2025-08-15T14:47:06-05:00 2024-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2023-10-01 920574426 Deaconess Illinois Union County Hospital Inc DEAC 6188334511 517 N Main St Anna IL 62906 William Davis Illinois Region President 6188334511 2025-08-15 1 1 Kim Hunwardsen CPA P00484560 6122536500 2025-08-15 2023 2025-03-06 01:10:19Z William Davis 517 N Main St Anna IL 62906 30020799 0 X www.unioncountyhospital.com X 2022 IL Critical access hospital and 24-hour emergency department serving Anna, IL community. 7 7 184 7 0 0 183986 1050000 18516585 28969698 6914 1101 0 0 18707485 30020799 9016 0 0 0 7096371 10279895 0 0 0 14685867 17615621 21791254 27895516 -3083769 2125283 20111150 19958728 14392442 12114737 5718708 7843991 X None 0 0 21510108 28969698 Deaconess Illinois Union County Hospital, Inc. (the Hospital) is a 25-bed critical access hospital located in Anna, Illinois. The Hospital provides inpatient, outpatient, and emergency care services for residents of southern Illinois. Effective January 14, 2023, Union County Hospital was acquired by Deaconess Regional Healthcare Services Illinois, Inc. which is organized as a nonprofit corporation to facilitate diversification of services across Southern Illinois and Indiana.Statement continued on Schedule O.The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Since the Hospital does not pursue collections of these amounts, they are not reported as patient service revenue. The estimated cost of providing these services was $108,000 for the year ended September 30, 2024, 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. 21510108 1 0 0 0 0 0 0 0 0 0 1 0 0 1 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 36 0 1 184 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 IL X William Davis 6189987021 517 N Main St Anna IL 62906 X Marc J Florence President 1.00 3.00 X X 0 0 0 Steve Titzer Chairperson 1.00 3.00 X X 0 0 0 Glenn Clarida Vice Chairperson 1.00 3.00 X X 0 0 0 Gene Morris Secretary 1.00 3.00 X X 0 0 0 Tony Wielt Treasurer 1.00 3.00 X X 0 0 0 Jeff Justice Director 1.00 3.00 X 0 0 0 Lynn Lingafelter Director 1.00 3.00 X 0 0 0 William Davis Illinois Region President 10.00 30.00 X 0 0 0 Amber Lipe CFO 10.00 30.00 X 0 0 0 Harry Brockus CAO 40.00 0.00 X 0 0 0 Robert A Reichert Director of Pharmacy 40.00 0.00 X 119914 0 36611 Mark Yates CNO 40.00 0.00 X 113411 0 39241 Debbie Coyle Med/Surg RN 40.00 0.00 X 109211 0 14399 Ian Rich Phamacist 40.00 0.00 X 107232 0 14549 Denise M Crane RN 40.00 0.00 X 102921 0 3867 552689 0 108667 5 0 1 0 Deaconess Health System 600 Mary St Evansville IN 47710 Administrative & Management 4070131 Integritas Emergency Physician Services 2250 N Illinois Ave Carbondale IL 62901 Emergency Room Providers 1453941 Granite City Hospitalist Services LLC 2250 N Illinois Ave Carbondale IL 629015612 Hospitalist Providers 741450 HHS Environmental Services LLC 12495 Silver Creek Rd Dripping Springs TX 78620 Housekeeping Services 522232 Psychiatric Medical Care LLC PO Box 734606 Dallas TX 753734606 Mental Health Services 461285 9 1050000 1050000 Patient Service Revenue 621110 28745830 28745830 Cafeteria Revenue 722514 33162 33162 190706 190706 28969698 1101 1101 30020799 28969698 0 1101 X 7527599 6657183 870416 177804 166301 11503 1938965 1813523 125442 635527 594411 41116 57651 57651 10532665 6596912 3935753 31511 1954 29557 208529 149185 59344 88293 43651 44642 401199 357067 44132 33547 18738 14809 32782 18311 14471 193587 193587 806285 718840 87445 183780 163803 19977 Medical Supplies 2174545 1867059 307486 Other Taxes & Licenses 1725972 1538362 187610 Repairs & Maintenance 773042 403301 369741 Memberships & Dues 46664 26065 20599 325569 181855 143714 27895516 21510108 6385408 0 11534 2430404 2108323 6915749 5813534 513154 497407 164605 191607 9067932 1287579 7494427 7780353 651 2580626 3567504 20111150 19958728 2103515 2530118 12288927 9584619 14392442 12114737 X 5718708 7343570 500421 5718708 7843991 20111150 19958728 2125283 0 X 0 1 X 0 0 X 3687132 183321 3503811 4499829 1104258 3395571 880971 880971 7780353 Estimated Third Party Payor Settlements 3238883 Finance lease ROU Assets 70891 Operating lease ROU Assets 257730 3567504 Affiliate Payables 8528916 Estimated health claims liability 280000 Estimated Third Party Payor Settlements 445422 Finance lease ROU liability 72552 Operating lease ROU liability 257729 9584619 X 30020799 0 30020799 0 30020799 27895516 0 27895516 0 27895516 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. 1 1 X 1 X 1 X 1 1 1 0 0 108000 108000 0.00390 8414700 1876497 6538203 0.23440 8522700 1876497 6646203 0.23830 5557981 4201391 1356590 0.04860 5557981 4201391 1356590 0.04860 14080681 6077888 8002793 0.28690 1 3941071 1225673 9201672 9238026 -36354 X 1 1 1 1 Deaconess Illinois Union County Hospital Inc 517 N Main St Anna IL 62906 www.unioncountyhospital.com 0006379 X X X X 1 provider based rural health clinic Deaconess Illinois Union County Hospital 1 0 1 1 X X X X X X X X X 23 1 0 0 1 X www.deaconessillinoisunioncounty.com X 1 23 1 www.deaconessillinoisunioncounty.com 0 1 X 200.000000000000 350.000000000000 X X X X X 1 1 X X X 1 X https://unioncountyhospital.com/financial-assistance/ X https://unioncountyhospital.com/financial-assistance/ X https://unioncountyhospital.com/financial-assistance/ X X X X X X 1 X 0 X X X X 1 X 0 0 Deaconess Illinois Union County Hospital, Inc. Part V, Section B, Line 2: Deaconess Illinois Union County Hospital, Inc. is a new legal entity, incorporated October 3, 2022. The IRS granted tax exempt status as of October 3, 2022. The hospital was acquired by this entity and operations began January 14, 2023. Prior to that date, the hospital was owned and operated by a governmental entity. Deaconess Illinois Union County Hospital, Inc. Part V, Section B, Line 5: Community meetings were held in April 2024, and many agencies and communities were present representing the medically underserved and minorities. Healthcare partners, Educators, Community Services Providers, and Government Officials were also present. Deaconess Illinois Union County Hospital, Inc. Part V, Section B, Line 11: A community health needs assessment was completed in fiscal year 2024 and thus no specific actions were taken during the current year. The following needs identified will be addressed over the next 3 years.Access to CareCommunity CollaborationHealth Education1. ACCESS TO CARE: Improve access to care by continuing to recruit and retain providers for specialty care clinics, mental health provision and substance abuse treatment/services.Actions the hospital intends to take to address the health need Evaluate the primary and specialty care services needed in the community. Potentially recruit or provide those services through Deaconess Health partnerships. Evaluate the mental and substance abuse services provided in the community and the need for additional providers/services. Work with community partners and Deaconess Health to ensure gaps are filled as possible. Work with current providers in the service market area to retain their services to Deaconess Illinois Union County and the community. Evaluate internal processes within Deaconess Illinois Union County to ensure the best customer experience.2. COMMUNITY COLLABORATION: Improve community coordination by developing and maximizing health service partnerships.Actions the hospital intends to take to address the health need Support and participate in the inner agency group meeting in the community (if one exists) or develop this group to ensure agencies understand what each does and the priorities they are working on. This will potentially reduce duplication of services and allow more agency collaboration. Investigate developing or renovating a resource guide to assist agencies and patients/residents in finding needed resources. Support local agencies that address homelessness. Investigate budgeting dollars for this and leverage social media channels to raise awareness of these agencies and solicit potential donors. Develop charity care policy education for the community and share with providers.3. HEALTH EDUCATION: Improve the overall health education of the community through health promotion screenings and events in chronic disease management, cancer screenings, and health education.Actions the hospital intends to take to address the health need Review patient educational documents to ensure understandable explanations of the patient's condition, care and treatment. Educate nursing staff to reinforce the importance of this additional education with patients. Health fair in the community. Investigate a partnership with local schools utilizing employees to educate students on the benefits of diet and exercise, strategies to improve their physical and mental health, chronic diseases and management and exposure to health careers and job opportunities at Deaconess Illinois Union County. Increase free or low-cost cancer screenings in the community. Rebranding of the facility in the community to improve awareness of services and the changes that are being made as a part of Deaconess Health Smoking cessation program (partnership with health department?) Create low-cost/free exercise programs (walking paths, challenges, etc.) Radiology lung cancer screenings Focus on Medicare Annual Wellness Exam Completion Deaconess Illinois Union County Hospital, Inc. Part V, Section B, Line 13h: In the event there is no evidence to support a patient's eligibility for charity care, the Hospital could, for patients above 200% of the Federal Poverty Guidelines, use outside agencies in determining collectability scoring for the basis of determining charity care eligibility. Presumptive eligibility may also be determined on the basis of individual life circumstances that may include: 1. Homeless or received care from a homeless clinic 2. Food stamp eligibility 3. Patient is deceased with no known estate a. Balances due for deceased minors are excluded from charity care. These balances will remain due. 4. For all Medicaid Financial Class Payors, if a denial or edit for a non-covered Medicaid/HIP charge is received, that charge will be adjusted to charity.Services eligible under this Policy will be made available to the patient on a sliding fee scale, in accordance with financial need, as determined in reference to Federal Poverty Levels (FPL) in effect at the time of the determination. The basis for the amounts the Hospital will charge patients qualifying for financial assistance may also be modified as follows: - Patients whose family income exceeds 350% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of the Hospital. -The Hospital Uninsured Patient Discount Act also provides for a maximum collectable amount. During a 12-month period, a hospital may collect no more than 20% of the patient's' family income. The 12-month period begins on the first date the uninsured patient receives health care services eligible for an uninsured discount. Uninsured patients must be permitted to apply for a discount within 90 days of the date of discharge/service. Part I, Line 3c: Uninsured patients, without any third-party liability coverage, automatically qualify for the standard uninsured discount. This discount is applied to total charges and reduces that amount owed to a comparable amount that is based on the general amount that would have been paid to the Hospital by private health insurers and Medicare, including co-pays and deductibles, if the patient had been insured.In the event there is no evidence to support a patient's eligibility for charity care, the Hospital could, for patients above 200% of the Federal Poverty Guidelines, use outside agencies in determining collectability scoring for the basis of determining charity care eligibility. Presumptive eligibility may also be determined on the basis of individual life circumstances that may include: 1. Homeless or received care from a homeless clinic 2. Food stamp eligibility 3. Patient is deceased with no known estate a. Balances due for deceased minors are excluded from charity care. These balances will remain due. 4. For all Medicaid Financial Class Payors, if a denial or edit for a non-covered Medicaid/HIP charge is received, that charge will be adjusted to charity.Services eligible under this Policy will be made available to the patient on a sliding fee scale, in accordance with financial need, as determined in reference to Federal Poverty Levels (FPL) in effect at the time of the determination. The basis for the amounts the Hospital will charge patients qualifying for financial assistance may also be modified as follows: 1. Patients whose family income exceeds 350% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of the Hospital. 2. The Hospital Uninsured Patient Discount Act also provides for a maximum collectable amount. During a 12-month period, a hospital may collect no more than 20% of the patient's' family income. The 12-month period begins on the first date the uninsured patient receives health care services eligible for an uninsured discount. Uninsured patients must be permitted to apply for a discount within 90 days of the date of discharge/service. 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. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. 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 Organization determines its estimate of implicit price concession based on its historical collection experience with this class of patients. Part III, Line 3: The estimated amount of the Organization's implicit price concessions attributable to patients eligible under the Organization's charity care policy is calculated based on an approximate 31.1% of individuals living below the poverty level in the service area. Part III, Line 4: The footnote to the organization's financial statements that describes implicit price concessions is located on pages 8 and 9 of the attached financial statements. Part III, Line 8: Deaconess Illinois Union County Hospital, Inc. is a critical access hospital showing a Medicare shortfall. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit.Total revenue received from Medicare is the gross reimbursement plus settlement. Both 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. Part III, Line 9b: The Hospital does not pursue collection activities for patients that qualify for charity care or patients that have set up payment arrangements for their accounts. Also, collection activities are not pursued for patients that are in the process of applying for charity care and patients waiting for approval or denial from public aid. Any personal portion due after financial assistance is established would follow normal collection procedures.No extraordinary collection activities will begin until after 120 days from the time the first post-discharge statement was provided. Accounts remain in a primary collection agency for approximately 250 days. After 250 days accounts may be place with a secondary collection agency. Part VI, Line 2: Community input on desired services is obtained through patient satisfaction surveys that are initiated by the inpatient unit and emergency department that provide a line of communication to identify additional health care services that community desires. Part VI, Line 3: The Hospital seeks out patients that may qualify for finanical assistance. Interviews are conducted on self-pay patients while they are at the Hospital. The financial assistance policy is posted in admission areas where patients are present and on the Hospital website. Discussions with patients also occur regarding availability of various government programs, such as Medicaid or state programs and assists the patient with qualification with such programs, where applicable. Well Fund is available to patients to assist with applying for Medicaid or exchange products. Part VI, Line 4: Deaconess Illinois Union County Hospital, Inc. is a 25-bed critical access hospital located in Anna, Illinois. The Hospital provides inpatient, outpatient, and emergency care services for residents of southern Illinois. The service area, defined by zip code data, includes the following rural communities: Anna, Mill Creek, Cobden, Dongola, Jonesboro, Alto Pass.31.1% of the population for whom poverty status is determined in Anna, IL (1.27k out of 4.07k people) live below the poverty line, a number that is higher than the national average of 12.4%. Unemployment was 4.5%, equivalent to the Illinois state average and higher than the United States unemployment rate average (3.5%). As in much of rural Illinois, the average household income in the service area, $69,910, is lower than the statewide and national average. Median household income also fell behind the state and national averages.From 2022 to 2023, employment in Anna, IL declined at a rate of -4.01%, from 1.57k employees to 1.51k employees. The most common job groups, by number of people living in Anna, IL, are Office & Administrative Support Occupations, Transportation Occupations, and Food Preparation & Serving Related Occupations. Part VI, Line 5: The Hospital is dedicated to improving health by providing education and wellness programs and innovative services at all the stages of life for its residents. As a 25-bed critical access hospital services include cardiology, diagnostic imaging, emergency room, orthopedics, podiatry, rehabilitation services, senior emotional health, surgical services, wound care, and swing bed program. Deaconess Illinois Union County Hospital, Inc. has a board appointed by the community board of its sole member, Deaconess Illinois. Medical staff privileges in the Hospital are available to all qualified physicians in the area, consistent with the size and nature of its facilities. The Hospital operates a full-time emergency room and extends treatment to anyone requiring emergency medical care regardless of ability to pay. Any excess funds generally are applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement in patient care, and medical training, education, and research. Treatment at the Hospital's facilities is available to all those able to pay directly or through third-party reimbursement, including through Medicare and Medicaid. In addition, the Hospital operates in accordance with Section 501(r) of the Code, including through a financial assistance policy pursuant to which the Hospital provides emergency and medically necessary care to patients regardless of their ability to pay. 0 0 0 0 0 0 0 0 0 Robert A Reichert Director of Pharmacy 119914 0 0 0 0 0 7171 0 29461 0 156546 0 0 0 Mark Yates CNO 113411 0 0 0 0 0 17728 0 21769 0 152908 0 0 0 Part I, Line 3 William Davis, Illinois Region President, is compensated by Deaconess Health System, an unrelated organization, through a management agreement for services to the Hospital and related entities. Deaconess Health System uses some of the processes described in Part I, Question 3 to determine compensation, including comparability data and an independent compensation consultant. Compensation approval is done by the Board of Directors or Compensation Committee of Deaconess Health System. Form 990, Part VI, Section A, line 3 The officers are employed by Deaconess Health System, an unrelated organization. Compensation is provided by Deaconess Health System through a management agreement for services to Deaconess Illinois Red Bud Regional Hospital, Deaconess Illinois Union County Hospital, Deaconess Illinois Crossroads, and Deaconess Regional Healthcare Services Illinois. All four are related entities. The Illinois Region President and CAO positions have the responsibility of supervising the management, administration, and operation of the organizations. The CFO has the responsibility for managing the financial operations of the organizations. Calendar year 2023 compensation is below. Compensation Benefits William Davis 323,636 21,697 Amber Lipe 329,969 1,007 Jennifer Gregson 270,873 721 Form 990, Part VI, Section A, line 6 The Sole Member is Deaconess Regional Healthcare Services Illinois, Inc., an Illinois not for profit corporation that is exempt from federal income taxation under Section 501(a) of the Code as an organization described in Section 501(c)(3) of the Code. Form 990, Part VI, Section A, line 7a All Directors shall be appointed by the Member. Form 990, Part VI, Section A, line 7b The actions set forth below shall be reserved solely to the Member. Governance 1. Appointment and removal of the Corporation's Directors. Financial 1. Approval of any capital and operating budgets for the Corporation (subject to the right of the Member, as part of the approval process, to make modifications as the Member deems necessary or appropriate); 2. Approval of any financial commitment, obligation or expenditure by the Corporation of an amount that exceeds a financial limit for capital expenditures or otherwise that may be established from time to time by the Member; 3. Approval of borrowing or lending of money or the incurrence or guarantee of any debt or other financial obligation, directly or indirectly, by the Corporation that exceeds a financial threshold (whether or not strictly monetary) that may be established from time to time by the Member; 4. Approval of any charitable contributions in excess of, or outside of, policies previously established and approved by the Member; 5. Making of any distribution to the Member or any Affiliate, provided that the Member or the Affiliate shall be, at the time of such distribution, a nonprofit organization duly qualified under Section 501(c)(3) of the Code. 6. Approval of any compensation or reimbursement of expenses for Directors of the Corporation beyond that allowed by policies adopted from time to time by the Member. Operations 1. Approval of any strategic plan, business plan, or mission plan of the Corporation, including without limitation authorization of any material changes in the scope of services offered by the Corporation, or any amendments thereto (subject in each case to the right of the Member, as part of the approval process, to make modifications as the Member deems necessary or appropriate); 2. The initiation of any studies, audits, and other periodic reviews as are deemed necessary by the Member with respect to the existing or planned operations of the Corporation; 3.Adoption and amendment of compensation plans or methodologies, salaries and other compensation (including the awarding of any incentive compensation) and benefits; and 4. Approval of the other terms of employment or engagement of the officers and employees, including, but not limited to, physician employees of the Corporation, and physicians who are independent contractors to the Corporation (subject in each case to the right of the Member, as part of the approval process, to make modifications as the Member deems necessary or appropriate). Legal 1. Creation, ownership, or acquisition (whether in whole or in part) and dissolution of any subsidiary or affiliate of the Corporation; 2. Any acquisition, purchase, sale, lease, mortgage, or other transfer or encumbrance ("Transfers") of (i) any property in excess of a financial threshold (whether or not strictly monetary) established by the Member from time to time or (ii) any real property of the Corporation, irrespective of the value; 3. Any Transfer of any personal property of the Corporation, if the sum of the value of such Transferred personal property and the aggregate value of all prior Transfers of personal property during the fiscal year is greater than a financial threshold (whether or not strictly monetary) that may be established from time to time by the Member; 4. Any dissolution, merger, consolidation, sale, or other corporate restructuring of the Corporation; 5. Any creation, modification or termination by the Corporation of any corporate compliance program different from the program maintained by Deaconess Regional Healthcare Services Illinois, Inc.; 6. The amendment, modification or restatement of the Corporation's policies addressing the provision of charity or uncompensated care or the process for collecting amounts due from patients; 7. Selection, retention or termination of the Corporation's auditors or legal counsel; 8. Establishment, adoption or amendment of any indemnification rights, obligations, or agreements affecting the Corporation; 9. Purchase, adoption, amendment, cancellation, or replacement of any insurance coverage for the Corporation or its Directors, officers, employees, and agents; 10. The commencement, settlement or termination of litigation or other claims, or alternative dispute resolution, including, but not limited to, mediation or arbitration that exceeds a financial limit (whether or not strictly monetary) that may be established from time to time by the Member; 11. The filing of any voluntary petition in bankruptcy or any other petition or pleading seeking any reorganization, receivership or similar relief under federal or state law; 12. Any of the foregoing reserve powers with respect to any subsidiary or affiliate of the Corporation; and 13. Any other matters with respect to which authority is granted to the Member by the Articles of Incorporation, these Bylaws, or applicable law. Form 990, Part VI, Section A, line 8b The Organization does not have committees with authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The Form 990 is provided to the board before it is filed. The CEO and CFO review the Form 990. Form 990, Part VI, Section B, line 12c The Board of Directors are required to comply with the Conflict of Interest Policy and individually disclose to the Member and to the Board of Directors, at times of nomination and appointment, the identity of each potential conflict known to the Director. Conflicts are considered with respect to outside interest, investments, outside activities, and business interests among the interested persons as well as their family members. If a conflict is identified, the interested person is not allowed to vote on the matter and may be asked to leave the meeting. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990, Part IX, line 11g Purchased Services: Program service expenses 3,900,747. Management and general expenses 3,931,603. Fundraising expenses 0. Total expenses 7,832,350. Medical Professional Fees: Program service expenses 2,696,165. Management and general expenses 4,150. Fundraising expenses 0. Total expenses 2,700,315. Deaconess Regional Healthcare Services Illinois Inc 3333 W Deyoung Marion IL 62959 810693478 Health care services IL 501(c)(3) Line 10 0 Deaconess Illinois Red Bud Regional Hospital Inc 325 Spring St Red Bud IL 62278 884142509 Health care services IL 501(c)(3) Line 3 Deaconess Regional Healthcare Services Illinois Inc 0 Deaconess Illinois Crossroads Inc 8 Doctors Park Rd Mount Vernon IL 62864 920573933 Health care services IL 501(c)(3) Line 3 Deaconess Regional Healthcare Services Illinois Inc 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0