2018-10-03T12:00:35-05:00 2017-12-31 430352985 Kerber Eck & Braeckel LLP 1116 West Main Carbondale IL 629012335 990 2017-01-01 370860281 HOSPITAL & MEDICAL FOUNDATION OF PARIS INC HOSP 2174654141 721 EAST COURT STREET PARIS IL 61944 OLIVER M SMITH CEO 2174654141 2018-09-27 1 Anna Guetersloh P01315485 6185291040 2017 2022-09-23 18:48:47Z OLIVER M SMITH 721 EAST COURT STREET PARIS IL 61944 45256199 0 X MYHORIZONHEALTH.ORG X 1958 IL OPERATION OF HOSPITAL - INPATIENT DAYS PLUS EMERGENCY, ANCILLARY AND OUTPATIENT SERVICES FOR RESIDENTS IN PARIS, EDGAR COUNTY AND EAST CENTRAL ILLINOIS. 15 13 457 46 0 0 177639 52179 51150596 42605479 38004 71139 1528945 2527402 52895184 45256199 0 0 0 0 28900257 30198485 0 0 0 22456738 16938929 51356995 47137414 1538189 -1881215 37565072 35060032 7202708 6189810 30362364 28870222 OPERATION OF HOSPITAL AND MEDICAL CLINIC - 3,017 INPATIENT DAYS (INCLUDING SWING) PLUS EMERGENCY, ANCILLARY AND OUTPATIENT SERVICES FOR RESIDENTS IN PARIS, EDGAR COUNTY, AND EAST CENTRAL ILLINOIS. 0 0 45953683 45184056 OPERATION OF HOSPITAL AND MEDICAL CLINIC - 3,017 INPATIENT DAYS (INCLUDING SWING) PLUS EMERGENCY, ANCILLARY AND OUTPATIENT SERVICES FOR RESIDENTS IN PARIS, EDGAR COUNTY, AND EAST CENTRAL ILLINOIS. 45953683 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 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 1 0 0 0 0 0 0 1 0 0 0 1 39 0 457 1 0 0 0 0 0 1 1 0 0 X 15 13 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X MARTIN D ADAMS 2174654141 721 E COURT ST PARIS IL 61944 NOLAN LONGEST BOARD CHAIR 1.00 X 0 0 0 MARY LIZ WRIGHT BOARD VICE CHAIR 1.00 X 0 0 0 RENEE CRAIG BOARD TREASURER 1.00 X 0 0 0 BRIAN BLAIR BOARD SECRETARY 1.00 X 0 0 0 DAVE FRISSE DIRECTOR 1.00 1.00 X 0 0 0 TOM HEBERMEHL DIRECTOR 1.00 X 0 0 0 SCOTT HOGAN DIRECTOR 1.00 X 0 0 0 JAIME HOULIHAN DIRECTOR 1.00 X 0 0 0 NED JENISON DIRECTOR 1.00 X 0 0 0 DARRIN JOHNSON DIRECTOR 1.00 X 0 0 0 MANDY NEAL DIRECTOR 1.00 X 0 0 0 DOUG SMITTKAMP DIRECTOR 1.00 X 0 0 0 CRAIG SMITH DIRECTOR 1.00 X 0 0 0 DR LELAND PHIPPS CHIEF OF MEDICAL STAFF 40.00 X 308614 0 16949 DR REID SUTTON MD CHIEF OF MEDICAL STAFF 40.00 X 295689 0 30636 BRUCE YOUNG DIRECTOR 1.00 X 0 0 0 BARBARA DICK BOARD SECRETARY 1.00 X 0 0 0 KEITH PERRY DIRECTOR 1.00 X 0 0 0 MARTIN D ADAMS CFO 40.00 1.00 X 180183 0 25022 OLIVER M SMITH CEO 40.00 1.00 X 284308 0 29832 SUSAN LIVVIX VP OF NURSING & PROFESSIONAL SERVICES 40.00 X 160391 0 24535 DR BRUCE J HOULE PHYSICIAN 40.00 X 472966 0 9183 DR RAHAT HAMEED SHEIKH PHYSICIAN 40.00 X 411926 0 31982 DR JUHUI LI PHYSICIAN 40.00 X 405207 0 32836 DR JOHN P NADEAU PHYSICIAN 40.00 X 385703 0 24953 DR ARTURO MENCHACA PHYSICIAN 40.00 X 332919 0 24143 3237906 0 250071 40 0 1 0 MIDWEST EMERGENCY 320 EAST HIGHWAY 50 OFALLON IL 62269 ER PHYSICIAN SERVICES 2061410 HERITAGE BUILDERS 1016 SOUTH WILLOW EFFINGHAM IL 62401 CONSTRUCTION MANAGEMENT/GENERAL CONTRACT 993866 ULTRA GROUP 651 E 4TH ST SUITE 100 CHATTANOOGA TN 37403 PROFESSIONAL STAFFING & MANAGEMENT SERVI 455351 LABORATORY CORP OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LAB WORK 353594 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 72633 LUCUM TENENS/PHYSICIAN STAFFING 188623 9 50281 1898 52179 NET PATIENT SERVICE REVENUE 621110 42605479 42605479 42605479 71139 71139 19964 0 19964 19964 19964 340B Revenue 1454150 1454150 Other Operating Revenue 980300 980300 Cafeteria Income 72988 72988 2507438 45256199 45184056 0 19964 624882 624882 23364774 23364774 470936 470936 4199540 4120151 79389 1538353 1538353 479460 479460 82388 82388 45455 45455 197942 197942 131059 131059 715826 715826 274766 274766 91097 91097 2343005 2343005 736474 736474 Supplies 4644425 4644425 Outside Services 3079403 3079403 Physician Fees 2960086 2960086 1157543 1157543 47137414 45953683 1183731 0 2450 9864711 10116972 364094 9495 100498 9675077 7369675 910321 48122 1367713 1277683 609824 392805 46291132 31235145 14465911 15055987 22683 0 384626 586457 37565072 35060032 4586683 3931351 2616025 2258459 7202708 6189810 X 30114559 28284052 247805 586170 30362364 28870222 37565072 35060032 X -1881215 389073 X 0 1 X 1 0 X 403842 403842 24822186 16625476 8196710 74744 62286 12458 17113271 12917955 4195316 3877089 1629428 2247661 15055987 X Part X, Line 2: There were no uncertain tax benefits or liabilities identified and recorded as of December 31, 2017. 1 1 1 X 1 X 1 1 0 0 345608 345608 0.00730 10102890 5717169 4385721 0.09300 10448498 5717169 4731329 0.10030 3000 3000 0.00010 3000 3000 0.00010 10451498 5717169 4734329 0.10040 88167 88167 0.00190 88167 88167 0.00190 2135831 640750 15350079 18009037 -2658958 X 1 1 PARIS COMMUNITY HOSPITAL 721 E COURT ST PARIS IL 61944 X X X X FAMILY MEDICAL CENTER PARIS COMMUNITY HOSPITAL 0 0 1 X X X X X X X X X 16 1 0 0 1 X www.myhorizonhealth.org/community-resources/community-health-needs/ www.myhorizonhealth.org/community-resources/community-health-needs/ X 1 16 1 www.myhorizonhealth.org/community-resources/community-health-needs/ 0 1 X 150.000000000000 250.000000000000 X X 1 1 X X X 0 0 0 1 X 0 0 PARIS COMMUNITY HOSPITAL Part V, Section B, Line 5: A CONSULTANT LED AN INTERNAL WORKING GROUP TO CONDUCT THREE FOCUS GROUPS COMPRISED OF AREA HEALTH CARE PROFESSIONALS/PARTNERS AND LOCAL OFFICIALS/COMMUNITY LEADERS. PARIS COMMUNITY HOSPITAL Part V, Section B, Line 11: AN IMPLEMENTATION STRATEGY WAS DEVELOPED IN THE FOURTH QUARTER OF 2016 AND EXECUTION OF THE STRATEGY BEGAN IN 2017. THE IMPLEMENTATION STRATEGY ADDRESSES ALL SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA CONDUCTED IN 2016. THE HOSPITAL IS EXECUTING STRATEGIES AS THEY BECOME FINANCIALLY FEASIBLE. 5 1 - FAMILY MEDICAL CENTER 727 E COURT STREET PARIS IL 61944 RURAL HEALTH CLINIC 2 - FAMILY MEDICAL CENTER 112 W MADISON AVENUE CHRISMAN IL 61924 RURAL HEALTH CLINIC 3 - SENOIR CARE 15323 US HIGHWAY 150 PARIS IL 61944 CLINIC 4 - FAMILY MEDICAL CENTER 5 S WALNUT ST OAKLAND IL 61943 RURAL HEALTH CLINIC 5 - WALK-IN CLINIC EZ CARE 1 PHIPPS LANE PARIS IL 61944 CLINIC Part I, Line 7: THE ORGANIZATION USED AN OVERALL COST TO CHARGE RATIO TO DETERMINE THE AMOUNTS ON PARIT I OF THE SCHEDULE H. Part II, Community Building Activities: THE ORGANIZATION EXPENDED FUNDS TO RECRUIT ADDITIONAL PHYSICIANS TO THE COMMUNITY WHICH IS MEDICALLY UNDERSERVED. Part III, Line 2: IT IS ESTIMATED THAT 30% OF BAD DEBTS WOULD BE ELIGIBLE FOR FINANCIAL ASSISTANCE IF THE PATIENTS APPLIED AND PROVIDED FAMILY INCOME INFORMATION. THIS PORTION OF BAD DEBT SHOULD BE INCLUDED IN COMMUNITY BENEFIT AS THE PATIENTS ARE UNINSURED AND PRESUMED TO BE NEEDY AND UNABLE TO PAY FOR THE SERVICES. Part III, Line 8: THE SAME COST TO CHARGE RATIO CALCULATED TO DETERMINE COMMUNITY BENEFIT EXPENSES IN PART I WAS APPLIED TO MEDICARE CHARGES TO DETERMINE ESTIMATED COST. UNPAID COST OF MEDICARE REPRESENTS THE COST OF PROVIDING SERVICES TO PRIMARILY ELDERLY BENEFICIARIES OF THE MEDICARE PROGRAM, IN EXCESS OF PAYMENTS FOR THOSE SERVICES. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT 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. Part III, Line 9b: PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ARE IDENTIFIED AT REGISTRATION WITH A UNIQUE FINANCIAL CLASS CODE. IF THEY QUALIFY FOR 100% ASSISTANCE, THEIR ACCOUNT IS ADJUSTED TO ZERO AND NO BILL IS SENT. IF THEY QUALIFY FOR PARTIAL ASSISTANCE, THEIR ACCOUNT IS ADJUSTED ACCORDINGLY BEFORE A BILL IS SENT FOR THE BALANCE DUE. Part VI, Line 2: ON A BI-ANNUAL BASIS THE HOSPITAL'S MANAGEMENT COMPANY, ALONG WITH ADMINISTRATIVE STAFF, MEET IN A RETREAT WITH THE BOARD OF DIRECTORS AND MEDICAL STAFF TO ASSESS AND PLAN FOR THE NEEDS OF THE COMMUNITY. A PHONE SURVEY OF 375 RESIDENTS OF THE HOSPITAL'S SERVICE ARE IS PERFORMED TO GET COMMUNITY INPUT. Part VI, Line 3: NOTICES OF THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE POSTED IN ADMISSIONS AREA OF THE HOSPITAL AND MEDICAL CENTER AND IN THE EMERGENCY ROOM. UNINSURED PATIENTS NOT ALREADY IN THE PROGRAM ARE GIVEN A BROCHURE THAT EXPLAINS THE PROGRAM ALONG WITH AN APPLICATION WHEN THEY ARE ADMITTED OR REGISTERED. A BROCHURE IS INCLUDED IN THE INFORMATION PACKET GIVEN TO ALL INPATIENTS. INFORMATION IS ALSO POSTED ON THE HOSPITAL'S WEBSITE. THE FINANCIAL ASSISTANCE CORRDINATOR FOLLOW UP WITH PATIENTS TO ANSWER QUESTIONS AND PROVIDE ASSISTANCE IN APPLYING. ALL BILLS SENT TO THE HOSPITAL PATIENTS INCLUDE A MESSAGE ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND WHO TO CONTACT TO APPLY. PATIENTS ARE SCREENED FOR STATE PROGRAMS AND ASSITED WITH APPLICATIONS. Part VI, Line 4: THE ORGANIZATION'S CRITICAL ACCESS HOSPITAL (CAH) AND RURAL HEALTH CENTERS SERVE PRIMARILY THE RURAL EDGAR COUNTY, ILLINOIS THAT IS DESIGNATED BY THE STATE AS A MEDICALLY UNDERSERVED AREA. ABOUT HALF OF THE 18,000 POPULATION LIVE IN SMALL CITIES AND THE REST LIVE IN RURAL AREAS. THE LATEST CENSUS INFORMATION SHOWS THE MEAN PER CAPITA HOUSEHOLD INCOME TO BE $25,017 AND 17.1% OF EDGAR COUNTY FAMILIES HAVE INCOME BELOW THE POVERTY LEVEL. APPROXIMATELY 26.23% OF THE POPULATION IS ENROLLED IN THE STATE MEDICAID PROGRAM AND 19.34% OF THE RESIDENTS ARE 65 YEARS AND OLDER. Part VI, Line 5: THE ORGANIZATION CONDUCTS HEALTH FAIRS IN THE COMMUNITY THROUGHOUT THE YEAR AND PROVIDES VARIOUS HEALTH SCREENINGS FOR INDUSTRY WORKERS AND THE PUBLIC IN GENERAL. A MONTHLY NEWSLETTER IS DEVOTED TO INFORMING THE PUBLIC ABOUT TIMELY HEALTH ISSUES AND THE AVAILABILITY OF THE LOCAL HEALTH SERVICES. THE VOLUNTEER GOVERNING BODY IS COMPRISED MOSTLY OF PEOPLE WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. ALL SURPLUS FUNDS ARE USED TO IMPROVE FACILITIES AND TO REPLACE OR UPGRADE EQUIPMENT TO PROVIDE THE HIGHEST QUALITY OF PATIENT CARE POSSIBLE. CONTINUOUS MEDICAL EDUCATION IS PROVIDED TO PHYSICIANS AND STAFF. X X X X 0 0 0 0 0 0 0 0 0 DR LELAND PHIPPS CHIEF OF MEDICAL STAFF 226053 0 82561 0 0 0 12150 0 4799 0 325563 0 0 0 DR REID SUTTON MD CHIEF OF MEDICAL STAFF 295689 0 0 0 0 0 12611 0 18025 0 326325 0 0 0 MARTIN D ADAMS CFO 180183 0 0 0 0 0 6306 0 18716 0 205205 0 0 0 OLIVER M SMITH CEO 256308 0 28000 0 0 0 11792 0 18040 0 314140 0 0 0 SUSAN LIVVIX VP OF NURSING & PROFESSIONAL SERVICE 160391 0 0 0 0 0 7218 0 17317 0 184926 0 0 0 DR BRUCE J HOULE PHYSICIAN 472966 0 0 0 0 0 0 0 9183 0 482149 0 0 0 DR RAHAT HAMEED SHEIKH PHYSICIAN 328002 0 83924 0 0 0 12698 0 19284 0 443908 0 0 0 DR JUHUI LI PHYSICIAN 405207 0 0 0 0 0 0 0 32836 0 438043 0 0 0 DR JOHN P NADEAU PHYSICIAN 385703 0 0 0 0 0 7059 0 17894 0 410656 0 0 0 DR ARTURO MENCHACA PHYSICIAN 332919 0 0 0 0 0 4803 0 19340 0 357062 0 0 0 A CITY OF PARIS 376000744 2003-12-01 6060000 CONSTRUCTION OF ADDITIONAL FACILITIES 0 1 0 A 6060000 989995 60000 5010005 0 0 1 1 A 0 0 0 0 0.00800 0.00800 0 0 1 A 0 0 0 0 0 0 0 0 0 PARIS CLINIC PHARMACY OWNER IS A DIRECTOR 14631 LEASE OF PHARMACY SPACE 0 MAIN STREET CAFE OWNER IS A SPOUSE OF A DIRECTOR 29001 CATERING/MEALS 0 Form 990, Part VI, Section A, line 3 THE HOSPITAL HAS A CONSULTING AGREEMENT WITH BLUE MANAGEMENT SERVICES, LLC d/b/a ALLIANT MANAGEMENT SERVICES TO ADVISE ON HOSPITAL OPERATIONS. Form 990, Part VI, Section A, line 6 MEMBERSHIP IS BY VIRTUE OF ACHIEVING CERTAIN LEVELS OF DONATION TO THE ORGANIZATION. Form 990, Part VI, Section A, line 7a THE ORGANIZATION HAS MEMBERS AND THEY HAVE CERTAIN RIGHTS INCLUDING THE RIGHT TO VOTE ON MEMBERS OF THE BOARD. MEMBERSHIP OF THE ORGANIZATION IS BY VIRTURE OF ACHIEVING CERTAIN LEVEL OF DONATION TO THE ORGANIZATION. OTHER RIGHTS INCLUDE THE RIGHT TO RECEIVE AN ANNUAL REPORT AND TO ATTEND THE ANNUAL MEETING AT WHICH TIME NOMINATIONS FOR MEMBERS OF THE BOARD MAY BE MADE AND MEMBERS OF THE BOARD ARE ELECTED OR RE-ELECTED BY VOTE OF MEMBERS. Form 990, Part VI, Section B, line 11b THE ORGANIZATION POSTS THE FORM 990 TO THE HOSPITAL'S INTRANET AND EACH MEMBER OF THE BOARD OF DIRECTORS, CEO AND CFO ARE ASKED TO REVIEW BEFORE THE FINAL 990 IS FILED. Form 990, Part VI, Section B, line 12c CONFLICT OF INTEREST STATEMENTS ARE GIVEN TO THE BOARD MEMBERS YEARLY AND ARE ACCUMULATED BY THE PRESIDENT/CEO'S SECRETARY WHO MONITORS THAT ALL ARE RETURNED. Form 990, Part VI, Section B, line 15 CEO/CFO REVIEW PROCESS - EACH BOARD MEMBER IS ASKED TO COMPLETE A SURVEY THAT SCORES THE CEO/CFO IN SEVERAL AREAS OF JOB PERFORMACE ADN COMMUNITY INVOLVEMENT. THE EXECUTIVE COMMITTEE OF THE BOARD TOGETHER WITH A REPRESENTATIVE FROM ALLIANT MANAGEMENT SERVICES REVIEWS THE SURVEY RESULTS AND REVIEWS SALARY SURVEY DATA FOR THE SAME POSITIONS IN COMPARABLE ORGANIZATIONS. PHYSICIAN EMPLOYEE REVIEW PROCESS - PHYSICIANS ARE REVIEWED BY THE RECRUITMENT AND RETENTION COMMITTEE OF THE BOARD AND THE CEO PRESENTS THEM WITH MARKET BENCHMARK DATA THAT COMPARES THEIR PRODUCTION AND SALARY LEVEL AND THE CEO MAKES A RECOMMENDATION. NON-PHYSICIAN REVIEW PROCESS - NON-PHYSICIAN EMPLOYEES ARE EVALUATED BY THE CEO AND MARKET BENCHMARK DATA IS OBTAINED FOR REVIEW IN MAKING A DECISION ON SALARY CHANGES. COST OF LIVING ADJUSTMENTS ARE APPROVED BY THE BOARD. Form 990, Part VI, Section C, line 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST FROM ADMINISTRATION. Form 990, Part XI, line 9: Changes for Foundation Net Assets 389,073. PARIS COMMUNITY HOSPITAL FOUNDATION INC 721 EAST COURT ST PARIS IL 619442460 473034746 FOUNDATION - SUPPORTING ORGANIZATION IL 501C Line 12a, I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0