FERRELL HOSPITAL COMMUNITY FOUNDATION: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- FERRELL HOSPITAL COMMUNITY FOUNDATION (EIN 20-1244058)
- Tax period
- 2016-04-01 to 2017-03-31
- Filed
- 2018-02-13
- IRS object ID
- 201820449349301377
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-02-13T14:29:09-06:00 | ReturnTs |
| Tax Period End | 2017-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 WASHINGTON AVENUE SUITE 1800 | AddressLine1Txt |
| City | ST LOUIS | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201244058 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FERRELL HOSPITAL COMMUNITY FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FERR | BusinessNameControlTxt |
| Phone | 6182733361 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 PINE STREET | AddressLine1Txt |
| City | ELDORADO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62930 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOSEPH HOHENBERGER | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 6182733361 | PhoneNum |
| Signature | 2018-02-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JEFF PARKER | PreparerPersonNm |
| PTIN | P00970069 | PTIN |
| Phone | 3149254300 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.137.57.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-02-12 | IPDt |
| IP Tm | 09:43:17 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 121501B7AC3CACF2E9E4A9E5B63715338B18D0F0 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 91CEC10FCE41CD9386A3334136B5DACB34123101 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ALISA COLEMAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 PINE STREET | AddressLine1Txt |
| City | ELDORADO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62930 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $20,930,885 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FERRELLHOSP.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2004 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | OPERATE ACUTE CARE HOSPITAL - DEDICATED TO IMPROVING THE HEALTH AND QUALITY OF LIFE FOR THE PEOPLE AND COMMUNITIES WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 239 | TotalEmployeeCnt |
| Total Volunteers | 20 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $542,094 | PYContributionsGrantsAmt |
| CY Contributions Grants | $51,852 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,274,123 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $20,809,772 | CYProgramServiceRevenueAmt |
| PY Investment Income | $7,830 | PYInvestmentIncomeAmt |
| CY Investment Income | $11,414 | CYInvestmentIncomeAmt |
| PY Other Revenue | $139,567 | PYOtherRevenueAmt |
| CY Other Revenue | $57,734 | CYOtherRevenueAmt |
| PY Total Revenue | $18,963,614 | PYTotalRevenueAmt |
| CY Total Revenue | $20,930,772 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,040,809 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,505,460 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,470,315 | PYOtherExpensesAmt |
| CY Other Expenses | $9,319,005 | CYOtherExpensesAmt |
| PY Total Expenses | $17,511,124 | PYTotalExpensesAmt |
| CY Total Expenses | $19,824,465 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,452,490 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,106,307 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,149,677 | TotalAssetsBOYAmt |
| Total Assets EOY | $10,285,037 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,748,607 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,777,660 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,401,070 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,507,377 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | OPERATE ACUTE CARE HOSPITAL - DEDICATED TO IMPROVING THE HEALTH AND QUALITY OF LIFE FOR THE PEOPLE AND COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $19,508,813 | ExpenseAmt |
| Revenue | $20,809,772 | RevenueAmt |
| Desc | MEDICAL CARE IS PROVIDED TO OUTPATIENTS AND INPATIENTS FOR SURGERY AND OTHER DIAGNOSTIC SERVICES AND EDUCATION. QUALITY HEALTHCARE IS PROVIDED REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. FERRELL HOSPITAL COMMUNITY FOUNDATION OFFERS VARIOUS BENEFITS TO THE COMMUNITY INCLUDING BUT NOT LIMITED TO CPR/FIRST AID, PARTICIPATION IN THE SALINE COUNTY HEALTHY COALITION, PARTICIPATION IN HEALTH FAIRS AT LOCAL HIGH SCHOOLS AND COLLEGES, POISON PREVENTION AND HEALTH CARE CAREER PRESENTATIONS TO LOCAL SCHOOLS, PROVIDE TOURS OF THE HOSPITAL, HOLD FLU VACCINATION CLINICS, PERIODIC BLOOD PRESSURE AND GLUCOSE SCREENINGS, SPEAKING ENGAGEMENTS FOR COMMUNITY ORGANIZATIONS, CO-SPONSOR THE KIDNEY MOBILE, SPONSOR THE LOCAL HIGH SCHOOL PROM, PARTICIPATE IN THE RELAY FOR LIFE, SPONSOR FUNCTIONS AT THE LOCAL SENIOR CITIZENS CENTER, HOLD WELLNESS WORKSHOPS, PROVIDE A TRAINER FOR THE LOCAL HIGH SCHOOL SPORTS TEAMS, PROVIDE FIRST AID KITS FOR LOCAL SPORTS TEAMS, PROVIDE CLOTHING FOR DOMESTIC ABUSE VICTIMS AND PARTICIPATE IN THE SAFE HAVEN PROGRAM. | Desc |
| Total Program Service Expenses | $19,508,813 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 18 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 239 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOSEPH HOHENBERGER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6182733361 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 PINE STREET | AddressLine1Txt |
| City | ELDORADO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62930 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| CLIFFORD EUGENE MORRIS | |||||||
| CHAIRMAN | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| E T SEELY | |||||||
| VICE-CHAIRMAN | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ALBERT BLEDIG MD | |||||||
| BOARD MEMBER / PHYSICIAN | 40.00 | Yes (X) | $176,891 | $0 | $0 | ||
| BILL JONES | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| NATE OLDHAM MD | |||||||
| BOARD MEMBER / PHYSICIAN | 60.00 | Yes (X) | $383,988 | $0 | $19,987 | ||
| JASON KASIAR | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| BARB DEVOUS | |||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| NIKKI ROSER | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| SHAWN MCCOY | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| JAMES PORTER MD | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| ALISA COLEMAN | |||||||
| CEO | 50.00 | Yes (X) | $0 | $0 | $0 | ||
| JOSEPH HOHENBERGER | |||||||
| CFO | 50.00 | Yes (X) | $0 | $0 | $0 | ||
| ELLIOTT PARTRIDGE MD | |||||||
| PHYSICIAN | 40.00 | $317,574 | $0 | $0 | Yes (X) | ||
| DALLAS C BASINGER | |||||||
| PHARMACIST | 40.00 | $126,799 | $0 | $7,602 | Yes (X) | ||
| JOSEPH A JACKSON MD | |||||||
| PHYSICIAN | 50.00 | $245,505 | $0 | $16,432 | Yes (X) | ||
| SAMIR ABDO MD | |||||||
| PHYSICIAN | 40.00 | $225,576 | $0 | $0 | Yes (X) | ||
| JANNA PATHI MD | |||||||
| PHYSICIAN | 40.00 | $181,428 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,657,761 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $44,021 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| DEACONESS REGIONAL EMERGENCY DEPT STAFFI | |||||
| 600 MARY ST | EVANSVILLE | IN | 47747 | ER PHYSICIANS, MANAGEMENT FEES | $1,289,051 |
| PROGRESSIVE HEALTH OF INDIANA LLC | |||||
| PO BOX 6890 | EVANSVILLE | IN | 47719 | PHYSICAL AND OCCUPATIONAL THERAPIST | $475,536 |
| MEDHOST OF TENNESSEE INC | |||||
| 6550 CAROTHERS PARKWAY | FRANKLIN | TN | 37067 | DATA PROCESSING | $244,971 |
| RANDY WIENTJES CRBA MA | |||||
| 3042 LAKEVIEW DR | METROPOLIS | IL | 62960 | ANESTHESIOLOGY | $238,411 |
| DIAGNOSTIC SHARED SERVICES INC | |||||
| 2650 EASTPOINT PARKWAY | LOUISVILLE | KY | 40223 | MRI SERVICES | $192,372 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $14,004 | GovernmentGrantsAmt |
| All Other Contributions | $37,848 | AllOtherContributionsAmt |
| Total Contributions | $51,852 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| INPATIENT & OUTPATIENT SVC | 624110 | $19,614,200 | $19,614,200 |
| 340B REVENUE | 624110 | $776,165 | $776,165 |
| EMR/EHR REVENUE | 624110 | $352,135 | $352,135 |
| IL STATE INCENTIVE PAYMENTS | 624110 | $67,272 | $67,272 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $20,809,772 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,414 | TotalRevenueColumnAmt |
| Exclusion | $11,414 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $10,785 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $113 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $10,672 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,672 | TotalRevenueColumnAmt |
| Exclusion | $10,672 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| EMPLOYEE CAFETERIA | 624110 | $31,684 | $31,684 |
| OTHER | 624110 | $8,973 | $8,973 |
| REBATES | 624110 | $6,405 | $6,405 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $47,062 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,930,772 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $20,809,772 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $69,148 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $952,784 | TotalAmt |
| Program Services | $925,334 | ProgramServicesAmt |
| Management And General | $27,450 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,831,375 | TotalAmt |
| Program Services | $7,828,088 | ProgramServicesAmt |
| Management And General | $3,287 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,497 | TotalAmt |
| Program Services | $75,233 | ProgramServicesAmt |
| Management And General | $264 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,067,096 | TotalAmt |
| Program Services | $1,063,362 | ProgramServicesAmt |
| Management And General | $3,734 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $578,708 | TotalAmt |
| Program Services | $576,683 | ProgramServicesAmt |
| Management And General | $2,025 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,000 | TotalAmt |
| Program Services | $120,000 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,185,385 | TotalAmt |
| Program Services | $3,906,493 | ProgramServicesAmt |
| Management And General | $278,892 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,810 | TotalAmt |
| Program Services | $32,810 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,167,288 | TotalAmt |
| Program Services | $1,167,288 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $271,745 | TotalAmt |
| Program Services | $271,745 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,672 | TotalAmt |
| Program Services | $93,672 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $193,646 | TotalAmt |
| Program Services | $193,646 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $593,901 | TotalAmt |
| Program Services | $593,901 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $198,739 | TotalAmt |
| Program Services | $198,739 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| BAD DEBTS | $1,132,845 | $1,132,845 |
| DRUGS | $674,055 | $674,055 |
| MISC/PROVIDER TAX | $490,875 | $490,875 |
| FOOD | $90,952 | $90,952 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,092 | TotalAmt |
| Program Services | $73,092 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,824,465 | TotalAmt |
| Program Services | $19,508,813 | ProgramServicesAmt |
| Management And General | $315,652 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,349 | BOYAmt |
| EOY | $6,034 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,462,433 | BOYAmt |
| EOY | $970,783 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,935,132 | BOYAmt |
| EOY | $4,517,783 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $236,525 | BOYAmt |
| EOY | $217,999 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $228,639 | BOYAmt |
| EOY | $220,481 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $9,534,696 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,182,739 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,228,599 | BOYAmt |
| EOY | $4,351,957 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,149,677 | BOYAmt |
| EOY | $10,285,037 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,721,809 | BOYAmt |
| EOY | $2,143,264 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,026,798 | BOYAmt |
| EOY | $4,634,396 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,748,607 | BOYAmt |
| EOY | $6,777,660 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,401,070 | BOYAmt |
| EOY | $3,507,377 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,401,070 | BOYAmt |
| EOY | $3,507,377 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,149,677 | BOYAmt |
| EOY | $10,285,037 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,106,307 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $5,921 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $5,921 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | ORGANIZATION PAYS DUES TO IHA ANNUALLY. 31% OF THESE DUES ARE USED FOR LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $183,412 | OtherCostOrOtherBasisAmt |
| Book Value | $183,412 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,289,503 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,341,627 | DepreciationAmt |
| Book Value | $1,947,876 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $43,892 | OtherCostOrOtherBasisAmt |
| Depreciation | $40,462 | DepreciationAmt |
| Book Value | $3,430 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,655,902 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,800,650 | DepreciationAmt |
| Book Value | $855,252 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,361,987 | OtherCostOrOtherBasisAmt |
| Book Value | $1,361,987 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,351,957 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $19,797,927 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $19,797,927 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,132,845 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,132,845 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $20,930,772 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $18,691,620 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $18,691,620 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,132,845 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,132,845 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $19,824,465 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE HOSPITAL'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE HOSPITAL IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS AND IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBTS RECLASSED 1,132,845. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBTS RECLASSED 1,132,845. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 100.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $209,253 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $209,253 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01120 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,033,921 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,736,615 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,297,306 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06940 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,243,174 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,736,615 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,506,559 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08060 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,243,174 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,736,615 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,506,559 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08060 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,132,845 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $454,786 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,952,025 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,730,741 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,778,716 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FERRELL HOSPITAL COMMUNITY FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 PINE STREET | AddressLine1Txt |
| City | ELDORADO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62930 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | FERRELLHOSP.ORG | WebsiteAddressTxt |
| State License | 0005363 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FERRELL HOSPITAL COMMUNITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://FERRELLHOSP.ORG/PDFS/CHNA | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://FERRELLHOSP.ORG/PDFS/CHNA | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 100.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://FERRELLHOSP.ORG/PDFS/FHCF-FINANCIAL-ASSISTANCE-POLICY | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://FERRELLHOSP.ORG/FOR-PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://FERRELLHOSP.ORG/FOR-PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FERRELL HOSPITAL COMMUNITY | PART V, SECTION B, LINE 3J: POTENTIAL INFORMATION GAPS WERE DISCUSSED RELATED TO RESIDENTS LIVING IN POVERTY IN ELDORADO AND CARMI AND THE FERRELL HOPITAL PRIMARY SERVICE AREA. |
| FERRELL HOSPITAL COMMUNITY | PART V, SECTION B, LINE 5: THIS ASSESSMENT HAS EXPLORED THE INSULAR NEEDS OF THE IDENTIFIED GROUPS BY SPECIFICALLY SEEKING INPUT FROM PERSONS WITH KNOWLEDGE OF THE SPECIFIC HEALTH CONCERNS. INPUT WAS ALSO SOUGHT FROM MEMBERS OF THE COMMUNITY CHARGED PROFESSIONALLY WITH ADVANCING THE HEALTH AND EDUCATION OF THE COMMUNITY AND ALL ITS MEMBERS INCLUDING SCHOOL OFFICIALS DEALING DAILY WITH YOUTH AND FAMILIES. THOSE CONSULTED INCLUDE HOSPITAL EXECUTIVE STAFF AND AN INTERNAL WORKING GROUP. THE FOCUS GROUP AND INTERVIEW PARTICIPANTS INCLUDE ANDREA MAY, RN COMMUNITY NURSE LIAISON, TONYA ASHFORD, RN DIRECTOR, JERRY DOUG WATSON, JUNE CSERNY, BSN AUXILIARY PRESIDENT, LISA ANDERSON, RB CHIEF NURSE EXECUTIVE, MARTHA VAUGHN, BSN MEDSURG DIRECTOR, JACQUE TRIPP, RN EMERGENCY DEPARTMENT SUPERVISOR, ANGIE HAMPTON, EXECUTIVE DIRECTOR, JAMIE BYRD, OVERSIGHT AND PLANNING COMMITTEE, TOM CLORE, PRESIDENT, FLECTHER JOHNSON, REAL ESTATE BROKER, GINA SIRACH, MSN DEAN OF NURSING, JIM MORSE, CITY COUNCIL REPRESENTIVE. |
| FERRELL HOSPITAL COMMUNITY | PART V, SECTION B, LINE 11: HOSPITAL PERSONNEL AND COMMUNITY ADVISORS MEET TO EVALUATE THE FINDINGS IN THE CHNA AND ASSESS THE PERFORMANCE OF THE HOSPITAL IN EACH OF THE TARGETED AREAS. MANAGEMENT MONITORS PROGRESS AND DEVOTES RESOURSES TO THE ACCOMPLISHMENT OF IDENTIFIED PLANS TO MEET THE NEEDS IDENTIFIED. |
| FERRELL HOSPITAL COMMUNITY | PART V, SECTION B, LINE 23: THE HOSPITAL CHARGES THE SAME AMOUNT FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE FOR FAP-ELIGIBLE PATIENTS AND ALL OTHER PATIENTS. |
| PART V, SECTION B, LINE 16B: | THE FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND AT:HTTPS://FERRELLHOSP.ORG/PDFS/FERRELL-HOSPITAL-COMMUNITY-FOUNDATION-FINANCIAL-AS |
| PART V, SECTION B, LINE 16C: | THE PLAIN LANGUAGE SUMMARY OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAMS CAN BE FOUND AT:HTTPS://FERRELLHOSP.ORG/PDFS/PLAIN-LANGUAGE-SUMMARY-OF-FINANCIAL-ASSISTANCE-PRO |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - FERRELL HOSPITAL FAMILY PRACTICE | ||||
| 1036 MAPLE STREET | ELDORADO | IL | 62930 | RURAL HEALTH CLINIC |
| 2 - ELDORADO FAMILY MEDICINE | ||||
| 1407 LOCUST STREET | ELDORADO | IL | 62930 | RURAL HEALTH CLINIC |
| 3 - CARMI FAMILY MEDICINE | ||||
| 1340 IL HWY 1 SUITE A | CARMI | IL | 62821 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE HOSPITAL USED A COST TO CHARGE RATIO AS CALCULATED FROM WORKSHEET 2 RATIO OF PATIENT CARE COST TO CHARGES INCLUDED IN THE SCHEDULE H INSTRUCTIONS TO DETERMINE THE AMOUNTS ON LINES 7A OF PART 1 OF SCHEDULE H |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,132,845. |
| PART III, LINE 2: | THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD PARTY PAYORS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT AFTER 120 DAYS. |
| PART III, LINE 3: | FINANCIAL ASSISTANCE COUNSELORS ARE IN PLACE TO CONTACT ANY PATIENT EXPRESSING INTEREST IN THE PROGRAM. PROCEDURES ARE IN PLACE TO MAKE DETERMINATIONS OF ALL PATIENTS ELIGIBILITY AND TO PROVIDE THE APPROPRIATE ASSISTANCE. |
| PART III, LINE 4: | THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYORS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD-PARTY PAYORS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT AFTER 120 DAYS. AT MARCH 31, 2017 AND 2016, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS WAS APPROXIMATELY $814,000 AND $637,000, RESPECTIVELY. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS AN AVERAGE OF 80 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT MARCH 31, 2017 AND 2016. IN ADDITION, THE HOSPITAL'S SELF-PAY WRITE-OFFS INCREASED APPROXIMATELY $256,000 TO $1,133,000 FOR FISCAL YEAR 2017 FROM $877,000 FOR FISCAL YEAR 2016. |
| PART III, LINE 8: | MEDICARE ALLOWABLE COSTS INCLUDE AMOUNTS FROM THE FISCAL YEAR 2017 COST REPORT FOR MEDICARE INPATIENT MEDICARE SWING BED ROUTINE AND ANCILLARY MEDICARE OUTPATIENT AND THE RURAL HEALTH CLINIC. IN ADDITION PROFESSIONAL FEES FOR EMERGENCY ROOM AND MAMMOGRAMS AS REPORTED ON THE 2016 FISCAL YEAR PSR WERE INCLUDED AFTER APPLYING THE OVERALL HOSPITAL COST TO CHARGE RATIO FROM THE 2017 FISCAL YEAR COST REPORT. |
| PART III, LINE 9B: | FERRELL HOSPITAL COMMUNITY FOUNDATION PROVIDES ASSISTANCE TO MEET THE NEEDS OF THE UNINSURED PATIENTS TO WHICH THEY SERVE. FOR THOSE PATIENTS WHO ARE EXPECTED TO QUALIFY UNDER THEIR FINANCIAL ASSISTANCE POLICY, THE HOSPITAL ASSIGNS THE FINANCIAL CARRIER FOR CHARITY CARE AT THE TIME OF THE REQUEST FOR THE HEALTH ASSISTANCE PROGRAM (HAP) APPLICATION. ONCE ASSIGNED, SEVERAL PROCEDURES ARE IN PLACE TO COMPLETE THE PROCESS INCLUDING INVESTIGATION FOR ANY OTHER AVAILABLE FUNDING SOURCES SUCH AS MEDICAID AND INCOME VERIFICATION. THOSE THAT COMPLETE THE HAP ACCURATELY AND QUALIFY UNDER THE HOSPITALS POLICY RECEIVE FREE OR DISCOUNTED CARE. |
| PART VI, LINE 2: | INVOLVEMENT IN COMMUNITY ORGANIZATIONS, INCLUDING CHURCHES, CIVIC GROUPS AND PROFESSIONAL ORGANIZATIONS. |
| PART VI, LINE 3: | OUR FINANCIAL ASSISTANCE PROGRAM IS ON THE FRONT PAGE OF OUR FERRELL HOSPITAL INTERNET AND HAS THE FORMS ALSO LISTED FOR THE PATIENT TO PRINT OFF IF NEEDED. THE CONTACT PHONE NUMBER OF OUR FINANCIAL COUNSELOR IS ALSO LISTED ALONG WITH HIS/HER WORK HOURS. THERE ARE FERRELL HOSPITAL FINANCIAL ASSISTANCE BROCHURES IN THE LOBBY AREAS OF THE HOSPITAL. ALL SELF PAY PATIENTS IN THE HOSPITAL ARE VISITED BY THE FINANCIAL COUNSELOR AND GIVEN THE NECESSARY PAPERWORK IF THE PATIENT REQUESTS IT. IF THE FINANCIAL COUNSELOR DOES NOT GET TO SEE THE PATIENT OR FAMILY THEN A LETTER IS MAILED ALONG WITH THE APPLICATION TO THE PATIENT. UPON REGISTRATION OF THE PATIENT THE REGISTRATION STAFF ALWAYS INFORMS THE PATIENT OF THE HOSPITAL FINANCIAL ASSISTANCE PROGRAMS AND GIVES THEM A BROCHURE. IF THE PATIENT WANTS TO TALK TO THE FINANCIAL COUNSELOR THEN THAT PERSON IS CALLED. |
| PART VI, LINE 4: | THE MAJORITY OF FERRELL HOSPITAL PATIENTS RESIDE IN SALINE, GALLATIN, WHITE AND HAMILTON COUNTIES. WE ALSO SEE SEVERAL PATIENTS FROM POPE AND HARDIN COUNTIES. OUR FACILITIES ARE LOCATED IN SALINE AND GALLATIN COUNTIES. THE UNEMPLOYMENT RATE AND POVERTY RATE OF THESE COUNTIES IS HIGHER THAN THE NATIONAL AVERAGE AND VERY CLOSE TO THE STATE OF ILLINOIS AVERAGE. THE PAYER MIX IS HEAVILY MEDICAID / MEDICARE DEPENDENT. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IL |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ALBERT BLEDIG MD | ||||||||||||||
| BOARD MEMBER / PHYSICIAN | $176,891 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $176,891 | $0 | $0 | $0 |
| NATE OLDHAM MD | ||||||||||||||
| BOARD MEMBER / PHYSICIAN | $336,503 | $0 | $27,485 | $0 | $20,000 | $0 | $7,908 | $0 | $12,079 | $0 | $403,975 | $0 | $0 | $0 |
| ELLIOTT PARTRIDGE MD | ||||||||||||||
| PHYSICIAN | $317,574 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $317,574 | $0 | $0 | $0 |
| JOSEPH A JACKSON MD | ||||||||||||||
| PHYSICIAN | $220,505 | $0 | $0 | $0 | $25,000 | $0 | $5,739 | $0 | $10,693 | $0 | $261,937 | $0 | $0 | $0 |
| SAMIR ABDO MD | ||||||||||||||
| PHYSICIAN | $225,576 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $225,576 | $0 | $0 | $0 |
| JANNA PATHI MD | ||||||||||||||
| PHYSICIAN | $181,428 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $181,428 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 2 | INTRODUCED NEW WOUND CARE DEPARTMENT AND RESTARTED THE GERIATRIC/PSYCH DEPARTMENT. ALSO OPENED A NEW PHYSICIAN CLINIC IN THE NEIGHBORING TOWN OF CARMI. WE ALSO ADDED TWO SURGEONS TO OUR RHC SURGICAL SERVICES DEPARTMENT. |
| FORM 990, PART VI, SECTION A, LINE 2 | DR. ALBERT BLEDIG AND BILL JONES HAVE A BUSINESS RELATIONSHIP. GENE MORRIS AND DR. NATE OLDHAM HAVE A FAMILY RELATIONSHIP. |
| FORM 990, PART VI, SECTION A, LINE 3 | EFFECTIVE JANUARY 1, 2016, THE HOSPITAL ENTERED INTO A FIVE-YEAR MANAGEMENT SERVICES AGREEMENT. MANAGEMENT SERVICES PROVIDED TO THE HOSPITAL CONSIST OF MANAGEMENT PERSONNEL INCLUDING A CEO AND CFO, FACILITY PLANNING, STRATEGIC PLANNING, RECRUITING, AND SEVERAL OTHER SUPPORT AND OVERSIGHT SERVICES. THE INITIAL TERM OF THE AGREEMENT IS FOR A FIVE YEAR PERIOD, WHICH CAN BE EXTENDED BEYOND THE INITIAL FIVE YEAR PERIOD, IF SO DESIRED. THE AGREEMENT CAN BE TERMINATED BY EITHER PARTY WITH A ONE HUNDRED EIGHTY DAY NOTICE WITHOUT RECOURSE SUBSEQUENT TO THE INITIAL FIVE YEAR TERM OF THE AGREEMENT. IF THE AGREEMENT IS TERMINATED BY THE HOSPITAL WITHIN THE INITIAL FIVE YEAR TERM, THE HOSPITAL WILL BE ASSESSED A PENALTY IN THE AMOUNT OF $500,000 TO BE PAYABLE TO THE MANAGEMENT SERVICE ORGANIZATION. THE HOSPITAL WILL REIMBURSE THE MANAGEMENT SERVICE PROVIDER THE ACTUAL COST OF PROVIDING THE MANAGEMENT SERVICES ON A MONTHLY BASIS. FOR THE YEARS ENDED MARCH 31, 2017 AND 2016, MANAGEMENT FEES INCURRED WERE $120,000 PER YEAR. DURING THE 2016 CALENDAR YEAR, THE FOLLOWING INDIVIDUALS WERE COMPENSATED BY THE MANAGEMENT SERVICE PROVIDER IN THE FOLLOWING AMOUNTS: ALISA COLEMAN, CHIEF EXECUTIVE OFFICER: $211,468 JOSEPH HOHENBERGER, CHIEF FINANCIAL OFFICER: $124,622 |
| FORM 990, PART VI, SECTION B, LINE 11B | THE CEO AND CFO REVIEW THE COMPLETED FORM 990 AS PREPARED BY THE PAID PREPARER FOR COMPLETENESS AND ACCURACY. THE BOARD CHAIR AND THE CEO AND CFO SUBMIT THE FORM TO THE BOARD FOR FINAL APPROVAL IMMEDIATELY PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | COPIES OF THE CONFLICT OF INTEREST POLICY ARE PROVIDED TO EACH DIRECTOR, OFFICER AND MANAGEMENT PERSON AT LEAST ONCE PER YEAR, WITH THE REQUIREMENT THAT THEY COMPLETE A CERTIFICATE WHICH CONFIRMS THAT THEY UNDERSTAND THIS POLICY, AGREE TO COMPLY, INDICATE ANY KNOWN CONFLICTS, AND HAVE NO KNOWLEDGE OF ANY ADDITIONAL VIOLATIONS OF THE POLICY. ANY PERSON WITH A CONFLICT IS REQUIRED TO COMPLETE A SPECIFIC DISCLOSURE NOTICE. |
| FORM 990, PART VI, SECTION B, LINE 15 | CEO SALARY WAS DETERMINED BY COMPARISON WITH PRIOR PERSONS EMPLOYED IN POSITION, INDUSTRY COMPARISONS, RELATIVE EXPERIENCE AND KNOWLEDGE. CEO SALARY WAS APPROVED BY ENTIRE BOARD. ALL DELIBERATIONS INCLUDED IN BOARD MINUTES. THIS PROCESS WAS LAST COMPLETED IN 2016. CFO SALARY DETERMINED AND APPROVED IN SAME MANNER AS CEO. ALL OTHER EXECUTIVE SALARIES APPROVED BY EXECUTIVE MANAGEMENT AND ANALYZED BASED ON INDUSTRY COMPARATIVE DATA AND POSITION DESCRIPTIONS, COMMENSURATE EXPERIENCE, EXPERTISE AND TRAINING. THIS PROCESS WAS LAST COMPLETED IN 2016. |
| FORM 990, PART VI, SECTION C, LINE 19 | FERRELL HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND FEDERAL FORM 990 TAX RETURNS ARE AVAILABLE TO THE PUBLIC BY REQUEST MADE TO ADMINISTRATION. |
| FORM 990, PART IX, LINE 11G | EMERGENCY ROOM STAFFING: PROGRAM SERVICE EXPENSES 1,087,801. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,087,801. PHYSICAL AND OCCUPATIONAL THERAPY STAFFING: PROGRAM SERVICE EXPENSES 527,092. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 527,092. ANESTHESIOLOGY STAFFING: PROGRAM SERVICE EXPENSES 238,411. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 238,411. MANAGEMENT STAFFING: PROGRAM SERVICE EXPENSES 446,178. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 446,178. MRI AND MAMMOGRAPHY SERVICES: PROGRAM SERVICE EXPENSES 199,172. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 199,172. MAINTENANCE SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 167,129. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 167,129. OTHER PROFESSIONAL FEES AND PURCHASED SERVICES:: PROGRAM SERVICE EXPENSES 1,240,710. MANAGEMENT AND GENERAL EXPENSES 278,892. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,519,602. |
| FORM 990, PAGE 12, PART XII, LINE 2C | PROCESS HAS NOT CHANGED FROM PROIR YEAR. |
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