2022-06-14T10:41:31-05:00 2021-07-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2020-08-01 370645239 Carlinville Area Hospital Association CARL 2178543141 20733 North Broad Street Carlinville IL 62626 Brian Burnside CEO 2178543141 2022-06-10 1 Brian Burnside 999009999 Kim Hunwardsen CPA P00484560 6122536500 2022-06-07 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Brian Burnside 20733 North Broad Street Carlinville IL 62626 39874886 0 X www.cahcare.com X 1947 IL Provide quality acute and preventative health care benefits 8 7 290 121 -18604 0 250559 6337086 25726992 32955789 156638 136778 299788 168001 26433977 39597654 0 0 0 0 14440527 16417200 0 0 0 13611966 16381093 28052493 32798293 -1618516 6799361 44892446 46342668 29047550 23039318 15844896 23303350 X To 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. 0 0 26331809 33178303 Carlinville 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. 26331809 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 7 0 1 290 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 8 7 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X Paul Courtney 2178543857 20733 North Broad Street Carlinville IL 62626 J Richard Schien Chair 1.00 0.60 X X 0 0 0 Richard Walden Vice Chair 1.00 0.80 X X 0 0 0 Ralph March Secretary 1.00 0.60 X X 0 0 0 Dennis Pickrel Treasurer 1.00 0.60 X X 0 0 0 Heather DeNeve Member 1.00 0.30 X 0 0 0 Katie Goodman-Thomas Member 1.00 0.30 X 0 0 0 James Salske Member 1.00 0.00 X 0 0 0 August Adams MD - Physician Medical Staff President 41.00 0.00 X 280998 0 25895 Michael Layfield Interim CEO until August 2020 40.00 1.30 X 0 0 0 Brian Burnside CEO as of August 2020 40.00 1.30 X 0 0 0 Michael Brown CFO until December 2020 40.00 1.30 X 0 0 0 Patrick Nudo CFO as of Decmeber 2020 40.00 1.30 X 0 0 0 Kate Wilkens MD Primary Care Physician 41.00 0.00 X 177109 0 10919 Anne Borwick DO Internal Med & Pediatrics 40.00 0.00 X 283121 0 25246 Connee Sloman CRNA 40.00 0.00 X 253025 0 3684 Lourdes Cruz MD Pediatrician 40.00 0.00 X 247457 0 22399 Thomas Hatley MD MPH Preventative & Emergency Medicine 40.00 0.00 X 199871 0 10454 1441581 0 98597 14 0 1 0 Illinois Emergency Physicians LLP PO Box 674579 Detroit MI 482674579 Emergency Room Physicians 1700000 HealthTechS3 PO Box 636426 Cincinnati OH 425636426 Management Services 1007704 Reditus 1805 Riverway Drive Pekin IL 61554 Lab Testing 330600 CPSI PO Box 850309 Mobile AL 366850309 Computer Software Services 321829 Aramark 26792 Network Place Chicago IL 60673 Laundry Service 310736 11 6317375 19711 6337086 Patient service revenue 621110 32294660 32294660 Pharmacy revenue 446110 411560 411560 249569 249569 32955789 80000 80000 222719 277232 -54513 -54513 -18604 -35909 56778 0 56778 56778 56778 Insurance Proceeds 900099 222514 222514 222514 39597654 33178303 -18604 100869 X 314985 314985 12829161 11012097 1817064 365270 312209 53061 1978502 1703041 275461 929282 800546 128736 1013664 1013664 45083 45083 105375 105375 4578660 4315618 263042 270962 40 270922 3785055 2552176 1232879 116869 116869 221965 221965 15500 10570 4930 106737 47195 59542 627046 492298 134748 2295337 1782730 512607 437459 70241 367218 Medical supplies 2334947 2334947 Food 243602 242398 1204 Repairs and maintenance 110010 93361 16649 72822 25392 47430 32798293 26331809 6466484 0 16509391 16732260 2870879 5082119 372 296311 295512 241411 198955 41264634 24109822 18555378 17154812 5596948 6139362 100000 821756 639648 44892446 46342668 1345781 1846578 10055982 5798596 14750150 13908140 2510637 385000 1486004 29047550 23039318 X 15249140 22583702 595756 719648 15844896 23303350 44892446 46342668 X 6799361 535201 123892 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 500172 500172 26113249 21043895 5069354 11981480 1806327 10175153 2669733 1259600 1410133 17154812 Employee health claims 250000 Estimated third-party payor settlements 1233260 Due to Affiliates 2744 1486004 X 40410087 535201 535201 39874886 -277232 -277232 39597654 33075525 277232 277232 32798293 0 32798293 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. 1 1 X 1 X 125.000000000000 1 X 1 1 0 0 39000 39000 0.00120 39000 39000 0.00120 7946988 2747335 5199653 0.15850 7946988 2747335 5199653 0.15850 7985988 2747335 5238653 0.15970 1 864712 201478 10353713 10251200 102513 X 1 1 1 1 Carlinville Area Hospital Association 20733 North Broad Street Carlinville IL 62626 www.cahcare.com 0005686 X X X X 2 provider based RHCs and 1 provider based clinic Carlinville Area Hospital Association 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X https://www.cahcare.com/ X 1 18 1 https://www.cahcare.com/ 0 1 X 125.000000000000 300.000000000000 X X X 1 1 X X X X 1 X www.cahcare.com/financial-information/ X www.cahcare.com/financial-information/ X www.cahcare.com/financial-information/ X X X X X X 1 X 0 X X X X 1 X 0 1 Carlinville Area Hospital Association Part 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 Association Part 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 Association Part 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 Association Part 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. 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 States IL 0 0 0 0 0 0 0 0 0 Anne Borwick DO Internal Med & Pediatrics 283121 0 0 0 0 0 22783 0 2769 0 308673 0 0 0 August Adams MD - Physician Medical Staff President 280998 0 0 0 0 0 23390 0 3860 0 308248 0 0 0 Lourdes Cruz MD Pediatrician 247457 0 0 0 0 0 20968 0 2776 0 271201 0 0 0 Connee Sloman CRNA 253025 0 0 0 0 0 1221 0 3810 0 258056 0 0 0 Thomas Hatley MD MPH Preventative & Emergency Medicine 199871 0 0 0 0 0 10454 0 1417 0 211742 0 0 0 Kate Wilkens MD Primary Care Physician 177109 0 0 0 0 0 10919 0 204 0 188232 0 0 0 Schedule J, Part I, Question 3: Carlinville 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. Form 990, Part VI, Section A, line 1 The 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 2 J. 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 3 Management 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 6 The Organization's sole member is Middle Macoupin Health Care Systems. Form 990, Part VI, Section A, line 7a The 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 7b The 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 11b The 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 12c Any 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 15 The 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 19 The 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 11g Purchased 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. Carlinville Area Hospital Foundation 20733 North Broad Street Carlinville IL 62626 371193348 Support Carlinville Area Hospital Association IL 501(c)(3) Line 12a, I Middle Macoupin Healthcare Systems 0 Middle Macoupin Healthcare Systems 20733 North Broad Street Carlinville IL 62626 371193396 Provide support and benefit Carlinville Area Hospital Association IL 501(c)(3) Line 12c, III-FI N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0