2018-02-13T14:29:09-06:00 2017-03-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2016-04-01 201244058 FERRELL HOSPITAL COMMUNITY FOUNDATION FERR 6182733361 1201 PINE STREET ELDORADO IL 62930 JOSEPH HOHENBERGER CFO 6182733361 2018-02-12 1 JEFF PARKER P00970069 3149254300 67.137.57.251 2018-02-12 09:43:17 CS P 121501B7AC3CACF2E9E4A9E5B63715338B18D0F0 91CEC10FCE41CD9386A3334136B5DACB34123101 2016 2021-01-29 14:40:06Z ALISA COLEMAN 1201 PINE STREET ELDORADO IL 62930 20930885 0 X WWW.FERRELLHOSP.ORG X 2004 IL OPERATE ACUTE CARE HOSPITAL - DEDICATED TO IMPROVING THE HEALTH AND QUALITY OF LIFE FOR THE PEOPLE AND COMMUNITIES WE SERVE. 10 8 239 20 0 0 542094 51852 18274123 20809772 7830 11414 139567 57734 18963614 20930772 0 0 0 0 9040809 10505460 0 0 0 8470315 9319005 17511124 19824465 1452490 1106307 8149677 10285037 5748607 6777660 2401070 3507377 X OPERATE ACUTE CARE HOSPITAL - DEDICATED TO IMPROVING THE HEALTH AND QUALITY OF LIFE FOR THE PEOPLE AND COMMUNITIES WE SERVE. 1 0 19508813 20809772 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. 19508813 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 18 0 239 1 0 0 0 0 0 0 0 0 0 0 X 10 8 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X JOSEPH HOHENBERGER 6182733361 1201 PINE STREET ELDORADO IL 62930 CLIFFORD EUGENE MORRIS CHAIRMAN 5.00 X X 0 0 0 E T SEELY VICE-CHAIRMAN 5.00 X X 0 0 0 ALBERT BLEDIG MD BOARD MEMBER / PHYSICIAN 40.00 X 176891 0 0 BILL JONES BOARD MEMBER 2.00 X 0 0 0 NATE OLDHAM MD BOARD MEMBER / PHYSICIAN 60.00 X 383988 0 19987 JASON KASIAR BOARD MEMBER 2.00 X 0 0 0 BARB DEVOUS SECRETARY 2.00 X X 0 0 0 NIKKI ROSER BOARD MEMBER 2.00 X 0 0 0 SHAWN MCCOY BOARD MEMBER 2.00 X 0 0 0 JAMES PORTER MD BOARD MEMBER 2.00 X 0 0 0 ALISA COLEMAN CEO 50.00 X 0 0 0 JOSEPH HOHENBERGER CFO 50.00 X 0 0 0 ELLIOTT PARTRIDGE MD PHYSICIAN 40.00 X 317574 0 0 DALLAS C BASINGER PHARMACIST 40.00 X 126799 0 7602 JOSEPH A JACKSON MD PHYSICIAN 50.00 X 245505 0 16432 SAMIR ABDO MD PHYSICIAN 40.00 X 225576 0 0 JANNA PATHI MD PHYSICIAN 40.00 X 181428 0 0 1657761 0 44021 7 0 1 0 DEACONESS REGIONAL EMERGENCY DEPT STAFFI 600 MARY ST EVANSVILLE IN 47747 ER PHYSICIANS, MANAGEMENT FEES 1289051 PROGRESSIVE HEALTH OF INDIANA LLC PO BOX 6890 EVANSVILLE IN 47719 PHYSICAL AND OCCUPATIONAL THERAPIST 475536 MEDHOST OF TENNESSEE INC 6550 CAROTHERS PARKWAY FRANKLIN TN 37067 DATA PROCESSING 244971 RANDY WIENTJES CRBA MA 3042 LAKEVIEW DR METROPOLIS IL 62960 ANESTHESIOLOGY 238411 DIAGNOSTIC SHARED SERVICES INC 2650 EASTPOINT PARKWAY LOUISVILLE KY 40223 MRI SERVICES 192372 6 14004 37848 51852 INPATIENT & OUTPATIENT SVC 624110 19614200 19614200 340B REVENUE 624110 776165 776165 EMR/EHR REVENUE 624110 352135 352135 IL STATE INCENTIVE PAYMENTS 624110 67272 67272 20809772 11414 11414 10785 113 10672 10672 10672 EMPLOYEE CAFETERIA 624110 31684 31684 OTHER 624110 8973 8973 REBATES 624110 6405 6405 47062 20930772 20809772 0 69148 X 952784 925334 27450 7831375 7828088 3287 75497 75233 264 1067096 1063362 3734 578708 576683 2025 120000 120000 4185385 3906493 278892 32810 32810 1167288 1167288 271745 271745 93672 93672 193646 193646 593901 593901 198739 198739 BAD DEBTS 1132845 1132845 DRUGS 674055 674055 MISC/PROVIDER TAX 490875 490875 FOOD 90952 90952 73092 73092 19824465 19508813 315652 0 58349 6034 1462433 970783 2935132 4517783 236525 217999 228639 220481 9534696 5182739 3228599 4351957 8149677 10285037 1721809 2143264 4026798 4634396 5748607 6777660 X 2401070 3507377 2401070 3507377 8149677 10285037 1106307 0 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 5921 5921 0 PART II-B, LINE 1: ORGANIZATION PAYS DUES TO IHA ANNUALLY. 31% OF THESE DUES ARE USED FOR LOBBYING ACTIVITIES. 183412 183412 3289503 1341627 1947876 43892 40462 3430 4655902 3800650 855252 1361987 1361987 4351957 X 19797927 0 19797927 1132845 1132845 20930772 18691620 0 18691620 1132845 1132845 19824465 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. 1 1 1 X 1 X 100.000000000000 1 1 0 1 1 209253 209253 0.01120 5033921 3736615 1297306 0.06940 5243174 3736615 1506559 0.08060 5243174 3736615 1506559 0.08060 1 1132845 454786 7952025 9730741 -1778716 X 1 1 1 1 FERRELL HOSPITAL COMMUNITY FOUNDATION 1201 PINE STREET ELDORADO IL 62930 FERRELLHOSP.ORG 0005363 X X X X FERRELL HOSPITAL COMMUNITY 0 0 1 X X X X X X X X X X 15 1 0 0 1 X HTTPS://FERRELLHOSP.ORG/PDFS/CHNA X 1 15 1 HTTPS://FERRELLHOSP.ORG/PDFS/CHNA 0 1 X 100.000000000000 100.000000000000 X X X X X 1 1 X X X 1 X HTTPS://FERRELLHOSP.ORG/PDFS/FHCF-FINANCIAL-ASSISTANCE-POLICY X HTTPS://FERRELLHOSP.ORG/FOR-PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://FERRELLHOSP.ORG/FOR-PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE X X X X 1 X 0 X X X X 1 X 0 0 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 3 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 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 X X X 0 0 0 0 0 0 0 0 0 ALBERT BLEDIG MD BOARD MEMBER / PHYSICIAN 176891 0 0 0 0 0 0 0 0 0 176891 0 0 0 NATE OLDHAM MD BOARD MEMBER / PHYSICIAN 336503 0 27485 0 20000 0 7908 0 12079 0 403975 0 0 0 ELLIOTT PARTRIDGE MD PHYSICIAN 317574 0 0 0 0 0 0 0 0 0 317574 0 0 0 JOSEPH A JACKSON MD PHYSICIAN 220505 0 0 0 25000 0 5739 0 10693 0 261937 0 0 0 SAMIR ABDO MD PHYSICIAN 225576 0 0 0 0 0 0 0 0 0 225576 0 0 0 JANNA PATHI MD PHYSICIAN 181428 0 0 0 0 0 0 0 0 0 181428 0 0 0 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.