2020-06-29T09:09:20-05:00 2019-06-30 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2018-07-01 237426289 HARRISBURG MEDICAL CENTER HARR 6182537671 100 DR WARREN TUTTLE DRIVE HARRISBURG IL 62946 JUNE HAYES CHIEF FINANCIAL OFFICER 6182537671 2020-06-03 1 JEFF PARKER P00970069 3149254300 67.137.57.251 2020-06-03 10:40:34 CD P 48943B999F87A455DDDAC2F617771C67E5F72438 B37335DB0E92613669297DB35897B6E949903B5E 2018 2020-09-23 17:36:50Z JUNE HAYES 100 DR WARREN TUTTLE DRIVE HARRISBURG IL 62946 61178944 0 X WWW.HARRISBURGMC.COM X 1975 IL TO MAINTAIN AND IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. 11 11 681 13 27745 -12031 3270 34400 67887865 58953826 264948 122395 643233 341559 68799316 59452180 8722 0 0 0 38640519 37977086 0 0 0 35243348 24764912 73892589 62741998 -5093273 -3289818 51672675 44928312 30934924 27512299 20737751 17416013 THE MISSION OF HARRISBURG MEDICAL CENTER IS TO MAINTAIN AND IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. 0 0 49422968 58416617 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 $1,976,000 FOR 2019. 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. 485827 509464 THE AVAILABILITY OF QUALITY IN-HOME HEALTH CARE SERVICES HAS MANY BENEFITS FOR PATIENTS: THE COMFORT OF FAMILIAR SURROUNDINGS, A GREATER DEGREE OF SELF-SUFFICIENCY, AND LOWER COSTS THAN HOSPITAL OR NURSING HOME CARE. LICENSED PROFESSIONALS PROVIDE SKILLED CARE, AS ORDERED BY A PHYSICIAN, IN A 50-MILE RADIUS OF HARRISBURG.THE HARRISBURG MEDICAL CENTER HOME HEALTH CARE PROGRAM PROVIDES A VARIETY OF SERVICES, INCLUDING: SKILLED NURSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY AND SPEECH THERAPY. 49908795 1 0 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 64 0 681 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 11 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 X X 0 0 0 DAVID EDMISTER VICE-CHAIR 4.00 X X 0 0 0 MICHAEL WILLIAMS SECRETARY/TREASURER 2.00 X X 0 0 0 LARRY JONES MD BOARD MEMBER 2.00 X 0 0 0 JOAN HARPER BOARD MEMBER 2.00 X 0 0 0 BENNA DAUGHERTY BOARD MEMBER 2.00 X 0 0 0 MICHAEL TISON BOARD MEMBER 4.00 X 0 0 0 MATT BUSINARO BOARD MEMBER 4.00 X 0 0 0 BECKY MITCHELL BOARD MEMBER 4.00 X 0 0 0 KELLY PHELPS BOARD MEMBER 4.00 X 0 0 0 ANGELA ROWE BOARD MEMBER 2.00 X 0 0 0 STEVE LEDBETTER BOARD CHAIR (TERM ENDED NOV. 2018) 4.00 X X 0 0 0 TOM DAVIS SECRETARY/TREASURER (TERM ENDED NOV. 2018) 2.00 X X 0 0 0 DONALD HUTSON PRESIDENT/CEO 40.00 1.00 X 273127 0 6909 RODNEY SMITH PRESIDENT/CEO (TERM ENDED JAN. 2018) 40.00 1.00 X 52529 0 1642 LESLIE FERRELL VICE-PRESIDENT/CFO 40.00 X 167916 0 13320 THERESA JUNE HAYES VICE-PRESIDENT/CFO 40.00 X 181778 0 20945 DANIEL LAMPLEY VICE-PRESIDENT/COO (TERM ENDED JUNE 2018) 40.00 X 173052 0 14998 TIMOTHY THARP VICE-PRESIDENT/COO (TERM ENDED AUG. 2018) 40.00 X 126639 0 1645 KEVIN KOTH PHYSICIAN 40.00 X 910755 0 11601 JAMES ALEXANDER PHYSICIAN 40.00 X 581866 0 15814 THOMAS BUCINSKI PHYSICIAN 36.00 X 365981 0 21826 TIMOTHY MORTHLAND PHYSICIAN 36.00 X 350759 0 7767 DEAN LANGENFELD PHYSICIAN 36.00 X 334785 0 22143 3519187 0 138610 42 0 1 0 THIRD COAST GROUP LLC 325 WEST HURON ST SUITE 602 CHICAGO IL 60654 REFERENCE LAB MARKETING 2982224 SHAWNEE GROUP LLC 325 WEST HURON ST SUITE 602 CHICAGO IL 60654 REFERENCE LAB BILLING 2402120 LAB CORP OF AMERICA PO BOX 12140 BURLINGTON NC 272162140 LAB SEND OUTS 458578 ABS LABS LLC 1600 WALLACE SUITE 100 CARROLLTON TX 75006 REFERENCE LAB SEND OUTS 371070 HORIZON MENTAL HEALTH MANAGEMENT PO BOX 840839 DALLAS TX 752840839 BEHAVIORAL HEALTH MGMT SERVICES 322360 12 34400 34400 PATIENT SERVICE REVENUE 624110 58321254 58321254 HOME HEALTH 621610 509464 509464 RENT REVENUE 624100 95363 95363 REFERENCE LAB REVENUE 624100 27745 27745 58953826 75561 75561 1640722 132876 1535188 191576 105534 -58700 46834 46834 OTHER REVENUE 624100 232439 232439 CAFETERIA REVENUE 624110 99653 99653 COIN MACHINES & TV 624100 5479 5479 3988 3988 341559 59452180 58926081 27745 463954 X 945645 945645 27824194 23883038 3941156 788457 654531 133926 6528085 5419234 1108851 1890705 1569553 321152 101375 101375 6634653 3982073 2652580 431118 431118 4593717 3501528 1092189 726763 612907 113856 145709 123480 22229 41000 31533 9467 867270 697485 169785 3030639 3030639 950365 764313 186052 BAD DEBT EXPENSE 3113416 3113416 MEDICAL SUPPLIES 1786665 494721 1291944 PHARMACY SUPPLIES 1672897 1672897 FOOD & DIETARY 299192 244513 54679 370133 112934 257199 62741998 49908795 12833203 0 17837 20530 5807082 1818721 10482199 9439750 269277 218867 1393404 1461405 823864 782890 56934662 28732065 30015307 28202597 2813628 2933085 50077 50467 51672675 44928312 10414966 7502014 19440847 19075241 1079111 935044 30934924 27512299 X 20737751 17416013 20737751 17416013 51672675 44928312 -3289818 -23396 -8524 0 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 17013 17013 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. 839600 839600 37372745 14987946 22384799 893892 593879 300013 17569882 13150240 4419642 258543 258543 28202597 1 1 X 1 X 1 X 1 1 0 0 687523 687523 0.01210 17286192 8712137 8574055 0.15130 17973715 8712137 9261578 0.16340 17973715 8712137 9261578 0.16340 1 3113416 1037702 16789141 20469050 -3679909 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 SHERIFF, AND DALE FOWLER, 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: HOW HOSPITAL IS ADDRESSING SIGNIFICANT NEEDS INDENTIFIED IN THE MOST RECENT CHNA: 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 THEY ARE BEING ADDRESSED: 1) SUBSTANCE ABUSE - HMC'S COMMUNITY OUTREACH NURSE PROVIDES EDUCATION IN LOCAL SCHOOLS AND TEACHES ABOUT THE "IMPACT OF ADDICTION", 2) HEART DISEASE - HMC HAS PARTNERED WITH PRAIRIE CARDIOVASCULAR TO PROVIDE CARDIOVASCULAR CARE FIVE DAYS PER WEEK IN THE HOSPITAL AND CLINIC SETTINGS, 3) STROKE - HMC HAS PARTNERED WITH MEMORIAL HOSPITAL OF CARBONDALE (SIHS) AS PART OF THEIR ONGOING INITIATIVE TO ENHANCE STROKE CARE ACROSS OUR REGION, AND 4) CANCER - HMC'S IMAGING DEPARTMENT NOW OFFERS LOW DOSE LUNG CANCER SCREENING TO PATIENTS WHO ARE AT RISK. HARRISBURG MEDICAL CENTER PART V, SECTION B, LINE 13H: OTHER CRITERIA USED IN THE FAP AS ELIGIBILITY CRITERIA FOR FREE AND DISCOUNTED 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/2019/04/FINANCIAL-ASSISTANCE-POLICY-04.01.19.PDF SCHEDULE H, PART V, SECTION B, LINE 16B THE FAP APPLICATION WAS WIDELY AVAILABLE AT:HTTP://WWW.HARRISBURGMC.COM/WP-CONTENT/UPLOADS/2019/04/FINANCIAL-ASSISTANCE-APPLICATION-04.01.19.PDF SCHEDULE H, PART V, SECTION B, LINE 16C THE FAP PLAIN LANGUAGE SUMMARY WAS WIDELY AVAILABLE AT:HTTPS://HARRISBURGMC.COM/WP-CONTENT/UPLOADS/2019/07/FINANCIAL-ASSISTANCE-PLAIN-LANGUAGE-SUMMARY-04.01.19.PDF SCHEDULE H, PART V, SECTION B, LINE 7A THE ORGANIZATION'S MOST RECENT CHNA REPORT CAN BE FOUND AT:WWW.HARRISBURGMC.COM/WP-CONTENT/UPLOADS/2019/07/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.PDF SCHEDULE H, PART V, SECTION B, LINE 10A THE ORGANIZATION'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND WITH ITS CHNA REPORT AT:HTTPS://HARRISBURGMC.COM/CHNA/ 8 1 - HMC CLINIC AT HARRISBURG 901 S COMMERCIAL HARRISBURG IL 62946 PRIMARY CARE CLINIC 2 - ELDORADO PRIMARY CARE 1007 US HIGHWAY 45 ELDORADO IL 62930 PROVIDER BASED RURAL HEALTH CLINIC 3 - EQUALITY FAMILY PRACTICE 183 WEST LANE EQUALITY IL 62934 PROVIDER BASED RURAL HEALTH CLINIC 4 - HMC CLINIC AT MARION 3106 OUTER DRIVE MARION IL 62959 PRIMARY CARE CLINIC 5 - GALATIA PRIMARY CARE 124 EAST MAIN GALATIA IL 62935 PROVIDER BASED RURAL HEALTH CLINIC 6 - MACH MINE CLINIC 16468 LIBERTY SCHOOL ROAD MARION IL 62959 PRIMARY CARE CLINIC 7 - VIKING MINE CLINIC 13643 NORTH THOMPSONVILLE ROAD MACEDONIA IL 62860 PRIMARY CARE CLINIC 8 - HMC ORTHOPAEDIC CLINIC 50 DR WARREN TUTTLE DRIVE HARRISBURG IL 62946 ORTHOPAEDIC 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 $ 3,113,416. 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 OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. PATIENT SERVICES ARE PROVIDED ON AN UNSECURED BASIS. PAYMENT IS REQUIRED UPON RECEIPT OF THE INVOICE. THE HOSPITAL BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. AN ESTIMATED ALLOWANCE OF APPROXIMATELY $4,659,000 AND $4,769,000 WAS RECORDED AT JUNE 30, 2019 AND 2018, RESPECTIVELY. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS AN AVERAGE OF 97% AND 71% OF SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2019 AND 2018, RESPECTIVELY. DURING THE YEARS ENDING JUNE 30, 2019 AND 2018, THE HOSPITAL WROTE OFF APPROXIMATELY $3,113,000 AND $2,104,000, 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 ASSISTANCE. 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: HOSPITAL ASSESSES HEALTHCARE NEEDS OF COMMUNITY AND HOW THE HOSPITAL MIGHTADDRESS THOSE NEEDS BY PARTICIPATING IN STRATEGIC PLANNING SESSIONS THAT INCLUDES COMMUNITY BOARD MEMBERS, PHYSICIANS AND STAFF. CEO ALSO PARTICIPATES IN STRATEGIC PLANNING SESSIONS WITH NEARBY REGIONAL HOSPITAL.CEO MEETS WITH LOCAL PROVIDERS AND ADMINISTRATORS FROM NURSING HOMES ANDOTHER LOCAL HOSPITALS TO DETERMINE HOW STRATEGIC ALLIANCES CAN BEST SERVICE OUR REGION'S PATIENTS. HOSPITAL DATA IS REVIEWED TO DETERMINE NEEDS OF PATIENTS BY ANALYZING TOP DIAGNOSES AS WELL AS RE-ADMISSION RATES AND RELATED DIAGNOSES. ALONG WITH STAFF FROM THE EMERGENCY MANAGEMENT AGENCY AND PERSONNEL FROM THE COUNTY HEALTH, LAW ENFORCEMENT, AND FIRE DEPARTMENTS, HOSPITAL STAFF PARTICIPATES IN ANNUAL REGIONAL HAZARD VULNERABILITY ASSESSMENTS TO ASSESS COMMUNITY READINESS FOR DISASTERS SUCH AS MINING ACCIDENTS, EARTHQUAKES AND TORNADOES. PART VI, LINE 3: ALL PATIENTS THAT ARE WITHOUT THIRD PARTY COVERAGE, I.E. "SELF PAY", RECEIVE A HANDOUT DURING REGISTRATION THAT DETAILS THE FINANCIAL ASSISTANCE PROGRAM. ALL PATIENT BILLING STATEMENTS FOR THE HOSPITAL INCLUDE A STATEMENT REGARDING HOW A PATIENT MAY APPLY FOR CONSIDERATION UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. SIGNAGE IS DISPLAYED IN REGISTRATION, PATIENT CARE AND BUSINESS OFFICE AREAS THAT ANNOUNCES FINANCIAL HELP WITH PATIENT BILLS FOR THOSE WHO QUALIFY. IF A PATIENT CONTACTS THE BUSINESS OFFICE WITH AN INABILITY TO MAKE PAYMENT ISSUE, HOSPITAL PERSONNEL INFORM THE PATIENT OF THE FINANCIAL ASSISTANCE PROGRAM. ONE FULL-TIME EMPLOYEE SERVES AS A FINANCIAL COUNSELOR TO HELP THE ORGANIZATION'S PATIENTS APPLY FOR GOVERNMENT FUNDED MEDICAL COVERAGE OR FOR THE HOSPITAL'S OWN FINANCIAL ASSISTANCE PROGRAM. PART VI, LINE 4: THE COMMUNITIES SERVED BY HARRISBURG MEDICAL CENTER ARE SALINE, GALLATIN, HARDIN, POPE AND WHITE COUNTIES. IN THE FIVE COUNTIES, THERE IS A TOTAL POPULATION OF ROUGHLY 52,000, WITH ABOUT 23% OVER THE AGE OF 65. THIS AREA HAS EXPERIENCED DECLINING POPULATION BETWEEN 2000 AND 2016. THE RESIDENTS IN THE COUNTIES SERVED ARE PREDOMINANTLY WHITE AND THE MEDIAN INCOME RANGES FROM $39,500 IN POPE COUNTY TO A HIGH OF $46,300 IN WHITE COUNTY. ALMOST 20% OF THE POPULATION LIVES IN POVERTY. UNEMPLOYMENT RATES RANGE FROM 4.8% TO 9.3%, AS COMPARED TO THE NATIONAL AVERAGE OF 4.4% IN JANUARY 2019. THE MOST COMMON EMPLOYMENT SECTORS FOR THOSE WHO LIVE IN SALINE COUNTY ARE RETAIL TRADE, TRANSPORTATION & UTILITIES, EDUCATIONAL & HEALTH SERVICES, AND PUBLIC ADMINISTRATION. HARRISBURG MEDICAL CENTER'S ENTIRE SERVICE AREA IS CONSIDERED A FEDERALLY DESIGNATED 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 ORGANIZATIONS' EVENTS TO PROMOTE HEALTH SUCH AS HEALTH FAIRS AT THE LOCAL MIDDLE SCHOOLS, COMMUNITY COLLEGE AND COAL MINES, LOCAL PARADES, SALINE COUNTY CHAMBER BUSINESS EXPO, SALINE COUNTY CHAMBER GOLF TOURNAMENT, SIC KIDS FAIR, AND HARRISBURG DISTRICT LIBRARY'S SUMMER READING KICK OFF. 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. HMC ALSO HOST BLOOD DRIVES FOR THE AMERICAN RED CROSS TWICE A YEAR AT THE HOSPITAL.OF HMC'S FIVE-COUNTY SERVICE AREA, APPROXIMATELY 23% OF ITS RESIDENTS ARE 65 OR OLDER. FOR THIS REASON, HMC IS INVOLVED IN MANY HEALTH EVENTS AND PROGRAMS TARGETED TO SENIORS. HMC IS VERY ACTIVE WITH THE GOLDEN CIRCLE SENIOR CITIZENS ORGANIZATION IN HARRISBURG AND PROVIDES AT THE CENTER FREE OF CHARGE PACE EXERCISE FOR SENIORS TWICE A WEEK, NUTRITIONAL PRESENTATIONS. HMC'S REGISTERED DIETICIANS REVIEW AND APPROVE THEIR MENU EVERY MONTH. HMC ALSO PARTICIPATE AND SPONSOR A BOOTH AT THE FRANKLIN-WILLIAMSON HEALTHY COMMUNITIES COALITION SENIOR FUN FEST EVERY SPRING.ONE OF OUR COMMUNITY HEALTH CONCERNS WE IDENTIFIED IN OUR COMMUNITY HEALTH NEEDS ASSESSMENT IS SUBSTANCE ABUSE. HMC IS WORKING TO PROVIDE EARLY INTERVENTION TO HELP DETER OUR YOUTH FROM DOING DRUGS. HMC'S COMMUNITY AWARENESS NURSE VISITS ELEMENTARY, MIDDLE, AND HIGH SCHOOLS EVERY WEEK IN THREE COUNTIES PRESENTING A PROGRAM CALLED "IMPACT OF ADDICTION". THIS PROGRAM TOUCHES ON THE TOPICS OF ADDICTION, SELF-DEFENSE, AND PREVENTING CHILD ABDUCTION. SHE HAS SPOKEN TO OVER 1,000 STUDENTS AND THAT NUMBER CONTINUES TO GROW. SELF DEFENSE & IMPACT OF ADDICTION CLASSES IS ALSO PRESENTED AT OUR LOCAL PARK DISTRICTS, CHURCHES, AND AREA YOUTH GROUPS. IN ADDITION TO THIS PROGRAM, OUR RESPIRATORY THERAPY DIRECTOR VISITS LOCAL SCHOOLS TOUCHING ON THE DANGERS OF SMOKING AND VAPING. WE ALSO PROVIDE AN ATHLETIC TRAINER AND DRUG SCREENING TEST AT NO CHARGE TO HARRISBURG HIGH SCHOOL.EVERY YEAR, HMC HOSTS OUR TEDDY BEAR CARE FAIR. THIS EVENT ALLOWS CHILDREN TO BRING A STUFFED ANIMAL TO OUR HOSPITAL FOR A MOCK HOSPITAL EXPERIENCE. THE STUFFED ANIMAL IS TREATED AS THE PATIENT AND RECEIVES SERVICES SUCH AS TRIAGE, SURGERY, RADIOLOGY, LAB WORK, RESPIRATORY THERAPY, AND PHYSICAL THERAPY. LOCAL EMERGENCY AGENCIES PARTICIPATE BY ALLOWING CHILDREN TO SEE THEIR VEHICLES SUCH AS AMBULANCES AND MEDICAL HELICOPTER AS WELL THE GEAR THEY USE SUCH AS FIREFIGHTER SUITS. OUR GOAL IS TO EASE THE FEAR OF GOING TO THE HOSPITAL SHOULD THE CHILD ONE DAY NEED TO BE ADMITTED TO A HOSPITAL OR IS INVOLVED IN AN EMERGENCY SITUATION. X X X X X 0 1 0 0 0 0 0 0 0 DONALD HUTSON PRESIDENT/CEO 260149 0 0 0 12978 0 0 0 6909 0 280036 0 0 0 LESLIE FERRELL VICE-PRESIDENT/CFO 158163 0 0 0 9753 0 6502 0 6818 0 181236 0 0 0 THERESA JUNE HAYES VICE-PRESIDENT/CFO 161678 0 0 0 20100 0 7380 0 13565 0 202723 0 0 0 DANIEL LAMPLEY VICE-PRESIDENT/COO (TERM ENDED JUNE 130052 0 0 0 43000 0 6955 0 8043 0 188050 0 0 0 KEVIN KOTH PHYSICIAN 607703 0 266053 0 36999 0 6474 0 5127 0 922356 0 0 0 JAMES ALEXANDER PHYSICIAN 291366 0 248000 0 42500 0 11000 0 4814 0 597680 0 0 0 THOMAS BUCINSKI PHYSICIAN 323020 0 0 0 42961 0 11000 0 10826 0 387807 0 0 0 TIMOTHY MORTHLAND PHYSICIAN 344355 0 0 0 6404 0 4840 0 2927 0 358526 0 0 0 DEAN LANGENFELD PHYSICIAN 316285 0 0 0 18500 0 11000 0 11143 0 356928 0 0 0 PART I, LINE 4B RODNEY SMITH, NON-QUALIFIED RETIREMENT PLAN CONTRIBUTIONS: $692 DANIEL LAMPLEY, NON-QUALIFIED RETIREMENT PLAN CONTRIBUTIONS: $18,500 JAMES ALEXANDER, NON-QUALIFIED RETIREMENT PLAN CONTRIBUTIONS: $18,000 MICHAEL BLAIN, NON-QUALIFIED RETIREMENT PLAN CONTRIBUTIONS: $18,500 THOMAS BUCINSKI, NON-QUALIFIED RETIREMENT PLAN CONTRIBUTIONS: $18,481 KEVIN KOTH, NON-QUALIFIED RETIREMENT PLAN CONTRIBUTIONS: $18,500 ONE NON-QUALIFIED RETIREMENT PLAN ARRANGEMENT USED A SPECIALLY DESIGNED LIFE INSURANCE CONTRACT AS THE FUNDING VEHICLE. WHILE THE CONTRACT WAS JOINTLY OWNED BY BOTH RODNEY SMITH AND HARRISBURG MEDICAL CENTER, THE ARRANGEMENT WAS TREATED AS A HARRISBURG MEDICAL CENTER LOAN TO RODNEY SMITH FOR TAX PURPOSES. HARRISBURG MEDICAL CENTER PAID POLICY PREMIUM CONSTITUTES THE "LOAN" UPON WHICH RODNEY SMITH REPORTED THE INTEREST AS INCOME. THIS INTEREST PLUS RODNEY SMITH "EQUITY TRANSFER", IF ANY, OF THE LOAN PREMIUM WAS PAID BY HIM VIA COMPENSATION BONUS. RODNEY SMITH LEFT HARRISBURG MEDICAL CENTER (HMC) ON 1/27/2018, AND HMC'S NET LOAN VALUE IS ZERO AT 6/30/2018. A ILLINOIS FINANCE AUTHORITY 861091967 45204ETA6 2017-03-14 19500000 REFUND MORTGAGE NOTE AND FUND EXPANSION PROJECT 0 0 0 A 392844 19500000 382353 9414749 9133299 569599 2018 1 0 0 0 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 SCHEDULE K, PAGE 1, PART II LINE 17 ONCE THE ORGANIZATION MAKES A FINAL ALLOCATION OF PROCEEDS, THEY WILL HAVE BOOKS AND RECORDS TO SUPPORT SUCH AN ALLOCATION. TIFFANY BUSINARO EMPLOYEE - WIFE OF BOARD MEMBER MATT BUSINARO 41667 WAGES 0 SKYLAR EDMISTER EMPLOYEE - DAUGHTER OF BOARD MEMBER DAVID EDMISTER 19238 WAGES 0 SCHEDULE L, PART IV, LINE 1 HMC EMPLOYEE KRISTIN WILSON IS A FAMILY MEMBER OF BOARD MEMBER HAROLD WILSON. 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 A CONFLICT OF INTEREST FORM IS COMPLETED AND REVIEWED ANNUALLY TO DISCLOSE ANY POSSIBLE CONFLICTS OF INTEREST. 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 DOCUMENTED IN BOARD MEETING MINUTES AND WAS MOST RECENTLY COMPLETED IN 2019. 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 DOCUMENTED IN BOARD MEETING MINUTES AND WAS MOST RECENTLY COMPLETED IN 2019. 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 3,875,731. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,875,731. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 106,342. MANAGEMENT AND GENERAL EXPENSES 2,652,580. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,758,922. 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 0 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0