PEKIN MEMORIAL HOSPITAL: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- PEKIN MEMORIAL HOSPITAL (EIN 37-0692351)
- Tax period
- 2015-05-01 to 2016-04-30
- Filed
- 2017-03-13
- IRS object ID
- 201700729349300110
- Schema version
- 2015v3.0
- 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 K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-03-13T09:14:05-05:00 | ReturnTs |
| Tax Period End | 2016-04-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 211 N BROADWAY SUITE 600 | AddressLine1Txt |
| City | ST LOUIS | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 631022733 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-05-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 370692351 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pekin Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % PAM ROGERS | InCareOfNm |
| Business Name Control | PEKI | BusinessNameControlTxt |
| Phone | 3093530700 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 South 13th Street | AddressLine1Txt |
| City | Pekin | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61554 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STEVEN C HALL | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3093530700 | PhoneNum |
| Signature | 2017-03-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Donna J Larson | PreparerPersonNm |
| PTIN | P00043751 | PTIN |
| Phone | 3142315544 | PhoneNum |
| Preparation | 2017-03-09 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pekin Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | STEVEN C HALL CFO | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 S 13TH STREET | AddressLine1Txt |
| City | PEKIN | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61554 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $68,587,949 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | PEKINHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1913 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY AND TO DO SO WITH LOVE, COMPASSION AND EXTRAORDINARY MEDICAL CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 820 | TotalEmployeeCnt |
| Total Volunteers | 129 | TotalVolunteersCnt |
| Total Gross UBI | $1,025,461 | TotalGrossUBIAmt |
| PY Contributions Grants | $82,928 | PYContributionsGrantsAmt |
| CY Contributions Grants | $182,586 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $67,745,618 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $65,092,368 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,522,760 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,199,373 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,303,413 | PYOtherRevenueAmt |
| CY Other Revenue | $1,059,594 | CYOtherRevenueAmt |
| PY Total Revenue | $70,654,719 | PYTotalRevenueAmt |
| CY Total Revenue | $68,533,921 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $32,150,708 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $32,378,569 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $31,821,288 | PYOtherExpensesAmt |
| CY Other Expenses | $38,226,569 | CYOtherExpensesAmt |
| PY Total Expenses | $63,971,996 | PYTotalExpensesAmt |
| CY Total Expenses | $70,605,138 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $6,682,723 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,071,217 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $71,558,832 | TotalAssetsBOYAmt |
| Total Assets EOY | $55,168,214 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $33,705,968 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $31,519,948 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $37,852,864 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $23,648,266 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY AND TO DO SO WITH LOVE, COMPASSION AND EXTRAORDINARY MEDICAL CARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $63,993,177 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $65,267,378 | RevenueAmt |
| Desc | PEKIN MEMORIAL HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY SERVICES TO PATIENTS IN PEKIN, ILLINOIS AND SURROUNDING AREAS. THE HOSPITAL OPERATES A LICENSED 107 ACUTE CARE BED FACILITY. PATIENT DAYS WERE 12,786; ADJUSTED PATIENT DAYS WERE 41,160; CASE MIX INDEX WAS 1.3103. SEE COMMUNITY BENEFIT REPORT ATTACHED TO FORM 990. | Desc |
| Total Program Service Expenses | $63,993,177 | 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 | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| 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 | Yes (true) | 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 | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 111 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 820 | 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | 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 | false | 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 | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PAM ROGERS | PersonNm |
| Phone | 3093530796 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 SOUTH 13TH STREET | AddressLine1Txt |
| City | PEKIN | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61554 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 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 | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| DELORES EAGLESON | |||||||||
| SECRETARY/TREASURER | 1.0 | 4.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| CURTIS EETON | |||||||||
| TRUSTEE | 1.0 | 4.0 | Yes (X) | $0 | $0 | $0 | |||
| RONALD MILLER | |||||||||
| CHAIRMAN | 1.0 | 4.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JASON PROEHL | |||||||||
| TRUSTEE | 1.0 | 4.0 | Yes (X) | $0 | $0 | $0 | |||
| DIRK ROECKER | |||||||||
| TRUSTEE | 1.0 | 4.0 | Yes (X) | $0 | $0 | $0 | |||
| RUSTY DUNN | |||||||||
| TRUSTEE | 1.0 | 4.0 | Yes (X) | $0 | $0 | $0 | |||
| ROSS GOULD | |||||||||
| TRUSTEE | 1.0 | 4.0 | Yes (X) | $0 | $0 | $0 | |||
| MARIA HORNSTEIN | |||||||||
| TRUSTEE | 1.0 | 4.0 | Yes (X) | $0 | $0 | $0 | |||
| DR GORDON CROSS | |||||||||
| TRUSTEE | 1.0 | 4.0 | Yes (X) | $0 | $0 | $0 | |||
| DR FARNAZ MOAZZAM | |||||||||
| TRUSTEE | 1.0 | 4.0 | Yes (X) | $12,950 | $0 | $0 | |||
| DR JAMES SMALLEY | |||||||||
| VICE CHAIRMAN | 1.0 | 4.0 | Yes (X) | Yes (X) | $14,229 | $0 | $0 | ||
| BOB HALEY | |||||||||
| CEO | 40.0 | 4.0 | Yes (X) | $290,000 | $0 | $39,095 | |||
| STEVE HALL | |||||||||
| CFO | 40.0 | 4.0 | Yes (X) | $243,178 | $0 | $22,815 | |||
| JO ELLEN PATTERSON | |||||||||
| CHIEF NURSING OFFICER | 40.0 | 0.0 | $153,210 | $0 | $8,621 | Yes (X) | |||
| CINDY JUSTUS | |||||||||
| DIRECTOR OF ER AND URGENT CARE | 40.0 | 0.0 | $100,703 | $0 | $11,069 | Yes (X) | |||
| ASHOKKUMAR PATEL | |||||||||
| PHARMACIST | 40.0 | 0.0 | $121,463 | $0 | $23,867 | Yes (X) | |||
| LINDA COLE | |||||||||
| DIRECTOR OF IT | 40.0 | 0.0 | $144,743 | $0 | $6,745 | Yes (X) | |||
| ANGELIA DREHER | |||||||||
| DIRECTOR OF PHARMACY | 40.0 | 0.0 | $151,256 | $0 | $27,553 | Yes (X) | |||
| MICHAEL JOHNSON | |||||||||
| ADMIN DIR OF ANCILLARY SERVCS | 40.0 | 0.0 | $121,006 | $0 | $10,267 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,352,738 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $150,032 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (true) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| EPSSLCC CENTRAL SERIES | |||||
| 12528 SR 78 | HAVANA | IL | 62644 | ER PHYSICIANS | $3,672,001 |
| MIDWEST ANESTHESIA CONSULTANTS SC | |||||
| 2006 HOGBACK RD | ANN ARBOR | MI | 48105 | ANESTHESIA SERVICES | $1,299,335 |
| PROFESSIONAL THERAPY SERVICES INC | |||||
| 2810 FRANK SCOTT PARKWAY STE 824 | BELLEVILLE | IL | 62223 | REHAB SERVICES | $1,040,826 |
| RIVER CITY CONSTRUCTION | |||||
| 101 HOFFER LANE | EAST PEORIA | IL | 61611 | CONSTRUCTION SERVICE | $1,068,922 |
| QUORUM | |||||
| 105 CONTINENTAL PLACE | PEORIA | IL | 61615 | MANAGEMENT SERVICES | $912,891 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 17 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $182,586 | RelatedOrganizationsAmt |
| Total Contributions | $182,586 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT REVENUE | 621110 | $64,037,995 | $64,037,995 | |
| MEDICAL RECORD REVENUE | 561000 | $28,912 | $28,912 | |
| REFERENCE LAB REVENUE | 621500 | $1,025,461 | $1,025,461 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $65,092,368 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $692,156 | TotalRevenueColumnAmt |
| Exclusion | $692,156 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $44,707 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $44,707 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $44,707 | TotalRevenueColumnAmt |
| Exclusion | $44,707 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,506,995 | SecuritiesAmt |
| Other | $54,250 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $54,028 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,506,995 | SecuritiesAmt |
| Other | $222 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,507,217 | TotalRevenueColumnAmt |
| Exclusion | $1,507,217 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| EHR FUNDS | 900099 | $175,010 | $175,010 | |
| CAFETERIA REVENUE | 722410 | $570,069 | $570,069 | |
| NAVIGATOR GRANT | 900099 | $139,691 | $139,691 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $130,117 | TotalRevenueColumnAmt |
| Exclusion | $130,117 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,014,887 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $68,533,921 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $64,241,917 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $1,025,461 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,083,957 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $937,404 | TotalAmt |
| Program Services | $211,137 | ProgramServicesAmt |
| Management And General | $726,267 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,000 | TotalAmt |
| Program Services | $34,000 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,639,813 | TotalAmt |
| Program Services | $22,242,116 | ProgramServicesAmt |
| Management And General | $2,397,697 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $832,258 | TotalAmt |
| Program Services | $784,994 | ProgramServicesAmt |
| Management And General | $47,264 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,033,891 | TotalAmt |
| Program Services | $3,591,500 | ProgramServicesAmt |
| Management And General | $442,391 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,901,203 | TotalAmt |
| Program Services | $1,675,782 | ProgramServicesAmt |
| Management And General | $225,421 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,769,091 | TotalAmt |
| Management And General | $1,769,091 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $162,205 | TotalAmt |
| Management And General | $162,205 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,057 | TotalAmt |
| Management And General | $66,057 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,642,462 | TotalAmt |
| Program Services | $12,642,462 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $578,025 | TotalAmt |
| Program Services | $173,466 | ProgramServicesAmt |
| Management And General | $404,559 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,809,258 | TotalAmt |
| Program Services | $8,770,446 | ProgramServicesAmt |
| Management And General | $38,812 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,435,603 | TotalAmt |
| Program Services | $1,435,603 | ProgramServicesAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,148,039 | TotalAmt |
| Program Services | $1,142,299 | ProgramServicesAmt |
| Management And General | $5,740 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,759 | TotalAmt |
| Program Services | $54,759 | ProgramServicesAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $177,723 | TotalAmt |
| Program Services | $149,166 | ProgramServicesAmt |
| Management And General | $28,557 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $450,280 | TotalAmt |
| Program Services | $450,280 | ProgramServicesAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,732,967 | TotalAmt |
| Program Services | $3,714,302 | ProgramServicesAmt |
| Management And General | $18,665 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $534,070 | TotalAmt |
| Program Services | $376,712 | ProgramServicesAmt |
| Management And General | $157,358 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEDICAID ASSESSMENT EXPENSE | $2,733,945 | $2,733,945 |
| FOOD EXPENSE | $534,789 | $534,789 |
| IMPLANT FEES | $2,304,814 | $2,304,814 |
| REFERENCE LAB | $594,222 | $594,222 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $498,260 | TotalAmt |
| Program Services | $376,383 | ProgramServicesAmt |
| Management And General | $121,877 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,605,138 | TotalAmt |
| Program Services | $63,993,177 | ProgramServicesAmt |
| Management And General | $6,611,961 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $103,996 | BOYAmt |
| EOY | $24,329 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,628,123 | BOYAmt |
| EOY | $677,553 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,523,840 | BOYAmt |
| EOY | $12,568,784 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,061,171 | BOYAmt |
| EOY | $1,039,846 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,593,739 | BOYAmt |
| EOY | $1,566,044 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $90,093,835 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $65,363,664 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,148,803 | BOYAmt |
| EOY | $24,730,171 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,108,752 | BOYAmt |
| EOY | $13,872,862 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,390,408 | BOYAmt |
| EOY | $688,625 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71,558,832 | BOYAmt |
| EOY | $55,168,214 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,618,888 | BOYAmt |
| EOY | $6,081,585 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,405,000 | BOYAmt |
| EOY | $8,570,000 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,130,972 | BOYAmt |
| EOY | $2,453,985 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,551,108 | BOYAmt |
| EOY | $14,414,378 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,705,968 | BOYAmt |
| EOY | $31,519,948 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,500,657 | BOYAmt |
| EOY | $23,254,824 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $352,207 | BOYAmt |
| EOY | $393,442 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,852,864 | BOYAmt |
| EOY | $23,648,266 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71,558,832 | BOYAmt |
| EOY | $55,168,214 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$2,071,217 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$2,743,937 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$9,389,444 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | false | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
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) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| 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 | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $30,188 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $30,188 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | LOBBYING ACTIVITIES LOBBYING EXPENSES ARE ONLY INCURRED THROUGH ASSOCIATIONS WITH NATIONAL ORGANIZATIONS OF WHICH THE ORGANIZATION IS A MEMBER. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,449,581 | OtherCostOrOtherBasisAmt |
| Book Value | $1,449,581 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,585,946 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,206,490 | DepreciationAmt |
| Book Value | $2,379,456 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,362,006 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,326,991 | DepreciationAmt |
| Book Value | $5,035,015 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $52,490,575 | OtherCostOrOtherBasisAmt |
| Depreciation | $39,083,088 | DepreciationAmt |
| Book Value | $13,407,487 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,205,727 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,747,095 | DepreciationAmt |
| Book Value | $2,458,632 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $24,730,171 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO THIRD PARTIES | $3,358,857 |
| MINIMUM PENSION LIABILITY | $10,840,878 |
| DUE (FROM)/TO MEDICARE | $214,643 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $14,414,378 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PART X, LINE 2 | FormAndLineReferenceDesc |
| Explanation | FIN 48 DISCLOSURE MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 600. | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | $312,099 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $312,099 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00440 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,536,729 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,268,737 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,267,992 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11660 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,848,828 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,268,737 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,580,091 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12100 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,450 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $18,450 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,450 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $18,450 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,867,278 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,268,737 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,598,541 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12130 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,309,000 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $196,350 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $18,754,701 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $31,412,670 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$12,657,969 | 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 | PEKIN MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 SOUTH 13TH STREET | AddressLine1Txt |
| City | PEKIN | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61554 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | PEKINHOSPITAL.ORG | WebsiteAddressTxt |
| State License | 001834 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEKIN MEMORIAL 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | 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 | SEE PART V, SECTION C | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C | StrategyWebsiteURLTxt |
| 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 | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 600. | FPGFamilyIncmLmtDscntCarePct |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, SECTION C | 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | CHNA - INPUT FROM PERSONS REPRESENTING THE COMMUNITY INTERVIEWS WITH KEY STAKEHOLDERS (PERSONS WITH KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH, COMMUNITY MEMBERS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY OR PERSONS REPRESENTING VULNERABLE POPULATIONS) IS A TECHNIQUE EMPLOYED TO ASSESS PUBLIC PERCEPTIONS OF THE COUNTY'S HEALTH STATUS AND UNMET NEEDS. THESE INTERVIEWS ARE INTENDED TO ASCERTAIN OPINIONS AMONG INDIVIDUALS LIKELY TO BE KNOWLEDGEABLE ABOUT THE COMMUNITY AND INFLUENTIAL OVER THE OPINIONS OF OTHERS ABOUT HEALTH CONCERNS IN THE COMMUNITY. INTERVIEWS WERE PERFORMED WITH 20 KEY STAKEHOLDERS. STAKEHOLDERS WERE DETERMINED BASED ON A) THEIR SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH, B) THEIR INVOLVEMENT WITH UNDERSERVED AND MINORITY POPULATIONS OR C) THEIR AFFILIATION WITH LOCAL GOVERNMENT, SCHOOLS AND INDUSTRY. PARTICIPANTS PROVIDED COMMENTS ON THE FOLLOWING ISSUES: HEALTH AND QUALITY OF LIFE FOR RESIDENTS OF THE PRIMARY COMMUNITY, UNDERSERVED POPULATIONS AND COMMUNITIES OF NEED, BARRIERS TO IMPROVING HEALTH AND QUALITY OF LIFE FOR RESIDENTS OF THE COMMUNITY, OPINIONS REGARDING THE IMPORTANT HEALTH ISSUES THAT AFFECT COMMUNITY RESIDENTS AND THE TYPES OF SERVICES THAT ARE IMPORTANT FOR ADDRESSING THESE ISSUES. INTERVIEW DATA WAS INITIALLY RECORDED IN NARRATIVE FORM ASKING PARTICIPANTS A SERIES OF FOURTEEN QUESTIONS. KEY STAKEHOLDERS FROM THE COMMUNITY WORKED FOR THE FOLLOWING TYPES OF ORGANIZATIONS AND AGENCIES: PEKIN HOSPITAL, SOCIAL SERVICE AGENCIES, LOCAL SCHOOL SYSTEMS AND UNIVERSITIES, PUBLIC HEALTH AGENCIES, OTHER MEDICAL PROVIDERS AND COMMUNITY CENTERS. PEKIN HOSPITAL COLLABORATED WITH THE OSF HEALTHCARE SYSTEM TO CONDUCT A COMMUNITY HEALTH NEEDS SURVEY. REPRESENTATIVES FROM BRADLEY UNIVERSITY PREPARED THE SURVEY INSTRUMENT. PEKIN HOSPITAL, OSF HEALTHCARE SYSTEM AND LOCAL HEALTH DEPARTMENTS WORKED TOGETHER TO PUBLICIZE AND DISTRIBUTE SURVEYS THROUGHOUT THE COMMUNITY. THE SURVEY WAS LAUNCHED ON AUGUST 1, 2015, AND WAS CLOSED ON SEPTEMBER 30, 2015. THE BROAD SURVEY WAS INTENDED TO GATHER INFORMATION REGARDING OVERALL HEALTH OF THE COMMUNITY. THE RESULTS OF THIS SURVEY YIELD INFORMATION ON DIFFERENT HEALTH AND COMMUNITY FACTORS. AREAS SURVEYED INCLUDE DEMOGRAPHICS AND SOCIOECONOMIC CHARACTERISTICS, BEHAVIORAL RISK FACTORS, HEALTH CONDITIONS AND ACCESS TO HEALTH RESOURCES. A WEB-BASED SURVEY TOOL WAS UTILIZED TO CONDUCT AN ELECTRONIC SURVEY. PAPER SURVEYS, WHICH WERE IDENTICAL TO THE ELECTRONIC SURVEY, WERE ALSO DISTRIBUTED TO POPULATIONS WHO MAY NOT HAVE ACCESS TO THE INTERNET OR GENERATIONALLY ARE MORE LIKELY TO COMPLETE A PAPER SURVEY. ELECTRONIC AND PAPER SURVEYS WERE CIRCULATED TO THE RESIDENTS OF THE CHNA COMMUNITY. THE SURVEY WAS PUBLICIZED ON THE LOCAL RADIO STATION, THROUGH MULTIPLE NEWSPAPER ADVERTISEMENTS AND AT VARIOUS HEALTH FAIRS. THE SURVEY WAS DISTRIBUTED THROUGH: - LINKS ON PEKIN HOSPITAL'S WEBSITE AND FACEBOOK ACCOUNT - TAZEWELL COUNTY HEALTH DEPARTMENT (ONLINE AND IN-PERSON) THERE WERE 771 SURVEYS COMPLETED. SOCIO-DEMOGRAPHIC CHARACTERISTICS SUCH AS AGE, EDUCATION, INCOME AND EMPLOYMENT STATUS WERE FAIRLY COMPARABLE TO THE MOST RECENT CENSUS DATA. OVER 80 PERCENT OF THE SURVEY RESPONDENTS WERE FEMALE WHICH IS MORE THAN THE 50 PERCENT OF THE POPULATION THAT IS FEMALE IN THE COMMUNITY. ADDITIONALLY, REPRESENTATION OF THOSE INDIVIDUALS 66 AND OLDER IS LESS THAN THAT REPORTED IN THE LATEST CENSUS DATA. THE FINAL SURVEY INSTRUMENT WAS CREATED AND COMPILED BY DR. LAURENCE G. WEINZIMMER, BRADLEY UNIVERSITY PROFESSOR. |
| SCHEDULE H, PART V, SECTION B, LINE 7A | http://www.pekinhospital.org/_data/mediaCenter/files/1062.pdf |
| SCHEDULE H, PART V, SECTION B, LINE 11 | SEE SEPARATE SCHEDULE ATTACHED TO RETURN. |
| SCHEDULE H, PART V, SECTION B, LINE 16A & 16C | http://pekinhospital.com/_data/files/Full%20Financial%20Assistance %20Policy.pdf |
| SCHEDULE H, PART V, SECTION B, LINE 16B | HTTP://WWW.PEKINHOSPITAL.ORG/PATIENTS-VISITORS/PATIENTS/FINANCIAL-ASSISTAN CE/ |
| SCHEDULE H, PART V, SECTION B, LINE 16I | PUBLISHING OF FINANCIAL ASSISTANCE POLICY THE POLICY IS ALSO AVAILABLE IN COMMON AREAS OF THE HOSPITAL, IN PATIENT FINANCIAL SERVICES AND ON OUR WEBSITE. |
| SCHEDULE H, PART V, SECTION B, LINE 22D | PEKIN HOSPITAL HAS ELECTED TO USE THE LOOK BACK METHOD FOR CALCULATING AGB: THE AGB IS CALCULATED BY REVIEWING ACTUAL CLAIMS THAT HAVE BEEN PAID IN FULL FOR MEDICALLY NECESSARY CARE BY MEDICARE AND THIRD PARTY PAYERS. THE CLAIMS REVIEWED COVER CLAIMS PAID IN FULL FOR THE LAST 12 MONTHS. THE AMOUNTS PAID INCLUDE CO-INSURANCE, COPAYMENTS AND DEDUCTIBLES. THE AGB FOR EMERGENCY AND MEDICALLY NECESSARY CARE PROVIDED TO A FINANCIAL ASSISTANCE-ELIGIBLE INDIVIDUAL IS CALCULATED BY MULTIPLYING GROSS CHARGES FOR THAT CARE BY THE AVERAGE COLLECTION PERCENTAGE FOR MEDICARE AND PRIVATE HEALTH INSURERS THE PERCENTAGE IS CALCULATED AT LEAST ANNUALLY BY DIVIDING THE SUM OF PAID CLAIMS BY THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS. THE PERCENTAGE IS THEN APPLIED TO INDIVIDUAL'S GROSS CHARGES TO REDUCE THE BILL. A REVISED PERCENTAGE WILL BE CALCULATED AND APPLIED BY THE 45TH DAY AFTER THE FIRST DAY OF THE START OF THE FISCAL YEAR USED TO DETERMINE THE CALCULATIONS. |
| SCHEDULE H, PART V, SECTION B, LINE 10A | THE IMPLEMENTATION STRATEGY IS INCLUDED WITH THE CHNA ON THE WEBSITE AT THE FOLLOWING LINK: http://www.pekinhospital.org/_data/mediaCenter/files/1062.pdf |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| PEKIN HOSPITAL MRI BUILDING | ||||
| 1300 PARK AVENUE | PEKIN | IL | 61554 | DIAGNOSTIC CENTER |
| PEKIN HOSPITAL PAIN MANAGEMENT LLC | ||||
| 600 SOUTH 13TH STREET | PEKIN | IL | 61554 | PAIN CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART III, SECTION A, LINE 2 | BAD DEBT METHODOLOGY THE COST OF BAD DEBT EXPENSE TO THE ORGANIZATION IS DETERMINED BY COMPUTING A RATIO OF COST (TOTAL OPERATING EXPENSE) TO GROSS CHARGES AND THEN MULTIPLYING THAT RATIO BY THE BAD DEBT EXPENSE REPORTED FOR THE HOSPITAL. |
| SCHEDULE H, PART III, SECTION A, LINE 3 | BAD DEBT INCLUDED IN COMMUNITY BENEFIT THE ORGANIZATION ESTIMATED THE COST OF BAD DEBT AT 15%. PERCENTAGE WAS OBTAINED UTILIZING LOXOGON TESTING. THE HOSPITAL COMMITS SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND CRITICAL SERVICES WHICH MEET OTHERWISE UNFILLED COMMUNITY NEEDS. MANY OF THESES ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE SELF-SUPPORTING OR FINANCIALLY VIABLE. ADDITIONALLY, AMOUNTS IN LINE 3 EXIST DUE TO THE NUMBER OF PATIENTS WHO DID NOT TAKE THE TIME TO APPLY FOR CHARITY CARE, BUT OTHERWISE QUALIFIED. |
| SCHEDULE H, PART III, SECTION A, LINE 4 | BAD DEBT EXPENSE ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. 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, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (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 HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS 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 OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| SCHEDULE H, PART III, SECTION B, LINE 8 | SHORTFALL LINE 6 IS TAKEN FROM MCR COST REPORT - COST TO CHARGE RATIO. THE MEDICARE COST REPORT IS FILED FOLLOWING THE COST REPORT GUIDELINES. MEDICARE PAYMENT SHORTFALLS SHOULD BE REFLECTED AS COMMUNITY BENEFIT AS THE FEDERAL GOVERNMENT PROSPECTIVELY SETS THE HOSPITAL PAYMENT RATES; THE RATES ARE NOT NEGOTIABLE AND CONSEQUENTLY, NO LONGER COVER THE HOSPITAL'S COST TO PROVIDE SERVICES TO MEDICARE BENEFICIARIES. |
| SCHEDULE H, PART III, SECTION C, LINE 9B | DEBT COLLECTION POLICY PEKIN FOLLOWS THE CHARITY POLICY, REGARDLESS OF THEIR INSURANCE SITUATION. FOR EXAMPLE, IF THE PERSON HAS A FORM OF INSURANCE, THE INSURANCE COMPANY PAYS, AND PEKIN APPLIES CHARITY CARE BENEFITS TO THE SELF-PAY PORTION REMAINING AFTER THE INSURANCE PAYMENT. |
| SCHEDULE H, PART VI, LINE 2 | NEEDS ASSESSMENT PEKIN HOSPITAL CONTRACTED WITH BKD, TO ASSIST WITH THE CREATION OF ITS STRATEGIC PLAN. THE COMMUNITY ASSESSMENT WAS PERFORMED THROUGH A SERIES OF FOCUS GROUPS, COMMUNITY SURVEYS, INTERNAL STATISTICAL DATA, AND COUNTY AND SERVICE AREA DEMOGRAPHICS. |
| SCHEDULE H, PART VI, LINE 3 | PATIENT EDUCATION OF ELIGIBILITY TO MAKE OUR PATIENTS, FAMILIES AND THE BROADER COMMUNITY AWARE OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM, THE HOSPITAL HAS TAKEN A NUMBER STEPS TO NOTIFY VISITORS TO ITS FACILITY OF THIS POLICY AND TO WIDELY PUBLICIZE THIS POLICY TO MEMBERS OF THE BROADER COMMUNITY SERVED BY THE HOSPITAL INCLUDING: POSTING OF LEGIBLE SIGNAGE IN HEAVILY TRAFFICKED PATIENT AREAS SUCH AS ADMITTING, EMERGENCY DEPARTMENT AND AMBULATORY REGISTRATION AREAS; PROVIDING PAMPHLETS AND BROCHURES DURING THE ADMISSION AND/OR DISCHARGE PROCESS; PROVIDING NOTICE OF AVAILABILITY OF FINANCIAL ASSISTANCE OR DISCOUNTED CARE AND OTHER FORMS OF COMMUNICATIONS; OFFERING PATIENT AND FAMILY COUNSELING SESSIONS WITH REGISTRARS, PATIENT ACCOUNTING STAFF, OR FINANCIAL COUNSELORS EITHER BEFORE, DURING OR AFTER THE TIME OF SERVICE, AS APPROPRIATE; AND PROVIDING INFORMATION ABOUT THIS POLICY ON THE HOSPITAL'S WEBSITE, INCLUDING THE APPLICATION AND A PLAIN LANGUAGE SUMMARY OF THE POLICY IN A WIDELY AVAILABLE FORMAT, FOR EXAMPLE AS A PDF DOCUMENT. PROVIDING A PLAIN LANGUAGE SUMMARY OF THE POLICY WITH ALL BILLING STATEMENTS (AT LEAST 3 BILLING STATEMENTS) AND ALL OTHER WRITTEN COMMUNICATIONS REGARDING THE BILL DURING THE NOTIFICATION PERIOD; OFFERING AN APPLICATION BEFORE DISCHARGE FROM THE HOSPITAL; INFORMING PATIENTS ABOUT THE HOSPITAL'S POLICY IN ALL ORAL COMMUNICATION REGARDING THE AMOUNT DUE; AND PROVIDING AT LEAST ONE WRITTEN NOTICE STATING WHAT ECAS THE HOSPITAL MAY TAKE IF NO APPLICATION IS RECEIVED OR NO PAYMENTS ARE MADE BY A SPECIFIED DATE (AT LEAST AS LONG AS NOTIFICATION PERIOD) AND THIS NOTICE IS PROVIDED AT LEAST 30 DAYS BEFORE THE DEADLINE. SIGNAGE MUST COMMUNICATE IN CAPITAL LETTERS IF YOU ARE UNINSURED, A SOCIAL SECURITY NUMBER IS NOT REQUIRED TO QUALIFY FOR FREE OR DISCOUNTED CARE. ALL PRINTED INFORMATION AND/OR FORMS REGARDING THE FINANCIAL ASSISTANCE PROGRAM WILL BE AVAILABLE IN PRIMARY LANGUAGES SPOKEN BY POPULATIONS WE SERVE IN ACCORDANCE WITH STATE AND FEDERAL LAW. PRINTED COPIES OF THIS POLICY (INCLUDING THE APPLICATION), ITS PLAIN LANGUAGE SUMMARY, AND THE HOSPITAL'S COLLECTIONS POLICY MAY BE OBTAINED AT NO EXTRA COST BY VISITING OR CALLING THE HOSPITAL'S BUSINESS OFFICE. |
| SCHEDULE H, PART VI, LINE 4 | COMMUNITY INFORMATION PEKIN HOSPITAL PRIMARILY SERVES TAZEWELL, MASON AND PEORIA COUNTIES IN THE STATE OF ILLINOIS. IT IS ONE OF THE LARGEST EMPLOYERS IN THE CITY OF PEKIN AND IN TAZEWELL COUNTY. THE SERVICE AREA SITS TO THE SOUTH AND EAST OF THE GREATER PEORIA AREA, WHERE CATERPILLAR IS A MAJOR INDUSTRIAL EMPLOYER. ITS PRIMARY SERVICE AREA HAS A POPULATION OF 59,000 WITH A SECONDARY SERVICE AREA OF APPROXIMATELY 14,000. THE MEDIAN AGE OF ITS SERVICE AREA IS 41 YEARS, WHILE THE MEDIAN HOUSEHOLD INCOME IS $55,000. |
| SCHEDULE H, PART VI, LINE 5 | PROMOTION OF COMMUNITY HEALTH PEKIN HOSPITAL PROVIDES MANY FREE HEALTH SCREENINGS THROUGHOUT THE YEAR TO PROMOTE EARLY DETECTION AND PREVENTION. THIS INCLUDES BUT IS NOT LIMITED TO MAMMOGRAPHY, BONE DENSITY, BLOOD PRESSURE, COLON, OBESITY AND SPIROMETRY. PEKIN HOSPITAL HAS ENGAGED ITS PHYSICIANS TO SPEAK AT DIFFERENT COMMUNITY ORGANIZATIONS, TO SHARE INFORMATION ON HEALTH AND WELL-BEING. IT HAS ALSO SENT REPRESENTATIVES OUT TO DISCUSS HEALTHCARE REFORM. IN FY 2016, PEKIN HOSPITAL HAD CONSOLIDATED COST OF BAD DEBT, CHARITY CARE, AND UNREIMBURSED MEDICAID COSTS TOTALING $9,944,743. IN FY 2015 THAT NUMBER WAS $9,128,000. |
| SCHEDULE H, PART VI, LINE 6 | AFFILIATED HEALTH CARE SYSTEM PROGRESSIVE HEALTH SYSTEM IS THE SOLE MEMBER OF PEKIN HOSPITAL, PEKIN HOSPITAL FOUNDATION, PARK COURT LIMITED, PRO HEALTH INC AND PEKIN PAIN MANAGEMENT, LLC. PEKIN HOSPITAL IS A NOT-FOR-PROFIT ENTITY AND IS THE ONLY HOSPITAL UNDER THE PROGRESSIVE HEALTH SYSTEM UMBRELLA. THE FOUNDATION IS A NOT-FOR-PROFIT ENTITY THAT RAISES FUNDS ON BEHALF OF PEKIN HOSPITAL TO ASSIST WITH PURCHASES OF CAPITAL EQUIPMENT AND OTHER LARGE EXPENSES FOR MEDICAL CARE. PARK COURT LIMITED IS A NOT-FOR-PROFIT ENTITY THAT FUNCTIONS AS A PROPERTY HOLDING COMPANY WHICH LEASES MEDICAL OFFICE SPACE TO MEDICAL CARE PROVIDERS. PRO HEALTH INC. IS A FOR-PROFIT PHYSICIAN CLINIC THAT EMPLOYS PHYSICIANS TO CARE FOR ITS PATIENTS AND WHO ALSO HAVE ADMITTING RIGHTS TO PEKIN HOSPITAL. PEKIN HOSPTAL PARTNERED WITH TAZEWELL PAIN MANAGEMENT, LLC TO BRING A PAIN MANAGEMENT SERVICES TO THE COMMUNITY. THE PAIN SERVICES ARE OFFERED UNDER PEKIN PAIN MANAGEMENT, LLC. |
| SCHEDULE H, PART VI, LINE 7 | FILING OF COMMUNITY BENEFIT REPORT ILLINOIS ONLY |
| SCHEDULE H, PART I, LINE 7 | COST METHODOLOGY THE COSTS REPORTED IN THE TABLE IN PART I, LINE 7 USED A RATIO OF PATIENT CARE COSTS TO CHARGES AS COMPUTED IN WORKSHEET 2 OF THE FORM INSTRUCTIONS. THIS METHODOLOGY WAS USED FOR ALL PATIENT SEGMENTS. |
| SCHEDULE H, PART I, LINE 7, COLUMN F | BAD DEBT NO BAD DEBT EXPENSE WAS INCLUDED IN PART IX, LINE 25. |
| SCHEDULE H, PART I, LINE 3C | SEE SCHEDULE H, PART V, LINE 13 FOR OTHER FACTORS CONSIDERED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. |
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 Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | 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 (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BOB HALEY | ||||||||||||
| CEO | $262,250 | $0 | $27,750 | $0 | $0 | $0 | $10,785 | $0 | $28,310 | $0 | $329,095 | $0 |
| STEVE HALL | ||||||||||||
| CFO | $218,500 | $0 | $24,678 | $0 | $0 | $0 | $10,400 | $0 | $12,415 | $0 | $265,993 | $0 |
| LINDA COLE | ||||||||||||
| DIRECTOR OF IT | $132,685 | $0 | $12,058 | $0 | $0 | $0 | $0 | $0 | $6,745 | $0 | $151,488 | $0 |
| ANGELIA DREHER | ||||||||||||
| DIRECTOR OF PHARMACY | $143,572 | $0 | $7,684 | $0 | $0 | $0 | $4,649 | $0 | $22,904 | $0 | $178,809 | $0 |
| JO ELLEN PATTERSON | ||||||||||||
| CHIEF NURSING OFFICER | $143,174 | $0 | $10,036 | $0 | $0 | $0 | $8,621 | $0 | $0 | $0 | $161,831 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PART I, LINE 1A | HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES BOB HALEY, CEO, IS THE ONLY INDIVIDUAL THAT RECEIVED PAYMENT FOR HEALTH/SOCIAL CLUB MEMBERSHIP DUES. THE ORGANIZATION ONLY PAYS FOR EXPENSES RELATED TO THE BUSINESS USE OF THE MEMBERSHIP. |
| SCHEDULE J, PART I, LINE 4C | MIKE JOHNSON RECEIVED 6 MONTHS SALARY AS SEVERANCE PAY, PAID OUT OVER 6 MONTHS AT A RATE OF $4,600 PER PAY PERIOD FOR A TOTAL PAYMENT OF $59,800. |
| FORM 990, PART VII, SECTION A, LINE 5 | COMPENSATION PAID BY AN UNRELATED MANAGEMENT COMPANY THE CEO, BOB HALEY, IS PAID BY AN UNRELATED MANAGEMENT COMPANY, QUORUM HEALTH RESOURCES. QUORUM PROVIDED BOB HALEY WITH COMPENSATION IN THE AMOUNT OF $329,095. ALL FEES ARE PAID TO QUORUM BY PEKIN MEMORIAL HOSPITAL. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF PEKIN TAZEWELL COUNTY IL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 376002169 | BondIssuerEIN |
| Bond Issued | 2010-03-30 | BondIssuedDt |
| Issue Price | $23,530,000 | IssuePriceAmt |
| Purpose | SEE PART VI | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $13,145,000 | RetiredAmt |
| Bond Defeased | $0 | BondDefeasedAmt |
| Total Proceeds | $23,530,000 | TotalProceedsAmt |
| In Reserve Fund | $2,955,000 | InReserveFundAmt |
| Capitalized Interest | $0 | CapitalizedInterestAmt |
| Refunding Escrow | $10,385,000 | RefundingEscrowAmt |
| Issuance Costs From Proceeds | $283,000 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $0 | CreditEnhancementAmt |
| Working Capital Expenditures | $0 | WorkingCapitalExpendituresAmt |
| Capital Expenditures | $0 | CapitalExpendituresAmt |
| Other Spent Proceeds | $0 | OtherSpentProceedsAmt |
| Unspent | $0 | UnspentAmt |
| Substantial Completion | 2010 | SubstantialCompletionYr |
| Current Refunding | Yes (true) | CurrentRefundingInd |
| Advance Refunding | false | AdvanceRefundingInd |
| Final Allocation Made | false | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | Yes (true) | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | false | MgmtContractBondFincdPropInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.02400 | PrivateBusUseByOthersPct |
| Total Private Business Use | 0.02400 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Remedial Action Taken | false | RemedialActionTakenInd |
| Procs Nonqualified Bond Remdtd | Yes (true) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | Yes (true) | Form8038TFiledInd |
| Variable Rate Issue | false | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
Hedge Provider Name HedgeProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
GIC Provider Name GICProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested | false | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | false | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | false | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE K, PART I, LINE A, COLUMN F | REV REFUNDING BONDS SER 1993B AND C AND 1997 |
| SCHEDULE K, PART IV, LINE 7 AND PART V | THE BOND OBLIGATIONS WERE SUBSEQUENTLY RETIRED IN FULL IN FEBRUARY 2017. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc |
|---|---|---|
| MADISON DUNN | ||
| RELATIVE OF BOARD MEMBER | $21,000 | EMPLOYMENT |
| JACOB MILLER | ||
| RELATIVE OF BOARD MEMBER | $13,000 | EMPLOYMENT |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (20 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | FAMILY AND BUSINESS RELATIONSHIPS DR. SMALLEY AND CURTIS EETON HAVE A BUSINESS RELATIONSHIP. ALL BOARD MEMBERS AND OFFICERS HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER AS A RESULT OF ALL SERVING AS BOARD MEMBERS OR OFFICERS OF PEKIN PROHEALTH, INC., A FOR-PROFIT AFFILIATE OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 3 | DELEGATING AUTHORITY THE BOARD OF DIRECTORS HAS CONTRACTED WITH QUORUM HEALTH RESOURCES (QHR) TO SERVE AS A MANAGEMENT CORPORATION TO ASSIST IN THE LEADERSHIP OF THE HOSPITAL. QHR PROVIDES PEKIN HOSPITAL WITH LEADERSHIP VIA THE CEO ALONG WITH OTHER CONSULTING SERVICES ON FINANCIAL AND STAFFING NEEDS. |
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERS AND STOCKHOLDERS PROGRESSIVE HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | ELECTION OF GOVERNING BODY THE SOLE MEMBER, PROGRESSIVE HEALTH SYSTEMS, HAS THE POWER TO ELECT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7B | APPROVAL BY MEMBERS THE SOLE MEMBER, PROGRESSIVE HEALTH SYSTEMS, HAS THE RIGHT TO APPROVE THE FOLLOWING DECISIONS BY THE GOVERNING BODY: A) ESTABLISHMENT OR MODIFICATION OF COMPENSATION AND BENEFIT POLICIES; B) DEVELOPMENT OR MODIFICATION OF CORPORATE COMPLIANCE PROGRAMS, INCLUDING PROGRAMS DESIGNED TO DETECT OR PREVENT HEALTH CARE FRAUD OR IMPROPER THIRD PARTY BILLING, ACTIVITIES REGARDING LEGAL AND REGULATORY COMPLIANCE RELATING TO THE CODE, ENVIRONMENTAL ISSUES, OCCUPATIONAL SAFETY AND HEALTH, ANTITRUST, FEDERAL ELECTION LAWS, AND ALL OTHER LAWS APPLICABLE TO THE CORPORATION. VARIOUS OTHER POWERS ARE RESERVED EXCLUSIVELY TO THE SOLE MEMBER, AS OUTLINED IN THE BYLAWS OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | PROCESS TO REVIEW 990 FORM 990 WAS REVIEWED BY THE CEO, CFO, AND CONTROLLER. PRIOR TO FILING, THE 990 WAS PROVIDED TO THE BOARD OF DIRECTORS ELECTRONICALLY, AND REVIEWED INDEPENDENTLY BY EACH MEMBER. QUESTIONS BY BOARD MEMBERS WERE HANDLED ON AN INDIVIDUAL BASIS WITH MANAGEMENT. |
| FORM 990, PART VI, SECTION B, LINE 12C | ORGANIZATION'S POLICY FOR MONITORING COMPLIANCE PERIODIC SURVEYS ARE PERFORMED REQUESTING DISCLOSURES OF CONFLICTS OF INTEREST. IF IT IS DETERMINED THAT A CONFLICT EXISTS, THE EMPLOYEE WILL BE REQUIRED TO RELINQUISH EITHER THE OUTSIDE BUSINESS INTEREST/ARRANGEMENT OR HIS/HER PHS EMPLOYMENT. THE CONFLICT OF INTEREST POLICIES APPLY TO INDIVIDUALS WHO SERVE AS TRUSTEES, MANAGERS (DEPARTMENT HEADS AND ABOVE), CHIEFS OF CLINICAL DEPARTMENTS, AND ANY OTHER EMPLOYEE, MEDICAL STAFF MEMBER OR NON-EMPLOYED CONTRACTOR ACTING IN A MANAGERIAL OR CLINICAL LEADERSHIP CAPACITY DEEMED BY AN ADMINISTRATIVE OFFICER OR CHIEF OF SERVICE TO BE IN A POSITION TO INFLUENCE DECISION-MAKING FOR THE ORGANIZATION. DISCLOSURE WILL OCCUR THROUGH AN ANNUAL CONFLICT OF INTEREST DISCLOSURE STATEMENT AND THE DISCLOSURE OF OTHER ACTUAL OR POTENTIAL CONFLICTS AS THEY ARISE. POTENTIAL CONFLICTS OF INTEREST SHOULD BE REPORTED TO AN IMMEDIATE UPERVISOR, WHO, IN TURN, IS OBLIGATED TO REPORT THE MATTER TO THE CORPORATE COMPLIANCE OFFICER. THE CORPORATE COMPLIANCE OFFICER IS EXPECTED TO INVESTIGATE REPORTED CONFLICTS AND MAKE A REPORT TO THE COMPLIANCE COMMITTEE ON A QUARTERLY BASIS. ALL BOARD MEMBERS ARE REQUIRED TO REPORT ANY POTENTIAL CONFLICTS OFINTEREST TO THE BOARD OR AN APPLICABLE COMMITTEE OF THE BOARD. AFTER EXCUSING THE MEMBER WITH A POTENTIAL CONFLICT, THE REMAINING MEMBERS OF THE BOARD OR COMMITTEE WILL DISCUSS AND DECIDE IF A CONFLICT EXISTS, BOARD MEMBERS FOUND TO HAVE A CONFLICT ARE REQUIRED TO EXCUSE THEMSELVES FROM ANY DISCUSSIONS REGARDING A TRANSACTION RELATED TO A POTENTIAL CONFLICT AND ARE PROHIBITED FROM VOTING ON ANY SUCH MATTER. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE EXECUTIVE COMMITTEE SHALL MEET AT LEAST ONCE A YEAR, OR MORE FREQUENTLY IF CIRCUMSTANCES DICTATE, TO CARRY OUT ITS RESPONSIBILITIES UNDER THIS POLICY. THE PORTION OF SUCH MEETINGS DEVOTED TO SUCH RESPONSIBILITIES SHALL BE HELD IN EXECUTIVE SESSION EXCEPT THAT (A) THE CEO OF PEKIN HOSPITAL SHALL BE INVITED TO ATTEND THOSE PORTIONS OF THE MEETING THAT RELATE TO COMPENSATION OF PERSONS OTHER THAN THE CEO, AND (B) AT THE INVITATION OF THE BOARD CHAIRMAN, OTHER MEMBERS OF MANAGEMENT OR OUTSIDE CONSULTANTS AND LEGAL COUNSEL MAY BE INVITED TO ATTEND SUCH PORTIONS OF THE MEETINGS. MINUTES SHALL BE PREPARED AND APPROVED WITHIN 60 DAYS AFTER THE MEETING OF THE EXECUTIVE COMMITTEE. AT LEAST ONCE EVERY FOUR YEARS, THE EXECUTIVE COMMITTEE SHALL MEET SEPARATELY TO REVIEW SURVEY INFORMATION OF EXECUTIVE COMPENSATION FOR SIMILAR POSITIONS. THE EXECUTIVE COMMITTEE WILL DETERMINE ANNUALLY WHETHER EXECUTIVE COMMITTEE MEMBERS WHO HAVE BEEN DETERMINED TO HAVE A MATERIAL CONFLICT OF INTEREST WITH PEKIN HOSPITAL ARE ELIGIBLE TO VOTE ON MATTERS RELATED TO COMPENSATION OF OFFICERS AND KEY EMPLOYEES. THIS DETERMINATION WILL BE MADE BASED ON THE EXECUTIVE COMMITTEE'S JUDGMENT AS TO WHETHER THE EXECUTIVE COMMITTEE MEMBER IS OR COULD APPEAR TO BE CONFLICTED IN EXERCISING INDEPENDENT JUDGMENT IN DETERMINING EXECUTIVE COMPENSATION BECAUSE OF SUCH CONFLICT OF INTEREST TRANSACTION WITH PEKIN HOSPITAL. COMPENSATION OF THE CEO IN JULY OF EACH YEAR, THE EXECUTIVE COMMITTEE SHALL REVIEW THE COMPENSATION OF THE PRESIDENT FOR THE NEXT YEAR. IN CONNECTION WITH THAT REVIEW: 1. THE EXECUTIVE COMMITTEE SHALL REVIEW THE EXECUTIVE COMPENSATION SURVEY INFORMATION 2. THE EXECUTIVE COMMITTEE SHALL REVIEW THE JOB PERFORMANCE OF THE CEO 3. THE EXECUTIVE COMMITTEE SHALL REVIEW ANY SIGNIFICANT CHANGES TO THE PEKIN HOSPITAL EXECUTIVE COMPENSATION POLICIES AND BENEFITS APPLICABLE TO THE CEO. 4. THE EXECUTIVE COMMITTEE SHALL RECOMMEND TO THE FULL BOARD OF DIRECTORS THE COMPENSATION OF THE CEO AND WHETHER SUCH COMPENSATION IS REASONABLE AND CONSISTENT WITH FAIR MARKET VALUE FOR SIMILAR POSITIONS IN LIKE FACILITIES. |
| FORM 990, PART VI, SECTION B, LINE 15B | COMPENSATION OF OFFICERS AND KEY EMPLOYEES OTHER THAN THE CEO: IN JULY OF EACH YEAR, THE EXECUTIVE COMMITTEE SHALL REVIEW THE PROPOSED COMPENSATION FOR EACH OFFICER AND KEY EMPLOYEE FOR THE NEXT YEAR. IN CONNECTION WITH THAT REVIEW: 1. THE EXECUTIVE COMMITTEE SHALL REVIEW EXECUTIVE COMPENSATION SURVEY INFORMATION. 2. THE EXECUTIVE COMMITTEE SHALL REVIEW ANY SIGNIFICANT CHANGES TO THE PEKIN HOSPITAL EXECUTIVE COMPENSATION POLICIES AND BENEFITS APPLICABLE TO SUCH OFFICERS AND KEY EMPLOYEES. 3. THE EXECUTIVE COMMITTEE SHALL DETERMINE WHETHER THE COMPENSATION OF OFFICERS AND KEY EMPLOYEES IS REASONABLE AND CONSISTENT WITH FAIR MARKET VALUE FOR SIMILAR POSITIONS IN LIKE FACILITIES, AND IF SO, SHALL RECOMMEND TO THE FULL BOARD OF DIRECTORS THAT MANAGEMENT BE AUTHORIZED TO PROCEED WITH IMPLEMENTATION OF PROPOSED COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | DISCLOSURE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 9 | OTHER CHANGES IN NET ASSETS CHANGE IN MINIMUM PENSION LIABILITY <1,020,196> TRANSFERS TO AFFILIATES <5,711,585> IMPAIRMENT LOSS OF GOODWILL <2,698,898> CHANGE IN INVESTMENT IN FOUNDATION 41,235 ------------- TOTAL OTHER CHANGE IN NET ASSETS <9,389,444> |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHYSICIAN FEES TOTAL FEES:1375994 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:BLOOD PROCESSING FEES TOTAL FEES:365787 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:ER PROFESSIONAL EXPENSES TOTAL FEES:3206020 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:UC PROFESSIONAL EXPENSES TOTAL FEES:881904 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:THERAPY FEES TOTAL FEES:1089631 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:SERVICE CONTRACTS TOTAL FEES:1588297 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:COLLECTION AGENCY FEES TOTAL FEES:288537 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACT LABOR & OTHER PUR SRV TOTAL FEES:3480505 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:RADIOISOTOPES TOTAL FEES:365787 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| PROGRESSIVE HEALTH SYSTEMS | ||||||||||
| 600 SOUTH 13TH STREET | PEKIN | IL | 61554 | 371200263 | SUPPORT ORG | IL | 501(C)3 | 11 - II | NA | false |
| PARK COURT LIMITED | ||||||||||
| 600 SOUTH 13TH STREET | PEKIN | IL | 61554 | 371178386 | SUPPORT ORG | IL | 501(C)3 | 11 - II | PROG HEALTH | false |
| PEKIN MEMORIAL HOSPITAL FOUNDATION | ||||||||||
| 600 SOUTH 13TH STREET | PEKIN | IL | 61554 | 371200267 | SUPPORT ORG | IL | 501(C)3 | 11 - II | PROG HEALTH | false |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEKIN HOSP PAIN MGT | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 SOUTH 13TH STREET | AddressLine1Txt |
| City | PEKIN | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61554 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 465038592 | EIN |
| Primary Activities | CLINIC | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEKIN HOSP | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | $103,429 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $113,922 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | false | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (true) | GeneralOrManagingPartnerInd |
| Ownership | 0.51000 | OwnershipPct |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 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 |
|---|---|---|---|---|---|---|---|---|---|
| PRO HEALTH INC (PHI) | |||||||||
| 600 SOUTH 13TH STREET | PEKIN | IL | 61554 | 371117052 | CLINIC | IL | PROG HEALTH | C CORP | false |
| MARIGOLD CITY LAND TRUST NO ONE | |||||||||
| 2956 COURT STREET | PEKIN | IL | 61554 | 272750273 | PROPERTY MGMT | IL | PARK COURT | TRUST | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | 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 | false | 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 | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| PEKIN PAIN MANAGEMENT LLC | ||
| B | $104,937 | FMV |
| PEKIN PAIN MANAGEMENT LLC | ||
| J | $26,446 | C+OH ALLOCATION |
| PEKIN PAIN MANAGEMENT LLC | ||
| J | $70,113 | C+OH ALLOCATION |
| PEKIN PAIN MANAGEMENT LLC | ||
| J | $143,949 | COST PLUS BENEF |
| PEKIN PAIN MANAGEMENT LLC | ||
| R | $699,388 | PPM CASH COLLEC |
Comments