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CARLINVILLE AREA HOSPITAL ASSOCATION: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
CARLINVILLE AREA HOSPITAL ASSOCATION (EIN 37-0645239)
Tax period
2020-08-01 to 2021-07-31
Filed
2022-06-14
IRS object ID
202211659349300121
Schema version
2020v4.2
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)
Return2022-06-14T10:41:31-05:00ReturnTs
Tax Period End2021-07-31TaxPeriodEndDt

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 Begin2020-08-01TaxPeriodBeginDt

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)
PersonBrian BurnsidePersonNm
Person TitleCEOPersonTitleTxt
Phone2178543141PhoneNum
Signature2022-06-10SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstBrianPersonFirstNm
Person LastBurnsidePersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKim Hunwardsen CPAPreparerPersonNm
PTINP00484560PTIN
Phone6122536500PhoneNum
Preparation2022-06-07PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

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$39,874,886GrossReceiptsAmt
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 Body8VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee290TotalEmployeeCnt
Total Volunteers121TotalVolunteersCnt
Total Gross UBI-$18,604TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$250,559PYContributionsGrantsAmt
CY Contributions Grants$6,337,086CYContributionsGrantsAmt
PY Program Service Revenue$25,726,992PYProgramServiceRevenueAmt
CY Program Service Revenue$32,955,789CYProgramServiceRevenueAmt
PY Investment Income$156,638PYInvestmentIncomeAmt
CY Investment Income$136,778CYInvestmentIncomeAmt
PY Other Revenue$299,788PYOtherRevenueAmt
CY Other Revenue$168,001CYOtherRevenueAmt
PY Total Revenue$26,433,977PYTotalRevenueAmt
CY Total Revenue$39,597,654CYTotalRevenueAmt
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$14,440,527PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$16,417,200CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$13,611,966PYOtherExpensesAmt
CY Other Expenses$16,381,093CYOtherExpensesAmt
PY Total Expenses$28,052,493PYTotalExpensesAmt
CY Total Expenses$32,798,293CYTotalExpensesAmt
PY Revenues Less Expenses-$1,618,516PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$6,799,361CYRevenuesLessExpensesAmt
Total Assets BOY$44,892,446TotalAssetsBOYAmt
Total Assets EOY$46,342,668TotalAssetsEOYAmt
Total Liabilities BOY$29,047,550TotalLiabilitiesBOYAmt
Total Liabilities EOY$23,039,318TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$15,844,896NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$23,303,350NetAssetsOrFundBalancesEOYAmt
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$26,331,809ExpenseAmt
Revenue$33,178,303RevenueAmt
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 2021, 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 151 patients in our swing bed unit, with an average length of stay of 9.7 days. 3) Provided 24 hour a day emergency room services. Our emergency room treated 5,590 patients during fiscal year 2021. 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 29,890 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 7,017 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 14,236 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 $39,000 for the year ended July 31, 2021, 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$26,331,809TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
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 Document7IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee290EmployeeCnt
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 Members8GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
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 (17 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
J Richard Schien
Chair1.000.60Yes (X)Yes (X)$0$0$0
Richard Walden
Vice Chair1.000.80Yes (X)Yes (X)$0$0$0
Ralph March
Secretary1.000.60Yes (X)Yes (X)$0$0$0
Dennis Pickrel
Treasurer1.000.60Yes (X)Yes (X)$0$0$0
Heather DeNeve
Member1.000.30Yes (X)$0$0$0
Katie Goodman-Thomas
Member1.000.30Yes (X)$0$0$0
James Salske
Member1.000.00Yes (X)$0$0$0
August Adams MD - Physician
Medical Staff President41.000.00Yes (X)$280,998$0$25,895
Michael Layfield
Interim CEO until August 202040.001.30Yes (X)$0$0$0
Brian Burnside
CEO as of August 202040.001.30Yes (X)$0$0$0
Michael Brown
CFO until December 202040.001.30Yes (X)$0$0$0
Patrick Nudo
CFO as of Decmeber 202040.001.30Yes (X)$0$0$0
Kate Wilkens MD
Primary Care Physician41.000.00$177,109$0$10,919Yes (X)
Anne Borwick DO
Internal Med & Pediatrics40.000.00$283,121$0$25,246Yes (X)
Connee Sloman
CRNA40.000.00$253,025$0$3,684Yes (X)
Lourdes Cruz MD
Pediatrician40.000.00$247,457$0$22,399Yes (X)
Thomas Hatley MD MPH
Preventative & Emergency Medicine40.000.00$199,871$0$10,454Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,441,581TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$98,597TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K14IndivRcvdGreaterThan100KCnt
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
Illinois Emergency Physicians LLP
PO Box 674579DetroitMI482674579Emergency Room Physicians$1,700,000
HealthTechS3
PO Box 636426CincinnatiOH425636426Management Services$1,007,704
Reditus
1805 Riverway DrivePekinIL61554Lab Testing$330,600
CPSI
PO Box 850309MobileAL366850309Computer Software Services$321,829
Aramark
26792 Network PlaceChicagoIL60673Laundry Service$310,736
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K11CntrctRcvdGreaterThan100KCnt
Government Grants$6,317,375GovernmentGrantsAmt
All Other Contributions$19,711AllOtherContributionsAmt
Total Contributions$6,337,086TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Patient service revenue621110$32,294,660$32,294,660
Pharmacy revenue446110$411,560$411,560

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$249,569TotalRevenueColumnAmt
Related Or Exempt Func Income$249,569RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$32,955,789TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$80,000TotalRevenueColumnAmt
Exclusion$80,000ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$222,719RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$277,232RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real-$54,513RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column-$54,513TotalRevenueColumnAmt
Unrelated Business Revenue-$18,604UnrelatedBusinessRevenueAmt
Exclusion-$35,909ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$56,778SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$56,778SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$56,778TotalRevenueColumnAmt
Exclusion$56,778ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescInsurance ProceedsDesc
Business900099BusinessCd
Total Revenue Column$222,514TotalRevenueColumnAmt
Related Or Exempt Func Income$222,514RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$222,514OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$39,597,654TotalRevenueColumnAmt
Related Or Exempt Func Income$33,178,303RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue-$18,604UnrelatedBusinessRevenueAmt
Exclusion$100,869ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$314,985TotalAmt
Program Services$314,985ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$12,829,161TotalAmt
Program Services$11,012,097ProgramServicesAmt
Management And General$1,817,064ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$365,270TotalAmt
Program Services$312,209ProgramServicesAmt
Management And General$53,061ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,978,502TotalAmt
Program Services$1,703,041ProgramServicesAmt
Management And General$275,461ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$929,282TotalAmt
Program Services$800,546ProgramServicesAmt
Management And General$128,736ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$1,013,664TotalAmt
Management And General$1,013,664ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$45,083TotalAmt
Management And General$45,083ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$105,375TotalAmt
Management And General$105,375ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$4,578,660TotalAmt
Program Services$4,315,618ProgramServicesAmt
Management And General$263,042ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$270,962TotalAmt
Program Services$40ProgramServicesAmt
Management And General$270,922ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$3,785,055TotalAmt
Program Services$2,552,176ProgramServicesAmt
Management And General$1,232,879ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$116,869TotalAmt
Management And General$116,869ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$221,965TotalAmt
Program Services$221,965ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$15,500TotalAmt
Program Services$10,570ProgramServicesAmt
Management And General$4,930ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$106,737TotalAmt
Program Services$47,195ProgramServicesAmt
Management And General$59,542ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$627,046TotalAmt
Program Services$492,298ProgramServicesAmt
Management And General$134,748ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,295,337TotalAmt
Program Services$1,782,730ProgramServicesAmt
Management And General$512,607ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$437,459TotalAmt
Program Services$70,241ProgramServicesAmt
Management And General$367,218ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Medical supplies$2,334,947$2,334,947
Food$243,602$242,398$1,204
Repairs and maintenance$110,010$93,361$16,649

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$72,822TotalAmt
Program Services$25,392ProgramServicesAmt
Management And General$47,430ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$32,798,293TotalAmt
Program Services$26,331,809ProgramServicesAmt
Management And General$6,466,484ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$16,509,391BOYAmt
EOY$16,732,260EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,870,879BOYAmt
EOY$5,082,119EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$372BOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$296,311BOYAmt
EOY$295,512EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$241,411BOYAmt
EOY$198,955EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$41,264,634LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$24,109,822LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$18,555,378BOYAmt
EOY$17,154,812EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$5,596,948BOYAmt
EOY$6,139,362EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

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

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$821,756BOYAmt
EOY$639,648EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$44,892,446BOYAmt
EOY$46,342,668EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,345,781BOYAmt
EOY$1,846,578EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$10,055,982BOYAmt
EOY$5,798,596EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$14,750,150BOYAmt
EOY$13,908,140EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$2,510,637BOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$385,000BOYAmt
EOY$1,486,004EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$29,047,550BOYAmt
EOY$23,039,318EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$15,249,140BOYAmt
EOY$22,583,702EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$595,756BOYAmt
EOY$719,648EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$15,844,896BOYAmt
EOY$23,303,350EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$44,892,446BOYAmt
EOY$46,342,668EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$6,799,361ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$535,201NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$123,892OtherChangesInNetAssetsAmt
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 B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

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$26,113,249OtherCostOrOtherBasisAmt
Depreciation$21,043,895DepreciationAmt
Book Value$5,069,354BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$11,981,480OtherCostOrOtherBasisAmt
Depreciation$1,806,327DepreciationAmt
Book Value$10,175,153BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,669,733OtherCostOrOtherBasisAmt
Depreciation$1,259,600DepreciationAmt
Book Value$1,410,133BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$17,154,812TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
Employee health claims$250,000
Estimated third-party payor settlements$1,233,260
Due to Affiliates$2,744
FieldValueIRS element (for citing)
Total Liability$1,486,004TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$40,410,087TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$535,201NetUnrealizedGainsInvstAmt
Revenue Not Reported$535,201RevenueNotReportedAmt
Revenue Subtotal$39,874,886RevenueSubtotalAmt
Other Revenues Not Included-$277,232OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt-$277,232RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$39,597,654TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$33,075,525TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$277,232OtherExpensesIncludedAmt
Expenses Not Reported$277,232ExpensesNotReportedAmt
Expenses Subtotal$32,798,293ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$32,798,293TotalExpensesPerForm990Amt

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 -277,232.
Part XII, Line 2d - Other Adjustments:Rental expenses recorded in revenue for Form 990 277,232.

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$39,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$39,000NetCommunityBenefitExpnsAmt
Total Expense0.00120TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$39,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$39,000NetCommunityBenefitExpnsAmt
Total Expense0.00120TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$7,946,988TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,747,335DirectOffsettingRevenueAmt
Net Community Benefit Expns$5,199,653NetCommunityBenefitExpnsAmt
Total Expense0.15850TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$7,946,988TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,747,335DirectOffsettingRevenueAmt
Net Community Benefit Expns$5,199,653NetCommunityBenefitExpnsAmt
Total Expense0.15850TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$7,985,988TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,747,335DirectOffsettingRevenueAmt
Net Community Benefit Expns$5,238,653NetCommunityBenefitExpnsAmt
Total Expense0.15970TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$864,712BadDebtExpenseAmt
Bad Debt Expense Attributable$201,478BadDebtExpenseAttributableAmt
Reimbursed By Medicare$10,353,713ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$10,251,200CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$102,513MedicareSurplusOrShortfallAmt

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 Conducted18CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
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 Adpt18ImplementationStrategyAdptYr
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 (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Carlinville Area Hospital AssociationPart V, Section B, Line 5: Two 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 11: A Community Health Needs Assessment was completed in fiscal year 2019. The following are the needs identified and the accomplishments for fiscal year 2021.Prioritized Needs:Obesity: Provide education and programming aimed at youth on the need for recreation, exercise, and healthy eating. The group felt that addressing this issue would also impact other issues identified as significant, including diabetes and mental health.- The walking path remained open and a video was released on social media to promote and encourage walking on the path while social distancing. - 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: Education and prevention programming for pre-diabetes and diabetes - Smoking prevention education and programs - Programs encouraging recreation and exercise at all ages.- Continue development of chronic care management with focus on diabetes, migrating toward patient centered medical home.- Develop a relationship with endocrinologist.- Continue support of MCPHD Diabetes Workshops.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. Diversion to concentrated services for persons identified with Adverse Childhood Experiences (ACES) - Continue to educate and market Senior Behavioral Health SELF Program.- Support efforts of the Macoupin Montgomery Addiction and Behavioral health Coalition.- Continue relationship with Locust Street Resource Center to help with evaluation and placement of patients.- Explore telebehavorial health crisis assessment.- Added a Social Worker to the Rural Health ClinicPreventative 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- Continue to offer and communicate information regarding CAH tuition assistance program to employees.- Continue to support the Macoupin CEO Program.- Continue to offer High School to Health Care Program.- Continue to offer clinical rotations.- Communicate scholarship opportunities available to employees.- Explore international recruitment for areas with professional shortages.- Provide Hospital tours to students. - Provide job shadowing opportunities for students. - Provide resources to local high school students regarding healthcare careers.- Explore different advertising avenues to communicate job openings.- Continue to solicit feedback from employees through employee satisfaction surveys.- Continue to monitor turnover rates and exit interview comments.
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 charity care policy is calculated based on the percentage of individuals living below the poverty level in 2021. 23.3% 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 $139,923.Medicare fee schedule revenue $ 167,367Medicare estimated costs of care relating to payments (307,291)Net (Shortage) $ (139,923)
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 third CHNA in FY 2019 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 20 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 5,543 in 2018. Unemployment was 9.90% compared to 4.2% in the state of Illinois in 2018. The median household income in Carlinville is 25% lower than the national average. The poverty level in Carlinville is 18% 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 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.The following services are typically provided but due to the covid pandemic all services and activities ceased.1. CPR training to the community for a special rate of $25 per participant.2. Free blood pressure checks in Carlinville and Palmyra on a monthly basis.3. 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.4. Food for Thought Series for seniors5. Safe Sitter class 6. High School to Healthcare Program where high school student get to explore healthcare professions. 7. 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.In prior years, 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$283,121$0$0$0$0$0$22,783$0$2,769$0$308,673$0$0$0
August Adams MD - Physician
Medical Staff President$280,998$0$0$0$0$0$23,390$0$3,860$0$308,248$0$0$0
Lourdes Cruz MD
Pediatrician$247,457$0$0$0$0$0$20,968$0$2,776$0$271,201$0$0$0
Connee Sloman
CRNA$253,025$0$0$0$0$0$1,221$0$3,810$0$258,056$0$0$0
Thomas Hatley MD MPH
Preventative & Emergency Medicine$199,871$0$0$0$0$0$10,454$0$1,417$0$211,742$0$0$0
Kate Wilkens MD
Primary Care Physician$177,109$0$0$0$0$0$10,919$0$204$0$188,232$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 uses the processes described in Part I, Question 3 to determine appropriate compensation for the CEO. The Board of Directors also approves the Organization's contract with the Management Company.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 1The 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 Brian Burnside, CEO as of August 2020 Compensation: $101,006 Michael Layfield, Interim CEO until August 2020 Compensation: $124,770 Michael Brown, CFO until December 2020 Compensation: $187,380 Patrick Nudo, CFO as of December 2020 Compensation: $28,609 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 2,485,688. Management and general expenses 58,248. Fundraising expenses 0. Total expenses 2,543,936. Professional fees: Program service expenses 1,829,930. Management and general expenses 204,794. Fundraising expenses 0. Total expenses 2,034,724.
Form 990, Part XI, line 9:Change in beneficial interest in perpetual trust 123,892.

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 12a, IMiddle 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