2024-08-14T17:01:29-05:00 2023-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2022-10-03 920573933 Deaconess Illinois Crossroads Inc DEAC 6182445500 8 Doctors Park Rd Mount Vernon IL 62864 Amber Lipe CFO 6182445500 2024-08-14 1 1 Kim Hunwardsen CPA P00484560 6122536500 2024-08-14 2022 2024-08-08 14:25:15Z X William Davis 8 Doctors Park Rd Mount Vernon IL 62864 33055907 0 X www.crossroadshospital.com X 2022 IL Acute care hospital providing inpatient, outpatient, and emergency care services. 7 7 0 7 0 0 0 33053903 2004 0 33055907 0 0 11692674 0 0 30679664 42372338 -9316431 30773120 31233692 -460572 X None 0 0 33337961 33053903 Deaconess Illinois Crossroads, Inc. (Hospital), is a 47-bed acute care hospital located in Mount Vernon, Illinois, formerly known as Crossroads Community Hospital. The Hospital provides inpatient, outpatient, and emergency care services for residents of southern Illinois. Effective January 14, 2023, Crossroads Community Hospital was acquired by Deaconess Regional Healthcare Services Illinois, Inc. (Deaconess) which is organized as a nonprofit corporation to facilitate diversification of services across Southern Illinois and Indiana.Statement continued on Schedule O.The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Since the Hospital does not pursue collections of these amounts, they are not reported as patient service revenue. The estimated cost of providing these services was $28,000 for the period January 14, 2023 (Date of Inception) to September 30, 2023, calculated by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients. 33337961 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 1 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 IL X Amber Lipe 6189987020 3333 Deyoung St Marion IL 62959 X X Marc J Florence President 0.50 45.00 X X 0 0 0 Lynn C Lingafelter Secretary 0.50 1.50 X X 0 0 0 Glenn Clarida Director 0.50 1.50 X 0 0 0 Jeff Justice Director 0.50 1.50 X 0 0 0 Gene Morris Director 0.50 1.50 X 0 0 0 Steve Titzer Director 0.50 1.50 X 0 0 0 Tony Wielt Director 0.50 1.50 X 0 0 0 William Davis CAO as of 1/14/23 5.00 55.00 X 0 0 0 Amber Lipe CFO 5.00 55.00 X 0 0 0 0 0 0 0 0 0 0 0 Patient service revenue 621110 33004103 33004103 49800 49800 33053903 654 654 1350 0 1350 1350 1350 33055907 33053903 0 2004 X 9255158 8442199 812959 1711990 1561612 150378 725526 653407 72119 317109 317109 10400 10400 14922810 9185297 5737513 116606 116606 3336119 2690919 645200 256447 40656 215791 837556 626465 211091 37443 18362 19081 38165 26146 12019 305149 305149 621969 462199 159770 333419 259475 73944 Medical Supplies 6153946 6083089 70857 Other Taxes & Licenses 2382030 2174618 207412 Repairs & Maintenance 814558 765003 49555 Memberships & Dues 135853 40736 95117 60085 2629 57456 42372338 33337961 9034377 0 1110 5102293 12993812 1809854 447582 4826132 559126 0 4267006 0 6151463 0 30773120 3673637 0 27560055 0 31233692 X -460572 0 -460572 0 30773120 X -9316431 8855859 X 0 1 X 0 0 X 92995 3308 89687 4733137 555818 4177319 4267006 Estimated Third Party Payor Settlements 2807841 Other Assets 16953 Right-of-Use Assets 3326669 6151463 Estimated third-party payor settlements 8827499 Due to related parties 14664759 Right-of-use liabilities 3377797 Estimated health claims 690000 27560055 X 33055907 0 33055907 0 33055907 42372338 0 42372338 0 42372338 Part X, Line 2: The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. 1 1 X 1 X 1 X 1 1 1 0 0 28000 28000 0.00070 10510039 3061526 7448513 0.17580 10538039 3061526 7476513 0.17650 5577730 2199195 3378535 0.07970 5577730 2199195 3378535 0.07970 16115769 5260721 10855048 0.25620 1 3874668 546328 4489871 6855052 -2365181 X 1 1 1 1 Deaconess Illinois Crossroads Inc 8 Doctors Park Rd Mount Vernon IL 62864 www.crossroadshospital.com 0006353 X X X 2 provider based rural health clinics Deaconess Illinois Crossroads Inc 1 0 1 0 0 1 X 200.000000000000 350.000000000000 X X X X X 1 1 X X X 1 X https://crossroadshospital.com/financial-assistance/ X https://crossroadshospital.com/financial-assistance/ X https://crossroadshospital.com/financial-assistance/ X X X X X X 1 X 0 X X X X 1 X 0 0 Deaconess Illinois Crossroads, Inc. Part V, Section B, Line 2: Deaconess Illinois Crossroads, Inc. is a new legal entity, incorporated October 3, 2022. The IRS granted tax exempt status as of October 3, 2022. The hospital was acquired by this entity and operations began January 14, 2023. Prior to that date, the hospital was owned and operated by a governmental entity. Deaconess Illinois Crossroads, Inc. Part V, Section B, Line 13h: In the event there is no evidence to support a patient's eligibility for charity care, the Hospital could, for patients above 200% of the Federal Poverty Guidelines, use outside agencies in determining collectability scoring for the basis of determining charity care eligibility. Presumptive eligibility may also be determined on the basis of individual life circumstances that may include:1. Homeless or received care from a homeless clinic2. Food stamp eligibility3. Patient is deceased with no known estate a. Balances due for deceased minors are excluded from charity care. These balances will remain due.4. For all Medicaid Financial Class Payors, if a denial or edit for a non-covered Medicaid/HIP charge is received, that charge will be adjusted to charity.Services eligible under this Policy will be made available to the patient on a sliding fee scale, in accordance with financial need, as determined in reference to Federal Poverty Levels (FPL) in effect at the time of the determination. The basis for the amounts the Hospital will charge patients qualifying for financial assistance may also be modified as follows:- Patients whose family income exceeds 350% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of the Hospital.-The Hospital Uninsured Patient Discount Act also provides for a maximum collectable amount. During a 12-month period, a hospital may collect no more than 20% of the patient's' family income. The 12-month period begins on the first date the uninsured patient receives health care services eligible for an uninsured discount. Uninsured patients must be permitted to apply for a discount within 90 days of the date of discharge/service. Part I, Line 3c: In the event there is no evidence to support a patient's eligibility for charity care, the Hospital could, for patients above 200% of the Federal Poverty Guidelines, use outside agencies in determining collectability scoring for the basis of determining charity care eligibility. Presumptive eligibility may also be determined on the basis of individual life circumstances that may include:1. Homeless or received care from a homeless clinic2. Food stamp eligibility3. Patient is deceased with no known estate a. Balances due for deceased minors are excluded from charity care. These balances will remain due.4. For all Medicaid Financial Class Payors, if a denial or edit for a non-covered Medicaid/HIP charge is received, that charge will be adjusted to charity.Services eligible under this Policy will be made available to the patient on a sliding fee scale, in accordance with financial need, as determined in reference to Federal Poverty Levels (FPL) in effect at the time of the determination. The basis for the amounts the Hospital will charge patients qualifying for financial assistance may also be modified as follows:- Patients whose family income exceeds 350% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of the Hospital.-The Hospital Uninsured Patient Discount Act also provides for a maximum collectable amount. During a 12-month period, a hospital may collect no more than 20% of the patient's' family income. The 12-month period begins on the first date the uninsured patient receives health care services eligible for an uninsured discount. Uninsured patients must be permitted to apply for a discount within 90 days of the date of discharge/service. Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost to charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concession based on its historical collection experience with this class of patients. Part III, Line 3: The estimated amount of the Organization's implicit price concessions attributable to patients eligible under the Organization's charity care policy is calculated based on an approximate 14.1% of individuals living below the poverty level in the service area. Part III, Line 4: The footnote to the organization's financial statements that describes implicit price concessions is located on pages 9 and 10 of the attached financial statements. Part III, Line 8: Deaconess Illinois Crossroads, Inc. is an acute care hospital showing a Medicare shortfall. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit.Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: The Hospital does not pursue collection activities for patients that qualify for charity care or patients that have set up payment arrangements for their accounts. Also, collection activities are not pursued for patients that are in the process of applying for charity care and patients waiting for approval or denial from public aid. Any personal portion due after financial assistance is established would follow normal collection procedures.No extraordinary collection activities will begin until after 120 days from the time the first post-discharge statement was provided. Accounts remain in a primary collection agency for approximately 250 days. After 250 days accounts may be place with a secondary collection agency. Part VI, Line 2: Community input on desired services is obtained through patient satisfaction surveys that are initiated by the inpatient unit and emergency department that provide a line of communication to identify additional health care services that community desires. Part VI, Line 3: The financial assistance policy is posted in admission areas where patients are present and on the hospital website. Discussions with patients also occur regarding availability of various government programs, such as Medicaid or state programs and assists the patient with qualification with such programs, where applicable. Part VI, Line 4: Deaconess Illinois Crossroads, Inc. (Hospital), is a 47-bed acute care hospital located in Mount Vernon, Illinois. The Hospital provides inpatient, outpatient, and emergency care services for residents of southern Illinois. 14.1% of the population for whom poverty status is determined in Mount Vernon, IL (4.98k out of 35.2k people) live below the poverty line, a number that is higher than the national average of 12.5%. Between 2021 and 2022, the percent of uninsured citizens in Mount Vernon, IL grew by 0.266% from 7.05% to 7.07%.Unemployment was 4.1%, which is lower than the Illinois average (4.4%) but higher than the United States unemployment rate average (3.5%). As in much of rural Illinois, the average household income in the service area, $74,161, is lower than the statewide or national average.From 2021 to 2022, employment in Mount Vernon, IL grew at a rate of 0.982%, from 16.2k employees to 16.4k employees. The most common employment sectors for those who live in Mount Vernon, IL, are Health Care & Social Assistance, Manufacturing, and Retail Trade. Part VI, Line 5: The Hospital is dedicated to improving health by providing education and wellness programs and innovative services at all the stages of life for its residents. As a 47-bed acute care hospital services include gastroenterology, family and internal medicine, intensive care, orthopedics, podiatry, rehabilitation services, surgical services and robotic surgery, urology, women's health, and a sleep disorders center. Deaconess Illinois Crossroads, Inc. has a board appointed by the community board of its sole member, Deaconess Illinois. Medical staff privileges in the Hospital are available to all qualified physicians in the area, consistent with the size and nature of its facilities. The Hospital operates a full-time emergency room and extends treatment to anyone requiring emergency medical care regardless of ability to pay. Any excess funds generally are applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement in patient care, and medical training, education, and research. Treatment at the Hospital's facilities is available to all those able to pay directly or through third-party reimbursement, including through Medicare and Medicaid. In addition, the Hospital operates in accordance with Section 501(r) of the Code, including through a financial assistance policy pursuant to which the Hospital provides emergency and medically necessary care to patients regardless of their ability to pay. Form 990, Part VI, Section A, line 4 The Bylaws were amended on 8/1/2023 Article VI 6.1 The offices of Secretary and Treasurer could be held by the same individual. That was updated to any two or more offices may be held by the same individual. The term the officer can serve was changed from 2 years to 1 year. President was added as an officer. 6.6 Duties of the President were added to the amended Bylaws. Article VIII 8.1 Quality Improvement: The Board established a quality improvement program to maintain, support and exercise oversight of an ongoing quality improvement program that includes specific and effective review, evaluation and monitoring mechanisms to assess, preserve and improve the overall quality and efficiency of patient care by the Corporation with respect to the Hospital and any related healthcare entity. Article IX 9.1 Case Management: In the interest of patient safety and financial integrity of the institution, it is the Board's responsibility to ensure the Hospital conducts an ongoing program of case management to determine the propriety of admissions to the Hospital, utilization of Hospital resources, appropriate length of stay in the Hospital and timely discharge of patients from the Hospital. Form 990, Part VI, Section A, line 6 The Sole Member is Deaconess Regional Healthcare Services Illinois, Inc., an Illinois not for profit corporation that is exempt from federal income taxation under Section 501(a) of the Code as an organization described in Section 501(c)(3) of the Code. Form 990, Part VI, Section A, line 7a All Directors shall be appointed by the Member. Form 990, Part VI, Section A, line 7b The actions set forth below shall be reserved solely to the Member. Governance 1. Appointment and removal of the Corporation's Directors. Financial 1. Approval of any capital and operating budgets for the Corporation (subject to the right of the Member, as part of the approval process, to make modifications as the Member deems necessary or appropriate); 2. Approval of any financial commitment, obligation or expenditure by the Corporation of an amount that exceeds a financial limit for capital expenditures or otherwise that may be established from time to time by the Member; 3. Approval of borrowing or lending of money or the incurrence or guarantee of any debt or other financial obligation, directly or indirectly, by the Corporation that exceeds a financial threshold (whether or not strictly monetary) that may be established from time to time by the Member; 4. Approval of any charitable contributions in excess of, or outside of, policies previously established and approved by the Member; 5. Making of any distribution to the Member or any Affiliate, provided that the Member or the Affiliate shall be, at the time of such distribution, a nonprofit organization duly qualified under Section 501(c)(3) of the Code. 6. Approval of any compensation or reimbursement of expenses for Directors of the Corporation beyond that allowed by policies adopted from time to time by the Member. Operations 1. Approval of any strategic plan, business plan, or mission plan of the Corporation, including without limitation authorization of any material changes in the scope of services offered by the Corporation, or any amendments thereto (subject in each case to the right of the Member, as part of the approval process, to make modifications as the Member deems necessary or appropriate); 2. The initiation of any studies, audits, and other periodic reviews as are deemed necessary by the Member with respect to the existing or planned operations of the Corporation; 3. Adoption and amendment of compensation plans or methodologies, salaries and other compensation (including the awarding of any incentive compensation) and benefits; and 4. Approval of the other terms of employment or engagement of the officers and employees, including, but not limited to, physician employees of the Corporation, and physicians who are independent contractors to the Corporation (subject in each case to the right of the Member, as part of the approval process, to make modifications as the Member deems necessary or appropriate). Legal 1. Creation, ownership, or acquisition (whether in whole or in part) and dissolution of any subsidiary or affiliate of the Corporation; 2. Any acquisition, purchase, sale, lease, mortgage, or other transfer or encumbrance ("Transfers") of (i) any property in excess of a financial threshold (whether or not strictly monetary) established by the Member from time to time or (ii) any real property of the Corporation, irrespective of the value; 3. Any Transfer of any personal property of the Corporation, if the sum of the value of such Transferred personal property and the aggregate value of all prior Transfers of personal property during the fiscal year is greater than a financial threshold (whether or not strictly monetary) that may be established from time to time by the Member; 4. Any dissolution, merger, consolidation, sale, or other corporate restructuring of the Corporation; 5. Any creation, modification or termination by the Corporation of any corporate compliance program different from the program maintained by Deaconess Regional Healthcare Services Illinois, Inc.; 6. The amendment, modification or restatement of the Corporation's policies addressing the provision of charity or uncompensated care or the process for collecting amounts due from patients; 7. Selection, retention or termination of the Corporation's auditors or legal counsel; 8. Establishment, adoption or amendment of any indemnification rights, obligations, or agreements affecting the Corporation; 9. Purchase, adoption, amendment, cancellation, or replacement of any insurance coverage for the Corporation or its Directors, officers, employees, and agents; 10. The commencement, settlement or termination of litigation or other claims, or alternative dispute resolution, including, but not limited to, mediation or arbitration that exceeds a financial limit (whether or not strictly monetary) that may be established from time to time by the Member; 11. The filing of any voluntary petition in bankruptcy or any other petition or pleading seeking any reorganization, receivership or similar relief under federal or state law; 12. Any of the foregoing reserve powers with respect to any subsidiary or affiliate of the Corporation; and 13. Any other matters with respect to which authority is granted to the Member by the Articles of Incorporation, these Bylaws, or applicable law. Form 990, Part VI, Section A, line 8b The Organization does not have committees with authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The Form 990 is provided to the board before it is filed. The CAO and CFO review the Form 990. Form 990, Part VI, Section B, line 12c The Board of Directors are required to comply with the Conflict of Interest Policy and individually disclose to the Member and to the Board of Directors, at times of nomination and appointment, the identity of each potential conflict known to the Director. Conflicts are considered with respect to outside interest, investments, outside activities, and business interests among the interested persons as well as their family members. If a conflict is identified, the interested person is not allowed to vote on the matter and may be asked to leave the meeting. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990, Part VII: Deaconess Illinois Crossroads, Inc. was acquired by Deaconess Regional Healthcare Services Illinois, Inc. and began health care services on January 14, 2023, therefore the Hospital did not pay compensation in calendar year 2022 to any employees or independent contractors. William Davis, CAO, and Amber Lipe, CFO, are compensated by Deaconess Health System, Inc., an unrelated organization, for services to Deaconess Illinois Crossroads, Inc. and other related hospitals. The CAO and CFO began officer duties in January 2023 when the Hospital was acquired by Deaconess Regional Healthcare Services Illinois, Inc. Form 990, Part IX, line 11g Purchased Services: Program service expenses 4,968,199. Management and general expenses 5,737,513. Fundraising expenses 0. Total expenses 10,705,712. Medical Fees: Program service expenses 3,323,654. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,323,654. Contract Labor: Program service expenses 893,444. Management and general expenses 0. Fundraising expenses 0. Total expenses 893,444. Form 990, Part XI, line 9: Transfer from Affiliate 8,855,859. Deaconess Regional Healthcare Services Illinois Inc 3333 W Deyoung Marion IL 62959 810693478 Health care services IL 501(c)(3) Line 10 N/A 0 Deaconess Illinois Red Bud Regional Hospital Inc 325 Spring St Red Bud IL 62278 884142509 Health care services IL 501(c)(3) Line 3 Deaconess Regional Healthcare Services Illinois Inc 0 Deaconess Illinois Union County Hospital Inc 517 N Main St Anna IL 62906 920574426 Health care services IL 501(c)(3) Line 3 Deaconess Regional Healthcare Services Illinois Inc 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 1 1 0 0 1