KATHERINE SHAW BETHEA HOSPITAL: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization: KATHERINE SHAW BETHEA HOSPITAL (EIN 36-1000540)
Tax period: 2021-01-01 to 2021-12-31
Filed: 2022-11-15
IRS object ID: 202223199349324812
Schema version: 2021v4.2
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	2022-11-15T16:21:33-06:00	ReturnTs
Tax Period End	2021-12-31	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	2021-01-01	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	DAVID SCHREINER	PersonNm
Person Title	CEO	PersonTitleTxt
Phone	8152855521	PhoneNum
Signature	2022-11-15	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	DAVID	PersonFirstNm
Person Last	SCHREINER	PersonLastNm

Field	Value	IRS element (for citing)
SSN	361000540	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	AMBER ROGNAN-HAMILTON	PreparerPersonNm
PTIN	P01251012	PTIN
Phone	3149254300	PhoneNum
Preparation	2022-11-15	PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	3	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2021	TaxYr
Build TS	2022-09-23 18:48:47Z	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	$160,782,073	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	11	VotingMembersGoverningBodyCnt
Voting Members Independent	9	VotingMembersIndependentCnt
Total Employee	1158	TotalEmployeeCnt
Total Volunteers	85	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$15,551,134	PYContributionsGrantsAmt
CY Contributions Grants	$7,654,933	CYContributionsGrantsAmt
PY Program Service Revenue	$135,437,712	PYProgramServiceRevenueAmt
CY Program Service Revenue	$151,479,780	CYProgramServiceRevenueAmt
PY Investment Income	$1,215,966	PYInvestmentIncomeAmt
CY Investment Income	$41,570	CYInvestmentIncomeAmt
PY Other Revenue	$904,160	PYOtherRevenueAmt
CY Other Revenue	$859,460	CYOtherRevenueAmt
PY Total Revenue	$153,108,972	PYTotalRevenueAmt
CY Total Revenue	$160,035,743	CYTotalRevenueAmt
PY Grants And Similar Paid	$102,396	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$256,991	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$80,224,804	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$86,842,852	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$131,615	CYTotalFundraisingExpenseAmt
PY Other Expenses	$87,838,811	PYOtherExpensesAmt
CY Other Expenses	$77,699,314	CYOtherExpensesAmt
PY Total Expenses	$168,166,011	PYTotalExpensesAmt
CY Total Expenses	$164,799,157	CYTotalExpensesAmt
PY Revenues Less Expenses	-$15,057,039	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$4,763,414	CYRevenuesLessExpensesAmt
Total Assets BOY	$143,545,322	TotalAssetsBOYAmt
Total Assets EOY	$132,187,622	TotalAssetsEOYAmt
Total Liabilities BOY	$84,645,214	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$76,989,025	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$58,900,108	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$55,198,597	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	$141,936,619	ExpenseAmt
Grant	$256,991	GrantAmt
Revenue	$151,479,780	RevenueAmt
Desc	IN 2021, KATHERINE SHAW BETHEA HOSPITAL (KSB) HAD 3,224 INPATIENT VISITS AND 246,728 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 $67,000 IN 2021.KSB PROVIDES 24-HOUR EMERGENCY MEDICAL SERVICES STAFFED BY FULL-TIME PHYSICIANS. PATIENTS ARE TREATED REGARDLESS OF INSURANCE OR ABILITY PAY. ER VISITS IN 2021 WERE 16,575.	Desc
Total Program Service Expenses	$141,936,619	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	0	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	Yes (1)	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	87	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	1158	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
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	11	GoverningBodyVotingMembersCnt
Independent Voting Member	9	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

Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Highest Compensated EmployeeHighestCompensatedEmployeeInd
LYNETTE KNODLE
CHAIRPERSON	2.10	0.00	Yes (X)	Yes (X)	$0	$0	$0
COLLEEN T HENKEL
VICE CHAIRPERSON	1.40	0.00	Yes (X)	Yes (X)	$0	$0	$0
KATIE PRATT
SECRETARY	0.90	0.00	Yes (X)	Yes (X)	$0	$0	$0
CHRIS HAMMITT
TREASURER	1.40	0.00	Yes (X)	Yes (X)	$0	$0	$0
RICK CURIA
PAST CHAIRPERSON	0.90	1.00	Yes (X)		$0	$0	$0
JOSEPH WELTY MD
BOARD MEMBER / PHYSICIAN	7.00	0.00	Yes (X)		$126,830	$0	$6,342
RAY NEISEWANDER III
BOARD MEMBER	0.90	1.00	Yes (X)		$0	$0	$0
DAVID HELLMICH
BOARD MEMBER	1.30	1.00	Yes (X)		$0	$0	$0
RICHARD BOYSEN
BOARD MEMBER	1.40	0.00	Yes (X)		$0	$0	$0
PATRICK KING DDS
BOARD MEMBER	1.70	0.00	Yes (X)		$0	$0	$0
DAVID SCHREINER
CEO AND BOARD MEMBER	40.00	1.00	Yes (X)	Yes (X)	$562,900	$0	$30,778
LINDA CLEMEN
VP-CHIEF NURSING OFFICER	40.00	0.00		Yes (X)	$263,082	$0	$30,231
SUZANNE RAVLIN
VP-CHIEF LEGAL OFFICER	40.00	1.00		Yes (X)	$312,601	$0	$25,978
PRATIP NAG MD
CHIEF MEDICAL OFFICER	40.00	0.00		Yes (X)	$294,131	$0	$23,437
MICHAEL KITTOE
VP-CHIEF FINANCIAL OFFICER	40.00	0.00		Yes (X)	$339,551	$0	$18,648
RAY SHARP
VP-CHIEF INFORMATION OFFICER	40.00	0.00		Yes (X)	$255,751	$0	$25,256
MONTHER ELBZOUR MD
PHYSICIAN	40.00	0.00			$1,931,934	$0	$37,511	Yes (X)
SOHAIL HANIF MD
PHYSICIAN	40.00	0.00			$1,279,598	$0	$37,511	Yes (X)
ROBB RYDZYNSKI MD
PHYSICIAN	40.00	0.00			$919,548	$0	$46,850	Yes (X)
FADI MOHAMAD MUSTAPHA MD
PHYSICIAN	40.00	0.00			$887,451	$0	$38,711	Yes (X)
KURT CROWE MD
PHYSICIAN	40.00	0.00			$829,601	$0	$46,850	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$8,002,978	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$368,103	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	99	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
PAYCOM PAYROLL LLC
7501 W MEMORIAL ROAD	OKLAHOMA CITY	OK	73142	PAYROLL SERVICES	$5,112,339
RSM US LLP
5155 PAYSPHERE CIRCLE	CHICAGO	IL	60674	CONSULTING SERVICES	$1,242,114
LAB CORPORATION
PO BOX 12140	BURLINGTON	NC	27216	LAB TESTING	$1,138,872
ROCKFORD ANESTHESIOLOGISTS ASSOCIATED L
PO BOX 4569	ROCKFORD	IL	61110	ANESTHESIOLOGY	$602,553
HORIZON HEALTH
PO BOX 840839	DALLAS	TX	75284	MENTAL HEALTH SERVICES	$600,919

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	17	CntrctRcvdGreaterThan100KCnt
Related Organizations	$12,830	RelatedOrganizationsAmt
Government Grants	$7,613,731	GovernmentGrantsAmt
All Other Contributions	$28,372	AllOtherContributionsAmt
Total Contributions	$7,654,933	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE	621110	$151,033,108	$151,033,108
NET CLINIC SPACE RENTAL	621110	$446,672	$446,672

Field	Value	IRS element (for citing)
Total Program Service Revenue	$151,479,780	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$210,131	TotalRevenueColumnAmt
Exclusion	$210,131	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$282,102	SecuritiesAmt
Other	$295,667	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$297,461	SecuritiesAmt
Other	$448,869	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	-$15,359	SecuritiesAmt
Other	-$153,202	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$168,561	TotalRevenueColumnAmt
Exclusion	-$168,561	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt
CAFETERIA SALES	900099	$398,327	$398,327
INCENTIVE PAYMENT	900099	$192,902	$192,902
REVENUE SHARE	900099	$135,061	$135,061

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$133,170	TotalRevenueColumnAmt
Exclusion	$133,170	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$859,460	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$160,035,743	TotalRevenueColumnAmt
Related Or Exempt Func Income	$151,479,780	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$901,030	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	$246,991	TotalAmt
Program Services	$246,991	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$10,000	TotalAmt
Program Services	$10,000	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$2,315,516	TotalAmt
Program Services	$744,053	ProgramServicesAmt
Management And General	$1,571,463	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$64,947,882	TotalAmt
Program Services	$62,703,712	ProgramServicesAmt
Management And General	$2,142,380	ManagementAndGeneralAmt
Fundraising	$101,790	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$2,026,316	TotalAmt
Program Services	$1,515,721	ProgramServicesAmt
Management And General	$510,595	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$13,748,056	TotalAmt
Program Services	$10,220,240	ProgramServicesAmt
Management And General	$3,527,816	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$3,805,082	TotalAmt
Program Services	$3,572,693	ProgramServicesAmt
Management And General	$224,667	ManagementAndGeneralAmt
Fundraising	$7,722	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$100,163	TotalAmt
Program Services	$100,163	ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$66,789	TotalAmt
Program Services	$49,424	ProgramServicesAmt
Management And General	$17,365	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$31,106	TotalAmt
Management And General	$31,106	ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$18,387	TotalAmt
Management And General	$18,387	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$19,131,003	TotalAmt
Program Services	$12,933,141	ProgramServicesAmt
Management And General	$6,197,273	ManagementAndGeneralAmt
Fundraising	$589	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$216,253	TotalAmt
Program Services	$160,666	ProgramServicesAmt
Management And General	$55,587	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$19,721,939	TotalAmt
Program Services	$18,225,340	ProgramServicesAmt
Management And General	$1,493,621	ManagementAndGeneralAmt
Fundraising	$2,978	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$5,579,275	TotalAmt
Program Services	$4,152,228	ProgramServicesAmt
Management And General	$1,426,087	ManagementAndGeneralAmt
Fundraising	$960	FundraisingAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,633,015	TotalAmt
Program Services	$932,098	ProgramServicesAmt
Management And General	$700,917	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$135,508	TotalAmt
Program Services	$120,497	ProgramServicesAmt
Management And General	$15,011	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$174,684	TotalAmt
Program Services	$141,854	ProgramServicesAmt
Management And General	$32,830	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$901,827	TotalAmt
Program Services	$640,394	ProgramServicesAmt
Management And General	$261,433	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$7,047,221	TotalAmt
Program Services	$5,339,890	ProgramServicesAmt
Management And General	$1,706,017	ManagementAndGeneralAmt
Fundraising	$1,314	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$2,610,491	TotalAmt
Program Services	$1,900,861	ProgramServicesAmt
Management And General	$709,630	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
BAD DEBT EXPENSE	$11,549,521	$11,549,521
IPA/SALES & USE TAX	$4,894,779	$3,623,591	$1,271,188
REPAIRS AND MAINTENANCE	$1,669,436	$1,386,569	$282,867
LICENSE FEES	$892,434	$668,794	$223,640

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,325,483	TotalAmt
Program Services	$998,178	ProgramServicesAmt
Management And General	$311,043	ManagementAndGeneralAmt
Fundraising	$16,262	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$164,799,157	TotalAmt
Program Services	$141,936,619	ProgramServicesAmt
Management And General	$22,730,923	ManagementAndGeneralAmt
Fundraising	$131,615	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$303,293	BOYAmt
EOY	$232,511	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$24,624,463	BOYAmt
EOY	$20,285,472	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$38,938,505	BOYAmt
EOY	$31,064,802	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,952,691	BOYAmt
EOY	$1,905,297	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$1,393,908	BOYAmt
EOY	$1,647,567	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$157,588,078	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$107,887,523	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$51,336,570	BOYAmt
EOY	$49,700,555	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$19,109,357	BOYAmt
EOY	$21,580,012	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$5,886,535	BOYAmt
EOY	$5,771,406	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$143,545,322	BOYAmt
EOY	$132,187,622	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$53,442,198	BOYAmt
EOY	$50,689,260	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$4,748,667	BOYAmt
EOY	$6,287,141	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$20,560,941	BOYAmt
EOY	$20,012,624	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$5,893,408	BOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$84,645,214	BOYAmt
EOY	$76,989,025	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	$57,620,259	BOYAmt
EOY	$53,918,748	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,279,849	BOYAmt
EOY	$1,279,849	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$58,900,108	BOYAmt
EOY	$55,198,597	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$143,545,322	BOYAmt
EOY	$132,187,622	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$4,763,414	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$777,032	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$284,871	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	$31,106	OtherActivitiesAmt
Total Lobbying Expenditures	$31,106	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	$912,772	BeginningYearBalanceAmt
End Year Balance	$912,772	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,043,624	BeginningYearBalanceAmt
Contributions	$41,546	ContributionsAmt
End Year Balance	$1,085,170	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,016,016	BeginningYearBalanceAmt
Contributions	$27,608	ContributionsAmt
End Year Balance	$1,043,624	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,892,631	BeginningYearBalanceAmt
Contributions	$103,244	ContributionsAmt
Administrative Expenses	$979,859	AdministrativeExpensesAmt
End Year Balance	$1,016,016	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.00000	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	1.00000	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	$57,286,020	OtherCostOrOtherBasisAmt
Depreciation	$35,652,406	DepreciationAmt
Book Value	$21,633,614	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$5,639,755	OtherCostOrOtherBasisAmt
Depreciation	$4,342,412	DepreciationAmt
Book Value	$1,297,343	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$91,286,789	OtherCostOrOtherBasisAmt
Depreciation	$67,892,705	DepreciationAmt
Book Value	$23,394,084	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,086,475	OtherCostOrOtherBasisAmt
Book Value	$1,086,475	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$49,700,555	TotalBookValueLandBuildingsAmt
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.

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	$414,118	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$414,118	NetCommunityBenefitExpnsAmt
Total Expense	0.00250	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$24,407,548	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$7,230,264	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$17,177,284	NetCommunityBenefitExpnsAmt
Total Expense	0.10420	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$24,821,666	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$7,230,264	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$17,591,402	NetCommunityBenefitExpnsAmt
Total Expense	0.10670	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$697,216	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$142	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$697,074	NetCommunityBenefitExpnsAmt
Total Expense	0.00420	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,656,967	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$6,072,360	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	$44,659	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$51,207	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$61,567	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$61,567	NetCommunityBenefitExpnsAmt
Total Expense	0.00040	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,460,409	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$6,123,709	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$758,641	NetCommunityBenefitExpnsAmt
Total Expense	0.00460	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$29,282,075	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$13,353,973	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$18,350,043	NetCommunityBenefitExpnsAmt
Total Expense	0.11130	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$11,549,521	BadDebtExpenseAmt
Bad Debt Expense Attributable	$1,462,592	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$24,840,085	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$28,785,830	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$3,945,745	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	19	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	19	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	WWW.KSBHOSPITAL.COM/FINANCIALASSISTANCE/	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	WWW.KSBHOSPITAL.COM/FINANCIALASSISTANCE/	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 (6 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 THE COMMUNITY COMMONS WEBSITE THROUGH THEIR CHNA REPORT TOOL. POPULATION DATA WAS OBTAINED FROM THE U.S. CENSUS BUREAU WEBSITE AND THEIR AMERICAN COMMUNITY SURVEY TOOL.AS PART OF A STRATEGIC PLANNING PROCESS IN EARLY 2019, KSB ADMINISTRATION AND MEMBERS OF THE BOARD OF DIRECTORS CONDUCTED MORE THAN 100 IN-PERSON INTERVIEWS WITH STAKEHOLDERS AND REPRESENTATIVES OF WIDELY VARIED PARTS OF THE COMMUNITY. THOSE INTERVIEWS WERE DOCUMENTED IN A STANDARDIZED WAY AND ALLOWED SEVERAL VALUABLE INSIGHTS INTO THE HEALTH NEEDS AND PERCEIVED LEVELS OF ACCESS TO VARIOUS SERVICES WITHIN OUR COMMUNITY.A CHNA SURVEY WAS OPENED TO THE GENERAL PUBLIC IN SEPTEMBER 2019 AND RESPONSES WERE SOLICITED THROUGH THE KSB HOSPITAL WEBSITE AND SOCIAL MEDIA ACCOUNTS. WE RECEIVED 122 RESPONSES, INCLUDING 14% FROM INDIVIDUALS WHO RECEIVED FINANCIAL ASSISTANCE IN PAST YEAR SUCH AS TANF, PUBLIC AID, MEDICAL CARD, FOOD STAMPS, TOWNSHIP ASSISTANCE, OR OTHER TYPES OF AID, NOT INCLUDING MEDICARE OR SOCIAL SECURITY.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: THE SURVEYS, INTERVIEWS, CENSUS INFORMATION, DEMOGRAPHICS, AND HEALTH INDICATOR DATA - COMBINED WITH THE INPUT FROM CLINICIANS AND ORGANIZATIONAL LEADERS - INDICATE THE FOLLOWING TO BE THE TOP HEALTH NEEDS OF THE COMMUNITY: BEHAVIORAL HEALTH, OBESITY AND PHYSICAL INACTIVITY, ACCESS TO CARE AND TRANSPORTATION, FOOD INSECURITY, AND TOBACCO AND E-CIGARETTE USE.BEHAVIORAL 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'RE INVESTING IN TELEHEALTH EQUIPMENT AND TRAINING IN ORDER TO ADDRESS THE WORKFORCE RECRUITMENT CHALLENGES, ESPECIALLY WITH REGARD TO PSYCHIATRISTS AND THE NECESSITY OF PHYSICIAN SERVICES IN THE KSB INPATIENT BEHAVIORAL HEALTH UNIT. RECRUITMENT FOR AN ON-SITE PSYCHIATRIST CONTINUES, AND REMOTE TELEHEALTH PROVIDERS HELP ENSURE CONTINUITY OF SERVICES IN OUR COMMUNITY DURING THE SEARCH FOR DIFFICULT-TO-RECRUIT POSITIONS. WE ALSO MADE SIGNIFICANT CAPITAL INVESTMENTS TO IMPROVE PATIENT SAFETY WITHIN THE INPATIENT UNIT.STILL TODAY, SURVEYS INDICATE WIDESPREAD NEED FOR BEHAVIORAL HEALTH SERVICES. MORE THAN 50% OF SURVEY RESPONDENTS SAID THEY OR SOMEONE IN THEIR HOUSEHOLD HAD EXPERIENCED ANXIETY IN THE PAST YEAR, AND 45% ANSWERED AFFIRMATIVELY FOR DEPRESSION. FURTHER, 12% SAID YES FOR BIPOLAR DISORDER AND 9% YES FOR ADHD.IMPLEMENTATION PLAN FOR BEHAVIORAL HEALTH NEED:1)WORKING WITH THE BRAIN HEALTH NOW ORGANIZATION TO HELP END THE STIGMA AROUND MENTAL ILLNESS BY HOSTING STAFF MEETINGS, COMMUNITY SEMINARS, AND USING THE OUTREACH TOOLKIT2)FORMATION AND EXPANSION OF KSB MENTAL HEALTH COMMITTEE TO FOCUS ON STAFF TRAINING IN MENTAL HEALTH AWARENESS, CEU TRAINING FOR PROFESSIONALS, COMMUNITY AWARENESS SEMINARS, AND FUNDRAISING3)PROJECT OPEN, A COMMUNITY PROJECT OF MEDICAL, BEHAVIORAL HEALTH, PUBLIC HEALTH, EDUCATION, COURT, AND LAW ENFORCEMENT ORGANIZATIONS TO HELP BUILD A NETWORK TO PREVENT OPIOID ADDICTION THROUGH AWARENESS, EDUCATION, AND TRAINING4)ENGAGEMENT WITH THIRD-PARTY BEHAVIORAL HEALTH SERVICE LINE OPERATORS IN ORDER TO IMPROVE EFFICIENCY, ADOPT CLINICAL BEST PRACTICES, AND STRENGTHEN OPERATIONAL SUSTAINABILITY OF THE SPECTRUM OF MENTAL HEALTH SERVICES AT KSB5)HOSTING A TEN-PART COMMUNITY EDUCATIONAL EVENT SERIES ON BRAIN HEALTH WITH PRESENTATIONS BY BEHAVIORAL HEALTH EXPERTS TO HELP REDUCE STIGMA AND PROVIDE TIPS ON SUPPORTING POSITIVE BRAIN HEALTH6)MONTHLY BRAIN EXERCISE CLASSES TO HELP AGING LOCAL RESIDENTS BETTER UNDERSTAND BRAIN HEALTH AND HOW THEY CAN PROMOTE PHYSICAL AND MENTAL WELLNESS7)PATH 2 PURPOSE, A FREE, VOLUNTARY PROGRAM FOR TEENAGERS WHO WANT TO IMPROVE THEIR MOOD AND LEARN COPING SKILLS TO MANAGE DIFFICULT SITUATIONS, IN CONJUNCTION WITH A GRANT FROM THE NATIONAL CENTER FOR RURAL HEALTH PROFESSIONS8)IMPLEMENTATION OF A ZERO SUICIDE INITIATIVE THROUGH SCREENINGS AND ASSESSMENTS OF ALL PATIENTS ACROSS KSB SERVICE LINES AND FACILITIESOBESITY AND PHYSICAL INACTIVITY: AGAIN IN THE 2019 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 SHOW 63% OF PEOPLE HAVE PERSONAL OR FAMILY EXPERIENCE WITH BEING OBESE OR OVERWEIGHT. COUNTY HEALTH DATA SHOWS 37.6% OBESITY AND 53.4% OVERWEIGHT, COMPARED TO 29.4% OBESE AND 36.4% OVERWEIGHT AT THE STATE LEVEL.FURTHER SURVEY RESPONSES INDICATE 49% HAVE PERSONAL OR FAMILY EXPERIENCE WITH HIGH BLOOD PRESSURE AND 43% WITH HIGH CHOLESTEROL. AND 26.5% SAY THEY HAVE NO PHYSICAL ACTIVITY OUTSIDE OF WORK, COMPARED TO A STATE AVERAGE OF 21.8%.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 ALSO HOSTS EXERCISE CLASSES FOR ACTIVITIES LIKE A SIX-WEEK COURSE ON RESISTIVE BAND TRAINING, A SIX-WEEK COURSE ON INTERVAL TRAINING, AND YOGA.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 WILL ALSO SPONSOR A BIKE GIVEAWAY AND AN ADOLESCENT BIKE RIDING GROUP IN CONJUNCTION WITH THE DIXON CITY MARKET EVENTS.IMPLEMENTATION PLAN FOR OBESITY AND PHYSICAL INACTIVITY NEED:1) OFFER RECURRING CLASSES ON EXERCISE TYPES AND NEW TRAINING METHODS TO HELP LOCAL RESIDENTS FIND AN INDIVIDUALIZED WAY TO INCORPORATE PHYSICAL ACTIVITY IN TO 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 TO LIVE WELL 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, AND EXPANDING TO OREGON CLINIC7) MONTHLY WELLNESS SCREENINGS FOR CHOLESTEROL AND ONE-ON-ONE CONSULTATIONS WITH A REGISTERED DIETITIANACCESS AND TRANSPORTATION: HEALTH SERVICES MAY BE AVAILABLE WITHIN A COMMUNITY BUT LOCAL RESIDENTS ARE UNABLE TO ACCESS THOSE SERVICES BECAUSE THEY DON'T KNOW ABOUT THEM, THEY CAN'T FIND TRANSPORTATION TO THEM, THEY CAN'T GET A CONVENIENT SCHEDULED APPOINTMENT TIME, OR THEY HAVE FINANCIAL LIMITATIONS TO ACCESS.CHNA SURVEY RESPONDENTS RATED "PUBLIC TRANSPORTATION FOR ALL RESIDENTS" WITH THE LOWEST SCORE OUT OF 11 CATEGORIES ON THE SURVEY. ADDITIONALLY, "EASY TO FIND INFORMATION ABOUT LOCAL SERVICES" WAS THE THIRD-LOWEST SCORE. SCORING SLIGHTLY BETTER WERE PUBLIC TRANSPORTATION FOR SENIORS OR THOSE WITH DISABILITIES. THE LEE-OGLE TRANSPORTATION SYSTEM OFFERS REGIONAL PUBLIC TRANSPORTATION, BUT HAS MORE RIDERS FROM THE SENIOR OR DISABLED POPULATIONS THAN FROM THE POPULATION AT-LARGE.KSB WILL SEEK TO OFFER MEDICAL SERVICES WHEN POSSIBLE VIA VIRTUAL VISITS, THUS ALLEVIATING THE NEED FOR TRANSPORTATION FOR SOME TYPES OF MEDICAL VISITS. A WIDER IMPLEMENTATION OF TELEMEDICINE WILL PROVIDE LOCAL RESIDENTS WITH A COST-EFFECTIVE WAY TO RECEIVE MEDICAL CARE WITHOUT THE RESULTING TRANSPORTATION HURDLES THAT MAY APPLY FOR PATIENTS WITH LIMITED OPTIONS.ADDITIONALLY, KSB IS PARTICIPATING IN A GRANT-SPONSORED MOBILITY PROJECT WITH THE LEE-OGLE TRANSPORTATION SYSTEM TO IDENTIFY SOLUTIONS TO MOBILITY PROBLEMS FOR LOW-INCOME INDIVIDUALS AND CHILDREN. THE MOBILITY PROJECT MEMBERS INTERVIEWED LOW-INCOME INDIVIDUALS AND USERS OF PUBLIC TRANSPORTATION TO ABOUT THE CHALLENGES THEY FACE, AND WHAT OPTIONS THEY HAVE FOR TRANSPORTATION TODAY.IMPLEMENTATION PLAN FOR ACCESS AND TRANSPORTATION NEED:1) LAUNCH AND SCALE UP KSB CARE ANYWHERE VIRTUAL VISITS THROUGH THE ZIPNOSIS TELEMEDICINE PLATFORM TO OFFER MEDICAL CARE FROM THE CONVENIENCE OF THE PATIENT'S HOME OR WORKPLACE TO ALLEVIATE THE NEED FOR TRANSPORTATION AND REDUCE WORK- AND SCHOOL-RELATED SCHEDULING CONFLICTS2) USE OF KSB HOSPITAL ADVERTISING SPENDING, SOCIAL MEDIA PRESENCE, FACILITY SIGNAGE, AND WEBSITE TO SHARE AND DISSEMINATE INFORMATION ON HEALTH AND WELLNESS SERVICES THAT ARE AVAILABLE WITHIN OUR COMMUNITY3) PARTICIPATE ON STEERING COMMITTEE OF LEE-OGLE TRANSPORTATION SYSTEM MOBILITY PROJECT AND SHARE INFORMATION ON APPOINTMENT CANCELLATIONS AND NO-SHOWS RELATED TO PATIENT TRANSPORTATION PROBLEMS4) SEE SCHEDULE O FOR REST OF EXPLANATION
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:WWW.KSBHOSPITAL.COM/WORDPRESS2017/WP-CONTENT/UPLOADS/2019/06/FINANCIAL-ASSISTANCE-PLAIN-LANGUAGE-SUMMARY.PDF

Field	Value	IRS element (for citing)
Facility	10	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (10 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
7 - KSB EYE & VISION CARE
511 PALMYRA STREET	DIXON	IL	61021	PHYSICIAN CLINIC
8 - POLO CLINIC
1107 SOUTH DIVISION AVENUE	POLO	IL	61064	PHYSICIAN CLINIC
9 - ASHTON CLINIC
707 S MAIN STREET	ASHTON	IL	61006	PHYSICIAN CLINIC
10 - PHYSICIANS IMMEDIATE CARE
1672 SOUTH GALENA AVENUE	DIXON	IL	61021	PHYSICIAN CLINIC
11 - LOVETT CENTER
101 W FIRST ST	DIXON	IL	61021	ADMIN, TRAINING

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 2021 CALCULATED COST TO CHARGE RATIO USING THE IRS WORKSHEET 2.
PART I, LINE 7G:	FOR 2021, 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 THROUGHT CONTRIBUTIONS OF DOLLARS AND HOURS. WE SUPPORT THE LOCAL ECONOMIC DEVELOPMENT ORGANIZATIONS IN AN EFFORT 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 THROUGHT THE JUNIOR ACHIEVEMENT PROGRAM. HOURS AND DOLLARS ARE DONATED TO THIS PROGRAM. KSB ALSO SUPPORTS HABITAT FOR HUMANITY IN AN EFFORT 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 34,049 IN 2021. 20.5% OF THE POPULATION WAS AGE 65 AND OLDER. THE CENSUS BUREAU ESTIMATED THAT 10.6% OF LEE COUNTY WAS BELOW THE POVERTY LINE. IN 2021, 70.1% 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 INCLUDED 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 2021 MEDICARE COST REPORT THE MEDICARE ALLOWABLE COSTS FOR 2021 WERE $28,785,830 AND PAYMENTS RECEIVED FROM MEDICARE WERE $24,840,085. WE BELIEVE THAT THE SHORTFALL OF $3,945,745 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:	KSB HAS A LONGSTANDING HISTORY, IN ADVANCE OF THE COMMUNITY BENEFITS STATUTE, OF WORKING COLLABORATIVELY WITH OTHER ORGANIZATIONS TO ASSESS AND ADDRESS COMMUNITY NEEDS. THERE ARE SEVERAL AREA AGENCIES THAT WE GARNER INFORMATION FROM IN GAUGING THE PULSE OF THE NEEDS OF THE SAUK VALLEY AREA. KSB EXAMINES THE NEEDS OF OUR SERVICE AREA AND RESPONDS THROUGH AVAILABLE PHYSICIANS, OPEN DISCLOSURE FROM OUR PATIENTS, AND INFORMATION FROM COLLABORATIVE AGENCIES. PATIENT OUTREACH SERVICES ARE CONDUCTED WITH COMMUNITY PARTNERS SUCH AS THE LEE COUNTY HEALTH DEPARTMENT, DIXON FAMILY YMCA, YWCA OF THE SAUK VALLEY, SINNISSIPPI CENTERS AND AN ABUNDANCE OF PARTNERS PROVIDING SERVICES TO INDIVIDUALS IN NEED. THESE PROJECTS BRING TOGETHER REPRESENTATIVES OF MANY HEALTH AND HUMAN SERVICE PROVIDER AGENCIES TO UNDERTAKE A COLLABORATIVE APROACH TO UNDERSTAND THE CRUCIAL HEALTH ISSUES IN THE COMMUNITY AND TO PRIORITIZE THOSE PROBLEMS.
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 2021 POPULATION OF LEE COUNTY WAS ESTIMATED AT 34,049. THE COMMUNITIES OF LEE AND WESTERN OGLE COUNTY COMPRISE THE KSB HOSPITAL PRIMARY SERVICE AREA. THIS AREA SAW A POPULATION DECLINE OF 0.3% BETWEEN 2020 AND 2021, A PERIOD DURING WHICH THE STATE DECLINED BY 1.1%. 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 84.3% 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 4.5%, COMPARABLE TO NORTHWEST ILLINOIS OVERALL AND COMPARABLE TO THE STATE AVERAGE OF 6.1%. WITH A MEDIAN HOUSEHOLD IN INCOME OF $59,986, LEE COUNTY IS LOWER THAN THE STATE AVERAGE OF $68,428. LEE COUNTY PER CAPITA INCOME IS $29,343, BELOW THE STATE AVERAGE OF $37,306. THE PROPORTION OF LEE COUNTY RESIDENTS, 10.6%, LIVING BELOW THE FEDERAL POVERTY LEVEL IS LOWER THAN THE STATE AVERAGE OF 12.1%. UNINSURED (1.2%) AND MEDICAID (28.7%) PATIENTS COMPRISE A TOTAL OF 29.9% OF OUR PAYER MIX FOR 2021. 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. THE MAJORITY 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, NEW TECHNOLOGY AND OUR PHYSICAL PROPERTIES. THE LAST YEAR HAS SEEN SIGNIFICANT GROWTH WITHIN AND OUTSIDE THE WALLS OF KSB. IN 2021 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 WORKS 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 (3 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)	$20,300	$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
KSB HOSPITAL FOUNDATION
403 EAST FIRST STREET	DIXON	IL	61021	841787288	501(C)(3)	$200,000	$0	GENERAL OPERATING SUPPORT

Field	Value	IRS element (for citing)
Total501c3 Org	3	Total501c3OrgCnt
Total Other Org	0	TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

Field	Value	IRS element (for citing)
Grant Type	SCHOLARSHIPS	GrantTypeTxt
Recipient	12	RecipientCnt
Cash Grant	$10,000	CashGrantAmt

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	Yes (1)	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	Yes (1)	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 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	$1,087,209	$0	$844,725	$0	$0	$0	$7,250	$0	$30,261	$0	$1,969,445	$0	$0	$0
SOHAIL HANIF MD
PHYSICIAN	$798,961	$0	$480,637	$0	$0	$0	$7,250	$0	$30,261	$0	$1,317,109	$0	$0	$0
ROBB RYDZYNSKI MD
PHYSICIAN	$741,964	$0	$162,584	$0	$15,000	$0	$7,250	$0	$39,600	$0	$966,398	$0	$0	$0
FADI MOHAMAD MUSTAPHA MD
PHYSICIAN	$582,419	$0	$290,032	$0	$15,000	$0	$7,250	$0	$31,461	$0	$926,162	$0	$0	$0
KURT CROWE MD
PHYSICIAN	$617,076	$0	$212,525	$0	$0	$0	$7,250	$0	$39,600	$0	$876,451	$0	$0	$0
DAVID SCHREINER
CEO AND BOARD MEMBER	$560,925	$0	$0	$0	$1,975	$0	$7,250	$0	$23,528	$0	$593,678	$0	$0	$0
MICHAEL KITTOE
VP-CHIEF FINANCIAL OFFICER	$339,551	$0	$0	$0	$0	$0	$7,250	$0	$11,398	$0	$358,199	$0	$0	$0
SUZANNE RAVLIN
VP-CHIEF LEGAL OFFICER	$312,601	$0	$0	$0	$0	$0	$7,250	$0	$18,728	$0	$338,579	$0	$0	$0
PRATIP NAG MD
CHIEF MEDICAL OFFICER	$294,131	$0	$0	$0	$0	$0	$7,250	$0	$16,187	$0	$317,568	$0	$0	$0
LINDA CLEMEN
VP-CHIEF NURSING OFFICER	$263,082	$0	$0	$0	$0	$0	$6,459	$0	$23,772	$0	$293,313	$0	$0	$0
RAY SHARP
VP-CHIEF INFORMATION OFFICER	$255,751	$0	$0	$0	$0	$0	$7,250	$0	$18,006	$0	$281,007	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 7	FormAndLineReferenceDesc
Explanation	CERTAIN PHYSICIANS THAT ARE CONSIDERED "PERSONS OF INTEREST" RECEIVE BONUSES BASED ON NET CASH COLLECTIONS OF THEIR INDIVIDUAL PRACTICE.	ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
KAILE VALDEZ
FAMILY MEMBER OF DAVID SCHREINER, CURRENT OFFICER/TRUSTEE	$30,579	EMPLOYEE COMPENSATION	0
LINDA HELLMICH
FAMILY MEMBER OF DAVID HELLMICH, CURRENT BOARD MEMBER	$63,593	EMPLOYEE COMPENSATION	0
SUSAN NAG
FAMILY MEMBER OF PRATIP NAG, CURRENT OFFICER	$56,761	EMPLOYEE COMPENSATION	0

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 IMMEDIATE PAST CHAIRPERSON IF STILL A BOARD MEMBER. IF THE IMMEDIATE PAST CHAIRPERSON IS NO LONGER ON THE BOARD, THEN THE BOARD SHALL BY MAJORITY VOTE ELECT A MEMBER AT-LARGE TO SERVE AS THE FIFTH PERSON ON THE EXECUTIVE COMMITTEE. THIS MEMBER AT-LARGE SHALL SERVE AS PER ARTICLE III IN THE BYLAWS IN REGARDS TO TENURE OF OFFICE. 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 2021. 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 IX, LINE 11G	REPAIRS AND MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 1,934,344. MANAGEMENT AND GENERAL EXPENSES 284,819. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,219,163. PROFESSIONAL: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 178,947. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 178,947. PURCHASED: PROGRAM SERVICE EXPENSES 10,920,760. MANAGEMENT AND GENERAL EXPENSES 5,523,901. FUNDRAISING EXPENSES 589. TOTAL EXPENSES 16,445,250. RECOGNITION: PROGRAM SERVICE EXPENSES 20,065. MANAGEMENT AND GENERAL EXPENSES 2,722. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,787. OTHER: PROGRAM SERVICE EXPENSES 57,972. MANAGEMENT AND GENERAL EXPENSES 206,884. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 264,856.
FORM 990, PART XI, LINE 9:	CHANGES IN VALUE OF SUBSIDIARIES 284,871.
FORM 990, PAGE 12, PART XII, LINE 2C	THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
FORM 990, SCHEDULE H, PART V, LINE 11	CONTINUED EXPLANATION FOR LINE 11: 4) IDENTIFY POSSIBLE SOLUTIONS INCLUDING LAUNCH OF LYFT OR UBER RIDE-SHARING PLATFORMS IN THE LOCAL AREA, AND PROVIDE FINANCIAL SUPPORT TO DEFRAY THE COST OF USING PUBLIC TRANSPORTATION, TAXIS, OR RIDE-SHARING TO GET TO CLINICAL APPOINTMENTS, PHARMACIES, OR HEALTH AND WELLNESS ACTIVITIES PRIORTIES NOT SELECTED: IN THE 2016 CHNA, WE IDENTIFIED FOOD INSECURITY AS A KEY PRIORITY AND ENACTED AN IMPLEMENTATION PLAN TO MEET THE NEED. THIS PLAN INCLUDED KSB PARTICIPATION IN SEVERAL COMMUNITY EFFORTS TO PROVIDE FOOD TO BOTH CHILDREN AND ADULTS WHO WERE FOOD INSECURE. WE ARE CONTINUING TO PARTICIPATE IN THESE EFFORTS AND HAVE BEEN PLEASED WITH THE PROGRESS THEY'VE MADE TOWARD REDUCING FOOD INSECURITY. AT THE TIME OF THE 2016 CHNA, THE FOOD INSECURITY RATE WAS 12.9%, WHICH WAS ABOVE THE STATE AND NATIONAL AVERAGES. THE LATEST DATA SHOWS THAT NUMBER HAS DROPPED TO 9.9%, WHICH IS BELOW THE STATE AND NATIONAL AVERAGES. THE FOOD INSECURITY RATE FOR CHILDREN HAS DROPPED FROM 21.5% TO 14.9%. WHILE THERE IS STILL ROOM FOR IMPROVEMENT, AND KSB WILL REMAIN ENGAGED WITH "FIGHTING HUNGER, FEEDING WELLNESS AND HOSTING FOOD DRIVES TO REDUCE FOOD INSECURITY, THE GAINS MADE IN THE LAST THREE YEARS HAVE LED THIS TO BECOME A PRIORITY WHICH 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.

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 Total Income	$162,845	ShareOfTotalIncomeAmt
Share Of EOY Assets	$1,402,897	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	Yes (1)	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	KSB HOSPITAL FOUNDATION	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Transaction Type	B	TransactionTypeTxt
Involved	$200,000	InvolvedAmt
Method Of Amount Determination	GENERAL LEDGER	MethodOfAmountDeterminationTxt