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CARLINVILLE AREA HOSPITAL ASSOCATION: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
CARLINVILLE AREA HOSPITAL ASSOCATION (EIN 37-0645239)
Tax period
2021-08-01 to 2022-07-31
Filed
2023-06-02
IRS object ID
202311539349300501
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 ReturnHeader

FieldValueIRS element (for citing)
Return2023-06-02T07:13:42-05:00ReturnTs
Tax Period End2022-07-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN450250958PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Eide Bailly LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1800 Nicollet Mall Ste 1300AddressLine1Txt
CityMinneapolisCityNm
State AbbreviationMNStateAbbreviationCd
ZIP554027033ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-08-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN370645239EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Carlinville Area Hospital AssociationBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCARLBusinessNameControlTxt
Phone2178543141PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line120733 North Broad StreetAddressLine1Txt
CityCarlinvilleCityNm
State AbbreviationILStateAbbreviationCd
ZIP62626ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonPaul CourtneyPersonNm
Person TitleCFOPersonTitleTxt
Phone2178543141PhoneNum
Signature2023-05-17SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstPaulPersonFirstNm
Person LastCourtneyPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKim Hunwardsen CPAPreparerPersonNm
PTINP00484560PTIN
Phone6122536500PhoneNum
Preparation2023-05-01PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerBrian BurnsidePrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line120733 North Broad StreetAddressLine1Txt
CityCarlinvilleCityNm
State AbbreviationILStateAbbreviationCd
ZIP62626ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$39,632,090GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.cahcare.comWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1947FormationYr
Legal Domicile StateILLegalDomicileStateCd
Activity Or MissionProvide quality acute and preventative health care benefitsActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee324TotalEmployeeCnt
Total Volunteers8TotalVolunteersCnt
Total Gross UBI-$20,059TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$6,337,086PYContributionsGrantsAmt
CY Contributions Grants$2,125,265CYContributionsGrantsAmt
PY Program Service Revenue$32,955,789PYProgramServiceRevenueAmt
CY Program Service Revenue$37,117,090CYProgramServiceRevenueAmt
PY Investment Income$136,778PYInvestmentIncomeAmt
CY Investment Income$169,049CYInvestmentIncomeAmt
PY Other Revenue$168,001PYOtherRevenueAmt
CY Other Revenue-$90,370CYOtherRevenueAmt
PY Total Revenue$39,597,654PYTotalRevenueAmt
CY Total Revenue$39,321,034CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$16,417,200PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$21,302,283CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$16,381,093PYOtherExpensesAmt
CY Other Expenses$19,498,325CYOtherExpensesAmt
PY Total Expenses$32,798,293PYTotalExpensesAmt
CY Total Expenses$40,800,608CYTotalExpensesAmt
PY Revenues Less Expenses$6,799,361PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$1,479,574CYRevenuesLessExpensesAmt
Total Assets BOY$46,342,668TotalAssetsBOYAmt
Total Assets EOY$38,337,789TotalAssetsEOYAmt
Total Liabilities BOY$23,039,318TotalLiabilitiesBOYAmt
Total Liabilities EOY$17,086,743TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$23,303,350NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$21,251,046NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTo maintain a professional medical community, a primary care hospital and other health care services, in order to provide quality acute and preventative health care for the benefit of those persons living in the service area.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$32,322,947ExpenseAmt
Revenue$37,117,090RevenueAmt
DescCarlinville Area Hospital Association is a 25-bed acute care hospital located in Carlinville, Illinois. The Hospital provides inpatient, outpatient and emergency care services for residents of central Illinois.During fiscal year 2022, we carried out our exempt purpose in the following ways: 1) Provided quality short term acute care medical services to 347 inpatients, of which 77% were eligible for Medicare. Without our services these elderly patients would have had to travel over 20 miles to receive similar services. (Continued on Schedule O) 2) Provided quality short term skilled care to 116 patients in our swing bed unit, with an average length of stay of 10.91 days. 3) Provided 24 hour a day emergency room services. Our emergency room treated 6,736 patients during fiscal year 2022. We treat everyone who presents themselves to our emergency room regardless of their medical condition or ability to pay. We provided 24-hour physician service so people residing in the Carlinville area do not have to travel long distances for emergency medical care. 4) In addition to the inpatient and emergency services we provide, we also had 32,222 visits in our outpatient departments. These services range from preventative care items such as mammograms and lab tests to rehabilitative services such as Physical and Occupational therapy. 5) The hospital also had 8,108 visits to their specialty clinics. These clinics bring specialists from metropolitan areas to Carlinville on a rotating basis. This provides access to specialty services not otherwise offered in the area.6) The hospital also had 17,366 visits in our Rural Health Clinics. These clinics allow for patients to stay closer to home and get in to see a medical provider.The Hospital provides health care services to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Since the Hospital does not pursue collection of these amounts, they are not reported as patient service revenue. The estimated costs of providing these services was $211,000 for the year ended July 31, 2022, calculated by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients.Desc
Total Program Service Expenses$32,322,947TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document15IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee324EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldILStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Paul CourtneyBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone2178543857PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line120733 North Broad StreetAddressLine1Txt
CityCarlinvilleCityNm
State AbbreviationILStateAbbreviationCd
ZIP62626ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtHighest Compensated EmployeeHighestCompensatedEmployeeIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerInd
Anne Borwick DO
Internal Med & Pediatrics40.000.00Yes (X)$322,666$0$33,065
Connee Sloman
CRNA40.000.00Yes (X)$308,914$0$25,790
August Adams MD
Internal Medicine41.000.00Yes (X)$268,698$0$31,612
Harald Lausen MD
Internal Medicine40.000.00Yes (X)$242,350$0$6,838
Lourdes Cruz MD
Pediatrician40.000.00Yes (X)$238,188$0$15,302
Kate Wilkens MD - Director
Medical Staff Pres as of 2.1.2241.000.00$170,121$0$6,600Yes (X)
Dennis Pickrel - Treasurer
until 12.31.21/Chair as of 1.1.221.000.60$0$0$0Yes (X)Yes (X)
J Richard Schien - Chair
until 12.31.21/Dir. as of 1.1.221.000.60$0$0$0Yes (X)Yes (X)
Richard Walden
Vice Chair1.000.60$0$0$0Yes (X)Yes (X)
Ralph March
Secretary1.000.60$0$0$0Yes (X)Yes (X)
Heather DeNeve - Member
until 12.31.21/Treas as of 1.1.221.000.30$0$0$0Yes (X)Yes (X)
Katie Goodman-Thomas
Member1.000.30$0$0$0Yes (X)
James Salske
Member1.000.00$0$0$0Yes (X)
Tom Denby
Member starting 1.1.221.000.30$0$0$0Yes (X)
Brian Burnside
CEO40.001.30$0$0$0Yes (X)
Paul Courtney
CFO as of January 202240.001.30$0$0$0Yes (X)
Patrick Nudo
CFO until August 202140.001.30$0$0$0Yes (X)
Steve Miller
CFO until December 202140.001.30$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,550,937TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$119,207TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K20IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
HealthTechS3
PO Box 636426CincinnatiOH425636426Management Services$1,033,797
Sanburg Emergency Group
PO Box 677979DallasTX752677979Emergency Room Physicians$744,592
Macoupin Physician Services
PO Box 677979DallasTX752677979Hospitalist Physicians$601,603
Illinois Emergency Physicians LLP
PO Box 674579DetroitMI482674579Emergency Room Physicians$500,000
Aramark
26792 Network PlaceChicagoIL60673Laundry Service$466,235
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K19CntrctRcvdGreaterThan100KCnt
Government Grants$2,089,157GovernmentGrantsAmt
All Other Contributions$36,108AllOtherContributionsAmt
Total Contributions$2,125,265TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Patient service revenue621110$36,662,979$36,662,979
Pharmacy revenue446110$187,185$187,185

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$266,926TotalRevenueColumnAmt
Related Or Exempt Func Income$266,926RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$37,117,090TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$78,028TotalRevenueColumnAmt
Exclusion$78,028ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$220,686RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$311,056RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real-$90,370RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column-$90,370TotalRevenueColumnAmt
Unrelated Business Revenue-$20,059UnrelatedBusinessRevenueAmt
Exclusion-$70,311ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$91,021SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$91,021SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$91,021TotalRevenueColumnAmt
Exclusion$91,021ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$39,321,034TotalRevenueColumnAmt
Related Or Exempt Func Income$37,117,090RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue-$20,059UnrelatedBusinessRevenueAmt
Exclusion$98,738ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$244,601TotalAmt
Program Services$244,601ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$16,693,493TotalAmt
Program Services$13,740,172ProgramServicesAmt
Management And General$2,953,321ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$415,956TotalAmt
Program Services$341,784ProgramServicesAmt
Management And General$74,172ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,741,756TotalAmt
Program Services$2,263,403ProgramServicesAmt
Management And General$478,353ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,206,477TotalAmt
Program Services$995,999ProgramServicesAmt
Management And General$210,478ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$1,282,144TotalAmt
Management And General$1,282,144ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$66,496TotalAmt
Management And General$66,496ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$86,933TotalAmt
Management And General$86,933ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$6,057,619TotalAmt
Program Services$5,602,493ProgramServicesAmt
Management And General$455,126ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$240,941TotalAmt
Management And General$240,941ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$4,069,806TotalAmt
Program Services$2,717,869ProgramServicesAmt
Management And General$1,351,937ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$123,883TotalAmt
Management And General$123,883ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$241,347TotalAmt
Program Services$241,347ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$61,952TotalAmt
Program Services$16,333ProgramServicesAmt
Management And General$45,619ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$249,786TotalAmt
Program Services$62,247ProgramServicesAmt
Management And General$187,539ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$560,206TotalAmt
Program Services$439,821ProgramServicesAmt
Management And General$120,385ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,385,705TotalAmt
Program Services$1,853,767ProgramServicesAmt
Management And General$531,938ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$302,838TotalAmt
Program Services$166,445ProgramServicesAmt
Management And General$136,393ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Medical supplies$3,266,828$3,266,828
Food$270,426$270,279$147
Repairs and maintenance$78,806$69,730$9,076

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$152,609TotalAmt
Program Services$29,829ProgramServicesAmt
Management And General$122,780ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$40,800,608TotalAmt
Program Services$32,322,947ProgramServicesAmt
Management And General$8,477,661ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$16,732,260BOYAmt
EOY$11,323,199EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$5,082,119BOYAmt
EOY$4,872,927EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$295,512BOYAmt
EOY$318,966EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$198,955BOYAmt
EOY$315,041EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$41,956,008LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$26,585,179LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$17,154,812BOYAmt
EOY$15,370,829EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$6,139,362BOYAmt
EOY$5,318,278EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$100,000BOYAmt
EOY$125,000EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$639,648BOYAmt
EOY$693,549EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$46,342,668BOYAmt
EOY$38,337,789EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,846,578BOYAmt
EOY$3,083,363EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$5,798,596BOYAmt
EOY$568,234EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$13,908,140BOYAmt
EOY$13,058,340EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,486,004BOYAmt
EOY$376,806EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$23,039,318BOYAmt
EOY$17,086,743EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$22,583,702BOYAmt
EOY$20,650,597EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$719,648BOYAmt
EOY$600,449EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$23,303,350BOYAmt
EOY$21,251,046EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$46,342,668BOYAmt
EOY$38,337,789EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$1,479,574ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$453,531NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$119,199OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$500,172OtherCostOrOtherBasisAmt
Book Value$500,172BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$26,277,902OtherCostOrOtherBasisAmt
Depreciation$23,388,160DepreciationAmt
Book Value$2,889,742BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$12,600,709OtherCostOrOtherBasisAmt
Depreciation$1,789,518DepreciationAmt
Book Value$10,811,191BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,577,225OtherCostOrOtherBasisAmt
Depreciation$1,407,501DepreciationAmt
Book Value$1,169,724BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$15,370,829TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
Employee health claims$375,000
Due to Affiliates$1,806
FieldValueIRS element (for citing)
Total Liability$376,806TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$39,178,559TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$453,531NetUnrealizedGainsInvstAmt
Revenue Not Reported-$453,531RevenueNotReportedAmt
Revenue Subtotal$39,632,090RevenueSubtotalAmt
Other Revenues Not Included-$311,056OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt-$311,056RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$39,321,034TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$41,111,664TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$311,056OtherExpensesIncludedAmt
Expenses Not Reported$311,056ExpensesNotReportedAmt
Expenses Subtotal$40,800,608ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$40,800,608TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part X, Line 2:The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred.
Part XI, Line 4b - Other Adjustments:Rental expenses recorded in revenue for Form 990 -311,056.
Part XII, Line 2d - Other Adjustments:Rental expenses recorded in revenue for Form 990 311,056.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other125.000000000000FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft Report0AnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$211,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$211,000NetCommunityBenefitExpnsAmt
Total Expense0.00520TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$211,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$211,000NetCommunityBenefitExpnsAmt
Total Expense0.00520TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$12,926,359TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,320,776DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,605,583NetCommunityBenefitExpnsAmt
Total Expense0.18640TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$12,926,359TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,320,776DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,605,583NetCommunityBenefitExpnsAmt
Total Expense0.18640TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$13,137,359TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,320,776DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,816,583NetCommunityBenefitExpnsAmt
Total Expense0.19160TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$1,340,041BadDebtExpenseAmt
Bad Debt Expense Attributable$301,643BadDebtExpenseAttributableAmt
Reimbursed By Medicare$11,148,722ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$11,078,500CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$70,222MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Carlinville Area Hospital AssociationBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line120733 North Broad StreetAddressLine1Txt
CityCarlinvilleCityNm
State AbbreviationILStateAbbreviationCd
ZIP62626ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.cahcare.comWebsiteAddressTxt
State License0005686StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
Other2 provider based RHCs and 1 provider based clinicOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Carlinville Area Hospital AssociationBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted21CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts0CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLhttps://www.cahcare.com/OwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt21ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLhttps://www.cahcare.com/StrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care125.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.000000000000FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLwww.cahcare.com/financial-information/FAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLwww.cahcare.com/financial-information/FAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLwww.cahcare.com/financial-information/FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross ChargesYes (1)GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Carlinville Area Hospital AssociationPart V, Section B, Line 5: Focus groups were formed for input. Medical professionals and partners and key community leaders were the groups. After the groups met, a prioritization process identified several potential health needs that were chosen for the needs assessment.
Carlinville Area Hospital AssociationPart V, Section B, Line 6a: HSHS St. Francis Hospital, Hillsboro Area Hospital
Carlinville Area Hospital AssociationPart V, Section B, Line 11: A Community Health Needs Assessment was completed in fiscal year 2019. The following are the needs identified and the accomplishments for fiscal year 2022.Prioritized Needs:Obesity: Provide education and programming aimed at youth on the need for recreation, exercise, and healthy eating. - The walking path remained open.- Continue to offer and promote wellness path, aquatic classes, Cardiac Rehab Phase III program, golf clinic, fall and balance classes, and Parkinsons exercise group.- Offer employee wellness program platform to area employers.Diabetes: Programs encouraging recreation and exercise at all ages.- Continue development of chronic care management with focus on diabetes, migrating toward patient centered medical home.Mental Health: Improve availability of mental health and substance use and misuse counseling. Improve access to local mental health case management services for persons suffering mental health issues including depression, grief, and loss. -Continue to offer Senior Behavioral Health Intensive Outpatient Program for Medicare covered senior citizens facing mental health challenges.-Continue to provide a Social Worker to do 1:1 and/or family counseling in RHC-Added an activity-focused group for seniors in Senior Behavioral Health program-Partner in Community Partnership Mental Health Grant with Carlinville CUSD for collaboration on mental health services within schools for '22-'23 school year-Outreach to senior centers presenting topics on mental health-Wrote and received Mental Health Services Award grant through ICAHN which led to implementation of Behavioral Health Screening process in E/D and Inpatient Med/Surg units of CAH for quick identification of inpatients with co-morbid mental health concerns-Established/Streamlined mental health referral process for RHC counseling and SBH programs-Participated in collaborative efforts in Behavioral Health programs utilizing South Central Hospital Alliance-Social Worker/Counselor attend daily huddle on inpatient med surg unit and provide consult services to hospitalized inpatients and swing bed patients with mental health co-morbidities-Participate in Health Jam/Health Fair providing information on Mental Health careers-Behavioral Health Counselor/Social Worker providing Emergency Department consultations and assistance for Mental Health Issues-Added mental health focused areas and trauma informed care components to inpatient assessment and behavioral health staff provide bedside consultation to inpatients facing crisis/trauma.Preventative Care and Case Management Services - Continue to offer case management services in the rural health clinics.- Expand rural health clinics' hours.- Explore expanding rural health clinics into other communities within the Hospital's service area.- Offer wellness program to local businesses and civic organizations.- Expand telehealth services offered.Local Healthcare Workforce Development- Started the CAN program with L&C and Carlinville High School to allow high school students to get CAN training for a high school and college credit. Funded the learning lab supplies and hosted clinical experience. - Developed the Nursing Clinical Ladder to strengthen and develop our bedside professional nurses- Continue to offer and communicate information regarding CAH&C tuition assistance program to employees- Continue to support the Macoupin CEO Program- Continue to offer clinical rotations- Communicate scholarship opportunities available to employees- Developed Employee Referral Program/Policy- Established $15/hr minimum wage ahead of IL minimum wage requirement schedule- Hosted multiple walk-in interviews- Attended LCCC Nursing Career Days- Explored international recruitment in areas with professional shortages- Provided hospital tours to students- Provided job shadowing opportunities to students- Provided resources to local high school students regarding healthcare careers- Significantly reduced employee costs for health insurance through the new hospital plan starting in January 2022- Explored different advertising avenues to communicate job openings including: radio, social media, streaming apps, etc.- Developed and rolled out a video recruitment campaign- Established and Education department allowing us to be better aligned to hire new grads and "grow our own" clinical staff- Continued to solicit feedback from employees through employee satisfaction surveys- Continued to monitor turnover rates and exit interview commentsCarlinville Area Hospital completed a Community Health Needs Assessment in fiscal year 2022. The following needs were identified and will be addressed over the next 3 years.1. Access to Mental Health and Behavioral Health Services2. Workforce Development3. Food InsecurityThere were no needs identified that will not be addessed.
Carlinville Area Hospital AssociationPart V, Section B, Line 16j: Financial assistance contact information is provided on each bill. A notice about the availability of charity care is posted in the admitting areas, including the ER. The Hospital also employs a full-time financial counselor to discuss the availability of various government services and charity care with patients.
Carlinville Area Hospital AssociationPart V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures.

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 7:Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report.
Part III, Line 2:The amount on line 2 represents implicit price concessions. The Hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients.
Part III, Line 3:The estimated amount of the Organization's implicit price concessions attributable to patients eligible under the Organization's charity care policy is calculated based on the percentage of individuals living below the poverty level in 2022. 22.51% can reasonably be considered a community benefit as it would have been written off to charity care.
Part III, Line 4:The footnote to the Organization's financial statements can be found on page 12 and 13 of the attached audited financial statements.
Part III, Line 8:Carlinville Area Hospital Association is a critical access hospital with a Medicare surplus.Both the total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.Hospital services reimbursed on a fee schedule are not included in the Medicare calculation per the 990 instructions. Had this been reported the total loss from Medicare services would have been $173,693.Medicare fee schedule revenue $ 273,663Medicare estimated costs of care relating to payments (447,356)Net (Shortage) $ (173,693)
Part III, Line 9b:Carlinville Area Hospital Association will give the charity care applicant at least 120 days from the date of the first bill to apply for financial assistance without any collection efforts. If the applicant has applied for health care coverage under Medicaid, Kidcare, or other government sponsored health care programs, Carlinville Area Hospital will await the approval or denial of the application without additional collection efforts.Carlinville Area Hospital Association will not refer a bill to collection without first offering the patient the opportunity to request a reasonable payment plan for the amount personally owed by the patient.
Part VI, Line 2:The Hospital works with physicians, the health department, nursing homes and other health care providers in the community to determine the health care needs of the community. The Hospital completed a fourth CHNA in FY 2022 and posted to the Hospital's website.
Part VI, Line 3:Financial assistance contact information is provided on each bill. A notice about the availability of charity care is posted in the admitting areas, including the ER. The Hospital also employs a full-time financial counselor to discuss the availability of various government services and charity care with patients.
Part VI, Line 4:Carlinville Area Hospital Association is a 25-bed acute care hospital located in Carlinville, Illinois. The Hospital serves the residents of Macoupin County. Carlinville Area Hospital is the only hospital within a 14-mile radius of Carlinville Illinois, a small rural community in central Illinois. Illinois Route 4 passes through Carlinville. Interstate 55 is also within 12 miles of the city. The community is mostly agricultural.Other hospitals and medical centers near Carlinville are St. Francis Hospital, a Critical Access Hospital in Litchfield, IL, approximately 14 miles away, Community Memorial Hospital, a Critical Access Hospital in Staunton, IL, approximately 20 miles away and Hillsboro Area Hospital, a Critical Access Hospital in Hillsboro, IL, approximately 24 miles away.Carlinville had a population of 5,575 in 2021. Unemployment was 4.03% compared to 4.78% in the state of Illinois in 2022. The median household income in Carlinville is $57,891. The poverty level in Carlinville is 19.7% higher than the national average.
Part VI, Line 5:Carlinville Area Hospital Association's core purpose is "Excellent healthcare close to home." This is very important to our board as all of our members live in our service area and use our facility. The Hospital extends medical staff privileges to all qualified physicians in the community. Carlinville Area Hospital invests in improvements in the community and continues to minimize long-term debt. The Hospital also provides the following services that would not otherwise be available within the Hospital's service area: Twenty-four hour a day emergency room that treats all patients regardless of ability to pay Specialty Clinic - The Hospital has an arrangement with a physician group out of Springfield, IL that brings specialists to the Carlinville Area that would not otherwise be available.Carlinville Area Hospital's Imaging Department hosted a free community presentation in observance of National Breast Cancer Awareness Month in October. Early detection, benefits of digital mammography, and how the advanced technology aids in early detection were discussed.The Hospital operates a Weekend Walk-In Clinic to provide a need for the community who might need medical care on the weekend, but, do not want to go the Hospital emergency room.Carlinville Area Hospital participated in the Illinois Cooperative Work Study Program. The program offered opportunities for college students to gain hands-on experience in their field of study. The Hospital also served as a clinical site for students in Radiology from Southwestern Illinois College and Pharmacy from St. Louis College of Pharmacy.
Part VI, Line 7, Reports Filed With StatesIL

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Anne Borwick DO
Internal Med & Pediatrics$322,666$0$0$0$0$0$12,878$0$20,452$0$355,996$0$0$0
Connee Sloman
CRNA$308,914$0$0$0$0$0$12,114$0$15,022$0$336,050$0$0$0
August Adams MD
Internal Medicine$268,698$0$0$0$0$0$11,425$0$21,543$0$301,666$0$0$0
Harald Lausen MD
Internal Medicine$242,350$0$0$0$0$0$0$0$6,838$0$249,188$0$0$0
Lourdes Cruz MD
Pediatrician$238,188$0$0$0$0$0$9,631$0$7,017$0$254,836$0$0$0
Kate Wilkens MD - Director
Medical Staff Pres as of 2.1.22$170,121$0$0$0$0$0$6,600$0$204$0$176,925$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule J, Part I, Question 3:FormAndLineReferenceDesc
ExplanationCarlinville Area Hospital Association does not pay compensation to the CEO directly. The CEO is compensated by an unrelated management company, HealthTech S3. The Hospital Board of Directors use the processes described in Part I, Question 3 to determine appropriate compensation for the CEO. The Board of Directors also approves the Organization's contract with the Management Company.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 1aThe Executive Committee is composed of the elected officers of the Board and includes the Chairman, Vice Chairman, Secretary, and Treasurer of the Association. The Executive Committee has the power and authority to manage and control the business and affairs of the Association as the Board of Directors; however, the Executive Committee is not allowed to exercise those powers prohibited by Illinois law which include: amending the Articles or Bylaws; sell, transfer, or otherwise dispose of substantially all of the Association's assets; or adopt Articles of Merger or Consolidation.
Form 990, Part VI, Section A, line 2J. Richard Schien, Chair, and Richard Walden, Vice Chair, have a business relationship. James Salske, board member, and Richard Walden, Vice Chair have a business relationship.
Form 990, Part VI, Section A, line 3Management Company Compensation (CY 2021): Brian Burnside, CEO Compensation: $270,362 Patrick Nudo, CFO until August 2021 Compensation: $114,191 Steve Miller, CFO August-December 2021 Compensation: $111,550 Paul Courtney, CFO as of January 2022 Compensation: N/A The officers are common law employees of HealthTech S3, an unrelated management company, and are compensated for services to Carlinville Area Hospital Association. The CEO has the responsibility of supervising the management, administration and operation of the Organization. The CFO has the responsibility for managing the Organization's finances.
Form 990, Part VI, Section A, line 6The Organization's sole member is Middle Macoupin Health Care Systems.
Form 990, Part VI, Section A, line 7aThe Member has the exclusive right and power to designate three of its Directors to serve as members of the Board of Directors, and by resolution has authority to appoint and remove all Directors from the Board.
Form 990, Part VI, Section A, line 7bThe Member has the exclusive right and power to approve or reject the following actions prior to the Board of Directors taking any action: 1. the annual operating budget, capital budget, long-range plan and any action which will result in a substantial change in the expenditures or revenue forecast; 2. the undertaking of or substantive amendments to a contractual obligation in excess of $50,000, or the guaranteeing of any obligation in excess of $50,000; 3. the purchase, lease, transfer, mortgage or sale of any asset or property with a value in excess of $50,000, except with respect to transactions specified and previously approved within the capital budget; 4. any plan of construction or remodeling involving an expenditure in excess of $50,000, except with respect to transactions specified and previously approved within the capital budget; 5. any borrowing; 6. any application for a government grant; 7. any general plan for the solicitation of charitable contributions or the solicitation or acceptance as a gift of any real property or any interest; 8. any proposal to adopt Articles of Dissolution, Merger, or Consolidation; 9. any selection, removal or change in the compensation or other terms of employment of the operating officers; 10. any substantial change in employee fringe benefits or personnel policies; and 11. any other matters as may be required by law to be submitted to the Member or as to which the Member determines, by resolution, that submission is advisable.
Form 990, Part VI, Section B, line 11bThe Form 990 is distributed to the governing body before it is filed. The CEO and CFO review the Form 990.
Form 990, Part VI, Section B, line 12cAny duality of interest or possible conflict of interest on the part of any Board member should be disclosed to the other members of the Board and made a matter of record through an annual procedure and also when the interest becomes a matter of Board action. Any Board member having a duality of interest or possible conflict of interest on any matter should not vote or use his or her personal influence on the matter. The minutes of the meeting must reflect the disclosure, the abstention from voting, and the quorum situation. Any new member of the Board will be advised of this policy upon entering on the duties of office. The governing Board, CEO, and CFO complete and sign the conflict of interest form yearly. The forms are reviewed by the CEO of the Organization and if a potential conflict is identified the CEO follows up.
Form 990, Part VI, Section B, line 15The CEO and CFO are compensated through HealthTechS3, an unrelated management company. They are considered common law employees of the management company. HealthTechS3 gives the Board of Directors a recommended salary range for the CEO and CFO and the Board sets the compensation within this range after review of performance evaluations and comparability data. The process is documented and is completed on an annual basis.
Form 990, Part VI, Section C, line 19The Organization's governing documents, conflict of interest policy, and financial statements are not available to the public. Financial information is available through the public disclosure copy of the 990.
Form 990, Part IX, line 11gPurchased services and contract labor: Program service expenses 1,992,030. Management and general expenses 194,534. Fundraising expenses 0. Total expenses 2,186,564. Professional fees: Program service expenses 3,610,463. Management and general expenses 260,592. Fundraising expenses 0. Total expenses 3,871,055.
Form 990, Part XI, line 9:Change in beneficial interest in perpetual trust -119,199.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
Carlinville Area Hospital Foundation
20733 North Broad StreetCarlinvilleIL62626371193348Support Carlinville Area Hospital AssociationIL501(c)(3)Line 7Middle Macoupin Healthcare Systems0
Middle Macoupin Healthcare Systems
20733 North Broad StreetCarlinvilleIL62626371193396Provide support and benefit Carlinville Area Hospital AssociationIL501(c)(3)Line 12c, III-FI0N/A
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd