Form990
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
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MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
A For the 2020 calendar year, or tax year beginning 04-01-2020 , and ending 03-31-2021
BCheck if applicable:
CName of organization
Southern Illinois Hospital Services
 
 
Doing business as
Southern Illinois Healthcare
 
Number and street (or P.O. box if mail is not delivered to street address)
PO BOX 3988
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Carbondale, IL629023988
D Employer identification number

37-0618939
E Telephone number

G Gross receipts $ 5,103,504,174
F Name and address of principal officer:
REX BUDDE
PO BOX 3988
CARBONDALE,IL629023988
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.SIH.net
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1946
M State of legal domicile: IL
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: Southern Illinois Hospital Services' (SIHS) mission statement is "We are dedicated to improving the health and well-being of all of the people in the communities we serve."
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 12
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 11
5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) ...... 5 3,864
6 Total number of volunteers (estimate if necessary) ............. 6 45
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 39 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,888,177 41,794,961
9 Program service revenue (Part VIII, line 2g) ......... 597,748,183 575,430,690
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 34,289,238 -16,211,715
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 7,195,186 8,381,303
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 641,120,784 609,395,239
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 640,980 1,309,978
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 237,084,336 229,053,420
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet127,688    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 326,169,759 332,721,519
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 563,895,075 563,084,917
19 Revenue less expenses. Subtract line 18 from line 12....... 77,225,709 46,310,322
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 1,095,233,961 1,431,641,838
21 Total liabilities (Part X, line 26)............. 353,968,271 523,680,875
22 Net assets or fund balances. Subtract line 21 from line 20..... 741,265,690 907,960,963
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2020)
Form 990 (2020)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: Southern Illinois Hospital Services (SIHS) is dedicated to promoting the health and well being of all of the people in the communities we serve. Our mission is guided by our values: compassion, collaboration, quality, stewardship, integrity, accountability and respect. (Continued in Schedule O)
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 467,002,092 including grants of $ 0 ) (Revenue $ 582,188,555 )
SOUTHERN ILLINOIS HOSPITAL SERVICES (SIHS) PROVIDES QUALITY HEALTH SERVICES TO PEOPLE THROUGHOUT SOUTHERN ILLINOIS REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. THROUGH DAILY OPERATIONS, SIHS' HOSPITALS PROVIDE SIGNIFICANT AMOUNTS OF UNCOMPENSATED CHARITY CARE, UNCOMPENSATED GOVERNMENT-SPONSORED HEALTH CARE, SUBSIDIZED HEALTH SERVICES AND MEDICAL EDUCATION. THE PRIMARY SERVICE AREA OF SIHS IS A VERY RURAL SEVEN-COUNTY REGION WITH A COMBINED POPULATION OF APPROXIMATELY 235,000. THE RESIDENTS OF THESE COUNTIES' MEDIAN HOUSEHOLD INCOMES ARE BELOW THE STATE AVERAGE AND IN ADDITION, THE POVERTY RATE IS HIGHER THAN THE STATE AVERAGE. (CONTINUED IN SCHEDULE O)
4b (Code:   ) (Expenses $ 2,156,723 including grants of $ 1,309,978 ) (Revenue $ 0 )
THROUGH OUR COMMUNITY BENEFITS PROGRAM AND SERVICES, SOUTHERN ILLINOIS HOSPITAL SERVICES (SIHS) HAS EXTENDED ITS CARE BEYOND HOSPITAL WALLS AND INTO THE NEIGHBORHOODS WHERE PEOPLE LIVE AND WORK TO POSITIVELY IMPACT THOSE COMMUNITIES. THE COMMUNITY BENEFITS DEPARTMENT OF SIHS WAS INSTITUTED IN 1994 WITH AN OPERATING BUDGET SPECIFICALLY ALLOCATED TO BRING HEALTH-RELATED PROGRAMS TO THE AREAS IN WHICH THEY WERE MOST NEEDED. COMMUNITY BENEFITS HAS UNDERTAKEN A WIDE VARIETY OF SUCCESSFUL PROGRAMS SINCE ITS INCEPTION. (CONTINUED IN SCHEDULE O)
4c (Code:   ) (Expenses $ 359,682 including grants of $ 0 ) (Revenue $ 0 )
SOUTHERN ILLINOIS HOSPITAL SERVICES (SIHS) PROVIDES PROGRAMS TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES. (CONTINUED IN SCHEDULE O)
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet469,518,497
Form 990 (2020)
Form 990 (2020)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III..
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part III..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
Form 990 (2020)
Form 990 (2020)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part IIClick to see attachment...........
26
Yes
 
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....Click to see attachment
28b
Yes
 
c
A 35% controlled entity of one or more individuals and/or organizations described in lines 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ..
1a
297
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2020)
Form 990 (2020)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
3,864
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletCJ
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see instructions and file Form 4720, Schedule N.
15
Yes
 
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
Form 990 (2020)
Form 990 (2020)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
12
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
11
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
IL
18
Section 6104 requires an organization to make its Form 1023 (or 1024-A if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletMIKE KASSER1239 EAST MAIN STREET   CARBONDALE,IL62901 (618) 457-5200
Form 990 (2020)
Form 990 (2020)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Bob Mees
 
Vice Chair
 2.0
.................
1.0 		X   X       0 0 0
(2) Marlene Simpson
 
Secretary
 2.0
.................
1.0 		X   X       0 0 0
(3) Mike Hudson
 
Chair
 2.0
.................
2.0 		X   X       300 0 0
(4) Rex Budde
 
President/CEO
 40.0
.................
15.0 		X   X       1,051,964 0 329,512
(5) Daniel Booth
 
Trustee
 2.0
.................
2.0 		X           0 0 0
(6) Debra McMorrow
 
Trustee
 2.0
.................
1.0 		X           0 0 0
(7) Dr Terrence Glennon
 
Trustee
 1.0
.................
2.0 		X           250 0 0
(8) Eugene Basanta
 
Trustee
 2.0
.................
2.0 		X           250 0 0
(9) George O'Neill
 
Trustee
 1.0
.................
2.0 		X           250 0 0
(10) Kathleen Fralish
 
Trustee
 1.0
.................
1.0 		X           300 0 0
(11) Morton Levine
 
Trustee
 2.0
.................
2.0 		X           300 0 0
(12) Steve Sabens
 
Trustee
 2.0
.................
1.0 		X           0 0 0
(13) Al Taylor
 
VP/Administrator
 50.0
.................
0 		    X       452,840 0 94,461
(14) Daniel Skiles
 
VP/Health Transformation
 43.0
.................
12.0 		    X       371,941 0 82,593
(15) David Hakanson
 
VP/Innovation Technology
 40.0
.................
14.0 		    X       327,745 0 46,932
(16) Jennifer Harre
 
VP/CNO
 50.0
.................
0 		    X       278,953 0 67,309
(17) John B Millstead
 
SR VP/COO
 55.0
.................
0 		    X       736,703 0 220,277
Form 990 (2020)
Form 990 (2020)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) John Daly
 
VP/General Counsel
 40.0
.......................15.0 		    X       356,808 0 37,137
(19) Marci L Moore-Connelley MD
 
SR VP/CMO
 40.0
.......................15.0 		    X       570,061 0 82,645
(20) Mike Kasser
 
SR VP/CFO/TREASURER
 40.0
.......................15.0 		    X       801,909 0 165,592
(21) Pam Henderson
 
VP/ HR
 50.0
.......................0 		    X       395,947 0 94,330
(22) Philip Schaefer
 
SR VP/ ADMINISTRATOR/CCNDO
 15.0
.......................40.0 		    X       822,700 0 177,827
(23) Rodney Smith
 
VP/Administrator
 55.0
.......................0 		    X       416,573 0 86,135
(24) Shelly Pierce
 
VP/Quality
 30.0
.......................25.0 		    X       344,952 0 67,965
(25) Todd Guenzburger
 
VP/Chief Health Info Officer
 40.0
.......................14.0 		    X       323,300 0 30,031
(26) William Thorne
 
VP/ Community Benefits
 50.0
.......................0 		    X       319,383 0 102,980
(27) Gery Blackburn
 
Treasury Manager
 40.0
.......................0 		        X   289,297 0 12,853
(28) Paul Troiano
 
System Pharmacy Director
 40.0
.......................0 		        X   272,368 0 10,762
(29) Rebecca Brasel
 
Registered Nurse Shift Supervisor
 60.0
.......................0 		        X   253,503 0 42,968
(30) Shannon Hartke
 
PFS Manager
 40.0
.......................0 		        X   238,686 0 12,172
(31) Tim Kernan
 
System Surgery Director
 40.0
.......................0 		        X   247,476 0 24,579
(32) Gerald Mourey
 
Former Officer
 0.0
.......................0.0 		          X 516,939 0 44,655
(33) William Sherwood
 
Former Officer
 20.0
.......................0.0 		          X 201,368 0 38,091
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 9,593,066 0 1,871,806
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet251
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
SHIRLEY RYAN ABILITY LAB

355 EAST ERIE
CHICAGO,IL60611 		REHAB SERVICES 3,339,628
MEDICAL STAFFING NETWORK INC

PO BOX 840292
DALLAS,TX75284 		STAFFING 3,153,591
HURON CONSULTING GRP

4795 PAYSPHERE CIR
CHICAGO,IL60674 		CONSULTING SERVICES 2,190,453
FRESENIUS MEDICAL CARE

16343 COLLECTIONS CTR DR
CHICAGO,IL60693 		LAB SERVICES 1,479,084
Claim Assist

Corp Finance Department
PO Box 827
Norwood,MA020620827 		collection services 1,062,172
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet47
Form 990 (2020)
Form 990 (2020)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a 0
b Membership dues..1b 0
c Fundraising events..1c 0
d Related organizations1d 633,480
e Government grants (contributions)1e 40,538,781
f All other contributions, gifts, grants, and similar amounts not included above1f 622,700
g Noncash contributions included in lines 1a - 1f:$ 1g 0
h Total. Add lines 1a-1f.......MediumBullet 41,794,961
Program Service RevenueAmt Business Code
2a Patient Revenue 622110 570,988,535 570,988,535 0 0
b Affiliate Income in Southern Illinois Orthopedic Center 900099 1,913,182 1,913,182 0 0
c Interest on state payments 900099 1,290,149 1,290,149 0 0
d Leasehold revenue from related organizations 531120 1,238,824 1,238,824 0 0
e     0   0 0
f All other program service revenue. 0 0 0 0
g Total. Add lines 2a–2f .....MediumBullet 575,430,690
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 10,665,548 0 0 10,665,548
4 Income from investment of tax-exempt bond proceedsMediumBullet 0 0 0 0
5 Royalties...........MediumBullet 0 0 0 0
(ii) Personal (i) Real
6a Gross rents   2,085,438 6a
b Less: rental expenses   1,981,166 6b
c Rental income or (loss) 0 104,272 6c
d Net rental income or (loss).......MediumBullet 104,272 0 0 104,272
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory   4,465,250,506 7a
b Less: cost or other basis and sales expenses   4,492,127,769 7b
c Gain or (loss) 0 -26,877,263 7c
d Net gain or (loss).........MediumBullet -26,877,263 0 0 -26,877,263
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a  
b Less: direct expenses ... 8b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a  
b Less: direct expenses ... 9b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
10a  
b Less: cost of goods sold .. 10b  
c Net income or (loss) from sales of inventory..MediumBullet        
Business Code Miscellaneous Revenue
11a Physician Hospital Organization Revenue 900099 6,004,594 6,004,594    
b Cafeteria/Vending/Hospital Auxiliary 900099 1,925,158 405,992   1,519,166
c Medical records/x-ray 621300 134,582 134,582 0 0
d All other revenue .... 212,697 212,697 0 0
e Total. Add lines 11a–11d ...... MediumBullet 8,277,031
12 Total revenue. See instructions.....MediumBullet 609,395,239 582,188,555 0 -14,588,277
Form 990 (2020)
Form 990 (2020)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 1,309,978 1,309,978
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ........... 0 0
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. ............. 0 0
4 Benefits paid to or for members ....... 0 0
5 Compensation of current officers, directors, trustees, and key employees ........... 9,379,334 1,431,010 7,948,324 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ......... 160,572 160,572 0 0
7 Other salaries and wages........ 177,238,008 137,180,567 39,956,446 100,995
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 3,969,510 3,735,478 232,083 1,949
9 Other employee benefits ....... 25,244,470 24,820,930 417,329 6,211
10 Payroll taxes ........... 13,061,526 9,963,733 3,090,227 7,566
11 Fees for services (non-employees):        
a Management ...... 0 0 0 0
b Legal ......... 1,138,714 70,715 1,067,999 0
c Accounting ........... 213,280 8,094 205,186 0
d Lobbying ........... 142,610 0 142,610 0
e Professional fundraising services. See Part IV, line 17 0 0
f Investment management fees ...... 800,184 0 800,184 0
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 77,500,307 66,980,001 10,520,306 0
12 Advertising and promotion .... 1,002,297 1,081 1,001,216 0
13 Office expenses ....... 11,196,610 7,242,433 3,943,210 10,967
14 Information technology ...... 20,454,362 17,065,797 3,388,565 0
15 Royalties .. 0 0 0 0
16 Occupancy ........... 9,709,679 8,189,257 1,520,422 0
17 Travel ............ 218,178 99,926 118,252 0
18 Payments of travel or entertainment expenses for any federal, state, or local public officials . 0 0 0 0
19 Conferences, conventions, and meetings .... 284,859 152,344 132,515 0
20 Interest ........... 10,789,739 6,487,881 4,301,858 0
21 Payments to affiliates ....... 0 0 0 0
22 Depreciation, depletion, and amortization .. 40,836,060 29,431,124 11,404,936 0
23 Insurance ... 5,968,087 5,406,902 561,185 0
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a Medical Supplies 120,402,636 120,402,636 0 0
b Provider Tax 18,744,104 18,744,104 0 0
c Equipment Rental 9,189,646 8,249,552 940,094 0
d Hospital Auxiliary 377,646 377,646 0 0
e All other expenses 3,752,521 2,006,736 1,745,785 0
25 Total functional expenses. Add lines 1 through 24e 563,084,917 469,518,497 93,438,732 127,688
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2020)
Form 990 (2020)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 25,829 1 37,202
2 Savings and temporary cash investments ......... 22,392,834 2 88,047,123
3 Pledges and grants receivable, net ...... 0 3  
4 Accounts receivable, net ............. 84,103,281 4 81,952,850
5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
307,834 5 307,615
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
0 6 0
7 Notes and loans receivable, net ........... 499,481 7 442,219
8 Inventories for sale or use ............ 18,805,337 8 20,437,345
9 Prepaid expenses and deferred charges ...... 8,328,745 9 9,025,372
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 659,772,712
b Less: accumulated depreciation 10b 344,507,047 306,864,024 10c 315,265,665
11 Investments—publicly traded securities . 439,382,278 11 662,422,023
12 Investments—other securities. See Part IV, line 11 ..... 4,926,441 12 4,465,196
13 Investments—program-related. See Part IV, line 11 .. 0 13  
14 Intangible assets ............... 1,118,916 14 1,446,420
15 Other assets. See Part IV, line 11 ........... 208,478,961 15 247,792,808
16 Total assets. Add lines 1 through 15 (must equal line 33)... 1,095,233,961 16 1,431,641,838
Liabilities 17 Accounts payable and accrued expenses ..... 58,349,415 17 63,427,652
18 Grants payable ... 0 18 0
19 Deferred revenue ......... 0 19 0
20 Tax-exempt bond liabilities ......... 216,625,765 20 212,460,797
21 Escrow or custodial account liability. Complete Part IV of Schedule D 0 21 0
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .. 0 24 436,993
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D 78,993,091 25 247,355,433
26 Total liabilities. Add lines 17 through 25.. 353,968,271 26 523,680,875
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 740,458,651 27 906,951,433
28 Net assets with donor restrictions ........... 807,039 28 1,009,530
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds ..... 0 29 0
30 Paid-in or capital surplus, or land, building or equipment fund ... 0 30 0
31 Retained earnings, endowment, accumulated income, or other funds 0 31 0
32 Total net assets or fund balances ........... 741,265,690 32 907,960,963
33 Total liabilities and net assets/fund balances ........ 1,095,233,961 33 1,431,641,838
Form 990 (2020)
Form 990 (2020)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
609,395,239
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
563,084,917
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
46,310,322
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
741,265,690
5
Net unrealized gains (losses) on investments ...............
5
116,473,796
6
Donated services and use of facilities .................
6
0
7
Investment expenses .....................
7
0
8
Prior period adjustments .....................
8
0
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
3,911,155
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
907,960,963
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2020)
Form 990 (2020)
Additional Data


Software ID: 20011424
Software Version: 2020v4.0
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
Southern Illinois Hospital Services
 
Employer identification number

37-0618939
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support. Add lines 7 through 10  
12
12
 
13
First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose            
3 Gross receipts from activities that are not an unrelated trade or business under section 513 .....            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge            
6 Total. Add lines 1 through 5            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support. (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in lines 11b and 11c below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in 11a above?
11b
 
 
c
A 35% controlled entity of a person described in line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    
Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by 0.035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes 1  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity 		2  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations 3  
4 Amounts paid to acquire exempt-use assets 4  
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) 5  
6 Other distributions (describe in Part VI). See instructions 6  
7Total annual distributions. Add lines 1 through 6. 7  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions 		8  
9 Distributable amount for 2020 from Section C, line 6 9  
10 Line 8 amount divided by Line 9 amount 10  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2020 		(iii)
Distributable
Amount for 2020
1 Distributable amount for 2020 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2020:
a From 2015.......  
b From 2016.......  
c From 2017.......  
d From 2018.......  
e From 2019.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2020 distributable amount  
i Carryover from 2015 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.  
4Distributions for 2020 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2020 distributable amount  
c Remainder. Subtract lines 4a and 4b from line 4.  
5 Remaining underdistributions for years prior to
2020, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions. 		 
6 Remaining underdistributions for 2020. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions. 		 
7 Excess distributions carryover to 2021. Add lines
3j and 4c. 		 
8 Breakdown of line 7:
a Excess from 2016.....  
b Excess from 2017.....  
c Excess from 2018.....  
d Excess from 2019.....  
e Excess from 2020.....  
Schedule A (Form 990 or 990-EZ) (2020)

Schedule A (Form 990 or 990-EZ) 2020
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2020


Additional Data


Software ID: 20011424
Software Version: 2020v4.0
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2020
Name of the organization
Southern Illinois Hospital Services
 
Employer identification number

37-0618939
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2
Name of organization
Southern Illinois Hospital Services
  		Employer identification number
37-0618939
Part I
Contributors
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
 
 
 
 
  ,    

$ RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Page 3
Name of organization
Southern Illinois Hospital Services
  		Employer identification number

37-0618939
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Page 4
Name of organization
Southern Illinois Hospital Services
  		Employer identification number

37-0618939
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Additional Data


Software ID: 20011424
Software Version: 2020v4.0
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet Complete if the organization is described below. SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Southern Illinois Hospital Services
 
Employer identification number

37-0618939
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

2
Political campaign activity expenditures (see instructions) ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities (see instructions) ..................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2020

Schedule C (Form 990 or 990-EZ) 2020
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................    
b Total lobbying expenditures to influence a legislative body (direct lobbying) ........................    
c Total lobbying expenditures (add lines 1a and 1b) ............................................................    
d Other exempt purpose expenditures ...............................................................................    
e Total exempt purpose expenditures (add lines 1c and 1d) ..................................................    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................................................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ...................................................................................................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))		  
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2020


Schedule C (Form 990 or 990-EZ) 2020
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes|No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
Yes
 
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
Yes
 
142,610
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
68,290
j
Total. Add lines 1c through 1i ....................................................................................................
210,900
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Schedule C, Part II-B, Line 1g DIRECT CONTACT WITH LEGISLATORS THE ORGANIZATION HAS HIRED A PROFESSIONAL SERVICES FIRM TO CONDUCT LOBBYING ON BEHALF OF THE ORGANIZATION.
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY A portion of dues paid to Illinois Hospital Association is used for lobbying by that Association in the amount of $68,290.
Schedule C (Form 990 or 990EZ) 2020


Additional Data


Software ID: 20011424
Software Version: 2020v4.0

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
SchDMd Bullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
Southern Illinois Hospital Services
 
Employer identification number

37-0618939
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2020

Schedule D (Form 990) 2020
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....
Part V
Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back
1a Beginning of year balance ....          
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Term endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .......................
3a(i)
 
 
(ii) Related organizations .......................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment) 		(b) Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .....   18,931,638 18,931,638
b Buildings ....   205,912,830 104,082,108 101,830,722
c Leasehold improvements   4,376,156 4,033,414 342,742
d Equipment ....   388,546,496 224,901,374 163,645,122
e Other .....   42,005,592 11,490,151 30,515,441
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 315,265,665
Schedule D (Form 990) 2020

Schedule D (Form 990) 2020
Page 3
Part VII
Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) Financial derivatives.........    
(2) Closely-held equity interests........    
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)Due from affiliates 238,034,047
(2)Student/Tuition Loans Receivable 1,439,436
(3)Other Current Assets 1,655,355
(4)Executive Benefit Plan 5,113,962
(5)Long Term Prepaid Expense 1,550,008
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 247,792,808
Part X
Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes  
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 247,355,433
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2020

Schedule D (Form 990) 2020
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1.................. 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities ......... 2a  
b Prior year adjustments ............ 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d.................... 2e  
3 Subtract line 2e from line 1................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote The organization is included in consolidated financial statements. Below is the FIN 48 (ASC 740) footnote from those financial statements: SIHE and its affiliated organizations, with the exception of the Captive, HSSI and PSC, are exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code. The Corporation realized certain income which the Internal Revenue Service considers to be unrelated business income subject to income tax. For the years ended March 31, 2021 and 2020, no tax was due related to these operations. The Captive is incorporated under the laws of the Cayman Islands, which imposes no tax on income or capital gains. However, the Captive is subject to U.S. federal corporate taxation to the extent that it generates income that is effectively connected with a U.S. trade or business. The Captive is not engaged in any such trade or business in the U.S. PSC is a pass-through entity and its members separately account for their share of PSC's net income or loss which is allocated to the members based on the ownership percentage. Accordingly, income taxes are not provided for in the accompanying consolidated financial statements. When tax returns are filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would be ultimately sustained. Examples of tax positions common to health systems include matters such as the tax exempt entity taking a tax position that an organization is tax exempt without observing corresponding proof of tax exemption from federal and state taxing authorities and there is material net income generated by the entity or egregious compensation paid to insiders that could result in revocation of exempt status (outside the scope of intermediate sanctions excise tax penalties). The tax position is to consider that these compensatory arrangements do not jeopardize tax exemption. The benefit of a tax position is recognized in the consolidated financial statements in the period during which, based on all available evidence, management believes it is more likely than not that the position will be sustained upon examination, including the resolution of appeals or litigation processes, if any. Tax positions taken are not offset or aggregated with other positions. Tax positions that meet the "more-likely-than-not" recognition threshold are measured as the largest amount of tax benefit that is more than 50 percent likely of being realized upon settlement with the applicable taxing authority. There were no uncertain tax benefits identified and recorded at March 31, 2021 and 2020. The Corporation does not expect the total amount of unrecognized tax benefits to significantly change in the next 12 months. The Corporation would recognize interest and/or penalties related to income tax matters in miscellaneous expenses. There was no interest and/or penalties related to income tax matters identified and recorded at March 31, 2021 and 2020. Tax returns filed by the Corporation are subject to examination by the Internal Revenue Service (IRS) up to three years from the extended due date of each return. Tax returns filed by the Corporation are no longer subject to examination for the years ended March 31, 2017 and prior.
Schedule D (Form 990) 2020


Additional Data


Software ID: 20011424
Software Version: 2020v4.0




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990.Right pointing arrow large image Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
Southern Illinois Hospital Services
 
Employer identification number

37-0618939
Part I
General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants and
other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in the region (d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in the region		 (f) Total expenditures
for and investments
in the region
Central America and the Caribbean 0 0 Investments   120,000
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .... 0 0 120,000
b Total from continuation sheets to Part I ... 0 0 0
c Totals (add lines 3a and 3b) 0 0 120,000
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2020
Schedule F (Form 990) 2020
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount
of noncash
assistance 		(h) Description
of noncash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......MediumBullet
 
3 Enter total number of other organizations or entities .......................MediumBullet
 
Schedule F (Form 990) 2020
Schedule F (Form 990) 2020Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
noncash
assistance 		(g) Description
of noncash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2020
Schedule F (Form 990) 2020
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule F (Form 990) 2020
Schedule F (Form 990) 2020
Page 5
Part V
Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.
ReturnReference Explanation
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule F (Form 990) 2020
Additional Data


Software ID: 20011424
Software Version: 2020v4.0



SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
Southern Illinois Hospital Services
 
Employer identification number

37-0618939
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    6,361,982 0 6,361,982 1.13 %
b Medicaid (from Worksheet 3, column a) . . . . .     122,337,948 95,239,300 27,098,648 4.81 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     0 0 0 0 %
d Total Financial Assistance and Means-Tested Government Programs . . . . . 0 0 128,699,930 95,239,300 33,460,630 5.94 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     597,104 0 597,104 0.11 %
f Health professions education (from Worksheet 5) . . .     3,753,131 844,436 2,908,695 0.52 %
g Subsidized health services (from Worksheet 6) . . . .     3,483,344 1,663,622 1,819,722 0.32 %
h Research (from Worksheet 7) .     239,284 17,238 222,046 0.04 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     1,309,978   1,309,978 0.23 %
j Total. Other Benefits . . 0 0 9,382,841 2,525,296 6,857,545 1.22 %
k Total. Add lines 7d and 7j . 0 0 138,082,771 97,764,596 40,318,175 7.16 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing         0 0 %
2 Economic development         0 0 %
3 Community support         0 0 %
4 Environmental improvements         0 0 %
5 Leadership development and
training for community members		         0 0 %
6 Coalition building     249,641 0 249,641 0.04 %
7 Community health improvement advocacy     359,682 0 359,682 0.06 %
8 Workforce development         0 0 %
9 Other         0 0 %
10 Total 0 0 609,323 0 609,323 0.11 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
24,493,138
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
5,020,512
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
150,380,673
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
174,426,149
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-24,045,476
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1PHYSICIAN'S SURGERY CENTER
  		SURGERY CENTER 65.09 % 0 % 34.91 %
2SOUTHERN ILLINOIS ORTHOPEDICS CENTER
  		MEDICINE 49 % 0 % 51 %
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?3Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 MEMORIAL HOSPITAL OF CARBONDALE
405 WEST JACKSON STREET
CARBONDALE,IL62901
www.sih.net
0000513 		X X   X     X     A
2 HERRIN HOSPITAL
201 SOUTH 14TH STREET
HERRIN,IL62948
www.sih.net
0000935 		X X         X   ACUTE REHAB A
3 ST JOSEPH MEMORIAL HOSPITAL
2 SOUTH HOSPITAL DRIVE
MURPHYSBORO,IL62966
www.sih.net
0004614 		X X     X   X     A
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
A
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		 
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 18
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): WWW.SIH.NET/ABOUT/COMMUNITY-BENEFITS/
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
A
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
www.sih.net/patients-visitors/healthcare-assistance-program/
b
ww.sih.net/patients-visitors/healthcare-assistance-program/
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 6
Part VFacility Information (continued)

Billing and Collections
A
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
A
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Schedule H, Part V, Section B, Line 3E The significant health needs of the community are identified through the CHNA. These needs were prioritized based on overall impact, magnitude of the problem, severity and ability and interest of the community. CHNA advisory team members discussed and voted on the top 5 issues. Feedback from senior leadership was obtained and the following areas were identified as the priority needs: 1 - Cancer 2 - Cardiovascular disease and its risk factors of obesity and diabetes 3 - Mental Health
Schedule H, Part V, Section B, Line 5 Facility A, 1 Facility A, 1 - A. The broad interests of the community we serve were incorporated by including input from residents, patient groups, health care practitioners, local health departments, social services providers, and other community organizations and partners. A survey of 699 community members and partners and 40 healthcare providers was conducted to gain input regarding overall health issues to be addressed. The most important health issues in our service area were identified, particularly for vulnerable and under-represented population. These populations include low income, medically under-served, uninsured individuals. Participants contributed to this assessment by: -Identifying and prioritizing needs; -Highlighting current successful and ongoing activities; -Identifying gaps where attention is needed; -Fostering collaboration, pursuing opportunities for innovation and sustainability; -Developing plans to address significant community health issues. The process was guided by a steering committee composed of an internal team of SIH representatives and an external team of community stakeholders knowledgeable about health, needs assessment, and the local community. The process included a primary survey of our community's health priorities, meetings with healthcare providers and a 34 member SIH CHNA Advisory team. The CHNA Advisory team members included SIH staff, local public health department staff, and health and social service providers. This team reviewed the data, provided input and shared their perceptions of overall impact, magnitude of the problem, severity, and ability and interest of the community to address the issues. Active participation in local Health Community Coalitions also provided insight into the needs and priorities of our community members.
Schedule H, Part V, Section B, Line 6a Facility A, 1 Facility A, 1 - A. MEMORIAL HOSPITAL OF CARBONDALE, CARBONDALE, IL HERRIN HOSPITAL, HERRIN, IL ST JOSEPH MEMORIAL HOSPITAL, MURPHYSBORO, IL
Schedule H, Part V, Section B, Line 11 Facility A, 1 Facility A, 1 - A. The most recently conducted CHNA was completed in March 2019 for which an implementation strategy has been developed for April 1, 2019 through March 31, 2022. The information below describes how the hospital is addressing the needs identified in the most recent CHNA. Three implementation plan teams were developed in order to bring experts together with expertise and interest in each of the chosen areas. Key issues and needs were identified and intervention strategies were developed. The Community Health Needs Assessment and Implementation Plan was reviewed and adopted by the SIH Board of Trustees in March 2019. The priority areas through this needs assessment will be used to focus Community Benefits Department planning for the next three years (April 1 2019 - March 31, 2022). These issues are Prescription Drug and Opiod Use, Non-Emergency Medical Transportation, and Barriers to Health & Healthcare. Some issues were identified but not prioritized to directly address at this time due to such factors as other groups and organizations, including SIH, already working to address them.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?25
Name and address Type of Facility (describe)
1 Logan Park Radiology & Lab
405 Rushing Drive
Herrin,IL62948 		Radiology, Lab
2 Prairie Building
409 West Oak
Carbondale,IL62901 		Cardiac Diagnostic
3 Primary Care Group
117 East Clark Street
Harrisburg,IL62946 		Lab, Imaging, Wound Care, Physical Therapy
4 Physician Surgery Center
2601 West Main
Carbondale,IL62901 		Surgery Center
5 Cancer Institute
1400 Pin Oak Drive
Carterville,IL62918 		Cancer treatment
6 St Jo Lab & Imaging - St Jo
2601 West Main St
Carbondale,IL62901 		Lab & Imaging Services
7 LPC-WF Imaging & Lab
502 St Louis Street
West Frankfort,IL62896 		Lab, Imaging, Rehab Services
8 Breast Center
1237 East Main St
Carbondale,IL62901 		Mammography
9 Women's Center
3117 Williamson Co Parkway
Marion,IL62959 		Mammography
10 Outpatient Rehab - Marion
1403 Joe Abbott Way
Marion,IL62959 		Physical Therapy
11 Wound Care
315 South 13th St
Herrin,IL62948 		Wound Care
12 Outpatient Rehab - Carbondale
305 West Jackson
Carbondale,IL62901 		Physical Therapy
13 Outpatient Rehab - Anna
515 East Vienna St
Anna,IL62906 		Physical Therapy
14 Sleep Center
8305 Express Drive
Marion,IL62959 		Sleep Studies
15 Outpatient Rehab - Murphysboro
6 East Shawnee Drive
Murphysboro,IL62966 		Physical Therapy
16 Prairie Heart Marion
3905 Ernestine Drive
Marion,IL62959 		Cardiac Diagnostic
17 Miners Memorial Health Center
2553 Ken Gray Blvd
West Frankfort,IL62896 		Family Practice, Radiology, Lab and Specialty Clinics
18 RICSIH Rehabilitation Services
PO BOX 3988
CARBONDALE,IL62901 		Rehabilitation Services
19 Outpatient Rehab - Logan Park
3308 Logan Drive
Herrin,IL62948 		Physical Therapy
20 Cardiac Diagnostic Services
217 S Park Avenue
Herrin,IL62948 		Rehabilitation Services
21 RIC Physician Practices
3224 South Park Avenue
Herrin,IL62948 		Rehabilitation Services
22 Outpatient Rehab - Marion East
1501 Sandbar Drive
Marion,IL62959 		Rehabilitation services
23 Franklin Medical Arts
203 Bailey Lane
Benton,IL62812 		Lab
24 Oldenhage-Hughes
207 W Jackson St
Carbondale,IL62901 		Lab Services
25 Medical Arts Clinic
19 East Shawnee Drive
Murphysboro,IL62868 		Lab Services
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Schedule H, Part I, Line 7g Subsidized Health Services A FAMILY PRACTICE CENTER IS INCLUDED IN SUBSIDIZED HEALTH SERVICES. THE COST OF PROVIDING THIS CENTER WAS $1,544,700.
Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 0
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED VARY ACCORDING TO THE INFORMATON REQUESTED AND THE MOST ACCURATE MEANS OF GATHERING THE REQURIED INFORMATION. THE IRS PROVIDED WORKSHEET NUMBER 2 WAS USED TO CALCULATE A COST TO CHARGE RATIO USING INFORMATION FROM THE ORGANIZATION'S GENERAL LEDGER AND COST REPORTS. THAT RATIO WAS THEN USED IN CONJUNCTION WITH IRS WORKSHEET 1 TO CALCULATE THE COST OF FINANCIAL ASSISTANCE PROVIDED AND WORKSHEET NUMBER 3 TO CALCULATE UNREIMBURSED MEDICAID AMOUNTS. THE ORGANIZATION'S COST ACCOUNTING PROGRAM WAS UTILIZED FOR CALCULATING PORTIONS OF THE SUBSIDIZED HEALTH SERVICES. THE ORGANZATION'S COST ACCOUNTING PROGRAM ENCOMPASSES ALL PATIENT TYPES, SERVICE AND PAYORS. THE COST ASSOCIATED WITH A SERVICE ARE REVIEWED AND UPDATED ANNUALLY TO PROVIDE THE MOST ACCURATE COST POSSIBLE. BOTH DIRECT AND INDIRECT COSTS ARE UTILIZED IN CALCULATING COST. ACTUAL COST OF HEALTH IMPROVEMENT AND COMMUNITY BENEFIT PROGRAMS, HEALTH EDUCATION, RESEARCH PROGRAM, SOME SUBSIDIZED HEALTH SERVICES AND DONATIONS ARE STATED AT ACTUAL COST. THE COSTS OF THESE ITEMS ARE TRACKED THROUGH THE GENERAL LEDGER PROCESS AND THROUGH OTHER ACCOUNTING SOFTWARE.
Schedule H, Part II Community Building Activities Through Community Building activities, Southern Illinois Hospital Services addresses the causes of health problems through programs that advocate for Community Health Improvements. These programs include: Healthy Communities - This initiative is directed at improving community health through timely assessment of needs and facilitating the planning, implementation, and evaluation of community-based programs and services. SIH is active in two Healthy Communities Coalitions in local counties. These coalitions are comprised of health providers, social service agencies, citizens and other interested community groups interested in improving the health of their respective communities. The Jackson County Healthy Community Coalition raises awareness about health issues relevant to Jackson County, develops projects that address unmet needs or gaps in health services, coordinates services and collaborations to maximize resources, develop plans and reports, encourages advocacy and assists in accessing funding. Membership includes partners from over 80 different Jackson county organizations. Action teams have been developed to address the following: - Behavioral Health - works to prevent substance abuse, enhance mental health and emotional well-being of the county residents - Positive Youth Development - trainings, education and related activities for community youth. - Sexual Action Team - focus on decreasing sexually transmitted diseases through education, screenings and protective behaviors - Health Living Action Team - works to prevent cardiovascular disease by targeting eating behaviors, physical activity and tobacco use. - Joint Access to Care Team - focuses on improving access to all health care services - Cancer Action Team - works to increase screening and public education - Built Environment Team - works to improve the environment for pedestrians and bicyclists - Preparedness Team - prepares communities for emergencies - Diabetes Today Resource Team - works to reduce diabetes and its impact on those living with the disease. The Franklin/Williamson Counties Healthy Communities Coalition supports the collection, tracking and reporting of relevant county health data, develops projects to address identified health priorities, develops plans and reports, fosters collaboration and encourages advocacy. Membership includes partners from over 60 different Franklin/Williamson county organizations. Action teams have been developed to address the following: - Healthy Seniors Action Team - provides activities which promote the health and well-being of individuals age 55 and older - Positive Youth Development - addresses health issues concerning youth - Joint Access to Care Team - focuses on improving access to all health care services. As part of the above coalitions, Southern Illinois Healthcare provided funding to local health departments for their work to provide a regional chronic disease/diabetes self-management program. Accomplishments of this initiative include training over 98 certified leaders in these programs, conducting classes for 56 individuals in FY21, and conducting screening events to promote early detection of diabetes and hypertension. Other initiatives of our Health Communities include the following: - Provide funding of the Medical Legal Partnership of Southern Illinois which offers individuals and families legal help to improve their health. The collaborative effort of Southern Illinois Healthcare and Land of Lincoln Legal Assistance Foundation assists patients in improving their health by alleviating the legal stressors in their lives. During the current year 207 low-income patients were assisted through this initiative. - Dental care is an area identified as an access to care issue in our community health needs assessment. Southern Illinois Healthcare has partnered with 3 local federally qualified health centers to address the issue of dental coverage. The program ensures appointments are available for oral health concerns. - SIH provides funding to the Illinois Poison Center. The Illinois Poison Center is a non-profit health service that provides comprehensive and trusted information and treatment advice on potentially harmful substances via a free, confidential 24 hour helpline. Information materials are provided to schools and community groups to spread prevention and poison awareness messages. - Prior to COVID, in collaboration with the Southern Illinois Food Pantry, free health screening events at local food pantries and food truck distribution sites, targeting low income, uninsured and underinsured residents were provided. These screenings are planned to be reinstated in the future. - The lack of non-emergency medical transportation was identified as a priority in the community health needs assessment. A pilot program was launched to provide rides for non-emergency medical appointments. The program will be expanded in the coming year due to the success of the pilot program. Community Health Worker Program - Community Health Workers are frontline public health workers from within the community who serve as a liaison to healthcare agencies. The program targets patients living in Jackson County, 18-59 years of age, uninsured or on Medicaid who have frequent inpatient and ED visits. In FY21 the first community heath worker was trained, the program developed, and a manual completed. Coordinated School Health - This program is directed at reducing the growth of childhood obesity and improving the overall health and well-being of children and adolescents. The "Illinois CATCH on to Health Consortium (ICHC)" is a collaborative initiative between the SIU School of Medicine Center for Rural Health and Social Services Development, local health departments and community organizations in southern Illinois. Together SIH impacted over 80 schools and 20,000 kids in the lower 15 counties of Illinois. SIH partners with local schools to form School Wellness Committees, complete the CDC's School Health Index, and implement Coordinated School Health Programs and policies to improve health and reduce overweight and obesity among southern Illinois students. During FY21, SIH staff worked with 35 schools, which impacted over 9,900 children, in the 5-county service area. SIH also impacted over 1,644 students/ families through Family Fun Nights, school sponsored 5K's, math and science nights, Family Vacation Nights, school safety days, and much more. ICHC members also worked collaboratively with schools in the SIH coverage area to promote and assist in the implementation of coordinated school health programming by providing training and technical support, and by training staff on the CATCH (Coordinated Approach to Child Health) program and supplying CATCH curriculum and materials. Program partners have implemented components of the CATCH program in over 80 elementary school districts in 16 counties impacting over 20,000 students and their families. School Based Fitness Assessment and Training for Physical Education Teachers - Southern Illinois Healthcare promotes lifelong fitness by supporting quality physical education is southern Illinois schools and assisting children to meet the surgeon general's recommendation for 60 minutes of daily physical activity. Support for this is provided through: - Awarding stipends for physical education teachers to attend training workshops - Hosting annual physical education workshops that highlight national physical education standards - Hosting networking sessions throughout the year for physical education teachers - Completing System for Observing Fitness Instruction Time evaluations in participating schools. Patient Support Initiative - Southern Illinois Hospital Services provides a Patient Support Initiative (PSI) with the goal of providing patients with adequate care and compensating physicians at reasonable rates for patients that do not have resources available to pay their health care bills. SIHS compensates physicians for the care of patients that enter the healthcare system via the emergency departments at SIHS facilities and are assigned to physicians based upon the on-call rotation coverage. PSI is designed for physician/patient contact that occurs in a hospital based setting when there was no previous relationship between the patient and the physician or the physician's practice. PSI pays compensation for professional fees only, relating directly to the episode of care begun in the Emergency Department, not to exceed 30 days. Indigent Care Funding - Southern Illinois Hospital Services provides funding to purchase prescriptions, medical supplies and transportation to patients deemed financially indigent on a case-by case basis.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount FOR FINANCIAL STATEMENT PURPOSES, SOUTHERN ILLINOIS HOSPITAL SERVICES HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE ON IRS FORM 990, PART IX. THE AMOUNT REPORTED ON PART III, LINE 3 IS THE ESTIMATED BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED COLLECTIONS OF ACCOUNTS RECEIVABLE CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology The cost to charge ratio is calculated utilizing Worksheet 2 included in the Internal Revenue Service's Form 990 Schedule H instructions. This cost to charge ratio is applied to the gross charges that are deemed to be price concessions written of as bad debt. To estimate the amount of these price concessions that was determined to be bad debt that would have been eligible for charity under our policy the following calculation was prepared: - The number of encounters by county at each of our 3 facilities was obtained from our registration system. The percentage of patients from each county varies by facility due to the location of the facility. - An estimate of the amount of bad debt price concessions by county at each hospital was calculated by applying the percentages obtained above to the amount of gross charges written off as bad debt at each facility. - The poverty rate of each county was then applied to these allocated charges to estimate the amount of charges that would have been eligible under our charity policy based on poverty level guidelines.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote Consolidated Audit Report Pages 12-13: The Patient service revenue note details explicit price concessions.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs The expenses from the audited financial statements are adjusted per Medicare regulations. Overheads are allocated based on the step-down method by using Medicare approved statistics. Medicare costs are determined by multiplying the days or charges times the per diem amount or the cost to charge ratio applicable to the department. Home office expenses are allocated to the facilities based on the Home office cost report. Statistics used on the Home office cost report are approved by the Medicare intermediary. One hundred percent of the shortfall of Medicare allowable costs over Medicare revenue is considered to be a community benefit. By continuing to treat patients eligible for Medicare, hospitals alleviate the federal government's burden for directly providing medical services. The IRS has acknowledged that lessening the government burden associated with providing Medicare benefits is a charitable purpose.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance If SIH determines the individual is eligible for financial assistance, SIH will: -Provide the individual with a billing statement that indicates the amount the individual owes for the care as an individual eligible for financial assistance ("HAP-eligible") (assuming the individual is eligible for assistance other than free care) and how that amount was determined and states, or describes how the individual can get information regarding, the amounts generally billed for the care -Refund to the individual any amount he or she has paid for the care (whether to the hospital facility or any other party to whom the hospital facility has referred or sold the individual's debt for the care) that exceeds the amount he or she is determined to be personally responsible for paying as a HAP-eligible individual, unless such amount is less than $5 (or such other amount published in the Internal Revenue Bulletin). -Take all reasonable available measures to reverse any extraordinary collection actions ("ECAs") (with the exception of a sale of debt) taken against the individual to obtain payment for the care. After determining financial assistance eligibility, SIH takes the following actions at least 30 days before first initiating one or more of the above ECAs to obtain payment for care: - Provide the individual with a written notice that indicates financial assistance is available for eligible individuals, identifies the ECA(s) that SIH (or other authorized party) intends to initiate to obtain payment for the care, and states a deadline after which such ECA(s) may be initiated that is no earlier than 30 days after the date that the written notice is provided. -Provide the individual with a plain language summary of the HAP with the written notice described above. -Make a reasonable effort to orally notify the individual about SIH's HAP and about how the individual may obtain assistance with the HAP application process.
Schedule H, Part V, Section B, Line 16a FAP website A - MEMORIAL HOSPITAL OF CARBONDALE: Line 16a URL: www.sih.net/patients-visitors/healthcare-assistance-program/;
Schedule H, Part V, Section B, Line 16b FAP Application website A - MEMORIAL HOSPITAL OF CARBONDALE: Line 16b URL: ww.sih.net/patients-visitors/healthcare-assistance-program/;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website A - MEMORIAL HOSPITAL OF CARBONDALE: Line 16c URL: ww.sih.net/patients-visitors/healthcare-assistance-program/;
Schedule H, Part VI, Line 2 Needs assessment A complete copy of the organization's most recently conducted community health needs assessment and implementation strategy can be found at: http://www.sih.net/about/community-benefits/. The community benefits department at SIHS regularly assesses the needs within the community and provides programs in order to meet the needs in surrounding areas through the following activities: - Monitoring the data and meeting with community coalitions and others to learn about various programs and needs in the communities. - Work with Healthy Southern Illinois Delta Network and others such as local health departments and federally qualified health centers to assess needs on an ongoing basis. - Conduct physician "meet and greets" to discuss the needs and issues the physicians and their staff are seeing in their practices.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance SIH takes the following steps to notify patients about the availability of the healthcare assistance policy ("HAP"): -Financial Assistance notices are placed in all departments registering patients. -SIH posts signage in English and Spanish regarding the availability of financial assistance. -SIH's website posts notice of financial assistance through the Healthcare Assistance Program and applications in English, Arabic and Spanish. -Information regarding HAP is available in all Patient Intake offices and in other public locations within the hospital, (upon request without charge). -Registrars inform all patients of the Healthcare Assistance Program, and offers a plain language summary.
Schedule H, Part VI, Line 4 Community information The primary service area of Southern Illinois Healthcare is a seven-county region in Southern Illinois that includes Perry, Jackson, Franklin, Williamson, Union, Johnson, and Saline counties. The combined population of this area is approximately 245,000. Median household income in the area is $25,845, which is substantially less than the statewide average. All seven counties have more residents living in poverty than the state average. 18.93% of the population is below the federal poverty guidelines, and 8.24% of the population is uninsured. Eight non-SIH hospitals exist within the 7-county primary market area. The Marion VA Medical Center in Marion (Williamson County) is a 55-bed bed acute care facility owned and operated by the US Department of Veterans Affairs. Heartland Regional Medical Center, also located in Marion, is a 92-bed acute care hospital owned by Community Health Systems (CHS). Harrisburg Medical Center in Harrisburg (Saline County) is licensed for 45 acute care beds plus 31 acute mental illness beds. The remaining facilities are 25-bed Critical Access Hospitals: Ferrell Hospital in Eldorado (Saline County); Franklin Hospital in Benton (Franklin County); Marshall Browning Hospital in Du Quoin (Perry County); Pinckneyville Community Hospital in Pinckneyville (Perry County); and CHS-owned Union County Hospital District in Anna (Union County). Harrisburg Medical Center and Marshall Browning Hospital have affiliation agreements with Southern Illinois Healthcare. Each of the seven counties within the primary market area has been federally designated as a Health Professional Shortage Area, and at least a portion of each county has been federally designated as a Medically Underserved Area or having a Medically Underserved Population.
Schedule H, Part VI, Line 5 Promotion of community health Southern Illinois Hospital Services (SIHS) is dedicated to promoting the health and well-being of all of the people in the communities we serve. Our mission is guided by our values: compassion, collaboration, quality, stewardship, integrity, accountability and respect. Over 3,000 employees, along with physicians and volunteers, are working together to achieve our missions and ensure that the health care needs of those we serve are met by treating patients in SIHS facilities, by offering services in rural clinics, by collaborating with some of America's best hospitals and by improving the quality of life in our communities with our charitable community benefits programs. SIHS provides quality health services to people throughout Southern Illinois regardless of race, creed, sex, national origin, handicap, age or ability to pay. SIHS operates 3 community hospitals with a combined total of 279 beds. Each hospital operates a full time emergency room. No one is denied care or treatment within the hospitals or emergency rooms. Medical staff privileges are available to all qualified physicians in the area, consistent with the services provided at each facility. The Board of Trustees of SIHS is comprised of 13 members. These members are comprised of local community leaders, physicians and our CEO. The majority of the Board is comprised of persons who are neither employees nor independent contractors of the organization or family members thereof. SIHS invests excess funds from operations into the expansion and replacement of existing facilities and equipment, repayment of debt and improvement in patient care. Southern Illinois Hospital Services has also extended its services beyond hospital walls and into the neighborhoods where people live and work. Annually operating funds are allocated specifically to bring health-related programs to the areas in which they are most needed. Our goal is to respond to identified community health needs, increase access to care, lead and serve as an example to others in service to the community and improve the overall health status of those in the communities served by SIH facilities. Currently, the Community Benefits Department of SIHS collaborates with Southern Illinois schools to address childhood obesity. Included in this initiative are the Coordinated School Health program, CATCH (Coordinated Approach to Child Health) program and School Based Fitness Assessment and Training for Physical Education Teachers. A Health Ministry initiative, aiding the region's faith communities through the training and support of parish nurses, is an ongoing effort of the department. Over 150 parish nurses have been trained and are being supported in the health promotion work of their respective faith communities to date. Over 41,000 contacts were made during the current year. Also the department is active in the creation and facilitation of Healthy Community Coalitions. These groups include health providers, social service agencies, concerned citizens and other community groups interested in improving the health of their respective communities. The groups seek to meet locally identified community health needs and through the implementation of programs that address the demonstrated unmet health needs of the residents of the communities served. These coalitions make a significant impact on the lives of those within the communities served by SIHS. Currently, staff is engaged in numerous community health promotion, education, and prevention initiatives. An increase in access to primary health, behavioral health, and oral health care services has been affected through the SIHS support of existing and developing community-based interventions. Increased numbers of collaborative partnerships that support increased individual and community capacity to achieve a healthy community vision are ongoing. In order to accomplish the organization's mission as well as the overall goals previously outlined, the Community Benefits Department of Southern Illinois Healthcare implements a number of directed initiatives. Following is a description of these initiatives, the specific goals and objectives to be achieved for FY21, and an outline of the means by which department staff will work to plan, implement, and evaluate these programs. The Coordinated School Health program is working to reduce the growth of childhood obesity and improve the overall health and well-being of children and adolescents. The goal is to increase the number of schools involved in the SIH programs and to increase active PE time. The Health Ministry program collaborates with southern Illinois faith communities to improve the health and wellness of people in the communities they serve. Emphasizing wholeness of body, mind and spirit, faith communities with a health ministry offer health promotion and education activities; advocacy and referral; and caring spiritual support. The goal is to raise awareness of the Parish nursing specialty and establish new health ministries. The focus of the SIH Health Communities Program is to improve the community health through timely assessment of needs and facilitating the planning, implementation, and evaluation of community based programs and services. The goal is to increase collaborative capacity of local agencies and to develop a regional chronic disease/diabetes self-management program. SIH provides funding to sponsor activities and events in the community to promote and encourage healthy and active lifestyles. Sponsored efforts help build a sustainable community-linked infrastructure and a health enhancing environment. On an on-going basis, Community Benefit Department staff participates in and facilitates a variety of boards, coalitions, networks, commissions, committees, partnerships and panels. Spending time in the community enable staff to bring back first-hand knowledge of community needs, existing resources, and identify opportunities for clinical and community linkages. Southern Illinois Hospital Services responded to the COVID pandemic by providing health care and support to our communities. Our facilities adapted to the surge in patients through adapting our facilities to care for COVID patients in a safe environment for our staff and community. Elective procedures were delayed ensuring all beds were available for COVID patients. Southern Illinois Hospital Services established testing sites and established a COVID hotline for the community. SIH Marketing developed a COVID website for community members and medical providers to obtain information and updates from SIH. A COVID at Home program was developed in FY21 and served its first patents in March of 2021. Through the SIH COVID at Home program, thermometers, pulse oximeters and educational materials were provided to patients discharging from Inpatient. Follow-up calls were then made to these patients to ensure they knew how to use their kit and that they had followed up with their primary care provider. The SIH Vice President of Community Affairs/Chief Development Officer and the System Director for Community Health served in the "Community Liaison" roles in our Incident Command Structure and assisted community agencies with information and their response to COVID concerns. The Community Liaisons worked to: * Develop and promote Community COVID Updates to over 2,300 individuals through e-mail updates (including Mayors and City Managers, Law Enforcement , Local Health Departments and Federally Qualified Health Centers, healthcare providers and practice managers, Shawnee Preparedness and Response Coalition Members, other hospitals, local EMA, Higher Education, School superintendents and principals, local business leaders, Chamber of Commerce contacts, Healthy Southern Illinois Delta Network Members (public health and social service agencies as well as community members in the lower 16 counties), Faith Communities, and interested community members. * Purchase handheld forehead thermometers for community agencies, such as the Carbondale Warming Center. * Accept and handle requests and questions from community members and various healthcare agencies In FY21, SIH also partnered with many community members, healthcare agencies, and clinics to begin development and promotion of the "Our Shot" vaccination campaign. The purpose of the campaign is to increase vaccine confidence and promote the availability of COVID-19 vaccine by providing information thru various types of media such as radio, television and social media ads. Through "Our Shot" vaccine champions were identified and assisted in promoting COVID vaccinations throughout Southern Illinois with a focus on the lower 16 counties. For more information visit www.ourshotsi.com.
Schedule H, Part VI, Line 6 Affiliated health care system Southern Illinois Hospital Services (SIHS) is part of a larger system that provides health services to the population of Southern Illinois. SIHS provides care through its three hospitals and one community health center. Southern Illinois Medical Services (SIMS) provides care through physician practices. These practices are comprised of the Center for Medical Arts, Logan Primary Care, Physician Care Group, individual physician practices, hospital physicians and emergency room physicians. SIHS and SIMS work together in providing care and treatment of the medically sick, injured or afflicted. Both provide quality health services to people throughout Southern Illinois regardless of race, creed, sex, national origin, handicap, age or ability to pay.
Schedule H, Part VI, Line 7 State filing of community benefit report IL
Schedule H (Form 990) 2020
Additional Data


Software ID: 20011424
Software Version: 2020v4.0

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
Southern Illinois Hospital Services
 
Employer identification number
37-0618939
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) LAND OF LINCOLN LEGAL ASSISTANCE FOUNDATION
509 S UNIVERSITY AVE
3RD FLOOR
CARBONDALE,IL62901 		37-0958448 501(C)(3) 115,000 0 N/A N/A GENERAL PROGRAM FUNDING
(2) SIU FOUNDATION
PO BOX 19666
SPRINGFIELD,IL62794 		37-6024575 501(C)(3) 333,333 0 N/A N/A GENERAL PROGRAM FUNDING
(3) ILLINOIS POISON CENTER
222 S RIVERSIDE PLAZA
SUITE 1900
CHICAGO,IL60606 		37-2167008 501(C)(3) 27,884 0 N/A N/A GENERAL PROGRAM FUNDING
(4) JACKSON COUNTY HEALTH DEPARTMENT
415 HEALTH DEPT ROAD
MURPHYSBORO,IL62956 		37-6001092 GOVERNMENT ENTITY 117,316 0 N/A N/A GENERAL PROGRAM FUNDING
(5) SOUTHERN SEVEN HEALTH DEPARTMENT
260 LICK CREEK ROAD
ANNA,IL62906 		37-1069423 GOVERNMENT ENTITY 135,198 0 N/A N/A GENERAL PROGRAM FUNDING
(6) EGYPTIAN HEALTH DEPARTMENT
1412 US 45 NORTH
ELDORADO,IL62930 		37-6006931 GOVERNMENT ENTITY 199,320 0 N/A N/A GENERAL PROGRAM FUNDING
(7) FRANKLIN WILLIAMSON HEALTH DEPARTMENT
2312 W MAIN STREET
MARION,IL62959 		37-6021157 GOVERNMENT ENTITY 49,232 0 N/A N/A GENERAL PROGRAM FUNDING
(8) SHAWNEE HEALTH SERVICE
PO BOX 577
CARTERVILLE,IL62918 		37-0966854 501(C)(3) 11,045 0 N/A N/A GENERAL PROGRAM FUNDING
(9) FARMERS MARKET
1282 WING HILL ROAD
COBDEN,IL62920 		26-1352663 501(C)(3) 24,000 0 N/A N/A GENERAL PROGRAM FUNDING
(10) HERRIN CHAMBER OF COMMERCE
3 SOUTH PARK AVE
SUITE A
HERRIN,IL62948 		37-0618499 501(C)(6) 8,750 0 N/A N/A GENERAL PROGRAM FUNDING
(11) WOMEN'S CENTER
610 S THOMPSON STREET
CARBONDALE,IL62901 		23-7417709 501(C)(3) 10,000 0 N/A N/A GENERAL PROGRAM FUNDING
(12) BOYS & GIRLS CLUB
PO BOX 3092
CARBONDALE,IL62901 		37-1391223 501(C)(3) 10,000 0 N/A N/A GENERAL PROGRAM FUNDING
(13) COALITION FOR THE HOMELESS
608 EAST COLLEGE ST
CARBONDALE,IL62901 		84-3917640 501(C)(3) 48,000 0 N/A N/A GENERAL PROGRAM FUNDING
(14) AMERICAN HEART ASSOCIATION
7272 GREENVILLE AVE
DALLAS,TX75231 		13-5613797 501(C)(3) 15,000 0 N/A N/A GENERAL PROGRAM FUNDING
(15) SOUTHERN IL COMMUNITY FOUNDATION
3000 W DEYOUNG ST
MARION,IL62959 		37-1373067 501(C)(3) 13,000 0 N/A N/A GENERAL PROGRAM FUNDING
(16) CARBONDALE CHAMBER OF COMMERCE
131 S ILLINOIS AVE
CARBONDALE,IL62901 		37-0205240 501(C)(6) 5,368 0 N/A N/A GENERAL PROGRAM FUNDING
(17) CARBONDALE COMMUNITY HIGH SCHOOL
330 S GIANT CITY ROAD
CARBONDALE,IL62901 		37-6003379 PUBLIC SCHOOL 5,580 0 N/A N/A GENERAL PROGRAM FUNDING
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
14
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
3
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2020

Schedule I (Form 990) 2020
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. All grants made are unrestricted and can be used in any way the donee organization sees fit to further its exempt purpose
Schedule I (Form 990) 2020



Additional Data


Software ID: 20011424
Software Version: 2020v4.0


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Graphic Arrow Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Graphic Arrow Attach to Form 990.
Graphic Arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
Southern Illinois Hospital Services
 
Employer identification number

37-0618939
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2020

Schedule J (Form 990) 2020
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation in column (B) reported as deferred on prior Form 990
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1Rex Budde
 
President/CEO 		(i)

(ii)		 781,908
-------------
0 		0
-------------
0 		270,056
-------------
0 		294,895
-------------
0 		34,617
-------------
0 		1,381,476
-------------
0 		233,490
-------------
0
2William Sherwood
 
Former Officer 		(i)

(ii)		 200,183
-------------
0 		0
-------------
0 		1,185
-------------
0 		9,194
-------------
0 		28,897
-------------
0 		239,459
-------------
0 		0
-------------
0
3Gerald Mourey
 
Former Officer 		(i)

(ii)		 0
-------------
0 		0
-------------
0 		516,939
-------------
0 		26,386
-------------
0 		18,269
-------------
0 		561,594
-------------
0 		107,104
-------------
0
4Mike Kasser
 
SR VP/CFO/TREASURER 		(i)

(ii)		 467,362
-------------
0 		0
-------------
0 		334,547
-------------
0 		131,980
-------------
0 		33,612
-------------
0 		967,501
-------------
0 		300,924
-------------
0
5Philip Schaefer
 
SR VP/ ADMINISTRATOR/CCNDO 		(i)

(ii)		 419,608
-------------
0 		0
-------------
0 		403,092
-------------
0 		138,584
-------------
0 		39,243
-------------
0 		1,000,527
-------------
0 		366,311
-------------
0
6Pam Henderson
 
VP/ HR 		(i)

(ii)		 292,871
-------------
0 		0
-------------
0 		103,076
-------------
0 		86,610
-------------
0 		7,720
-------------
0 		490,277
-------------
0 		70,694
-------------
0
7John B Millstead
 
SR VP/COO 		(i)

(ii)		 534,935
-------------
0 		0
-------------
0 		201,768
-------------
0 		176,023
-------------
0 		44,254
-------------
0 		956,980
-------------
0 		169,386
-------------
0
8William Thorne
 
VP/ Community Benefits 		(i)

(ii)		 232,291
-------------
0 		0
-------------
0 		87,092
-------------
0 		62,347
-------------
0 		40,633
-------------
0 		422,363
-------------
0 		53,755
-------------
0
9Shelly Pierce
 
VP/Quality 		(i)

(ii)		 275,747
-------------
0 		0
-------------
0 		69,205
-------------
0 		51,310
-------------
0 		16,655
-------------
0 		412,917
-------------
0 		36,504
-------------
0
10Daniel Skiles
 
VP/Health Transformation 		(i)

(ii)		 306,057
-------------
0 		0
-------------
0 		65,884
-------------
0 		37,592
-------------
0 		45,001
-------------
0 		454,534
-------------
0 		21,767
-------------
0
11Marci L Moore-Connelley MD
 
SR VP/CMO 		(i)

(ii)		 485,997
-------------
0 		0
-------------
0 		84,064
-------------
0 		60,217
-------------
0 		22,428
-------------
0 		652,706
-------------
0 		53,194
-------------
0
12Rodney Smith
 
VP/Administrator 		(i)

(ii)		 362,331
-------------
0 		0
-------------
0 		54,242
-------------
0 		45,065
-------------
0 		41,070
-------------
0 		502,708
-------------
0 		22,940
-------------
0
13Jennifer Harre
 
VP/CNO 		(i)

(ii)		 238,821
-------------
0 		0
-------------
0 		40,132
-------------
0 		24,583
-------------
0 		42,726
-------------
0 		346,262
-------------
0 		0
-------------
0
14Al Taylor
 
VP/Administrator 		(i)

(ii)		 410,146
-------------
0 		0
-------------
0 		42,694
-------------
0 		52,082
-------------
0 		42,379
-------------
0 		547,301
-------------
0 		10,357
-------------
0
15John Daly
 
VP/General Counsel 		(i)

(ii)		 314,173
-------------
0 		0
-------------
0 		42,635
-------------
0 		33,345
-------------
0 		3,792
-------------
0 		393,945
-------------
0 		0
-------------
0
16David Hakanson
 
VP/Innovation Technology 		(i)

(ii)		 250,293
-------------
0 		35,000
-------------
0 		42,452
-------------
0 		18,750
-------------
0 		28,182
-------------
0 		374,677
-------------
0 		0
-------------
0
17Todd Guenzburger
 
VP/Chief Health Info Officer 		(i)

(ii)		 251,093
-------------
0 		30,000
-------------
0 		42,207
-------------
0 		20,500
-------------
0 		9,531
-------------
0 		353,331
-------------
0 		0
-------------
0
18Gery Blackburn
 
Treasury Manager 		(i)

(ii)		 285,813
-------------
0 		0
-------------
0 		3,484
-------------
0 		10,959
-------------
0 		1,894
-------------
0 		302,150
-------------
0 		0
-------------
0
19Rebecca Brasel
 
Registered Nurse Shift Supervisor 		(i)

(ii)		 240,503
-------------
0 		0
-------------
0 		13,000
-------------
0 		4,141
-------------
0 		38,827
-------------
0 		296,471
-------------
0 		0
-------------
0
20Shannon Hartke
 
PFS Manager 		(i)

(ii)		 228,469
-------------
0 		0
-------------
0 		10,217
-------------
0 		8,682
-------------
0 		3,490
-------------
0 		250,858
-------------
0 		0
-------------
0
21Tim Kernan
 
System Surgery Director 		(i)

(ii)		 244,819
-------------
0 		0
-------------
0 		2,657
-------------
0 		6,394
-------------
0 		18,185
-------------
0 		272,055
-------------
0 		0
-------------
0
22Paul Troiano
 
System Pharmacy Director 		(i)

(ii)		 272,345
-------------
0 		0
-------------
0 		23
-------------
0 		10,762
-------------
0 		0
-------------
0 		283,130
-------------
0 		0
-------------
0
Schedule J (Form 990) 2020

Schedule J (Form 990) 2020
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
Schedule J, Part I, Line 4a Severance or change-of-control payment Gerald Mourey, VP Information Systems, received severance payments of $317,671.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan The organization made the following supplemental nonqualified retirement plan payments/contributions: Rex Budde - $233,490 payment, $286,312 deferred compensation Pam Henderson - $70,694 payment, $75,291 deferred compensation Mike Kasser - $300,924 payment, $120,655 deferred compensation Bart Millstead - $169,386 payment, $164,698 deferred compensation Phil Schaefer - $366,311 payment; $127,259 deferred compensation William Thorne - $53,755 payment. $52,941 deferred compensation Shelly Pierce - $36,504 payment, $42,214 deferred compensation Dan Skiles - $21,767 payment, $26,267 deferred compensation Marci Moore-Connelley - $53,194 payment, $51,043 deferred compensation Gerald Mourey - $107,104 payment, $26,386 deferred compensation Jennifer Harre - No payment, $16,346 deferred compensation Rodney Smith - $22,940 payment, $33,740 deferred compensation Al Taylor - $10,357 payment, $40,757 deferred compensation John Daly - No payment, $25,834 deferred compensation David Hakanson - No payment, $18,750 deferred compensation Todd Guenzburger - No payment, $20,500 deferred compensation CERTAIN EXECUTIVES PARTICIPATE IN A SPLIT-DOLLAR LIFE INSURANCE PLAN. PREMIUMS PAID ON BEHALF OF THE EXECUTIVES ARE TREATED AS LOANS. LISTED BELOW ARE THE EXECUTIVES WHO PARTICIPATE IN THE PLAN AND THE OUTSTANDING LOAN BALANCE AS OF 3/31/21: REX BUDDE - $137,640 MIKE KASSER - $74,992 PHILLIP SCHAEFER - $94,983
Schedule J (Form 990) 2020

Additional Data


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Software Version: 2020v4.0

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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet Attach to Form 990.
SchKMediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
Southern Illinois Hospital Services
 
Employer identification number
37-0618939
Part Ⅰ
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A ILLINOIS FINANCE AUTHORITY
  		86-1091967 000000000 07-01-2014 127,215,000 See Supplemental Information   X   X   X
B ILLINOIS FINANCE AUTHORITY
  		86-1091967 45204ESL3 02-16-2017 36,355,638 See Supplemental Information   X   X   X
C ILLINOIS FINANCE AUTHORITY
  		86-1091967 45204EZB7 09-12-2017 76,037,298 REFUNDED 2010 BOND ISSUE   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 18,045,000 0 1,755,000  
2 Amount of bonds legally defeased .............. 2 0 0  
3 Total proceeds of issue .................. 127,632,149 35,185,412 76,037,298  
4 Gross proceeds in reserve funds ............. 0 0 0  
5 Capitalized interest from proceeds ............. 0 0 0  
6 Proceeds in refunding escrows ............... 0 0 0  
7 Issuance costs from proceeds ............... 979,638 587,619 927,485  
8 Credit enhancement from proceeds ............. 0 0 0  
9 Working capital expenditures from proceeds ............. 0 0 0  
10 Capital expenditures from proceeds ............. 75,000,000 34,597,793 0  
11 Other spent proceeds ............. 51,235,362 0 75,109,813  
12 Other unspent proceeds ............. 0 0 0  
13 Year of substantial completion ............. 2015 2016 2017
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue of tax-exempt
bonds (or, if issued prior to 2019, a current refunding issue)? ........ 		X     X X      
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2019, an advance refunding issue)? ........ 		  X   X   X    
16 Has the final allocation of proceeds been made? .......... X   X   X      
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X      
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2020

Schedule K (Form 990) 2020
Page 2
Part Ⅲ
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X   X   X    
3a Are there any management or service contracts that may result in private business use of bond-financed property? ............. X   X   X      
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? X   X   X      
c Are there any research agreements that may result in private business use of bond-financed property? ............. X   X   X      
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? X   X   X      
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet 0 % 0 % 0 %  
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet 0 % 0 % 0 %  
6 Total of lines 4 and 5 ............. 0 % 0 % 0 %  
7 Does the bond issue meet the private security or payment test? ...   X   X   X    
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X   X    
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		X   X   X      
Part Ⅳ
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X   X   X    
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? ....... X   X   X      
b Exception to rebate? ........   X   X   X    
c No rebate due? ......... X     X   X    
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? ..... X     X   X    
Schedule K (Form 990) 2020

Schedule K (Form 990) 2020
Page 3
Part Ⅳ
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X    
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of hedge .........        
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X   X    
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of GIC ......... 0 %      
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X   X   X    
7 Has the organization established written procedures to monitor the requirements of section 148? ... X   X   X      
Part Ⅴ
Procedures To Undertake Corrective Action
--------------------------------------------------------------------------------------------------------------- A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X      
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
Schedule K, Part I, Column (f) Explanation of bond issue 2014 bond issue - The bond issue contains two bonds issued at the same time. It includes revenue bonds in the amount of $75,580,000 and revenue refunding bonds in the amount of $51,635,000. These bonds were reported on one Form 8038. 2011 bond issue - The bond issue financed capital expenditures and refunded the 2008 variable rate demand revenue bonds which had a deemed reissuance in 2011. 2010 bond issue - The bond issue refunded the 1998 bond issue. 2017 bond issue - Finance capital expenditures
Schedule K, Part V Different Procedures to Undertake Corrective Action Issuer name: ILLINOIS FINANCE AUTHORITY NO DIFFERENCE FOR REPORTED BOND ISSUES
Schedule K, Part IV, Line 2c COLUMN A Issuer name: ILLINOIS FINANCE AUTHORITY The calculation for computing no rebate due was performed on 07/01/2019
Schedule K, Part V Different Procedures to Undertake Corrective Action Issuer name: ILLINOIS FINANCE AUTHORITY NO DIFFERENCES FOR REPORTED BOND ISSUES
Schedule K, Part V Different Procedures to Undertake Corrective Action Issuer name: ILLINOIS FINANCE AUTHORITY N/A
Schedule K (Form 990) 2020

Additional Data


Software ID: 20011424
Software Version: 2020v4.0

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
Southern Illinois Hospital Services
 
Employer identification number

37-0618939
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e) Original principal amount (f) Balance due (g) In default? (h) Approved by board or committee? (i) Written agreement?
To From Yes No Yes No Yes No
(1) Rex Budde
  		Officer Split Dollar Life Insurance treated as a Loan   X 137,803 137,640   No Yes   Yes  
(2) Mike Kasser
  		Officer Split Dollar Life Insurance Treated as a Loan   X 75,955 74,992   No Yes   Yes  
(3) Phillip Schaefer
  		Officer Split Dollar Life Insurance treated as a Loan   X 95,174 94,983   No Yes   Yes  
Total ...............Small Bullet $ 307,615
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2020
Schedule L (Form 990 or 990-EZ) 2020
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) DANIEL SHERWOOD
  		SON OF FORMER VP/GENERAL COUNSEL WILLAIM SHERWOOD 125,864 EMPLOYEE COMPENSATION   No
(2) JESSICA SHERWOOD
  		DAUGHTER IN LAW OF FORMER VP/GENERAL COUNSEL WILLIAM SHERWOOD 34,708 EMPLOYEE COMPENSATION   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2020


Additional Data


Software ID: 20011424
Software Version: 2020v4.0




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
Southern Illinois Hospital Services
 
Employer identification number

37-0618939
Return Reference Explanation
Form 990, Part III, Line 1 ORGANIZATION'S MISSION (CONTINUED FROM PART III) OVER 3,000 EMPLOYEES, ALONG WITH PHYSICIANS AND VOLUNTEERS, ARE WORKING TOGETHER TO ACHIEVE OUR MISSION AND ENSURE THAT THE HEALTH CARE NEEDS OF THOSE WE SERVE ARE MET. WE MAKE THIS A REALITY BY TREATING PATIENTS IN SIHS FACILITIES, OFFERING SERVICES IN RURAL CLINICS, COLLABORATING WITH SOME OF AMERICA'S BEST HOSPITALS AND IMPROVING OUR COMMUNITIES WITH OUR CHARITABLE COMMUNITY BENEFITS PROGRAMS. OUR SERVICES ARE PROVIDED REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY.
Form 990, Part III, Line 4a HOSPITAL SERVICES (CONTINUED FROM PART III) THE FACILITIES THAT MAKE UP SOUTHERN ILLINOIS HOSPITAL SERVICES (SIHS) INCLUDE: MEMORIAL HOSPITAL OF CARBONDALE: OPENED IN 1950, MEMORIAL HOSPITAL OF CARBONDALE, A 154 BED TERTIARY CARE HOSPITAL, IS THE FLAGSHIP HOSPITAL FOR SIH AND A REGIONAL REFERRAL CENTER FOR THE 16 COUNTY SOUTHERN ILLINOIS REGION. PHYSICIANS IN OVER 45 DIFFERENT SPECIALTIES PRACTICE HERE, BRINGING EXPERTISE AND NEW PROCEDURES, BUT SUCCESSFULLY TAILORING THEM TO THE PARTICULAR NEEDS OF A RURAL SETTING. IT IS THE CORE HOSPITAL FOR SIH'S COMPREHENSIVE, REGIONAL HEART PROGRAM, PRAIRIE HEART INSTITUTE. OUR NEUROSCIENCE PROGRAM INCLUDES NEUROSURGERY AND THE REGION'S ONLY PRIMARY STROKE CENTER. THE HOSPITAL IS ALSO HOME TO A COMMISSION ON CANCER ACCREDITED COMPREHENSIVE CANCER TREATMENT CENTER. THE HOSPITAL HAS THE REGION'S LARGEST BIRTHING CENTER WITH LEVEL II PLUS SPECIAL CARE NURSERY, AND THE ONLY PEDIATRIC UNIT IN THE IMMEDIATE SOUTHERN ILLINOIS AREA. THE HOSPITAL IS AFFILIATED WITH SOUTHERN ILLINOIS UNIVERSITY'S SCHOOL OF MEDICINE THROUGH ITS FAMILY PRACTICE RESIDENCY PROGRAM. HERRIN HOSPITAL: OPENED IN 1913, HERRIN HOSPITAL WAS THE FIRST HOSPITAL OWNED AND OPERATED BY THE ORGANIZATION. HERRIN HOSPITAL CURRENTLY OPERATES 85 LICENSED BEDS. IT IS ALSO HOME TO THE 29 BED ACUTE REHABILITATION CENTER THROUGH AN ALLIANCE WITH THE SHIRLEY RYAN ABILITY LAB, RECOGNIZED AS THE TOP REHABILITATION HOSPITAL IN AMERICA. THE HOSPITAL HOUSES THE AREA'S ONLY BARIATRIC SURGICAL PROGRAM FOR WEIGHT LOSS. IN ADDITION, THE REGION'S FIRST ACCREDITED CHEST PAIN CENTER IS LOCATED AT THIS HOSPITAL. ST. JOSEPH MEMORIAL HOSPITAL: ST JOSEPH MEMORIAL HOSPITAL IS LOCATED IN MURPHYSBORO, ILLINOIS AND IS A FULL-SERVICE, CRITICAL ACCESS HOSPITAL WITH 25 LICENSED BEDS. ST. JOSEPH OPENED ON OCTOBER 1, 1960 AND WAS ACQUIRED BY SOUTHERN ILLINOIS HOSPITAL SERVICES ON JANUARY 5, 1995 FROM THE SISTERS OF THE ASC HEALTH SYSTEM. ST JOSEPH'S CATHOLIC IDENTITY HAS BEEN RETAINED BY SIHS SINCE THE PURCHASE AND THE STAFF TAKES PRIDE IN THE HOSPITAL'S SPIRITUAL ROOTS. ST. JOSEPH HAS EVOLVED OVER TIME TO BECOME A REGIONAL PROVIDER OF SPECIALIZED OUTPATIENT SERVICES. THESE SPECIALIZED SERVICES INCLUDE A SLEEP DISORDERS CENTER ACCREDITED BY THE AMERICAN ACADEMY OF SLEEP MEDICINE, A COMPREHENSIVE WOUND CARE CENTER WITH HYPERBARIC THERAPY, A COORDINATED INFUSION THERAPY PROGRAM, AND AN OUTPATIENT GERIATRIC COUNSELING PROGRAM. MINERS MEMORIAL HEALTH CENTER: WEST FRANKFORT, ILLINOIS IS HOME TO MINERS MEMORIAL HEALTH CENTER. THE HEALTH CENTER HOUSES A PHYSICIAN SPECIALTY CLINIC THAT OFFERS VISITING SPECIALISTS INCLUDING UROLOGY, PODIATRY AND CARDIOLOGY. IT IS ALSO HOME TO WEST FRANKFORT FAMILY MEDICINE, WITH FAMILY MEDICINE AND OBSTETRIC PHYSICIANS FROM SIU SCHOOL OF MEDICINE, AND OFFERS MAMMOGRAPHY, X-RAY, ULTRASOUND, BONE DENSITOMETRY, AND LABORATORY SERVICES. SERVICES PROVIDED: DURING THIS REPORTING PERIOD, OUR HOSPITALS RECORDED 71,098 ADULT AND CHILD PATIENT DAYS AND 3,270 NEWBORN PATIENT DAYS. OUTPATIENT REGISTRATIONS TOTALED 423,018 WITH 57,913 OF THESE REGISTRATIONS BEING EMERGENCY ROOM VISITS. APPROXIMATELY 70.25% OF THESE DAYS AND REGISTRATIONS PROVIDED CARE THAT WAS CLASSIFIED AS EITHER UNCOMPENSATED CHARITY CARE OR UNCOMPENSATED GOVERNMENT HEALTH CARE. AN ADDITIONAL 1.23% OF THE CARE PROVIDED IN THESE DAYS AND REGISTRATIONS WERE WRITTEN OFF AS BAD DEBT. ROUTINE INPATIENT CARE AND OUTPATIENT PROCEDURES ARE PROVIDED AT ALL THREE OF OUR FACILITIES. EACH FACILITY ALSO HAS ITS OWN UNIQUE PROGRAMS AND PATIENT CARE UNITS. OUR TWO LARGER FACILITIES, CARBONDALE MEMORIAL HOSPITAL AND HERRIN HOSPITAL BOTH HOUSE INTENSIVE CARE UNITS. THESE TWO LARGER FACILITIES EACH HAVE SPECIALTY UNITS WITHIN THEIR RESPECTIVE FACILITIES. CARBONDALE MEMORIAL HOSPITAL PROVIDES OBSTETRICAL, PEDIATRICS, AND A NEONATAL NURSERY. HERRIN HOSPITAL PROVIDES THE ACUTE REHABILITATION CENTER. SURGICAL SERVICES ARE OFFERED AT ALL FACILITIES, WITH CARBONDALE MEMORIAL HOSPITAL PROVIDING OPEN-HEART AND CARDIAC SERVICES. ST. JOSEPH MEMORIAL HOSPITAL ALSO OPERATES SWING BEDS. ST. JOSEPH ALSO OFFERS UNIQUE OUTPATIENT SERVICES TO THE AREA. THE SLEEP DISORDERS CENTER OFFERS TWO LOCATIONS AND THE SENIOR RENEWAL PROGRAM OFFERS OUTPATIENT BEHAVIORAL HEALTH TREATMENT. SIHS HAS ALSO PROVIDED SUBSIDIZED HEALTH CARE SERVICES. SUBSIDIZED HEALTH SERVICES INCLUDE, BUT ARE NOT LIMITED TO PHYSICIAN REFERRAL CENTERS, FAMILY PRACTICE CENTERS, SENIOR MEMBERSHIP, ETC. THESE HEALTH CARE SERVICES ARE PROVIDED IN RESPONSE TO COMMUNITY NEEDS. THESE HEALTH SERVICES MUST BE SUBSIDIZED FROM OTHER REVENUE SOURCES IN ORDER TO BE PROVIDED. SIHS PROVIDES MEDICAL EDUCATION THROUGH AN AFFILIATION WITH THE SOUTHERN ILLINOIS UNIVERSITY'S MEDICAL SCHOOL FAMILY PRACTICE RESIDENCY PROGRAM.
Form 990, Part III, Line 4b COMMUNITY BENEFITS (CONTINUED FROM PART III) THE OVERARCHING GOAL OF SOUTHERN ILLINOIS HEALTHCARE'S COMMUNITY BENEFITS DEPARTMENT IS TO RESPOND TO IDENTIFIED COMMUNITY HEALTH NEEDS, INCREASE ACCESS TO CARE, LEAD AND SERVE AS AN EXAMPLE TO OTHERS IN SERVICE TO THE COMMUNITY, AND IMPROVE THE OVERALL HEALTH STATUS OF THOSE IN THE COMMUNITIES SERVED BY SIH FACILITIES. SOUTHERN ILLINOIS HEALTHCARE'S OVERALL APPROACH TO COMMUNITY BENEFITS IS TO TARGET THE INTERSECTIONS OF DOCUMENTED UNMET COMMUNITY HEALTH NEEDS AND THE ORGANIZATION'S MISSION, VALUES AND KEY STRENGTHS. COMMUNITY BENEFIT ACTIVITIES EMPHASIZE PRIMARY HEALTH CARE SERVICES, HIGH IMPACT HEALTH SCREENING AND PROMOTION, CHRONIC DISEASE PREVENTION AND MANAGEMENT, AND INCREASE ACCESS TO CARE ESPECIALLY FOR VULNERABLE AND UNDERSERVED PEOPLE. STRATEGIC EFFORTS ARE INCREASING THE INTEGRATION OF COMMUNITY BASED SERVICES WITH CLINICAL SERVICES TO HELP STRENGTHEN THE CONTINUUM OF CARE AND SUPPORT AN EFFICIENT AND EFFECTIVE HEALTH CARE DELIVERY SYSTEM. IN ORDER TO ACCOMPLISH THE ORGANIZATION'S MISSION, THE COMMUNITY BENEFITS DEPARTMENT OF SIHS IMPLEMENTS A NUMBER OF DIRECTED INITIATIVES. PROGRAMS DURING THE REPORTING YEAR INCLUDE: HEALTH MINISTRY - THE HEALTH MINISTRY PROGRAM COLLABORATES WITH SOUTHERN ILLINOIS FAITH COMMUNITIES TO IMPROVE THE HEALTH AND WELLNESS OF PEOPLE IN THE COMMUNITIES THEY SERVE. EMPHASIZING WHOLENESS OF BODY, MIND AND SPIRIT, FAITH COMMUNITIES WITH A HEALTH MINISTRY OFFER HEALTH PROMOTION AND EDUCATION ACTIVITIES; ADVOCACY AND REFERRAL; AND CARING SPIRITUAL SUPPORT. HEALTH MINISTRY INCLUDES OVER 75 CHURCHES AND 2 FAITH BASED COMMUNITIES IN 9 COUNTIES. REGULARLY SCHEDULED ACTIVITIES INCLUDE HEALTH EDUCATION, HEALTH SCREENINGS, SUPPORT GROUPS AND EXERCISE PROGRAMS. OVER 150 REGISTERED NURSES HAVE COMPLETED THE PARISH NURSE BASIC PREP COURSE. IN FY21 OVER 41,000 CONTACTS WERE MADE BY FAITH COMMUNITY/PARISH NURSES, CONGREGATIONAL HEALTH CONNECTORS, AND SPIRITUAL HOMEBOUND VISITOR VOLUNTEERS. THESE CONTACTS WERE MADE IN THE FORM OF HOME VISITS, CHURCH, HOSPITAL, NURSING HOME VISITS AND TELEPHONE CALLS, AS WELL AS EDUCATIONAL AND SCREENING EVENTS AND EDUCATIONAL MATERIALS DISTRIBUTION. SERVICES AND RESOURCES PROVIDED INCLUDED TRANSPORTATION, MEALS, GERIATRIC AND CAREGIVER SUPPORT, REFERRAL TO HEALTHCARE PROVIDERS AND COMMUNITY BASED AGENCIES AND OTHER SERVICES. SIH CONTINUED COLLABORATIVE EFFORTS TO IMPACT EMERGENCY PREPAREDNESS BY PROVIDING MINI GRANTS FOR AEDS AND NEEDED SUPPLIES TO FAITH BASED COMMUNITIES AND FAITH BASED ORGANIZATIONS. HEALTHY COMMUNITIES - THIS INITIATIVE IS DIRECTED AT IMPROVING COMMUNITY HEALTH THROUGH TIMELY ASSESSMENT OF NEEDS AND FACILITATING THE PLANNING, IMPLEMENTATION, AND EVALUATION OF COMMUNITY BASED PROGRAMS AND SERVICES. THE FOCUS OF THE WORK OF HEALTHY COMMUNITIES IS TO INCREASE THE CAPACITY OF LOCAL AGENCIES TO WORK COLLABORATIVELY TO ADDRESS HEALTH NEEDS AND IMPROVE ACCESS TO HEALTH CARE SERVICES, DEVELOP HIGH IMPACT SCREENING OPPORTUNITIES TO PROMOTE EARLY DETECTION OF DISEASE (SPECIFICALLY DIABETES AND HYPERTENSION) AND A REGIONAL DISEASE/DIABETES SELF-MANAGEMENT PROGRAM. HEALTHY C0MMUNITY COALITIONS -- THE COALITIONS ARE COMPRISED OF HEALTH PROVIDERS, SOCIAL SERVICE AGENCIES, CONCERNED CITIZENS, AND OTHER COMMUNITY GROUPS INTERESTED IN IMPROVING THE HEALTH OF THEIR RESPECTIVE COMMUNITIES. SIHS IS ACTIVE IN TWO SUCH COALITIONS, REPRESENTING FOUR COUNTIES - JACKSON, PERRY, FRANKLIN AND WILLIAMSON COUNTIES. EMERGENCY ORAL HEALTH CARE - COLLABORATION WITH LOCAL DENTAL PROVIDERS TO PROVIDE PREVENTIVE ORAL HEALTH CARE FOR MEDICAID PATIENTS; HOPEFULLY REPLACING EMERGENCY ROOM VISITS FOR TOOTH RELATED ISSUES. SOUTHERN ILLINOIS FOOD PANTRY - PRIOR TO COVID-19 RESTRICTIONS, COLLABORATED WITH COMMUNITY PARTNERS TO ORGANIZE FREE HEALTH FAIR/SCREENING EVENTS AT LOCAL PANTRIES AND FOOD TRUCK DISTRIBUTION SITES, TARGETING LOW INCOME, UNINSURED AND UNDERINSURED RESIDENTS. THESE SCREENINGS WILL BE REINSTATED ONCE RESTRICTIONS ARE LIFTED. NON-EMERGENCY MEDICAL TRANSPORTATION - LACK OF TRANSPORTATION WAS IDENTIFIED AS A PRIORITY HEALTH ISSUE IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. A PILOT PROGRAM WAS LAUNCHED IN FY20 AT TWO FACILITIES AND EXPANDED TO SEVEN LOCATIONS IN FY21 TO PROVIDE RIDES TO/FROM NON-EMERGENCY MEDICAL APPOINTMENTS. IN FY21 A TOTAL OF 340 RIDE REQUESTS WERE RECEIVED. COMMUNITY HEALTH WORKER - COMMUNITY HEALTH WORKERS ASSIST TARGETED LOW-INCOME POPULATIONS TO AVOID UNNECESSARY FREQUENT INPATIENT AND ED VISITS. COMMUNITY BENEFITS SUPPORT PROGRAM CONDUCTS DATA DRIVEN NEEDS ASSESSMENTS FOR SUBSTANCE USE DISORDER AND OPIOID USE DISORDER FOR MEDICAID BENEFICIARIES. MEDICAL LEGAL PARTNERSHIP SI -- AN INNOVATIVE PROGRAM THAT PROVIDES LEGAL ASSISTANCE TO LOW-INCOME AND UNDER INSURED ADULTS SEEKING MEDICAL CARE. THE ONGOING MEDICAL-LEGAL COLLABORATION BETWEEN LAND OF LINCOLN LEGAL SERVICES AND SIH IS ADDRESSING MANY OF THE SOCIAL ISSUES FACED BY PATIENTS CONTRIBUTING TO THEIR HEALTH CARE NEEDS. LEGAL ASSISTANCE IN PROVIDED IN THE AREAS OF PUBLIC BENEFITS, DISABILITY, FAMILY, HOUSING AND CONSUMER ISSUES. DIABETES SELF MANAGEMENT PROGRAM - PROVIDED GRANTS TO LOCAL HEALTH DEPARTMENTS FOR ESTABLISHMENT OF DIABETES RESOURCE TEAMS ILLINOIS POISON CENTER - PROVIDED FUNDING TO THIS NON-PROFIT HEALTH SERVICES THAT PROVIDES FREE INFORMATION AND TREATMENT ADVICE OPIOID USE DISORDER -HELD AND CO-SPONSORED NUMEROUS REGIONAL SUMMITS, MEETINGS AND CONFERENCES THAT ADDRESSED THIS ISSUE OF SUBSTANCE ABUSE MENTAL HEALTH INITIATIVES - WORKING WITH COMMUNITY PARTNERS TO PROVIDE THE APPROPRIATE LEVEL OF CARE THROUGH COMMUNITY SUPPORT SERVICES TO ADDRESS PATIENT'S MENTAL HEALTH NEEDS. Southern Illinois Hospital Services responded to the COVID pandemic by providing health care and support to our communities. Our facilities adapted to the surge in patients through adapting our facilities to care for COVID patients in a safe environment for our staff and community. Elective procedures were delayed ensuring all beds were available for COVID patients. Southern Illinois Hospital Services established testing sites and established a COVID hotline for the community. SIH Marketing developed a COVID website for community members and medical providers to obtain information and updates from SIH. A COVID at Home program was developed in FY21 and served its first patents in March of 2021. Through the SIH COVID at Home program, thermometers, pulse oximeters and educational materials were provided to patients discharging from Inpatient. Follow-up calls were then made to these patients to ensure they knew how to use their kit and that they had followed up with their primary care provider. The SIH Vice President of Community Affairs/Chief Development Officer and the System Director for Community Health served in the "Community Liaison" roles in our Incident Command Structure and assisted community agencies with information and their response to COVID concerns. The Community Liaisons worked to: * Develop and promote Community COVID Updates to over 2,300 individuals through e-mail updates (including Mayors and City Managers, Law Enforcement , Local Health Departments and Federally Qualified Health Centers, healthcare providers and practice managers, Shawnee Preparedness and Response Coalition Members, other hospitals, local EMA, Higher Education, School superintendents and principals, local business leaders, Chamber of Commerce contacts, Healthy Southern Illinois Delta Network Members (public health and social service agencies as well as community members in the lower 16 counties), Faith Communities, and interested community members. * Purchase handheld forehead thermometers for community agencies, such as the Carbondale Warming Center. * Accept and handle requests and questions from community members and various healthcare agencies In FY21, SIH also partnered with many community members, healthcare agencies, and clinics to begin development and promotion of the "Our Shot" vaccination campaign. The purpose of the campaign is to increase vaccine confidence and promote the availability of COVID-19 vaccine by providing information thru various types of media such as radio, television and social media ads. Through "Our Shot" vaccine champions were identified and assisted in promoting COVID vaccinations throughout Southern Illinois with a focus on the lower 16 counties. For more information visit www.ourshotsi.com.
Form 990, Part III, Line 4c SCHOOL BASED HEALTH SERVICES (CONTINUED FROM PART III) SOUTHERN ILLINOIS HEALTHCARE COORDINATED SCHOOL HEALTH PROGRAM IS WORKING TO REDUCE THE GROWTH OF CHILDHOOD OBESITY AND IMPROVE THE OVERALL HEALTH AND WELL-BEING OF CHILDREN AND ADOLESCENTS. THE FOLLOWING IS A SUMMARY OF THE SCHOOL HEALTH PROGRAMS DURING THIS REPORTING YEAR: THE ILLINOIS CATCH ON TO HEALTH CONSORTIUM IS A COLLABORATIVE INITIATIVE BETWEEN THE SIU SCHOOL OF MEDICINE CENTER FOR RURAL HEALTH AND SOCIAL SERVICES DEVELOPMENT, SOUTHERN ILLINOIS HEALTHCARE, LOCAL HEALTH DEPARTMENTS AND COMMUNITY ORGANIZATION IN SOUTHERN ILLINOIS. DURING FY21, SIH STAFF WORKED WITH 35 SCHOOLS, IMPACTING OVER 10,000 CHILDREN, IN THE 5 COUNTY SERVICE AREA. SIH ALSO IMPACTED OVER 1,600 STUDENTS/FAMILIES THROUGH VARIOUS ACTIVITIES. THIS CONSORTIUM ALSO WORKED WITH SCHOOLS TO PROMOTE AND ASSIST IN THE IMPLEMENTATION OF COORDINATED SCHOOL HEALTH PROGRAMMING BY PROVIDING TRAINING AND TECHNICAL SUPPORT. CATCH (COORDINATED APPROACH TO CHILD HEALTH) -- CATCH IS A PROGRAM DESIGNED TO PROMOTE PHYSICAL ACTIVITY, HEALTHY FOOD CHOICES, AND PREVENT TOBACCO USE IN ELEMENTARY SCHOOL AGED CHILDREN. CATCH EMPLOYS A COORDINATED APPROACH TO CHILD HEALTH PROMOTION BY TARGETING MULTIPLE ASPECTS OF THE SCHOOL ENVIRONMENT AND INVOLVING CLASSROOM TEACHERS, SCHOOL FOOD SERVICE STAFF, PHYSICAL EDUCATION (PE) TEACHERS, STUDENTS' FAMILIES, AND THE BROADER SCHOOL COMMUNITY IN A RANGE OF HEALTH PROMOTING ACTIVITIES FOR ALL CHILDREN IN GRADES PREK-8, SIMILAR TO THE CDC'S COORDINATED SCHOOL HEALTH PROGRAM MODEL. THE FOUR CORE COMPONENTS OF CATCH INCLUDE: (1) THE EAT SMART SCHOOL NUTRITION PROGRAM, (2) A CLASSROOM PHYSICAL ACTIVITY AND HEALTHY EATING CURRICULA, (3) THE CATCH PHYSICAL EDUCATION PROGRAM, AND (4) A FAMILY EDUCATION AND INVOLVEMENT PROGRAM. THE COORDINATION OF HEALTH MESSAGES AND ACTIVITIES BETWEEN THESE FOUR COMPONENT AREAS IS CRITICAL TO POSITIVELY IMPACTING CHILDREN'S KNOWLEDGE, SKILLS, AND BEHAVIOR. SIH AND PROGRAM PARTNERS ARE IMPLEMENTING COMPONENTS OF THE CATCH PROGRAM IN OVER 80 ELEMENTARY SCHOOL DISTRICTS IN THE 16 COUNTIES IN THE SOUTHERN ILLINOIS REGION. THIS PROGRAM IMPACTS OVER 20,000 STUDENTS AND THEIR FAMILIES. ANOTHER INITIATIVE IS PROMOTING LIFELONG FITNESS BY SUPPORTING QUALITY PHYSICAL EDUCATION IN SOUTHERN ILLINOIS SCHOOLS AND ASSISTING CHILDREN TO MEET THE SURGEON GENERAL'S RECOMMENDATION FOR 60 MINUTES OF DAILY PHYSICAL ACTIVITY. THIS NEED IS BASED UPON CURRENT LOCATOC RESEARCH AND NATIONAL PHYSICIAN EDUCATION STANDARDS. PROGRAM COMPONENTS ASSIST SCHOOLS IN DEVELOPING A QUALITY PHYSICAL EDUCATION PROGRAM THAT HELPS STUDENTS SET AND WORK TOWARD GOALS, PRACTICE SELF-ASSESSMENT AND LEARN THE BENEFITS OF LIFELONG PHYSICAL ACTIVITY. OTHER SIH INITIATIVES TO SUPPORT THE HEALTH CARE NEEDS OF OUR COMMUNITIES INCLUDE: THE FUNDING OF THE PATIENT CARE INITIATIVE - PROVIDES FUNDING TO OTHER HEALTH CARE PROVIDERS TO SUPPLEMENT IN THE CARE OF INDIGENT PATIENTS. THE FUNDING OF THE INDIGENT FUND - PROVIDES MONETARY SUPPORT TO INDIGENT PATIENTS FOR TRAVEL, PRESCRIPTIONS AND OTHER EXPENSES.
Form 990, Part VI, Line 1a Delegate broad authority to a committee GOVERNANCE COMMITTEE The Board has a Governance Committee consisting of 5 Trustees. The purpose of the Governance Committee is to assure the Board of Trustees that the respective programs are functional to fulfill the responsibilities of the Board of Trustees: * Develop and maintain effective compensation and benefit policies and practices; review and recommend in advance all executive compensation arrangements; provide for the evaluation of the performance of the CEO and other System Officers; review and recommend annual performance objectives for System Officers; provide for conduct of a periodic self-evaluation of the Board of Trustees. * Assure that the programs which address new Board member orientation, continuing education, mentoring, and facilitate understanding of current trends in healthcare and medical terminology, are functional. * Identify competent, highly qualified individuals to serve as members of the Board of Trustees; recommend individuals to serve in leadership positions on the Board; and facilitate and interview potential Board members. * Act for the Board of Trustees in all matters as specifically authorized by resolution of the Board or when the Board of Trustees is not in session.
Form 990, Part VI, Line 6 Classes of members or stockholders The organization's sole member is Southern Illinois Hospital Enterprises, Inc., a related tax-exempt organization. The member has the right to elect members to the board of trustees and approve some decisions of the board.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body The organization's sole member, Southern Illinois Healthcare Enterprises, has the exclusive right to elect Trustees to the organization's Board of Trustees
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders The organization's sole member, Southern Illinois Healthcare Enterprises (Corporate Member), has reserved powers found in the Organizations bylaws. Except for transfers identified in the budget of the Organization approved by the Corporate Member, the Organization may not transfer assets to entities other than the Corporate Member or entities that the Corporate Member controls (the "Corporate Member Affiliates"), without the approval of the Corporate Member. The Corporate Member has the right to require the Organization to transfer assets to the extent necessary to accomplish the Corporate Member's goals and objectives. The Corporate Member also has the right to require the organization to provide for the payment of all indebtedness of the Corporate Member or a Corporate Member Affiliate. The Organization cannot be required to violate its charitable purposes, the terms of any restricted gifts, or the covenants of its debt instruments in complying with any asset transfers directed by the Corporate Member. In addition, the following matters must be submitted to and receive the approval of the Corporate Member: 1. Capital expenditures in excess of $500,000; 2. The buying, selling, leasing, mortgaging or disposing of real property belonging to the Corporation or any of its subsidiaries; 3. The establishment or discontinuance of any major services; including services requiring Certificates of Need; 4. Long-Range Strategic Plans; 5. Master Facilities and Site Plans; 6. The creation or dissolution of any corporation, the sole member or majority stockholder of which is the Corporation; 7. Joint venture or affiliation agreements; 8. The incurrence of indebtedness in excess of $500,000; 9. Such other matters as may be required by law or by the Organization's Articles of Incorporation, or by its bylaws to be submitted to the Corporate Member; 10. Delegation of the functions, powers, duties and responsibilities of any officer of the Corporation, and; 11. Any other matter which may be specified from time to time by the Corporate Member. In addition, The Corporate Member retains the right to approve all changes to the organization's bylaws.
Form 990, Part VI, Line 11b Review of form 990 by governing body A draft of the Form 990 and supplemental schedules was distributed to the CEO, CFO and certain Vice-Presidents of the corporation for their review and comments. A draft copy was presented to the Finance Committee by the CFO and the organization's tax advisors for review and comments. After the review and comment period, all suggestions and comments were considered and the Form 990 was updated as appropriate. The finalized Form 990 and supplemental schedules was then presented to the Board of Trustees and a copy of the return was made available to every member of the governing body before it was filed with the IRS.
Form 990, Part VI, Line 12c Conflict of interest policy Annually, the General Counsel sends out a Conflict of Interest Questionnaire to each Trustee, Director, Officer, Manager and key employee to complete and return. The General Counsel then reviews these Questionnaires to determine what conflicts, real or perceived, exist. During every board meeting, the General Counsel reminds the Trustees that the Board has a conflict of interest policy, that the General Counsel has reviewed the agenda for any conflicts, but that the Trustees are obligated to give notice if a conflict has been over-looked or if a discussion or action comes before the Board which may involve or create a conflict of interest for someone. If a Trustee has a conflict of interest, the Trustee or the General Counsel discloses the conflict. The Trustee with the conflict is allowed to remain in the meeting to answer any question the Trustee may need to answer and then the conflicted Trustee is excused from the meeting. The remaining Trustees then discuss the matter further and action is taken on the matter. Finally, the conflicted Trustee is then invited back into the meeting. Interested persons may also be asked, in rare situations, to resign their position on the Board.
Form 990, Part VI, Line 15a Process to establish compensation of top management official The Board of Trustees sets the executive compensation policy and is responsible for approval of the compensation. The Governance Committee is designated by the Board to act as the Compensation Committee for matters concerning executive compensation. Each member of the Committee, while considering executive compensation issues, must be an independent director, free from any conflict of interest. The Committee seeks out and contracts the services of an outside, independent executive compensation consultant to advise the Committee in matters of market values of comparable executive positions. The Committee annually reviews all comparability data and prepares a recommendation as to the compensation package of the President/CEO for the full Board. Only the full Board has the authority to approve the compensation of the President/CEO. The decisions and deliberations are documented in the governance committee minutes. This process was last undertaken in June 2020.
Form 990, Part VI, Line 15b Process to establish compensation of other employees The Board of Trustees sets the executive compensation policy and is responsible for approval of the compensation. The Governance Committee is designated by the Board to act as the Compensation Committee for matters concerning executive compensation. Each member of the Committee, while considering executive compensation issues, must be an independent director, free from any conflict of interest. The Committee seeks out and contracts the services of an outside, independent executive compensation consultant to advise the Committee in matters of market values of comparable executive positions. The Committee annually reviews all comparability data and prepares a recommendation as to the compensation package of all officers for the full Board. Only the Committee will have the authority to approve the compensation of the senior management team and will report it's actions to the Board. The decisions and deliberations are documented in the governance committee minutes. This process was last undertaken in June 2020.
Form 990, Part VI, Line 19 Required documents available to the public The organization makes its conflict of interest policy available to the public on its website and upon request. Governing documents and financial statements are not required disclosures pursuant to Internal Revenue Code (IRC) Section 6104; these documents are not available to the public at this time.
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Misc - Total Revenue: 212697, Related or Exempt Function Revenue: 212697, Unrelated Business Revenue: 0, Revenue Excluded from Tax Under Sections 512, 513, or 514: 0;
Form 990, Part IX, Line 11g Other Fees Consulting Fees - Total Expense: 10064150, Program Service Expense: 9312269, Management and General Expenses: 751881, Fundraising Expenses: 0; Credit & Collection Fees - Total Expense: 1288193, Program Service Expense: 33607, Management and General Expenses: 1254586, Fundraising Expenses: 0; Clinical Service Fees - Total Expense: 4249891, Program Service Expense: 4246563, Management and General Expenses: 3328, Fundraising Expenses: 0; Engineering Fees - Total Expense: 53408, Program Service Expense: 53408, Management and General Expenses: 0, Fundraising Expenses: 0; Architect Fees - Total Expense: 38076, Program Service Expense: 22265, Management and General Expenses: 15811, Fundraising Expenses: 0; Recruitment Fees - Total Expense: 445876, Program Service Expense: 0, Management and General Expenses: 445876, Fundraising Expenses: 0; Other Professional Fees - Total Expense: 6051383, Program Service Expense: 4044720, Management and General Expenses: 2006663, Fundraising Expenses: 0; Agency Staffing - Total Expense: 1859630, Program Service Expense: 1683962, Management and General Expenses: 175668, Fundraising Expenses: 0; Physician Services - Total Expense: 41538836, Program Service Expense: 41441940, Management and General Expenses: 96896, Fundraising Expenses: 0; Purchased Services - Total Expense: 11910864, Program Service Expense: 6141267, Management and General Expenses: 5769597, Fundraising Expenses: 0;
Form 990, Part X, Line 20 Tax Exempt Bond Liabilities The Series 2017A Non-Taxable bond is split between Southern Illinois Hospital Services and Southern Illinois Medical Services, a related tax exempt entity. The amount listed on line 25 represents the piece of the bond that Southern Illinois Hospital Services holds.
Form 990, Part XI, Line 9 Other changes in net assets or fund balances EQUITY TRANSFERS - -2377513; GAIN/LOSS ON SWAP - 3518201; GAIN/LOSS ON DERIVATIVE - 3032176; MINORITY INTEREST IN NET INCOME - 88379; PSC - EQUITY PURCHASE - -350088;
Form 990, Part XII, Line 3a REQUIREMENTS UNDER SINGLE AUDIT ACT AND OMB CIRCULAR A-133 AS REQUIRED BY THE U.S. OFFICE OF MANAGEMENT AND BUDGET CIRCULAR A-133, AUDITS OF STATES, LOCAL GOVERNMENTS, AND NON-PROFIT ORGANIZATIONS, IN 2021 SOUTHERN ILLINOIS HEALTHCARE SERVICES AND AFFILIATES RECEIVED AN AUDIT FOR THE 2021 CONSOLIDATED FINANCIAL STATEMENTS IN ACCORDANCE WITH THE SINGLE AUDIT ACT.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2020


Additional Data


Software ID: 20011424
Software Version: 2020v4.0
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
Southern Illinois Hospital Services
 
Employer identification number

37-0618939
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity
(1) QUALITY HEALTH PARTNERS LLC
1239 E MAIN ST
CARBONDALE,IL62901
45-4435852 		ADMINISTRATIVE SERVICES IL 4,084,754 1,654,529 SOUTHERN ILLINOIS HOSPITAL SERVICES
 










Part II
Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1)SOUTHERN ILLINOIS HEALTHCARE ENTERPRISES INC
PO BOX 3988

CARBONDALE,IL62902
37-1136788 		PARENT COMPANY - ADMINISTRATIVE FUNCTION IL 501(c)(3) Type II NA
 
 
No
(2)SOUTHERN ILLINOIS MEDICAL SERVICES NFP
1239 EAST MAIN STREET

CARBONDALE,IL62901
20-5521741 		MEDICAL SERVICES IL 501(c)(3) 3 SOUTHERN ILLINOIS HOSPITAL SERVICES
 
Yes
 
(3)SIH FOUNDATION NFP
1239 EAST MAIN STREET

CARBONDALE,IL62901
27-1933790 		FUNDRAISING IL 501(c)(3) Type I SOUTHERN ILLINOIS HOSPITAL SERVICES
 
Yes
 








For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) RIC AND SIHS REHABILITATION SERVICES LLC

PO BOX 3988
CARBONDALE,IL62902
36-4566925 		MEDICAL SERVICES IL SIHS
  		Related -1,601,252 999   No 0   No 99.9 %
(2) PHYSICIANS' SURGERY CENTER LLC

2601 WEST MAIN STREET
CARBONDALE,IL62901
26-0425547 		MEDICAL SERVICES IL SIHS
  		Related -364,195 1,298,224   No     No 100 %










Part IV
Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) SIH CAYMAN SPC GROUP LTD

PO BOX 1051
Cayman Islands,CAYMAN ISLANDSKY11102
CJ
98-0611605 		FINANCING CJ SIHS
  		C Corporation 11,186,923 49,524,222 100 % Yes  
(2) HEALTH SERVICES OF SOUTHERN ILLINOIS INC

PO BOX 3988
CARBONDALE,IL62902
37-1115061 		INACTIVE IL SIHE
  		C Corporation     0 %   No
(3) HIDK PROPERTIES LAND TRUST

1239 EAST MAIN STREET
CARBONDALE,IL62901
46-6693066 		RENTAL PROPERTIES IL SIHS
  		Trust 0 0 100 % Yes  








Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
Yes
 
e Loans or loan guarantees by related organization(s) ............................
1e
Yes
 
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
 
No
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) SOUTHERN ILLINOIS MEDICAL SERVICES

 A 1,055,344 FMV
(2) SOUTHERN ILLINOIS MEDICAL SERVICES

 R 2,377,513 FMV
(3) SOUTHERN ILLINOIS MEDICAL SERVICES

 J 1,325,760 FMV
(4) SIH FOUNDATION

 C 633,480 FMV


Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference Explanation
Schedule R (Form 990) 2020

Additional Data


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Software Version: 2020v4.0