2014-01-31T13:35:10-06:00 2013-06-30 KERBER ECK & BRAECKEL LLP 1116 W MAIN ST CARBONDALE IL 629012335 990 2012-07-01 370661202 FAIRFIELD MEMORIAL HOSPITAL ASSOC FAIR 6188422611 303 NW 11TH ST FAIRFIELD IL 62837 KATHY CLAYTON 6188422611 2014-01-28 true MARK DALLAS 6185291040 2014-01-31 2012 2015-11-30 17:44:51Z KATHERINE BUNTING 303 NW 11TH ST FAIRFIELD IL 62837 26428182 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 6 311 58 0 563381 457411 25564158 25143695 12363 13167 328286 813409 26468188 26427682 0 0 12636087 12902387 0 0 13911946 12829401 26548033 25731788 -79845 695894 25545808 25285680 12939954 11983932 12605854 13301748 X THE MISSION OF FAIRFIELD MEMORIAL HOSPITAL IS TO MAINTAIN AND IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. false false 25731788 26427682 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 2013 THIS AMOUNTED TO 2,550,666. 25731788 true false false false false false false false false false true false false true true true true false 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 23 0 true 311 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 KATHY CLAYTON 6188422611 303 NW 11TH ST FAIRFIELD IL 62837 PATRICK MOLT MD 10.00 X 79100 0 0 MARTY HEFLIN 5.00 X 0 0 0 JAMIE POLLARD 1.00 X 0 0 0 MIKE ST LEDGER 10.00 X 0 0 0 SANDY SIMPSON 1.00 X 0 0 0 DONNA SULLIVAN 4.00 X 0 0 0 RENA TALBERT 1.00 X 0 0 0 DALE WARREN 2.00 X 0 0 0 JARED VAUGHN 4.00 X 0 0 0 KATHY BUNTING 40.00 X 207397 0 5125 ANN IGNAS 40.00 X 109254 0 8822 KATHY CLAYTON 40.00 X 0 0 0 WESLEY THOMPSON 40.00 X 363603 0 32961 CHRIS BALLARD 40.00 X 323174 0 32249 KYLE KAKAC 40.00 X 285600 0 31110 ALEX KING 40.00 X 225544 0 29836 KIM KING 40.00 X 219297 0 5303 MIKE BROWN 40.00 X 130096 0 2570 1943065 147976 15 true true false AMERISOURCE BERGEN DRUG COMPANY 25199 NETWORK PLACE CHICAGO IL 606731251 PHARMACEUTICALS 811637 WAY-FAIR NURSING & REHABILITATION CE 305 NW 11TH ST FAIRFIELD IL 62837 DIETARY 766914 JE SHEKELL 424 W TENNESSEE STREET EVANSVILLE IN 477102448 GENERATOR PROJE 640833 ARAMARK UNIFORM SERVICE PO BOX 660452 INDIANAPOLIS IN 46266 LAUNDRY 500840 DR RODNEY BEELER 2142 KETTLES HILL COURT EVANSVILLE IN 47725 ER PHYSICIAN 355236 11 457411 457411 NET PATIENT SERVICE REVENUE 25143695 25143695 25143695 12724 12724 241936 241936 241936 241936 943 500 443 443 443 MEDICAID EHR REVENUE 209420 209420 MISCELLANEOUS 127494 127494 MEDICARE EHR REVENUE 118863 118863 115696 115696 571473 26427682 25970271 X 316651 316651 130096 130096 10095862 10095862 131195 131195 1526128 1526128 702455 702455 8939 8939 35100 35100 4584848 4584848 118221 118221 2316247 2316247 893373 893373 188107 188107 401157 401157 1336105 1336105 178823 178823 DRUGS 905319 905319 REPAIRS AND MAINTENANCE 650475 650475 BED AND PROVIDER TAX ASMT 512347 512347 FOOD 449850 449850 250490 250490 25731788 25731788 0 0 995 2640 2717565 2729891 4984323 4676914 301993 330331 102527 123718 34372432 18665359 16328345 15707073 300800 300800 809260 1414313 25545808 25285680 2574522 2300464 191058 9419829 8616672 56800 18933 888803 856805 12939954 11983932 X 11877535 12371703 727750 929476 569 569 12605854 13301748 25545808 25285680 695894 X false true X true false X 421395 421395 19035401 7131828 11903573 14767764 11514492 3253272 147872 19039 128833 15707073 THIRD PARTY REIMBURSEMENT PROGRAM 775701 INVESTMENT IN INTERRELATED ORG. 632004 OIL LEASEHOLD 6608 1414313 THIRD PARTY REIMBURSEMENT PROGRAMS 856805 856805 X 26427682 26427682 26427682 25731788 25731788 25731788 LIABILITY UNDER FIN 48 FOOTNOTE SCHEDULE D, PAGE 3, PART X THERE WERE NO UNCERTAIN TAX BENEFITS IDENTIFIED AND RECORDED AS A LIABILITY UPON THE ADOPTION OF ASC TOPIC 740-10-25 OR AT JUNE 30, 2013. true true true X true X true true true false false 955581 955581 0.03710 848883 588727 260156 0.01010 1804464 588727 1215737 0.04720 44081 44081 0.00170 44081 44081 0.00170 1848545 588727 1259818 0.04900 true 759863 189966 12691312 13212372 -521060 X true true 2 1 FAIRFIELD MEMORIAL HOSPITAL

303 NW 11TH ST FAIRFIELD IL 62837

X X X X 2 HORIZON HEALTHCARE

1021 HARDING ST FAIRFIELD IL 62837

OUTPATIENT PHYSCIAN CLINIC FAIRFIELD MEMORIAL HOSPITAL 1 true X X X X X X X X X X 12 false false true X X X X X X X X X X true false true true 200.0 true 300.0 true X X X true true X X X X X X true X X true X X X X X X true X false false HORIZON HEALTHCARE 2 true X X X X X X X X X X 12 false false true X X X X X X X X X X true false true true 200.0 true 300.0 true X X X true true X X X X X X true X X true X X X X X X true X false false EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE PART I LINE 7 COLUMN F 2028251 COSTING METHODOLOGY EXPLANATION PART I LINE 7 THE FAIRFIELD MEMORIAL HOSPITAL ASSOCIATION USED A COST TO CHARGE RATIO AS CALCULATED FROM WORKSHEET 2 RATIO OF PATIENT CARE COSTTOCHARGES INCLUDED IN THE SCHEDULE H INSTRUCTIONS TO DETERMINE THE AMOUNTS ON LINES 7A AND 7B OF PART I OF SCHEDULE H BAD DEBT EXPENSE EXPLANATION PART III LINE 4 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 BASED ON THE HOSPITALS 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 FOLLOWING IS NOTE C UNCOMPENSATED CARE AND COMMUNITY BENEFIT COPIED DIRECTLY FROM THE AUDITED FINANCIAL STATEMENTS IN SUPPORT OF ITS MISSION THE HOSPITAL VOLUNTARILY PROVIDES CARE TO PATIENTS AT LESS THAN ITS ESTABLISHED CHARGES FOR PATIENTS THAT MEET THE HOSPITALS 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 CHARGES EXCLUDED FROM REVENUE UNDER THE HOSPITALS CHARITY CARE POLICY WERE APPROXIMATELY 2550666 AND 2078000 FOR 2013 AND 2012 IN ADDITION THE HOSPITAL PROVIDES SERVICES TO OTHER MEDICALLY INDIGENT PATIENTS UNDER CERTAIN GOVERNMENTREIMBURSED 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 HOSPITALS TOTAL COST OF UNCOMPENSATED CARE RELATING TO THESE SERVICES AND OTHER SERVICES ARE AS FOLLOWS CHARITY CARE 821301 STATE MEDICAID AND OTHER PUBLIC PROGRAMS 63223 UNCOLLECTIBLE ACCOUNTS 590301 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 UNFILLED COMMUNITY NEEDS MANY OF THESE ACTIVITIES ARE SPONSORED WITH KNOWLEDGE THAT THEY WILL NOT BE SELFSUPPORTING OR FINANCIALLY VIABLE MEDICARE EXPLANATION PART III LINE 8 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 69545 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 COLLECTION PRACTICES EXPLANATION PART III LINE 9B THE FAIRFIELD MEMORIAL HOSPITAL APPLIES ITS COLLECTION PRACTICES EQUALLY TO ALL PATIENTS BOTH CHARITY CARE ELIGIBLE AND NONCHARITY CARE PATIENTS THE PROCEDURES FOR COLLECTION ON PATIENT ACCOUNTS ARE AS FOLLOWS SELFPAY 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 EARLYOUT DEPARTMENT FOR A FOLLOWUP STATEMENTPHONE CALL TO THE PATIENT THE HOSPITAL OFFERS THE PATIENTS SEVERAL PAYMENT ALTERNATIVES 1 CASHCHECK FOR THE FULL AMOUNT 2 MASTERCARDVISADISCOVER 3 SHORTTERM 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 714 FIRST PHONE CALL IS MADE AT LEAST ONE PHONE CALL OR NOTICE PER WEEK FOR THE REMAINDER OF THE EARLYOUT 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 NEEDS ASSESSMENT PART VI 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 HOSPITALS SENIOR LEADERSHIP AND INCORPORATED INTO STRATEGIC PLANNING PROCESSES PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI SIGNS ARE POSTED IN THE FACILITY THE PATIENTS 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 COMMUNITY INFORMATION PART VI 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 16760 THE MEDIAN HOUSEHOLD INCOME IN 2011 WAS 39207 WHICH WAS 77 OF ILLINOIS AVERAGE AND 78 OF THE US AVERAGE THE PERCENTAGE OF INDIVIDUALS BELOW POVERTY LEVEL WAS 143 LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILED PART VI ILLINOIS ADDITIONAL INFORMATION PART VI STUDY FINDINGS SHOWED THAT FAIRFIELD MEMORIAL HOSPITAL ECONOMIC IMPACT IN ONE YEAR FOR 2009 BASED ON COMMUNITY BENFIT STUDY DONE IN 2009 WERE THE FOLLOWING EMPLOYED 356 POEPLE GENERATED SALARIES AND BENEFITS OF 13539909 INVESTED 2218116 IN CAPITAL EXPEDITURES GENERATED 56780973 OF ECONOMIC ACTIVITY US DEPARTMENT OF COMMERCE GENERATED 24032877 OF HOUSEHOLD EARNINGSUS DEPARTMENT OF COMMERCE CREATED APPROXIMATELY 1240 JOBS IN WAYNE COUNTY OUTSIDE OF HEALTHCARE THESE NUMBERS CLEARLY DEMONSTATE THAT FAIRFIELD MEMORIAL HOSPITAL WILL BE A MAJOR FACTOR IN FUTURE ECONOMIC DEVELOPMENT IN WAYNE COUNTY FAIRFIELD MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 14G PART V LINE 14G THE POLICY IS VERBALLY DISCUSSED WITH ALL SELFPAY PATIENTS FAIRFIELD MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 20D PART V LINE 20D 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 HORIZON HEALTHCARE LINE NUMBER 2 PART V LINE 14G PART V LINE 14G POLICY IS VERBALLY DISCUSSED WITH ALL SELFPAY PATIENTS HORIZON HEALTHCARE LINE NUMBER 2 PART V LINE 20D PART V LINE 20D 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 X X X X X false false false false false false false false false KATHY BUNTING 207397 4208 917 212522 WESLEY THOMPSON 363603 32044 917 396564 CHRIS BALLARD 323174 31332 917 355423 KYLE KAKAC 285600 30193 917 316710 ALEX KING 225544 28919 917 255380 KIM KING 219297 4386 917 224600 MIKE BROWN 130096 1902 668 132666 CHARLOTTE ST LEDGER EMPLOYEE 44443 WIFE OF PRESIDENT false NICOLE FYIE PHYSICIAN 63718 WIFE OF BOARD MEMBER false PATRICK MOLT PHYSICIAN 79100 BOARD MEMBER false EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITS 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. FIRST ACCOMPLISHMENT DESCRIPTION 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 2013 THIS AMOUNTED TO 2,550,666. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 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. ENFORCEMENT OF CONFLICTS POLICY 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. COMPENSATION PROCESS FOR TOP OFFICIAL 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. COMPENSATION PROCESS FOR OFFICERS 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. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 COPIES OF THE ORGANIZATIONS GOVERING DOCUMENTS, CONFLICT IF INTEREST POLICIES, FINANCIAL STATEMENTS, AND THE FEDERAL FORM 990 TAX RETURN ARE AVAILABLE UPON REQUEST FROM THE ADMINISTRATIVE OFFICES. OTHER FEES FOR SERVICES FORM 990, PART IX, LINE 11G PROFESSIONAL SERVICES 3,101,087 0 0 PHYSICIANS FEES 1,483,761 0 0 FAIRFIELD MEMORIAL HOSPITAL FOUNDAT 303 NW 11TH STREET FAIRFIELD IL 62837 371185754 SUPPORT IL 501C3 11B N/A false false false false false false false false false false false false false false false false false false false false