2020-02-25T16:13:37-06:00 2019-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2018-07-01 370661218 MARSHALL BROWNING HOSPITAL ASSOCIATION MARS 6185422146 900 N WASHINGTON ST DU QUOIN IL 62832 DAN EAVES CEO 6185422146 2020-02-25 1 MICHAEL J PETERSON CPA P01833529 2187224705 2020-02-25 216.54.158.12 2020-02-25 11:07:02 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 2018 2020-09-23 17:36:50Z DAN EAVES 900 N WASHINGTON ST DU QUOIN IL 62832 26144489 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 9 342 50 0 0 75814 46671 25237600 25356925 379444 393406 56937 336051 25749795 26133053 0 0 0 0 12243288 13521277 0 0 0 12852247 14358761 25095535 27880038 654260 -1746985 21108633 18903221 12751034 12446528 8357599 6456693 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 22110590 0 25607484 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 2,110 PATIENT DAYS. 1,599 OF THOSE DAYS WERE MEDICARE PATIENT DAYS, WHILE 46 CONSISTED OF MEDICAID AND MEDICAID MCO DAYS. DURING FY 2019, THE HOSPITAL ADMITTED 384 PATIENTS AND DISCHARGED 386. THE AVERAGE LENGTH OF STAY FOR A PATIENT IS 5.5 DAYS. THE HOSPITAL PROVIDED 134,267 OUTPATIENT OCCASIONS OF SERVICE WHICH INCLUDED 5,354 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 2019 THIS AMOUNTED TO $308,117 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 DEFIBULATOR'S (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 THEIR TRADITION OF SUPPORTING THE COMMUNITY BY SUPPORTING THE LOCAL FOOD PANTRY, CLOTHES CLOSET, NURSING HOMES, STUDENT EVENTS AND SPORTS, AND HUMANE SHELTER. 22110590 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 24 0 342 1 0 0 0 0 0 1 1 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 GUY ALONGI DIRECTOR 1.00 X 0 0 0 ANDREW CROESSMAN DIRECTOR 1.00 X 0 0 0 BRAD GALLI RPH DIRECTOR 1.00 X 0 0 0 CHARLES GENESIO DIRECTOR (THRU APRIL) 1.00 X 0 0 0 WILLIAM PLACE DIRECTOR 1.00 X 0 0 0 DAVID SEARBY DIRECTOR 1.00 X 0 0 0 RICHARD K HAINES PRESIDENT 1.00 X X 0 0 0 KATHY WEST VICE PRESIDENT 1.00 X X 0 0 0 SUSAN ENGELHARDT SECRETARY 1.00 X X 0 0 0 DON HOFFMAN TREASURER 1.00 X X 0 0 0 DAN EAVES CHIEF EXECUTIVE OFFICER 40.00 X 134210 0 787 BRICE HARSY CHIEF FINANCIAL OFFICER 40.00 X 77783 0 20896 EDWARD TRAVIS MD PHYSICIAN 40.00 X 214641 0 22742 MALCOLM SCHULZ MD PHYSICIAN 40.00 X 198563 0 24513 GLADSTONE TUCKER MD PHYSICIAN 40.00 X 216338 0 1958 MICHAEL STAFF PHYSICIAN ASSISTANT 40.00 X 154860 0 23014 996395 0 93910 5 0 1 0 INTEGRITAS 2250 NORTH ILLINOIS AVENU CARBONDALE IL 62901 EMERGENCY PHYSICIAN SERVICES 1104000 FORTE - HOSPITALISTS 2251 NORTH ILLINOIS AVENU CARBONDALE IL 62901 HOSPITALISTS 879996 CLOUDWAVE DEPT CH 19800 PALENTINE IL 60055 CLOUD HOSTING SERVICES 297565 ST LOUIS UNIVERSITY 1402 SOUTH GRAND BLVD FDT NORTH ST LOUIS MO 63104 GI PHYSICIAN SERVICES 230400 LABORATORY OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LABORATORY TESTING SERVICES 168388 17 14734 31937 46671 INPATIENT AND OUTPATIENT 621990 24483512 24483512 340B PROGRAM 621990 435608 435608 INDEPENDNT LIVING RENT 532000 315589 315589 122216 122216 25356925 227365 227365 5013 5013 15110 0 15110 15110 15110 177477 0 11436 177477 -11436 166041 166041 315928 250559 65369 315928 26133053 25607484 0 478898 X 255361 255361 10155292 8588756 1566536 138296 115102 23194 2229386 1837585 391801 742942 607162 135780 62539 62539 23676 23676 5152667 3960109 1192558 131003 131003 262066 184911 77155 447064 447064 51238 41524 9714 428467 303002 125465 1437095 1033108 403987 380525 380525 PROVISION FOR BAD DEBT 2015126 2015126 DRUGS 1122465 1122465 MED SUPPLY 1043890 938626 105264 REPAIRS AND MAINTENANCE 827818 355849 471969 973122 560201 412921 27880038 22110590 5769448 0 125208 208241 464679 14922 3978568 4837974 637467 620315 274526 466130 22951751 16322942 7761300 6628809 7524171 5636746 342714 490084 21108633 18903221 1913668 2339801 250996 25487 9645135 9123767 941235 957473 12751034 12446528 X 8357599 6456693 8357599 6456693 21108633 18903221 X -1746985 -112569 -41352 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 7838 7838 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 5512013 3422997 13987002 10810929 3176073 26625 26625 6628809 DEFERRED COMPENSATION PLAN 249001 ACCUMULATED POST RETIREMENT BENEIFT OBLIGATION 708472 957473 24094251 -2015126 -2015126 26109377 23676 23676 26133053 25841236 0 25841236 23676 2015126 2038802 27880038 PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -2,015,126. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 2,015,126. 1 1 X 1 X 1 X 0 1 1 0 1 1 161805 161805 0.00630 4783678 4083478 700200 0.02710 4945483 4083478 862005 0.03340 1188731 1188731 0.04600 9944688 4043374 5901314 0.22820 11133419 4043374 7090045 0.27420 16078902 8126852 7952050 0.30760 0 1058224 211645 7246782 7279654 -32872 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 SUPPLEMENTAL INFORMATION 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 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 INDENTIFIED 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 STRATEGY--THE IMPLEMENTATION STRATEGY WAS DEVELOPED THROUGH A FACILITATED MEETING INVOLVING KEY ADMINISTRATIVE STAFF AT MARSHALL BROWNING HOSPITAL, INCLUDING: DAN EAVES, CHIEF EXECUTIVE OFFICER; PAM LOGAN, DIRECTOR, MARKETING/PATIENT RELATIONS; BRICE HARSY, CHIEF FINANCIAL OFFICER; LAURIE KELLERMAN, CHIEF CLINICAL OFFICER; BRIAN SCHANDL, CHIEF INFORMATION OFFICER; HEATHER KATTENBRAKER, EXECUTIVE ASSISTANT. THE GROUP REVIEWED THE NEEDS ASSESSMENT PROCESS AND CONSIDERED THE PRIORITIZED SIGNIFICANT NEEDS AND SUPPORTING DOCUMENTS. THEY DISCUSSED STEPS TAKEN TO ADDRESS THE PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENT. THEY ALSO CONSIDERED INTERNAL AND EXTERNAL RESOURCES POTENTIALLY AVAILABLE TO ADDRESS THE CURRENT PRIORITIZED NEEDS. THE GROUP THEN CONSIDERED EACH OF THE PRIORITIZED NEEDS. FOR EACH OF THE FIVE CATEGORIES, ACTIONS THE HOSPITAL INTENDS TO TAKE WERE IDENTIFIED ALONG WITH THE ANTICIPATED IMPACT OF THE ACTIONS, THE RESOURCES THE HOSPITAL INTENDS TO COMMIT TO THE ACTIONS, AND THE EXTERNAL COLLABORATORS THE HOSPITAL PLANS TO COOPERATE WITH TO ADDRESS THE NEED. THE PLAN WILL BE EVALUATED BY PERIODIC REVIEW OF MEASURABLE OUTCOME INDICATORS IN CONJUNCTION WITH ANNUAL REVIEW AND REPORTING. PROCESS BY WHICH NEEDS WILL BE ADDRESSED: 1. AVAILABILITY OF AMBULANCES FOR EMERGENCY, LOCAL, AND OUT-OF-AREA TRANSPORT - MARSHALL BROWNING HOSPITAL WILL INVESTIGATE COLLABORATION WITH UNITS OF LOCAL GOVERNMENT, PINCKNEYVILLE AMBULANCE, AND PINCKNEYVILLE COMMUNITY HOSPITAL TO ATTEMPT TO FIND REASONABLE SOLUTIONS TO EQUIPMENT AND PERSONNEL NEEDS. ANTICIPATED IMPACTS OF THESE ACTIONS: THE HOSPITAL HOPES THAT IF ALL OF THE INTERESTED PARTIES WORK TOGETHER IT WILL BE POSSIBLE TO SECURE, EQUIP, AND STAFF AT LEAST ONE ADDITIONAL AMBULANCE FOR LOCAL SERVICE. PLANNED COLLABORATION BETWEEN THE HOSPITAL AND CITY OF DU QUOIN, CITY OF PINCKNEYVILLE, PERRY COUNTY HEALTH DEPARTMENT, PINCKNEYVILLE AMBULANCE AND PINCKNEYVILLE COMMUNITY HOSPITAL. 2. AREA-WIDE NURSING SHORTAGE THAT IMPACTS ACCESS TO TRANSFER BEDS - MARSHALL BROWNING HOSPITAL IS FORTUNATE THAT IT IS CURRENTLY ABLE TO FULLY ADDRESS STAFFING NEEDS. WHILE IT IS NOT EQUIPPED TO PROVIDE NURSING EDUCATION, IT IS FULLY READY TO COOPERATE AS APPROPRIATE WITH OTHER RESOURCES THAT MAY DEVELOP TO HELP ADDRESS THIS CONCERN IN OUR REGION. THE HOSPITAL WILL CONTINUE SUCCESSION PLANNING FOR ITS OWN STAFFING NEEDS, INCLUDING NURSING. ANTICIPATED IMPACT OF THESE ACTIONS: THE HOSPITAL ANTICIPATES THAT IT WILL BE ABLE TO MAINTAIN SUFFICIENT STAFFING FOR THE FORESEEABLE FUTURE. NEW REGIONAL RESOURCES AND EFFORTS IN GENERAL MAY BE ABLE TO RESOLVE THE NURSING SHORTAGE. PROGRAMS AND RESOURCES THE HOSPITAL PLANS TO COMMIT TO ADDRESS THE NEED INCLUDE ADMINISTRATION AND NURSING AND SURROUNDING LARGER FACILITIES AND GOVERNMENT AGENCIES. 3. EDUCATION FOR YOUTH, INCLUDING WELLNESS, SUBSTANCE ABUSE AND SEXUAL HEALTH - MARSHALL BROWNING HOSPITAL WILL COOPERATE WITH PERRY COUNTY HEALTH DEPARTMENT TO SUPPORT YOUTH EDUCATION BY OFFERING MEDICAL PROVIDER AND OTHER EXPERTISE TO PROVIDE PROGRAMS. THE HOSPITAL WILL CONTINUE EXTERNAL EDUCATION PROGRAMMING. THE HOSPITAL WILL CONTINUE THE COUNTY-WIDE 8TH GRADE TEEN CONFERENCE. ANTICIPATED IMPACTS OF THESE ACTIONS: MARSHALL BROWNING HOSPITAL ANTICIPATES THAT THESE ACTION STEPS WILL INCREASE THE NUMBER AND QUALITY OF EDUCATIONAL PROGRAMS AVAILABLE TO YOUTH IN THE AREA AND WILL INCREASE THE NUMBER YOUTH TOUCHED AND INFLUENCED BY THE PROGRAMS. PROGRAMS AND RESOURCES COMMITTED TO ADDRESS THE NEED INCLUDE ADMINISTRATION,, COMMUNITY RELATIONS, MEDICAL PROVIDERS , SCHOOLS, CITY OF DU QUOIN, LAW ENFORCEMENT, UNIVERSITY OF ILLINOIS EXTENSION. 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 WILL DEVELOP THE YOUTH COMPONENT OF A NEW MENTAL HEALTH NURSE PRACTITIONER. MARSHALL BROWNING HOSPITAL WILL CONTINUE TO SUPPORT THE EFFORTS OF THE DU QUOIN YOUTH CLUB. MARSHALL BROWNING HOSPITAL WILL EXPLORE EDUCATION PROGRAMS TO HELP YOUTH DEVELOP LIFE AND COPING SKILLS, INCLUDING BABYSITTING AND OTHER AREAS. ANTICIPATED IMPACTS OF THESE ACTIONS: THE HOSPITAL ANTICIPATES THESE ACTION STEPS WILL CREATE NEW LOCAL MENTAL HEALTH SERVICES FOR YOUTH AND YOUNG ADULTS AND EXPANDED OPPORTUNITIES FOR SUPPORT AND EDUCATION. PROGRAMS/RESOURCES THE HOSPITAL PLANS TO COMMIT TO ADDRESS THE NEED INCLUDE ADMINISTRATION, STAFF AS IDENTIFIED BY PROGRAM NEEDS, RURAL HEALTH CLINIC, MEDICAL PROVIDERS, PERRY COUNTY COUNSELING, SCHOOLS, OTHER COMMUNITY ORGANIZATIONS. 5) CONTINUED ACCESS TO PREVENTION EDUCATION FOR CHRONIC ILLNESS, ESPECIALLY DIABETES AND CARDIOVASCULAR ISSUES - MARSHALL BROWNING HOSPITAL WILL CONTINUE CHRONIC ILLNESS EDUCATION OFFERINGS AND EXPLORE DEVELOPMENT OF ADDITIONAL PROGRAMMING. THE HOSPITAL WILL DEVELOP A CHRONIC DISEASE MANAGEMENT PROGRAM, UTILIZING INTERNISTS. THE HOSPITAL WILL EXPLORE EXPANSION OF EDUCATION STRATEGIES TO INCLUDE EDUCATION, UTILIZING TECHNOLOGY, AND WEB-BASED PROGRAMMING. ANTICIPATED IMPACTS OF THESE ACTIONS: THE HOSPITAL ANTICIPATES THAT THESE ACTIONS WILL CREATE A CHRONIC DISEASE MANAGEMENT PROGRAM AND EXPAND CHRONIC ILLNESS AWARENESS AND MANAGEMENT EDUCATION. PROGRAMS/RESOURCES THE HOSPITAL PLANS TO COMMIT INCLUDE ADMINISTRATION, CARDIOPULMONARY STAFF, MEDICAL PROVIDERS, PERRY COUNTY HEALTH DEPARTMENT AND EXTERNAL MEDICAL PROVIDERS. SINCE THE FOCUS GROUP MEETINGS WERE CONDUCTED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT, THIS IMPLEMENTATION STRATEGY FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT OF MARSHALL BROWNING HOSPITAL WAS APPROVED BY THE MARSHALL BROWNING HOSPITAL BOARD OF DIRECTORS ON THE 29TH DAY OF APRIL, 2019. 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 16A, 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 1 1 - MARSHALL BROWNING HOSPITAL MEDICAL CLINI 900 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, EMERGENCY ROOM, AND RURAL HEALTH CLINIC. 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 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 $ 2,015,126. 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 ACCOUNTS RECEIVABLE, THE ORGANIZATION 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 PAYOR COVERAGE, THE ORGANIZATION 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 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 ORGANIZATION 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 FIAR 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 EDWARD TRAVIS MD PHYSICIAN 213608 0 0 0 1033 0 3179 0 19563 0 237383 0 0 0 MALCOLM SCHULZ MD PHYSICIAN 195515 0 0 0 3048 0 6028 0 18485 0 223076 0 0 0 GLADSTONE TUCKER MD PHYSICIAN 213290 0 0 0 3048 0 0 0 1958 0 218296 0 0 0 MICHAEL STAFF PHYSICIAN ASSISTANT 151812 0 0 0 3048 0 4776 0 18238 0 177874 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 OTHER PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,956,255. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,956,255. EMERGENCY PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 1,114,320. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,114,320. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 889,534. MANAGEMENT AND GENERAL EXPENSES 1,192,558. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,082,092. FORM 990, PART XI, LINE 9: POSTRETIREMENT BENEFIT ADJUSTMENT -41,352.