2016-02-03T12:57:04-06:00 2015-06-30 430352985 KERBER ECK & BRAECKEL LLP 1116 W MAIN ST CARBONDALE IL 62901 990 2014-07-01 370661202 FAIRFIELD MEMORIAL HOSPITAL ASSOC FAIR 6188422611 303 NW 11TH ST FAIRFIELD IL 62837 MELODY MORGAN CFO 6188422611 2016-02-02 true ANNA GUETERSLOH P01315485 6185291040 2016-02-03 2014 2016-04-25 22:37:26Z KATHERINE BUNTING 303 NW 11TH ST FAIRFIELD IL 62837 28521254 false X WWW.FAIRFIELDMEMORIAL.ORG X 1943 IL THE MISSION OF FAIRFIELD MEMORIAL HOSPITAL IS TO MAINTAIN AND IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. 9 6 322 50 0 617561 554388 25574524 27127241 161774 31240 706232 808385 27060091 28521254 0 0 12983828 13584090 0 0 13387906 14079425 26371734 27663515 688357 857739 25122686 25680755 11132581 10857590 13990105 14823165 X THE MISSION OF FAIRFIELD MEMORIAL HOSPITAL IS TO MAINTAIN AND IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. false false 27663515 27966866 AS A NON-FOR-PROFIT COMMUNITY HOSPITAL, FAIRFIELD MEMORIAL HOSPITAL IS A CHARITABLE ORGANIZATION THAT EXISTS TO ADVANCE THE HEALTH OF THE RESIDENTS OF WAYNE COUNTY AND SURROUNDING COMMUNITIES. FAIRFIELD MEMORIAL HOSPITAL OPERATES A RURAL HEALTHCARE FACILITY WITH 25 ACUTE CARE BEDS AND 30 SKILLED CARE BEDS. IN AUGUST 2008 THE HOPSITAL OPENED AN OUTPATIENT PHYSICIAN CLINIC. FAIRFIELD MEMORIAL HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORGIN, HANDICAP, AGE OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF FAIFIELD MEMORIAL HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. THEREFORE, IN KEEPING WITH THIS CORPORATION'S COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE,CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST,AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR INDIVIDUALS INABILITY TO PAY COEXISTS. THE COMMUNITY BENEFITS CAN BE MEASURED IN MANY WAYS INCLUDING: DIRECT PATIENT CARE, SCREENINGS, EDUCATION, FUNDRAISING, AND COMMUNITY SERVICE EFFORTS OF OUR COLLEAGUES. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS, PROVIDING SERVICES TO BOTH MEDICARE AND MEDICAID PATIENTS. CHARITY CARE IS ALSO PROVIDED THROUGH THE HOSPITAL'S INTERNAL POLICY AND IN FY 2015 THIS AMOUNTED TO 108,211. 27663515 true true false false false false false false false false true false false false true true true false false false false false false false false false true true false false true false false false true false false true false false false false false false true false false false true 21 0 322 true false false false false false false false false false false false false X 9 6 false false false false false false false true true false false true true true true true true true true false IL X MELODY MORGAN 6188422611 303 NW 11TH ST FAIRFIELD IL 62837 PATRICK MOLT MD PRESIDENT 10.00 X 60600 0 0 MARTY HEFLIN TREASURER 5.00 X 0 0 0 JAMIE POLLARD TRUSTEE 1.00 X 0 0 0 MIKE ST LEDGER TRUSTEE 10.00 X 0 0 0 SANDY SIMPSON TRUSTEE 1.00 X 0 0 0 DONNA SULLIVAN TRUSTEE 4.00 X 0 0 0 JOSEPH HUNGERFORD TRUSTEE 1.00 X 0 0 0 DALE WARREN VICE PRESIDE 2.00 X 0 0 0 JARED VAUGHN TRUSTEE 4.00 X 0 0 0 KATHERINE BUNTING CEO 40.00 X 240959 0 13956 KATHY CLAYTON CFO 40.00 X 113698 0 16101 ANN IGNAS CNO 40.00 X 111760 0 8038 MELODY MORGAN CFO 40.00 0.00 X 0 0 0 WESLEY THOMPSON PHYSICIAN 40.00 X 372887 0 32804 CHRIS BALLARD PHYSICIAN 40.00 X 299709 0 31340 ALEXIS KING CRNA 40.00 X 223461 0 21035 KIMBERLY KING CRNA 40.00 X 221384 0 12971 KYLE KAKAC PHYSCIAN 40.00 X 205482 0 29456 1849940 165701 12 false true false WAY-FAIR NURSING & REHABILITATION CE 305 NW 11TH ST FAIRFIELD IL 62837 DIETARY 689603 MURRAY COMPANY 1215 FERN RIDGE PKWY SUITE 213 ST LOUIS MO 63141 CAFE CONTRACTOR 567901 ARAMARK UNIFORM SERVICE 25259 NETWORK PLACE CHICAGO IL 606731252 LAUNDRY 541251 JAMES GRUBER MD 2025 ST MEINRAD RD SAINT MEINRAD IN 47577 ER PHYSICIAN 349123 MICHELLE O'NEILL MD 10345 WILMINGTON DRIVE EVANSVILLE IN 47725 ER PHYSICIAN 327176 16 120754 61121 372513 554388 NET PATIENT SERVICE REVENUE 27127241 27127241 27127241 31240 31240 250516 250516 250516 250516 MEDICARE EHR REVENUE 275805 275805 MISCELLANEOUS 223956 223956 CAFETERIA SERVICES 41591 41591 16517 16517 557869 28521254 27966866 X 565112 565112 10546754 10546754 128387 128387 1594610 1594610 749227 749227 6441 6441 36550 36550 5189784 5189784 105843 105843 1446981 1446981 952636 952636 154882 154882 363899 363899 1466963 1466963 383783 383783 DRUGS 1163402 1163402 MEDICAL SUPPLIES 932563 932563 REPAIRS AND MAINTENANCE 642677 642677 BED AND PROVIDER TAX AMT 586494 586494 646527 646527 27663515 27663515 0 0 1745 1744 2396369 2101457 4633457 5442175 220964 167484 665388 778302 292309 323720 276767 285501 37385416 21431917 15945246 15953499 800 800 689641 626073 25122686 25680755 2556486 2446397 84212 708759 7765310 7135031 527612 270181 198961 297222 11132581 10857590 X 13644291 14502030 345245 320566 569 569 13990105 14823165 25122686 25680755 857739 -24679 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 434486 434486 20194545 8519097 11675448 16688552 12879219 3809333 67833 33601 34232 15953499 THIRD PARTY REIMBURSEMENT PROGRAMS 297222 297222 X 28496575 -24679 -24679 28521254 28521254 27663515 27663515 27663515 SCHEDULE D, PAGE 3, PART X THERE WERE NO PENALTIES, INTEREST, OR UNCERTAIN TAX BENEFITS IDENTIFIED AND RECORDED AS A LIABILITY. SCHEDULE D, PAGE 4, PART XI, LINE 2D CHANGE IN TEMPORARILY RESTRICTED ASSETS -24,679 true true true X true X true true false false 38910 38910 0.00140 1668487 586494 1081993 0.03910 1707397 586494 1120903 0.04050 35299 35299 0.00130 35299 35299 0.00130 1742696 586494 1156202 0.04180 true 882248 220562 13154030 13571302 -417272 X true true 2 1 FAIRFIELD MEMORIAL HOSPITAL 303 NW 11TH ST FAIRFIELD IL 62837 X X X X 2 HORIZON HEALTHCARE 213 NW 10TH ST SUITE A FAIRFIELD IL 62837 OUTPATIENT PHYSCIAN CLINIC FAIRFIELD MEMORIAL HOSPITAL 1 false false true X X X X X X X X X X 12 true false false true X false false true X 200.000000000000 300.000000000000 X X X true true X X X X true X WWWFAIRFIELDMEMORIALORG X X X X X X true X X true X X X X X X true X false false HORIZON HEALTHCARE 2 false false true X X X X X X X X X X 12 false false false true X WWW.FAIRFIELDMEMORIAL.ORG X false false true X 200.000000000000 300.000000000000 X X true true X X X true X WWWFAIRFIELDMEMORIALORG X X X X X X true X X true X X X X X X true X false false FACILITY 1, FAIRFIELD MEMORIAL HOSPITAL - PART V, LINE 5 THREE FOCUS GROUPS WERE FORMED THAT INCLUDED MEMBERS FROM LOCAL BUSINESSES, COMMUNITY LEADERS AS WELL AS KEY EMPLOYEES FROM THE ORGANIZAITON. MEMBERS INCLUDED BUT WERE NOT LIMITED TO THE MAYOR, COUNTY BOARD MEMBERS, SCHOOL REPRESENTATIVES, CLERGY, RIDES MASS TRANSIT REPRESENTATIVES, AND LOCAL PHYSICIANS. ALSO REPRESENTED WAS MEMBERS OF WADI - COMMUNITY ACTION AGENCY, PHARMACISTS, THERAPY MANAGERS, THE CEO OF THE ORGANIZATION AND REPRESENTATIVES FROM THE LOCAL HEALTH DEPARTMENT. FACILITY 1, FAIRFIELD MEMORIAL HOSPITAL - PART V, LINE 11 NEEDS ARE ASSESSED AT LEAST EVERY TWO YEARS THROUGH ACTIVITIES AT THE ORGANIZATIONS STRATEGIC RETREAT. THE ORGANIZATIONS ASSESSMENT INCLUDED THE INCREASED NEED FOR BEHAVIORAL HEALTH AND TELEPSYCHIATRY SERVICES AS MORE AREA MENTAL HEALTH AGENCIES HAVE CLOSED DUE TO FUNDING LOSSES FROM THE IL STATE'S BUDGET CRISIS. ANOTHER ASSESSED NEED RELATES TO TELEMEDICINE FOR STROKE PATIENTS IN THE ER. ALSO THE NEEDS ASSESSMENT REVEALED THE NEED FOR MORE ACCESS TO CARE IN WHICH THE ORGANIZATION IS LOOKING AT THE POSSIBILITY OF OFFERING EXTENDED HOURS OF CARE AT THE HORIZON HEALTHCARE CLINIC WITH WALK-IN TYPES OF SERVICES OFFERED AND RE-DIRECTING NON-EMERGENCY CASES FROM THE ER TO THE WALK-IN CLINIC. FACILITY 1, FAIRFIELD MEMORIAL HOSPITAL - PART V, LINE 16I THE POLICY IS VERBALLY DISCUSSED WITH ALL SELF-PAY PATIENTS. FACILITY 1, FAIRFIELD MEMORIAL HOSPITAL - PART V, LINE 22D IF A PATIENT APPLIES FOR FINANCIAL ASSISTANCE AND THEY ARE APPROVED THE BILL IS REDUCED TO ZERO. IF THE PATIENT QUALIFIES FOR THE PATIENT DISCOUNT ACT, THEN THE CURRENT ASSIGNED PERCENTAGE IS CHARGED. IF NEITHER APPLY, THEN THE PATIENT IS OFFERED A 20% DISCOUNT IF PAID IN FULL OR AN OFFER OF REASONABLE INTEREST FREE PAYMENTS ARE SET UP. FACILITY 2, HORIZON HEALTHCARE - PART V, LINE 16I POLICY IS VERBALLY DISCUSSED WITH ALL SELF-PAY PATIENTS. FACILITY 2, HORIZON HEALTHCARE - PART V, LINE 22D IF A PATIENT APPLIES FOR FINANCIAL ASSISTANCE AND THEY ARE APPROVED THE BILL IS REDUCED TO ZERO. IF THE PATIENT QUALIFIES FOR THE PATIENT DISCOUNT ACT, THEN THE CURRENT ASSIGNED PERCENTAGE IS CHARGED. IF NEITHER APPLY, THEN THE PATIENT IS OFFERED A 20% DISCOUNT IF PAID IN FULL OR AN OFFER OF REASONABLE INTEREST FREE PAYMENTS ARE SET UP. PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE 2,782,454 PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE FAIRFIELD MEMORIAL HOSPITAL ASSOCIATION 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 AND 7B OF PART I OF SCHEDULE H. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY THE HOSPITAL CALCULATED BAD DEBT EXPENSE AT COST USING THE COST TO CHARGE RATIO AS CALCULATED USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT ONLY AFTER ALL COLLECTION PROCEDURES HAVE BEEN EXHAUSTED AS OUTLINED IN SCHEDULE H, PART III, LINE 9B. PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER ALL DISCOUNTS AND PAYMENTS HAVE BEEN APPLIED. PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE BASED ON THE HOSPITAL'S EXPERIENCE WITH ALL ITS PATIENTS, THEY ESTIMATE THAT IT IS LIKELY THAT UP TO ONE FOURTH OF THE PATIENT ACCOUNTS WRITTEN OFF TO BAD DEBTS MAY QUALIFY FOR CHARITY CARE OR OTHER ASSISTANCE BUT CHOSE NOT TO APPLY. THEREFORE, 25% OF THE BAD DEBT EXPENSE WAS INCLUDED ON PART III, LINE 3 AT COST. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS NOTE R - UNCOMPENSATED CARE AND COMMUNITY BENEFIT IN SUPPORT OF ITS MISSION, THE HOSPITAL VOLUNTARILY PROVIDES CARE TO PATIENTS AT LESS THAN ITS ESTABLISHED CHARGES FOR PATIENTS THAT MEET THE HOSPITAL'S CHARITY CARE CRITERIA. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED IN NET PATIENT SERVICES REVENUE. IN ADDITION, THE HOSPITAL PROVIDES SERVICES TO OTHER MEDICALLY INDIGENT PATIENTS UNDER CERTAIN GOVERNMENT-REIMBURSED PUBLIC AID PROGRAMS. SUCH PROGRAMS PAY PROVIDERS AMOUNTS WHICH ARE LESS THAN ESTABLISHED CHARGES FOR THE SERVICES PROVIDED TO THE RECIPIENTS AND MANY TIMES THE PAYMENTS ARE LESS THAN THE COST OF RENDERING THE SERVICES PROVIDED. THE HOSPITAL'S TOTAL COST OF UNCOMPENSATED CARE RELATING TO THESE SERVICES AND OTHER SERVICES ARE AS FOLLOWS: 2015 2014 CHARITY CARE 38,910 316,406 STATE MEDICAID AND OTHER PUBLIC PROGRAMS 1,081,993 914,486 UNCOLLECTIBLE ACCOUNTS 882,248 1,022,943 THE UNCOMPENSATED CARE COST OF STATE MEDICAID AND OTHER PUBLIC AID PROGRAMS IS DETERMINED BY COMPUTING THE COST OF PROVIDING THAT CARE LESS AMOUNTS PAID BY THE PROGRAM. IN ADDITION TO THE ABOVE COST OF UNCOMPENSATED CARE, THE HOSPITAL ALSO COMMITS SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND CRITICAL SERVICES WHICH MEET OTHERWISE UNFULFILLED COMMUNITY NEEDS. MANY OF THESE ACTIVITIES ARE SPONSORED WITH KNOWLEDGE THAT THEY WILL NOT BE SELF-SUPPORTING OR FINANCIALLY VIABLE. PART III, LINE 8 - MEDICARE EXPLANATION UNPAID COST OF MEDICARE REPRESENTS THE COST (DETERMINED USING THE OVERALL COST TO CHARGE RATIO) OF PROVIDING SERVICES TO PRIMARILY ELDERLY BENEFICIARIES OF THE MEDICARE PROGRAM, IN EXCESS OF PAYMENTS FOR THOSE SERVICES. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFTIS, 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. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION THE FAIRFIELD MEMORIAL HOSPITAL APPLIES ITS COLLECTION PRACTICES EQUALLY TO ALL PATIENTS, BOTH CHARITY CARE ELIGIBLE AND NON-CHARITY CARE PATIENTS. THE PROCEDURES FOR COLLECTION ON PATIENT ACCOUNTS ARE AS FOLLOWS: SELF-PAY ACCOUNTS AND ACCOUNTS WITH BALANCES AFTER INSURANCE ARE SENT A LETTER REQUESTING PAYMENT. IF NO RESPONSE IS RECEIVED WITHIN 35 DAYS, THE ACCOUNT IS TRANSFERRED TO OUR EARLY-OUT DEPARTMENT FOR A FOLLOW-UP STATEMENT/PHONE CALL TO THE PATIENT. THE HOSPITAL OFFERS THE PATIENTS SEVERAL PAYMENT ALTERNATIVES: 1. CASH/CHECK FOR THE FULL AMOUNT 2. MASTERCARD/VISA/DISCOVER 3. SHORT-TERM MONTHLY INSTALLMENTS BASED ON OUTSTANDING BALANCE SPECIAL PAYMENT ARRANGEMENTS CAN BE MADE UPON REQUEST AND COMPLETION OF A CREDIT APPLICATION WHICH WILL BE VERIFIED AND APPROVED BY THE BUSINESS OFFICE DIRECTOR. IF PAYMENT OR SATISFACTORY PAYMENT ARRANGMENTS AS OUTLINED ABOVE ARE NOT MADE, THE ACCOUNT WILL PROCEED THROUGH A COLLECTION PROCESS AS FOLLOWS: DAY 1 - 1ST NOTICE SENT DAY 7-14 - FIRST PHONE CALL IS MADE. AT LEAST ONE PHONE CALL OR NOTICE PER WEEK FOR THE REMAINDER OF THE EARLY-OUT 90 DAY PERIOD DAY 75 - DEMAND NOTICE IS SENT DAY 90 - ACCOUNT IS SENT TO COLLECTIONS ANY ACCOUNT THAT IS SENT TO COLLECTIONS MAY BE TURNED OVER TO AN ATTORNEY AND ANY ADDITIONAL COSTS ASSOCIATED WITH COLLECTIONS WILL BE ADDED TO THE ACCOUNT BALANCE. PART VI, LINE 2 - NEEDS ASSESSMENT GENERALLY SPEAKING, THE DETERMINATION OF CURRENT AND FUTURE HEALTH CARE NEEDS OF THE COMMUNITY OR COMMUNITIES SERVED BY FAIRFIELD MEMORIAL HOSPITAL IS BASED ON ALL OR A COMBINATION OF THE FOLLOWING FACTORS; EXISTENCE OR NONEXISTENCE OF SERVICES, OPPORTUNITY, SUPPLY, DEMONSTRATED NEED, "VOICE OF THE CUSTOMER", AND /OR COLLABORATIVE EFFORTS WITH OUTSIDE ENTITIES, GOVERMENT AGENCIES, AND OTHER HEALTH CARE PROVIDERS THAT WOULD ENABLE THE FILLING OF A NEED OR ENHANCE AND COMPLIMENT AN ALREADY EXISTING SERVICE. DATA IS GATHERED CONSTANTLY THROUGH BENCHMARKETING, MARKET RESEARCH, CUSTOMER SURVEYS, PHYSCIAN INPUT, AND THROUGH CONSTANT MONITORING OF STATE AND FEDERAL GUIDELINES. THIS INFORMATION IS REVIEWED AND ANALYZED BY THE HOSPITAL'S SENIOR LEADERSHIP AND INCORPORATED INTO STRATEGIC PLANNING PROCESSES. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SIGNS ARE POSTED IN THE FACILITY. THE PATIENT'S BILL INFORMS THEM OF FINANCIAL ASSISTANCE PROGRAM. OUR HOSPITAL WEBSITE HAS A LINK TO THE FINANCIAL ASSISTANCE APPLICATION. SOCIAL SERVICE DEPARTMENT SPEAKS TO INPATIENTS ABOUT THE PROGRAM. PART VI, LINE 4 - COMMUNITY INFORMATION FAIRFIELD MEMORIAL HOSPITAL SERVES THE POPULATIONS OF WAYNE COUNTY AND THE SURROUNDING COMMUNITIES WITHOUT REGARD TO AGE, GENDER, INCOME , ETHIC ORGIN, INSURANCE COVERAGE, OR ABILITY TO PAY. WAYNE COUNTY IS A RURAL AREA WITH AN ESTIMATED POPULATION OF 16,543. THE MEDIAN HOUSEHOLD INCOME IN 2013 WAS 43,605, WHICH WAS 77% OF ILLINOIS' AVERAGE. THE PERCENTAGE OF INDIVIDUALS BELOW POVERTY LEVEL WAS 13.0%. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT ILLINOIS X X X X X false false false false false false false false false KATHERINE BUNTING CEO 240959 4875 9081 254915 WESLEY THOMPSON PHYSICIAN 372887 7458 25346 405691 CHRIS BALLARD PHYSICIAN 299709 5994 25346 331049 ALEXIS KING CRNA 223461 4595 16440 244496 KIMBERLY KING CRNA 221384 4595 8376 234355 KYLE KAKAC PHYSCIAN 205482 4110 25346 234938 NICOLE FYIE PHYSICIAN WIFE OF BOARD MEMBER MEDICAL SCHOOL LOAN X 267400 167484 false true true 167484 CHARLOTTE ST LEDGER EMPLOYEE 45825 WIFE OF BOARD MEMBER false PATRICK MOLT PHYSICIAN 60600 BOARD MEMBER false FORM 990, PAGE 1, PART I, LINE 6 VOLUNTEERS ARE PART OF THE HOSPITAL AUXILIARY WHO RUN FUNDRAISERS ON BEHALF OF THE HOSPITAL AND OPERATE THE GIFT SHOP. FORM 990, PAGE 2, PART III, LINE 4A COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE,CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST,AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR INDIVIDUALS INABILITY TO PAY COEXISTS. THE COMMUNITY BENEFITS CAN BE MEASURED IN MANY WAYS INCLUDING: DIRECT PATIENT CARE, SCREENINGS, EDUCATION, FUNDRAISING, AND COMMUNITY SERVICE EFFORTS OF OUR COLLEAGUES. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS, PROVIDING SERVICES TO BOTH MEDICARE AND MEDICAID PATIENTS. CHARITY CARE IS ALSO PROVIDED THROUGH THE HOSPITAL'S INTERNAL POLICY AND IN FY 2015 THIS AMOUNTED TO 108,211. FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 WAS REVIEWED BY THE CFO AND FINANCE COMMITTEE. AFTER THE FINANCE COMMITTEE IT WAS TAKEN TO THE FULL BOARD FOR APPROVAL. FORM 990, PAGE 6, PART VI, LINE 12C ANNUALLY EACH BOARD MEMBER RECEIVES THE CORPORATE COMPLIANCE POLICY WHICH INCLUDES THE CONFLICT OF INTEREST POLICY WITHIN IT TO REVIEW AND SIGN THAT THEY HAVE READ THE POLICY AND HAVE NO COMFLICTS. ALL SIGNED DOCUMENTS ARE KEPT ON FILE IN ADMINISTRATION OFFICE. FORM 990, PAGE 6, PART VI, LINE 15A THE CEO'S COMPENSATION PROCESS INVOLVES ALLIANT, THE HOSPITAL'S MANAGEMENT COMPANY, BRINGING EVALUATION TIME SALARY INFORMATION FOR OTHER ALLIANT HOSPITALS WHICH INCLUDE HOSPITAL'S IN THE FOLLOWING STATES: ILLINOIS, KENTUCKY, AND INDIANIA; AS WELL AS SALARY INFORMATION FOR CEO'S FROM OTHER HOSPITAL'S IN RELEVANT SIZE (IN REVENUES) TO FMH. THE SALARY COMPARISON INFORMATION IS PRESENTED TO THE PERSONNEL COMMITTEE OF THE BOARD IN WHICH THEY REVIEW THE INFORMATION AND ESTABLISH THE RATE FOR THE CEO. FORM 990, PAGE 6, PART VI, LINE 15B MARKET WAGE DATA FOR THE HEALTHCARE INDUSTRY IS REVIEWED FOR COMPARABLE RATES FROM THREE SALARY SURVEYS INCLUDING ALLIANT AS ONE. THE CEO DETERMINES THE AMOUNTS FOR THE OFFICERS. FORM 990, PAGE 6, PART VI, LINE 19 COPIES OF THE ORGANIZATIONS GOVERING DOCUMENTS, CONFLICT OF INTEREST POLICIES, FINANCIAL STATEMENTS, AND THE FEDERAL FORM 990 TAX RETURN ARE AVAILABLE UPON REQUEST FROM THE ADMINISTRATIVE OFFICES. FORM 990, PART IX, LINE 11G PROFESSIONAL SERVICES 3,548,592 0 0 PHYSICIANS FEES 1,641,192 0 0 FORM 990, PART XI, LINE 9 CHANGE IN TEMPORARILY RESTRICTED ASSETS -24,679 FAIRFIELD MEMORIAL HOSPITAL FOUNDAT 303 NW 11TH STREET FAIRFIELD IL 62837 371185754 SUPPORT IL 501C3 11B N/A false false false true false false false false false false false false false false false false false false false false FMH FOUNDATION C 100000 ACTUAL CASH RECEIVED