2014-08-27T14:46:38-05:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2013-01-01 370792770 GREENVILLE REGIONAL HOSPITAL INC GREE 6186641230 200 HEALTH CARE DRIVE GREENVILLE IL 622461156 BRIAN NALL PRESIDENT & CEO 6186641230 2014-08-21 1 JEFF PARKER P00970069 3149254300 2013 2015-11-30 17:44:51Z BRIAN NALL 200 HEALTH CARE DRIVE GREENVILLE IL 622461156 36817489 0 X WWW.GREENVILLEREGIONALHOSPITAL.COM X 1956 IL PROVIDE COMPASSIONATE CARE AND EXCELLENT SERVICE IN A MODERN AND EFFICIENT HEALTHCARE ORGANIZATION STAFFED BY HIGHLY TRAINED PROFESSIONALS. 11 9 515 750 0 0 2827313 388720 37003093 34828807 49680 124074 1064838 1412208 40944924 36753809 300000 315000 0 0 22355171 20842290 24000 0 8479 17934141 17243464 40613312 38400754 331612 -1646945 33001751 29493628 17674183 15539000 15327568 13954628 X PROVIDE COMPASSIONATE CARE AND EXCELLENT SERVICE IN A MODERN AND EFFICIENT HEALTHCARE ORGANIZATION STAFFED BY HIGHLY TRAINED PROFESSIONALS. 0 0 32004291 315000 34828807 GREENVILLE REGIONAL HOSPITAL IS A FULL-SERVICE, ACUTE CARE FACILITY OFFERING 42 LICENSED BEDS, A GERIATRIC BEHAVIORAL HEALTH UNIT, A 24-HOUR EMERGENCY DEPARTMENT, FAMILY BIRTH CENTER, SURGERY DEPARTMENT, REHABILITATION DEPARTMENT, SLEEP DISORDERS CENTER, OUTPATIENT PSYCHIATRIC/MENTAL HEALTH SERVICES, AND OUTPATIENT SPECIALTY CLINICS. DIAGNOSTIC SERVICES INCLUDE A LABORATORY, CARDIOPULMONARY DEPARTMENT, AND IMAGING SERVICES DEPARTMENT. THE HOSPITAL IS CERTIFIED BY THE HEALTHCARE FACILITIES ACCREDITATION PROGRAM (HFAP). IN ADDITION TO PROVIDING INPATIENT ACUTE CARE, GREENVILLE REGIONAL HOSPITAL OFFERS "SWING BEDS". MEDICARE PATIENTS QUALIFYING FOR TRANSITIONAL CARE CAN RECEIVE TREATMENT AT GREENVILLE REGIONAL THROUGH THE "SWING BED" PROGRAM. THE GERIATRIC BEHAVIORAL HEALTH UNIT IS A 10-BED INPATIENT UNIT INTENDED FOR SENIORS NEEDING MEDICATION ADJUSTMENT AND THERAPY PROGRAMS DESIGNED FOR BEHAVIORAL ISSUES. THE GERIATRIC BEHAVIORAL HEALTH UNIT SERVES SENIOR PATIENTS FROM A 150-MILE RADIUS. A PSYCHIATRIST DIRECTS THE CARE PROVIDED. WHITE OAKS SENIOR WELLNESS IS AN OUTPATIENT, GERIATRIC DAY-CARE PROGRAM INTENDED FOR PATIENTS DISCHARGED FROM A BEHAVIORAL HEALTH UNIT, OR THOSE EXPERIENCING BEHAVIORAL ISSUES. MEDICARE PATIENTS QUALIFYING FOR OUTPATIENT BEHAVIORAL HEALTH TREATMENTS CAN RECEIVE CARE THROUGH THE WHITE OAKS PROGRAM. BOND COUNTY EMERGENCY MEDICAL SERVICES IS BASED AT AND OPERATED BY THE HOSPITAL. THE SERVICE PROVIDES ADVANCED CARDIAC LIFE SUPPORT (ACLS) AND THE ORGANIZATION HAS ALSO ACHIEVED "RESOURCE HOSPITAL" STATUS. SOME YEARS AGO, THE HOSPITAL WAS ASKED BY THE BOND COUNTY BOARD TO ASSUME OPERATION OF THE AMBULANCE SERVICE AND PROVIDE EMERGENCY MEDICAL TREATMENT AT THE SCENE AFTER IT BECAME APPARENT THAT A PRIVATE COMPANY COULD NO LONGER REMAIN OPERATIONAL. THE HOSPITAL EMERGENCY DEPARTMENT IS STAFFED 24-HOURS PER DAY BY A PHYSICIAN. FOUR MAJOR TRAUMA SUITES, THREE EXAMINATION ROOMS, A TRIAGE ROOM, AND AN IV THERAPY ROOM ARE LOCATED WITHIN THE DEPARTMENT. WHEN NEEDED, HELICOPTER AMBULANCE SERVICE IS AVAILABLE. IN 2013, 240 INFANTS WERE DELIVERED AT THE GREENVILLE REGIONAL FAMILY BIRTH CENTER. PHYSICAL, SPEECH, AND OCCUPATIONAL THERAPY ARE OFFERED ON BOTH AN INPATIENT AND OUTPATIENT BASIS. THE HOSPITAL OUTPATIENT SPECIALTY CLINIC OFFERS 16 MEDICAL SPECIALTIES AND CONTAINS 13 EXAMINATION ROOMS. FOUR CLINICS CAN BE IN OPERATION SIMULTANEOUSLY. THE HOSPITAL MAY HOST AS MANY AS 100 CLINICS IN JUST 27 WORKING DAYS. THE HOSPITAL'S LABORATORY CAN PERFORM A WIDE ARRAY OF BLOOD, TISSUE, AND FLUID TESTING. THE IMAGING SERVICES DEPARTMENT OFFERS IN-HOUSE X-RAY, CAT SCAN, MRI, ULTRASOUND, NUCLEAR SCAN, BONE DENSITY, AND DIGITAL MAMMOGRAPHY TECHNOLOGY. MOBILE PET SCANS ARE ALSO AVAILABLE. THE HOSPITAL HAS THE CAPABILITY OF TRANSMITTING IMAGES TO ON-CALL RADIOLOGISTS FOR SCANS PERFORMED AFTER NORMAL BUSINESS HOURS. FAIR OAKS IS A 108-BED, MEDICARE AND MEDICAID CERTIFIED, SHORT-TERM REHABILITATION AND LONG-TERM CARE FACILITY ADJOINING THE HOSPITAL. ADULT DAY CARE AND RESPITE CARE ARE ALSO PROVIDED AT FAIR OAKS. EMERALD POINTE IS AN INDEPENDENT, SENIOR LIVING DEVELOPMENT LOCATED ON THE HOSPITAL CAMPUS. THE DEVELOPMENT CONSISTS OF A 15-UNIT APARTMENT BUILDING, FIVE DUPLEX STRUCTURES, AND A SINGLE UNIT PROVIDING 11 RESIDENCES. THE ORGANIZATION OWNS THREE CLINIC STRUCTURES ON THE HOSPITAL CAMPUS, AS WELL AS THREE CLINICS LOCATED IN NEARBY, RURAL COMMUNITIES. ALL SIX FACILITIES ARE CERTIFIED RURAL HEALTH CLINICS. THE CLINICS ARE UTILIZED BY PRIMARY CARE AND SPECIALTY PHYSICIANS, AS WELL AS MID-LEVEL PRACTITIONERS. 32004291 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 21 0 515 1 0 0 0 0 0 0 0 0 0 0 X 11 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X BRIAN NALL PRESIDENT & CEO 6186641230 200 HEALTH CARE DRIVE GREENVILLE IL 622461156 JEFF MOLLET BOARD MEMBER/CHAIRMAN OF THE BOARD 5.00 10.00 X X 0 0 0 DOUG STROUD ASSISTANT TREASURER & SECRETARY 1.00 2.00 X 0 0 0 LEONARD TAYLOR VICE CHAIR 1.00 2.00 X X 0 0 0 BART CALDIERARO SECRETARY 1.00 2.00 X X 0 0 0 BETTY IMBODEN BOARD MEMBER 1.00 2.00 X 0 0 0 DR SUSAN HUGHEY-RASLER BOARD MEMBER/PHYSICIAN 1.00 2.00 X 17255 0 0 FRANK JOY JR BOARD MEMBER 1.00 2.00 X 0 0 0 ROSIE YORK TREASURER 1.00 2.00 X X 0 0 0 ERNIE CHAPPEL BOARD MEMBER 1.00 2.00 X 0 0 0 DR RANDALL BERGEN BOARD MEMBER 1.00 2.00 X 0 0 0 JERRY GAFFNER BOARD MEMBER 1.00 2.00 X 0 0 0 MIKE SUESS BOARD MEMBER 1.00 2.00 X 0 0 0 DR KELSEY HOPKINS BOARD MEMBER/PHYSICIAN 40.00 1.00 X 264072 0 4801 BRIAN NALL CEO 40.00 2.00 X 233121 0 4967 SHERRY KOEHLER CFO 40.00 2.00 X 132892 0 2040 MARK ENNEN DIRECTOR OF ACCOUNTING 40.00 2.00 X 77641 0 5181 TAMMY LETT CNO 40.00 2.00 X 122967 0 5061 DR DAWN MCDAID PHYSICIAN 40.00 X 309412 0 5082 DR BOYD MCCRACKEN PHYSICIAN 40.00 X 288483 0 4694 DR RICHARD FUNNEMAN PHYSICIAN 40.00 X 283561 0 5082 DR PHILIP SIEFKEN PHYSICIAN 40.00 X 257953 0 6707 1987357 0 43615 17 0 1 0 ILLIANA EMERGENCY PHYSICIANS PO BOX 674579 DETROIT MI 48267 ER PHYSICIAN SERVICES 1180816 SELECT REHABILITATION PO BOX 809056 CHICAGO IL 606809056 THERAPY SERVICES 846578 MIDWEST EMERGENCY DEPARTMENT SVCS 320 EAST HIGHWAY 50 OFALLON IL 62269 ER PHYSICIAN SERVICES 628892 APEXNETWORK PHYSICAL THERAPY 15 APEX DR HIGHLAND IL 62249 THERAPY SERVICES 472862 QUEST DIAGNOSTICS PO BOX 14730 ST LOUIS MO 631504730 REFERENCE LABS 399213 19 334273 32406 22041 388720 NET PATIENT REVENUES 621110 33344387 33344387 EHR REIMBURSEMENTS 621110 1027138 1027138 PHARMACEUTICALS 446110 277991 277991 LABORATORY 621500 179291 179291 34828807 146695 146695 328960 0 328960 328960 328960 41059 63680 -22621 -22621 -22621 MISCELLANEOUS INCOME 624100 573383 573383 GIFT SHOP 453220 337315 337315 CAFETERIA 722210 130038 130038 42512 42512 1083248 36753809 34828807 0 1536282 315000 315000 847948 84795 754674 8479 15671213 13010694 2660519 155957 129480 26477 3053740 2535303 518437 1113432 924403 189029 181264 181264 79647 79647 15786 15786 3162757 2625812 536945 177443 147318 30125 4382818 3638742 744076 265631 220535 45096 1828603 1518159 310444 90881 75452 15429 47786 47786 466906 387639 79267 1946610 1946610 714203 592952 121251 PROVISION FOR BAD DEBT 2336388 2336388 PHYSICIAN SERVICES 1359831 1359831 DUES/ FEES 109424 90847 18577 MISCELLANEOUS 77486 48545 28941 38400754 32004291 6387984 8479 1950702 1743041 6292248 4846507 22457 483501 484612 1182505 898645 42101980 23233949 20170833 18868031 2516351 2506611 383154 146181 33001751 29493628 4690189 3388385 616952 535272 9534542 9045349 82997 15961 2749503 2554033 17674183 15539000 X 15325221 13931040 2347 23588 15327568 13954628 33001751 29493628 X -1646945 274005 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 15786 1 0 0 15786 0 PART II-B, LINE 1: LOBBYING COSTS WERE FROM THE FOLLOWING MEMBERSHIPS: IHA DUES ($35,863 X 39%) + AHA DUES ($7,079 X 23.65%) + MCHC DUES ($500 X 25%). 32123013 15530097 16592916 9938796 7703852 2234944 40171 40171 18868031 ASSET RETIREMENT OBLIGATION 331971 DUE TO THIRD PARTY PAYORS 1168024 LIFE RESIDENCY FEES 1054038 2554033 X PART X, LINE 2: THE CONSOLIDATED AFFILIATES ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3)OF THE INTERNAL REVENUE CODE, THUS THERE IS NO PROVISION FOR INCOME TAXES AT DECEMBER 31, 2013 AND 2012. THE HOSPITAL APPLIES THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE HOSPITAL DOES NOT CURRENTLY INCLUDE AN INCOME TAX PROVISION IN THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT MONITORS THE REPORTING OF UNCERTAIN TAX POSITIONS, WHICH COULD RESULT IN RECORDING OF AN INCOME TAX PROVISION IN THE FUTURE. THE CONSOLIDATED AFFILIATES INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE HOSPITAL IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS AND IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE TAX RETURNS FOR THE FISCAL YEARS 2010 TO 2012 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. 1 1 1 X 1 X 1 1 0 1 1 457893 457893 0.01270 4710656 2405022 2305634 0.06390 5168549 2405022 2763527 0.07660 4002 131769 171488 -39719 0.00000 43412 9827817 7251008 2576809 0.07150 67168 67168 0.00190 47414 10026754 7422496 2604258 0.07340 47414 15195303 9827518 5367785 0.15000 1 1030130 103013 9009541 9998633 -989092 X 1 0 1 1 GREENVILLE REGIONAL HOSPITAL 200 HEALTHCARE DRIVE GREENVILLE IL 62246 X X X GREENVILLE REGIONAL HOSPITAL 1 1 X X X X X X X X 13 1 0 1 X WWW.GREENVILLEREGIONALHOSPITAL.COM X X X X X X X 1 0 1 1 150.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X X X X 1 0 X X X X 1 X 0 1 GREENVILLE REGIONAL HOSPITAL PART V, SECTION B, LINE 3: THE NEEDS ASSESSMENT SOUGHT INPUT FROM PERSONS WITH KNOWLEDGE OF THE SPECIFIC HEALTH CONCERNS OF THE COMMUNITY. INPUT WAS ALSO SOUGHT FROM MEMBERS OF THE COMMUNITY CHARGED PROFESSIONALLY WITH ADVANCING THE HEALTH AND EDUCATION OF THE COMMUNITY AND ALL ITS MEMBERS, INCLUDING SCHOOL OFFICIALS AND FAMILIES. A SERIES OF THREE FOCUS GROUPS WERE HELD. SPECIFIC EXAMPLES INCLUDE: PHYSICIANS, REPRESENTATIVES FROM THE BOND COUNTY HEALTH DEPARTMENT, THE GREENVILLE MAYOR, 911 COORINATOR, COUNTY OFFICIALS, REPRESENTATIVES FROM THE WHITE HALL LIONS CLUB, BUSINESS OWNERS, AND OTHERS. GREENVILLE REGIONAL HOSPITAL PART V, SECTION B, LINE 20D: IF THE PATIENT DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE AND HE/SHE REQUESTS A DISCOUNT, GREENVILLE REGIONAL HOSPITAL AWARDS A 40% REDUCTION. A "PROMPT PAY" MARKDOWN IS ALSO GRANTED (UP TO 20%) IF THE PATIENT PAYS WITHIN 10 DAYS OF SERVICE DATE. GREENVILLE REGIONAL HOSPITAL PART V, SECTION B, LINE 22: ALL PATIENTS ARE CHARGED THE SAME AMOUNT (GROSS CHARGES) AND ANY APPLICABLE DISCOUNTS FOR CHARITY CARE, PROMPT PAY, UNINSURED, MANAGED CARE, ETC. ARE APPLIED AFTER THE FACT. 5 FAIR OAKS NURSING HOME 200 HEALTH CARE DRIVE GREENVILLE IL 62246 LONG-TERM CARE AND SKILLED NURSING FACILITY GREENVILLE FAMILY WELLNESS CENTER 150 HEALTH CARE DRIVE GREENVILLE IL 62246 PHYSICIAN CLINIC GREENVILLE MEDICAL ASSOCIATES 101 HEALTHCARE DRIVE GREENVILLE IL 62246 PHYSICIAN CLINIC MCCRACKEN-DAWDY-HALL FAMILY PRACTICE 201 HEALTHCARE DRIVE GREENVILLE IL 62246 PHYSICIAN CLINIC EMERALD POINTE 105 HONEY LOCUST LANE GREENVILLE IL 62246 INDEPENDENT LIVING FACILITY PART I, LINE 6A: THE UTLAUT MEMORIAL FOUNDATION'S ANNUAL REPORT CONTAINS THE COMMUNITY BENEFIT INFORMATION. PART I, LINE 7: THE COST TO CHARGE RATIO SHOWN IN THE MEDICARE COST REPORT IS APPLIED TO THE GROSS AMOUNTS FOR CHARITY, MEDICAID, ETC. TO DETERMINE THE TRUE COST OF THESE PROGRAMS. FOR THE OTHER SUBSIDIZED PROGRAMS, SOME COSTS ARE ESTIMATED BASED ON CERTAIN ALLOCATIONS: SQUARE FOOTAGE, STATISTICS, STAFF TIME, SUPPLIES USED, AND OTHER VARIOUS FACTORS. PART I, LINE 7G: THE SERVICE OF PHYSICIAN PRACTICE OPERATIONS INCLUDES COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS. SOME OF THE COSTS INCLUDED IN THIS SUBSIDIZED SERVICE ARE SALARIES, BENEFITS, SUPPLIES, OUTSOURCED PHYSICIAN FEES, AND OTHER VARIOUS EXPENSES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2,336,388. PART III, LINE 4: THE COST TO CHARGE RATIO FROM THE MOST RECENT MEDICARE COST REPORT IS APPLIED TO THE ORGANIZATION'S BAD DEBT EXPENSE FOR THE FISCAL YEAR. THE ORGANIZATION EMPLOYS A FINANCIAL COUNSELOR THAT WORKS WITH ALL SELF-PAY PATIENTS. BASED ON REVIEW OF TAX RETURNS, BANK STATEMENTS, AND OTHER FINANCIAL DOCUMENTS PROVIDED BY THE PATIENT, AN ESTIMATE EQUAL TO 10% OF BAD DEBT PATIENTS WOULD QUALIFY FOR CHARITY CARE BUT FAILED TO PROVIDE THE APPROPRIATE LEVEL OF DOCUMENTATION AND INFORMATION. PART III, LINE 8: THE COST TO CHARGE RATIO FROM THE MEDICARE COST REPORT IS UTILIZED IN DETERMINING THE ORANIZATION'S COMMUNITY BENEFIT. PART VI, LINE 2: GREENVILLE REGIONAL HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES USING A VARIETY OF FORMAL AND INFORMAL METHODS. NRC PICKER SURVEYS WERE UTILIZED TO MONITOR THE QUALITY OF SERVICES PROVIDED AT THE HOSPITAL. FEEDBACK REGARDING HEALTH CARE NEEDS IS RECEIVED CONTINUALLY FROM FREQUENT INTERACTION AND ENCOUNTERS WITHIN THE COMMUNITY. SERVING A CLOSELY-KNIT AREA, GREENVILLE REGIONAL HOSPITAL'S MANAGEMENT TEAM IS INVOLVED IN MANY COMMUNITY CLUBS, ORGANIZATIONS, CHURCHES, TEAMS, AND COMMITTEES. THE BOARD OF DIRECTORS REPRESENTS A DIVERSE, CROSS SECTION OF THE COMMUNITY. BOARD MEMBERS RECEIVE AND SHARE COMMENTS RELATED TO HEALTH CARE NEEDS AND NEW SERVICES DESIRED. AN EVALUATION FORM IS SENT TO EACH HEALTH FAIR PARTICIPANT. THESE INDIVIDUALS ARE AFFORDED THE OPPORTUNITY TO PROVIDE FEEDBACK REGARDING THE EVENT AND THEIR NEED FOR LOW COST HEALTH SCREENINGS AND TESTING. ANY HEALTH TRENDS DETECTED THROUGH THE TESTING OFFERED AT THE HEALTH FAIR CAN BE ASSESSED AND USED TO SHAPE SERVICES PROVIDED BY THE HOSPITAL. MONTHLY MEDICAL STAFF MEETINGS OFFER PHYSICIANS THE OPPORTUNITY TO INTERACT WITH HOSPITAL MANAGEMENT AND DISCUSS SERVICES NEEDED BY THEIR PATIENTS. IN 2011, THE HOSPITAL UTILIZED A CONSULTANT TO CONDUCT A MARKET RESEARCH SURVEY. THE STUDY GENERATED CONSUMER INFORMATION REGARDING HEALTH ISSUES, UNMET MEDICAL NEEDS, PHYSICIAN SHORTAGES, AND DESIRED SERVICES. A FORMAL NEEDS ASSESSMENT WAS COMPLETED IN 2013 AND IS BEING IMPLEMENTED. PART VI, LINE 3: THE HOSPITAL EMPLOYS A FINANCIAL COUNSELOR WHO WORKS WITH ALL SELF-PAY PATIENTS. THE COUNSELOR ASSESSES THE PATIENTS FINANCIAL POSITION AND WILL ASSIST THE PATIENT IN COMPLETING THE NECESSARY PAPERWORK TO APPLY FOR MEDICAID OR CHARITY CARE ASSISTANCE (IF APPLICABLE). PART VI, LINE 4: GREENVILLE REGIONAL HOSPITAL SERVES THE RESIDENTS OF BOND COUNTY AND THE SURROUNDING FOUR COUNTIES (FAYETTE, CLINTON, MONTGOMERY, AND MADISON). THE HOSPITAL HAS A PRIMARY AND SECONDARY MARKET AREA CONSISTING OF APPROXIMATELY 30,000 TO 32,000 INDIVIDUALS. THE MARKET AREA INCLUDES AN ABOVE AVERAGE NUMBER OF SENIOR CITIZENS. RESIDENTS OVER THE AGE OF 55 ACCOUNT FOR 28 PERCENT OF THE HOSPITAL'S PRIMARY MARKET. THE MARKET AREA IS RURAL IN ITS COMPOSITION. THE AGRICULTURAL ECONOMY IS SIGNIFICANT WITHIN THE AREA. SOME MANUFACTURING DOES EXIST IN THE LOCAL COMMUNITIES. MEDICARE, MEDICAID, AND UNCOMPENSATED CARE PATIENTS COMPRISE A MAJORITY OF THOSE SERVED BY THE HOSPITAL. THE INCOME LEVELS OF THE MARKET AREA ARE NOT HIGH. MANY OF THE RESIDENTS IN THE REGION RELY ON THE HOSPITAL TO PROVIDE ROUTINE DIAGNOSTIC SERVICES SUCH AS LAB AND IMAGING SERVICES. THE HOSPITAL IS THE PRIMARY SOURCE OF AMBULANCE, EMERGENCY, AND REHABILITATION SERVICES. GREENVILLE REGIONAL IS THE ONLY FACILITY IN THE COUNTY, AND ONE OF ONLY TWO HOSPITALS IN THE AREA, THAT PROVIDES OBSTETRICAL SERVICES. THE NEXT CLOSEST OB UNIT WOULD REQUIRE A MINIMUM DRIVE TIME OF 30 MINUTES. THE HOSPITAL PROVIDES INFANT DELIVERY SERVICES FOR PATIENTS SPANNING AN 80 MILE RADIUS. GREENVILLE REGIONAL HOSPITAL IS THE LARGEST EMPLOYER IN BOND COUNTY WITH APPROXIMATELY 375 FULL-AND PART-TIME EMPLOYEES. THE FACILITY'S ANNUAL PAYROLL IS APPROXIMATELY $16.5 MILLION WITHOUT BENEFITS AND $20.9 MILLION WITH BENEFITS. THE HOSPITAL'S ECONOMIC IMPACT EXCEEDS $86 MILLION. PART VI, LINE 5: GREENVILLE REGIONAL HOSPITAL, AND ITS AFFILIATED DIVISIONS, EXISTS ONLY TO PROVIDE HEALTH CARE SERVICES FOR RESIDENTS OF THE AREA. IN 2013, THE HOSPITAL'S COMMUNITY BENEFIT TOTAL WAS DETERMINED TO BE APPROXIMATELY $6.4 MILLION. THE HOSPITAL IS INTENTIONALLY STRUCTURED AS A NOT-FOR-PROFIT ORGANIZATION IN THAT ITS ONLY PURPOSE IS TO SERVE OTHERS. NO SINGLE INDIVIDUAL OR GROUP OF INVESTORS PROFITS FROM THE ACTIVITIES OF THE HOSPITAL. AS IS EVIDENT BY THE FINANCIAL LOSSES REPORTED IN THIS DOCUMENT, THE HOSPITAL BOARD OF DIRECTORS IS COMMITTED TO SERVING THE HEALTH CARE NEEDS OF THE REGION. MEDICAL SERVICES CRITICAL TO THE HEALTH AND WELL-BEING OF THOSE SERVED BY THE HOSPITAL ARE PROVIDED EVEN THOUGH THE REVENUES GENERATED MAY NOT COVER THE OPERATIONAL COSTS. THE HOSPITAL'S "NOT-FOR-PROFIT" STATUS IS VITAL TO THE ORGANIZATION'S EXISTENCE. GREENVILLE REGIONAL ADHERES TO A "NON-DISCRIMINATION TREATMENT POLICY". REGARDLESS OF A PATIENT'S FINANCIAL OR HEALTH INSURANCE STATUS, CARE IS PROVIDED. NO PATIENT IS REFUSED TREATMENT BASED UPON THEIR ABILITY TO PAY. GREENVILLE REGIONAL HOSPITAL FUNDS ITS OWN "HEALTH CARE ASSISTANCE PROGRAM". IN 2013, $457,893 IN CHARITY ASSISTANCE (AT COST) WAS PROVIDED TO PATIENTS WHO QUALIFIED FOR BILLING REDUCTIONS UP TO 100 PERCENT. INCOME GUIDELINES AND FAMILY SIZE ARE USED TO DETERMINE ELIGIBILITY FOR THIS SELF-FUNDED PROGRAM. THE HOSPITAL-OWNED, OBSTETRICS/GYNECOLOGY (OB/GYN) PROVIDER PRACTICE LOST $528,000 IN 2013. THE PRACTICE CONSISTS OF ONE OB/GYN SPECIALISTS AND TWO MIDWIVES. OBSTETRICAL PATIENTS FROM A WIDE GEOGRAPHICAL RADIUS USE THE GREENVILLE REGIONAL OBSTETRICAL DEPARTMENT. GREENVILLE REGIONAL IS ONE OF ONLY TWO HOSPITALS IN THE IMMEDIATE AREA THAT PROVIDE INFANT DELIVERY SERVICES. AN ANNUAL LOSS ASSOCIATED WITH PROVIDING INFANT DELIVERIES HAS BECOME AN EXPECTED PRACTICE. THE HOSPITAL'S BOARD OF DIRECTORS HAS ACCEPTED THE LOSS AS A RESULT OF THE PAYER MIX AND THE LACK OF OBSTETRICAL SERVICES WITHIN THE AREA. SIX OF EVERY TEN BIRTHS AT THE HOSPITAL ARE OF MEDICAID STATUS. THE STATE OF ILLINOIS MEDICAID PROGRAM DOES NOT MEET THE COST OF PROVIDING CARE. THE MEDICAID PAYMENT CYCLE RANGES FROM SEVEN TO EIGHT MONTHS, CREATING A CASH FLOW CRISIS. THE "LOW AND SLOW" CHALLENGE HAS BEEN A PROBLEM IN ILLINOIS FOR OVER 30 YEARS. THE BOARD OF DIRECTORS BELIEVES THAT THE AVAILABILITY OF INFANT DELIVERY SERVICES IS VITALLY IMPORTANT FOR THE HEALTH AND WELL BEING OF THE MULTI-COUNTY AREA SERVED BY THE HOSPITAL. GREENVILLE REGIONAL PROVIDES OUTPATIENT PSYCHIATRIC AND MENTAL HEALTH SERVICES, INCLUDING COUNSELING. THESE SERVICES ARE HIGHLY UTILIZED AS A RESULT OF NEED AND LIMITED AVAILABILITY WITHIN THE REGION. THE HOSPITAL-OWNED FAMILY, OB/GYN, PSYCHIATRIC, SPORTS MEDICINE, ONCOLOGY, PULMONOLOGY, AND SURGERY PRACTICES EXPERIENCED A LOSS OF $2.1M IN 2013. DURING THE 2013 FISCAL YEAR, THE OPERATIONAL LOSS AT FAIR OAKS NURSING HOME WAS $859K. THE RESIDENT PAYER MIX IS A SIGNIFICANT CAUSE OF THE LOSS. APPROXIMATELY 50 TO 60 PERCENT OF THE RESIDENTS ARE COVERED BY THE MEDICAID PROGRAM. THE ILLINOIS MEDICAID LONG-TERM CARE REIMBURSEMENT RATE RANKS 49TH LOWEST IN THE NATION. FAIR OAKS IS ONE OF ONLY TWO NURSING HOMES LOCATED IN BOND COUNTY. BOND COUNTY EMERGENCY MEDICAL SERVICES IS OPERATED BY THE HOSPITAL AND REPRESENTS A UNIQUE PRIVATE-PUBLIC PARTNERSHIP. GREENVILLE REGIONAL HOSPITAL IS A "COMMUNITY RESOURCE" THAT IMPROVES THE HEALTH AND QUALITY OF LIFE FOR THOSE RESIDING IN THE AREA. IN ADDITION TO THE AVAILABILITY OF EMERGENCY, DIAGNOSTIC, TREATMENT, AND REHABILITATION SERVICES, GREENVILLE REGIONAL HOSPITAL OFFERS MONTHLY SUPPORT MEETINGS AT NO CHARGE TO THE PARTICIPANTS. SUPPORT GROUPS ARE OFFERED ON THE TOPICS OF DEMENTIA, DIABETES, PARKINSON'S DISEASE, AND CHILDBIRTH EDUCATION. A "WOMEN'S WELLNESS" PROGRAM IS ALSO HELD EACH YEAR. NO-COST LANGUAGE TRANSLATION IS PROVIDED FOR PATIENTS IN NEED OF THIS SERVICE. THE HOSPITAL OWNS MEDICAL CLINICS IN THREE, NEIGHBORING, SMALL COMMUNITIES. THESE MEDICAL OFFICES SAVE TIME AND COSTS FOR MANY WHO WOULD HAVE TO DRIVE GREATER DISTANCES TO RECEIVE PRIMARY CARE. ACCESS TO A PHYSICIAN IS MADE POSSIBLE BECAUSE OF THE CLINIC BUILDINGS OWNED BY THE HOSPITAL. THE FACILITIES ARE CERTIFIED RURAL HEALTH CLINICS. MID - LEVEL PRACTITIONERS AND PHYSICIANS STAFF THE OUTREACH FACILITIES. FOR THE PAST 30 YEARS, GREENVILLE REGIONAL HOSPITAL HAS SPONSORED A MULTI-FACETED HEALTH FAIR. THE EVENT IS ONE OF THE LARGEST HEALTH FAIRS IN THE ST. LOUIS METROPOLITAN AREA. THE EVENT FEATURES MANY FREE HEALTH TESTS IN ADDITION TO FOUR, LOW-COST COMPREHENSIVE BLOOD TESTS. IN 2013, APPROXIMATELY 3,500 BLOOD TESTS WERE PERFORMED IN CONJUNCTION WITH THE HEALTH FAIR. THE PARTICIPANTS RECEIVE THE DIRECT COMMUNITY BENEFIT OF THE FREE AND REDUCED PRICE TESTING OFFERED BY THE HOSPITAL. PARTICIPANTS COULD CHOOSE FROM A COMPREHENSIVE BLOOD TEST, PROSTATE SPECIFIC ANTIGEN BLOOD TEST (PSA), HEMOGLOBIN A1-C, VITAMIN D BLOOD TEST, OR A COMBINATION OF THE FOUR BLOOD TESTS. THE OPPORTUNITY COST INCURRED BY GREENVILLE REGIONAL HOSPITAL FOR OFFERING THESE DISCOUNTED SERVICES WAS $1,689,818. THE ORGANIZATION CONSIDERS THE OPPORTUNITY COST AS THE REDUCTION IN REVENUE THAT WOULD HAVE BEEN RECEIVED HAD THE HEALTH FAIR TESTING BEEN PROVIDED AT TYPICAL RETAIL PRICING. MORE THAN 250 VOLUNTEERS ASSIST WITH THE EVENT. IN ADDITION TO THE SERVICES PROVIDED ON THE DAY OF THE HEALTH FAIR, THE HOSPITAL ALSO PERFORMS THE LOW-COST BLOOD TESTS AT SEVERAL OFF-SITE LOCATIONS FOR THE EMPLOYEES OF AREA SCHOOLS, BUSINESSES, AND MANUFACTURERS. THROUGH THE YEARS, A NUMBER OF LIFE-THREATENING AND SERIOUS MEDICAL CONDITIONS HAVE BEEN DISCOVERED BY TESTING PERFORMED IN ASSOCIATION WITH THE EVENT. THE $952,036 VIOLA THOMPSON SCHOLARSHIP FUND, ADMINISTERED BY GREENVILLE REGIONAL HOSPITAL, PROVIDES TUITION ASSISTANCE FOR INDIVIDUALS PURSUING A HEALTH OR MEDICAL CAREER. NURSING STUDENTS, MEDICAL STUDENTS, PHYSICIAN RESIDENTS, AND GREENVILLE COLLEGE PSYCHOLOGY STUDENTS UTILIZE THE HOSPITAL AND SENIOR CARE FACILITIES FOR TRAINING AND LEARNING OPPORTUNITIES. THE HOSPITAL IS OFFERED AS A TRAINING SITE AT NO COST TO THE STUDENTS. THE HOSPITAL IS ALSO THE SITE OF REGULARLY SCHEDULED BLOOD COLLECTION DRIVES. THESE ORGANIZATIONS ARE NOT CHARGED FOR USE OF THE HOSPITAL. THE LEMUAL RHODES CANCER FUND BOARD OF DIRECTORS MEETS AT THE HOSPITAL AND AWARDS FUNDING TO PATIENTS UNDERGOING TREATMENT FOR CANCER. EXERCISE CLASSES, RETIRED TEACHERS, COMMUNITY CLUBS, AND ORGANIZATIONS MEET AT THE HOSPITAL. NO FUNDS ARE PAID FOR USE OF THE FACILITY. TWO SCOREBOARDS LOCATED AT THE LOCAL HIGH SCHOOL ARE CO-SPONSORED BY THE HOSPITAL. GREENVILLE REGIONAL HOSPITAL SUPPORTS VARIOUS COMMUNITY ORGANIZATIONS AND ACTIVITIES THAT PROMOTE HEALTHY LIFESTYLES AND WORK TO IMPROVE QUALITY OF LIFE ISSUES. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. 1 UTLAUT MEMORIAL FOUNDATION INC 200 HEALTH CARE DRIVE GREENVILLE IL 62246 371140166 501(C)(3) 315000 HOSPITAL / AUXILIARY ACTIVITY 1 SCHEDULE I, PART I, LINE 2 GRANTS ARE GIVEN FROM THE HOSPITAL / AUXILIARY TO THE FOUNDATION. OUR GENERAL LEDGER PROGRAM MONITORS THESE TRANSACTIONS. X X X 1 1 X X X X 1 1 0 0 0 0 0 0 0 DR KELSEY HOPKINS BOARD MEMBER/PHYSICIAN 180733 0 81539 0 1800 0 0 0 4801 0 268873 0 0 0 BRIAN NALL CEO 230033 0 0 0 3088 0 0 0 4967 0 238088 0 0 0 DR DAWN MCDAID PHYSICIAN 308053 0 0 0 1359 0 0 0 5082 0 314494 0 0 0 DR BOYD MCCRACKEN PHYSICIAN 211379 0 73003 0 4101 0 0 0 4694 0 293177 0 0 0 DR RICHARD FUNNEMAN PHYSICIAN 193193 0 87909 0 2459 0 0 0 5082 0 288643 0 0 0 DR PHILIP SIEFKEN PHYSICIAN 156224 0 99936 0 1793 0 0 0 6707 0 264660 0 0 0 PART I, LINE 1A THE HOSPITAL PROVIDES A DISCRETIONARY SPENDING ACCOUNT. THIS SPENDING ACCOUNT IS USED IN BUSINESS MATTERS FOR THE HOSPITAL. THE GROSS-UP PAYMENT IS FOR LONG-TERM DISABILITY. BRIAN NALL RECEIVED $815 IN SOCIAL CLUB DUES, INCLUDED IN HIS COMPENSATION. PART I, LINES 4A-B SARA MCPEAK: $70,215 - SEVERANCE PAYMENT SHERRY KOEHLER: $84,713 - SEVERANCE PAYMENT JAMES HAYES $3,558 - 457(B) WITHDRAW A CITY OF GREENVILLE 376000403 NONEAVAIL 2011-10-20 10000000 REFUND A PRIOR ISSUE (04/01/03) CONSTRUCTION/ REMODEL PROJECTS AND EQUIPMENT 0 0 0 A 954651 10000000 952249 7119136 115223 309516 12000 1491876 2014 1 0 0 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 3 EFFECTIVE JULY 15, 2013, THE HOSPITAL ENTERED INTO AN AGREEMENT WITH ALDEN MANAGEMENT SERVICES, INC. (ALDEN) TO PROVIDE MANAGEMENT SERVICES FOR THE DAILY OPERATIONS OF FAIR OAKS NURSING HOME, WHICH IS A DEPARTMENT OF THE HOSPITAL. FAIR OAKS IS A 108 BED SKILLED NURSING FACILITY THAT PROVIDES SKILLED NURSING AND REHABILITATION SERVICES TO RESIDENTS. THE AGREEMENT HAS A TERM OF ONE YEAR BEGINNING ON THE EFFECTIVE DATE OF JULY 15, 2013 AND CAN BE CANCELLED BY EITHER PARTY WITH A THIRTY-DAY NOTICE. UNDER THE TERMS OF THE AGREEMENT, ALDEN IS RESPONSIBLE FOR THE NET REVENUES OR LOSSES OF THE FACILITY, CALCULATED AS THE ACTUAL CASH COLLECTIONS LESS ANY REFUNDS AND EXPENSESATTRIBUTABLE TO THE FACILITY AS DEFINED IN THE AGREEMENT. FOR THE YEAR ENDING DECEMBER 31, 2013 THE HOSPITAL RECOGNIZED APPROXIMATELY $423,000 OF OTHER OPERATING REVENUE RELATED TO THE LOSSES THAT ARE TO BE FUNDED BY ALDEN. AS OF DECEMBER 31, 2013 THE HOSPITAL HAS RECOGNIZED AN APPROXIMATE RECEIVABLE OF $143,000 FROM ALDEN ON THE CONSOLIDATED BALANCE SHEET. SUBSEQUENT TO YEAR END, EFFECTIVE FEBRUARY 21, 2014, THE HOSPITAL AND ALDEN TERMINATED THE MANAGEMENT SERVICES AGREEMENT AND THE HOSPITAL ANNOUNCED CLOSURE OF FAIR OAKS. FORM 990, PART VI, SECTION B, LINE 11 REVIEWED BY KEY EMPLOYEES (CFO, CEO, CNO) AND DISTRIBUTED TO THE BOARD OF DIRECTORS VIA EMAIL BEFORE FINAL SUBMISSION. AMPLE TIME IS ALLOWED FOR BOARD MEMBERS TO REVIEW THE 990 AND SUGGEST ANY CHANGES PRIOR TO FINAL SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR, THE BOARD OF DIRECTORS AND ANY KEY EMPLOYEES, HIGHEST COMPENSATED EMPLOYEES, AND MEMBERS OF MANAGEMENT COMPLETE A RELATIONSHIP/CONFLICT OF INTEREST QUESTIONAIRE. ANY CONFLICTS THAT ARISE ARE DEALT WITH ACCORDINGLY BY THE ORGANIZATION'S OFFICERS. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD AND THE HOSPITAL'S HUMAN RESOURCES' COLLABORATE AND MAKE A FINAL DETERMINATION BY REVIEWING COMPARABLE SALARIES OF THE REGION. FORM 990, PART VI, SECTION C, LINE 19 GREENVILLE REGIONAL HOSPITAL MAKES ITS FORM 990 AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST, BUT ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: NET TRANSFERS BETWEEN AFFILIATE 274,005. FORM 990, PAGE 12, PART XII, LINE 2C THE ORGANIZATION HAS AN AUDIT COMMITTEE THAT OVERSEES THE AUDIT AND THE SELECTION OF THE INDEPENDENT AUDITOR. GREENVILLE REGIONAL HEALTHCARE INC 200 HEALTHCARE DRIVE GREENVILLE IL 62246 371139987 HEALTHCARE IL 501(C)(3) LINE 11B, II N/A 0 UTLAUT MEMORIAL FOUNDATION INC 200 HEALTHCARE DRIVE GREENVILLE IL 62246 371140166 FUNDRAISING IL 501(C)(3) LINE 11B, II N/A 0 0 1 1 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0