2021-04-12T11:56:20-05:00 2020-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2019-07-01 370661218 MARSHALL BROWNING HOSPITAL ASSOCIATION MARS 6185422146 900 N WASHINGTON ST DU QUOIN IL 62832 DAN EAVES CEO 6185422146 2021-03-30 1 MICHAEL J PETERSON CPA P01833529 2187224705 2021-02-25 2019 2022-09-23 18:48:47Z DAN EAVES 900 N WASHINGTON ST DU QUOIN IL 62832 27485181 0 X WWW.MARSHALLBROWNINGHOSPITAL.COM X 1919 IL MISSION-TO IDENTIFY AND PROVIDE EXCEPTIONAL HEALTHCARE SERVICES TO THE COMMUNITY AND THE SURROUNDING AREA. VISION-TO BE THE ORGANIZATION WHERE PEOPLE WANT TO COME FOR HEALTHCARE, EMPLOYEES WANT TO WORK AND PHYSICIANS AND OTHER PROVIDERS WANT TO PRACTICE. 9 9 355 50 0 0 46671 2328575 25356925 24892927 393406 216461 336051 39402 26133053 27477365 0 0 0 0 13521277 13652740 0 0 0 14358761 13424688 27880038 27077428 -1746985 399937 18903221 28701435 12446528 21866451 6456693 6834984 X MISSION-TO IDENTIFY AND PROVIDE EXCEPTIONAL HEALTHCARE SERVICES TO THE COMMUNITY AND THE SURROUNDING AREA. VISION-TO BE THE ORGANIZATION WHERE PEOPLE WANT TO COME FOR HEALTHCARE, EMPLOYEES WANT TO WORK AND PHYSICIANS AND OTHER PROVIDERS WANT TO PRACTICE. 0 0 20978812 0 24892927 AS A NON-FOR-PROFIT COMMUNITY HOSPITAL, MARSHALL BROWNING HOSPITAL IS A CHARITABLE ORGANIZATION THAT EXISTS TO ADVANCE THE HEALTH OF THE RESIDENTS OF DUQUOIN AND THE SURROUNDING COMMUNITIES. MARSHALL BROWNING HOSPITAL PROVIDES QUALITY HEALTHCARE SERVICES REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF MARSHALL BROWNING HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH THIS CORPORATION'S COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE, ARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST, AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR INDIVIDUAL'S INABILITY TO PAY COEXISTS. THE COMMUNITY BENEFITS CAN BE MEASURED IN MANY WAYS INCLUDING: DIRECT PATIENT CARE, SCREENINGS, EDUCATION, AND COMMUNITY SERVICE EFFORTS OF OUR COLLEAGUES. MARSHALL BROWNING HOSPITAL RECORDED 1,678 PATIENT DAYS. 1,493 OF THOSE DAYS WERE MEDICARE PATIENT DAYS, WHILE 52 CONSISTED OF MEDICAID AND MEDICAID MCO DAYS. DURING FY 2020, THE HOSPITAL ADMITTED 340 PATIENTS AND DISCHARGED 342. THE AVERAGE LENGTH OF STAY FOR A PATIENT IS 4.9 DAYS. THE HOSPITAL PROVIDED 127,001 OUTPATIENT OCCASIONS OF SERVICE WHICH INCLUDED 4,694 EMERGENCY ROOM VISITS. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS, PROVIDING SERVICES TO BOTH MEDICARE AND MEDICAID PATIENTS. FINANCIAL ASSISTANCE IS ALSO PROVIDED THROUGH THE HOSPITAL'S INTERNAL POLICY AND IN FY 2020 THIS AMOUNTED IS ESTIMATED TO $90,000 AT COST. MARSHALL BROWNING HOSPITAL OFFERS VARIOUS PROGRAMS AND SERVICES THAT SUPPORT THE HEALTH OF THE COMMUNITY. SOME EXAMPLES INCLUDE THE FOLLOWING: THE HOSPITAL ANNUALLY PROVIDES ATHLETIC TRAINING SERVICES TO DUQUOIN HIGH SCHOOL ATHLETES. SERVICES ARE PROVIDED AT PRACTICES AS WELL AS AT SCHOOL SPORTING EVENTS AT NO COST TO THE SCHOOL. MONTHLY COMMUNITY EDUCATION LUNCHEONS ARE OFFERED WITH PHYSICIANS/ PROVIDERS PRESENTING PROGRAMS ON HEALTH TOPICS. THE HOSPITAL OFFERS A WEEKLY COUMADIN CLINIC FOR PATIENTS TAKING COUMADIN (WARFARIN) THERAPY. THE CLINIC IS DIRECTED BY THE HOSPITAL PHARMACIST OF WHICH NO REIMBURSEMENT IS RECEIVED FOR PHARMACIST SERVICES. HOSPITAL MANAGERS ARE FREQUENTLY GUEST SPEAKERS AT SCHOOLS ON VARIOUS HEALTH TOPICS AND HEALTHCARE CAREERS. HIGH SCHOOL STUDENTS PARTICIPATE IN JOB SHADOWING AND COOPERATIVE EDUCATION PROGRAMS AT THE HOSPITAL. MARSHALL BROWNING HOSPITAL ANNUALLY PROVIDES TWO SPORTS PHYSICALS CLINICS TO AREA JUNIOR HIGH AND HIGH SCHOOL STUDENTS AT A COST OF $10. THE FEE IS THEN RETURNED TO THE SCHOOLS. THE HOSPITAL ALSO SERVES AS A CLINICAL SITE FOR JOHN A. LOGAN COLLEGE NURSING STUDENTS AND IS A CLINICAL SITE FOR OTHER COLLEGES INCLUDING SIU MEDICAL SCHOOL, SIU-C, ST. LOUIS COLLEGE OF PHARMACY, REND LAKE COLLEGE, KASKASKIA COLLEGE, CHAMBERLAIN COLLEGE, SOUTHWESTER ILLINOIS, AND SICCM. MARSHALL BROWNING HOSPITAL PROVIDES A VARIETY OF COMMUNITY SERVICES TO CITIZENS AND EMPLOYEES FOR WHICH WE RECEIVE NO REIMBURSEMENT SUCH AS COMMUNITY HEALTH FAIRS OFFERING DEEPLY DISCOUNTED LAB TESTING, SCHOOL HEALTH FAIRS, FIRST AID STATIONS, CLASSES FOR AUTOMATIC ELECTRONIC DEFIBULATORS (AED) AND BASIC LIFE SUPPORT (BLS). ADDITIONALLY, MBH STAFF REACH HUNDREDS OF PEOPLE WITH PRESENTATIONS ON A WIDE VARIETY OF TOPICS INCLUDING HEART HEALTH, NUTRITION, ASTHMA, DIABETES, ALZHEIMER'S DISEASE, SLEEP APNEA, ARTHRITIS, BREAST CANCER, EXERCISE AND DIET, SMOKING CESSATION, PNEUMONIA VACCINE, ETC. THE HOSPITAL ANNUALLY SUPPORTS THE DU QUOIN YOUTH CLUB AND NUBABILITY ORGANIZATIONS. THE HOSPITAL ANNUALLY PROVIDES A FOUR-YEAR $1,000 SCHOLARSHIP TO A LOCAL HIGH SCHOOL SENIOR ENTERING THE HEALTHCARE FIELD. THE HOSPITAL PROVIDES SPEAKERS FOR CAMPING CONVENTIONS AND SCREENINGS FOR LOCAL MANUFACTURING COMPANIES. THE HOSPITAL HOSTS SIX AMERICAN RED CROSS BLOOD DRIVES EACH YEAR. MBH EMPLOYEES CONTINUE TO GROW. HOWEVER DUE TO THE COVID19 PANDEMIC, SOME COMMUNITY SERVICES WERE CANCELLED, INCLUDING ATHLETIC TRAINER SERVICES, COMMUNITY EDUCATION SUCH AS 2ND ACT, AND HIGH SCHOOL JOB SHADOWING. 20978812 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 25 0 355 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 DAN EAVES CEO 6185422416 900 N WASHINGTON ST DU QUOIN IL 62832 DAVID DICKINSON PHYSICIAN 40.00 X 315246 0 0 EDWARD TRAVIS MD PHYSICIAN 40.00 X 212566 0 13143 GLADSTONE TUCKER MD PHYSICIAN 40.00 X 213261 0 52 MALCOLM SCHULZ MD PHYSICIAN 40.00 X 198363 0 12221 MICHAEL STAFF MD PHYSICIAN ASSISTANT 40.00 X 151967 0 11263 DAN EAVES CHIEF EXECUTIVE OFFICER 40.00 X 134188 0 756 BRICE HARSY CHIEF FINANCIAL OFFICER (THRU AUG) 40.00 X 49269 0 6530 RICHARD K HAINES PRESIDENT 1.00 X X 0 0 0 KATHY WEST VICE PRESIDENT 1.00 X X 0 0 0 DON HOFFMAN TREASURER 1.00 X X 0 0 0 SUSAN ENGELHARDT SECRETARY 1.00 X X 0 0 0 GUY ALONGI DIRECTOR 1.00 X 0 0 0 ANDREW CROESSMAN DIRECTOR (THRU JAN) 1.00 X 0 0 0 ISAAC DAVISON DIRECTOR 1.00 X 0 0 0 BRAD GALLI R PH DIRECTOR 1.00 X 0 0 0 WILLIAM PLACE DIRECTOR 1.00 X 0 0 0 DAVID SEARBY DIRECTOR 1.00 X 0 0 0 1274860 0 43965 11 0 1 0 INTEGRITAS 2250 NORTH ILLINOIS AVENUE CARBONDALE IL 62901 EMERGENCY PHYSICIAN SERVICES 1316908 FORTE - HOSPITALISTS 2250 NORTH ILLINOIS AVENUE CARBONDALE IL 62901 HOSPITALISTS 823331 CLOUDWAVE DEPT CH 19800 PALENTINE IL 60055 CLOUD HOSTING SERVICES 346318 NAVIN HAFFTY & ASSOCIATES 1900 WEST PARK DRIVE SUITE 180 WESTBOROUGH MA 60055 IT CONSULTING SERVICES 314889 ST LOUIS UNIVERSITY 1402 SOUTH GRAND BLVD FDT NORTH ST LOUIS MO 63104 GI PHYSICIAN SERVICES 225600 17 2302554 26021 2328575 INPATIENT AND OUTPATIENT SERVICES 621990 23519907 23519907 340B PROGRAM 621990 1033908 1033908 INDEPENDENT LIVING RENT 532000 253642 253642 85470 85470 24892927 101657 101657 5110 5110 11851 0 11851 11851 11851 122620 0 7816 122620 -7816 114804 114804 22441 22441 22441 27477365 24892927 0 255863 X 190744 190744 10652642 8783217 1869425 165766 137600 28166 1881481 1552742 328739 762107 627015 135092 78950 78950 25776 25776 4838497 3674540 1163957 94057 94057 305982 149947 156035 160803 160803 382265 382265 35215 32015 3200 431833 310439 121394 1134904 815867 319037 445766 445766 BAD DEBT EXPENSE 1315701 1315701 DRUG 1250901 1250901 MEDICAL SUPPLIES 1098920 900990 197930 REPAIRS & MAINTENANCE 911498 389787 521711 913620 655786 257834 27077428 20978812 6098616 0 208241 4404656 14922 7547917 4837974 3320896 620315 523436 466130 1271447 22731408 16988999 6628809 5742409 5636746 5342484 490084 548190 18903221 28701435 2339801 3116746 25487 2071452 9123767 10987348 957473 5690905 12446528 21866451 X 6456693 6834984 6456693 6834984 18903221 28701435 X 399937 17744 -39390 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8234 8234 0 PART II-B, LINE 1: THE ORGANIZATION PAYS MEMBERSHIP DUES TO THE ILLINOIS HEALTH AND HOSPITAL ASSOCIATION. IHHA DUES SUPPORT A WIDE VARIETY OF ACTIVITIES AND PROGRAMS FOCUSED ON ADVOCACY AS WELL AS OTHER BENEFITS TO THEIR MEMBERS. OF THE MEMBERSHIP DUES PAID TO IHHA, 37% WERE USED FOR LOBBYING PURPOSES. 3114 3114 8935010 5875958 3059052 13707909 11113041 2594868 85375 85375 5742409 DEFERRED COMPENSATION PLAN 356943 ACCUMULATED POST RETIREMENT BENEFIT OBLIGATION 716400 MEDICARE ACCELERATED PAYMENTS 4617562 5690905 26153632 17744 -1315701 -1297957 27451589 25776 25776 27477365 25735951 0 25735951 25776 1315701 1341477 27077428 PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -1,315,701. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,315,701. 1 1 X 1 X 1 X 0 1 1 0 1 1 178068 178068 0.00660 3888199 2020143 1868056 0.06900 4066267 2020143 2046124 0.07560 396310 396310 0.01460 8184303 3560466 4623837 0.17080 8580613 3560466 5020147 0.18540 12646880 5580609 7066271 0.26100 0 660634 132127 7641161 7659020 -17859 X 1 1 1 1 MARSHALL BROWNING HOSPITAL ASSOCIATION 900 N WASHINGTON ST DU QUOIN IL 62832 WWW.MARSHALLBROWNINGHOSPITAL.COM 0001388 X X X X OUTPATIENT PHYSICIAN CLINIC MARSHALL BROWNING HOSPITAL ASSOCIATION 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE SUPPLEMENTAL INFORMATION X X 1 18 1 SEE PART V, PAGE 8 0 1 X 200.000000000000 300.000000000000 X X 0 1 X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X 1 X 0 X X X X 1 X 0 0 MARSHALL BROWNING HOSPITAL ASSOCIATION PART V, SECTION B, LINE 5: MBH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FROM OCTOBER 2018 THROUGH JANUARY 2019. THE CHNA IS A SYSTEMATIC PROCESS INVOLVING THE COMMUNITY TO IDENTIFY AND ANALYZE COMMUNITY HEALTH NEEDS AS WELL AS COMMUNITY ASSETS AND RESOURCES IN ORDER TO PLAN AND ACT UPON PRIORITY COMMUNITY HEALTH NEEDS. THIS ASSESSMENT PROCESS RESULTED IN A CHNA REPORT TO ASSIST THE HOSPITAL IN PLANNING, IMPLEMENTING, AND EVALUATING HOSPITAL STRATEGIES AND COMMUNITY BENEFIT ACTIVITIES. THE CHNA WAS DEVELOPED AND CONDUCTED IN PARTNERSHIP WITH REPRESENTATIVES FROM THE COMMUNITY, BY A CONSULTANT PROVIDED THROUGH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (ICAHN). ICAHN IS A NOT-FOR-PROFIT 501(C)(3) CORPORATION, ESTABLISHED IN 2003 FOR THE PURPOSES OF SHARING RESOURCES, EDUCATION, PROMOTING OPERATIONAL EFFICIENCIES AND IMPROVING HEALTHCARE SERVICES FOR MEMBER CRITICAL ACCESS HOSPITALS AND THEIR RURAL COMMUNITIES. THE PROCESS INVOLVED THE REVIEW OF SEVERAL HUNDRED PAGES OF DEMOGRAPHIC AND HEALTH DATA SPECIFIC TO THE MARSHALL BROWNING HOSPITAL SERVICE AREA. THE SECONDARY DATA AND PREVIOUS HEALTH PLANNING CONCLUSIONS DRAW ATTENTION TO SEVERAL COMMON ISSUES OF RURAL DEMOGRAPHICS AND ECONOMIES. IN ADDITION, THE PROCESS INVOLVED FOCUS GROUPS COMPRISED OF AREA HEALTHCARE PROVIDERS AND PARTNERS AND PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF, OR EXPERTISE IN PUBLIC HEALTH. MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS SERVED BY THE HOSPITAL OR INDIVIDUALS OR ORGANIZATIONS REPRESENTING THE INTERESTS OF SUCH POPULATIONS ALSO PROVIDED INPUT. THE MEDICALLY UNDERSERVED ARE MEMBERS OF A POPULATION WHO EXPERIENCE HEALTH DISPARITIES, ARE AT-RISK OF NOT RECEIVING ADEQUATE MEDICAL CARE AS A RESULT OF BEING UNINSURED OR UNDERINSURED, AND/OR EXPERIENCING BARRIERS TO HEALTHCARE DUE TO GEOGRAPHIC, LANGUAGE, FINANCIAL, OR OTHER CHALLENGES. TWO FOCUS GROUPS MET SEPARATELY ON OCTOBER 11, 2018 TO DISCUSS THE OVERALL STATE OF HEALTH AND THE LOCAL DELIVERY OF HEALTHCARE AND HEALTH-RELATED SERVICES. THEY IDENTIFIED POSITIVE RECENT DEVELOPMENTS IN LOCAL SERVICES AND CARE AND ALSO IDENTIFIED ISSUES OR CONCERNS THAT THEY FELT STILL EXISTED INT HE AREA. A THIRD GROUP COMPRISED OF MEMBERS OR REPRESENTATIVES OF MEMBERS OF THE FOCUS GROUPS THEN MET ON JANUARY 10, 2019 AND CONSIDERED THE QUALITATIVE DATA GATHERED AND ESTIMATED FEASIBILITY AND EFFECTIVENESS OF POSSIBLE INTERVENTIONS BY THE HOSPITAL TO IMPACT THE HEALTH PRIORITIES; THE BURDEN, SCOPE, SEVERITY, OR URGENCY OF THE HEALTH NEED; THE HEALTH DISPARITIES ASSOCIATED WITH THE HEALTH NEEDS; AND OTHER COMMUNITY ASSETS AND RESOURCES THAT COULD BE LEVERAGED THROUGH STRATEGIC COLLABORATION IN THE HOSPITAL'S SERVICE AREA TO ADDRESS THE HEALTH NEEDS. AS AN OUTCOME OF THE PRIORITIZATION PROCESS, DISCUSSED ABOVE, SEVERAL POTENTIAL HEALTH NEEDS OR ISSUES FLOWING FROM THE PRIMARY AND SECONDARY DATA WERE NOT IDENTIFIED AS SIGNIFICANT CURRENT HEALTH NEEDS AND WERE NOT ADVANCED FOR FUTURE CONSIDERATION. FIVE NEEDS WERE IDENTIFIED AS SIGNIFICANT HEALTH NEEDS AND PRIORITIZED: (1) AVAILABILITY OF AMBULANCES FOR EMERGENCY, LOCAL, AND OUT-OF-AREA TRANSPORT; (2) AREA-WIDE NURSING SHORTAGE THAT IMPACTS ACCESS TO TRANSFER BEDS; (3) EDUCATION FOR YOUTH IN THE AREAS OF WELLNESS, SUBSTANCE ABUSE, SEXUAL HEALTH; (4) ACCESS TO MENTAL HEALTH EDUCATION AND SERVICES FOR YOUTH AND YOUNG ADULTS IN GENERAL AND INCLUDING COPING SKILLS AND OPPORTUNITIES FOR PEER SUPPORT; AND (5) PLAN FOR CONTINUED ACCESS TO PREVENTION EDUCATION FOR CHRONIC ILLNESS, ESPECIALLY DIABETES AND CARDIOVASCULAR ISSUES. MARSHALL BROWNING HOSPITAL ASSOCIATION PART V, SECTION B, LINE 7D: COPIES ARE LOCATED IN EACH OF THE HOSPITAL'S WAITING ROOMS, MADE AVAILABLE TO THE COMMUNITY ADVISORY COMMITTEE, POSTED ON THE HOSPITAL WEBSITE AND ARE AVAILABLE UPON REQUEST.HTTP://WWW.MARSHALLBROWNINGHOSPITAL.COM/GETPAGE.PHP?NAME=CHNA MARSHALL BROWNING HOSPITAL ASSOCIATION PART V, SECTION B, LINE 11: IMPLEMENTATION STRATEGYTHE CHNA IMPLEMENTATION STRATEGY WAS AN ONGOING FOCUS OF KEY ADMINISTRATIVE STAFF AT MARSHALL BROWNING HOSPITAL, INCLUDING DAN EAVES, CEO; PAM LOGAN, DIRECTOR, MARKETING/PATIENT RELATIONS; HAROLD CALDERON, CFO; LAURIE KELLERMAN, CCO; BRIAN SCHANDL, CIO; AND HEATHER KATTENBRAKER, EXECUTIVE ASSISTANT. THIS GROUP MET WEEKLY ON A VARIETY OF ISSUES; HOWEVER, THE FOCUS WAS PRIMARILY ON ADDRESSING THE HEALTHCARE NEEDS OF THE COMMUNITY AND THE INTERNAL AND EXTERNAL RESOURCES POTENTIALLY AVAILABLE TO MEET THE PRIORITIZED NEEDS.1. AVAILABILITY OF AMBULANCES FOR EMERGENCY, LOCAL, AND OUT-OF-AREA TRANSPORT MARSHALL BROWNING HOSPITAL CEO MET WITH THE DU QUOIN FIRE DEPARTMENT AND DIRECTOR OF PINCKNEYVILLE AMBULANCE SERVICE TO DISCUSS THE ISSUE OF RESPONSE TIME DURING EMERGENCIES. NO REAL SOLUTION WAS FOUND. THE PINCKNEYVILLE AMBULANCE SERVICE RECEIVES TAX MONIES, BUT IT DOES NOT HAVE SUFFICIENT FUNDS AVAILABLE TO SECURE AN ADDITIONAL AMBULANCE NOR THE EQUIPMENT OR STAFFING NEEDED FOR AN ADDITIONAL AMBULANCE. THE HOSPITAL DOES NOT HAVE SUFFICIENT FUNDING TO ADDRESS THIS NEED AS WELL. HOWEVER, THE HOSPITAL IS INVOLVED IN A THREE-YEAR GRANT WITH THE DELTA REGION HEALTH SYSTEMS DEVELOPMENT (DRCHSD) PROGRAM TO EXPLORE THIS FURTHER.2. AREA-WIDE NURSING SHORTAGE MARSHALL BROWNING HOSPITAL CONTINUES TO MAINTAIN SUFFICIENT STAFFING AND IS INVOLVED IN SUCCESSION PLANNING FOR NURSING IN THE FUTURE. STAFFING NEEDS AT OTHER LARGER FACILITIES CONTINUES TO BE AN ISSUE WHICH IMPACTS ACCESS TO TRANSFER BEDS.3. EDUCATION FOR YOUTH, INCLUDING WELLNESS, SUBSTANCE ABUSE AND SEXUAL HEALTH MARSHALL BROWNING HOSPITAL OFFERED TWO SPORTS PHYSICAL CLINICS TO AREA JUNIOR HIGH AND HIGH SCHOOL YOUTH. IN ADDITION TO THE CLINICS, STUDENTS AND PARENTS WERE INVITED TO TOUR "HIDDEN IN PLAIN SITE". WORKING WITH OUR LOCAL SHERIFF, A ROOM WAS TURNED INTO AN INTERACTIVE DISPLAY OF A TEENAGER'S BEDROOM CONTAINING ITEMS THAT CAN HIDE SUBSTANCES AND HELP PARENTS SPOT SIGNS OF AT-RISK BEHAVIORS THAT CAN LEAD TO OPIOID USE, ADDICTION, AND SUBSTANCE ABUSE DISORDERS. THE HOSPITAL ALSO PROVIDED EDUCATION ON STD'S AT THE 8TH GRADE TEEN CONFERENCE. IN ADDITION, THE HOSPITAL PROVIDED EDUCATION ON THE DANGERS OF VAPING TO JUNIOR HIGH AND HIGH SCHOOL STUDENTS AND EDUCATION FOR PARENTS IN THE COMMUNITY NEWSLETTER WHICH WAS MAILED TO 13,000 HOMES IN A SEVEN ZIP-CODE AREA.4. ACCESS TO MENTAL HEALTH EDUCATION AND SERVICES FOR YOUTH AND YOUNG ADULTS IN GENERAL, INCLUDING COPING SKILLS AND OPPORTUNITIES FOR PEER SUPPORT MARSHALL BROWNING HOSPITAL CONTINUES TO PROVIDE THE SERVICES OF A CLINIC NURSE SPECIALIST WHO HAS A MASTER'S IN PSYCHIATRIC NURSING. SHE PROVIDES CARE TO PATIENTS, BOTH CHILDREN AND ADULT, TWICE A MONTH. REFERRALS ARE ALSO MADE TO PERRY COUNTY COUNSELING AND OTHER AREA COUNSELING SERVICES.5. CONTINUED ACCESS TO PREVENTION FOR CHRONIC ILLNESS, ESPECIALLY DIABETES AND CARDIOVASCULAR ISSUES MARSHALL BROWNING HOSPITAL CONTINUED TO PROVIDE EDUCATION FOR CHRONIC ILLNESS THROUGH SIX-WEEK PROGRAMS HELD AT THE HOSPITAL IN COORDINATION WITH THE PERRY COUNTY HEALTH DEPARTMENT. MONTHLY COMMUNITY EDUCATION LUNCHEONS WERE ALSO HELD ON A VARIETY OF TOPICS FOR CHRONIC DISEASES INCLUDING DIABETES, HEART DISEASE, HYPERTENSION, SLEEP APNEA, AND CANCER. THESE PROGRAMS WERE CANCELLED FROM MARCH 2020 THROUGH JUNE 2020 DUE TO THE COVID-19 PANDEMIC. TELEHEALTH VISITS WERE OFFERED BEGINNING IN APRIL 2020. MARSHALL BROWNING HOSPITAL ASSOCIATION PART V, SECTION B, LINE 16J: 16I - ENGLISH IS THE ONLY PRIMARY LANGUAGE THEREFORE THE FAP, FAP APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY HAS NOT BEEN TRANSLATED. PART V, LINE 16A, FAP WEBSITE HTTP://WWW.MARSHALLBROWNINGHOSPITAL.COM/DOCS/FINANCIAL_ASSISTANCE_APPL_HOSPITAL_REV_07.01.PDF PART V, LINE 16B, FAP APPLICATION WEBSITE HTTP://WWW.MARSHALLBROWNINGHOSPITAL.COM/DOCS/FINANCIAL_ASSISTANCE_APPL_HOSPITAL_REV_07.01.PDF PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTP://WWW.MARSHALLBROWNINGHOSPITAL.COM/DOCS/FINANCIAL_ASSISTANCE_APPL_HOSPITAL_REV_07.01.PDF SCHEDULE H, PART V, LINE 10: HTTP://WWW.MARSHALLBROWNINGHOSPITAL.COM/GETPAGE.PHP?NAME=CHNA 2 1 - MARSHALL BROWNING HOSPITAL MEDICAL CLINI 900 N WASHINGTON ST DU QUOIN IL 62832 RURAL HEALTH CLINIC 2 - MARSHALL BROWNING FAMILY HEALTH CENTER 20 N WASHINGTON ST DU QUOIN IL 62832 RURAL HEALTH CLINIC PART I, LINE 6A: COPIES ARE LOCATED IN EACH OF THE HOSPITAL'S WAITING ROOMS, MADE AVAILABLE TO THE COMMUNITY ADVISORY COMMITTEE, POSTED ON THE HOSPITAL WEBSITE AND ARE AVAILABLE UPON REQUEST. PART I, LINE 7: THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE ORGANIZATION'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT MARSHALL BROWNING HOSPITAL INCLUDE THE OPERATION OF THE INPATIENT MEDICAL SURGICAL UNIT AND TWO RURAL HEALTH CLINICS. THE HOSPITAL AND CLINICS ARE OPERATED TO PROVIDE SUPPORT TO THE COMMUNITY BY PROVIDING HOSPITALIZATION, EMERGENCY, AND CLINICAL SERVICES TO THE SURROUNDING RURAL AREAS, WHICH WOULD OTHERWISE BE UNDERSERVED. IT IS THE GOAL OF MARSHALL BROWNING HOSPITAL TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. THE COSTING METHOD FOR SUBSIDIZED HEALTH SERVICES IS BASED ON THE COSTING METHODS USED IN THE HOSPITAL'S MEDICARE COST REPORT WHICH PROVIDES FOR A DIRECT ALLOCATION OF EXPENSES AS WELL AS PROVIDING THE SAME DATA TO THE MEDICARE PROGRAM AS WELL AS TO THE IRS FOR 990 PURPOSES. PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. PART III, LINE 4: ACCOUNTS RECEIVABLE AND CREDIT POLICY:IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H TO THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUE DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE ORGANIZATION AS WELL AS ANESTHESIA PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, AND REVENUE FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN PROFESSIONAL SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENTS AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGICAL, AND CLINICAL PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT MARSHALL BROWNING HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT, AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES, AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE).WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART VI, LINE 2: MARSHALL BROWNING HOSPITAL HAS A COMMUNITY ADVISORY COMMITTEE WHICH IS COMPRISED OF COMMUNITY MEMBERS INCLUDING THE ADMINISTRATOR OF THE PERRY COUNTY HEALTH DEPARTMENT. MARSHALL BROWNING HOSPITAL IS ALSO AN ACTIVE PARTICIPANT IN THE PERRY COUNTY HEALTHY COMMUNITY COALITION. THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED TO IDENTIFY THE MOST IMPORTANT HEALTH ISSUES IN PERRY COUNTY, PARTICULARLY FOR VULNERABLE AND UNDER-REPRESENTED POPULATIONS, TO ENSURE THAT PROGRAMS AND SERVICES CLOSELY MATCH THE PRIORITIES AND NEEDS OF THE COMMUNITY, AND TO STRATEGICALLY ADDRESS THOSE NEEDS TO IMPROVE THE HEALTH OF THE COMMUNITY WE SERVE. MARSHALL BROWNING HOSPITAL CONDUCTED A CHNA FOR 2019. MARSHALL BROWNING HOSPITAL LED THE PLANNING, IMPLEMENTATION, AND COMPLETION OF THE CHNA THROUGH A CONSULTING AGREEMENT WITH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (ICAHN). THE PROJECT WAS OVERSEEN AT THE OPERATIONAL LEVEL BY THE DIRECTOR OF MARKETING AND PATIENT RELATIONS, REPORTING DIRECTLY TO THE CEO. ARRANGEMENTS WERE MADE WITH ICAHN TO FACILITATE TWO FOCUS GROUPS AND A MEETING TO IDENTIFY AND PRIORITIZE SECONDARY DATA AND TO PREPARE A FINAL REPORT FOR SUBMISSION TO MARSHALL BROWNING HOSPITAL BOARD OF DIRECTORS. THE DIRECTOR OF MARKETING AND PATIENT RELATIONS WORKED CLOSELY WITH ICAHN'S CONSULTANT TO IDENTIFY AND ENGAGE KEY COMMUNITY PARTNERS AND TO COORDINATE LOCAL MEETINGS AND GROUP ACTIVITIES. PARTICIPATION INCLUDED TWO COMMUNITY FOCUS GROUPS INCLUDING A DIVERSE GROUP OF REPRESENTATIVES FROM THE COMMUNITY AND A GROUP OF MEDICAL PROFESSIONALS AND PARTNERS. PARTICIPATION INCLUDED THE ADMINISTRATOR OF THE COUNTY HEALTH DEPARTMENT. REPRESENTATION ALSO INCLUDED THE PERRY COUNTY HEALTHY COMMUNITY COALITION AND AN INTERNAL TEAM CONSISTING OF THE HOSPITAL CEO, HOSPITAL CFO, HOSPITAL CHIEF CLINICAL OFFICER, HOSPITAL DIRECTOR OF MARKETING AND PATIENT RELATIONS, HOSPITAL CHIEF INFORMATION OFFICER AND HOSPITAL EXECUTIVE ASSISTANT. PART VI, LINE 3: PATIENT EDUCATION REGARDING ELIGIBILITY FOR ASSISTANCE IS PROVIDED IN THE FOLLOWING MEDIUMS: HOSPITAL BROCHURE, HOSPITAL WEBSITE, POSTED IN ADMITTING, POSTED IN THE EMERGENCY DEPARTMENT, AND PATIENTS ARE CONTACTED BY A PATIENT ACCOUNTS REPRESENTATIVE DURING AND AFTER THEIR HOSPITAL STAY REGARDING ELIGIBILITY FOR ASSISTANCE. PART VI, LINE 4: PERRY COUNTY IS A RURAL AREA WITH AN ESTIMATED POPULATION OF 21,595. THE MEDIAN HOUSEHOLD INCOME (ACCORDING TO US CENSUS BUREAU 2012-16) WAS $43,308. THERE WERE 27.36% OF CHILDREN IN THE MARSHALL BROWNING HOSPITAL SERVICE AREA LIVING IN POVERTY IN 2012 WHICH IS CONSIDERED HIGHER THAN 19.55% OVERALL IN ILLINOIS. PINCKNEYVILLE COMMUNITY HOSPITAL, LOCATED 12 MILES AWAY, ALSO SERVES THE HEALTHCARE NEEDS OF PERRY COUNTY RESIDENTS. MARSHALL BROWNING HOSPITAL PRIMARILY SERVES RESIDENTS OF PERRY COUNTY. HOWEVER, A SMALL PORTION OF SURROUNDING COMMUNITIES IS SERVED AND INCLUDES THE FOLLOWING ZIP CODES: 62832 (DU QUOIN); 62888 (TAMAROA); 62274 (PINCKNEYVILLE), 62932 (ELKVILLE); 62927 (DOWELL); 62884 (SESSER); AND 62865 (MULKEYTOWN). ACCORDING TO THE U.S. CENSUS DATA, THE POPULATION IN THE MARSHALL BROWNING HOSPITAL SERVICE AREA FELL FROM 30,262 PEOPLE TO 29,244 PEOPLE BETWEEN THE YEARS 2000 AND 2010, A 3.36% DECREASE. AGE DISTRIBUTION OF POPULATION IN PERRY COUNTY IN YEAR 2012 (COMMUNITY COMMONS) INCLUDED: AGE 0-4 (1,033); AGE 5-17 (3,187); AGE 18-24 (2,122); AGE 25-34 (2,705); AGE 35-44 (2,828); AGE 45-54 (3,115); AGE 55-64 (2,887); AGE 65+ (3,718). PART VI, LINE 5: MARSHALL BROWNING HOSPITAL PROVIDES ACTIVITIES AND SERVICES FOR WHICH NO PATIENT BILL EXISTS. THESE SERVICES ARE NOT EXPECTED TO BE FINANCIALLY SELF-SUPPORTING, ALTHOUGH SOME MAY BE SUPPORTED BY OUTSIDE GRANTS OR FUNDING. SOME EXAMPLES INCLUDE FREE OR LOW-COST CLINICS SUCH AS THE SPORTS PHYSICAL CLINIC WHEREBY THE FEES ARE ONLY $10 AND DONATED BACK TO THE STUDENT'S SCHOOL. ALL PHYSICIANS AND STAFF DONATE THEIR TIME TO THE CLINICS. THE HOSPITAL PROVIDES THE SALARY OF OUR ATHLETIC TRAINER TO ATTEND ALL PRACTICES AND BALLGAMES FOR ATHLETIC TRAINING SERVICES TO DU QUOIN HIGH SCHOOL ATHLETES. THE HOSPITAL ESTABLISHED A COUMADIN CLINIC WHICH IS AN ANTICOAGULATION CLINIC HELD EACH WEDNESDAY. THE CLINIC PROVIDES ONE-ON-ONE CARE TO ASSIST PATIENTS WITH THE CONTROL OF THEIR ANTICOAGULATION THERAPY, SPECIFICALLY COUMADIN (GENERIC WARFARIN). PATIENTS ARE GIVEN EDUCATION AND DIETARY INSTRUCTION AND KNOW THEIR RESULTS AND DOSAGE FOR THE WEEK FOLLOWING EACH APPOINTMENT. THIS IS A COLLABORATIVE PRACTICE WITH NO BILLING CODES FOR THE CONSULTATION OF THE PHARMACIST OR LAB DIRECTOR WHO PROVIDE THE INSTRUCTION FOR THE PATIENTS. THIS SERVICE IS DONATED BACK TO THE COMMUNITY. THE CLINIC IS HIGHLY SUCCESSFUL AND RESULTS IN THE AVOIDANCE OF ER VISITS AND ADMISSIONS TO THE HOSPITAL. MARSHALL BROWNING HOSPITAL OFFERS A MONTHLY "SECOND ACT" LUNCHEON PROGRAM FOR INDIVIDUALS AGE 50 AND OLDER WITH A PHYSICIAN OR OTHER HEALTHCARE PROVIDER PRESENTING A HEALTHCARE PROGRAM. COMMUNITY MEMBERS ARE GIVEN FREE COLON CANCER SCREENING KITS AND PROVIDE THE TESTING AT NO CHARGE DURING COLON CANCER AWARENESS MONTH. THE HOSPITAL HOSTS MANY FREE EDUCATIONAL PROGRAMS TO THE COMMUNITY THROUGHOUT THE YEAR ON TOPICS SUCH AS DIABETES, CERVICAL AND OVARIAN CANCER, SLEEP APNEA, PROSTATE CANCER, SKIN CANCER, HEART DISEASE, HIGH BLOOD PRESSURE, ALZHEIMER'S DISEASE, EXERCISE AND DIET, COPD, ANEMIA, EYE DISEASES, FIRST AID/CPR/AED CLASSES, CHANGES IN LAWS FOR SENIORS AND PROVIDES SPEAKERS FOR VARIOUS COMMUNITY ORGANIZATIONS. THE HOSPITAL PROVIDES FREE SPACE EVERY OTHER MONTH FOR WEIGHT LOSS PROGRAMS PRESENTED BY A BARIATRIC SURGEON AT HERRIN HOSPITAL. THE HOSPITAL OFFERED A LARGE COMMUNITY HEALTH FAIR WITH REDUCED FEE LAB TESTING AS WELL AS MANY OTHER FREE HEALTH SCREENINGS. MARSHALL BROWNING PROVIDES CLINICAL ROTATIONS AND INTERNSHIPS FOR MEDICAL STUDENTS AND A VARIETY OF COLLEGE STUDENTS ENTERING THE HEALTHCARE FIELD. MARSHALL BROWNING HOSPITAL OFFERS A FOUR-YEAR $1,000 SCHOLARSHIP TO A HIGH SCHOOL SENIOR EACH YEAR ENTERING THE HEALTHCARE FIELD. THE HOSPITAL HOSTS SIX COMMUNITY BLOOD DRIVES PER YEAR. THE HOSPITAL PROVIDES A FIRST AID STATION AT THE LOCAL CONSERVATION FAIR FOR AREA SCHOOL CHILDREN. THE HOSPITAL DONATES EACH YEAR TO THE DU QUOIN YOUTH CLUB, NUBABILITY, SPECIAL OLYMPICS, DU QUOIN FOOD PANTRY, CLOTHES CLOSET, AND VARIOUS OTHER NEEDS IN THE COMMUNITY. THE HOSPITAL OFFERS A SENIOR INDEPENDENT LIVING FACILITY ON ITS CAMPUS THAT IS OFFERED AS A BREAK-EVEN SERVICE AND HAS NEVER BEEN OPERATED AS A FOR-PROFIT ENTITY. MARSHALL BROWNING HOSPITAL PROVIDES OVERHEAD AND SPACE FOR COMMUNITY MEETINGS. THE HOSPITAL PROVIDES EDUCATIONAL PROGRAMS FREE OF CHARGE TO CAMPERS UTILIZING THE DU QUOIN STATE FAIRGROUNDS FOR CAMPING CONVENTIONS. PART VI, LINE 6: MARSHALL BROWNING HOSPITAL IS AFFILIATED WITH SOUTHERN ILLINOIS HEALTHCARE TO ENHANCE SERVICES FOR THE RESIDENTS OF PERRY COUNTY. IT IS NOT A MERGER OR ACQUISITION BUT IS A PARTNERSHIP TO PROVIDE EDUCATIONAL, ADMINISTRATIVE AND CLINICAL OPPORTUNITIES FOR HEALTHCARE STAFF, DEVELOP LINKAGES AMONG HEALTHCARE PROVIDERS, PROVIDE BETTER COORDINATION OF CARE AND SERVICES AND EXPAND THE POOL OF SPECIALISTS. SINCE THE AFFILIATION, MARSHALL BROWNING HOSPITAL HAS EXPANDED THE NUMBER OF SPECIALISTS OFFERING CLINICS AT THE HOSPITAL, BEGAN OFFERING SECOND ACT COMMUNITY EDUCATION PROGRAMS, AND OFFERS UROLOGIC SURGICAL PROCEDURES. PART VI, LINE 7, REPORTS FILED WITH STATES IL X X 0 0 0 0 0 0 0 0 0 DAVID DICKINSON PHYSICIAN 315006 0 0 0 240 0 0 0 0 0 315246 0 0 0 EDWARD TRAVIS MD PHYSICIAN 211534 0 0 0 1032 0 6544 0 6599 0 225709 0 0 0 GLADSTONE TUCKER MD PHYSICIAN 210213 0 0 0 3048 0 0 0 52 0 213313 0 0 0 MALCOLM SCHULZ MD PHYSICIAN 195315 0 0 0 3048 0 6028 0 6193 0 210584 0 0 0 MICHAEL STAFF MD PHYSICIAN ASSISTANT 148919 0 0 0 3048 0 4661 0 6602 0 163230 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B ALL BOARD MEMBERS ARE PROVIDED A COPY OF THE FORM 990 FOR THEIR REVIEW AND COMMENT BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES ARE TO COMPLETE A CONFLICT OF INTEREST STATEMENT. EACH YEAR OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES ARE EDUCATED ON THE DEFINITION OF A CONFLICT OF INTEREST AND HOW TO AVOID THEM. A CONFLICT SHALL BE REPORTED TO THE BOARD OF DIRECTORS TO DETERMINE IF A CONFLICT ACTUALLY EXISTS. THE INTERESTED BOARD MEMBER MAY PARTICIPATE IN DISCUSSION BUT ABSTAIN FROM VOTING ON THE ISSUE. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S SALARY IS DETERMINED BY THE BOARD OF DIRECTORS IN WHICH THEY REVIEW MARKET WAGE DATA FOR COMPARABILITY. ALL OTHER OFFICERS AND EMPLOYEES ARE APPROVED BY THE CEO THROUGH THE HOSPITAL'S NORMAL WAGE AND SALARY POLICY. ALL EMPLOYEES WAGES ARE COMPARED TO MARKET RATES IN THE HEALTHCARE INDUSTRY. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS DISCLOSURE EXPLANATION COPIES OF THE ORGANIZATIONS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, FINANCIAL STATEMENTS, AND THE FEDERAL FORM 990 TAX RETURN ARE AVAILABLE UPON REQUEST FROM THE ADMINISTRATIVE OFFICE. FORM 990, PART IX, LINE 11G EMERGENCY PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 1,114,320. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,114,320. OTHER PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,803,371. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,803,371. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 756,849. MANAGEMENT AND GENERAL EXPENSES 1,163,957. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,920,806. FORM 990, PART XI, LINE 9: POSTRETIREMENT BENEFIT ADJUSTMENT -39,390.