2022-02-15T11:49:32-06:00 2021-03-31 351178661 BLUE & CO LLC 2650 EASTPOINT PKWY SUITE 300 LOUISVILLE KY 40223 990 2020-04-01 201244058 FERRELL HOSPITAL COMMUNITY FOUNDATION FERR 6182733361 1201 PINE STREET ELDORADO IL 62930 DIRK MORGAN CFO 6182733361 2022-02-15 1 DIRK MORGAN XXX-XX-XXXX CARRIE A MERRILL CPA P00832283 5029923500 2022-02-15 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z DIRK MORGAN 1201 PINE STREET ELDORADO IL 62930 31549796 0 X WWW.FERRELLHOSP.ORG X 2004 IL OPERATE ACUTE CARE HOSPITAL - DEDICATED TO IMPROVING THE HEALTH AND QUALITY OF LIFE FOR THE PEOPLE AND COMMUNITIES WE SERVE. 10 9 327 25 0 0 688360 4554106 26187043 26789321 19766 20316 185850 186053 27081019 31549796 0 0 0 0 14421491 14876140 0 0 0 12843172 14624895 27264663 29501035 -183644 2048761 25980464 53152353 21067017 47514318 4913447 5638035 OPERATE ACUTE CARE HOSPITAL - DEDICATED TO IMPROVING THE HEALTH AND QUALITY OF LIFE FOR THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 25689742 26926907 FERRELL HOSPITAL COMMUNITY FOUNDATION (FHCF) OFFERS QUALITY HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. FHCF PROVIDES MEDICAL CARE TO OUTPATIENTS AND INPATIENTS AS WELL AS PROVIDES VARIOUS COMMUNITY BENEFITS TO THE COMMUNITY. 25689742 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 44 0 1 327 1 0 0 0 0 0 0 0 0 0 0 X 10 9 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X DIRK MORGAN 6182733361 1201 PINE STREET ELDORADO IL 62930 CLIFFORD EUGENE MORRIS CHAIRMAN 5.00 X 0 0 0 E T SEELY VICE-CHAIRMAN 5.00 X 0 0 0 BARB DEVOUS SECRETARY 2.00 X 0 0 0 NATE OLDHAM MD BOARD MEMBER/PHYSICIAN 40.00 X 420015 0 19926 JEFF CAMPBELL BOARD MEMBER 2.00 X 0 0 0 AYN BARTIK BOARD MEMBER 2.00 X 0 0 0 NIKKI ROSER BOARD MEMBER 2.00 X 0 0 0 JARED FLORENCE BOARD MEMBER 2.00 X 0 0 0 DR JAMES PORTER BOARD MEMBER 2.00 X 0 0 0 AUSTIN RAHMOELLER BOARD MEMBER 2.00 X 0 0 0 RACHEL PRATHER CHIEF NURSING OFFICER 40.00 X 90680 0 15484 CALEIGH BRUCE CHIEF COMPLIANCE OFFICER 40.00 X 80128 0 2826 ALISA COLEMAN CEO 50.00 X 0 0 0 DIRK MORGAN CFO 50.00 X 0 0 0 JOSEPH A JACKSON MD PHYSICIAN 40.00 X 508303 0 20112 JANNA PATHI MD SURGEON 30.00 X 451638 0 6480 LUKE HALL PHYSICIAN 40.00 X 265653 0 15507 CALEB MITCHELL DO PHYSICIAN 40.00 X 277050 0 21113 CARY HANNI SURGEON 40.00 X 176361 0 0 2269828 0 101448 18 0 1 0 DEACONESS REGIONAL HEALTHCARE SERVICES 600 MARY ST EVANSVILLE IN 47747 ER PHYSICIANS, MANAGEMENT FEES 1714665 CROSSROADS EMERGENCY PHYSICIANS PO BOX 677979 DALLAS TX 75267 ER PHYSICIANS 1556401 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH ST CHICAGO IL 606015099 MEDICAL PLAN 1100377 PROGRESSIVE HEALTH OF INDIANA LLC PO BOX 6890 EVANSVILLE IN 47719 PHYSICAL AND OCCUPATIONAL THERAPIST 566517 SYSTEMS SOLUTIONS 110 CARLISLE COURT PADUCAH KY 42001 INFORMATION TECHNOLOGY SYSTEMS 393498 10 69301 4292892 191913 4554106 NET PATIENT SERVICE REVENUE 621110 24043284 24043284 340B INCOME 621110 2746037 2746037 26789321 20316 20316 9120 0 9120 9120 9120 0 69301 0 0 REBATES AND MISCELLANEOUS INCOME 900099 137586 137586 EMPLOYEE CAFETERIA 722210 39347 39347 176933 31549796 26926907 0 68783 X 189118 156476 32642 12583537 10411618 2171919 163755 137317 26438 1116220 936010 180210 823510 690557 132953 1020000 856800 163200 6542849 6327554 215295 79015 79015 565771 430302 135469 500380 386524 113856 79417 78533 884 401782 357259 44523 1212910 761489 451421 215310 155386 59924 MEDICAL SUPPLIES & DRUG 2814351 2814351 PROVIDER TAX 558609 558609 FOOD 127577 126157 1420 DUES & SUBSCRIPTIONS 79115 78235 880 427809 426565 1244 29501035 25689742 3811293 0 2138993 2139158 993853 12619462 2340595 1789306 289480 519435 217761 309162 40413619 7863140 16837117 32550479 1884310 1278355 3225351 25980464 53152353 3124158 7423527 6381563 13977364 30106133 3965495 3603095 21067017 47514318 X 4913447 5638035 4913447 5638035 25980464 53152353 2048761 -1324173 0 X X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10099 10099 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO IHA AND AHA ANNUALLY. 37% AND 25.56% OF THESE DUES ARE USED FOR LOBBYING. 188327 188327 9422664 2077561 7345103 43892 42956 936 29775032 5742623 24032409 983704 983704 32550479 OTHER RECEIVABLES 787883 THIRD PARTY PAYOR 2437468 3225351 X PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL, AND HAS CONCLUDED THAT AS OF MARCH 31, 2021 AND 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. NAMING RIGHTS 69301 69301 69301 69301 SCHEDULE G, PART II DUE TO COVID, THERE WERE NO PHYSICAL FUNDRAISERS FOR THE FY 2020. FERRELL HOSPITAL COMMUNITY FOUNDATION HELD A CAMPAIGN TO RAISE MONEY FOR DONORS TO NAME AREAS OF THE HOSPITAL. 1 1 1 X 1 X 1 1 0 1 1 411157 1379757 0 0.00000 4322990 2559190 1763800 0.05980 4734147 3938947 1763800 0.05980 4734147 3938947 1763800 0.05980 1 2489811 0 9023007 11624546 -2601539 X 1 1 1 1 FERRELL HOSPITAL COMMUNITY FOUNDATION 1201 PINE STREET ELDORADO IL 62930 FERRELLHOSP.ORG 0005363 X X X X FERRELL HOSPITAL COMMUNITY 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE WEBSITE ADDRESS LISTED IN PART V, SECTION B, LINE 7D. X X 1 18 1 SEE WEBSITE ADDRESS LISTED IN PART V, SECTION B, LINE 7D. 0 1 X 200.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X HTTPS://FERRELLHOSP.ORG/FOR-YOU/PATIENTS-VISITORS/PATIENTS/FINANCIAL-ASSIST X HTTPS://FERRELLHOSP.ORG/FOR-YOU/PATIENTS-VISITORS/PATIENTS/FINANCIAL-ASSIST X HTTPS://FERRELLHOSP.ORG/FOR-YOU/PATIENTS-VISITORS/PATIENTS/FINANCIAL-ASSIST X X X X 1 X 0 X X X X 1 X 0 0 FERRELL HOSPITAL COMMUNITY PART V, SECTION B, LINE 5: FERRELL HOSPITAL LED THE PLANNING, IMPLEMENTATION, AND COMPLETION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT THROUGH A CONSULTING ARRANGEMENT WITH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK. TERRY MADSEN, AN ICAHN CONSULTANT, ATTORNEY, FORMER EDUCATOR, AND COMMUNITY DEVELOPMENT SPECIALIST, CONFERENCED WITH HOSPITALEXECUTIVE STAFF TO DEFINE THE COMMUNITY, SCOPE OF THE PROJECT, AND SPECIAL NEEDS AND CONCERNS. AN INTERNAL WORKING GROUP, POSSIBLE LOCAL SOURCES FOR SECONDARY DATA AND KEY EXTERNAL CONTACTS WERE IDENTIFIED, AND A TIMELINE WAS ESTABLISHED.INTERNAL -FERRELL HOSPITAL UNDERTOOK A FOUR-MONTH PLANNING AND IMPLEMENTATION EFFORT TO DEVELOP THE CHNA, AND TO IDENTIFY AND PRIORITIZE COMMUNITY HEALTH NEEDS FOR ITS SERVICE AREA. THESE PLANNING AND DEVELOPMENT ACTIVITIES INCLUDED THE FOLLOWING STEPS: THE PROJECT WAS OVERSEEN AT THE OPERATIONAL LEVEL BY THE DIRECTOR OF COMMUNITY EDUCATION, REPORTING DIRECTLY TO THE CEO. ARRANGEMENTS WERE MADE WITH ICAHN TO FACILITATE THREE FOCUS GROUPS AND A MEETING TO IDENTIFY AND PRIORITIZE SIGNIFICANT NEEDS. ICAHN WAS ALSO ENGAGED TO COLLECT, ANALYZE, AND PRESENT SECONDARY DATA AND TO PREPARE A FINAL REPORT FOR SUBMISSION TO FERRELL HOSPITAL. THE DIRECTOR OF COMMUNITY EDUCATION WORKED CLOSELY WITH ICAHN'S CONSULTANT TO IDENTIFY AND ENGAGE KEY COMMUNITY PARTNERS AND TO COORDINATE LOCAL MEETINGS AND GROUP ACTIVITIES.EXTERNAL- FERRELL HOSPITAL ALSO LEVERAGED EXISTING RELATIONSHIPS THAT PROVIDED DIVERSE INPUT FOR A COMPREHENSIVE REVIEW AND ANALYSIS OF COMMUNITY HEALTH NEEDS IN THE HOSPITAL'S SERVICE AREA. THESE STEPS INCLUDED: THE DIRECTOR OF COMMUNITY EDUCATION SECURED THE PARTICIPATION OF A DIVERSE GROUP OF REPRESENTATIVES FROM THE COMMUNITY AND THE HEALTH PROFESSION. ICAHN'S CONSULTANT PROVIDED SECONDARY DATA FROM MULTIPLE SOURCES SET OUT BELOW IN SECTION III. DATA COLLECTION AND ANALYSIS. PARTICIPATION INCLUDED REPRESENTATIVES OF COUNTY HEALTH DEPARTMENTS SERVING THE AREA SERVED BY THE HOSPITAL. FERRELL HOSPITAL COMMUNITY PART V, SECTION B, LINE 7D: HTTPS://WWW.FERRELLHOSP.ORG/ABOUT-US/DOCUMENTS-ABOUT-US/HOME-PAGE-LINK-COMMUNITY-HEALTH-NEEDS-ASSESSMENT-7 FERRELL HOSPITAL COMMUNITY PART V, SECTION B, LINE 11: THE HEALTH PROFILE OF THE FERRELL HOSPITAL'S SERVICE AREA IS INFLUENCED BY THE FOLLOWING INDICATORS OF SOCIAL DETERMINANTS OF HEALTH: POVERTY - CHILDREN LIVING IN POVERTY POVERTY - POPULATION BELOW 100% OF FEDERAL POVERTY LEVEL BUILT ENVIRONMENT - RECREATION AND FITNESS FACILITY ACCESSTHE NEEDS IDENTIFIED AND PRIORITIZED THROUGH THE CHNA CARRIED FORWARD VARIANTS OF PREVIOUS CHNAS AND ADDED OTHERS. THE IDENTIFIED AND PRIORITIZED NEEDS SELECTED INCLUDE:1. EXPLORING THE CAUSES OF CHRONIC ILLNESS AND IMPROVING EARLY IDENTIFICATION THROUGH SCREENINGS AND OTHER METHODS, ESPECIALLY CANCER AND HEART DISEASE.2. EDUCATION AND GUIDANCE FOR SENIORS ON THE TOPICS OF MEDICARE, SENIOR WELLNESS, AND OTHER HEALTH SERVICES FOR OLDER ADULTS.3. MENTAL HEALTH, WITH SPECIFIC REFERENCE TO THE FOLLOWING IDENTIFIED NEEDS: -AN ATTEMPT TO ADDRESS THE LOCAL SHORTAGE OF MENTAL HEALTH SERVICES PROVIDERS, INCLUDING THE NEED TO IMPROVE LOCAL ACCESS TO PHYSICIANS- IMPROVED AVAILABILITY OF MENTAL HEALTH AND SUBSTANCE USE AND MISUSE TREATMENT BEDS, BOTH LOCAL AND TRANSFER- IMPROVED ACCESS TO LOCAL MENTAL HEALTH SERVICES IN GENERAL FOR PERSONS SUFFERING DEPRESSION AND OTHER SITUATIONAL CONDITIONS INFLUENCED ESPECIALLY BY TRAUMA AND/OR POVERTY- LOCAL ACCESS TO MEDICATION-ASSISTED TREATMENT FOR OPIOID USE DISORDER AND OTHER SUBSTANCES4. ADDRESSING TEEN BIRTH RATE, LOW BIRTH WEIGHT, AND INFANT MORTALITY THROUGH EDUCATION AND ACCESS TO CARE5. LOCAL ACCESS TO DENTAL CARE, ESPECIALLY FOR PERSONS ON MEDICAID.HOSPITAL PERSONNEL AND COMMUNITY ADVISORS MEET TO EVALUATE THE FINDINGS IN THE CHNA AND ASSESS THE PERFORMANCE OF THE HOSPITAL IN EACH OF THE TARGETED AREAS. MANAGEMENT MONITORS PROGRESS AND DEVOTES RESOURCES TO THE ACCOMPLISHMENT OF IDENTIFIED PLANS TO MEET THE NEEDS IDENTIFIED. FERRELL HOSPITAL COMMUNITY PART V, SECTION B, LINE 23: THE HOSPITAL CHARGES THE SAME AMOUNT FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE FOR FAP-ELIGIBLE PATIENTS AND ALL OTHER PATIENTS. 3 1 - FERRELL HOSPITAL FAMILY PRACTICE 1036 MAPLE STREET ELDORADO IL 62930 RURAL HEALTH CLINIC 2 - ELDORADO FAMILY MEDICINE 1407 LOCUST STREET ELDORADO IL 62930 RURAL HEALTH CLINIC 3 - CARMI FAMILY MEDICINE 1340 IL HWY 1 SUITE A CARMI IL 62821 RURAL HEALTH CLINIC PART I, LINE 7: THE HOSPITAL USED A COST TO CHARGE RATIO AS CALCULATED FROM WORKSHEET 2; RATIO OF PATIENT CARE COST TO CHARGES INCLUDED IN THE SCHEDULE H INSTRUCTIONS TO DETERMINE THE AMOUNTS ON LINE 7A OF PART 1 OF SCHEDULE H. PART II, COMMUNITY BUILDING ACTIVITIES: FERRELL HOSPITAL COMMUNITY FOUNDATION OFFERS VARIOUS BENEFITS TO THE COMMUNITY INCLUDING BUT NOT LIMITED TO CPR/FIRST AID, PARTICIPATION IN THE SALINE COUNTY HEALTHY COALITION, PARTICIPATION IN HEALTH FAIRS AT LOCAL HIGH SCHOOLS AND COLLEGES, POISON PREVENTION AND HEALTH CARE CAREER PRESENTATIONS TO LOCAL SCHOOLS, PROVIDE TOURS OF THE HOSPITAL, HOLD FLU VACCINATION CLINICS, PERIODIC BLOOD PRESSURE AND GLUCOSE SCREENINGS, SPEAKING ENGAGEMENTS FOR COMMUNITY ORGANIZATIONS, CO-SPONSOR THE KIDNEY MOBILE, SPONSOR THE LOCAL HIGH SCHOOL PROM, PARTICIPATE IN THE RELAY FOR LIFE, SPONSOR FUNCTIONS AT THE LOCAL SENIOR CITIZENS CENTER, HOLD WELLNESS WORKSHOPS, PROVIDE A TRAINER FOR THE LOCAL HIGH SCHOOL SPORTS TEAMS, PROVIDE FIRST AID KITS FOR LOCAL SPORTS TEAMS, PROVIDE CLOTHING FOR DOMESTIC ABUSE VICTIMS AND PARTICIPATE IN THE SAFE HAVEN PROGRAM. PART III, LINE 2: THE BAD DEBT EXPENSE IS FROM THE TRIAL BALANCE. SEE ATTACHED PY FINANCIAL STMT PAGES 7 & 8 FOR METHODOLOGY. PART III, LINE 3: FINANCIAL ASSISTANCE COUNSELORS ARE IN PLACE TO CONTACT ANY PATIENT EXPRESSING INTEREST IN THE PROGRAM. PROCEDURES ARE IN PLACE TO MAKE DETERMINATIONS OF ALL PATIENTS' ELIGIBILITY AND TO PROVIDE THE APPROPRIATE ASSISTANCE. PART III, LINE 4: SEE THE PAGES 7 & 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENT. PART III, LINE 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE REVENUE AND ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, LINE 8: THE MEDICARE TOTAL REVENUE AND ALLOWABLE COSTS WERE BASED ON THE 2020 MEDICARE COST REPORT. THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT DUE TO THE HOSPTIAL PROVIDING CARE TO MEDICARE PATIENTS AT LESS THAN THE ALLOWABLE MEDICARE COSTS. PART III, LINE 9B: FERRELL HOSPITAL COMMUNITY FOUNDATION PROVIDES ASSISTANCE TO MEET THE NEEDS OF THE UNINSURED PATIENTS TO WHICH THEY SERVE. FOR THOSE PATIENTS WHO ARE EXPECTED TO QUALIFY UNDER THEIR FINANCIAL ASSISTANCE POLICY, THE HOSPITAL ASSIGNS THE FINANCIAL CARRIER FOR CHARITY CARE AT THE TIME OF THE REQUEST FOR THE HEALTH ASSISTANCE PROGRAM (HAP) APPLICATION. ONCE ASSIGNED, SEVERAL PROCEDURES ARE IN PLACE TO COMPLETE THE PROCESS INCLUDING INVESTIGATION FOR ANY OTHER AVAILABLE FUNDING SOURCES SUCH AS MEDICAID AND INCOME VERIFICATION. THOSE THAT COMPLETE THE HAP ACCURATELY AND QUALIFY UNDER THE HOSPITALS POLICY RECEIVE FREE OR DISCOUNTED CARE. PART VI, LINE 2: FCHF IS INVOLVED IN COMMUNITY ORGANIZATIONS, INCLUDING CHURCHES, CIVIC GROUPS AND PROFESSIONAL ORGANIZATIONS. PART VI, LINE 3: OUR FINANCIAL ASSISTANCE PROGRAM IS EASILY ACCESSED THROUGH OUR WEBSITE AND HAS THE FORMS LISTED FOR THE PATIENT TO PRINT OFF IF NEEDED. THE CONTACT PHONE NUMBERS OF OUR FINANCIAL COUNSELORS ARE ALSO LISTED. THERE ARE FERRELL HOSPITAL FINANCIAL ASSISTANCE BROUCHURES IN THE LOBBY AREAS OF THE HOSPITAL. ALL SELF PAY PATIENTS IN THE HOSPITAL ARE VISITED BY THE FINANCIAL COUNSELOR AND GIVEN THE NECESSARY PAPERWORK IF THE PATIENT REQUESTS IT. IF THE FINANCIAL COUNSELOR DOES NOT GET TO SEE THE PATIENT OR FAMILY, THEN A LETTER IS MAILED ALONG WITH THE APPLICATION TO THE PATIENT. UPON REGISTRATION OF THE PATIENT, THE REGISTRATION STAFF INFORMS THE PATIENT OF THE HOSPITAL FINANCIAL ASSISTANCE PROGRAMS AND GIVES THEM A BROCHURE. IF THE PATIENT REQUESTS TO TALK TO THE FINANCIAL COUNSELOR THEN THAT PERSON IS CALLED. PART VI, LINE 4: THE MAJORITY OF FERRELL HOSPITAL PATIENTS RESIDE IN SALINE, GALLATIN, WHITE AND HAMILTON COUNTIES. WE ALSO SEE SEVERAL PATIENTS FROM POPE AND HARDIN COUNTIES. OUR FACILITIES ARE LOCATED IN SALINE AND GALLATIN COUNTIES. THE UNEMPLOYMENT RATE AND POVERTY RATE OF THESE COUNTIES ARE HIGHER THAN THE NATIONAL AVERAGE AND VERY CLOSE TO THE STATE OF ILLINOIS AVERAGE. THE PAYER MIX IS HEAVILY MEDICAID/MEDICARE DEPENDENT. PART VI, LINE 7, REPORTS FILED WITH STATES IL 0 0 0 0 0 0 0 1 0 NATE OLDHAM MD BOARD MEMBER/PHYSICIAN 324722 0 95293 0 0 0 7446 0 12480 0 439941 0 0 0 JOSEPH A JACKSON MD PHYSICIAN 361197 0 147106 0 0 0 7632 0 12480 0 528415 0 0 0 JANNA PATHI MD SURGEON 451638 0 0 0 0 0 0 0 6480 0 458118 0 0 0 LUKE HALL PHYSICIAN 265653 0 0 0 0 0 6483 0 9024 0 281160 0 0 0 CALEB MITCHELL DO PHYSICIAN 262957 0 14093 0 0 0 6089 0 15024 0 298163 0 0 0 CARY HANNI SURGEON 115161 0 61200 0 0 0 0 0 0 0 176361 0 0 0 PART I, LINE 7 PHYSICIANS ARE ELIGIBLE FOR INCENTIVE COMPENSATION. THE PHYSICIAN IS COMPENSATED FOR EACH WORK RVU PERFORMED BY A PHYSICIAN IN A YEAR IN EXCESS OF THE PHYSICIAN'S WORK RVU INCENTIVE THRESHOLD FOR THE YEAR. A ILLINOIS FINANCE AUTHORITY 861091967 2019-03-27 33260000 CONSTRUCTION AND EQUIPMENT FOR NEW HOSPITAL 0 0 0 A 32951953 510877 809783 308047 30557212 766034 2020 0 0 0 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 2 GENE MORRIS AND DR. NATE OLDHAM HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 EFFECTIVE JANUARY 1, 2016, THE HOSPITAL ENTERED INTO A FIVE-YEAR MANAGEMENT SERVICES AGREEMENT. MANAGEMENT SERVICES PROVIDED TO THE HOSPITAL CONSIST OF MANAGEMENT PERSONNEL INCLUDING A CEO AND CFO, FACILITY PLANNING, STRATEGIC PLANNING, RECRUITING, AND SEVERAL OTHER SUPPORT AND OVERSIGHT SERVICES. THE INITIAL TERM OF THE AGREEMENT IS FOR A FIVE-YEAR PERIOD, WHICH CAN BE EXTENDED BEYOND THE INITIAL FIVE-YEAR PERIOD, IF SO DESIRED. THE AGREEMENT CAN BE TERMINATED BY EITHER PARTY WITH A ONE HUNDRED AND EIGHTY DAY NOTICE WITHOUT RECOURSE SUBSEQUENT TO THE INITIAL FIVE-YEAR TERM. IF THE AGREEMENT IS TERMINATED BY THE HOSPITAL WITHIN THE INITIAL FIVE YEAR TERM OF THE AGREEMENT, THE HOSPITAL WILL BE ASSESSED A PENALTY IN THE AMOUNT OF $500,000 TO BE PAYABLE TO THE MANAGEMENT SERVICE ORGANIZATION. THE HOSPITAL WILL REIMBURSE THE MANAGEMENT SERVICE PROVIDER THE ACTUAL COST OF PROVIDING THE MANAGEMENT SERVICES ON A MONTHLY BASIS FOR THE YEARS ENDED MARCH 31, 2021 AND 2020, MANAGEMENT FEES INCURRED WERE $120,000 PER YEAR DURING THE 2020 YEAR, A PORTION OF COST REPORT PROCEEDS TOTALING $833,400 AND THE FOLLOWING INDIVIDUALS WERE COMPENSATED BY THE MANAGEMENT SERVICE PROVIDER: ALISA COLEMAN, CHIEF EXECUTIVE OFFICER AND DIRK MORGAN, CHIEF FINANCIAL OFFICER TOTALING $590,855. FORM 990, PART VI, SECTION B, LINE 11B THE CEO AND CFO REVIEW THE COMPLETED FORM 990 AS PREPARED BY THE PAID PROVIDER FOR COMPLETENESS AND ACCURACY. THE BOARD CHAIR AND THE CEO AND CFO SUBMIT THE FORM TO THE BOARD FOR FINAL APPROVAL IMMEDIATELY PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C COPIES OF THE CONFLICT OF INTEREST POLICY ARE PROVIDED TO EACH DIRECTOR, OFFICER, AND MANAGEMENT PERSON AT LEAST ONCE PER YEAR, WITH REQUIREMENT THAT THEY COMPLETE A CERTIFICATE. THE CERTIFICATE CONFIRMS THAT THEY UNDERSTAND THIS POLICY, AGREE TO COMPLY, INDICATE ANY KNOWN CONFLICTS, AND HAVE NO KNOWLEDGE OF ANY ADDITIONAL VIOLATIONS OF THE POLICY. ANY PERSON WITH A CONFLICT IS REQUIRED TO COMPLETE A SPECIFIC DISCLOSURE NOTICE. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S SALARY WAS DETERMINED BY COMPARISON WITH PRIOR PERSONS EMPLOYED IN THE POSITION, INDUSTRY COMPARISONS, RELATIVE EXPERIENCE AND KNOWLEDGE. THE CEO'S SALARY WAS APPROVED BY THE BOARD OF DIRECTORS. ALL DELIBERATIONS ARE INCLUDED IN BOARD MINUTES. THIS PROCESS WAS LAST COMPLETED IN 2016. THE CFO'S SALARY WAS DETERMINED AND APPROVED IN THE SAME MANNER AS THE CEO'S SALARY. ALL OTHER EXECUTIVE SALARIES ARE APPROVED BY EXECUTIVE MANAGEMENT AND ANALYZED BASED ON INDUSTRY COMPARATIVE DATA AND POSITION DESCRIPTIONS, COMMENSURATE EXPERIENCE, EXPERTISE AND TRAINING. THIS PROCESS WAS LAST COMPLETED IN 2016. FORM 990, PART VI, SECTION C, LINE 19 FERRELL HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND FEDERAL FORM 990 TAX RETURNS ARE AVAILABLE TO THE PUBLIC BY REQUEST. FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,504,725. MANAGEMENT AND GENERAL EXPENSES 164,097. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,668,822. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,822,829. MANAGEMENT AND GENERAL EXPENSES 51,198. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,874,027. FORM 990, PART XI, LINE 2C, AUDIT OVERSIGHT THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990 PART XII AUDITED FINANCIAL STATEMENTS ARE IN PROCESS BUT HAVE NOT BEEN ISSUED FOR THE PERIOD ENDED MARCH 31, 2021. WE HAVE ATTACHED THE PRIOR YEAR AUDITED FINANCIAL STATEMENTS TO THIS TAX RETURN.