2025-04-14T14:35:13-05:00 2024-07-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2023-08-01 370645239 Carlinville Area Hospital Association CARL 2178543141 20733 North Broad Street Carlinville IL 62626 Brian Burnside CEO 2178543141 2025-04-14 1 1 Kim Hunwardsen CPA P00484560 6122536500 2025-04-14 2023 2025-03-06 01:10:19Z Brian Burnside 20733 North Broad Street Carlinville IL 62626 56242266 0 X www.cahcare.com X 1947 IL Provide quality acute and preventative health care benefits 8 7 408 7 -7277 0 153490 35261 44953661 51711436 392486 658715 -103633 -54526 45396004 52350886 0 0 0 0 23678529 30448414 0 0 0 19977187 22279066 43655716 52727480 1740288 -376594 39338322 40073743 16282387 16984037 23055935 23089706 X To maintain a professional medical community, a primary care hospital and other health care services, in order to provide quality acute and preventative health care for the benefit of those persons living in the service area. 1 0 41292879 51711436 Carlinville Area Hospital Association is a 25-bed acute care hospital located in Carlinville, Illinois. The Hospital provides inpatient, outpatient and emergency care services for residents of central Illinois.During fiscal year 2024, we carried out our exempt purpose in the following ways: 1) Provided quality short term acute care medical services to 412 inpatients, of which 66.2% were eligible for Medicare. Without our services these elderly patients would have had to travel over 20 miles to receive similar services. (Continued on Schedule O) 2) Provided quality short term skilled care to 161 patients in our swing bed unit, with an average length of stay of 11.1 days. 3) Provided 24 hour a day emergency room services. Our emergency room treated 7,155 patients during fiscal year 2024. We treat everyone who presents themselves to our emergency room regardless of their medical condition or ability to pay. We provided 24-hour physician service so people residing in the Carlinville area do not have to travel long distances for emergency medical care. 4) In addition to the inpatient and emergency services we provide, we also had 37,559 visits in our outpatient departments. These services range from preventative care items such as mammograms and lab tests to rehabilitative services such as Physical and Occupational therapy. 5) The hospital also had 10,714 visits to their specialty clinics. These clinics bring specialists from metropolitan areas to Carlinville on a rotating basis. This provides access to specialty services not otherwise offered in the area.6) The hospital also had 21,625 visits in our Rural Health Clinics. These clinics allow for patients to stay closer to home and get in to see a medical provider.The Hospital provides health care services to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Since the Hospital does not pursue collection of these amounts, they are not reported as patient service revenue. The estimated costs of providing these services was $68,000 for the year ended July 31, 2024, calculated by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients. 41292879 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 20 0 1 408 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 8 7 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X Jay Hodges 2178543857 20733 North Broad Street Carlinville IL 62626 Harald Lausen MD Director/Medical Staff President 41.00 0.00 X 537453 0 23147 Connee Sloman CRNA 40.00 0.00 X 326282 0 37733 Kate Wilkens MD Internal Medicine 40.00 0.00 X 317704 0 13073 Mary Damery CRNA 40.00 0.00 X 255947 0 39864 Ruth Holley ARPN Family Medicine 40.00 0.00 X 170517 0 19959 Thomas Hatley MD Internal Medicine 30.00 0.00 X 168671 0 19653 Dennis Pickrel Chair 1.00 0.60 X X 0 0 0 Ralph March Secretary 1.00 0.60 X X 0 0 0 Heather DeNeve Treasurer 1.00 0.60 X X 0 0 0 Tom Denby Director 1.00 0.00 X 0 0 0 Katie Goodman-Thomas Director 1.00 0.30 X 0 0 0 James Salske Director 1.00 0.00 X 0 0 0 Richard Walden Director 1.00 0.60 X 0 0 0 Brian Burnside CEO 40.00 1.30 X 0 0 0 Paul Courtney CFO 40.00 1.30 X 0 0 0 1776574 0 153429 63 0 1 0 HealthTech Management Service Inc 5110 Maryland Way Ste 200 Brentwood TN 37027 Management Services 1131071 Macoupin Physician Services PO Box 677979 Dallas TX 752677979 Hospitalist Physicians 1065651 Sanburg Emergency Group PO Box 677979 Dallas TX 752677979 Emergency Room Physicians 992789 Consociate PO Box 1068 Decatur IL 62525 Health Insurance Admin 487817 Trubridge Dept 6448 Birmingham AL 352463448 EMR/Computer Software 466042 29 6553 28708 35261 Patient service revenue 621110 51202028 51202028 Pharmacy Revenue 456110 2535 2535 506873 506873 51711436 586736 586736 222705 277231 -54526 -54526 -7277 -47249 3686128 3614149 71979 71979 71979 52350886 51711436 -7277 611466 X 546697 546697 23295085 19278794 4016291 575513 478469 97044 4387396 3643612 743784 1643723 1366554 277169 1251402 1251402 72938 72938 211018 211018 6461383 5474740 986643 279367 279367 4821807 3106132 1715675 134472 134472 321725 321725 98475 41231 57244 259386 82692 176694 554886 435645 119241 2463910 1915078 548832 786260 164271 621989 Medical supplies 3884316 3884316 Food 397082 397082 Repairs and maintenance 146924 109624 37300 133715 46217 87498 52727480 41292879 11434601 0 7118624 5362077 5279575 6877869 341665 332317 379840 680715 43013429 30260406 14263389 12753023 11002182 12612558 125000 125000 828047 1330184 39338322 40073743 3056583 4609847 12247273 11382117 978531 992073 16282387 16984037 X 22427555 22433117 628380 656589 23055935 23089706 39338322 40073743 X -376594 382156 28209 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 645780 645780 27052437 27739735 -687298 12740151 818070 11922081 2575061 1702601 872460 12753023 Employee Health Claims 366748 Operating Lease Liability 264373 Due from Affiliates 360952 992073 X 53010273 382156 382156 52628117 -277231 -277231 52350886 53004711 277231 277231 52727480 0 52727480 Part X, Line 2: The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 4b - Other Adjustments: Rental expenses recorded in revenue for Form 990 -277,231. Part XII, Line 2d - Other Adjustments: Rental expenses recorded in revenue for Form 990 277,231. 1 1 X 1 X 125.000000000000 1 X 1 1 0 0 68000 68000 0.00130 68000 68000 0.00130 15451324 7580277 7871047 0.14930 15451324 7580277 7871047 0.14930 15519324 7580277 7939047 0.15060 1 1592932 409384 11915607 11959439 -43832 X 1 1 1 1 Carlinville Area Hospital Association 20733 North Broad Street Carlinville IL 62626 www.cahcare.com 0005686 X X X X 4 provider based RHCs and 1 provider based clinic Carlinville Area Hospital Association 1 0 0 1 X X X X X X X X X 21 1 1 0 1 X See Part V, Page 8 X 1 21 1 See Part V, Page 8 0 1 X 125.000000000000 300.000000000000 X X X 1 1 X X X X 1 X www.cahcare.com/financial-assistance-process X www.cahcare.com/financial-assistance-process X www.cahcare.com/financial-assistance-process X X X X X X 1 X 0 X X X X 1 X 0 1 Carlinville Area Hospital Association Part V, Section B, Line 5: Focus groups were formed for input. Medical professionals and partners and key community leaders were the groups. After the groups met, a prioritization process identified several potential health needs that were chosen for the needs assessment. Carlinville Area Hospital Association Part V, Section B, Line 6a: HSHS St. Francis Hospital, Hillsboro Area Hospital Carlinville Area Hospital Association Part V, Section B, Line 11: Carlinville Area Hospital completed a Community Health Needs Assessment in fiscal year 2022. The following are the needs identified and the accomplishments for fiscal year 2024. 1. Access to Mental Health and Behavioral Health Services2. Workforce Development3. Food Insecurity1. The Hospital's Behavioral Health Team offers education and is involved at area Senior Centers.2. The Hospital's Therapy Departments offer job shadowing to students interested in fields of healthcare. Two of the Hospital's Executive Team members serve as mentors of the county-wide CEO (Creating Entrepreneurial Opportunities) classes.3. Provide food to Project Third Day (which provided food for children in need in the community)There were no needs identified that will not be addressed. Carlinville Area Hospital Association Part V, Section B, Line 16j: Financial assistance contact information is provided on each bill. A notice about the availability of charity care is posted in the admitting areas, including the ER. The Hospital also employs a full-time financial counselor to discuss the availability of various government services and charity care with patients. Carlinville Area Hospital Association Part V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. Form 990, Schedule H, Part V, Line 7 and Line 10: CHNA and Implementation Strategy:https://www.cahcare.com/community-outreach/community-health-needs-assessment Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients. Part III, Line 3: The estimated amount of the Organization's implicit price concessions attributable to patients eligible under the Organization's charity care policy is calculated based on the percentage of individuals living below the poverty level in 2023. 25.7% can reasonably be considered a community benefit as it would have been written off to charity care. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 11 and 12 of the attached audited financial statements. Part III, Line 8: Carlinville Area Hospital Association is a critical access hospital with a Medicare shortfall. This is considered a community benefit because providing services to Medicare patients is essential to the patients and the community and increases their access to healthcare services.Both the total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.Hospital services reimbursed on a fee schedule are not included in the Medicare calculation per the 990 instructions. Had this been reported the total loss from Medicare services would have increased by $185,269.Medicare fee schedule revenue $ 301,151Medicare estimated costs of care relating to payments (486,420)Net (Shortage) $ (185,269) Part III, Line 9b: Carlinville Area Hospital Association will give the charity care applicant at least 120 days from the date of the first bill to apply for financial assistance without any collection efforts. If the applicant has applied for health care coverage under Medicaid, Kidcare, or other government sponsored health care programs, Carlinville Area Hospital will await the approval or denial of the application without additional collection efforts.Carlinville Area Hospital Association will not refer a bill to collection without first offering the patient the opportunity to request a reasonable payment plan for the amount personally owed by the patient. Part VI, Line 2: The Hospital works with physicians, the health department, nursing homes and other health care providers in the community to determine the health care needs of the community. The Hospital completed a fourth CHNA in FY 2022 and posted to the Hospital's website. Part VI, Line 3: Financial assistance contact information is provided on each bill. A notice about the availability of charity care is posted in the admitting areas, including the ER. The Hospital also employs a full-time financial counselor to discuss the availability of various government services and charity care with patients. Part VI, Line 4: Carlinville Area Hospital Association is a 25-bed acute care hospital located in Carlinville, Illinois. The Hospital serves the residents of Macoupin County. Carlinville Area Hospital is the only hospital within a 14-mile radius of Carlinville Illinois, a small rural community in central Illinois. Illinois Route 4 passes through Carlinville. Interstate 55 is also within 12 miles of the city. The community is mostly agricultural.Other hospitals and medical centers near Carlinville are St. Francis Hospital, a Critical Access Hospital in Litchfield, IL, approximately 14 miles away, Community Memorial Hospital, a Critical Access Hospital in Staunton, IL, approximately 20 miles away and Hillsboro Area Hospital, a Critical Access Hospital in Hillsboro, IL, approximately 24 miles away.Carlinville had a population of 5,576 in 2022. Unemployment was 3.8% compared to 4.8% in the state of Illinois in 2022. The median household income in Carlinville is $53,583. The poverty level in Carlinville was 25.7%. Part VI, Line 5: Carlinville Area Hospital Association's core purpose is "Excellent healthcare close to home." This is very important to our board as all of our members live in our service area and use our facility. The Hospital extends medical staff privileges to all qualified physicians in the community. Carlinville Area Hospital invests in improvements in the community and continues to minimize long-term debt. The Hospital also provides the following services that would not otherwise be available within the Hospital's service area: Twenty-four hour a day emergency room that treats all patients regardless of ability to pay. Specialty Clinic - The Hospital has an arrangement with a physician group out of Springfield, IL that brings specialists to the Carlinville Area that would not otherwise be available.Throughout the year, Carlinville Area Hospital offered CPR training to the community for a special rate of $30 per participant.The Hospital provided free blood pressure checks in Carlinville and Palmyra on a monthly basis.Carlinville Area Hospital's Imaging Department hosted a free community presentation in observance of National Breast Cancer Awareness Month in October. Early detection, benefits of digital mammography, and how the advanced technology aids in early detection were discussed.Carlinville Area Hospital provides a number of services to the community such as the Safe Sitter Class and the very popular High School to Healthcare Program where high school students get to explore healthcare professions. The Hospital also operates a Weekend Walk-In Clinic to provide a need for the community who might need medical care on the weekend, but do not want to go to the Hospital Emergency Room.Carlinville Area Hospital participated in the Illinois Cooperative Work Study Program. The program offered opportunities for college students to gain hands-on experience in their field of study. The Hospital also served as a clinical site for students in Radiology from Southwestern Illinois College and Pharmacy from St. Louis College of Pharmacy.Other community activities:1. RHC Providers did Free Community Presentations 2. Teamed up with the U of I Extension Office to participate in Health Jam 3. Lunch Bunch Summer Food Program4. Project Third Day - Provide food for kids during long weekends5. Parkinson's Support Group - free classes6. Fall and Balance Class for Seniors - free classes7. Teamed up with Blackburn to offer the Rural Immersion Program. Blackburn college students spend theirspring break learning and exploring careers in health care.8. Human Resources hosted a Blackburn college student for an internship. Part VI, Line 7, Reports Filed With States IL 0 0 0 0 0 0 0 0 0 Harald Lausen MD Director/Medical Staff President 357253 0 180200 0 0 0 0 0 23543 0 560996 0 0 0 Connee Sloman CRNA 248782 0 77500 0 0 0 12428 0 25562 0 364272 0 0 0 Kate Wilkens MD Internal Medicine 242704 0 75000 0 0 0 13073 0 396 0 331173 0 0 0 Mary Damery CRNA 203372 0 52575 0 0 0 0 0 40260 0 296207 0 0 0 Ruth Holley ARPN Family Medicine 151517 0 19000 0 0 0 7100 0 13255 0 190872 0 0 0 Thomas Hatley MD Internal Medicine 168671 0 0 0 0 0 7394 0 12517 0 188582 0 0 0 Part I, Line 3 Carlinville Area Hospital Association does not pay compensation to the CEO directly. The CEO is compensated by an unrelated management company, HealthTech Management. The Hospital Board of Directors uses the processes described in Part I, Question 3 to determine appropriate compensation for the CEO. The Board of Directors also approves the Organization's contract with the Management Company. Form 990, Part III, line 2 A new Mobile Medical Clinic opended in Virden, IL. The clinic provides care on a walk-in basis. On June 27, 2024, Carlinville Area Hospital broke ground on a new permanent clinic in Virden. Virden Family Health Care is scheduled to open to patients on March 31, 2025. Form 990, Part VI, Section A, line 1a The Executive Committee is composed of the elected officers of the Board and includes the Chairman, Vice Chairman, Secretary, and Treasurer of the Association. The Executive Committee has the power and authority to manage and control the business and affairs of the Association as the Board of Directors; however, the Executive Committee is not allowed to exercise those powers prohibited by Illinois law which include: amending the Articles or Bylaws; sell, transfer, or otherwise dispose of substantially all of the Association's assets; or adopt Articles of Merger or Consolidation. Form 990, Part VI, Section A, line 2 James Salske, board member, and Richard Walden, Vice Chair have a business relationship. Form 990, Part VI, Section A, line 3 Management Company Compensation (CY 2023): Brian Burnside, CEO Compensation: $303,865 Paul Courtney, CFO Compensation: $232,498 The officers are common law employees of HealthTech Management Service, Inc., an unrelated management company, and are compensated for services to Carlinville Area Hospital Association. The CEO has the responsibility of supervising the management, administration and operation of the Organization. The CFO has the responsibility for managing the Organization's finances. Form 990, Part VI, Section A, line 6 The Organization's sole member is Middle Macoupin Health Care Systems. Form 990, Part VI, Section A, line 7a The Member has the exclusive right and power to designate three of its Directors to serve as members of the Board of Directors, and by resolution has authority to appoint and remove all Directors from the Board. Form 990, Part VI, Section A, line 7b The Member has the exclusive right and power to approve or reject the following actions prior to the Board of Directors taking any action: 1. the annual operating budget, capital budget, long-range plan and any action which will result in a substantial change in the expenditures or revenue forecast; 2. the undertaking of or substantive amendments to a contractual obligation in excess of $50,000, or the guaranteeing of any obligation in excess of $50,000; 3. the purchase, lease, transfer, mortgage or sale of any asset or property with a value in excess of $50,000, except with respect to transactions specified and previously approved within the capital budget; 4. any plan of construction or remodeling involving an expenditure in excess of $50,000, except with respect to transactions specified and previously approved within the capital budget; 5. any borrowing; 6. any application for a government grant; 7. any general plan for the solicitation of charitable contributions or the solicitation or acceptance as a gift of any real property or any interest; 8. any proposal to adopt Articles of Dissolution, Merger, or Consolidation; 9. any selection, removal or change in the compensation or other terms of employment of the operating officers; 10. any substantial change in employee fringe benefits or personnel policies; and 11. any other matters as may be required by law to be submitted to the Member or as to which the Member determines, by resolution, that submission is advisable. Form 990, Part VI, Section B, line 11b The Form 990 is distributed to the governing body before it is filed. The CEO and CFO review the Form 990. Form 990, Part VI, Section B, line 12c Any duality of interest or possible conflict of interest on the part of any Board member should be disclosed to the other members of the Board and made a matter of record through an annual procedure and also when the interest becomes a matter of Board action. Any Board member having a duality of interest or possible conflict of interest on any matter should not vote or use his or her personal influence on the matter. The minutes of the meeting must reflect the disclosure, the abstention from voting, and the quorum situation. Any new member of the Board will be advised of this policy upon entering on the duties of office. The governing Board, CEO, and CFO complete and sign the conflict of interest form yearly. The forms are reviewed by the CEO of the Organization and if a potential conflict is identified the CEO follows up. Form 990, Part VI, Section B, line 15 The CEO and CFO are compensated through HealthTechS3, an unrelated management company. They are considered common law employees of the management company. HealthTechS3 gives the Board of Directors a recommended salary range for the CEO and CFO and the Board sets the compensation within this range after review of performance evaluations and comparability data. The process is documented and is completed on an annual basis. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are not available to the public. Financial information is available through the public disclosure copy of the 990. Form 990, Part IX, line 11g Professional Fees: Program service expenses 4,926,067. Management and general expenses 764,027. Fundraising expenses 0. Total expenses 5,690,094. Purchased services and contract labor: Program service expenses 548,673. Management and general expenses 222,616. Fundraising expenses 0. Total expenses 771,289. Form 990, Part XI, line 9: Change in beneficial interest in perpetual trust 28,209. Carlinville Area Hospital Foundation 20733 North Broad Street Carlinville IL 62626 371193348 Support Carlinville Area Hospital Association IL 501(c)(3) Line 7 Middle Macoupin Healthcare Systems 0 Middle Macoupin Healthcare Systems 20733 North Broad Street Carlinville IL 62626 371193396 Provide support and benefit Carlinville Area Hospital Association IL 501(c)(3) Line 12c, III-FI N/A 0 Carlinville Area Hospital Foundation 200 E Homer Adams Parkway Alton IL 62002 376024648 Support Carlinville Area Hospital Association IL 501(c)(3) Line 12d, III-O 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0