2016-03-10T15:18:09-06:00 2015-07-31 450250958 EIDE BAILLY LLP 1545 ASSOCIATES DR STE 101 DUBUQUE IA 52002 990 2014-08-01 370645239 Carlinville Area Hospital Association CARL 2178543141 20733 North Broad Street Carlinville IL 62626 Kenneth Reid CEO 2178543141 2016-03-07 1 Carmen Krantz P00031958 5635561790 2016-03-06 2014 2016-08-17 19:52:53Z Kenneth Reid 20733 North Broad Street Carlinville IL 62626 24246871 0 X www.cahcare.com X 1947 IL Provide quality acute and preventative health care benefits 9 8 211 142 0 0 351384 3203020 20242526 20963459 -300580 -258491 20874 23693 20314204 23931681 0 0 0 0 8586697 9093348 0 0 0 11870805 12525035 20457502 21618383 -143298 2313298 34349507 36154486 21014714 20507015 13334793 15647471 X To maintain a professional medical community, a primary care hospital and other health care services, in order to provide quality acute and preventative health care for the benefit of those persons living in the service area. 1 0 17272650 20963459 Carlinville Area Hospital Association is a 25-bed acute care hospital located in Carlinville, Illinois. The Hospital provides inpatient, outpatient and emergency care services for residents of central Illinois.During fiscal year 2015, we carried out our exempt purpose in the following ways: 1) Provided quality short term acute care medical services to 322 inpatients, of which 84% were eligible for Medicare. Without our services these elderly patients would have had to travel over 20 miles to receive similar services. 2) Provided quality short term skilled care to 139 patients in our swing bed unit, with an average length of stay of 9.1 days. 3) Provided 24 hour a day emergency room services. Our emergency room treated 6,494 patients during fiscal year 2015. We treat everyone who presents themselves to our emergency room regardless of their medical condition or ability to pay. We provided 24 hour physician service so people residing in the Carlinville area do not have to travel long distances for emergency medical care. 4) In addition to the inpatient and emergency services we provide, we also had 20,846 visits in our outpatient departments. These services range from preventative care items such as mammograms and lab tests to rehabilitative services such as Physical and Occupational therapy. 5) The hospital also had 5,469 visits to their specialty clinics. These clinics bring specialists from metropolitan areas to Carlinville on a rotating basis. This provides access to specialty services not otherwise offered in the area. 6) The hospital also had 4,621 visits in our Rural Health Clinics. These clinics allow for patients to stay closer to home and get in to see a medical provider.The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The amounts of charges foregone were $301,000 for the year ended July 31, 2015. The estimated costs of the charges foregone, based upon an overall cost-to-charge ratio calculation, for the year ended July 31, 2015 were $177,000. 17272650 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 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 1 0 0 0 1 18 0 1 211 1 0 0 0 0 0 0 0 0 0 0 X 9 8 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X Michael Brown 2178543857 20733 North Broad Street Carlinville IL 62626 J Richard Schien Chairman 1.00 0.30 X X 0 0 0 James Salske Vice Chairman 1.00 0.30 X X 0 0 0 Ralph March Secretary 1.00 0.60 X X 0 0 0 Dennis Pickrel Treasurer 1.00 0.60 X X 0 0 0 Steve Gourley Member 1.00 0.00 X 0 0 0 Tracey Smith Member 1.00 0.00 X 0 0 0 Richard Walden Member 1.00 0.00 X 0 0 0 Kate Wilkens MD Ex-officio voting member 41.00 0.00 X 191388 0 13295 Elizabeth O'Brien MD Ex-officio voting member 1.00 0.00 X 0 0 0 Kenneth Reid CEO 40.00 1.30 X 0 0 0 Michael Brown CFO 40.00 1.30 X 0 0 0 Curtis Cravens CRNA Nurse Anesthesiology 40.00 0.00 X 174840 0 17378 Sara McPeak Chief Nurse Executive 40.00 0.00 X 142247 0 5279 Kathleen Laboray PT Physical Therapy 40.00 0.00 X 108855 0 9801 Dr Meta Jo Floyd Pharmacist 40.00 0.00 X 124106 0 0 741436 0 45753 5 0 1 0 Illinois Emergency Physicians 4075 Copper Ridge Drive Traverse City MI 496840793 Emergency room physicians 1469532 Jaren Industries Inc 6868 Pec Road Springfield IL 62711 Demoliton services 525000 CPSI 6600 Wall St Mobile AL 36695 Information technology services 315794 HealthTech Management Services Inc PO Box 636426 Cincinnati OH 452636426 Management services 304075 CPP Wound Care #25 LLC 3445 N Causeway Metairie LA 70002 Wound care services 216025 9 3123024 25122 54874 3203020 Patient service revenue 622110 20495286 20495286 EHR Medicare incentive 900099 348916 348916 Supporting revenue 900099 119257 119257 20963459 56699 56699 23693 0 23693 23693 23693 315190 -315190 -315190 -315190 23931681 20963459 0 -234798 X 203948 203948 7055862 5853415 1202447 198030 164034 33996 1090008 908212 181796 545500 453513 91987 723648 723648 108049 108049 66020 66020 2597616 2432448 165168 209165 148 209017 1099587 427768 671819 251036 251036 23968 15884 8084 91011 30880 60131 2223026 2223026 2012145 2012145 339155 13787 325368 Dues and subscriptions 1076792 599988 476804 Medical supplies 877461 877461 Bad debt expense 624957 624957 Food 167262 167262 34137 12738 21399 21618383 17272650 4345733 0 4629580 4360218 3118387 2823744 365 173520 188895 214542 221381 32499128 10662767 19336825 21836361 2136058 2758265 2344792 2686225 2395803 1279032 34349507 36154486 1190879 1101257 396000 296664 18282835 17921069 1145000 1188025 21014714 20507015 X 12660944 14974242 673849 673229 13334793 15647471 34349507 36154486 X 2313298 -620 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 517172 517172 19812583 8608946 11203637 6451328 1682045 4769283 5718045 371776 5346269 21836361 Beneficial interest in perpetual trust 593229 F Mortgage escrow funds 2092996 F 2686225 Employee health claims 185000 Construction 1003025 1188025 X 20183700 -624957 -624957 20808657 3123024 3123024 23931681 20993426 0 20993426 624957 624957 21618383 Part X, Line 2: The Hospital is organized as an Illinois nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Provision for bad debts included in total expenses for Form 990 -624,957. Part XI, Line 4b - Other Adjustments: Transfer from related party included in fund balance for financial statement 3,123,024. Part XII, Line 4b - Other Adjustments: Provision for bad debts included in total expenses for Form 990 624,957. 1 1 X 1 X 125.000000000000 1 X 1 1 1 0 1 1 177000 177000 0.00840 4127195 3574962 552233 0.02630 4304195 3574962 729233 0.03470 2211281 739269 1472012 0.07010 2211281 739269 1472012 0.07010 6515476 4314231 2201245 0.10480 2 3290 16000 16000 0.00080 2 3290 16000 16000 0.00080 0 624957 5301 8813103 8878786 -65683 X 1 1 1 1 Carlinville Area Hospital Association 20733 North Broad Street Carlinville IL 62626 www.cahcare.com 0005686 X X X X 2 provider based RHCs and 1 provider based clinic Carlinville Area Hospital Association 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X www.cahcare.com X 1 12 1 www.cahcare.com 0 0 1 X 125.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X www.cahcare.com X X X X 1 X 0 X X X 1 X 0 1 Carlinville Area Hospital Association Part V, Section B, Line 5: Input from persons who represent the community include a nurse practitioner, the Dean from Lewis and Clark Community College, Ambulance Districts, VNA-TIP, Nursing Homes, a Local Pharmacy, a dentist and an optometrist. Also consulted was the Superintendent of Carlinville Schools, the principal of Carlinville High School, President of Carlinville Chamber of Commerce, Macoupin County sheriff, President of Carlinville National Bank, and Davis-Anderson Funeral Home. A town hall meeting was also held. Carlinville Area Hospital Association Part V, Section B, Line 11: From the completion of the Community Health Needs Assessment, Carlinville Area Hospital Association is not able to address increasing local resources for the treatment of sexual assault victims. The Hospital has transfer agreements with nearby facilities which provide extensive specialty services to sexual assault victims. Duplicating those specialized services locally is not financially feasible.The following needs identified in the Community Health Needs Assessment were still in process in fiscal year 2015.1. Physician recruitment and replacement planningA full-time Hospitalist/Primary Care was hired 5/1/2015. Hired Ann zahniser, NP to establish practice at Carlinville Family Health Care. Broke ground on Medical Office Building on 10/13/2014. 2. Plan for sustainability of local dental careThe Hospital works with the Public Health Department Transportation Program in Macoupin County to notify them when a patient is seen that needs dental care and has transportation issues so the public health department can provide assistance. The Hospital plans to actively assist the Carlinville Winning Community Organization with keeping a current resource inventory.3. Plan for recruitment of mental health care providers and emergency mental health care providersThere has been significant improvement in the availability of services from the Locust Street Resource Center, which includes a visiting psychiatrist from the Springfield area. A new Senior Behavioral Health Program tailored for the Medicare-aged population to provide individual and group therapy as part of the new Medical Office Building on the Hospital Campus.4. Increase wellness education and care opportunities for the elderlyThe Hospital will create a wellness resource availability guide promoted through social media and create and/or participate in new wellness activities for seniors.5. Increase prevention education for alcohol abuse among all agesThe Hospital created a relationship with the community substance abuse awareness group (i.e. Anti-Meth Coalition) and will co-sponsor a community-wide activity on substance abuse.6. Increase prevention education programs for smokingThe Hospital with measure employee smoking reduction and cessation with completion of the classes. Carlinville Area Hospital Association Part V, Section B, Line 16i: Financial assistance contact information is provided on each bill. A notice about the availability of charity care is posted in the admitting areas, including the ER. The Hospital also employs a full time financial counselor to discuss the availability of various government services and charity care with patients. Carlinville Area Hospital Association Part V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Carlinville Area Hospital Association Part V, Section B, line 16b website: www.cahcare.com Part I, Line 6a: The annual community benefit report is mailed to 15,000 residents in our service area. Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. Part I, Ln 7 Col(f): The amount of bad debt expense removed from total expenses to determine the percentage was $624,957. Part II, Community Building Activities: The Lunch Bunch Program provides healthy meals for children from low income households at no cost during the summer when meals are not available through the district. The service ran from June 1 through August 1 and served 1,520 adults and 1,730 children. The total cost to the Hospital was over $13,000.The Third Day Project serves underprivileged children by providing food to children on long weekends from school where they may otherwise not have food available to them. Approximately 40 children from Carlinville Primary School, selected by school administration, are provided with a free healthy sack of food the day prior to long weekends from school. The Hospital Dietary Department orders all the food and helps the group of volunteers inventory the food that goes into the bags. The cost to provide the food bags was over $3,000. Part III, Line 2: The bad debt expense is only the uncollected portion of the patient account. Any discounts would be treated as a reduction in revenue. All forms of payment, including self-pay, insurance, contractual allowances, and discounts reduce the patient's account prior to the account being classified as bad debt. A payment received on an account previously written off as bad debt reduces bad debt expense. Bad debt expense reported on line 2 is at charges as reported on the financial statements. Part III, Line 3: The estimated amount of the Organization's bad debt expense attributable to patients eligible under the Organization's charity care policy is calculated based on an estimate of charges foregone to gross patient charges. This portion can reasonably be considered a community benefit as it would have been written off to charity care. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 9 of the attached audited financial statements. Part III, Line 8: Carlinville Area Hospital Association is a critical access hospital with a Medicare shortfall. The shortfall is due to sequestration. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit.Both the total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: Carlinville Area Hospital Association will give the charity care applicant at least 120 days from the date of service to apply for financial assistance without any collection efforts. If the applicant has applied for health care coverage under Medicaid, Kidcare, or other government sponsored health care programs, Carlinville Area Hospital will await the approval or denial of the application without additional collection efforts.Carlinville Area Hospital Association will not refer a bill to collection without first offering the patient the opportunity to request a reasonable payment plan for the amount personally owed by the patient. Such an opportunity shall be made available for the 30 days following the date of the initial bill. If the patient requests a reasonable payment plan, but fails to agree to a plan within 30 days of the request the hospital may proceed with collection action against the patient.No collection efforts will be pursued if the uninsured patient has agreed to a reasonable payment plan and the patient keeps to the agreement. If the patient fails to make the payments agreed upon, regular collection efforts will be pursued.Carlinville Area Hospital Association will not pursue legal action for non-payment of a hospital bill against uninsured patients who have clearly demonstrated that they have neither sufficient income nor assets to meet their financial obligations. Part VI, Line 2: The Hospital works with physicians, the health department, nursing homes and other health care providers in the community to determine the health care needs. A formal community health needs assessment was completed in FY 2013 and posted to our website to meet one of the 501r requirements. We are in the process of collecting and analyzing data for our second CHNA due in FY2016. Part VI, Line 3: Financial assistance contact information is provided on each bill. A notice about the availability of charity care is posted in the admitting areas, including the ER. The Hospital also employs a full time financial counselor to discuss the availability of various government services and charity care with patients. Part VI, Line 4: Carlinville Area Hospital Association is a 25-bed acute care hospital located in Carlinville, Illinois. The Hospital serves the residents of Macoupin County. Carlinville Area Hospital is the only hospital within a 20 mile radius of Carlinville Illinois, a small rural community in central Illinois. Illinois Route 4 passes through Carlinville. Interstate 55 is also within 12 miles of the city. The community is mostly agricultural.Other hospitals and medical centers near Carlinville are St. Francis Hospital, a Critical Access Hospital in Litchfield, IL, approximately 14 miles away, Community Memorial Hospital, a Critical Access Hospital in Staunton, IL, approximately 20 miles away and Hillsboro Area Hospital, a Critical Access Hospital in Hillsboro, IL, approximately 24 miles away.Carlinville had a population of 5,813 in 2013. Unemployment was 6.8% compared to 6.7% in the state of Illinois in 2014. Carlinville residents with income below the poverty level was 23.6% and residents with income below 50% of the poverty level was 3.7%. Part VI, Line 5: Carlinville Area Hospital Association's core purpose is "Excellent healthcare close to home." This is very important to our board as all of our members live in our service area and use our facility. The Hospital extends medical staff privileges to all qualified physicians in the community. Carlinville Area Hospital invests in improvements in the community and continues to minimize long-term debt. The Hospital also provides the following services that would not otherwise be available within the Hospital's service area: Twenty-four hour a day emergency room that treats all patients regardless of ability to pay Specialty Clinic - The Hospital has an arrangement with a physician group out of Springfield, IL that brings specialists to the Carlinville Area that would not otherwise be available.Throughout the year, Carlinville Area Hospital offered CPR training to the community for a special rate of $12 per participant.The Hospital provided free blood pressure checks in Carlinville and Palmyra on a monthly basis.Carlinville Area Hospital's Imaging Department hosted a free community presentation in observance of National Breast Cancer Awareness Month in October. Early detection, benefits of digital mammography, and how the advanced technology aids in early detection were discussed.Approximately 16 churches throughout Macoupin County received first aid supply bags from Carlinville Area Hospital. The bags included a pillow, blanket, stethoscope, blood pressure cuff, gloves, disposable washcloths, ice packs, pocket CPR mask, band aids, various dressings, peroxide, alcohol wipes, and cotton balls. These basic supplies were provided to help the churches during services or activities when church members may become ill or injured.Carlinville Area Hospital participated in the Illinois Cooperative Work Study Program. The program offered opportunities for college students to gain hands-on experience in their field of study. The Hospital also served as a clinical site for students in Radiology from Southwestern Illinois College and Pharmacy from St. Louis College of Pharmacy. Part VI, Line 7, Reports Filed With States IL 0 0 0 0 0 0 0 0 0 Kate Wilkens MD Ex-officio voting member 190653 0 0 0 735 0 6868 0 6426 0 204682 0 0 0 Curtis Cravens CRNA Nurse Anesthesiology 173696 0 0 0 1144 0 6207 0 11172 0 192219 0 0 0 Schedule J, Part I, Question 3: Carlinville Area Hospital Association does not pay compensation to the CEO directly. The CEO is compensated by an unrelated management company, HealthTech Management Services, Inc. The Hospital Board of Directors uses the processes described in Part I, Question 3 to determine appropriate compensation for the CEO. The Board of Directors also approves the Organization's contract with the Management Company. Form 990, Part III, line 2 The hospital added a new physician to act as a hospitalist. In this role, this physician handles the primary care for patients who present to the emergency room and may need to be admitted to the hospital or put into an observation status. This has been well received by the patients who no longer have to be transferred out of town for care. Form 990, Part VI, Section A, line 1 The Executive Committee is composed of the elected officers of the Board and includes the Chairman, Vice Chairman, Secretary, and Treasurer of the Association. The Executive Committee has the power and authority to manage and control the business and affairs of the Association as the Board of Directors; however, the Executive Committee is not allowed to exercise those powers prohibited by Illinois law which include: amending the Articles or Bylaws; sell, transfer, or otherwise dispose of substantially all of the Association's assets; or adopt Articles of Merger or Consolidation. Form 990, Part VI, Section A, line 2 J. Richard Schien, Chairman, and Richard Walden, board member have a business relationship. James Salske, Vice Chairman, and Richard Walden, board member have a business relationship. Form 990, Part VI, Section A, line 3 Kenneth Reid, CEO, and Michael Brown, CFO, are common law employees of HealthTech Management Services, Inc., an unrelated management company. The CEO has the responsibility of supervising the management, administration and operation of the Organization. The CFO has the responsibility for managing the Organization's finances. Kenneth Reid was compensated $200,000 for services to Carlinville Area Hospital Association. Michael Brown was compensated $133,900 for services to Carlinville Area Hospital Association. Form 990, Part VI, Section A, line 6 The Organization's sole member is Middle Macoupin Health Care Systems. Form 990, Part VI, Section A, line 7a The Member has the exclusive right and power to designate three of its Directors to serve as members of the Board of Directors, and by resolution has authority to appoint and remove all Directors from the Board. Form 990, Part VI, Section A, line 7b The Member has the exclusive right and power to approve or reject the following actions prior to the Board of Directors taking any action: 1. the annual operating budget, capital budget, long-range plan and any action which will result in a substantial change in the expenditures or revenue forecast; 2. the undertaking of or substantive amendments to a contractual obligation in excess of $50,000, or the guaranteeing of any obligation in excess of $50,000; 3. the purchase, lease, transfer, mortgage or sale of any asset or property with a value in excess of $50,000, except with respect to transactions specified and previously approved within the capital budget; 4. any plan of construction or remodeling involving an expenditure in excess of $50,000, except with respect to transactions specified and previously approved within the capital budget; 5. any borrowing; 6. any application for a government grant; 7. any general plan for the solicitation of charitable contributions or the solicitation or acceptance as a gift of any real property or any interest; 8. any proposal to adopt Articles of Dissolution, Merger, or Consolidation; 9. any selection, removal or change in the compensation or other terms of employment of the operating officers; 10. any substantial change in employee fringe benefits or personnel policies; and 11. any other matters as may be required by law to be submitted to the Member or as to which the Member determines, by resolution, that submission is advisable. Form 990, Part VI, Section B, line 11 The Form 990 is distributed to the governing body before it is filed. The CEO and CFO review the Form 990. Form 990, Part VI, Section B, line 12c Any duality of interest or possible conflict of interest on the part of any Board member should be disclosed to the other members of the Board and made a matter of record through an annual procedure and also when the interest becomes a matter of Board action. Any Board member having a duality of interest or possible conflict of interest on any matter should not vote or use his or her personal influence on the matter. The minutes of the meeting must reflect the disclosure, the abstention from voting, and the quorum situation. Any new member of the Board will be advised of this policy upon entering on the duties of office. The governing Board, CEO, and CFO complete and sign the conflict of interest form yearly. The forms are reviewed by the CEO of the Organization and if a potential conflict is identified the CEO follows up. Form 990, Part VI, Section B, line 15 The CEO and CFO are compensated through HealthTech Management Services, Inc., an unrelated management company. They are considered common law employees of HealthTech Management Services, Inc. HealthTech Management Services, Inc. gives the Board of Directors a recommended salary range for the CEO and CFO and the Board sets the compensation within this range after review of performance evaluations and comparability data. The process is documented and is completed on an annual basis. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are not available to the public. Financial information is available through the public disclosure copy of the 990. Form 990, Part IX, line 11g Repairs and maintenance: Program service expenses 44,480. Management and general expenses 293. Fundraising expenses 0. Total expenses 44,773. Purchased services and contract labor: Program service expenses 1,626,081. Management and general expenses 58,305. Fundraising expenses 0. Total expenses 1,684,386. Professional fees: Program service expenses 761,887. Management and general expenses 106,570. Fundraising expenses 0. Total expenses 868,457. Form 990, Part XI, line 9: Change in beneficial interest in perpetual trust -620. Carlinville Area Hospital Foundation 20733 North Broad Street Carlinville IL 62626 371193348 Support Carlinville Area Hospital Association IL 501(c)(3) Line 11a, I Middle Macoupin Healthcare Systems 0 Middle Macoupin Healthcare Systems 20733 North Broad Street Carlinville IL 62626 371193396 Provide support and benefit Carlinville Area Hospital Association IL 501(c)(3) Line 11c, III-FI N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0