PEKIN MEMORIAL HOSPITAL: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
PEKIN MEMORIAL HOSPITAL (EIN 37-0692351)
Tax period
2014-05-01 to 2015-04-30
Filed
2016-03-09
IRS object ID
201600699349300315
Schema version
2014v6.0
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 ReturnHeader

FieldValueIRS element (for citing)
Return2016-03-09T10:57:49-06:00ReturnTs
Tax Period End2015-04-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1211 N BROADWAY SUITE 600AddressLine1Txt
CityST LOUISCityNm
State AbbreviationMOStateAbbreviationCd
ZIP631022733ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-05-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN370692351EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Pekin Memorial HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% PAM ROGERSInCareOfNm
Business Name ControlPEKIBusinessNameControlTxt
Phone3093530700PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1600 SOUTH 13TH STREETAddressLine1Txt
CityPEKINCityNm
State AbbreviationILStateAbbreviationCd
ZIP61554ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSTEVEN C HALLPersonNm
Person TitleCFOPersonTitleTxt
Phone3093530700PhoneNum
Signature2016-03-09SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDonna J LarsonPreparerPersonNm
PTINP00043751PTIN
Phone3142315544PhoneNum
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-08-17 19:52:53ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1Pekin HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerSTEVEN C HALL CFOPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1600 S 13TH STREETAddressLine1Txt
CityPEKINCityNm
State AbbreviationILStateAbbreviationCd
ZIP61554ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$70,737,312GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.PEKINHOSPITAL.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1913FormationYr
Legal Domicile StateILLegalDomicileStateCd
Activity Or MissionTO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY AND TO DO SO WITH LOVE, COMPASSION AND EXTRAORDINARY MEDICAL CARE.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent10VotingMembersIndependentCnt
Total Employee807TotalEmployeeCnt
Total Volunteers137TotalVolunteersCnt
Total Gross UBI$1,072,923TotalGrossUBIAmt
PY Contributions Grants$387,071PYContributionsGrantsAmt
CY Contributions Grants$82,928CYContributionsGrantsAmt
PY Program Service Revenue$64,938,205PYProgramServiceRevenueAmt
CY Program Service Revenue$67,745,618CYProgramServiceRevenueAmt
PY Investment Income$1,703,389PYInvestmentIncomeAmt
CY Investment Income$1,522,760CYInvestmentIncomeAmt
PY Other Revenue$2,734,781PYOtherRevenueAmt
CY Other Revenue$1,303,413CYOtherRevenueAmt
PY Total Revenue$69,763,446PYTotalRevenueAmt
CY Total Revenue$70,654,719CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$32,672,990PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$32,150,708CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$31,655,182PYOtherExpensesAmt
CY Other Expenses$31,821,288CYOtherExpensesAmt
PY Total Expenses$64,328,172PYTotalExpensesAmt
CY Total Expenses$63,971,996CYTotalExpensesAmt
PY Revenues Less Expenses$5,435,274PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$6,682,723CYRevenuesLessExpensesAmt
Total Assets BOY$70,369,575TotalAssetsBOYAmt
Total Assets EOY$71,558,832TotalAssetsEOYAmt
Total Liabilities BOY$31,937,730TotalLiabilitiesBOYAmt
Total Liabilities EOY$33,705,968TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$38,431,845NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$37,852,864NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY AND TO DO SO WITH LOVE, COMPASSION AND EXTRAORDINARY MEDICAL CARE.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$58,812,929ExpenseAmt
Grant$0GrantAmt
Revenue$68,328,211RevenueAmt
DescPEKIN MEMORIAL HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY SERVICES TO PATIENTS IN PEKIN, ILLINOIS AND SURROUNDING AREAS. THE HOSPITAL OPERATES A LICENSED 97 ACUTE CARE BED FACILITY. PATIENT DAYS WERE 14,577; ADJUSTED PATIENT DAYS WERE 42,847; CASE MIX INDEX WAS 1.2366. SEE SCHEDULE O.Desc
Total Program Service Expenses$58,812,929TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document128IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee807EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member10IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (true)DelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VentureYes (true)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (true)WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldILStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonPAM ROGERSPersonNm
Phone3093530796PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1600 SOUTH 13TH STREETAddressLine1Txt
CityPEKINCityNm
State AbbreviationILStateAbbreviationCd
ZIP61554ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
DR ERIC REINERTSON
TRUSTEE1.043.0Yes (X)$0$387,774$9,536
GORDON CROSS MD
TRUSTEE1.04.0Yes (X)$0$0$0
DELORES EAGLESON
TRUSTEE1.04.0Yes (X)$0$0$0
CURTIS EETON
TRUSTEE1.04.0Yes (X)$0$0$0
RONALD MILLER
TRUSTEE1.04.0Yes (X)$0$0$0
JASON PROEHL
TRUSTEE1.04.0Yes (X)$0$0$0
EDWARD SIROTAK
TRUSTEE1.04.0Yes (X)$0$0$0
JAMES SMALLEY MD
SECRETARY/TREASURER1.04.0Yes (X)$0$0$0Yes (X)
ANDREW SPARKS
VICE CHAIRMAN1.04.0Yes (X)$0$0$0Yes (X)
MICHAEL TIBBS
CHAIRMAN1.04.0Yes (X)$0$0$0Yes (X)
DIRK ROECKER
TRUSTEE1.04.0Yes (X)$0$0$0
STEVEN C HALL
CFO40.04.0$269,789$0$15,064Yes (X)
BOB HALEY
CEO40.04.0$140,000$0$39,216Yes (X)
GARY JEPSON
CEO (FORMER)43.04.0$111,962$0$29,992Yes (X)
JO ELLEN PATTERSON
CNO40.00.0$170,377$0$9,151Yes (X)
MICHAEL JOHNSON
ADMIN DIRECTOR OF ANCILLARY SE40.00.0$117,123$0$6,015Yes (X)
ANGELIA DREHER
DIRECTOR OF PHARMACY40.00.0$144,544$0$13,946Yes (X)
CYNTHIA DORR HARTHAN
PHARMACIST40.00.0$117,761$0$7,795Yes (X)
CATHERINE METESH
PHARMACIST40.00.0$109,833$0$8,074Yes (X)
ASHOKKUMAR PATEL
PHARMACIST40.00.0$112,341$0$8,279Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,293,730TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$387,774TotReportableCompRltdOrgAmt
Total Other Compensation$147,068TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K9IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsYes (true)CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
PROFESSIONAL THERAPY SERVICES INC
2810 FRANK SCOTT PARKWAY STE 824BELLEVILLEIL62223REHAB SERVICES$1,139,140
MIDWEST ANESTHESIA CONSULTANTS SC
2006 HOGBACK RDANN ARBORMI48105ANESTHESIOLOGY$1,095,839
QUORUM
105 CONTINENTAL PLACEPEORIAIL61615CONSULTING$819,594
ARAMARK FACILITY SVCS
22506 NETWORKCHICAGOIL60673EQUIPMENT SERVICES$523,112
ARAMARK FOOD
PO BOX 651009CHARLOTTENC28265DIETARY$511,658
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K11CntrctRcvdGreaterThan100KCnt
Related Organizations$82,928RelatedOrganizationsAmt
Total Contributions$82,928TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
PATIENT REVENUE621110$66,629,279$66,629,279
MEDICAL RECORD REVENUE561000$43,416$43,416
REFERENCE LAB REVENUE621500$1,072,923$1,072,923
FieldValueIRS element (for citing)
Total Program Service Revenue$67,745,618TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$924,825TotalRevenueColumnAmt
Exclusion$924,825ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$26,548RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$26,548RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$26,548TotalRevenueColumnAmt
Exclusion$26,548ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$629,988SecuritiesAmt
Other$50,540OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$82,593OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$629,988SecuritiesAmt
Other-$32,053OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$597,935TotalRevenueColumnAmt
Exclusion$597,935ExclusionAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtExclusionExclusionAmt
EHR FUNDS900099$582,593$582,593
CAFETERIA REVENUE722410$558,519$558,519
WELLNESS CENTER621400$16,689$16,689

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$119,064TotalRevenueColumnAmt
Exclusion$119,064ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$1,276,865OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$70,654,719TotalRevenueColumnAmt
Related Or Exempt Func Income$67,255,288RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$1,072,923UnrelatedBusinessRevenueAmt
Exclusion$2,243,580ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$811,767TotalAmt
Program Services$196,858ProgramServicesAmt
Management And General$614,909ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$25,641,084TotalAmt
Program Services$23,416,516ProgramServicesAmt
Management And General$2,224,568ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$678,014TotalAmt
Program Services$607,243ProgramServicesAmt
Management And General$70,771ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$3,112,409TotalAmt
Program Services$2,865,849ProgramServicesAmt
Management And General$246,560ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,907,434TotalAmt
Program Services$1,708,335ProgramServicesAmt
Management And General$199,099ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$795,533TotalAmt
Management And General$795,533ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$184,826TotalAmt
Management And General$184,826ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$60,420TotalAmt
Management And General$60,420ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$9,254,812TotalAmt
Program Services$9,254,812ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$622,903TotalAmt
Program Services$203,402ProgramServicesAmt
Management And General$419,501ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$8,132,230TotalAmt
Program Services$8,109,850ProgramServicesAmt
Management And General$22,380ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$14,468TotalAmt
Program Services$14,468ProgramServicesAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,083,088TotalAmt
Program Services$1,077,673ProgramServicesAmt
Management And General$5,415ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$63,861TotalAmt
Program Services$63,861ProgramServicesAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$135,193TotalAmt
Program Services$126,917ProgramServicesAmt
Management And General$8,276ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$583,346TotalAmt
Program Services$583,346ProgramServicesAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$3,915,200TotalAmt
Program Services$3,895,624ProgramServicesAmt
Management And General$19,576ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$627,232TotalAmt
Program Services$471,911ProgramServicesAmt
Management And General$155,321ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
MEDICAID ASSESSMENT EXPENSE$2,720,380$2,720,380
FOOD EXPENSE$595,726$595,726
IMPLANT FEES$1,898,219$1,898,219
REFERENCE LAB$694,893$694,893

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$438,958TotalAmt
Program Services$307,046ProgramServicesAmt
Management And General$131,912ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$63,971,996TotalAmt
Program Services$58,812,929ProgramServicesAmt
Management And General$5,159,067ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$122,210BOYAmt
EOY$103,996EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$4,991,299BOYAmt
EOY$5,628,123EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$10,302,326BOYAmt
EOY$11,523,840EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,005,098BOYAmt
EOY$1,061,171EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,162,723BOYAmt
EOY$1,593,739EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$86,194,566LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$63,045,763LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$24,203,715BOYAmt
EOY$23,148,803EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$25,053,928BOYAmt
EOY$25,108,752EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$3,528,276BOYAmt
EOY$3,390,408EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$70,369,575BOYAmt
EOY$71,558,832EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$5,770,289BOYAmt
EOY$6,618,888EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$14,135,000BOYAmt
EOY$11,405,000EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$2,774,861BOYAmt
EOY$2,130,972EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$9,257,580BOYAmt
EOY$13,551,108EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$31,937,730BOYAmt
EOY$33,705,968EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$38,116,431BOYAmt
EOY$37,500,657EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$315,414BOYAmt
EOY$352,207EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$38,431,845BOYAmt
EOY$37,852,864EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$70,369,575BOYAmt
EOY$71,558,832EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$6,682,723ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$446,805NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$7,708,509OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsYes (true)GrantsOtherOrganizationsInd
Grants Other Organizations$30,154GrantsOtherOrganizationsAmt
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesfalseOtherActivitiesInd
Total Lobbying Expenditures$30,154TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEUDLE C, PART II-B, LINE 1FormAndLineReferenceDesc
ExplanationLOBBYING ACTIVITIES LOBBYING EXPENSES ARE ONLY INCURRED THROUGH ASSOCIATIONS WITH NATIONAL ORGANIZATIONS OF WHICH THE ORGANIZATION IS A MEMBER.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,449,581OtherCostOrOtherBasisAmt
Book Value$1,449,581BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$11,585,946OtherCostOrOtherBasisAmt
Depreciation$8,982,257DepreciationAmt
Book Value$2,603,689BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$19,494,196OtherCostOrOtherBasisAmt
Depreciation$14,725,759DepreciationAmt
Book Value$4,768,437BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$51,116,977OtherCostOrOtherBasisAmt
Depreciation$37,638,358DepreciationAmt
Book Value$13,478,619BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,547,866OtherCostOrOtherBasisAmt
Depreciation$1,699,389DepreciationAmt
Book Value$848,477BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$23,148,803TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
DUE TO THIRD PARTIES$3,678,797
MINIMUM PENSION LIABILITY$9,851,755
DUE TO MEDICARE$20,556
FieldValueIRS element (for citing)
Total Liability$13,551,108TotalLiabilityAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE D, PART X, LINE 2FormAndLineReferenceDesc
ExplanationFIN 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

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Discounted Care Other600.DiscountedCareOtherPct
FieldValueIRS element (for citing)
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$152,688TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$152,688NetCommunityBenefitExpnsAmt
Total Expense0.00240TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$14,362,245TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$6,646,270DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,715,975NetCommunityBenefitExpnsAmt
Total Expense0.12030TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$14,514,933TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$6,646,270DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,868,663NetCommunityBenefitExpnsAmt
Total Expense0.12270TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$10,487TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$10,487NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$10,487TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$10,487NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$14,525,420TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$6,646,270DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,879,150NetCommunityBenefitExpnsAmt
Total Expense0.12290TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$1,064,896BadDebtExpenseAmt
Bad Debt Expense Attributable$159,408BadDebtExpenseAttributableAmt
Reimbursed By Medicare$14,322,075ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$27,050,869CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$12,728,794MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

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

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PEKIN MEMORIAL HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1600 SOUTH 13TH STREETAddressLine1Txt
CityPEKINCityNm
State AbbreviationILStateAbbreviationCd
ZIP61554ZIPCd
FieldValueIRS element (for citing)
Website AddressPEKINHOSPITAL.ORGWebsiteAddressTxt
State License001834StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1PEKIN MEMORIAL HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted12CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE PART V, SECTION COwnWebsiteURLTxt
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt12ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLSEE PART V, SECTION CStrategyWebsiteURLTxt
Strategy AttachedfalseStrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care600.FPGFamilyIncmLmtDscntCarePct
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLSEE PART V, SECTION CFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSEE PART V, SECTION CFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLSEE PART V, SECTION CFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART V, SECTION B, LINE 5CHNA - INPUT FROM PERSONS REPRESENTING THE COMMUNITY WE RECEIVED COMMUNITY INPUT FROM 341 AREA RESIDENTS; OCTOBER 23, 2012 THROUGH NOVEMBER 13, 2012. INFORMATION ANALYSIS AUGMENTED BY LOCAL OPINIONS SHOWED HOW TAZEWELL COUNTY RELATES TO ITS PEERS IN TERMS OF PRIMARY AND CHRONIC NEEDS, AS WELL AS OTHER ISSUES OF UNINSURED PERSONS, LOW-INCOME PERSONS AND MINORITY GROUPS; RESPONDENTS COMMENTED ON IF THEY BELIEVE CERTAIN POPULATION GROUPS (OR PEOPLE WITH CERTAIN SITUATIONS) NEED HELP TO IMPROVE THEIR CONDITION.
SCHEDULE H, PART V, SECTION B, LINE 7AHTTP://PEKINHOSPITAL.ORG/_DATA/FILES/COMMUNITYHEALTHNEEDSASSESSMENT2.PDF
SCHEDULE H, PART V, SECTION B, LINE 16IPUBLISHING 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 22DDETERMINING MAXIMUM AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS APPLICATIONS FOR FINANCIAL ASSISTANCE WILL BE REVIEWED ACCORDING TO THE GUIDELINES. UN-INSURED PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE WILL NOT BE CHARGED MORE THAN THAT GENERALLY BILLED TO INSURED PATIENTS. THE HOSPITAL WILL NOT USE GROSS CHARGES WHEN BILLING PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE. 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 COMMERCIAL PAYORS. 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 11HEALTH NEEDS ASSESSMENT REPORT CARD A. HEALTH RESOURCE AVAILABILITY/AFFORDABILITY CONSIDERABLE RESIDENT CONCERN, 71% REPORTED NO ACCESS PROBLEM; NOT HAVING HEALTH INSURANCE 68% LISTED AS A MAJOR CONCERN, WITH SUPPORT OF "INSURANCE LACK" BEING A SECONDARY ISSUE IN THE WRITTEN COMMENTS; HEALTHCARE AVAILABILITY - LEADING PROBLEMS TO SOLVE; TAZEWELL NOT DESIGNATED AS MEDICALLY UNDERSERVED; PRIMARY CARE PHYSICIANS TO POPULATION RATIO - MORE THAN DOUBLE THE STATE AVERAGE AND 350% WORSE THAN THE DESIRED NATIONAL GOAL; UNEMPLOYMENT LOWER THAN IL AND U.S. PROBLEM STATEMENT: SHORTAGE OF PRIMARY CARE PHYSICIANS AND SIZABLE UNINSURED POPULATION. 1. AGGRESSIVELY RECRUIT PRIMARY CARE PROVIDERS TO PROGRESSIVE HEALTH SYSTEMS SERVICE AREA - PROGRESSIVE HEALTH SYSTEMS HAS MADE SIGNIFICANT STRIDES IN THE RECRUITMENT OF PRIMARY CARE PHYSICIANS AND MIDLEVEL PROVIDERS. OVER THE LAST 3 YEARS PROGRESSIVE HEALTH SYSTEMS HAS SUCCESSFULLY RECRUITED 14 PROVIDERS. WE CONTINUE TO RECRUIT PROVIDERS IN THE FOLLOWING SPECIALTIES; INTERNAL MEDICINE, OBGYN, HOSPITALIST, PEDIATRIC NP, (2) GENERAL SURGEONS, PULMONOLOGIST, GASTROENTEROLOGIST NP AND (2) FAMILY MEDICINE PROVIDERS. RECRUITMENT DOLLARS SPENT IN FY 2013 $132,000, FY 2014 $70,000, FY 2015 $66,000 AND FY 2016 $12,000 2. PROVIDE FREE HEALTH SCREENINGS AND EDUCATION TO THE PUBLIC - PROGRESSIVE HEALTH SYSTEMS PROVIDED A VARIETY OF COMMUNITY SCREENINGS TO INCLUDE BONES DENSITY, BLOOD PRESSURE CHECKS, BODY COMPOSITION, CHOLESTEROL CHECKS, HEMOGLOBIN, PULMONARY FUNCTION TESTING, PHYSICAL THERAPY, DISTANT ACUITY, COGNITION ASSESSMENTS, SKIN SCREENING, FOOT SCREENING, HEEL SCANS, SPIROMETRY TESTING AND PERIPHERAL VASCULAR SCREENING. IN ADDITION, AS PART OF MAMMOGRAPHY DAY WE PARTNER WITH TAZEWELL COUNTY HEALTH DEPARTMENT TO OFFER FREE MAMMOGRAMS TO UNINSURED WOMEN AGE OF 40 AND ABOVE. THERE WERE 3,828 SCREENINGS GIVEN IN THE LAST THREE YEARS. PROGRESSIVE HEALTH SYSTEMS ALSO PARTICIPATED IN A NUMBER OF HEALTH FAIRS THROUGHOUT TAZEWELL AND PEORIA COUNTIES. FROM 2013 TO 2015, THE NUMBER OF PEOPLE THAT PARTICIPATED IN HEALTH FAIR SCREENINGS WAS 1,276. PROGRESSIVE HEALTH SYSTEMS CONTINUES TO OFFER EDUCATION ON DIABETES, CPR, WEIGHT LOSS, SKIN CANCER, BONE AND JOINT HEALTH, COLON HEALTH, HEALTHY EATING AND EXERCISE AND CARDIO EDUCATION. IT TOOK ONE THOUSAND FOUR HUNDRED AND FIFTY TWO MAN HOURS TO CONDUCT THE HEALTH FAIRS AND SCREENINGS. 3. PROVIDE PRIMARY CARE SERVICES TO MEDICAID RECIPIENTS THROUGH PROHEALTH PRIMARY CARE PRACTICES - THE PHYSICIANS AT PROHEALTH HAVE PROVIDED 41,000 VISITS TO MEDICAID PATIENTS IN THE LAST THREE YEARS. WE HAVE OPENED UP A PEDIATRIC URGENT CARE WITH EXTENDED HOURS FROM 8:00A TO 8:00P MONDAY THROUGH SATURDAY TO INCREASE PATIENT ACCESS. MEDICAL CARE IS ALSO AVAILABLE TO PATIENTS, BASED ON MEDICAL NECESSITY, REGARDLESS OF THEIR ABILITY TO PAY. PATIENTS MAY REQUEST CHARITY ASSISTANCE APPLICATIONS BY TELEPHONE OR IN PERSON. PEKIN HOSPITAL WAIVES CHARGES BASED ON REVIEW OF THE PATIENT'S FINANCIAL STATUS COMPARED TO FEDERAL POVERTY GUIDELINES. INFORMATION REGARDING CHARITY CARE MAY BE FOUND THROUGHOUT THE HOSPITAL INCLUDING IN PATIENT REGISTRATION, OUTPATIENT DEPARTMENTS, EMERGENCY DEPARTMENT, AND THE PATIENT SERVICE DEPARTMENTS. INFORMATION REGARDING FINANCIAL PROGRAMS, INCLUDING CHARITY CARE, CAN ALSO BE FOUND ON THE HOSPITAL'S WEBSITE AT WWW.PEKINHOSPITAL.ORG. COST: UNCOMPENSATED CARE IS PROVIDED TO PATIENTS UNDER MEDICAID PROGRAMS, ELIGIBILITY IS BASED ON FINANCIAL NEED. THE COST OF UNCOMPENSATED CARE TO THE ORGANIZATION WAS $13,327,000 FY 2013, $11,284,000 FY 2014 AND $13,932,623 FY 2015. THE COST OF PROVIDING CHARITY CARE AMOUNTED TO $3,000,000 OVER THE LAST THREE YEARS. COST: ANNUAL COSTS ASSOCIATED WITH THE PEDIATRIC URGENT CARE ARE $870,000. 4. EXPLORE THE OPPORTUNITY TO PARTNER WITH THE HEARTLAND COMMUNITY CLINIC TO BUILD A FEDERALLY QUALIFIED HEALTH CENTER IN PEKIN - DISCUSSIONS WITH HEARTLAND COMMUNITY CLINIC HAVE BEEN INITIATED BUT NO SOLID COMMITMENTS HAVE BEEN MADE AT THIS TIME. 5. SUPPORT MEDICAID EXPANSION EFFORTS AND THE AFFORDABLE CARE ACT DEVELOPMENT OF INSURANCE EXCHANGES TO PROVIDE SUBSIDIZED HEALTH INSURANCE TO LOW INCOME, UNDERSERVED AND AT-RISK POPULATIONS - IN NOVEMBER 2013, PROGRESSIVE HEALTH SYSTEMS BECAME A CERTIFIED APPLICATION ORGANIZATION SUCCESSFULLY REACHING, EDUCATING, AND ENROLLING UNINSURED AND HARD-TO-REACH POPULATIONS INTO QUALIFIED HEALTH PLANS (QHPS) AND INSURANCE AFFORDABILITY PROGRAMS. SINCE BECOMING CERTIFIED PROGRESSIVE HEALTH SYSTEMS HAS HELPED ENROLL 521 CONSUMERS WHICH INCLUDE BOTH PROGRESSIVE HEALTH SYSTEMS PATIENTS AND INDIVIDUALS FROM THE GENERAL PUBLIC INTO THE EXCHANGE. OUR SERVICE AREA CURRENTLY HAS A POPULATION OF 14,000 THAT ARE UNINSURED. OVER THE NEXT 3 YEARS PROGRESSIVE HEALTH SYSTEMS WILL HIRE 5 NEW NAVIGATORS TO HELP OUR PATIENTS BECOME ENROLLED IN AN INSURANCE PLAN. WE ANTICIPATE 48 EVENTS PER YEAR AND EXPECT TO HAVE ASSISTED 10,500 INDIVIDUALS TO APPLY FOR COVERAGE OVER THE NEXT THREE YEARS. COST OF NAVIGATORS: IN THE FIRST TWO YEARS THE NAVIGATORS HELPED 521 CONSUMERS GET SIGNED UP FOR INSURANCE ON THE EXCHANGE. WE ARE DEDICATING $250,000 PER YEAR FOR THE NEXT THREE YEARS TO EXPAND THE NAVIGATOR PROGRAM TO. THE GOAL IS TO REACH OUT TO THE 14,000 UNINSURED CONSUMERS IN OUR SERVICE AREA. LEADING INDICATOR NUMBER OF VISITS OVER FY 2013 - THE BASE YEAR = 5535 LAGGING INDICATOR FOR IMPROVEMENT TOTAL ENROLLEES IN ILLINOIS MEDICAID PROGRAM 2011 = 24,557 ACTUAL RESULTS 2015 = 27,235 B. CORONARY HEART DISEASE LEADING CAUSE OF DEATH, RATE SIGNIFICANTLY LOWER THAN EXPECTED, ADVERSE FINDING IMPACTING 10% OF POPULATION; LOWEST NATIONAL RATE CLASS FOR DEATHS, RATE FOR NON-HISPANIC BLACKS IS HIGHER: BETTER THAN NATIONAL AND PEER AVERAGES PROBLEM STATEMENT: HEART DISEASE REMAINS THE PROMINENT CAUSE OF DEATH 1. EDUCATE THE PUBLIC AND OUR PATIENTS ABOUT THE DANGERS OF HEART DISEASE, THE ADVANTAGES OF HEART HEALTHY LIFESTYLE AND THE NEED FOR EARLY DIAGNOSIS AND TREATMENT IN FY 2015, PROGRESSIVE HEALTH SYSTEMS CREATED A POSITION TO COORDINATE HEALTH AND WELLNESS OF OUR COMMUNITY. THE POSITION IS AIMED AT IMPROVING THE HEALTH OUTCOMES OF THE COMMUNITY WE SERVE. THE POSITION WORKED WITH LOCAL BUSINESSES AND KEY COMMUNITY PARTNERS AND ORGANIZED AND IMPLEMENTED COMMUNITY PROGRAMS THAT WILL MEASURABLY IMPROVE HEALTH FOR THE PROGRESSIVE HEALTH SYSTEMS POPULATION. THE POSITION GOES AROUND TO SCHOOLS, BUSINESSES AND EDUCATES COMMUNITY MEMBERS ON THE BENEFITS OF LIVING A HEALTHY LIFESTYLE THROUGH EXERCISE AND DIET. $80,000 PER YEAR IS DEDICATED TO PROVIDING INCREASED AWARENESS OF HEALTH AND WELLNESS IN OUR COMMUNIT 2. ALLOCATE RESOURCES TO PROVIDE EDUCATIONAL MATERIAL FOR DISTRIBUTION TO THE PUBLIC AND PATIENTS PROGRESSIVE HEALTH SYSTEMS HAS SEVERAL DEPARTMENTS THAT PROVIDE HANDOUTS TO THEIR PATIENTS AND CONSUMERS AT HEALTH FAIRS AND SCREENINGS. THERAPY, WELLNESS CENTER, HOME HEALTH AND PROHEALTH ARE JUST A FEW OF THE DEPARTMENTS THAT PROVIDE EDUCATIONAL BROCHURES. CLINICAL DEPARTMENTS HAVE EXPENSES ALLOCATED FOR THE COST OF PRINTING AND EDUCATIONAL EXPENSES. 3. PROVIDE A SCHEDULE OF EDUCATIONAL SEMINARS TO PATIENTS AND INTERESTED RESIDENTS - LOCATED ON THE PROGRESSIVE HEALTH SYSTEM'S WEBSITE, IS A CALENDAR OF EVENTS THAT SHOWS UPCOMING EDUCATIONAL CLASSES OFFERED TO THE COMMUNITY. IN ADDITION, OUR WELLNESS CENTER OFFERS THE FOLLOWING TOPICS OF EDUCATION FOR OUR PHASE TWO CARDIAC PATIENTS. THE COURSES ARE HEART ANATOMY AND PHYSIOLOGY, CARDIAC ANGIOGRAM PROCEDURE, HEART SURGERY, CORONARY STENTING, READING FOOD LABELS, STRESS AND HEART DISEASE, CARDIAC RISK FACTORS AND MEDICATIONS 4. PROVIDE SCREENING PROGRAMS THAT SUPPORT EDUCATION AND EARLY HEART DISEASE DETECTION - PROGRESSIVE HEALTH SYSTEMS PROVIDED A VARIETY OF COMMUNITY SCREENS TO INCLUDE BONES DENSITY, BLOOD PRESSURE CHECKS, BODY COMPOSITION, CHOLESTEROL CHECKS, HEMOGLOBIN, PULMONARY FUNCTION TESTING, PHYSICAL THERAPY, DISTANT ACUITY, COGNITION ASSESSMENTS, SKIN SCREENING, FOOT SCREENING, HEEL SCANS, SPIROMETRY TESTING AND PERIPHERAL VASCULAR SCREENING. IN ADDITION, AS PART OF MAMMOGRAPHY DAY WE PARTNER WITH TAZEWELL COUNTY HEALTH DEPARTMENT TO OFFER FREE MAMMOGRAMS TO UNINSURED WOMEN OF THE AGE OF 40. THERE WERE 1,037 SCREENINGS GIVEN IN 2013, 1,980 GIVEN IN 2014 AND 811 IN 2015. PROGRESSIVE HEALTH SYSTEMS ALSO PARTICIPATED IN A NUMBER OF HEALTH FAIRS THROUGHOUT TAZEWELL AND PEORIA COUNTIES. FROM 2013 TO 2015, THE NUMBER OF PEOPLE THAT PARTICIPATED IN HEALTH FAIR SCREENINGS WAS 1276. PROGRESSIVE HEALTH SYSTEMS CONTINUES TO OFFER EDUCATION ON DIABETES, CPR, WEIGHT LOSS, SKIN CANCER, BONE AND JOINT HEALTH, COLON HEALTH, HEALTH EATING AND EXERCISE AND CARDIO EDUCATION. 5. BECOME A CERTIFIED CHEST PAIN CENTER - N/A 6. OPEN A CLINICAL DECISION UNIT ADJACENT TO THE EMERGENCY DEPARTMENT TO ENHANCE OPTIMUM CARE FOR CARDIAC PATIENTS - IN JULY 2013, PROGRESSIVE HEALTH SYSTEMS OPENED A CLINICAL DECISION UNIT (CDU) THAT PROVIDES AN AREA TO CARE FOR PATIENTS WHO HAS HAVE BEEN ADMITTED, BUT WHOSE CONDITION NECESSITATES
SCHEDULE H, PART V, SECTION B, LINE 10AHTTP://PEKINHOSPITAL.ORG/_DATA/FILES/COMMUNITYHEALTHNEEDSASSESSMENT2.PDF
SCHEDULE H, PART V, SECTION B, LINE 16AHTTP://PEKINHOSPITAL.ORG/_DATA/FILES/FULL%20FINANCIAL%20ASSISTANCE%20POLIC Y.PDF
SCHEDULE H, PART V, SECTION B, LINE 16BHTTP://WWW.PEKINHOSPITAL.ORG/_DATA/FILES/1_2_HOSPITAL%20ASSISTANCE%20APPLI CATION_0116.DOCX
SCHEDULE H, PART V, SECTION B, LINE 16CHTTP://WWW.PEKINHOSPITAL.ORG/_DATA/FILES/1_2_HOSPITAL%20ASSISTANCE%20APPLI CATION_0116.DOCX
FieldValueIRS element (for citing)
Facility2FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
PEKIN HOSPITAL MRI BUILDING
1300 PARK AVENUEPEKINIL61554DIAGNOSTIC CENTER
PEKIN HOSPITAL PAIN MANAGEMENT LLC
600 SOUTH 13TH STREETPEKINIL61554PAIN CLINIC

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART III, SECTION A, LINE 2BAD 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 3BAD 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 4BAD 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 8SHORTFALL 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 9BDEBT 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 2NEEDS ASSESSMENT PEKIN HOSPITAL CONTRACTED WITH QHR, ITS MANAGEMENT CONSULTANT, TO ASSIST WITH THE CREATION OF ITS STRATEGIC PLAN. THE COMMUNITY ASSESSMENT WAS PERFORMED THROUGH A SERIES OF FOCUS GROUPS, COMMUNITY SURVEYS, PHYSICIAN PANEL DISCUSSIONS, INTERNAL STATISTICAL DATA, AND COUNTY AND SERVICE AREA DEMOGRAPHICS.
SCHEDULE H, PART VI, LINE 3PATIENT 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 4COMMUNITY 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 58,997 WITH A SECONDARY SERVICE AREA OF APPROXIMATELY 14,213. THE MEDIAN AGE OF ITS SERVICE AREA IS 43 YEARS, WHILE THE MEDIAN HOUSEHOLD INCOME IS $54,500.
SCHEDULE H, PART VI, LINE 5PROMOTION 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 2014, PEKIN HOSPITAL HAD CONSOLIDATED COST OF BAD DEBT, CHARITY CARE, AND UNREIMBURSED MEDICAID COSTS TOTALING $7,751,000. IN FY 2015 THAT NUMBER WAS $9,128,000.
SCHEDULE H, PART VI, LINE 6AFFILIATED 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 7STATEMENT FILING OF COMMUNITY BENEFIT REPORT ILLINOIS ONLY
SCHEDULE H, PART I, LINE 7COST 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 FBAD DEBT NO BAD DEBT EXPENSE WAS INCLUDED IN PART IX, LINE 25.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
STEVEN C HALL
CFO$269,789$0$0$0$0$0$9,384$0$5,680$0$284,853$0$0$0
BOB HALEY
CEO$140,000$0$0$0$0$0$0$0$39,216$0$179,216$0$0$0
DR ERIC REINERTSON
TRUSTEE$0$385,473$0$0$0$2,301$0$0$0$9,536$0$397,310$0$0
GARY JEPSON
CEO (FORMER)$111,962$0$0$0$0$0$0$0$29,992$0$141,954$0$0$0
ANGELIA DREHER
DIRECTOR OF PHARMACY$144,361$0$0$0$183$0$4,410$0$9,536$0$158,490$0$0$0
JO ELLEN PATTERSON
CNO$169,177$0$0$0$1,200$0$7,951$0$1,200$0$179,528$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PART I, LINE 1AHEALTH 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 1BWRITTEN POLICY REGARDING PAYMENT OR REIMBURSEMENT THE COUNTRY CLUB DOES NOT ALLOW MEMBERSHIPS TO BE IN THE NAME OF ANY BUSINESS, THEREFORE, THE ORGANIZATION IS USING THE NAME OF ITS CEO. THE ORGANIZATION ONLY PAYS FOR EXPENSES RELATED TO THE BUSINESS USE OF THE MEMBERSHIP.
COMPENSATION PAID BY AN UNRELATED MANAGEMENT COMPANYTHE FORMER CEO, GARY JEPSON, AND THE PRESENT CEO, BOB HALEY, ARE PAID BY AN UNRELATED MANAGEMENT COMPANY, QUORUM HEALTH RESOURCES. QUORUM PROVIDED GARY JEPSON AND BOB HALEY WITH COMPENSATION IN THE AMOUNT OF $141,954 AND $179,216 RESPECTIVELY. ALL FEES ARE PAID TO QUORUM BY PEKIN MEMORIAL HOSPITAL.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF PEKIN TAZEWELL COUNTY ILLINOISBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN376002169BondIssuerEIN
Bond Issued2010-03-30BondIssuedDt
Issue Price$23,530,000IssuePriceAmt
PurposeSEE PART VIPurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingfalsePoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$12,125,000RetiredAmt
Bond Defeased$0BondDefeasedAmt
Total Proceeds$23,530,000TotalProceedsAmt
In Reserve Fund$2,835,000InReserveFundAmt
Capitalized Interest$0CapitalizedInterestAmt
Refunding Escrow$11,405,000RefundingEscrowAmt
Issuance Costs From Proceeds$283,000IssuanceCostsFromProceedsAmt
Credit Enhancement$0CreditEnhancementAmt
Working Capital Expenditures$0WorkingCapitalExpendituresAmt
Capital Expenditures$0CapitalExpendituresAmt
Other Spent Proceeds$0OtherSpentProceedsAmt
Unspent$0UnspentAmt
Substantial Completion2010SubstantialCompletionYr
Current RefundingYes (true)CurrentRefundingInd
Advance RefundingfalseAdvanceRefundingInd
Final Allocation MadefalseFinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsYes (true)AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropfalseMgmtContractBondFincdPropInd
Any Research AgreementsfalseAnyResearchAgreementsInd
Private Bus Use By Others0.02400PrivateBusUseByOthersPct
Private Bus Concerning UBI0.00000PrivateBusConcerningUBIPct
Total Private Business Use0.02400TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt TestfalseBondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed PropfalseChangeInUseBondFinancedPropInd
Remedial Action TakenfalseRemedialActionTakenInd
Procs Nonqualified Bond RemdtdYes (true)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledYes (true)Form8038TFiledInd
Variable Rate IssuefalseVariableRateIssueInd
Hedge Identified In Bks And RecfalseHedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1Txt
FieldValueIRS element (for citing)
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd

GIC Provider Name GICProviderName

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1Txt
FieldValueIRS element (for citing)
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsfalseWrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionfalseProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE A, COLUMN FFormAndLineReferenceDesc
ExplanationREV REFUNDING BONDS SER 1993B AND C AND 1997ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (19 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 2FAMILY 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 3DELEGATING 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 6MEMBERS AND STOCKHOLDERS PROGRESSIVE HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7AELECTION 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 7BAPPROVAL 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 11BPROCESS 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 12CORGANIZATION'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 C, LINE 19DISCLOSURE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC.
FORM 990, PART IX, LINE 9OTHER CHANGES IN NET ASSETS CHANGE IN MINIMUM PENSION LIABILITY <3,654,386> TRANSFERS TO AFFILIATES <4,090,916> CHANGE IN INVESTMENT IN FOUNDATION 36,793 ------------- TOTAL OTHER CHANGE IN NET ASSETS <7,708,509>
FORM 990, SUPPLEMENT TO PART III, LINE 4ASTATEMENT OF PROGRAM SERVICE ACCOMPLISHMENT PROGRESSIVE HEALTH SYSTEMS PEKIN HOSPITAL COMPREHENSIVE COMMUNITY BENEFIT REPORT FOR THE YEAR-ENDED APRIL 30, 2015 MISSION STATEMENT: TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY AND TO DO SO WITH LOVE, COMPASSION AND EXTRAORDINARY MEDICAL CARE. OUR VISION: PEKIN HOSPITAL WILL CONSISTENTLY PROVIDE A SUPERIOR HEALTH CARE EXPERIENCE THAT EARNS THE TRUST OF OUR COMMUNITY. PEKIN HOSPITAL IS: ACCREDITED BY: JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS LICENSED BY: THE STATE OF ILLINOIS DEPARTMENT OF PUBLIC HEALTH AFFILIATED WITH: OSF HEALTHCARE SYSTEM UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE AT PEORIA PROFESSIONAL THERAPY SERVICES ILLINOIS CENTRAL COLLEGE BRADLEY UNIVERSITY QUORUM HEALTH RESOURCES MEMBER OF: AMERICAN HOSPITAL ASSOCIATION AMERICAN RED CROSS PEORIA REGIONAL BLOOD PROGRAM CONSORTIUM FOR TOTAL HEALTH CARE ILLINOIS ASSOCIATION OF HOME CARE (IAHC) ILLINOIS HOSPITAL ASSOCIATION ILLINOIS MATERNAL CHILD HEALTH COUNCIL PEKIN CHAMBER OF COMMERCE REGION IB TRAUMA AND PERINATAL NETWORKS CERTIFIED BY ILLINOIS DEPARTMENT OF PUBLIC HEALTH DESIGNATED AFFILIATE TRAUMA HOSPITAL EMERGENCY DEPARTMENT APPROVED FOR PEDIATRICS (EDAP) COMMUNITY BENEFIT PLAN - GOALS AND OBJECTIVES A. MEDICATION RECONCILIATION TO FURTHER PROMOTE PATIENT SAFETY, PEKIN HOSPITAL'S MEDICATION RECONCILIATION TEAM WILL HEIGHTEN COMMUNITY AWARENESS OF THE IMPORTANCE OF HAVING AN ACCURATE LISTING OF THEIR MEDICATIONS, AS WELL AS ANY HERBALS, SUPPLEMENTS, OVER-THE-COUNTERS, ETC. B. COMMUNITY EDUCATION TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE, PEKIN HOSPITAL WILL OFFER A VARIETY OF EDUCATIONAL OPPORTUNITIES FOR AREA RESIDENTS INCLUDING LECTURES AND CLASSROOM SESSIONS. C. COMMUNITY SUPPORT UNITED WAY - PEKIN HOSPITAL CONTRIBUTES TO THE ANNUAL CAMPAIGN. D. COMMUNITY EMERGENCY RESPONSE E. PROVIDING CARE BASED ON NEED 1. CHARITY CARE 2. MEDICAID 3. MEDICARE F. COMMUNITY INVOLVEMENT 1. COMMUNITY OUTREACH THE MARKETING AND COMMUNITY RELATIONS DEPARTMENT PLAYS AN ACTIVE ROLE IN THE COMMUNITY. OUTREACH AND ENGAGEMENT EFFORTS INCLUDE REGULAR PARTICIPATION IN EVENTS AND SERVICE ORGANIZATIONS INCLUDING BUT NOT LIMITED TO LOCAL CHAMBERS OF COMMERCE, LOCAL CONVENTION AND VISITORS BUREAUS, LOCAL PARK DISTRICTS, LOCAL NOT-FOR-PROFITS, ROTARY, PEKIN MAIN STREET, AND NETWORKING GROUPS. OUR TEAM IS DEVELOPING STRONGER RELATIONSHIPS WITH OUR VALUED COMMUNITY PARTNERS, INCLUDING MEMBERS OF THE LOCAL MEDIA. 2. PEKIN AREA CHAMBER OF COMMERCE PEKIN HOSPITAL WILL CONTINUE ITS ACTIVE ROLE WITH THE CHAMBER OF COMMERCE, AND WILL ENCOURAGE EMPLOYEE PARTICIPATION IN THEIR MANY EVENTS AND/OR VOLUNTEER ROLES. 3. COMMUNITY LEADERSHIP ACADEMY PEKIN HOSPITAL IS DEDICATED TO IDENTIFYING AND PROMOTING FUTURE COMMUNITY LEADERS AND WILL CONTINUE TO ENROLL EMPLOYEES IN THE PEKIN AREA CHAMBER OF COMMERCE ANNUAL COMMUNITY LEADERSHIP ACADEMY. THE ACADEMY AIMS TO INFORM AND EDUCATE EXISTING AND EMERGING LEADERS OF THE LOCAL COMMUNITY, AND TO MOTIVATE THEM TOWARD LEADERSHIP RESPONSIBILITIES BY EXPOSING THEM TO THE REALITIES, OPPORTUNITIES AND CHALLENGES OF THE LOCAL COMMUNITY. G. COMMUNITY SCREENINGS TO FURTHER PROMOTE THE HEALTH OF THE COMMUNITIES WE SERVE, PEKIN HOSPITAL IS COMMITTED TO OFFERING FREE COMMUNITY SCREENINGS EACH MONTH. POPULATIONS AND COMMUNITIES SERVED BY THE HOSPITAL PEKIN HOSPITAL'S PRIMARY SERVICE AREA IS COMPRISED OF THE THREE PEKIN ZIP CODES (INCLUDES SOUTH PEKIN) AND SEVEN ADDITIONAL ZIP CODES LOCATED WEST, SOUTH AND EAST OF PEKIN WITH A TOTAL POPULATION OF APPROXIMATELY 58,997. PEKIN HOSPITAL'S SECONDARY SERVICE AREA IS COMPRISED OF FIVE ZIP CODES LOCATED NORTHWEST, NORTHEAST AND EAST OF PEKIN WITH A TOTAL POPULATION OF APPROXIMATELY 14,213. MEDIAN AGE PRIMARY SERVICE AREA: 40.7 YEARS MEDIAN AGE SECONDARY SERVICE AREA: 42.5 YEARS MEDIAN AGE ILLINOIS: 38.2 YEARS COMPARED TO THE STATE OF ILLINOIS OVERALL, THE PRIMARY SERVICE AREA RESIDENTS HAVE LESS HOUSEHOLD INCOME AND THE SECONDARY SERVICE AREA RESIDENTS HAVE MORE HOUSEHOLD INCOME. MEAN HOUSEHOLD INCOME PRIMARY SERVICE AREA: $54,500 MEAN HOUSEHOLD INCOME SECONDARY SERVICE AREA: $68,864 MEAN HOUSEHOLD INCOME ILLINOIS: $60,363 CHARITY CARE MEDICAL CARE IS AVAILABLE TO PATIENTS, BASED ON MEDICAL NECESSITY, REGARDLESS OF THEIR ABILITY TO PAY. PATIENTS MAY REQUEST CHARITY ASSISTANCE APPLICATIONS BY TELEPHONE OR IN PERSON. PEKIN HOSPITAL WAIVES CHARGES BASED ON REVIEW OF THE PATIENT'S FINANCIAL STATUS COMPARED TO FEDERAL POVERTY GUIDELINES. INFORMATION REGARDING CHARITY CARE MAY BE FOUND THROUGHOUT THE HOSPITAL INCLUDING IN PATIENT REGISTRATION, OUTPATIENT DEPARTMENTS, EMERGENCY DEPARTMENT, AND THE PATIENT SERVICE DEPARTMENTS. INFORMATION REGARDING FINANCIAL PROGRAMS, INCLUDING CHARITY CARE, CAN ALSO BE FOUND ON THE HOSPITAL'S WEBSITE AT WWW.PEKINHOSPITAL.ORG. CHARITY CARE DOES NOT INCLUDE BAD DEBT OR UNREIMBURSED COSTS OF MEDICARE, MEDICAID OR OTHER GOVERNMENT PROGRAMS. THE COST OF PROVIDING CHARITY CARE FOR THE FISCAL YEAR ENDING APRIL 30, 2015 WAS $159,000 COMMUNITY BENEFITS A. LANGUAGE ASSISTANT SERVICES BASED ON THE NEEDS OF OUR NON-ENGLISH SPEAKING GUESTS, PEKIN HOSPITAL PROVIDES INTERPRETER PHONE SERVICES FOR A VARIETY OF LANGUAGES. PEKIN ALSO HAS INTERNAL INTERPRETERS. B. GOVERNMENT SPONSORED INDIGENT HEALTH CARE UNREIMBURSED CARE PROVIDED TO PATIENTS UNDER MEDICARE AND PUBLIC AID PROGRAMS, ELIGIBILITY WHICH IS BASED ON FINANCIAL NEED. INPATIENT AND OUTPATIENTS COSTS ARE INCLUDED. UNREIMBURSED CARE FROM MEDICARE WAS $6,761,000 AND PUBLIC AID WAS $7,728,000 FOR FISCAL YEAR ENDING APRIL 30, 2015 FOR A TOTAL OF $14,489,000. C. DIRECT SUPPORT OF OTHER COMMUNITY ORGANIZATIONS - 1. CONFERENCE SPACE: OVER 400 HOURS WERE DONATED FOR CONFERENCE ROOMS - MOMS WHOLEHEARTED SUPPORT GROUP, CHILDBIRTH EDUCATION, HELP AT HOME, THE COMPASSIONATE FRIENDS, TAZEWELL COUNTY HEALTH DEPARTMENT, PRENATAL AND BREASTFEEDING EDUCATION AND SUPPORT GROUPS, BREASTFEEDING MOTHERS, PEKIN AREA CHAMBER OF COMMERCE, CENTRAL ILLINOIS BREASTFEEDING TASK FORCE, 4-H, ILLINOIS CANCER CENTER, THE UNITED WAY, RED CROSS, AND THE BUSINESS FORUM. 2. UNITED WAY OF PEKIN: $8,000 WAS DONATED IN SUPPORT OF THE 2015 UNITED WAY CAMPAIGN. D. VOLUNTEERS 1. VOLUNTEER HOURS - 19,133 2. VOLUNTEER HOURS FROM SCREENINGS - 525 E. SCREENINGS/HEALTH FAIRS 1. COMMUNITY SCREENINGS: FROM MAY 1, 2014 THROUGH APRIL 30, 2015, PEKIN HOSPITAL PROVIDED A VARIETY OF FREE COMMUNITY SCREENINGS TO 811 INDIVIDUALS IN THE PEKIN AREA. OF THE 811 INDIVIDUALS SCREENED, 218 HAD ABNORMAL RESULTS. THE FOLLOWING SCREENINGS WERE PROVIDED: SKIN SCREENING, BONE DENSITY, HEEL SCANS, BLOOD PRESSURE CHECKS, BODY COMPOSITION, SPIROMETRY TESTING, PERIPHERAL VASCULAR SCREENING, AND PHYSICAL THERAPY FITNESS. PEKIN HIGH SCHOOL BOYS AND GIRLS PHYSICALS IN AUGUST OF 2014, 130 PHYSICALS COMPLETED. WOMEN'S LIFESTYLE SHOW, PERFORMED BONE DENSITY SCREENING, 93 NORMAL SCREENINGS AND 23 ABNORMAL SCREENINGS. SCHRAMM SCHOOL BONE DENSITY SCREENINGS, 15 NORMAL AND 1 ABNORMAL SCREENING. AS PART OF NATIONAL MAMMOGRAPHY DAY 2014, PEKIN HOSPITAL PARTNERED WITH TAZEWELL COUNTY HEALTH DEPARTMENT TO OFFER FREE MAMMOGRAMS TO TAZEWELL COUNTY WOMEN AGES 40 AND OVER WHO ARE UNINSURED. THERE WERE 26 FREE MAMMOGRAMS PROVIDED, WITH 3 ABNORMAL RESULTS. THIS WAS THE 13TH YEAR FOR THE ANNUAL EVENT. 2. HEALTH FAIRS: PEKIN HOSPITAL PARTICIPATED BY PROVIDING SCREENINGS AT A NUMBER OF LOCAL HEALTH FAIRS. A. HERGET BANK HEALTH FAIR: 12 WERE SCREENED FOR BONE DENSITY, 21 FOR SPIROMETRY SCREENING AND 16 FOR BLOOD PRESSURE SCREENING, AND 27 FLU SHOTS ADMINISTERED. B. AVENTINE HEALTH FAIR: 170 PARTICIPATED IN THE LIFTING APTITUDE TEST, 65 FLU SHOTS ADMINISTERED, 144 PARTICIPANTS RECEIVED BLOOD DRAWS. C. PEKIN INSURANCE HEALTH FAIR: 139 FLU SHOTS ADMINISTERED. D. CITY OF PEKIN/TAZEWELL COUNTY HEALTH FAIR: 67 RECEIVED BONE DENSITY SCREENINGS, 16 HAD FOOT SCREENINGS, 9 HAD SKIN SCREENINGS, AND 35 HAD PHYSICAL THERAPY FITNESS SCREENINGS. E. FAMILY & BUSINESS SHOWCASE: 13 PARTICIPANTS RECEIVED BLOOD PRESSURE SCREENINGS, 15 RECEIVED BONE DENSITY SCREENINGS, AND 9 RECEIVED SPIROMETRY SCREENINGS, 6 PARTICIPATED IN THE PHYSICAL THERAPY CHALLENGE, 5 PARTICIPATED IN THE SKIN CANCER SCREENING. F. WOMEN'S LIFESTYLE SHOW: 116 PARTICIPATED IN THE BONE DENSITY SCREENING. G. TREMONT UNITED METHODIST CHURCH: 22 RECEIVED SPIROMETRY SCREENINGS, AND 28 RECEIVED BONE DENSITY SCREENINGS. H. PERIPHERAL VASCULAR DISEASE SCREENING: 23 NORMAL SCREENINGS, 1 ABNORMAL SCREENING. F. COMMUNITY EDUCATION 1. DIABETES EDUCATION: NINE (THREE-HOUR) COMMUNITY DIABETES CLASSES WERE OFFERED TO INCLUDE A TOTAL OF 20 PARTICIPANTS. 2. MEDICATION RECONCILIATION: TO RAISE COMMUNITY AWARENESS ON THIS TOPIC, WALLET CARDS THAT ASSIST PATIENTS IN KEEPING ACCURATE LISTS OF MEDICATIONS WERE PLACED IN ALL INPATIENT FOLDERS. THE WALLET CARDS WERE ALSO PROVIDED AT OUR RETAIL PHARMACY, SENIOR EXPO EVENTS, AND OTHER COMMUNITY EVENTS. 3. PUBLIC LECTURES: A. STRETCH BREAK WORKSHOP AT PEKIN INSURANCE MAIN OFFICE 02/24/2014: 27 PARTICIPANTS B. WO
FORM 990, PART VI, SECTION B, LINE 15ACOMPENSATION REVIEW THE CEO IS EMPLOYED BY AN OUTSIDE MANAGEMENT COMPANY.
FORM 990, PART VI, SECTION B, LINE 15BCOMPENSATION REVIEW HUMAN RESOURCES AND THE CEO REVIEW THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION ON AN ANNUAL BASIS.
FORM 990 PART IX LINE 11GDESCRIPTION:PHYSICIAN FEES TOTAL FEES:1198189
FORM 990 PART IX LINE 11GDESCRIPTION:BLOOD PROCESSING FEES TOTAL FEES:537744
FORM 990 PART IX LINE 11GDESCRIPTION:RADIOISOTOPES TOTAL FEES:213655
FORM 990 PART IX LINE 11GDESCRIPTION:THERAPY FEES TOTAL FEES:1082430
FORM 990 PART IX LINE 11GDESCRIPTION:SERVICE CONTRACTS TOTAL FEES:2348736
FORM 990 PART IX LINE 11GDESCRIPTION:COLLECTION AGENCY FEES TOTAL FEES:331921
FORM 990 PART IX LINE 11GDESCRIPTION:CONTRACT LABOR & OTHER PUR SRV TOTAL FEES:3542137

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
PROGRESSIVE HEALTH SYSTEMS
600 SOUTH 13TH STREETPEKINIL61554371200263SUPPORT ORGIL501(C)311 - IINAfalse
PARK COURT LIMITED
600 SOUTH 13TH STREETPEKINIL61554371178386SUPPORT ORGIL501(C)311 - IIPROG HEALTHfalse
PEKIN MEMORIAL HOSPITAL FOUNDATION
600 SOUTH 13TH STREETPEKINIL61554371200267SUPPORT ORGIL501(C)311 - IIPROG HEALTHfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1PEKIN HOSP PAIN MGTBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1600 SOUTH 13TH STREETAddressLine1Txt
CityPEKINCityNm
State AbbreviationILStateAbbreviationCd
ZIP61554ZIPCd
FieldValueIRS element (for citing)
EIN465038592EIN
Primary ActivitiesCLINICPrimaryActivitiesTxt
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Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1PEKIN HOSPBusinessNameLine1Txt
FieldValueIRS element (for citing)
Predominant Income TypeRELATEDPredominantIncomeTypeTxt
Share Of Total Income-$24,917ShareOfTotalIncomeAmt
Share Of EOY Assets$38,138ShareOfEOYAssetsAmt
Disproportionate AllocationsfalseDisproportionateAllocationsInd
General Or Managing PartnerYes (true)GeneralOrManagingPartnerInd
Ownership0.51000OwnershipPct

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtControlled OrganizationControlledOrganizationInd
PRO HEALTH INC (PHI)
600 SOUTH 13TH STREETPEKINIL61554371117052CLINICILPROG HEALTHC CORP$0$0false
MARIGOLD CITY LAND TRUST NO ONE
2956 COURT STREETPEKINIL61554272750273PROPERTY MGMTILPARK COURTTRUST$0$0false
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (true)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (7 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
PEKIN PAIN MANAGEMENT LLC
A$21,148FMV
PEKIN PAIN MANAGEMENT LLC
J$78,452COST +O/H ALLOC
PEKIN PAIN MANAGEMENT LLC
J$161,673SALARY/BENEFITS
PEKIN PAIN MANAGEMENT LLC
L$29,241COST +O/H ALLOC
PEKIN PAIN MANAGEMENT LLC
L$13,602MARKETING COST
PEKIN PAIN MANAGEMENT LLC
L$9,882COST +O/H ALLOC
PEKIN PAIN MANAGEMENT LLC
R$294,309PPM PAYMENTS

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