2017-05-10T10:48:58-05:00 2016-06-30 430352985 KERBER ECK & BRAECKEL LLP 1116 W MAIN ST CARBONDALE IL 629012335 990 2015-07-01 800618988 LAWRENCE COUNTY MEMORIAL HOSPITAL LAWR 6189431000 2200 STATE STREET LAWRENCEVILLE IL 62439 CARL ATEN BOARD CHAIR 6189431000 2017-05-10 true BRENT KOCHEL P01055927 6185291040 2017-05-10 2015 2021-01-29 14:40:06Z CARL ATEN 2200 STATE STREET LAWRENCEVILLE IL 62439 17355218 false X WWW.LCMHOSP.ORG X 1950 IL AT LAWRENCE COUNTY MEMORIAL HOSPITAL, WE OFFER COMPASSIONATE, PROFESSIONAL HEALTHCARE THAT MEETS THE HIGHEST STANDARDS OF EXCELLENCE. 9 6 197 39 0 66850 105531 15868522 16710334 15765 7411 624135 531942 16575272 17355218 0 0 7972018 9082174 0 0 7584021 8085847 15556039 17168021 1019233 187197 12434966 13047774 3574231 3999842 8860735 9047932 AT LAWRENCE COUNTY MEMORIAL HOSPITAL WE OFFER COMPASSIONATE, PROFESSIONAL HEALTHCARE THAT MEETS THE HIGHEST STANDARDS OF EXCELLENCE. false false 12049878 17242276 THE HOSPITPAL'S MISSION IS TO PROVIDE HIGH QUALITY CARE AND COST EFFECTIVE HEALTHCARE, WHICH INCLUDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO THE RESIDENTS OF LAWRENCE COUNTY, IL. ALL EXPENSES RELATE TO COSTS ASSOCIATED WITH PROVIDING THESE SERVICES, AND MAINLY INCLUDE SALARY AND WAGES TO STAFF AND COST OF SUPPLIES. 12049878 true true false false false false false false false true true false false false true false 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 false false false true 39 0 true 197 true false false false false false false false false false false X 9 6 false true false false false false false true true false false false true true true true true true true false IL X X LARRY SPOUR 6189437202 2200 STATE STREET LAWRENCEVILLE IL 62439 CARL ATEN BOARD CHAIR 3.00 1.00 X X 0 0 0 RON WALDROP VICE CHAIR 2.00 X X 0 0 0 REBECCA NESTLEROAD TRUSTEE 1.00 X X 0 0 0 MIKE SHEPPARD TRUSTEE 1.00 X 0 0 0 STANLEY WILLIAMS TRUSTEE 1.00 X 0 0 0 BJ SHAFFER TRUSTEE 2.00 X 0 0 0 CURT BENSON TRUSTEE/BEG 1.00 X 0 0 0 DR GARY CARR TRUSTEE /PHY 40.00 X 228417 0 0 DOUG FLORKOWSKI CEO 40.00 X 210000 0 63313 LARRY SPOUR CFO 40.00 X 110436 0 13036 RITA GARVEY CNO 40.00 X 92175 0 0 VALERIE BURNS PHYSICAN 40.00 X 206002 0 4185 STEVEN RAMSARAN PHYSICAN 40.00 X 338613 0 21495 CHARLES CLAGETT PHYSICAN 40.00 X 195572 0 18865 KEVIN STRANGE TRUSTEE 2.00 X 0 0 0 RODNEY FINCH PHYSICAN 40.00 X 186781 0 18865 1567996 139759 7 false true false HEALTHCARE SERVICE CORP 25551 NETWORK PLACE CHICAGO IL 606731255 EMPL HEALTH INS 901705 QUORUM HEALTH RESOURCES LLC 1573 MALLORY LANE BRENTWOOD TN 37027 CONTRACT MGT SV 649165 WISCONSIN PHYSICIANS SERVICE 912 NORTH PENTECOST DRIVE MARION IL 62959 CONTRACTED PHYS 516437 CPSI PO BOX 850309 6600 WALL STREET MOBILE AL 366850309 HOSP COMP SOFTW 367800 MARTIN GOLDSTONE MD 3926 W TOUHY STE 369 LINCOLNWOOD IL 60712 CONTRACTED PHYS 326280 23 74326 31205 105531 PATIENT SERVICE REVENUE 16710334 16710334 16710334 7411 7411 28883 28883 28883 28883 MEANINGFUL REVENUE 334350 334350 CAFETERIA INCOME 120492 120492 OTHER REVENUE 48217 48217 503059 17355218 17242276 7411 X 1567996 1567996 5768679 4326509 1442170 113320 84990 28330 1146185 859639 286546 485994 364495 121499 210021 210021 7936 7936 42301 42301 6748 6748 2706587 2072513 634074 28692 26211 2481 291837 124276 167561 8357 6268 2089 818333 613750 204583 4154 4154 37116 15944 21172 36809 36809 960263 720197 240066 212723 159542 53181 UNCOLLECTABLE ACCOUNTS 1252450 1252450 MEDICAL SUPPLY 670293 670293 MISCELLANEOUS 317555 238166 79389 DRUG EXPENSE 288370 288370 185302 185302 17168021 12049878 5118143 0 2164196 1968367 2789988 2567529 289377 289940 118262 701611 18073292 10552965 7073143 7520327 12434966 13047774 1312572 1577106 261835 432350 618575 1080235 1381249 910151 3574231 3999842 X 8860735 9047932 8860735 9047932 12434966 13047774 187197 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false 20150 20150 10514110 4635190 5878920 7539032 5917775 1621257 7520327 THIRD - PARTY REIMBURSEMENT 716093 LINE OF CREDIT 194058 910151 16102768 -1252450 -1252450 17355218 17355218 15915571 -1252450 -1252450 17168021 17168021 SCHEDULE D, PAGE 4, PART XI, LINE 2D PROVISION FOR UNCOLLECTABLE -1,252,450 SCHEDULE D, PAGE 4, PART XII, LINE 2D PROVISION FOR UNCOLLECTABLE -1,252,450 true true X true X 1.100000000000 true X true true true false false 622194 622194 0.03620 4521198 3775067 746131 0.04350 5143392 3775067 1368325 0.07970 5143392 3775067 1368325 0.07970 true 469543 6602051 6612639 -10588 X true true 1 1 LAWRENCE COUNTY MEMORIAL HOSPITAL 2200 STATE STREET LAWRENCEVILLE IL 62439 HTTPS://LCMHOSP.ORG 0005769 X X X X LAWRENCE COUNTY MEMORIAL HOSPITAL 1 false false true X X X X X X X X X X 16 true false false true X HTTPS://LCMHOSP.ORG X true 16 false false false true X 110.000000000000 300.000000000000 X X true true X X X X X true X HTTPSLCMHOSPORG X HTTPSLCMHOSPORG X X X true X true X X X X X true X false true FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 5 LCMH CONTRACTED WITH QHR CONSULTING SERVICES AS IT PRETAINED TO THE PREPARATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE FIRM PERFORMS SEVERAL INDEPENDENT DATA, AND RESOLVES ANY DATA INCONSISTENCIES OR DISCREPANCIES FROM THE COMBINED OPINIONS FORMED FROM LOCAL EXPERTS. ADDITIONALLY, QHR RELIES ON SECONDARY SOURCE DATA, AND MOST SECONDARY SOURCES USE THE COUNTY AS THE SMALLEST UNIT OF ANALYSIS. FINALLY, QHR ASKED OUR LOCAL EXPERT AREA RESIDENTS TO NOTE IF THEY PRECEIVED THE PROBLEMS OR NEEDS IDENTIFIED BY SECONDARY SOURCES TO EXIST IN THEIR PORTION OF THE COUNTY. MOST DATA USED IN THE ANALYSIS IS AVAILABLE FROM PUBLIC INTERNET SOURCES. IN ADDITION, WE DEPLOYED A CHNA "ROUND 1" SURVEY TO OUR LOCAL EXPERT ADVISORS TO GAIN LOCAL INPUT AS TO LOCAL HEALTH NEEDS AND THE NEEDS OF PRIORITY POPULATIONS. LOCAL EXPERT ADVISORS WERE LOCAL INDIVIDUALS SELECTED TO CONFORM TO THE INPUT REQUIRED BY THE FEDERAL GUIDELINES AND REGULATIONS. WE RECEIVED COMMUNITY INPUT FROM 19 LOCAL EXPERT ADVISORS. INFORMATION ANALYSIS AUGMENTED BY LOCAL OPINIONS SHOWED HOW LAWRENCE COUNTY RELATES TO ITS PEERS IN TERMS OF PRIMARY AND CHRONIC NEEDS AND OTHER ISSUES OF UNINSURED PERSONS, LOW-INCOME PERSONS, AND MINORITY GROUPS. RESPONDENTS COMMENTED ON IF THEY BELIEVE CERTAIN POPULATION GROUPS (OR PEOPLE WITH CERTAIN SITUATIONS) NEED HELP TO IMPROVE THEIR CONDITION, AND IF SO, WHO NEEDS TO DO WHAT. WHEN THE ANALYSIS WAS COMPLETE, WE PUT THE INFORMATION AND SUMMARY CONCLUSIONS BEFORE OUR LOCAL GROUP OF EXPERTS, WHO WERE ASKED TO AGREE OR DISAGREE WITH THE SUMMARY CONCLUSIONS. THEY WERE FREE TO AUGMENT POTENTIAL CONCLUSIONS WITH ADDITIONAL STATEMENTS OF NEED, AND NEW NEEDS DID EMERGE FROM THE EXCHANGE. CONSULTATION WITH 13 LOCAL EXPERTS OCCURRED AGAIN VIA AN INTERNET-BASED SURVEY. WITH THE PRIOR STEPS IDENTIFYING POTENTIAL COMMUNITY NEEDS, THE LOCAL EXPERTS PARTICIPATED IN A STRUCTURED COMMUNICATION TECHNIQUE CALLED A "WISDOM OF CROWDS" METHOD. THE PREMISE OF THIS APPROACH RELIES ON A PANEL OF EXPERTS WITH THE ASSUMPTION THAT THE COLLECTIVE WISDOM OF PARTICIPANTS IS SUPERIOR TO THE OPINION OF ANY ONE INDIVIDUAL, REGARDLESS OF THEIR PROFESSIONAL CREDENTIALS. IN THE LCMH PROCESS, EACH LOCAL EXPERT HAD THE OPPORTUNITY TO INTRODUCE NEEDS PREVIOUSLY UNIDENTIFIED AND TO CHALLENGE CONCLUSIONS DEVELOPED FROM THE DATA ANALYSIS. WHILE THERE WERE A FEW OPINIONS OF THE DATA CONCLUSIONS NOT BEING COMPLETELY ACCURATE, THE VAST MAJORITY OF COMMENTS AGREED WITH OUR FINDINGS. WE DEVELOPED A SUMMARY OF ALL NEEDS IDENTIFIED BY ANY OF THE ANALYZED DATA SETS. THE LOCAL EXPERTS THEN ALLOCATED 100 POINTS AMONG THE POTENTIAL SIGNIFICANT NEED CANDIDATES, INCLUDING THE OPPORTUNITY TO AGAIN PRESENT ADDITIONAL NEEDS THAT WERE NOT IDENTIFIED FROM THE DATA. A RANK ORDER OF PRIORITIES EMERGED, WITH SOME NEEDS RECEIVING NONE OR VIRTUALLY NO SUPPORT, AND OTHER NEEDS RECEIVING IDENTICAL POINT ALLOCATIONS. WE DICHOTOMIZED THE RANK ORDER OF PRIORITIZED NEEDS INTO TWO GROUPS: "SIGNIFICANT- AND "OTHER IDENTIFIED NEEDS." OUR CRITERIA FOR IDENTIFYING AND PRIORITIZING SIGNIFICANT NEEDS WAS BASED ON A DESCENDING FREQUENCY RANK ORDER OF THE NEEDS BASED ON TOTAL POINTS CAST BY THE LOCAL EXPERTS, FURTHER RANKED BY A DESCENDING FREQUENCY COUNT OF THE NUMBER OF LOCAL EXPERTS CASTING ANY POINTS FOR THE NEED. BY OUR DEFINITION, A SIGNIFICANT NEED HAD TO INCLUDE ALL RANK ORDERED NEEDS UNTIL AT LEAST FIFTY PERCENT (50%) OF ALL POINTS WERE INCLUDED AND TO THE EXTENT POSSIBLE, REPRESENTED POINTS ALLOCATED BY A MAJORITY OF VOTING LOCAL EXPERTS. THE DETERMINATION OF THE BREAK POINT - "SIGNIFICANT" AS OPPOSED TO "OTHER" - WAS A QUALITATIVE INTERPRETATION BY QUORUM AND THE LCMH EXECUTIVE TEAM WHERE A REASONABLE BREAK POINT IN RANK ORDER OCCURRED. FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 11 CHNA SIGNIFICANT NEEDS ARE: 1.MENTAL HEALTH/SUICIDE/SUBSTANCE ABUSE LCMH SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: A.PROVIDE FRONT-LINE STAFFING NEEDS (PRIMARY CARE SERVICES/EMERGENCY DEPARTMENT SERVICES) FOR INITIAL TREATMENT, IDENTIFICATION, AND REFERRAL TO THE APPROPRIATE MENTAL HEALTH/SUBSTANCE ABUSE SERVICE B.FACILITY SPACE PROVIDED BI-WEEKLY TO LOCAL SUBSTANCE ABUSE SUPPORT GROUPS C.FINANCIAL SUPPORT PROVIDED TO LOCAL LAW ENFORCEMENT AGENCIES (DRUG AWARENESS PROGRAMS) FOR THE LOCAL SCHOOL DISTRICT D.DINE WITH A DOC EDUCATION SEMINAR ON DEPRESSION PREVENTION/DIAGNOSIS/TREATMENT FOR SENIOR CITIZENS ADDITIONALLY, LCMH PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: A.CONTINUE ABOVE ACTIONS B.INITIATING STEPS TO DEVELOP LOCAL SUBSTANCE ABUSE COALITION (LOCAL SCHOOLS/HOSPITAL/LAW ENFORCEMENT/EMS/PUBLIC HEALTH) C.BRINGING IN NATIONAL SUBSTANCE ABUSE EXPERT (AWARENESS/TREATMENT/EDUCATION) D.LOOKING INTO DEVELOPING DETOX BEDS E.DEVELOPING TELE-PSYCH SERVICES F.PROMOTE EDUCATION/PREVENTION OPPORTUNITIES THROUGH LOCAL MEDIA CHANNELS 2.CORONARY HEART DISEASE LCMH SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: A.VISITING CARDIOLOGY CLINIC IN LAWRENCE MEDICAL CENTER B.LCMH PRIMARY CARE CLINIC SERVICES C.LCMH DIAGNOSTIC IMAGING D.LCMH LABORATORY SERVICES E.STRESS TEST SERVICES F.HOLTER/EVENT MONITORS G.LCMH CARDIAC REHAB PROGRAM H.PROMOTE GO RED FOR WOMEN (NATIONAL MOVEMENT TO END HEART DISEASE/STROKE AMONG WOMEN) I.PROMOTE HEART HEALTH MONTH J.PROVIDE FREE CHOLESTEROL SCREENINGS AT COMMUNITY EVENTS AND HEALTH FAIRS K.REFER PATIENTS TO HEALTH DEPARTMENT SMOKING CESSATION PROGRAM L.DINE WITH A DOC EDUCATION SEMINAR ON HEART DISEASE PREVENTION/DIAGNOSIS/TREATMENT FOR SENIOR CITIZENS ADDITIONALLY, LCMH PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: A.CONTINUE ABOVE ACTIONS B.INCREASE CARDIOLOGY COVERAGE 3.CANCER LCMH SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: A.LCMH DIAGNOSTIC IMAGING B.LCMH LABORATORY SERVICES C.LCMH SCREENING COLONOSCOPY D.WEEKLY VISITING OB/GYN AT CLINIC PROVIDING CERVICAL CANCER SCREENINGS E.LCMH PRIMARY CARE SERVICES AND SURGICAL CLINIC PROVIDERS ADDRESS THIS NEED BY EDUCATION AND MEDICAL SERVICES F.LCMH SCREENING PROGRAMS AT VARIOUS COMMUNITY EVENTS G.PARTICIPATE IN RELAY FOR LIFE; PROMOTE BREAST CANCER AWARENESS MONTH H.UTILIZE MOBILE MAMMOGRAPHY UNIT TO PROVIDE ON-SITE SCREENING TO LOCAL INDUSTRIES I.PROVIDE EDUCATIONAL MATERIALS REGARDING PREVENTION/DIAGNOSIS/TREATMENT J.DINE WITH A DOC EDUCATION SEMINAR ON CANCER PREVENTION/DIAGNOSIS/TREATMENT FOR SENIOR CITIZENS ADDITIONALLY, LCMH PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: A.CONTINUE ABOVE ACTIONS B.RESEARCHING STEREOTACTIC MOBILE SERVICES C.CONTINUE TO EXPLORE OPPORTUNITIES TO DELIVER ON-SITE CLINICAL ONCOLOGY SERVICES 4.OBESITY/OVERWEIGHT LCMH DOES NOT INTEND TO DEVELOP AN IMPLEMENTATION STRATEGY FOR THIS SIGNIFICANT NEED WE ARE CHOOSING NOT TO RESPOND TO THIS NEED AT THIS TIME. WE FEEL WE CAN HAVE A GREATER IMPACT BY PUTTING ATTENTION AND RESOURCES TOWARD OTHER SIGNIFICANT NEEDS FOR WHICH WE ARE BETTER QUALIFIED TO SERVE. 5.STROKE-2013 SIGNIFICANT NEED; 3 LEADING CAUSE OF DEATH LCMH SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: A.EXPANDED REHABILITATION SERVICES TO TREAT STROKE PATIENTS B.DINE WITH A DOC EDUCATION SEMINAR ON STROKE PREVENTION/DIAGNOSIS/TREATMENT FOR SENIOR CITIZENS C.PROVIDE EDUCATIONAL MATERIALS (PREVENTION/IDENTIFICATION) D.BOARD-CERTIFIED NEURO-RADIOLOGIST READING CT SCANS AND IMPLEMENTING STAT READS FOR STROKE PATIENTS ADDITIONALLY, LCMH PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: A.CONTINUE ABOVE ACTIONS B.EXPAND TELEMEDICINE OPPORTUNITIES TO MONITOR BLOOD PRESSURE/VITAL SIGNS OTHER NEEDS WHERE HOSPITAL DID NOT DEVELOP IMPLEMENTATION STRATEGY 6.COMPLIANCE BEHAVIOR/PREDISPOSING CONDITIONS 7.DIABETES 8.PHYSICAL INACTIVITY 9.AFFORDABILITY 10.SMOKING/TOBACCO USE 11.PHYSICIAN 12.FLU/PNEUMONIA 13.CHRONIC COPD/LUNG DISEASE/PULMONARY 14.KIDNEY DISEASE 15.ALZHEIMER'S 16.MATERNAL MEASURES 17.ACCIDENTS 18.LIFE EXPECTANCY 19.CHOLESTEROL 20.DENTAL 21.SEXUALLY TRANSMITTED INFECTION 22.BLOOD POISONING 23.EDUCATION/PREVENTION FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 13B LCMH CHARGES THE SAME AMOUNT FOR ALL PATIENTS AND DISCOUNTS ARE GIVEN BASED ON FEDERAL PROVERTY GUIDELINES. FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 13H LCMH CHARGES THE SAME AMOUNT FOR ALL PATIENTS AND DISCOUNTS BASED ON FEDERAL POVERTY GUIDELINES. FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 15E LCMH CHARGES THE SAME AMOUNT FOR ALL PATIENTS AND DISCOUNTS BASED ON FEDERAL POVERTY GUIDELINES. FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 19D LCMH USES SEARCH AMERICA WHICH MEANS THAT ADDITIONAL THIRD PARTIES ARE NOT NEEDED BEFORE MAKING REASONABLE EFFORTS REGARDING ELIGIBILITY. FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 20E OUTPATIENTS ARE NOTIFIED ON THE FIRST STATEMENT THEY RECEIVE THAT SHOWS ANY PATIENT BALANCE. LCMH ATTEMPTS TO NOTIFY ALL INPATIENTS AS PART OF THEIR STAY BUT WITH ALOS OF 3.8 DAYS THIS IS NOT ALWAYS ACCOMPLISHED. THEY ALSO RECEIVE NOTICE ON THEIR FIRST STATEMENT OF THE FINANCIAL ASSISTANCE POLICY. ALL UNINSURED PATIENTS RECEIVE AN FA APPLICATION UPON REGISTRATION. FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 22D LCMH HAS NO POLICY IN PLACE TO ADJUST NORMAL CHARGES TO A LOWER AMOUNT BEFORE FAP CHARITY IS APPLIED. FACILITY 1, LAWRENCE COUNTY MEMORIAL HOSPITAL - PART V, LINE 24 CHARGES ARE ALL AT NORMAL RATES. ANY FAP DISCOUNT IS APPLIED BASED ON NORMAL CHARGES. NO FAP-ELIGIBLE PATIENT PAID ANYTHING CLOSE TO USUAL CHARGES. PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION COMMUNITY BUILDING ACTIVITIES FORM 990, SCH H, PART II LAWRENCE COUNTY MEMORIAL HOSPITAL DID NOT CONDUCT ANY COMMUNITY BUILDING ACTIVITIES FOR THE YEAR ENDED 6/30/2016. BAD DEBT EXPENSE FORM 990, SCH H, PART III, LINES 2-4 ACCOUNTS ARE REPORTED AS BAD DEBT ONLY IF PATIENTS ARE NOT ELIGIBLE UNDER PRESUMPTIVE CHARITY OR DO NOT COMPLETE AN APPLICATION FOR FINANCIAL ASSISTANCE IF THEY CANNOT BE QUALIFIED AS PRESUMPTIVE. BAD DEBT EXPENSES ARE ACCOUNTS FOR PATIENTS THAT HAVE NOT PAID LCMH FOR THE SERVICES PROVIDED. EVERY EFFORT IS MADE TO QUALIFY THEM AS PRESUMPTIVE IF THEY DO NOT DIRECTLY REQUEST FINANCIAL ASSISTANCE. AN ELECTRONIC RESOURCE IS USED TO QUALIFY PATIENTS AS CHARITY BEFORE THE COLLECTION PROCESS IS STARTED. THE HOSPITALS ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF PAY PATIENTS WAS 86% AT JUNE 30, 2016 AND 69% AT JUNE 30, 2015. IN ADDITION, THERE WERE NO SIGNIFICANT FLUCTUATIONS IN WRITE-OFFS FROM SELF-PAY PATIENTS DURING FISCAL YEAR 2016 COMPARED TO FISCAL YEAR 2015. THE HOSPITAL PROVIDES CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS MEETING CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT REPORTED AS NET PATIENT SERVICE REVENUE. MEDICARE INFORMATION FORM 990, SCH H PART III LINE 8 MEDICARE AMOUNTS ARE TAKEN FROM THE AUDITED FINANCIAL STATMENTS. COLLECTION PRACTICES FORM 990, SCH H, PART III LINE 9B ANY PATIENT BALANCE THAT HAS GONE THROUGH THE IN-HOUSE COLLECTION PROCESS WILL BE SUBMITTED TO SEARCH AMERICA PRIOR TO BECOMING BAD DEBT. SEARCH AMERICA WILL YIELD BACK FEDERAL POVERTY PERCENTAGES THAT CAN BE USED TO QUALITY AS PRESUMPTIVE CHARITY WITHOUT APPLICATION BY THE PATIENT OR FAMILY. PATIENT EDUCATION OF ELGIBILITY FOR ASSISTANCE FORM 990, SCH H, PART VI, LINE 3 LCHM HAS POSTERS IN ALL REGISRATION AREAS RELATED TO ANY HOSPITAL DEPARTMENT INCLUDING OUR RURAL HEALTH CLINIC INFORMING PATIENTS THAT WE SEE ANYONE REGARDLESS OF THEIR ABILITY TO PAY AND THAT FINANCIAL ASSISTANCE IS AVALABLE TO UNINSURED AND UNDERINSURED. ALL ED PATIENTS ARE SEEN BY A PRACTITIONER PRIOR TO REQUEST FOR ANY FINANCIAL INFORMATION/INSURANCE AS REQUIRED BY EMTALA. ALL PATIENTS THAT DO NOT HAVE INSURANCE OR THAT HAVE A PATIENT BALANCE AFTER INSURANCE ARE CONTACTED BY OUR PATIENT FINANICAL SERVICES REPRESENTATIVE WHO THEN PROVIDES A FINANCIAL ASSISTANCE FORM. COMMUNITY INFORMATION FORM 990, SCH H, PART VI, LINE 4 LCMH SERVES AS A PREDOMINANTLY RURAL COUNTY IN SOUTH EASTERN ILLINOIS. THE POPULATION IS MORE ELDERLY AND LESS AFFLUENT THAN MOST COUNTIES IN THE STATE. 23.4% OF THE POPULATION HAS LESS THAN A HIGH SCHOOL DIPLOMA WITH ANOTHER 34.1% HAVING ONLY A HIGH SCHOOL EDUCATION. 12.3% OF THE HOUSEHOLDS REPORT INCOME OF LESS THAN 15,000. A LARGE TERTIARY HOSPITAL IS WITHIN 12 MILES OF LCMH LOCATED IN VINCENNES, IN. MANY PATIENTS WITH INSURANCE MAKE THE DRIVE LEAVING LCHM WITH A MUCH HIGHER PERCENT OF MEDICAID BUSINESS. WITH LCMH MOVEMENT TO NOT-FOR-PROFIT STATUS IN FY 2012 A MORE CONCERTED EFFORT WAS UNDERATKEN AT THE DIRECTION OF OUR BOARD TO IDENTIFY ANY PATIENT THAT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. TO BETTER SERVE THE NEED OF THESE PATIENTS, LCMH OPENED A RURAL HEALTH CLINIC STAFFED WITH PHYSICIANS AND MID-LEVEL PRACTITIONERS TO PROVIDE A PRIMARY SOURCE OF CARE THAT IS EASILY ACCESSIBLE FOR THEM. IN FY16, LCMH RHC EXTENDED THEIR HOURS ON EVENINGS AND WEEKENDS TO PROVIDE PRIMARY CARE TO THE COMMUNITY. PROMOTION OF COMMUNITY HEALTH FORM 990, SCH H. PART V, LINE 5 LCMH PARTICIPATES IN MANY COMMUNITY GROUPS THAT ARE DESIGNED TO IMPROVE THE HEALTH OF THE COMMUNITY. LCMH PROVIDES A MEETING LOCATION FOR ALCOHOLICS ANONYMOUS TWICE PER WEEK AS WELL AS A LOCATION FOR A LOCAL BEREAVEMENT AND SUPPORT GROUP. LCMH LEADERSHIP ALSO IS ONE OF SEVERAL BOARDS IN THE AREA TO SUPPORT ECONOMIC DEVELOPMENT AS WELL AS PROVIDE LEADERSHIP ROLES IN BOARDS THAT PROVIDE RESOURCES DURING FLOODING AND PROVIDE ACTIVE LEADERSHIP IN COMMITTEES FOR ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK PROVIDING SUPPORT TO ALL CAHS IN ILLINOIS TO HELP THEM BETTER SERVE THEIR COMMUNITIES. AFFLIATED HEALTH CARE SYSTEMS FORM 990, SCH H, PART VI LINE 6 LCMH IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. STATE FILING OF COMMUNITY BENEFIT REPORT FORM 990, SCH H. PART VI, LINE 7 LCHM IS NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT IN ILLNOIS DUE TO THE FACT THAT THE HOSPITAL CONTAINS LESS THAN 100 BEDS. NEEDS ASSESSMENT FORM 990, SCH H. PART VI LINE 2 LCMH UTILIZED SERVICES FROM QHR TO PERFORM A COMMUNITY HEALTH NEEDS ASSESSEMENT (CHNA) AND THE REPORT WAS PROVIDED IN JUNE 2016. X X false false false false false false false true false DR GARY CARR TRUSTEE /PHYSICAN 228417 228417 DOUG FLORKOWSKI CEO 210000 56053 7260 273313 VALERIE BURNS PHYSICAN 206002 4185 210187 STEVEN RAMSARAN PHYSICAN 206743 131870 21495 360108 CHARLES CLAGETT PHYSICAN 195572 18865 214437 RODNEY FINCH PHYSICAN 186781 18865 205646 SCHEDULE J, PAGE 1, PART I, LINE 7 PHYSICAN COMPENSATION PAID BASED ON ANTICIPATED VOLUME (VISITS) AND RECONCILED QUARTERLY. STAN WLLIAMS FAMILY MEMBER 66016 W-2 WAGES false RON WALDROP FAMILY MEMBER 34205 W-2 WAGES false SCHEDULE L, PART V RON WALDROP IS A VOTING OFFICER OF THE HOSPITAL BOARD. HIS DAUGHTER IN LAW IS EMPLOYED IN THE IT DEPARTMENT. THE 2015 WAGES PAID BY LAWRENCE COUNTY MEMORIAL HOSPITAL LISTED ON HER W-2 TOTALED 34,205.26. STAN WILLIAMS IS A VOTING TRUSTEE OF THE HOSPITAL BOARD. HIS SON IN LAW IS THE DIRECTOR OF THE IT DEPARTMENT. THE 2015 WAGES PAID BY LAWRENCE COUNTY MEMORIAL HOSPITAL LISTED ON HIS W-2 TOTALED 66,016.21. FORM 990, PAGE 6, PART VI, LINE 3 QUORUM HEALTH RESOURCES, LLC HAS A MANAGEMENT CONTRACT WITH THE BOARD OF LCMH SINCE MAY OF 2006. THIS CONTRACT WAS RENEWED IN 2015 FOR 5 YEARS WHICH WILL CONTINUE UNTIL JUNE 30, 2021. QUORUM HEALTH RESOURCES PROVIDES ASSISTANCE IN THE EVALUATION OF OFFICERS, PROVIDES ADMINISTRATIVE RESOURCES, CONSULTING SERVICES, CHARGE MASTER AND COMPLIANCE SERVICES. COMPENSATION OF BOARD MEMBERS FORM 990 PART VII, SECTION A DR GARY CARR IS COMPENSATED FOR BEING A PRACTICING PHYSICIAN AT LCMH. HE IS NOT COMPENSATED AS A MEMBER OF THE BOARD. FORM 990, PAGE 6, PART VI, LINE 11B THE CFO AND AN INDEPENDENT ACCOUNTING FIRM REVIEWED THE FORM 990 BEFORE FILING. AN ELECTRONIC OR HARD COPY OF THE FORM 990 IS PROVIDED TO ALL BOARD MEMBERS AFTER IT IS FILED. FORM 990, PAGE 6, PART VI, LINE 12C TRUSTEES AND DEPARTMENT LEADERS SIGN ANNUAL CONFLICT OF INTEREST POLICY STATEMENTS. ANYONE WITH A CONFLICT DOES NOT PARTICIPATE IN ANY RELATED DECISION MAKING PROCESSES. STAFF AND DEPARTMENT LEADERS HAVE THIS INCLUDED AS A PART OF THEIR ANNUAL TRAINING CONDUCTED ELECTRONICALLY THROUGH HEALTH STREAM. THE SIGNED STATEMENTS ARE REVIEWED BY THE COO AND THE CEO. FORM 990, PAGE 6, PART VI, LINE 15A A REVIEW IS CONDUCTED ANNUALLY BY THE ENTIRE BOARD OF TRUSTEES ALONG WITH THE REGIONAL MANAGEMENT TEAM FROM QUORUM HEALTH RESOURCES. NATIONAL COMPARATIVE DATA IS PROVIDED BY QHR AS PART OF THE ANNUAL CEO EVALUATION AND WAGE ADJUSTMENT. OFFICER COMPENSATION DECISIONS ARE ALSO DOCUMENTED IN THE BOARD MINUTES. FORM 990, PAGE 6, PART VI, LINE 15B A REVIEW IS CONDUCTED BY THE ENTIRE BOARD OF TRUSTEES ALONG WITH THE REGIONAL MANAGEMENT TEAM FROM QUROUM HEALTH RESOURCES. NATIONAL COMPARATIVE DATA IS PROVIDED BY QHR AS PART OF THE ANNUAL CEO EVALUATION AND WAGE ADJUSTMENT. OFFICER COMPENSATION DECISIONS ARE ALSO DOCUMENTED IN THE BOARD MINUTES. FORM 990, PAGE 6, PART VI, LINE 18 FORM 1023 HAS BEEN FILED, APPROVED AND IS AVAILAVLE TO THE PUBLIC UPON REQUEST. FORM 990, PAGE 6, PART VI, LINE 19 THE DOCUMENTS ARE AVAILABLE UPON REQUEST AT THE ADMINISTRATIVE OFFICES. FORM 990, PART IX, LINE 11G ED PHYSICIAN SERVICES 769,485 0 0 CONTRACTED SURGEON 349,839 0 0 LAUNDRY/LINEN SERVICE 112,165 0 0 CPSI - SOFTWARE 0 139,329 0 DIAGNOSTIC SHARED 0 182,365 0 NUC MED ULTRASOUND 351,673 0 0 VARIOUS OTHER SERVICES 489,351 312,380 0 FORM 990, PART XI, LINE 9 PROVISION FOR UNCOLLECTABLE -1,252,450 PROVISION FOR UNCOLLECTABLE 1,252,450 END AND DEV FOUNDATION FOR LAWREN 2200 STATE STREET LAWRENCEVILLE IL 62439 376052607 FUNDRAISIN IL 501C3 9 N/A false false false true false false false false false false false false false false false false false false false true LCMH E&D FOUNDATION C 74326 FMV