HARRISBURG MEDICAL CENTER INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- HARRISBURG MEDICAL CENTER INC (EIN 23-7426289)
- Tax period
- 2021-07-01 to 2022-03-31
- Filed
- 2023-02-10
- IRS object ID
- 202330419349301813
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-02-10T13:43:43-06:00 | ReturnTs |
| Tax Period End | 2022-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 475 REGENCY PARK SUITE 175 | AddressLine1Txt |
| City | OFALLON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62269 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237426289 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HARRISBURG MEDICAL CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HARR | BusinessNameControlTxt |
| Phone | 6182537671 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DR WARREN TUTTLE DRIVE | AddressLine1Txt |
| City | HARRISBURG | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62946 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DONALD H HUTSON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6182537671 | PhoneNum |
| Signature | 2023-02-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | DONALD | PersonFirstNm |
| Person Last | HUTSON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JEFF PARKER | PreparerPersonNm |
| PTIN | P00970069 | PTIN |
| Phone | 6182331200 | PhoneNum |
| Preparation | 2023-02-07 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-03-07 01:45:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DONALD H HUTSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DR WARREN TUTTLE DRIVE | AddressLine1Txt |
| City | HARRISBURG | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62946 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $39,584,498 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.HARRISBURGMC.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1975 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | TO MAINTAIN AND IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 576 | TotalEmployeeCnt |
| Total Volunteers | 17 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $12,797,053 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,212,279 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $51,202,471 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $34,849,559 | CYProgramServiceRevenueAmt |
| PY Investment Income | $158,706 | PYInvestmentIncomeAmt |
| CY Investment Income | $64,066 | CYInvestmentIncomeAmt |
| PY Other Revenue | $204,718 | PYOtherRevenueAmt |
| CY Other Revenue | $71,921 | CYOtherRevenueAmt |
| PY Total Revenue | $64,362,948 | PYTotalRevenueAmt |
| CY Total Revenue | $39,197,825 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $30,889,993 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $24,060,963 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $26,824,795 | PYOtherExpensesAmt |
| CY Other Expenses | $24,378,619 | CYOtherExpensesAmt |
| PY Total Expenses | $57,714,788 | PYTotalExpensesAmt |
| CY Total Expenses | $48,439,582 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $6,648,160 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$9,241,757 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $53,080,348 | TotalAssetsBOYAmt |
| Total Assets EOY | $43,345,882 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $27,674,972 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $27,110,612 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $25,405,376 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,235,270 | NetAssetsOrFundBalancesEOYAmt |
| Mission | HARRISBURG MEDICAL CENTER AND SOUTHERN ILLINOIS HEALTHCARE IS DEDICATED TO IMPROVING THE HEALTH AND WELL-BEING OF ALL THE PEOPLE IN THE COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $29,629,957 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $26,876,647 | RevenueAmt |
| Desc | IN SUPPORT OF ITS MISSION, THE HOSPITAL PROVIDES CARE TO PATIENTS AT LESS THAN ITS ESTABLISHED CHARGES FOR PATIENTS THAT MEET THE HOSPITAL'S FINANCIAL ASSISTANCE CRITERIA. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE, THEY ARE NOT REPORTED IN NET PATIENT SERVICE REVENUE. CHARGES EXCLUDED FROM REVENUE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY (FAP) WERE APPROXIMATELY $1,630,000 FOR FISCAL YEAR 2022. IN ADDITION, THE HOSPITAL PROVIDES SERVICES TO OTHER MEDICALLY INDIGENT PATIENTS UNDER CERTAIN GOVERNMENT-REIMBURSED PUBLIC AID PROGRAMS. SUCH PROGRAMS PAY PROVIDERS AMOUNTS WHICH ARE LESS THAN ESTABLISHED CHARGES FOR THE SERVICES PROVIDED TO THE RECIPIENTS AND THE PAYMENTS ARE LESS THAN THE COST OF RENDERING CARE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $9,852,703 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $7,972,912 | RevenueAmt |
| Desc | MULBERRY CENTER AT HARRISBURG OFFERS PATIENT-CENTERED PSYCHIATRIC CARE IN AN ENVIRONMENT WHERE COMPREHENSIVE MEDICAL CARE IS AVAILABLE. THROUGH INTERACTIVE EXPERIENCES, PATIENTS LEARN TO BETTER UNDERSTAND THEIR SYMPTOMS AND LEARN HOW TO MANAGE THEM AFTER DISCHARGE. THE INPATIENT UNIT IS DIVIDED INTO TWO WINGS. ONE IS A GENERAL ADULT UNIT, HOUSING INDIVIDUALS WITH PSYCHIATRIC DISORDERS WHICH DO NOT INVOLVE DEMENTIA. THE SECOND WING IS A GEROPSYCHIATRIC UNIT WHICH TREATS PATIENTS WHOSE ILLNESS IS COMPLICATED BY DEMENTIA AND EMPHASIS IS PLACED ON MANAGING COGNITIVE DEFICITS ASSOCIATED WITH DEMENTIA. IN BOTH WINGS, PATIENTS RECEIVE SERVICES FROM A MULTI-DISCIPLINARY TEAM UNDER THE DIRECTION OF PSYCHIATRISTS. THE MULBERRY CENTER PROVIDES FOR 24/7 EMERGENCY ADMISSIONS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $39,482,660 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 52 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 576 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JUNE HAYES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6182537671 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DR WARREN TUTTLE DR | AddressLine1Txt |
| City | HARRISBURG | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62946 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| DENNIS MURPHY | ||||||||
| BOARD CHAIR | 4.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MICHAEL WILLIAMS | ||||||||
| SECRETARY/TREASURER | 4.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| LARRY JONES MD | ||||||||
| BOARD MEMBER (TERM ENDED 1/22) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BENNA DAUGHERTY | ||||||||
| BOARD MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL TISON | ||||||||
| BOARD MEMBER | 4.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MATT BUSINARO | ||||||||
| VICE CHAIR | 4.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KELLY PHELPS | ||||||||
| BOARD MEMBER (TERM ENDED 8/21) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ANGELA ROWE | ||||||||
| BOARD MEMBER | 2.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| GINA SIRACH | ||||||||
| BOARD MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JACQUELINE SCOTT | ||||||||
| BOARD MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MATT WINKELMAN | ||||||||
| BOARD MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| REX BUDDE | ||||||||
| PRESIDENT/CEO - SIH | 1.00 | 39.00 | Yes (X) | $0 | $2,396,463 | $48,546 | ||
| JOHN B MILLSTEAD | ||||||||
| SENIOR VP/COO - SIH | 1.00 | 39.00 | Yes (X) | $0 | $836,256 | $226,646 | ||
| DONALD HUTSON | ||||||||
| PRESIDENT/CEO, VP/ADMINISTRATOR | 40.00 | 0.50 | Yes (X) | $230,049 | $152,164 | $34,665 | ||
| LESLIE FERRELL | ||||||||
| FORMER VICE-PRESIDENT/CNO (TERM 6/21) | 40.00 | 0.00 | Yes (X) | $103,548 | $0 | $7,923 | ||
| THERESA JUNE HAYES | ||||||||
| VICE-PRESIDENT/CFO, FINANCE DIRECTOR | 40.00 | 0.50 | Yes (X) | $204,250 | $0 | $12,599 | ||
| JAMES ALEXANDER | ||||||||
| VICE-PRESIDENT/CMO | 40.00 | 0.00 | Yes (X) | $682,212 | $0 | $14,809 | ||
| MARIE GORSKI | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $279,346 | $0 | $2,756 | Yes (X) | ||
| CLAYTON FORD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $431,615 | $0 | $18,127 | Yes (X) | ||
| ANDREA MILLER | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $262,935 | $0 | $23,059 | Yes (X) | ||
| THOMAS BUTLER | ||||||||
| CRNA | 36.00 | 0.00 | $286,834 | $0 | $12,363 | Yes (X) | ||
| JASON VALLETTE | ||||||||
| CRNA | 40.00 | 0.00 | $267,804 | $0 | $36,601 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,748,593 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,384,883 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $438,094 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 34 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SOUTHERN ILLINOIS PSYCHIATRY LLC | |||||
| 112 AIRWAY DR | MARION | IL | 62959 | CONTRACTED PHYSICIANS AND OTHER STAFF | $1,712,279 |
| STATERA HEALTHCARE LLC | |||||
| 2250 N ILLINOIS AVE | CARBONDALE | IL | 62902 | CONTRACTED PHYSICIANS AND OTHER STAFF | $1,467,422 |
| TRINITY MEDICAL STAFFING LLC | |||||
| 2250 N ILLINOIS AVE | CARBONDALE | IL | 62902 | CONTRACTED PHYSICIANS AND OTHER STAFF | $1,258,268 |
| AB STAFFING SOLUTIONS LLC | |||||
| 3451 S MERCY ROAD SUITE 102 | GILBERT | AZ | 85297 | CONTRACTED PHYSICIANS AND OTHER STAFF | $546,388 |
| POLSINELLI PC | |||||
| 900 W 48TH PLACE SUITE 900 | KANSAS CITY | MO | 64112 | LEGAL SERVICES | $299,988 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 13 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $4,212,279 | GovernmentGrantsAmt |
| Total Contributions | $4,212,279 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 624110 | $34,780,292 | $34,780,292 |
| RENT REVENUE | 624100 | $69,267 | $69,267 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $34,849,559 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $49,520 | TotalRevenueColumnAmt |
| Exclusion | $49,520 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $401,219 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $386,673 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $14,546 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,546 | TotalRevenueColumnAmt |
| Exclusion | $14,546 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA REVENUE | 624110 | $46,602 | $46,602 |
| OTHER REVENUE | 624100 | $21,656 | $21,656 |
| COIN MACHINES & TV | 624100 | $3,350 | $3,350 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $313 | TotalRevenueColumnAmt |
| Exclusion | $313 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $71,921 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,197,825 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $34,849,559 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $135,987 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,269,554 | TotalAmt |
| Management And General | $1,269,554 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,223,346 | TotalAmt |
| Program Services | $15,279,347 | ProgramServicesAmt |
| Management And General | $1,943,999 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $491,616 | TotalAmt |
| Program Services | $394,824 | ProgramServicesAmt |
| Management And General | $96,792 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,822,521 | TotalAmt |
| Program Services | $3,066,406 | ProgramServicesAmt |
| Management And General | $756,115 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,253,926 | TotalAmt |
| Program Services | $1,007,046 | ProgramServicesAmt |
| Management And General | $246,880 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $299,988 | TotalAmt |
| Management And General | $299,988 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $116,192 | TotalAmt |
| Management And General | $116,192 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,727 | TotalAmt |
| Management And General | $15,727 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,417,729 | TotalAmt |
| Program Services | $7,928,533 | ProgramServicesAmt |
| Management And General | $1,489,196 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $146,360 | TotalAmt |
| Management And General | $146,360 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,155,376 | TotalAmt |
| Program Services | $3,302,713 | ProgramServicesAmt |
| Management And General | $852,663 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $540,235 | TotalAmt |
| Program Services | $492,061 | ProgramServicesAmt |
| Management And General | $48,174 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,775 | TotalAmt |
| Program Services | $77,955 | ProgramServicesAmt |
| Management And General | $2,820 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,838 | TotalAmt |
| Program Services | $23,930 | ProgramServicesAmt |
| Management And General | $6,908 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $428,825 | TotalAmt |
| Program Services | $372,792 | ProgramServicesAmt |
| Management And General | $56,033 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,068,170 | TotalAmt |
| Program Services | $2,068,170 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $534,158 | TotalAmt |
| Program Services | $464,362 | ProgramServicesAmt |
| Management And General | $69,796 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PHARMACY SUPPLIES | $2,384,757 | $2,384,757 | |
| BAD DEBT EXPENSE | $1,862,536 | $1,862,536 | |
| MEDICAL SUPPLIES | $1,557,338 | $284,293 | $1,273,045 |
| LOSS ON REACQUISITION | $292,348 | $292,348 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $447,267 | TotalAmt |
| Program Services | $180,587 | ProgramServicesAmt |
| Management And General | $266,680 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,439,582 | TotalAmt |
| Program Services | $39,482,660 | ProgramServicesAmt |
| Management And General | $8,956,922 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $823,645 | BOYAmt |
| EOY | $502,460 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,067,728 | BOYAmt |
| EOY | $7,191,728 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $360,586 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,493,164 | BOYAmt |
| EOY | $6,518,533 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,642 | BOYAmt |
| EOY | $46,259 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,609,933 | BOYAmt |
| EOY | $1,392,714 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $822,394 | BOYAmt |
| EOY | $625,176 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $58,347,019 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $33,383,852 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,508,113 | BOYAmt |
| EOY | $24,963,167 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,684,511 | BOYAmt |
| EOY | $1,744,281 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,218 | BOYAmt |
| EOY | $978 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,080,348 | BOYAmt |
| EOY | $43,345,882 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,194,320 | BOYAmt |
| EOY | $5,880,884 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $497,846 | BOYAmt |
| EOY | $150,400 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,034,183 | BOYAmt |
| EOY | $18,052,288 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $948,623 | BOYAmt |
| EOY | $717,905 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,674,398 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $634,737 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,674,972 | BOYAmt |
| EOY | $27,110,612 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,405,376 | BOYAmt |
| EOY | $16,235,270 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,405,376 | BOYAmt |
| EOY | $16,235,270 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,080,348 | BOYAmt |
| EOY | $43,345,882 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$9,241,757 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $71,651 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $15,727 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $15,727 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL PAYS MEMBERSHIP DUES TO THE ILLINOIS HEALTH AND HOSPITAL ASSOCIATION (IHA) AND THE AMERICAN HOSPITAL ASSOCIATION (AHA), A PERCENTAGE OF THESE DUES IS SPENT ON LOBBYING ACTIVITIES BY THESE ASSOCIATIONS. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $772,443 | OtherCostOrOtherBasisAmt |
| Book Value | $772,443 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $38,242,567 | OtherCostOrOtherBasisAmt |
| Depreciation | $18,319,983 | DepreciationAmt |
| Book Value | $19,922,584 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $667,589 | OtherCostOrOtherBasisAmt |
| Depreciation | $532,903 | DepreciationAmt |
| Book Value | $134,686 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,559,713 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,530,966 | DepreciationAmt |
| Book Value | $4,028,747 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $104,707 | OtherCostOrOtherBasisAmt |
| Book Value | $104,707 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $24,963,167 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO RELATED PARTY | Desc |
| Amt | $634,737 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $634,737 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | TAX POSITIONS TAKEN ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE-LIKELY-THAN-NOT" RECOGNITION THESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THERE WERE NO UNCERTAIN TAX BENEFITS IDENTIFIED AND RECORDED AT MARCH 31, 2022. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $538,738 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $538,738 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01160 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,001,418 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,183,743 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,817,675 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12490 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,540,156 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,183,743 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,356,413 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13650 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,540,156 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,183,743 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,356,413 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13650 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,862,536 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $620,845 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $10,152,161 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $14,026,398 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$3,874,237 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HARRISBURG MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DR WARREN TUTTLE DRIVE | AddressLine1Txt |
| City | HARRISBURG | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62946 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.HARRISBURGMC.COM | WebsiteAddressTxt |
| State License | 521 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HARRISBURG MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, PAGE 8, SECTION C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, PAGE 8, SECTION C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, PAGE 8, SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, PAGE 8, SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, PAGE 8, SECTION C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| HARRISBURG MEDICAL CENTER | PART V, SECTION B, LINE 5: THE CHNA AND DEVELOPMENT OF ITS IMPLEMENTATION PLAN IS A WAY FOR THE HOSPITAL'S CORPORATE MEMBER, SOUTHERN ILLINOIS HOSPITAL SERVICES (SIH), AND COMMUNITY PARTNERS TO WORK COLLABORATIVELY TO IMPROVE THE HEALTH AND WELL-BEING OF ALL THE PEOPLE IN THE COMMUNITIES SERVED. SIH COLLABORATED WITH INDIVIDUALS FROM THE ELEVEN COUNTIES (FRANKLIN, JACKSON, JOHNSON, PERRY, SALINE, UNION, WILLIAMSON, WHITE, GALLATIN, POPE, AND HARDIN) TO CONDUCT THE ASSESSMENT. APPROXIMATELY 781 PEOPLE ACROSS THE ELEVEN COUNTIES PROVIDED INPUT INTO THIS PROCESS THROUGH THE FOLLOWING METHODS: 1) COMMUNITY MEMBER & COMMUNITY PARTNER SURVEY 637 SURVEY RESPONDENTS; 2) PHYSICIAN & HEALTHCARE PROVIDER/LEADER SURVEY 17 PEOPLE PARTICIPATED, INCLUDING VARIOUS PHYSICIANS AND KEY LEADERS WITHIN THE SIH HEALTHCARE SYSTEM; 3) SIH CHNA ADVISORY TEAM THE 53-MEMBER TEAM REVIEWED THE DATA, PROVIDED INPUT AND SHARED THEIR PERCEPTIONS OF OVERALL IMPACT, MAGNITUDE OF THE PROBLEM, SEVERITY, AND ABILITY AND INTEREST OF THE COMMUNITY TO ADDRESS THE ISSUES, AND VOTED ON THE TOP PRIORITY HEALTH ISSUES. |
| HARRISBURG MEDICAL CENTER | PART V, SECTION B, LINE 11: THE MOST RECENTLY CONDUCTED CHNA WAS COMPLETED IN MARCH 2022 FOR WHICH AN IMPLEMENTATION STRATEGY WAS DEVELOPED FOR THE NEXT THREE YEARS BEGINNING APRIL 1, 2022. THE INFORMATION BELOW DESCRIBES HOW THE HOSPITAL IS ADDRESSING THE NEEDS IDENTIFIED IN THE MOST RECENT CHNA. THREE IMPLEMENTATION PLAN TEAMS WERE DEVELOPED IN ORDER TO BRING EXPERTS TOGETHER WITH EXPERTISE AND INTEREST IN EACH OF THE CHOSEN AREAS. KEY ISSUES AND NEEDS WERE IDENTIFIED AND INTERVENTION STRATEGIES WERE DEVELOPED. THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN WAS REVIEWED AND ADOPTED BY THE SIH BOARD OF TRUSTEES IN MARCH 2022. THE PRIORITY AREAS THROUGH THIS NEEDS ASSESSMENT WILL BE USED TO FOCUS COMMUNITY BENEFITS DEPARTMENT PLANNING FOR THE NEXT THREE YEARS. THE PRIORITY HEALTH ISSUES THAT THE FOUR HOSPITALS WILL ADDRESS FROM 2022 - 2025 ARE: SOCIAL DETERMINANTS OF HEALTH (ACCESS TO CARE, HUNGER/FOOD ACCESS, HOUSING, AND POVERTY), BEHAVIORAL HEALTH (MENTAL HEALTH AND SUBSTANCE MISUSE), AND CHRONIC DISEASE PREVENTION AND MANAGEMENT. FOR EACH HEALTH PRIORITY, STAFF WILL CONDUCT EVALUATION EFFORTS TO DEMONSTRATE IMPACT OF THE RELATED STRATEGIES AND ACTIVITIES. THESE PLANS WILL INCLUDE SPECIFIC DATA SOURCES SUCH AS PROGRAM RECORDS, HOSPITAL PATIENT DATA, AND/OR COMMUNITY-LEVEL DATA SUCH AS THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). MEASURES MAY INCLUDE (BUT NOT LIMITED TO): COMMUNITY INDICATORS, PARTNERS, FUNDING, AND PROGRAMMATIC OUTCOMES VIA PROGRAM RECORDS). DATA WILL BE REVIEWED BY THE SIH COMMUNITY BENEFITS ADVISORY COMMITTEE TO BE REPORTED AT APPROPRIATE INTERVALS. |
| HARRISBURG MEDICAL CENTER | PART V, SECTION B, LINE 13H: IF A PATIENT MEETS CERTAIN PRESUMPTIVE ELIGIBILITY CRITERIA, THE PATIENT SHALL NOT BE REQUIRED TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION AND SHALL BE DEEMED TO RECEIVE A 100% ALLOWANCE. PRESUMPTIVE ELIGIBILITY CATEGORIES ARE: 1) HOMELESSNESS, DEFINED AS AN INDIVIDUAL WITHOUT PERMANENT HOUSING WHO MAY LIVE ON THE STREETS, STAY IN A SHELTER, MISSION, SINGLE ROOM OCCUPANCY FACILITIES, ABANDONED BUILDING OR VEHICLE, OR IN ANY OTHER UNSTABLE OR NON-PERMANENT SITUATION; 2) DECEASED WITH NO ESTATE; 3) MENTAL INCAPACITATION WITH NO REPRESENTATIVE; 4) MEDICAID ELIGIBLE BUT NOT ON DATE OF SERVICE; 5) MEDICAID ELIGIBLE ON DATE OF SERVICE, BUT THE SERVICE IS NON-COVERED, AND 6) INCARCERATION IN A PENAL INSTITUTION. |
| SCHEDULE H, PART V, SECTION B, LINE 16A | THE FAP WAS WIDELY AVAILABLE AT:HTTPS://HARRISBURGMC.COM/WP-CONTENT/UPLOADS/2022/12/HEALTHCARE-ASSISTANCE-PROGRAM-AND-PRESUMPTIVE-HB-PI-003.PDF |
| SCHEDULE H, PART V, SECTION B, LINE 16B | THE FAP APPLICATION WAS WIDELY AVAILABLE AT:HTTPS://HARRISBURGMC.COM/WP-CONTENT/UPLOADS/2022/12/HEALTHCARE-ASSISTANCE-PROGRAM_12082022.PDF |
| SCHEDULE H, PART V, SECTION B, LINE 16C | THE FAP PLAIN LANGUAGE SUMMARY WAS WIDELY AVAILABLE AT:HTTPS://HARRISBURGMC.COM/WP-CONTENT/UPLOADS/2022/12/HEALTHCARE-ASSISTANCE-PROGRAM_12082022.PDF |
| SCHEDULE H, PART V, SECTION B, LINE 7A | THE ORGANIZATION'S MOST RECENT CHNA REPORT CAN BE FOUND AT:HTTPS://HARRISBURGMC.COM/WP-CONTENT/UPLOADS/2022/03/2021-JOINT-COMMUNITY-HEALTH-NEEDS-ASSESSMENT.PDF |
| SCHEDULE H, PART V, SECTION B, LINE 10A | THE ORGANIZATION'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND AT:HTTPS://HARRISBURGMC.COM/WP-CONTENT/UPLOADS/2022/03/2021-JOINT-IMPLEMENTATION-PLAN.PDF |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 6 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - HMC CLINIC AT HARRISBURG | ||||
| 901 S COMMERCIAL | HARRISBURG | IL | 62946 | PROVIDER BASED RURAL HEALTH CLINIC |
| 2 - ELDORADO PRIMARY CARE | ||||
| 1007 US HIGHWAY 45 | ELDORADO | IL | 62930 | PROVIDER BASED RURAL HEALTH CLINIC |
| 3 - HMC CLINIC AT MARION | ||||
| 3106 OUTER DRIVE | MARION | IL | 62959 | PROVIDER BASED RURAL HEALTH CLINIC |
| 4 - MACH MINE CLINIC | ||||
| 16468 LIBERTY SCHOOL ROAD | MARION | IL | 62959 | PRIMARY CARE CLINIC |
| 5 - VIKING MINE CLINIC | ||||
| 13643 NORTH THOMPSONVILLE ROAD | MACEDONIA | IL | 62860 | PRIMARY CARE CLINIC |
| 6 - HMC SURGICAL SERVICES CLINIC | ||||
| 50 DR WARREN TUTTLE DRIVE | HARRISBURG | IL | 62946 | SURGICAL MEDICINE CLINIC |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | FACTORS OTHER THAN FEDERAL POVERTY GUIDELINES (FPG) USED TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE INCLUDE A) HOMELESSNESS, B) DECEASED WITH NO ESTATE, C) MENTAL INCAPACITATION WITH NO REPRESENTATIVE, D) MEDICAID ELIGIBLE BUT NOT ON DATE OF SERVICE, E) MEDICAID ELIGIBLE ON DATE OF SERVICE BUT SERVICE IS NON-COVERED, AND F) INCARCERATION IN A PENAL INSTITUTION. THESE FACTORS ARE DESCRIBED UNDER THE HOSPITAL'S PRESUMPTIVE ELIGIBILITY RULES FOR FINANCIAL ASSISTANCE. THE HOSPITAL DOES NOT USE AN ASSET TEST AS A FACTOR IN DETERMINING ELIGIBILITY. |
| PART I, LINE 7: | THE ORGANIZATION USED A COST-TO-CHARGE RATIO AS CALCULATED UTILIZING DATA FROM INTERNAL ACCOUNTING RECORDS AND USING A METHODOLOGY CONSISTENT WITH SCHEDULE H INSTRUCTIONS TO DETERMINE AMOUNTS ON LINES 7A AND 7B OF PART I SCHEDULE H. |
| 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 $ 1,862,536. |
| PART III, LINE 2: | THE HOSPITAL CALCULATED BAD DEBT EXPENSE AT COST USING THE COST-TO-CHARGE RATIO, AS CALCULATED USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT ONLY AFTER ALL COLLECTION PROCEDURES HAVE BEEN EXHAUSTED AND AFTER ALL DISCOUNTS AND PAYMENTS HAVE BEEN APPLIED. |
| PART III, LINE 3: | BASED ON THE HOSPITAL'S EXPERIENCE WITH ALL ITS PATIENTS, THE ORGANIZATION ESTIMATES THAT IT IS LIKELY THAT UP TO ONE-THIRD OF ACCOUNTS WRITTEN OFF TO BAD DEBT MAY HAVE QUALIFIED FOR FINANCIAL ASSISTANCE, BUT THE PATIENT CHOSE NOT TO APPLY. THEREFORE, 33.333% OF THE BAD DEBT ADJUSTMENTS ARE INCLUDED ON PART III, LINE 3 AT COST. |
| PART III, LINE 4: | THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE CAN BE FOUND ON PAGE 12 OF SOUTHERN ILLINOIS HEALTHCARE ENTERPRISES, INC CONSOLIDATED FINANCIAL REPORT WITH SUPPLEMENTARY INFORMATION MARCH 31, 2022, AND 2021. |
| PART III, LINE 8: | UNPAID COST OF MEDICARE REPRESENTS THE COST (DETERMINED USING THE OVERALL COST TO CHARGE RATIO) OF PROVIDING SERVICES TO PRIMARILY ELDERLY BENEFICIARIES OF THE MEDICARE PROGRAM, IN EXCESS OF PAYMENTS FOR THOSE SERVICES. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. |
| PART III, LINE 9B: | THE HOSPITAL'S COLLECTION POLICY AND FINANCIAL ASSISTANCE POLICY (FAP) CONTAIN PROVISIONS FOR COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO BE ELIGIBLE FOR FINANCIAL ASSISTANT. THESE PRACTICES ALSO APPLY BROADLY TO ALL TYPES OF PATIENTS. HOSPITAL WILL PROVIDE PATIENTS WITH A PLAIN LANGUAGE SUMMARY OF THE FAP. HOSPITAL WILL MAKE A REASONABLE EFFORT TO ORALLY NOTIFY THE INDIVIDUAL ABOUT THE FAP AND ABOUT HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FAP APPLICATION. IF HOSPITAL DETERMINES THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE, HOSPITAL WILL A) PROVIDE THE INDIVIDUAL WITH A BILLING STATEMENT THAT INDICATES THE AMOUNT HE OR SHE OWES FOR THE CARE RECEIVED, ASSUMING THE INDIVIDUAL IS ELIGIBLE FOR ASSISTANCE OTHER THAN FREE CARE AND HOW THAT AMOUNT WAS DETERMINED, B) REFUND TO THE INDIVIDUAL ANY AMOUNT HE OR SHE HAS PAID THAT EXCEEDS THE AMOUNT THE INDIVIDUAL IS DETERMINED TO BE PERSONALLY RESPONSIBLE FOR PAYING, C) TAKE ALL REASONABLE AVAILABLE MEASURES TO REVERSE ANY EXTRAORDINARY COLLECTION ACTIONS ("ECAS") TAKEN AGAINST THE INDIVIDUAL. FOR ALL TYPES OF PATIENTS, HOSPITAL TAKES THE FOLLOWING ACTIONS AT LEAST 30 DAYS BEFORE INITIATING ECA TO OBTAIN PAYMENT FOR CARE: A) PROVIDE THE INDIVIDUAL WITH A WRITTEN NOTICE THAT INDICATES FINANCIAL ASSISTANCE IS AVAILABLE FOR ELIGIBLE INDIVIDUALS, B) IDENTIFIES THE ECA(S) THAT HOSPITAL (OR OTHER AUTHORIZED PARTY) INTENDS TO INITIATE TO OBTAIN PAYMENT FOR THE CARE AND C) STATES A DEADLINE AFTER WHICH SUCH ECAS MAY BE INITIATED THAT IS NO EARLIER THAN 30 DAYS AFTER THE DATE THAT THE WRITTEN NOTICE IS PROVIDED. |
| PART VI, LINE 2: | THE HOSPITAL ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY AND THEY MIGHT BE ADDRESSED BY PARTICIPATING IN STRATEGIC AND OPERATIONAL PLANNING SESSIONS THAT INCLUDE THE BOARD OF DIRECTORS, STATE LEGISLATORS, OFFICIALS FROM THE LOCAL COMMUNITY COLLEGE AND LOCAL CLERGY. THE CEO PARTICIPATES IN STRATEGIC PLANNING MEETINGS WITH LEADERSHIP OF HOSPITAL'S CORPORATE MEMBER. HOSPITAL LEADERSHIP MEETS WITH LEADERSHIP FROM LOCAL HEALTH DEPARTMENTS, AREA HOSPITALS, AREA LONG TERM CARE FACILITIES AND EMERGENCY PLANNERS ON AN ONGOING BASIS. THE PRESIDENT OF THE MEDICAL STAFF MEETS REGULARLY WITH PRIMARY BEHAVIORAL HEALTH CLINIC LEADERS AS WELL AS REPRESENTATIVES FROM COMMUNITY BEHAVIORAL HEALTH AND SUPPORT ORGANIZATIONS TO ASCERTAIN NEEDS AND ASSESS MEETING OF THE NEEDS. HOSPITAL DATA IS REVIEWED TO DETERMINE PATIENTS' NEEDS BY ANALYZING DIAGNOSIS, READMISSION RATES AND THE MEDICARE CASE MIX INDEX. THE HOSPITAL PARTICIPATES IN REGIONAL HAZARD ASSESSMENTS AND DRILLS. |
| PART VI, LINE 3: | ALL PATIENTS WITHOUT THIRD PARTY COVERAGE, I.E., CONSIDERED "SELF-PAY", RECEIVE A COPY OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM (FAP) PLAIN LANGUAGE SUMMARY DURING REGISTRATION THAT DETAILS THE FAP. HOSPITAL PATIENT BILLING STATEMENTS INCLUDE A STATEMENT EXPLAINING HOW A PATIENT MAY APPLY FOR CONDSIDERATION UNDER THE HOSPITAL'S FAP. SIGNAGE IS DISPLAYED IN REGISTRATION, PATIENT CARE, AND BUSINESS OFFICE AREAS THAT ANNOUNCES FINANCIAL HELP WITH BILLS FOR THOSE PATIENTS WHO QUALIFY. IF A PATIENT CONTACTS THE BUSINESS OFFICE REGARDING DIFFICULTY IN MAKING PAYMENTS, HOSPITAL PERSONNEL INFORMS THE PATIENT OF THE FAP. ONE FULL-TIME FINANCIAL COUNSELOR ASSISTS THE HOSPITAL'S PATIENTS IN APPLYING FOR GOVERNMENT FUNDED MEDICAL COVERAGE. |
| PART VI, LINE 4: | WHILE EACH OF THE ELEVEN COUNTIES IN THE HOSPITAL SYSTEM SERVICE AREA IS UNIQUE, ALL SHARE SIMILAR CHALLENGES. ALL HAVE ISOLATED HOUSEHOLDS, RESIDENTS WITH LOW INCOME AND LOW EDUCATIONAL LEVELS, AND HIGH RATES OF POVERTY, ILLNESS, AND MORTALITY. ALL HAVE A LARGE NUMBER OF MEDICALLY UNDERSERVED RESIDENTS. IN GENERAL, SOUTHERN ILLINOIS RESIDENTS ARE MORE PRONE TO HAVE HIGHER BMI, HIGHER BLOOD PRESSURE, INCREASED RISK FOR DIABETES AND ARE MORE APT TO SMOKE AND BE SEDENTARY THAN ALL OTHER ILLINOISANS. IMPROVEMENTS ARE NEEDED IN AREAS SUCH AS PREVENTATIVE SCREENINGS, HEALTHY EATING, AND PHYSICAL ACTIVITY. RESIDENTS FACE CONSIDERABLE BARRIERS TO ACCESS, DEMONSTRATED BY UNMET OR MISSED PRIMARY CARE APPOINTMENTS AND HIGH EMERGENCY DEPARTMENT UTILIZATION. UNEMPLOYMENT, POVERTY, FOOD INSECURITY, ACCESS TO CARE AND LACK OF TRANSPORTATION SERVE AS BARRIERS TO HEALTH AND HEALTHCARE.HARRISBURG MEDICAL CENTER PREDOMINATELY SERVES A FIVE-COUNTY AREA INCLUDING SALINE, GALLATIN, HARDIN, POPE, AND WHITE COUNTIES. EACH OF THE COUNTIES IS FEDERALLY DESIGNATED AS A MEDICALLY UNDERSERVED AREA. THE POPULATION OF THE FIVE COUNTIES IS APPROXIMATELY 50,000 AND THE POPULATION HAS SHOWN A DECLINING TREND FOR AT LEAST THE PAST TWENTY YEARS. APPROXIMATELY 17% OF THE POPULATION IS 65 YEARS OLD OR OLDER AS COMPARED TO 12% OF ALL ILLINOISANS. EIGHTY-SEVEN PERCENT OF THE POPULATION HAVE A HIGH SCHOOL DIPLOMA WHILE ONLY 16% OF THE POPULATION OVER 25 YEARS OLD HAVE EARNED A BACHELOR'S DEGREE OR HIGHER. INCOME PER CAPITAL IS $26,500 FOR THE POPULATION WHICH IS 26% LESS THAN THE INCOME PER CAPITAL OF THE STATE OF ILLINOIS AND 22% LESS THAN OF THE U.S. THE PERCENTAGE OF INDIVIDUALS IN THIS AREA LIVING IN POVERTY EXCEEDS THE PERCENTAGE FOR THE STATE OF ILLINOIS AND FOR THE UNITED STATES OF AMERICA. THIRTY-TWO PERCENT OF THE SERVICE AREA RECEIVES MEDICAID AS COMPARED TO 21% OF ILLINOISANS AND 22% OF THE U.S. POPULATION. FIFTY-NINE PERCENT OF CHILDREN LIVING IN THE 5-COUNTY SERVICE AREA ARE ELIGIBLE FOR FREE OR REDUCED-PRICE SCHOOL LUNCHES. |
| PART VI, LINE 5: | HMC IS PASSIONATE ABOUT THE HEALTH AND WELL-BEING OF THE COMMUNITIES SERVED. HMC PARTICIPATES IN MANY COMMUNITY EVENTS TO PROMOTE THE HEALTH AND WELL-BEING OF THE COMMUNITY. COVID-19 SAFETY PRECAUTIONS HAVE PREVENTED THE HOSPITAL FROM HOLDING MOST OF THE COMMUNITY EVENTS NORMALLY HELD, BUT WE HAVE FOUND WAYS TO SUPPORT AND PROVIDE OUTREACH FOR OUR COMMUNITY. HMC PARTICIPATES IN MANY COMMUNITY ORGANIZATIONS EVENTS TO PROMOTE HEALTH SUCH AS HEALTH FAIRS AT THE COMMUNITY COLLEGE, LOCAL PARADES, SALINE COUNTY CHAMBER OF COMMERCE, SALINE COUNTY CHAMBER GOLF TOURNAMENT.THE HOSPITAL ACTIVELY SUPPORTS AND WORKS WITH OTHER HEALTH-RELATED ORGANIZATIONS SUCH AS HOSPICE OF SOUTHERN ILLINOIS AND EGYPTIAN HEALTH DEPARTMENT, AS WELL AS OTHER AREA HOSPITALS, AND NURSING HOMES. HMC HOSTS SEMI-ANNUAL BLOOD DRIVES FOR THE AMERICAN RED CROSS AT THE HOSPITAL. DURING THE COVID-19 PANDEMIC, THE HOSPITAL AND CLINICS HAVE SUPPORTED OUR LOCAL SCHOOLS IN SALINE COUNTY BY PROVIDING FACE MASKS, HAND SANITIZER, AND DISINFECTING WIPES FOR STUDENTS THAT ARE UNABLE TO PURCHASE THEIR OWN. THE HOSPITAL AND CLINICS HAVE ALSO CONDUCTED FOOD DRIVES FOR LOCAL FOOD PANTRIES, A BABY SUPPLY DRIVE FOR OUR LOCAL CRISIS PREGNANCY CENTER, AND COAT/GLOVE DRIVES FOR THE LOCAL KIDS. HMC CLINICS ALSO PROVIDED FOOD BASKETS TO LOCAL FAMILIES AT THANKSGIVING AND CHRISTMAS AND ALSO PURCHASED GIFTS FOR THE SCHOOLS UNDERPRIVILEGED STUDENTS. HMC IS A SPONSOR OF THE SALINE COUNTY "CREATING ENTREPRENEURIAL OPPORTUNITIES (CEO) PROGRAM" FOR LOCAL HIGH SCHOOL STUDENTS AND HMC'S CEO AND MARKETING DIRECTOR ARE ACTIVELY INVOLVED AS MENTORS TO THE STUDENTS THROUGHOUT THE YEAR. SALINE COUNTY CEO PROGRAM IS A MENTORING PROGRAM THAT PROVIDES EFFECTIVE NETWORKING MODEL FOR STUDENTS. HMC IS ACTIVE WITH THE GOLDEN CIRCLE SENIOR CITIZENS ORGANIZATION IN HARRISBURG. HMC'S REGISTERED DIETICIANS REVIEW AND APPROVE THEIR MENU EVERY MONTH AT NO CHARGE. OUR REGISTERED DIETICIANS ALSO PROVIDE NUTRITIONAL CONSULTS AT NO CHARGE IN THE CLINICS. HMC PROVIDES AN ATHLETIC TRAINER AND DRUG SCREENING TESTS AT NO CHARGE TO THE HARRISBURG HIGH SCHOOL. |
| PART VI, LINE 6: | THE HOSPITAL IS PART OF A LARGER SYSTEM, SOUTHERN ILLINOIS HOSPITAL SERVICES (SIHS), THAT PROVIDES HEALTH SERVICES TO THE POPULATION OF SOUTHERN ILLINOIS. SIHS PROVIDES CARE THROUGH ITS FOUR HOSPITALS AND A COMMUNITY HEALTH CENTER. THREE OF THE HOSPITALS ARE REPORTED AS SOUTHERN ILLINOIS HOSPITAL SERVICES AND ONE IS REPORTED AS HARRISBURG MEDICAL CENTER. HARRISBURG MEDICAL CENTER ALSO PROVIDES CARE THROUGH TWO RURAL HEALTH CLINICS. SOUTHERN ILLINOIS MEDICAL SERVICES (SIMS) PROVIDES CARE THROUGH PHYSICIAN PRACTICES. THESE PRACTICES ARE COMPRISED OF THE CENTER FOR MEDICAL ARTS, LOGAN PRIMARY CARE, PHYSICIAN CARE GROUP, INDIVIDUAL PHYSICIAN PRACTICES, HOSPITAL PHYSICIAN AND EMERGENCY ROOM PHYSICIANS. SIHS AND SIMS WORK TOGETHER IN PROVIDING CARE AND TREATMENT OF THE MEDICALLY SICK, INJURED OR AFFLICTED. BOTH PROVIDE QUALITY HEALTH SERVICES TO PEOPLE THROUGHOUT SOUTHERN ILLINOIS REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| REX BUDDE | ||||||||||||||
| PRESIDENT/CEO - SIH | $0 | $778,971 | $0 | $121,287 | $0 | $1,496,205 | $0 | $11,525 | $0 | $37,021 | $0 | $2,445,009 | $0 | $1,452,756 |
| JOHN B MILLSTEAD | ||||||||||||||
| SENIOR VP/COO - SIH | $0 | $532,848 | $0 | $83,514 | $0 | $219,894 | $0 | $181,753 | $0 | $44,893 | $0 | $1,062,902 | $0 | $186,021 |
| JAMES ALEXANDER | ||||||||||||||
| VICE-PRESIDENT/CMO | $345,663 | $0 | $335,189 | $0 | $1,360 | $0 | $11,000 | $0 | $3,809 | $0 | $697,021 | $0 | $0 | $0 |
| CLAYTON FORD | ||||||||||||||
| PHYSICIAN | $320,185 | $0 | $102,303 | $0 | $9,127 | $0 | $11,000 | $0 | $7,127 | $0 | $449,742 | $0 | $0 | $0 |
| DONALD HUTSON | ||||||||||||||
| PRESIDENT/CEO, VP/ADMINISTRATOR | $211,392 | $128,167 | $10,000 | $0 | $8,657 | $23,997 | $8,398 | $3,459 | $5,765 | $17,043 | $244,212 | $172,666 | $0 | $0 |
| JASON VALLETTE | ||||||||||||||
| CRNA | $259,042 | $0 | $35 | $0 | $8,727 | $0 | $10,274 | $0 | $26,327 | $0 | $304,405 | $0 | $0 | $0 |
| THOMAS BUTLER | ||||||||||||||
| CRNA | $282,510 | $0 | $35 | $0 | $4,289 | $0 | $10,824 | $0 | $1,539 | $0 | $299,197 | $0 | $0 | $0 |
| ANDREA MILLER | ||||||||||||||
| PHYSICIAN | $186,466 | $0 | $66,592 | $0 | $9,877 | $0 | $9,953 | $0 | $13,106 | $0 | $285,994 | $0 | $0 | $0 |
| MARIE GORSKI | ||||||||||||||
| PHYSICIAN | $279,311 | $0 | $35 | $0 | $0 | $0 | $0 | $0 | $2,756 | $0 | $282,102 | $0 | $0 | $0 |
| THERESA JUNE HAYES | ||||||||||||||
| VICE-PRESIDENT/CFO, FINANCE DIRECTOR | $197,979 | $0 | $35 | $0 | $6,236 | $0 | $7,823 | $0 | $4,776 | $0 | $216,849 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | JAMES ALEXANDER, NON-QUALIFIED RETIREMENT PLAN CONTRIBUTIONS: $19,500 THOMAS BUTLER, NON-QUALIFIED RETIREMENT PLAN CONTRIBUTIONS: $19,500 | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ILLINOIS FINANCE AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 861091967 | BondIssuerEIN |
| Bond Issued | 2021-12-01 | BondIssuedDt |
| Issue Price | $18,565,000 | IssuePriceAmt |
| Purpose | REFUND TAX-EXEMPT SERIES 2017 BONDS (ISSUED 3/14/17) | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $135,000 | RetiredAmt |
| Total Proceeds | $18,565,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $337,239 | IssuanceCostsFromProceedsAmt |
| Other Spent Proceeds | $18,227,761 | OtherSpentProceedsAmt |
| Substantial Completion | 2017 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | Yes (1) | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | 0 | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE K, PART II, LINE 17 | FormAndLineReferenceDesc |
| Explanation | ADEQUATE BOOKS AND RECORDS WILL BE AVAILABLE TO SUPPORT THE FINAL ALLOCATION OF PROCEEDS ONCE THEY ARE MADE. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TIFFANY BUSINARO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | EMPLOYEE - WIFE OF BOARD MEMBER MATT BUSINARO | RelationshipDescriptionTxt |
| Transaction | $57,390 | TransactionAmt |
| Transaction | WAGES | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED IN THE BYLAWS. |
| FORM 990, PART VI, SECTION A, LINE 4 | SOUTHERN ILLINOIS HOSPITAL SERVICES BECAME THE SOLE MEMBER OF THE ORGANIZATION ON AUGUST 1, 2021. ON THAT DATE, THE ORGANIZATION'S BYLAWS WERE AMENDED TO REFERENCE THE NEW SOLE MEMBER AND ITS RESERVED POWERS. |
| FORM 990, PART VI, SECTION A, LINE 6 | IN 2020, THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES WAS AUTHORIZED TO NEGOTIATE A LETTER OF INTENT WITH SOUTHERN ILLINOIS HOSPITAL SERVICES. THE ORGANIZATION'S BOARD OF TRUSTEES AGREED UPON AND SIGNED THE LETTER OF INTENT AND AFFILIATION AGREEMENT IN JULY 2021 AND SOUTHERN ILLINOIS HOSPITAL SERVICES BECAME THE SOLE MEMBER OF THE ORGANIZATION ON AUGUST 1, 2021. THE MEMBER HAS THE RIGHT TO ELECT MEMBERS TO BOARD OF TRUSTEES AND TO APPROVE SOME DECISIONS OF THE BOARD. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE ORGANIZATION'S SOLE MEMBER, SOUTHERN ILLINOIS HOSPITAL SERVICES (CORPORATE MEMBER), HAS THE EXCLUSIVE RIGHT TO ELECT BOARD MEMBERS TO THE ORGANIZATION'S BOARD OF TRUSTEES |
| FORM 990, PART VI, SECTION A, LINE 7B | THE ORGANIZATION'S SOLE MEMBER, SOUTHERN ILLINOIS HOSPITAL SERVICES (CORPORATE MEMBER), HAS RESERVED POWERS FOUND IN THE ORGANIZATION'S BYLAWS THE FOLLOWING MATTERS REQUIRE THE APPROVAL OF THE CORPORATE MEMBER: 1. APPROVAL AND REMOVAL OF THE MEMBERS OF THE BOARD OF TRUSTEES; 2. APPROVAL OF ANY CHANGE TO THE STATEMENT OF MISSION, PHILOSOPHY, ROLE AND PURPOSE OF THE CORPORATION; 3. APPROVAL OF CAPITAL EXPENDITURES IN EXCESS OF $50,000; 4. APPROVAL OF THE BUYING, SELLING, LEASING, MORTGAGING OR DISPOSING OF PROPERTY; 5. APPROVAL OF STRATEGIC PLANS; 6. APPROVAL OF THE CREATION OR DISSOLUTION OF ANY CORPORATION, THE SOLE MEMBER OR MAJORITY STOCKHOLDER OF WHICH IS THE CORPORATION; 7. APPROVAL OF MERGER, DISSOLUTION, CONSOLIDATION OR REORGANIZATION OF THE CORPORATION; 8. APPROVAL OF JOINT VENTURES OR AFFILIATIONS; 9. APPROVAL OF THE INCURRENCE OF ANY INDEBTEDNESS; 10. APPROVAL OF SUCH OTHER MATTERS AS MAY BE REQUIRED BY LAW OR BY THE CORPORATION'S ARTICLES OF INCORPORATION, OR BY THE BYLAWS TO BE SUBMITTED TO THE CORPORATE MEMBER; 11. APPROVAL OF ANY AMENDMENT TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; AND 12. SELECTION AND TERMINATION OF THE ADMINISTRATOR OF THE CORPORATION, FOLLOWING CONSULTATION WITH THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 11B | A DRAFT OF THE FORM 990 AND SUPPLEMENTAL SCHEDULES WAS DISTRIBUTED TO THE ORGANIZATION'S ADMINISTRATOR AND FINANCE DIRECTOR, AND TO THE CORPORATE MEMBER'S CFO AND FINANCIAL STAFF FOR REVIEW AND COMMENTS. AFTER A REVIEW AND COMMENT PERIOD, ALL SUGGESTIONS AND COMMENTS WERE CONSIDERED, AND THE FORM 990 WAS UPDATED AS APPROPRIATE. THE FINALIZED FORM 990 AND SUPPLEMENTAL SCHEDULES WAS THEN PRESENTED TO THE ORGANIZATION'S BOARD OF TRUSTEES AND A COPY OF THE RETURN WAS MADE AVAILABLE TO EVERY MEMBER OF THE GOVERNING BODY BEFORE IT WAS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY, THE CORPORATE MEMBER'S GENERAL COUNSEL SENDS OUT A CONFLICT-OF-INTEREST QUESTIONNAIRE TO EACH TRUSTEE, DIRECTOR, OFFICER, MANAGER, AND KEY EMPLOYEE TO COMPLETE AND RETURN. THE GENERAL COUNSEL THEN REVIEWS THESE QUESTIONNAIRES TO DETERMINE WHAT CONFLICTS, REAL OR PERCEIVED, EXIST. PER THE POLICY, THE TRUSTEES ARE OBLIGATED TO GIVE NOTICE IF A CONFLICT HAS BEEN OVERLOOKED OR IF A DISCUSSION OR ACTION COMES BEFORE THE BOARD WHICH MAY INVOLVE OR CREATE A CONFLICT OF INTEREST FOR SOMEONE. IF A TRUSTEE HAS A CONFLICT OF INTEREST, THE TRUSTEE OR THE GENERAL COUNSEL DISCLOSES THE CONFLICT. THE TRUSTEE WITH THE CONFLICT IS ALLOWED TO REMAIN IN THE MEETING TO ANSWER ANY QUESTION THE TRUSTEE MAY NEED TO ANSWER AND THEN THE CONFLICTED TRUSTEE IS EXCUSED FROM THE MEETING. THE REMAINING TRUSTEES THEN DISCUSS THE MATTER FURTHER AND ACTION IS TAKEN ON THE MATTER. FINALLY, THE CONFLICTED TRUSTEE IS THEN INVITED BACK INTO THE MEETING. INTERESTED PERSONS MAY ALSO BE ASKED, IN RARE SITUATIONS, TO RESIGN THEIR POSITION ON THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CORPORATE MEMBER'S BOARD OF TRUSTEES SETS THE EXECUTIVE COMPENSATION POLICY AND IS RESPONSIBLE FOR APPROVAL OF THE COMPENSATION. THE GOVERNANCE COMMITTEE IS DESIGNATED BY THE BOARD TO ACT AS THE COMPENSATION COMMITTEE FOR MATTERS CONCERNING EXECUTIVE COMPENSATION. EACH MEMBER OF THE COMMITTEE, WHILE CONSIDERING EXECUTIVE COMPENSATION ISSUES, MUST BE AN INDEPENDENT DIRECTOR, FREE FROM ANY CONFLICT OF INTEREST. THE COMMITTEE SEEKS OUT AND CONTRACTS THE SERVICES OF AN OUTSIDE, INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT TO ADVISE THE COMMITTEE IN MATTERS OF MARKET VALUES OF COMPARABLE EXECUTIVE POSITIONS. THE COMMITTEE ANNUALLY REVIEWS ALL COMPARABILITY DATA AND PREPARES A RECOMMENDATION AS TO THE COMPENSATION PACKAGE OF THE PRESIDENT/CEO FOR THE FULL BOARD. ONLY THE FULL BOARD HAS THE AUTHORITY TO APPROVE THE COMPENSATION OF THE PRESIDENT/CEO. THE DECISIONS AND DELIBERATIONS ARE DOCUMENTED IN SIHS' GOVERNANCE COMMITTEE MINUTES. THIS PROCESS WAS LAST UNDERTAKEN IN JUNE 2021. THE GOVERNANCE COMMITTEE IS DESIGNATED BY THE BOARD TO ACT AS THE COMPENSATION COMMITTEE FOR MATTERS CONCERNING COMPENSATION. EACH MEMBER OF THE COMMITTEE, WHILE CONSIDERING EXECUTIVE COMPENSATION ISSUES, MUST BE AN INDEPENDENT DIRECTOR, FREE FROM ANY CONFLICT OF INTEREST. THE COMMITTEE SEEKS OUT AND CONTRACTS THE SERVICES OF AN OUTSIDE, INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT TO ADVISE THE COMMITTEE IN MATTERS OF MARKET VALUES OF COMPARABLE EXECUTIVE POSITIONS. THE COMMITTEE ANNUALLY REVIEWS ALL COMPARABILITY DATA AND PREPARES A RECOMMENDATION TO THE FULL BOARD AS TO THE COMPENSATION PACKAGE OF ALL OFFICERS. ONLY THE COMMITTEE HAS THE AUTHORITY TO APPROVE THE COMPENSATION OF THE SENIOR MANAGEMENT TEAM AND WILL REPORT ITS ACTIONS TO THE BOARD. THE DECISIONS AND DELIBERATIONS ARE DOCUMENTED IN SIHS' GOVERNANCE COMMITTEE MINUTES. THIS PROCESS WAS LAST UNDERTAKEN IN JUNE 2021. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS CONFLICT-OF-INTEREST POLICY AVAILABLE TO THE PUBLIC ON ITS WEBSITE AND UPON REQUEST. GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104 THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 7,877,787. MANAGEMENT AND GENERAL EXPENSES 1,387,337. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,265,124. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 50,746. MANAGEMENT AND GENERAL EXPENSES 101,859. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 152,605. |
| FORM 990, PART XII, LINE 2C | EFFECTIVE AUGUST 1, 2021, SOUTHERN ILLINOIS HOSPITAL SERVICES ASSUMED OWNERSHIP OF HARRISBURG MEDICAL CENTER BY BECOMING ITS SOLE MEMBER (CORPORATE MEMBER). THE CORPORATE MEMBER'S AUDIT COMMITTEE HAS RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE CORPORATE MEMBER AND ALL OF ITS AFFILIATED ORGANIZATIONS, AS WELL AS THE SELECTION OF AN INDEPENDENT AUDITOR/ACCOUNTANT. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| HARRISBURG MEDICAL CENTER FOUNDATION | |||||||||||
| 540 N COMMERCIAL | HARRISBURG | IL | 62946 | 371411984 | FUNDRAISING | IL | 501(C)(3) | LINE 12A, I | HARRISBURG MEDICAL CENTER | Yes (1) | |
| SOUTHERN ILLINOIS HOSPITAL SERVICES | |||||||||||
| PO BOX 3988 | CARBONDALE | IL | 62902 | 370618939 | HEALTHCARE | IL | 501(C)(3) | LINE 3 | SOUTHERN ILLINOIS HOSPITAL ENTERPRISES INC | 0 | |
| SOUTHERN ILLINOIS HOSPITAL ENTERPRISES INC | |||||||||||
| PO BOX 3988 | CARBONDALE | IL | 62902 | 371136788 | HEALTHCARE | IL | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |