KATHERINE SHAW BETHEA HOSPITAL: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization: KATHERINE SHAW BETHEA HOSPITAL (EIN 36-1000540)
Tax period: 2018-01-01 to 2018-12-31
Filed: 2019-06-19
IRS object ID: 201931709349300528
Schema version: 2018v3.1
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule G
Schedule H
Schedule I
Schedule J
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2019-06-19T11:40:58-05:00	ReturnTs
Tax Period End	2018-12-31	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	2018-01-01	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	2019-06-18	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	JEFF PARKER	PreparerPersonNm
PTIN	P00970069	PTIN
Phone	3149254300	PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	67.137.57.251	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2019-06-18	IPDt
IP Tm	12:25:46	IPTm
IP Timezone	CD	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	4DC81AC5090E51A43603AD047BBA54151ACF830E	AtSubmissionCreationDeviceId
At Submission Filing Device Id	487AB1A67A5D20F4613B23BD8ED7DDEFEAED86AA	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2018	TaxYr
Build TS	2019-02-21 02:37:17Z	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	$150,545,892	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	1159	TotalEmployeeCnt
Total Volunteers	71	TotalVolunteersCnt
Total Gross UBI	$5,575	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$379,488	PYContributionsGrantsAmt
CY Contributions Grants	$596,014	CYContributionsGrantsAmt
PY Program Service Revenue	$146,958,861	PYProgramServiceRevenueAmt
CY Program Service Revenue	$147,949,665	CYProgramServiceRevenueAmt
PY Investment Income	$888,689	PYInvestmentIncomeAmt
CY Investment Income	$683,633	CYInvestmentIncomeAmt
PY Other Revenue	$541,479	PYOtherRevenueAmt
CY Other Revenue	$597,896	CYOtherRevenueAmt
PY Total Revenue	$148,768,517	PYTotalRevenueAmt
CY Total Revenue	$149,827,208	CYTotalRevenueAmt
PY Grants And Similar Paid	$218,441	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$234,897	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$80,073,214	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$82,565,089	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$72,481	CYTotalFundraisingExpenseAmt
PY Other Expenses	$63,813,192	PYOtherExpensesAmt
CY Other Expenses	$63,537,246	CYOtherExpensesAmt
PY Total Expenses	$144,104,847	PYTotalExpensesAmt
CY Total Expenses	$146,337,232	CYTotalExpensesAmt
PY Revenues Less Expenses	$4,663,670	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$3,489,976	CYRevenuesLessExpensesAmt
Total Assets BOY	$123,715,545	TotalAssetsBOYAmt
Total Assets EOY	$135,957,530	TotalAssetsEOYAmt
Total Liabilities BOY	$51,445,799	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$60,538,193	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$72,269,746	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$75,419,337	NetAssetsOrFundBalancesEOYAmt
Mission	THE MISSION OF KATHERINE SHAW BETHEA HOSPITAL (KSB) IS 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	$120,191,487	ExpenseAmt
Grant	$234,897	GrantAmt
Revenue	$147,949,665	RevenueAmt
Desc	IN 2018, KATHERINE SHAW BETHEA HOSPITAL (KSB) HAD 9,915 INPATIENT VISITS AND 194,223 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 $252,340 IN 2018.KSB PROVIDES 24-HOUR EMERGENCY MEDICAL SERVICES STAFFED BY FULL-TIME PHYSICIANS. PATIENTS ARE TREATED REGARDLESS OF INSURANCE OR ABILITY PAY. ER VISITS IN 2018 WERE 19,608.	Desc
Total Program Service Expenses	$120,191,487	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	Yes (1)	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Temp Or Permanent Endowments	Yes (1)	TempOrPermanentEndowmentsInd
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	Yes (1)	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 With Officer Ent	0	BusinessRlnWithOfficerEntInd
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	0	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	59	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	1159	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
DAF Excess Business Holdings	0	DAFExcessBusinessHoldingsInd
Taxable Distributions	0	TaxableDistributionsInd
Distribution To Donor	0	DistributionToDonorInd
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	0	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	JERRY LILLIG	PersonNm
Phone	8152855523	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 (22 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Highest Compensated EmployeeHighestCompensatedEmployeeInd
DOUG LEE
CHAIRPERSON	2.90	Yes (X)	Yes (X)	$0	$0	$0
LYNETTE KNODLE
VICE CHAIRPERSON	1.70	Yes (X)	Yes (X)	$0	$0	$0
KATIE PRATT
SECRETARY	0.90	Yes (X)	Yes (X)	$0	$0	$0
RAY NEISEWANDER III
TREASURER	1.10	Yes (X)	Yes (X)	$0	$0	$0
COLLEEN T HENKEL
PAST CHAIRPERSON	1.50	Yes (X)		$0	$0	$0
RICK CURIA
BOARD MEMBER	1.10	Yes (X)		$0	$0	$0
JOSEPH WELTY MD
BOARD MEMBER / PHYSICIAN	41.40	Yes (X)		$255,179	$0	$44,203
CHAD WEIGLE
BOARD MEMBER	1.50	Yes (X)		$0	$0	$0
CHRIS HAMMITT
BOARD MEMBER	1.60	Yes (X)		$0	$0	$0
DAVID HELLMICH
BOARD MEMBER	1.40	Yes (X)		$0	$0	$0
DAVID SCHREINER
CEO AND BOARD MEMBER	40.00	Yes (X)	Yes (X)	$551,250	$0	$193,284	1.00
LINDA CLEMEN
VP-CHIEF NURSING OFFICER	40.00		Yes (X)	$259,323	$0	$33,050
ANTHONY EVERS
VP-CHIEF FINANCIAL OFFICER	40.00		Yes (X)	$328,214	$0	$45,832
PRATIP NAG MD
CHIEF MEDICAL OFFICER	40.00		Yes (X)	$355,746	$0	$51,853
JULIE MANN
VP-ADMINISTRATIVE OFFICER	40.00		Yes (X)	$292,951	$0	$27,959
KEVIN T MARX
VP-MEDICAL GROUP MANAGEMENT	40.00		Yes (X)	$226,373	$0	$25,178
SUZANNE RAVLIN
VP-CHIEF LEGAL OFFICER	40.00		Yes (X)	$300,499	$0	$34,576
MONTHER ELBZOUR MD
PHYSICIAN	40.00			$1,333,696	$0	$51,853		Yes (X)
ROBB RYDZYNSKI MD
PHYSICIAN	40.00			$1,074,021	$0	$14,961		Yes (X)
SOHAIL HANIF MD
PHYSICIAN	40.00			$985,025	$0	$46,253		Yes (X)
DAVID J POWERS MD
PHYSICIAN	40.00			$701,543	$0	$32,956		Yes (X)
THOMAS HERNANDEZ MD
PHYSICIAN	40.00			$687,436	$0	$51,853		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$7,351,256	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$653,811	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	87	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
CERNER HEALTH SERVICES
PO BOX 412732	KANSAS CITY	MO	64141	SOFTWARE SUPPORT	$5,499,140
HEALTHCARE AND FAMILY SERVICES
PO BOX 19493	SPRINGFIELD	IL	62796	CONSULTING	$3,677,026
AMERISOURCE BERGEN
1001 W TAYLOR ROAD	ROMEOVILLE	IL	60446	PHARMACEUTICAL SOLUTIONS	$3,000,394
PHARMAVAIL BENEFIT MANAGEMENT
3380 TRICKLUM ROAD	WOODSTOCK	GA	30188	BENEFITS MANAGEMENT	$2,057,550
PHILLIPS
PO BOX 100355	ATLANTA	GA	30384	HEALTHCARE SERVICES	$1,373,688

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	108	CntrctRcvdGreaterThan100KCnt
Fundraising	$14,673	FundraisingAmt
Government Grants	$431,229	GovernmentGrantsAmt
All Other Contributions	$150,112	AllOtherContributionsAmt
Total Contributions	$596,014	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE	621110	$142,557,630	$142,557,630
430B PROGRAM PAYMENTS	621110	$5,177,898	$5,177,898
NET CLINIC SPACE RENTAL	621110	$214,137	$214,137

Field	Value	IRS element (for citing)
Total Program Service Revenue	$147,949,665	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$664,354	TotalRevenueColumnAmt
Exclusion	$664,354	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$723,484	SecuritiesAmt
Other	$7,052	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$709,897	SecuritiesAmt
Other	$1,360	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$13,587	SecuritiesAmt
Other	$5,692	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$19,279	TotalRevenueColumnAmt
Exclusion	$19,279	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$9,142	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$14,673	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$7,427	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,715	TotalRevenueColumnAmt
Exclusion	$1,715	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt	ExclusionExclusionAmt
CAFETERIA SALES	900099	$451,461	$5,575	$445,886
ALL OTHER REVENUE	900099	$67,034		$67,034
COPY REVENUE	900099	$48,580		$48,580

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$29,106	TotalRevenueColumnAmt
Exclusion	$29,106	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$596,181	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$149,827,208	TotalRevenueColumnAmt
Related Or Exempt Func Income	$147,949,665	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$5,575	UnrelatedBusinessRevenueAmt
Exclusion	$1,275,954	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	$225,041	TotalAmt
Program Services	$225,041	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$9,856	TotalAmt
Program Services	$9,856	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$2,576,088	TotalAmt
Program Services	$699,972	ProgramServicesAmt
Management And General	$1,876,116	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$59,905,174	TotalAmt
Program Services	$52,736,181	ProgramServicesAmt
Management And General	$7,146,181	ManagementAndGeneralAmt
Fundraising	$22,812	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$2,293,519	TotalAmt
Program Services	$2,016,783	ProgramServicesAmt
Management And General	$275,859	ManagementAndGeneralAmt
Fundraising	$877	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$14,232,520	TotalAmt
Program Services	$12,284,343	ProgramServicesAmt
Management And General	$1,942,876	ManagementAndGeneralAmt
Fundraising	$5,301	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$3,557,788	TotalAmt
Program Services	$3,048,793	ProgramServicesAmt
Management And General	$507,686	ManagementAndGeneralAmt
Fundraising	$1,309	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$85,561	TotalAmt
Management And General	$85,561	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$113,913	TotalAmt
Management And General	$113,913	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$29,611	TotalAmt
Management And General	$29,611	ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$17,317	TotalAmt
Program Services	$7,439	ProgramServicesAmt
Management And General	$9,878	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$14,765,881	TotalAmt
Program Services	$7,412,324	ProgramServicesAmt
Management And General	$7,353,557	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$448,157	TotalAmt
Program Services	$25,180	ProgramServicesAmt
Management And General	$422,977	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$18,188,688	TotalAmt
Program Services	$17,768,795	ProgramServicesAmt
Management And General	$379,525	ManagementAndGeneralAmt
Fundraising	$40,368	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$3,042,296	TotalAmt
Program Services	$381,098	ProgramServicesAmt
Management And General	$2,661,198	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$2,298,391	TotalAmt
Program Services	$2,051,338	ProgramServicesAmt
Management And General	$247,053	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$227,776	TotalAmt
Program Services	$227,776	ProgramServicesAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$312,000	TotalAmt
Program Services	$286,689	ProgramServicesAmt
Management And General	$25,311	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$718,152	TotalAmt
Management And General	$718,152	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$5,498,397	TotalAmt
Program Services	$3,530,017	ProgramServicesAmt
Management And General	$1,967,064	ManagementAndGeneralAmt
Fundraising	$1,316	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$2,044,702	TotalAmt
Program Services	$1,842,438	ProgramServicesAmt
Management And General	$202,264	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	FundraisingFundraisingAmt	Management And GeneralManagementAndGeneralAmt
BAD DEBT EXPENSE	$11,437,374	$11,437,374
IPA/SALES & USE TAX	$3,725,378	$3,725,378
DUES & MEMBERSHIPS	$431,447	$430,949	$498
MISCELLANEOUS	$127,091	$18,793		$108,298

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$25,114	TotalAmt
Program Services	$24,930	ProgramServicesAmt
Management And General	$184	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$146,337,232	TotalAmt
Program Services	$120,191,487	ProgramServicesAmt
Management And General	$26,073,264	ManagementAndGeneralAmt
Fundraising	$72,481	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$225,477	BOYAmt
EOY	$209,503	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$16,108,228	BOYAmt
EOY	$20,029,861	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$36,843,382	BOYAmt
EOY	$42,434,250	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,515,017	BOYAmt
EOY	$1,374,044	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$1,000,178	BOYAmt
EOY	$1,313,789	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$136,663,018	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$88,757,013	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$42,339,714	BOYAmt
EOY	$47,906,005	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$16,800,874	BOYAmt
EOY	$15,116,322	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$6,135,275	BOYAmt
EOY	$5,353,065	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$2,747,400	BOYAmt
EOY	$2,220,691	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$123,715,545	BOYAmt
EOY	$135,957,530	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$34,534,132	BOYAmt
EOY	$37,196,327	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$16,911,667	BOYAmt
EOY	$23,341,866	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$51,445,799	BOYAmt
EOY	$60,538,193	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$70,989,482	BOYAmt
EOY	$74,190,458	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$264,248	BOYAmt
EOY	$185,255	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,016,016	BOYAmt
EOY	$1,043,624	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$72,269,746	BOYAmt
EOY	$75,419,337	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$123,715,545	BOYAmt
EOY	$135,957,530	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$3,489,976	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$498,951	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$158,566	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	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

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	$29,611	OtherActivitiesAmt
Total Lobbying Expenditures	$29,611	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

Field	Value	IRS element (for citing)
Donor Advised Funds Held	1	DonorAdvisedFundsHeldCnt
Donor Advised Funds Contri	$31,800	DonorAdvisedFundsContriAmt
Donor Advised Funds Grants	$0	DonorAdvisedFundsGrantsAmt
Donor Advised Funds Vl EOY	$185,255	DonorAdvisedFundsVlEOYAmt
Disclosed Org Leg Ctrl	Yes (1)	DisclosedOrgLegCtrlInd
Disclosed For Charitable Prps	Yes (1)	DisclosedForCharitablePrpsInd

CY Endwmt Fund CYEndwmtFundGrp

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 Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,602,358	BeginningYearBalanceAmt
Contributions	$102,102	ContributionsAmt
Investment Earnings Or Losses	$193,943	InvestmentEarningsOrLossesAmt
Administrative Expenses	$5,772	AdministrativeExpensesAmt
End Year Balance	$1,892,631	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,573,393	BeginningYearBalanceAmt
Contributions	$28,965	ContributionsAmt
End Year Balance	$1,602,358	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,266,546	BeginningYearBalanceAmt
Contributions	$306,847	ContributionsAmt
End Year Balance	$1,573,393	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	$2,343,039	OtherCostOrOtherBasisAmt
Book Value	$2,343,039	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$51,011,302	OtherCostOrOtherBasisAmt
Depreciation	$31,205,570	DepreciationAmt
Book Value	$19,805,732	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$5,529,345	OtherCostOrOtherBasisAmt
Depreciation	$3,562,618	DepreciationAmt
Book Value	$1,966,727	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$71,669,520	OtherCostOrOtherBasisAmt
Depreciation	$53,988,825	DepreciationAmt
Book Value	$17,680,695	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$6,109,812	OtherCostOrOtherBasisAmt
Book Value	$6,109,812	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$47,906,005	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 G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

Field	Value	IRS element (for citing)
Event1	TICKLING THE IVORIES	Event1Nm
Gross Receipts Event1	$23,815	GrossReceiptsEvent1Amt
Charitable Contri Event1	$14,673	CharitableContriEvent1Amt
Gross Revenue Event1	$9,142	GrossRevenueEvent1Amt
Rent Facility Costs Event1	$1,000	RentFacilityCostsEvent1Amt
Food And Beverage Event1	$3,397	FoodAndBeverageEvent1Amt
Entertainment Event1	$2,500	EntertainmentEvent1Amt
Other Direct Expenses Event1	$530	OtherDirectExpensesEvent1Amt
Gross Receipts Total	$23,815	GrossReceiptsTotalAmt
Charitable Contributions Tot	$14,673	CharitableContributionsTotAmt
Gross Revenue Total Events	$9,142	GrossRevenueTotalEventsAmt
Rent Fclty Costs Total Events	$1,000	RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events	$3,397	FoodAndBeverageTotalEventsAmt
Entertainment Total Events	$2,500	EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events	$530	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$7,427	DirectExpenseSummaryEventsAmt
Net Income Summary	$1,715	NetIncomeSummaryAmt

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	$815,090	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$815,090	NetCommunityBenefitExpnsAmt
Total Expense	0.00560	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$19,953,473	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$11,558,950	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$8,394,523	NetCommunityBenefitExpnsAmt
Total Expense	0.05740	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$20,768,563	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$11,558,950	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$9,209,613	NetCommunityBenefitExpnsAmt
Total Expense	0.06300	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$657,463	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$657,463	NetCommunityBenefitExpnsAmt
Total Expense	0.00450	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$2,019,256	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,442,758	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	$64,381	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$152,118	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$193,105	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$193,105	NetCommunityBenefitExpnsAmt
Total Expense	0.00130	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$2,935,205	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,594,876	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$851,568	NetCommunityBenefitExpnsAmt
Total Expense	0.00580	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$23,703,768	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$15,153,826	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$10,061,181	NetCommunityBenefitExpnsAmt
Total Expense	0.06880	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$11,437,374	BadDebtExpenseAmt
Bad Debt Expense Attributable	$1,143,737	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$24,639,681	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$26,474,871	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$1,835,190	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	16	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	16	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: FOR THIS NEEDS ASSESSMENT, WE GATHERED INFORMATION FROM A VARIETY OF SOURCES IN ORDER TO GET A COMPREHENSIVE PICTURE OF THE HEALTH AND NEEDS OF OUR COMMUNITY. FIRST, WE REVIEWED A REPORT FROM COMMUNITY COMMONS THAT GAVE US TREMENDOUS INSIGHT INTO VARIOUS HEALTH RISK FACTORS FOR LEE COUNTY RESIDENTS. THE REPORT INCLUDED INFORMATION ON POPULATION, DEMOGRAPHICS, SOCIAL ECONOMIC FACTORS, PHYSICAL ENVIRONMENT, ACCESS TO CLINICAL CARE, HEALTH BEHAVIORS, AND HEALTH OUTCOMES. IN ALL, COMMUNITY COMMONS PROVIDED MORE THAN 100 DATA SETS TO ENABLE US TO LOOK FOR OUTLIER VALUES THAT SUGGEST LEE COUNTY'S AREAS FOR IMPROVEMENT.WE ALSO USED DATA GATHERED FROM LEE COUNTY 8TH GRADE, 10TH GRADE, AND 12TH GRADE STUDENTS ON TOPICS LIKE SUBSTANCE USE AND BULLYING. THE STUDENT DATA WAS MADE AVAILABLE THROUGH THE ILLINOIS YOUTH SURVEY, A SURVEY IN WHICH A MAJORITY OF LEE COUNTY STUDENTS PARTICIPATED. TO SUPPLEMENT OUR AVAILABLE DATA, WE ALSO CREATED AND DISSEMINATED A COMMUNITY SURVEY TO THE GENERAL POPULATION. THIS SURVEY ASKED RESPONDENTS TO RATE THE QUALITY AND AVAILABILITY OF SEVERAL HEALTH-RELATED SERVICES. IT ALSO ASKED FOR INCIDENCE OF VARIOUS HEALTH CONDITIONS AMONG THE RESPONDENTS AND THEIR HOUSEHOLDS. FINALLY, IT OFFERED RESPONDENTS A CHANCE FOR FREE-TEXT RESPONSES TO QUESTIONS ON HOW WE COULD IMPROVE. IN ALL, WE COLLECTED RESPONSES FROM 241 MEMBERS OF THE GENERAL PUBLIC, FROM SIX DIFFERENT COMMUNITIES WITHIN LEE COUNTY, AND WITH 7.5% OF THE RESPONSES COMING FROM HOUSEHOLDS WHICH RECEIVED FINANCIAL ASSISTANCE SUCH AS MEDICAID, FOOD STAMPS, TOWNSHIP ASSISTANCE, AND OTHERS DURING THE PAST YEAR.DATA FROM THE COMMUNITY COMMONS AND ILLINOIS YOUTH SURVEY HELPED DRIVE OUR CONVERSATIONS ON THE CHNA/IPLAN COMMITTEE THAT WAS COFOUNDED BY KSB HOSPITAL AND THE LEE COUNTY HEALTH DEPARTMENT FOR PURPOSES OF IDENTIFYING COMMUNITY HEALTH NEEDS. THE CHNA/IPLAN COMMITTEE WAS COMPRISED OF 23 MEMBERS REPRESENTING 17 DIFFERENT ORGANIZATIONS WHO SERVE LEE COUNTY. MEMBERS REPRESENTED LOCAL HEALTH CARE PROVIDERS, GOVERNMENT AGENCIES, SCHOOLS, LAW ENFORCEMENT, ADVOCACY GROUPS, AND NOT-FOR-PROFITS.FURTHER, THE DATA AND INITIAL FINDINGS WERE REVIEWED AND COMMENTED ON BY MEMBERS OF THE KSB HOSPITAL PATIENT & FAMILY ADVISORY COUNCIL, A PANEL OF MEMBERS OF THE COMMUNITY WHO PROVIDE FEEDBACK AND GUIDANCE FOR PATIENT-CENTERED DECISIONS, AND THE KSB HOSPITAL SENIOR EXECUTIVE TEAM.
KATHERINE SHAW BETHEA HOSPITAL	PART V, SECTION B, LINE 6B: THE HOSPITAL'S CHNA WAS CONDUCTED WITH THE LEE COUNTY HEALTH DEPARTMENT.
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: BASED ON THE DATA, INPUT FROM DIVERSE COMMUNITY MEMBERS, AND EXPERTISE FROM ORGANIZATIONAL LEADERS, THE FOLLOWING ARE THE PRIMARY HEALTH NEEDS OF OUR COMMUNITY IN WHICH KSB HOSPITAL CAN BEST MAKE AN IMPACT: DIABETES, FOOD INSECURITY, AND OBESITY & PHYSICAL INACTIVITY. DIABETES: PEOPLE IN LEE COUNTY STRUGGLE WITH DIABETES MORE AND MORE EACH YEAR. ACCORDING TO THE CENTERS FOR DISEASE CONTROL AND PREVENTION, THE RATE OF DIABETES AMONG LEE COUNTY ADULTS HAS INCREASED FROM 6.6% IN 2004 TO 9% IN 2012, THE MOST RECENT YEAR FOR WHICH WE HAVE DATA. THAT MEANS THAT MORE THAN 2,700 LOCAL ADULTS STRUGGLE WITH DIABETES.TO MEET THE COMMUNITY NEED FOR DIABETES CARE, KSB HOSPITAL WILL OFFER SPECIALLY TAILORED SERVICES IN THE KSB CENTER FOR DIABETES MANAGEMENT. THE CENTER OFFERS SERVICES FOR THOSE WITH PRE-DIABETES, GESTATIONAL DIABETES, AND BOTH TYPE 1 AND TYPE 2 DIABETES. PATIENTS WHO VISIT THE CENTER CAN COMPLETE A SCREENING, CONSULT WITH A CERTIFIED DIABETES EDUCATOR, GET HEALTHY RECIPES FROM A DIETITIAN, AND BE CONNECTED WITH DOCTORS, PHYSICAL THERAPISTS, AND PHARMACISTS ALL WITHIN KSB HOSPITAL.THE KSB CENTER FOR DIABETES MANAGEMENT OFFERS FREE BLOOD GLUCOSE SCREENINGS TO THE GENERAL PUBLIC ON THE FIRST TUESDAY OF EACH MONTH.ADDITIONALLY, TO MEET THE NEEDS OF THOSE WITH DIABETES, KSB COMMUNITY WELLNESS WILL HOST VARIOUS OUTREACH ACTIVITIES WHICH MAY INCLUDE A DIABETES PREVENTION PROGRAM IN ASSOCIATION WITH THE YMCA, A DIABETIC YOUTH CAMP, SCHOOL-BASED EDUCATION, AND THE LEARNING TO LIVE WELL COMMUNITY LECTURE SERIES.KSB HOSPITAL WILL EVALUATE THE SUCCESS OF OUR DIABETES CARE INITIATIVES BY THE NUMBER OF PEOPLE WHO PARTICIPATE IN COMMUNITY PROGRAMS, THE NUMBER OF PATIENTS WHO VISIT THE KSB CENTER FOR DIABETES MANAGEMENT, AND REVERSING OR SLOWING THE GROWTH OF DIABETES INCIDENCE IN LEE COUNTY.FOOD INSECURITY: SURVEY DATA FROM FEEDING AMERICA SHOWS THAT 12.9% OF LEE COUNTY RESIDENTS MEET THE CRITERIA FOR FOOD INSECURITY, THAT IS THEY HAVE LIMITED OR UNCERTAIN ACCESS TO ADEQUATE FOOD. FURTHER, MORE THAN 1 IN 5, OR 21.5%, OF LEE COUNTY CHILDREN ARE FOOD INSECURE. OF THOSE CHILDREN WHO ARE FOOD INSECURE, 30% ARE INELIGIBLE FOR ASSISTANCE PROGRAMS LIKE SNAP OR WIC.THESE FOOD INSECURITY FACTS DEMONSTRATE A COMMUNITY HEALTH NEED FOR STABLE, NUTRITIOUS FOOD. INADEQUATE NUTRITION CAN HAVE NEGATIVE EFFECTS ON MANY PREEXISTING HEALTH CONDITIONS, OR MAY MAKE INDIVIDUALS MORE LIKELY TO SUFFER ADVERSE HEALTH CONSEQUENCES. BECAUSE OF THIS, KSB HOSPITAL INTENDS TO INTERVENE TO HELP ALLEVIATE FOOD INSECURITY IN LEE COUNTY.KSB HOSPITAL IS THE COUNTY'S LARGEST EMPLOYER WITH NEARLY 1,000 EMPLOYEES. IN ADDITION, TENS OF THOUSANDS OF MEMBERS OF THE COMMUNITY VISIT KSB FACILITIES EACH YEAR FOR MEDICAL APPOINTMENTS, TO VISIT LOVED ONES, OR TO ATTEND ORGANIZATIONAL MEETINGS OR EVENTS. MAKING THE MOST OF THE HIGH TRAFFIC LOCATIONS, KSB HOSPITAL WILL CONDUCT FOOD DRIVES TO SOLICIT CHARITABLE CONTRIBUTIONS FROM EMPLOYEES, VISITORS, AND GUESTS. THESE FOOD DRIVES WILL BENEFIT LOCAL FOOD PANTRIES AND BE AVAILABLE FOR THOSE WHO ARE FOOD INSECURE.KSB WILL PARTICIPATE IN THE PARTNERSHIP FOR A HEALTHY LEE COUNTY (PHLC) ALONG WITH THE LEE COUNTY HEALTH DEPARTMENT, THE UNIVERSITY OF ILLINOIS EXTENSION, MASTER GARDNER PROGRAM, AND LOCAL CHURCHES TO OFFER A HEALTHY HARVEST COMMUNITY GARDEN PROGRAM IN WHICH CHILDREN LEARN ABOUT GROWING AND EATING HEALTHY FOODS. IN ADDITION TO THE GARDENING, CHILDREN PARTICIPATE IN EDUCATIONAL SESSIONS ON TOPICS INCLUDE PLOTTING, CANNING, PESTS, AND HEALTHY EATING.FURTHER, KSB HOSPITAL WILL WORK IN PARTNERSHIP WITH THE UNITED WAY, LEE COUNTY HEALTH DEPARTMENT, DIXON FAMILY YMCA, AND OTHERS TO OFFER A SUMMER FOOD PROGRAM FOR LOCAL CHILDREN. KSB IS WELL POSITIONED TO BE A KEY CONTRIBUTOR TO THE SUMMER FOOD PROGRAM WITH A LARGE, PRODUCTIVE COMMERCIAL KITCHEN, SKILLED STAFF, AND A WIDE AREA OF COVERAGE THROUGH LOCAL CLINIC LOCATIONS.KSB HOSPITAL WILL EVALUATE THE SUCCESS OF MEETING THE COMMUNITY NEED FOR FOOD SECURITY BY THE NUMBER OF CHILDREN SERVED BY SUMMER FOOD PROGRAMS, THE NUMBER OF PARTICIPANTS WITH A COMMUNITY GARDEN PLOT, AND THE POUNDS OF FOOD THAT ARE COLLECTED DURING FOOD DRIVES.OBESITY & PHYSICAL INACTIVITY: INFORMATION FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION SHOW US THAT LEE COUNTY RESIDENTS STRUGGLE WITH HEALTHY BODY WEIGHTS AND ARE LESS PHYSICALLY ACTIVE THAN AVERAGE. THE DATA SHOWS THAT 53.4% OF LEE COUNTY ADULTS ARE CLASSIFIED AS OVERWEIGHT, THAT IS THEY HAVE A BMI BETWEEN 25 AND 30. AN ADDITIONAL 31.9% OF LEE COUNTY ADULTS ARE OBESE, THAT IS THEY HAVE A BMI IN EXCESS OF 30. TAKEN TOGETHER, WE SEE THAT 85.3% OF LEE COUNTY ADULTS ARE OVERWEIGHT OR OBESE. THAT COMPARES TO A COMBINED RATE OF 63.4% OF ILLINOIS ADULTS AND 63.3% OF AMERICAN ADULTS. FURTHER, 27.9% OF LEE COUNTY ADULTS REPORT NO PHYSICAL ACTIVITY AT ALL OUTSIDE WORK, WHICH IS A HIGHER RATE OF INACTIVITY THAN EITHER STATE OR NATIONAL AVERAGES.KSB PLANS TO MEET THE COMMUNITY HEALTH NEED OF IMPROVED PHYSICAL ACTIVITY AND DECREASED INCIDENCE OF OVERWEIGHT OR OBESITY BY ENGAGING THE COMMUNITY IN INTERESTING AND ENJOYABLE WAYS. KSB COMMUNITY WELLNESS AMBASSADORS WILL PROVIDE HEALTHY RECIPES AND FOOD SAMPLES AT THE DIXON MAIN STREET SUMMER CITY MARKET EVENTS. TO FURTHER EDUCATION ON HEALTHY EATING CHOICES THAT AFFECT WEIGHT, KSB WILL BE THE LEAD SPONSOR AND ORGANIZER OF THE LEARNING TO LIVE WELL COMMUNITY LECTURE SERIES WITH SPECIAL PRESENTATIONS BY MULTIDISCIPLINARY PROVIDERS.PHYSICAL ACTIVITY IS AN IMPORTANT CONTRIBUTOR TO BODY WEIGHT, AND KSB WILL PLAY AN ACTIVE ROLE IN PROMOTING PHYSICAL ACTIVITY AND FITNESS. KSB WILL SPONSOR THE REAGAN RUN 5K AND COORDINATE THE KSB CORPORATE CHALLENGE DURING THE RACE TO ENCOURAGE LOCAL EMPLOYERS TO FORM TEAMS TO ENTER THE COMPETITION. KSB WILL AGAIN SPONSOR A COMMUNITY-WIDE HEALTHY WEIGHT CONTEST NAMED MOVE FOR A CHANGE, BUILDING ON A SUCCESSFUL PROGRAM WITH HUNDREDS OF LOCAL PARTICIPANTS AND TEAMS COMPETING TO LOSE WEIGHT IN A HEALTHY AND SUSTAINABLE WAY.KSB WILL ALSO SPONSOR THE KSB WELLNESS CENTER AT THE DIXON FAMILY YMCA AND UNDERWRITE NEW EXERCISE EQUIPMENT PURCHASES TO INCREASE OPPORTUNITIES FOR THOSE LOOKING FOR PHYSICAL ACTIVITIES. KSB ALSO WORKS WITH THE YMCA ON A YOUTH RUNNING PROGRAM THAT TEACHES KIDS HOW TO TRAIN FOR AND PRACTICE RUNNING FOR EXERCISE. KSB WILL PROVIDE PHYSICAL THERAPISTS AND PHYSICIANS TO COMMUNITY RACES AND SPORTING EVENTS TO ENSURE PARTICIPANTS HAVE ACCESS TO PROFESSIONAL ADVICE ON HEALTHY FITNESS PRACTICES.TO SUPPORT THOSE WHO WANT TO BEGIN EXERCISING FOR THE FIRST TIME, KSB PHYSICIANS WILL WRITE PRESCRIPTIONS FOR A FREE 30-DAY MEMBERSHIP TO THE DIXON FAMILY YMCA, WHERE NEW MEMBERS RECEIVE AN EDUCATIONAL ORIENTATION ON HOW TO GET STARTED WORKING OUT INDIVIDUALLY OR IN A GROUP OR CLASS SETTING.FURTHER POTENTIAL ACTIVITIES TO PROMOTE HEALTHY LIFESTYLES INCLUDE AN AMAZING RACE-STYLE CONTEST, WALKING CLUBS, EDUCATIONAL EVENTS WITH THE YMCA OR OTHER COMMUNITY PARTNERS, A BICYCLING INITIATIVE, AND TARGETED OUTREACH THROUGH LARGE LOCAL EMPLOYERS.KSB HOSPITAL DID NOT CHOOSE TO FOCUS ON BEHAVIORAL HEALTH BECAUSE IT IS A PRIMARY FOCUS OF SINNISSIPPI CENTERS, A COMMUNITY LEADER IN MENTAL HEALTH AND SUBSTANCE ABUSE COUNSELING. KSB HOSPITAL WILL CONTINUE TO PARTNER WITH SINNISSIPPI ON THESE EFFORTS. ADDITIONALLY, KSB HOSPITAL DID NOT CHOOSE BULLYING AS AN AREA OF FOCUS BECAUSE IT IS AN ISSUE THAT IS BEST DEALT WITH BY SCHOOLS AND YOUTH-CENTERED ORGANIZATIONS. AS A MEDICAL CENTER, KSB HOSPITAL DID NOT FEEL IT IS BEST POSITIONED TO LEAD EFFORTS AGAINST BULLYING.
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	11	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (11 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - COMMERCE TOWERS
215 EAST FIRST STREET	DIXON	IL	61021	PHYSICIAN CLINIC
2 - TOWN SQUARE CENTER
102 S HENNEPIN AVENUE	DIXON	IL	61021	PHYSICIAN CLINIC
3 - KSB OREGON CLINIC
1307 WASHINGTON	OREGON	IL	61061	PHYSICIAN CLINIC
4 - EDWARDS CLINIC
144 NORTH COURT	DIXON	IL	61021	PHYSICIAN CLINIC
5 - AMBOY CLINIC
305 EAST JOE DRIVE	AMBOY	IL	61310	PHYSICIAN CLINIC
6 - MT MORRIS CLINIC
405 CHARLES AVENUE	MT MORRIS	IL	61054	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 2018 CALCULATED COST TO CHARGE RATIO USING THE IRS WORKSHEET 2.
PART I, LINE 7G:	FOR 2018, 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 17 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 34,223 IN 2018. 19.1% OF THE POPULATION WAS AGE 65 AND OLDER. THE CENSUS BUREAU ESTIMATED THAT 11.4% OF LEE COUNTY WAS BELOW THE POVERTY LINE. IN 2018, 46.2% 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, INCLUDINGMEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.BASED ON KSB HOSPITAL'S FILED 2018 MEDICARE COST REPORT THE MEDICARE ALLOWABLE COSTS FOR 2018 WERE $26,474,871 AND PAYMENTS RECEIVED FROM MEDICARE WERE $24,639,681. WE BELIEVE THAT THE SHORTFALL OF $1,835,190 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 2018 POPULATION OF LEE COUNTY WAS ESTIMATED AT 34,223. THE COMMUNITIES OF LEE AND WESTERN OGLE COUNTY COMPRISE THE KSB HOSPITAL PRIMARY SERVICE AREA. THIS AREA SAW A POPULATION DECLINE OF 5.0% BETWEEN 2010 AND 2018, A PERIOD DURING WHICH THE STATE DECLINED BY 0.7%. DIXON IS THE COUNTY SEAT AND THE LARGEST COMMUNITY IN LEE COUNTY WITH AN ESTIMATED POPULATION OF 15,165. LEE COUNTY RACE AND ETHNICITY SHOWS 86.4% WHITE, NOT HISPANIC; 5.5% BLACK; 6.2% HISPANIC; WITH THE REMAINING 2.6% AMERICAN INDIAN AND ALASKA NATIVE, ASIAN, OR PERSONS REPORTING TWO OR MORE RACES. 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 2018 ANNUAL AVERAGE UNEMPLOYMENT RATE FOR LEE COUNTY WAS 4.4%, COMPARABLE TO NORTHWEST ILLINOIS OVERALL AND COMPARABLE TO THE STATE AVERAGE OF 4.3%. WITH A MEDIAN HOUSEHOLD IN INCOME OF $58,319, LEE COUNTY IS LOWER THAN THE STATE AVERAGE OF $61,229. LEE COUNTY PER CAPITA INCOME IS $28,179, BELOW THE STATE AVERAGE OF $32,924. THE PROPORTION OF LEE COUNTY RESIDENTS, 11.4%, LIVING BELOW THE FEDERAL POVERTY LEVEL IS HIGHER THAN THE STATE AVERAGE OF 12.6%. UNINSURED (2.5%) AND MEDICAID (19.4%) PATIENTS COMPRISE A TOTAL OF 22.0% OF OUR PAYER MIX FOR 2018. 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 2016 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 (9 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt
AMBOY COMMUNITY SCHOOL DISTRICT 272
11 E HAWLEY STREET	AMBOY	IL	61310	366005054	GOVERNMENT	$6,206	GENERAL OPERATING SUPPORT
DIXON FAMILY YMCA
110 N GALENA AVENUE	DIXON	IL	61021	362487927	501(C)(3)	$20,280	GENERAL OPERATING SUPPORT
DIXON PUBLIC SCHOOL DISTRICT 170
1335 FRANKLIN GROVE ROAD	DIXON	IL	61021	366007311	GOVERNMENT	$8,000	GENERAL OPERATING SUPPORT
HOME OF HOPE CANCER WELLNESS CENTERS
1637 PLOCK ROAD	DIXON	IL	61021	010743626	501(C)(3)	$15,000	GENERAL OPERATING SUPPORT
NEWMAN CENTRAL CATHOLIC HIGH SCHOOL
1101 W 23RD STREET	STERLING	IL	61081	237055337	501(C)(3)	$8,100	GENERAL OPERATING SUPPORT
UNIVERSITY OF ILLINOIS FOUNDATION
1305 WEST GREEN STREET	URBANA	IL	61801	376006007	501(C)(3)	$10,000	GENERAL OPERATING SUPPORT
DIXON CHAMBER OF COMMERCE & MAIN STREET
87 S HENNEPIN AVE	DIXON	IL	61021	362031370	501(C)(6)	$8,679	GENERAL OPERATING SUPPORT
LEE COUNTY COUNCIL ON AGING (LCCOA)
100 WEST SECOND ST	DIXON	IL	61021	362861690	501(C)(3)	$5,016	GENERAL OPERATING SUPPORT
METROPOLITAN CHICAGO HEALTHCARE COUNCIL (MCHC)
1151 E WARRENVILLE RD PO BOX 3015	NAPERVILLE	IL	60563	362167008	501(C)(3)	$7,610	GENERAL OPERATING SUPPORT

Field	Value	IRS element (for citing)
Total501c3 Org	7	Total501c3OrgCnt
Total Other Org	2	TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

Field	Value	IRS element (for citing)
Grant Type	STUDENT SCHOLARSHIPS	GrantTypeTxt
Recipient	12	RecipientCnt
Cash Grant	$9,856	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. SCHOLARSHIPS ARE GRANTED BASED ON SET CRITERIA. APPLICATIONS ARE REVIEWED AND RECIPIENTS ARE CHOSEN BY A SCHOLARSHIP COMMITTEE. USE OF SCHOLARSHIPS ARE NOT RESTRICTIVE.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	Yes (X)	CompensationCommitteeInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (1)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	Yes (1)	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (13 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
JOSEPH WELTY MD
BOARD MEMBER / PHYSICIAN	$254,783	$0	$0	$0	$396	$0	$12,798	$0	$31,405	$0	$299,382	$0	$0	$0
DAVID SCHREINER
CEO AND BOARD MEMBER	$528,375	$0	$0	$0	$22,875	$0	$163,625	$0	$29,659	$0	$744,534	$0	$0	$0
LINDA CLEMEN
VP-CHIEF NURSING OFFICER	$258,081	$0	$0	$0	$1,242	$0	$11,388	$0	$21,662	$0	$292,373	$0	$0	$0
ANTHONY EVERS
VP-CHIEF FINANCIAL OFFICER	$313,400	$0	$0	$0	$14,814	$0	$12,996	$0	$32,836	$0	$374,046	$0	$0	$0
PRATIP NAG MD
CHIEF MEDICAL OFFICER	$354,936	$0	$0	$0	$810	$0	$13,625	$0	$38,228	$0	$407,599	$0	$0	$0
JULIE MANN
VP-ADMINISTRATIVE OFFICER	$272,129	$0	$0	$0	$20,822	$0	$13,508	$0	$14,451	$0	$320,910	$0	$0	$0
KEVIN T MARX
VP-MEDICAL GROUP MANAGEMENT	$222,809	$0	$0	$0	$3,564	$0	$10,798	$0	$14,380	$0	$251,551	$0	$0	$0
SUZANNE RAVLIN
VP-CHIEF LEGAL OFFICER	$300,013	$0	$0	$0	$486	$0	$13,214	$0	$21,362	$0	$335,075	$0	$0	$0
MONTHER ELBZOUR MD
PHYSICIAN	$874,432	$0	$440,674	$0	$18,590	$0	$13,625	$0	$38,228	$0	$1,385,549	$0	$0	$0
ROBB RYDZYNSKI MD
PHYSICIAN	$619,408	$0	$435,975	$0	$18,638	$0	$13,625	$0	$1,336	$0	$1,088,982	$0	$0	$0
SOHAIL HANIF MD
PHYSICIAN	$783,139	$0	$183,128	$0	$18,758	$0	$13,625	$0	$32,628	$0	$1,031,278	$0	$0	$0
DAVID J POWERS MD
PHYSICIAN	$682,785	$0	$0	$0	$18,758	$0	$13,625	$0	$19,331	$0	$734,499	$0	$0	$0
THOMAS HERNANDEZ MD
PHYSICIAN	$687,376	$0	$0	$0	$60	$0	$13,625	$0	$38,228	$0	$739,289	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 4B	DAVID SCHREINER - $150,000
PART I, LINE 7	CERTAIN PHYSICIANS THAT ARE CONSIDERED "PERSONS OF INTEREST" RECEIVE BONUSES BASED ON NET CASH COLLECTIONS OF THEIR INDIVIDUAL PRACTICE.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
KAILE VALDEZ
FAMILY MEMBER OF DAVID SCHREINER, CURRENT OFFICER/TRUSTEE	$24,063	EMPLOYEE COMPENSATION	0
LESLIE MANN
FAMILY MEMBER OF JULIE MANN, OFFICER	$68,463	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 (9 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1	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 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 2018. 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 1,311,436. MANAGEMENT AND GENERAL EXPENSES 190,315. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,501,751. PROFESSIONAL: PROGRAM SERVICE EXPENSES 310,660. MANAGEMENT AND GENERAL EXPENSES 335,830. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 646,490. PURCHASED: PROGRAM SERVICE EXPENSES 3,621,764. MANAGEMENT AND GENERAL EXPENSES 5,946,557. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,568,321. COMMUNICATIONS: PROGRAM SERVICE EXPENSES 180,951. MANAGEMENT AND GENERAL EXPENSES 297,354. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 478,305. RECOGNITION: PROGRAM SERVICE EXPENSES 21,392. MANAGEMENT AND GENERAL EXPENSES 1,720. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,112. OTHER: PROGRAM SERVICE EXPENSES 1,966,121. MANAGEMENT AND GENERAL EXPENSES 581,781. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,547,902.
FORM 990, PART XI, LINE 9:	CHANGES IN VALUE OF SUBSIDIARIES 158,566.
FORM 990, PAGE 12, PART XII, LINE 2C	THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp

Disregarded Entity Name DisregardedEntityName

Field	Value	IRS element (for citing)
Business Name Line1	KSB - RMHSC PARTNERSHIP	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2400 N ROCKTON AVE	AddressLine1Txt
City	ROCKFORD	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	61103	ZIPCd

Field	Value	IRS element (for citing)
EIN	364143516	EIN
Primary Activities	HEALTHCARE OFFICES	PrimaryActivitiesTxt
Legal Domicile State	IL	LegalDomicileStateCd
Total Income	-$16,612	TotalIncomeAmt
End Of Year Assets	$809,953	EndOfYearAssetsAmt

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	KATHERINE SHAW BETHEA HOSPITAL	BusinessNameLine1Txt

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

Field	Value	IRS element (for citing)
Business Name Line1	KSB HOSPITAL AUXILIARY	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)
EIN	366192116	EIN
Primary Activities	FUNDRAISING FOR RELATED HOSPITAL	PrimaryActivitiesTxt
Legal Domicile State	IL	LegalDomicileStateCd
Exempt Code Section	501(C)(3)	ExemptCodeSectionTxt
Public Charity Status	LINE 12D, III-O	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	$407,555	ShareOfTotalIncomeAmt
Ownership	1.00000	OwnershipPct
Controlled Organization	Yes (1)	ControlledOrganizationInd

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	0	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	0	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