2025-08-15T14:47:17-05:00 2024-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2023-10-01 920573933 Deaconess Illinois Crossroads Inc DEAC 6182445500 8 Doctors Park Rd Mount Vernon IL 62864 William Davis Illinois Region President 6182445500 2025-08-15 1 1 Kim Hunwardsen CPA P00484560 6122536500 2025-08-15 2023 2025-03-06 01:10:19Z William Davis 8 Doctors Park Rd Mount Vernon IL 62864 59401273 0 X www.crossroadshospital.com X 2022 IL Acute care hospital providing inpatient, outpatient, and emergency care services. 7 7 287 7 0 0 0 0 33053903 59364341 2004 3576 0 33356 33055907 59401273 0 0 0 0 11692674 16105659 0 0 0 30679664 45864256 42372338 61969915 -9316431 -2568642 30773120 28137367 31233692 31166581 -460572 -3029214 X In keeping with our Christian heritage and tradition of service, the mission of Deaconess is to advance the health and well-being of our community with a compassionate and caring spirit. 0 0 42062096 59364341 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 $79,000 for the year ended September 30, 2024, 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. 42062096 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 36 0 1 287 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 IL X William Davis 6189987020 3333 Deyoung St Marion IL 62959 X Marc J Florence President 1.00 3.00 X X 0 0 0 Steve Titzer Chairperson 1.00 3.00 X X 0 0 0 Glenn Clarida Vice Chairperson 1.00 3.00 X X 0 0 0 Gene Morris Secretary 1.00 3.00 X X 0 0 0 Tony Wielt Treasurer 1.00 3.00 X X 0 0 0 Jeff Justice Director 1.00 3.00 X 0 0 0 Lynn C Lingafelter Director 1.00 3.00 X 0 0 0 William Davis Illinois Region President 10.00 30.00 X 0 0 0 Amber Lipe CFO 10.00 30.00 X 0 0 0 Desiree Stumpf CNO 40.00 0.00 X 135082 0 19856 Kimberly Belangee Family Nurse Practitioner 40.00 0.00 X 125362 0 21149 Paul Lane PA-C General Medicine 40.00 0.00 X 116585 0 28902 David Ray Pharmacy Supervisor 40.00 0.00 X 115417 0 15267 Sonya McKinney APRN FNP-BC Family Medicine 40.00 0.00 X 107347 0 30896 599793 0 116070 8 0 1 0 Deaconess Health System 600 Mary St Evansville IN 47710 Administrative and mgmt services 8976633 Integritas Emergency Physician Services 2250 N Illinois Ave Carbondale IL 62901 Contracted ED Providers 1470635 Trinity Medical Staffing LLC 2250 North Illinois Ave Carbondale IL 62901 Contracted Medical Staffing 1427941 G & G Anesthesia LLC 2023 Vadalabene Drive Suite 350 Maryville IL 62062 Contracted Anesthesia Providers 1405836 HHS Environmental Services LLC 12495 Silver Creek RD Dripping Springs TX 78620 Housekeeping Services 802389 10 Patient Revenue 621110 59318662 59318662 45679 45679 59364341 3576 3576 33356 0 33356 33356 33356 59401273 59364341 0 36932 X 13166227 10798409 2367818 368649 324242 44407 1483914 1305163 178751 1086869 955946 130923 114741 114741 23776557 10406542 13370015 109088 81899 27189 1101188 463469 637719 4825067 3769334 1055733 68379 29737 38642 46362 39802 6560 963309 713344 249965 881601 654548 227053 381905 57005 324900 Medical Supplies 8038691 8038691 Other Taxes & Licenses 3965427 3208192 757235 Repairs & Maintenance 1390170 1173560 216610 Memberships & Dues 201771 42213 159558 61969915 42062096 19907819 0 1110 1110 5102293 4825174 12993812 13108781 1809854 1769034 447582 412225 5245063 1268024 4267006 3977039 6151463 4044004 30773120 28137367 3673637 6850232 27560055 24316349 31233692 31166581 X -460572 -3029214 -460572 -3029214 30773120 28137367 -2568642 0 X 0 1 X 0 0 X 146526 13840 132686 4991561 1254184 3737377 106976 106976 3977039 Estimated Third Party Payor Settlements 98924 Right-of-Use Assets 3945080 4044004 Estimated Third Party Payor Settlement 4312675 Intercompany Liabilities 16007085 Right-of-Use Liabilities 3866589 Estimated Health Claims 130000 24316349 X 59401273 0 59401273 0 59401273 61969915 0 61969915 0 61969915 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 79000 79000 0.00130 14149821 4775634 9374187 0.15130 14228821 4775634 9453187 0.15260 9006026 4472454 4533572 0.07320 9006026 4472454 4533572 0.07320 23234847 9248088 13986759 0.22580 1 5075608 949139 7829055 12020301 -4191246 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 1 X X X X X X X X X 23 1 0 0 1 X https://deaconessillinoiscrossroads.com/ X 1 23 1 https://deaconessillinoiscrossroads.com/ 0 1 X 200.000000000000 350.000000000000 X X X X X 1 1 X X X 1 X https://deaconessillinoiscrossroads.com/financial-assistance/ X https://deaconessillinoiscrossroads.com/financial-assistance/ X https://deaconessillinoiscrossroads.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 5: The data was collected at on-site meetings held in May 2024. Community members, providers, leaders, and employees of Deaconess Illinois Crossroads contributed to this data. Participants from many agencies and communities represented the medically underserved and minorities. The Community Survey Data was collected using Survey Monkey. A link to the survey was open for approximately 60 days and distributed to the community using Crossroad's social media channels. 56 community members completed the survey. Participants included:CASAJefferson County HealthRend Lake CollegeState Farm InsuranceAngels on AssignmentSouth Central TransitAmy Schulz Child Advocacy CenterJefferson Co. Chamber of CommerceComprehensive ConnectionsMt. Vernon Township High School 201Mt. Vernon City Schools D80United WayFamily Medicine M.D. Deaconess Illinois Crossroads, Inc. Part V, Section B, Line 11: A community health needs assessment was completed in fiscal year 2024 and thus no specific actions were taken during the current year. The following needs identified will be addressed over the next 3 years.Access to CareCommunity CollaborationHealth EducationACCESS TO CARE: Improve access to care by continuing to recruit and retain providers for primary care, specialty care clinics, mental health provision, and substance abuse treatment/services.Actions the hospital intends to take to address the health need -Evaluate the primary and specialty care services needed in the community. Potentially recruit or provide those services through Deaconess Health partnerships.-Evaluate the mental and substance abuse services provided in the community and the need for additional providers/services. Work with community partners and Deaconess Health to ensure gaps are filled as possible.-Work with current providers in the service market area to retain their services to Deaconess Illinois Crossroads and the community.-Evaluate internal processes within Deaconess Illinois Crossroads to ensure the best customer experience.COMMUNITY COLLABORATION: Improve community coordination by developing and maximizing health service partnerships.Actions the hospital intends to take to address the health need-Support and participate in the inner agency group meeting in the community (if one exists) or develop this group to ensure agencies understand what each does and the priorities they are working on. This will potentially reduce duplication of services and allow more agency collaboration. -Investigate developing or renovating a resource guide to assist agencies and patients/residents in finding needed resources.-Support local agencies that address food insecurity, such as local food pantries. Investigate budgeting dollars for this and leverage social media channels to raise awareness of these agencies and solicit potential donors.HEALTH EDUCATION: Improve the overall health education of the community through health promotion screenings and events in chronic disease management, cancer screenings, and health education.Actions the hospital intends to take to address the health need-Review patient educational documents to ensure understandable explanations of the patient's condition, care, and treatment. Educate nursing staff to reinforce the importance of this additional education with patients.-Health fair in the community.-Investigate a partnership with local schools utilizing employees to educate students on the benefits of diet and exercise, strategies to improve their physical and mental health, chronic diseases and management, and exposure to health careers and job opportunities at Deaconess Illinois Crossroads.-Increase free or low-cost cancer screenings in the community.-Rebranding of the facility in the community to improve awareness of services and the changes that are being made as a part of Deaconess Health.-Focus on men's and women's health prevention care in primary care offices.-Smoking cessation-Stroke awareness 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 18.7% 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 8 and 9 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 placed 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 Hospital seeks out patients that may qualify for finanical assistance. Interviews are conducted on self-pay patients while they are at the Hospital. 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. Well Fund is available to patients to assist with applying for Medicaid or exchange products. 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. 18.7% of the population for whom poverty status is determined in Mount Vernon, IL (2.6k out of 13.9k people) live below the poverty line, a number that is higher than the national average of 12.4%. In 2023, the median household income in Mount Vernon, IL grew to $52,751 from the previous year's value of $48,786. Between 2022 and 2023, the percent of uninsured citizens in Mount Vernon, IL grew from 6.05% to 6.06%.From 2022 to 2023, employment in Mount Vernon, IL declined at a rate of 0.88%, from 6.59k employees to 6.54k employees. The most common job groups, by number of people living in Mount Vernon, IL, are Office & Administrative Support Occupations, Production Occupations, and Food Preparation & Serving Related Occupations. 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. 0 0 0 0 0 0 0 0 0 Desiree Stumpf CNO 135082 0 0 0 0 0 1918 0 17978 0 154978 0 0 0 Part I, Line 3 William Davis, Illinois Region President, is compensated by Deaconess Health System, an unrelated organization, through a management agreement for services to the Hospital and related entities. Deaconess Health System uses some of the processes described in Part I, Question 3 to determine compensation, including comparability data and an independent compensation consultant. Compensation approval is done by the Board of Directors or Compensation Committee of Deaconess Health System. Form 990, Part VI, Section A, line 3 William Davis, Illinois Region President, and Amber Lipe, CFO, are employed by Deaconess Health System, an unrelated organization. Compensation is provided by Deaconess Health System through a management agreement for services to Deaconess Illinois Red Bud Regional Hospital, Deaconess Illinois Union County Hospital, Deaconess Illinois Crossroads, and Deaconess Regional Healthcare Services Illinois. All four are related entities. The Illinois Region President position has the responsibility of supervising the management, administration, and operation of the organizations. The CFO has the responsibility for managing the financial operations of the organizations. Calendar year 2023 compensation is below. Compensation Benefits William Davis 323,636 21,697 Amber Lipe 329,969 1,007 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 CEO 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 IX, line 11g Purchased Services: Program service expenses 2,935,311. Management and general expenses 13,356,108. Fundraising expenses 0. Total expenses 16,291,419. Medical Fees: Program service expenses 6,557,275. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,557,275. Contract labor: Program service expenses 913,956. Management and general expenses 13,907. Fundraising expenses 0. Total expenses 927,863. 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 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0