2014-09-22T09:46:42-05:00 2013-12-31 BKD LLP 211 N BROADWAY SUITE 600 ST LOUIS MO 631022733 990 2013-01-01 376062326 Pana Community Hospital Association % JAMES MOON CFO PANA 2175622131 101 EAST NINTH STREET Suite PANA IL 62557 JOYCE MORGAN CHAIRMAN 2175622131 2014-09-22 true Donna J Larson 3142315544 2013 2015-11-30 17:44:51Z JOYCE MORGAN CHAIRMAN 101 EAST NINTH STREET PANA IL 62557 22340784 false X www.panahospital.com X 1966 IL OUR MISSION IS TO BE A LEADING PARTNER IN ASSURING COMMUNITY-BASED ASSURING COMMUNITY-BASED QUALITY HEALTH CARE. 12 12 237 90 2612 282600 403163 19576907 21736555 73724 141110 52348 48997 19985579 22329825 0 0 0 0 8954425 9590199 0 0 52889 9650814 10574273 18605239 20164472 1380340 2165353 22818621 24647665 3495203 3192490 19323418 21455175 X OUR MISSION IS TO BE A LEADING PARTNER IN ASSURING COMMUNITY-BASED QUALITY HEALTH CARE. TO ACHIEVE THIS MISSION WE PROMOTE A VISION STRIVING TO DEVELOP A COMPREHENSIVE SYSTEM OF HEALTHCARE SERVICES, IN PARTNERSHIP WITH THE OTHER COMMUNITY HEALTHCARE PROVIDERS, TO ASSIST OUR SERVICE AREA RESIDENTS IN REACHING THEIR PERSONAL MAXIMUM FOR HEALTH; TO PROVIDE PROGRAMS THAT PROMOTE HEALTH EDUCATION AND WELLNESS; TO ENHANCE OUR PERSONALIZED CARE CONCEPT IN THE PROVISION OF SERVICES TO OUR COMMUNITY; TO MAINTAIN AN ENVIRONMENT WHICH PROMOTES SATISFACTION AND OPPORTUNITY FOR THE PATIENT, THEIR FAMILY, THE EMPLOYEE, AND THE PHYSICIAN; TO MAINTAIN THE HOSPITAL'S ABILITY TO SUPPORT THE DELIVERY OF QUALITY HEALTH CARE AT A REASONABLE COST, IN ACCORDANCE WITH COMMUNITY NEEDS AND THE HEALTH CARE REGULATORY ENVIRONMENT; AND TO DEMONSTRATE BY ACTIONS AND RESULTS OUR COMMITMENT TO CONTINUOUS QUALITY IMPROVEMENT. false false 18239284 21736555 TO PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF PANA, ILLINOIS AND THE SURROUNDING AREA. THESE SERVICES INCLUDE NURSING, EMERGENCY AND ANCILLARY SERVICES FOR 903 INPATIENT DAYS, 21,522 OUTPATIENT ADMISSSIONS, 8,684 EMERGENCY VISITS AND 279 OUTPATIENT SURGICAL PATIENTS. 18239284 true true false true false false false false false true true false false false true false false true false false false false false false false false true true false false true false false false false false false true false false false false false false true true true false false true 16 0 true 237 true true true false false false false false false false false false X 12 12 true false false false true true false true true false false false true true true true true true true false IL X JAMES MOON CFO 2175622131 101 EAST NINTH STREET PANA IL 62557 X JOYCE MORGAN CHAIRMAN 1.5 0.1 X X 0 0 0 JUDGE DAVID SLATER DIRECTOR 1.5 0.1 X 0 0 0 CAROLYN MARLEY DIRECTOR 1.5 X 0 0 0 JIM RANDOLPH VICE-CHAIRMAN 1.5 0.1 X X 0 0 0 MARY ANN RHOADES DIRECTOR 1.5 X 0 0 0 DJ ASUNCION MD DIRECTOR 1.5 X 0 0 0 STEVE NEECE DIRECTOR 1.5 X 0 0 0 MATTHEW BEAVERS DIRECTOR 1.5 X 0 0 0 JOHN GARDNER TREASURER 1.5 0.1 X X 0 0 0 JOYCE THRONEBURG SECRETARY 1.5 0.1 X X 0 0 0 CAROL SCHRAMM DIRECTOR 1.5 X 0 0 0 RICK MILES DIRECTOR 1.5 X 0 0 0 KATRINA J CASNER PRESIDENT & CEO 40.0 X 141066 0 11335 VICKIE COEN CCO/CNE 40.0 X 110080 0 6781 JAMES MOON CFO 40.0 X 97798 0 7616 WALTER CUNNINGTON PHYSICIAN 40.0 1.5 X 359534 0 10637 CATHERINE TEODORO PHYSICIAN 40.0 X 209190 0 7703 MICHELLE FOREMAN PHARMACIST 40.0 X 113815 0 6908 1031483 0 50980 5 false true true MIDWEST EMERGENCY SERVICE INC 320 E HIGHWAY 50 OFALLON IL 62269 EMERGENCY PHYSICIANS 1259977 PRECISE SPECIALTIES CORP 514 S MAIN HILLSBORO IL 62049 ULTRASOUND TECH. 108188 MCKESSON TECHNOLOGIES INC PO BOX 98347 CHICAGO IL 60693 HARD/SOFTWARE IMPLEM 262958 ALLSCRIPTS 24630 NETWORK PLACE CHICAGO IL 60673 HARD/SOFTWARE IMPLEM 115891 4 176972 218691 7500 403163 PATIENT CARE SERVICES 621110 20955376 20955376 OTHER OPERATING REVENUE 621110 178746 178746 ELECTRONIC HEALTH RECORDS REVENUE 621110 602433 602433 21736555 151069 151069 0 0 5850 0 5850 0 5850 5850 1000 10959 -9959 -9959 -9959 0 0 0 CAFETERIA & VENDING 722514 40535 40535 CATERING 722320 2612 2612 43147 22329825 21736555 2612 187495 X 0 0 0 0 961740 587064 374676 0 6761072 6278819 442354 39899 146076 135657 9557 862 1342015 1246292 87803 7920 379296 352242 24816 2238 0 2632 2632 64647 64647 0 0 0 2089287 2018882 70405 59012 59012 2988234 2842506 143758 1970 11400 11400 0 241848 51180 190668 47594 47594 0 63394 54775 8619 0 0 1299993 1169994 129999 149148 104529 44619 BAD DEBT EXPENSE 2864935 2864935 FEES & LICENSES 460504 432090 28414 EMPLOYEES RELATIONS 74342 74342 DUES & SUBSCRIPTIONS 91211 91211 66092 52725 13367 20164472 18239284 1872299 52889 4874023 9762589 3574870 3703069 0 0 5550603 2783225 0 0 0 0 347488 289670 290768 295614 156908 147801 18074838 10716509 8023471 7358329 0 326361 -19924 -36063 0 0 0 0 20414 17070 22818621 24647665 1268861 1466853 0 0 1769882 1308173 0 0 0 0 0 0 0 0 0 0 456460 417464 3495203 3192490 X 19323418 21455175 0 0 0 0 19323418 21455175 22818621 24647665 X 2165353 -17461 -16135 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 9317 false false false 9317 false PART II-B, LINE 1F GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES WE PARTICIPATE INDIRECTLY WITH LOBBYING ACTIVITIES THROUGH OUR MEMBERSHIPS IN THE ILLINOIS HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. IT IS ESTIMATED THAT OUR LOBBYING EXPENDITURES ARE 39% & 23.65%, RESPECTIVELY, OF OUR MEMBERSHIP DUES AS PROVIDED BY THE IHA. 1283522 1451 1284973 1282115 1407 1283522 1347734 -65619 1282115 1470956 -123222 1347734 2889351 1341547 -11108 2748834 1470956 1.00000 0.00000 0.00000 false false 11496 11496 6985413 4082898 2902515 10431345 6454165 3977180 646584 179446 467138 7358329 0 Third Party Payor Settlements 417464 417464 PART V ENDOWMENT FUNDS PANA HOSPITAL INTENDS TO USE THE FUNDS FOR CAPITAL IMPROVEMENTS. PART X, LINE 2 FIN 48 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true true true X true X true true true false false 294821 294821 0.01700 3862529 3277460 585069 0.03380 4157350 3277460 879890 0.05080 31199 520 30679 0.00180 71767 71767 0.00410 102966 520 102446 0.00590 4260316 3277980 982336 0.05670 true 2864935 1718961 7498322 7408496 89826 X true false 1 1 PANA COMMUNITY HOSPITAL 101 EAST 9TH STREET PANA IL 62557 www.panahospital.com 0001776 X X X X PANA COMMUNITY HOSPITAL true X X X X X X X X X 13 true false true X SEE SECTION C FOR FULL URL X X X X X X X X X true false true true 150. true 250. true X true true X X X X X X true false X X X X true X false false PART V, SECTION B, LINE 3 CHNA INPUT PCH CONSULTED THE CHRISTIAN COUNTY HEALTH DEPT., UTILIZED SURVEYS MADE AVAILABLE TO THE PUBLIC, CONDUCTED COMMUNITY MEETINGS THAT ALL INTERESTED PARTIES COULD ATTEND. PART V, SECTION B, LINE 5A CHNA URL HTTP://WWW.PANAHOSPITAL.COM/ABOUTUS/ASSESSMENT.PHP PART V, SECTION B, LINE 5 IMPLEMENTATION STRATEGY THE IMPLEMENTATION STRATEGY IS INCLUDED IN THE CHNA POSTED ON THE WEBSITE. PART V, SECTION B, LINE 20D INDIVIDUALS ELIGIBILITY FOR FINANCIAL ASSISTANCE ALL PATIENTS QUALIFYING FOR THE FACILITY'S FINANCIAL ASSISTANCE POLICY ARE BILLED A MAXIMUM OF 50% OF GROSS CHARGES. THIS RATE IS SIGNIFICANTLY BELOW OUR LOWEST NEGOTIATED COMMERCIAL INSURANCE RATE. 5 COMMUNITY MEDICAL CLINIC OF PANA 101 EAST 9TH STREET PANA IL 62557 PHYSICIAN SATELLITE OFFICE QUAD COUNTY HOME HEALTH & HOSPICE 1 HUBER STREET PANA IL 62557 HOME HEALTH & HOSPICE AGENCY COMMUNITY MEDICAL CLINIC OF ASSUMPTION 118 N WALNUT STREET ASSUMPTION IL 62510 PHYSICIAN SATELLITE OFFICE COMMUNITY MEDICAL CLINIC OF RAMSEY 715 S SUPERIOR RAMSEY IL 62080 PHYSICIAN SATELLITE OFFICE COMMUNITY MEDICAL CLINIC OF NOKOMIS 120 CEDAR STREET NOKOMIS IL 62075 PHYSICIAN SATELLITE OFFICE PART I, LINE 7 FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST 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 7, COLUMN (F) FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $2,864,935 REPORTED ON PART IX, LINE 25, HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. PART III, SECTION A, LINES 2, 3 & 4 BAD DEBT EXPENSE LINE 2 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 BAD DEBT EXPENSE. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. LINE 3 THE BAD DEBT EXPENSE REPORTED ON LINE 2 REPRESENTS THE EXPENSE REPORTED ON THE ATTACHED FINANCIAL STATEMENTS BASED ON NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. BAD DEBT EXPENSE IS DETERMINED BASED ON THE CRITERIA DESCRIBED ABOVE. IT IS ESTIMATED THAT APPROXIMATELY 60% OF OUR BAD DEBT EXPENSE QUALIFIES UNDER THE ORGANIZATION'S CHARITY CARE POLICY. THIS PERCENTAGE WAS DETERMINED BASED UPON ANALYSIS OF DEMOGRAPHICS AND RECORD REVIEWS. LINE 4 SEE NOTE 2: NET PATIENT SERVICE REVENUE ON PAGE 11 OF THE AUDITED FINANCIAL STATEMENTS. ALSO SEE NOTE 1: PATIENT ACCOUNTS RECEIVABLE ON PAGE 7 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8 MEDICARE LINE 6 COSTS WERE TAKEN DIRECTLY FROM THE ORGANIZATION'S 12/31/13 MEDICARE COST REPORT. PART III, LINE 9B COLLECTION PRACTICES THE COLLECTION PRACTICES FOLLOWED BY THE ORGANIZATION FOR PATIENTS WHO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE ADDRESSED IN ITS HEALTHCARE ASSISTANCE POLICY. PART VI, LINE 2 NEEDS ASSESSMENT THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES THROUGH STRATEGIC PLANNING ACTIVITIES THAT INCORPORATE ANALYSIS OF SERVICE AREA DEMOGRAPHICS AND STRUCTURED AND CONSISTENT PATIENT SURVEY PROCESSES. THE ORGANIZATION ALSO ASSESSES COMMUNITY HEALTH NEEDS THROUGH INPUT FROM ITS ACTIVE AND CONSULTING MEDICAL STAFF, COMMUNITY LEADERS, ORGANIZATION BOARD MEMBERS AND COUNTY HEALTH DEPARTMENTS. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE ORGANIZATION INFORMS AND EDUCATES ITS PATIENTS REGARDING ASSISTANCE FROM FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS THROUGH ITS SOCIAL SERVICES DIRECTOR. THE ORGANIZATION INFORMS AND EDUCATES PATIENTS REGARDING ASSISTANCE FROM ITS CHARITY CARE POLICY THROUGH DISCUSSION AT REGISTRATION OR DISCHARGE, INFORMATIONAL DOCUMENT SENT WITH BILLING STATEMENTS AND A DESCRIPTION OF THE PROGRAM PLUS AN APPLICATION POSTED ON ITS WEBSITE. PART VI, LINE 4 COMMUNITY INFORMATION THE ORGANIZATION SERVES A RURAL AREA THAT INCLUDES 13 SMALL COMMUNITIES. THE POPULATION OF THE SERVICE AREA TOTALS APPROXIMATELY 13,000 RESIDENTS. THE SIZE OF THE COMMUNITIES WE SERVE IN OUR SERVICE AREA RANGE FROM LESS THAN 150 TO APPROXIMATELY 5,800 RESIDENTS. OF THE 13,000 RESIDENTS, 16.7% ARE BELOW THE FEDERAL POVERTY LEVEL AND THE AVERAGE HOUSEHOLD INCOME IS APPROXIMATELY $30,900. OUR SERVICE AREA POPULATION CONSISTS OF 19.5% MEDICAID AND 7.4% UNINSURED. OUR ORGANIZATION PROVIDES SERVICES TO FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS. PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH ONE OF THE VERY IMPORTANT ASSETS OF A COMMUNITY IS IT'S HOSPITAL. THE HOSPITAL, AS AN ORGANIZATION, FILLS THE ROLE AS THE FOCAL POINT OF THE COMMUNITY'S HEALTHCARE ACTIVITIES AND THE CATALYST WHICH BRINGS TOGETHER THE PRACTICING PHYSICIANS, OTHER HEALTHCARE PROVIDERS, COMMUNITY HEALTHCARE AGENCIES, AND OTHER HEALTHCARE FOCUSED RESOURCES TO MAINTAIN AND PRESERVE THE COMMUNITY'S HEALTH STATUS. THE ORGANIZATION IS GOVERNED BY A VOLUNTEER BOARD OF DIRECTORS THAT CONSIST OF INDIVIDUALS WHO RESIDE IN THE HOSPITAL'S SERVICE AREA. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL PHYSICIANS IN OUR SERVICE AREA. SURPLUS FUNDS GENERATED THROUGH THE PROVISION OF SERVICES ARE INVESTED IN IMPROVED PATIENT CARE TECHNOLOGIES AND ENHANCED TREATMENT AREAS SO THAT THE ORGANIZATION CAN CONTINUE TO PROVIDE QUALITY PATIENT CARE. PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM NOT APPLICABLE PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT NOT APPLICABLE X X X X X false false false true false false false false false KATRINA J CASNER PRESIDENT & CEO 129853 0 10802 0 411 0 5815 0 5520 0 152401 0 0 0 DJ ASUNCION MD DIRECTOR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 WALTER CUNNINGTON PHYSICIAN 147355 0 211870 0 309 0 6077 0 4560 0 370171 0 0 0 CATHERINE TEODORO PHYSICIAN 148885 0 60039 0 266 0 6023 0 1680 0 216893 0 0 0 PART I, LINE 5A CONTINGENT COMPENSATION WALTER CUNNINGTON AND CATHERINE TEODORO ARE COMPENSATED USING A BASE SALARY PLUS PRODUCTIVITY COMPENSATION. THE PRODUCTIVITY COMPENSATION IS CALCULATED BASED UPON MINIMUM LEVELS OF RECEIPTS GENERATED BY EACH PHYSICIAN. PART II COMPENSATION FROM UNRELATED ORGANIZATION D J ASUNCION IS EMPLOYED BY MIDWEST EMERGENCY SERVICES INC (MES) WHICH PROVIDES EMERGENCY PHYSICIANS, INCLUDING D J ASUNCION, TO PCH. PCH PAID $1,259,977 TO MES DURING 2013. ANDREW CASNER SON OF KATRINA CASNER 17538 EMPLOYED BY HOSPITAL false DR LAURIE CUNNINGTON WIFE OF DR. CUNNINGTON 97574 EMPLOYED BY HOSPITAL false PART VI, SECTION A, LINE 2 FAMILY AND BUSINESS RELATIONSHIPS STEVE NEECE AND DAVID SLATER HAVE A BUSINESS RELATIONSHIP. MATTHEW BEAVERS AND STEVE NEECE HAVE A BUSINESS RELATIONSHIP. DAVID SLATER, JOHN GARDNER, AND JIM RANDOLPH HAVE A BUSINESS RELATIONSHIP. JOYCE MORGAN, DAVID SLATER, JOHN GARDNER, JIM RANDOLPH, AND JOYCE THRONEBURG ALL HAVE A BUSINESS RELATIONSHIP DUE TO THE FACT THAT THEY ARE ALL BOARD MEMBERS OF QUAD COUNTY HOME MEDICAL SUPPLIES & EQUIPMENT, A TAXABLE SUBSIDIARY OF PANA COMMUNITY HOSPITAL ASSOCIATION. PART VI, SECTION A, LINES 6 & 7A MEMBERS AND STOCKHOLDERS MEMBERS OF THE HOSPITAL THAT CONTRIBUTE $5.00 TO THE PANA COMMUNITY HOSPITAL FOUNDATION MAY VOTE FOR THE MEMBERS OF THE GOVERNING BODY DURING THE HOSPITAL'S ANNUAL MEETING. PART VI, SECTION B, LINE 11A FORM 990 REVIEW PROCESS THE FORM 990 IS REVIEWED BY THE CFO PRIOR TO FILING WITH THE IRS. PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY ALL BOARD MEMBERS, MEMBERS OF THE MEDICAL STAFF, ADMINISTRATION AND DEPARTMENT MANAGERS ARE ASKED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNIARE ANNUALLY. THE HUMAN RESOURCES MANAGER REVIEWS QUESTIONNAIRES AND PRESENTS ANY CONFLICTS NOTED TO THE PRESIDENT & CEO TO REVIEW AND RESOLVE. IF ANY CONFLICTS ARE NOTED, THE PRESIDENT & CEO, WITH BOARD APPROVAL, IMPOSES APPROPRIATE RESTRICTIONS ON THE INDIVIDUAL(S) WITH A CONFLICT OF INTEREST. PART VI, SECTION B, LINES 15A & 15B COMPENSATION PROCESS EACH YEAR THE BOARD OF DIRECTORS DETERMINES COMPENSATION FOR THE CEO, CCO/CNE AND THE CFO. THE BOARD USES COMPARATIVE COMPENSATION INFORMATION FROM THE ILLINOIS HOSPITAL ASSOCIATION TO DETERMINE THE ABOVE INDIVIDUALS' COMPENSATION. PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS ARE AVAILABLE FOR THE PUBLIC TO REVIEW DURING THE ORGANIZATION'S ANNUAL MEETING. PART XI, LINE 9 OTHER CHANGES IN NET ASSETS INVESTMENT IN SUBSIDIARY ($16,139) ROUNDING $4 --------- OTHER CHANGES IN NET ASSETS ($16,135) PART IX, LINE 11G OTHER FEES FOR SERVICES EMERGENCY DEPARTMENT 1,264,068 LAB 74,509 IMAGING 473,062 OTHER PURCHASED SERVICES 277,648 ----------- TOTAL 2,089,287 PANA COMMUNITY HOSPITAL FOUNDATION 101 EAST 9TH STREET PANA IL 62557 371293506 FUNDRAISING IL 501(C)(3) 11-I PCH true QUAD COUNTY HOME MEDICAL SPPLS & EQPMT 1 HUBER STREET PANA IL 62557 371198049 EQPMT RETAILER IL PCH C 2656 254264 1.00000 true false false true false false false false false false false false false false true true false true false false PANA COMMUNITY HOSPITAL FOUNDATION C 176972 CASH TRANSFER