2020-07-09T12:24:38-05:00 2019-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2019-01-01 370684691 Memorial Hospital Association MEMO 2173573131 PO Box 160 Carthage IL 62321 Teresa Smith CFO 2173573131 2020-07-07 1 Kim Hunwardsen CPA P00484560 6122536500 2020-07-07 216.147.181.47 2020-07-07 11:34:48 CD P 9EB6867304309B5BA7CF1F8994B8B429DCF961D0 9EB6867304309B5BA7CF1F8994B8B429DCF961D0 2019 2020-09-23 17:36:50Z Ada Bair PO Box 160 Carthage IL 62321 31045506 0 X www.mhtlc.org X 1947 IL Memorial Hospital provides clinical care, diagnostic, treatment, and wellness services 13 11 276 100 0 0 13472 491662 12956426 29416095 206926 256725 1789 23933 13178613 30188415 0 0 0 0 7166695 15414780 0 0 92892 7977138 15104150 15143833 30518930 -1965220 -330515 36656456 35871886 25532690 24594339 11123766 11277547 X Memorial Hospital is committed to improving health by providing education and wellness programs and innovative services at all the stages of life. 0 1 25088125 29416095 Memorial Hospital is dedicated to maintaining and improving the health of all people in the Hancock County area. Governed by a Board of Directors, we serve as a vital safety net, serving our communities with access to quality healthcare services. Memorial Hospital provides many types of community benefit care. Community benefit care includes charity care, community health fairs, lectures, and free health screenings, demonstrating our commitment to improving the overall health of the residents of the Hancock County area.In 2019, the Hospital had 2,187 patient days with 603 admissions and 602 discharges. (Continued on Schedule O)There were 4,299 emergency room visits, 621 provider-based physician clinic visits, 3,690 independent physcian clinic visits and 30,652 rural health physician clinic visits.We are always committed to providing compassionate care to every member of our community regardless of their ability to pay.To fulfill its mission of community service, the Organization provides care to patients and residents who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Revenue from services to these patients and residents is recorded in the accounting system at the established rates, but the Organization does not pursue collection of the amounts. The resulting adjustments are recorded as adjustments to patient and resident service revenue, depending on the timing of the charity determination.The Illinois legislature passed a bill titled the "Hospital Uninsured Patient Discount Act." Effective April 1, 2009, this Act requires hospitals to provide certain mandated discounts from charges to the uninsured in Illinois. Charges are to be discounted at 135% of cost. Furthermore, a hospital may not collect more than 25% of an uninsured family's gross income in any one year.The Organization provides care to patients and residents who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the Organization does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The amount of charges foregone, based on established rates was $396,724 for the year ended December 31, 2019. The estimated costs of the charges foregone, based upon an overall cost-to-charge ratio calculation, for the year end December 31, 2019 was $205,000.In addition, the Organization provides services to other medically indigent patients under certain government-reimbursed public aid programs. Such programs pay providers amounts which are less than established charges for the services provided to the recipients, and for some services the payments are less than the cost of rendering the services provided. The Organization also commits significant time and resources to endeavors and critical services which meet otherwise unfulfilled community needs. Many of these activities are sponsored with the knowledge that they will not be self-supporting or financially viable. 25088125 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 1 0 0 1 52 0 1 276 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 11 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 1 IL X Kim Byers 2173576571 PO Box 160 Carthage IL 62321 Dan Asbury President 3.00 1.00 X X 0 0 0 LuAnn Haas Vice President 3.00 1.00 X X 0 0 0 Dennis Rankin Secretary/Treasurer 3.00 1.00 X X 0 0 0 Terry Pope Director 3.00 1.00 X 0 0 0 Beth Boley Director until April 2019 3.00 1.00 X 0 0 0 Doug Groth DVM Director 3.00 1.00 X 0 0 0 Debbie Simon Director 3.00 1.00 X 0 0 0 Larry McClintock Director 3.00 1.00 X 0 0 0 Christopher Jones MD Director 40.00 1.00 X 392131 0 37941 Sharon Morrison Director 3.00 1.00 X 0 0 0 Angela Pollock Director 3.00 1.00 X 0 0 0 Charles Gilbert Director 3.00 1.00 X 0 0 0 Robert Barlow Director as of October 2019 3.00 1.00 X 0 0 0 Joe Zumwalt Director as of September 2019 3.00 1.00 X 0 0 0 Ada Bair CEO 40.00 3.00 X 228865 0 16197 Teresa Smith CFO 40.00 3.00 X 141818 0 23614 Nileshwa Senthe MD Pediatrician 40.00 0.00 X 434183 0 18523 Victoria Popela Family Practice Physician 40.00 0.00 X 330993 0 10562 Edward McKenney DO Family Practice Physician 40.00 0.00 X 304712 0 11044 Douglas Heighton MD Family Practice Physician 40.00 0.00 X 267272 0 39585 Daryl Chenoweth CRNA 40.00 0.00 X 238223 0 28640 2338197 0 186106 21 0 1 0 Aimes of Carthage LLC 8657 Wedgewood Dr Burr Ridget IL 60527 ER physician service 1852235 UnityPoint Health 1776 West Lakes Parkway Suite 400 West Des Moines IA 50266 Management services 481965 Quincy Medical Group 1025 Maine Street Quincy IL 62301 Physician services 423236 Medical Solutions LLC 1010 North 2nd Street Omaha NE 68114 Temporary staffing personnel 257817 Shared Medical Services Inc 209 Limestone Pass Cottage WI 53527 MRI services 206190 10 256095 235567 78627 491662 Patient & resident service revenu 622110 27735774 27735774 Pharmacy revenue 900099 1574471 1574471 Equity in Advance Phys Therapy 900099 30872 30872 Meaningful use revenue 900099 15547 15547 Equity in Sherrick Home Health 900099 -50616 -50616 110047 110047 29416095 207367 207367 47883 1800 25750 0 22133 1800 23933 23933 755699 125000 685269 146072 70430 -21072 49358 49358 30188415 29416095 0 280658 X 820395 429719 390676 69932 69932 11653284 10106747 1472377 74160 134330 121064 13143 123 1908551 1657540 249370 1641 828288 713651 113948 689 47993 47993 74737 74737 8733 8733 5482767 3988181 1493625 961 144507 29264 107896 7347 1012100 555423 451303 5374 509536 464521 45015 95115 61959 31491 1665 67746 53321 14425 780310 757922 22388 2218506 2147327 71179 255349 209825 45524 Medical supplies 1944137 1944137 Bad debt expense 1469803 1469803 Provider tax 587760 587760 Repairs and maintenance 386330 283587 102743 18721 15469 2320 932 30518930 25088125 5337913 92892 3677657 5211540 19300 18100 6209598 4872552 15064 354105 340491 197481 188320 36975136 20849200 17734914 16125936 7237517 7218067 66300 66300 528334 441070 631250 1374446 36656456 35871886 3569301 3384903 15547 17100000 16415000 4253001 4394436 594841 400000 25532690 24594339 X 10962848 11091592 160918 185955 11123766 11277547 36656456 35871886 X -330515 459262 25034 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8733 8733 0 Part II-B, Line 1: Memorial Hospital is a member of the Illinois Health & Hospital Association (IHA) and 37% of their dues are used for lobbying expenses which totaled $8,733 in 2019. 3951916 592682 287073 4257525 4185386 -84735 148735 3951916 4105493 345604 265711 4185386 3987871 374801 257179 4105493 4157292 106993 276414 3987871 0.97530 0.02470 0.00000 0 0 499957 499957 24940955 13069899 11871056 23098 23098 0 10127157 7261260 2865897 1383969 494943 889026 16125936 Estimated health claims 400000 400000 X Part V, Line 4: An endowment fund with the income to be used for the benefit of Memorial Hospital Association. Permanently restricted funds are required to be retained permanently, either by explicit donor stipulation or by UPMIFA. Board designated funds are to be used for facility and equipment upgrades. Part X, Line 2: The Hospital believes they have 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 consolidated 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. 1 1 X 1 X 1 X 0 1 1 0 1 1 205000 205000 0.00710 6826726 3394979 3431747 0.11810 7031726 3394979 3636747 0.12520 11235147 6852307 4382840 0.15090 11235147 6852307 4382840 0.15090 18266873 10247286 8019587 0.27610 1 1469803 118025 6204596 6265859 -61263 X 1 1 1 1 Memorial Hospital Association 1454 North County Road 2050 Carthage IL 62321 www.mhtlc.org 0005611 X X X X 6 Rural Health Clinics Memorial Hospital Association 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X www.mhtlc.org/about-us/community-reports/ X 1 18 1 http://www.mhtlc.org/about-us/community-reports/ 0 1 X 150.000000000000 300.000000000000 X X X 1 1 X X X X 1 X http://www.mhtlc.org/patients-visitors/financial-assistance/ X http://www.mhtlc.org/patients-visitors/financial-assistance/ X http://www.mhtlc.org/patients-visitors/financial-assistance/ X X X X X 1 X 0 X X X X 1 X 0 1 Memorial Hospital Association Part V, Section B, Line 5: Data collection came from multiple sources for analysis. Some of the sources identified were the IPLAN data system, CDC, Behavioral Risk Factor Surveys, local mental health agency, local hospital as well as Comp Data which is an Illinois repository for hospital discharge data and demographics. As the process progressed, data from local law enforcement as well as a Hancock County Economic Development Survey was included in the analysis by this group. Memorial Hospital Association Part V, Section B, Line 6b: Hancock County Health Department Memorial Hospital Association Part V, Section B, Line 11: The top 3 priority areas of focus from the 2018 Community Health Needs Assessment are diabetes, cardiovascular disease, lung cancer, drug abuse, and alcohol dependency. The same needs carried over from the 2015 CHNA. Below are the 2019 accomplishments.Cardio Vascular-Blood pressure checks provided at health fairs and screening events county wide where 100% of elevated blood pressure checks at screening events resulted in education and a referral for follow up. -Quarterly social media posts with educational tips on hypertension appeared on the Hancock County Health Department and Memorial Hospital sites. -Investigated resources for low income individuals to obtain medication if needed. -Offered county wide physical activity Challenge in September around the Memorial Hospital walking path. Better Health...Better Life 15 for 15 wellness challenge. This was in May 2019. It was 15 minutes of exercise every day for 15 weeks. It was advertised on Facebook in the Better Health Better life group page.Intervention Strategies for Diabetes -Seven A1c screening dates were offered to the residents of Hancock County at local events. Screening participants received education on Physical activity, healthy eating choices, local resources available for support, referral if A1c is abnormal, follow up phone call 1 month post screening. -Hancock County providers received education on the Diabetes Health & Wellness Center resources annually.-A Diabetes Spotlight, half day education, was offered annually to residents. Day and evening half day events occurred on October 24, 2019.-Residents hospitalized locally with elevated glucose levels received consultation prior to discharge. Dietician recommended referral to physicians while on rounds. In 2019 there were 17 recommendations and 9 referrals.-All diagnosed prediabetes and diabetics received an auto referral to the Diabetes Health and Wellness Center from Memorial Hospital provider offices. In 2019 there were 96 patients referred who took advantage of the services.Intervention Strategies for Lung Cancer-Annual updates on resources and QUITLINE for 100% of health care providers in Hancock County. Providers have information on Quitline and updates are sent if there are changes. Smoking cessation discussion is a measure that is tracked on the provider dashboard and improvements are reviewed.-At least one educational program per year in all area schools on the harmful effects of tobacco use. Tobacco use and e-cigarette/vaping assembly was performed at IWHS in November 2019.-Quarterly social media posts on Hancock County Health Department and Memorial Hospital sites with resources for tobacco cessation. -Education was provided to all expectant mothers in Memorial Hospital clinic settings as documented by medical record and in the WIC clinic at Hancock County Health Department. This is part of the new OB intake process.The Hospital will not address drug abuse and alcohol dependency as a separate task force was develped to address these needs. Memorial Hospital Association Part V, Section B, Line 13h: PRESUMPTIVE ELIGIBILITY: A patient may appear eligible for charity care discounts but there is no financial assistance form and a lack of supporting documentation. Often there is adequate information provided by the patient through other sources which could provide sufficient evidence to provide the patient with charity care assistance.In the event there is no evidence to support a patient's eligibility for charity care, Memorial Hospital and Memorial Medical Clinics could use outside agencies in determining estimated income amounts for the basis of determining charity care eligibility and potential discount amounts.Presumptive eligibility may be determined on the basis of individual life circumstance. In these situations, a patient is deemed to be eligible for 100% write off. A patient in this situation is presumed to be eligible and therefore does not need to complete a financial assistance applicationif they can provide proof that they meet one of the following criteria:a. Patient states that he/she is homeless. The due diligence efforts must be documented.b. Patient is deceased with no known estate.c. Patient is mentally incapacitated with no one to act on their behalf.d. Patient is currently eligible for Medicaid, but was not eligible on a prior date of service or for non-covered services. Instead of making the patient duplicate the required paperwork Memorial Hospital will rely on the financial assistance determination process from Medicaid.e. Accounts deemed uncollectible by a contracted collection agency.f. In the event of "special" circumstances where the income exceeds the poverty guidelines but medical bills are high, the Patient Account Director and/or Chief Financial Officer may determine partial or full eligibility provided proper documentation is available.PROPENSITY TO PAY: Propensity to pay may be determined by obtaining a healthcare score from an outside vendor. Memorial 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. 3 1 - Advance Physical Therapy 620 Wabash Street Carthage IL 62321 Physical therapy rehabilitation 2 - Sherrick Home Health 1204 Buchanan Street 2 Carthage IL 62321 Home health care services (closed 6/30/19) 3 - Memorial Medical Clinic Hamilton 1471 Keokuk Street Hamilton IL 62341 Physician clinic Part I, Line 3c: PRESUMPTIVE ELIGIBILITY: A patient may appear eligible for charity care discounts but there is no financial assistance form and a lack of supporting documentation. Often there is adequate information provided by the patient through other sources which could provide sufficient evidence to provide the patient with charity care assistance.In the event there is no evidence to support a patient's eligibility for charity care, Memorial Hospital and Memorial Medical Clinics could use outside agencies in determining estimated income amounts for the basis of determining charity care eligibility and potential discount amounts.Presumptive eligibility may be determined on the basis of individual life circumstance. In these situations, a patient is deemed to be eligible for 100% write off. A patient in this situation is presumed to be eligible and therefore does not need to complete a financial assistance applicationif they can provide proof that they meet one of the following criteria:a. Patient states that he/she is homeless. The due diligence efforts must be documented.b. Patient is deceased with no known estate.c. Patient is mentally incapacitated with no one to act on their behalf.d. Patient is currently eligible for Medicaid, but was not eligible on a prior date of service or for non-covered services. Instead of making the patient duplicate the required paperwork Memorial Hospital will rely on the financial assistance determination process from Medicaid.e. Accounts deemed uncollectible by a contracted collection agency.f. In the event of "special" circumstances where the income exceeds the poverty guidelines but medical bills are high, the Patient Account Director and/or Chief Financial Officer may determine partial or full eligibility provided proper documentation is available.PROPENSITY TO PAY: Propensity to pay may be determined by obtaining a healthcare score from an outside vendor. Part I, Line 6a: The community benefit report information is shared in Memorial Hospital's annual report and available on their website www.mhtlc.org. 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 I, Line 7g: A physician clinic included as a subsidized service on the 990. Direct and indirect costs were $1,058,556. Part I, Ln 7 Col(f): The amount of bad debt expense removed from total expenses to determine the percentage was $1,469,803. Part III, Line 2: Accounts are not written off to bad debt until all payments on the account are applied including all third party payments, contractual allowances, and discounts. Any financial assistance or charity care is recorded as an adjustment to patient service revenue and is not written off to bad debt. We realize some patients may qualify for financial assistance but do not complete the required paperwork. We try to work with these patients to provide them with some form of financial assistance or other payment arrangements, but when patients are able to pay and do not, their balances are written off to bad debt. Payments received on an account previously written off to bad debt reduces bad debt expense.Bad debt expense on line 2 is reported at charges as presented on the financial statements. Part III, Line 3: The estimated amount of the Organization's bad debt expense is calculated based on the percentage of residents with income below the poverty level. In 2019 the percentage was 8.03%. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 10 of the attached audited financial statements. Part III, Line 8: Memorial Hospital Association is a critical access hospital showing 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.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 Centers for Medicare and Medicaid Services. These amounts do not include fee schedule amounts. Part III, Line 9b: Memorial Hospital does not pursue collection activities for patients that qualify for charity care or patients that have set up payment arrangements for their accounts. Memorial Hospital does not charge interest on patients with payment arrangements. Also, collection activities are not pursued for patients that are in the process of applying for charity care and patients waiting for approval or denial from public aid. Any personal portion due after financial assistance is established would follow normal collection procedures. Part VI, Line 2: Memorial Hospital, based on its mission, wants to ensure that the health care needs of the community it serves are met. The Hospital has medical clinics located throughout Hancock County to improve access to health care services to our patients. The Board also has four committees; Finance, Planning, Quality and Community Health, and Marketing Committees that have community representation to ensure that input is obtained from the community when considering the health care needs of those we serve. Community input on desired services is obtained through patient satisfaction surveys that are initiated by the inpatient unit, emergency department, and medical clinics that provide a line of communication to identify additional health care services that community desires. The second Community Health Needs Assessment is completed and posted to our website at www.mhtlc.com. Part VI, Line 3: Memorial Hospital strives to provide a rewarding and healing process to our patients, plus an affordable, comfortable process to meet their financial obligations. Memorial Hospital informs their patients individually upon admission about the eligibility for assistance under federal, state or local government programs, and provides the patient with information regarding the Organization's charity care policy.The Collection and Financial Assistance Policies and applications are on our website. We also provide financial counseling to any patient. We post our Charity Care Policy and information regarding federal, state, and local programs at all our registration areas. Brochures are distributed regarding financial assistance with all admission packages.Billing statements have financial assistance support telephone numbers at the bottom of each statement. Our third party billing service provides counseling to our patients regarding available financial assistance if there is a need. Part VI, Line 4: Memorial Hospital Association is an 18-bed critical access hospital located in Carthage, IL. Carthage is a city in Hancock County, Illinois. It is located in western Illinois along the Mississippi River. The nearest city with a population > 50,000 is Peoria, IL. Its primary service area from its most recently completed community health needs assessment is defined as Hancock County, with Colchester, Lomax, Keokuk, Tennessee and Blandinsville as the secondary service area. The 2019 population is approximately 31,399. The 2019 median household income is approximately $50,077, significantly lower than the state of Illinois. The unemployment rate was 4.9%, higher than the rate for the state of Illinois.The most common industries are manufacturing, agriculture, construction and health care. The nearest hospital is Keokuk Area Hospital about 15 miles away on the Iowa side of the Mississippi River. Part VI, Line 5: Memorial Hospital is dedicated to improving health by providing education and wellness programs and innovative services at all the stages of life for residents of Hancock County. The Hospital is governed by a 13-member, volunteer Board of Directors that represent key areas within Hancock County as well as the medical staff. As a critical access hospital, Memorial Hospital is an 18-bed facility that provides general medical, surgical services along with obstetrics and an array of outpatient services for the community. Specialty clinics are also provided locally in the areas of cardiology, dermatology, oncology, neurology, ophthalmology, podiatry, orthopedic, pulmonology, and sleep apnea so that our patients don't have to travel far to receive needed health care services. These specialty physicians are members of the Hospital's medical staff along with other providers that desire to serve members of our service area. The Hospital extends medical staff privileges to all qualified physicians in the community. With the support of the community, Memorial Hospital built a new 18-bed hospital that was occupied in August 2009. The facility provides up-to-date, diagnostic equipment and services with a capital budget also presented and approved on an annual basis to ensure that needed equipment is obtained to meet the expectations of our patients. Memorial Hospital operates an emergency room available to all regardless of ability to pay.The Hospital also participates in several health care events throughout the year providing free services as well as a listing of services that are offered through the Hospital, clinics, and specialty clinics. This includes, but is not limited to, health fairs, blood pressure screenings, and diabetic education. Memorial Hospital sponsors the bloodmobile and provides language assistance services. X X X 0 0 0 0 0 0 0 0 0 Christopher Jones MD Director 391717 0 0 0 414 0 5600 0 32401 0 430132 0 0 0 Ada Bair CEO 212629 0 15000 0 1236 0 4274 0 11983 0 245122 0 0 0 Teresa Smith CFO 141404 0 0 0 414 0 2958 0 20716 0 165492 0 0 0 Nileshwa Senthe MD Pediatrician 433409 0 0 0 774 0 5600 0 12983 0 452766 0 0 0 Victoria Popela Family Practice Physician 329805 0 0 0 1188 0 0 0 10622 0 341615 0 0 0 Edward McKenney DO Family Practice Physician 302145 0 0 0 2567 0 0 0 11104 0 315816 0 0 0 Douglas Heighton MD Family Practice Physician 266084 0 0 0 1188 0 5518 0 34127 0 306917 0 0 0 Daryl Chenoweth CRNA 235937 0 0 0 2286 0 4869 0 23832 0 266924 0 0 0 A Western Illinois Economic Development Authority 352256539 958362BL8 2016-07-21 18659314 Refund Revenue Bond Series 2016 issued 9/16/2008 0 0 0 A 2244314 18659314 344284 18315030 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 0 0 0 0 1 A 1 Roxanne Rankin Family member to Dennis Rankin, Secretary/Treasurer of board 34110 Employee compensation 0 Shelley Smith Family member to Teresa Smith, Officer 35822 Employee compensation 0 X IT Core Switch 1 78627 Cost 0 0 0 0 Part I, Column (b): The organization is reporting the number of items in Part I, column (b). Form 990, Part III, line 3 Effective July 1, 2019, Sherrick Home Health discontinued operations as part of Memorial Hospital Association and was no longer a wholly owned subsidiary of the Organization. Form 990, Part VI, Section A, line 1 The Executive Committee consists of the President, Vice President, Secretary-Treasurer, additional members as the Board appoints, the Chief Executive Officer and any other leadership team members deemed appropriate by the officers of the Board. The Chief Executive Officer and any Leadership Team members do not have the right to vote upon any action being taken. The Executive Committee meets only in the event that the Board is unable to take necessary action, has an agenda for each meeting, keeps minutes of its meetings, and mails a copy of the minutes of each meeting to each member of the Board of Directors within twenty-four (24) hours of the adjournment of the meeting. The primary purpose of the Executive Committee is to carry out critical tasks for effective Board functioning, including, but not limited to, Chief Executive Officer Management performance, management company performance, if applicable, and providing assistance to the Board in situations requiring action when it is impossible or impractical to convene a full Board meeting. Form 990, Part VI, Section A, line 4 The Articles of Incorporation and Bylaws were amended in September 2019 to remove Unity Point Health as the sole corporate member. Unity Point Health no longer has authority to appoint one of the board members. Upon dissolution of the Corporation, all remaining assets of the Corporation are distributed to Hancock County Senior Services (HCSS) Association. If HCSS is not in existence or does not qualify as an organization exempt from tax under Section 501(c)(3) of the Code, the assets of the Corporation will be distributed to any other not-for-profit corporation engaged in health care activities which is exempt from tax under Section 501(c)(3) of the Code as approved by the Corporation's board of directors. The Board of Directors has final authority of the selection of any new, or removal of any existing, CEO as well as the administrative reporting relationship of the CEO. Form 990, Part VI, Section A, line 6 The sole member of the Corporation was Iowa Health System d/b/a UnityPoint Health from January thru September 2019. Form 990, Part VI, Section A, line 7a Unity Point Health, sole corporate member, had authority to appoint one board member January thru September 2019. Form 990, Part VI, Section A, line 7b The Member had final authority on the following actions from January thru September 2019: A. Adoption of strategic plans for the Corporation and its Affiliates; B. Adoption of business plans for the Corporation and its Affiliates; C. Adoption of operating and capital budgets for the Corporation and its Affiliates; D. Adoption of a plan for internal corporate re-structure which involves the Corporation, a Corporation Affiliate, and/or an affiliate of the Member; E. Incurrence of indebtedness by the Corporation and its Affiliates, due to bonds, bank loans, capital leases, or otherwise borrowing money whether or not included in the operating or capital budgets approved by the Member (but not including trade payables incurred in the ordinary course of business in accordance with operating and capital budgets approved by the Member) F. Selection (after consultation with the Corporation's Board of Directors) of any new, or removal of any existing, CEO of the Corporation (subject to the terms of Section 5(e) of the Affiliation Agreement between the Corporation and the Member dated June 5, 2018), as well as the administrative reporting relationship of the CEO of the Corporation; G. Subject to the Corporation's Board of Directors' reserved powers, the transfer, sale or closure of any facility, department, or function at the Corporation or the Corporation's Affiliates; H. Subject to the Corporation's Board of Directors' reserved powers, any amendment to the Articles or Bylaws of the Corporation or its Affiliates; I. Managed care strategy and execution of managed care contracts; however, local managed care contracts may or may not be executed by the Corporation so long as the decision does not negatively impact the Member's managed care strategy; and J. Payments or transfer of assets between the Corporation and the Member, so long as the obligation of the Corporation is proportionate or equitable to other Affiliates of the Member; the Corporation will be responsible for its proportionate share of system-wide costs. Form 990, Part VI, Section B, line 11b The Form 990 is reviewed by the Finance Committee and then by the Board of Directors before it is filed. The final return is reviewed and signed by the CFO. Form 990, Part VI, Section B, line 12c Officers, Board members, and key employees are required to sign a conflict of interest statement upon hiring or becoming a Board member. The disclosure is updated at the annual meeting. Any possible conflict of interest is disclosed to the other Board members and made a matter of record through an annual procedure and also when the interest becomes a matter of Board action. Disclosures are reviewed by the Board of Directors and any Member for whom conflicts have been identified leaves and abstains from voting. Appropriate documentation of the handling of the conflict is kept to protect the interested party and Memorial Hospital Association. Additionally, the Compliance Officer meets with the Compliance Committee of the board. Any issues identified are logged and followed up by the Compliance Officer. Form 990, Part VI, Section B, line 15a Salary surveys are reviewed annually to ensure all positions individually are within the market rate. The Executive Committee determines the salary for the CEO. Each Board member does an independent performance review of the CEO, which is compiled and used by the Executive Committee. The Executive Committee uses the Illinois Hospital Association salary survey as a guide for compensation using the high, middle, and low ranges for similar size organizations. Measures such as revenue, performance of the CEO, and budgetary constraints are all factors that are considered when reviewing the CEO's salary. The salary for the CFO is determined by the CEO using the CAH Compensation Survey sponsored by Integrated Healthcare Strategies as a guide for similar organizations. The most recent review of salary occurred in 2019. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request. The financial statements are also required to be attached to the Form 990. Form 990, Part IX, line 11g Purchased services: Program service expenses 3,724,474. Management and general expenses 1,116,600. Fundraising expenses 961. Total expenses 4,842,035. Professional fees: Program service expenses 263,707. Management and general expenses 377,025. Fundraising expenses 0. Total expenses 640,732. Form 990, Part XI, line 9: Change in interest in net assets of Memorial Hospital Foundation 25,034. Hancock County Senior Services PO Box 160 Carthage IL 62321 370902248 Caring for the elderly IL 501(c)(3) Line 3 Memorial Hospital Association 1 Advance Physical Therapy of Hancock County 620 Wabash Street Carthage IL 62321 113655886 Physical therapy rehabilitation IL Memorial Hospital Association Related 62111 10081 0 1 0.50000 Hancock County SLF LLP 403 S Adams Carthage IL 62321 204445121 Assisted living facility IL N/A Hancock Area Medical Supply dba Sherrick Home Health 1204 Buchanan St Ste 2 Carthage IL 62321 371180373 Home health IL Memorial Hospital Association C 615598 1.00000 1 HGV Foundation Inc 400 S Adams St Carthage IL 62321 450609346 Supporting living IL N/A C 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 0 1 Hancock County Senior Services P 340213 General Ledger Advance Physical Therapy of Hancock County S 65000 Amount on K-1