2016-02-11T10:10:54-06:00 2015-03-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2014-04-01 201244058 FERRELL HOSPITAL COMMUNITY FOUNDATION FERR 6182733361 1201 PINE STREET ELDORADO IL 62930 JOSEPH HOHENBERGER CFO 6182733361 2016-02-09 1 JEFF PARKER P00970069 3149254300 2014 2016-04-25 22:37:26Z ALISA COLEMAN 1201 PINE STREET ELDORADO IL 62930 17019360 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. 11 8 221 20 0 0 226389 28936 16580217 16834906 63324 13047 1606458 142471 18476388 17019360 0 0 0 0 9204091 8184228 0 0 0 7669557 8031620 16873648 16215848 1602740 803512 7364276 7158746 7219208 6210166 145068 948580 X OPERATE ACUTE CARE HOSPITAL - DEDICATED TO IMPROVING THE HEALTH AND QUALITY OF LIFE FOR THE PEOPLE AND COMMUNITIES WE SERVE 0 0 15927562 16834906 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 PROVIDED CHARITY CARE WITH CHARGES OF APPROXIMATELY $235,000. ADDITIONALLY, FERRELL HOSPITAL COMMUNITY FOUNDATION OFFERS VARIOUS BENEFITS TO THE COMMUNITY INCLUDING BUT NOT LIMITED TO CPR/FIRST AID, PARTICIPATION IN THE SALINE COUNTY HEALTH COALITION, PARTICIPATION IN THE HEALTH FAIRS AT LOCAL HIGH SCHOOLS AND COLLEGES, POISON PREVENTION AND HEALTH CARE CAREER PRESENATIONS 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 SENIOR 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 FINALLY PARTICIPATE IN THE SAFE HAVEN PROGRAM. 15927562 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 22 0 221 1 0 0 0 0 0 0 0 0 0 0 X 11 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 JOE BUTLER SECRETARY 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 72308 0 0 BILL JONES BOARD MEMBER 2.00 X 0 0 0 NATE OLDHAM MD BOARD MEMBER / PHYSICIAN 40.00 X 272150 0 8749 JASON KASIAR BOARD MEMBER 2.00 X 0 0 0 BARB DEVOUS BOARD MEMBER / EMPLOYEE 40.00 X 54045 0 1351 NIKKI ROSER BOARD MEMBER 2.00 X 0 0 0 SHAWN MCCOY BOARD MEMBER 2.00 X 0 0 0 JAMES PORTER BOARD MEMBER 2.00 X 0 0 0 DONALD G BROWN CEO 40.00 X 119032 0 0 CHARLES WILL CFO 40.00 X 102798 0 0 ALISA COLEMAN CEO 40.00 X 0 0 0 JOSEPH HOHENBERGER CFO 40.00 X 0 0 0 ELLIOTT PARTRIDGE MD PHYSICIAN 40.00 X 233796 0 0 DALLAS C BASINGER PHARMACIST 40.00 X 123876 0 0 978005 0 10100 5 0 1 0 REGIONAL EMERGENCY DEPT STAFFING LLC 600 MARY ST EVANSVILLE IN 47747 EMERGENCY ROOM PHYSICIANS 1194579 MEDHOST OF TENNESSEE INC 6550 CAROTHERS PARKWAY FRANKLIN TN 37067 DATA PROCESSING 369519 PROGRESSIVE HEALTH OF INDIANA LLC PO BOX 6890 EVANSVILLE IN 47719 PHYSICAL AND OCCUPATIONAL THERAPIST 234661 RANDY WIENTJES CRBA MA 3042 LAKEVIEW DR METROPOLIS IL 62960 ANESTHESIOLOGY 222600 DIAGNOSTIC SHARED SERVICES INC 2650 EASTPOINT PARKWAY LOUISVILLE KY 40223 MRI SERVICES 201424 7 28533 403 28936 INPATIENT & OUTPATIENT SVC 624110 16347058 16347058 340B REVENUE 624110 400938 400938 EHR REVENUE 624110 86910 86910 16834906 13047 13047 8625 0 8625 8625 8625 NON OP REVENUE 624110 51582 51582 OTHER REVENUE 624110 31214 31214 EMP CAFETERIA 624110 27874 27874 23176 23176 133846 17019360 16834906 0 155518 X 827663 827663 5985389 5985389 71637 71637 820563 820563 478976 478976 104163 104163 3469297 3181011 288286 29919 29919 1031393 1031393 221157 221157 68224 68224 205025 205025 472727 472727 116186 116186 BAD DEBTS 1071491 1071491 DRUGS 617979 617979 MISC/PROVIDER TAX 473788 473788 FOOD 93174 93174 57097 57097 16215848 15927562 288286 0 213293 247262 492035 465896 3271546 2883851 22050 4410 17000 228026 240091 62932 327016 7614304 4641084 3074394 2973220 7364276 7158746 2198685 1413818 4129680 3963193 890843 833155 7219208 6210166 X 145068 948580 145068 948580 7364276 7158746 803512 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 7449 7449 0 PART II-B, LINE 1: ORGANIZATION PAYS DUES TO IHA ANNUALLY. 39% OF THESE DUES ARE USED FOR LOBBYING ACTIVITIES. 159712 159712 2893995 1147111 1746884 44285 36068 8217 4504744 3457905 1046839 11568 11568 2973220 3RD PARTY REIMBURSEMENT PROGRAMS 833155 833155 X 15947869 0 15947869 1071491 1071491 17019360 15144357 0 15144357 1071491 1071491 16215848 PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL APPLIES THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATIONS'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 INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE HOSPITAL IS NOT AWARE OF ANY ACTIVITES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS AND IS NOT AWARE OF ANY ACTIVITES THAT ARE SUBJECT TO TAX ON UNREALTED BUSINESS INCOME OR EXCISE OR OTHER TAXES. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,071,491. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,071,491. 1 1 1 X 1 X 100.000000000000 1 1 0 1 1 94890 94890 0.00630 3833951 1433237 2400714 0.15850 3928841 1433237 2495604 0.16480 3928841 1433237 2495604 0.16480 1 1071491 234513 6587870 7776428 -1188558 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 FOUNDATION 0 0 1 X X X X X X X X X X 12 1 0 0 1 X FERRELLHOSP.ORG 1 13 0 1 0 1 X 100.000000000000 100.000000000000 X X X X X 1 1 X X X 1 X FERRELLHOSP.ORG X X X X 1 X 0 X X X X 1 X 0 0 FERRELL HOSPITAL COMMUNITY FOUNDATION PART V, SECTION B, LINE 3J: POTENTIAL INFORMATION GAPS WERE DISCUSSED RELATED TO RESIDENTS LIVING IN POVERTY IN ELDORADO AND CARMI AND THE FERRELL HOSPITAL PRIMARY SERVICE AREA. FERRELL HOSPITAL COMMUNITY FOUNDATION 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 OF COUNCIL REPRESENTIVE. FERRELL HOSPITAL COMMUNITY FOUNDATION PART V, SECTION B, LINE 11: FERRELL HAS DEVELOPED AN INTERACTIVE ROLE WITH CAADA TO REPORT EVENTS AND INSTITUTE PREVENTIVE MEASURES; FERRELL HAS INCREASE STAFF MENTAL HEALTH TRAINING AND HAS IMPLEMENTED MENTAL HEALTH COUNSELING SERVICES; IMPROVED ACCESS TO WELLNESS EDUCATION BY IMPLEMENTING EDUCATION PROGRAMS, EDUCATIONAL MATERIALS, ENCOURAGING LOCAL EFFORTS, WORKING TOWARD CREATION OF LOCAL FOOD BANK; EXPANDED RURAL HEALTH CLINIC HOURS DURING EVENINGS, WEEKENDS AND HOLIDAYS; FERRELL IS PROVIDING TRANSLATION SERVICES FOR SPANISH SPEAKING PATIENTS; IMPLEMENTED A TEEN PREGNANCY AWARENESS PROGRAM; INCREASED PROFESSIONAL MEDICAL PROVIDER STAFF BY THREE PA/NP'S AND ONE PHYSICIAN. FERRELL HOSPITAL COMMUNITY FOUNDATION PART V, SECTION B, LINE 22D: 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 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY FERRELL HOSPITAL COMMUNITY FOUNDATION PART V, SECTION B, LINE 16A WEBSITE: FERRELLHOSP.ORG 2 FERRELL HOSPITAL FAMILY PRACTICE 1201 PINE STREET ELDORADO IL 62930 RURAL HEALTH CLINIC LOCUST STREET CLINIC 1407 LOCUST STREET ELDORADO IL 62930 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, LN 7 COL(F): 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 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, 2015 AND 2014, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS WAS APPROXIMATELY $627,000 AND $838,000, RESPECTIVELY. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS AN AVERAGE OF 80 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AS OF MARCH 31, 2015 AND 2014. IN ADDITION, THE HOSPITAL'S SELF-PAY WRITE-OFFS DECREASED APPROXIMATELY $328,000 TO $1,071,000 FOR FISCAL YEAR 2015 FROM $1,399,000 FOR FISCAL YEAR 2014. PART III, LINE 8: MEDICARE ALLOWABLE COSTS INCLUDE AMOUNTS FROM THE FISCAL YEAR 2015 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 2015 FISCAL YEAR PSR WAS INCLUDED AFTER APPLYING THE OVERALL HOSPITAL COST TO CHARGE RATIO FROM THE 2015 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 PROCEDURED 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 0 0 0 0 0 0 0 1 0 NATE OLDHAM MD BOARD MEMBER / PHYSICIAN 219510 0 7500 0 45140 0 0 0 8749 0 280899 0 0 0 ELLIOTT PARTRIDGE MD PHYSICIAN 233796 0 0 0 0 0 0 0 0 0 233796 0 0 0 PART I, LINE 7 DR. OLDHAM RECEIVED A PAYMENT PROVIDED IN HIS CONTRACT FOR THE RECRUITMENT OF A NEW PHYSICIAN. IT WAS A FIXED PAYMENT AMOUNT CONTINGENT ON SIGNING A PHYSICIAN WHO HE RECRUITED. DR NATHAN OLDHAM MD DIRECTOR BUYOUT PREVIOUS AGREEMENT/OBLIGATION X 88200 4410 0 1 1 4410 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 THE HOSPITAL AND A MANAGEMENT SERVICE PROVIDER ENTERED INTO A MANAGEMENT AGREEMENT UNDER WHICH THE HOSPITAL'S BOARD RETAINS ALL AUTHORITY. MANAGEMENT SERVICES PROVIDED TO THE HOSPITAL CONSIST OF MANAGEMENT PERSONNEL INCLUDING A CEO AND CFO, FACILITY PLANNING, STRATEGIC PLANNING, AND SEVERAL OTHER SUPPORT AND OVERSIGHT SERVICES. THE TERM OF THE AGREEMENT IS FOR A THREE YEAR PERIOD, WHICH CAN BE TERMINATED BY EITHER PARTY WITH THIRTY DAY NOTICE AND EXTENDED BEYOND THE INITIAL THREE YEAR PERIOD IF SO DESIRED. THE HOSPITAL WILL REIMBURSE THE MANAGEMENT SERVICE PROVIDER THE ACTUAL COST OF PROVIDING THE MANAGEMENT SERVICES ON A MONTHLY BASIS. IN ADDITION, THE HOSPITAL AND AN AFFILIATE OF THE MANAGEMENT SERVICE PROVIDER HAVE ENTERED INTO A STRATEGIC AFFILIATION AGREEMENT. UNDER THE AGREEMENT THE PARTIES WILL EVALUATE THE FEASIBILITY OF A LONG-TERM AFFILIATION AND DEVELOP AN AFFILIATION MODEL IF BOTH PARTIES DESIRE. FORM 990, PART VI, SECTION B, LINE 11 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 2013. CFO SALARY DETERMINED AND APPROVED IN SAME MANNER AS CEO. ALL OTHER EXECUTIVE SALARIES APPROVED BY EXECUTIVE MANAGEMENT AND ANALYSED BASED ON INDUSTRY COMPARATIVE DATA AND POSITION DESCRIPTIONS, COMMENSURATE EXPERIENCE, EXPERTISE AND TRAINING. THIS PROCESS WAS LAST COMPLETED IN 2014. 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 PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,973,728. MANAGEMENT AND GENERAL EXPENSES 288,286. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,262,014. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,207,283. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,207,283. FORM 990, PAGE 12, PART XII, LINE 2C PROCESS HAS NOT CHANGED FROM PROIR YEAR.