4A (Expenses $ 23718084 including grants of $ 0) (Revenue $ 28513989)
AS A NOT-FOR-PROFIT COMMUNITY HOSPITAL, MARSHALL BROWNING HOSPITAL IS A CHARITABLE ORGANIZATION THAT EXISTS TO ADVANCE THE HEALTH OF THE RESIDENTS OF DU QUOIN AND THE SURROUNDING COMMUNITIES. MARSHALL BROWNING HOSPITAL PROVIDES QUALITY HEALTHCARE SERVICES REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF MARSHALL BROWNING HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH THIS CORPORATION'S COMMITMENT TO SERVING ALL MEMBERS OF THE COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE, ARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST, AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR INDIVIDUAL'S INABILITY TO PAY COEXISTS. THE COMMUNITY BENEFITS CAN BE MEASURED IN MANY WAYS INCLUDING: DIRECT PATIENT CARE, SCREENINGS, EDUCATION, AND COMMUNITY SERVICE EFFORTS OF OUR COLLEAGUES. MARSHALL BROWNING HOSPITAL RECORDED 3,256 PATIENT DAYS. 2211 OF THOSE DAYS WERE MEDICARE PATIENT DAYS, WHILE 173 CONSISTED OF MEDICAID AND MEDICAID MCO DAYS. DURING FY 2022, THE HOSPITAL ADMITTED 504 PATIENTS AND DISCHARGED 504. THE AVERAGE LENGTH OF STAY FOR A PATIENT IS 6.8 DAYS. THE HOSPITAL PROVIDED 138,691 OUTPATIENT OCCASIONS OF SERVICE WHICH INCLUDED 4,819 EMERGENCY ROOM VISITS. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS, PROVIDING SERVICES TO BOTH MEDICARE AND MEDICAID PATIENTS. FINANCIAL ASSISTANCE IS ALSO PROVIDED THROUGH THE HOSPITAL'S INTERNAL POLICY AND IN FY 2022 THIS AMOUNTED IS ESTIMATED TO $65,000 AT COST. MARSHALL BROWNING HOSPITAL OFFERS VARIOUS PROGRAMS AND SERVICES THAT SUPPORT THE HEALTH OF THE COMMUNITY. SOME EXAMPLES INCLUDE THE FOLLOWING: THE HOSPITAL ANNUALLY PROVIDES ATHLETIC TRAINING SERVICES TO DU QUOIN HIGH SCHOOL ATHLETES. SERVICES ARE PROVIDED AT PRACTICES AS WELL AS AT SCHOOL SPORTING EVENTS AT NO COST TO THE SCHOOL. MONTHLY COMMUNITY EDUCATION LUNCHEONS ARE OFFERED WITH PHYSICIANS/ PROVIDERS PRESENTING PROGRAMS ON HEALTH TOPICS. THE HOSPITAL OFFERS A WEEKLY COUMADIN CLINIC FOR PATIENTS TAKING COUMADIN (WARFARIN) THERAPY. THE CLINIC IS DIRECTED BY THE HOSPITAL PHARMACIST OF WHICH NO REIMBURSEMENT IS RECEIVED FOR PHARMACIST SERVICES. THE HOSPITAL'S COMMUNITY CHAMPION TAUGHT SEXUAL HEALTH CLASSES AT THE HIGH SCHOOL AT NO CHARGE. HOSPITAL MANAGERS ARE FREQUENTLY GUEST SPEAKERS AT SCHOOLS ON VARIOUS HEALTH TOPICS AND HEALTHCARE CAREERS. HIGH SCHOOL STUDENTS PARTICIPATE IN JOB SHADOWING AND COOPERATIVE EDUCATION PROGRAMS AT THE HOSPITAL. MARSHALL BROWNING HOSPITAL PROVIDED FREE SPORTS PHYSICALS, SCHOOL PHYSICALS, AND VACCINATIONS TO LOCAL STUDENTS. THE HOSPITAL ALSO SERVES AS A CLINICAL SITE FOR JOHN A. LOGAN COLLEGE NURSING STUDENTS AND IS A CLINICAL SITE FOR OTHER COLLEGES INCLUDING SIU MEDICAL SCHOOL, SIU-C, ST. LOUIS COLLEGE OF PHARMACY, REND LAKE COLLEGE, KASKASKIA COLLEGE, CHAMBERLAIN COLLEGE, SOUTHWESTERN ILLINOIS, AND SICCM. MARSHALL BROWNING HOSPITAL PROVIDES A VARIETY OF COMMUNITY SERVICES TO CITIZENS AND EMPLOYEES FOR WHICH WE RECEIVE NO REIMBURSEMENT SUCH AS COMMUNITY HEALTH FAIRS OFFERING DEEPLY DISCOUNTED LAB TESTING, SCHOOL HEALTH FAIRS, FIRST AID STATIONS, CLASSES FOR AUTOMATIC ELECTRONIC DEFIBULATOR'S (AED) AND BASIC LIFE SUPPORT (BLS). ADDITIONALLY, MBH STAFF REACH HUNDREDS OF PEOPLE WITH PRESENTATIONS ON A WIDE VARIETY OF TOPICS INCLUDING HEART HEALTH, NUTRITION, ASTHMA, DIABETES, ALZHEIMER'S DISEASE, SLEEP APNEA, ARTHRITIS, BREAST CANCER, EXERCISE AND DIET, SMOKING CESSATION, PNEUMONIA VACCINE, ETC. THE HOSPITAL ANNUALLY SUPPORTS THE DU QUOIN YOUTH CLUB AND NUBABILITY ORGANIZATIONS. THE HOSPITAL ANNUALLY PROVIDES A FOUR-YEAR $1,000 SCHOLARSHIP TO A LOCAL HIGH SCHOOL SENIOR ENTERING THE HEALTHCARE FIELD. THE HOSPITAL PROVIDES SPEAKERS FOR CAMPING CONVENTIONS AND SCREENINGS FOR LOCAL MANUFACTURING COMPANIES. THE HOSPITAL HOSTS SIX AMERICAN RED CROSS BLOOD DRIVES EACH YEAR. MBH EMPLOYEES CONTINUE TO GROW. MARSHALL BROWNING HOSPITAL INITIATED A CARE COORDINATION PROGRAM THAT ORGANIZES PATIENT CARE ACTIVITIES DRIVEN BY A PATIENT-CENTERED FOCUS. TO SUPPORT CARE COORDINATION, THE HOSPITAL ADDED THREE KEY TEAM MEMBERS. THE NEW POSITIONS INCLUDE A TRANSITIONAL CARE NAVIGATOR, ANNUAL WELLNESS NURSE, AND CARE COORDINATOR. THE NEW STAFF MEMBERS COORDINATE SAFE PATIENT TRANSITIONS BETWEEN HOSPITAL STAYS TO DISCHARGE HOME, ADDITIONAL FOLLOW-UP AFTER ED VISITS AND CHRONIC DISEASE CARE MANAGEMENT. ANNUAL WELLNESS VISITS INCLUDE COMPREHENSIVE YEARLY HEALTH REVIEW THAT HELPS OUR PATIENTS CREATE A PERSONALIZED PREVENTION PLAN WITH THEIR PRIMARY CARE PROVIDER.

MARSHALL BROWNING HOSPITAL ASSOCIATION
PART V, SECTION B, LINE 5: MBH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FROM OCTOBER 2021 THROUGH MARCH 2022. 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 RESULTED IN A CHNA REPORT TO ASSIST THE HOSPITAL IN PLANNING, IMPLEMENTING, AND EVALUATING HOSPITAL STRATEGIES AND COMMUNITY BENEFIT ACTIVITIES. THE CHNA 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 HOSPITALS AND THEIR RURAL COMMUNITIES. THE PROCESS INVOLVED THE REVIEW OF SEVERAL HUNDRED PAGES OF DEMOGRAPHIC AND HEALTH DATA SPECIFIC TO THE MARSHALL BROWNING HOSPITAL SERVICE AREA. THE SECONDARY DATA AND PREVIOUS HEALTH PLANNING CONCLUSIONS DRAW ATTENTION TO SEVERAL COMMON ISSUES OF RURAL DEMOGRAPHICS AND ECONOMIES. IN ADDITION, THE PROCESS INVOLVED FOCUS GROUPS COMPRISED OF AREA HEALTHCARE PROVIDERS, PARTNERS, AND PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF, OR EXPERTISE IN PUBLIC HEALTH. MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS SERVED BY THE HOSPITAL OR INDIVIDUALS OR ORGANIZATIONS REPRESENTING THE INTERESTS OF SUCH POPULATIONS ALSO PROVIDED INPUT. THE MEDICALLY UNDERSERVED ARE MEMBERS OF A POPULATION WHO EXPERIENCE HEALTH DISPARITIES, ARE AT-RISK OF NOT RECEIVING ADEQUATE MEDICAL CARE AS A RESULT OF BEING UNINSURED OR UNDERINSURED, AND/OR EXPERIENCING BARRIERS TO HEALTHCARE DUE TO GEOGRAPHIC, LANGUAGE, FINANCIAL, OR OTHER CHALLENGES. TWO FOCUS GROUPS MET SEPARATELY ON OCTOBER 14, 2021, AND OCTOBER 15, 2021, TO DISCUSS THE OVERALL STATE OF HEALTH AND THE LOCAL DELIVERY OF HEALTHCARE AND HEALTH-RELATED SERVICES. THEY IDENTIFIED POSITIVE RECENT DEVELOPMENTS IN LOCAL SERVICES AND CARE AND ALSO IDENTIFIED ISSUES OR CONCERNS THAT THEY FELT STILL EXISTED IN THE AREA. A THIRD GROUP COMPRISED OF MEMBERS OR REPRESENTATIVES OF MEMBERS OF THE FOCUS GROUPS THEN MET ON MARCH 7, 2022, AND CONSIDERED THE QUALITATIVE DATA GATHERED AND ESTIMATED FEASIBILITY AND EFFECTIVENESS OF POSSIBLE INTERVENTIONS BY THE HOSPITAL TO IMPACT THE HEALTH PRIORITIES; THE BURDEN, SCOPE, SEVERITY, OR URGENCY OF THE HEALTH NEED; THE HEALTH DISPARITIES ASSOCIATED WITH THE HEALTH NEEDS; AND OTHER COMMUNITY ASSETS AND RESOURCES THAT COULD BE LEVERAGED THROUGH STRATEGIC COLLABORATION IN THE HOSPITAL'S SERVICE AREA TO ADDRESS THE HEALTH NEEDS. AS AN OUTCOME OF THE PRIORITIZATION PROCESS, DISCUSSED ABOVE, SEVERAL POTENTIAL HEALTH NEEDS OR ISSUES FLOWING FROM THE PRIMARY AND SECONDARY DATA WERE NOT IDENTIFIED AS SIGNIFICANT CURRENT HEALTH NEEDS AND WERE NOT ADVANCED FOR FUTURE CONSIDERATION. FIVE NEEDS WERE IDENTIFIED AS SIGNIFICANT HEALTH NEEDS AND PRIORITIZED: (1) ISSUES SURROUNDING MENTAL HEALTH, INCLUDING A) INCREASE ACCESS AND IMPROVE TRANSPORTATION FOR LONG-TERM MENTAL HEALTHCARE OUTSIDE THE COMMUNITY, INCLUDING CARE FOR SUBSTANCE USE DISORDERS, B) IMPROVE COMMUNITY EDUCATION ABOUT RISKY BEHAVIOR AMONG YOUTH, C) INCREASE EDUCATION AND TRAINING OPPORTUNITIES ON YOUTH MENTAL HEALTH FOR SCHOOL FACULTY AND STAFF; (2) BEGIN TO ADDRESS THE ISSUES SURROUNDING YOUTH LIVING IN POVERTY; (3) STAFF PUBLIC TRANSPORTATION NEEDS TO BE AT A SUFFICIENT LEVEL TO FULLY MEET NEEDS FOR BROADER GENERAL SERVICES AND FLEXIBILITY TO ADDRESS ACCESS TO HEALTH-RELATED APPOINTMENTS AND SERVICES; (4) TELEHEALTH ACCESS FOR YOUTH IN SCHOOLS FOR PHYSICAL AND MENTAL HEALTH; (5) ADDRESS THE TEEN BIRTH RATE; (6) BETTER ACCESS TO SERVICES FROM THE DEPARTMENT OF HUMAN SERVICES.

MARSHALL BROWNING HOSPITAL ASSOCIATION
PART V, SECTION B, LINE 7D: 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.HTTP://WWW.MARSHALLBROWNINGHOSPITAL.COM/GETPAGE.PHP?NAME=CHNA

MARSHALL BROWNING HOSPITAL ASSOCIATION
PART V, SECTION B, LINE 11: THE IMPLEMENTATION STRATEGY WAS DEVELOPED THROUGH A FACILITATED MEETING INVOLVING KEY ADMINISTRATIVE STAFF AT MARSHALL BROWNING HOSPITAL, INCLUDING: LARRY SPOUR, CHIEF EXECUTIVE OFFICER; STEPHANIE HALL, CHIEF NURSING OFFICER; HAROLD CALDERON, CHIEF FINANCIAL OFFICER; JOANNA ELLIOTT, PERFORMANCE IMPROVEMENT OFFICER; BROOKE FELTMEYER, CLINIC MANAGER; NATHAN BARTNICKI, INFORMATION TECHNOLOGY MANAGER; RYAN JUHL, DIRECTOR OF PLANT OPERATIONS; PAM LOGAN, DIRECTOR OF MARKETING/PATIENT RELATIONS; HEATHER KATTENBRAKER, EXECUTIVE ASSISTANT; AND CELENA SLOWICK, COMMUNITY CHAMPION. THE GROUP REVIEWED THE NEEDS ASSESSMENT PROCESS AND CONSIDERED THE PRIORITIZED SIGNIFICANT NEEDS AND SUPPORTING DOCUMENTS. THEY DISCUSSED STEPS TAKEN TO ADDRESS THE PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENT. THEY ALSO CONSIDERED INTERNAL AND EXTERNAL RESOURCES POTENTIALLY AVAILABLE TO ADDRESS THE CURRENT PRIORITIZED NEEDS. THE GROUP THEN CONSIDERED EACH OF THE PRIORITIZED NEEDS. FOR EACH OF THE SIX CATEGORIES, ACTIONS THE HOSPITAL INTENDS TO TAKE WERE IDENTIFIED ALONG WITH THE ANTICIPATED IMPACT OF THE ACTIONS, THE RESOURCES THE HOSPITAL INTENDS TO COMMIT TO THE ACTIONS, AND THE EXTERNAL COLLABORATORS THE HOSPITAL PLANS TO COOPERATE WITH TO ADDRESS THE NEED. THE PLAN WILL BE EVALUATED BY PERIODIC REVIEW OF MEASURABLE OUTCOME INDICATORS IN CONJUNCTION WITH ANNUAL REVIEW AND REPORTING. PROCESS BY WHICH NEEDS WILL BE ADDRESSED: 1. ISSUES SURROUNDING MENTAL HEALTH. MARSHALL BROWNING HOSPITAL WILL COOPERATE WITH EMERGING EFFORTS OF CHRISTOPHER RURAL HEALTH CLINIC AND THE HEALTH DEPARTMENT ON NEW BEHAVIORAL HEALTH PROBLEMS; EXPLORE COOPERATIVE TRANSPORT PROGRAMS WITH SOUTH CENTRAL TRANSIT; COLLABORATE WITH AREA HOSPITALS TO DEVELOP FUNDING FOR DISTANT TRANSFER FOR INPATIENT MENTAL HEALTH AND SUBSTANCE USE DISORDER TREATMENT; EXPLORE EXPANDING COMMUNITY EDUCATION PROGRAMS TO LOCATIONS AWAY FROM THE HOSPITAL IN ORDER TO INCREASE ACCESS AND ATTENDANCE; EXPLORE DEVELOPING LOCAL MENTAL HEALTH FIRST AID TRAINERS AND OTHER RESOURCES FOR SCHOOL STAFF, PARENTS, AND COMMUNITY MEMBERS.2. BEGIN TO ADDRESS THE ISSUES SURROUNDING YOUTH LIVING IN POVERTY. MARSHALL BROWNING HOSPITAL WILL SUPPORT THE SCHOOL SYSTEM'S EFFORTS TO CREATE LOCAL CAREER OPPORTUNITIES FOR YOUTH AND YOUNG ADULTS. THE HOSPITAL WILL RE-ENGAGE AND BROADEN ITS WORK SHADOWING PROGRAM.3. STAFF PUBLIC TRANSPORTATION NEEDS TO BE AT A SUFFICIENT LEVEL TO FULLY MEET NEEDS FOR BROADER GENERAL SERVICES AND FLEXIBILITY TO ADDRESS ACCESS TO HEALTH-RELATED APPOINTMENTS AND SERVICES. MARSHALL BROWNING HOSPITAL WILL SUPPORT SOUTH CENTRAL TRANSIT IN ITS POST-PANDEMIC REBUILDING AS IS REASONABLE AND APPROPRIATE. MARSHALL BROWNING HOSPITAL BELIEVES THAT THE SOLUTIONS TO MASS TRANSIT ISSUES MUST BE LED BY TRANSIT EXPERTS AND LEADERS. MARSHALL BROWNING HOSPITAL ANTICIPATES THAT RECENTLY ANNOUNCED STEPS TO RESTORE AND EXPAND THE LOCAL TRANSIT PROGRAM WILL ADDRESS THE ISSUES RAISED HERE. 4. TELEHEALTH ACCESS FOR YOUTH IN SCHOOLS FOR PHYSICAL AND MENTAL HEALTH. MARSHALL BROWNING HOSPITAL WILL EXPLORE EXPANDING TELEHEALTH SERVICES TO PROVIDE REASONABLE AND APPROPRIATE ACCESS TO STAFF AND YOUTH IN SCHOOLS IN COLLABORATION WITH THE HEALTH DEPARTMENT. THE HOSPITAL ANTICIPATES THAT THIS COOPERATIVE EFFORT BETWEEN THE HOSPITAL, PUBLIC HEALTH, AND THE SCHOOLS COULD PROVIDE INCREASED ACCESS TO MENTAL AND PHYSICAL CARE FOR YOUTH. 5. ADDRESS THE TEEN BIRTH RATE. MARSHALL BROWNING HOSPITAL WILL COLLABORATE WITH THE HEALTH DEPARTMENT TO INCREASE EDUCATION ON TOPICS RELEVANT TO THIS ISSUE TO THE COMMUNITY AND INTO SCHOOLS. THE HOSPITAL ANTICIPATES THAT INCREASING COMMUNICATION ON TOPICS RELATED TO TEEN BIRTHS WILL HAVE A POSITIVE IMPACT ON THE BIRTH RATE. 6. BETTER ACCESS TO SERVICES FROM THE DEPARTMENT OF HUMAN SERVICES. MARSHALL BROWNING HOSPITAL WILL EXPLORE COLLABORATION TO PROVIDE A LIAISON FOR SERVICES THAT PRESENT AT THE HOSPITAL. THE HOSPITAL WILL EXPLORE SUPPORT OF ANY REASONABLE AND APPROPRIATE COMMUNITY-BASED EFFORT TO CONVINCE THE DEPARTMENT OF HUMAN SERVICES TO RESTORE LOCAL ACCESS TO THE DEPARTMENT IN THIS AREA, IF SUCH AN EFFORT IS INITIATED.

MARSHALL BROWNING HOSPITAL ASSOCIATION
PART V, SECTION B, LINE 16J: 16I - ENGLISH IS THE ONLY PRIMARY LANGUAGE THEREFORE THE FAP, FAP APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY HAVE NOT BEEN TRANSLATED.

SECTION B, PART V, LINES 16A-C:
HTTP://WWW.MARSHALLBROWNINGHOSPITAL.COM/DOCS/FINANCIAL_ASSISTANCE_APPL_HOSPITAL_REV_07.01.PDF

PART I, LINE 6A:
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.

PART I, LINE 7:
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.

PART I, LINE 7G:
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.

PART I, LINE 7, COLUMN (F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,063,186.

PART III, LINE 2:
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.

PART III, LINE 3:
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.

PART III, LINE 4:
ACCOUNTS RECEIVABLE AND CREDIT POLICY:IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION 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 PAYOR COVERAGE, THE ORGANIZATION 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 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 ORGANIZATION 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.

PART III, LINE 8:
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.

PART III, LINE 9B:
THE ORGANIZATION'S COLLECTIONS POLICY DOES CONTAIN A PROVISION FOR PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. WHEN IT IS DISCOVERED AND INDIVIDUAL MAY OR DOES APPLY, THERE IS A HOLD PUT ON THE ACCOUNT AND COLLECTIONS ARE NOT PURSUED UNTIL AN APPLICATION IS COMPLETE AND PROCESSED.

PART VI, LINE 3:
PATIENT EDUCATION REGARDING ELIGIBILITY FOR ASSISTANCE IS PROVIDED IN THE FOLLOWING MEDIUMS: HOSPITAL BROCHURES, 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.

PART VI, LINE 2:
MARSHALL BROWNING HOSPITAL CONTINUED TO ASSESS COMMUNITY HEALTH NEEDS AND MONITOR HEALTH OUTCOMES THROUGH MANY INITIATIVES. COMMUNICATION WITH THE COMMUNITY ADVISORY COMMITTEE CONTINUED EVEN THOUGH IN-PERSON MEETINGS WERE NOT ALWAYS POSSIBLE DUE TO THE COVID-19 PANDEMIC. THE HOSPITAL OFFERED DRIVE-THRU COVID-19 TESTING FOR THE COMMUNITY. INSURANCE FOR WAS BILLED FOR THE TESTING; HOWEVER, PATIENTS DID NOT INCUR ANY OUT-OF-POCKET EXPENSES. THE HOSPITAL ALSO PROVIDED COVID-19 TESTING FOR THE SCHOOL FACULTY ON A WEEKLY BASIS. THE COMMUNITY CHAMPION AND MARKETING DIRECTOR WORKED WITH COMMUNITY ORGANIZATIONS TO PROVIDE WINTER WEATHER RESOURCES AND CLOTHING DRIVES FOR LOCAL AGENCIES IN NEED. THE HOSPITAL INITIALLY OFFERED A COMMUNITY HEALTH CHECK PROVIDING DEEPLY DISCOUNTED LAB TESTING FOR ONE WEEK IN JULY. DUE TO THE SIGNIFICANT COMMUNITY NEED, THE HOSPITAL BEGAN OFFERING DISCOUNTED LAB TESTING EVERY TUESDAY THROUGHOUT THE YEAR. THIS GREATLY IMPROVED THE HEALTH OF INDIVIDUALS WHO COULD NOT AFFORD LAB TESTING PRIOR TO THE DISCOUNT. THE HOSPITAL MET REGULARLY WITH THE HEALTHY LIFESTYLES COMMITTEE WHICH INCLUDED COMMUNITY REPRESENTATIVES. THE COMMITTEE COMPLETED THE WORK AND PUBLISHED THE PERRY COUNTY RESOURCE GUIDE LISTING ALL SERVICES IN THE COUNTY. THE GUIDE IS LOCATED ON THE HOSPITAL'S WEBSITE AS WELL AS COPIES IN THE CHAMBER OFFICE, TRANSITION2HOPE (RESOURCE CENTER), LIBRARY, SCHOOLS, ETC. THE COMMUNITY CHAMPION AND MARKETING DIRECTOR MET WITH COMMUNITY JOINT PARTNERS AS WELL AS REPRESENTATIVES FROM A NEIGHBORING HOSPITAL IN THE COUNTY TO DISCUSS COMMUNITY CARE COORDINATION AND BRAINSTORM THE MOST SIGNIFICANT HEALTH NEEDS THE COUNTY WAS FACING. MENTAL HEALTH SERVICES EMERGED AS THE HIGHEST PRIORITY NEED. MEETINGS ARE CONTINUING WITH A FOCUS ON MORE MENTAL HEALTH SERVICES IN SCHOOLS, INCREASING THE MENTAL HEALTH WORKFORCE, TRANSPORTATION, AND INCREASED FUNDING. COMMUNITY JOINT PARTNERS REPRESENTED INCLUDED THE MAYOR, SCHOOL, HEALTH DEPARTMENT, PERRY COUNTY COUNSELING, ILLINOIS EXTENSION, AMBULANCE SERVICE, MINISTER, LIBRARY, FUNERAL HOME, POLICE, TRANSPORTATION, AND CARE COORDINATORS FROM BOTH HOSPITALS IN THE COUNTY. THE HOSPITAL'S COMMUNITY CHAMPION AND MARKETING DIRECTOR SERVE ON THE TRANSITION2HOPE BOARD OF DIRECTORS, WHICH ACCOMPLISHED OPENING THE COUNTY'S NEW RESOURCE CENTER/WARMING CENTER. RESOURCES INCLUDE COUNSELING, CLOTHING, AND A FREE WEEKLY MEAL. ONCE THE COVID-19 PANDEMIC IMPROVED, THE HOSPITAL OFFERED FREE EDUCATIONAL LUNCHEONS TO THE COMMUNITY ON DIABETES, VISION ISSUES, ADVANCE DIRECTIVES, COPD, MEN'S HEALTH, AND WEIGHT LOSS. THE HOSPITAL'S TWO RURAL HEALTH CLINICS OFFERED FREE SCHOOL AND SPORTS PHYSICALS AS WELL AS VACCINATIONS.

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MARSHALL BROWNING HOSPITAL HAS DEFINED ITS PRIMARY SERVICE AREA AND POPULATIONS AS THE GENERAL POPULATION WITHIN THE GEOGRAPHIC AREA IN AND SURROUNDING DU QUOIN. THE HOSPITAL'S PATIENT POPULATION INCLUDES ALL WHO RECEIVE CARE WITHOUT REGARD TO INSURANCE COVERAGE OR ELIGIBILITY FOR ASSISTANCE. THE HOSPITAL'S AREA OF SERVICE IS COMPRISED OF AROUND 441 SQUARE MILES, WITH A POPULATION OF APPROXIMATELY 27,900 PEOPLE AND A POPULATION DENSITY OF 63 PEOPLE PER SQUARE MILE. THE SERVICE AREAS CONSIST OF RURAL COMMUNITIES INCLUDING DU QUOIN, MULKEYTOWN, ELKVILLE, SESSER, DOWELL, TAMARAROA, CHRISTOPHER, AND PINCKNEYVILLE. THE AVERAGE HOUSEHOLD SIZE IN THE AREA, AT 2.3, IS LOWER THAN BOTH ILLINOIS (3.0) AND THE U.S. (2.5) OVERALL AVERAGE. THE LARGEST LEVEL OF EDUCATION IS SOME COLLEGE, FOLLOWED BY HIGH SCHOOL GRADUATES. THE AREA'S UNEMPLOYMENT RATE OF 5.1% IS HIGHER THAN THE STATEWIDE AND NATIONAL AVERAGE. MEDIAN FAMILY HOUSEHOLD INCOME IN THE SERVICE AREA IS LOWER THAN THE STATEWIDE AVERAGE. PERRY COUNTY HAS A HIGHER PERCENTAGE OF DISABLED POPULATION (16%) COMPARED TO THE STATE OF ILLINOIS (7.3%) AND NATIONAL AVERAGES (8.7%). THE COUNTY'S PER CAPITA INCOME ($24,442) IS LOWER THAN THE STATE OF ILLINOIS ($37,306). PERRY COUNTY HAS A HIGHER PERCENTAGE OF THE UNINSURED POPULATION (7%), AND CHILDREN IN SINGLE-PARENT HOUSEHOLDS (37%). PERRY COUNTY IS RANKED AMONG THE UNHEALTHIEST COUNTIES IN ILLINOIS (0-25%) IN HEALTH FACTORS AND AMONG THE LOWER/MIDDLE RANGE OF UNHEALTHIEST COUNTIES IN ILLINOIS (25%-50%) IN HEALTH OUTCOMES.

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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 SPORTS PHYSICALS, SCHOOL PHYSICALS AND VACCINATIONS TO AREA STUDENTS. 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 PROVIDES 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 WHO PROVIDES 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 EDUCATIONAL LUNCHEON PROGRAM FOR INDIVIDUALS 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 OFFERS A COMMUNITY HEALTH CHECK PROVIDING DISCOUNTED LAB TESTING ON A WEEKLY BASIS. 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 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 OFFERED DRIVE-THRU COVID-19 TESTING FOR THE COMMUNITY AS WELL AS EDUCATION ON COVID-19 THROUGH VARIOUS MEDIUMS INCLUDING SOCIAL MEDIA VIDEOS, NEWSLETTERS, WEBSITE, AND PRINT AS WELL AS FREE EDUCATION AT THE CITY PARK ON COVID AND THE IMPORTANCE OF REGULAR SCREENINGS AND VACCINATIONS. THE HOSPITAL PROVIDED WEEKLY COVID-19 TESTING FOR SCHOOL FACULTY AND PROVIDED STAFF TO THE HEALTH DEPARTMENT TO ASSIST WITH COVID-19 VACCINATIONS. THE HOSPITAL CONTINUES TO PROVIDE EXTENDED WI-FI RANGE TO PROVIDE ADDITIONAL OPPORTUNITIES FOR STUDENTS.

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MARSHALL BROWNING HOSPITAL WAS AFFILIATED WITH SOUTHERN ILLINOIS HEALTHCARE; HOWEVER, THE AFFILIATION AGREEMENT WAS DISSOLVED ON APRIL 26, 2021. THE BOARD OF DIRECTORS BELIEVED IT WAS NO LONGER BENEFICIAL TO THE HOSPITAL AND THAT DISSOLVING THE RELATIONSHIP WOULD ALLOW THE ESTABLISHMENT OF FUTURE RELATIONSHIPS WITH OTHER HEALTHCARE SYSTEMS. THIS HAS PROVEN TO BE TRUE AS WORKING RELATIONSHIPS WITH OTHER HEALTHCARE SYSTEMS HAVE BEEN ESTABLISHED AND BROUGHT ADDITIONAL SPECIALISTS TO THE HOSPITAL.

PART VI, LINE 7, REPORTS FILED WITH STATES
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