2017-08-15T11:17:47-05:00 2016-09-30 KPMG LLP 191 West Nationwide Blvd Ste 500 Columbus OH 432152568 990 2015-10-01 362167785 Mendota Community Hospital % Dawn Trompeter MEND 8155397461 1401 E 12TH STREET MENDOTA IL 61342 SISTER DIANE MARIE MCGREW TREASURER 2017-08-10 true MOLLIE P LONGHOUSE P00294881 6142492300 2017-08-14 2015 2021-01-29 14:40:06Z OSF Saint Paul Medical Center JENNIFER JUNIS 1401 E 12TH STREET MENDOTA IL 61342 36907785 false X WWW.OSFHEALTHCARE.ORG/SAINT-PAUL/ X 1944 IL SEE SCHEDULE O 9 6 260 80 2369 1369 27371 393476 16772373 34837983 45331 -17082 38989 1150928 16884064 36365305 0 0 0 0 7936967 17485759 0 0 0 9346178 17985428 17283145 35471187 -399081 894118 38730652 38658000 37532550 36512465 1198102 2145535 IN THE SPIRIT OF CHRIST AND THE EXAMPLE OF FRANCIS OF ASSISI, THE MISSION OF OSF HEALTHCARE IS TO SERVE PERSONS WITH THE GREATEST CARE AND LOVE IN A COMMUNITY THAT CELEBRATES THE GIFT OF LIFE. false false 17748349 35904331 MENDOTA COMMUNITY HOSPITAL PROVIDED 25 BEDS IN FISCAL YEAR 2016. THIS HOSPITAL GAVE $485,357 IN CHARITY CARE, AND PROVIDED 5,988 MEALS ON WHEELS TO MEMBERS OF OUR COMMUNITY. THE NET COMMUNITY BENEFIT EXPENSE FOR MEALS ON WHEELS WAS $35,806. MENDOTA COMMUNITY HOSPITAL OFFERS FLU AND IMMUNIZATION CLINICS ALONG WITH MANY OTHER CLINICS IN MENDOTA AND OTHER OUTREACH COMMUNITES. THE HOSPITAL HELD CPR CLASSES, DIABETIC SUPPORT GROUPS, PROVIDED FREE DIABETIC AND NUTRITION EDUCATION CLASSES, AND OFFERED SEVERAL OTHER PROGRAMS THROUGHOUT THE YEAR. THE NET COMMUNITY BENEFIT EXPENSE FOR THESE PROGRAMS WAS $16,384. 17748349 true true false true false false false false false true true false false true true false true true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 39 0 true 260 true true true false false false false false false false false false X 9 6 false false false false true true true true true true false true true true true true true true true false IL X Dawn Trompeter 8155397461 1401 E 12th Steet Mendota IL 61342 SISTER JUDITH ANN DUVALL OSF CHAIRPERSON 1.0 40.0 X X 0 4880 0 SISTER DIANE MARIE MCGREW OSF PRESIDENT/TREASURER 1.0 40.0 X X 0 4880 0 SISTER AGNES JOSEPH WILLIAMS ASSISTANT SECRETARY 1.0 40.0 X X 0 4880 0 SISTER THERESA ANN BRAZEAU SECRETARY 1.0 40.0 X X 0 4880 0 SISTER ROSE THERESE MANN OSF BOARD MEMBER 1.0 40.0 X 0 0 0 SISTER M MIKELA MEIDL FSGM BOARD MEMBER 1.0 40.0 X 0 0 0 KEVIN D SCHOEPLEIN VICE CHAIRPERSON 1.0 40.0 X X 0 1839068 51216 GERALD J MCSHANE MD BOARD MEMBER 1.0 40.0 X 0 776476 49808 BRIAN SILVERSTEIN MD BOARD MEMBER 1.0 40.0 X 0 45000 0 SISTER MARIA ELENA PADILLA BOARD MEMBER 1.0 40.0 X 0 0 0 JAMES W GIRARDY MD BOARD MEMBER 1.0 40.0 X 0 0 0 JENNIFER JUNIS PRESIDENT 40.0 0.0 X 0 171576 16063 DAWN TROMPETER CFO 40.0 1.0 X 0 196390 25137 ALLEN U VAN MD PHYSICIAN 40.0 0.0 X 881838 0 40563 ERIC A KIVISTO MD PHYSICIAN 40.0 0.0 X 431734 0 26190 MARY M CHINN MD PHYSICIAN 40.0 0.0 X 487548 0 39719 DAVID A SCHOLL MD PHYSICIAN 40.0 0.0 X 262531 0 35691 AMY M MATHEIS-SOLIMAN MD PHYSICIAN 40.0 0.0 X 240648 0 48926 2304299 3048030 333313 9 false true false ER DOCTORS LTD 7 WOOD DUCK LANE OTTAWA IL 61350 ER SERVICES 1691032 MEDICAL OUTSOURCING SOLUTIONS INC 1735 DEKALB AVE SYCAMORE IL 60178 IMAGING SERVICES 567850 DRINKER BIDDLE AND REATH LLP ONE LOGAN SQUARE PHILADELPHIA PA 19103 LEGAL 216723 BKD LLP 211 N BROADWAY SUITE 600 ST LOUIS MO 63102 AUDIT 118653 DELTA HEALTHCARE PROVIDERS STAFFING PO BOX 202940 DALLAS TX 75320 MEDICAL STAFFING 103477 5 374742 18734 393476 Patient Revenue 900099 34837983 34837983 34837983 6471 6471 0 0 75398 75398 0 75398 75398 507327 530880 -23553 -23553 -23553 0 0 18413 11600 6813 6813 Contracted Pharmacy 719945 719945 MEANINGFUL USE 104520 104520 MANAGED CARE FEES 67075 67075 177177 174808 2369 1068717 36365305 35904331 2369 65129 0 0 0 0 402248 402248 0 13452197 10296536 3155661 614959 614959 2305819 611443 1694376 710536 710536 0 -21773 -21773 124683 124683 0 0 0 2416283 2367465 48818 3263 2691 572 4424128 2268119 2156009 0 0 392017 8137 383880 131643 71509 60134 0 0 1399165 1399165 1192073 1192073 2597761 813099 1784662 763367 71137 692230 CONTRACTS AND REPAIRS 2392208 1127955 1264253 BAD DEBTS 1351586 1351586 PROVIDER TAX 486560 486560 COLLECTION FEES 96226 96226 236238 110258 125980 35471187 17748349 17722838 0 87113 400074 3619164 5029299 0 0 4134368 4356029 0 0 0 0 0 0 556029 810048 1099031 683260 37198345 22292344 16505967 14906001 313927 28878 0 0 0 0 0 0 12415053 12444411 38730652 38658000 4947097 5652365 0 0 0 0 0 0 0 0 0 0 32536084 30835000 0 0 49369 25100 37532550 36512465 X -399081 518993 976674 1006033 620509 620509 1198102 2145535 38730652 38658000 X 894118 53315 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 16072 false false false 16072 false false SCHEDULE C, PART II-B, LINE 1F NATURE OF LOBBYING ACTIVITIES: THE ORGANIZATION'S LOBBYING ACTIVITIES INCLUDE PAYING MEMBERSHIP DUES TO THE ILLINOIS HOSPITAL ASSOCIATION and America Hospital Association, WHo PARTICIPATE IN LOBBYING ACTIVITIES. 591555 53315 644870 3222501 170224 -24080 61027 3307618 3908566 123950 810015 3222501 3797903 154423 43760 3908566 4638248 170921 1011266 3797903 0.96220 0.03780 false true true 0 1927000 1927000 0 17332301 7080003 10252298 0 2405200 1723510 681690 0 15533844 13488831 2045013 14906001 GOODWILL 10817871 RESTRICTED FOUNDATION ASSETS 1626540 12444411 0 ASSET RETIREMENT OBLIGATION 25100 25100 X 35049277 46168 46168 35003109 1362196 1362196 36365305 34131201 11600 11600 34119601 1351586 1351586 35471187 FORM SCH D PART V LINE 1A BEGINNING ENDOWMENT BALANCE waS REDUCED in the current fiscal year TO REMOVE FUNDS RESTRICED UNDER A MORTGAGE AGREEMENT. THESE FUNDS ARE NOT DONOR-RESTRICTED GIFTS AND WILL NOT BE HELD IN PERPETUITY BY THE HOSPITAL TO FUND A PERMANENT SOURCE OF INCOME. Form Sch D Part V Line 4 INTENDED USES OF ENDOWMENT FUNDS: PROCEEDS OF THE ENDOWMENT, AS DICTATED BY THE DONORS, ARE USED AS BEST DETERMINED BY THE FOUNDATION COUNCIL. Form Sch D Part X Line 2 OSF Healthcare System (OSF) adopted ASC Subtopic 740-10, Accounting for Uncertainty in Income Taxes - an interpretation of FASB Statement No. 109. The interpretation addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded in the consolidated financial statements. Under ASC Subtopic 740-10, OSF must recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured based on the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement. ASC Subtopic 740-10 also provides guidance on derecognition, classification, interest and penalties on income taxes, and accounting in interim periods and requires increased disclosures. As of September 30, 2016 and 2015, OSF does not have any uncertain tax positions. Form Sch D Part XI Line 2d OTHER REVENUE INCLUDED ON RETURN BUT NOT ON BOOKS: Cost of Goods Sold $11,600 Net Assets released from restrictions $34,568 TOTAL $46,168 Form Sch D Part XI Line 4b OTHER REVENUE INCLUDED ON RETURN BUT NOT ON BOOKS: PROVISION FOR BAD DEBT $1,351,586 RESTRICTED CONTRIBUTIONS $ 10,610 TOTAL $1,362,196 Form Sch D Part XII Line 2d OTHER EXPENSES INCLUDED ON RETURN BUT NOT ON BOOKS: GIFT SHOP EXPENSES $11,600 TOTAL $11,600 Form Sch D Part XII Line 4b OTHER EXPENSES INCLUDED ON RETURN BUT NOT ON BOOKS: PROVISION FOR BAD DEBT $1,351,586 TOTAL $1,351,586 true true true X 125. true X true true true false true true 485357 485357 0.01420 5860327 3454297 2406030 0.07050 6345684 3454297 2891387 0.08470 112718 25080 87638 0.00260 50510 50510 0.00150 5500 5500 0.00020 168728 25080 143648 0.00430 6514412 3479377 3035035 0.08900 true 582939 13677297 13007897 669400 X true true 1 1 MENDOTA COMMUNITY HOSPITAL 1401 E 12TH STREET MENDOTA IL 61342 WWW.OSFHEALTHCARE.ORG/SAINT-PAIL/ X X X X Mendota Community Hospital 1 false false true X X X X X X X X X 16 true true false true X PART V, SECTION C X true 16 false true false true X 125. 400. X X X X true true X X true X SEE SCHEDULE H, PART V, SECTION C X SEE SCHEDULE H, PART V, SECTION C X X X X X true X false X X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 3 Treasury regulation 1.501(r)-3(d)(1) provides that a newly acquired Hospital facility must meet the CHNA requirements by the last day of the Second taxable year beginning after the date the hospital facility was Acquired. The hospital facility was acquired on April 1, 2015 and has changed to a fiscal year starting on October 1, therefore, it is not required to meet the CHNA requirements until the tax year ended September 30, 2017. This most recent CHNA was conducted in 2016 for mendota community hospital dba osf Saint Paul Medical Center and was approved and adopted by the OSF board of directors on July 25, 2016. This CHNA is effective for fiscal years 2017, 2018 and 2019. SCHEDULE H, PART V, SECTION B, LINE 5 FOR THE 2016 CHNA, MENDOTA COMMUNITY HOSPITAL dba OSF Saint Paul Medical Center TOOK INTO ACCOUNT THE INPUT OF THE COMMUNITY MEMBERS BY HAVING THESE INDIVIDUALS HELP PRIOrITIZE THE IDENTIFIED NEEDS WITHIN EACH COMMUNITY. IN ADDITION, MENDOTA COMMUNITY HOSPITAL OBTAINED AND USED RESOURCES FROM OR RESOURCES PROVIDED BY THESE COMMUNITY MEMBERS. SCHEDULE H, PART V, SECTION B, LINE 6A mendota community hospital dba osf Saint Paul medical center Mendota, IL The COMMUNITY HEALTH NEEDS ASSESSMENT FOR 2016 FOR LASALLE County WAS a collaborative undertaking by Ottawa Regional Hospital and Healthcare Center DBA OSF Saint Elizabeth Medical Center and Mendota Community Hospital DBA OSF Saint Paul Medical Center. The CHNA highlights the health needs and well-being of residents in Lasalle County. Schedule H, Part V, Section B, Line 7a Https://www.osfhealthcare.org/about/community-health/ Schedule H, Part V, Section B, Line 11 See Part VI, Line 2, "Needs Assessment" - for detailed description of how significant community health needs are being addressed along with the needs not addressed. SCHEDULE H, PART V, SECTION B, LINE 13B and 13h Please Refer to the response to Schedule H, Part I, Line 3C for a description of how Saint Paul Medical center explained the basis for calculating amounts charged to patients using factors other than FPG. Schedule h, part v, section b, line 16a & 16b FAP application form: Https://www.osfhealthcare.org/billing/financial-assistance/ Schedule H, Part V, Section B, Line 16F & 16I A PLAIN LANGUAGE SUMMARY OF THE FAP IS OFFERED TO PATIENTS AS PART OF THE INTAKE OR DISCHARGE PROCESS, INFORMATION ABOUT FINANCIAL ASSISTANCE AND THE APPLICATION PROCESS IS INCLUDED ON OR WITH THE OSF PATIENT BILLING STATEMENT, AND OSF PROVIDES COPIES OF THE PLAIN LANGUAGE SUMMARY AND THE FAP APPLICATION FORM TO REFERRING STAFF PHYSICIANS. SCHEDULE H, PART V, SECTION B, LINE 20E ALL OSF HOSPITALS SCREEN ALL PATIENTS WITH NO INSURANCE BENEFITS, OR INSUFFICIENT INSURANCE BENEFITS FOR PRESUMPTIVE CHARITY CARE. Schedule h, part v, section b, line 22d The hospital determined the amounts billed to individuals who did not have insurance covering emergency or other medically necessary care in the following ways. The amount billed to the individual was the lowest Amount determined under any of the following methods which apply to the Individual: -for Illinois residents who incur gross charges in excess of $300 for any One inpatient admission or outpatient encounter, who apply for financial Assistance, and whose family income is 125% or less of the federal Poverty guideline for family size, the amount billed is $0.00. If family Income is between 126% and 300% of the federal poverty guideline for their family size, the amount billed is calculated by multiplying gross Charges times the hospital's cost to charge ratio determined from its Most recently filed Medicare cost report and then multiplying that Product times 135%. The amount billed to patients regardless of residency whose family income is not more than 200% of federal poverty guidelines for their family size is $0.00. Discounted financial assistance is available on a sliding scale to Patients regardless of residency whose family income is between 201% and 400% of federal poverty guidelines for their family size. Catastrophic financial assistance is available when charges exceed 25% OF Annual family income. The amount billed is adjusted to 25% of family Income when OSF determines this is the most generous Assistance. -the maximum amount that can be collected in a 12 month period for Emergency or other medically necessary care to any patient who applies For financial assistance does not exceed 25% of family income. -the amount billed to FAP-eligible individuals is never more than the Amount generally billed (AGB) to individuals who have insurance covering such Care. This maximum charge billed to FAP-eligible individuals is Determined by multiplying the gross charges for all emergency and other Medically necessary care by a percentage calculated annually and equal To: (i) the aggregate dollar amount of claims allowed for all medical Services during the 12-month period ended on the preceding September 30 By both medicare ffs private insurers, together with any associated portions of these Claims the medicare beneficiaries and insured individuals are responsible for paying in the form of Co-payments, co-insurance, or deductibles, divided by (ii) the sum of the Associated gross charges for those claims. If the amount a health insurer will allow for a claim has not been finally determined as of the last day of the 12 month period used to calculate the AGB percentage, the hospital excludes the amount of the claim from that calculation and includes it in the subsequent 12 month period during which the amount allowed is finally determined. The amount billed to a patient eligible for financial assistance is less than the amount of the gross charges. Schedule h, part i, line 3c The corporation provides: -Catastrophic charity assistance regardless of income or asset levels for medically necessary services which exceed 25% of annual family income. The amount due is adjusted to 25% of family income when OSF determines catastrophic charity is more generous. -PRESUMPTIVE CHARITY: CHARGES MAY BE ADJUSTED TO PROVIDE FOR A CHARITY DISCOUNT OF 100% OF BILLED CHARGES FOR MEDICALLY NECESSARY SERVICES PROVIDED TO AN UNINSURED PATIENT WHO ESTABLISHES FINANCIAL NEED AT TIME OF REGISTRATION BY SATISFYING ONE OF THE FOLLOWING CATEGORIES OF PRESUMPTIVE ELIGIBILITY CRITERIA. PRESUMPTIVE CHARITY CATEGORIES FOR ALL OSF HOSPITALS: -HOMELESSNESS; -DECEASED WITH NO ESTATE; -MENTAL INCAPACITATION WITH NO ONE TO ACT ON PATIENT'S BEHALF; OR -CURRENT MEDICAID ELIGIBILITY, BUT NOT ON DATE OF SERVICE OR FOR NON-COVERED SERVICE. -All patients receive the greatest requested discount available under any of the OSF programs. No asset tests are used. -Except as otherwise noted, these policies apply both to uninsured patients and to insured patients with respect to the patient responsibility amount. Schedule h, part i, line 7, column f Bad Debt Expense in the amount of 1,351,586 is included on Form 990, Part IX, Line 24B, Column (A), but was subtracted for purposes of calculating the percentages in Schedule H, Part I, Line 7, Column (F). Schedule h, part iii, section a, lines 2, 3, 4, and 8 In general, and in accordance with Medicare regulations, patient account balances are written off to bad debt expense after reasonable collection efforts have been exhausted and the account has been sent to a collection agency or law firm. Patients' accounts receivable are reduced by an allowance for uncollectible accounts. In evaluating the collectability of patients' accounts receivable, OSF analyzes past history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for uncollectible accounts and provision for bad debts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, OSF analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary. for receivables associated with patient responsibility (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the patients are screened against the OSF financial assistance policy and uninsured discount policy. For any remaining patient responsibility balance, OSF records a provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. Bad debt expense of 1,351,586 on form 990, part ix, line 24b is based upon Accrual accounting required by generally accepted accounting principles. This amount consequently differs from the bad debt expense of 582,939 on Schedule h, part iii, line 2 which requires the organization to report Aggregate bad debt at cost. Bad debt expense reported on part iii, line 2 is therefore calculated by multiplying gross charges written off to bad Debt expense times the ratio of patient care cost-to-charges derived from Worksheet 2. Schedule h, part iii, section a, lines 2, 3, 4 and 8 Discounts, including any applicable third party payer contractual Allowances and any charity care discounts (valued at gross charges), are Applied to patient account gross charges to determine the account balance before patient payments. The aggregate amount of all patient payments is then applied to the account balance. When determination is made that no further amounts can be collected in accordance with the corporation's bad debt policy, the remaining balance is written off to bad debt expense. Presumptive charity: charges may be adjusted to provide for a charity Discount of 100% of billed charges for medically necessary services provided to an uninsured patient who establishes financial need at time of registration by satisfying one of the following categories of Presumptive eligibility criteria. Presumptive charity categories for all OSF hospitals: -homelessness; -deceased with no estate; -mental incapacitation with no one to act on patient's behalf; or -current Medicaid eligibility, but not on date of service or for Non-covered service. Therefore, the corporation does not believe that bad debt expense reported on part iii, line 3 includes any amounts that reasonably could be attributable to patients who would likely qualify under the Corporation's financial assistance policy. Schedule H, part iii, section c, line 9b The corporation has a fair billing/collection policy which applies for all patients. The policy includes: -required information provided in bills to patients (including a Requirement that information be provided on how the patient may apply for financial assistance). -process for patients to inquire about or dispute a bill, including Toll-free telephone number, address, contact name and e-mail address. -requirements for timely response to patient inquiries. -conditions which must be satisfied before patient may be Sent to a collection agency or attorney. -legal action for non-payment of a patient bill may not be initiated until an authorized hospital official has determined that all conditions in the corporation's policy (including all the foregoing policy Provisions) have been satisfied for initiating legal action. -legal action may not be pursued against uninsured patients who have Clearly demonstrated that they have neither sufficient income nor assets to meet their financial obligations - even if such patients do not apply For financial assistance. -the corporation shall not engage in any extraordinary collection Actions, such as submitting reports to credit agencies before reasonable Attempts to determine eligibility for financial assistance have been Completed. -If a patient receives an application for financial assistance but fails to return it, OSF will try to use secondary sources to determine the patients eligibility for noncompliant charity before pursuing legal action for nonpayment. -The hospital shall not obtain a body attachment against any patient or guarantor. Schedule h, part vi, line 2 Mendota Community Hospital dba OSF Saint Paul Medical Center Completed a Community Health Needs Assessment ("CHNA") during fiscal year 2016 as required by Internal Revenue Code section 501(r)(3). The final CHNA for the hospital was approved and adopted by the system's board of directors on July 25, 2016. This most recent CHNA is effective for fiscal years 2017, 2018 and 2019 for the hospital. In response to the significant health needs identified in the hospital's 2016 CHNA, the hospital completed and adopted an implementation strategy to address these critical health needs. The LaSalle County CHNA was done as a collaborative undertaking by Mendota Community Hospital dba OSF Saint Paul Medical Center and Ottawa Regional Hospital and Healthcare Center dba Saint Elizabeth Medical Center to highlight the health needs and well being of residents in LaSalle County. The joint group identified the following significant community health needs as a priority: Healthy Behaviors and Behavioral Health. Healthy behaviors is defined as active living and healthy eating and their impact on society. Behavioral Health includes mental health and substance abuse. ACTIVE LIVING: A HEALTHY LIFESTYLE, COMPRISED OF REGULAR PHYSICAL ACTIVITY AND BALANCED DIET, HAS BEEN SHOWN TO INCREASE PHYSICAL, MENTAL, AND EMOTIONAL WELL-BEING. nOTE THAT 73% OF RESPONDENTS IN LASALLE COUNTY INDICATED THAT THEY DO NOT EXERCISE AT ALL, OR 1-2 TIMES PER WEEK. HEALTHY EATING: WELL OVER HALF (68%) OF LASALLE COUNTY RESIDENTS REPORT NO CONSUMPTION OR LOW CONSUMPTION (1-2 SERVINGS PER DAY) OF FRUITS AND VEGETABLES PER DAY. nOTE THAT THE PERCENTAGE OF LASALLE COUNTY RESIDENTS WHO CONSUME FIVE OR MORE SERVINGS PER DAY IS ONLY 5%. OBESITY: IN LASALLE COUNTY, THE NUMBER OF PEOPLE DIAGNOSED WITH OBESITY AND BEING OVERWEIGHT HAS INCREASED OVER THE YEARS FROM 2007-2009 TO 2010-2014. NOTE SPECIFICALLY THAT THE PERCENTAGE OF OBESE AND OVERWEIGHT PEOPLE HAS INCREASED FROM 63.5% TO 68.5%. OVERWEIGHT AND OBESITY RATES IN ILLINOIS HAVE DECREASED FROM 2009 (64.0%) TO 2014 (63.7%). BEHAVIORAL HEALTH - MENTAL HEALTH AND SUBSTANCE ABUSE MENTAL HEALTH: FOR 2009, JUST OVER 25% OF RESIDENTS IN LASALLE COUNTY REPORTED THEY HAD EXPERIENCED 1-7 DAYS WITH POOR MENTAL HEALTH PER MONTH, AND 13.6% FELT MENTALLY UNHEALTHY ON EIGHT OR MORE DAYS PER MONTH. IN 2014, THERE WAS A MODERATE DECREASE IN THE NUMBER OF PEOPLE THAT REPORTED POOR MENTAL HEALTH FOR 1-7 DAYS (18.7%) AND A SLIGHT INCREASE OF PEOPLE THAT REPORTED POOR MENTAL HEALTH 8 OR MORE DAYS PER MONTH (14.3%). SUBSTANCE ABUSE: aLCOHOL AND DRUGS IMPAIR DECISION-MAKING OFTEN LEADING TO ADVERSE CONSEQUENCES AND OUTCOMES. RESEARCH SUGGESTS THAT ALCOHOL IS A GATEWAY DRUG FOR YOUTH, LEADING TO INCREASED USAGE OF CONTROLLED SUBSTANCES IN ADULT YEARS. ACCORDINGLY, THE SUBSTANCE ABUSE VALUES AND BEHAVIORS OF STUDENTS IS A LEADING INDICATOR OF ADULT SUBSTANCE ABUSE IN LATER YEARS. dATA FROM THE 2014 ILLINOIS YOUTH SURVEY MEASURES ILLEGAL SUBSTANCE USE (ALCOHOL, TOBACCO, AND OTHER DRUGS - MAINLY MARIJUANA) AMONG ADOLESCENTS. LASALLE COUNTY IS AT OR ABOVE STATE AVERAGES IN ALL CATEGORIES AMONG 8TH GRADERS EXCEPT FOR ALCOHOL AND MARIJUANA. FOR 12TH GRADERS, LASALLE COUNTY IS AT OR ABOVE THE STATE IN ALL CATEGORIES. OVERALL TOBACCO USAGE IS ALSO A CONCERN IN LASALLE COUNTY. Schedule h, part vi, line 3 The corporation informs and educateS patients and persons who are billed for patient care about their eligibility for assistance under government Programs and the corporation's financial assistance policy, in english and in any other language spoken by populations with limited english proficiency that constitute the lesser of 1,000 individuals or 5% of the community of the hospital, in the following Ways: -signs are posted in patient registration areas (including emergency Department registration) informing patients of the availability of Financial assistance, the availability of financial assistance counselors, and how to obtain a copy of the OSF financial assistance policy and application. -a plain language summary of the OSF Financial Assistance Policy is offered to patients as part of the intake or discharge process and included in the billing statement mailed prior to initiating extraordinary collection actions. In addition, the plain language summary and application are provided to referring staff physicians. -OSF makes reasonable efforts to orally notify patients about the financial assistance policy and how to obtain assistance in applying. -a notice of availability of the corporation's financial assistance and uninsured Patient discount policies is prominently available on the corporation's Web site. The application form with instructions and the plain language summary is available for Download. -a note regarding the availability of financial assistance (together with contact phone numbers) appears on every patient billing Statement as well as the website where copies of the policy, application and plain language summary may be obtained. -financial assistance counselors are available in person and by phone to Assist patients in completing the financial assistance Application and in determining eligibility and applying for government Program benefits, including Medicaid. -THE CORPORATION'S financial assistance POLICY IS FILED WITH THE ILLINOIS ATTORNEY GENERAL AND IS AVAILABLE TO THE PUBLIC. Schedule h, part vi, line 4 Mendota Community Hospital dba OSF Saint Paul Medical Center is located in Lasalle County. Its population in 2014 was 111,241. For Lasalle County, the median household income from 2009-2013 Was $52,640 and the percent of persons below poverty level was 12.2%. Schedule h, part vi, line 5 The corporation's sponsoring organization is a religious congregation of the Roman Catholic Church known as the sisters of the third order of Saint Francis. In accordance with canon law of the Roman Catholic Church And federal tax law applicable to supporting organizations, a majority of the members of the board of directors of the corporation are professed Members of the sponsoring religious congregation. Each hospital operated by the corporation has a community advisory board consisting of members of the community who are not directors, officers, or contractors of the Corporation. The corporation extends medical staff privileges to all qualified physicians in its communities. The corporation meets the requirements of revenue ruling 69-545 by: -operating an emergency department which is staffed 24 hours per day by Qualified physicians and other medical personnel and which are open to All persons without regard to ability to pay. -having a medical staff which ARE open to all qualified physicians, Mid-level providers, podiatrists, and dentists in the community (except where restricted in rare cases for clinical quality reasons by action of The medical staff and the board of directors). -accepting Medicare, Medicaid and other government program patients. Accepting all patients, including uninsured patients, without regard to their ability to pay. -USING SURPLUS FUNDS TO IMPROVE THEIR FACILITIES, EQUIPMENT, PATIENT CARE, MEDICAL TRAINING, EDUCATION, AND RESEARCH AS DESCRIBED ABOVE. mendota community hospital dba OSF Saint Paul medical center is involved in the community by providing health screening Booths at community events, performing wellness screenings at various Businesses in the community, and preparing and delivering meals to Community members in need with our meals on wheels program. Schedule h, part vi, line 6 Affiliated health care system roles: The corporation is part of an affiliated health care system (the "osf HEALTHCARE system") which provides integrated health care services throughout central Illinois, parts of northern Illinois, and parts of the upper peninsula of Michigan. The OSF system includes the other corporations listed below, all of which are controlled, directly or indirectly, by the sisters of the third order of St. Francis (the "congregation"). all affiliated corporations (whether taxable or exempt) apply and follow the charity care policy of the corporation and are operated in furtherance of the mission of the congregation to provide comprehensive, integrated, quality care, including preventive, primary, acute, continuous and rehabilitative health services to the communities served by the corporation and the osf system. Special emphasis is placed on meeting the physical, spiritual, emotional, and social needs of everyone who is cared for in the OSF system regardless of race, color, religion and ability to pay. The affiliated corporations are: -The sisters of the third order of St. Francis, which holds the assets of the religious congregation and directs all other corporations in the affiliated health care system through board representation and the exercise of reserved powers. -OSF saint Francis, Inc., which provides home infusion and durable medical equipment services, mobile medical imaging services, medical equipment maintenance and repair services, medical staffing services, billing services, and other services in support of the affiliated health care system. -OSF Aviation, LLC, which is an FAA Part 135 certified carrier providing EMS helicopter services througHout Central Illinois and Parts of Northern Illinois. -OSF lifeline ambulance, llc, which provides ground ambulance transportation services in parts of northern Illinois. -OSF multispecialty group - Peoria, llc, which provides pediatric cardiology physician services in central Illinois effective until December 31, 2016. These providers and services after December 31, 2016 are provided under OSF multi-specialty group which is a separate corporation of which OSF Healthcare System is the sole member. -Illinois neurological institute - physicians, llc, which provides physician neurosurgery services in central Illinois effective until December 31, 2016. These providers and services after december 31, 2016 are provided under OSF Multi-specialty group. -Heartcare Midwest, ltd., which provides cardiology and cardiovascular surgery physician services in central illinois effective until December 31, 2016. These providers and services after December 31, 2016 are provided under OSF multi-specialty group. -Cardiovascular institute at OSF, llc, which provides cardiology and cardiovascular surgery physician services in parts of northern Illinois effective until December 31, 2016. These providers and services after December 31, 2016 are provided under OSF multi-specialty group. -OSF multispecialty group - eastern region, llc, which provides primary and specialty physician services in parts of central Illinois effective until December 31, 2016. These providers and services after December 31, 2016 are provided under OSF multi-specialty group. -Illinois pathologist services, llc, which provides professional pathology services in parts of northern Illinois. -Illinois specialty physician services at OSF, llc, which provides pulmonology and critical care physician services in central Illinois effective until December 31, 2016. These providers and services after December 31, 2016 are provided under OSF multi-specialty group. -OSF perinatal associates, llc, which provides maternal fetal medicine physician services in central Illinois effective until December 31, 2016. These providers and services after December 31, 2016 are provided under OSF multi-specialty group. -OSF multispecialty group - western region, llc, which provides primary and specialty physician services in western Illinois effective until December 31, 2016. These providers and services after December 31, 2016 are provided under OSF multi-specialty group. -OSF children's medical group- congenital heart center, llc which provides pediatric care for cardiovascular illnesses in northern Illinois effective until December 31, 2016. These providers and services after December 31, 2016 are provided under OSF multi-specialty group. -Preferred emergency physicians of Illinois, llc which provides physician coverage for emergency departments effective until December 31, 2016. These providers and services after December 31, 2016 are provided under OSF multi-specialty group. -Saint Anthony physician group which provides a variety of general and specialty physicians services in Alton, Illinois. Schedule h, part vi, line 7 IL false true false false false false false false false KEVIN D SCHOEPLEIN VICE CHAIRPERSON 0 1037970 0 719984 0 81114 0 36850 0 14366 0 1890284 0 0 GERALD J MCSHANE MD BOARD MEMBER 0 576571 0 156839 0 43066 0 36850 0 12958 0 826284 0 0 JENNIFER JUNIS PRESIDENT 0 116956 0 48253 0 6367 0 5039 0 11024 0 187639 0 0 DAWN TROMPETER CFO 0 166581 0 28271 0 1538 0 13898 0 11239 0 221527 0 0 ALLEN U VAN MD PHYSICIAN 872087 0 2143 0 7608 0 24101 0 16462 0 922401 0 0 0 ERIC A KIVISTO MD PHYSICIAN 429660 0 0 0 2074 0 10600 0 15590 0 457924 0 0 0 MARY M CHINN MD PHYSICIAN 355497 0 111480 0 20571 0 27918 0 11801 0 527267 0 0 0 DAVID A SCHOLL MD PHYSICIAN 208501 0 35883 0 18147 0 20287 0 15404 0 298222 0 0 0 AMY M MATHEIS-SOLIMAN MD PHYSICIAN 219122 0 15285 0 6241 0 33518 0 15408 0 289574 0 0 0 Form Sch J Part I Line 3 THE BOARD OF DIRECTORS HAS ESTABLISHED A BOARD COMMITTEE KNOWN AS THE HUMAN RESOURCES COMMITTEE WHOSE MEMBERS ARE ALL PROFESSED MEMBERs OF THE RELIGIOUS CONGREGATION KNOWN AS THE SISTERS OF THE THIRD ORDER OF SAINT FRANCIS WHO HAVE TAKEN A VOW OF POVERTY. HENCE, THEY DO NOT PERSONALLY BENEFIT FROM DECISIONS OF THE COMMITTEE. THE COMMITTEE DETERMINES WHICH OFFICERS, KEY EMPLOYEES AND OTHER EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN THE EXECUTIVE COMPENSATION PLAN. BASED ON PERFORMAnCE REVIEWS BY THE SUPERVISORS OF SUCH PERSONS, COMPENSATION SURVEY DATA AND RECOMMENDATIONS FROM A NATIONALLY KNOWN INDEPENDENT COMPENSATION CONSULTANT, THE COMMITTEE APPROVES ANY EXECUTIVE COMPENSATION PLAN APPLICABLE TO KEY EMPLOYEES AND ESTABLISHES THE BASE SALARY AND BENEFITS FOR PLAN PARTICIPANTS. PRIOR TO PAYMENT OF ANY BONUS OR INCENTIVE COMPENSATION, THE TOTAL COMPENSATION FOR EACH KEY EMPLOYEE, INCLUDING BASE SALARY, BENEFITS, AND PROPOSED BONUS OR INCENTIVE COMPENSATION, IS AGAIN REVIEWED BY A NATIONALLY RECOGNIZED COMPENSATION CONSULTANT TO ENSURE THAT NO EXCESS BENEFIT AMOUNT IS PAID OR FURNISHED. Form Sch J Part I Line 4B OSF HEALTHCARE SYSTEM HAS A DEFERRED COMPENSATION PLAN FOR SELECT KEY EXECUTIVES. THIS PLAN WAS DEVELOPED TO ASSIST WITH ATTRACTING AND RETAINING CERTAIN KEY EXECUTIVES IN THE CORPORATION. THE PLAN IS DESIGNED TO ENCOURAGE THE PARTICIPANTS TO STAY UNTIL A CERTAIN RETIREMENT DATE. IF THE PARTICIPAnTS TERMINATE PRIOR TO THEIR TARGET RETIREMENT DATE, THEY FORFEIT WHAT IS IN THE PLAN. THE CORPORATION DETERMINES THE REQUIRED DEPOSITS FOR THE PLAN AT A CONSOLIDATED LEVEL. DURING 2016, $412,000 IN DEPOSITS WERE MADE TO THE PLAN AND NO DISTRIBUTIONS WERE MADE TO THE PLAN. FORM 990 PART I The tax law requires that each legal entity within the OSF Healthcare System complete a separate tax return which appropriately reflects the activities and financial position of the particular organization. This reporting, however, is not reflective of the OSF Healthcare System as a whole. Please see the attached audited financial statements of OSF Healthcare System and Subsidiaries for a complete overview of the system. Form 990, Part I, Line 1 IN THE SPIRIT OF CHRIST AND THE EXAMPLE OF FRANCIS OF ASSISI, THE MISSION OF OSF HEALTHCARE IS TO SERVE PERSONS WITH THE GREATEST CARE AND LOVE IN A COMMUNITY THAT CELEBRATES THE GIFT OF LIFE. FORM 990 Part I Line 8 through Line 19 The 2015 Mendota Community Hospital Form 990 includes financial activity for a full fiscal year for the year ended September 30, 2016. However, the return also includes "comparative" financial information from the most recently filed return. The prior year return information will vary significantly from the current year amounts since the prior return was a "short period return" only reflecting six months of activity as a result of the organization's change in year-end so as to align with the year-end of OSF Healthcare System. Form 990 Part VI Line 1a DELEGATING BROAD AUTHORITY: BY ADOPTING CERTAIN PROVISIONS OF THE CORPORATE BYLAWS, THE BOARD OF DIRECTORS HAS DELEGATED BROAD AUTHORITY TO THE EXECUTIVE COMMITTEE OF THE BOARD. THE BYLAWS PROVIDE THAT THE EXECUTIVE COMMITEE SHALL BE AUTHORIZED TO TAKE SUCH ACTION AS MAY BE NECESSARY ON BEHALF OF THE CORPORATION DURING PERIODS WHEN THE BOARD OF DIRECTORS IS NOT IN SESSION. of OSF Healthcare System. Form 990 Part VI Line 6 DESCRIPTION OF MEMBERS: OSF HEALTHCARE SYSTEM IS THE SOLE CORPORATE MEMBER OF MENDOTA COMMUNITY HOSPITAL. Form 990 Part VI Line 7a ELECTION OF BOARD MEMBERS: OSF HEALTHCARE SYSTEM AS A SOLE CORPORATE MEMBER OF Mendota Community Hospital HAS THE POWER TO ELECT MEMBERS OF THE BOARD. Form 990 Part VI Line 7b RESERVED POWERS: THE FOLLOWING POWERS ARE RESERVED FOR THE MEMBER: (A) TO ESTABLISH, APPROVE, OR MODIFY THE PHILOSOPHY, VISION, VALUES, AND MISSION ACCORDING TO WHICH THE CORPORATION OPERATES. (B) TO AMEND THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS. (C) TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE DIRECTORS OF THE CORPORATION. (D) TO MERGE OR CONSOLIDATE THE CORPORATION WITH OTHER ENTITIES OR TO DISSOLVE THE CORPORATION. (E) TO ACQUIRE AN INTEREST IN AN EXISTING ENTITY OR TO ESTABLISH A NEW ENTITY. (F) TO LEASE, SELL, ENCUMBER OR OTHERWISE ALIENATE ANY REAL PROPERTY OR INTEREST IN REAL PROPERTY OF THE CORPORATION. (G) TO APPROVE ANY TRANSFER, LEASE, SALE OR ENCUMBRANCE OF PERSONAL PROPERTY OF THE CORPORATION EXCEPT IN THE ORDINARY COURSE OF BUSINESS. (H) TO APPROVE ANY BORROWING OR DEBT FINANCING ON BEHALF OF THE CORPORATION. (I) TO APPOINT, DISCIPLINE, TERMINATE AND ReMoVE THE CORPORATION'S OPERATING DIVISION PRESIDENT. (J) TO APPOINT AND REMOVE THE CORPORATION'S CHAIRPERSON, VICE CHAIRPERSON(S), CHIEF EXECUTIVE OFFICER, PRESIDENT, SECRETARY, AND TREASURER, AND THE ASSISTANT SECRETARY AND ASSISTANT TREASURER, IF ANY. (K) TO APPROVE OR AMEND STRATEGIC PLANS, MANAGEMENT OBJECTIVES, AND CAPITAL AND OPERATING BUDGETS OF THE CORPORATION. (L) TO APPROVE ANY PURCHASE OR OTHER AQUISITION BY THE CORPORATION THAT IS NOT INCLUDED IN ITS CAPITAL BUDGET AND EXCEEDS ONE MILLION DOLLARS ($1,000,000) PER ITEM. (M) TO NAME OR RENAME ANY HOSPITAL OR MEDICAL CENTER OWNED AND OPERATED BY THE CORPORATION. (N) TO REQUIRE A CERTIFIED AUDIT OF FINANCES OF THE CORPORATION AND TO APPOINT THE CERTIFIED PUBLIC ACCOUNTANT TO PERFORM THE AUDIT. (O) TO APPROVE THE ENGAGEMENT OF AND TO DiSMISS ANY OUTSIDE LEGAL COUNSEL TO REPRESENT THE CORPORATION ON A REGULAR BASIS OR IN CONNECTION WITH ANY MATTER DEEMED BY THE MEMBER, IN GOOD FAITH, TO HAVE SIGNIFICANCE FOR THE CORPORATION AS A WHOLE. (P) TO GIVE PRELIMINARY APPROVAL PRIOR TO THE DEVELOPMENT OF, AND TO GIVE FINAL APPROVAL PRIOR TO THE EXECUTION OF, ALL DOCUMENTS TO WHICH THE CORPORATION IS OR WiLL BE A PARTY AND WHICH RELATE TO THE CREATION, FORMATION, ORGANIZATION, OR TERMINATION OF ANY OTHER LEGAL ENTITY (WHETHER A CORPORATION, LIMITED LIABILITY COMPANY, PARTNERSHIP, OR ANY OTHER ENTITY) IN WHICH THE CORPORATION WILL HAVE ANY OWNERSHIP INTEREST, MEMBERSHIP INTEREST, POWER TO ELECT OR APPOINT BOARD MEMBERS OR OFFICERS, OR ANY OTHER FORMAL PARTICIPATION ARRANGEMENT, WHETHER ACTING ALONE OR IN CONJUNCTION WITH ANY OTHER PERSON OR ENTITY. (Q) TO TAKE ANY AND ALL ACTIONS DEEMED NECESSARY, IN THE SOLE JUDGEMENT OF THE MEMBER BOARD TO PROTECT AND PRESERVE THE TAX-EXEMPT STATUS AND PUBLIC CHARITY STATUS OF THE CORPORATION OR THE MEMBER AND ANY TAX-EXEMPT AFFILIATE OF THE CORPORATION OR THE MEMBER (INCLUDING FEDERAL AND STATE INCOME TAX EXEMPTIONS, PROPERTY TAX EXEMPTIONS, AND SALES TAX EXEMPTIONS); PROVIDED THE MEMBER BOARD HAS GIVEN A WRITTEN REQUEST TO THE BOARD TO TAKE ACTION OR REFRAIN FROM TAKING ACTION, WHICH WOULD HAVE SUFFICIENTLY PROTECTED AND PRESERVED SUCH TAX-EXEMPT AND PUBLIC CHARITY STATUS, AND THE BOARD HAS FAILED TO PROMPTLY TAKE SUCH ACTION OR REFRAIN FROM TAKING SUCH ACTION. FORM 990 PART VI SECTION A LINE 9 JAMES W. GIRARDY, M.D. 5666 EAST STATE STREET ROCKFORD, IL 61108 Form 990 Part VI Line 11b REVIEW OF 990: THE PROPOSED FINAL VERSION OF THE 990 IS SENT VIA E-MAIL TO ALL OFFICERS AND MEMBER OF THE BOARD OF DIRECTORS FOR THEIR REVIEW PRIOR TO FILING. ANY APPROPRIATE CHANGES REQUESTED BY THE OFFICERS AND DIRECTORS ARE THEN INCORPORATED INTO THE FINAL FORM 990 AND ALL SCHEDULES FOR FILING. Form 990 Part VI Line 12c COMPLIANCE WITH WRITTEN CONFLICT OF INTEREST POLICY: DISCLOSURES BY OFFICERS, DIRECTORS AND TRUSTEES, AS WELL AS KEY EMPLOYEES AND EMPLOYEES CHARGED WITH PURCHASING, PROCUREMENT AND CONTRACTION DECISION-MAKING ARE MADE THROUGH AN ELECTRONIC REPORTING SYSTEM. DISCLOSURES ARE RECEIVED AND REVIEWED BY THE CORPORATE COMPLIANCE DIVISION. IF A POTENTIAL CONFLICT OF INTEREST IS IDENTIFIED, THEN THE DISCLOSING EMPLOYEE IS NOTIFIED OF THE POTENTIAL CONFLICT AND MAY BE ASKED FOR ADDITIONAL INFORMATION ABOUT THE INTEREST. THE CORPORATE COMPLIANCE DIVISION DETERMINES WHETHER A PLAN TO MANAGE A POSSIBLE OR ACTUAL CONFLICT OF INTEREST IS NEEDED, DISCUSSES THE MANGEMENT PLAN WITH THE EMPLOYEE AND MONITORS THE EMPLOYEE'S COMPLIANCE WITH THE PLAN. PLANS TO MANAGE CONFLICTS ARE TRACKED THROUGH THE ELECTRONIC DISCLOSURE SYSTEM. Form 990 Part VI Line 15a COMPENSATION DETERMINATION: THE BOARD OF DIRECTORS HAS ESTABLISHED A BOARD COMMITTEE KNOWN AS THE HUMAN RESOURCES COMMITTEE WHOSE MEMBERS ARE ALL PROFESSED MEMBERS OF THE RELIGIOUS CONGREGATION KNOWN AS THE SISTERS OF THE THIRD ORDER OF SAINT FRANCIS WHO HAVE TAKEN A VOW OF POVERTY. HENCE, THEY DO NOT PERSONALLY BENEFIT FROM DECISION OF THE COMMITTEE. THE PERFORMANCE OF THE CEO AND HIS ACHIEVEMENT OF ANNUAL GOALS IS EVALUATED EACH YEAR BY THE FULL BOARD OF DIRECTORS, AND THIS PERFORMANCE REVIEW IS PROVIDED TO THE COMMITEE. THE COMMITEE ALSO OBTAINS COMPENSATION SURVEY DATA AND RECOMMENDATION FROM A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTANT. BASED ON ALL OF THESE FACTORS, THE COMMITTEE SETS BASE SALARY AND BENEFITS OF THE CEO AND APPROVES THE EXECUTIVE COMPENSATION PLAN APPLICABLE TO THE CEO. PRIOR TO PAYMENT OF ANY BONUS OR INCENTIVE COMPENSATION, THE TOTAL COMPENSATION FOR THE CEO, INCLUDING BASE SALARY, BENEFITS, AND PROPOSED BONUS OR INCENTIVE COMPENSATION, IS AGAIN REVEIWED BY A NATIONALLY RECOGNIZED COMPENSATION CONSULTANT TO ENSURE THAT NO EXESS BENEFIT AMOUNT IS PAID OR FURNISHED. Form 990 Part VI Line 15b COMPENSATION DETERMINATION: THE BOARD OF DIRECTORS HAS ESTABLISHED A BOARD COMMITTEE KNOWN AS THE HUMAN RESOURCES COMMITTEE WHOSE MEMBERS ARE ALL PROFESSED MEMBER OF THE RELIGIOUS CONGREGATION KNOWN AS THE SISTERS OF THE THIRD ORDER OF SAINT FRANCIS WHO HAVE TAKEN A VOW OF POVERTY. HENCE, THEY DO NOT PERSONALLY BENEFIT FROM DECISIONS OF THE COMMITTEE. THE COMMiTTEE DETERMINES WHICH OFFICERS, KEY EMPLOYEES AND OTHER EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN THE EXECUTIVE COMPENSATION PLAN. BASED ON PERFORMAnCE REVIEWS BY THE SUPERVISORS OF SUCH PERSONS AND COMPENSATION SURVEY DATA AND RECOMMENDATIONS FROM A NATIONALLY KNOWN INDEPENDENT COMPENSATION CONSULTANT, THE COMMITTEE APPROVES ANY EXECUTIVE COMPENSATION PLAN APPLICABLE TO KEY EMPLOYEES AND ESTABLISHED THE BASE SALARY AND BENEFITS FOR PLAN PARTICIPANTS. PRIOR TO PAYMENT OF ANY BONUS OR INCENTIVE COMPENSATION, THE TOTAL COMPENSATION FOR EACH KEY EMPLOYEE, INCLUDING BASE SALARY, BENEFITS, AND PROPOSED BONUS OR INCENTIVE COMPENSATION, IS AGAIN REVIEWED BY A NATIONALLY RECOGNIZED COMPENSATION CONSULTANT TO ENSURE THAT NO EXCESS BENEFIT AMOUNT IS PAID OR FURNISHED. Form 990 Part VI Line 19 AVAILABLE TO PUBLIC: THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. SISTERS OF THE THIRD ORDER OF STFRANCIS 800 NE GLEN OAK AVE PEORIA IL 61603 371259286 PARENT/SU ORG IL 501(C)(3) LN11 TYPEII NA false OSF HEALTHCARE FOUNDATION 800 NE GLEN OAK AVE PEORIA IL 61603 371259284 SUPPORT ORG IL 501(C)(3) LN11 TYPEII NA false ST FRANCIS COMMUNITY CLINIC 530 NE GLEN OAK AVE PEORIA IL 61637 370661235 FREE CLINIC IL 501(C)(3) ln7 SIS 3RD OSF false OTTAWA REGIONAL HOSP & HEALTHCARE CTR 1100 EAST NORRIS DRIVE OTTAWA IL 61350 362604009 HOSPITAL IL 501(C)(3) LN3 osf false OTTAWA REGIONAL HOSPITAL FOUNDATION 1100 EAST NORRIS DRIVE OTTAWA IL 61350 364007569 SUPPORT ORG IL 501(C)(3) LN11A TYPEI orhhc false OSF MULTI-SPECIALTY GROUP 800 NE GLEN OAK AVE PEORIA IL 61603 383852646 HLTHCARE SVCS IL 501(C)(3) LN11A TYPEI osf false OSF HEART & VASCULAR INSTITUTE 800 NE GLEN OAK AVE PEORIA IL 61603 352422385 HLTHCARE SVCS IL 501(C)(3) LN11A TYPEI osf false CHILDREN'S HOSPITAL OF ILLINOIS MED GRP 800 NE GLEN OAK AVE PEORIA IL 61603 320353954 HLTHCARE SVCS IL 501(C)(3) LN11A TYPEI osf false ILLINOIS NEUROSCIENCE INSTITUTE 800 NE GLEN OAK AVE PEORIA IL 61603 364709999 HLTHCARE SVCS IL 501(C)(3) LN11A TYPEI osf false OSF HEALTHCARE SYSTEM 800 NE GLEN OAK AVE PEORIA IL 61603 370813229 HOSPITAL IL 501(C)(3) ln3 SIS 3RD OSF false SAINT ANTHONY'S PHYSICIAN GROUP PO BOX 340 ALTON IL 62002 371365059 HLTHCARE SVCS IL 501(C)(3) LN9 osf false SISTERS OF ST FRANCIS MARTYR ST GEORGE 1 FRANCISCAN WAY PO BOX 9020 ALTON IL 62002 376034163 RELIGIOUS IL 501(C)(3) LN1 osf false IPMR 6501 N SHERIDAN ROAD PEORIA IL 61614 370681567 REHAB IL 501(C)(3) LN3 osf false OTTAWA REGIONAL HOSPITAL AUXILIARY 1100 EAST NORRIS DRIVE PEORIA IL 61350 363854788 SUPPORT ORG IL 501(C)(3) LN11A TYPEI osf false CENTER FOR HEALTH AMBULATORY SURGERY 8800 RTE 91 N PEORIA IL 61615 205557171 SURGICAL CENTER IL OSF related 0 0 false 0 true STATE AND ROXBURY LLC 1725 HUNTWOOD DR CHERRY VALLEY IL 61016 261728983 REAL ESTATE MGMT IL OSF related 0 0 false 0 true EASTLAND MEDICAL PLAZA SURGICENTER LLC 1505 EASTLAND DRIVE BLOOMINGTON IL 61701 371400643 SURGICAL CENTER IL OSF related 0 0 false 0 true FORT JESSE IMAGING CENTER LLC 2200 FT JESSE ROAD NORMAL IL 61761 460515604 MEDICAL IMAGING IL OSF related 0 0 false 0 true RADIATIO ONCOLOGY OF NORTHERN ILLINOIS 1200 STARFIRE DRIVE OTTAWA IL 61350 753247165 RADIATION ONCOLOG IL ORHHC related 0 0 false 0 true POINT CORE NETWORK SERVICES LLC 222 3RD AVE SE SUITE 500 CEDAR RAPIDS IA 52401 465393141 IT SERVICES IA POINTCORE LLC related 0 0 false 0 true SAINT CLARE'S VILLA LIMITED PARTNERSHIP 915 EAST 5TH STREET ALTON IL 62002 371397289 LOW INC HOUSING IL osf unrelated 0 0 false 0 true FOX RIVER CANCER CENTER 1211 STARFIRE DRIVE OTTAWA IL 61350 870805865 ONCOLOGY IL ORHHC related 0 0 false 0 true OSF SAINT FRANCIS INC 800 NE GLEN OAK AVE PEORIA IL 61603 363484677 HLTHCARe SVCS IL osf C Corp 0 0 false HEARTCARE MIDWEST LTD 5405 N KNOXVILLE AVENUE PEORIA IL 61614 370996868 CARDIOVASCULAR IL osf C Corp 0 0 false CARDIOVASCULAR INSTITUTE AT OSF LLC 444 ROXBURY ROAD ROCKFORD IL 61107 264225726 CARDIOVASCULAR IL osf C Corp 0 0 false ILLINOIS PATHOLOGIST SERVICES LLC 5666 EAST STATE STREET ROCKFORD IL 61108 800439081 PATHOLOGY SVCS IL osf C Corp 0 0 false OSF MULTISPECIALTY GRP-EASTERN REG LLC 1701 E COLLEGE AVENUE BLOOMINGTON IL 61704 300561892 MULTISPEC CLINIC IL osf C Corp 0 0 false OSF MULTISPECIALTY GROUP-PEORIA LLC 530 NE GLEN OAK AVENUE PEORIA IL 61637 262800379 PEDIATRIC CARDIOV IL osf C Corp 0 0 false ILLINOIS NEUROLOGICAL INSTITUTE-PHYLLC 719 N WILLIAM KUMPF BLVD PEORIA IL 61605 263109118 PEDIATRIC NEUROLO IL osf C Corp 0 0 false ILLINOIS SPEC PHY SVCS AT OSF LLC 1001 MAIN STREET PEORIA IL 61606 800462209 PULMONOLOGY IL osf C Corp 0 0 false OSF PERINATAL ASSOCIATES LLC 4911 EXECUTIVE DRIVE PEORIA IL 61614 800498373 MATERNAl FET MED IL osf C Corp 0 0 false OSF MULTISPECIALTY GR-WESTERN REGION 3315 NORTH SEMINARY STREET GALESBURG IL 61401 800608541 MULTISPEC CLINIC IL osf C Corp 0 0 false OSF CHILDREN'S MEDICAL GROUP-CONGENITAL 5701 STRATHMOOR DRIVE ROCKFORD IL 61107 900714643 PEDIATRIC CARDIOV IL osf C Corp 0 0 false PREFERRED EMERGENCY PHY OF ILLINOIS LLC 800 NE GLEN OAK AVENUE PEORIA IL 61603 900749855 EMERGENCY ROOM IL osf C Corp 0 0 false OTTAWA REG HEALTHCARE AFFILIATES INC 1100 EAST NORRIS DRIVE OTTAWA IL 61350 263937519 HOLDING COMPANY IL ORHHC C Corp 0 0 false OTTAWA REGIONAL MEDICAL CENTER INC 1614 EAST NORRIS DRIVE OTTAWA IL 61350 271036071 OUTPATIENT DIAG IL ORHHC C Corp 0 0 false ASSOC MED INSTITUTE CONDO ASSOC 6501 N SHERIDAN ROAD PEORIA IL 61614 371402305 CONDO ASSOC IL OSF C CORP 0 0 false false false false false true false false false false false true false true false true true false false false FORM SCH R PART III For purposes of completion, the related organizations listed below are taxable as a partnership. Center for Health Ambulatory Surgery Center, LLC 20-5557171 8800 Route 91 North, Peoria, IL 61615 State and Roxbury, LLC 26-1728983 1725 Huntwood Dr., Ste 400, Cherry Valley, IL 61016 Eastland Medical Plaza Surgicenter, LLC 37-1400643 1505 Eastland Drive, Bloomington, IL 61701 Fort Jesse Imaging Center, LLC 46-0515604 2200 Ft. Jesse Road, Suite B, Normal, IL 61761 Radiation Oncology of Northern Illinois, LLC 75-3247165 1200 Starfire Drive, Ottawa, IL 61350 Point Core Network Services, LLC 46-5393141 222 3rd Ave. S.E. Suite 500, Cedar Rapids, Iowa 52401 Saint Clare's Villa Limited Partnership 37-1397289 915 East 5th Street, Alton, IL 62002 Fox River Cancer Center 87-0805865 1211 Starfire Drive, Ottawa, IL 61350