2016-02-03T12:00:42-06:00 2015-06-30 430352985 KERBER ECK & BRAECKEL LLP ONE MEMORIAL DRIVE STE 900 ST LOUIS MO 63102 990 2014-07-01 370661208 HILLSBORO AREA HOSPITAL INC HILL 2175326111 1200 EAST TREMONT STREET HILLSBORO IL 62049 REX BROWN PRESIDENT & CEO 2175326111 2016-01-22 1 STEVE ECKHARD CPA P00019710 3142316232 2014 2016-04-25 22:37:26Z REX BROWN 1200 EAST TREMONT STREET HILLSBORO IL 62049 22550561 0 X WWW.HILLSBOROAREAHOSPITAL.ORG X 1906 IL OPERATION OF HOSPITAL (INPATIENT, SWING BED AND OUTPATIENT) AND ASSISTED LIVING FACILITIES. 11 10 269 20 0 0 412289 199415 21316903 22023934 236139 234862 86603 87147 22051934 22545358 0 0 0 0 8794889 9177704 0 0 0 11542403 11159217 20337292 20336921 1714642 2208437 31915109 33086855 8757381 8289738 23157728 24797117 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 15354966 22064640 OPERATION OF A 25 BED CRITICAL ACCESS HOSPITAL (INPATIENT, SWING BED AND OUTPATIENT) WITH AN ASSISTED LIVING FACILITY. 931 ACUTE DAYS, 1,739 SWING BED DAYS, 15,768 OUTPATIENT VISITS AND 14,042 ASSISTED LIVING RESIDENT DAYS PROVIDED IN FY 2015. HILLSBORO AREA HOSPITAL ALSO PROVIDES $790,405 IN CHARITY CARE AND $2,386,695 IN OTHER COMMUNITY BENEFITS, NOT INCLUDING BAD DEBT. 15354966 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 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 49 0 1 269 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X TERRI CARROLL CFO 2175324187 1200 EAST TREMONT STREET HILLSBORO IL 62049 BEN CADY DIRECTOR 1.00 X 0 0 40470 BILL BRINK SECRETARY 1.00 X X 0 0 0 BRIAN KNODLE CHAIRMAN 1.00 X X 0 0 0 DAVE IMLER VICE CHAIR 1.00 X X 0 0 0 GREG HOLCOMB DIRECTOR 1.00 0.10 X 0 0 0 JULIE JENKINS DIRECTOR 1.00 0.30 X 0 0 0 MICHELLE ONDREY DIRECTOR 1.00 X 0 0 0 PATRICIA CLARKE TREASURER 1.00 0.10 X X 0 0 0 PATRICIA WHITWORTH DIRECTOR 1.00 X 0 0 0 TODD DEAN TREASURER 0.50 0.10 X X 0 0 0 EARL FLACK DIRECTOR 1.00 X 0 0 0 LINDSAY WAGAHOFF DIRECTOR 1.00 X 0 0 0 REX BROWN CEO 40.00 1.30 X 0 0 0 TERRI CARROLL CFO 40.00 1.00 X 150162 0 8130 ELVIS HARRISON VP OF PATIENT CARE SERVICE 40.00 X 109038 0 21342 259200 0 69942 2 0 1 1 ILLINOIS EMERGENCY PHYSICIANS 4075 COPPER RIDGE DRIVE TRAVERSE CITY MI 49684 ER COVERAGE 1586374 VIGILANT ANESTHESIA INC 121 LAKEWOOD DRIVE HILLSBORO IL 62049 CRNA SERVICES 211161 DIAGNOSTIC HEALTH SERVICES PO BOX 972288 DALLAS TX 75397 MRI SERVICES 192300 PRECISE SPECIALTIES CORP PO BOX 572 HILLSBORO IL 62049 ULTRASOUND SERVICES 165115 WCP LABORATORIES INC 2326 MILLPARK DRIVE MARYLAND HEIGHTS MO 63043 PATHOLOGY SERVICES 127147 5 175319 24096 24096 199415 PATIENT SERVICE REVENUE 900099 22023934 22023934 22023934 234091 234091 7123 0 7123 7123 7123 5974 5203 771 771 771 CAFETERIA 900099 39318 39318 OTHER INCOME 900099 30495 30495 AMBULANCE REVENUE 900099 5195 5195 5016 5016 80024 22545358 22064640 0 281303 142129 142129 6572612 5803457 769155 126655 109622 17033 1840640 1601340 239300 495668 429007 66661 517682 517682 31986 31986 1936 1936 10643 10643 1563078 1201519 361559 51173 51173 165887 52694 113193 679159 627500 51659 50914 34838 16076 241073 163364 77709 1816900 1222562 594338 190528 36880 153648 PHYSICIAN'S FEES 1834029 1834029 SUPPLIES 1609371 1576291 33080 BAD DEBT 1087235 1087235 MISCELLANEOUS 615197 126501 488696 692426 535362 157064 20336921 15354966 4981955 0 5971250 1719802 5297763 12839551 2914048 2051873 378752 402399 225389 247274 30156122 16841155 14716682 13314967 1844647 1933857 566578 577132 31915109 33086855 2382803 2142735 6219956 5963192 154622 183811 8757381 8289738 X 22137579 23789133 735149 722984 285000 285000 23157728 24797117 31915109 33086855 X 2208437 -58510 -510538 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10643 10643 0 PART II-B, LINE 1: A PORTION OF THE DUES PAID TO THE ILLINOIS HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION ARE CLASSIFIED AS BEING FOR LOBBYING. 409239 1628 410867 425092 5610 21463 409239 431455 -6363 425092 429495 1960 431455 425202 4293 429495 0.00000 0.69370 0.30630 0 1 1 265746 265746 16369137 7267085 9102052 1687647 782686 904961 11748902 8791384 2957518 84690 84690 13314967 ASSET RETIREMENT OBLIGATION 163342 CAPITAL LEASE OBLIGATION 20469 183811 X 22492178 -58510 5330 -53180 22545358 0 22545358 20336921 0 20336921 0 20336921 PART V, LINE 4: PERMANENTLY RESTRICTED ENDOWMENT FUND INTEREST IS TO BE USED FOR THE HOSPITAL'S BUILDING AND MAINTENANCE. PART X, LINE 2: THE HOSPITAL HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501 OF THE INTERNAL REVENUE CODE AND SIMILAR PROVISIONS OF STATE LAW. HOWEVER, THE HOSPITAL WOULD BE SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE HOSPITAL FILES FEDERAL INFORMATION RETURNS. THE STATUTES OF LIMITATIONS FOR INFORMATION RETURNS FILED FOR THE YEARS ENDED JUNE 30, 2012 THROUGH 2015 HAVE NOT EXPIRED AND THEREFORE ARE SUBJECT TO EXAMINATION. PART XI, LINE 2D - OTHER ADJUSTMENTS: TRANSFER FROM AFFILIATE HILLSBORO AREA HEALTH FOUNDATION 5,330. 1 1 X 1 X 125.000000000000 1 X 0 1 0 1 0 357371 357371 0.01860 3403076 1972217 1430859 0.07430 3760447 1972217 1788230 0.09290 45406 12660 32746 0.00170 3588749 2716052 872697 0.04530 155921 155921 0.00810 3790076 2728712 1061364 0.05510 7550523 4700929 2849594 0.14800 1 491578 0 1 1 1 1 HILLSBORO AREA HOSPITAL 1200 EAST TREMONT STREET HILLSBORO IL 62049 WWW.HILLSBOROHEALTH.ORG X X X X HILLSBORO AREA HOSPITAL 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X WWW.HILLSBOROHEALTH.ORG X 1 12 0 0 0 1 X 125.000000000000 200.000000000000 X X X X 1 1 X X X X 1 X WWW.HILLSBOROHEALTH.ORG X 1 X X 1 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 27, 2013. 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 27, 2013. 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 27, 2013. THE GROUP INCLUDED 18 COMMUNITY MEMBERS AND ORGANIZATION REPRESENTATIVES. HILLSBORO AREA HOSPITAL PART V, SECTION B, LINE 20E: A MINIMUM OF 2 STATEMENTS AND 2 LETTERS 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, NO DISCOUNT IS APPLIED PER HOSPITAL POLICY, SO GROSS CHARGES ARE BILLED TO THOSE PATIENTS. PART V, SECTION B LINE 11 THIS IMPLEMENTATION STRATEGY WAS APPROVED AND ADOPTED BY THE BOARD OF DIRECTORS OF HILLSBORO AREA HOSPITAL. THE FOLLOWING ITEMS HAVE BEEN SELECTED AS TOP PRIORITY ITEMS (WITH THE REMAINING ITEMS TO BE ADDRESSED AS TIME, FUNDS, AND OPPORTUNITY ARISE):TOP PRIORITY CHNA ITEMS1. ADDRESS GAPS IN DELIVERY OF MENTAL HEALTH SERVICES WHEREVER POSSIBLE. HAH DID NOT FIND CONSELORS IN SUFFICIENT NUMBERS TO DEVELOP A "LIST" TO ADDRESS ACCESS TO MENTAL HEALTH SERVICES. HAH IS IN DISCUSSIONS WITH "IN TOUCH PHYSICIANS", A CHICAGO BASED PSYCHIATRIC SERVICE, FOR A TELE PSYCHIATRY PROPOSAL. 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 IS ON THE FREE AND REDUCED LUNCHES 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 PER WEEK. OVER THE SUMMER THE PROGRAM SERVED APPROXIMATELY 730 MEALS TO NEARLY 100 CHILDREN. IN 2014, THE PROGRAM WAS EXPANDED TO INCLUDE 5 DAYS PER WEEK INCLUDING A SERVICE DAY TO MENTOR CHILDREN IN GIVE BACK TO THE COMMUNITY. ALSO ADDED WERE SPEAKERS DELIVERING DIFFERENT TOPICS PROMOTING HEALTH LIFE STYLE 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. IN 2014, A BAG OF NON-PERISHABLE FOOD DISTRIBUTED TO TEH CHILDREN ON FRIDAYS WAS ADDED SO THEY WOULD EAT DURING THE WEEKEND. THESE BAGS WERE DONATED BY LOCAL CHURCH GROUPS. PACKS FILLED WITH SCHOOL SUPPLIES AND DONATED BY THE COMMUNITY WERE PRESENTED TO THE CHILDREN ON THE LAST DAY OF THE PROGRAM. IN 2014, 1227 MEALS WERE SERVED TO 130 DIFFERENT CHILDREN. 3. SUPPORT REGIONAL CARE INFORMATION FOR WEBSITE BEING DEVELOPED BY SPRINGFIELD CLINICIN 2015, HAH CONTRACTED WITH LEGATO, A COMMUNICATIONS COMPANY, TO CONSTRUCT A WEBSITE FOR THE HOSPITAL THAT WILL CONTAIN ELEMENTS OF THE REGIONAL CARE AND CONNECT TO A VARIETY OF PERTINENT WEBSITES, INCLUDING THE SPRINGFIELD CLINIC. THE WEBSITE IS NEAR COMPLETION AND ANTICIPATED RELEASE IS SPRING 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 TO INCREASE AWARENESS OF THE BENEFITS OF EARLY DETECTION AND PAYMENT OF MAMMOGRAPHY USING 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. 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. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY HILLSBORO AREA HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: WWW.HILLSBOROHEALTH.ORG 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 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 $ 1,087,235. PART III, LINE 2: THE COSTING METHODOLOGY USED WAS THE RATIO OF PATIENT CARE COST-TO-CHARGES.PART III, LINE 3:THE HOSPITAL BELIEVES THAT THE COMMUNITY BENEFIT OBTAINED FROM ITS CHARITY CARE IS UNDERSTATED DUE TO PATIENTS THAT COULD QUALIFY FOR CHARITY CARE BUT DO NOT APPLY OR PROVIDE INCOMPLETE INFORMATION. SOME CARE PROVIDED TO PATIENTS IS NOT CLASSIFIED AS CHARITY CARE DUE TO PATIENTS MISSING DOCUMENTATION THAT PROVES THEY QUALIFY FOR CHARITY CARE. THE HOSPITAL'S BAD DEBT DOES INCLUDE AMOUNTS THAT COULD BE CLASSIFIED AS CHARITY CARE IF THE PATIENTS WOULD APPLY OR PROVIDE THE APPROPRIATE INFORMATION TO COMPLETE THE CHARITY CARE APPLICATION. PART III, LINE 4: TEXT OF FOOTNOTE FROM THE FINANCIAL STATEMENTSTHE HOSPITAL VOLUNTARILY PROVIDES FREE CARE TO PATIENTS WHO ARE UNABLE TO PAY FOR ALL OR PART OF THEIR HEALTH CARE EXPENSES AS DETERMINED BY THE HOSPITAL'S CRITERIA FOR FINANCIAL ASSISTANCE.IN SOME CASES, THE HOSPITAL DOES NOT RECEIVE THE AMOUNT BILLED FOR PATIENT SERVICES EVEN THOUGH IT DID NOT RECEIVE INFORMATION NECESSARY TO DETERMINE IF THE PATIENTS MET THE CRITERIA FOR FINANCIAL ASSISTANCE. BAD DEBTS EXPENSE IS THE ESTIMATED AMOUNT OF PATIENT REVENUE THAT THE HOSPITAL WILL NOT COLLECT.THE COSTING METHODOLOGY USED WAS THE RATIO OF PATIENT CARE COST-TO-CHARGES. NO BAD DEBT AMOUNTS WERE INCLUDED IN COMMUNITY BENEFIT. PART III, LINE 9B: ALL COLLECTION EFFORTS WILL CEASE IMMEDIATELY ON AMOUNTS APPROVED FOR SPECIAL FINANCIAL CONSIDERATIONS. PART VI, LINE 2: HILLSBORO AREA HOSPITAL CONDUCTS A NEEDS ASSESSMENT DURING ITS STRATEGIC PLANNING AND LONG RANGE BUDGETING PROCESS. THIS PROCESS INCLUDES OBTAINING AND ANALYZING VARIOUS DATA AND MARKET DEMOGRAPHICS. THE DATA IS THEN SUPPLEMENTED WITH VIEWS AND CONCERNS FROM OUR COMMUNITY BOARD MEMBERS, OTHER COMMUNITY OUTREACH RELATIONSHIPS AND OTHER COMMUNITY ORGANIZATIONS. PART VI, LINE 3: UNINSURED PATIENTS AND PERSONS WHO SEEK AND / OR OBTAIN SERVICES FROM THE HOSPITAL, ARE INFORMED OF THE AVAILABILITY OF FINANCIAL ASSISTANCE VIA SIGNAGE THROUGHOUT THE PATIENT ACCESS AREAS OF THE FACILITY, BROCHURES, ADMISSION PACKETS, DISCLOSURE ON THE PATIENT BILL, IN PERSON AND TELEPHONE ASSISTED CUSTOMER SERVICE, AS WELL AS INFORMATION SUCH AS THE GUIDELINES AND APPLICATION BEING PREDOMINATELY POSTED ON THE HOSPITAL 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 ASSESSEMENT ON THE HOSPITAL WEBSITE AT WWW.HILLSBOROHEALTH.ORG. PART VI, LINE 5: DESIGNATED AS A 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, PART III, LINE 1 AND 4A. THE BOARD OF DIRECTORS IS MADE UP OF VOLUNTEER COMMUNITY LEADERS WITHIN ITS PRIMARY SERVICE AREA THAT ARE APPROVED BY THE MEMBER ORGANIZATION. PART VI, LINE 6: THE HOSPITAL IS PART OF A CRITICAL ACCESS NETWORK THAT INCLUDES HILLSBORO AREA HEALTH SYSTEM NFP, ITS SOLE CORPORATE MEMBER, WHICH PROVIDES HEALTH AND SUPPORTIVE SERVICES TO THE COMMUNITIES THEY SERVE.THE HOSPITAL ALSO COMMITS SIGNIFICANT TIME AND RESOURCES TO ACTIVITIES AND SERVICES THAT MEET UNMET COMMUNITY NEEDS. MANY OF THESE ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE SELF-SUPPORTING OR FINANCIALLY VIABLE. SUCH PROGRAMS INCLUDE, BUT ARE NOT LIMITED TO, HEALTH FAIRS AND EVENTS, HEALTH SCREENINGS AND ASSESSMENTS, SPACE FOR DAYCARE PROGRAMS OFFERED BY THE LOCAL SCHOOL SYSTEM, SUPPORT FOR VITAL COMMUNITY SERVICES, TRAUMA CARE, AND VARIOUS COMMUNITY EDUCATIONAL SERVICES. HILLSBORO AREA HOSPITAL RECEIVED LEED CERTIFICATION FOR THE BUILDING ADDITION COMPLETED IN JULY 2010. THE ENVIRONMENTAL BENEFITS OF LEED INCLUDE: REDUCTION OF WASTE SENT TO LANDFILLS, CONSERVATION OF ENERGY AND WATER, REDUCTION OF HARMFUL GREENHOUSE GASES, AND A HEALTHIER AND SAFER PLACE FOR EMPLOYEES, PATIENTS, AND THE ENVIRONMENT. THE HOSPITAL IS ALSO A MEMBER OF THE CHAMBER OF COMMERCE AND PARTNERS WITH THE MONTGOMERY COUNTY ECONOMIC DEVELOPMENT CORPORATION TO OBTAIN GRANTS AND EXPAND THE SERVICES NEEDED IN THE COMMUNITY. THE HOSPITAL PROVIDES THE USE OF SPACE AT NO CHARGE TO THE HILLSBORO COMMUNITY SCHOOL DISTRICT FOR A DAYCARE FACILITY. FOR MANY YEARS, UNTIL MAY 2010, THE HOSPITAL PROVIDED CLASSROOM SPACE, FREE OF CHARGE, FOR LINCOLN LAND COMMUNITY COLLEGE TO USE FOR NURSING INSTRUCTION. THE SPACE IS NOW PROVIDED BY THE HILLSBORO AREA HEALTH SYSTEM. THE HOSPITAL ALSO PROVIDES GRAND ADVANTAGE SENIOR EXERCISE CLASSES TO THE SENIORS IN THE AREA AT NO CHARGE, AND PROVIDES THE DIAMOND CLUB TO SENIORS FOR ASSISTANCE WITH THE UNDERSTANDING AND ORGANIZATION OF MEDICAL BILLS AND INSURANCE. HOSPITAL EMPLOYEES ALSO SHARE THEIR EXPERTISE THROUGH COMMUNITY SPEAKING AT LOCAL ORGANIZATIONS AND EVENTS. SEVERAL MONETARY DONATIONS ARE MADE BY THE HOSPITAL THROUGHOUT THE YEAR TO OTHER NON-PROFIT ORGANIZATIONS. AN AUTOMATIC BLOOD PRESSURE MACHINE IS LOCATED IN THE HOSPITAL LOBBY WHERE THE COMMUNITY MEMBERS CAN USE IT FREE OF CHARGE, AND THE HOSPITAL PROVIDES A BOOTH AT THE LOCAL COMMUNITY FAIR EACH YEAR WHERE EMPLOYEES TAKE BLOOD PRESSURES AND PROVIDE HEALTH INFORMATION TO THE PUBLIC.THE HOSPITAL RECEIVED A USDA DISTANCE LEARNING & TELEMEDICINE GRANT TO EXPAND CERTIFIED NURSING ASSISTANT INSTRUCTION TO HIGH SCHOOL STUDENTS IN OUR COMMUNITY. IN COMBINATION WITH THE HOSPITAL'S MATCHING FUNDS, VIDEO CONFERENCING EQUIPMENT WAS PURCHASED AND PLACED IN 4 COMMUNITY HIGH SCHOOLS SO THAT THE STUDENTS CAN REMAIN IN THEIR OWN CLASSROOMS INSTEAD OF BEING TRANSPORTED TO THE HOSPITAL'S CAMPUS FOR CNA INSTRUCTION. IN ADDITION, THE HOSPITAL 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 HOSPITAL JUNIOR BOARD WHICH IS COMPRISED OF STUDENT VOLUNTEERS AGES 9-16. THE JUNIOR BOARD MEMBERS LEARN HOW ORGANIZATIONS WORK, DEVELOP LEADERSHIP SKILLS, AND PLAN AND EXECUTE COMMUNITY IMPROVEMENT ACTIVITIES WITH THE HELP OF HOSPITAL STAFF MEMBERS.THE HOSPITAL ALSO PARTICIPATED IN THE STATE COLORECTAL CANCER SCREENING INITIATIVE, HELPED COORDINATE APPOINTMENTS FOR OTHER CANCER SCREENS IN COORDINATION WITH THE MONTGOMERY COUNTY CANCER ASSOCIATION, AND PROVIDED PRODUCE PLANTS TO COMMUNITY MEMBERS TO PROMOTE HEALTHIER EATING HABITS AND FOOD SUSTAINABILITY. FURTHERMORE, 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 X X X 0 0 0 0 0 0 0 0 0 REX BROWN CEO 0 0 0 0 0 0 0 0 0 0 0 0 TERRI CARROLL CFO 150162 0 0 0 0 0 0 0 8130 0 158292 0 0 0 FORM 990, PART VII, SECTION A, LINE 5: HEALTHTECH MANAGEMENT SERVICES, FORMERLY BRIM HEALTHCARE, INC., WAS PAID $498,178 FOR MANAGEMENT SERVICES. CEO REX BROWN IS EMPLOYED BY HEALTHTECH MANAGEMENT SERVICES. TERRI CARROLL, CFO WAS EMPLOYED BY HEALTHTECH MANAGEMENT SERVICES UNTIL SEPTEMBER 1, 2013 WHEN SHE BECAME AN EMPLOYEE OF HILLSBORO AREA HOSPITAL. A CITY OF HILLSBORO MONTGOMERY COUNTY ILLINOIS 376001658 2008-09-30 7220000 CAPITAL IMPROVEMENT PROJECT - EXPANSION CONSTRUCTION 0 0 0 A 1256808 7220000 83500 7030981 105519 2010 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 3 HILLSBORO AREA HOSPITAL DELEGATED CONTROL OVER MANAGEMENT TO HEALTHTECH MANAGEMENT SERVICES, FORMERLY BRIM HEALTHCARE, INC. - CEO IS EMPLOYED BY HEALTHTECH MANAGEMENT SERVICES. THE CEO IS UNDER THE SUPERVISION OF HEALTHTECH MANAGEMENT SERVICES. FORM 990, PART VI, SECTION A, LINE 6 HILLSBORO AREA HEALTH 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 11 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 EMPLOYEES COMPLETE AND SIGN AN ANNUAL DISCLOSURE STATEMENT AND THE BOARD OF DIRECTORS COMPLETE AND SIGN A CONFLICT OF INTEREST FORM ANNUALLY. 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 XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 3,441. CHANGE IN NET ASSETS RELEASED FROM RESTRICTIONS -19,309. TRANSFERS TO HILLSBORO AREA HEALTH SYSTEM NFP -500,000. TRANSFERS FROM AFFILIATE HILLSBORO AREA HEALTH FOUNDATION 5,330. HILLSBORO AREA HEALTH SYSTEM NFP 1200 EAST TREMONT HILLSBORO IL 62049 364539688 MANAGEMENT AND OVERSIGHT OF HEALTH CARE SYSTEM IL 501(C)3 LINE 11C, 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 9 HILLSBORO AREA HEALTH SYSTEM NFP 0 0 0 1 0 0 0 0 0 0 1 1 0 1 0 1 1 0 1 1