2025-08-26T17:13:55-05:00 2024-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2024-01-01 370684691 Memorial Hospital Association MEMO 2173573131 PO Box 160 Carthage IL 62321 Teresa Smith CFO 2173573131 2025-08-26 1 1 Kim Hunwardsen CPA P00484560 6122536500 2025-08-26 2024 2025-03-06 01:10:19Z Ada Bair PO Box 160 Carthage IL 62321 55380479 0 X www.mhtlc.org X 1947 IL Memorial Hospital provides clinical care, diagnostic, treatment, and wellness services 14 13 409 25 0 0 2121827 460641 47943394 53127386 419212 849741 -12872 62197 50471561 54499965 562333 350000 0 0 27180067 32431753 0 0 225074 20356740 21552276 48099140 54334029 2372421 165936 50796946 49504003 22404212 20477825 28392734 29026178 X Memorial Hospital is committed to improving health by providing education and wellness programs and innovative services at all the stages of life. 1 0 45456530 350000 53127386 Memorial Hospital is dedicated to maintaining and improving the health of all people in the Hancock County area. Governed by a Board of Directors, we serve as a vital safety net, serving our communities with access to quality healthcare services. Memorial Hospital provides many types of community benefit care. Community benefit care includes charity care, community health fairs, lectures, and free health screenings, demonstrating our commitment to improving the overall health of the residents of the Hancock County area.In 2024 the Hospital had 2,499 patient days with 524 admissions and 526 discharges. (Continued on Schedule O)There were 6,038 emergency room visits, 1,444 provider-based physician clinic visits, 12,288 independent physician visits and 45,773 rural health physician clinic visits.We are always committed to providing compassionate care to every member of our community regardless of their ability to pay.To fulfill its mission of community service, the Organization provides care to patients and residents who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Revenue from services to these patients and residents is recorded in the accounting system at the established rates, but the Organization does not pursue collection of the amounts. The resulting adjustments are recorded as adjustments to patient and resident service revenue, depending on the timing of the charity determination.The Illinois legislature passed a bill titled the "Hospital Uninsured Patient Discount Act." Effective April 1, 2009, this Act requires hospitals to provide certain mandated discounts from charges to the uninsured in Illinois. Charges are to be discounted at 135% of cost. Furthermore, a hospital may not collect more than 25% of an uninsured family's gross income in any one year.The Organization provides health care services to patients and residents who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Since the Organization does not pursue collection of these amounts, they are not reported as patient and resident service revenue. The estimated cost of providing these services was $711,000 for the year ended December 31, 2024, calculated by multiplying the ratio of cost to gross charges for the Organization by the gross uncompensated charges associated with providing charity care to its patients and residents.In addition, the Organization provides services to other medically indigent patients under certain government-reimbursed public aid programs. Such programs pay providers amounts which are less than established charges for the services provided to the recipients, and for some services the payments are less than the cost of rendering the services provided. The Organization also commits significant time and resources to endeavors and critical services which meet otherwise unfulfilled community needs. Many of these activities are sponsored with the knowledge that they will not be self-supporting or financially viable. 45456530 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 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 1 1 1 0 0 1 68 0 1 409 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 1 1 IL X Teresa Smith 2173578573 PO Box 160 Carthage IL 62321 Dan Asbury-PresidentUntil Sept 24)/Director (As of Sept 24) 3.00 1.00 X X 0 0 0 Doug Groth-DirectorUntil Sept 24)/President (As of Sept 24) 3.00 1.00 X X 0 0 0 LuAnn Haas- VP Until Sept 24)/Director (As of Sept 24) 3.00 1.00 X X 0 0 0 Brenda Young-DirectorUntil Sept 24)/VP (As of Sept 24) 3.00 1.00 X X 0 0 0 Dennis Rankin Secretary/Treasurer 3.00 1.00 X X 0 0 0 Robert Barlow Director (Until Sept 24) 3.00 1.00 X 0 0 0 Charles Gilbert Director 3.00 1.00 X 0 0 0 Larry McClintock Director 3.00 1.00 X 0 0 0 Katie Pearson Director (Until Sept 24) 3.00 1.00 X 0 0 0 Terry Pope Director 3.00 1.00 X 0 0 0 Victoria Kalivoda-Popela DO Director 40.00 1.00 X 520774 0 32009 Debbie Simon Director (Until Sept 24) 3.00 1.00 X 0 0 0 Dr Jean Alexandre Director (Until Sept 24) 3.00 1.00 X 0 0 0 Noah Dearwester Director 3.00 1.00 X 0 0 0 Jami Hocker Director 3.00 1.00 X 0 0 0 Karen Araya Director (As of Sept 24) 3.00 1.00 X 0 0 0 Pat Schou Director (As of Sept 24) 3.00 1.00 X 0 0 0 James Van den Bogaerde MD Director (As of Sept 24) 3.00 1.00 X 0 0 0 Ada Bair CEO 40.00 3.00 X 286981 0 30863 Teresa Smith CFO 40.00 3.00 X 188350 0 45820 Peter Perll MD Surgeon 40.00 0.00 X 572849 0 57245 Drake White MD Surgeon 40.00 0.00 X 520209 0 53813 Christopher Jones MD OB/GYN 40.00 0.00 X 404621 0 47619 Gina Bell MD OB/GYN 40.00 0.00 X 359764 0 47619 Nileshwa Senthe MD Pediatrician 40.00 0.00 X 359446 0 57245 3212994 0 372233 42 0 1 0 Nes Illinois Inc 39 Main St Tiburon CA 94920 ER Physician Services 1948262 Quincy Medical Group 1025 Maine Street Quincy IL 62301 Temporary Staffing Personnel 829850 Unity Point Health PO Box 9183381 Chicago IL 606913381 Purchased Services 632938 Psychiatric Medical Care LLC PO Box 734606 Dallas TX 753734606 Geriatric Behavioral Health 552696 Burwood Group Inc 1515 West 22nd Street Suite 200 W Oak Brook IL 60523 IT Strategy Consulting 396423 19 317096 143545 15000 460641 Patient & resident service revenu 621110 51303274 51303274 Pharmacy revenue 900099 1315222 1315222 Equity in Advance Phys Therapy 900099 -21125 -21125 530015 530015 53127386 638178 638178 67353 5156 62197 62197 62197 1085921 1000 875358 0 210563 1000 211563 211563 54499965 53127386 0 911938 X 350000 350000 1056883 528230 528653 23988743 20887387 2922816 178540 265464 236311 29153 5493952 4790943 703009 1626711 1405787 220924 159180 159180 70008 70008 11440 11440 8149389 6474958 1669946 4485 312635 91664 208253 12718 1633748 1334119 280877 18752 682368 633739 48629 163210 95326 57371 10513 98214 76649 21565 636194 429068 207126 2536146 1710454 825692 545453 329952 215501 Medical supplies 4634744 4634744 Provider Tax 807881 807881 Repairs and maintenance 541305 538615 2690 Dues, Fees, Subscriptio 527181 89040 438141 43180 223 42891 66 54334029 45456530 8652425 225074 1820 1970 14572202 12868119 7196541 6488905 123 510994 480988 707430 665601 47344254 30196295 16987528 17147959 7035079 7104485 66300 66300 278126 422487 3440926 4257066 50796946 49504003 3243305 3313744 17850 17965 13302963 12483991 3371350 3046771 2468744 1615354 22404212 20477825 X 27626181 28084100 766553 942078 28392734 29026178 50796946 49504003 X 165936 292019 175489 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11440 11440 0 Part II-B, Line 1: Memorial Hospital is a member of the Illinois Health & Hospital Association (IHA) and 43.5% of their dues are used for lobbying expenses which totaled $11,440 in 2024. 4332453 398283 98711 4632025 4136202 387925 191674 4332453 4958105 -509244 312659 4136202 4590361 692053 324309 4958105 4257525 291901 -40935 4590361 0.99500 0.00500 0.00000 0 0 514957 514957 30501878 18871919 11629959 23098 23098 0 14666204 10302067 4364137 1638117 999211 638906 17147959 Other Receivables 1010082 Interest in net assets of Memorial Hospital Foundation 866838 Right-of-use asset - Operating 295312 Employee retention tax credit 1704992 Estimated third party payor settlement 379842 4257066 Estimated Health Claims 650000 Construction Payable 1500 Lease Liability 963854 1615354 X 54447140 292019 -350000 -57981 54505121 -5156 -5156 54499965 53989185 5156 5156 53984029 350000 350000 54334029 Part V, Line 4: An endowment fund with the income to be used for the benefit of Memorial Hospital Association. Permanently restricted funds are required to be retained permanently, either by explicit donor stipulation or by UPMIFA. Board designated funds are to be used for facility and equipment upgrades. Part X, Line 2: The Hospital believes they have 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 consolidated 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. Part XI, Line 2d - Other Adjustments: Transfer between affiliates -350,000. Part XI, Line 4b - Other Adjustments: Rent expenses included in revenue for Form 990 -5,156. Part XII, Line 2d - Other Adjustments: Rent expenses included in revenue for Form 990 5,156. Part XII, Line 4b - Other Adjustments: Transfer between affiliates 350,000. 1 1 X 1 X 1 X 0 1 1 0 1 1 711000 711000 0.01310 11035566 7772115 3263451 0.06010 11746566 7772115 3974451 0.07320 22110865 12958636 9152229 0.16840 22110865 12958636 9152229 0.16840 33857431 20730751 13126680 0.24160 1 2498166 317267 10402132 10431522 -29390 X 1 1 1 1 Memorial Hospital Association 1454 North County Road 2050 Carthage IL 62321 www.mhtlc.org 0005611 X X X X 6 Rural Health Clinics Memorial Hospital Association 1 0 0 1 X X X X X X X X X 24 1 0 1 1 X See Part V X 1 24 1 https://www.mhtlc.org/about-us/community-reports/ 0 1 X 150.000000000000 300.000000000000 X X X 1 1 X X X X 1 X https://www.mhtlc.org/patients-visitors/financial-assistance/ X https://www.mhtlc.org/patients-visitors/financial-assistance/ X https://www.mhtlc.org/patients-visitors/financial-assistance/ X X X X X 1 X 0 X X X X 1 X 0 1 Memorial Hospital Association Part V, Section B, Line 5: This is the fourth joint Community Health Needs Assessment conducted through the collaboration between Memorial Hospital and Hancock County Health Department.The Hospital continued to work with the Agency Collaboration Team (ACT) committee which was set up after the first Community Health Needs Assessment (CHNA). Organizations and agencies represented on the Agency Collaboration Team (ACT) include Illinois Department of Public Health IQuery data system, IDPH Opioid Dashboard, Illinois Cancer registry, Centers for Disease Control and Prevention (CDC), DATAUSA, United States Census Bureau, County Health Rankings & Roadmaps, Illinois Behavioral Risk Factor Surveys, Illinois Department of Healthcare and Family Services, Illinois State Police Crime reports, and the Illinois State Board of Education.A survey was distributed to individuals in the general community using an online tool Survey Monkey. A paper version was also available. The surveys were available in both English and Spanish. There was a total of 334 respondents, a decrease of approximately 750 respondents from the previous survey. It should be noted that most of the 1000 surveys collected in 2021 were collected at COVID-19 vaccine clinics, that were not happening during this survey. The paper tools, as well as the information for the online survey were distributed in a wide variety of public locations including public events, and all provider practices, emails to businesses and the school systems. Memorial Hospital Association Part V, Section B, Line 6b: Hancock County Health Department Memorial Hospital Association Part V, Section B, Line 11: A community health needs assessment was conducted in December 2024. The following needs were identified and will be addressed over the next 3 years.1. Health and Wellness2. Mental Health 3. Access to CareHealth and WellnessGoals for Health and Wellness To improve the quality of life for Hancock County residents through promoting different physical activities/programs that are available throughout the County. To reduce food insecurity in Hancock County through educational campaigns and increased awareness of current resourcesIntervention Strategies for Health and Wellness Work with providers on the importance of promoting physical activity. Materials promoting good health are distributed in both English and Spanish. Measure by the number of participants at County nutrition events through signin sheets and county of interactions from the public online events. Pre-post survey of County restaurants on education provided. Education is done at mobile food pantries and education in conjunction with the health department and hospital. Education materials are sent in Food for Thought backpacks for good nutrition. Monthly marketing of park district's opportunities for physical activity. Greenspace/park knowledge and pictures available for residents online. Continue A1-C screening efforts throughout the County. Provide and A1-C participants with follow-up calls for anyone with pre-diabetes/diabetes.Mental HealthGoals for Mental Health To improve general mental wellnessthrough community education on effective stress management and resiliency. Increase access to mental health and substance abuse for adults and children that live in Hancock County.Intervention Strategies for Mental Health Develop one community mental health/stress management educational campaign or program to be delivered in Hancock County communities each year. Make monthly health communication posts offering information on stress management and local mental health resources people can use to maintain mental wellness. Develop Mental Health Minute Videos. Provide education to parents on the resources available to kids regarding stress and anxiety. Promotion of the available stress/anxiety call lines currently available to community adults and adolescents. Design and release new mental health and substance abuse service line for the hospital. Use marketing and social media to increase awareness of mental health services available to Hancock County residents. Provide 3 youth and 3 adult mental health first aid classes per year to educate the local community no identifying and supporting those who may be struggling with mental health and substance abuse. Collaborate with HCAC, MHCWI, and school administration to increase opportunities for counselors to be present in each of the local schools. Collaborate with HCAC, MHCWI, and school administration to host substance abuse adolescent and parental education programs in the local schools.Access to CareGoals for Access to Care To increase the number of dental providers within Hancock County To decrease the wait time/availability for residents to access specialty care To increase the availability of transportation for provider appointmentsIntervention Strategiesfor Accessto Care Convene a health department staff committee to assist in developing a recruitment/retention plan to reopen the dental center and keep it open. Research recruiting agencies to help recruit staff. Advertise on job boards, dental schools, etc. to help find a dentist. Advertise what specialty services are offered at Memorial Hospital on social media and other areas. Conversations to be held with specialty providers about wait times. Evaluate current wait times for allspecialty providers and pinpoint the most urgent to work with. Run reports for no call/no show rates and evaluate how to decrease them so these empty slots can be filled. Evaluate current optionsfortransportation Determine resources available to our region other than Hancock County Transportation. Create handouts and social media posts for what transportation is available. Work with Care Coordination.Cost of medication and ability to pay for healthcare will not be address by the Hospital as there are not enough funds or resources to address these needs.The Hospital accomplished the following in FY2024 to address the needs identified in the 2021 CHNA.1. Poor Physical Health Maintenance2. Mental Health3. CancerCurrent year actions:- Continued several health screening events throughout the county. Free A1-C testing, blood pressure checks, lipid analyzer, and skin cancer checks were performed. - Continued to work with our local Mental Health Services. Monitored the number of counselors in the school systems to help our children with mental health issues.- Hospital Dietitian visited schools within the county for healthy food options education for our children.- Hospital represented at the local Farmer's Market monthly. Provides information regarding healthy choices.- Social Media posts completed monthly for all areas of the CHNA goals - Hospital wide fund raising for Hancock County Fights Cancer- Mammography screening increased by 5% from our last CHNA. Continued to offer Low Dose CT Lung Cancer screenings. - Hospital participated in a community-based group to improve health to individuals who live in Hancock County. KEY- Keep Encouraging Yourself- to good health. The Key group provided signage for milage for walking trails, hosted swim events at all pools in the county and attended health fairs and hosted 2 glow walks around the county. Memorial Hospital Association Part V, Section B, Line 13h: PRESUMPTIVE ELIGIBILITY: A patient may appear eligible for charity care discounts but there is no financial assistance form and a lack of supporting documentation. Often there is adequate information provided by the patient through other sources which could provide sufficient evidence to provide the patient with charity care assistance.In the event there is no evidence to support a patient's eligibility for charity care, Memorial Hospital and Memorial Medical Clinics could use outside agencies in determining estimated income amounts for the basis of determining charity care eligibility and potential discount amounts.Presumptive eligibility may be determined on the basis of individual life circumstance. In these situations, a patient is deemed to be eligible for 100% write off. A patient in this situation is presumed to be eligible and therefore does not need to complete a financial assistance applicationif they can provide proof that they meet one of the following criteria:a. Patient states that he/she is homeless. The due diligence efforts must be documented.b. Patient is deceased with no known estate.c. Patient is mentally incapacitated with no one to act on their behalf.d. Patient is currently eligible for Medicaid but was not eligible on a prior date of service or for non-covered services. Instead of making the patient duplicate the required paperwork Memorial Hospital will rely on the financial assistance determination process from Medicaid.e. Accounts deemed uncollectible by a contracted collection agency.f. In the event of "special" circumstances where the income exceeds the poverty guidelines, but medical bills are high, the Patient Account Director and/or Chief Financial Officer may determine partial or full eligibility provided proper documentation is available.PROPENSITY TO PAY: Propensity to pay may be determined by obtaining a healthcare score from an outside vendor. Memorial Hospital Association Part V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. Part V, Section B, Line 7a: Website for Hospital's CHNA:https://www.mhtlc.org/about-us/community-reports/ 4 1 - Advance Physical Therapy 1452 N County Road 2050 E Carthage IL 62321 Physical therapy rehabilitation 2 - Memorial Medical Clinic Hamilton 1471 Keokuk Street Hamilton IL 62341 Physician clinic 3 - Memorial Medical Clinic Locust Street 610 Locust Street Carthage IL 62321 Dermatology 4 - Memorial Medical Clinic Broadway 951 Broadway Street Hamilton IL 62341 Pediatrics and Podiatry Part I, Line 3c: PRESUMPTIVE ELIGIBILITY: A patient may appear eligible for charity care discounts but there is no financial assistance form and a lack of supporting documentation. Often there is adequate information provided by the patient through other sources which could provide sufficient evidence to provide the patient with charity care assistance.In the event there is no evidence to support a patient's eligibility for charity care, Memorial Hospital and Memorial Medical Clinics could use outside agencies in determining estimated income amounts for the basis of determining charity care eligibility and potential discount amounts.Presumptive eligibility may be determined on the basis of individual life circumstance. In these situations, a patient is deemed to be eligible for 100% write off. A patient in this situation is presumed to be eligible and therefore does not need to complete a financial assistance applicationif they can provide proof that they meet one of the following criteria:a. Patient states that he/she is homeless. The due diligence efforts must be documented.b. Patient is deceased with no known estate.c. Patient is mentally incapacitated with no one to act on their behalf.d. Patient is currently eligible for Medicaid but was not eligible on a prior date of service or for non-covered services. Instead of making the patient duplicate the required paperwork Memorial Hospital will rely on the financial assistance determination process from Medicaid.e. Accounts deemed uncollectible by a contracted collection agency.f. In the event of "special" circumstances where the income exceeds the poverty guidelines but medical bills are high, the Patient Account Director and/or Chief Financial Officer may determine partial or full eligibility provided proper documentation is available.PROPENSITY TO PAY: Propensity to pay may be determined by obtaining a healthcare score from an outside vendor. Part I, Line 6a: The community benefit report information is shared in Memorial Hospital's annual report and available on their website www.mhtlc.org. 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 I, Line 7g: A physician clinic included as a subsidized service on the 990. Direct and indirect costs were $3,757,244. 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 bad debt expense is calculated based on the percentage of residents with income below the poverty level. In 2024 the percentage was 12.7%. Part III, Line 4: The footnote to the organization's financial statements that describes implicit price concessions is located in Footnote 1 on pages 15-16 of the attached financial statements. Part III, Line 8: Memorial Hospital Association 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. These amounts do not include fee schedule amounts. Hospital services reimbursed on a fee schedule are not included in the Medicare calculation per the 990 instructions. Had this been reported the total loss from Medicare services would have increased by $1,021,311.Total revenue received from Medicare based on a fee schedule 1,021,311Medicare estimated costs of care relating to payments (445,129)Net Shortage (1,021,311) Part III, Line 9b: Memorial Hospital does not pursue collection activities for patients that qualify for charity care or patients that have set up payment arrangements for their accounts. Memorial Hospital does not charge interest on patients with payment arrangements. 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. Part VI, Line 2: Memorial Hospital, based on its mission, wants to ensure that the health care needs of the community it serves are met. The Hospital has medical clinics located throughout Hancock County to improve access to health care services to our patients. The Board also has four committees; Finance, Planning, Quality and Community Health, and Marketing Committees that have community representation to ensure that input is obtained from the community when considering the health care needs of those we serve. Community input on desired services is obtained through patient satisfaction surveys that are initiated by the inpatient unit, emergency department, and medical clinics that provide a line of communication to identify additional health care services that community desires. The third Community Health Needs Assessment is completed and posted to our website at www.mhtlc.com. Part VI, Line 3: Memorial Hospital strives to provide a rewarding and healing process to our patients, plus an affordable, comfortable process to meet their financial obligations. Memorial Hospital informs their patients individually upon admission about the eligibility for assistance under federal, state or local government programs, and provides the patient with information regarding the Organization's charity care policy.Our Collection and Financial Assistance Policies and applications are on our website. We also provide financial counseling to any patient. We post our Charity Care Policy and information regarding federal, state, and local programs at all our registration areas. Brochures are distributed regarding financial assistance with all admission packages.Billing statements have financial assistance support telephone numbers at the bottom of each statement. Our third party billing service provides counseling to our patients regarding available financial assistance if there is a need. Part VI, Line 4: Memorial Hospital Association is an 18-bed critical access hospital located in Carthage, IL. Carthage is a city in Hancock County, Illinois. It is located in western Illinois along the Mississippi River. The nearest city with a population > 50,000 is Peoria, IL. Its primary service area from its most recently completed community health needs assessment is defined as Hancock County, with Colchester, Lomax, Keokuk, Tennessee and Blandinsville as the secondary service area. The 2024 population is approximately 28,737.The 2024 median household income is approximately $65,044, significantly lower than the state of Illinois. The unemployment rate was 4.4% which is lower than the rate for the state of Illinois of 4.9%.The most common industries are manufacturing, agriculture, construction and health care. The nearest hospital is McDonough District Hospital in Macomb, IL about 28 miles east of Carthage, IL. Part VI, Line 5: Memorial Hospital is dedicated to improving health by providing education and wellness programs and innovative services at all the stages of life for residents of Hancock County. The Hospital is governed by a 15-member, volunteer Board of Directors that represent key areas within Hancock County as well as the medical staff. As a critical access hospital, Memorial Hospital is an 18-bed facility that provides general medical, surgical services along with an array of outpatient services for the community. Specialty clinics are also provided locally in the areas of behavioral health, cardiology, dermatology, oncology, neurology, ophthalmology, podiatry, orthopedic, pulmonology, urology, ENT, rheumatology, and sleep apnea so that our patients don't have to travel far to receive needed health care services. These specialty physicians are members of the Hospital's medical staff along with other providers that desire to serve members of our service area. The Hospital extends medical staff privileges to all qualified physicians in the community. With the support of the community, Memorial Hospital built a new 18-bed hospital that was occupied in August 2009. The facility provides up-to-date, diagnostic equipment and services with a capital budget also presented and approved on an annual basis to ensure that needed equipment is obtained to meet the expectations of our patients. Memorial Hospital operates an emergency room available to all regardless of ability to pay.The Hospital also participates in several health care events throughout the year providing free services as well as a listing of services that are offered through the Hospital, clinics, and specialty clinics. This includes, but is not limited to, health fairs, blood pressure screenings, and diabetic education. Memorial Hospital sponsors the bloodmobile and provides language assistance services. Part VI, Line 6: An "affiliated health care system" is a system that includes affiliates under common governance or control, or that cooperate in providing health care services to their community or communities. 1 Hancock County Senior and Childcare Services Association PO Box 160 Carthage IL 62321 370902248 501(c)(3) 350000 0 Daycare operations 1 0 Part I, Line 2: The Board of Directors determines and votes on specific expenditures. The amount given to Hancock County Senior Services, related organization, was to provide funds for their daycare operations and other operating expenses. The daycare is intergenerational as Hancock County Senior and Childcare Services Association has the children interact with the elderly. X X X 0 0 0 0 0 0 0 0 0 Peter Perll MD Surgeon 568161 0 3500 0 1188 0 6900 0 50405 0 630154 0 0 0 Drake White MD Surgeon 519021 0 0 0 1188 0 6900 0 46973 0 574082 0 0 0 Victoria Kalivoda-Popela DO Director 506738 0 11750 0 2286 0 6900 0 25169 0 552843 0 0 0 Christopher Jones MD OB/GYN 403847 0 0 0 774 0 6900 0 40779 0 452300 0 0 0 Nileshwa Senthe MD Pediatrician 358258 0 0 0 1188 0 6900 0 50405 0 416751 0 0 0 Gina Bell MD OB/GYN 358990 0 0 0 774 0 6900 0 40779 0 407443 0 0 0 Ada Bair CEO 265745 0 20000 0 1236 0 5153 0 25769 0 317903 0 0 0 Teresa Smith CFO 187576 0 0 0 774 0 3915 0 41966 0 234231 0 0 0 A Western Illinois Economic Development Authority 352256539 958362BL8 2016-07-21 18659314 Refund Revenue Bond Series 2016 issued 9/16/2008 0 0 0 A 5925000 18659314 344284 18315030 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 Date Rebate Computation Performed Issuer Name: Western Illinois Economic Development Authority Date the Rebate Computation was Performed: 07/16/2021 Form 990, Part III, line 2 The organization began providing Podiatry services in April 2024. Form 990, Part VI, Section A, line 1a The Executive Committee consists of the President, Vice President, Secretary-Treasurer, additional members as the Board appoints, the Chief Executive Officer and any other leadership team members deemed appropriate by the officers of the Board. The Chief Executive Officer and any Leadership Team members do not have the right to vote upon any action being taken. The Executive Committee meets only in the event that the Board is unable to take necessary action, has an agenda for each meeting, keeps minutes of its meetings, and mails a copy of the minutes of each meeting to each member of the Board of Directors within twenty-four (24) hours of the adjournment of the meeting. The primary purpose of the Executive Committee is to carry out critical tasks for effective Board functioning, including, but not limited to, Chief Executive Officer Management performance, management company performance, if applicable, and providing assistance to the Board in situations requiring action when it is impossible or impractical to convene a full Board meeting. Form 990, Part VI, Section B, line 11b The Form 990 is reviewed by the Finance Committee and then by the Board of Directors before it is filed. The final return is reviewed and signed by the CFO. Form 990, Part VI, Section B, line 12c Officers, Board members, and key employees are required to sign a conflict of interest statement upon hiring or becoming a Board member. The disclosure is updated at the annual meeting. Any possible conflict of interest is disclosed to the other Board members and made a matter of record through an annual procedure and also when the interest becomes a matter of Board action. Disclosures are reviewed by the Board of Directors and any Member for whom conflicts have been identified leaves and abstains from voting. Appropriate documentation of the handling of the conflict is kept to protect the interested party and Memorial Hospital Association. Additionally, the Compliance Officer meets with the Compliance Committee of the board. Any issues identified are logged and followed up by the Compliance Officer. Form 990, Part VI, Section B, line 15a Salary surveys are reviewed annually to ensure all positions individually are within the market rate. The Executive Committee determines the salary for the CEO. Each Board member does an independent performance review of the CEO, which is compiled and used by the Executive Committee. The Executive Committee uses the Illinois Hospital Association salary survey as a guide for compensation using the high, middle, and low ranges for similar size organizations. Measures such as revenue, performance of the CEO, and budgetary constraints are all factors that are considered when reviewing the CEO's salary. The salary for the CFO is determined by the CEO using the CAH Compensation Survey sponsored by Integrated Healthcare Strategies as a guide for similar organizations. The most recent review of salary occurred in 2019. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request. The financial statements are also required to be attached to the Form 990. Form 990, Part IX, line 11g Purchased services: Program service expenses 6,058,019. Management and general expenses 1,441,484. Fundraising expenses 4,485. Total expenses 7,503,988. Professional fees: Program service expenses 416,939. Management and general expenses 228,462. Fundraising expenses 0. Total expenses 645,401. Form 990, Part XI, line 9: Change in interest in net assets of Memorial Hospital Foundation 175,489. Hancock County Senior and Childcare Services Association PO Box 160 Carthage IL 62321 370902248 Caring for the elderly IL 501(c)(3) Line 10 Memorial Hospital Association 1 Advance Physical Therapy of Hancock County 620 Wabash Street Carthage IL 62321 113655886 Physical therapy rehabilitation IL Memorial Hospital Association Related 8240 22705 0 1 0.50000 Hancock County SLF LLP 403 S Adams Carthage IL 62321 204445121 Assisted living facility IL N/A 0 0 HGV Foundation Inc 400 S Adams St Carthage IL 62321 450609346 Supporting living IL N/A C 0 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 1 0 0 Hancock County Senior and Childcare Services Association Q 448974 General Ledger Hancock County Senior and Childcare Services Association B 350000 General Ledger