4A (Expenses $ 8790527 including grants of $ 0) (Revenue $ 12279133)
HARDIN COUNTY GENERAL HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGN, HANDICAP, AGE, OR ABILITY TO PAY. HARDIN COUNTY GENERAL HOSPITAL RECORDED 2,146 ADULT AND CHILDREN PATIENT DAYS AND 19,000 OUTPATIENT VISITS. THE EMERGENCY ROOM TREATED APPROXIMATELY 4,099 PATIENTS. 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 COMMUNTIY WITH RESPECT TO PROVIDING QUALITY HEALTHCARE.

PART V, SECTION A:
HARDIN COUNTY GENERAL HOSPITAL ACCEPTS PATIENTS REGARDLESS OF ABILITY TO PAY AND IS AN EQUAL OPPORTUNITY EMPLOYER. THE HOSPITAL PARTICIPATES IN NUMEROUS CHARITABLE ACTIVITIES. THE HOSPITAL SUBSIDIZES THE COUNTY AMBULANCE SERVICE AND SOMETIMES THE LOCAL NURSING HOME. WE ALSO DONATE SPACE AND PERSONNEL FOR THE AMERICAN RED CROSS BLOOD DRIVES. IN ADDITION, TIME, MONEY AND SUPPLIES ARE DONATED TO THE ANNUAL AMERICAN CANCER SOCIETY-RELAY FOR LIFE. HARDIN COUNTY GENERAL HOSPITAL SERVES AS A TRAINING SITE FOR LICENSED PRACTICAL NURSE, REGISTERED NURSE AND CERTIFIED NURSES' AIDE STUDENTS FROM THE LOCAL COMMUNITY COLLEGE AND FOR MID-LEVELS WHO ARE FULFILLING CLINICAL REQUIREMENTS THROUGH NEARBY UNIVERSITIES. FREE CPR CLASSES ARE OFFERED TO THE COMMUNITY EVERY YEAR AT THE HOSPITAL.THE LOCAL SCHOOL IS PROVIDED FREE CPR TRAINING FOR TEACHERS AS WELL AS REGISTERED NURSING SERVICES AND REQUIRED OVERSIGHT AS NEEDED DURING THE SCHOOL YEAR. SCHOOL PHYSICALS ARE CONDUCTED ON SCHOOL GROUNDS FOR THE CONVENIENCE OF STUDENTS BY HOSPITAL CLINIC STAFF. HARDIN COUNTY GENERAL HOSPITAL PARTICIPATES IN LOCAL CONSORTIUMS FOR THE IMPROVEMENT OF THE MENTAL AND PHYSICAL HEALTH OF THE COMMUNITY. WE ACTIVELY WORK WITH LOCAL AGENCIES SUCH AS ARROWLEAF AND SOUTHERN 7 HEALTH DEPARTMENT TO ASSIST IN THE BATTLE AGAINST SUBSTANCE ABUSE. SPACE AND STAFF ARE PROVIDED FOR A MENTAL HEALTH COUNSELOR FROM ARROWLEAF IN THE HOSPITAL CLINIC. THE HOSPITAL SPONSORS LOCAL ANNUAL WALK/RUN ACTIVITIES TO ENCOURAGE A HEALTHY LIFESTYLE. IN ADDITION, HARDIN COUNTY GENERAL HOSPITAL HOLDS ANNUAL FOOD BANK COLLECTION FOR THE LOCAL SCHOOL AND CHURCHES, AS WELL AS SERVING AS A LIAISON FOR REFERRING PATIENTS TO COMMUNITY RESOURCES (CHURCHES, FOOD BANKS, FINANCIAL ASSISTANCE, ETC.). DURING THE COVID CRISIS, THE HOSPITAL HAS PROVIDED FREE TESTING FOR PATIENTS AND HAS DONATED NECESSARY PPE AND SCARCE DRUGS TO OTHER HEALTHCARE ENTITIES IN NEED. THE HOSPITAL ALSO WAIVED ALL DEDUCTIBLES AND CO-INSURANCE TO ANY PATIENT WITH A COVID DIAGNOSIS AS WELL AS PROVIDED FREE CARE TO ANY UNINSURED PATIENT WITH A COVID DIAGNOSIS.

HARDIN COUNTY GENERAL HOSPITAL
PART V, SECTION B, LINE 5: SURVEY: 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 OCTOBER 2019 TO DECEMBER 2019. WE CREATED AND USED AN ONLINE SURVER TO COLLECT THE DATA. IN FIVE TO TEN MINUTES, RESPONDENTS ANSWERED 25 QUESTIONS RELATED TO INDIVIDUAL HEALTH AND ACCESS TO CARE, HEALTH SERVICES, CHALLENGES AND RISK FACTORS, AND SOURCES OF HEALTH INFORMATION.FOCUS GROUP INTERVIEWS:WE FACILITATED FOCUS GROUP INTERVIEWS IN NOVEMBER 2019 AND DECEMBER 2019, WITH KEY COMMUNITY MEMBERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY. WE SELECTED THE FOCUS GROUP MEMBERS BASED ON THEIR ABILITY TO UNDERSTAND THE MOST PROMINENT HEALTH ISSUES AFFECTING HARDING AND POPE COUNTY RESIDENTS, AS WELLS AS THEIR ABILITY TO IDENTIFY EXISTING COMMUNITY STRENGTHS AND RESOURCES. THE FOCUS GORUP MEMBERS INCLUDED:-SHERRI CRABB, FAMILY COUNSELING CENTER-RHONDA ANDREWS-RAY, 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 IMPROVE 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 OF CERTAIN NEEDS BY IMPLEMENTING PROGRAMS, EDUCATION, AND PREVENTATIVE SCREENINGS.HARDIN COUNTY GENERAL HOSPITAL 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 OF THE WAYS THAT HARDIN COUNTY GENERAL HOSPITAL CAN ADDRESS AND MAKE AN IMPACT ON CERTAIN NEEDS INCLUDES:1) SUBSTANCE ABUSE PREVENTION, EDUCATION, AND TREATMENT2) PROVIDE EDUCATION AND SUPPORT FOR PREVALENT CHRONIC DISEASES3) IDENTIFYING AND IMPROVING ACCESS OF SPECIALTY PHYSICIANS AND INCLUDING MENTAL HEALTH SERVICES4) CREATE OR IDENTIFY PROGRAMS AND ACTIVITIES TO ENCOURAGE HEALTHLY LIFESTYLES FOR STAFF AND COMMUNITY MEMBERS

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 LINES 7A AND 7B OF PART I OF SCHEDULE H.

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 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 ASSISTANCE PROGRAM (FAP), PRESUMPTIVE ELIGIBILITY CRITERIA, COLLECTION PRACTICES AND BAD DEBT REFERRAL PROCEDURES:COMMUNITY SERVICE IN THE FORM OF FINANCIAL ASSISTANCE AND/OR CHARITY WILL BE AVAILABLE TO PERSONS WHO ARE UNINSURED. FINANCIAL ASSISTANCE MAY 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 INSURANCE 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 CHARGES FOR ALL UNINSURED CUSTOMERS WITH AN ADDITIONAL 10% DISCOUNT 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 WILL BE REFERRED TO THE COLLECTION MANAGER. PATIENTS WITH PRIOR BALANCES MAY 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. 12-MONTH INTEREST FREE LOAN FOR AMOUNTS OVER $600. IF THE CUSTOMER MISSES THE ESTABLISHED PAYMENT OR GOES OVER THE ALLOTTED 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 OF HARDSHIP, BY PRODUCING TERMINATION LETTER, BANK STATEMENTS AND ANY OTHER PROOF REQUESTED. DURING THE COVID-19 PANDEMIC, EFFECTIVE JANUARY 2020 THROUGHOUT THE PANDEMIC EMERGENCY STATUS, ALL COPAYS AND DEDUCTIBLES FOR THE INSURED WITH A DIAGNOSIS OF COVID, IN NETWORK OR OUT 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) CHARGES ARE POSTED AND BILLS ARE SUBMITTED TO ALL AVAILABLE INSURANCES. UPON RECEIPT OF EXPLANATION OF BENEFITS OR REMITTANCE ADVICE FROM 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 CONCERNING FINANCIAL ASSISTANCE, DISCOUNTS AND PAYMENT PLANS AVAILABLE. AFTER 30 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 CUSTOMER BY TELEPHONE, CELL PHONE, EMAIL, 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 BY TELEPHONE AND 10 DAYS IN WRITING). THE APPLICANT 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 A 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 ELIGIBILITY 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 FORWARDED 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) HOMELESSC) 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 BEHALFI) MEDICAID ELIGIBILITY, BUT NOT ON DATE OF SERVICE OR FOR NON-COVERED SERVICE.J) RECENT PERSONAL BANKRUPTCYK) INCARCERATION IN A PENAL INSTITUTIONL) ENROLLMENT IN THE FOLLOWING ASSISTANCE PROGRAMS FOR 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 ASSIST THE HOSPITAL IN DETERMINING IF THE PATIENT MEETS PRESUMPTIVE ELIGIBILITY. 4. HCGHC 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 COPAY).C) BILLED MEDICAID SERVICES THAT HAVE BEEN DENIED OR REJECTED FOR PAYMENT BY HFS.D) MEDICAID SPEND DOWNS. 5. HCGH 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. THE MANAGEMENT TEAM OF HARDIN COUNTY GENERAL HOSPITAL REVIEWS AND USES THE HOSPITAL STRATEGIC PLAN TO IDENTIFY AREAS OF SERVICE THAT NEED TO BE CONSIDERED, CONTINUED, UPDATED, OR ELIMINATED. THE MANGEMENT 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 HEALTH 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 DIRECTORS 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 QUARTERLY MEETINGS 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 VERBAGE 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 WEBSITE ILHCGH.ORG AND AN APPLICATION IS AVAILABLE FOR PRINTING.

PART VI, LINE 4:
HARDIN COUNTY GENERAL HOSPITAL IS A 25 BED, NON-PROFIT, CRITICAL ACCESS HOSPITAL LOCATED IN SOUTHERN ILLINOIS, HARDIN COUNTY. THE HOSPITAL IS LOCATED IN A RURAL HEALTH CARE PROFESSIONAL SHORTAGE AREA AS DETERMINED FOR PURPOSESS OF SECTION 1886(D)(3)(D) OF THE SOCIAL SECURITY ACT, QUALIFIES AS A STATE DISPROPORTIONATE SHARE FACILITY UNDER THE REQUIREMENTS OF MEDICAID, AND IS BEING PAID UNDER THE MEDICARE COST REIMBURSEMENT SYSTEM. HARDIN COUNTY GENERAL HOSPITAL IS LICENSES BY THE ILLINOIS DEPARTMENT OF PUBLIC HEALTH AND IS A MEMBER OF THE ILLINOIS HOSPITAL AND HEALTH SYSTEMS ASSOCIATION. THE CLOSEST MEDICAL FACILITY TO HCGH IS 31 MILES AWAY, LOCATED IN HARRISBURG, IL, SALINE COUNTY.THE TARGET POPULATION BASED ON OUR DEMOGRAPHICS FROM THE 2021 U.S. CENSUS BUREAU, IS APPROXIMATELY 7,429 RESIDENTS. THIS IS THE PRIMARY TARGET GROUP OF POPE AND HARDIN COUNTIES THAT WE SERVE. AN AVERAGE OF 28% OF OUR TARGET POPULATION IS 65 YEARS OF AGE AND OVER. AGE DISTRIBUTION UNDER 18 YEARS OF AGE IS 17% FOR HARDIN COUNTY AND 11% FOR POPE COUNTY WITH STATE OF ILLINOIS BEING 22% UNDER 18 YEARS OF AGE. MEDIAN INCOME FOR THESE TWO COUNTIES AVERAGES $48,876 WITH STATE AVERAGE OF $72,500. ECONOMICALLY, AN AVERAGE OF 18% OF OUR POPULATION IS BELOW THE POVERTY LEVEL. THE UNEMPLOYEMENT RATE FOR OUR TARGET POPULATION IS APPROXIMATELY 5%, AS COMPARED TO THE STATE OF ILLINOIS WITH IS 7%.