4A (Expenses $ 54026939 including grants of $ 226587) (Revenue $ 51844932)
SEE SCHEDULE O

PART V, SECTION B, LINE 5 - COMMUNITY HEALTH NEEDS ASSESSMENT
PROVISIONS IN THE AFFORDABLE CARE ACT (ACA) REQUIRE CHARITABLE HOSPITALS TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE CHNA IS A SYSTEMATIC PROCESS INVOLVING THE COMMUNITY TO IDENTIFY AND ANALYZE COMMUNITY HEALTH NEEDS AS WELL AS COMMUNITY ASSETS AND RESOURCES IN ORDER TO PLAN AND ACT UPON PRIORITY COMMUNITY HEALTH NEEDS. THIS ASSESSMENT PROCESS RESULTS IN A CHNA REPORT WHICH ASSISTS THE HOSPITAL IN PLANNING, IMPLEMENTING, AND EVALUATING HOSPITAL STRATEGIES AND COMMUNITY BENEFIT ACTIVITIES. THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS DEVELOPED AND CONDUCTED, IN PARTNERSHIP WITH REPRESENTATIVES FROM THE COMMUNITY, BY A CONSULTANT PROVIDED THROUGH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (ICAHN). ICAHN IS A NOT-FOR-PROFIT 501(C)(3) CORPORATION ESTABLISHED IN 2003 FOR THE PURPOSES OF SHARING RESOURCES, EDUCATION, PROMOTING OPERATIONAL EFFICIENCIES, AND IMPROVING HEALTHCARE SERVICES FOR MEMBER CRITICAL ACCESS AND RURAL HOSPITALS AND THEIR COMMUNITIES. ICAHN, WITH 57 MEMBER HOSPITALS, IS AN INDEPENDENT NETWORK GOVERNED BY A NINE-MEMBER BOARD OF DIRECTORS, WITH STANDING AND PROJECT DEVELOPMENT COMMITTEES FACILITATING THE OVERALL ACTIVITIES OF THE NETWORK. ICAHN CONTINUALLY STRIVES TO STRENGTHEN THE CAPACITY AND VIABILITY OF ITS MEMBERS AND RURAL HEALTH PROVIDERS. THIS COMMUNITY HEALTH NEEDS ASSESSMENT WILL SERVE AS A GUIDE FOR PLANNING AND IMPLEMENTATION OF HEALTHCARE INITIATIVES THAT WILL ALLOW THE HOSPITAL AND ITS PARTNERS TO BEST SERVE THE EMERGING HEALTH NEEDS OF OLNEY AND THE SURROUNDING AREA. THREE FOCUS GROUPS MET THROUGH FACILITATED VIRTUAL CONFERENCING ON MAY 20, 2021, TO DISCUSS THE STATE OF OVERALL HEALTH AND WELLNESS IN THE RICHLAND MEMORIAL HOSPITAL (RMH) SERVICE AREA. THEY WERE ALSO TASKED WITH IDENTIFYING HEALTH CONCERNS AND NEEDS IN THE DELIVERY OF HEALTHCARE AND HEALTH SERVICES IN ORDER TO IMPROVE WELLNESS AND REDUCE CHRONIC ILLNESS FOR ALL RESIDENTS. THE FOCUS GROUPS INCLUDED REPRESENTATION OF HEALTHCARE PROVIDERS, COMMUNITY LEADERS, COMMUNITY SERVICES PROVIDERS, SCHOOLS, FAITH-BASED ORGANIZATIONS, LOCAL ELECTED OFFICIALS, PUBLIC HEALTH, AND OTHERS. SEVERAL MEMBERS OF THE GROUPS PROVIDED SERVICES TO UNDERSERVED AND UNSERVED PERSONS AS ALL OR PART OF THEIR ROLES. THE FINDINGS OF THE FOCUS GROUPS WERE PRESENTED ALONG WITH SECONDARY DATA ANALYZED BY THE CONSULTANT TO A THIRD GROUP FOR IDENTIFICATION AND PRIORITIZATION OF THE SIGNIFICANT HEALTH NEEDS FACING THE COMMUNITY THROUGH A VIRTUAL CONFERENCE ON JUNE 28, 2021. THE GROUP CONSISTED OF REPRESENTATIVES OF PUBLIC HEALTH, COMMUNITY LEADERS, HEALTHCARE PROVIDERS, AND COMMUNITY SERVICES PROVIDERS. PART V, SECTION B, LINES 7a & 10 - COMMUNITY HEALTH NEEDS ASSESSMENT THE CHNA AND IMPLEMENTATION STRATEGY ARE AVAILABLE AT HTTPS://CARLE.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS.

PART V, SECTION B, LINE 11 - COMMUNITY HEALTH NEEDS ASSESSMENT

PART V, SECTION C, LINE 16
"THE NEEDS IDENTIFIED AND PRIORITIZED THROUGHOUT THE 2021 CHNA CARRIED FORWARD VARIANTS OF PREVIOUS CHNAS AND ADDED OTHERS. THE IDENTIFIED AND PRIORITIZED NEEDS SELECTED INCLUDE: 1. MENTAL HEALTH SERVICES FOR CHILDREN, ADOLESCENTS, AND ADULTS, INCLUDING: - YOUTH AND ADULT INPATIENT CARE FOR TREATMENT THROUGH RECOVERY - IMPROVED ACCESS TO COUNSELING FOR YOUTH, INCLUDING SERVICES AT SCHOOLS - INPATIENT BEHAVIORAL HEALTH AND SUBSTANCE USE CRISIS CARE - ADDICTION MEDICINE SERVICES, INCLUDING MEDICATION ASSISTED TREATMENT ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED: - RMH WILL EXPLORE INCREASING ACCESS TO MEDICATION ASSISTED TREATMENT/RECOVERY RESOURCES - RMH WILL EXPLORE INCREASING RELATIONSHIPS WITH INPATIENT BEHAVIORAL HEALTH AND SUBSTANCE USE DISORDER PROVIDERS - RMH WILL PROVIDE REASONABLE AND APPROPRIATE SUPPORT TO DEVELOPMENT OF THE CRISIS PROGRAM AT LAWRENCE COUNTY HEALTH DEPARTMENT - RMH WILL EXPLORE DEVELOPING TELEPHONE COUNSELING - RMH WILL EXPLORE NEW AVENUES TO INCREASE ACCESS TO COUNSELING - RMH WILL CONTINUE AND EXPAND THE MENTAL HEALTH FIRST AID PROGRAM (MHFA) ANTICIPATED IMPACTS OF THESE ACTIONS: RMH ANTICIPATES THAT THE STEPS SET OUT ABOVE WILL CREATE INCREASED ACCESS TO COUNSELING FOR YOUTH AND ADULTS, MEDICATION ASSISTED TREATMENT, AND INPATIENT AND CRISIS CARE FOR BEHAVIORAL HEALTH AND SUBSTANCE USE DISORDER. PROGRAMS AND RESOURCES THE HOSPITAL PLANS TO COMMIT TO ADDRESS HEALTH NEED: - ADMINISTRATIVE TEAM PLANNED COLLABORATION BETWEEN HOSPITAL AND OTHER FACILITIES OR ORGANIZATIONS: - SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE - PUBLIC HEALTH - INPATIENT PROVIDERS - LAW ENFORCEMENT - CARLE BEHAVIORAL HEALTH SERVICES 2. FLEXIBLE TRANSPORTATION FOR LOCAL APPOINTMENTS AND ASSISTANCE WHEN NEEDED FOR PERSONS THAT HAVE LITTLE OR NO TRANSPORTATION AT HOME ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED: - RMH WILL EXPLORE EXPANDING CARE COORDINATION SERVICES TO INCLUDE TRANSPORTATION ANTICIPATED IMPACTS OF THESE ACTIONS: RMH ANTICIPATES EXPANDING CARE COORDINATION SERVICES TO INCLUDE TRANSPORTATION WILL IMPROVE COORDINATION OF TRANSPORTATION WITH APPOINTMENTS AND ADDRESS PATIENT NEEDS RELATED TO TRANSPORTATION. PROGRAMS AND RESOURCES THE HOSPITAL PLANS TO COMMIT TO ADDRESS HEALTH NEED: - ADMINISTRATION PLANNED COLLABORATION BETWEEN HOSPITAL AND OTHER FACILITIES OR ORGANIZATIONS: - MASS TRANSIT DISTRICT RIDES - EMBARRAS RIVER BASIN AREA AGENCY (ERBA) 3. IMPROVED OPPORTUNITIES TO ACHIEVE WELLNESS THROUGH: - ACCESS TO HEALTHY FOODS AND NUTRITION EDUCATION - ACCESS TO LOW COST OR FREE OPPORTUNITIES FOR RECREATION AND FITNESS ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED: - RMH WILL EXPLORE DEVELOPMENT OF A COMMUNITY GARDEN PROGRAM - RMH WILL CONTINUE THE DEMONSTRATION GARDEN FOR NUTRITION EDUCATION - RMH WILL PROVIDE FUNDING FOR LIGHTING TO ENHANCE USE OF THE COMMUNITY WALKING PATH IN OLNEY - RMH WILL EXPLORE EXPANDING SERVICES OF CARLE HEALTH'S MOBILE MARKET - RMH WILL PARTNER WITH CARLE HEALTH TO PROVIDE THE COMMUNITY WITH ACCESS TO VIDEO WITH HEALTH AND WELLNESS CONTENT - RMH WILL CONTINUE TO SUPPORT LOCAL YOUTH SPORTS ANTICIPATED IMPACTS OF THESE ACTIONS: RMH ANTICIPATES THAT THE ADDITION OF THE PROGRAMS AND SERVICES TO BE UNDERTAKEN WILL IMPROVE OPPORTUNITIES TO ACHIEVE WELLNESS THROUGH ACCESS TO HEALTHY FOODS AND NUTRITION EDUCATION, AND ACCESS TO LOW COST OR FREE OPPORTUNITIES FOR RECREATION AND FITNESS. PROGRAMS AND RESOURCES THE HOSPITAL PLANS TO COMMIT TO ADDRESS HEALTH NEED: - ADMINISTRATIVE TEAM - ORGANIZATIONAL AND COMMUNITY DEVELOPMENT PLANNED COLLABORATION BETWEEN HOSPITAL AND OTHER FACILITIES OR ORGANIZATIONS: - VOLUNTEERS - CARLE HEALTH - CITY OF OLNEY - UNIVERSITY OF ILLINOIS EXTENSION - CARLE RICHLAND AUXILIARY 4. DENTAL CARE FOR UNDERINSURED AND UNINSURED ACTIONS THE HOSPITAL INTENDS TO TAKE TO ADDRESS THE HEALTH NEED: RMH CONTINUES TO RECOGNIZE THE IMPORTANCE OF ACCESS TO DENTAL CARE AND THE IMPACT OF DENTAL CARE ON WELLNESS BUT OBSERVES THAT DENTAL CARE IS NOT A FUNCTION FOR WHICH THE HOSPITAL IS WELL-SUITED. RMH RECOGNIZES THAT THE FEDERALLY QUALIFIED HEALTH CENTER (FQHC) MAY BE BETTER POSITIONED TO ADDRESS THIS ISSUE, AND THE HOSPITAL WILL PROMOTE PARTNERSHIPS BETWEEN DENTISTS, THE FQHC, AND ANY OTHER POTENTIAL PARTNERS AS REASONABLY POSSIBLE. ANTICIPATED IMPACTS OF THESE ACTIONS: ANY IMPACTS FROM ANY DEVELOPMENTS ON THIS ISSUE ARE DEPENDENT ON EXTERNAL PARTNERS AND SOLUTIONS THEY MAY OFFER. PROGRAMS AND RESOURCES THE HOSPITAL PLANS TO COMMIT TO ADDRESS HEALTH NEED: - ADMINISTRATION PLANNED COLLABORATION BETWEEN HOSPITAL AND OTHER FACILITIES OR ORGANIZATIONS: - FEDERALLY QUALIFIED HEALTH CENTER - DENTISTS - OTHERS THAT MAY BE INTERESTED IN THE EFFORT - PUBLIC HEALTH ADDITIONAL ACTION TAKEN SINCE LAST CHNA: THE COMMUNITY HEALTH NEEDS PROCESS IS CONDUCTED EVERY THREE YEARS. IN RESPONSE TO ISSUES IDENTIFIED AND PRIORITIZED AND THE IMPLEMENTATION STRATEGY DEVELOPED TO ADDRESS THEM, RMH HAS TAKEN THESE STEPS SINCE THE LAST CHNA. MENTAL HEALTH - HAVE IMPLEMENTED A FULL-TIME MHFA PROGRAM FOR BOTH ADULT AND YOUTH MHFA - CONTINUE RECRUITMENT OF BEHAVIORAL HEALTH PROVIDERS - HAVE HIRED AN Licensed Clinical Professional Counselor (LCPC) - SUPPORT COMMUNITY INITIATIVES TO BRING ADDITIONAL MONIES TO THIS AREA FOR MENTAL HEALTH SERVICES BY PROVIDING A LETTER OF SUPPORT FOR GRANT MONEY - ENTERED INTO AN AGREEMENT FOR TELEHEALTH SERVICES FROM PAVILION BEHAVIORAL HEALTH FOR TELE-MENTAL HEALTH SERVICES TO THE HOSPITAL'S EMERGENCY DEPARTMENT PATIENTS DENTAL HEALTH RMH STANDS READY TO PARTNER WITH THE LOCAL FQHC TO PROMOTE THESE SERVICES IF NEEDED. THIS WAS IDENTIFIED AS A NEED THAT RMH IS NOT BEST SUITED TO PROVIDE AT THIS TIME. ACCESS TO CARE MANAGERS HIRED A SOCIAL WORKER. THIS PERSON WILL MAINLY TAKE CARE OF INPATIENTS, BUT COULD ALSO ASSIST IN ED. TRANSPORTATION: - ADDED ADDITIONAL STOPS WITH RIDES MASS TRANSIT AND HAVE AN AGREEMENT WITH THEM TO PROVIDE DISCHARGE PATIENTS A RIDE DURING SERVICE HOURS REGARDLESS OF ABILITY TO PAY. - RICHLAND COUNTY NOW HAS A LYFT SERVICE AVAILABLE ON A LIMITED BASIS. IMPROVED ACCESS TO SERVICES FOR ADDICTION/RECOVERY/PREVENTION - A MEMBER OF THE RMH ADMINISTRATIVE TEAM SERVES ON THE RICHLAND COUNTY ADDICTION PREVENTION COALITION. THIS GROUP WAS FORMED IN THE LAST FEW YEARS TO HELP BRING AWARENESS TO THE NEED FOR ADDICTION PREVENTION SERVICES. - RMH HAS ADDED A ""TAKE BACK"" BOX IN THE HOSPITAL'S MAIN LOBBY FOR THE PUBLIC TO OUTDATED PRESCRIPTION DRUGS FOR SAFE DISPOSAL AT ANY TIME. ACCESS TO WEEKEND AND AFTER-HOURS CARE - OPENED CONVENIENT CARE. ORIGINAL HOURS AT OPENING WERE 10 AM - 8 PM, SEVEN DAYS A WEEK. CONVENIENT CARE HAS SINCE EXPANDED THOSE HOURS TO 8 AM -8 PM EACH DAY, CLOSED HOLIDAYS."

PART I, LINE 3 FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA
PATIENTS MAY REQUEST AND COMPLETE A FINANCIAL ASSISTANCE APPLICATION AT ANY TIME, INCLUDING BEFORE CARE IS RECEIVED. PATIENTS ARE INFORMED ABOUT FINANCIAL ASSISTANCE ON MULTIPLE OCCASIONS THROUGHOUT THE COLLECTION PROCESS. IN ADDITION TO PATIENTS COMPLETING APPLICATIONS FOR OUR FINANCIAL ASSISTANCE PROGRAM, WE HAVE ROBUST PRESUMPTIVE ELIGIBILITY PROCESSES IN PLACE. WE HAVE PARTNERED WITH EXPERIAN INFORMATION SOLUTIONS, INC. TO HELP US IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON KEY FINANCIAL INDICATORS. THESE PATIENTS MAY BE APPROVED WITHOUT EVER COMPLETING AN APPLICATION OR EXPRESSING A NEED FOR FINANCIAL ASSISTANCE. IN ADDITION, WE PRESUME ELIGIBILITY FOR PATIENTS WHO ARE VERIFIED HOMELESS, DECEASED WITH NO ESTATE, MENTALLY INCAPACITATED, ELIGIBLE FOR SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) OR WOMEN, INFANTS, AND CHILDREN NUTRITION PROGRAM (WIC), TOWNSHIP ASSISTANCE, LOW INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP), ILLINOIS FREE LUNCH AND BREAKFAST PROGRAM OR COVERED BY ILLINOIS MEDICAID. PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION SUBSIDIZED HEALTH SERVICES ARE NET COSTS FOR BILLED SERVICES THAT ARE SUBSIDIZED BY THE HOSPITAL. THESE INCLUDE SERVICES OFFERED DESPITE A FINANCIAL LOSS BECAUSE THEY ARE NEEDED IN THE COMMUNITY AND EITHER OTHER PROVIDERS ARE UNWILLING TO PROVIDE THE SERVICES OR THE SERVICES WOULD OTHERWISE NOT BE AVAILABLE IN SUFFICIENT AMOUNT. WE INCLUDED AS UNREIMBURSED COSTS OF SUBSIDIZED HEALTH SERVICES: $96,448 FOR HOSPITAL OUTPATIENT SERVICES, $632,783 FOR EMERGENCY ROOM, AND $5,415,233 FOR SUBSIDIZED CONTINUING CARE. PART I, LINE 7 AND PART III, LINE 2 - COSTING METHODOLOGY EXPLANATION TO COMPUTE AND CONVERT FINANCIAL ASSISTANCE, UNREIMBURSED MEDICAID, MEANS-TESTED PROGRAMS AND BAD DEBT CHARGES TO COST; A CONSISTENT GAAP (GENERALLY ACCEPTED ACCOUNTING PRINCIPLES) BASED COST-TO-CHARGE RATIO WAS USED ACROSS ALL PAYERS. ALTHOUGH THE METHODOLOGY WAS SIMILAR TO WORKSHEET #2, FOR SIMPLICITY PURPOSES CERTAIN IMMATERIAL VALUES WERE OMITTED. OTHER COMMUNITY BENEFITS COSTS WERE REPORTED AT THE ACTUAL EXPENSE INCURRED. PATIENT RECEIVABLE PAYMENTS AND RELATED DISCOUNTS WERE RECORDED AT ACTUAL AMOUNTS AT THE TIME OF PAYMENT RECEIPT. A SEPARATE GAAP BASED PROVISION FOR ESTIMATED BAD DEBTS AND DISCOUNTS WAS RECOGNIZED FOR ACCOUNTS IN PROCESS AND PENDING ADJUDICATION AND PAYMENT. THE ESTIMATED PORTION WAS BASED ON HISTORICAL TRENDS AND ADJUSTED TO ACTUAL WHEN ADJUDICATION AND PAYMENT OCCUR. ACCOUNTS DETERMINED ELIGIBLE FOR FINANCIAL ASSISTANCE WERE PROCESSED IMMEDIATELY FOR FINANCIAL ASSISTANCE DISCOUNT WITH NO COLLECTION EFFORT. FOR ACCOUNTS WITH INSUFFICIENT INFORMATION AND DOCUMENTATION TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY, THE HOSPITAL CONSULTED WITH A VARIETY OF ALTERNATIVE SOURCES TO HELP DETERMINE AN INDIVIDUAL'S FINANCIAL MEANS (OR LACK OF MEANS) TO PAY. BASED ON RELATED TRENDS, THE HOSPITAL FURTHER DEVELOPED A GENERAL ESTIMATE OF FINANCIAL ASSISTANCE WHICH CONTINUED TO RESIDE WITHIN BAD DEBTS. SCHEDULE H, PART II OTHER COMMUNITY BENEFITS / COMMUNITY BUILDING: CASH AND IN-KIND: A LARGE PORTION OF CARLE'S COMMUNITY-BUILDING ACTIVITIES FOCUSED ON ECONOMIC DEVELOPMENT, INCLUDING CASH, IN-KIND DONATIONS AND BUDGETED EXPENDITURES FOR THE CITY, BUSINESS ASSOCIATIONS AND OTHER PROGRAMS IN RICHLAND COUNTY. IN ADDITION TO THE MORE THAN $218,000 IN CASH DONATIONS, LEADERSHIP PROVIDED IN-KIND SUPPORT OF OVER $17,000 BY SERVING ON NUMEROUS COMMUNITY BOARDS AND COMMITTEES. VOLUNTEER SERVICES: EMPLOYEE: CARLE RICHLAND ADMINISTRATORS AND LEADERS PROVIDED MORE THAN 120 HOURS ON BEHALF OF CARLE FOR PARTICIPATION IN COMMUNITY BOARDS, COMMITTEES AND COMMUNITY FUNCTIONS. MOST OF THESE HOURS WERE SPENT BY SENIOR LEADERSHIP. NON-EMPLOYEE: IN 2021, NON-EMPLOYEE VOLUNTEERS PUT IN MORE THAN 2,500 HOURS AT THE HOSPITAL, RECEIVING NO PAYMENT BUT CONTRIBUTING TO CARLE'S MISSION. AT A MINIMUM WAGE OF $11/HOUR, THIS EQUATED TO MORE THAN $28,000 OF POTENTIAL WAGES THAT CARLE SAVED BY HAVING SUCH A STRONG VOLUNTEER PROGRAM. PART III, LINE 3 - BAD DEBT, MEDICARE, & COLLECTION PRACTICES RMH USES 50% AS A GENERAL ESTIMATE OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 4 - BAD DEBT FOOTNOTE THE FOOTNOTE PERTAINING TO BAD DEBT EXPENSE CAN BE FOUND ON PAGE 28 OF THE ATTACHED CONSOLIDATED FINANCIAL STATEMENTS.

PART III, LINE 8 - MEDICARE EXPLANATION
THE NUMERATOR (TOTAL EXPENSE) AND DENOMINATOR (TOTAL GROSS CHARGES) OF THE SIMPLE RATIO OF PATIENT CARE COST TO CHARGES IS ADJUSTED BY ELIMINATING NON-PATIENT CARE THAT GENERATES OTHER REVENUE, BAD DEBT EXPENSE, MEDICAID AND OTHER PROVIDER TAXES AND THE TOTAL COST OF COMMUNITY BENEFIT ACTIVITIES AND PROGRAMS. ALSO, ANY GROSS PATIENT CHARGES FOR PROGRAMS NOT RELYING ON THE RATIO ARE ELIMINATED FROM BOTH THE NUMERATOR AND DENOMINATOR OF THE RATIO. THESE ADJUSTMENTS ARE INTENDED TO ELIMINATE ANY POTENTIAL FOR DOUBLE COUNTING OF COMMUNITY BENEFIT EXPENSES. THE RESULTANT RATIO ALIGNS WITH SCHEDULE H REQUIREMENTS. ILLINOIS LAW DEFINES GOVERNMENTAL-SPONSORED INDIGENT HEALTH CARE AS THE UNREIMBURSED COST OF MEDICARE, MEDICAID AND OTHER FEDERAL, STATE OR LOCAL INDIGENT CARE PROGRAMS. WHEN THERE IS A SHORTFALL, WE DO BELIEVE THIS IS A COMMUNITY BENEFIT BECAUSE, AS A HOSPITAL, WE ARE STEPPING UP TO CARRY THE BURDEN OF THE GOVERNMENT, ASSURING CARE TO SENIORS, AND THOSE LESS FORTUNATE DEMOGRAPHICS THAT HAVE EXPERIENCED INCREASING COSTS OVER THE PAST DECADE WHILE LIVING ON FIXED INCOMES.

PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH
RMH HAS AN OPEN MEDICAL STAFF AND IS GOVERNED BY A COMMUNITY BOARD THAT SERVES ON A VOLUNTEER BASIS. SURPLUS FUNDS ARE REINVESTED INTO THE ORGANIZATION FOR TECHNOLOGY REPLACEMENT AND ADVANCEMENT, CLINICAL SERVICE EXPANSION AND QUALITY IMPROVEMENT. FUNDS ARE ALSO INVESTED INTO OUR COMMUNITIES TO MEET IDENTIFIED HEALTH NEEDS WHICH CONTRIBUTE TO THE OVERALL WELL-BEING OF THE RESIDENTS OF THE COMMUNITIES WE SERVE.

PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT
RMH FILES AN ILLINOIS COMMUNITY BENEFIT REPORT.

PART III, LINE 9 B - COLLECTION PRACTICES EXPLANATION
RMH APPLIES ITS COLLECTION PRACTICES EQUALLY TO ALL PATIENTS, BOTH THOSE ELIGIBLE FOR FINANICAL ASSISTANCE AND THOSE THAT AREN'T ELIGIBLE. THE PROCEDURES ARE AS FOLLOWS: 1. WE WILL SEND TWO STATEMENTS AND TWO COLLECTION LETTERS IN A 28 DAY CYCLE. WE WILL SEND STATEMENTS BASED UPON PATIENT PORTION OF $10 OR GREATER. 2. THE PATIENT'S ACCOUNT WILL AGE THROUGH THE STATEMENT PROCESS BEFORE BEING WRITTEN OFF TO BAD DEBT. - PRIVATE PAY ACCOUNTS WILL RECEIVE A STATEMENT WITHIN NINE DAYS OF THE DISCHARGE DATE. - ACCOUNTS WITH A PATIENT PORTION AFTER INSURANCE WILL BE ELIGIBLE TO RECEIVE A STATEMENT APPROXIMATELY FOURTEEN DAYS AFTER THE INSURANCE PAYMENT HAS BEEN POSTED. - TWENTY-EIGHT DAYS LATER THE PATIENT IS MAILED A THIRD STATEMENT - TWENTY-EIGHT DAYS LATER THE PATIENT IS MAILED THE FIRST COLLECTION LETTER - TWENTY-EIGHT DAYS LATER THE PATIENT IS MAILED THE FINAL COLLECTION LETTER - APPROXIMATELY FIFTEEN DAYS LATER THE PATIENT IS WRITTEN OFF TO BAD DEBT. 3. RMH WILL ATTEMPT TO CONTACT THE GUARANTOR VIA PHONE AFTER THEY RECEIVE THE FIRST STATEMENT ON BALANCES GREATER THAN $1,000. 4. RMH WILL ATTEMPT TO CONTACT THE GUARANTOR VIA PHONE AFTER THE SECOND STATEMENT ON BALANCES LESS THAN $1,000. 5. RMH WILL MAKE A SECOND ATTEMPT TO CONTACT THE GUARANTOR VIA PHONE IF PAYMENT OR CONTACT HAS NOT BEEN MADE, USUALLY AROUND THE SAME TIME THE SECOND COLLECTION LETTER IS SENT. 6. RMH WILL SEND TWO COLLECTION LETTERS TO THE PATIENT. THE PATIENT HAS FIFTEEN DAYS AFTER THE FINAL LETTER TO PAY BEFORE BEING WRITTEN OFF TO BAD DEBT.

PART VI, LINE 2 - NEEDS ASSESSMENT
CARLE PRIMARILY ADDRESSES HEALTHCARE NEEDS IN OUR COMMUNITY BY BEING A PART OF THE AFOREMENTIONED CHNA. HOWEVER, CARLE IS ACUTELY AWARE OF THE NEED FOR ACCESS TO CARE, MAKING IT A MAINSTAY OF OUR COMMUNITY BENEFIT EFFORTS. WE HAVE A STRONG FINANCIAL ASSISTANCE PROGRAM BASED ON A PHILOSOPHY OF DOING THE RIGHT THING FOR THE COMMUNITY AND PATIENTS, BALANCED BY A CAREFUL STEWARDSHIP OF THE COMMUNITY'S RESOURCES. WHILE ACCESS TO CARE WAS NOT SELECTED AS A PRIORITY FOR THE 2021 CHNA IT WILL CONTINUE TO BE A PRIORITY FOR CARLE. AS A TAX-EXEMPT ORGANIZATION, RMH PROVIDES CARE TO PATIENTS REGARDLESS OF THE ABILITY TO PAY. CARLE'S GENEROUS FINANCIAL ASSISTANCE PROGRAM HAS RESULTED IN OUR ABILITY TO REACH MANY PEOPLE OVER THE YEARS. TO ENSURE WE ARE ADDRESSING THE NEEDS OF THE COMMUNITY, THE FINANCE AND QUALITY COMMITTEES OF THE CARLE BOARD OF TRUSTEES REVIEW AND EVALUATE CHARITY CARE FIGURES ANNUALLY. WE DO NOT LIMIT THE AMOUNT OF FINANCIAL ASSISTANCE WE PROVIDE, AT THIS TIME. OTHER WAYS TO HELP IMPROVE ACCESS TO CARE: IN ADDITION TO CHARITY CARE, CARLE SUPPORTS A WIDE RANGE OF PROGRAMS AND SERVICES TO INCREASE COMMUNITY CAPACITY, HEALTH CARE WORK FORCE EXPANSION, AND SOCIAL SERVICES THAT PROVIDE COMPLEMENTARY HEALTHCARE-RELATED SERVICES. RMH HAS, AND WILL CONTINUE TO, PURSUE THESE INITIATIVES TO IMPROVE ACCESS TO CARE: 1. OFFER A CHARITY CARE PROGRAM 2. COMMUNICATE THE AVAILABILITY OF THE CHARITY CARE PROGRAM 3. RECRUIT MORE PROVIDERS INTO THE CARLE SYSTEM, THEREBY EXPANDING ACCESS/CAPACITY 4. SUPPORT LOCAL COMMUNITY CLINICS TO ENSURE ADDED LOCAL CAPACITY FOR HEALTH CARE 5. SUPPORT UNITED WAY AND OTHER AREA AGENCIES TO IMPROVE AVAILABILITY OF HEALTH SERVICES 6. DONATE TO EXISTING COMMUNITY HEALTH 7. PARTICIPATE IN POPULATION HEALTH INITIATIVES THAT ACTIVELY MANAGE THE HEALTH OF MEMBERS 8. PROMOTE PRESCRIPTION AFFORDABILITY AS A 340B PROVIDER 9. ENHANCE ACCESS-RELATED INITIATIVES THAT WILL IMPROVE PATIENT ACCESS AND ABILITY TO INTERFACE MORE EFFICIENTLY FOR NEEDED SERVICES - PATIENT CONTACT CENTER, PRESCRIPTION REFILL REQUEST PROCESS, E-VISITS, VIRTUAL VISITS AND MORE 10. CONTINUE ACCESS TO CARE THROUGH SUBSIDIZED SERVICES, INCLUDING THE LTC SKILLED NURSING, THE EXTENDED CARE WING, THE EMERGENCY DEPARTMENT, CARDIAC REHAB, AND MORE.

PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSITANCE
OUR PRACTICE IS TO LOOK AT EACH PATIENT'S FINANCIAL STATUS IN RELATION TO OUR CARLE FINANCIAL ASSISTANCE PROGRAM AND THE CRITERIA OF THE UNINSURED PATIENT DISCOUNT ACT, AND TO PROVIDE THE PATIENT WITH THE DEEPEST DISCOUNT AVAILABLE. BY EXPANDING THE PRESUMPTIVE ELIGIBILITY SCREENING PROCESSES AND DETERMINING THE FINANCIAL STATUS OF PATIENTS UP-FRONT, WE HAVE BEEN ABLE TO PINPOINT THOSE NEEDING ASSISTANCE EARLY IN THE PROCESS, MINIMIZING BAD DEBT AND OPTIMIZING OUR ABILITY TO HELP. STAFF IS ALSO DILIGENT IN FOLLOWING UP WITH PATIENTS DURING HOSPITALIZATION AND AFTER DISCHARGE IF THERE'S ANY REASON TO BELIEVE THE PATIENT COULD BENEFIT FROM FINANCIAL ASSISTANCE, AND WE AUTO-QUALIFY CERTAIN PATIENT POPULATIONS FOR CARLE FINANCIAL ASSISTANCE PROGRAM, SUCH AS THE HOMELESS, WIC, SNAP (SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM), MEDICAID, LOW INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP), AND TOWNSHIP ASSISTANCE RECIPIENTS. COMMUNICATING THAT FINANCIAL ASSISTANCE IS AVAILABLE CARLE FOUNDATION HOSPITAL HAS MADE A CONCERTED, CONTINUOUS EFFORT TO BE SURE THAT PEOPLE HAVE ACCESS TO INFORMATION THAT WILL HELP THEM WITH THEIR MEDICAL BILLS. THESE INCLUDE: - ADVERTISING CARLE FINANCIAL ASSISTANCE PROGRAM; CONTINUED PRESENCE IN APPROPRIATE COMMUNITY PUBLICATIONS; AND ON-SITE VIA DISPLAYS THROUGHOUT THE HOSPITAL AND CLINICS - SIMPLIFIED APPLICATION FORM, INCLUDING A VERSION IN SPANISH, THAT CONTAINS INFORMATION REGARDING THE CARLE FINANCIAL ASSISTANCE PROGRAM - PUBLICATION OF A PLAIN LANGUAGE SUMMARY AND ALL OTHER FINANCIAL ASSISTANCE-RELATED INFORMATION ON CARLE.ORG/FINANCIALASSISTANCE - INFORMATION ABOUT THE CARLE FINANCIAL ASSISTANCE PROGRAM ON ALL STATEMENTS, COLLECTION LETTERS AND HOSPITAL ADMISSION PACKETS - CARLE FINANCIAL ASSISTANCE PROGRAM INFORMATION AND APPLICATIONS AT ALL REGISTRATION POINTS, HOSPITAL MAIN LOBBY AND CARLE.ORG - MEETINGS WITH LOCAL LEGISLATORS TO HELP THEM ASSIST CONSTITUENTS WITH HEALTHCARE NEEDS, INCLUDING FINANCIAL ASSISTANCE

PART VI, LINE 4 - COMMUNITY INFORMATION
DESCRIPTION OF THE COMMUNITY/POPULATION RMH HAS DEFINED ITS PRIMARY SERVICE AREA AND POPULATIONS AS THE GENERAL POPULATION WITHIN THE GEOGRAPHIC AREA IN AND SURROUNDING RICHLAND COUNTY DEFINED IN DETAIL BELOW. THE HOSPITAL'S PATIENT POPULATION INCLUDES ALL WHO RECEIVE CARE WITHOUT REGARD TO INSURANCE COVERAGE OR ELIGIBILITY FOR ASSISTANCE. RMH'S SERVICE AREA IS COMPRISED OF APPROXIMATELY 3,298.30 SQUARE MILES, WITH A POPULATION OF APPROXIMATELY 108,055 PEOPLE AND A POPULATION DENSITY OF 33 PEOPLE PER SQUARE MILE. THE SERVICE AREA CONSISTS OF THE FOLLOWING RURAL ILLINOIS COUNTIES: RICHLAND, LAWRENCE, EDWARDS, JASPER, CLAY, CRAWFORD, WABASH, AND WAYNE. THE AVERAGE HOUSEHOLD SIZE OF THE AREA, AT 2.3, IS LOWER THAN BOTH ILLINOIS (3) AND THE U.S. (2.5). MEDIAN AGE IS OVER 43.5 YEARS, WHICH IS HIGHER THAN ILLINOIS AND THE U.S. THE LARGEST EDUCATION SEGMENT IS REPORTED AS SOME COLLEGE, FOLLOWED BY HIGH SCHOOL GRADUATES. COLLEGE GRADUATES IN THE AREA EXCEED THE NUMBER OF RESIDENTS THAT DID NOT COMPLETE HIGH SCHOOL. THE UNEMPLOYMENT RATE IS TYPICAL OF SURROUNDING COUNTIES AND OTHER RURAL COUNTIES IN ILLINOIS AND IS BETTER THAN NATIONAL AND STATEWIDE NUMBERS. ALSO, AS IS THE CASE IN MUCH OF RURAL ILLINOIS, INCOME BY HOUSEHOLDS IN THE SERVICE AREA IS LOWER THAN STATEWIDE. OF THE 84,721 RESIDENTS OVER THE AGE OF 18, 7014 ARE VETERANS. THIS REPRESENTS 8.28% OF THE ELIGIBLE POPULATION.

PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM
RMH IS A 104 BED, NOT-FOR-PROFIT HEALTHCARE FACILITY LOCATED IN OLNEY, IL AND BECAME PART OF THE CARLE HEALTH SYSTEM ON APRIL 1, 2017. AS PART OF THE CARLE HEALTH SYSTEM, IT CURRENTLY SERVES EIGHT SOUTHEASTERN ILLINOIS COUNTIES, WITH A TOTAL POPULATION OF MORE THAN 107,000 INDIVIDUALS. THE INTEGRATION OF CARLE AND RMH ALLOWS FOR EXPANDED ACCESS TO HEALTHCARE IN THE REGION. THOUGH RMH FALLS UNDER THE UMBRELLA OF THE CARLE FOUNDATION, IT MAINTAINS A SEPARATE BOARD OF DIRECTORS AND SENIOR LEADERSHIP. WHILE RMH'S CHNA AND COMMUNITY BENEFIT REPORTING IS SEPARATE FROM THE CARLE FOUNDATION HOSPITAL, IT FOLLOWS THE SAME GUIDELINES AND PRINCIPLES AS CARLE. RMH STAFF IS INVOLVED IN THE CHNA AND IMPLEMENTATION PLAN, AND SERVE ON HUMAN SERVICES AGENCY BOARDS AND COMMITTEES TO PROVIDE SUPPORT TO HELP ADDRESS IDENTIFIED COMMUNITY HEALTH NEEDS.