2022-11-15T15:25:23-06:00 2021-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 4000 INDIANAPOLIS IN 46204 990 2021-01-01 371363001 RICHLAND MEMORIAL HOSPITAL % DENNIS HESCH RICH 6183952131 800 East Locust Street Olney IL 62450 DENNIS HESCH EXEC VP & CFO 6183952131 2022-11-15 true DENNIS HESCH 999009999 JENNIFER D RHODERICK P00395735 3176817000 2 2021 2022-09-23 18:48:47Z Dennis Hesch Exec VP CFO 611 W Part St Urbana IL 61801 55839614 false X See Schedule O X 1953 IL To provide excellent healthcare, promote wellness, and educate patients, staff, and the community. 12 8 508 45 716260 0 8928295 2055880 45322924 51779241 120538 87875 518657 958547 54890414 54881543 26017 226587 0 0 28430416 34209626 0 0 0 31659047 28250546 60115480 62686759 -5225066 -7805216 53443489 31450471 18464663 16108992 34978826 15341479 X TO PROVIDE EXCELLENT HEALTHCARE, PROMOTE WELLNESS, AND EDUCATE PATIENTS, STAFF, AND THE COMMUNITY. false false 54026939 226587 51844932 SEE SCHEDULE O 54026939 true true false true false false false false false false true false false false true true false true false false false false false false false false true true true false true false false false false false false true false false false false false false true true true false false true 56 0 true 508 true true true false false false false false false false false false false false X 12 8 true false false false true true true true true false false true true true true true true true true false IL X X DENNIS HESCH 2173833311 611 W PARK ST URBANA IL 61801 X James C Leonard MD Ex-Officio, President & CEO 1.0 39.0 X 0 2558835 641658 JOHN SNYDER Officer - Former 0.0 0.0 X 0 1942803 14339 Dennis Hesch Exec VP & CFO 1.0 39.0 X 0 1566892 375816 MATTHEW KOLB Trustee, EVP, & COO 1.0 39.0 X X 0 1159563 337604 HARRY BROCKUS CEO TERM 3/2021 40.0 0.0 X 0 695134 207122 LAUREN SCHMID EXEC VP, CHIEF HR OFFICER 1.0 39.0 X 0 657819 185334 JARROD ALMAROAD MD TRUSTEE - FORMER 0.0 40.0 X 0 786301 38945 KENNETH ARONSON MD MED DIR - DIAGNOSTIC SERVICES 1.0 39.0 X 0 568392 36812 SALLY SALMONS MD TRUSTEE & PHYSICIAN 2.0 38.0 X 0 491634 81599 RAYMOND FISHER MD TRUSTEE & PHYSICIAN 40.0 0.0 X 521074 0 33828 TANNER MILLER MD RMH MEDICAL DIRECTOR 2.0 39.0 X 0 382552 50451 John Allen CRNA - RMH Anesth 40.0 0.0 X 262531 0 50982 John Wall CRNA LEAD - RMH ANESTH 40.0 0.0 X 264583 0 47684 Thomas Falcone CRNA - RMH Anesth 40.0 0.0 X 253578 0 45715 Benjamin Curtis CRNA - RMH Anesth 40.0 0.0 X 250133 0 47231 Regina Thomas PRESIDENT OF RMH 40.0 0.0 X 249919 0 35746 MELISSA KUENSTLER NP NP - RICHLAND CONVENIENT CARE 40.0 0.0 X 183476 0 13933 CHRISTINA BARE Key Employee - Former 40.0 0.0 X 171985 0 13190 DAN EICHELBERGER CHAIR OF THE BOARD TERM 9/2021 0.0 0.0 X X 0 0 0 GARY HOUCHIN VICE CHAIR OF BOARD 1.0 0.0 X X 0 0 0 JASON GLOVER SECRETARY OF BOARD 1.0 0.0 X X 0 0 0 Jennifer Cummins-Zuber CHAIR OF BOARD 1.0 0.0 X X 0 0 0 ROB MCCLAIN TREASURER OF BOARD 1.0 0.0 X X 0 0 0 TOMMIE FEHRENBACHER TRUSTEE 1.0 0.0 X 0 0 0 PATRICIA KESSLER-BOOKHOUTDDS TRUSTEE 1.0 0.0 X 0 0 0 COLE DUKE TRUSTEE 1.0 0.0 X 0 0 0 LARRY DUNN TRUSTEE 1.0 0.0 X 0 0 0 SHERRY GEIER TRUSTEE 1.0 0.0 X 0 0 0 2157279 10809925 2257989 37 true true false RURAL PHYSICIANS GROUP 5575 DTC PARKWAY STE 225 GREENWOOD VILLAGE CO 80111 STAFFING 861042 ALL STAR RECRUITING LOCUMS 800 FAIRWAY DRIVE DEERFIELD FL 33441 STAFFING 501798 GRUNLOH CONSTRUCTION INC 101 W TEMPLE AVE EFFINGHAM IL 62401 CONSTRUCTION 284663 QUEST DIAGNOSTICS PO BOX 775460 CHICAGO IL 606775460 LAB SERVICES 224495 COMPHEALTH INC PO BOx 872651 DALLAS TX 753972651 STAFFING 184206 12 77844 1978036 0 11897 2055880 NET PATIENT SERVICE REVENUE 622110 51768268 51768268 RENT FROM RELATED ORGS 523000 10176 10176 ALL OTHER PROGRAM SERVICES REVENUE 900099 797 797 51779241 87875 87875 0 0 0 0 0 0 0 0 0 0 0 0 1531800 958071 573729 573729 CAFETERIA SERVICES 722331 155564 155564 LAUNDRY SERVICES 812331 121966 121966 CATERING REVENUE 722320 20565 20565 86723 65691 21032 384818 54881543 51844932 716260 264471 X 226587 226587 0 0 0 851112 851112 107128 107128 27202482 22750532 4451950 1484894 1224855 260039 2781223 2369210 412013 1782787 1465190 317597 0 38122 38122 0 1680 1680 0 0 2062197 1878850 183347 5540 5540 1412972 1052734 360238 179831 154552 25279 0 889136 688775 200361 42882 30295 12587 0 32686 28169 4517 243547 195972 47575 0 2502948 1714897 788051 138556 113571 24985 OTHER PURCHASED SERVICES 1928148 1335662 592486 PATIENT CARE SUPPLIES 5136366 5136366 INTERNAL PURCHASED SERVS 10761682 10107496 654186 PROVIDER ASSESSMENT TAX 2519613 2519613 354640 75373 279267 62686759 54026939 8659820 0 0 0 23021800 4100567 0 0 7527209 5974379 0 0 0 0 658741 411380 893260 893708 211758 239268 63164224 43530138 20912708 19634086 0 0 0 0 0 0 0 0 218013 197083 53443489 31450471 5610116 4553156 0 0 1985272 2307829 0 0 0 0 0 0 5355558 5005634 0 0 5513717 4242373 18464663 16108992 X 34978826 15341479 0 0 34978826 15341479 53443489 31450471 X -7805216 0 -11832131 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1680 1680 false SCHEDULE C, PART IV $1,680 - PORTION OF HEALTH CARE ORGANIZATION DUES ATTRIBUTABLE TO LOBBYING 1005119 1005119 33223219 21226154 11997065 27807603 21740419 6067184 1128283 563565 564718 19634086 0 DUE TO BLUE CROSS 1136780 ASSET RETIREMENT OBLIGATION 3105593 OPERATING LEASE LIABILITY 0 4242373 X SCHEDULE D, PART X, LINE 2 - FIN 48(ASC740) FOOTNOTE THE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES PRESCRIBES A MORE-LIKELY-THAN-NOT RECOGNITION THERESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENTS RECOGNITION OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN. THERE WERE NO UNCERTAIN TAX BENEFITS IDENTIFIED OR RECORDED AS A LIABILITY AS OF DECEMBER 31, 2021 AND 2020. true true X true X true X true true false true true 1009926 1009926 0.01610 14129562 6113264 8016298 0.12790 15139488 6113264 9026224 0.14400 3020 3020 0.00000 91570 91570 0.00150 6144464 6144464 0.09800 235717 235717 0.00380 6474771 6474771 0.10330 21614259 6113264 15500995 0.24730 17899 17899 0.00030 17899 17899 0.00030 true 610845 305423 15588420 21928555 -6340135 X true true 1 1 Richland Memorial Hospital 800 East locust Olney IL 62450 See Part V, Section C 0004200 X X X RICHLAND MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 21 true false false true X SEE PART V, SECTION C X true 21 true SEE PART V, SECTION C false true X 200. 400. true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X X true X false false PART V, SECTION B, LINE 5 - COMMUNITY HEALTH NEEDS ASSESSMENT PROVISIONS IN THE AFFORDABLE CARE ACT (ACA) REQUIRE CHARITABLE HOSPITALS TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE CHNA IS A SYSTEMATIC PROCESS INVOLVING THE COMMUNITY TO IDENTIFY AND ANALYZE COMMUNITY HEALTH NEEDS AS WELL AS COMMUNITY ASSETS AND RESOURCES IN ORDER TO PLAN AND ACT UPON PRIORITY COMMUNITY HEALTH NEEDS. THIS ASSESSMENT PROCESS RESULTS IN A CHNA REPORT WHICH ASSISTS THE HOSPITAL IN PLANNING, IMPLEMENTING, AND EVALUATING HOSPITAL STRATEGIES AND COMMUNITY BENEFIT ACTIVITIES. THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS DEVELOPED AND CONDUCTED, IN PARTNERSHIP WITH REPRESENTATIVES FROM THE COMMUNITY, BY A CONSULTANT PROVIDED THROUGH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (ICAHN). ICAHN IS A NOT-FOR-PROFIT 501(C)(3) CORPORATION ESTABLISHED IN 2003 FOR THE PURPOSES OF SHARING RESOURCES, EDUCATION, PROMOTING OPERATIONAL EFFICIENCIES, AND IMPROVING HEALTHCARE SERVICES FOR MEMBER CRITICAL ACCESS AND RURAL HOSPITALS AND THEIR COMMUNITIES. ICAHN, WITH 57 MEMBER HOSPITALS, IS AN INDEPENDENT NETWORK GOVERNED BY A NINE-MEMBER BOARD OF DIRECTORS, WITH STANDING AND PROJECT DEVELOPMENT COMMITTEES FACILITATING THE OVERALL ACTIVITIES OF THE NETWORK. ICAHN CONTINUALLY STRIVES TO STRENGTHEN THE CAPACITY AND VIABILITY OF ITS MEMBERS AND RURAL HEALTH PROVIDERS. 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 OLNEY AND THE SURROUNDING AREA. THREE FOCUS GROUPS MET THROUGH FACILITATED VIRTUAL CONFERENCING ON MAY 20, 2021, TO DISCUSS THE STATE OF OVERALL HEALTH AND WELLNESS IN THE RICHLAND MEMORIAL HOSPITAL (RMH) SERVICE AREA. THEY WERE ALSO TASKED WITH IDENTIFYING 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, FAITH-BASED ORGANIZATIONS, LOCAL ELECTED OFFICIALS, PUBLIC HEALTH, AND OTHERS. SEVERAL MEMBERS OF THE 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 THROUGH A VIRTUAL CONFERENCE ON JUNE 28, 2021. THE GROUP CONSISTED OF REPRESENTATIVES OF PUBLIC HEALTH, COMMUNITY LEADERS, HEALTHCARE PROVIDERS, AND COMMUNITY SERVICES PROVIDERS. PART V, SECTION B, LINES 7a & 10 - COMMUNITY HEALTH NEEDS ASSESSMENT THE CHNA AND IMPLEMENTATION STRATEGY ARE AVAILABLE AT HTTPS://CARLE.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS. PART V, SECTION B, LINE 11 - COMMUNITY HEALTH NEEDS ASSESSMENT PART V, SECTION C, LINE 16 THE NEEDS IDENTIFIED AND PRIORITIZED THROUGHOUT THE 2021 CHNA CARRIED FORWARD VARIANTS OF PREVIOUS CHNAS AND ADDED OTHERS. THE IDENTIFIED AND PRIORITIZED NEEDS SELECTED INCLUDE: 1. MENTAL HEALTH SERVICES FOR CHILDREN, ADOLESCENTS, AND ADULTS, INCLUDING: - YOUTH AND ADULT INPATIENT CARE FOR TREATMENT THROUGH RECOVERY - IMPROVED ACCESS TO COUNSELING FOR YOUTH, INCLUDING SERVICES AT SCHOOLS - INPATIENT BEHAVIORAL HEALTH AND SUBSTANCE USE CRISIS CARE - ADDICTION MEDICINE SERVICES, INCLUDING MEDICATION ASSISTED TREATMENT ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED: - RMH WILL EXPLORE INCREASING ACCESS TO MEDICATION ASSISTED TREATMENT/RECOVERY RESOURCES - RMH WILL EXPLORE INCREASING RELATIONSHIPS WITH INPATIENT BEHAVIORAL HEALTH AND SUBSTANCE USE DISORDER PROVIDERS - RMH WILL PROVIDE REASONABLE AND APPROPRIATE SUPPORT TO DEVELOPMENT OF THE CRISIS PROGRAM AT LAWRENCE COUNTY HEALTH DEPARTMENT - RMH WILL EXPLORE DEVELOPING TELEPHONE COUNSELING - RMH WILL EXPLORE NEW AVENUES TO INCREASE ACCESS TO COUNSELING - RMH WILL CONTINUE AND EXPAND THE MENTAL HEALTH FIRST AID PROGRAM (MHFA) ANTICIPATED IMPACTS OF THESE ACTIONS: RMH ANTICIPATES THAT THE STEPS SET OUT ABOVE WILL CREATE INCREASED ACCESS TO COUNSELING FOR YOUTH AND ADULTS, MEDICATION ASSISTED TREATMENT, AND INPATIENT AND CRISIS CARE FOR BEHAVIORAL HEALTH AND SUBSTANCE USE DISORDER. PROGRAMS AND RESOURCES THE HOSPITAL PLANS TO COMMIT TO ADDRESS HEALTH NEED: - ADMINISTRATIVE TEAM PLANNED COLLABORATION BETWEEN HOSPITAL AND OTHER FACILITIES OR ORGANIZATIONS: - SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE - PUBLIC HEALTH - INPATIENT PROVIDERS - LAW ENFORCEMENT - CARLE BEHAVIORAL HEALTH SERVICES 2. FLEXIBLE TRANSPORTATION FOR LOCAL APPOINTMENTS AND ASSISTANCE WHEN NEEDED FOR PERSONS THAT HAVE LITTLE OR NO TRANSPORTATION AT HOME ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED: - RMH WILL EXPLORE EXPANDING CARE COORDINATION SERVICES TO INCLUDE TRANSPORTATION ANTICIPATED IMPACTS OF THESE ACTIONS: RMH ANTICIPATES EXPANDING CARE COORDINATION SERVICES TO INCLUDE TRANSPORTATION WILL IMPROVE COORDINATION OF TRANSPORTATION WITH APPOINTMENTS AND ADDRESS PATIENT NEEDS RELATED TO TRANSPORTATION. PROGRAMS AND RESOURCES THE HOSPITAL PLANS TO COMMIT TO ADDRESS HEALTH NEED: - ADMINISTRATION PLANNED COLLABORATION BETWEEN HOSPITAL AND OTHER FACILITIES OR ORGANIZATIONS: - MASS TRANSIT DISTRICT RIDES - EMBARRAS RIVER BASIN AREA AGENCY (ERBA) 3. IMPROVED OPPORTUNITIES TO ACHIEVE WELLNESS THROUGH: - ACCESS TO HEALTHY FOODS AND NUTRITION EDUCATION - ACCESS TO LOW COST OR FREE OPPORTUNITIES FOR RECREATION AND FITNESS ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED: - RMH WILL EXPLORE DEVELOPMENT OF A COMMUNITY GARDEN PROGRAM - RMH WILL CONTINUE THE DEMONSTRATION GARDEN FOR NUTRITION EDUCATION - RMH WILL PROVIDE FUNDING FOR LIGHTING TO ENHANCE USE OF THE COMMUNITY WALKING PATH IN OLNEY - RMH WILL EXPLORE EXPANDING SERVICES OF CARLE HEALTH'S MOBILE MARKET - RMH WILL PARTNER WITH CARLE HEALTH TO PROVIDE THE COMMUNITY WITH ACCESS TO VIDEO WITH HEALTH AND WELLNESS CONTENT - RMH WILL CONTINUE TO SUPPORT LOCAL YOUTH SPORTS ANTICIPATED IMPACTS OF THESE ACTIONS: RMH ANTICIPATES THAT THE ADDITION OF THE PROGRAMS AND SERVICES TO BE UNDERTAKEN WILL IMPROVE OPPORTUNITIES TO ACHIEVE WELLNESS THROUGH ACCESS TO HEALTHY FOODS AND NUTRITION EDUCATION, AND ACCESS TO LOW COST OR FREE OPPORTUNITIES FOR RECREATION AND FITNESS. PROGRAMS AND RESOURCES THE HOSPITAL PLANS TO COMMIT TO ADDRESS HEALTH NEED: - ADMINISTRATIVE TEAM - ORGANIZATIONAL AND COMMUNITY DEVELOPMENT PLANNED COLLABORATION BETWEEN HOSPITAL AND OTHER FACILITIES OR ORGANIZATIONS: - VOLUNTEERS - CARLE HEALTH - CITY OF OLNEY - UNIVERSITY OF ILLINOIS EXTENSION - CARLE RICHLAND AUXILIARY 4. DENTAL CARE FOR UNDERINSURED AND UNINSURED ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED: RMH CONTINUES TO RECOGNIZE THE IMPORTANCE OF ACCESS TO DENTAL CARE AND THE IMPACT OF DENTAL CARE ON WELLNESS BUT OBSERVES THAT DENTAL CARE IS NOT A FUNCTION FOR WHICH THE HOSPITAL IS WELL-SUITED. RMH RECOGNIZES THAT THE FEDERALLY QUALIFIED HEALTH CENTER (FQHC) MAY BE BETTER POSITIONED TO ADDRESS THIS ISSUE, AND THE HOSPITAL WILL PROMOTE PARTNERSHIPS BETWEEN DENTISTS, THE FQHC, AND ANY OTHER POTENTIAL PARTNERS AS REASONABLY POSSIBLE. ANTICIPATED IMPACTS OF THESE ACTIONS: ANY IMPACTS FROM ANY DEVELOPMENTS ON THIS ISSUE ARE DEPENDENT ON EXTERNAL PARTNERS AND SOLUTIONS THEY MAY OFFER. PROGRAMS AND RESOURCES THE HOSPITAL PLANS TO COMMIT TO ADDRESS HEALTH NEED: - ADMINISTRATION PLANNED COLLABORATION BETWEEN HOSPITAL AND OTHER FACILITIES OR ORGANIZATIONS: - FEDERALLY QUALIFIED HEALTH CENTER - DENTISTS - OTHERS THAT MAY BE INTERESTED IN THE EFFORT - PUBLIC HEALTH ADDITIONAL ACTION TAKEN SINCE LAST CHNA: THE COMMUNITY HEALTH NEEDS PROCESS IS CONDUCTED EVERY THREE YEARS. IN RESPONSE TO ISSUES IDENTIFIED AND PRIORITIZED AND THE IMPLEMENTATION STRATEGY DEVELOPED TO ADDRESS THEM, RMH HAS TAKEN THESE STEPS SINCE THE LAST CHNA. MENTAL HEALTH - HAVE IMPLEMENTED A FULL-TIME MHFA PROGRAM FOR BOTH ADULT AND YOUTH MHFA - CONTINUE RECRUITMENT OF BEHAVIORAL HEALTH PROVIDERS - HAVE HIRED AN Licensed Clinical Professional Counselor (LCPC) - SUPPORT COMMUNITY INITIATIVES TO BRING ADDITIONAL MONIES TO THIS AREA FOR MENTAL HEALTH SERVICES BY PROVIDING A LETTER OF SUPPORT FOR GRANT MONEY - ENTERED INTO AN AGREEMENT FOR TELEHEALTH SERVICES FROM PAVILION BEHAVIORAL HEALTH FOR TELE-MENTAL HEALTH SERVICES TO THE HOSPITAL'S EMERGENCY DEPARTMENT PATIENTS DENTAL HEALTH RMH STANDS READY TO PARTNER WITH THE LOCAL FQHC TO PROMOTE THESE SERVICES IF NEEDED. THIS WAS IDENTIFIED AS A NEED THAT RMH IS NOT BEST SUITED TO PROVIDE AT THIS TIME. ACCESS TO CARE MANAGERS HIRED A SOCIAL WORKER. THIS PERSON WILL MAINLY TAKE CARE OF INPATIENTS, BUT COULD ALSO ASSIST IN ED. TRANSPORTATION: - ADDED ADDITIONAL STOPS WITH RIDES MASS TRANSIT AND HAVE AN AGREEMENT WITH THEM TO PROVIDE DISCHARGE PATIENTS A RIDE DURING SERVICE HOURS REGARDLESS OF ABILITY TO PAY. - RICHLAND COUNTY NOW HAS A LYFT SERVICE AVAILABLE ON A LIMITED BASIS. IMPROVED ACCESS TO SERVICES FOR ADDICTION/RECOVERY/PREVENTION - A MEMBER OF THE RMH ADMINISTRATIVE TEAM SERVES ON THE RICHLAND COUNTY ADDICTION PREVENTION COALITION. THIS GROUP WAS FORMED IN THE LAST FEW YEARS TO HELP BRING AWARENESS TO THE NEED FOR ADDICTION PREVENTION SERVICES. - RMH HAS ADDED A "TAKE BACK" BOX IN THE HOSPITAL'S MAIN LOBBY FOR THE PUBLIC TO OUTDATED PRESCRIPTION DRUGS FOR SAFE DISPOSAL AT ANY TIME. ACCESS TO WEEKEND AND AFTER-HOURS CARE - OPENED CONVENIENT CARE. ORIGINAL HOURS AT OPENING WERE 10 AM - 8 PM, SEVEN DAYS A WEEK. CONVENIENT CARE HAS SINCE EXPANDED THOSE HOURS TO 8 AM -8 PM EACH DAY, CLOSED HOLIDAYS. 5 CARLE OLNEY PRIMARY CARE 363 N WEST ST OLNEY IL 62450 RURAL HEALTH CLINIC CARLE (OLNEY) SURGICAL SERVICES 605 E MAIN ST OLNEY IL 62450 SURGICAL SERVICES CARLE WEST SALEM 100 S MAIN ST WEST SALEM IL 62476 RURAL HEALTH CLINIC CARLE BRIDGEPORT 101 INDUSTRY RD BRIDGEPORT IL 624172242 OUTPATIENT CLINIC CARLE NEWTON 500 S SCOTT AVE NEWTON IL 62448 PRIMARY CARE PART I, LINE 3 FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA PATIENTS MAY REQUEST AND COMPLETE A FINANCIAL ASSISTANCE APPLICATION AT ANY TIME, INCLUDING BEFORE CARE IS RECEIVED. PATIENTS ARE INFORMED ABOUT FINANCIAL ASSISTANCE ON MULTIPLE OCCASIONS THROUGHOUT THE COLLECTION PROCESS. IN ADDITION TO PATIENTS COMPLETING APPLICATIONS FOR OUR FINANCIAL ASSISTANCE PROGRAM, WE HAVE ROBUST PRESUMPTIVE ELIGIBILITY PROCESSES IN PLACE. WE HAVE PARTNERED WITH EXPERIAN INFORMATION SOLUTIONS, INC. TO HELP US IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON KEY FINANCIAL INDICATORS. THESE PATIENTS MAY BE APPROVED WITHOUT EVER COMPLETING AN APPLICATION OR EXPRESSING A NEED FOR FINANCIAL ASSISTANCE. IN ADDITION, WE PRESUME ELIGIBILITY FOR PATIENTS WHO ARE VERIFIED HOMELESS, DECEASED WITH NO ESTATE, MENTALLY INCAPACITATED, ELIGIBLE FOR SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) OR WOMEN, INFANTS, AND CHILDREN NUTRITION PROGRAM (WIC), TOWNSHIP ASSISTANCE, LOW INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP), ILLINOIS FREE LUNCH AND BREAKFAST PROGRAM OR COVERED BY ILLINOIS MEDICAID. PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION SUBSIDIZED HEALTH SERVICES ARE NET COSTS FOR BILLED SERVICES THAT ARE SUBSIDIZED BY THE HOSPITAL. THESE INCLUDE SERVICES OFFERED DESPITE A FINANCIAL LOSS BECAUSE THEY ARE NEEDED IN THE COMMUNITY AND EITHER OTHER PROVIDERS ARE UNWILLING TO PROVIDE THE SERVICES OR THE SERVICES WOULD OTHERWISE NOT BE AVAILABLE IN SUFFICIENT AMOUNT. WE INCLUDED AS UNREIMBURSED COSTS OF SUBSIDIZED HEALTH SERVICES: $96,448 FOR HOSPITAL OUTPATIENT SERVICES, $632,783 FOR EMERGENCY ROOM, AND $5,415,233 FOR SUBSIDIZED CONTINUING CARE. PART I, LINE 7 AND PART III, LINE 2 - COSTING METHODOLOGY EXPLANATION TO COMPUTE AND CONVERT FINANCIAL ASSISTANCE, UNREIMBURSED MEDICAID, MEANS-TESTED PROGRAMS AND BAD DEBT CHARGES TO COST; A CONSISTENT GAAP (GENERALLY ACCEPTED ACCOUNTING PRINCIPLES) BASED COST-TO-CHARGE RATIO WAS USED ACROSS ALL PAYERS. ALTHOUGH THE METHODOLOGY WAS SIMILAR TO WORKSHEET #2, FOR SIMPLICITY PURPOSES CERTAIN IMMATERIAL VALUES WERE OMITTED. OTHER COMMUNITY BENEFITS COSTS WERE REPORTED AT THE ACTUAL EXPENSE INCURRED. PATIENT RECEIVABLE PAYMENTS AND RELATED DISCOUNTS WERE RECORDED AT ACTUAL AMOUNTS AT THE TIME OF PAYMENT RECEIPT. A SEPARATE GAAP BASED PROVISION FOR ESTIMATED BAD DEBTS AND DISCOUNTS WAS RECOGNIZED FOR ACCOUNTS IN PROCESS AND PENDING ADJUDICATION AND PAYMENT. THE ESTIMATED PORTION WAS BASED ON HISTORICAL TRENDS AND ADJUSTED TO ACTUAL WHEN ADJUDICATION AND PAYMENT OCCUR. ACCOUNTS DETERMINED ELIGIBLE FOR FINANCIAL ASSISTANCE WERE PROCESSED IMMEDIATELY FOR FINANCIAL ASSISTANCE DISCOUNT WITH NO COLLECTION EFFORT. FOR ACCOUNTS WITH INSUFFICIENT INFORMATION AND DOCUMENTATION TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY, THE HOSPITAL CONSULTED WITH A VARIETY OF ALTERNATIVE SOURCES TO HELP DETERMINE AN INDIVIDUAL'S FINANCIAL MEANS (OR LACK OF MEANS) TO PAY. BASED ON RELATED TRENDS, THE HOSPITAL FURTHER DEVELOPED A GENERAL ESTIMATE OF FINANCIAL ASSISTANCE WHICH CONTINUED TO RESIDE WITHIN BAD DEBTS. SCHEDULE H, PART II OTHER COMMUNITY BENEFITS / COMMUNITY BUILDING: CASH AND IN-KIND: A LARGE PORTION OF CARLE'S COMMUNITY-BUILDING ACTIVITIES FOCUSED ON ECONOMIC DEVELOPMENT, INCLUDING CASH, IN-KIND DONATIONS AND BUDGETED EXPENDITURES FOR THE CITY, BUSINESS ASSOCIATIONS AND OTHER PROGRAMS IN RICHLAND COUNTY. IN ADDITION TO THE MORE THAN $218,000 IN CASH DONATIONS, LEADERSHIP PROVIDED IN-KIND SUPPORT OF OVER $17,000 BY SERVING ON NUMEROUS COMMUNITY BOARDS AND COMMITTEES. VOLUNTEER SERVICES: EMPLOYEE: CARLE RICHLAND ADMINISTRATORS AND LEADERS PROVIDED MORE THAN 120 HOURS ON BEHALF OF CARLE FOR PARTICIPATION IN COMMUNITY BOARDS, COMMITTEES AND COMMUNITY FUNCTIONS. MOST OF THESE HOURS WERE SPENT BY SENIOR LEADERSHIP. NON-EMPLOYEE: IN 2021, NON-EMPLOYEE VOLUNTEERS PUT IN MORE THAN 2,500 HOURS AT THE HOSPITAL, RECEIVING NO PAYMENT BUT CONTRIBUTING TO CARLE'S MISSION. AT A MINIMUM WAGE OF $11/HOUR, THIS EQUATED TO MORE THAN $28,000 OF POTENTIAL WAGES THAT CARLE SAVED BY HAVING SUCH A STRONG VOLUNTEER PROGRAM. PART III, LINE 3 - BAD DEBT, MEDICARE, & COLLECTION PRACTICES RMH USES 50% AS A GENERAL ESTIMATE OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 4 - BAD DEBT FOOTNOTE THE FOOTNOTE PERTAINING TO BAD DEBT EXPENSE CAN BE FOUND ON PAGE 28 OF THE ATTACHED CONSOLIDATED FINANCIAL STATEMENTS. PART III, LINE 8 - MEDICARE EXPLANATION THE NUMERATOR (TOTAL EXPENSE) AND DENOMINATOR (TOTAL GROSS CHARGES) OF THE SIMPLE RATIO OF PATIENT CARE COST TO CHARGES IS ADJUSTED BY ELIMINATING NON-PATIENT CARE THAT GENERATES OTHER REVENUE, BAD DEBT EXPENSE, MEDICAID AND OTHER PROVIDER TAXES AND THE TOTAL COST OF COMMUNITY BENEFIT ACTIVITIES AND PROGRAMS. ALSO, ANY GROSS PATIENT CHARGES FOR PROGRAMS NOT RELYING ON THE RATIO ARE ELIMINATED FROM BOTH THE NUMERATOR AND DENOMINATOR OF THE RATIO. THESE ADJUSTMENTS ARE INTENDED TO ELIMINATE ANY POTENTIAL FOR DOUBLE COUNTING OF COMMUNITY BENEFIT EXPENSES. THE RESULTANT RATIO ALIGNS WITH SCHEDULE H REQUIREMENTS. ILLINOIS LAW DEFINES GOVERNMENTAL-SPONSORED INDIGENT HEALTH CARE AS THE UNREIMBURSED COST OF MEDICARE, MEDICAID AND OTHER FEDERAL, STATE OR LOCAL INDIGENT CARE PROGRAMS. WHEN THERE IS A SHORTFALL, WE DO BELIEVE THIS IS A COMMUNITY BENEFIT BECAUSE, AS A HOSPITAL, WE ARE STEPPING UP TO CARRY THE BURDEN OF THE GOVERNMENT, ASSURING CARE TO SENIORS, AND THOSE LESS FORTUNATE DEMOGRAPHICS THAT HAVE EXPERIENCED INCREASING COSTS OVER THE PAST DECADE WHILE LIVING ON FIXED INCOMES. PART III, LINE 9 B - COLLECTION PRACTICES EXPLANATION RMH APPLIES ITS COLLECTION PRACTICES EQUALLY TO ALL PATIENTS, BOTH THOSE ELIGIBLE FOR FINANICAL ASSISTANCE AND THOSE THAT AREN'T ELIGIBLE. THE PROCEDURES ARE AS FOLLOWS: 1. WE WILL SEND TWO STATEMENTS AND TWO COLLECTION LETTERS IN A 28 DAY CYCLE. WE WILL SEND STATEMENTS BASED UPON PATIENT PORTION OF $10 OR GREATER. 2. THE PATIENT'S ACCOUNT WILL AGE THROUGH THE STATEMENT PROCESS BEFORE BEING WRITTEN OFF TO BAD DEBT. - PRIVATE PAY ACCOUNTS WILL RECEIVE A STATEMENT WITHIN NINE DAYS OF THE DISCHARGE DATE. - ACCOUNTS WITH A PATIENT PORTION AFTER INSURANCE WILL BE ELIGIBLE TO RECEIVE A STATEMENT APPROXIMATELY FOURTEEN DAYS AFTER THE INSURANCE PAYMENT HAS BEEN POSTED. - TWENTY-EIGHT DAYS LATER THE PATIENT IS MAILED A THIRD STATEMENT - TWENTY-EIGHT DAYS LATER THE PATIENT IS MAILED THE FIRST COLLECTION LETTER - TWENTY-EIGHT DAYS LATER THE PATIENT IS MAILED THE FINAL COLLECTION LETTER - APPROXIMATELY FIFTEEN DAYS LATER THE PATIENT IS WRITTEN OFF TO BAD DEBT. 3. RMH WILL ATTEMPT TO CONTACT THE GUARANTOR VIA PHONE AFTER THEY RECEIVE THE FIRST STATEMENT ON BALANCES GREATER THAN $1,000. 4. RMH WILL ATTEMPT TO CONTACT THE GUARANTOR VIA PHONE AFTER THE SECOND STATEMENT ON BALANCES LESS THAN $1,000. 5. RMH WILL MAKE A SECOND ATTEMPT TO CONTACT THE GUARANTOR VIA PHONE IF PAYMENT OR CONTACT HAS NOT BEEN MADE, USUALLY AROUND THE SAME TIME THE SECOND COLLECTION LETTER IS SENT. 6. RMH WILL SEND TWO COLLECTION LETTERS TO THE PATIENT. THE PATIENT HAS FIFTEEN DAYS AFTER THE FINAL LETTER TO PAY BEFORE BEING WRITTEN OFF TO BAD DEBT. PART VI, LINE 2 - NEEDS ASSESSMENT CARLE PRIMARILY ADDRESSES HEALTHCARE NEEDS IN OUR COMMUNITY BY BEING A PART OF THE AFOREMENTIONED CHNA. HOWEVER, CARLE IS ACUTELY AWARE OF THE NEED FOR ACCESS TO CARE, MAKING IT A MAINSTAY OF OUR COMMUNITY BENEFIT EFFORTS. WE HAVE A STRONG FINANCIAL ASSISTANCE PROGRAM BASED ON A PHILOSOPHY OF DOING THE RIGHT THING FOR THE COMMUNITY AND PATIENTS, BALANCED BY A CAREFUL STEWARDSHIP OF THE COMMUNITY'S RESOURCES. WHILE ACCESS TO CARE WAS NOT SELECTED AS A PRIORITY FOR THE 2021 CHNA IT WILL CONTINUE TO BE A PRIORITY FOR CARLE. AS A TAX-EXEMPT ORGANIZATION, RMH PROVIDES CARE TO PATIENTS REGARDLESS OF THE ABILITY TO PAY. CARLE'S GENEROUS FINANCIAL ASSISTANCE PROGRAM HAS RESULTED IN OUR ABILITY TO REACH MANY PEOPLE OVER THE YEARS. TO ENSURE WE ARE ADDRESSING THE NEEDS OF THE COMMUNITY, THE FINANCE AND QUALITY COMMITTEES OF THE CARLE BOARD OF TRUSTEES REVIEW AND EVALUATE CHARITY CARE FIGURES ANNUALLY. WE DO NOT LIMIT THE AMOUNT OF FINANCIAL ASSISTANCE WE PROVIDE, AT THIS TIME. OTHER WAYS TO HELP IMPROVE ACCESS TO CARE: IN ADDITION TO CHARITY CARE, CARLE SUPPORTS A WIDE RANGE OF PROGRAMS AND SERVICES TO INCREASE COMMUNITY CAPACITY, HEALTH CARE WORK FORCE EXPANSION, AND SOCIAL SERVICES THAT PROVIDE COMPLEMENTARY HEALTHCARE-RELATED SERVICES. RMH HAS, AND WILL CONTINUE TO, PURSUE THESE INITIATIVES TO IMPROVE ACCESS TO CARE: 1. OFFER A CHARITY CARE PROGRAM 2. COMMUNICATE THE AVAILABILITY OF THE CHARITY CARE PROGRAM 3. RECRUIT MORE PROVIDERS INTO THE CARLE SYSTEM, THEREBY EXPANDING ACCESS/CAPACITY 4. SUPPORT LOCAL COMMUNITY CLINICS TO ENSURE ADDED LOCAL CAPACITY FOR HEALTH CARE 5. SUPPORT UNITED WAY AND OTHER AREA AGENCIES TO IMPROVE AVAILABILITY OF HEALTH SERVICES 6. DONATE TO EXISTING COMMUNITY HEALTH 7. PARTICIPATE IN POPULATION HEALTH INITIATIVES THAT ACTIVELY MANAGE THE HEALTH OF MEMBERS 8. PROMOTE PRESCRIPTION AFFORDABILITY AS A 340B PROVIDER 9. ENHANCE ACCESS-RELATED INITIATIVES THAT WILL IMPROVE PATIENT ACCESS AND ABILITY TO INTERFACE MORE EFFICIENTLY FOR NEEDED SERVICES - PATIENT CONTACT CENTER, PRESCRIPTION REFILL REQUEST PROCESS, E-VISITS, VIRTUAL VISITS AND MORE 10. CONTINUE ACCESS TO CARE THROUGH SUBSIDIZED SERVICES, INCLUDING THE LTC SKILLED NURSING, THE EXTENDED CARE WING, THE EMERGENCY DEPARTMENT, CARDIAC REHAB, AND MORE. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSITANCE OUR PRACTICE IS TO LOOK AT EACH PATIENT'S FINANCIAL STATUS IN RELATION TO OUR CARLE FINANCIAL ASSISTANCE PROGRAM AND THE CRITERIA OF THE UNINSURED PATIENT DISCOUNT ACT, AND TO PROVIDE THE PATIENT WITH THE DEEPEST DISCOUNT AVAILABLE. BY EXPANDING THE PRESUMPTIVE ELIGIBILITY SCREENING PROCESSES AND DETERMINING THE FINANCIAL STATUS OF PATIENTS UP-FRONT, WE HAVE BEEN ABLE TO PINPOINT THOSE NEEDING ASSISTANCE EARLY IN THE PROCESS, MINIMIZING BAD DEBT AND OPTIMIZING OUR ABILITY TO HELP. STAFF IS ALSO DILIGENT IN FOLLOWING UP WITH PATIENTS DURING HOSPITALIZATION AND AFTER DISCHARGE IF THERE'S ANY REASON TO BELIEVE THE PATIENT COULD BENEFIT FROM FINANCIAL ASSISTANCE, AND WE AUTO-QUALIFY CERTAIN PATIENT POPULATIONS FOR CARLE FINANCIAL ASSISTANCE PROGRAM, SUCH AS THE HOMELESS, WIC, SNAP (SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM), MEDICAID, LOW INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP), AND TOWNSHIP ASSISTANCE RECIPIENTS. COMMUNICATING THAT FINANCIAL ASSISTANCE IS AVAILABLE CARLE FOUNDATION HOSPITAL HAS MADE A CONCERTED, CONTINUOUS EFFORT TO BE SURE THAT PEOPLE HAVE ACCESS TO INFORMATION THAT WILL HELP THEM WITH THEIR MEDICAL BILLS. THESE INCLUDE: - ADVERTISING CARLE FINANCIAL ASSISTANCE PROGRAM; CONTINUED PRESENCE IN APPROPRIATE COMMUNITY PUBLICATIONS; AND ON-SITE VIA DISPLAYS THROUGHOUT THE HOSPITAL AND CLINICS - SIMPLIFIED APPLICATION FORM, INCLUDING A VERSION IN SPANISH, THAT CONTAINS INFORMATION REGARDING THE CARLE FINANCIAL ASSISTANCE PROGRAM - PUBLICATION OF A PLAIN LANGUAGE SUMMARY AND ALL OTHER FINANCIAL ASSISTANCE-RELATED INFORMATION ON CARLE.ORG/FINANCIALASSISTANCE - INFORMATION ABOUT THE CARLE FINANCIAL ASSISTANCE PROGRAM ON ALL STATEMENTS, COLLECTION LETTERS AND HOSPITAL ADMISSION PACKETS - CARLE FINANCIAL ASSISTANCE PROGRAM INFORMATION AND APPLICATIONS AT ALL REGISTRATION POINTS, HOSPITAL MAIN LOBBY AND CARLE.ORG - MEETINGS WITH LOCAL LEGISLATORS TO HELP THEM ASSIST CONSTITUENTS WITH HEALTHCARE NEEDS, INCLUDING FINANCIAL ASSISTANCE PART VI, LINE 4 - COMMUNITY INFORMATION DESCRIPTION OF THE COMMUNITY/POPULATION RMH HAS DEFINED ITS PRIMARY SERVICE AREA AND POPULATIONS AS THE GENERAL POPULATION WITHIN THE GEOGRAPHIC AREA IN AND SURROUNDING RICHLAND COUNTY DEFINED IN DETAIL BELOW. THE HOSPITAL'S PATIENT POPULATION INCLUDES ALL WHO RECEIVE CARE WITHOUT REGARD TO INSURANCE COVERAGE OR ELIGIBILITY FOR ASSISTANCE. RMH'S SERVICE AREA IS COMPRISED OF APPROXIMATELY 3,298.30 SQUARE MILES, WITH A POPULATION OF APPROXIMATELY 108,055 PEOPLE AND A POPULATION DENSITY OF 33 PEOPLE PER SQUARE MILE. THE SERVICE AREA CONSISTS OF THE FOLLOWING RURAL ILLINOIS COUNTIES: RICHLAND, LAWRENCE, EDWARDS, JASPER, CLAY, CRAWFORD, WABASH, AND WAYNE. THE AVERAGE HOUSEHOLD SIZE OF THE AREA, AT 2.3, IS LOWER THAN BOTH ILLINOIS (3) AND THE U.S. (2.5). MEDIAN AGE IS OVER 43.5 YEARS, WHICH IS HIGHER THAN ILLINOIS AND THE U.S. THE LARGEST EDUCATION SEGMENT IS REPORTED AS SOME COLLEGE, FOLLOWED BY HIGH SCHOOL GRADUATES. COLLEGE GRADUATES IN THE AREA EXCEED THE NUMBER OF RESIDENTS THAT DID NOT COMPLETE HIGH SCHOOL. THE UNEMPLOYMENT RATE IS TYPICAL OF SURROUNDING COUNTIES AND OTHER RURAL COUNTIES IN ILLINOIS AND IS BETTER THAN NATIONAL AND STATEWIDE NUMBERS. ALSO, AS IS THE CASE IN MUCH OF RURAL ILLINOIS, INCOME BY HOUSEHOLDS IN THE SERVICE AREA IS LOWER THAN STATEWIDE. OF THE 84,721 RESIDENTS OVER THE AGE OF 18, 7014 ARE VETERANS. THIS REPRESENTS 8.28% OF THE ELIGIBLE POPULATION. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH RMH HAS AN OPEN MEDICAL STAFF AND IS GOVERNED BY A COMMUNITY BOARD THAT SERVES ON A VOLUNTEER BASIS. SURPLUS FUNDS ARE REINVESTED INTO THE ORGANIZATION FOR TECHNOLOGY REPLACEMENT AND ADVANCEMENT, CLINICAL SERVICE EXPANSION AND QUALITY IMPROVEMENT. FUNDS ARE ALSO INVESTED INTO OUR COMMUNITIES TO MEET IDENTIFIED HEALTH NEEDS WHICH CONTRIBUTE TO THE OVERALL WELL-BEING OF THE RESIDENTS OF THE COMMUNITIES WE SERVE. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM RMH IS A 104 BED, NOT-FOR-PROFIT HEALTHCARE FACILITY LOCATED IN OLNEY, IL AND BECAME PART OF THE CARLE HEALTH SYSTEM ON APRIL 1, 2017. AS PART OF THE CARLE HEALTH SYSTEM, IT CURRENTLY SERVES EIGHT SOUTHEASTERN ILLINOIS COUNTIES, WITH A TOTAL POPULATION OF MORE THAN 107,000 INDIVIDUALS. THE INTEGRATION OF CARLE AND RMH ALLOWS FOR EXPANDED ACCESS TO HEALTHCARE IN THE REGION. THOUGH RMH FALLS UNDER THE UMBRELLA OF THE CARLE FOUNDATION, IT MAINTAINS A SEPARATE BOARD OF DIRECTORS AND SENIOR LEADERSHIP. WHILE RMH'S CHNA AND COMMUNITY BENEFIT REPORTING IS SEPARATE FROM THE CARLE FOUNDATION HOSPITAL, IT FOLLOWS THE SAME GUIDELINES AND PRINCIPLES AS CARLE. RMH STAFF IS INVOLVED IN THE CHNA AND IMPLEMENTATION PLAN, AND SERVE ON HUMAN SERVICES AGENCY BOARDS AND COMMITTEES TO PROVIDE SUPPORT TO HELP ADDRESS IDENTIFIED COMMUNITY HEALTH NEEDS. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT RMH FILES AN ILLINOIS COMMUNITY BENEFIT REPORT. true RICHLAND COUNTY HIGH SCHOOL 1200 EAST LAUREL STREET OLENY IL 62450 376004449 501(C)(3) 6000 SPONSORSHIP RICHLAND COUNTY DEVELOPMENT CORPORATION 315 WEST MAIN STREET OLNEY IL 62450 371201502 501(C)(3) 10000 PROGRAM SERVICES CITY OF OLNEY 300 S WHITTLE AVE OLNEY IL 62450 376001911 GOV't 10000 COMMUNITY IMPROVEMENT SOUTH EASTERN SPECIAL EDUCATION 111 W Mound St Ste Marie IL 62459 371111065 501(C)(3) 184877 BOOK REAL ESTATE PROGRAM SERVICES 4 FORM 990, SCHEDULE I DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS ANY CHARITABLE ORGANIZATION WISHING TO REQUEST FUNDS IS ASKED TO SUBMIT THEIR REQUEST IN WRITING. EMAILED REQUESTS ARE ACCEPTABLE. THE REQUEST MUST INCLUDE A DESCRIPTION OF THE PURPOSE OF THE CONTRIBUTION AND OTHER RELEVANT INFORMATION SUCH AS REQUESTORS NAME, AMOUNT OF THE REQUEST, ETC. THE REQUESTS ARE REVIEWED, EVALUATED, AND ADMINISTERED BY THE MARKETING AND COMMUNICATIONS (PUBLIC RELATIONS) DEPARTMENT, SEEKING ADDITIONAL INFORMATION FROM THE REQUESTOR, AS NEEDED, AND INPUT FROM ANY APPROPRIATE CARLE ADMINISTRATOR OR DIRECTOR. A SET OF ESTABLISHED GUIDELINES DRIVE THESE DECISIONS WHILE MOST ARE MADE TO IMPROVE HEALTHCARE/ACCESS TO HEALTHCARE OR ARE IN LINE WITH OUR ROLE AS A CORPORATE CITIZEN. ASSESSED NEED IS A COMMON CRITERIA. IN THE CASE OF MOST DONATIONS OF $5,000 OR MORE, SUCH AS TO COLLEGES AND UNIVERSITIES OR COMMUNITY CLINICS, WRITTEN AGREEMENTS ARE IN PLACE AND WE HAVE REGULAR CONTACT WITH THOSE ORGANIZATIONS, OFTENTIMES THROUGH A CARLE CONTACT PERSON TO ASSURE THAT THE DONATIONS ARE BEING USED AS AGREED UPON. THE RECORDS ARE EITHER MAINTAINED IN ADMINISTRATION OR PUBLIC RELATIONS. true true false false false false false true false JARROD ALMAROAD MD TRUSTEE - FORMER 0 773537 0 0 0 12764 0 23244 0 15701 0 825246 0 0 JOHN SNYDER Officer - Former 0 0 0 0 0 1942803 0 0 0 14339 0 1957142 0 1928464 CHRISTINA BARE Key Employee - Former 156620 0 15048 0 317 0 12594 0 596 0 185175 0 0 0 HARRY BROCKUS CEO TERM 3/2021 0 66896 0 49009 0 579229 0 199406 0 7716 0 902256 0 243978 Regina Thomas PRESIDENT OF RMH 213751 0 27476 0 8692 0 20202 0 15544 0 285665 0 0 0 Dennis Hesch Exec VP & CFO 0 928295 0 275474 0 363123 0 357272 0 18544 0 1942708 0 329498 James C Leonard MD Ex-Officio, President & CEO 0 1484721 0 505818 0 568296 0 621615 0 20043 0 3200493 0 524075 John Allen CRNA - RMH Anesth 233780 0 6817 0 21934 0 20922 0 30060 0 313513 0 0 0 Benjamin Curtis CRNA - RMH Anesth 233780 0 6452 0 9901 0 20592 0 26639 0 297364 0 0 0 MATTHEW KOLB Trustee, EVP, & COO 0 868994 0 197972 0 92597 0 311540 0 26064 0 1497167 0 68733 SALLY SALMONS MD TRUSTEE & PHYSICIAN 0 367823 0 54828 0 68983 0 65944 0 15655 0 573233 0 36484 LAUREN SCHMID EXEC VP, CHIEF HR OFFICER 0 468482 0 107632 0 81705 0 161242 0 24092 0 843153 0 58248 Thomas Falcone CRNA - RMH Anesth 239782 0 6452 0 7344 0 20403 0 25312 0 299293 0 0 0 John Wall CRNA LEAD - RMH ANESTH 246916 0 7018 0 10649 0 21470 0 26214 0 312267 0 0 0 KENNETH ARONSON MD MED DIR - DIAGNOSTIC SERVICES 0 488249 0 35100 0 45043 0 23244 0 13568 0 605204 0 0 RAYMOND FISHER MD TRUSTEE & PHYSICIAN 478465 0 0 0 42609 0 23244 0 10584 0 554902 0 0 0 MELISSA KUENSTLER NP NP - RICHLAND CONVENIENT CARE 176644 0 6461 0 371 0 13623 0 310 0 197409 0 0 0 TANNER MILLER MD RMH MEDICAL DIRECTOR 0 377749 0 4200 0 603 0 23244 0 27207 0 433003 0 0 Schedule J, Part I, Question 3 THE BOARD OF TRUSTEES OF THE CARLE FOUNDATION, THE PARENT COMPANY OF RICHLAND MEMORIAL HOSPITAL, THROUGH ITS COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT MEMBERS FREE OF CONFLICT, ANNUALLY REVIEWS EXECUTIVE COMPENSATION LEVELS AND ESTABLISHES APPROPRIATE SALARY RANGES AND OTHER FEATURES OF THE COMPENSATION PLAN IN ACCORDANCE WITH THE ORGANIZATION'S APPROVED COMPENSATION PHILOSOPHY AND STRATEGY: *THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES; WHO ARE INDEPENDENT OF THE CARLE FOUNDATION MANAGEMENT; HAVE NO PERSONAL INTEREST IN THE COMPENSATION ARRANGEMENTS; ARE NOT RELATED TO, OR UNDER THE CONTROL OF ANY INDIVIDUAL WHOSE COMPENSATION ARRANGEMENT IS BEING REVIEWED; AND HAVE NO MATERIAL BUSINESS RELATIONSHIP WITH THE CARLE FOUNDATION. *THE CHIEF EXECUTIVE OFFICER'S COMPENSATION IS DETERMINED BY THE COMPENSATION COMMITTEE IN RELATION TO APPROPRIATE COMPARABILITY DATA. COMPENSATION FOR OTHER MEMBERS OF THE EXECUTIVE STAFF IS DEVELOPED BY THE CEO, EVALUATED AGAINST MARKET DATA, AND REVIEWED AND APPROVED BY THE COMMITTEE. *THE COMMITTEE APPROVES ALL ANNUAL COMPENSATION DECISIONS IN ADVANCE OF THEIR IMPLEMENTATION AND DOCUMENTS ITS DETERMINATIONS AND DISCUSSIONS. *THE COMPENSATION COMMITTEE RELIES UPON A NUMBER OF EXTERNAL RESOURCES AND COMPARISONS, AND ITS ANALYSIS INCLUDES TOTAL COMPENSATION (CASH COMPENSATION PLUS BENEFITS PROVIDED BY THE CARLE FOUNDATION) IN RELATION TO ORGANIZATIONAL PERFORMANCE AND PREVAILING INDUSTRY PRACTICES FOR LIKE RESPONSIBILITIES AT COMPARABLY-SIZED ORGANIZATIONS. THE COMMITTEE HAS ENGAGED THE SERVICES OF A COMPENSATION CONSULTING FIRM SPECIALIZING IN THE NOT-FOR-PROFIT SECTOR WHICH HAS WORKED WITH THE CARLE FOUNDATION AND MAKES ITS REPORTS DIRECTLY AVAILABLE TO THE COMPENSATION COMMITTEE. Schedule J, Part I, Question 4a IN 2021, SEVERANCE PAYMENTS WERE PAID TO HARRY BROCKUS ($262,065) AND JOHN SNYDER ($773,686). Schedule J, Part I, Question 4B THE 2021 PARTICIPANTS IN THE 457(F) PLAN OFFERED BY THE CARLE FOUNDATION, THE PARENT ORGANIZATION OF RICHLAND MEMORIAL HOSPITAL, THAT ARE LISTED IN THE 990 PART VII INCLUDE HARRY BROCKUS, DENNIS HESCH, MATTHEW KOLB, JAMES LEONARD, MD, SALLY SALMONS, MD, LAUREN SCHMID, AND GINA THOMAS. IN 2021, PAYMENTS FROM THE 457(F) PLAN WERE MADE TO HARRY BROCKUS ($243,978), DENNIS HESCH ($329,498), MATTHEW KOLB ($68,733), JAMES LEONARD, MD ($524,075), SALLY SALMONS, MD ($36,484), AND LAUREN SCHMID ($58,248), AND JOHN SNYDER ($1,154,778). Schedule J, Part I, Question 7 PART OF THE CEO'S COMPENSATION INCLUDES AN INCENTIVE COMPONENT WHICH IS DESIGNED TO ENCOURAGE AND PROMOTE THE ACHIEVEMENT OF CERTAIN QUALITY, OPERATIONAL, AND EFFICIENCY IMPROVEMENTS. ALTHOUGH THIS INCENTIVE COMPONENT IS BASED ON THE ORGANIZATION MEETING CERTAIN MINIMUM FINANCIAL THRESHOLDS, ALL PAYMENTS MUST BE APPROVED BY THE BOARD OF DIRECTORS PRIOR TO ANY INCENTIVE PAYOUT. WHITLEY HOUCHIN FAMILY MEMBER OF TRUSTEE 107128 Employment false Schedule L, Part V WHITLEY HOUCHIN IS AN EMPLOYEE OF RICHLAND MEMORIAL HOSPITAL AND HAS A FAMILY RELATIONSHIP WITH GARY HOUCHIN WHO SERVES AS A TRUSTEE OF THE BOARD. FORM 990, Box J Website - https://carle.org/locations/carle-richland-memorial-hospital FORM 990, PART III, LINE 4A RICHLAND MEMORIAL HOSPITAL, INC., DBA CARLE RICHLAND MEMORIAL HOSPITAL (RMH) IS A TAX-EXEMPT ILLINOIS NOT-FOR-PROFIT CORPORATION ESTABLISHED FOR THE PURPOSE OF OPERATING A HOSPITAL AND CONDUCTING PATIENT CARE RELATED ACTIVITIES. RICHLAND IS A 104 BED HOSPITAL PROVIDING A RANGE OF ANCILLARY AND SUPPORT SERVICES. THE HOSPITAL ADMITS APPROXIMATELY 1,200 PATIENTS ANNUALLY, IS FULLY ACCREDITED BY THE HEALTHCARE FACILITIES ACCREDITATION PROGRAM (HFAP), HAS AN EMERGENT STROKE READY DESIGNATION AND A LEVEL II NURSERY DESIGNATION BY THE ILLINOIS DEPARTMENT OF PUBLIC HEALTH AND IS A CLINICAL HUB SITE FOR SOUTHERN ILLINOIS UNIVERSITY PHYSICIAN ASSISTANT PROGRAM. IN 2021, RMH RECORDED 10,386 PATIENT DAYS. IN ADDITION TO THE HOSPITAL, THE ORGANIZATION HAS THREE RURAL HEALTH CLINICS: - CARLE BRIDGEPORT IS LOCATED AT 100 INDUSTRY ROAD, BRIDGEPORT, IL, AND OFFERS AUDIOLOGY AND HEARING, BEHAVIORAL HEALTH, CARDIOVASCULAR MEDICINE, FAMILY MEDICINE, MIDWIFERY, ORTHOPEDICS, AND OTOLARYNGOLOGY (ENT: EAR, NOSE, AND THROAT) SERVICES MONDAY THROUGH FRIDAY, 8 A.M. TO 5 P.M. - CARLE OLNEY IS LOCATED AT 363 N. WEST STREET, OLNEY, IL, 1.3 MILES FROM THE HOSPITAL, WHICH OFFERS BEHAVIORAL HEALTH, CONVENIENT CARE, AND FAMILY MEDICINE SERVICES 8 A.M. - 8 P.M. SEVEN DAYS PER WEEK. - CARLE WEST SALEM IS LOCATED AT 100 S. MAIN STREET, WEST SALEM, IL, AND OFFERS FAMILY MEDICINE SERVICES MONDAY THROUGH FRIDAY, 8 A.M. TO 5 P.M. IN ADDITION TO THE RURAL HEALTH CLINICS, RICHLAND PROVIDES SERVICES UNDER THE FOLLOWING: - RMH PROFESSIONAL SERVICES LOCATED AT 605 E. MAIN STREET, OLNEY, IL ONE-HALF MILE FROM THE HOSPITAL AND OFFERS GENERAL SURGERY AND PODIATRY SERVICES. - THE APOTHECARY SHOPPE, LOCATED AT 108 S. MAIN STREET, WEST SALEM, IL, OFFERS RETAIL PHARMACY SERVICES MONDAY THROUGH FRIDAY FROM 9 A.M. TO 3 P.M., AND SATURDAYS FROM 9 A.M. TO NOON. RMH PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, GENDER, NATIONAL ORIGIN, DISABILITY, AGE OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. THE MISSION OF RMH IS TO SERVE OUR COMMUNITY WITH RESPECT IN PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH THE COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, WE OFFER: - FREE CARE TO QUALIFIED INDIVIDUALS UNDER THE RMH FINANCIAL ASSISTANCE PROGRAM - CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST; AND - HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT AND EDUCATE THE COMMUNITY. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, PROFESSIONAL EDUCATION PROGRAMS, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. RMH PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST. THE HOSPITAL ALSO PROVIDES CARE TO PERSONS COVERED BY COMMERCIAL INSURANCE AT BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE HOSPITAL RECOGNIZES THESE AMOUNTS AS COST INCURRED IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. FINANCIAL ASSISTANCE WAS ALSO PROVIDED THROUGH RMH'S FINANCIAL ASSISTANCE POLICY OFFERED IN 2021. FORM 990, PART VI, QUESTION 2 JAMES C. LEONARD, MD (OFFICER), LAUREN SCHMID (KEY EMPLOYEE), AND DENNIS HESCH (OFFICER) HAD BUSINESS RELATIONSHIPS. JAMES C. LEONARD, MD (OFFICER), MATTHEW KOLB (OFFICER), AND SALLY SALMONS, MD (TRUSTEE) HAD BUSINESS RELATIONSHIPS. FORM 990, PART VI, QUESTION 6 RICHLAND MEMORIAL HOSPITAL, INC. HAS ONE MEMBER WHICH IS THE PARENT COMPANY, THE CARLE FOUNDATION. FORM 990, PART VI, QUESTION 7A RICHLAND MEMORIAL HOSPITAL INC.'S SOLE MEMBER, THE CARLE FOUNDATION, ACTING THROUGH ITS BOARD OF TRUSTEES, HAS THE EXCLUSIVE POWER TO ELECT AND REMOVE MEMBERS OF THE BOARD OF TRUSTEES FOR THE CORPORATION IN ADDITION TO FILLING VACANCIES. FORM 990, PART VI, QUESTION 7B RICHLAND MEMORIAL HOSPITAL, INC. MUST HAVE THE APPROVAL OF ITS SOLE MEMBER, THE CARLE FOUNDATION, THROUGH ITS BOARD OF TRUSTEES, WHEN VOTING ON MATTERS INCLUDING THE AMENDING OF GOVERNING DOCUMENTS; RECOMMENDING THE CEO TO THE BOARD; APPROVING ANY ANNUAL OR LONG-TERM CAPITAL OR OPERATIONAL BUDGETS; APPROVING PAYMENT TO THE MEMBERS OF THE RICHLAND BOARD OF TRUSTEES FOR THEIR EXPENSES OR COMPENSATION FOR SERVICES; APPROVING ANY NEW, LONG-TERM OR MASTER INSTITUTIONAL PLANS OR CHANGES TO SUCH PLANS; APPROVING THE ADDITION OF ANY NEW MEMBER AND ANY DISSOLUTION, MERGER, CONSOLIDATION, OR SALE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL ASSETS OR ANY DISPOSITION OF REAL PROPERTY OR RELOCATION OF THE HOSPITAL AND/OR CLINIC; APPROVING ANY ORGANIZATION OR ACQUISITION OF A SUBSIDIARY OR AFFILIATE; APPROVING ANY INITIATIVE REQUIRING CERTIFICATE OF NEED (CON) APPROVAL; APPROVING ANY PLEDGE OF ALL OR ANY PART OF THE CORPORATION'S ASSETS AS SECURITY FOR A DEBT, LIABILITY OR OTHER OBLIGATION; APPROVING ANY LOAN TO OR FOR THE CORPORATION OR ANY OTHER INDEBTEDNESS; AND APPROVING NON-BUDGETED EXPENDITURES OR SALE EXCEEDING THE CHIEF EXECUTIVE OFFICER'S (CEO) AUTHORIZED SPENDING AUTHORITY. FORM 990, PART VI, QUESTION 11B THE FORM 990 WAS PREPARED BY STAFF AND AN EXTERNAL TAX ADVISOR AND REVIEWED BY MANAGEMENT. PRIOR TO FILING THIS FORM 990, A FULL AND COMPLETE COPY WAS PROVIDED TO THE GOVERNING BODY. AT THEIR DISCRETION, THE GOVERNING MEMBERS HAVE THE OPPORTUNITY TO CONTACT MANAGEMENT OR DISCUSS AND ADDRESS CONCERNS AT SUBSEQUENT BOARD MEETINGS. FORM 990, PART VI, QUESTION 12C THE ORGANIZATION'S ESTABLISHED CONFLICT OF INTEREST POLICIES REQUIRE ANNUAL DISCLOSURE OF ACTUAL AND POTENTIAL CONFLICTS OF INTEREST FOR OFFICERS, DIRECTORS, TRUSTEES, MEMBERS OF BOARD COMMITTEES, ADMINISTRATIVE AND MANAGERIAL EMPLOYEES AS WELL AS ALL EMPLOYEES OF THE PURCHASING DEPARTMENT. IF CIRCUMSTANCES CHANGE DURING THE COURSE OF A YEAR, INTERIM DISCLOSURE IS ALSO REQUIRED OF THE SAME INDIVIDUALS. THE DISCLOSURES OF EMPLOYEES ARE REVIEWED INITIALLY BY THE COMPLIANCE DEPARTMENT AND ANY IDENTIFIED CONFLICTS ARE REFERRED TO, AND ADDRESSED BY, THE ORGANIZATION'S INTERNAL LEGAL COUNSEL AND/OR CORPORATE INTEGRITY OFFICER. THE DISCLOSURES OF TRUSTEES AND MEMBERS OF BOARD COMMITTEES ARE REVIEWED BY THE CHAIR OF THE BOARD. THE ENTIRE BOARD, ABSENT THE SUBJECT TRUSTEE OR COMMITTEE MEMBER DETERMINES WHETHER A CONFLICT EXISTS. TRUSTEES AND/OR BOARD COMMITTEE MEMBERS WITH IDENTIFIED CONFLICTS ARE REQUIRED TO RECUSE THEMSELVES FROM DELIBERATING AND VOTING ON MATTERS THAT MAY PRESENT A CONFLICT. THE ORGANIZATION ALSO MAINTAINS PURCHASING POLICIES REQUIRING COUNTER SIGNATURES TO FURTHER MINIMIZE THE RISK ASSOCIATED WITH ACTUAL AND/OR POTENTIAL CONFLICTS OF INTEREST. FORM 990, PART VI, QUESTION 15B THE BOARD OF TRUSTEES OF THE CARLE FOUNDATION, THE PARENT ORGANIZATION OF RICHLAND MEMORIAL HOSPITAL, THROUGH ITS COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT MEMBERS FREE OF CONFLICT, ANNUALLY REVIEWS EXECUTIVE COMPENSATION LEVELS AND ESTABLISHES APPROPRIATE SALARY RANGES AND OTHER FEATURES OF THE COMPENSATION PLAN IN ACCORDANCE WITH THE ORGANIZATION'S APPROVED COMPENSATION PHILOSOPHY AND STRATEGY: *THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES; WHO ARE INDEPENDENT OF THE CARLE FOUNDATION MANAGEMENT; HAVE NO PERSONAL INTEREST IN THE COMPENSATION ARRANGEMENTS; ARE NOT RELATED TO, OR UNDER THE CONTROL OF ANY INDIVIDUAL WHOSE COMPENSATION ARRANGEMENT IS BEING REVIEWED; AND HAVE NO MATERIAL BUSINESS RELATIONSHIP WITH THE CARLE FOUNDATION. *THE CHIEF EXECUTIVE OFFICER'S COMPENSATION IS DETERMINED BY THE COMPENSATION COMMITTEE IN RELATION TO APPROPRIATE COMPARABILITY DATA. COMPENSATION FOR OTHER MEMBERS OF THE EXECUTIVE STAFF IS DEVELOPED BY THE CEO, EVALUATED AGAINST MARKET DATA, AND REVIEWED AND APPROVED BY THE COMMITTEE. *THE COMMITTEE APPROVES ALL ANNUAL COMPENSATION DECISIONS IN ADVANCE OF THEIR IMPLEMENTATION AND DOCUMENTS ITS DETERMINATIONS AND DISCUSSIONS. *THE COMPENSATION COMMITTEE RELIES UPON A NUMBER OF EXTERNAL RESOURCES AND COMPARISONS, AND ITS ANALYSIS INCLUDES TOTAL COMPENSATION (CASH COMPENSATION PLUS BENEFITS PROVIDED BY THE CARLE FOUNDATION) IN RELATION TO ORGANIZATIONAL PERFORMANCE AND PREVAILING INDUSTRY PRACTICES FOR LIKE RESPONSIBILITIES AT COMPARABLY-SIZED ORGANIZATIONS. THE COMMITTEE HAS ENGAGED THE SERVICES OF A COMPENSATION CONSULTING FIRM SPECIALIZING IN THE NOT-FOR-PROFIT SECTOR WHICH HAS WORKED WITH THE CARLE FOUNDATION AND MAKES ITS REPORTS DIRECTLY AVAILABLE TO THE COMPENSATION COMMITTEE. FORM 990, PART VI, QUESTION 19 RICHLAND MEMORIAL HOSPITAL, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9 RICHLAND MEMORIAL HOSPITAL, INC. SETTLED VARIOUS INTERCOMPANY RECEIVABLE/PAYABLE BALANCES THROUGH EQUAL OFFSETTING EQUITY TRANSFERS IN THE AMOUNT OF $-11,832,131. THESE INTERCOMPANY RECEIVABLE/PAYABLE BALANCES RESULT FROM THE NORMAL COURSE OF OPERATIONS AND WERE PRIMARILY ATTRIBUTABLE TO CENTRALIZED CASH MANAGEMENT AND DISBURSEMENT ACTIVITIES. THESE INTERCOMPANY RECEIVABLE/PAYABLE SETTLEMENTS HELPED PROVIDE SUPPLEMENTAL FUNDING FOR CERTAIN RELATED ORGANIZATIONS TO FURTHER THEIR EXEMPT PURPOSE. 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