PART I, LINE 6A:
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COPIES ARE LOCATED IN EACH OF THE HOSPITAL'S WAITING ROOMS, MADE AVAILABLE TO THE COMMUNITY ADVISORY COMMITTEE, POSTED ON THE HOSPITAL WEBSITE AND ARE AVAILABLE UPON REQUEST.
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PART I, LINE 7:
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THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE ORGANIZATION'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990.
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PART I, LINE 7G:
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SUBSIDIZED HEALTH SERVICES AT MARSHALL BROWNING HOSPITAL INCLUDE THE OPERATION OF THE INPATIENT MEDICAL SURGICAL UNIT AND TWO RURAL HEALTH CLINICS. THE HOSPITAL AND CLINICS ARE OPERATED TO PROVIDE SUPPORT TO THE COMMUNITY BY PROVIDING HOSPITALIZATION, EMERGENCY, AND CLINICAL SERVICES TO THE SURROUNDING RURAL AREAS, WHICH WOULD OTHERWISE BE UNDERSERVED. IT IS THE GOAL OF MARSHALL BROWNING HOSPITAL TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. THE COSTING METHOD FOR SUBSIDIZED HEALTH SERVICES IS BASED ON THE COSTING METHODS USED IN THE HOSPITAL'S MEDICARE COST REPORT WHICH PROVIDES FOR A DIRECT ALLOCATION OF EXPENSES AS WELL AS PROVIDING THE SAME DATA TO THE MEDICARE PROGRAM AS WELL AS TO THE IRS FOR 990 PURPOSES.
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PART III, LINE 2:
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THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL.
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PART III, LINE 3:
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MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE.
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PART III, LINE 4:
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ACCOUNTS RECEIVABLE AND CREDIT POLICY:IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE.
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PART III, LINE 8:
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THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H TO THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUE DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE ORGANIZATION AS WELL AS ANESTHESIA PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, AND REVENUE FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN PROFESSIONAL SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENTS AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGICAL, AND CLINICAL PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT MARSHALL BROWNING HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT, AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES, AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE).WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.
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PART VI, LINE 2:
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MARSHALL BROWNING HOSPITAL HAS A COMMUNITY ADVISORY COMMITTEE WHICH IS COMPRISED OF COMMUNITY MEMBERS INCLUDING THE ADMINISTRATOR OF THE PERRY COUNTY HEALTH DEPARTMENT. MARSHALL BROWNING HOSPITAL IS ALSO AN ACTIVE PARTICIPANT IN THE PERRY COUNTY HEALTHY COMMUNITY COALITION. THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED TO IDENTIFY THE MOST IMPORTANT HEALTH ISSUES IN PERRY COUNTY, PARTICULARLY FOR VULNERABLE AND UNDER-REPRESENTED POPULATIONS, TO ENSURE THAT PROGRAMS AND SERVICES CLOSELY MATCH THE PRIORITIES AND NEEDS OF THE COMMUNITY, AND TO STRATEGICALLY ADDRESS THOSE NEEDS TO IMPROVE THE HEALTH OF THE COMMUNITY WE SERVE. MARSHALL BROWNING HOSPITAL CONDUCTED A CHNA FOR 2019. MARSHALL BROWNING HOSPITAL LED THE PLANNING, IMPLEMENTATION, AND COMPLETION OF THE CHNA THROUGH A CONSULTING AGREEMENT WITH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (ICAHN). THE PROJECT WAS OVERSEEN AT THE OPERATIONAL LEVEL BY THE DIRECTOR OF MARKETING AND PATIENT RELATIONS, REPORTING DIRECTLY TO THE CEO. ARRANGEMENTS WERE MADE WITH ICAHN TO FACILITATE TWO FOCUS GROUPS AND A MEETING TO IDENTIFY AND PRIORITIZE SECONDARY DATA AND TO PREPARE A FINAL REPORT FOR SUBMISSION TO MARSHALL BROWNING HOSPITAL BOARD OF DIRECTORS. THE DIRECTOR OF MARKETING AND PATIENT RELATIONS WORKED CLOSELY WITH ICAHN'S CONSULTANT TO IDENTIFY AND ENGAGE KEY COMMUNITY PARTNERS AND TO COORDINATE LOCAL MEETINGS AND GROUP ACTIVITIES. PARTICIPATION INCLUDED TWO COMMUNITY FOCUS GROUPS INCLUDING A DIVERSE GROUP OF REPRESENTATIVES FROM THE COMMUNITY AND A GROUP OF MEDICAL PROFESSIONALS AND PARTNERS. PARTICIPATION INCLUDED THE ADMINISTRATOR OF THE COUNTY HEALTH DEPARTMENT. REPRESENTATION ALSO INCLUDED THE PERRY COUNTY HEALTHY COMMUNITY COALITION AND AN INTERNAL TEAM CONSISTING OF THE HOSPITAL CEO, HOSPITAL CFO, HOSPITAL CHIEF CLINICAL OFFICER, HOSPITAL DIRECTOR OF MARKETING AND PATIENT RELATIONS, HOSPITAL CHIEF INFORMATION OFFICER AND HOSPITAL EXECUTIVE ASSISTANT.
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PART VI, LINE 3:
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PATIENT EDUCATION REGARDING ELIGIBILITY FOR ASSISTANCE IS PROVIDED IN THE FOLLOWING MEDIUMS: HOSPITAL BROCHURE, HOSPITAL WEBSITE, POSTED IN ADMITTING, POSTED IN THE EMERGENCY DEPARTMENT, AND PATIENTS ARE CONTACTED BY A PATIENT ACCOUNTS REPRESENTATIVE DURING AND AFTER THEIR HOSPITAL STAY REGARDING ELIGIBILITY FOR ASSISTANCE.
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PART VI, LINE 4:
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PERRY COUNTY IS A RURAL AREA WITH AN ESTIMATED POPULATION OF 21,595. THE MEDIAN HOUSEHOLD INCOME (ACCORDING TO US CENSUS BUREAU 2012-16) WAS $43,308. THERE WERE 27.36% OF CHILDREN IN THE MARSHALL BROWNING HOSPITAL SERVICE AREA LIVING IN POVERTY IN 2012 WHICH IS CONSIDERED HIGHER THAN 19.55% OVERALL IN ILLINOIS. PINCKNEYVILLE COMMUNITY HOSPITAL, LOCATED 12 MILES AWAY, ALSO SERVES THE HEALTHCARE NEEDS OF PERRY COUNTY RESIDENTS. MARSHALL BROWNING HOSPITAL PRIMARILY SERVES RESIDENTS OF PERRY COUNTY. HOWEVER, A SMALL PORTION OF SURROUNDING COMMUNITIES IS SERVED AND INCLUDES THE FOLLOWING ZIP CODES: 62832 (DU QUOIN); 62888 (TAMAROA); 62274 (PINCKNEYVILLE), 62932 (ELKVILLE); 62927 (DOWELL); 62884 (SESSER); AND 62865 (MULKEYTOWN). ACCORDING TO THE U.S. CENSUS DATA, THE POPULATION IN THE MARSHALL BROWNING HOSPITAL SERVICE AREA FELL FROM 30,262 PEOPLE TO 29,244 PEOPLE BETWEEN THE YEARS 2000 AND 2010, A 3.36% DECREASE. AGE DISTRIBUTION OF POPULATION IN PERRY COUNTY IN YEAR 2012 (COMMUNITY COMMONS) INCLUDED: AGE 0-4 (1,033); AGE 5-17 (3,187); AGE 18-24 (2,122); AGE 25-34 (2,705); AGE 35-44 (2,828); AGE 45-54 (3,115); AGE 55-64 (2,887); AGE 65+ (3,718).
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PART VI, LINE 5:
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MARSHALL BROWNING HOSPITAL PROVIDES ACTIVITIES AND SERVICES FOR WHICH NO PATIENT BILL EXISTS. THESE SERVICES ARE NOT EXPECTED TO BE FINANCIALLY SELF-SUPPORTING, ALTHOUGH SOME MAY BE SUPPORTED BY OUTSIDE GRANTS OR FUNDING. SOME EXAMPLES INCLUDE FREE OR LOW-COST CLINICS SUCH AS THE SPORTS PHYSICAL CLINIC WHEREBY THE FEES ARE ONLY $10 AND DONATED BACK TO THE STUDENT'S SCHOOL. ALL PHYSICIANS AND STAFF DONATE THEIR TIME TO THE CLINICS. THE HOSPITAL PROVIDES THE SALARY OF OUR ATHLETIC TRAINER TO ATTEND ALL PRACTICES AND BALLGAMES FOR ATHLETIC TRAINING SERVICES TO DU QUOIN HIGH SCHOOL ATHLETES. THE HOSPITAL ESTABLISHED A COUMADIN CLINIC WHICH IS AN ANTICOAGULATION CLINIC HELD EACH WEDNESDAY. THE CLINIC PROVIDES ONE-ON-ONE CARE TO ASSIST PATIENTS WITH THE CONTROL OF THEIR ANTICOAGULATION THERAPY, SPECIFICALLY COUMADIN (GENERIC WARFARIN). PATIENTS ARE GIVEN EDUCATION AND DIETARY INSTRUCTION AND KNOW THEIR RESULTS AND DOSAGE FOR THE WEEK FOLLOWING EACH APPOINTMENT. THIS IS A COLLABORATIVE PRACTICE WITH NO BILLING CODES FOR THE CONSULTATION OF THE PHARMACIST OR LAB DIRECTOR WHO PROVIDE THE INSTRUCTION FOR THE PATIENTS. THIS SERVICE IS DONATED BACK TO THE COMMUNITY. THE CLINIC IS HIGHLY SUCCESSFUL AND RESULTS IN THE AVOIDANCE OF ER VISITS AND ADMISSIONS TO THE HOSPITAL. MARSHALL BROWNING HOSPITAL OFFERS A MONTHLY "SECOND ACT" LUNCHEON PROGRAM FOR INDIVIDUALS AGE 50 AND OLDER WITH A PHYSICIAN OR OTHER HEALTHCARE PROVIDER PRESENTING A HEALTHCARE PROGRAM. COMMUNITY MEMBERS ARE GIVEN FREE COLON CANCER SCREENING KITS AND PROVIDE THE TESTING AT NO CHARGE DURING COLON CANCER AWARENESS MONTH. THE HOSPITAL HOSTS MANY FREE EDUCATIONAL PROGRAMS TO THE COMMUNITY THROUGHOUT THE YEAR ON TOPICS SUCH AS DIABETES, CERVICAL AND OVARIAN CANCER, SLEEP APNEA, PROSTATE CANCER, SKIN CANCER, HEART DISEASE, HIGH BLOOD PRESSURE, ALZHEIMER'S DISEASE, EXERCISE AND DIET, COPD, ANEMIA, EYE DISEASES, FIRST AID/CPR/AED CLASSES, CHANGES IN LAWS FOR SENIORS AND PROVIDES SPEAKERS FOR VARIOUS COMMUNITY ORGANIZATIONS. THE HOSPITAL PROVIDES FREE SPACE EVERY OTHER MONTH FOR WEIGHT LOSS PROGRAMS PRESENTED BY A BARIATRIC SURGEON AT HERRIN HOSPITAL. THE HOSPITAL OFFERED A LARGE COMMUNITY HEALTH FAIR WITH REDUCED FEE LAB TESTING AS WELL AS MANY OTHER FREE HEALTH SCREENINGS. MARSHALL BROWNING PROVIDES CLINICAL ROTATIONS AND INTERNSHIPS FOR MEDICAL STUDENTS AND A VARIETY OF COLLEGE STUDENTS ENTERING THE HEALTHCARE FIELD. MARSHALL BROWNING HOSPITAL OFFERS A FOUR-YEAR $1,000 SCHOLARSHIP TO A HIGH SCHOOL SENIOR EACH YEAR ENTERING THE HEALTHCARE FIELD. THE HOSPITAL HOSTS SIX COMMUNITY BLOOD DRIVES PER YEAR. THE HOSPITAL PROVIDES A FIRST AID STATION AT THE LOCAL CONSERVATION FAIR FOR AREA SCHOOL CHILDREN. THE HOSPITAL DONATES EACH YEAR TO THE DU QUOIN YOUTH CLUB, NUBABILITY, SPECIAL OLYMPICS, DU QUOIN FOOD PANTRY, CLOTHES CLOSET, AND VARIOUS OTHER NEEDS IN THE COMMUNITY. THE HOSPITAL OFFERS A SENIOR INDEPENDENT LIVING FACILITY ON ITS CAMPUS THAT IS OFFERED AS A BREAK-EVEN SERVICE AND HAS NEVER BEEN OPERATED AS A FOR-PROFIT ENTITY. MARSHALL BROWNING HOSPITAL PROVIDES OVERHEAD AND SPACE FOR COMMUNITY MEETINGS. THE HOSPITAL PROVIDES EDUCATIONAL PROGRAMS FREE OF CHARGE TO CAMPERS UTILIZING THE DU QUOIN STATE FAIRGROUNDS FOR CAMPING CONVENTIONS.
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PART VI, LINE 6:
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MARSHALL BROWNING HOSPITAL IS AFFILIATED WITH SOUTHERN ILLINOIS HEALTHCARE TO ENHANCE SERVICES FOR THE RESIDENTS OF PERRY COUNTY. IT IS NOT A MERGER OR ACQUISITION BUT IS A PARTNERSHIP TO PROVIDE EDUCATIONAL, ADMINISTRATIVE AND CLINICAL OPPORTUNITIES FOR HEALTHCARE STAFF, DEVELOP LINKAGES AMONG HEALTHCARE PROVIDERS, PROVIDE BETTER COORDINATION OF CARE AND SERVICES AND EXPAND THE POOL OF SPECIALISTS. SINCE THE AFFILIATION, MARSHALL BROWNING HOSPITAL HAS EXPANDED THE NUMBER OF SPECIALISTS OFFERING CLINICS AT THE HOSPITAL, BEGAN OFFERING SECOND ACT COMMUNITY EDUCATION PROGRAMS, AND OFFERS UROLOGIC SURGICAL PROCEDURES.
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PART VI, LINE 7, REPORTS FILED WITH STATES
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IL
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