2019-02-26T15:42:44-06:00 2018-06-30 390758449 WIPFLI LLP 4890 OWEN AYRES COURT SUITE 200 EAU CLAIRE WI 54701 990 2017-07-01 370661208 HILLSBORO AREA HOSPITAL INC HILL 2175326111 1200 EAST TREMONT STREET HILLSBORO IL 62049 REX BROWN PRESIDENT & CEO 2175326111 2019-02-21 1 PAUL M TRACZEK CPA P01368830 7158323407 2019-02-09 137.26.200.211 2019-02-21 14:04:55 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 558C6F47C777A73CECB93EB9107DCB0C387663C8 2017 2019-02-21 02:37:17Z REX BROWN 1200 EAST TREMONT STREET HILLSBORO IL 62049 25035012 0 X WWW.HILLSBOROAREAHOSPITAL.ORG X 1906 IL OPERATION OF HOSPITAL (INPATIENT, SWING BED AND OUTPATIENT) AND ASSISTED LIVING FACILITIES. 10 10 304 20 0 0 162890 67141 23318733 24120810 259828 640593 105614 206468 23847065 25035012 0 0 0 0 9920538 10341324 0 0 0 11495806 11803139 21416344 22144463 2430721 2890549 35961012 39631406 7680124 8803942 28280888 30827464 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 16776374 24244719 OPERATION OF A 25-BED CRITICAL ACCESS HOSPITAL (INPATIENT, SWING BED AND OUTPATIENT) WITH AN ASSISTED LIVING FACILITY. IN FY2018, 848 ACUTE DAYS, 1,647 SWING BED DAYS, 15,088 OUTPATIENT VISITS AND 12,604 ASSISTED LIVING RESIDENT DAYS WERE PROVIDED. HILLSBORO AREA HOSPITAL ALSO PROVIDED $970,097 IN CHARITY CARE AND $1,086,094 IN OTHER COMMUNITY BENEFITS, NOT INCLUDING BAD DEBT. 16776374 1 1 0 1 0 0 0 0 0 1 1 0 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 62 0 1 304 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X TERRI CARROLL CFO 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 LINDSAY WAGAHOFF DIRECTOR 1.00 X 0 0 0 DAVE IMLER CHAIRMAN 1.00 X X 0 0 0 MICHELLE ONDREY 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 170766 0 29665 ELVIS HARRISON VP OF PATIENT CARE SERVICE 40.00 X 137870 0 27797 ABBY BUGG TEAMWORK DIRECTOR 40.00 X 104100 0 39105 AGNES OTTO CLINICAL SUPERVISOR 40.00 X 107892 0 32185 520628 0 128752 4 0 1 1 ILLINOIS EMERGENCY PHYSICIANS 4075 COPPER RIDGE DRIVE TRAVERSE CITY MI 49684 PHYSICIAN COVERAGE 1518427 PRECISE SPECIALTIES CORP PO BOX 572 HILLSBORO IL 62049 ULTRASOUND 206835 MEDICAL OUTSOURCING SOLUTIONS 1735 DEKALB AVE SYCAMORE IL 60178 NUCLEAR MEDICINE 180000 VIGILANT ANESTHESIA INC 121 LAKEWOOD DRIVE HILLSBORO IL 62049 ANESTHESIA 155977 WCP LABORATORIES INC 2326 MILLPARK DRIVE MARYLAND HEIGHTS MO 630433530 PATHOLOGY 130005 6 8075 59066 8075 67141 PATIENT SERVICE REVENUE 622110 24120810 24120810 24120810 639725 639725 41495 0 41495 41495 41495 868 0 868 868 868 OTHER INCOME 900099 117700 117700 CAFETERIA 722514 41064 41064 AMBULANCE REVENUE 900099 6209 6209 164973 25035012 24244719 0 723152 X 200432 200432 7832813 5868137 1964676 185176 138729 46447 1538038 1152258 385780 584865 438165 146700 587691 587691 51981 51981 40701 40701 2293336 1429604 863732 65595 65595 98298 58220 40078 664106 312161 351945 52311 31496 20815 1317931 1202461 115470 228783 42851 185932 PHYSICIAN FEES 2129026 2129026 SUPPLIES 1952062 1863414 88648 BAD DEBT 1084620 1084620 REPAIRS & MAINTENANCE 707163 499382 207781 529535 525850 3685 22144463 16776374 5368089 0 984937 1560753 16114309 20557412 3709403 2448623 448786 512385 416611 366716 32159870 21162610 11437178 10997260 2314471 2674746 535317 513511 35961012 39631406 2083347 2184503 5414491 5116728 182286 1502711 7680124 8803942 X 27294621 29852573 701267 689891 285000 285000 28280888 30827464 35961012 39631406 X 2890549 172666 -516639 X 0 1 X 0 0 X 0 0 0 0 0 0 0 0 1 10968 10968 0 PART II-B, LINE 1: HILLSBORO AREA HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE ILLINOIS HOSPITAL ASSOCIATION (IHA), THE AMERICAN HOSPITAL ASSOCIATION (AHA), STRATEGIC HEALTHCARE, AND THE NATIONAL RURAL HEALTH ASSOCIATION (NRHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS, TO HELP WITH STAFF TRAINING, AND TO ASSIST WITH REIMBURSEMENT. HILLSBORO AREA HOSPITAL ESTIMATED THAT $10,968 OUT OF THE TOTAL DUES PAID TO IHA, AHA, STRATEGIC HEALTHARE, AND NRHA WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT IN ILLINOIS. 414863 3567 418430 412788 2075 414863 410867 1921 412788 409239 1628 410867 425092 5610 21463 409239 0.68110 0.31890 0 1 1 295110 295110 16740035 8633065 8106970 1759062 974868 784194 13295394 11554677 1740717 70269 70269 10997260 ASSET RETIREMENT OBLIGATION 105299 AMOUNTS PAYABLE TO THIRD-PARTY REIMBURSEMENT PROGRAMS 1397412 1502711 23623058 172666 172666 23450392 1584620 1584620 25035012 21059843 0 21059843 1084620 1084620 22144463 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 1,084,620. TRANSFERS TO RELATED PARTY 500,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,084,620. 1 1 X 1 X 125.000000000000 1 X 0 1 1 0 1 0 429646 429646 0.02040 3406850 1965678 1441172 0.06840 3836496 1965678 1870818 0.08880 38844 8832 30012 0.00140 3880981 3186124 694857 0.03300 197028 197028 0.00940 4116853 3194956 921897 0.04380 7953349 5160634 2792715 0.13260 1 480367 240184 9238829 9267963 -29134 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 15 1 0 0 1 X WWW.HILLSBOROHEALTH.ORG X 1 15 1 WWW.HILLSBOROHEALTH.ORG 0 1 X 125.000000000000 200.000000000000 X X X X 1 1 X X X X 1 X WWW.HILLSBOROHEALTH.ORG X WWW.HILLSBOROHEALTH.ORG X WWW.HILLSBOROHEALTH.ORG X X X X X X 1 X X 1 X X X X X X X 1 X 0 1 HILLSBORO AREA HOSPITAL PART V, SECTION B, LINE 5: PRIMARY SOURCE INPUT WAS GATHERED THROUGH THE USE OF FOCUS GROUPS. PARTICIPANTS WERE SELECTED TO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVICED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE OF THE COMMUNITIES' HEALTH AND NEEDS: SENIORS, DAY CARE WORKERS, PERSONS WITH DISABILITIES, LOCAL HEALTH DEPARTMENT, DENTIST, OPTOMETRIST, ELECTED OFFICIALS, BOARDS OF COMMUNITY AGENCIES AND ORGANIZATIONS, AND LOCAL BUSINESS PERSONS ALL REPRESENTING THE INTEREST OF THE COMMUNITIES SERVED BY HILLSBORO AREA HOSPITAL. REPRESENTATIVES FROM THE HOSPITAL, INCLUDING MANAGERS OF ALL DEPARTMENTS WITH EXPERTISE IN THEIR FIELD OF SERVICE, ALSO PARTICIPATED.FOCUS GROUP #1 - HEALTH CARE PROFESSIONALS AND PARTNERSA FOCUS GROUP COMPRISED OF HEALTH CARE PROFESSIONALS AND PARTNERS MET ON FEBRUARY 11, 2016. THE GROUP INCLUDED THE ADMINISTRATOR OF THE MONTGOMERY COUNTY HEALTH DEPARTMENT, PHYSICIANS, A PHARMACIST, AN OPTOMETRIST, A DENTIST, NURSES, NURSING HOME ADMINISTRATORS, AND OTHERS.FOCUS GROUP #2 - COMMUNITY OFFICIALSA FOCUS GROUP COMPRISED OF COMMUNITY LEADERS AND GROUP REPRESENTATIVES MET ON FEBRUARY 11, 2016. THE GROUP CONSISTED OF 20 PARTICIPANTS, INCLUDING A MEMBER OF THE MONTGOMERY COUNTY BOARD, THE HILLSBORO MAYOR, A SCHOOL SUPERINTENDENT, A CHAMBER OF COMMERCE EXECUTIVE, AND OTHERS.FOCUS GROUP #3 - COMMUNITY MEMBERS AND ORGANIZATIONSA FOCUS GROUP COMPRISED OF COMMUNITY MEMBERS AND REPRESENTATIVES OF COMMUNITY ORGANIZATIONS MET ON FEBRUARY 11, 2016. THE GROUP INCLUDED 18 COMMUNITY MEMBERS AND ORGANIZATION REPRESENTATIVES. HILLSBORO AREA HOSPITAL PART V, SECTION B, LINE 11: A NEW CHNA WAS COMPLETED DURING TAX YEAR 2015. FOLLOWING ARE THE ACTIONS TAKEN DURING THE YEAR TO ADDRESS THE CHNA COMPLETED IN TAX YEAR 2015. TOP PRIORITY CHNA ITEMS FROM THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT1. ADDRESS GAPS IN DELIVERY OF MENTAL HEALTH SERVICES WHEREVER POSSIBLE-THE ASSESSMENT OF BUILDING A LOCAL INVENTORY OF COUNSELORS INCLUDING CLERGY, IN YEAR ONE FOR MENTAL HEALTHHILLSBORO AREA HOSPITAL DID NOT FIND COUNSELORS IN SUFFICIENT NUMBERS TO DEVELOP A LIST. HAH IS SUBMITTING A PROPOSAL FOR TELEPSYCHIATRY SERVICES WITH INTOUCH PHYSICIANS, A CHICAGO-BASED PSYCHIATRIC SERVICE, TO ADDRESS ACCESS TO MENTAL HEALTH SERVICES.2. THE SUMMER FOOD AND EXERCISE PROGRAM FOR YOUTH IMPROVE AVAILABILITY OF BASIC WELLNESS CARE OPPORTUNITIES FOR YOUTH.THE FREE SUMMER LUNCH PROGRAM WAS INSTITUTED TO PROVIDE NUTRITIOUS MEALS AND PHYSICAL ACTIVITY TO CHILDREN DURING THE SUMMER MONTHS WHEN SCHOOL IS NOT IN SESSION. THE HOSPITAL STARTED THE PROGRAM IN 2013, GIVEN THAT ABOUT 50 PERCENT OF THE HILLSBORO SCHOOL DISTRICT POPULATION WAS ON THE FREE AND REDUCED LUNCH PROGRAM DURING THE SCHOOL YEAR. THIS PROGRAM FILLS THE NEED FOR THOSE SAME STUDENTS DURING THE SUMMER MONTHS WHO MAY NOT HAVE ACCESS TO A HOT MEAL FOR LUNCH.VOLUNTEERS CONSIST OF CHURCH MEMBERS, TEACHERS, AND OTHER SERVICE ORGANIZATIONS WHICH ASSIST IN PROVIDING STAFFING FOR THE PROGRAM. TRANSPORTATION FOR THE CHILDREN IS PROVIDED BY ONE OF THE LOCAL CHURCHES. FUSION FITNESS AND AQUATICS, A SISTER ORGANIZATION TO HAH, PROVIDES FREE PHYSICAL ACTIVITIES AND SWIMMING FOR THE CHILDREN TWO DAYS A WEEK. OVER THE SUMMER, THE PROGRAM SERVED APPROXIMATELY 730 MEALS TO NEARLY 100 CHILDREN.THE PROGRAM WAS EXPANDED TO INCLUDE ACTIVITIES FIVE DAYS A WEEK, INCLUDING A SERVICE DAY TO MENTOR CHILDREN IN GIVING BACK TO THE COMMUNITY. ALSO ADDED WERE SPEAKERS DELIVERING DIFFERENT TOPICS TO PROMOTE HEALTHY LIFESTYLE CHOICES. A GARDEN PLANTED, MAINTAINED, AND HARVESTED BY THE CHILDREN TAUGHT CHILDREN HOW HEALTHY FOOD CHOICES CAN BE RAISED IN THEIR BACKYARD. LOCAL CHURCHES EXPANDED THE TRANSPORTATION OPTIONS, WITH VOLUNTEERS CONTINUING TO PROVIDE STAFFING FOR THE PROGRAM.A BAG OF NON-PERISHABLE FOOD DISTRIBUTED TO THE CHILDREN ON FRIDAYS WAS ADDED SO THEY WOULD BE ABLE TO EAT DURING THE WEEKEND. THESE BAGS WERE DONATED BY LOCAL CHURCH GROUPS. BACKPACKS FILLED WITH SCHOOL SUPPLIES WERE DONATED BY THE COMMUNITY AND PRESENTED TO THE CHILDREN ON THE LAST DAY OF THE PROGRAM.3. SUPPORT REGIONAL CARE INFORMATION FOR WEBSITE BEING DEVELOPED BY SPRINGFIELD CLINICIN 2015, HAH CONTRACTED WITH LEGATO HEALTHCARE MARKETING, A COMMUNICATIONS COMPANY, TO CONSTRUCT A WEBSITE FOR THE HOSPITAL THAT WILL CONTAIN ELEMENTS OF THE REGIONAL CARE OFFERED AND ALSO CONNECT TO A VARIETY OF PERTINENT WEBSITES, INCLUDING THE SPRINGFIELD CLINIC. THE WEBSITE BECAME AVAILABLE IN SPRING OF 2016.4. PROVIDE LOCAL CARE INFORMATION FOR YOUTHHAH USED A VARIETY OF APPROACHES TO MAKING LOCAL CARE INFORMATION AVAILABLE TO YOUTH. THE STAFF OF HAH ARE AVAILABLE TO HIGH SCHOOL COUNSELORS (2015-16), THE FOUR SCHOOL DISTRICT'S CERTIFIED NURSING ASSISTANT CLASSES (2013-16), THE JUNIOR BOARD (2014-16) INTERACT (2015-16) AND THE COUNTY'S CREATING ENTREPRENEURIAL OPPORTUNITIES (2015-16). HEALTHFUL BEHAVIORS ARE INTEGRATED INTO THE HOSPITAL'S SUMMER LUNCH PROGRAM AND THE CATCH PROGRAM THAT IS SPONSORED BY HAH.5. CREATE BUSINESS PARTNERSHIPS FOR MAMMOGRAPHYTHIS INITIATIVE WAS CREATED TO INCREASE AWARENESS OF THE BENEFITS OF EARLY DETECTION AND PAYMENT OF MAMMOGRAPHY UTILIZING THE ASSISTANCE OF LOCAL BUSINESSES. INITIALLY, THERE WAS NOT MUCH INTEREST GENERATED. HOWEVER, THE MONTGOMERY COUNTY CANCER ASSOCIATION PROVIDED FUNDS THAT COULD BE USED TO OFFSET COSTS, AND HAH CREATED AN AWARENESS PROGRAM EDUCATING THE PUBLIC ON THE BENEFITS OF 3-D MAMMOGRAPHY, WHICH ENHANCED INTEREST.6. THE CATCH PROGRAM - IMPROVE AVAILABILITY OF BASIC WELLNESS CARE OPPORTUNITIES FOR YOUTHFUSION FITNESS & AQUATICS, IN COLLABORATION WITH HILLSBORO AREA HOSPITAL, OFFERS AN AFTER-SCHOOL PROGRAM FOR CHILDREN WHO ARE AT RISK OF BECOMING OVERWEIGHT OR OBESE.CATCH KIDS CLUB IS A 2-HOUR LONG MONDAY - FRIDAY PROGRAM. EACH DAY'S SESSION INCLUDES STRUCTURED TIME FOR NUTRITION EDUCATION, HEALTHY SNACKS AND HOMEWORK FOLLOWED BY 60 MINUTES OF FUN, HIGH-ENERGY GAMES LED BY FUSION STAFF. THE ATTENDANCE FOR THE AFTER SCHOOL PROGRAM AVERAGE FROM 10-15 CHILDREN PER DAY.THE PROGRAM IS FREE FOR CHILDREN WHO QUALIFY FOR THEIR SCHOOL DISTRICT'S FREE/REDUCED PRICE LUNCH PROGRAM. THOSE CHILDREN WHO DO NOT MEET THE INCOME ELIGIBILITY REQUIREMENT PAY A FEE THAT IS ESTABLISHED ACCORDING TO FAMILY INCOME.THROUGHOUT THE SUMMER, TWO CATCH KIDS CAMPS ARE OFFERED FOR CHILDREN WHO WILL BE STARTING GRADES 3-6. CLASS SIZE IS 30 STUDENTS AND A WAITING LIST EXISTS.7. THE MARINA PROJECT - ENCOURAGE IMPROVED ACCESS TO INDOOR AND OUTDOOR RECREATION OPPORTUNITIES TO ADDRESS PUBLIC ACCESS NEEDS FOR PERSONS WITH IMPAIRMENT, DISABILITY AND/OR HANDICAP IN COMMUNITY.HAH PRESENTED THE VALUE OF IMPROVED ACCESS TO THE HILLSBORO AREA HEALTH FOUNDATION AND SUPPORTED THE CREATION OF FUND-RAISING ACTIVITIES (2014-2016) TO BUILD AND MAINTAIN AN ACCESSIBLE DOCK ON GLEN SHOALS LAKE.8. THE PROMOTION OF LOCAL RECREATIONAL RESOURCESTHROUGH ITS SISTER CORPORATION, HAH COLLABORATED WITH THE NATURAL AREA GUARDIANS TO CREATION A ACTIVITY/EXERCISE CHALLENGE FOR USE OF THE VARIOUS PROTECTED AREAS DEVELOPED AND MAINTAINED BY THE NATURAL AREA GUARDIANS (2015-16).9. PROMOTING LOCAL STUDENTS INTERESTED IN MEDICAL SCHOOL RECRUIT PRIMARY CARE PHYSICIANS AND PROVIDERS.HAH HOSTED NUMEROUS INTRODUCTORY SESSIONS WITH STUDENTS AND PARENTS (2014-2016). ONE MEDICAL RESIDENT IS PRESENTLY RECEIVING FINANCIAL SUPPORT, TWO RESIDENTS ARE BEING RECOMMENDED FOR SUPPORT AND A FOURTH STUDENT IS IN LINE TO RECEIVE SUPPORT WHEN HE GRADUATES FROM MEDICAL SCHOOL AND ENTERS A RESIDENCY PERTINENT TO THE AREA'S NEEDS.10. CONTINUE TO DEVELOP A PLAN FOR AN URGENT CARE ALTERNATIVE TO EMERGENCY ROOM CARE.HAH SUPPORTED THE EDUCATION (2013-2015) OF TWO ADVANCED PRACTICE NURSES WITH THE INTENT OF HIRING THEM TO STAFF THE URGENT CARE ALTERNATIVE. THEY ACCEPTED EMPLOYMENT ELSEWHERE. HAH REMAINS ACTIVE IN SEEKING STAFF FOR AN URGENT CARE ALTERNATIVE. 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. HILLSBORO AREA HOSPITAL PART V, SECTION B, LINE 24: IF A PATIENT DOES NOT APPLY FOR FINANCIAL ASSISTANCE AND DOESN'T MEET PRESUMPTIVE ELIGIBILITY REQUIREMENTS, NO DISCOUNT IS APPLIED PER HOSPITAL POLICY, SO GROSS CHARGES ARE BILLED TO THOSE PATIENTS. 3 1 - TREMONT RIDGE ASSISTED LIVING 801 E TREMONT STREET HILLSBORO IL 62049 ASSISTED LIVING FACILITY 2 - HILLSBORO AREA HOSPITAL - LITCHFIELD 120 W SAINT JOHN STREET SUITE 2 LITCHFIELD IL 62056 OUTPATIENT PHYSICAL THERAPY 3 - HILLSBORO AREA HOSPITAL - NOKOMIS 207 W STATE STREET NOKOMIS IL 62075 OUTPATIENT PHYSICAL THERAPY 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 $ 1,084,620. PART III, LINE 2: THE COSTING METHODOLGY 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 COLLECTIBILITY 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 FOR. 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 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 AVALIBILITY 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: THE HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF PATIENTS IN THE CITY OF HILLSBORO AND THE SURROUNDING AREAS. THE HOSPITAL IS THE LEADING HEALTHCARE PROVIDER FOR THE MONTGOMERY COUNTY ILLINOIS COMMUNITY. THESE COMMUNITIES ARE MEDICALLY VULNERABLE AND HAVE A LARGE INDIGENT POPULATION. FOR FURTHER INFORMATION ABOUT THE COMMUNITY SERVED PLEASE REFER TO OUR COMMUNITY HEALTH NEEDS ASSESSMENT ON THE HOSPITAL WEBSITE AT WWW.HILLSBOROHEALTH.ORG. 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 PRIVIDES 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 ENVIROMENTAL 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 ASISTANCE 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 MONTOGOMERY 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 161030 0 9736 0 0 0 5307 0 24358 0 200431 0 0 0 ELVIS HARRISON VP OF PATIENT CARE SERVICE 126346 0 11524 0 0 0 0 0 27797 0 165667 0 0 0 FORM 990, PART VII, SECTION A, LINE 5: HEALTHTECH MANAGEMENT SERVICES, FORMERLY BRIM HEALTHCARE, INC., WAS PAID $586,811 FOR MANAGEMENT SERVICES. CEO REX BROWN IS EMPLOYED BY HEALTHTECH MANAGEMENT SERVICES. A CITY OF HILLSBORO MONTGOMERY COUNTY ILLINOIS 376001658 2008-09-30 7220000 CAPITAL IMPROVEMENT PROJECT 0 0 0 A 2103273 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 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. 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 TRAINING AND OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 803,085. MANAGEMENT AND GENERAL EXPENSES 353,049. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,156,134. MEDICAL AND ADMINISTRATIVE PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 626,519. MANAGEMENT AND GENERAL EXPENSES 510,683. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,137,202. FORM 990, PART XI, LINE 9: TRANSFER TO HILLSBORO AREA HEALTH SYSTEM NFP -500,000. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 8,080. NET ASSETS RELEASED FROM RESTRICTION -24,719. 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 0 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 0 0 0 1 0 0 0 0 0 0 1 1 0 1 0 1 1 1 1 1