KATHERINE SHAW BETHEA HOSPITAL: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- KATHERINE SHAW BETHEA HOSPITAL (EIN 36-1000540)
- Tax period
- 2023-01-01 to 2023-12-31
- Filed
- 2024-11-15
- IRS object ID
- 202433209349303658
- Schema version
- 2023v5.1
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-11-15T08:24:18-06:00 | ReturnTs |
| Tax Period End | 2023-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 WASHINGTON AVENUE SUITE 1800 | AddressLine1Txt |
| City | ST LOUIS | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 361000540 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KATHERINE SHAW BETHEA HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | KATH | BusinessNameControlTxt |
| Phone | 8152885531 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 403 EAST FIRST STREET | AddressLine1Txt |
| City | DIXON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61021 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AUSTIN FRAZIER JR | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 8152885531 | PhoneNum |
| Signature | 2024-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMBER ROGNAN-HAMILTON | PreparerPersonNm |
| PTIN | P01251012 | PTIN |
| Phone | 3149254300 | PhoneNum |
| Preparation | 2024-11-04 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2024-10-15 13:58:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID SCHREINER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 403 EAST FIRST STREET | AddressLine1Txt |
| City | DIXON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61021 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $160,543,012 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.KSBHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1893 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | RESTORE, MAINTAIN, AND ENHANCE HEALTH BY PROVIDING SUPERIOR CARE NOW AND IN THE FUTURE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 1304 | TotalEmployeeCnt |
| Total Volunteers | 23 | TotalVolunteersCnt |
| Total Gross UBI | $64,283 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,348,152 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,546,788 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $138,172,133 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $154,006,638 | CYProgramServiceRevenueAmt |
| PY Investment Income | $281,288 | PYInvestmentIncomeAmt |
| CY Investment Income | $527,912 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,067,865 | PYOtherRevenueAmt |
| CY Other Revenue | $1,076,930 | CYOtherRevenueAmt |
| PY Total Revenue | $140,869,438 | PYTotalRevenueAmt |
| CY Total Revenue | $157,158,268 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $92,282 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $70,954 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $87,355,925 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $88,303,930 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $68,526,099 | PYOtherExpensesAmt |
| CY Other Expenses | $73,233,422 | CYOtherExpensesAmt |
| PY Total Expenses | $155,974,306 | PYTotalExpensesAmt |
| CY Total Expenses | $161,608,306 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$15,104,868 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$4,450,038 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $109,247,507 | TotalAssetsBOYAmt |
| Total Assets EOY | $103,111,013 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $70,096,192 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $68,402,871 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $39,151,315 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $34,708,142 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO RESTORE, MAINTAIN, AND ENHANCE HEALTH BY PROVIDING SUPERIOR CARE NOW AND IN THE FUTURE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $142,492,098 | ExpenseAmt |
| Grant | $70,954 | GrantAmt |
| Revenue | $154,006,638 | RevenueAmt |
| Desc | IN 2023, KATHERINE SHAW BETHEA HOSPITAL (KSB) HAD 2,718 INPATIENT VISITS AND 242,921 OUTPATIENT VISITS. KSB IS COMMITTED TO PROVIDING THE HIGHEST QUALITY OF HEALTHCARE REGARDLESS OF ABILITY TO PAY. KSB SUBSIDIZES THE COST OF TREATING PATIENTS WHO ARE UNABLE TO PAY AND THOSE WHO RECEIVE GOVERNMENT ASSISTANCE WHERE REIMBURSEMENT IS LIMITED. THE COST OF CHARITY CARE, BASED ON THE HOSPITAL'S COST-TO-CHARGE RATIO, PROVIDED BY THE HOSPITAL, WAS APPROXIMATELY $183,000 IN 2023.KSB PROVIDES 24-HOUR EMERGENCY MEDICAL SERVICES STAFFED BY FULL-TIME PHYSICIANS. PATIENTS ARE TREATED REGARDLESS OF INSURANCE OR ABILITY PAY. ER VISITS IN 2023 WERE 19,644. | Desc |
| Total Program Service Expenses | $142,492,098 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 97 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 1304 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AUSTIN FRAZIER JR | PersonNm |
| Phone | 8152855511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 403 EAST FIRST STREET | AddressLine1Txt |
| City | DIXON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61021 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| LYNETTE KNODLE | ||||||||
| BOARD MEMBER | 2.10 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| COLLEEN T HENKEL | ||||||||
| PAST-CHAIRPERSON | 1.40 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| CHRIS HAMMITT | ||||||||
| VICE-CHAIRPERSON | 1.40 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| RICK CURIA | ||||||||
| BOARD MEMBER | 0.90 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JOSEPH WELTY MD | ||||||||
| BOARD MEMBER / PHYSICIAN | 9.00 | 0.00 | Yes (X) | $147,279 | $0 | $1,620 | ||
| RAY NEISEWANDER III | ||||||||
| BOARD MEMBER | 0.90 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID HELLMICH | ||||||||
| CHAIRPERSON | 1.30 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| RICHARD BOYSEN | ||||||||
| TREASURER | 1.40 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| PATRICK KING DDS | ||||||||
| SECRETARY | 1.70 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| DAVID SCHREINER | ||||||||
| CEO AND BOARD MEMBER | 40.00 | 1.00 | Yes (X) | $1,049,137 | $0 | $35,884 | Yes (X) | |
| LINDA CLEMEN | ||||||||
| VP-CHIEF NURSING OFFICER | 40.00 | 0.00 | $268,217 | $0 | $22,486 | Yes (X) | ||
| SUZANNE RAVLIN | ||||||||
| VP-CHIEF LEGAL OFFICER (TERM ENDED) | 40.00 | 1.00 | $68,205 | $0 | $0 | Yes (X) | ||
| RAY SHARP | ||||||||
| VP-CHIEF INFORMATION OFFIC | 40.00 | 0.00 | $266,248 | $0 | $46,090 | Yes (X) | ||
| AUSTIN FRAZIER | ||||||||
| VP-CHIEF FINANCIAL OFFICER | 40.00 | 2.00 | $352,455 | $0 | $45,640 | Yes (X) | ||
| DREW FENNER | ||||||||
| VP-CHIEF QUALITY OFFICER | 40.00 | 0.00 | $230,386 | $0 | $45,640 | Yes (X) | ||
| RYAN MILLER | ||||||||
| VP-CHIEF PEOPLE OFFICER | 40.00 | 2.00 | $234,820 | $0 | $25,580 | Yes (X) | ||
| JOYCE JOHNSON MD | ||||||||
| MEDICAL STAFF PRESIDENT | 40.00 | 0.00 | $525,209 | $0 | $5,666 | Yes (X) | ||
| MONTHER ELBZOUR MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $2,008,870 | $0 | $40,888 | Yes (X) | ||
| SOHAIL HANIF MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $1,548,486 | $0 | $40,828 | Yes (X) | ||
| KURT CROWE MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $841,860 | $0 | $46,090 | Yes (X) | ||
| STEPHEN GABRIEL | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $836,174 | $0 | $34,264 | Yes (X) | ||
| FADI MOHAMAD MUSTAPHA | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $984,230 | $0 | $41,458 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $9,361,576 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $432,134 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 114 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ROCKFORD ANESTHESIOLOGISTS ASSOCIATED L | |||||
| 2202 HARLEM RD | LOVES PARK | IL | 61111 | ANESTHESIOLOGY | $1,475,327 |
| BROWN CONSTRUCTION CO | |||||
| 200 N WASHINGTON ST | MILLEDGEVILLE | IL | 61051 | CONSTRUCTION SERVICES | $901,025 |
| LAB CORPORATION | |||||
| PO BOX 12140 | BURLINGTON | NC | 27216 | LAB TESTING | $759,416 |
| RSM US LLP | |||||
| 5155 PAYSPHERE CIRCLE | CHICAGO | IL | 60674 | CONSULTING SERVICES | $509,982 |
| HORIZON HEALTH | |||||
| PO BOX 840839 | DALLAS | TX | 75284 | BEHAVIORAL HEALTH SERVICES | $493,204 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 18 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $82,107 | RelatedOrganizationsAmt |
| Government Grants | $1,464,681 | GovernmentGrantsAmt |
| Total Contributions | $1,546,788 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621110 | $153,678,599 | $153,678,599 |
| NET CLINIC SPACE RENTAL | 621110 | $328,039 | $328,039 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $154,006,638 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $267,069 | TotalRevenueColumnAmt |
| Exclusion | $267,069 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,645,587 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,384,744 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $260,843 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $260,843 | TotalRevenueColumnAmt |
| Exclusion | $260,843 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| CAFETERIA SALES | 900099 | $528,784 | $64,283 | $464,501 |
| INCENTIVE PAYMENT | 900099 | $282,133 | $282,133 | |
| REVENUE SHARE | 900099 | $166,913 | $166,913 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $99,100 | TotalRevenueColumnAmt |
| Exclusion | $99,100 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,076,930 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $157,158,268 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $154,006,638 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $64,283 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,540,559 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,954 | TotalAmt |
| Program Services | $68,954 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,000 | TotalAmt |
| Program Services | $2,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,302,357 | TotalAmt |
| Program Services | $970,477 | ProgramServicesAmt |
| Management And General | $2,331,880 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,843,224 | TotalAmt |
| Program Services | $66,493,557 | ProgramServicesAmt |
| Management And General | $349,667 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,027,602 | TotalAmt |
| Program Services | $1,503,216 | ProgramServicesAmt |
| Management And General | $524,386 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,939,761 | TotalAmt |
| Program Services | $9,039,185 | ProgramServicesAmt |
| Management And General | $2,900,576 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,190,986 | TotalAmt |
| Program Services | $3,986,084 | ProgramServicesAmt |
| Management And General | $204,902 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $124,331 | TotalAmt |
| Program Services | $124,331 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $186,160 | TotalAmt |
| Program Services | $147,118 | ProgramServicesAmt |
| Management And General | $39,042 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,124 | TotalAmt |
| Management And General | $32,124 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,350 | TotalAmt |
| Management And General | $1,350 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,567,458 | TotalAmt |
| Program Services | $15,238,628 | ProgramServicesAmt |
| Management And General | $4,328,830 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $224,392 | TotalAmt |
| Program Services | $167,353 | ProgramServicesAmt |
| Management And General | $57,039 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,884,965 | TotalAmt |
| Program Services | $17,313,021 | ProgramServicesAmt |
| Management And General | $1,571,944 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,810,813 | TotalAmt |
| Program Services | $2,826,138 | ProgramServicesAmt |
| Management And General | $984,675 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,899,735 | TotalAmt |
| Program Services | $1,016,798 | ProgramServicesAmt |
| Management And General | $882,937 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $137,041 | TotalAmt |
| Program Services | $121,812 | ProgramServicesAmt |
| Management And General | $15,229 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $205,734 | TotalAmt |
| Program Services | $162,192 | ProgramServicesAmt |
| Management And General | $43,542 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $883,759 | TotalAmt |
| Program Services | $590,043 | ProgramServicesAmt |
| Management And General | $293,716 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,794,744 | TotalAmt |
| Program Services | $4,977,166 | ProgramServicesAmt |
| Management And General | $1,817,578 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,151,356 | TotalAmt |
| Program Services | $2,345,591 | ProgramServicesAmt |
| Management And General | $805,765 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $9,663,108 | $9,663,108 | |
| IPA/SALES & USE TAX | $5,789,761 | $4,285,770 | $1,503,991 |
| REPAIRS AND MAINTENANCE | $727,170 | $551,917 | $175,253 |
| FOOD SUPPLY | $714,740 | $533,647 | $181,093 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $434,681 | TotalAmt |
| Program Services | $363,992 | ProgramServicesAmt |
| Management And General | $70,689 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $161,608,306 | TotalAmt |
| Program Services | $142,492,098 | ProgramServicesAmt |
| Management And General | $19,116,208 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $263,292 | BOYAmt |
| EOY | $226,456 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,469,772 | BOYAmt |
| EOY | $2,890,132 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,923,697 | BOYAmt |
| EOY | $32,752,815 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,817,881 | BOYAmt |
| EOY | $1,680,102 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,376,613 | BOYAmt |
| EOY | $1,373,259 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $164,039,236 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $120,320,833 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,235,272 | BOYAmt |
| EOY | $43,718,403 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,962,413 | BOYAmt |
| EOY | $13,510,638 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,719,400 | BOYAmt |
| EOY | $5,116,137 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,479,167 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $1,843,071 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $109,247,507 | BOYAmt |
| EOY | $103,111,013 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,240,812 | BOYAmt |
| EOY | $48,795,615 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $22,019 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,855,380 | BOYAmt |
| EOY | $17,723,609 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $1,861,628 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $70,096,192 | BOYAmt |
| EOY | $68,402,871 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,871,466 | BOYAmt |
| EOY | $34,708,142 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,279,849 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,151,315 | BOYAmt |
| EOY | $34,708,142 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $109,247,507 | BOYAmt |
| EOY | $103,111,013 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$4,450,038 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $412,628 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$405,763 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $32,124 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $32,124 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | A PORTION OF THE HOSPITAL'S MEMBERSHIP DUES WITH THE ILLINOIS HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION ARE USED BY THOSE ASSOCIATIONS TO CONDUCT LOBBYING ACTIVITIES ON BEHALF OF ALL MEMBER HOSPITALS. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $912,774 | BeginningYearBalanceAmt |
| Other Expenditures | $912,774 | OtherExpendituresAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $912,772 | BeginningYearBalanceAmt |
| Contributions | $2 | ContributionsAmt |
| End Year Balance | $912,774 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $912,772 | BeginningYearBalanceAmt |
| End Year Balance | $912,772 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,085,170 | BeginningYearBalanceAmt |
| Other Expenditures | $172,398 | OtherExpendituresAmt |
| End Year Balance | $912,772 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,043,624 | BeginningYearBalanceAmt |
| Contributions | $41,546 | ContributionsAmt |
| End Year Balance | $1,085,170 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,289,039 | OtherCostOrOtherBasisAmt |
| Book Value | $2,289,039 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $61,649,114 | OtherCostOrOtherBasisAmt |
| Depreciation | $39,129,977 | DepreciationAmt |
| Book Value | $22,519,137 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,660,750 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,767,118 | DepreciationAmt |
| Book Value | $893,632 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $93,798,840 | OtherCostOrOtherBasisAmt |
| Depreciation | $76,423,738 | DepreciationAmt |
| Book Value | $17,375,102 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $641,493 | OtherCostOrOtherBasisAmt |
| Book Value | $641,493 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $43,718,403 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RIGHT OF USE LIABILITIES | Desc |
| Amt | $1,861,628 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,861,628 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE PURPOSE OF THE BULK OF THE ENDOWMENT FUND IS TO FUND COMMUNITY WELLNESS PROJECTS FOR THE KSB SERVICE AREA. THE REST OF THE ENDOWMENT, $25,000, WAS ESTABLISHED MANY YEARS AGO AND IS IN AN ACCOUNT WITH OTHER RESTRICTED FUNDS WHICH ALL EARN INTEREST. THE INTEREST ON THIS ENDOWMENT IS INTENDED TO BE USED TO PROVIDE FREE SERVICES TO THE NEEDY. AT THIS TIME, THE BANK GROUPS ALL INTEREST BEARING ACCOUNTS TOGETHER TO DETERMINE INTEREST EARNED AGAINST FEES INCURRED. ANY INTEREST EARNED IS THEN REPORTED IN TOTAL FOR ALL ACCOUNTS ON THE STATEMENT OF REVENUE. THOUGH KSB IS NOT ABLE TO SEPARATELY REPORT THE INTEREST EARNED ON THE ENDOWMENT, THE HOSPITAL HAS SHOWN ON SCHEDULE H THAT THEY PROVIDE MANY FREE SERVICES TO THOSE IN NEED WITH THE FUNDS THEY RECEIVE. DURING THE 2023 TAX YEAR, THE RESTRICTIONS ON THE ENDOWMENT FUNDS WERE RELEASED, AND AS SUCH, THE FUNDS NO LONGER QUALIFY AS AN ENDOWMENT UNDER ASC 958. THE FUNDS WERE UTILIZED FOR OPERATIONS DURING THE 2023 TAX YEAR AND ARE REPORTED AS OTHER EXPENDITURE FOR FACILITIES AND PROGRAMS ON SCHEDULE D. |
| PART X, LINE 2: | THE HOSPITAL APPLIES THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE HOSPITAL DOES NOT CURRENTLY INCLUDE AN INCOME TAX PROVISION IN THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT MONITORS THE REPORTING OF UNCERTAIN TAX POSITIONS, WHICH COULD RESULT IN RECORDING OF AN INCOME TAX PROVISION IN THE FUTURE. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $181,928 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $181,928 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $29,555,928 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,117,340 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $19,438,588 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12030 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $950,046 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $950,046 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00590 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,687,902 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,117,340 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $20,570,562 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12730 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $866,220 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,028 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $858,192 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00530 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,883,411 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,111,286 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,077 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $28,816 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $870,308 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $870,308 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00540 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $87,969 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $21,320 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $66,649 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,718,985 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,169,450 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,795,149 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01110 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $35,406,887 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,286,790 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $22,365,711 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13840 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $9,663,108 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $2,037,280 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $19,755,034 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $23,337,153 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$3,582,119 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KATHERINE SHAW BETHEA HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 403 E FIRST STREET | AddressLine1Txt |
| City | DIXON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61021 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.KSBHOSPITAL.COM | WebsiteAddressTxt |
| State License | 2114484 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Teaching Hospital | Yes (X) | TeachingHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KATHERINE SHAW BETHEA HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.KSBHOSPITAL.COM/CHNA | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.KSBHOSPITAL.COM/CHNA | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V PAGE 8 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V PAGE 8 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V PAGE 8 | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| KATHERINE SHAW BETHEA HOSPITAL | PART V, SECTION B, LINE 5: DATA FOR THIS CHNA WAS OBTAINED FROM A VARIETY OF SOURCES, BOTH IN PERSON AND ONLINE. DEMOGRAPHIC DATA AND HEALTH INDICATORS WERE OBTAINED ON FROM THE LEE COUNTY ILLINOIS YOUTH SURVEY 2020; CDC WONDER; ILLINOIS HEALTH AND HOSPITAL ASSOCIATION, COMP DATA; ILLINOIS BEHAVIORAL RISK SURVEY 2020; NATIONAL CENTER FOR HEALTH STATISTICS; AND ILLINOIS SECRETARY OF STATE. POPULATION DATA WAS OBTAINED FROM THE U.S. CENSUS BUREAU WEBSITE AND THEIR AMERICAN COMMUNITY SURVEY TOOL.KSB HOSPITAL PARTNERED WITH THE LEE COUNTY HEALTH DEPARTMENT TO COLLECT DATA FOR THE CHNA. LEE COUNTY HEALTH DEPARTMENT IS COMPLETING THEIR IPLAN FOR 2022. THIS WAS A GREAT COLLABORATION SINCE THE CHNA AND IPLAN ARE VERY SIMILAR ASSESSMENTS FOR LEE COUNTY AND OUR SERVICE AREA.A CHNA SURVEY WAS OPENED TO THE PUBLIC IN JUNE 2022 AND RESPONSES WERE SOLICITED THROUGH SOCIAL MEDIA ACCOUNTS. WE RECEIVED 396 RESPONSES. 5 FOCUS GROUPS WERE ALSO CONDUCTED BY LEE COUNTY HEALTH DEPARTMENT.DATA FROM THESE REPORTS, INTERVIEWS, AND SURVEYS WERE SHARED WITH THE KSB WELLNESS STEERING COMMITTEE TO SOLICIT INPUT AND STIMULATE DISCUSSION OF COMMUNITY HEALTH NEEDS AMONG A COMMITTEE THAT MEETS THROUGHOUT THE YEAR TO DISCUSS WELLNESS INITIATIVES. |
| KATHERINE SHAW BETHEA HOSPITAL | PART V, SECTION B, LINE 6B: THE HOSPITAL'S CHNA WAS CONDUCTED WITH THE LEE COUNTY HEALTH DEPARTMENT AND LEE-OGLE TRANSPORTATION SYSTEM |
| KATHERINE SHAW BETHEA HOSPITAL | PART V, SECTION B, LINE 7D: KATHERINE SHAW BETHEA HOSPITAL IS A 80 BED RURAL ACUTE CARE HOSPITAL. ITS CHNA IS ALSO PROVIDED TO THE PUBLIC THROUGH SOCIAL MEDIA, INCLUDING BUT NOT LIMITED TO FACEBOOK AND TWITTER. |
| KATHERINE SHAW BETHEA HOSPITAL | PART V, SECTION B, LINE 11: TO IDENTIFY AND PRIORITIZE THE NEEDS, WE USED THE HANLON METHOD OF HEALTH PROBLEM PRIORITY SETTING, AND THE PEARL TEST FOR FEASIBILITY. THE HANLON METHOD MEASURES THE SIZE OF THE HEALTH PROBLEM, THE IMPACT OF THE HEALTH PROBLEM, AND THE EFFECTIVENESS OF INTERVENTION. THE SCORING IDENTIFIED THE FOLLOWING THREE KEY PRIORITIES WHICH WILL BECOME THE FOCUS OF IMPLEMENTATION PLANS FROM KSB HOSPITAL DURING THE LIFE OF THIS COMMUNITY HEALTH NEEDS ASSESSMENT:BEHAVIORAL HEALTH (FOCUS ON ANXIETY AND DEPRESSION)HEART DISEASEOBESITY & PHYSICAL INACTIVITYBEHAVIORAL HEALTH:BEHAVIORAL HEALTH HAS BEEN PART OF COMMUNITY HEALTH NEEDS ASSESSMENTS SINCE OUR FIRST PROCESS IN 2013. AT KSB HOSPITAL, WE OFFER BOTH INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH SERVICES. WE ALSO PARTNER WITH STRONG LOCAL PROVIDERS LIKE SINNISSIPPI CENTERS, A MULTI-COUNTY BEHAVIORAL HEALTH AND SUBSTANCE USE DISORDER SERVICE PROVIDER. TOGETHER WE OFFER BEHAVIORAL HEALTH SCREENINGS IN PRIMARY CARE OFFICES AND THE EMERGENCY DEPARTMENT. WE ALSO CREATED THE ROLE OF MENTAL HEALTH CRISIS PREVENTIONIST TO BE TRAINED AND READY TO RESPOND WITH DE-ESCALATION TECHNIQUES AND SUPPORT PATIENT AND STAFF SAFETY.WE HAVE INVESTED IN TELEHEALTH EQUIPMENT, IMPLEMENTING BEHAVIORAL HEALTH PRESCREENING TOOLS. REMOTE TELEHEALTH PROVIDERS HELP ENSURE CONTINUITY OF SERVICES IN OUR COMMUNITY. WE ALSO MADE SIGNIFICANT CAPITAL INVESTMENTS TO IMPROVE PATIENT SAFETY WITHIN THE INPATIENT UNIT.STILL TODAY, SURVEYS INDICATE WIDESPREAD NEED FOR BEHAVIORAL HEALTH SERVICES, ESPECIALLY WITH THE IMPACT OF THE OCVID 19 PANDEMIC. MORE THAN 70% OF SURVEY RESPONDENTS LISTED MENTAL HEALTH ISSUES AS THE NUMBER HEALTH ISSUE IN LEE COUNTY. 60% OF RESPONDENTS INDICATED THAT THEY OR SOMEONE IN THEIR HOUSEHOLD HAD EXPERIENCED ANXIETY IN THE PAST YEAR, AND 55% ANSWERED AFFIRMATIVELY FOR DEPRESSION. FURTHER, 21% LISTED BEING AFFECTED BY POST TRAUMATIC STRESS DISORDER WITH 19% THAT INDICATED THEY HAVE THOUGHT ABOUT OR ATTEMPTED SUICIDE.IMPLEMENTATION PLAN1. HOSTING COMMUNITY EDUCATIONAL EVENT SERIES ON BRAIN HEALTH WITH PRESENTATIONS BY BEHAVIORAL HEALTH EXPERTS TO HELP REDUCE STIGMA AND PROVIDE TIPS ON SUPPORTING POSITIVE BRAIN HEALTH2. WORK WITH PARTNERS TO BRING INTERNATIONAL PRESENTATIONS FOR PROFESSIONALS AND THE COMMUNITY, INCLUDING CEU TRAINING FOR PROFESSIONALS.3. PARTNER WITH OTHER AGENCIES TO BRING MENTAL HEALTH RESOURCES TO SPECIAL INTEREST GROUPS, SUCH AS FARMERS.4. CONTINUE TO WORK WITH COMMUNITY NETWORK ESTABLISHED BY PROJECT OPEN, A COMMUNITY PROJECT OF MEDICAL, BEHAVIORAL HEALTH, PUBLIC HEALTH, EDUCATION, COURT, AND LAW ENFORCEMENT ORGANIZATIONS TO HELP BUILD A NETWORK TO ADDRESS TRAUMA AND PREVENT OPIOID ADDICTION THROUGH AWARENESS, EDUCATION, AND TRAINING5. ENGAGEMENT WITH THIRD-PARTY BEHAVIORAL HEALTH SERVICE LINE OPERATORS TO IMPROVE EFFICIENCY, ADOPT CLINICAL BEST PRACTICES, AND STRENGTHEN OPERATIONAL SUSTAINABILITY OF THE SPECTRUM OF MENTAL HEALTH SERVICES AT KSB6. MONTHLY BRAIN EXERCISE CLASSES TO HELP AGING RESIDENTS BETTER UNDERSTAND BRAIN HEALTH AND HOW THEY CAN PROMOTE PHYSICAL AND MENTAL WELLNESS7. WITHIN THE NEXT THREE YEARS WE WANT TO IMPLEMENT AN INTENSIVE OUTPATIENT PROGRAM (IOP) AT THE HOSPITAL THAT WOULD EXPAND OUR CONTINUUM OF SERVICES AND BE A STEP-DOWN FROM AN INPATIENT HOSPITALIZATION (AND A BRIDGE BETWEEN INPATIENT AND OUTPATIENT TREATMENT).8. WE JUST STARTED A COPING SKILLS GROUP FOR OUTPATIENTS TO INCREASE ACCESS TO SERVICES FOR THE COMMUNITY. WE WANT TO EXPAND AND HAVE OTHER 'STAND-ALONE' GROUPS LIKE THIS: GRIEF AND LOSS GROUP, PARENT TRAINING GROUP9. HAVE COMMUNITY LED GROUP HOSTED HERE: AA AND ALANON10. OUTREACH TO SCHOOLS AND TEACHERS TO PROVIDE SKILLS AND STRATEGIES FOR WORKING WITH BEHAVIORAL HEALTH NEEDS IN STUDENTSHEART DISEASE:BASED ON CDC WONDER DATA, HEART DISEASE IS A CONDITION THAT NEEDS ADDITIONAL ATTENTION. HEART DISEASE IS THE LEADING CAUSE OF DEATH IN LEE COUNTY, AVERAGE ONE HUNDRED DEATHS PER YEAR, WHICH ACCOUNTS FOR 24% OF ALL RESIDENT DEATHS.THE CRUDE DEATH RATE DUE TO HEART DISEASE IS 42% ABOVE THE NATIONAL RATE AND WHEN ADJUSTED FOR AGE IS 14% ABOVE THE NATIONAL RATE. ADDITIONALLY, THE DEATH RATE IS 7.7% HIGHER THAN A DECADE AGO. 19% OF THE COUNTY'S HEART DISEASE DEATHS OCCUR TO AGES UNDER 65 YEARS OF AGE, WITH 40% TO THOSE OVER 85.KSB OFFERS SERVICES FOR CARDIOLOGY, IN ADDITION TO PROVIDING CATH LAB PROCEDURES. CARDIAC REHAB, PHASES TWO & THREE ARE OFFERED AT KSB FOR PATIENTS RECOVERING FROM CARDIAC PROCEDURES. CARDIAC SCORING IS ALSO OFFERED TO THE COMMUNITY WITHOUT A PHYSICIAN REFERRAL.IMPLEMENTATION PLAN1. HOSTING COMMUNITY EDUCATIONAL EVENT SERIES ON HEART HEALTH WITH PRESENTATIONS BY HEALTH PROFESSIONALS TO FOCUS ON PREVENTION AND SCREENINGS.2. USE OF KSB HOSPITAL ADVERTISING SPENDING, SOCIAL MEDIA PRESENCE, AND WEBSITE TO SHARE AND DISSEMINATE INFORMATION ON HEALTH AND WELLNESS SERVICES THAT ARE AVAILABLE WITHIN OUR COMMUNITY3. CONTINUE TO OFFER FREE BLOOD PRESSURE SCREENINGS AT LOCAL PHARMACIES AND GROCERY STORES CONVENIENT TO THE PUBLIC.4. IMPLEMENTATION OF THE HEALTH E INTENT PLATFORM TO PROACTIVELY SCHEDULE PATIENTS FOR AGE-APPROPRIATE SCREENINGSOBESITY & PHYSICAL INACTIVITYAGAIN, IN THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT, BOTH SURVEY AND HEALTH INDICATOR DATA SHOW THAT RESIDENTS OF LEE COUNTY EXPERIENCE OBESITY OR BEING OVERWEIGHT AT RATES THAT EXCEED STATE AND NATIONAL AVERAGES. SURVEY RESPONSES INDICATE THAT THIS IS THE THIRD MOST UNHEALTHY BEHAVIOR THAT HAS THE GREATEST IMPACT ON THE OVERALL COMMUNITY HEALTH IN LEE COUNTY. 71% OF PEOPLE HAVE PERSONAL OR FAMILY EXPERIENCE WITH BEING OBESE OR OVERWEIGHT. COUNTY HEALTH DATA SHOWS 34.9% OBESITY AND 36.3% OVERWEIGHT, COMPARED TO 31.64% OBESE AND 34.1% OVERWEIGHT AT THE STATE LEVEL.THE INCIDENCE OF OBESE, OVERWEIGHT, OR INACTIVE RESIDENTS PRESENTS SIGNIFICANT HEALTH CHALLENGES, INCLUDING HIGH BLOOD PRESSURE AND CHOLESTEROL, DIABETES, AND MANY OTHER ASSOCIATED CLINICAL ISSUES.KSB WILL CONTINUE TO OFFER AND SUPPORT LOCAL OPPORTUNITIES FOR PHYSICAL ACTIVITY AND EXERCISE. KSB IS A LEAD SPONSOR OF THE ANNUAL REAGAN 5K RUN DURING THE DIXON PETUNIA FESTIVAL, WHICH ALSO INCLUDES THE KSB CORPORATE CHALLENGE FOR EMPLOYER-BASED TEAM COMPETITION.KSB WILL ALSO SPONSOR A NEW TEAM-BASED WEIGHT LOSS COMPETITION CALLED THE HEALTHYWAGE JACKPOT CHALLENGE, WHICH INCLUDES ACCESS TO AN APP WITH SUPPORT, MOTIVATION, AND MINI-CHALLENGES TO ENGAGE TEAM MEMBERS IN HEALTHY WEIGHT LOSS GOALS. KSB IS THE PRESENTING SPONSOR OF THE KSB WELLNESS CENTER EXERCISE FACILITY IN THE DIXON FAMILY YMCA, WITH DONATIONS TO PURCHASE NEW EXERCISE AND WEIGHT EQUIPMENT. KSB CLINICIANS ALSO OFFER A 'PRESCRIPTION' FOR THE DIXON FAMILY YMCA, THE NASH RECREATION CENTER, AND ANYTIME FITNESS, WHICH PROVIDES A FREE TRIAL TO RESIDENTS LOOKING TO START NEW HEALTHY HABITS. A REGISTERED DIETITIAN HOST ONE-ON-ONE NUTRITION AND FITNESS CONSULTATIONS WITH LOCAL PATIENTS. KSB SPONSORED A DISC GOLF SET GIVEAWAY CONJUNCTION WITH THE DIXON CITY MARKET EVENTS.IMPLEMENTATION PLAN1. OFFER RECURRING CLASSES ON EXERCISE TYPES AND NEW TRAINING METHODS TO HELP LOCAL RESIDENTS FIND AN INDIVIDUALIZED WAY TO INCORPORATE PHYSICAL ACTIVITY INTO THEIR LIFE2. SPONSOR THE HEALTHYWAGE JACKPOT CHALLENGE TO PROMOTE TEAM WEIGHT LOSS AND PROVIDE APP-BASED EDUCATION AND SUPPORT3. REACH PATIENTS THROUGH ONE-ON-ONE CONSULTATIONS WITH A REGISTERED DIETITIAN IN A CLINICAL OR COMMUNITY SETTING4. SPONSOR LEARNING FOR EDUCATIONAL SERIES WITH SPECIALIZED SESSIONS FOR NUTRITION, EXERCISE, GOAL-SETTING, AND SEASONAL FOCUS ON NEW YEAR'S RESOLUTIONS, HEALTH DURING THE HOLIDAYS, AND OTHER RELEVANT TOPICS5. ONGOING FINANCIAL COMMITMENT TO THE KSB WELLNESS CENTER AT THE DIXON FAMILY YMCA, AND ENGAGEMENT WITH DIXON PARK DISTRICT PLANS FOR THE CONSTRUCTION OF A NEW COMMUNITY CENTER WITH WELLNESS AND FITNESS SERVICES6. HOSTING WEEKLY FREE BLOOD PRESSURE CHECKS AT LOCAL GROCERY STORE, EXPANDING TO MT. MORRIS7. MONTHLY WELLNESS SCREENINGS FOR CHOLESTEROL AND GLUCOSE |
| KATHERINE SHAW BETHEA HOSPITAL | PART V, SECTION B, LINE 13B: STATE REGULATIONS ARE CONSIDERED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. |
| PART V, LINE 16 C | PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://WWW.KSBHOSPITAL.COM/WORDPRESS2017/WP-CONTENT/UPLOADS/2024/04/FINANCIAL-ASSISTANCE-PLAIN-LANGUAGE_4-2024.PDF |
| PART V, LINE 16 A | FINANCIAL ASSISTANCE POLICY WEBSITE:HTTPS://WWW.KSBHOSPITAL.COM/WORDPRESS2017/WP-CONTENT/UPLOADS/2024/04/FINANCIAL-ASSISTANCE-PROGRAM-POLICY_4-2024.PDF |
| PART V, LINE 16 B | FINANCIAL ASSISTANCE APPLICATION WEBSITE:HTTPS://WWW.KSBHOSPITAL.COM/WORDPRESS2017/WP-CONTENT/UPLOADS/2024/04/FINANCIAL-ASSISTANCE-APPLICATION_4-2024.PDF |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 9 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - COMMERCE TOWERS | ||||
| 215 EAST FIRST STREET | DIXON | IL | 61021 | PHYSICIAN CLINIC |
| 2 - TOWN SQUARE CENTER | ||||
| 102 S HENNEPIN AVENUE | DIXON | IL | 61021 | PHYSICIAN CLINIC |
| 3 - KSB OREGON CLINIC | ||||
| 1307 WASHINGTON | OREGON | IL | 61061 | PHYSICIAN CLINIC |
| 4 - EDWARDS CLINIC | ||||
| 144 NORTH COURT | DIXON | IL | 61021 | PHYSICIAN CLINIC |
| 5 - AMBOY CLINIC | ||||
| 305 EAST JOE DRIVE | AMBOY | IL | 61310 | PHYSICIAN CLINIC |
| 6 - KSB EYE & VISION CARE | ||||
| 511 PALMYRA STREET | DIXON | IL | 61021 | PHYSICIAN CLINIC |
| 7 - POLO CLINIC | ||||
| 1107 SOUTH DIVISION AVENUE | POLO | IL | 61064 | PHYSICIAN CLINIC |
| 8 - ASHTON CLINIC | ||||
| 707 S MAIN STREET | ASHTON | IL | 61006 | PHYSICIAN CLINIC |
| 9 - PHYSICIANS IMMEDIATE CARE | ||||
| 1672 SOUTH GALENA AVENUE | DIXON | IL | 61021 | PHYSICIAN CLINIC |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | FINANCIAL ASSISTANCE IS DETERMINED BASED ON FAMILY INCOME, ASSETS AND LIABILITIES, INSURANCE STATUS, AND QUALIFICATION FOR OTHER AVAILABLE ASSISTANCE PROGRAMS. INDIVIDUALS MAY QUALIFY FOR A PRESUMPTIVE DETERMINATION BASED ON HOMELESSNESS, DECEASED WITH NO ESTATE, MENTAL INCAPACITATION WITH NO ONE TO ACT ON THE PATIENT'S BEHALF, MEDICAID ELIGIBILITY, AND INCARCERATION IN A PENAL INSTITUTION. |
| PART I, LINE 7: | IT IS KSB HOSPITAL'S POLICY NOT TO WITHHOLD OR DENY ANY REQUIRED MEDICAL CARE AS A RESULT OF A PATIENT'S LACK OF THE ABILITY TO PAY. THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS IN THE ABOVE TABLE WAS DERIVED FROM THE 2023 CALCULATED COST TO CHARGE RATIO USING THE IRS WORKSHEET 2. |
| PART I, LINE 7G: | FOR 2023, SUBSIDIZED HEALTH SERVICES INCLUDED A DIABETIC CLINIC AND EMERGENCY MEDICAL SERVICES. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | KSB HOSPITAL STRIVES TO BRING THE BEST INTEGRATED, QUALITY, AND COST-EFFECTIVE CARE AND INNOVATIVE TECHNOLOGY TO OUR SERVICE AREA. KSB SUPPORTS OTHER LOCAL NON-PROFITS THROUGH CONTRIBUTIONS OF DOLLARS AND HOURS. WE SUPPORT THE LOCAL ECONOMIC DEVELOPMENT ORGANIZATIONS TO BRING EMPLOYERS AND JOBS TO OUR SERVICE AREA. KSB IS A SUPPORTER OF THE ADOPT-A-ROAD PROGRAM. OUR EMPLOYEES CLEAN UP A STRETCH OF ILLINOIS ROUTE 2 TWICE A YEAR TO HELP IMPROVE AND PRESERVE OUR ENVIRONMENT. KSB SUPPORTS WORKFORCE DEVELOPMENT THROUGH THE JUNIOR ACHIEVEMENT PROGRAM. HOURS AND DOLLARS ARE DONATED TO THIS PROGRAM. KSB ALSO SUPPORTS HABITAT FOR HUMANITY TO PROVIDE AFFORDABLE HOUSING IN OUR SERVICE AREA. MANY OF OUR EMPLOYEES DONATED THEIR OWN TIME TO THIS ORGANIZATION. KSB HAS SUPPORTED HABITAT FOR HUMANITY WITH CASH DONATIONS. |
| PART III, LINE 2: | A PATIENT'S ACCOUNT IS WRITTEN OFF TO BAD DEBT AFTER 180 DAYS. ANY PATIENT PAYMENTS AND DISCOUNTS ARE DEDUCTED FROM GROSS CHARGES PRIOR TO THE WRITE-OFF |
| PART III, LINE 3: | THIS PORTION OF BAD DEBT IS RELATED TO ACCOUNTS THAY MAY HAVE QUALIFIED FOR THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THE METHODOLOGY USED IS BASED ON HISTORICAL INFORMATION. THIS PORTION OF BAD DEBT WOULD HAVE BEEN INCLUDED IN CHARITY CARE HAD THE PATIENT COMPLETED THE NECESSARY PAPERWORK. |
| PART III, LINE 4: | FOOTNOTE #2 IS LOCATED ON PAGE 16 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS AND BRIEFLY DESCRIBES THE PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS. BAD DEBT IS LISTED AS A DEDUCTION FROM REVENUE. THIS TREATEMENT IS CONSISTENT WITH THE HFMA PRINCIPLES AND PRACTICES BOARD STATEMENT NO. 15 AND WITH THE AICPA AUDIT AND ACCOUNTING GUIDE FOR HEALTHCARE ORGANIZATIONS. |
| PART III, LINE 8: | KSB HOSPITAL IS A SMALL 80 BED HOSPITAL LOCATED IN RURAL LEE COUNTY IN NORTHERN ILLINOIS. IT WAS ESTIMATED THAT THE POPULATION OF LEE COUNTY WAS 33,848 IN 2022. 21.2% OF THE POPULATION WAS AGE 65 AND OLDER. THE CENSUS BUREAU ESTIMATED THAT 12% OF LEE COUNTY WAS BELOW THE POVERTY LINE. IN 2022, 39.65% OF OUR PAYOR MIX WAS MEDICARE RECIPIENTS. AS A HEALTHCARE PROVIDER WE REALIZE THAT SUBSTANTIAL SHORTFALLS ARISE FROM PAYMENTS THAT ARE LESS THAN WHAT IT COSTS TO PROVIDE CARE OR SERVICE AND DO NOT INCLUDE ANY AMOUNTS THAT RESULT FROM INEFFICIENCIES OR POOR MANAGEMENT. KSB HOSPITAL ACCEPTS ALL MEDICARE PATIENTS KNOWING THAT THERE MAY BE SHORTFALLS, THEREFORE IT HAS TAKEN THE POSITION THAT THEY SHOULD BE COUNTED AS PART OF THE COMMUNITY BENEFIT. ADDITIONALLY, IT IS IMPLIED IN THE INTERNAL REVENUE SERVICE REVENUE RULING 69-545 THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NON-PROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.BASED ON KSB HOSPITAL'S FILED 2023 MEDICARE COST REPORT THE MEDICARE ALLOWABLE COSTS FOR 2023 WERE $19,930,790 AND PAYMENTS RECEIVED FROM MEDICARE WERE $23,337,153. WE BELIEVE THAT THE SHORTFALL OF $3,406,363 SHOULD BE CONSIDERED COMMUNITY BENEFIT. |
| PART III, LINE 9B: | AFTER THREE STATEMENTS (90) DAYS WITH NO PAYMENT FROM PATIENT, THE ACCOUNT IS ELIGIBLE FOR COLLECTION ACCOUNTS UNDER $500 ARE TO BE PAID OFF IN 6 MONTHS AND OVER $500 PAID OFF WITHIN ONE YEAR. ACCOUNTS THAT HAVE BEEN APPROVED FOR FINANCIAL ASSISTANCE ARE NOT SENT TO COLLECTION. |
| PART VI, LINE 2: | IN THE 2019 CHNA, WE IDENTIFIED ACCESS TO CARE/TRANSPORTATION AS A KEY PRIORITY AND ENACTED AN IMPLEMENTATION PLAN TO MEET THE NEED. THIS PLAN INCLUDED KSB PARTNERING WITH THE LEE OGLE TRANSPORTATION SERVICE (LOTS) AND PROVIDING TELEHEALTH SERVICES TO ALLEVIATE THE NEED FOR IN OFFICE VISITS. THIS BECAME LESS OF AN ISSUE WITH THE IMPACT OF THE COVID 19 PANDEMIC. WE CONTINUE TO PARTICIPATE IN ACCESS TO CARE EFFORTS. WHILE THERE IS STILL ROOM FOR IMPROVEMENT, KSB WILL REMAIN ENGAGED IN FINDING SOLUTIONS. AS LOW NUMBERS IN THE DATA RESPONDED THAT THIS WAS AN ISSUE; IT WAS NOT SELECTED AMONG THE TOP THREE ITEMS IN THIS YEAR'S CHNA.ADDITIONALLY, WHILE KSB WILL ALSO BE ENGAGED FROM A CLINICAL AND EDUCATIONAL PERSPECTIVE IN TOBACCO USE AND E-CIGARETTE USE, WE DID NOT SCORE THIS IN THE TOP THREE BECAUSE OF THE NUMBER OF OTHER COMMUNITY ORGANIZATIONS WHO ARE SHARING RESPONSIBILITY FOR INTERVENTION IN THIS AREA. THE LEE COUNTY HEALTH DEPARTMENT, LOCAL SCHOOL DISTRICTS, LAW ENFORCEMENT, AND PARENT AND STUDENT ADVOCATES ARE WORKING TO EDUCATE AND PREVENT TOBACCO AND E-CIGARETTE USAGE. KSB WILL PARTICIPATE IN THESE EFFORTS EVEN THOUGH THIS IS NOT ONE OF THE TOP THREE PRIORITIES LISTED IN THIS CHNA.ALSO, WHILE KSB WILL BE ENGAGED FROM A CLINICAL AND EDUCATIONAL PERSPECTIVE IN SUBSTANCE USE DISORDER, WE DID NOT SCORE THIS IN THE TOP THREE BECAUSE OF THE NUMBER OF OTHER COMMUNITY ORGANIZATIONS WHO ARE SHARING RESPONSIBILITY FOR INTERVENTION IN THIS AREA. SINNISSIPPI CENTERS, RECOVERY FAMILY WORKPLACE ILLINOIS, LOCAL SCHOOL DISTRICTS, LAW ENFORCEMENT, LOCAL HEALTH DEPARTMENT AND PARENT AND STUDENT ADVOCATES ARE WORKING TO EDUCATE AND PREVENT SUBSTANCE USE DISORDER. KSB WILL PARTICIPATE IN THESE EFFORTS EVEN THOUGH THIS IS NOT ONE OF THE TOP THREE PRIORITIES LISTED IN THIS CHNA. |
| PART VI, LINE 3: | KSB HOSPITAL STRIVES TO EDUCATE OUR PATIENTS OF THEIR ELIGBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, AND LOCAL PROGRAMS. PATIENTS ARE ALSO INFORMED OF OUR CHARITY CARE POLICY. EVERY SELF PAY PATIENT THAT COMES TO THE HSOPITAL IS GIVEN A CHARITY APPLICATION AND OFFERED ASSISTANCE IN HELPING THEM COMPLETE THE APPLICATION. NOTICES ABOUT ASSISTANCE PROGRAMS ARE POSTED IN THE REGISTRATION AREAS AND THE INFORMATION IS ALSO INCLUDED IN THE PATIENT'S STATEMENT AND ON THE KSB WEBSITE. A PATIENT ADVOCATE VISITS EACH INPATIENT WITH A NOTICE OF THEIR INSURANCE BENEFITS AND THEN COUNSELS EACH PATIENT OF ADDITIONAL OPTIONS FOR ASSISTANCE. |
| PART VI, LINE 4: | KSB HOSPITAL SERVES LEE COUNTY, A RURAL COUNTY IN NORTHWESTERN ILLINOIS ONE HUNDRED MILES WEST OF CHICAGO AND FORTY-FIVE MILES SOUTHWEST OF ROCKFORD. ACCORDING TO THE U.S. CENSUS BUREAU, THE 2022 POPULATION OF LEE COUNTY WAS ESTIMATED AT 33,848. THE COMMUNITIES OF LEE AND WESTERN OGLE COUNTY COMPRISE THE KSB HOSPITAL PRIMARY SERVICE AREA. THIS AREA SAW A POPULATION DECLINE OF 0.7% BETWEEN 2021 AND 2022, A PERIOD DURING WHICH THE STATE DECLINED BY 0.9%. DIXON IS THE COUNTY SEAT AND THE LARGEST COMMUNITY IN LEE COUNTY WITH AN ESTIMATED POPULATION OF 15,380. LEE COUNTY RACE AND ETHNICITY SHOWS 90.6% WHITE, NOT HISPANIC; 6.4% BLACK; 7.2% HISPANIC OR LATINO; WITH NO OTHER RACE ABOVE 1%. LEE COUNTY COVERS 725 SQUARE MILES. PUBLIC TRANSPORTATION IS AVAILABLE THROUGH THE LEE/OGLE TRANSPORTATION SYSTEM AND PRIVATE CAB COMPANIES. ACCORDING TO THE ILLINOIS DEPARTMENT OF EMPLOYMENT SECURITY, THE 2021 ANNUAL AVERAGE UNEMPLOYMENT RATE FOR LEE COUNTY WAS 4.0%, COMPARABLE TO NORTHWEST ILLINOIS OVERALL AND COMPARABLE TO THE STATE AVERAGE OF 4.6%. WITH A MEDIAN HOUSEHOLD IN INCOME OF $60,542, LEE COUNTY IS LOWER THAN THE STATE AVERAGE OF $78,020. LEE COUNTY PER CAPITA INCOME IS $30,461, BELOW THE STATE AVERAGE OF $39,571. THE PROPORTION OF LEE COUNTY RESIDENTS, 10.7%, LIVING BELOW THE FEDERAL POVERTY LEVEL IS LOWER THAN THE STATE AVERAGE OF 12.1%. UNINSURED (1.5%) AND MEDICAID (20.68%) PATIENTS COMPRISE A TOTAL OF 22.2% OF OUR PAYER MIX FOR 2022. KATHERINE SHAW BETHEA HOSPITAL IS THE SOLE HOSPITAL IN THE COMMUNITY OF DIXON. THE AREA OF DIXON DOES NOT CONTAIN ANY FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS OR POPULATIONS. |
| PART VI, LINE 5: | IN ADDITION TO MEDICAL CARE, SOUND LEADERSHIP AND MANAGEMENT ARE CRITICAL PARTS OF ANY GOOD HOSPITAL. AT KSB HOSPITAL, OUR MISSION AND VISION ARE PUT INTO ACTION EVERY DAY BY AN ADMINISTRATIVE TEAM, A BOARD OF DIRECTORS AND THE MEDICAL STAFF. THESE LEADERS OVERSEE THE HOSPITAL'S OPERATIONS AND MAKE VALUES-BASED DECISIONS THAT ARE CONSISTENT WITH OUR MISSION. MOST OF THE BOARD OF DIRECTORS IS COMPRISED OF PERSONS WHO RESIDE IN OUR SERVICE AREA, WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION. KSB HAS CLINICS IN 10 LOCATIONS AND THOSE COMMUNITIES ARE WELL REPRESENTED ON THE KSB BOARD. FOR EXAMPLE, COLLEEN HENKLE IS FROM THE AMBOY AREA AND LYNETTE KNODLE WORKS IN OREGON-THESE ARE TWO LOCALES WHERE KSB HAS CLINICS THAT SERVE THOSE COMMUNITIES. OFFERING MORE THAN 60 PHYSICIANS IN A VARIETY OF DISCIPLINES, KSB MEDICAL GROUP ENHANCES HEALTHCARE OPTIONS FOR SAUK VALLEY RESIDENTS. THIS MULTI-SPECIALTY PRACTICE HAS BROUGHT TOGETHER PHYSICIANS WHO ARE NEW TO THE AREA AND THOSE WHO HAVE SPENT AN ENTIRE CAREER IN OUR HOMETOWNS. KSB ALSO EXTENDS AN OPPORTUNITY TO ALL QUALIFIED PHYSICIANS SEEKING PRIVILEGES IN THE SAUK VALLEY SERVICE AREA. KSB UTILIZES ALL SURPLUS FUNDS FOR IMPROVEMENTS IN PATIENT CARE, INNOVATIVE TECHNOLOGY, AND OUR PHYSICAL PROPERTIES. THE LAST YEAR HAS SEEN SIGNIFICANT GROWTH WITHIN AND OUTSIDE THE WALLS OF KSB. IN 2023, WE CONTINUED UPDATING PATIENT ROOMS TO INCLUDE THE LATEST IN TECHNOLOGY AND EQUIPMENT. OUR EDUCATION DEPARTMENT OFFERS A VARIETY OF CLASSES TO EMPLOYEES AND THE PUBLIC. OUR COMMUNITY WELLNESS DEPARTMENT COLLABORATES WITH OTHER COMMUNITY ORGANIZATIONS TO BRING A VARIETY OF HEALTH-RELATED AND WELLNESS PROGRAMS TO THE COMMUNITY. THESE OPPORTUNITIES ARE AN OUTREACH TO THE COMMUNITY THAT ARE FUN AND EDUCATIONAL. A LOOK AROUND AT THE VARIOUS DEPARTMENTS THAT MAKE UP KSB HOSPITAL REVEALS A CONTEMPORARY MEDICAL FACILITY THAT IS PROUD TO OFFER PATIENTS THE FINEST SERVICE POSSIBLE YET IS NEVER CONTENT TO REST ON ITS PAST ACCOMPLISHMENTS. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| DIXON FAMILY YMCA | ||||||||
| 110 N GALENA AVENUE | DIXON | IL | 61021 | 362487927 | 501(C)(3) | $20,250 | $0 | GENERAL OPERATING SUPPORT |
| HOME OF HOPE CANCER WELLNESS CENTERS | ||||||||
| 1637 PLOCK ROAD | DIXON | IL | 61021 | 010743626 | 501(C)(3) | $15,000 | $0 | GENERAL OPERATING SUPPORT |
| SAUK VALLEY COMMUNITY COLLEGE | ||||||||
| 173 IL-2 | DIXON | IL | 61021 | 362588599 | GOVERNMENT | $8,313 | $0 | GENERAL OPERATING SUPPORT |
| THE HISTORIC DIXON THEATRE GROUP | ||||||||
| 93 S HENNEPIN AVE | DIXON | IL | 61021 | 833904556 | 501(C)(3) | $7,500 | $0 | GENERAL OPERATING SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 4 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | GRANTS TO OTHER ORGANIZATIONS ARE NOT MONITORED. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MONTHER ELBZOUR MD | ||||||||||||||
| PHYSICIAN | $1,895,930 | $0 | $112,940 | $0 | $0 | $0 | $1,230 | $0 | $39,658 | $0 | $2,049,758 | $0 | $0 | $0 |
| SOHAIL HANIF MD | ||||||||||||||
| PHYSICIAN | $1,539,059 | $0 | $9,427 | $0 | $0 | $0 | $1,170 | $0 | $39,658 | $0 | $1,589,314 | $0 | $0 | $0 |
| DAVID SCHREINER | ||||||||||||||
| CEO AND BOARD MEMBER | $785,283 | $0 | $475 | $0 | $263,379 | $0 | $1,620 | $0 | $34,264 | $0 | $1,085,021 | $0 | $0 | $0 |
| FADI MOHAMAD MUSTAPHA | ||||||||||||||
| PHYSICIAN | $941,667 | $0 | $42,563 | $0 | $0 | $0 | $1,800 | $0 | $39,658 | $0 | $1,025,688 | $0 | $0 | $0 |
| KURT CROWE MD | ||||||||||||||
| PHYSICIAN | $781,385 | $0 | $60,475 | $0 | $0 | $0 | $1,800 | $0 | $44,290 | $0 | $887,950 | $0 | $0 | $0 |
| STEPHEN GABRIEL | ||||||||||||||
| PHYSICIAN | $741,694 | $0 | $94,480 | $0 | $0 | $0 | $0 | $0 | $34,264 | $0 | $870,438 | $0 | $0 | $0 |
| JOYCE JOHNSON MD | ||||||||||||||
| MEDICAL STAFF PRESIDENT | $240,587 | $0 | $189,622 | $0 | $95,000 | $0 | $5,666 | $0 | $0 | $0 | $530,875 | $0 | $0 | $0 |
| AUSTIN FRAZIER | ||||||||||||||
| VP-CHIEF FINANCIAL OFFICER | $336,980 | $0 | $15,475 | $0 | $0 | $0 | $1,350 | $0 | $44,290 | $0 | $398,095 | $0 | $0 | $0 |
| RAY SHARP | ||||||||||||||
| VP-CHIEF INFORMATION OFFIC | $265,773 | $0 | $475 | $0 | $0 | $0 | $1,800 | $0 | $44,290 | $0 | $312,338 | $0 | $0 | $0 |
| LINDA CLEMEN | ||||||||||||||
| VP-CHIEF NURSING OFFICER | $267,742 | $0 | $475 | $0 | $0 | $0 | $1,800 | $0 | $20,686 | $0 | $290,703 | $0 | $0 | $0 |
| DREW FENNER | ||||||||||||||
| VP-CHIEF QUALITY OFFICER | $229,911 | $0 | $475 | $0 | $0 | $0 | $1,350 | $0 | $44,290 | $0 | $276,026 | $0 | $0 | $0 |
| RYAN MILLER | ||||||||||||||
| VP-CHIEF PEOPLE OFFICER | $234,345 | $0 | $475 | $0 | $0 | $0 | $843 | $0 | $24,737 | $0 | $260,400 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | DAVID SCHREINER RECEIVED CONTRIBUTIONS TO A SERP PLAN IN THE AMOUNT OF $263,379. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KAILE VALDEZ | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | FAMILY MEMBER OF DAVID SCHREINER, CURRENT OFFICER/TRUSTEE | RelationshipDescriptionTxt |
| Transaction | $15,954 | TransactionAmt |
| Transaction | EMPLOYEE COMPENSATION | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART IV | FormAndLineReferenceDesc |
| Explanation | KSB IS ONE OF THE LARGEST EMPLOYERS IN LEE COUNTY, ILLINOIS AND IT IS VERY COMMON IN LESSER POPULATED RURAL AREAS FOR FAMILY MEMBERS TO WORK AT SUCH A SIGNIFICANT EMPLOYER. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE BOARD CHAIRPERSON AS CHAIRPERSON OF THE COMMITTEE, THE VICE CHAIRPERSON, THE SECRETARY, THE TREASURER AND THE CHIEF EXECUTIVE OFFICER. THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE INTERIM BETWEEN BOARD MEETINGS PROVIDED ANY ACTION TAKEN SHALL NOT CONFLICT WITH THE POLICIES AND EXPRESSED WISHES OF THE BOARD. |
| FORM 990, PART VI, SECTION A, LINE 7A | BOARD MEMBERS ARE ELECTED BY A MAJORITY VOTE OF THE CITY COUNCIL OF THE CITY OF DIXON, ILLINOIS. IF TWO-THIRDS OR MORE OF THE BOARD POSITIONS ARE VACATED IN ANY ONE YEAR, THE MAYOR OF THE CITY OF DIXON, ILLINOIS, WOULD HAVE THE POWER TO APPOINT ALL BOARD MEMBERS TO FILL SUCH VACANCIES. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE MAYOR MAY, BY AND WITH THE CONSENT OF THE CITY COUNCIL, REMOVE ANY DIRECTOR FOR MISCONDUCT OR NEGLECT OF DUTY. |
| FORM 990, PART VI, SECTION B, LINE 11B | FULL COMPLETE COPIES OF THE FORM 990 ARE PROVIDED TO THE ENTIRE GOVERNING BODY AND MANAGEMENT PRIOR TO FILING, WITH A REVIEW AT THE BOARD MEETING TO ADDRESS ANY QUESTIONS THAT MAY ARISE. |
| FORM 990, PART VI, SECTION B, LINE 12C | ON AN ANNUAL BASIS, A CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO ALL MEMBERS OF THE GOVERNING BODY AND MANAGEMENT TO IDENTIFY ANY CONFLICTS OF INTEREST. IN ADDITION, ON AN ONGOING BASIS, PRIOR TO EACH BOARD ACTION, EACH VOTING OFFICER IS RESPONSIBLE TO SELF-EVALUATE TO DETERMINE WHETHER A CONFLICT OF INTEREST IS PRESENT. AN INDIVIDUAL WITH A POTENTIAL CONFLICT DISCLOSES THE MATTER TO THE BOARD OR COMMITTEE. AFTER DISCLOSURE OF THE RELEVANT FACTS, THAT INDIVIDUAL LEAVES THE ROOM WHILE THE REMAINING BOARD OR COMMITTEE MEMBERS VOTE ON WHETHER A CONFLICT OF INTEREST EXISTS. IN THE INSTANCE THAT CONFLICT EXISTS, THE NECESSARY PARTIES ARE EXCUSED FROM THE ROOM WHILE THE REMAINING BOARD OR COMMITTEE MEMBERS DISCUSS THE TRANSACTION AND VOTE ON THE MATTER. IF AN INDIVIDUAL FAILS TO DISCLOSE A CONFLICT, THE BOARD WILL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANZATION ENGAGES AN OUTSIDE CONSULTANT TO PROVIDE COMPARABILITY COMPENSATION DATA FOR THE CEO POSITION. THE OUTSIDE CONSULTANT PROVIDES THE BOARD WITH A SUGGESTED RANGE FOR COMPENSATION. THE BOARD AND COMPENSATION COMMITTEE THEN REVIEWS THE INFORMATION RECEIVED AND DETERMINES THE COMPENSATION OF THE CEO WITH LEGAL COUNSEL. THE BOARD APPROVES IN ADVANCE AND DOCUMENTS THE COMPENSATION DETERMINATIONS IN THE BOARD MINUTES ON A TIMELY BASIS. A FIVE YEAR CONTRACT WAS NEGOTATED. THIS CONTRACT IS IN EFFECT FOR 2023. THE VICE PRESIDENTS' (CFO, CNO, CPO(CHIEF PRACTICE OFFICER), CMO AND CAO) COMPENSATION ARE DETERMINED BY PROVIDING THE CEO WITH COMPARABILITY DATA. THE COMPARABILITY DATA IS GATHERED BY THE HUMAN RESOURCES DEPARTMENT. THE CEO DETERMINES THE APPROPRIATE COMPENSATION FOR THE VICE PRESIDENTS AND PRESENTS A REPORT TO THE COMPENSATION COMMITTEE. PHYSCICIAN COMPENSATION IS NEGOTIATED AT THE TIME OF CONTRACT RENEWAL. THE ORGANZATION ENGAGES AN OUTSIDE CONSULTANT TO PROVIDE COMPARABILITY DATA FOR THE PHYSICIANS. |
| FORM 990, PART VI, SECTION C, LINE 19 | FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICTS OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO IRC SECTION 6104. PORTIONS OF THE FINANCIAL STATEMENTS ARE PUBLISHED IN THE ANNUAL REPORT THAT IS MAILED TO THE LOCAL COMMUNITY. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. |
| FORM 990, PART VII, SECTION B, LINE 1 | IT IS POSSIBLE THAT A PORTION OF THE AMOUNT REPORTED FOR BROWN CONSTRUCTION CO. WAS RELATED TO MATERIALS IN ADDITION TO AMOUNTS PAID FOR SERVICES, HOWEVER, THE AMOUNTS ARE NOT DISTINGUISHABLE. |
| FORM 990, PART IX, LINE 11G | REPAIRS AND MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 2,182,629. MANAGEMENT AND GENERAL EXPENSES 242,284. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,424,913. PROFESSIONAL: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 68,211. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 68,211. PURCHASED: PROGRAM SERVICE EXPENSES 12,914,556. MANAGEMENT AND GENERAL EXPENSES 3,767,785. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,682,341. RECOGNITION: PROGRAM SERVICE EXPENSES 42,663. MANAGEMENT AND GENERAL EXPENSES 12,117. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,780. OTHER: PROGRAM SERVICE EXPENSES 98,780. MANAGEMENT AND GENERAL EXPENSES 238,433. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 337,213. |
| FORM 990, PART XI, LINE 9: | CHANGES IN VALUE OF SUBSIDIARIES -405,763. |
| FORM 990, PAGE 12, PART XII, LINE 2C | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KSB HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 403 EAST FIRST STREET | AddressLine1Txt |
| City | DIXON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61021 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 841787288 | EIN |
| Primary Activities | TO RAISE FUNDS TO SUPPORT KSB'S MISSION | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12A, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KATHERINE SHAW BETHEA HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KSB VENTURES INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 403 EAST 1ST STREET | AddressLine1Txt |
| City | DIXON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61021 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 465278274 | EIN |
| Primary Activities | HOLD PARTNERSHIP INVESTMENT | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KATHERINE SHAW BETHEA HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of EOY Assets | $294,652 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KSH HOSPITAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $82,107 | InvolvedAmt |
| Method Of Amount Determination | FMV | MethodOfAmountDeterminationTxt |