2026-02-13T15:44:22-06:00 2025-03-31 351178661 BLUE & CO LLC 2650 EASTPOINT PKWY SUITE 300 LOUISVILLE KY 40223 990 2024-04-01 201244058 FERRELL HOSPITAL COMMUNITY FOUNDATION FERR 6182733361 1201 PINE STREET ELDORADO IL 62930 GREG WRIGHT CFO 6182733361 2026-02-13 1 1 EMILIE M KNIERIEM CPA P01330194 5029923500 2026-02-13 2024 2025-03-06 01:10:19Z GREG WRIGHT 1201 PINE STREET ELDORADO IL 62930 68780854 0 X WWW.FERRELLHOSP.ORG X 2004 IL OPERATE ACUTE CARE HOSPITAL - DEDICATED TO IMPROVING THE HEALTH AND QUALITY OF LIFE FOR THE PEOPLE AND COMMUNITIES WE SERVE. 9 8 423 25 0 0 710254 192873 56307541 57534834 289605 252388 470157 10789968 57777557 68770063 3000 0 0 0 26285098 30152403 0 0 0 31809144 43253170 58097242 73405573 -319685 -4635510 51917628 56996654 45153681 51687327 6763947 5309327 OPERATE ACUTE CARE HOSPITAL - DEDICATED TO IMPROVING THE HEALTH AND QUALITY OF LIFE FOR THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 56466928 68322243 FERRELL HOSPITAL COMMUNITY FOUNDATION (FHCF) OFFERS QUALITY HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. FHCF PROVIDES MEDICAL CARE TO OUTPATIENTS AND INPATIENTS AS WELL AS PROVIDES VARIOUS COMMUNITY BENEFITS TO THE COMMUNITY. 56466928 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 71 0 1 423 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 1 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 IL X GREG WRIGHT 6182733361 1201 PINE STREET ELDORADO IL 62930 NATE OLDHAM MD BOARD MEMBER/PHYSICIAN 40.00 X 541331 0 56535 CLIFFORD EUGENE MORRIS CHAIRMAN 5.00 X 0 0 0 E T SEELY VICE-CHAIRMAN 5.00 X 0 0 0 BARB DEVOUS SECRETARY 2.00 X 0 0 0 JEFF CAMPBELL BOARD MEMBER 2.00 X 0 0 0 AYN BARTOK BOARD MEMBER 2.00 X 0 0 0 NIKKI ROSER BOARD MEMBER 2.00 X 0 0 0 JARED FLORENCE BOARD MEMBER 2.00 X 0 0 0 DR JAMES PORTER MD BOARD MEMBER 2.00 X 0 0 0 AUSTIN RAHMOELLER BOARD MEMBER (TERM END 06/24)) 2.00 X 0 0 0 CALEIGH BRUCE CHIEF COMPLIANCE OFFICER 40.00 X 114453 0 6526 RACHEL PRATHER CHIEF NURSING OFFICER 40.00 X 0 0 0 TONY KEENE CEO 50.00 X 0 0 0 GREG WRIGHT CFO 50.00 X 0 0 0 JOSEPH A JACKSON MD PHYSICIAN 40.00 X 393003 0 60532 JANNA PATHI MD SURGEON 30.00 X 460997 0 18710 CALEB MITCHELL DO PHYSICIAN 40.00 X 474921 0 56472 CLAYTON FORD PHYSICIAN 40.00 X 388583 0 58854 DAVID GUNZEL PHYSICIAN 40.00 X 357466 0 39684 2730754 0 297313 28 0 1 0 DEACONESS HOSPITAL 600 MARY ST EVANSVILLE IN 47747 ER PHYSICIANS 2513777 MIDWEST NURSING AND VASCULAR SERVICES 222 W MAIN ST A SALEM IL 62881 NURSING SERVICES 1599327 PROGRESSIVE HEALTH OF INDIANA LLC PO BOX 6890 EVANSVILLE IN 47719 PHYSICAL AND OCCUPATIONAL THERAPISTS 1439624 ELDORADO EMERGENCY GROUP PC 1201 PINE STREET ELDORADO IL 62930 ER SERVICES 1361776 DEACONESS REGIONAL HEALTHCARE SERVICES 600 MARY STREET EVANSVILLE IN 47747 ER PHYSICIANS, MANAGEMENT FEES 1184226 37 50322 142551 192873 NET PATIENT SERVICE REVENUE 621999 57066341 57066341 PHARMACY SERVICES (340B) 621399 468493 468493 57534834 252388 252388 6360 0 6360 6360 6360 6990 50322 10791 -3801 -3801 FLOOD INSURANCE PROCEEDS 900099 10000000 10000000 IRCCO MSSP REVENUE 900099 297401 297401 REBATES 900099 236119 236119 253889 253889 10787409 68770063 68322243 0 254947 X 741547 543386 198161 22723822 16651416 6072406 327240 211507 115733 4817326 3113605 1703721 1542468 996951 545517 1693495 1693495 181179 113873 67306 198481 124748 73733 14271233 9405298 4865935 153271 105851 47420 931359 643211 288148 253821 175293 78528 645071 645071 58087 40116 17971 60783 41978 18805 921050 876527 44523 2476685 2075973 400712 703717 354737 348980 MEDICAL SUPPLIES & DRUG 19106252 19106252 PROVIDER TAX 736984 736984 REPAIRS AND MAINTENANCE 411706 193376 218330 MINOR EQUIPMENT 308892 213326 95566 141104 97449 43655 73405573 56466928 16938645 0 5940314 5113279 1758208 3002434 5398094 5416622 1178122 1098131 544184 615318 50901273 17222795 36131686 33678478 39600 178446 927420 7893946 51917628 56996654 6828460 11532640 33231629 33221709 2773254 1858678 2320338 5074300 45153681 51687327 X 6763947 5309327 6763947 5309327 51917628 56996654 X -4635510 3180890 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 16690 16690 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO IHA AND AHA ANNUALLY. 44.6% OF THESE DUES ARE USED FOR LOBBYING. 375541 375541 18862969 4212642 14650327 675540 88299 587241 30987223 12921854 18065369 33678478 OTHER RECEIVABLES 887121 ASSETS WHOSE USE IS LIMITED 237533 ROU ASSET - FINANCE LEASE 10752 ROU ASSET - OPERATING LEASE 4057541 ESTIMATED THIRD PARTY SETTLEMENTS 2700999 7893946 RELATED PARTY PAYABLE - DEACONESS CARMI CLINIC 1016759 ROU LIABILITY OPERATING LEASE 4057541 5074300 X 68770063 0 68770063 0 68770063 73405573 0 73405573 0 73405573 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 MARCH 31, 2025 AND 2024, 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. DUELING PIANOS 34822 34822 2000 4000 GALA 22490 15500 6990 2311 1220 1260 57312 50322 6990 4311 1220 4000 1260 10791 -3801 1 1 1 X 1 X 1 1 0 1 1 765371 765371 0.01040 10873662 7029016 3844646 0.05240 11639033 7029016 4610017 0.06280 18646 18646 0.00030 18646 18646 0.00030 11657679 7029016 4628663 0.06310 1 2227682 19522419 26466312 -6943893 X 1 1 1 1 FERRELL HOSPITAL COMMUNITY FOUNDATION 1201 PINE STREET ELDORADO IL 62930 FERRELLHOSP.ORG 0005363 X X X X FERRELL HOSPITAL COMMUNITY 0 0 1 X X X X X X X X X 24 1 0 0 1 X WEBSITE LISTED IN PART V, SEC. B, LINE 7D. X X 1 24 1 WEBSITE LISTED IN PART V, SEC. B, LINE 7D. 0 1 X 200.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X HTTPS://WWW.FERRELLHOSPITAL.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE X HTTPS://WWW.FERRELLHOSPITAL.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE X HTTPS://WWW.FERRELLHOSPITAL.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE X X X X 1 X 0 X X X X 1 X 0 0 FERRELL HOSPITAL COMMUNITY PART V, SECTION B, LINE 5: THREE FOCUS GROUPS MET TO DISCUSS OVERALL HEALTH AND WELLNESS IN THE FERRELL HOSPITAL SERVICE AREA AND IDENTIFY HEALTH CONCERNS AND NEEDS IN DELIVERING HEALTHCARE AND HEALTH SERVICES TO IMPROVE WELLNESS AND REDUCE CHRONIC ILLNESS FOR ALL RESIDENTS. THE FOCUS GROUPS INCLUDED REPRESENTATION OF HEALTHCARE PROVIDERS, COMMUNITY LEADERS, COMMUNITY SERVICES PROVIDERS, SCHOOLS, FAITH-BASED ORGANIZATIONS, LOCAL ELECTED OFFICIALS, PUBLIC HEALTH, AND OTHERS. SEVERAL MEMBERS OF THESE GROUPS PROVIDED SERVICES TO UNDERSERVED AND UNSERVED PERSONS AS PART OF THEIR ROLES. THE FOCUS GROUPS' FINDINGS AND SECONDARY DATA ANALYZED BY THE CONSULTANT WERE PRESENTED TO A FOCUSED GROUP TO IDENTIFY ANDPRIORITIZE THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS.A. THREE FOCUS GROUPS WERE CONVENED AT FERRELL HOSPITAL IN OCTOBER 2024, REPRESENTING A BROAD CROSS SECTION OF THE COMMUNITY. THE GROUPS INCLUDED REPRESENTATION FROM COMMUNITY LEADERS, HOSPITAL DEPARTMENT MANAGERS AND MEDICAL PROVIDERS. FOCUS GROUP PARTICIPANTS:FOCUS GROUP ONE - COMMUNITY LEADERSPARTICIPANTS INCLUDED: LOCAL GOVERNMENT LEADERS SCHOOL DISTRICT REPRESENTATIVES COMMUNITY SERVICE PROVIDERS PUBLIC HEALTH OFFICIALS FAITH-BASED GROUPS ORGANIZATIONS SERVING UNDERSERVED/UNSERVED RESIDENTSFOCUS GROUP TWO - HOSPITAL DEPARTMENT MANAGERSINCLUDED LEADERSHIP ACROSS CLINICAL DEPARTMENTS, OPERATIONS, AND ADMINISTRATION.FOCUS GROUP THREE - MEDICAL PROVIDERSINCLUDED FAMILY MEDICINE, SPECIALTY PROVIDERS, AND CLINIC-BASED PHYSICIANS AND ADVANCED PRACTICE PROVIDERS.B. ADDITIONAL ON SITE STAKEHOLDER GROUPS (46 TOTAL PARTICIPANTS)REPRESENTATIVES CAME FROM: CITY OF ELDORADO MEDICINE SHOPPE PHARMACY SOUTHEAST ILLINOIS COLLEGE LAKESIDE EMS EGYPTIAN HEALTH DEPARTMENT ELDORADO CUSD #4 HARRISBURG CUSD #3 YORK PHARMACY FERRELL HOSPITAL LEADERSHIP (25 PARTICIPANTS) FERRELL HOSPITAL PROVIDERS (10 PARTICIPANTS)C. PUBLIC INPUT 94 COMMUNITY MEMBERS COMPLETED A PUBLIC HEALTH NEEDS SURVEY DISTRIBUTED VIA ONLINE PLATFORMS AND SOCIAL MEDIA. COMMUNITY MEMBERS ACROSS ALL SERVICE AREA ZIP CODES PARTICIPATED.D. INTERNAL LEADERSHIP & COORDINATION DIRECTOR OF COMMUNITY RELATIONS & FOUNDATION CHIEF PEOPLE OFFICER SENIOR STAFF AND ADMINISTRATIVE TEAM ICAHN CONSULTANT (ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK) FERRELL HOSPITAL COMMUNITY PART V, SECTION B, LINE 7D: HTTPS://WWW.FERRELLHOSPITAL.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS FERRELL HOSPITAL COMMUNITY PART V, SECTION B, LINE 11: THE TEAM PRIORITIZED TWO OF THE TOP FIVE ISSUES IDENTIFIED - COMMUNITY HEALTH IMPROVEMENT AND ACCESS TO DENTAL CARE RESOURCES. ACTION PLANNING AROUND THESE TWO PRIORITIES CAN INCLUDE BASIC NEEDS, CHRONIC DISEASE PREVENTION AND SUPPORT, AND DEVELOPING A PARTNERSHIP WITH LOCAL SCHOOLS. THEY DID NOT PRIORITIZE SUBSTANCE ABUSE AS THERE IS ALREADY AN ACTIVE SUBSTANCE ABUSE COALITION, SI-SUPRT, IN THE COMMUNITY. THEY WILL, HOWEVER, CONTINUE TO WORK WITH THIS GROUP ON THIS PRIORITY. FOR EACH OF THE PRIORITY AREAS, BROAD ACTIONS THE HOSPITAL INTENDS TO TAKE WERE IDENTIFIED ALONG WITH THE ANTICIPATED IMPACT, THE RESOURCES THE HOSPITAL INTENDS TO COMMIT TO THE ACTIONS, AND THE EXTERNAL COLLABORATORS THE HOSPITAL PLANS TO COOPERATE WITH TO ADDRESS THE NEED. THE PLAN WILL BE EVALUATED BY PERIODIC REVIEW OF MEASURABLE OUTCOME INDICATORS AND ANNUAL REVIEW AND REPORTING.FINAL PRIORITIZED COMMUNITY HEALTH NEEDS - AFTER REVIEWING ALL DATA, THE PRIORITIZATION GROUP IDENTIFIED TWO MAJOR HEALTH PRIORITIES:1. COMMUNITY HEALTH IMPROVEMENT, INCLUDING CHRONIC DISEASE PREVENTION AND MANAGEMENT- INCREASING SCREENINGS (CANCER, DIABETES, ETC.)- NUTRITION AND OBESITY- SMOKING/VAPING CESSATION- HEALTH EDUCATION AND LITERACY- PARTNERSHIPS WITH SCHOOLS FOR YOUTH WELLNESS- ACCESS TO SPECIALTY CAREACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED:- DEVELOP/CONTINUE TO PROVIDE MONTHLY EVENTS TO EDUCATE THE COMMUNITY ON CHRONIC DISEASES, THEIR CAUSES, AND THEIR MANAGEMENT. - REVIEW EDUCATIONAL DOCUMENTS FOR THE PRIMARY CARE OFFICES TO ENSURE THEY ARE COMPLETE, UP-TO-DATE, AND USEFUL FOR CHRONIC DISEASE PATIENTS.- WORK WITH PRIMARY CARE PROVIDERS TO IMPROVE THE NUMBER OF OVERALL CANCER SCREENINGS (MAMMOGRAMS, CERVICAL SCREENINGS, AND GI SCREENINGS). - WORK WITH THE SOUTHERN ILLINOIS HEALTHY COALITION ON EDUCATION TO STOP SMOKING AND VAPING.- WORK WITH COMMUNITY HEALTHCARE PARTNERS TO PROMOTE EACH OTHER'S HEALTH SCREENINGS AND EDUCATIONAL OFFERINGS. - CONTINUE NUTRITIONAL COUNSELING EFFORTS USING THE CURRENT DIETICIANS. - INVESTIGATE POTENTIAL PARTNERSHIPS WITH SCHOOLS AND LOCAL BUSINESSES ON WELLNESS PROGRAMMING.2. ACCESS TO DENTAL CARE RESOURCES, INCLUDING:- LACK OF LOCAL DENTAL PROVIDERS- INCREASED TOOTH LOSS AMONG ADULTS- POOR UTILIZATION OF PREVENTIVE DENTAL CARE- CONNECTION BETWEEN DENTAL HEALTH AND CHRONIC DISEASE- NEED FOR PEDIATRIC DENTAL ACCESS- COMMUNITY MOBILE/"DENTAL SAFARI" CLINIC SUPPORTACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED:- COOPERATE WITH THE FQHC IN THEIR EFFORTS TO PROVIDE PEDIATRIC DENTAL CLINICS. - SUPPORT THE NEW DENTISTS IN THE COMMUNITY. ASK THEM TO SERVE ON MEDICAL STAFF COMMITTEES TO ENGAGE THEM IN THE HOSPITAL'S OPERATIONS. - IMPROVE EDUCATIONAL EFFORTS TO PROMOTE DENTAL HEALTH IN THE COMMUNITY.- ASSIST WITH DENTAL SAFARI/MOBILE CLINICS TO PROMOTE ORAL HEALTH.- INVITE LOCAL DENTAL PROVIDERS TO PARTICIPATE IN FUTURE HEALTH EVENTS FOR THE COMMUNITY.OPPORTUNITIES / NEEDS IDENTIFIED:- TRANSPORTATION BARRIERS- EMS STAFFING AND TRANSFER CHALLENGES- RECRUITMENT OF SPECIALTY AND PRIMARY CARE PROVIDERS- WORKFORCE SHORTAGES- BEHAVIORAL HEALTH AND SUBSTANCE USE DISORDER SERVICES- YOUTH SUPPORT AND PROGRAMMING- ECONOMIC INSTABILITY- ACCESS TO FRESH/HEALTHY FOOD- EXPANDED WELLNESS AND RECREATION OPPORTUNITIES- DAYCARE AVAILABILITY- BROADBAND/TECHNOLOGY GAPS AFFECTING TELEHEALTH FERRELL HOSPITAL COMMUNITY PART V, SECTION B, LINE 23: THE HOSPITAL CHARGES THE SAME AMOUNT FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE FOR FAP-ELIGIBLE PATIENTS AND ALL OTHER PATIENTS. 6 1 - FERRELL HOSPITAL FAMILY PRACTICE 1036 MAPLE STREET ELDORADO IL 62930 RURAL HEALTH CLINIC 2 - EL DORADO FAMILY MEDICINE 1407 LOCUST STREET ELDORADO IL 62930 RURAL HEALTH CLINIC 3 - CARMI FAMILY MEDICINE 1340 IL HWY 1 SUITE A CARMI IL 62821 RURAL HEALTH CLINIC 4 - MCLEANSBORO FAMILY MEDICINE 206 S WASHINGTON STREET MCLEANSBORO IL 62859 RURAL HEALTH CLINIC 5 - HARRISBURG FAMILY MEDICINE 716 S COMMERCIAL STREET HARRISBURG IL 62946 RURAL HEALTH CLINIC 6 - FERRELL HOSPITAL HARRISBURG FAMILY PRACT 30 VETERANS DRIVE HARRISBURG IL 62946 RURAL HEALTH CLINIC PART I, LINE 7: THE HOSPITAL USED A COST TO CHARGE RATIO AS CALCULATED FROM WORKSHEET 2; RATIO OF PATIENT CARE COST TO CHARGES INCLUDED IN THE SCHEDULE H INSTRUCTIONS TO DETERMINE THE AMOUNTS ON LINE 7A OF PART 1 OF SCHEDULE H. PART II, COMMUNITY BUILDING ACTIVITIES: FERRELL HOSPITAL COMMUNITY FOUNDATION OFFERS VARIOUS BENEFITS TO THE COMMUNITY INCLUDING BUT NOT LIMITED TO CPR/FIRST AID, PARTICIPATION IN THE SALINE COUNTY HEALTHY COALITION, PARTICIPATION IN HEALTH FAIRS AT LOCAL HIGH SCHOOLS AND COLLEGES, POISON PREVENTION AND HEALTH CARE CAREER PRESENTATIONS TO LOCAL SCHOOLS, PROVIDE TOURS OF THE HOSPITAL, HOLD FLU VACCINATION CLINICS, PERIODIC BLOOD PRESSURE AND GLUCOSE SCREENINGS, SPEAKING ENGAGEMENTS FOR COMMUNITY ORGANIZATIONS, CO-SPONSOR THE KIDNEY MOBILE, SPONSOR THE LOCAL HIGH SCHOOL PROM, PARTICIPATE IN THE RELAY FOR LIFE, SPONSOR FUNCTIONS AT THE LOCAL SENIOR CITIZENS CENTER, HOLD WELLNESS WORKSHOPS, PROVIDE A TRAINER FOR THE LOCAL HIGH SCHOOL SPORTS TEAMS, PROVIDE FIRST AID KITS FOR LOCAL SPORTS TEAMS, PROVIDE CLOTHING FOR DOMESTIC ABUSE VICTIMS AND PARTICIPATE IN THE SAFE HAVEN PROGRAM. PART III, LINE 2: THE BAD DEBT EXPENSE IS FROM THE TRIAL BALANCE. SEE ATTACHED PRIOR YEAR FINANCIAL STMT PAGES 10 & 11 FOR METHODOLOGY. PART III, LINE 3: FINANCIAL ASSISTANCE COUNSELORS ARE IN PLACE TO CONTACT ANY PATIENT EXPRESSING INTEREST IN THE PROGRAM. PROCEDURES ARE IN PLACE TO MAKE DETERMINATIONS OF ALL PATIENTS' ELIGIBILITY AND TO PROVIDE THE APPROPRIATE ASSISTANCE. PART III, LINE 4: SEE THE PAGES 10 & 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE REVENUE AND ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, LINE 8: THE MEDICARE TOTAL REVENUE AND ALLOWABLE COSTS WERE BASED ON THE FYE 2025 MEDICARE COST REPORT. THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT DUE TO THE HOSPTIAL PROVIDING CARE TO MEDICARE PATIENTS AT LESS THAN THE ALLOWABLE MEDICARE COSTS. PART III, LINE 9B: FERRELL HOSPITAL COMMUNITY FOUNDATION PROVIDES ASSISTANCE TO MEET THE NEEDS OF THE UNINSURED PATIENTS TO WHICH THEY SERVE. FOR THOSE PATIENTS WHO ARE EXPECTED TO QUALIFY UNDER THEIR FINANCIAL ASSISTANCE POLICY, THE HOSPITAL ASSIGNS THE FINANCIAL CARRIER FOR CHARITY CARE AT THE TIME OF THE REQUEST FOR THE HEALTH ASSISTANCE PROGRAM (HAP) APPLICATION. ONCE ASSIGNED, SEVERAL PROCEDURES ARE IN PLACE TO COMPLETE THE PROCESS INCLUDING INVESTIGATION FOR ANY OTHER AVAILABLE FUNDING SOURCES SUCH AS MEDICAID AND INCOME VERIFICATION. THOSE THAT COMPLETE THE HAP ACCURATELY AND QUALIFY UNDER THE HOSPITALS POLICY RECEIVE FREE OR DISCOUNTED CARE. PART VI, LINE 2: FCHF IS INVOLVED IN COMMUNITY ORGANIZATIONS, INCLUDING CHURCHES, CIVIC GROUPS AND PROFESSIONAL ORGANIZATIONS. PART VI, LINE 3: OUR FINANCIAL ASSISTANCE PROGRAM IS EASILY ACCESSED THROUGH OUR WEBSITE AND HAS THE FORMS LISTED FOR THE PATIENT TO PRINT OFF IF NEEDED. THE CONTACT PHONE NUMBERS OF OUR FINANCIAL COUNSELORS ARE ALSO LISTED. THERE ARE FERRELL HOSPITAL FINANCIAL ASSISTANCE BROCHURES IN THE LOBBY AREAS OF THE HOSPITAL. ALL SELF-PAY PATIENTS IN THE HOSPITAL ARE VISITED BY THE FINANCIAL COUNSELOR AND GIVEN THE NECESSARY PAPERWORK IF THE PATIENT REQUESTS IT. IF THE FINANCIAL COUNSELOR DOES NOT GET TO SEE THE PATIENT OR FAMILY, THEN A LETTER IS MAILED ALONG WITH THE APPLICATION TO THE PATIENT. UPON REGISTRATION OF THE PATIENT, THE REGISTRATION STAFF INFORMS THE PATIENT OF THE HOSPITAL FINANCIAL ASSISTANCE PROGRAMS AND GIVES THEM A BROCHURE. IF THE PATIENT REQUESTS TO TALK TO THE FINANCIAL COUNSELOR, THEN THAT PERSON IS CALLED. PART VI, LINE 4: THE MAJORITY OF FERRELL HOSPITAL PATIENTS RESIDE IN SALINE, GALLATIN, WHITE AND HAMILTON COUNTIES. WE ALSO SEE SEVERAL PATIENTS FROM POPE AND HARDIN COUNTIES. OUR FACILITIES ARE LOCATED IN SALINE AND GALLATIN COUNTIES. THE UNEMPLOYMENT RATE AND POVERTY RATE OF THESE COUNTIES ARE HIGHER THAN THE NATIONAL AVERAGE AND VERY CLOSE TO THE STATE OF ILLINOIS AVERAGE. THE PAYER MIX IS HEAVILY MEDICAID/MEDICARE DEPENDENT. PART VI, LINE 7, REPORTS FILED WITH STATES IL X X 0 0 0 0 0 0 0 0 0 NATE OLDHAM MD BOARD MEMBER/PHYSICIAN 413779 0 125374 0 2178 0 8244 0 48291 0 597866 0 0 0 CALEB MITCHELL DO PHYSICIAN 385735 0 89186 0 0 0 6836 0 49636 0 531393 0 0 0 JANNA PATHI MD SURGEON 460997 0 0 0 0 0 0 0 18710 0 479707 0 0 0 JOSEPH A JACKSON MD PHYSICIAN 345280 0 47723 0 0 0 9684 0 50848 0 453535 0 0 0 CLAYTON FORD PHYSICIAN 290012 0 81071 0 17500 0 8419 0 50435 0 447437 0 0 0 DAVID GUNZEL PHYSICIAN 270097 0 62369 0 25000 0 5892 0 33792 0 397150 0 0 0 A ILLINOIS FINANCE AUTHORITY 861091967 000000000 2019-03-27 33260000 CONSTRUCTION AND EQUIPMENT FOR NEW HOSPITAL 0 0 0 A 1147052 33260000 510877 308047 32441076 2021 0 1 1 1 A 0 0 0 0 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 2 CLIFFORD EUGENE MORRIS AND DR. NATE OLDHAM HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 EFFECTIVE JANUARY 1, 2016, THE HOSPITAL ENTERED INTO A FIVE-YEAR MANAGEMENT SERVICES AGREEMENT. MANAGEMENT SERVICES PROVIDED TO THE HOSPITAL CONSIST OF MANAGEMENT PERSONNEL INCLUDING A CEO AND CFO, FACILITY PLANNING, STRATEGIC PLANNING, RECRUITING, AND SEVERAL OTHER SUPPORT AND OVERSIGHT SERVICES. THE INITIAL TERM OF THE AGREEMENT WAS FOR A FIVE-YEAR PERIOD, WHICH COULD BE EXTENDED BEYOND THE INITIAL FIVE-YEAR PERIOD, IF SO DESIRED. FERRELL HOSPITAL ELECTED TO EXTEND THE AGREEMENT AFTER THE INITIAL FIVE-YEAR PERIOD ENDED. THE AGREEMENT COULD BE TERMINATED BY EITHER PARTY WITH A ONE HUNDRED AND EIGHTY DAY NOTICE WITHOUT RECOURSE SUBSEQUENT TO THE INITIAL FIVE-YEAR TERM. THE HOSPITAL WILL REIMBURSE THE MANAGEMENT SERVICE PROVIDER THE ACTUAL COST OF PROVIDING THE MANAGEMENT SERVICES ON A MONTHLY BASIS FOR THE YEARS ENDED MARCH 31, 2025 AND 2024. MANAGEMENT FEES INCURRED WERE $120,000 PER YEAR DURING THE FYE 2025, A PORTION OF COST REPORT PROCEEDS TOTALING $1,573,495 AND THE FOLLOWING INDIVIDUALS WERE COMPENSATED BY THE MANAGEMENT SERVICE PROVIDER: TONY KEENE, CEO, GREG WRIGHT, CFO, AND RACHEL PRATHER, CNO TOTALING $699,559.14. UNLESS OTHERWISE TERMINATED, UPON EXPIRATION OF THE INITIAL TERM THE MANAGEMENT AGREEMENT WILL THEREAFTER AUTOMATICALLY RENEW FOR ADDITIONAL CONSECUTIVE ONE YEAR PERIODS ("EXTENDED TERMS"). FORM 990, PART VI, SECTION B, LINE 11B THE CEO AND CFO REVIEW THE COMPLETED FORM 990 AS PREPARED BY THE PAID PROVIDER FOR COMPLETENESS AND ACCURACY. THE BOARD CHAIR, THE CEO AND THE CFO SUBMIT THE FORM TO THE BOARD AT THE NEXT BOARD MEETING WHICH WILL TAKE PLACE AFTER THE 990 IS SUBMITTED FOR FYE 2025. FORM 990, PART VI, SECTION B, LINE 12C COPIES OF THE CONFLICT OF INTEREST POLICY ARE PROVIDED TO EACH DIRECTOR, OFFICER, AND MANAGEMENT PERSON AT LEAST ONCE PER YEAR, WITH REQUIREMENT THAT THEY COMPLETE A CERTIFICATE. THE CERTIFICATE CONFIRMS THAT THEY UNDERSTAND THIS POLICY, AGREE TO COMPLY, INDICATE ANY KNOWN CONFLICTS, AND HAVE NO KNOWLEDGE OF ANY ADDITIONAL VIOLATIONS OF THE POLICY. ANY PERSON WITH A CONFLICT IS REQUIRED TO COMPLETE A SPECIFIC DISCLOSURE NOTICE. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S SALARY WAS DETERMINED BY COMPARISON WITH PRIOR PERSONS EMPLOYED IN THE POSITION, INDUSTRY COMPARISONS, RELATIVE EXPERIENCE AND KNOWLEDGE. THE CEO'S SALARY WAS APPROVED BY THE BOARD OF DIRECTORS. ALL DELIBERATIONS ARE INCLUDED IN BOARD MINUTES. THIS PROCESS WAS LAST COMPLETED IN 2016 UPON ENTERING INTO THE MANAGEMENT SERVICES AGREEMENT.THE CFO'S SALARY WAS DETERMINED AND APPROVED IN THE SAME MANNER AS THE CEO'S SALARY. ALL OTHER EXECUTIVE SALARIES ARE APPROVED BY EXECUTIVE MANAGEMENT AND ANALYZED BASED ON INDUSTRY COMPARATIVE DATA AND POSITION DESCRIPTIONS, COMMENSURATE EXPERIENCE, EXPERTISE AND TRAINING. THIS PROCESS WAS LAST COMPLETED IN 2016. FORM 990, PART VI, SECTION C, LINE 19 FERRELL HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND FEDERAL FORM 990 TAX RETURNS ARE AVAILABLE TO THE PUBLIC BY REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL MEDICAL FEES: PROGRAM SERVICE EXPENSES 1,172,709. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,172,709. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 8,232,589. MANAGEMENT AND GENERAL EXPENSES 4,865,935. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,098,524. FORM 990, PART XI, LINE 9: CHANGE IN PRIOR YEAR NPRS AND NONOPERATING REVENUE ON FINAL AFS 3,180,890. FORM 990, PART XI, LINE 2C THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR.