KATHERINE SHAW BETHEA HOSPITAL: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- KATHERINE SHAW BETHEA HOSPITAL (EIN 36-1000540)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-04
- IRS object ID
- 201523089349301397
- Schema version
- 2014v5.0
- 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 I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-04T15:25:08-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | 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 | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 361000540 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KATHERINE SHAW BETHEA HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | KATH | BusinessNameControlTxt |
| Phone | 8152885531 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 403 EAST FIRST STREET | AddressLine1Txt |
| City | DIXON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61021 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID SCHREINER | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 8152855521 | PhoneNum |
| Signature | 2015-11-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TODD M ETHERIDGE | PreparerPersonNm |
| PTIN | P00233050 | PTIN |
| Phone | 8152859300 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-03-07 17:11:31Z | 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 | $137,267,106 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.KSBHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1893 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | RESTORE, MAINTAIN & ENHANCE HEALTH BY PROVIDING SUPERIOR CARE REGARDLESS OF ABILITY TO PAY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 1156 | TotalEmployeeCnt |
| Total Volunteers | 161 | TotalVolunteersCnt |
| Total Gross UBI | $10,525 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$5,971 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $595,382 | PYContributionsGrantsAmt |
| CY Contributions Grants | $735,319 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $125,114,193 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $132,456,104 | CYProgramServiceRevenueAmt |
| PY Investment Income | $600,946 | PYInvestmentIncomeAmt |
| CY Investment Income | $575,348 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,368,116 | PYOtherRevenueAmt |
| CY Other Revenue | $1,622,744 | CYOtherRevenueAmt |
| PY Total Revenue | $129,678,637 | PYTotalRevenueAmt |
| CY Total Revenue | $135,389,515 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $8,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $159,146 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $83,737,526 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $82,883,308 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $85,844 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $43,732,854 | PYOtherExpensesAmt |
| CY Other Expenses | $51,060,289 | CYOtherExpensesAmt |
| PY Total Expenses | $127,478,380 | PYTotalExpensesAmt |
| CY Total Expenses | $134,102,743 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,200,257 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,286,772 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $147,008,398 | TotalAssetsBOYAmt |
| Total Assets EOY | $140,486,791 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $67,404,785 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $59,532,126 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $79,603,613 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $80,954,665 | 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, REGARDLESS OF THE PATIENT'S ABILITY TO PAY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $110,041,941 | ExpenseAmt |
| Grant | $159,146 | GrantAmt |
| Revenue | $132,456,104 | RevenueAmt |
| Desc | IN 2014 KATHERINE SHAW BETHEA HOSPITAL (KSB) HAD 14,581 INPATIENT VISITS AND 186,604 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 $3,156,110 IN 2014.KSB PROVIDES 24-HOUR EMERGENCY MEDICAL SERVICES STAFFED BY FULL-TIME PHYSICIANS. PATIENTS ARE TREATED REGARDLESS OF INSURANCE OR ABILITY PAY. ER VISITS IN 2014 WERE 18,963. | Desc |
| Total Program Service Expenses | $110,041,941 | 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 | 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 | Yes (1) | 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 | 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 | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 67 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 1156 | 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 |
| Form1098 C Filed | Yes (1) | Form1098CFiledInd |
| 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 | 0 | 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 | TONY EVERS | PersonNm |
| Phone | 8152855521 | 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 | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| WILLIAM LEFEVRE | ||||||||
| CHAIRPERSON | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| COLLEEN HENKEL | ||||||||
| VICE CHARIPERSON | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CRAIG CARPENTER | ||||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DOUG LEE | ||||||||
| TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RICK CURIA | ||||||||
| PAST CHAIRPERSON | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JOAN MELZER | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| RAY NEISEWANDER III | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| KATIE PRATT | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| THOMAS SUITS | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JOSEPH WELTY MD | ||||||||
| BOARD MEMBER | 40.00 | 0.00 | Yes (X) | $248,167 | $0 | $36,886 | ||
| DAVID SCHREINER | ||||||||
| CEO | 40.00 | 1.00 | Yes (X) | Yes (X) | $434,892 | $0 | $61,714 | |
| ALPHEUS APPENHEIMER MD | ||||||||
| CMO | 40.00 | 0.00 | Yes (X) | $301,883 | $0 | $36,089 | ||
| LINDA CLEMEN | ||||||||
| CNO | 40.00 | 0.00 | Yes (X) | $213,514 | $0 | $41,259 | ||
| DEBRA DIDIER | ||||||||
| CFO | 40.00 | 0.00 | Yes (X) | $218,648 | $0 | $38,551 | ||
| JULIE MANN | ||||||||
| CAO | 40.00 | 0.00 | Yes (X) | $215,361 | $0 | $40,798 | ||
| KEVIN MARX | ||||||||
| CHIEF BUSINESS DEVELOPMENT OFFICER | 40.00 | 0.00 | Yes (X) | $219,197 | $0 | $26,888 | ||
| DARRYL VANDERVORT | ||||||||
| VP - MD RECRUITING & FUND DVLPMT | 40.00 | 0.00 | Yes (X) | $53,853 | $0 | $3,230 | ||
| SULAIMAN MOHAMMAD MD | ||||||||
| NEUROLOGIST | 40.00 | 0.00 | $934,428 | $0 | $43,856 | Yes (X) | ||
| MONTHER ELBZOUR MD | ||||||||
| CARDIOLOGIST | 40.00 | 0.00 | $874,504 | $0 | $43,856 | Yes (X) | ||
| SOHAIL HANIF MD | ||||||||
| CARDIOLOGIST | 40.00 | 0.00 | $794,925 | $0 | $41,356 | Yes (X) | ||
| TYLER GUNDERSON MD | ||||||||
| SURGEON | 40.00 | 0.00 | $698,938 | $0 | $41,356 | Yes (X) | ||
| IMRE ALMASSY MD | ||||||||
| RADIOLOGIST | 40.00 | 0.00 | $664,114 | $0 | $37,287 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $5,872,424 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $493,126 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 94 | 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 |
|---|---|---|---|---|---|
| QUAMMEN HEALTHCARE CONSULTANTS | |||||
| 522B BRANDIES CIRCLE | MURFREESBORO | TN | 37128 | SOFTWARE CONSULTANTS | $1,099,643 |
| WESTERN LITIGATION SPECIALISTS | |||||
| 9821 KATY FREEWAY SUITE 700 | HOUSTON | TX | 77024 | LEGAL CONSULTANTS | $668,986 |
| COMPHEALTH | |||||
| PO BOX 972651 | DALLAS | TX | 75397 | STAFFING | $601,264 |
| MAGNET SOLUTIONS | |||||
| 2223 BROADWAY | SCOTTSBLUFF | NE | 69361 | BILLING SERVICES | $593,696 |
| MECHANICAL INC | |||||
| PO BOX 690 | FREEPORT | IL | 61032 | MECHANICAL ENGINEERS | $496,487 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 22 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $193,221 | GovernmentGrantsAmt |
| All Other Contributions | $542,098 | AllOtherContributionsAmt |
| Noncash Contributions | $10,500 | NoncashContributionsAmt |
| Total Contributions | $735,319 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621110 | $132,134,394 | $132,134,394 |
| SUBSIDIARY EARNINGS | 621110 | $321,710 | $321,710 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $132,456,104 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $604,449 | TotalRevenueColumnAmt |
| Exclusion | $604,449 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $305,868 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $342,497 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$36,629 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$36,629 | TotalRevenueColumnAmt |
| Exclusion | -$36,629 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,505,793 | SecuritiesAmt |
| Other | $200 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,524,042 | SecuritiesAmt |
| Other | $11,052 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$18,249 | SecuritiesAmt |
| Other | -$10,852 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$29,101 | TotalRevenueColumnAmt |
| Exclusion | -$29,101 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| MEANINGFUL USE PAYMENTS | 621110 | $2,093,835 | $2,093,835 | |
| CAFETERIA SALES | 900099 | $403,904 | $393,379 | $10,525 |
| ALL OTHER REVENUE | 900099 | -$190,877 | -$190,877 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$647,489 | TotalRevenueColumnAmt |
| Exclusion | -$647,489 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,659,373 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $135,389,515 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $132,456,104 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $10,525 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,187,567 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $150,146 | TotalAmt |
| Program Services | $150,146 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,000 | TotalAmt |
| Program Services | $9,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,905,877 | TotalAmt |
| Program Services | $843,973 | ProgramServicesAmt |
| Management And General | $1,004,821 | ManagementAndGeneralAmt |
| Fundraising | $57,083 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,511,518 | TotalAmt |
| Program Services | $52,854,146 | ProgramServicesAmt |
| Management And General | $7,651,645 | ManagementAndGeneralAmt |
| Fundraising | $5,727 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,842,036 | TotalAmt |
| Program Services | $2,444,151 | ProgramServicesAmt |
| Management And General | $395,043 | ManagementAndGeneralAmt |
| Fundraising | $2,842 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,135,300 | TotalAmt |
| Program Services | $12,156,358 | ProgramServicesAmt |
| Management And General | $1,964,807 | ManagementAndGeneralAmt |
| Fundraising | $14,135 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,488,577 | TotalAmt |
| Program Services | $2,896,777 | ProgramServicesAmt |
| Management And General | $588,039 | ManagementAndGeneralAmt |
| Fundraising | $3,761 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $464,099 | TotalAmt |
| Program Services | $324,869 | ProgramServicesAmt |
| Management And General | $139,230 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $183,888 | TotalAmt |
| Management And General | $183,888 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,000 | TotalAmt |
| Management And General | $45,000 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,742 | TotalAmt |
| Management And General | $33,742 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,701,656 | TotalAmt |
| Program Services | $5,125,924 | ProgramServicesAmt |
| Management And General | $6,573,436 | ManagementAndGeneralAmt |
| Fundraising | $2,296 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $646,911 | TotalAmt |
| Program Services | $497,996 | ProgramServicesAmt |
| Management And General | $148,915 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $197,379 | TotalAmt |
| Program Services | $133,874 | ProgramServicesAmt |
| Management And General | $63,505 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,569,340 | TotalAmt |
| Program Services | $2,335,533 | ProgramServicesAmt |
| Management And General | $1,233,807 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,854 | TotalAmt |
| Program Services | $56,854 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,885 | TotalAmt |
| Program Services | $49,445 | ProgramServicesAmt |
| Management And General | $6,440 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $305,997 | TotalAmt |
| Program Services | $214,578 | ProgramServicesAmt |
| Management And General | $91,419 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $844,155 | TotalAmt |
| Program Services | $764,382 | ProgramServicesAmt |
| Management And General | $79,773 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,276,291 | TotalAmt |
| Program Services | $3,672,242 | ProgramServicesAmt |
| Management And General | $2,604,049 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,613,945 | TotalAmt |
| Program Services | $973,880 | ProgramServicesAmt |
| Management And General | $640,065 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PATIENT SUPPLIES | $13,059,277 | $13,057,747 | $1,530 |
| BAD DEBT EXPENSE | $6,978,279 | $6,978,279 | |
| IPA TAX | $2,586,640 | $2,586,640 | |
| NON PATIENT SUPPLIES | $1,670,729 | $1,459,454 | $211,275 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $770,222 | TotalAmt |
| Program Services | $455,693 | ProgramServicesAmt |
| Management And General | $314,529 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $134,102,743 | TotalAmt |
| Program Services | $110,041,941 | ProgramServicesAmt |
| Management And General | $23,974,958 | ManagementAndGeneralAmt |
| Fundraising | $85,844 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,195 | BOYAmt |
| EOY | $4,204 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,869,984 | BOYAmt |
| EOY | $9,974,931 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $148,126 | BOYAmt |
| EOY | $122,266 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,538,358 | BOYAmt |
| EOY | $55,946,385 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,483,858 | BOYAmt |
| EOY | $1,369,336 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,197,204 | BOYAmt |
| EOY | $5,214,022 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $123,124,371 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $74,789,955 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,510,738 | BOYAmt |
| EOY | $48,334,416 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,891,146 | BOYAmt |
| EOY | $4,616,563 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,129,937 | BOYAmt |
| EOY | $6,546,501 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $192,076 | BOYAmt |
| EOY | $91,755 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,042,776 | BOYAmt |
| EOY | $8,266,412 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $147,008,398 | BOYAmt |
| EOY | $140,486,791 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,955,325 | BOYAmt |
| EOY | $27,448,316 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,406,684 | BOYAmt |
| EOY | $23,817,398 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,042,776 | BOYAmt |
| EOY | $8,266,412 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,404,785 | BOYAmt |
| EOY | $59,532,126 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $79,050,142 | BOYAmt |
| EOY | $80,085,070 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $137,554 | BOYAmt |
| EOY | $157,119 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $415,917 | BOYAmt |
| EOY | $712,476 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $79,603,613 | BOYAmt |
| EOY | $80,954,665 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $147,008,398 | BOYAmt |
| EOY | $140,486,791 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,286,772 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $64,280 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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 | $33,742 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $33,742 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | A PORTION OF THE HOSPITAL'S MEMBERSHIP DUES WITH THE ILLINOIS HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION ARE USED BY THOSE ASSOCIATIONS TO CONDUCT LOBBYING ACTIVITIES ON BEHALF OF ALL MEMBER HOSPITALS. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,266,546 | BeginningYearBalanceAmt |
| Contributions | $306,847 | ContributionsAmt |
| End Year Balance | $1,573,393 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,073,194 | BeginningYearBalanceAmt |
| Contributions | $193,352 | ContributionsAmt |
| End Year Balance | $1,266,546 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $25,000 | BeginningYearBalanceAmt |
| Contributions | $1,048,194 | ContributionsAmt |
| End Year Balance | $1,073,194 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $25,000 | BeginningYearBalanceAmt |
| End Year Balance | $25,000 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $25,000 | BeginningYearBalanceAmt |
| End Year Balance | $25,000 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.98000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.02000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,129,972 | OtherCostOrOtherBasisAmt |
| Book Value | $2,129,972 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $47,494,934 | OtherCostOrOtherBasisAmt |
| Depreciation | $25,231,480 | DepreciationAmt |
| Book Value | $22,263,454 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,800,500 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,383,176 | DepreciationAmt |
| Book Value | $2,417,324 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $67,250,912 | OtherCostOrOtherBasisAmt |
| Depreciation | $47,175,299 | DepreciationAmt |
| Book Value | $20,075,613 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,448,053 | OtherCostOrOtherBasisAmt |
| Book Value | $1,448,053 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $48,334,416 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DEFERRED COMPENSATION | Desc |
| Book Value | $8,266,412 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $8,266,412 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DEFERRED COMPENSATION PAYABLE | Desc |
| Amt | $8,266,412 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $8,266,412 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $127,996,508 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $1,036,483 | OtherRevenueAmt |
| Revenue Not Reported | $1,036,483 | RevenueNotReportedAmt |
| Revenue Subtotal | $126,960,025 | RevenueSubtotalAmt |
| Other Revenues Not Included | $8,429,490 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $8,429,490 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $135,389,515 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $127,457,961 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $342,497 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $342,497 | ExpensesNotReportedAmt |
| Expenses Subtotal | $127,115,464 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $6,987,279 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $6,987,279 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $134,102,743 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE PURPOSE OF THE BULK OF THE ENDOWMENT FUND IS TO FUND COMMUNITY WELLNESS PROJECTS FOR THE KSB SERVICE AREA. THE REST OF THE ENDOWMENT, $25,000, WAS ESTABLISHED MANY YEARS AGO AND IS IN AN ACCOUNT WITH OTHER RESTRICTED FUNDS WHICH ALL EARN INTEREST. THE INTEREST ON THIS ENDOWMENT IS INTENDED TO BE USED TO PROVIDE FREE SERVICES TO THE NEEDY. AT THIS TIME, THE BANK GROUPS ALL INTEREST BEARING ACCOUNTS TOGETHER TO DETERMINE INTEREST EARNED AGAINST FEES INCURRED. ANY INTEREST EARNED IS THEN REPORTED IN TOTAL FOR ALL ACCOUNTS ON THE STATEMENT OF REVENUE. THOUGH KSB IS NOT ABLE TO SEPARATELY REPORT THE INTEREST EARNED ON THE ENDOWMENT, THE HOSPITAL HAS SHOWN ON SCHEDULE H THAT THEY PROVIDE MANY FREE SERVICES TO THOSE IN NEED WITH THE FUNDS THEY RECEIVE. |
| PART X, LINE 2: | THE HOSPITAL FILES A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THIS RETURN IS FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF THE ENTITY AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). UBIT IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50 PERCENT LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING STATEMENTS OF FINANCIAL POSITION ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. PRESENTLY, THERE ARE NO ONGOING INCOME TAX AUDITS OR UNRESOLVED DISPUTES WITH TAX AUTHORITIES THAT THE HOSPITAL CURRENTLY FILES OR HAS FILED WITH. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | LOSS ON DISPOSAL OF EQUIPMENT 10,852. LOSS ON DEFINED BENEFIT PLAN TERMINATION 647,489. NET ASSETS RELEASED FROM RESTRICTIONS 35,645. RENTAL EXPENSES 342,497. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR UNCOLLECTIBLE ACCOUNTS 6,978,279. OTHER INTEREST AND INVESTMENT INCOME 475,694. INCOME ON INVESTMENTS WHOSE USE IS LIMITED 110,506. EQUITY IN EARNINGS OF INVESTEES 321,710. UNRESTRICTED CONTRIBUTION INCOME 10,500. OTHER INCOME 172,707. TEMPORARILY RESTRICTED CONTRIBUTIONS 55,210. PERMANENTLY RESTRICTED CONTRIBUTIONS 295,884. SCHOLARSHIP EXPENSE 9,000. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 342,497. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR UNCOLLECTIBLE ACCOUNTS 6,978,279. SCHOLARSHIP EXPENSE 9,000. |
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 | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,156,110 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,156,110 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02390 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,573,712 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,449,861 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,123,851 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09180 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $21,729,822 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,449,861 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $15,279,961 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11570 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $539,163 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,699 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $535,464 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00410 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,764,422 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,447,081 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,317,341 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01000 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $311,048 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $232,038 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $79,010 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $205,618 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $55,472 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $150,146 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,820,251 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,738,290 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,081,961 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01580 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,550,073 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,188,151 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $17,361,922 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13150 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,750 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $12,750 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,750 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $12,750 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,000,673 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $200,067 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $24,809,776 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $32,898,575 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$8,088,799 | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | 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 | 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 | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.KSBHOSPITAL.COM/CHNA | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| 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 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 Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| KATHERINE SHAW BETHEA HOSPITAL | PART V, SECTION B, LINE 5: (1) THE NATIONAL CENTER FOR RURAL HEALTH PROFESSIONALS WORKS TO IMPROVE HEALTHCARE IN RURAL COMMUNITIES THROUGH EDUCATION, EVALUATION AND RESEARCH. THE NATIONAL CENTER FOR RURAL HEALTH PROFESSIONALS IS A MEMBER OF THE STEERING COMMITTE. (2) NORTHWEST ILLINOIS SPECIAL OLYMPICS SERVES DEVELOPMENTALLY DISABLED ADULTS AND CHILDREN. THIS ORGANIZATION WAS PART OF THE STEERING COMMITTEE AND ASSESSMENTS OF THE COMMUNITY. (3) ILLINOIS EMERGENCY MANAGEMENT AGENCY PROVIDES TRAINING AND EDUCATION FOR THE DISASTERS IN NORTHWEST ILLINOIS COUNTIES. THIS ORGANIZATION WAS PART OF THE STEERING COMMITTEE AND PROVIDED DATA TO FACILITATE THE EDUCATION FOR OUR FACILITY TO ASSIST THE UNDERSERVED POPULATION IN OUR SERVICE AREA IN THE EVENT OF AN EMERGENCY. (4) LEE COUNTY HEALTH DEPARTMENT SERVES RURAL LEE COUNTY TO PROTECT THE HEALTH AND SAFETY OF INDIVIDUALS RESIDING IN AND VISITORS TO LEE COUNTY. (5) THE NATIONAL CENTER FOR RURAL HEALTH PROFESSIONALS WORKS TO IMPROVE HEALTHCARE IN RURAL COMMUNITIES THROUGH EDUCATION, EVALUATION AND RESEARCH. (6) KSB HOSPITAL INFORMATION TECHNOLOGICAL SERVICES STRIVES TO PROMOTE HEALTH AND WELLNESS EDUCATION TO THE UNDERSERVED. KSB HOSPITAL TECHNICAL SERVICES COACHES STEERING COMMITTEE ON OPPORTUNITIES TO COMMUNICATE TO THE UNDERSERVED BY SOCIAL MEDIA OR TEXT MESSAGING. (7) KSB HOSPITAL OUTPATIENT WELLLNESS DIETITIAN PROVIDES EDUCATION AND TRAINING TO MEDICAID AND UNINSURED. (8) AMBOY PUBLIC SCHOOL DISTRICT STUDENTS WERE ABLE TO COMMUNICATE, THROUGH A GOOGLE SURVEY, THE WELLNESS NEEDS OF THEIR COMMUNITY. (9) THE DIRECTOR OF THE LINCOLN HIGHWAY HISTORICAL SOCIETY WAS ABLE TO COMMUNICATE THE NEEDS OF FRANKLING GROVE ILLINOIS, ONE OF OUR SERVICE AREAS. THE LINCOLN HIGHWAY HISTORICAL SOCIETY WAS A MEMBER OF A FOCUS GROUP. (10) UNIVERSITY OF ILLINOIS EXTENSION SERVING LEE, CARROLL, AND WHITESIDE COUNTIES WAS A MEMBER OF THE FOCUS GROUP. U OF I EXTENSION'S PROGRAMS ARE RESEARCH-BASED AND PRACTICAL. |
| 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: OUR COMMUNITY'S SIGNIFICANT COMMUNITY HEALTH NEEDS ARE OBESITY EDUCATION AND PREVENTION, TOBACCO USE PREVENTION AND TREATMENT, AND COMMUNITY AWARENESS IMPROVEMENT. OBESITY EDUCATION AND PREVENTION: THE EDUCATIONAL PROGRAM JUMP WITH JILL - A NUTRITIONAL ROCK SHOW - WAS PERFORMED IN 5 SCHOOL DISTRICTS THAT HAVE A MINIMUM OF 50% REDUCED TO FREE LUNCHES. COMMUNITY GARDENS WERE PLACED AT REAGAN MIDDLE SCHOOL, PADS HOMELESS SHELTER AND CAMP REYNOLDSWOOD WITH EDUCATION ON PLANTING, GROWING AND HARVESTING SUSTAINABLE FOOD. FOOD PRESERVATION WILL ALSO BE CONDUCTED IN THE LATE FALL 2015. OPERATION MOVE TO WIN HAS IMPACTED OVER 2,400 FAMILIES WITH A TOTAL WEIGHT LOSS OF 10,081 LBS. OPERATION MOVE TO WIN PROVIDES EDUCATION ON NUTRITION, EXERCISE, HEALTH LIVING, STRESS MANAGEMENT AND BEHAVIOR MODIFICATION. NUTRITIONAL COOKING WITH A DIETITIAN ALONG WITH WALK WITH A DOC AND ULTIMATE FRISBEE WITH OUR PODIATRIC DEPARTMENTS WERE CONDUCTED. PREVENTION & TREATMENT OF TOBACCO USE: A TOBACCO QUITLINE WAS ACTIVATED IN ALL CLINICS AND PHYSICIAN OFFICES. PULMONOLOGY CONDUCTED A FREE FORUM ON E-CIGARETTES AND TOBACCO PREVENTION. A PARTNERSHIP WITH THE DIXON PARK DISTRICT TO PROMOTE TOBACCO FREE PARKS WAS CONDUCTED.IMPROVING COMMUNITY AWARENESS: FREE HEALTH AND WELLNESS EDUCATION WAS PROVIDED BUT NOT LIMITED TO SENIORS, THE MEDICALLY UNDERSERVED, AT RISK POPULATIONS, HOMELESS SHELTER AND FOOD PANTRY VIA HEALTH FAIRS, FLU VACCINE CLINICS, CARDIOLOGY PREVENTION AND WOMEN'S HEALTH EVENTS. ALL PROGRAMING AND EVENTS WERE FREE. SOCIAL MEDIA, LOCAL WEB SITES, MARQUEES, AND PLACES SERVING AT RISK POPULATIONS LIKE PROBATION AND COUNSELING CENTERS WERE INFORMED OF ALL UPCOMING EVENTS AND PROGRAMING THAT WERE FREE OF CHARGE. |
| KATHERINE SHAW BETHEA HOSPITAL | PART V, SECTION B, LINE 13B: STATE REGULATIONS ARE CONSIDERED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. |
| KATHERINE SHAW BETHEA HOSPITAL | PART V, SECTION B, LINE 22D: KATHERINE SHAW BETHEA HOSPITAL PERIODICALLY REVIEWS DISCOUNTS PROVIDED TO INSURANCE COMPANIES BY COMPARING ACTUAL COLLECTIONS TO GROSS CHARGES. THE HOSPITAL THEN COMPARES THAT AVERAGE (AMOUNTS GENERALLY BILLED) TO THE DISCOUNT GIVEN TO INDIVIDUALS UNDER ITS FINANCIAL ASSISTANCE POLICY TO ENSURE THAT ALL FAP-ELIGIBLE INDIVIDUALS RECEIVE A DISCOUNT AT LEAST AS LARGE AS THE AMOUNTS GENERALLY BILLED DISCOUNT. |
| PART V, SECTION B, LINE 16 | FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY |
| KATHERINE SHAW BETHEA HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: | WWW.KSBHOSPITAL.COM/NEW/WP-CONTENT/UPLOADS/2012/05/PFS-BROCHURE.PDF |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 9 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| COMMERCE TOWERS | ||||
| 215 EAST FIRST STREET | DIXON | IL | 61021 | PHYSICIAN CLINIC |
| TOWN SQUARE CENTER | ||||
| 102 S HENNEPIN AVENUE | DIXON | IL | 61021 | PHYSICIAN CLINIC |
| KSB OREGON CLINIC | ||||
| 1307 WASHINGTON | OREGON | IL | 61061 | PHYSICIAN CLINIC |
| EDWARDS CLINIC | ||||
| 144 NORTH COURT | DIXON | IL | 61021 | PHYSICIAN CLINIC |
| AMBOY CLINIC | ||||
| 305 EAST JOE DRIVE | AMBOY | IL | 61310 | PHYSICIAN CLINIC |
| MT MORRIS CLINIC | ||||
| 405 CHARLES AVENUE | MT MORRIS | IL | 61054 | PHYSICIAN CLINIC |
| KSB EYE & VISION CARE | ||||
| 511 PALMYRA STREET | DIXON | IL | 61021 | PHYSICIAN CLINIC |
| POLO CLINIC | ||||
| 1107 SOUTH DIVISION AVENUE | POLO | IL | 61064 | PHYSICIAN CLINIC |
| ASHTON CLINIC | ||||
| 707 S MAIN STREET | ASHTON | IL | 61006 | PHYSICIAN CLINIC |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | IT IS KSB HOSPITAL'S POLICY NOT TO WITHHOLD OR DENY ANY REQUIRED MEDICAL CARE AS A RESULT OF A PATIENTS'S LACK OF THE ABILITY TO PAY. THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS IN THE ABOVE TABLE WAS DERIVED FROM THE 2014 CALCULATED COST TO CHARGE RATION USING THE IRS WORKSHEET 2. |
| PART I, LINE 7G: | FOR 2014, SUBSIDIZED HEALTH SERVICES INCLUDED A DIABETIC CLINIC AND EMERGENCY MEDICAL SERVICES. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2,000,673. |
| 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: | GROSS CHARGES WRITTEN OFF TO BAD DEBT IN 2014 WERE $6,978,279. WE USED IRS WORKSHEET 2 TO CALCULATE THE COST TO CHARGE RATIO. THIS RATIO WAS USED TO ESTIMATE BAD DEBT AT COST. A PATIENTS'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 THAT 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 27 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS AND DESCRIBES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. 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 34,735 IN 2014. 17.1% OF THE POPULATION WAS AGE 65 AND OLDER. THE CENSUS BUREAU ESTIMATED THAT BETWEEN 2008-2012, 10% OF LEE COUNTY WAS BELOW THE POVERTY LEVEL. IN 2014, 39.9% 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 2014 MEDICARE COST REPORT THE MEDICARE ALLOWABLE COSTS FOR 2014 WERE $32,898,575 AND PAYMENTS RECEIVED FROM MEDICARE WERE $24,809,776. WE BELIEVE THAT THE SHORTFALL OF $8,088,799 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 2014 POPULATION OF LEE COUNTY WAS ESTIMATED AT 34,735. THE COMMUNITIES OF LEE AND WESTERN OGLE COUNTY COMPRISE THE KSB HOSPITAL PRIMARY SERVICE AREA. THIS AREA SAW A POPULATION DECLINE OF 2.6% BETWEEN 2010 AND 2014, A PERIOD DURING WHICH THE STATE GREW BY 5%. DIXON IS THE COUNTY SEAT AND THE LARGEST COMMUNITY IN LEE COUNTY WITH AN ESTIMATED POPULATION OF 15,333. LEE COUNTY RACE AND ETHNICITY SHOWS 87.2% WHITE, NOT HISPANIC; 5.2% BLACK; 5.7% HISPANIC; WITH THE REMAINING 1.9% 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 2014 ANNUAL AVERAGE UNEMPLOYMENT RATE FOR LEE COUNTY WAS 9.2%, COMPARABLE TO NORTHWEST ILLINOIS OVERALL AND EQUAL TO THE STATE AVERAGE OF 9.2%. WITH A MEDIAN HOUSEHOLD IN INCOME OF $50,060, LEE COUNTY IS LOWER THAN THE STATE AVERAGE OF $56,797. LEE COUNTY PER CAPITA INCOME IS $25,409, BELOW THE STATE AVERAGE OF $29,666. HOWEVER, THE PROPORTION OF LEE COUNTY RESIDENTS, 10.7%, LIVING BELOW THE FEDERAL POVERTY LEVEL IS LOWER THAN THE STATE AVERAGE OF 14.1%. UNINSURED (4.2%) AND MEDICAID (17.0%) PATIENTS COMPRISE A TOTAL OF 21.2% OF OUR PAYER MIX FOR 2014. 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 9 LOCATIONS AND THOSE COMMUNITIES ARE WELL REPRESENTED ON THE KSB BOARD. FOR EXAMPLE, TOM SUITS IS FROM THE POLO AREA AND CRAIG CARPENTER LIVES AND WORKS IN OREGON, 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 2014 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 | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc |
|---|---|---|---|---|---|---|---|---|---|---|
| AMBOY COMMUNITY SCHOOL DISTRICT 272 | ||||||||||
| 11 EAST HAWLEY STREET | AMBOY | IL | 61310 | 366005054 | GOVERNMENT | $8,500 | GENERAL OPERATING SUPPORT | |||
| ASHTON-FRANKLIN CENTER CUSD | ||||||||||
| 611 WESTERN AVENUE | ASHTON | IL | 61006 | 366008985 | GOVERNMENT | $6,000 | GENERAL OPERATING SUPPORT | |||
| DIXON FAMILY YMCA | ||||||||||
| 110 N GALENA AVENUE | DIXON | IL | 61021 | 362487927 | 501(C)(3) | $25,000 | GENERAL OPERATING SUPPORT | |||
| DIXON PUBLIC SCHOOL DISTRICT 170 | ||||||||||
| 1335 FRANKLIN GROVE ROAD | DIXON | IL | 61021 | 366007311 | GOVERNMENT | $10,000 | GENERAL OPERATING SUPPORT | |||
| HOME OF HOPE CANCER WELLNESS CENTERS | ||||||||||
| 1637 PLOCK ROAD | DIXON | IL | 61021 | 010743626 | 501(C)(3) | $15,000 | GENERAL OPERATING SUPPORT | |||
| NEWMAN CENTRAL HIGH SCHOOL | ||||||||||
| 1101 ST MARYS STREET | STERLING | IL | 61081 | 362385216 | GOVERNMENT | $10,000 | GENERAL OPERATING SUPPORT | |||
| MEALS ON WHEELS | ||||||||||
| 634 NORTH BEND DRIVE | DIXON | IL | 61021 | 362905096 | 501(C)(3) | GENERAL OPERATING SUPPORT | $43,219 | COST | MEALS | |
| OREGON COMMUNITY UNIT SCHOOL DISTRICT 220 | ||||||||||
| 206 SOUTH 10TH STREET | OREGON | IL | 61061 | 362656248 | GOVERNMENT | $5,000 | GENERAL OPERATING SUPPORT | |||
| POLO COMMUNITY UNIT SCHOOL DISTRICT 222 | ||||||||||
| 100 UNION AVENUE | POLO | IL | 61064 | 366008484 | GOVERNMENT | $5,000 | GENERAL OPERATING SUPPORT | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 9 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | STUDENT SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 9 | RecipientCnt |
| Cash Grant | $9,000 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | GRANTS TO OTHER ORGANIZATIONS ARE NOT MONITORED. 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) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| 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 | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 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 | $244,458 | $0 | $0 | $0 | $3,709 | $0 | $12,322 | $0 | $24,564 | $0 | $285,053 | $0 | $0 | $0 |
| DAVID SCHREINER | ||||||||||||||
| CEO | $415,967 | $0 | $0 | $0 | $18,925 | $0 | $12,875 | $0 | $48,839 | $0 | $496,606 | $0 | $0 | $0 |
| ALPHEUS APPENHEIMER MD | ||||||||||||||
| CMO | $282,458 | $0 | $0 | $0 | $19,425 | $0 | $12,875 | $0 | $23,214 | $0 | $337,972 | $0 | $0 | $0 |
| LINDA CLEMEN | ||||||||||||||
| CNO | $212,668 | $0 | $0 | $0 | $846 | $0 | $10,778 | $0 | $30,481 | $0 | $254,773 | $0 | $0 | $0 |
| DEBRA DIDIER | ||||||||||||||
| CFO | $200,293 | $0 | $0 | $0 | $18,355 | $0 | $10,707 | $0 | $27,844 | $0 | $257,199 | $0 | $0 | $0 |
| JULIE MANN | ||||||||||||||
| CAO | $197,026 | $0 | $0 | $0 | $18,335 | $0 | $10,695 | $0 | $30,103 | $0 | $256,159 | $0 | $0 | $0 |
| KEVIN MARX | ||||||||||||||
| CHIEF BUSINESS DEVELOPMENT OFFICER | $217,914 | $0 | $0 | $0 | $1,283 | $0 | $10,726 | $0 | $16,162 | $0 | $246,085 | $0 | $0 | $0 |
| SULAIMAN MOHAMMAD MD | ||||||||||||||
| NEUROLOGIST | $553,984 | $0 | $362,851 | $0 | $17,593 | $0 | $12,875 | $0 | $30,981 | $0 | $978,284 | $0 | $0 | $0 |
| MONTHER ELBZOUR MD | ||||||||||||||
| CARDIOLOGIST | $774,782 | $0 | $82,160 | $0 | $17,562 | $0 | $12,875 | $0 | $30,981 | $0 | $918,360 | $0 | $0 | $0 |
| SOHAIL HANIF MD | ||||||||||||||
| CARDIOLOGIST | $777,282 | $0 | $0 | $0 | $17,643 | $0 | $12,875 | $0 | $28,481 | $0 | $836,281 | $0 | $0 | $0 |
| TYLER GUNDERSON MD | ||||||||||||||
| SURGEON | $651,686 | $0 | $27,200 | $0 | $20,052 | $0 | $12,875 | $0 | $28,481 | $0 | $740,294 | $0 | $0 | $0 |
| IMRE ALMASSY MD | ||||||||||||||
| RADIOLOGIST | $444,295 | $0 | $200,000 | $0 | $19,819 | $0 | $12,875 | $0 | $24,412 | $0 | $701,401 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | THE C-SUITE AND PHYSICIANS RECEIVE REIMBURSEMENT FOR SOME HEALTH AND SOCIAL CLUB DUES. THESE AMOUNTS ARE CONSIDERED TAXABLE COMPENSATION TO THE INDIVIDUAL. |
| PART I, LINE 6 | CERTAIN PHYSICIANS THAT ARE CONSIDERED "PERSONS OF INTEREST" RECEIVE BONUSES BASED ON NET CASH COLLECTIONS OF THEIR INDIVIDUAL PRACTICE. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (5 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| KAILE VALDEZ | |||
| FAMILY MEMBER OF DAVID SCHREINER, CURRENT OFFICER/TRUSTEE | $22,563 | EMPLOYEE COMPENSATION | 0 |
| ALPHEUS B APPENHEIMER | |||
| FAMILY MEMBER OF TIM APPENHEIMER, OFFICER | $110,449 | EMPLOYMENT COMPENSATION | 0 |
| STACEY APPENHEIMER | |||
| FAMILY MEMBER OF TIM APPENHEIMER, OFFICER | $69,275 | EMPLOYMENT COMPENSATION | 0 |
| DAN MANN | |||
| FAMILY MEMBER OF JULIE MANN, OFFICER | $21,199 | EMPLOYMENT COMPENSATION | 0 |
| LESLIE MANN | |||
| FAMILY MEMBER OF JULIE MANN, OFFICER | $53,382 | EMPLOYMENT 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 (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE CONSISTS OF THE OFFICERS OF THE BOARD OF DIRECTORS AND ONE OTHER MEMBER OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE INTERIM BETWEEN BOARD MEETINGS AS LONG AS SUCH ACTION DOES 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 11 | 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 ADDTION, ON AN ONGOING BASIS, PRIOR TO EACH BOARD ACTION, EACH VOTING OFFICER IS RESPONSBILE 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 15A | THE ORGANZATION ENGAGES AN OUTSIDE CONSULTANT TO PROVIDE COMPARABILITY COMPENSATION DATA FOR THE CEO POSTION. 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 IN 2010. THIS CONTRACT IS IN EFFECT FOR 2014. 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. |
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 | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 11D, III-O | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KATHERINE SHAW BETHEA HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE OREGON 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) |
|---|---|---|
| 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 | -$80,964 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $551,507 | 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 | $266,758 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $551,537 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | 0 | 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 | Yes (1) | 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 |