E. BAKER - $93,493 DURING 2016, NO DISTRIBUTIONS WERE MADE BY OSF HEALTHCARE SYSTEM FROM THE PLAN: KEVIN D. SCHOEPLEIN - $0 DANIEL E. BAKER - $0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part I, Line 1 PART I	THE TAX LAW REQUIRES THAT EACH LEGAL ENTITY WITHIN THE OSF HEALTHCARE SYSTEM COMPLETE A SEPARATE TAX RETURN WHICH APPROPRIATELY REFLECTS THE ACTIVITIES AND FINANCIAL POSITION OF THE PARTICULAR ORGANIZATION. THIS REPORTING, HOWEVER, IS NOT REFLECTIVE OF THE OSF HEALTHCARE SYSTEM AS A WHOLE. PLEASE SEE THE ATTACHED AUDITED FINANCIAL STATEMENTS OF OSF HEALTHCARE SYSTEM AND SUBSIDIARIES FOR A COMPLETE OVERVIEW OF THE SYSTEM.
Form 990, Part VI, Line 1a Delegate broad authority to a committee	BY ADOPTING CERTAIN PROVISIONS OF THE CORPORATE BYLAWS, THE BOARD OF DIRECTORS HAS DELEGATED BROAD AUTHORITY TO THE EXECUTIVE COMMITTEE OF THE BOARD. THE BYLAWS PROVIDE THAT THE EXECUTIVE COMMITEE SHALL BE AUTHORIZED TO TAKE SUCH ACTION AS MAY BE NECESSARY ON BEHALF OF THE CORPORATION DURING PERIODS WHEN THE BOARD OF DIRECTORS IS NOT IN SESSION. OF OSF HEALTHCARE 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	Farming Income - Total Revenue: 3209, Related or Exempt Function Revenue: , Unrelated Business Revenue: 3209, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; All Other - Total Revenue: 193922, Related or Exempt Function Revenue: 193922, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	Inter-company Contributions - 10228; Net assets Released from Restrictions - -14701; Equity Transfers - -692324;

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 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
SISTERS OF ST FRANCIS MARTYR ST GEORGE
1 FRANCISCAN WAY PO BOX 902	ALTON	IL	62002	376034163	RELIGIOUS	IL	501(c)(3)	1	OSF	false
IPMR
6501 N SHERIDAN ROAD	PEORIA	IL	61614	370681567	REHAB	IL	501(c)(3)	3	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 (6 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Predominant Income TypePredominantIncomeTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd	OwnershipOwnershipPct	UBI Code VUBICodeVAmt
CENTER FOR HEALTH AMBULATORY
8800 RTE 91 N	PEORIA	IL	61615	205557171	SURGICAL CENTER	IL	OSF	Related	$0	$0	false	Yes (true)	0
EASTLAND MEDICAL PLAZA
1505 EASTLAND DRIVE	Bloomington	IL	61701	371400643	SURGICAL CENTER	IL	OSF	Related	$0	$0	false	Yes (true)	0	$0
FORT JESSE IMAGING CENTER LLC
2200 FT JESSE ROAD	NORMAL	IL	61761	460515604	MEDICAL IMAGING	IL	OSF	Related	$0	$0	false	Yes (true)	0
POINT CORE NETWORK SERVICES
222 3RD AVE SE SUITE 500	Cedar Rapids	IA	52401	465393141	IT SERVICES	IA	POINTCORE LLC	Related	$0	$0	false	Yes (true)	0
SAINT CLARE'S VILLA
915 EAST 5TH STREET	ALTON	IL	62002	371397289	LOW INC HOUSING	IL	OSF	Related	$0	$0	false	Yes (true)	0
FOX RIVER CANCER CENTER
1211 STARFISH DRIVE	OTTAWA	IL	61350	870805865	ONCOLOGY	IL	ORHHC	Related	$0	$0	false	Yes (true)	0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (15 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
HEARTCARE MIDWEST LTD
5405 N KNOXVILLE AVENUE	PEORIA	IL	61614	370996868	CARDIOVASCULAR	IL	OSF	C Corporation	false
CARDIOVASCULAR INSTITUTE AT OSF LLC
444 ROXBURY ROAD	ROCKFORD	IL	61107	264225726	CARDIOVASCULAR	IL	OSF	C Corporation	false
ILLINOIS PATHOLOGST SERVICES LLC
5666 EAST STATE STREET	ROCKFORD	IL	61108	800439081	PATHOLOGY SVCS	IL	OSF	C Corporation	false
OSF MULTISPECIALTY GRP - EASTERN REG LLC
1701 E COLLEGE AVENUE	BLOOMINGTON	IL	61704	300561892	MULISPEC CLINIC	IL	OSF	C Corporation	false
OSF MULTISPECIALTY GROUP - PEORIA LLC
530 NE GLEN OAK AVENUE	PEORIA	IL	61637	262800379	PEDIATRIC CARDIO	IL	OSF	C Corporation	false
ILLINOIS NEUROLOGICAL INSTITUTE - PH LLC
719 N WILLIAM KUMPF BLVD	PEORIA	IL	61605	263109118	PEDIATRIC NEURO	IL	OSF	C Corporation	false
ILLINOIS SPEC PHYS SVCS AT OSF LLC
1001 MAIN STREET	PEORIA	IL	61606	800462209	PULMONOLOGY	IL	OSF	C Corporation	false
OSF PERINATAL ASSOCIATES LLC
4911 EXECUTIVE DRIVE	PEORIA	IL	61614	800498373	MATERNAL FET MED	IL	OSF	C Corporation	false
OSF MULTISPECIALTY GR-WESTERN REGION
3315 NORTH SEMINARY STREET	GALESBURG	IL	61401	800608541	MULTISPEC CLINIC	IL	OSF	C Corporation	false
OSF CHILDREN'S MEDICAL GROUP - CONGENITAL
5701 STRATHMOOR	ROCKFORD	IL	61107	900714643	PEDIATRIC CARDIO	IL	OSF	C Corporation	false
PREFERRED EMERGENCY PHY OF ILLINOIS LLC
800 NE GLEN OAK AVENUE	PEORIA	IL	61603	900749855	EMERGENCY ROOM	IL	OSF	C Corporation	false
OTTAWA REG HEALTHCARE AFFILIATES INC
1100 EAST NORRIS	OTTAWA	IL	61350	263937519	HOLDING COMPANY	IL	ORHHC	C Corporation	false
OTTAWA REGIONAL MEDICAL CENTER INC
1614 EAST NORRIS DRIVE	OTTAWA	IL	61350	271036071	OUTPATIENT DIAG	IL	ORHHC	C Corporation	false
ASSOC MED INSTITUTE CONDO ASSOC
6501 N SHERIDAN ROAD	PEORIA	IL	61614	371402305	CONDO ASSOC	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