2026-08-17T08:58:10-05:00 2025-09-30 393647910 WIPFLI ADVISORY LLC 1502 LONDON ROAD SUITE 220 DULUTH MN 55812 990 2024-10-01 370673512 IROQUOIS MEMORIAL HOSPITAL & RESIDENT HOME IROQ 8154327777 200 E FAIRMAN AVENUE WATSEKA IL 60970 MICHAEL J TILSTRA PRESIDENT & CEO 8154327777 2026-08-14 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2026-08-14 2024 2025-03-06 01:10:19Z MICHAEL J TILSTRA 200 E FAIRMAN AVENUE WATSEKA IL 60970 47017332 0 X HTTPS://IROQUOISMEMORIAL.COM/ X 1914 IL IROQUOIS MEMORIAL HOSPITAL & RESIDENT HOME IS COMMITTED TO PROVIDING QUALITY HEALTHCARE SERVICES. 9 9 405 51 0 0 1564718 1672791 38895890 45027457 212522 36632 172833 272019 40845963 47008899 0 0 0 0 19743859 19181574 0 0 0 25710364 26611335 45454223 45792909 -4608260 1215990 22123594 21924422 11645345 10230183 10478249 11694239 X IROQUOIS MEMORIAL HOSPITAL & RESIDENT HOME IS COMMITTED TO PROVIDING QUALITY HEALTHCARE SERVICES FOR THE REGION IN A CONVENIENT, CARING ENVIRONMENT. 0 0 35331309 0 44691672 IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME PROVIDES HIGH QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. THEREFORE, IN KEEPING WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF OUR COMMUNITY, SOME CARE IS PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST. THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR AN INDIVIDUAL'S INABILITY TO PAY EXIST. THESE ACTIVITIES INCLUDE PREVENTION AND WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, AND THE MEDICAL UNDERSERVED INCLUDING A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES.THE HOSPITAL IS LOCATED IN WATSEKA, ILLINOIS AND SERVES THE SURROUNDING COMMUNITIES IN IROQUOIS COUNTY AND WEST-CENTRAL INDIANA. THERE ARE OUTPATIENT CLINICS MAINTAINED IN GILMAN, MILFORD, ST ANNE, AND WATSEKA, ILLINOIS AS WELL AS KENTLAND, INDIANA. THE HOSPITAL PROVIDES BEDS FOR ACUTE CARE, INTENSIVE CARE, NURSERY, AND LONG-TERM CARE. THE HOSPITAL ALSO PROVIDES AMBULANCE SERVICES TO MOST OF IROQUOIS COUNTY WITH STATIONS IN GILMAN AND WATSEKA. HOME HEALTH AND HOSPICE PROVIDE SERVICES TO WATSEKA AND SURROUNDING COMMUNITIES IN THE HOSPITAL'S SERVICE AREA. THE IROQUOIS REGIONAL HEALTH CENTER HOUSES PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPIES. THE HOSPITAL IS CERTIFIED TO PROVIDE CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICE ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE HOSPITAL RECORDS THESE AMOUNTS AS UNCOMPENSATED CARE IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY.IROQUOIS MEMORIAL HOSPITAL PROVIDES NON-TRADITIONAL HOSPITAL BASED SERVICES SUCH AS AMBULANCE COVERAGE TO WATSEKA AND THE SURROUNDING IROQUOIS COUNTY COMMUNITIES. IN ADDITION TO THE COSTS OF UNCOMPENSATED CARE AND OTHER NON-TRADITIONAL SERVICES, IROQUOIS MEMORIAL HOSPITAL & RESIDENT HOME COMMITTED SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND OTHER CRITICAL SERVICES WHICH MEET OTHERWISE UNFILLED COMMUNITY NEEDS. SOME OF THOSE PROGRAMS THAT FURTHER THE HOSPITAL'S MISSION INCLUDE: - AMBULANCE SUPPORT FOR SPORTING EVENTS AND SURROUNDING VOLUNTEERS- AMBULANCE DEPARTMENTS- BLOOD DRIVES- BREAST CANCER AWARENESS EVENT- BREAST-FEEDING CLASSES FOR EXPECTANT MOTHERS- CAMP 911 SAFETY PROGRAMS FOR AREA SCHOOL CHILDREN- FARM SAFETY EDUCATION- FIRST AID FOR LOCALLY COMMUNITY EVENTS- FREE AND REDUCED FEE HEALTH SCREENINGS- FREE BLOOD PRESSURE SCREENINGS- FREE CPR TRAINING FOR THE PUBLIC- GO RED HEALTHY HEART EVENT- HEALTH-RELATED ARTICLES IN LOCAL PUBLICATIONS- BIRTHING CLASSES- LIFELINE- MEALS ON WHEELS- SPEAKER'S BUREAU- TOURS FOR AREA SCHOOL CHILDREN 35331309 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 53 0 405 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 9 9 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 IL X ROBYN MEMENGA 8154325841 200 E FAIRMAN AVENUE WATSEKA IL 60970 RHONDA PENCE CHAIR 3.00 1.00 X X 0 0 0 KATHY PERKINSON VICE CHAIR 3.00 1.00 X X 0 0 0 DOUG GEIGER VICE CHAIR (THRU 06/25) 3.00 1.00 X X 0 0 0 SARA MIKUTA TREASURER 3.00 1.00 X X 0 0 0 DAN TINCHER SECRETARY 3.00 1.00 X X 0 0 0 JOHN BELL DIRECTOR 3.00 1.00 X 0 0 0 ROGER DITTRICH DIRECTOR 3.00 1.00 X 0 0 0 KIRA EBERT DIRECTOR 3.00 1.00 X 0 0 0 ADAM KNAPP DIRECTOR 3.00 1.00 X 0 0 0 PHILIP ZUMWALT MD DIRECTOR 3.00 1.00 X 0 0 0 MICHAEL TILSTRA CEO 40.00 1.00 X 239724 0 12331 DENISE GRAVES CNO (AS OF 01/25) 40.00 1.00 X 0 0 0 SHAWN BRANSKY CFO (THRU 10/24) 40.00 1.00 X 133487 0 0 MICHELLE FAIRLEY CNO (THRU 02/25)/VP CUSTOMER CARE 40.00 1.00 X 125602 0 14233 SERGE MARINKOVIC PHYSICIAN 40.00 X 433706 0 19136 M HYTHAM BECK PHYSICIAN 40.00 X 327565 0 15427 GONZALO FLORIDO PHYSICIAN 40.00 X 225013 0 9329 CRISTANTO REYES PHYSICIAN 40.00 X 219828 0 10141 MOHANNAD RAJJOUB PHYSICIAN 40.00 X 187114 0 0 1892039 0 80597 21 0 1 0 STATERA 2250 N ILLINOIS CARBONDALE IL 62901 EMERGENCY ROOM SERVICES 1890798 CLIPBOARD HEALTH 440 N BARRANCA AVENUE 5028 COVINA CA 91723 CONTRACT LABOR 885898 ATHENA 311 ARSENAL STREET WATERTOWN MA 02472 HEALTH CARE SYSTEM 743123 TRINITY MEDICAL STAFFING 14217 DAYTON CIRCLE OMAHA NE 68137 MEDICAL STAFFING 726946 VIGILANCE ANESTHSIOLOGIST 200 E FAIRMAN AVENUE WATSEKA IL 60970 CRNA 375217 30 19352 2602 1650837 1672791 NET PATIENT REVENUE 621400 42107343 42107343 IDPA PROGRAM 621400 2353519 2353519 340B PHARMACY REVENUE 456110 129692 129692 436903 436903 45027457 36632 36632 54073 0 54073 54073 54073 8433 19352 8433 0 INCENTIVE PAYMENTS 900099 101118 101118 116828 116828 217946 47008899 44691672 0 644436 X 706286 567130 139156 14666091 12580537 2085554 2669194 2281622 387572 1140003 974939 165064 32928 32928 9521 9521 9098457 5877566 3220891 91711 58817 32894 2282031 1463536 818495 893827 573238 320589 27427 17590 9837 22204 18364 3840 591458 489166 102292 1236213 792821 443392 BAD DEBT EXPENSE 4844762 4844762 MEDICAL SUPPLIES 3526173 2261442 1264731 HAF EXPENSE 2387226 1531000 856226 REPAIRS & MAINTENANCE 648536 415926 232610 918861 582853 336008 45792909 35331309 10461600 0 2227949 4120286 211683 168135 7876906 6005394 1021127 913094 181472 191191 43197535 37876257 5783331 5321278 4821126 5205044 22123594 21924422 8575753 7530554 1904078 1916314 890762 495512 274752 287803 11645345 10230183 X 5840818 6674697 4637431 5019542 10478249 11694239 22123594 21924422 1215990 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 9521 9521 0 PART II-B, LINE 1: A PORTION OF MEMBERSHIP DUES TO PROFESSIONAL HEALTHCARE ASSOCIATIONS IS USED FOR LOBBYING ACTIVITIES. 4637431 382111 5019542 6725167 1150584 3238320 4637431 6510362 610995 396190 6725167 8321487 -1377033 434092 6510362 7196915 1124572 8321487 0.00800 0.99200 0.00000 0 0 531825 531825 24588580 21265021 3323559 17190866 16611236 579630 886264 886264 5321278 INVESTMENT IN UNCONSOLIDATED AFFILIATE 50000 ASSETS LIMITED AS TO USE - DONOR RESTRICTED 135502 ASSETS LIMITED AS TO USE - BENEFICIAL INTEREST IN PERPETUAL TRUST 5019542 5205044 ASSET RETIREMENT OBLIGATION 287803 287803 PART V, LINE 4: THE ENDOWMENT FUNDS ARE USED TO SUPPORT THE ONGOING OPERATIONAL AND CAPITAL NEEDS OF THE ORGANIZATION IN MEETING THE COMMUNITY NEEDS AND SERVICES. IMH GOLF OUTING 27785 19352 8433 8433 27785 19352 8433 8433 8433 0 1 1 1 X 125.000000000000 1 X 1 1 0 0 337221 337221 0.00820 10128588 7057329 3071259 0.07500 10465809 7057329 3408480 0.08320 10465809 7057329 3408480 0.08320 1 2372407 0 9641831 9694910 -53079 X 1 1 1 1 IROQUOIS MEMORIAL HOSPITAL 200 E FAIRMAN AVENUE WATSEKA IL 60970 HTTPS://IROQUOISMEMORIAL.COM/ X X X X IROQUOIS MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 24 1 0 0 1 X SEE SUPPLEMENTAL INFORMATION X X 1 24 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 125.000000000000 300.000000000000 1 1 X X X X 1 X HTTPS://IROQUOISMEMORIAL.COM/FINANCIAL-ASSISTANCE X HTTPS://IROQUOISMEMORIAL.COM/FINANCIAL-ASSISTANCE X HTTPS://IROQUOISMEMORIAL.COM/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 IROQUOIS MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE HOSPITAL'S COMMUNITY WAS IDENTIFIED THROUGH A FACILITATED MEETING WITH SENIOR STAFF AND DEFINED AS THE HOSPITAL'S PRIMARY AND SECONDARY SERVICE AREAS. THE ASSESSMENT AREA INCLUDES ALL OR PORTIONS OF ZIP CODE SERVICE AREAS SURROUNDING WATSEKA, ILLINOIS, EXTENDING INTO IROQUOIS, FORD, AND KANKAKEE COUNTIES IN ILLINOIS AND BENTON AND NEWTON COUNTIES IN INDIANA. THE SERVICE AREA WAS SELECTED BECAUSE IT REPRESENTS THE POPULATION THAT UTILIZES THE HOSPITAL'S INPATIENT, OUTPATIENT, CLINIC, ANCILLARY, AND SPECIALTY SERVICES. IROQUOIS MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: PART V, SECTION B, LINE 7A & 10A:HTTPS://IROQUOISMEMORIAL.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT IROQUOIS MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: IROQUOIS MEMORIAL HOSPITAL CONDUCTED ITS 2025 COMMUNITY HEALTH NEEDS ASSESSMENT USING A COMBINATION OF PRIMARY AND SECONDARY DATA SOURCES. PRIMARY DATA INCLUDED SURVEYS, THREE FOCUS GROUPS CONSISTING OF THE BOARD OF DIRECTORS, EXECUTIVE TEAM, AND ADMINISTRATIVE TEAM, AND PARTICIPATION IN THE ILLINOIS PROJECT FOR LOCAL ASSESSMENT OF NEEDS (IPLAN). SECONDARY DATA INCLUDED INFORMATION FROM THE U.S. CENSUS BUREAU, AMERICAN COMMUNITY SURVEY, COUNTY HEALTH RANKINGS, AND OTHER STATE, FEDERAL, AND PROFESSIONAL SOURCES. COMMUNITY LEADERS, HEALTH PROFESSIONALS, FAITH LEADERS, BUSINESS LEADERS, LOCAL OFFICIALS, SCHOOLS, AND COMMUNITY MEMBERS PARTICIPATED IN THE ASSESSMENT PROCESS. IDENTIFIED NEEDS WERE EVALUATED THROUGH REVIEW OF THE DATA, DISCUSSION AMONG PARTICIPANTS, AND COMPARISON OF PRIMARY AND SECONDARY FINDINGS. PRIORITY HEALTH NEEDS IDENTIFIED INCLUDED SPECIALTY SERVICES, COMMUNITY WELLNESS, MENTAL HEALTH ISSUES, WOMEN'S HEALTH, ACCESS TO CARE, ELDERLY CARE, OBESITY, TRANSPORTATION, SUBSTANCE ABUSE PROGRAMS, AND SERVICES FOR UNDERSERVED POPULATIONS. THE HOSPITAL DEVELOPED IMPLEMENTATION STRATEGIES FOCUSED ON SPECIALTY SERVICE EXPANSION, EMERGENCY SERVICES, AND COMMUNITY WELLNESS. RESOURCES AVAILABLE TO ADDRESS IDENTIFIED NEEDS INCLUDE THE HOSPITAL'S INPATIENT AND OUTPATIENT SERVICES, PRIMARY CARE AND SPECIALTY CLINICS, BEHAVIORAL HEALTH SERVICES, HOME HEALTH AND HOSPICE PROGRAMS, REHABILITATION SERVICES, TRANSPORTATION ASSISTANCE PROGRAMS, PUBLIC HEALTH AGENCIES, FOOD ASSISTANCE PROGRAMS, HOUSING AND UTILITY ASSISTANCE RESOURCES, AND NUMEROUS COMMUNITY ORGANIZATIONS IDENTIFIED IN THE RESOURCE INVENTORY. 6 1 - IROQUOIS REGIONAL HEALTH CENTER 200 LAIRD LANE WATSEKA IL 60970 REHAB SERVICES, HOME HEALTH, HOSPICE 2 - MULTI-SPECIALTY CLINIC 200 E FAIRMAN AVENUE WATSEKA IL 60970 PHYSICIAN OFFICE 3 - KENTLAND CLINIC 303 N 7TH STREET KENTLAND IN 47951 PHYSICIAN OFFICE 4 - GILMAN CLINIC 720 S CRESCENT STREET GILMAN IL 60938 PHYSICIAN OFFICE 5 - MILFORD CLINIC 34 EAST JONES MILFORD IL 60953 PHYSICIAN OFFICE 6 - ST ANNE CLINIC 135 WEST STATION STREET ST ANNE IL 60964 PHYSICIAN OFFICE PART I, LINE 7: A COST-TO-CHARGE RATIO AS CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, INCLUDED IN THE SCHEDULE H INSTRUCTIONS WAS USED TO DETERMINE THE AMOUNTS ON LINE 7B OF PART I OF SCHEDULE H. ACTUAL COSTS WERE USED TO DETERMINE THE BENEFIT EXPENSES ON LINES 7A, 7E, 7F, 7G, AND7I OF SCHEDULE H, PART I. 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 $ 4,844,762. PART III, LINE 2: THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINE 2 WAS A RATIO OF PATIENT CARE COSTS TO CHARGES AS COMPUTED IN WORKSHEET 2 OF THE FORM 990, SCHEDULE H INSTRUCTIONS. PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES, PATIENTS DO NOT COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE HOSPITAL PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTS PATIENTS WITH THE APPLICATION. DUE TO NO RESPONSES FROM SOME PATIENTS, A PORTION OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE IS REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE ORGANIZATION EXPECTS TO BE ENTITLED, IN EXCHANGE FOR PROVIDING PATIENT CARE SERVICES. PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND IMPLICIT PRICE CONCESSIONS WHICH REFLECTS MANAGEMENT'S ESTIMATE OF THE TRANSACTION PRICE. THE ORGANIZATION ESTIMATES THE TRANSACTION PRICE BASED ON NEGOTIATED CONTRACTUAL AGREEMENTS, HISTORICAL EXPERIENCE, AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS AND IS RECORDED THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE.THE ORGANIZATION DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS.THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: THE COSTING METHOD USED ABOVE FOR IRS FORM 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES AND THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFITS EXPENSE BECAUSE PROVIDING MEDICAL CARE AT A SHORTFALL IMPACTS THE HOSPITAL'S OPERATIONS AND GROWTH. THE CARE IS PROVIDED BECAUSE THERE IS A NEED AND A DESIRE TO PROVIDE MEDICAL CARE IN THIS COMMUNITY.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: QUALIFICATIONS ARE BASED ON POVERTY GUIDELINES PUBLISHED. NO COLLECTION EFFORTS FOR QUALIFYING PATIENTS. PART VI, LINE 2: IN ADDITION TO THE CHNA, OUR FACILITY PARTICIPATES IN THE IROQUOIS COUNTY PUBLIC HEALTH DEPARTMENT'S IPLAN PROCESS AND MAINTAINS ONGOING COMMUNICATION WITH PUBLIC HEALTH OFFICIALS AND OTHER COMMUNITY PARTNERS. WE ALSO REVIEWS SERVICE UTILIZATION, PATIENT AND PROVIDER FEEDBACK, COMMUNITY SURVEY AND FOCUS-GROUP FINDINGS, DEMOGRAPHIC AND PUBLIC HEALTH DATA, AND BARRIERS TO CARE WHEN PLANNING SERVICES. IMH LEADERSHIP IS REPRESENTED ON THE LOCAL PUBLIC HEALTH BOARD. PART VI, LINE 3: WE PROVIDE INFORMATION ABOUT OUR FINANCIAL ASSISTANCE POLICY DURING THE REGISTRATION OR ADMISSION PROCESS AND DISPLAYS NOTICES IN PATIENT REGISTRATION AREAS. STAFF ARE TRAINED TO DISCUSS AVAILABLE ASSISTANCE WHEN PATIENTS EXPRESS CONCERNS ABOUT THEIR ABILITY TO PAY. PATIENTS MAY ALSO BE DIRECTED TO STAFF WHO CAN EXPLAIN THE APPLICATION PROCESS AND PROVIDE INFORMATION ABOUT POSSIBLE ELIGIBILITY FOR MEDICAID OR OTHER GOVERNMENT ASSISTANCE PROGRAMS. PART VI, LINE 4: IMH SERVES A PRIMARILY RURAL AREA THAT INCLUDES ALL OR PORTIONS OF IROQUOIS, FORD, AND KANKAKEE COUNTIES IN ILLINOIS AND BENTON AND NEWTON COUNTIES IN INDIANA. THE SERVICE AREA INCLUDES CHILDREN, WORKING-AGE ADULTS, AND OLDER ADULTS, AS WELL AS LOWER-INCOME, UNINSURED, AND UNDERINSURED RESIDENTS. COMMUNITY MEMBERS MAY FACE LONG TRAVEL DISTANCES, LIMITED TRANSPORTATION, PROVIDER SHORTAGES, CHRONIC HEALTH CONDITIONS, AND LIMITED LOCAL ACCESS TO SPECIALTY SERVICES. PART VI, LINE 5: IMH PROMOTES COMMUNITY HEALTH THROUGH ITS RURAL CLINICS, SPECIALTY SERVICES, BEHAVIORAL HEALTH SERVICES, CHRONIC CARE MANAGEMENT, HEALTH EDUCATION, COMMUNITY EVENTS, REDUCED-COST SCREENINGS, VACCINATIONS, AND OUTREACH TO LOCAL EMPLOYERS AND ORGANIZATIONS. THESE SERVICES HELP REDUCE GEOGRAPHIC AND FINANCIAL BARRIERS TO CARE. IMH IS GOVERNED BY A COMMUNITY-BASED BOARD AND REINVESTS AVAILABLE RESOURCES IN FACILITIES, EQUIPMENT, STAFFING, AND SERVICES NEEDED TO MAINTAIN ACCESS TO CARE IN THE RURAL COMMUNITIES IT SERVES. X X 0 0 0 0 0 0 0 0 0 SERGE MARINKOVIC PHYSICIAN 429651 0 0 0 4055 0 0 0 19136 0 452842 0 0 0 M HYTHAM BECK PHYSICIAN 327565 0 0 0 0 0 0 0 15427 0 342992 0 0 0 MICHAEL TILSTRA CEO 239208 0 0 0 516 0 0 0 12331 0 252055 0 0 0 GONZALO FLORIDO PHYSICIAN 225013 0 0 0 0 0 0 0 9329 0 234342 0 0 0 CRISTANTO REYES PHYSICIAN 219828 0 0 0 0 0 0 0 10141 0 229969 0 0 0 MOHANNAD RAJJOUB PHYSICIAN 187114 0 0 0 0 0 0 0 0 0 187114 0 0 0 FORM 990, PART VI, SECTION A, LINE 7A THE MAYOR, COUNTY BOARD CHAIRPERSON, AND DISTRICT JUDGE EACH APPOINT THREE MEMBERS OF THE ORGANIZATION'S BOARD OF TRUSTEES TO THREE YEAR TERMS. FORM 990, PART VI, SECTION B, LINE 11B THE STAFF MEMBERS THAT PROVIDE THE INFORMATION TO THE OUTSIDE RETURN PREPARER CONDUCT A THOROUGH REVIEW OF A DRAFT OF THE RETURN. PRIOR TO FILING, THE FORM 990 IS DISTRIBUTED TO THE BOARD OF TRUSTEES FOR REVIEW AND COMMENT. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY COVERS DIRECTORS, OFFICERS, MANAGERS, MEDICAL STAFF MEMBERS, PHYSICIANS, EXECUTIVE STAFF MEMBERS, DEPARTMENT DIRECTORS, AND COORDINATORS. CONFLICT OF INTEREST STATEMENTS ARE REQUIRED TO BE COMPLETED ANNUALLY BY DIRECTORS, OFFICERS, AND HIGHLY COMPENSATED EMPLOYEES AND ARE REVIEWED BY ADMINISTRATION. INDIVIDUALS WITH CONFLICTS OF INTEREST ARE REQUIRED TO DISCLOSE THEM AND TO REFRAIN FROM PARTICIPATION IN ANY DECISION THAT COULD BENEFIT THEM PERSONALLY. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF TRUSTEES CONDUCTED A COMPENSATION REVIEW. CEO HAS A TWO YEAR CONTRACT. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL DOCUMENTS ARE AVAILABLE UPON REQUEST. CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE NOT PUBLIC INFORMATION AT THIS TIME. HOWEVER, IF REQUESTED, THE BOARD WOULD BE NOTIFIED TO DETERMINE RESPONSE. FORM 990, PART IX, LINE 11G EMERGENCY ROOM FEES: PROGRAM SERVICE EXPENSES 1,405,168. MANAGEMENT AND GENERAL EXPENSES 785,853. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,191,021. OTHER CONTRACTED LABOR: PROGRAM SERVICE EXPENSES 4,021,443. MANAGEMENT AND GENERAL EXPENSES 2,249,027. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,270,470. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 450,955. MANAGEMENT AND GENERAL EXPENSES 186,011. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 636,966. IROQUOIS MEMORIAL HOSPITAL FOUNDATION INC 200 E FAIRMAN AVENUE WATSEKA IL 60970 453834535 SUPPORTING ORGANIZATION IL 501(C)(3) LINE 12A, I IROQUOIS MEMORIAL HOSPITAL & RESIDENT HOME 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0