2014-05-15T15:08:03-05:00 2013-06-30 BKD LLP 225 NORTH WATER ST SUITE 400 DECATUR IL 62523 990 2012-07-01 370661215 Kirby Medical Center % MR STEVEN TENHOUSE KIRB 2177622115 1000 Medical Center Drive Suite Monticello IL 61856 Steven D Tenhouse 2177622115 2014-05-14 true 2174292411 2012 2015-11-30 17:44:51Z STEVEN D TENHOUSE 1000 MEDICAL CENTER DRIVE MONTICELLO IL 61856 35149761 false X WWW.KIRBYHEALTH.ORG X 1939 IL Kirby Medical Center is committed to providing progressive hospital, outpatient, and specialty services to those who are served, in a convenient compassionate setting, regardless of their ability to pay. 8 8 291 250 0 0 462093 6988554 21130037 23319030 228742 762313 413203 2679397 22234075 33749294 0 0 0 0 13020624 11792431 0 0 0 12545200 13832765 25565824 25625196 -3331749 8124098 57187437 66512145 35667098 36164566 21520339 30347579 KIRBY MEDICAL CENTER IS COMMITTED TO PROVIDING QUALITY AND COMPASSIONATE CARE TO ALL. false false 18497697 25564530 THE HOSPITAL PROVIDES QUALITY INPATIENT AND OUTPATIENT SERVICES TO ITS COMMUNITY. FREE, SUBSIDIZED, AND GOVERNMENT ASSISTED CARE ARE PROVIDED AT A REDUCED RATE WHEN NEEDED. SERVICES PROVIDED DURING THE YEAR INCLUDE APPROXIMATELY 22,214 PATIENTS SERVED THROUGH THE KIRBY MEDICAL CLINIC, 1,961 NURSING CARE INPATIENT DAYS, AND 86,233 LABORATORY PROCEDURES. 18497697 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 false false true false false false false true true false false false true 41 0 true 291 true false false false false false false false false false false X 8 8 false false false false false false false true true false false false true true true true true true false false IL X MR STEVEN TENHOUSE 2177622115 1000 MEDICAL CENTER DRIVE MONTICELLO IL 61856 CRAIG WEBB 1.0 0.0 X X 11700 0 0 STEPHEN AYERS 1.0 0.0 X X 7500 0 0 GARY HUISINGA 1.0 0.0 X X 9000 0 0 STEVEN MILLS 1.0 0.0 X 1500 0 0 STEVEN TENHOUSE 40.0 0.5 X X 188758 0 38657 EDWARD EWALD 1.0 0.5 X 4650 0 0 JAMES BALLSRUD 1.0 0.0 X 5400 0 0 NAT RASSI 1.0 0.0 X 6000 0 0 DYKE PIATT 1.0 0.5 X 7650 0 0 BILL TRACY 1.0 0.0 X 3900 0 0 NARAIN DAS MANDHAN 40.0 0.0 X 380270 0 48998 DAVE HARMS 40.0 0.0 X 116043 0 9825 JENNIFER MOSS 40.0 0.0 X 94852 0 26700 ALEXANDER NAZARIAN 40.0 0.0 X 0 0 0 JAMES MANINT 40.0 0.0 X 168577 0 34280 JOSEPH LAMB 40.0 0.0 X 106908 0 34529 LAURIE LEE 40.0 0.0 X 112913 0 25575 CHUNLING GONG 40.0 0.0 X 130754 0 14473 DIANNE GEISSAL 40.0 0.0 X 103079 0 17496 1459454 0 250533 8 false true false CARLE PHYSICIAN GROUP 611 W PARK ST URBANA IL 61801 PHYSICIAN SERVICES 2158631 CARLE FOUNDATION HOSPITAL 611 W PARK ST URBANA IL 61801 DRUG & PHARM CONSULT 654332 MEDICAL INFORMATION TECHNOLOGY MEDITECH CIRCLE WESTWOOD MA 02090 OP SYSTEM & SUPPORT 302273 FOLEY LARDNER ATTY AT LAW 321 N CLARK ST SUITE 2800 CHICAGO IL 60610 LEGAL SERVICES 256754 GE HEALTHCARE PO BOX 641419 PITTSBURG PA 152641419 CT MACHINE 227462 18 158726 6829828 6829828 6988554 NET PATIENT SERVICE REVENUE 621110 23319030 23319030 23319030 183211 183211 0 0 453131 25472 427659 0 427659 427659 1366092 574410 1262280 99120 103812 475290 579102 579102 0 0 19833 13595 6238 6238 EMR INCENTIVE REIMBURSEMENT 900099 1698694 1698694 GOVT STIPEND - AMB 900099 57460 57460 PHYSICAL THERAPY INCOME 621110 48404 48404 440942 440942 2245500 33749294 25564530 1196210 X 0 0 0 0 972389 972389 0 8146674 5702672 2444002 420765 294536 126229 1610260 1127182 483078 642343 417523 224820 0 380640 243610 137030 89286 57143 32143 0 0 0 3049734 2897247 152487 191694 122684 69010 436721 331908 104813 109842 70299 39543 0 371943 238044 133899 70148 44895 25253 0 71430 30001 41429 1896326 1896326 0 3331943 2132444 1199499 468101 299585 168516 SUPPLIES 2155668 1724534 431134 REPAIRS AND MAINTENANCE 664715 412123 252592 EQUIPMENT RENTAL 300522 282491 18031 DUES AND SUBSCRIPTIONS 54147 34654 19493 189905 137796 52109 25625196 18497697 7127499 0 3058 600 1143702 4117045 0 0 4318837 5133943 0 0 0 0 0 0 274824 275255 389384 531164 43342088 7551024 38176829 35791064 12080741 18527604 0 0 0 0 0 0 800062 2135470 57187437 66512145 3650900 2945729 0 0 0 0 0 0 0 0 0 0 32016198 30380656 0 0 0 2838181 35667098 36164566 X 11660520 14520020 0 487246 9859819 15340313 21520339 30347579 57187437 66512145 X 8124098 147604 555538 X false true X true true true X false false false RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 6936 6936 false OTHER LOBBYING ACTIVITIES PART II-B, LINE 1I THE AMOUNT REPORTED ON THIS LINE REPRESENTS THE PORTION OF DUES PAID BY KIRBY MEDICAL CENTER TO HOSPITAL ASSOCIATIONS THAT WERE USED FOR LOBBYING ACTIVITIES. 15594288 7189877 683374 988050 40541 22438948 15987486 1234605 525859 2112809 40853 15594288 11769155 201691 4513189 465369 31180 15987486 9869103 3730121 1796537 33532 11769155 10804326 189054 741931 1822726 43482 9869103 0.31640 0.68360 true false 520000 349650 869650 3884909 15743095 2675817 16952187 15242008 3435806 11806202 7602426 1439401 6163025 35791064 0 DUE TO MEDICARE 2805427 USE INTEREST OF BENEFICIARY 32754 2838181 PART V LINE 4 USE OF ORGANIZATION'S ENDOWMENT FUNDS THE PERMANENT ENDOWMENT AND THE BOARD DESIGNATED QUASI-ENDOWMENT FUNDS PROVIDE INCOME TO SUPPORT CURRENT HOSPITAL OPERATIONS. ANY TERM ENDOWMENT FUND ALSO SUPPORTS CURRENT OPERATIONS THROUGH ITS SPECIFIED PURPOSE OF DEFRAYING CHARITY CARE. UNCERTAIN TAX POSITIONS PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE UNCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANACIAL STATEMENTS. true true true X 280. true X 280. true true true false true false 1517954 1517954 0.05930 2985116 1448151 1536965 0.06010 4503070 1448151 3054919 0.11940 14965 1237 13728 0.00050 911430 750119 161311 0.00630 25720 25720 0.00100 952115 751356 200759 0.00780 5455185 2199507 3255678 0.12720 2850 2850 0.00010 1225 1225 58 58 4133 4133 0.00010 true 45158 0 6814021 6844615 -30594 X true true 1 1 KIRBY MEDICAL CENTER

1000 MEDICAL CENTER DRIVE MONTICELLO IL 61856

X X X KIRBY MEDICAL CENTER 1 true X X X X X X X X X 13 true false true X X X X X X true false true true 280. true 280. true X X true true X X X X X true false X X X X true X false false CHARITY CARE PERCENTAGE PART I, LINE 7, COLUMN F THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $45,158 REPORTED IN PART IX, LINE 25, HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. COST METHODOLOGY 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. COMMUNITY BUILIDNG ACTIVITIES PART II ECONOMIC DEVELOPMENT ACTIVITIES INCLUDED ROTARY, CHAMBER OF COMMERCE, AND MONTICELLO MAIN STREET ACTIVITIES. COALITION BUILDING ACTIVITIES INCLUDED 911 & CRISIS TEAM MEETINGS. BAD DEBT METHODOLOGY PART III, SECTION A, LINE 2 IN 2013, THE MEDICAL CENTER CHANGED ITS METHOD OF PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR UNCOLLECTIBLE ACCOUNTS AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN ACCORDANCE WITH ACCOUNTING STANDARDS UPDATE (ASU) 2011-07, PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTH CARE ENTITIES. THE MAJOR CHANGES ASSOCIATED WITH ASU 2011-07 ARE TO RECLASSIFY THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS RELATED TO PATIENT SERVICE REVENUE TO A DEDUCTION FROM PATIENT SERVICE REVENUE AND TO PROVIDE ENHANCED DISCLOSURES OF THE MEDICAL CENTER'S POLICIES RELATED TO UNCOLLECTIBLE ACCOUNTS. THE BAD DEBT AMOUNT INCLUDED ON LINE 2 IS THE BAD DEBT EXPENSE THAT WAS REPORTED ON THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS. BAD DEBT FOOTNOTE PART III, SECTION A, LINE 4 PATIENT ACCOUNTS RECEIVABLE ARE STATED AT NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYERS AND OTHERS FOR SERVICES RENDERED PLUS ANY ACCRUED AND UNPAID INTEREST. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, WHICH IS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. PATIENT ACCOUNTS RECEIVABLE ARE ORDINARILY DUE 30 DAYS AFTER THE ISSUANCE OF THE INVOICE. BALANCES PAST DUE MORE THAN 120 DAYS ARE CONSIDERED DELINQUENT. DELINQUENT ACCOUNTS PAST DUE MORE THAN ONE YEAR ARE WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT OR THIRD-PARTY PAYER. MEDICARE PART III, SECTION B, LINE 8 UNDER THE CURRENT MEDICARE RULES CAH HOSPITALS RECEIVE THEIR ALLOWABLE COST OF PATIENT CARE ADJUSTED FOR SEQUESTRATION REDUCTION FOR THE REIMBURSEMENT OF ALLOWABLE HOSPITAL COSTS AND 100% OF CLINIC ALLOWABLE COSTS. COLLECTION PRACTICES PART III, SECTION C, LINE 9B THIS POLICY AND RELATED PRACTICES HAVE SUBSEQUENTLY BEEN REVISED TO INCLUDE THE REVIEW OF THE PATIENT'S FINANCIAL STATUS AND QUALIFICATIONS AT THE TIME OF ADMISSION. PRACTICES RELATED TO THE COLLECTION OF BAD DEBT HAVE ALSO SUBSEQUENTLY BEEN REVISED TO ALLOW FOR THE SCREENING OF THE HOSPITAL'S FINANCIAL ASSISTANCE GUIDELINES. COMMUNITY INPUT IN CHNA PROCESS PART V, SECTION B, LINE 3 THE ORGANIZATION'S CONSULTANT PERFORMING THE ASSESSMENT MET WITH VARIOUS COMMUNITY GROUPS, PHYSICIANS, REPRESENTATIVES THE LOCAL SCHOOL DISTRICT AND OF LOCAL HEALTH AGENCIES TO DISCUSS THE HEALTH NEEDS OF MONTICELLO AND PIATT COUNTY. FINANCIAL ASSISTANCE POLICY PART V, SECTION B, LINES 9 - 14 KIRBY MEDICAL CENTER OFFERS A PROGRAM CALLED "KIRBY CARE ASSISTANCE PROGRAM". THE PROGRAM PROVIDES A DISCOUNT TO GROSS CHARGES BASED ON FINANCIAL NEED. THE PROGRAM IS PUBLICIZED ON THE HOSPITAL WEBSITE AND IS ALSO NOTED ON ALL PATIENT INVOICES. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON THE APPLICATION WHICH IS USED TO DETERMINE A PERSON'S ABILITY TO PAY WITHIN THE INCOME CRITERIA OUTLINED IN THE ASSISTANCE PROGRAM. KIRBY MEDICAL CENTER ALSO HAS A "PRESUMPTIVE ELIGIBILITY" POLICY THAT REDUCES ALL CHARGES TO ZERO, A FULL WRITE OFF OF CHARGES, IF A PATIENT IS ELIGIBLE FOR A VARIETY OF STATE FUNDED SUPPORT PROGRAMS. UNDER THE "PRESUMPTIVE ELIGIBILITY" POLICY THERE IS NO NEED FOR A PATIENT TO APPLY UNDER THE KIRBY CARE ASSISTANCE PROGRAM AS IT IS ASSUMED THE PATIENT IS MEDICALLY FINANCIALLY INDIGENT. CHARGES FOR MEDICAL CARE PART V, SECTION B, LINES 20-22 MEDICARE REIMBURSEMENT REGULATIONS REQUIRE A UNIFORM CHARGE STRUCTURE. SINCE KIRBY MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL, MEDICARE REIMBURSES THE HOSPITAL ON THE BASIS OF COST. THE MEDICARE PROGRAM REQUIRES THE HOSPITAL TO FILE AN ANNUAL MEDICARE COST REPORT TO DETERMINE THE FINAL AMOUNT OF PAYMENT FOR SERVICES TRADITIONAL MEDICARE FEE FOR SERVICE PATIENTS. THROUGH THE ANNUAL COST REPORT, MEDICARE ULTIMATELY APPORTIONS COSTS BASED ON THE PREMISE THAT ALL CHARGES ARE THE SAME FOR EACH PATIENT, THEREFORE REQUIRING ALL CHARGES BE THE SAME FOR ALL PATIENTS. THE CONCEPT FOR DISCOUNTING CHARGES AT KIRBY MEDICAL CENTER IS MADE ON THE PATIENT'S ABILITY TO PAY THE CHARGE, DISCOUNTING THE RECEIVABLE, RATHER THAN THE CHARGE ITSELF. KIRBY MEDICAL CENTER OFFERS A PROGRAM CALLED "KIRBY CARE ASSISTANCE PROGRAM". THE PROGRAM PROVIDES A DISCOUNT TO GROSS CHARGES BASED ON FINANCIAL NEED. THE PROGRAM IS PUBLICIZED ON THE HOSPITAL WEBSITE AND IS ALSO NOTED ON ALL PATIENT INVOICES. KIRBY MEDICAL CENTER ALSO HAS A "PRESUMPTIVE ELIGIBILITY" POLICY THAT REDUCES ALL CHARGES TO ZERO. NEEDS ASSESSMENT IN CONCERT WITH THE LOCAL COMMUNITY HEALTH AGENCIES, KIRBY MEDICAL COLLABORATES TO ASSESS THE HEALTH NEEDS OF THE LOCAL COMMUNITY AND THE IMMEDIATELY SURROUNDING COUNTY. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE INFORMATION REGARDING ELIGIBILITY FOR FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS AND THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM IS PUBLISHED ON THE HOSPITAL'S WEB SITE AND IS AVAILABLE VIA LITERATURE THAT IS PLACED AT THE VARIOUS LOCATIONS IN THE HOSPITAL WHERE PATIENTS ARE REGISTERED FOR ADMISSION. INFORMATION IS ALSO PROVIDED BY THE PATIENT FINANCIAL SERVICES STAFF AND IS ALSO REFERENCED IN NEWSPAPER AND BILLBOARD ADVERTISING. COMMUNITY INFORMATION KIRBY MEDICAL CENTER SERVES THE IMMEDIATE COMMUNITY OF MONTICELLO WHICH HAS A POPULATION OF ROUGHLY 6,000 AND A MUCH LARGER SERVICE AREA OF APPROXIMATELY 16,000 THAT INCLUDES THE SURROUNDING COMMUNITIES OF BEMENT, CISCO, ATWOOD, WHITE HEATH, IVESDALE AND WELDON, TO NAME A FEW. PROMOTION OF COMMUNITY HEALTH KIRBY MEDICAL CENTER CONTINUES TO PROMOTE HEALTH EDUCATION VIA HEALTH FAIRS AND VIA THEIR PRESENCE AT VARIOUS COMMUNITY EVENTS WITH HEALTH EDUCATION MATERIALS. KIRBY PROVIDES READY ACCESS TO VACCINES BY SETTING UP SPECIAL VACCINE LOCATIONS IN THE COMMUNITY PRIOR TO THE FLU SEASON. THE KIRBY AMBULANCE STAFF PROVIDES ON CALL COVERAGE AT LOCAL ATHLETIC EVENTS AND PROVIDES EDUCATION TO ELEMENTARY SCHOOL KIDS THROUGH THEIR ADOPT A MEDIC PROGRAM. STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI IL, X true true X X X false false false false false false false true false STEVEN TENHOUSE 156768 0 25500 0 6490 0 14796 0 23861 0 227415 0 0 0 NARAIN DAS MANDHAN 296835 0 74853 0 8582 0 21438 0 27560 0 429268 0 0 0 JAMES MANINT 126883 0 40244 0 1450 0 13137 0 21143 0 202857 0 0 0 NON-FIXED PAYMENTS SCHEDULE J, PART I, LINE 7 THE CEO, STEVEN TENHOUSE, RECEIVES A BONUS OF UP TO 15% OF BASED COMPENSATION BASED ON SUCCESSFUL FINANCIAL, OPERATIONAL, AND QUALITY INDICATORS OF THE KIRBY ORGANIZATION. THE FOLLOWING INDIVIDUALS RECEIVED A BONUS BASED ON THEIR CLINIC PATIENT PRODUCTION AND QUALITY INDICATORS SUCH AS CHART REVIEW, CHART AUDITS, AND PATIENT SATISFACTION: NARAIN DAS MANDHAN CHUNLING GONG JAMES MANINT JOSEPH LAMB THE BONUS AMOUNTS ARE DETERMINED BASED ON A FUNCTION OF BASE SALARY AND NATIONAL SURVEYS ON PHYSICIAN COMPENSATION AND PRODUCTION. HEALTH OR SOCIAL CLUB DUES SCHEDULE J, PART 1, LINE 1 KIRBY MEDICAL CENTER PAYS PROFESSIONAL AND OTHER DUES FOR THE CEO, STEVEN TENHOUSE, INCLUDING A GOLF CLUB MEMBERSHIP. ANY DUES MUST BE APPROVED BY THE CHAIRMAN OF THE BOARD BEFORE THEY ARE PAID AS BEING IN THE BEST INTERESTS OF THE MEDICAL CENTER. ANY PERSONAL USE ASSOCIATED WITH THE GOLF CLUB DUES IS INCLUDED IN THE TAXABLE COMPENSATION OF THE CEO. X 2 1423442 FAIR MARKET VALUE X 2 5406386 APPRAISAL false false false NUMBER OF CONTRIBUTIONS SCHEDULE M, PART I, COLUMN B THE AMOUNTS REPORTED ON COLUMN B OF PART I REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED DURING THE YEAR. PROCESS TO REVIEW FORM 990 PART VI, SECTION B, LINE 11 THE FORM 990 FINANCIAL INFORMATION IS REVIEWED BY THE INTERNAL ACCOUNTING STAFF FOR ACCURACY TO THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS. OTHER FORM 990 INFORMATION IS REVIEWED BY THE CFO AND CEO. THE FINAL VERSION OF THE FORM 990 IS REVIEWED BY THE GOVERNING BOARD'S AUDIT AND COMPLIANCE COMMITTEE BEFORE THE FORM IS FILED WITH THE IRS. CONFLICT OF INTEREST POLICY PART VI, SECTION B, LINE 12 GENERALLY THE BOARD ASSESSES THE CONFLICTS THAT EXIST WITH ITS MEMBERS AND REQUESTS THAT MEMBERS WITH THESE CONFLICTS BE EXCUSED FROM ANY DISCUSSION RELATED TO THEM. BECAUSE OF THE FAMILIARITY OF BOARD MEMBERS WITH ONE ANOTHER AND THE SIZE OF THE COMMUNITY, THE BOARD'S SELF ASSESSMENT OF CONFLICTS CAN BE MADE WITH RELATIVE EASE. COMPENSATION REVIEW PROCESS PART VI, SECTION B, LINE 15A THE KIRBY BOARD UTILIZES THE BI-ANNUAL IHA COMPENSATION SURVEY RESULTS TO SET AND COMPARE THE CEO'S COMPENSATION. THE LATEST REVIEW WAS DONE IN THE SPRING OF 2012. GOVERNING DOCUMENTS PART VI, SECTION C, LINE 19 AT THIS TIME NONE OF KIRBY'S GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE GENERAL PUBLIC. OTHER FEE FOR SERVICES PART IX, LINE 11G MEDICAL SERVICES FEES $2,897,247 ADMINISTRATIVE SERVICE FEES $152,487 ---------- TOTAL OTHER FEES FOR SERVICES $3,049,734 OTHER CHANGES IN NET ASSETS PART XI, LINE 9 CHANGE IN INTEREST IN PERPETUAL TRUST $74,108 PRIOR YEAR ADJUSTMENT FOR RESTRICTED LAND 487,246 ADJUSTMENT FOR GIFT SHOP (5,816) -------- TOTAL OTHER CHANGES TO NET ASSETS $555,538 THE KIRBY FOUNDATION 1000 MEDICAL CENTER DRIVE MONTICELLO IL 61856 061836473 CHARITABLE IL 501(C)(3) 7 KIRBY MED CR true PERPETUAL TRUSTS - 4 FARMING IL KIRBY MED CR TRUST false false false false false false false false false false false false true true false false false false