2023-06-02T07:13:42-05:00 2022-07-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2021-08-01 370645239 Carlinville Area Hospital Association CARL 2178543141 20733 North Broad Street Carlinville IL 62626 Paul Courtney CFO 2178543141 2023-05-17 1 Paul Courtney 999009999 Kim Hunwardsen CPA P00484560 6122536500 2023-05-01 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Brian Burnside 20733 North Broad Street Carlinville IL 62626 39632090 0 X www.cahcare.com X 1947 IL Provide quality acute and preventative health care benefits 9 8 324 8 -20059 0 6337086 2125265 32955789 37117090 136778 169049 168001 -90370 39597654 39321034 0 0 0 0 16417200 21302283 0 0 0 16381093 19498325 32798293 40800608 6799361 -1479574 46342668 38337789 23039318 17086743 23303350 21251046 X To maintain a professional medical community, a primary care hospital and other health care services, in order to provide quality acute and preventative health care for the benefit of those persons living in the service area. 0 0 32322947 37117090 Carlinville Area Hospital Association is a 25-bed acute care hospital located in Carlinville, Illinois. The Hospital provides inpatient, outpatient and emergency care services for residents of central Illinois.During fiscal year 2022, we carried out our exempt purpose in the following ways: 1) Provided quality short term acute care medical services to 347 inpatients, of which 77% were eligible for Medicare. Without our services these elderly patients would have had to travel over 20 miles to receive similar services. (Continued on Schedule O) 2) Provided quality short term skilled care to 116 patients in our swing bed unit, with an average length of stay of 10.91 days. 3) Provided 24 hour a day emergency room services. Our emergency room treated 6,736 patients during fiscal year 2022. We treat everyone who presents themselves to our emergency room regardless of their medical condition or ability to pay. We provided 24-hour physician service so people residing in the Carlinville area do not have to travel long distances for emergency medical care. 4) In addition to the inpatient and emergency services we provide, we also had 32,222 visits in our outpatient departments. These services range from preventative care items such as mammograms and lab tests to rehabilitative services such as Physical and Occupational therapy. 5) The hospital also had 8,108 visits to their specialty clinics. These clinics bring specialists from metropolitan areas to Carlinville on a rotating basis. This provides access to specialty services not otherwise offered in the area.6) The hospital also had 17,366 visits in our Rural Health Clinics. These clinics allow for patients to stay closer to home and get in to see a medical provider.The Hospital provides health care services to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Since the Hospital does not pursue collection of these amounts, they are not reported as patient service revenue. The estimated costs of providing these services was $211,000 for the year ended July 31, 2022, calculated by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients. 32322947 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 15 0 1 324 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 8 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X Paul Courtney 2178543857 20733 North Broad Street Carlinville IL 62626 Anne Borwick DO Internal Med & Pediatrics 40.00 0.00 X 322666 0 33065 Connee Sloman CRNA 40.00 0.00 X 308914 0 25790 August Adams MD Internal Medicine 41.00 0.00 X 268698 0 31612 Harald Lausen MD Internal Medicine 40.00 0.00 X 242350 0 6838 Lourdes Cruz MD Pediatrician 40.00 0.00 X 238188 0 15302 Kate Wilkens MD - Director Medical Staff Pres as of 2.1.22 41.00 0.00 X 170121 0 6600 Dennis Pickrel - Treasurer until 12.31.21/Chair as of 1.1.22 1.00 0.60 X X 0 0 0 J Richard Schien - Chair until 12.31.21/Dir. as of 1.1.22 1.00 0.60 X X 0 0 0 Richard Walden Vice Chair 1.00 0.60 X X 0 0 0 Ralph March Secretary 1.00 0.60 X X 0 0 0 Heather DeNeve - Member until 12.31.21/Treas as of 1.1.22 1.00 0.30 X X 0 0 0 Katie Goodman-Thomas Member 1.00 0.30 X 0 0 0 James Salske Member 1.00 0.00 X 0 0 0 Tom Denby Member starting 1.1.22 1.00 0.30 X 0 0 0 Brian Burnside CEO 40.00 1.30 X 0 0 0 Paul Courtney CFO as of January 2022 40.00 1.30 X 0 0 0 Patrick Nudo CFO until August 2021 40.00 1.30 X 0 0 0 Steve Miller CFO until December 2021 40.00 1.30 X 0 0 0 1550937 0 119207 20 0 1 0 HealthTechS3 PO Box 636426 Cincinnati OH 425636426 Management Services 1033797 Sanburg Emergency Group PO Box 677979 Dallas TX 752677979 Emergency Room Physicians 744592 Macoupin Physician Services PO Box 677979 Dallas TX 752677979 Hospitalist Physicians 601603 Illinois Emergency Physicians LLP PO Box 674579 Detroit MI 482674579 Emergency Room Physicians 500000 Aramark 26792 Network Place Chicago IL 60673 Laundry Service 466235 19 2089157 36108 2125265 Patient service revenue 621110 36662979 36662979 Pharmacy revenue 446110 187185 187185 266926 266926 37117090 78028 78028 220686 311056 -90370 -90370 -20059 -70311 91021 0 91021 91021 91021 39321034 37117090 -20059 98738 X 244601 244601 16693493 13740172 2953321 415956 341784 74172 2741756 2263403 478353 1206477 995999 210478 1282144 1282144 66496 66496 86933 86933 6057619 5602493 455126 240941 240941 4069806 2717869 1351937 123883 123883 241347 241347 61952 16333 45619 249786 62247 187539 560206 439821 120385 2385705 1853767 531938 302838 166445 136393 Medical supplies 3266828 3266828 Food 270426 270279 147 Repairs and maintenance 78806 69730 9076 152609 29829 122780 40800608 32322947 8477661 0 16732260 11323199 5082119 4872927 295512 318966 198955 315041 41956008 26585179 17154812 15370829 6139362 5318278 100000 125000 639648 693549 46342668 38337789 1846578 3083363 5798596 568234 13908140 13058340 1486004 376806 23039318 17086743 X 22583702 20650597 719648 600449 23303350 21251046 46342668 38337789 X -1479574 -453531 -119199 X 0 1 X 1 0 X 500172 500172 26277902 23388160 2889742 12600709 1789518 10811191 2577225 1407501 1169724 15370829 Employee health claims 375000 Due to Affiliates 1806 376806 X 39178559 -453531 -453531 39632090 -311056 -311056 39321034 41111664 311056 311056 40800608 0 40800608 Part X, Line 2: The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 4b - Other Adjustments: Rental expenses recorded in revenue for Form 990 -311,056. Part XII, Line 2d - Other Adjustments: Rental expenses recorded in revenue for Form 990 311,056. 1 1 X 1 X 125.000000000000 1 X 1 1 0 0 211000 211000 0.00520 211000 211000 0.00520 12926359 5320776 7605583 0.18640 12926359 5320776 7605583 0.18640 13137359 5320776 7816583 0.19160 1 1340041 301643 11148722 11078500 70222 X 1 1 1 1 Carlinville Area Hospital Association 20733 North Broad Street Carlinville IL 62626 www.cahcare.com 0005686 X X X X 2 provider based RHCs and 1 provider based clinic Carlinville Area Hospital Association 1 0 0 1 X X X X X X X X X 21 1 1 0 1 X https://www.cahcare.com/ X 1 21 1 https://www.cahcare.com/ 0 1 X 125.000000000000 300.000000000000 X X X 1 1 X X X X 1 X www.cahcare.com/financial-information/ X www.cahcare.com/financial-information/ X www.cahcare.com/financial-information/ X X X X X X 1 X 0 X X X X 1 X 0 1 Carlinville Area Hospital Association Part V, Section B, Line 5: Focus groups were formed for input. Medical professionals and partners and key community leaders were the groups. After the groups met, a prioritization process identified several potential health needs that were chosen for the needs assessment. Carlinville Area Hospital Association Part V, Section B, Line 6a: HSHS St. Francis Hospital, Hillsboro Area Hospital Carlinville Area Hospital Association Part V, Section B, Line 11: A Community Health Needs Assessment was completed in fiscal year 2019. The following are the needs identified and the accomplishments for fiscal year 2022.Prioritized Needs:Obesity: Provide education and programming aimed at youth on the need for recreation, exercise, and healthy eating. - The walking path remained open.- Continue to offer and promote wellness path, aquatic classes, Cardiac Rehab Phase III program, golf clinic, fall and balance classes, and Parkinsons exercise group.- Offer employee wellness program platform to area employers.Diabetes: Programs encouraging recreation and exercise at all ages.- Continue development of chronic care management with focus on diabetes, migrating toward patient centered medical home.Mental Health: Improve availability of mental health and substance use and misuse counseling. Improve access to local mental health case management services for persons suffering mental health issues including depression, grief, and loss. -Continue to offer Senior Behavioral Health Intensive Outpatient Program for Medicare covered senior citizens facing mental health challenges.-Continue to provide a Social Worker to do 1:1 and/or family counseling in RHC-Added an activity-focused group for seniors in Senior Behavioral Health program-Partner in Community Partnership Mental Health Grant with Carlinville CUSD for collaboration on mental health services within schools for '22-'23 school year-Outreach to senior centers presenting topics on mental health-Wrote and received Mental Health Services Award grant through ICAHN which led to implementation of Behavioral Health Screening process in E/D and Inpatient Med/Surg units of CAH for quick identification of inpatients with co-morbid mental health concerns-Established/Streamlined mental health referral process for RHC counseling and SBH programs-Participated in collaborative efforts in Behavioral Health programs utilizing South Central Hospital Alliance-Social Worker/Counselor attend daily huddle on inpatient med surg unit and provide consult services to hospitalized inpatients and swing bed patients with mental health co-morbidities-Participate in Health Jam/Health Fair providing information on Mental Health careers-Behavioral Health Counselor/Social Worker providing Emergency Department consultations and assistance for Mental Health Issues-Added mental health focused areas and trauma informed care components to inpatient assessment and behavioral health staff provide bedside consultation to inpatients facing crisis/trauma.Preventative Care and Case Management Services - Continue to offer case management services in the rural health clinics.- Expand rural health clinics' hours.- Explore expanding rural health clinics into other communities within the Hospital's service area.- Offer wellness program to local businesses and civic organizations.- Expand telehealth services offered.Local Healthcare Workforce Development- Started the CAN program with L&C and Carlinville High School to allow high school students to get CAN training for a high school and college credit. Funded the learning lab supplies and hosted clinical experience. - Developed the Nursing Clinical Ladder to strengthen and develop our bedside professional nurses- Continue to offer and communicate information regarding CAH&C tuition assistance program to employees- Continue to support the Macoupin CEO Program- Continue to offer clinical rotations- Communicate scholarship opportunities available to employees- Developed Employee Referral Program/Policy- Established $15/hr minimum wage ahead of IL minimum wage requirement schedule- Hosted multiple walk-in interviews- Attended LCCC Nursing Career Days- Explored international recruitment in areas with professional shortages- Provided hospital tours to students- Provided job shadowing opportunities to students- Provided resources to local high school students regarding healthcare careers- Significantly reduced employee costs for health insurance through the new hospital plan starting in January 2022- Explored different advertising avenues to communicate job openings including: radio, social media, streaming apps, etc.- Developed and rolled out a video recruitment campaign- Established and Education department allowing us to be better aligned to hire new grads and "grow our own" clinical staff- Continued to solicit feedback from employees through employee satisfaction surveys- Continued to monitor turnover rates and exit interview commentsCarlinville Area Hospital completed a Community Health Needs Assessment in fiscal year 2022. The following needs were identified and will be addressed over the next 3 years.1. Access to Mental Health and Behavioral Health Services2. Workforce Development3. Food InsecurityThere were no needs identified that will not be addessed. Carlinville Area Hospital Association Part V, Section B, Line 16j: Financial assistance contact information is provided on each bill. A notice about the availability of charity care is posted in the admitting areas, including the ER. The Hospital also employs a full-time financial counselor to discuss the availability of various government services and charity care with patients. Carlinville Area Hospital Association Part V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients. Part III, Line 3: The estimated amount of the Organization's implicit price concessions attributable to patients eligible under the Organization's charity care policy is calculated based on the percentage of individuals living below the poverty level in 2022. 22.51% can reasonably be considered a community benefit as it would have been written off to charity care. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 12 and 13 of the attached audited financial statements. Part III, Line 8: Carlinville Area Hospital Association is a critical access hospital with a Medicare surplus.Both the total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.Hospital services reimbursed on a fee schedule are not included in the Medicare calculation per the 990 instructions. Had this been reported the total loss from Medicare services would have been $173,693.Medicare fee schedule revenue $ 273,663Medicare estimated costs of care relating to payments (447,356)Net (Shortage) $ (173,693) Part III, Line 9b: Carlinville Area Hospital Association will give the charity care applicant at least 120 days from the date of the first bill to apply for financial assistance without any collection efforts. If the applicant has applied for health care coverage under Medicaid, Kidcare, or other government sponsored health care programs, Carlinville Area Hospital will await the approval or denial of the application without additional collection efforts.Carlinville Area Hospital Association will not refer a bill to collection without first offering the patient the opportunity to request a reasonable payment plan for the amount personally owed by the patient. Part VI, Line 2: The Hospital works with physicians, the health department, nursing homes and other health care providers in the community to determine the health care needs of the community. The Hospital completed a fourth CHNA in FY 2022 and posted to the Hospital's website. Part VI, Line 3: Financial assistance contact information is provided on each bill. A notice about the availability of charity care is posted in the admitting areas, including the ER. The Hospital also employs a full-time financial counselor to discuss the availability of various government services and charity care with patients. Part VI, Line 4: Carlinville Area Hospital Association is a 25-bed acute care hospital located in Carlinville, Illinois. The Hospital serves the residents of Macoupin County. Carlinville Area Hospital is the only hospital within a 14-mile radius of Carlinville Illinois, a small rural community in central Illinois. Illinois Route 4 passes through Carlinville. Interstate 55 is also within 12 miles of the city. The community is mostly agricultural.Other hospitals and medical centers near Carlinville are St. Francis Hospital, a Critical Access Hospital in Litchfield, IL, approximately 14 miles away, Community Memorial Hospital, a Critical Access Hospital in Staunton, IL, approximately 20 miles away and Hillsboro Area Hospital, a Critical Access Hospital in Hillsboro, IL, approximately 24 miles away.Carlinville had a population of 5,575 in 2021. Unemployment was 4.03% compared to 4.78% in the state of Illinois in 2022. The median household income in Carlinville is $57,891. The poverty level in Carlinville is 19.7% higher than the national average. Part VI, Line 5: Carlinville Area Hospital Association's core purpose is "Excellent healthcare close to home." This is very important to our board as all of our members live in our service area and use our facility. The Hospital extends medical staff privileges to all qualified physicians in the community. Carlinville Area Hospital invests in improvements in the community and continues to minimize long-term debt. The Hospital also provides the following services that would not otherwise be available within the Hospital's service area: Twenty-four hour a day emergency room that treats all patients regardless of ability to pay Specialty Clinic - The Hospital has an arrangement with a physician group out of Springfield, IL that brings specialists to the Carlinville Area that would not otherwise be available.Carlinville Area Hospital's Imaging Department hosted a free community presentation in observance of National Breast Cancer Awareness Month in October. Early detection, benefits of digital mammography, and how the advanced technology aids in early detection were discussed.The Hospital operates a Weekend Walk-In Clinic to provide a need for the community who might need medical care on the weekend, but, do not want to go the Hospital emergency room.Carlinville Area Hospital participated in the Illinois Cooperative Work Study Program. The program offered opportunities for college students to gain hands-on experience in their field of study. The Hospital also served as a clinical site for students in Radiology from Southwestern Illinois College and Pharmacy from St. Louis College of Pharmacy. Part VI, Line 7, Reports Filed With States IL 0 0 0 0 0 0 0 0 0 Anne Borwick DO Internal Med & Pediatrics 322666 0 0 0 0 0 12878 0 20452 0 355996 0 0 0 Connee Sloman CRNA 308914 0 0 0 0 0 12114 0 15022 0 336050 0 0 0 August Adams MD Internal Medicine 268698 0 0 0 0 0 11425 0 21543 0 301666 0 0 0 Harald Lausen MD Internal Medicine 242350 0 0 0 0 0 0 0 6838 0 249188 0 0 0 Lourdes Cruz MD Pediatrician 238188 0 0 0 0 0 9631 0 7017 0 254836 0 0 0 Kate Wilkens MD - Director Medical Staff Pres as of 2.1.22 170121 0 0 0 0 0 6600 0 204 0 176925 0 0 0 Schedule J, Part I, Question 3: Carlinville Area Hospital Association does not pay compensation to the CEO directly. The CEO is compensated by an unrelated management company, HealthTech S3. The Hospital Board of Directors use the processes described in Part I, Question 3 to determine appropriate compensation for the CEO. The Board of Directors also approves the Organization's contract with the Management Company. Form 990, Part VI, Section A, line 1a The Executive Committee is composed of the elected officers of the Board and includes the Chairman, Vice Chairman, Secretary, and Treasurer of the Association. The Executive Committee has the power and authority to manage and control the business and affairs of the Association as the Board of Directors; however, the Executive Committee is not allowed to exercise those powers prohibited by Illinois law which include: amending the Articles or Bylaws; sell, transfer, or otherwise dispose of substantially all of the Association's assets; or adopt Articles of Merger or Consolidation. Form 990, Part VI, Section A, line 2 J. Richard Schien, Chair, and Richard Walden, Vice Chair, have a business relationship. James Salske, board member, and Richard Walden, Vice Chair have a business relationship. Form 990, Part VI, Section A, line 3 Management Company Compensation (CY 2021): Brian Burnside, CEO Compensation: $270,362 Patrick Nudo, CFO until August 2021 Compensation: $114,191 Steve Miller, CFO August-December 2021 Compensation: $111,550 Paul Courtney, CFO as of January 2022 Compensation: N/A The officers are common law employees of HealthTech S3, an unrelated management company, and are compensated for services to Carlinville Area Hospital Association. The CEO has the responsibility of supervising the management, administration and operation of the Organization. The CFO has the responsibility for managing the Organization's finances. Form 990, Part VI, Section A, line 6 The Organization's sole member is Middle Macoupin Health Care Systems. Form 990, Part VI, Section A, line 7a The Member has the exclusive right and power to designate three of its Directors to serve as members of the Board of Directors, and by resolution has authority to appoint and remove all Directors from the Board. Form 990, Part VI, Section A, line 7b The Member has the exclusive right and power to approve or reject the following actions prior to the Board of Directors taking any action: 1. the annual operating budget, capital budget, long-range plan and any action which will result in a substantial change in the expenditures or revenue forecast; 2. the undertaking of or substantive amendments to a contractual obligation in excess of $50,000, or the guaranteeing of any obligation in excess of $50,000; 3. the purchase, lease, transfer, mortgage or sale of any asset or property with a value in excess of $50,000, except with respect to transactions specified and previously approved within the capital budget; 4. any plan of construction or remodeling involving an expenditure in excess of $50,000, except with respect to transactions specified and previously approved within the capital budget; 5. any borrowing; 6. any application for a government grant; 7. any general plan for the solicitation of charitable contributions or the solicitation or acceptance as a gift of any real property or any interest; 8. any proposal to adopt Articles of Dissolution, Merger, or Consolidation; 9. any selection, removal or change in the compensation or other terms of employment of the operating officers; 10. any substantial change in employee fringe benefits or personnel policies; and 11. any other matters as may be required by law to be submitted to the Member or as to which the Member determines, by resolution, that submission is advisable. Form 990, Part VI, Section B, line 11b The Form 990 is distributed to the governing body before it is filed. The CEO and CFO review the Form 990. Form 990, Part VI, Section B, line 12c Any duality of interest or possible conflict of interest on the part of any Board member should be disclosed to the other members of the Board and made a matter of record through an annual procedure and also when the interest becomes a matter of Board action. Any Board member having a duality of interest or possible conflict of interest on any matter should not vote or use his or her personal influence on the matter. The minutes of the meeting must reflect the disclosure, the abstention from voting, and the quorum situation. Any new member of the Board will be advised of this policy upon entering on the duties of office. The governing Board, CEO, and CFO complete and sign the conflict of interest form yearly. The forms are reviewed by the CEO of the Organization and if a potential conflict is identified the CEO follows up. Form 990, Part VI, Section B, line 15 The CEO and CFO are compensated through HealthTechS3, an unrelated management company. They are considered common law employees of the management company. HealthTechS3 gives the Board of Directors a recommended salary range for the CEO and CFO and the Board sets the compensation within this range after review of performance evaluations and comparability data. The process is documented and is completed on an annual basis. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are not available to the public. Financial information is available through the public disclosure copy of the 990. Form 990, Part IX, line 11g Purchased services and contract labor: Program service expenses 1,992,030. Management and general expenses 194,534. Fundraising expenses 0. Total expenses 2,186,564. Professional fees: Program service expenses 3,610,463. Management and general expenses 260,592. Fundraising expenses 0. Total expenses 3,871,055. Form 990, Part XI, line 9: Change in beneficial interest in perpetual trust -119,199. Carlinville Area Hospital Foundation 20733 North Broad Street Carlinville IL 62626 371193348 Support Carlinville Area Hospital Association IL 501(c)(3) Line 7 Middle Macoupin Healthcare Systems 0 Middle Macoupin Healthcare Systems 20733 North Broad Street Carlinville IL 62626 371193396 Provide support and benefit Carlinville Area Hospital Association IL 501(c)(3) Line 12c, III-FI N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0