2023-03-02T15:17:12-06:00 2022-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2021-07-01 370673506 GRAHAM HOSPITAL ASSOCIATION GRAH 3096475240 210 WEST WALNUT CANTON IL 61520 ROBERT SENNEFF PRESIDENT AND CEO 3096475240 2023-02-08 1 ROBERT SENNEFF 999009999 MICHAEL J PETERSON CPA P01833529 2187224705 2023-02-08 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z ROBERT SENNEFF 210 WEST WALNUT CANTON IL 61520 151001566 0 X WWW.GRAHAMHOSPITAL.ORG X 1905 IL TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES, IN A RESPONSIBLE AND CHARITABLE MANNER, TO THE PEOPLE AND COMMUNITIES WE SERVE. 13 12 836 59 398986 0 10002707 5012094 95465039 102889786 702062 6082543 232072 115136 106401880 114099559 76900 1097370 0 0 47952307 54713831 0 0 0 54198448 49004493 102227655 104815694 4174225 9283865 247992362 232591256 83987426 78082725 164004936 154508531 X TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES, IN A RESPONSIBLE AND CHARITABLE MANNER, TO THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 41755912 1097370 50409745 GRAHAM HOSPITAL IS A PROVIDER OF HEALTHCARE SERVICES IN FULTON COUNTY AND PEORIA COUNTY. DURING THIS REPORTING PERIOD 2,199 ADULTS AND CHILDREN WERE ADMITTED AND 222 BABIES WERE BORN. THEY RECEIVED INPATIENT SERVICES IN THE ACUTE CARE FACILITY. 144 PATIENTS WERE ADMITTED FOR 4,787 DAYS OF SERVICE IN THE EXTENDED CARE FACILITY. 120,575 OUTPATIENT SERVICES WERE PROVIDED. 22267970 0 26882965 SURGICAL SERVICES - THE HOSPITAL PERFORMED 544 INPATIENT SURGERIES AND 3,599 OUTPATIENT SURGERIES IN FISCAL YEAR 2022. 13919714 0 16804549 GRAHAM MEDICAL GROUP WHICH PROVIDES PHYSICIAN AND PROFESSIONAL HEALTH CARE SERVICES TO THE PATIENTS IN FULTON COUNTY AND PEORIA COUNTY. THIS INCLUDES CHARITY CARE TO QUALIFIED INDIVIDUALS AND 101,242 OFFICE VISITS AND 11,817 NURSING HOME AND HOSPITAL VISITS. 6952623 0 8393541 ED PROGRAM - THE HOSPITAL OPERATES A 24 HOUR EMERGENCY DEPARTMENT WHICH HAD 13,307 PATIENTS REGISTERED TO THE EMERGENCY DEPARTMENT IN FISCAL YEAR 2022. 6952623 0 8393541 84896219 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 109 0 836 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X ROBERT SENNEFF 3096475240 210 WEST WALNUT CANTON IL 61520 ROBERT SENNEFF PRESIDENT/CEO 40.00 X X 814186 0 129344 MIKE RENNER CHAIRMAN 2.00 X X 0 0 0 ROBERT BOBELL OD VICE CHAIRMAN 2.00 X X 0 0 0 BILL CARLBERG TREASURER 2.00 X X 0 0 0 JANIS BLOUT SECRETARY 2.00 X X 0 0 0 PAULA GRIGSBY TRUSTEE 2.00 X 0 0 0 ANNE HOLLIS TRUSTEE 2.00 X 0 0 0 KENNETH KROCK MD TRUSTEE 2.00 X 0 0 0 DAN'L LEE TRUSTEE 2.00 X 0 0 0 KEVIN MEADE TRUSTEE 2.00 X 0 0 0 JOSHUA MILLER TRUSTEE 2.00 X 0 0 0 TERRY MOSS TRUSTEE 2.00 X 0 0 0 PATRICK RENICK MD TRUSTEE 2.00 X 0 0 0 HOLLY HENLINE VP ANCILLARY/CCO 40.00 X 280292 0 67530 JULIE REEDER VP FINANCE/CFO 40.00 X 309148 0 39575 TERESA MCCONKEY VP PATIENT SERVICES 40.00 X 257023 0 32253 JAMES SCHREINER VP INFO SERVICES 40.00 X 251215 0 30701 ALLISON SOURS VP QUALITY 40.00 X 281455 0 49039 MICHELLE DALY VP CLINIC SERVICES 40.00 X 244260 0 21582 KEITH IFFT MD ANESTHETIST 40.00 X 469614 0 50587 DWAYNE BERNARD MD MEDICAL DIRECTOR 40.00 X 444592 0 50234 ABENA KROW-RODNEY MD PHYSICIAN 40.00 X 420264 0 52072 BRENT PARRY DPM PODIATRIST 40.00 X 413197 0 30956 DEVASHISH AGARWAL PHYSICIAN 40.00 X 416796 0 58414 4602042 0 612287 12 0 1 0 PJ HOERR INC 107 W COMMERCE PEORIA IL 61604 CONSTRUCTION 10141600 COLEMAN MEDICAL ASSOCIATES LTD 180 SOUTH MAIN STREET CANTON IL 61520 PHYSICIAN SERVICES 8386777 FORGOTTONIA LLC 2907 W WARDCLIFFE DRIVE PEORIA IL 61604 MEDICAL AND MANAGEMENT SERVICES 598757 DIVERSIFIED CLINICAL SERVICES PO BOX 551187 JACKSONVILLE FL 32255 WOUND CARE AND MANAGEMENT SERVICES 545628 PARK PLACE INTERNATIONAL 7227 CHAGRIN ROAD CHAGRIN FALLS OH 44023 CLOUD CARE SUPPORT SERVICES 522901 32 4969734 42360 5012094 PATIENT SERVICE REVENUE 621990 96997902 96997902 340(B) REVENUE 621990 4036225 4036225 SCHOOL OF NURSING 621990 639898 639898 LABORATORY 621500 344633 344633 871128 816775 54353 102889786 2596730 2596730 383085 267949 115136 115136 115136 40107272 12599 36614622 19436 3492650 -6837 3485813 3485813 114099559 102490800 398986 6197679 X 1097370 1097370 4343506 2055484 2288022 39078816 32183191 6895625 658194 642476 15718 7713748 6099180 1614568 2919567 2299485 620082 139314 139314 31579 31579 52689 52689 17899193 15908369 1990824 73375 22483 50892 435134 165732 269402 702986 41837 661149 1444520 1151547 292973 39231 8458 30773 12989 8930 4059 1583760 1407546 176214 5798029 5133666 664363 1392736 1392736 MEDICAL SUPPLIES 11189322 11187126 2196 BAD DEBT EXPENSE 3252839 3252839 MEDICAID ASSESSMENT 2384590 2384590 DIETARY 666689 648398 18291 1905518 1582102 323416 104815694 84896219 19919475 0 2668660 4643965 9049531 3572235 10513760 11953658 3160374 3303239 2124075 1937817 1344714 1758665 162706114 75636737 85895287 87069377 120172188 106499854 10250315 8813444 2813458 3039002 247992362 232591256 12507022 10939245 0 128490 58093534 56296798 1217754 842193 12169116 9875999 83987426 78082725 X 153754621 145695087 10250315 8813444 164004936 154508531 247992362 232591256 X 9283865 -19796661 1016391 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 28091 28091 0 PART II-B, LINE 1: LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED: 44% OF MEMBERSHIP DUES PAID TO THE ILLINOIS HOSPITAL ASSOCIATION, OR $27,128 AND 35.19% OF MEMBERSHIP DUES PAID TO THE ILLINOIS HEALTH CARE ASSOCIATION, OR $963. 124069504 32530350 -15370244 16900 26444450 631311 114136949 93225811 6606063 24959388 19250 508247 194261 124069504 94502686 167929 -1066495 7200 114228 256881 93225811 91454034 860760 3919679 12300 256453 1463034 94502686 81121870 621102 5169957 13150 -5143522 589245 91454056 0.92280 0.07490 0.00230 1 0 3406289 3406289 103995382 39913573 64081809 52178117 35723164 16454953 3126326 3126326 87069377 ESTIMATED SELF-INSURANCE COSTS 3054666 ASSET RETIREMENT OBLIGATION 266162 DEFERRED COMPENSATION PLAN OBLIGATIONS 1176349 FMV OF SWAP OPTIONS 1487101 DUE TO THIRD PARTY PAYORS 3891721 9875999 93324139 -19796661 -978759 -20775420 114099559 0 114099559 101830804 0 101830804 2984890 2984890 104815694 PART V, LINE 4: THE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS IS TO PROVIDE SCHOLARSHIPS BASED ON STUDENT NEEDS FROM THE INCOME OF THE DONOR-RESTRICTED ENDOWMENT FUNDS. THE PERMANENT ENDOWMENT IS USED FOR THE PURCHASE OF PROPERTY AND EQUIPMENT. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 2,006,131. RENTAL EXPENSES 267,949. BAD DEBT EXPENSE -3,252,839. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 3,252,839. RENTAL EXPENSES -267,949. PART V, LINE 3A(I) CHARLES D INGERSOLL TRUST AND WILLIAM P INGERSOLL TRUST ARE ADMINISTERED BY MIDAMERICA NATIONAL BANK AND J.P. MORGAN 1 1 X 1 X 180.000000000000 1 X 1 1 0 1 0 1402652 1402652 0.01340 21015958 17709407 3306551 0.03150 22418610 17709407 4709203 0.04490 90156 1532 88624 0.00080 1010595 1010595 0.00960 157361 1200 156161 0.00150 1258112 2732 1255380 0.01190 23676722 17712139 5964583 0.05680 14101 14101 0.00010 3278 3278 0.00000 17379 17379 0.00010 0 1246274 0 19361344 20978104 -1616760 X 1 1 1 1 GRAHAM HOSPITAL ASSOCIATION 210 WEST WALNUT STREET CANTON IL 61520 WWW.GRAHAMHEALTHSYSTEM.ORG 0000869 X X GRAHAM HOSPITAL ASSOCIATION 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X SEE PART V, SECTION C, LINE 7D 1 21 1 SEE PART V, SECTION C, LINE 7D 0 1 X 180.000000000000 300.000000000000 X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 GRAHAM HOSPITAL ASSOCIATION PART V, SECTION B, LINE 5: FOCUS GROUP ONE HEALTHCARE PROVIDERS AND COMMUNITY LEADERS:TRYGVE MEADE, ATTORNEY/PROPRIETOR, MEADE LAW OFFICEJEFF STANDARD, FULTON COUNTY SHERIFFCARLA BOBELL, EXECUTIVE DIRECTOR, CANTON AREA CHAMBER OF COMMERCEJED RHOADES, REAL ESTATE & AUCTION SERVICESKATHY LOCK, PRESIDENT, GRAHAM HOSPITAL SERVICE LEAGUEJEFF UTSINGER, ASSISTANT SUPERINTENDENT, CANTON UNION SCHOOL DISTRICTJAY SHEPLER, ST. MARY'S FOOD PANTRY REPRESENTATIVETHE REV. KEVIN VANTINE, COVENANT COMMUNITY FELLOWSHIP, CANTONKENT MCDOWELL, MAYOR, CITY OF CANTONDIANA PAVLEY-ROCK, CANTON CITY CLERKFOCUS GROUP TWO MEDICAL PROFESSIONALS AND PARTNERS:LIZ UTSINGER, HEALTH PROFESSIONAL/HEALTH EDUCATOR, FULTON COUNTY HEALTH DEPARTMENTKATIE LYNN, ADMINISTRATOR, FULTON COUNTY HEALTH DEPARTMENTMISSY KOLOWSKI, ADMINISTRATOR, HEALTH & WELLNESS CONNECTION OF FULTON COUNTYERIN ANDERSON, CASE MANAGER, GRAHAM HEALTH SYSTEMANDY FRENCH, SENIOR DIRECTOR, CARDIAC PULMONARY REHAB & WELLNESSBECKY SHERWOOD, DIRECTOR, GRAHAM SCHOOL OF NURSINGWESLEY KIMBROUGH, SUPERVISOR, COMMUNITY CARE SERVICESKELLI KELLEY, COORDINATOR, COMMUNITY CARE SERVICESRACHEL BUNDY, PHARMACIST, GRAHAM HEALTH SYSTEM GRAHAM HOSPITAL ASSOCIATION PART V, SECTION B, LINE 7D: HTTPS://WWW.GRAHAMHEALTHSYSTEM.ORG/COMMUNITY-RESOURCE-GUIDE/COMMUNITY-HEALTH-NEEDS-ASSESSMENT GRAHAM HOSPITAL ASSOCIATION PART V, SECTION B, LINE 11: 1. AVAILABILITY OF MENTAL HEALTH SERVICES, INCLUDING:- INCREASING ACCESS TO LOCAL TREATMENT FOR MENTAL HEALTH SERVICES OF ALL TYPES FOR YOUTH AND ADULTS- IMPROVING AND INCREASING ACCESS TO LONG-TERM MENTAL HEALTHCARE OUTSIDE THE COMMUNITY, INCLUDING CARE FOR SUBSTANCE USE DISORDERS- PROVIDING COMMUNITY EDUCATION ABOUT AVAILABLE LOCAL MENTAL HEALTH SERVICES 2. IMPROVE HEALTH EDUCATION AND HEALTH SERVICES IN SOME LOCAL SCHOOLS THAT ARE NOT CURRENTLY SUFFICIENTLY STAFFED TO FULLY MEET THESE NEEDS. ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED:- GRAHAM HEALTH SYSTEM WILL COLLABORATE WITH CANTON UNION SCHOOL DISTRICT TO DETERMINE NEEDS AND DEVELOP SOLUTIONS BASED ON NEEDS OF THE SCHOOLS- GRAHAM HEALTH SYSTEM WILL FACILITATE INFORMATION-SHARING OPPORTUNITIES FOR SCHOOL NURSES WORKING THROUGHOUT THE SERVICE AREA - PROVIDING LOCAL ACCESS TO A PSYCHIATRIST & ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED:- GRAHAM HEALTH SYSTEM WILL ADD A MENTAL HEALTH NURSE PRACTITIONER TO THEPROFESSIONAL STAFF AT THE CLINIC- GRAHAM HEALTH SYSTEM WILL COLLABORATE WITH NORTH CENTRAL BEHAVIORAL HEALTH SYSTEMS TO PROVIDE A FULL-TIME, IN-HOUSE CRISIS WORKER AT GRAHAM HEALTH SYSTEM - GRAHAM HEALTH SYSTEM WILL SEEK TO EXPAND CONTACTS FOR OUT-OF-THE-AREA REFERRALS FOR CARE FOR PERSONS NEEDING INPATIENT CARE FOR MENTAL HEALTH AND SUBSTANCE USE DISORDERS- GRAHAM HEALTH SYSTEM WILL EXPLORE HIRING AN OUTPATIENT ADVANCED PRACTICE PROVIDER- GRAHAM HEALTH SYSTEM WILL EXPLORE TELE-PSYCHIATRY AND TELE-MENTAL HEALTH COUNSELING- GRAHAM HEALTH SYSTEM WILL COLLABORATE WITH THE FULTON COUNTY HEALTH DEPARTMENT AND LOCAL SCHOOLS TO ADDRESS MENTAL HEALTH NEEDS FOR YOUTH AND COMMUNITY EDUCATION ABOUT AVAILABILITY OF LOCAL SERVICES FOR YOUTH, ADULT, AND FAMILY 3. ADDRESS HOMELESSNESS.ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED:- RECOGNIZING THAT THIS IS A COMMUNITY-WIDE ISSUE AND BEYOND THE RESOURCES AND SERVICES OF THE HOSPITAL, GRAHAM HOSPITAL WILL ATTEMPT TO FORM AND FACILITATE A COMMUNITY WORKGROUP OF INTERESTED AGENCIES, LOCAL GOVERNMENTS, SCHOOLS, BUSINESSES, AND INDIVIDUALS TO DEVELOP AND IMPLEMENT STRATEGIES TO EXPLORE THE SCOPE AND ADDRESS THIS ISSUE. GRAHAM HOSPITAL ASSOCIATION PART V, SECTION B, LINE 16J: THE FAP AND FAP SUMMARY ARE ONLY PROVIDED IN ENGLISH. GRAHAM HOSPITAL ASSOCIATION IS NOT REQUIRED TO PROVIDE THE FAP AND FAP SUMMARY IN LANGUAGES THAT ARE SPOKEN BY LEP POPULATIONS. PART V, LINE 10A: HTTPS://WWW.GRAHAMHEALTHSYSTEM.ORG/COMMUNITY-RESOURCE-GUIDE/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART V, LINE 16A-C: HTTPS://WWW.GRAHAMHEALTHSYSTEM.ORG/PATIENT-VISITOR-RESOURCES/BILLING-FINANCIAL-ASSISTANCE/FINANCIAL-ASSISTANCE 10 1 - GRAHAM MEDICAL GROUP 180 SOUTH MAIN STREET CANTON IL 61520 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 2 - GRAHAM HOSPITAL EXTENDED CARE UNIT 210 WEST WALNUT STREET CANTON IL 61520 SKILLED NURSING & LONG TERM CARE UNITS 3 - GHA HOME MEDICAL EQUIPMENT STORE 101 SOUTH MAIN STREET CANTON IL 61520 HOME MEDICAL EQUIPMENT RETAIL STORE 4 - GRAHAM MEDICAL GROUP - LEWISTOWN 408 SOUTH MAIN STREET LEWISTOWN IL 61542 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 5 - GRAHAM MEDICAL GROUP - FARMINGTON 601 EAST FORT STREET FARMINGTON IL 64531 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 6 - GRAHAM HOSPITAL SCHOOL OF NURSING 210 WEST WALNUT STREET CANTON IL 61520 SCHOOL OF NURSING 7 - GRAHAM CARDIAC REHABILITATION 180 SOUTH MAIN STREET CANTON IL 61520 CARDIAC REHAB SERVICES 8 - GRAHAM MEDICAL GROUP - ELMWOOD 1024 NORTH MAGNOLIA STREET ELMWOOD IL 61529 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 9 - GRAHAM HOSPITAL PHARMACY 210 WEST WALNUT STREET CANTON IL 61520 PHARMACY FOR PATIENTS & RETAIL FOR EMPLOYEES 10 - GRAHAM MEDICAL GROUP - WILLIAMSFIELD 120 EAST GALE STREET WILLIAMSFIELD IL 61489 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC PART I, LINE 6A: NOT APPLICABLE PART I, LINE 7: THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDING BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART II, COMMUNITY BUILDING ACTIVITIES: A DONATION OF $5,000 WAS MADE TO THE SPOON RIVER PARTNERSHIP FOR ECONOMIC DEVELOPMENT. THIS ORGANIZATION FOCUSES ON BUILDING IN THE LOCAL COMMUNITY THROUGH ECONOMIC GROWTH, WHICH IMPROVES OPPORTUNITIES FOR JOBS AND INSURANCE WITHIN THE COMMUNITY. THIS DONATION HELPED SUPPORT THE LOCAL ECONOMY BY HELPING A SMALL BUSINESS. A DONATION OF $10,000 WAS MADE TO THE UNIVERSITY OF ILLINOIS FAMILY MEDICINE RURAL STUDENT PHYSICIAN PROGRAM. THIS DONATION WILL HELP GIVE OPPORTUNITY TO PHYSICIANS WHO WANT TO WORK IN RURAL HOSPITALS LIKE GRAHAM. A MONTHLY DONATION OF $5,000 WAS MADE TO THE HEALTH AND WELLNESS CONNECTION OF FULTON COUNTY. THIS CLINIC IS CONSISTENT WITH AND SUPPORTIVE OF GRAHAM'S MISSION OF PROVIDING CHARITY CARE AND HEALTH IMPROVEMENT SERVICES TO THOSE IN NEED.CURRENT YEARUNIVERSITY OF IL - $510,000SPOON RIVER COLLEGE - $500,000HEALTH AND WELLNESS CONNECTION OF FULTON COUNTY - $61,250 ($60,000 340 B, $1,200 ADMINISTRATION DONATION)VIT UNIT SCHOOL DISTRICT - $10,000SPOON RIVER PARTNERSHIP - $5,000 PART III, LINE 2: PATIENT RECEIVABLES ARE WRITTEN OFF AS BAD DEBT EXPENSE BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. PART III, LINE 3: PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. THE HOSPITAL DOES NOT CHARGE INTEREST ON RECEIVABLES. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED PAST DUE WHEN AN AMOUNT IS PAST DUE ACCORDING TO THE PAYOR'S AGREED-UPON TERMS. PATIENT RECEIVABLES ARE WRITTEN OFF AS BAD DEBT EXPENSE BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. PART III, LINE 8: THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFITS EXPENSE BECAUSE PROVIDING MEDICAL CARE AT A SHORTFALL IMPACTS THE HOSPITAL'S OPERATIONS AND GROWTH. THE CARE IS PROVIDED BECAUSE THERE IS A NEED AND A DESIRE TO PROVIDE MEDICAL CARE IN THIS COMMUNITY.THE COSTING METHOD USED ABOVE FOR IRS FORM 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES AND THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: THE COLLECTION POLICY DESCRIBES THE STEPS TAKEN TO COLLECT SELF PAY BALANCES OUTSTANDING INCLUDING NOTIFICATIONS TO THE PATIENT THROUGH STATEMENTS, FOLLOW-UP PHONE CALLS, VERIFICATION OF INSURANCE ELIGIBILITY AND ULTIMATELY AT WHAT POINT THE UNPAID BALANCE IS WRITTEN OFF AS UNCOLLECTIBLE. IN PRACTICE, WHEN A PATIENT IS IDENTIFIED AS QUALIFYING FOR FINANCIAL ASSISTANCE, A SEARCH OF ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE IS DONE AND THOSE ACCOUNTS ARE REPROCESSED. PART VI, LINE 2: IN ADDITION TO THE CHNA, A PHYSICIAN NEEDS ASSESSMENT IS DONE TO IDENTIFY NEEDS FOR SPECIFIC SPECIALTY SERVICES BASED ON THE SIZE OF THE CATCHMENT AREA. DATA IS ANALYZED TO IDENTIFY SERVICES THAT ARE PROVIDED TO COUNTY RESIDENTS BY OTHER FACILITIES THAT WOULD BE MORE ACCESSIBLE TO PATIENTS IF PROVIDED AT GRAHAM HEALTH SYSTEM. INPUT IS GAINED FROM PHYSICIANS AND OTHER HEALTHCARE WORKERS PROVIDING SERVICE IN THE AREA ALONG WITH INPUT PROVIDED BY THE BOARD OF DIRECTORS WHO REPRESENT THE COMMUNITY AND PROVIDE A COMMUNICATION LINK BETWEEN GRAHAM HEALTH SYSTEM AND THE COMMUNITIES WE SERVE. PART VI, LINE 3: THE CHARITY CARE/FINANCIAL ASSISTANCE PROGRAM IS MADE AVAILABLE TO PATIENTS UPON REGISTRATION. FINANCIAL ASSISTANCE APPLICATIONS ARE AVAILABLE TO PATIENTS UPON REGISTRATION OR TO ANYONE REQUESTING THE APPLICATION. THE APPLICATIONS ARE ALSO AVAILABLE ON GRAHAM HEALTH SYSTEM'S WEBSITE AT WWW.GRAHAMHEALTHSYSTEM.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-ASSISTANCE. APPOINTMENTS MAY BE MADE WITH A FINANCIAL ADVOCATE IF ASSISTANCE IS NEEDED. MEDICAID SERVICES APPLICATION ASSISTANCE IS AVAILABLE. PART VI, LINE 4: THE GRAHAM HEALTH SYSTEM PRIMARY CATCHMENT AREA IS LOCATED PRIMARILY IN FULTON COUNTY AND INCLUDES ALL OR PORTIONS OF THE TOWNS OF CANTON, BUSHNELL, LEWISTOWN, FAIRVIEW, ELLISVILLE, AVON, BANNER, ELMWOOD, ASTORIA, WILLIAMSFIELD, CUBA, DUNFERMLINE, BRYANT, TABLE GROVE, FARMINGTON, HAVANA, GLASFORD, NORRIS, MARIETTA, SMITHFIELD, IPAVA, SAINT DAVID, LONDON MILLS, VERMONT AND LIVERPOOL. THE RACE AND ETHNICITY MAKEUP ARE TYPICAL OF RURAL ILLINOIS BASED ON US CENSUS BUREAU DATA AND INCLUDES 95.2% WHITE, 2.8% BLACK, AND 2.0% OTHER. ACCORDING TO THE US CENSUS BUREAU MEDIAN HOUSEHOLD INCOME WAS $52,165. FULTON COUNTY'S UNEMPLOYMENT RATE WAS 6.7%. PART VI, LINE 5: DURING EACH FISCAL YEAR VARIOUS COMMUNITY HEALTH IMPROVEMENT SERVICES ARE HELD AT A FACILITY OWNED BY GRAHAM HEALTH SYSTEM OR ITS EMPLOYEES ASSIST WITH SERVICES HELD AT VARIOUS LOCATIONS WITHIN THE CATCHMENT AREA. EXAMPLES OF THESE ACTIVITIES INCLUDE ANNUAL SPONSORSHIP OF A COMMUNITY TALK AND DINNER THAT IS FREE TO THE PUBLIC COVERING HEALTH TOPICS; FREE BLOOD PRESSURE CLINICS OFFERED ON A REGULAR BASIS; PROVIDING SPACE FOR OPERATION OF AN OUTPATIENT CLINIC THAT PROVIDES FREE HEALTHCARE SERVICES TO FULTON COUNTY RESIDENTS. CLINIC SERVICES ARE PROVIDED BY COMMUNITY VOLUNTEERS. (DUE TO COVID, THERE WAS NO EDUCATIONAL TALK AND DINNER; AND THE BLOOD PRESSURE CLINICS WERE STOPPED.) GRAHAM DID ASSIST IN SEVERAL COVID VACCINE CLINICS IN CONJUNCTION WITH THE FULTON COUNTY HEALTH DEPARTMENT DURING THE YEAR. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES IL 0 UNIVERSITY OF ILLINOIS FOUNDATION HARKER HALL MC 386 1305 WEST GREEN STREET URBANA IL 61801 376006007 501(C)(3) 510000 0 PROVIDE SUPPORT TO ORGANIZATION SPOON RIVER COLLEGE 23235 N CO 22 CANTON IL 61521 370895488 GOVERNMENT 500000 0 PROVIDE SUPPORT TO ORGANIZATION HEALTH AND WELLNESS CONNECTION OF FULTON COUNTY 103A S MAIN STREET CANTON IL 61520 272753264 501(C)(3) 61200 0 PROVIDE SUPPORT TO ORGANIZATION VIT UNIT SCHOOL DIST NO 2 1500 E US HWY 136 TABLE GROVE IL 61482 376002910 GOVERNMENT 10000 0 PROVIDE SUPPORT TO ORGANIZATION SPOON RIVER PARTNERSHIP FOR ECONOMIC DEVELOPMENT 209 EAST CHESTNUT SUITE 2 CANTON IL 61520 050633175 501(C)(3) 5000 0 PROVIDE SUPPORT TO ORGANIZATION 5 0 X X X 0 1 0 0 0 0 0 0 0 ROBERT SENNEFF PRESIDENT/CEO 449747 0 121329 0 243110 0 110044 0 19300 0 943530 0 187051 0 KEITH IFFT MD ANESTHETIST 430048 0 1260 0 38306 0 8700 0 41887 0 520201 0 0 0 DWAYNE BERNARD MD MEDICAL DIRECTOR 362662 0 69685 0 12245 0 8700 0 41534 0 494826 0 0 0 DEVASHISH AGARWAL PHYSICIAN 340598 0 60748 0 15450 0 8700 0 49714 0 475210 0 0 0 ABENA KROW-RODNEY MD PHYSICIAN 332498 0 46525 0 41241 0 7136 0 44936 0 472336 0 0 0 BRENT PARRY DPM PODIATRIST 351117 0 30042 0 32038 0 20700 0 10256 0 444153 0 0 0 JULIE REEDER VP FINANCE/CFO 207706 0 63676 0 37766 0 32362 0 7213 0 348723 0 0 0 HOLLY HENLINE VP ANCILLARY/CCO 193087 0 57295 0 29910 0 31133 0 36397 0 347822 0 0 0 ALLISON SOURS VP QUALITY 165239 0 41998 0 74218 0 32502 0 16537 0 330494 0 53767 0 TERESA MCCONKEY VP PATIENT SERVICES 168283 0 52203 0 36537 0 28393 0 3860 0 289276 0 0 0 JAMES SCHREINER VP INFO SERVICES 173040 0 51116 0 27059 0 27731 0 2970 0 281916 0 0 0 MICHELLE DALY VP CLINIC SERVICES 148590 0 33829 0 61841 0 17901 0 3681 0 265842 0 49662 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) PLAN IN 2021 SPONSORED BY GRAHAM HOSPITAL ASSOCIATION: ROBERT SENNEFF - $101,345, TERESA MCCONKEY - $20,630, JAMES SCHREINER - $20,148, HOLLY HENLINE - $22,622, MICHELLE DALY - $16,385, JULIE REEDER - $25,149, ALLISON SOURS - $24,031, BRENT PARRY - $12,000, BRETT BARNHART - $12,000. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GRAHAM HOSPITAL ASSOCIATION ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2021. THIS INFORMATION IS INCLUDED IN DEFERRED COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. A CITY OF CANTON IL 376000876 2019-09-26 44500000 REFUND PRIOR ISSUE AND FUND BUILDING PROJECTS. 0 0 0 B CITY OF CANTON IL 376000876 2020-06-18 17000000 FUND BUILDING PROJECTS AND EQUIPMENT 0 0 0 A 1490000 44500000 44500000 2017 1 0 1 1 B 330000 17000000 207600 16792400 2021 0 0 0 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 1 0 0 1 0 0 0 1 A 1 B 1 FORM 990, PART VI, SECTION B, LINE 11B THE PREPARED FORM 990 IS REVIEWED BY THE BOARD OF TRUSTEES, CEO, CFO, DIRECTOR OF ACCOUNTING, AND SENIOR ACCOUNTANT BEFORE FILING WITH THE IRS. BEFORE FILING, THE CFO PRESENTS THE FORM 990 TO THE ORGANIZATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C GRAHAM HOSPITAL REQUIRES THAT ALL TRUSTEES AND ADMINISTRATIVE OFFICERS KEEP THE BOARD OF TRUSTEES INFORMED OF POTENTIAL CONFLICTS OF INTEREST, AND THAT EACH PERSON MAKE AN ANNUAL DECLARATION OF SUCH INTEREST. A CONFLICT OF INTEREST MIGHT EXIST WHEN ORGANIZATIONS IN WHICH TRUSTEES OR OFFICERS HAVE A MATERIAL FINANCIAL INTEREST ARE EITHER DOING BUSINESS WITH, COMPETING WITH, OR HAVE A FINANCIAL INTEREST IN GRAHAM HOSPITAL. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE ADMINISTRATIVE OFFICERS IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. THE ORGANIZATION UTILIZES AN OUTSIDE FIRM, SULLIVAN, COTTER AND ASSOCIATES, INC. TO PROVIDE OUTSIDE EXECUTIVE COMPENSATION INFORMATION. THE LAST REVIEW WAS COMPLETED IN JANUARY 2020. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G OUTSIDE CONTRACTORS: PROGRAM SERVICE EXPENSES 561,234. MANAGEMENT AND GENERAL EXPENSES 4,566. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 565,800. PHYSICIANS: PROGRAM SERVICE EXPENSES 9,834,681. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,834,681. SERVICE AGREEMENT: PROGRAM SERVICE EXPENSES 1,123,406. MANAGEMENT AND GENERAL EXPENSES 1,194,738. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,318,144. PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 5,546. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,546. REPAIR AND MAINTENANCE: PROGRAM SERVICE EXPENSES 69,068. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 69,068. OTHER FEES: PROGRAM SERVICE EXPENSES 4,077,056. MANAGEMENT AND GENERAL EXPENSES 791,520. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,868,576. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 237,378. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 237,378. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 2,006,131. CHANGE IN BENEFICAL INTEREST IN PERPETUAL TRUSTS 35,921. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT -1,025,661. FORM 990, PART XII, LINE 3B: THE ORGANIZATION IS REQUIRED TO BE INCLUDED IN A SINGLE AUDIT FOR THE YEAR ENDED 06/30/2022. THE DEADLINE FOR THIS FILING FALLS AFTER THE DEADLINE FOR THE 990 FOR THE SAME FISCAL YEAR END. THE SINGLE AUDIT WILL NOT BE FINALIZED AT THE TIME OF THIS SUBMISSION.