With an agreement to lease Oak Hill to Accolade Healthcare still pending, Monroe County remains responsible for overseeing business operations at the county-owned  senior living and rehabilitation center in Waterloo. 

Unfortunately, Oak Hill is still “treading water” financially, Monroe County Treasurer Kevin Koenigstein told commissioners on Monday.

During the most recent meeting of the Monroe County Board, Koenigstein delivered a financial report of county operations through the third quarter of the current fiscal year. 

Koenigstein reported Oak Hill is not projected to end the year in the red, but only due to $350,000 in county taxpayer support levied at the beginning of the year – $245,000 of which was used to make the facility’s final construction bond payment in January.

As of Aug. 31, Oak Hill’s skilled nursing operations are shown at a loss of just over $420,000.

That figure is offset by $380,000 of revenue generated by Oak Hill’s Magnolia Terrace senior living apartments and Evergreen Pointe rehabilitation center, lessening the operating deficit to $39,798.

A net gain in non-operating revenue minus expenses – which includes the county tax contribution – brings the total net income for all Oak Hill operations up to $119,776 through the third quarter of Fiscal Year 2025.   

A projected decrease in revenue of just under $800,000 in FY25 compared FY24 is due mostly to a stoppage of  Medicaid  payments this summer.

Monroe County Clerk Jonathan McLean pointed out the facility has not received two months of Medicare payments.

It was discovered that a required report was not submitted to the Centers for Medicare & Medicaid Services which led to a suspension of Oak Hill’s validation as a Medicaid-eligible provider.

McLean later told the Republic-Times that Oak Hill was unable to collect Medicaid payments or admit Medicaid patients in June or July, although the issue has since been addressed and Medicaid reimbursements have started to come in recently.

He also said the facility is just now billing Medicare to request June, July and August reimbursements. 

During Monday’s meeting, McLean said county officials have begun to “triple check” Oak Hill financial reports.

“We’re losing lots of money,” McLean said, adding the facility’s use of “best practices (had) dropped off.”

Koenigstein also reported financial reserves from prior year Oak Hill profits is dwindling.

The facility currently has about $1 million in cash and $1 million in a certificate of deposit account.

“That’s it,” Koenigstein said of Oak Hill’s liquid assets. “Let’s hope this is the bottom.”

He reminded commissioners Oak Hill “made money” in the 2010s, but the facility has not been able to maintain profitability – and even lost money – in the past four to five years. 

Early last month, commissioners announced intentions to lease Oak Hill operations to Accolade Healthcare.

A copy of the lease agreement has been requested during the past two county board meetings. 

Monroe County State’s Attorney Ryan Webb explained Monday the draft is not publicly available because it is still in draft form. 

During an Aug. 26 special meeting which approved Monroe County Board Chairman George Green to authorize the finalized lease, the lease was expected to be in place Oct. 1.

A few setbacks – including potential fallout from the Medicaid validation issue – have pushed the expected takeover date to Dec. 1, McLean told the Republic-Times on Tuesday.

Another delay is due to the special meeting to approve lease authorization being rescheduled two weeks after the original Aug. 11 date.

Furthermore, a hearing to record public comment on the matter has been scheduled for 4 p.m. Oct. 8 at the Monroe County Annex in Waterloo.

McLean said this hearing was scheduled following a request by a county resident.

He added the hearing is not a special meeting of the Monroe County Board, but is only to officially record public comment to be entered into the record for consideration by the Illinois Health Facilities and Services Review Board.

County commissioners are not required to attend the hearing.

McLean also pointed out the health facilities board does not have any discretion over whether or not the lease is approved. Rather, the board is tasked with “perfunctory” matters of ensuring Accolade meets requirements to assume control of Oak Hill operations.

A public notice of the hearing may be found on page 2C of this week’s Republic-Times.

The notice describes “an application for change of ownership of Oak Hill Senior Living & Rehabilitation Center.”

McLean said the word “ownership” is a misnomer, as Accolade will only be leasing the property and business operations for a five-year period once the current lease is finalized. 

If a referendum question to sell Oak Hill passes at the end of the lease term, McLean said another set of hearings and application to the state health facilities review board would be needed.

In other business, Monroe County Engineer Aaron Metzger discussed the upcoming Rogers Street Extension in Waterloo.

Metzger explained that a “consistent” ordinance governing ingress and egress restrictions for the extension would need to be officially adopted before he can begin right-of-way acquisition.

In July, commissioners approved a zoning amendment to allow a single access point to parcels along the current Rogers Street zoned A1 or A2 agricultural if the lots are a minimum of five acres with at least 330 feet of frontage along Rogers Street.

The amendment was made after property owner Steve Wilke requested permission to construct a driveway to the property where he plans to build his personal residence. 

Wilke cited a 2004 ruling in Monroe County Court which allowed an ingress on that parcel specifically.

That property was also brought up Monday during a presentation by Monroe County Geographic Information Systems Coordinator Brad Hausmann, who proposed a change in how the county manages its GIS data.

Hausmann explained the county is currently only tapping in to a “fraction” of the potential capabilities and applications of ArcGIS.

He explained that ArcGIS Enterprise, an updated version of the county’s current computer-based GIS program, is the standard for most local governing bodies in the region.

Switching to Enterprise would benefit other county departments besides the county clerk’s office, including the assessor’s office, 911 operations, the county health department,  zoning and public works as well as county municipalities and organizations such as Heartland Conservancy.

The cloud-based system would be more user friendly, allow multiple users to enter data simultaneously and record information in “almost real time.”

The only issue is money. 

While the county’s GIS system is currently self-sufficient, using a specific GIS recording fee as its funding mechanism, the update to Enterprise would add about $76,000 to its budget line.

McLean noted “we don’t really have a choice” in adopting the new system, adding other departments that rely on county GIS information would be asked to contribute funds to cover the shortfall.

While no action was taken Monday, Commissioner Vicki Koerber told Hausmann he “just cut about 45 minutes” from the county clerk’s budget hearing time by presenting the information on Monday.

Also during the meeting, Koenigstein reminded owners of taxable parcels in Monroe County the first installment of property tax payments is due this Friday, Sept. 19.

The second installment is due Nov. 14. 

Residents may pay their entire tax bill in their first installment and prior to the due date, if they wish. 

County taxpayers may also pay bills online at monroecountyil.gov.

Those who do so are urged to use the “e-check” direct debit payment, which carries a $2 charge, rather than a credit card payment, which carries a fee of 2.35 percent of the total tax bill.

The next meeting of the Monroe County Board is scheduled for Oct. 6, beginning at 8:15 a.m. at the Monroe County Courthouse.