2026-02-06T11:52:16-06:00 2025-03-31 351178661 BLUE & CO LLC 2650 EASTPOINT PKWY SUITE 300 LOUISVILLE KY 40223 990 2024-04-01 370702309 HARDIN COUNTY GENERAL HOSPITAL HARD 6182856634 6 FERRELL ROAD ROSICLARE IL 62982 ROBY WILLIAMS CEO 6182856634 2026-02-06 1 1 EMILIE M KNIERIEM CPA P01330194 5029923500 2026-02-06 2024 2025-03-06 01:10:19Z ROBY WILLIAMS 6 FERRELL ROAD ROSICLARE IL 62982 16916723 0 X WWW.ILHCGH.ORG X 1953 IL THE PURPOSES OF THE HARDIN COUNTY GENERAL HOSPITAL, INCORPORATED SHALL BE TO OPERATE AND MAINTAIN IN THE CITY OF ROSICLARE, ILLINOIS, A HOSPITAL NOT FOR PECUNIARY PROFIT, WITH ALL THE NET INCOME THERE FROM TO BE APPLIED TO THE CHARITABLE PURPOSES OF PROVIDING QUALITY HEALTH CARE AT A REASONABLE COST AND TO THE IMPROVEMENT OF HOSPITAL FACILITIES AND SERVICES. 8 6 163 6 0 0 15103 115736 14164315 16632871 0 159339 1074638 8777 15254056 16916723 0 709 0 0 11286559 11972049 0 0 0 4628044 4759963 15914603 16732721 -660547 184002 6001189 5837709 1853854 1506372 4147335 4331337 X THE PURPOSES OF THE HARDIN COUNTY GENERAL HOSPITAL, INCORPORATED SHALL BE TO OPERATE AND MAINTAIN IN THE CITY OF ROSICLARE, ILLINOIS, A HOSPITAL NOT FOR PECUNIARY PROFIT, WITH ALL THE NET INCOME THERE FROM TO BE APPLIED TO THE CHARITABLE PURPOSES OF PROVIDING QUALITY HEALTH CARE AT A REASONABLE COST AND TO THE IMPROVEMENT OF HOSPITAL FACILITIES AND SERVICES. 0 0 10768952 709 16641648 HARDIN COUNTY GENERAL HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. HARDIN COUNTY GENERAL HOSPITAL RECORDED 2,404 ADULT AND CHILDREN PATIENT DAYS AND 14,534 OUTPATIENT VISITS DURING THE FISCAL YEAR END 2025. THE EMERGENCY ROOM TREATED APPROXIMATELY 3,899 PATIENTS, AND THERE WERE 201 ER TRANSFERS. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND FURTHER THAT THE MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING QUALITY HEALTHCARE. 10768952 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 5 0 1 163 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X THE ORGANIZATION 6182856634 6 FERRELL ROAD ROSICLARE IL 62982 CHARLES SOWARD PRESIDENT 1.00 0.00 X X 0 0 0 DOTTY CUBLEY VICE PRESIDENT 1.00 0.00 X X 0 0 0 LUCINDA SPIVEY SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 GARY GROSS BOARD MEMBER 1.00 0.00 X 0 0 0 GEORGE THODOROPOULOS BOARD MEMBER 1.00 0.00 X 0 0 0 DANA ROBINSON BOARD MEMBER 1.00 0.00 X 0 0 0 DR MARCOS SUNGA MD BOARD MEMBER/PHYSICIAN 85.00 0.00 X 771686 0 18927 ROBY WILLIAMS CEO/BOARD MEMBER 40.00 0.00 X X 162387 0 15019 SUSIE DEGRAVE CFO (BEG 03/24) 40.00 0.00 X 87874 0 5146 ANDREA BEBOUT CNO 40.00 0.00 X 199984 0 11356 ELADIO CHATTO MD PHYSICIAN 40.00 0.00 X 601275 0 19379 JOSHUA HASTIE MD PHYSICIAN 40.00 0.00 X 508357 0 17434 CHERYL HICKS FNP-C 40.00 0.00 X 126044 0 7198 ANGELA KAYLOR APN 40.00 0.00 X 125192 0 7923 EVA WINTERS RN 40.00 0.00 X 116343 0 4654 2699142 0 107036 10 0 1 0 MIDWEST NURSING & VASCULAR SERVICE LLC 1222 S WALNUT STREET SALEM IL 62881 TRAVEL NURSES 206242 HARDIN COUNTY PHARMACY LLC PO BOX 98 ROSICLARE IL 62982 PHARMACY OVERSIGHT 112267 DEACONESS HOSPITAL 600 MARY STREET EVANSVILLE IN 47747 MEDICAL SERVICES 111047 3 115206 530 115736 NET PATIENT REVENUE 621399 14872804 14872804 340B REVENUE 621999 1760067 1760067 16632871 159339 159339 REBATES 900099 6160 6160 MEDICAL TRANSCRIPTS 900099 2183 2183 MISCELLANEOUS REVENUE 900099 434 434 8777 16916723 16641648 0 159339 709 709 1324316 946356 377960 516895 369373 147522 5129747 3665717 1464030 798453 480749 317704 1929821 1161946 767875 2272817 1368464 904353 105444 75814 29630 836604 752259 84345 54134 27013 27121 427120 265444 161676 10505 5242 5263 26317 26317 467814 364427 103387 174468 174468 OTHER SUPPLIES 827394 412870 414524 MEDICAL SUPPLIES & DRUG 687681 494442 193239 REPAIRS AND MAINTENANCE 398674 198938 199736 PROVIDER TAX 384711 384711 359097 179189 179908 16732721 10768952 5963769 0 1782012 19229 0 2841877 2266828 1195482 254431 330601 37396 32403 6922792 5801976 1437523 1120816 222999 297301 6001189 5837709 1377466 1179946 30540 0 445848 326426 1853854 1506372 X 4147335 4331337 4147335 4331337 6001189 5837709 184002 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10218 10218 0 PART II-B, LINE 1: HCGH PAID MEMBERSHIP DUES IN FYE 2025 TO IHA AND AHA, IN WHICH A PORTION OF DUES WERE ATTRIBUTABLE TOWARDS LOBBYING ACTIVITIES. 17000 17000 2105826 1735635 370191 256674 254421 2253 4543292 3811920 731372 1120816 ROU ASSET - FINANCING LEASE 297301 297301 THIRD PARTY PAYORS 29125 ROU LIABILITY - FINANCE LEASE 297301 326426 X 16916723 0 16916723 0 16916723 16732721 0 16732721 0 16732721 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL, AND HAS CONCLUDED THAT AS OF MARCH 31, 2025 AND 2024 , THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 1 1 1 X 1 X 1 1 0 1 0 654335 607232 47103 0.00280 3596517 1226280 2370237 0.14170 4250852 1833512 2417340 0.14450 1 1380535 265878 1114657 0.06660 1 1380535 265878 1114657 0.06660 1 5631387 2099390 3531997 0.21110 1 1091071 5153623 7845423 -2691800 X 1 1 1 1 HARDIN COUNTY GENERAL HOSPITAL 6 FERRELL ROAD ROSICLARE IL 62982 WWW.ILHCGH.ORG X X X X HARDIN COUNTY GENERAL HOSPITAL 1 0 0 1 X X X X X X X X 23 1 0 0 1 X WWW.ILHCGH.ORG X 1 23 1 WWW.ILHCGH.ORG 0 1 X 125.000000000000 400.000000000000 X X 1 1 X X X 1 X HTTPS://ILHCGH.ORG/FINANCIAL-ASSISTANCE X HTTPS://ILHCGH.ORG/FINANCIAL-ASSISTANCE X HTTPS://ILHCGH.ORG/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 PART V, SECTION A: HARDIN COUNTY GENERAL HOSPITAL (HCGH) IS A 25-BED, NON-PROFIT CRITICAL ACCESS HOSPITAL LICENSED BY THE ILLINOIS DEPARTMENT OF PUBLIC HEALTH AND IS A MEMBER OF THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK AND THE ILLINOIS HOSPITAL AND HEALTH SYSTEMS ASSOCIATION. THE FULL SCOPE OF PATIENT CARE IS PROVIDED ONLY BY THOSE PROFESSIONALS WHO ARE ALSO COMPETENT TO ASSESS PATIENTS AND PLAN OF CARE BASED ON FINDINGS FROM THAT ASSESSMENT. HCGH ACCEPTS PATIENTS REGARDLESS OF ABILITY TO PAY AND IS AN EQUAL OPPORTUNITY EMPLOYER. THE SCOPE OF SERVICES PROVIDED BY THE HOSPITAL INCLUDE 24-HOUR EMERGENCY ROOM COVERAGE BY 3 PHYSICIANS AND 3 MID-LEVEL PRACTITIONERS WHICH ARE BOARD CERTIFIED. THE HOSPITAL ALSO EMPLOYS 37 NURSES ON STAFF, OF WHICH 7 ARE ACLS CERTIFIED AND 4 ARE NURSES THAT ARE PEDIATRIC ADVANCED LIFE SUPPORT CERTIFIED, ALL OF WHICH PROVIDE A WIDE VARIETY OF HEALTH SERVICES SUCH AS RESPIRATORY THERAPY, CARDIO-PULMONARY SERVICES, RADIOLOGY, ULTRASOUND, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, CAT SCAN INCLUDING CTA, MAMMOGRAPHY, MRI, SOCIAL SERVICES, MEDICARE SWING BED, BEHAVIORAL HEALTH, RURAL HEALTH CLINIC (PROVIDER-BASED), SLEEP STUDY, ENDOSCOPY, COLONOSCOPY, LATORATORY, NUCLEAR MEDICINE, IN-PATIENT AND OBSERVATION BED, EMERGENCY AMBULANCE. HARDIN COUNTY GENERAL HOSPITAL PART V, SECTION B, LINE 5: PRIMARY DATA WAS COLLECTED THROUGH A SURVEY OF HARDIN AND POPE COUNTY RESIDENTS. PARTICIPANTS WERE ASKED THEIR GENDER, RACE, EDUCATION, AND INCOME LEVELS. ALL OF THE SURVEYS WERE ANONYMOUS. WE SURVEYED HARDIN AND POPE COUNTY RESIDENTS FROM DECEMBER 2022 TO FEBRUARY 2023. WE CREATED AND USED AN ONLINE SURVEY TO COLLECT THE DATA. IN FIVE TO TEN MINUTES, RESPONDANTS ANSWERED 25 QUESTIONS RELATED TO INDOVIDUAL HEALTH AND ACCESS TO CARE, HEALTH SERVICES, CHALLENGES AND RISK FACTORS, AND SOURCES OF HEALTH INFORMATION. FOCUS GROUP INTERVIEWS AND SURVEYS WERE PROVIDED TO KEY COMMUNITY PROVIDERS FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE FOCUS GROUP MEMBERS WERE SELECTED BASED ON THEIR ABILITY TO UNDERSTAND THE MOST PROMINANT HEALTH ISSUES AFFECTING HARDIN AND POPE COUNTY RESIDENTS, AS WELL AS THEIR ABILITY TO IDENTIFY EXISTING COMMUNITY STRENGTHS AND RESOURCES. THE FOCUS GROUP MEMBERS INCLUDED AT LEAST ONE PERSON FROM ARROWLEAF HUMAN SERVICES, SOUTHERN SEVEN HEALTH DEPARTMENT. HARDIN COUNTY GENERAL HOSPITAL PART V, SECTION B, LINE 11: OUR PURPOSE WAS TO IDENTIFY HEALTH CHALLENGES AND RISK FACTORS THAT CAN BE MODIFIED OR PREVENTED TO IMPOVE THE HEALTH OF OUR COMMUNITY. WE IDENTIFIED AND PRIORITIZED COMMUNITY NEEDS FOR HARDIN AND POPE COUNTIES. HARDIN COUNTY GENERAL HOSPITAL CAN ADDRESS AND HAVE AN IMPACT ON CERTAIN NEEDS BY IMPLEMENTING PROGRAMS, EDUCATION, AND PREVENTATIVE SCREENINGS. HCGH WILL NOT BE ABLE TO ADDRESS ALL OF THE IDENTIFIED NEEDS OF THE COMMUNITY BUT WILL RELY ON OTHER RESOURCES BETTER POSITIONED TO ADDRESS SPECIFIC NEEDS. SOME WAYS THAT HCGH CAN ADDRESS IDENTIFIED ISSUES AND MAKE AN IMPACT ON CERTAIN NEEDS INCLUDE: 1) PROVIDING SUBSTANCE ABUSE PREVENTION, EDUCATION, AND TREATMENT2) PROVIDING EDUCATION AND SUPPORT FOR PREVALENT CHRONIC DISEASES SUCH AS HIGH BLOOD PRESSURE, DIABETES, AND OBESITY 3) IDENTIFYING AND IMPROVING ACCESS TO SPECIALTY PHYSICIANS OR PROVIDERS FOR REFERRAL OF PATIENTS FOR MENTAL AND BEHAVIORAL HEALTH SERVICES4) CREATING A MARKETING STRATEGY TO HELP OPTIMIZE PATIENT EXPERIENCE AND EXPAND THE PATIENTS BASES5) PARTICIPATING IN MULTISECTOR COLLABORATIONS THAT SUPPORT SHARED OWNERSHIP OF ALL PHASES OF COMMUNITY HEALTH IMPROVEMENT PART I, LINE 7: THE HOSPITAL USED A COST-TO-CHARGE RATIO AS CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, INCLUDED IN THE SCHEDULE H INSTRUCTIONS TO DETERMINE THE AMOUNTS ON LINE 7A AND 7B OF PART I OF SCHEDULE H. PART I, LINE 7G: LINES 7G IS BASED ON ACTUAL COSTS PROVIDED FOR THE RURAL HEALTH CLINIC. PART III, LINE 2: THE HOSPITAL CALCULATED BAD DEBT EXPENSE AT COST USING THE COST-TO-CHARGE RATIO AS CALCULATED USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT ONLY AFTER ALL COLLECTION PROCEDURES HAVE BEEN EXHAUSTED AS OUTLINED IN SCHEDULE H, PART III, LINE 9B. PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER ALL DISCOUNTS AND PAYMENTS HAVE BEEN APPLIED. BASED ON THE HOSPITAL'S EXPERIENCE WITH ITS PATIENTS, THEY ESTIMATE THAT IT IS LIKELY UP TO 50% OF THE PATIENT ACCOUNTS WRITTEN OFF TO BAD DEBTS MAY QUALIFY FOR CHARITY CARE OR OTHER ASSISTANCE BUT CHOSE NOT TO APPLY. THEREFORE, 50% OF THE BAD DEBT EXPENSE WAS INCLUDED ON PART III, LINE 3 AT COST. THE PROVISION FOR BAD DEBTS IS CLEARLY OUTLINED ON THE STATEMENT OF OPERATIONS. THE PROVISION FOR BAD DEBTS REPRESENTS UNCOMPENSATED CARE FOR PATIENTS OF WHICH A MAJORITY ARE UNINSURED OR UNDERINSURED BUT DID NOT APPLY FOR OR QUALIFY FOR CHARITY CARE. PART III, LINE 4: SEE PAGE 7 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE HOSPITAL USED AN OVERALL COST-TO-CHARGE RATIO TO DETERMINE THE UNPAID COST OF MEDICARE. UNPAID COST OF MEDICARE REPRESENTS THE COST OF PROVIDING SERVICES TO PRIMARILY ELDERLY BENEFICIARIES OF THE MEDICARE PROGRAM, IN EXCESS OF PAYMENTS FOR THOSE SERVICES. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. PART III, LINE 9B: FINANCIAL ASSSITANCE PROGRAM (FAP), PRESUMPTIVE ELIGIBILITY CRITERIA, COLLECTION PRACTICES AND BAD DEBT REFERRAL PROCEDURES: COMMUNITY SERVIE IN THE FORM OF FINANCIAL ASSISTANCE AND/OR CHARITY WILL BE AVAILABLE TO PERSONS WHO ARE UNINSURED. FINANCIAL ASSISTANCE MY BE GIVEN IN THE FORM OF FREE CARE, DISCOUNTS ON BILLS AND/OR PAYMENT PLANS. THE FINANCIAL ASSISTANCE PROGRAM INCLUDES ALL BILLS FROM THE HOSPITAL, PROVIDER BASED RURAL HEALTH CLINIC AND HOSPITAL EMPLOYED PROVIDERS WHO HAVE REASSIGNED THEIR BENEFITS TO THE HOSPITAL (HOSPITAL BILLS FOR PHYSICIANS). THIS CURRENTLY INCLUDES PHYSICIAN FEES FOR DR. SUNGA, DR. HASTIE, DR. CHATTO AND DR. BOSE. YOU MAY RECEIVE SEPARATE BILLS FOR PROFESSIONAL FEES BY OTHER HEALTH CARE PROFESSIONALS. THE HOSPITAL FAP DOES NOT COVER OUTSIDE BILLS FOR INDEPENDENT PHYSICIAN BILLS INCLUDING RADIOLOGY AND PATHOLOGY WHICH CURRENTLY INCLUDES SPECIALIST MEDICAL IMAGING (SMI)/SALINE VALLEY OF RADIOLOGY PARTNERS AND LABORATORY OF AMERICA HOLDINGS (LABCORP) AND QUEST DIAGNOSTICS, AS WELL AS CARDIO/PULMONARY SERVICES PROVIDED BY IRHYTHM TECHNOLOGIES, INC., PHILLIPS BIOTEL HEART AND BLACK STONE MEDICAL. NO ONE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FAP WILL BE CHARGED MORE FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE THAN AMOUNTS GENERALLY BILLED (AGB) TO INDIVIDUALS WHO HAVE INSURANCE COVERAGE. THE AGB BILLED BY HARDIN COUNTY GENERAL HOSPITAL IS A COMBINATION OF THE "LOOK-BACK" METHOD AND A PERCENT OF THE MEDICARE FEE SCHEDULE. THIS INCLUDES A COMPARISON AND REVIEW OF THE HOSPITAL'S MEDICARE COST REPORT SUBMITTED ANNUALLY, AS WELL AS THE PAST YEAR'S PRIVATE HEALTH INCLSURANCE CLAIMS PAID TO THE FACILITY AND THE MEDICARE FEE SCHEDULE TIMES 2.5 A) UPON ADMISSION AND REGISTRATION, THE PATIENT'S PAY STATUS IS DETERMINED AND RECORDED (I.E. INSURED OR UNINSURED). INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE IS DISTRIBUTED AND POSTED TO ALL PATIENTS IN THE WAITING AREAS OR ON THE HOSPITAL WEBSITE AT WWW.ILHCGH.ORG. THIS INCLUDES ACCESS TO THE FAP PLAIN LANGUAGE SUMMARY AND APPLICATION. IF AN INDIVIDUAL IS DEEMED TO BE UNINSURED, A BILL WITH THE HOSPITAL TELEPHONE NUMBER, ADDRESS, BRIEF EXPLANATION OF SERVICES, TOTAL BILL AND INFORMATION ABOUT THE AVAILABILITY OF AN ITEMIZED BILL AND FINANCIAL ASSISTANCE IS PROVIDED WITHIN 10 DAYS OF THE DATE OF SERVICE. IF YOU ARE UNINSURED, A SOCIAL SECURITY NUMBER IS NOT REQUIRED TO QUALIFY FOR FREE OR DISCOUNTED CARE. B) BASED ON THE NO SURPRISES ACT, (REFER TO NO SURPRISES ACT POLICY) EFFECTIVE JANUARY 1, 2022, A GOOD FAITH ESTIMATE (PROVIDED ON FORM CMS-10780) WILL BE PROVIDED TO ALL UNINSURED AND/OR SELF-PAY PATIENTS WITH A TEST OR PROCEDURE SCHEDULED 3 DAYS PRIOR TO SAID TEST OR PROCEDURE. THE BILL WILL AUTOMATICALLY REFLECT A 10% DISCOUNT OFF OF BILLED CHARGED FOR ALL UNINSURED CUSTOMERS WITH AN ADDITIONAL 10% IF PAID PROMPTLY. THE CUSTOMER WILL BE DIRECTED TO THE COLLECTION MANAGER IF THE BILL IS UNPAID AFTER 30 DAYS. C) IN THE EVENT THE PATIENT IS DEEMED INSURED, CO-PAYMENTS AND DEDUCTIBLES WILL BE EXPECTED AT TIME OF SERVICE. IF THE CUSTOMER IS UNABLE TO PAY OR HAS PRIOR BAD DEBTS, THEY WIULL BE REFERRED TO THE COLLECTION MANAGER. PATIENTS WITH PRIOR BALANCES BAY BE REQUESTED TO MAKE EITHER PAYMENT IN FULL OR PARTIAL PAYMENT ON BALANCES BEFORE ADDITIONAL NON-EMERGENCY SERVICES ARE RENDERED. 50% OF THE BILL WILL BE REQUESTED AND/OR A PAYMENT PLAN ESTABLISHED BASED ON THE FOLLOWING GUIDELINES: 6-MONTH INTEREST FREE LOAN FOR AMOUNTS LESS THAN $600, A 12-MONTH INTEREST FREE LOAN FOR AMOUNTS OVER $600. IF THE CUSTOMER MISSES THE ESTABLISHED PAYMENT OR GOES OVER THE ALOTTED TIME FOR REPAYMENT, THE ACCOUNT IS AUTOMATICALLY SENT TO THE OUTSIDE COLLECTION AGENCY. EXCEPTIONS WILL ONLY BE MADE THROUGH PROOF OF HARDSHIP. THIS WOULD INCLUDE LOSS OF JOB, INCOME, ETC. THE CUSTOMER WILL BE ASKED TO PROVIDE PROOF BY PRODUCING TERMINATION LETTERS, BANK STATEMENTS AND ANY OTHER PROOF REQUESTED. DURING COVID-19, EFFECTIVE JANUARY 2020 THROUGHOUT THE PANDEMIC EMERGENCY STATUS, ALL COPAYS AND DEDUCTIBLES FOR THE INSURED WITH A DIAGNOSIS OF COVID, IN NETWORK OR OUR OF NETWORK SHALL BE WAIVED. IN ADDITION, ALL UNINSURED PATIENTS WILL BE DEEMED AS PRESUMPTIVELY ELIGIBLE FOR FREE CARE IF THE PATIENT HAS A COVID DIAGNOSIS. D) CHARGESA ARE POSTED AND BILLS ARE SUBMITTED TO ALL AVAILABLE INSRUANCES. UPON RECEIPT OF EXPLANATION OF BENEFITS OR REMITTANCE ADVICE FROM THE INSURANCE COMPANY, ANY BALANCE REMAINING ON ACCOUNT IS PLACED IN PRIVATE PAY CLASS AND SENT AN INITIAL BILL IN THE SAME MANNER AS STEP B FOR UNINSURED. NON-COVERED OR DENIED SERVICES WILL BE TREATED AS UNINSURED SERVICES. E) WHEN OUTSTANDING BILLS ARE 60 DAYS OLD, A SECOND STATEMENT IS MAILED WITH FINANCIAL ASSISTANCE INFORMATION INCLUDED. F) A THIRD STATEMENT IS MAILED AT THE END OF AN ADDITIONAL 30 DAYS WITH INFORMATION CONCERING FINANCIAL ASSISTANCE, DISCOUNTS, AND PAYMENT PLANS AVAILABLE. AFTER 30 OR MORE DAYS A FINAL DEMAND NOTICE IS MAILED (120 DAYS TOTAL). AT THIS POINT THE CREDIT MANAGER OR ASSIGNED AGENT OF THE HOSPITAL ATTEMPTS TO CONTACT THE CUSTOMER BY TELEPHONE, CELL PHONE, EMAL, MAIL, TEXT MESSAGE OR ANY OTHER ACCEPTABLE MANNER OF CONTACT AND DETERMINES WHETHER THE BILL IS COLLECTIBLE. G) IF AT ANY TIME DURING THE TIME OF REGISTRATION OR THROUGH THE ENTIRE COLLECTION PROCESS, THE CUSTOMER NOTIFIES THE HOSPITAL ABOUT THE NEED FOR FINANCIAL ASSISTANCE, THE CREDIT MANAGER WILL PROMPTLY RESPOND WITH THE PROPER APPLICATION (IN 2 DAYS IF CONTACTED BE TELEPHONE AND IN 10 DAYS IN WRITING). THE APPLICATION HAS UP TO 120 DAYS FROM THE DATE OF SERVICE TO COMPLETE THE APPLICATION AND SUBMIT IT TO THE HOSPITAL. THE APPLICATION WILL BE REVIEWED FOR THE FOLLOWING: 1. ELIGIBILITY REQUIRES PROOF OF NEED WHICH INCLUDES STATE AND FEDERAL TAX RETURNS, PROOF OF INCOME AND MINIMUM OF TWO MOST RECENT BANK STATEMENTS, PROOF OF DISABILITY OR LETTER FROM FAMILY OR RESPONSIBLE PARTY INDICATING NEED, SELF-EMPLOYMENT TAX RETURNS, PROOF OF SOCIAL SECURITY, RETIREMENT INCOME AND ANY OTHER FORM OF INCOME. IF A PATIENT MEETS PRESUMPTIVE ELIGIBILTY CRITERIA, THE PATIENT SHALL NOT BE REQUIRED TO COMPLETE THE APPLICATION'S SECTION ON MONTHLY EXPENSES. 2. APPLICANTS MAY BE ASKED TO APPLY FOR ASSISTANCE FROM OTHER APPROPRIATE SOURCES IF IT IS DETERMINED THEY COULD QUALIFY FOR ANOTHER PROGRAM. ONCE THE INFORMATION IS COMPILED AND REVIEWED BY THE CREDIT MANAGER AND A DETERMINATION IS MADE THAT THE FINANCIAL ASSISTANCE APPLICATION MEETS THE CRITERIA, IT WILL BE FORWARDDED TO ADMINISTRATION FOR REVIEW. PROMPT DETERMINATION OF ELIGIBILITY WILL BE BASED ON INCOME LEVEL SET BY THE CURRENT DEPARTMENT OF HEALTH AND HUMAN SERVICES POVERTY GUIDELINES. THE PATIENT WILL RECEIVE NOTICE AS TO THE APPROVAL OR DENIAL OF FINANCIAL ASSISTANCE/CHARITY CARE. THE PATIENT WILL ALSO BE NOTIFIED ABOUT ANY DISCOUNTS OR PAYMENT PLANS THAT MIGHT BE AVAILABLE. THE APPROVED APPLICATION IS VALID FOR THE YEAR APPLIED IN AND MUST BE RENEWED ANNUALLY. 3. PRESUMPTIVE ELIGIBILITY: AS SOON AS POSSIBLE AFTER RECEIPT OF HOSPITAL SERVICES BY AN UNINSURED PATIENT, THE HOSPITAL WILL ATTEMPT TO DETERMINE IF THE PATIENT AUTOMATICALLY QUALIFIES FOR FREE CARE BASED ON PRESUMPTIVE ELIGIBILITY CRITERIA AS FOLLOWS: A) EXPIRED PATIENTS WITH NO ESTATE B) HOMELESS C) RESIDENT OF SHELTER FACILITIES D) RAPE VICTIM OR VICTIM OF VIOLENT CRIMES E) UNEMPLOYED WITH NO BENEFITS F) INABILITY TO CONTACT AS A RESULT OF BAD ADDRESS AND TELEPHONE NUMBER AFTER 1 YEAR OF ATTEMPTS G) NON-COVERED OR DENIED SERVICES H) MENTAL INCAPACITATION WITH NO ONE TO ACT ON PATIENT'S BEHALF I) MEDICAID ELIGIBILTY, BUT NOT ON DATE OF SERVICE OR FOR NON-COVERED SERVICE J) RECENT PERSONAL BANKRUPTCY K) INCARCERATION IN A PENAL INSTITUTION L) ENROLLMENT IN THE FOLLOWING ASSISTANCE PROGRAMS FO LOW-INCOME INDIVIDUALS: 1. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) 2. ILLINOIS HOUSING DEVELOPMENT AUTHORITY'S RENTAL HOUSING SUPPORT PROGRAM 3. WOMEN, INFANTS AND CHILDREN NUTRITION PROGRAM (WIC) 4. SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP). PATIENTS WILL BE EXPECTED TO MAKE A GOOD FAITH EFFORT TO PROVIDE INFORMATION TO ASSIST THE HOSPITAL IN DETERMINING IF THE PATIENT MEETS PRESUMPTIVE ELIGIBILITY. 4. HCGC HAS MADE DETERMINATION THAT PATIENTS RECEIVING THE FOLLOWING SERVICES WILL AUTOMATICALLY QUALIFY FOR 100% ASSISTANCE WITHOUT APPLICATION: A) MEDICAID PATIENTS DETERMINED TO BE MEDICAID QUALIFIED AFTER THE 6-MONTH TIMELY FILING PERIOD, VERIFIED THROUGH HFS, B) MEDICAID SMALL BALANCES OF $10.00 OR LESS (AFTER A STATEMENT IS MAILED IF DEDUCTIBLE OR CO-PAY), C) BILLED MEDICAID SERVICES THAT HAVE BEEN DENIED OR REJECTED FOR PAYMENT BY HFS, D) MEDICAID SPEND DOWNS.5. HCGC UTILIZES THE FEDERAL POVERTY GUIDELINES PUBLISHED BY US DHHS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE OR COMMUNITY BENEFITS. PLEASE VISIT THE HOSPITAL'S WEBSITE TO VIEW THE COMPLETE FINANCIAL ASSISTANCE PROGRAM. PART VI, LINE 2: THE CURRENT AND FUTURE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED BY HARDIN COUNTY GENERAL HOSPITAL ARE DETERMINED BY VARIOUS METHODS. ELEMENTS OF HCGH'S ASSESSMENT PROCESS INCLUDE:1. A COLLECTION AND ANALYSIS OF DATA FROM EXISTING DATA SOURCES REGARDING COMMUNITY DEMOGRAPHICS, SOCIOECONOMIC AND HEALTH STATISTICS, AND HEALTH CARE RESOURCES2. COMMUNITY SURVEYS AND AREA SERVICE PROVIDER INTERVIEWS3. STAFF AND COMMITTEE MEETINGS HELD WITHIN THE HCGH4. AN ANALYSIS OF EXISTING COMMUNITY PLANS FROM SOUTHERN SEVEN HEALTH DEPARTMENT.THE MANAGEMENT TEAM OF HCGH REVIEWS AND USES THE HOSPITAL STRATEGIC PLANT OT IDENTIFY AREAS OF SERVICE THAT NEED TO BE CONSIDERED, CONTINUED, UPDATED, OR ELIMINATED. THE MANAGEMENT TEAM WHICH INCLUDES THE ADMINISTRATOR AND HOSPITAL DEPARTMENT HEADS, MEETS MONTHLY TO IDENTIFY PRIORITIES AND ONGOING ISSUES, REVIEW RESOURCES AND DETERMINE SERVICES THAT CAN BE IMPROVED OR ADDED. THE BOARD OF DIRECTORS OF HARDIN COUNTY GENERAL HOSPITAL IS MADE UP OF REPRESENTATIVES FROM THE SERVICE AREA AND MEETS MONTHLY TO REVIEW FINANCIALS, BE INFORMED OF HOSPITAL ACTIVITIES AND ASSESS THE NEEDS OF THE COMMUNITY. HCGH PROFESSIONAL ADVISORY COMMITTEES FOR BOTH CRITICAL ACCESS HOSPITAL AND RURAL HEALHT CLINIC MEET ANNUALLY TO REVIEW AND ANALYZE THE OPERATIONS AND THE COMMUNITY NEEDS OF THOSE ORGANIZATIONS. THESE COMMITTEES INCLUDE MEMBERS OF ADMINISTRATION AND MEDICAL STAFF. PERIODICALLY, HOSPITAL FOCUS GROUPS ARE APPOINTED TO ADDRESS ONGOING CONCERNS THAT WILL IMPROVE CARE TO THE COMMUNITY. OUTSIDE AGENCIES ARE CONTRACTED TO MONITOR THE GROUPS AND COMPILE INFORMATION FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT AND OTHER REPORTS TO BE STUDIED BY THE BOARD OF DIRECTORS, ADMINISTRATIONS, AND VARIOUS COMMITTEES. INTERNAL SATISFACTION SURVEYS FOR THE PUBLIC ARE DISTRIBUTED AND REVIEWED QUARTERLY IN THE QUALITY IMPROVEMENT MEETINGS AND THE BOARD OF DIRECTOR MEETINGS. IN ADDITION, THE HOSPITAL PARTICIPATES IN THE HCAPS PROGRAM WHICH SUBMITS SURVEYS INDEPENDENTLY AND IS COMPARED NATIONALLY AND STATEWIDE AS SEEN ON THE HOSPITAL COMPARE WEBSITE. HCGH IS ALSO PARTICIPATING IN THE EDCAPS PILOT SURVEY PROGRAM FOR EMERGENCY ROOM DATA. THESE SURVEYS ARE ALSO REVIEWED DURING THE Q1 MEETING BY ADMINISTRATORS AND SUPERVISORS. PART VI, LINE 3: INFORMATION REGARDING THE HOSPITAL FINANCIAL ASSISTANCE PROGRAM IS POSTED IN THE EMERGENCY ROOM AND LOBBY. EVERY STATEMENT SENT TO PRIVATE PAY PATIENTS HAS VERBIAGE ABOUT CONTACTING THE HOSPITAL ABOUT THE FINANCIAL ASSISTANCE PROGRAM. ALL PRIVATE PAY INPATIENTS ARE VISITED BY THE FINANCIAL ASSISTANCE REPRESENTATIVE AND ALL PRIVATE PAY EMERGENCY ROOM PATIENTS ARE AUTOMATICALLY MAILED A CHARITY PROGRAM APPLICATION. IN ADDITION, THE FINANCIAL ASSISTANCE PROGRAM IS POSTED ON THE HOSPITAL'S WEBSITE AT WWW.ILHCGH.ORG AND AN APPLICATION IS AVAILABLE FOR PRINTING. PART VI, LINE 4: HARDIN COUNTY GENERAL HOSPITAL & CLINIC'S PRIMARY SERVICE AREA INCLUDES HARDIN AND POPE COUNTIES. THE PRIMARY TARGET POPULATION BASED ON DEMOGRAPHICS FROM 2023 U.S. CENSUS BUREAU IS APPROXIMATELY 7,276 RESIDENTS. THE AVERAGE MEDIAN AGE IN OUR SERVICE AREA IS APPROXIMATELY 53 YEAR OF AGE. AN AVERAGE OF 30% OF OUR TARGET POPULATION IS 65 YEARS OF AGE OR OVER. AGE DISTRIBUTION UNDER 18 YEARS OF AGE IS 18% FOR HARDIN COUNTY AND 11% FOR POPE COUNTY, WITH THE STATE OF ILLINOIS BEING 22% UNDER 18 YEARS OF AGE. MEDIAN INCOME WAS $53,026 FOR HARDIN COUNTY AND $57,582 FOR POPE COUNTY FOR AN AVERAGE OF $55,304, WITH A STATE AVERAGE OF $78,433 AND U.S. AVERAGE OF $75,149. ECONOMICALLY, AN AVERAGE OF 17% OF OUR POPULATION IS BELOW THE POVERTY LEVEL, 18% FOR HARDIN AND 16% FOR POPE. THE UNEMPLOYMENT RATE FOR OUR TARGET POPULATION IS APPROXIMATELY 3.2%, AS COMPARED TO THE STATE OF ILLINOIS AT 4.8% AND U.S. OF 4.3%. X X 0 0 0 0 0 0 0 0 0 DR MARCOS SUNGA MD BOARD MEMBER/PHYSICIAN 771186 0 500 0 0 0 13800 0 5127 0 790613 0 0 0 ELADIO CHATTO MD PHYSICIAN 600775 0 500 0 0 0 13800 0 5579 0 620654 0 0 0 JOSHUA HASTIE MD PHYSICIAN 507857 0 500 0 0 0 13800 0 3634 0 525791 0 0 0 ANDREA BEBOUT CNO 199484 0 500 0 0 0 7999 0 3357 0 211340 0 0 0 ROBY WILLIAMS CEO/BOARD MEMBER 161887 0 500 0 0 0 6496 0 8523 0 177406 0 0 0 JOSHUA HASTIE MD SON-IN-LAW OF BOARD MEMBER LUCINDA SPIVEY 516895 COMPENSATION 0 FORM 990, PART VI, SECTION B, LINE 11B BOARD MEMBERS ARE PROVIDED A COPY OF THE FORM 990 FOR THEIR REVIEW AND COMMENT BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR AND OFFICER ARE GIVEN A QUESTIONNAIRE THAT INCLUDES ASKING THEM TO DISCLOSE ANY APPLICABLE CONFLICTS OF INTEREST. THIS IS DONE ON AN ANNUAL BASIS AND ENFORCEMENT IS DONE ON A PER INCIDENT BASIS, WITH ALL ASPECTS OF THE CONFLICT TAKEN INTO CONSIDERATION. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS PERFORMS A FORMAL REVIEW PROCESS FOR THE CEO'S COMPENSATION IN APRIL EACH YEAR DURING A BOARD MEETING, USING REGIONAL WAGE DATA FOR COMPARABLE SIZE FACILITIES. HCGH HAS A SYSTEM IN PLACE WHERE THE COMPENSATION IS SET AT A BASE RATE AND THE BOD DETERMINES A YEARLY INCREASE FOR THE FIRST 10 YEARS OF EMPLOYMENT. AFTER THAT POINT, THE INCREASES ARE DETERMINED BY THE BOD ON A YEARLY BASIS. THE DECISIONS ARE DOCUMENTED. THE BOD REVIEWS ALL OTHER OFFICER AND DIRECTOR COMPENSATIONS IN APRIL OF EACH YEAR DURING A BOARD MEETING. ALL INCREASES FOR DIRECTORS AND PHYSICIANS ARE APPROVED BY THE BOD. HCGH HAS A SYSTEM IN PLACE WHEN A NEW OFFICER OR PHYSICIAN IS APPOINTED OR HIRED THEY COME IN AT A BASE RATE AND THE BOD DETERMINES A YEARLY INCREASE FOR THE FIRST 10 YEARS OF EMPLOYMENT. AFTER THAT POINT, THE INCREASES ARE DETERMINED BY THE BOD ON A YEARLY BASIS. THE DECISIONS ARE DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.