2020-08-04T08:48:05-05:00 2019-09-30 363077757 GRAY HUNTER STENN LLP 500 MAINE ST QUINCY IL 62301 990 2018-10-01 371396010 BLESSINGCARE CORPORATION BLES 2172852113 640 WEST WASHINGTON PITTSFIELD IL 62363 PATRICK M GERVELER TREASURER 2172852113 2020-05-07 true ERIN J WHARTON CPA P01294277 2172220304 2020-07-30 216.138.22.18 2020-08-04 08:48:05 CD P 2BE353FB2307F31039FDCCB65331A33EA6E48E3A 2BE353FB2307F31039FDCCB65331A33EA6E48E3A 2018 2021-01-29 14:40:06Z ILLINI COMMUNITY HOSPITAL KATHLEEN E HULL 640 WEST WASHINGTON PITTSFIELD IL 62363 30776976 false X WWW.ILLINIHOSPITAL.ORG X 2000 IL TO IMPROVE THE HEALTH OF OUR COMMUNITY. 9 5 301 36 598 126879 171629 30345074 30050511 7680 12136 711922 501435 31191555 30735711 7213 5000 0 13473847 13604359 0 0 13881213 14482326 27362273 28091685 3829282 2644026 27073327 29496751 8266369 8045766 18806958 21450985 X TO IMPROVE THE HEALTH OF OUR COMMUNITY. false false 20488806 5000 30050511 ILLINI COMMUNITY HOSPITAL TREATED PATIENTS THROUGH THE FOLLOWING SERVICES DURING FISCAL YEAR 2019: INPATIENT ADMISSIONS 498 OBSERVATION ADMISSIONS 147 OUTPATIENT VISITS 79,772 TOTAL SURGERIES 327 EMERGENCY VISITS 5,448 LABORATORY TESTS 70,080 RESPIRATORY TREATMENTS 2,678 RADIOLOGY PROCEDURES 9,729 RURAL HEALTH CLINIC & XPRESS VISITS 13,677 IN ADDITION TO THESE HEALTHCARE SERVICES, ILLINI COMMUNITY HOSPITAL PROVIDED 549,491 IN CHARITY CARE AND INCURRED MEDICARE SHORTFALLS OF 654,999. THE HOSPITAL PROVIDED ADDITIONAL BENEFITS DURING FISCAL YEAR 2019 AS FOLLOWS: 1)HEALTH PROFESSIONALS EDUCATION - 97,327 HEALTHCARE STUDENT INTERNSHIPS NURSE PRACTITIONER CLINICALS RADIOLOGY CLINICALS 2)IN-KIND CONTRIBUTIONS AND DONATIONS - 31,030 COURTESY BLOOD DRAWS FOR AREA PUBLIC AGENCIES PIKE CEO PROGRAM PIKE COUNTY MINISTERIAL ALLIANCE DONATED MEETING ROOM SPACE HEALTH FAIRS HEALTH SCREENINGS GED PARTNERS BARRY YMCA 3)COMMUNITY HEALTH IMPROVEMENT PROGRAMS AND SERVICES - 53,278 FLU CLINICS PIKELAND WELLNESS COMMITTEE READY, SET, GLOW RUN BLOOD AND PLATELET DRIVES SPORTS INJURY CLINIC UNREIMBURSED PATIENT TRANSPORTATION DRUG TAKE BACK KIOSK 4)COMMUNITY EDUCATIONAL PROGRAMS AND SERVICES - 6,967 DESTRUCTIVE DECISIONS EDUCATIONAL PROGRAM HEALTH OCCUPATIONS JOB SHADOWING ALCS AND BLS CLASSES SELF-DEFENSE CLASSES DIABETES COACHING 20488806 true true false false false false false false false false true false false false true false false true false false false false false false true false true true false false true true false false false false false false false false true false false false false false false true false false false true 33 0 true 301 true true true false false false false false false false false false false false X 9 5 false true false false true true true true true false false true true true true true true false false true true IL X KATHY HULL 2172852113 640 WEST WASHINGTON PITTSFIELD IL 62363 JAN BLEICH CHAIRPERSON 1.00 X X 0 0 0 DAMAN EMRICK TRUSTEE 1.00 X 0 0 0 PATRICK M GERVELER TREASURER 1.00 39.00 X X 0 623711 129314 K JEANNIE GOODMAN CHAIRPERSON 1.00 X X 0 0 0 KATHLEEN E HULL PRESIDENT/CE 40.00 X X 0 312353 40422 MAUREEN A KAHN SECRETARY 1.00 39.00 X X 0 1041403 240033 LAURA KENT-DONAHUE TRUSTEE 1.00 X 0 0 0 CHRISTOPHER S WAGONER MD PRES - MED S 40.00 X 35371 257392 31095 JASON STRATTON TRUSTEE 1.00 X 0 0 0 DIANE VOSE TRUSTEE 1.00 X 0 0 0 KAYLA L HILL PHARMACIST 40.00 X 138506 0 14573 CAITLIN M HOLLAND PHARMACIST 40.00 X 151417 0 17523 HOLLY A JONES VP OPERATION 40.00 X 142495 0 27097 LYNDELL LOMAX NURSE PRACTI 40.00 X 124133 0 22512 GINGER L TORREZ NURSE PRACTI 40.00 X 120242 0 26411 712164 2234859 548980 8 false true false AIMS OF PITTSFIELD LLC 8657 WEDGEWOOD DRIVE BURR RIDGE IL 60527 ER PHYSICIANS 1821566 QUINCY MEDICAL GROUP 1025 MAINE ST QUINCY IL 62301 MEDICAL SVCS 257150 CHRISTNER INC 168 N MERAMEC AVE 400 ST LOUIS MO 63105 ENGINEERING SVC 250889 BROWN ELECTRIC INC 1309 WATTS LANE QUINCY IL 62305 ELECTRICAL SVCS 167080 SHARED MEDICAL SERVICES INC 209 LIMESTONE PASS COTTAGE GROVE WI 53527 MRI/RAD SVCS 158370 6 2925 5460 78887 84357 171629 PATIENT REVENUE 70419813 70419813 CONTRACTUAL ALLOWANCE -40369302 -40369302 30050511 12136 12136 129654 36065 93589 93589 -7723 101312 15460 2925 5200 10260 10260 43818 43818 43818 OTHER 900099 220353 220353 EQUITY IN SUB'S EARNINGS 900099 125094 125094 ILLINI HEALTH SERVICES, LLC 531120 8321 8321 353768 30735711 30050511 598 512973 5000 5000 10172967 7453113 2719854 393550 288330 105220 2343030 1696867 646163 694812 509046 185766 13691 13691 59258 59258 377365 151732 225633 64976 20503 44473 95363 95363 1082235 392895 689340 65299 65299 OUTSIDE FEES 3619617 1746253 1873364 PATIENT SUPPLIES 3556857 3450431 106426 PHYSICIAN FEES 2484491 2484491 BAD DEBTS 1013185 1013185 2049989 1276960 773029 28091685 20488806 7602879 0 8131649 8945087 1663467 1675523 3594274 3945656 696543 647846 174374 184933 26388932 12797081 12510233 13591851 123041 140419 179746 365436 27073327 29496751 520691 1304862 3755 3691945 3163239 4053733 3573910 8266369 8045766 X 18754854 21412653 52104 38332 18806958 21450985 27073327 29496751 X 2644026 1 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 279691 279691 16322963 6821964 9500999 606751 409996 196755 7721477 5565121 2156356 1458050 1458050 13591851 ESTIMATED THIRD-PARTY SETTLEMENTS 2101898 ACCRUED SALARIES 962862 DUE TO BLESSING HOSPITAL 271570 PAYROLL TAXES & WITHHOLDING 124726 NONCURRENT ACCRUED MALPRACTICE 106042 ACCRUED INTEREST 6309 ACCRUED EMPLOYEE BENEFITS 503 3573910 29758591 -1013185 -1013185 30771776 -36065 -36065 30735711 27114565 27114565 977120 977120 28091685 SCHEDULE D, PAGE 4, PART XI, LINE 2D BAD DEBT REDUCTION OF REVENUE ON FS -1,013,185 SCHEDULE D, PAGE 4, PART XI, LINE 4B RENTAL EXPENSES -29,809 CLASSIFICATION ADJUSTMENT -6,256 SCHEDULE D, PAGE 4, PART XII, LINE 4B BAD DEBT REDUCTION OF REVENUE ON F/S 1,013,185 RENTAL EXPENSES -29,809 990-T DEPRECIATION -1,612 CLASSIFICATION ADJUSTMENT -6,256 BOOK / TAX DEPRECIATION DIFFERENCE 1,612 GOLF 10609 2925 7684 1050 580 2280 207 100 10609 2925 7684 1050 580 2280 207 100 4217 3467 true true true X true X true true false true true 549491 549491 0.02030 6812257 6812257 7361748 6812257 549491 0.02030 60245 60245 0.00220 97327 97327 0.00360 31030 31030 0.00110 188602 188602 0.00690 7550350 6812257 738093 0.02720 true 1013185 47316 11524576 12179575 -654999 X true true 1 1 ILLINI COMMUNITY HOSPITAL 640 WEST WASHINGTON STREET PITTSFIELD IL 62363 WWW.BLESSINGHEALTH.ORG HF110395 X X X ILLINI COMMUNITY HOSPITAL 1 false false true X X X X X X X X 18 true false true true X WWW.BLESSINGHEALTH.ORG X true 19 false false false true X 150.000000000000 250.000000000000 X X X X X X true true X X X true X WWW.BLESSINGHEALTH.ORG X WWW.BLESSINGHEALTH.ORG X WWW.BLESSINGHEALTH.ORG X X X X X true X false X X X X true X false false FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 3E THE CHNA PROCESS HAS IDENTIFIED THE FOLLOWING COMMUNITY HEALTH NEEDS AS A PRIORITY: ADVANCING EDUCATION, SUPPORTING FINANCIAL STABILITY, AND PROMOTING GOOD HEALTH. FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 5 THE CHNA WAS CONDUCTED FOR ILLINI COMMUNITY HOSPITAL THROUGH A CONSULTING ARRANGEMENT WITH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (ICAHN). MULTIPLE METHODS WERE USED TO COLLECT DATA FOR THE PROJECT. SURVEY QUESTIONS AND PROTOCOLS WERE DEVELOPED IN PARTNERSHIP WITH THE ICAHN. ILLINI COMMUNITY HOSPITAL UNDERTOOK A THREE-MONTH PLANNING AND IMPLEMENTATION EFFORT TO DEVELOP THE CHNA, AND TO IDENTIFY AND PRIORITIZE COMMUNITY HEALTH NEEDS FOR ITS SERVICE AREA. THESE PLANNING AND DEVELOPMENT ACTIVITIES INCLUDED THE FOLLOWING STEPS: THE PROJECT WAS OVERSEEN AT THE OPERATIONAL LEVEL BY THE CEO. ARRANGEMENTS WERE MADE WITH ICAHN TO FACILITATE TWO FOCUS GROUPS AND A MEETING TO IDENTIFY AND PRIORITIZE SIGNIFICANT NEEDS. ICAHN WAS ALSO ENGAGED TO COLLECT, ANALYZE, AND PRESENT SECONDARY DATA AND TO PREPARE A FINAL REPORT FOR SUBMISSION TO ILLINI COMMUNITY HOSPITAL. THE CEO WORKED CLOSELY WITH ICAHN'S CONSULTANT TO IDENTIFY AND ENGAGE KEY COMMUNITY PARTNERS AND TO COORDINATE LOCAL MEETINGS AND GROUP ACTIVITIES. ILLINI COMMUNITY HOSPITAL ALSO LEVERAGED EXISTING RELATIONSHIPS THAT PROVIDED DIVERSE INPUT FOR A COMPREHENSIVE REVIEW AND ANALYSIS OF COMMUNITY HEALTH NEEDS IN THE HOSPITAL'S SERVICE AREA. THESE STEPS INCLUDED: THE CEO SECURED THE PARTICIPATION OF A DIVERSE GROUP OF REPRESENTATIVES FROM THE COMMUNITY AND THE HEALTH PROFESSION. ICAHN'S CONSULTANT PROVIDED SECONDARY DATA FROM MULTIPLE SOURCES. PARTICIPATION INCLUDED REPRESENTATIVES OF COUNTY HEALTH DEPARTMENTS SERVING THE AREA SERVED BY THE HOSPITAL. FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 6B YES, THE CHNA INCLUDED THE SCHOOL NURSES OF PIKE COUNTY AS WELL AS REPRESENTATIVES FROM THE PIKE COUNTY HEALTH DEPARTMENT. FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 11 THE NEEDS IDENTIFIED AND PRIORITIZED THROUGH THE CHNA CARRIED FORWARD VARIANTS OF PREVIOUS CHNAS AND ADDED OTHERS. THE IDENTIFIED AND PRIORITIZED NEEDS SELECTED INCLUDE: 1. IMPROVE AWARENESS OF THE AVAILABILITY OF LOCAL HEALTHCARE, HEALTH- RELATED SERVICES AND OPPORTUNITIES, AND HOW TO ACCESS THEM: - BETTER CONNECT THE COMMUNITY TO NUTRITION INFORMATION AND HEALTHY FOODS. - IMPROVE TRANSPORTATION TO MEDICAL APPOINTMENTS AND SERVICES OUTSIDE OF THE SERVICE AREA 2. IMPROVE COMMUNICATION AND COLLABORATION AMONG HEALTHCARE PROVIDERS, COMMUNITY SERVICE PROVIDERS, FAITH-BASED COMMUNITY LEADERS, AND COMMUNITY GROUPS IN ORDER TO MAXIMIZE USE OF LOCAL RESOURCES. 3. ADDRESS ISSUES RELATED TO MENTAL HEALTH, INCLUDING: - IMPROVING LOCAL ACCESS TO MENTAL HEALTH SERVICES FOR YOUTH AND FAMILIES - ADDRESSING SUBSTANCE USE/MISUSE/ABUSE PREVENTION AND RECOVERY SERVICES REDUCE SMOKING - ADDRESSING THE CULTURE OF POVERTY IN LOCAL COMMUNITIES - ADDRESSING THE STIGMA ASSOCIATED WITH SEEKING OR RECEIVING MENTAL HEALTHCARE 4. ADDRESSING SERVICES FOR THE HOMELESS, BOTH TRANSIENT HOMELESS AND YOUTH AND YOUNG ADULTS, INCLUDING FINDING SHELTER WITH UNRELATED PERSONS. THE IMPLEMENTATION PLAN DEVELOPED BY THE SENIOR STAFF AT ILLINI COMMUNITY HOSPITAL IS SPECIFIC AND THOROUGH. THE PLAN, SET OUT IN THIS REPORT, INCLUDES THESE HIGHLIGHTS: ILLINI COMMUNITY HOSPITAL WILL WORK WITH CHURCHES AND OTHER FAITH-BASED ORGANIZATIONS TO BUILD, PLACE, AND STOCK "LITTLE PANTRIES" IN COMMUNITIES THROUGHOUT PIKE COUNTY. ILLINI COMMUNITY HOSPITAL WILL CREATE INSTRUCTIONAL VIDEOS FOR LOCAL BROADCAST TO EXPLAIN BASIC PREPARATION OF VEGETABLES AND OTHER HEALTHY FOODS AND SNACKS. ILLINI COMMUNITY HOSPITAL WILL EXPAND WEB-BASED AND SOCIAL MEDIA INFORMATION SHARING. ILLINI COMMUNITY HOSPITAL WILL EXPLORE SPONSORING OR CO-SPONSORING PERIODIC MOBILE FOOD PANTRIES IN SMALL COMMUNITIES ILLINI COMMUNITY HOSPITAL WILL ESTABLISH A HOSPITAL-BASED, NON-EMERGENCY MEDICAL TRANSPORTATION SERVICE FOR PERSONS REQUIRED TO TRAVEL TO LOCAL OR OUT-OF-AREA SERVICES. ILLINI COMMUNITY HOSPITAL WILL EXPLORE PARTNERSHIPS WITH SCHOOL DISTRICTS TO IDENTIFY THE MENTAL HEALTH SERVICE NEEDS OF YOUTH, DETERMINE HOW TO ADDRESS THOSE NEEDS, AND THEN ADDRESS THEM. ILLINI COMMUNITY HOSPITAL WILL ARRANGE FOR AND PRESENT CULTURE OF POVERTY EDUCATION AND AWARENESS PROGRAMS FOR ITS STAFF AND THE COMMUNITY. ILLINI COMMUNITY HOSPITAL WILL CONVENE MEETINGS AND DISCUSSIONS AMONG POTENTIAL LOCAL RESOURCES TO IDENTIFY THE SCOPE OF AVAILABLE SERVICES AND THEN MOVE FORWARD FROM THERE. ILLINI COMMUNITY HOSPITAL WILL CREATE CAMPAIGNS PROMOTING MENTAL HEALTH SERVICES AWARENESS, TARGETING THE STIGMA OF SEEKING OR RECEIVING MENTAL HEALTHCARE. ILLINI COMMUNITY HOSPITAL WILL CONVENE AND HOST MEETINGS AT LEAST TWICE PER YEAR TO BRING TOGETHER COMMUNITY ORGANIZATIONS, AGENCIES, HEALTH SERVICES AND OTHERS TO IDENTIFY WHAT INITIATIVES ARE GOING ON IN THE COMMUNITY AND TO DISCUSS HOW THE GROUPS CAN HELP EACH OTHER. FACILITY 1, ILLINI COMMUNITY HOSPITAL - PART V, LINE 13B PATIENTS ARE ELIGIBLE FOR CATASTROPHIC FINANCIAL ASSISTANCE IF THEIR INCOME EXCEEDS 250% OF THE FEDERAL POVERTY GUIDELINES AND THEIR MEDICAL BILLS EXCEED 20% OF THEIR TOTAL REPORTED FAMILY INCOME. ELIGIBILITY IS BASED ON AN INDIVIDUAL'S FAMILY'S TOTAL INCOME, FAMILY SIZE, AND ASSETS. PATIENTS EXPERIENCING CATASTROPHIC MEDICAL INDIGENCE ARE ELIGIBLE FOR A DISCOUNT OF 85%. 1 ILLINI COMMUNITY HOSPITAL RURAL HEA 321 WEST WASHINGTON PITTSFIELD IL 62363 RURAL HEALTH CLINIC PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE PATIENTS ARE ELIGIBLE FOR CATASTROPHIC FINANCIAL ASSISTANCE IF THEIR INCOME EXCEEDS 250% OF THE FEDERAL POVERTY GUIDELINES AND THEIR MEDICAL BILLS EXCEED 20% OF THEIR TOTAL REPORTED FAMILY INCOME. ELIGIBILITY IS BASED ON AN INDIVIDUAL'S OR FAMILY'S TOTAL INCOME, FAMILY SIZE AND ASSETS. PATIENTS EXPERIENCING CATASTROPHIC MEDICAL INDIGENCE ARE ELIGIBLE FOR AN 85% DISCOUNT. PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION ILLINI COMMUNITY HOSPITAL DOES NOT INCLUDE AS SUBSIDIZED HEALTH SERVICES ANY COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC. PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE BAD DEBT EXPENSE OF 1,013,185 IS SUBTRACTED FROM TOTAL EXPENSES OF 28,091,685 REPORTED ON LINE 25, COLUMN A OF FORM 990, PART IX, FOR A NET TOTAL EXPENSE OF 27,078,500. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION WHEN POSSIBLE, CALCULATIONS OF DIRECT AND INDIRECT COSTS ASSOCIATED WITH THE SERVICES PROVIDED ARE REPORTED. IF NOT AVAILABLE, A COST-TO-CHARGE RATIO IS USED TO CALCULATE THE COST AMOUNTS. THIS RATIO IS COMPUTED USING ILLINI COMMUNITY HOSPITAL'S AS-FILED MEDICARE COST REPORT. THESE COSTS AND CHARGES ARE ADJUSTED TO ACCOUNT FOR ITEMS NOT REIMBURSED THROUGH THE COST REPORT SUCH AS PROVIDER-BASED PHYSICIAN SERVICES. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY METHODOLOGY USED TO DETERMINE BAD DEBT EXPENSE - BAD DEBT EXPENSE IS CALCULATED ON THE NET PATIENT ACCOUNT BALANCE AFTER THE BALANCE HAS BEEN REDUCED FOR ANY PAYMENTS RECEIVED OR DISCOUNTS/ADJUSTMENTS THAT ARE KNOWN. PATIENTS QUALIFYING FOR FINANCIAL ASSISTANCE ARE RECOGNIZED AS CHARITY CARE ACCOUNTS WHEN SUFFICIENT INFORMATION IS RECEIVED TO DETERMINE THEIR ELIGIBILITY. PRIOR TO THIS POINT, AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IS CALCULATED ON UNINSURED ACCOUNTS. THIS ALLOWANCE IS REVERSED IF THE ACCOUNT IS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE. PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE METHODOLOGY OF ESTIMATED AMOUNT & RATIONALE FOR INCLUDING IN COMMUNITY BENEFIT - A NUMBER OF PATIENTS ARE TRULY UNABLE TO PAY FOR THEIR MEDICAL EXPENDITURES BUT DO NOT COMPLETE THE PROCESS REQUIRED TO APPLY FOR FINANCIAL ASSISTANCE. THE HOSPITAL PERFORMS AN ASSESSMENT USING FINANCIAL AND OTHER INFORMATION OF SUCH PATIENTS OTHERWISE AVAILABLE TO THE HOSPITAL TO IDENTIFY THOSE PATIENTS THAT WOULD QUALIFY FOR CHARITY CARE IF THEY COMPLETED THE PAPERWORK. THIS INFORMATION IS USED TO ESTIMATE THE AMOUNT OF THE HOSPITAL'S BAD DEBT EXPENSE THAT WILL BE FOUND TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE. THE BAD DEBT EXPENSE WITH SUCH PATIENTS ACCOUNTS ARE TREATED AS COMMUNITY BENEFIT. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS SEE NOTE (3) ON PAGE 15 OF THE ATTACHED AUDITED CONSOLIDATED FINANCIAL STATEMENTS. PART III, LINE 8 - MEDICARE EXPLANATION THE HOSPITAL USES A COST-TO-CHARGE RATIO TO CALCULATE COST AMOUNTS. THIS RATIO IS COMPUTED USING ILLINI COMMUNITY HOSPITAL'S AS-FILED MEDICARE COST REPORT. THESE COSTS AND CHARGES ARE ADJUSTED TO ACCOUNT FOR ITEMS NOT REIMBURSED THROUGH THE COST REPORT SUCH AS PROVIDER-BASED PHYSICIAN SERVICES. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION COLLECTION PRACTICES ARE NOT PURSUED IF A COMPLETED FINANCIAL ASSISTANCE APPLICATION HAS BEEN RETURNED AND APPROVED. PART VI, LINE 2 - NEEDS ASSESSMENT THE CHNA WAS CONDUCTED WITH ILLINI COMMUNITY HOSPITAL THROUGH A CONSULTING ARRANGEMENT WITH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (ICAHN). A LARGE CROSS SECTION OF COMMUNITY PARTNERS WERE REPRESENTED (GEOGRAPHIC, AGE, SOCIOECONOMIC, ETC.) THAT INCLUDED THE SCHOOL NURSES OF PIKE COUNTY AS WELL AS REPRESENTATIVES FROM THE PIKE COUNTY HEALTH DEPARTMENT. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE BLESSING HOSPITAL FINANCIAL ACCOUNT SPECIALISTS (FAS) ATTEMPT TO CONTACT SELF-PAY INPATIENTS WITHIN 24 HOURS OF ADMISSION. IF THIS ATTEMPT TO MEET WITH THE PATIENT IS UNSUCCESSFUL, FURTHER ATTEMPTS ARE MADE LATER DURING THEIR STAY OR AT THEIR HOME. THE PATIENT IS SCREENED FOR GOVERNMENT PROGRAMS AND ELIGIBILITY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. OUTPATIENTS ARE CONTACTED ONCE THE PATIENT'S CONDITION HAS BEEN STABILIZED AND ARE SCREENED IN THE SAME MANNER AS INPATIENTS. FOR SCHEDULED TESTING, FAS CONTACT UNINSURED PATIENTS PRIOR TO THEIR SERVICE AND PROVIDE ESTIMATES OF CHARGES AND EDUCATION ON AVAILABLE PROGRAMS. IF THE FAS ARE NOT AVAILABLE TO MEET WITH THE PATIENT PRIOR TO SERVICE, CONTACT INFORMATION IS GIVEN TO THE PATIENT IF ASSISTANCE IS NEEDED. PART VI, LINE 4 - COMMUNITY INFORMATION ILLINI COMMUNITY HOSPITAL OPENED ITS DOORS ON JANUARY 26, 1942 TO SERVE THE PEOPLE RESIDING WITHIN A 25 MILE RADIUS OF PITTSFIELD, ILLINOIS, WHICH IS PRIMARILY PIKE COUNTY BUT INCLUDES PARTS OF SCOTT, GREEN, CALHOUN, BROWN, AND ADAMS COUNTY. PIKE COUNTY HAS 831 SQUARE MILES OF LAND AREA AND A POPULATION OF APPROXIMATELY 15,611 PEOPLE. PIKE COUNTY AGE DEMOGRAPHICS INCLUDE 22.3% UNDER 18 YEARS OLD, AND 21.0% OVER 65 YEARS OLD. 49.8% OF THE RESIDENTS ARE FEMALE, 96.0% CAUCASIAN AND 1.4% AFRICAN-AMERICAN. 88.7% OF THE POPULATION HAVE GRADUATED FROM HIGH SCHOOL AND 15.1% HAVE A BACHELORS DEGREE OR HIGHER. THE MEDIAN HOUSEHOLD INCOME IS 42,664 AND 14.1% OF THE POPULATION IS BELOW THE POVERTY LEVEL. PIKE COUNTY IS DESIGNATED AS A HEALTH PROFESSIONALS SHORTAGE AREA AND MEDICALLY UNDERSERVED AREA. THE UNEMPLOYMENT RATE IN PIKE COUNTY WAS 6.9% IN JANUARY 2019. THE REGIONS ECONOMY IS HEAVILY AGRICULTURAL WITH RETAIL AND TOURISM ASSOCIATED WITH DEER HUNTING. ILLINI COMMUNITY HOSPITAL IS ONE OF THE LARGEST EMPLOYERS IN THE COUNTY WITH 301 EMPLOYEES. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH ILLINI COMMUNITY HOSPITAL OFFERS A WIDE RANGE OF SERVICES IMPORTANT TO PROMOTING THE HEALTH AND WELL-BEING OF PIKE COUNTY AND THE SURROUNDING AREA. ILLINI COMMUNITY HOSPITAL OPERATES AN EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF THE ABILITY TO PAY. THE FINANCIAL ASSISTANCE POLICY OF ILLINI COMMUNITY HOSPITAL ENABLES PATIENTS TO HAVE ACCESS TO AREA RESOURCES TO ASSIST THEM WITH PAYMENT OF MEDICAL EXPENSES. ILLINI COMMUNITY HOSPITAL IS THE LARGEST EMPLOYER IN THE AREA WITH 301 EMPLOYEES. OF SIGNIFICANT IMPORTANCE IS THE VOLUNTEERS THAT SERVE THE HOSPITAL. IN FISCAL YEAR 2019, ILLINI COMMUNITY HOSPITAL HAD 36 ACTIVE VOLUNTEERS. IN ADDITION TO THE VOLUNTEERS ACTIVELY WORKING IN THE HOSPITAL, ILLINI COMMUNITY HOSPITAL'S BOARD OF TRUSTEES IS COMPRISED OF VOLUNTEERS THAT INCLUDES BUSINESS LEADERS, PHYSICIANS, AND OTHER COMMUNITY LEADERS. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM BLESSING CORPORATE SERVICES, INC. IS THE PARENT ORGANIZATION OF A GROUP OF RELATED ORGANIZATIONS AND PROVIDES OVERALL DIRECTION TO ALL ENTITIES WITHIN THE STRUCTURE. DURING THE YEAR ENDED SEPTEMBER 30, 2005, BLESSING CORPORATE SERVICES, INC. BEGAN OPERATING A DIVISION COMPRISED OF PRACTICING PHYSICIANS. THE GROUP IS RELATED BY BLESSING CORPORATE SERVICES, INC. CONTROL OVER THE RELATED ORGANIZATION'S BOARD. THE FOLLOWING IS A BRIEF DESCRIPTION OF EACH MEMBER OF THE GROUP: ORGANIZATION - BLESSING HOSPITAL (HOSPITAL), LOCATED IN QUINCY, ILLINOIS, IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF WESTERN ILLINOIS, NORTHEASTERN MISSOURI, AND SOUTHEASTERN IOWA. THE HOSPITAL WAS INCORPORATED IN ILLINOIS IN 1875. ORGANIZATION - THE BLESSING FOUNDATION, INC. SERVES BLESSING CORPORATE SERVICES AND ITS AFFILIATED ENTITIES BY PROVIDING FINANCIAL SUPPORT FOR SERVICES AND PROGRAMS PROMOTING THE IMPROVEMENT AND AVAILABILITY OF HEALTHCARE SERVICES WITHIN THE GENERAL COMMUNITY. ORGANIZATION - DENMAN SERVICES, INC. (A TAXABLE CORPORATION) ENGAGES PRIMARILY IN THE BUSINESS OF SELLING AND RENTING MEDICAL EQUIPMENT AND OPERATING A COMMERCIAL LAUNDRY. DENMAN SERVICES, INC. IS A WHOLLY OWNED SUBSIDIARY OF BLESSING CORPORATE SERVICES, INC. ORGANIZATION - BLESSINGCARE CORPORATION DBA ILLINI COMMUNITY HOSPITAL, LOCATED IN PITTSFIELD, ILLINOIS, IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF WESTERN ILLINOIS. THE HOSPITAL WAS INCORPORATED ON JANUARY 20, 2000. ORGANIZATION - ILLINI HEALTH SERVICES, LLC CONDUCTS A PHARMACY BUSINESS IN PITTSFIELD, ILLINOIS. THE PHARMACY IS OWNED NINETY-FIVE PERCENT (95%) BY DENMAN SERVICES, INC. AND FIVE PERCENT (5%) BY BLESSINGCARE CORPORATION DBA ILLINI COMMUNITY HOSPITAL. ORGANIZATION - CHS HOLDING COMPANY (A TAXABLE ORGANIZATION) PROVIDES HEALTH INSURANCE PRODUCTS AND SERVICES. ORGANIZATION - BLESSING WALK-IN CLINIC, LLC DBA BLESSING CONVENIENT CARE OPERATES HEALTH CLINICS IN RETAIL FACILITIES. ORGANIZATION - CROSSRIVER QUALITY HEALTH PARTNERS IS A CLINICALLY INTEGRATED NETWORK FOCUSED ON IMPROVING QUALITY AND EFFICENCY OF PATIENT CARE ACROSS ILLINOIS, MISSOURI, AND IOWA. IT IS A WHOLLY OWNED SUBSIDIARY OF BLESSING CORPORATE SERVICES, INC. ORGANIZATION - BLESSING ASSURANCE COMPANY IS A WHOLLY OWNED FOREIGN SUBSIDIARY OF BLESSING CORPORATE SERIVCES, INC. AND IS A PROVIDER OF SELF- INSURANCE TO THE AFFILIATED GROUP. ORGANIZATION - HANNIBAL CLINIC, INC. IS A GROUP OF HEALTH CARE PROVIDERS SERVING NORTHEAST MISSOURI AND WEST CENTRAL ILLINOIS. IT IS A WHOLLY OWNED SUBSIDIARY OF BLESSING CORPORATE SERVICVES, INC. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT ILLINOIS ADDITIONAL INFORMATION PART I, LINE 6B - ILLINI COMMUNITY HOSPITAL'S COMMUNITY BENEFIT REPORT IS PUBLISHED IN THE LOCAL NEWSPAPER AS AN INSERT AND IS AVAILABLE ON THE HOSPITAL'S WEBSITE @ WWW.BLESSINGHEALTH.ORG false false false false false false false false false PATRICK M GERVELER TREASURER 405141 136215 82355 98500 30814 753025 KATHLEEN E HULL PRESIDENT/CEO 205614 72501 34238 13750 26672 352775 MAUREEN A KAHN SECRETARY 645235 251223 144945 209500 30533 1281436 CHRISTOPHER S WAGONER MD PRES - MED STAFF 255713 35371 1679 7895 23200 35371 288487 KAYLA L HILL PHARMACIST 135885 778 1843 7064 7509 153079 CAITLIN M HOLLAND PHARMACIST 150160 778 479 7673 9850 168940 HOLLY A JONES VP OPERATIONS 134677 5275 2543 7354 19743 169592 SCHEDULE J, PAGE 1, PART I, LINE 3 RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION COMPENSATION OF ORGANIZATION'S CEO - EXECUTIVE DIRECTOR - KATHLEEN HULL IS AN EMPLOYEE OF BLESSING CORPORATE SERVICES, INC., THE PARENT COMPANY OF BLESSINGCARE CORPORATION. COMPARABILITY DATA PROVIDED BY A THIRD PARTY IS USED TO ESTABLISH A MARKET RANGE OF COMPENSATION. THIS INFORMATION IS SUBMITTED TO THE PRESIDENT OF BLESSING CORPORATE SERVICES FOR REVIEW AND TO THE BLESSING CORPORATE SERVICES BOARD OF TRUSTEES COMPENSATION COMMITTEE FOR APPROVAL. COMPENSATION OF ORGANIZATION'S BOARD MEMBERS - MAUREEN KAHN AND PATRICK GERVELER ARE EMPLOYEES OF BLESSING CORPORATE SERVICES, INC., THE PARENT COMPANY OF BLESSINGCARE CORPORATION DBA ILLINI COMMUNITY HOSPITAL. COMPARABILITY DATA PROVIDED BY A THIRD PARTY IS USED TO ESTABLISH A MARKET RANGE OF COMPENSATION. THIS INFORMATION IS SUBMITTED TO THE BLESSING CORPORATE SERVICES BOARD OF TRUSTEES COMPENSATION COMMITEE FOR APPROVAL. A CITY OF PITTSFIELD PROJECT REVENUE BONDS SERIES 2015 370817800 2015-05-12 3000000 CONSTRUCTION false false false A 318607 2156326 37000 2119326 2016 false false true true A false false false false true false true A false false true false true false false false true A true SCHEDULE K - PURPOSE OF ISSUE DESCRIPTION CITY OF PITTSFIELD CONSTRUCTION OF HOSPITAL GERIATRIC PSYCHIATRY SERVICE UNIT LOCATED ON WEST WASHINGTON STREET IN PITTSFIELD, ILLINOIS. JOHN HULL FAMILY MEMBER 52331 EMPLOYMENT false JESSICA L HULL FAMILY MEMBER 46339 EMPLOYMENT false KATHLEEN E SIDWELL FAMILY MEMBER 41129 EMPLOYMENT false FORM 990, PAGE 2, PART III, LINE 4A ILLINI COMMUNITY HOSPITAL TREATED PATIENTS THROUGH THE FOLLOWING SERVICES DURING FISCAL YEAR 2019: INPATIENT ADMISSIONS 498 OBSERVATION ADMISSIONS 147 OUTPATIENT VISITS 79,772 TOTAL SURGERIES 327 EMERGENCY VISITS 5,448 LABORATORY TESTS 70,080 RESPIRATORY TREATMENTS 2,678 RADIOLOGY PROCEDURES 9,729 RURAL HEALTH CLINIC & XPRESS VISITS 13,677 IN ADDITION TO THESE HEALTHCARE SERVICES, ILLINI COMMUNITY HOSPITAL PROVIDED 549,491 IN CHARITY CARE AND INCURRED MEDICARE SHORTFALLS OF 654,999. THE HOSPITAL PROVIDED ADDITIONAL BENEFITS DURING FISCAL YEAR 2019 AS FOLLOWS: 1)HEALTH PROFESSIONALS EDUCATION - 97,327 HEALTHCARE STUDENT INTERNSHIPS NURSE PRACTITIONER CLINICALS RADIOLOGY CLINICALS 2)IN-KIND CONTRIBUTIONS AND DONATIONS - 31,030 COURTESY BLOOD DRAWS FOR AREA PUBLIC AGENCIES PIKE CEO PROGRAM PIKE COUNTY MINISTERIAL ALLIANCE DONATED MEETING ROOM SPACE HEALTH FAIRS HEALTH SCREENINGS GED PARTNERS BARRY YMCA 3)COMMUNITY HEALTH IMPROVEMENT PROGRAMS AND SERVICES - 53,278 FLU CLINICS PIKELAND WELLNESS COMMITTEE READY, SET, GLOW RUN BLOOD AND PLATELET DRIVES SPORTS INJURY CLINIC UNREIMBURSED PATIENT TRANSPORTATION DRUG TAKE BACK KIOSK 4)COMMUNITY EDUCATIONAL PROGRAMS AND SERVICES - 6,967 DESTRUCTIVE DECISIONS EDUCATIONAL PROGRAM HEALTH OCCUPATIONS JOB SHADOWING ALCS AND BLS CLASSES SELF-DEFENSE CLASSES DIABETES COACHING FORM 990, PAGE 6, PART VI, LINE 3 BLESSING CORPORATE SERVICES PROVIDES GENERAL MANAGEMENT SERVICES. FORM 990, PAGE 6, PART VI, LINE 6 BLESSING CORPORATE SERVICES, INC., AN ILLINOIS NOT FOR PROFIT CORPORATION, IS THE SOLE VOTING MEMBER OF BLESSINGCARE CORPORATION, DBA ILLINI COMMUNITY HOSPITAL. FORM 990, PAGE 6, PART VI, LINE 7A BLESSING CORPORATE SERVICES, INC., THE SOLE VOTING MEMBER OF BLESSINGCARE CORPORATION, SHALL POSSESS THE RIGHTS AND RESPONSIBILITIES TO APPOINT AND/OR REMOVE ALL THE TRUSTEES OF THE CORPORATION, AND APPOINT THE CORPORATION'S PRESIDENT. FORM 990, PAGE 6, PART VI, LINE 7B BLESSING CORPORATE SERVICES, INC., THE SOLE VOTING MEMBER OF BLESSINGCARE CORPORATION, SHALL POSSESS THE RIGHTS AND RESPONSIBILITIES TO APPROVE EXPRESSLY ALL AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS BEFORE THEY MAY BECOME EFFECTIVE; APPROVE CAPITAL AND OPERATING BUDGETS, LONG-TERM DEBT, LONG-RANGE PLANS, THE SALE OR PURCHASE OF REAL ESTATE AND CONTRACTS ENTERED INTO BY THE CORPORATION, THE REASONABLE VALUE OF WHICH EXCEEDS AN AMOUNT SPECIFIED IN THE BYLAWS OF THE MEMBER; APPROVE MATERIAL INVESTMENT DECISIONS, INCLUDING WITHOUT LIMITATION ESTABLISHMENT AND MODIFICATION OF INVESTMENT POLICIES, ENGAGEMENT AND REMOVAL OF INVESTMENT MANAGERS AND ADVISORS, AND CHANGES IN INVESTMENT ALLOCATIONS NOT PERMITTED BY AN EXISTING INVESTMENT POLICY; APPROVE THE PARAMETERS FOR TERMS OF EMPLOYMENT OF PHYSICIANS, INCLUDING PHYSICIAN COMPENSATION PLANS, AND ANY MATERIAL VARIANCES FROM SUCH PARAMETERS FOR INDIVIDUAL PHYSICIANS; APPROVE THE SELECTION OF AUDITORS AND LEGAL COUNSEL; APPROVE CHARITY CARE AND COMMUNITY BENEFITS-RELATED POLICIES; APPROVE THE FORMATION OF SUBSIDIARY ENTITIES AND/OR JOINT VENTURES; APPROVE THE FILING OF A PETITION IN BANKRUPTCY, MAKING AN ASSIGNMENT FOR THE BENEFIT OF CREDITORS, OR APPLYING FOR PROTECTION UNDER ANY INSOLVENCY LAWS; APPROVE THE PARTICIPATION IN ANY MERGER, COMBINATION, CONSOLIDATION, LIQUIDATION, DISSOLUTION OR OTHER CORPORATE OR BUSINESS ENTITY RESTRUCTURING, AND HAVE THE POWER TO COMPEL THE CORPORATION TO ENFORCE AND/OR PERFORM ANY CONTRACTUAL OBLIGATION. FORM 990, PAGE 6, PART VI, LINE 11B FOLLOWING MANAGEMENT AND LEGAL REVIEW, THE FORM 990 WAS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW AND COMMENT PRIOR TO FILING. FORM 990, PAGE 6, PART VI, LINE 12C A COPY OF THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED ANNUALLY TO OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES TO BE READ, SIGNED, AND RETURNED TO THE ORGANIZATION. THE SIGNED POLICIES ARE RETAINED IN THE CORPORATE ADMINISTRATIVE FILES. IN ADDITION, EACH OFFICER, DIRECTOR, OR TRUSTEE IS REQUIRED TO DECLARE NO CONFLICT OF INTEREST IN REGARDS TO AGENDA ITEMS BEING PRESENTED AT THE START OF EACH MONTHLY BOARD MEETING. FORM 990, PAGE 6, PART VI, LINE 19 THESE DOCUMENTS ARE LOCATED IN THE HOSPITAL'S ADMINISTRATIVE OFFICES AND ARE AVAILABLE UPON REQUEST FOR PUBLIC INSPECTION. FORM 990, PART XI, LINE 9 990-T DEPRECIATION 0 1 TOTAL 1 BLESSING CORPORATE SERVICES INC BROADWAY AT 11TH PO BOX 7005 QUINCY IL 623057005 371128706 MGMT SVCS IL 501C3 10 N/A false BLESSING HOSPITAL 1005 BROADWAY QUINCY IL 62301 370661183 NON-PROFIT IL 501C3 3 BCS INC BLESSING CORPORATE SERVICES INC false BLESSING AFFILIATES INC BROADWAY AT 11TH PO BOX 7005 QUINCY IL 623057005 371128708 INACTIVE IL 501C3 10 BCS INC BLESSING CORPORATE SERVICES INC false THE BLESSING FOUNDATION INC PO BOX 7005 QUINCY IL 62301 371128705 FUNDRAISE IL 501C3 12B BCS INC BLESSING CORPORATE SERVICES INC false BLESSING WALK-IN CLINIC LLC 1005 BROADWAY QUINCY IL 62301 814181593 MED SVCS IL 501C3 3 BCS INC false BLESSINGCARE CORPORATION - MISSOURI 1005 BROADWAY QUINCY IL 62301 431371818 INACTIVE MO 501C3 3 BCS INC BCS INC false BLESSING HOSPITAL SELF-INSURANCE PL BROADWAY AT 11TH PO BOX 7005 QUINCY IL 62301 371045366 MED CLAIMS IL 501C3 12A BCS INC false ILLINI HEALTH SERVICES LLC PO BOX 40 QUINCY IL 623060040 470901851 PHARMACY IL DENMAN DENMAN UNRELATED 8321 64734 false false 0.05000 CURRENT HEALTH NETWORK LLC 1005 BROADWAY QUINCY IL 62301 811681509 PRVDR NTWK IL CHS HLDGS false false NORTHEAST MISSOURI AMBULATORY SURGE 98 MEDICAL DRIVE HANNIBAL MO 634010511 431857277 MED SVCS MO HANNIBAL false false DENMAN SERVICES INC BROADWAY AT 11TH PO BOX 40 QUINCY IL 62306 371132117 MED EQUIP IL BCS INC C CORP false CHS HOLDING COMPANY 1005 BROADWAY QUINCY IL 62301 320481381 GRP HLTH IL BCS INC C CORP false HANNIBAL CLINIC INC 100 MEDICAL DRIVE HANNIBAL MO 63401 431033473 MED SVCS MO BCS INC C CORP false BLESSING ASSURANCE COMPANY PO BOX 1159 GRAND CAYMAN CAYMAN ISLANDS CJ KY1-1102 981454767 SELF-INSUR CJ BCS INC C CORP false false false false false true false false false true true true false true true true true true false false