2022-08-15T15:30:39-05:00 2021-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2021-07-01 362852553 St Margaret's Health-Peru STMA 8152233300 925 West Street Peru IL 61354 Timothy A Muntz President & CEO 8152233300 2022-08-15 1 Timothy Muntz 999009999 Kim Hunwardsen CPA P00484560 6122536500 2022-08-15 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Timothy A Muntz 925 West Street Peru IL 61354 20245930 0 X www.aboutsmh.org X 1978 IL Provide exceptional care through commitment to clinical excellence and compassion for every patient. 5 1 0 150 0 0 3220883 89090 71366712 19971559 413672 72716 -144212 -21355 74857055 20112010 6075 400 0 0 38380183 10141542 0 0 0 43161531 10747946 81547789 20889888 -6690734 -777878 64866732 61240861 54424974 50097503 10441758 11143358 X St. Margaret's Health Care, in union with the Sisters of Mary of the Presentation, is committed to the values of Catholic health care in caring for the needs of our patients and their families, the community and one another. Through our belief in God and our respect for life, we provide holistic quality health care with dignity and compassion. 0 0 19057816 400 19971559 St. Margaret's Health-Peru is a 49-bed acute care hospital located in Peru, Illinois. The Hospital also operates a network of primary and specialty care physician clinics in Peru and the surrounding area. Services range from employed physicians and mid-levels in the specialties of Family Medicine, Internal Medicine, Obstetrics/Gynecology, Orthopedics, Otorhinolaryngology, and Sleep Medicine. (Continued on Sch. O)In addition to these physician practices, the Hospital also offers the Care Today Clinic which provides a lower-cost, convenient alternative to emergency room care. Contracted physician services are provided for Emergency Medicine, Anesthesiology, Pathology and Hospitalists' services. Inpatient hospital services provided include medical and surgical services, ICU, Obstetrics, Swing Beds, Diagnostic, Rehab and Treatment Services. Outpatient services include Surgery, Emergency Room, Laboratory, Diagnostic Imaging, Rehab Services, Pain Management, Sleep Therapy, Wound Management, Respiratory Care, EKG, other diagnostic and therapeutic services. Hospice services are also provided. St. Margaret's Health - Peru is a Medicare dependent Hospital and qualifies for disproportionate share payments. The Hospital is committed to providing the highest quality of health services to all patients, regardless of their financial status or ability to pay. Statistics:- inpatient admissions: 405- inpatient days: 1,319- newborn deliveries: 91- inpatient surgeries: 88- outpatient surgeries: 834- outpatient visits: 32,930- emergency room visits: 3,049- clinic visits: 16,876 19057816 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 1 1 1 0 0 0 IL X Lisa Lynch 8157803574 925 West Street Peru IL 61354 X Timothy A Muntz Chair/President & CEO 4.00 57.00 X X 0 0 0 Kim Santman VP of Finance/Director 4.00 57.00 X X 0 0 0 Tommy Hobbs VP of Operations/Director 57.00 4.00 X X 0 0 0 Mark Fernandez MD Director 40.00 0.00 X 0 0 0 Eric Santos MD Director 1.00 0.00 X 0 0 0 Lisa Lynch Assistant VP of Finance 57.00 4.00 X 0 0 0 0 0 0 0 0 0 0 0 84090 5000 89090 Patient Service Revenue 621110 19160338 19160338 Management Fees 541610 15000 15000 Cafeteria Revenue 721000 6435 6435 789786 789786 19971559 72716 72716 112565 133920 -21355 -21355 -21355 20112010 19971559 0 51361 X 400 400 8002424 7603774 398650 201588 191546 10042 1426222 1355173 71049 511308 485837 25471 5717 5717 12000 12000 4185313 3316998 868315 60309 1339 58970 93379 51701 41678 500484 335324 165160 575499 564875 10624 12051 12031 20 251946 204076 47870 506763 410478 96285 -475532 241500 -717032 Supplies and minor equi 2123139 1424992 698147 Medical Supplies 1526691 1526691 Hospital Assessment Pay 775521 775521 Repairs and Maintenance 307970 298653 9317 286696 256907 29789 20889888 19057816 1832072 0 11485885 7902119 11407530 11894395 2085367 1891781 1117884 1127319 117942774 95511606 22829310 22431168 7782178 8037065 363549 408259 7795029 7548755 64866732 61240861 10013060 10029754 6263 8697757 20635388 20470344 15078769 19591142 54424974 50097503 X 9705484 10408113 736274 735245 10441758 11143358 64866732 61240861 X -777878 266941 -830707 2043244 X X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1476235 1476235 53756101 38548636 15207465 325067 282907 42160 60901664 55451841 5449823 1483707 1228222 255485 22431168 Dues from Affiliates 5754357 Interest in net assets of Illinois Valley Community Hospital Foundation 735245 Rent Receivable 42882 Estimated insurance recoveries 1016271 7548755 Deferred compensation obligation 1193329 Estimated Third-Party Payor Settlements 2870311 Estimated claims reserves 2557717 Due to Affiliates 6079933 Medicare advanced payments 6607443 Deferred payroll taxes 282409 19591142 X Part X, Line 2: St. Margaret's Health-Peru is a nonprofit corporation described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Internal Revenue Code. However, the Hospital is subject to federal income tax on any unrelated business taxable income. 1 1 X 1 X 1 X 1 1 0 0 17243 17243 0.00080 2619671 1348482 1271189 0.06090 2636914 1348482 1288432 0.06170 1621262 655329 965933 0.04620 1621262 655329 965933 0.04620 4258176 2003811 2254365 0.10790 1 1290848 129085 3084840 3226964 -142124 X 1 1 1 1 St Margaret's Health-Peru 925 West Street Peru IL 61354 aboutsmh.org 0003418 X X X 5 rural health provider based clinics and 1 provider based clinic St Margaret's Health-Peru 1 0 0 1 X X X X X X X X X X 18 1 0 0 1 X See Supplemental Information X 1 18 1 See Supplemental Information 0 1 X 150.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X https://aboutsmh.org/financial-assistance/ X https://aboutsmh.org/financial-assistance/ X https://aboutsmh.org/financial-assistance/ X X X X X 1 X 0 X X X X 1 X 0 0 St. Margaret's Health-Peru Part V, Section B, Line 3j: Industry data related to projected growth in need for various services specific to the population of this area. St. Margaret's Health-Peru Part V, Section B, Line 5: The Community Health Needs Assessment (CHNA) stakeholders working group, comprised of members representing the broad interests of the communities served, was responsible for the CHNA process. The stakeholder group included members from St. Margaret's Health - Peru, IVCH Medical Group, La Salle County Health Dept, Alternatives for the Older Adult, North Central Behavioral Health Services, Oglesby Public Schools and Illinois Valley United Way. The working group developed a survey instrument, evaluated survey responses, collected and evaluated secondary data, synthesized the primary and secondary data, and identified and prioritized community health needs. Primary data for this assessment came from a survey developed, distributed and analyzed by the stakeholders working group specifically for CHNA. St. Margaret's Health-Peru Part V, Section B, Line 11: The community health needs assessment includes a description of the actions taken to meet needs that were identified in the community health needs assessment. The areas of concern that have been identified in the new 2018 community health needs assessment, relate to cost and quality of healthcare, access to specialists and specialized treatments, and mental health and substance abuse.Regarding cost and quality of care, St. Margaret's Health - Peru has implemented a palliative care program to reduce patient and overall cost of care while enhancing care and service to patients; promoted and provided annual wellness visits to proactively manage the health of patients; and educated and assisted patients to understand available insurance and coverages provided by Medicare and Medicaid.Regarding access to specialists and specialized care, St. Margaret's Health - Peru conducted analysis to determine more specifically what the community is seeking, and augmented a medical staff development plan to recruit orthopedic surgeon, OB/GYN physicians and neurologist.Regarding mental health and substance abuse, St. Margaret's Health - Peru has increased access to mental health treatment by providing telepsychiatry services in primary care clinics; continued focus on pediatric mental health through services offered at the hygienic institute; and increased awareness of current medication assisted therapy treatment options offered through the IVCH Medical Group. Form 990, Sch H, Part V, Section B, Line 7 and 10: CHNA:https://aboutsmh.org/community-health-needs-assessments/Implementation Strategy:https://aboutsmh.org/community-health-needs-assessments/ 3 1 - Center for Physical Rehabilitation 300 Walnut Street Peru IL 61354 Outpatient Physical Rehabilitation 2 - IVCH Wound & Hyperbaric Center 1403 6th Street Peru IL 61354 Wound and Hyperbaric Therapy 3 - IVCH Care Today 300 Walnut Street Peru IL 61354 Urgent Care Alternative to ER 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. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. The cost for subsidized health services reported on line 7g was determined using the Medicare cost report. Part III, Line 2: The amount reported 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: An estimated 10% of implicit price concessions are assumed to be attributable to patients that would have qualified for the organization's financial assistance policy. Part III, Line 4: The financial statement footnote regarding implicit price concessions may be found on page 13 of the audited financial statements. Part III, Line 8: St. Margaret's Health-Peru provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the Medicare shortfall is considered a community benefit.Total revenue received from Medicare is the gross reimbursement plus settlement. Both 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 the Centers for Medicare and Medicaid Services. Part III, Line 9b: When a patient is in the process of applying for financial assistance the account is placed on hold and no further collection efforts are made until the request for assistance has been resolved. The application process includes facilitating the patient's application for various assistance programs, and identifying where the patient falls in the discount scale of the organization based on income level and size of family. If there is a balance remaining after charity care or other financial assistance has been applied, a mutually agreen upon payment plan is developed and the account follows the same collection procedures as all other self-pay accounts. Monthly payments are required and balances are typically expected to be paid in full within one year. Extensions may be approved for unexpected changes in ability to meet the payment schedule. Collection procedures include statements, past due notices, phone calls, and, if agreed upon payment arrangements cannot be met, the account is referred to a collection agency. Part VI, Line 2: The determination of current and future health care needs of the communities served by St. Margaret's Health-Peru is based on a combination of the following factors: existence or non-existence of appropriate services, demonstrated need, voice of the customer, collaboration with community organizations, government agencies and other health care providers, benchmarking market research, customer surveys, physician input and monitoring of state and federal guidelines. This information is reviewed and analyzed by the hospital's administrative team and incorporated into the hospital's strategic planning process. Part VI, Line 3: Documentation is provided at the time of registration informing patients that financial assistance is available and providing contact information for the patient financial services department. Basic information and contact information is also available at aboutsmh.org by selecting the home page's financial assistance button. When contacted by a patient, financial counselors work individually with each applicant to determine eligibility for charity or financial assistance. Notices about financial assistance programs are posted in the registration areas and information is also included on the patient statements. The social services department notifies each inpatient of financial assistance programs available at St. Margaret's Health-Peru as well as local, state, and federal programs they may be eligible for. Part VI, Line 4: St. Margaret's Health-Peru serves the residents of rural communities located in LaSalle, Bureau and Putnam counties, in north central Illinois. The hospital is located near the junction of interstates 80 and 39 and is 62 miles west of Joliet and 64 miles north of Bloomington. The primary service area of the hospital has a population of about 35,000 people. No population growth is projected for the area. The largest area employers are involved in transportation, warehousing, agriculture, light industry, and retail services. The service area race and ethnicity is composed of 85% White, 3% African American, 10% Hispanic, and 1% Asian. According to the Illinois department of employment security, the 2021 unemployment rate in LaSalle county was 6.0%, which was slightly lower than the state of Illinois (6.1%) and higher than the United States (5.3%). The median household income is LaSalle ($60,069), Bureau ($55,549) and Putnam ($64,694) counties were below the state of Illinois figure of $68,428. The proportion of LaSalle county residents living below the federal poverty level of 11.4% is more than the state average of 11.0%. St. Margaret's Health-Peru serves patients without regard to age, gender, income, ethnic origin, insurance coverage, or ability to pay. Part VI, Line 5: The board of directors of St. Margaret's Health-Peru have regular input on strategic planning, new services, technology, and physician recruitment. St. Margaret's Health-Peru maintains an open medical staff and is constantly recruiting new physicians to meet identified needs. All available cash flow generated by the organization is reinvested back into the hospital through the purchase of property and equipment to provide services that meet the needs of the service area. The community outreach department offers a wide variety of health and wellness programming, including Tai Chi classes, free blood pressure and glucose screenings, hemoglobin A1C screenings, lipid profile screenings, healthy heart screenings, prostate cancer screenings, smoking cessation classes, babysitting clinics, CPR instruction, and first aid. Form 990, Part VI, Section A, line 6 St. Margaret's Health-Peru is a subsidiary of its sole corporate member, IV Health Corp, Inc. Form 990, Part VI, Section A, line 7a Members of the board of directors of the parent company, IV Health Corp, Inc., acting on behalf of the parent, have reserved powers to, as it relates to the operations of St. Margaret's Health-Peru to appoint and remove directors and to ratify and remove officers. Form 990, Part VI, Section A, line 7b Members of the board of directors of the parent company, IV Health Corp, Inc., acting on behalf of the parent, have reserved powers to, as it relates to the operations of St. Margaret's Health-Peru, to adopt, amend, or repeal the articles of incorporation and/or bylaws, adopt a plan of merger, consolidation or dissolution, approve the purchase, sale, transfer, lease encumbrance of property, approve borrowing with a term greater than a one year term or which requires a mortgage of real property, and selection or modificiation of the business/legal name of the entity. Form 990, Part VI, Section A, line 8b The Organization does not have a committee with authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The President & CEO and VP of Finance review the Form 990 prior to submission to the IRS. The final version of the Form 990 is e-mailed or hand delivered to each board member for their review and to answer questions regarding the 990. Form 990, Part VI, Section B, line 12c The officers and directors of St. Margaret's Health - Peru are covered under the conflict of interest policy and have a duty to disclose actual or possible conflicts of interest. All persons covered under the policy are required to annually complete a conflict of interest questionnaire and disclose any interest that could give rise to conflicts. Transactions with covered persons, or entities in which a covered person has any type of interest, must be an arms length transaction. The board of directors will review any transactions in question and determine if a conflict exists. The interested person may make a presentation, but must leave the meeting during discussion of, and the vote on, the transaction. If a conflict of interest exists, the board of directors may appoint a disinterested person or committee to investigate alternatives to the proposed transaction, determine if there's a more advantageous transaction that would not give rise to a conflict, or vote to determine if the transaction is in the hospital's best interest and whether it is fair and reasonable. If the board of directors has reasonable cause to believe that a member has failed to disclose a possible conflict of interest, the board will inform the member of the basis of such belief and afford the member an opportunity to explain. Further investigation maybe be warranted, and the board shall take appropriate disciplinary and corrective action as needed. Form 990, Part VI, Section B, line 15 The President & CEO and VP of Finance are compensated by Sisters of Mary of the Presentation Health System, a related organization that is the sole member of IV Health Corp. Compensation is not disclosed for the short year period Form 990. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Form 990, Part IX, line 11g Purchased Services: Program service expenses 2,061,624. Management and general expenses 868,315. Fundraising expenses 0. Total expenses 2,929,939. Other Fees: Program service expenses 1,255,374. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,255,374. Form 990, Part XI, line 9: Change in unrecognized funded status of terminated pension plan 7,210,474. Change in equity of investees 46,739. Net periodic pension cost -5,213,969. Form 990, Part XII, Line 2c: IV HealthCorp Inc., the sole member, assumes the responsibility for oversight of the audit for St. Margaret's Health-Peru. Sisters of Mary of the Presentation Health Ministry 1202 Page Drive SW Fargo ND 58106 813757471 Supports SMP Health and the related entities ND 501(c)(3) Canonical Entity N/A 0 Sisters of Mary of the Presentation Health System dba SMP Health 1202 Page Drive SW Fargo ND 58103 450359620 Support related ND Catholic Health Care System ND 501(c)(3) Line 12a, I SMP Health Ministry 0 St Aloisius Medical Center dba SMP Health - St Aloisius 325 E Brewster St Harvey ND 58341 450226729 Provision of health care services ND 501(c)(3) Line 3 SMP Health 0 St Andrew's Health Center dba SMP Health - St Andrew's 316 Ohmer St Bottineau ND 58318 450226426 Provision of health care services ND 501(c)(3) Line 3 SMP Health 0 St Andrew's Hospital Foundation dba SMP Health St Andrew's Foundation Inc 316 Ohmer St Bottineau ND 58318 450413201 Support SMP Health - St. Andrew's ND 501(c)(3) Line 12a, I SMP Health 0 Presentation Medical Center dba SMP Health - St Kateri 213 2nd Ave NE Rolla ND 58367 450227391 Provision of health care services ND 501(c)(3) Line 3 SMP Health 0 Sisters of Mary of the Presentation Prairieland Home Care dba Prairieland H 1102 Page Drive SW Fargo ND 58106 450391192 Home health and supportive services ND 501(c)(3) Line 10 SMP Health 0 Sisters of Mary of the Presentation Long Term Care dba SMP Health - Long Te 1202 Page Drive SW Fargo ND 58106 752999939 Provide extended care and medically related services ND 501(c)(3) Line 10 SMP Health 0 St Margaret's Hospital Foundation 600 E 1st St Spring Valley IL 61362 364042262 Support SMP Health - St. Margaret's IL 501(c)(3) Line 12a, I SMP Health 0 SMP Illinois Region Health System dba St Margaret's Health 600 E 1st St Spring Valley IL 61362 842023121 Support related Illinois health care entities IL 501(c)(3) Line 12a, I SMP Health 0 IV HealthCorp Inc 925 W St Peru IL 61354 371211890 Support SMP affiliated entities IL 501(c)(3) Line 12a, I St Margaret's Health 0 St Margaret's Health - Spring Valley 600 E 1st St Spring Valley IL 61362 362167884 Provision of health care services IL 501(c)(3) Line 3 St Margaret's Health 0 Illinois Valley Community Hospital Foundation 925 W St Peru IL 61354 371211780 Support IV HealthCorp, Inc. IL 501(c)(3) Line 12a, I IV HealthCorp Inc 0 Hygienic Institute Fro LaSalle Peru and Oglesby 925 West Street Peru IL 61354 362167742 Provide primary health care servcies IL 501(c)(3) Line 10 IV HealthCorp Inc 0 Valley Regional Health Services 4391 Venture Drive Peru IL 61354 273891281 Outpatient oncology services IL N/A 0 0 St Andrew's Bottineau Clinic LLC 316 Ohmer St Bottineau ND 58318 450451306 Health care services ND N/A 0 0 Valley Health Enterprises 925 West Street Peru IL 61354 363476877 Home medical equipment IL N/A C 0 SMP Enterprises PO Box 10007 Fargo ND 58106 363486506 Collection Agency ND N/A C 0 SMP Enterprises IL 600 E 1st St Spring Valley IL 61362 363456566 Healthcare management IL N/A C 0 Illinois Valley Health Services Inc 925 West Street Peru IL 61354 364050682 Inative IL St Margaret's Health - Peru C 1.00000 0 Health Care Building Corp 925 West Street Peru IL 61354 363306917 Inactive IL St Margaret's Health - Peru C 1.00000 0 IVCH General Professional Liab Loss Fund 925 West Street Peru IL 61354 366673231 Inactive IL St Margaret's Health - Peru T 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0