2024-02-29T09:43:31-06:00 2023-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-07-01 370673506 GRAHAM HOSPITAL ASSOCIATION GRAH 3096475240 210 WEST WALNUT CANTON IL 61520 ROBERT SENNEFF PRESIDENT AND CEO 3096475240 2024-02-24 1 ROBERT SENNEFF 999009999 1 MICHAEL J PETERSON CPA P01833529 2187224705 2024-02-24 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ROBERT SENNEFF 210 WEST WALNUT CANTON IL 61520 238322033 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. 13 12 892 79 295346 0 5012094 3014469 102889786 118640792 6082543 3752880 115136 156038 114099559 125564179 1097370 83525 0 0 54713831 63057424 0 0 0 49004493 54669082 104815694 117810031 9283865 7754148 232591256 261203159 78082725 91309039 154508531 169894120 X TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES, IN A RESPONSIBLE AND CHARITABLE MANNER, TO THE PEOPLE AND COMMUNITIES WE SERVE. 0 1 45300251 83525 55916548 GRAHAM HOSPITAL IS A PROVIDER OF HEALTHCARE SERVICES IN FULTON, KNOX, MCDONOUGH, MASON AND PEORIA COUNTY. DURING THIS REPORTING PERIOD 1,906 ADULTS AND CHILDREN WERE ADMITTED AND 225 BABIES WERE BORN. THEY RECEIVED INPATIENT SERVICES IN THE ACUTE CARE FACILITY. 188 PATIENTS WERE ADMITTED FOR 7,179 DAYS OF SERVICE IN THE EXTENDED CARE FACILITY. 110,349 OUTPATIENT SERVICES WERE PROVIDED. 24706151 0 30496138 SURGICAL SERVICES - THE HOSPITAL PERFORMED 512 INPATIENT SURGERIES AND 4,270 OUTPATIENT SURGERIES IN FISCAL YEAR 2023. 16906215 0 20868256 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 128,642 OFFICE VISITS AND 11,801 NURSING HOME AND HOSPITAL VISITS. 8963802 0 11064504 ED PROGRAM - THE HOSPITAL OPERATES A 24 HOUR EMERGENCY DEPARTMENT WHICH HAD 13,337 PATIENTS REGISTERED TO THE EMERGENCY DEPARTMENT IN FISCAL YEAR 2023. 8963802 0 11064504 95876419 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 1 0 0 0 0 0 0 0 0 1 131 0 892 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X ROBERT SENNEFF 3096475240 210 WEST WALNUT CANTON IL 61520 ROBERT SENNEFF PRESIDENT/CEO 40.00 X X 664133 0 110877 MIKE RENNER CHAIRMAN 2.00 X X 0 0 0 KEVIN MEADE 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 ROBERT BOBELL OD TRUSTEE 2.00 X 0 0 0 PAULA GRIGSBY TRUSTEE 2.00 X 0 0 0 ANNE HOLLIS TRUSTEE 2.00 X 0 0 0 KENNETH KROCK MD 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 TERRY MOSS TRUSTEE 2.00 X 0 0 0 JULIE REEDER VP FINANCE/CFO 40.00 X 366940 0 84458 HOLLY HENLINE VP ANCILLARY/CCO 40.00 X 336639 0 79179 TERESA MCCONKEY VP PATIENT SERVICES 40.00 X 315452 0 52689 ALLISON SOURS VP QUALITY 40.00 X 282293 0 56510 MICHELLE DALY VP CLINIC SERVICES 40.00 X 248312 0 53701 BRETT BARNHART MD PHYSICIAN 40.00 X 733494 0 107392 ALYSSA CRAWFORD MD PHYSICIAN 40.00 X 731005 0 76701 BRENT PARRY DPM PODIATRIST 40.00 X 647193 0 101695 JAMES QUEENAN III DO ANESTHETIST 40.00 X 513108 0 32700 DWAYNE BERNARD MD MEDICAL DIRECTOR 40.00 X 501857 0 60775 5340426 0 816677 58 0 1 0 COLEMAN MEDICAL ASSOCIATES LTD 180 SOUTH MAIN STREET CANTON IL 61520 PHYSICIAN SERVICES 7956907 PJ HOERR INC 107 W COMMERCE PEORIA IL 61604 CONSTRUCTION 2215009 FORGOTTONIA LLC 2907 W WARDCLIFFE DRIVE PEORIA IL 61604 PHYSICIAN SERVICES 693770 PARK PLACE INTERNATIONAL 7227 CHAGRIN ROAD CHAGRIN FALLS OH 44023 CLOUD CARE SUPPORT SERVICES 524015 AB STAFFING SOLUTIONS 3451 S MERCY ROAD STE 102 GILBERT AZ 85297 STAFFING SERVICES 462225 39 250035 2764434 2675000 3014469 PATIENT SERVICE REVENUE 621990 110336139 110336139 340(B) REVENUE 621990 6651061 6651061 SCHOOL OF NURSING 621990 330673 330673 LABORATORY 621500 228148 228148 1094771 1027573 67198 118640792 2348956 2348956 424080 268042 156038 156038 156038 113861331 32405 112489382 430 1371949 31975 1403924 1403924 125564179 118345446 295346 3908918 X 83525 83525 2651184 523362 2127822 47680937 38894667 8786270 792506 783771 8735 8658409 6820684 1837725 3274388 2531223 743165 191406 191406 30261 30261 60783 60783 26961 26961 19199598 18093351 1106247 58099 18122 39977 471836 210102 261734 590048 19748 570300 1597422 1218452 378970 46651 6823 39828 5542 5542 2157040 1916469 240571 4858455 4303113 555342 1635947 1635947 MEDICAL SUPPLIES 12549511 12537842 11669 BAD DEBT EXPENSE 5810232 5810232 MEDICAID ASSESSMENT 2984628 2984628 DIETARY 802728 781872 20856 1591934 1317519 274415 117810031 95876419 21933612 0 4643965 636391 3572235 3222309 11953658 12488554 3303239 3702980 1937817 2132951 1758665 1720833 178261746 79070834 87069377 99190912 106499854 125165743 8813444 9061490 3039002 3880996 232591256 261203159 10939245 12334630 128490 0 56296798 66355450 842193 445589 9875999 12173370 78082725 91309039 X 145695087 160832630 8813444 9061490 154508531 169894120 232591256 261203159 X 7754148 5965301 1666140 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 26961 26961 0 PART II-B, LINE 1: LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED: 37% OF MEMBERSHIP DUES PAID TO THE ILLINOIS HOSPITAL ASSOCIATION, OR $16,983; 37% OF MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, OR $8,938; 35.08% OF MEMBERSHIP DUES PAID TO THE ILLINOIS HEALTH CARE ASSOCIATION, OR $1,040. 114136949 10635144 9559117 13800 12982559 70217 121264634 124069504 32530350 -15370244 16900 26444450 631311 114136949 93225811 6606063 24959388 19250 508247 194261 124069504 94502686 167929 -1066495 7200 114228 256881 93225811 91454034 860760 3919679 12300 256453 1463034 94502686 0.92530 0.07260 0.00210 1 0 9074236 9074236 108397037 42258559 66138478 54160575 36812275 17348300 6629898 6629898 99190912 ESTIMATED SELF-INSURANCE COSTS 4177145 ASSET RETIREMENT OBLIGATION 266162 DEFERRED COMPENSATION PLAN OBLIGATIONS 1611428 FMV OF SWAP OPTIONS 519305 DUE TO THIRD PARTY PAYORS 5599330 12173370 126955086 5965301 -4574394 1390907 125564179 0 125564179 112267841 0 112267841 5542190 5542190 117810031 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 967,796. RENTAL EXPENSES 268,042. BAD DEBT EXPENSE -5,810,232. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 5,810,232. RENTAL EXPENSES -268,042. PART V, LINE 3A(I) CHARLES D INGERSOLL TRUST AND WILLIAM P INGERSOLL TRUST ARE ADMINISTERED BY MIDAMERICA NATIONAL BANK AND J.P. MORGAN 1 1 X 1 X 180.000000000000 1 X 1 1 0 1 0 1144382 1144382 0.01020 25376655 19574565 5802090 0.05180 26521037 19574565 6946472 0.06200 82738 3102 79636 0.00070 10515 10515 0.00010 208353 1200 207153 0.00180 301606 4302 297304 0.00260 26822643 19578867 7243776 0.06460 5000 5000 0.00000 3288 3288 0.00000 8288 8288 0.00000 0 2121573 0 19617506 22317530 -2700024 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 21 1 0 0 1 X SEE PART V, SECTION C, LINE 7D 1 21 1 SEE PART V, SECTION C, LINE 7D 0 1 X 180.000000000000 300.000000000000 X 1 1 X X 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: FOCUS GROUP ONE - HEALTHCARE PROVIDERS AND COMMUNITY LEADERS:TRYGVE MEADE, ATTORNEY/PROPRIETOR, MEADE LAW OFFICEJEFF STANDARD, FULTON COUNTY SHERIFFCARLA BOBELL, EXECUTIVE DIRECTOR, CANTON AREA CHAMBER OF COMMERCEJED RHOADES, REAL ESTATE & AUCTION SERVICESKATHY LOCK, PRESIDENT, GRAHAM HOSPITAL SERVICE LEAGUEJEFF UTSINGER, ASSISTANT SUPERINTENDENT, CANTON UNION SCHOOL DISTRICTJAY SHEPLER, ST. MARY'S FOOD PANTRY REPRESENTATIVETHE REV. KEVIN VANTINE, COVENANT COMMUNITY FELLOWSHIP, CANTONKENT MCDOWELL, MAYOR, CITY OF CANTONDIANA PAVLEY-ROCK, CANTON CITY CLERKFOCUS GROUP TWO - MEDICAL PROFESSIONALS AND PARTNERS:LIZ UTSINGER, HEALTH PROFESSIONAL/HEALTH EDUCATOR, FULTON COUNTY HEALTH DEPARTMENTKATIE LYNN, ADMINISTRATOR, FULTON COUNTY HEALTH DEPARTMENTMISSY KOLOWSKI, ADMINISTRATOR, HEALTH & WELLNESS CONNECTION OF FULTON COUNTYERIN ANDERSON, CASE MANAGER, GRAHAM HEALTH SYSTEMANDY FRENCH, SENIOR DIRECTOR, CARDIAC PULMONARY REHAB & WELLNESSBECKY SHERWOOD, DIRECTOR, GRAHAM SCHOOL OF NURSINGWESLEY KIMBROUGH, SUPERVISOR, COMMUNITY CARE SERVICESKELLI KELLEY, COORDINATOR, COMMUNITY CARE SERVICESRACHEL BUNDY, PHARMACIST, GRAHAM HEALTH SYSTEM 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: 1. AVAILABILITY OF MENTAL HEALTH SERVICES, INCLUDING:- INCREASING ACCESS TO LOCAL TREATMENT FOR MENTAL HEALTH SERVICES OF ALL TYPES FOR YOUTH AND ADULTS- IMPROVING AND INCREASING ACCESS TO LONG-TERM MENTAL HEALTHCARE OUTSIDE THE COMMUNITY, INCLUDING CARE FOR SUBSTANCE USE DISORDERS- PROVIDING COMMUNITY EDUCATION ABOUT AVAILABLE LOCAL MENTAL HEALTH SERVICES DURING FY2023, BEHAVIORAL HEALTH AMBER WOLD, PMHNP AND ALI KERANS, PMHNP CONTINUED TO SEE PATIENTS IN CANTON AND EXPANDED SERVICES TO MACOMB, ELMWOOD, FARMINGTON, & LEWISTOWN. AN LCSW WAS ALSO ADDED TO THE TEAM WITH PLANS TO ADD AN LCPC IN EARLY 2024 TO MEET THE NEEDS OF THE POPULATION.2. IMPROVE HEALTH EDUCATION AND HEALTH SERVICES IN SOME LOCAL SCHOOLS THAT ARE NOT CURRENTLY SUFFICIENTLY STAFFED TO FULLY MEET THESE NEEDS. ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED:- GRAHAM HEALTH SYSTEM WILL COLLABORATE WITH CANTON UNION SCHOOL DISTRICT TO DETERMINE NEEDS AND DEVELOP SOLUTIONS BASED ON NEEDS OF THE SCHOOLS PROVIDED EPI-PEN TRAINING TO SCHOOL DISTRICT STAFF FOR CANTON SCHOOL DISTRICT AUGUST 2023- GRAHAM HEALTH SYSTEM WILL FACILITATE INFORMATION-SHARING OPPORTUNITIES FOR SCHOOL NURSES WORKING THROUGHOUT THE SERVICE AREA - PROVIDING LOCAL ACCESS TO A PSYCHIATRIST & ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED:- GRAHAM HEALTH SYSTEM WILL ADD A MENTAL HEALTH NURSE PRACTITIONER TO THEPROFESSIONAL STAFF AT THE CLINIC- GRAHAM HEALTH SYSTEM WILL COLLABORATE WITH NORTH CENTRAL BEHAVIORAL HEALTH SYSTEMS TO PROVIDE A FULL-TIME, IN-HOUSE CRISIS WORKER AT GRAHAM HEALTH SYSTEM CRISIS WORKER IS PLACED IN THE EMERGENCY ROOM SUNDAY -THURSDAY 230-1030. - GRAHAM HEALTH SYSTEM WILL SEEK TO EXPAND CONTACTS FOR OUT-OF-THE-AREA REFERRALS FOR CARE FOR PERSONS NEEDING INPATIENT CARE FOR MENTAL HEALTH AND SUBSTANCE USE DISORDERS- GRAHAM HEALTH SYSTEM WILL EXPLORE HIRING AN OUTPATIENT ADVANCED PRACTICE PROVIDER- GRAHAM HEALTH SYSTEM WILL EXPLORE TELE-PSYCHIATRY AND TELE-MENTAL HEALTH COUNSELING- GRAHAM HEALTH SYSTEM WILL COLLABORATE WITH THE FULTON COUNTY HEALTH DEPARTMENT AND LOCAL SCHOOLS TO ADDRESS MENTAL HEALTH NEEDS FOR YOUTH AND COMMUNITY EDUCATION ABOUT AVAILABILITY OF LOCAL SERVICES FOR YOUTH, ADULT, AND FAMILY 3. ADDRESS HOMELESSNESS.ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED:- RECOGNIZING THAT THIS IS A COMMUNITY-WIDE ISSUE AND BEYOND THE RESOURCES AND SERVICES OF THE HOSPITAL, GRAHAM HOSPITAL WILL ATTEMPT TO FORM AND FACILITATE A COMMUNITY WORKGROUP OF INTERESTED AGENCIES, LOCAL GOVERNMENTS, SCHOOLS, BUSINESSES, AND INDIVIDUALS TO DEVELOP AND IMPLEMENT STRATEGIES TO EXPLORE THE SCOPE AND ADDRESS THIS ISSUE. 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/FINANCIAL-ASSISTANCE 13 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 - GRAHAM MEDICAL GROUP - LEWISTOWN 408 SOUTH MAIN STREET LEWISTOWN IL 61542 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 4 - GHA HOME MEDICAL EQUIPMENT STORE 101 SOUTH MAIN STREET CANTON IL 61520 HOME MEDICAL EQUIPMENT RETAIL STORE 5 - GRAHAM MEDICAL GROUP - FARMINGTON 601 EAST FORT STREET FARMINGTON IL 64531 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 6 - GRAHAM MEDICAL GROUP - GALESBURG A 1174 N SEMINARY STREET GALESBURG IL 61401 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 7 - GRAHAM MEDICAL GROUP - ELMWOOD 1024 NORTH MAGNOLIA STREET ELMWOOD IL 61529 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 8 - GRAHAM CARDIAC REHABILITATION 235 WEST WALNUT CANTON IL 61520 CARDIAC REHAB SERVICES 9 - GRAHAM HOSPITAL SCHOOL OF NURSING 210 WEST WALNUT STREET CANTON IL 61520 SCHOOL OF NURSING 10 - GRAHAM MEDICAL GROUP - WILLIAMSFIELD 120 EAST GALE STREET WILLIAMSFIELD IL 61489 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 11 - GRAHAM HOSPITAL PHARMACY 210 WEST WALNUT STREET CANTON IL 61520 PHARMACY FOR PATIENTS & RETAIL FOR EMPLOYEES 12 - GRAHAM MEDICAL GROUP - MACOMB 1630 E JACKSON MACOMB IL 61455 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 13 - GRAHAM MEDICAL GROUP - GALESBURG B 530 N SEMINARY ST GALESBURG IL 61401 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 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 $ 5,810,232. PART II, COMMUNITY BUILDING ACTIVITIES: A DONATION OF $5,000 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 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 $5,000 WAS MADE TO THE VILLAGE OR WILLIAMSFIELD FOR THE VETERANS PARK RENOVATION PROJECT.CURRENT YEARUNIVERSITY OF IL - $10,000HEALTH AND WELLNESS CONNECTION OF FULTON COUNTY - $60,000 ($60,000 340 B)VILLAGE OF WILLIAMSFIELD - $5,000SPOON RIVER PARTNERSHIP - $5,000 PART III, LINE 2: 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 3: 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 WWW.GRAHAMHEALTHSYSTEM.ORG/PATIENTS-VISITORS/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 AND INCLUDES ALL OR PORTIONS OF THE TOWNS OF ABINGDON, ASTORIA, AVON, BANNER, BRYANT, BUSHNELL, CANTON, CUBA, DUNFERMLINE, ELLISVILLE, ELMWOOD, FAIRVIEW, FARMINGTON, GALESBURG, GLASFORD, HAVANA, IPAVA, KNOXVILLE, LEWISTOWN, LIVERPOOL, LONDON MILLS, MACOMB, MARIETTA, NORRIS, 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 0 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 HARKER HALL MC 386 1305 WEST GREEN STREET URBANA IL 61801 376006007 501(C)(3) 10000 0 PROVIDE SUPPORT TO ORGANIZATION SPOON RIVER PARTNERSHIP FOR ECONOMIC DEVELOPMENT 209 EAST CHESTNUT SUITE 2 CANTON IL 61520 050633175 501(C)(3) 5000 0 PROVIDE SUPPORT TO ORGANIZATION VILLAGE OF WILLIAMSFIELD 113 N CHICAGO WILLIAMSFIELD IL 61489 370914152 501(C)(3) 5000 0 PROVIDE SUPPORT TO ORGANIZATION 4 0 X X X 0 1 0 0 0 0 0 0 0 BRETT BARNHART MD PHYSICIAN 639034 0 21631 0 72829 0 33150 0 74242 0 840886 0 0 0 ALYSSA CRAWFORD MD PHYSICIAN 625740 0 0 0 105265 0 30381 0 46320 0 807706 0 0 0 ROBERT SENNEFF PRESIDENT/CEO 464441 0 114121 0 85571 0 85078 0 25799 0 775010 0 0 0 BRENT PARRY DPM PODIATRIST 555514 0 12960 0 78719 0 33150 0 68545 0 748888 0 0 0 DWAYNE BERNARD MD MEDICAL DIRECTOR 419644 0 78738 0 3475 0 9150 0 51625 0 562632 0 0 0 JAMES QUEENAN III DO ANESTHETIST 448521 0 0 0 64587 0 32700 0 0 0 545808 0 0 0 JULIE REEDER VP FINANCE/CFO 215646 0 58762 0 92532 0 35211 0 49247 0 451398 0 52348 0 HOLLY HENLINE VP ANCILLARY/CCO 195639 0 52760 0 88240 0 32550 0 46629 0 415818 0 49358 0 TERESA MCCONKEY VP PATIENT SERVICES 184567 0 47971 0 82914 0 30425 0 22264 0 368141 0 53391 0 ALLISON SOURS VP QUALITY 200599 0 50312 0 31382 0 31783 0 24727 0 338803 0 0 0 MICHELLE DALY VP CLINIC SERVICES 175502 0 43294 0 29516 0 27385 0 26316 0 302013 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) PLAN IN 2022 SPONSORED BY GRAHAM HOSPITAL ASSOCIATION: ROBERT SENNEFF - $75,928, MICHELLE DALY - $27,385, JULIE REEDER - $26,061, BRENT PARRY - $24,000, BRETT BARNHART - $24,000, JAMES QUEENAN III - $24,000, HOLLY HENLINE - $23,400, ALLISON SOURS - $23,288, TERESA MCCONKEY - $21,275, ALYSSA CRAWFORD - $21,231. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GRAHAM HOSPITAL ASSOCIATION ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2022. 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 A 1550000 44500000 44500000 2017 1 0 1 1 B 340000 17000000 207600 16792400 2022 0 0 0 1 C 12000000 182467 1100269 10899731 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 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 A 1 B 1 C 1 X LAND 1 2675000 VALUE IN EXCESS OF P 0 0 0 0 SCHEDULE M, LINE 29: THE ORGANIZATION DID NOT RECEIVE AN IRS FORM 8283 ON BEHALF OF THE LAND RECEIVED, HOWEVER AS A PART OF THE ACCEPTANCE OF THE GIFT A THIRD PARTY LAND APPRAISAL AND REAL ESTATE EVALUATION WAS PERFORMED. FORM 990, PART III, LINE 3 DURING THE FISCAL YEAR, GRAHAM HOSPITAL ASSOCIATION ADDED TWO NEW LOCATIONS IN GALESBURG AND ON LOCATION IN MACOMB. FORM 990, PART VI, SECTION B, LINE 11B THE PREPARED FORM 990 IS REVIEWED BY THE BOARD OF TRUSTEES, CEO, CFO, DIRECTOR OF ACCOUNTING, AND SENIOR ACCOUNTANT BEFORE FILING WITH THE IRS. BEFORE FILING, THE CFO PRESENTS THE FORM 990 TO THE ORGANIZATION'S BOARD OF DIRECTORS. 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 635,331. MANAGEMENT AND GENERAL EXPENSES 4,783. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 640,114. PHYSICIANS: PROGRAM SERVICE EXPENSES 9,734,054. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,734,054. SERVICE AGREEMENT: PROGRAM SERVICE EXPENSES 2,559,381. MANAGEMENT AND GENERAL EXPENSES 249,708. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,809,089. PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 4,256. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,256. REPAIR AND MAINTENANCE: PROGRAM SERVICE EXPENSES 62,513. MANAGEMENT AND GENERAL EXPENSES 1,860. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 64,373. OTHER FEES: PROGRAM SERVICE EXPENSES 4,799,963. MANAGEMENT AND GENERAL EXPENSES 849,896. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,649,859. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 297,853. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 297,853. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 120,574. CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS 577,770. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 967,796.