2019-11-15T16:29:23-06:00 2018-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 4000 INDIANAPOLIS IN 46204 990 2018-01-01 371363001 RICHLAND MEMORIAL HOSPITAL % DENNIS HESCH RICH 6183952131 800 East Locust Street Olney IL 62450 DENNIS P HESCH Director of Business 6183952131 2019-11-15 true JENNIFER D RHODERICK P00395735 3176817000 164.57.159.254 35057220193195000022 2019-11-15 P 6DFBA33F1DAEE8CAFFEB9AC40683ECF49AA6169A 42D26865FF540D3EA6F803EEB3CCA5BB79F92251 2018 2020-04-17 16:48:07Z Christina Bare 800 East Locust Street Olney IL 62450 52809084 false X www.richlandmemorial.com X 1953 IL To provide excellent healthcare, promote wellness, and educate patients, staff, and the community. 11 7 650 144 274311 5000 25000 10937326 50984712 163019 385742 287795 1413630 11393140 52809084 0 0 0 0 8709299 35230505 0 0 0 5154130 24332726 13863429 59563231 -2470289 -6754147 38080288 33259131 12846862 15111238 25233426 18147893 X TO PROVIDE EXCELLENT HEALTHCARE, PROMOTE WELLNESS, AND EDUCATE PATIENTS, STAFF, AND THE COMMUNITY. false false 45263746 51148866 SEE SCHEDULE O 45263746 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 false true false false false false false false true false false false false false false true true true false false true 45 0 true 650 true true true false false false false false false false false false false false X 11 7 false false false false true true true true true false false true true true true true true true true false IL X DENNIS HESCH 2173833311 611 W PARK ST URBANA IL 61801 X CAROL SCHAFER SECRETARY/TREASURER 2.0 0.0 X 0 0 0 DAN EICHELBERGER CHAIR OF THE BOARD 2.0 0.0 X 0 0 0 Dennis Graves TRUSTEE 1.0 0.0 X 0 0 0 Gary Houchin TRUSTEE 1.0 0.0 X 0 0 0 HERBERT BROKHOF DDS TRUSTEE 1.0 0.0 X 0 0 0 HERMAN ZUBER TRUSTEE 1.0 0.0 X 0 0 0 JARROD ALMAROAD MD TRUSTEE 1.0 0.0 X 0 0 0 JASON GLOVER TRUSTEE 1.0 0.0 X 0 0 0 Jennifer Cummins-Zuber TRUSTEE 1.0 0.0 X 0 0 0 JOHN SNYDER TRUSTEE, EXEC VP & COO 5.0 35.0 X 0 1550531 353891 ROB MCCLAIN VICE CHAIR OF BOARD 2.0 0.0 X 0 0 0 ROBERT ANNISS TRUSTEE 1.0 0.0 X 0 0 0 TOMMIE FEHRENBACHER TRUSTEE 1.0 0.0 X 0 0 0 H TIMOTHY GARRETT DO TRUSTEE & PHYSICIAN 40.0 0.0 X 325323 0 41036 CHRISTINA BARE DIRECTOR OF BUSINESS OPS 40.0 0.0 X 128608 0 16707 HARRY BROCKUS CEO 36.0 4.0 X 374472 0 85619 JENNIFER EMMONS INTERIM CEO (UNTIL 5/2018) 20.0 0.0 X 82362 0 14925 Regina Thomas CNO & DIR PATIENT CARE SVS 40.0 0.0 X 170109 0 20134 MARY WALLER MD PHYSICIAN 40.0 0.0 X 363074 0 29947 Paul Sutherland MD PHYSICIAN 40.0 0.0 X 341410 0 43238 Phillip Rosett MD PHYSICIAN 40.0 0.0 X 322591 0 36898 PRASHANTH ANAND MD PHYSICIAN 40.0 0.0 X 462218 0 38118 STEPHEN REID MD PHYSICIAN 40.0 0.0 X 341181 0 41863 DAVID ALLEN CEO - FORMER 0.0 0.0 X 300530 0 4023 3211878 1550531 726399 30 true true false Carle Health Care Incorporated 611 W Park St Urbana IL 61801 Physician Services 2423787 Sodexho 4880 Paysphere Circle Chicago IL 60674 Food Services 881926 The Carle Foundation Hospital 611 W Park St Urbana IL 61801 Internal MNGMT SVCS 520732 Quest Diagnostics PO Box 772976 Chicago IL 606770276 Lab Services 334761 Pharmacy Systems Inc 5050 Bradenton Avenue Dublin OH 43017 Pharmacy Mngmt Labor 259750 37 25000 25000 NET PATIENT SERVICE REVENUE 622110 50984712 50984712 0 0 50984712 381242 381242 0 0 0 0 0 4500 0 4500 4500 4500 0 0 0 0 0 0 0 0 0 AMBULANCE REVENUE FROM PROPERTY TAX 900099 427452 0 0 427452 Cafeteria Services 722331 250795 0 0 250795 Laundry Services 812331 248680 0 248680 0 486703 164154 25631 296918 1413630 52809084 51148866 274311 1360907 X 0 0 0 0 0 0 0 0 1290775 580265 710510 0 674480 0 674480 0 24478718 21003259 3475459 0 715506 618508 96998 0 6396074 5267607 1128467 0 1674952 1401637 273315 0 0 0 0 0 8565 0 8565 0 54588 0 54588 0 17123 0 17123 0 0 0 0 0 0 0 170929 138329 32600 0 372083 0 372083 0 4159671 3404391 755280 0 464730 398201 66529 0 0 0 0 0 808823 716988 91835 0 238840 130606 108234 0 0 0 0 0 130851 92848 38003 0 249836 210755 39081 0 0 0 0 0 2462923 1681389 781534 0 850267 795925 54342 0 OTHER PURCHASED SERVICES 3358147 1657119 1701028 0 PATIENT CARE SUPPLIES 2618125 2616537 1588 0 INTERNAL PURCHASED SERVS 2730204 2490022 240182 0 PROVIDER ASSESSMENT TAX 2053534 2053534 0 0 3583487 5826 3577661 59563231 45263746 14299485 0 0 0 0 6445516 3742281 0 0 5464603 6708982 0 0 0 0 1508325 1130170 767402 728221 929753 790799 53788684 38569814 14156994 15218870 7969645 3900579 0 0 0 0 0 0 838050 1039229 38080288 33259131 6735161 4866146 0 0 0 0 0 0 0 0 0 0 6111701 6025709 0 0 0 4219383 12846862 15111238 X 24913332 17754145 320094 393748 0 0 25233426 18147893 38080288 33259131 X -6754147 -322699 0 0 -77340 68653 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false 0 false 0 false 0 false 0 false 0 false 0 true 17123 17123 false SCHEDULE C, PART II-B, LINE 1 $17,123 - PORTION OF ILLINOIS HOSPITAL ASSOCIATION (IHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA) DUES ATTRIBUTABLE TO LOBBYING. 447601 447601 26679979 19126557 7553422 487119 390810 96309 26173985 19052447 7121538 15218870 0 INTERCOMPANY PAYABLES 180522 DUE TO BLUE CROSS 1158161 ASSET RETIREMENT OBLIGATION 2880700 4219383 X 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, 2018 AND 2017. true true X true X true X true true true false false 1420577 0 1420577 0.02380 11607838 4108588 7499250 0.12590 13028415 4108588 8919827 0.14970 112320 0 112320 0.00190 4834273 2673978 2160295 0.03630 4946593 2673978 2272615 0.03820 17975008 6782566 11192442 0.18790 true 1274403 637202 11181556 26422136 -15240580 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 false true X 200. 300. X X X 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 2 RICHLAND MEMORIAL HOSPITAL, INC. (RMH) INTEGRATED INTO THE CARLE FOUNDATION THROUGH A MEMBERSHIP SUBSTITUTION EFFECTIVE APRIL 1, 2017. THE ORGANIZATION CONTINUES TO BE ORGANIZED AND EXCLUSIVELY OPERATED AS A NOT-FOR-PROFIT CORPORATION FOR CHARITABLE, BENEVOLENT, SCIENTIFIC, AND EDUCATIONAL PURPOSES WITHIN THE MEANING OF SECTION 501(C) (3) OF THE INTERNAL REVENUE CODE OF 1986. 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 COMMUNITY HEALTH NEEDS ASSESSMENT 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: - RICHLAND COUNTY SHERIFF DEPARTMENT - RICHLAND COUNTY ADDICTIONS PREVENTION COALITION - OLNEY CENTRAL COLLEGE - RICHLAND COUNTY SCHOOL DISTRICT, SOCIAL SERVICES - RICHLAND COUNTY MINISTERIAL ASSOCIATION - EMBARRASS RIVER BASIN AGENCY - STOPPING WOMEN ABUSE NOW (SWAN) - DEPARTMENT OF HUMAN SERVICES - RICHLAND COUNTY HOUSING AUTHORITY - RICHLAND COUNTY TB & HEALTH OFFICE - CRAWFORD COUNTY HEALTH DEPARTMENT - LINCOLN TRAIL COLLEGE - WABASH COUNTY HEALTH DEPARTMENT - JASPER COUNTY SCHOOL DISTRICT - JASPER COUNTY HEALTH DEPARTMENT - THE MASTER'S HANDS - LAWRENCE COUNTY HEALTH DEPARTMENT - RIDES MASS TRANSIT DISTRICT - CARLE HEALTH SYSTEM - RICHLAND MEMORIAL HOSPITAL, INC. - JASPER COUNTY HEALTH DEPARTMENT - HOME HEALTH/HOSPICE OF SE IL PART V, SECTION C, LINES 5 AND 7 THE CHNA AND IMPLEMENTATION STRATEGY ARE AVAILABLE AT HTTPS://WWW.CARLERMH.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 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 HOSPITAL'S 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). THE HOSPITAL IS CURRENTLY RECRUITING MORE PNPS AND ANTICIPATES OPENING AN OUTPATIENT PSYCHIATRIC CLINIC IN 2019. 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 WOMEN'S HEALTH NP, AND OVER THE LAST FEW YEARS, HAS ADDED A PEDIATRIC NP, GENERAL SURGERY CONSULTS, AND ORTHOPEDIC CONSULTS. THE HOSPITAL ALSO RECENTLY ADDED A FAMILY PRACTICE/OBSTETRICS PHYSICIAN AND AN INTERNAL MEDICINE PHYSICIAN TO THE CLINIC. 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. AS OF SEPTEMBER 2018, THE CLINIC IS BACK TO ONE PHYSICIAN AND ONE FNP. 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 WILL BE A SIGNIFICANT ASSET TO THE COMMUNITY, AND WILL PROVIDE A LONG-SOUGHT SOLUTION TO AN IDENTIFIED NEED OF PAST AND CURRENT CHNAS. TO ADDRESS CHRONIC DISEASE MANAGEMENT, THE HOSPITAL ADDED A TRANSITION CARE NURSE. SHE MEETS WITH PATIENTS WHO HAVE CHRONIC DISEASES SUCH AS COPD, CONGESTIVE HEART FAILURE, DIABETES, AND PNEUMONIA, AND TALKS WITH THEM ABOUT WHAT THEY NEED TO KNOW AND DO ONCE THEY RETURN HOME. SHE ALSO FOLLOWS UP WITH THEM AFTER THEY RETURN HOME. THE HOSPITAL ALSO STARTED A 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." THE HOSPITAL ADDED A CARDIOLOGY CLINIC IN 2017 WITH THE ARRIVAL OF A NEW CARDIOLOGIST IN NOVEMBER OF 2018. IN JANUARY OF 2018, DOCTORS FOR THE EMERGENCY ROOM TRANSITIONED TO A GROUP PROVIDED BY CARLE HEALTH SYSTEM. THE TRANSITION APPEARS 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. IT IS ANTICIPATED THAT THE NEW CARLE RELATIONSHIP WILL CONTINUE TO IMPROVE LOCAL HEALTH CIRCUMSTANCES FOR ALL PATIENTS, ESPECIALLY THOSE WHO MAY HAVE BEEN UNDERSERVED IN THE PAST. 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, ESPECIALL 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, $1,452,791 FOR PHYSICIAN CLINICS, $183,964 FOR EMERGENCY ROOM, AND $523,540 FOR AMBULANCE SERVICE. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION RMH CALCULATED BAD DEBT EXPENSE AT COST USING A COST-TO-CHARGE RATIO AS CALCULATED UTILIZING DATA FROM AN INTERNAL COST ACCOUNTING SYSTEM AND USING A METHODOLOGY CONSISTENT WITH SCHEDULE H INSTRUCTIONS. AFTER EXHAUSTING ALL COLLECTION PROCEDURES PATIENT ACCOUNTS ARE THEN WRITTEN OFF TO BAD DEBT EXPENSE. 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 ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 4 - BAD DEBT FOOTNOTE THE FOOTNOTE PERTAINING TO BAD DEBT EXPENSE CAN BE FOUND ON PAGE 27 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 FINANICAL ASSISTANCE AND THOSE THAT AREN'T 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 HOSPITAL'S PATIENT POPULATION INCLUDES ALL WHO RECEIVE CARE, WITHOUT REGARD TO INSURANCE COVERAGE OR ELIGIBILITY FOR ASSISTANCE. RMH'S 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 134 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 TRUSTEES AND SENIOR LEADERSHIP. WHILE RMH'S CHNA AND COMMUNITY BENEFIT REPORTING IS SEPARATE FROM THE CARLE FOUNDATION HOSPITAL (TCFH), IT FOLLOWS THE SAME GUIDELINES AND PRINCIPLES AS TCFH. 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. X X X true false false false false false false true false JOHN SNYDER TRUSTEE, EXEC VP & COO 0 961660 0 243554 0 345317 0 338446 0 15445 0 1904422 0 306629 HARRY BROCKUS CEO 260507 0 29625 0 84340 0 63361 0 22258 0 460091 0 41939 0 Regina Thomas CNO & DIR PATIENT CARE SVS 149822 0 0 0 20287 0 15767 0 4367 0 190243 0 0 0 MARY WALLER MD PHYSICIAN 362412 0 0 0 662 0 29051 0 896 0 393021 0 0 0 Paul Sutherland MD PHYSICIAN 340748 0 0 0 662 0 35457 0 7781 0 384648 0 0 0 Phillip Rosett MD PHYSICIAN 321929 0 0 0 662 0 31696 0 5202 0 359489 0 0 0 PRASHANTH ANAND MD PHYSICIAN 461556 0 0 0 662 0 29702 0 8416 0 500336 0 0 0 STEPHEN REID MD PHYSICIAN 340519 0 0 0 662 0 35451 0 6412 0 383044 0 0 0 DAVID ALLEN CEO - FORMER 0 0 21326 0 279204 0 4023 0 0 0 304553 0 0 0 H TIMOTHY GARRETT DO TRUSTEE & PHYSICIAN 324661 0 0 0 662 0 41036 0 0 0 366359 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 DAVID ALLEN RECEIVED SEVERANCE PAYMENTS IN 2018 IN THE AMOUNT OF $255,122. Schedule J, Part I, Question 4B THE 2018 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 AND JOHN SNYDER. IN 2018, PAYMENTS FROM THE 457(F) PLAN WERE MADE TO HARRY BROCKUS ($41,939) AND JOHN SNYDER ($306,629). 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 TRUSTEES PRIOR TO ANY INCENTIVE PAYOUT. Marcia Vaughn Family member secretary/treasurer 97434 Employment false Ray Vaughn Family member secretary/treasurer 195872 Legal Services false Susan Zuber Family Member trustee 64024 Employment false Schedule L, Part V RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION SUSAN ZUBER IS AN EMPLOYEE OF RICHLAND MEMORIAL HOSPITAL AND HAS A FAMILY RELATIONSHIP WITH HERMAN ZUBER WHO SERVES AS A TRUSTEE FOR THE HOSPITAL. RAY VAUGHN PROVIDES LEGAL SERVICES TO RICHLAND MEMORIAL HOSPITAL AND HAS A FAMILY RELATIONSHIP WITH CAROL SCHAFER WHO SERVES AS SECRETARY/TREASURER OF THE BOARD. MARCIA VAUGHN IS AN EMPLOYEE OF RICHLAND MEMORIAL HOSPITAL AND HAS A FAMILY RELATIONSHIP WITH CAROL SCHAFER WHO SERVES AS SECRETARY/TREASURER 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, 2018 THROUGH DECEMBER 31, 2018, RMH RECORDED 14,072 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 IS ALSO PROVIDED THROUGH RMH'S FINANCIAL ASSISTANCE POLICY OFFERED IN 2018. 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: - APERION CARE - OLNEY - AMERICAN CANCER SOCIETY - BIG BROTHERS BIG SISTERS - BLUE KNIGHT TIP OFF CLUB - FLORA HIGH SCHOOL ATHLETIC DEPARTMENT - FRIENDS OF OLNEY - ILLINOIS HOSPITAL RESEARCH & EDUCATIONAL FOUNDATION - JASPER COUNTY CREATING ENTREPRENEURIAL OPPORTUNITIES (CEO) PROGRAM - JASPER COUNTY EXTENSION COUNCIL - JASPER COUNTY FAIR ASSOCIATION - JASPER COUNTY COMMUNITY FOUNDATION - JASPER COUNTY CHAMBER OF COMMERCE - JASPER COUNTY SCHOOL DISTRICT - MUSCULAR DYSTROPHY ASSOCIATION - NATIONAL CHILD SAFETY COUNCIL - NATIONAL FIRE SAFETY COUNCIL, INC. - OLNEY COUNTY COLLEGE FOUNDATION - OLNEY ARTS COUNCIL - OLNEY ELKS CLUB - OLNEY LADY TIGERS SOFTBALL - OLNEY LITTLE LEAGUE - OLNEY LIONS CLUB FOUNDATION - OLNEY TIGER FOOTBALL - OLNEY TIGER SHARKS SWIM TEAM - OUTREACH MISSIONS - FOOD PANTRY - RICHLAND COUNTY 4-H FOUNDATION - RICHLAND COUNTY CREATING ENTREPRENEURIAL OPPORTUNITIES (CEO) PROGRAM - RICHLAND COUNTY ELEMENTARY SCHOOL - RICHLAND COUNTY FARM & FAIR ASSOCIATION - RICHLAND COUNTY SOCCER ASSOCIATION - RICHLAND COUNTY HIGH SCHOOL - ST. THOMAS SCHOOL - SWAN - U.S. ROUTE 50 FOUR-LANE COALITION - VOLUNTEER FIREMAN'S ASSOCIATION OF WEST SALEM - WEST SALEM GRADE SCHOOL PTO - WEST SALEM DEVELOPMENT ASSOCIATION 5. VARIOUS WELLNESS EVENTS, COMMUNITY CLINICS, SUPPORT GROUPS, MEDICAL OUTREACH AND EDUCATION INCLUDING: - BLOOD PRESSURE SCREENING CLINICS - DIABETIC EDUCATION DAY - HEALTHFEST - NATIONAL HOSPITAL WEEK CHOLESTEROL / PSA SCREENING CLINIC - OLNEY SENIOR EXPO - SUPPORT GROUPS A. BREAST CANCER SUPPORT GROUP - TICKET FOR THE CURE B. BREAST HEALTH OUTREACH/EDUCATION - TICKET FOR THE CURE C. CPR CLASSES D. DIABETES SUPPORT GROUP E. FIRST AID CLASSES F. INFECTION CONTROL IN-SERVICES TO LOCAL SCHOOLS G. LIFE SMART FOR WOMEN EDUCATIONAL CLASSES H. PREPARED CHILDBIRTH CLASSES I. 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) - MAMMOGRAPHY ASSISTANCE IN THE FORM OF A SUSAN G. KOMAN FOR THE CURE GRANT. 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 CORPORATION'S 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 OFFICER'S (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 BOARD'S 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 MEMBER'S 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 ORGANIZATION'S 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 Other Changes in Net Assets of Fund Balances Interest in Richland Memorial Hospital Foundation - $68,653 THE CARLE FOUNDATION 611 W PARK ST URBANA IL 618012595 370673465 PARENT/INVMGT IL 501(c)(3) 12C, III-FI NA false THE CARLE FOUNDATION HOSPITAL 611 W PARK ST URBANA IL 618012595 371119538 HOSPITAL SVCS IL 501(c)(3) 3 TCF true THE CARLE DEVELOPMENT FOUNDATION 611 W PARK ST URBANA IL 618012595 371159978 Fundraising IL 501(c)(3) 7 TCF true CARLE RETIREMENT CENTERS INC 611 W PARK ST URBANA IL 618012595 371160033 Retirement IL 501(c)(3) 10 TCF true CARLE COMMUNITY HEALTH CORPORATION 611 W PARK ST URBANA IL 618012595 364458371 FNDN MISSION IL 501(c)(3) 12A, TYPE I TCDF true HOOPESTON COMMUNITY MEMORIAL HOSPITAL 701 E ORANGE ST HOOPESTON IL 609421801 363637465 HOSPITAL SVCS IL 501(c)(3) 3 TCF true CARLE HEALTH CARE INCORPORATED 611 W PARK ST URBANA IL 618012595 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 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 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 false false true true false false false false false false HEALTH ALLIANCE MEDICAL PLANS INC l 968222 BOOK HEALTH ALLIANCE CONNECT INC l 82921 BOOK HEALTH ALLIANCE MEDICAL PLANS INC m 460008 BOOK CARLE HEALTH CARE INCORPORATED m 2562715 BOOK