2021-02-08T06:35:06-06:00 2020-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2019-07-01 370673506 GRAHAM HOSPITAL ASSOCIATION GRAH 3096475240 210 WEST WALNUT CANTON IL 61520 ROBERT G SENNEFF PRESIDENT AND CEO 3096475240 2021-01-27 1 MICHAEL J PETERSON CPA P01833529 2187224705 2021-01-27 2019 2022-09-23 18:48:47Z ROBERT G SENNEFF 210 WEST WALNUT CANTON IL 61520 151977032 0 X WWW.GRAHAMHOSPITAL.ORG X 1905 IL TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES, IN A RESPONSIBLE AND CHARITABLE MANNER, TO THE PEOPLE AND COMMUNITIES WE SERVE. 13 12 852 74 232043 0 399717 70713 85089299 94803032 3397555 3566207 929030 121840 89815601 98561792 0 82500 0 0 44648460 42342282 0 0 0 43680585 50144640 88329045 92569422 1486556 5992370 194646676 225591552 61596588 91941161 133050088 133650391 X TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES, IN A RESPONSIBLE AND CHARITABLE MANNER, TO THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 38495304 82500 47877204 GRAHAM HOSPITAL IS A PROVIDER OF HEALTHCARE SERVICES IN FULTON COUNTY, ELMWOOD AND SURROUNDING AREAS. DURING THIS REPORTING PERIOD, 2,376 ADULTS AND CHILDREN WERE ADMITTED AND 223 BABIES WERE BORN. THEY RECEIVED INPATIENT SERVICES IN THE ACUTE CARE FACILITY. 230 PATIENTS WERE ADMITTED FOR 8,191 DAYS OF SERVICE IN THE EXTENDED CARE FACILITY. 97,648 OUTPATIENT SERVICES WERE PROVIDED. 19917618 24771850 SURGICAL SERVICES - THE HOSPITAL PERFORMED 548 INPATIENT SURGERIES AND 3,125 OUTPATIENT SURGERIES IN FISCAL YEAR 2020. 11498748 14301171 GRAHAM MEDICAL GROUP WHICH PROVIDES PHYSICIAN AND PROFESSIONAL HEALTH CARE SERVICES TO THE PATIENTS IN FULTON COUNTY AND ELMWOOD, ILLINOIS. THIS INCLUDES CHARITY CARE TO QUALIFIED INDIVIDUALS AND 92,794 OFFICE VISITS AND 12,199 NURSING HOME AND HOSPITAL VISITS. 6127418 7620764 ED PROGRAM(MISSING PROGRAM DESCRIPTION) 6127418 7620764 76039088 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 73 0 852 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X ROBERT SENNEFF 3096475240 210 WEST WALNUT CANTON IL 61520 BRENT PARRY DPM PODIATRIST 36.00 X 469284 0 44306 JULIO RAMOS MD PHYSICIAN 36.00 X 408111 0 20066 DEVASHISH AGARWAL MD PHYSICIAN 36.00 X 375613 0 45223 JEFFREY HEMP MD PHYSICIAN 36.00 X 295503 0 42607 JOHN QUINONES DO PHYSICIAN 36.00 X 234179 0 0 KEITH IFFT MD ANESTHESIOLOGIST MEDICAL DIRECTOR 36.00 X 429152 0 61033 DWAYNE BERNARD MD MEDICAL DIRECTOR 36.00 X 415312 0 48566 ANDREW ROUDEBUSH DO WOUND CLINIC DIRECTOR 36.00 X 288287 0 41827 ROBERT SENNEFF PRESIDENT/CEO 40.00 X X 677924 0 88444 JULIE REEDER VP FINANCE/CFO 40.00 X 206362 0 50782 HOLLY HENLINE VP ANCILLARY/CCO 40.00 X 196460 0 67782 JAMES SCHREINER VP INFO SERVICES 40.00 X 222455 0 36199 TERESA MCCONKEY VP PATIENT SERVICES 40.00 X 220710 0 37674 ALLISON SOURS VP QUALITY 40.00 X 165133 0 27622 MICHELLE DALY VP CLINIC SERVICES 40.00 X 141766 0 30813 MIKE RENNER CHAIRMAN 2.00 X X 0 0 0 ROBERT BOBELL OD VICE CHAIRMAN 2.00 X X 0 0 0 JANIS BLOUT SECRETARY 2.00 X X 0 0 0 BILL CARLBERG TRUSTEE 2.00 X X 0 0 0 BROOKE DENNISTON TRUSTEE (THRU DECEMBER) 2.00 X 0 0 0 PAULA GRIGSBY TRUSTEE 2.00 X 0 0 0 DONALD HACKETT TRUSTEE (THRU DECEMBER) 2.00 X 0 0 0 ANNE HOLLIS TRUSTEE 2.00 X 0 0 0 ELIZABETH JAMES TRUSTEE 2.00 X 0 0 0 KENNETH KROCK MD TRUSTEE 2.00 X 0 0 0 KEVIN MEADE TRUSTEE 2.00 X 0 0 0 MARION KUZNIAR TRUSTEE (THRU DECEMBER) 2.00 X 0 0 0 JOSHUA MILLER TRUSTEE 2.00 X 0 0 0 TERRY MOSS TRUSTEE 2.00 X 0 0 0 PATRICK RENICK MD TRUSTEE 2.00 X 0 0 0 4746251 0 642944 15 0 1 0 COLEMAN MEDICAL ASSOCIATES 180 SOUTH MAIN STREET CANTON IL 61520 PHYSICIAN SERVICES 8235071 PJ HOERR INC 107 W COMMERCE PEORIA IL 61604 CONSTRUCTION 2683973 ENDURACARE ACUTE CARE SERVICES PO BOX 654072 DALLAS TX 75265 REHAB SERVICES 1993404 PEORIA SURGICAL GROUP LTD 1001 MAIN ST SUITE 300 PEORIA IL 61606 SURGICAL SERVICES 753466 PARK PLACE INTERNATIONAL 7227 CHAGRIN ROAD CHAGRIN FALLS OH 44023 CLOUD CARE SUPPORT SERVICES 636063 5 70713 70713 PATIENT SERVICE REVENUE 900099 87468050 87468050 340(B) REVENUE 900099 5765781 5765781 SCHOOL OF NURSING 900099 263547 263547 LABORATORY 900099 157347 157347 1148307 1073611 74696 94803032 2887330 2887330 397694 275854 121840 121840 121840 53803483 14780 53139386 0 664097 14780 678877 678877 98561792 94570989 232043 3688047 X 80000 80000 2500 2500 2170126 390505 1779621 31084188 25567893 5516295 550655 550655 6284080 5218945 1065135 2253233 1834599 418634 226944 226944 82897 82897 76869 76869 20013476 18821862 1191614 461354 7279 454075 416203 172838 243365 161489 75067 86422 1761309 1407376 353933 48047 13233 34814 14065 11653 2412 1475076 1280340 194736 5631254 4867436 763818 1137340 1137340 MEDICAL SUPPLIES 9961528 9961528 BAD DEBT EXPENSE 4358588 4358588 MEDICAID ASSESSMENT 2287704 2287704 DIETARY 663467 641610 21857 1367030 775181 591849 92569422 76039088 16530334 0 702413 6334627 3572625 14429098 11329607 9702725 2932186 3187907 1846830 2056836 1700920 1217144 145685064 69353014 74588874 76332050 86868947 101499670 8764595 8560121 2339679 2271374 194646676 225591552 6915782 10276562 9456740 44069585 59836900 1288784 10611221 11082175 61596588 91941161 X 124285493 125090270 8764595 8560121 133050088 133650391 194646676 225591552 X 5992370 -4185837 -1206230 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 23432 23432 0 PART II-B, LINE 1: LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED: 37% OF MEMBERSHIP DUES PAID TO THE ILLINOIS HOSPITAL ASSOCIATION, OR $13,874; 37% OF MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, OR $8,806; 27.48% OF MEMBERSHIP DUES PAID TO THE ILLINOIS HEALTH CARE ASSOCIATION, OR $752. 94502686 167929 -1066495 7200 114228 256881 93225811 91454034 860760 3919679 12300 256453 1463034 94502686 81121870 621102 5169957 13150 -5143522 589245 91454056 76601005 131055 8619102 10550 302248 916494 84121870 74358133 292468 -235443 8445 12750 792958 73601005 0.90820 0.08980 0.00200 1 0 3265233 3265233 90478505 33769760 56708745 50214692 33475782 16738910 1726634 2107472 -380838 76332050 ESTIMATED SELF-INSURANCE COSTS 2789228 ASSET RETIREMENT OBLIGATION 266162 DEFERRED COMPENSATION PLAN OBLIGATIONS 1287193 FMV OF SWAP OPTIONS 4895255 DUE TO THIRD PARTY PAYORS 1844337 11082175 88902978 -4185837 -5472977 -9658814 98561792 0 98561792 88506341 -4063081 -4063081 92569422 0 92569422 PART V, LINE 4: THE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS IS TO PROVIDE SCHOLARSHIPS BASED ON STUDENT NEEDS FROM THE INCOME OF THE DONOR-RESTRICTED ENDOWMENT FUNDS. THE PERMANENT ENDOWMENT IS USED FOR THE PURCHASE OF PROPERTY AND EQUIPMENT. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT -1,409,896. RENTAL EXPENSES 275,854. BAD DEBT EXPENSE -4,338,935. PART XII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -4,338,935. RENTAL EXPENSES 275,854. PART V, LINE 3A(I) CHARLES D INGERSOLL TRUST AND WILLIAM P INGERSOLL TRUST ARE ADMINISTERED BY MIDAMERICA NATIONAL BANK AND J.P. MORGAN 1 1 X 1 X 180.000000000000 1 X 1 1 0 1 0 1645548 1645548 0.01780 16331723 14001548 2330175 0.02520 17977271 14001548 3975723 0.04300 48646 2125 46521 0.00050 10382 10382 0.00010 199719 1200 198519 0.00210 258747 3325 255422 0.00270 18236018 14004873 4231145 0.04570 5000 5000 0.00010 1916 1916 0.00000 6916 6916 0.00010 0 1561429 0 21846540 24310244 -2463704 X 1 1 1 1 GRAHAM HOSPITAL ASSOCIATION 210 WEST WALNUT STREET CANTON IL 61520 WWW.GRAHAMHEALTHSYSTEM.ORG 0000869 X X GRAHAM HOSPITAL ASSOCIATION 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X SEE SUPPLEMENTAL INFORMATION 1 19 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 180.000000000000 300.000000000000 X 1 1 X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 GRAHAM HOSPITAL ASSOCIATION PART V, SECTION B, LINE 5: FOCUS GROUP 1 COMMUNITY LEADERS AND REPRESENTATIVESRUSTY MELHOUSE FINANCIAL ADVISOR EDWARD D. JONESTRYGVE MEADE ATTORNEY/PROPRIETOR MEADE LAW OFFICEJEFF STANDARD SHERIFF FULTON COUNTY SHERIFF'S DEPARTMENTAMANDA ATCHLEY EXECUTIVE DIRECTOR CANTON AREA CHAMBER OF COMMERCEAARON AND VEANNA THUM OWNERS CRAWFORD'S HOME FURNISHINGSKATHY EDWARDS PRESIDENT GRAHAM HOSPITAL SERVICE LEAGUEROLF SILVERSTEIN SUPERINTENDENT CANTON UNION SCHOOL DISTRICT #66BROOKE DENNISTON EXECUTIVE DIRECTOR CANTON YWCAJAY SHEPLER REPRESENTATIVE ST. MARY'S FOOD PANTRYREV. KEVIN VAN TINE PASTOR COVENANT COMMUNITY FELLOWSHIP, CANTONKENT MCDOWELL MAYOR CITY OF CANTONDICK FAIRBURN PUBLIC SAFETY DIRECTOR CITY OF CANTONIDENTIFICATION AND PRIORITIZATION GROUPAMANDA ATCHLEY EXECUTIVE DIRECTOR CANTON AREA CHAMBER OF COMMERCEKATIE LYNN ADMINISTRATOR FULTON COUNTY HEALTH DEPARTMENTMISSY KOLOWSKI ADMINISTRATOR HEALTH & WELLNESS CONNECTION OF FULTON COUNTYMICHELLE LOCKE CLINICAL SOCIAL WORKER GRAHAM HOSPITALSUE LIVINGSTON DIRECTOR GRAHAM SCHOOL OF NURSINGJEFF HOWD ADMINISTRATOR THE LOFT REHAB & NURSING CENTER, CANTON GRAHAM HOSPITAL ASSOCIATION PART V, SECTION B, LINE 7D: HTTPS://WWW.GRAHAMHEALTHSYSTEM.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT GRAHAM HOSPITAL ASSOCIATION PART V, SECTION B, LINE 11: 1. PREVALENCE OF OBESITY AMONG YOUTH AND ADULTS IN THE COMMUNITY, AND THE NEED FOR NUTRITION EDUCATION FOR THE COMMUNITY AND ACCESS TO HEALTHY FOODS.ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED:A) EXPAND THE PRITIKEN CARDIAC PROGRAM:THE PROGRAM WAS CLOSED DOWN FOR CLOSE TO 2 MONTHS, DUE TO COVID, AND HAS TAKEN SOME TIME TO BUILD BACK UP. WE ARE STILL STRUGGLING TO GROW THIS SERVICE, AS PATIENTS SEEM TO HAVE A LESSENED INTEREST IN THE EDUCATIONAL PIECE DURING THIS PANDEMIC, AND THE REFERRALS HAVE BEEN LOWER AS WELL.B) CREATE A COMMUNITY BIKE SHARE PROGRAM:THIS PROGAM WENT LIVE ON APRIL 5, 2019 IN PARTNERSHIP WITH THE CANTON PARK DISTRICT. THE BIKE SHARE PROGRAM HAS 3 LOCATIONS (GRAHAM MEDICAL GROUP, WALLACE PARK, AND LAKELAND PARK) THAT RESIDENTS ARE ABLE TO RENT BIKES USING A MOBILE APP. ADDITIONAL INFORMATION CAN BE FOUND BY VISITING THE CANTON BIKE SHARE FACEBOOK PAGE.C) COLLABORATE WITH THE YMCA TO PRESENT A HEALTHY KIDS DAYD) GROW PROGRAMS FOR BUSINESS AT THE COMMUNITY WELLNESS CENTER:THIS INITIATIVE HAS BEEN TREMENDOUSLY IMPACTED DUE TO COVID. THE HOSPITAL HAS HAD THE WELLNESS CENTER CLOSED DOWN TO THESE TYPE OF OPERATIONS SINCE MARCH.E) CREATE WELLNESS CHECK PROGRAMS:THIS INITIATIVE HAS BEEN TREMENDOUSLY IMPACTED DUE TO COVID. THE HOSPITAL HAS HAD THE WELLNESS CENTER CLOSED DOWN TO THESE TYPE OF OPERATIONS SINCE MARCH.F) IMPROVE PATIENT BMI THROUGH TRACKING AND EDUCATION AT CLINICS AND THE WELLNESS CENTER:THIS INITIATIVE HAS BEEN TREMENDOUSLY IMPACTED DUE TO COVID. THE HOSPITAL HAS HAD THE WELLNESS CENTER CLOSED DOWN TO THESE TYPE OF OPERATIONS SINCE MARCH.2. PREVALENCE OF DIABETES IN THE COMMUNITY AND THE NEED FOR PHYSICAL, HEALTH, AND NUTRITION EDUCATION FOR YOUTH AND ADULTS, AND FOR ACCESS TO REASONABLY PRICED INSULIN AND OTHER DIABETES MEDICATIONS FOR THE UNDERINSURED AND UNINSURED.ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED:A) EXPAND THE PRITIKEN CARDIAC PROGRAM:THE PROGRAM WAS CLOSED DOWN FOR CLOSE TO 2 MONTHS, DUE TO COVID, AND HAS TAKEN SOME TIME TO BUILD BACK UP. WE ARE STILL STRUGGLING TO GROW THIS SERVICE, AS PATIENTS SEEM TO HAVE A LESSENED INTEREST IN THE EDUCATIONAL PIECE DURING THIS PANDEMIC, AND THE REFERRALS HAVE BEEN LOWER AS WELL.B) EXPAND MERIT-BASED INCENTIVE PAYMENT SYSTEM ADDRESSING A1C MEASURESC) CONTINUE TO SUPPORT CONNECTIONS CLINIC:THE HOSPITAL DONATES $5,000 MONTHLY TO THE HEALTH & WELLNESS CONNECTION OF FULTON COUNTY. THE HEALTH & WELLNESS CONNECTION OF FULTON COUNTY (HWCFC) IS A CASE MANAGEMENT FACILITY STAFFED BY DEDICATED VOLUNTEERS AND PROFESSIONALS. OUR MISSION IS TO HELP LOCAL PROVIDERS WITH QUALITY PRIMARY HEALTHCARE FOR THE UNDERINSURED PATIENTS AND UNDERSERVED RESIDENTS OF FULTON COUNTY. SERVICES INCLUDE: HELP WITH MEDICATION COSTS; HELP WITH DIABETIC SUPPLIES; HELP WITH VISION CARE COST; HELP WITH DENTAL CARE COSTS; COUNSELING; HELP WITH CERTAIN HEALTH RELATED TRANSPORTATION COSTS; FLU SHOTSD) CONTINUE SUPPORT OF BIO-MED CLASSROOM AND EDUCATION PROGRAMS AT CANTON HIGH SCHOOL:THE HOSPITAL DONATED $25,000 TO CANTON HIGH SCHOOL TO HELP BUILD A STATE OF THE ART BIO-MED CLASSROOM THAT WILL BE USED TO HOUSE THE FOLLOWING COURSES: PRINCIPLES OF BIOMEDICAL SCIENCE, BIOLOGY, BIOLOGY 11, AND HUMAN BODY SYSTEMS. MORE INFORMATION ON THIS PROJECT CAN BE FOUND HERE: HTTPS://WWW.GRAHAMHEALTHSYSTEM.ORG/NEWS/2018/10/GRAHAM-HEALTH-SYSTEM-BIOMEDICAL-LAB3. THE THIRD PRIORITIZED NEED WAS MENTAL HEALTH, INCLUDING:A) RESOURCES TO ADDRESS SUICIDEB) LOCAL ACCESS TO MENTAL HEALTH PROVIDERS AT ALL LEVELSC) LOCAL MENTAL HEALTH SUPPORT SERVICESD) LOCAL ACCESS TO DETOXIFICATION, REHABILITATION, AND RECOVERY FOR PERSONS FACING SUBSTANCE USE DISORDERS4. THE GROUP NEXT IDENTIFIED THE NEED TO ADDRESS THE NUMBER OF LOCAL TEEN BIRTHS.ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED:A) EXPLORE FACE-TO-FACE EDUCATION BETWEEN MEDICAL STAFF AND STUDENTSB) PROVIDE SUPPORT FOR THE FULTON COUNTY HEALTH DEPARTMENT IN ITS EFFORTS TO ADDRESS THIS ISSUEDURING THE 2020 CALENDAR YEAR, THE HOSPITAL HAS BEEN ACTIVELY WORKING ON A DEDICATED BEHAVIORAL HEALTH PROGRAM TO BRING INTO OUR CLINICS. THE PROGRAM IS SET TO KICK OFF AT THE BEGINNING OF CALENDAR YEAR 2021. THE BEHAVIORAL HEALTH SPECIALIST WILL COVER THE FOLLOWING:- ANXIETY, DEPRESSION, ADJUSTMENT DISORDERS, AND OTHER BEHAVIORAL HEALTH DIAGNOSES - SMOKING CESSATION; STRESS MANAGEMENT- BEHAVIORAL INTERVENTIONS FOR WEIGHT LOSS AND HEALTHY LIFESTYLE CHANGES- RELATIONSHIP ISSUES AND/OR DOMESTIC VIOLENCE CONCERNS- CHRONIC PAIN AND PAIN MANAGEMENT- PSYCHOTROPIC MEDICATIONS - GRIEF AND BEREAVEMENT ISSUES- CAREGIVER BURDEN- SUBSTANCE MISUSE OR ABUSE (OR SUSPECTED)- TRAUMA (BRIEF TREATMENT THEN MOST LIKELY TRIAGE)- SOMATIC SYMPTOMS; NON-ADHERENCE TO TREATMENT PLAN- MENTAL HEALTH CRISIS (PANIC ATTACKS, SUICIDAL OR HOMICIDAL IDEATION, SUSPECTED PHYSICAL OR MENTAL ABUSE)- MONITORING OF DISCHARGED PATIENTS FROM PSYCHIATRIC IN-PATIENT UNTIL A HIGHER LEVEL OF CARE CAN BE ESTABLISHED5. THE GROUP'S FINAL IDENTIFIED NEED WAS ACCESS TO INCREASE LOCAL ACCESS TO DENTISTS FOR UNDERINSURED AND UNINSURED COMMUNITY MEMBERS.ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED:A) GRAHAM HOSPITAL WILL CONTINUE TO PROVIDE FINANCIAL SUPPORT FOR DENTAL SERVICES AT THE CONNECTIONS CLINICB) GRAHAM HOSPITAL WILL SUPPORT, AS REASONABLY POSSIBLE, EFFORTS BY THE FULTON COUNTY HEALTH DEPARTMENT TO PROVIDE DENTAL SERVICES GRAHAM HOSPITAL ASSOCIATION PART V, SECTION B, LINE 16J: THE FAP AND FAP SUMMARY ARE ONLY PROVIDED IN ENGLISH. GRAHAM HOSPITAL ASSOCIATION IS NOT REQUIRED TO PROVIDE THE FAP AND FAP SUMMARY IN LANGUAGES THAT ARE SPOKEN BY LEP POPULATIONS. PART V, LINE 16A, FAP WEBSITE: HTTPS://WWW.GRAHAMHEALTHSYSTEM.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-ASSISTANCE/FINANCIAL-ASSISTANCE PART V, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://WWW.GRAHAMHEALTHSYSTEM.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-ASSISTANCE/FINANCIAL-ASSISTANCE PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://WWW.GRAHAMHEALTHSYSTEM.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-ASSISTANCE/FINANCIAL-ASSISTANCE SCHEDULE H, PART V, LINE 10: HTTP://WWW.GRAHAMHEALTHSYSTEM.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 10 1 - GRAHAM MEDICAL GROUP 180 SOUTH MAIN STREET CANTON IL 61520 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 2 - GRAHAM HOSPITAL EXTENDED CARE UNIT 210 WEST WALNUT STREET CANTON IL 61520 SKILLED NURSING & LONG TERM CARE UNITS 3 - GHA HOME MEDICAL EQUIPMENT STORE 101 SOUTH MAIN STREET CANTON IL 61520 HOME MEDICAL EQUIPMENT RETAIL STORE 4 - GRAHAM MEDICAL GROUP - FARMINGTON 601 EAST FORT STREET FARMINGTONGG IL 64531 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 5 - GRAHAM MEDICAL GROUP - LEWISTOWN 408 SOUTH MAIN STREET LEWISTOWN IL 61542 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 6 - GRAHAM MEDICAL GROUP - ELMWOOD 1024 N MAGNOLIA STREET ELMWOOD IL 61529 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 7 - GRAHAM CARDIAC REHABILITATION 235 WEST WALNUT CANTON IL 61520 CARDIAC REHAB SERVICES 8 - GRAHAM HOSPITAL SCHOOL OF NURSING 210 WEST WALNUT STREET CANTON IL 61520 SCHOOL OF NURSING 9 - GRAHAM HOSPITAL PHARMACY 210 WEST WALNUT STREET CANTON IL 61520 PHARMACY FOR PATIENTS & RETAIL FOR EMPLOYEES 10 - GRAHAM MEDICAL GROUP - AVON 1800 23RD AVENUE AVON IL 61415 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC PART I, LINE 6A: NOT APPLICABLE PART I, LINE 7: THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDING BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART II, COMMUNITY BUILDING ACTIVITIES: A DONATION OF $5,000 WAS MADE TO THE SPOON RIVER PARTNERSHIP FOR ECONOMIC DEVELOPMENT. THIS ORGANIZATION FOCUSES ON BUILDING IN THE LOCAL COMMUNITY THROUGH ECONOMIC GROWTH, WHICH IMPROVES OPPORTUNITIES FOR JOBS AND INSURANCE WITHIN THE COMMUNITY. THIS DONATION HELPED SUPPORT THE LOCAL ECONOMY BY HELPING A SMALL BUSINESS. A DONATION OF $10,000 WAS MADE TO THE UNIVERSITY OF ILLINOIS FAMILY MEDICINE RURAL STUDENT PHYSICIAN PROGRAM. THIS DONATION WILL HELP GIVE OPPORTUNITY TO PHYSICIANS WHO WANT TO WORK IN RURAL HOSPITALS LIKE GRAHAM. A MONTHLY DONATION OF $5,000 WAS MADE TO THE HEALTH & WELLNESS CONNECTION OF FULTON COUNTY (HWCFC). THIS CLINIC IS CONSISTENT WITH AND SUPPORTIVE OF GRAHAM'S MISSION OF PROVIDING CHARITY CARE AND HEALTH IMPROVEMENT SERVICES TO THOSE IN NEED. A $5,000 DONATION TOWARDS THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK BUILDING FUND WAS ALSO PROVIDED. PART III, LINE 2: PATIENT RECEIVABLES ARE WRITTEN OFF AS BAD DEBT EXPENSE BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. PART III, LINE 3: PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. THE HOSPITAL DOES NOT CHARGE INTEREST ON RECEIVABLES. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED PAST DUE WHEN AN AMOUNT IS PAST DUE ACCORDING TO THE PAYOR'S AGREED-UPON TERMS. PATIENT RECEIVABLES ARE WRITTEN OFF AS BAD DEBT EXPENSE BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. PART III, LINE 8: THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFITS EXPENSE BECAUSE PROVIDING MEDICAL CARE AT A SHORTFALL IMPACTS THE HOSPITAL'S OPERATIONS AND GROWTH. THE CARE IS PROVIDED BECAUSE THERE IS A NEED AND A DESIRE TO PROVIDE MEDICAL CARE IN THIS COMMUNITY.THE COSTING METHOD USED ABOVE FOR IRS FORM 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES AND THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: THE COLLECTION POLICY DESCRIBES THE STEPS TAKEN TO COLLECT SELF PAY BALANCES OUTSTANDING INCLUDING NOTIFICATIONS TO THE PATIENT THROUGH STATEMENTS, FOLLOW-UP PHONE CALLS, VERIFICATION OF INSURANCE ELIGIBILITY AND ULTIMATELY AT WHAT POINT THE UNPAID BALANCE IS WRITTEN OFF AS UNCOLLECTIBLE. IN PRACTICE, WHEN A PATIENT IS IDENTIFIED AS QUALIFYING FOR FINANCIAL ASSISTANCE, A SEARCH OF ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE IS DONE AND THOSE ACCOUNTS ARE REPROCESSED. PART VI, LINE 2: IN ADDITION TO THE CHNA, A PHYSICIAN NEEDS ASSESSMENT IS DONE TO IDENTIFY NEEDS FOR SPECIFIC SPECIALTY SERVICES BASED ON THE SIZE OF THE CATCHMENT AREA. DATA IS ANALYZED TO IDENTIFY SERVICES THAT ARE PROVIDED TO COUNTY RESIDENTS BY OTHER FACILITIES THAT WOULD BE MORE ACCESSIBLE TO PATIENTS IF PROVIDED AT GRAHAM HEALTH SYSTEM. INPUT IS GAINED FROM PHYSICIANS AND OTHER HEALTHCARE WORKERS PROVIDING SERVICE IN THE AREA ALONG WITH INPUT PROVIDED BY THE BOARD OF DIRECTORS WHO REPRESENT THE COMMUNITY AND PROVIDE A COMMUNICATION LINK BETWEEN GRAHAM HEALTH SYSTEM AND THE COMMUNITIES WE SERVE. PART VI, LINE 3: THE CHARITY CARE/FINANCIAL ASSISTANCE PROGRAM IS MADE AVAILABLE TO PATIENTS UPON REGISTRATION. FINANCIAL ASSISTANCE APPLICATIONS ARE AVAILABLE TO PATIENTS UPON REGISTRATION OR TO ANYONE REQUESTING THE APPLICATION. THE APPLICATIONS ARE ALSO AVAILABLE ON GRAHAM HEALTH SYSTEM'S WEBSITE AT WWW.GRAHAMHEALTHSYSTEM.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-ASSISTANCE. APPOINTMENTS MAY BE MADE WITH A FINANCIAL ADVOCATE IF ASSISTANCE IS NEEDED. MEDICAID SERVICES APPLICATION ASSISTANCE IS AVAILABLE. PART VI, LINE 4: THE GRAHAM HEALTH SYSTEM PRIMARY CATCHMENT AREA IS LOCATED PRIMARILY IN FULTON COUNTY AND INCLUDES ALL OR PORTIONS OF THE TOWNS OF CANTON, LEWISTOWN, CUBA, ELMWOOD, FARMINGTON, HAVANA, ST. DAVID, ASTORIA, DUNFERMLINE AND BRYANT. THE RACE AND ETHNICITY MAKEUP ARE TYPICAL OF RURAL ILLINOIS BASED ON US CENSUS BUREAU DATA AND INCLUDES 91.6% WHITE, 4.0% BLACK, 3.1% HISPANIC ORIGIN, AND 1.3% OTHER. ACCORDING TO THE US CENSUS BUREAU MEDIAN HOUSEHOLD INCOME 2016 WAS $46,183. FULTON COUNTY'S AUGUST 2019 UNEMPLOYMENT RATE WAS 5.7%. PART VI, LINE 5: DURING EACH FISCAL YEAR VARIOUS COMMUNITY HEALTH IMPROVEMENT SERVICES ARE HELD AT A FACILITY OWNED BY GRAHAM HEALTH SYSTEM OR ITS EMPLOYEES ASSIST WITH SERVICES HELD AT VARIOUS LOCATIONS WITHIN THE CATCHMENT AREA. EXAMPLES OF THESE ACTIVITIES INCLUDE ANNUAL SPONSORSHIP OF A COMMUNITY TALK AND DINNER THAT IS FREE TO THE PUBLIC COVERING HEALTH TOPICS; FREE BLOOD PRESSURE CLINICS OFFERED ON A REGULAR BASIS; PROVIDING SPACE FOR OPERATION OF AN OUTPATIENT CLINIC THAT PROVIDES FREE HEALTHCARE SERVICES TO FULTON COUNTY RESIDENTS. CLINIC SERVICES ARE PROVIDED BY COMMUNITY VOLUNTEERS. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES IL 0 FULTON COUNTY FREE HEALTH AND WELLNESS CLINIC 103A S MAIN STREET CANTON IL 61520 272753264 501(C)(3) 60000 PROVIDE SUPPORT TO ORGANIZATION UNIVERSITY OF ILLINOIS FOUNDATION HARKER HALL MC 386 1305 WEST GREEN STREET URBANA IL 61801 376006007 501(C)(3) 10000 PROVIDE SUPPORT TO ORGANIZATION ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK 1945 VANS WAY PRINCETON IL 61356 550809159 501(C)(3) 5000 PROVIDE SUPPORT TO ORGANIZATION - BUILDING FUND DONATION SPOON RIVER PARTNERSHIP FOR ECONOMIC DEVELOPMENT 209 EAST CHESTNUT SUITE 2 CANTON IL 61520 050633175 501(C)(3) 5000 PROVIDE SUPPORT TO ORGANIZATION 4 0 X X X 0 1 0 0 0 0 0 0 0 BRENT PARRY DPM PODIATRIST 388884 0 0 0 80400 0 8400 0 35906 0 513590 0 0 0 JULIO RAMOS MD PHYSICIAN 339888 0 48710 0 19513 0 8400 0 11666 0 428177 0 0 0 DEVASHISH AGARWAL MD PHYSICIAN 306114 0 44980 0 24519 0 8400 0 36823 0 420836 0 0 0 JEFFREY HEMP MD PHYSICIAN 256557 0 35000 0 3946 0 8400 0 34207 0 338110 0 0 0 JOHN QUINONES DO PHYSICIAN 0 0 0 0 234179 0 0 0 0 0 234179 0 0 0 KEITH IFFT MD ANESTHESIOLOGIST MEDICAL DIRECTOR 402766 0 0 0 26386 0 8400 0 52633 0 490185 0 0 0 DWAYNE BERNARD MD MEDICAL DIRECTOR 323685 0 61834 0 29793 0 8400 0 40166 0 463878 0 0 0 ANDREW ROUDEBUSH DO WOUND CLINIC DIRECTOR 196431 0 56814 0 35042 0 8400 0 33427 0 330114 0 0 0 ROBERT SENNEFF PRESIDENT/CEO 396460 0 88397 0 193067 0 76216 0 12228 0 766368 0 0 0 JULIE REEDER VP FINANCE/CFO 141846 0 35775 0 28741 0 24071 0 26711 0 257144 0 0 0 HOLLY HENLINE VP ANCILLARY/CCO 136336 0 33788 0 26336 0 21554 0 46228 0 264242 0 0 0 JAMES SCHREINER VP INFO SERVICES 164521 0 34069 0 23865 0 25635 0 10564 0 258654 0 0 0 TERESA MCCONKEY VP PATIENT SERVICES 161331 0 31636 0 27743 0 25854 0 11820 0 258384 0 0 0 ALLISON SOURS VP QUALITY 121912 0 26647 0 16574 0 17108 0 10514 0 192755 0 0 0 MICHELLE DALY VP CLINIC SERVICES 115920 0 15957 0 9889 0 16810 0 14003 0 172579 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) PLAN IN 2019 SPONSORED BY GRAHAM HOSPITAL ASSOCIATION: ROBERT SENNEFF - $67,816, TERESA MCCONKEY - $19,139, JAMES SCHREINER - $18,893, HOLLY HENLINE - $15,500, JULIE REEDER - $17,654, ALLISON SOURS - $13,981, MICHELLE DAY - $12,385. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GRAHAM HOSPITAL ASSOCIATION ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2019. A CITY OF CANTON IL 376000876 2015-11-04 48540000 REFUND PRIOR ISSUE AND FUND BUILDING PROJECTS 0 0 0 B CITY OF CANTON IL 376000876 2020-06-18 17000000 FUND BUILDING PROJECTS AND EQUIPMENT 0 0 0 A 5415001 48540000 26755000 488550 21296450 2017 1 0 1 1 B 17000000 207600 1245613 15546787 0 0 0 1 A 0 1 0 0 0.15000 0.15000 1 0 1 B 0 0 0 0 1 0 1 A 1 1 1 MORGAN STANLEY & BMO 25.000000000000 0 0 0 0 0 B 0 1 0 0 1 0 0 0 0 A 0 B 0 FORM 990, PART VI, SECTION B, LINE 11B THE PREPARED FORM 990 IS REVIEWED BY THE BOARD OF TRUSTEES, CEO, CFO, DIRECTOR OF ACCOUNTING, AND SENIOR ACCOUNTANT BEFORE FILING WITH THE IRS. BEFORE FILING, THE CFO PRESENTS THE FORM 990 TO THE ORGANIZATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C GRAHAM HOSPITAL REQUIRES THAT ALL TRUSTEES AND ADMINISTRATIVE OFFICERS KEEP THE BOARD OF TRUSTEES INFORMED OF POTENTIAL CONFLICTS OF INTEREST, AND THAT EACH PERSON MAKE AN ANNUAL DECLARATION OF SUCH INTEREST. A CONFLICT OF INTEREST MIGHT EXIST WHEN ORGANIZATIONS IN WHICH TRUSTEES OR OFFICERS HAVE A MATERIAL FINANCIAL INTEREST ARE EITHER DOING BUSINESS WITH, COMPETING WITH, OR HAVE A FINANCIAL INTEREST IN GRAHAM HOSPITAL. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE ADMINISTRATIVE OFFICERS IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. THE ORGANIZATION UTILIZES AN OUTSIDE FIRM, SULLIVAN, COTTER AND ASSOCIATES, INC. TO PROVIDE OUTSIDE EXECUTIVE COMPENSATION INFORMATION. THE LAST REVIEW WAS COMPLETED IN JANUARY 2020. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G OUTSIDE CONTRACTORS: PROGRAM SERVICE EXPENSES 601,954. MANAGEMENT AND GENERAL EXPENSES 478,876. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,080,830. PHYSICIANS: PROGRAM SERVICE EXPENSES 10,724,431. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,724,431. SERVICE AGREEMENT: PROGRAM SERVICE EXPENSES 1,998,815. MANAGEMENT AND GENERAL EXPENSES 33,957. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,032,772. PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 1,427,575. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,427,575. REPAIR AND MAINTENANCE : PROGRAM SERVICE EXPENSES 64,446. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 64,446. OTHER FEES: PROGRAM SERVICE EXPENSES 4,004,641. MANAGEMENT AND GENERAL EXPENSES 678,781. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,683,422. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 26,088. CHANGE IN BENEFICAL INTEREST IN PERPETUAL TRUSTS 177,578. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT -1,409,896.