PANA COMMUNITY HOSPITAL ASSOCIATION: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- PANA COMMUNITY HOSPITAL ASSOCIATION (EIN 37-6062326)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-14
- IRS object ID
- 201703189349310415
- Schema version
- 2016v3.0
- 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 J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-14T16:15:07-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | 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 | 114 E EVERETT | AddressLine1Txt |
| City | DIXON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61021 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 376062326 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PANA COMMUNITY HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PANA | BusinessNameControlTxt |
| Phone | 2175622131 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 EAST NINTH STREET | AddressLine1Txt |
| City | PANA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62557 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KATRINA CASNER | PersonNm |
| Person Title | PRESIDENT & CEO | PersonTitleTxt |
| Phone | 2175622131 | PhoneNum |
| Signature | 2017-11-13 | 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 | 8152859300 | 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 | 2017-11-13 | IPDt |
| IP Tm | 17:29:15 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | F9B6E4BAE08ED6E5B912E8E807B31791D539E9C8 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 4264D1B680993024C276DC83B894831CF63E241F | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KATRINA CASNER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 EAST NINTH STREET | AddressLine1Txt |
| City | PANA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62557 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $25,096,028 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PANAHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1966 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | OUR MISSION IS TO BE A LEADING PARTNER IN ASSURING COMMUNITY-BASED QUALITY HEALTH CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 276 | TotalEmployeeCnt |
| Total Volunteers | 90 | TotalVolunteersCnt |
| Total Gross UBI | $5,242 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $118,505 | PYContributionsGrantsAmt |
| CY Contributions Grants | $229,191 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $23,438,428 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $24,626,427 | CYProgramServiceRevenueAmt |
| PY Investment Income | $112,882 | PYInvestmentIncomeAmt |
| CY Investment Income | $100,702 | CYInvestmentIncomeAmt |
| PY Other Revenue | $83,641 | PYOtherRevenueAmt |
| CY Other Revenue | $118,354 | CYOtherRevenueAmt |
| PY Total Revenue | $23,753,456 | PYTotalRevenueAmt |
| CY Total Revenue | $25,074,674 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,609,531 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,457,569 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,895,210 | PYOtherExpensesAmt |
| CY Other Expenses | $11,417,303 | CYOtherExpensesAmt |
| PY Total Expenses | $20,504,741 | PYTotalExpensesAmt |
| CY Total Expenses | $23,874,872 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,248,715 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,199,802 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $28,234,466 | TotalAssetsBOYAmt |
| Total Assets EOY | $29,257,704 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,377,610 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,184,444 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $25,856,856 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $27,073,260 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | OUR MISSION IS TO BE A LEADING PARTNER IN ASSURING COMMUNITY-BASED QUALITY HEALTH CARE. TO ACHIEVE THIS MISSION, WE PROMOTE A VISION STRIVING TO DEVELOP A COMPREHENSIVE SYSTEM OF HEALTHCARE SERVICES, IN PARTNERSHIP WITH THE OTHER COMMUNITY HEALTHCARE PROVIDERS, TO ASSIST OUR SERVICE AREA RESIDENTS IN REACHING THEIR PERSONAL MAXIMUM FOR HEALTH; TO PROVIDE PROGRAMS THAT PROMOTE HEALTH EDUCATION AND WELLNESS; TO ENHANCE OUR PERSONALIZED CARE CONCEPT IN THE PROVISION OF SERVICES TO OUR COMMUNITY; TO MAINTAIN AN ENVIRONMENT WHICH PROMOTES SATISFACTION AND OPPORTUNITY FOR THE PATIENT, THEIR FAMILY, THE EMPLOYEE, AND THE PHYSICIAN; TO MAINTAIN THE HOSPITAL'S ABILITY TO SUPPORT THE DELIVERY OF QUALITY HEALTH CARE AT A REASONABLE COST, IN ACCORDANCE WITH COMMUNITY NEEDS AND THE HEALTH CARE REGULATORY ENVIRONMENT; AND TO DEMONSTRATE BY ACTIONS AND RESULTS OUR COMMITMENT TO CONTINUOUS QUALITY IMPROVEMENT. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $18,376,980 | ExpenseAmt |
| Revenue | $24,626,427 | RevenueAmt |
| Desc | TO PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF PANA, ILLINOIS AND THE SURROUNDING AREA. THESE SERVICES INCLUDE NURSING, EMERGENCY AND ANCILLARY SERVICES FOR 974 INPATIENT DAYS, 22,061 OUTPATIENT ADMISSSIONS, 7,974 EMERGENCY VISITS AND 483 SURGICAL PATIENTS. | Desc |
| Total Program Service Expenses | $18,376,980 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | 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 | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln 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 | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 31 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 276 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | 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 | JAMES MOON CFO | PersonNm |
| Phone | 2175622131 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 EAST NINTH STREET | AddressLine1Txt |
| City | PANA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62557 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 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 | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| CAROL SCHRAMM | |||||||||
| CHAIRMAN | 1.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| MATT BEAVERS | |||||||||
| VICE CHAIRMAN | 1.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| JOYCE THRONEBURG | |||||||||
| SECRETARY | 1.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| JOHN GARDNER | |||||||||
| TREASURER | 1.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| MARY ANN RHOADES | |||||||||
| PAST CHARIRMAN (TERM 4/16) | 1.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| JIM BREWER | |||||||||
| DIRECTOR | 1.50 | Yes (X) | $0 | $0 | $0 | ||||
| LARRY CEARLOCK | |||||||||
| DIRECTOR | 1.50 | Yes (X) | $0 | $0 | $0 | ||||
| DR TERRY CUNNINGTON | |||||||||
| DIRECTOR | 40.00 | Yes (X) | $372,900 | $0 | $11,269 | ||||
| GREGORY HOLTHAUS | |||||||||
| DIRECTOR | 1.50 | Yes (X) | $0 | $0 | $0 | ||||
| DR DAVID LETT | |||||||||
| DIRECTOR | 1.50 | Yes (X) | $0 | $0 | $0 | ||||
| SARAH MYER | |||||||||
| DIRECTOR | 1.50 | Yes (X) | $0 | $0 | $0 | ||||
| CHARLES O'MALLEY | |||||||||
| DIRECTOR | 1.50 | Yes (X) | $0 | $0 | $0 | ||||
| RICK SCHMITZ | |||||||||
| DIRECTOR | 1.50 | Yes (X) | $0 | $0 | $0 | ||||
| RIC MILES | |||||||||
| PAST DIRECTOR (TERM 4/16) | 1.50 | Yes (X) | $0 | $0 | $0 | ||||
| JOYCE MORGAN | |||||||||
| PAST DIRECTOR (TERM 4/16) | 1.50 | Yes (X) | $0 | $0 | $0 | ||||
| KATRINA CASNER | |||||||||
| PRESIDENT & CEO | 40.00 | Yes (X) | $185,097 | $0 | $13,305 | 1.50 | |||
| JAMES MOON | |||||||||
| CFO | 40.00 | Yes (X) | $113,514 | $0 | $8,335 | 1.50 | |||
| VICKIE COEN | |||||||||
| CCO & CNE | 40.00 | Yes (X) | $124,569 | $0 | $5,812 | ||||
| DIANNE BAILEY | |||||||||
| CIO | 40.00 | Yes (X) | $79,443 | $0 | $12,551 | ||||
| DR MARLON MUNESES | |||||||||
| PHYSICIAN | 40.00 | $365,694 | $0 | $12,264 | 1.50 | Yes (X) | |||
| DR CATHERINE TEODORO | |||||||||
| PHYSICIAN | 40.00 | $199,691 | $0 | $8,350 | Yes (X) | ||||
| DR DEMOSTHENES ASUNCION | |||||||||
| PHYSICIAN | 40.00 | $160,520 | $0 | $10,036 | Yes (X) | ||||
| DR STEVEN WEBER | |||||||||
| PT SURGEON | 16.00 | $225,445 | $0 | $0 | Yes (X) | ||||
| MICHELLE FORMAN | |||||||||
| PHARMACIST | 40.00 | $121,775 | $0 | $11,742 | Yes (X) | ||||
| DR MOLLIE BEYERS | |||||||||
| PHYSICAL THERAPIST | 40.00 | $101,936 | $0 | $10,431 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,050,584 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $104,095 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | 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 |
|---|---|---|---|---|---|
| MIDWEST EMERGENCY SERVICE INC | |||||
| 320 E HIGHWAY 50 | OFALLON | IL | 62269 | EMERGENCY PHYSICIANS | $1,164,498 |
| MCKESSON TECHNOLOGIES INC | |||||
| PO BOX 98347 | CHICAGO | IL | 60693 | HARD/SOFT SUPPORT/MAINT | $529,024 |
| CROSSROADS EMERGENCY PHYSICIANS LLP | |||||
| PO BOX 674579 | DETROIT | MI | 48267 | EMERGENCY PHYSICIANS | $455,770 |
| CONSOCIATE-DANSIG | |||||
| 151 E DECATUR ST | DECATUR | IL | 62525 | THIRD PARTY ADMINISTRATION - HEALTH INSU | $334,407 |
| ALLSCRIPTS | |||||
| 24630 NETWORK PLACE | CHICAGO | IL | 60693 | HARD/SOFT SUPPORT/MAINT | $237,610 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $208,034 | RelatedOrganizationsAmt |
| Government Grants | $9,082 | GovernmentGrantsAmt |
| All Other Contributions | $12,075 | AllOtherContributionsAmt |
| Total Contributions | $229,191 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT CARE SERVICES | 621110 | $24,027,065 | $24,027,065 |
| ELECTRONIC HEALTH RECORDS REVENUE | 621110 | $435,757 | $435,757 |
| OTHER OPERATING REVENUE | 621110 | $163,605 | $163,605 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $24,626,427 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $122,056 | TotalRevenueColumnAmt |
| Exclusion | $122,056 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $72,203 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $72,203 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $72,203 | TotalRevenueColumnAmt |
| Exclusion | $72,203 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $21,354 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$21,354 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$21,354 | TotalRevenueColumnAmt |
| Exclusion | -$21,354 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| CAFETERIA & VENDING | 722514 | $40,909 | $40,909 | |
| CATERING | 722320 | $5,242 | $5,242 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $46,151 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,074,674 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,626,427 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $5,242 | UnrelatedBusinessRevenueAmt |
| Exclusion | $213,814 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,683,350 | TotalAmt |
| Program Services | $1,125,357 | ProgramServicesAmt |
| Management And General | $557,993 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,550,769 | TotalAmt |
| Program Services | $6,976,207 | ProgramServicesAmt |
| Management And General | $1,574,562 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $227,799 | TotalAmt |
| Program Services | $192,041 | ProgramServicesAmt |
| Management And General | $35,758 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,585,137 | TotalAmt |
| Program Services | $1,270,868 | ProgramServicesAmt |
| Management And General | $314,269 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $410,514 | TotalAmt |
| Program Services | $325,918 | ProgramServicesAmt |
| Management And General | $84,596 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $107,013 | TotalAmt |
| Management And General | $107,013 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,931 | TotalAmt |
| Management And General | $61,931 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,044,083 | TotalAmt |
| Program Services | $2,793,645 | ProgramServicesAmt |
| Management And General | $250,438 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,754 | TotalAmt |
| Management And General | $66,754 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $522,569 | TotalAmt |
| Management And General | $522,569 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $319,886 | TotalAmt |
| Management And General | $319,886 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $237,783 | TotalAmt |
| Program Services | $140,292 | ProgramServicesAmt |
| Management And General | $97,491 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,033 | TotalAmt |
| Management And General | $69,033 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,496 | TotalAmt |
| Management And General | $39,496 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,286,039 | TotalAmt |
| Program Services | $758,763 | ProgramServicesAmt |
| Management And General | $527,276 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $206,723 | TotalAmt |
| Program Services | $121,967 | ProgramServicesAmt |
| Management And General | $84,756 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $2,111,532 | $2,111,532 | |
| BAD DEBT EXPENSE | $1,656,158 | $1,656,158 | |
| REPAIRS & MAINTENANCE | $846,904 | $499,673 | $347,231 |
| FEES & LICENSES | $489,391 | $284,032 | $205,359 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $352,008 | TotalAmt |
| Program Services | $120,527 | ProgramServicesAmt |
| Management And General | $231,481 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,874,872 | TotalAmt |
| Program Services | $18,376,980 | ProgramServicesAmt |
| Management And General | $5,497,892 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $625 | BOYAmt |
| EOY | $1,225 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,820,922 | BOYAmt |
| EOY | $14,062,585 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,150,652 | BOYAmt |
| EOY | $4,549,922 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,850 | BOYAmt |
| EOY | $1,850 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $413,098 | BOYAmt |
| EOY | $439,761 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $180,814 | BOYAmt |
| EOY | $328,373 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $19,705,306 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,613,256 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,331,140 | BOYAmt |
| EOY | $7,092,050 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,061,455 | BOYAmt |
| EOY | $2,401,596 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $98,591 | BOYAmt |
| EOY | $56,935 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $175,319 | BOYAmt |
| EOY | $323,407 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,234,466 | BOYAmt |
| EOY | $29,257,704 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,735,029 | BOYAmt |
| EOY | $2,180,394 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $384,757 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $257,824 | BOYAmt |
| EOY | $4,050 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,377,610 | BOYAmt |
| EOY | $2,184,444 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,856,856 | BOYAmt |
| EOY | $27,073,260 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,856,856 | BOYAmt |
| EOY | $27,073,260 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,234,466 | BOYAmt |
| EOY | $29,257,704 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,199,802 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $60,782 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$44,180 | 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
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $7,841 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,841 | 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 | WE PARTICIPATE INDIRECTLY WITH LOBBYING ACTIVITIES THROUGH OUR MEMBERSHIPS IN THE ILLINOIS HOSPITAL ASSOCIATION ("IHA") AND THE AMERICAN HOSPITAL ASSOCIATION ("AHA"). IT IS ESTIMATED THAT OUR LOBBYING EXPENDITURES FOR 2016 WERE 31% AND 21.78% OF OUR MEMBERSHIP DUES PAID TO AHA AND IHA, RESPECTIVELY. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $51,361 | OtherCostOrOtherBasisAmt |
| Book Value | $51,361 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,831,127 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,112,339 | DepreciationAmt |
| Book Value | $4,718,788 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,084,017 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,500,917 | DepreciationAmt |
| Book Value | $1,583,100 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $738,801 | OtherCostOrOtherBasisAmt |
| Book Value | $738,801 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,092,050 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | THIRD PARTY PAYOR SETTLEMENTS | Desc |
| Amt | $4,050 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,050 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | IT WAS DETERMINED IN THE CURRENT YEAR THAT THE FUNDS ORIGINALLY REPORTED AS ENDOWMENT FUNDS DO NOT MEET THE DEFINITION OF SFAS 117. AS A RESULT, THESE HAVE BEEN REMOVED IN ACCORDANCE WITH IRS INSTRUCTIONS. |
| PART X, LINE 2: | AT DECEMBER 31, 2016 AND 2015, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED. PRESENTLY, THERE ARE NO ONGOING INCOME TAX AUDITS OR UNRESOLVED DISPUTES WITH THE TAX AUTHORITIES THAT THE ORGANIZATION CURRENTLY FILES OR HAS FILED WITH. |
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 | $346,349 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $346,349 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01450 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,820,843 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,957,141 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $863,702 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03620 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,167,192 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,957,141 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,210,051 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05070 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $54,296 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,647 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $50,649 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00210 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $46,667 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $46,667 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $100,963 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,647 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $97,316 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00410 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,268,155 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,960,788 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,307,367 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05480 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,656,158 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $993,695 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,956,504 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,376,272 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$419,768 | 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 | 0 | 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 | PANA COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 EAST 9TH STREET | AddressLine1Txt |
| City | PANA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62557 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.PANAHOSPITAL.COM | WebsiteAddressTxt |
| State License | 0001776 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PANA COMMUNITY 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 | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://WWW.PANAHOSPITAL.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT- | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://WWW.PANAHOSPITAL.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT- | 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 |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| 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.PANAHOSPITAL.COM/UPLOAD/FILES/2016_FINANCIAL_ASSIST-POLICY.PDF | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://WWW.PANAHOSPITAL.COM/UPLOAD/FILES/2016-REVISED-APPLICATION.PDF | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://WWW.PANAHOSPITAL.COM/UPLOAD/FILES/3.-PLAIN-LANGUAGE-SUMMARY.PDF | 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 |
| 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 Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PANA COMMUNITY HOSPITAL | PART V, SECTION B, LINE 5: PCH CONSULTED THE CHRISTIAN COUNTY HEALTH DEPT., UTILIZED SURVEYS MADE AVAILABLE TO THE PUBLIC, AND CONDUCTED COMMUNITY MEETINGS THAT ALL INTERESTED PARTIES COULD ATTEND. A CONSULTANT FROM THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK DIRECTED THE MEETINGS.IN ADDITION, THE PROCESS INVOLVED FOCUS GROUPS COMPRISED OF AREA HEALTHCARE PROVIDERS AND PARTNERS AND PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF, OR EXPERTISE IN PUBLIC HEALTH. MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS SERVED BY THE HOSPITAL OR INDIVIDUALS OR ORGANIZATIONS REPRESENTING THE INTEREST OF SUCH POPULATIONS ALSO PROVIDED INPUT. |
| PANA COMMUNITY HOSPITAL | PART V, SECTION B, LINE 11: PANA COMMUNITY HOSPITAL'S SIGNIFICANT COMMUNITY HEALTH NEEDS, AS IDENTIFIED IN ITS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, ARE MENTAL HEALTH, WELLNESS , IMPROVE THE LOCAL ECONOMY AND PLANNING FOR PHYSICIAN SUPPLY. THE IMPLEMENTATION STRATEGY AND PROCESS BY WHICH NEEDS WILL BE ADDRESSED WAS IDENTFIED AND PRIORITIZED BY THE CHNA STEERING COMMITTEE AND KEY ADMINISTRATIVE STAFF AT PANA COMMUNITY HOSPITAL. THE GROUP REVIEWED THE NEEDS ASSESSMENT PROCESS AND PRIORITIZED SIGNIFICANT NEEDS AND SUPPORTING DOCUMENTS. THEY DISCUSSED STEPS TAKEN TO ADDRESS THE PREVIOUS COMMUNITY HEALTH NEEDS ASSESMENT AND CONSIDERED INTENRAL AND EXTERNAL RESOURCES POTENTIALLY AVAILABLE TO ADDRESS THE CURRENT PRIORITIZED NEEDS. THE FOLLOWING NEEDS AND ISSUES IDENTIFIED WERE. MENTAL HEALTH:1) ADDRESS PREVALENCE OF TOBACCO USE AMONG YOUTH AND ADULTS2) ADDRESS PREVALENCE OF ALCOHOL USE AMONG YOUTH ADULTS3) ADDRESS ADDICTION RELATED ISSUES INCLUDING ACCESS TO SERVICES FOR REHABILITATION AND RECOVERY 4) ADDRESS YOUTH SUBSTANCE USETHE GROUP ALSO SINGLED OUT A NEED FOR IMPROVED ACCESS TO BEDS FOR PERSONS WITH BEHAVIORAL MENTAL HEALTH ISSUES AND SUBSTANCE ABUSE ISSUES REQURING IN-PATIENT SERVICESACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE MENTAL HEALTH NEED:1) EXPLORE EXPANDING TELEHEALTH TO INCLUDE TELEPSYCHIATRY2) EXPLORE EXPANDING MENTAL HEALTH COUNSELING AND EVALUATION TO IMPROVE BEHAVIORAL MENTAL HEALTH ACCESS AND ADDICTION-RELATED SERVICES3) CONTINUE TO PARTNER WITH CHRISTIAN COUNTY MENTAL HEALTH TO PROVIDE EMERGENT CARE AND CRISIS MANAGEMENT FOR BEHAVIORAL MENTAL HEALTH AND SUBSTRANCE RELATED ISSUES4) EXPLORE CREATION OF LOCAL LIMITED STAY DETOXIFICATION SERVICES IN ORDER TO REMOVE HURDLES TO LONG TERM PLACEMENT FOR REHABILITATION AND RECOVERY FOR ADDICTION5) CONTINUE TO SUPPORT THE COMMUNITY SUBSTANCE ABUSE PREVENTION EFFORTS OF THE CHRISTIAN COUNTY HEALTH DEPARTMENT AND THE CHRISTIAN COUNTY PREVENTION COALITION THROUGH INFORMATION EXCHANGE AND REMAINING OPEN TO PARTNERING ON SPECIFIC PROGRMAS AND/OR PROJECTS UNDER SPECIFIC CIRCUMSTANCES. 6) EXPLORE PROVIDING A LOCAL HEALTHCARE SCHOLARSHIP FOR USE FOR EDUCATION TOWARD BECOMING A MEDICAL OR SOCIAL WORK PROFESSIONAL FOR MENTAL HEALTH.WELLNESS:1) BETTER ACCESS TO VACCINATIONS FOR EVERYONE2) IMPROVED ACCESS TO EDUCATION AND CARE FOR THE PREVENTION OF DIABETES, CANCER AND HEART DISEASEACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE WELLNESS NEED:1) COLLABORATE WITH CHRISTIAN COUNTY HEALTH DEPARTMENT TO OFFER DRIVE-THROUGH VACCINATION SERVICES2) EXPLORE EXPANDING ROUTINE VACCINATION OFFERINGS TO INCLUDE PNEUMONIA AND OTHER RECOMMENDED VACCINES3) EXPLORE EXPANDING THE STATE YOUTH VACCINE PROGRAMS TO THE NEWLY ACQUIRED CLINIC4) IMPLEMENT A CHRONIC CARE MANAGEMENT PROGRAM5) IMPLEMENT CHRONIC CARE AND CHRONIC DISEASE EDUCATION THROUGH COMMUNITY "LUNCH AND LEARN" PROGRAMS6) IMPLEMENT WELLNESS EDUCATION IN COMMUNITY "LUNCH AND LEARN" PROGRAMS7) INCLUDED CHRONIC ILLNESS EDUCATION IN THE "LIVE WELL" PROGRAMS BY PANA COMMUNITY HOSPITAL8) EXPAND NUTRITION COUNSELING AND EDUCATION IMPROVE THE LOCAL ECONOMY:IN ORDER TO ADDRESS CIRCUMSTANCES OF COMMUNITY MEMBERS THAT IMPACT THEIR HEALTH AND HEALTHCAREACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS IMPROVING THE LOCAL ECONOMY:1) HELP EDUCATE LOCAL AND STATE GOVERNMENT REPRESENTATIVES ABOUT THE INITATIVES NEEDED TO IMPROVE THE LOCAL ECONOMY2) CONTINUE FINANCIAL SUPPORT FOR THE CREATING ENTREPRENEURIAL OPPORTUNITIES (CEO) PROGRAM3) KEEP PANA COMMUNITY HOSPITAL STRONG IN ORDER TO IMPACT THE QUALITY OF LIFE OF THE COMMUNITY4) CARRY OUT CAPITAL IMPROVEMENTS THAT WILL CREATE CONSTRUCTION JOBS IN THE NEAR TERM5) CONINTUE TO IMPROVE THE MARKETABILITY OF THE COMMUNITY THROUGH ADDRESSING MENTAL HEALTH, SUBSTANCE ABUSE, WELLNESS AND CHRONIC ILLNESS, THEREBY IMPROVING THE QUALITY OF LIFE AND REDUCING CRIME IN THE COMMUNITY. PLANNING FOR PHYSICIAN SUPPLY:THE FINAL SIGNIFICANT NEED IDENTIFIED AND PRIORITZIED WAS CREATION OF A SINGLE LIST OF AVAILABLE HEALTH-RELATED SERVICES AND PROVIDERS (INCLUDING HEALTHCARE, SOCIAL AND RELATED SERVICES, AND WELLNESS RELATED OPPORTUNITIES) THAT COULD BE UTILIZED BY ALL HEALTHCARE PROVIDERS AND OTHER COMMUNITY GROUPS AND ORGANIZATIONS TO REFER PERSONS TO LOCAL HEALTH-RELATED SERVICES.ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS PLANNING FOR PHYSICIAN SUPPLY:1) CONTINUE AN AGGRESSIVE SCHOLARSHIP PROGRAM TO ENCOURAGE LOCAL YOUNG PEOPLE TO FURTHER THEIR EDUCATION IN HEALTHCARE PROFESSIONS AND THEN TO RETURN TO PANA TO PRACTICE2) MONITOR PRIMARY CARE PROVIDERS3) KEEP PANA COMMUNITY HOSPITAL STRONG IN ORDER TO IMPACT THE QUALITY OF LIFE OF THE COMMUNITY4) EXPLORE COLLABORATION OPPORTUNITIES TO CREATE LOCAL ACCESS TO SPECIALISTS |
| PANA COMMUNITY HOSPITAL | PART V, SECTION B, LINE 13B: THE COST OF THE SERVICE MAY IMPACT AN INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE. PRESUMPTIVE ELIGIBILITY FOR FREE CARE IS AVAILABLE FOR INDIVIDUALS WHO ARE HOMELESS, MENTALLY INCAPACITATED WITH NOBODY TO ACT ON THEIR BEHALF, MEDICAID ELIGIBLE (BUT NOT ON THE DATE OF SERVICE), FILING PERSONAL BANKRUPCTY, DECEASED WITH NO ESTATE, INCARCERATED IN A PENAL INSTITUTION, OR AFFILIATED WITH A RELIGIOUS ORDER AND TAKING A VOW OF POVERTY.BASED ON THE GUIDANCE FROM THE ILLINOIS ATTORNEY GENERAL'S OFFICE, PANA DETERMINES THE DISCOUNT PERCENT REQUIRED TO GIVE UNINSURED PATIENTS AT 300% OF FPG. THE SAME DISCOUNT IS GIVEN TO UNDERINSURED. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 7 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - COMMUNITY MEDICAL CLINIC OF PANA | ||||
| 101 EAST 9TH STREET | PANA | IL | 62557 | PHYSICIAN SATELLITE OFFICE |
| 2 - QUAD COUNTY HOME HEALTH & HOSPICE | ||||
| 1 HUBER STREET | PANA | IL | 62557 | HOME HEALTH & HOSPICE AGENCY |
| 3 - COMMUNITY MEDICAL CLINIC OF ASSUMPTION | ||||
| 118 N WALNUT STREET | ASSUMPTION | IL | 62510 | PHYSICIAN SATELLITE OFFICE |
| 4 - COMMUNITY MEDICAL CLINIC OF RAMSEY | ||||
| 715 S SUPERIOR | RAMSEY | IL | 62080 | PHYSICIAN SATELLITE OFFICE |
| 5 - COMMUNITY MEDICAL CLINIC OF NOKOMIS | ||||
| 120 CEDAR STREET | NOKOMIS | IL | 62075 | PHYSICIAN SATELLITE OFFICE |
| 6 - PANA MEDICAL GROUP | ||||
| 217 SOUTH LOCUST STREET | PANA | IL | 62557 | PHYSICIAN SATELLITE OFFICE |
| 7 - NOKOMIS MEDICAL GROUP | ||||
| 107 WEST STATE STREET | NOKOMIS | IL | 62075 | PHYSICIAN SATELLITE OFFICE |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | ELGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON FAMILY INCOME COMPARED TO FEDERAL POVERTY GUIDELINES AS WELL AS SUBMISSION OF A COMPLETE FINANCIAL ASSISTANCE APPLICATION. HOWEVER, IN THE FOLLOWING INSTANCES, AN INDIVIDUAL MAY PRESUMPTIVELY QUALIFY FOR 100% FINANCIAL ASSISTANCE WITHOUT SUBMITTING A FINANCIAL ASSISTANCE APPLICATION AND REGARDLESS OF THEIR INCOME: ENROLLMENT IN CERTAIN FEDERAL OR STATE PROGRAMS (E.G. WIC, SUPPLEMENTAL NUTRITION AND ASSISTANCE PROGRAM, ILLINOIS FREE BREAKFAST/LUNCH PROGRAM, TEMPORARY ASSISTANCE FOR NEEDY FAMILIES, ETC.), HOMELESSNESS, MENTAL INCAPACITATION WITH NO ONE TO ACT ON THE PATIENT'S BEHALF, MEDICAID ELIGIBILITY, RECENT PERSONAL BANKRUPTCY, DECEASED WITH NO ESTATE, INCARCERATION IN A PENAL INSTITUTION, AND AFFILIATION WITH A RELIGIOUS ORDER AND A VOW OF POVERTY. |
| PART I, LINE 7: | FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. THE COSTS REPORTED IN THE TABLE IN PART I, LINE 7 USED A RATIO OF PATIENT CARE COSTS TO CHARGES AS COMPUTED IN WORKSHEET 2 OF THE FORM INSTRUCTIONS. THIS METHODOLOGY WAS USED FOR ALL PATIENT SEGMENTS. |
| PART I, LN 7 COL(F): | FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $1,656,158 REPORTED ON PART IX, LINE 25. HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSED OF CALCULATING THE PERCENTAGE IN THIS COLUMN. |
| PART III, LINE 2: | ACCOUNTS RECEIVABLE ARE REDUCTED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND BAD DEBT EXPENSE. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| PART III, LINE 3: | THE BAD DEBT EXPENSE REPORTED ON LINE 2 REPRESENTS THE EXPENSE REPORTED ON THE ATTACHED FINANCIAL STATEMENTS BASED ON NET REALIZABLE AMOUNTS FROM THIRD PARTY PAYERS, PATIENTS AND OTHERS. BAD DEBT EXPENSE IS DETERMINED BASED ON THE CRITERIA DESCRIBED ABOVE. IT IS ESTIMATED THAT APPROXIMATELY 60% OF OUR BAD DEBT EXPENSE QUALIFIES UNDER THE ORGANIZATION'S CHARITY CARE POLICY. THIS PERCENTAGE WAS DETERMINED BASED UPON ANALYSIS OF DEMOGRAPHICS AND RECORD REVIEWS. |
| PART III, LINE 4: | SEE NOTE 2: NET PATIENT SERVICE REVENUE ON PAGES 12, 13 AND 14 OF THE AUDITED FINANCIAL STATEMENTS. ALSO, SEE NOTE 1: PATIENT ACCOUNTS RECEIVABLE ON PAGES 7 AND 8 OF THE AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | MEDICARE. LINE 6 COSTS WERE TAKEN DIRECTLY FROM THE ORGANIZATION'S 12/31/16 MEDICARE COST REPORT.THE SHORTFALL REPORTED IN PART III, LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT. BY PARTICIPATING IN MEDICARE AND ABSORBING RELATED SHORTFALLS, WE ARE PROVIDING HEALTHCARE SERVICES TO MEDICARE BENEFICIARIES WHO ARE A SIGNIFICANT PORTION OF OUR COMMUNITY. |
| PART III, LINE 9B: | COLLECTION PRACTICES. THE COLLECTION PRACTICES FOLLOWED BY THE ORGANIZATION FOR PATIENTS WHO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE ADDRESSED IN ITS HEALTHCARE ASSISTANCE POLICY. |
| PART VI, LINE 2: | NEEDS ASSESSMENT. THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES THROUGH STRATEGIC PLANNING ACTIVITIES THAT INCORPORATE ANALYSIS OF SERVICE AREA DEMOGRAPHICS AND STRUCTURED AND CONSISTENT PATIENT SURVEY PROCESSES. THE ORGANIZATION ALSO ASSESSES COMMUNITY HEALTH NEEDS THROUGH INPUT FROM ITS ACTIVE AND CONSULTING MEDICAL STAFF, COMMUNITY LEADERS, ORGANIZATION BOARD MEMBERS AND COUNTY HEALTH DEPARTMENTS. |
| PART VI, LINE 3: | PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE. THE ORGANIZATION INFORMS AND EDUCATES ITS PATIENTS REGARDING ASSISTANCE FROM FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS THROUGH ITS SOCIAL SERVICES DIRECTOR. THE ORGANIZATION INFORMS AND EDUCATES PATIENTS REGARDING ASSISTANCE FROM ITS CHARITY CARE POLICY THROUGH DISCUSSION AT REGISTRATION OR DISCHARGE, AN INFORMATIONAL DOCUMENT SENT WITH BILLING STATEMENTS AND A DESCRIPTION OF THE PROGRAM PLUS AN APPLICATION POSTED ON ITS WEBSITE. |
| PART VI, LINE 4: | COMMUNITY INFORMATION. THE ORGANIZATION SERVES A RURAL AREA THAT INCLUDES 13 SMALL COMMUNITIES. THE POPULATION OF THE SERVICE AREA TOTALS APPROXIMATELY 21,000 RESIDENTS. THE SIZE OF THE COMMUNITIES WE SERVE IN OUR SERVICE AREA RANGE FROM LESS THAN 150 TO APPROXIMATELY 5,800 RESIDENTS. OF THE 21,000 RESIDENTS, APPROXIMATELY 17% ARE BELOW THE FEDERAL POVERTY LEVEL AND THE PER CAPITA INCOME IS APPROXIMATELY $20,100. OUR SERVICE AREA POPULATION CONSISTS OF 27.69% MEDICAID AND APPROXIMATELY 8% UNINSURED. OUR ORGANIZATION PROVIDES SERVICES TO FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS. |
| PART VI, LINE 5: | PROMOTION OF COMMUNITY HEALTH. ONE OF THE VERY IMPORTANT ASSETS OF A COMMUNITY IS IT'S HOSPITAL. THE HOSPITAL, AS AN ORGANIZATION, FILLS THE ROLE AS THE FOCAL POINT OF THE COMMUNITY'S HEALTHCARE ACTIVITIES AND THE CATALYST WHICH BRINGS TOGETHER THE PRACTICING PHYICIANS, OTHER HEALTHCARE PROVIDERS, COMMUNITY HEALTHCARE AGENCIES, AND OTHER HEALTHCARE FOCUSED RESOURCES TO MAINTAIN AND PRESERVE THE COMMUNITY'S HEALTH STATUS. THE ORGANIZATION IS GOVERNED BY A VOLUNTEER BOARD OF DIRECTORS THAT CONSIST OF INDIVIDUALS WHO RESIDE IN THE HOSPITAL'S SERVICE AREA. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL PHYSICIANS IN OUR SERVICE AREA. SURPLUS FUNDS GENERATED THROUGH THE PROVISION OF SERVICES ARE INVESTED IN IMPROVED PATIENT CARE TECHNOLOGIES AND ENHANCED TREATMENT AREA SO THAT THE ORGANIZATIONS CAN CONTINUE TO PROVIDE QUALITY PATIENT CARE. |
| PART VI, LINE 6: | NOT APPLICABLE |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| 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 (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR TERRY CUNNINGTON | ||||||||||||||
| DIRECTOR | $176,645 | $0 | $195,943 | $0 | $312 | $0 | $5,569 | $0 | $5,700 | $0 | $384,169 | $0 | $0 | $0 |
| KATRINA CASNER | ||||||||||||||
| PRESIDENT & CEO | $171,874 | $0 | $12,533 | $0 | $690 | $0 | $7,007 | $0 | $6,298 | $0 | $198,402 | $0 | $0 | $0 |
| DR MARLON MUNESES | ||||||||||||||
| PHYSICIAN | $162,255 | $0 | $202,099 | $0 | $1,340 | $0 | $6,564 | $0 | $5,700 | $0 | $377,958 | $0 | $0 | $0 |
| DR CATHERINE TEODORO | ||||||||||||||
| PHYSICIAN | $156,792 | $0 | $42,626 | $0 | $273 | $0 | $6,490 | $0 | $1,860 | $0 | $208,041 | $0 | $0 | $0 |
| DR DEMOSTHENES ASUNCION | ||||||||||||||
| PHYSICIAN | $160,330 | $0 | $0 | $0 | $190 | $0 | $0 | $0 | $10,036 | $0 | $170,556 | $0 | $0 | $0 |
| DR STEVEN WEBER | ||||||||||||||
| PT SURGEON | $98,000 | $0 | $127,445 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $225,445 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 7 | FormAndLineReferenceDesc |
| Explanation | MARLON MUNESES, TERRY CUNNINGTON AND CATHERINE TEODORO ARE COMPENSATED USING A BASE SALARY PLUS PRODUCTIVITY COMPENSATION. THE PRODUCTIVITY COMPENSATION IS CALCULATED BASED UPON MINIMUM LEVELS OF RECEIPTS GENERATED BY EACH PHYSICIAN. BONUSES ARE BASED ON COLLECTIONS. A CERTAIN PORTION OF COLLECTIONS ARE SHARED WITH THE PHYSICIANS AFTER REACHING A MINIMUM THRESHOLD. AFTER REACHING THE THRESHOLD, AN INCREASING % IS SHARED AS COLLECTIONS INCREASE. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| DR LAURIE CUNNINGTON | |||
| WIFE OF DR. TERRY CUNNINGTON, A BOARD MEMBER | $20,000 | EMPLOYED BY HOSPITAL | 0 |
| ANDREW CASNER | |||
| SON OF KATRINA CASNER, PRESIDENT & CEO | $34,438 | EMPLOYED BY HOSPITAL | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS AND ONE OTHER MEMBER OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE INTERIM BETWEEN THE REGULAR MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED ANY ACTION TAKEN SHALL NOT CONFLICT WITH THE POLICIES AND EXPRESS WISHES OF THE BOARD OF DIRECTORS AND THAT IT SHALL REFER ALL MATTERS OF MAJOR IMPORTANCE TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 2 | JOHN GARDNER, MATT BEAVERS, JOYCE THRONEBURG, DR. DAVID LETT AND CAROL SCHRAMM HAVE A BUSINESS RELATIONSHIP DUE TO THE FACT THAT THEY ARE ALL BOARD MEMBERS OF QUAD COUNTY HOME MEDICAL SUPPLIES & EQUIPMENT, A TAXABLE SUBSIDIARY OF PANA COMMUNITY HOSPITAL ASSOCIATION. |
| FORM 990, PART VI, SECTION A, LINE 6 | PANA COMMUNITY HOSPITAL HAS TWO CLASSES OF MEMBERS, KNOWN AS REGULAR MEMBERS AND LIFE MEMBERS. REGULAR MEMBERS CONSIST OF INDIVIDUALS WHO PAY THE APPROPRIATE MEMBERSHIP DUES TO PANA COMMUNITY HOSPITAL. LIFE MEMBERS CONSIST OF INDIVIDUALS WHO CONTRIBUTE $100.00 OR MORE TO PANA COMMUNITY HOSPITAL OR PANA COMMUNITY HOSPITAL FOUNDATION. FOR THE PURPOSE OF SUPPORTING THE FINANCING OF BUILDING, EQUIPMENT, LIFE MEMBERSHIP, ENDOWMENT, OR ANY OTHER LAWFUL PURPOSE. |
| FORM 990, PART VI, SECTION A, LINE 7A | MEMBERS OF THE HOSPITAL VOTE FOR THE MEMBERS OF THE GOVERNING BODY DURING THE HOSPITAL'S ANNUAL MEETING. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED BY THE CFO PRIOR TO THE FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL BOARD MEMBERS, MEMBERS OF THE MEDICAL STAFF, ADMINISTRATION AND DEPARTMENT MANAGERS ARE ASKED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNIARE ANNUALLY. THE HUMAN RESOURCES MANAGER REVIEWS QUESTIONNAIRES AND PRESENTS ANY CONFLICTS NOTED TO THE PRESIDENT & CEO TO REVIEW AND RESOLVE. IF ANY CONFLICTS ARE NOTED, THE PRESIDENT & CEO, WITH BOARD APPROVAL, IMPOSES APPROPRIATE RESTRICTIONS ON THE INDIVIDUAL(S) WITH A CONFLICT OF INTEREST. |
| FORM 990, PART VI, SECTION B, LINE 15 | EACH YEAR THE BOARD OF DIRECTORS DETERMINES COMPENSATION FOR THE CEO, CCO/CNE AND THE CFO. THE BOARD USES COMPARATIVE COMPENSATION INFORMATION FROM THE ILLINOIS HOSPITAL ASSOCIATION TO DETERMINE THE ABOVE INDIVIDUALS' COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | REQUESTS FOR THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY WILL BE EVALUATED ON A CASE-BY-CASE BASIS. IF DEEMED APPROPRIATE, THE DOCUMENT(S) WILL BE PROVIDED TO THE PUBLIC. THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS ARE AVAILABLE FOR THE PUBLIC TO REVIEW DURING THE ORGANIZATION'S ANNUAL MEETING. |
| FORM 990, PART IX, LINE 11G | IMAGING: PROGRAM SERVICE EXPENSES 452,148. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 452,148. EMERGENCY DEPARTMENT: PROGRAM SERVICE EXPENSES 1,593,187. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,593,187. LAB: PROGRAM SERVICE EXPENSES 98,460. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 98,460. OTHER: PROGRAM SERVICE EXPENSES 278,415. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 278,415. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 371,435. MANAGEMENT AND GENERAL EXPENSES 250,438. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 621,873. |
| FORM 990, PART XI, LINE 9: | INVESTMENT INCOME FROM SUBSIDIARY -44,180. |
| FORM 990, PART XII, LINE 2C: | NO CHANGE IN PROCESS FROM PRIOR YEARS |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PANA COMMUNITY HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 EAST 9TH STREET | AddressLine1Txt |
| City | PANA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62557 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 371293506 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12A, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PANA COMMUNITY HOSPITAL ASSOCIATION | 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 | QUAD COUNTY HOME MEDICAL SUPPLIES & EQUIPMENT | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 HUBER STREET | AddressLine1Txt |
| City | PANA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62557 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 371198049 | EIN |
| Primary Activities | EQUIPMENT RETAILER | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PANA COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | $36,934 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $280,413 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 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 | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PANA COMMUNITY HOSPITAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $208,034 | InvolvedAmt |
| Method Of Amount Determination | CASH TRANSFER | MethodOfAmountDeterminationTxt |