2018-08-22T10:50:12-05:00 2017-12-31 BKD LLP 211 N BROADWAY SUITE 600 ST LOUIS MO 631022733 990 2017-01-01 370624255 Community Memorial Hospital Association % BRIAN ENGELKE COMM 6186354242 400 Caldwell Street Staunton IL 62088 BRIAN ENGELKE CFO 6186354242 2018-08-22 true Donna J Larson P00043751 3142315544 2018-07-25 2017 2022-09-23 18:48:47Z Community Hospital of Staunton SUE E CAMPBELL 400 N CALDWELL STAUNTON IL 62088 18128084 false X WWW.STAUNTONHOSPITAL.ORG X 1946 IL COMMUNITY HOSPITAL OF STAUNTON PROVIDES COMPASSIONATE PATIENT-CENTERED HEALTH CARE SERVICES, WHILE MAINTAINING CLINICAL EXCELLENCE AND FINANCIAL VIABILITY. 9 9 177 20 0 0 7805 452155 9619017 17442369 21084 53195 64545 176224 9712451 18123943 3100 5360 0 0 3627108 7384253 0 0 0 6386460 11102549 10016668 18492162 -304217 -368219 25436972 24887091 13110293 12928428 12326679 11958663 COMMUNITY HOSPITAL OF STAUNTON PROVIDES COMPASSIONATE PATIENT-CENTERED HEALTH CARE SERVICES, WHILE MAINTAINING CLINICAL EXCELLENCE AND FINANCIAL VIABILITY. false false 15576625 3360 17463359 THE ORGANIZATION OPERATES A FULL SERVICE CRITICAL ACCESS HOSPITAL IN STAUNTON, ILLINOIS WITH A TOTAL OF 25 BEDS. TOTAL PATIENT DAYS FOR THE PERIOD ENDING DECEMBER 31, 2017 WAS 720 ACUTE DAYS AND 639 SWING BED DAYS. THE HOSPITAL ALSO PROVIDED SERVICES TO 23,408 OUTPATIENTS, 5,574 EMERGENCY DEPARTMENT VISITS, AND 6,629 PHYSICIAN OFFICE VISITS. 15576625 true true false false false false false false false false true false false false false false false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true true true false false true 31 0 true 177 true false false false false false false false false false false X 9 9 true false false false true true true true true false false true true true true true true false false false IL X BRIAN ENGELKE 6186354242 400 CALDWELL STAUNTON IL 62088 X DON KASUBKE PRESIDENT 5.0 0.01 X X 0 0 0 EDDY SARACCO VICE PRESIDENT 2.0 0.0 X X 0 0 0 HULDA BLACK TREASURER 2.0 0.0 X X 0 0 0 BERNICE HENKE SECRETARY 2.0 0.01 X X 0 0 0 JEROME LESICKO TRUSTEE 2.0 0.0 X 0 0 0 MIKE COX TRUSTEE 2.0 0.0 X 0 0 0 CLIFF HOMEIER TRUSTEE 2.0 2.0 X 0 0 0 TIM WILLIAMSON TRUSTEE 2.0 0.0 X 0 0 0 BRIAN URY TRUSTEE 2.0 0.0 X 0 0 0 SUE CAMPBELL CEO 40.0 2.0 X 182542 0 7571 BRIAN ENGELKE CFO 40.0 0.0 X 127812 0 11560 JOSHUA POOS PHYSICIAN 40.0 0.0 X 202248 0 14152 SCOTT KATICH PHARMACIST 40.0 0.0 X 141555 0 18399 654157 0 51682 4 false true false ILLINOIS EMERGENCY PHYSICIAN PO BOX 674579 DETROIT MI 482674579 EMERGENCY PHYSICIANS 1557487 SCHWEGEL PHYSICAL THERAPY 1719 CLAWSON ALTON IL 62002 PHYSICAL THERAPY 651280 PRECISE SPECIALTIES PO BOX 572 HILLSBORO IL 62049 ULTRASOUND 158412 SHARED MEDICAL SERVICE 209 LIMESTONE PASS COTTAGE GROVE IL 53527 MRI 153075 CPSI PO BOX 850309 MOBILE AL 366850309 COMPUTER SUPPORT 205432 9 114145 338010 452155 NET PATIENT SERVICE REVENUE 621110 17442369 17442369 17442369 57336 57336 0 0 44144 44144 0 44144 44144 0 4141 -4141 -4141 -4141 0 0 0 0 0 0 0 0 0 CAFETERIA 721000 32910 32910 ANCILLARY SERVICES 900099 14303 14303 MEDICAL RECORDS 900099 6687 6687 78180 78180 132080 18123943 17463359 208429 X 3360 3360 2000 2000 0 0 329485 329485 0 5783223 4834774 948449 85230 71252 13978 736734 615910 120824 449581 375850 73731 116680 116680 126850 126850 11648 11648 0 0 0 3642801 3045382 597419 23503 19649 3854 2194965 2160557 34408 217314 181675 35639 0 374431 313024 61407 3035 2537 498 0 0 389340 389340 0 1364607 1140811 223796 419723 350888 68835 PROVISION FOR BAD DEBTS 1049781 1049781 0 0 EQUIPMENT RENTAL 640110 535132 104978 0 HOSPITAL PROVIDER ASSESSMENT 265214 265214 0 0 DUES & SUBSCRIPTIONS 178628 149333 29295 0 83919 70156 13763 18492162 15576625 2915537 0 633595 2369482 30987 211435 0 0 4693758 3450398 0 0 0 0 0 0 303261 342931 353538 208297 24208987 9778231 15634500 14430756 3787333 3873792 0 0 0 0 0 0 0 0 25436972 24887091 1865211 2110275 0 0 0 0 2967475 2721613 0 0 0 0 8277607 8096540 0 0 0 0 13110293 12928428 X 12326679 11641738 0 316925 0 0 12326679 11958663 25436972 24887091 X -368219 203 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 546486 546486 8501752 3037632 5464120 12849374 6209600 6639774 2311375 530999 1780376 14430756 SCHEDULE D, PART X, LINE 2 FIN 48 DISCLOSURE: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true true X true X 125. true X true true true false false 157384 157384 0.00900 3570599 2768443 802156 0.04600 3727983 2768443 959540 0.05500 8990 8990 0.00050 7861 7861 0.00050 3360 3360 0.00020 20211 20211 0.00120 3748194 2768443 979751 0.05620 true 1049781 8354322 8309873 44449 X true false 1 1 COMMUNITY MEMORIAL HOSPITAL 400 CALDWELL STAUNTON IL 62088 STAUNTONHOSPITAL.ORG 414 X X X X COMMUNITY MEMORIAL HOSPITAL 1 false true true X X X X X X X X X 15 true false false true X SEE PART V, SECTION C X true 15 true SEE PART V, SECTION C false true X 125. 300. true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY: THE HOSPITAL HAD TWO FOCUS GROUPS. THE FIRST FOCUS GROUP WAS HEALTH CARE PROFESSIONALS WHICH INCLUDED REPRESENTATIVES OF MACOUPIN COUNTY HEALTH DEPARTMENT, VNA-TIP (HOME HEALTH), STAUNTON AREA AMBULANCE, GLENWOOD SUPPORTIVE LIVING, HERITAGE MANOR (NURSING HOME), A LOCAL PHARMACIST AND HOSPITAL DEPARTMENT MANAGERS. THE SECOND FOCUS GROUP INCLUDED COMMUNITY LEADERS AND REPRESENTATIVES FROM THE LOCAL SCHOOL, THE TOWNSHIP SUPERVISOR, A COMMUNITY BASED AMBULANCE SERVICE, LEWIS AND CLARK COMMUNITY COLLEGE NURSING PROGRAM AND A LOCAL PHYSICIAN. A TOWN HALL MEETING WAS ALSO HELD FOR MEMBERS OF THE COMMUNITY. SCHEDULE H, PART V, SECTION B, LINE 7A HOSPITAL FACILITY WEBSITE (URL): http://stauntonhospital.org/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SCHEDULE H, PART V, SECTION B, LINE 11 SIGNIFICANT NEEDS: DURING THE LAST FISCAL YEAR COMMUNITY MEMORIAL HOSPITAL HAS CONTINUED TO PROVIDE SUPPORT EFFORTS TO IMPROVE THE HEALTH AND WELLNESS OF OUR COMMUNITY. SPECIFICALLY, WE HAVE SPONSORED THE STARTUP OF THE ALPHA DOG RUNNING CLUB. THIS CLUB HELPS PROMOTE RUNNING AS A PART OF A HEALTHY LIFESTYLE. WE HAVE ALSO SUPPORTED THE KIDS CAFE A LOCAL ORGANIZATION THAT PROVIDES NUTRITIOUS LUNCHES FOR LOW INCOME STUDENTS DURING THE SUMMER MONTHS WHEN SCHOOL IS NOT IN SESSION. WE HAVE ALSO CONTINUED TO OPERATE OUR SENIOR LIFE PROGRAM WHICH PROVIDES OUTPATIENT PSYCHIATRIC SERVICES TO THE ELDERLY IN OUR COMMUNITY. WE ALSO CONTINUE TO SUPPORT A WEEKLY ONCOLOGY CLINIC AND PROVIDE CHEMOTHERAPY SERVICES TO HELP THOSE IN OUR COMMUNITY WHO ARE BATTLING CANCER. MENTAL HEALTH - CONTINUE TO OPERATE AN OUTPATIENT GERIATRIC BEHAVIORAL HEALTH PROGRAM, HAVE GRIEF CONSOLING MEETINGS, CONTINUED TRAINING ON DRUG AWARENESS. SCHEDULE H, PART V, SECTION B, LINE 10A HOSPITAL FACILITY IMPLEMENTATION STRATEGY (URL): http://stauntonhospital.org/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SCHEDULE H, PART V, SECTION B, LINES 16A, 16B & 16C FAP, FAP APPLICATION, AND FAP PLAIN LANGUAGE SUMMARY AVAILABILITY: http://stauntonhospital.org/patients-visitors/financial-assistance SCHEDULE H, PART V, SECTION B, LINE 2 HOSPITAL FACILITY ACQUIRED OR PLACED INTO SERVICE AS A TAX-EXEMPT HOSPITAL IN THE CURRENT TAX YEAR: ON 7/1/16, COMMUNITY MEMORIAL HOSPITAL OF STAUNTON FORMED AN AFFILIATION WITH ANDERSON HOSPITAL. AS A RESULT OF THIS AFFILIATION, ANDERSON HOSPITAL BECAME THE SOLE CORPORATE MEMBER AS OF 7/1/16. 2 STAUNTON MEDICAL CLINIC 325 CALDWELL STAUNTON IL 62088 CLINIC BENLD CLINIC 311 EAST CENTRAL BENLD IL 62009 CLINIC SCHEDULE H, PART III, SECTION A, LINE 2 METHODOLOGY USED TO ESTIMATE BAD DEBT EXPENSE: THE BAD DEBT EXPENSE AS REPORTED ON THE FINANCIAL STATEMENT HAS BEEN REPORTED ON LINE 2, THEREFORE, THE COSTING METHODOLOGY FOR THIS LINE IS BASED ON THE PATIENT CHARGES THAT WERE WRITTEN OFF ON THE BOOKS. NO BAD DEBT AMOUNTS WERE INCLUDED IN COMMUNITY BENEFIT. SCHEDULE H, PART III, SECTION A, LINE 3 METHODOLOGY USED TO ESTIMATE BAD DEBT EXPENSE FOR FAP ELIGIBLE PATIENTS: THE HOSPITAL BELIEVES THAT THE COMMUNITY BENEFIT OBTAINED FROM ITS CHARITY CARE IS UNDERSTATED DUE TO PATIENTS THAT COULD QUALIFY FOR CHARITY CARE BUT DO NOT APPLY OR PROVIDE INCOMPLETE INFORMATION. SOME CARE PROVIDED TO PATIENTS IS NOT CLASSIFIED AS CHARITY CARE DUE TO PATIENTS MISSING DOCUMENTATION THAT PROVES THEY QUALIFY FOR CHARITY CARE. THE HOSPITAL'S BAD DEBT DOES INCLUDE AMOUNTS THAT COULD BE CLASSIFIED AS CHARITY CARE IF THE PATIENTS WOULD APPLY OR PROVIDE THE APPROPRIATE INFORMATION TO COMPLETE THE CHARITY CARE APPLICATION. IN LINE WITH ITS MISSION, THE HOSPITAL PROVIDES A SAFETY NET FOR THE COMMUNITIES SERVED TO ACCESS MUCH NEEDED CARE BY OFFERING SOME SERVICES TO PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY FOR THOSE SERVICES. FOR SOME OF THEIR PATIENT SERVICES, THE HOSPITAL RECEIVES NO PAYMENT OR PAYMENT THAT IS LESS THAN THE FULL COST OF PROVIDING THE SERVICES. THE HOSPITAL VOLUNTARILY PROVIDES FREE CARE TO PATIENTS WHO ARE UNABLE TO PAY FOR ALL OR PART OF THEIR HEALTH CARE EXPENSES AS DETERMINED BY THE HOSPITAL'S CRITERIA FOR FINANCIAL ASSISTANCE. IN SOME CASES, THE HOSPITAL DOES NOT RECEIVE THE AMOUNT BILLED FOR PATIENT SERVICES EVEN THOUGH IT DID NOT RECEIVE INFORMATION NECESSARY TO DETERMINE IF THE PATIENTS MET THE CRITERIA FOR FINANCIAL ASSISTANCE. BAD DEBT EXPENSE IS THE ESTIMATED AMOUNT OF PATIENT REVENUE THAT THE HOSPITAL WILL NOT COLLECT. SCHEDULE H, PART III, SECTION A, LINE 4 FINANCIAL STATEMENT BAD DEBT EXPENSE: FINANCIAL STATEMENT FOOTNOTE: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY 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 PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SCHEDULE H, PART III, SECTION B, LINE 8 SHORTFALL TREATED AS A COMMUNITY BENEFIT: THE COSTING METHODOLOGY USED TO DETERMINE MEDICARE ALLOWABLE COSTS WAS ALLOWABLE COST AS REPORTED IN OUR FISCAL YEAR 2017 MEDICARE COST REPORT. ANY SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT SINCE IT REPRESENTS THE UNREIMBURSED COSTS OF CARING FOR THE ELDERLY IN OUR COMMUNITY. SCHEDULE H, PART III, SECTION C, LINE 9B DEBT COLLECTION POLICY: THERE IS NO COLLECTION PRACTICE ON PATIENTS WHO QUALIFY FOR CHARITY. ANY PATIENT WHO SUBMITS AN APPLICATION FOR CHARITY AND MEETS THE GUIDELINES SET IN OUR CHARITY POLICY HAS THEIR ACCOUNT WRITTEN OFF WITH NO COLLECTION EFFORT. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: THE HOSPITAL'S BOARD IS MADE UP OF INDIVIDUALS WHO LIVE WITHIN THE HOSPITAL'S SERVICE AREA. THESE INDIVIDUALS ALONG WITH SUPPORT FROM THE HOSPITAL'S MANAGEMENT AND MEDICAL STAFF ARE CONTINUALLY REVIEWING HOW THE HOSPITAL CAN BE AN ASSET WITHIN OUR SERVICE AREA. THE HOSPITAL HAS ALSO CONDUCTED A COMMUNITY PERCEPTION SURVEY TO HELP IDENTIFY AREAS TO IMPROVE PATIENT CARE OR THE NEED FOR ADDITIONAL SERVICES. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: INFORMATION REGARDING THE FINANCIAL ASSISTANCE PROGRAMS THAT THE HOSPITAL OFFERS IS LISTED ON THE HOSPITAL WEBSITE, AND IT IS PRINTED ON THE BOTTOM OF THE STATEMENTS THAT ARE MAILED TO THE PATIENTS. THE INFORMATION IS ALSO POSTED NEAR THE CASHIER'S WINDOW AND THE BUSINESS OFFICE STAFF ARE TRAINED TO PROVIDE THE INFORMATION TO PATIENTS THAT CALL INTO THE OFFICE AND DO NOT HAVE KNOWLEDGE OF THE PROGRAMS. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: THE COMMUNITY THAT THE ORGANIZATION SERVES CONSISTS OF ABOUT A TWELVE MILE RADIUS SURROUNDING STAUNTON AND THE COMMUNITIES WITHIN THAT RADIUS ARE: WORDEN, HAMEL, ALHAMBRA, LIVINGSTON, NEW DOUGLAS, MT. OLIVE, BENLD, GILLESPIE, BUNKER HILL, AND PRAIRIETOWN. THIS IS A RURAL AREA WITH A DEPRESSED ECONOMIC CLIMATE. MANY OF THE INDIVIDUALS ARE ELDERLY, POOR, AND INDIGENT WHICH RESULTS IN HIGHER NUMBERS OF MEDICARE AND MEDICAID RECIPIENTS. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: THE HOSPITAL RESTOCKS THE AMBULANCES OF ANY SUPPLIES USED DURING THE TRANSPORT OF PATIENTS AT NO COST TO THE AMBULANCE SERVICE. THE HOSPITAL ALSO COMMITS SIGNIFICANT TIME AND RESOURCES TO ACTIVITIES AND SERVICES THAT MEET UNMET COMMUNITY NEEDS. MANY OF THESE ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE SELF-SUPPORTING OR FINANCIALLY VIABLE. SUCH PROGRAMS INCLUDE HEALTH SCREENINGS AND ASSESSMENTS, PARENTAL EDUCATION AND CARE, CPR TRAINING, BABY SITTER TRAINING, FIRST AID TRAINING, SUPPORT FOR VITAL COMMUNITY SERVICES, TRAUMA CARE, COMMUNITY EDUCATIONAL SERVICES, AND VARIOUS SUPPORT GROUPS. THE HOSPITAL PARTICIPATES IN EVENTS AND HEALTH FAIRS IN EACH OF THE COMMUNITIES WITHIN THE SERVICE AREA, AND IT DONATES STAFF LABOR, SUPPLIES, AND OTHER GOODS. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: ON 7/1/16 COMMUNITY MEMORIAL HOSPITAL AFFILIATED WITH ANDERSON HOSPITAL SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: NOT APPLICABLE SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $1,409,781 REPORTED ON PART IX, LINE 24A. HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. SCHEDULE H, 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. X X false false false false false false false false false SUE CAMPBELL CEO 182542 0 0 0 0 0 2634 0 4937 0 190113 0 JOSHUA POOS PHYSICIAN 202248 0 0 0 0 0 0 0 14152 0 216400 0 SCOTT KATICH PHARMACIST 141555 0 0 0 0 0 4247 0 14152 0 159954 0 A ILLINOIS FINANCE AUTHORITY 861091967 2010-06-25 780000 5500 SQ FT. MEDICAL OFFICE BUILDIN false false false B CITY OF STAUNTON 376001380 2014-07-10 3000000 HOSPITAL RENOVATION false false false A 503498 0 780000 0 0 0 0 0 0 780000 0 0 2010 false false true true B 554889 0 3000000 0 0 0 60000 0 0 2892066 0 47934 2016 false false true true A false false false false 0 false false false true B false false false false 0 false false false true A false false true false false false 0 false 0 false true B false false true false false false 0 false 0 false true A true B true FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIPS: BRIAN URY AND EDDY SARACCO HAVE A BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 MEMBERS: THE ORGANIZATION HAS A SOLE CORPORATE MEMBER, SOUTHWESTERN ILLINOIS HEALTH FACILITIES, INC., D/B/A ANDERSON HOSPITAL (EIN 37-0662561). FORM 990, PART VI, SECTION A, LINE 7A POWER OF APPOINTMENT: BOARD MEMBERS MUST BE APPROVED BY ANDERSON HOSPITAL FORM 990, PART VI, SECTION A, LINE 7B GOVERNANCE DECISIONS: ANDERSON HOSPITAL APPROVES BOARD MEMBERS AND ANNUAL BUDGETS. DECISIONS THAT REQUIRE APPROVAL INCLUDE REVISIONS TO THE MISSION; AMENDMENTS OF THE ORGANIZING DOCUMENTS; APPOINTMENT AND REMOVAL OF MEMBERS OF THE BOARD OF TRUSTEES AND THE PRESIDENT OF THE ORGANIZATION; APPROVAL OF STRATEGIC PLANS, BUDGETS, SALE OR LEASE OF ASSETS IN EXCESS OF $100,000, OR INCURRENCE OF DEBT; APPROVAL OF MERGERS OR AFFILIATIONS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS: THE CFO REVIEWS THE FORM 990, WHICH IS THEN REVIEWED BY THE CEO, FOLLOWED BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE WITH CONFLICT OF INTEREST POLICY: THE CONFLICT OF INTEREST POLICY AND A DISCLOSURE STATEMENT ARE PRESENTED TO OFFICERS, DIRECTORS OR TRUSTEES AND KEY EMPLOYEES ANNUALLY. THE DISCLOSURE STATEMENT MUST BE RETURNED AND IS REVIEWED BY FINANCIAL AUDITORS AND HOSPITAL ADMINISTRATION. FORM 990, PART VI, SECTION B, LINE 15A and 15B PROCESS FOR DETERMINING COMPENSATION: COMMUNITY HOSPITAL OF STAUNTON'S CEO IS EVALUATED BY THE CEO OF ANDERSON HOSPITAL. THE RESULTS OF THIS EVALUATION ARE USED TO DETERMINE ANY RATE INCREASE IN THE SAME MANNER AS ALL OTHER EMPLOYEES OF COMMUNITY HOSPITAL OF STAUNTON. COMMUNITY HOSPITAL OF STAUNTON'S CFO IS EVALUATED BY THE CEO OF COMMUNITY HOSPITAL OF STAUNTON. THE RESULTS OF THIS EVALUATION ARE USED TO DETERMINE ANY RATE INCREASE IN THE SAME MANNER AS ALL OTHER EMPLOYEES OF COMMUNITY HOSPITAL OF STAUNTON. FORM 990, PART VI, SECTION C, LINE 19 PROCESS FOR MAKING GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC: COMMUNITY MEMORIAL HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9 OTHER CHANGES IN FUND BALANCES: OTHER ADJUSTMENT 203 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN PROFESSIONAL FEES TOTAL FEES:1696726 FORM 990 PART IX LINE 11G DESCRIPTION:NONPHYSICIAN PROFESSIONAL FEES TOTAL FEES:107628 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:740398 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PROFESSIONAL SERVICES TOTAL FEES:139070 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR TOTAL FEES:958979 SOUTHWESTERN ILLINOIS HEALTH FACILITIES ILLINOIS ROUTE 162 MARYVILLE IL 62062 370662561 HEALTHCARE IL 501(C)(3) 3 NA false ANDERSON HOSPITAL FOUNDATION 6800 STATE ROUTE 162 MARYVILLE IL 62062 274548522 SUPPORT ORG IL 501(C)(3) 7 SW IL HEALTH false FRIENDS OF COMMUNITY MEMORIAL HOSPITAL 400 N CALDWELL STAUNTON IL 62088 363913722 FUNDRAISING IL 501(C)(3) 10 COM MEM HOSP true false false true false true false false false false false false false false false true true false false false FRIENDS OF COMMUNITY HOSPITAL OF STAUNTON C 114145 ACTUAL COSTS