2025-03-18T08:43:57-05:00 2024-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-07-01 370673506 GRAHAM HOSPITAL ASSOCIATION GRAH 3096475240 210 WEST WALNUT CANTON IL 61520 ROBERT SENNEFF PRESIDENT AND CEO 3096475240 2025-02-26 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-02-26 2023 2025-03-06 01:10:19Z ROBERT SENNEFF 210 WEST WALNUT CANTON IL 61520 134865097 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. 14 13 961 69 249142 0 3014469 31493 118640792 128078803 3752880 6108274 156038 446725 125564179 134665295 83525 171315 0 0 63057424 72111042 0 0 0 54669082 58649904 117810031 130932261 7754148 3733034 261203159 284979304 91309039 102186750 169894120 182792554 X TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES, IN A RESPONSIBLE AND CHARITABLE MANNER, TO THE PEOPLE AND COMMUNITIES WE SERVE. 1 0 47118778 171315 56628540 GRAHAM HOSPITAL IS A PROVIDER OF HEALTHCARE SERVICES IN FULTON, KNOX, MCDONOUGH, MASON AND PEORIA COUNTY. DURING THIS REPORTING PERIOD 2,080 ADULTS AND CHILDREN WERE ADMITTED AND 209 BABIES WERE BORN. THEY RECEIVED INPATIENT SERVICES IN THE ACUTE CARE FACILITY. 211 PATIENTS WERE ADMITTED FOR 7,986 DAYS OF SERVICE IN THE EXTENDED CARE FACILITY. 115,105 OUTPATIENT SERVICES WERE PROVIDED. 32227970 0 38732387 SURGICAL SERVICES - THE HOSPITAL PERFORMED 487 INPATIENT SURGERIES AND 4,989 OUTPATIENT SURGERIES IN FISCAL YEAR 2024. 18188062 0 21858872 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 145,472 OFFICE VISITS AND 12,512 NURSING HOME AND HOSPITAL VISITS. 8828126 0 10609862 ED PROGRAM - THE HOSPITAL OPERATES A 24 HOUR EMERGENCY DEPARTMENT WHICH HAD 13,369 PATIENTS REGISTERED TO THE EMERGENCY DEPARTMENT IN FISCAL YEAR 2024. 8828126 0 10609862 106362936 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 1 140 0 961 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 13 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 917677 0 61438 ALYSSA CRAWFORD MD OB-GYN 40.00 X 821351 0 101821 BRETT BARNHART MD ORTHOPEDIC SURGEON 40.00 X 727038 0 107416 BRENT PARRY DPM PODIATRIST 40.00 X 661293 0 101798 DAVID CAO MD PHYSICIAN 40.00 X 601609 0 67553 KEITH IFFT MD PHYSICIAN 40.00 X 524552 0 54764 JULIE REEDER VP FINANCE/CFO 40.00 X 332407 0 83822 ALLISON SOURS VP QUALITY 40.00 X 345813 0 55613 HOLLY HENLINE VP ANCILLARY/CCO 40.00 X 304023 0 78511 MICHELLE DALY VP CLINIC SERVICES 40.00 X 306438 0 57057 TERESA MCCONKEY VP PATIENT SERVICES 40.00 X 272202 0 52215 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 (THRU DEC 2023) 2.00 X 0 0 0 LAURA FIDLER 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 VAL RAMIREZ TRUSTEE 2.00 X 0 0 0 5814403 0 822008 77 0 1 0 COLEMAN MEDICAL ASSOCIATES LTD 180 SOUTH MAIN STREET CANTON IL 61520 PHYSICIAN SERVICES 7507397 PJ HOERR INC 107 W COMMERCE PEORIA IL 61604 CONSTRUCTION 6582794 SPOON RIVER RENTALS LLC 130 N MAIN STREET CANTON IL 61520 CONSTRUCTION 820713 AB STAFFING SOLUTIONS 3451 S MERCY ROAD STE 102 GILBERT AZ 85297 STAFFING SERVICES 712669 FORGOTTONIA LLC 2907 W WARDCLIFFE DRIVE PEORIA IL 61604 PHYSICIAN SERVICES 613473 34 31493 31493 PATIENT SERVICE REVENUE 621990 121366150 121366150 340(B) REVENUE 621990 4171815 4171815 SCHOOL OF NURSING 621990 288811 288811 LABORATORY 621500 169051 169051 2082976 2002885 80091 128078803 2657580 2657580 446725 0 446725 446725 446725 3616685 33811 0 199802 3616685 -165991 3450694 3450694 134665295 127829661 249142 6554999 X 171315 171315 2867216 515684 2351532 54323870 44996420 9327450 1040874 840648 200226 9982079 7292643 2689436 3897003 2808712 1088291 110417 110417 21885 21885 64237 64237 31927 31927 21597291 20060220 1537071 130185 18704 111481 458863 183228 275635 639870 24114 615756 1907668 1476785 430883 64273 11439 52834 13827 5226 8601 2367064 2103965 263099 5402226 4803992 598234 1289505 1289505 MEDICAL SUPPLIES 13351556 13351556 BAD DEBT EXPENSE 5340329 5340329 MEDICAID ASSESSMENT 3193346 3193346 DIETARY 828544 807872 20672 1836891 1550084 286807 130932261 106362936 24569325 0 636391 1031461 3222309 3834304 12488554 14706426 3702980 3900778 2132951 2593845 1720833 1947418 189307448 82314585 99190912 106992863 125165743 136170939 9061490 9630817 3880996 4170453 261203159 284979304 12334630 15557511 66355450 75594493 445589 34878 12173370 10999868 91309039 102186750 X 160832630 173161737 9061490 9630817 169894120 182792554 261203159 284979304 X 3733034 7962566 1202834 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 31927 31927 0 PART II-B, LINE 1: LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED: 43.5% OF MEMBERSHIP DUES PAID TO THE ILLINOIS HOSPITAL ASSOCIATION, OR $19,983.90; 43.5% OF MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, OR $10,823.67; 35.08% OF MEMBERSHIP DUES PAID TO THE ILLINOIS HEALTH CARE ASSOCIATION, OR $1,119.75. 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 94502686 167929 -1066495 7200 114228 256881 93225811 0.93000 0.07000 0.00000 1 0 9314481 9314481 116283837 44798715 71485122 55100635 37515870 17584765 8608495 8608495 106992863 ESTIMATED SELF-INSURANCE COSTS 4140409 ASSET RETIREMENT OBLIGATION 99247 DEFERRED COMPENSATION PLAN OBLIGATIONS 2380314 FMV OF SWAP OPTIONS 326978 DUE TO THIRD PARTY PAYORS 4052920 10999868 137479858 7962566 -5148003 2814563 134665295 0 134665295 125591932 0 125591932 5340329 5340329 130932261 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 192,326. BAD DEBT EXPENSE -5,340,329. PART XI, LINE 4B - OTHER ADJUSTMENTS: \ PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 5,340,329. 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 1 0 1 0 1717906 1717906 0.01370 24129082 17583271 6545811 0.05210 25846988 17583271 8263717 0.06580 199227 1451 197776 0.00160 65533 65533 0.00050 152716 1200 151516 0.00120 417476 2651 414825 0.00330 26264464 17585922 8678542 0.06910 7501 7501 0.00010 1888 1888 0.00000 9389 9389 0.00010 0 1949182 19394765 20773889 -1379124 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 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: 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 14 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 - FARMINGTON 601 EAST FORT STREET FARMINGTON IL 64531 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 CARDIAC REHABILITATION 235 WEST WALNUT CANTON IL 61520 CARDIAC REHAB SERVICES 9 - GRAHAM MEDICAL GROUP - GALESBURG B 530 N SEMINARY ST GALESBURG IL 61401 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 10 - GRAHAM MEDICAL GROUP - ELMWOOD 1024 NORTH MAGNOLIA STREET ELMWOOD IL 61529 MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC 11 - GRAHAM MEDICAL GROUP - GALESBURG A 1174 N SEMINARY STREET 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 HOSPITAL PHARMACY 210 WEST WALNUT STREET CANTON IL 61520 PHARMACY FOR PATIENTS & RETAIL FOR EMPLOYEES 14 - GRAHAM MEDICAL GROUP - GLASFORD 201 EAST MAIN STREET GLASFORD IL 61533 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 $ 5,340,329. 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 $9,914.40 WAS MADE TO THE ELMWOOD COMMUNITY FOUNDATION. THIS DONATION HELPED WITH THE IMPLEMENTATION OF THE BLACKBAUD SOFTWARE SYSTEM. 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 $20,000 WAS MADE TO THE CANTON FAMILY YMCA. THIS DONATION HELPED PROVIDE FUNDING FOR THE CONSTRUCTION OF A WALKING TRACK. A DONATION OF $5,000 WAS MADE TO CARL SANDBURG COLLEGE. THIS DONATION WILL HELP PROVIDE OPPORTUNITIES FOR NURSING STUDENTS TO CONTINUE THEIR EDUCATION.CURRENT YEAR:CARL SANDBURG COLLEGE FOUNDATION - $50,000; CARL SANDBURG COLLEGE $5,000UNIVERSITY OF IL - $10,000HEALTH AND WELLNESS CONNECTION OF FULTON COUNTY - $60,000 ($60,000 340 B)ELMWOOD COMMUNITY FOUNDATION - $9,914.40SPOON RIVER PARTNERSHIP - $5,000; CANTON FAMILY YMCA $20,000THE BREATHING TREE - $1500KNOX COUNTY PARTNERSHIP FOR ECONOMIC DEVELOPMENT - $2501GALESBURG DISCOVERY DEPOT - $5000 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 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, 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 CANTON FAMILY YMCA 1325 E ASH ST CANTON IL 61520 370748000 501(C)(3) 20000 0 PROVIDE SUPPORT TO ORGANIZATION ELMWOOD COMMUNITY FOUNDATION PO BOX 439 201 W MAIN ST ELMWOOD IL 61529 371381626 501(C)(3) 9914 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 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 ROBERT SENNEFF PRESIDENT/CEO 536161 0 135655 0 245861 0 36550 0 24888 0 979115 0 154185 0 ALYSSA CRAWFORD MD OB-GYN 735457 0 0 0 85894 0 28305 0 73516 0 923172 0 0 0 BRETT BARNHART MD ORTHOPEDIC SURGEON 635304 0 12128 0 79606 0 33900 0 73516 0 834454 0 0 0 BRENT PARRY DPM PODIATRIST 603756 0 0 0 57537 0 33900 0 67898 0 763091 0 0 0 DAVID CAO MD PHYSICIAN 555878 0 0 0 45731 0 43131 0 24422 0 669162 0 0 0 KEITH IFFT MD PHYSICIAN 482930 0 0 0 41622 0 9900 0 44864 0 579316 0 0 0 JULIE REEDER VP FINANCE/CFO 224926 0 69848 0 37633 0 36612 0 47210 0 416229 0 0 0 ALLISON SOURS VP QUALITY 208602 0 62414 0 74797 0 32499 0 23114 0 401426 0 45630 0 HOLLY HENLINE VP ANCILLARY/CCO 215529 0 62717 0 25777 0 33063 0 45448 0 382534 0 0 0 MICHELLE DALY VP CLINIC SERVICES 187540 0 55068 0 63830 0 21320 0 35737 0 363495 0 40569 0 TERESA MCCONKEY VP PATIENT SERVICES 185803 0 53469 0 32930 0 29954 0 22261 0 324417 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) PLAN IN 2023 SPONSORED BY GRAHAM HOSPITAL ASSOCIATION: ROBERT SENNEFF - $26,649.72, MICHELLE DALY - $21,320.00, JULIE REEDER - $26,712.40, BRENT PARRY - $24,000.08, BRETT BARNHART - $24,000.08, HOLLY HENLINE - $23,985.52, ALLISON SOURS - $23,869.04, TERESA MCCONKEY - $21,807.76, ALYSSA CRAWFORD - $24,000.08, DAVID CAO - $33,230.88. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GRAHAM HOSPITAL ASSOCIATION ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2023. 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 7465000 44500000 44500000 2017 1 0 1 1 B 1025000 17000000 207600 16792400 2022 0 0 0 1 C 12000000 182467 9064550 2935450 0 0 0 1 D 11322000 143098 11178902 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 NEW LOCATIONS IN CANTON, GALESBURG AND GLASFORD. 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 837,409. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 837,409. PHYSICIANS: PROGRAM SERVICE EXPENSES 12,305,869. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,305,869. SERVICE AGREEMENT: PROGRAM SERVICE EXPENSES 2,665,970. MANAGEMENT AND GENERAL EXPENSES 358,487. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,024,457. PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 79,507. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 79,507. REPAIR AND MAINTENANCE: PROGRAM SERVICE EXPENSES 65,820. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 65,820. OTHER FEES: PROGRAM SERVICE EXPENSES 3,816,440. MANAGEMENT AND GENERAL EXPENSES 1,178,584. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,995,024. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 289,205. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 289,205. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 797,379. CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS 213,129. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 192,326.