2020-02-15T13:11:09-06:00 2019-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2018-07-01 370661208 HILLSBORO AREA HOSPITAL INC HILL 2175326111 1200 EAST TREMONT STREET HILLSBORO IL 62049 REX BROWN PRESIDENT & CEO 2175326111 2020-01-31 1 MICHAEL J PETERSON CPA P01833529 2187224705 2020-01-31 216.54.158.12 2020-01-31 11:07:14 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 2018 2020-09-23 17:36:50Z REX BROWN 1200 EAST TREMONT STREET HILLSBORO IL 62049 26485917 0 X WWW.HILLSBOROAREAHOSPITAL.ORG X 1906 IL OPERATION OF HOSPITAL (INPATIENT, SWING BED & OUTPATIENT) AND ASSISTED LIVING FACILITIES. 10 10 318 51 0 0 67141 46106 24120810 25630247 640593 687451 206468 122113 25035012 26485917 0 0 0 0 10341324 11064714 0 0 0 11803139 12872959 22144463 23937673 2890549 2548244 39631406 41262184 8803942 8351263 30827464 32910921 TO POSITIVELY AFFECT THE HEALTH AND WELFARE OF THE COMMUNITIES WE SERVE THROUGH THE OPERATION OF A HOSPITAL (INPATIENT, SWING BED AND OUTPATIENT) AND AN ASSISTED LIVING FACILITY. 0 0 19381670 0 25503999 OPERATION OF A 25 BED CRITICAL ACCESS HOSPITAL (INPATIENT, SWING BED AND OUTPATIENT) WITH AN ASSISTED LIVING FACILITY. 551 ACUTE DAYS, 1,897 SWING BED DAYS, 14,905 OUTPATIENT VISITS AND 12,883 ASSISTED LIVING RESIDENT DAYS PROVIDED IN FY 2019. HILLSBORO AREA HOSPITAL ALSO PROVIDED $916,016 IN CHARITY CARE AND $1,102,425 IN OTHER COMMUNITY BENEFITS, NOT INCLUDING BAD DEBT. HILLSBORO AREA HOSPITAL ADDED PODIATRY, PULMONOLOGY, AND BEHAVIORAL HEALTH SERVICES IN FY19. 19381670 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 78 0 318 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X TERRI CARROLL 2175324187 1200 EAST TREMONT STREET HILLSBORO IL 62049 DR DOUG BYERS DIRECTOR 1.00 X 0 0 0 DR BEN CADY DIRECTOR 1.00 X 0 0 0 EARL FLACK DIRECTOR 1.00 X 0 0 0 GREG HOLCOMB DIRECTOR 1.00 0.10 X 0 0 0 BRIAN KNODLE DIRECTOR 1.00 X 0 0 0 JORDAN RUPPERT DIRECTOR 1.00 X 0 0 0 LISA WHITE DIRECTOR (THRU SEPT) 1.00 X 0 0 0 MICHELLE ONDREY DIRECTOR 1.00 X 0 0 0 DAVE IMLER CHAIRMAN 1.00 X X 0 0 0 LINDSAY WAGAHOFF VICE CHAIR 1.00 X X 0 0 0 PATRICIA CLARKE TREASURER 1.00 0.10 X X 0 0 0 JULIE JENKINS SECRETARY 1.00 0.30 X X 0 0 0 REX BROWN PRESIDENT & CEO 40.00 1.30 X 0 0 0 TERRI CARROLL CFO 40.00 1.00 X 172351 0 30937 ELVIS HARRISON VP OF PATIENT CARE SERVICE 40.00 X 139972 0 23861 ABBY BUGG TEAMWORK REHAB DIRECTOR 40.00 X 110087 0 40555 THERESA RAPP DIRECTOR OF SURGICAL SERVICES 40.00 X 102581 0 3097 524991 0 98450 4 0 1 1 ILLINOIS EMERGENCY PHYSICIANS 4075 COPPER RIDGE DRIVE TRAVERSE CITY MI 49684 PHYSICIAN COVERAGE 2071391 HEALTHTECH MANAGEMENT SERVICES INC 5110 MARYLAND WAY SUITE 200 BRENTWOOD TN 37027 MANAGEMENT & CEO SERVICES 598250 READYLINK PO BOX 1047 THOUSAND PALMS CA 92276 NURSING SERVICES 201754 PRECISE SPECIALTIES CORPORATION PO BOX 572 HILLSBORO IL 62049 IMAGING SERVICES 191745 MEDICAL OUTSOURCING SOLUTIONS 1735 DEKALB AVE SYCAMORE IL 60178 NUCLEAR MEDICINE 180000 7 7911 38195 46106 PATIENT SERVICE REVENUE 621110 25503999 25503999 126248 126248 25630247 687227 687227 76136 0 76136 76136 76136 224 0 224 224 224 CAFETERIA 722514 40838 40838 AMBULANCE REVENUE 900099 5139 5139 45977 26485917 25635386 0 804425 X 203287 203287 8250199 7074656 1175543 194109 164024 30085 1803429 1504057 299372 613690 504657 109033 610417 610417 51178 51178 40704 40704 4734059 4097281 636778 72797 72797 98909 26349 72560 623252 381934 241318 77876 41069 36807 31761 12098 19663 1009993 844502 165491 292914 45127 247787 SUPPLIES 2044352 1431681 612671 BAD DEBT 1229453 1229453 REPAIRS & MAINTENANCE 710873 509305 201568 OTHER EXPENSES 481551 179761 301790 762870 725299 37571 23937673 19381670 4556003 0 952958 1254654 8692794 12192719 2448623 3139308 512385 532890 366716 453684 32901249 22172603 10997260 10728646 2860921 3000504 12286238 9439503 513511 520276 39631406 41262184 2184503 2402979 5116728 4807480 1502711 1140804 8803942 8351263 X 29852573 31939083 689891 686838 285000 285000 30827464 32910921 39631406 41262184 X 2548244 -60939 -392772 -11076 X X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10619 10619 0 PART II-B, LINE 1: HILLSBORO AREA HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE ILLINOIS HOSPITAL ASSOCIATION (IHA) AND THE AMERICAN HOSPITAL ASSOCIATION (AHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS, TO HELP WITH STAFF TRAINING, AND TO ASSIST WITH REIMBURSEMENT. HILLSBORO AREA HOSPITAL ESTIMATED THAT $10,619 OUT OF THE TOTAL DUES PAID TO IHA AND AHA WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT IN ILLINOIS. 418430 2746 421176 414863 3567 418430 412788 2075 414863 410867 1921 412788 409239 1628 410867 0.00000 0.67700 0.32300 0 1 1 295110 295110 18633137 10118549 8514588 13939152 12054054 1885098 33850 33850 10728646 CERTIFICATE OF DEPOSITS 9439503 C 9439503 ASSET RETIREMENT OBLIGATION 111419 AMOUNTS PAYABLE TO THIRD-PARTY REIMBURSEMENT PROGRAMS 1002670 RELATED PARTY 26715 1140804 25248441 0 25248441 1237476 1237476 26485917 22708220 0 22708220 1229453 1229453 23937673 PART V, LINE 4: THE ENDOWMENTS ARE INTENDED TO BE USED TO SUPPORT THE MAINTENANCE AND EQUIPMENT NEEDS OF THE HOSPITAL. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,229,453. INVESTMENT INCOME RECORDED TO RESTRICTED NET ASSET 8,023. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,229,453. 1 1 X 1 X 1 X 1 1 1 0 1 0 415782 415782 0.01830 3559876 1881086 1678790 0.07390 3975658 1881086 2094572 0.09220 35221 8541 26680 0.00120 4051370 3299637 751733 0.03310 163713 163713 0.00720 4250304 3308178 942126 0.04150 8225962 5189264 3036698 0.13370 0 558061 279031 9480394 9528232 -47838 X 1 1 1 1 HILLSBORO AREA HOSPITAL 1200 EAST TREMONT STREET HILLSBORO IL 62049 WWW.HILLSBOROHEALTH.ORG 968 X X X X HILLSBORO AREA HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE PART V, PAGE 8 X 1 18 1 SEE PART V, PAGE 8 0 1 X 100.000000000000 200.000000000000 X X X X 1 1 X X X X 1 X HTTP://WWW.HILLSBOROAREAHOSPITAL.ORG/PATIENT-BILLING/FINANCIAL-ASSISTANCE/ X HTTP://WWW.HILLSBOROAREAHOSPITAL.ORG/PATIENT-BILLING/FINANCIAL-ASSISTANCE/ X HTTP://WWW.HILLSBOROAREAHOSPITAL.ORG/PATIENT-BILLING/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X X 1 X 0 0 HILLSBORO AREA HOSPITAL PART V, SECTION B, LINE 5: 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 THE 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. MONTGOMERY COUNTY PUBLIC HEALTH PARTICIPATED IN THE PROCESS. FOCUS GROUP#1 - THE GROUP CONSISTED OF MEDICAL PROFESSIONALS AND PARTNERS, INCLUDING REPRESENTATIVES OF GROUPS THAT REPRESENT OR SERVE PERSONS THAT MAY BE UNDERSERVED BY LOCAL MEDICAL SERVICES. THE GROUP INCLUDED PHYSICIANS, A NURSE PRACTITIONER, A PHARMACIST, AN ANESTHESIOLOGIST, AN OPTOMETRIST, NURSES, AND REPRESENTATIVES OF SENIOR CARE FACILITIES. THE GROUP MET ON OCTOBER 17, 2018 AT HILLSBORO AREA HOSPITAL.FOCUS GROUP#2 - THE GROUP CONSISTED OF COMMUNITY LEADERS AND REPRESENTATIVES OF GROUPS THAT REPRESENT OR SERVE PERSONS THAT MAY BE UNDERSERVED BY LOCAL MEDICAL SERVICES. THE GROUP INCLUDED SCHOOL OFFICIALS, THE COUNTY PUBLIC HEALTH ADMINISTRATOR, A REPRESENTATIVE OF THE SHERIFF'S OFFICE, LOCAL COMMUNITY DEVELOPMENT LEADERS, UNIVERSITY OF ILLINOIS EXTENSION, COMMUNITY ORGANIZATION MEMBERS, AND OTHERS. THE GROUP MET ON OCTOBER 17, 2018 AT HILLSBORO AREA HOSPITAL.FOCUS GROUP#3 - THE GROUP CONSISTED OF COMMUNITY LEADERS AND REPRESENTATIVES OF GROUPS THAT REPRESENT OR SERVE PERSONS THAT MAY BE UNDERSERVED BY LOCAL MEDICAL SERVICES. THE GROUP INCLUDED LEADERS OF VOLUNTEER ORGANIZATIONS, SENIOR CITIZENS, THE MAYOR OF HILLSBORO, AND OTHERS. THE GROUP MET ON OCTOBER 17, 2018 AT HILLSBORO AREA HOSPITAL. HILLSBORO AREA HOSPITAL PART V, SECTION B, LINE 7D: PART V, SECTION B, LINE 7A:HTTP://WWW.HILLSBOROAREAHOSPITAL.ORG/COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/PART V, SECTION B, LINE 10A:HTTP://WWW.HILLSBOROAREAHOSPITAL.ORG/COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/ HILLSBORO AREA HOSPITAL PART V, SECTION B, LINE 11: THE IMPLEMENTATION STRATEGY WAS DEVELOPED THROUGH A FACILITATED MEETING WITH A GROUP OF KEY ADMINISTRATIVE STAFF AT HILLSBORO AREA HOSPITAL THAT REVIEWED THE NEEDS ASSESSMENT PROCESS AND CONSIDERED THE PRIORITIZED SIGNIFICANT NEEDS IN THE COMMUNITY. THE FIVE PRIORITIES IDENTIFIED ARE: MENTAL HEALTH, FLEXIBLE TRANSPORTATION, IMPROVED AWARENESS, ACCESS TO URGENT CARE, AND CHRONIC ILLNESSES. THE GROUP REVIEWED THE STEPS TAKEN TO ADDRESS THE PREVIOUS CHNA AND CONSIDERED RESOURCES POTENTIALLY AVAILABLE TO ADDRESS THE CURRENT PRIORITIZED NEEDS. THE 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. HILLSBORO AREA HOSPITAL PART V, SECTION B, LINE 20E: A MINIMUM OF 2 STATEMENTS AND 1 LETTER ARE SENT PRIOR TO SENDING THE ACCOUNT TO COLLECTIONS, EACH NOTING HOW TO CONTACT THE HOSPITAL FOR FINANCIAL ASSISTANCE. 3 1 - TREMONT RIDGE ASSISTED LIVING 801 E TREMONT STREET HILLSBORO IL 62049 ASSISTED LIVING FACILITY 2 - TEAMWORK REHAB LITCHFIELD 120 W SAINT JOHN STREET SUITE 2 LITCHFIELD IL 62056 OUTPATIENT PHYSICAL & OCCUPATIONAL THERAPY 3 - TEAMWORK REHAB NOKOMIS 207 W STATE STREET NOKOMIS IL 62075 OUTPATIENT PHYSICAL THERAPY PART I, LINE 3C: HILLSBORO AREA HOSPITAL USES THE FEDERAL POVERTY GUIDELINES AS ONE MEANS OF DETERMINING ELIGIBILITY FOR CHARITY CARE. THE FEDERAL POVERTY GUIDELINES ARE UPDATED AND PUBLISHED ANNUALLY BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. AS A GENERAL RULE, A PATIENT'S INCOME, BASED ON FAMILY SIZE, MUST BE AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES TO BE ELIGIBLE FOR THE CHARITY CARE PROGRAM AND AT OR BELOW 300% OF THE FEDERAL POVERTY GUIDELINES FOR THE UNINSURED/UNDERINSURED CHARITY DISCOUNT. A SLIDING SCALE BASED ON THE PATIENT'S INCOME LEVEL UNDER THE FEDERAL POVERTY GUIDELINES WILL BE USED TO DETERMINE THE PRECISE AMOUNT OF CHARITY CARE FOR WHICH A PATIENT WILL BE ELIGIBLE. SOME PATIENTS' INCOME MAY EXCEED THESE GUIDELINES, BUT MAY STILL BE ELIGIBLE FOR CHARITY CARE WHEN ADDITIONAL CRITERIA SUCH AS HOMELESSNESS, DECEASED WITH NO ESTATE, MENTAL INCAPACITATION WITH NO ONE TO ACT ON THEIR BEHALF, MEDICAID ELIGIBILITY NOT ON THE DATE OF SERVICE (IE SPENDDOWN UNMET) OR NON-COVERED SERVICE, CURRENTLY ENROLLED IN A COMMUNITY PROGRAM REQUIRING POVERTY LEVEL INCOME, INCARCERATION IN A PENAL INSTITUTION WITHOUT OTHER COVERAGE AVAILABLE, SELF-ADMINISTERED DRUGS-MEDICARE/MEDICAID DUAL ELIGIBILITY ONLY, MEDICAID DHS SERVICES ONLY (IE. MENTAL HEALTH SERVICES ONLY), DRUG AND ALCOHOL REHAB PATIENTS, MEDICAID ELIGIBLE FOR HEALTH WOMEN'S BENEFITS (IE. COVERAGE FOR PAPS, MAMM, ONLY), AND OUT OF STATE MEDICAID. PART I, LINE 7: THE COST TO CHARGES RATIO WAS USED AS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT THE HOSPITAL INCLUDES THE OPERATION OF THE EMERGENCY ROOM. THE EMERGENCY ROOM IS OPERATED 24 HOURS A DAY, 7 DAYS A WEEK, AND IS STAFFED BY A HIGHLY TRAINED GROUP OF NURSING STAFF AND PHYSICIANS WHO DO THEIR BEST TO PROVIDE EXCEPTIONAL CARE TO MEMBERS OF THE COMMUNITY IN NEED OF EMERGENCY CARE. THE EMERGENCY DEPARTMENT HAS A LARGE AMOUNT OF FIXED EXPENSES WHICH ARE NECESSARY TO PROVIDE THE SERVICE ON A 24 HOUR A DAY BASIS, WHICH IS A REQUIREMENT OF OPERATING A CRITICAL ACCESS HOSPITAL. THE HOSPITAL TREATS ALL PATIENTS, REGARDLESS OF ABILITY TO PAY, IN ITS EMERGENCY ROOM AND FOR THESE REASONS IT IS A SUBSIDIZED SERVICE WHICH THE HOSPITAL PROVIDES AND OFFERS TO THE COMMUNITY FOR THOSE IN NEED. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,229,453. SCHEDULE H, PART I, LINE 6A ALTHOUGH NOT REQUIRED TO BE COMPLETED AS A CRITICAL ACCESS HOSPITAL, AN INFORMAL COMMUNITY BENEFITS REPORT IS PREPARED ANNUALLY. PART III, LINE 2: THE COSTING METHODOLOGY USED WAS THE RATIO OF PATIENT CARE COST-TO-CHARGES. PART III, LINE 3: THE HOSPITAL BELIEVES THAT THE COMMUNITY BENEFIT OBTAINED FROM ITS CHARITY CARE IS UNDERSTATED DUE TO PATIENTS THAT COULD QUALIFY FOR CHARITY CARE BUT DO NOT APPLY OR PROVIDE INCOMPLETE INFORMATION. SOME CARE PROVIDED TO PATIENTS IS NOT CLASSIFIED AS CHARITY CARE DUE TO PATIENTS MISSING DOCUMENTATION THAT PROVES THEY QUALIFY FOR CHARITY CARE. THE HOSPITAL'S BAD DEBT DOES INCLUDE AMOUNTS THAT COULD BE CLASSIFIED AS CHARITY CARE IF THE PATIENTS WOULD APPLY OR PROVIDE THE APPROPRIATE INFORMATION TO COMPLETE THE CHARITY CARE APPLICATION. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A 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 INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFITS EXPENSE BECAUSEPROVIDING MEDICAL CARE AT A SHORTFALL IMPACTS THE HOSPITAL'S OPERATIONSAND GROWTH. THE CARE IS PROVIDED BECAUSE THERE IS A NEED AND A DESIRE TOPROVIDE MEDICAL CARE IN THIS COMMUNITY.THE COSTING METHOD USED ABOVE FOR IRS FORM 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO 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) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES AND THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY 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 III, LINE 9B: COLLECTION ACTIONS ARE STOPPED ON PATIENT BALANCES THAT ARE DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: HILLSBORO AREA HOSPITAL CONDUCTS A NEEDS ASSESSMENT DURING ITS STRATEGIC PLANNING AND LONG RANGE BUDGETING PROCESS. THIS PROCESS INCLUDES OBTAINING AND ANALYZING VARIOUS DATA AND MARKET DEMOGRAPHICS. THE DATA IS THEN SUPPLEMENTED WITH VIEWS AND CONCERNS FROM OUR COMMUNITY BOARD MEMBERS, OTHER COMMUNITY OUTREACH RELATIONSHIPS, AND OTHER COMMUNITY ORGANIZATIONS PART VI, LINE 3: UNINSURED PATIENTS AND PERSONS WHO SEEK AND / OR OBTAIN SERVICES FROM THE HOSPITAL, ARE INFORMED OF THE AVAILABILITY OF FINANCIAL ASSISTANCE VIA SIGNAGE THROUGHOUT THE PATIENT ACCESS AREAS OF THE FACILITY, BROCHURES, ADMISSION PACKETS, DISCLOSURE ON THE PATIENT BILL, IN PERSON AND TELEPHONE ASSISTED CUSTOMER SERVICE, AS WELL AS INFORMATION SUCH AS THE GUIDELINES AND APPLICATION BEING PREDOMINATELY POSTED ON THE HOSPITAL'S WEBSITE. PART VI, LINE 4: HILLSBORO AREA HOSPITAL DEFINED ITS PRIMARY SERVICE AREA AND POPULATIONS AS THE GENERAL POPULATION WITHIN THE GEOGRAPHIC AREA IN AND SURROUNDING THE CITY OF HILLSBORO, DEFINED IN DETAIL BELOW. THE HOSPITAL'S PATIENT POPULATION INCLUDES ALL WHO RECEIVE CARE WITHOUT REGARD TO INSURANCE COVERAGE OR ELIGIBILITY FOR ASSISTANCE. THE SERVICE AREA CONSISTS OF THE FOLLOWING RURAL COMMUNITIES. CITIES: HILLSBORO, NOKOMIS, WITTVILLAGES AND UNINCORPORATED COMMUNITIES: FILLMORE, IRVING, COFFEEN, RAYMOND, BUTLER, DONNELLSONACCORDING TO U.S. CENSUS DATA, THE POPULATION IN THE HILLSBORO AREA HOSPITAL SERVICE AREA FELL FROM 19,425 PEOPLE TO 18,938 PEOPLE BETWEEN THE YEARS 2000 AND 2010, A 2.51% DECREASE. THE HISPANIC POPULATION IN BOND COUNTY INCREASED BY 294 (116.21%), INCREASED IN CHRISTIAN COUNTY BY 126 (36.52%), INCREASED IN FAYETTE COUNTY BY 130 (74.71%), INCREASED IN MACOUPIN COUNTY BY 113 (37.05%), AND INCREASED IN MONTGOMERY COUNTY BY 133 (40.8%). IN BOND COUNTY, ADDITIONAL POPULATION CHANGES WERE AS FOLLOWS: WHITE 0.89%, BLACK -17.3%, AMERICAN INDIAN/ALASKA NATIVE 13.58%, ASIAN 47.83%, AND NATIVE HAWAIIAN/PACIFIC ISLANDER -62.5%. IN CHRISTIAN COUNTY, ADDITIONAL POPULATION CHANGES WERE AS FOLLOWS: WHITE -1.37%, BLACK -34.7%, AMERICAN INDIAN/ALASKA NATIVE -10.53%, ASIAN 26.52%, AND NATIVE HAWAIIAN/PACIFIC ISLANDER -27.27% PART VI, LINE 5: DESIGNATED AS CRITICAL ACCESS HOSPITAL THE HOSPITAL USES ANY LIMITED SURPLUS FUNDS TO FURTHER ITS EXEMPT PURPOSE BY PROVIDING PROGRAMS AND ACCESS AS NOTED IN FORM 990, LINE 1 AND 4A. THE BOARD OF DIRECTORS IS MADE UP OF VOLUNTEER COMMUNITY LEADERS WITHIN ITS PRIMARY SERVICE AREA THAT ARE APPROVED BY THE MEMBER ORGANIZATION. PART VI, LINE 6: THE HOSPITAL IS PART OF A CRITICAL ACCESS NETWORK THAT INCLUDES HILLSBORO AREA HEALTH SYSTEM NFP, ITS SOLE CORPORATE MEMBER, WHICH PROVIDES HEALTH AND SUPPORTIVE SERVICES TO THE COMMUNITIES THEY SERVE. THE HOSPITAL ALSO COMMITS SIGNIFICANT TIME AND RESOURCES TO ACTIVITIES AND SERVICES THAT MEET UNMET COMMUNITY NEEDS. MANY OF THESE ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE SELF-SUPPORTING OR FINANCIALLY VIABLE. SUCH PROGRAMS INCLUDE, BUT ARE NOT LIMITED TO, HEALTH FAIRS AND EVENTS, HEALTH SCREENINGS AND ASSESSMENTS, SPACE FOR DAYCARE PROGRAMS OFFERED BY THE LOCAL SCHOOL SYSTEM, SUPPORT FOR VITAL COMMUNITY SERVICES, TRAUMA CARE, AND VARIOUS COMMUNITY EDUCATIONAL SERVICES.HILLSBORO AREA HOSPITAL RECEIVED LEED CERTIFICATION FOR THE BUILDING ADDITION COMPLETED IN JULY 2010. THE ENVIRONMENTAL BENEFITS OF LEED INCLUDE: REDUCTION OF WASTE SENT TO LANDFILLS, CONSERVATION OF ENERGY AND WATER, REDUCTION OF HARMFUL GREENHOUSE GASES, AND A HEALTHIER AND SAFER PLACE FOR EMPLOYEES, PATIENTS, AND THE ENVIRONMENT. THE HOSPITAL IS ALSO A MEMBER OF THE CHAMBER OF COMMERCE AND PARTNERS WITH THE MONTGOMERY COUNTY ECONOMIC DEVELOPMENT CORPORATION TO OBTAIN GRANTS AND EXPAND THE SERVICES NEEDED IN THE COMMUNITY.THE HOSPITAL PROVIDES THE USE OF SPACE AT NO CHARGE TO THE HILLSBORO COMMUNITY SCHOOL DISTRICT FOR A DAYCARE FACILITY. FOR MANY YEARS, UNTIL MAY 2010, THE HOPSITAL PROVIDED CLASSROOM SPACE, FREE OF CHARGE, FOR LINCOLN LAND COMMUNITY COLLEGE TO USE FOR NURSING INSTRUCTION. THE SPACE IS NOW PROVIDED BY THE HILLSBORO AREA HEALTH SYSTEM. THE HOSPITAL ALSO PROVIDES GRAND ADVANTAGE SENIOR EXERCISE CLASSES TO THE SENIORS IN THE AREA AT NO CHARGE, AND PROVIDES THE DIAMOND CLUB TO SENIORS FOR ASSISTANCE WITH THE UNDERSTANDING AND ORGANIZATION OF MEDICAL BILLS AND INSURANCE. HOSPITAL EMPLOYEES ALSO SHARE THEIR EXPERTISE THROUGH COMMUNITY SPEAKING AT LOCAL ORGANIZATIONS AND EVENTS. SEVERAL MONETARY DONATIONS ARE MADE BY THE HOSPITAL THROUGHOUT THE YEAR TO OTHER NON-PROFIT ORGANIZATIONS. AN AUTOMATIC BLOOD PRESSURE MACHINE IS LOCATED IN THE HOSPITAL LOBBY WHERE THE COMMUNITY MEMBERS CAN USE IT FREE OF CHARGE, AND THE HOSPITAL PROVIDES A BOOTH AT THE LOCAL COMMUNITY FAIR EACH YEAR WHERE EMPLOYEES TAKE BLOOD PRESSURES AND PROVIDE HEALTH INFORMATION TO THE PUBLIC.THE HOSPITAL RECEIVED A USDA DISTANCE LEARNING & TELEMEDICINE GRANT TO EXPAND CERTIFIED NURSING ASSISTANT INSTRUCTION TO HIGH SCHOOL STUDENTS IN OUR COMMUNITY. IN COMBINATION WITH THE HOSPITAL'S MATCHING FUNDS, VIDEO CONFERENCING EQUIPMENT WAS PURCHASED AND PLACED IN 4 COMMUNITY HIGH SCHOOLS SO THAT THE STUDENTS CAN REMAIN IN THEIR OWN CLASSROOMS INSTEAD OF BEING TRANSPORTED TO THE HOSPITAL'S CAMPUS FOR CNA INSTRUCTION. IN ADDITION, THE HOPSITAL PROVIDES THE USE OF SPACE ON OUR CAMPUS FOR THE CLASSES FREE OF CHARGE, SO THE COMBINATION OF FREE SPACE USAGE AND REDUCED TRANSPORTATION COSTS PROVIDES GREAT BENEFITS FOR THIS STATE-APPROVED PROGRAM. THE HOSPITAL ALSO HAS THE HILLSBORO AREA HOPSITAL JUNIOR BOARD WHICH IS COMPRISED OF STUDENT VOLUNTEERS AGES 9-16. THE JUNIOR BOARD MEMBERS LEARNED HOW THE ORGANIZATION WORK, DEVELOP LEADERSHIP SKILLS, AND PLAN AND EXECUTE COMMUNITY IMPROVEMENT ACTIVITES WITH THE HELP OF THE HOSPITAL STAFF MEMBERS.THE HOSPITAL ALSO PARTICIPATED IN THE STATE COLORECTAL CANCER SCREENING INITATIVE, HELPED COORDINATE APPOINTMENTS FOR OTHER CANCER SCREENS IN COORDINATION WITH THE MONTGOMERY COUNTY CANCER ASSOCIATION, AND PROVIDED PRODUCE PLANTS TO COMMUNITY MEMBERS TO PROMOTE HEALTHIER EATING HABITS AND FOOD SUSTAINABILITY. FURTHEMORE, THE HOSPITAL HAS BEEN RECOGNIZED AS HILLSBORO'S BUSINESS OF THE YEAR FOR ITS POSITIVE ECONOMIC AND CIVIC IMPACT AND ITS OVERWHELMING SUPPORT OF THE COMMUNITY. X 1 1 X X X 0 0 0 0 0 0 0 0 0 TERRI CARROLL CFO 160776 0 11575 0 0 0 5353 0 25584 0 203288 0 0 0 ELVIS HARRISON VP OF PATIENT CARE SERVICE 134521 0 5451 0 0 0 972 0 22889 0 163833 0 0 0 ABBY BUGG TEAMWORK REHAB DIRECTOR 105585 0 4502 0 0 0 3580 0 36975 0 150642 0 0 0 PART I, LINE 1B ALL FULL TIME EMPLOYEES HAVE THE OPTION TO BE A MEMBER OF THE HILLSBORO AREA HEALTH SERVICES' FUSION WELLNESS FACILITY WHICH THE HOSPITAL PAYS DIRECTLY TO HILLSBORO AREA HEALTH SERVICES AS A BENEFIT TO HOSPITAL EMPLOYEES. A CITY OF HILLSBORO MONTGOMERY COUNTY ILLINOIS 376001658 2008-09-30 7220000 CAPITAL IMPROVEMENT PROJECT 0 0 0 A 2412520 7220000 83500 7030981 105519 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 0 A 0 SCHEDULE K, PART IV, LINE 2C: THE ORGANIZATION QUALIFIED FOR AN EXCEPTION TO REBATE. THE BOND QUALIFIES FOR THE 2-YEAR SPENDING EXCEPTION. FORM 990, PART VI, SECTION A, LINE 3 HEALTHTECH MANAGEMENT SERVICES, INC. DBA HEALTHTECHS3, PROVIDE MANAGEMENT AND CEO SERVICES. REX BROWN, PRESIDENT & CEO OF HILLSBORO AREA HOSPITAL, IS EMPLOYED BY HEALTHTECHS3. THE AMOUNT PAID IN TOTAL TO HEALTHTECHS3 IS INCLUDED IN PART VII, SECTION B. FORM 990, PART VI, SECTION A, LINE 6 HILLSBORO AREA HEATLH SYSTEM NFP, A NOT-FOR-PROFIT CORPORATION IS THE SOLE CORPORATE MEMBER OF HILLSBORO AREA HOSPITAL, INC. THE HOSPITAL ALSO HAS INDIVIDUAL MEMBERS. THERE ARE TWO CLASSES OF INDIVIDUAL MEMBERS. ANNUAL (REGULAR) AND LIFE MEMBERS MAKE UP THE CLASSES OF INDIVIDUAL MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A ONLY THE INDIVIDUAL MEMBERS CAN ELECT MEMBERS TO THE GOVERNING BODY. THE VOTING OF DIRECTORS TO THE BOARD ONLY OCCURS IN OCTOBER. IN ADDITION, THE SOLE CORPORATE MEMBER MUST APPROVE ALL BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE CORPORATE MEMBER, HILLSBORO AREA HEALTH SYSTEM NFP, APPROVES ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION OR TO THE BYLAWS OF THE CORPORATION AND APPROVES HOSPITAL BOARD MEMBERS ELECTED. THE ONLY VOTING RIGHT OF THE INDIVIDUAL MEMBERS IS THE RIGHT TO ELECT DIRECTORS. IN ADDITION, HILLSBORO AREA HEALTH SYSTEM NFP MUST APPROVE SUCH ITEMS AS BUDGETS, STRATEGIC PLANS, LARGE UNBUDGETED CAPITAL EXPENDITURES, LAND SALES, ETC. FORM 990, PART VI, SECTION B, LINE 11B THE CFO REVIEWS THE FORM 990 AND PROVIDES A COPY OF THE 990 TO EACH MEMBER OF THE BOARD FOR REVIEW. THE BOARD THEN VOTES ON THE APPROVAL OF THE 990 AS IT IS OR CONTINGENT UPON CHANGES PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, EMPLOYEES COMPLETE AND SIGN A DISCLOSURE STATEMENT AND THE BOARD OF DIRECTORS COMPLETE AND SIGN A CONFLICT OF INTEREST FORM . THE BOARD REVIEWS THE DISCLOSURES AND TAKES APPROPRIATE ACTION TO RESOLVE ANY ISSUES. IF A CONFLICT EXISTS, THE BOARD MEMBER SHALL ABSTAIN FROM VOTING ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 A PERFORMANCE EVALUATION IS COMPLETED AND DISCUSSED IN EXECUTIVE SESSION BY THE BOARD OF DIRECTORS FOR EXECUTIVE EMPLOYEES. THE PROCESS FOR DETERMINING COMPENSATION INCLUDES REVIEWS OF SALARY RANGES FOR THE POSITIONS PER VARIOUS DATABASES AND/OR MATERIAL AVAILABLE. THE DELIBERATION AND DECISION BY THE BOARD OF DIRECTORS IS DOCUMENTED IN THE EXECUTIVE SESSION BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G EMERGENCY ROOM PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,081,335. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,081,335. OTHER PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 392,662. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 392,662. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,623,284. MANAGEMENT AND GENERAL EXPENSES 636,778. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,260,062. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 6,765. NET ASSETS RELEASED FROM RESTRICTION -17,841. FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS OF THE ORGANIZATION WORK CLOSELY WITH HILLSBORO AREA HEALTH SYSTEM NFP AND THE OTHER RELATED ENTITIES TO SELECT AND APPOINT THE AUDITOR OF THE FINANCIAL STATEMENTS. HILLSBORO AREA HEALTH SYSTEM NFP 1200 EAST TREMONT HILLSBORO IL 62049 364539688 MANAGEMENT AND OVERSIGHT OF HEALTH CARE SYSTEM IL 501(C)(3) LINE 12C, III-FI 0 HILLSBORO AREA HEALTH FOUNDATION 1200 EAST TREMONT HILLSBORO IL 62049 371247796 PROVIDE SUPPORT FOR HILLSBORO AREA HOSPITAL IL 501(C)(3) LINE 7 HILLSBORO AREA HEALTH SYSTEM NFP 1 HILLSBORO AREA HEALTH SERVICES INC 1210 EAST TREMONT HILLSBORO IL 62049 371240643 ESTABLISH AND OPERATE FACILITIES FOR WELLBEING OF PERSONS IN AREA IL 501(C)(3) LINE 10 HILLSBORO AREA HEALTH SYSTEM NFP 1 0 0 1 0 0 0 0 0 0 1 1 0 1 0 1 1 1 1 1