2013-10-30T13:33:22-05:00 2012-12-31 BKD LLP 211 N BROADWAY SUITE 600 ST LOUIS MO 631022733 990 2012-01-01 376062326 Pana Community Hospital Association % JAMES MOON CFO PANA 2175622131 101 EAST NINTH STREET Suite PANA IL 62557 JOYCE MORGAN 2175622131 2013-10-29 true Donna J Larson 3142315544 2012 2016-03-07 17:11:31Z JOYCE MORGAN CHAIRMAN 101 E NINTH STREET PANA IL 62557 19986101 false X www.panahospital.com X 1966 IL OUR MISSION IS TO BE A LEADING PARTNER IN ASSURING COMMUNITY-BASED QUALITY HEALTH CARE. 12 12 221 90 9906 225836 282600 20785653 19576907 82523 73724 41490 52348 21135502 19985579 0 0 0 0 9168471 8954425 0 0 53027 9653661 9650814 18822132 18605239 2313370 1380340 19543272 22818621 1529684 3495203 18013588 19323418 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 16741481 19576907 TO PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF PANA, ILLINOIS AND THE SURROUNDING AREA. THESE SERVICES INCLUDE NURSING, EMERGENCY AND ANCILLARY SERVICES FOR 988 INPATIENT DAYS, 22,148 OUTPATIENT VISITS, 8,847 EMERGENCY VISITS AND 215 OUTPATIENT SURGERIES. 16741481 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 11 0 true 221 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 JOYCE MORGAN 1.5 X X 0 0 0 JUDGE DAVID SLATER 1.5 X 0 0 0 CAROLYN MARLEY 1.5 X 0 0 0 JIM RANDOLPH 1.5 X X 0 0 0 MARY ANN RHOADES 1.5 X 0 0 0 DJ ASUNCION MD 1.5 X 0 0 0 STEVE NEECE 1.5 X 0 0 0 MIKE TREXLER 1.5 X X 0 0 0 JOHN GARDNER 1.5 X 0 0 0 JOYCE THRONEBURG 1.5 X X 0 0 0 CAROL SCHRAMM 1.5 X 0 0 0 RICK MILES 1.5 X 0 0 0 KATRINA J CASNER 40.0 X 138796 0 11277 VICKIE COEN 40.0 X 108690 0 7637 JAMES MOON 40.0 X 93092 0 7196 WALTER CUNNINGTON 40.0 1.5 X 290478 0 15660 JARED KOCHER 40.0 X 314997 0 8450 MICHELLE FOREMAN 40.0 X 108985 0 6215 1055038 0 56435 5 false true true MIDWEST EMERGENCY SERVICE INC 320 E HIGHWAY 50 OFALLON IL 62269 EMERGENCY PHYSICIANS 1222475 PRECISE SPECIALTIES CORP 514 S MAIN HILLSBORO IL 62049 ULTRASOUND TECH. 112648 MCKESSON TECHNOLOGIES INC PO BOX 98347 CHICAGO IL 60693 HARD/SOFTWARE IMPLEM 286902 3 46802 225798 10000 282600 PATIENT CARE SERVICES 621110 19115418 19115418 OTHER OPERATING REVENUE 621110 192159 192159 ELECTRONIC HEALTH RECORDS REVENUE 621110 269330 269330 19576907 71196 71196 0 0 5266 5266 0 5266 5266 3050 522 2528 2528 2528 0 0 0 CAFETERIA & VENDING 722514 37176 37176 CATERING 722320 9906 9906 47082 19985579 19576907 9906 116166 X 0 0 0 0 996273 629586 366687 0 6328543 5832366 455241 40936 134632 124076 9685 871 1133769 1044878 81557 7334 361208 332889 25983 2336 0 1194 1194 66754 66754 0 0 0 2110410 2037339 73071 50273 50273 2648314 2512070 134694 1550 8557 8557 0 199132 28533 170599 51472 51472 0 68024 46302 21722 0 0 1308886 1177997 130889 188617 146149 42468 BAD DEBT EXPENSE 2636191 2636191 FEES & LICENSES 118216 101845 16371 EMPLOYEE RELATIONS 89036 89036 DUES & SUBSCIPTIONS 60169 60169 45569 39788 5781 18605239 16741481 1810731 53027 2527788 4874023 3535649 3574870 0 0 4051826 5550603 0 0 0 0 246419 347488 324201 290768 153987 156908 17555674 9532203 8633768 8023471 0 0 45453 -19924 0 0 0 0 24181 20414 19543272 22818621 1432425 1268861 0 0 0 1769882 0 0 0 0 0 0 0 0 0 0 97259 456460 1529684 3495203 X 18013588 19323418 0 0 0 0 18013588 19323418 19543272 22818621 X 1380340 -5137 -65373 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 9948 false false false 9948 false FORM 990, SCHEDULE C PART 1-A, LINE 1F 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 37% OF OUR MEMBERSHIP DUES AS PROVIDED BY THE IHA. 1282115 1407 1283522 1347734 -65619 1282115 1470956 -123222 1347734 2889351 1341547 -11108 2748834 1470956 757088 3260183 57773 1184693 1000 2889351 1.00000 false false 0 11496 11496 0 6902438 3871391 3031047 0 10270671 5499434 4771237 0 371069 161378 209691 8023471 0 Third Party Payor Settlements 456460 456460 ENDOWMENT FUNDS SCHEDULE D, PART V PANA HOSPITAL INTENDS TO USE THE FUNDS FOR CAPITAL IMPROVEMENTS. FIN 48 PART X, LINE 2 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 235996 235996 0.01480 3231959 2080964 1150995 0.07210 3467955 2080964 1386991 0.08690 31359 31359 0.00200 76357 76357 0.00480 107716 107716 0.00680 3575671 2080964 1494707 0.09370 true 2636191 1581715 7079650 7048804 30846 X true false 1 1 PANA COMMUNITY HOSPITAL

101 EAST 9TH STREET PANA IL 62557

X X X X PANA COMMUNITY HOSPITAL 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 6 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 QUAD COUNTY HOME HEALTH & HOSPICE

433 S MAIN HILLSBORO IL 62049

HOME HEALTH & HOSPICE SATELLITE OFFICE FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST 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. FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST PART I, LINE 7, COLUMN (F) THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $2,636,191 REPORTED ON PART IX, LINE 25, HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. BAD DEBT EXPENSE PART III, SECTION A, LINES 2A, 3A & 4 2A 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. 3A 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. 4 SEE NOTE 2: NET PATIENT SERVICE REVENUE ON PAGE 12 OF THE AUDITED FINANCIAL STATEMENTS MEDICARE PART III, LINE 8 LINE 6 COSTS WERE TAKEN DIRECTLY FROM THE ORGANIZATION'S 12/31/12 MEDICARE COST REPORT. COLLECTION PRACTICES PART III, LINE 9B THE COLLECTION PRACTICES FOLLOWED BY THE ORGANIZATION FOR PATIENTS WHO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE ADDRESSED IN ITS CHARITY CARE/FINANCIAL ASSISTANCE POLICY. NEEDS ASSESSMENT PART VI, LINE 2 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. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 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. COMMUNITY INFORMATION PART VI, LINE 4 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 19.1% MEDICAID AND 7.6% UNINSURED. OUR ORGANIZATION PROVIDES SERVICES TO FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS. PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 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. INDIVIDUALS ELIGIBILITY FOR FINANCIAL ASSISTANCE PART V, SECTION B, LINE 20 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. X X X X X false false false true false false false false false KATRINA J CASNER 128903 0 9500 0 393 0 5757 0 5520 0 150073 0 0 0 DJ ASUNCION MD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 WALTER CUNNINGTON 142947 0 147232 0 299 0 6100 0 9560 0 306138 0 0 0 JARED KOCHER 138178 0 176580 0 239 0 4738 0 3712 0 323447 0 0 0 FORM 990 SCHEDULE J, PART 1, LINE 5A WALTER CUNNINGTON AND JARED KOCHER ARE COMPENSATED USING A BASE SALARY PLUS PRODUCTIVITY COMPENSATION. THE PRODUCTIVITY COMPENSATION IS CALCULATED BASED UPON MINIMUM LEVELS OF RECEIPTS GENERATED BY EACH PHYSICIAN. FORM 990 SCHEDULE J, PART II D J ASUNCION IS EMPLOYED BY MIDWEST EMERGENCY SERVICES INC (MES) WHICH PROVIDES EMERGENCY PHYSICIANS, INCLUDING D J ASUNCION, TO PCH. PCH PAID $1,222,475 TO MES DURING 2012. ANDREW CASNER SON OF KATRINA CASNER 30953 EMPLOYED BY HOSPITAL false DR LAURIE CUNNINGTON WIFE OF DR. CUNNINGTON 99030 EMPLOYED BY HOSPITAL false FAMILY AND BUSINESS RELATIONSHIPS PART VI, SECTION A, LINE 2 STEVE NEECE AND DAVID SLATER HAVE A BUSINESS RELATIONSHIP. MIKE TREXLER, DAVID SLATER, JOHN GARDNER, AND JIM RANDOLPH HAVE A BUSINESS RELATIONSHIP. MEMBERS AND STOCKHOLDERS PART VI, SECTION A, LINE 6 AND 7A 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. FORM 990 REVIEW PROCESS PART VI, SECTION B, LINE 11A THE FORM 990 IS REVIEWED BY THE CFO PRIOR TO FILING WITH THE IRS. CONFLICT OF INTEREST POLICY PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS, MEMBERS OF THE MEDICAL STAFF, ADMINISTRATION AND DEPARTMENT MANAGERS ARE ASKED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY. COMPENSATION PROCESS PART VI, SECTION B, LINE 15A & 15B 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. GOVERNING DOCUMENTS PART VI, SECTION C, LINE 19 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. OTHER CHANGES IN NET ASSETS PART XI, LINE 9 INVESTMENT IN SUBSIDIARY ($65,377) ROUNDING $4 --------- OTHER CHANGES IN NET ASSETS ($65,373) OTHER FEES FOR SERVICES PART IX, LINE 11G EMERGENCY DEPARTMENT 1,226,436 LAB 106,065 IMAGING 500,361 OTHER PURCHASED SERVICES 277,548 ----------- TOTAL 2,110,410 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 6595 329479 1.00000 true false false true false false false false false false false false false false true true false true false false