2020-03-26T11:04:22-05:00 2019-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2018-07-01 370673506 GRAHAM HOSPITAL ASSOCIATION GRAH 3096475240 210 W WALNUT CANTON IL 61520 ROBERT G SENNEFF PRESIDENT AND CEO 3096475240 2020-02-28 1 MICHAEL J PETERSON CPA P01833529 2187224705 2020-02-25 216.54.158.12 2020-02-28 13:29:53 CS P E4255D669FE7A429B540D12C0E645A16D05D3497 05365E77D662BDC17E2AAA2C6021CC7EC3235B8D 2018 2020-09-23 17:36:50Z ROBERT G SENNEFF 210 W WALNUT CANTON IL 61520 103028100 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. 15 14 818 77 319193 0 647708 399717 84072982 85089299 13149854 3397555 6444683 929030 104315227 89815601 0 0 0 0 40276740 44648460 0 0 0 44711134 43680585 84987874 88329045 19327353 1486556 193875235 194646676 61832768 61596588 132042467 133050088 X TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES, IN A RESPONSIBLE AND CHARITABLE MANNER, TO THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 39983827 0 46205148 GRAHAM HOSPITAL IS A PROVIDER OF HEALTHCARE SERVICES IN FULTON COUNTY AND SURROUNDING AREAS. DURING THIS REPORTING PERIOD, 2,516 ADULTS AND CHILDREN WERE ADMITTED AND 217 BABIES WERE BORN. THEY RECEIVED INPATIENT SERVICES IN THE ACUTE CARE FACILITY. 244 PATIENTS WERE ADMITTED FOR 9,690 DAYS OF SERVICE IN THE EXTENDED CARE FACILITY. 103,852 OUTPATIENT SERVICES WERE PROVIDED. 10497332 0 12130674 GRAHAM MEDICAL GROUP WHICH PROVIDES PHYSICIAN AND PROFESSIONAL HEALTH CARE SERVICES TO THE PATIENTS IN FULTON COUNTY, ILLINOIS. THIS INCLUDES CHARITY CARE TO QUALIFIED INDIVIDUALS AND 91,316 OFFICE VISITS AND 10,406 NURSING HOME AND HOSPITAL VISITS. 10995023 0 12705804 SURGICAL SERVICES - THE HOSPITAL PERFORMED 556 INPATIENT SURGERIES AND 3,144 OUTPATIENT SURGERIES IN FISCAL YEAR 2019. 5954015 0 6880436 THE HOSPITAL OPERATES A 24 HOUR EMERGENCY DEPARTMENT WHICH HAD 14,383 PATIENTS REGISTERED TO THE EMERGENCY DEPARTMENT IN FISCAL YEAR 2019. 5954015 0 6880436 67430197 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 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 68 0 818 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X ROBERT G SENNEFF 3096475240 210 W WALNUT CANTON IL 61520 BILL CARLBERG TRUSTEE 2.00 X 0 0 0 BROOKE DENNISTON TRUSTEE 2.00 X 0 0 0 PAULA GRIGSBY TRUSTEE 2.00 X 0 0 0 DONALD HACKETT 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 MARION KUZNIAR TRUSTEE 2.00 X 0 0 0 KEVIN MEADE TRUSTEE 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 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 ROBERT SENNEFF PRESIDENT/CEO 40.00 X X 534264 0 88043 HOLLY HENLINE VP ANCILLARY/CCO 40.00 X 187234 0 41846 CAROLYN JACOBUS VP CLINIC SERVICES (THRU JULY) 40.00 X 134711 0 16362 TERESA MCCONKEY VP PATIENT SERVICES 40.00 X 250513 0 35248 JULIE REEDER VP FINANCE/CFO 40.00 X 183668 0 41655 JAMES SCHREINER VP INFO SERVICES 40.00 X 251165 0 32255 ALLISON SOURS VP QUALITY 40.00 X 84049 0 14890 ANDREW ROUDEBUSH DO WOUND CLINIC DIRECTOR 36.00 X 270033 0 33654 DWAYNE BERNARD MD MEDICAL DIRECTOR 36.00 X 420599 0 42870 DEVASHISH AGARWAL MD PHYSICIAN 36.00 X 410297 0 42120 JEFFREY HEMP MD PHYSICIAN 36.00 X 331848 0 33920 MATTHEW MCMILLIN MD PHYSICIAN 24.00 X 240909 0 3223 BRENT PARRY DPM PODIATRIST 36.00 X 407753 0 36157 JULIO RAMOS MD PHYSICIAN 36.00 X 403364 0 16644 4110407 0 478887 13 0 1 0 COLEMAN MEDICAL ASSOCIATES 180 SOUTH MAIN STREET CANTON IL 61520 PHYSICIAN SERVICES 7815523 PJ HOERR INC 107 W COMMERCE PEORIA IL 61604 CONSTRUCTION 2536106 ENDURACARE ACUTE CARE SERVICES PO BOX 654072 DALLAS TX 75265 REHAB SERVICES 1981839 MIDWEST MOBILE ANESTHESIA 4128 W STONEWATER DRIVE PEORIA IL 61615 ANESTHESIA SERVICES 1006302 PEORIA SURGICAL GROUP LTD 1001 MAIN ST SUITE 300 PEORIA IL 61606 SURGICAL SERVICES 707500 28 399717 399717 PATIENT SERVICES 621110 77922062 77922062 340(B) REVENUE 446110 6026919 6026919 SCHOOL OF NURSING 611600 450335 450335 LABORATORY SERVICES 621500 199196 199196 490787 370790 119997 85089299 2855886 2855886 390809 240578 150231 150231 150231 13513590 12519974 451947 993616 -451947 541669 541669 CAFETERIA 722210 647861 647861 EMPLOYEE PHARMACY 446110 130938 130938 778799 89815601 85548905 319193 3547786 X 2519823 1213883 1305940 31570005 25183258 6386747 695913 602255 93658 7519425 6333041 1186384 2343294 1961930 381364 363904 363904 36269 36269 72090 72090 369880 369880 16955618 13343574 3612044 297985 8349 289636 426985 185107 241878 1880627 117712 1762915 1632769 1365200 267569 54037 17029 37008 13212 10226 2986 1552394 1347451 204943 5260793 4550190 710603 547497 547497 MEDICAL SUPPLIES 9955973 9665377 290596 MEDICAID ASSESSMENT 2307692 2307692 DIETARY 742628 721366 21262 REPAIRS AND MAINTENANCE 578009 437445 140564 632223 366804 265419 88329045 67430197 20898848 0 1191164 702413 7024737 3572625 11578992 11329607 2200664 2932186 1873940 1846830 1977716 1700920 138199794 63610920 73684711 74588874 84084256 86868947 8666367 8764595 1592688 2339679 193875235 194646676 11319528 6915782 45378239 44069585 5135001 10611221 61832768 61596588 X 123376100 124285493 320008 362678 8346359 8401917 132042467 133050088 193875235 194646676 X 1486556 347786 -826721 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 23011 23011 0 PART II-B, LINE 1: LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED: 37% OF MEMBERSHIP DUES PAID TO THE ILLINOIS HOSPITAL ASSOCIATION, OR $13,749; 37% OF MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, OR $8,550; 28.42% OF MEMBERSHIP DUES PAID TO THE ILLINOIS HEALTH CARE ASSOCIATION, OR $712. 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 70323226 2730813 1877809 3050 570665 74358133 0.90730 0.09000 0.00270 1 0 3145860 3145860 87475197 31633094 55842103 44442446 29992795 14449651 3136291 1985031 1151260 74588874 DUE TO THIRD PARTY PAYORS 2861958 ESTIMATED SELF INSURANCE COSTS 2727275 ASSET RETIREMENT OBLIGATION 266162 DEFERRED COMP PLAN OBLIGATIONS 1130856 FMV OF SWAP OPTIONS 3485359 RECOURSE LIABILITY 139611 10611221 89384317 347786 -779070 -431284 89815601 0 89815601 88569623 240578 240578 88329045 0 88329045 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: RENT EXPENSES 240,578. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -1,019,648. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENT EXPENSES 240,578. 1 1 X 1 X 180.000000000000 1 X 1 1 1 0 1 0 1787649 1787649 0.02020 16718869 13343571 3375298 0.03820 18506518 13343571 5162947 0.05840 60506 1282 59224 0.00070 212342 212342 0.00240 272848 1282 271566 0.00310 18779366 13344853 5434513 0.06150 10000 10000 0.00010 1336 1336 0.00000 3550 3550 0.00000 14886 14886 0.00010 0 3687051 0 21495646 24138166 -2642520 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 18 1 0 0 1 X SEE SUPPLEMENTAL INFORMATION 1 18 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 REPRESENTATIVES: RUSTY MELHOUSE - FINANCIAL ADVISOR EDWARD D. JONES TRYGVE MEADE - ATTORNEY/PROPRIETOR MEADE LAW OFFICE JEFF STANDARD SHERIFF - FULTON COUNTY SHERIFF'S DEPARTMENT AMANDA ATCHLEY - EXECUTIVE DIRECTOR CANTON AREA CHAMBER OF COMMERCE AARON AND VEANNA THUM - OWNERS CRAWFORD'S HOME FURNISHINGS KATHY EDWARDS - PRESIDENT GRAHAM HOSPITAL SERVICE LEAGUE ROLF SILVERSTEIN - SUPERINTENDENT CANTON UNION SCHOOL DISTRICT #66 BROOKE DENNISTON - EXECUTIVE DIRECTOR CANTON YWCA JAY SHEPLER - REPRESENTATIVE ST. MARY'S FOOD PANTRY REV. KEVIN VAN TINE - PASTOR COVENANT COMMUNITY FELLOWSHIP, CANTON KENT MCDOWELL - MAYOR CITY OF CANTON DICK FAIRBURN - PUBLIC SAFETY DIRECTOR CITY OF CANTONIDENTIFICATION AND PRIORITIZATION GROUP AMANDA ATCHLEY - EXECUTIVE DIRECTOR CANTON AREA CHAMBER OF COMMERCE KENT MCDOWELL - MAYOR CITY OF CANTON KATIE LYNN - ADMINISTRATOR FULTON COUNTY HEALTH DEPARTMENT MISSY KOLOWSKI - ADMINISTRATOR HEALTH & WELLNESS CONNECTION OF FULTON COUNTY MICHELLE LOCKE - CLINICAL SOCIAL WORKER GRAHAM HOSPITAL SUE LIVINGSTON - DIRECTOR GRAHAM SCHOOL OF NURSING JEFF HOWD - ADMINISTRATOR THE LOFT REHAB & NURSING CENTER, CANTONFOCUS GROUP 2 - MEDICAL PROFESSIONALS AND PARTNERS KATIE LYNN - ADMINISTRATOR FULTON COUNTY HEALTH DEPARTMENT LIZ UTSINGER - HEALTH PROFESSIONAL/HEALTH EDUCATOR FULTON COUNTY HEALTH DEPARTMENT MISSY KOLOWKI - ADMINISTRATOR HEALTH & WELLNESS CONNECTION OF FULTON COUNTY 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 PRITIKIN CARDIAC PROGRAM B. CREATE A COMMUNITY BIKE SHARE PROGRAM C. COLLABORATE WITH THE YMCA TO PRESENT A HEALTHY KIDS DAY D. GROW PROGRAMS FOR BUSINESS AT THE COMMUNITY WELLNESS CENTER E. CREATE WELLNESS CHECK PROGRAMS G. IMPROVE PATIENT BMI THROUGH TRACKING AND EDUCATION AT CLINICS AND THE WELLNESS CENTER2. 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 PRITIKIN CARDIAC PROGRAM B. EXPAND MERIT-BASED INCENTIVE PAYMENT SYSTEM ADDRESSING A1C MEASURES C. CONTINUE TO SUPPORT CONNECTIONS CLINIC D. CONTINUE SUPPORT OF BIO-MED CLASSROOM AND EDUCATION PROGRAMS AT CANTON HIGH SCHOOL3. THE THIRD PRIORITIZED NEED WAS MENTAL HEALTH, INCLUDING: A. RESOURCES TO ADDRESS SUICIDE B. LOCAL ACCESS TO MENTAL HEALTH PROVIDERS AT ALL LEVELS C. LOCAL MENTAL HEALTH SUPPORT SERVICES D. 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 STUDENTS B. PROVIDE SUPPORT FOR THE FULTON COUNTY HEALTH DEPARTMENT IN ITS EFFORTS TO ADDRESS THIS ISSUE5. THE GROUP'S FINAL IDENTIFIED NEED ACCESSED WAS 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 CLINIC B. 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 HOSPTIAL 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: HTTPS://WWW.GRAHAMHEALTHSYSTEM.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 8 1 - GRAHAM MEDICAL GROUP 180 SOUTH MAIN STREET CANTON IL 61520 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 2 - GRAHAM HOSPITAL PHARMACY 210 WEST WALNUT STREET CANTON IL 61520 PHARMACY FOR PATIENTS & RETAIL FOR EMPLOYEES 3 - GRAHAM MEDICAL GROUP - LEWISTOWN 408 SOUTH MAIN STREET LEWISTOWN IL 61542 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 4 - GRAHAM MEDICAL GROUP - FARMINGTON 601 EAST FORT STREET FARMINGTON IL 64531 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 5 - GRAHAM HOSPITAL EXTENDED CARE UNIT 210 WEST WALNUT STREET CANTON IL 61520 SKILLED NURSING & LONG TERM CARE UNITS 6 - GHA HOME MEDICAL EQUIPMENT STORE 101 SOUTH MAIN STREET CANTON IL 61520 HOME MEDICAL EQUIPMENT RETAIL STORE 7 - GRAHAM HOSPITAL SCHOOL OF NURSING 210 WEST WALNUT STREET CANTON IL 61520 SCHOOL OF NURSING 8 - GRAHAM CARDIAC REHABILITATION 235 WEST WALNUT CANTON IL 61520 CARDIAC REHAB SERVICES PART I, LINE 3C: NOT APPLICABLE 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 DIVIDED 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 $5,000 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 FULTON COUNTY FREE HEALTH AND WELLNESS CLINIC. THIS CLINIC IS CONSISTENT WITH AND SUPPORTIVE OF GRAHAM'S MISSION OF PROVIDING CHARITY CARE AND HEALTH IMPROVEMENT SERVICES TO THOSE IN NEED. A DONATION OF $2,500 WAS GIVEN TO THE AMERICAN HEART ASSOCIATION. A DONATION OF $9,339.50 WAS MADE TO THE CITY OF ELMWOOD FOUNDATION FOR FEASIBILITY RESEARCH FOR A YMCA COMMUNITY CENTER. A TOTAL OF $8,557.55 WORTH OF MEDICAL SUPPLIES WERE ASSEMBLED INTO KITS AND DONATED TO AREA SCHOOL DISTRICTS. 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: NOT APPLICABLE. PART VI, LINE 7, REPORTS FILED WITH STATES IL X X X 0 1 0 0 0 0 0 0 0 ROBERT SENNEFF PRESIDENT/CEO 438149 0 77725 0 18390 0 73899 0 14144 0 622307 0 0 0 HOLLY HENLINE VP ANCILLARY/CCO 146959 0 27900 0 12375 0 20892 0 20954 0 229080 0 0 0 CAROLYN JACOBUS VP CLINIC SERVICES (THRU JULY) 117500 0 15302 0 1909 0 3692 0 12670 0 151073 0 0 0 TERESA MCCONKEY VP PATIENT SERVICES 181958 0 27300 0 41255 0 26854 0 8394 0 285761 0 35374 0 JULIE REEDER VP FINANCE/CFO 153478 0 29700 0 490 0 22001 0 19654 0 225323 0 0 0 JAMES SCHREINER VP INFO SERVICES 180273 0 27000 0 43892 0 26121 0 6134 0 283420 0 34017 0 ANDREW ROUDEBUSH DO WOUND CLINIC DIRECTOR 245201 0 24034 0 798 0 7984 0 25670 0 303687 0 0 0 DWAYNE BERNARD MD MEDICAL DIRECTOR 407759 0 11034 0 1806 0 8250 0 34620 0 463469 0 0 0 DEVASHISH AGARWAL MD PHYSICIAN 409772 0 0 0 525 0 8250 0 33870 0 452417 0 0 0 JEFFREY HEMP MD PHYSICIAN 329076 0 0 0 2772 0 8250 0 25670 0 365768 0 0 0 MATTHEW MCMILLIN MD PHYSICIAN 240909 0 0 0 0 0 3223 0 0 0 244132 0 0 0 BRENT PARRY DPM PODIATRIST 391946 0 0 0 15807 0 8250 0 27907 0 443910 0 0 0 JULIO RAMOS MD PHYSICIAN 399106 0 0 0 4258 0 8250 0 8394 0 420008 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) PLAN IN 2018 SPONSORED BY GRAHAM HOSPITAL ASSOCIATION: ROBERT SENNEFF - $65,649, TERESA MCCONKEY - $19,247, JAMES SCHREINER - $18,493, HOLLY HENLINE - $15,135, JULIE REEDER - $16,212. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GRAHAM HOSPITAL ASSOCIATION ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2018. THIS INFORMATION IS INCLUDED IN DEFERRED COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) PLAN IN 2018 SPONSORED BY GRAHAM HOSPITAL ASSOCIATION: TERESA MCCONKEY - $40,289, ALISON SOURS - $8,500 AND JAMES SCHREINER - $36,474. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR DISTRIBUTION FROM THE PLAN IN 2018. THIS INFORMATION IS INCLUDED IN REPORTABLE COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. A CITY OF CANTON IL 376000876 2015-11-04 48540000 REFUND PRIOR ISSUE AND FUND BUILDING PROJECTS 0 0 0 A 4040001 48540000 26755000 488550 21296450 2017 1 0 1 1 A 0 1 0 0 0.15000 0.15000 1 0 1 A 1 1 1 MORGAN STANLEY & BMO 25.000000000000 0 0 0 0 0 A 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 INDEPENDENT ACCOUNTANT 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 MAY 2019. 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 REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 37,246. MANAGEMENT AND GENERAL EXPENSES 1,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 38,246. PHYSICIANS: PROGRAM SERVICE EXPENSES 9,859,498. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,859,498. SERVICE AGREEMENT: PROGRAM SERVICE EXPENSES 961,415. MANAGEMENT AND GENERAL EXPENSES 28,688. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 990,103. OUTSIDE CONTRACTORS: PROGRAM SERVICE EXPENSES 556,456. MANAGEMENT AND GENERAL EXPENSES 119,416. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 675,872. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 322,715. MANAGEMENT AND GENERAL EXPENSES 3,462,940. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,785,655. PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 1,606,244. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,606,244. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 137,368. CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS 55,559. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -1,019,648.