2015-11-13T13:55:48-06:00 2014-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 4000 INDIANAPOLIS IN 46204 990 2014-01-01 363637465 Hoopeston Community Memorial Hospital % DENNIS HESCH EXEC VP & CFO HOOP 2172835531 701 E Orange Street Hoopeston IL 60942 DENNIS HESCH EXEC VP & CFO 2712835531 2015-11-13 true JENNIFER RHODERICK P00395735 3176817000 2014 2016-04-25 22:37:26Z CARLE HOOPESTON REGIONAL HEALTH CTR DENNIS HESCH EXEC VP CFO 611 W PARK ST URBANA IL 61801 35661148 false X www.carle.org/hoopeston X 1956 IL TO PROVIDE QUALITY HEALTH CARE AND OTHER MEDICALLY RELATED SERVICES AND EDUCATION TO THE COMMUNITY THROUGH THE OPERATION OF A CRITICAL ACCESS HOSPITAL and rural health clinics. 7 2 362 0 24863 3116 38867 28016 25964439 35348183 18422 10053 602558 242009 26624286 35628261 33528 28586 0 0 12873555 16779900 0 0 0 16126714 22343549 29033797 39152035 -2409511 -3523774 34747313 36308585 31271627 36283096 3475686 25489 X MISSION STATEMENT SECTION 1. GENERAL PURPOSES. THE CORPORATION IS ORGANIZED AND SHALL BE EXCLUSIVELY OPERATED AS A NOT-FOR-PROFIT CORPORATION FOR CHARITABLE, BENEVOLENT, SCIENTIFIC AND EDUCATIONAL PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, OR THE CORRESPONDING PROVISIONS OF ANY FUTURE UNITED STATES INTERNAL REVENUE LAW (THE "CODE"). AND, IN FURTHERANCE OF SUCH CHARITABLE PURPOSES, THE CORPORATION SHALL ENGAGE IN THE ACTIVITIES DESCRIBED IN SECTION 2 OF THIS STATEMENT. SECTION 2. SPECIFIC PURPOSES. THE CORPORATION'S PURPOSES SHALL INCLUDE, BUT NOT BE LIMITED TO, THE FOLLOWING: (A) TO PROVIDE AND TO ASSIST IN PROVIDING FACILITIES FOR THE RENDERING OF HEALTH CARE SERVICES ON AN INPATIENT OR OTHER BASIS THROUGH THE OPERATION OF A CRITICAL ACCESS HOSPITAL AND RURAL HEALTH CLINICS, AND OTHER CLINICAL SERVICES THROUGH ALL OTHER APPROPRIATE MEANS; AND (B) TO TRAIN AND TO PROVIDE CONTINUING EDUCATION FOR PERSONS ENGAGED IN PROVIDING HEALTH true false 34129729 28586 35352883 HOOPESTON COMMUNITY MEMORIAL HOSPITAL (HCMH), A 24 BED CRITICAL ACCESS HOSPITAL LOCATED IN HOOPESTON, IL SERVES HOOPESTON, VERMILION COUNTY AND THE SURROUNDING AREA. HCMH EMPLOYS MORE THAN 255 STAFF MEMBERS, 40 PHYSICIANS AND 32 ADVANCED PRACTICE PROVIDERS. HCMH IS COMMITTED TO PROVIDING QUALITY, DEPENDABLE HEALTH SERVICES. HCMH OFFERS SPECIALTY SERVICES WITH CARDIOLOGY, ORTHOPEDICS, GYNECOLOGY, MENTAL HEALTH, UROLOGY AND DIAGNOSTIC SERVICES INCLUDING NUCLEAR MEDICINE, DIGITAL MAMMOGRAPHY, RADIOLOGY AND LABORATORY. EMERGENCY MEDICINE AND SURGICAL SERVICES ARE PROVIDED IN STATE OF THE ART FACILITIES WHICH OPENED IN 2012. HCMH PROVIDES ACCESS TO PRIMARY CARE WITH CLINICS IN HOOPESTON, ROSSVILLE, MILFORD, CISSNA PARK, DANVILLE, WATSEKA, TUSCOLA AND MATTOON, IL. HCMH HAS BEEN DEDICATED TO CARING FOR THOSE IN THE AREA FOR OVER 50 YEARS. 34129729 true false false true false false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false true false false false false false false true true true false false true 25 0 true 362 true true true false false false false false false false false false X 7 2 true false false false true true true true true false false true true true true true true false false false IL X X DENNIS HESCH EXEC VP CFO 2173833311 611 WEST PARK ST URBANA IL 61801 X Russ Leigh Chairman of Board 1.0 0.0 X X 0 0 0 Lynn Galloway Secretary/Treasurer of Board 2.0 0.0 X X 0 0 0 Ed Layden Jr Trustee 1.0 0.0 X 0 0 0 Karla Coon Trustee 2.0 0.0 X 0 0 0 Henry Hornbeck Trustee 0.25 0.0 X 0 0 0 Joseph Barkmeier MD Trustee 0.5 39.5 X 0 455993 141838 Letha Kramer Trustee 2.96 37.04 X 0 166274 21147 Harry Brockus Ex-Officio Board, CEO 40.0 0.0 X 215062 0 68635 Dennis Hesch Exec VP & CFO 1.0 39.0 X 0 878025 204201 Laurence Fallon Exec VP-Legal Affairs & HR 1.0 39.0 X 0 647842 159301 Jay Colbert DO DPM Ex-Officio Brd,CMO & Physician 40.0 0.0 X 231739 0 14176 Daniel Chase MD Physician 40.0 0.0 X 487695 0 41073 William McCarthy MD Physician 40.0 0.0 X 278077 0 21460 Albert Tanlim MD Physician 40.0 0.0 X 245194 0 37447 Cortney Joneikis MD MS Physician 40.0 0.0 X 310417 0 15163 Susan Berg MD Physician 40.0 0.0 X 290121 0 5494 2058305 2148134 729935 22 false true false HOOPESTON EMERGENCY MEDICINE SPECIA 6523 26TH PLACE BERWYN IL 60402 PHYSICIAN STAFFING 1238096 DMS IMAGING INC 26273 NETWORK PL CHICAGO IL 606731262 IMAGING SERVICES 192667 MED ONE CAPITAL FUNDING ILLINOIS LP PO BOX 271128 SALT LAKE CITY UT 84127 MEDICAL EQUIP LEASIN 138881 GOLDFISH LOCUMS LLC 5741 LEGACY DRIVE STE 200 PLANO TX 75024 PHYSICIAN STAFFING 110036 4 0 0 0 0 28016 0 0 28016 NET PATIENT SERVICES 622110 35348183 35348183 35348183 15898 15898 0 0 19416 19617 -201 0 -201 -201 7425 13270 -5845 -5845 -5845 0 0 0 CATERING 722320 24863 24863 COFFEE SHOP 722212 14960 14960 PERPETUAL TRUST INTEREST 900099 178710 178710 23677 4700 18977 242210 35628261 35352883 24863 222499 28586 28586 0 0 0 0 550599 245915 304684 302687 302687 12370946 11512759 858187 651185 600387 50798 2013624 1903034 110590 890859 802711 88148 0 0 172 172 11582 11582 0 0 1848591 1517914 330677 1083 1083 1799088 1423758 375330 611696 323420 288276 0 1332048 886353 445695 99153 83793 15360 0 53427 42058 11369 382861 382834 27 0 1762762 1012998 749764 502996 492135 10861 INTERNAL PURCHASED SERVICES 5506273 5397552 108721 INTERNAL MANAGEMENT FEES 4388886 3436238 952648 PATIENT CARE SUPPLIES 3153615 3153615 OTHER TAXES 382376 375127 7249 506940 205855 301085 39152035 34129729 5022306 0 2682596 4118020 0 0 0 0 6994575 7164549 0 0 0 0 0 0 0 0 158421 340227 19961033 3919201 16252110 16041832 0 0 0 0 0 0 4444690 4444690 4214921 4199267 34747313 36308585 1384904 1519914 0 0 0 0 0 0 0 0 0 0 11362003 7094839 0 0 18524720 27668343 31271627 36283096 X -97543 -3618818 0 57646 3573229 3586661 3475686 25489 34747313 36308585 X -3523774 0 0 0 59674 13903 X X false true X true false X false false false false false false false false true 11582 11582 false PART II-B, LINE 1I OTHER ACTIVITIES $8,063 - PORTION OF ILLINOIS HOSPITAL ASSOCIATION (IHA) DUES ATTRIBUTABLE TO LOBBYING $3,202 - PORTION OF AMERICAN HOSPITAL ASSOCIATION (AHA) DUES ATTRIBUTABLE TO LOBBYING $317 - PORTION OF MISCELLANEOUS HEALTH CARE ORGANIZATION DUES ATTRIBUTABLE TO LOBBYING 84231 84231 10319085 1388268 8930817 25947 6305 19642 7832036 2355738 5476298 1699734 168890 1530844 16041832 HRHC FCS ESCROW 554960 DEVL LIMITED ASSETS 57646 LONG TERM INVESTMENTS 3586661 4199267 0 ACCTS REC-MEDICARE 307798 DUE TO BLUE CROSS 695247 HRHC/FNDN NOTES PAYABLE 3718322 ASSET RETIREMENT OBLIGATION 144350 INTERCOMPANY PAYABLES 22802626 27668343 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, 2014 AND 2013. true true X true X 125. true X true true true false false 2074018 0 2074018 0.05300 8787686 7845630 942056 0.02410 0 0 0 0.00000 10861704 7845630 3016074 0.07710 171178 0 171178 0.00440 30079 0 30079 0.00080 0 0 0 0.00000 0 0 0 0.00000 25336 0 25336 0.00060 226593 0 226593 0.00580 11088297 7845630 3242667 0.08290 2675 2675 0.00010 19056 19056 0.00040 149 149 21880 21880 0.00050 true 664858 332429 10093642 11060134 -966492 X true true 1 1 HOOPESTON COMMUNITY MEMORIAL HOSPITAL 701 E ORANGE ST HOOPESTON IL 609421801 WWW.CARLE.ORG/HOOPESTON 0004200 X X X X HOOPESTON COMMUNITY MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 13 true false false true X CARLE.ORG/CHNA X true 13 true CARLE.ORG/CHNA false false true X 125. 300. X X X true true X X true X X X X X X X X X X X false X false X X X X X true X false false SCHEDULE H, PART V SUPPLEMENTAL INFORMATION COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SECT B, LINE 3J) A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS COMPLETED IN 2013 TO COVER PROGRAMS FOR 2014-2016. SURVEYS AND ASSESSMENTS WERE DISCUSSED AT THE ANNUAL STRATEGIC PLANNING SESSION WITH THE COMMUNITY BOARD OF DIRECTORS. SUBSEQUENTLY, THE 2014-16 CHNA AND implementation PLAN WAS APPROVED BY THE BOARD IN DECEMBER 2013. COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SECT B, LINE 5) CONDUCTED INTERVIEWS WITH COMMUNITY STAKEHOLDERS, EVALUATED OUTSIDE RESEARCH, PRIORITIZED NEEDS BASED ON THAT INFORMATION. PHONE AND IN-PERSON INTERVIEWS WERE CONDUCTED IN SEPTEMBER 2013. KEY INFORMANTS PARTICIPATED IN INTERVIEWS RANGING FROM 30-90 MINUTES IN LENGTH: KAREN LANGDON, PA-C, AND MISTI RUNGE, INFECTION CONTROL MANAGER & QUALITY NURSE SPECIALIST, HCMH; MARCIE SHERIDAN, EXECUTIVE DIRECTOR OF HOOPESTON MULTI-AGENCY; JOSIE SIDDENS, RN, SCHOOL NURSE AT BISMARCK-HENNING SCHOOL DISTRICT AND ALSO REGISTERED NURSE AT PRESENCE UNITED SAMARITANS MEDICAL CENTER EMERGENCY DEPARTMENT; JENNY TRIMMELL, BSN, DIRECTOR OF COMMUNITY HEALTH SERVICES AT THE VERMILION COUNTY HEALTH DEPARTMENT; DIANA CORENZA, ASSOCIATE DIRECTOR OF THE VETERAN'S AFFAIRS (VA) ILLIANA HEALTH CARE SYSTEM; ALICE MARIE JACOBS, PHD, PRESIDENT OF DANVILLE AREA COMMUNITY COLLEGE; AND THOM POLLOCK, EXECUTIVE DIRECTOR OF CROSSPOINT HUMAN SERVICES. COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SECT B, LINE 11) CARLE HOOPESTON REGIONAL HEALTH CENTER CONTINUES ITS WORK TO IMPROVE THE OVERALL HEALTH OF THE COMMUNITY WHICH INCLUDES EMPHASIS ON ACCESS TO HEALTH SERVICES, HEART DISEASE AND STROKE AND THE OTHER SPECIALTIES AND SERVICES THE HOSPITAL OR CARLE HEALTH SYSTEM PROVIDES. THE CARLE FOUNDATION IS DILIGENTLY WORKING TO IMPROVING ACCESS AND SERVICES THROUGHOUT THE EAST CENTRAL ILLINOIS REGION, NOT JUST FOR THIS GEOGRAPHIC AREA. MANY OF THE OTHER CONCERNS ARE ALSO ADDRESSED THROUGH SERVICES PROVIDED, BUT THESE AREAS ARE NOT THE PRIMARY EMPHASIS OF THE COMMUNITY BENEFIT IMPLEMENTATION PLAN WHICH TARGETS MORE SPECIFIC LOW INCOME POPULATIONS IN VERMILION COUNTY. HOW HCMH IS ADDRESSING SIGNIFICANT HEALTH NEEDS 1. CHILDREN'S HEALTH HCMH STAFF MAINTAINED A PRESENCE IN THE LOCAL SCHOOL SYSTEM, PROVIDING HEAD LICE CHECKS, HANDWASHING EDUCATION, AND VISION AND HEARING TESTING FOR SCHOOLS IN THE REGION. THE HOSPITAL ALSO PROVIDED FULL-TIME ATHLETIC TRAINERS TO SCHOOLS IN HOOPESTON, CISSNA PARK AND MILFORD. SERVICE IS PROVIDED TO ALL STUDENT ATHLETES, REGARDLESS OF WHERE THEY RECEIVE CARE, AND IS FREE OF CHARGE TO THE SCHOOL DISTRICTS. IN 2014, THREE PEDIATRIC PROVIDERS WERE IN THE ORGANIZATION'S PRIMARY CARE FACILITY IN DANVILLE, ALSO IN VERMILION COUNTY, AND THEY BEGAN A ROTATION TO HOOPESTON. THIS ROTATION HELPED MEET THE NEED FOR PEDIATRIC CARE AND NOW A NEW FULL-TIME PEDIATRICIAN POSITION HAS BEEN PERMANENTLY LOCATED IN HOOPESTON. IN ADDITION, HCMH ADDED A DEDICATED PEDIATRICIAN TO THE WATSEKA LOCATION, BOTH OF WHICH HELP COVER THE GAPS IN PEDIATRIC CARE IN NORTHERN VERMILION AND SOUTHERN IROQUOIS COUNTIES. 2. TEEN AND ADOLESCENT HEALTH HCMH IMPLEMENTED A SCHOOL-BASED EDUCATION PROGRAM FOR SEXUALLY TRANSMITTED DISEASE (STD) EDUCATION IN 2014. HCMH PROVIDERS PRESENTED TO ALL STUDENTS IN PHYSICAL EDUCATION CLASSES AT HOOPESTON AREA HIGH SCHOOL. THE PLAN IS TO PRESENT THIS MATERIAL TO STUDENTS EVERY OTHER YEAR, AND THE NEXT SESSION WILL BE CONDUCTED IN THE FALL OF 2016. ADDITIONALLY, HCMH OFFERED THIS STD EDUCATION MATERIAL TO ALL OTHER SCHOOL DISTRICTS IN VERMILION AND IROQUOIS COUNTIES. ALTHOUGH THERE HAS BEEN INTEREST FROM SEVERAL SCHOOLS, NO PROGRAMS HAVE BEEN SCHEDULED; HOWEVER, SCHOOL OFFICIALS CONTINUE TO MEET WITH AND DISCUSS THIS OPTION WITH HOSPITAL MANAGEMENT. HCMH ALSO ADDED OB/GYN SERVICES VIA A VISITING SPECIALIST FROM DANVILLE IN 2013. THIS PROVIDER CONTINUES TO OFFER GENERAL OB/GYN CARE IN HOOPESTON TWICE A MONTH. LAB AND RADIOLOGY PROVIDE NECESSARY RELATED OB/GYN SCREENINGS AT HOOPESTON. TO FURTHER EXPAND ACCESS TO CARE, HCHM HIRED AN ADDITIONAL OB/GYN, DR. LORAINE NOLLA, IN 2014. 3. ORAL HEALTH HOOPESTON COMMUNITY MEMORIAL HOSPITAL CONTINUES TO FUND THE DELTA DENTAL OF ILLINOIS' LAND OF SMILES PROGRAM IN VERMILION COUNTY. THIS PROGRAM TEACHES CHILDREN IN THE COMMUNITY HOW TO TAKE CARE OF THEIR TEETH BY DEMONSTRATING PROPER BRUSHING AND FLOSSING TECHNIQUES, REVIEWING GOOD AND BAD FOODS FOR TEETH AND WHY IT IS IMPORTANT TO VISIT THE DENTIST REGULARLY. THIS PROGRAM HAS REACHED HUNDREDS OF CHILDREN IN ROSSVILLE AND BISMARCK-HENNING, TWO RURAL COMMUNITIES LOCATED WITHIN VERMILION COUNTY WHERE IT HAS BEEN IDENTIFIED THAT YOUTH LACK EDUCATION ABOUT THE IMPORTANCE OF DENTAL CARE. PRE- AND POST-TESTING ILLUSTRATES THAT CHILDREN IMPROVE THEIR KNOWLEDGE OF THE IMPORTANCE OF DENTAL CARE BOTH AT HOME AND AT THE DENTIST AFTER PARTICIPATING IN THE SESSION. 4. CANCER CANCER-RELATED DEATHS IN VERMILION COUNTY ILLUSTRATED THE NEED FOR FURTHER PROGRAMS AND INITIATIVES IN VERMILION COUNTY, CENTERING PRIMARILY AROUND EARLY DETECTION AND SCREENINGS. CARLE HOOPESTON OFFERS DIGITAL MAMMOGRAPHY PROVIDING CLEARER IMAGES FOR WOMEN RECEIVING SCREENINGS. PATIENTS CAN NOW ALSO GET BIOPSIES PERFORMED AT HOOPESTON FACILITIES - TWO PROVIDERS WERE TRAINED TO DO BASIC SKIN BIOPSIES IN THEIR HOOPESTON PHYSICIAN OFFICE, AS WELL AS A GENERAL SURGEON, WHO HAS BEGUN PERFORMING MANY GENERAL SURGERY BIOPSIES. HCMH HAS ALSO WORKED WITH MILLS BREAST CANCER INSTITUTE (MBCI) IN URBANA, IL TO DO AT LEAST ONE SCREENING EVENT IN HOOPESTON EACH YEAR. IN 2014, BREAST CANCER RISK ASSESSMENTS WERE PERFORMED ON APPROXIMATELY 150 LOCAL RESIDENTS THROUGH A HEALTH FAIR. AFTER TRAINING WITH PATIENTS WHO HAVE PORTS, NURSING STAFF AT HCMH HAS ALSO BECOME MORE EDUCATED IN TREATING PATIENTS WITH CANCER, THUS LOWERING INFECTION CHANCES AND HELPING WITH CONTINUITY OF CARE. 5. DIABETES IN 2014, HCMH FOCUSED ON CONTINUING TO EDUCATE STAFF, PATIENTS, AND THE COMMUNITY ABOUT DIABETES. AS SUCH, A DIETICIAN PROVIDED FREE DIABETIC NUTRITION CLASSES, AND PLANNED A DIABETIC EDUCATION AND SUPPORT GROUP. HCMH HAS ALSO ACQUIRED PEDIATRIC DIABETIC COOKBOOKS THROUGH THE INITIATIVE OF MEDICAL/SURGICAL NURSES WHO PROVIDE THEM TO FAMILIES OF PEDIATRIC PATIENTS WITH DIABETES. CASH AND IN-KIND DONATIONS HOOPESTON COMMUNITY MEMORIAL HOSPITAL CONTRIBUTED NEARLY $20,000 TO CHARITABLE ORGANIZATIONS IN THE COMMUNITY VIA CASH AND IN-KIND DONATIONS, INCLUDING PROGRAMS AIMED TO HELP YOUTH, HEALTH IMPROVEMENT, HEALTH EDUCATION AND HEALTH PROFESSIONS EDUCATION. BECAUSE THE NEEDS ARE GREAT AND IT WOULD BE UNREASONABLE TO ADDRESS EACH AND EVERY IDENTIFIED NEED, WE SET PRIORITIES AND USE OUR RESOURCES TO FOCUS PRIMARILY ON IDENTIFIED NEEDS WITHIN THE COMMUNITY BENEFIT PRIORITIES SET. MANY OF THESE NEEDS ARE ADDRESSED THROUGH PARTNERSHIPS AND COLLABORATIVE EFFORTS. ONE SIGNIFICANT CONTRIBUTION WAS TO THE HOOPESTON MULTI AGENCY ($2,500) TO ENHANCE THE MULTITUDE OF SERVICES THEY OFFER. THE MULTI AGENCY IS A COMMUNITY PARTNER THAT HELPS PROVIDE DISABLED AND ELDERLY PATIENTS RIDES THROUGHOUT HOOPESTON AND DANVILLE TO HELP MAINTAIN THEIR HEALTH AND LIFESTYLE. THE ORGANIZATION ALSO ADDRESSES TWO OTHER CRITICAL AREAS OF NEED IN VERMILION COUNTY BY PROVIDING A FREE AFTER-SCHOOL PROGRAM FOR TEENS. THIS PROGRAM PROVIDES THE PARTICIPANT WITH A MEAL AND TUTORING, HELPING KEEP YOUTH FED, HEALTHY AND IN SCHOOL. THE FINAL SERVICE PROVIDED BY THE MULTI AGENCY IS HEALTH NAVIGATION. THEY ASSIST CLIENTS IN COORDINATING CARE APPOINTMENTS, AND FINDING RESOURCES TO ASSIST THEM WITH ALL THEIR DIFFICULTIES. HCMH ALSO SUPPORTS ALL LIONS CLUB CHAPTERS IN VERMILION COUNTY. THE LIONS CLUB IS KNOWN FOR THEIR HUMANITARIAN EFFORTS ON BEHALF OF THE DEAF AND BLIND, AND SPECIFICALLY PROVIDES EYE GLASSES FOR UNDERPRIVILEGED CHILDREN IN THEIR RESPECTIVE SERVICE AREAS. THERE ARE ALSO SEVERAL STATEWIDE AND NATIONWIDE ORGANIZATIONS THAT HAVE REGIONAL CHAPTERS THAT RECEIVE SUPPORT FROM HCMH. THOSE INCLUDE: ROTARY OF HOOPESTON, SPECIAL OLYMPICS OF ILLINOIS, AND FELLOWSHIP OF CHRISTIAN ATHLETES. EACH OF THESE ORGANIZATIONS HAS A MISSION STATEMENT OUTLINING THEIR COMMITMENT TO IMPROVING THE HEALTH OF OTHERS, STAYING ACTIVE AND THE WELLBEING OF OUR YOUTH. WHILE THERE WERE A NUMBER OF ADDITIONAL NEEDS IDENTIFIED BY THE DATA AND INPUT FROM COMMUNITY LEADERS, AS A CRITICAL ACCESS HOSPITAL, CARLE HOOPESTON REGIONAL HEALTH CENTER DOES NOT HAVE THE RESOURCES TO ADDRESS ALL OF THEM. THE ISSUES THAT WILL NOT BE ADDRESSED IN THE IMPLEMENTATION PLAN ARE LOWER PRIORITY BECAUSE THE NEED WAS NOT AS SIGNIFICANT; THEY ARE NOT CENTRAL TO THE HOSPITAL'S MISSION; AND CHRHC HAS DETERMINED IT DOES NOT HAVE THE ABILITY TO MAKE A MEASURABLE IMPACT IN THOSE AREAS. CHRHC WILL NOT FOCUS THE COMMUNITY BENEFIT IMPLEMENTATION PLAN ON ADDRESSING COMMUNITY HEALTH CHALLENGES RELATED TO DISABILITIES; EXERCISE, NUTRITION AND WEIGHT; IMMUNIZATION AND INFECTIOUS DISEASES; MATERNAL, FETAL AND INFANT HEALTH; MENTAL HEALTH; OLDER ADULTS AND AGING; RESPIRATORY DISEASES OR SUBSTANCE ABUSE. FINANCIAL ASSISTANCE POLICY (PART V, SECT B, LINE 20E) HOOPESTON COMMUNITY MEMORIAL HOSPITAL HAS MADE A CONCERTED, CONTINUOUS EFFORT TO BE CERTAIN THAT PEOPLE HAVE ACCESS TO INFORMATION THAT WILL HELP THEM WITH THEIR MEDICAL BILLS. THIS INCLUDES: - A SIMPLIFIED APPLICATION FORM THAT CLEARLY EXPLAINS PATIENT RIGHTS AND Hoopeston community memorial hospital'S EXPECTATIONS - INFORMATION ABOUT THE FINANCIAL ASSISTANCE PROGRAM ON ALL BILLING STATEMENTS, COLLECTION LETTERS AND HOSPITAL ADMISSION PACKETS - INFORMATION AND APPLICATION FORMS ARE READILY AVAILABLE AND ACCESSED AT WWW.CARLE.ORG/HOOPESTON - FINANCIAL ASSISTANCE APPLICATION FORMS AND BROCHURES ARE AVAILABLE AT ALL INPATIENT AND OUTPATIENT REGISTRATION POINTS, AS WELL AS IN THE HOSPITAL'S MAIN LOBBY - MEETING WITH OUR STAFF TO KEEP THEM INFORMED ABOUT THE PROGRAM AND THE BENEFITS THAT ARE AVAILABLE TO PATIENTS - FINANCIAL ASSISTANCE REPRESENTATIVES ARE AVAILABLE AT VARIOUS COMMUNITY FORUMS - SCREENING PATIENTS THROUGH OUR VENDOR FOR KEY FINANCIAL INDICATORS TO PRESUME ELIGIBILITY OR CONTACT REGARDING OUR ASSISTANCE PROGRAMS FINANCIAL ASSISTANCE POLICY (PART V, SECT B, LINE 22D) Carle establishes a standardized fee schedule using a national database of fee information which blends the relative value of a service with statistical profiling of actual charge data specific to this region. This is the same methodology used by the Centers for Medicare and Medicaid Services (CMS) to set Medicare fees. This allows us to establish a fair fee that represents the cost of delivering the services. Charges for patients who apply and are identified as qualified for financial assistance are discounted based upon THE discount level FOR WHICH THEY QUALIFY. Discounts for Hoopeston Regional Health Center financial assistance program are either 50% or 100% based upon the applicants Federal Poverty Level. 8 CARLE DANVILLE ON FAIRCHILD 311 W FAIRCHILD DANVILLE IL 61832 RURAL HEALTH CLINIC CHARLOTTE ANN RUSSELL MEDICAL CENTER 801 E ORANGE ST HOOPESTON IL 60342 RURAL HEALTH CLINIC ROBERTS CLINIC 845 S 4th St WATSEKA IL 60970 RURAL HEALTH CLINIC CARLE MATTOON ON HURST 2512 HURST DRIVE MATTOON IL 61938 MEDICAL CLINIC ROSSVILLE MEDICAL CENTER 619 N CHICAGO ST ROSSVILLE IL 60963 RURAL HEALTH CLINIC MILFORD CLINIC 322 CHICAGO ST MILFORD IL 60953 RURAL HEALTH CLINIC CISSNA PARK MEDICAL CLINIC 141 W GARFIELD AVE CISSNA PARK IL 60924 RURAL HEALTH CLINIC CARLE AT TUSCOLA 301 E SOUTHLINE ROAD TUSCOLA IL 61953 RURAL HEALTH CLINIC SCHEDULE H SUPPLEMENTAL INFORMATION SCHEDULE H, PART VI 1 - REQUIRED DESCRIPTIONS FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA (PART I, LINE 3C) PATIENTS ARE INFORMED ABOUT FINANCIAL ASSISTANCE ON MULTIPLE OCCASIONS. IT IS THE RESPONSIBILITY OF THE PATIENT TO REQUEST AND COMPLETE A FINANCIAL ASSISTANCE APPLICATION. IF A PATIENT DOES NOT REQUEST OR COMPLETE AND RETURN THE APPLICATION, THEN THE BALANCE IS DEEMED THEIR RESPONSIBILITY TO PAY. WE PRESUME ELIGIBILITY FOR VERIFIED HOMELESS, DECEASED WITH NO ESTATE, MENTAL INCAPACITATION AND PATIENTS COVERED BY MEDICAID TITLE XIX. A VENDOR, EXPERIAN INFORMATION SOLUTIONS, INC. IS UTILIZED TO DETERMINE THOSE PATIENTS WHO MAY BE PRESUMPTIVELY QUALIFIED FOR ASSISTANCE BASED ON KEY FINANCIAL INDICATORS. IDENTIFIED PATIENTS MAY BE PRESUMED ELIGIBLE OR RECEIVE ADDITIONAL CONTACT REGARDING APPLICATION FOR ASSISTANCE. PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME, INCLUDING BEFORE CARE IS RECEIVED. THE MAXIMUM AMOUNT HOOPESTON COMMUNITY MEMORIAL HOSPITAL SHALL COLLECT FOR FACILITY SERVICES FROM A PATIENT IN A TWELVE MONTH PERIOD IS 25% OF THE ANNUAL PRE-TAX EARNINGS AND CASH BENEFITS FROM ALL SOURCES OF THE PATIENT; IF THE PATIENT IS UNINSURED AND EARNS AT OR BELOW 300% OF THE FEDERAL POVERTY LEVEL. EXPLANATION OF COSTING METHODOLOGY (PART I, LINE 7 AND PART III, LINE 2) 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 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. COMMUNITY BUILDING ACTIVITIES (PART II) ECONOMIC DEVELOPMENT MUCH OF HOOPESTON COMMUNITY MEMORIAL HOSPITAL'S COMMUNITY BUILDING ACTIVITIES ARE THROUGH IN-KIND SUPPORT VIA COMMITTEES, BOARDS AND SPECIAL PROJECTS. THREE MEMBERS OF HOOPESTON COMMUNITY MEMORIAL HOSPITAL LEADERSHIP AND STAFF WERE A PART OF THE HOOPESTON COMMUNITY ALLIANCE IN 2014, A COMMITTEE DEDICATED TO THE IMPROVEMENT OF HOOPESTON. 74 HOURS OF MEETINGS AND PREPARATION WERE SPENT ON THE COMMITTEE AND VARIOUS SUB-COMMITTEES FOR THE ALLIANCE, AMOUNTING TO $4,400 IN COMMUNITY BENEFIT. IN ADDITION, CEO HARRY BROCKUS JOINED THE VERMILION ADVANTAGE BOARD IN 2014, AMOUNTING TO $1,092 OF IN-KIND SUPPORT. AGAIN THIS YEAR, THE HOOPESTON ECONOMIC DEVELOPMENT COMMITTEE HELD WEEKLY MEETINGS TO DISCUSS A NUMBER OF ISSUES THAT IMPACT THE COMMUNITY'S HEALTH AND SAFETY, WHICH AMOUNTED TO 12 HOURS SPENT BY HOOPESTON COMMUNITY MEMORIAL HOSPITAL LEADERSHIP AND STAFF, OR $690 OF IN-KIND SUPPORT. COMMUNITY SUPPORT A SIGNIFICANT PORTION OF HOOPESTON COMMUNITY MEMORIAL HOSPITAL'S COMMUNITY-BUILDING ACTIVITIES ($13,175) FOCUSED ON COMMUNITY SUPPORT, INCLUDING CASH, IN-KIND DONATIONS AND BUDGETED EXPENDITURES FOR THE CITY, BUSINESS ASSOCIATIONS AND OTHER PROGRAMS IN HOOPESTON. ALTHOUGH THESE ITEMS WERE NOT COUNTED AS COMMUNITY BENEFIT, THIS SUPPORT IS AN IMPORTANT PART OF CONTRIBUTING TO THE ECONOMIC VIABILITY OF THE COMMUNITY. EMERGENCY MANAGEMENT THE ADDITIONAL FUNDS CAPTURED AS COMMUNITY BUILDING ($1,483) WERE FOR DISASTER READINESS - THOSE HOURS AND STAFF TIME SPENT ABOVE AND BEYOND NORMAL REQUIREMENTS FOR A HOSPITAL. AT HOOPESTON COMMUNITY MEMORIAL HOSPITAL'S EMERGENCY PREPAREDNESS WAS A PRIORITY, WITH ONE STAFF MEMBER SERVING AS THE DISASTER PREPAREDNESS COORDINATOR. THIS INDIVIDUAL SAT ON THE HOOPESTON EMERGENCY MANAGEMENT AGENCY AS A REPRESENTATIVE OF CARLE HOOPESTON, ATTENDED DISASTER MEETINGS, AND PARTICIPATED IN DRILLS. SHE ALSO CONTINUED TO PARTICIPATE IN REGULAR DISCUSSIONS WITH THE REGION, INCLUDING THE CARLE EMERGENCY MANAGEMENT COMMITTEE, WORKING TOGETHER AND STANDING READY IF THE NEED OCCURS. BAD DEBT, MEDICARE, & COLLECTION PRACTICES (PART III, LINE 3) HOOPESTON COMMUNITY MEMORIAL HOSPITAL USES 50% AS A GENERAL ESTIMATE OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. BAD DEBT FOOTNOTE (PART III, LINE 4) THE FOOTNOTE PERTAINING TO BAD DEBT EXPENSE CAN BE FOUND ON PAGE 28 OF THE ATTACHED CONSOLIDATED FINANCIAL STATEMENTS. EXPLANATION OF MEDICARE COST REPORT COSTING METHODOLOGY (PART III, LINE 8) 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 DESIGNED 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, A DEMOGRAPHIC THAT HAS EXPERIENCED INCREASING COSTS OVER THE PAST DECADE WHILE LIVING ON FIXED INCOMES. COLLECTION PRACTICES (PART III, LINE 9B) ONCE ALL APPLICABLE DISCOUNTS HAVE BEEN APPLIED TO QUALIFIED PATIENTS, WE MAKE EVERY ATTEMPT TO WORK WITH THE PATIENT TO SET UP PAYMENT ARRANGEMENTS ON THE REMAINING IN-HOUSE BALANCE DUE. OUR IN-HOUSE COLLECTORS WILL WORK WITH THE PATIENT TO SET UP A TEMPORARY/SHORT TERM PAYMENT ARRANGEMENT. IF A MUTUALLY ACCEPTABLE ARRANGEMENT CANNOT BE REACHED OR IF THEY ARE UNABLE TO MAKE PAYMENT ON THE REMAINING BALANCE AFTER THE FINANCIAL ASSISTANCE DISCOUNTS, THE BALANCE MAY BE LISTED WITH AN OUTSIDE COLLECTION AGENCY. THE MINIMUM NOTIFICATIONS ARE MONTHLY ITEMIZED STATEMENTS ON IN-HOUSE BALANCES. IF A PATIENT DOES NOT RESPOND TO US, THE ACCOUNT IS SENT A FINAL NOTICE LETTER AND REFERRED TO AN OUTSIDE COLLECTION AGENCY. HOOPESTON COMMUNITY MEMORIAL HOSPITAL WILL NOT FILE COLLECTION SUIT LIENS ON A PRIMARY RESIDENCE, NOR DO WE AUTHORIZE THE COLLECTION ATTORNEYS TO USE SO-CALLED BODY ATTACHMENTS. THE AGENCIES ARE AWARE OF OUR FINANCIAL ASSISTANCE PROGRAM AND HAVE BEEN ADVISED TO REFER THE PATIENTS BACK TO OUR IN-HOUSE COLLECTORS AND/OR PATIENT ACCOUNTS DEPARTMENT AT HOOPESTON COMMUNITY MEMORIAL HOSPITAL IF THEY DEEM THE PATIENT UNABLE TO PAY AND THE PATIENT HAS NOT ALREADY APPLIED OR BEEN APPOVED FOR CHARITY. WE THEN MAKE ONE MORE ATTEMPT TO WORK WITH THE PATIENT TO SEE IF HELP IS AVAILABLE. IF HOOPESTON COMMUNITY MEMORIAL HOSPITAL THEN DETERMINES THAT THE PATIENT MIGHT QUALIFY, WE SEND THE PATIENT A FINANCIAL ASSISTANCE APPLICATION AND PUT A HOLD ON THE ACCOUNT LISTED WITH THE AGENCY FOR AS LONG AS WE HAVE DETERMINED NECESSARY; THE AVERAGE IS 60 DAYS. IF THE PATIENT IS THEN APPROVED FOR DISCOUNTS AT 100% FOR FINANCIAL ASSISTANCE, THE BALANCE IS ADJUSTED AND THE ACCOUNT IS CLOSED. IF THEY ARE APPROVED FOR LESS THAN 100%, THE ADJUSTMENTS ARE REPORTED TO THE AGENCY TO COLLECT ANY REMAINING BALANCE. 2 - NEEDS ASSESSMENT HOOPESTON COMMUNITY MEMORIAL HOSPITAL USED EXISTING DATA, INFORMAL DISCUSSIONS, AND A COMPREHENSIVE QUALITATIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO DETERMINE IF EXISTING PROGRAMS ARE ON TRACK; WHAT NEEDS TO BE ADDED, DELETED OR ENHANCED; AND WHERE OUR FOCUS NEEDED TO BE PLACED IN THE FUTURE. THE CHNA INCLUDED DISCUSSIONS WITH COMMUNITY LEADERS, INCLUDING HUMAN SERVICE AGENCY ADMINISTRATORS, PUBLIC HEALTH REPRESENTATIVES AND HOOPESTON COMMUNITY MEMORIAL HOSPITAL LEADERSHIP. 3 - PATIENT EDUCATION FOR ELIGIBILITY FOR ASSISTANCE HOOPESTON COMMUNITY MEMORIAL HOSPITAL IS ACUTELY AWARE OF THE NEED FOR ACCESS TO CARE AND AS A RESULT, OFFERS A STRONG FINANCIAL ASSISTANCE PROGRAM THAT IS BASED IN A PHILOSOPHY OF DOING THE RIGHT THING FOR THE COMMUNITY AND PATIENTS AND BALANCED BY A CAREFUL STEWARDSHIP OF THE COMMUNITY'S RESOURCES. BY DETERMINING THE FINANCIAL STATUS OF PATIENTS UP-FRONT, WE HAVE BEEN ABLE TO PINPOINT THOSE NEEDING FINANCIAL 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. HOOPESTON COMMUNITY MEMORIAL HOSPITAL HAS MADE A CONCERTED, CONTINUOUS EFFORT TO BE SURE THAT PEOPLE HAVE ACCESS TO INFORMATION THAT WILL HELP THEM WITH THEIR MEDICAL BILLS. THIS INCLUDES: - A SIMPLIFIED APPLICATION FORM THAT CLEARLY EXPLAINS PATIENT RIGHTS AND HOOPESTON COMMUNITY MEMORIAL HOSPITAL'S EXPECTATIONS - INFORMATION ABOUT THE FINANCIAL ASSISTANCE PROGRAM ON ALL BILLING STATEMENTS, COLLECTION LETTERS AND HOSPITAL ADMISSION PACKETS - INFORMATION AND APPLICATION FORMS ARE READILY AVAILABLE AND ACCESSED AT WWW.CARLE.ORG/HOOPESTON - FINANCIAL ASSISTANCE APPLICATION FORMS AND BROCHURES ARE AVAILABLE AT ALL INPATIENT AND OUTPATIENT REGISTRATION POINTS, AS WELL AS IN THE HOSPITAL'S MAIN LOBBY - CONTINUOUSLY EDUCATING OUR STAFF TO KEEP THEM INFORMED ABOUT THE PROGRAM AND WHAT BENEFITS ARE AVAILABLE TO PATIENTS - FINANCIAL ASSISTANCE REPRESENTATIVES ARE AVAILABLE AT VARIOUS COMMUNITY FORUMS - SCREENING PATIENTS THROUGH OUR VENDOR FOR KEY FINANCIAL INDICATORS TO PRESUME ELIGIBILITY OR CONTACT REGARDING OUR ASSISTANCE PROGRAMS 4 - COMMUNITY INFORMATION THE SERVICE AREA OF HOOPESTON COMMUNITY MEMORIAL HOSPITAL IS DEFINED AS THE GEOGRAPHICAL BOUNDARY OF VERMILION COUNTY, ILLINOIS. WHILE SOME RESIDENTS OF SURROUNDING COUNTIES UTILIZE HOOPESTON COMMUNITY MEMORIAL HOSPITAL'S SERVICES, OUR MOST RECENT CHNA TARGETED VERMILION COUNTY RESIDENTS, WHO MAKE UP 84% OF HOOPESTON COMMUNITY MEMORIAL HOSPITAL PATIENTS. POCKETS OF EXTREME POVERTY EXIST THROUGHOUT THIS REGION, WITH RATES HIGHEST AROUND THE CITY OF DANVILLE. THE PROGRAMS WITHIN OUR COMMUNITY Health PLAN GENERALLY HAVE IMPACT UPON ALL THE TARGETED COMMUNITIES, WITH CERTAIN PROGRAMS DIRECTED AT SPECIFIC POPULATIONS. 5 - PROMOTION OF COMMUNITY HEALTH HOOPESTON COMMUNITY MEMORIAL HOSPITAL HAS AN OPEN MEDICAL STAFF AND IS GOVERNED BY AN 11-MEMBER COMMUNITY BOARD THAT SERVES ON A VOLUNTEER BASIS, WITH 7 VOTING MEMBERS AND 4 NON-VOTING STAFF MEMBERS. 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. 6 - AFFILIATED HEALTH CARE SYSTEM HOOPESTON COMMUNITY MEMORIAL HOSPITAL IS A CRITICAL ACCESS HOSPITAL COMMITTED TO IMPROVING QUALITY OF LIFE IN NORTHERN VERMILION COUNTY AND THE SURROUNDING AREA. HOOPESTON COMMUNITY MEMORIAL HOSPITAL INTEGRATED WITH THE CARLE FOUNDATION IN 2012 TO PROVIDE MORE ACCESS TO PRIMARY AND SPECIALTY CARE. THOUGH HCMH FALLS UNDER THE UMBRELLA OF THE CARLE FOUNDATION, IT MAINTAINS A SEPARATE BOARD OF DIRECTORS AND SENIOR LEADERSHIP, AND CONDUCTED ITS OWN COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN IN 2013. WHILE HOOPESTON COMMUNITY MEMORIAL HOSPITAL'S CHNA AND COMMUNITY BENEFIT REPORTING IS SEPARATE FROM CARLE FOUNDATION HOSPITAL, IT FOLLOWS THE SAME GUIDELINES AND PRINCIPLES AS CARLE. HOOPESTON COMMUNITY MEMORIAL HOSPITAL STAFF ARE INVOLVED IN THE CHNA AND IMPLEMENTATION PLAN, AND SERVE ON HUMAN SERVICES AGENCY BOARDS AND COMMITTEES TO PROVIDE SUPPORT TO HELP ADDRESS IDENTIFIED COMMUNITY NEEDS IN NORTHERN VERMILION COUNTY, INCLUDING CHILDREN'S HEALTH, TEEN AND ADOLESCENT HEALTH, ORAL HEALTH, CANCER AND DIABETES. 7 - STATE FILING OF COMMUNITY BENEFIT REPORT AS A CRITICAL ACCESS HOSPITAL, HOOPESTON COMMUNITY MEMORIAL HOSPITAL IS NOT RESPONSIBLE FOR FILING A STATE COMMUNITY BENEFIT REPORT. false true false false false false false true false Joseph Barkmeier MD Trustee 0 383446 0 64029 0 8518 0 131763 0 10075 0 597831 0 Letha Kramer Trustee 0 151833 0 13596 0 845 0 12811 0 8336 0 187421 0 0 Harry Brockus Ex-Officio Board, CEO 187744 0 26049 0 1269 0 48427 0 20208 0 283697 0 0 0 Dennis Hesch Exec VP & CFO 0 574941 0 123194 0 179890 0 182686 0 21515 0 1082226 0 152969 Laurence Fallon Exec VP-Legal Affairs & HR 0 473396 0 81195 0 93251 0 138667 0 20634 0 807143 0 88905 Jay Colbert DO DPM Ex-Officio Brd,CMO & Physician 216206 0 0 0 15533 0 0 0 14176 0 245915 0 0 0 Daniel Chase MD Physician 435776 0 0 0 51919 0 21060 0 20013 0 528768 0 0 0 William McCarthy MD Physician 229435 0 0 0 48642 0 19524 0 1936 0 299537 0 0 0 Albert Tanlim MD Physician 221400 0 0 0 23794 0 17586 0 19861 0 282641 0 0 0 Cortney Joneikis MD MS Physician 283419 0 25000 0 1998 0 0 0 15163 0 325580 0 0 0 Susan Berg MD Physician 257047 0 25000 0 8074 0 0 0 5494 0 295615 0 0 0 SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, QUESTION 3 THE BOARD OF TRUSTEES OF THE CARLE FOUNDATION, THE PARENT COMPANY OF HCMH, 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 COMPENSATION DECISIONS IN ADVANCE OF THEIR IMPLEMENTATION AND DOCUMENTS ITS DETERMINATIONS AND DISCUSSIONS. *THE COMPENSATION COMMITTEE USES 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 REPORTS DIRECTLY TO THE COMPENSATION COMMITTEE. SCHEDULE J, PART I, QUESTION 4B PARTICIPANTS IN THE 457(F) PLAN OFFERED BY THE CARLE FOUNDATION, THE PARENT ORGANIZATION OF HCMH, THAT ARE LISTED IN THE 990 PART VII INCLUDE JOSEPH BARKMEIER, MD, HARRY BROCKUS, DENNIS HESCH, AND LAURENCE FALLON. IN 2014, PAYMENTS FROM THE 457(F) PLAN WERE MADE TO DENNIS HESCH ($152,969), AND LAURENCE FALLON ($88,905). 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. ELIZABETH SILVER FAMILY MEMB OF BOARD CHR 60735 EMPLOYMENT false SHAUN GILLINS FAMILY MEMB OF BOARD CHR 48638 EMPLOYMENT false KIMBERLY S HOUMES FAMILY MEMB OF TRUSTEE 90500 EMPLOYMENT false JONI HORNBECK FAMILY MEMB OF TRUSTEE 83408 EMPLOYMENT false ABIGAIL COLBERT FAMILY MEMB OF KEY EMP 19406 EMPLOYMENT false FORM 990, SUPPLEMENTAL INFORMATION FORM 990, PART III, LINE 2 HOOPESTON COMMUNITY MEMORIAL HOSPITAL BEGAN OPERATING CLINICS IN TUSCOLA AND MATTOON DURING THE TAX YEAR PROVIDING PRIMARY CARE ACCESS TO RESIDENTS OF THOSE COMMUNITIES. REFER TO PART III, LINE 4A FOR A MORE DETAILED DESCRIPTION OF THESE SERVICES. FORM 990, PART VI, QUESTION 2 TRUSTEE, JOSEPH BARKMEIER, MD AND OFFICER, DENNIS HESCH HAD A BUSINESS RELATIONSHIP. FORM 990, PART VI, QUESTION 6 HOOPESTON COMMUNITY MEMORIAL HOSPITAL HAS ONE MEMBER WHICH IS THE PARENT COMPANY, THE CARLE FOUNDATION. FORM 990, PART VI, QUESTION 7A HOOPESTON COMMUNITY MEMORIAL HOSPITAL'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 HOOPESTON COMMUNITY MEMORIAL HOSPITAL'S BOARD OF TRUSTEES MUST HAVE THE APPROVAL OF ITS SOLE MEMBER, THE CARLE FOUNDATION, THROUGH ITS BOARD OF TRUSTEES, WHEN VOTING ON MATTERS INCLUDING THE AMENDING OF THE BY-LAWS; AMENDMENTS TO THE ARTICLES OF INCORPORATION; AUTHORIZING ANY NON-BUDGETED EXPENDITURE IN EXCESS OF $50,000 (THE EXCESS OF ANY PROPOSED EXPENDITURE OVER THE PREVIOUSLY APPROVED BUDGETED AMOUNT SHALL BE DEEMED A NON-BUDGETED EXPENDITURE); TO ADOPT ANY NEW OR ANY CHANGES TO EXISTING LONG TERM OR MASTER INSTITUTIONAL PLANS OF THE CORPORATION; TO ORGANIZE OR ACQUIRE, OR TO AUTHORIZE OR APPROVE THE ORGANIZATION'S ACQUISITION OF ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; THE AUTHORIZATION TO ENTER INTO ANY CONTRACT OR ENGAGE IN ANY TRANSACTION OR ACTIVITY WHICH REQUIRES APPLICATION TO THE ILLINOIS HEALTH FACILITIES PLANNING BOARD FOR A PERMIT OR CERTIFICATE OF NEED AND FOR RECOMMENDING THE CEO OF THE CORPORATION TO THE HOOPESTON BOARD OF TRUSTEES. 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 HUMAN RESOURCES 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 VOTING ON MATTERS RELATED TO THEIR CONFLICTS. THE ORGANIZATION ALSO MAINTAINS PURCHASING POLICIES REQUIRING COUNTER SIGNATURES TO FURTHER MINIMIZE THE RISK ASSOCIATED WITH CONFLICTS OF INTEREST. FORM 990, PART VI, QUESTIONS 15A & 15B THE BOARD OF TRUSTEES OF THE CARLE FOUNDATION, THE PARENT COMPANY OF HOOPESTON COMMUNITY 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 OF THE CARLE FOUNDATION, EVALUATED AGAINST MARKET DATA, AND REVIEWED AND APPROVED BY THE COMMITTEE. *THE COMMITTEE APPROVES ALL COMPENSATION DECISIONS IN ADVANCE OF THEIR IMPLEMENTATION AND DOCUMENTS ITS DETERMINATIONS AND DISCUSSIONS. *THE COMPENSATION COMMITTEE USES 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 REPORTS DIRECTLY TO THE COMPENSATION COMMITTEE. FORM 990, PART VI, QUESTIONS 18 & 19 THE CARLE FOUNDATION, THE SOLE MEMBER OF HOOPESTON COMMUNITY MEMORIAL HOSPITAL, PUBLISHES THROUGH WWW.DACBOND.COM ITS QUARTERLY UNAUDITED FINANCIAL STATEMENTS, ANNUAL AUDITED FINANCIAL STATEMENTS, A MANAGEMENT'S DISCUSSION & ANALYSIS TO ACCOMPANY THE FINANCIAL STATEMENTS, AND AN ANNUAL REPORT OF CERTAIN OPERATING AND FINANCIAL INFORMATION. ADDITIONALLY, OFFICIAL STATEMENTS FOR OUTSTANDING MUNICIPAL BOND ISSUES FOR WHICH THE CARLE FOUNDATION IS OBLIGATED ARE AVAILABLE AT THIS WEBSITE. THESE DOCUMENTS INCLUDE EXTENSIVE INFORMATION ABOUT THE ORGANIZATION'S HEALTH CARE DELIVERY SYSTEM MODEL, RECENT HIGHLIGHTS/ACCOMPLISHMENTS, GOVERNANCE AND ADMINISTRATION, STRATEGIC PLAN, FACILITIES, CLINICAL PROGRAMS, MEDICAL STAFF, SERVICE AREA, COMPETITIVE ENVIRONMENT, DEMOGRAPHIC DATA, UTILIZATION STATISTICS, SUMMARY FINANCIAL INFORMATION, ACADEMIC AFFILIATIONS AND EDUCATIONAL PROGRAMS, MEDICAL RESEARCH, ACCREDITATIONS, AND ITS EMPLOYEES. THIS INFORMATION IS AVAILABLE AT NO CHARGE TO THOSE WHO REGISTER AT THE WWW.DACBOND.COM WEBSITE. IN ADDITION, THE FORM 990S OF THE ORGANIZATION'S FILING ENTITIES ARE AVAILABLE THROUGH DACBOND. QUARTERLY FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST DELIVERED TO THE ORGANIZATION'S ADMINISTRATIVE OFFICES. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICIES ARE ALSO AVAILABLE UPON REQUEST TO THE ORGANIZATION'S ADMINISTRATIVE OFFICES. FORM 990, PART VII, SECTION A, COLUMN B THE AVERAGE ESTIMATED HOURS PER WEEK LISTED FOR THE REPORTING ORGANIZATION AND RELATED ORGANIZATIONS ARE BASED ON A STANDARD 40 HOUR WEEK. MEMBERS MAY FREQUENTLY DEVOTE MORE THAN 40 HOURS OF SERVICE TO THE ENTIRE ORGANIZATION DURING AN AVERAGE WEEK. FORM 990, PART XI, 8 $59,674 REVERSAL OF PRIOR YEAR REAL ESTATE TAX ACCRUAL. FORM 990, PART XI, LINE 9 PERMANANTLY RESTRICTED ASSETS INCREASED AS A RESULT OF A CHANGE IN VALUE OF THE BENEFICIAL INTEREST IN A PERPETUAL TRUST OF $13,432. TEMPORARILY RESTRICTED ASSETS INCREASED BY $471 RESULTING FROM CHANGES IN THE POLAND TRUST ACCOUNT WHICH IS A TEMPORARILY RESTRICTED FUND USED TO PROVIDE TUITION ASSITANCE FOR NURSING STUDENTS. FORM 990, PART XII, LINES 2A, B, C AND PART IV, LINES 12A & 12B THE FINANCIAL STATEMENTS FOR HOOPESTON COMMUNITY MEMORIAL HOSPITAL WERE REVIEWED ON A CONSOLIDATED BASIS UNDER THE PARENT ORGANIZATION, THE CARLE FOUNDATION. THE CARLE FOUNDATION DOES HAVE AN AUDIT COMMITTEE CONSISTING OF MEMBERS OF THE GOVERNING BOARD AND THE CHIEF FINANCIAL OFFICER WHO TOGETHER ASSUME RESPONSIBILITY FOR OVERSIGHT OF THE REVIEW AND AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE CARLE FOUNDATION HOSPITAL 611 W PARK ST URBANA IL 618012595 371119538 HOSPITAL SERV IL 501(c)(3) 3 TCF true THE CARLE FOUNDATION 611 W PARK ST URBANA IL 618012595 370673465 PARENT/INVMGT IL 501(c)(3) 11b TYPE II NA false CARLE HEALTH CARE INCORPORATED 611 W PARK ST URBANA IL 618012595 371140016 VAR MED SVCS IL 501(c)(3) 9 TCF true CARLE RETIREMENT CENTERS INC 611 W PARK ST URBANA IL 618012595 371160033 RTRMT LIVING IL 501(C)(3) 9 TCF true THE CARLE DEVELOPMENT FOUNDATION 611 W PARK ST URBANA IL 618012595 371159978 FUNDRAISING IL 501(c)(3) 7 TCF true CARLE COMMUNITY HEALTH CORPORATION 611 W PARK ST URBANA IL 618012595 364458371 FNDN MISSION IL 501(c)(3) 11a TYPE I TCDF true CHAMPAIGN SURGICENTER LLC 611 W PARK ST URBANA IL 618012595 201915925 SURGICAL CENT IL NA N/A HEALTH SYSTEMS INSURANCE LIMITED GOVERNORS SQ 2ND FL BLDG 3 GRAND CAYMAN CJ KY1-1102 INSURANCE CJ NA C Corp true CARLE HOLDING COMPANY INC 611 W PARK ST URBANA IL 618012595 371188284 HOLDING COMPA IL NA C Corp true CARLE RISK MANAGEMENT COMPANY 611 W PARK ST URBANA IL 618012595 371217973 RISK MANAGEMENT IL NA C Corp true EVALIDATA INC 611 W PARK ST URBANA IL 618012595 462022658 PHYS CREDENTI IL NA C Corp true HEALTH ALLIANCE CONNECT INC 301 S VINE ST URBANA IL 61801 464796891 HEALTH CARE C IL NA C Corp true HEALTH ALLIANCE MEDICAL PLANS INC 301 S VINE ST URBANA IL 61801 371260731 HEALTH COVERAGE IL NA C CORP true CHA HOLDING INC 301 S VINE ST URBANA IL 61801 471854275 HOLDING COMPANY IL NA C CORP true HEALTH ALLIANCE NORTHWEST HOLDING INC 820 N CHELAN AVE WENATCHEE WA 98801 461717578 HOLDING COMPANY WA NA C CORP true HEALTH ALLIANCE NORTHWEST HEALTHPLAN INC 820 N CHELAN AVE WENATCHEE WA 98801 461966323 HEALTH COVERAGE WA NA C CORP true HEALTH ALLIANCE MIDWEST INC 301 S VINE ST URBANA IL 61801 371354502 HEALTH COVERAGE IL NA C CORP true false false false false false false false true false false true true true false false true false true false HEALTH ALLIANCE MEDICAL PLANS INC L 7844544 Book Value CARLE HEALTH CARE INCORPORATED M 5274037 Book Value CARLE HEALTH CARE INCORPORATED H 594419 Book Value HEALTH SYSTEMS INSURANCE LIMITED M 81307 Book value THE CARLE FOUNDATION HOSPITAL M 164350 BOOK VALUE