2015-08-17T10:20:11-05:00 2014-09-30 371335003 ECK SCHAFER & PUNKE LLP 227 South Seventh Street Springfield IL 62701 990 2013-10-01 370647938 Gibson Community Hospital Association GIBS 2177844251 1120 North Melvin Gibson City IL 60936 Rob Schmitt CEO 2177844251 2015-08-13 1 Brent Leach P00331592 2175251111 2013 2016-02-25 16:41:14Z Rob Schmitt 1120 North Melvin Gibson City IL 60936 74072807 0 X http://www.gibsonhospital.org X 1952 IL Health care and related services 14 13 690 211 0 0 5000 99758 63245626 70970179 70649 89530 2193649 2873361 65514924 74032828 25000 20000 0 0 37850437 41442369 0 0 0 28310976 32372592 66186413 73834961 -671489 197867 39593664 44231359 21912951 25571881 17680713 18659478 To provide personalized, professional services to the residents of the communities we serve. 0 0 62759717 20000 73843540 The organization provides for inpatient and outpatient health care along with long-term care for members of the community and surrounding areas. 62759717 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 1 46 0 1 690 1 0 0 0 0 0 0 0 0 X 14 13 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X Rob Schmitt 2177844251 1120 North Melvin Gibson City IL 60936 Jim Hood President 1.00 X X 0 0 0 Margo Martin Vice-President 1.00 X X 0 0 0 Tracy Epps Treasurer 1.00 X X 0 0 0 Ellen Lee Secretary 1.00 X X 0 0 0 Carl Hudson Jr Director 1.00 X 0 0 0 Steve Kelly Director 1.00 X 0 0 0 David J Hagan MD Director 1.00 X 0 0 0 Marty Nuss Director 1.00 X 0 0 0 Mark Spangler MD Director 1.00 X 0 0 0 Nancy Krumwiede Director 1.00 X 0 0 0 John Leonard Director 1.00 X 0 0 0 Michael Young Director 1.00 X 0 0 0 Kathy Bennett Director 1.00 X 0 0 0 Ted Swanson Director 1.00 X 0 0 0 Rob Schmitt CEO 40.00 X 244861 0 14428 John Jacobson CFO 40.00 X 150117 0 10106 Robin Rose COO 40.00 X 197843 0 11215 Mike Meunier CCO 40.00 X 164614 0 8783 Richard Foellner DO Physician 40.00 X 532663 0 43568 William Price MD Physician 40.00 X 603049 0 24872 Benjamin Brewer MD Physician 40.00 X 399582 0 20568 Anthony San Diego MD Physician 40.00 X 452253 0 23456 Joseph Chung MD Physician 40.00 X 449920 0 18904 3194902 0 175900 35 0 1 0 All Inclusive Medical Services Orland Park Illinois Orland Park IL 60462 ER Hospitalist Physicians 1741609 Cardinal Health Pharmacy Management 1330 Enclave Parkway Houston TX 77077 Pharmacy Management 1703734 Gary W Kerber MD 1002 S Busey Ave Urbana IL 61801 Radiologist 548600 Petry-Kuhne Co 2110 Clearlake Boulevard 101 Champaign IL 61822 Construction 286860 CPSI 6600 Wall Street Mobile AL 36695 Computer Services 245882 13 99758 99758 Net Patient Service 621990 70970179 70970179 70970179 86649 86649 42860 39979 2881 2881 2881 Miscellaneous 900099 2873361 2873361 2873361 74032828 73843540 0 89530 20000 20000 451677 383925 67752 31897206 27112626 4784580 9093486 7729463 1364023 4256546 3618064 638482 425388 361580 63808 588565 500280 88285 2315627 1968283 347344 1054440 896274 158166 Supplies 8596759 7307245 1289514 Purchased Services 6507043 5530987 976056 Bad Debts 3467315 2947218 520097 Other 2155509 1829183 326326 3005400 2554589 450811 73834961 62759717 11075244 0 706708 1128930 11142869 14287674 642754 629649 509719 503233 47073079 28780988 17952524 18292091 2117420 1584341 242212 201843 6279458 7603598 39593664 44231359 6842039 7250596 13760184 16698609 1310728 1622676 21912951 25571881 X 17523558 18510124 157155 149354 17680713 18659478 39593664 44231359 X 197867 21346 759552 X 0 1 X 1 0 X 544832 544832 26250155 14994575 11255580 18932751 12844740 6088011 1345341 941673 403668 18292091 Bond Issuance Costs 228540 Construction in Progress 7375058 7603598 Capital lease payable 209741 Estimated Third pary Settlements 1412935 1622676 X Part X, Line 2: GAHHS follows accounting principles generally accepted in the United States of America which sets a minimum threshold for financial statement recognition of the benefit of a tax position taken or expected to be taken in a tax return. Tax positions for the open tax years as of September 30, 2014 were reviewed, and it was determined that no provision for uncertain tax positions is required. GAHHS information income tax returns for years subsequent to fiscal year 2010 are open, by statute, for review by authorities. 1 1 1 X 1 X 1 1 0 1 1 1750635 325892 1424743 0.01930 7499984 3580655 3919329 0.05310 9250619 3906547 5344072 0.07240 114210 114210 0.00150 6871713 3254763 3616950 0.04900 546249 1000 545249 0.00740 7532172 3255763 4276409 0.05790 16782791 7162310 9620481 0.13030 1 3467315 173366 15948656 18432950 -2484294 X 1 1 15 1 Gibson Community Hospital 1120 North Melvin Gibson City IL 60936 X X X Long-term care 2 Paxton Clinic 227 N Market Paxton IL 60957 Physician clinic 3 Onarga Clinic 109 N Chestnut Onarga IL 60955 Physician clinic 4 Family Healthcare of Hoopeston 837 E Orange Hoopeston IL 60942 Physician clinic 5 Family Health Care of Farmer City 1230 S George Rock Dr Farmer City IL 61842 Physician clinic 6 Prairie Family Medicine and Obstetrics 122 E Wabash Forrest IL 60936 Physician clinic 7 Gibson Area Hospital Orthopedics 10 Doctors Park Gibson City IL 60936 Physician clinic 8 Gibson Area Ambulance Service 1120 North Melvin Gibson City IL 60936 Ambulance service 9 Gibson Area Hospital Surgery Clinic 1 Doctors Park Gibson City IL 60936 Physician clinic 10 Family Health Care of Fairbury 401 S Clay Street Fairbury IL 61739 Physician clinic 11 Family Health Care of Gibson City 7 Doctors Park Gibson City IL 60936 Physician clinic 12 Gibson Cosmetology 1117 N Melvin Street Gibson City IL 60936 Physician clinic 13 Family Health Care of Potomac 106 E State Street Potomac IL 61865 Physician clinic 14 Mahomet Specialty Clinic 1504 Patton Drive Suite 2 Mahomet IL 61853 Physician clinic 15 GAH Cardiology 10 Doctors Park Gibson City IL 60936 Physician clinic Gibson Area Hospital and Health Services 1 1 X X X X X X X X X 12 1 1 1 X www.gibsonhospital.org X X X X X X X X X 1 0 1 1 200.000000000000 1 200.000000000000 1 X X X X X X X 1 1 X X X X X X 1 0 X X X X 1 X 0 0 Gibson Area Hospital and Health Services Part V, Section B, Line 3: In conducting the CHNA, three focus groups were utilized. The first consisted of community officials including the Ford County Board, Gibson City Officials, School District officials, and others. The second group consisted of Health Care Professionals such as physicians, pharmacists, nursing home representatives, public health department officials and others. The third group consisted of community leaders such as farmers, local business owners, clergy, and others. Gibson Area Hospital and Health Services Part V, Section B, Line 4: The CHNA was conducted including all of the facilities listed on Part V Section A. Part I, Line 7: Cost to charge ratio was obtained using Cost Accounting System. This system does address all patient segments and it is used to calculate the overall cost to charge ratio for the hospital. Part III, Line 4: Cost methodology for numbers in 2, and 3: 2 - actual bad debt expenses recorded in FY 2013 times 53.7% cost to charge ratio. 3 - 5% of total bad debt expense. Patient Financial Services works towards getting charity eligible patients qualified several times during the collection process. Unpaid patient accounts are turned over to agencies that try to collect the patient monies left unpaid. Patients are never turned over to a credit reporting agency nor are they sued over amounts due. Part III, Line 8: Part of the shortfall is settled after the CMS intermediary finalizes the cost report. Part III, Line 9b: To the extent patients are eligible for charity care and financial assistance, no further collection actions are taken. Part VI, Line 2: The hospital is currently working on a community needs assessment outlined by CMS guidelines. Part VI, Line 3: Charity care/financial assistance is posted on the hospital website. It is also discussed during the pre-registration process for all self pay and patients with a high deductible. Informational packets are distributed from each registration area [including ED] for self pay & high deductible. The informational packets have a application, cover letter about the program, and contact info on who/where to call for more info or assistance. Each self pay patient is contacted by Financial Healthcare Resources to discuss the government programs they may be eligible for and/or charity care. Charity care is also offered on the first statement that the patient receives. Part VI, Line 4: The hospital is located Ford County, IL. The hospital also has clinics in Livingston, DeWitt, and Iroquois counties, as well as serving Vermillion County. The hospital and clinics serve areas that are all considered rural; small towns and farmland. Of the counties listed above, as of 2008, percentage of persons below poverty level: Ford, 9.8%; Livingston 11.4%; DeWitt 10.2%; Iroquois 10.8%; Vermillion 14.6%; State level is 12.2% . Median Income, 2008: Ford, $51,313; Livingston, $50,972, DeWitt, $47,645; Iroquois, $46,529; Vermillion $41,292; State level is $56,230. Percent of population enrolled with HFS for benefits as of 2009: Ford, 18.8%; Livingston, 17.2%; DeWitt 18.7%; Iroquois 19.6%; Vermillion 27.1%. Closest hospital facilities are 30 miles to the southeast in Champaign/Urbana (Carle, Provena), and 35 miles to the west in Bloomington/Normal (OSF, Advocate/BroMenn). Part VI, Line 5: The entire Board of Directors is comprised of persons who reside in our primary service area, as do the Administrative Staff of the hospital. All of the physicians in the community have privileges at the hospital. The organization has also recruited and placed physicians in other rural communities, that also have privileges at the hospital. The hospital runs and maintains EMS services to several rural communities, which the organization runs at a loss every year. Any surplus funds are used to improve medical equipment, purchase needed supplies and pharmaceuticals, recruit providers for needed services, pay for staff to attend educational workshops, and other needed items and services for the betterment of the community. No excess of revenue over expenses are used to pay any shareholders or investors. This organization does not have either of the latter. Part VI, Line 6: Gibson Hospital is not part of an affiliated healthcare system. Part VI, Line 7, Reports Filed With States IL 1 Telecare 215 E 3rd St Gibson City IL 60936 237353001 501(c)3 20000 Community Benefit Community Benefit Part I, Line 2: Grants are made to 501 (c)(3) organizations to provide community benefit. X X X 0 0 0 0 0 0 0 0 0 Rob Schmitt CEO 244861 0 0 0 0 0 11360 0 3068 0 259289 0 0 0 John Jacobson CFO 150117 0 0 0 0 0 7038 0 3068 0 160223 0 0 0 Robin Rose COO 197843 0 0 0 0 0 11215 0 0 0 209058 0 0 0 Mike Meunier CCO 164614 0 0 0 0 0 8783 0 0 0 173397 0 0 0 Richard Foellner DO Physician 532663 0 0 0 0 0 40500 0 3068 0 576231 0 0 0 William Price MD Physician 603049 0 0 0 0 0 23000 0 1872 0 627921 0 0 0 Benjamin Brewer MD Physician 327032 0 72550 0 0 0 17500 0 3068 0 420150 0 0 0 Anthony San Diego MD Physician 433459 0 18794 0 0 0 20388 0 3068 0 475709 0 0 0 Joseph Chung MD Physician 375351 0 74569 0 0 0 17500 0 1404 0 468824 0 0 0 A The City of Gibson City 376000811 2010-12-01 11720000 Refinancing of prior bonds, costs associated with facility renovation 0 0 0 A 1554932 13306062 858896 77708 11398979 281280 689199 1 0 1 0 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 Mark Spangler MD Start-up costs for his practice X 345000 70696 0 1 1 70696 Mark Spangler MD Current board member of the Organization 131706 Pays the Organization a monthly fee for management services for his office. 0 Form 990, Part VI, Section A, line 2 Mark Spangler has a outstanding loan with the Hospital. Form 990, Part VI, Section A, line 3 The hospital is in a contract with a managment company but the CEO remains employed by the hospital. Form 990, Part VI, Section A, line 6 The Hospital has association members. These members are any individual who contributed $100 or more to the Hospital during the fiscal year and Life Members - Being those who have contributed a sum of One Thousand ($1,000) dollars or more to further the objectives of the Hospital. Form 990, Part VI, Section A, line 7a The Association's members are allowed to vote annually at the member meeting. Form 990, Part VI, Section A, line 7b At the annual meeting, the members are asked to vote on the approval of the Board of Directors acting on the member's behalf. Form 990, Part VI, Section B, line 11 Form 990 is prepared by our independent accountants and provided to the governing body prior to filing. Form 990 is reviewed in detail by the Controller and CFO. Form 990, Part VI, Section B, line 12c Yearly conflict of interest agreements are signed by board members. There is also a quarterly compliance review of these agreeements. Form 990, Part VI, Section B, line 15 Top management and key employees' compensation is determined based on a review of current market comparables, experience level, and competitive compensation packages. The CEO is responsible for all compensation negotiations. Form 990, Part VI, Section C, line 19 All documents are available to the public upon request. Form 990, Part XI, line 9: Transfer of Net Assets from Gibson Area Hospital Foundation #36-4311943 759,552. Form 990, Part IV, Line 12 The Hospital received an unmodified GAAP opinion on financial statements that were combined with the Gibson Area Hospital Foundation. Gibson Area Hospital Foundation 1120 N Melvin Gibson City IL 60936 364311943 Support of the Hospital IL 501(c)3 509(a)2 N/A 0 Gibson Community Hospital Auxiliary 1120 N Melvin Gibson City IL 60936 371150282 Scholarships, Giftshop, Gala Fundraiser IL 501(c)3 509(a)2 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0