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PANA COMMUNITY HOSPITAL ASSOCIATION: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
PANA COMMUNITY HOSPITAL ASSOCIATION (EIN 37-6062326)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-10-30
IRS object ID
201313039349301021
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-10-30T13:33:22-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1211 N BROADWAY SUITE 600AddressLine1
CityST LOUISCity
StateMOState
ZIP Code631022733ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN376062326EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Pana Community Hospital AssociationBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% JAMES MOON CFOInCareOfName
Name ControlPANANameControl
Phone2175622131Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1101 EAST NINTH STREETAddressLine1
Address Line2SuiteAddressLine2
CityPANACity
StateILState
ZIP Code62557ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJOYCE MORGANName
TitleCHAIRMANTitle
Phone2175622131Phone
Date Signed2013-10-29DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDonna J LarsonName
Phone3142315544Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJOYCE MORGAN CHAIRMANNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1101 E NINTH STREETAddressLine1
CityPANACity
StateILState
ZIP Code62557ZIPCode
FieldValueIRS element (for citing)
Gross Receipts19986101GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.panahospital.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1966YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionOUR MISSION IS TO BE A LEADING PARTNER IN ASSURING COMMUNITY-BASED QUALITY HEALTH CARE.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees221TotalNbrEmployees
Total Nbr Volunteers90TotalNbrVolunteers
Total Gross UBI9906TotalGrossUBI
Contributions Grants Prior Year225836ContributionsGrantsPriorYear
Contributions Grants Current Year282600ContributionsGrantsCurrentYear
Program Service Revenue Prior Year20785653ProgramServiceRevenuePriorYear
Program Service Revenue CY19576907ProgramServiceRevenueCY
Investment Income Prior Year82523InvestmentIncomePriorYear
Investment Income Current Year73724InvestmentIncomeCurrentYear
Other Revenue Prior Year41490OtherRevenuePriorYear
Other Revenue Current Year52348OtherRevenueCurrentYear
Total Revenue Prior Year21135502TotalRevenuePriorYear
Total Revenue Current Year19985579TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year9168471SalariesEtcPriorYear
Salaries Etc Current Year8954425SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year53027TotalFundrsngExpCurrentYear
Other Expense Prior Year9653661OtherExpensePriorYear
Other Expenses Current Year9650814OtherExpensesCurrentYear
Total Expenses Prior Year18822132TotalExpensesPriorYear
Total Expenses Current Year18605239TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2313370RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1380340RevenuesLessExpensesCY
Total Assets BOY19543272TotalAssetsBOY
Total Assets EOY22818621TotalAssetsEOY
Total Liabilities BOY1529684TotalLiabilitiesBOY
Total Liabilities EOY3495203TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY18013588NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY19323418NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionOUR 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.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense16741481Expense
Revenue19576907Revenue
DescriptionTO PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF PANA, ILLINOIS AND THE SURROUNDING AREA. THESE SERVICES INCLUDE NURSING, EMERGENCY AND ANCILLARY SERVICES FOR 988 INPATIENT DAYS, 22,148 OUTPATIENT VISITS, 8,847 EMERGENCY VISITS AND 215 OUTPATIENT SURGERIES.Description
Total Program Service Expense16741481TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109611NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees221NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJAMES MOON CFONamePerson
Telephone Number2175622131TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1101 EAST NINTH STREETAddressLine1
CityPANACity
StateILState
ZIP Code62557ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationAverage Hours Per Week RelatedAverageHoursPerWeekRelatedKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
JOYCE MORGAN
CHAIRMAN1.5XX000
JUDGE DAVID SLATER
DIRECTOR1.5X000
CAROLYN MARLEY
DIRECTOR1.5X000
JIM RANDOLPH
VICE-CHAIRMAN1.5XX000
MARY ANN RHOADES
DIRECTOR1.5X000
DJ ASUNCION MD
DIRECTOR1.5X000
STEVE NEECE
DIRECTOR1.5X000
MIKE TREXLER
TREASURER1.5XX000
JOHN GARDNER
DIRECTOR1.5X000
JOYCE THRONEBURG
SECRETARY1.5XX000
CAROL SCHRAMM
DIRECTOR1.5X000
RICK MILES
DIRECTOR1.5X000
KATRINA J CASNER
PRESIDENT & CEO40.0X138796011277
VICKIE COEN
CCO/CNE40.0X10869007637
JAMES MOON
CFO40.0X9309207196
WALTER CUNNINGTON
PHYSICIAN40.02904780156601.5X
JARED KOCHER
PHYSICIAN40.031499708450X
MICHELLE FOREMAN
PHARMACIST40.010898506215X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1055038TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation56435TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcestrueCompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MIDWEST EMERGENCY SERVICE INC
320 E HIGHWAY 50OFALLONIL62269EMERGENCY PHYSICIANS1222475
PRECISE SPECIALTIES CORP
514 S MAINHILLSBOROIL62049ULTRASOUND TECH.112648
MCKESSON TECHNOLOGIES INC
PO BOX 98347CHICAGOIL60693HARD/SOFTWARE IMPLEM286902
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Related Organizations46802RelatedOrganizations
Government Grants225798GovernmentGrants
All Other Contributions10000AllOtherContributions
Total Contributions282600TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT CARE SERVICES6211101911541819115418
OTHER OPERATING REVENUE621110192159192159
ELECTRONIC HEALTH RECORDS REVENUE621110269330269330
FieldValueIRS element (for citing)
Total Program Service Revenue19576907TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column71196TotalRevenueColumn
Exclusion$71,196ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real5266Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real5266Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column5266TotalRevenueColumn
Exclusion$5,266ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other3050Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other522Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other2528Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column2528TotalRevenueColumn
Exclusion$2,528ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountUnrelated Business RevenueUnrelatedBusinessRevenue
CAFETERIA & VENDING72251437176$37,176
CATERING72232099069906
FieldValueIRS element (for citing)
Total Other Revenue47082TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column19985579TotalRevenueColumn
Related Or Exempt Function Income19576907RelatedOrExemptFunctionIncome
Unrelated Business Revenue9906UnrelatedBusinessRevenue
Exclusion$116,166ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total996273Total
Program Services629586ProgramServices
Management And General366687ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total6328543Total
Program Services5832366ProgramServices
Management And General455241ManagementAndGeneral
Fundraising40936Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total134632Total
Program Services124076ProgramServices
Management And General9685ManagementAndGeneral
Fundraising871Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1133769Total
Program Services1044878ProgramServices
Management And General81557ManagementAndGeneral
Fundraising7334Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total361208Total
Program Services332889ProgramServices
Management And General25983ManagementAndGeneral
Fundraising2336Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1194Total
Management And General1194ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total66754Total
Management And General66754ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2110410Total
Program Services2037339ProgramServices
Management And General73071ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total50273Total
Management And General50273ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2648314Total
Program Services2512070ProgramServices
Management And General134694ManagementAndGeneral
Fundraising1550Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total8557Total
Management And General8557ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total199132Total
Program Services28533ProgramServices
Management And General170599ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total51472Total
Program Services51472ProgramServices

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total68024Total
Program Services46302ProgramServices
Management And General21722ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1308886Total
Program Services1177997ProgramServices
Management And General130889ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total188617Total
Program Services146149ProgramServices
Management And General42468ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT EXPENSE26361912636191
FEES & LICENSES11821610184516371
EMPLOYEE RELATIONS8903689036
DUES & SUBSCIPTIONS6016960169

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total45569Total
Program Services39788ProgramServices
Management And General5781ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total18605239Total
Program Services16741481ProgramServices
Management And General1810731ManagementAndGeneral
Fundraising53027Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2527788BOY
EOY4874023EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3535649BOY
EOY3574870EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4051826BOY
EOY5550603EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY246419BOY
EOY347488EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY324201BOY
EOY290768EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY153987BOY
EOY156908EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis17555674LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec9532203LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY8633768BOY
EOY8023471EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY45453BOY
EOY-19924EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY24181BOY
EOY20414EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY19543272BOY
EOY22818621EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1432425BOY
EOY1268861EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY1769882EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY97259BOY
EOY456460EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1529684BOY
EOY3495203EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY18013588BOY
EOY19323418EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY18013588BOY
EOY19323418EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY19543272BOY
EOY22818621EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1380340ReconcilationRevenueExpenses
Reconciliation Unrealized Invest-5137ReconciliationUnrealizedInvest
Reconcilation Other Changes-65373ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationstrueGrantsOtherOrganizations
Grants Other Organizations$9,948GrantsOtherOrganizationsAmount
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiesfalseOtherActivities
Total Lobbying Expenditures IIB9948TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierFORM 990, SCHEDULE CIdentifier
Return ReferencePART 1-A, LINE 1FReturnReference
ExplanationWE PARTICIPATE INDIRECTLY WITH LOBBYING ACTIVITIES THROUGH OUR MEMBERSHIPS IN THE ILLINOIS HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. IT IS ESTIMATED THAT OUR LOBBYING EXPENDITURES ARE 37% OF OUR MEMBERSHIP DUES AS PROVIDED BY THE IHA.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance1282115BeginningOfYearBalance
Investment Earnings Or Losses1407InvestmentEarningsOrLosses
End Of Year Balance1283522EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1347734BeginningOfYearBalance
Investment Earnings Or Losses-65619InvestmentEarningsOrLosses
End Of Year Balance1282115EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1470956BeginningOfYearBalance
Investment Earnings Or Losses-123222InvestmentEarningsOrLosses
End Of Year Balance1347734EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2889351BeginningOfYearBalance
Contributions1341547Contributions
Investment Earnings Or Losses-11108InvestmentEarningsOrLosses
Other Expenditures2748834OtherExpenditures
End Of Year Balance1470956EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance757088BeginningOfYearBalance
Contributions3260183Contributions
Investment Earnings Or Losses57773InvestmentEarningsOrLosses
Other Expenditures1184693OtherExpenditures
Administrative Expenses1000AdministrativeExpenses
End Of Year Balance2889351EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance1.00000BoardDesignatedEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis11496OtherCostOrOtherBasis
Book Value11496BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis6902438OtherCostOrOtherBasis
Depreciation3871391Depreciation
Book Value3031047BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis10270671OtherCostOrOtherBasis
Depreciation5499434Depreciation
Book Value4771237BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis371069OtherCostOrOtherBasis
Depreciation161378Depreciation
Book Value209691BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings8023471TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionThird Party Payor SettlementsDescription
Amount$456,460Amount
FieldValueIRS element (for citing)
Total Of Amounts456460TotalOfAmounts

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ENDOWMENT FUNDSSCHEDULE D, PART VPANA HOSPITAL INTENDS TO USE THE FUNDS FOR CAPITAL IMPROVEMENTS.
FIN 48PART X, LINE 2MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent250XPcent250
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReportfalseAnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense235996TotalCommunityBenefitExpense
Net Community Benefit Expense235996NetCommunityBenefitExpense
Percent Of Total Expense0.01480PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense3231959TotalCommunityBenefitExpense
Direct Offsetting Revenue2080964DirectOffsettingRevenue
Net Community Benefit Expense1150995NetCommunityBenefitExpense
Percent Of Total Expense0.07210PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense3467955TotalCommunityBenefitExpense
Direct Offsetting Revenue2080964DirectOffsettingRevenue
Net Community Benefit Expense1386991NetCommunityBenefitExpense
Percent Of Total Expense0.08690PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense31359TotalCommunityBenefitExpense
Net Community Benefit Expense31359NetCommunityBenefitExpense
Percent Of Total Expense0.00200PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense76357TotalCommunityBenefitExpense
Net Community Benefit Expense76357NetCommunityBenefitExpense
Percent Of Total Expense0.00480PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense107716TotalCommunityBenefitExpense
Net Community Benefit Expense107716NetCommunityBenefitExpense
Percent Of Total Expense0.00680PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense3575671TotalCommunityBenefitExpense
Direct Offsetting Revenue2080964DirectOffsettingRevenue
Net Community Benefit Expense1494707NetCommunityBenefitExpense
Percent Of Total Expense0.09370PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$2,636,191BadDebtExpenseAmount
Amount Attributable To1581715AmountAttributableTo
Amount Reimbursed By Medicare7079650AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare7048804CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall30846MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CarefalseProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1PANA COMMUNITY HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1101 EAST 9TH STREETAddressLine1
CityPANACity
StateILState
ZIP Code62557ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1PANA COMMUNITY HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent150.FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent250.FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities6NumberOfOtherFacilities

Other Facilities OtherFacilities (6 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
COMMUNITY MEDICAL CLINIC OF PANA
101 EAST 9TH STREETPANAIL62557PHYSICIAN SATELLITE OFFICE
QUAD COUNTY HOME HEALTH & HOSPICE
1 HUBER STREETPANAIL62557HOME HEALTH & HOSPICE AGENCY
COMMUNITY MEDICAL CLINIC OF ASSUMPTION
118 N WALNUT STREETASSUMPTIONIL62510PHYSICIAN SATELLITE OFFICE
COMMUNITY MEDICAL CLINIC OF RAMSEY
715 S SUPERIORRAMSEYIL62080PHYSICIAN SATELLITE OFFICE
COMMUNITY MEDICAL CLINIC OF NOKOMIS
120 CEDAR STREETNOKOMISIL62075PHYSICIAN SATELLITE OFFICE
QUAD COUNTY HOME HEALTH & HOSPICE
433 S MAINHILLSBOROIL62049HOME HEALTH & HOSPICE SATELLITE OFFICE

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COSTPART I, LINE 7THE 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.
FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COSTPART I, LINE 7, COLUMN (F)THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $2,636,191 REPORTED ON PART IX, LINE 25, HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN.
BAD DEBT EXPENSEPART III, SECTION A, LINES 2A, 3A & 42A ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY 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. 3A 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. 4 SEE NOTE 2: NET PATIENT SERVICE REVENUE ON PAGE 12 OF THE AUDITED FINANCIAL STATEMENTS
MEDICAREPART III, LINE 8LINE 6 COSTS WERE TAKEN DIRECTLY FROM THE ORGANIZATION'S 12/31/12 MEDICARE COST REPORT.
COLLECTION PRACTICESPART III, LINE 9BTHE COLLECTION PRACTICES FOLLOWED BY THE ORGANIZATION FOR PATIENTS WHO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE ADDRESSED IN ITS CHARITY CARE/FINANCIAL ASSISTANCE POLICY.
NEEDS ASSESSMENTPART VI, LINE 2THE 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.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEPART VI, LINE 3THE 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, INFORMATIONAL DOCUMENT SENT WITH BILLING STATEMENTS AND A DESCRIPTION OF THE PROGRAM PLUS AN APPLICATION POSTED ON ITS WEBSITE.
COMMUNITY INFORMATIONPART VI, LINE 4THE ORGANIZATION SERVES A RURAL AREA THAT INCLUDES 13 SMALL COMMUNITIES. THE POPULATION OF THE SERVICE AREA TOTALS APPROXIMATELY 13,000 RESIDENTS. THE SIZE OF THE COMMUNITIES WE SERVE IN OUR SERVICE AREA RANGE FROM LESS THAN 150 TO APPROXIMATELY 5,800 RESIDENTS. OF THE 13,000 RESIDENTS, 16,7% ARE BELOW THE FEDERAL POVERTY LEVEL AND THE AVERAGE HOUSEHOLD INCOME IS APPROXIMATELY $30,900. OUR SERVICE AREA POPULATION CONSISTS OF 19.1% MEDICAID AND 7.6% UNINSURED. OUR ORGANIZATION PROVIDES SERVICES TO FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS.
PROMOTION OF COMMUNITY HEALTHPART VI, LINE 5ONE 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 PHYSICIANS, 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 AREAS SO THAT THE ORGANIZATION CAN CONTINUE TO PROVIDE QUALITY PATIENT CARE.
INDIVIDUALS ELIGIBILITY FOR FINANCIAL ASSISTANCEPART V, SECTION B, LINE 20ALL PATIENTS QUALIFYING FOR THE FACILITY'S FINANCIAL ASSISTANCE POLICY ARE BILLED A MAXIMUM OF 50% OF GROSS CHARGES. THIS RATE IS SIGNIFICANTLY BELOW OUR LOWEST NEGOTIATED COMMERCIAL INSURANCE RATE.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgtrueCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
KATRINA J CASNER
PRESIDENT & CEO12890309500039305757055200150073000
DJ ASUNCION MD
DIRECTOR00000000000000
WALTER CUNNINGTON
PHYSICIAN1429470147232029906100095600306138000
JARED KOCHER
PHYSICIAN1381780176580023904738037120323447000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FORM 990SCHEDULE J, PART 1, LINE 5AWALTER CUNNINGTON AND JARED KOCHER ARE COMPENSATED USING A BASE SALARY PLUS PRODUCTIVITY COMPENSATION. THE PRODUCTIVITY COMPENSATION IS CALCULATED BASED UPON MINIMUM LEVELS OF RECEIPTS GENERATED BY EACH PHYSICIAN.
FORM 990SCHEDULE J, PART IID J ASUNCION IS EMPLOYED BY MIDWEST EMERGENCY SERVICES INC (MES) WHICH PROVIDES EMERGENCY PHYSICIANS, INCLUDING D J ASUNCION, TO PCH. PCH PAID $1,222,475 TO MES DURING 2012.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
ANDREW CASNER
SON OF KATRINA CASNER30953EMPLOYED BY HOSPITALfalse
DR LAURIE CUNNINGTON
WIFE OF DR. CUNNINGTON99030EMPLOYED BY HOSPITALfalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FAMILY AND BUSINESS RELATIONSHIPSPART VI, SECTION A, LINE 2STEVE NEECE AND DAVID SLATER HAVE A BUSINESS RELATIONSHIP. MIKE TREXLER, DAVID SLATER, JOHN GARDNER, AND JIM RANDOLPH HAVE A BUSINESS RELATIONSHIP.
MEMBERS AND STOCKHOLDERSPART VI, SECTION A, LINE 6 AND 7AMEMBERS OF THE HOSPITAL THAT CONTRIBUTE $5.00 TO THE PANA COMMUNITY HOSPITAL FOUNDATION MAY VOTE FOR THE MEMBERS OF THE GOVERNING BODY DURING THE HOSPITAL'S ANNUAL MEETING.
FORM 990 REVIEW PROCESSPART VI, SECTION B, LINE 11ATHE FORM 990 IS REVIEWED BY THE CFO PRIOR TO FILING WITH THE IRS.
CONFLICT OF INTEREST POLICYPART VI, SECTION B, LINE 12CALL BOARD MEMBERS, MEMBERS OF THE MEDICAL STAFF, ADMINISTRATION AND DEPARTMENT MANAGERS ARE ASKED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY.
COMPENSATION PROCESSPART VI, SECTION B, LINE 15A & 15BEACH 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.
GOVERNING DOCUMENTSPART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS ARE AVAILABLE FOR THE PUBLIC TO REVIEW DURING THE ORGANIZATION'S ANNUAL MEETING.
OTHER CHANGES IN NET ASSETSPART XI, LINE 9INVESTMENT IN SUBSIDIARY ($65,377) ROUNDING $4 --------- OTHER CHANGES IN NET ASSETS ($65,373)
OTHER FEES FOR SERVICESPART IX, LINE 11GEMERGENCY DEPARTMENT 1,226,436 LAB 106,065 IMAGING 500,361 OTHER PURCHASED SERVICES 277,548 ----------- TOTAL 2,110,410

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1PANA COMMUNITY HOSPITAL FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1101 EAST 9TH STREETAddressLine1
CityPANACity
StateILState
ZIP Code62557ZIPCode
FieldValueIRS element (for citing)
EIN371293506EIN
Primary ActivitiesFUNDRAISINGPrimaryActivities
Legal Domicile StateILLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status11-IPublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1PCHBusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgtrueControlledOrg

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1QUAD COUNTY HOME MEDICAL SPPLS & EQPMTBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11 HUBER STREETAddressLine1
CityPANACity
StateILState
ZIP Code62557ZIPCode
FieldValueIRS element (for citing)
EIN371198049EIN
Primary ActivityEQPMT RETAILERPrimaryActivity
Legal Domicile StateILLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1PCHBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Share Of Total Income6595ShareOfTotalIncome
Share Of EOY Assets329479ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
Controlled OrgtrueControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg