2020-11-16T13:20:05-06:00 2019-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 4000 INDIANAPOLIS IN 46204 990 2019-01-01 371363001 RICHLAND MEMORIAL HOSPITAL % DENNIS HESCH RICH 6183952131 800 East Locust Street Olney IL 62450 DENNIS HESCH Director of Business 6183952131 2020-11-16 true JENNIFER D RHODERICK P00395735 3176817000 69.136.161.74 35057220203215000033 2020-11-16 P 8A643FFA55DAADCC2D7DB737B1A92A286D034D88 34163F381DEDE5EE0CABDD6E8F3BD042227F3C04 2019 2021-01-29 14:40:06Z Christina Bare 800 East Locust Street Olney IL 62450 55890164 false X www.richlandmemorial.com X 1953 IL To provide excellent healthcare, promote wellness, and educate patients, staff, and the community. 11 6 695 77 153140 25000 25000 50984712 54499558 385742 78830 1413630 918823 52809084 55522211 0 45584 0 0 35230505 38718242 0 0 0 24332726 27450692 59563231 66214518 -6754147 -10692307 33259131 29782143 15111238 21945001 18147893 7837142 X TO PROVIDE EXCELLENT HEALTHCARE, PROMOTE WELLNESS, AND EDUCATE PATIENTS, STAFF, AND THE COMMUNITY. false false 52279676 45584 54932012 SEE SCHEDULE O 52279676 true true false true false false false false false false true false false false true true false true false false false false false false false false true true false true true false false false false false false true false false false false false false true true true false false true 47 0 true 695 true true true false false false false false false false false false false false X 11 6 false false false false true true true true true false false true true true true true true false false false IL X DENNIS HESCH 2173833311 611 W PARK ST URBANA IL 61801 X JOHN SNYDER TRUSTEE, EX VP & COO THRU 6/19 2.0 18.0 X 0 2476327 2177803 JARROD ALMAROAD MD TRUSTEE & PHYSICIAN(THRU 9/19) 1.0 39.0 X 0 811688 46210 MATTHEW KOLB TRUSTEE & COO (Start 06/19) 5.0 35.0 X X 0 703948 129541 LAUREN SCHMID EXEC VP, CHIEF HR OFFICER 2.0 38.0 X 0 430309 98880 PRASHANTH ANAND MD PHYSICIAN 40.0 0.0 X 472659 0 41007 HARRY BROCKUS CEO 36.0 4.0 X 400330 0 99514 SALLY SALMONS MD TRUSTEE & PHYSICIAN Start 9/19 2.0 38.0 X 0 405652 77564 H TIMOTHY GARRETT DO TRUSTEE & PHYSICIAN 3.0 37.0 X 384692 0 51497 MARY WALLER MD PHYSICIAN 40.0 0.0 X 378949 0 29326 NIRANAT DEJTIRANUKUL PHYSICIAN 40.0 0.0 X 364980 0 37154 Paul Sutherland MD PHYSICIAN 40.0 0.0 X 347354 0 45507 STEPHEN REID MD PHYSICIAN 40.0 0.0 X 351902 0 40264 Regina Thomas CNO & DIR PATIENT CARE SVS 40.0 0.0 X 208434 0 21560 CHRISTINA BARE DIRECTOR OF BUSINESS OPS 40.0 0.0 X 150711 0 17560 CAROL SCHAFER TRUSTEE 2.0 0.0 X 0 0 0 DAN EICHELBERGER CHAIR OF THE BOARD 5.0 0.0 X X 0 0 0 Gary Houchin TRUSTEE 2.0 0.0 X 0 0 0 JASON GLOVER SECRETARY/ TREASURER 2.0 0.0 X X 0 0 0 Jennifer Cummins-Zuber TRUSTEE 2.0 0.0 X 0 0 0 ROB MCCLAIN VICE CHAIR OF BOARD 1.0 0.0 X X 0 0 0 TOMMIE FEHRENBACHER TRUSTEE 2.0 0.0 X 0 0 0 PATRICIA KESSLER-BOOKH TRUSTEE (Start 09/19) 2.0 0.0 X 0 0 0 ROBERT ANNIS TRUSTEE (THRU 09/19) 2.0 0.0 X 0 0 0 3060011 4827924 2913387 55 false true false CARLE PHYSICIAN GROUP 611 WEST PARK URBANA IL 61801 ER & HOSP PROVIDERS 2998277 The Carle Foundation Hospital 611 WEST PARK URBANA IL 61801 MANAGEMENT SERVICES 2565671 SODEXHO 4880 PAYSPHERE CIRCLE CHICAGO IL 60674 FOOD SERVICES 900202 THE CARLE FOUNDATION 611 WEST PARK URBANA IL 61801 MANAGEMENT SERVICES 694583 QUORUM HEALTH RESOURCES 1573 MALLORY LANE 200 BRENTWOOD TN 37027 CONSULTING SERVICES 657005 10 25000 0 25000 NET PATIENT SERVICE REVENUE 622110 54499558 54499558 54499558 79263 79263 0 0 0 0 0 367520 367953 -433 -433 -433 0 0 0 0 0 0 0 0 0 AMBULANCE REVENUE FROM PROPERTY TAX 900099 275403 275403 CAFETERIA SERVICES 722331 219335 219335 LAUNDRY SERVICES 812331 127000 127000 297085 157051 26140 113894 918823 55522211 54932012 153140 412059 30584 30584 15000 15000 0 0 1383849 1126904 256945 249303 184149 65154 26928853 22018400 4910453 1117286 924399 192887 7174013 5873513 1300500 1864938 1523227 341711 0 140129 140129 54588 54588 14973 14973 0 0 2426401 2069608 356793 362115 362115 4495709 3800249 695460 427786 372487 55299 0 1083613 842275 241338 341954 207734 134220 0 203727 144184 59543 258984 204114 54870 0 2485577 1757102 728475 1090161 1000833 89328 OTHER PURCHASED SERVICES 4936639 1858731 3077908 PATIENT CARE SUPPLIES 3257205 3257205 0 INTERNAL PURCHASED SERVS 3437221 2860520 576701 PROVIDER ASSESSMENT TAX 2205551 2205551 228359 2907 225452 66214518 52279676 13934842 0 0 0 3742281 1317147 0 0 6708982 7303754 0 0 0 0 1130170 1103347 728221 873309 790799 446922 57747337 39693158 15218870 18054179 3900579 0 0 0 0 0 0 0 1039229 683485 33259131 29782143 4866146 9019392 0 0 0 0 0 0 0 0 0 0 6025709 5696073 0 0 4219383 7229536 15111238 21945001 X 17754145 7425293 393748 411849 18147893 7837142 33259131 29782143 X -10692307 363454 18102 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 14973 14973 false SCHEDULE C, PART IV $14,973 PORTION OF ILLINOIS HOSPITAL ASSOCIATION (IHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA) DUES ATTRIBUTABLE TO LOBBYING. 1005119 1005119 29532724 19714279 9818445 487119 411909 75210 26722375 19566970 7155405 0 0 0 18054179 0 INTERCOMPANY PAYABLES 815085 DUE TO BLUE CROSS 1650217 OPERATING LEASE LIABILITY 68101 RMH - SAVINGS ACCOUNT 1739453 ASSET RETIREMENT OBLIGATION 2956680 7229536 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, 2019 AND 2018. true true X true X true X true true false true true 1421201 0 1421201 0.02150 13434064 4907431 8526633 0.12880 0 0 0 14855265 4907431 9947834 0.15030 133348 0 133348 0.00200 2220 0 2220 0.00000 6618269 3112311 3505958 0.05290 0 0 0 0.00000 91145 0 91145 0.00140 6844982 3112311 3732671 0.05630 21700247 8019742 13680505 0.20660 0 0 0.00000 17038 17038 0.00000 797 797 0.00000 0 0 0.00000 0 0 0.00000 1206 1206 0.00000 544 544 0.00000 0 0 0.00000 0 0 0.00000 19585 19585 0.00000 true 1258481 629241 11506499 28099619 -16593120 X true true 1 1 Richland Memorial Hospital 800 East locust Olney IL 62450 WWW.CARLERMH.COM 0004788 X X X RICHLAND MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 18 true false false true X SEE PART V, SECTION C X true 18 true SEE PART V, SECTION C false true X 200. 300. true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X X true X false false FACILITY 1, RICHLAND MEMORIAL HOSPITAL, PART V, LINE 3E The needs identified and prioritized throughout the 2018 CHNA carried forward variants of previous CHNAs and added others. The identified and prioritized needs selected include: 1) Access to mental health services 2) Access to dental care for youth and adults 3) Improved access to prevention, treatment, and recovery resources for substance abuse for youth and adults. 4) Access to case managers 5) Transportation 6) After hour and weekend access to care FACILITY 1, RICHLAND MEMORIAL HOSPITAL - PART V, SECTION B, LINE 5 Provisions in the Affordable Care Act (ACA) require charitable hospitals to conduct a community health needs assessment (CHNA). 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. Richland Memorial Hospital, Inc. (RMH) conducted its first CHNA in 2013 and second in 2016. The 2018 CHNA was conducted in June, July, and august of 2018. This community health needs assessment and implementation plan of RMH was approved by the board of trustees on the 13th day of October, 2018. RMH led the planning, implementation, and completion of the community health needs assessment through a consulting arrangement with the Illinois critical access hospital network. Terry Madsen, an ICAHN consultant, attorney, and former educator and community development specialist, met with hospital executive staff to define the community, scope of the project, and special needs and concerns. An internal working group, possible local sources for secondary data and key external contacts were identified, and a timeline was established. For the 2018 CHNA, qualitative data was reviewed to help validate the selection of health priorities. In alignment with IRS treasury notice 2011-52,2 and the subsequent final rules reported at 79 FR 78953, the qualitative/primary data received and reviewed included primary input from (1) at least one state, local, tribal, or regional governmental public health department (or equivalent department or agency) with knowledge, information, or expertise relevant to the health needs of the community and, (2) members of medically underserved, low-income, and minority populations in the community, or individuals or organizations serving or representing the interests of such populations. Data was also gathered representing the broad interests of the community. The hospital took into account input from persons who represent the broad interests of the community served by the hospital, including those with special knowledge of, or expertise in public health (local, regional, state and/or tribal). 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 health care due to geographic, language, financial or other barriers. Members of the CHNA steering committee, those who both participated in focus groups and the needs identification and prioritization process, were chosen based on their unique expertise and experience, informed perspectives and involvement with the community. The organizations and persons that participated are: NAPOLEON KNIGHT, MD EMERGENCY MEDICAL DIRECTOR, CARLE FELICIA NOHREN RICHLAND COUNTY SHERIFF DEPARTMENT SARA BUEHNERKEMPER RICHLAND COUNTY ADDICTIONS PREVENTION COALITION ANDI PAMPE OLNEY CENTRAL COLLEGE SHERRY SLANKARD RICHLAND COUNTY SCHOOL DISTRICT, SOCIAL SERVICES TIM LOOMIS RICHLAND COUNTY MINISTERIAL ASSOCIATION SYLVIA LANCASTER EMBARRASS RIVER BASIN AGENCY PAT STALEY EMBARRASS RIVER BASIN AGENCY LINDA BOOKWALTER - STOPPING WOMEN ABUSE NOW (SWAN) LISA TOTTEN - DEPARTMENT OF HUMAN SERVICES DEANNA MITCHELL - RICHLAND COUNTY HOUSING AUTHORITY DEBORAH LAMB - RICHLAND COUNTY TB & HEALTH OFFICE LEEANN HYDER - CRAWFORD COUNTY HEALTH DEPARTMENT BRENT TODD - LINCOLN TRAIL COLLEGE KENDRA GROUNDS - WABASH COUNTY HEALTH DEPARTMENT MELISSA SEMPLE - JASPER COUNTY SCHOOL DISTRICT ANDREW JOHNSON - JASPER COUNTY SCHOOL DISTRICT JEANNIE JOHNSON - JASPER COUNTY HEALTH DEPARTMENT WILLARD ANDERSON - THE MASTERS HANDS AMY MARLEY - LAWRENCE COUNTY HEALTH DEPARTMENT KAYCEE MILLER - RIDES MASS TRANSIT DISTRICT DANA HAGERSTROM - CARLE HEALTH SYSTEM JENNIFER HENDRICKS-KAUFMANN - CARLE HEALTH SYSTEM TARA LEMKE RICHLAND MEMORIAL HOSPITAL, INC. ERIC TOLIVER - RICHLAND MEMORIAL HOSPITAL, INC. DEBORAH RIDDLE - JASPER COUNTY HEALTH DEPARTMENT HOLLY OBRIEN - HOME HEALTH/HOSPICE OF SE IL PART V, SECTION C, LINES 7B The CHNA and implementation strategy are available at https://www.carle.org/chna PART V, SECTION C, LINE 11 The first CHNA was conducted in 2013 and identified three significant needs: - Mental health and related services -Access to health services health providers, health department -Chronic disease The second CHNA was conducted in 2016 and identified: -Behavioral health -Increasing access to healthcare services -Chronic disease Behavioral health has been considered a major need in the hospitals service area. Until 2017, RMH had an inpatient psychiatric unit, but due to lack of a psychiatrist, it had to be closed. Since then, the hospital has been working on finding outpatient psychiatric providers. In 2018, RMH hired a psychiatric nurse practitioner (PNP). In 2019, RMH hired an additional psychiatric nurse practitioner (PNP) to continue its commitment to the field. The hospital is currently recruiting more PNPs and anticipates adjusting space meant for mental health services in 2020 to a 'private suite' model in order to focus on safety and security of patients. In 2019, RMH also began offering mental health first aid programs to local businesses and organizations. To address the need for improved access to healthcare services, the RMH opened the Newton Clinic in Jasper County in 2013. When it opened, it employed a family nurse practitioner (FNP), a nurse practitioner (NP), a womens health NP, and over the last few years, has added a pediatric NP, general surgery consults, and orthopedic consults. In 2019, the newton clinic provided family practice and pediatrics services. In 2015, RMH purchased the West Salem Rural Health Clinic in Edwards County. The clinic was already established in the area with a family practice physician and a FNP, and the hospital added another FNP. In 2019 the clinic is housed one physician and two FNPs. The hospital opened a primary care clinic on main street in Olney in 2017. It has been successful utilizing one family medicine/OB physician and one FNP. Both providers are natives of the community. This location is also where a convenient care clinic opened at the beginning of September 2017, providing walk-in only care to patients seven days a week. This clinic has proven to be a significant asset to the community, and continues to provide a long-sought solution to an identified need of past and current CHNAs. In 2019, RMH expanded hours, and added a full time nurse practitioner to the location to meet the growing needs and utilization of the community. RMH has continued to care for needs of the community through the better breathers club, which is hosted monthly by the respiratory therapy department. Those with COPD are encouraged to attend and learn ways they can best manage their disease, including "harmonica therapy." RMH works to check in regularly with the members of this club to ensure ongoing best practices and safety. The hospital added a cardiology clinic in 2017 which in 2019 housed a cardiologist and a cardiology NP. This service has allowed RMH to bring a service to the community that had not previously been available. In 2019, patients travelled from across RMHs service area and beyond to access this care. In January of 2018, doctors for the emergency room transitioned to a group provided by Carle health system. 2019 continues to show the transition to have improved services, according to patients and staff. Integration with the Carle health System in April 2017 has led to many partnerships and easier transition of care for patients who have health issues that require further evaluation. This integration has also helped resolve many identified local health needs in significant ways. In 2019, the new Carle relationship continued to improve local health circumstances for all patients, especially those who may have been underserved in the past. RMH also contributed a significant amount of cash and in-kind donations to the community in 2019. Community-building activities focused on economic development, community-building activities focused on economic development, including cash, in-kind donations and budgeted expenditures for the city, business associations, and other programs in Richland County. In addition to more than $28,000 in cash donation in 2019, RMH leadership provided in-kind support of over $19,000 by serving on numerous community boards and committees. The CHNA is influenced by circumstances and conditions that existed prior to the integration with the Carle Health System. The CHNA is also influenced by the large rural service area of RMH. In addition, it is noted that local health conditions are possibly impacted by the fact that Richland County and Edwards County are the only counties in Illinois that have no local health department. The needs identified and prioritized throughout the 2018 CHNA carried forward variants of previous CHNAs and added others. The identified and prioritized needs selected include: 1) access to mental health services, including: A. Access to inpatient mental health care, especially for patients that rely on Illinois Medicaid B. Access to all levels of mental health services for youth, especially youth on medical cards C. Better public information about available mental health services and resources, especially for college age young adults D. Local access to a psychiatrist E. Access to outpatient mental health services, including counselors 2) access to dental care for youth and adults that are uninsured, underinsured, or reliant on Medicaid or medical card; 3) improved access to prevention, treatment, and recovery resources for substance abuse for youth and adults; 4) access to case managers to help patients with transition of care, transportation, and other issues 5) transportation, including; A. Addressing transportation needs of patients that arrive at the hospital via ambulance or another means that is not available to return them home B. Better information about how to obtain transportation to and from healthcare 6) after hour and weekend access to care. The implementation plan developed by the senior staff at RMH is specific and thorough. The plan, set out in the report, includes these highlights: 1. Partnering with Carle Foundation Hospital to provide mental healthcare at the pavilion behavioral health system, begin tele- psychiatry services, and to improve mental health services for youth 2. Encouraging a dental care partnership among outside local providers 3. Continuing to support local substance abuse prevention coalitions and other community-based efforts to address substance misuse and disorders, recovery, And rehabilitation 4. Working with community groups to sponsor substance abuse awareness events 5. Continuing to utilize the Carle addiction recovery center 6. Exploring additional case manager services 7. Partnering with public transportation to improve access information 8. Creating evening and weekend clinic services While there are a number of additional concerns identified by the focus groups including adult day cares, non-emergency transportation, diabetes, and vision care, RMH will not focus on addressing those challenges at this time. The hospital and implementation committee determined these issues are lower priority because the needs are not as significant, they are not central to the hospitals mission, and/or RMH does not have the ability to make a measurable impact in those areas. PART V, SECTION C, LINE 16 The financial assistance policy, application form, and plain language summary is available at https://www.carle.org/chna 10 OUTPATIENT THERAPY 800 E LOCUST ST OLNEY IL 62450 OUTPATIENT THERAPY HOME HEALTH 800 E LOCUST ST OLNEY IL 62450 HOME HEALTH AGENCY RMH PROFESSIONAL SERVICES 1200 N EAST ST OLNEY IL 62450 PHYSICIAN PRACTICE (GENERAL SURGERY) HOSPICE 800 E LOCUST ST OLNEY IL 62450 HOSPICE SERVICES RMH PROFESSIONAL SERVICES - ENT 800 E LOCUST ST OLNEY IL 62450 PHYSICIAN PRACTICE (EAR, NOSE THROAT) RMH PROFESSIONAL SERVICES 1200 N EAST ST OLNEY IL 62450 PHYSICIAN PRACTICE (UROLOGY, ORTHO, FAMILY Practice) RMH PROFESSIONAL SERVICES - PRIMARY 800 E LOCUST ST OLNEY IL 62450 PRIMARY CARE PHYSICIANS WEST SALEM HEALTH CLINIC 100 S MAIN ST WEST SALEM IL 62476 RURAL HEALTH CLINIC JASPER COUNTY MEDICAL CENTER 500 S SCOTT AVE NEWTON IL 62448 PRIMARY CARE CARLE - RICHLAND PRIMARY CARE 605 E MAIN ST OLNEY IL 62450 PRIMARY CARE PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION Subsidized health services are net costs for billed services that are subsidized by the hospital. These include services offered despite a financial loss because they are needed in the community and either other providers are unwilling to provide the services or the services would otherwise not be available in sufficient amount. We included as unreimbursed costs of subsidized health services, $1,913,856for physician clinics $2,240,064 for emergency room, and $2,665,161 for ambulance service. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION 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 COMMUNITY 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 OCCURRED. 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 RICHLAND MEMORIAL 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 RICHLAND MEMORIAL HOSPITAL FURTHER DEVELOPED A GENERAL ESTIMATE OF FINANCIAL ASSISTANCE WHICH CONTINUED TO RESIDE WITHIN BAD DEBTS. SCHEDULE H, PART II A large portion of Richland Memorial Hospitals community-building activities focused on economic development, including cash, in-kind donations and budgeted expenditures for the city, business associations and other programs in Richland County. In addition to the more than $28,000 in cash donations, leadership provided in-kind support of over $19,000 by serving on numerous community boards and committees. PART III, LINE 3 - BAD DEBT, MEDICARE, & COLLECTION PRACTICES RMH uses 50% as a general estimate of bad debt expense attributable to patients eligible under the organizations financial assistance policy. PART III, LINE 4 - BAD DEBT FOOTNOTE The footnote pertaining to bad debt expense can be found on page 28 of the attached consolidated financial statements. PART III, LINE 8 - MEDICARE EXPLANATION 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 INTENDED 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, AND THOSE LESS FORTUNATE DEMOGRAPHICS THAT HAVE EXPERIENCED INCREASING COSTS OVER THE PAST DECADE WHILE LIVING ON FIXED INCOMES. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION RMH applies its collection practices equally to all patients, both those eligible for financial assistance and those that arent eligible. The procedures are as follows: 1. We will send two statements and two collection letters in a 28 day cycle. We will send statements based upon patient portion of $10 or greater. 2. The patient's account will age through the statement process before being written off to bad debt. A. Private pay accounts will receive a statement within nine days of the discharge date. B. Accounts with a patient portion after insurance will be eligible to receive a statement approximately fourteen days after the insurance payment has been posted. C. Twenty-eight days later the patient is mailed a third statement D. Twenty-eight days later the patient is mailed the first collection letter E. Twenty-eight days later the patient is mailed the final collection letter F. Approximately fifteen days later the patient is written off to bad debt. 3. RMH will attempt to contact the guarantor via phone after they receive the first statement on balances greater than $1,000. 4. RMH will attempt to contact the guarantor via phone after the second statement on balances less than $1,000. 5. RMH will make a second attempt to contact the guarantor via phone if payment or contact has not been made, usually around the same time the second collection letter is sent. 6. RMH will send two collection letters to the patient. The patient has fifteen days after the final letter to pay before being written off to bad debt. PART VI, LINE 2 - NEEDS ASSESSMENT The determination of current and future health care needs of the communities served are based on the following factors: existence or nonexistence of services, opportunity, supply, demonstrated need, requests from patients, and/or combined efforts with outside entities that would help fill a need or strengthen a current service. We are constantly collecting data that would help make these decisions and often consult with various departments within the hospital including nursing, information technology, finance, and physicians. This information is then reviewed and the hospital's administrative team incorporates the identified health care needs into the strategic plan. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSITANCE All patient billing statements include a statement that mentions contacting the hospital if they wish to apply for financial assistance or would like to set up payments on the account. If a patient contacts the patient financial services department about the inability to pay, they are informed of the available options, including financial assistance, Medicare, and Medicaid applications. Patient financial services will also explain how the patient can apply for assistance. PART VI, LINE 4 - COMMUNITY INFORMATION RMH defined its primary service area and populations as the general population within the geographic area in and surrounding the city of Olney including eight southeastern Illinois counties. The hospitals patient population includes all who receive care, without regard to insurance coverage or eligibility for assistance. RMHs service area is comprised of approximately 3,178 square miles, with a population of approximately 107,185 and a population density of 34 people per square mile. We provide services to patients without regard to age, sex, race, color, national origin, religious creed, gender identity, sexual orientation, disability, insurance coverage or ability to pay. The population of RMH 's service area is economically disadvantaged making it more difficult to afford healthcare. Furthermore, there is no health department in Richland County making the hospital the primary source for healthcare services and health education. Poverty is considered a key driver of health status. In the RMH service area, 13.34% or 13,346 individuals are living in households with income below the federal poverty level (FPL). This indicator is relevant because poverty creates barriers to access including health services, healthy food, and other necessities that contribute to poor health status. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH RMH has an open medical staff and is governed by a community board that serves on a volunteer basis. 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. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM RMH is a 104 bed, not-for-profit healthcare facility located in Olney, IL and became part of the Carle Health System on April 1, 2017. As part of the Carle Health System, it currently serves eight southeastern Illinois counties, with a total population of more than 107,000 individuals. The integration of Carle and RMH allows for expanded access to healthcare in the region. Though RMH falls under the umbrella of the Carle Foundation, it maintains a separate board of directors and senior leadership. While RMHs CHNA and community benefit reporting is separate from the Carle Foundation Hospital, it follows the same guidelines and principles as Carle. RMH staff is involved in the CHNA and implementation plan, and serve on human services agency boards and committees to provide support to help address identified community health needs. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT RMH files an Illinois community benefit report. true Educational Scholarships 15 15000 FORM 990, SCHEDULE I DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS ANY CHARITABLE ORGANIZATION WISHING TO REQUEST FUNDS IS ASKED TO SUBMIT THEIR REQUEST IN WRITING. EMAILED REQUESTS ARE ACCEPTABLE. THE REQUEST MUST INCLUDE A DESCRIPTION OF THE PURPOSE OF THE CONTRIBUTION AND OTHER RELEVANT INFORMATION SUCH AS REQUESTORS NAME, AMOUNT OF THE REQUEST, ETC. THE REQUESTS ARE REVIEWED, EVALUATED, AND ADMINISTERED BY THE MARKETING AND COMMUNICATIONS (PUBLIC RELATIONS) DEPARTMENT, SEEKING ADDITIONAL INFORMATION FROM THE REQUESTOR, AS NEEDED, AND INPUT FROM ANY APPROPRIATE CARLE ADMINISTRATOR OR DIRECTOR. A SET OF ESTABLISHED GUIDELINES DRIVE THESE DECISIONS WHILE MOST ARE MADE TO IMPROVE HEALTHCARE/ACCESS TO HEALTHCARE OR ARE IN LINE WITH OUR ROLE AS A CORPORATE CITIZEN. ASSESSED NEED IS A COMMON CRITERIA. IN THE CASE OF MOST DONATIONS OF $5,000 OR MORE, SUCH AS TO COLLEGES AND UNIVERSITIES OR COMMUNITY CLINICS, WRITTEN AGREEMENTS ARE IN PLACE AND WE HAVE REGULAR CONTACT WITH THOSE ORGANIZATIONS, OFTENTIMES THROUGH A CARLE CONTACT PERSON TO ASSURE THAT THE DONATIONS ARE BEING USED AS AGREED UPON. THE RECORDS ARE EITHER MAINTAINED IN ADMINISTRATION OR PUBLIC RELATIONS. true true false false false false false true false JARROD ALMAROAD MD TRUSTEE & PHYSICIAN(THRU 9/19) 0 802576 0 2500 0 6612 0 22542 0 23668 0 857898 0 JOHN SNYDER TRUSTEE, EX VP & COO THRU 6/19 0 482857 0 298156 0 1695314 0 2161020 0 16783 0 4654130 0 1076615 CHRISTINA BARE DIRECTOR OF BUSINESS OPS 150399 0 0 0 312 0 17014 0 546 0 168271 0 0 0 HARRY BROCKUS CEO 306805 0 39773 0 53752 0 77284 0 22230 0 499844 0 44733 0 Regina Thomas CNO & DIR PATIENT CARE SVS 186661 0 0 0 21773 0 17322 0 4238 0 229994 0 0 0 MARY WALLER MD PHYSICIAN 378287 0 0 0 662 0 28430 0 896 0 408275 0 0 0 Paul Sutherland MD PHYSICIAN 346464 0 0 0 890 0 33542 0 11965 0 392861 0 0 0 PRASHANTH ANAND MD PHYSICIAN 471997 0 0 0 662 0 27542 0 13465 0 513666 0 0 0 STEPHEN REID MD PHYSICIAN 351240 0 0 0 662 0 33542 0 6722 0 392166 0 0 0 H TIMOTHY GARRETT DO TRUSTEE & PHYSICIAN 384030 0 0 0 662 0 39513 0 11984 0 436189 0 0 0 MATTHEW KOLB TRUSTEE & COO (Start 06/19) 0 537981 0 58621 0 107346 0 104199 0 25342 0 833489 0 40837 SALLY SALMONS MD TRUSTEE & PHYSICIAN Start 9/19 0 350208 0 48601 0 6843 0 62826 0 14738 0 483216 0 0 LAUREN SCHMID EXEC VP, CHIEF HR OFFICER 0 322593 0 40818 0 66898 0 76250 0 22630 0 529189 0 44771 NIRANAT DEJTIRANUKUL MD PHYSICIAN 364876 0 0 0 104 0 33542 0 3612 0 402134 0 0 0 Schedule J, Part I, Question 3 THE BOARD OF TRUSTEES OF THE CARLE FOUNDATION, THE PARENT COMPANY OF RICHLAND 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, EVALUATED AGAINST MARKET DATA, AND REVIEWED AND APPROVED BY THE COMMITTEE. - THE COMMITTEE APPROVES ALL ANNUAL COMPENSATION DECISIONS IN ADVANCE OF THEIR IMPLEMENTATION AND DOCUMENTS ITS DETERMINATIONS AND DISCUSSIONS. - THE COMPENSATION COMMITTEE RELIES UPON 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 MAKES ITS REPORTS DIRECTLY AVAILABLE TO THE COMPENSATION COMMITTEE. Schedule J, Part I, Question 4a JOHN SNYDER RECEIVED SEVERANCE PAYMENTS IN 2019 IN THE AMOUNT OF $586,504. Schedule J, Part I, Question 4B THE 2019 PARTICIPANTS IN THE 457(F) PLAN OFFERED BY THE CARLE FOUNDATION, THE PARENT ORGANIZATION OF RICHLAND MEMORIAL HOSPITAL, THAT ARE LISTED IN THE 990 PART VII INCLUDE HARRY BROCKUS, MATTHEW KOLB, SALLY SALMONS, MD, LAUREN SCHMIDT, AND JOHN SNYDER. IN 2019, PAYMENTS FROM THE 457(F) PLAN WERE MADE TO HARRY BROCKUS ($44,733), MATTHEW KOLB ($40,837), LAUREN SCHMIDT ($44,771), AND JOHN SNYDER ($1,076,615). 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. Marcia Vaughn FAMILY MEMBER OF TRUSTEE 94766 Employment false Ray Vaughn FAMILY MEMBER OF TRUSTEE 65154 Legal Fees false WHITNEY HOUCHIN FAMILY MEMBER OF TRUSTEE 89383 Employment false Schedule L, Part V RELATIONSHIP BETWEEN INTERESTED PERSON & ORGANIZATION MARCIA VAUGHN IS AN EMPLOYEE OF RICHLAND MEMORIAL HOSPITAL AND HAS A FAMILY RELATIONSHIP WITH CAROL SCHAFER WHO SERVES AS A TRUSTEE OF THE BOARD. RAY VAUGHN PROVIDES LEGAL SERVICES TO RICHLAND MEMORIAL HOSPITAL AND HAS A FAMILY RELATIONSHIP WITH CAROL SCHAFER WHO SERVES AS A TRUSTEE OF THE BOARD. WHITLEY HOUCHIN IS AN EMPLOYEE OF RICHLAND MEMORIAL HOSPITAL AND HAS A FAMILY RELATIONSHIP WITH GARY HOUCHIN WHO SERVES AS A TRUSTEE OF THE BOARD. FORM 990, PART III, LINE 4A - FIRST ACCOMPLISHMENT RICHLAND MEMORIAL HOSPITAL, INC., DBA CARLE RICHLAND MEMORIAL HOSPITAL (RMH) PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, GENDER, NATIONAL ORIGIN, DISABILITY, AGE OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. THE MISSION OF RMH IS TO SERVE OUR COMMUNITY WITH RESPECT IN PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH THE COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, WE OFFER: - FREE CARE TO QUALIFIED INDIVIDUALS UNDER THE RMH FINANCIAL ASSISTANCE PROGRAM - CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST; AND - HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT AND EDUCATE THE COMMUNITY. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, PROFESSIONAL EDUCATION PROGRAMS, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. DURING THE PERIOD JANUARY 1, 2019 THROUGH DECEMBER 31, 2019, RMH RECORDED 14,400 PATIENT DAYS. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST. THE HOSPITAL ALSO PROVIDES CARE TO PERSONS COVERED BY COMMERCIAL INSURANCE AT BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE HOSPITAL RECOGNIZES THESE AMOUNTS AS COST INCURRED IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. FINANCIAL ASSISTANCE WAS ALSO PROVIDED THROUGH RMHS FINANCIAL ASSISTANCE POLICY OFFERED IN 2019. THE HOSPITAL ALSO OFFERS AND PARTICIPATES IN PROGRAMS THROUGHOUT THE COMMUNITY. THESE INCLUDE: 1. AMBULANCE COVERAGE 2. MEETINGS / CONFERENCE FACILITIES 3. SCHOLARSHIPS 4. SUPPORT OF COMMUNITY ORGANIZATIONS, EVENTS AND ACTIVITIES INCLUDING: AMERICAN CANCER SOCIETY BIG BROTHERS/BIG SISTERS BLUE KNIGHT TIP OFF CLUB CLAREMONT-BONPAS FIRE PROTECTION DISTRICT FLORA HIGH SCHOOL ATHLETIC DEPT. FRIENDS OF FR.JERRY 5K FRIENDS OF OLNEY JASPER COUNTY CHAMBER OF COMMERCE JASPER COUNTY FAIR LAWRENCE COUNTY JR FAIR ASSOCIATION LAWRENCE COUNTY YOUTH LIVESTOCK AUCTION LINCOLN'S PLACE FUND MISS RICHLAND COUNTY FAIR QUEEN PAGEANT MS "JOIN THE MOVEMENT" NATONAL FIRE SAFETY COUNCIL, INC NEWTON COMMUNITY HIGH SCHOOL CHORUS NEWTON COMMUNITY HIGH SCHOOL NICK'S RACE OLNEY & RICHLAND COUNTY CHAMBER OF COMMERCE OLNEY ARTS COUNCIL FINE ARTS SHOWCASE OLNEY CENTRAL COLLEGE FOUNDATION OLNEY ELKS CLUB OLNEY LITTLE LEAGUE OLNEY ROTARY CLUB OLNEY TIGER SHARKS OLNEY TIGER WRESTLING OUTREACH MISSIONS IMMAN UNITED METH CHURCH RED HILL FUTURE FARMERS OF AMERICA RICHLAND COUNTY 4-H FOUNDATION RICHLAND COUNTY FARM AND FAIR ASSOCIATION RICHLAND COUNTY HIGH AFTER PROM RICHLAND COUNTY HIGH SCHOOL AGRICULTURE DEPARTMENT RICHLAND COUNTY HIGH SCHOOL INTERACT CLUB RICHLAND COUNTY HIGH SCHOOL LADY TIGERS SOFTBALL RICHLAND COUNTY HIGH SCHOOL TENNIS RICHLAND COUNTY HIGH SCHOOL THEATER DEPT RICHLAND COUNTY SOCCER ASSOCIATION ST JOSEPH SCHOOL ST. THOMAS SCHOOL DUCK RACE SWAN ANNUAL GOLF OUTING VOLUNTEER FIREMAN'S ASSOC OF WEST SALEM WEST SALEM DEVELOPMENT ASSOCIATION WEST SALEM GRADE SCHOOL PTO 5. VARIOUS WELLNESS EVENTS, COMMUNITY CLINICS, SUPPORT GROUPS, MEDICAL OUTREACH AND EDUCATION INCLUDING: BLOOD PRESSURE SCREENING CLINICS DIABETIC EDUCATION DAY HEALTHFEST NATIONAL HOSPITAL WEEK SCREENING CLINIC OLNEY SENIOR EXPO SUPPORT GROUPS BREAST CANCER SUPPORT GROUP TICKET FOR THE CURE BREAST HEALTH OUTREACH/EDUCATION TICKET FOR THE CURE CPR CLASSES DIABETES SUPPORT GROUP FIRST AID CLASSES INFECTION CONTROL IN-SERVICES TO LOCAL SCHOOLS LIFE SMART FOR WOMEN EDUCATIONAL CLASSES PREPARED CHILDBIRTH CLASSES REGIONAL PSYCHIATRIC CENTER PATIENT SUPPORT GROUP 6. SPECIAL ASSISTANCE PROGRAMS INCLUDING: - MAMMOGRAPHY ASSISTANCE (ILLINOIS BREAST AND CERVICAL CANCER PROGRAM SERVICE PROVIDER LITTLE EGYPT AND EAST CENTRAL REGION) FORM 990, PART VI, QUESTION 6 RICHLAND MEMORIAL HOSPITAL, INC. HAS ONE MEMBER WHICH IS THE PARENT COMPANY, THE CARLE FOUNDATION. FORM 990, PART VI, LINE 7A - ELECTION OF MEMBERS AND THEIR RIGHTS RICHLAND MEMORIAL HOSPITAL INC.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, LINE 7B - DECISIONS SUBJECT TO APPROVAL OF MEMBERS RICHLAND MEMORIAL HOSPITAL, INC. MUST HAVE THE APPROVAL OF ITS SOLE MEMBER, THE CARLE FOUNDATION, THROUGH ITS BOARD OF TRUSTEES, WHEN VOTING ON MATTERS INCLUDING THE AMENDING OF GOVERNING DOCUMENTS; RECOMMENDING THE CEO TO THE BOARD; APPROVING ANY ANNUAL OR LONG-TERM CAPITAL OR OPERATIONAL BUDGETS; APPROVING PAYMENT TO THE MEMBERS OF THE RICHLAND BOARD OF TRUSTEES FOR THEIR EXPENSES OR COMPENSATION FOR SERVICES; APPROVING ANY NEW, LONG-TERM OR MASTER INSTITUTIONAL PLANS OR CHANGES TO SUCH PLANS; APPROVING THE ADDITION OF ANY NEW MEMBER AND ANY DISSOLUTION, MERGER, CONSOLIDATION, OR SALE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL ASSETS OR ANY DISPOSITION OF REAL PROPERTY OR RELOCATION OF THE HOSPITAL AND/OR CLINIC; APPROVING ANY ORGANIZATION OR ACQUISITION OF A SUBSIDIARY OR AFFILIATE; APPROVING ANY INITIATIVE REQUIRING CERTIFICATE OF NEED (CON) APPROVAL; APPROVING ANY PLEDGE OF ALL OR ANY PART OF THE CORPORATIONS ASSETS AS SECURITY FOR A DEBT, LIABILITY OR OTHER OBLIGATION; APPROVING ANY LOAN TO OR FOR THE CORPORATION OR ANY OTHER INDEBTEDNESS; AND APPROVING NON-BUDGETED EXPENDITURES OR SALE EXCEEDING THE CHIEF EXECUTIVE OFFICERS (CEO) AUTHORIZED SPENDING AUTHORITY. FORM 990, PART VI, LINE 11B - ORGANIZATION'S PROCESS TO REVIEW FORM 990 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, LINE 12C - ENFORCEMENT OF CONFLICTS POLICY 1. ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY BOARD MEMBER IS DISCLOSED TO THE OTHER MEMBERS OF THE BOARD BY THE BOARD MEMBER WHO HAS THE CONFLICT AND MADE A MATTER OF RECORD THROUGH THE BOARDS ANNUAL FILING OF CONFLICT OF INTEREST STATEMENTS OR WHEN THE INTEREST BECOMES A MATTER OF BOARD ACTION. 2. ANY BOARD MEMBER HAVING A DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER DOES NOT VOTE OR USE HIS/HER PERSONAL INFLUENCE ON THE MATTER, AND HE/SHE IS NOT TO BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING, EVEN WHERE PERMITTED BY LAW. THE MINUTES OF THE MEETING REFLECT THAT A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING, AND THE QUORUM SITUATION. 3. THE FOREGOING REQUIREMENTS SHOULD NOT BE CONSTRUED AS PREVENTING THE BOARD MEMBER FROM ANSWERING PERTINENT QUESTIONS OF OTHER BOARD MEMBERS, SINCE HIS/HER KNOWLEDGE MAY BE OF GREAT ASSISTANCE. HOWEVER, THE MEMBER WITH THE CONFLICT MUST ABSTAIN FROM MAKING MOTIONS, PARTICIPATING IN RELEVANT DELIBERATIONS, VOTING, EXECUTING AGREEMENTS, ATTEMPTING TO INFLUENCE OTHERS VOTES, OR TAKING ANY SIMILAR DIRECT ACTION ON BEHALF OF THE CORPORATION WHERE THE CONFLICT OF INTEREST MIGHT PERTAIN. 4. ALL MEMBERS OF THE BOARD (INCLUDING EX-OFFICIO MEMBERS) ARE REQUIRED TO COMPLETE AND RETURN THE CONFLICT OF INTEREST DISCLOSURE STATEMENT NO LATER THAN NOVEMBER 30TH OF EACH YEAR OR WITHIN 30 DAYS OF THE CREATION OR OCCURRENCE OF ANY NEW CONFLICT. MEMBERS(S) WHO DO NOT RETURN THE CONFLICT OF INTEREST STATEMENT WILL BE ADDRESSED IN ACCORDANCE WITH THE BYLAWS. 5. RESPONSES MAY BE COMPLIED INTO PACKETS FOR DISTRIBUTION AND DISCUSSION ANNUALLY (AT THE NEXT BOARD MEETING FOLLOWING THE DUE DATE), SEMI-ANNUALLY (SIX MONTHS FOLLOWING THE INITIAL REVIEW), AND AS ANY NEW CONFLICT IS IDENTIFIED. 6. THE POLICY ON CONFLICT OF INTEREST WILL BE DISCUSSED WITH CANDIDATES FOR BOARD POSITIONS DURING THEIR INTERVIEW WITH THE NOMINATING COMMITTEE. THE IMPORTANCE OF AVOIDING CONFLICT OF INTEREST SITUATIONS WILL BE EMPHASIZED. 7. WHEN A CONFLICT OF INTEREST SITUATION IS IDENTIFIED, THE INDIVIDUAL BOARD MEMBER HAS THE PRIMARY RESPONSIBILITY TO BRING A POTENTIAL OR ACTUAL CONFLICT OF INTEREST SITUATION TO THE ATTENTION OF THE BOARD. A CONFLICT OF INTEREST SITUATION MAY ALSO COME TO THE ATTENTION OF THE BOARD DUE TO THE CONCERNS OF A BOARD MEMBER WHO MAY NOT BE INVOLVED IN THE SITUATION. THAT BOARD MEMBER SHOULD NOTIFY THE CHAIRPERSON OF THE CONFLICT OF INTEREST CONCERN AND THE BOARD CHAIRPERSON SHOULD BRING THE SITUATION TO THE ATTENTION OF THE FULL BOARD. REGARDLESS OF THE METHOD BY WHICH THE CONFLICT IS BROUGHT UP, THERE SHOULD BE FULL AND OPEN DISCUSSION BY BOARD MEMBERS OF THE POTENTIAL OR ACTUAL CONFLICT OF INTEREST SITUATION. THE FURTHER PARTICIPATION OF THE BOARD MEMBER IN THE DISCUSSION SHOULD BE AGREED UPON AND APPROVED BY THE BOARD. 8. AS A RESULT OF DISCUSSIONS ON CONFLICT OF INTEREST SITUATIONS, THERE MAY BE CONSIDERATIONS FOR A BOARD MEMBERS RESIGNATION. THE BOARD MEMBER MAY WISH TO RESIGN TO AVOID A FUTURE CONFLICT OF INTEREST SITUATION DUE TO A DESIRE TO BID ON A PARTICULAR BOARD PROJECT OR TO AVOID A FURTHER CONFLICT OF INTEREST CONCERN. IN THE EVENT THAT THE BOARD MEMBER DOES NOT LEAVE AND A CONFLICT OF INTEREST SITUATION EXISTS, IN ACCORDANCE WITH ORGANIZATIONS BYLAWS ARTICLE VI, SECTION 5, THE BOARD MAY ASK THE BOARD MEMBER TO RESIGN. 9. THE POLICY IS REVIEWED ANNUALLY FOR THE INFORMATION AND GUIDANCE OF BOARD MEMBERS FORM 990, PART VI, LINE 15B - COMPENSATION PROCESS FOR OFFICERS THE BOARD OF TRUSTEES OF THE CARLE FOUNDATION, THE PARENT ORGANIZATION OF RICHLAND 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, EVALUATED AGAINST MARKET DATA, AND REVIEWED AND APPROVED BY THE COMMITTEE. - THE COMMITTEE APPROVES ALL ANNUAL COMPENSATION DECISIONS IN ADVANCE OF THEIR IMPLEMENTATION AND DOCUMENTS ITS DETERMINATIONS AND DISCUSSIONS. - THE COMPENSATION COMMITTEE RELIES UPON 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 MAKES ITS REPORTS DIRECTLY AVAILABLE TO THE COMPENSATION COMMITTEE. FORM 990, PART VI, LINE 19 - GOVERNING DOCUMENTS DISCLOSURE EXPLANATION RICHLAND MEMORIAL HOSPITAL, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part XI, Line 9 THE OTHER CHANGES IN NET ASSETS INCLUDES THE INCREASE IN INTEREST IN RICHLAND MEMORIAL HOSPITAL FOUNDATION ($18,102). THE CARLE FOUNDATION 611 W PARK ST URBANA IL 61801 370673465 PARENT/INVMGT IL 501(c)(3) 12C, III-FI NA false THE CARLE FOUNDATION HOSPITAL 611 W PARK ST URBANA IL 61801 371119538 HOSPITAL SVCS IL 501(c)(3) 3 TCF true THE CARLE DEVELOPMENT FOUNDATION 611 W PARK ST URBANA IL 61801 371159978 Fundraising IL 501(c)(3) 7 TCF true CARLE RETIREMENT CENTERS INC 611 W PARK ST URBANA IL 61801 371160033 Retirement IL 501(c)(3) 10 TCF true CARLE COMMUNITY HEALTH CORPORATION 611 W PARK ST URBANA IL 61801 364458371 FNDN MISSION IL 501(c)(3) 12A, TYPE I TCDF true HOOPESTON COMMUNITY MEMORIAL HOSPITAL 701 E ORANGE ST HOOPESTON IL 60942 363637465 HOSPITAL SVCS IL 501(c)(3) 3 TCF true CARLE HEALTH CARE INCORPORATED 611 W PARK ST URBANA IL 61801 371140016 VAR MED SVCS IL 501(c)(3) 10 TCF true CHAMPAIGN SURGICENTER LLC 611 W PARK ST URBANA IL 618012595 201915925 SURG CNTR IL NA N/A false false HEALTH SYSTEMS INSURANCE LIMITED Governors Square 2nd Floor Bldg 3 GRAND CAYMEN CJ INSURANCE CJ C Corp true CARLE RISK MANAGEMENT COMPANY 611 W PARK ST URBANA IL 618012595 371217973 RISK MANAGEMENT IL C Corp true EVALIDATA INC 611 W PARK ST URBANA IL 618012595 462022658 PHYS CREDENTIALS IL C Corp true CHA HOLDING INC 3310 SOUTH FIELDS DR CHAMPAIGN IL 61822 471854275 HOLDING COMPANY IL C Corp true CARLE HOLDING COMPANY INC 611 W PARK ST URBANA IL 618012595 371188284 HOLDING COMPANY IL C Corp true HEALTH ALLIANCE MEDICAL PLANS INC 3310 SOUTH FIELDS DR CHAMPAIGN IL 61822 371260731 HEALTH COVERAGE IL C Corp true HEALTH ALLIANCE CONNECT INC 3310 SOUTH FIELDS DR CHAMPAIGN IL 61822 464796891 HEALTH CARE COORD IL C Corp true HEALTH ALLIANCE NORTHWEST HOLDING INC 820 N CHELAN AVE WENATCHEE WA 98801 461717578 HOLDING COMPANY WA C Corp true HEALTH ALLIANCE NORTHWEST HLTH PLAN INC 820 N CHELAN AVE WENATCHEE WA 98801 461966323 Health CoveraGE WA C Corp true HEALTH ALLIANCE-MIDWEST INC 3310 SOUTH FIELDS DR CHAMPAIGN IL 61822 371354502 HEALTH COVERAGE IL C Corp true false false false false false false false false false true true true false true false false true false HEALTH ALLIANCE CONNECT INC L 153746 BOOK HEALTH ALLIANCE MEDICAL PLANS L 1434110 BOOK HEALTH ALLIANCE MEDICAL PLANS M 451640 BOOK CARLE HEALTH CARE INCORPORATED M 3059214 BOOK THE CARLE FOUNDATION HOSPITAL M 721997 BOOK CARLE HEALTH CARE INCORPORATED O 2437700 BOOK