KEWANEE HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- KEWANEE HOSPITAL (EIN 36-2167767)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-08-12
- IRS object ID
- 201332249349301983
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-12T13:46:53-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390758449 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12237 | AddressLine1 |
| City | GREEN BAY | City |
| State | WI | State |
| ZIP Code | 543072237 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 362167767 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KEWANEE HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | KEWA | NameControl |
| Phone | 3098527500 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1051 W SOUTH ST | AddressLine1 |
| City | KEWANEE | City |
| State | IL | State |
| ZIP Code | 61443 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | LYNN A FULTON | Name |
| Title | CEO | Title |
| Phone | 3098527525 | Phone |
| Date Signed | 2013-08-09 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TERRI REXRODE CPA MST | Name |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | Phone |
| Date Prepared | 2013-08-09 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | LYNN A FULTON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1051 W SOUTH ST | AddressLine1 |
| City | KEWANEE | City |
| State | IL | State |
| ZIP Code | 61443 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 29877529 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.KEWANEEHOSPITAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1902 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | OPERATES A 25 BED CRITICAL ACCESS HOSPITAL PLUS RELATED HEALTH CARE SERVICES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 275 | TotalNbrEmployees |
| Total Nbr Volunteers | 86 | TotalNbrVolunteers |
| Total Gross UBI | 194 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 121248 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 102928 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 27118267 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 27718747 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 565006 | InvestmentIncomePriorYear |
| Investment Income Current Year | 727361 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 174608 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1264524 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 27979129 | TotalRevenuePriorYear |
| Total Revenue Current Year | 29813560 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 4300 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 11142 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 11163389 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 11333325 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 16852485 | OtherExpensePriorYear |
| Other Expenses Current Year | 16473273 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 28020174 | TotalExpensesPriorYear |
| Total Expenses Current Year | 27817740 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -41045 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1995820 | RevenuesLessExpensesCY |
| Total Assets BOY | 58950000 | TotalAssetsBOY |
| Total Assets EOY | 63224383 | TotalAssetsEOY |
| Total Liabilities BOY | 32626606 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 33412238 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 26323394 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 29812145 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO IMPROVE THE HEALTH AND CARE OF THOSE WE SERVE FOCUSING ON QUALITY OF CARE REGARDLESS OF ABILITY TO PAY. | MissionDescription |
| Significant New Program Services | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 18232008 | Expense |
| Revenue | 26804553 | Revenue |
| Description | KEWANEE HOSPITAL IS A 501(C)(3) NOT-FOR-PROFIT CORPORATION LICENSED ASA 25-BED CRITICAL ACCESS HOSPITAL (CAH) LOCATED IN A RURAL COMMUNITY INILLINOIS. KEWANEE HOSPITAL STRIVES TO PROVIDE QUALITY HEALTH CARE TOALL PATIENTS REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP,AGE, OR ABILITY TO PAY. MANY OF THE COMMUNITY MEMBERS WOULD HAVE NOACCESS TO HEALTH CARE WITHOUT KEWANEE HOSPITAL. THE PATIENTS AND THEIRFAMILIES ABILITY TO TRAVEL 50+ MILES TO A LARGER TERTIARY CENTER ISCOMPROMISED BY A LACK OF MOBILITY, A LACK OF INCOME, AND A LACK OFTRANSPORTATION. MANY OF THE SERVICES PROVIDED BY KEWANEE HOSPITAL ARE REIMBURSED AT OR BELOW THE COST TO PROVIDE CARE. KEWANEE HOSPITAL OFFERS A WIDE VARIETY OF SERVICES INCLUDING INPATIENT ACUTE AND CRITICAL CARE, SKILLED LEVEL CARE THROUGH SWING BEDS, DIAGNOSTIC CAPABILITIES INCLUDING RADIOLOGY,LABORATORY AND CARDIOPULMONARY, INPATIENT AND OUTPATIENT REHABILITATION AND TREATMENT, INPATIENT AND OUTPATIENT SURGICAL SERVICES, AND PRIMARY CARE SERVICES THROUGH THE FAMILY HEALTH CLINIC (FHC). DURING FY 2012 KEWANEE HOSPITAL PROVIDED 1,762 DAYS OF INPATIENT CARE AND 326 DAYS OF SWING BED CARE IN 2012. KEWANEE HOSPITAL PROVIDED A WIDE SCOPE OF OUTPATIENT SERVICES WHICH PROVIDED CARE TO 33,477 OUTPATIENTS. THE EMERGENCY DEPARTMENT (ED) IS A SAFETY NET TO THE RURAL COMMUNITY OF KEWANEE AND THE SURROUNDING AREA. THE ED IS STAFFED 24/7 BY DEDICATED EMERGENCY DEPARTMENT PHYSICIANS; DURING FY 2012 THE ED TREATED 9,739 PATIENTS, WITH OVER 50% OF THEM PAYING LESS THAN THE COST OF THE CARE RECEIVED. THE HOSPITAL OFFERS A VARIETY OF SURGICAL SERVICES INCLUDING GENERAL, ORTHOPEDIC, OPHTHALMOLOGIC, ENDOSCOPY AND GASTROENTEROLOGY. IN FY 2012 THE HOSPITAL PROVIDED A TOTAL OF 791 SURGICAL PROCEDURES. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1317897 | Expense |
| Revenue | 2002806 | Revenue |
| Description | KEWANEE HOSPITAL STAFFS A MULTI-DISCIPLINARY OUTPATIENT FAMILY HEALTHCLINIC (FHC) WITH A COMPLIMENT OF BOTH PHYSICIAN AND MID-LEVELPROVIDERS EMPLOYED BY THE HOSPITAL. THE FHC PROVIDES AN ARRAY OFSERVICES INCLUDING PRIMARY CARE (ADULTS AND PEDIATRICS) AND SURGICALSERVICES. THE FHC IS A LICENSED RURAL HEALTH CLINIC AND PROVIDES MANYNEEDED SERVICES TO THE COMMUNITY. THE FHC IS ONE OF THE ONLY CLINICSIN THE AREA TO ACCEPT THE TREATMENT AND CARE OF CHILDREN WITH ATTENTIONDEFICIT DISORDER. THE PROVIDERS IN THE FHC HAVE PARTICIPATED INSEVERAL OUTREACH EFFORTS INCLUDING DIABETIC HEALTH, SMOKING CESSATION,MEDICATION MANAGEMENT, AND HEALTH AND NUTRITION. IN FY 2012 THE FHCPROVIDERS BROUGHT THEIR SERVICES TO THE AREA HIGH SCHOOL TO PROVIDEFREE SPORTS PHYSICALS. BECAUSE OF THE HIGH POVERTY LEVEL IN THE KEWANEE DISTRICT, MANY STUDENTS HAVE DIFFICULTY TRAVELING TO PROVIDEROFFICES FOR THEIR PHYSICALS AND MOST CANNOT PAY THE COST. KEWANEEHOSPITAL MADE THE DECISION TO OUTREACH TO THESE STUDENTS IN ORDER TOENSURE THEY CAN TAKE PART IN SPORT ACTIVITIES AND RECEIVE THEIR NEEDEDPHYSICAL EXAM.THE FHC PRACTICES THE MEDICAL HOME MODEL THROUGH THE ILLINOIS HEALTHCONNECT PROGRAM. THE NURSE PRACTITIONERS PROVIDE AFTER-HOURS CALL INORDER TO ENSURE PATIENTS HAVE THE ABILITY TO ACCESS A PROVIDERAFTER-HOURS AND ON WEEKENDS WHEN NEEDED. THE FHC PRACTITIONERSCONTINUALLY COLLABORATE WITH THE AREA SCHOOLS AND PROVIDERS OF OTHERHEALTH SERVICES IN ORDER TO PROVIDE THE BEST CARE POSSIBLE TO THE AREACOMMUNITY. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 19549905 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 34 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 275 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PRESTON BECKER CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3098527525 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1051 W SOUTH STREET | AddressLine1 |
| City | KEWANEE | City |
| State | IL | State |
| ZIP Code | 61443 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| LYNN A FULTON | |||||||
| CEO | 40.00 | X | X | 123601 | 0 | 37024 | |
| MARGARET M GUSTAFSON | |||||||
| CEO (THROUGH JUNE 2012) | 40.00 | X | X | 225037 | 0 | 36745 | |
| MARY KAY NORTH | |||||||
| SECRETARY | 2.00 | X | X | 0 | 0 | 0 | |
| GARY PHEIFFER | |||||||
| CHAIRPERSON | 2.00 | X | X | 0 | 0 | 0 | |
| MARK REWERTS | |||||||
| VICE CHAIRPERSON | 2.00 | X | X | 0 | 0 | 0 | |
| TOM BURHORN | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| DANIEL CONGREVE MD | |||||||
| TRUSTEE | 40.00 | X | 337813 | 0 | 31832 | ||
| RITA HUNGATE MD | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| RUSSELL MEDLEY | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| FRANK TOCHA | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| MIKE YAKLICH | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| PRESTON BECKER | |||||||
| CFO | 40.00 | X | 98909 | 0 | 17682 | ||
| JENNIFER JUNIS | |||||||
| CNO | 40.00 | X | 105878 | 0 | 10330 | ||
| MICHAEL STEWART CRNA | |||||||
| CRNA | 40.00 | 196958 | 0 | 21840 | X | ||
| DEBRA EWING DO | |||||||
| PHYSICIAN | 40.00 | 186634 | 0 | 9691 | X | ||
| AIMEE SHANE CRNA | |||||||
| CRNA | 40.00 | 165310 | 0 | 15789 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1440140 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 180933 | TotalOtherCompensation |
| Number Individuals GT100 K | 7 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| EPSS | |||||
| 12528 SR 78 | HAVANA | IL | 62644 | ED PHYSIAN STAFFING | 1433849 |
| HOSPITAL CARE CONSULTANTS | |||||
| 17304 PRESTON RD | DALLAS | TX | 75252 | HOSPITALIST STAFFING | 523794 |
| DRINKER BIDDLE & REATH LLP | |||||
| ONE LOGAN SQUARE SUITE 2000 | PHILADELPHIA | PA | 19103 | LEGAL | 359834 |
| OSF SAINT FRANCIS INC | |||||
| 1420 W PIONEER PARKWAY | PEORIA | IL | 61615 | MRI SERVICES | 200050 |
| CARLSON PARTNERS LTD | |||||
| 2500 S HIGHLAND AVE | LOMBARD | IL | 60148 | LEGAL | 182229 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Fundraising Events | 26457 | FundraisingEvents |
| Government Grants | 42711 | GovernmentGrants |
| All Other Contributions | 33760 | AllOtherContributions |
| Noncash Contributions | 2715 | NoncashContributions |
| Total Contributions | 102928 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| PATIENT SERVICE REVENU | 621400 | 27606622 | 27606622 | |
| CAFETERIA MEALS | 621400 | 93156 | $93,156 | |
| MASSAGE THERAPY | 621400 | 17408 | 17408 | |
| MEDICAL RECORDS | 621400 | 1561 | $1,561 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 27718747 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 730184 | TotalRevenueColumn |
| Exclusion | $730,184 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 79857 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1691 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 78166 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 78166 | TotalRevenueColumn |
| Exclusion | $78,166 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 2823 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -2823 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -2823 | TotalRevenueColumn |
| Exclusion | -$2,823 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 9781 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 26457 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 9781 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 52509 | GrossSalesOfInventory |
| Cost Of Goods Sold | 49674 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2835 | TotalRevenueColumn |
| Exclusion | $2,835 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| EHR REVENUE | 900099 | 821313 | 821313 |
| MISC OPERATING REVENUE | 900099 | 340936 | 340936 |
| MEDICAL STAFF | 900099 | 16418 | 16418 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4856 | TotalRevenueColumn |
| Related Or Exempt Function Income | 4662 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 194 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1183523 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 29813560 | TotalRevenueColumn |
| Related Or Exempt Function Income | 28807359 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 194 | UnrelatedBusinessRevenue |
| Exclusion | $903,079 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7842 | Total |
| Program Services | 7842 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3300 | Total |
| Program Services | 3300 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1440140 | Total |
| Program Services | 886715 | ProgramServices |
| Management And General | 553425 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8148392 | Total |
| Program Services | 5875257 | ProgramServices |
| Management And General | 2273135 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 331850 | Total |
| Program Services | 234025 | ProgramServices |
| Management And General | 97825 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 655921 | Total |
| Program Services | 462565 | ProgramServices |
| Management And General | 193356 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 757022 | Total |
| Program Services | 533863 | ProgramServices |
| Management And General | 223159 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3900 | Total |
| Management And General | 3900 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 302866 | Total |
| Management And General | 302866 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2737639 | Total |
| Program Services | 1609333 | ProgramServices |
| Management And General | 1128306 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 164016 | Total |
| Management And General | 164016 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 326403 | Total |
| Program Services | 198408 | ProgramServices |
| Management And General | 127995 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 396727 | Total |
| Program Services | 25386 | ProgramServices |
| Management And General | 371341 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 107633 | Total |
| Program Services | 67878 | ProgramServices |
| Management And General | 39755 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17183 | Total |
| Program Services | 7304 | ProgramServices |
| Management And General | 9879 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1526474 | Total |
| Program Services | 1526474 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2819397 | Total |
| Program Services | 1113921 | ProgramServices |
| Management And General | 1705476 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 387300 | Total |
| Program Services | 129531 | ProgramServices |
| Management And General | 257769 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 2638533 | 2638533 | |
| MEDICAL PROFESSIONAL FE | 2470558 | 2470558 | |
| MEDICAL SUPPLIES | 1227045 | 1226080 | 965 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1347599 | Total |
| Program Services | 532932 | ProgramServices |
| Management And General | 814667 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27817740 | Total |
| Program Services | 19549905 | ProgramServices |
| Management And General | 8267835 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6383547 | BOY |
| EOY | 3237627 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7277922 | BOY |
| EOY | 11510806 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 56959 | BOY |
| EOY | 18100 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3322516 | BOY |
| EOY | 5169827 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 387588 | BOY |
| EOY | 384691 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 397391 | BOY |
| EOY | 426201 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 44018397 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 16649780 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29280107 | BOY |
| EOY | 27368617 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10508869 | BOY |
| EOY | 11730680 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1335101 | BOY |
| EOY | 3377834 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 58950000 | BOY |
| EOY | 63224383 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2689990 | BOY |
| EOY | 2821670 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 786616 | BOY |
| EOY | 644327 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29100000 | BOY |
| EOY | 28225000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50000 | BOY |
| EOY | 1721241 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32626606 | BOY |
| EOY | 33412238 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25594118 | BOY |
| EOY | 29082522 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55767 | BOY |
| EOY | 56114 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 673509 | BOY |
| EOY | 673509 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26323394 | BOY |
| EOY | 29812145 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 58950000 | BOY |
| EOY | 63224383 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1995820 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 1492931 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 1 | MailingsMembers |
| Mailings Members | $10 | MailingsMembersAmount |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 1 | DirectContactLegislators |
| Direct Contact Legislators | $1,000 | DirectContactLegislatorsAmount |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $21,582 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 22592 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | THE LOBBYING EFFORTS BY KEWANEE HOSPITAL FOR 2012 CONSISTED OF SEVERAL LETTERS AND E-MAILS TO AREA LEGISLATORS REGARDING PENDING LEGISLATION. ANNUALLY, A PORTION OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND ILLINOIS HOSPITAL ASSOCIATION (IHA) DUES ARE ALLOCATED TO LOBBYING EFFORTS BOTH ORGANIZATIONS EXERT ON BEHALF OF HOSPITALS AT THE NATIONAL AND STATE LEVEL. ACCORDING TO THE AHA AND IHA, 24% AND 39% RESPECTIVELY, OF OUR DUES WENT TOWARDS LOBBYING; THIS REPRESENTS $21,582 FOR THE YEAR. PART II-B 1 (G), DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS, GOVERNMENTAL OFFICIALS, OR A LEGISLATIVE BODY: LEADERSHIP TIME SPENT WITH LEGISLATORS CONCERNING ISSUES RELATING TO PROPERTY TAX LEGISLATION. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 8148017 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 1280567 | InvestmentEarningsOrLosses |
| Other Expenditures | 56174 | OtherExpenditures |
| End Of Year Balance | 9372410 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 9131640 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -552439 | InvestmentEarningsOrLosses |
| Other Expenditures | 431184 | OtherExpenditures |
| End Of Year Balance | 8148017 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 7210168 | BeginningOfYearBalance |
| Contributions | 892005 | Contributions |
| Investment Earnings Or Losses | 1241101 | InvestmentEarningsOrLosses |
| Other Expenditures | 211634 | OtherExpenditures |
| End Of Year Balance | 9131640 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 7970742 | BeginningOfYearBalance |
| Contributions | 118559 | Contributions |
| Investment Earnings Or Losses | -664217 | InvestmentEarningsOrLosses |
| Other Expenditures | 214916 | OtherExpenditures |
| End Of Year Balance | 7210168 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.92210 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.07190 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.00600 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1040521 | OtherCostOrOtherBasis |
| Book Value | 1040521 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 20581269 | OtherCostOrOtherBasis |
| Depreciation | 4713531 | Depreciation |
| Book Value | 15867738 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 25127 | OtherCostOrOtherBasis |
| Depreciation | 25127 | Depreciation |
| Book Value | 0 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 22022189 | OtherCostOrOtherBasis |
| Depreciation | 11911122 | Depreciation |
| Book Value | 10111067 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 349291 | OtherCostOrOtherBasis |
| Book Value | 349291 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 27368617 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| OTHER RECEIVABLES | 1162973 |
| LIFE INSURANCE | 20298 |
| UNAMORTIZED BOND COSTS | 728923 |
| EHR RECEIVABLE | 1465640 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 3377834 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO THIRD PARTY PAYORS | Description |
| Amount | $1,721,241 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1721241 | TotalOfAmounts |
| Total Revenue | 29813560 | TotalRevenue |
| Total Expenses | 27817740 | TotalExpenses |
| Excess Or Deficit For Year | 1995820 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 1492584 | NetUnrealizedGLOnInvestments |
| Other | $347 | OtherAmount |
| Total Adjustments | 1492931 | TotalAdjustments |
| Excess Or Deficit Per FS | 3488751 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 29874706 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 29874706 | RevenueSubtotal |
| Other Revenues Not Included | -61146 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -61146 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 29813560 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 27878886 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 61146 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 61146 | ExpensesNotRptdF990 |
| Expenses Subtotal | 27817740 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 27817740 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | ENDOWMENTS INCLUDED ON FORM 990 INCLUDE ASSETS SET ASIDE BY THE BOARD OF TRUSTEES FOR FUTURE CAPITAL IMPROVEMENTS, OVER WHICH THE BOARD RETAINS CONTROL AND MAY AT ITS DISCRETION SUBSEQUENTLY USE FOR OTHER PURPOSES. ENDOWMENTS ALSO INCLUDE DONOR-RESTRICTED FUNDS WHICH WILL BE USED FOR PROPERTY AND EQUIPMENT ADDITIONS, REIMBURSEMENT OF OPERATING EXPENSES, AND TO SUPPORT HEALTH CARE SERVICES. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | IN ORDER TO ACCOUNT FOR UNCERTAIN TAX POSITIONS, THE HOSPITAL DETERMINES WHETHER IT IS MORE LIKELY THAN NOT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE HOSPITAL RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS IN 2012 OR 2011. FEDERAL AND STATE INCOME TAX RETURNS FOR THE YEARS ENDED SEPTEMBER 30, 2009, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY MAJOR TAX JURISDICTIONS. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | CONTRIBUTIONS AND UNREALIZED GAIN LOSS 347. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | COGS ON INVENTORY SALES -49,674. RENTAL EXPENSES -1,691. FUNDRAISING EXPENSES -9,781. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | COGS ON INVENTORY SALES 49,674. RENTAL EXPENSE 1,691. FUNDRAISING EXPENSES 9,781. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | WILLIAM LININGER GOLF CLASSIC | NameOfEvent1 |
| Gross Receipts Event1 | 36238 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 26457 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 9781 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 5946 | CashPrizesEvent1 |
| Food And Beverage Event1 | 1573 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 2262 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 36238 | GrossReceiptsTotal |
| Charitable Contributions Total | 26457 | CharitableContributionsTotal |
| Gross Revenue Total Events | 9781 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 5946 | CashPrizesTotalEvents |
| Food And Beverage Total Events | 1573 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 2262 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 9781 | DirectExpenseSummaryEvents |
| Net Income Summary | 0 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 125.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1002577 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1002577 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03980 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6130772 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3041249 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3089523 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.12270 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7133349 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3041249 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4092100 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.16250 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 250705 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 250705 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01000 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 18606 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 18606 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20187 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 20187 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 289498 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 289498 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01150 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7422847 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3041249 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4381598 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.17400 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,411,875 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 6773207 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 9380554 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2607347 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KEWANEE HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1051 WEST SOUTH STREET | AddressLine1 |
| City | KEWANEE | City |
| State | IL | State |
| ZIP Code | 61443 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | RURAL HEALTH | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KEWANEE HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 125.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KEWANEE HOSPITAL FAMILY HEALTH CLINIC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1051 WEST SOUTH STREET | AddressLine1 |
| City | KEWANEE | City |
| State | IL | State |
| ZIP Code | 61443 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | RURAL HEALTH CLINIC | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, L7 COL(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 $2,638,533. | |
| PART II: KEWANEE HOSPITAL HAS AN OPEN MEDICAL STAFF AND WELCOMES PHYSICIANS AND MID-LEVEL PROVIDERS TO PRACTICE AND PROVIDE CARE IN THE KEWANEE COMMUNITY. THE BOARD OF TRUSTEES IS MADE UP OF COMMUNITY MEMBERS FROM THE LOCAL SERVICE AREA WHO ARE COMMITTED TO THEIR ROLE IN KEEPING QUALITY HEALTH CARE LOCAL. THE HOSPITAL PROVIDES MANY SERVICES THAT WOULD OTHERWISE BE UNAVAILABLE, PARTICULARLY TO THOSE COMMUNITY MEMBERS UNABLE TO TRAVEL FOR SERVICES OR UNABLE TO PAY. THE HOSPITAL CONTINUALLY WORKS WITH AREA STUDENTS PURSUING MEDICAL RELATED CAREERS AND PARTNERS WITH THE AREA COMMUNITY COLLEGE AND REGIONAL COLLEGES AND UNIVERSITIES TO OFFER CLINICAL AND ADMINISTRATIVE EXPERIENCES. THIS INCLUDES PRE-MED, NURSING, LAB, RADIOLOGY, CARDIOPULMONARY, FINANCE, AND ADMINISTRATION.IN ORDER TO RECRUIT AND RETAIN PHYSICIANS AND MID-LEVEL PROVIDERS TO THE RURAL COMMUNITY, KEWANEE HOSPITAL MUST OFFER COMPETITIVE EMPLOYMENT OPPORTUNITIES. EMPLOYING PHYSICIANS IS AN EXPENSIVE UNDERTAKING WHICH INCLUDES TAKING THE RISK OF PRACTICE DEVELOPMENT AND ASSUMING THE EXPENSE AND RISK FOR LIABILITY INSURANCE. CURRENTLY THE FHC PROVIDERS STRUGGLE TO ACCESS SPECIALISTS FOR THEIR PATIENTS WHEN NEEDED. THERE IS A RELUCTANCE OF OUT-OF-TOWN SPECIALISTS TO ACCEPT PATIENTS RELIANT ON MEDICAID. ILLINOIS' CURRENT MEDICAID CRISISHAS CAUSED THOSE SPECIALISTS ONCE WILLING TO TAKE NEW MEDICAID PATIENTS TO CEASE BECAUSE THEY CANNOT DETERMINE WHEN THEY WILL RECEIVE PAYMENT. THE CHILDREN UNDER THE CARE OF THE FHC ARE TURNED DOWN BY ENT'S, PSYCHIATRIST, AND OTHER NEEDED SPECIALIST BECAUSE OF THEIR RELIANCE ON MEDICAID. BECAUSE OF THE SIZE OF THE COMMUNITY, THE DEMOGRAPHICS AND THE CURRENT PHYSICIAN SHORTAGE, KEWANEE HOSPITAL IS UNABLE TO RECRUIT SPECIALISTS SUCH AS ENT, PSYCHIATRISTS, UROLOGISTS, CARDIOLOGISTS,ETC. TO THE AREA. THE FHC PROVIDERS THEREFORE HAVE TO RELY ON OUT-OF-TOWN SPECIALISTS FOR REFERRAL. THE FHC HAS STARTED A PATIENT ASSISTANCE PROGRAM THAT REACHES OUT TO ORGANIZATIONS, PROGRAMS, FOUNDATIONS, ETC. TO MATCH PATIENTS SO THEY CAN ACCESS SPECIALTY CARE, TREATMENT, OR MEDICATIONS THAT ARE NEEDED.KEWANEE HOSPITAL CONTINUES THE COMMITMENT TO THEIR MISSION OF IMPROVING THE HEALTH AND CARE OF THOSE THEY SERVE WITHIN THEIR COMMUNITIES. FY 2012 CONTINUES A FOCUS ON HEALTH EDUCATION, DISEASE MANAGEMENT, PREVENTION, AND WELLNESS. DESPITE GROWING ECONOMIC HARDSHIPS DUE TO CONTINUED DECREASE IN THE NUMBER OF COMMERCIALLY INSURED INDIVIDUALS, THE GROWTH IN PATIENTS RELIANT ON MEDICAID, AND THE INCREASE IN UNINSURED PATIENTS, THE HOSPITAL WILL CONTINUE TO PROVIDE COMMUNITY OUTREACH TO ASSIST THOSE IN NEED. THE HOSPITAL'S VALUE TO THE COMMUNITY WELL EXCEEDS $4 MILLION CONTRIBUTED IN FY 2012. THE HOSPITAL IS THERE 24 HOURS A DAY, 7 DAYS A WEEK, FOR COMMUNITY MEMBERS IN THEIR TIME OF NEED-WHETHER FOR A CHILD WHO IS SICK THROUGHOUT THE NIGHT, A PARENT EXPERIENCING CHEST PAINS, A GRANDMOTHER WITH THE WARNING SIGNS OF A STROKE, OR THE VICTIMS OF A TRAUMATIC CAR ACCIDENT. KEWANEE HOSPITAL STANDS READY TO TAKE CARE OF THOSE COMMUNITY MEMBERS IN NEED AND CONTINUES TO WORK TOWARDS THEIR VISION OF SETTING THE STANDARD FOR LOCAL HEALTH CARE WITH A TEAM OF COMPASSIONATE PROFESSIONALS WHO ARE FOCUSED ON CLINICAL EXCELLENCE AND CUSTOMER SERVICE. | |
| PART III, LINE 4: BAD DEBTS WERE REPORTED ON THE FINANCIAL STATEMENTS AT GROSS CHARGES. THEN THE COST TO CHARGE RATIO WAS USED TO CONVERT THE BAD DEBT AMOUNT FROM A CHARGE BASED NUMBER TO A COST BASED NUMBER. | |
| PART III, LINE 8: THE MEDICARE PROGRAM DOES NOT COVER ALL SERVICES PROVIDED TO THEIR PARTICIPANTS AND THE HOSPITAL IS NOT ALLOWED TO COLLECT FROM THE PARTICIPANTS FOR SOME SERVICES BASED ON THE HOSPITAL'S AGREEMENT WITH THE PROGRAM. THEREFORE, NOT ALL REVENUES ARE COVERED BY MEDICARE. IN ADDITION, MEDICARE DOES NOT ALLOW ALL BUSINESS COSTS OF THE HOSPITAL TO BE INCLUDED IN THE COST REPORT, SO THERE ARE ADDITIONAL UNCOVERED COSTS. THE SHORTFALL BY THE MEDICARE PROGRAM COULD BE AVOIDED BY NOT PROVIDING CARE TO MEDICARE PATIENTS; THEREFORE, THIS SHORTFALL SHOULD BE INCLUDED AS A BENEFIT PROVIDED BY THE HOSPITAL.PART I, LINE 7: THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST REPORT IS BASED ON THE AUDITED FINANCIAL STATEMENTS OF KEWANEE HOSPITAL AND THE HOSPITAL'S EXPENSING OF COSTS TO THE APPROPRIATE COST CENTER THROUGH THE HOSPITAL'S INTERNAL COMPUTER SYSTEM. | |
| PART III, LINE 9B: IT IS THE POLICY OF KEWANEE HOSPITAL TO EXTEND A FULL OR PARTIAL DISCOUNT FROM CHARGES TO QUALIFYING PATIENTS WHOSE CARE IS NOT COVERED BY OTHER FINANCIAL AID OR GOVERNMENT HEALTHCARE PROGRAMS. KEWANEE HOSPITAL UTILIZES A NUMBER OF METHODS FOR COMMUNICATING FINANCIAL ASSISTANCE, INCLUDING CHARITY CARE, TO PATIENTS AND THE COMMUNITY INCLUDING:A. SIGNS STATING THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE POSTED INTHE EMERGENCY DEPARTMENT, REGISTRATION AND ADMITTING AREAS AND THECASHIERS OFFICE. BROCHURES WITH INFORMATION REGARDING CHARITY CARE ARE ALSO AVAILABLE.B. NOTICE OF THE AVAILABILITY OF CHARITY CARE IS INCLUDED ON THEHOSPITALS WEB SITE.C. PATIENT FINANCIAL SERVICES STAFF IS KNOWLEDGEABLE ABOUT THE POLICY AND PROCESS.D. THE STAFFS OF THE OUTSOURCED SELF PAY BILLING SERVICE AND BAD DEBTCOLLECTION AGENCY ARE ALSO KNOWLEDGEABLE ABOUT THE POLICY AND PROCESS.E. NOTICE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE IS INCLUDED ON ORWITH HOSPITAL BILLING STATEMENTS TO GUARANTORS.KEWANEE HOSPITAL ATTEMPTS TO IDENTIFY UNINSURED PATIENTS ELIGIBLE FORCHARITY CARE PRIOR TO OR AT TIME OF SERVICE. FINANCIAL ASSISTANCEINFORMATION AND APPLICATIONS MAY BE OBTAINED FROM THE FINANCIALCOUNSELORS. COMPLETED APPLICATIONS AND DOCUMENTATION WILL BE REVIEWED AND PROCESSED. APPLICANTS WILL THEN RECEIVE A WRITTEN DETERMINATION OF ELIGIBILITY. | |
| PART V, SECTION B, LINE 9: KEWANEE HOSPITAL REVIEWS THE FOLLOWING CRITERIA TO DETERMINE FREE AND/OR DISCOUNTED CARE: INCOME LEVEL, ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNINSURED DISCOUNT, MEDICARE/MEDICAID AND STATE REGULATION. | KEWANEE HOSPITAL |
| PART V, SECTION B, LINE 10: KEWANEE HOSPITAL REVIEWS THE FOLLOWING CRITERIA TO DETERMINE FREE AND/OR DISCOUNTED CARE: INCOME LEVEL, ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNINSURED DISCOUNT, MEDICARE/MEDICAID AND STATE REGULATION. | KEWANEE HOSPITAL |
| PART V, SECTION B, LINE 19D: FOR UNINSURED, THE MAXIMUM CHARGED AMOUNT CANNOT EXCEED 25% OF ANNUAL INCOME. | KEWANEE HOSPITAL |
| PART VI, LINE 2: KEWANEE HOSPITAL CONTINUALLY STRIVES TO MEET THE HEALTH CARE NEEDS OF THE COMMUNITY SERVED AND PERFORMS ONGOING ASSESSMENTS IN ORDER TO BEST ALLOCATE THE HOSPITAL'S SCARCE RESOURCES, THE HOSPITAL EVALUATES THE NEEDS OF THE KEWANEE COMMUNITY THROUGH INTERNAL EVALUATION OF MARKET DATA, COMMUNITY DEMOGRAPHICS, CDC AND OTHER HEALTH RELATED DATA, ANALYSIS OF PATIENTS SERVED THROUGH THE HOSPITALS FAMILY HEALTH CLINIC, REVIEW OF EMERGENCY DEPARTMENT VISITS, AND COLLABORATIVE MEETINGS WITH THE AREA SCHOOL DISTRICTS AND THE COUNTY HEALTH DEPARTMENT.KEWANEE HOSPITAL WORKS WITH A NUMBER OF COMMUNITY VOLUNTEERS THROUGH THE HOSPITALS DEVELOPMENT COUNCIL. THE COMMUNITY RELATIONS COMMITTEE IS CHARGED WITH NEEDED EDUCATION FOR THE COMMUNITY AND UTILIZES THE INFORMATION GAINED AS TOPICS FOR EDUCATION. THROUGH THE ONGOING ASSESSMENT PROCESS THE HOSPITAL HAS IDENTIFIED AND PROVIDED OUTREACH INCLUDING A SUICIDE PREVENTION EDUCATIONAL SERIES FOR TEACHERS AND PARENTS, FINANCIAL WELLNESS FOR WOMEN, AND SKIN-CANCER PREVENTION.THROUGH COLLABORATION WITH KEWANEE HOSPITAL'S REGIONAL PARTNERS, INCLUDING THE HENRY COUNTY HEALTH DEPARTMENT, THE HOSPITAL IDENTIFIED DISASTER PREPAREDNESS AS A COMMUNITY NEED. AS A RURAL COMMUNITY, KEWANEE HAS FEW CITY RESOURCES. CITIZENS VIEW THE HOSPITAL AS THE MAINSTAY OR COMMUNITY CORNERSTONE AND THUS WOULD LOOK TO KEWANEE HOSPITAL IN AN EMERGENCY. THE HOSPITAL LEADERSHIP TEAM, STAFF AND PROVIDERS HAVE GONE THROUGH EDUCATION AND TRAINING ON INCIDENT COMMAND. | |
| PART VI, LINE 3: KEWANEE HOSPITAL PROVIDED NEARLY $1,900,000 IN CHARITY CARE TO NEEDY COMMUNITY MEMBERS IN FY 2012. KEWANEE HOSPITAL COMMUNICATES TO PATIENTS ABOUT THEIR FINANCIAL OBLIGATIONS THROUGHOUT THE HEALTH CARE EXPERIENCE. IT IS THE HOSPITAL'S GOAL TO ASSESS FINANCIAL NEED AS SOON AS POSSIBLE IN THE CARE PROCESS. PATIENTS SETTING UP DIAGNOSTIC TESTING THROUGH CENTRALIZED SCHEDULING DISCUSS THE PAYMENT OBLIGATIONS PRIOR TO VISITING THE HOSPITAL, ALLOWING FOR PATIENTS NEEDING ASSISTANCE TO START THE PROCESS RIGHT THEN. THE FAMILY HEALTH CLINIC (FHC) PATIENTS BENEFIT FROM HAVING FHC STAFF TALK WITH THEM ABOUT OBLIGATIONS RELATED TO PROCEDURES, DIAGNOSTICS, ETC. AND ARE OFTEN ABLE TO ACCESS FINANCIAL ASSISTANCE PRIOR TO THE PROCEDURE. KEWANEE HOSPITAL STAFF IS TRAINED TO RECOGNIZE POTENTIAL NEED AND TO PROACTIVELY DISCUSS PAYMENT ARRANGEMENTS. THE HOSPITAL PROMOTES FINANCIAL ASSISTANCE THROUGHOUT THE ORGANIZATION AND THROUGH VARIOUS PUBLICATIONS. INFORMATION ABOUT THE HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE PROGRAMS IS POSTED THROUGH:-SIGNAGE (ADMISSIONS/REGISTRATION AT MAIN ENTRANCE, EMERGENCY DEPARTMENT ADMISSIONS, ADMISSION BOOTHS).-KEWANEE HOSPITAL'S WEBSITE, WWW.KEWANEEHOSPITAL.COM DIRECT MAIL PIECES INCLUDING BIANNUAL NEWSLETTERS AND COMMUNITY BENEFIT REPORT-HENRY COUNTY TOURISM VIDEO/WEB-SITE LINK-RADIO PROGRAM, MONDAY MORNING TUNED-IN, WKEI-PATIENT EDUCATION THROUGHOUT THE CARE PROCESS-FINANCIAL ASSISTANCE BROCHURES AT CASHIERS WINDOW-PATIENT BILL FOR SERVICE.-IDENTIFICATION OF NEED AND EDUCATION THROUGH CENTRALIZED SCHEDULING, ADMISSIONS STAFF, FHC STAFF, CASHIERS OFFICE, FINANCIAL COUNSELORS, PROVIDERS OF SERVICES, AND OTHER STAFF AS THEY BECOME AWARE OF THE PATIENTS NEED.-ANNOUNCEMENTS AND POSTINGS AT BOOTHS AT FREE COMMUNITY EDUCATION AND OUTREACH CONDUCTED BY KEWANEE HOSPITAL. | |
| PART VI, LINE 4: KEWANEE HOSPITAL IS LOCATED IN A RURAL AREA OF NORTHERN WEST-CENTRAL ILLINOIS, ABOUT 10 MILES SOUTH OF INTERSTATE 80 AND BETWEEN THE LARGER URBAN AREAS OF PEORIA, ILLINOIS AND THE QUAD CITIES (LOCATED ABOUT 50-55 MILES FROM EACH). THE HOSPITAL SERVES THE PRIMARY MARKET AREA (POPULATION APPROXIMATELY 19,700) OF KEWANEE AND THE SURROUNDING RURAL COMMUNITIES INCLUDING GALVA AND TOULON. THE OVERALL MARKET (POPULATION APPROXIMATELY 29,000) INCLUDES THE THREE COUNTY PORTIONS OF HENRY, BUREAU, AND STARK IN RURAL ILLINOIS. THE LARGEST PERCENTAGES OF KEWANEE HOSPITALS PATIENTS ARE DERIVED FROM THE KEWANEE ZIP CODE OF 61443. THE POPULATION OF KEWANEE IS AGING AND POOR WITH THE GREATEST NUMBERS IN THE OVER 65 AND UNDER 18. IN 2000, 12.8% OF THE POPULATION WAS BELOW THE POVERTY LEVEL. THE KEWANEE SCHOOL DISTRICT REPORTED OVER 85% OF CHILDREN ATTENDING SCHOOL ON THE FREE AND REDUCED LUNCH PROGRAM. SUBSEQUENTLY THAT LEAVES FEW CITIZENS IN THE MIDDLE WHERE A COMMUNITY TYPICALLY SEES THE WORKING CLASS. AS A RESULT OF THE DEMOGRAPHICS, KEWANEE HOSPITAL SEES A HIGH PROPORTION OF PATIENTS RELIANT ON MEDICAID AND UNINSURED. FOLLOWING THE NATIONAL TREND, THE HIGHEST CONCENTRATION IS IN THE EMERGENCY DEPARTMENT AND THE HOSPITAL'S FAMILY HEALTH CLINIC (FHC). FY 2012 REPORTED 30% OF PATIENTS IN THE EMERGENCY DEPARTMENT WERE RELIANT ON MEDICAID WHILE 15% WERE UNINSURED. THE FAMILY HEALTH CLINIC REPORTED 42% OF PATIENTS WERE RELIANT ON MEDICAID AND 11% WERE UNINSURED. THE OVERALL HOSPITAL REPORTED 22% RELIANT ON MEDICAID AND 10% UNINSURED. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | IL HOSPITAL RESEARCH & EDUCATION FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1151 E WARRENVILLE | AddressLine1 |
| City | NAPERVILLE | City |
| State | IL | State |
| ZIP Code | 60566 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 237421930 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 7842 | AmountOfCashGrant |
| Purpose Of Grant | TO ADDRESS THE DISPARATE AND NEGATIVE EFFECTS OF THE ILLINOIS MEDICAID PROGRAM. | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: FOR GRANTS GIVEN TO ORGANIZATIONS, SUBSTANTIATION IS REQUIRED PRIOR TO DISBURSEMENT OF ALL FUNDS FOR SCHOLARSHIPS, ALL INDIVIDUALS MUST SIGN A SUPPORT AGREEMENT VERIFYING THEIR OBLIGATIONS AS AWARD RECIPIENTS AND THE RAMIFICATIONS IF THE AGREEMENT IS NOT MET. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LYNN A FULTON | |||||||||||||
| 123601 | 0 | 0 | 0 | 0 | 0 | 6870 | 0 | 30154 | 0 | 160625 | 0 | 0 | 0 |
| MARGARET M GUSTAFSON | |||||||||||||
| 225037 | 0 | 0 | 0 | 0 | 0 | 10689 | 0 | 26056 | 0 | 261782 | 0 | 0 | 0 |
| DANIEL CONGREVE MD | |||||||||||||
| 337813 | 0 | 0 | 0 | 0 | 0 | 11076 | 0 | 20756 | 0 | 369645 | 0 | 0 | 0 |
| MICHAEL STEWART CRNA | |||||||||||||
| 196958 | 0 | 0 | 0 | 0 | 0 | 4804 | 0 | 17036 | 0 | 218798 | 0 | 0 | 0 |
| DEBRA EWING DO | |||||||||||||
| 186634 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 9691 | 0 | 196325 | 0 | 0 | 0 |
| AIMEE SHANE CRNA | |||||||||||||
| 165310 | 0 | 0 | 0 | 0 | 0 | 4227 | 0 | 11562 | 0 | 181099 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ILLINOIS FINANCE AUTHORITY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 861091967 | IssuerEIN |
| CUSIP Number | 45200BH27 | CUSIPNumber |
| Date Issued | 2006-08-31 | DateIssued |
| Issue Price | 32114451 | IssuePrice |
| Description Of Purpose | SEE PART VI | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amount Retired | 3980000 | AmountRetired |
| Total Proceeds | 33978645 | TotalProceeds |
| Amount In Reserve Fund | 2352650 | AmountInReserveFund |
| Issuance Costs From Proceeds | 642289 | IssuanceCostsFromProceeds |
| Capital Expenditures | 33336356 | CapitalExpenditures |
| Year Of Subst Completion | 2008 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 1 | MngmentCntrctBondFinancdPrprty |
| Engage Bond Counsel Contracts | 1 | EngageBondCounselContracts |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00650 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00650 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | 1 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 1 | Form8038TFiled |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 1 | GrossProceedsInvestedInGIC |
Name Of GIC Provider NameOfGICProvider
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEE PART VI | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Regulatory Safe Harbor Satisfied | 1 | RegulatorySafeHarborSatisfied |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Form990 Schedule K Part VI Form990ScheduleKPartVI (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| FORM 990, SCHEDULE K, PART I, LINES A(F) | DESCRIPTION OF PURPOSE | THE PURPOSE OF THE $32,205,000 ILLINOIS FINANCE AUTHORITY REVENUE BONDS, SERIES 2006 (KEWANEE HOSPITAL PROJECT) (THE "BONDS") WAS, TOGETHER WITH CERTAIN OTHER AMOUNTS AVAILABLE TO KEWANEE HOSPITAL, TO (A) PAY OR REIMBURSE KEWANEE HOSPITAL FOR THE PAYMENT OF THE COST OF ACQUIRING, CONSTRUCTING, RENOVATING, REMODELING AND EQUIPPING CERTAIN OF ITS HEALTH FACILITIES, (B) PROVIDE FUNDED INTEREST FOR THE BONDS, AND (C) PAY CERTAIN EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE BONDS. |
| FORM 990, SCHEDULE K, PART IV, LINES 4B & 4C | NAME OF GIC PROVIDER AND TERM OF GIC | TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY- GIC PROVIDER FOR PROCEEDS DEPOSITED IN A PROJECT FUND - 1.61 YEARS. CITIGROUP FINANCIAL PRODUCTS, INC. - GIC PROVIDER FOR GROSS PROCEEDS DEPOSITED IN A DEBT SERVICE FUND - 4.90 YEARS - TERMINATED ON JANUARY 9, 2009. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| NEW PROGRAM SERVICES | FORM 990, PART III, LINE 2 | IN JULY 2012, KEWANEE HOSPITAL ENTERED INTO A RELATIONSHIP WITH GREAT PLAINS ORTHOPAEDICS TO PROVIDE ROUTINE ORTHOPAEDIC CARE AT KEWANEE HOSPITAL INCLUDING CONSULTATION AND SURGICAL SERVICES. |
| FORM 990, PART VI, SECTION A, LINE 8B | THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE STRATEGIC PLANNING AND FINANCE COMMITTEE (SPF) IS THE BOARD OF TRUSTEE LEVEL COMMITTEE CHARGED WITH REVIEWING THE FINAL FORM 990 PRIOR TO ITS FILING. EACH BOARD MEMBER IS PROVIDED A COPY OF THE 990 FOR THEIR REVIEW AND GIVEN THE OPPORTUNITY TO ASK QUESTIONS AND MAKE COMMENTS. A FORMAL PRESENTATION OF THE 990 TO THE BOARD OF TRUSTEES WILL OCCUR AFTER FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ANY INTERESTED PERSON WHO HAS A PERSONAL OR PRIVATE INTEREST IN A MEASURE, CONTRACT, RESOLUTION, OR OTHER TRANSACTION PRESENTED TO THE BOARD OR A COMMITTEE THEREOF FOR DELIBERATION, AUTHORIZATION, APPROVAL, OR RATIFICATION, OR ANY INTERESTED PERSON WHO REASONABLY BELIEVES SUCH AN INTEREST EXISTS IN ANOTHER PERSON, SHALL MAKE A PROMPT, FULL, AND FRANK DISCLOSURE IN WRITING OF THE PERSONAL OR PRIVATE INTEREST TO THE BOARD OR COMMITTEE PRIOR TO ITS ACTING ON SUCH CONTRACT OR TRANSACTION. THE INTERESTED PERSON SHALL DISCLOSE THE EXISTENCE OF HIS OR HER PERSONAL OR PRIVATE INTEREST AND ALL MATERIAL FACTS, KNOWN TO HIM OR HER ABOUT THE PERSONAL OR PRIVATE INTEREST AND POTENTIAL CONFLICT OF INTEREST. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE EXECUTIVE COMMITTEE OF THE HOSPITAL BOARD OF TRUSTEES ACTS AS THE COMPENSATION COMMITTEE FOR KEWANEE HOSPITAL. ANNUALLY THE EXECUTIVE COMMITTEE OF THE BOARD MEETS TO REVIEW AND APPROVE COMPENSATION FOR THE EXECUTIVE TEAM WHICH INCLUDES THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER AND CHIEF NURSING OFFICER. RESOURCE DATA FOR THIS REVIEW COMES FROM SALARY SURVEYS FROM A NUMBER OF SOURCES INCLUDING SULLIVAN COTTER, CENTRAL ILLINOIS SOCIETY FOR HEALTHCARE HUMAN RESOURCE ADMINISTRATION (CISHRA), IHA EXECUTIVE AND MANAGEMENT SALARY SURVEY, AND A 990 REVIEW THROUGH GUIDESTAR.ORG OF LOCAL AND REGIONAL ORGANIZATIONS. THE SURVEYS ARE ANALYZED BY REVIEWING APPLICABLE CUTS OF THE SURVEY INCLUDING CRITICAL ACCESS HOSPITALS, HOSPITALS WITH LIKE REVENUE, AND SIMILARLY STAFFED ORGANIZATIONS. SURVEYS ARE ALSO REVIEWED AT REGIONAL AND NATIONAL LEVELS. COMPENSATION IS PROPOSED TO THE COMMITTEE TAKING INTO CONSIDERATION THE MEDIAN RANGE OF ALL SALARY SOURCES, EDUCATION/DEGREE, TRAINING, CERTIFICATION, AND EXPERIENCE. THE COMMITTEE REVIEWS THE SALARY PROPOSAL FOR REASONABLENESS BASED ON THE DATA SOURCES. THE CHIEF EXECUTIVE OFFICER MAKES RECOMMENDATIONS FOR THE SALARIES OF THE OTHER EXECUTIVES (CFO AND CNO). | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 5: | NET UNREALIZED GAINS ON INVESTMENTS: 1,492,584. CONTRIBUTIONS AND UNREALIZED GAIN LOSS 347. TOTAL TO FORM 990, PART XI, LINE 5: 1,492,931. |
| AUDITED FINANCIAL STATEMENTS | FORM 990, PART XII, LINE 2C | THE ORGANIZATION'S BOARD OF TRUSTEES ENGAGES THE INDEPENDENT ACCOUNTANTS TO PERFORM THE AUDIT. THE BOARD MEETS WITH THE AUDITORS TO GO OVER THE AUDIT REPORT. |