2016-05-16T08:17:52-05:00 2015-06-30 430352985 KERBER ECK & BRAECKEL LLP 1116 W MAIN ST CARBONDALE IL 629012335 990 2014-07-01 800618988 LAWRENCE COUNTY MEMORIAL HOSPITAL LAWR 6189431000 2200 WEST STATE STREET LAWRENCEVILLE IL 62439 CARL ATEN BOARD CHAIR 6189431000 2016-05-12 true BRENT KOCHEL P01055927 6185291040 2016-05-16 2014 2016-08-17 19:52:53Z CARL ATEN 2200 STATE STREET LAWRENCEVILLE IL 62439 16575272 false X WWW.LCMHOSP.ORG X 1950 IL AT LAWRENCE COUNTY MEMORIAL HOSPITAL WE OFFER COMPASSIONATE, PROFESSIONAL HEALTHCARE THAT MEETS THE HIGHEST STANDARDS OF EXCELLENCE. 9 6 174 37 0 3518169 66850 13762197 15868522 26155 15765 31433 624135 17337954 16575272 0 0 6521431 7972018 0 0 7230270 7584021 13751701 15556039 3586253 1019233 11441097 12434966 3599595 3574231 7841502 8860735 AT LAWRENCE COUNTY MEMORIAL HOSPITAL WE OFFER COMPASSIONATE, PROFESSIONAL HEALTHCARE THAT MEETS THE HIGHEST STANDARDS OF EXCELLENCE. false false 11297590 16492657 THE HOSPITPAL'S MISSION IS TO PROVIDE HIGH QUALITY CARE AND COST EFFECTIVE HEALTHCARE, WHICH INCLUDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO THE RESIDENTS OF LAWRENCE COUNTY, IL. ALL EXPENSES RELATE TO COSTS ASSOCIATED WITH PROVIDING THESE SERVICES, AND MAINLY INCLUDE SALARY AND WAGES TO STAFF AND COST OF SUPPLIES. 11297590 true true false false false false false false false true true false false false true false false true false false false false false false false false true true false false true false false false false false false true false false false false false false true false false false true 50 0 true 174 true false false false false false false false false false false X 9 6 false true false false false false false true true false false false true true true true true true true false IL X X LARRY SPOUR 6189437202 2200 WEST STATE STREET LAWRENCEVILLE IL 62439 CARL ATEN BOARD CHAIR 3.00 1.00 X X 0 0 0 RON WALDROP VICE CHAIR 3.00 X X 0 0 0 MATT PARGIN TREASURER 2.00 X X 0 0 0 REBECCA NESTLEROAD SECRETARY 2.00 X X 0 0 0 MIKE SHEPPARD TRUSTEE 2.00 X 0 0 0 STAN WILLIAMS TRUSTEE 2.00 X 0 0 0 BJ SHAFFER TRUSTEE 1.00 X 0 0 0 CURT BENSON TRUSTEE/BEG 1.00 X 0 0 0 DR GARY CARR TRUSTEE /PHY 42.00 X 224258 0 0 DOUG FLORKOWSKI CEO 43.00 X 201334 0 59950 LARRY SPOUR CFO 45.00 X 104616 0 26991 RITA GARVEY CNO 45.00 X 87825 0 20703 KIM WEBER PHARMACIST 40.00 X 133541 0 14867 STEVEN RAMSARAN PHYSICAN 40.00 X 321687 0 22122 GEORGE NELSON CRNA 40.00 X 103909 0 11957 1177170 156590 6 false true false HEALTHCARE SERVICE CORP 25551 NETWORK PLACE CHICAGO IL 606731255 EMPL HEALTH INS 716988 QUORUM HEALTH RESOURCES LLC 105 CONTINENTAL PLACE BRENTWOOD TN 370271018 CONTRACT MGT SV 683868 MARTIN GOLDSTONE MD 3926 W TOUHY STE 369 LINCOLNWOOD IL 60712 CONTRACTED PHYS 419580 CPSI PO BOX 850309 6600 WALL STREET MOBILE AL 366860309 HOSP COMP SOFTW 406617 CARDINAL HEALTH PHARM DISTRIB ST LOUIS DIV 5279 COLLECTION CENTER CHICAGO IL 60646 PHARMACUETICALS 378436 23 26105 40745 66850 PATIENT SERVICE REVENUE 15868522 15868522 15868522 15765 15765 24796 24796 24796 24796 MEANINGFULL REVENUE 463974 463974 CAFETERIA INCOME 95797 95797 OTHER REVENUE 39568 39568 599339 16575272 16492657 15765 X 759772 759772 5793688 4345266 1448422 102477 76858 25619 875392 656544 218848 440689 330517 110172 204300 204300 13620 13620 85021 85021 6748 6748 2637918 1988333 649585 31947 26223 5724 280651 122031 158620 3389 2542 847 763211 572408 190803 3479 3479 64378 35571 28807 36646 36646 883055 662291 220764 198241 148681 49560 UNCOLLECTABLE ACCOUNTS 998756 998756 MEDICAL SUPPLY 600617 600617 MISCELLANEOUS 324904 243687 81217 DRUG EXPENSE 281759 281759 165381 165381 15556039 11297590 4258449 0 1035 2164196 682025 2135131 2789988 267373 289377 684056 118262 16665846 9592703 7671477 7073143 11441097 12434966 1219490 1312572 500000 261835 819912 618575 1060193 1381249 3599595 3574231 X 7841502 8860735 7841502 8860735 11441097 12434966 1019233 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false 20150 20150 10078534 4194786 5883748 6567162 5397917 1169245 7073143 THIRD - PARTY REIMBURSEMENT 1130269 LINE OF CREDIT 250980 1381249 15576516 -998756 -998756 16575272 16575272 14557283 -998756 -998756 15556039 15556039 SCHEDULE D, PAGE 4, PART XI, LINE 2D PROVISION FOR UNCOLLECTABLE -998,756 SCHEDULE D, PAGE 4, PART XII, LINE 2D PROVISION FOR UNCOLLECTABLE -998,756 SCHEDULE D, PAGE 4, PART XIII MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITION UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true true X true X 1.100000000000 true X true true false false 461703 461703 0.02970 4048640 3376679 671961 0.04320 4510343 3376679 1133664 0.07290 4510343 3376679 1133664 0.07290 true 367288 7664488 7706733 -42245 X true true 1 1 LAWRENCE COUNTY MEMORIAL HOSPITAL 2200 STATE STREET LAWRENCEVILLE IL 62439 HTTPS://LCMHOSP.ORG 0005769 X X X X LAWRENCE COUNTY MEMORIAL HOSPITAL 1 false false true X X X X X X X X X X 13 true false false true X HTTPS://LCMHOSP.ORG X true 13 false false false true X 110.000000000000 300.000000000000 true true X X X X X true X HTTPSLCMHOSPORG X HTTPSLCMHOSPORG X X X true X true X true X false true FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 5 LCMH CONTRACTED WITH QHR CONSULTING SERVICES AS IT PRETAINED TO THE PREPARATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE FIRM PERFORMS SEVERAL INDEPENDENT DATA, AND RESOLVES ANY DATA INCONSISTENCIES OR DISCREPANCIES FROM THE COMBINED OPINIONS FORMED FROM LOCAL EXPERTS. ADDITIONALLY, QHR RELIES ON SECONDARY SOURCE DATA, AND MOST SECONDARY SOURCES USE THE COUNTY AS THE SMALLEST UNIT OF ANALYSIS. FINALLY, QHR ASKED OUR LOCAL EXPERT AREA RESIDENTS TO NOTE IF THEY PRECEIVED THE PROBLEMS OR NEEDS IDENTIFIED BY SECONDARY SOURCES TO EXIST IN THEIR PORTION OF THE COUNTY. MOST DATA USED IN THE ANALYSIS IS AVAILABLE FROM PUBLIC INTERNET SOURCES. IN ADDITION, WE DEPLOYED A CHNA "ROUND 1" SURVEY TO OUR LOCAL EXPERT ADVISORS TO GAIN LOCAL INPUT AS TO LOCAL HEALTH NEEDS AND THE NEEDS OF PRIORITY POPULATIONS. LOCAL EXPERT ADVISORS WERE LOCAL INDIVIDUALS SELECTED TO CONFORM TO THE INPUT REQUIRED BY THE FEDERAL GUIDELINES AND REGULATIONS. WE RECEIVED COMMUNITY INPUT FROM 19 LOCAL EXPERT ADVISORS. INFORMATION ANALYSIS AUGMENTED BY LOCAL OPINIONS SHOWED HOW LAWRENCE COUNTY RELATES TO ITS PEERS IN TERMS OF PRIMARY AND CHRONIC NEEDS AND OTHER ISSUES OF UNINSURED PERSONS, LOW-INCOME PERSONS, AND MINORITY GROUPS. RESPONDENTS COMMENTED ON IF THEY BELIEVE CERTAIN POPULATION GROUPS (OR PEOPLE WITH CERTAIN SITUATIONS) NEED HELP TO IMPROVE THEIR CONDITION, AND IF SO, WHO NEEDS TO DO WHAT. WHEN THE ANALYSIS WAS COMPLETE, WE PUT THE INFORMATION AND SUMMARY CONCLUSIONS BEFORE OUR LOCAL GROUP OF EXPERTS, WHO WERE ASKED TO AGREE OR DISAGREE WITH THE SUMMARY CONCLUSIONS. THEY WERE FREE TO AUGMENT POTENTIAL CONCLUSIONS WITH ADDITIONAL STATEMENTS OF NEED, AND NEW NEEDS DID EMERGE FROM THE EXCHANGE. CONSULTATION WITH 19 LOCAL EXPERTS OCCURRED AGAIN VIA AN INTERNET-BASED SURVEY. WITH THE PRIOR STEPS IDENTIFYING POTENTIAL COMMUNITY NEEDS, THE LOCAL EXPERTS PARTICIPATED IN A STRUCTURED COMMUNICATION TECHNIQUE CALLED A DELPHI METHOD, ORIGINALLY DEVELOPED AS A SYSTEMATIC, INTERACTIVE FORECASTING METHOD THAT RELIES ON A PANEL OF EXPERTS. EXPERTS ANSWER QUESTIONNAIRES IN A SERIES OF ROUNDS. AFTER EACH ROUND, WE PROVIDED AN ANONYMOUS SUMMARY OF THE EXPERTS' FORECASTS FROM THE PREVIOUS ROUND, AS WELL AS REASONS PROVIDED FOR THEIR JUDGEMENTS. THE PROCESS ENCOURAGED EXPERTS TO REVISE THEIR EARLIER ANSWERS IN LIGHT OF THE REPLIES OF OTHER MEMBERS OF THEIR PANEL. TYPICALLY, THIS PROCESS DECREASES THE RANGE OF ANSWERS AND MOVES THE EXPERT OPINIONS TOWARD A CONSENSUS "CORRECT" ANSWER. THE PROCESS STOPS WHEN WE IDENTIFY THE MOST PRESSING, HIGHEST PRIORITY, COMMUNITY NEEDS. FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 11 1. SMOKING/TOBACCO USE (LCMH NOW PROVIDES EDUCATION MATERIALS TO PATIENTS AND EMPLOYEES.) A. RESOURCE CONSTRAINTS (LCMH RECENTLY IS LOSING MONEY FROM OPERATIONS SO NO RESOURCES ARE AVAILABLE TO DEVOTE TO THE NEED; AND B. NEED IS ADDRESSED BY OTHER FACILITY OR ORGANIZAION. 2. COMPLIANCE BEHAVIOR/PREDISPOSING CONDITIONS A. A LACK OF IDENTIFIED EFFECTIVE INTERVENTIONS TO ADDRESS THE NEED. 3. DENTISTS A. RESOURCE CONSTRAINTS (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO THE NEED; B. LACK OF EXPERTISE OF COMPETENCY (I.E. CERTAIN PROFESSIONAL CREDENTIAL REQUIRED AND NO SUCH INDIVIDUAL IS IN AREA); AND C. NEED IS ADDRESSED BY OTHER FACILITY OR ORGANIZATION. 4. MATERNAL AND INFANT MEASURES A. RESOURCE CONSTRAINTS (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO THE NEED); 5. PRIORITY POPULATIONS A. RESOURCE CONSTRAINTS (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO NEED); 6. CHOLESTEROL (HIGH) A. RESOURCE CONSTRAINTS (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO NEED); 7. BLOOD PRESSURE (HIGH) A. RESOURCE CONSTRAINT (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO NEED); 8. PHYSICIANS INCLUDING SPECIALITY (PHYSICANS) A. RESOURCE CONSTRAINT (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO NEED); 9. POLLUTION A. RESOURCE CONSTRAINT (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO NEED); 10 EMERGENCY SERVICES A. RESOURCE CONSTRAINT (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO NEED); 11. ALZHEIMER'S A. RESOURCE CONSTRAINT (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO NEED); 12. PREVENTABLE HOSPITALIZATION A. RESOURCE CONSTRAINT (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO NEED); 13. ACCIDENTS A. RESOURCE CONSTRAINT (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO NEED); 14. LIFE EXPECTANCY/PREMATURE DEATH A. RESOURCE CONSTRAINT (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO NEED); 15. KIDNEY DISEASE A. RESOURCE CONSTRAINT (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO NEED); 16. PALLIATIVE CARE AND HOSPICE A. RESOURCE CONSTRAINT (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO NEED); 17. CHRONIC OSTEOPOROSIS A. RESOURCE CONSTRAINT (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO NEED); 18. FLU-PNEUMONIA A. RESOURCE CONSTRAINT (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO NEED); 19. LOW BACK PAIN (CHRONIC) A. RESOURCE CONSTRAINT (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO NEED); 20. BLOOD POISONING A. RESOURCE CONSTRAINT (LCMH RECENTLY LOST MONEY FROM OPERATIONS SO NO RESOURCES TO DEVOTE TO NEED); FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 15E LCMH CHARGES THE SAME AMOUNT FOR ALL PATIENTS AND DISCOUNTS BASED ON FEDERAL POVERTY GUIDELINES. FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 19D LCMH USES SEARCH AMERICA WHICH MEANS THAT ADDITIONAL THIRD PARTIES ARE NOT NEEDED BEFORE MAKING REASONABLE EFFORTS REGARDING ELIGIBILITY. FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 20E OUTPATIENTS ARE NOTIFIED ON THE FIRST STATEMENT THEY RECEIVE THAT SHOWS ANY PATIENT BALANCE. LCMH ATTEMPTS TO NOTIFY ALL INPATIENTS AS PART OF THEIR STAY, BUT WITH THE AVERAGE LENGTH OF STAY OF 3 DAYS THIS IS NOT ALWAYS ACCOMPLISHED. THEY ALSO RECEIVE NOTICE ON THEIR FIRST STATEMENT OF THE FINANCIAL ASSISTANCE POLICY. ALL UNISURED PATIENTS RECEIVE A FINANCIAL ASSISTANCE APPLICATION UPON REGISTRATION. FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 22D LCMH HAS NO POLICY IN PLACE TO ADJUST NORMAL CHARGES TO A LOWER AMOUNT BEFORE FAP CHARITY IS APPLIED. FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 24 CHARGES ARE ALL AT NORMAL RATES. ANY FAP DISCOUNT IS APPLIED BASED ON NORMAL CHARGES. NO FAP-ELIGIBLE PATIENT PAID ANYTHING CLOSE TO USUAL CHARGES. PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION COMMUNITY BUILDING ACTIVITIES FORM 990, SCH H, PART II LAWRENCE COUNTY MEMORIAL HOSPITAL DID NOT CONDUCT ANY COMMUNITY BUILDING ACTIVITIES FOR THE YEAR ENDED 6/30/2015. BAD DEBT EXPENSE FORM 990, SCH H, PART III, LINES 2-4 ACCOUNTS ARE REPORTED AS BAD DEBT ONLY IF PATIENTS ARE NOT ELIGIBLE UNDER PRESUMPTIVE CHARITY OR DO NOT COMPLETE AN APPLICATION FOR FINANCIAL ASSISTANCE IF THEY CANNOT BE QUALIFIED AS PRESUMPTIVE. BAD DEBT EXPENSES ARE ACCOUNTS FOR PATIENTS THAT HAVE NOT PAID LCMH FOR THE SERVICES PROVIDED. EVERY EFFORT IS MADE TO QUALIFY THEM AS PRESUMPTIVE IF THEY DO NOT DIRECTLY REQUEST FINANCIAL ASSISTANCE. AN ELECTRONIC RESOURCE IS USED TO QUALIFY PATIENTS AS CHARITY BEFORE THE COLLECTION PROCESS IS STARTED. THE HOSPITALS ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF PAY PATIENTS WAS 69% AT JUNE 30, 2015 AND 71% AT JUNE 30, 2014. IN ADDITION, THERE WERE NO SIGNIFICANT FLUCTUATIONS IN WRITE-OFFS FROM SELF-PAY PATIENTS DURING FISCAL YEAR 2015 COMPARED TO FISCAL YEAR 2014. THE HOSPITAL PROVIDES CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS MEETING CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT REPORTED AS NET PATIENT SERVICE REVENUE. MEDICARE INFORMATION FORM 990, SCH H PART III LINE 8 MEDICARE AMOUNTS ARE TAKEN FROM THE AUDITED FINANCIAL STATMENTS. COLLECTION PRACTICES FORM 990, SCH H, PART III LINE 9B ANY PATIENT BALANCE THAT HAS GONE THROUGH THE IN-HOUSE COLLECTION PROCESS WILL BE SUBMITTED TO SEARCH AMERICA PRIOR TO BECOMING BAD DEBT. SEARCH AMERICA WILL YIELD BACK FEDERAL POVERTY PERCENTAGES THAT CAN BE USED TO QUALITY AS PRESUMPTIVE CHARITY WITHOUT APPLICATION BY THE PATIENT OR FAMILY. PATIENT EDUCATION OF ELGIBILITY FOR ASSISTANCE FORM 990, SCH H, PART VI, LINE 3 LCHM HAS POSTERS IN ALL REGISRATION AREAS RELATED TO ANY HOSPITAL DEPARTMENT INCLUDING OUR RURAL HEALTH CLINIC INFORMING PATIENTS THAT WE SEE ANYONE REGARDLESS OF THEIR ABILITY TO PAY AND THAT FINANCIAL ASSISTANCE IS AVALABLE TO UNINSURED AND UNDERINSURED. ALL ED PATIENTS ARE SEEN BY A PRACTITIONER PRIOR TO REQUEST FOR ANY FINANCIAL INFORMATION/INSURANCE AS REQUIRED BY EMTALA. ALL PATIENTS THAT DO NOT HAVE INSURANCE OR THAT HAVE A PATIENT BALANCE AFTER INSURANCE ARE CONTACTED BY OUR PATIENT FINANICAL SERVICES REPRESENTATIVE WHO THEN PROVIDES A FINANCIAL ASSISTANCE FORM. COMMUNITY INFORMATION FORM 990, SCH H, PART VI, LINE 4 LCMH SERVES AS A PREDOMINANTLY RURAL COUNTY IN SOUTH EASTERN ILLINOIS. THE POPULATION IS MORE ELDERLY AND LESS AFFLUENT THAN MOST COUNTIES IN THE STATE. 18.8% OF THE POPULATION HAS LESS THAN A HIGH SCHOOL DIPLOMA WITH ANOTHER 37.7% HAVING ONLY A HIGH SCHOOL EDUCATION. 22% OF THE HOUSEHOLDS REPORT INCOME OF LESS THAN 15,000. A LARGE TERTIARY HOSPITAL IS WITHIN 12 MILES OF LCMH LOCATED IN VINCENNES, IN. MANY PATIENTS WITH INSURANCE MAKE THE DRIVE LEAVING LCHM WITH A MUCH HIGHER PERCENT OF MEDICAID BUSINESS. WITH LCMH MOVEMENT TO NOT-FOR-PROFIT STATUS IN FY 2012 A MORE CONCERTED EFFORT WAS UNDERATKEN AT THE DIRECTION OF OUR BOARD TO IDENTIFY ANY PATIENT THAT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. TO BETTER SERVE THE NEED OF THESE PATIENTS, LCMH OPENED A RURAL HEALTH CLINIC STAFFED WITH PHYSICIANS AND MID-LEVEL PRACTITIONERS TO PROVIDE A PRIMARY SOURCE OF CARE THAT IS EASILY ACCESSIBLE FOR THEM. PROMOTION OF COMMINTY HEALTH FORM 990, SCH H. PART V, LINE 5 LCMH PARTICIPATES IN MANY COMMUNITY GROUPS THAT ARE DESIGNED TO IMPROVE THE HEALTH OF THE COMMUNITY. LCMH PROVIDES A MEETING LOCATION FOR ALCOHOLICS ANONYMOUS TWICE PER WEEK AS WELL AS A LOCATION FOR A LOCAL BEREAVEMENT AND SUPPORT GROUP. LCMH LEADERSHIP ALSO IS ONE OF SEVERAL BOARDS IN THE AREA TO SUPPORT ECONOMIC DEVELOPMENT AS WELL AS PROVIDE LEADERSHIP ROLES IN BOARDS THAT PROVIDE RESOURCES DURING FLOODING AND PROVIDE ACTIVE LEADERSHIP IN COMMITTEES FOR ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK PROVIDING SUPPORT TO ALL CAHS IN ILLINOIS TO HELP THEM BETTER SERVE THEIR COMMUNITIES. AFFLIATED HEALTH CARE SYSTEMS FORM 990, SCH H, PART VI LINE 6 LCMH IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. STATE FILING OF COMMUNITY BENEFIT REPORT FORM 990, SCH H. PART VI, LINE 7 LCHM IS NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT IN ILLNOIS DUE TO THE FACT THAT THE HOSPITAL CONTAINS LESS THAN 100 BEDS. NEEDS ASSESSMENT FORM 990, SCH H. PART VI LINE 2 LCMH UTILIZED SERVICES FROM QHR TO PERFORM A COMMUNITY HEALTH NEEDS ASSESSEMENT (CHNA) AND THE REPORT WAS PROVIDED IN JUNE 2013. X X false false false false false false false true false DR GARY CARR TRUSTEE /PHYSICAN 224258 224258 DOUG FLORKOWSKI CEO 201334 52690 7260 261284 STEVEN RAMSARAN PHYSICAN 301494 20193 22122 343809 SCHEDULE J, PAGE 1, PART I, LINE 7 SCHEDULE J, PART I, LINE 7 PHYSICAIN COMPENSATION PAID BASED ON ANTICIPATED VOLUME (VISITS) AND RECONCILED QUARTERLY. STAN WLLIAMS FAMILY MEMBER 56456 W-2 WAGES false RON WALDROP FAMILY MEMBER 27196 W-2 WAGES false SCHEDULE L, PART V RON WALDROP IS A VOTING OFFICER OF THE HOSPITAL BOARD. HIS DAUGHTER IN LAW IS EMPLOYED IN THE IT DEPARTMENT. THE 2014 WAGES PAID BY LAWRENCE COUNTY MEMORIAL HOSPITAL LISTED ON HER W-2 TOTALED 27,195.20. STAN WILLIAMS IS A VOTING TRUSTEE OF THE HOSPITAL BOARD. HIS SON IN LAW IS THE DIRECTOR OF THE IT DEPARTMENT. THE 2014 WAGES PAID BY LAWRENCE COUNTY MEMORIAL HOSPITAL LISTED ON HIS W-2 TOTALED 56,455.98. FORM 990, PAGE 6, PART VI, LINE 3 QUORUM HEALTH RESOURCES, LLC HAS A MANAGEMENT CONTRACT WITH THE BOARD OF LCMH SINCE MAY OF 2006. THIS CONTRACT WAS RENEWED IN 2011 FOR 6 YEARS. QUORUM HEALTH RESOURCES PROVIDES ASSISTANCE IN THE EVALUATION OF OFFICERS, PROVIDES ADMINISTRATIVE RESOURCES, CONSULTING SERVICES, CHARGE MASTER AND COMPLIANCE SERVICES. COMPENSATION OF BOARD MEMBERS FORM 990 PART VII, SECTION A DR GARY CARR IS COMPENSATED FOR BEING A PRACTICING PHYSICIAN AT LCMH. HE IS NOT COMPENSATED AS A MEMBER OF THE BOARD. FORM 990, PAGE 6, PART VI, LINE 11B THE CFO AND AN INDEPENDENT ACCOUNTING FIRM REVIEWED THE FORM 990 BEFORE FILING. AN ELECTRONIC OR HARD COPY OF THE FORM 990 IS PROVIDED TO ALL BOARD MEMBERS AFTER IT IS FILED. FORM 990, PAGE 6, PART VI, LINE 12C TRUSTEES AND DEPARTMENT LEADERS SIGN ANNUAL CONFLICT OF INTEREST POLICY STATEMENTS. ANYONE WITH A CONFLICT DOES NOT PARTICIPATE IN ANY RELATED DECISION MAKING PROCESSES. STAFF AND DEPARTMENT LEADERS HAVE THIS INCLUDED AS A PART OF THEIR ANNUAL TRAINING CONDUCTED ELECTRONICALLY THROUGH HEALTH STREAM. THE SIGNED STATEMENTS ARE REVIEWED BY THE COO AND THE CEO. FORM 990, PAGE 6, PART VI, LINE 15A A REVIEW IS CONDUCTED ANNUALLY BY THE ENTIRE BOARD OF TRUSTEES ALONG WITH THE REGIONAL MANAGEMENT TEAM FROM QUORUM HEALTH RESOURCES. NATIONAL COMPARATIVE DATA IS PROVIDED BY QHR AS PART OF THE ANNUAL CEO EVALUATION AND WAGE ADJUSTMENT. OFFICER COMPENSATION DECISIONS ARE ALSO DOCUMENTED IN THE BOARD MINUTES. FORM 990, PAGE 6, PART VI, LINE 15B A REVIEW IS CONDUCTED BY THE ENTIRE BOARD OF TRUSTEES ALONG WITH THE REGIONAL MANAGEMENT TEAM FROM QUROUM HEALTH RESOURCES. NATIONAL COMPARATIVE DATA IS PROVIDED BY QHR AS PART OF THE ANNUAL CEO EVALUATION AND WAGE ADJUSTMENT. OFFICER COMPENSATION DECISIONS ARE ALSO DOCUMENTED IN THE BOARD MINUTES. FORM 990, PAGE 6, PART VI, LINE 18 FORM 1023 HAS BEEN FILED, APPROVED AND IS AVAILAVLE TO THE PUBLIC UPON REQUEST. FORM 990, PAGE 6, PART VI, LINE 19 THE DOCUMENTS ARE AVAILABLE UPON REQUEST AT THE ADMINISTRATIVE OFFICES. FORM 990, PART IX, LINE 11G ED PHYSICIAN SERVICES 766,830 0 0 CONTRACTED SURGEON 300,000 0 0 CONTRACTED RHC PHYSICIAN 112,948 0 0 LAUNDRY/LINEN SERVICE 0 127,057 0 CPSI - SOFTWARE 0 127,214 0 DIAGNOSTIC SHARED 156,086 0 0 NUC MED ULTRASOUND 332,011 0 0 VARIOUS OTHER SERVICES 320,458 395,314 0 FORM 990, PART XI, LINE 9 PROVISION FOR UNCOLLECTABLE -998,756 PROVISION FOR UNCOLLECTABLE 998,756 END AND DEV FOUNDATION FOR LAWREN 2200 STATE STREET LAWRENCEVILLE IL 62439 376052607 FUNDRAISIN IL 501C3 9 N/A false false false false false false false false false false false false false false false false false false false false