2019-11-14T12:15:22-06:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2018-01-01 376062326 PANA COMMUNITY HOSPITAL ASSOCIATION PANA 2175622131 101 EAST NINTH STREET PANA IL 62557 KATRINA CASNER PRESIDENT & CEO 2175622131 2019-11-08 1 JEFF PARKER P00970069 3149254300 67.137.57.251 2019-11-08 15:41:52 CS P 616D57ED59C9C12D8A28A3D9D480C81CB0617C5C 3B8AD87D3D4D2D1864CA6013C36879B94F3F1DCF 2018 2020-03-31 21:24:44Z KATRINA CASNER 101 EAST NINTH STREET PANA IL 62557 28113287 0 X WWW.PANAHOSPITAL.COM X 1966 IL ASSURING COMMUNITY-BASED QUALITY HEALTH CARE. 12 11 294 12 4895 0 49841 536207 25457046 27217816 201983 255335 129763 101577 25838633 28110935 0 0 0 0 13877216 14575200 0 0 0 11115511 11866326 24992727 26441526 845906 1669409 31508242 37706737 3418278 8308522 28089964 29398215 X TO BE A LEADING PARTNER IN ASSURING COMMUNITY-BASED QUALITY HEALTH CARE. 0 0 21258275 27327004 TO PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF PANA, ILLINOIS AND THE SURROUNDING AREA. THESE SERVICES INCLUDE NURSING, EMERGENCY AND ANCILLARY SERVICES FOR 1,303 INPATIENT DAYS, 21,800 OUTPATIENT ADMISSSIONS, 6,866 EMERGENCY VISITS AND 543 OUTPATIENT SURGICAL PATIENTS.WE PROMOTE A VISION STRIVING TO DEVELOP A COMPREHENSIVE SYSTEM OF HEALTHCARE SERVICES, IN PARTNERSHIP WITH THE OTHER COMMUNITY HEALTHCARE PROVIDERS, TO ASSIST OUR SERVICE AREA RESIDENTS IN REACHING THEIR PERSONAL MAXIMUM FOR HEALTH; TO PROVIDE PROGRAMS THAT PROMOTE HEALTH EDUCATION AND WELLNESS; TO ENHANCE OUR PERSONALIZED CARE CONCEPT IN THE PROVISION OF SERVICES TO OUR COMMUNITY; TO MAINTAIN AN ENVIRONMENT WHICH PROMOTES SATISFACTION AND OPPORTUNITY FOR THE PATIENT, THEIR FAMILY, THE EMPLOYEE, AND THE PHYSICIAN; TO MAINTAIN THE HOSPITAL'S ABILITY TO SUPPORT THE DELIVERY OF QUALITY HEALTH CARE AT A REASONABLE COST, IN ACCORDANCE WITH COMMUNITY NEEDS AND THE HEALTH CARE REGULATORY ENVIRONMENT; AND TO DEMONSTRATE BY ACTIONS AND RESULTS OUR COMMITMENT TO CONTINUOUS QUALITY IMPROVEMENT. -109188 THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THE HOSPITAL PROVIDES 100% CHARITY CARE TO PATIENTS WHOSE INCOME LEVEL IS BELOW 200% OF THE FEDERAL POVERTY LEVEL. FOR PATIENTS WHOSE INCOME LEVEL IS BETWEEN 200% AND 300% OF THE FEDERAL POVERTY LEVEL, THE HOSPITAL PROVIDES 50% CHARITY CARE. THE HOSPITAL USES COST AS THE MEASUREMENT BASIS FOR CHARITY CARE DISCLOSURE PURPOSES WITH THE COST BEING IDENTIFIED AS THE DIRECT AND INDIRECT COSTS OF PROVIDING THE CHARITY CARE. CHARITY CARE INCLUDES THE AMOUNT OF COSTS FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. CHARITY CARE COST WAS DETERMINED ON THE APPLICATION OF THE ASSOCIATED COST-TO-CHARGE RATIOS. 21258275 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 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 0 0 0 1 26 0 294 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X JAMES MOON CFO 2175622131 101 EAST NINTH STREET PANA IL 62557 MATT BEAVERS CHAIRMAN 1.50 X X 0 0 0 RICK SCHMITZ VICE CHAIRMAN 1.50 X X 0 0 0 SARAH MYER SECRETARY 1.50 X X 0 0 0 CHARLES O'MALLEY TREASURER 1.50 X X 0 0 0 DR DAVID LETT DIRECTOR 1.50 X 0 0 0 LARRY CEARLOCK DIRECTOR 1.50 X 0 0 0 DAVE SLATER DIRECTOR 1.50 X 0 0 0 JIM BREWER DIRECTOR 1.50 X 0 0 0 GREGORY HOLTHAUS DIRECTOR 1.50 X 0 0 0 DR TERRY CUNNINGTON DIRECTOR, PHYSICIAN 40.00 X 416184 0 12479 KENNETH FLESCH DIRECTOR 1.50 X 0 0 0 PASTOR AMANDA RICHARDS DIRECTOR 1.50 X 0 0 0 CAROL SCHRAMM PAST CHAIRMAN (TERM 4/18) 1.50 X X 0 0 0 KATRINA CASNER PRESIDENT & CEO 40.00 1.50 X 200762 0 12720 JAMES MOON CFO 40.00 1.50 X 122454 0 8190 VICKIE COEN CCO & CNE 40.00 X 135033 0 5794 DIANNE BAILEY CIO 40.00 X 88829 0 11240 DR SHABAZ MOHAMMAD BEGUM PHYSICIAN 40.00 X 232288 0 10532 DR MARLON MUNESES PHYSICIAN 40.00 1.50 X 280460 0 15215 DR CATHERINE TEODORO PHYSICIAN 40.00 X 198878 0 8390 DR DEMOSTHENES ASUNCION PHYSICIAN 40.00 X 226157 0 10676 DR DENNIS YAP PHYSICIAN 40.00 X 150000 0 0 DR STEVEN WEBER PT SURGEON 40.00 X 183166 0 0 ROBERT LUDWIG CRNA 32.00 X 199445 0 17233 MICHELLE FORMAN PHARMACIST 40.00 X 128681 0 10897 DR MOLLIE BEYERS PHYSICAL THERAPIST 40.00 X 107390 0 10717 2669727 0 134083 14 0 1 0 O'SHEA BUILDERS 3401 CONSTITUTION DRIVE SPRINGFIELD IL 62711 CONSTRUCTION SERVICES 11729564 CROSSROADS EMERGENCY PHYSICIANS LLP PO BOX 674579 DETROIT MI 48267 EMERGENCY PHYSICIANS 1695119 ALLSCRIPTS 24630 NETWORK PLACE CHICAGO IL 60673 IT SUPPORT/MAINT 429799 CONSOCIATE-DANSIG 151 E DECATUR ST DECATUR IL 62525 HEALTH INS TPA 428858 GE HEALTHCARE PO BOX 96483 CHICAGO IL 60693 EQUIP MAINT 163814 11 424306 20793 91108 74395 536207 PATIENT CARE SERVICES 621110 26739342 26739342 340B PHARMACY REVENUE 621110 322684 322684 OTHER OPERATING REVENUE 621110 155790 155790 27217816 257687 257687 73837 0 73837 73837 73837 2352 -2352 -2352 -2352 CAFETERIA & VENDING 722514 22845 22845 CATERING 722320 4895 4895 27740 28110935 27217816 4895 352017 X 1996283 1384401 611882 9713165 7961944 1751221 244402 205483 38919 2218497 1784346 434151 402853 322234 80619 74456 74456 63125 63125 9799 9799 3388652 3029514 359138 64238 64238 448078 448078 390269 282205 108064 252931 171950 80981 111278 111278 47140 47140 939892 638966 300926 226725 154134 72591 MEDICAL SUPPLIES 2310352 2310352 BAD DEBT EXPENSE 1872226 1872226 REPAIRS & MAINTENANCE 846858 575719 271139 MCAID PROVIDER ASSESSME 408285 408285 412022 156516 255506 26441526 21258275 5183251 0 1226 2328 12853008 6265715 3804003 3923057 1850 1850 471854 482181 194030 295148 37868988 14216479 11022483 23652509 2692268 2606827 53548 47779 94180 83100 319792 346243 31508242 37706737 3418278 4687545 2620977 1000000 3418278 8308522 X 28089964 29398215 28089964 29398215 31508242 37706737 X 1669409 -352738 -8420 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 9799 9799 0 PART II-B, LINE 1: GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES - WE PARTICIPATE INDIRECTLY WITH LOBBYING ACTIVITIES THROUGH OUR MEMBERSHIPS IN THE ILLINOIS HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. IT IS ESTIMATED THAT OUR LOBBYING EXPENDITURES ARE 38% & 22.98%, RESPECTIVELY, OF OUR MEMBERSHIP DUES AS PROVIDED BY THE IHA. 51361 51361 11230711 6575937 4654774 864526 367976 496550 8629924 7272566 1357358 17092466 17092466 23652509 X PART X, LINE 2: AT DECEMBER 31, 2018 AND 2017, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED. PRESENTLY, THERE ARE NO ONGOING INCOME TAX AUDITS OR UNRESOLVED DISPUTES WITH THE TAX AUTHORITIES THAT THE ORGANIZATION CURRENTLY FILES OR HAS FILED WITH. 1 1 X 1 X 1 X 1 1 0 0 453077 453077 0.01710 4567922 4354776 213146 0.00810 5020999 4354776 666223 0.02520 48708 3571 45137 0.00170 53397 53397 0.00200 4595940 2274150 2321790 0.08780 4698045 2277721 2420324 0.09150 9719044 6632497 3086547 0.11670 1 1872226 1123336 9237363 9770587 -533224 X 1 0 1 1 PANA COMMUNITY HOSPITAL 101 EAST 9TH STREET PANA IL 62557 WWW.PANAHOSPITAL.COM 0001776 X X X X PANA COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X SEE PART V, PG.8 FOR URL X 1 16 1 SEE PART V, PG.8 FOR URL 0 1 X 200.000000000000 300.000000000000 X X 1 1 X X X X 1 X SEE NOTE ON THE FOLLOWING PAGES FOR FULL URL OF FAP X SEE NOTE ON FOLLOWING PAGES FOR FULL URL OF FAP APPLICATION X SEE NOTE ON FOLLOWING PAGES FOR FULL URL OF FAP PLAIN LANGUAGE SUMMARY X X X 1 X 0 X X X X 1 X 0 0 PANA COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: PCH CONSULTED THE CHRISTIAN COUNTY HEALTH DEPT. AND CONDUCTED COMMUNITY MEETINGS WHICH A DIVERSE BACKGROUND OF INDIVIDUALS COULD ATTEND. ALL OF THIS WAS DONE UNDER THE DIRECTION OF A CONSULTANT FROM THE ILLINOIS CRITICAL ACCESS HOSPTIAL NETWORK.IN ADDITION, THE PROCESS INVOLVED FOCUS GROUPS COMPRISED OF AREA HEALTHCARE PROVIDERS AND PARTNERS AND PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF, OR EXPERTISE IN PUBLIC HEALTH. MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS SERVED BY THE HOSPITAL OR INDIVIDUALS OR ORGANIZATIONS REPRESENTING THE INTEREST OF SUCH POPULATIONS ALSO PROVIDED INPUT. PANA COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: PANA COMMUNITY HOSPITAL'S SIGNIFICANT COMMUNITY HEALTH NEEDS, AS IDENTIFIED IN ITS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, ARE MENTAL HEALTH, WELLNESS, IMPROVE THE LOCAL ECONOMY AND PLANNING FOR PHYSICIAN SUPPLY. THE IMPLEMENTATION STRATEGY AND PROCESS BY WHICH NEEDS WILL BE ADDRESSED WAS IDENTFIED AND PRIORITIZED BY THE CHNA STEERING COMMITTEE AND KEY ADMINISTRATIVE STAFF AT PANA COMMUNITY HOSPITAL. THE GROUP REVIEWED THE NEEDS ASSESSMENT PROCESS AND PRIORITIZED SIGNIFICANT NEEDS AND SUPPORTING DOCUMENTS. THEY DISCUSSED STEPS TAKEN TO ADDRESS THE PREVIOUS COMMUNITY HEALTH NEEDS ASSESMENT AND CONSIDERED INTENRAL AND EXTERNAL RESOURCES POTENTIALLY AVAILABLE TO ADDRESS THE CURRENT PRIORITIZED NEEDS. THE FOLLOWING NEEDS AND ISSUES IDENTIFIED WERE. MENTAL HEALTH:1) ADDRESS PREVALENCE OF TOBACCO USE AMONG YOUTH AND ADULTS2) ADDRESS PREVALENCE OF ALCOHOL USE AMONG YOUTH ADULTS3) ADDRESS ADDICTION RELATED ISSUES INCLUDING ACCESS TO SERVICES FOR REHABILITATION AND RECOVERY 4) ADDRESS YOUTH SUBSTANCE USETHE GROUP ALSO SINGLED OUT A NEED FOR IMPROVED ACCESS TO BEDS FOR PERSONS WITH BEHAVIORAL MENTAL HEALTH ISSUES AND SUBSTANCE ABUSE ISSUES REQURING IN-PATIENT SERVICESACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE MENTAL HEALTH NEED:1) EXPLORE EXPANDING TELEHEALTH TO INCLUDE TELEPSYCHIATRY2) EXPLORE EXPANDING MENTAL HEALTH COUNSELING AND EVALUATION TO IMPROVE BEHAVIORAL MENTAL HEALTH ACCESS AND ADDICTION-RELATED SERVICES3) CONTINUE TO PARTNER WITH CHRISTIAN COUNTY MENTAL HEALTH TO PROVIDE EMERGENT CARE AND CRISIS MANAGEMENT FOR BEHAVIORAL MENTAL HEALTH AND SUBSTRANCE RELATED ISSUES4) EXPLORE CREATION OF LOCAL LIMITED STAY DETOXIFICATION SERVICES IN ORDER TO REMOVE HURDLES TO LONG TERM PLACEMENT FOR REHABILITATION AND RECOVERY FOR ADDICTION5) CONTINUE TO SUPPORT THE COMMUNITY SUBSTANCE ABUSE PREVENTION EFFORTS OF THE CHRISTIAN COUNTY HEALTH DEPARTMENT AND THE CHRISTIAN COUNTY PREVENTION COALITION THROUGH INFORMATION EXCHANGE AND REMAINING OPEN TO PARTNERING ON SPECIFIC PROGRMAS AND/OR PROJECTS UNDER SPECIFIC CIRCUMSTANCES. 6) EXPLORE PROVIDING A LOCAL HEALTHCARE SCHOLARSHIP FOR USE FOR EDUCATION TOWARD BECOMING A MEDICAL OR SOCIAL WORK PROFESSIONAL FOR MENTAL HEALTH.WELLNESS:1) BETTER ACCESS TO VACCINATIONS FOR EVERYONE2) IMPROVED ACCESS TO EDUCATION AND CARE FOR THE PREVENTION OF DIABETES, CANCER AND HEART DISEASEACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE WELLNESS NEED:1) COLLABORATE WITH CHRISTIAN COUNTY HEALTH DEPARTMENT TO OFFER DRIVE-THROUGH VACCINATION SERVICES2) EXPLORE EXPANDING ROUTINE VACCINATION OFFERINGS TO INCLUDE PNEUMONIA AND OTHER RECOMMENDED VACCINES3) EXPLORE EXPANDING THE STATE YOUTH VACCINE PROGRAMS TO THE NEWLY ACQUIRED CLINIC4) IMPLEMENT A CHRONIC CARE MANAGEMENT PROGRAM5) IMPLEMENT CHRONIC CARE AND CHRONIC DISEASE EDUCATION THROUGH COMMUNITY "LUNCH AND LEARN" PROGRAMS6) IMPLEMENT WELLNESS EDUCATION IN COMMUNITY "LUNCH AND LEARN" PROGRAMS7) INCLUDED CHRONIC ILLNESS EDUCATION IN THE "LIVE WELL" PROGRAMS BY PANA COMMUNITY HOSPITAL8) EXPAND NUTRITION COUNSELING AND EDUCATION IMPROVE THE LOCAL ECONOMY:IN ORDER TO ADDRESS CIRCUMSTANCES OF COMMUNITY MEMBERS THAT IMPACT THEIR HEALTH AND HEALTHCAREACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS IMPROVING THE LOCAL ECONOMY:1) HELP EDUCATE LOCAL AND STATE GOVERNMENT REPRESENTATIVES ABOUT THE INITATIVES NEEDED TO IMPROVE THE LOCAL ECONOMY2) CONTINUE FINANCIAL SUPPORT FOR THE CREATING ENTREPRENEURIAL OPPORTUNITIES (CEO) PROGRAM3) KEEP PANA COMMUNITY HOSPITAL STRONG IN ORDER TO IMPACT THE QUALITY OF LIFE OF THE COMMUNITY4) CARRY OUT CAPITAL IMPROVEMENTS THAT WILL CREATE CONSTRUCTION JOBS IN THE NEAR TERM5) CONINTUE TO IMPROVE THE MARKETABILITY OF THE COMMUNITY THROUGH ADDRESSING MENTAL HEALTH, SUBSTANCE ABUSE, WELLNESS AND CHRONIC ILLNESS, THEREBY IMPROVING THE QUALITY OF LIFE AND REDUCING CRIME IN THE COMMUNITY. PLANNING FOR PHYSICIAN SUPPLY:THE FINAL SIGNIFICANT NEED IDENTIFIED AND PRIORITZIED WAS CREATION OF A SINGLE LIST OF AVAILABLE HEALTH-RELATED SERVICES AND PROVIDERS (INCLUDING HEALTHCARE, SOCIAL AND RELATED SERVICES, AND WELLNESS RELATED OPPORTUNITIES) THAT COULD BE UTILIZED BY ALL HEALTHCARE PROVIDERS AND OTHER COMMUNITY GROUPS AND ORGANIZATIONS TO REFER PERSONS TO LOCAL HEALTH-RELATED SERVICES.ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS PLANNING FOR PHYSICIAN SUPPLY:1) CONTINUE AN AGGRESSIVE SCHOLARSHIP PROGRAM TO ENCOURAGE LOCAL YOUNG PEOPLE TO FURTHER THEIR EDUCATION IN HEALTHCARE PROFESSIONS AND THEN TO RETURN TO PANA TO PRACTICE2) MONITOR PRIMARY CARE PROVIDERS3) KEEP PANA COMMUNITY HOSPITAL STRONG IN ORDER TO IMPACT THE QUALITY OF LIFE OF THE COMMUNITY4) EXPLORE COLLABORATION OPPORTUNITIES TO CREATE LOCAL ACCESS TO SPECIALISTS PANA COMMUNITY HOSPITAL PART V, SECTION B, LINE 13B: THE COST OF THE SERVICE MAY IMPACT AN INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE. PRESUMPTIVE ELIGIBILITY FOR FREE CARE IS AVAILABLE FOR INDIVIDUALS WHO ARE HOMELESS, MENTALLY INCAPACITATED WITH NOBODY TO ACT ON THEIR BEHALF, MEDICAID ELIGIBLE (BUT NOT ON THE DATE OF SERVICE), FILING PERSONAL BANKRUPCTY, DECEASED WITH NO ESTATE, INCARCERATED IN A PENAL INSTITUTION, OR AFFILIATED WITH A RELIGIOUS ORDER AND TAKING A VOW OF POVERTY.BASED ON THE GUIDANCE FROM THE ILLINOIS ATTORNEY GENERAL'S OFFICE, PANA DETERMINES THE DISCOUNT PERCENT REQUIRED TO GIVE UNINSURED PATIENTS AT 300% OF FPG. THE SAME DISCOUNT IS GIVEN TO UNDERINSURED. PANA COMMUNITY HOSPITAL PART V, SECTION B, LINE 7A:URL FOR CHNA:HTTP://WWW.PANAHOSPITAL.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT- PANA COMMUNITY HOSPITAL PART V, SECTION B, LINE 10A:URL FOR IMPLEMENTATION STRATEGY:HTTP://WWW.PANAHOSPITAL.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT- PANA COMMUNITY HOSPITAL PART V, SECTION B, LINE 16A:URL FOR FAP:HTTP://WWW.PANAHOSPITAL.COM/PATIENTS-AND-VISITORS/PATIENTS-AND-VISITORS/PROFILE/FINANCIAL-ASSISTANCE PANA COMMUNITY HOSPITAL PART V, SECTION B, LINE 16B:URL FOR FAP APPLICATION:HTTP://WWW.PANAHOSPITAL.COM/PATIENTS-AND-VISITORS/PATIENTS-AND-VISITORS/PROFILE/FINANCIAL-ASSISTANCE PANA COMMUNITY HOSPITAL PART V, SECTION B, LINE 16C:URL FOR FAP PLAIN LANGUAGE SUMMARY:HTTP://WWW.PANAHOSPITAL.COM/PATIENTS-AND-VISITORS/PATIENTS-AND-VISITORS/PROFILE/FINANCIAL-ASSISTANCE 7 1 - COMMUNITY MEDICAL CLINIC OF PANA 101 EAST 9TH STREET PANA IL 62557 PHYSICIAN SATELLITE OFFICE 2 - QUAD COUNTY HOME HEALTH & HOSPICE 1 HUBER STREET PANA IL 62557 HOME HEALTH & HOSPICE AGENCY 3 - COMMUNITY MEDICAL CLINIC OF ASSUMPTION 118 N WALNUT STREET ASSUMPTION IL 62510 PHYSICIAN SATELLITE OFFICE 4 - COMMUNITY MEDICAL CLINIC OF RAMSEY 715 S SUPERIOR RAMSEY IL 62080 PHYSICIAN SATELLITE OFFICE 5 - COMMUNITY MEDICAL CLINIC OF NOKOMIS 120 CEDAR STREET NOKOMIS IL 62075 PHYSICIAN SATELLITE OFFICE 6 - PANA MEDICAL GROUP 217 SOUTH LOCUST STREET PANA IL 62557 PHYSICIAN SATELLITE OFFICE 7 - NOKOMIS MEDICAL GROUP 107 WEST STATE STREET NOKOMIS IL 62075 PHYSICIAN SATELLITE OFFICE PART I, LINE 3C: ELGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON FAMILY INCOME COMPARED TO FEDERAL POVERTY GUIDELINES AS WELL AS SUBMISSION OF A COMPLETE FINANCIAL ASSISTANCE APPLICATION. HOWEVER, IN THE FOLLOWING INSTANCES, AN INDIVIDUAL MAY PRESUMPTIVELY QUALIFY FOR 100% FINANCIAL ASSISTANCE WITHOUT SUBMITTING A FINANCIAL ASSISTANCE APPLICATION AND REGARDLESS OF THEIR INCOME: ENROLLMENT IN CERTAIN FEDERAL OR STATE PROGRAMS (E.G. WIC, SUPPLEMENTAL NUTRITION AND ASSISTANCE PROGRAM, ILLINOIS FREE BREAKFAST/LUNCH PROGRAM, TEMPORARY ASSISTANCE FOR NEEDY FAMILIES, ETC.), HOMELESSNESS, MENTAL INCAPACITATION WITH NO ONE TO ACT ON THE PATIENT'S BEHALF, MEDICAID ELIGIBILITY, RECENT PERSONAL BANKRUPTCY, DECEASED WITH NO ESTATE, INCARCERATION IN A PENAL INSTITUTION, AND AFFILIATION WITH A RELIGIOUS ORDER AND A VOW OF POVERTY. PART I, LINE 7: FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. THE COSTS REPORTED IN THE TABLE IN PART I, LINE 7 USED A RATIO OF PATIENT CARE COSTS TO CHARGES AS COMPUTED IN WORKSHEET 2 OF THE FORM INSTRUCTIONS. THIS METHODOLOGY WAS USED FOR ALL PATIENT SEGMENTS. PART I, LN 7 COL(F): FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $1,872,226 REPORTED ON PART IX, LINE 25. HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSED OF CALCULATING THE PERCENTAGE IN THIS COLUMN. PART III, LINE 2: ACCOUNTS RECEIVABLE ARE REDUCTED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND BAD DEBT EXPENSE. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 3: THE BAD DEBT EXPENSE REPORTED ON LINE 2 REPRESENTS THE EXPENSE REPORTED ON THE ATTACHED FINANCIAL STATEMENTS BASED ON NET REALIZABLE AMOUNTS FROM THIRD PARTY PAYERS, PATIENTS AND OTHERS. BAD DEBT EXPENSE IS DETERMINED BASED ON THE CRITERIA DESCRIBED ABOVE. IT IS ESTIMATED THAT APPROXIMATELY 60% OF OUR BAD DEBT EXPENSE QUALIFIES UNDER THE ORGANIZATION'S CHARITY CARE POLICY. THIS PERCENTAGE WAS DETERMINED BASED UPON ANALYSIS OF DEMOGRAPHICS AND RECORD REVIEWS. PART III, LINE 4: SEE NOTE 10: NET PATIENT SERVICE REVENUE ON PAGES 20, 21 AND 22 OF THE AUDITED FINANCIAL STATEMENTS. ALSO, SEE NOTE 1: PATIENT ACCOUNTS RECEIVABLE ON PAGE 8 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE. LINE 6 COSTS WERE TAKEN DIRECTLY FROM THE ORGANIZATION'S 12/31/18 MEDICARE COST REPORT.THE SHORTFALL REPORTED IN PART III, LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT. BY PARTICIPATING IN MEDICARE AND ABSORBING RELATED SHORTFALLS, WE ARE PROVIDING HEALTHCARE SERVICES TO MEDICARE BENEFICIARIES WHO ARE A SIGNIFICANT PORTION OF OUR COMMUNITY. PART III, LINE 9B: COLLECTION PRACTICES. THE COLLECTION PRACTICES FOLLOWED BY THE ORGANIZATION FOR PATIENTS WHO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE ADDRESSED IN ITS HEALTHCARE ASSISTANCE POLICY. PART VI, LINE 2: NEEDS ASSESSMENT. THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES THROUGH STRATEGIC PLANNING ACTIVITIES THAT INCORPORATE ANALYSIS OF SERVICE AREA DEMOGRAPHICS AND STRUCTURED AND CONSISTENT PATIENT SURVEY PROCESSES. THE ORGANIZATION ALSO ASSESSES COMMUNITY HEALTH NEEDS THROUGH INPUT FROM ITS ACTIVE AND CONSULTING MEDICAL STAFF, COMMUNITY LEADERS, ORGANIZATION BOARD MEMBERS AND COUNTY HEALTH DEPARTMENTS. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE. THE ORGANIZATION INFORMS AND EDUCATES ITS PATIENTS REGARDING ASSISTANCE FROM FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS THROUGH ITS SOCIAL SERVICES DIRECTOR. THE ORGANIZATION INFORMS AND EDUCATES PATIENTS REGARDING ASSISTANCE FROM ITS CHARITY CARE POLICY THROUGH DISCUSSION AT REGISTRATION OR DISCHARGE, AN INFORMATIONAL DOCUMENT SENT WITH BILLING STATEMENTS AND A DESCRIPTION OF THE PROGRAM PLUS AN APPLICATION POSTED ON ITS WEBSITE. PART VI, LINE 4: COMMUNITY INFORMATION. THE ORGANIZATION SERVES A RURAL AREA THAT INCLUDES 13 SMALL COMMUNITIES. THE POPULATION OF THE SERVICE AREA TOTALS APPROXIMATELY 21,000 RESIDENTS. THE SIZE OF THE COMMUNITIES WE SERVE IN OUR SERVICE AREA RANGE FROM LESS THAN 150 TO APPROXIMATELY 5,800 RESIDENTS. OF THE 21,000 RESIDENTS, APPROXIMATELY 17% ARE BELOW THE FEDERAL POVERTY LEVEL AND THE PER CAPITA INCOME IS APPROXIMATELY $20,100. OUR SERVICE AREA POPULATION CONSISTS OF 27.69% MEDICAID AND APPROXIMATELY 8% UNINSURED. OUR ORGANIZATION PROVIDES SERVICES TO FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH IS ONE OF THE VERY IMPORTANT RESPONSIBILITIES OF A COMMUNITY HOSPITAL. THE HOSPITAL, AS AN ORGANIZATION, FILLS THE ROLE AS THE FOCAL POINT OF THE COMMUNITY'S HEALTHCARE ACTIVITIES AND THE CATALYST WHICH BRINGS TOGETHER THE PRACTICING PHYSICIANS, OTHER HEALTHCARE PROVIDERS, COMMUNITY HEALTHCARE AGENCIES, AND OTHER HEALTHCARE FOCUSED RESOURCES TO MAINTAIN AND PRESERVE THE COMMUNITY'S HEALTH STATUS. THE ORGANIZATION IS GOVERNED BY A VOLUNTEER BOARD OF DIRECTORS THAT CONSIST OF INDIVIDUALS WHO RESIDE IN THE HOSPITAL'S SERVICE AREA. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL PHYSICIANS IN OUR SERVICE AREA. SURPLUS FUNDS GENERATED THROUGH THE PROVISION OF SERVICES ARE INVESTED IN IMPROVED PATIENT CARE TECHNOLOGIES AND ENHANCED TREATMENT AREAS SO THAT THE ORGANIZATION CAN CONTINUE TO PROVIDE QUALITY PATIENT CARE. PART VI, LINE 6: NOT APPLICABLE X X X X X 0 0 0 0 0 0 0 1 0 DR TERRY CUNNINGTON DIRECTOR, PHYSICIAN 177835 0 238349 0 0 0 6514 0 5965 0 428663 0 0 0 KATRINA CASNER PRESIDENT & CEO 182189 0 18573 0 0 0 6921 0 5799 0 213482 0 0 0 DR SHABAZ MOHAMMAD BEGUM PHYSICIAN 228788 0 3500 0 0 0 4567 0 5965 0 242820 0 0 0 DR MARLON MUNESES PHYSICIAN 278510 0 1950 0 0 0 9250 0 5965 0 295675 0 0 0 DR CATHERINE TEODORO PHYSICIAN 169319 0 29559 0 0 0 6462 0 1928 0 207268 0 0 0 DR DEMOSTHENES ASUNCION PHYSICIAN 225657 0 500 0 0 0 0 0 10676 0 236833 0 0 0 DR STEVEN WEBER PT SURGEON 98000 0 85166 0 0 0 0 0 0 0 183166 0 0 0 ROBERT LUDWIG CRNA 198945 0 500 0 0 0 7978 0 9255 0 216678 0 0 0 PART I, LINE 7 MARLON MUNESES, TERRY CUNNINGTON AND CATHERINE TEODORO ARE COMPENSATED USING A BASE SALARY PLUS PRODUCTIVITY COMPENSATION. THE PRODUCTIVITY COMPENSATION IS CALCULATED BASED UPON MINIMUM LEVELS OF RECEIPTS GENERATED BY EACH PHYSICIAN. BONUSES ARE BASED ON COLLECTIONS. A CERTAIN PORTION OF COLLECTIONS ARE SHARED WITH THE PHYSICIANS AFTER REACHING A MINIMUM THRESHOLD. AFTER REACHING THE THRESHOLD, AN INCREASING % IS SHARED AS COLLECTIONS INCREASE. A THE COUNTY OF CHRISTIAN ILLINOIS 376000560 2018-02-22 7000000 EXPANSION AND RENOVATION PROJECT 0 0 0 A 7000000 2727168 4272832 2019 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 DR LAURIE CUNNINGTON WIFE OF DR. TERRY CUNNINGTON, A BOARD MEMBER 20400 EMPLOYED BY HOSPITAL 0 ANDREW CASNER SON OF KATRINA CASNER, PRESIDENT & CEO 41022 EMPLOYED BY HOSPITAL 0 X 3 74395 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS AND ONE OTHER MEMBER OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE INTERIM BETWEEN THE REGULAR MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED ANY ACTION TAKEN SHALL NOT CONFLICT WITH THE POLICIES AND EXPRESS WISHES OF THE BOARD OF DIRECTORS AND THAT IT SHALL REFER ALL MATTERS OF MAJOR IMPORTANCE TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 PANA COMMUNITY HOSPITAL HAS TWO CLASSES OF MEMBERS, KNOWN AS REGULAR MEMBERS AND LIFE MEMBERS. REGULAR MEMBERS CONSIST OF INDIVIDUALS WHO PAY THE APPROPRIATE MEMBERSHIP DUES TO PANA COMMUNITY HOSPITAL. LIFE MEMBERS CONSIST OF INDIVIDUALS WHO CONTRIBUTE $100.00 OR MORE TO PANA COMMUNITY HOSPITAL OR PANA COMMUNITY HOSPITAL FOUNDATION, FOR THE PURPOSE OF SUPPORTING THE FINANCING OF BUILDING, EQUIPMENT, LIFE MEMBERSHIP, ENDOWMENT, OR ANY OTHER LAWFUL PURPOSE. MEMBERS OF THE HOSPITAL THAT CONTRIBUTE $5.00 TO THE PANA COMMUNITY HOSPITAL FOUNDATION MAY VOTE FOR THE MEMBERS OF THE GOVERNING BODY DURING THE HOSPITAL'S ANNUAL MEETING. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OF THE HOSPITAL VOTE FOR THE MEMBERS OF THE GOVERNING BODY DURING THE HOSPITAL'S ANNUAL MEETING. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE CFO PRIOR TO THE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS, MEMBERS OF THE MEDICAL STAFF, ADMINISTRATION AND DEPARTMENT MANAGERS ARE ASKED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNIARE ANNUALLY. THE HUMAN RESOURCES MANAGER REVIEWS QUESTIONNAIRES AND PRESENTS ANY CONFLICTS NOTED TO THE PRESIDENT & CEO TO REVIEW AND RESOLVE. IF ANY CONFLICTS ARE NOTED, THE PRESIDENT & CEO, WITH BOARD APPROVAL, IMPOSES APPROPRIATE RESTRICTIONS ON THE INDIVIDUAL(S) WITH A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 EACH YEAR THE BOARD OF DIRECTORS DETERMINES COMPENSATION FOR THE CEO, CCO/CNE AND THE CFO. THE BOARD USES COMPARATIVE COMPENSATION INFORMATION FROM THE ILLINOIS HOSPITAL ASSOCIATION TO DETERMINE THE ABOVE INDIVIDUALS' COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 REQUESTS FOR THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY WILL BE EVALUATED ON A CASE-BY-CASE BASIS. IF DEEMED APPROPRIATE, THE DOCUMENT(S) WILL BE PROVIDED TO THE PUBLIC. THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS ARE AVAILABLE FOR THE PUBLIC TO REVIEW DURING THE ORGANIZATION'S ANNUAL MEETING. FORM 990, PART IX, LINE 11G IMAGING: PROGRAM SERVICE EXPENSES 525,839. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 525,839. EMERGENCY DEPARTMENT: PROGRAM SERVICE EXPENSES 1,707,464. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,707,464. LAB: PROGRAM SERVICE EXPENSES 120,189. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 120,189. OTHER: PROGRAM SERVICE EXPENSES 278,655. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 278,655. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 397,367. MANAGEMENT AND GENERAL EXPENSES 359,138. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 756,505. FORM 990, PART XI, LINE 9: INVESTMENT INCOME FROM SUBSIDIARY -8,420. FORM 990, PART XII, LINE 2C: NO CHANGE IN PROCESS FROM PRIOR YEARS PANA COMMUNITY HOSPITAL FOUNDATION 101 EAST 9TH STREET PANA IL 62557 371293506 FUNDRAISING IL 501(C)(3) LINE 12A, I PANA COMMUNITY HOSPITAL ASSOCIATION 1 QUAD COUNTY HOME MEDICAL SUPPLIES & EQUIPMENT 1 HUBER STREET PANA IL 62557 371198049 EQUIPMENT RETAILER IL PANA COMMUNITY HOSPITAL C 53877 294812 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 1 PANA COMMUNITY HOSPITAL FOUNDATION S 424306