2016-05-12T16:12:28-05:00 2015-06-30 BKD LLP 211 N BROADWAY SUITE 600 ST LOUIS MO 631022733 990 2014-07-01 362852553 Illinois Valley Community Hospital % DIANE GARLAND ILLI 8152233300 925 WEST STREET PERU IL 61354 TOMMY HOBBS CEO 8152233300 2016-05-11 true Troy A Lindsey P01041237 3142315544 2014 2016-08-17 19:52:53Z TOMMY HOBBS 925 WEST STREET PERU IL 61354 81163175 false X WWW.IVCH.ORG X 1978 IL ILLINOIS VALLEY COMMUNITY HOSPITAL IS DEDICATED TO PROVIDING EXCEPTIONAL CARE THROUGH A COMMITMENT TO CLINICAL EXCELLENCE AND COMPASSION FOR EVERY PATIENT, EVERY DAY. 10 10 710 170 0 439388 56272 83035966 79511873 649191 425856 644437 627854 84768982 80621855 43695 40520 0 0 37944930 40080651 0 0 0 46264933 43139215 84253558 83260386 515424 -2638531 76014036 76142677 39971042 46458665 36042994 29684012 X ILLINOIS VALLEY COMMUNITY HOSPITAL IS DEDICATED TO PROVIDING EXCEPTIONAL CARE THROUGH A COMMITMENT TO CLINICAL EXCELLENCE AND COMPASSION FOR EVERY PATIENT, EVERY DAY. false false 68951442 40520 79511873 ILLINOIS VALLEY COMMUNITY HOSPITAL (IVCH) IS A SMALL, INTEGRATED COMMUNITY HEALTH CARE DELIVERY SYSTEM. SERVICES RANGE FROM EMPLOYED PHYSICIANS AND MID-LEVELS IN THE SPECIALTIES OF FAMILY MEDICINE, INTERNAL MEDICINE, OBSTETRICS/GYNECOLOGY, ORTHOPEDICS, OTORHINOLARYNGOLOY, AND SLEEP MEDICINE. IN ADDITION TO THESE PHYSICIAN PRACTICES, IVCH ALSO OFFERS A FAST CARE AND CARE TODAY CLINIC WHICH PROVIDES A LOWER-COST, CONVENIENT ALTERNATIVE TO EMERGENCY ROOM CARE. CONTRACTED PHYSICIAN SERVICES ARE PROVIDED FOR EMERGENCY MEDICINE, ANESTHESIOLOGY AND HOSPITALISTS SERVICES. INPATIENT HOSPITAL SERVICES PROVIDED BY IVCH INCLUDE MEDICAL AND SURGICAL SERVICES, ICU, OBSTETRICS, SWING BEDS, DIAGNOSTIC, REHAB AND TREATMENT SERVICES. OUTPATIENT SERVICES INCLUDE SURGERY, EMERGENCY ROOM, LABORATORY, DIAGNOSTIC IMAGING, REHAB SERVICES, PAIN MANAGEMENT, SLEEP THERAPY, WOUND MANAGEMENT, RESPIRATORY CARE, EKG, OTHER DIAGNOSTIC AND THERAPEUTIC SERVICES. HOSPICE AND ADULT DAY CARE SERVICES ARE ALSO PROVIDED. IVCH IS A MEDICARE DEPENDENT HOSPITAL AND QUALIFIES FOR DISPROPORTIONATE SHARE PAYMENTS. IVCH IS COMMITTED TO PROVIDING THE HIGHEST QUALITY OF HEALTH SERVICES TO ALL PATIENTS, REGARDLESS OF THEIR FINANCIAL STATUS OR ABILITY TO PAY. IVCH SUBSIDIZES THE COST OF TREATING PATIENTS WHO ARE UNABLE TO PAY AND THOSE WHO RECEIVE GOVERNMENT ASSISTANCE WHERE REIMBURSEMENT IS LIMITED. IN FY 2015 THE COST OF FINANCIAL ASSISTANCE AND MEANS TESTED GOVERNMENT PROGRAMS PROVIDED BY IVCH WAS $6,798,890. STATISTICS: INPATIENT ADMISSIONS: 2,555 INPATIENT DAYS: 7,346 NEWBORN DELIVERIES: 464 INPATIENT SURGERIES: 735 OUTPATIENT SURGERIES: 4,628 OUTPATIENT VISITS: 91,092 EMERGENCY ROOM VISITS: 15,552 CLINIC VISITS: 71,094 68951442 true true false true false false false false false false true false false true true false false true false false false false false false false false true true true false true true false false false false false false false false true false false false false false false true true true false false true 69 0 true 710 true false false false false false false false false false false X 10 10 true false true false true true true true true false false true true true true true true true false false IL X DIANE GARLAND 8157803500 925 WEST STREET PERU IL 61354 X CYNTHIA KURKOWSKI DIRECTOR 1.0 1.0 X 0 0 0 DAVID J SICKLEY TREASURER 1.0 2.0 X X 0 0 0 GEORGE BUCKMAN DIRECTOR 1.0 2.0 X 0 0 0 JAMES CLINARD DIRECTOR 1.0 1.0 X 0 0 0 JAMES LOVELAND VICE PRESIDENT 1.0 3.0 X X 0 0 0 JOSEPH HOGAN DIRECTOR 1.0 2.0 X 0 0 0 KRISTINE A PAUL PRESIDENT 1.0 3.0 X X 0 0 0 MICHAEL ROONEY OD DIRECTOR 1.0 1.0 X 0 0 0 RICHARD MARTUZZO SECRETARY 1.0 3.0 X X 0 0 0 WILLIAM ETZENBACH DIRECTOR 1.0 1.0 X 0 0 0 WILLIAM VLASNIK DIRECTOR 1.0 3.0 X 0 0 0 STEPHEN DAVIS CFO 34.0 6.0 X 139992 0 36763 TOMMY HOBBS CEO 34.0 6.0 X 235319 0 43382 BRANDON MUSGRAVE MD PHYSICIAN 40.0 0.0 X 510249 0 34727 MARIO COTE MD PHYSICIAN 40.0 0.0 X 467560 0 37126 PETER MEIER MD PHYSICIAN 40.0 0.0 X 726707 0 33790 ROBERT MITCHELL MD PHYSICIAN 40.0 0.0 X 578642 0 31069 SCOTT MILLINGTON MD PHYSICIAN 40.0 0.0 X 415993 0 33366 3074462 0 250223 31 false true false PERU EMERGENCY PHYSICIANS LLP PO BOX 674579 DETROIT MI 48267 PHYSICIAN SERVICES 3282384 IVAA 925 WEST STREET PERU IL 61354 ANESTHESIOLOGY 1167667 EUGENE BECKER MD 14637 RIVER OAKS DRIVE LINCONSHIRE IL 60069 ANESTHESIOLOGY 450000 DOWNSTATE SHOCKWAVE THERAPIES 405 BRONCO DRIVE BLOOMINGTON IL 61704 LITHOTRIPSY 380901 LOCUMTENENSCOM PO BOX 405547 ATLANTA GA 30384 PHYSICIAN STAFFING 273290 13 56272 56272 NET PATIENT SERVICE REVENUE 621110 78849913 78849913 EHR INCENTIVE REVENUE 621110 661960 661960 79511873 425856 0 425856 0 0 426499 541320 -114821 0 -114821 -114821 0 0 0 0 CAFETERIA REVENUE 721000 272237 272237 MANAGEMENT FEES 541610 58000 58000 TRANSPORT VEHICLE REVENUE 900099 248541 248541 163897 163897 742675 80621855 79511873 1053710 40520 40520 0 0 0 455456 455456 0 25474 25474 28360139 23296120 5064019 1314368 1084456 229912 7966707 6498058 1468649 1958507 1586307 372200 0 560795 560795 69651 69651 46685 46685 0 0 5565617 5565617 592921 133727 459194 702390 338604 363786 1201254 800836 400418 0 1846708 1622665 224043 17084 16294 790 0 133015 118500 14515 601175 486947 114228 0 4063823 3285967 777856 854786 496980 357806 SUPPLIES 12051161 11817139 234022 PURCHASED SERVICES 7457747 5019072 2438675 BAD DEBT EXPENSE 4267911 4267911 REPAIRS & MAINTENANCE 1582321 1208081 374240 1524171 1267641 256530 83260386 68951442 14308944 0 1682073 3420379 100807 0 0 0 11254591 10174899 0 0 0 0 0 0 2927763 2707034 1130385 1340551 112738937 75525518 38981086 37213419 14377346 15819673 436084 405300 0 0 0 0 5123901 5061422 76014036 76142677 8190488 10067413 0 0 0 0 21559750 21430000 0 0 0 0 2210865 1793247 0 0 8009939 13168005 39971042 46458665 X 34832432 28473430 1210562 1210582 0 0 36042994 29684012 76014036 76142677 X -2638531 -154046 -2761088 -805317 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false true 100 false false false false true 64004 64104 false SCHEDULE C, PART II-B, LINE 1I ALLOCATED PORTION OF MEMBERSHIP DUES WITH ILLINOIS HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION AND MEDICARE DEPENDENT RURAL HOSPITAL COALITION. 1476235 1476235 52703163 29891975 22811188 304038 184042 119996 56831404 44397794 12433610 1424097 1051707 372390 37213419 DUE FROM AFFILIATES 2042685 INTEREST IN IVCH FOUNDATION 1210582 OTHER ASSETS 1808155 5061422 0 PENSION OBLIGATION 4965800 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 3903132 ESTIMATED SELF-INSURANCE COSTS 3912000 DUE TO AFFILIATES 387073 13168005 true true true X true X true true false true true 551327 551327 0.00700 11719815 6553248 5166567 0.06540 12271142 6553248 5717894 0.07240 805320 319151 486169 0.00620 17270 17270 0.00020 964246 613434 350812 0.00120 44520 44520 0.00060 1831356 932585 898771 0.00820 14102498 7485833 6616665 0.08060 false 4267911 427000 18901544 19027488 -125944 X true true 1 1 ILLINOIS VALLEY COMMUNITY HOSPITAL 925 WEST STREET PERU IL 61354 WWW.IVCH.ORG 0003418 X X X VARIOUS PHYSICIAN CLINICS & OUTPATIENT SERVICES ILLINOIS VALLEY COMMUNITY HOSPITAL 1 false false true X X X X X X X X X 13 true false false true X SEE SECTION C X true 14 true SEE SECTION C false false true X 150. 300. X X X X true true X X X X true X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X true X false X X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 3J INDUSTRY DATA RELATED TO PROJECTED GROWTH IN NEED FOR VARIOUS SERVICES SPECIFIC TO THE POPULATION OF THIS AREA SCHEDULE H, PART V, SECTION B, LINE 5 COMMUNITY INPUT FOR CHNA: THE CHNA STAKEHOLDERS WORKING GROUP, COMPRISED OF MEMBERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITIES SERVED, WAS RESPONSIBLE FOR THE CHNA PROCESS. THE STAKEHOLDER GROUP INCLUDED MEMBERS FROM : IVCH, IVCH MEDICAL GROUP, LA SALLE COUNTY HEALTH DEPT., ALTERNATIVES FOR THE OLDER ADULT, YOUTH SERVICE BUREAU, NORTH CENTRAL BEHAVIORAL HEALTH SERVICES, HYGIENIC INSTITUTE, OGLESBY PUBLIC SCHOOLS AND ILLINOIS VALLEY UNITED WAY. THE WORKING GROUP DEVELOPED A SURVEY INSTRUMENT, EVALUATED SURVEY RESPONSES, COLLECTED AND EVALUATED SECONDARY DATA, SYNTHESIZED THE PRIMARY AND SECONDARY DATA, AND IDENTIFIED AND PRIORITIZED COMMUNITY HEALTH NEEDS. PRIMARY DATA FOR THIS ASSESSMENT CAME FROM TWO SOURCES, A COMMUNITY STUDY PERFORMED FOR IVCH BY LEEDE RESEARCH IN 2008 AND A SURVEY DEVELOPED, DISTRIBUTED AND ANALYZED BY THE STAKEHOLDERS WORKING GROUP SPECIFICALLY FOR THE CHNA. SCHEDULE H, PART V, SECTION B, LINE 7A WWW.IVCH.ORG IS THE ORGANIZATION'S WEBSITE. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE UNDER THE ABOUT US TAB ON THE HOME PAGE. SCHEDULE H, PART V, SECTION B, LINE 10A WWW.IVCH.ORG UNDER THE PATIENT TAB OF THE HOME PAGE OF THE ORGANIZATION. SCHEDULE H, PART V, SECTION B, LINE 11 THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDES A DESCRIPTION OF THE ACTIONS TAKEN TO MEET NEEDS THAT WERE IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE AREAS OF CONCERN THAT HAVE BEEN IDENTIFIED HISTORICALLY, AND WERE FURTHER ELEVATED IN THE NEW 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, RELATE TO MENTAL HEALTH/ADDICTION SERVICES AND DENTAL CARE. REGARDING DENTAL CARE, IVCH HAS DEVELOPED A LISTING OF SERVICES AVAILABLE IN THE AREA WHICH IS PROVIDED TO PATIENTS. THE MOST SIGNIFICANT NEED IS THE MENTAL HEALTH AND ADDICTION SERVICES. IN ADDITION TO THE ALREADY IDENTIFIED NEED, A SIGNIFICANT MENTAL HEALTH AGENCY IN THE SERVICE AREA HAS GREATLY REDUCED ITS SERVICES DUE TO THE REDUCTION IN ITS GRANT FUNDING. THIS IS CURRENTLY SIGNIFICANTLY IMPACTING ACCESS TO MENTAL HEALTH CARE. INADEQUATE AVAILABILE MENTAL HEALTH INPATIENT CARE IS RESULTING IN A BACKUP OF PATIENTS IN EMERGENCY CARE. IVCH IS EXPLORING PSYCHIATRY TELEHEALTH SERVICES AS WELL AS A POTENTIAL JOINT VENTURE OF PSYCHIATRY SERVICES WITH A HOSPITAL IN THE ADJACENT SERVICE AREA. SCHEDULE H, PART V, SECTION B, LINES 16 A, B, & C WWW.IVCH.ORG LOCATED IN THE PATIENTS TAB ON THE HOME PAGE SCHEDULE H, PART V, SECTION B, LINE 20E EFFORTS ARE MADE ON EACH ACCOUNT TO DETERMINE ELIGIBILITY FOR THE FINANCIAL ASSISTANCE POLICY, AND WITH PATIENTS WHO DO NOT WISH TO BECOME ELIGIBLE, A REASONABLE RE-PAYMENT PLAN IS DEVELOPED THAT IS KNOWN TO THE PATIENT. 5 CENTER FOR PHYSICAL REHABILITATION 300 WALNUT ST PERU IL 61354 OUTPATIENT PHYSICAL REHABILITATION IVCH WOUND & HYPERBARIC CENTER 1403 6TH ST PERU IL 61354 WOUND AND HYPERBARIC THERAPY ILLINOIS VALLEY ADULT DAY CENTER 1040 SECOND ST LA SALLE IL 61301 ADULT DAY CARE IVCH CARE TODAY 300 WALNUT ST PERU IL 61354 URGENT CARE ALTERNATIVE TO ER IVCH FAST CARE 5307 ST ROUTE 251 PERU IL 63154 RETAIL CLINIC SCHEDULE H, PART III, SECTION A, LINE 2 THE ORGANIZATION RECORDS CONTRACTUAL DISCOUNTS AT THE TIME OF THE POSTING OF THE PAYMENT FOR SERVICES FROM THIRD PARTY PAYORS. BAD DEBT IS RECORDED AT THE TIME THE ACCOUNT IS EITHER PRESUMED UNCOLLECTIBLE OR TURNED OVER TO COLLECTION. FURTHER, THE ORGANIZATION RECORDS APPROPRIATE ALLOWANCES FOR CONTRACTUAL DISCOUNTS AND BAD DEBT/CHARITY CARE ORDER TO REFLECT ACCOUNTS RECEIVABLE AT THE EXPECTED COLLECTIBLE AMOUNT. CONTRACTUAL DISCOUNTS/MEDICARE/MEDICAID: MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYORS IN EVALUATING THE REASONABLE ESTIMATE OF THE ALLOWANCE FOR CONTRACTUAL DISCOUNTS. FOR SERVICES PROVIDED TO PATIENTS THAT HAVE THIRD PARTY COVERAGE, THE CORPORATION ANALYZES THE DISCOUNT RATES FOR EACH MAJOR PAYOR. THE DIFFERENCE BETWEEN THE NEGOTIATED RATES FOR THE MEDICARE/MEDICAID STANDARD RATES ARE USED TO DETERMINE THE ALLOWANCE FOR CONTRACTUAL DISCOUNTS. SELF-PAY ACCOUNTS RECEIVABLE INCLUDE THE PATIENT RESPONSIBILITY FOR SERVICES AFTER THE THIRD PARTY COVERAGE HAS BEEN APPLIED TO THE PATIENT ACCOUNT AS WELL AS THE UNINSURED. AN ALLOWANCE FOR BAD DEBT IS ESTIMATED BASED ON PAST EXPERIENCE AS WELL AS THE AGE OF THE ACCOUNTS. THE ORGANIZATION HAS A COLLECTIONS PRACTICES POLICY THAT IS USED TO SET GUIDELINES ON THE APPROACH AND TIMELINE TO MAKE REASONABLE COLLECTION EFFORTS BEFORE ANY ACCOUNTS ARE TURNED OVER TO A COLLECTION AGENCY. THE ORGANIZATION HAD BAD DEBT EXPENSE TOTALING $4,267,911. THIS REFLECTS THE COMBINED IMPACT OF WRITE-OFFS OF UNCOLLECTIBLE ACCOUNTS, PROVISIONS RECORDED TO ESTIMATE BAD DEBT ON ACCOUNTS RECEIVABLE. DURING FISCAL 2015 THERE WERE NO CHANGES IN THE ORGANIZATION'S POLICIES OR PRACTICES. IN FISCAL 2016 THE CHARITY CARE POLICY AND COLLECTION PRACTICES POLICIES HAVE ALL BEEN UPDATED AND ARE 501(R) COMPLIANT. SCHEDULE H, PART III, SECTION A, LINE 3 10% OF BAD DEBT IS ASSUMED TO BE PROVIDED INCLUDE AMOUNTS WRITTEN OFF FOR PATIENTS THAT WOULD HAVE QUALIFIED FOR THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE RATIONALE FOR THE PERCENTAGE BEING THIS IS BECAUSE OF THE SIGNIFICANT STEPS TAKEN WITH PATIENTS TO FACILITATE MEDICAID OR FINANCIAL ASSISTANCE QUALIFICATION. SCHEDULE H, PART III, SECTION A, LINE 4 ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL 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. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL 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 PATIENTS (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 HOSPITAL 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. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS 73 PERCENT AT JUNE 30, 2015. SCHEDULE H, PART III, SECTION B, LINE 8 IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NON-PROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. THE AMOUNTS REPORTED ON LINE 6 WERE OBTAINED FROM WORKSHEET D OF THE FY 2015 MEDICARE COST REPORT. SCHEDULE H, PART III, SECTION C, LINE 9B WHEN A PATIENT IS IN THE PROCESS OF APPLYING FOR FINANCIAL ASSISTANCE THE ACCOUNT IS PLACED ON HOLD AND NO FURTHER COLLECTION EFFORTS ARE MADE UNTIL THE REQUEST FOR ASSISTANCE HAS BEEN RESOLVED. THE APPLICATION PROCESS INCLUDES FACILITATING THE PATIENT'S APPLICATION FOR VARIOUS ASSISTANCE PROGRAMS, AND IDENTIFYING WHERE THE PATIENT FALLS IN THE DISCOUNT SCALE OF THE ORGANIZATION BASED ON INCOME LEVEL AND SIZE OF FAMILY. IF THERE IS A BALANCE REMAINING AFTER CHARITY CARE OR OTHER FINANCIAL ASSISTANCE HAS BEEN APPLIED, A MUTUALLY AGREED UPON PAYMENT PLAN IS DEVELOPED AND THE ACCOUNT FOLLOWS THE SAME COLLECTION PROCEDURES AS ALL OTHER SELF-PAY ACCOUNTS. MONTHLY PAYMENTS ARE REQUIRED AND BALANCES ARE TYPICALLY EXPECTED TO BE PAID IN FULL WITHIN ONE YEAR. EXTENSIONS MAY BE APPROVED FOR UNEXPECTED CHANGES IN ABILITY TO MEET THE PAYMENT SCHEDULE. COLLECTION PROCEDURES INCLUDE STATEMENTS, PAST DUE NOTICES, PHONE CALLS AND IF AGREED UPON PAYMENT ARRANGEMENTS CAN NOT BE MET, THE ACCOUNT IS REFERRED TO A COLLECTION AGENCY. SCHEDULE H, PART VI, LINE 2 THE DETERMINATION OF CURRENT AND FUTURE HEALTH CARE NEEDS OF THE COMMUNITIES SERVED BY IVCH IS BASED ON A COMBINATION OF THE FOLLOWING FACTORS: EXISTENCE OR NON-EXISTENCE OF APPROPRIATE SERVICES, DEMONSTRATED NEED, VOICE OF THE CUSTOMER, COLLABORATION WITH COMMUNITY ORGANIZATIONS, GOVERNMENT AGENCIES AND OTHER HEALTH CARE PROVIDERS, BENCHMARKING MARKET RESEARCH, CUSTOMER SURVEYS, PHYSICIAN INPUT AND MONITORING OF STATE AND FEDERAL GUIDELINES. THIS INFORMATION IS REVIEWED AND ANALYZED BY THE HOSPITAL'S ADMINISTRATIVE TEAM AND INCORPORATED INTO THE HOSPITAL'S STRATEGIC PLANNING PROCESS. SCHEDULE H, PART VI, LINE 3 DOCUMENTATION IS PROVIDED AT THE TIME OF REGISTRATION INFORMING PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE AND PROVIDING CONTACT INFORMATION FOR THE PATIENT FINANCIAL SERVICES DEPT. BASIC INFORMATION AND CONTACT INFORMATION IS ALSO AVAILABLE AT WWW.ICVH.ORG ON THE PATIENTS & VISITORS TAB ON THE HOME PAGE. WHEN CONTACTED BY A PATIENT, FINANCIAL COUNSELORS WORK INDIVIDUALLY WITH EACH APPLICANT TO DETERMINE ELIGIBILITY FOR CHARITY OR FINANCIAL ASSISTANCE. NOTICES ABOUT FINANCIAL ASSISTANCE PROGRAMS ARE POSTED IN THE REGISTRATION AREAS AND INFORMATION IS ALSO INCLUDED ON THE PATIENT STATEMENTS. THE SOCIAL SERVICES DEPARTMENT NOTIFIES EACH INPATIENT OF FINANCIAL ASSISTANCE PROGRAMS AVAILABLE AT IVCH AS WELL AS LOCAL, STATE AND FEDERAL PROGRAMS THEY MAY BE ELIGIBLE FOR. SCHEDULE H, PART VI, LINE 4 ILLINOIS VALLEY COMMUNITY HOSPITAL SERVES THE RESIDENTS OF RURAL COMMUNITIES LOCATED IN LA SALLE, BUREAU AND PUTNAM COUNTIES, IN NORTH CENTRAL ILLINOIS. THE HOSPITAL IS LOCATED NEAR THE JUNCTION OF INTERSTATES 80 AND 39 AND IS 62 MILES WEST OF JOLIET AND 64 MILES NORTH OF BLOOMINGTON. THE PRIMARY SERVICE AREA OF THE HOSPITAL HAS A POPULATION OF ABOUT 35,000. NO POPULATION GROWTH IS PROJECTED FOR THE AREA. THE LARGEST AREA EMPLOYERS ARE INVOLVED IN TRANSPORTATION, WAREHOUSING, AGRICULTURE, LIGHT INDUSTRY AND RETAIL SERVICES. THE SERVICE AREA RACE AND ETHNICITY IS COMPOSED OF 88% WHITE, 2% AFRICAN AMERICAN, 9% HISPANIC AND 1% ASIAN. ACCORDING TO THE ILLINOIS DEPARTMENT OF EMPLOYMENT SECURITY, THE 2015 UNEMPLOYMENT RATE IN LA SALLE COUNTY WAS 8.3%, WHICH WAS HIGHER THAN THE STATE OF ILLINOIS (7.1%) AND THE UNITED STATES (6.2%). THE MEDIAN HOUSEHOLD INCOME IN LA SALLE ($49,487), BUREAU ($49,062) AND PUTNAM ($56,212) COUNTIES WERE ALL BELOW THE STATE OF ILLINOIS FIGURE OF $58,438. THE PROPORTION OF LA SALLE COUNTY RESIDENTS LIVING BELOW THE FEDERAL POVERTY LEVEL (13.2%) IS SLIGHTLY LESS THAN THE STATE AVERAGE OF 14.4%. IVCH SERVES PATIENTS WITHOUT REGARD TO AGE, GENDER, INCOME, ETHNIC ORIGIN, INSURANCE COVERAGE OR ABILITY TO PAY. APPROXIMATELY 63.5% OF THE HOSPITAL'S GROSS PATIENT SERVICE REVENUE WAS FROM PARTICIPATION IN THE MEDICARE AND MEDICAID PROGRAMS FOR THE YEAR ENDING JUNE 30, 2015. SCHEDULE H, PART VI, LINE 5 THE BOARD OF DIRECTORS OF IVCH IS COMPOSED OF 10 COMMUNITY MEMBERS RESIDING IN OUR SERVICE AREA. THESE BOARD MEMBERS HAVE REGULAR INPUT ON STRATEGIC PLANNING, NEW SERVICES, TECHNOLOGY, AND PHYSICIAN RECRUITMENT. IVCH MAINTAINS AN OPEN MEDICAL STAFF AND IS CONSTANTLY RECRUITING NEW PHYSICIANS TO MEET IDENTIFIED NEEDS. ALL AVAILABLE CASH FLOW GENERATED BY THE ORGANIZATION IS REINVESTED BACK INTO THE HOSPITAL THROUGH THE PURCHASE OF PROPERTY AND EQUIPMENT TO PROVIDE SERVICES THAT MEET THE NEEDS OF THE SERVICE AREA. THE COMMUNITY OUTREACH DEPARTMENT OFFERS A WIDE VARIETY OF HEALTH AND WELLNESS PROGRAMMING, INCLUDING TAI CHI CLASSES, FREE BLOOD PRESSURE AND GLUCOSE SCREENINGS, HEMOGLOBIN A1C SCREENINGS, LIPID PROFILE SCREENINGS, HEALTHY HEART SCREENINGS, PROSTATE CANCER SCREENINGS, SMOKING CESSATION CLASSES, BABYSITTING CLINICS, CPR INSTRUCTION AND FIRST AID. SCHEDULE H, PART VI, LINE 6 NOT APPLICABLE SCHEDULE H, PART VI, LINE 7 ILLINOIS SCHEDULE H, PART I, LINE 7, COLUMNF F THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $4,267,911 REPORTED ON FORM 990, PART IX, LINE 25, HOWEVER, THIS EXPENSE HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. SCHEDULE H, PART I, LINE 7 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 WAS USED FOR ALL PATIENT SEGMENTS. SCHEDULE H, PART I, LINE 7G THE AMOUNTS REPORTED ON ROW 7G DO NOT CONTAIN COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC. true MARCH OF DIMES 425 FIRST ST LA SALLE IL 61301 131846366 501(C)(3) 13000 DONATION 1 SCHEDULE I, PART I, LINE 2 IVCH GRANTS FUNDS TO OTHER ORGANIZATIONS AND COMMUNITY BENEFIT PROJECTS AROUND THEIR COMMUNITY TO IMPROVE THE HEALTH AND WELLNESS OF RESIDENTS. ALL RECIPIENTS WHO RECEIVED OVER $5,000 DURING THE YEAR ARE REPORTED ON PART II. X X X X X true false false false false false false true false STEPHEN DAVIS CFO 139992 0 0 0 0 0 9184 0 27579 0 176755 0 0 0 TOMMY HOBBS CEO 235319 0 0 0 0 0 15296 0 28086 0 278701 0 0 0 BRANDON MUSGRAVE MD PHYSICIAN 480249 0 30000 0 0 0 7800 0 26927 0 544976 0 0 0 MARIO COTE MD PHYSICIAN 206206 0 261354 0 0 0 7800 0 29326 0 504686 0 0 0 PETER MEIER MD PHYSICIAN 626707 0 100000 0 0 0 7800 0 25990 0 760497 0 0 0 ROBERT MITCHELL MD PHYSICIAN 553642 0 25000 0 0 0 7800 0 23269 0 609711 0 0 0 SCOTT MILLINGTON MD PHYSICIAN 415993 0 0 0 0 0 7800 0 25566 0 449359 0 0 0 SCHEDULE J, PART I, LINE 4A STEPHEN DAVIS, FORMER CFO, WAS PAID A SEVERANCE PAYMENT OF $10,000 RELATED TO HIS SEPARATION FROM THE ORGANIZATION IN DECEMBER 2014. THE SEVERANCE PAYMENT MADE TO STEPHEN DAVIS WAS DETERMINED BY TOMMY HOBBS, CEO, AND WAS ADVISED AND APPROVED BY THE BOARD OF DIRECTORS. SCHEDULE J, PART I, LINE 7 EMPLOYED PHYSICIANS OF THE ORGANIZATION RECEIVE A BASE SALARY BASED ON THE MARKET FOR PHYSICIANS IN THEIR MEDICAL SPECIALTY. EACH PHYSICIAN HAS AN EMPLOYMENT CONTRACT WHICH MAY INCLUDE A COMPONENT OF INCENTIVE COMPENSATION. INCENTIVE COMPENSATION IS BASED ON THEIR INDIVIDUAL PROFESSIONAL PRODUCTION, PROVIDING AN OPPORTUNITY TO EARN ABOVE THE BASE SALARY LEVEL. THE BASE SALARY IS RECONCILED WITH THE PHYSICIAN'S PROFESSIONAL PRODUCTION ON A QUARTERLY AND ANNUAL BASIS. ANY AMOUNTS DUE TO THE PHYSICIANS FOR INCENTIVE COMPENSATION ARE PAID WITHIN 30 DAYS OF THE END OF THE PERIOD. A ILLINOIS FINANCING AUTHORITY 861091967 45203HK35 2014-12-15 10000000 RE-FINANCING OF EXISTING DEBT false false false B ILLINOIS FINANCING AUTHORITY 861091967 45203HK43 2014-12-15 8000000 RE-FINANCING OF EXISTING DEBT false false false C ILLINOIS FINANCING AUTHORITY 861091967 45203HK50 2014-12-15 3160000 RE-FINANCING OF EXISTING DEBT false false false D ILLINOIS FINANCING AUTHORITY 861091967 450285255 2014-12-15 670000 RE-FINANCING OF EXISTING DEBT false false false A 0 0 10000000 0 0 10000000 0 0 0 0 0 0 2015 true false true true B 0 0 8000000 0 0 8000000 0 0 0 0 0 0 2015 true false true true C 0 0 3160000 0 0 3160000 0 0 0 0 0 0 2015 true false true true D 400000 0 670000 0 0 975 669025 0 0 0 0 0 2015 true false true true A false true false false 0.01000 0.00000 0.01000 false false false true B false true false false 0.01000 0.00000 0.01000 false false false true C false true false false 0.01000 0.00000 0.01000 false false false true D false true false false 0.01000 0.00000 0.01000 false false false true A false true false false true false 0 false 0 false true B false true false false true false 0 false 0 false true C false true false false true false 0 false 0 false true D false true false false true false 0 false 0 false true A true B true C true D true DIANE DAVIS SPOUSE OF OFFICER 25474 EMPLOYMENT false FORM 990, PART VI, SECTION A, LINE 2 WILLIAM ETZENBACH, BOARD MEMBER, AND JAMES CLINARD, BOARD MEMBER, HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 4 THE FOLLOWING CHANGES WERE MADE TO THE ORGANIZATION'S GOVERNING DOCUMENTS DURING THE YEAR: 1) RESTATEMENT OF CORPORATE PURPOSE, WITH SPECIFIC REFERENCE TO EXCLUSIVE OPERATION AS A NON-PROFIT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. 2) CLARIFIED THE PROCEDURE IN THE EVENT OF CORPORATE DISSOLUTION AND 3) INCORPORATED THE CONFLICT OF INTEREST POLICY OF IVCH INTO THE PROCESS OF DECLARING AND MANAGING ANY CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION A, LINE 6 ILLINOIS VALLEY COMMUNITY HOSPITAL IS A SUBSIDIARY OF ITS SOLE CORPORATE MEMBER, ILLINOIS VALLEY HEALTH CORP. ,INC. FORM 990, PART VI, SECTION A, LINE 7A & 7B MEMBERS OF THE BOARD OF DIRECTORS OF THE PARENT COMPANY, ILLINOIS VALLEY HEALTH CORP., INC. , ACTING ON BEHALF OF THE PARENT, HAVE RESERVED POWERS TO AS IT RELATES TO THE OPERATIONS OF IVCH: APPOINT AND REMOVE DIRECTORS, RATIFY AND REMOVE OFFICERS, ADOPT, AMEND, OR REPEAL THE ARTICLES OF INCORPORATION AND/OR BY-LAWS, ADOPT A PLAN OF MERGER, CONSOLIDATION OR DISSOLUTION, APPROVE THE PURCHASE, SALE, TRANSFER, LEASE ENCUMBRANCE OF PROPERTY, APPROVE BORROWING WITH A TERM > A ONE YEAR TERM OR WHICH REQUIRES A MORTGAGE OF REAL PROPERTY, AND SELECTION OR MODIFICATION OF THE BUSINESS/LEGAL NAME OF THE ENTITY. FORM 990, PART VI, SECTION B, LINE 11B THE CEO AND CFO REVIEW THE FORM 990 PRIOR TO SUBMISSION TO THE IRS. THE FINAL VERSION OF THE FORM 990 IS E-MAILED OR HAND DELIVERED TO EACH BOARD MEMBER FOR THEIR REVIEW AND A SPECIAL BOARD MEETING IS HELD TO REVIEW AND ANSWER QUESTIONS REGARDING THE 990 PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE OFFICERS AND DIRECTORS OF IVCH ARE COVERED UNDER THE POLICY AND HAVE A DUTY TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST. ALL PERSONS COVERED UNDER THE POLICY ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE AND DISCLOSE ANY INTEREST THAT COULD GIVE RISE TO CONFLICTS. ANY TRANSACTIONS WITH COVERED PERSONS, OR ENTITIES IN WHICH A COVERED PERSON HAS ANY TYPE OF INTEREST, MUST BE AN ARM'S LENGTH TRANSACTION. THE DIRECTORS WILL REVIEW ANY TRANSACTIONS IN QUESTION AND DETERMINE IF A CONFLICT EXISTS. IF A CONFLICT EXISTS, THE INTERESTED PERSON MAY MAKE A PRESENTATION, BUT MUST LEAVE THE MEETING DURING DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15A AN ADHOC COMMITTEE OF THE BOARD OF DIRECTORS (INCLUDING THE BOARD PRESIDENT, CHAIRPERSON OF THE PERSONNEL COMMITTEE AND AT LEAST ONE OTHER MEMBER) CONDUCT AN ANNUAL PERFORMANCE REVIEW OF THE CEO AND DETERMINE ANY CHANGE/INCREASE IN THE COMPENSATION, IF ANY, BASED UPON BENCHMARK COMPENSATION SURVEYS AND AREA NORMS. THE CEO HAS A WRITTEN EMPLOYMENT CONTRACT. RENEWAL OF THE CONTRACT OR INCREASE IN COMPENSATION MUST BE APPROVED BY A MAJORITY OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9 CHANGE IN MINIMUM PENSION LIABILITY -770,651 CHANGES DUE TO FOUNDATION CONTRIBUTIONS -34,666 -------- TOTAL -805,317 HYGIENIC INSTITUTE 925 WEST STREET PERU IL 61354 362167742 PRIMARY CARE IL 501(C)(3) 9 IVHC true IVCH FOUNDATION 925 WEST STREET PERU IL 61354 371211780 FUNDRAISING IL 501(C)(3) 11A IVHC true IV HEALTH CORP INC 925 WEST STREET PERU IL 61354 371211890 HEALTH CARE IL 501(C)(3) 11B IVHC true VALLEY REGIONAL HEALTH SERVICE 4391 VENTURE DR PERU IL 61354 273891281 CANCER CARE IL IVCH RELATED -30784 521974 false true 0.50000 VALLEY HEALTH ENTERPRISES 925 WEST STREET PERU IL 61354 363476877 DME IL NA C CORPORATION true ILLINOIS VALLEY HEALTH SERVICES INC 925 WEST STREET PERU IL 61354 364050682 DORMANT IL NA C CORPORATION true ILLINOIS VALLEY PHO 925 WEST STREET PERU IL 61354 363978381 PPO CONTRACTING IL IVCH C CORPORATION 30 28632 0.50000 false IVCH GENERAL&PROFESSIONAL LIAB LOSS FUND 925 WEST STREET PERU IL 61354 366673231 DORMANT IL NA TRUST true HEALTH CARE BUILDING CORP 925 WEST STREET PERU IL 61354 363306917 DORMANT IL NA C CORPORATION true false false true false true false false false false false false false false true true false true true true IVCH FOUNDATION C 56272 CASH HYGIENIC INSTITUTE R 493087 CASH HYGIENIC INSTITUTE S 330000 CASH IV HEALTH CORP E 1154437 CASH VALLEY HEALTH ENTERPRISES O 354021 CASH VALLEY HEALTH ENTERPRISES Q 68405 CASH VALLEY HEALTH ENTERPRISES S 425981 CASH