2011-08-15T10:01:50-05:00 2010-12-31 LARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2010-01-01 370792770 GREENVILLE REGIONAL HOSPITAL INC GREE 6186641230 200 HEALTH CARE DRIVE GREENVILLE IL 622461156 SHERRY KOEHLER 6186641230 2011-08-18 1 3149254300 2010 2016-02-24 21:20:13Z BILL BRUCE 200 HEALTH CARE DRIVE GREENVILLE IL 622461156 32098850 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. 12 9 514 750 0 0 727648 457198 31343931 30405442 354783 52083 1172524 1141907 33598886 32056630 800000 325000 0 0 16712300 16830172 0 0 5181 17595583 16666346 35107883 33821518 -1508997 -1764888 31765062 30568777 15399750 15865444 16365312 14703333 X PROVIDE COMPASSIONATE CARE AND EXCELLENT SERVICE IN A MODERN AND EFFICIENT HEALTHCARE ORGANIZATION STAFFED BY HIGHLY TRAINED PROFESSIONALS 0 0 27864006 325000 30405442 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. THE HOSPITAL OWNS THREE CLINIC STRUCTURES ON THE HOSPITAL CAMPUS, AS WELL AS TWO CLINICS LOCATED IN NEARBY, RURAL COMMUNITIES. TWO OF THE THREE FACILITIES ON THE HOSPITAL CAMPUS, AND THE TWO STRUCTURES IN NEARBY COMMUNITIES, ARE CERTIFIED RURAL HEALTH CLINICS. THE CLINICS ARE UTILIZED BY PRIMARY CARE AND SPECIALTY PHYSICIANS, AS WELL AS MID - LEVEL PRACTITIONERS. BOND COUNTY EMERGENCY MEDICAL SERVICE IS BASED AT AND OPERATED BY THE HOSPITAL. THE SERVICE PROVIDES PARAMEDIC-LEVEL CARE 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, AND AN IV THERAPY ROOM ARE LOCATED WITHIN THE DEPARTMENT. WHEN NEEDED, HELICOPTER AMBULANCE SERVICE IS AVAILABLE. IN 2010, 180 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 HAS THE STATE-OF-THE-ART BIONESS FOOT DROP SYSTEM AVAILABLE. THE HOSPITAL IS THE ONLY FACILITY IN THE IMMEDIATE AREA OFFERING THIS TECHNOLOGY. 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. FOR THE CONVENIENCE OF PATIENTS, SATURDAY CARDIOLOGY APPOINTMENTS ARE AVAILABLE. MEDICAL SPECIALTIES AVAILABLE AT THE HOSPITAL'S OUTPATIENT CLINIC ARE: CARDIOLOGY, OBSTETRICS/GYNECOLOGY, NEPHROLOGY, SPORTS MEDICINE, MEMORY, ORTHOPEDICS, ONCOLOGY, PULMONARY MEDICINE, EARS/NOSE/THROAT, HAND SURGERY, GASTROENTEROLOGY, NERVE CONDUCTION, UROLOGY, GENERAL AND VASCULAR SURGERY, ALLERGIES, AND SLEEP DISORDERS. 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 GREENVILLE REGIONAL HOSPITAL AUXILIARY SUPPORTS THE HEALTH CARE MISSION OF GREENVILLE REGIONAL HOSPITAL AND ITS AFFILIATED DIVISIONS. THE VOLUNTEER ORGANIZATION WAS FORMED IN 1957, THREE YEARS BEFORE THE HOSPITAL OPENED, AND HAS A PAID MEMBERSHIP OF APPROXIMATELY 750 INDIVIDUALS. THE AUXILIARY SUPPORTS THE HOSPITAL WITH VOLUNTEER SERVICE, AS WELL AS CHARITABLE CONTRIBUTIONS THAT ARE USED TO PURCHASE MEDICAL EQUIPMENT, CONSTRUCT NEW PATIENT CARE AREAS, AND RENOVATE EXISTING FACILITIES. ANNUALLY, IT IS ESTIMATED THAT APPROXIMATELY 1,000 BOND COUNTY RESIDENTS PARTICIPATE IN A GREENVILLE REGIONAL HOSPITAL AUXILIARY VOLUNTEER SERVICE OR FUND RAISING PROJECT. VOLUNTEERS ASSIST THE HOSPITAL BY SERVING AS LOBBY HOSTS AND HOSTESSES, AS WELL AS SURGICAL DEPARTMENT HOSTS AND HOSTESSES. THEY ASSIST AT COMMUNITY EDUCATION PROGRAMS, WHEN NEEDED. HOSPITAL AUXILIARY VOLUNTEERS PROVIDE A VARIETY OF SERVICES AT THE GREENVILLE REGIONAL HOSPITAL HEALTH FAIR, HELD EACH YEAR. THE VOLUNTEERS REGISTER ATTENDEES, SERVE AS GUIDES, STAFF INFORMATION AND HEALTH TESTING BOOTHS, AND PREPARE BLOOD TEST RESULTS FOR MAILING. DURING THE 2010 HEALTH FAIR, 3,561 COMPREHENSIVE BLOOD TESTS WERE PERFORMED AND RETURNED TO PARTICIPANTS. IN 2010, THE HOSPITAL AUXILIARY SPONSORED OVER 20 FUND RAISING PROJECTS THAT INCLUDED: OPERATION OF A 22,000 SQUARE-FOOT THRIFT SHOP; OPERATION OF A HOSPITAL GIFT SHOP; A HOLIDAY BAZAAR; THE LIFELINE IN-HOME EMERGENCY RESPONSE SYSTEM; A BOOK FAIR; SPRING SALAD LUNCHEON; FOUR, NEW BOOKS SALES; AN APPLE BUTTER PROJECT; A UNIFORM SALE; THE LIGHT A LUMINARY FOR A LOVED ONE OR FRIEND PROJECT; TWO BAKE SALES; THREE CHOCOLATE SALES; TWO MICHE BAG SALES; A GOLD REFINERY SALE; A "MINI BAZAAR"; CARD FLIGHTS; AND APPLE DAY SALES. PROCEEDS FROM THESE FUND RAISING PROJECTS RESULTED IN A GIFT OF $310,000 THAT WAS DESIGNATED FOR IMPLEMENTATION OF AN ELECTRONIC HEALTH RECORD SYSTEM. THE DONATION IS THE SECOND - HIGHEST IN THE HISTORY OF THE ORGANIZATION AND WILL BE USED TO PURCHASE COMPUTER HARDWARE AND SOFTWARE, WITHOUT THE CHARITABLE FINANCIAL SUPPORT PROVIDED BY THE HOSPITAL AUXILIARY, THE PURCHASE OF MEDICAL EQUIPMENT AND FACILITY RENOVATION WOULD NOT BE POSSIBLE AT GREENVILLE REGIONAL HOSPITAL. 27864006 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 25 0 514 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X SHERRY KOEHLER CFO 6186641230 200 HEALTH CARE DRIVE GREENVILLE IL 622461156 MORRIS BOND 20.00 X X 110048 0 0 RICHARD FUNNEMAN 1.00 X 9708 0 292 LEONARD TAYLOR 1.00 X 0 0 0 JEFF MOLLET 1.00 X 0 0 0 DOUG STROUD 1.00 X 0 0 0 SALLY BOLEN 1.00 X 0 0 0 BART CALDIERARO 1.00 X 0 0 0 MICHAEL COLING 1.00 X 0 0 0 BETTY DELAURENTI 1.00 X 0 0 0 SUSAN HUGHEY-RASLER 1.00 X 10975 0 0 FRANK JOY 1.00 X 0 0 0 JILL YOUNG 1.00 X 0 0 0 ROSIE YORK 1.00 X 0 0 0 BILL BRUCE 40.00 X 123479 0 1498 SHERRY KOEHLER 40.00 X 154750 0 1308 SARA MCPEAK 40.00 X 113411 0 3608 DR DAWN MCDAID 40.00 X 275562 0 5688 DR OME NWANZE 40.00 X 211687 0 2929 GABRIEL GIGLIOTTI 40.00 X 183672 0 3504 DR ANNE BORWICK 40.00 X 160045 0 2185 STEVEN DONNAN 40.00 X 128837 0 9170 JAMES HAYES 40.00 X 0 0 0 1482174 0 30182 15 0 1 0 MIDWEST EMERGENCY DEPARTMENT SVCS 320 HIGHWAY 50 OFALLON IL 62269 ER PHYSICIAN COVERAGE 1339735 SELECT REHABILITATION 35338 EAGLE WAY CHICAGO IL 60678 REHAB SERVICES 818272 DELTA LOCUM TENENS PO BOX 678082 DALLAS TX 75267 OTHER PHYSICIAN COVERAGE 410431 SPECIALCARE HOSPITAL MANAGEMENT 502 EARTH CITY PLAZA EARTH CITY MO 63045 MEDICAL STABILIZATION 180000 JOINER SHEET METAL & ROOFING 817 E HARRIS AVE GREENVILLE IL 62246 CONSTRUCTION/REPAIRS 155431 9 400000 56916 282 457198 NET PATIENT REVENUES 621110 30182989 30182989 LABORATORY 621500 160691 160691 PHARMACEUTICALS 446110 61762 61762 30405442 69068 69068 392415 392415 392415 392415 25235 42220 -16985 -16985 -16985 GIFT SHOP 453220 422322 422322 MISCELLANEOUS 900099 173135 173135 CAFETERIA 722210 77467 77467 76568 76568 749492 32056630 30405442 0 1193990 325000 325000 518104 51811 461112 5181 13129332 10524294 2605038 79951 64088 15863 2146524 1720624 425900 956261 766526 189735 49757 49757 90213 90213 12176 12176 148608 119122 29486 3992757 3200540 792217 232410 186297 46113 937305 751331 185974 77564 62174 15390 462402 370655 91747 1953639 1953639 756536 606429 150107 CONTRACTED SERVICES 2853741 2287520 566221 PHYSICIAN SERVICES 2316016 2316016 PROVISION FOR BAD DEBT 1647808 1647808 MISCELLANEOUS 816197 642076 174121 EQUIPMENT & REPAIRS 242262 194194 48068 76955 61686 15269 33821518 27864006 5952331 5181 1944906 1463542 4216324 4333979 8400 70493 428561 429912 517267 557519 40941432 18876997 22920421 22064435 1419688 1421656 309495 227241 31765062 30568777 2922160 3354677 745644 9420000 8930000 21948 54478 3035642 2780645 15399750 15865444 X 16359821 14697560 5491 5773 16365312 14703333 31765062 30568777 X -1764888 102909 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 12176 1 0 0 12176 0 31798050 12093518 19704532 8963402 6783479 2179923 179980 179980 22064435 LIFE RESIDENCY FEES 1673817 ASSET RETIREMENT OBLIGATION 288828 DUE TO THIRD PARTY PAYORS 818000 2780645 32056630 33821518 -1764888 102909 102909 -1661979 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 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 2008 TO 2010 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. SCHEDULE D, PART XI, LINE 8; NET OTHER TRANSFERS AFFILIATE- $102,909 1 1 1 X 1 X 1 1 0 1 1 444361 444361 0.01380 4434135 2669341 1764794 0.05490 4878496 2669341 2209155 0.06870 9 3579 114273 154445 -40172 0.00000 2 12817 12817 0.00040 3 7817158 5850247 1966911 0.06110 5 34506 34506 0.00110 19 3579 7978754 6004692 1974062 0.06260 19 3579 12857250 8674033 4183217 0.13130 4 1455 1455 0.00000 4 1455 1455 1 770644 77064 7407888 7838344 -430456 X 1 0 1 1 GREENVILLE REGIONAL HOSPITAL

200 HEALTHCARE DRIVE GREENVILLE IL 62246

X X X NOT REQUIRED IN 2010 1 2 FAIR OAKS

200 HEALTH CARE DRIVE GREENVILLE IL 62246

SKILLED NURSING FACILITY 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, COSTS ARE ESTIMATED BASED ON 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 $ 1647808. PART II: GREENVILLE REGIONAL HOSPITAL HOSTS A VARIETY OF COMMUNITY EVENTS. A NUMBER OF HOSPITAL ROOMS ARE USED FOR HEALTH-RELATED COMMUNITY FUNCTIONS. SUPPORT GROUPS THAT MEET WITHIN THE HOSPITAL INCLUDE: DIABETES; DEMENTIA CAREGIVERS; PARKINSON'S DISEASE; AND LOOK GOOD, FEEL BETTER. GOOD HEALTH, HEALTH IMPROVEMENT, AND QUALITY OF LIFE ARE PROMOTED THROUGH THE EDUCATION, INFORMATION, AND SUPPORT THAT IS PROVIDED DURING THE SESSIONS LISTED. INDIVIDUALS AFFLICTED WITH DIABETES AND PARKINSON'S DISEASE HAVE THE OPPORTUNITY TO RECEIVE IMPORTANT INFORMATION RELATED TO THEIR ILLNESS. TREATMENT REGIMES, MEDICATIONS AVAILABLE, AND SUGGESTIONS FOR COPING WITH THE DISEASES ARE OFFERED. PATIENTS DIAGNOSED WITH THESE DISEASES CAN INTERACT WITH OTHERS WHO ARE AFFLICTED WITH THESE CONDITIONS. INDIVIDUALS PROVIDING ASSISTANCE TO THOSE WITH DEMENTIA-RELATED CONDITIONS OR ALZHEIMER'S DISEASE ATTEND THE DEMENTIA CAREGIVERS SUPPORT GROUP. FAMILY MEMBER MEMBERS ARE WELCOME TO ATTEND THE SUPPORT GROUP SESSIONS AND BENEFIT FROM THE INFORMATION PRESENTED AND THE SOCIAL INTERACTION THAT TAKES PLACE. WOMEN UNDERGOING TREATMENT FOR CANCER ARE INVITED TO THE LOOK GOOD, FEEL BETTER SUPPORT GROUP. COSMETICS, WIGS, HEAD COVERINGS, AND FASHION SUGGESTIONS ARE AMONG THE TOPICS COVERED DURING THESE SESSIONS. THOSE ATTENDING CAN ALSO GAIN VALUABLE PSYCHOLOGICAL REINFORCEMENT BY INTERACTING WITH OTHERS EXPERIENCING SIMILAR APPEARANCE-ALTERING SIDE EFFECTS CAUSED BY CHEMOTHERAPY AND RADIATION TREATMENTS. 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. THE ORGANIZATIONS'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE FOR BAD DEBT AND IT IS RECORDED AS AN OPERATING EXPENSE. PART III, LINE 8: THE COST TO CHARGE RATIO FROM THE MEDICARE COST REPORT IS APPLIED. PART V, SECTION A: 1 LICENSED HOSPITAL, 1 LICENSED LONG-TERM CARE FACILITY, 4 RURAL HEALTH CLINICS. 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 2010, PLANNING WAS INITIATED FOR A FORMAL HEALTH NEEDS ASSESSMENT / MARKETING SURVEY TO BE PERFORMED IN 2011. 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 THEY QUALIFY). 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. WHILE THE NATIONAL AND STATE AVERAGE FOR THOSE OVER THE AGE OF 60 IS APPROXIMATELY 12 PERCENT, THOSE OVER THE AGE OF 60 IN THE HOSPITAL'S PRIMARY MARKET AREA IS 22 PERCENT. 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 OF 40 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 435 FULL- AND PART-TIME STAFF MEMBERS. THE FACILITY'S ANNUAL PAYROLL IS $13,647,434 WITHOUT BENEFITS AND $16,830,170 WITH BENEFITS. THE HOSPITAL'S ECONOMIC IMPACT EXCEEDS $55 MILLION. PART VI, LINE 6: GREENVILLE REGIONAL HOSPITAL, AND ITS AFFILIATED DIVISIONS, EXISTS ONLY TO PROVIDE HEALTH CARE SERVICES FOR RESIDENTS OF THE AREA. IN 2010, THE HOSPITAL'S COMMUNITY BENEFIT TOTAL WAS DETERMINED TO BE $4,955,316. 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 2010, $444,361 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. A COMMITTEE MAKES THE FINAL DETERMINATION OF ELIGIBILITY. UNCOMPENSATED CARE TOTALING $2,979,798 WAS PROVIDED DURING THE YEAR. THE HOSPITAL-OWNED, OB PROVIDER PRACTICE LOST $745,762 IN 2010. THE PRACTICE CONSISTS OF TWO OB 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 LACK OF OBSTETRICAL SERVICES WITHIN THE AREA. 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 OB, PSYCHIATRIC, SPORTS MEDICINE, ONCOLOGY, AND SURGERY PRACTICES EXPERIENCED A LOSS OF $1,032,064 IN 2010. DURING THE 2010 FISCAL YEAR, THE OPERATIONAL LOSS AT FAIR OAKS NURSING HOME WAS $774,156. THE BOARD OF DIRECTORS HAS COMMITTED TO THE EXISTENCE OF FAIR OAKS, EVEN THOUGH THE FACILITY OPERATES AT A LOSS OF APPROXIMATELY $2,121 PER DAY. 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 STATE OF ILLINOIS' MEDICAID PROGRAM RANKS 49TH LOWEST IN THE NATION. THE "LOW AND SLOW PAY" CHALLENGE HAS BEEN A PROBLEM IN ILLINOIS FOR OVER 30 YEARS. FAIR OAKS IS ONE OF ONLY TWO NURSING HOMES LOCATED IN BOND COUNTY. IF THE FAIR OAKS BEDS WERE NOT AVAILABLE, THE REMAINING FACILITY WOULD NOT BE ABLE TO ABSORB THE DISPLACED RESIDENTS. FAIR OAKS IS "HOME" FOR THE FACILITY'S APPROXIMATELY 75 RESIDENTS. THE BOARD OF DIRECTORS VIEWS THE NEED FOR THE FAIR OAKS SERVICES AS AN IMPORTANT PART OF THE ORGANIZATION'S MISSION. BOND COUNTY EMERGENCY MEDICAL SERVICES IS OPERATED BY THE HOSPITAL AND REPRESENTS A UNIQUE PRIVATE - PUBLIC PARTNERSHIP. ALTHOUGH A CONTRACT WITH COUNTY GOVERNMENT AUTHORIZES REIMBURSEMENT FOR SOME COSTS ASSOCIATED WITH THE OPERATION OF THE EMERGENCY MEDICAL SERVICE, THE HOSPITAL PROVIDES IMPORTANT SUPPORT FUNCTIONS TOTALING $160,691 THAT ARE NOT COVERED BY PAYMENTS FROM COUNTY FUNDS. 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 CAREGIVERS, DIABETES, PARKINSON'S DISEASE, CHILDBIRTH EDUCATION, AND CANCER. DURING THE YEAR, THE HOSPITAL SPONSORS A STROKE SCREENING CLINIC, BREAST CANCER AWARENESS PROGRAM, DIABETES PROGRAM, DIABETES LUNCH AND LEARN, AND A LOOK GOOD / FEEL BETTER PROGRAM FOR WOMEN AFFLICTED BY CANCER. THE STROKE SCREENING CLINIC OFFERS EKG TESTING, BLOOD PRESSURE CHECKS, CAROTID ARTERY CHECKS, AND HEIGHT AND WEIGHT SCREENING IN AN EFFORT TO IDENTIFY INDIVIDUALS WHO COULD BE AT RISK FOR STROKE. RISK FACTOR ANALYSIS, TAKE-HOME INFORMATION, AND CONSULTATION WITH A HEALTH CARE PROVIDER ARE OFFERED TO EACH PARTICIPANT. (DETAILED INFORMATION REGARDING SUPPORT GROUPS IS PROVIDED WITHIN ANOTHER PORTION OF THE NARRATIVE.) A "WOMEN'S WELLNESS" PROGRAM IS HELD EACH YEAR. NO - COST LANGUAGE TRANSLATION IS PROVIDED FOR PATIENTS IN NEED OF THIS SERVICE. THE HOSPITAL OWNS MEDICAL CLINICS IN TWO, 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 13 FREE HEALTH TESTS, THREE, LOW-COST COMPREHENSIVE BLOOD TESTS, AND PARTICIPATION BY OVER 40 NATIONAL, STATE, AND LOCAL ORGANIZATIONS. THE OPPORTUNITY COST INCURRED BY GREENVILLE REGIONAL HOSPITAL FOR OFFERING THESE DISCOUNTED SERVICES WAS $1,411,867. 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. THE MORE-THAN 3,500 HEALTH FAIR PARTICIPANTS RECEIVE THE DIRECT COMMUNITY BENEFIT OF THE FREE AND REDUCED PRICE TESTING OFFERED BY THE HOSPITAL. IN 2010, 3,561 BLOOD TESTS WERE PERFORMED IN CONJUNCTION WITH THE HEALTH FAIR. PARTICIPANTS COULD CHOOSE FROM A COMPREHENSIVE BLOOD TEST, PROSTATE SPECIFIC ANTIGEN BLOOD TEST (PSA), HEMOGLOBIN A1 - C BLOOD TEST, OR A COMBINATION OF THE THREE BLOOD TESTS. 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 13, OFF-SITE LOCATIONS FOR THE EMPLOYEES OF AREA SCHOOLS, BUSINESSES, AND MANUFACTURERS. EMPLOYEES FROM SMALLER ENTERPRISES ARE INVITED TO PARTICIPATE IN A "BUSINESS EXPRESS" BLOOD TESTING DAY HELD AT THE HOSPITAL. THESE ADDED FEATURES, OFFERED FOR THE CONVENIENCE OF THE COMMUNITY, INCREASE ACCESS TO THE BENEFITS PROVIDED BY THE HEALTH FAIR. THROUGH THE YEARS, A NUMBER OF LIFE-THREATENING AND SERIOUS MEDICAL CONDITIONS HAVE BEEN DISCOVERED BY TESTING PERFORMED IN ASSOCIATION WITH THE EVENT. FOR APPROXIMATELY 25 YEARS, GREENVILLE REGIONAL HOSPITAL AND THE GREENVILLE REGIONAL HOSPITAL AUXILIARY SPONSORED THE LIFELINE IN-HOME EMERGENCY RESPONSE SYSTEM. LIFELINE UNITS WERE USED IN 114 HOMES LOCATED THROUGHOUT THE HOSPITAL'S MARKET AREA. MONTHLY RENTAL FEES WERE PAID TO THE HOSPITAL AUXILIARY. THE LIFELINE SYSTEM ALLOWS THE SUBSCRIBER TO CALL FOR ASSISTANCE IN THE EVENT OF AN EMERGENCY OR ACCIDENT. FOR MANY OF THE SUBSCRIBERS, THE LIFELINE UNIT ENABLES INDIVIDUALS TO LIVE INDEPENDENTLY IN THEIR HOMES. A BUTTON SENDS A WIRELESS SIGNAL TO A RECEIVER THAT ACTIVATES A PHONE CALL WHICH IS PLACED TO A RESPONSE CENTER. ASSISTANCE IS DISPATCHED TO THE SUBSCRIBER'S HOME. A COMBINATION OF VOLUNTEERS AND A HOSPITAL STAFF MEMBER COORDINATED THE HOSPITAL'S LIFELINE PROGRAM. IN THE FALL OF 2009, THE GREENVILLE REGIONAL HOSPITAL LIFELINE PROGRAM WAS REVISED. THE FINANCIAL RESPONSIBILITIES OF THE PROGRAM WERE TRANSFERRED TO THE LIFELINE CORPORATION. A GREENVILLE REGIONAL HOSPITAL STAFF MEMBER CONTINUES TO MARKET THE SERVICE AND THE BENEFITS OF THE EMERGENCY RESPONSE SYSTEM. THE $819,001 VIOLA THOMPSON SCHOLARSHIP FUND, ADMINISTERED BY GREENVILLE REGIONAL HOSPITAL, PROVIDES TUITION ASSISTANCE FOR INDIVIDUALS PURSUING A HEALTH OR MEDICAL CAREER. IN 2010, SCHOLARSHIPS TOTALING $12,300 WERE AWARDED. 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. THE SHRINERS CONDUCT AN ANNUAL, FREE, ORTHOPEDIC SCREENING CLINIC FOR CHILDREN. THESE ORGANIZATIONS ARE NOT CHARGED PART VI, LINE 7: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. SCHEDULE H, PART IV LINE 5 (CONTINUED) 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. THE EXERCISE SESSIONS ARE DESIGNED TO PROMOTE CARDIOVASCULAR HEALTH, WEIGHT LOSS, AND FLEXIBILITY. MANY OF THE NON HEALTH-RELATED MEETINGS THAT ARE HELD AT THE HOSPITAL ARE ASSOCIATED WITH QUALITY OF LIFE ISSUES AND HAVE A DIRECT RELATIONSHIP TO MENTAL AND EMOTIONAL HEALTH. GROUPS SUCH AS RETIRED TEACHERS FREQUENTLY USE THE HOSPITAL'S MEETING ROOMS. THEIR SESSIONS PROVIDE AN OPPORTUNITY FOR LEARNING ABOUT VARIOUS TOPICS, AS WELL AS SOCIAL INTERACTION. 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.GREENVILLE REGIONAL HOSPITAL HAS A STRONG AND VIBRANT RELATIONSHIP WITH A NUMBER OF PUBLIC, PRIVATE, AND MEDICAL PROVIDERS WHO PARTNER WITH THE ORGANIZATION DURING THE YEAR. THE PARTNERS ASSIST WITH BOTH ON - GOING, AS WELL AS SPECIAL, PROJECTS. THE HOSPITAL PARTNERS WITH COUNTY GOVERNMENT TO OPERATE BOND COUNTY EMERGENCY MEDICAL SERVICES. THE BOND COUNTY HEALTH DEPARTMENT AND UNIVERSITY OF ILLINOIS COOPERATIVE EXTENSION JOIN WITH THE HOSPITAL IN SPONSORING THE ANNUAL "WOMEN'S WELLNESS" PROGRAM. THE HOSPITAL PARTNERS WITH THE BOND COUNTY HEALTH DEPARTMENT IN CONDUCTING THE "STROKE PREVENTION CLINIC" OFFERED IN MAY. THE AMERICAN CANCER SOCIETY SUPPORTS THE LOOK GOOD / FEEL BETTER PROGRAM SPONSORED BY THE HOSPITAL. GREENVILLE COLLEGE AND THE BOND COUNTY COMMUNITY UNIT TWO SCHOOL DISTRICT PARTNER WITH THE HOSPITAL IN OFFERING ATHLETIC TRAINERS WHO SUPPORT VARIOUS SPORTS' TEAMS. A NUMBER OF MEDICAL PROVIDERS AND ORGANIZATIONS PARTICIPATE IN THE ANNUAL GREENVILLE REGIONAL HOSPITAL HEALTH FAIR. THEY INCLUDE: DR. MARCUS DERANIAN, OPHTHALMOLOGIST; CENTRAL ILLINOIS VISION; DR. DEANNA DUCOMB, DERMATOLOGIST; DR. MATTHEW MCCULLOUGH, DENTIST; DR. SHEILA KUTZ, AUDIOLOGIST; DR. MATT CHENAULT, CHIROPRACTOR; GREENVILLE REHAB AND PAIN CLINIC; THE GREENVILLE HEARING CENTER; FAMILY EYE CARE ASSOCIATION; CANDY MOORE, MASSAGE THERAPIST; THE BOND COUNTY HEALTH DEPARTMENT; BOND COUNTY HEALTH DEPARTMENT HOME HEALTH; BOND COUNTY HOSPICE; THE UNIVERSITY OF ILLINOIS COOPERATIVE EXTENSION; SOUTHWESTERN ILLINOIS VISITING NURSES ASSOCIATION; SERVICES FOR SENIORS - CARE COORDINATION UNIT; SUNRISE CARE GIVERS; FOX MEDICAL; LIFELINE EMERGENCY RESPONSE SYSTEM; RELIVE; THE BOND COUNTY SENIOR CITIZENS CENTER; ILLINOIS STATE REPRESENTATIVE, RON STEPHENS; SOUTH CENTRAL FS; THE GREENVILLE POLICE DEPARTMENT; CVS PHARMACY; BOND COUNTY RELAY FOR LIFE; THE AMERICAN ASSOCIATION OF RETIRED PERSONS; THE SENIOR HEALTH INSURANCE PROGRAM; THE AMERICAN DIABETES ASSOCIATION; THE STATE OF ILLINOIS TREASURER'S OFFICE; AMERICAN RED CROSS; BLUE CROSS - BLUE SHIELD OF ILLINOIS; AND LAB CORP. 1 UTLAUT MEMORIAL FOUNDATION INC 200 HEALTH CARE DRIVE GREENVILLE IL 62246 371140166 501(C)(3) 325000 HOSPITAL / AUXILIARY ACTIVITY 1 OTHER INFORMATION: PART IV: 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 1 1 X X 0 0 0 0 0 0 0 0 0 SHERRY KOEHLER 146769 0 5000 0 2981 0 0 0 1308 0 156058 0 0 0 DR DAWN MCDAID 275562 0 0 0 0 0 0 0 5688 0 281250 0 0 0 DR OME NWANZE 191687 0 0 0 20000 0 0 0 2929 0 214616 0 0 0 GABRIEL GIGLIOTTI 183672 0 0 0 0 0 0 0 3504 0 187176 0 0 0 DR ANNE BORWICK 160045 0 0 0 0 0 0 0 2185 0 162230 0 0 0 PART I, LINE 1A THE HOSPITAL PROVIDES COUNTRY CLUB MEMBERSHIP DUES AND A DISCRETIONARY SPENDING ACCOUNT IN THE AMOUNT OF $300 PER MONTH TO THE CEO. THIS MEMBERSHIP AND SPENDING ACCOUNT IS USED IN BUSINESS MATTERS FOR THE HOSPITAL. CITY OF GREENVILLE 376000403 396097AV0 2003-04-01 12000000 ADDITION TO BUILDING 0 0 0 12000000 1421656 357086 12000000 2004 0 0 1 1 0 0 0 0 0 1 0 1 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 REVIEWED BY KEY EMPLOYEES (CFO, CEO, COO, ETC) AND DISTRIBUTED TO THE BOARD OF DIRECTORS 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 PERSONNEL ARE REQUIRED TO SIGN A "NO CONFLICT OF INTEREST" POLICY ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS AND THE HOSPITAL'S HUMAN RESOURCES' COLLABORATE AND MAKE A FINAL DETERMINATION BY COMPARING TO COMPARABLE SALARIES OF THE REGION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENT AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET TRANSFERS BETWEEN AFFILIATE 102,909. TOTAL TO FORM 990, PART XI, LINE 5: 102,909. SELECTION OF AUDITORS AND OVERSIGHT OF AUDIT 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 PARENT COMPANY 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 1 0 1 1 1 1 1 0 0 0 0 UTLAUT MEMORIAL FOUNDATION INC B 325000 UTLAUT MEMORIAL FOUNDATION INC C 400000