2016-04-25T15:27:11-05:00 2015-09-30 430352985 KERBER ECK & BRAECKEL LLP 1116 W MAIN ST CARBONDALE IL 629012335 990 2014-10-01 371363001 RICHLAND MEMORIAL HOSPITAL RICH 6183952131 800 EAST LOCUST STREET OLNEY IL 62450 MIKE STOVERINK CFO 6183952131 2016-04-25 true MARK DALLAS P00187265 6185291040 2016-04-25 2014 2016-08-17 19:52:53Z DAVID ALLEN 800 EAST LOCUST STREET OLNEY IL 62450 52259774 false X WWW.RICHLANDMEMORIAL.COM X 1953 IL TO PROVIDE EXCELLENT HEALTHCARE, PROMOTE WELLNESS, AND EDUCATE PATIENTS, STAFF, AND THE COMMUNITY. 11 9 641 0 196797 1836956 44395229 48418213 89172 278954 2101728 1725651 46782926 52259774 0 0 27681712 30667459 0 0 17832740 17772959 45514452 48440418 1268474 3819356 35258665 39087946 12607883 13124313 22650782 25963633 X TO PROVIDE EXCELLENT HEALTHCARE, PROMOTE WELLNESS, AND EDUCATE PATIENTS, STAFF, AND THE COMMUNITY. false false 48440418 52259774 RICHLAND MEMORIAL HOSPITAL, INC., D/B/A RICHLAND MEMORIAL HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF RICHLAND MEMORIAL 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 TO PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH THE COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, WE OFFER > FREE CARE > 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 FISCAL YEAR 2015, RICHLAND MEMORIAL HOSPITAL RECORDED 17,888 PATIENT DAYS. RICHLAND MEMORIAL 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, RICHLAND MEMORIAL HOSPITAL RECOGNIZES THESE AMOUNTS AS COSTS INCURRED IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. CHARITY CARE IS ALSO PROVIDED THROUGH THE HOSPITAL'S INTERNAL POLICY OFFERED IN FY 2015. RICHLAND MEMORIAL 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/ACTIVITIES: > AINAD SHRINE TEMPLE > AMATEUR SPORTS PROMOTION > ABASSADOR COMPANY > AMERICAN HEART ASSOCIATION > BIG BROTHERS BIG SISTERS > BLUE KNIGHT TIP OFF CLUB > BUILD COMMUNITY > BUSINESS AFTER HOURS EVENTS > CHRISTMAS TREE / SANTA PRETZEL - 100 > EAST RICHLAND POST PROM > EDWARDS COUNTY FAIR > ERHS TIGER BASEBALL > FIRST PRESBYTERIAN CHURCH > HOLIDAY TOUR OF HOMES > HOME / BUSINESS EXPO > HSEI MEMORY MILES > IL HIGH SCHOOL RODEO > IL SOCIETY OF HEALTHCARE > LAGALA BOARD MEETING AND EVENT > LINCOLNLAND DISTRICT > MUSCULAR DYSTROPHY ASSN > NATIONAL MULTIPLE SCHLEROSIS > NEWTON ROTARY CLUB > OCC FOUNDATION > OCC MUSIC DEPT > OLNEANS YEARBOOK > OLNEY ARTS COUNCIL > OLNEY CENTRAL COLLEGE > OLNEY CHAMBER OF COMMERCE > OLNEY CHRISTMAS PARADE > OLNEY CITY COUNCIL > OLNEY ELKS CLUB > OLNEY FFA > OLNEY LADY TIGERS SOFTBALL > OLNEY LITTLE LEAGUE > OLNEY TIGER FOOTBALL > OLNEY TIGERS ATHLETICS > OLNEY TIGERSHARKS SWIM TEAM > OLNEY WHITE SQUIRREL COUNT > OUTREACH MISSION > RCRC WHITE SQUIRREL TRIATHLON > RICHLAND COUNTY 4-H > RICHLAND COUNTY CTA > RICHLAND COUNTY DEVELOPMENT CORP > RICHLAND COUNTY FARM & FAIR WEEK > RICHLAND COUNTY RECREATION COUNCIL > RICHLAND COUNTY COUNTY WALK AND ROLL > RICHLAND COUNTY YOUTH SOCCER (RCYS) > RIDGWAY CHAPTER IL AUDUBON SOCIETY > RMH & COMMUNITY GOLF OUTINGS > ROTARY CLUB OF OLNEY > RUCKERS WHOLESALE > SHRINE CLUB > SOUTHEASTEN ILLINOIS CONCERT ASSN > ST JOSEPH SCHOOL > ST THOMAS GOLF OUTING > SWAN > U.S. RT 50 FOUR-LANE COALITION > WEST RICHLAND HIGH SCHOOL > WEST RICHLAND POST PROM > WEST RICHLAND PTO 5. WELLNESS EVENTS/COMMUNITY CLINICS/SUPPORT GROUPS/ OUTREACH/EDUCATION > BLOOD PRESSURE SCREENING CLINICS > DIABETIC EDUCATION DAY > HEALTHFEST > NATIONAL HOSPITAL WEEK CHOLESTEROL/PSA SCREENING CLINIC > OLNEY SENIOR EXPO > SUPPORT GROUPS/EDUCATION 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 > MAMMOGRAPHY ASSISTANCE - IL BREAST AND CERVICAL CANCER PROGRAM SERVICE PROVIDER (LITTLE EGYPT & EAST CENTRAL REGION) > MAMMOGRAPHY ASSISTANCE - SUSAN G. KOMEN FOR THE CURE GRANT 48440418 true true false false false false false false false false true false false true false true true false false false false false false false false false true true false false true false false false false false true true true false false false false false true false false false true 40 0 true 641 true false false false false false false false false false false false false X 11 9 false false false false false false false true true false false true true true true true true true true false X MIKE STOVERINK 6183952131 800 EAST LOCUST ST OLNEY IL 62450 PAT BURKE SECRETARY/TR 2.00 X 0 0 0 ANDY SCHUETZ VICE CHAIR 2.00 X 0 0 0 RICK BUSSARD BOARD MEMBER 0.50 X 0 0 0 DENNIS GRAVES BOARD MEMBER 1.00 X 0 0 0 HERBERT BROKHOF BOARD MEMBER 1.00 X 0 0 0 HARRY GARRETT MD BOARD MEMBER 30.00 X 0 0 0 JESSICA SLATER BOARD MEMBER 1.00 X 0 0 0 CAROL SCHAFER BOARD MEMBER 0.25 X 0 0 0 DAN EICHELBERGER BOARD MEMBER 3.00 X 0 0 0 HERMAN ZUBER CHAIRMAN 5.00 X 0 0 0 ROBERT ANNISS BOARD MEMBER 1.00 X 0 0 0 DAVE ALLEN CEO 40.00 X 180689 0 12319 MIKE STOVERINK CFO 40.00 X 122162 0 8106 PRASHANTH ANAND PHYSICIAN 40.00 X 395631 0 19906 MARY WALLER PHYSICIAN 40.00 X 355044 0 762 NIRANAT DEJTIRANUKUL ENT DOCTOR 40.00 X 323237 0 15521 STEPHEN REID PHYSICIAN 40.00 X 298708 0 14311 PAUL SUTHERLAND MD PHYSICIAN 40.00 X 293269 0 20841 1968740 91766 21 false true false SODEXHO 4880 PAYSPHERE CIRCLE CHICAGO IL 60674 FOOD SERVICE PR 868607 EMERGENCY DEPARTMENT ASSOCIATION PC 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 ER PHYSICIANS 660073 PHARMACY SYSTEMS INC 5050 BRADENTON AVE DUBLIN OH 43017 PHARMACY DIRECT 244552 SAJJAN K NAMANI MD MRCP 1054 ML KING DRIVE STE 124 CENTRALIA IL 62801 SLEEP STUDIES 176250 TRI-STATE FIRE PROTECTION PO BOX 70 NEWBURGH IN 476290070 MAINTENANCE 150822 11 196398 16952 1623606 1836956 NET PATIENT SERVICE REVENUE 48418213 48418213 48418213 278954 278954 EHR MEANINGFUL USE INCENTIVE 648122 648122 MISC. OTHER REVENUE 440877 440877 PROPERTY TAX 399996 399996 236656 236656 1725651 52259774 48418213 2004605 302851 302851 21986776 21986776 658676 658676 6203050 6203050 1516106 1516106 33445 33445 4776824 4776824 340238 340238 4131767 4131767 817071 817071 98127 98127 150234 150234 310370 310370 1851659 1851659 636143 636143 PROVIDER TAX ASSESSMENT 1653814 1653814 PURCHASE OF DRUGS 1480226 1480226 REPAIRS/MAINTENANCE 1199613 1199613 OTHER EXPENSES 293428 293428 48440418 48440418 0 0 7504270 8873121 5932251 5934066 795065 821516 360476 956055 44814495 31252377 12778385 13562118 5375406 6204475 2512812 2736595 35258665 39087946 5553738 6347611 7054145 6776702 12607883 13124313 X 22319837 25709205 330945 254428 22650782 25963633 35258665 39087946 3819356 -429988 -76517 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 39983 39983 25009932 17348574 7661358 385022 353886 31136 19379558 13549917 5829641 13562118 MISCELLANEOUS RECEIVABLES 1384553 DUE FROM MEDICAID ASSESMENT 405848 DUE TO THRID PARTY PAYORS 310074 INTEREST IN NET ASSETS OF FOUNDATION 254428 DUE FROM COUNTY-AMBULANCE SUBSIDY 218594 EST. MEDICAL MALPRACTICE RECIEVABLE 150000 DUE FROM PHYSICIANS 13098 2736595 X 51829786 -429988 -429988 52259774 52259774 48440418 48440418 48440418 SCHEDULE D, PAGE 3, PART X THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM INCOME TAXES. THERE WERE NO UNCERTAIN TAX BENEFITS IDENTIFIED AND RECORDED AS A LIABILITY UPON THE ADOPTION OF ASC TOPIC 740-10-25 ON SEPTEMBER 30, 2012. AT SEPTEMBER 30, 2015 NO INTEREST OR PENALTIES WERE ATTRIBUTED TO THE HOSPITAL. TAX RETURNS FILED BY THE HOSPITAL ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. TAX RETURNS FILED BY THE HOSPITAL ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEARS ENDED SEPTEMBER 30, 2011 AND PRIOR. true true true X true X true true true false true true 669000 669000 0.01380 11559000 9075000 2484000 0.05130 12228000 9075000 3153000 0.06510 255000 255000 0.00530 6853000 3640000 3213000 0.06630 7108000 3640000 3468000 0.07160 19336000 12715000 6621000 0.13670 true 893328 446664 16727000 22001000 -5274000 X true true 1 1 RICHLAND MEMORIAL HOSPITAL 800 EAST LOCUST OLNEY IL 62450 X X X RICHLAND MEMORIAL HOSPITAL 1 false false true X X X X X X X X X X 12 true false false true X WWW.RICHLANDMEMORIAL.COM true 13 true WWW.RICHLANDMEMORIAL.COM false false true X 200.000000000000 300.000000000000 X X X true true X X X true X HTTPWWWRICHLANDMEMORIALCOM X HTTPWWWRICHLANDMEMORIALCOM X X true X true X true X false true FACILITY 1, RICHLAND MEMORIAL HOSPITAL - PART V, LINE 5 INPUT RECEIVED THROUGH FOCUS GROUPS CONSISTING OF INDIVIDUALS FROM OUR SURROUNDING COMMUNITIES. FACILITY 1, RICHLAND MEMORIAL HOSPITAL - PART V, LINE 11 COMPLETED IMPLMENTATION ACTIONS: HEALTH NEED 1: MENTAL HEALTH AND RELATED SOCIAL ISSUES -DISCUSSIONS WITH SIHF REGARDING RECRUITMENT STRATEGIES/INTENTIONS FOR MENTAL HEALTH SERVICES -RMH OUTREACH SPECIALIST INITIATING RESEARCH INTO VARIOUS OPTIONS FOR THE INCREASED PROVISION OF MENTAL HEALTH SERVICES: -RMH ACTED AS A LIASON TO LOCAL SCHOOL SYSTEM FOR LINK TO LAWRENCE COUNTY HEALTH DEPARTMENT BEHAVIORAL HEALTH SERVICES FOR ON-SITE,AT- RISK PROGRAMMING. -DISCUSSIONS WITH CENTERPOINTE HOSPITAL FOR PROVISION OF MENTAL HEALTH SERVICES (INPATIENT AND OUTPATIENT) -DISCUSSION WITH LOCAL MENTAL HEALTH PROVIDERS FOR IDEAS/LEADS ON RECRUITMENT OF PROVIDERS. -ONGOING EXPLORATION OF VIABLE OPTIONS TO INCREASE MENTAL HEALTH SERVICES. HEALTH NEED 2: ACCESS TO HEALTH SERVICES -RECRUITED SEVERAL NEW PROVIDERS AND INCEASED NUMBER OF ATHLETIC TRAINERS IN REHAB SERVIES. -AFFILIATION AGREEMENT WITH CARLE CLINIC IN CHAMPAIGN-URBANA -CONTINUED INVESTMENT IN MEDICAL SCHOOL STUDENTS TO PROVIDE FOR FUTURE RMH STAFFING. -PARTICIPATED IN RICHLAND COUNTY INTERAGENCY STEERING COMMITTE - DISCUSSION ON THE DEVELOPMENT OF A LOCAL HEALTH DEPARTMENT HEALTH NEET 3: CHRONIC DISEASE MANAGEMENT -PROVIDE SPACE FOR MEDASSIST PROGRAM TO ASSIST WITH MEDICATION AQUISITION -PROVIDE DIABETES EDUCATION AND SUPPORT GROUP, LEAD BY RMH CERTIFIED DIABETIC EDUCATOR -COLLABORATE WITH SIHF TO PROVIDE CERTIFIED APPLICATION COUNSELORS TO ASSIST WITH ACA DIRECTED INSURANCE MARKETPLACE -PROVIDE SODIUM REDUCTION PROGRAM TO RMH PATIENTS, STAFF, AND COMMUNITY -HIRED TRANSITIONAL CARE SPECIALIST TO PROVIDE FOLLOW-UP/PREVENTION EDUCATION WITH PATIENTS AT HIGHER RISK OF READMISSION DUE TO CHRONIC ILLNESS. -DEVELOP SMOKING CESSATION PROGRAM TO BE OFFERED TO PATIENTS, COMMUNITY MEMBER, AND AREA CORPORATIONS. NO COMMUNITY NEEDS WERE LEFT UNADRESSED. FACILITY 1, RICHLAND MEMORIAL HOSPITAL - PART V, LINE 18D OUTSOURCED TO OUTSIDE COLLECTION AGENCY FACILITY 1, RICHLAND MEMORIAL HOSPITAL - PART V, LINE 22D THE HOSPITAL CHARGES ALL PATIENTS THE SAME REGARDLESS OF FINANCIAL CLASS AND/OR ABILITY TO PAY. FACILITY 1, RICHLAND MEMORIAL HOSPITAL - PART V, LINE 24 THE HOSPITAL CHARGES ALL PATIENTS THE SAME REGARDLESS OF FINANCIAL CLASS AND/OR ABILITY TO PAY. 7 OUTPATIENT THERAPY 800 E LOCUST STREET OLNEY IL 62450 OUTPATIENT THERAPY HOME HEALTH 800 E LOCUST STREET OLNEY IL 62450 HOME HEALTH AGENCY RMH PROFESSIONAL SERVICES 1200 NORTH EAST STREET OLNEY IL 62450 PHYSICIAN PRACTICE (GENERAL SURGERY) HOSPICE 800 E LOCUST STREET OLNEY IL 62450 HOSPICE SERVICES RMH PROFESSIONAL SERVICES-ENT 800 E LOCUST STREET OLNEY IL 62450 PHYSICIAN PRACTICE (EAR, NOSE,THROAT) RMH PROFESSIONAL SERVICES-UROLOGY 1200 NORTH EAST STREET OLNEY IL 62450 PHYSICIAN PRACTICE (UROLOGY) RMH PROFESSIONAL SERVICES - PRIMARY 800 E LOCUST STREET OLNEY IL 62450 PRIMARY CARE PHYSICIANS 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, 1,846,000 FOR PHYSICIAN CLINICS 843,000 FOR EMERGENCY ROOM, 395,000 FOR PSYCHIATRIC CENTER, AND 130,000 FOR AMBULANCE SERVICE. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION WE USED A COST-TO-CHARGE RATIO AS CALCULATED UTILIZING DATA FROM AN INTERNAL COST ACCOUNTING SYSTEM AND USING A METHODOLOGY CONSISTENT WITH SCEDULE H INSTRUCTIONS TO DETERMINE THE AMOUNTS ON LINES 7A AND 7B OF PART I OF SCHEDULE H. WE USED ACTUAL COSTS AS REPORTED IN THE GENERAL LEDGER SYSTEM TO DETERMINE THE AMOUNTS ON LINES 7E AND 7I OF SCHEDULE H PART I. SCHEDULE H, PART I, LINE 7G WAS DETERMINED USING BOTH ACTUAL AMOUNTS FROM THE GENERAL LEDGER AND A COST-TO-CHARGE RATIO SPECIFIC TO EACH PROGRAM. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY WE 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 SCEDULE H INSTRUCTIONS. AFTER EXHAUSTING ALL COLLECTION PROCEDURES PATIENT ACCOUNTS ARE THEN WRITTEN OFF TO BAD DEBT EXPENSE. WE ESTIMATE THAT 50% OF OUR PATIENT ACCOUNTS WRITTEN OFF TO BAD DEBT WOULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE BUT THE PATIENTS CHOSE NOT TO APPLY. THE FOLLOWING IS THE FOOTNOTE RELATING TO BAD DEBT EXPENSE EXACTLY AS IT APPEARS IN THE FOOTNOTES TO OUR AUDITED FINANCIAL STATEMENTS: FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE HOSPITAL RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED (OR ON THE BASIS OF DISCOUNTED RATES, IF NEGOTIATED OR PROVIDED BY POLICY). ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE HOSPITAL'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. DURING THE YEAR ENDED SEPTEMBER 30, 2015 THE HOSPITAL REPORTED PROVISIONS FOR UNCOLLECTIBLE ACCOUNTS OF 3,074,081. PART III, LINE 8 - MEDICARE EXPLANATION THE HOSPITAL UTILIZED THE INTERNAL COST ACCOUNTING SYSTEM TO CALCULATE UNREIMBURSED MEDICARE COSTS. SOME MEDICARE CHARGES NOT ASSOCIATED WITH ITEMS PAID ON THE COST REPORT, THE COSTS ASSOCIATED WITH THOSE CHARGES, AND OTHER COST PER THE HOSPITAL'S COST ACCOUNTING SYSTEM HAVE BEEN INCLUDED. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION RICHLAND MEMORIAL HOSPITAL (RMH) APPLIES ITS COLLECTION PRACTICES EQUALLY TO ALL PATIENTS, BOTH CHARITY CARE ELIGIBLE AND NON-CHARITY CARE PATIENTS. THE PROCEDURES ARE AS FOLLOWS: 1. WE WILL SEND 2 STATEMENTS AND 2 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 9 DAYS OF THE DISCHARGE DATE. B.ACCOUNTS WITH A PATIENT PORTION AFTER INSURANCE WILL BE ELIGIBLE TO RECEIVE A STATEMENT APPROXIMATELY 14 DAYS AFTER THE INSURANCE PAYMENT HAS BEEN POSTED. C.28 DAYS LATER THE PATIENT IS MAILED A THIRD STATEMENT D.28 DAYS LATER THE PATIENT IS MAILED THE FIRST COLLECTION LETTER E.28 DAYS LATER THE PATIENT IS MAILED THE FINAL COLLECTION LETTER F.APPROXIMATELY 15 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 2 COLLECTION LETTERS TO THE PATIENT. PATIENT HAS 15 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 HEALTHCARE 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 WOULD INCORPORATE THE NEWLY IDENTIFIED HEALTH CARE NEEDS INTO THE STRATEGIC PLAN. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE 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. THEY WILL ALSO EXPLAIN HOW THE PATIENT CAN APPLY FOR ASSISTANCE. PART VI, LINE 4 - COMMUNITY INFORMATION RICHLAND MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA INCLUDES PORTIONS OF EIGHT SOUTHEASTERN ILLINOIS COUNTIES WITH A TOTAL PATIENT POPULATION OF ABOUT 60,000. THERE ARE EIGHT COUNTIES WITHIN THE HOSPITAL'S PRIMARY SERVICE AREA. RMH FURTHER EXTENDS HOME HEALTH AND HOSPICE SERVICES TO INDIVIDUALS LIVING IN FIVE ADDITIONAL COUNTIES. 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 RICHLAND MEMORIAL HOSPITAL'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. ACCORDING TO THE 2013 UNITED STATES CENSUS, THE MEDIAN HOUSEHOLD INCOME IN THE HOSPITAL'S SERVICE AREA FALLS WELL BELOW THE STATE MEDIAN OF 56,797, WHERE RICHLAND COUNTY'S MEDIAN INCOME IS 44,070. THE ILLINOIS DEPARTMENT OF PUBLIC HEALTH CENTER FOR RURAL HEALTH INDICATES ON ITS WEB SITE THAT ALL OF THE COUNTIES IN THE HOSPITAL'S SERVICE AREA HAVE AT LEAST A PARTIAL FEDERAL HPSA DESIGNATION, WITH THE LOW-INCOME POPULATION BEING A PRIMARY CONCERN. X X X false false false false false false false false false DAVE ALLEN CEO 180689 7400 4919 193008 PRASHANTH ANAND PHYSICIAN 395631 14722 5184 415537 MARY WALLER PHYSICIAN 355044 762 355806 NIRANAT DEJTIRANUKUL ENT DOCTOR 323237 13000 2521 338758 STEPHEN REID PHYSICIAN 298708 12010 2301 313019 PAUL SUTHERLAND MD PHYSICIAN 293269 12933 7908 314110 RICK BUSSARD INSURANCE AGENT 728405 INSURANCE PREMIUM false HERMAN ZUBER FAMILY MEMBER 43128 REPORTABLE COMPENSAT false FORM 990, PAGE 2, PART III, LINE 4A OFFER > FREE CARE > 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 FISCAL YEAR 2015, RICHLAND MEMORIAL HOSPITAL RECORDED 17,888 PATIENT DAYS. RICHLAND MEMORIAL 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, RICHLAND MEMORIAL HOSPITAL RECOGNIZES THESE AMOUNTS AS COSTS INCURRED IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. CHARITY CARE IS ALSO PROVIDED THROUGH THE HOSPITAL'S INTERNAL POLICY OFFERED IN FY 2015. RICHLAND MEMORIAL 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/ACTIVITIES: > AINAD SHRINE TEMPLE > AMATEUR SPORTS PROMOTION > ABASSADOR COMPANY > AMERICAN HEART ASSOCIATION > BIG BROTHERS BIG SISTERS > BLUE KNIGHT TIP OFF CLUB > BUILD COMMUNITY > BUSINESS AFTER HOURS EVENTS > CHRISTMAS TREE / SANTA PRETZEL - 100 > EAST RICHLAND POST PROM > EDWARDS COUNTY FAIR > ERHS TIGER BASEBALL > FIRST PRESBYTERIAN CHURCH > HOLIDAY TOUR OF HOMES > HOME / BUSINESS EXPO > HSEI MEMORY MILES > IL HIGH SCHOOL RODEO > IL SOCIETY OF HEALTHCARE > LAGALA BOARD MEETING AND EVENT > LINCOLNLAND DISTRICT > MUSCULAR DYSTROPHY ASSN > NATIONAL MULTIPLE SCHLEROSIS > NEWTON ROTARY CLUB > OCC FOUNDATION > OCC MUSIC DEPT > OLNEANS YEARBOOK > OLNEY ARTS COUNCIL > OLNEY CENTRAL COLLEGE > OLNEY CHAMBER OF COMMERCE > OLNEY CHRISTMAS PARADE > OLNEY CITY COUNCIL > OLNEY ELKS CLUB > OLNEY FFA > OLNEY LADY TIGERS SOFTBALL > OLNEY LITTLE LEAGUE > OLNEY TIGER FOOTBALL > OLNEY TIGERS ATHLETICS > OLNEY TIGERSHARKS SWIM TEAM > OLNEY WHITE SQUIRREL COUNT > OUTREACH MISSION > RCRC WHITE SQUIRREL TRIATHLON > RICHLAND COUNTY 4-H > RICHLAND COUNTY CTA > RICHLAND COUNTY DEVELOPMENT CORP > RICHLAND COUNTY FARM & FAIR WEEK > RICHLAND COUNTY RECREATION COUNCIL > RICHLAND COUNTY COUNTY WALK AND ROLL > RICHLAND COUNTY YOUTH SOCCER (RCYS) > RIDGWAY CHAPTER IL AUDUBON SOCIETY > RMH & COMMUNITY GOLF OUTINGS > ROTARY CLUB OF OLNEY > RUCKERS WHOLESALE > SHRINE CLUB > SOUTHEASTEN ILLINOIS CONCERT ASSN > ST JOSEPH SCHOOL > ST THOMAS GOLF OUTING > SWAN > U.S. RT 50 FOUR-LANE COALITION > WEST RICHLAND HIGH SCHOOL > WEST RICHLAND POST PROM > WEST RICHLAND PTO 5. WELLNESS EVENTS/COMMUNITY CLINICS/SUPPORT GROUPS/ OUTREACH/EDUCATION > BLOOD PRESSURE SCREENING CLINICS > DIABETIC EDUCATION DAY > HEALTHFEST > NATIONAL HOSPITAL WEEK CHOLESTEROL/PSA SCREENING CLINIC > OLNEY SENIOR EXPO > SUPPORT GROUPS/EDUCATION 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 > MAMMOGRAPHY ASSISTANCE - IL BREAST AND CERVICAL CANCER PROGRAM SERVICE PROVIDER (LITTLE EGYPT & EAST CENTRAL REGION) > MAMMOGRAPHY ASSISTANCE - SUSAN G. KOMEN FOR THE CURE GRANT FORM 990, PAGE 6, PART VI, LINE 11B 990 IS REVIEWED BY ALL BOARD MEMBERS DURING SCHEDULED MEETINGS BEFORE IT IS FILED. FORM 990, PAGE 6, PART VI, LINE 12C 1. ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY BOARD MEMBER SHOULD BE 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 SHOULD NOT VOTE OR USE HIS/HER PERSONAL INFLUENCE ON THE MATTER, AND HE/SHE SHOULD NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING, EVEN WHERE PERMITTED BY LAW. THE MINUTES OF THE MEETING SHOULD 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 A CONFLICT MUST ABSTAIN FROM MAKING MOTIONS, PARTICIPATING IN RELEVANT DELIBERATIOINS, 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. MEMBER(S) WHO DO NOT RETURN THE CONFLICT OF INTEREST STATEMENT WILL BE ADDRESSED IN ACCORDANCE WITH THE BYLAWS. 5. RESPONSES MAY BE COMPILED 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 IMPORATANCE 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 BYLAWS SECTION III.11 "REMOVAL OF DIRECTORS" THE BOARD MAY ASK THE BOARD MEMBER TO RESIGN IF NINE OF THE TWELVE VOTING MEMBERS VOTE AFFIRMATIVELY ON A MOTION OF REMOVAL. 9. THIS POLICY WILL BE REVIEWED ANNUALLY FOR THE INFORMATION AND GUIDANCE OF BOARD MEMBERS. FORM 990, PAGE 6, PART VI, LINE 15A THE HR DEPARTMENT USES AN EXECUTIVE SURVEY FROM THE ILLINOIS HOSPITAL ASSOCIATION (IHA) TO GET A STARTING POINT FOR THE SALARY. THEN THEY FACTOR IN YEARS OF EXPERIENCE AND NEGOTIATIONS ON BOTH ENDS. ULTIMATELY THE BOARD DETERMINES THE SALARY AND THE CONTRACT IS SET ANNUALLY. FORM 990, PAGE 6, PART VI, LINE 15B SALARIES ARE BASED OFF OF THE SOUTHERN ILLINOIS HUMAN RESOURCE SURVEY. YEARS OF EXPERIENCE AND NEGOTIATION ARE FACTORS THAT ARE CONSIDERED. ONCE A SALARY IS SET A % INCREASE IS GIVEN ANNUALLY DETERMINED BY THE CEO. FORM 990, PAGE 6, PART VI, LINE 19 RICHLAND MEMORIAL HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AFTER A REQUEST IS MADE TO ADMINISTRATION. FORM 990, PART XI, LINE 9 CHANGE IN INTEREST IN NET ASSETS OF RMH FOUNDATION -76,517 RMH FOUNDATION 800 EAST LOCUST STREET OLNEY IL 62450 371178290 FUNDRAISIN 501C3 9 N/A false false false true false false false false false false false false false false true false false false false false RMH FOUNDATION C 196398 ACTUAL COST