2014-03-26T11:47:55-05:00 2013-09-30 KERBER ECK & BRAECKEL LLP 1116 W MAIN ST CARBONDALE IL 629012335 990 2012-10-01 371363001 RICHLAND MEMORIAL HOSPITAL RICH 6183952131 800 EAST LOCUST STREET OLNEY IL 624502598 MIKE STOVERINK 6183952131 2014-03-14 true DAVID SCHNAKE 6185291040 2014-03-26 2012 2015-11-30 17:44:51Z DAVID ALLEN 800 EAST LOCUST STREET OLNEY IL 62450 45762298 false X WWW.RICHLANDMEMORIAL.COM X 1953 IL TO PROVIDE EXCELLENT HEALTHCARE, PROMOTE WELLNESS, AND EDUCATE PATIENTS, STAFF, AND THE COMMUNITY. 13 9 613 0 1367758 350638 38963162 42853432 50615 27891 2839868 2530337 43221403 45762298 0 0 24844856 27458817 0 0 16391987 16876644 41236843 44335461 1984560 1426837 31747672 34044597 12223352 12961206 19524320 21083391 X TO PROVIDE EXCELLENT HEALTHCARE, PROMOTE WELLNESS, AND EDUCATE PATIENTS, STAFF, AND THE COMMUNITY. false false 44335461 45762298 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 2013, RICHLAND MEMORIAL HOSPITAL RECORDED 19,548 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 2013. 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 44335461 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 false true true false false false false false true false false false true 36 0 true 613 true false false false false false false false false false false false false X 13 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 1.50 X 0 0 0 ANDY SCHUETZ 2.00 X 0 0 0 RICK BUSSARD 2.00 X 0 0 0 DENNIS GRAVES 1.00 X 0 0 0 HERBERT BROKHOF 2.00 X 0 0 0 HARRY GARRETT MD 1.00 X 0 0 0 JESSICA SLATER 2.00 X 0 0 0 DON HATTEN MD 1.00 X 0 0 0 BRADLEY HOUSTON MD 1.00 X 0 0 0 DOUG TOMPSON 4.00 X 0 0 0 KRISTI URFER 1.00 X 0 0 0 HERMAN ZUBER 2.00 X 0 0 0 ROB ANNISS 1.50 X 0 0 0 DAVE ALLEN 40.00 X 163810 0 10746 MIKE STOVERINK 40.00 X 114587 0 9152 MARY WALLER 40.00 X 340018 0 7562 NIRANAT DEJTIRANUKUL 40.00 X 323290 0 12472 STEPHEN REID 40.00 X 239852 0 3233 JOHN WALL 40.00 X 200100 0 12845 BILLY ROSS 40.00 X 198056 0 10694 1579713 66704 16 false true false SODEXHO 4880 PAYSPHERE CIRCLE CHICAGO IL 60674 FOOD SERVICE PR 796543 DR DIRK V ROSENBERG PO BOX 457 OLNEY IL 62450 ER PHYSICIAN 279053 PHARMACY SYSTEMS INC PO BOX 71-0716 COLUMBUS OH 43217 PHARMACY MANAGE 265841 DELTA LOCUM TENENES PO BOX 202940 DALLAS TX 753202056 PHYSICIAN RECRU 235245 EMERGENCY DEPARTMENT ASSOCIATION PC 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 ER PHYSICIANS 182492 12 25000 86339 239299 350638 NET PAT REVENUE LESS MED/MEDC 42853432 42853432 42853432 27891 27891 EHR MEANINGFUL USE INCENTIVE 1341054 1341054 MISC. OTHER REVENUE 567687 567687 PROPERTY TAX 413481 413481 208115 208115 2530337 45762298 42853432 2558228 X 278397 278397 20581341 20581341 641404 641404 4532597 4532597 1425078 1425078 16274 16274 4587108 4587108 286369 286369 4211233 4211233 622370 622370 130840 130840 108614 108614 310001 310001 1673862 1673862 458526 458526 PROVIDER TAX ASSESSMENT 1630392 1630392 PURCHASE OF DRUGS 1286028 1286028 REPAIRS/MAINTENANCE 1259249 1259249 OTHER EXPENSES 295778 295778 44335461 44335461 0 0 10308868 7867964 6103436 6360612 456385 777127 706659 690517 44094929 30716903 13008887 13378026 2086641 1163437 2883710 31747672 34044597 4569726 5639707 7653626 7321499 12223352 12961206 X 19312204 20828988 212116 254403 19524320 21083391 31747672 34044597 1426837 89947 42287 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 39983 39983 24224611 16458561 7766050 510497 466071 44426 19319838 13792271 5527567 13378026 DUE TO THRID PARTY PAYORS 1820736 MISCELLANEOUS RECEIVABLES 676374 INTEREST IN NET ASSETS OF FOUNDATION 254403 DUE FROM COUNTY-AMBULANCE SUBSIDY 70000 EST. MEDICAL MALPRACTICE RECIEVABLE 50000 DUE FROM PHYSICIANS 12197 2883710 45852245 89947 89947 45762298 45762298 44335461 44335461 44335461 LIABILITY UNDER FIN 48 FOOTNOTE 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 OR AT SEPTEMBER 30, 2012. AT SEPTEMBER 30, 2013, NO INTEREST OR PENALTIES WERE ATTRIBUTED TO THE HOSPITAL. TAX RETURNS FILED BY THE HOSPITAL ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) 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, 2009 AND PRIOR. true true true X true X true true true false true true 1749000 1749000 0.03940 8846000 7067000 1779000 0.04010 10595000 7067000 3528000 0.07960 270000 270000 0.00610 6407000 2764000 3643000 0.08220 6677000 2764000 3913000 0.08830 17272000 9831000 7441000 0.16780 true 762370 381185 14965000 20739000 -5774000 X true true 1 1 RICHLAND MEMORIAL HOSPITAL

800 EAST LOCUST OLNEY IL 62450

X X X RICHLAND MEMORIAL HOSPITAL 1 true X X X X X X X X X X 12 true false true X X X X X X X X X true false true true 200.0 true 300.0 true X X X X X X true true X X X X X X true X false true X false true 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 SUBSIDIZED HEALTH SERVICES EXPLANATION PART I LINE 7G 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 AMOUNTWE INCLUDED AS UNREIMBURSED COSTS OF SUBSIDIZED HEALTH SERVICES 2057000 FOR PHYSICIAN CLINICS 792000 FOR EMERGENCT ROOM 614000 FOR PSYCHIATRIC CENTER AND 180000 FOR AMBULANCE SERVICE COSTING METHODOLOGY EXPLANATION PART I LINE 7 WE USED A COSTTOCHARGE 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 COSTTOCHARGE RATIO SPECIFIC TO EACH PROGRAM BAD DEBT EXPENSE EXPLANATION PART III LINE 4 WE CALCULATED BAD DEBT EXPENSE AT COST USING A COSTTOCHARGE 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 HOSPITALS 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 2013 THE HOSPITAL REPORTED PROVISIONS FOR UNCOLLECTIBLE ACCOUNTS OF 2448203 MEDICARE EXPLANATION PART III LINE 8 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 HOSPITALS COST ACCOUNTING SYSTEM HAVE BEEN INCLUDED COLLECTION PRACTICES EXPLANATION PART III LINE 9B RICHLAND MEMORIAL HOSPITAL RMH APPLIES ITS COLLECTION PRACTICES EQUALLY TO ALL PATIENTS BOTH CHARITY CARE ELIGIBLE AND NONCHARITY 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 PATIENTS ACCOUNT WILL AGE THROUGH THE STATEMENT PROCESS BEFORE BEING WRITTEN OFF TO BAD DEBT APRIVATE PAY ACCOUNTS WILL RECEIVE A STATEMENT WITHIN 9 DAYS OF THE DISCHARGE DATE BACCOUNTS WITH A PATIENT PORTION AFTER INSURANCE WILL BE ELIGIBLE TO RECEIVE A STATEMENT APPROXIMATELY 14 DAYS AFTER THE INSURANCE PAYMENT HAS BEEN POSTED C28 DAYS LATER THE PATIENT IS MAILED A THIRD STATEMENT D28 DAYS LATER THE PATIENT IS MAILED THE FIRST COLLECTION LETTER E28 DAYS LATER THE PATIENT IS MAILED THE FINAL COLLECTION LETTER FAPPROXIMATELY 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 1000 4 RMH WILL ATTEMPT TO CONTACT THE GUARANTOR VIA PHONE AFTER THE SECOND STATEMENT ON BALANCES LESS THAN 1000 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 NEEDS ASSESSMENT PART VI 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 ANDOR 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 HOSPITALS ADMINISTRATIVE TEAM WOULD INCORPORATE THE NEWLY IDENTIFIED HEALTH CARE NEEDS INTO THE STRATEGIC PLAN PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI 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 COMMUNITY INFORMATION PART VI RICHLAND MEMORIAL HOSPITALS PRIMARY SERVICE AREA INCLUDES PORTIONS OF EIGHT SOUTHEASTERN ILLINOIS COUNTIES WITH A TOTAL PATIENT POPULATION OF ABOUT 60000 THERE ARE EIGHT COUNTIES WITHIN THE HOSPITALS 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 HOSPITALS 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 2011 UNITED STATES CENSUS THE MEDIAN HOUSEHOLD INCOME IN THE HOSPITALS SERVICE AREA FALLS WELL BELOW THE STATE MEDIAN OF 56576 WHERE RICHLAND COUNTYS MEDIAN INCOME IS 42305 THE ILLINOIS DEPARTMENT OF PUBLIC HEALTH CENTER FOR RURAL HEALTH INDICATES ON ITS WEB SITE THAT ALL OF THE COUNTIES IN THE HOSPITALS SERVICE AREA HAVE AT LEAST A PARTIAL FEDERAL HPSA DESIGNATION WITH THE LOWINCOME POPULATION BEING A PRIMARY CONCERN RICHLAND MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 3 PART V LINE 3 INPUT RECEIVED THROUGH FOCUS GROUPS CONSISTING OF INDIVIDUALS FROM OUR SURROUNDING COMMUNITIES RICHLAND MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 16E PART V LINE 16E OUTSOURCED TO A COLLECTION AGENCY RICHLAND MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 20D PART V LINE 20D THE HOSPITAL CHARGES ALL PATIENTS THE SAME REGARDLESS OF FINANCIAL CLASS ANDOR ABILITY TO PAY RICHLAND MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 22 PART V LINE 22 THE HOSPITAL CHARGES ALL PATIENTS THE SAME REGARDLESS OF FINANCIAL CLASS ANDOR ABILITY TO PAY X X X false false false false false false false false false DAVE ALLEN 163810 6691 4055 174556 MARY WALLER 340018 6800 762 347580 NIRANAT DEJTIRANUKUL 323290 10000 2472 335762 STEPHEN REID 239852 3233 243085 JOHN WALL 200100 8165 4680 212945 BILLY ROSS 198056 8029 2665 208750 RICK BUSSARD INSURANCE AGENT 479385 INSURANCE PREMIUM false HERMAN ZUBER FAMILY MEMBER 40965 REPORTABLE COMPENSA false FIRST ACCOMPLISHMENT DESCRIPTION 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 2013, RICHLAND MEMORIAL HOSPITAL RECORDED 19,548 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 2013. 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 ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B 990 IS REVIEWED BY ALL BOARD MEMBERS DURING SCHEDULED MEETINGS BEFORE IT IS FILED. ENFORCEMENT OF CONFLICTS POLICY 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 THIRTEEN VOTING MEMBERS VOTE AFFIRMATIVELY ON A MOTION OF REMOVAL. 9. THIS POLICY WILL BE REVIEWED ANNUALLY FOR THE INFORMATION AND GUIDANCE OF BOARD MEMBERS. COMPENSATION PROCESS FOR TOP OFFICIAL 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. COMPENSATION PROCESS FOR OFFICERS 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. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION 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. OTHER FEES FOR SERVICES FORM 990, PART IX, LINE 11G PHYSICIANS SERVICES 1,138,957 0 0 CONTRACTED FOOD SERVICES 849,582 0 0 CONTRACTED PHYCHIATRIC SERV 2,675 0 0 OTHER CONTRACTED SERVICES 2,595,894 0 0 OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 9 CHANGE IN INTEREST IN NET ASSETS OF RMH FOUNDATION 42,287 RMH FOUNDATION 800 EAST LOCUST STREET OLNEY IL 62450 371178290 FUNDRAISIN 501C3 9 N/A false false false false false false false false false false false false false false true false false false false false