2015-11-13T08:31:08-06:00 2014-12-31 BKD LLP 211 N BROADWAY SUITE 600 ST LOUIS MO 631022733 990 2014-01-01 370635502 Protestant Memorial Medical Center Inc % MEMORIAL HOSPITAL - CONTROLL PROT 6182575602 4500 Memorial Drive Belleville IL 622265399 JOE LANIUS VP FINANCE 6182575602 2015-11-10 true Donna J Larson P00043751 3142315544 2014 2016-04-25 22:37:26Z Mark J Turner President 4500 Memorial Drive Belleville IL 622265399 266283993 false X www.memhosp.com X 1947 IL SEE SCHEDULE O. 14 13 2724 323 133364 186420 87600 252678468 257400765 1726809 953390 3886245 4100754 258477942 262542509 0 0 0 0 138681634 127784757 0 0 0 116440853 111556129 255122487 239340886 3355455 23201623 193664592 219188493 78172900 80527360 115491692 138661133 X MEMORIAL IS COMMITTED TO BEING THE HEALTHCARE PROVIDER OF CHOICE BY DELIVERING EXTRAORDINARY CARE AND COMPASSIONATE SERVICE TO PATIENTS OF SOUTHWEST ILLINOIS THROUGH EXPANDED SERVICES, PHYSICAL FACILITIES, AND ADVANCED TECHNOLOGY. false false 199384372 247601599 GENERAL SHORT TERM ACUTE CARE HOSPITAL: 316 BEDS, 15,403 PATIENTS ADMITTED, 64,238 PATIENT DAYS, 68,063 EMERGENCY ROOM VISITS, 30,460 MEDICARE PATIENT DAYS, 348,620 OUTPATIENT DEPARTMENT VISITS, AND 12,921 MEDICAID PATIENT DAYS. SEE SCHEDULE O FOR ADDITIONAL STATISTICS AND VALUE OF COMMUNITY BENEFITS PROVIDED DURING 2014. 9075047 10273149 SKILLED NURSING FACILITY-MEMORIAL CARE CENTER: 108 BEDS, 1,025 PATIENTS ADMITTED, 22,895 PATIENT DAYS, 15,294 MEDICARE PATIENT DAYS, 52 MEDICAID PATIENT DAYS. 208459419 true true false true false false false false false false true false true true true false false true false false false false false false false false true true false false true true false false false false false false false false true false false false false false false true false false false true 192 0 true 2724 true true true false false false false false false false false false X 14 13 true false false false true true true true true false false true true true true true true true true false IL X MEMORIAL HOSPITAL - CONTROLL 6182575602 4500 MEMORIAL DRIVE BELLEVILLE IL 62226 X R BRAD RINGHOFER MD DIRECTOR 0.5 0.5 X 0 0 0 LESLIE MEHRTENS DIRECTOR 0.5 0.8 X 0 0 0 EDWARD HOERING DIRECTOR 0.5 1.2 X 0 0 0 LARY ECKERT DIRECTOR 0.5 1.2 X 0 0 0 THOMAS LIPPERT DIRECTOR 0.5 0.8 X 0 0 0 EDWARD ROSE MD DIRECTOR 0.5 0.5 X 0 0 0 ROLAND THOUVENOT CHAIRMAN, DIRECTOR 0.5 0.85 X 0 0 0 ROBERT WANLESS MD DIRECTOR 0.5 0.5 X 0 288124 26226 SCOTT GIVENS DIRECTOR 0.5 0.5 X 0 0 0 MARQUITA WILEY DIRECTOR 0.5 0.5 X 0 0 0 JEFFRY LUTZ DIRECTOR 0.5 1.2 X 0 0 0 REV ROB DYER DIRECTOR 0.5 0.5 X 0 0 0 ROBERT GRAEBE DIRECTOR 0.5 0.5 X 0 0 0 KEITH COOK DIRECTOR 0.5 0.85 X 0 0 0 MARK TURNER PRESIDENT 55.0 5.62 X 544046 0 137324 JOE LANIUS VP FINANCE 23.0 37.62 X 0 310394 45486 NANCY WESTON VP NURSING SERVICES 65.0 0.0 X 326236 0 35380 RUTH HOLMES ADMINISTRATOR MEMORIAL EAST 10.0 60.0 X 0 202212 33668 CHERYL CREASY VP RISK MANAGEMENT 49.0 1.0 X 145105 0 28424 JAMES DAVIS VP PHYSICIAN SERVICES 1.0 59.0 X 0 179367 31213 WILLIAM CASPERSON MD VP MEDICAL AFFAIRS 60.0 0.0 X 329374 0 61039 AMY THOMAS VICE PRESIDENT FINANCE 60.0 0.0 X 203590 0 33226 JOHN ZIEGLER VP HUMAN RESOURCES 55.0 5.0 X 182719 0 31673 MICHAEL MCMANUS CHIEF OPERATING OFFICER 55.0 0.0 X 279423 0 40608 LINDA FRITSCHE TELEMETRY NURSE 60.0 0.0 X 135115 0 19706 MARIA GHORMLEY EMERGENCY NURSE 60.0 0.0 X 149525 0 16363 STARLA ELLER DIRECTOR SURGICAL SERVICES 60.0 0.0 X 180855 0 17484 JENNIFER MEINKOTH DIRECTOR INFORMATION TECHNOLOG 55.0 0.0 X 189817 0 27296 GLEN KOHNZ DIRECTOR PHARMACY 60.0 0.0 X 145727 0 14946 2811532 980097 600062 65 false true false CALIFORNIA EMERGENCY PHYSICIANS 2100 POWELL ST EMERYVILLE CA 94608 PHYSICIAN SERVICES 3824475 CROTHALL HEALTHCARE 13028 COLLECTION CTR DR CHICAGO IL 60693 CONSULTING SERVICES 3584347 ANESTHESIA ASSOCIATES 4500 MEMORIAL DR BELLEVILLE IL 62226 ANESTHESIA SERVICES 3106982 HURON CONSULTING SERVICES 550 W VAN BUREN CHICAGO IL 60607 CONSULTING SERVICES 2416440 ARUP LABORATORIES 500 CHIPETA WAY SALT LAKE CITY UT 84108 LAB TEST SERVICES 963552 73 87600 87600 PATIENT SERVICES - ACUTE CARE HOSP. 621110 247127616 246994252 133364 PATIENT SERVICES - SKILLED NURS. FAC 621110 10273149 10273149 257400765 937156 937156 0 0 49056 49056 0 49056 49056 3757718 3741484 16234 16234 16234 0 0 0 CAFETERIA/COFFEE SHOP SALES 722210 1573801 1573801 VHA PATRONAGE PROG 621110 473983 473983 EMR INCENTIVE PAYMENT 900099 1596119 1596119 407795 407795 4051698 262542509 257741384 133364 4580161 0 0 0 0 2378167 2378167 38605 38605 90495886 83007377 7488509 3105945 2777164 328781 24756291 22135705 2620586 7009863 6267832 742031 0 373630 373630 94024 94024 0 0 0 25198927 17902993 7295934 1054968 1054968 41794452 41127783 666669 0 0 3988184 3566013 422171 97411 54512 42899 0 0 1151695 1151695 0 14736720 13204489 1532231 2299763 1995659 304104 REPAIRS & MAINTENANCE 7595442 5366171 2229271 ASSOCIATION DUES 315112 315112 MICROFILMING 42000 42000 MEDICAL WASTE DISPOSAL 285569 285569 12528232 10729547 1798685 239340886 208459419 30881467 0 4200 4200 9781616 30783994 0 0 47450427 44254007 0 0 0 0 0 0 2882714 2834468 3405134 3543952 236543632 175641838 67789386 60901794 31115810 33316897 0 0 12110181 13131080 0 0 19125124 30418101 193664592 219188493 45778407 48004576 0 0 0 0 15586237 15350155 0 0 0 0 0 0 0 0 16808256 17172629 78172900 80527360 X 103381511 125530053 12110181 13131080 0 0 115491692 138661133 193664592 219188493 X 23201623 -301571 269389 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 88570 88570 false PART II-B, LINE 1I PROTESTANT MEMORIAL MEDICAL CENTER, INC. PAID MEMBERSHIP DUES TO ILINOIS HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. THESE ORGANIZATIONS ESTIMATED EXPENSES ALLOCATED TO LOBBYING ACTIVITIES TO BE 39.5% OF MEMBERSHIP DUES. PROTESTANT MEMORIAL MEDICAL CENTER, INC. ENGAGED AND PAID KANE CONSULTING $48,000 TO ASSIST MEMORIAL HOSPITAL WORKING WITH THE ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES (DHFS) ON THE MEDICAL CENTER'S MEDICAID REIMBURSEMENTS. 1486451 1486451 37670663 30779881 6890782 5097425 3985294 1112131 191416169 140876663 50539506 872924 872924 60901794 NET ASSETS OF MEMORIAL FOUNDAT 13131080 F 13131080 AUXILIARY OTHER ASSETS 151498 DUE FROM AFFILIATED CORPS 13093974 DUE FROM INSURANCE AFFILIATE 17172629 30418101 0 ESTIMATED PROFESSIONAL LIABILI 17172629 17172629 262404076 -425764 287331 -138433 262542509 262542509 242285977 2945091 2945091 239340886 239340886 PART V SCHEDULE D, PART V HAS NOT BEEN COMPLETED. THE ORGANIZATION ONLY REPORTS SUCH FUNDS ON THE BALANCE SHEET DUE TO AN AUDIT REQUIREMENT THAT THE INTEREST IN A RELATED FOUNDATION BE RECOGNIZED ON THE BOOKS. THE FUNDS HAVE BEEN ANALYZED ON FORM 990 OF MEMORIAL FOUNDATION, INC. (EIN#37-1186034). PART X, LINE 2-FIN 48 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. PART XI, LINE 2D $287,331 OF INVESTMENT INCOME OF MEMORIAL HOSPITAL SELF INSURANCE TRUST FUND (EIN#37-1064809), A RELATED 501(C)(3) ORGANIZATION IS INCLUDED ON THE AUDITED FINANCIAL STATEMENTS OF PROTESTANT MEMORIAL MEDICAL CENTER, INC. PART XII, LINE 2D $219,181 OF EXPENSES OF MEMORIAL HOSPITAL SELF INSURANCE TRUST FUND (EIN#37-1064809), A RELATED 501(C)(3) ORGANIZATION ARE INCLUDED IN THE AUDITED FINANCIAL STATEMENTS OF PROTESTANT MEMORIAL MEDICAL CENTER, INC. $2,725,910 OF INSURANCE EXPENSES ON THE AUDITED FINANCIAL STATEMENTS OF PROTESTANT MEMORIAL MEDICAL CENTER, INC. ARE INCLUDED IN OTHER CHANGES IN NET ASSETS ON THIS FORM 990 PART XI LINE 9 AND REPRESENT AN INSURANCE RELATIONSHIP WITH MEMORIAL CAPTIVE INSURANCE COMPANY (EIN#98-1082415), A RELATED ORGANIZATION. true true true X 249. true X true true false true true 2521442 2521442 0.01050 29628737 19334047 10294690 0.04300 32150179 19334047 12816132 0.05350 1260615 1260615 0.00530 271944 271944 0.00110 1532559 1532559 0.00640 33682738 19334047 14348691 0.05990 false 11276742 1691511 86531071 95958249 -9427178 X true true 1 1 MEMORIAL HOSPITAL 4500 MEMORIAL DRIVE BELLEVILLE IL 62226 WWW.MEMHOSP.COM 0001461 X X X MEMORIAL HOSPITAL 1 false false true X X X X X X X X 12 true false false true X SEE SCHEDULE H, PART V, SECTION C true 12 true SEE SCHEDULE H, PART V, SECTION C false false true X 249. 350. X X true true X X X true X X X X X X X X X X true false X X true X false false PART V, SECTION B, LINE 5 PERSONS WHO REPRESENT THE COMMUNITY THE MAPP ASSESSMENT TEAMS CONDUCTED A COMPREHENSIVE ASSESSMENT OF THE ENTIRE POPULATION THROUGH THE USE OF COMMUNITY SURVEYS, A REVIEW OF POPULATION TRENDS, HEALTH OUTCOMES AND BEHAVIORS OVER THE LAST 5 YEARS. SECONDARY ASSESSMENTS OCCURRED AMONG KEY INFORMANTS AND FOCUS GROUPS FOR SELECT SEGMENTS OF THE POPULATION REPRESENTED BY PARTICIPATING HEALTH AND HUMAN SERVICE ORGANIZATIONS (I.E. THE HOMEBOUND ELDERLY, PERSONS WITH DISABILITIES, SENIOR CITIZENS, RESIDENTS OF COUNTY HOUSING AUTHORITIES, THE FAITH COMMUNITY, HEALTH ADVOCACY GROUPS, MEDICALLY MANAGED INDIVIDUALS AND THOSE PERSON WITH SERIOUS MENTAL ILLNESS). SEE COMMUNITY HEALTH NEEDS ASSESSMENT FOR LISTING OF HEALTHCARE COMMISSION MEMBERS AND AFFILIATES CONSULTED. PART V, SECTION B, LINE 7, 10, 11 CHNA MADE WIDELY AVAILABLE THE HOSPITAL FACILITY POSTS THE CHNA, ALONG WITH ITS IMPLEMENTATION STRATEGY AT THE FOLLOWING SITE: http://memhosp.com.jtsite.com/media/uploads/Patient-Visitor/community_heal th_needs_assessment_2012.pdf THE NEEDS IDENTIFIED IN THE MOST RECENT CHNA AND HOW THEY ARE BEING MET ARE DESCRIBED IN THE IMPLEMENTATION STRATEGY. THE ORGANIZATION DOES NOT HAVE ANY IDENTIFIED NEEDS THAT ARE NOT BEING ADDRESSED. PART V, SECTION B, LINE 22D ATTACHMENT A TO THE FINANCIAL ASSISTANCE POLICY DESCRIBED IN THE NOTE FOR PART I, LINE 3, AND THE UNINSURED DISCOUNT POLICY FOUND IN PART VI, PROVIDE THE FACTORS FOR DETERMINING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE PATIENTS. PART V, SECTION B, LINES 16A-C ACCESS THE FOLLOWING WEBSITE FOR THE THREE QUESTIONS LISTED ABOVE: HTTP://MEMHOSP.COM.JTSITE.COM/FINANCIAL-ASSISTANCE 2 MEMORIAL CARE CENTER 4315 MEMORIAL DRIVE BELLEVILLE IL 62226 SKILLED NURSING FACILITY BELLEVILLE HEALTH & SPORTS CENTER 1001 SOUTH 74TH STREET BELLEVILLE IL 62223 SPORTS FACILITY PART I, LINE 3C FINANCIAL ASSISTANCE (CHARITY CARE) I. PURPOSE To describe the guidelines and process by which Memorial will grant charity care to patients. II. POLICY Memorial Hospital and Memorial Care Center (collectively "Memorial") are not-for-profit healthcare facilities established to meet the health care needs of the community. Individuals who need financial assistance and do not possess sufficient resources to pay all or a portion of Memorial's bill may be eligible for charity care according to the guidelines set forth in this policy. Charity care is available for all services provided by Memorial with the exception of the following: 1. Elective cosmetic surgery, elective sterilization and reverse sterilization procedures and screening tests 2. Any services not covered by Medicare. 3. Memorial Care Center services for long-term residential care. 4. Services not billed by Memorial (e.g., ambulance services, physician services, etc.) Patients who do not qualify for assistance pursuant to this policy may be eligible for discounts pursuant to AP 740 (Uninsured Patient Discount Policy). III. GUIDELINES 1. Eligibility for financial assistance will be based upon income guidelines approved by the Board of Directors, as well as the size of the patient's bill relative to the patient's household income. A. Eligibility based on income. Eligibility for financial assistance will be based upon income guidelines approved by the Memorial Board of Directors, based on federal poverty guidelines published by the United States Department of Health & Human Services ("Income Eligibility"). The Income Eligibility Guidelines, as amended from time to time by the Board of Directors, are set forth in Attachment A to this policy. B. Eligibility based on catastrophic medical expenses. Eligibility for financial assistance also will be based on the size of the patient's bill relative to the patient's household income. Payment responsibility for patients qualifying for Income Eligibility will be capped at ten percent (10%) of annual family income, as determined in the application process. Uninsured patients who face extraordinary medical expenses and who do not qualify for charity care based on Income Eligibility will qualify for financial assistance if their self-pay balances exceed ten percent (10%) of annual family income ("Medical Expense Eligibility"). Patients eligible on the basis of Medical Expense Eligibility will be responsible for the portion of the self-pay balance up to 10% of annual family income. Charity care will be granted to cover the excess amount. C. Eligibility based on Presumptive Mandated Categories. Eligibility for financial assistance also will be based on the following presumptive categories: Homelessness; deceased with no estate; mental incapacitation with no one to act on behalf; Medicaid eligibility, but not covered on date of service or non-covered service; Women, Infants, Children (WIC); Supplemental Nutrition Assistance Program (SNAP); Free Lunch and Breakfast Program; Low Income Home Energy Assistance Program (LIHEAP); Grant assistance for medical services; and Community medical care programs to low income. 2. Memorial will identify patients requiring financial assistance either prior to or and at any time during the billing and collection process. Memorial's Point of Service program will help to identify patients qualifying for financial assistance prior to service. Patients in the presumptive mandated categories may also be identified as eligible prior to receiving services. In addition, circumstances relating to a patient's (or a responsible party's) ability to pay may change subsequent to the rendering of medical services. Accordingly, a charity care determination can be made for a patient prior to, at the time of service or at any time during the billing and collection process. 3. The availability of charity care will be communicated to patients through a variety of means to ensure that Memorial's policy reaches persons in need of assistance. Communications to patients regarding the availability of charity care will be clear and concise and will include, but not be limited to, information provided by registration personnel, statements included on consent forms and patient statements, patient handbooks, signage within the hospital and publication on Memorial's website. Copies of Memorial's Application for Financial Assistance form ("Application Form") will be available for distribution in the Patient Access & Financial Services Department. Recognizing the sensitivity of patients and their families regarding the need for charity, all publications, forms, etc. will use the term "financial assistance" in lieu of "charity care" or "charity assistance." 4. Patients' specific questions about financial assistance should be directed to the Revenue Cycle Director or his/her designee. 5. All patients seeking financial assistance will be requested to complete an Application Form except for the patients in the presumptive financial categories (see section III Ic). Each patient or a patient representative will be requested to complete the Application Form in order for Memorial to determine eligibility for financial assistance on the basis of either Income Eligibility or Medical Expense Eligibility, provided that patients who demonstrate eligibility for any of the presumptive financial categories will be deemed eligible for charity assistance without an Application Form. It is the responsibility of the person seeking assistance to provide Memorial with sufficient and complete financial information to evaluate any request for charity care. Memorial personnel are available to assist with completion of the Application Form by telephone or in person. If translation is needed to facilitate completion of applications, it will be provided. Confidentiality of information and preservation of privacy shall be maintained for all patients who seek charity care. No information obtained in the application process will be released to third parties without the patient's written consent. 6. The patient or responsible party must apply to any local, state or federal government program for which the patient may be eligible for medical payment assistance when applicable. Memorial personnel will assist the patient or responsible party in the completion of any required application(s). A government application form may be substituted for the Application Form. 7. Any insurance benefit or third party obligation that is available for covering the cost of Memorial's services must be considered prior to the determination of charity care. This includes any medical liability, no-fault or insurance benefits. Memorial reserves the right to recover any amount previously approved for charity care that is subsequently paid by such insurance benefit or third party. 8. Memorial may consider the availability of liquid assets in determining charity care. In determining whether a patient qualifies for charity care, Memorial may also consider the extent to which the person has liquid assets (cash and investments) that could be used to meet the financial obligation. The patient's primary residence, automobile, pension assets and other personal property are specifically exempted from consideration in the determination of financial need. 9. A determination of the patient's eligibility for charity care will be made within fifteen (15) business days from the receipt of a completed Application Form, and collection efforts will be suspended pending such determination and otherwise in compliance with AP 730 (Billing and Collections Policy). Patients will be notified in writing of Memorial's decision to grant or to deny financial assistance. Charity care will be extended for any open account at the time of application and may continue for a period of six (6) months unless a change in patient financial status is determined. 10. Memorial offers payment plan options to patients eligible for charity care to successfully retire self-pay balances. Charity care patients are offered interest free payment plans to assist them in retiring their outstanding hospital bills. 11. Memorial will offer patients the opportunity to apply for charity care prior to referring an outstanding hospital bill to collection. Memorial will offer to conduct a financial assessment or will arrange for an alternative payment plan prior to sending a bill to collection. (Refer to AP 730 Billing and Collections Policy). 12. Memorial will train its Patient Access and Financial Services Department staff with regard to the availability of financial assistance under this policy. 13. Memorial will periodically evaluate its charity care program and will file annual reports as appropriate. Management will make periodic reports to the Board of Directors regarding charity care. This policy will be reviewed periodically by senior managers for possible revision. Any revisions recommended by management will be submitted to the Board of Direct PART I, LINE 6A SEE SCHEDULE O - COMMUNITY BENEFITS REPORT FILED WITH ILLINOIS OFFICE OF ATTORNEY GENERAL PREPARED BY PMMCI PART I, LINE 7, COLUMN (F) THE COST OF CHARITY AND OTHER COMMUNITY BENEFITS WERE DIVIDED BY ORGANIZATION'S TOTAL OPERATING EXPENSES, WHICH DID NOT INCLUDE BAD DEBT EXPENSE. PART I, LINE 7 CHARITY CARE AND OTHER COMMUNITY BENEFITS WERE CALCULATED IN ACCORDANCE WITH STATE OF ILLINOIS REQUIREMENTS FOR COMMUNITY BENEFITS REPORT. THE MEDICARE COST TO CHARGE RATIO WAS USED FROM THE MEDICARE COST REPORT. PART III, LINE 4 THE AMOUNT ON LINE 2 REPRESENTS THE AMOUNT WRITTEN OFF TO BAD DEBT EXPENSE DURING 2014. THE ORGANIZATION DID NOT EMPLOY A METHODOLOGY TO ITS ESTIMATE OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE CHARITY CARE AS THERE ARE NO SUPPORTING STATISTICS AVAILABLE. RATHER, THE AMOUNT INCLUDED ON LINE 3 REPRESENTS AN ESTIMATED 15% OF THE TOTAL BAD DEBT EXPENSE REPORTED ON LINE 2. FOOTNOTE FROM AUDITED FINANCIAL STATEMENTS: "ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS." PART III, LINE 8 MEDICARE COST REPORT IS FILED FOLLOWING COST REPORT GUIDELINES. MEDICARE PAYMENT SHORTFALLS SHOULD BE REFLECTED AS COMMUNITY BENEFIT AS THE FEDERAL GOVERNMENT PROSPECTIVELY SETS THE HOSPITAL PAYMENT RATES; THE RATES ARE NOT NEGOTIABLE AND CONSEQUENTLY NO LONGER COVER THE HOSPITAL'S COST TO PROVIDE SERVICES TO MEDICARE BENEFICIARIES. PART III, LINE 9B BILLING AND COLLECTIONS I. PURPOSE To insure billing and collection efforts are fair, consistent and in accordance with applicable law. II. POLICY Memorial Hospital and Memorial Care Center (collectively, "Memorial") are not-for-profit healthcare facilities established to meet the health care needs of the community. Accordingly, Memorial shall pursue patient accounts fairly and consistently pursuant to the law and only after offering patients the opportunity to apply for charity care pursuant to AP 700 ("Financial Assistance Policy") and/or applying a discount pursuant to AP 740 ("Uninsured Patient Discount Policy"). III. GUIDELINES 1. Bill Information. When Memorial bills a patient for health care services, it shall provide the following information: (a) the date or dates that health care services were provided to the patient; (b) a brief description of the services; (c) the amount owed for services; (d) contact information for addressing billing inquiries to Memorial; (e) notice that the patient may obtain an itemized bill upon request; and (f) a statement regarding how an uninsured patient may apply for consideration under the Financial Assistance Policy on or with each Memorial bill sent to an uninsured patient. 2. Bill Inquiries. Memorial will provide patients with a telephone number to inquire about or dispute a bill. Memorial will return calls made by patients promptly, and in any case no later than two business days after receipt. If Memorial receives correspondence from the patient regarding a bill, Memorial will respond within ten business days of receipt. 3. Collections; Limitation on Collections. (a) In General. Memorial and its agents will not pursue a collection action against a patient until the patient has had the opportunity to assess the accuracy of the bill and apply for financial assistance under the Financial Assistance Policy or establish a reasonable payment plan under the Financial Assistance Policy or this policy. (b) Approval of Collection Actions. Memorial will not refer an account to collections, and will not permit any collection agency, law firm or individual to initiate legal action for non-payment of a hospital bill against a patient, without the written approval of the Revenue Cycle Director or his/her designee. Such action will only be approved if it is reasonably believed that the conditions for pursuing the action under this Policy are met. (c) Special Considerations for Uninsured Patients. An uninsured patient will have sixty days following the date of discharge or receipt of care or thirty days following the initial bill (whichever is longer) to submit an application for financial assistance or to request a reasonable payment plan. Thereafter, Memorial may pursue collection action against an uninsured patient only when: (i) the patient has not paid his or her bill (as adjusted pursuant to the Uninsured Patient Discount Policy) during such time and has not contacted Memorial about payment; (ii) the patient has informed Memorial that he or she has applied for a government sponsored healthcare program but the patient's application has been denied; (iii) the patient has agreed to a reasonable payment plan with Memorial and the patient has failed to make payments in accordance with that reasonable payment plan; or (iv) the patient requests a reasonable payment plan but fails to agree to a plan within thirty days of that request. (d) Other Considerations. (i) Memorial will not pursue legal action for non-payment of bills against patients who qualify for financial assistance and who have clearly demonstrated that they have neither sufficient income nor assets to meet their financial obligation. (ii) Legal action may be taken by Memorial to enforce the terms of the payment plan when there is evidence that the responsible party has sufficient income and/or assets to meet his or her financial obligation. (iii) Memorial will not place a lien on the primary residence of a patient receiving financial assistance unless the value of the property clearly indicates an ability to assume significant financial obligations. Further, Memorial will not execute a lien by forcing the sale or foreclosure of the primary residence of a patient receiving financial assistance to pay for an outstanding medical bill. (iv) Memorial will not use body attachment to require any person, whether receiving financial assistance or not, to appear in court. (e) Adoption of Standards by Collection Agencies. Memorial will ensure that the guidelines outlined above are adhered to by any external collection agency, law firm or individual engaged to assist in obtaining payment on outstanding bills from patients. 4. Periodic Review. Memorial will review this policy periodically for compliance with the federal Fair Debt Collection Practices Act, the Illinois Fair Patient Billing Act and the Illinois Hospital Uninsured Patient Discount Act. PART V 1 HOSPITAL & 1 SKILLED NURSING FACILITY ILLINOIS NEEDS ASSESSMENT SEE SCHEDULE O - COMMUNITY BENEFITS REPORT REGARDING COMMUNITY NEEDS. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE FINANCIAL ASSISTANCE IS COMMUNICATED VIA SIGNS POSTED THROUGHOUT THE HOSPITAL, NEWSPAPER, BROCHURES, WEBSITE, AND PATIENT BILLING STATEMENTS. COMMUNITY INFORMATION SEE SCHEDULE O - COMMUNITY BENEFIT REPORT FOR DESCRIPTION OF THE GEOGRAPHIC AND DEMOGRAPHIC PROFILES OF PATIENTS SERVED. PROMOTION OF COMMUNITY HEALTH SEE SCHEDULE O - COMMUNITY BENEFIT REPORT REGARDING SUBSIDIZED COMMUNITY OUTREACH, COMMUNITY EDUCATION, SUPPORT GROUPS AND SCREENINGS OTHER INFORMATION REQUIRED SEE SCHEDULE O - COMMUNITY BENEFITS REPORT FOR A DESCRIPTION OF ACTIVITIES THAT FURTHER THE ORGANIZATION'S EXEMPT PURPOSE. ADDITIONALLY, THE FOLLOWING IS THE UNINSURED PATIENT DISCOUNT POLICY: UNINSURED PATIENT DISCOUNT I. PURPOSE To describe the guidelines and process by which Memorial will grant uninsured patients a discount from billed charges. II. POLICY Memorial Hospital and Memorial Care Center (collectively "Memorial") are not-for-profit healthcare facilities established to meet the health care needs of the community. In an effort to provide affordable health care services, patients who lack private or public health insurance will receive an automatic discount from Memorial's billed charges. Memorial will discuss financial responsibility with patients prior to services being provided pursuant to the Point of Service Policy (AP 750). The uninsured patient discount is available for all services provided by Memorial with the exception of the following: 1. Elective cosmetic surgery, elective sterilization and reverse sterilization procedures and procedures or other services not covered by Medicare. 2. Memorial Care Center services for long-term residential care. 3. Non-medical services (e.g., social and vocational services). 4. Services not billed by Memorial (e.g., ambulance services, physician services etc.) This policy will be interpreted and applied in a manner consistent with the Illinois Hospital Uninsured Patient Discount Act. III. GUIDELINES 1. Eligibility for the discount. An "uninsured patient" is defined as: Any patient who is not covered under a policy of health insurance and is not a beneficiary under a public or private health insurance, health benefit, or other health coverage program, including high deductible health insurance plans, workers' compensation, accident liability insurance or other third party liability or no fault insurance. Patients that are insured but not covered for a particular service do not qualify for the uninsured patient discount. The availability of the uninsured discount is contingent upon the uninsured patient applying, at Memorial's request, for coverage under public programs (i.e., Medicare, Medicaid, etc.) if Memorial determines there is a basis to believe the patient may be eligible for such programs. 2. Calculation of the discount. The discount is calculated as the difference between billed charges and one hundred thirty-five percent (135%) of cost, using the total cost-to-charge ratio from Memorial's most recently filed Medicare cost report (Worksheet C, Part I). 3. Maximum annual collection. The maximum amount collected from an eligible patient in a twelve-month period is twenty-five percent (25%) of the family's annual household income. The twelve-month period begins as of the first date of service eligible for discount. For subsequent services to be counted toward the maximum, the patient must inform Memorial that he/she had received prior discounted services from Memorial. The annual cap is applicable only to services provided at Memorial and does not include services provided at other hospital facilities. 4. Communication to Patients. Memorial will include a statement on all patient bills that financial assistance may be available on the remaining account balance, pursuant to AP 700 (Financial Assistance Policy). POINT OF SERVICE I. PURPOSE To describe the guidelines and process by which Memorial will collect patient payments prior to service. II. POLICY Memorial Hospital and Memorial Care Center (collectively "Memorial") are not-for-profit healthcare facilities established to meet the health care needs of the community. As healthcare continues to evolve it is necessary to educate patients regarding their financial liability prior to service. Discussing financial responsibility before service is provided will improve the patient experience as well as increase revenue and reduce costs for the organization. III. GUIDELINES 1. Patient responsibility will be determined using payment estimation software or communication (online or phone call) to the patient's benefit administrator. 2. Guidelines for the payment of the patient's responsibility are based on estimated amount due. a. All patients will be asked to pay 100% of estimated balance due. b. Patients that pay their total estimated amount due prior to service being rendered will receive a 10% prompt pay discount. c. Patients with an estimated balance due of $100.00 or less and who do not pay 100% will be asked to establish a payment plan of at least $25.00 per month until the balance is paid in full. d. Patients whose estimated balance due is more than $100.00 and who cannot pay 100% will be asked to pay 50% with an automated payment plan for the remaining balance not to exceed 12 months. e. Patients whose estimated balance due is more than $100.00 and who cannot pay 100% or 50% will set up an automated payment plan for the entire estimated balance not to exceed 12 months. 3. Patients will be offered payment options of cash, check, credit/debit card, or electronic funds transfer. 4. Patients will be pre-screened for financial assistance based on information they provide to staff regarding income and presumptive eligibility per Financial Assistance Charity Care Policy (AP700). 5. Uninsured patients will receive up-front estimates of patient liability per Uninsured Patient Discount Policy (AP 740). 6. Patients that refuse to either pay their estimated balance or fail to cooperate in establishing a payment plan within the above guidelines will be notified that their test may be postponed. a. An exception to postponement will be made if the ordering physician determines that a delay in testing would be harmful to the patient's health. b. Emergency services will not be delayed based on a patient's ability to pay. 7. Patients will be billed per the collection guidelines included in the Billing and Collections Policy (AP 730). 8. If the actual patient responsibility is less than the original estimate the patient paid, the patient will be refunded if there are no other outstanding accounts. Otherwise, the credit will be applied towards any outstanding balance(s). STATE FILING OF COMMUNITY BENEFIT REPORT IL, X X X X X X false true false false false false false false false MARK TURNER PRESIDENT 526546 0 0 0 17500 0 117420 0 19904 0 681370 0 0 0 JOE LANIUS VP FINANCE 0 292894 0 0 0 17500 0 29320 0 16166 0 355880 0 0 NANCY WESTON VP NURSING SERVICES 308736 0 0 0 17500 0 24610 0 10770 0 361616 0 0 0 RUTH HOLMES ADMINISTRATOR MEMORIAL EAST 0 195368 0 0 0 6844 0 14837 0 18831 0 235880 0 0 ROBERT WANLESS MD DIRECTOR 0 283999 0 0 0 4125 0 11407 0 14819 0 314350 0 0 CHERYL CREASY VP RISK MANAGEMENT 139461 0 0 0 5644 0 9819 0 18605 0 173529 0 0 0 JAMES DAVIS VP PHYSICIAN SERVICES 0 170390 0 0 0 8977 0 14266 0 16947 0 210580 0 0 WILLIAM CASPERSON MD VP MEDICAL AFFAIRS 311874 0 0 0 17500 0 47046 0 13993 0 390413 0 0 0 LINDA FRITSCHE TELEMETRY NURSE 135115 0 0 0 0 0 4073 0 15633 0 154821 0 0 0 MARIA GHORMLEY EMERGENCY NURSE 149525 0 0 0 0 0 3684 0 12679 0 165888 0 0 0 AMY THOMAS VICE PRESIDENT FINANCE 186090 0 0 0 17500 0 16504 0 16722 0 236816 0 0 0 JOHN ZIEGLER VP HUMAN RESOURCES 165219 0 0 0 17500 0 13030 0 18643 0 214392 0 0 0 STARLA ELLER DIRECTOR SURGICAL SERVICES 180855 0 0 0 0 0 9584 0 7900 0 198339 0 0 0 JENNIFER MEINKOTH DIRECTOR INFORMATION TECHNOLOG 189817 0 0 0 0 0 10612 0 16684 0 217113 0 0 0 MICHAEL MCMANUS CHIEF OPERATING OFFICER 261923 0 0 0 17500 0 19736 0 20872 0 320031 0 0 0 GLEN KOHNZ DIRECTOR PHARMACY 145727 0 0 0 0 0 7046 0 7900 0 160673 0 0 0 PART II, 4B DEFERRED COMPENSATION AND RETIREMENT CONTRIBUTIONS PER PART II(C): ROBERT WANLESS, DIRECTOR: RETIREMENT CONTRIBUTION - $11,407 DEFERRED COMPENSATION - NONE MARK TURNER, PRESIDENT: RETIREMENT CONTRIBUTION - $16,120 DEFERRED COMPENSATION - $101,300 JOE H. LANIUS, VICE PRESIDENT FINANCE: RETIREMENT CONTRIBUTION - $16,120 DEFERRED COMPENSATION - $13,200 CHERYL CREASY, VICE PRESIDENT RISK MANAGEMENT: RETIREMENT CONTRIBUTION - $6,996 DEFERRED COMPENSATION - $2,823 WILLIAM CASPERSON, VICE PRESIDENT MEDICAL AFFAIRS: RETIREMENT CONTRIBUTION - $16,120 DEFERRED COMPENSATION - $30,926 NANCY WESTON, VICE PRESIDENT NURSING SERVICES: RETIREMENT CONTRIBUTION - $13,634 DEFERRED COMPENSATION - $10,976 RUTH HOLMES, ADMINISTRATOR MEMORIAL EAST: RETIREMENT CONTRIBUTION - $11,414 DEFERRED COMPENSATION - $3,423 JAMES DAVIS, VICE PRESIDENT PHYSICIAN SERVICES: RETIREMENT CONTRIBUTION - $9,776 DEFERRED COMPENSATION - $4,490 AMY THOMAS, VICE PRESIDENT FINANCE: RETIREMENT CONTRIBUTION - $10,607 DEFERRED COMPENSATION - $5,897 JOHN ZIEGLER, VICE PRESIDENT HUMAN RESOURCES: RETIREMENT CONTRIBUTION - $10,546 DEFERRED COMPENSATION - $2,484 MICHAEL MCMANUS, CHIEF OPERATING OFFICER: RETIREMENT CONTRIBUTION - $16,120 DEFERRED COMPENSATION - $3,616 JENNIFER MEINKOTH, DIRECTOR INFORMATION TECHNOLOGY: RETIREMENT CONTRIBUTION - $10,612 DEFERRED COMPENSATION - NONE LINDA FRITSCHE, TELEMETRY NURSE: RETIREMENT CONTRIBUTION - $4,073 DEFERRED COMPENSATION - NONE STARLA ELLER, DIRECTOR SURGICAL SERVICES: RETIREMENT CONTRIBUTION - $9,584 DEFERRED COMPENSATION - NONE MARIA GHORMLEY, EMERGENCY NURSE: RETIREMENT CONTRIBUTION - $3,684 DEFERRED COMPENSATION - NONE GLEN KOHNZ, DIRECTOR PHARMACY RETIREMENT CONTRIBUTION - $7,046 DEFERRED COMPENSATION - $0 A SOUTHWEST ILLINOIS DEVELOPMENT AUTH 371234684 84553AAE2 2013-12-06 156712718 CAPITAL BUILDING PROJECTS false false false A 0 0 15586237 0 0 114474 0 0 0 0 15471763 0 true false true true A false false false false 0 false false false true A false true true false 0 false 0 false true A true SCHEDULE K, PART II ON DECEMBER 6, 2013, SOUTHWESTERN ILLINOIS DEVELOPMENT AUTHORITY ISSUED TO MEMORIAL GROUP, INC. REVENUE BONDS IN THE ORIGINAL PAR AMOUNT OF $156,712,718. OF THE TOTAL INDEBTEDNESS, $15,586,237 WAS ALLOCATED TO PROTESTANT MEMORIAL MEDICAL CENTER, INC. AND $16,763,777 WAS ALLOCATED TO SOUTHWEST ILLINOIS HEALTH VENTURES, INC. MEMORIAL GROUP, INC. WAS ALLOCATED $124,362,704. SUSAN MCMANUS COO FAMILY MEMBER 38605 EMPLOYMENT false FORM 990, PART 1, LINE 1 BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES: PROTESTANT MEMORIAL MEDICAL CENTER OPERATES AN ACUTE CARE HOSPITAL AND SKILLED NURSING FACILITY WHOSE MISSION IS TO PROVIDE EXCEPTIONAL HEALTHCARE AND COMPASSIONATE SERVICE TO THE RESIDENTS OF SOUTHWEST ILLINOIS. COMMUNITY BENEFIT INFORMATION I. SUMMARY The value of community benefits provided by Memorial Hospital during 2014 exceeded $35.0 million. Community Benefit Value ------------------------- Unpaid Costs of Medicaid and Medicare $19,721,868 Bad Debts 11,276,742 Charity Care 2,521,442 Volunteer Services 421,203 Subsidized Health Services 133,762 Education 652,063 Donations 271,944 Language Assistant Services 43,007 Other Community Activities 10,580 Total Community Benefits for 2014 $35,052,591 In 2015 Memorial Hospital will continue to provide a comprehensive range of quality healthcare services to residents of the communities it serves throughout Southwestern Illinois, continue its charity care assistance program, and improve communication with community partners and patients regarding the health resources and patient care. II. MISSION STATEMENT Provide exceptional healthcare and compassionate service. III. VISION STATEMENT Memorial, in partnership with its medical staff, employees, volunteers, and the community, is committed to being the healthcare provider of choice by: -Delivering extraordinary care and compassionate service to patients every day -Continually identifying performance improvement opportunities -Expanding services based on community need and enhancing accessibility to care -Providing physical facilities and acquiring the advanced technology to exceed patient and physician expectations -Being the employer of choice, continuing to recruit and retain skilled staff committed to providing service excellence to patients, visitors, and co-workers IV. COMMUNITY BENEFITS PROVIDED IN 2014 During 2014 Memorial provided the following community outreach services to area residents at no or minimal cost: COMMUNITY BENEFIT INFORMATION (CONT) Service Persons Served ------------------------------ ---------------- 1. Community Health Education -Smart Driver Program 39 -Healthy Conversation-Heart Health 15 -Healthy Conversation-Fabulous and Fit Over 50 10 2. Wellness Programs -Healthy Lifesyle 53 -Lively Lungs Participants 112 -Cardiac Wellness/Rehab Program 9,721 -Belleville East Health Education Club 200 -Parish Nurses 15 3. Speakers Bureau (Topics) -Nutrition (Benefits of Healthy Eating) 407 -Pharmacy Participants -Cardiac Rehabilitation in -Heart Health Speakers -Obstetrics Bureau -Heat Related Issues-Signs,Symptoms,Prevention -Dehydration and Heat Exhaustion -Health, Wellness, and Faith -Breast Health -Diabetes Education -Pain Management -EPI Pen Training -Belleville Health and Sports Center -CPR -Cancer Awareness and Prevention 4. Clinics, Screenings, and Services -Diabetes Alert Day 50 -Kidney Mobile 30 -Skin Cancer Screening at Memorial Hospital 109 -Skin Cancer Screening at St. Clair County Office 40 -Stress and Mediatation Class 20 Blood Drive Donations: -Memorial Blood Drives 309 -New Donors 26 5. Support Groups -Diabetes 161 -Pulmonary Rehab 350 -Mended Hearts 49 -Hope Blooms 67 -AWAKE 140 -Stroke 240 -Alzheimer's 144 -Heart Failure 60 -Spinal Cord Injury 180 6. Special Events and Partnerships -Healthy Kids Day at the YMCA 200 -Healthy Living Expo 250 -Mingle and Mammograms 56 -Salute to Scott 3,000 -Get Up and Go Biathlon 500 -Back Pack to School 500 -Maternity Fair 175 -Dominate Your Diabetes 100 -Zumba for Heart Health 50 -Zumba for Breast Cancer 50 -Making Strides Against Breast Cancer Kick-Off 50 -Day of Play at St. Clair Square 50 -Heart and Vascular Screenings 28 -East Belleville YMCA 120 -Passport to Wellness 150 -Law Day Run 200 -Mckendree Involvement Fair 1,000 Health Fairs and Screenings: -Belleville East High School (3) -Casino Queen (2) -Monroe County Employees -Collinsville Middle School -Madison County Government (2) -Allsup -Scott Air Force Base -American Legion O'Fallon -Atrium Senior Apartments -Signal Hill -Cedars of Lebanon -Hospice of Southern Illinois -New Antioch Baptist Church -Mckendree University -The National Shrine of Our Lady of the Snows -St. Nicholas Church-O'Fallon -Holy Trinity Catholic Church-Fairview Heights -Nick 5K Run -Dupo High School -Monroe County Electric -Zoar UCC-Waterloo, IL -Clergy Day -Freize Harley Davidson -O'Fallon Township High School -St. Teresa's School -St. Clair County Office of Aging -Fairview Heights VFW -SWIC -Bluffview Elementary School -City of O'Fallon -Metro East Air and Health Forum Healthy Direction (Wellness Vehicle) -Belleville East High School -Casino Queen -Madison County Government -Memorial Medical Group-Nashville, IL -Scout Event-Dupo, IL -Program and Services for Older Persons -MetroLink (2) -McKendree University -St. Teresa's Catholic Church -Plummer Johnson -Scott Credit Union -Memorial Medical Group-Columbia, IL -Beacon 5K -Monroe County YMCA -Village of Dupo -Cedarhurst-Shiloh, IL -Freeburg Township -St. Nicholas Catholic Church-O'Fallon, IL -Knollwood Retirement Center Screenings Provided Include: -Screening Mammography (Healthy Direction Wellness Vehicle) -Blood Pressure -BMI with Body Fat Percentage -Cholesterol/Glucose -Lipid panels -PSAs -Forced Vital Capacity -Pulse Oximetry -Colorectal Screenings -Skin Cancer Screening -Cardiac Risk Profiles Other -Heart Walk - Memorial and its employees participated in the American Heart Association Heart Walk and have been represented on various committees. -March of Dimes Walk America - Memorial has been a check point sponsor for this event the past several years and has had representation on its board via a nursery nurse. Memorial has been the host site for this event since 2009. -Making Strides Against Breast Cancer - Memorial has supported this event through sponsorship, participation, and other in-kind support. -American Diabetes Association Run/Walk - As a certified Center for Diabetic Education, Memorial served a major sponsor for this run/walk through participation and in-kind support. -Get Up & Go - Memorial Hospital supports the Get Up & Go initiative to promote health/wellness in St. Clair County as well as is a key supporter of its annual biathlon. TOTAL COMMUNITY BENEFITS Total community benefits, including outreach programs, totaled $35,052,591 during 2014. Below is a summary of these activities: 1. Unpaid costs of providing care to Medicaid and Medicare patients a. Target Populations - Medicaid and Medicare enrollees b. Objectives - Provide needed inpatient and outpatient services to the community. c. Costs and Outcomes - $19,721,868 2. Bad Debts a. Target Populations - Broad community b. Objectives - Provide needed inpatient and outpatient services to the community. c. Costs and Outcomes - $11,276,742 3. Charity Care a. Target Populations - Low income uninsured, underinsured residents b. Objectives - Provide medical services to patients unable to pay for care. c. Costs and Outcomes - $2,521,422 4. Volunteer Services a. Target Populations - Memorial patients, family, visitors and board community. b. Objectives - Promote employee and volunteer participation in community benefit activities. c. Community Partners - Various non-profit agencies d. Costs and Outcomes - $421,203 over 33,000 volunteer hours 5. Community Outreach: Education, Screenings, Support Groups, Self Help Program a. Target Populations - Broad community, the uninsured, low income residents, residents without a primary care physician. b. Objectives - Provide health and wellness, safety, early disease detection, disease maintenance/support c. Community Partners - Various local groups d. Costs and Outcomes - $133,762 6. Health Care Education a. Target Populations - Potential health care workers, scholarships, student training opportunities b. Objectives - Address workforce shortage with universities c. Community Partners - Area colleges and universities d. Costs and Outcomes - $652,063 COMMUNITY BENEFIT INFORMATION (CONT) 7. Cash and In Kind Donations a. Target Populations - Broad community, low income residents b. Objectives - provide funds, services, staff, equipment, supplies, space to support local agencies and community programs. c. Community Partners - Social service agencies, churches, schools, health care providers d. Costs and Outcome - $271,944 8. Language Assistant Services a. Target Populations - Non-English speaking residents b. Objectives - Provide communication assistants c. Community Partners - Social service agencies d. Costs and Outcome - $43,007 9. Other Community Benefits a. Costs and Outcomes - $10,580 IV. 2015 COMMUNITY BENEFIT PLAN This section describes the communities served by Memorial, the health needs identified, program goals and objectives for 2015, and program priorities. A. Populations and Communities Served by Memorial Hospital 1. 2014 Adult & Pediatric Inpatient Discharges by County of Residence County Number Percent of Total St. Clair 12,860 83.58% Madison 973 6.32 Monroe 333 2.16 Randolph 377 2.45 Clinton 279 1.81 Washington 181 1.18 Other 383 2.50 -------- --------- Total 15,386 100.0% 2. More than half of Memorial's inpatients reside in five cities: Belleville, O'Fallon, Fairview Heights, East St. Louis, and Cahokia. 2014 Adult & Pediatric Inpatient Discharges by Zip Code of Residents Zip Code City # of Discharges Percent of Total 62226 Belleville 1,969 12.4% 62221 Belleville 1,242 8.2 62223 Belleville 1,249 7.9 62269 O'Fallon 1,169 7.9 62208 Fairview Heights 898 6.1 62206 Cahokia 885 5.9 62220 Belleville 777 5.1 62205 East St. Louis 586 3.6 ------- ------ Total 8,775 57.1 62234 Collinsville 512 3.3 62203 East St. Louis 515 3.3 62232 Caseyville 493 3.2 ------- ------ Total 1,520 9.8 All Other 5,091 33.1 Total 15,386 100% 3. Medical and surgical patients account for 89.5 percent of Memorial's inpatients. 2014 Adult & Pediatric Inpatient Discharges by Clinical Service Service Type Number Percent of Total Medical 10,520 68.37% Surgery 3,259 21.18 Obstetrics 1,596 10.38 Pediatrics 5 0.03 Oral/Dental 6 0.04 ------- -------- Total 15,386 100.0% 4. Patients enrolled in government-sponsored healthcare programs account for 58% of Memorial's inpatients. Self-pay patients, from whom Memorial receives limited payment, account for 3% of admissions. 2014 Adult & Pediatric Discharges by Financial Class Financial Class Number Percent of Total Medicare 6,869 44.64% Medicaid 1,764 11.46 TRICARE 332 2.16 ------- ------- 8,965 58.26 Managed Care & Commercial 5,594 36.36 Self-pay 410 2.66 Other 417 2.72 ------- ------- Total 15,386 100.0% 5. Just over 50% percent of Memorial's inpatients are adults age 65 and over. 2014 Adult & Pediatric Inpatient Discharges by Age Group Age Group Number Percent of Total 0 - 14 7 0.04% 15 - 44 3,396 22.07 45 - 64 4,414 28.69 65 - 74 2,832 18.41 75+ 4,737 30.79 --------- --------- Total 15,386 100.0% 6. While adults comprise the majority of Emergency Department outpatient visits, children under 15 account for 15% of the visits. 2014 Emergency Department Visits by Age Group (Excludes Admitted Patients) Service Number Percent of Total 0 - 14 8,728 15.39% 15 - 44 27,747 48.93 45 - 64 12,616 22.25 65 - 74 3,290 5.80 75+ 4,323 7.63 --------- -------- Total 56,704 100.0% 7. Over 53% of Emergency Department outpatients are enrolled in government-sponsored programs while roughly 15% are self-pay. 2014 Emergency Department Visits by Financial Class (Excludes Admitted Patients) Financial Class Number Percent of Total Medicare 7,985 14.08% Medicaid 15,289 26.96 TRICARE 2,740 4.84 -------- --------- Total 26,014 45.88 Managed Care/ Commercial 24,765 43.67 Self-pay 5,236 9.23 Other 689 1.22 --------- -------- Total 56,704 100.0% In summary, the above data shows that Memorial primarily serves the residents of St. Clair County, particularly those living in Belleville and adjacent communities. Target populations within the county include the elderly, children, Medicare and Medicaid enrollees and the uninsured. COMMUNITY BENEFIT INFORMATION (CONT) B. Healthcare Needs Assessment 1. The following table below shows that St. Clair County ranks 86th in health outcomes among 102 counties in Illinois for the lowest health outcomes and health factors, moving up three places for last year's 89th ranking. Length of life dropped from 87 years to 80 in the latest rankings. Health Outcomes St Clair 2014 Illinois 2014 US 2014 1. Length of Life 8,341 6,349 5,200 -Premature Death- 2. Morbidity -Poor or Fair Health- 16% 15% 10% -Poor Physical Health 4.0 3.4 2.5 Days- -Poor Mental Health 3.5 3.3 2.3 Days- -Low Birthweight- 9.2% 8.4% 5.9% Health Factors: Health Behaviors -Adult Smoking- 22% 18% 14% -Adult Obesity- 31% 27% 25% -Food Environment Index- 5.9 7.8 8.4 -Physical Inactivity- 28% 23% 20% -Access to Exercise 82% 89% 92% Opportunities- -Excessive Drinking- 19% 20% 10% -Alcohol Impaired 41% 37% 14% Driving Deaths- -Teen Births- 48 35 20 -Sexually Transmitted Infection- 789 526 138 Clinical Care -Uninsured- 12% 15% 11% -Primary Care Physicians- 1,670:1 1,266:1 1,045:1 -Dentists- 1,517:1 1,453:1 1,377:1 -Mental Health Providers- 1,271:1 604:1 386:1 -Preventable Hospital Stays- 68 65 41 -Diabetic Screening- 82% 85% 90% -Mammography Screening- 61.8% 64.4% 70.7% Social and Economic Factors -High School Graduation- 81% 82% -Some College- 67.2% 66.7% 71% -Unemployment- 9.5% 9.2% 4.0% -Children In Poverty- 27% 21% 13% -Income inequality- 5.2% 4.8% 3.7% -Children-Single Parent 45% 32% 20% Households- -Violent Crime Rate- 904 430 59 -Injury Deaths- 70 50 50 Physical Environment -Air Pollution-Particulate 12.1 12.5 9.5 Matter- -Drinking Water Violations- 4% 2% 0% -Severe Housing Problems- 16% 19% 9% -Driving Alone To Work- 81% 74% 71% -Long Commute-Driving Alone- 31% 40% 15% Source: www.countyhealthrankings.org/illinois/st-clair-2015 2. A statewide comparison reveals that St. Clair County has more African-American residents but fewer Hispanic residents, and fewer not proficient in English. Demographic Characteristics of St. Clair County Characteristic St. Clair County Illinois Population 265,729 12,880,580 % Under 18 years of age 24.3% 23.5% % 65 and older 13.5% 13.5% % White 65.7% 77.7% % African-American 30.4% 14.7% % Asian 1.4% 5.1% % Hispanic or Latino 3.7% 16.5% % Language other than English 5.8% 22.3% % Foreign Born 2.7% 13.8% Source: U.S. Census Bureau (2011) Based on Memorial's Community Health Needs Assessment and analysis, the following health issues for St. Clair County residents have been identified in addition to the stated goals and objectives. C. 2015 Goals and Objectives Priority health issues for St. Clair County, as identified through Memorial's Community Health Needs Assessment include: 1. Lung Cancer 2. Chronic Obstructive Pulmonary Disease (COPD) 3. Diabetes 4. Cardiovascular Disease Memorial Hospital plans to provide the following community benefits in 2015: 1. Provide free or discounted healthcare services through Memorial's uninsured patient discount and charity care policies to persons who are unable to pay. 2. Provide minimal or no cost needed health services, such as community health screenings, health education and support groups to residents in the communities served. 3. Serve the residents of St. Clair County and surrounding counties as the area's IDPH Resource Hospital and Regional Hospital Coordination Center. 4. Work closely with local, state, and federal disaster preparedness agencies as the IDPH Hospital in St. Clair County and nine surrounding counties and coordinate necessary disaster response and relief activities in case of severe emergency events. 5. Assure access to primary care and specialty physicians for area residents through continued recruitment efforts. COMMUNITY BENEFIT INFORMATION (CONT) D. Community Benefit Program Priorities Based on the populations served by Memorial Hospital and the assessment of healthcare needs, the following priorities are identified for the 2015 Community Benefit Program: 1. Access: Access to healthcare services is the number one priority due to the high percentage of the service area population that is uninsured or insured through public programs such as Medicaid and Medicare. Memorial is committed to providing healthcare services to patients in the service area regardless of ability to pay. Memorial does not discriminate based on race, sex, religion, color, or national origin. Additionally, Memorial will continue its efforts to provide charity care to those in need by: -Communicating the availability of charity care to patients. -Quickly identifying patients requiring financial assistance. -Assisting patients in completing appropriate applications for financial assistance. 2. Physician Recruitment: Memorial will continue to invest in physician recruitment to improve access to primary and specialty healthcare services for area residents. 3. Age-Specific Programs: Adults, seniors, and children differ in terms of health conditions, health behaviors, sources of financing, and other issues of access. Programs will be targeted for specific age groups, particularly seniors and children, and will include the following: -Children -Visits to schools and an onsite health fair to acquaint children with the hospital, car seat safety checks, health fairs, and screening for school sports participants. -Seniors - Older adult driving course, health fairs for seniors, Senior Care outpatient mental health program, skilled nursing care in Memorial Care Center, cooperation and support of various community agencies serving seniors. 5. Disease Management: Chronic illnesses such as diabetes, heart disease and hypertension affect many St. Clair County residents. According to the Centers for Disease Control, premature mortality rates (per 100,000) for leading chronic disease conditions in St. Clair County are: Cardiovascular Disease 136.6 COPD 83.5 Diabetes 36.6 Lung Cancer 58.1 Efforts are ongoing to enhance self-management of chronic conditions to benefit individuals and their families, such as: -Heart disease - Presentations by physicians and dietitians, smoking cessation counseling, cholesterol and blood pressure checks, health fairs, CPR classes, cardiac support groups and rehabilitation exercise programs, meditation classes and a Heart Failure Program. -COPD and Lung Cancer-Smoking cessation consultations, education to school-aged children, COPD/Pulmonary Rehab program and support group, and exercise programs. -Diabetes - Diabetes Education Program, nutritional classes, support groups, health fairs, weight management classes. -Hypertension - Blood pressure checks, nutritional counseling, meditation and weight management classes. 5. Healthy Lifestyles: Many healthcare problems are the result of individual lifestyle choices which ultimately cause chronic conditions, hospitalization, and death. Memorial will work collaboratively with schools, community agencies, and others to promote healthy lifestyles and a safe community through: -Employee Wellness Program - Continue to educate and promote healthy living by providing resources and incentives to achieve a healthy balanced life among employees. Employees participate in biometric health screenings annually. Those who participate also receive daily health tips via email. -For the fourth consecutive year, Memorial was named a Platinum Level Fit Friendly Worksite by the American Heart Association. -Self-help programs - Smoking cessation counseling, weight management. -Education - Older adult driving course through AARP, family safety, car seat safety checks, nutrition, partnerships with local Farmers' Markets to promote healthy lifestyles to students as well as with local high school health education clubs. 6. Screenings: Regular, easily accessible screenings are essential to detect disease in its early stages and to facilitate responsibility for disease management by the individual. Many in St. Clair County do not use the formal healthcare system on a regular basis due to access issues. Memorial will continue to conduct screening programs, targeted by condition and age to reach the community. These programs include: -Healthy Direction, Memorial's wellness vehicle will continue to provide health screening services such as vein screenings, diabetes and cholesterol screenings, pulse oximeters as well as a variety of other health screenings and exams. -Screenings for heart disease, diabetes, hypertension, skin cancer, and colorectal screening. 7. Other Activities: In addition to the above priorities, Memorial is Engaged in the following 2015 initiatives to improve care for the residents in the communities it serves throughout Southwest Illinois: -Gather information for the 2015/2016 Community Health Needs Assessment -Work collaboratively with the St. Clair County Health Department to identify community health needs issues -Conduct a Consumer Perception Study -Continue to develop and promote the Heart and Vascular Center of Excellence to educate people about the quality of cardiovascular care conveniently available. A risk assessment tool will be added to the site in 2015. -Continue to promote the Heart Failure Clinic to reduce patient mortality and readmission. -Promote and further develop a comprehensive disease management center for Heart Failure, Diabetic Education and Nutrition Counseling. -Continue to implement and Electronic Medical Record system to improve patient care and safety. Functionality includes physician order entry and physician documentation. -Continue to promote the services available in The Center for Orthopedic and Neurosciences located on Memorial's main campus. The 85,000-square-foot facility houses outpatient services including physical, occupation, speech and hand therapy; pain management; sports medicine; an open MRI and CT scanner. -Promote the Joint Replacement Center of Excellence as part of Memorial's Orthopedic and Neurosciences Center. -Promote Onsite Neonatal Partners as part of the Family Care Birthing Center services. This service allows us to reduce transfers of special care babies. -Package and promote the Women's Health Services available at Memorial to include but not limited to Family Care Birthing Center, Breast Health Center, Minimally-invasive surgery using Robotics, Vein treatment -Plan for the opening of Memorial Hospital-East, a 94-bed satellite hospital in nearby Shiloh. This facility, anticipated to open in April 2016, will provide for all private beds at both the Belleville and Shiloh hospital locations. -Explore strategic affiliation opportunities with BJC Healthcare -Further develop Memorial's Breast Health Center of Excellence to provide an integrated multi-disciplinary delivery of breast care in the Metro East. Launch website memorialbreasthealth.com in 2015 as part of this initiative -Continue to promote the MyMemorial patient portal for access to test results and appointment information. -Continue ONECall centralized scheduling line allowing first-time patients and physician's assistance in making appointments for an array of services. -Continue to promote the Direct Call Transfer Line to assist facilities in outlying communities in making facility to facility transfers in accordance with established prototcols. FORM 990, PART VI, LINES 6, 7A, 7B GOVERANCE AND DISCLOUSRE: PROTESTANT MEMORIAL MEDICAL CENTER, INC. HAS TWO CLASSES OF MEMBERS - COMMUNITY AND CORPORATE. COMMUNITY MEMBERS, WHICH INCLUDE BOTH INDIVIDUALS AND LOCAL AREA CHURCHES, HAVE THE EXCLUSIVE POWER TO APPROVE NOMINEES FOR ELECTION AS ELECTED DIRECTORS. THE CORPORATE MEMBER, MEMORIAL GROUP, INC HAS THE POWER TO ELECT, REMOVE, AND REPLACE ANY DIRECTOR, APPROVE AMMENDMENTS TO GOVERNING DOCUMENTS AND TO MAKE INVESTMENT POLICY. FORM 990, PART VI, LINE 11A REVIEW PROCESS: DIRECTORS OF PROTESTANT MEMORIAL MEDICAL CENTER , INC. ARE PROVIDED A COPY OF THE TAX RETURN PRIOR TO FILING FOR REVIEW. ANY DISCREPANCIES OR QUESTIONS ARE THEN SUBMITTED TO THE VICE PRESIDENT OF FINANCE. FORM 990, PART VI, LINE 12C CONFLICT OF INTEREST POLICY: OFFICERS AND DIRECTORS OF PROTESTANT MEMORIAL MEDICAL CENTER, INC. COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. TRANSACTIONS DISCLOSED ON THE STATEMENTS ARE REVIEWED BY THE BOARD. THE BOARD OR A DULY CONSTITUTED COMMITTEE THEREOF SHALL DETERMINE WHETHER A CONFLICT EXISTS AND IN THE CASE OF AN EXISTING CONFLICT, WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR, AND REASONABLE. FORM 990, PART VI, LINE 15A & 15B COMPENSATION POLICIES: THE COMPENSATION COMMITTEE UTILIZES THE SERVICES OF AN INDEPENDENT CONSULTANT TO DEVELOP HOSPITAL SURVEY DATA TO COMPARE SALARIES AND BENEFITS FOR MEMORIAL'S CORPORATE OFFICERS (CEO AND VICE PRESIDENTS). BASED ON THE SURVEY RESULTS, THE COMPENSATION COMMITTEE ESTABLISHES COMPENSATION FOR THE ENSUING YEAR. FORM 990, PART VI, LINES 18 & 19 PUBLIC DISCLOSURE: UPON FILING FORM 990 AND SUPPORTING SCHEDULES, PUBLIC DISCLOSURE COPIES ARE AVAILABLE FOR PUBLIC INSPECTION IN THE OFFICE OF THE PRESIDENT OF PROTESTANT MEMORIAL MEDICAL CENTER, INC. DURING REGULAR BUSINESS HOURS OF 8:30AM-5:00PM. COPIES ARE PROVIDED UPON REQUEST FOR A NOMINAL FEE. WRITTEN REQUESTS ARE HONORED WITHIN 30 DAYS. REQUESTS IN PERSON ARE PROVIDED ON THE DAY OF REQUEST. PROTESTANT MEMORIAL MEDICAL CENTER, INC. PROVIDES FOR PUBLIC INSPECTION THE MOST RECENT THREE YEARS OF FILINGS. PROTESTANT MEMORIAL MEDICAL CENTER, INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VI, LINE 2 GOVERANCE & DISCLOSURE: MARK TURNER, WILLIAM CASPERSON, AND LARY ECKERT ALL HAVE A BUSINESS RELATIONSHIP AS A RESULT OF ALSO SERVING AS OFFICERS OR DIRECTORS OF MEMORIAL CAPTIVE INSURANCE COMPANY, A RELATED TAXABLE ENTITY. FORM 990, PART IX, LINE 11G STATEMENT OF FUNCTIONAL EXPENSES - OTHER FEES FOR SERVICES PHYSICIAN FEES $11,379,872 CONSULTING FEES $4,151,665 TESTS PERFORMED BY OUTSIDE COMPANIES $3,858,900 PURCHASED SERVICES $3,706,652 COLLECTION FEES $2,101,838 TOTAL OTHER FEES FOR SERVICES $25,198,927 FORM 990, PART XI, LINE 9 RECONCILIATION OF NET ASSETS - LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES: ($540,909) FUND BALANCE TRANSFER TO MEMORIAL GROUP, INC., A RELATED 501(C)(3) ORGANIZATION. ($210,600) FUND BALANCE TRANSFER TO MEMORIAL HOSPITAL SELF INSURANCE TRUST FUND, A REALTED 501(C)(3) ORGANIZATION. $1,020,898 NET CHANGE IN INTEREST IN MEMORIAL FOUNDATION, INC., A RELATED 501(C)(3) ORGANIZATION. $269,389 TOTAL OTHER CHANGES IN NET ASSETS OR FUND BALANCES. MEMORIAL HOSP SELF INSURANCE TRUST FUND 4500 MEMORIAL DRIVE BELLEVILLE IL 62226 371064809 INSURANCE IL 501(C)(3) 11-TYPE I MGI false MEMORIAL FOUNDATION INC 4500 MEMORIAL DRIVE BELLEVILLE IL 62226 371186034 FUNDRAISING IL 501(C)(3) 11-TYPE I MGI false SOUTHWEST ILLINOIS HEALTH VENTURES INC 4500 MEMORIAL DRIVE BELLEVILLE IL 62226 371413286 MANAGEMENT IL 501(C)(3) 11-TYPE I MGI false MEMORIAL GROUP INC 4500 MEMORIAL DRIVE BELLEVILLE IL 62226 371186035 MANAGEMENT IL 501(C)(3) 11-III-FI NA false METRO EAST SERVICES INC 4500 MEMORIAL DRIVE BELLEVILLE IL 62226 460838901 HEALTHCARE IL 501(C)(3) 3 MGI false MEMORIAL CAPTIVE INSURANCE CO 1850 N CENTRAL AVENUE STE 1700 PHOENIX AZ 85004 201267507 INSURANCE AZ MGI C CORP 0 0 0.00000 false MEMORIAL CAPTIVE INSURANCE COMPANY 94 SOLARIS 2ND FLOOR GEORGETOWN CAYMAN ISLANDS CJ 981082415 INSURANCE CJ MGI C-CORP 0 0 0.00000 false false true true false false false false false false false true true true true true true true true true