2015-05-13T14:15:15-07:00 2014-09-30 Gray Hunter Stenn LLP 500 Maine Street Quincy IL 62301 990 2013-10-01 371396010 BLESSINGCARE CORPORATION dba ILLINI COMMUNITY HOSPITAL BLES 2172852113 640 WEST WASHINGTON PITTSFIELD IL 62363 PATRICK M GERVELER Treasurer 2015-05-13 true STEPHEN C KOESTER CPA P00342386 2172220304 2013 2016-02-25 16:41:14Z 21504800 false false X www.illinihospital.org X 2000 IL TO IMPROVE THE HEALTH OF OUR COMMUNITY. 9 5 210 34 0 7947 318053 328852 22961559 20859514 8886 12187 459978 295862 23748476 21496415 0 0 9746709 9961694 0 0 12067897 10807141 21814606 20768835 1933870 727580 17222145 17813565 8125196 7989036 9096949 9824529 TO IMPROVE THE HEALTH OF OUR COMMUNITY. false false 14982134 20859514 THE HOSPITAL TREATED PATIENTS THROUGH THE FOLLOWING SERVICES DURING THE YEAR: 6,675 EMERGENCY ROOM VISITS, 20,363 OUTPATIENT VISITS, 362 SURGICAL OPERATIONS, 266 INPATIENT ADMISSIONS AND 151 OBSERVATION ADMISSIONS. 14982134 true true false false 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 false false false false false false false false false false false false false false false false true false false false false true 33 0 true 210 true true false false false false false false 0 false false false false false false false false false false X 9 5 false true false false true true true true true false false true true true true true true true true true true X KATHY HULL 2172852113 640 WEST WASHINGTON PITTSFIELD IL 62363 JAN BLEICH Trustee 1.00 0.00 X 0 0 0 JOSE C DEL-ROSARIO PRES - MEDICAL 1.00 39.00 X 0 269294 18470 B BRADFORD BILLINGS Secretary 1.00 39.00 X X 0 1822822 81211 ROBERTA SIMPSON-DOLBEARE Chairperson 1.00 0.00 X X 0 0 0 CHRISTOPHER S WAGONER MD PRES - MEDICAL 1.00 39.00 X 0 179027 16825 KATHLEEN E HULL President/CEO 40.00 0.00 X X 0 225196 20030 JAMES C GAY Trustee 1.00 0.00 X 0 0 0 PATRICK M GERVELER Treasurer 1.00 39.00 X X 0 402302 58124 ERIC MILLER Trustee 1.00 0.00 X 0 0 0 LAURA KENT-DONAHUE ViceChairperson 1.00 0.00 X X 0 0 0 ROBERT ROWLES CRNA 40.00 0.00 X 199834 0 3250 MARK TATUM PHARMACIST 40.00 0.00 X 128796 0 14910 328630 2898641 212820 2 false true false AIMS OF PITTSFIELD LLC 12533 W LAKE VIEW DR ORLAND PARK IL 60467 ER PHYSICIANS 1848592 BLESSING CORPORATE SERVICES BROADWAY AT 11TH QUINCY IL 62301 MANAGEMENT SERVICES 506913 QUINCY MEDICAL GROUP 1025 MAINE ST QUINCY IL 62301 MEDICAL SERVICES 304500 SIEMENS MEDICAL SOLUTIONS INC 51 VALLEY STREAM PARKWAY MALVERN PA 19355 MAINTENANCE 183826 SHARED MEDICAL SERVICES INC 209 LIMESTONE PASS COTTAGE GROVE WI 53527 RADIOLOGY SERVICES 115850 6 45443 283409 328852 CONTRACTUAL ALLOWANCE -22632325 -22632325 PATIENT REVENUE 43491839 43491839 20859514 12187 12187 0 0 132147 8385 123762 123762 123762 0 0 0 44923 44923 44923 EQUITY IN SUB'S INCOME -33889 -33889 OTHER 161066 161066 127177 21496415 20859514 308049 0 0 0 0 0 0 7138569 5283950 1854619 168761 124916 43845 2157971 1596214 561757 496393 367429 128964 0 -8841 -8841 0 0 0 0 0 77199 77199 0 0 0 363843 109615 254228 58005 33114 24891 0 0 86464 86464 0 876014 268849 607165 177209 177209 PHYSICIAN FEES 2736699 2736699 OUTSIDE FEES 2307233 966306 1340927 PATIENT SUPPLIES 1630854 1542283 88571 BAD DEBTS 840898 840898 1661564 1111861 549703 20768835 14982134 5786701 0 2660426 5575607 1716059 1719520 0 5356069 3088791 0 0 0 471094 465737 130175 112332 16979705 10300885 5676795 6678820 0 0 0 0 1211527 172758 17222145 17813565 468291 733361 3900459 3506125 3756446 3749550 8125196 7989036 X 8749392 9786838 347557 37691 9096949 9824529 17222145 17813565 727580 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 264751 264751 7458412 4160095 3298317 370497 272176 98321 7716470 5868614 1847856 1169575 1169575 6678820 ACCRUED EMPLOYEE BENEFITS 9117 ACCRUED INTEREST 6512 ACCRUED SALARIES 844760 DUE TO BLESSING HOSPITAL 336758 ESTIMATED THIRD-PARTY SETTLEMENTS 2392949 NONCURRENT ACCRUED MALPRACTICE 76979 PAYROLL TAXES & WITHHOLDING 14750 RETAINAGE AND CONSTRUCTION AP 67725 3749550 20441077 -773276 -773276 21214353 282062 282062 21496415 19935442 8385 8385 19927057 841778 841778 20768835 Part XI, Line 4b: Other revenue amounts included on 990 but not included in F/S RESTRICTED CONTRIBUTIONS $290447 RENTAL EXPENSES $-8385 Part XII, Line 2d: Other expenses and losses per audited F/S RENTAL EXPENSES $8385 Part XII, Line 4b: Other revenue amounts included on 990 but not included in F/S BAD DEBT REDUCTION OF REVENUE ON F/S $841778 true true X true X true X 275.000000000 true true true false true true 556557 556557 0.02710 4329841 2398018 1931823 0.09420 4886398 2398018 2488380 0.12130 42864 42864 0.00210 42864 42864 0.00210 4929262 2398018 2531244 0.12340 true 841778 39311 8413062 8477317 -64255 X true true ILLINI HEALTH SERVICES LLC PHARMACY/MEDICAL EQUIPMENT 0.05000 ADVANCE PTILLINI COMM HOSP PHYSICAL THERAPY SERVICES 0.47000 1 1 ILLINI COMMUNITY HOSPITAL true X X X X X X X X X 12 true false true X X X X X X false false false true true 150.0000 true 275.0000 true X X X X X X X X true true X X X X X X true false true X false false Part V, Line 3 - Account Input from Person Who Represent the Community The community health needs assessment was conducted with Illini Community Hospital through a consulting arrangement with the Illinois Critical Access Hospital Network. Avenues for gathering primary data were reviewed and it was determined to proceed with three focus groups. Focus Group #1, comprised of Health Care Professionals/Partners included a doctor, a representative of the local health department, a pharmacist, and a representative of an ambulance service. Focus Group #2, comprised of Community Leaders and Groups included representatives of local service organizations, a food bank, a chamber of commerce, and a nutrition program at University of Illinois Extension and a rural electric cooperative. Focus Group #3, comprised of Community Officials and Program Administrators, included school board members, school officials, mayors, and representatives of the mental health center and nursing homes. Part V, Line 7 - Explanation of Needs Not Addressed and Reasons Why Illini Community Hospital did not address Prevention and Tax of Substance abuse. There are other resources in the county who address these issues: ATOD (Alcohol, Tobacco & Other Drugs) task force and Mental Health Services of Western Illinois. 1 ILLINI COMMUNITY HOSPITAL RURAL HEALTH CLINIC 321 WEST WASHINGTON PITTSFIELD IL 62363 RURAL HEALTH CLINIC Part I, Line 7 - Explanation of Costing Methodology When possible, calculations of direct and indirect costs associated with the services provided are reported. If not available, a cost-to-charge ratio is used to calculate the cost amounts. This ratio is computed using Illini Hospital's as-filed Medicare cost report. These costs and charges are adjusted to account for items not reimbursed through the cost report such as provider-based physician services. Part I, Line 7, Column F - Explanation of Bad Debt Expense Bad Debt Expense of $840,898 is subtracted from total expenses of $20,768,835 reported on line 25, column a of Form 990, part IX. Part I, Line 7g - Costs Associated With Physicans Clinics Illini Hospital does not include as subsidized health services any costs attributable to a physician clinic. Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense Methodology used to Determine Bad Debt Expense - Bad Debt Expense is calculated on the Net Patient Account balance after the balance has been reduced for any payments received or discounts/adjustments that are known. Patients qualifying for financial assistance are recognized as charity care accounts when sufficient information is received to determine their eligibility. Prior to this point, an Allowance for Doubtful Accounts is calculated on uninsured accounts. This allowance is reversed if the account is determined to qualify for financial assistance. Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit Methodology of estimated amount & rationale for including in Community Benefit - A number of patients are truly unable to pay for their medical expenditures but do not complete the process required to apply for financial assistance. The Hospital uses financial and other information of such patients otherwise available to the Hospital to identify those patients that would qualify for charity care if they completed the paperwork. The bad debt expense associated with such patient's accounts are treated as community benefit. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients Collection practices are not pursued if a completed financial assistance application has been returned and approved. Part VI - Needs Assessment Illini has contracted with the Illinois Critical Access Hospital Network to assist with the completion of the community health needs assessment. Illini will partner with the Pike County Community Health Partnership to assure the broad interests of the community served by the hospital are assessed and individuals with special knowledge or expertise in public health are included. Part VI - Patient Education of Eligibility for Assistance All Illini Hospital self-pay inpatients are contacted by a Financial Counselor within 24 hours of admission ON WEEKDAYS. The patient is screened for government programs or eligibility for participation in available community programs. Outpatients are contacted once the patient's condition has been stabilized and are screened in the same manner as inpatients. If the financial counselor is not available to meet with a patient at an appropriate time OR IT IS THE WEEKEND, the patient is given contact information and asked to call if assistance is needed. Part VI - Community Information Illini opened its doors on January 26, 1942 to serve the people residing within a 25 mile radius of Pittsfield, Illinois, which is primarily Pike County but includes parts of Scott, Green, Calhoun, Brown, and Adams County. Pike County has 831 square miles of land area and a population of around 16,300 and the total service area is around 25,000. Pike County age demographics include 6.0% under 5 years old, 22.5% under 18 years old, AND 18.9% over 65 years old. 50.0% of the population is female, 96.9% are white, and 1.8% are black. 84.9% of the population have graduated from high school and 12.1% have a bachelors degree OR higher. The median household income is $40,668 and 16.2% of the population is below the poverty level. Pike County is designated as a health professional shortage area and medically underserved area. The unemployment rate in Pike County WAS 6.6% AT 12/31/2013. The region's economy is heavily agriculture with retail and tourism associated with deer hunting. Illini is one of the largest employers with 182 employees. Part VI - Community Building Activities Illini Hospital conducts no activities considered Community Building Activities as defined by the Schedule H instructions. Part VI - Explanation Of How Organization Furthers Its Exempt Purpose Illini Hospital offers a wide range of services important to promoting the health and well-being of Pike County and the surrounding area. Illini Hospital operates an emergency room available to all regardless of the ability to pay. The financial assistance policy of Illini Hospital enables patients to have access to area resources to assist them with payment of medical expenses. Illini Hospital is the largest employer in the area with 210 employees. Of significant importance is the volunteers that serve the Hospital. In Fiscal Year 2014, Illini Community Hospital had 34 active volunteers. In addition to the volunteers actively working in the hospital, Illini's Board of Trustees is comprised of volunteers that includes business leaders, physicians, and other community leaders. Part VI - Affilated Health Care System Roles and Promotion Blessing Corporate Services, Inc. is the parent organization of a group of related organizations and provides overall direction to all entities within the structure. During the year ended September 30, 2005, Blessing Corporate Services, Inc. began operating a division comprised of practicing physicians. The Group is related through Board control. The following is a brief description of each member of the Group.Organization - Blessing Hospital (Hospital), located in Quincy, Illinois, is a not-for-profit acute care hospital. The Hospital provides inpatient, outpatient and emergency care services for residents of Western Illinois and Northeastern Missouri. The Hospital was incorporated in Illinois in 1875.Organization - The Blessing Foundation, Inc. serves Blessing Corporate Services and its affiliated entities by providing financial support for services and programs promoting the improvement and availability of healthcare services within the general community.Organization - Denman Services, Inc. (a taxable corporation) engages primarily in the business of selling and renting medical equipment and operating a commercial laundry. Denman Services, Inc. is a wholly owned subsidiary of Blessing Corporate Services, Inc.Organization - BlessingCare Corporation dba Illini Community Hospital, located in Pittsfield, Illinois, is a not-for-profit acute care hospital. The Hospital provides inpatient, outpatient and emergency care services for residents of Western Illinois. The Hospital was incorporated on January 20, 2000. Organization - Illini Health Services, LLC conducts a pharmacy business in Pittsfield, Illinois. The Pharmacy is owned ninety-five percent (95%) by Denman Services, Inc. and five percent (5%) by BlessingCare Corporation dba Illini Community Hospital. Part VI - States Where Community Benefit Report Filed IL Part V - Explanation of Number of Facility Type Illini Hospital operated no facilities other than the locations listed in Part V. Part VI - Additional Information Part I, line 3C - Illini Hospital uses Federal Poverty Guidelines to determine eligibility for providing free or discounted care.Part I, line 6B - Illini Hospital's community benefit report is published in the local newspaper as an insert and is available on the hospital's website. false true false false false false false false false false B BRADFORD BILLINGS Secretary 440341 10340 1372141 68790 12421 1904033 964000 CHRISTOPHER S WAGONER MD PRES - MEDICAL 177842 1185 1339 15486 195852 JOSE C DEL-ROSARIO PRES - MEDICAL 223546 43042 2706 2984 15486 287764 KATHLEEN E HULL President/CEO 168499 52697 4000 2224 17806 245226 PATRICK M GERVELER Treasurer 283788 87577 30937 39827 18297 460426 ROBERT ROWLES CRNA 197156 248 2430 3250 203084 Form 990, Part VI, Line 3: Description of Delegated Duties to Management Company 1) BLESSING CORPORATE SERVICES PROVIDES GENERAL MANAGEMENT SERVICES.2) WOUND CARE ADVANTAGE PROVIDES MANAGEMENT OF THE WOUND CLINIC. Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder BLESSING CORPORATE SERVICES, INC., AN ILLINOIS NOT FOR PROFIT CORPORATION, IS THE SOLE VOTING MEMBER OF BLESSINGCARE CORPORATION, DBA ILLINI COMMUNITY HOSPITAL. Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body BLESSING CORPORATE SERVICES, INC., THE SOLE VOTING MEMBER OF BLESSINGCARE CORPORATION, SHALL POSSESS THE RIGHTS AND RESPONSIBILITIES TO APPOINT AND/OR REMOVE ALL THE TRUSTEES OF THE CORPORATION, AND APPOINT THE CORPORATION'S PRESIDENT. Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders BLESSING CORPORATE SERVICES, INC., THE SOLE VOTING MEMBER OF BLESSINGCARE CORPORATION, SHALL POSSESS THE RIGHTS AND RESPONSIBILITIES TO approveexpressly all amendments to the corporation's articles of incorporationand bylaws before they may become effective; approve capital and operating budgets, long-term debt, long-range plans, the sale or purchase of real estate and contracts entered into by the corporation, the reasonable value of which exceeds an amount specified in the bylaws of the member; approve material investment decisions,including without limitation establishment and modification ofinvestment policies, engagement and removal of investment managers andadvisors, and changes in investment allocations not permitted by anexisting investment policy; approve the parameters for terms of employment of physicians, including physician compensation plans, and any material variances from such parameters for individual physicians; approve of the selection of auditors and legal counsel; approve of charity care and community benefits-related policies; approve of the formation of subsidiary entities and/or joint ventures; approve of the filing of a petition in bankruptcy, making and assignment for the benefit of creditors, or applying for protection under any insolvency laws; approve of the participation in any merger, combination, consolidation, liquidation, dissolution or other corporate or business entity restructuring, and have the power to compel the corporation to enforce and/or perform any contractual obligation. Form 990, Part VI, Line 11b: Form 990 Review Process FOLLOWING MANAGEMENT AND LEGAL REVIEW, THE FORM 990 WAS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW AND COMMENT PRIOR TO FILING. Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts A COPY OF THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED ANNUALLY TO OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES TO BE READ, SIGNED, AND RETURNED TO THE ORGANIZATION. THE SIGNED POLICIES ARE RETAINED IN THE CORPORATE ADMINISTRATIVE FILES. IN ADDITION, EACH OFFICER, DIRECTOR, OR TRUSTEE IS REQUIRED TO DECLARE NO CONFLICT OF INTEREST IN REGARDS TO AGENDA ITEMS BEING PRESENTED AT THE START OF EACH MONTHLY BOARD MEETING. Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management THE PRESIDENT/CEO OF BLESSING CORPORATE SERVICES, INC. uses Sullivan and Cotter to identify appropriate compensation. He takes his recommendations to the BCS board compensation committee. He leaves and the committee decides. Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees THE PRESIDENT/CEO OF BLESSING CORPORATE SERVICES, INC. uses Sullivan and Cotter to identify appropriate compensation. He takes his recommendations to the BCS board compensation committee. He leaves and the committee decides. Form 990, Part VI, Line 19: Other Organization Documents Publicly Available THESE DOCUMENTS ARE LOCATED IN THE HOSPITAL'S ADMINISTRATIVE OFFICES AND ARE AVAILABLE UPON REQUEST FOR PUBLIC INSPECTION. BLESSING CORPORATE SERVICES INC BROADWAY AT 11TH PO BOX 7005 QUINCY IL 623057005 371128706 PROVIDES DIRECTION AND CONTROL TO ENTITIES IL 501(C)(3) 9 N/A false BLESSING HOSPITAL 1005 BROADWAY QUINCY IL 62301 370661183 NOT-FOR-PROFIT HOSPITAL IL 501(C)(3) 3 BLESSING CORPORATE SERVICES INC false BLESSING AFFILIATES INC BROADWAY AT 11TH PO BOX 7005 QUINCY IL 623057005 371128708 COMMUNITY OUTREACH CLINIC, EDUCATIONAL PROGRAMS IL 501(C)(3) 9 BLESSING CORPORATE SERVICES INC false THE BLESSING FOUNDATION INC PO BOX 7005 QUINCY IL 62301 371128705 FUNDRAISING TO BENEFIT THE RELATED HOSPITALS IL 501(C)(3) 11b BLESSING CORPORATE SERVICES INC false ILLINI HEALTH SERVICES LLC PO BOX 40 QUINCY IL 623060040 470901851 PHARMACY IL BCS INC false false DENMAN SERVICES INC BROADWAY AT 11TH PO BOX 40 QUINCY IL 62306 371132117 MED EQUIP IL BCS INC C CORP false false false false false true false false false true true true false true true true true true false false