2017-03-27T11:48:39-05:00 2016-08-31 BKD LLP 211 N BROADWAY SUITE 600 ST LOUIS MO 631022733 990 2015-09-01 370512290 Shelby Memorial Hospital Association Inc % MARILYN SEARS SHEL 2177743961 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 MARILYN SEARS CEO/INTERIM CFO 2017-03-27 true Donna J Larson P00043751 3142315544 2017-03-17 2015 2021-01-29 14:40:06Z MARILYN SEARS 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 19038693 false X WWW.MYSMH.ORG X 1916 IL SEE SCHEDULE O. 12 12 218 12 243075 -13157 40678 39778 13569374 14017474 2406881 130411 323714 359434 16340647 14547097 0 0 0 0 8672443 8716327 0 0 0 9258041 8708662 17930484 17424989 -1589837 -2877892 29975636 27413119 9041511 8435128 20934125 18977991 X THE ASSOCIATION'S PURPOSE IS TO ESTABLISH AND MAINTAIN A FACILITY FOR THE CARE OF PERSONS SUFFERING FROM ILLNESS OR DISABILITIES; REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY; TO CARRY ON EDUCATIONAL ACTIVITIES RELATED TO RENDERING CARE TO THE SICK AND INJURED; AND TO PARTICIPATE IN ANY ACTIVITY DESIGNED AND CARRIED ON SO AS TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY. false false 14339811 14017474 OPERATION OF A 30 BED HOSPITAL FACILITY PROVIDING ALL ROUTINE AND ANCILLARY SERVICES. SERVICES INCLUDED: 24,771 OUTPATIENT REGISTRATIONS, 8,428 RURAL HEALTH CLINIC VISITS, 1,717 INPATIENT DAYS AND 4,637 EMERGENCY ROOM VISITS. 14339811 true true false true false false false false false true true false false false true true 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 21 0 true 218 true true true false false false false false false false false false X 12 12 true false false false false false false true true false false false true true true true true true false false IL X MARILYN SEARS 2177743961 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 X MICHAEL KILEY PRESIDENT 1.0 0.0 X X 0 0 0 RANDY BIEHLER VICE-PRESIDENT 1.0 0.0 X X 0 0 0 ERIN CHAMBERS SECRETARY 1.0 0.0 X X 0 0 0 SUSAN LEACH BOARD MEMBER 1.0 0.0 X 0 0 0 JOHN BRIX BOARD MEMBER 1.0 0.0 X 0 0 0 DAVID CRUITT BOARD MEMBER 1.0 0.0 X 0 0 0 ELAINE BEERY BOARD MEMBER 1.0 0.0 X 0 0 0 MATTHEW BEYERS BOARD MEMBER 1.0 0.0 X 0 0 0 BRIAN GREEN BOARD MEMBER 1.0 0.0 X 0 0 0 DR DAVID OLIGSCHLAEGER BOARD MEMBER 1.0 0.0 X 0 0 0 JOSH SHALLENBERGER BOARD MEMBER 1.0 0.0 X 0 0 0 DENISE BENCE BOARD MEMBER 1.0 0.0 X 0 0 0 BRUCE STEINKE BOARD MEMBER 1.0 0.0 X 0 0 0 MARILYN SEARS CEO 40.0 1.0 X 161202 0 12681 DR ARNOLD AGAPITO PHYSICIAN 40.0 0.0 X 231040 0 9577 DR TRUMAN MARK VASKO PHYSICIAN 40.0 0.0 X 283165 0 21101 DR MUHAMMAD H UL ISLAM PHYSICIAN 40.0 0.0 X 108308 0 14106 RICHARD IAN KUHLMAN IT MANAGER 40.0 0.0 X 138698 0 10042 922413 0 67507 5 false true false CARDINAL HEALTH 21377 NETWORK PLACE CHICAGO IL 62565 PHARMACY MANAGEMENT 915571 EMERGENCY STAFFING SOLUTIONS 17304 PRESTON ROAD DALLAS TX 75252 ER PHYSICIANS 784920 CONSOCIATE-DANSIG 2828 NORTH MONROE STREET DECATUR IL 62525 INSURANCE PLAN ADMIN 208073 BKD LLP ONE METRO SQUARE ST LOUIS MO 63102 AUDITING AND CONSULT 178548 SPECIAL CARE HOSPITAL 1551 WALL STREET STE 210 ST CHARLES MO 63303 DETOX MED SERVICES 177415 15 21044 18734 39778 CHARGE FOR MEDICAL SRVC, ROOM, CARE & OT 621110 13740148 13740148 SHE ANCILLARY 446199 243075 243075 MISCELLANEOUS INCOME 900099 34251 34251 14017474 435573 435573 0 0 278014 21256 256758 0 256758 256758 4165178 4470340 -305162 -305162 -305162 0 0 0 CATERING INCOME 722320 9492 9492 CAFETERIA SALES 721000 70496 70496 WELLNESS PROGRAM 621990 22688 22688 102676 14547097 13774399 243075 489845 X 0 0 0 0 176666 176666 0 0 6840333 5968520 871813 203014 178487 24527 1017790 872591 145199 478524 407760 70764 0 26341 26341 104921 104921 0 0 0 2551417 2518248 33169 48487 48487 1958704 1434227 524477 0 0 298997 298997 52774 41184 11590 0 0 243222 243222 0 1356533 1220880 135653 261769 261769 BAD DEBT EXPENSE 745296 745296 IPA ASSESSMENT FEE 375157 375157 DUES & FEES 336513 109622 226891 COLLECTION & ADMINISTRATION 175477 175477 173054 120355 52699 17424989 14339811 3085178 0 65262 261941 0 0 0 0 2414335 2368211 0 0 0 0 210000 30000 185386 181368 241492 262165 32364503 24028895 9451739 8335608 15977420 15759409 4356 4356 29757 32553 0 0 1395889 177508 29975636 27413119 1031511 1055128 0 0 0 0 7800000 7350000 0 0 0 0 0 0 0 0 210000 30000 9041511 8435128 X 20834125 18877991 60000 60000 40000 40000 20934125 18977991 29975636 27413119 -2877892 921758 X false true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 16662 false false false 16662 false SCHEDULE C, PART II-B, LINE 1F GRANTS TO OTHER ORGANIZATION: THE AMOUNT REPRESENTS THE PORTION OF DUES PAID TO PROFESSIONAL HOSPITAL ASSOCIATIONS THAT WAS ALLOCATED TO LOBBYING ACTIVITIES. 1500122 39379 45662 1312137 273026 1494769 36899 58187 89733 1500122 534529 960240 1494769 401490 133039 534529 399597 1893 401490 0.42430 0.21980 0.35590 false true true 473600 473600 15214332 10434273 4780059 280987 139812 141175 4851267 3912376 938891 11544317 9542434 2001883 8335608 0 PROFESSIONAL LIABILITY RESERVE 30000 30000 SCHEDULE D, PART V, LINE 4 USE OF ENDOWMENT FUNDS: THE FUNDS ARE TO BE USED FOR BOND RESERVE FUND, OPERATIONS, AND MAINTENANCE OF ASSOCIATION. 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 true X true X true true true false false 160733 160733 0.01000 2719547 1465053 1254495 0.07500 2880280 1465053 1415228 0.08500 13592 13592 0.00100 13592 13592 0.00100 2893872 1465053 1428820 0.08600 true 745296 87945 4158954 6300500 -2141546 X true true 1 1 SHELBY MEMORIAL HOSPITAL ASSOCIATION 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 WWW.MYSMH.ORG 0002154 X X X SHELBY MEMORIAL HOSPITAL ASSOCIATION false false true X X X X X X X X X 15 true false false true X SEE PART V, SECTION C X true 15 false true false true X 200. 400. X X X true true X 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 COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED THROUGH A CONSULTING ARRANGEMENT WITH BKD, LLP. THIS ASSESSMENT EXPLORED THE NEEDS OF THOSE WHO MAY BE IMPACTED BY ISOLATED LOCAL ACCESS ISSUES BY SEEKING INPUT FROM PERSONS EXPECTED TO HAVE KNOWLEDGE OF POTENTIAL SPECIFIC ISSUES FACING AREA COMMUNITIES. 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. SCHEDULE H, PART V, SECTION B, LINE 7A DIRECT WEBSITE URL: https://www.hshsgoodshepherd.org/Hospital-Information/About/Community-Outr each SCHEDULE H, PART V, SECTION B, LINE 11 SIGNIFICANT NEEDS IDENTIFIED IN CHNA: SMH IS CONSIDERING THE NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT THROUGH OUR STRATEGIC PLANNING PROCESS BY DECIDING HOW BEST TO MEET THE NEEDS IDENTIFIED. SCHEDULE H, PART V, SECTION B, LINES 16A, 16B, & 16C THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY OF THE FAP WAS POSTED ON THE WEBSITE, WWW.MYSMH.ORG, DURING THE TAX YEAR. AS OF JANUARY 16, 2017, THE ORGANIZATION BECAME AFFILIATED WITH HOSPITAL SISTERS HEALTH SYSTEM AND THE WEBSITE IS NO LONGER FUNCTIONAL. 3 SHELBY HOME EQUIPMENT 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 DURABLE MEDICAL EQUIPMENT SHELBY MEMORIAL HOME HEALTH 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 HOME HEALTH AGENCY RURAL HEALTH CLINIC 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 RURAL HEALTH CLINIC SCHEDULE H, PART I, LINE 7, COLUMN F CHARITY CARE & COMMUNITY BENEFITS AT COST PERCENT OF TOTAL EXPENSE: THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $745,296 REPORTED ON PART IX, LINE 25, HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSE OF CALCULATING THE PERCENTAGE IN THIS COLUMN. SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT METHODOLOGY: IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE ASSOCIATION 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. SCHEDULE H, PART III, SECTION A, LINE 3 METHODOLOGY TO ESTIMATE COMMUNITY BENEFIT PORTION OF BAD DEBT: THE U.S. CENSUS BUREAU'S PERCENTAGE FOR PERSONS BELOW THE FEDERAL POVERTY LEVEL WAS USED TO MAKE ESTIMATES FOR SHELBY COUNTY. THIS PORTION OF BAD DEBT SHOULD BE INCLUDED IN THE COMPUTATION OF COMMUNITY BENEFIT DUE TO THE FACT THAT IF SUFFICIENT INFORMATION HAD BEEN PROVIDED TO DETERMINE ELIGIBILITY UNDER THE FINANCIAL ASSISTANCE POLICY, THE AMOUNT WOULD HAVE BEEN CLASSIFIED AS FINANCIAL ASSISTANCE REPORTABLE IN PART I, LINE 7A. SCHEDULE H, PART III, SECTION B, LINE 4 BAD DEBT EXPENSE: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE ASSOCIATION 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 ASSOCIATION 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 BALANCES, 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 ASSOCIATION 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 AND MEDICARE COSTS: THE AMOUNT REPORTED ON LINE 6 WAS OBTAINED FROM THE ORGANIZATION'S MEDICARE COST REPORT. THE MEDICARE COST REPORT IS FILED FOLLOWING THE COST REPORT GUIDELINES. MEDICARE PAYMENT SHORTFALLS SHOULD BE REFLECTED AS COMMUNITY BENEFIT AS THE FEDERAL GOVERNMENT PROSPECTIVELY SETS THE HOSPITAL PAYMENT RATES; THE RATES ARE NOT NEGOTIABLE AND CONSEQUENTLY, NO LONGER COVER THE HOSPITAL'S COST TO PROVIDE SERVICES TO MEDICARE BENEFICIARIES. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: SHELBY MEMORIAL HOSPITAL HAS CONDUCTED JOINT COMMUNITY HEALTH ASSESSMENTS THROUGH A LOCAL COMMUNITY HEALTH COMMITTEE. THE COMMITTEE CONSISTS OF EXECUTIVES OF SHELBY MEMORIAL HOSPITAL, PHYSICIAN REPRESENTATION FROM THE SHELBY COUNTY BOARD OF HEALTH, A REPRESENTATIVE FROM THE SHELBY COUNTY COMMUNITY SERVICES, A REPRESENTATIVE OF THE LOCAL COMMUNITY, AND LOCAL HEALTH DEPARTMENT OFFICIALS. DATA FROM DIFFERENT GROUPINGS WAS COLLECTED AND ANALYZED TO HELP ESTABLISH PRIORITIES. GROUPINGS INCLUDED DEMOGRAPHIC AND SOCIOECONOMIC CHARACTERISTICS, GENERAL HEALTH AND ACCESS TO CARE, MATERNAL AND CHILD HEALTH CARE, CHRONIC DISEASE, INFECTIOUS DISEASE, AND ENVIRONMENTAL/OCCUPATIONAL HEALTH AND INJURY CONTROL. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: MULTIPLE AVENUES OF EDUCATION ARE UTILIZED TO INSURE ELIGIBLE INDIVIDUALS ARE AWARE OF AVAILABILITY OF ASSISTANCE THROUGH GOVERNMENTAL AND HOSPITAL BASED PROGRAMS. PATIENTS ARE PROVIDED WITH A PACKET OF INFORMATION THAT DETAILS THE AVAILABILITY OF UNINSURED DISCOUNTS AND CHARITY CARE PROGRAMS. ALL STATEMENTS WITH PATIENT DUE BALANCES HAVE WORDING INCLUDED TO SHOW THE AVAILABILITY OF SUCH ASSISTANCE. PRINTED MATERIALS CLEARLY IDENTIFY THE AVAILABILITY OF PROGRAMS. THE HOSPITAL WEB SITE ALSO HAS PROMINENT LANGUAGE ON ALL PAGES CONCERNING AVAILABILITY OF ASSISTANCE. TO SHOW THE AVAILABILITY OF SUCH ASSISTANCE. PRINTED MATERIALS CLEARLY IDENTIFY THE AVAILABILITY OF PROGRAMS. THE HOSPITAL WEB SITE ALSO HAS PROMINENT LANGUAGE ON ALL PAGES CONCERNING AVAILABILITY OF ASSISTANCE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: SHELBY MEMORIAL HOSPITAL PRIMARILY SERVES THE RESIDENTS OF SHELBY COUNTY, ILLINOIS. TOTAL POPULATION OF 21,874 ACCORDING TO THE 2008 CENSUS AVAILABLE ON FACTFINDER.CENSUS.GOV. 22% OF RESIDENTS ARE UNDER THE AGE OF 18; 18.6% ARE 65 OR OLDER. 10.4% OF ALL PEOPLE AER IDENTIFIED AS BEING AT OR BELOW THE POVERTY LEVEL. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: SINCE 1918, SHELBY MEMORIAL HOSPITAL HAS PROVIDED FOR THE HEALTH CARE NEEDS OF SHELBY COUNTY AND OTHER SURROUNDING COMMUNITIES. SMH IS LOCATED IN CENTRAL ILLINOIS, AND IT IS THE ONLY HOSPITAL LOCATED IN SHELBY COUNTY. SMH IS COMMITTED TO THE HEALTH AND WELFARE OF THE PEOPLE IT SERVES. OVER THE LAST 90+ YEARS, SMH HAS PROVIDED EMERGENCY AND NONEMERGENT CARE REGARDLESS OF A PERSON'S ABILITY TO PAY. SMH WORKS CLOSELY WITH OTHER AGENCIES IN THE AREA TO PROVIDE FOR THOSE NEEDS BEYOND THE SCOPE OF THE HOSPITAL, SUCH AS TRANSPORTATION, PRESCRIPTION ASSISTANCE, SOCIAL WELFARE AND DAILY LIVING NEEDS. SMH PROVIDED THE RESOURCES TO RECRUIT HEALTHCARE WORKERS, PHYSICIAN ASSISTANTS, AND PHYSICIANS TO THE AREA. SMH HAS ESTABLISHED A RURAL HEALTH CARE CENTER TO HELP COMBAT THE PHYSICIAN SHORTAGE IN RURAL AMERICAN AND PROVIDE FOR THOSE UNABLE TO PAY FOR SUCH CARE. MEMBERS OF THE SMH TEAM ARE ACTIVE MEMBERS IN THE ECONOMIC DEVELOPMENT COMMITTEE OF SHELBY COUNTY, THE CHAMBER OF COMMERCE AND OTHER CIVIC AND NOT FOR PROFIT ORGANIZATIONS DEDICATED TO THE BETTERMENT OF LIVING STANDARDS FOR THE RESIDENTS OF THE AREA. THE BOARD OF DIRECTORS AND MANAGEMENT OF SMH ARE COMMITTED TO PROVIDING THE BEST IN CARE AND EQUIPMENT TO THE COMMUNITY. THE BEST IN CARE AND EQUIPMENT TO THE COMMUNITY. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: NOT APPLICABLE SCHEDULE H, PART I, LINE 7 CHARITY CARE & 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 AS USED FOR ALL PATIENT SEGMENTS. SCHEDULE H, PART I, LINE 3C SEE PART V, LINE 13 FOR ADDITIONAL CRITERIA USED TO DETERMINE ELIGIBILITY. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: NOT APPLICABLE SCHEDULE H, PART III, SECTION C, LINE 9B The initial statement sent to the patient (after all insurance payments are received) includes information on applying for financial assistance. If the patient contacts us and wishes to pursue financial assistance, the Collection Clerk will help them fill out necessary paperwork. If there is a balance after financial assistance, a payment plan will be set up. If the patient does not honor the payment plan, the account may then be referred to a Collection Agency, at the discretion of the hospital. If there is no response from the patient after 60 days of the first statement, the patient is contacted by telephone. If there is still no response from the patient after 130 days of the first statement, the patient will receive written final notice communicating that the patient has 15 days to make payment arrangements or apply for financial assistance and failure to do so will result in further collection actions. X X X X false false false false false false false false false MARILYN SEARS CEO 161202 0 0 0 0 0 6448 0 6233 0 173883 0 DR ARNOLD AGAPITO PHYSICIAN 231040 0 0 0 0 0 9242 0 335 0 240617 0 DR TRUMAN MARK VASKO PHYSICIAN 283165 0 0 0 0 0 11327 0 9774 0 304266 0 A CITY OF SHELBYVILLE 376002116 2015-12-01 7500000 CONSTRUCTION/RETIREMENT OF BONDS false false false A 150000 0 7500000 0 0 0 0 0 0 0 7500000 0 2015 true false true true A false false false false 0 false false false true A false false false false false false 0 false 0 false true A true FORM 990, PART I, LINE 1 ORGANIZATION'S MISSION: ORGANIZATION'S UNIFIED MISSION IS TO MAINTAIN AND IMPROVE THE QUALITY OF LIFE OF THE PEOPLE IN THIS SERVICE AREA THROUGH THE PROVISION OF QUALITY HEALTH CARE PROGRAMS, SERVICES, EQUIPMENT AND PERSONAL CARE. FORM 990, PART VI, SECTION A, LINE 2 FAMILY RELATIONSHIPS: MICHAEL KILEY HAS A FAMILY RELATIONSHIP WITH DAVID CRUITT. JOSH SHALLENBERGER HAS A FAMILY RELATIONSHIP WITH ERIN CHAMBERS. FORM 990, PART VI, SECTION B, LINE 15A REVIEW PROCESS: THE 990 IS REVIEWED BY THE INTERIM CFO FOR ACCURACY. NO REVIEW WAS OR WILL BE CONDUCTED BY THE ORGANIZATION'S GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 12C MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: OFFICERS, DIRECTORS OR TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANNUALLY INTERESTS THAT COULD GIVE RISE TO CONFLICTS. THE ORGANIZATION ALSO HOLDS QUARTERLY MEETINGS WITH EMPLOYEES. THE HOSPITAL'S CEO, INTERIM CFO, AND ACTING CNE ARE RESPONSIBLE FOR DETERMINING AND REVIEWING ANY CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A/B PROCESS FOR DETERMINING COMPENSATION: WAGE SCALE IS PREPARED USING COMPARISON INFO FROM OTHER HOSPITALS. IT IS PREPARED BY THE HUMAN RESOURCE DIRECTOR AND ENFORCED BY THE HUMAN RESOURCE DIRECTOR AND THE CEO. THE COMPENSATION OF THE CEO IS REVIEWED AND APPROVED BY THE GOVERNING BODY. FORM 990, PART VI, SECTION C, LINE 19 PROCESS FOR MAKING DOCUMENTS AVAILABLE TO PUBLIC: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC, UPON REQUEST. FORM 990 PART IX LINE 11G DESCRIPTION:AGENCY WAGES TOTAL FEES:22481 FORM 990 PART IX LINE 11G DESCRIPTION:PROF. FEES-EMERGENCY ROOM TOTAL FEES:784920 FORM 990 PART IX LINE 11G DESCRIPTION:PROF. FEES-OTHER MEDICAL TOTAL FEES:297493 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES-PHARMACY TOTAL FEES:902131 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES-OTHER MEDIC TOTAL FEES:511223 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES-IT TOTAL FEES:33169 SHELBY MEMORIAL HOSPITAL FOUNDATIONINC 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 371294401 FUNDRAISING IL 501(C)(3) 11 - I SMHA true false false true false false false false false false false false false false true true false false false false