2026-03-14T07:36:53-05:00 2025-06-30 393647910 WIPFLI ADVISORY LLC 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2024-07-01 370673506 GRAHAM HOSPITAL ASSOCIATION GRAH 3096475240 210 WEST WALNUT CANTON IL 61520 ALLISON SOURS PRESIDENT AND CEO 3096475240 2026-03-05 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2026-03-05 2024 2025-03-06 01:10:19Z ALLISON SOURS 210 WEST WALNUT CANTON IL 61520 179782243 0 X WWW.GRAHAMHEALTHSYSTEM.ORG X 1905 IL TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES, IN A RESPONSIBLE AND CHARITABLE MANNER, TO THE PEOPLE AND COMMUNITIES WE SERVE. 15 14 1015 74 309321 0 31493 478855 128078803 143689098 6108274 6631591 446725 191855 134665295 150991399 171315 163452 0 0 72111042 79908406 0 0 0 58649904 67428706 130932261 147500564 3733034 3490835 284979304 299362116 102186750 103764738 182792554 195597378 X TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES, IN A RESPONSIBLE AND CHARITABLE MANNER, TO THE PEOPLE AND COMMUNITIES WE SERVE. 1 0 55291396 163452 64520899 GRAHAM HOSPITAL IS A PROVIDER OF HEALTHCARE SERVICES IN FULTON, KNOX, MCDONOUGH, MASON AND PEORIA COUNTY. DURING THIS REPORTING PERIOD 2,112 ADULTS AND CHILDREN WERE ADMITTED AND 237 BABIES WERE BORN. THEY RECEIVED INPATIENT SERVICES IN THE ACUTE CARE FACILITY. 173 PATIENTS WERE ADMITTED FOR 8,020 DAYS OF SERVICE IN THE EXTENDED CARE FACILITY. 124,390 OUTPATIENT SERVICES WERE PROVIDED. 34403535 0 40146338 SURGICAL SERVICES - THE HOSPITAL PERFORMED 463 INPATIENT SURGERIES AND 5,237 OUTPATIENT SURGERIES IN FISCAL YEAR 2025. 22116558 0 25808360 GRAHAM MEDICAL GROUP WHICH PROVIDES PHYSICIAN AND PROFESSIONAL HEALTH CARE SERVICES TO THE PATIENTS IN FULTON, KNOX, MCDONOUGH, MASON AND PEORIA COUNTY. THIS INCLUDES CHARITY CARE TO QUALIFIED INDIVIDUALS AND 162,721 OFFICE VISITS AND 18,004 NURSING HOME AND HOSPITAL VISITS. 11058280 0 12904180 ED PROGRAM - THE HOSPITAL OPERATES A 24 HOUR EMERGENCY DEPARTMENT WHICH HAD 13,295 PATIENTS REGISTERED TO THE EMERGENCY DEPARTMENT IN FISCAL YEAR 2025. 11058280 0 12904180 122869769 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 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 0 0 0 0 1 139 0 1015 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X ALLISON SOURS 3096475240 210 WEST WALNUT CANTON IL 61520 ALYSSA CRAWFORD MD OB-GYN 40.00 X 865380 0 99208 BRETT BARNHART MD ORTHOPEDIC SURGEON 40.00 X 819775 0 109833 BRENT PARRY DPM PODIATRIST 40.00 X 583505 0 104371 DAVID CAO MD UROLOGIST 40.00 X 594494 0 57721 JAMES QUEENAN III DO ORTHOPEDIC SURGEON 40.00 X 604047 0 34350 ROBERT SENNEFF PRESIDENT/CEO 40.00 X X 565250 0 37695 JULIE REEDER VP FINANCE/CFO 40.00 X 406055 0 86890 HOLLY HENLINE VP ANCILLARY/CCO 40.00 X 361203 0 82672 ALLISON SOURS PRESIDENT/CEO 40.00 X 356398 0 64962 MICHELLE DALY VP CLINIC SERVICES 40.00 X 274058 0 72577 TERESA MCCONKEY VP PATIENT SERVICES 40.00 X 276348 0 53094 MIKE RENNER CHAIRMAN (THRU DECEMBER 2024) 2.00 X X 0 0 0 KEVIN MEADE CHAIRMAN 2.00 X X 0 0 0 TERRY MOSS VICE CHAIRMAN 2.00 X X 0 0 0 BILL CARLBERG TREASURER 2.00 X X 0 0 0 JANIS BLOUT SECRETARY 2.00 X X 0 0 0 ERIN BAILEY MD TRUSTEE 2.00 X 0 0 0 LAURA FIDLER TRUSTEE 2.00 X 0 0 0 PAULA GRIGSBY TRUSTEE (THRU DECEMBER 2024) 2.00 X 0 0 0 ANNE HOLLIS TRUSTEE 2.00 X 0 0 0 SARAH KEEFER TRUSTEE 2.00 X 0 0 0 KENNETH KROCK MD TRUSTEE 2.00 X 0 0 0 JANET KRULAC TRUSTEE 2.00 X 0 0 0 DAN'L LEE TRUSTEE 2.00 X 0 0 0 JOSHUA MILLER TRUSTEE 2.00 X 0 0 0 VAL RAMIREZ TRUSTEE 2.00 X 0 0 0 CHUCK TAYLOR TRUSTEE 2.00 X 0 0 0 5706513 0 803373 92 0 1 0 PJ HOERR INC 107 W COMMERCE PEORIA IL 61604 CONSTRUCTION 10490213 COLEMAN MEDICAL ASSOCIATES LTD 180 SOUTH MAIN STREET CANTON IL 61520 PHYSICIAN SERVICES 8019840 FORGOTTONIA LLC 2907 W WARDCLIFFE DRIVE PEORIA IL 61604 PHYSICIAN SERVICES 658901 PARK PLACE INTERNATIONAL 8401 CHAGRIN ROAD SUITE 6B CHAGRIN FALLS OH 44023 HEALTHCARE IT SERVICES 607198 QUEST DIAGNOSTICS PO BOX 775460 CHICAGO IL 606775460 LABORATORY SERVICES 559180 41 167486 311369 478855 PATIENT SERVICE REVENUE 621990 134319837 134319837 340(B) REVENUE 621990 6661636 6661636 SCHOOL OF NURSING 621990 236062 236062 LABORATORY 621500 213046 213046 2258517 2162242 96275 143689098 2798017 2798017 453831 261976 191855 191855 191855 32354806 7636 28491065 37803 3863741 -30167 3833574 3833574 150991399 143379777 309321 6823446 X 163452 163452 2637199 337443 2299756 59758559 49509311 10249248 1222031 1096264 125767 12006315 9827798 2178517 4284302 3453905 830397 103397 103397 37162 37162 136212 136212 33624 33624 23613708 22515107 1098601 119479 26908 92571 473459 176615 296844 594688 20416 574272 1877069 1402775 474294 88007 3306 84701 7484 4982 2502 2711641 2403393 308248 6211734 5489922 721812 1396589 1396589 MEDICAL SUPPLIES 15302596 15302596 BAD DEBT EXPENSE 8330047 8330047 MEDICAID ASSESSMENT 3219256 3219256 DIETARY 869566 847337 22229 2302988 1958192 344796 147500564 122869769 24630795 0 1031461 1510024 3834304 1956611 14706426 16070414 1209081 1996684 2593845 3383191 1947418 2395751 196378375 79744704 106992863 116633671 136170939 135485216 9630817 10024137 6862150 9906417 284979304 299362116 15557511 15964989 75594493 73336264 34878 0 10999868 14463485 102186750 103764738 X 173161737 185573241 9630817 10024137 182792554 195597378 284979304 299362116 X 3490835 8680850 633139 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 33624 33624 0 PART II-B, LINE 1: LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED: 44.6% OF MEMBERSHIP DUES PAID TO THE ILLINOIS HOSPITAL ASSOCIATION, OR $32,533.92; 31.46% OF MEMBERSHIP DUES PAID TO THE ILLINOIS HEALTH CARE ASSOCIATION, OR $1,090.28. 130389692 752653 15348751 14900 6135674 19185 140321337 121264634 403956 14286521 13170 5505351 46898 130389692 114136949 10635144 9559117 13800 12982559 70217 121264634 124069504 32530350 -15370244 16900 26444450 631311 114136949 93225811 6606063 24959388 19250 508247 194261 124069504 0.93000 0.07000 0.00000 1 0 9386538 9386538 133636394 47643607 85992787 52477259 32101097 20376162 878184 878184 116633671 ESTIMATED SELF-INSURANCE COSTS 6767293 ASSET RETIREMENT OBLIGATION 146119 DEFERRED COMPENSATION PLAN OBLIGATIONS 2436820 FMV OF SWAP OPTIONS 514184 DUE TO THIRD PARTY PAYORS 4599069 14463485 151249487 8680850 -8422762 258088 150991399 0 150991399 139432493 0 139432493 8068071 8068071 147500564 PART V, LINE 4: THE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS IS TO PROVIDE SCHOLARSHIPS BASED ON STUDENT NEEDS FROM THE INCOME OF THE DONOR-RESTRICTED ENDOWMENT FUNDS. THE PERMANENT ENDOWMENT IS USED FOR THE PURCHASE OF PROPERTY AND EQUIPMENT. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT -187,205. BAD DEBT EXPENSE -8,330,047. CONTRIBUTIONS TO RESTRICTED NET ASSETS -167,486. RENTAL EXPENSES 261,976. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 8,330,047. RENTAL EXPENSES -261,976. PART V, LINE 3A(I) CHARLES D INGERSOLL TRUST AND WILLIAM P INGERSOLL TRUST ARE ADMINISTERED BY MIDAMERICA NATIONAL BANK. 1 1 X 1 X 180.000000000000 1 X 1 1 1 0 1 0 2124885 2124885 0.01520 24963035 18995703 5967332 0.04280 27087920 18995703 8092217 0.05800 148711 1476 147235 0.00110 60000 60000 0.00040 102275 5500 96775 0.00070 310986 6976 304010 0.00220 27398906 19002679 8396227 0.06020 17500 17500 0.00010 1128 1128 0.00000 18628 18628 0.00010 0 3022896 22351497 24046624 -1695127 X 1 1 1 1 GRAHAM HOSPITAL ASSOCIATION 210 WEST WALNUT STREET CANTON IL 61520 WWW.GRAHAMHEALTHSYSTEM.ORG 0000869 X X GRAHAM HOSPITAL ASSOCIATION 1 0 0 1 X X X X X X X X X 24 1 0 0 1 X SEE PART V, SECTION C, LINE 7D 1 24 1 SEE PART V, SECTION C, LINE 7D 0 1 X 180.000000000000 300.000000000000 1 1 X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 GRAHAM HOSPITAL ASSOCIATION PART V, SECTION B, LINE 5: GRAHAM HEALTH SYSTEM CONDUCTED THE CHNA IN PARTNERSHIP WITH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (ICAHN), AN EXPERIENCED RURAL HEALTH AND PUBLIC HEALTH CONSULTANT. - TWO IN-PERSON FOCUS GROUPS WERE HELD IN SEPTEMBER 2025 WITH 33 PARTICIPANTS REPRESENTING HEALTHCARE PROVIDERS, PUBLIC HEALTH, COMMUNITY SERVICE ORGANIZATIONS, SCHOOLS, FAITH-BASED ORGANIZATIONS, LOCAL GOVERNMENT, AND OTHER COMMUNITY STAKEHOLDERS. - PARTICIPANTS INCLUDED INDIVIDUALS WITH DIRECT EXPERIENCE SERVING UNDERSERVED AND AT-RISK POPULATIONS. - QUANTITATIVE PUBLIC HEALTH DATA FROM FEDERAL, STATE, AND LOCAL SOURCES (INCLUDING CDC, CMS, IDPH, U.S. CENSUS, AND COUNTY HEALTH RANKINGS) WERE REVIEWED ALONGSIDE COMMUNITY INPUT. - FINDINGS FROM FOCUS GROUPS AND SECONDARY DATA ANALYSIS WERE PRESENTED TO A COMMUNITY PRIORITIZATION GROUP TO IDENTIFY AND RANK SIGNIFICANT HEALTH NEEDS. GRAHAM HOSPITAL ASSOCIATION PART V, SECTION B, LINE 7D: LINES 7A & 10A:HTTPS://WWW.GRAHAMHEALTHSYSTEM.ORG/COMMUNITY-RESOURCE-GUIDE/COMMUNITY-HEALTH-NEEDS-ASSESSMENT GRAHAM HOSPITAL ASSOCIATION PART V, SECTION B, LINE 11: ADDRESSING SIGNIFICANT COMMUNITY HEALTH NEEDS:GRAHAM HEALTH SYSTEM IDENTIFIED THREE SIGNIFICANT PRIORITY HEALTH NEEDS THROUGH ITS 2025 COMMUNITY HEALTH NEEDS ASSESSMENT: CLINICAL WORKFORCE DEVELOPMENT, AFFORDABLE HOUSING, AND COMPREHENSIVE MENTAL HEALTH SERVICES. THESE PRIORITIES WERE SELECTED BASED ON COMMUNITY INPUT, FOCUS GROUP FINDINGS, AND ANALYSIS OF QUANTITATIVE HEALTH AND SOCIAL DETERMINANT DATA. THE HOSPITAL HAS ADOPTED A MULTI-YEAR IMPLEMENTATION STRATEGY TO ADDRESS EACH NEED, LEVERAGING INTERNAL RESOURCES AND COMMUNITY PARTNERSHIPS. 1. CLINICAL WORKFORCE DEVELOPMENT:GRAHAM HEALTH SYSTEM IDENTIFIED CLINICAL WORKFORCE SHORTAGES AS A CRITICAL BARRIER TO ACCESS TO CARE, PARTICULARLY IN ITS RURAL SERVICE AREA. INDICATORS INCLUDE HIGH VACANCY RATES, LONG TIME-TO-FILL POSITIONS, AN AGING WORKFORCE NEARING RETIREMENT, AND INCREASED RELIANCE ON CONTRACT AND TRAVEL STAFF.TO ADDRESS THIS NEED, GRAHAM HEALTH SYSTEM IS ACTIVELY PARTNERING WITH LOCAL AND REGIONAL COLLEGES OF NURSING, COMMUNITY COLLEGES, TRADE SCHOOLS, AND SCHOOL DISTRICTS TO SUPPORT THE DEVELOPMENT OF FUTURE CLINICAL AND NON-CLINICAL HEALTHCARE WORKERS. THE HOSPITAL CONTINUES TO PROVIDE FINANCIAL SUPPORT THROUGH CAREER AND TUITION ASSISTANCE PROGRAMS AND HAS COMMITTED ENDOWMENT FUNDING TO SUPPORT WORKFORCE DEVELOPMENT INITIATIVES.THESE ACTIONS ARE INTENDED TO STABILIZE STAFFING, ENSURE CONTINUED ACCESS TO CARE, PROMOTE HEALTH EQUITY IN UNDERSERVED RURAL COMMUNITIES, AND REDUCE BURNOUT AND TURNOVER THAT CAN NEGATIVELY IMPACT PATIENT SAFETY AND QUALITY OF CARE. 2. AFFORDABLE HOUSING:SAFE AND AFFORDABLE HOUSING WAS IDENTIFIED AS A MAJOR SOCIAL DETERMINANT OF HEALTH AFFECTING BOTH COMMUNITY MEMBERS AND THE HOSPITAL'S ABILITY TO RECRUIT AND RETAIN STAFF. FULTON COUNTY HAS LOWER AVERAGE HOUSEHOLD INCOME THAN STATE AND NATIONAL AVERAGES, ELEVATED POVERTY RATES, OLDER HOUSING STOCK, AND LIMITED AFFORDABLE HOUSING OPTIONS.GRAHAM HEALTH SYSTEM IS ADDRESSING THIS NEED BY PROVIDING DIRECT FINANCIAL ASSISTANCE TO SUPPORT EMPLOYEE HOUSING AND SUBSIDIZED APARTMENT OPTIONS. THE HOSPITAL IS ALSO COLLABORATING WITH THE CITY OF CANTON AND PRIVATE PARTNERS TO SUPPORT SUBDIVISION DEVELOPMENT OR EXPANSION AIMED AT INCREASING HOUSING AVAILABILITY.THESE EFFORTS ARE EXPECTED TO IMPROVE WORKFORCE RECRUITMENT AND RETENTION, REDUCE HOUSING-RELATED FINANCIAL STRESS, AND SUPPORT IMPROVED PHYSICAL AND MENTAL HEALTH OUTCOMES BY INCREASING HOUSING STABILITY. WHILE THE HOSPITAL DOES NOT DIRECTLY DEVELOP OR MANAGE HOUSING PROJECTS, IT PLAYS A CONVENING AND SUPPORTIVE ROLE CONSISTENT WITH ITS MISSION AND AVAILABLE RESOURCES. 3. COMPREHENSIVE MENTAL HEALTH SERVICES:ACCESS TO MENTAL HEALTH AND SUBSTANCE USE SERVICES WAS IDENTIFIED AS THE MOST SIGNIFICANT HEALTH CONCERN BY COMMUNITY PARTICIPANTS. ALTHOUGH ACCESS HAS IMPROVED SINCE THE PRIOR CHNA, PROVIDER AVAILABILITY REMAINS WELL BELOW STATE AND NATIONAL LEVELS, AND RATES OF DEPRESSION AND BEHAVIORAL HEALTH NEEDS REMAIN ELEVATED.GRAHAM HEALTH SYSTEM IS ADDRESSING THIS NEED BY CONTINUING TO EXPAND ITS BEHAVIORAL HEALTH WORKFORCE, INCLUDING THE ADDITION OF PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONERS (PMHNPS), LICENSED CLINICAL SOCIAL WORKERS (LCSWS), AND LICENSED CLINICAL PROFESSIONAL COUNSELORS (LCPCS). THE HOSPITAL COLLABORATES WITH NORTH CENTRAL BEHAVIORAL HEALTH, FULTON COUNTY HEALTH DEPARTMENT, SCHOOLS, AND OTHER COMMUNITY PARTNERS TO PROVIDE CRISIS INTERVENTION, SCHOOL-BASED MENTAL HEALTH SERVICES, EMERGENCY DEPARTMENT SUPPORT, AND CARE COORDINATION.ADDITIONAL STRATEGIES INCLUDE EXPANDED TELEHEALTH OPTIONS, IMPROVED REFERRAL NETWORKS FOR INPATIENT AND SPECIALTY CARE, AND COMMUNITY EDUCATION REGARDING AVAILABLE MENTAL HEALTH RESOURCES. THESE ACTIONS ARE DESIGNED TO IMPROVE ACCESS, REDUCE EMERGENCY DEPARTMENT UTILIZATION FOR BEHAVIORAL HEALTH CRISES, AND SUPPORT EARLIER INTERVENTION. NEEDS NOT BEING DIRECTLY ADDRESSED:THE CHNA IDENTIFIED ADDITIONAL COMMUNITY CONCERNS SUCH AS HOMELESSNESS, FOOD INSECURITY, AND EMPLOYMENT OPPORTUNITIES. GRAHAM HEALTH SYSTEM RECOGNIZES THESE AS IMPORTANT ISSUES BUT DOES NOT DIRECTLY ADDRESS THEM THROUGH HOSPITAL-LED PROGRAMS DUE TO LIMITATIONS IN SCOPE, EXPERTISE, AND RESOURCES. INSTEAD, THE HOSPITAL SUPPORTS COLLABORATIVE, COMMUNITY-WIDE APPROACHES BY PARTNERING WITH ORGANIZATIONS SUCH AS LOCAL GOVERNMENTS, UNITED WAY, SALVATION ARMY, SCHOOLS, AND SOCIAL SERVICE AGENCIES. THE HOSPITAL'S ROLE IS PRIMARILY SUPPORTIVE AND FACILITATIVE RATHER THAN OPERATIONAL FOR THESE BROADER SOCIAL NEEDS. GRAHAM HOSPITAL ASSOCIATION PART V, SECTION B, LINE 16J: THE FAP AND FAP SUMMARY ARE ONLY PROVIDED IN ENGLISH. GRAHAM HOSPITAL ASSOCIATION IS NOT REQUIRED TO PROVIDE THE FAP AND FAP SUMMARY IN LANGUAGES THAT ARE SPOKEN BY LEP POPULATIONS. PART V, LINE 16A-C: HTTPS://WWW.GRAHAMHEALTHSYSTEM.ORG/PATIENT-VISITOR-RESOURCES/BILLING-FINANCIAL-ASSISTANCE 15 1 - GRAHAM MEDICAL GROUP 180 SOUTH MAIN STREET CANTON IL 61520 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 2 - GRAHAM HOSPITAL EXTENDED CARE UNIT 210 WEST WALNUT STREET CANTON IL 61520 SKILLED NURSING & LONG TERM CARE UNITS 3 - GHA HOME MEDICAL EQUIPMENT STORE 101 SOUTH MAIN STREET CANTON IL 61520 HOME MEDICAL EQUIPMENT RETAIL STORE 4 - GRAHAM MEDICAL GROUP - LEWISTOWN 408 SOUTH MAIN STREET LEWISTOWN IL 61542 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 5 - GRAHAM MEDICAL GROUP - CENTER FOR AMBULA 2028 NORTH SEMINARY STREET GALESBURG IL 61401 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 6 - GRAHAM MEDICAL GROUP - CANTON CONVENIENT 126 NORTH 5TH AVENUE CANTON IL 61520 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 7 - GRAHAM MEDICAL GROUP - MACOMB 1630 E JACKSON MACOMB IL 61455 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 8 - GRAHAM MEDICAL GROUP - FARMINGTON 601 EAST FORT STREET FARMINGTON IL 61531 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 9 - GRAHAM CARDIAC REHABILITATION 235 WEST WALNUT CANTON IL 61520 CARDIAC REHAB SERVICES 10 - GRAHAM MEDICAL GROUP - ELMWOOD 1024 NORTH MAGNOLIA STREET ELMWOOD IL 61529 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 11 - GRAHAM MEDICAL GROUP - GALESBURG B 530 N SEMINARY ST GALESBURG IL 61401 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 12 - GRAHAM MEDICAL GROUP - WILLIAMSFIELD 120 EAST GALE STREET WILLIAMSFIELD IL 61489 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 13 - GRAHAM MEDICAL GROUP - GALESBURG SOUTH 455 EAST 3RD STREET GALESBURG IL 61401 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 14 - GRAHAM MEDICAL GROUP - GLASFORD 201 EAST MAIN STREET GLASFORD IL 61533 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 15 - GRAHAM HOSPITAL PHARMACY 211 WEST WALNUT STREET CANTON IL 61521 PHARMACY FOR PATIENTS & RETAIL FOR EMPLOYEES PART I, LINE 7: THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDING BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 8,330,047. PART II, COMMUNITY BUILDING ACTIVITIES: A DONATION OF $17,500 WAS MADE TO THE SPOON RIVER PARTNERSHIP FOR ECONOMIC DEVELOPMENT. THIS ORGANIZATION FOCUSES ON BUILDING IN THE LOCAL COMMUNITY THROUGH ECONOMIC GROWTH, WHICH IMPROVES OPPORTUNITIES FOR JOBS AND INSURANCE WITHIN THE COMMUNITY. THIS DONATION HELPED SUPPORT THE LOCAL ECONOMY BY HELPING A SMALL BUSINESS. A DONATION OF $10,000 WAS MADE TO THE KNOX COUNTY AREA PARTNERSHIP FOR ECONOMIC DEVELOPMENT. THIS ORGANIZATION FOCUSES ON BUILDING IN THE LOCAL COMMUNITY THROUGH ECONOMIC GROWTH, WHICH IMPROVES OPPORTUNITIES FOR JOBS AND INSURANCE WITHIN THE COMMUNITY. THIS DONATION HELPED SUPPORT THE LOCAL ECONOMY BY HELPING A SMALL BUSINESS. A DONATION OF $10,000 WAS MADE TO THE UNIVERSITY OF ILLINOIS FAMILY MEDICINE RURAL STUDENT PHYSICIAN PROGRAM. THIS DONATION WILL HELP GIVE OPPORTUNITY TO PHYSICIANS WHO WANT TO WORK IN RURAL HOSPITALS LIKE GRAHAM. A MONTHLY DONATION OF $5,000 WAS MADE TO THE HEALTH AND WELLNESS CONNECTION OF FULTON COUNTY. THIS CLINIC IS CONSISTENT WITH AND SUPPORTIVE OF GRAHAM'S MISSION OF PROVIDING CHARITY CARE AND HEALTH IMPROVEMENT SERVICES TO THOSE IN NEED. A DONATION OF $2,877.23 WAS MADE TO THE ELMWOOD COMMUNITY FOUNDATION. THIS DONATION HELPED WITH THE FUNDING FOR THE WELLNESS CENTER AND YMCA. A DONATION OF $50,000 WAS MADE TO THE CARL SANDBURG FOUNDATION. THIS DONATION WILL HELP PROVIDE SCHOLARSHIP MONEY FOR STUDENT'S PURSUING A CAREER IN HEALTHCARE. A DONATION OF $5,000 WAS MADE TO THE CANTON FAMILY YMCA. THIS DONATION HELPED PROVIDE FUNDING FOR A SECURITY CAMERA PROJECT. A DONATION OF $5,000 WAS MADE TO THE GALESBURG DISCOVERY DEPOT CHILDREN'S MUSEUM. A DONATION FOR $1,000 WAS MADE TO THE SPOON RIVER CEO PROGRAM, WHICH PROVIDES HIGH SCHOOL STUDENTS IN FULTON COUNTY HANDS-ON BUSINESS EXPERIENCE AND MENTORSHIP PROGRAMS.CURRENT YEAR:CARL SANDBURG COLLEGE FOUNDATION - $50,000UNIVERSITY OF IL - $10,000HEALTH AND WELLNESS CONNECTION OF FULTON COUNTY - $60,000 ($60,000 340 B)ELMWOOD COMMUNITY FOUNDATION - $2,877.23SPOON RIVER PARTNERSHIP - $17,500; CANTON FAMILY YMCA $5,000; SPOON RIVER CEO $1,000KNOX COUNTY PARTNERSHIP FOR ECONOMIC DEVELOPMENT - $10,000GALESBURG DISCOVERY DEPOT - $5,000 PART III, LINE 2: PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. THE HOSPITAL DOES NOT CHARGE INTEREST ON RECEIVABLES. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED PAST DUE WHEN AN AMOUNT IS PAST DUE ACCORDING TO THE PAYOR'S AGREED-UPON TERMS. PATIENT RECEIVABLES ARE WRITTEN OFF AS BAD DEBT EXPENSE BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. PART III, LINE 8: THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFITS EXPENSE BECAUSE PROVIDING MEDICAL CARE AT A SHORTFALL IMPACTS THE HOSPITAL'S OPERATIONS AND GROWTH. THE CARE IS PROVIDED BECAUSE THERE IS A NEED AND A DESIRE TO PROVIDE MEDICAL CARE IN THIS COMMUNITY.THE COSTING METHOD USED ABOVE FOR IRS FORM 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES AND THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: THE COLLECTION POLICY DESCRIBES THE STEPS TAKEN TO COLLECT SELF PAY BALANCES OUTSTANDING INCLUDING NOTIFICATIONS TO THE PATIENT THROUGH STATEMENTS, FOLLOW-UP PHONE CALLS, VERIFICATION OF INSURANCE ELIGIBILITY AND ULTIMATELY AT WHAT POINT THE UNPAID BALANCE IS WRITTEN OFF AS UNCOLLECTIBLE. IN PRACTICE, WHEN A PATIENT IS IDENTIFIED AS QUALIFYING FOR FINANCIAL ASSISTANCE, A SEARCH OF ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE IS DONE AND THOSE ACCOUNTS ARE REPROCESSED. PART VI, LINE 2: IN ADDITION TO THE CHNA, A PHYSICIAN NEEDS ASSESSMENT IS DONE TO IDENTIFY NEEDS FOR SPECIFIC SPECIALTY SERVICES BASED ON THE SIZE OF THE CATCHMENT AREA. DATA IS ANALYZED TO IDENTIFY SERVICES THAT ARE PROVIDED TO COUNTY RESIDENTS BY OTHER FACILITIES THAT WOULD BE MORE ACCESSIBLE TO PATIENTS IF PROVIDED AT GRAHAM HEALTH SYSTEM. INPUT IS GAINED FROM PHYSICIANS AND OTHER HEALTHCARE WORKERS PROVIDING SERVICE IN THE AREA ALONG WITH INPUT PROVIDED BY THE BOARD OF DIRECTORS WHO REPRESENT THE COMMUNITY AND PROVIDE A COMMUNICATION LINK BETWEEN GRAHAM HEALTH SYSTEM AND THE COMMUNITIES WE SERVE. PART VI, LINE 3: THE CHARITY CARE/FINANCIAL ASSISTANCE PROGRAM IS MADE AVAILABLE TO PATIENTS UPON REGISTRATION. FINANCIAL ASSISTANCE APPLICATIONS ARE AVAILABLE TO PATIENTS UPON REGISTRATION OR TO ANYONE REQUESTING THE APPLICATION. THE APPLICATIONS ARE ALSO AVAILABLE ON GRAHAM HEALTH SYSTEM'S WEBSITE AT HTTPS://WWW.GRAHAMHEALTHSYSTEM.ORG/PATIENT-VISITOR-RESOURCES/BILLING-FINANCIAL-ASSISTANCE. APPOINTMENTS MAY BE MADE WITH A FINANCIAL ADVOCATE IF ASSISTANCE IS NEEDED. MEDICAID SERVICES APPLICATION ASSISTANCE IS AVAILABLE. PART VI, LINE 4: THE GRAHAM HEALTH SYSTEM PRIMARY CATCHMENT AREA IS LOCATED PRIMARILY IN FULTON COUNTY, KNOX COUNTY, MCDONOUGH COUNTY, MASON COUNTY AND PEORIA COUNTY AND INCLUDES ALL OR PORTIONS OF THE TOWNS OF ABINGDON, ASTORIA, AVON, BANNER, BRYANT, BUSHNELL, CANTON, CUBA, DUNFERMLINE, ELLISVILLE, ELMWOOD, FAIRVIEW, FARMINGTON, FULTON, GALESBURG, GLASFORD, HAVANA, IPAVA, KNOX, KNOXVILLE, LEWISTOWN, LIVERPOOL, LONDON MILLS, MACOMB, MARIETTA, MASON, MCDONOUGH, NORRIS, PEORIA, SAINT DAVID, SMITHFIELD, TABLE GROVE, VERMONT, WILLIAMSFIELD, YATES CITY. THE RACE AND ETHNICITY MAKEUP ARE TYPICAL OF RURAL ILLINOIS BASED ON US CENSUS BUREAU DATA AND INCLUDES 91.7% WHITE, 3.3% BLACK, AND 5.0% OTHER. ACCORDING TO THE US CENSUS BUREAU MEDIAN HOUSEHOLD INCOME WAS $53,441. FULTON COUNTY'S UNEMPLOYMENT RATE WAS 4.8%. PART VI, LINE 5: DURING EACH FISCAL YEAR VARIOUS COMMUNITY HEALTH IMPROVEMENT SERVICES ARE HELD AT A FACILITY OWNED BY GRAHAM HEALTH SYSTEM OR ITS EMPLOYEES ASSIST WITH SERVICES HELD AT VARIOUS LOCATIONS WITHIN THE CATCHMENT AREA. EXAMPLES OF THESE ACTIVITIES INCLUDE ANNUAL SPONSORSHIP OF A COMMUNITY TALK AND DINNER THAT IS FREE TO THE PUBLIC COVERING HEALTH TOPICS; FREE BLOOD PRESSURE CLINICS OFFERED ON A REGULAR BASIS; PROVIDING SPACE FOR OPERATION OF AN OUTPATIENT CLINIC THAT PROVIDES FREE HEALTHCARE SERVICES TO FULTON COUNTY RESIDENTS. CLINIC SERVICES ARE PROVIDED BY COMMUNITY VOLUNTEERS. (DUE TO COVID, THERE WAS NO EDUCATIONAL TALK AND DINNER; AND THE BLOOD PRESSURE CLINICS WERE STOPPED.) PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES IL 1 FULTON COUNTY HEALTH AND WELLNESS CLINIC 103A S MAIN STREET CANTON IL 61520 272753264 501(C)(3) 60000 0 PROVIDE SUPPORT TO ORGANIZATION UNIVERSITY OF ILLINOIS FOUNDATION ONE ILLINI DRIVE ATTN KIM DEETS PEORIA IL 61605 376006007 501(C)(3) 10000 0 PROVIDE SUPPORT TO ORGANIZATION SPOON RIVER PARTNERSHIP FOR ECONOMIC DEVELOPMENT 48 N MAIN ST CANTON IL 61520 050633175 501(C)(3) 17500 0 PROVIDE SUPPORT TO ORGANIZATION CARL SANDBURG FOUNDATION 2400 TOM L WILSON BLVD GALESBURG IL 61401 370896983 501(C)(3) 50000 0 PROVIDE SUPPORT TO ORGANIZATION KNOX COUNTY AREA PARTNERSHIP FOR ECONOMIC DEVELOPMENT 200 E MAIN ST SUITE 200 GALESBURG IL 61401 371356170 501(C)(3) 10000 0 PROVIDE SUPPORT TO ORGANIZATION 5 0 PART I, LINE 2: ALL FUNDS DONATED BY GRAHAM HEALTH SYSTEM TO DESERVING ORGANIZATIONS AND INDIVIDUALS ARE REVIEWED AND APPROVED BY THE PRESIDENT & CEO. FUNDS ARE DONATED TO ORGANIZATIONS AND INDIVIDUALS THAT ALIGN WITH GRAHAM HEALTH SYSTEM'S PRIORITIES TO PROMOTE HEALTH AND WELL-BEING, EDUCATION, AND ECONOMIC DEVELOPMENT WITHIN THE COMMUNITIES WE SERVE. X X 0 1 0 0 0 0 0 0 0 ALYSSA CRAWFORD MD OB-GYN 731630 0 0 0 133750 0 24000 0 75208 0 964588 0 0 0 BRETT BARNHART MD ORTHOPEDIC SURGEON 633994 0 17620 0 168161 0 34350 0 75483 0 929608 0 0 0 BRENT PARRY DPM PODIATRIST 407599 0 0 0 175906 0 34350 0 70021 0 687876 0 0 0 DAVID CAO MD UROLOGIST 548839 0 0 0 45655 0 31298 0 26423 0 652215 0 0 0 JAMES QUEENAN III DO ORTHOPEDIC SURGEON 473337 0 9577 0 121133 0 34350 0 0 0 638397 0 0 0 ROBERT SENNEFF PRESIDENT/CEO 487260 0 0 0 77990 0 10350 0 27345 0 602945 0 0 0 JULIE REEDER VP FINANCE/CFO 226438 0 72202 0 107415 0 37730 0 49160 0 492945 0 0 0 HOLLY HENLINE VP ANCILLARY/CCO 191356 0 64832 0 105015 0 34936 0 47736 0 443875 0 0 0 ALLISON SOURS PRESIDENT/CEO 254701 0 60529 0 41168 0 40028 0 24934 0 421360 0 0 0 MICHELLE DALY VP CLINIC SERVICES 187882 0 58313 0 27863 0 22114 0 50463 0 346635 0 0 0 TERESA MCCONKEY VP PATIENT SERVICES 186324 0 51660 0 38364 0 30608 0 22486 0 329442 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) PLAN IN 2024 SPONSORED BY GRAHAM HOSPITAL ASSOCIATION: JULIE REEDER - $27,380.08, ALLISON SOURS - $29,678.56, TERESA MCCONKEY - $22,352.72, MICHELLE DALY - $22,113.52, HOLLY HENLINE - $24,585.60, ALYSSA CRAWFORD - $24,000.08, BRETT BARNHART - $24,000.08, JAMES QUEENAN III - $24,000.08, DAVID CAO - $24,000.08, BRENT PARRY - $24,000.08. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GRAHAM HOSPITAL ASSOCIATION ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2024. THIS INFORMATION IS INCLUDED IN DEFERRED COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. A CITY OF CANTON IL 376000876 2019-09-26 44500000 REFUND PRIOR ISSUE AND FUND BUILDING PROJECTS. 0 0 0 B CITY OF CANTON IL 376000876 2020-06-18 17000000 FUND BUILDING PROJECTS AND EQUIPMENT 0 0 0 C CITY OF CANTON IL 376000876 2023-06-21 12000000 FUND BUILDING PROJECTS AND EQUIPMENT 0 0 0 D CITY OF CANTON IL 376000876 2024-05-15 11322000 FUND BUILDING PROJECTS AND EQUIPMENT 0 0 0 A 9144999 44500000 44500000 2017 1 0 1 1 B 1390000 17000000 207600 16792400 2022 0 0 1 1 C 140000 12000000 182467 11817533 2024 0 0 1 1 D 11322000 143098 8466000 2712902 0 0 0 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 D 0 0 0 0 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 1 0 0 0 1 D 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 D 1 FORM 990, PART III, LINE 2 GRAHAM ADDED TWO NEW CLINIC LOCATIONS IN GALESBURG. FORM 990, PART VI, SECTION B, LINE 11B THE PREPARED FORM 990 IS REVIEWED BY THE BOARD OF TRUSTEES, PRESIDENT AND CEO, CFO, DIRECTOR OF ACCOUNTING, VICE PRESIDENT OF ACCOUNTING AND SUPPORT SERVICES AND SENIOR ACCOUNTANT BEFORE FILING WITH THE IRS. BEFORE FILING, THE VICE PRESIDENT OF ACCOUNTING AND SUPPORT SERVICES PRESENTS THE FORM 990 TO THE ORGANIZATION'S BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C GRAHAM HOSPITAL REQUIRES THAT ALL TRUSTEES AND ADMINISTRATIVE OFFICERS KEEP THE BOARD OF TRUSTEES INFORMED OF POTENTIAL CONFLICTS OF INTEREST, AND THAT EACH PERSON MAKE AN ANNUAL DECLARATION OF SUCH INTEREST. A CONFLICT OF INTEREST MIGHT EXIST WHEN ORGANIZATIONS IN WHICH TRUSTEES OR OFFICERS HAVE A MATERIAL FINANCIAL INTEREST ARE EITHER DOING BUSINESS WITH, COMPETING WITH, OR HAVE A FINANCIAL INTEREST IN GRAHAM HOSPITAL. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE ADMINISTRATIVE OFFICERS IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. THE ORGANIZATION UTILIZES AN OUTSIDE FIRM, SULLIVAN, COTTER AND ASSOCIATES, INC. TO PROVIDE OUTSIDE EXECUTIVE COMPENSATION INFORMATION. THE LAST REVIEW WAS COMPLETED IN JANUARY 2020. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G OUTSIDE CONTRACTORS: PROGRAM SERVICE EXPENSES 1,389,453. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,389,453. PHYSICIANS: PROGRAM SERVICE EXPENSES 13,052,481. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,052,481. SERVICE AGREEMENT: PROGRAM SERVICE EXPENSES 3,021,663. MANAGEMENT AND GENERAL EXPENSES 286,298. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,307,961. PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 97,779. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 97,779. REPAIR AND MAINTENANCE: PROGRAM SERVICE EXPENSES 60,661. MANAGEMENT AND GENERAL EXPENSES 1,748. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 62,409. OTHER FEES: PROGRAM SERVICE EXPENSES 4,570,651. MANAGEMENT AND GENERAL EXPENSES 810,555. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,381,206. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 322,419. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 322,419. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 386,151. CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS 601,679. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT -187,205. CONTRIBUTIONS TO RESTRICTED NET ASSETS -167,486.