KATHERINE SHAW BETHEA HOSPITAL: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- KATHERINE SHAW BETHEA HOSPITAL (EIN 36-1000540)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-10-31
- IRS object ID
- 201813049349302061
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-10-31T16:53:00-05:00 | ReturnTs |
| Tax Period End | 2017-12-31 | 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 | 2017-01-01 | 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 | TONY EVERS | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 8152885531 | PhoneNum |
| Signature | 2018-09-14 | 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 | 2018-09-14 | IPDt |
| IP Tm | 14:31:11 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 3B841B4929CB13614851E7295B43E23F4F886B06 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | EB2AA38712426DB00C71B75584DD409442BAD006 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | 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 | $148,755,432 | 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 | THE MISSION OF KATHERINE SHAW BETHEA HOSPITAL (KSB) IS TO 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 | 1127 | TotalEmployeeCnt |
| Total Volunteers | 80 | TotalVolunteersCnt |
| Total Gross UBI | $9,109 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $441,062 | PYContributionsGrantsAmt |
| CY Contributions Grants | $379,488 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $135,082,986 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $146,958,861 | CYProgramServiceRevenueAmt |
| PY Investment Income | $330,101 | PYInvestmentIncomeAmt |
| CY Investment Income | $888,689 | CYInvestmentIncomeAmt |
| PY Other Revenue | $627,227 | PYOtherRevenueAmt |
| CY Other Revenue | $541,479 | CYOtherRevenueAmt |
| PY Total Revenue | $136,481,376 | PYTotalRevenueAmt |
| CY Total Revenue | $148,768,517 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $221,678 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $218,441 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $76,279,915 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $80,073,214 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $55,326,443 | PYOtherExpensesAmt |
| CY Other Expenses | $63,813,192 | CYOtherExpensesAmt |
| PY Total Expenses | $131,828,036 | PYTotalExpensesAmt |
| CY Total Expenses | $144,104,847 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,653,340 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,663,670 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $116,079,669 | TotalAssetsBOYAmt |
| Total Assets EOY | $123,715,545 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $48,805,145 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $51,445,799 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $67,274,524 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $72,269,746 | 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 | $114,761,652 | ExpenseAmt |
| Grant | $218,441 | GrantAmt |
| Revenue | $146,958,861 | RevenueAmt |
| Desc | IN 2017, KATHERINE SHAW BETHEA HOSPITAL (KSB) HAD 10,365 INPATIENT VISITS AND 174,012 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 $989,884 IN 2017.KSB PROVIDES 24-HOUR EMERGENCY MEDICAL SERVICES STAFFED BY FULL-TIME PHYSICIANS. PATIENTS ARE TREATED REGARDLESS OF INSURANCE OR ABILITY PAY. ER VISITS IN 2017 WERE 19,659. | Desc |
| Total Program Service Expenses | $114,761,652 | 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 | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln 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 | 51 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 1127 | 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 |
| 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 | |||
| CHRIS HAMMITT | ||||||||
| BOARD MEMBER | 1.60 | Yes (X) | $0 | $0 | $0 | |||
| DAVID HELLMICH | ||||||||
| BOARD MEMBER | 1.40 | Yes (X) | $0 | $0 | $0 | |||
| CHAD WEIGLE | ||||||||
| BOARD MEMBER | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| JOSEPH WELTY MD | ||||||||
| BOARD MEMBER | 1.40 | Yes (X) | $244,004 | $0 | $43,855 | |||
| DAVID SCHREINER | ||||||||
| CEO AND BOARD MEMBER | 40.00 | Yes (X) | Yes (X) | $526,581 | $0 | $46,137 | 1.00 | |
| LINDA CLEMEN | ||||||||
| VP-CHIEF NURSING OFFICER | 40.00 | Yes (X) | $245,992 | $0 | $33,555 | |||
| ANTHONY EVERS | ||||||||
| VP-CHIEF FINANCIAL OFFICER | 40.00 | Yes (X) | $308,718 | $0 | $41,462 | |||
| PRATIP NAG MD | ||||||||
| VP- CHIEF MEDICAL OFFICER | 40.00 | Yes (X) | $305,165 | $0 | $32,706 | |||
| JULIE MANN | ||||||||
| VP-ADMINISTRATIVE SERVICES | 40.00 | Yes (X) | $285,897 | $0 | $27,409 | |||
| KEVIN T MARX | ||||||||
| VP-MEDICAL GROUP MANAGEMENT | 40.00 | Yes (X) | $221,793 | $0 | $24,700 | |||
| SUZANNE RAVLIN | ||||||||
| VP-CHIEF LEGAL OFFICER | 40.00 | Yes (X) | $248,664 | $0 | $32,472 | |||
| MONTHER ELBZOUR MD | ||||||||
| PHYSICIAN | 40.00 | $1,145,517 | $0 | $46,211 | Yes (X) | |||
| SOHAIL HANIF MD | ||||||||
| PHYSICIAN | 40.00 | $961,723 | $0 | $46,003 | Yes (X) | |||
| KURT CROWE MD | ||||||||
| PHYSICIAN | 40.00 | $759,548 | $0 | $51,395 | Yes (X) | |||
| DAVID J POWERS MD | ||||||||
| PHYSICIAN | 40.00 | $681,853 | $0 | $32,706 | Yes (X) | |||
| THOMAS HERNANDEZ MD | ||||||||
| PHYSICIAN | 40.00 | $660,844 | $0 | $51,603 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $6,596,299 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $510,214 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 77 | 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 |
|---|---|---|---|---|---|
| AMERISOURCE BERGEN | |||||
| 1001 W TAYLOR ROAD | ROMEOVILLE | IL | 60446 | PHARMACEUTICAL SOLUTIONS | $3,442,306 |
| CERNER HEALTH SERVICES | |||||
| PO BOX 412732 | KANSAS CITY | MO | 64141 | SOFTWARE SUPPORT | $2,749,659 |
| HEALTHCARE AND FAMILY SERVICES | |||||
| PO BOX 19493 | SPRINGFIELD | IL | 62796 | CONSULTING | $2,288,103 |
| PHARMAVAIL BENEFIT MANAGEMENT | |||||
| 3380 TRICKLUM ROAD | WOODSTOCK | GA | 30188 | BENEFITS MANAGEMENT | $1,559,874 |
| HEALTHCARE CODING & CONSULTING SERVICES | |||||
| 8000 SUMMERLIN LAKES DR SUITE 200 | FORT MYERS | FL | 33097 | CODING AND CONSULTING | $1,326,808 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 90 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $166,466 | GovernmentGrantsAmt |
| All Other Contributions | $213,022 | AllOtherContributionsAmt |
| Total Contributions | $379,488 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621110 | $145,969,586 | $145,969,586 |
| 430B PROGRAM PAYMENTS | 621110 | $918,869 | $918,869 |
| NET CLINIC SPACE RENTAL | 621110 | $70,406 | $70,406 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $146,958,861 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $669,659 | TotalRevenueColumnAmt |
| Exclusion | $669,659 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $110,945 | SecuritiesAmt |
| Other | $95,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $20,734 | SecuritiesAmt |
| Other | -$33,819 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $90,211 | SecuritiesAmt |
| Other | $128,819 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $219,030 | TotalRevenueColumnAmt |
| Exclusion | $219,030 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| CAFETERIA SALES | 900099 | $441,914 | $9,109 | $432,805 |
| COPY REVENUE | 900099 | $48,017 | $48,017 | |
| REBATES | 900099 | $28,954 | $28,954 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,594 | TotalRevenueColumnAmt |
| Exclusion | $22,594 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $541,479 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $148,768,517 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $146,958,861 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $9,109 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,421,059 | 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 | $207,941 | TotalAmt |
| Program Services | $207,941 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,500 | TotalAmt |
| Program Services | $10,500 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,669,112 | TotalAmt |
| Program Services | $692,056 | ProgramServicesAmt |
| Management And General | $1,977,056 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,067,801 | TotalAmt |
| Program Services | $51,383,976 | ProgramServicesAmt |
| Management And General | $6,683,825 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,266,590 | TotalAmt |
| Program Services | $2,047,908 | ProgramServicesAmt |
| Management And General | $218,682 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,699,779 | TotalAmt |
| Program Services | $12,487,235 | ProgramServicesAmt |
| Management And General | $1,212,544 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,369,932 | TotalAmt |
| Program Services | $2,908,740 | ProgramServicesAmt |
| Management And General | $461,192 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,856 | TotalAmt |
| Management And General | $157,856 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,116 | TotalAmt |
| Management And General | $80,116 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,612 | TotalAmt |
| Management And General | $167,612 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,453 | TotalAmt |
| Management And General | $29,453 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,012,874 | TotalAmt |
| Program Services | $8,626,218 | ProgramServicesAmt |
| Management And General | $7,386,656 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $476,150 | TotalAmt |
| Program Services | $348,681 | ProgramServicesAmt |
| Management And General | $127,469 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $199,165 | TotalAmt |
| Program Services | $137,630 | ProgramServicesAmt |
| Management And General | $61,535 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,479,620 | TotalAmt |
| Program Services | $359,183 | ProgramServicesAmt |
| Management And General | $3,120,437 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,618,197 | TotalAmt |
| Program Services | $2,227,335 | ProgramServicesAmt |
| Management And General | $390,862 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,296 | TotalAmt |
| Program Services | $37,187 | ProgramServicesAmt |
| Management And General | $8,109 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $249,691 | TotalAmt |
| Program Services | $167,080 | ProgramServicesAmt |
| Management And General | $82,611 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $660,398 | TotalAmt |
| Management And General | $660,398 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,260,659 | TotalAmt |
| Program Services | $3,306,031 | ProgramServicesAmt |
| Management And General | $1,954,628 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,389,990 | TotalAmt |
| Program Services | $172,890 | ProgramServicesAmt |
| Management And General | $2,217,100 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PATIENT SUPPLIES | $13,934,707 | $13,934,366 | $341 |
| BAD DEBT EXPENSE | $11,237,906 | $11,237,906 | |
| IPA TAX | $3,048,120 | $3,048,120 | |
| OTHER EXPENSES | $2,241,906 | $125,909 | $2,115,997 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,523,476 | TotalAmt |
| Program Services | $1,294,760 | ProgramServicesAmt |
| Management And General | $228,716 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $144,104,847 | TotalAmt |
| Program Services | $114,761,652 | ProgramServicesAmt |
| Management And General | $29,343,195 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,370 | BOYAmt |
| EOY | $4,425 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,448,720 | BOYAmt |
| EOY | $16,329,280 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $95,729 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,361,994 | BOYAmt |
| EOY | $36,843,382 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,447,389 | BOYAmt |
| EOY | $1,515,017 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,147,776 | BOYAmt |
| EOY | $1,000,178 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $127,565,467 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $85,225,753 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,727,627 | BOYAmt |
| EOY | $42,339,714 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,403,706 | BOYAmt |
| EOY | $16,800,874 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,220,397 | BOYAmt |
| EOY | $6,135,275 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,221,961 | BOYAmt |
| EOY | $2,747,400 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $116,079,669 | BOYAmt |
| EOY | $123,715,545 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,513,977 | BOYAmt |
| EOY | $34,534,132 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,291,168 | BOYAmt |
| EOY | $16,911,667 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,805,145 | BOYAmt |
| EOY | $51,445,799 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $66,136,169 | BOYAmt |
| EOY | $70,989,482 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $225,583 | BOYAmt |
| EOY | $264,248 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $912,772 | BOYAmt |
| EOY | $1,016,016 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,274,524 | BOYAmt |
| EOY | $72,269,746 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $116,079,669 | BOYAmt |
| EOY | $123,715,545 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $4,663,670 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $311,527 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $20,025 | 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 | $29,453 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $29,453 | 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 | $11,154 | DonorAdvisedFundsContriAmt |
| Donor Advised Funds Grants | $25,000 | DonorAdvisedFundsGrantsAmt |
| Donor Advised Funds Vl EOY | $115,777 | 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 | $1,892,631 | BeginningYearBalanceAmt |
| Contributions | $103,244 | ContributionsAmt |
| Administrative Expenses | $979,859 | AdministrativeExpensesAmt |
| End Year Balance | $1,016,016 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| 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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| 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 Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,266,546 | BeginningYearBalanceAmt |
| Contributions | $306,847 | ContributionsAmt |
| End Year Balance | $1,573,393 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,073,194 | BeginningYearBalanceAmt |
| Contributions | $193,352 | ContributionsAmt |
| End Year Balance | $1,266,546 | 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 | $2,183,972 | OtherCostOrOtherBasisAmt |
| Book Value | $2,183,972 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $49,432,280 | OtherCostOrOtherBasisAmt |
| Depreciation | $30,002,705 | DepreciationAmt |
| Book Value | $19,429,575 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,477,463 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,277,952 | DepreciationAmt |
| Book Value | $2,199,511 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $69,972,033 | OtherCostOrOtherBasisAmt |
| Depreciation | $51,945,096 | DepreciationAmt |
| Book Value | $18,026,937 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $499,719 | OtherCostOrOtherBasisAmt |
| Book Value | $499,719 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $42,339,714 | 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. IN THE CURRENT YEAR IT WAS DETERMINED THAT PRIOR YEAR AMOUNTS REPORTED ENDOWMENT FUNDS THAT DID NOT MEET THE DEFINITION OF SFAS 117. AS A RESULT, THESE AMOUNTS HAVE BEEN REMOVED IN THE CURRENT YEAR COLUMN UNDER ADMINISTRATIVE EXPENSES TO CONFORM WITH THE IRS INSTRUCTIONS REGARDING WHICH ENDOWMENT FUNDS TO REPORT IN THIS SECTION. |
| PART X, LINE 2: | THE HOSPITAL APPLIES THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE HOSPITAL DOES NOT CURRENTLY INCLUDE AN INCOME TAX PROVISION IN THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT MONITORS THE REPORTING OF UNCERTAIN TAX POSITIONS, WHICH COULD RESULT IN RECORDING OF AN INCOME TAX PROVISION IN THE FUTURE. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,110,548 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,110,548 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00770 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,125,890 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,671,680 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,454,210 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06560 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,236,438 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,671,680 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,564,758 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07330 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $812,127 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $812,127 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00560 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,130,824 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,790,376 | 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 | $61,563 | 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 | $6,500 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,500 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $156,651 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $156,651 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,167,665 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,942,494 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $975,278 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00670 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,404,103 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,614,174 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,540,036 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08000 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $11,237,906 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,123,791 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $26,212,064 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $27,777,669 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,565,605 | 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 | HTTP://WWW.KSBHOSPITAL.COM/FINANCIALASSISTANCE/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://WWW.KSBHOSPITAL.COM/FINANCIALASSISTANCE/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://WWW.KSBHOSPITAL.COM/FINANCIALASSISTANCE/ | 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 (5 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. |
| 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 2017 CALCULATED COST TO CHARGE RATIO USING THE IRS WORKSHEET 2. |
| PART I, LINE 7G: | FOR 2017, 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 #9 IS LOCATED ON PAGE 23 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 34,406 IN 2017. 19.1% OF THE POPULATION WAS AGE 65 AND OLDER. THE CENSUS BUREAU ESTIMATED THAT 13.3% OF LEE COUNTY WAS BELOW THE POVERTY LINE. IN 2017, 45.5% 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 2017 MEDICARE COST REPORT THE MEDICARE ALLOWABLE COSTS FOR 2017 WERE $27,777,669 AND PAYMENTS RECEIVED FROM MEDICARE WERE $26,212,064. WE BELIEVE THAT THE SHORTFALL OF $1,565,605 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 2017 POPULATION OF LEE COUNTY WAS ESTIMATED AT 34,406. THE COMMUNITIES OF LEE AND WESTERN OGLE COUNTY COMPRISE THE KSB HOSPITAL PRIMARY SERVICE AREA. THIS AREA SAW A POPULATION DECLINE OF 4.5% BETWEEN 2010 AND 2017, A PERIOD DURING WHICH THE STATE DECLINED BY 0.2%. DIXON IS THE COUNTY SEAT AND THE LARGEST COMMUNITY IN LEE COUNTY WITH AN ESTIMATED POPULATION OF 15,202. 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 2017 ANNUAL AVERAGE UNEMPLOYMENT RATE FOR LEE COUNTY WAS 4.3%, COMPARABLE TO NORTHWEST ILLINOIS OVERALL AND LESS THAN THE STATE AVERAGE OF 5.0%. WITH A MEDIAN HOUSEHOLD IN INCOME OF $55,067, LEE COUNTY IS LOWER THAN THE STATE AVERAGE OF $59,196. LEE COUNTY PER CAPITA INCOME IS $27,021, BELOW THE STATE AVERAGE OF $31,502. THE PROPORTION OF LEE COUNTY RESIDENTS, 13.3%, LIVING BELOW THE FEDERAL POVERTY LEVEL IS HIGHER THAN THE STATE AVERAGE OF 13.0%. UNINSURED (2.1%) AND MEDICAID (18.8%) PATIENTS COMPRISE A TOTAL OF 20.9% OF OUR PAYER MIX FOR 2017. 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 | $6,000 | GENERAL OPERATING SUPPORT |
| DIXON FAMILY YMCA | |||||||
| 110 N GALENA AVENUE | DIXON | IL | 61021 | 362487927 | 501(C)(3) | $20,280 | GENERAL OPERATING SUPPORT |
| DIXON MAIN STREET INC | |||||||
| 115 S HENNEPIN | DIXON | IL | 61021 | 364068737 | 501(C)(3) | $7,500 | GENERAL OPERATING SUPPORT |
| DIXON PUBLIC SCHOOL DISTRICT 170 | |||||||
| 1335 FRANKLIN GROVE ROAD | DIXON | IL | 61021 | 366007311 | GOVERNMENT | $9,200 | GENERAL OPERATING SUPPORT |
| HOME OF HOPE CANCER WELLNESS CENTERS | |||||||
| 1637 PLOCK ROAD | DIXON | IL | 61021 | 010743626 | 501(C)(3) | $16,000 | GENERAL OPERATING SUPPORT |
| ILLINOIS HOSPITAL RESEARCH & EDUCATION FOUNDATION | |||||||
| 1151 E WARRENVILLE RD PO BOX 3015 | NAPERVILLE | IL | 60566 | 237421930 | 501(C)(3) | $5,097 | GENERAL OPERATING SUPPORT |
| NEWMAN CENTRAL CATHOLIC HIGH SCHOOL | |||||||
| 1101 W 23RD STREET | STERLING | IL | 61081 | 237055337 | 501(C)(3) | $8,450 | GENERAL OPERATING SUPPORT |
| UNITED WAY OF LEE COUNTY INC | |||||||
| PO BOX 382 | DIXON | IL | 61021 | 366009288 | 501(C)(3) | $5,500 | GENERAL OPERATING SUPPORT |
| UNIVERSITY OF ILLINOIS FOUNDATION | |||||||
| 1305 WEST GREEN STREET | URBANA | IL | 61801 | 376006007 | 501(C)(3) | $10,000 | GENERAL OPERATING SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 9 | Total501c3OrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | STUDENT SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 12 | RecipientCnt |
| Cash Grant | $10,500 | 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 | 0 | 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 | $243,608 | $0 | $0 | $0 | $396 | $0 | $12,450 | $0 | $31,405 | $0 | $287,859 | $0 | $0 | $0 |
| DAVID SCHREINER | ||||||||||||||
| CEO AND BOARD MEMBER | $504,315 | $0 | $0 | $0 | $22,266 | $0 | $13,375 | $0 | $32,762 | $0 | $572,718 | $0 | $0 | $0 |
| LINDA CLEMEN | ||||||||||||||
| VP-CHIEF NURSING OFFICER | $244,750 | $0 | $0 | $0 | $1,242 | $0 | $11,757 | $0 | $21,798 | $0 | $279,547 | $0 | $0 | $0 |
| ANTHONY EVERS | ||||||||||||||
| VP-CHIEF FINANCIAL OFFICER | $302,630 | $0 | $0 | $0 | $6,088 | $0 | $8,626 | $0 | $32,836 | $0 | $350,180 | $0 | $0 | $0 |
| PRATIP NAG MD | ||||||||||||||
| VP- CHIEF MEDICAL OFFICER | $304,355 | $0 | $0 | $0 | $810 | $0 | $13,375 | $0 | $19,331 | $0 | $337,871 | $0 | $0 | $0 |
| JULIE MANN | ||||||||||||||
| VP-ADMINISTRATIVE SERVICES | $265,575 | $0 | $0 | $0 | $20,322 | $0 | $12,958 | $0 | $14,451 | $0 | $313,306 | $0 | $0 | $0 |
| KEVIN T MARX | ||||||||||||||
| VP-MEDICAL GROUP MANAGEMENT | $218,229 | $0 | $0 | $0 | $3,564 | $0 | $10,320 | $0 | $14,380 | $0 | $246,493 | $0 | $0 | $0 |
| SUZANNE RAVLIN | ||||||||||||||
| VP-CHIEF LEGAL OFFICER | $248,178 | $0 | $0 | $0 | $486 | $0 | $11,110 | $0 | $21,362 | $0 | $281,136 | $0 | $0 | $0 |
| MONTHER ELBZOUR MD | ||||||||||||||
| PHYSICIAN | $867,837 | $0 | $259,620 | $0 | $18,060 | $0 | $13,375 | $0 | $32,836 | $0 | $1,191,728 | $0 | $0 | $0 |
| SOHAIL HANIF MD | ||||||||||||||
| PHYSICIAN | $782,645 | $0 | $160,820 | $0 | $18,258 | $0 | $13,375 | $0 | $32,628 | $0 | $1,007,726 | $0 | $0 | $0 |
| KURT CROWE MD | ||||||||||||||
| PHYSICIAN | $584,410 | $0 | $175,000 | $0 | $138 | $0 | $13,375 | $0 | $38,020 | $0 | $810,943 | $0 | $0 | $0 |
| DAVID J POWERS MD | ||||||||||||||
| PHYSICIAN | $663,595 | $0 | $0 | $0 | $18,258 | $0 | $13,375 | $0 | $19,331 | $0 | $714,559 | $0 | $0 | $0 |
| THOMAS HERNANDEZ MD | ||||||||||||||
| PHYSICIAN | $660,784 | $0 | $0 | $0 | $60 | $0 | $13,375 | $0 | $38,228 | $0 | $712,447 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 7 | FormAndLineReferenceDesc |
| Explanation | CERTAIN PHYSICIANS THAT ARE CONSIDERED "PERSONS OF INTEREST" RECEIVE BONUSES BASED ON NET CASH COLLECTIONS OF THEIR INDIVIDUAL PRACTICE. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| KAILE VALDEZ | |||
| FAMILY MEMBER OF DAVID SCHREINER, CURRENT OFFICER/TRUSTEE | $25,063 | EMPLOYEE COMPENSATION | 0 |
| LESLIE MANN | |||
| FAMILY MEMBER OF JULIE MANN, OFFICER | $69,370 | EMPLOYEE COMPENSATION | 0 |
| ASHLEY HENKEL | |||
| FAMILY MEMBER OF COLLEEN T. HENKEL, CURRENT CHAIRPERSON/TRUSTEE | $12,117 | 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 2017. 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 | OTHER FEES: PROGRAM SERVICE EXPENSES 2,906,108. MANAGEMENT AND GENERAL EXPENSES 3,769,522. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,675,630. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 5,720,110. MANAGEMENT AND GENERAL EXPENSES 3,617,134. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,337,244. |
| FORM 990, PART XI, LINE 9: | CHANGES IN VALUE OF SUBSIDIARIES 20,025. |
| FORM 990, PAGE 12, PART XII, LINE 2C | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KSB HOSPITAL 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 | 0 | ControlledOrganizationInd |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| 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 AVENUE | 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 |
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) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | -$31,971 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $761,176 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (1) | GeneralOrManagingPartnerInd |
| Ownership | 0.72600 | OwnershipPct |
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 | $345,840 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $783,845 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 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 | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | 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 |