4A (Expenses $ 25398440 including grants of $ 127857) (Revenue $ 33462152)
OPERATION OF A 25-BED CRITICAL ACCESS HOSPITAL (INPATIENT, SWING BED AND OUTPATIENT) WITH AN ASSISTED LIVING FACILITY. 889 ACUTE DAYS, 394 SWING BED DAYS, 18,910 OUTPATIENT VISITS AND 7,138 ASSISTED LIVING RESIDENT DAYS PROVIDED IN FY 2022. HILLSBORO AREA HOSPITAL ALSO PROVIDED $552,650 IN CHARITY CARE AND $2,832,888 IN OTHER COMMUNITY BENEFITS, NOT INCLUDING BAD DEBT.

HILLSBORO AREA HOSPITAL
PART V, SECTION B, LINE 5: HILLSBORO AREA HOSPITAL (HAH) PARTNERED WITH HSHS ST. FRANCIS (SFL) AND CARLINVILLE AREA HOSPITAL & CLINICS (CAH&C), LOCAL HEALTH CARE ORGANIZATIONS THAT SHARE THE SAME SERVICE AREA: MACOUPIN AND MONTGOMERY COUNTIES. THE ASSESSMENT WAS LED BY THE SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF POPULATION SCIENCE AND POLICY (PSP). THE THREE FORMS OF PRIMARY DATA COLLECTION WERE A DEMOGRAPHIC SURVEY, A COMMUNITY ADVISORY COUNCIL MEETING AND FOCUS GROUPS.DEMOGRAPHIC SURVEY: THE DEMOGRAPHIC SURVEY DOCUMENTED HOW PARTICIPANTS REPRESENTED THE GENERAL COMMUNITY. EVERYONE ON THE COMMUNITY ADVISORY COUNCIL AND THOSE WHO PARTICIPATED IN THE FOCUS GROUPS TOOK THE 17-ITEM DEMOGRAPHIC SURVEY. IT WAS ADMINISTERED VIA ZOOM SESSIONS BY PROVIDING A LINK TO TAKE THE SURVEY ON REDCAP. COMMUNITY ADVISORY COUNCIL MEETING: A MEETING OF STAKEHOLDERS FROM MONTGOMERY AND MACOUPIN COUNTY WAS HELD ON FEBRUARY 24, 2021, VIA ZOOM. OUT OF 24 INVITED STAKEHOLDERS, 20 STAKEHOLDERS CONSENTED TO MEET WITH REPRESENTATIVES FROM SFL, HAH, CAH&C AND PSP. A TOTAL OF 18 (38.9% FEMALE) TOOK THE DEMOGRAPHIC SURVEY. THEY REPRESENTED VARIOUS FIELDS (E.G., MINISTRY, EDUCATION, HEALTH, LAW ENFORCEMENT) AS WELL AS SPECIAL POPULATION GROUPS (E.G., RURAL, AT-RISK, AND YOUTH). YOUTH PARTICIPANTS PARTICIPATED VIRTUALLY. THE AVERAGE AGE OF PARTICIPANTS WAS 46.1 YEARS (SD = 17.3) WITH A RANGE OF 15 YEARS TO 71 YEARS. THIS DIVERSE GROUP OF INDIVIDUALS HELPS ENSURE THE CONVERSATION ABOUT AND VOTING ON COMMUNITY HEALTH NEEDS WAS DETERMINED BY A BROAD REPRESENTATION OF THE COMMUNITY AND NOT JUST THOSE IN THE HOSPITALS OR IN POSITIONS OF POWER. THE COMMUNITY ADVISORY COUNCIL MEETING MET FOR 120 MINUTES.FOCUS GROUPS: THE HOSPITALS HOSTED FOUR ONLINE FOCUS GROUPS ON MARCH 4, 5, 15 AND 17. FIFTEEN OUT OF THE 29 COMMUNITY MEMBERS INVITED CONSENTED TO PARTICIPATE. THE FOCUS GROUPS WERE FACILITATED BY PSP VIA ZOOM AND SCHEDULED BOTH DURING AND OUTSIDE OF TYPICAL BUSINESS HOURS TO ACCOMMODATE WORK/SCHOOL SCHEDULES. THE SESSIONS WERE RECORDED, AND TRANSCRIPTIONS WERE PRODUCED BY WINDY CITY TRANSCRIPTION TO USE FOR ANALYSIS. THE MAJORITY OF THE PARTICIPANTS WERE FEMALE (73.3%). THE AVERAGE AGE WAS 55.47 YEARS (SD = 20.99) WITH A RANGE OF 15 YEARS TO 76 YEARS. ONCE AGAIN, THE DISCUSSIONS ABOUT AND VOTING ON COMMUNITY HEALTH NEEDS WAS DETERMINED BY A BROAD REPRESENTATION OF THE COMMUNITY AND NOT JUST THOSE IN THE HOSPITAL OR IN POSITIONS OF POWER. EACH FOCUS GROUP WAS 60 MINUTES LONG.INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY:THE INVOLVED HOSPITALS ARE COMMITTED TO ADDRESS COMMUNITY HEALTH NEEDS IN COLLABORATION WITH LOCAL ORGANIZATIONS AND OTHER AREA HEALTH CARE INSTITUTIONS. THE FY2021 ASSESSMENT SOUGHT INPUT FROM A BROAD SECTION OF COMMUNITY STAKEHOLDERS. INPUT FROM COMMUNITY STAKEHOLDERS:THE FY2021 ASSESSMENT WAS DESIGNED TO BETTER DOCUMENT COMMUNITY INCLUSION. PSP CREATED AN ELECTRONIC DEMOGRAPHIC SURVEY FOR THE COMMUNITY ADVISORY COUNCIL (CAC) AND FOCUS GROUP PARTICIPANTS TO DOCUMENT THESE INCLUSION EFFORTS. THIS SURVEY DOCUMENTED BASIC INFORMATION SUCH AS GENDER, AGE, AND PROFESSION. IN TOTAL, 33 INDIVIDUALS COMPLETED THE SURVEY. WHILE THE CAC WAS MOSTLY MALE AND THE FOCUS GROUPS WERE MAJORITY FEMALE, THE GENDER DISPERSION WAS NEARLY EVEN (45.5% MALE; 54.5% FEMALE). NO PARTICIPANTS IDENTIFIED AS TRANSGENDER OR NONCONFORMING. THE AGE RANGE ACROSS ALL PARTICIPANTS WAS FROM 15 YEARS OLD TO 71 YEARS OLD, WITH AN AVERAGE AGE OF 50.4 YEARS OLD AND A MEDIAN AGE OF 51 YEARS OLD. ALMOST 67% OF CAC MEMBERS WORKED OUTSIDE OF HEALTH CARE (E.G., HOSPITALS, CLINICS, PUBLIC HEALTH DEPARTMENTS) AND 100% OF THE FOCUS GROUP PARTICIPANTS WORKED OUTSIDE OF HEALTH CARE. IN ADDITION TO THE NINE RETIREES, PARTICIPANTS WORKED IN MINISTRY, LAW ENFORCEMENT, PUBLIC EDUCATION, FARM BUREAU, SOCIAL WORK, PUBLIC HOUSING, AND ECONOMIC DEVELOPMENT. THIS INFORMATION DEMONSTRATES THE MAJORITY OF THE STAKEHOLDERS WERE NOT EMPLOYED BY THE HOSPITALS. INPUT FROM MEMBERS OF MEDICALLY UNDERSERVED, LOW INCOME AND MINORITY POPULATIONS: TO BEST UNDERSTAND THE REASONS FOR AND SOLUTIONS TO THE GREATEST HEALTH PRIORITIES CONCERNING THE COMMUNITY, THE HOSPITALS INVITED A DIVERSE GROUP OF INDIVIDUALS WHO WOULD BE DIRECTLY IMPACTED TO BE PART OF THE CAC AND FOCUS GROUPS. YOUTH WERE INCLUDED FOR THE FIRST TIME IN FY2021 TO BETTER LEARN ABOUT THEIR HEALTH CONCERNS FIRSTHAND. OUT OF THE 33 PARTICIPANTS, 15.5% WERE YOUTH. FY2021 WAS ALSO THE FIRST YEAR DEMOGRAPHIC DATA WAS COLLECTED FROM CAC AND FOCUS GROUP PARTICIPANTS TO CAPTURE HOW IT PROVIDES A GOOD REPRESENTATION OF THE POPULATION. ALL PARTICIPANTS HAD VOTING POWER AND TIME TO DISCUSS THEIR THOUGHTS AND OPINIONS ON THE PRIORITY AREAS AND THE DATA ASSOCIATED WITH IT. ACROSS ADULT AND YOUTH PARTICIPANTS, BOTH RACIAL/ETHNIC MINORITIES AND SEXUAL MINORITIES WERE REPRESENTED: 3.03% IDENTIFIED AS NATIVE AMERICAN AND 3.03% IDENTIFIED AS AFRICAN AMERICAN/BLACK. ADDITIONALLY, 9.10% REPORTED BEING A MEMBER OF THE LGBTQ2+ COMMUNITY. ALL PARTICIPANTS REPORTED HAVING MEDICAL INSURANCE; HOWEVER, THERE WAS ALSO SOME DIFFERENCES IN SOCIOECONOMIC STATUS AS INDICATED BY INCOME, EMPLOYMENT, AND EDUCATION. AMONG ALL PARTICIPANTS, 18.20% REPORTED A HOUSEHOLD INCOME LEVEL LESS THAN $49,999, BUT ONLY 3.03% REPORTED THEIR HOUSEHOLD INCOME FELL BELOW THE FEDERAL POVERTY LINE. OUT OF THE ADULT PARTICIPANTS, 10.71% REPORTED THEIR EMPLOYMENT STATUS AS DISABLED. IN ADDITION, 7.14% INDICATED THEY WERE NOT HOMEOWNERS. FINALLY, WHILE ADULT EDUCATION WAS HIGHER ON AVERAGE THAN THE GENERAL POPULATION, 7.14% OF ADULT PARTICIPANTS HAD COMPLETED SOME HIGH SCHOOL AND 17.9% HAD COMPLETED SOME COLLEGE, THUS INDICATING THAT NOT ALL PARTICIPANTS WERE FROM POSITIONS OF POWER OR PRIVILEGE.

HILLSBORO AREA HOSPITAL
PART V, SECTION B, LINE 6A: -HSHS ST. FRANCIS-CARLINVILLE AREA HOSPITAL

HILLSBORO AREA HOSPITAL
PART V, SECTION B, LINE 7D: PART V, SECTION B, LINE 7A:HTTP://WWW.HILLSBOROAREAHOSPITAL.ORG/COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/PART V, SECTION B, LINE 10A:HTTP://WWW.HILLSBOROAREAHOSPITAL.ORG/COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/

HILLSBORO AREA HOSPITAL
PART V, SECTION B, LINE 11: AN INTERNAL ADVISORY COUNCIL FROM THE HOSPITALS REVIEWED THE PRIORITIES IDENTIFIED IN THE RESULTS FROM THE SURVEY AND CAC AND FOCUS GROUP SESSIONS. BASED ON THE CHNA PLANNING AND DEVELOPMENT PROCESS DESCRIBED, THE FOLLOWING COMMUNITY HEALTH NEEDS WERE IDENTIFIED: ACCESS TO MENTAL AND BEHAVIORAL HEALTH TREATMENT, WORKFORCE DEVELOPMENT, AND FOOD INSECURITY. ACCESS TO MENTAL HEALTH AND BEHAVIORAL HEALTH SERVICES:MENTAL AND BEHAVIORAL HEALTH ARE A CHALLENGE FOR BOTH ADULTS AND YOUTH IN THIS SERVICE AREA. MENTAL HEALTH SURFACED AS A PRIORITY FOR SFL IN FY2015 AND FY2018. IT ALSO EMERGED AS A PRIORITY FOR HAH IN FY2019 AND AS A PRIORITY FOR CAH&C IN 2016. DATA FOR ADULTS SUGGESTS THERE ARE TWO TIMES AS MANY SUICIDES FOR MONTGOMERY COUNTY AND FOUR TIMES AS MANY SUICIDES FOR MACOUPIN COUNTY THAN STATE LEVELS. IN ADDITION, THERE WERE MORE OPIOID OVERDOSE DEATHS AMONG ADULTS IN BOTH COUNTIES THAN COCAINE AND ALCOHOL OVERDOSE DEATHS COMBINED. THESE ISSUES PERSIST IN YOUTH WITH AROUND ONE IN FOUR YOUTH IN MIDDLE SCHOOL AND ONE IN THREE HIGH SCHOOL STUDENTS IN HILLSBORO REPORTING MODERATE TO VERY SEVERE DEPRESSION. ADDITIONALLY, AROUND ONE IN FIVE YOUTH VAPED OR CONSUMED ALCOHOL RECENTLY AND ONE IN 10 YOUTH USED MARIJUANA. PART OF THE REASONS THESE ISSUES COULD HAVE PERSISTED OVER THE YEARS IS THAT THERE IS LITTLE ACCESS TO SOCIAL WORKERS, PSYCHOLOGISTS AND PSYCHIATRISTS IN THIS AREA COMPARED TO STATE AVERAGES. FOCUS GROUPS CONFIRMED THE CHALLENGES OF OBTAINING MENTAL HEALTH ACCESS IN A TIMELY MANNER AND ALSO SHARED THE VIEW THAT WHEN SERVICES ARE AVAILABLE THERE IS NOT ALWAYS A SUPPORTIVE NETWORK ENCOURAGING TREATMENT. WORKFORCE DEVELOPMENT:LESS THAN ONE IN FIVE ADULTS HAS A COLLEGE DEGREE. APPROXIMATELY 50% OF RESIDENTS HAVE A HIGH SCHOOL DEGREE OR LESS. THIS SUGGESTS IS THERE IS A GAP IN THE MARKET FOR SPECIALTY TRAINING JOBS. ALTERNATIVELY, IT COULD MEAN THERE ARE NOT ENOUGH JOBS THAT REQUIRE A COLLEGE EDUCATION TO KEEP RESIDENTS IN THE COMMUNITY. THE AVERAGE AGE IN BOTH COUNTIES IS HIGHER THAN THE STATE AVERAGE WHICH SHOWS IT IS A CHALLENGE TO KEEP YOUNGER POPULATIONS IN THE COMMUNITY. PARTICIPANTS IN THE FOCUS GROUP CONVERSATIONS NOTED THE ONLY HIGH PAYING JOBS ARE IN THE SCHOOL DISTRICT, THE HOSPITALS, OR THE PRISON. WORKFORCE DEVELOPMENT ISSUES MAY BE EXACERBATED BY THE LACK OF INTERNET ACCESS. A LARGE SECTION OF THE POPULATION DOES NOT OWN A COMPUTER OR LACKS INTERNET ACCESS COMPARED TO THE STATE LEVEL. WHILE THIS MAY BE BECAUSE THE AVERAGE AGE OF THE POPULATION IS HIGHER AND LESS FAMILIAR NAVIGATING THE INTERNET, IT CAN ALSO RESULT IN A NUMBER OF CONSEQUENCES. SPECIFICALLY, LACK OF INTERNET ACCESS POSES BARRIERS TO TELEHEALTH TREATMENT, E-LEARNING OPPORTUNITIES AND APPLYING FOR JOBS. FOCUS GROUP PARTICIPANTS REPORTED SEEING INDIVIDUALS GO TO FAST FOOD RESTAURANTS AND LIBRARY PARKING LOTS TO ACCESS THE INTERNET AND APPLY FOR JOBS. FOCUS GROUP PARTICIPANTS BELIEVE WORKFORCE DEVELOPMENT IS RELATED TO MENTAL AND BEHAVIORAL HEALTH AND THAT MORE PEOPLE WOULD STAY IN THE COMMUNITY IF INTERNET ACCESS IMPROVED. FOOD INSECURITY:FOOD INSECURITY IMPACTS ALL AGES, BUT ESPECIALLY THE YOUTH. NEARLY ONE IN FIVE CHILDREN WERE FOUND TO BE FOOD INSECURE, AND ONE IN 10 PEOPLE OVERALL. A LACK OF ACCESS TO GROCERY STORES ONLY COMPOUNDS THE PROBLEM. FOCUS GROUP DISCUSSIONS REVEALED THE CHALLENGES AROUND ACCESSING NUTRITIOUS FOOD AND REPORTED RESIDENTS OFTEN RELY ON CONVENIENCE STORES TO PURCHASE STUDENT LUNCH SUPPLIES. WHILE LARGE GROCERY STORES WITH FRESH PRODUCE CAN BE FOUND IN CITIES NEARBY, NOT EVERYONE MAY HAVE THE TIME OR TRANSPORTATION TO TRAVEL. FOCUS GROUP PARTICIPANTS MENTIONED SHORT-TERM FOOD INSECURITY IS BEING ADDRESSED BY LOCAL FOOD PANTRIES, MEALS OFFERED AT CHURCHES AND NEIGHBORHOOD INITIATIVES TO SHARE EXCESS FOOD. HOWEVER, MORE LONG-TERM AND COHESIVE SOLUTIONS ARE NEEDED.COMMUNITY HEALTH NEEDS ASSESSMENT NOTES:THE COMMUNITY SURVEY WAS CONDUCTED TO CREATE AN IMPLEMENTATION STRATEGY TO CONTINUE THE FY2021 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS FOR ST. FRANCIS HOSPITAL, HILLSBORO AREA HOSPITAL, AND CARLINVILLE AREA HOSPITAL & CLINICS. THE HILLSBORO AREA HOSPITAL BOARD SELECTED THE STRATEGIES TO BE IMPLEMENTED FROM THE CHNA. AS A NOTE TO READERS, THE PLANNING PROCESS IDENTIFIED MENTAL AND BEHAVIORAL HEALTH DATA THAT SUGGESTS THAT ONE IN EIGHT PARTICIPANTS WERE LIKELY TO HAVE MAJOR DEPRESSION. ADDITIONALLY, ONLY 44.7% OF RESPONDENTS REPORTED THAT THEIR DOCTOR HAD TALKED TO THEM ABOUT MENTAL HEALTH DURING THEIR LAST APPOINTMENT. THESE FINDINGS RESULTED IN STRATEGIES THAT HAD NOT BEEN PINPOINTED IN EARLIER IMPLEMENTATION PLANS. IMPLEMENTATION PLAN (FY 2022-2024):COLLABORATE WITH EXISTING PROVIDERS, ORGANIZATIONS, AND AGENCIES TO BETTER RESPOND TO COMMUNITY NEEDS. HAH WILL CONTINUE TO DEVELOP ITS INTEGRATED BEHAVIORAL HEALTH SERVICES, INCLUDING INCREASING ACCESS TO TELEHEALTH AND SPECIFICALLY FOCUS ON TELEPSYCHIATRY. IF POSSIBLE, ALIGN WITH THE ILLINOIS TELEHEALTH NETWORK EFFORTS TO PROVIDE A MORE ROBUST ACCESS BEYOND REQUIRING USERS TO TRAVEL TO A HOSPITAL SITE TO BENEFIT FROM THE TELEPSYCHIATRY OFFERINGS. IN COLLABORATION WITH THE HILLSBORO SCHOOL DISTRICT, HAH WILL CONTINUE TO SUPPORT THE EVIDENCE-BASED SUICIDE PREVENTION PROGRAMMING FOR YOUTH IN THE AREA HIGH SCHOOL. THE COMMUNITY LED STEERING COMMITTEE WILL PROVIDE THE LEADERSHIP AS TO HOW AND WHAT SHOULD BE ACCOMPLISHED, AND THE HOSPITAL WILL FIND THE RESOURCES TO SUPPORT THEIR DECISIONS. IN COLLABORATION WITH THE NOKOMIS SCHOOL DISTRICT, EXPAND RESEARCH TO THE COUNTY'S THIRD LARGEST SCHOOL SYSTEM AND PROVIDE RESOURCES FOR THAT COMMUNITY TO SELECT EVIDENCE-BASED SUICIDE PREVENTION PROGRAM(S) FOR THEIR YOUTH. INTEGRATE THIS PLAN INTO THE HOSPITAL'S STRATEGIC PLAN AND BUDGET PLANNING TO ASSURE THERE IS SUPPORT AND FINANCIAL RESOURCES TO FOLLOW THROUGH WITH THE IMPLEMENTATION PLAN. REMAIN IN COMMUNICATION WITH HSHS ST. FRANCIS-LITCHFIELD AND CARLINVILLE AREA HOSPITAL TO BE ABLE TO ASSESS ANY DEVELOPMENTS THAT WOULD BENEFIT OUR COMMUNITIES THROUGH COLLABORATION, AND ACT WHERE COLLABORATION IS DEEMED FEASIBLE. HAH WILL SEEK TO ESTABLISH RELATIONSHIPS, IN PARTICULAR WITH HSHS ST. FRANCIS-LITCHFIELD TO CREATE OPPORTUNITIES IN HILLSBORO TO ADDRESS THE HEALTHCARE AND COMMUNITY WORKFORCE SHORTAGES. HAH WILL CONTINUE TO SEEK COLLABORATIVE OPPORTUNITIES TO IMPROVE THE CHRONIC HEALTH ISSUES FACED BY LARGE SEGMENTS OF THE POPULATION, E.G., DIABETES, STROKE, CANCER SCREENING. HAH WILL PARTNER WITH ST. FRANCIS HOSPITAL RELATED TO A COMBINED APPROACH TO ADDRESSING FOOD INSUFFICIENCY WHILE CONTINUING OUR SUPPORT OF THE SUMMER FOOD PROGRAM FOR YOUTH UNDER 18. APPROVAL:THIS IMPLEMENTATION PLAN WAS ADOPTED BY THE HILLSBORO AREA HOSPITAL BOARD OF DIRECTORS ON JUNE 23, 2022.

HILLSBORO AREA HOSPITAL
PART V, SECTION B, LINE 20E: A MINIMUM OF 2 STATEMENTS AND 1 LETTER ARE SENT PRIOR TO SENDING ACCOUNT TO COLLECTIONS, EACH NOTING HOW TO CONTACT THE HOSPITAL FOR FINANCIAL ASSISTANCE.

PART V, SECTION B, LINES 16A-C:
HTTP://WWW.HILLSBOROAREAHOSPITAL.ORG/PATIENT-BILLING/FINANCIAL-ASSISTANCE/

PART I, LINE 3C:
HILLSBORO AREA HOSPITAL USES THE FEDERAL POVERTY GUIDELINES AS ONE MEANS OF DETERMINING ELIGIBILITY FOR CHARITY CARE. THE FEDERAL POVERTY GUIDELINES ARE UPDATED AND PUBLISHED ANNUALLY BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. AS A GENERAL RULE, A PATIENT'S INCOME, BASED ON FAMILY SIZE, MUST BE AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES TO BE ELIGIBLE FOR THE CHARITY CARE PROGRAM AND AT OR BELOW 300% OF THE FEDERAL POVERTY GUIDELINES FOR THE UNINSURED/UNDERINSURED CHARITY DISCOUNT. A SLIDING SCALE BASED ON THE PATIENT'S INCOME LEVEL UNDER THE FEDERAL POVERTY GUIDELINES WILL BE USED TO DETERMINE THE PRECISE AMOUNT OF CHARITY CARE FOR WHICH A PATIENT WILL BE ELIGIBLE. SOME PATIENTS' INCOME MAY EXCEED THESE GUIDELINES, BUT MAY STILL BE ELIGIBLE FOR CHARITY CARE WHEN ADDITIONAL CRITERIA SUCH AS HOMELESSNESS, DECEASED WITH NO ESTATE, MENTAL INCAPACITATION WITH NO ONE TO ACT ON THEIR BEHALF, MEDICAID ELIGIBILITY NOT ON THE DATE OF SERVICE (I.E. SPENDDOWN UNMET) OR NON-COVERED SERVICE, CURRENTLY ENROLLED IN A COMMUNITY PROGRAM REQUIRING POVERTY LEVEL INCOME, INCARCERATION IN A PENAL INSTITUTION WITHOUT OTHER COVERAGE AVAILABLE, SELF-ADMINISTERED DRUGS-MEDICARE/MEDICAID DUAL ELIGIBILITY ONLY, MEDICAID DHS SERVICES ONLY (I.E. MENTAL HEALTH SERVICES ONLY), DRUG AND ALCOHOL REHAB PATIENTS, MEDICAID ELIGIBLE FOR HEALTH WOMEN'S BENEFITS (I.E. COVERAGE FOR PAPS, MAMM, ONLY), AND OUT OF STATE MEDICAID.

PART I, LINE 7:
THE COST TO CHARGES RATIO WAS USED AS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES.

PART I, LINE 7G:
SUBSIDIZED HEALTH SERVICES AT THE HOSPITAL INCLUDES THE OPERATION OF THE EMERGENCY ROOM. THE EMERGENCY ROOM IS OPERATED 24 HOURS A DAY, 7 DAYS A WEEK, AND IS STAFFED BY A HIGHLY TRAINED GROUP OF NURSING STAFF AND PHYSICIANS WHO DO THEIR BEST TO PROVIDE EXCEPTIONAL CARE TO MEMBERS OF THE COMMUNITY IN NEED OF EMERGENCY CARE. THE EMERGENCY DEPARTMENT HAS A LARGE AMOUNT OF FIXED EXPENSES WHICH ARE NECESSARY TO PROVIDE THE SERVICE ON A 24 HOUR A DAY BASIS, WHICH IS A REQUIREMENT OF OPERATING A CRITICAL ACCESS HOSPITAL. THE HOSPITAL TREATS ALL PATIENTS, REGARDLESS OF ABILITY TO PAY, IN ITS EMERGENCY ROOM AND FOR THESE REASONS IT IS A SUBSIDIZED SERVICE WHICH THE HOSPITAL PROVIDES AND OFFERS TO THE COMMUNITY FOR THOSE IN NEED.

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 $ 2,753,063.

PART II, COMMUNITY BUILDING ACTIVITIES:
COVID-19 RESPONSE DURING FY 2021 CONTINUING IN FY 2022 - HILLSBORO AREA HOSPITAL HAS CONTINUED IMPLEMENTING PROCESSES TO ENSURE THE SAFETY AND WELLNESS OF OUR TEAM MEMBERS, PATIENTS, AND THE COMMUNITY. THE HOSPITAL MAINTAINS A DAILY COVID-19 TESTING SITE, AND OUR TEAM MEMBERS HAVE UNDERGONE TRAINING TO RESPOND TO THE PANDEMIC AND PROVIDE SERVICES TO PATIENTS WHILE MAINTAINING THEIR OWN SAFETY AND THE SAFETY OF OTHERS IN THE HOSPITAL AND COMMUNITY. HOSPITAL LEADERS HAVE WORKED TIRELESSLY WITH THE MONTGOMERY COUNTY HEALTH DEPARTMENT AND OTHERS IN THE COMMUNITY TO ENSURE THAT PROCEDURES ARE IN PLACE TO RESPOND TO OUTBREAKS AND ALSO INFORM THE PUBLIC OF HEALTH PRECAUTIONS. COALITION WITH PANA, CARLINVILLE, AND JERSEYVILLE HOSPITALS - THIS ALLIANCE ESTABLISHED THE FRAMEWORK TO ALLOW THESE CRITICAL ACCESS HOSPITALS TO COLLABORATE ON MUTUALLY BENEFICIAL OPPORTUNITIES IN ORDER TO MAINTAIN PROFESSIONAL, COMMUNITY-BASED, HIGH QUALITY HEALTHCARE IN THEIR LOCAL COMMUNITIES. THIS ALLIANCE IS NOT A FORMAL AFFILIATION, MERGER OR ACQUISITION, AND DID NOT CHANGE THE INDEPENDENT STATUS OF EACH HOSPITAL. WHILE THE FOUR HOSPITALS SERVE DISTINCT, RURAL, SOUTH-CENTRAL ILLINOIS COMMUNITIES, THEY SHARE SIMILAR MISSIONS, GOALS AND CHALLENGES, AND CURRENTLY COLLABORATE IN A VARIETY OF WAYS. ALL FOUR HOSPITAL LEADERS ALONG WITH THEIR BOARDS OF DIRECTORS BELIEVE THAT THE HOSPITALS CAN BE STRONGER TOGETHER THROUGH THIS COLLABORATIVE ALLIANCE. CRITICAL ACCESS HOSPITALS FACE MAJOR REGULATORY, GEOGRAPHIC, SOCIAL, AND ECONOMIC CHALLENGES WHICH DEMAND CREATIVE, COLLABORATIVE THINKING TO ENSURE RURAL COMMUNITIES CONTINUE TO HAVE ACCESS TO LOCAL, HIGH-QUALITY HEALTHCARE, INCLUDING NEW TECHNOLOGY AND PHYSICIAN SPECIALISTS, WHILE AT THE SAME TIME INCREASING EFFICIENCIES AND LOWERING COSTS. THIS ALLIANCE BETWEEN CARLINVILLE, HILLSBORO, PANA, AND JERSEYVILLE WILL BETTER POSITION THE FOUR HOSPITALS TO FACE CURRENT AND FUTURE CHALLENGES AND ENABLE THEM TO CONTINUE TO PROVIDE HIGH-QUALITY CARE LOCALLY.

PART III, LINE 2:
THE COSTING METHODOLOGY USED WAS THE RATIO OF PATIENT CARE COST-TO-CHARGES.

PART III, LINE 3:
THE HOSPITAL BELIEVES THAT THE COMMUNITY BENEFIT OBTAINED FROM ITS CHARITY CARE IS UNDERSTATED DUE TO PATIENTS THAT COULD QUALIFY FOR CHARITY CARE BUT DO NOT APPLY OR PROVIDE INCOMPLETE INFORMATION. SOME CARE PROVIDED TO PATIENTS IS NOT CLASSIFIED AS CHARITY CARE DUE TO PATIENTS MISSING DOCUMENTATION THAT PROVES THEY QUALIFY FOR CHARITY CARE. THE HOSPITAL'S BAD DEBT DOES INCLUDE AMOUNTS THAT COULD BE CLASSIFIED AS CHARITY CARE IF THE PATIENTS WOULD APPLY OR PROVIDE THE APPROPRIATE INFORMATION TO COMPLETE THE CHARITY CARE APPLICATION.

PART III, LINE 9B:
COLLECTION ACTIONS ARE STOPPED ON PATIENT BALANCES THAT ARE DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE.

PART VI, LINE 2:
HILLSBORO AREA HOSPITAL CONDUCTS A NEEDS ASSESSMENT AS ITS STRATEGIC PLANNING AND LONG-RANGE BUDGETING PROCESS. THIS PROCESS INCLUDES OBTAINING AND ANALYZING VARIOUS DATA AND MARKET DEMOGRAPHICS. THE DATA IS THEN SUPPLEMENTED WITH VIEWS AND CONCERNS FROM OUR COMMUNITY BOARD MEMBERS, OTHER COMMUNITY OUTREACH RELATIONSHIPS, AND OTHER COMMUNITY ORGANIZATIONS TO DEVELOP AN IMPLEMENTATION PLAN.

PART VI, LINE 3:
UNINSURED PATIENTS AND PERSONS WHO SEEK AND / OR OBTAIN SERVICES FROM THE HOSPITAL, ARE INFORMED OF THE AVAILABILITY OF FINANCIAL ASSISTANCE VIA SIGNAGE THROUGHOUT THE PATIENT ACCESS AREAS OF THE FACILITY, BROCHURES, ADMISSION PACKETS, DISCLOSURE ON THE PATIENT BILL, IN PERSON AND TELEPHONE ASSISTED CUSTOMER SERVICE, AS WELL AS INFORMATION SUCH AS THE GUIDELINES AND APPLICATION BEING PREDOMINATELY POSTED ON THE HOSPITAL'S WEBSITE.

PART VI, LINE 5:
DESIGNATED AS CRITICAL ACCESS HOSPITAL THE HOSPITAL USES ANY LIMITED SURPLUS FUNDS TO FURTHER ITS EXEMPT PURPOSE BY PROVIDING PROGRAMS AND ACCESS AS NOTED IN FORM 990, LINE 1 AND 4A. THE BOARD OF DIRECTORS IS MADE UP OF VOLUNTEER COMMUNITY LEADERS WITHIN ITS PRIMARY SERVICE AREA THAT ARE APPROVED BY THE MEMBER ORGANIZATION.

PART III, LINE 4:
PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY: PATIENT ACCOUNTS RECEIVABLE IS REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE HOSPITAL EXPECTS TO BE ENTITLED, IN EXCHANGE FOR PROVIDING PATIENT CARE SERVICES. PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND IMPLICIT PRICE CONCESSIONS WHICH REFLECTS MANAGEMENT'S ESTIMATE OF THE TRANSACTION PRICE. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE BASED ON NEGOTIATED CONTRACTUAL AGREEMENTS, HISTORICAL EXPERIENCE, AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS AND IS RECORDED THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE.THE HOSPITAL DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS.THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE.

PART III, LINE 8:
THE COSTING METHOD USED ABOVE FOR IRS FORM 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO 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) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES AND THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFITS EXPENSE BECAUSE PROVIDING MEDICAL CARE AT A SHORTFALL IMPACTS THE HOSPITAL'S OPERATIONS AND GROWTH. THE CARE IS PROVIDED BECAUSE THERE IS A NEED AND A DESIRE TO PROVIDE MEDICAL CARE IN THIS COMMUNITY.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY 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 VI, LINE 4:
HILLSBORO AREA HOSPITAL DEFINED ITS PRIMARY SERVICE AREA AND POPULATIONS AS THE GENERAL POPULATION WITHIN THE GEOGRAPHIC AREA IN AND SURROUNDING THE CITY OF HILLSBORO, DEFINED IN DETAIL BELOW. THE HOSPITAL'S PATIENT POPULATION INCLUDES ALL WHO RECEIVE CARE WITHOUT REGARD TO INSURANCE COVERAGE OR ELIGIBILITY FOR ASSISTANCE. THE SERVICE AREA CONSISTS OF THE FOLLOWING RURAL COMMUNITIES. CITIES: HILLSBORO, NOKOMIS, WITTVILLAGES AND UNINCORPORATED COMMUNITIES: FILLMORE, IRVING, COFFEEN, RAYMOND, BUTLER, DONNELLSONACCORDING TO U.S. CENSUS DATA, THE POPULATION IN THE HILLSBORO AREA HOSPITAL SERVICE AREA FELL FROM 19,425 PEOPLE TO 18,938 PEOPLE BETWEEN THE YEARS 2000 AND 2010, A 2.51% DECREASE. ACCORDING TO U.S. CENSUS DATA, THE POPULATION BY GENDER IN THE SERVICE AREA IS 55% MALE AND 45% FEMALE. THE REGION HAS 902 PEOPLE IN THE AGES 0-4, 2580 AGES 5-17, 1504 AGES 18-24, 2787 AGES 25-34, 2,400 AGES 25-44, 2,492 AGES 45-54, 2527 AGES 55-64, AND 3,545 AGES 65 AND OLDER. THE SERVICE AREA IS WHITE (NON-HISPANIC): 93.3% - BLACK OR AFRICAN-AMERICAN: 0.04% - NATIVE AMERICAN OR ALASKAN NATIVE: <0.0% - ASIAN: <0.0% - HISPANIC OR LATINO: 0.02%IN CALENDAR YEAR 2020, 40.52% OF THE PATIENTS SERVED WERE MALE AND 59.48% WERE FEMALE. THE PATIENTS IN 2020 WERE 98.04% NON-HISPANIC OR LATINO, 0.44% HISPANIC OR LATINO, AND 1.52% DECLINED TO RESPOND. IN ADDITION, 90.45% OF THE PATIENTS SERVED IN CALENDAR YEAR 2020 WERE OLDER THAN 18 YEARS AND 9.55% WERE 18 YEARS OR YOUNGER.

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THE HOSPITAL IS PART OF A CRITICAL ACCESS NETWORK THAT INCLUDES HILLSBORO AREA HEALTH SYSTEM NFP, ITS SOLE CORPORATE MEMBER, WHICH PROVIDES HEALTH AND SUPPORTIVE SERVICES TO THE COMMUNITIES THEY SERVE. THE HOSPITAL ALSO COMMITS SIGNIFICANT TIME AND RESOURCES TO ACTIVITIES AND SERVICES THAT MEET UNMET COMMUNITY NEEDS. MANY OF THESE ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE SELF-SUPPORTING OR FINANCIALLY VIABLE. SUCH PROGRAMS INCLUDE, BUT ARE NOT LIMITED TO, HEALTH FAIRS AND EVENTS, HEALTH SCREENINGS AND ASSESSMENTS, SPACE FOR DAYCARE PROGRAMS OFFERED BY THE LOCAL SCHOOL SYSTEM, SUPPORT FOR VITAL COMMUNITY SERVICES, TRAUMA CARE, AND VARIOUS COMMUNITY EDUCATIONAL SERVICES.HILLSBORO AREA HOSPITAL RECEIVED LEED CERTIFICATION FOR THE BUILDING ADDITION COMPLETED IN JULY 2010. THE ENVIRONMENTAL BENEFITS OF LEED INCLUDE: REDUCTION OF WASTE SENT TO LANDFILLS, CONSERVATION OF ENERGY AND WATER, REDUCTION OF HARMFUL GREENHOUSE GASES, AND A HEALTHIER AND SAFER PLACE FOR EMPLOYEES, PATIENTS, AND THE ENVIRONMENT. THE HOSPITAL IS ALSO A MEMBER OF THE CHAMBER OF COMMERCE AND PARTNERS WITH THE MONTGOMERY COUNTY ECONOMIC DEVELOPMENT CORPORATION TO OBTAIN GRANTS AND EXPAND THE SERVICES NEEDED IN THE COMMUNITY.THE HOSPITAL PROVIDES THE USE OF SPACE AT NO CHARGE TO THE HILLSBORO COMMUNITY SCHOOL DISTRICT FOR A DAYCARE FACILITY AND FUNDS STUDER GROUP CONSULTING FEES FOR THE SCHOOL'S COMMITMENT TO A CULTURE OF EXCELLENCE. THE HOSPITAL HAS PROVIDED GRAND ADVANTAGE SENIOR EXERCISE CLASSES TO THE SENIORS IN THE AREA AT NO CHARGE AND THE DIAMOND CLUB TO SENIORS FOR ASSISTANCE WITH THE UNDERSTANDING AND ORGANIZATION OF MEDICAL BILLS AND INSURANCE. HOSPITAL EMPLOYEES ALSO SHARE THEIR EXPERTISE THROUGH COMMUNITY SPEAKING AT LOCAL ORGANIZATIONS AND EVENTS. SEVERAL MONETARY DONATIONS ARE MADE BY THE HOSPITAL THROUGHOUT THE YEAR TO OTHER NON-PROFIT ORGANIZATIONS. AN AUTOMATIC BLOOD PRESSURE MACHINE IS LOCATED IN THE HOSPITAL LOBBY WHERE THE COMMUNITY MEMBERS CAN USE IT FREE OF CHARGE, AND THE HOSPITAL HAS PROVIDED A BOOTH AT THE LOCAL COMMUNITY FAIR EACH YEAR WHERE EMPLOYEES TAKE BLOOD PRESSURES AND PROVIDE HEALTH INFORMATION TO THE PUBLIC.THE HOSPITAL UTILIZED A USDA DISTANCE LEARNING & TELEMEDICINE GRANT TO EXPAND CERTIFIED NURSING ASSISTANT INSTRUCTION TO HIGH SCHOOL STUDENTS IN OUR COMMUNITY. IN COMBINATION WITH THE HOSPITAL'S MATCHING FUNDS, VIDEO CONFERENCING EQUIPMENT WAS PURCHASED AND PLACED IN 4 COMMUNITY HIGH SCHOOLS SO THAT THE STUDENTS CAN REMAIN IN THEIR OWN CLASSROOMS INSTEAD OF BEING TRANSPORTED TO THE HOSPITAL'S CAMPUS FOR CNA INSTRUCTION. IN ADDITION, THE HOSPITAL PROVIDES THE USE OF SPACE ON OUR CAMPUS FOR THE CLASSES FREE OF CHARGE, SO THE COMBINATION OF FREE SPACE USAGE AND REDUCED TRANSPORTATION COSTS PROVIDES GREAT BENEFITS FOR THIS STATE-APPROVED PROGRAM. THE HOSPITAL ALSO HAS THE HILLSBORO AREA HOSPITAL JUNIOR BOARD WHICH IS COMPRISED OF STUDENT VOLUNTEERS AGES 9-16. THE JUNIOR BOARD MEMBERS LEARNED HOW THE ORGANIZATION WORK, DEVELOP LEADERSHIP SKILLS, AND PLAN AND EXECUTE COMMUNITY IMPROVEMENT ACTIVITIES WITH THE HELP OF THE HOSPITAL STAFF MEMBERS.THE HOSPITAL ALSO PARTICIPATED IN THE STATE COLORECTAL CANCER SCREENING INITIATIVE, HELPED COORDINATE APPOINTMENTS FOR OTHER CANCER SCREENS IN COORDINATION WITH THE MONTGOMERY COUNTY CANCER ASSOCIATION, AND HAS ASSISTED SIU SCHOOL OF MEDICINE WITH RESEARCH PROJECTS IN THE COMMUNITY RELATED TO CHILD DEVELOPMENT, LUNG CANCER SCREENINGS AND YOUTH ASSESSMENTS. FURTHERMORE, THE HOSPITAL HAS HISTORICALLY BEEN RECOGNIZED AS HILLSBORO'S BUSINESS OF THE YEAR FOR ITS POSITIVE ECONOMIC AND CIVIC IMPACT AND ITS OVERWHELMING SUPPORT OF THE COMMUNITY.