2025-11-07T07:15:11-06:00 2024-12-31 351178661 BLUE & CO LLC 2650 EASTPOINT PKWY SUITE 300 LOUISVILLE KY 40223 990 2024-01-01 370860281 HOSPITAL & MEDICAL FOUNDATION OF PARIS INC HOSP 2174654141 721 EAST COURT STREET PARIS IL 61944 JAY CARMICHAEL PRESIDENT/CEO 2174654141 2025-11-06 1 1 EMILIE M KNIERIEM CPA P01330194 5029923500 2025-11-06 2024 2025-03-06 01:10:19Z HORIZON HEALTH JAY CARMICHAEL 721 EAST COURT STREET PARIS IL 61944 145723699 0 X WWW.MYHORIZONHEALTH.ORG X 1958 IL TO PROVIDE EXCELLENT PATIENT CARE AND PROMOTE WELLNESS THROUGHOUT OUR COMMUNITIES. 14 13 1056 37 0 0 1513217 3953450 124232814 138912536 61783 85432 2198576 2761586 128006390 145713004 25919 13517 0 0 74336489 86534613 0 0 0 52699227 56804907 127061635 143353037 944755 2359967 91262818 94862299 38140069 39379583 53122749 55482716 TO PROVIDE EXCELLENT PATIENT CARE AND PROMOTE WELLNESS THROUGHOUT OUR COMMUNITIES. 0 0 120708633 13517 141196249 OPERATION OF A HOSPITAL AND MEDICAL CLINIC - 3,010 INPATIENT DAYS PLUS EMERGENCY, ANCILLARY, AND OUTPATIENT SERVICES FOR RESIDENTS IN PARIS, EDGAR COUNTY, EAST IL, AND CENTRAL IL. 120708633 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 98 0 1 1056 1 0 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 1 1 IL X MARTIN D ADAMS CPA 2174654141 721 EAST COURT STREET PARIS IL 61944 NOLAN LONGEST CHAIRMAN 1.00 0.00 X X 0 0 0 MARY LIZ WRIGHT VICE CHAIRWOMAN 1.00 0.00 X X 0 0 0 J RENEE CRAIG TREASURER 1.00 0.00 X X 0 0 0 BRIAN BLAIR SECRETARY 1.00 0.00 X X 0 0 0 DAVID FRISSE BOARD MEMBER 1.00 1.00 X 0 0 0 SCOTT HOGAN BOARD MEMBER 1.00 0.00 X 0 0 0 JAIME HOULIHAN BOARD MEMBER 1.00 0.00 X 0 0 0 DARRIN JOHNSON BOARD MEMBER 1.00 0.00 X 0 0 0 AMANDA MARTIN BOARD MEMBER (BEG 04/24) 1.00 0.00 X 0 0 0 DUSTIN MELTON BOARD MEMBER (BEG 04/24) 1.00 0.00 X 0 0 0 DR REID SUTTON BOARD MEMBER 1.00 0.00 X 0 0 0 DR RAHAT SHEIKH MD BOARD MEMBER/CHIEF MEDICAL STAFF 40.00 0.00 X X 491407 0 49454 BRUCE YOUNG BOARD MEMBER (END 04/24) 1.00 0.00 X 0 0 0 JANET CLARK BOARD MEMBER (BEG 04/24) 1.00 0.00 X 0 0 0 NORA SWALLS BOARD MEMBER (BEG 04/24) 1.00 0.00 X 0 0 0 OLIVER M SMITH CEO 40.00 0.00 X 460655 0 39952 MARTIN D ADAMS CFO 40.00 1.00 X 350941 0 42853 RACHEL KELLEY CHIEF NURSING OFFICER 40.00 0.00 X 221188 0 25629 KYM PFRANK COO 40.00 0.00 X 258174 0 16281 LACEY STULTS VP OF CLINIC OPERATIONS 40.00 0.00 X 187959 0 11359 EUNICE CHANEY CHIEF RISK AND PRIVACY OFFICER 40.00 0.00 X 154803 0 9807 ADAM SCHNEIDER CRNA 40.00 0.00 X 811860 0 62753 DR JOHN VENTURA PHYSICIAN 40.00 0.00 X 878352 0 21105 DR JEFFEREY BOLLENBACHER PHYSICIAN 40.00 0.00 X 800744 0 49454 DR JAMES HARRY GRIGGS PHYSICIAN 40.00 0.00 X 720627 0 49454 DR HARISH KEMPEGOWDA PHYSICIAN 40.00 0.00 X 871478 0 62753 6208188 0 440854 120 0 1 0 SYCAMORE PAIN & WELLNESS 1378 S STATE ROAD 46 TERRE HAUTE IN 47803 PAIN MANAGEMENT PROVIDER SERVICES 3584590 COCHRAN DESIGN GROUP LTD 1231 E WOOD STREET PARIS IL 61944 GENERAL CONTRACTOR 3530128 THE REVENUE CYCLIST LLC PO BOX 129 STE GENEVIEVE MO 63670 REVENUE CYCLE/BILLING CONSULTING 1578616 LABORATORY CORP OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 744017 SYCAMORE ENGINEERING 1010 CHESTNUT ST PO BOX 1056 TERRE HAUTE IN 47808 ENGINEERING , CONSTRUCTION AND MAINTENAN 719335 32 3920922 32528 3953450 NET PATIENT SERVICE REVENUE 621999 137263980 137263980 340B PHARMACY REVENUE 621399 1389614 1389614 EMS SERVICE REVENUE 621999 189583 189583 OTHER PHARMACY REVENUE 621399 69359 69359 138912536 81302 81302 154947 0 154947 154947 154947 14825 10695 4130 4130 4130 MEDICAL SERVICES AGREEMENT REVENU 900099 744034 744034 INCENTIVE REVENUE 900099 664397 664397 CAFETERIA REVENUE 722310 230777 230777 967431 875282 92149 2606639 145713004 141196249 0 563305 X 13517 13517 2320462 1845739 474723 63737466 50697979 13039487 2001274 1595899 405375 14942448 11915726 3026722 3532963 2817331 715632 474481 289620 184861 121351 74072 47279 55500 55500 18574346 16346576 2227770 762333 657142 105191 5363961 4858980 504981 1466324 1230279 236045 468743 404063 64680 1593223 1370171 223052 5909484 5082156 827328 1623462 1396177 227285 MEDICAL SUPPLIES AND DR 15744363 15744363 PROVIDER TAX 2076276 2076276 REPAIRS AND MAINTENANCE 1608767 1463055 145712 TAXES AND LICENSES 107027 92259 14768 855266 737253 118013 143353037 120708633 22644404 0 130797 591498 1488574 1758942 17538907 15294038 1592944 1919986 21507 12167 3285093 2946947 1154422 1791442 120613538 56276806 60409980 64336732 5640594 6210547 91262818 94862299 9279333 11715556 106038 94927 25177694 24591197 3577004 2977903 38140069 39379583 X 53122749 55482716 53122749 55482716 91262818 94862299 2359967 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 40303 40303 0 PART II-B, LINE 1: HORIZON HEALTH PAID MEMBERSHIP DUES TO IHA AND AHA IN 2024. 43.5% AND 44.6% OF THE TOTAL IHA AND AHA DUES WERE ALLOCABLE TOWARDS LOBBYING EXPENDITURES, RESPECTIVELY. 2107350 2107350 80371940 29484231 50887709 154786 154786 0 30547417 23892426 6654991 7432045 2745363 4686682 64336732 ROU ASSETS - FINANCING LEASE 2197931 ROU ASSET - OPERATING LEASE 543203 ESTIMATED THIRD PARTY SETTLEMENTS 1653156 MINORITY INTEREST INVESTMENT 525000 RELATED PARTY RECEIVABLE 1291257 6210547 OPERATING LEASE LIABILITY 543203 FINANCE LEASE LIABILITY 2434700 2977903 X PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2024 AND 2023, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 1 1 1 X 1 X 1 1 0 1 1 1957471 1957471 0.01370 21438067 13143716 8294351 0.05790 23395538 13143716 10251822 0.07160 7 2250 300573 300573 0.00210 2 184 147516 147516 0.00100 4543816 4131433 412383 0.00290 2 30918 30918 0.00020 11 2434 5022823 4131433 891390 0.00620 11 2434 28418361 17275149 11143212 0.07780 4155 4155 0.00000 4345 4345 0.00000 1508 1508 0.00000 6127 6127 0.00000 7421 7421 0.00010 23556 23556 0.00010 0 6601236 1980371 19274633 39618786 -20344153 X 1 1 1 1 PARIS COMMUNITY HOSPITAL 721 E COURT ST PARIS IL 61944 WWW.MYHORIZONHEALTH.ORG 0001784 X X X X X FAMILY MEDICAL CENTER PARIS COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X WWW.MYHORIZONHEALTH.ORG X 1 22 1 WWW.MYHORIZONHEALTH.ORG 0 1 X 150.000000000000 250.000000000000 X X 1 1 X X X 1 X WWW.MYHORIZONHEALTH.ORG/FINANCIALASSISTANCE X WWW.MYHORIZONHEALTH.ORG/FINANCIALASSISTANCE X WWW.MYHORIZONHEALTH.ORG/FINANCIALASSISTANCE X X X X X X 1 X 0 X 1 X 0 0 PARIS COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: THIS COMMUNITY HEALTH NEEDS ASSESSMENT WILL SERVE AS A GUIDE FOR PLANNING AND IMPLEMENTATION OF HEALTHCARE INITIATIVES THAT WILL ALLOW THE HOSPITAL AND ITS PARTNERS TO BEST SERVE THE EMERGING HEALTH NEEDS OF PARIS AND THE SURROUNDING AREA. THE CHNA PROCESS WAS COORDINATED BY THE EXECUTIVE ASSISTANT. TWO FOCUS GROUPS MET TO DISCUSS THE STATE OF OVERALL HEALTH AND WELLNESS IN THE HORIZON HEALTH SERVICE AREA AND TO IDENTIFY HEALTH CONCERNS AND NEEDS IN THE DELIVERY OF HEALTHCARE AND HEALTH SERVICES IN ORDER TO IMPROVE WELLNESS AND REDUCE CHRONIC ILLNESS FOR ALL RESIDENTS. THE FOCUS GROUPS INCLUDED REPRESENTATION OF HEALTHCARE PROVIDERS, COMMUNITY LEADERS, COMMUNITY SERVICES PROVIDERS, SCHOOLS, A COMMUNITY COLLEGE, FAITH-BASED ORGANIZATIONS, LAW ENFORCEMENT, LOCAL ELECTED OFFICIALS, PUBLIC HEALTH, AND OTHERS. SOME MEMBERS OF THESE GROUPS PROVIDED SERVICES TO UNDERSERVED AND UNSERVED PERSONS AS ALL OR PART OF THEIR ROLES. THE FINDINGS OF THE FOCUS GROUPS WERE PRESENTED, ALONG WITH SECONDARY DATA ANALYZED BY THE CONSULTANT, TO A THIRD GROUP FOR IDENTIFICATION AND PRIORITIZATION OF THE SIGNIFICANT HEALTH NEEDS FACING THE COMMUNITY. THE GROUP CONSISTED OF REPRESENTATIVES OF PUBLIC HEALTH, COMMUNITY LEADERS, HEALTHCARE PROVIDERS, SCHOOLS, AND COMMUNITY SERVICES PROVIDERS. MANY PROVIDE SERVICES TO POTENTIALLY UNDERSERVED AND UNSERVED POPULATIONS. PARIS COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: AT THE CONCLUSION OF 2 FOCUS GROUPS' REVIEW AND DISCUSSION, THEY ADVANCED THE FOLLOWING NEEDS:1. MENTAL HEALTH:- CONTINUE TO IDENTIFY STRATEGIC PARTNERS IN ORDER TO CREATE SUSTAINABILITY FOR PROGRAMS AND SERVICES- DEVELOP CRISIS COVERAGE- CONTINUE TO IMPROVE ACCESS TO CARE AT ALL LEVELS2. TRANSPORTATION:- EXPLORE WAYS TO ADDRESS GAPS IN NON-EMERGENT/NON-AMBULANCE MEDICAL TRANSPORTATION (LONGER HOURS, FLEXIBLE TRANSPORTATION FOR LOW-INCOME RESIDENTS IN OUTLYING AREAS, BETTER COORDINATION AND COOPERATION AMONG SYSTEMS IN DIFFERENT COUNTIES).- EXPLORE WAYS TO ADDRESS GAPS IN MEDICAL TRANSPORTATION (OUT-OF-AREA TRANSPORTATION FOR MEDICAL APPOINTMENTS AND CARE) 3. DEVELOP/EXPAND COMMUNITY EDUCATION ABOUT INSURANCE, INCLUDING:- MEDICARE AND MEDICAID (AVAILABILITY, CHOICES, AND COVERAGE)4. DEVELOP/EXPAND COMMUNITY EDUCATION ABOUT PARENTING AND FAMILY WELLNESS5. IMPROVE COOPERATION AND COORDINATION AMONG PROVIDERS, AGENCIES, COMMUNITY GROUPS, AND INTEREST PERSONS IN ORDER TO PROMOTE COMMUNITY WELLNESSTHE RESULTS OF THE ASSESSMENT PROCESS WERE THEN PRESENTED TO SENIOR STAFF AT HORIZON HEALTH THROUGH A FACILITATED DISCUSSION FOR DEVELOPMENT OF A PLAN TO ADDRESS THE IDENTIFIED AND PRIORITIZED NEEDS. THE GROUP ADDRESSED THE NEEDS WITH THE FOLLOWING STRATEGIES:- HORIZON HEALTH WILL RECRUIT TWO ADVANCED PRACTICE PSYCHIATRIC NURSES.- HORIZON HEALTH WILL EXPAND THE TYPES AND NUMBERS OF MENTAL HEALTH THERAPISTS.- HORIZON HEALTH WILL DEVELOP COMMUNITY PARTNERSHIPS TO SUPPORT GROWTH AND SUSTAINABILITY FOR PROGRAMS AND SERVICES.- HORIZON HEALTH WILL WORK WITH COMMUNITY PARTNERS TO ASSESS NON-MEDICAL AND MEDICAL TRANSPORTATION GAPS AND DEVELOP A COOPERATIVE PLAN TO ADDRESS GAPS WHERE POSSIBLE.- HORIZON HEALTH WILL SHARE CURRENT INFORMATION ABOUT AVAILABLE TRANSPORTATION OPTIONS AND HOW TO ACTIVATE THEM WITH ALL STAFF.- HORIZON HEALTH WILL EXPLORE DEVELOPING RESOURCES, IN-HOUSE AND IN COLLABORATION WITH PARTNERS, TO PURSUE GRANTS AND OTHER FUNDING OPPORTUNITIES FOR THESE AND OTHER EFFORTS.- HORIZON HEALTH WILL OFFER A LIVE (AND WEB VIEWABLE) EDUCATION PROGRAM ON MEDICARE. 22 1 - PARIS CLINIC 727 E COURT ST PARIS IL 61944 RURAL HEALTH CLINIC 2 - CHRISMAN CLINIC 112 W MADISON AVE CHRISMAN IL 61924 RURAL HEALTH CLINIC 3 - SENIOR CARE 745 EAST COURT STREET PARIS IL 61944 CLINIC 4 - OAKLAND CLINIC 5 S WALNUT ST OAKLAND IL 61943 RURAL HEALTH CLINIC 5 - WALK-IN CLINIC EZ CARE (PARIS) 1 PHIPPS LANE PARIS IL 61944 RURAL HEALTH CLINIC 6 - NAL HEALTH CLINIC 1 PHIPPS LANE PARIS IL 61944 CLINIC 7 - WALK-IN CLINIC EZ CARE (MARSHALL) 1602 N IL HWY 1 MARSHALL IL 62441 RURAL HEALTH CLINIC 8 - ACKLIN-SHACKELFORD CLINIC 721 E COURT ST PARIS IL 61944 CLINIC 9 - MARSHALL SPECIALTY CLINIC 1006 S 6TH STREET MARSHALL IL 62441 CLINIC 10 - TERRE HAUTE SPECIALTY CLINIC 3736 SOUTH 4TH STREET TERRE HAUTE IN 47802 CLINIC 11 - SYCAMORE WELLNESS CLINIC 1378 SOUTH STATE ROAD 46 STE A TERRE HAUTE IN 47803 RURAL HEALTH CLINIC 12 - EDUCATION CENTER 15197 US HIGHWAY 150 PARIS IL 61944 EDUCATION 13 - HOME CARE 798 E COURT STREET PARIS IL 61944 CLINIC 14 - DIALYSIS CENTER 725 EAST COURT STREET PARIS IL 61944 CLINIC 15 - PAIN MANAGEMENT CLINIC 15317 US HIGHWAY 150 PARIS IL 61944 CLINIC 16 - OCCUPATIONAL HEALTH 1 PHIPPS LANE PARIS IL 61944 CLINIC 17 - HORIZON HEALTH MEDICAL EQUIPMENT 721 EAST COURT STREET PARIS IL 61944 MEDICAL EQUIPMENT 18 - SYCAMORE PAIN CLINIC 1378 SOUTH STATE ROAD 46 STE B TERRE HAUTE IN 47803 CLINIC 19 - JASPER CLINIC 15325 US HIGHWAY 150 STE B PARIS IL 61944 CLINIC 21 - WLLOWBROOK - HORIZON HEALTH 1002 NORTH 2ND STREET MARSHALL IL 62441 MEMORY CARE/ASSISTED LIVING 22 - TILTON CLINIC 2 ILLIANA DRIVE STE C TILTON IL 61832 CLINIC 23 - TERRE HAUTE SURGICAL CENTER 227 EAST MCCALLISTER DRIVE TERRE HAUTE IN 47802 OUTPATIENT SURGERY CENTER PART I, LINE 3C: ELIGIBILITY CRITERIA: THE FOLLOWING CLASSES OF INDIVIDUALS AND CATEGORIES OF CARE ARE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY:1. FINANCIALLY IN NEED: TO QUALIFY AS FINANCIALLY IN NEED, THE PATIENT MUST BE UNINSURED OR UNDERINSURED AND HAVE A HOUSEHOLD INCOME OF EQUAL TO OR LESS THAN 250% OF FEDERAL POVERTY LEVEL. THE FOLLOWING DEFINITIONS APPLY TO SUCH ELIGIBILITY CRITERIA: "UNINSURED": A PATIENT WHO (I) HAS NO HEALTH INSURANCE OR COVERAGE UNDER GOVERNMENTAL HEALTH CARE PROGRAMS, AND (II) IS NOT ELIGIBLE FOR ANY OTHER THIRD-PARTY PAYMENT SUCH AS WORKER'S COMPENSATION OR CLAIMS AGAINST OTHERS INVOLVING ACCIDENTS. "UNDERINSURED": A PATIENT WHO (I) HAS LIMITED HEALTH INSURANCE COVERAGE THAT DOES NOT PROVIDE COVERAGE FOR HOSPITAL SERVICES OR OTHER MEDICALLY NECESSARY SERVICES PROVIDED BY HORIZON HEALTH OR (II) HAS EXCEEDED THE MAXIMUM LIABILITY UNDER HIS/HER INSURANCE COVERAGE. "HOUSEHOLD INCOME": THE TOTAL INCOME OF ALL MEMBERS LIVING IN THE PATIENT'S HOUSEHOLD OVER THE TWELVE (12) MONTHS PRIOR TO APPLICATION FOR ASSISTANCE UNDER THIS POLICY.2. FAILURE TO APPLY FOR MEDICAID: PATIENTS WHO MAY BE ELIGIBLE FOR MEDICAID AND FAIL TO APPLY FOR MEDICAID AT HORIZON HEALTH'S REQUEST ARE NOT CONSIDERED ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY.3. CATEGORIES OF CARE ELIGIBLE FOR FINANCIAL ASSISTANCE: PROVIDED THAT THE PATIENT QUALIFIES AS FINANCIALLY IN NEED, THE FOLLOWING CLASSES OF CARE ARE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY:- EMERGENCY MEDICAL CARE- MEDICALLY NECESSARY CAREREGARDLESS OF A PATIENT'S STATUS AS FINANCIALLY IN NEED, COSMETIC PROCEDURES, SPECIAL CASH PAY SERVICES, AND OCCUPATIONAL HEALTH SERVICES ARE NOT ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY. VETERANS: FINANCIAL ASSISTANCE IS ONLY AVAILABLE FOR SERVICES APPROVED BY THE VA TO BE PROVIDED BY HORIZON HEALTH. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED VARY ACCORDING TO THE INFORMATION REQUESTED AND THE MOST ACCURATE MEANS OF GATHERING THE REQUIRED INFORMATION. THE IRS PROVIDED WORKSHEET NUMBER 2 WAS USED TO CALCULATE A COST TO CHARGE RATIO USING INFORMATION FROM THE ORGANIZATION'S GENERAL LEDGER AND COST REPORTS. THAT RATIO WAS THEN USED IN CONJUNCTION WITH IRS WORKSHEET NUMBER 1 TO CALCULATE THE COST OF FINANCIAL ASSISTANCE PROVIDED AND WORKSHEET NUMBER 3 WAS USED TO CALCULATE UNREIMBURSED MEDICAID AMOUNTS. THE ORGANIZATION'S COST ACCOUNTING PROGRAM WAS UTILIZED FOR CALCULATING PORTIONS OF THE SUBSIDIZED HEALTH SERVICES. THE ORGANIZATION'S COST ACCOUNTING PROGRAM ENCOMPASSES ALL PATIENT TYPES, SERVICES AND PAYORS. THE COST ASSOCIATED WITH A SERVICE ARE REVIEWED AND UPDATED ANNUALLY TO PROVIDE THE MOST ACCURATE COST POSSIBLE. BOTH DIRECT AND INDIRECT COSTS ARE UTILIZED IN CALCULATING COST. ACTUAL COST OF HEALTH IMPROVEMENT AND COMMUNITY BENEFIT PROGRAMS, HEALTH EDUCATION, RESEARCH PROGRAM, SOME SUBSIDIZED SERVICES AND DONATIONS ARE STATED AT ACTUAL COST. THE COST OF THESE ITEMS ARE TRACKED THROUGHOUT THE GENERAL LEDGER PROCESS AND THROUGH OTHER ACCOUNTING SOFTWARE. PART I, LINE 7G: NET COSTS REPORTED ON SCHEDULE H, PART I, LINE 7G RELATE TO CERTAIN RURAL HEALTH CLINICS OPERATED BY THE FILING ORGANIZATION. PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION CONDUCTS HEALTH FAIRS IN THE COMMUNITY THROUGHOUT THE YEAR AND PROVIDES VARIOUS HEALTH SCREENINGS FOR INDUSTRY WORKERS AND THE PUBLIC IN GENERAL. A MONTHLY NEWSLETTER IS DEVOTED TO INFORMING THE PUBLIC ABOUT TIMELY HEALTH ISSUES AND THE AVAILABILITY OF THE LOCAL HEALTH SERVICES. THE VOLUNTEER GOVERNING BODY IS COMPRISED MOSTLY OF PEOPLE WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEDGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OF ALL OF ITS DEPARTMENTS. ALL SURPLUS FUNDS ARE USED TO IMPROVE FACILITIES AND TO REPLACE OR UPGRADE EQUIPMENT TO PROVIDE THE HIGHEST QUALITY OF PATIENT CARE POSSIBLE. CONTINUOUS MEDICAL EDUCATION IS PROVIDED TO PHYSICIANS AND STAFF. PART III, LINE 2: THE ORGANIZATION USED AN OVERALL COST TO CHARGE RATIO TO DETERMINE THE AMOUNTS ON PART III, SECTION A. PART III, LINE 3: IT IS ESTIMATED THAT 30% OF BAD DEBTS WOULD BE ELIGIBLE FOR FINANCIAL ASSISTANCE IF THE PATIENTS APPLIED AND PROVIDED FAMILY INCOME INFORMATION. THIS PORTION OF BAD DEBT SHOULD BE INCLUDED IN COMMUNITY BENEFIT AS THE PATIENTS ARE UNINSURED AND PRESUMED TO BE NEEDY AND UNABLE TO PAY FOR THE SERVICES. PART III, LINE 4: PART III, LINE 4: GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HOSPITAL ALSO PROVIDES SERVICES TO UNINSURED PATIENTS AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE INSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE.AT DECEMBER 31, 2024 AND 2023, IMPLICIT PRICE CONCESSIONS (PROVISION FOR BAD DEBT) INCLUDE $6,601,236 AND $5,243,422, RESPECTIVELY. PART III, LINE 8: THE SAME COST TO CHARGE RATIO CALCULATED TO DETERMINE COMMUNITY BENEFIT EXPENSE IN PART I WAS APPLIED TO MEDICARE CHARGES TO DETERMINE ESTIMATED COST. UNPAID COST OF MEDICARE REPRESENTS THE COST OF PROVIDING SERVICES TO PRIMARILY ELDERLY BENEFICIARIES OF THE MEDICARE PROGRAM, IN EXCESS OF PAYMENTS FOR THOSE SERVICES. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPIATL SERVES PATIENTS WITH GOVERNMENT BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. PART III, LINE 9B: PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ARE IDENTIFIED AT REGISTRATION WITH A UNIQUE FINANCIAL CLASS CODE. IF THEY QUALIFY FOR 100% ASSISTANCE, THEIR ACCOUNT IS ADJUSTED TO ZERO AND NO BILL IS SENT. IF THEY QUALIFY FOR PARTIAL ASSISTANCE, THEIR ACCOUNT IS ADJUSTED ACCORDINGLY BEFORE A BILL IS SENT FOR THE BALANCE DUE. PART VI, LINE 2: ON A BI-ANNUAL BASIS THE ADMINISTRATIVE STAFF MEET IN A RETREAT WITH THE BOARD OF DIRECTORS AND MEDICAL STAFF TO ASSESS AND PLAN FOR THE NEEDS OF THE COMMUNITY. A PHONE SURVEY OF 375 RESIDENTS OF THE HOSPITAL'S SERVICE AREA IS PERFORMED TO GET COMMUNITY INPUT. PART VI, LINE 3: NOTICES OF THE AVAILABILITY OF FINANCIAL ASSITANCE ARE POSTED IN THE ADMISSIONS AREA OF THE HOSPITAL AND MEDICAL CENTER AND IN THE EMERGENCY ROOM. UNINSURED PATIENTS NOT ALREADY IN THE PROGRAM ARE GIVEN A BROCHURE THAT EXPLAINS THE PROGRAM ALONG WITH AN APPLICATION WHEN THEY ARE ADMITTED OR REGISTERED. A BROCHURE IS INCLUDED IN THE INFORMATION PACKET GIVEN TO ALL INPATIENTS. INFORMATION IS ALSO POSTED ON THE HOSPITAL'S WEBISTE. THE FINANCIAL ASSISTANCE COORDINATOR FOLLOWS UP WITH PATIENTS TO ANSWER QUESTIONS AND PROVIDE ASSISTANCE IN APPLYING. ALL BILLS SENT TO THE HOSPITAL PATIENTS INCLUDE A MESSAGE ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND WHO TO CONTACT TO APPLY. PATIENTS ARE SCREENED FOR STATE PROGRAMS AND ASSISTED WITH APPLICATIONS. PART VI, LINE 4: HORIZON HEALTH HAS DEFINED ITS PRIMARY SERVICE AREA AND POPULATION BY ZIP CODES THAT INCLUDE EDGAR COUNTY AND PARTS OF CLARK, COLES, AND DOUGLAS COUNTIES. A TOTAL OF 25,405 PEOPLE LIVE IN THE 771.50 SQUARE MILE REPORT AREA DEFINED FOR THIS ASSESSMENT ACCORDING TO THE U.S. CENSUS BUREAU AMERICAN COMMUNITY SURVEY 2016-2020 5-YEAR ESTIMATES. THE POPULATION DENSITY FOR THIS AREA, ESTIMATED AT 33 PERSONS PER SQUARE MILE, IS LESS THAN THE NATIONAL AVERAGE POPULATION DENSITY OF 92 PERSONS PER SQUARE MILE. THE AVERAGE HOUSEHOLD SIZE OF THE AREA, AT 2.4, IS LOWER THAN BOTH ILLINOIS (3.00) AND THE U.S. (2.50). MEDIAN AGE IS 44.1 YEARS, WHICH IS HIGHER THAN BOTH ILLINOIS (38.6) AND THE U.S. (38.0). THE LARGEST EDUCATION SEGMENT IS HIGH SCHOOL GRADUATE, FOLLOWED BY SOME COLLEGE. THE UNEMPLOYMENT RATE OF 3.4% IS LOWER THAN BOTH ILLINOIS (4.6%) AND THE U.S. (3.6%) ALSO, MEDIAN FAMILY HOUSEHOLD INCOME IN THE SERVICE AREA ($63,962) IS LOWER THAN THE ILLINOIS' MEDIAN FAMILY HOUSEHOLD INCOME ($65,886) AND HIGHER THAN THE U.S. ($61,937). PART VI, LINE 5: COMMUNITY BENEFITS ARE PROGRAMS AND SERVICES DESIGNED TO IMPROVE HEALTH IN COMMUNITIES AND INCREASE ACCESS TO HEALTHCARE. HORIZON HEALTH PERFORMS COMMUNITY BENEFIT ACTIVITIES IN SEVERAL WAYS, INCLUDING OFFERING FREE HEALTH-RELATED EVENTS AND PROGRAMS THROUGHOUT ITS SERVICE AREA.HORIZON HEALTH PROVIDED 5,897 STAFF HOURS OF FREE OR DISCOUNTED PROGRAMS/SERVICES IN 2024. MAJOR CATEGORIES INCLUDED PROVIDING FREE CPR/AED/FIRST AID CLASSES; COMMUNITY HEALTH EDUCATION; EDUCATION/JOB SHADOWING FOR HIGH SCHOOL STUDENTS, MEDICAL STUDENTS, AND OTHER HEALTHCARE PROFESSIONALS; AND FINANCIAL ENROLLMENT ASSISTANCE.HORIZON HEALTH'S COMMUNITY INVOLVEMENT INCLUDED:- NUMEROUS HEALTH & CAREER FAIRS- SCHOOL TOURS- SPEAKING ENGAGEMENTS: 26 DINE WITH A DOC EVENTS, EDGAR CLARK CAREER EXPLORATION LEADERSHIP ACADEMY (ECCEL), OSHER LIFELONG LEARNING INSTITUTE (OLLI) - WELLNESS (WEAR RED EVENT, ANNUAL FOOT CARE CLINIC, HEART SAVER COMMUNITY CLASSES, BLOOD TYPING & GLUCOSE TESTING AT THE LOCAL HIGH SCHOOL)- MONTHLY RADIO PODCASTS (MIDWEST COMMUNICATIONS 100.7 FM)- EDUCATION SEGMENTS (WEIU-TV)- NON-EMERGENT PATIENT TRANSPORT SERVICES PART VI, LINE 7, REPORTS FILED WITH STATES IL X X 0 1 0 0 0 0 0 1 0 DR HARISH KEMPEGOWDA PHYSICIAN 849231 0 0 0 22247 0 20700 0 42053 0 934231 0 0 0 DR JOHN VENTURA PHYSICIAN 769540 0 106100 0 2712 0 20700 0 405 0 899457 0 0 0 ADAM SCHNEIDER CRNA 432025 0 377437 0 2398 0 20700 0 42053 0 874613 0 0 0 DR JEFFEREY BOLLENBACHER PHYSICIAN 797000 0 0 0 3744 0 20700 0 28754 0 850198 0 0 0 DR JAMES HARRY GRIGGS PHYSICIAN 716883 0 0 0 3744 0 20700 0 28754 0 770081 0 0 0 DR RAHAT SHEIKH MD BOARD MEMBER/CHIEF MEDICAL STAFF 374167 0 114048 0 3192 0 20700 0 28754 0 540861 0 0 0 OLIVER M SMITH CEO 414423 0 0 0 46232 0 20700 0 19252 0 500607 0 0 0 MARTIN D ADAMS CFO 343176 0 0 0 7765 0 20700 0 22153 0 393794 0 0 0 KYM PFRANK COO 256014 0 0 0 2160 0 15510 0 771 0 274455 0 0 0 RACHEL KELLEY CHIEF NURSING OFFICER 213049 0 0 0 8139 0 13464 0 12165 0 246817 0 0 0 LACEY STULTS VP OF CLINIC OPERATIONS 178224 0 0 0 9735 0 11278 0 81 0 199318 0 0 0 EUNICE CHANEY CHIEF RISK AND PRIVACY OFFICER 148967 0 0 0 5836 0 9314 0 493 0 164610 0 0 0 PART I, LINE 4B CERTAIN INDIVIDUALS LISTED ON 990, PART VII PARTICIPATED IN A SPLIT DOLLAR LIFE INSURANCE PLAN. PLEASE REFER TO SCHEDULE L FOR PARTICIPANTS, PREMIUMS AND OUTSTANDING LOAN AMOUNTS. PART I, LINE 7 SOME PROVIDERS' CONTRACTS CONTAIN A PRODUCTIVITY COMPENSATION CLAUSE. IF ELIGIBLE, THE POTENTIAL PRODUCTIVITY PAYMENT IS BASED UPON A CALCULATION THAT INCLUDES A PERCENTAGE OF THE PROVIDERS' PRACTICE PROFESSIONAL SERVICES COLLECTIONS THAT EXCEED A SET AMOUNT. RAHAT SHEIKH MD BOD/OFFICER TO FUND SPLIT DOLLAR LIFE INSURANCE PREMIUMS FOR SUPPLEMENTAL LIFE INSURANC X 440361 497420 0 1 1 DR SODVADIYA EMPLOYEE TO FUND SPLIT DOLLAR LIFE INSURANCE PREMIUMS FOR SUPPLEMENTAL LIFE INSURANC X 727784 776759 0 1 1 DR HARISH KEMPEGOWDA EMPLOYEE TO FUND SPLIT DOLLAR LIFE INSURANCE PREMIUMS FOR SUPPLEMENTAL LIFE INSURANC X 433846 456975 0 1 1 ADAM SCHNEIDER EMPLOYEE TO FUND SPLIT DOLLAR LIFE INSURANCE PREMIUMS FOR SUPPLEMENTAL LIFE INSURANC X 177885 188832 0 1 1 1919986 FORM 990, PART VI, SECTION A, LINE 1A THE CORPORATION SHALL HAVE AN EXECUTIVE COMMITTEE, WHICH SHALL CONSIST OF NOT FEWER THAN THREE (3) NOR MORE THAN FIVE (5) PERSONS, AS SHALL FROM TIME TO TIME BE PRESCRIBED IN A RESOLUTION OF THE BOARD OF DIRECTORS, EACH OF WHOM SHALL BE AN ELECTED DIRECTOR. THE CHAIR SHALL BE A MEMBER OF THE EXECUTIVE COMMITTEE, SHALL SERVE AS THE CHAIRMAN OF SUCH COMMITTEE, AND , SUBJECT TO THE APPROVAL OF THE BOARD OF DIRECTORS AT EACH ANNUAL MEETING, SHALL APPOINT THE OTHER MEMBERS OF SUCH COMMITTEE, EACH FOR A ONE (1) YEAR TERM. THE EXECUTIVE DIRECTOR, IF ANY, SHALL SERVE AS EX OFFICIO, NON-VOTING MEMBER OF THE EXECUTIVE COMMITTEE. WHEN THE BOARD OF DIRECTORS IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE ALL POWERS OF THE BOARD OF DIRECTORS THAT MAY BE LEGALLY DELEGATED TO THE EXECUTIVE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PREPARED BY AN INDEPENDENT AUDIT FIRM. THE HOSPITAL POSTS FORM 990 TO THE HOSPITAL'S INTRANET AND EACH MEMBER OF THE BOARD OF DIRECTORS, CEO, AND CFO ARE ASKED TO REVIEW BEFORE THE FORM 990 IS FILED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE GIVEN TO THE BOARD MEMBERS YEARLY AND ARE ACCUMULATED BY THE PRESIDENT/CEO'S SECRETARY WHO MONITORS THAT ALL ARE RETURNED. WHEN THERE IS A DIRECT CONFLICT OR PERCEIVED CONFLICT, THOSE MEMBERS INVOLVED ABSTAIN FROM VOTING ON THAT PARTICULAR MATTER AND ABSTENTIONS ARE NOTED IN THE MINUTES. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PROCESS FOR TOP OFFICIAL: CEO/CFO REVIEW PROCESS - EACH BOARD MEMBER IS ASKED TO COMPLETE A SURVEY THAT SCORES THE CEO/CFO IN SEVERAL AREAS OF JOB PERFORMANCE AND COMMUNITY INVOLVEMENT. THE EXECUTIVE COMMITTEE OF THE BOARD REVIEWS THE SURVEY RESULTS AND REVIEWS SALARY SURVEY DATA FOR THE SAME POSITIONS IN COMPARABLE ORGANIZATIONS. COMPENSATION PROCESS FOR OFFICERS: PHYSICIAN EMPLOYEE REVIEW PROCESS - PHYSICIANS ARE REVIEWED BY THE CEO. NON-PHYSICIAN REVIEW PROCESS - NON-PHYSICIAN EMPLOYEES ARE EVALUATED BY THE CEO AND MARKET BENCHMARK DATA IS OBTAINED FOR REVIEW IN MAKING A DECISION ON SALARY CHANGES. COL ADJUSTMENTS ARE APPROVED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST FROM ADMINISTRATION. FORM 990, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 4,304,943. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,304,943. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 4,374,576. MANAGEMENT AND GENERAL EXPENSES 1,104,046. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,478,622. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 1,968,537. MANAGEMENT AND GENERAL EXPENSES 196,056. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,164,593. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 5,698,520. MANAGEMENT AND GENERAL EXPENSES 927,668. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,626,188. PARIS COMMUNITY HOSPITAL FOUNDATION INC 721 EAST COURT ST PARIS IL 619442460 473034746 FOUNDATION - SUPPORTING ORGANIZATION IL 501(C)(3) LINE 12A, I HORIZON HEALTH 1 TERRE HAUTE SURGICAL CENTER LLC 227 EAST MCCALLISTER DRIVE TERRE HAUTE IN 47802 203750008 SURGICAL CARE IN N/A RELATED -28215 228984 0 0 0.30000 ILLINOIS RURAL COMMUNITY CARE ORGANIZATION 1945 VANS WAY PRINCETON IL 61356 465654316 HEALTHCARE IL N/A RELATED 88269 474963 0 0 0.05560 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 HORIZON HEALTH FOUNDATION OF EAST CENTRAL ILLINOIS INC C 3920922 FMV HORIZON HEALTH FOUNDATION OF EAST CENTRAL ILLINOIS INC O 216976 CASH