2024-11-14T16:46:10-06:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 475 REGENCY PARK SUITE 175 OFALLON IL 62269 990 2023-01-01 370624255 COMMUNITY HOSPITAL OF STAUNTON COMM 6186354245 400 N CALDWELL ST STAUNTON IL 62088 PATRICK J GARVEY CPA CFO 6183916421 2024-11-14 1 0 JEFF PARKER P00970069 6182331200 2024-11-14 2023 2024-10-15 13:58:12Z LARRY F SPOUR 400 N CALDWELL ST STAUNTON IL 62088 22300781 0 X WWW.STAUNTONHOSPITAL.ORG X 1946 IL COMMUNITY HOSPITAL OF STAUNTON PROVIDES COMPASSIONATE PATIENT-CENTERED HEALTH CARE SERVICES, WHILE MAINTAINING CLINICAL EXCELLENCE AND FINANCIAL VIABILITY. 7 7 149 8 0 0 939440 3264 20559407 20908899 309387 378622 215206 279015 22023440 21569800 5521 9470 0 0 7590515 8486108 0 0 0 11800678 11271469 19396714 19767047 2626726 1802753 27855025 39147624 9141582 9432674 18713443 29714950 TO BE THE LEADER IN PROVIDING AND PROMOTING EXCELLENCE IN HEALTHCARE AND WELLNESS SERVICES IN PARTNERSHIP WITH THE COMMUNITIES WE SERVE. 0 0 15916326 9470 21155939 THE ORGANIZATION OPERATES A FULL SERVICE CRITICAL ACCESS HOSPITAL IN STAUNTON, ILLINOIS WITH A TOTAL OF 25 BEDS. TOTAL PATIENT DAYS FOR THE PERIOD ENDING DECEMBER 31, 2023 WAS 249 ACUTE DAYS AND 824 SWING BED DAYS. THE HOSPITAL ALSO PROVIDED SERVICES TO 23,602 OUTPATIENTS, 5,642 EMERGENCY DEPARTMENT VISITS, AND 4,670 PHYSICIAN OFFICE VISITS. 15916326 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 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 1 0 0 0 1 10 0 149 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X PATRICK GARVEY CPA 6183916421 6800 STATE ROUTE 162 MARYVILLE IL 62062 CLIFF HOMEIER PRESIDENT 1.50 0.25 X X 0 0 0 DERREK TIBURZI VICE PRESIDENT 0.25 0.00 X X 0 0 0 AILEE TAYLOR SECRETARY 0.50 0.00 X X 0 0 0 MIKE BROWN BOARD MEMBER 0.25 0.00 X 0 0 0 BILL HANKS BOARD MEMBER 0.25 0.00 X 0 0 0 RON MAEDGE BOARD MEMBER 0.25 0.00 X 0 0 0 BECKY PAINTER BOARD MEMBER 0.25 0.00 X 0 0 0 DONALD KASUBKE BOARD MEMBER (UNTIL 4/23) 0.50 0.50 X 0 0 0 SUE CAMPBELL PRESIDENT & CEO (UNTIL 12/23) 40.00 0.25 X 260898 0 12262 LARRY SPOUR PRESIDENT & CEO 40.00 0.25 X 166707 0 16981 MICHAEL MARSHALL ANDERSON HEALTHCARE COO 3.50 40.25 X 0 327905 52419 PATRICK GARVEY ANDERSON HEALTHCARE CFO 3.50 35.50 X 0 103223 5991 KEITH PAGE ANDERSON HEALTHCARE PRESIDENT/CEO 3.50 40.25 X 0 560441 110100 JOSH BUSCHLING PHYSICIAN 36.00 0.00 X 265393 0 16044 TIFFANY SPUDICH PHARMACY MANAGER 40.00 0.00 X 122904 0 21765 MELISSA OSTENDORF SPECIALTY CARE RN 36.00 0.00 X 149494 0 28277 ROBIN PRUDEN SPECIALTY CARE RN 36.00 0.00 X 101872 0 12684 1067268 991569 276523 6 0 1 0 ANDERSON HOSPITAL 6800 STATE ROUTE 62 MARYVILLE IL 62062 STAFFING 1613282 MIDWEST EMERGENCY DEPARTMENT 320 EAST US HIGHWAY 50 OFALLON MO 622692704 EMERGENCY PHYSICIANS 1414148 AYA HEALTHCARE INC 1200 E CAMPBELL RD SUITE 108 RICHARDSON TX 75081 MEDICAL STAFFING 1054575 ALTON PHYSICAL THERAPY 1719 CLAWSON ALTON IL 62002 PHYSICAL THERAPY 966860 ANDERS MINKLER HUBER & HELM 800 MARKET ST SUITE 500 ST LOUIS MO 63101 PROFESSIONAL SERVICES 175700 2 3264 3264 NET PATIENT SERVICE REVENUE 621110 20908899 20908899 20908899 321984 321984 27371 0 27371 27371 27371 787619 730981 56638 56638 56638 REBATE INCOME 621110 111744 111744 ANCILLARY SERVICES 621110 87072 87072 OTHER INCOME 621110 48224 48224 4604 4604 251644 21569800 21155939 0 410597 X 8045 8045 1425 1425 456848 456848 6698296 5568892 1129404 39419 33888 5531 831150 669315 161835 460395 359799 100596 80826 80826 24086 24086 152350 152350 28900 28900 4286146 3349623 936523 19420 15177 4243 2532958 2510128 22830 517131 404138 112993 569544 445099 124445 4040 3158 882 257490 257490 1395741 1090767 304974 270453 211359 59094 HOSPITAL PROVIDER ASSES 471691 471691 OTHER EXPENSES 286236 223694 62542 MAINTENANCE & REPAIRS 206749 161574 45175 EQUIPMENT 85680 66959 18721 82028 64105 17923 19767047 15916326 3850721 0 1312715 4248219 2412127 2719651 333121 286741 132613 140955 31302855 11441354 12963158 19861501 10392991 11728086 308300 162471 27855025 39147624 1558919 2036899 7582663 7309232 0 86543 9141582 9432674 X 18713443 29714950 18713443 29714950 27855025 39147624 1802753 1044530 8154224 0 X 0 1 X 1 1 1 X 177500 177500 27825051 9946282 17878769 3300304 1495072 1805232 19861501 DUE TO RELATED PARTY 86543 86543 1 1 X 1 X 125.000000000000 1 X 1 1 0 1 1 110053 110053 0.00560 4361715 3786475 575240 0.02910 4471768 3786475 685293 0.03470 18407 18407 0.00090 4002184 3786475 215709 0.01090 1730 1730 0.00010 4022321 3786475 235846 0.01190 8494089 7572950 921139 0.04660 1 996926 600000 10336242 11232678 -896436 X 1 1 1 1 COMMUNITY HOSPITAL OF STAUNTON 400 CALDWELL STAUNTON IL 62088 STAUNTONHOSPITAL.ORG 0000414 X X X X COMMUNITY HOSPITAL OF STAUNTON 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X HTTPS://STAUNTONHOSPITAL.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 1 21 1 HTTPS://WWW.STAUNTONHOSPITAL.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 0 1 X 125.000000000000 300.000000000000 1 1 X X X 1 X HTTPS://ANDERSONHOSPITAL.ORG/WP-CONTENT/UPLOADS/2023/10/2023-UPDATED-FA-POL X HTTPS://ANDERSONHOSPITAL.ORG/WP-CONTENT/UPLOADS/2024/08/ANDERSON-HEALTHCARE X HTTPS://ANDERSONHOSPITAL.ORG/WP-CONTENT/UPLOADS/2023/08/PLS_OF_FAP_ENGLISH2 X X X X X 1 X 0 X X X X 1 X 0 0 COMMUNITY HOSPITAL OF STAUNTON PART V, SECTION B, LINE 5: THE HOSPITAL HAD TWO FOCUS GROUPS. THE FIRST FOCUS GROUP WAS COMMUNITY LEADERS. THE SECOND FOCUS GROUP INCLUDED MEDICAL PROFESSIONALS. REPRESENTATIVES FROM THE FOLLOWING ORGANIZATIONS PARTICIPATED IN THE FOCUS GROUPS: HERITAGE HEALTH NURSING HOME, GILLESPIE-BENLD AMBULANCE, ST. PAUL'S CHURCH OF CHRIST, ILLINOIS VALLEY ECONOMIC DEVELOPMENT, AND COMMUNITY HOSPITAL OF STAUNTON. COMMUNITY HOSPITAL OF STAUNTON PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED 5 SIGNIFICANT NEEDS:(1) IMPROVED ACCESS TO MENTAL HEALTH SERVICES (2) IMPROVED PROMOTION OF WELLNESS AND HEALTHY LIVING (3) ACCESS TO HEALTHY FOODS AND NUTRITION EDUCATION (4 )IMPROVED ACCESS TO AFFORDABLE HOUSING (5) SECURE, RELIABLE EMS SERVICES FOR STAUNTON AREAWE COMPLETED THIS CHNA DURING THE COVID PANDEMIC. DURING THE PANDEMIC WE HAVE HAD TO FOCUS ON HOSPITAL OPERATIONS. 1 1 - COMMUNITY CLINIC OF STAUNTON 325 CALDWELL STAUNTON IL 62088 CLINIC PART III, LINE 2: THE BAD DEBT EXPENSE AS REPORTED ON THE FINANCIAL STATEMENT HAS BEEN REPORTED ON LINE 2, THEREFORE, THE COSTING METHODOLOGY FOR THIS LINE IS BASED ON THE PATIENT CHARGES THAT WERE WRITTEN OFF ON THE BOOKS. NO BAD DEBT AMOUNTS WERE INCLUDED IN COMMUNITY BENEFIT. 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. IN LINE WITH ITS MISSION, THE HOSPITAL PROVIDES A SAFETY NET FOR THE COMMUNITIES SERVED TO ACCESS MUCH NEEDED CARE BY OFFERING SOME SERVICES TO PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY FOR THOSE SERVICES. FOR SOME OF THEIR PATIENT SERVICES, THE HOSPITAL RECEIVES NO PAYMENT OR PAYMENT THAT IS LESS THAN THE FULL COST OF PROVIDING THE SERVICES. THE 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 DEBT EXPENSE IS THE ESTIMATED AMOUNT OF PATIENT REVENUE THAT THE HOSPITAL WILL NOT COLLECT. PER US CENSUS BUREAU 13.8% OF MACOUPIN COUNTY IS BELOW THE POVERTY LEVEL. PART III, LINE 8: ANY SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT SINCE IT REPRESENTS THE UNREIMBURSED COSTS OF CARING FOR THE ELDERLY IN OUR COMMUNITY. PART III, LINE 9B: THERE IS NO COLLECTION PRACTICE ON PATIENTS WHO QUALIFY FOR CHARITY. ANY PATIENT WHO SUBMITS AN APPLICATION FOR CHARITY AND MEETS THE GUIDELINES SET IN OUR CHARITY POLICY HAS THEIR ACCOUNT WRITTEN OFF WITH NO COLLECTION EFFORT. PART VI, LINE 2: THE HOSPITAL'S BOARD IS MADE UP OF INDIVIDUALS WHO LIVE WITHIN THE HOSPITAL'S SERVICE AREA. THESE INDIVIDUALS ALONG WITH SUPPORT FROM THE HOSPITAL'S MANAGEMENT AND MEDICAL STAFF ARE CONTINUALLY REVIEWING HOW THE HOSPITAL CAN BE AN ASSET WITHIN OUR SERVICE AREA. THE HOSPITAL HAS ALSO CONDUCTED A COMMUNITY PERCEPTION SURVEY TO HELP IDENTIFY AREAS TO IMPROVE PATIENT CARE OR THE NEED FOR ADDITIONAL SERVICES. PART VI, LINE 3: INFORMATION REGARDING THE FINANCIAL ASSISTANCE PROGRAMS THAT THE HOSPITAL OFFERS IS LISTED ON THE HOSPITAL WEBSITE, AND IT IS PRINTED ON THE BOTTOM OF THE STATEMENTS THAT ARE MAILED TO THE PATIENTS. THE INFORMATION IS ALSO POSTED NEAR THE CASHIER'S WINDOW AND THE BUSINESS OFFICE STAFF ARE TRAINED TO PROVIDE THE INFORMATION TO PATIENTS THAT CALL INTO THE OFFICE AND DO NOT HAVE KNOWLEDGE OF THE PROGRAMS. PART VI, LINE 4: THE COMMUNITY THAT THE ORGANIZATION SERVES CONSISTS OF ABOUT A TWELVE MILE RADIUS SURROUNDING STAUNTON AND THE COMMUNITIES WITHIN THAT RADIUS ARE: WORDEN, HAMEL, ALHAMBRA, LIVINGSTON, NEW DOUGLAS, MT. OLIVE, BENLD, GILLESPIE, BUNKER HILL, AND PRAIRIETOWN. THIS IS A RURAL AREA WITH A DEPRESSED ECONOMIC CLIMATE. MANY OF THE INDIVIDUALS ARE ELDERLY, POOR, AND INDIGENT WHICH RESULTS IN HIGHER NUMBERS OF MEDICARE AND MEDICAID RECIPIENTS. PART VI, LINE 5: THE HOSPITAL RESTOCKS THE AMBULANCE OF ANY SUPPLIES USED DURING THE TRANSPORT OF PATIENTS AT NO COST TO THE AMBULANCE SERVICE. 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. THE HOSPITAL DONATES TO THE LOCAL FOOD PANTRY AND SCHOOL SUPPLY DRIVES IN THE COMMUNITY. THE HOSPITAL PROVIDES SCHOLARSHIPS TO STUDENTS FROM THE SCHOOLS IN OUR SERVICE AREA THAT ARE SEEKING DEGREES IN HEALTHCARE. IN ADDITION, THE HOSPITAL PARTNERS WITH THE LOCAL SCHOOL AND THE UNIVERSITY OF ILLINOIS EXTENSION OFFICE TO PROVIDE FOOD/NUTRITION EDUCATION TO COMMUNITY MEMBERS. PART VI, LINE 6: ON 7/1/16 COMMUNITY HOSPITAL OF STAUNTON AFFILIATED WITH ANDERSON HOSPITAL X X 0 1 0 0 0 0 0 0 0 KEITH PAGE ANDERSON HEALTHCARE PRESIDENT/CEO 0 552284 0 0 0 8157 0 89703 0 20397 0 670541 0 0 MICHAEL MARSHALL ANDERSON HEALTHCARE COO 0 322019 0 0 0 5886 0 23000 0 29419 0 380324 0 0 JOSH BUSCHLING PHYSICIAN 259994 0 0 0 5399 0 7726 0 8318 0 281437 0 0 0 SUE CAMPBELL PRESIDENT & CEO (UNTIL 12/23) 255052 0 0 0 5846 0 3944 0 8318 0 273160 0 0 0 LARRY SPOUR PRESIDENT & CEO 161395 0 0 0 5312 0 0 0 16981 0 183688 0 0 0 MELISSA OSTENDORF SPECIALTY CARE RN 149494 0 0 0 0 0 1588 0 26689 0 177771 0 0 0 PART I, LINE 4B NAME: KEITH PAGE, DESCRIPTION: 2023 ANNUAL CONTRIBUTION, CURRENT YEAR AMOUNT: $9,515. PLAN DESCRIPTION: SECTION 457(F) PLAN OF RELATED ORGANIZATION NAME: MICHAEL MARSHALL, DESCRIPTION: 2023 ANNUAL CONTRIBUTION, CURRENT YEAR AMOUNT: $12,975. PLAN DESCRIPTION: SECTION 457(F) PLAN OF RELATED ORGANIZATION FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A SOLE CORPORATE MEMBER, ANDERSON HEALTHCARE. FORM 990, PART VI, SECTION A, LINE 7A BOARD MEMBERS MUST BE APPROVED BY ANDERSON HEALTHCARE. FORM 990, PART VI, SECTION A, LINE 7B ANDERSON HEALTHCARE APPROVES BOARD MEMBERS AND ANNUAL BUDGETS. DECISIONS THAT REQUIRE APPROVAL INCLUDE REVISIONS TO THE MISSION; AMENDMENTS OF THE ORGANIZING DOCUMENTS; APPOINTMENT AND REMOVAL OF MEMBERS OF THE BOARD OF TRUSTEES AND THE PRESIDENT OF THE ORGANIZATION; APPROVAL OF STRATEGIC PLANS, BUDGETS, SALE OF LEASE OF ASSETS IN EXCESS OF $100,000, OR INCURRENCE OF DEBT; APPROVAL OF MERGERS OR AFFILIATIONS. FORM 990, PART VI, SECTION B, LINE 11B THE CEO REVIEWS THE FORM 990, WHICH IS THEN REVIEWED BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY AND A DISCLOSURE STATEMENT ARE PRESENTED TO OFFICERS, DIRECTORS OR TRUSTEES AND KEY EMPLOYEES ANNUALLY. THE DISCLOSURE STATEMENT MUST BE RETURNED AND IS REVIEWED BY FINANCIAL AUDITORS AND HOSPITAL ADMINISTRATION. FORM 990, PART VI, SECTION B, LINE 15 COMMUNITY HOSPITAL OF STAUNTON'S CEO IS EVALUATED BY THE CEO OF ANDERSON HEALTHCARE. THE RESULTS OF THIS EVALUATION ARE USED TO DETERMINE ANY RATE INCREASE IN THE SAME MANNER AS ALL OTHER EMPLOYEES OF COMMUNITY HOSPITAL OF STAUNTON. THE ANDERSON HEALTHCARE CFO SERVES AS THE CFO FOR THE COMMUNITY HOSPITAL OF STAUNTON. THIS POSITION / ROLE IS EVALUATED BY THE CEO OF ANDERSON HEALTHCARE AND THE RESULTS OF THIS EVALUATION ARE USED TO DETERMINE ANY RATE INCREASE IN THE SAME MANNER AS ALL OTHER EMPLOYEES OF COMMUNITY HOSPITAL OF STAUNTON. FORM 990, PART VI, SECTION C, LINE 19 COMMUNITY HOSPITAL OF STAUNTON MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENT AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,892,123. MANAGEMENT AND GENERAL EXPENSES 529,020. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,421,143. OTHER FEES: PROGRAM SERVICE EXPENSES 1,457,500. MANAGEMENT AND GENERAL EXPENSES 407,503. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,865,003. ANDERSON HOSPITAL FOUNDATION 6800 STATE ROUTE 162 MARYVILLE IL 62062 274548522 SUPPORT ORG IL 501(C)(3) LINE 7 ANDERSON HOSPITAL 0 ANDERSON HOSPITAL ILLINOIS ROUTE 162 MARYVILLE IL 62062 370662561 HEALTHCARE IL 501(C)(3) LINE 3 ANDERSON HEALTHCARE 0 ANDERSON HEALTHCARE 6800 STATE ROUTE 162 MARYVILLE IL 62062 843965822 HEALTHCARE IL 501(C)(3) LINE 12C, III-FI N/A 0 FRIENDS OF COMMUNITY MEMORIAL HOSPITAL 400 N CALDWELL STAUNTON IL 62088 363913722 FUNDRAISING IL 501(C)(3) LINE 10 COMMUNITY HOSPITAL OF STAUNTON 1 ANDERSON SURGERY CENTER LLC 6800 STATE ROUTE 162 MARYVILLE IL 62062 834200085 SURGERY IL ANDERSON HOSPITAL N/A 0 0 ANDERSON REHABILITATION INSTITUTE LLC 6800 STATE ROUTE 162 MARYVILLE IL 62062 832844780 REHAB IL ANDERSON HOSPITAL N/A 0 0 0 1 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 1 0