2016-03-09T10:57:49-06:00 2015-04-30 BKD LLP 211 N BROADWAY SUITE 600 ST LOUIS MO 631022733 990 2014-05-01 370692351 Pekin Memorial Hospital % PAM ROGERS PEKI 3093530700 600 SOUTH 13TH STREET PEKIN IL 61554 STEVEN C HALL CFO 3093530700 2016-03-09 true Donna J Larson P00043751 3142315544 2014 2016-08-17 19:52:53Z Pekin Hospital STEVEN C HALL CFO 600 S 13TH STREET PEKIN IL 61554 70737312 false X WWW.PEKINHOSPITAL.ORG X 1913 IL TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY AND TO DO SO WITH LOVE, COMPASSION AND EXTRAORDINARY MEDICAL CARE. 11 10 807 137 1072923 387071 82928 64938205 67745618 1703389 1522760 2734781 1303413 69763446 70654719 0 0 0 0 32672990 32150708 0 0 0 31655182 31821288 64328172 63971996 5435274 6682723 70369575 71558832 31937730 33705968 38431845 37852864 X TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY AND TO DO SO WITH LOVE, COMPASSION AND EXTRAORDINARY MEDICAL CARE. false false 58812929 0 68328211 PEKIN 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. 58812929 true true false true false false false false false false true false false false true false false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true true true false false true 128 0 true 807 true true true false false false false false false false false false X 11 10 true true false false true true true true true false false true true true true true true false false true true IL X PAM ROGERS 3093530796 600 SOUTH 13TH STREET PEKIN IL 61554 X DR ERIC REINERTSON TRUSTEE 1.0 43.0 X 0 387774 9536 GORDON CROSS MD TRUSTEE 1.0 4.0 X 0 0 0 DELORES EAGLESON TRUSTEE 1.0 4.0 X 0 0 0 CURTIS EETON TRUSTEE 1.0 4.0 X 0 0 0 RONALD MILLER TRUSTEE 1.0 4.0 X 0 0 0 JASON PROEHL TRUSTEE 1.0 4.0 X 0 0 0 EDWARD SIROTAK TRUSTEE 1.0 4.0 X 0 0 0 JAMES SMALLEY MD SECRETARY/TREASURER 1.0 4.0 X X 0 0 0 ANDREW SPARKS VICE CHAIRMAN 1.0 4.0 X X 0 0 0 MICHAEL TIBBS CHAIRMAN 1.0 4.0 X X 0 0 0 DIRK ROECKER TRUSTEE 1.0 4.0 X 0 0 0 STEVEN C HALL CFO 40.0 4.0 X 269789 0 15064 BOB HALEY CEO 40.0 4.0 X 140000 0 39216 GARY JEPSON CEO (FORMER) 43.0 4.0 X 111962 0 29992 JO ELLEN PATTERSON CNO 40.0 0.0 X 170377 0 9151 MICHAEL JOHNSON ADMIN DIRECTOR OF ANCILLARY SE 40.0 0.0 X 117123 0 6015 ANGELIA DREHER DIRECTOR OF PHARMACY 40.0 0.0 X 144544 0 13946 CYNTHIA DORR HARTHAN PHARMACIST 40.0 0.0 X 117761 0 7795 CATHERINE METESH PHARMACIST 40.0 0.0 X 109833 0 8074 ASHOKKUMAR PATEL PHARMACIST 40.0 0.0 X 112341 0 8279 1293730 387774 147068 9 false true true PROFESSIONAL THERAPY SERVICES INC 2810 FRANK SCOTT PARKWAY STE 824 BELLEVILLE IL 62223 REHAB SERVICES 1139140 MIDWEST ANESTHESIA CONSULTANTS SC 2006 HOGBACK RD ANN ARBOR MI 48105 ANESTHESIOLOGY 1095839 QUORUM 105 CONTINENTAL PLACE PEORIA IL 61615 CONSULTING 819594 ARAMARK FACILITY SVCS 22506 NETWORK CHICAGO IL 60673 EQUIPMENT SERVICES 523112 ARAMARK FOOD PO BOX 651009 CHARLOTTE NC 28265 DIETARY 511658 11 82928 82928 PATIENT REVENUE 621110 66629279 66629279 MEDICAL RECORD REVENUE 561000 43416 43416 REFERENCE LAB REVENUE 621500 1072923 1072923 67745618 924825 924825 0 0 26548 26548 0 26548 26548 629988 50540 82593 629988 -32053 597935 597935 0 0 0 EHR FUNDS 900099 582593 582593 CAFETERIA REVENUE 722410 558519 558519 WELLNESS CENTER 621400 16689 16689 119064 119064 1276865 70654719 67255288 1072923 2243580 X 0 0 0 0 811767 196858 614909 0 0 25641084 23416516 2224568 678014 607243 70771 3112409 2865849 246560 1907434 1708335 199099 795533 795533 184826 184826 60420 60420 0 0 0 9254812 9254812 622903 203402 419501 8132230 8109850 22380 14468 14468 0 1083088 1077673 5415 63861 63861 0 135193 126917 8276 583346 583346 0 3915200 3895624 19576 627232 471911 155321 MEDICAID ASSESSMENT EXPENSE 2720380 2720380 FOOD EXPENSE 595726 595726 IMPLANT FEES 1898219 1898219 REFERENCE LAB 694893 694893 438958 307046 131912 63971996 58812929 5159067 0 122210 103996 4991299 5628123 0 0 10302326 11523840 0 0 0 0 0 0 1005098 1061171 1162723 1593739 86194566 63045763 24203715 23148803 25053928 25108752 0 0 0 0 0 0 3528276 3390408 70369575 71558832 5770289 6618888 0 0 0 0 14135000 11405000 0 0 0 0 2774861 2130972 0 0 9257580 13551108 31937730 33705968 X 38116431 37500657 315414 352207 0 0 38431845 37852864 70369575 71558832 X 6682723 446805 -7708509 X false true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 30154 false false false 30154 false SCHEUDLE C, PART II-B, LINE 1 LOBBYING ACTIVITIES LOBBYING EXPENSES ARE ONLY INCURRED THROUGH ASSOCIATIONS WITH NATIONAL ORGANIZATIONS OF WHICH THE ORGANIZATION IS A MEMBER. 1449581 1449581 11585946 8982257 2603689 19494196 14725759 4768437 51116977 37638358 13478619 2547866 1699389 848477 23148803 0 DUE TO THIRD PARTIES 3678797 MINIMUM PENSION LIABILITY 9851755 DUE TO MEDICARE 20556 13551108 SCHEDULE D, PART X, LINE 2 FIN 48 DISCLOSURE MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true true true X true X 600. true true false true true 152688 152688 0.00240 14362245 6646270 7715975 0.12030 14514933 6646270 7868663 0.12270 10487 10487 0.00020 10487 10487 0.00020 14525420 6646270 7879150 0.12290 true 1064896 159408 14322075 27050869 -12728794 X true true 1 1 PEKIN MEMORIAL HOSPITAL 600 SOUTH 13TH STREET PEKIN IL 61554 PEKINHOSPITAL.ORG 001834 X X X PEKIN MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 12 true false false true X SEE PART V, SECTION C true 12 true SEE PART V, SECTION C false false true X 200. 600. X X true true X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 CHNA - INPUT FROM PERSONS REPRESENTING THE COMMUNITY 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 7A HTTP://PEKINHOSPITAL.ORG/_DATA/FILES/COMMUNITYHEALTHNEEDSASSESSMENT2.PDF SCHEDULE H, PART V, SECTION B, LINE 16I PUBLISHING OF FINANCIAL ASSISTANCE POLICY THE POLICY IS ALSO AVAILABLE IN COMMON AREAS OF THE HOSPITAL, IN PATIENT FINANCIAL SERVICES AND ON OUR WEBSITE. SCHEDULE H, PART V, SECTION B, LINE 22D DETERMINING 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 11 HEALTH 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 10A HTTP://PEKINHOSPITAL.ORG/_DATA/FILES/COMMUNITYHEALTHNEEDSASSESSMENT2.PDF SCHEDULE H, PART V, SECTION B, LINE 16A HTTP://PEKINHOSPITAL.ORG/_DATA/FILES/FULL%20FINANCIAL%20ASSISTANCE%20POLIC Y.PDF SCHEDULE H, PART V, SECTION B, LINE 16B HTTP://WWW.PEKINHOSPITAL.ORG/_DATA/FILES/1_2_HOSPITAL%20ASSISTANCE%20APPLI CATION_0116.DOCX SCHEDULE H, PART V, SECTION B, LINE 16C HTTP://WWW.PEKINHOSPITAL.ORG/_DATA/FILES/1_2_HOSPITAL%20ASSISTANCE%20APPLI CATION_0116.DOCX 2 PEKIN HOSPITAL MRI BUILDING 1300 PARK AVENUE PEKIN IL 61554 DIAGNOSTIC CENTER PEKIN HOSPITAL PAIN MANAGEMENT LLC 600 SOUTH 13TH STREET PEKIN IL 61554 PAIN CLINIC SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT METHODOLOGY THE COST OF BAD DEBT EXPENSE TO THE ORGANIZATION IS DETERMINED BY COMPUTING A RATIO OF COST (TOTAL OPERATING EXPENSE) TO GROSS CHARGES AND THEN MULTIPLYING THAT RATIO BY THE BAD DEBT EXPENSE REPORTED FOR THE HOSPITAL. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT INCLUDED IN COMMUNITY BENEFIT THE ORGANIZATION ESTIMATED THE COST OF BAD DEBT AT 15%. PERCENTAGE WAS OBTAINED UTILIZING LOXOGON TESTING. THE HOSPITAL COMMITS SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND CRITICAL SERVICES WHICH MEET OTHERWISE UNFILLED COMMUNITY NEEDS. MANY OF THESES ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE SELF-SUPPORTING OR FINANCIALLY VIABLE. ADDITIONALLY, AMOUNTS IN LINE 3 EXIST DUE TO THE NUMBER OF PATIENTS WHO DID NOT TAKE THE TIME TO APPLY FOR CHARITY CARE, BUT OTHERWISE QUALIFIED. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT EXPENSE ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SCHEDULE H, PART III, SECTION B, LINE 8 SHORTFALL LINE 6 IS TAKEN FROM MCR COST REPORT - COST TO CHARGE RATIO. THE MEDICARE COST REPORT IS FILED FOLLOWING THE COST REPORT GUIDELINES. MEDICARE PAYMENT SHORTFALLS SHOULD BE REFLECTED AS COMMUNITY BENEFIT AS THE FEDERAL GOVERNMENT PROSPECTIVELY SETS THE HOSPITAL PAYMENT RATES; THE RATES ARE NOT NEGOTIABLE AND CONSEQUENTLY, NO LONGER COVER THE HOSPITAL'S COST TO PROVIDE SERVICES TO MEDICARE BENEFICIARIES. SCHEDULE H, PART III, SECTION C, LINE 9B DEBT COLLECTION POLICY PEKIN FOLLOWS THE CHARITY POLICY, REGARDLESS OF THEIR INSURANCE SITUATION. FOR EXAMPLE, IF THE PERSON HAS A FORM OF INSURANCE, THE INSURANCE COMPANY PAYS, AND PEKIN APPLIES CHARITY CARE BENEFITS TO THE SELF-PAY PORTION REMAINING AFTER THE INSURANCE PAYMENT. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT PEKIN HOSPITAL CONTRACTED WITH 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 3 PATIENT EDUCATION OF ELIGIBILITY TO MAKE OUR PATIENTS, FAMILIES AND THE BROADER COMMUNITY AWARE OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM, THE HOSPITAL HAS TAKEN A NUMBER STEPS TO NOTIFY VISITORS TO ITS FACILITY OF THIS POLICY AND TO WIDELY PUBLICIZE THIS POLICY TO MEMBERS OF THE BROADER COMMUNITY SERVED BY THE HOSPITAL INCLUDING: POSTING OF LEGIBLE SIGNAGE IN HEAVILY TRAFFICKED PATIENT AREAS SUCH AS ADMITTING, EMERGENCY DEPARTMENT AND AMBULATORY REGISTRATION AREAS; PROVIDING PAMPHLETS AND BROCHURES DURING THE ADMISSION AND/OR DISCHARGE PROCESS; PROVIDING NOTICE OF AVAILABILITY OF FINANCIAL ASSISTANCE OR DISCOUNTED CARE AND OTHER FORMS OF COMMUNICATIONS; OFFERING PATIENT AND FAMILY COUNSELING SESSIONS WITH REGISTRARS, PATIENT ACCOUNTING STAFF, OR FINANCIAL COUNSELORS EITHER BEFORE, DURING OR AFTER THE TIME OF SERVICE, AS APPROPRIATE; AND PROVIDING INFORMATION ABOUT THIS POLICY ON THE HOSPITAL'S WEBSITE, INCLUDING THE APPLICATION AND A PLAIN LANGUAGE SUMMARY OF THE POLICY IN A WIDELY AVAILABLE FORMAT, FOR EXAMPLE AS A PDF DOCUMENT. PROVIDING A PLAIN LANGUAGE SUMMARY OF THE POLICY WITH ALL BILLING STATEMENTS (AT LEAST 3 BILLING STATEMENTS) AND ALL OTHER WRITTEN COMMUNICATIONS REGARDING THE BILL DURING THE NOTIFICATION PERIOD; OFFERING AN APPLICATION BEFORE DISCHARGE FROM THE HOSPITAL; INFORMING PATIENTS ABOUT THE HOSPITAL'S POLICY IN ALL ORAL COMMUNICATION REGARDING THE AMOUNT DUE; AND PROVIDING AT LEAST ONE WRITTEN NOTICE STATING WHAT ECAS THE HOSPITAL MAY TAKE IF NO APPLICATION IS RECEIVED OR NO PAYMENTS ARE MADE BY A SPECIFIED DATE (AT LEAST AS LONG AS NOTIFICATION PERIOD) AND THIS NOTICE IS PROVIDED AT LEAST 30 DAYS BEFORE THE DEADLINE. SIGNAGE MUST COMMUNICATE IN CAPITAL LETTERS IF YOU ARE UNINSURED, A SOCIAL SECURITY NUMBER IS NOT REQUIRED TO QUALIFY FOR FREE OR DISCOUNTED CARE. ALL PRINTED INFORMATION AND/OR FORMS REGARDING THE FINANCIAL ASSISTANCE PROGRAM WILL BE AVAILABLE IN PRIMARY LANGUAGES SPOKEN BY POPULATIONS WE SERVE IN ACCORDANCE WITH STATE AND FEDERAL LAW. PRINTED COPIES OF THIS POLICY (INCLUDING THE APPLICATION), ITS PLAIN LANGUAGE SUMMARY, AND THE HOSPITAL'S COLLECTIONS POLICY MAY BE OBTAINED AT NO EXTRA COST BY VISITING OR CALLING THE HOSPITAL'S BUSINESS OFFICE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION PEKIN HOSPITAL PRIMARILY SERVES TAZEWELL, MASON AND PEORIA COUNTIES IN THE STATE OF ILLINOIS. IT IS ONE OF THE LARGEST EMPLOYERS IN THE CITY OF PEKIN AND IN TAZEWELL COUNTY. THE SERVICE AREA SITS TO THE SOUTH AND EAST OF THE GREATER PEORIA AREA, WHERE CATERPILLAR IS A MAJOR INDUSTRIAL EMPLOYER. ITS PRIMARY SERVICE AREA HAS A POPULATION OF 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 5 PROMOTION OF COMMUNITY HEALTH PEKIN HOSPITAL PROVIDES MANY FREE HEALTH SCREENINGS THROUGHOUT THE YEAR TO PROMOTE EARLY DETECTION AND PREVENTION. THIS INCLUDES BUT IS NOT LIMITED TO MAMMOGRAPHY, BONE DENSITY, BLOOD PRESSURE, COLON, OBESITY AND SPIROMETRY. PEKIN HOSPITAL HAS ENGAGED ITS PHYSICIANS TO SPEAK AT DIFFERENT COMMUNITY ORGANIZATIONS, TO SHARE INFORMATION ON HEALTH AND WELL-BEING. IT HAS ALSO SENT REPRESENTATIVES OUT TO DISCUSS HEALTHCARE REFORM. IN FY 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 6 AFFILIATED HEALTH CARE SYSTEM PROGRESSIVE HEALTH SYSTEM IS THE SOLE MEMBER OF PEKIN HOSPITAL, PEKIN HOSPITAL FOUNDATION, PARK COURT LIMITED, PRO HEALTH INC AND PEKIN PAIN MANAGEMENT, LLC. PEKIN HOSPITAL IS A NOT-FOR-PROFIT ENTITY AND IS THE ONLY HOSPITAL UNDER THE PROGRESSIVE HEALTH SYSTEM UMBRELLA. THE FOUNDATION IS A NOT-FOR-PROFIT ENTITY THAT RAISES FUNDS ON BEHALF OF PEKIN HOSPITAL TO ASSIST WITH PURCHASES OF CAPITAL EQUIPMENT AND OTHER LARGE EXPENSES FOR MEDICAL CARE. PARK COURT LIMITED IS A NOT-FOR-PROFIT ENTITY THAT FUNCTIONS AS A PROPERTY HOLDING COMPANY WHICH LEASES MEDICAL OFFICE SPACE TO MEDICAL CARE PROVIDERS. PRO HEALTH INC. IS A FOR-PROFIT PHYSICIAN CLINIC THAT EMPLOYS PHYSICIANS TO CARE FOR ITS PATIENTS AND WHO ALSO HAVE ADMITTING RIGHTS TO PEKIN HOSPITAL. PEKIN HOSPTAL PARTNERED WITH TAZEWELL PAIN MANAGEMENT, LLC TO BRING A PAIN MANAGEMENT SERVICES TO THE COMMUNITY. THE PAIN SERVICES ARE OFFERED UNDER PEKIN PAIN MANAGEMENT, LLC. SCHEDULE H, PART VI, LINE 7 STATEMENT FILING OF COMMUNITY BENEFIT REPORT ILLINOIS ONLY SCHEDULE H, PART I, LINE 7 COST METHODOLOGY THE COSTS REPORTED IN THE TABLE IN PART I, LINE 7 USED A RATIO OF PATIENT CARE COSTS TO CHARGES AS COMPUTED IN WORKSHEET 2 OF THE FORM INSTRUCTIONS. THIS METHODOLOGY WAS USED FOR ALL PATIENT SEGMENTS. SCHEDULE H, PART I, LINE 7, COLUMN F BAD DEBT NO BAD DEBT EXPENSE WAS INCLUDED IN PART IX, LINE 25. X true true X false false false false false false false false false STEVEN C HALL CFO 269789 0 0 0 0 0 9384 0 5680 0 284853 0 0 0 BOB HALEY CEO 140000 0 0 0 0 0 0 0 39216 0 179216 0 0 0 DR ERIC REINERTSON TRUSTEE 0 385473 0 0 0 2301 0 0 0 9536 0 397310 0 0 GARY JEPSON CEO (FORMER) 111962 0 0 0 0 0 0 0 29992 0 141954 0 0 0 ANGELIA DREHER DIRECTOR OF PHARMACY 144361 0 0 0 183 0 4410 0 9536 0 158490 0 0 0 JO ELLEN PATTERSON CNO 169177 0 0 0 1200 0 7951 0 1200 0 179528 0 0 0 SCHEDULE J, PART I, LINE 1A HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES BOB HALEY, CEO, IS THE ONLY INDIVIDUAL THAT RECEIVED PAYMENT FOR HEALTH/SOCIAL CLUB MEMBERSHIP DUES. THE ORGANIZATION ONLY PAYS FOR EXPENSES RELATED TO THE BUSINESS USE OF THE MEMBERSHIP. SCHEDULE J, PART I, LINE 1B WRITTEN 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 COMPANY THE 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. A CITY OF PEKIN TAZEWELL COUNTY ILLINOIS 376002169 2010-03-30 23530000 SEE PART VI false false false A 12125000 0 23530000 2835000 0 11405000 283000 0 0 0 0 0 2010 true false false true A false true false false 0.02400 0.00000 0.02400 false false false true A true false false 0 false 0 false false A false PART I, LINE A, COLUMN F REV REFUNDING BONDS SER 1993B AND C AND 1997 FORM 990, PART VI, SECTION A, LINE 2 FAMILY AND BUSINESS RELATIONSHIPS DR. SMALLEY AND CURTIS EETON HAVE A BUSINESS RELATIONSHIP. ALL BOARD MEMBERS AND OFFICERS HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER AS A RESULT OF ALL SERVING AS BOARD MEMBERS OR OFFICERS OF PEKIN PROHEALTH, INC., A FOR-PROFIT AFFILIATE OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 3 DELEGATING AUTHORITY THE BOARD OF DIRECTORS HAS CONTRACTED WITH QUORUM HEALTH RESOURCES (QHR) TO SERVE AS A MANAGEMENT CORPORATION TO ASSIST IN THE LEADERSHIP OF THE HOSPITAL. QHR PROVIDES PEKIN HOSPITAL WITH LEADERSHIP VIA THE CEO ALONG WITH OTHER CONSULTING SERVICES ON FINANCIAL AND STAFFING NEEDS. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS AND STOCKHOLDERS PROGRESSIVE HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF GOVERNING BODY THE SOLE MEMBER, PROGRESSIVE HEALTH SYSTEMS, HAS THE POWER TO ELECT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B APPROVAL BY MEMBERS THE SOLE MEMBER, PROGRESSIVE HEALTH SYSTEMS, HAS THE RIGHT TO APPROVE THE FOLLOWING DECISIONS BY THE GOVERNING BODY: A) ESTABLISHMENT OR MODIFICATION OF COMPENSATION AND BENEFIT POLICIES; B) DEVELOPMENT OR MODIFICATION OF CORPORATE COMPLIANCE PROGRAMS, INCLUDING PROGRAMS DESIGNED TO DETECT OR PREVENT HEALTH CARE FRAUD OR IMPROPER THIRD PARTY BILLING, ACTIVITIES REGARDING LEGAL AND REGULATORY COMPLIANCE RELATING TO THE CODE, ENVIRONMENTAL ISSUES, OCCUPATIONAL SAFETY AND HEALTH, ANTITRUST, FEDERAL ELECTION LAWS, AND ALL OTHER LAWS APPLICABLE TO THE CORPORATION. VARIOUS OTHER POWERS ARE RESERVED EXCLUSIVELY TO THE SOLE MEMBER, AS OUTLINED IN THE BYLAWS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW 990 FORM 990 WAS REVIEWED BY THE CEO, CFO, AND CONTROLLER. PRIOR TO FILING, THE 990 WAS PROVIDED TO THE BOARD OF DIRECTORS ELECTRONICALLY, AND REVIEWED INDEPENDENTLY BY EACH MEMBER. QUESTIONS BY BOARD MEMBERS WERE HANDLED ON AN INDIVIDUAL BASIS WITH MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 12C ORGANIZATION'S POLICY FOR MONITORING COMPLIANCE PERIODIC SURVEYS ARE PERFORMED REQUESTING DISCLOSURES OF CONFLICTS OF INTEREST. IF IT IS DETERMINED THAT A CONFLICT EXISTS, THE EMPLOYEE WILL BE REQUIRED TO RELINQUISH EITHER THE OUTSIDE BUSINESS INTEREST/ARRANGEMENT OR HIS/HER PHS EMPLOYMENT. THE CONFLICT OF INTEREST POLICIES APPLY TO INDIVIDUALS WHO SERVE AS TRUSTEES, MANAGERS (DEPARTMENT HEADS AND ABOVE), CHIEFS OF CLINICAL DEPARTMENTS, AND ANY OTHER EMPLOYEE, MEDICAL STAFF MEMBER OR NON-EMPLOYED CONTRACTOR ACTING IN A MANAGERIAL OR CLINICAL LEADERSHIP CAPACITY DEEMED BY AN ADMINISTRATIVE OFFICER OR CHIEF OF SERVICE TO BE IN A POSITION TO INFLUENCE DECISION-MAKING FOR THE ORGANIZATION. DISCLOSURE WILL OCCUR THROUGH AN ANNUAL CONFLICT OF INTEREST DISCLOSURE STATEMENT AND THE DISCLOSURE OF OTHER ACTUAL OR POTENTIAL CONFLICTS AS THEY ARISE. POTENTIAL CONFLICTS OF INTEREST SHOULD BE REPORTED TO AN IMMEDIATE UPERVISOR, WHO, IN TURN, IS OBLIGATED TO REPORT THE MATTER TO THE CORPORATE COMPLIANCE OFFICER. THE CORPORATE COMPLIANCE OFFICER IS EXPECTED TO INVESTIGATE REPORTED CONFLICTS AND MAKE A REPORT TO THE COMPLIANCE COMMITTEE ON A QUARTERLY BASIS. ALL BOARD MEMBERS ARE REQUIRED TO REPORT ANY POTENTIAL CONFLICTS OFINTEREST TO THE BOARD OR AN APPLICABLE COMMITTEE OF THE BOARD. AFTER EXCUSING THE MEMBER WITH A POTENTIAL CONFLICT, THE REMAINING MEMBERS OF THE BOARD OR COMMITTEE WILL DISCUSS AND DECIDE IF A CONFLICT EXISTS, BOARD MEMBERS FOUND TO HAVE A CONFLICT ARE REQUIRED TO EXCUSE THEMSELVES FROM ANY DISCUSSIONS REGARDING A TRANSACTION RELATED TO A POTENTIAL CONFLICT AND ARE PROHIBITED FROM VOTING ON ANY SUCH MATTER. FORM 990, PART VI, SECTION C, LINE 19 DISCLOSURE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 9 OTHER 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 4A STATEMENT 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 15A COMPENSATION REVIEW THE CEO IS EMPLOYED BY AN OUTSIDE MANAGEMENT COMPANY. FORM 990, PART VI, SECTION B, LINE 15B COMPENSATION REVIEW HUMAN RESOURCES AND THE CEO REVIEW THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION ON AN ANNUAL BASIS. 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