2019 ICAHN Annual Report : simplebooklet.com

Our Mission ICAHN is a not for profit corporation established in 2003 for the purposes of sharing resources providing education promoting efficiency and best practices and improving healthcare services for member critical access and small rural hospitals and their communities Be like ICAHN is a common phrase often heard in rural healthcare circles across the country ICAHN has grown into a national leader and role model for many rural health organizations We believe it is because our hospital members are willing to share resources and respect support each other and believe that we truly are better together As a group we want the best for our rural communities and are willing to carry the message to Springfield and Washington D C Our hospital members understand the importance of a strong viable hospital to the community s economic success and that if we do not advocate and create our own solutions rural will not matter and others will have a louder voice That is why organizations want to be like ICAHN ICAHN members care speak out and are willing to be innovative They also take on risk whether it be offering a new urgent care service taking on a local ambulance system where others have failed or buying only local food sources for the cafeteria PAST BOA RD PRESIDENT S 2004 Susan Urso CEO Mendota Community Hospital Mendota 2005 2006 Nancy Newby CEO Washington County Hospital Nashville 2007 Randall Dauby CEO Hamilton Memorial Hospital District McLeansboro 2008 Patty Luker CEO Dr John Warner Hospital Clinton 2009 Steven Tenhouse CEO Kirby Medical Center Monticello 2010 Ada Bair CEO Memorial Hospital Carthage 2011 Susie Campbell CEO Community Memorial Hospital Staunton 2012 Lynn Klein CEO Mendota Community Hospital Mendota 2013 Steve Hayes CEO Memorial Hospital Chester 2014 Greg Starnes CEO Fayette County Hospital Vandalia 2015 Tom Hudgins CEO Pinckneyville Community Hospital District Mark Rossi COO Hopedale Medical Complex 2016 Mark Rossi COO Hopedale Medical Complex 2017 Trina Casner CEO Pana Community Hospital 2018 Tracy Bauer CEO Midwest Medical Center 2019 Doug Florkowski CEO Crawford Memorial Hospital Mike Milligan President of Legato Healthcare Marketing Inc advises Stephanie DeMay Communications and Media Specialist and all ICAHN staff on the creation of ICAHN s new brand identity 2 20 1 9 IC AHN AN NUAL R EPO RT MESSAGE FROM THE PRESIDENT AND EXECUTIVE DIRECTOR The value of the ICAHN organization is that it provides staff and resources as a framework to cultivate new ideas or simply help members improve their departmental operations or even improve patient satisfaction scores ICAHN has developed a wealth of clinical expertise and educational programs that can provide ongoing education and meet the needs of new requirements like sexual harassment training or the implementation of advanced practice registered nurses into the medical staff Year after year the collaborative efforts of ICAHN hospitals and the ICAHN staff continue to strengthen rural healthcare across Illinois Together we positively influence healthcare policy and care delivery to the communities we serve ICAHN is positioned to continue to be the rural healthcare leader now and in the future Doug Florkowski ICAHN Board President and Crawford Memorial Hospital CEO In 2019 ICAHN hosted more than 125 educational events published Hospital Governing Board Manual Volume III held two regional governing board retreats and expanded its rural accountable care organization the Illinois Rural Community Care Organization to 25 members ICAHN expanded its Survey Solutions program by adding physician and board satisfaction surveys IT support services and a full time person to support remote coding services to members While there are a growing number of states with rural hospitals at financial risk for closure Illinois has very few In fact ICAHN was honored with a Community Star Award by the National Doug Florkowski ICAHN Board President Organization of State Offices of Rural Health for its work helping to sustain rural hospitals and addressing substantive issues including drawing attention to the opioid crisis in rural Illinois counties before it became a national issue The ICAHN Board and staff are prepared and willing to lead its members through the inevitable transformation process into value based care systems where rural healthcare has an integral part ICAHN is the rural flag and represents its dedicated hospital members that care for a better tomorrow for their rural communities Yes ICAHN is strength through collaboration Pat Schou ICAHN Executive Director 2019 ICAH N AN N UAL R EPORT 3

Page 3

Page 4

2019 BOA RD OF DIRECTORS Doug Florkowski President Lawrence County Memorial Hospital Lawrenceville Tracy Bauer Past President Midwest Medical Center Galena Ted Rogalski Genesis Medical Center Aledo 4 201 9 IC AHN AN NUAL R EPO RT Joann Emge President Elect Sparta Community Hospital Sparta Kathleen Hull Illini Community Hospital Pittsfield Paul Skowron Warner Hospital Health Services Clinton Alisa Coleman Secretary Treasurer Ferrell Hospital Eldorado Ken Reid Carlinville Area Hospital Carlinville Ollie Smith Horizon Health Paris 2 01 9 S TA FF D IREC TORY ME MB E R D IREC TORY Pat Schou Executive Director Nancy Allen Senior Operations Specialist Brian Ashpole Data and Grant Project Coordinator Angie Charlet Senior Director Quality Education and Compliance Scott Cimarusti IT Consultant Trudi Colby Stroke Coordinator Regional Manager Gregg Davis MD Chief Medical Officer IRCCO Stephanie DeMay Communications and Media Specialist Kathy Fauble Professional Education Services Director Krista Fischer Regional Manager Laura Fischer Flex Grant Project Manager Michele Folsom Certified Medical Coder Auditor Lori Frick Administrative Assistant Diane Garland Senior Director Finance and HR Jackie King Clinical Informatics Director HIM Consultant Holly Lendy Assistant Controller Terry Madsen CHNA Project Consultant Ryan Morgan Chief Information Security Officer Ryan Sierman Chief Information Officer Liz Swanson Professional Education Services Assistant Director Dennis Toth IT Services Operations Coordinator Curt Zimmerman Senior Director Business Services and Development Aledo Genesis Medical Center Anna Union County Hospital Benton Franklin Hospital Canton Graham Hospital Carlinville Carlinville Area Hospital Carrollton Boyd Healthcare Services Carthage Memorial Hospital Chester Memorial Hospital Clinton Warner Hospital Health Services DuQuoin Marshall Browning Hospital Eldorado Ferrell Hospital Eureka Advocate Eureka Hospital Fairfield Fairfield Memorial Hospital Flora Clay County Hospital Galena Midwest Medical Center Geneseo Hammond Henry Hospital Gibson City Gibson Area Hospital Health Services Harvard Mercyhealth Hospital Medical Center Havana Mason District Hospital Highland St Joseph s Hospital Hillsboro Hillsboro Area Hospital Hoopeston Carle Hoopeston Regional Health Center Hopedale Hopedale Medical Complex Jerseyville Jersey Community Hospital Kewanee OSF Saint Luke Medical Center Lawrenceville Lawrence County Memorial Hospital Lincoln Abraham Lincoln Memorial Hospital Litchfield St Francis Hospital McLeansboro Hamilton Memorial Hospital District Mendota OSF Saint Paul Medical Center Metropolis Massac Memorial Hospital Monmouth OSF Holy Family Medical Center Monticello Kirby Medical Center Morrison Morrison Community Hospital Mount Carmel Wabash General Hospital Mount Vernon Crossroads Community Hospital Murphysboro St Joseph Memorial Hospital Nashville Washington County Hospital Olney Carle Richland Memorial Hospital Pana Pana Community Hospital Paris Horizon Health Pinckneyville Pinckneyville Community Hospital District Pittsfield Illini Community Hospital Princeton Perry Memorial Hospital Red Bud Red Bud Regional Hospital Robinson Crawford Memorial Hospital Rochelle Rochelle Community Hospital Rosiclare Hardin County General Hospital Rushville Sarah D Culbertson Memorial Hospital Salem Salem Township Hospital Sandwich Northwestern Medicine Valley West Hospital Sparta Sparta Community Hospital Staunton Community Hospital of Staunton Taylorville Taylorville Memorial Hospital Vandalia Sarah Bush Lincoln Fayette County Hospital Watseka Iroquois Memorial Hospital Galena Harvard MIDWEST MEDICAL CENTER MERCYHEALTH HOSPITAL AND MEDICAL CENTER HARVARD Rochelle ROCHELLE COMMUNITY HOSPITAL Morrison MORRISON COMMUNITY HOSPITAL Sandwich NORTHWESTERN MEDICINE VALLEY WEST HOSPITAL Mendota Geneseo OSF SAINT PAUL MEDICAL CENTER HAMMOND HENRY HOSPITAL Princeton PERRY MEMORIAL HOSPITAL Kewanee Aledo OSF SAINT LUKE MEDICAL CENTER GENESIS MEDICAL CENTER Monmouth Watseka OSF HEALTHCARE HOLY FAMILY MEDICAL CENTER IROQUOIS MEMORIAL HOSPITAL Eureka ADVOCATE EUREKA HOSPITAL Canton Gibson City GRAHAM HOSPITAL GIBSON AREA HOSPITAL HEALTH SERVICES Hopedale Carthage HOPEDALE MEDICAL COMPLEX MEMORIAL HOSPITAL AN AFFILIATE OF UNITYPOINT HEALTH Havana Hoopeston CARLE HOOPESTON REGIONAL HEALTH CENTER Clinton MASON DISTRICT HOSPITAL WARNER HOSPITAL HEALTH SERVICES Rushville Lincoln SARAH D CULBERTSON MEMORIAL HOSPITAL Monticello ABRAHAM LINCOLN MEMORIAL HOSPITAL KIRBY MEDICAL CENTER Pittsfield Paris ILLINI COMMUNITY HOSPITAL HORIZON HEALTH Taylorville TAYLORVILLE MEMORIAL HOSPITAL Pana Carlinville Carrollton CARLINVILLE AREA HOSPITAL BOYD HEALTHCARE SERVICES Litchfield Jerseyville PANA COMMUNITY HOSPITAL Hillsboro ST FRANCIS HOSPITAL HILLSBORO AREA HOSPITAL Staunton JERSEY COMMUNITY HOSPITAL COMMUNITY HOSPITAL OF STAUNTON Robinson Vandalia CRAWFORD MEMORIAL HOSPITAL SARAH BUSH LINCOLN FAYETTE COUNTY HOSPITAL Highland ST JOSEPH S HOSPITAL CLAY COUNTY HOSPITAL SALEM TOWNSHIP HOSPITAL Mt Vernon Nashville Red Bud Sparta SPARTA COMMUNITY HOSPITAL Chester MEMORIAL HOSPITAL Pinckneyville Mt Carmel FAIRFIELD MEMORIAL WABASH GENERAL HOSPITAL HOSPITAL McLeansboro PINCKNEYVILLE COMMUNITY HOSPITAL DISTRICT DuQuoin Lawrenceville CARLE RICHLAND MEMORIAL HOSPITAL LAWRENCE COUNTY MEMORIAL HOSPITAL Fairfield CROSSROADS COMMUNITY HOSPITAL WASHINGTON COUNTY HOSPITAL RED BUD REGIONAL HOSPITAL Olney Flora Salem HAMILTON MEMORIAL HOSPITAL DISTRICT Benton MARSHALL BROWNING HOSPITAL FRANKLIN HOSPITAL Murphysboro ST JOSEPH MEMORIAL HOSPITAL Anna UNION COUNTY HOSPITAL Eldorado FERRELL HOSPITAL Rosiclare HARDIN COUNTY GENERAL HOSPITAL Metropolis MASSAC MEMORIAL HOSPITAL 2019 ICAH N AN N UAL R EPORT 5

Page 5

Page 6

At a Glance Grants More than 1 5 million in grant benefits were distributed to critical access and small rural hospitals as part of ICAHN s distribution of the Medicare Rural Hospital Flexibility Program Flex Small Hospital Improvement Program SHIP and the 1815 Hypertension and Diabetes Grant in 2019 FLEX Program special project awards totaling 343 210 were given to critical access hospitals CAHs to implement customer service plans outpatient and emergency department improvements financial and operational improvement undertakings population health activities and EMS education projects CAHs also benefited from an additional 264 435 in educational or technical assistance related to infection control best practices quality reporting education stroke preparedness swing bed training care coordination training benchmarking software and revenue cycle management education In addition ICAHN administered the Flex EMS Sustainability Grant This grant was used to fund educational scholarships at 10 CAH owned EMS agencies create educational webinars and provide subscriptions to a web based educational platform specifically designed for emergency medical personnel Fund distribution for the Flex EMS Sustainability Grant was 52 631 and the Small Hospital Improvement Program awarded 589 860 for use in the implementation of HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems projects ICD 10 training and other value based purchasing investment activities Lastly the 1815 Grant which focuses on improving the health of Illinoisans through prevention and management of diabetes heart disease and stroke provided 120 000 in funds for education and training throughout southern Illinois 6 201 9 IC AHN AN NUAL R EPO RT Quality The Flex grant continues to support the participation in national benchmarking through the Quality Health Indicators portal This dashboard provides immediate benchmarking for our hospitals and rural health clinics around quality financial and operational measures ICAHN currently has 41 hospitals and 29 clinics registered to use this site with 12 hospitals and 11 clinics using the dashboard routinely In addition the ICAHN Ancillary Peer Network Group established the first benchmarking report for ancillary services Thirteen imaging and 15 lab participants provide benchmarking data All benchmarking is currently free to the network and highly encouraged for comparisons and best practice identification Information Technology Services ICAHN s IT services provided more than 4 000 information technology support hours and conducted 160 IT site visits to member hospitals in 2019 On average ICAHN supported about 21 member hospitals each month Member hospitals contracted with ICAHN to ensure backups are updated and systems are upgraded as needed on a weekly basis Peer Network Groups and Education ICAHN currently has over 51 peer network group Listservs with 30 having continuous activity for sharing of resources There are over 25 peer network groups meeting throughout the year with six of these having monthly peer group conference calls This resource has proven to add value to the network and allowed for quick sharing of tools resources and new models of care Throughout 2019 ICAHN held 23 peer group meetings webinars an additional 12 special webinars based on Listserv driven needs 13 consulting on site training sessions 18 outreach events based on needs 43 professional educational events 17 preceptor mentor training sessions and 10 Survey Solutions educational events challenges they face Our comprehensive and expanding portfolio of services involves many strategic business partners carefully vetted by the network and each providing unique expertise and services The network receives important financial support as these services are utilized by our members keeping ICAHN sustainable and enabling us to better serve the needs of our members and other small rural healthcare organizations External Peer Review Network In 2019 164 external peer reviews were provided to 16 ICAHN hospital members and seven out of state hospitals in Indiana and Michigan ICAHN added the new specialties of CRNA certified registered nurse anesthetist and anesthesia pain management as well as new providers for these two services plus family practice and general surgery Stroke Initiative Community Health Needs Assessments Survey Solutions ICAHN s Community Health Needs Assessments CHNAs provide a comprehensive look into future healthcare trends by organizing community stakeholder focus groups and reporting on their findings The CHNA and Implementation Strategies give critical access and small rural hospitals the opportunity to identify and address the area s most pressing healthcare needs Survey Solutions by ICAHN provides efficient and cost effective patient satisfaction survey solutions dedicated solely to rural hospitals and providers At the end of 2019 ICAHN had 48 clients for HCAHPS 23 for ED satisfaction 16 for physician practice five for outpatient services three for ambulatory surgery and 13 for swing bed The ICAHN Stroke Initiative continues to focus on networking and sharing valuable education through its active Stroke Leaders Listserv and stroke meetings throughout the state Through the ICAHN Stroke Initiative with the help of a Flex grant 30 hospitals are utilizing Get With The Guidelines to track and trend stroke related data allowing hospitals to determine where changes in the processes may need to be updated and celebrating the successes of best practice patient care Coding Support Services Mock Surveys Professional Education Services ICAHN provides a comprehensive review of health information management HIM departmental operations to assist in identifying any areas of risk and providing support and education to implement processes that ensure coding billing or documentation improvement projects are completed efficiently and effectively ICAHN has revitalized our mock survey program including an on site review of your hospital and or clinic The program offers education about new regulations and developing customizable survey readiness booklets for your staff showcases best practice and evaluates current practice to policy The full mock survey can be customized to one department or the entire hospital and can include scheduled quarterly focus surveys document review audits and quality performance to meet Conditions of Participation guidance ICAHN Professional Education Services offers inperson and distance learning continuing education and workforce development programs that focus on leadership development and clinical knowledge The majority of the programs presented are in webinar format and available 24 7 through the ICAHN Workforce Academy In 2019 Professional Education Services developed 48 programs most of which were specifically designed for nurses to receive contact hours A total of 1 200 participants were involved Professional Education Services also offered education credit social work credit clinical psychologist credit and respiratory credit through the American College of Healthcare Executives Business Solutions ICAHN Business Solutions offer several practical cost effective resources to meet the needs of our members and the financial and operational 2019 ICAHN Board President Doug Florkowski offers suggestions for the state network s strategic plan A Kirby Medical Center EMS recruitment video filmed in Monticello IL was created and distributed to rural EMS departments to encourage local recruitment efforts Several ICAHN member hospital marketers were recognized for their marketing campaigns during ISHMPR s annual awards conference ICAHN staff celebrated a successful fitness challenge with some camaraderie at the Peoria Chiefs game 2019 ICAH N AN N UAL R EPORT 7

Page 7

Page 8

REGULATORY AND LEGISLATIVE REPORT Illinois Governor J B Pritzker signs Senate Bill 1469 into law bringing 55 million in funding for critical access hospitals throughout the state The event was held at Ferrell Hospital in Eldorado U S Senator Dick Durbin meets with Pat Schou and several member hospital CEOs during their day of advocacy on Capitol Hill 8 201 9 IC AHN AN NUAL R EPO RT Rural Matters The 2019 ICAHN regulatory and legislative year began with the polar vortex positioned over Illinois but that did not stop state Randall Dauby legislative activity Chairman and Pinckneyville in Springfield The Community General Assembly Hospital CEO passed the use of recreational marijuana the Minimum Wage Act and requirements for licensed healthcare professionals to have annual training to prevent sexual harassment In addition the General Assembly passed legislation to correct the CAH outpatient procedure rate and tighten monitoring requirements on the new state Medicaidmanaged care organization The Illinois Department of Professional Regulations implemented new rules for advanced practice registered nurses APRNs and those APRNs with Full Practice Authority which will allow Illinois APRNs to practice to the top of their licenses On the federal front the concept of Medicare for all was floated leaving health professionals and consumers wondering what the impact would be on the healthcare system and election year 2020 Congress did not pass any rural legislation in 2019 yet several bills were introduced that would benefit rural health such as the Rural Health Clinic Modernization Act Rural Physician Workforce Production Act Strengthening Our Rural Work Force Act the Rural America Health Corps Act and Improving Access to Care in Rural and Underserved Areas In late December Illinois Senator Dick Durbin and Oklahoma Senator James Lankford on the Senate side and Illinois Congressman Adam Kinzinger and Iowa Congressman Dave Loebsack introduced The Rural Hospital Closure Relief Act which would reopen the critical access hospital program eliminating the distance requirement for small rural facilities Since 2010 there were 210 rural hospital closures as well as closures of rural health clinics and nursing homes Efforts will be underway in 2020 for a larger rural healthcare bill to address the closures workforce shortages and operational issues for rural providers such as the 96 hour certification rule Centers for Medicare and Medicaid Services CMS had a busy year and enacted a number of new rules to reduce the regulatory burden for hospitals and medical providers such as eliminating requirements to ask for autopsies having physicians sign off on medical student or practitioner records or requiring all rural health clinics to carry anti snake venom CMS implemented a new payment system for skilled nursing facilities requiring medical necessity for rehab therapies and performance based on quality CMS eliminated physician supervision for outpatient therapy services and added several new Medicare codes for chronic care management telehealth and virtual services Also CMS added new Conditions of Participation that require hospitals and other care services to have discharge planning processes in place as part of an overall effort to coordinate care throughout the healthcare system Lastly CMS introduced a new Medicare Shared Savings Program Pathways to Success which moves accountable care organizations into greater financial exposure with the opportunity for greater financial reward for improved performance CMS has placed greater attention on rural and increased the rural wage index to match the wage index for urban Nationally disparities between urban and rural continue to increase rural has greater numbers of residents with chronic diseases and in poverty with fewer local resources available There are fewer obstetric services and many rural communities worry about maintaining their emergency medical services The good news is that policymakers realize that rural does matter and are focusing programs and initiatives to benefit and sustain our rural communities ICAHN members must continue to tell our story raise awareness and share our solutions that will keep our rural hospitals clinics and communities stronger and viable ISSUES COMMITTEE REPORT Following a survey of the membership the ICAHN Issues Committee selected topics of greatest value for focus in 2019 Those identified as top priorities were 1 Mental and behavioral health 2 Cybersecurity 3 Medicare Advantage White Paper 4 Hospitalist benchmarking program 5 Wellness workgroup 6 Data training Annette Schnabel Chairman and Perry Memorial Hospital President CEO 2019 Progress Report M ental and behavioral health ICAHN hosted its second annual statewide mental and behavioral health conference in April with more than 125 in attendance and in cooperation with Illinois Department of Public Health Illinois Hospital Association and Southern Illinois University SIU Medicine Center for Rural Health and Social Service Development ICAHN hosted its sixth Opioid Crisis Next Door conference This year s conference had over 160 attendees highlighted several CAH local coalitions and covered topics from coalition building to Medication Assisted Treatment and community resources ICAHN also recently developed a Crisis Prevention Institute training program for hospitals with on site trainer availability Cybersecurity ICAHN staff held a cybersecurity training workshop in June and identified a phishing training vendor for members to use at a group discounted rate ICAHN conducted a cybersecurity survey to identify additional educational needs with ransomware and phishing training as the top two educational priorities for hospital staffs Dr Narain Mandhan Liberty Grzybowski and Dr Paul Bonucci presented information on substance use disorders and opioids at ICAHN s rural health summit Medicare Advantage The Issues Committee agreed to oversee the Medicare Advantage White Paper project ICAHN staff contracted with Northern Illinois University s Center for Governmental Studies to develop and administer a survey to members and then prepare a White Paper that will measure the impact of Medicare Advantage on rural providers and beneficiaries Hospitalist benchmarking program The Issues Committee is in the process of developing a standard rural hospitalist benchmarking tool to measure quality and performance Wellness workgroup The Wellness Peer Network Group held its first workshop in September 2019 with 30 in attendance Laura Fischer ICAHN Flex Grant Project Manager now leads the Wellness Peer Network Group which continues to meet bi monthly by phone or at various hospital sites Data training ICAHN held a data training series entitled Data Mania to teach hospital staff how to understand quality and performance data and how the new measures will impact value based care in the near future There were four webinars held over an eight week period with an average attendance of 30 participants per webinar 2019 ICAH N AN N UAL R EPORT 9

Page 9

Page 10

TRAILBLAZER COMMITTEE REPORT With the constant changes to our healthcare environment and market transformations combined with the way healthcare is delivered and managed ICAHN leaders recognize the benefits of a collaborative approach For those reasons the ICAHN Trailblazer Committee was created in 2016 and continues today Pam Pfister Chairman and Morrison Community Hospital CEO This collaborative group integrates knowledge and shares ideas and approaches for both old and new hospital and healthcare issues In December 2018 the Trailblazer group learned about the Health and Family Services Initiative s Integrated Health Homes for Medicaid Beneficiaries as well as a surgery placement service that provides 24 7 coverage This placement service is known for working well with staff as well as your local community and it eliminates the recruitment challenges and costs of which we have all become too familiar Doug Florkowski CEO Crawford Memorial Hospital shared his orthopedic placement service experience and how it stabilized and grew this particular service line at his hospital In August 2019 the Trailblazer group learned about a new foreign nurse recruitment service to fill gaps in nurse staffing The group also learned about a new physician hospitalist and surgery staffing model designed specifically for rural hospitals and how to manage the J 1 Visa process While the J 1 Visa process can be new territory for some this presentation assisted in explaining the contractual process and costs Each Trailblazer meeting consists of representatives from between 15 and 20 ICAHN member hospitals The discussion allows ICAHN leaders to utilize a think tank approach in sharing problems and solutions so that we all continue to deliver efficient high quality care to the patients and communities we serve 10 201 9 IC AHN AN NUAL R EPO RT The Game Changer Memorial Hospital uses Flex funds to put their best face forward More than 1 5 million in grant benefits was awarded to critical access and small rural hospitals as part of ICAHN s distribution of the Medicare Rural Hospital Flexibility Flex Program Small Hospital Improvement Program SHIP and the 1815 Hypertension and Diabetes Grant in 2019 Within the money designated for Flex 343 210 was granted to critical access hospitals who applied for several special project awards focused on the following topics Implementation of customer service plans Outpatient and emergency department improvements Financial and operational improvement Population health activities EMS education projects Memorial Hospital in Carthage was among the member hospitals that applied for the implementation of customer service plans Ada Bair CEO opted to use their award to offset the cost of travel for two already exceptional frontline employees a clinic nurse and an emergency department patient access staff member to attend Brian Lee s Ignite the Best Empower the Rest healthcare service excellence conference in New Orleans LA Upon their return Brian Lee founder of Custom Learning Systems CLS traveled to Memorial Hospital and presented to management and other leadership groups At this point our team was ready to commit to change but we needed to involve the entire staff said Bair After Brian s second visit and presentation of Everyone s a Care Giver to 100 percent of our staff we knew we were going from being a good hospital to a great hospital one that provided exceptional customer service to every patient every time A C c m Memorial is currently in its second year of a three year partnership with CLS to hardwire these changes and provide the foundation needed to continue to reach its goals Excellence does not come quickly nor does culture change It takes years of commitment from the whole organization but we have made exceptional strides already said Bair We call our program The Game Changer and it certainly is Eight of 11 HCAHPS domains have shown improvement after just one year of working with CLS The CMS HCAHPS rating has improved from four to five stars and the overall CMS star rating has increased from three to four stars We have committed to another 18 months of collaboration with CLS and we can t wait to see where this journey continues to take us 2019 ICAH N AN N UAL R EPORT 11

Page 11

Page 12

IR CCO I S M A K I N G A D IFFEREN C E in rural communities Galena Harvard MIDWEST MEDICAL CENTER MERCYHEALTH HOSPITAL AND MEDICAL CENTER HARVARD Rochelle ROCHELLE COMMUNITY HOSPITAL Morrison MORRISON COMMUNITY HOSPITAL 2019 27 participating hospitals in just fourth year of operation 40 000 Medicare beneficiaries 28 000 Blue Cross Blue Shield beneficiaries 50 of Medicare beneficiaries receive annual well visits Member hospitals improve quality scores Member hospitals decrease unnecessary ED visits Increased local market share lays groundwork for population health management In 2019 the Illinois Rural Community Care Organization IRCCO added Massac Memorial Hospital as its 25th participating hospital in the accountable care organization ACO Collectively IRCCO is covering more than 40 000 Medicare beneficiaries and 28 000 Blue Cross Blue Shield beneficiaries which puts IRCCO as one of the larger ACOs nationally in only its fourth year of operation The ICAHN staff manages IRCCO and supports its participating hospitals in their transition to value based care practices and strengthening of their local primary care services As an ACO IRCCO focuses on building care coordination processes from one care setting to the next along with prevention interventions and well visits IRCCO offers training in the patient centered medical home model which puts the patient beneficiary in the center of care In addition IRCCO tackles chronic disease management addressing things like diabetes and congestive heart failure through individual chronic care management programs and improving care quality measures IRCCO also addresses the care and cost of Medicare beneficiaries in skilled nursing units and establishes hospital tracking of beneficiaries to specialists and advanced care centers so that beneficiaries return locally to their primary care providers Rural ACOs have the advantage of being primary care based as healthcare is still local The challenge has been the fragmentation of care over the years and an ACO helps to pull care back together for better care management IRCCO has made great strides When IRCCO began in 2015 less than one percent of Medicare beneficiaries received an annual Medicare well visit and now more than 50 percent do Hospitals and providers have improved their quality scores and decreased unnecessary visits to emergency departments It has been a slow progress at times but an amazing transformation to watch how IRCCO hospitals have increased their local market share and laid the groundwork for population health management with the hospital and its providers leading the way Next year IRCCO members will take the next step to move to a more advanced ACO model with a greater financial reward IRCCO is very close to shared savings and having a special organization to move to direct contracts and other payment options because it has numbers to leverage and excellent care processes in place The future is bright for rural ACOs especially IRCCO What is an Accountable Care Organization ACO An ACO is a group of doctors hospitals and other healthcare providers who come together voluntarily to give coordinated high quality care to their Medicare patients The goal of coordinated care is to ensure that patients especially the chronically ill get the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors When an ACO succeeds both in delivering high quality care and spending healthcare dollars more wisely it will share in the savings it achieves from the Medicare program Kewanee Aledo 2020 More advanced ACO model with greater financial rewards 12 20 1 9 IC AHN AN NUAL R EPO RT OSF SAINT PAUL MEDICAL CENTER Princeton Peru PERRY MEMORIAL HOSPITAL ILLINOIS VALLEY COMMUNITY HOSPITAL OSF SAINT LUKE MEDICAL CENTER GENESIS MEDICAL CENTER Monmouth OSF HEALTHCARE HOLY FAMILY MEDICAL CENTER Watseka Eureka IROQUOIS MEMORIAL HOSPITAL ADVOCATE EUREKA HOSPITAL Canton Gibson City GRAHAM HOSPITAL Hopedale Carthage GIBSON AREA HOSPITAL HEALTH SERVICES HOPEDALE MEDICAL COMPLEX UNITYPOINT HEALTH MEMORIAL HOSPITAL Havana Rushville Lincoln SARAH D CULBERTSON MEMORIAL HOSPITAL ILLINI COMMUNITY HOSPITAL Hoopeston CARLE HOOPESTON REGIONAL HEALTH CENTER Clinton MASON DISTRICT HOSPITAL WARNER HOSPITAL HEALTH SERVICES Monticello ABRAHAM LINCOLN MEMORIAL HOSPITAL KIRBY MEDICAL CENTER Paris Taylorville HORIZON HEALTH TAYLORVILLE MEMORIAL HOSPITAL Pana Carlinville Carrollton PANA COMMUNITY HOSPITAL CARLINVILLE AREA HOSPITAL BOYD HEALTHCARE SERVICES ST FRANCIS HOSPITAL Jerseyville Hillsboro HILLSBORO AREA HOSPITAL Staunton JERSEY COMMUNITY HOSPITAL COMMUNITY HOSPITAL Charleston Highland ST JOSEPH S HOSPITAL Robinson SARAH BUSH LINCOLN Vandalia SARAH BUSH LINCOLN FAYETTE COUNTY HOSPITAL CRAWFORD MEMORIAL HOSPITAL Olney Lawrenceville CARLE RICHLAND MEMORIAL HOSPITAL LAWRENCE COUNTY MEMORIAL HOSPITAL CLAY COUNTY HOSPITAL Flora Salem SALEM TOWNSHIP HOSPITAL Mt Carmel Nashville WASHINGTON COUNTY HOSPITAL Red Bud Sparta SPARTA COMMUNITY HOSPITAL Chester Mt Vernon DuQuoin WABASH GENERAL HOSPITAL McLeansboro PINCKNEYVILLE COMMUNITY HOSPITAL DISTRICT MARSHALL BROWNING HOSPITAL FAIRFIELD MEMORIAL HOSPITAL SSM HEALTH GOOD SAMARITAN HOSPITAL CROSSROADS COMMUNITY HOSPITAL Pinckneyville RED BUD REGIONAL HOSPITAL ACOs provide hospitals with valuable information on how patients beneficiaries use local and specialty care IRCCO receives more than several hundred thousand raw claims each month which are then funneled into a dashboard so participant hospitals and providers can see how their care and utilization of services compare with others This last year IRCCO held a Data Mania webinar series to help its ACO members better understand data and learn how to make decisions based on beneficiary patient data NORTHWESTERN MEDICINE VALLEY WEST HOSPITAL Mendota Geneseo HAMMOND HENRY HOSPITAL Sandwich HAMILTON MEMORIAL HOSPITAL DISTRICT Benton FRANKLIN HOSPITAL MEMORIAL HOSPITAL Murphysboro ST JOSEPH MEMORIAL HOSPITAL Anna UNION COUNTY HOSPITAL Eldorado FERRELL HOSPITAL Rosiclare HARDIN COUNTY GENERAL HOSPITAL Metropolis MASSAC MEMORIAL HOSPITAL 2019 ICAH N AN N UAL R EPORT 13

Page 13

Page 14

2019 MBQIP QUALITY AWARDS In 2016 the Federal Office of Rural Health Policy deemed it necessary for critical access hospitals to participate in at least one measure in one domain in order to receive Flex funding opportunities As of 2017 this number had increased to one measure in at least two domains which continued into 2018 and 2019 14 201 9 IC AHN AN NUAL R EPO RT ICAHN recognized the following hospitals for quality of care as demonstrated by participating in all four domains The following hospitals have demonstrated most improved over one year in any domain Advocate Eureka Hospital Carlinville Area Hospital Crawford Memorial Hospital Fairfield Memorial Hospital Franklin Hospital Genesis Medical Center Aledo Hamilton Memorial Hospital Hillsboro Area Hospital Horizon Health HSHS St Francis Hospital Illini Community Hospital Kirby Medical Center Mason District Hospital Massac Memorial Hospital Memorial Hospital Carthage Midwest Medical Center Northwestern Medicine Valley West Hospital OSF Holy Family Medical Center OSF Saint Luke Medical Center Perry Memorial Hospital Pinckneyville Community Hospital Red Bud Regional Hospital Sparta Community Hospital St Joseph Memorial Hospital Taylorville Memorial Hospital Union County Hospital Wabash General Hospital Washington County Hospital Clay County Hospital Community Hospital of Staunton Ferrell Hospital Franklin Hospital Hammond Henry Hospital Hillsboro Area Hospital Hopedale Medical Complex Illini Community Hospital Kirby Medical Center Lawrence County Memorial Hospital Massac Memorial Hospital Memorial Hospital Carthage Memorial Hospital Chester Midwest Medical Center OSF Holy Family Medical Center OSF Saint Luke Medical Center OSF Saint Paul Medical Center Pana Community Hospital Red Bud Regional Hospital Rochelle Community Hospital Union County Hospital H C A H P S S TA R RAT IN G PE R FOR M E R S What is the purpose of HCAHPS Star Ratings CMS created the HCAHPS Star Ratings to allow consumers to more quickly and easily access patient experience information on the Hospital Compare website Star Ratings which CMS plans to roll out on other Compare websites as well will allow consumers to more easily compare hospitals Which hospitals are included in HCAHPS Star Ratings All hospitals that participate in the HCAHPS Survey are eligible to receive HCAHPS Star Ratings This includes both inpatient prospective payment system IPPS hospitals and critical access hospitals IPPS hospitals are required to report HCAHPS as part of the Inpatient Quality Reporting program and CAHs voluntarily participate Additionally hospitals must have at least 100 completed surveys in a 12 month reporting period to be eligible for HCAHPS Star Ratings The following hospitals are recognized for achieving 4 or 5 star ratings in HCAHPS scores 4 Star Rated Hospitals Ferrell Hospital Gibson Area Hospital Health Services Hammond Henry Hospital Hillsboro Area Hospital Horizon Health Massac Memorial Hospital Northwestern Medicine Valley West Hospital OSF Saint Paul Medical Center Perry Memorial Hospital Red Bud Regional Hospital St Joseph Memorial Hospital Taylorville Memorial Hospital 5 Star Rated Hospitals Crawford Memorial Hospital Hopedale Medical Complex HSHS St Francis Hospital HSHS St Joseph s Hospital Memorial Hospital Carthage Memorial Hospital Chester Midwest Medical Center Salem Township Hospital Wabash General Hospital Tom Morris Federal Office of Rural Health Policy FORHP Associate Administrator awards the Illinois Flex Program represented by Angie Charlet ICAHN Senior Director of Quality and Operations with a certificate of achievement for being among the Top 10 states during the reverse site visit held in Washington D C 2019 ICAH N AN N UAL R EPORT 15

Page 15

Page 16

IT SERV I C E S Remote Coding ICAHN s IT Services provided more than 4 000 IT support hours and made 160 IT site visits to our member hospitals in 2019 On average ICAHN supported about 21 member hospitals each month Member hospitals contracted with ICAHN to ensure backups are updated systems are upgraded as needed and for guidance with existing upgraded or new systems and equipment ICAHN s AHIMA AAPC and ARHPC credentialed and experienced remote coding team is comprised of contracted ICAHN coders who work with our member hospitals to help reduce expensive backlogs quickly save space in your facility and avoid expensive travel costs ICAHN IT Consulting offers member CEOs CFOs and IT Directors services to move the hospital s information technology plan forward with critical IT decision making Services include Remote coding specialties include Meaningful use assistance for IT and clinical staff HIPAA security review and assistance with updating HIPAA policies Enhanced network monitoring services and firewall monitoring Server virtualization installs and or upgrades Network support firewall VPN and switch configuration Vendor liaison including negotiated discounts on hardware and services Staff recruitment support training Cybersecurity Internal and external vulnerability assessments Eleven member hospitals commissioned ICAHN s IT Services Division to perform Internal Information Technology Vulnerability Assessments throughout 2019 Our goal is to expose and identify any potential security risks assess the likelihood and impact of a security breach and to recommend mitigation strategies to reduce those risks Vulnerabilities carry a high risk of exposure meaning that with very little effort an attacker can infiltrate a device through known back doors flaws or other means Prevention is the best tactic and we applaud those forward thinking hospitals that allow us to infiltrate their system before an outside hacker actually does Bottom line we want to prevent breaches before they occur Outpatient services Observation services Inpatient services critical access hospital non DRG Swing bed Physical occupational speech therapy Physician evaluation and management Emergency department Surgery Injection infusion Specialty practices Wound care Rural health clinic RHC Radiology Risk adjustment medical coding HCC In addition to these benefits ICAHN s coding staff takes pride in its high level of coding accuracy and productivity and further backs its services with a robust quality assurance program Remote coding for ICAHN allows me to utilize my coding skills and experience gained from working with larger PPS hospitals and clinics as well as critical access hospitals and RHCs daily said Michele Folsom CPC RH CBS Certified Medical Coder Auditor ICAHN Researching CPT codes reviewing diagnoses and working with many different medical providers drives my passion Coding is intriguing as it relates to detective like investigation reading each patient story and translating into CPT and ICD 10 codes It is very rewarding to ensure that patient visits are coded correctly providers follow proper documentation of procedures and by way of proper process that hospitals and or clinics continue their long term success In short as a medical coder I am an essential part of the medical process and contribute to the assurance of top tier healthcare provision to the community In addition to remote coding ICAHN also provides audit services and HIM health information management consulting Audit services include documentation and coding review including evaluation and management services procedures and ICD 10 CM for RHCs CAHs and other providers in group or solo practices retrospective or prospective methods annual audits or as needed new staff competencies executive summary and provider education HIM consulting includes HIPAA and ROI release of information training HIM department workflow and staffing and policy and procedure guidance Ryan Morgan ICAHN Chief Information Security Officer 16 201 9 IC AHN AN NUAL R EPO RT 2019 ICAH N AN N UAL R EPORT 17

Page 17

Page 18

Services PROFESSI O N A L E D U CATION Florence Nightingale famously said Let us never consider ourselves finished nurses We must be learning all our lives As this is The Year of the Nurse and the 200th anniversary of the birth of Florence Nightingale we find this quote to be a great reminder of the longstanding recognition of the importance of lifelong learning for all healthcare professionals ICAHN Professional Education Services offers our ICAHN member hospitals the opportunity to participate in educational programs that build on your staff s established knowledge and skills Each education event offered comes from our connection to you We work closely with our nurse planning committee and the ICAHN education committee to ensure that our programs meet your needs When planning the yearly schedule we look at requests you have given us in the areas of clinical education workforce development and community health Workforce development and leadership training were major focuses of the year Effective onboarding and mentoring of nurses and other healthcare professionals are more important than ever Our nurse preceptor and nurse residency programs help hospitals retain valuable nursing staff In addition 18 20 1 9 IC AHN AN NUAL R EPO RT we offer a three part mentoring series that focuses on integrating and retaining team members These programs have been highly regarded over the years and we will continue offering them in 2020 Other leadership trainings in 2019 included our Mastermind program Facilitated by People Centric Consulting Group the Mastermind program brought together senior leaders in a small group setting where they could learn share and gain insight The program was a personal journey as well as a leadership development course Participants formed a tight bond as they shared their leadership challenges successes and goals This was a pilot project for 2019 and we are looking for ways to grow and expand the program in the coming year We started re evaluating our orientation for new graduates This mentoring series will help us in adapting a good process into the orientation Participant comment from the preceptor and mentoring program Our final highlight of the year was the 2019 Diabetes Day that ICAHN hosted in partnership with the Illinois Health and Hospital Association and the Illinois Department of Public Health Almost 300 providers attended the two day event that featured nationally recognized speakers who shared current information on diabetes prevention and control motivational interviewing reimbursement recruitment oral health and medication management 2019 ICAH N AN N UAL R EPORT 19

Page 19

Page 20

NONVIOLENT CRISIS INTERVENTION TRAINING Creating a culture of safety with empathy compassion and respect ICAHN and the Crisis Prevention Institute now offer a comprehensive nonviolent crisis intervention foundation training to equip hospitals with an effective framework for safely managing and preventing difficult behavior in the workplace Nonviolent crisis intervention training is utilized to teach staff how to provide safe effective care for each patient when the patient may be showing escalating behavior When staff understand how to respond to any early warning signs of a potential crisis that could result in assault we can help them be prepared to provide prevention strategies de escalation skills and personal safety techniques said Trudi Colby IRCCO Regional Manager With these prevention skills everyone is safer The comprehensive two day course is delivered through 12 14 hours of classroom delivery and hands on skills practice The course focuses on prevention and deceleration strategies decision making managing behavioral risk using disengagement and or holding skills and postvention approaches Managing violence reducing restraint use along with complying with regulations and standards are all reasons our member hospitals benefit from this training In addition to reducing injuries staff turnover restraints and worker compensation claims as well as helping boost your HCAHPS score and staff confidence this training also saves your hospital money 20 20 1 9 IC AHN AN NUAL R EPO RT P R OG RA M S A ND SERV I CES FOR M EM B ERS Innovative solutions for rural healthcare Strategic Leadership Board consulting and education Executive leadership and mentoring Physician coaching and conflict resolution Physician hospital alignment Provider coaching and conflict resolution Rural healthcare regulatory and legislative support Strategic planning assistance Population Health and Wellness Accountable Care Organization management Care management services and consulting Community Health Needs Assessment Managed care consulting Managed Care Partners Patient Centered Medical Home Population health management IRPHA Stroke and STEMI consulting Professional Services Grant management Group health life and disability solutions Consociate Healthcare staffing solution Medefis Inc HIM informatics consulting Nonviolent crisis intervention training Member Listservs and peer networking Lean training Preceptor training Online Workforce Academy Professional Education Services and CEUs Rural Nurse Residency Program Executive physician advanced practitioners and allied health professional placement Adkisson Search Consultants Information Technology Services Cybersecurity and network monitoring solutions HIPAA and PCI security compliance HIPAA risk and business impact assessments Internal and external vulnerability assessments Network support firewall VPN and switch configuration Project management services Server and email management and connectivity support Strategic IT staffing assessments and CIO services Quality Services External peer review physician and advanced practice Hospital and clinic quality program consultant Meaningful use training and compliance readiness Mock surveys hospital and clinic surveys Survey Solutions patient physician board and employee surveys CAHPS approved vendor Quality database and benchmarking Supply Chain Risk Management Energy supply management Midwest Energy Group purchasing program Intalere GPO Property casualty professional liability medical malpractice Consociate Regulated medical and pharmacy waste management Stericycle Heritage Revenue Cycle Management Remote coding support services coding audits Patient responsibility estimator Revenue cycle networking and consulting efficientC Magnet Solutions 2019 ICAH N AN N UAL R EPORT 21

Page 21

Page 22

2019 FINANCIAL REVIEW ICAHN has achieved growth over the last five years due to the addition of new service lines as well as the growth of existing services This continued financial growth provides the member organizations with more resources by allowing ICAHN to offer a greater variety of educational and training programs based on member needs The increase in equity provides ICAHN an established foundation for further growth through the creation and development of value added programs to support our membership ICAHN had total revenue in 2019 of 4 551 269 The revenue primarily consisted of grant income and services provided by ICAHN The majority of grant revenue is received from the Medicare Rural Hospital Flexibility Program Flex and the Small Rural Hospital Improvement Grant Program SHIP The other main portion of revenue comes from services provided by ICAHN such as IT support Survey Solutions HCAHPS reporting along with managed care consulting and ICAHN s insurance program ICAHN had total expenses in 2019 of 4 384 085 Administration and grant expenses make up the largest share of the expenses incurred Administration expenses include all overhead for maintaining the organization along with the cost for services provided by the organization In 2019 ICAHN had a net income of 231 640 The net income includes interest and investment activity of 64 457 ICAHN invested 250 000 with Edward D Jones in 2015 and another 310 000 in December 2019 The December 31 2019 value of the investment is 641 493 2019 AWARDS AND ACCOMPLISHMENTS Pat Schou ICAHN Executive Director was elected as the National Rural Health Association President in 2019 but began her term in January 2020 She is shown here presiding over the 31st annual National Rural Policy Institute in Washington D C ICAHN also manages the Illinois Rural Community Care Organization IRCCO IRCCO ended 2019 with a net loss of 191 053 and has a total equity of 715 284 as of December 31 2019 Note Year end numbers are subject to audit The 2019 Woman of Distinction Award Angie Charlet ICAHN Senior Director of Quality and Operations was honored with the 2019 Illinois Valley Woman of Distinction Award given by Illinois Valley Living Magazine and the Bureau County Republican to area professional women who exemplify incredible energy talent and commitment to their communities and beyond The 2019 NOSORH Community Star Award The Illinois Critical Access Hospital Network was named Illinois Community Star for cultivating a vital innovative rural health landscape and infrastructure developing leadership capacity to grow rural health and health equity building capacity for rural data driven program planning and decisionmaking and contributing to rural health innovation education collaboration and communication ICAHN was nominated by Julie Casper Section Chief Illinois Department of Public Health Center for Rural Health 22 201 9 IC AHN AN NUAL R EPO RT powerofrural powerofrural org Illinois Critical Access Hospital Network Princeton Illinois 2019 ICAH N AN N UAL R EPORT 23

Page 23

Page 24

2019 AWARDS AND ACCOMPLISHMENTS 1 T he Exemplary Leadership Award Doug Florkowski CEO of Crawford Memorial Hospital was honored during the 2019 Annual Conference for his dedicated service as President of the Board of Directors for the state hospital network Doug had previously served as ICAHN s President Elect Secretary Treasurer and Regulatory and Legislative Chairman 2 P resident s Award Tracy Bauer CEO of Midwest Medical Center received the President s Award for exemplary character and services as a rural health leader Tracy had previously served as ICAHN s President of the Board President Elect and Secretary Treasurer 3 T he Special Partner Award Brian Lee CSP Founder CEO of Custom Learning Systems Group Ltd was granted the Special Partner Award ICAHN s highest award for leadership and ongoing service commitment to rural healthcare Brian employs methods to enhance the customer experience in all hospitals service areas focusing on small and rural as well as enhanced employee experience 2019 Hospital IMPACT Awards The IMPACT Awards are given to those ICAHN member hospitals who find creative ways to motivate staff initiate a new approach to improve patient relationships and implement successful community projects 20 1 9 IC AHN AN NUAL R EPO RT 1 2 3 4 5 6 8 9 10 2019 4 Under 40 Winners 7 J ennifer Berning Director of Physical Therapy Midwest Medical Center 8 Dr Valerie Burns Family Practice Physician Lawrence County Memorial Hospital 9 Johnna Smith Nurse Executive St Joseph Memorial Hospital 10 Karissa Turner President CEO Wabash General Hospital 4 Gibson Area Hospital Health Services Dental Clinic 5 Horizon Health s Patient Services Development 6 Genesis Medical Center Aledo s Mercer County Mental Health Action Program MHAP Gibson Area Hospital Health Services GAHHS was among the winners of ICAHN s 2019 IMPACT Awards for its dental clinic Area physicians and representatives from the local school system informed GAHHS of the need for access to dental care Patients had been on a waiting list for up to six months and were forced to go to the University of Illinois Chicago for care In response to the need GAHHS opened a dental clinic within its facility to provide dental care to those who struggle to find services and those who cannot afford to pay for these services To make the patient experience as convenient as possible Horizon Health created a one stop shop entitled Patient Services The creation of a centralized location for patient services streamlined a number of services into one location for staff departments and leadership The creation of Patient Services also helped to improve staff operations 24 Genesis Medical Center Aledo s Mercer County Mental Health Action Program MHAP established a nurse navigator at the Mercer County Health Department and coordinated care with behavioral health providers at GMCAledo The program s goal was to increase new enhanced mental health services and decrease delays in service 7 2019 ICAH N AN N UAL R EPORT 25

Page 25

Page 26

Preferred Partners B LU E S TA R PA RT N E RS Consociate Health provides insurance benefits and consulting services to employers in 48 states Consociate Health specializes in asset protection and cost containment proactively identifying and controlling risks The organization has 70 employees and with offices in Decatur and Peoria is centrally located to serve the needs of the ICAHN member hospitals Consociate Health prides itself on meeting in person with its clients regularly and participates in employee enrollment meetings health fairs and corporate level plan reviews and discussions efficientC is a claims processing software as a service developed in 2009 by OS Inc efficientC s parent company OS Inc has been providing healthcare training billing and A R services to hospitals throughout the country The software as a service provides an EMR agnostic single sign on application that houses clearinghouse claim scrubber user friendly account work queues remittance management analytics and more providing hospitals with a unified platform for more comprehensive oversight of their accounts receivable OS Inc is proud to serve members of ICAHN including Rochelle Community Hospital Advocate Eureka Hospital Midwest Medical Center Massac Memorial Hospital Kirby Medical Center and more Intalere s mission focuses on elevating the operational health of America s healthcare providers by designing tailored smart solutions that deliver optimal cost quality and clinical outcomes Intalere strives to be the essential partner for operational excellence in healthcare through customized solutions that address customers individual needs Intalere assists its customers in managing their entire non labor spend providing innovative technologies products and services and leveraging the best practices of a provider led model Midwest Energy combines its expertise and knowledge of the energy market and energy contracts with the ability to leverage preferred pricing from suppliers on behalf of hospitals This combination allows Midwest Energy to provide low cost electricity and natural gas supply to its more than 700 clients including several critical access hospitals throughout Illinois Midwest Energy serves as an advocate and resource for all energy needs of a healthcare provider and helps customers choose the lowest utility distribution rates while also offering tax saving strategies utility rebate programs and utility incentive programs all value added services provided to customers at no cost Unified Trust Company N A is a national bank trust company They are a discretionary trustee and fiduciary serving employer sponsored retirement plans as well as individual and institutional wealth management clients Unified Trust was among the first globally and the first trust company in the United States certified for fiduciary best practices by the Center for Fiduciary Excellence CEFEX With world class resources supporting its retirement and wealth management services Unified Trust s financial experts focus on creating innovative solutions to meet your long term goals ORG A N IZ AT ION S P ON SOR S Blue Co LLC HealthTechS3 Pain Management Group CastiaRx Integritas Emergency Physician Services P J Hoerr Inc CliftonLarsonAllen LP Management Services Relias Community Infusion Solutions Medefis Inc RSRH Consulting LLC Eide Bailly LLP O Shea Builders Systemax TAG Healthcare Marketing 26 20 1 9 IC AHN AN NUAL R EPO RT 2019 ICAH N AN N UAL R EPORT 27

Page 27

2019 ICAHN Annual Report

Page 1

Page 2