2017-03-13T09:14:05-05:00 2016-04-30 BKD LLP 211 N BROADWAY SUITE 600 ST LOUIS MO 631022733 990 2015-05-01 370692351 Pekin Memorial Hospital % PAM ROGERS PEKI 3093530700 600 South 13th Street Pekin IL 61554 STEVEN C HALL CFO 3093530700 2017-03-13 true Donna J Larson P00043751 3142315544 2017-03-09 2015 2021-01-29 14:40:06Z Pekin Hospital STEVEN C HALL CFO 600 S 13TH STREET PEKIN IL 61554 68587949 false X PEKINHOSPITAL.COM X 1913 IL TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY AND TO DO SO WITH LOVE, COMPASSION AND EXTRAORDINARY MEDICAL CARE. 11 6 820 129 1025461 82928 182586 67745618 65092368 1522760 2199373 1303413 1059594 70654719 68533921 0 0 0 0 32150708 32378569 0 0 0 31821288 38226569 63971996 70605138 6682723 -2071217 71558832 55168214 33705968 31519948 37852864 23648266 TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY AND TO DO SO WITH LOVE, COMPASSION AND EXTRAORDINARY MEDICAL CARE. false false 63993177 0 65267378 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. 63993177 true true false true false false false false false false true false false false true false false true false false false false false false false false true true false false true true false false false false false false false false true false false false false false false true true true false false true 111 0 true 820 true true true false false false false false false false false false X 11 6 true true false false true true true true true false false true true true true true true true true true true IL X PAM ROGERS 3093530796 600 SOUTH 13TH STREET PEKIN IL 61554 X DELORES EAGLESON SECRETARY/TREASURER 1.0 4.0 X X 0 0 0 CURTIS EETON TRUSTEE 1.0 4.0 X 0 0 0 RONALD MILLER CHAIRMAN 1.0 4.0 X X 0 0 0 JASON PROEHL TRUSTEE 1.0 4.0 X 0 0 0 DIRK ROECKER TRUSTEE 1.0 4.0 X 0 0 0 RUSTY DUNN TRUSTEE 1.0 4.0 X 0 0 0 ROSS GOULD TRUSTEE 1.0 4.0 X 0 0 0 MARIA HORNSTEIN TRUSTEE 1.0 4.0 X 0 0 0 DR GORDON CROSS TRUSTEE 1.0 4.0 X 0 0 0 DR FARNAZ MOAZZAM TRUSTEE 1.0 4.0 X 12950 0 0 DR JAMES SMALLEY VICE CHAIRMAN 1.0 4.0 X X 14229 0 0 BOB HALEY CEO 40.0 4.0 X 290000 0 39095 STEVE HALL CFO 40.0 4.0 X 243178 0 22815 JO ELLEN PATTERSON CHIEF NURSING OFFICER 40.0 0.0 X 153210 0 8621 CINDY JUSTUS DIRECTOR OF ER AND URGENT CARE 40.0 0.0 X 100703 0 11069 ASHOKKUMAR PATEL PHARMACIST 40.0 0.0 X 121463 0 23867 LINDA COLE DIRECTOR OF IT 40.0 0.0 X 144743 0 6745 ANGELIA DREHER DIRECTOR OF PHARMACY 40.0 0.0 X 151256 0 27553 MICHAEL JOHNSON ADMIN DIR OF ANCILLARY SERVCS 40.0 0.0 X 121006 0 10267 1352738 0 150032 8 false true true EPSSLCC CENTRAL SERIES 12528 SR 78 HAVANA IL 62644 ER PHYSICIANS 3672001 MIDWEST ANESTHESIA CONSULTANTS SC 2006 HOGBACK RD ANN ARBOR MI 48105 ANESTHESIA SERVICES 1299335 PROFESSIONAL THERAPY SERVICES INC 2810 FRANK SCOTT PARKWAY STE 824 BELLEVILLE IL 62223 REHAB SERVICES 1040826 RIVER CITY CONSTRUCTION 101 HOFFER LANE EAST PEORIA IL 61611 CONSTRUCTION SERVICE 1068922 QUORUM 105 CONTINENTAL PLACE PEORIA IL 61615 MANAGEMENT SERVICES 912891 17 182586 182586 PATIENT REVENUE 621110 64037995 64037995 MEDICAL RECORD REVENUE 561000 28912 28912 REFERENCE LAB REVENUE 621500 1025461 1025461 65092368 692156 692156 0 0 44707 44707 0 44707 44707 1506995 54250 54028 1506995 222 1507217 1507217 0 0 0 EHR FUNDS 900099 175010 175010 CAFETERIA REVENUE 722410 570069 570069 NAVIGATOR GRANT 900099 139691 139691 130117 130117 1014887 68533921 64241917 1025461 3083957 0 0 0 0 937404 211137 726267 0 34000 34000 24639813 22242116 2397697 832258 784994 47264 4033891 3591500 442391 1901203 1675782 225421 1769091 1769091 162205 162205 66057 66057 0 0 0 12642462 12642462 578025 173466 404559 8809258 8770446 38812 1435603 1435603 0 1148039 1142299 5740 54759 54759 0 177723 149166 28557 450280 450280 0 3732967 3714302 18665 534070 376712 157358 MEDICAID ASSESSMENT EXPENSE 2733945 2733945 FOOD EXPENSE 534789 534789 IMPLANT FEES 2304814 2304814 REFERENCE LAB 594222 594222 498260 376383 121877 70605138 63993177 6611961 0 103996 24329 5628123 677553 0 0 11523840 12568784 0 0 0 0 0 0 1061171 1039846 1593739 1566044 90093835 65363664 23148803 24730171 25108752 13872862 0 0 0 0 0 0 3390408 688625 71558832 55168214 6618888 6081585 0 0 0 0 11405000 8570000 0 0 0 0 2130972 2453985 0 0 13551108 14414378 33705968 31519948 X 37500657 23254824 352207 393442 0 0 37852864 23648266 71558832 55168214 X -2071217 -2743937 -9389444 X false true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 30188 false false false 30188 false SCHEDULE C, PART II-B, LINE 1 LOBBYING ACTIVITIES LOBBYING EXPENSES ARE ONLY INCURRED THROUGH ASSOCIATIONS WITH NATIONAL ORGANIZATIONS OF WHICH THE ORGANIZATION IS A MEMBER. 1449581 1449581 11585946 9206490 2379456 20362006 15326991 5035015 52490575 39083088 13407487 4205727 1747095 2458632 24730171 0 DUE TO THIRD PARTIES 3358857 MINIMUM PENSION LIABILITY 10840878 DUE (FROM)/TO MEDICARE 214643 14414378 SCHEDULE D, PART X, LINE 2 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. true true true X true X 600. true true true false true true 312099 312099 0.00440 19536729 11268737 8267992 0.11660 19848828 11268737 8580091 0.12100 18450 18450 0.00030 18450 18450 0.00030 19867278 11268737 8598541 0.12130 true 1309000 196350 18754701 31412670 -12657969 X true true 1 1 PEKIN MEMORIAL HOSPITAL 600 SOUTH 13TH STREET PEKIN IL 61554 PEKINHOSPITAL.ORG 001834 X X X PEKIN MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 15 true false false true X SEE PART V, SECTION C true 15 true SEE PART V, SECTION C false true X 200. 600. X X true true X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X true X false false 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 2 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 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. X true true X X true false false false false false false false false BOB HALEY CEO 262250 0 27750 0 0 0 10785 0 28310 0 329095 0 STEVE HALL CFO 218500 0 24678 0 0 0 10400 0 12415 0 265993 0 LINDA COLE DIRECTOR OF IT 132685 0 12058 0 0 0 0 0 6745 0 151488 0 ANGELIA DREHER DIRECTOR OF PHARMACY 143572 0 7684 0 0 0 4649 0 22904 0 178809 0 JO ELLEN PATTERSON CHIEF NURSING OFFICER 143174 0 10036 0 0 0 8621 0 0 0 161831 0 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. A CITY OF PEKIN TAZEWELL COUNTY IL 376002169 2010-03-30 23530000 SEE PART VI false false false A 13145000 0 23530000 2955000 0 10385000 283000 0 0 0 0 0 2010 true false false true A false true false false 0.02400 0.02400 false false false true A true false false 0 false 0 false false A false 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. MADISON DUNN RELATIVE OF BOARD MEMBER 21000 EMPLOYMENT JACOB MILLER RELATIVE OF BOARD MEMBER 13000 EMPLOYMENT 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 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 PEKIN HOSP PAIN MGT 600 SOUTH 13TH STREET PEKIN IL 61554 465038592 CLINIC IL PEKIN HOSP RELATED 103429 113922 false true 0.51000 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 false true true false false false false false false true false true false true true false false true false PEKIN PAIN MANAGEMENT LLC B 104937 FMV PEKIN PAIN MANAGEMENT LLC J 26446 C+OH ALLOCATION PEKIN PAIN MANAGEMENT LLC J 70113 C+OH ALLOCATION PEKIN PAIN MANAGEMENT LLC J 143949 COST PLUS BENEF PEKIN PAIN MANAGEMENT LLC R 699388 PPM CASH COLLEC