2011-02-02T16:51:06-06:00 2010-06-30 Kerber Eck & Braeckel LLP One Memorial Drive Ste 950 St Louis MO 63102 990 2009-07-01 370661208 Hillsboro Area Hospital Inc HILL 2175326111 1200 East Tremont Street Hillsboro IL 62049 Rex Brown 2175326111 2011-01-21 1 Steve Eckhard CPA 3142316232 2011-01-21 2009 2016-02-24 21:20:13Z Rex Brown 1200 East Tremont Street Hillsboro IL 62049 17394061 0 X hillsboroareahospital.org X 1906 IL OPERATION OF HOSPITAL (INPATIENT, Swing bed AND OUTPATIENT) and assisted living facilities. 10 10 240 20 0 0 31500 39900 16941785 16861504 265151 265327 216323 213848 17454759 17380579 0 0 7275544 7383537 0 0 8427394 8570017 15702938 15953554 1751821 1427025 27799613 29229565 12030435 11949443 15769178 17280122 To positively affect the health and welfare of the communities we serve through the operation of a hospital (inpatient, swing bed and outpatient) and an assisted living facility. 0 0 12333273 16951632 OPERATION OF a 25 BED CRITICAL ACCESS HOSPITAL (INPATIENT, swing bed and OUTPATIENT) with assisted living facility. 1,399 Acute days, 1,679 Swing Bed days, AND 17,015 outpatient visits and 13,089 ASSISTED LIVING DAYS PROVIDED IN FY 2010, INCLUDING CHARITY CARE OF $664,159 and total community benefits of $2,985,706. 12333273 1 1 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 27 0 1 240 1 0 0 0 0 0 0 0 0 0 10 10 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X Terri Carroll CFO 2175324187 1200 East Tremont Street Hillsboro IL 62049 X KURT AUMANN 1.00 X X 0 0 0 BILL BRINK 1.00 X 0 0 0 REX BROWN 40.00 X X 0 0 0 BRIAN CADY 1.00 X 0 0 0 TODD DEAN 1.00 X 0 0 0 TOM GOODING 1.00 X X 0 0 0 BARBARA HEWITT 1.00 X X 0 0 0 DOUG JARMAN 1.00 X X 0 0 0 Don Burton 1.00 X X 0 0 0 BARBARA MULCH 1.00 X 0 0 0 PAT POPE 1.00 X 0 0 0 Patricia Whitworth 1.00 X 0 0 0 Terri Carroll 40.00 X 0 0 0 CHRISTOPHER WHITTEN 40.00 X 109136 0 4049 Elvis David Harrison 40.00 X 104584 0 0 213720 0 4049 2 0 0 1 Brim Healthcare Inc PO Box 930736 Atlanta GA 31193 Management Services 579521 Illinois Emergency Physicians po box 793 Traverse City MI 49685 er Coverage 513276 Acute Care Inc PO Box 4130 Des Moines IA 50333 ER Coverage 446276 Pharmacy Systems Inc PO Box 71-0716 Columbus OH 43271 Pharmacy Management 248891 Diagnostic Health Services Liberty Plaza 1 Ste 500 Addison TX 75001 Nuclear Med 192000 10 39900 39900 Program Service Revenu 900099 16861504 16861504 16861504 278809 278809 80686 80686 80686 80686 13482 -13482 -13482 -13482 OTHER INCOME 900099 78587 78587 CAFETERIA 900099 43034 43034 AMBULANCE REVENUE 900099 6745 6745 4796 4796 133162 17380579 16951632 0 389047 5679843 5062838 617005 118845 105935 12910 1156232 1030630 125602 428617 382056 46561 27154 27154 47700 47700 8480 8480 1903168 1109684 793484 34654 40 34614 123780 48337 75443 433326 402734 30592 34042 24198 9844 131513 131513 708308 538198 170110 143806 29352 114454 supplies 1379078 1350294 28784 Physician's Fees 1268727 1268727 Bad Debt 1241004 1241004 Equipment rental and ma 440164 439468 696 Maintenance and Houseke 376479 286062 90417 268634 123207 145427 15953554 12333273 3620281 0 895938 365283 15121355 11079388 1679478 1930619 389965 394467 247820 303714 23374190 9993603 7838143 13380587 964334 1080881 662580 694626 27799613 29229565 1996775 2023964 9879176 9786533 154484 138946 12030435 11949443 X 14682611 16177088 801567 818034 285000 285000 15769178 17280122 27799613 29229565 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8480 8480 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: A portion of the dues Paid to the Illinois Hospital Association and the American Hospital Association are classified as being for lobbying. 420360 4842 425202 406863 13497 420360 0.67030 0.32970 0 1 1 237676 237676 8575418 5000048 3575370 647976 485404 162572 6363353 4508151 1855202 7549767 7549767 13380587 Capital Lease Obligations 14792 Asset Retirement Obligation 124154 138946 17380579 15953554 1427025 77912 6007 83919 1510944 17464498 77912 6007 83919 17380579 0 17380579 15953554 0 15953554 0 15953554 Part V, Line 4: Description of Intended Use of Endowment Funds: Permanently restricted endowment fund Interest is to be used for the Hospital's building and maintenance. Part XI, Line 8 - Other Adjustments: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION: 6007. Part XII, Line 2d - Other Adjustments: Change in interest in net assets of foundation: 6007. Part X, Line 2: The Hospital has been recognized as exempt from income taxes under section 501 of the internal Revenue code and similar provisions of state law. However, The hospital would be subject to federal income tax on any unrelated business taxable income. Effective July 1, 2009, the hospital adopted the standards for accounting for uncertainty in income taxes. These standards prescribe a comprehensive model for financial statement recognition, measurement, classification and disclosure of uncertain tax positions. The implementation of the standards had no effect on net assets as of July 1, 2009. The hospital continually evaluates the effects of all tax positions taken including expiring statutes of limitations, tax examinations, unrelated business income and new authoritative rulings. The hospital files federal information returns. The statutes of limitations for information returns filed for the years ended June 30, 2007 through 2010 have not expired and therefore are subject to examination. 1 1 X 1 X 1 X 1 1 1 0 1 0 302259 302259 0.02050 1761380 1320901 440479 0.02990 2063639 1320901 742738 0.05040 46272 8566 37706 0.00260 1994719 1521312 473407 0.03220 1161913 1161913 0.07900 3202904 1529878 1673026 0.11380 5266543 2850779 2415764 0.16420 1 564781 0 X 1 1 Hillsboro Area Hospital

1200 East Tremont Street Hillsboro IL 62049

X X X X Part I, Line 7: The Cost to charges ratio was used as derived from worksheet 2, ratio of patient care cost-to-charges. Part III, Line 3: The Hospital believes that the community benefit obtained from its charity care is understated due to patients that could qualify for charity care but do not apply or provide incomplete information. Some care provided to patients is not classified as charity care due to patients missing documentation that proves they qualify for charity care. The hospital's bad debt does include amounts that could be classified as charity care if the patients would apply or provide the appropriate information to complete the charity care application. Part III, Line 4: Text of Footnote from the financial statementsThe Hospital voluntarily provides free care to patients who are unable to pay for all or part of their health care expenses as determined by the Hospital's criteria for financial assistance.In some cases, the Hospital does not receive the amount billed for patient services even though it did not receive information necessary to determine if the patients met the criteria for financial assistance. Bad debts expense is the estimated amount of patient revenue that the Hospital will not collect.The costing methodology used was the ratio of patient care cost-to-charges. No bad debt amounts were included in community benefit. Part III, Line 9B: All collection efforts will cease immediately on amounts approved for special financial considerations. Part VI, Line 2: Hillsboro Area Hospital conducts a needs assessment during its Strategic Planning and long range Budgeting process. This process includes obtaining and analyzing various data and market demographics. The data is then supplemented with views and concerns from our community Board Members, other community outreach relationships and other common organizations. Part VI, Line 3: Uninsured patients and persons who seek and / or obtain services from the Hospital, are informed of the availability of Financial Assistance via signage throughout the patient access areas of the facility, brochures, admission packets, disclosure on the patient bill, in person and telephone assisted customer service, as well as information such as the guidelines and application being predominately posted on the Hospital website. Part VI, Line 4: The Hospital's primary service area consists of patients in the city of Hillsboro and the surrounding areas. The Hospital is the leading healthcare provider for the Montgomery County Illinois Community. These communities are medically vulnerable and have a large indigent population. Part VI, Line 6: Designated as a critical Access hospital, the Hospital uses any limited surplus funds to further its exempt purpose by providing programs and access as noted in Form 990, Part III, Line 1 and 4a and continued on Schedule O. The Board of Directors is made up of volunteer community leaders within its primary service area that are approved by the Member organization. Part VI, Line 7: The Hospital is part of a critical access network that includes Hillsboro Area Health System NFP, its sole corporate member, which provides health and supportive services to the communities they serve.The Hospital also commits significant time and resources to activities and services that meet unmet community needs. Many of these activities are sponsored with the knowledge that they will not be self-supporting or financially viable. Such programs include, but are not limited to, health fairs and events, health screenings and assessments, space for daycare programs offered by the local school system, support for vital community services, trauma care, and various community educational services. Hillsboro Area Hospital is pursuing LEED certification for the building addition being completed in July 2010. The environmental benefits of LEED include: reduction of waste sent to landfills, conservation of energy and water, reduction of harmful greenhouse gases, and a healthier and safer place for employees, patients, and the environment. The Hospital is also a member of the Chamber of Commerce and partners with the Montgomery County Economic Development Corporation to obtain grants and expand the services needed in the community. The Hospital provides the use of space at no charge to the Hillsboro Community School District for a Daycare facility. For many years, until May 2010, the Hospital provided classroom space, free of charge, for Lincoln Land Community College to use for nursing instruction. The Hospital also provides Grand Advantage senior exercise classes to the seniors in the area at no charge, and provides the Diamond Club to seniors for assistance with the understanding and organization of medical bills and insurance. Hospital employees also share their expertise through community speaking at local organizations and events. Several monetary donations are made by the Hospital throughout the year to other non-profit organizations. An automatic blood pressure machine is located in the Hospital lobby where the community members can use it free of charge, and the Hospital provides a booth at the local community fair each year where employees take blood pressures and provide health information to the public. X X 0 0 0 0 0 0 0 0 0 REX BROWN 0 0 0 0 0 0 0 0 0 0 0 0 Terri Carroll 0 0 0 0 0 0 0 0 0 0 0 0 Supplemental Information Part III Brim Healthcare, Inc. was paid $579,521 for management services. Rex Brown, CEO and Terri Carroll, CFO are employed by Brim Healthcare, Inc. City of Hillsboro Montgomery County Illinois 376001658 2008-09-30 7220000 Capital Improvement Project - Expansion construction 0 0 7220000 1459732 83500 5676768 2010 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 All transactions are below the reporting threshold of 10000 0 Form 990, Part VI, Section A, line 2 Tom Gooding and Doug Jarman have a business relationship. Form 990, Part VI, Section A, line 3 Hillsboro area hospital Delegated control over management to BRim Healthcare, Inc. - CEO & CFO are employed by Brim Healthcare. The CEO & CFO are under the supervision of BRIM Healthcare. Form 990, Part VI, Section A, line 6 Hillsboro Area Health System NFP, a not for profit corporation is the sole corporate member of Hillsboro Area Hospital, Inc. The Hospital also has individual members. There are two classes of individual members. Annual(Regular) and Life members make up the classes of individual members. Form 990, Part VI, Section A, line 7a Only the Individual members can elect members to the governing body. The Voting of Directors to the board only occurs in October. In addition, the sole corporate member must approve all board members. Form 990, Part VI, Section A, line 7b The corporate member, Hillsboro area health system nfp, approves all amendments to the articles of incorporation or to the bylaws of the corporation and approves hospital board members elected. The only voting right of the individual members is the right to elect directors. Form 990, Part VI, Section B, line 11 The CFO reviews the form 990 and provides a copy of the 990 to each member of the board for review. The Board then votes on the approval of the 990 as it is or contingent upon changes prior to filing. Form 990, Part VI, Section B, line 12c Employees complete and sign an annual disclosure statement and the board of directors complete and sign a conflict of interest form annually. The board reviews the disclosures and takes appropriate action to resolve any issues. Form 990, Part VI, Section B, line 15 A performance evaluation is completed and discussed in executive session by the board of directors for executive employees. The process for determining compensation includes reviews of salary ranges for the positions per various databases and/or material available. the deliberation and decision by the board of directors is documented in the executive session board minutes. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statements are not made available to the public. Hillsboro Area Health System NFP 1200 East Tremont hillsboro IL 62049 364539688 Management and oversight of health care system IL 501(C)3 Line 11c, III-FI Hillsboro Area Health Foundation 1200 East Tremont Hillsboro IL 62049 371247796 Provide support for Hillsboro Area Hospital IL 501(C)3 Line 7 Hillsboro area health system nfp HIllsboro Area health Services Inc 1210 East Tremont hillsboro IL 62049 371240643 Establish and operate facilities for wellbeing of persons in area IL 501(C)3 Line 11c, III-FI hillsboro area health system nfp 0 0 1 0 0 0 0 0 1 1 0 1 0 1 1 0 0 0