2022-05-16T12:11:53-05:00 2021-06-30 410746749 CLIFTONLARSONALLEN LLP 475 REGENCY PARK SUITE 175 OFALLON IL 62269 990 2020-07-01 237426289 HARRISBURG MEDICAL CENTER HARR 6182537671 100 DR WARREN TUTTLE DRIVE HARRISBURG IL 62946 DONALD H HUTSON CEO 6182537671 2022-05-13 1 DONALD HUTSON XXX-XX-XXXX JEFF PARKER P00970069 6182331200 2022-05-13 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z DONALD H HUTSON 100 DR WARREN TUTTLE DRIVE HARRISBURG IL 62946 65354472 0 X WWW.HARRISBURGMC.COM X 1975 IL TO MAINTAIN AND IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. 9 9 596 12 0 0 4101443 12797053 55857115 51202471 132164 158706 269727 204718 60360449 64362948 0 0 0 0 35496455 30889993 0 0 0 23528093 26824795 59024548 57714788 1335901 6648160 60904148 53080348 42306177 27674972 18597971 25405376 X THE MISSION OF HARRISBURG MEDICAL CENTER IS TO MAINTAIN AND IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. 0 0 34939676 39562530 IN SUPPORT OF ITS MISSION, THE HOSPITAL PROVIDES CARE TO PATIENTS AT LESS THAN ITS ESTABLISHED CHARGES FOR PATIENTS THAT MEET THE HOSPITAL'SFINANCIAL ASSISTANCE CRITERIA. BECAUSE THE HOSPITAL DOES NOT PURSUECOLLECTION OF AMOUNTS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE, THEY ARE NOT REPORTED IN NET PATIENT SERVICE REVENUE. CHARGES EXCLUDED FROM REVENUE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY (FAP) WERE APPROXIMATELY $2,233,000 FOR 2021. IN ADDITION, THE HOSPITAL PROVIDES SERVICES TO OTHER MEDICALLY INDIGENT PATIENTS UNDER CERTAIN GOVERNMENT-REIMBURSED PUBLIC AID PROGRAMS. SUCH PROGRAMS PAY PROVIDERS AMOUNTS WHICH ARE LESS THAN ESTABLISHED CHARGES FOR THE SERVICES PROVIDED TO THE RECIPIENTS AND MANY TIMES THE PAYMENTS ARE LESS THAN THE COST OF RENDERING CARE. 10437631 11639941 MULBERRY CENTER AT HARRISBURG IS DESIGNED TO OFFER QUALITY PSYCHIATRIC CARE IN AN ENVIRONMENT WHERE COMPREHENSIVE MEDICAL CARE IS AVAILABLE. THROUGH AN INTERACTIVE EXPERIENCE, PATIENTS LEARN TO BETTER UNDERSTAND THEMSELVES AND BEGIN ACCEPTING RESPONSIBILITY FOR THEIR OWN WELLBEING. THE INPATIENT UNIT IS DIVIDED INTO TWO WINGS. THE FIRST IS A GENERAL ADULT UNIT, HOUSING INDIVIDUALS WITH PSYCHIATRIC DISORDERS WHICH DO NOT INVOLVE DEMENTIA. THE SECOND WING IS A GEROPSYCHIATRIC UNIT WHICH TREATS INDIVIDUALS WHOSE PSYCHIATRIC CONDITION IS COMPLICATED BY DEMENTIA.IN THE GERIATRIC WING, PATIENTS ALSO RECEIVE SERVICES FROM NURSES, SOCIAL WORKERS AND ACTIVITY THERAPISTS UNDER THE DIRECTION OF PSYCHIATRISTS, BUT MORE EMPHASIS IS PLACED ON MANAGING THE COGNITIVE DEFICITS THAT ARE ASSOCIATED WITH DEMENTIA. MULBERRY CENTER AT HARRISBURG HAS EMERGENCY ADMISSIONS 24 HOURS A DAY, SEVEN DAYS A WEEK. 45377307 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 60 0 596 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X X JUNE HAYES 6182537671 100 DR WARREN TUTTLE DR HARRISBURG IL 62946 DENNIS MURPHY BOARD CHAIR 4.00 0.00 X X 0 0 0 DAVID EDMISTER VICE-CHAIR (TERM ENDED 4/21) 4.00 0.00 X X 0 0 0 MICHAEL WILLIAMS SECRETARY/TREASURER 4.00 0.00 X X 0 0 0 LARRY JONES MD BOARD MEMBER 4.00 0.00 X 0 0 0 BENNA DAUGHERTY BOARD MEMBER 2.00 0.00 X 0 0 0 MICHAEL TISON BOARD MEMBER 4.00 0.00 X 0 0 0 MATT BUSINARO BOARD MEMBER 2.00 0.00 X 0 0 0 BECKY MITCHELL BOARD MEMBER (TERM ENDED 12/20) 2.00 0.00 X 0 0 0 KELLY PHELPS BOARD MEMBER 2.00 0.00 X 0 0 0 ANGELA ROWE BOARD MEMBER 2.00 1.00 X 0 0 0 GINA SIRACH BOARD MEMBER 2.00 0.00 X 0 0 0 DONALD HUTSON PRESIDENT/CEO 40.00 0.50 X 343670 0 20924 LESLIE FERRELL VICE-PRESIDENT/CNO 40.00 0.00 X 180457 0 14345 THERESA JUNE HAYES VICE-PRESIDENT/CFO 40.00 1.00 X 197184 0 16667 JAMES ALEXANDER VICE-PRESIDENT/CMO 40.00 0.00 X 566816 0 15963 KEVIN KOTH PHYSICIAN 40.00 0.00 X 614706 0 17220 CLAYTON FORD PHYSICIAN 36.00 0.00 X 360363 0 20882 ANAND PATEL PHYSICIAN 36.00 0.00 X 501251 0 2488 THOMAS BUTLER CRNA 36.00 0.00 X 279360 0 13541 JASON VALLETTE CRNA 36.00 0.00 X 264949 0 19632 3308756 0 141662 35 0 1 0 SOUTHERN ILLINOIS PSYCHIATRY LLC 112 AIRWAY DR MARION IL 62959 CONTRACTED PHYSICIANS AND OTHER STAFF 1923067 STATERA HEALTHCARE LLC 2250 N ILLINOIS AVE CARBONDALE IL 62902 CONTRACTED PHYSICIANS AND OTHER STAFF 969377 TRINITY MEDICAL STAFFING LLC 2250 N ILLINOIS AVE CARBONDALE IL 62902 CONTRACTED PHYSICIANS AND OTHER STAFF 812236 LIQUID AGRENTS HEALTHCARE LLC 6900 DALLAS PARKWAY SUITE 450 PLANO TX 75024 CONTRACTED PHYSICIANS AND OTHER STAFF 284620 LOCUMTENENSCOM PO BOX 405547 ATLANTA GA 30384 CONTRACTED PHYSICIANS AND OTHER STAFF 274739 9 12652200 144853 12797053 PATIENT SERVICE REVENUE 624110 51100908 51100908 RENT REVENUE 624100 101563 101563 51202471 130456 130456 1019774 991524 28250 28250 28250 OTHER REVENUE 624100 116272 116272 CAFETERIA REVENUE 624110 80864 80864 COIN MACHINES & TV 624100 4219 4219 3363 3363 204718 64362948 51202471 0 363424 X 1374457 1374457 22385552 19082008 3303544 693884 557268 136616 4743940 3804757 939183 1692160 1358998 333162 92173 92173 18890 18890 10611453 7799121 2812332 178248 178248 4658173 3213677 1444496 680132 614418 65714 68866 66153 2713 61088 26271 34817 898299 780922 117377 2896902 2896902 720169 625555 94614 PHARMACY SUPPLIES 2275733 2275733 BAD DEBT EXPENSE 1561912 1561912 MEDICAL SUPPLIES 1497686 487338 1010348 FOOD & DIETARY 236507 156764 79743 368564 69510 299054 57714788 45377307 12337481 0 296910 823645 18759752 15067728 7451145 6493164 89257 65642 1842109 1609933 626416 822394 58369280 31861167 30296281 26508113 1491435 1684511 50843 5218 60904148 53080348 8939470 8194320 10650001 497846 18376501 18034183 3140161 948623 1200044 42306177 27674972 X 18597971 25405376 18597971 25405376 60904148 53080348 6648160 159245 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 18890 18890 0 PART II-B, LINE 1: THE HOSPITAL PAYS MEMBERSHIP DUES TO THE ILLINOIS HEALTH AND HOSPITAL ASSOCIATION (IHA) AND THE AMERICAN HOSPITAL ASSOCIATION (AHA), A PERCENTAGE OF THESE DUES IS SPENT ON LOBBYING ACTIVITIES BY THESE ASSOCIATIONS. 772443 772443 38287123 17413958 20873165 672089 510715 161374 18623187 13936494 4686693 14438 14438 26508113 1 1 X 1 X 1 X 1 1 0 0 941217 941217 0.01680 16731855 7291859 9439996 0.16810 17673072 7291859 10381213 0.18490 17673072 7291859 10381213 0.18490 1 1561912 520637 14550999 17195973 -2644974 X 1 1 1 1 HARRISBURG MEDICAL CENTER 100 DR WARREN TUTTLE DRIVE HARRISBURG IL 62946 WWW.HARRISBURGMC.COM 521 X X X HARRISBURG MEDICAL CENTER 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE PART V, PAGE 8, SECTION C X 1 18 1 SEE PART V, PAGE 8, SECTION C 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X SEE PART V, PAGE 8, SECTION C X SEE PART V, PAGE 8, SECTION C X SEE PART V, PAGE 8, SECTION C X X X X X 1 X 0 X X X X 1 X 0 0 HARRISBURG MEDICAL CENTER PART V, SECTION B, LINE 5: HOW INPUT FROM THE COMMUNITY WAS TAKEN INTO ACCOUNT IN MOST RECENT CHNA: PRIMARY DATA WAS COLLECTED FROM SURVEYS AND ONE-ON-ONE MEETINGS WITH COMMUNITY MEMBERS WHO REPRESENT THE COMMUNITY. COMMUNITY MEMBERS INCLUDED CEO OF EGYPTIAN HEALTH DEPARTMENT, AN ELDORADO SCHOOL NURSE, A CASE MANAGER AND FORMER GALATIA SCHOOL NURSE, AN HMC FAMILY PRACTICE PHYSICIAN, A HARRISBURG SCHOOL NURSE, AN HMC COMMUNITY OUTREACH REGISTERED NURSE, A REPRESENTATIVE FROM SOUTHERN SEVEN HEALTH DEPARTMENT, WHIPPER JOHNSON - SALINE COUNTY SHERRIFF, AND DALE FOUWLER, ILLINOIS STATE SENATOR. INTERVIEWS WERE HELD WITH THESE COMMUNITY LEADERS, WHO REPRESENT STATE AND LOCAL GOVERNMENT, OUR SCHOOLS, AND LOCAL HEALTH DEPARTMENTS, ABOUT SOUTHEASTERN ILLINOIS' HEALTHCARE NEEDS AND THE HOSPITAL'S STRENGTHS AND WEAKNESSES. WE ASKED COMMUNITY MEMBERS OF OUR MEDICALLY UNDERSERVED AREAS TO PARTICIPATE IN HMC'S CHNA BY ANSWERING A SET OF QUESTIONS USING SURVEY MONKEY TO COLLECT THE DATA. RESPONDENTS ANSWERED SEVERAL QUESTIONS RELATED TO INDIVIDUAL HEALTH AND ACCESS TO CARE, HEALTH SERVICES CHALLENGES, AND RISK FACTORS. WE ALSO ASKED AREA PHYSICIANS ABOUT THEIR THOUGHTS AND CONCERNS ABOUT THE HEALTH OF THE COMMUNITY AND THEIR PATIENTS VIA A SURVEY THAT WAS EMAILED TO THEM. HARRISBURG MEDICAL CENTER PART V, SECTION B, LINE 11: THE HOSPITAL'S MOST RECENTLY CONDUCTED CHNA IDENTIFIED AND PRIORITIZED THE FOLLOWING NEEDS: SUBSTANCE ABUSE, HEART DISEASE, STROKE AND CANCER. THE FOLLOWING ARE EXAMPLES OF HOW THESE PRIORITY AREAS ARE BEING ADDRESSED: 1) SUBSTANCE ABUSE HMC HAD PROVIDED AN OUTREACH NURSE TO DO COMMUNITY EDUCATION IN THE LOCAL SCHOOLS. THAT EDUCATION INCLUDED THE IMPACT OF ADDICTION ON COMMUNITY MEMBERS. THE EDUCATION STOPPED AT THE ONSET OF THE COVID 19 PANDEMIC. 2) HEART DISEASE HMC PARTNERS WITH PRAIRIE CARDIOVASCULAR TO PROVIDE CARDIAC SERVICES IN THE CLINIC SETTING 5 DAYS PER WEEK. HMC ALSO PROVIDES SERVICES SUCH AS CARDIOPULMONARY REHABILITATION, CARDIAC STRESS TESTING AND MONITORING. 3) STROKE HMC HAS PARTNERED WITH SOUTHERN ILLINOIS HEALTHCARE TO ENHANCE STROKE CARE ACROSS THE REGION. HMC UTILIZES TELEHEALTH CAPABILITIES TO PROVIDE FAST ACCESS TO NEUROLOGY CONSULTATION. 4) CANCER HMC IMAGING DEPARTMENT OFFERS LOW DOSE LUNG CANCER SCREENING TO PATIENTS WHO ARE AT RISK. HMC NOW HAS THE ABILITY TO PROVIDE MRI SERVICES ON SITE. HARRISBURG MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER CRITERIA USED IN THE FAP AS ELIGIBILITY CRITERIA FOR FREE AND DSCOUNTED CARE: IF A PATIENT MEETS THE PRESUMPTIVE ELIGIBILITY CATEGORIES LISTED BELOW, THE PATIENT SHALL NOT BE REQUIRED TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION AND SHALL BE DEEMED TO RECEIVE A 100% ALLOWANCE. PRESUMPTIVE ELIGIBILITY CATEGORIES ARE: 1. HOMELESSNESS-WHICH IS DEFINED AS AN INDIVIDUAL WITHOUT PERMANENT HOUSING WHO MAY LIVE ON THE STREETS, STAY IN A SHELTER, MISSION, SINGLE ROOM OCCUPANCY FACILITIES, ABANDONED BUILDING OR VEHICLE, OR IN ANY OTHER UNSTABLE OR NON-PERMANENT SITUATION; 2. DECEASED WITH NO ESTATE; 3. MENTAL INCAPACITATION WITH NO REPRESENTATIVE; 4. MEDICAID ELIGIBLE BUT NOT ON DATE OF SERVICE; 5. MEDICAID ELIGIBLE ON DATE OF SERVICE, BUT THE SERVICE IS NON-COVERED (I.E. HOSPITAL INPATIENT CO-PAYS, NONCOVERED DAYS, NON-COVERED CHARGES AND SPENDDOWN AMOUNTS. NOTE: THIS DOES NOT INCLUDE OFFICE CO-PAY AMOUNTS); AND 6. INCARCERATION IN A PENAL INSTITUTION. SCHEDULE H, PART V, SECTION B, LINE 16A THE FAP WAS WIDELY AVAILABLE AT:HTTPS://HARRISBURGMC.COM/WP-CONTENT/UPLOADS/2020/05/FINANCIAL-ASSISTANCE-POLICY-4.28.2020.PDF SCHEDULE H, PART V, SECTION B, LINE 16B THE FAP APPLICATION WAS WIDELY AVAILABLE AT:HTTPS://HARRISBURGMC.COM/WP-CONTENT/UPLOADS/2020/12/FINANCIAL-ASSISTANCE-PACKET-11.24.2020.PDF SCHEDULE H, PART V, SECTION B, LINE 16C THE FAP PLAIN LANGUAGE SUMMARY WAS WIDELY AVAILABLE AT:HTTPS://HARRISBURGMC.COM/WP-CONTENT/UPLOADS/2020/12/FINANCIAL-ASSISTANCE-PACKET-11.24.2020.PDF SCHEDULE H, PART V, SECTION B, LINE 7A THE ORGANIZATION'S MOST RECENT CHNA REPORT CAN BE FOUND AT:HTTPS://HARRISBURGMC.COM/WP-CONTENT/UPLOADS/2020/02/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.PDF SCHEDULE H, PART V, SECTION B, LINE 10A THE ORGANIZATION'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND AT:HTTPS://HARRISBURGMC.COM/WP-CONTENT/UPLOADS/2020/04/2019-CHNA-IMPLEMENTATIN-PLAN.PDF 6 1 - HMC CLINIC AT HARRISBURG 901 S COMMERCIAL HARRISBURG IL 62946 PROVIDER BASED RURAL HEALTH CLINIC 2 - ELDORADO PRIMARY CARE 1007 US HIGHWAY 45 ELDORADO IL 62930 PROVIDER BASED RURAL HEALTH CLINIC 3 - HMC CLINIC AT MARION 3106 OUTER DRIVE MARION IL 62959 PROVIDER BASED RURAL HEALTH CLINIC 5 - MACH MINE CLINIC 16468 LIBERTY SCHOOL ROAD MARION IL 62959 PRIMARY CARE CLINIC 6 - VIKING MINE CLINIC 13643 NORTH THOMPSONVILLE ROAD MACEDONIA IL 62860 PRIMARY CARE CLINIC 7 - HMC SURGICAL SERVICES CLINIC 50 DR WARREN TUTTLE DRIVE HARRISBURG IL 62946 SURGICAL MEDICINE CLINIC PART I, LINE 3C: HOMELESSNESS, DECEASED WITH NO ESTATE, MENTAL INCAPACITATION WITH NO REPRESENTATIVE, MEDICAID ELIGIBLE BUT NOT ON DATE OF SERVICE, MEDICAID ELIGIBLE ON DATE OF SERVICE BUT SERVICE IS NON-COVERED, AND INCARCERATION IN A PENAL INSTITUTION ARE FACTORS THAT QUALIFY A PATIENT UNDER THE HOSPITAL'S PRESUMPTIVE ELIGIBILITY RULES FOR FINANCIAL ASSISTANCE. THE HOSPITAL DOES NOT USE AN ASSET TEST AS A FACTOR IN DETERMINING ELIGIBILITY. PART I, LINE 7: THE ORGANIZATION USED A COST-TO-CHARGE RATIO AS CALCULATED UTILIZING DATA FROM INTERNAL ACCOUNTING RECORDS AND USING A METHODOLOGY CONSISTENT WITH SCHEDULE H INSTRUCTIONS TO DETERMINE AMOUNTS ON LINES 7A AND 7B OF PART I SCHEDULE H. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,561,912. PART III, LINE 2: THE HOSPITAL CALCULATED BAD DEBT EXPENSE AT COST USING THE COST-TO-CHARGE RATIO, AS CALCULATED USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT ONLY AFTER ALL COLLECTION PROCEDURES HAVE BEEN EXHAUSTED AND AFTER ALL DISCOUNTS AND PAYMENTS HAVE BEEN APPLIED. PART III, LINE 3: BASED ON THE HOSPITAL'S EXPERIENCE WITH ALL ITS PATIENTS, THE ORGANIZATION ESTIMATES THAT IT IS LIKELY THAT UP TO ONE-THIRD OF ACCOUNTS WRITTEN OFF TO BAD DEBT MAY HAVE QUALIFIED FOR FINANCIAL ASSISTANCE, BUT THE PATIENT CHOSE NOT TO APPLY. THEREFORE, 33.333% OF THE BAD DEBT ADJUSTMENTS ARE INCLUDED ON PART III, LINE 3 AT COST. PART III, LINE 4: THE ORGANIZATION'S BAD DEBT EXPENSE IS EXPLAINED IN NOTE 1 OF ITS AUDITED FINANCIAL STATEMENTS:--PATIENT ACCOUNTS RECEIVABLE--THE HOSPITAL PROVIDES AN ALLOWANCE FOR BAD DEBTS BASED UPON A REVIEW OF OUTSTANDINGRECEIVABLES, HISTORICAL COLLECTION INFORMATION, AND EXISTING ECONOMIC CONDITIONS. PATIENTSERVICES ARE PROVIDED ON AN UNSECURED BASIS. PAYMENT IS REQUIRED UPON RECEIPT OF THEINVOICE. THE HOSPITAL BILLS THIRD-PARTY PAYORS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'SLIABILITY IS DETERMINED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF ASBAD DEBTS BASED ON BILLING AND COLLECTION POLICIES OF THE HOSPITAL. AN ESTIMATED ALLOWANCE OFAPPROXIMATELY $2,805,000 AND $3,984,000 WAS RECORDED AT JUNE 30, 2021 AND 2020,RESPECTIVELY. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS ANAVERAGE OF 98% AND 97% OF SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2021 AND 2020,RESPECTIVELY. DURING THE YEARS ENDING JUNE 30, 2021 AND 2020, THE HOSPITAL WROTE OFFAPPROXIMATELY $2,740,000 AND $2,927,000, RESPECTIVELY. PART III, LINE 8: UNPAID COST OF MEDICARE REPRESENTS THE COST (DETERMINED USING THE OVERALL COST TO CHARGE RATIO) OF PROVIDING SERVICES TO PRIMARILY ELDERLY BENEFICIARIES OF THE MEDICARE PROGRAM, IN EXCESS OF PAYMENTS FOR THOSE SERVICES. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICY AND FINANCIAL ASSISTANCE POLICY (FAP) CONTAIN PROVISIONS FOR COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO BE ELIGIBLE FOR FINANCIAL ASSISTANT. THESE PRACTICES ALSO APPLY BROADLY TO ALL TYPES OF PATIENTS. HOSPITAL WILL PROVIDE PATIENTS WITH A PLAIN LANGUAGE SUMMARY OF THE FAP. HOSPITAL WILL MAKE A REASONABLE EFFORT TO ORALLY NOTIFY THE INDIVIDUAL ABOUT THE FAP AND ABOUT HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FAP APPLICATION. IF HOSPITAL DETERMINES THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE, HOSPITAL WILL A) PROVIDE THE INDIVIDUAL WITH A BILLING STATEMENT THAT INDICATES THE AMOUNT HE OR SHE OWES FOR THE CARE RECEIVED, ASSUMING THE INDIVIDUAL IS ELIGIBLE FOR ASSISTANCE OTHER THAN FREE CARE AND HOW THAT AMOUNT WAS DETERMINED, B) REFUND TO THE INDIVIDUAL ANY AMOUNT HE OR SHE HAS PAID THAT EXCEEDS THE AMOUNT THE INDIVIDUAL IS DETERMINED TO BE PERSONALLY RESPONSIBLE FOR PAYING, C) TAKE ALL REASONABLE AVAILABLE MEASURES TO REVERSE ANY EXTRAORDINARY COLLECTION ACTIONS ("ECAS") TAKEN AGAINST THE INDIVIDUAL. FOR ALL TYPES OF PATIENTS, HOSPITAL TAKES THE FOLLOWING ACTIONS AT LEAST 30 DAYS BEFORE INITIATING ECA TO OBTAIN PAYMENT FOR CARE: A) PROVIDE THE INDIVIDUAL WITH A WRITTEN NOTICE THAT INDICATES FINANCIAL ASSISTANCE IS AVAILABLE FOR ELIGIBLE INDIVIDUALS, B) IDENTIFIES THE ECA(S) THAT HOSPITAL (OR OTHER AUTHORIZED PARTY) INTENDS TO INITIATE TO OBTAIN PAYMENT FOR THE CARE AND C) STATES A DEADLINE AFTER WHICH SUCH ECAS MAY BE INITIATED THAT IS NO EARLIER THAN 30 DAYS AFTER THE DATE THAT THE WRITTEN NOTICE IS PROVIDED. PART VI, LINE 2: THE HOSPITAL ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY AND HOW THE HOSPITAL MIGHT ADDRESS THOSE NEEDS BY PARTICIPATING IN STRATEGIC AND OPERATIONAL PLANNING SESSIONS THAT INCLUDE THE BOARD OF DIRECTORS, STATE LEGISLATORS, OFFICIALS FROM THE LOCAL COMMUNITY COLLEGE AND LOCAL CLERGY. THE CEO PARTICIPATES IN STRATEGEGIC PLANNIC MEETINGS WITH A NEARBY REGIONAL HOSPITAL SYSTEM. HOSPITAL LEADERSHIP MEETS WITH LEADERSHIP FROM LOCAL HEALTH DEPARTMENTS, AREA HOSPITALS, AREA LONG TERM CARE FACILITIES AND EMERGENCY PLANNERS ON AN ONGOING BASIS. THE CMO MEETS REGULARLY WITH PRIMARY CARE CLINIC AND BEHAVIORAL HEALTH CLINIC LEADERS TO ASCERTAIN NEEDS AND ASSESS MEETING OF THE NEEDS. THE CMO MEETS REGULARLY WITH HOSPITALISTS AND EMERGENCY DEPARTMENT PHYSICIANS AND IMPLEMENTS RECOMMENDED CHANGES TO BETTER SERVE THE POPULATION. HOSPITAL DATA IS REVIEWED TO DETERMINE PATIENTS' NEEDS BY ANALYZING DIAGNOSIS, READMISSION RATES AND THE MEDICARE CASE MIX INDEX. THE HOSPITAL PARTICIPATES IN REGIONAL HAZZARD ASSESSMENTS AND DRILLS. PART VI, LINE 3: ALL PATIENTS WITHOUT THIRD PARTY COVERAGE, I.E., CONSIDERED "SELF-PAY", RECEIVE A COPY OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM (FAP) PLAIN LANGUAGE SUMMARY DURING REGISTRATION THAT DETAILS THE FAP. HOSPITAL PATIENT BILLING STATEMENTS INCLUDE A STATEMENT EXPLAINING HOW A PATIENT MAY APPLY FOR CONDSIDERATION UNDER THE HOSPITAL'S FAP. SIGNAGE IS DISPLAYED IN REGISTRATION, PATIENT CARE, AND BUSINESS OFFICE AREAS THAT ANNOUNCES FINANCIAL HELP WITH BILLS FOR THOSE PATIENTS WHO WUALIFY. FF A PATIENT CONTACTS THE BUSINESS OFFICE REGARDING DIFFICULTY IN MAKE PAYMENTS, HOSPITAL PERSONNEL INFORMS THE PATIENT OF THE FAP. ONE FULL-TIME FINANCIAL COUNSELOR ASSISTS THE HOSPITAL'S PATIENTS IN APPLYING FOR GOVERNMENT FUNDED MEDICAL COVERAGE OR IN APPLYING FOR THE HOSPITAL'S OWN FAP. PART VI, LINE 4: HARRISBURG MEDICAL CENTER PREDOMINATELY SERVES A FIVE-COUNTY AREA INCLUDING SALINE, GALLATIN, HARDIN, POPE AND WHITE COUNTIES. IN THE FIVE COUNTIES THERE IS A TOTAL POPULATION OF APPROXIMATELY 52,000. THE POPULATION HAS SHOWN A DECLINING TREND FOR AT LEAST THE PAST TWENTY YEARS. APPROXIMETELY 23% OF THE POPULATION IS 65 YEARS OLD OR OLDER. THE POPULATION IS PREDOMINANTLY WHITE. AN AVERAGE OF 86.4% OF THE POPULATION HAVE A HIGH SCHOL DIPLOMA WHILE ONLY 13.8% OF THE POPULATION OVER 25 YEARS OLD HAVE EARNED A BACHELOR'S DEGREE OR HIGHER. THE MEDIAN HOUSEHOLD INCOME IN THE POPULATION SERVED FALLS WELL BELOW THE MEDIAN HOUSEHOLD INCOME FOR THE STATE OF ILLINOIS AND FOR THE UNITED STATES OF AMERICA. THE PERCENTAGE OF INDIVIDUALS IN THIS AREA LIVING IN THE POVERTY LEVEL EXCEEDS THE PERCENTAGE FOR THE STATE OF ILLINOIS AND FOR THE UNITED STATES OF AMERICA. THE LOCAL ECONOMY IS HEAVILY DEPENDENT ON RETAIL TRADE, TRANSPORTATION AND UTILITIES (23.1%), EDUCATIONAL AND HEALTH SERVICES (21.8%), PUBLIC ADMINISTRATION (19.6%), AND OTHER PRIVATE SECTOR INDUSTRIES MAKING UP THE REMAINDER. HARRISBURG MEDICAL CENTER'S ENTIRE SERVICE AREA IS CONSIDERED A FEDERALLY DIESGNATED MEDICALLY UNDERSERVED AREA. PART VI, LINE 5: PROMOTING THE HEALTH OF THE COMMUNITY: HMC IS PASSIONATE ABOUT THE HEALTH AND WELL-BEING OF THE COMMUNITIES SERVED.HMC PARTICIPATES IN MANY COMMUNITY EVENTS TO PROMOTE THE HEALTH AND WELL-BEING OF THE COMMUNITY. COVID-19 SAFETY PRECAUTIONS HAVE PREVENTED THE HOSPITAL FROM HOLDING MOST OF THE COMMUNITY EVENTS NORMALLY HELD, BUT WE HAVE FOUND WAYS TO SUPPORT AND PROVIDE OUTREACH FOR OUR COMMUNITY. HMC PARTICIPATES IN MANY COMMUNITY ORGANIZATIONS EVENTS TO PROMOTE HEALTH SUCH AS HEALTH FAIRS AT THE COMMUNITY COLLEGE, LOCAL PARADES, SALINE COUNTY CHAMBER OF COMMERCE, SALINE COUNTY CHAMBER GOLF TOURNAMENT.HMC ACTIVELY SUPPORTS AND WORKS WITH OTHER HEALTH-RELATED ORGANIZATIONS SUCH AS HOSPICE OF SOUTHERN ILLINOIS AND EGYPTIAN HEALTH DEPARTMENT, AS WELL AS OTHER AREA HOSPITALS, NURSING HOMES, ETC. HMC HOSTS SEMI-ANNUAL BLOOD DRIVES FOR THE AMERICAN RED CROSS AT THE HOSPITAL. DURING THE COVID-19 PANDEMIC, THE HOSPITAL AND CLINICS HAVE SUPPORTED OUR LOCAL SCHOOLS IN SALINE COUNTY BY PROVIDING FACE MASKS, HAND SANITIZER, AND DISINFECTING WIPES FOR STUDENTS THAT ARE UNABLE TO PURCHASE THEIR OWN. THE HOSPITAL AND CLINICS HAVE ALSO CONDUCTED FOOD DRIVES FOR LOCAL FOOD PANTRIES, A BABY SUPPLY DRIVE FOR OUR LOCAL CRISIS PREGNANCY CENTER, AND COAT/GLOVE DRIVES FOR THE LOCAL KIDS. HMC CLINICS ALSO PROVIDED FOOD BASKETS TO LOCAL FAMILIES AT THANKSGIVING AND CHRISTMAS AND ALSO PURCHASED GIFTS FOR THE SCHOOLS UNDER PRIVILEDGED STUDENTS. HMC IS A SPONSOR OF THE THE SALINE COUNTY "CREATING ENTREPRENEURIAL OPPORTUNITIES (CEO) PROGRAM" FOR LOCAL HIGH SCHOOL STUDENTS AND HMC'S CEO AND MARKETING DIRECTOR ARE ACTIVELY INVOLVED AS MENTORS TO THE STUDENTS THROUGOUT THE YEAR. SALINE COUNTY CEO PROGRAM IS A MENTORING PROGRAM THAT PROVIDES EFFECTIVE NETWORKING MODEL FOR STUDENTS. HMC IS ACTIVE WITH THE GOLDEN CIRCLE SENIOR CITZENS ORGANIZATION IN HARRISBURG. HMC'S REGISTERED DIETICIANS REVIEW AND APPROVE THEIR MENU EVERY MONTH AT NO CHARGE. OUR REGISTERED DIETICIANS ALSO PROVIDE NUTRITIONAL CONSULTS AT NO CHARGE IN THE CLINICS.HMC PROVIDES AN ATHLETIC TRAINER AND DRUG SCREENING TESTS AT NO CHARGE TO THE HARRSIBURG HIGH SCHOOL. X X X X X 0 1 0 0 0 0 0 0 0 KEVIN KOTH PHYSICIAN 530129 0 69577 0 15000 0 11000 0 6220 0 631926 0 0 0 JAMES ALEXANDER VICE-PRESIDENT/CMO 311456 0 235860 0 19500 0 11000 0 4963 0 582779 0 0 0 ANAND PATEL PHYSICIAN 461110 0 40141 0 0 0 0 0 2488 0 503739 0 0 0 CLAYTON FORD PHYSICIAN 304403 0 55960 0 0 0 11000 0 9882 0 381245 0 0 0 DONALD HUTSON PRESIDENT/CEO 336470 0 0 0 7200 0 11000 0 9924 0 364594 0 0 0 THOMAS BUTLER CRNA 259860 0 0 0 19500 0 11000 0 2541 0 292901 0 0 0 JASON VALLETTE CRNA 258949 0 0 0 6000 0 11000 0 8632 0 284581 0 0 0 THERESA JUNE HAYES VICE-PRESIDENT/CFO 190684 0 0 0 6500 0 7668 0 8999 0 213851 0 0 0 LESLIE FERRELL VICE-PRESIDENT/CNO 180457 0 0 0 0 0 6973 0 7372 0 194802 0 0 0 PART I, LINE 4B JAMES ALEXANDER, NON-QUALIFIED RETIREMENT PLAN CONTRIBUTIONS: $19,500 KEVIN KOTH, NON-QUALIFIED RETIREMENT PLAN CONTRIBUTIONS: $15,000 THOMAS BUTLER, NON-QUALIFIED RETIREMENT PLAN CONTRIBUTIONS: $19,500 JASON VALLETTE, NON-QUALIFIED RETIREMENT PLAN CONTRIBUTIONS: $6,000 KEVIN KOTH, NON-QUALIFIED RETIREMENT PLAN DISTRIBUTIONS: $85,248 A ILLINOIS FINANCE AUTHORITY 861091967 45204ETA6 2017-03-14 19500000 REFUND MORTGAGE NOTE AND FUND EXPANSION PROJECT 0 0 0 A 1165468 19500000 382353 9984348 9133299 2018 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 TIFFANY BUSINARO EMPLOYEE - WIFE OF BOARD MEMBER MATT BUSINARO 49513 WAGES 0 SKYLAR EDMISTER EMPLOYEE - DAUGHTER OF BOARD MEMBER DAVID EDMISTER 36276 WAGES 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS WAS AUTHORIZED TO NEGOTIATE A LETTER OF INTENT WITH SOUTHERN ILLINOIS HOSPITAL SERVICES. THE HOSPITAL'S BOARD OF DIRECTORS AGREED UPON AND SIGNED THE LETTER OF INTENT AND AFFILIATION AGREEEMENT DURING THE ORGANIZATION'S TAX YEAR, AND SOUTHERN ILLINOIS HOSPITAL SERVICES BECAME THE SOLE MEMBER OF THE ORGANIZATION ON AUGUST 1, 2021. FORM 990, PART VI, SECTION B, LINE 11B DRAFT COPIES OF THE RETURN WILL BE DISTRIBUTED TO ALL BOARD MEMBERS WITH ADEQUATE TIME TO REVIEW. SPECIFIC ITEMS AND QUESTIONS WILL BE ADDRESSED FIRST WITH THE FINANCE COMMITTEE DURING A FINANCE COMMITTEE MEETING AND AGAIN WITH THE FULL BOARD AT A MONTHLY BOARD MEETING. REVISIONS WILL BE MADE AS REQUESTED AND FINAL COPY WILL BE APPROVED BY THE FULL BOARD AFTER FINANCE COMMITTEE REVIEW. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND OFFICERS ARE COVERED UNDER THE HOSPITAL'S CONFLICT OF INTEREST POLICY. INTERESTED PERSONS, FINANCIAL INTEREST, AND INDEPENDENCE OF THE BOARD AND OFFICERS ARE DEFINED WITHIN THE POLICY. AFTER DISCLOSURE OF THE FINANCIAL INTEREST, ALL MATERIAL FACTS WILL BE DISCLOSED AND REVIEWED, INCLUDING DISCUSSION WITH THE INTERESTED PERSON. UPON REQUEST BY A BOARD MEMBER THE MATERIAL FACTS OF A NONFINANCIAL INTEREST WILL BE REVIEWED, INCLUDING DISCUSSION WITH THE INTERESTED PARTY. THEN THE POTENTIALLY CONFLICTED MEMBER SHALL LEAVE THE BOARD OR EXECUTIVE COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR EXECUTIVE COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE POLICY OUTLINES THE PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST. IF THE BOARD OR EXECUTIVE COMMITTEE HAS REASONABLE CAUSE TO BELIEVE A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE MEMBER'S RESPONSE AND AFTER MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE BOARD OR EXECUTIVE COMMITTEE DETERMINES THE MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS, WITH ASSISTANCE FROM THE DIRECTOR OF HUMAN RESOURCES, REVIEWS THE ILLINOIS HOSPITAL ASSOCIATION (IHA) EXECUTIVE COMPENSATION SURVEY, ALONG WITH THE TOP DATA PAY AND BENEFIT SURVEY TO DETERMINE THE SALARY OF CEO. THE SURVEYS ARE USED EACH YEAR TO ENSURE THAT ANNUAL INCREASES HOLD THE CEO'S COMPENSATION WITHIN THE SALARY RANGE OF CEOS OF SIMILAR SIZED HOSPITALS. THIS PROCESS OF DELIBERATION AND DECISION WAS MOST RECENTLY COMPLETED IN 2020. THE CHIEF EXECUTIVE OFFICE DETERMINES THE PROPOSED COMPENSATION OF THE CHIEF FINANCIAL OFFICER, CHIEF NURSING OFFICER, AND CHIEF EXECUTIVE OFFICER BY REVIEWING THE IHA EXECUTIVE SALARY SURVEY. COMPARISONS ARE MADE BETWEEN HMC AND HOSPITAL OF SIMILAR SIZE, REVENUE AND NUMBER OF EMPLOYEES. THE PROPOSED COMPENSATIONS ARE REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. THE SURVEY IS REVIEWED EACH YEAR TO ENSURE THAT ANNUAL INCREASES HOLD THE COMPENSATION WITHIN THE SALARY RANGE OF OFFICERS OF SIMILAR SIZED HOSPITALS. THIS PROCESS OF DELIBERATION AND DECISION WAS MOST RECENTLY COMPLETED IN 2020. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 7,506,122. MANAGEMENT AND GENERAL EXPENSES 2,231,198. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,737,320. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 292,999. MANAGEMENT AND GENERAL EXPENSES 581,134. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 874,133. FORM 990, PART XII, LINE 2C THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT AND SELECTION PROCESSES DURING THE YEAR. HARRISBURG MEDICAL CENTER CLINIC SERVICES LLC 100 DR WARREN TUTTLE DRIVE HARRISBURG IL 62946 452945162 HEALTHCARE IL 0 0 HARRISBURG MEDICAL CENTER HARRISBURG MEDICAL CENTER FOUNDATION 6 EAST CLARK STREET HARRISBURG IL 62946 371411984 FUNDRAISING IL 501(C)(3) LINE 12A, I HARRISBURG MEDICAL CENTER 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 FORM 990, SCHEDULE R, PART I HARRISBURG MEDICAL CENTER CLINIC SERVICES LLC OPERATED A PHYSICIAN CLINIC UNTIL APRIL 1, 2018, AT WHICH POINT ALL CLINIC OPERATIONS WERE TRANSFERRED TO HARRISBURG MEDICAL CENTER. THE LLC WAS TERMINATED AS OF JUNE 30, 2021.