2021-06-14T13:45:07-05:00 2020-07-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2019-08-01 370645239 Carlinville Area Hospital Association CARL 2178543141 20733 North Broad Street Carlinville IL 62626 Patrick Nudo CFO 2178543141 2021-06-11 1 Kim Hunwardsen CPA P00484560 6122536500 2021-06-10 2019 2022-09-23 18:48:47Z Brian Burnside 20733 North Broad Street Carlinville IL 62626 26705113 0 X www.cahcare.com X 1947 IL Provide quality acute and preventative health care benefits 7 6 284 135 -29945 -29945 1114205 250559 27225973 25726992 149291 156638 -78634 299788 28410835 26433977 0 0 0 0 13781753 14440527 0 0 0 14141299 13611966 27923052 28052493 487783 -1618516 35131498 44892446 17847808 29047550 17283690 15844896 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 22260050 26053693 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 2020, we carried out our exempt purpose in the following ways: 1) Provided quality short-term acute care medical services to 282 inpatients, of which 82% 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 141 patients in our swing bed unit, with an average length of stay of 9.5 days. 3) Provided 24 hour a day emergency room services. Our emergency room treated 5,610 patients during fiscal year 2020. 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 23,569 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 5,688 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 13,263 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 $113,000 for the year ended July 31, 2020, 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. 22260050 1 1 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 8 0 1 284 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 7 6 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X Patrick Nudo 2178543857 20733 North Broad Street Carlinville IL 62626 Anne Borwick DO Internal Med & Pediatrics 40.00 0.00 X 291717 0 24615 August Adams MD -Physician Medical Staff President 41.00 0.00 X 281806 0 25243 Lourdes Cruz MD Pediatrician 40.00 0.00 X 251057 0 14507 Thomas Hatley MD MPH Preventative & Emergency Medicine 40.00 0.00 X 202871 0 5780 Kate Wilkens MD Primary Care Physician 40.00 0.00 X 193855 0 7697 Edmundo Rodrigues-Friaz MD Gastroenterology 40.00 0.00 X 157500 0 0 J Richard Schien Chair 1.00 0.30 X X 0 0 0 Richard Walden Vice Chair 1.00 0.30 X X 0 0 0 Ralph March Secretary 1.00 0.60 X X 0 0 0 Dennis Pickrel Treasurer 1.00 0.60 X X 0 0 0 James Salske Member 1.00 0.30 X 0 0 0 Heather DeNeve Member 1.00 0.00 X 0 0 0 Tracey Smith DNP PHCNS-BC MS - Member until June 2020 1.00 0.00 X 0 0 0 Kenneth Reid CEO until January 2020 40.00 1.30 X 0 0 0 Michael Layfield Interim CEO as of January 2020 40.00 1.30 X 0 0 0 Michael Brown CFO 40.00 1.30 X 0 0 0 1378806 0 77842 12 0 1 0 Illinois Emergency Physicians LLP PO Box 674579 Detroit MI 482674579 Emergency Room Physicians 1700000 HealthTechS3 PO Box 636426 Cincinnati OH 452636426 Management Services 912360 CPSI PO Box 850309 Mobile AL 366850309 Computer Software Services 313160 Numed Inc PO Box 1098 Denton TX 76202 Nuclear Medicine and MRI 265016 Medefis Corporation PO Box 5068 New York NY 100875068 Contract Labor Company 253175 10 186914 23366 40279 250559 Patient service revenue 621110 24946651 24946651 Pharmacy revenue 446110 554929 554929 225412 225412 25726992 134079 134079 244223 271136 -26913 -26913 -29945 3032 22559 0 22559 22559 22559 Insurance Proceeds 900099 326701 326701 326701 26433977 26053693 -29945 159670 X 318750 318750 11368680 9746486 1622194 319591 273453 46138 1610740 1384882 225858 822766 708322 114444 918954 918954 56663 56663 75025 75025 3255733 2965276 290457 297240 297240 3189678 2170962 1018716 73269 73269 189922 189922 24187 17844 6343 86671 47347 39324 622141 487973 134168 2420296 1878865 541431 373004 71485 301519 Medical supplies 1543251 1543251 Repairs and maintenance 228967 225887 3080 Food 211129 208052 3077 45836 21293 24543 28052493 22260050 5792443 0 2984259 16509391 3833366 2870879 17576 372 232949 296311 247539 241411 40279799 21724421 20625996 18555378 5417861 5596948 1771952 821756 35131498 44892446 2004504 1345781 29433 10055982 15678871 14750150 2510637 135000 385000 17847808 29047550 X 16681738 15249140 601952 595756 17283690 15844896 35131498 44892446 X -1618516 185918 -6196 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 500172 500172 26113249 18877228 7236021 11116606 1738441 9378165 2549772 1108752 1441020 18555378 Employee health claims 385000 385000 X 26891031 185918 185918 26705113 -271136 -271136 26433977 28323629 271136 271136 28052493 0 28052493 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 -271,136. Part XII, Line 2d - Other Adjustments: Rental expenses recorded in revenue for Form 990 271,136. 1 1 X 1 X 125.000000000000 1 X 1 1 1 0 1 1 113000 113000 0.00400 5048803 4646924 401879 0.01430 5161803 4646924 514879 0.01830 7196586 2987248 4209338 0.15010 7196586 2987248 4209338 0.15010 12358389 7634172 4724217 0.16840 1 978451 195690 9441510 9478068 -36558 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 18 1 0 0 1 X https://www.cahcare.com/ X 1 18 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: Two 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 11: A Community Health Needs Assessment was completed in fiscal year 2019. The following are the needs identified and the accomplishments for fiscal year 2020.Prioritized Needs:Obesity: Provide education and programming aimed at youth on the need for recreation, exercise, and healthy eating. The group felt that addressing this issue would also impact other issues identified as significant, including diabetes and mental health.- The Senior Series Walking Activity and several health fairs were cancelled due to Covid. - The walking path remained open and a video was released on social media to promote and encourage walking on the path while social distancing. - 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: Education and prevention programming for pre-diabetes and diabetes - Smoking prevention education and programs - Programs encouraging recreation and exercise at all ages - The Dangers of Vaping presentation was cancelled due to Covid.- Continue development of chronic care management with focus on diabetes, migrating toward patient centered medical home.- Develop a relationship with endocrinologist.- Continue support of MCPHD Diabetes Workshops.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. Diversion to concentrated services for persons identified with Adverse Childhood Experiences (ACES) - Continue to educate and market Senior Behavioral Health SELF Program.- Support efforts of the Macoupin Montgomery Addiction and Behavioral health Coalition.- Continue relationship with Locust Street Resource Center to help with evaluation and placement of patients.- Explore telebehavorial health crisis assessment.- Explore the addition of a social worker to the rural health clinics.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- Continue to offer and communicate information regarding CAH tuition assistance program to employees.- Continue to support the Macoupin CEO Program.- Continue to offer High School to Health Care Program.- Continue to offer clinical rotations.- Communicate scholarship opportunities available to employees.- Explore international recruitment for areas with professional shortages.- Attend career fairs at local high school and colleges. This was cancelled due to Covid.- Provide Hospital tours to students. This was cancelled due to Covid.- Provide job shadowing opportunities for students. This was cancelled due to Covid.- Provides resources to local high school students regarding healthcare careers.- Explore different advertising avenues to communicate job openings.- Continue to solicit feedback from employees through employee satisfaction surveys.- Continue to monitor turnover rates and exit interview comments. 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 6a: The annual community benefit report is mailed to 16,000 residents in our service area and can be found on its website at www.cahcare.com. 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 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 Hospital reasonably estimates the portion of implicit price considerations that could have qualified for charity care by identifying the uninsured, underinsured, and account balances assigned to a collection agency in the current year. An estimated 20% of implicit price concessions in 2019 are attributable to patients potentially eligible for 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 shortfall. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit.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. 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 third CHNA in FY 2019 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 20 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 5,543 in 2018. Unemployment was 9.90% compared to 4.2% in the state of Illinois in 2018. The median household income in Carlinville is 25% lower than the national average. The poverty level in Carlinville is 18% 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 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.The following services are typically provided but due to the covid pandemic all services and activities ceased.1. CPR training to the community for a special rate of $25 per participant.2. Free blood pressure checks in Carlinville and Palmyra on a monthly basis.3. 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.4. Food for Thought Series for seniors5. Safe Sitter class 6. High School to Healthcare Program where high school student get to explore healthcare professions. 7. 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.In prior years, 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 291717 0 0 0 0 0 11818 0 13103 0 316638 0 0 0 August Adams MD -Physician Medical Staff President 281806 0 0 0 0 0 11697 0 14430 0 307933 0 0 0 Lourdes Cruz MD Pediatrician 251057 0 0 0 0 0 9976 0 5408 0 266441 0 0 0 Thomas Hatley MD MPH Preventative & Emergency Medicine 202871 0 0 0 0 0 5780 0 1417 0 210068 0 0 0 Kate Wilkens MD Primary Care Physician 193855 0 0 0 0 0 7697 0 184 0 201736 0 0 0 Edmundo Rodrigues-Friaz MD Gastroenterology 157500 0 0 0 0 0 0 0 0 0 157500 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 uses 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 1 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 Kenneth Reid, CEO, Michael Brown, CFO, and Michael Layfield, Interim CEO, are common law employees of HealthTech S3, an unrelated management company. 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. Kenneth Reid was compensated $252,372 for services to Carlinville Area Hospital Association. Michael Brown was compensated $164,616 for services to Carlinville Area Hospital Association. Michael Layfield started with the organization in January 2020 therefore no calendar year 2019 compensation to report. 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 1,878,612. Management and general expenses 57,699. Fundraising expenses 0. Total expenses 1,936,311. Professional fees: Program service expenses 1,086,664. Management and general expenses 232,758. Fundraising expenses 0. Total expenses 1,319,422. Form 990, Part XI, line 9: Change in beneficial interest in perpetual trust -6,196. Carlinville Area Hospital Foundation 20733 North Broad Street Carlinville IL 62626 371193348 Support Carlinville Area Hospital Association IL 501(c)(3) Line 12a, I 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 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0