2021-05-17T18:25:38-05:00 2020-06-30 470714325 RSM US LLP 4650 E 53RD STREET DAVENPORT IA 52807 990 2019-07-01 362852553 ILLINOIS VALLEY COMMUNITY HOSPITAL ILLI 8152233300 925 WEST STREET PERU IL 61354 LISA LYCNH CHIEF FINANCIAL OFFICER 8152233300 2021-05-17 1 JENIFER L CHASE P01306883 5638884000 2021-05-17 2019 2022-09-23 18:48:47Z TOMMY HOBBS 925 WEST STREET PERU IL 61354 89589521 0 X WWW.IVCH.ORG X 1978 IL ILLINOIS VALLEY COMMUNITY HOSPITAL IS DEDICATED TO PROVIDING EXCEPTIONAL CARE THROUGH A COMMITMENT TO CLINICAL EXCELLENCE AND COMPASSION FOR EVERY PATIENT, EVERY DAY. 10 10 698 152 0 0 615399 12336464 80345895 68493879 846203 904827 1475612 -2320765 83283109 79414405 19900 13350 0 0 43976887 40280134 0 0 0 42126386 40170670 86123173 80464154 -2840064 -1049749 60770856 68370653 46654217 52310389 14116639 16060264 X ILLINOIS VALLEY COMMUNITY HOSPITAL IS DEDICATED TO PROVIDING EXCEPTIONAL CARE THROUGH A COMMITMENT TO CLINICAL EXCELLENCE AND COMPASSION FOR EVERY PATIENT, EVERY DAY. 0 0 69383816 13350 66352814 ILLINOIS VALLEY COMMUNITY HOSPITAL (IVCH) IS A SMALL, INTEGRATED COMMUNITY HEALTH CARE DELIVERY SYSTEM. SERVICES RANGE FROM EMPLOYED PHYSICIANS AND MID-LEVELS IN THE SPECIALTIES OF FAMILY MEDICINE, INTERNAL MEDICINE, OBSTETRICS/GYNECOLOGY, ORTHOPEDICS, OTORHINOLARYNGOLOGY, AND SLEEP MEDICINE. IN ADDITION TO THESE PHYSICIAN PRACTICES, IVCH ALSO OFFERS THE CARE TODAY CLINIC WHICH PROVIDES A LOWER-COST, CONVENIENT ALTERNATIVE TO EMERGENCY ROOM CARE. CONTRACTED PHYSICIAN SERVICES ARE PROVIDED FOR EMERGENCY MEDICINE, ANESTHESIOLOGY, AND HOSPITALISTS SERVICES. INPATIENT HOSPITAL SERVICES PROVIDED BY IVCH INCLUDE MEDICAL AND SURGICAL SERVICES, ICU, OBSTETRICS, SWING BEDS, DIAGNOSTIC, REHAB AND TREATMENT SERVICES. OUTPATIENT SERVICES INCLUDE SURGERY, EMERGENCY ROOM, LABORATORY, DIAGNOSTIC IMAGING, REHAB SERVICES, PAIN MANAGEMENT, SLEEP THERAPY, WOUND MANAGEMENT, RESPIRATORY CARE, EKG, OTHER DIAGNOSTIC AND THERAPEUTIC SERVICES HOSPICE AND ADULT DAY CARE SERVICES ARE ALSO PROVIDED. IVCH IS A MEDICARE DEPENDENT HOSPITAL AND QUALIFIES FOR DISPROPORTIONATE SHARE PAYMENTS. IVCH IS COMMITTED TO PROVIDING THE HIGHEST QUALITY OF HEALTH SERVICES TO ALL PATIENTS, REGARDLESS OF THEIR FINANCIAL STATUS OR ABILITY TO PAY. IVCH SUBSIDIZES THE COST OF TREATING PATIENTS WHO ARE UNABLE TO PAY AND THOSE WHO RECEIVE GOVERNMENT ASSISTANCE WHERE REIMBURSEMENT IS LIMITED. STATISTICS:- INPATIENT ADMISSIONS: 1,868- INPATIENT DAYS: 5,283- NEWBORN DELIVERIES: 370- INPATIENT SURGERIES: 450 - OUTPATIENT SURGERIES: 3,355 - OUTPATIENT VISITS: 65,289 - EMERGENCY ROOM VISITS: 11,309 - CLINIC VISITS: 51,257 69383816 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 81 0 1 698 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 IL X LISA LYNCH 8157803574 925 WEST STREET PERU IL 61354 ROBERT MITCHELL DO PHYSICIAN 40.00 X 732732 0 30305 MARIO COTE MD PHYSICIAN 40.00 X 600260 0 52907 PETER MEIER MD FORMER PHYSICIAN 40.00 X 600086 0 21354 IOANNIS KARKATZOUNIS MD PHYSICIAN 40.00 X 537548 0 34095 MAHER YOUNES MD PHYSICIAN 40.00 X 518406 0 11039 TOMMY HOBBS CHIEF EXECUTIVE OFFICER 36.00 4.00 X 286418 0 39423 LISA LYNCH CHIEF FINANCIAL OFFICER 36.00 4.00 X 151631 0 38422 JAMES CLINARD VICE PRESIDENT 1.00 1.00 X X 0 0 0 JOSEPH HOGAN DIRECTOR 1.00 2.00 X 0 0 0 CINDY KURKOWSKI DIRECTOR 1.00 1.00 X 0 0 0 JOEL LEIFHEIT MD DIRECTOR 1.00 1.00 X 0 0 0 JAMES LOVELAND PRESIDENT 1.00 1.00 X X 0 0 0 RICHARD MARTUZZO SECRETARY 1.00 2.00 X X 0 0 0 KRISTINE PAUL DIRECTOR 1.00 3.00 X 0 0 0 MICHAEL ROONEY OD DIRECTOR 1.00 1.00 X 0 0 0 DAVID SICKLEY TREASURER 1.00 1.00 X X 0 0 0 WILLIAM VLASTNIK DIRECTOR 1.00 3.00 X 0 0 0 3427081 0 227545 44 0 1 0 PERU EMERGENCY PHYSICIANS LLP PO BOX 677979 DALLAS TX 75267 PHYSICIAN SERVICES 3006030 SODEXO INC & AFFILIATES PO BOX 360170 PITTSBURGH PA 15251 DIETARY & ENVIRONMENTAL SERVICES 2819996 VALLEY ANESTHESIA SERVICES LLC 23273-2525 EAST STREET PRINCETON IL 61356 ANESTHESIA SERVICES 1332250 SAINT FRANCIS MEDICAL CENTER 7074 SOLUTIONS CENTER CHICAGO IL 60677 LABORATORY SERVICES 814749 DIVERSIFIED CLINICAL SERVICES 28525 NETWORK PLACE CHICAGO IL 60673 WOUND CARE & HYPERBARIC OXYGEN 697287 24 182489 11752679 401296 12336464 NET PATIENT SERVICE REVENUE 621110 68493879 68493879 68493879 263737 263737 403107 582807 -179700 -179700 -179700 10233399 9592309 641090 641090 641090 TRANSPORT VEHICLE REVENUE 900009 330372 330372 MANAGEMENT FEES 541610 60000 60000 CAFETERIA REVENUE 721000 51783 51783 -2583220 -2583220 -2141065 79414405 66352814 0 725127 13350 13350 441772 441772 31298571 27599351 3699220 1267307 1101968 165339 5347669 4649987 697682 1924815 1673695 251120 656149 656149 123705 123705 22477 22477 4591281 4591281 438753 134089 304664 339984 196007 143977 1364542 1008639 355903 2028583 1988582 40001 84151 82982 1169 592851 480209 112642 2424883 1964155 460728 709222 805886 -96664 PURCHASE SERVICES 10664510 7449967 3214543 SUPPLIES AND EQUIPMENT 10444267 10219298 224969 HOSPITAL ASSESSMENT PAY 2690047 2690047 REPAIRS AND MAINTENANCE 1836769 1726573 110196 1158496 1007750 150746 80464154 69383816 11080338 0 924502 15762599 10619069 7227591 2408993 2084685 981200 907307 117343726 92566110 26954898 24777616 11939707 8590919 326106 302427 6616381 8717509 60770856 68370653 15242907 12801697 6263 6263 16748447 15813402 1136499 11869215 13520101 11819812 46654217 52310389 X 12844097 14787467 1272542 1272797 14116639 16060264 60770856 68370653 X -1049749 -385997 3379371 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 22477 22477 0 PART II-B, LINE 1: ALLOCATED PORTION OF MEMBERSHIP DUES WITH ILLINOIS HOSPITAL ASSOCATION, AMERICAN HOSPITAL ASSOCATION, AND MEDICARE DEPENDENT RURAL HOSPITAL COALITION. 1476235 1476235 53756101 37161269 16594832 325067 270249 54818 60251705 53937001 6314704 1534618 1197591 337027 24777616 DUE FROM AFFILIATES 5048534 INTEREST IN ILLINOIS VALLEY COMMUNITY HOSPITAL FOUNDATION 1272797 OTHER ASSETS 2396178 8717509 PENSION OBLIGATION 3684416 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 2413393 ESTIMATED SELF-INSURANCE COSTS 3660902 DUE TO AFFILIATES 2061101 11819812 X PART X, LINE 2: IV HEALTH CORP, INC., ILLINOIS VALLEY COMMUNITY HOSPITAL, ILLINOIS VALLEY COMMUNITY HOSPITAL FOUNDATION AND HYGIENIC INSTITUTE OF LASALLE, PERU, AND OGLESBY ARE NONPROFIT CORPORATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. HOWEVER, THEY ARE SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. VALLEY HEALTH ENTERPRISES IS SUBJECT TO INCOME TAXATION AS A LIMITED LIABILITY COMPANY THAT IS TAXED AS A PARTNERSHIP. IV HEALTH CORP, INC., ILLINOIS VALLEY COMMUNITY HOSPITAL, ILLINOIS VALLEY COMMUNITY HOSPITAL FOUNDATION AND HYGIENIC INSTITUTE OF LASALLE, PERU, AND OGLESBY FILE A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE TAX POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO NONPROFIT ORGANIZATIONS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF EACH ENTITY AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS INCOME (UBI). UBI IS REPORTED ON FORM 990-T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESS, IF ANY. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50 PERCENT LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNCERTAIN TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. AS OF JUNE 30, 2020 AND 2019, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED AS A LIABILITY. TAX RETURNS FILED ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. 1 1 X 1 X 1 X 1 1 0 1 1 222704 222704 0.00280 12830950 3318694 9512256 0.11820 13053654 3318694 9734960 0.12100 479495 384356 95139 0.00120 18003 18003 0.00020 942372 520168 422204 0.00520 13350 13350 0.00020 1453220 904524 548696 0.00680 14506874 4223218 10283656 0.12780 1 4529107 452911 17711412 18762821 -1051409 X 1 1 1 1 ILLINOIS VALLEY COMMUNITY HOSPITAL 925 WEST STREET PERU IL 61354 WWW.IVCH.ORG 0003418 X X X VARIOUS PHYSICIAN CLINICS & OUTPATIENT SERVICES ILLINOIS VALLEY COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X X 18 1 0 0 1 X SEE PART V, PAGE 8 X 1 18 1 SEE PART V, PAGE 8 0 1 X 150.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X HTTPS://WWW.IVCH.ORG/PATIENTS-VISITORS/PATIENT/FINANCIAL-ASSISTANCE/ X HTTPS://WWW.IVCH.ORG/PATIENTS-VISITORS/PATIENT/FINANCIAL-ASSISTANCE/ X HTTPS://WWW.IVCH.ORG/PATIENTS-VISITORS/PATIENT/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 ILLINOIS VALLEY COMMUNITY HOSPITAL PART V, SECTION B, LINE 3J: INDUSTRY DATA RELATED TO PROJECTED GROWTH IN NEED FOR VARIOUS SERVICES SPECIFIC TO THE POPULATION OF THIS AREA. ILLINOIS VALLEY COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) STAKEHOLDERS WORKING GROUP, COMPRISED OF MEMBERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITIES SERVED, WAS RESPONSIBLE FOR THE CHNA PROCESS. THE STAKEHOLDER GROUP INCLUDED MEMBERS FROM IVCH, IVCH MEDICAL GROUP, LA SALLE COUNTY HEALTH DEPT, ALTERNATIVES FOR THE OLDER ADULT, NORTH CENTRAL BEHAVIORAL HEALTH SERVICES, OGLESBY PUBLIC SCHOOLS AND ILLINOIS VALLEY UNITED WAY. THE WORKING GROUP DEVELOPED A SURVEY INSTRUMENT, EVALUATED SURVEY RESPONSES, COLLECTED AND EVALUATED SECONDARY DATA, SYNTHESIZED THE PRIMARY AND SECONDARY DATA, AND IDENTIFIED AND PRIORITIZED COMMUNITY HEALTH NEEDS. PRIMARY DATA FOR THIS ASSESSMENT CAME FROM A SURVEY DEVELOPED, DISTRIBUTED AND ANALYZED BY THE STAKEHOLDERS WORKING GROUP SPECIFICALLY FOR CHNA. ILLINOIS VALLEY COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDES A DESCRIPTION OF THE ACTIONS TAKEN TO MEET NEEDS THAT WERE IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE AREAS OF CONCERN THAT HAVE BEEN IDENTIFIED IN THE NEW 2018 COMMUNITY HEALTH NEEDS ASSESSMENT, RELATE TO COST AND QUALITY OF HEALTHCARE, ACCESS TO SPECIALISTS AND SPECIALIZED TREATMENTS, AND MENTAL HEALTH AND SUBSTANCE ABUSE. REGARDING COST AND QUALITY OF CARE, ILLINOIS VALLEY COMMUNITY HOSPITAL (IVCH) HAS IMPLEMENTED A PALLIATIVE CARE PROGRAM TO REDUCE PATIENT AND OVERAL COST OF CARE WHILE ENHANCING CARE AND SERVICE TO PATIENTS; PROMOTED AND PROVIDED ANNUAL WELLNESS VISITS TO PROACTIVELY MANAGE THE HEALTH OF PATIENTS; AND EDUCATED AND ASSISTED PATIENTS TO UNDERSTAND AVAILABLE INSURANCE AND COVERAGES PROVIDED BY MEDICARE AND MEDICAID. REGARDING ACCESS TO SPECIALISTS AND SPECIALIZED CARE, IVCH CONDUCTED ANALYSIS TO DETERMINE MORE SPECIFICALLY WHAT THE COMMUNITY IS SEEKING, AND AUGMENTED A MEDICAL STAFF DEVELOPMENT PLAN TO RECRUIT ORTHOPEDIC SURGEON, OB/GYN PHYSICIANS AND NEUROLOGIST. REGARDING MENTAL HEALTH AND SUBSTANCE ABUSE, IVCH HAS INCREASED ACCESS TO MENTAL HEALTH TREATMENT BY PROVIDING TELEPSYCHIATRY SERVICES IN PRIMARY CARE CLINICS; CONTINUED FOCUS ON PEDIATRIC MENTAL HEALTH THROUGH SERVICES OFFERED AT THE HYGIENIC INSTITUTE; AND INCREASED AWARENESS OF CURRENT MEDICATION ASSISTED THERAPY TREATMENT OPTIONS OFFERED THROUGH THE IVCH MEDICAL GROUP. FORM 990, SCHEDULE H, PART V, LINE 7A, CHNA WEBSITE: HTTPS://WWW.IVCH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ FORM 990, SCHEDULE H, PART V, LINE 10A, IMPLEMENTATION STRATEGY WEBSITE: HTTPS://WWW.IVCH.ORG/DOCUMENTS/CHNA-2018-IMPLEMENTATION-STRATEGYV3.PDF 3 1 - CENTER FOR PHYSICAL REHABILITATION 300 WALNUT STREET PERU IL 61354 OUTPATIENT PHYSICAL REHABILITATION 2 - IVCH WOUND & HYPERBARIC CENTER 1403 6TH STREET PERU IL 61354 WOUND AND HYPERBARIC THERAPY 4 - IVCH CARE TODAY 300 WALNUT STREET PERU IL 61354 URGENT CARE ALTERNATIVE TO ER PART I, LINE 3C: NOT APPLICABLE PART I, LINE 6A: NOT APPLICABLE PART I, LINE 7: THE COSTS REPORTED IN THE TABLE IN PART I, LINE 7 USED A RATIO OF PATIENT CARE COSTS TO CHARGES AS COMPUTED IN WORKSHEET 2 OF THE FORM INSTRUCTIONS. THIS METHODOLOGY WAS USED FOR ALL PATIENT SEGMENTS. PART I, LINE 7G: THE AMOUNTS REPORTED ON ROW 7G DO NOT CONTAIN COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC. PART I, LN 7 COL(F): THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $4,529,107. BAD DEBT EXPENSE WAS NOT INCLUDED IN THE DENOMINATOR BECAUSE IT WAS REPORTED ON LINE 2D OF PART VIII, STATEMENT OF REVENUE. THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE AS A PERCENTAGE OF TOTAL EXPENSES IS 18.03%. THIS PERCENTAGE INCREASES TO 41.35% IF MEDICARE ALLOWABLE COSTS ARE INCLUDED IN THE TOTAL COMMUNTY BENEFIT EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: NOT APPLICABLE PART III, LINE 2: THE ORGANIZATION RECORDS CONTRACTUAL DISCOUNTS AT THE TIME OF THE POSTING OF THE PAYMENT FOR SERVICES FROM THIRD PARTY PAYORS. BAD DEBT IS RECORDED AT THE TIME THE ACCOUNT IS EITHER PRESUMED UNCOLLECTIBLE OR TURNED OVER TO COLLECTION. FURTHER, THE ORGANIZATION RECORDS APPROPRIATE ALLOWANCES FOR CONTRACTUAL DISCOUNTS AND BAD DEBT/CHARITY CARE IN ORDER TO REFLECT ACCOUNTS RECEIVABLE AT THE EXPECTED COLLECTIBLE AMOUNT.CONTRACTUAL DISCOUNTS/MEDICARE/MEDICAID: MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYORS IN EVALUATING THE REASONABLE ESTIMATE OF THE ALLOWANCE FOR CONTRACTUAL DISCOUNTS. FOR SERVICES PROVIDED TO PATIENTS THAT HAVE THIRD PARTY COVERAGE, THE CORPORATION ANALYZES THE DISCOUNT RATES FOR EACH MAJOR PAYOR. THE DIFFERENCE BETWEEN THE NEGOTIATED RATES FOR THE MEDICARE/MEDICAID STANDARD RATES ARE USED TO DETERMINE THE ALLOWANCE FOR CONTRACTUAL DISCOUNTS.SELF-PAY ACCOUNTS RECEIVABLE INCLUDE THE PATIENT RESPONSIBILITY FOR SERVICES AFTER THE THIRD PARTY COVERAGE HAS BEEN APPLIED TO THE PATIENT ACCOUNT AS WELL AS THE UNINSURED. AN ALLOWANCE FOR BAD DEBT IS ESTIMATED BASED ON PAST EXPERIENCE AS WELL AS THE AGE OF THE ACCOUNTS. THE ORGANIZATION HAS A COLLECTIONS PRACTICES POLICY THAT IS USED TO SET GUIDELINES ON THE APPROACH AND TIMELINE TO MAKE REASONABLE COLLECTION EFFORTS BEFORE ANY ACCOUNTS ARE TURNED OVER TO A COLLECTION AGENCY. THE ORGANIZATION HAD BAD DEBT EXPENSE TOTALING $4,529,107. THIS REFLECTS THE COMBINED IMPACT OF WRITE-OFFS OF UNCOLLECTIBLE ACCOUNTS, PROVISIONS RECORDED TO ESTIMATE BAD DEBT ON ACCOUNTS RECEIVABLE.DURING FISCAL 2020, THERE WERE NO CHANGES IN THE ORGANIZATION'S POLICIES OR PRACTICES. PART III, LINE 3: 10% OF BAD DEBT IS ASSUMED TO BE PROVIDED INCLUDE AMOUNTS WRITTEN OFF FOR PATIENTS THAT WOULD HAVE QUALIFIED FOR THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE RATIONALE FOR THE PERCENTAGE BEING THIS IS BECAUSE OF THE SIGNIFICANT STEPS TAKEN WITH PATIENTS TO FACILITATE MEDICAID OR FINANCIAL ASSISTANCE QUALIFICATION. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY).FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRDPARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITALS ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS 79 PERCENT AT JUNE 30, 2020. PART III, LINE 8: IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NON PROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. THE AMOUNTS REPORTED ON LINE 6 WERE OBTAINED FROM WORKSHEET D OF THE FISCAL YEAR 2020 MEDICARE COST REPORT. PART III, LINE 9B: WHEN A PATIENT IS IN THE PROCESS OF APPLYING FOR FINANCIAL ASSISTANCE THE ACCOUNT IS PLACED ON HOLD AND NO FURTHER COLLECTION EFFORTS ARE MADE UNTIL THE REQUEST FOR ASSISTANCE HAS BEEN RESOLVED. THE APPLICATION PROCESS INCLUDES FACILITATING THE PATIENT'S APPLICATION FOR VARIOUS ASSISTANCE PROGRAMS, AND IDENTIFYING WHERE THE PATIENT FALLS IN THE DISCOUNT SCALE OF THE ORGANIZATION BASED ON INCOME LEVEL AND SIZE OF FAMILY. IF THERE IS A BALANCE REMAINING AFTER CHARITY CARE OR OTHER FINANCIAL ASSISTANCE HAS BEEN APPLIED, A MUTUALLY AGREED UPON PAYMENT PLAN IS DEVELOPED AND THE ACCOUNT FOLLOWS THE SAME COLLECTION PROCEDURES AS ALL OTHER SELF-PAY ACCOUNTS. MONTHLY PAYMENTS ARE REQUIRED AND BALANCES ARE TYPICALLY EXPECTED TO BE PAID IN FULL WITHIN ONE YEAR. EXTENSIONS MAY BE APPROVED FOR UNEXPECTED CHANGES IN ABILITY TO MEET THE PAYMENT SCHEDULE. COLLECTION PROCEDURES INCLUDE STATEMENTS, PAST DUE NOTICES, PHONE CALLS AND, IF AGREED UPON PAYMENT ARRANGEMENTS CAN NOT BE MET, THE ACCOUNT IS REFERRED TO A COLLECTION AGENCY. PART VI, LINE 2: THE DETERMINATION OF CURRENT AND FUTURE HEALTH CARE NEEDS OF THE COMMUNITIES SERVED BY ILLINOIS VALLEY COMMUNITY HOSPITAL IS BASED ON A COMBINATION OF THE FOLLOWING FACTORS: EXISTENCE OR NON-EXISTENCE OF APPROPRIATE SERVICES, DEMONSTRATED NEED, VOICE OF THE CUSTOMER, COLLABORATION WITH COMMUNITY ORGANIZATIONS, GOVERNMENT AGENCIES AND OTHER HEALTH CARE PROVIDERS, BENCHMARKING MARKET RESEARCH, CUSTOMER SURVEYS, PHYSICIAN INPUT AND MONITORING OF STATE AND FEDERAL GUIDELINES. THIS INFORMATION IS REVIEWED AND ANALYZED BY THE HOSPITAL'S ADMINISTRATIVE TEAM AND INCORPORATED INTO THE HOSPITAL'S STRATEGIC PLANNING PROCESS. PART VI, LINE 3: DOCUMENTATION IS PROVIDED AT THE TIME OF REGISTRATION INFORMING PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE AND PROVIDING CONTACT INFORMATION FOR THE PATIENT FINANCIAL SERVICES DEPARTMENT. BASIC INFORMATION AND CONTACT INFORMATION IS ALSO AVAILABLE AT WWW.IVCH.ORG BY SELECTING THE HOME PAGE'S FINANCIAL ASSISTANCE BUTTON. WHEN CONTACTED BY A PATIENT, FINANCIAL COUNSELORS WORK INDIVIDUALLY WITH EACH APPLICANT TO DETERMINE ELIGIBILITY FOR CHARITY OR FINANCIAL ASSISTANCE. NOTICES ABOUT FINANCIAL ASSISTANCE PROGRAMS ARE POSTED IN THE REGISTRATION AREAS AND INFORMATION IS ALSO INCLUDED ON THE PATIENT STATEMENTS. THE SOCIAL SERVICES DEPARTMENT NOTIFIES EACH INPATIENT OF FINANCIAL ASSISTANCE PROGRAMS AVAILABLE AT ILLINOIS VALLEY COMMUNITY HOSPITAL AS WELL AS LOCAL, STATE, AND FEDERAL PROGRAMS THEY MAY BE ELIGIBLE FOR. PART VI, LINE 4: ILLINOIS VALLEY COMMUNITY HOSPITAL (IVCH) SERVES THE RESIDENTS OF RURAL COMMUNITIES LOCATED IN LASALLE, BUREAU AND PUTNAM COUNTIES, IN NORTH CENTRAL ILLINOIS. THE HOSPITAL IS LOCATED NEAR THE JUNCTION OF INTERSTATES 80 AND 39 AND IS 62 MILES WEST OF JOLIET AND 64 MILES NORTH OF BLOOMINGTON. THE PRIMARY SERVICE AREA OF THE HOSPITAL HAS A POPULATION OF ABOUT 35,000 PEOPLE. NO POPULATION GROWTH IS PROJECTED FOR THE AREA. THE LARGEST AREA EMPLOYERS ARE INVOLVED IN TRANSPORTATION, WAREHOUSING, AGRICULTURE, LIGHT INDUSTRY, AND RETAIL SERVICES. THE SERVICE AREA RACE AND ETHNICITY IS COMPOSED OF 85% WHITE, 3% AFRICAN AMERICAN, 10% HISPANIC AND 1% ASIAN. ACCORDING TO THE ILLINOIS DEPARTMENT OF EMPLOYMENT SECURITY, THE 2020 UNEMPLOYMENT RATE IN LASALLE COUNTY WAS 9.4%, WHICH WAS SLIGHTLY LOWER THAN THE STATE OF ILLINOIS (9.5%) AND HIGHER THAN THE UNITED STATES (8.1%). THE MEDIAN HOUSEHOLD INCOME IN LASALLE ($58,142), BUREAU ($57,436) AND PUTNAM ($63,638) COUNTIES WERE BELOW THE STATE OF ILLINOIS FIGURE OF $65,886. THE PROPORTION OF LASALLE COUNTY RESIDENTS LIVING BELOW THE FEDERAL POVERTY LEVEL OF 12.2% IS MORE THAN THE STATE AVERAGE OF 11.5%. IVCH SERVES PATIENTS WITHOUT REGARD TO AGE, GENDER, INCOME, ETHNIC ORIGIN, INSURANCE COVERAGE, OR ABILITY TO PAY. APPROXIMATELY 65% OF THE HOSPITAL'S GROSS PATIENT SERVICE REVENUE WAS FROM PARTICIPATION IN THE MEDICARE AND MEDICAID PROGRAMS FOR THE YEAR ENDING JUNE 30, 2020. PART VI, LINE 5: THE BOARD OF DIRECTORS OF ILLINOIS VALLY COMMUNITY HOSPITAL (IVCH) IS COMPOSED OF 10 COMMUNITY MEMBERS RESIDING IN OUR SERVICE AREA. THESE BOARD MEMBERS HAVE REGULAR INPUT ON STRATEGIC PLANNING, NEW SERVICES, TECHNOLOGY, AND PHYSICIAN RECRUITMENT. IVCH MAINTAINS AN OPEN MEDICAL STAFF AND IS CONSTANTLY RECRUITING NEW PHYSICIANS TO MEET IDENTIFIED NEEDS. ALL AVAILABLE CASH FLOW GENERATED BY THE ORGANIZATION IS REINVESTED BACK INTO THE HOSPITAL THROUGH THE PURCHASE OF PROPERTY AND EQUIPMENT TO PROVIDE SERVICES THAT MEET THE NEEDS OF THE SERVICE AREA. THE COMMUNITY OUTREACH DEPARTMENT OFFERS A WIDE VARIETY OF HEALTH AND WELLNESS PROGRAMMING, INCLUDING TAI CHI CLASSES, FREE BLOOD PRESSURE AND GLUCOSE SCREENINGS, HEMOGLOBIN A1C SCREENINGS, LIPID PROFILE SCREENINGS, HEALTHY HEART SCREENINGS, PROSTATE CANCER SCREENINGS, SMOKING CESSATION CLASSES, BABYSITTING CLINICS, CPR INSTRUCTION, AND FIRST AID. PART VI, LINE 6: NOT APPLICABLE PART VI, LINE 7, REPORTS FILED WITH STATES IL X X X X 0 0 0 0 0 0 0 1 0 ROBERT MITCHELL DO PHYSICIAN 617748 0 71148 0 43836 0 7075 0 23230 0 763037 0 0 0 MARIO COTE MD PHYSICIAN 337653 0 259019 0 3588 0 18500 0 34407 0 653167 0 0 0 PETER MEIER MD FORMER PHYSICIAN 418072 0 100000 0 82014 0 0 0 21354 0 621440 0 0 0 IOANNIS KARKATZOUNIS MD PHYSICIAN 446335 0 2687 0 88526 0 0 0 34095 0 571643 0 0 0 MAHER YOUNES MD PHYSICIAN 477885 0 0 0 40521 0 0 0 11039 0 529445 0 0 0 TOMMY HOBBS CHIEF EXECUTIVE OFFICER 284519 0 0 0 1899 0 14000 0 25423 0 325841 0 0 0 LISA LYNCH CHIEF FINANCIAL OFFICER 150667 0 0 0 964 0 7854 0 30568 0 190053 0 0 0 PART I, LINE 7 EMPLOYED PHYSICIANS OF THE ORGANIZATION RECEIVE A BASE SALARY BASED ON THE MARKET FOR PHYSICIANS IN THEIR MEDICAL SPECIALTY. EACH PHYSICIAN HAS AN EMPLOYMENT CONTRACT WHICH MAY INCLUDE A COMPONENT OF INCENTIVE COMPENSATION. INCENTIVE COMPENSATION IS BASED ON THEIR INDIVIDUAL PROFESSIONAL PRODUCTION, PROVIDING AN OPPORTUNITY TO EARN ABOVE THE BASE SALARY LEVEL. THE BASE SALARY IS RECONCILED WITH THE PHYSICIAN'S PROFESSIONAL PRODUCTION ON A QUARTERLY AND ANNUAL BASIS. ANY AMOUNTS DUE TO THE PHYSICIANS FOR INCENTIVE COMPENSATION ARE PAID WITHIN 30 DAYS OF THE END OF THE PERIOD. A ILLINOIS FINANCING AUTHORITY 861091967 45203HK35 2014-12-15 10000000 RE-FINANCING OF EXISTING DEBT 0 0 0 B ILLINOIS FINANCING AUTHORITY 861091967 45203HK43 2014-12-15 8000000 RE-FINANCING OF EXISTING DEBT 0 0 0 C ILLINOIS FINANCING AUTHORITY 861091967 45203HK60 2014-12-15 3160000 RE-FINANCING OF EXISTING DEBT 0 0 0 A 1943000 10000000 200000 9800000 2015 1 0 1 1 B 1553000 8000000 160000 7840000 2015 1 0 1 1 C 613000 3160000 63200 3096800 2015 1 0 1 1 A 0 1 0 0 0.01000 0.00000 0.01000 0 0 1 B 0 1 0 0 0.01000 0.00000 0.01000 0 0 1 C 0 1 0 0 0.01000 0.00000 0.01000 0 0 1 A 0 1 0 0 1 0 0 0 1 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 FORM 990, PART VI, SECTION A, LINE 6 ILLINOIS VALLEY COMMUNITY HOSPITAL IS A SUBSIDIARY OF ITS SOLE CORPORATE MEMBER, IV HEALTH CORP, INC. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OF THE BOARD OF DIRECTORS OF THE PARENT COMPANY, IV HEALTH CORP, INC., ACTING ON BEHALF OF THE PARENT, HAVE RESERVED POWERS TO, AS IT RELATES TO THE OPERATIONS OF ILLINOIS VALLEY COMMUNITY HOSPITAL TO APPOINT AND REMOVE DIRECTORS AND TO RATIFY AND REMOVE OFFICERS. FORM 990, PART VI, SECTION A, LINE 7B MEMBERS OF THE BOARD OF DIRECTORS OF THE PARENT COMPANY, IV HEALTH CORP, INC., ACTING ON BEHALF OF THE PARENT, HAVE RESERVED POWERS TO, AS IT RELATES TO THE OPERATIONS OF ILLINOIS VALLEY COMMUNITY HOSPITAL TO ADOPT, AMEND, OR REPEAL THE ARTICLES OF INCORPORATION AND/OR BY-LAWS, ADOPT A PLAN OF MERGER, CONSOLIDATION OR DISSOLUTION, APPROVE THE PURCHASE, SALE, TRANSFER, LEASE ENCUMBRANCE OF PROPERTY, APPROVE BORROWING WITH A TERM GREATER THAN A ONE YEAR TERM OR WHICH REQUIRES A MORTGAGE OF REAL PROPERTY, AND SELECTION OR MODIFICATION OF THE BUSINESS/LEGAL NAME OF THE ENTITY. FORM 990, PART VI, SECTION B, LINE 11B THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER REVIEW THE FORM 990 PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE. THE FINAL VERSION OF THE FORM 990 IS E-MAILED OR HAND DELIVERED TO EACH BOARD MEMBER FOR THEIR REVIEW AND TO ANSWER QUESTIONS REGARDING THE 990. FORM 990, PART VI, SECTION B, LINE 12C THE OFFICERS AND DIRECTORS OF ILLINOIS VALLEY COMMUNITY HOSPITAL ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY AND HAVE A DUTY TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST. ALL PERSONS COVERED UNDER THE POLICY ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE AND DISCLOSE ANY INTEREST THAT COULD GIVE RISE TO CONFLICTS. TRANSACTIONS WITH COVERED PERSONS, OR ENTITIES IN WHICH A COVERED PERSON HAS ANY TYPE OF INTEREST, MUST BE AN ARMS LENGTH TRANSACTION. THE BOARD OF DIRECTORS WILL REVIEW ANY TRANSACTIONS IN QUESTION AND DETERMINE IF A CONFLICT EXISTS. THE INTERESTED PERSON MAY MAKE A PRESENTATION, BUT MUST LEAVE THE MEETING DURING DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION. IF A CONFLICT OF INTEREST EXISTS, THE BOARD OF DIRECTORS MAY APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION, DETERMINE IF THERE'S A MORE ADVANTAGEOUS TRANSACTION THAT WOULD NOT GIVE RISE TO A CONFLICT, OR VOTE TO DETERMINE IF THE TRANSACTION IS IN THE HOSPITAL'S BEST INTEREST AND WHETHER IT IS FAIR AND REASONABLE. IF THE BOARD OF DIRECTORS HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE A POSSIBLE CONFLICT OF INTEREST, THE BOARD WILL INFORM THE MEMBER OF THE BASIS OF SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN. FURTHER INVESTIGATION MAY BE WARRANTED, AND THE BOARD SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION AS NEEDED. FORM 990, PART VI, SECTION B, LINE 15A AN ADHOC COMMITTEE OF THE BOARD OF DIRECTORS (INCLUDING THE BOARD PRESIDENT, CHAIRPERSON OF THE PERSONNEL COMMITTEE, AND AT LEAST ONE OTHER MEMBER) CONDUCT AN ANNUAL PERFORMANCE REVIEW OF THE CHIEF EXECUTIVE OFFICER AND DETERMINE ANY CHANGE/INCREASE IN THE COMPENSATION, IF ANY, BASED UPON BENCHMARK COMPENSATION SURVEYS AND AREA NORMS. THE CHIEF EXECUTIVE OFFICER HAS A WRITTEN EMPLOYMENT CONTRACT RENEWAL OF THE CONTRACT OR INCREASE IN COMPENSATION MUST BE APPROVED BY A MAJORITY OF THE BOARD OF DIRECTORS. THIS COMPENSATION REVIEW WAS COMPLETED IN 2020. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN UNRECOGNIZED FUNDED STATUS OF PENSION PLAN 3,379,116. CHANGE IN INTEREST OF ILLINOIS VALLEY COMMUNITY FOUNDATION 255. FORM 990, PART XII, LINE 2C: THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR TAX YEAR. IV HEALTH CORP INC 925 WEST STREET PERU IL 61354 371211890 PARENT IL 501(C)(3) LINE 12B, II N/A 0 HYGIENIC INSTITUTE FOR LASALLE PERU AND OGLESBY 925 WEST STREET PERU IL 61354 362167742 PRIMARY CARE IL 501(C)(3) LINE 10 IV HEALTH CORP INC 1 ILLINOIS VALLEY COMMUNITY HOSPITAL FOUNDATION 925 WEST STREET PERU IL 61354 371211780 FUNDRAISING FOR ILLINOIS VALLEY COMMUNITY HOSPITAL IL 501(C)(3) LINE 12A, I IV HEALTH CORP INC 1 VALLEY REGIONAL HEALTH SERVICES 4391 VENTURE DRIVE PERU IL 61354 273891281 CANCER CARE IL ILLINOIS VALLEY COMMUNITY HOSPITAL RELATED -23678 604818 0 0 0.50000 VALLEY HEALTH ENTERPRISES 925 WEST STREET PERU IL 61354 363476877 DME IL ILLINOIS VALLEY COMMUNITY HOSPITAL C 429441 3514224 1.00000 1 ILLINOIS VALLEY HEALTH SERVICES INC 925 WEST STREET PERU IL 61354 364050682 INACTIVE IL ILLINOIS VALLEY COMMUNITY HOSPITAL C 1.00000 1 ILLINOIS VALLEY PHO 925 WEST STREET PERU IL 61354 363978381 PPO CONTRACTING IL ILLINOIS VALLEY COMMUNITY HOSPITAL C -2113 98374 0.50000 0 IVCH GENERAL PROFESSIONAL LIAB LOSS FUND 925 WEST STREET PERU IL 61354 366673231 INACTIVE IL ILLINOIS VALLEY COMMUNITY HOSPITAL T 1.00000 1 HEALTH CARE BUILDING CORP 925 WEST STREET PERU IL 61354 363306917 INACTIVE IL ILLINOIS VALLEY COMMUNITY HOSPITAL C 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 ILLINOIS VALLEY COMMUNITY HOSPITAL FOUNDATION C 182489 FAIR MARKET VALUE HYGIENIC INSTITUTE OF LASALLE PERU AND OGELSBY O 130028 FAIR MARKET VALUE HYGIENIC INSTITUTE OF LASALLE PERU AND OGELSBY R 295414 FAIR MARKET VALUE HYGIENIC INSTITUTE OF LASALLE PERU AND OGELSBY S 177206 FAIR MARKET VALUE VALLEY HEALTH ENTERPRISES R 301941 FAIR MARKET VALUE