2020-03-09T06:58:44-05:00 2019-07-31 450250958 EIDE BAILLY LLP 1545 ASSOCIATES DR STE 101 DUBUQUE IA 52002 990 2018-08-01 370645239 Carlinville Area Hospital Association CARL 2178543141 20733 North Broad Street Carlinville IL 62626 Michael J Brown CFO 2178543141 2020-03-05 1 Kim Hunwardsen CPA P00484560 5635561790 2020-03-05 216.147.181.47 2020-03-05 14:22:31 CS P 330E77A2EC15986A2DC713C7FDB26B906589BB96 9EB6867304309B5BA7CF1F8994B8B429DCF961D0 2018 2020-09-23 17:36:50Z Michael Layfield 20733 North Broad Street Carlinville IL 62626 29435635 0 X www.cahcare.com X 1947 IL Provide quality acute and preventative health care benefits 7 6 268 135 -64947 -64947 125987 1114205 25723125 27225973 155433 149291 -27853 -78634 25976692 28410835 0 0 0 0 12096564 13781753 0 0 0 13574563 14141299 25671127 27923052 305565 487783 35254172 35131498 18514122 17847808 16740050 17283690 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 22634647 27225973 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 2019, we carried out our exempt purpose in the following ways: 1) Provided quality short term acute care medical services to 362 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 140 patients in our swing bed unit, with an average length of stay of 10.3 days. 3) Provided 24 hour a day emergency room services. Our emergency room treated 6,297 patients during fiscal year 2019. 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 26,228 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 6,842 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 14,005 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 $98,000 for the year ended July 31, 2019, 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. 22634647 1 1 0 0 0 0 0 0 0 0 1 0 0 1 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 9 0 1 268 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 Michael Brown 2178543857 20733 North Broad Street Carlinville IL 62626 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 Deveve Member 1.00 0.00 X 0 0 0 Tracey Smith Member through June 2019 1.00 0.00 X 0 0 0 Anne Borwick MD Ex-officio Member 41.00 0.00 X 298848 0 41615 Kenneth Reid CEO 40.00 1.30 X 0 0 0 Michael Brown CFO 40.00 1.30 X 0 0 0 August Adams MD Family Medicine 40.00 0.00 X 259118 0 32297 Lourdes Cruz MD Pediatrician 40.00 0.00 X 236772 0 30525 Sara McPeak CNO 40.00 0.00 X 150825 0 42589 Thomas Hatley MD MPH Preventative & Emergency Medicine 40.00 0.00 X 173390 0 0 Stacy Smith Pharmacist 40.00 0.00 X 141700 0 26727 1260653 0 173753 10 0 1 0 Illinois Emergency Physicians LLP PO Box 674579 Detroit MI 482674579 Emergency Room Physicians 1790769 Medefis Corporation PO Box 5068 New York NY 100875068 Contract Labor Company 432740 Numed Inc PO Box 1098 Denton TX 76202 Nuclear Medicine and MRI 331167 CPSI PO Box 850309 Mobile AL 366850309 Computer Software Services 328015 HealthTechS3 PO Box 636426 Cincinnati OH 452636426 Management Services 299586 10 1026927 20296 66982 1114205 Patient service revenue 622110 26633434 26633434 Pharmacy revenue 446110 399817 399817 192722 192722 27225973 155571 155571 242817 321451 -78634 -78634 -64947 -13687 693269 3800 703349 0 -10080 3800 -6280 -6280 28410835 27225973 -64947 135604 X 341391 341391 10731454 9356000 1375454 303901 264491 39410 1621278 1417726 203552 783729 686145 97584 881598 881598 43360 43360 68940 68940 3597699 3257291 340408 259309 259309 2998108 2136268 861840 80689 80689 163190 163190 19668 11735 7933 100316 53830 46486 655864 514423 141441 2082038 1613555 468483 415816 71494 344322 Medical supplies 1539301 1539301 Bad debt expense 896255 896255 Food 215014 214523 491 Repairs and maintenance 90838 80898 9940 33296 16131 17165 27923052 22634647 5288405 0 3549549 2984259 4008987 3833366 13108 17576 250853 232949 253733 247539 39839796 19213800 19833557 20625996 6806910 5417861 537475 1771952 35254172 35131498 1698375 2004504 14717 29433 16490030 15678871 311000 135000 18514122 17847808 X 16122575 16681738 617475 601952 16740050 17283690 35254172 35131498 X 487783 71380 -15523 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 500172 500172 25867479 16518767 9348712 8701808 1738054 6963754 4770337 956979 3813358 20625996 Beneficial interest in perpetual trust 521952 Estimated third-party payor settlements 1250000 1771952 Employee health claims 135000 135000 X 27907411 71380 -896255 -824875 28732286 -321451 -321451 28410835 27348248 321451 321451 27026797 896255 896255 27923052 Part X, Line 2: The Hospital is organized as an Illinois nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. 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 2d - Other Adjustments: Provision for bad debts included in total expenses for Form 990 -896,255. Part XI, Line 4b - Other Adjustments: Rental expenses recorded in revenue for Form 990 -321,451. Part XII, Line 2d - Other Adjustments: Rental expenses recorded in revenue for Form 990 321,451. Part XII, Line 4b - Other Adjustments: Provision for bad debts included in total expenses for Form 990 896,255. 1 1 X 1 X 125.000000000000 1 X 1 1 1 0 1 1 98000 98000 0.00360 5038038 5024909 13129 0.00050 5136038 5024909 111129 0.00410 6812540 2896538 3916002 0.14490 6812540 2896538 3916002 0.14490 11948578 7921447 4027131 0.14900 26551 26551 0.00100 26551 26551 0.00100 0 896255 169392 9238888 9308789 -69901 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 that will be addressed over the next three years.2019 Prioritized Needs:1. Addressing obesity by providing 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. 2. Specifically addressing diabetes and the need for: - Education and prevention programming for pre-diabetes and diabetes - Smoking prevention education and programs - Programs encouraging recreation and exercise at all ages 3. The third prioritized need fell generally under the category of mental health, with specific reference to the need for: - Improving availability of mental health and substance use and misuse counseling - Improving 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) 4. Improve access to preventative care and case management services 5. Local healthcare workforce developmentDifferences between FY2016 and FY2019 CHNA needs:1. Local access to specialists and specialty care was removed as a prioritized need: During the planning process, the focus groups expressed that there are more providers and specialist available since the 2016 groups were conducted. The groups did not see this as one of the top needs for the 2019 CHNA.2. Expanded hours for primary care was removed as a prioritized need.During the planning process, the focus groups expressed that there are more providers and times available for patients to see primary care providers than in the past. The groups did not see this as one of the top needs for the 2019 CHNA.3. Food security for youth was removed as a prioritized need.During the planning process, the focus group expressed that there were several programs that have sustained over time to help with food security in the youth. The groups did not see this as one of the top needs for the 2019 CHNA.4. Improve access to preventative care and case management services was added as a prioritized need.-It was determined that there is still a group of population that is not gaining access to preventative care services-The population served by CAH needs help understanding the health care industry and navigating their way through the serves available and insurances.5. Local healthcare workforce development was added as a prioritized need.-It was determined in the focus groups that there is a need to educate youth on careers options in the healthcare industry and the need to professionals to practice/work in the rural areas.-It is more and more difficult for rural hospitals, including Carlinville, to recruit in certain professions where there is a shortage such as Registered Nurses, Medical Technologists, Physical Therapists, and Physicians.-There is a need for succession planning as the baby boomers prepare to retire. 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 I, Ln 7 Col(f): The amount of bad debt expense removed from total expenses to determine the percentage was $896,255. Part II, Community Building Activities: The Lunch Bunch Program provides healthy meals for children from low income households at no cost during the summer when meals are not available through the school district. The service ran from June 1 through August 1 and served 1,935 adults and 3,404 children. The total cost to the Hospital was over $21,000.The Third Day Project serves underprivileged children by providing food to children on long weekends from school where they may otherwise not have food available to them. Approximately 71 children from Carlinville Primary School, selected by school administration, are provided with a free healthy sack of food the day prior to long weekends from school. The Hospital Dietary Department orders all the food and helps the group of volunteers inventory the food that goes into the bags. The cost to provide the food bags was over $5,551. Part III, Line 2: The bad debt expense is only the uncollected portion of the patient account. Any discounts would be treated as a reduction in revenue. All forms of payment, including self-pay, insurance, contractual allowances, and discounts reduce the patient's account prior to the account being classified as bad debt. A payment received on an account previously written off as bad debt reduces bad debt expense. Bad debt expense reported on line 2 is at charges as reported on the financial statements. Part III, Line 3: The estimated amount of the Organization's bad debt expense 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 2018. The 18.9% 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 9 and 10 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 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.Throughout the year, Carlinville Area Hospital offered CPR training to the community for a special rate of $25 per participant.The Hospital provided free blood pressure checks in Carlinville and Palmyra on a monthly basis.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.Carlinville Area Hospital provides a number of services to the community. The Food for Thought Series for seniors, the Safe Sitter class and the very popular High School to Healthcare Program where high school student get to explore healthcare professions. The hospital also opened up 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 MD Ex-officio Member 298542 0 0 0 306 0 18500 0 23115 0 340463 0 0 0 August Adams MD Family Medicine 258272 0 0 0 846 0 13621 0 18676 0 291415 0 0 0 Lourdes Cruz MD Pediatrician 235895 0 0 0 877 0 24500 0 6025 0 267297 0 0 0 Sara McPeak CNO 148704 0 0 0 2121 0 24500 0 18089 0 193414 0 0 0 Thomas Hatley MD MPH Preventative & Emergency Medicine 172044 0 0 0 1346 0 0 0 0 0 173390 0 0 0 Stacy Smith Pharmacist 141394 0 0 0 306 0 13402 0 13325 0 168427 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, and Michael Brown, CFO, 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. 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 2,048,172. Management and general expenses 65,546. Fundraising expenses 0. Total expenses 2,113,718. Professional fees: Program service expenses 1,209,119. Management and general expenses 274,862. Fundraising expenses 0. Total expenses 1,483,981. Form 990, Part XI, line 9: Change in beneficial interest in perpetual trust -15,523. 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