2024-11-08T08:12:41-06:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2023-01-01 376062326 PANA COMMUNITY HOSPITAL ASSOCIATION PANA 2175622131 101 EAST NINTH STREET PANA IL 62557 KATRINA CASNER PRESIDENT & CEO 2175622131 2024-11-06 1 0 AMBER ROGNAN-HAMILTON P01251012 3149254300 2024-11-06 2023 2024-10-15 13:58:12Z KATRINA CASNER 101 EAST NINTH STREET PANA IL 62557 43938364 0 X WWW.PANAHOSPITAL.COM X 1966 IL TO BE A LEADING PARTNER IN ASSURING COMMUNITY-BASED QUALITY HEALTH CARE. 10 9 353 12 0 0 1612977 2818474 33834911 40375546 249817 569352 109818 146003 35807523 43909375 360 180 0 0 18048540 20719248 0 0 84515 15815675 17574307 33864575 38293735 1942948 5615640 51242193 57231881 11545908 11367565 39696285 45864316 X TO BE A LEADING PARTNER IN ASSURING COMMUNITY-BASED QUALITY HEALTH CARE. 0 0 28829096 180 40413752 TO PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF PANA, ILLINOIS AND THE SURROUNDING AREA. THESE SERVICES INCLUDE NURSING, EMERGENCY AND ANCILLARY SERVICES FOR 564 INPATIENT DAYS, 21,936 OUTPATIENT ADMISSIONS, 5,698 EMERGENCY VISITS AND 591 OUTPATIENT SURGICAL PATIENTS.WE PROMOTE A VISION STRIVING TO DEVELOP A COMPREHENSIVE SYSTEM OF HEALTHCARE SERVICES, IN PARTNERSHIP WITH THE OTHER COMMUNITY HEALTHCARE PROVIDERS, TO ASSIST OUR SERVICE AREA RESIDENTS IN REACHING THEIR PERSONAL MAXIMUM FOR HEALTH; TO PROVIDE PROGRAMS THAT PROMOTE HEALTH EDUCATION AND WELLNESS; TO ENHANCE OUR PERSONALIZED CARE CONCEPT IN THE PROVISION OF SERVICES TO OUR COMMUNITY; TO MAINTAIN AN ENVIRONMENT WHICH PROMOTES SATISFACTION AND OPPORTUNITY FOR THE PATIENT, THEIR FAMILY, THE EMPLOYEE, AND THE PHYSICIAN; TO MAINTAIN THE HOSPITAL'S ABILITY TO SUPPORT THE DELIVERY OF QUALITY HEALTH CARE AT A REASONABLE COST, IN ACCORDANCE WITH COMMUNITY NEEDS AND THE HEALTH CARE REGULATORY ENVIRONMENT; AND TO DEMONSTRATE BY ACTIONS AND RESULTS OUR COMMITMENT TO CONTINUOUS QUALITY IMPROVEMENT. 0 0 -38206 THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THE HOSPITAL PROVIDES 100% CHARITY CARE TO PATIENTS WHOSE INCOME LEVEL IS BELOW 200% OF THE FEDERAL POVERTY LEVEL. FOR PATIENTS WHOSE INCOME LEVEL IS BETWEEN 200% AND 300% OF THE FEDERAL POVERTY LEVEL, THE HOSPITAL PROVIDES 50% CHARITY CARE. THE HOSPITAL USES COST AS THE MEASUREMENT BASIS FOR CHARITY CARE DISCLOSURE PURPOSES WITH THE COST BEING IDENTIFIED AS THE DIRECT AND INDIRECT COSTS OF PROVIDING THE CHARITY CARE. CHARITY CARE INCLUDES THE AMOUNT OF COSTS FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. CHARITY CARE COST WAS DETERMINED ON THE APPLICATION OF THE ASSOCIATED COST-TO-CHARGE RATIOS. 28829096 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 22 0 353 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 1 0 IL X JAMES MOON CFO 2175622131 101 EAST NINTH STREET PANA IL 62557 SARAH MYER CHAIRMAN (TERM ENDED 4/23) 1.50 0.00 X X 0 0 0 CHARLES O'MALLEY VICE CHAIRMAN 1.50 0.00 X X 0 0 0 DAVE DORN JR CHAIRMAN 1.50 0.00 X X 0 0 0 DAVE SLATER DIRECTOR 1.50 0.00 X 0 0 0 JIM BREWER SECRETARY 1.50 0.00 X X 0 0 0 GREGORY HOLTHAUS DIRECTOR (TERM ENDED 4/23) 1.50 0.00 X 0 0 0 DR TERRY CUNNINGTON DIRECTOR, PHYSICIAN 40.00 0.00 X 393215 0 52131 KENNETH FLESCH DIRECTOR 1.50 0.00 X 0 0 0 REV LEON GOFF DIRECTOR 1.50 0.00 X 0 0 0 FRANK MCCHRISTY TREASURER 1.50 0.00 X X 0 0 0 JASON BAUER DIRECTOR 1.50 0.00 X 0 0 0 BRIAN BLODGETT II DIRECTOR 1.50 0.00 X 0 0 0 KATRINA CASNER PRESIDENT & CEO 40.00 1.50 X 239924 0 24574 JAMES MOON CFO 40.00 1.50 X 159114 0 28472 VICKIE COEN CCO & CNE, RN EXECUTIVE 20.00 0.00 X 90349 0 4657 DIANNE BAILEY CIO 40.00 0.00 X 112891 0 30931 PATRICK MCGUIRE CCO & CNE 40.00 0.00 X 157578 0 3815 ROBERT LUDWIG CRNA 40.00 0.00 X 261941 0 23738 DR MARLON MUNESES PHYSICIAN 40.00 1.50 X 291022 0 53493 DR CATHERINE TEODORO PHYSICIAN 40.00 0.00 X 188744 0 20593 MARC SCHOLES NURSE PRACTITIONER 40.00 0.00 X 188648 0 32607 MICHELLE GOODRICH PHARMACIST 40.00 0.00 X 148511 0 7428 2231937 0 282439 14 0 1 0 CROSSROADS EMERGENCY PHYSICIANS LLP PO BOX 677979 DALLAS TX 752677979 EMERGENCY PHYSICIANS 1437270 CERNER CORPORATION 2800 ROCK CREEK PARKWAY KANSAS CITY MO 64117 SOFTWARE HOSTING 839572 AIMS OF PANA LLC 8657 WEDGEWOOD DR BURR RIDGE IL 60527 EMERGENCY PHYSICIANS 732788 SPRINGFIELD CLINIC LLP 800 NORTH 1ST STREET SPRINGFIELD IL 62702 PHYSICIAN SERVICES 555925 DECATUR MEMORIAL HOSPITAL 701 N FIRST ST BOX 198 SPRINGFIELD IL 62781 PHYSICIAN SERVICES 411307 16 2796039 22435 2818474 PATIENT CARE SERVICES 621110 40162181 40162181 340B PHARMACY REVENUE 621110 120113 120113 OTHER OPERATING REVENUE 621110 93252 93252 40375546 595591 595591 76742 0 76742 76742 76742 2750 28989 -26239 -26239 -26239 CAFETERIA & VENDING 722514 73838 73838 LOSS FROM SOUTH CENTRAL HOSPITAL 621110 -4577 -4577 69261 43909375 40375546 0 715355 X 180 180 1297651 427532 870119 14491454 12512226 1920198 59030 416997 371776 43488 1733 3817068 3178098 620354 18616 696078 572919 120560 2599 34878 34878 92640 92640 11668 11668 5681523 5164930 516593 61598 61598 545244 316621 227316 1307 818411 658662 159749 543559 28977 514582 91398 91398 93058 49304 43754 258433 258433 2631531 2631531 374903 48852 326051 MEDICAL SUPPLIES 2676337 2676337 BAD DEBT EXPENSE 1785281 1785281 MCAID PROVIDER ASSESSME 676292 676292 FEES & LICENSES 344495 109413 235082 853058 160298 691530 1230 38293735 28829096 9380124 84515 1625 1625 13317152 17499979 3895427 4831856 174072 200000 574573 813483 205556 200908 44889043 18621723 27093813 26267320 3824897 5476250 291171 286593 207109 70950 1656798 1582917 51242193 57231881 4005441 3279141 6335165 6123219 648780 465660 556522 1499545 11545908 11367565 X 39696285 45864316 39696285 45864316 51242193 57231881 X 5615640 556188 -3797 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11668 11668 0 PART II-B, LINE 1: THE ORGANIZATION PARTICIPATES INDIRECTLY WITH LOBBYING ACTIVITIES THROUGH MEMBERSHIPS IN THE ILLINOIS HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. 131721 131721 32829757 12521599 20308158 2846510 1103277 1743233 9023810 4996847 4026963 57245 57245 26267320 457(B) PLAN LIABILITY 535656 LEASE LIABILITIES 528188 THIRD-PARTY PAYORS PAYABLE 435701 1499545 X PART X, LINE 2: AT DECEMBER 31, 2023 AND 2022, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED. PRESENTLY, THERE ARE NO ONGOING INCOME TAX AUDITS OR UNRESOLVED DISPUTES WITH THE TAX AUTHORITIES THAT THE ORGANIZATION CURRENTLY FILES OR HAS FILED WITH. 1 1 X 1 X 1 X 1 1 0 0 714498 0 714498 0.01870 7207196 6143047 1064149 0.02780 7921694 6143047 1778647 0.04650 52771 3860 48911 0.00130 167266 0 167266 0.00440 6044004 3892809 2151195 0.05620 6264041 3896669 2367372 0.06190 14185735 10039716 4146019 0.10840 1 1785282 1071169 11014719 11291820 -277101 X 1 0 1 1 PANA COMMUNITY HOSPITAL 101 EAST 9TH STREET PANA IL 62557 WWW.PANAHOSPITAL.COM 0001776 X X X X PANA COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X SEE PART V, PG.8 FOR URL X 1 22 1 SEE PART V, PG.8 FOR URL 0 1 X 200.000000000000 300.000000000000 X X 1 1 X X X X 1 X SEE NOTE ON THE FOLLOWING PAGES FOR FULL URL OF FAP X SEE NOTE ON FOLLOWING PAGES FOR FULL URL OF FAP APPLICATION X SEE NOTE ON FOLLOWING PAGES FOR FULL URL OF FAP PLAIN LANGUAGE SUMMARY X X X X X 1 X 0 X X X X 1 X 0 0 PANA COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: PCH CONSULTED THE CHRISTIAN COUNTY HEALTH DEPT. AND CONDUCTED COMMUNITY MEETINGS WHICH A DIVERSE BACKGROUND OF INDIVIDUALS COULD ATTEND. ALL OF THIS WAS DONE UNDER THE DIRECTION OF A CONSULTANT FROM THE ILLINOIS CRITICAL ACCESS HOSPTIAL NETWORK.DATA WAS ALSO GATHERED REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY. THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF, OR EXPERTISE IN PUBLIC HEALTH (LOCAL, REGIONAL, STATE AND/OR TRIBAL). MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS SERVED BY THE HOSPITAL OR INDIVIDUALS OR ORGANIZATIONS REPRESENTING THE INTERESTS OF SUCH POPULATIONS ALSO PROVIDED INPUT. PANA COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: PCH COLLABORATED WITH THE CHRISTIAN COUNTY HEALTH DEPT. IN CONDUCTING ITS CHNA. PANA COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: A) EXPAND ACCESS TO LOCAL MENTAL HEALTH SERVICES INCLUDING COUNSELING, PSYCHIATRY, AND PROFESSIONAL CONSULTATION, ESPECIALLY FOR UNINSURED AND UNDER-INSURED.ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS ACCESS TO MENTAL HEALTH SERVICES:1) ATTEMPT TO RECRUIT A LICENSED CLINICAL SOCIAL WORKER, A LICENSED CLINICAL PROFESSIONAL COUNSELOR, OR A PSYCHIATRIC ADVANCED PRACTICE NURSE TO PROVIDE SERVICES AT AN OUTPATIENT LOCATION2) EXPLORE TELEHEALTH ACCESS TO PSYCHIATRIST SUPPORT FOR THE CLINICIAN3) EXPLORE A MODEL FOR PROVIDING EXPANDED MENTAL HEALTH SERVICE TO UNINSURED AND UNDER-INSURED PERSONSB) ADDRESS HOMELESSNESS: THE HOSPITAL RECOGNIZES THE PRESENCE AND IMPACT OF HOMELESS PERSONS WITHIN ITS SERVICE AREA AND OFFERS APPROPRIATE CARE TO THOSE THAT PRESENT FOR SERVICES.ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE NEEDS OF HOMELESSNESS:1) CONTINUE TO PARTNER WITH COMMUNITY ORGANIZATIONS, LOCAL GOVERNMENTS AND AGENCIES, AND OTHER INTERESTED GROUPS AND PERSONS TO COLLABORATE TOWARD A COMMUNITY-WIDE STRATEGY TO ADDRESS LOCAL HOMELESSNESSC) IMPROVE ACCESS TO DAY CARE, ESPECIALLY FOR HEALTHCARE WORKFORCE.ACTIONS THE HOSPITAL INTENDS TO TAKE TO IMPROVE ACCESS TO DAY CARE:1) INVESTIGATE AND ANALYZE OPPORTUNITIES TO PROVIDE DAY CARE SERVICES TO EMPLOYEES OF PANA COMMUNITY HOSPITALD) EXPAND LOCAL PREVENTION EFFORTS AND SERVICES FOR SUBSTANCE ABUSE AND SUBSTANCE USE DISORDERS.ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS SUBSTANCE ABUSE AND SUBSTANCE USE DISORDERS:1) ATTEMPT TO RECRUIT A LICENSED CLINICAL SOCIAL WORKER, A LICENSED CLINICAL PROFESSIONAL COUNSELOR, OR A PSYCHIATRIC ADVANCED PRACTICE NURSE TO PROVIDE SERVICES AT AN OUTPATIENT LOCATION2) EXPLORE TELEHEALTH ACCESS TO PSYCHIATRIST SUPPORT FOR THE CLINICIAN3) SUPPORT COLLABORATIVE EFFORTS TO ADDRESS COMMUNITY NEEDS RELATED TO SUBSTANCE ABUSE AND SUBSTANCE USE DISORDERSE) EXPAND LOCAL AVAILABILITY OF IN-HOME CARE.ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS AVAILABILITY OF IN-HOME CARE:1) EXPLORE OPPORTUNITIES TO PROVIDE IN-HOME NURSING SERVICES PANA COMMUNITY HOSPITAL PART V, SECTION B, LINE 13B: THE COST OF THE SERVICE MAY IMPACT AN INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE. PRESUMPTIVE ELIGIBILITY FOR FREE CARE IS AVAILABLE FOR INDIVIDUALS WHO ARE HOMELESS, MENTALLY INCAPACITATED WITH NOBODY TO ACT ON THEIR BEHALF, MEDICAID ELIGIBLE (BUT NOT ON THE DATE OF SERVICE), FILING PERSONAL BANKRUPCTY, DECEASED WITH NO ESTATE, INCARCERATED IN A PENAL INSTITUTION, OR AFFILIATED WITH A RELIGIOUS ORDER AND TAKING A VOW OF POVERTY.BASED ON THE GUIDANCE FROM THE ILLINOIS ATTORNEY GENERAL'S OFFICE, PANA DETERMINES THE DISCOUNT PERCENT REQUIRED TO GIVE UNINSURED PATIENTS AT 300% OF FPG. THE SAME DISCOUNT IS GIVEN TO UNDERINSURED. PANA COMMUNITY HOSPITAL PART V, SECTION B, LINE 7A:URL FOR CHNA:HTTPS://PANAHOSPITAL.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-PLEASE NOTE THAT THIS URL IS CASE-SENSITIVE AND MUST BE ENTERED IN ALL LOWERCASE. PANA COMMUNITY HOSPITAL PART V, SECTION B, LINE 10A:URL FOR IMPLEMENTATION STRATEGY:HTTP://WWW.PANAHOSPITAL.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-PLEASE NOTE THAT THIS URL IS CASE-SENSITIVE AND MUST BE ENTERED IN ALL LOWERCASE. PANA COMMUNITY HOSPITAL PART V, SECTION B, LINE 16A:URL FOR FAP:HTTPS://PANAHOSPITAL.COM/PATIENTS-AND-VISITORS/PATIENTS-AND-VISITORS/PROFILE/FINANCIAL-ASSISTANCE PANA COMMUNITY HOSPITAL PART V, SECTION B, LINE 16B:URL FOR FAP APPLICATION:HTTPS://PANAHOSPITAL.COM/PATIENTS-AND-VISITORS/PATIENTS-AND-VISITORS/PROFILE/FINANCIAL-ASSISTANCE PANA COMMUNITY HOSPITAL PART V, SECTION B, LINE 16C:URL FOR FAP PLAIN LANGUAGE SUMMARY:HTTPS://PANAHOSPITAL.COM/PATIENTS-AND-VISITORS/PATIENTS-AND-VISITORS/PROFILE/FINANCIAL-ASSISTANCE 8 1 - COMMUNITY MEDICAL CLINIC OF PANA 101 EAST 9TH STREET PANA IL 62557 PHYSICIAN SATELLITE OFFICE 2 - QUAD COUNTY HOME HEALTH & HOSPICE 8 HUBER STREET PANA IL 62557 HOME HEALTH & HOSPICE AGENCY 3 - COMMUNITY MEDICAL CLINIC OF ASSUMPTION 118 N WALNUT STREET ASSUMPTION IL 62510 PHYSICIAN SATELLITE OFFICE 4 - COMMUNITY MEDICAL CLINIC OF RAMSEY 715 S SUPERIOR RAMSEY IL 62080 PHYSICIAN SATELLITE OFFICE 5 - COMMUNITY MEDICAL CLINIC OF NOKOMIS 120 CEDAR STREET NOKOMIS IL 62075 PHYSICIAN SATELLITE OFFICE 6 - PANA MEDICAL GROUP 217 SOUTH LOCUST STREET PANA IL 62557 PHYSICIAN SATELLITE OFFICE 7 - NOKOMIS MEDICAL GROUP 107 WEST STATE STREET NOKOMIS IL 62075 PHYSICIAN SATELLITE OFFICE 8 - COWDEN MEDICAL GROUP 209 E ELM STREET COWDEN IL 62422 PHYSICIAN SATELLITE OFFICE PART I, LINE 3C: ELGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON FAMILY INCOME COMPARED TO FEDERAL POVERTY GUIDELINES AS WELL AS SUBMISSION OF A COMPLETE FINANCIAL ASSISTANCE APPLICATION. HOWEVER, IN THE FOLLOWING INSTANCES, AN INDIVIDUAL MAY PRESUMPTIVELY QUALIFY FOR 100% FINANCIAL ASSISTANCE WITHOUT SUBMITTING A FINANCIAL ASSISTANCE APPLICATION AND REGARDLESS OF THEIR INCOME: ENROLLMENT IN CERTAIN FEDERAL OR STATE PROGRAMS (E.G. WIC, SUPPLEMENTAL NUTRITION AND ASSISTANCE PROGRAM, ILLINOIS FREE BREAKFAST/LUNCH PROGRAM, TEMPORARY ASSISTANCE FOR NEEDY FAMILIES, ETC.), HOMELESSNESS, MENTAL INCAPACITATION WITH NO ONE TO ACT ON THE PATIENT'S BEHALF, MEDICAID ELIGIBILITY, RECENT PERSONAL BANKRUPTCY, DECEASED WITH NO ESTATE, INCARCERATION IN A PENAL INSTITUTION, AND AFFILIATION WITH A RELIGIOUS ORDER AND A VOW OF POVERTY. PART I, LINE 7: FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. THE COSTS REPORTED IN THE TABLE IN PART I, LINE 7 USED A RATIO OF PATIENT CARE COSTS TO CHARGES AS COMPUTED IN WORKSHEET 2 OF THE FORM INSTRUCTIONS. THIS METHODOLOGY WAS USED FOR ALL PATIENT SEGMENTS. PART I, LN 7 COL(F): FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $1,785,282 REPORTED ON PART IX, LINE 24. HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. PART III, LINE 2: ACCOUNTS RECEIVABLE ARE REDUCTED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND BAD DEBT EXPENSE. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 3: THE BAD DEBT EXPENSE REPORTED ON LINE 2 REPRESENTS THE EXPENSE REPORTED ON THE ATTACHED FINANCIAL STATEMENTS BASED ON NET REALIZABLE AMOUNTS FROM THIRD PARTY PAYERS, PATIENTS AND OTHERS. BAD DEBT EXPENSE IS DETERMINED BASED ON THE CRITERIA DESCRIBED ABOVE. IT IS ESTIMATED THAT APPROXIMATELY 60% OF OUR BAD DEBT EXPENSE QUALIFIES UNDER THE ORGANIZATION'S CHARITY CARE POLICY. THIS PERCENTAGE WAS DETERMINED BASED UPON ANALYSIS OF DEMOGRAPHICS AND RECORD REVIEWS. PART III, LINE 4: SEE NOTE 9: NET PATIENT SERVICE REVENUE ON PAGES 23-17 OF THE AUDITED FINANCIAL STATEMENTS. ALSO, SEE NOTE 1: PATIENT ACCOUNTS RECEIVABLE ON PAGE 10 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE. LINE 6 COSTS WERE TAKEN DIRECTLY FROM THE ORGANIZATION'S 12/31/23 MEDICARE COST REPORT.THE SHORTFALL REPORTED IN PART III, LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT. BY PARTICIPATING IN MEDICARE AND ABSORBING RELATED SHORTFALLS, WE ARE PROVIDING HEALTHCARE SERVICES TO MEDICARE BENEFICIARIES WHO ARE A SIGNIFICANT PORTION OF OUR COMMUNITY. PART III, LINE 9B: THE COLLECTION PRACTICES FOLLOWED BY THE ORGANIZATION FOR PATIENTS WHO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE ADDRESSED IN ITS HEALTHCARE ASSISTANCE POLICY. PART VI, LINE 2: NEEDS ASSESSMENT. THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES THROUGH STRATEGIC PLANNING ACTIVITIES THAT INCORPORATE ANALYSIS OF SERVICE AREA DEMOGRAPHICS AND STRUCTURED AND CONSISTENT PATIENT SURVEY PROCESSES. THE ORGANIZATION ALSO ASSESSES COMMUNITY HEALTH NEEDS THROUGH INPUT FROM ITS ACTIVE AND CONSULTING MEDICAL STAFF, COMMUNITY LEADERS, ORGANIZATION BOARD MEMBERS AND COUNTY HEALTH DEPARTMENTS. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE. THE ORGANIZATION INFORMS AND EDUCATES ITS PATIENTS REGARDING ASSISTANCE FROM FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS THROUGH ITS SOCIAL SERVICES DIRECTOR. THE ORGANIZATION INFORMS AND EDUCATES PATIENTS REGARDING ASSISTANCE FROM ITS CHARITY CARE POLICY THROUGH DISCUSSION AT REGISTRATION OR DISCHARGE, AN INFORMATIONAL DOCUMENT SENT WITH BILLING STATEMENTS AND A DESCRIPTION OF THE PROGRAM PLUS AN APPLICATION POSTED ON ITS WEBSITE. PART VI, LINE 4: COMMUNITY INFORMATION. THE ORGANIZATION SERVES A RURAL AREA THAT INCLUDES 13 SMALL COMMUNITIES. THE POPULATION OF THE SERVICE AREA TOTALS APPROXIMATELY 21,000 RESIDENTS. APPROXIMATELY 17% ARE BELOW THE FEDERAL POVERTY LEVEL AND THE PER CAPITA INCOME IS APPROXIMATELY $20,100. OUR SERVICE AREA POPULATION CONSISTS OF 17.01% MEDICAID AND APPROXIMATELY 2.44% UNINSURED. OUR ORGANIZATION PROVIDES SERVICES TO FEDERALLY-DESIGNATED MEDICALLY UNDESERVED AREAS. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH IS ONE OF THE VERY IMPORTANT RESPONSIBILITIES OF A COMMUNITY HOSPITAL. THE HOSPITAL, AS AN ORGANIZATION, FILLS THE ROLE AS THE FOCAL POINT OF THE COMMUNITY'S HEALTHCARE ACTIVITIES AND THE CATALYST WHICH BRINGS TOGETHER THE PRACTICING PHYSICIANS, OTHER HEALTHCARE PROVIDERS, COMMUNITY HEALTHCARE AGENCIES, AND OTHER HEALTHCARE FOCUSED RESOURCES TO MAINTAIN AND PRESERVE THE COMMUNITY'S HEALTH STATUS. THE ORGANIZATION IS GOVERNED BY A VOLUNTEER BOARD OF DIRECTORS THAT CONSIST OF INDIVIDUALS WHO RESIDE IN THE HOSPITAL'S SERVICE AREA. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL PHYSICIANS IN OUR SERVICE AREA. SURPLUS FUNDS GENERATED THROUGH THE PROVISION OF SERVICES ARE INVESTED IN IMPROVED PATIENT CARE TECHNOLOGIES AND ENHANCED TREATMENT AREAS SO THAT THE ORGANIZATION CAN CONTINUE TO PROVIDE QUALITY PATIENT CARE. PART VI, LINE 6: NOT APPLICABLE X X X X X X 0 0 0 0 0 0 0 0 0 DR TERRY CUNNINGTON DIRECTOR, PHYSICIAN 273204 0 120011 0 0 0 10586 0 41545 0 445346 0 0 0 DR MARLON MUNESES PHYSICIAN 291022 0 0 0 0 0 11948 0 41545 0 344515 0 0 0 ROBERT LUDWIG CRNA 261941 0 0 0 0 0 12350 0 11388 0 285679 0 0 0 KATRINA CASNER PRESIDENT & CEO 212949 0 26975 0 0 0 13186 0 11388 0 264498 0 0 0 MARC SCHOLES NURSE PRACTITIONER 124690 0 63958 0 0 0 4271 0 28336 0 221255 0 0 0 DR CATHERINE TEODORO PHYSICIAN 184480 0 4264 0 0 0 9205 0 11388 0 209337 0 0 0 JAMES MOON CFO 153698 0 5416 0 0 0 7976 0 20496 0 187586 0 0 0 PATRICK MCGUIRE CCO & CNE 127578 0 30000 0 0 0 3815 0 0 0 161393 0 0 0 MICHELLE GOODRICH PHARMACIST 148511 0 0 0 0 0 4260 0 3168 0 155939 0 0 0 PART I, LINE 7 MARLON MUNESES, TERRY CUNNINGTON AND CATHERINE TEODORO ARE COMPENSATED USING A BASE SALARY PLUS PRODUCTIVITY COMPENSATION. THE PRODUCTIVITY COMPENSATION IS CALCULATED BASED UPON MINIMUM LEVELS OF RECEIPTS GENERATED BY EACH PHYSICIAN. BONUSES ARE BASED ON COLLECTIONS. A CERTAIN PORTION OF COLLECTIONS ARE SHARED WITH THE PHYSICIANS AFTER REACHING A MINIMUM THRESHOLD. AFTER REACHING THE THRESHOLD, AN INCREASING % IS SHARED AS COLLECTIONS INCREASE. A THE COUNTY OF CHRISTIAN ILLINOIS 376000560 2018-02-22 7000000 EXPANSION AND RENOVATION PROJECT 0 0 0 A 792018 7000000 7000000 2019 0 0 1 1 A 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: THE COUNTY OF CHRISTIAN, ILLINOIS DATE THE REBATE COMPUTATION WAS PERFORMED: 04/28/2023 DR LAURIE CUNNINGTON WIFE OF DR. TERRY CUNNINGTON, A BOARD MEMBER 27923 EMPLOYED BY HOSPITAL 0 ANDREW CASNER SON OF KATRINA CASNER, PRESIDENT & CEO 50441 EMPLOYED BY HOSPITAL 0 TIMOTHY CASNER HUSBAND OF KATRINA CASNER, PRESIDENT & CEO 52671 EMPLOYED BY HOSPITAL 0 FORM 990, PART VI, SECTION A, LINE 1A THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS AND ONE OTHER MEMBER OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE INTERIM BETWEEN THE REGULAR MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED ANY ACTION TAKEN SHALL NOT CONFLICT WITH THE POLICIES AND EXPRESS WISHES OF THE BOARD OF DIRECTORS AND THAT IT SHALL REFER ALL MATTERS OF MAJOR IMPORTANCE TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 PANA COMMUNITY HOSPITAL HAS TWO CLASSES OF MEMBERS, KNOWN AS REGULAR MEMBERS AND LIFE MEMBERS. REGULAR MEMBERS CONSIST OF INDIVIDUALS WHO PAY THE APPROPRIATE MEMBERSHIP DUES TO PANA COMMUNITY HOSPITAL. LIFE MEMBERS CONSIST OF INDIVIDUALS WHO CONTRIBUTE $5000.00 OR MORE TO PANA COMMUNITY HOSPITAL OR PANA COMMUNITY HOSPITAL FOUNDATION, FOR THE PURPOSE OF SUPPORTING THE FINANCING OF BUILDING, EQUIPMENT, LIFE MEMBERSHIP, ENDOWMENT, OR ANY OTHER LAWFUL PURPOSE. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OF THE HOSPITAL VOTE FOR THE MEMBERS OF THE GOVERNING BODY DURING THE HOSPITAL'S ANNUAL MEETING. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION CONTRACTS WITH A PUBLIC ACCOUNTING FIRM FOR THE PREPARATION OF THE FORM 990. THE RETURN IS PREPARED BASED ON INFORMATION PROVIDED BY FINANCIAL MANAGEMENT AND OTHERS WITHIN THE FOUNDATION. THE FORM 990 IS REVIEWED BY THE CFO PRIOR TO FILING WITH THE IRS. CFO PRESENTS A COPY OF FORM 990 TO THE GOVERNING BOARD FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS, MEMBERS OF THE MEDICAL STAFF, ADMINISTRATION AND DEPARTMENT MANAGERS ARE ASKED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNIARE ANNUALLY. THE HUMAN RESOURCES MANAGER REVIEWS QUESTIONNAIRES AND PRESENTS ANY CONFLICTS NOTED TO THE PRESIDENT & CEO TO REVIEW AND RESOLVE. IF ANY CONFLICTS ARE NOTED, THE PRESIDENT & CEO, WITH BOARD APPROVAL, IMPOSES APPROPRIATE RESTRICTIONS ON THE INDIVIDUAL(S) WITH A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 EACH YEAR THE BOARD OF DIRECTORS DETERMINES COMPENSATION FOR THE CEO, CCO/CNE AND THE CFO. THE BOARD USES COMPARATIVE COMPENSATION INFORMATION FROM THE ILLINOIS HOSPITAL ASSOCIATION TO DETERMINE THE ABOVE INDIVIDUALS' COMPENSATION. THIS PROCESS LAST TOOK PLACE IN 2023. FORM 990, PART VI, SECTION C, LINE 19 REQUESTS FOR THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY WILL BE EVALUATED ON A CASE-BY-CASE BASIS. IF DEEMED APPROPRIATE, THE DOCUMENT(S) WILL BE PROVIDED TO THE PUBLIC. THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS ARE AVAILABLE FOR THE PUBLIC TO REVIEW DURING THE ORGANIZATION'S ANNUAL MEETING. FORM 990, PART IX, LINE 11G IMAGING: PROGRAM SERVICE EXPENSES 330,550. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 330,550. EMERGENCY DEPARTMENT: PROGRAM SERVICE EXPENSES 2,004,459. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,004,459. LAB: PROGRAM SERVICE EXPENSES 139,810. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 139,810. OTHER: PROGRAM SERVICE EXPENSES 2,475,232. MANAGEMENT AND GENERAL EXPENSES 423,663. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,898,895. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 214,879. MANAGEMENT AND GENERAL EXPENSES 92,930. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 307,809. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF AFFILIATE - QUAD COUNTY -3,797. FORM 990, PART XII, LINE 2C NO CHANGE IN PROCESS FROM PRIOR YEARS PANA COMMUNITY HOSPITAL FOUNDATION 101 EAST 9TH STREET PANA IL 62557 371293506 FUNDRAISING IL 501(C)(3) LINE 12A, I PANA COMMUNITY HOSPITAL ASSOCIATION 1 SOUTH CENTRAL HOSPITAL ALLIANCE LLC 1 N OLD STATE CAPITOL PLAZA STE 200 SPRINGFIELD IL 62701 844250687 HOSPITAL ALLIANCE IL N/A RELATED -782 93533 0 1 0.25000 QUAD COUNTY HOME MEDICAL SUPPLIES & EQUIPMENT 8 HUBER STREET PANA IL 62557 371198049 EQUIPMENT RETAILER IL PANA COMMUNITY HOSPITAL C 93481 251399 1.00000 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 1 QUAD COUNTY HOME MEDICAL SUPPLIES & EQUIPMENT D 77342 GL PANA COMMUNITY HOSPITAL FOUNDATION C 2796039 AMT RECEIVED QUAD COUNTY HOME MEDICAL SUPPLIES & EQUIPMENT Q 229245 AMT PAID