BLESSINGCARE CORPORATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- BLESSINGCARE CORPORATION (EIN 37-1396010)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-05-08
- IRS object ID
- 201411289349301746
- Schema version
- 2012v2.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-08T12:10:25-07:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Gray Hunter Stenn LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 Maine Street | AddressLine1 |
| City | Quincy | City |
| State | IL | State |
| ZIP Code | 62301 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 371396010 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLESSINGCARE CORPORATION | BusinessNameLine1 |
| Business Name Line2 | dba ILLINI COMMUNITY HOSPITAL | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | BLES | NameControl |
| Phone | 2172852113 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 640 WEST WASHINGTON | AddressLine1 |
| City | PITTSFIELD | City |
| State | IL | State |
| ZIP Code | 62363 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | PATRICK M GERVELER | Name |
| Title | Treasurer | Title |
| Date Signed | 2014-05-08 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | STEPHEN C KOESTER CPA | Name |
| PTIN | P00342386 | PTIN |
| Phone | 2172220304 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 23754283 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| All Affiliates Included | false | AllAffiliatesIncluded |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.illinihospital.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2000 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE THE BEST QUALITY HEALTHCARE AT THE BEST PRICE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 228 | TotalNbrEmployees |
| Total Nbr Volunteers | 38 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 3957 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 287457 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 318053 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 22311917 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 22961559 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 7523 | InvestmentIncomePriorYear |
| Investment Income Current Year | 8886 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1429798 | OtherRevenuePriorYear |
| Other Revenue Current Year | 459978 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 24036695 | TotalRevenuePriorYear |
| Total Revenue Current Year | 23748476 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 9992914 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 9746709 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 12301005 | OtherExpensePriorYear |
| Other Expenses Current Year | 12067897 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 22293919 | TotalExpensesPriorYear |
| Total Expenses Current Year | 21814606 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1742776 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1933870 | RevenuesLessExpensesCY |
| Total Assets BOY | 14529228 | TotalAssetsBOY |
| Total Assets EOY | 17222145 | TotalAssetsEOY |
| Total Liabilities BOY | 7366149 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 8125196 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 7163079 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 9096949 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROVIDE THE BEST QUALITY HEALTHCARE AT THE BEST PRICE. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 15991052 | Expense |
| Revenue | 22961559 | Revenue |
| Description | THE HOSPITAL TREATED PATIENTS THROUGH THE FOLLOWING SERVICES DURING THE YEAR: 6,844 EMERGENCY ROOM VISITS, 22,584 OUTPATIENT VISITS, 444 SURGICAL OPERATIONS, 308 INPATIENT ADMISSIONS AND 118 OBSERVATION ADMISSIONS. | Description |
| Total Program Service Expense | 15991052 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 17 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 228 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Number Of8282 Filed | 0 | NumberOf8282Filed |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Filed Lieu1041 | false | FiledLieu1041 |
| Licensed More Than One State | false | LicensedMoreThanOneState |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | true | InvestmentInJointVenture |
| Written Policy Or Procedure | true | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | KATHY HULL | NamePerson |
| Telephone Number | 2172852113 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 640 WEST WASHINGTON | AddressLine1 |
| City | PITTSFIELD | City |
| State | IL | State |
| ZIP Code | 62363 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| JOHN FRANK MCCARTNEY | ||||||||
| VICECHAIRPERSON | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| PAT SYRCLE | ||||||||
| Trustee | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| PATRICK M GERVELER | ||||||||
| Treasurer | 1.00 | 39.00 | X | X | 0 | 389072 | 59743 | |
| JAMES C GAY | ||||||||
| Trustee | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| KATHLEEN E HULL | ||||||||
| President/CEO | 40.00 | 0.00 | X | X | 0 | 213603 | 16304 | |
| KORHAN RAIF MD | ||||||||
| PRES - MEDICAL | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| CHRISTOPHER WAGONER MD | ||||||||
| PRES - MEDICAL | 1.00 | 39.00 | X | 0 | 180694 | 21395 | ||
| ROBERTA SIMPSON-DOLBEARE | ||||||||
| Chairperson | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| B BRADFORD BILLINGS | ||||||||
| Secretary | 1.00 | 39.00 | X | X | 0 | 821440 | 477102 | |
| JAN BLEICH | ||||||||
| Trustee | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| LAURA KENT-DONAHUE | ||||||||
| Trustee | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| ROBERT ROWLES | ||||||||
| CRNA | 40.00 | 0.00 | 212568 | 0 | 7690 | X | ||
| MARK TATUM | ||||||||
| PHARMACIST | 40.00 | 0.00 | 123773 | 0 | 18975 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 336341 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1604809 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 601209 | TotalOtherCompensation |
| Number Individuals GT100 K | 2 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| SIEMENS MEDICAL SOLUTIONS INC | |||||
| 51 VALLEY STREAM PARKWAY | MALVERN | PA | 19355 | MAINTENANCE | 203711 |
| QUINCY MEDICAL GROUP | |||||
| 1025 MAINE ST | QUINCY | IL | 62301 | MEDICAL SERVICES | 265480 |
| BLESSING HOSPITAL | |||||
| BROADWAY AT 11TH | QUINCY | IL | 62301 | PHYSICIANS/SUPPORT | 3989818 |
| BLESSING CORPORATE SERVICES | |||||
| BROADWAY AT 11TH | QUINCY | IL | 62301 | MANAGEMENT SERVICES | 399565 |
| AIMS OF PITTSFIELD LLC | |||||
| 12533 W LAKE VIEW DR | ORLAND PARK | IL | 60467 | ER PHYSICIANS | 1280045 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Government Grants | 225072 | GovernmentGrants |
| All Other Contributions | 92981 | AllOtherContributions |
| Total Contributions | 318053 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|
| PATIENT REVENUE | 45361006 | 45361006 |
| CONTRACTUAL ALLOWANCE | -22399447 | -22399447 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 22961559 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8886 | TotalRevenueColumn |
| Exclusion | $8,886 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 146609 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 5807 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 140802 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 140802 | TotalRevenueColumn |
| Exclusion | $140,802 | ExclusionAmount |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 46730 | GrossSalesOfInventory |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 46730 | TotalRevenueColumn |
| Exclusion | $46,730 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|
| OTHER | 198413 | $198,413 |
| EQUITY IN SUB'S INCOME | 74033 | $74,033 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 272446 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 23748476 | TotalRevenueColumn |
| Related Or Exempt Function Income | 22961559 | RelatedOrExemptFunctionIncome |
| Exclusion | $468,864 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7277243 | Total |
| Program Services | 5430974 | ProgramServices |
| Management And General | 1846269 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 168227 | Total |
| Program Services | 125547 | ProgramServices |
| Management And General | 42680 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1794216 | Total |
| Program Services | 1335657 | ProgramServices |
| Management And General | 458559 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 507023 | Total |
| Program Services | 378389 | ProgramServices |
| Management And General | 128634 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -24391 | Total |
| Management And General | -24391 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74705 | Total |
| Management And General | 74705 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 323095 | Total |
| Program Services | 98018 | ProgramServices |
| Management And General | 225077 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50059 | Total |
| Program Services | 22280 | ProgramServices |
| Management And General | 27779 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 95362 | Total |
| Management And General | 95362 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1003674 | Total |
| Program Services | 306924 | ProgramServices |
| Management And General | 696750 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 178169 | Total |
| Management And General | 178169 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBTS | 1828759 | 1828759 | |
| PATIENT SUPPLIES | 1847973 | 1753149 | 94824 |
| OUTSIDE FEES | 2273737 | 867053 | 1406684 |
| PHYSICIAN FEES | 2607949 | 2607949 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1808806 | Total |
| Program Services | 1236353 | ProgramServices |
| Management And General | 572453 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21814606 | Total |
| Program Services | 15991052 | ProgramServices |
| Management And General | 5823554 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1655645 | BOY |
| EOY | 2660426 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1708550 | BOY |
| EOY | 1716059 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4139661 | BOY |
| EOY | 5356069 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 495462 | BOY |
| EOY | 471094 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 169385 | BOY |
| EOY | 130175 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 15204091 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 9527296 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5957319 | BOY |
| EOY | 5676795 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 403206 | BOY |
| EOY | 1211527 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14529228 | BOY |
| EOY | 17222145 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 424904 | BOY |
| EOY | 468291 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4285734 | BOY |
| EOY | 3900459 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2655511 | BOY |
| EOY | 3756446 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7366149 | BOY |
| EOY | 8125196 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6968567 | BOY |
| EOY | 8749392 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 194512 | BOY |
| EOY | 347557 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7163079 | BOY |
| EOY | 9096949 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14529228 | BOY |
| EOY | 17222145 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 1933870 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 138751 | OtherCostOrOtherBasis |
| Book Value | 138751 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7436571 | OtherCostOrOtherBasis |
| Depreciation | 3858485 | Depreciation |
| Book Value | 3578086 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 303667 | OtherCostOrOtherBasis |
| Depreciation | 247443 | Depreciation |
| Book Value | 56224 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7180134 | OtherCostOrOtherBasis |
| Depreciation | 5421368 | Depreciation |
| Book Value | 1758766 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 144968 | OtherCostOrOtherBasis |
| Book Value | 144968 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 5676795 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| OTHER ACCOUNTS RECEIVABLE | 1099632 |
| DUE FROM BLESSING FOUNDATION | 23872 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1211527 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (7 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| PAYROLL TAXES & WITHHOLDING | $12,480 |
| NONCURRENT ACCRUED MALPRACTICE | $93,431 |
| ESTIMATED THIRD-PARTY SETTLEMENTS | $2,635,055 |
| DUE TO BLESSING HOSPITAL | $220,179 |
| ACCRUED SALARIES | $782,089 |
| ACCRUED INTEREST | $6,745 |
| ACCRUED EMPLOYEE BENEFITS | $6,467 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 3756446 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 21683613 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -1753127 | OtherRevenues |
| Revenue Not Rptd F990 | -1753127 | RevenueNotRptdF990 |
| Revenue Subtotal | 23436740 | RevenueSubtotal |
| Other Revenues Not Included | 311736 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 311736 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 23748476 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 19991654 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 5807 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 5807 | ExpensesNotRptdF990 |
| Expenses Subtotal | 19985847 | ExpensesSubtotal |
| Other Expenses Not Included | 1828759 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 1828759 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 21814606 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part XII, Line 4b | Part XII, Line 4b: Other revenue amounts included on 990 but not included in F/S | BAD DEBT REDUCTION OF REVENUE ON F/S $1828759 |
| Part XII, Line 2d | Part XII, Line 2d: Other expenses and losses per audited F/S | RENTAL EXPENSES $5807 |
| Part XI, Line 4b | Part XI, Line 4b: Other revenue amounts included on 990 but not included in F/S | RESTRICTED CONTRIBUTIONS $317543 RENTAL EXPENSES $-5807 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Tailored To Ind Hospitals | X | PolicyTailoredToIndHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 629164 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 629164 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03080 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3485299 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3145490 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 339809 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01660 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4114463 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3145490 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 968973 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04740 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 42337 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 42337 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 42337 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 42337 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4156800 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3145490 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1011310 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04950 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $1,828,759 | BadDebtExpenseAmount |
| Amount Attributable To | 85403 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 8841675 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 9059950 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -218275 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership |
|---|---|
| ADVANCE PTILLINI COMM HOSP | |
| PHYSICAL THERAPY SERVICES | 0.47000 |
| ILLINI HEALTH SERVICES LLC | |
| PHARMACY/MEDICAL EQUIPMENT | 0.05000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ILLINI COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 640 WEST WASHINGTON | AddressLine1 |
| City | PITTSFIELD | City |
| State | IL | State |
| ZIP Code | 62363 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ILLINI COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | false | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | false | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| File Form4720 Report Excise Tax | false | FileForm4720ReportExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 150.0000 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 400.0000 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Collection Activities | true | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ILLINI COMMUNITY HOSPITAL RURAL HEALTH CLINIC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 WEST WASHINGTON | AddressLine1 |
| City | PITTSFIELD | City |
| State | IL | State |
| ZIP Code | 62363 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | RURAL HEALTH CLINIC | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (19 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 6A - Illini Hospital's Community Benefit Report is prepared by Illini Hospital, not by a related organization.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. | |
| Part V - Explanation of Number of Facility Type | Illini Hospital operated no facilities other than the locations listed in Part V. | |
| Part VI - States Where Community Benefit Report Filed | IL | |
| 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 and Subsidiary, 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. For financial reporting purposes, the Hospital's financial information is consolidated with West Central Illinois Therapy & Sports Medicine, LLC. The Hospital has a 51% partnership interest in West Central Illinois Therapy & Sports Medicine, LLC, and the outside investor's 49% interest in the partnership is included as a minority interest. This partnership was dissolved in FY2013.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 - 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 182 employees. Of significant importance is the volunteers that serve the Hospital. In Fiscal Year 2013, Illini Community Hospital had 38 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 - Community Building Activities | Illini Hospital conducts no activities considered Community Building Activities as defined by the Schedule H instructions. | |
| 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 7.4% AT 12/31/2012. 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 - 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 - 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 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. | Number of Hospital Faciltiy - 1 |
| 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. | Number of Hospital Faciltiy - 1 |
| 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 III, Line 8 - Explanation Of Shortfall As Community Benefit | The hospital uses a cost-to-charge ratio to calculate 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. IRS Revenue Ruling 69-545, which established the community benefit standard for nonprofit hospital's states that if a hospital serves patients with government health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community. | |
| Part III, Line 4 - Bad Debt Expense | See Note (3) on page 13 of the attached financial statements for Blessing Corporate Services, Inc. and Affiliates, in which Illini Community Hospital is included. | |
| 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 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 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 I, Line 7, Column F - Explanation of Bad Debt Expense | Bad Debt Expense of $1,828,759 is subtracted from total expenses of $21,814,606 reported on line 25, column a of Form 990, part IX. | |
| 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
| Rebuttable Presumption Procedure | false | RebuttablePresumptionProcedure |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT ROWLES | ||||||||||||
| CRNA | 210287 | 248 | 2033 | 7690 | 220258 | |||||||
| PATRICK M GERVELER | ||||||||||||
| Treasurer | 268164 | 81817 | 39091 | 44614 | 15129 | 448815 | ||||||
| KATHLEEN E HULL | ||||||||||||
| President/CEO | 155922 | 49341 | 8340 | 1690 | 14614 | 229907 | ||||||
| CHRISTOPHER WAGONER MD | ||||||||||||
| PRES - MEDICAL | 179871 | 823 | 1851 | 19544 | 202089 | |||||||
| B BRADFORD BILLINGS | ||||||||||||
| Secretary | 435328 | 345933 | 40179 | 462674 | 14428 | 1298542 | 193647 | |||||
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Form 990, Part VI, Line 19 | 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. |
| Form 990, Part VI, Line 15b | Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | Brad Billings 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 15a | Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management | Brad Billings 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 12c | 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 11b | 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 7b | Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders | BLESSING CORPORATE SERVICES SHALL POSSESS THE RIGHTS AND RESPONSIBILITIES TO (b)appoint the corporation's president and nominate all candidates to serveas directors of Quincy Health Care Management, Inc., (c) approveexpressly all amendments to the corporation's articles of incorporationand bylaws before they may become effective, (d) approve long-term debt,long-range plans and capital and operating budgets, (e) approve thepurchase and sale of real and personal property and contracts enteredinto by the corporation, not expressly made part of an approved budget,the reasonable value of which exceeds an amount set forth in the bylawsof the member, (f) approval of 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, (g) approval of the parameters for terms of employment of physicians, including physician compensation plans, and any material variances from such parameters for individual physicians, (h) approval of the selection of auditors and legal counsel, (i) approval of charity care and community benefits-related policies, (j) approval of the formation of subsidiary entities and/or joint ventures, (k) approval of the filing of a petition in bankruptcy, making and assignment for the benefit of creditors, or applying for protection under any insolvency laws, (l) approval of the participation in any merger, combination, consolidation, liquidation, dissolution or other corporate or business entity restructuring, and (m) the power to compel the corporation to enforce and/or perform any contractual obligation. |
| Form 990, Part VI, Line 7a | Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body | BLESSING CORPORATE SERVICES SHALL POSSESS THE RIGHTS AND RESPONSIBILITIES TO (A) Appoint AND/OR REMOVE ALL THE TRUSTEES OF THE CORPORATION. |
| Form 990, Part VI, Line 6 | Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder | BLESSING CORPORATE SERVICES, INC. IS THE SOLE VOTING MEMBER OF BLESSINGCARE CORPORATION. |
| Form 990, Part VI, Line 3 | Form 990, Part VI, Line 3: Description of Delegated Duties to Management Company | 1) BLESSING CORPORATE SERVICES PROVIDES GENERAL MANAGEMENT SERVICES.2) QUINCY MEDICAL GROUP PROVIDES MANAGEMENT OF THERAPY.3) NATIONAL HEALING PROVIDES MANAGEMENT OF THE WOUND CLINIC. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | |
| 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 | |
| BLESSING HOSPITAL | |||||||||||
| 1005 BROADWAY | QUINCY | IL | 62301 | 370661183 | NOT-FOR-PROFIT HOSPITAL | IL | 501(C)(3) | 3 | BLESSING CORPORATE SERVICES INC | false | |
| 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 | false | N/A | |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Share Of EOY AssetsShareOfEOYAssets |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| W CEN IL THERAPY & SPORTS MED CTR LLC | ||||||||||||
| 128 WEST WASHINGTON ST | PITTSFIELD | IL | 62363 | 208207543 | PHYS THERAP | IL | BCC | RELATED | -11752 | false | true | |
| ILLINI HEALTH SERVICES LLC | ||||||||||||
| PO BOX 40 | QUINCY | IL | 623060040 | 470901851 | PHARMACY | IL | BCS INC | RELATED | 29759 | false | false | 80269 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DENMAN SERVICES INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | BROADWAY AT 11TH PO BOX 40 | AddressLine1 |
| City | QUINCY | City |
| State | IL | State |
| ZIP Code | 62306 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 371132117 | EIN |
| Primary Activity | MED EQUIP | PrimaryActivity |
| Legal Domicile State | IL | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BCS INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C CORP | TypeOfEntity |
| Controlled Org | false | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | true | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | true | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
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