Civic Intelligence

Blessing Hospital Self-Insurance Plan

990 • Fiscal year 2014 • EIN 37-1045366

Oct 01, 2013 to Sep 30, 2014 • Filed on May 13, 2015

Broadway At 11th PO Box 700562305

(217) 223-1200

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

4th percentile

0.00x

Tied with the lowest-debt nonprofits in its peer group.

2014 filings • 501(c)3 • $10M-$25M nonprofits • Source year 2014

Liabilities / Revenue

4th percentile

0.00x

Tied with the lowest-debt nonprofits in its peer group.

2014 filings • 501(c)3 • $10M-$25M nonprofits • Source year 2014

Net Margin

67th percentile

9.2%

Higher net margin than 67% of similar nonprofits.

2014 filings • 501(c)3 • $10M-$25M nonprofits • Source year 2014

Top Officer Pay

12th percentile

$0

Higher top officer pay than 12% of similar nonprofits.

Top officer pay equals 0.0% of source-year revenue.

2014 filings • 501(c)3 • $10M-$25M nonprofits • Source year 2014

Asset Growth

68th percentile

8.8%

Faster asset growth than 68% of similar nonprofits.

2014 filings • 501(c)3 • $10M-$25M nonprofits • Annualized from 2013 to 2014

Revenue Growth

100th percentile

4242%

Faster revenue growth than 100% of similar nonprofits.

2014 filings • 501(c)3 • $10M-$25M nonprofits • Annualized from 2012 to 2014

Assets

Up

$12,299,090

Up $997,414 (+8.8%) from 2013

Net Assets

Up

$12,299,090

Up $997,414 (+8.8%) from 2013

Liabilities

Flat

$0

Flat from 2013

Revenue

$995,486

No earlier filing loaded for comparison.

Expenses

Down

$904,019

Down $791,989 (-47%) from 2013

Net Income

$91,467

No earlier filing loaded for comparison.

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$20M$15M$10M$5.0M$0Assets 2011: $130,632Net Assets 2011: $130,6322011Assets 2012: $78,859Net Assets 2012: $78,8592012Assets 2013: $11,301,676Liabilities 2013: $0Net Assets 2013: $11,301,6762013Assets 2014: $12,299,090Liabilities 2014: $0Net Assets 2014: $12,299,0902014Assets 2015: $11,590,653Liabilities 2015: $0Net Assets 2015: $11,590,6532015Assets 2016: $12,503,606Liabilities 2016: $0Net Assets 2016: $12,503,6062016Assets 2017: $13,997,935Liabilities 2017: $0Net Assets 2017: $13,997,9352017Assets 2018: $17,040,858Liabilities 2018: $0Net Assets 2018: $17,040,8582018Assets 2019: $0Liabilities 2019: $0Net Assets 2019: $02019

Highlighted filing

2014

Assets$12,299,090
Liabilities$0
Net Assets$12,299,090

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$2.0M$1.0M$0-$1.0M-$2.0MRevenue 2011: $678Expenses 2011: $357,341Net Income 2011: -$356,6632011Revenue 2012: $528Expenses 2012: $952,301Net Income 2012: -$951,7732012Expenses 2013: $1,696,0082013Revenue 2014: $995,486Expenses 2014: $904,019Net Income 2014: $91,4672014Revenue 2015: $269,366Expenses 2015: $1,132,315Net Income 2015: -$862,9492015Revenue 2016: $175,761Expenses 2016: $1,888,376Net Income 2016: -$1,712,6152016Revenue 2017: $304,354Expenses 2017: $409,085Net Income 2017: -$104,7312017Revenue 2018: $379,112Expenses 2018: $461,708Net Income 2018: -$82,5962018Revenue 2019: $276,736Expenses 2019: $676Net Income 2019: $276,0602019

Highlighted filing

2014

Revenue$995,486
Expenses$904,019
Net Income$91,467
Jump To
Filing Snapshot
Filing Period
Oct 1, 2013 to Sep 30, 2014
Signed
May 13, 2015
Return Version
2013v4.0
Gross Receipts
$1,124,611
Mission and Program Overview

Mission

Accumulating and holding of funds for use in satisfying professional and comprehensive general liability claims against the following exempt organizations: blessing hospital, blessing corporate services, inc., the blessing foundation, inc., and blessing affiliates, inc. (inactive).

Accumulating and holding of funds for use in satisfying professional and comprehensive general liability claims against affiliated exempt organizations.

Balance Sheet Detail
LineBeginningEndChange
Assets
Investments in Publicly Traded Securities$11,268,578$11,471,994▲ $203,416
Investments Other Securities-$747,847-
Savings and Temporary Cash Investments$33,098$79,249▲ $46,151
Cash and Non-Interest-Bearing Accounts-$0-
Accounts Receivable-$0-
Other Notes and Loans Receivable, Net-$0-
Pledges and Grants Receivable-$0-
Receivable From Disqualified Prsn-$0-
Receivables From Officers Etc-$0-
Investments Program Related-$0-
Land, Buildings, and Equipment, Net-$0-
Intangible Assets-$0-
Inventories for Sale or Use-$0-
Prepaid Expenses and Deferred Charges-$0-
Total Assets$11,301,676$12,299,090▲ $997,414
Other Assets Total-$0-
Liabilities
Total Liabilities$0$0→ $0
Net Assets / Fund Balance
Unrestricted Net Assets$11,301,676$12,299,090▲ $997,414
Total Net Assets Fund Balance$11,301,676$12,299,090▲ $997,414
Total Liabilities and Net Assets / Fund Balance$11,301,676$12,299,090▲ $997,414

Asset Categories

AssetBook ValueDepreciationBasis
Financial Derivatives$747,847--
Compensation and Service Providers

Board Members and Trustees

NameTitle
Blessing HospitalTrustee

Highest Paid Contractors

ContractorServicesLocationCompensation
Schmiedeskamp Robertson Neu & Mitchell LLPLegal Services-$219,301
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$0
Investment Income
$995,486
Other Revenue
$0
Change in Net Assets
$91,467
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$904,019
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Other Expenses$623,275--$623,275
Fees for Services Legal$254,018--$254,018
Fees for Services Other$26,726--$26,726
Total Functional Expenses$904,019$0$0$904,019
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Insider Transactions and Loans

Loans and Receivables

Line ItemBeginningEndChange
Receivables from Disqualified Persons-$0-
Receivables from Officers, Directors, Trustees, and Key Employees-$0-
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Backup withholding compliance
No
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
No
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Line 11B: Form 990 Review Process

Following management and legal review, the form 990 was provided to the blessing hospital board of trustees for review and comment prior to filing.

Form 990, Part VI, Line 12C: Explanation of Monitoring and Enforcement of Conflicts

The blessing hospital self insurance plan does not have a conflict of interest policy written specifically for the organization. However, its controlling entity, blessing hospital, does have a conflict of interest policy. Since all management and governing decisions of the blessing hospital self insurance plan are made by blessing hospital, the policy applies equally to the blessing hospital self insurance plan as it does to blessing hospital.a copy of the conflict of interest policy is distributed annually to the blessing hospital trustees to be read, signed, and returned to the organization. The signed policies are retained in the corporate administrative files. In addition, each trustee is required to declare no conflict of interest in regards to agenda items being presented at the start of each meeting.

Form 990, Part VI, Line 19: Other Organization Documents Publicly Available

These forms are located in the corporate administrative offices and are available upon request for public inspection.

Filing and Contact Details

Filer

EIN
37-1045366
Phone
2172231200

Signing Officer

Name
Timothy a Moore
Title
CAO of Trustee
Signed
2015-05-13
Discuss with paid preparer
Yes

Organization Details

Voting Board Members
1
Independent Board Members
0
Employees
0

Preparer

Preparer
Stephen C Koester CPA
Phone
2172220304
Supplemental Narrative

Additional Explanations

Other Changes In Net Assets Or Fund Balances - Other Increases

Transfers from affiliated organizations = $950000

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This appendix keeps the raw XML leaves available for debugging and edge-case review. The human report above is the primary experience.

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IRS990ScheduleA/SupportedOrgInformationGrp/SupportAmt127238
IRS990ScheduleA/SupportedOrgInformationGrp/SupportedOrganizationName/BusinessNameLine10BLESSING HOSPITAL
IRS990ScheduleA/SupportedOrgInformationGrp/SupportedOrganizationName/BusinessNameLine11BLESSING CORPORATE SERVICES INC
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IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0FOLLOWING MANAGEMENT AND LEGAL REVIEW, THE FORM 990 WAS PROVIDED TO THE BLESSING HOSPITAL BOARD OF TRUSTEES FOR REVIEW AND COMMENT PRIOR TO FILING.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1THE BLESSING HOSPITAL SELF INSURANCE PLAN DOES NOT HAVE A CONFLICT OF INTEREST POLICY WRITTEN SPECIFICALLY FOR THE ORGANIZATION. HOWEVER, ITS CONTROLLING ENTITY, BLESSING HOSPITAL, DOES HAVE A CONFLICT OF INTEREST POLICY. SINCE ALL MANAGEMENT AND GOVERNING DECISIONS OF THE BLESSING HOSPITAL SELF INSURANCE PLAN ARE MADE BY BLESSING HOSPITAL, THE POLICY APPLIES EQUALLY TO THE BLESSING HOSPITAL SELF INSURANCE PLAN AS IT DOES TO BLESSING HOSPITAL.A COPY OF THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED ANNUALLY TO THE BLESSING HOSPITAL TRUSTEES TO BE READ, SIGNED, AND RETURNED TO THE ORGANIZATION. THE SIGNED POLICIES ARE RETAINED IN THE CORPORATE ADMINISTRATIVE FILES. IN ADDITION, EACH TRUSTEE IS REQUIRED TO DECLARE NO CONFLICT OF INTEREST IN REGARDS TO AGENDA ITEMS BEING PRESENTED AT THE START OF EACH MEETING.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2These forms are located in the corporate administrative offices and are available upon request for public inspection.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3TRANSFERS FROM AFFILIATED ORGANIZATIONS = $950000
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0Form 990, Part VI, Line 11b: Form 990 Review Process
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3Other Changes In Net Assets Or Fund Balances - Other Increases
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