SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
GRAHAM HOSPITAL ASSOCIATION
 
Employer identification number

37-0673506
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    2,228,264   2,228,264 3.110 %
b Medicaid (from Worksheet 3, column a) . . . . .     15,945,812 12,850,782 3,095,030 4.320 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     18,174,076 12,850,782 5,323,294 7.430 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     178,981 9,185 169,796 0.240 %
f Health professions education (from Worksheet 5) . . .            
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     23,054   23,054 0.030 %
j Total. Other Benefits . .     202,035 9,185 192,850 0.270 %
k Total. Add lines 7d and 7j .     18,376,111 12,859,967 5,516,144 7.700 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development     5,000   5,000 0.010 %
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total     5,000   5,000 0.010 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
4,318,048
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
16,949,000
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
17,814,025
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-865,025
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

 

No
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 GRAHAM HOSPITAL ASSOCIATION
210 WEST WALNUT STREET
CANTON,IL61520
WWW.GRAHMHOSPITAL.ORG
0000869 		X           X      
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
GRAHAM HOSPITAL ASSOCIATION
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted................. 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities
in Part VI.................................. 		4   No
5 Did the hospital facility make its CHNA report widely available to the public?.............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply
as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs........... 7 Yes  
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ................................ 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? .......... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 180.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If "Yes," indicate the FPG family income limit for eligibility for discounted care: 300.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?........ 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?........ 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 21   No
If "Yes," explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual?.......................... 22   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference Explanation
GRAHAM HOSPITAL ASSOCIATION PART V, SECTION B, LINE 3: GRAHAM HOSPITAL ASSOCIATION CREATED THE FOLLOWING FOCUS GROUPS TO GATHER INPUT FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT:FOCUS GROUP #1 INCLUDED THE FULTON COUNTY SHERIFF, THE CANTON FIRE CHIEF, A SCHOOL SUPERINTENDENT, A BANK EXECUTIVE, THE DIRECTOR OF A FOOD PANTRY, A LOCAL BUSINESS LEADER, THE DIRECTOR OF THE YMCA, A LIBRARIAN AND A COMMUNITY VOLUNTEER. THEY MET ON MAY 15, 2012.FOCUS GROUP #2 INCLUDED THE MAYOR OF CANTON, A VICE-PRESIDENT AT SPOON RIVER COLLEGE, A SCHOOL SUPERINTENDENT, A RETIRED PHYSICIAN, THE EXECUTIVE DIRECTOR OF THE YWCA AND THE PRESIDENT OF GRAHAM HOSPITAL SERVICE LEAGUE. THIS GROUP ALSO MET ON MAY 15, 2012.FOCUS GROUP #3 INCLUDED THE ADMINISTRATOR OF THE FULTON COUNTY HEALTH DEPARTMENT, THE DIRECTOR OF THE NURSING SCHOOL, THE ADMINISTRATOR OF A NURSING HOME, A PEDIATRIC PHYSICIAN, A PATHOLOGIST, A CHIROPRACTOR, A GENERAL SURGEON, NURSING HOME REPRESENTATIVES AND PHARMACISTS. THIS GROUP ALSO MET ON MAY 15, 2012.
GRAHAM HOSPITAL ASSOCIATION PART V, SECTION B, LINE 20D: GRAHAM HOSPITAL FOLLOWS THE ILLINOIS HOSPITAL UNINSURED PATIENT DISCOUNT ACT THAT REQUIRES ILLINOIS HOSPITALS TO PROVIDE DISCOUNTS TO UNINSURED PATIENTS MEETING CERTAIN ELIGIBILITY CRITERIA. THE DISCOUNTS MUST RESULT IN BILLS OF NO MORE THAN 135% OF COST AND THE MAXIMUM COLLECTIBLE AMOUNT IS 25% OF THE ANNUAL FAMILY INCOME FOR THOSE WHO MEET THE ELIGIBILITY CRITERIA AND DO NOT HAVE SIGNIFICANT ASSETS. COST IS DETERMINED BY USING THE COST TO CHARGE RATIO FROM THE MOST RECENTLY FILED MEDICARE COST REPORT.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?9
Name and address Type of Facility (describe)
1 GRAHAM HOSPITAL PHARMACY
210 WEST WALNUT STREET
CANTON,IL61520 		PHARMACY FOR PATIENTS & RETAIL FOR EMPLOYEES
2 GRAHAM MEDICAL GROUP
180 SOUTH MAIN STREET
CANTON,IL61520 		MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC
3 GRAHAM HOSPITAL EXTENDED CARE UNIT
210 WEST WALNUT STREET
CANTON,IL61520 		SKILLED NURSING & LONG TERM CARE UNITS
4 GRAHAM HOSPITAL HOME HEALTHHOSPICE
225 WEST WALNUT
CANTON,IL61520 		HOME HEALTH AND HOSPICE PROVIDER
5 GHA HOME MEDICAL EQUIPMENT STORE
101 SOUTH MAIN STREET
CANTON,IL61520 		HOME MEDICAL EQUIPMENT RETAIL STORE
6 GRAHAM MEDICAL GROUP - FARMINGTON
601 EAST FORT STREET
FARMINGTON,IL61531 		MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC
7 GRAHAM HOSPITAL SCHOOL OF NURSING
210 WEST WALNUT STREET
CANTON,IL61520 		SCHOOL OF NURSING
8 GRAHAM MEDICAL GROUP - LEWISTOWN
2001 NORTH MAIN STREET
LEWISTOWN,IL61542 		MULTI-SPECIALTY OUTPATIENT PHYSICIAN CLINIC
9 GRAHAM MEDICAL GROUP - CUBA
114 SOUTH 4TH STREET
CUBA,IL61427 		OUTPATIENT PHYSICIAN CLINIC
10
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
PART I, LINE 3C: NOT APPLICABLE
PART I, LINE 6A: NOT APPLICABLE
PART I, LINE 7: GRAHAM HOSPITAL ASSOCIATION UTILIZED WORKSHEET 2 TO CALCULATE ITS COST-TO-CHARGE RATIO. TOTAL EXPENSES REPORTED IN THE FINANCIAL REPORT FOR THE YEAR ENDED 06/30/14 LESS NONPATIENT CARE ACTIVITIES OF $1,628,029, THE MEDICAID ASSESSMENT PROVIDER TAX OF $2,617,685 AND THE COMMUNITY BENEFIT EXPENSES FOR VARIOUS PROGRAMS OF $202,035 AND $5,000 ARE DIVIDED BY GROSS PATIENT CHARGES OF $175,056,378 TO REACH A COST TO CHARGE RATIO OF 38.46%.DURING EACH FISCAL YEAR VARIOUS COMMUNITY HEALTH IMPROVEMENT SERVICES ARE HELD AT A FACILITY OWNED BY GRAHAM HOSPITAL ASSOCIATION OR GRAHAM HOSPITAL ASSOCIATION EMPLOYEES ASSIST WITH SERVICES HELD AT VARIOUS LOCATIONS WITHIN THE CATCHMENT AREA. AN ACTUAL COUNT OF COMMUNITY MEMBERS SERVED IS RECORDED IF AVAILABLE OR ESTIMATED IF NOT AVAILABLE. COST FOR EACH ACTIVITY IS RECORDED AT THE ACTUAL COST OF SUPPLIES, AND STAFF TIME IS CALCULATED USING ACTUAL TIME SPENT MULTIPLIED BY AVERAGE WAGES FOR THE EMPLOYEES INVOLVED. ANY OFFSETTING REVENUE IS SUBTRACTED FROM THE COST OF THE ACTIVITY TO REACH A NET COST OF EACH EVENT. WHEN COMMUNITY GROUPS USE A ROOM IN ONE OF THE GRAHAM HOSPITAL ASSOCIATION FACILITIES, THERE IS NO CHARGE FOR THE COMMUNITY GROUP AND THE COST OF THE ROOM USE IS ESTIMATED AT A NOMINAL FLAT RATE FEE AND RECORDED HERE AS AN IN-KIND CONTRIBUTION. THESE ACTIVITES REPRESNT THE COMMUNITY BENEFIT EXPENSES NOTED ABOVE.
PART I, LINE 7G: NOT APPLICABLE
PART I, LN 7 COL(F): NO BAD DEBT EXPENSE WAS INCLUDED IN THE DENOMINATOR BECAUSE BAD DEBT WAS REPORTED IN LINE 2E OF PART VIII, STATEMENT OF REVENUE. THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE AS A PERCENTAGE OF TOTAL EXPENSES IS 25.67%, AND THE PERCENTAGE INCREASES TO 50.56% IF MEDICARE ALLOWABLE COSTS ARE INCLUDED IN TOTAL COMMUNTY BENEFIT EXPENSE.
PART II, COMMUNITY BUILDING ACTIVITIES: NOT APPLICABLE
PART III, LINE 2: PATIENT RECEIVABLES ARE WRITTEN OFF AS BAD DEBT EXPENSE BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED.
PART III, LINE 3: NOT APPLICABLE
PART III, LINE 4: PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. THE HOSPITAL DOES NOT CHARGE INTEREST ON RECEIVABLES. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED PAST DUE WHEN AN AMOUNT IS PAST DUE ACCORDING TO THE PAYOR'S AGREED-UPON TERMS. PATIENT RECEIVABLES ARE WRITTEN OFF AS BAD DEBT EXPENSE BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED.
PART III, LINE 8: MEDICARE ALLOWABLE COSTS ARE TAKEN FROM WORKSHEET D-1 AS REPORTED IN THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED 6/30/2014.
PART III, LINE 9B: THE COLLECTION POLICY DESCRIBES THE STEPS TAKEN TO COLLECT SELF PAY BALANCES OUTSTANDING INCLUDING NOTIFICATIONS TO THE PATIENT THROUGH STATEMENTS, FOLLOW-UP PHONE CALLS, VERIFICATION OF INSURANCE ELIGIBILITY AND ULTIMATELY AT WHAT POINT THE UNPAID BALANCE IS WRITTEN OFF AS UNCOLLECTIBLE. IN PRACTICE, WHEN A PATIENT IS IDENTIFIED AS QUALIFYING FOR FINANCIAL ASSISTANCE, A SEARCH OF ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE IS DONE AND THOSE ACCOUNTS ARE REPROCESSED.
PART VI, LINE 2: IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTED DURING 2012, A PHYSICIAN NEEDS ASSESSMENT IS DONE TO IDENTIFY NEEDS FOR SPECIFIC SPECIALTY SERVICES BASED ON THE SIZE OF THE CATCHMENT AREA, DATA IS ANALYZED TO IDENTIFY SERVICES THAT ARE PROVIDED TO COUNTY RESIDENTS BY OTHER FACILITIES THAT WOULD BE MORE ACCESSIBLE TO PATIENTS IF PROVIDED AT GRAHAM HOSPITAL. INPUT IS GAINED FROM PHYSICIANS AND OTHER HEALTHCARE WORKERS PROVIDING SERVICE IN THE AREA ALONG WITH INPUT PROVIDED BY THE BOARD OF DIRECTORS WHO REPRESENT THE COMMUNITY AND PROVIDE A COMMUNICATION LINK BETWEEN GRAHAM HOSPITAL AND THE COMMUNITIES WE SERVE.
PART VI, LINE 3: THE CHARITY CARE/FINANCIAL ASSISTANCE PROGRAM IS MADE AVAILABLE TO PATIENTS UPON REGISTRATION. FINANCIAL ASSISTANCE APPLICATIONS ARE AVAILABLE TO PATIENTS UPON REGISTRATION OR TO ANYONE REQUESTING THE APPLICATION AT ANYTIME FOR CLAIMS EXCEEDING $300. THE APPLICATIONS ARE AVAILABLE ON GRAHAM HEALTH SYSTEM'S WEBSITE AT HTTP://WWW.GRAHAMHOSPITAL.ORG/FINANCIALASSISTANCE. APPOINTMENTS MAY BE MADE WITH A FINANCIAL COUNSELOR IF ASSISTANCE IS NEEDED. MEDICAID SERVICES APPLICATION ASSISTANCE IS AVAILABLE.
PART VI, LINE 4: THE GRAHAM HOSPITAL ASSOCIATION PRIMARY CATCHMENT AREA IS LOCATED PRIMARILY IN FULTON COUNTY AND INCLUDES ALL OR PORTIONS OF THE TOWNS OF CANTON, LEWISTOWN, CUBA, FARMINGTON, HAVANA, ST. DAVID, ASTORIA, DUNFERMLINE AND BRYANT. THE RACE AND ETHNICITY MAKEUP ARE TYPICAL OF RURAL ILLINOIS BASED ON US CENSUS BUREAU DATA AND INCLUDES 92.5% WHITE, 3.7% BLACK, 2.6% HISPANIC ORIGIN, AND 1.2% OTHER. ACCORDING TO THE US CENSUS BUREAU MEDIAN HOUSEHOLD INCOME 2012 WAS $41,899. FULTON COUNTY'S NOV 2014 UNEMPLOYMENT RATE WAS 7.3%.
PART VI, LINE 5: DURING EACH FISCAL YEAR VARIOUS COMMUNITY HEALTH IMPROVEMENT SERVICES ARE HELD AT A FACILITY OWNED BY GRAHAM HOSPITAL ASSOCIATION OR GRAHAM HOSPITAL ASSOCIATION EMPLOYEES ASSIST WITH SERVIES HELD AT VARIOUS LOCATIONS WITHIN THE CATCHMENT AREA. EXAMPLES OF THESE ACTIVITIES INCLUDE SPONSORSHIP OF AN ANNUAL WOMEN'S HEALTH FAIR HELD IN THE HOSPITAL LOBBY THAT IS OPEN TO THE PUBLIC WHERE EDUCATIONAL BOOTHS, FREE HEALTH SCREENINGS, HEALTHY LUNCHES, PRESENTATIONS BY LOCAL PHYSICIANS ARE AVAILABLE TO ATTENDEES DURING THE DAY; ANNUAL SPONSORSHIP OF A COMMUNITY TALK AND DINNER THAT IS FREE TO THE PUBLIC COVERING HEART HEALTH; FREE BLOOD PRESSURE CLINICS OFFERED THROUGHOUT THE COUNTY ON A REGULAR BASIS. GRAHAM HOSPITAL PROVIDES THE SPACE FOR OPERATION OF AN OUTPATIENT CLINIC THAT PROVIDES FREE HEALTHCARE SERVICES TO FULTON COUNTY RESIDENTS. CLINIC SERVICES ARE PROVIDED BY COMMUNITY VOLUNTEERS.
PART VI, LINE 6: NOT APPLICABLE
Schedule H (Form 990) 2013
Additional Data


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