2011-01-13T13:45:52-06:00 2010-06-30 KERBER ECK & BRAECKEL LLP 1116 W MAIN ST CARBONDALE IL 629012335 990 2009-07-01 370661202 FAIRFIELD MEMORIAL HOSPITAL ASSOC FAIR 6188422611 303 NW 11TH ST FAIRFIELD IL 62837 MIKE BROWN 6188422611 2011-01-11 true MARK DALLAS 6185291040 2011-01-13 2009 2016-02-24 21:20:13Z KATHERINE BUNTING 303 NW 11TH ST FAIRFIELD IL 62837 27021646 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 9 401 50 0 133843 201478 26167794 26801785 31550 18383 11617 0 26344804 27021646 0 0 13975777 13900865 0 0 14754148 12817060 28729925 26717925 -2385121 303721 17642310 18981709 5971720 7032398 11670590 11949311 THE MISSION OF FAIRFIELD MEMORIAL HOSPITAL IS TO MAINTAIN AND IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. false false 26717925 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, 30 SKILLED CARE BEDS, AND 104 NURSING HOME 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 2010 THIS AMOUNTED TO APPROXIMATELY 1,286,000. 26717925 true true false false false false false false false true true false false false false false false false false false true false false true false false false false false false false false false false false false false false false false false true 18 0 401 true false false false false false 9 9 false false false false false false false true true false false true true true true true true true true false IL X MIKE BROWN 6188422611 303 NW 11TH ST FAIRFIELD IL 62837 MARTY HEFLIN 5.00 X 0 0 0 PATRICK MOLT MD 10.00 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 HARLAN YATES 10.00 X 0 0 0 KATHY BUNTING 40.00 X 178506 0 875 MIKE BROWN 40.00 X 112586 0 588 CINDY MEAGHER 40.00 X 85780 0 450 CHRIS BALLARD 40.00 X 285251 0 2891 KYLE KAKAC 40.00 X 265991 0 1666 WES THOMPSON 40.00 X 225163 0 2891 ALEX KING 40.00 X 204144 0 2044 ROBERT REYNOLDS 40.00 X 149655 0 1612 1507076 13017 11 false true false US FOOD SERVICE PO BOX 504854 ST LOUIS MO 631504854 FOOD WHOLESALER 400554 ARAMARK UNIFORM SERVICE PO BOX 329 EVANSVILLE IN 47701 UNIFORMS 338542 MIDWEST MEDICAL SUPPLY PO BOX 955588 ST LOUIS MO 631955588 SUPPLIES 333956 CORE PHYSICIAN RESOURCES INC 503A NORTH FIRST STREET FAIRFIELD IL 62837 STAFFING 306158 J&J HEALTH CARE SERVICES 5972 COLLECTIONS CTR DRIVE CHICAGO IL 60693 CONSULTANTS 283940 16 201478 25000 201478 PROGRAM SERVICE REVENUE 26801785 26801785 26801785 18383 18383 27021646 26820168 369424 369424 10989586 10989586 97385 97385 1666371 1666371 778099 778099 122407 122407 27750 27750 183404 183404 864711 864711 320472 320472 SUPPLIES 2585140 2585140 PROFESSIONAL SERVICES 2494030 2494030 BAD DEBT 1311538 1311538 PHYSICIANS' FEES 1231926 1231926 DRUGS 979286 979286 2696396 2696396 26717925 26717925 0 0 995 995 2441867 2200698 3722042 3816069 325633 348892 287472 190738 26473333 15001878 10192865 11471455 300800 300800 370636 652062 17642310 18981709 2175118 2241294 3445992 4727488 350610 63616 5971720 7032398 X 11299112 11512537 370909 436205 569 569 11670590 11949311 17642310 18981709 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false 312785 312785 11536216 5202389 6333827 13289598 9792228 3497370 1334734 7261 1327473 11471455 OTHER LIABILITIES 63616 63616 27021646 26717925 303721 303721 27021646 27021646 27021646 26717925 26717925 26717925 true true true X false true true true false true true 555967 555967 0.02080 555967 555967 0.02080 503550 503550 0.01880 503550 503550 0.01880 1059517 1059517 0.03970 false 567107 187145 11047764 12258927 -1211163 X true true FAIRFIELD MEMORIAL HOSPITAL

303 NW 11TH ST FAIRFIELD IL 62837

X X HORIZON HEALTHCARE

1021 HARDING ST FAIRFIELD IL 62837

AS STATED IN FAIRFIELD MEMORIAL HOSPITAL FINANCIAL ASSISTANCE POLICY PROCEDURE, "PATIENTS WHO DO NOT MEET GUIDELINES WILL ALSO BE NOTIFIED THAT THEY SHOULD CONTACT THE BUSINESS OFFICE TO MAKE PAYMENT ARRANGEMENTS". THE HOPSITAL DOES NOT GIVE DISCOUNTED CARE, BUT FREE CARE IS GIVEN IF PATIENT MEETS THE 200% POVERTY GUIDELINE. 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 HOSPITAL'S EXPERIENCE WITH ALL ITS PATIENTS, THEY ESTIMATE THAT IT IS LIKELY THAT UP TO ONE THIRD OF THE PATIENT ACCOUNTS WRITTEN OFF TO BAD DEBTS MAY QUALIFY FOR CHARITY CARE OR OTHER ASSISTANCE BUT CHOSE NOT TO APPLY. THEREFORE, 33% OF THE BAD DEBT EXPENSE WAS INCLUDED ON PART III, LINE 3 AT COST. THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE THAT SPECIFICALLY ADDRESSES BAD DEBTS HOWEVER THE PROVISION FOR BAD DEBTS IS CLEARLY OUTLINED ON THE STATEMENT OF OPERATIONS. THE PROVISION FOR BAD DEBTS REPRESENTS UNCOMPENSATED CARE FOR PATIENTS OF WHICH A MAJORITY ARE UNINSURED OR UNDERINSURED, BUT DID NOT APPLY FOR OR QUALIFY FOR CHARITY CARE. 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. 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. STUDY FINDINGS SHOWED THAT FAIRFIELD MEMORIAL HOSPITAL ECONOMIC IMPACT IN ONE YEAR FOR 2009 WERE THE FOLLOWING: - EMPLOYED 356 POEPLE - GENERATED SALARIES AND BENEFITS OF 13,885,090 - INVESTED 2,218,116 IN CAPITAL EXPEDITURES - GENERATED 56,780,973 OF ECONOMIC ACTIVITY (US DEPARTMENT OF COMMERCE) - GENERATED 24,032,877 OF HOUSEHOLD EARNINGS(US DEPARTMENT OF COMMERCE) - CREATED APPROXIMATELY 1,240 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. 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. 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. 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 16,294 . THE MEDIAN HOUSEHOLD INCOME IN 2009 WAS 40,497, WHICH WAS 75% OF ILLINOIS' AVERAGE AND 81% OF THE US AVERAGE. THE PERCENTAGE OF INDIVIDUALS BELOW POVERTY LEVEL WAS 13.7%. IL X X false false false false false false false false false KATHY BUNTING 174977 3529 875 179381 CHRIS BALLARD 285251 2891 288142 KYLE KAKAC 265991 1666 267657 WES THOMPSON 225163 2891 228054 ALEX KING 204144 2044 206188 ROBERT REYNOLDS 149655 1612 151267 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. ALSO, THE NURSING HOME HAS VOLUNTEERS WHO HELP WITH THE CARE OF THE RESIDENTS. FIRST ACHIEVEMENT DESCRIPTION FORM 990, PAGE 2, PART III, LINE 4A 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 2010 THIS AMOUNTED TO APPROXIMATELY 1,286,000. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11 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 PERSONELL 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.