2016-08-24T08:52:36-05:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2015-01-01 370792770 GREENVILLE REGIONAL HOSPITAL INC GREE 6186641230 200 HEALTH CARE DRIVE GREENVILLE IL 622461156 BRIAN NALL CHIEF OPERATING OFFICER 6186641230 2016-08-19 1 JEFF PARKER P00970069 3149254300 2015 2016-12-15 16:53:06Z BRIAN NALL 200 HEALTH CARE DRIVE GREENVILLE IL 622461156 33381500 0 X HSHSHOLYFAMILY.ORG X 1956 IL PROVIDE COMPASSIONATE CARE AND EXCELLENT SERVICE IN A MODERN AND EFFICIENT HEALTHCARE ORGANIZATION STAFFED BY HIGHLY TRAINED PROFESSIONALS. 9 8 432 520 0 0 95689 1471975 33295577 31340153 51869 30481 715050 493389 34158185 33335998 1113077 78107 0 0 18132984 17572112 0 0 3552 16309611 16237883 35555672 33888102 -1397487 -552104 28017907 26089217 15461936 14104309 12555971 11984908 X PROVIDE COMPASSIONATE CARE AND EXCELLENT SERVICE IN A MODERN AND EFFICIENT HEALTHCARE ORGANIZATION STAFFED BY HIGHLY TRAINED PROFESSIONALS. 0 0 28706843 78107 30953478 GREENVILLE REGIONAL HOSPITAL IS A FULL-SERVICE, ACUTE CARE FACILITY OFFERING 42 LICENSED BEDS, A GERIATRIC BEHAVIORAL HEALTH UNIT, A 24-HOUR EMERGENCY DEPARTMENT, FAMILY BIRTH CENTER, SURGERY DEPARTMENT, REHABILITATION DEPARTMENT, SLEEP DISORDERS CENTER, OUTPATIENT PSYCHIATRIC/MENTAL HEALTH SERVICES, AND OUTPATIENT SPECIALTY CLINICS. DIAGNOSTIC SERVICES INCLUDE A LABORATORY, CARDIOPULMONARY DEPARTMENT, AND IMAGING SERVICES DEPARTMENT. THE HOSPITAL IS CERTIFIED BY THE HEALTHCARE FACILITIES ACCREDITATION PROGRAM (HFAP). IN ADDITION TO PROVIDING INPATIENT ACUTE CARE, GREENVILLE REGIONAL HOSPITAL OFFERS "SWING BEDS". MEDICARE PATIENTS QUALIFYING FOR TRANSITIONAL CARE CAN RECEIVE TREATMENT AT GREENVILLE REGIONAL THROUGH THE "SWING BED" PROGRAM. THE GERIATRIC BEHAVIORAL HEALTH UNIT IS A 10-BED INPATIENT UNIT INTENDED FOR SENIORS NEEDING MEDICATION ADJUSTMENT AND THERAPY PROGRAMS DESIGNED FOR BEHAVIORAL ISSUES. THE GERIATRIC BEHAVIORAL HEALTH UNIT SERVES SENIOR PATIENTS FROM A 150-MILE RADIUS. A PSYCHIATRIST DIRECTS THE CARE PROVIDED. WHITE OAKS SENIOR WELLNESS IS AN OUTPATIENT, GERIATRIC DAY-CARE PROGRAM INTENDED FOR PATIENTS DISCHARGED FROM A BEHAVIORAL HEALTH UNIT, OR THOSE EXPERIENCING BEHAVIORAL ISSUES. MEDICARE PATIENTS QUALIFYING FOR OUTPATIENT BEHAVIORAL HEALTH TREATMENTS CAN RECEIVE CARE THROUGH THE WHITE OAKS PROGRAM. BOND COUNTY EMERGENCY MEDICAL SERVICES IS BASED AT AND OPERATED BY THE HOSPITAL. THE SERVICE PROVIDES ADVANCED CARDIAC LIFE SUPPORT (ACLS) AND THE ORGANIZATION HAS ALSO ACHIEVED "RESOURCE HOSPITAL" STATUS. SOME YEARS AGO, THE HOSPITAL WAS ASKED BY THE BOND COUNTY BOARD TO ASSUME OPERATION OF THE AMBULANCE SERVICE AND PROVIDE EMERGENCY MEDICAL TREATMENT AT THE SCENE AFTER IT BECAME APPARENT THAT A PRIVATE COMPANY COULD NO LONGER REMAIN OPERATIONAL. THE HOSPITAL EMERGENCY DEPARTMENT IS STAFFED 24-HOURS PER DAY BY A PHYSICIAN. FOUR MAJOR TRAUMA SUITES, THREE EXAMINATION ROOMS, A TRIAGE ROOM, AND AN IV THERAPY ROOM ARE LOCATED WITHIN THE DEPARTMENT. WHEN NEEDED, HELICOPTER AMBULANCE SERVICE IS AVAILABLE. IN 2015, 222 INFANTS WERE DELIVERED AT THE GREENVILLE REGIONAL FAMILY BIRTH CENTER. PHYSICAL, SPEECH, AND OCCUPATIONAL THERAPY ARE OFFERED ON BOTH AN INPATIENT AND OUTPATIENT BASIS. THE HOSPITAL OUTPATIENT SPECIALTY CLINIC OFFERS 13 MEDICAL SPECIALTIES AND CONTAINS 13 EXAMINATION ROOMS. FOUR CLINICS CAN BE IN OPERATION SIMULTANEOUSLY. THE HOSPITAL MAY HOST AS MANY AS 100 CLINICS IN JUST 27 WORKING DAYS. THE HOSPITAL'S LABORATORY CAN PERFORM A WIDE ARRAY OF BLOOD, TISSUE, AND FLUID TESTING. THE IMAGING SERVICES DEPARTMENT OFFERS IN-HOUSE X-RAY, CAT SCAN, MRI, ULTRASOUND, NUCLEAR SCAN, BONE DENSITY, AND 3-D DIGITAL MAMMOGRAPHY TECHNOLOGY. MOBILE PET SCANS ARE ALSO AVAILABLE. THE HOSPITAL HAS THE CAPABILITY OF TRANSMITTING IMAGES TO ON-CALL RADIOLOGISTS FOR SCANS PERFORMED AFTER NORMAL BUSINESS HOURS. 309667 EMERALD POINTE IS AN INDEPENDENT, SENIOR LIVING DEVELOPMENT LOCATED ON THE HOSPITAL CAMPUS. THE DEVELOPMENT CONSISTS OF A 15-UNIT APARTMENT BUILDING, FIVE DUPLEX STRUCTURES, AND A SINGLE UNIT PROVIDING 11 RESIDENCES. 77008 THE ORGANIZATION OWNS AND OPERATES THREE CLINIC STRUCTURES ON THE HOSPITAL CAMPUS, A FOURTH CLINIC LOCATED ON THE SOUTH SIDE OF GREENVILLE, AND ANOTHER IN NEARBY POCAHONTAS, IL. ALL FACILITIES ARE CERTIFIED RURAL HEALTH CLINICS. THE CLINICS ARE UTILIZED BY PRIMARY CARE AND SPECIALTY PHYSICIANS, AS WELL AS MID-LEVEL PRACTITIONERS. 28706843 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 22 0 432 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 1 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X BRIAN NALL COO 6186641230 200 HEALTH CARE DRIVE GREENVILLE IL 622461156 JEFF MOLLET CHAIRMAN OF THE BOARD 5.00 10.00 X X 0 0 0 DOUG STROUD ASSISTANT TREASURER & SECRETARY 1.00 2.00 X X 0 0 0 LEONARD TAYLOR VICE CHAIR 1.00 2.00 X X 0 0 0 BART CALDIERARO SECRETARY 1.00 2.00 X X 0 0 0 BETTY IMBODEN BOARD MEMBER 1.00 2.00 X 0 0 0 ROSIE YORK TREASURER 1.00 2.00 X X 0 0 0 ERNIE CHAPPEL BOARD MEMBER 1.00 2.00 X 0 0 0 JERRY GAFFNER BOARD MEMBER 1.00 2.00 X 0 0 0 MIKE SUESS BOARD MEMBER 1.00 2.00 X 0 0 0 DR KELSEY HOPKINS BOARD MEMBER/PHYSICIAN 40.00 1.00 X 268434 0 11579 BRIAN NALL COO 40.00 2.00 X 247061 0 11622 MARK ENNEN DIRECTOR OF ACCOUNTING 40.00 2.00 X 95668 0 7310 TAMMY LETT CNO 40.00 2.00 X 143438 0 7002 DR MICHAEL SCHULTHEIS PHYSICIAN 40.00 1.00 X 380656 0 3458 DR BOYD MCCRACKEN PHYSICIAN 40.00 1.00 X 290136 0 11069 DR RICHARD FUNNEMAN PHYSICIAN 40.00 1.00 X 228890 0 12041 DR PHILIP SIEFKEN PHYSICIAN 40.00 1.00 X 231084 0 12164 STEVEN DONNAN CRNA 40.00 1.00 X 219614 0 8875 2104981 0 85120 14 0 1 0 ILLIANA EMERGENCY PHYSICIANS PO BOX 674579 DETROIT MI 48267 ER PHYSICIAN SERVICES 1295975 APEXNETWORK PHYSICAL THERAPY 15 APEX DR HIGHLAND IL 62249 THERAPY SERVICES 968077 COMPHEALTH PO BOX 972651 DALLAS TX 72651 PROVIDES OB DOCTOR COVERAGE 229495 QUEST DIAGNOSTICS PO BOX 14730 ST LOUIS MO 63150 REFERENCE LABS 215836 SPECIALCARE HOSPITAL MANAGMENT 1551 WALL ST SUITE 210 ST CHARLES MO 63303 NEW VISION MEDICAL STABILIZATION SVCS 164876 9 1410943 34039 26993 1471975 NET PATIENT REVENUES 621110 29588903 29588903 PHARMACEUTICALS 446110 1201236 1201236 SENIOR LIVING 623000 309667 309667 EHR REIMBURSEMENTS 621110 163339 163339 CLINIC 621110 77008 77008 31340153 63625 63625 250 0 250 250 250 12358 45502 -33144 -33144 -33144 GIFT SHOP 453220 335775 335775 CAFETERIA 722210 138946 138946 MISCELLANEOUS INCOME 624100 18418 18418 493139 33335998 31340153 0 523870 X 78107 78107 779039 297899 477588 3552 13434021 11289505 2144516 141411 118837 22574 2266644 1904812 361832 950997 799186 151811 144384 144384 79993 79993 16338 16338 5546329 4920352 625977 172645 145085 27560 4212099 3539708 672391 266181 223690 42491 1635373 1374313 261060 84862 71315 13547 24501 24501 391185 328739 62446 1834300 1834300 262231 220370 41861 PROVISION FOR BAD DEBT 1422284 1422284 DUES/ FEES 98870 83087 15783 MISCELLANEOUS 46308 38916 7392 33888102 28706843 5177707 3552 67722 39550 1930276 1262243 5560884 5296605 508066 492931 211246 363920 43019384 25409369 18431038 17610015 1190565 915754 118110 108199 28017907 26089217 3896538 3245648 479398 348655 8001266 7490713 197939 151084 2886795 2868209 15461936 14104309 X 12543312 11979963 12659 4945 12555971 11984908 28017907 26089217 X -552104 -18959 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 16338 0 0 0 16338 0 PART II-B, LINE 1: LOBBYING COSTS WERE FROM THE FOLLOWING MEMBERSHIPS: IHA DUES, AHA DUES AND MCHC DUES. 33170210 17719593 15450617 9770677 7689776 2080901 78497 78497 17610015 ASSET RETIREMENT OBLIGATION 364258 DUE TO THIRD PARTY PAYORS 1370025 LIFE RESIDENCY FEES 1133926 2868209 X PART X, LINE 2: THE CONSOLIDATED AFFILIATES ARE NONPROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, THUS THERE IS NO PROVISION FOR INCOME TAXES AT DECEMBER 31, 2015 AND 2014. THE HOSPITAL APPLIES THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE HOSPITAL DOES NOT CURRENTLY INCLUDE AN INCOME TAX PROVISION IN THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT MONITORS THE REPORTING OF UNCERTAIN TAX POSITIONS, WHICH COULD RESULT IN RECORDING OF AN INCOME TAX PROVISION IN THE FUTURE. 1 1 1 X 1 X 1 1 0 1 1 143856 143856 0.00440 5257945 2831047 2426898 0.07480 5401801 2831047 2570754 0.07920 3310 93774 143452 -49678 0.00000 15 18046 18046 0.00060 34491 5843999 4525140 1318859 0.04060 42987 42987 0.00130 37816 5998806 4668592 1330214 0.04250 37816 11400607 7499639 3900968 0.12170 1 1422284 55588 7288240 9097541 -1809301 X 1 1 1 1 GREENVILLE REGIONAL HOSPITAL 200 HEALTHCARE DRIVE GREENVILLE IL 62246 X X X GREENVILLE REGIONAL HOSPITAL 1 0 0 1 X X X X X X X X 13 1 0 0 1 X WWW.GREENVILLEREGIONALHOSPITAL.COM X 1 13 0 0 0 1 X 150.000000000000 300.000000000000 X X X X X X 1 1 X X X 1 X WWW.GREENVILLEREGIONALHOSPITAL.COM X WWW.GREENVILLEREGIONALHOSPITAL.COM X WWW.GREENVILLEREGIONALHOSPITAL.COM X X X X X X 1 X 0 X X X X 1 X 0 0 GREENVILLE REGIONAL HOSPITAL PART V, SECTION B, LINE 5: THE NEEDS ASSESSMENT SOUGHT INPUT FROM PERSONS WITH KNOWLEDGE OF THE SPECIFIC HEALTH CONCERNS OF THE COMMUNITY. 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 AND FAMILIES. A SERIES OF THREE FOCUS GROUPS WERE HELD. SPECIFIC EXAMPLES INCLUDE: PHYSICIANS, REPRESENTATIVES FROM THE BOND COUNTY HEALTH DEPARTMENT, THE GREENVILLE MAYOR, 911 COORDINATOR, COUNTY OFFICIALS, REPRESENTATIVES FROM THE LIONS CLUB, BUSINESS OWNERS, AND OTHERS. GREENVILLE REGIONAL HOSPITAL PART V, SECTION B, LINE 11: ESTABLISHED A WALK-IN CLINIC, AMONG OTHER GOALS MET. HAVE BEEN UNSUCCESSFUL RECRUITING FAMILY PRACTICE PHYSICIANS. SEVERAL HAVE INTERVIEWED BUT NONE HAVE COMMITTED FOR VARIOUS REASONS. EFFORTS CONTINUE. GREENVILLE REGIONAL HOSPITAL PART V, SECTION B, LINE 13H: STATE REGULATION GREENVILLE REGIONAL HOSPITAL PART V, SECTION B, LINE 16I: IN ADDITION TO THE ABOVE, A PLAIN LANGUAGE SUMMARY OF THE FAP IS SENT WITH EACH BILLING STATEMENT. 5 1 - GRH MEDICAL GROUP - MOB B 150 HEALTH CARE DRIVE GREENVILLE IL 62246 OB/GYN PHYSICIAN CLINIC 2 - GRH MEDICAL GROUP - MOB A 101 HEALTHCARE DRIVE GREENVILLE IL 62246 FAMILY PRACTICE PHYSICIAN CLINIC 3 - GRH MEDICAL GROUP - MOB C 201 HEALTHCARE DRIVE GREENVILLE IL 62246 FAMILY PRACTICE PHYSICIAN CLINIC 4 - EMERALD POINTE 105 HONEY LOCUST LANE GREENVILLE IL 62246 INDEPENDENT LIVING FACILITY 5 - CONVENIENT CARE 1345 S ROUTE 127 GREENVILLE IL 62246 WALK IN CLINIC STAFFED BY A NURSE PRACTITIONER PART I, LINE 6A: THE UTLAUT MEMORIAL FOUNDATION'S ANNUAL REPORT CONTAINS THE COMMUNITY BENEFIT INFORMATION. PART I, LINE 7: THE COST TO CHARGE RATIO SHOWN IN THE MEDICARE COST REPORT IS APPLIED TO THE GROSS AMOUNTS FOR CHARITY, MEDICAID, ETC. TO DETERMINE THE TRUE COST OF THESE PROGRAMS. FOR THE OTHER SUBSIDIZED PROGRAMS, SOME COSTS ARE ESTIMATED BASED ON CERTAIN ALLOCATIONS: SQUARE FOOTAGE, STATISTICS, STAFF TIME, SUPPLIES USED, AND OTHER VARIOUS FACTORS. PART I, LINE 7G: THE SERVICE OF PHYSICIAN PRACTICE OPERATIONS INCLUDES COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS. SOME OF THE COSTS INCLUDED IN THIS SUBSIDIZED SERVICE ARE SALARIES, BENEFITS, SUPPLIES, OUTSOURCED PHYSICIAN FEES, AND OTHER VARIOUS EXPENSES. 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 $ 1,422,284. PART III, LINE 2: THE ORGANIZATION APPLIES THE COST TO CHARGE RATIO FROM THE MOST RECENTLY FILED MEDICARE COST REPORT TO ITS AMOUNT OF GROSS BAD DEBT EXPENSE, PER THE GENERAL LEDGER. THIS METHODOLOGY CONVERTS THE GROSS AMOUNT TO NET COST. DISCOUNTS AND PAYMENTS ARE APPLIED TO THE ACCOUNT BEFORE ESTABLISHING THE GROSS BAD DEBT EXPENSE. PART III, LINE 3: THE COST TO CHARGE RATIO FROM THE MOST RECENT MEDICARE COST REPORT IS APPLIED TO THE ORGANIZATION'S BAD DEBT EXPENSE FOR THE FISCAL YEAR. THE ORGANIZATION EMPLOYS A FINANCIAL COUNSELOR THAT WORKS WITH ALL SELF-PAY PATIENTS. BASED ON REVIEW OF TAX RETURNS, BANK STATEMENTS, AND OTHER FINANCIAL DOCUMENTS PROVIDED BY THE PATIENT, AN ESTIMATE EQUAL TO 10% OF BAD DEBT PATIENTS WOULD QUALIFY FOR CHARITY CARE BUT FAILED TO PROVIDE THE APPROPRIATE LEVEL OF DOCUMENTATION AND INFORMATION. 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. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WITHIN 15 DAYS AFTER BILLING. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT AFTER 90 DAYS. AT DECEMBER 31, 2015 AND 2014, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS WAS APPROXIMATELY $1,658,000 AND $1,734,000, RESPECTIVELY. DURING FISCAL YEAR 2015, THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS DECREASED FROM AN AVERAGE OF 75% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2014 TO AN AVERAGE OF 69% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2015. IN ADDITION, THE HOSPITAL'S SELF-PAY WRITE-OFFS DECREASED APPROXIMATELY $321,000 FROM $1,743,000 FOR FISCAL YEAR 2014 TO $1,422,000 FOR FISCAL YEAR 2015. PART III, LINE 8: THE COST TO CHARGE RATIO FROM THE MEDICARE COST REPORT IS UTILIZED IN DETERMINING THE ORANIZATION'S COMMUNITY BENEFIT. PART III, LINE 9B: THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY INCLUDES A "PRESUMPTIVE ELIGIBILITY" SECTION. THE ORGANIZATION MAY DEEM A PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE WITHOUT ADDITIONAL SCRUTINY. THE PATIENT MUST DEMONSTRATE ONE OR MORE OF THE FOLLOWING TO MEET PRESUMPTIVE ELIGIBILITY CRITERIA: HOMELESSNESS, DECEASED WITH NO ESTATE, MENTAL INCAPACITATION WITH NO REPRESENTATIVE, MEDICAID ELIGIBLE BUT NOT ON DATE OF SERVICE OR FOR NON-COVERED SERVICE, INCARCERATION. IF THE PATIENT MEETS THE PRESUMPTIVE ELIGIBILITY CRITERIA OR IF THE PATIENT'S FAMILY INCOME IS BELOW THE FEDERAL POVERTY GUIDELINES, THE PATIENT IS NOT REQUIRED TO PROVIDE MONTHLY EXPENSE INFORMATION OR ESTIMATED EXPENSE FIGURES. PART VI, LINE 2: GREENVILLE REGIONAL HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES USING A VARIETY OF FORMAL AND INFORMAL METHODS. NRC PICKER SURVEYS WERE UTILIZED TO MONITOR THE QUALITY OF SERVICES PROVIDED AT THE HOSPITAL. FEEDBACK REGARDING HEALTH CARE NEEDS IS RECEIVED CONTINUALLY FROM FREQUENT INTERACTION AND ENCOUNTERS WITHIN THE COMMUNITY. SERVING A CLOSELY-KNIT AREA, GREENVILLE REGIONAL HOSPITAL'S MANAGEMENT TEAM IS INVOLVED IN MANY COMMUNITY CLUBS, ORGANIZATIONS, CHURCHES, TEAMS, AND COMMITTEES. THE BOARD OF DIRECTORS REPRESENTS A DIVERSE, CROSS SECTION OF THE COMMUNITY. BOARD MEMBERS RECEIVE AND SHARE COMMENTS RELATED TO HEALTH CARE NEEDS AND NEW SERVICES DESIRED. IN ADDITION, AN EVALUATION FORM IS SENT TO EACH "HEALTH FAIR" PARTICIPANT. THESE INDIVIDUALS ARE AFFORDED THE OPPORTUNITY TO PROVIDE FEEDBACK REGARDING THE EVENT AND THEIR NEED FOR LOW COST HEALTH SCREENINGS AND TESTING. ANY HEALTH TRENDS DETECTED THROUGH THE TESTING OFFERED AT THE HEALTH FAIR CAN BE ASSESSED AND USED TO SHAPE SERVICES PROVIDED BY THE HOSPITAL. MONTHLY MEDICAL STAFF MEETINGS OFFER PHYSICIANS THE OPPORTUNITY TO INTERACT WITH HOSPITAL MANAGEMENT AND DISCUSS SERVICES NEEDED BY THEIR PATIENTS. A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN 2013 AND ANOTHER WILL BE COMPLETED IN 2016. PART VI, LINE 3: THE HOSPITAL EMPLOYS A FINANCIAL COUNSELOR WHO WORKS WITH ALL SELF-PAY PATIENTS. THE COUNSELOR ASSESSES THE PATIENTS FINANCIAL POSITION AND WILL ASSIST THE PATIENT IN COMPLETING THE NECESSARY PAPERWORK TO APPLY FOR MEDICAID OR CHARITY CARE ASSISTANCE (IF APPLICABLE). PART VI, LINE 4: GREENVILLE REGIONAL HOSPITAL SERVES THE RESIDENTS OF BOND COUNTY AND THE SURROUNDING FOUR COUNTIES (FAYETTE, CLINTON, MONTGOMERY, AND MADISON). THE HOSPITAL HAS A PRIMARY MARKET AREA CONSISTING OF APPROXIMATELY 20,000 INDIVIDUALS. THE MARKET AREA INCLUDES AN ABOVE AVERAGE NUMBER OF SENIOR CITIZENS. RESIDENTS OVER THE AGE OF 55 ACCOUNT FOR 28 PERCENT OF THE HOSPITAL'S PRIMARY MARKET. THE MARKET AREA IS RURAL IN ITS COMPOSITION. THE AGRICULTURAL ECONOMY IS SIGNIFICANT WITHIN THE AREA. SOME MANUFACTURING DOES EXIST IN THE LOCAL COMMUNITIES. MEDICARE, MEDICAID, AND UNCOMPENSATED CARE PATIENTS COMPRISE A MAJORITY OF THOSE SERVED BY THE HOSPITAL. THE INCOME LEVELS OF THE MARKET AREA ARE NOT HIGH. MANY OF THE RESIDENTS IN THE REGION RELY ON THE HOSPITAL TO PROVIDE ROUTINE DIAGNOSTIC SERVICES SUCH AS LAB AND IMAGING SERVICES. THE HOSPITAL IS THE PRIMARY SOURCE OF AMBULANCE, EMERGENCY, AND REHABILITATION SERVICES. GREENVILLE REGIONAL IS THE ONLY FACILITY IN THE COUNTY, AND ONE OF ONLY TWO HOSPITALS IN THE AREA, THAT PROVIDES OBSTETRICAL SERVICES. THE NEXT CLOSEST OB UNIT WOULD REQUIRE A MINIMUM DRIVE TIME OF 30 MINUTES. THE HOSPITAL PROVIDES INFANT DELIVERY SERVICES FOR PATIENTS SPANNING AN 80 MILE RADIUS. GREENVILLE REGIONAL HOSPITAL IS THE LARGEST EMPLOYER IN BOND COUNTY WITH APPROXIMATELY 375 FULL-AND PART-TIME EMPLOYEES. THE FACILITY'S ANNUAL PAYROLL IS APPROXIMATELY $14.3 MILLION WITHOUT BENEFITS AND 18.1 MILLION WITH BENEFITS. THE HOSPITAL'S ECONOMIC IMPACT EXCEEDS $74 MILLION. PART VI, LINE 5: GREENVILLE REGIONAL HOSPITAL, AND ITS AFFILIATED DIVISIONS, EXISTS ONLY TO PROVIDE HEALTH CARE SERVICES FOR RESIDENTS OF THE AREA. IN 2015, THE HOSPITAL'S COMMUNITY BENEFIT TOTAL WAS DETERMINED TO BE APPROXIMATELY $4 MILLION. THE HOSPITAL IS INTENTIONALLY STRUCTURED AS A NOT-FOR-PROFIT ORGANIZATION IN THAT ITS ONLY PURPOSE IS TO SERVE OTHERS. NO SINGLE INDIVIDUAL OR GROUP OF INVESTORS PROFITS FROM THE ACTIVITIES OF THE HOSPITAL. AS IS EVIDENT BY THE FINANCIAL LOSSES REPORTED IN THIS DOCUMENT, THE HOSPITAL BOARD OF DIRECTORS IS COMMITTED TO SERVING THE HEALTH CARE NEEDS OF THE REGION. MEDICAL SERVICES CRITICAL TO THE HEALTH AND WELL-BEING OF THOSE SERVED BY THE HOSPITAL ARE PROVIDED EVEN THOUGH THE REVENUES GENERATED MAY NOT COVER THE OPERATIONAL COSTS. THE HOSPITAL'S NOT-FOR-PROFIT" STATUS IS VITAL TO THE ORGANIZATION'S EXISTENCE. GREENVILLE REGIONAL ADHERES TO A "NON-DISCRIMINATION TREATMENT POLICY". REGARDLESS OF A PATIENT'S FINANCIAL OR HEALTH INSURANCE STATUS, CARE IS PROVIDED. NO PATIENT IS REFUSED TREATMENT BASED UPON THEIR ABILITY TO PAY. GREENVILLE REGIONAL HOSPITAL FUNDS ITS OWN "HEALTH CARE ASSISTANCE PROGRAM". IN 2015, $141,270 IN CHARITY ASSISTANCE (AT COST) WAS PROVIDED TO PATIENTS WHO QUALIFIED FOR BILLING REDUCTIONS UP TO 100 PERCENT. INCOME GUIDELINES AND FAMILY SIZE ARE USED TO DETERMINE ELIGIBILITY FOR THIS SELF-FUNDED PROGRAM. OBSTETRICAL PATIENTS FROM A WIDE GEOGRAPHICAL RADIUS USE THE GREENVILLE REGIONAL OBSTETRICAL DEPARTMENT. GREENVILLE REGIONAL IS ONE OF ONLY TWO HOSPITALS IN THE IMMEDIATE AREA THAT PROVIDE INFANT DELIVERY SERVICES. AN ANNUAL LOSS ASSOCIATED WITH PROVIDING INFANT DELIVERIES HAS BECOME AN EXPECTED PRACTICE. THE HOSPITAL'S BOARD OF DIRECTORS HAS ACCEPTED THE LOSS AS A RESULT OF THE PAYER MIX AND THE LACK OF OBSTETRICAL SERVICES WITHIN THE AREA. SIX OF EVERY TEN BIRTHS AT THE HOSPITAL ARE OF MEDICAID STATUS. THE STATE OF ILLINOIS MEDICAID PROGRAM DOES NOT MEET THE COST OF PROVIDING CARE. THE BOARD OF DIRECTORS BELIEVES THAT THE AVAILABILITY OF INFANT DELIVERY SERVICES IS VITALLY IMPORTANT FOR THE HEALTH AND WELL BEING OF THE MULTI-COUNTY AREA SERVED BY THE HOSPITAL. THE HOSPITAL-OWNED FAMILY, OB/GYN, PSYCHIATRIC, SPORTS MEDICINE, ONCOLOGY, PULMONOLOGY, AND SURGERY PRACTICES EXPERIENCED A LOSS OF $1.4M IN 2015. DURING THE 2014 FISCAL YEAR, THE OPERATIONAL LOSS AT FAIR OAKS NURSING HOME WAS $178K. BOND COUNTY EMERGENCY MEDICAL SERVICES IS OPERATED BY THE HOSPITAL AND REPRESENTS A UNIQUE PRIVATE-PUBLIC PARTNERSHIP. GREENVILLE REGIONAL HOSPITAL IS A "COMMUNITY RESOURCE" THAT IMPROVES THE HEALTH AND QUALITY OF LIFE FOR THOSE RESIDING IN THE AREA. IN ADDITION TO THE AVAILABILITY OF EMERGENCY, DIAGNOSTIC, TREATMENT, AND REHABILITATION SERVICES, GREENVILLE REGIONAL HOSPITAL OFFERS NO-COST LANGUAGE TRANSLATION FOR PATIENTS IN NEED OF THIS SERVICE. THE HOSPITAL OWNS A MEDICAL CLINIC IN A SMALL, NEIGHBORING COMMUNITY. THIS MEDICAL OFFICE SAVES TIME AND COST FOR MANY WHO WOULD HAVE TO DRIVE GREATER DISTANCES TO RECEIVE PRIMARY CARE. THE FACILITY IS A CERTIFIED RURAL HEALTH CLINIC. MID LEVEL PRACTITIONERS AND PHYSICIANS STAFF THE OUTREACH FACILITY. FOR THE PAST 30 YEARS, GREENVILLE REGIONAL HOSPITAL HAS SPONSORED A MULTI-FACETED HEALTH FAIR. THE EVENT IS ONE OF THE LARGEST HEALTH FAIRS IN THE ST. LOUIS METROPOLITAN AREA. THE EVENT FEATURES MANY FREE HEALTH TESTS IN ADDITION TO FOUR, LOW-COST COMPREHENSIVE BLOOD TESTS. IN 2015, APPROXIMATELY 2,800 BLOOD TESTS WERE PERFORMED IN CONJUNCTION WITH THE HEALTH FAIR. THE PARTICIPANTS RECEIVE THE DIRECT COMMUNITY BENEFIT OF THE FREE AND REDUCED PRICE TESTING OFFERED BY THE HOSPITAL. PARTICIPANTS COULD CHOOSE FROM A COMPREHENSIVE BLOOD TEST, PROSTATE SPECIFIC ANTIGEN BLOOD TEST (PSA), HEMOGLOBIN A1-C, VITAMIN D BLOOD TEST, OR A COMBINATION OF THE FOUR BLOOD TESTS. THE OPPORTUNITY COST INCURRED BY GREENVILLE REGIONAL HOSPITAL FOR OFFERING THESE DISCOUNTED SERVICES WAS $1,332,935. THE ORGANIZATION CONSIDERS THE OPPORTUNITY COST AS THE REDUCTION IN REVENUE THAT WOULD HAVE BEEN RECEIVED HAD THE HEALTH FAIR TESTING BEEN PROVIDED AT TYPICAL RETAIL PRICING. MORE THAN 250 VOLUNTEERS ASSIST WITH THE EVENT. IN ADDITION TO THE SERVICES PROVIDED ON THE DAY OF THE HEALTH FAIR, THE HOSPITAL ALSO PERFORMS THE LOW-COST BLOOD TESTS AT SEVERAL OFF-SITE LOCATIONS FOR THE EMPLOYEES OF AREA SCHOOLS, BUSINESSES, AND MANUFACTURERS. THROUGH THE YEARS, A NUMBER OF LIFE-THREATENING AND SERIOUS MEDICAL CONDITIONS HAVE BEEN DISCOVERED BY TESTING PERFORMED IN ASSOCIATION WITH THE EVENT. THE $964,820 VIOLA THOMPSON SCHOLARSHIP FUND, ADMINISTERED BY GREENVILLE REGIONAL HOSPITAL, PROVIDES TUITION ASSISTANCE FOR INDIVIDUALS PURSUING A HEALTH OR MEDICAL CAREER. IN 2015, SCHOLARSHIPS TOTALING $18K WERE AWARDED. NURSING STUDENTS, MEDICAL STUDENTS, PHYSICIAN RESIDENTS, AND GREENVILLE COLLEGE PSYCHOLOGY STUDENTS UTILIZE THE HOSPITAL FACILITY FOR TRAINING AND LEARNING OPPORTUNITIES. THE HOSPITAL IS OFFERED AS A TRAINING SITE AT NO COST TO THE STUDENTS. THE HOSPITAL IS ALSO THE SITE OF REGULARLY SCHEDULED BLOOD COLLECTION DRIVES. THESE ORGANIZATIONS ARE NOT CHARGED FOR USE OF THE HOSPITAL. THE LEMUAL RHODES CANCER FUND BOARD OF DIRECTORS MEETS AT THE HOSPITAL AND AWARDS FUNDING TO PATIENTS UNDERGOING TREATMENT FOR CANCER. RETIRED TEACHERS, COMMUNITY CLUBS, AND ORGANIZATIONS MEET AT THE HOSPITAL. TWO SCOREBOARDS LOCATED AT THE LOCAL HIGH SCHOOL ARE CO-SPONSORED BY THE HOSPITAL. GREENVILLE REGIONAL HOSPITAL SUPPORTS VARIOUS COMMUNITY ORGANIZATIONS AND ACTIVITIES THAT PROMOTE HEALTHY LIFESTYLES AND WORK TO IMPROVE QUALITY OF LIFE ISSUES.GREENVILLE REGIONAL HOSPITAL HAS A STRONG AND VIBRANT RELATIONSHIP WITH A NUMBER OF PUBLIC, PRIVATE, AND MEDICAL PROVIDERS WHO PARTNER WITH THE ORGANIZATION DURING THE YEAR. THE COOPERATING AGENCIES ASSIST WITH BOTH ON-GOING, AS WELL AS SPECIAL PROJECTS. THE HOSPITAL PARTNERS WITH COUNTY GOVERNMENT TO OPERATE BOND COUNTY EMERGENCY MEDICAL SERVICES. FINALLY, NUMEROUS MEDICAL PROVIDERS AND ORGANIZATIONS WITH VARIOUS SPECIALTIES PARTICIPATE IN THE ANNUAL GREENVILLE REGIONAL HOSPITAL HEALTH FAIR. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. 1 GREENVILLE REGIONAL HEALTHCARE INC 200 HEALTH CARE DRIVE GREENVILLE IL 62246 371139987 501(C)(3) 78107 HOSPITAL/AUXILIARY ACTIVITY 1 PART I, LINE 2: THE ORGANIZATION'S GENERAL LEDGER PROGRAM MONITORS TRANSACTIONS. X X 1 1 X X X X 0 0 0 0 0 0 0 1 0 DR KELSEY HOPKINS BOARD MEMBER/PHYSICIAN 267197 0 0 0 1237 0 5019 0 6560 0 280013 0 0 0 BRIAN NALL COO 245075 0 0 0 1986 0 4566 0 7056 0 258683 0 0 0 TAMMY LETT CNO 135083 0 7500 0 855 0 1627 0 5375 0 150440 0 0 0 DR MICHAEL SCHULTHEIS PHYSICIAN 370517 0 10000 0 139 0 1411 0 2047 0 384114 0 0 0 DR BOYD MCCRACKEN PHYSICIAN 289079 0 0 0 1057 0 5595 0 5474 0 301205 0 0 0 DR RICHARD FUNNEMAN PHYSICIAN 227540 0 0 0 1350 0 4724 0 7317 0 240931 0 0 0 DR PHILIP SIEFKEN PHYSICIAN 230150 0 0 0 934 0 4505 0 7659 0 243248 0 0 0 STEVEN DONNAN CRNA 219034 0 0 0 580 0 2262 0 6613 0 228489 0 0 0 PART I, LINE 1A THE GROSS-UP PAYMENT IS FOR LONG-TERM DISABILITY. BRIAN NALL, KELSEY HOPKINS, BOYD MCCRACKEN, PHILIP SIEFKEN, AND RICHARD FUNNEMAN RECEIVED THE PAYMENT. THE PAYMENT WAS TREATED AS TAXABLE COMPENSATION. BRIAN NALL RECEIVED SOCIAL CLUB DUES. THIS AMOUNT IS INCLUDED IN HIS TAXABLE COMPENSATION. PART I, LINE 7 GENERAL RETENTION BONUS A CITY OF GREENVILLE 376000403 2011-10-20 10000000 REFUND PRIOR ISSUE (04/01/03) CONSTRUCTION / REMODEL PROJECTS AND EQUIPMENT 0 0 0 A 2509287 10000000 952249 115223 1288060 7631344 13124 2014 1 0 1 1 A 0 1 1 1 0 0.01140 0.00000 0.01140 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 4 THE BOARD OF DIRECTORS SHALL NOW CONSIST OF AT LEAST SEVEN BUT NO MORE THAN ELEVEN PERSONS. ALSO, THE BOARD OF DIRECTORS SHALL NOW REVIEW THE BYLAWS AT LEAST EVERY THREE YEARS. FORM 990, PART VI, SECTION A, LINE 6 GREENVILLE REGIONAL HEALTHCARE, INC., AN ILLINOIS NOT-FOR-PROFIT CORPORATION, IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A EACH DIRECTOR IS ELECTED BY THE MEMBER, GREENVILLE REGIONAL HEALTHCARE INC. FORM 990, PART VI, SECTION B, LINE 11 REVIEWED BY KEY EMPLOYEES (CFO, CEO, CNO) AND DISTRIBUTED TO THE BOARD OF DIRECTORS VIA EMAIL BEFORE FINAL SUBMISSION. AMPLE TIME IS ALLOWED FOR BOARD MEMBERS TO REVIEW THE 990 AND SUGGEST ANY CHANGES PRIOR TO FINAL SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR, THE BOARD OF DIRECTORS AND ANY KEY EMPLOYEES, HIGHEST COMPENSATED EMPLOYEES, AND MEMBERS OF MANAGEMENT COMPLETE A RELATIONSHIP/CONFLICT OF INTEREST QUESTIONAIRE. ANY CONFLICTS THAT ARISE ARE DEALT WITH ACCORDINGLY BY THE ORGANIZATION'S OFFICERS. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD AND THE HOSPITAL'S HUMAN RESOURCES' COLLABORATE AND MAKE A FINAL DETERMINATION BY REVIEWING COMPARABLE SALARIES OF THE REGION. FORM 990, PART VI, SECTION C, LINE 19 GREENVILLE REGIONAL HOSPITAL MAKES ITS FORM 990 AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST, BUT ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 3,295,366. MANAGEMENT AND GENERAL EXPENSES 625,977. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,921,343. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 1,624,986. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,624,986. FORM 990, PART XI, LINE 9: NET TRANSFERS BETWEEN AFFILIATE -18,959. FORM 990, PART XII, LINE 2C: PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. GREENVILLE REGIONAL HEALTHCARE INC 200 HEALTHCARE DRIVE GREENVILLE IL 62246 371139987 HEALTHCARE IL 501(C)(3) LINE 11B, II N/A 0 UTLAUT MEMORIAL FOUNDATION INC 200 HEALTHCARE DRIVE GREENVILLE IL 62246 371140166 FUNDRAISING IL 501(C)(3) LINE 11B, II GREENVILLE REGIONAL HEALTHCARE INC 0 0 1 1 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0