2019-05-13T15:36:05-05:00 2018-06-30 990 2017-07-01 362379649 GOTTLIEB MEMORIAL HOSPITAL GOTT 7086813200 701 W NORTH AVE MELROSE PARK IL 60160 DANIEL ISACKSEN CFO 7086813200 2019-05-13 170.232.227.252 2019-05-13 15:35:56 ED P 943C2B779621AE68CF3E0BED5C235FDF89DF7949 931FD144836D950546B27D5795367136474FF98E 2017 2019-02-21 02:37:17Z LORI PRICE 701 W NORTH AVE MELROSE PARK IL 60160 151466474 0 X WWW.GOTTLIEBHOSPITAL.ORG X 1956 IL TO PROVIDE HEALTH CARE AND HOSPITAL SERVICES 13 6 1199 112 15749 -9972 132674 15843057 130097606 130381857 486579 1432188 4116096 2407723 134832955 150064825 0 12500 0 0 60019378 56856348 0 0 0 72956517 74888087 132975895 131756935 1857060 18307890 190834194 233553969 95465032 122045574 95369162 111508395 X WE, LOYOLA UNIVERSITY HEALTH SYSTEM AND TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES.GOTTLIEB MEMORIAL HOSPITAL IS A MEMBER OF LOYOLA UNIVERSITY HEALTH SYSTEM AND TRINITY HEALTH. 0 0 125473800 12500 132011255 FOUNDED IN 1961, GOTTLIEB MEMORIAL HOSPITAL (GMH), LOCATED IN MELROSE PARK, ILLINOIS, IS A 254 BED ACUTE CARE NOT-FOR-PROFIT, COMMUNITY HOSPITAL THAT OFFERS EMERGENCY, INPATIENT AND OUTPATIENT MEDICAL SERVICES. GMH, WHICH IS PART OF LOYOLA UNIVERSITY HEALTH SYSTEM, PROVIDES VITAL HEALTH CARE SERVICES 24 HOURS A DAY, SEVEN DAYS A WEEK, TO PATIENTS IN VARIOUS SETTINGS INCLUDING CARDIOVASCULAR /THORACIC, OBSTETRICS, ORTHOPAEDICS, MEDICAL IMAGING, GASTROENTEROLOGY, UROLOGY, HOME CARE AND HOSPICE, TRANSITIONAL CARE, AND ADULT DAY CARE SERVICES. THE HOSPITAL CAMPUS INCLUDES AN EMERGENCY DEPT. AND LEVEL II TRAUMA CENTER WITH HELIPORT, WOUND CARE AND HYPERBARIC MEDICINE CENTER, SLEEP LAB AND DIAGNOSTIC CENTER, BIRTH CENTER, AND THE MARJORIE G. WEINBERG CANCER CENTER.DURING FISCAL YEAR 2018, GMH PROVIDED OVER 41,000 DAYS OF HEALTH CARE SERVICES AND OVER 59,000 OUTPATIENT VISITS TO THE COMMUNITY.PLEASE VISIT SCHEDULE H AND OUR WEBSITE FOR ADDITIONAL INFORMATION ABOUT OUR SERVICES, RECOGNITIONS AND AWARDS: HTTP://WWW.GOTTLIEBHOSPITAL.ORG/ 125473800 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 165 0 1 1199 1 1 1 0 0 0 0 1 1 0 0 0 0 X 13 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 IL NC X DANIEL ISACKSEN 7082164253 2160 SOUTH FIRST AVENUE MAYWOOD IL 601533328 ROGER SPOELMAN DIRECTOR; INT PRES & CEO AS OF 4/18 10.00 45.00 X X 0 993383 48564 LARRY GOLDBERG DIRECTOR, PRESIDENT & CEO THR 3/18 10.00 45.00 X X 0 1615151 28733 MARC SCHWARTZ DIRECTOR; CHAIR 2.00 4.00 X X 0 0 0 BENJAMIN CARTER DIRECTOR AT 1/18; TRINITY EVP, CFO 2.00 53.00 X 0 1622886 50779 JOY CUNNINGHAM DIRECTOR 2.00 4.00 X 0 0 0 OMAR DUQUE DIRECTOR 2.00 4.00 X 0 0 0 STEVE AN GOLDSTEIN MD DIRECTOR AS OF 7/17; PROFESSOR 2.00 4.00 X 0 618 602 LORI HEALEY DIRECTOR 2.00 4.00 X 0 0 0 SALLY JEFFCOAT DIR THR 12/17; EVP TRINITY HEALTH 2.00 53.00 X 0 1517657 43445 SCOTT MIROWITZ MD DIRECTOR AS OF 1/18; PROFESSOR 2.00 48.00 X 0 608656 21229 JUAN MORENO DIRECTOR 2.00 4.00 X 0 0 0 THE VERY REV JOHN O'CALLAGHAN DIRECTOR 2.00 4.00 X 0 0 0 RONALD POTKUL MD DIRECTOR; LUMC PHYSICIAN 2.00 48.00 X 0 762061 43711 BRIAN PROCTOR DO DIRECTOR; GMH COMMITTEE CHAIR 8.00 4.00 X 25000 0 0 WILLIAM SMALL MD DIRECTOR; PROFESSOR 2.00 48.00 X 0 609260 33324 JOAN MARIE STEADMAN CSC DIRECTOR THROUGH 10/17 2.00 4.00 X 0 0 0 KEITH VESELIK MD DIRECTOR THR 12/17; MEDICAL DIRECTOR 2.00 48.00 X 0 363553 41906 LORI PRICE PRESIDENT GMH 53.00 2.00 X 0 631343 47049 BLAINE PETERSEN TREASURER; EVP & REGIONAL CFO 13.00 42.00 X 0 798148 38275 DANIEL ISACKSEN ASSISTANT TREASURER; VP FINANCE 10.00 40.00 X 0 415350 32595 JILL RAPPIS SECRETARY; SVP LEGAL & GENL COUNSEL 2.00 48.00 X 0 438865 63302 MARIA PEKAR ASSISTANT SEC.; ASSOC GENL CNSL 2.00 48.00 X 0 276190 62235 DAVID HECHT MD MS MBA EVP, CLINICAL AFFAIRS 15.00 40.00 X 0 762010 29857 BERNARD GAWNE JR CHIEF MEDICAL OFFICER 50.00 0.00 X 368514 0 31182 GINGER HOOK VP CHIEF NURSE OFFICER 50.00 0.00 X 262330 0 32701 EWA BOGACZ CRITICAL CARE RN 50.00 0.00 X 169814 0 13318 ELIZABETH MCLAIN CRITICAL CARE RN 50.00 0.00 X 167353 0 18691 SANDRA SWANSON ADMIN DIR PERIOP/PERINATAL SVCS 50.00 0.00 X 157837 0 54213 JOE VADAKARA DIRECTOR OF PHARMACY 50.00 0.00 X 149329 0 20289 RICHARD O'CONNELL FORMER KEY EMPLOYEE 0.00 0.00 X 0 880863 16625 DONNA HALINSKI FORMER OFFICER; VP CLINICAL AFFRS 0.00 50.00 X 0 318183 77872 AJAY SIAL FORMER OFFICER 0.00 0.00 X 0 278567 10666 ELLYN CHIN FORMER OFFICER; VP PAYOR STRATEGIES 0.00 50.00 X 0 328585 52425 ALAN GOLDBERG FORMER KEY EMPLOYEE 0.00 0.00 X 219965 0 31262 1520142 13221329 944850 50 1 1 0 ENCOMPASS PHYSICIANS LLC 1121 LAKE COOK RD SUITE M DEERFIELD IL 60015 MEDICAL SERVICES 1928863 MIDWEST ANES HBRJ LLC 40 SHUMAN BLVD NAPERVILLE IL 60563 MEDICAL SERVICES 1191200 GEORGE SOLLITT CONSTRUCTION CO 790 N CENTRAL AVE WOODDALE IL 60191 CONSTRUCTION SERVICES 1044598 ANGELICA CORPORATION PO BOX 846777 LOS ANGELES CA 90084 LAUNDRY/LINEN SERVICES 847240 SELECT REHABILITATION 2600 COMPASS RD GLENVIEW IL 60026 MEDICAL SERVICES 828744 33 17820 15800000 25237 15843057 NET PATIENT SERVICE REVENUE 622110 128382652 128382652 LABORATORY REVENUE 621500 1999205 1989301 9904 130381857 672192 672192 1800310 1263445 536865 536865 536865 756996 3000 0 0 756996 3000 759996 759996 81200 17820 89592 -8392 -8392 85282 48612 36670 36670 INTERCOMPANY REVENUE 622110 641633 641633 CAFETERIA REVENUE 722514 197433 197433 PROFESSIONAL SERVICE AGREEEMENT R 622110 29977 29977 973537 967692 5845 1842580 150064825 132011255 15749 2194764 12500 12500 1103087 25000 1078087 251227 251227 48337919 46066326 2271593 136618 136618 3415149 3266831 148318 3612348 3357981 254367 43135 43135 6640 6640 56897 56897 10533553 10112721 420832 161315 149956 11359 1436407 1335261 101146 477971 444314 33657 3622976 3367861 255115 45449 42249 3200 101819 94649 7170 630677 630677 9871145 9176059 695086 2732150 2539763 192387 MEDICAL SUPPLIES 19756109 19756109 BAD DEBT 12900766 12900766 HOSPITAL PROVIDER TAX 6079021 6079021 EQUIPMENT MAINTENANCE 3132968 2912357 220611 3299089 3066781 232308 131756935 125473800 6283135 0 6504935 281452 442675 3794121 10182013 18845900 16126105 371078 719754 3397000 3127000 123409 271800 133270930 57675378 82204884 75595552 10340575 34534873 9102326 22046923 59501412 66874376 190834194 233553969 24539370 21968140 17541 4320 238811 302415 70669310 99770699 95465032 122045574 X 94926487 95887279 442675 15621116 95369162 111508395 190834194 233553969 X 18307890 74818 -2243475 X X 0 1 X 1 1 1 X 0 0 0 0 0 1 2320 0 0 0 2320 0 PART II-B, LINE 1: GOTTLIEB MEMORIAL HOSPITAL HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES. THESE GRANTS HAVE BEEN IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS, WHERE THE ORGANIZATIONS HAVE PROVIDED GOTTLIEB MEMORIAL HOSPITAL WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. 12500000 12500000 71932150 28227633 43704517 46829553 29447745 17381808 2009227 2009227 75595552 COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 7914280 F HEDGE FUNDS 4522446 F EQUITY METHOD INVESTMENTS 9610197 C 22046923 INTERCOMPANY RECEIVABLES 65481621 MISCELLANEOUS RECEIVABLES 974788 INVESTMENT IN UNCONSOLIDATED AFFILIATES 105000 OTHER CURRENT ASSETS 312967 66874376 INTERCOMPANY PAYABLES 80297723 LONG-TERM ASSET RETIREMENT OBLIGATION (FIN 47) 507385 OTHER CURRENT LIABILITIES 171678 OTHER LONG-TERM LIABILITIES 1324623 INTERCOMPANY NOTES PAYABLE 14740418 DEFERRED COMPENSATION LIABILITY 51223 INTERCOMPANY OTHER LIABILITIES 2677649 99770699 GALA 99020 17820 81200 70470 15100 4022 99020 17820 81200 70470 15100 4022 89592 -8392 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 1120188 1120188 0.00940 23866248 15387049 8479199 0.07130 24986436 15387049 9599387 0.08070 10 4007 238757 238757 0.00200 3 30 391767 391767 0.00330 5 855 145738 145738 0.00120 18 4892 776262 776262 0.00650 18 4892 25762698 15387049 10375649 0.08720 1 1 6454 6454 0.00010 1 1 6454 6454 0.00010 1 12900766 0 46561276 45658253 903023 X 1 1 1 GOTTLIEB WEST TOWNS PHO MEDICAL CONTRACT SERVICES 0.50000 0.00000 0.50000 1 1 GOTTLIEB MEMORIAL HOSPITAL 701 W NORTH AVE MELROSE PARK IL 60160 WWW.GOTTLIEBHOSPITAL.ORG 0005793 X X X INCLUDING OUTPATIENT SERVICES GOTTLIEB MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X SEE SCHEDULE H, PART V, SECTION C X X 1 15 1 SEE SCHEDULE H, PART V, SECTION C 0 1 X 200.000000000000 600.000000000000 X X X X X X 1 1 X X X 1 X SEE PART V X SEE PART V X SEE PART V X X X X X X 1 X 0 X X X X 1 X 0 0 GOTTLIEB MEMORIAL HOSPITAL PART V, SECTION B, LINE 3J: N/ALINE 3E: GOTTLIEB MEMORIAL HOSPITAL INCLUDED IN ITS CHNA WRITTEN REPORT A PRIORITIZED LIST AND DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGH THE MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT. THE FOLLOWING COMMUNITY HEALTH NEEDS WERE DEEMED SIGNIFICANT AND WERE PRIORITIZED FOR TAX YEAR 2017 THROUGH A COMMUNITY-INVOLVED SELECTION PROCESS: 1) IMPROVING SOCIAL, ECONOMIC, AND STRUCTURAL DETERMINANTS OF HEALTH, WHILE REDUCING SOCIAL AND ECONOMIC INEQUITIES; 2) IMPROVING MENTAL HEALTH AND DECREASING SUBSTANCE ABUSE3) PREVENTING AND REDUCING CHRONIC DISEASE, WITH A FOCUS ON RISK FACTORS - NUTRITION, PHYSICAL ACTIVITY AND TOBACCO; AND 4) INCREASING ACCESS TO CARE AND COMMUNITY SERVICES. GOTTLIEB MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: BEGINNING IN MARCH 2015, GOTTLIEB MEMORIAL HOSPITAL (GMH), A MEMBER OF LOYOLA UNIVERSITY HEALTH SYSTEM (LUHS), PARTICIPATED IN A COLLABORATIVE OF HOSPITALS IN CHICAGO AND SUBURBAN COOK COUNTY TO CONDUCT THEIR COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). KNOWN AS THE HEALTH IMPACT COLLABORATIVE OF COOK COUNTY (HICC), HOSPITALS, COMMUNITY ORGANIZATIONS AND PUBLIC HEALTH DEPARTMENTS COLLABORATIVELY GATHERED DATA AND INPUT THROUGH A COMMUNITY SURVEY AND A SERIES OF FOCUS GROUPS. THE ILLINOIS PUBLIC HEALTH INSTITUTE (IPHI) SERVED AS THE PROCESS FACILITATOR AND BACKBONE ORGANIZATION FOR THE COLLABORATIVE CHNA AND IMPLEMENTATION PLANNING PROCESS. IPHI AND PARTNERS WORKED TOGETHER TO DESIGN A SHARED LEADERSHIP MODEL AND COLLABORATIVE INFRASTRUCTURE TO SUPPORT COMMUNITY-ENGAGED PLANNING, PARTNERSHIPS, AND STRATEGIC ALIGNMENT OF IMPLEMENTATION, WHICH WILL FACILITATE MORE EFFECTIVE AND SUSTAINABLE COMMUNITY HEALTH IMPROVEMENT IN THE FUTURE. THE COLLABORATIVE DIVIDED COOK COUNTY INTO THREE REGIONS, OF WHICH THE GMH CHNA (WEST SUBURBAN COOK COUNTY) WAS INCLUDED WITHIN THE CENTRAL REGION. SEVEN NONPROFIT HOSPITALS, ONE PUBLIC HOSPITAL, THREE HEALTH DEPARTMENTS, AND APPROXIMATELY 30 COMMUNITY STAKEHOLDERS PARTNERED ON THE CHNA FOR THE CENTRAL REGION. HEALTH DEPARTMENTS WERE KEY PARTNERS IN LEADING THE COLLABORATIVE AND CONDUCTING THE CHNA. THE PARTICIPATING HEALTH DEPARTMENTS IN THE CENTRAL REGION WERE THE CHICAGO DEPARTMENT OF PUBLIC HEALTH, COOK COUNTY DEPARTMENT OF PUBLIC HEALTH, AND OAK PARK DEPARTMENT OF PUBLIC HEALTH. THE HICC IS FOCUSED ON COMMUNITY-ENGAGED ASSESSMENT, PLANNING, AND IMPLEMENTATION. STAKEHOLDERS AND COMMUNITY PARTNERS WERE INVOLVED IN MULTIPLE WAYS THROUGHOUT THE ASSESSMENT PROCESS, BOTH IN TERMS OF COMMUNITY INPUT DATA AND AS DECISION-MAKING PARTNERS. AVENUES FOR ENGAGEMENT IN THE CENTRAL REGION CHNA INCLUDED: STAKEHOLDER ADVISORY TEAM, HOSPITALS' COMMUNITY ADVISORY GROUPS, DATA COLLECTION (COMMUNITY INPUT THROUGH SURVEY AND FOCUS GROUPS), AND ACTION PLANNING FOR STRATEGIC PRIORITIES (STARTED IN SUMMER 2016). BETWEEN MARCH AND MAY 2016, IPHI WORKED WITH THE PARTICIPATING HOSPITALS AND HEALTH DEPARTMENTS IN THE CENTRAL REGION OF COOK COUNTY (I.E., CENTRAL LEADERSHIP TEAM) TO IDENTIFY AND INVITE COMMUNITY STAKEHOLDERS TO PARTICIPATE AS MEMBERS OF THE STAKEHOLDER ADVISORY TEAM. THE STAKEHOLDER ADVISORY TEAM MEMBERS BROUGHT DIVERSE PERSPECTIVES AND EXPERTISE, AND REPRESENTED POPULATIONS AFFECTED BY HEALTH INEQUITIES INCLUDING DIVERSE RACIAL AND ETHNIC GROUPS, IMMIGRANTS AND REFUGEES, OLDER ADULTS, YOUTH, HOMELESS INDIVIDUALS, UNEMPLOYED, UNINSURED, AND VETERANS. THE CENTRAL STAKEHOLDER ADVISORY TEAM INCLUDED REPRESENTATIVES OF DIVERSE COMMUNITY ORGANIZATIONS FROM ACROSS THE WEST SIDE OF CHICAGO AND WEST COOK SUBURBS. THE ORGANIZATIONS REPRESENTED ON THE CENTRAL STAKEHOLDER ADVISORY TEAM INCLUDED: AGE OPTIONS, AGING CARE CONNECTIONS, AMERICAN CANCER SOCIETY, CASA CENTRAL, CATHOLIC CHARITIES, CHICAGO POLICE DEPARTMENT - 14TH DISTRICT, CHICAGO PUBLIC SCHOOLS, COMMUNITYHEALTH, DIABETES EMPOWERMENT CENTER, HEALTHCARE ALTERNATIVES SYSTEMS, HOUSING FORWARD, INFANT WELFARE-OAK PARK/THE CHILDREN'S CLINIC, INTERFAITH LEADERSHIP PROJECT, LOYOLA UNIVERSITY STRITCH SCHOOL OF MEDICINE, METROPOLITAN PLANNING COUNCIL, MILE SQUARE HEALTH CENTER, PCC WELLNESS, PROVISO LEYDEN COUNCIL FOR COMMUNITY ACTION (PLCC), PROVISO TOWNSHIP MENTAL HEALTH COMMISSION, RESPIRATORY HEALTH ASSOCIATION, SAINT ANTHONY'S HOSPITAL, WEST 40 INTERMEDIATE SERVICE CENTER, WEST COOK YMCA, WEST HUMBOLDT PARK DEVELOPMENT COUNCIL, WEST SIDE HEALTH AUTHORITY, AND WICKER PARK BUCKTOWN CHAMBER OF COMMERCE. MEMBERS OF THE STAKEHOLDER ADVISORY TEAM WERE VERY IMPORTANT PARTNERS IN THE CHNA AND IMPLEMENTATION PLANNING PROCESS AND CONTRIBUTED IN SOME OF THE FOLLOWING WAYS: PARTICIPATED IN A SERIES OF 8-10 MEETINGS BETWEEN MAY 2015 AND AUGUST 2016; PROVIDED INPUT ON ASSESSMENT DESIGN, INCLUDING DATA INDICATORS, SURVEYS, FOCUS GROUPS, AND ASSET MAPPING; FACILITATED THE PARTICIPATION OF COMMUNITY MEMBERS TO PROVIDE INPUT THROUGH SURVEYS AND FOCUS GROUPS; REVIEWED ASSESSMENT DATA, ASSISTED WITH DEVELOPING FINDINGS, AND IDENTIFIED PRIORITY STRATEGIC ISSUES; AND JOINED AN ACTION TEAM TO HELP SHAPE IMPLEMENTATION STRATEGIES. THE HICC ORGANIZED 23 FOCUS GROUPS THROUGHOUT CHICAGO AND SUBURBAN COOK COUNTY BETWEEN OCTOBER 2015 AND MARCH 2016, INCLUDING SEVEN FOCUS GROUPS IN THE CENTRAL REGION. THE GOAL OF THE FOCUS GROUPS WAS TO UNDERSTAND THE NEEDS, ASSETS, AND POTENTIAL RESOURCES IN VARIOUS COMMUNITIES OF CHICAGO AND SUBURBAN COOK COUNTY AND TO GATHER IDEAS ABOUT HOW HOSPITALS CAN PARTNER WITH COMMUNITIES TO IMPROVE HEALTH. THE FOCUS GROUP FINDINGS WERE AN INTEGRAL COMPONENT OF DATA IN THE CHNA, AND THE HOSPITALS AND THEIR PARTNERS IN THE HICC FOCUSED ON HEARING FROM COMMUNITY REPRESENTATIVES WHO HAVE DIRECT KNOWLEDGE AND EXPERIENCE RELATED TO THE HEALTH INEQUITIES IN OUR REGION. MEMBERS OF THE REGIONAL LEADERSHIP TEAM AND STAKEHOLDER ADVISORY TEAM HOSTED THE FOCUS GROUPS AND RECRUITED FOCUS GROUP PARTICIPANTS, WITH AN INTENTIONAL APPROACH TO INCLUDE A DIVERSE RANGE OF COMMUNITIES AND SERVICE PROVIDERS. RECRUITERS SPECIFICALLY SOUGHT OUT PARTICIPANTS WHO BELONG TO OR INTERACT WITH POPULATIONS SUCH AS RACIAL OR ETHNIC MINORITIES, IMMIGRANTS, LIMITED ENGLISH SPEAKERS, LOW-INCOME COMMUNITIES, FAMILIES WITH CHILDREN, FORMERLY INCARCERATED INDIVIDUALS, VETERANS, SENIORS, AND YOUNG ADULTS. HOST ORGANIZATIONS INCLUDED: CASA CENTRAL, CATHOLIC CHARITIES, HOUSING FORWARD, NATIONAL ALLIANCE FOR THE EMPOWERMENT OF THE FORMERLY INCARCERATED (NAEFI), NORWEGIAN AMERICAN HOSPITAL, PRESENCE SAINT MARY AND ELIZABETH CENTER, AND QUINN COMMUNITY CENTER. ADDITIONALLY, BY LEVERAGING ITS PARTNERS AND NETWORKS, THE COLLABORATIVE COLLECTED APPROXIMATELY 5,200 RESIDENT SURVEYS BETWEEN OCTOBER 2015 AND JANUARY 2016, INCLUDING 1,200 IN THE CENTRAL REGION. THE SURVEY WAS AVAILABLE ON PAPER AND ONLINE AND WAS DISSEMINATED IN FIVE LANGUAGES - ENGLISH, SPANISH, POLISH, KOREAN, AND ARABIC.LUHS CONTINUED ITS MEMBERSHIP AND PARTICIPATION ON THE STEERING COMMITTEE OF HICC. THE STEERING COMMITTEE IDENTIFIES OPPORTUNITIES AND COLLABORATIVE EFFORTS TO ADDRESS THE FOCUS AREAS DEVELOPED THROUGH THE CHNA PROCESS. GOTTLIEB MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: OTHER HOSPITALS THAT PARTICIPATED IN THE CHNA INCLUDED LOYOLA UNIVERSITY MEDICAL CENTER (LUMC), NORWEGIAN AMERICAN HOSPITAL, PRESENCE SAINT MARY AND ELIZABETH MEDICAL CENTER, RML SPECIALTY HOSPITALS, RUSH (INCLUDING RUSH UNIVERSITY MEDICAL CENTER AND RUSH OAK PARK), AND STROGER HOSPITAL OF COOK COUNTY. GOTTLIEB MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: ORGANIZATIONS, OTHER THAN HOSPITAL FACILITIES, THAT PARTICIPATED IN THE CHNA INCLUDED AGE OPTIONS, AGING CARE CONNECTIONS, AMERICAN CANCER SOCIETY, CASA CENTRAL, CATHOLIC CHARITIES, CHICAGO POLICE DEPARTMENT - 14TH DISTRICT, CHICAGO PUBLIC SCHOOLS, COMMUNITYHEALTH, DIABETES EMPOWERMENT CENTER, HEALTHCARE ALTERNATIVES SYSTEMS, HOUSING FORWARD, INFANT WELFARE-OAK PARK/THE CHILDREN'S CLINIC, INTERFAITH LEADERSHIP PROJECT, LOYOLA UNIVERSITY STRITCH SCHOOL OF MEDICINE, METROPOLITAN PLANNING COUNCIL, MILE SQUARE HEALTH CENTER, PCC WELLNESS, PROVISO LEYDEN COUNCIL FOR COMMUNITY ACTION (PLCC), PROVISO TOWNSHIP MENTAL HEALTH COMMISSION, RESPIRATORY HEALTH ASSOCIATION, SAINT ANTHONY'S HOSPITAL, WEST 40 INTERMEDIATE SERVICE CENTER, WEST COOK YMCA, WEST HUMBOLDT PARK DEVELOPMENT COUNCIL, WEST SIDE HEALTH AUTHORITY, WICKER PARK BUCKTOWN CHAMBER OF COMMERCE. GOTTLIEB MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: IN ADDITION TO MAKING THE CHNA AVAILABLE AT THE HOSPITAL AND ON THE WEBSITE, COPIES OF THE CHNA WERE EMAILED TO ALL STEERING COMMITTEE MEMBERS. GOTTLIEB MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: BASED ON THE DATA AND FEEDBACK GATHERED THROUGH THE CHNA PROCESS, THE HICC CAME TO A CONSENSUS ON FOUR FOCUS AREAS THAT IMPACT ALL THREE REGIONS IN COOK COUNTY: 1) IMPROVING SOCIAL, ECONOMIC, AND STRUCTURAL DETERMINANTS OF HEALTH, WHILE REDUCING SOCIAL AND ECONOMIC INEQUITIES; 2) IMPROVING MENTAL HEALTH AND DECREASING SUBSTANCE ABUSE; 3) PREVENTING AND REDUCING CHRONIC DISEASE, WITH A FOCUS ON RISK FACTORS - NUTRITION, PHYSICAL ACTIVITY AND TOBACCO; AND 4) INCREASING ACCESS TO CARE AND COMMUNITY SERVICES. THE RECOMMENDATION OF THE COLLABORATIVE IS THAT ALL PARTICIPATING HOSPITALS INCLUDE FOCUS AREA #1 AS A PRIORITY WITHIN THEIR SPECIFIC CHNA AREA. AFTER REVIEW AND CONSULTATION WITH ITS COMMUNITY PARTNERS, GMH IS COMMITTED TO WORKING TO DEVELOP STRATEGIES AND PROGRAMS THAT WILL ADDRESS FOCUS SOCIAL AND STRUCTURAL DETERMINANTS OF HEALTH, CHRONIC DISEASE PREVENTION, AND ACCESS TO CARE. THROUGH COLLABORATION WITH ITS COMMUNITY PARTNERS AS WELL AS OTHER HEALTH PROVIDERS, GMH HAS SUPPORTED INITIATIVES THAT ADDRESS THE UNDERLYING ISSUES THAT CUT ACROSS THESE FOCUS AREAS. THESE INITIATIVES INCLUDED, DURING FY18, OFFERING A DEDICATED SPECIALTY CARE CLINIC FOR THE OVERWEIGHT OR OBESE CHILDREN, OFFERING A PEDIATRIC WEIGHT MANAGEMENT PROGRAM FOR DISADVANTAGED CHILDREN, AND CONDUCTING VARIOUS HEALTH SCREENINGS AND COMMUNITY COALITION OUTREACH ACTIVITIES.IN ORDER TO INCREASE ACCESS TO CARE, GMH PROVIDED TRANSPORTATION VAN SERVICE FOR THOSE WITH NO MEANS OF TRANSPORT TO HOSPITAL DIAGNOSTIC TESTING OR ANCILLARY SERVICES. GMH ALSO PROVIDED FREE VISION AND HEARING SCREENING FOR SCHOOLCHILDREN IN THE GMH SERVICE AREA, SPECIFICALLY IN MELROSE PARK. TO SUPPORT PERSONS LIVING WITH CHRONIC DISEASE, GMH ALSO LEADS SEVERAL FREE SUPPORT GROUPS FOR CARE GIVERS OF PERSONS LIVING WITH CHRONIC ILLNESS. FINALLY, REGARDING IMPROVING SOCIAL DETERMINANTS OF HEALTH, GMH CONTINUED TO ACTIVELY SUPPORT PROVISO PARTNERS FOR HEALTH (PP4H), A MULTI-SECTOR, COMMUNITY DRIVEN COALITION OF MORE THAN 25 LOCAL COMMUNITY GROUPS AND ORGANIZATIONS FOCUSED ON CREATING ENVIRONMENTS THAT PROMOTE HEALTHY LIFESTYLES. GMH LEADERS ACTIVELY PARTICIPATED ON PLANNING COMMITTEES TO IDENTIFY AND IMPLEMENT STRATEGIES TO IMPROVE CHILDHOOD NUTRITION, ACCESS TO HEALTHY FOOD, TOBACCO-FREE LIVING, AND THE BUILT ENVIRONMENT TO SUPPORT HEALTH AND WELL-BEING.GMH ACKNOWLEDGES THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS AND DETERMINED THAT IT COULD EFFECTIVELY FOCUS ON ONLY THOSE HEALTH NEEDS WHICH IT DEEMED MOST PRESSING, UNDER-ADDRESSED AND WITHIN ITS ABILITY TO INFLUENCE. GMH WILL NOT ALLOCATE SIGNIFICANT RESOURCES TO ADDRESS MENTAL AND SUBSTANCE ABUSE ISSUES DUE TO LIMITED PROGRAMS AND RESOURCES. GMH WILL CONTINUE TO WORK WITH AREA PROVIDERS AND SUPPORT INITIATIVES DEVELOPED BY THE HICC AS APPROPRIATE TO GMH'S MISSION AND RESOURCES. GOTTLIEB MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTH CARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS. GOTTLIEB MEMORIAL HOSPITAL - PART V, SECTION B, LINE 7A: HTTPS://WWW.LOYOLAMEDICINE.ORG/ABOUT-LOYOLA/COMMUNITY-BENEFIT GOTTLIEB MEMORIAL HOSPITAL - PART V, SECTION B, LINE 9: AS PERMITTED IN THE FINAL SECTION 501(R) REGULATIONS, THE HOSPITAL'S IMPLEMENTATION STRATEGY WAS ADOPTED WITHIN 4 1/2 MONTHS AFTER THE FISCAL YEAR END THAT THE CHNA WAS COMPLETED AND MADE WIDELY AVAILABLE TO THE PUBLIC. GOTTLIEB MEMORIAL HOSPITAL - PART V, SECTION B, LINE 10A: HTTPS://WWW.LOYOLAMEDICINE.ORG/ABOUT-LOYOLA/COMMUNITY-BENEFIT GOTTLIEB MEMORIAL HOSPITAL - PART V, SECTION B, LINE 16A: HTTPS://WWW.LOYOLAMEDICINE.ORG/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE-AND-CHARITY-CARE-POLICY GOTTLIEB MEMORIAL HOSPITAL - PART V, SECTION B, LINE 16B: HTTPS://WWW.LOYOLAMEDICINE.ORG/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE-AND-CHARITY-CARE-POLICY GOTTLIEB MEMORIAL HOSPITAL - PART V, SECTION B, LINE 16C: HTTPS://WWW.LOYOLAMEDICINE.ORG/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE-AND-CHARITY-CARE-POLICY 2 1 - GOTTLIEB HOME HEALTH & HOSPICE 905 W NORTH AVE MELROSE PARK IL 60160 HOME HEALTH AND HOSPICE PROGRAM 2 - GOTTLIEB ADULT DAY CARE CENTER 555 W NORTH AVE MELROSE PARK IL 60160 ADULT DAY CARE CENTER PART I, LINE 3C: IN ADDITION TO LOOKING AT A MULTIPLE OF THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS ARE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS. PART I, LINE 6A: GOTTLIEB MEMORIAL HOSPITAL (GMH) PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT, WHICH IT SUBMITS TO THE STATE OF ILLINOIS. IN ADDITION, GMH REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH (EIN 35-1443425) IN ITS AUDITED FINANCIAL STATEMENTS, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.GOTTLIEB MEMORIAL HOSPITAL ALSO INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM. PART I, LN 7 COL(F): THE FOLLOWING NUMBER, $12,900,766, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F). PART II, COMMUNITY BUILDING ACTIVITIES: IN FY18, THE GMH SECURITY AND PARKING STAFF CONDUCTED AN ACTIVE SHOOTER TRAINING DRILL ON THE CAMPUS OF GMH. THE DRILL WAS DESIGNED TO TRAIN AND EDUCATE SECURITY AND OTHER PERSONNEL IN RESPONDING TO AN ARMED ASSAILANT ON THE PREMISES OF GOTTLIEB MEMORIAL PROPERTY. PART III, LINE 2: METHODOLOGY USED FOR LINE 2 - ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS. PART III, LINE 3: GMH USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE: (1) SOCIO-ECONOMIC SCORE, (2) ESTIMATED FEDERAL POVERTY LEVEL (FPL), AND (3) HOMEOWNERSHIP. BASED ON THE MODEL, CHARITY CARE CAN STILL BE EXTENDED TO PATIENTS EVEN IF THEY HAVE NOT RESPONDED TO FINANCIAL COUNSELING EFFORTS AND ALL OTHER FUNDING SOURCES HAVE BEEN EXHAUSTED. FOR FINANCIAL STATEMENT PURPOSES, GMH IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, GMH IS REPORTING ZERO ON LINE 3, SINCE THEORETICALLY ANY POTENTIAL CHARITY CARE SHOULD HAVE BEEN IDENTIFIED THROUGH THE PREDICTIVE MODEL. PART III, LINE 4: GMH IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM PAGE 14 OF THOSE STATEMENTS: "THE CORPORATION RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED EVEN THOUGH THE CORPORATION DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY AT THAT TIME. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE CORPORATION ESTABLISHES AN ALLOWANCE TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THIS ALLOWANCE IS ESTABLISHED BASED ON THE AGING OF ACCOUNTS RECEIVABLE AND THE HISTORICAL COLLECTION EXPERIENCE BY THE HEALTH MINISTRIES FOR EACH TYPE OF PAYOR. A SIGNIFICANT PORTION OF THE CORPORATION'S PROVISION FOR DOUBTFUL ACCOUNTS RELATES TO SELF-PAY PATIENTS, AS WELL AS CO-PAYMENTS AND DEDUCTIBLES OWED TO THE CORPORATION BY PATIENTS WITH INSURANCE."PART III, LINE 5:TOTAL MEDICARE REVENUE REPORTED IN PART III, LINE 5 HAS BEEN REDUCED BY THE TWO PERCENT SEQUESTRATION REDUCTION. PART III, LINE 8: GMH DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CATHOLIC HEALTH ASSOCIATION RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTH CARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT. PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARITY DISCOUNTS ARE APPLIED TO THE AMOUNTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. COLLECTION PRACTICES FOR THE REMAINING BALANCES ARE CLEARLY OUTLINED IN THE ORGANIZATION'S COLLECTION POLICY. THE HOSPITAL HAS IMPLEMENTED BILLING AND COLLECTION PRACTICES FOR PATIENT PAYMENT OBLIGATIONS THAT ARE FAIR, CONSISTENT AND COMPLIANT WITH STATE AND FEDERAL REGULATIONS. PART VI, LINE 2: NEEDS ASSESSMENT - GMH ASSESSES THE HEALTH STATUS OF ITS COMMUNITY, IN PARTNERSHIP WITH COMMUNITY COALITIONS, AS PART OF THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITY. TO ASSESS THE HEALTH OF THE COMMUNITY, THE HOSPITAL USES PATIENT UTILIZATION DATA, PUBLIC HEALTH DATA, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES, AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH UTILIZATION FOR EMERGENCY SERVICES AND INPATIENT CARE, WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTATIVE SERVICES OR ARE UNINSURED. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - GMH COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES, FEDERAL, STATE, AND LOCAL GOVERNMENT PROGRAMS, AND OTHER COMMUNITY-BASED CHARITABLE PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTH CARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. GMH OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH PATIENT BROCHURES, MESSAGES ON PATIENT BILLS, POSTED NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON HOSPITAL WEBSITES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN OTHER LANGUAGES AS REQUIRED BY INTERNAL REVENUE CODE SECTION 501(R), REFLECTING OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITAL. GMH HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. GMH MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER. PART VI, LINE 4: COMMUNITY INFORMATION - BASED IN THE WESTERN SUBURBS OF CHICAGO, GMH IS A COMMUNITY-BASED HOSPITAL LOCATED ON A 36-ACRE CAMPUS. THE HOSPITAL CAMPUS IS LOCATED IN MELROSE PARK, 14 MILES WEST OF CHICAGO'S LOOP AREA. THE HEART OF THE CAMPUS IS THE GOTTLIEB MEMORIAL HOSPITAL, A 254 LICENSED-BED FACILITY. BESIDES THE HOSPITAL, THE FOLLOWING CLINICAL SERVICES AND FACILITIES ARE LOCATED ON THE CAMPUS: LEVEL 2 TRAUMA CENTER, THE MARJORIE WEINBERG CANCER CENTER, THE WOUND CARE AND HYPERBARIC MEDICINE CENTER, SLEEP LAB AND DIAGNOSTIC CENTER, ADULT DAY CENTER, A MEDICAL OFFICE BUILDING AND THE GOTTLIEB CENTER FOR FITNESS. GMH'S CLINICAL STRENGTHS INCLUDE PRIMARY CARE, GENERAL MEDICINE, OBSTETRICS & GYNECOLOGY, CARDIOVASCULAR SERVICES, ORTHOPEDICS, NEUROSCIENCES, AND ONCOLOGY. THE CHNA SERVICE AREA IS CENTERED AROUND THE TWO CAMPUSES OF LUMC (MAYWOOD) AND GMH (MELROSE PARK) IN THE WESTERN SUBURBS OF CHICAGO. THE CHNA AREA IS COMPOSED OF A DIVERSE POPULATION OF ABOUT 540,000. HISPANICS MAKE UP THE LARGEST RACE/ETHNIC GROUPS WITH 41.1% OF THE POPULATION. WHITE NON-HISPANIC IS THE SECOND LARGEST GROUP WITH 33.7% AND AFRICAN-AMERICANS REPRESENT 21.5% OF THE CHNA POPULATION. AN INVENTORY OF HOSPITALS FOR THE CHNA SERVICE AREA INCLUDED A TOTAL OF 12 FACILITIES. GMH'S PRIMARY SERVICE AREA HAS A DIVERSE POPULATION OF OVER 388,000. OVER 14% OF THE POPULATION IS AGE 65 OR OLDER. THE AVERAGE HOUSEHOLD INCOME IS $77,861, WITH 24.4% OF HOUSEHOLDS OVER $100,000 AND 21.2% UNDER $25,000. HISPANICS ARE AMONG THE FASTEST-GROWING DEMOGRAPHIC, MAKING UP 31% OF THE POPULATION.GMH SERVED 6,556 DISCHARGED INPATIENTS IN FY18. MORE THAN 25,655 EMERGENCY DEPARTMENT VISITS WERE SEEN AT GMH. THE EMERGENCY DEPARTMENT IS A LEVEL II TRAUMA CENTER RECOGNIZED BY THE ILLINOIS DEPARTMENT OF PUBLIC HEALTH AS AN EMERGENCY DEPARTMENT APPROVED FOR PEDIATRICS (EDAP). THROUGH GMH, PRE-HOSPITAL TRAINING IS PROVIDED IN THE EDUCATION AND TRAINING OF EMERGENCY MEDICAL TECHNICIANS (EMTS) AND PARAMEDICS IN NEIGHBORING COMMUNITIES. PART VI, LINE 5: OTHER INFORMATION - IN FURTHERANCE OF LUHS' TRADITION OF TEACHING, GMH SUPPORTS HOSPITAL-BASED EDUCATION AND TRAINING OF FUTURE PROFESSIONALS. GMH PROVIDED CLINICAL SUPERVISION OF PHYSICAL, SPEECH AND RESPIRATORY THERAPY STUDENTS.GMH ALSO PROVIDED COMMUNITY HEALTH AND SCREENING SERVICES DURING FY18. GMH PROVIDED TRANSPORTATION VAN SERVICE FOR THOSE WITH NO MEANS OF TRANSPORT TO HOSPITAL DIAGNOSTIC TESTING OR ANCILLARY SERVICES. GMH ALSO REGULARLY PROVIDES FREE VISION AND HEARING SCREENING FOR SCHOOLCHILDREN IN THE GMH SERVICE AREA, SPECIFICALLY IN MELROSE PARK. GMH ALSO LEADS SEVERAL FREE SUPPORT GROUPS FOR CARE GIVERS OF PERSONS LIVING WITH CHRONIC ILLNESS AND ONE SPECIFICALLY FOR AMPUTEES. GMH ALSO WORKED WITH A COMMITTEE OF AREA PROVIDERS AND AGENCIES TO HELP CONNECT SENIORS AND OTHERS WITH HEALTH CARE RESOURCES. GMH OFFERED NUMEROUS FREE COMMUNITY PRESENTATIONS AND CONSISTENT HEALTH EDUCATION THROUGHOUT THE YEAR WITH EXPERT SPEAKERS ON NUTRITION, MENTAL HEALTH AND CARING FOR AGING FAMILY MEMBERS. THESE INCLUDE MENTAL HEALTH FIRST AID TRAINING AND THE MIND DIET. THE PRESENTATIONS ARE OPEN TO THE PUBLIC. ANOTHER EXAMPLE OF HOW GMH PROMOTED COMMUNITY HEALTH RELATED TO RAISING AWARENESS AND PROVIDING INFORMATION TO THE COMMUNITY FOR HEALTH-RELATED CONDITIONS: GMH AND ITS STAFF ALLERGIST JOSEPH LEIJA, MD, PROVIDED GMH'S DAILY ALLERGY COUNT (FROM APRIL THROUGH OCTOBER) FOR THE ENTIRE CHICAGOLAND. THE COUNT IS PROVIDED, AT NO COST, TO NEWS OUTLETS AND ALL CHICAGO METEOROLOGISTS. THE COUNT ALSO IS AVAILABLE ON GMH'S WEB SITE, VIA TWITTER AND BY A TELEPHONE HOTLINE EACH WEEKDAY MORNING DURING ALLERGY SEASON. IT IS A RELIED-UPON RESOURCE BY PEOPLE IN THE CHICAGO AREA WHO NEED TO DETERMINE WHETHER TO TAKE ALLERGY MEDICATION BEFORE STEPPING OUT THE DOOR IN THE MORNING.IN 2016, LUHS/PP4H WAS AMONG SIX COLLABORATIONS RECEIVING THE FIRST TRANSFORMING COMMUNITIES INITIATIVE GRANTS SPONSORED BY TRINITY HEALTH. AS PART OF THIS AWARD LUHS/PP4H IS ELIGIBLE TO RECEIVE UP TO $500,000 A YEAR FOR FIVE YEARS TO BE DIRECTED TOWARDS THE IMPLEMENTATION OF A SERIES OF PRE-SELECTED, PRO-HEALTH POLICY, SYSTEM, AND ENVIRONMENTAL (PSE) INTERVENTIONS. INTERVENTIONS INCLUDE: TOBACCO 21, COMPLETE STREETS, IMPLEMENTATION OF NUTRITION STANDARDS IN EARLY CHILDHOOD SETTINGS, BREASTFEEDING POLICY ENHANCEMENT, SCHOOL BOARD POLICY TO ENHANCE PHYSICAL ACTIVITY IN SCHOOLS, AND FOOD & BEVERAGE STANDARDS/COMPETITIVE FOODS POLICIES.DURING FY18, GMH (AS PART OF LUHS) THROUGH ITS COMMUNITY COALITION PP4H, SUPPORTED EFFORTS ON THE STATE AND LOCAL LEVELS TO ADOPT TOBACCO 21 POLICIES. TOBACCO 21 ADVOCATES INCREASING THE LEGAL AGE TO PURCHASE TOBACCO PRODUCTS FROM 18 TO 21. LUHS JOINED THE TOBACCO 21 EFFORT IN ILLINOIS AND COORDINATED WITH COMMUNITY PARTNERS AND OTHERS FOR ADVOCACY OF STATE-WIDE LEGISLATION RESTRICTING SALE TO MINORS OF CIGARETTE PRODUCTS. OTHER STATEWIDE ORGANIZATIONS LUHS PARTNERED WITH INCLUDED THE ILLINOIS HOSPITAL ASSOCIATION, RESPIRATORY HEALTH ASSOCIATION, AMERICAN HEART ASSOCIATION, AMERICAN LUNG ASSOCIATION, AMERICAN CANCER ASSOCIATION, AND TOBACCO FREE KIDS. INITIATIVES INCLUDED A CAMPAIGN THAT ENCOURAGED LUHS EMPLOYEES AND THE PUBLIC TO WRITE THEIR REPRESENTATIVE IN SUPPORT OF THE LEGISLATION AS WELL AS MEETINGS WITH LAWMAKERS. IN MAY 2017, THE LOCAL COMMUNITY OF MAYWOOD BECAME ONE OF SIX COOK COUNTY CITIES TO ENACT AN ORDINANCE PROHIBITING THE SALE OF TOBACCO TO THOSE UNDER 21. PART VI, LINE 6: GMH IS A MEMBER OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE DELIVERY SYSTEMS IN THE COUNTRY. TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER MINISTRIES DEFINE - AND ACHIEVE - SPECIFIC COMMUNITY HEALTH AND WELL-BEING GOALS. IN FISCAL YEAR 2018, EVERY MINISTRY FOCUSED ON FOUR GOALS: 1. REDUCE TOBACCO USE 2. REDUCE OBESITY PREVALENCE3. ADDRESS AT LEAST ONE SIGNIFICANT HEALTH NEED IDENTIFIED IN THE MINISTRY COMMUNITY HEALTH NEEDS ASSESSMENT4. ADDRESS AT LEAST ONE SOCIAL DETERMINANT OF HEALTH TRINITY HEALTH ACKNOWLEDGES THE IMPACT SOCIAL DETERMINANTS SUCH AS ADEQUATE HOUSING, SAFETY, ACCESS TO FOOD, EDUCATION, INCOME, AND HEALTH COVERAGE HAVE ON THE HEALTH OF THE COMMUNITY. IN FISCAL YEAR 2016, TRINITY HEALTH LAUNCHED THE TRANSFORMING COMMUNITIES INITIATIVE (TCI) TO ADVANCE COMMUNITY PARTNERSHIPS THAT FOCUS ON IMPROVING THE HEALTH AND WELL-BEING IN COMMUNITIES SERVED BY THE MINISTRIES OF TRINITY HEALTH. TCI IS AN INNOVATIVE FUNDING MODEL AND TECHNICAL ASSISTANCE INITIATIVE SUPPORTING EIGHT COMMUNITIES USING POLICY, SYSTEM, AND ENVIRONMENTAL (PSE) CHANGE STRATEGIES TO PREVENT TOBACCO USE AND CHILDHOOD OBESITY, AS WELL AS ADDRESS SOCIAL DETERMINANTS OF HEALTH. TRINITY HEALTH INVESTED $3.6 MILLION IN FISCAL YEAR 2018 IN TCI. IN FISCAL YEAR 2018, TRINITY HEALTH LAUNCHED THE GOOD SAMARITAN INITIATIVE (GSI) TO SUPPORT THE MOST VULNERABLE PATIENTS' SOCIAL AND ECONOMIC NEEDS IN OUR SYSTEM THROUGH INTEGRATING COMMUNITY HEALTH WORKERS AS PART OF CARE TEAMS ACROSS NINE MINISTRIES. TRINITY HEALTH INVESTED OVER $260,000 IN FISCAL YEAR 2018 IN GSI. ADDITIONALLY, TRINITY HEALTH INVESTED $500,000 IN ELEVEN GRANTS TO IMPROVE THE BUILT ENVIRONMENT ACROSS EIGHT MINISTRIES. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO OUR COMMUNITIES THROUGH PROMOTING WELLNESS AND DEVELOPING PROGRAMS SPECIFICALLY SUPPORTING THOSE WHO ARE POOR AND VULNERABLE, HELPING MANAGE CHRONIC CONDITIONS LIKE DIABETES, PROVIDING HEALTH EDUCATION, AND MOVING FORWARD POLICY, SYSTEM AND ENVIRONMENTAL CHANGE. THE ORGANIZATION WORKS TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ENHANCE THE OVERALL HEALTH OF THE COMMUNITIES THEY SERVE BY ADDRESSING THE SPECIFIC NEEDS OF EACH COMMUNITY. IN FISCAL YEAR 2018, TRINITY HEALTH INVESTED OVER $1.1 BILLION IN SUCH COMMUNITY BENEFITS.FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. PART VI, LINE 7, REPORTS FILED WITH STATES IL 0 SCHOLARSHIPS 15 12500 1 1 0 0 0 0 0 0 0 ROGER SPOELMAN DIRECTOR; INT PRES & CEO AS OF 4/18 0 614701 0 211406 0 167276 0 20250 0 28314 0 1041947 0 0 LARRY GOLDBERG DIRECTOR, PRESIDENT & CEO THR 3/18 0 870178 0 346231 0 398742 0 12150 0 16583 0 1643884 0 183120 BENJAMIN CARTER DIRECTOR AT 1/18; TRINITY EVP, CFO 0 939676 0 366755 0 316455 0 12150 0 38629 0 1673665 0 90148 SALLY JEFFCOAT DIR THR 12/17; EVP TRINITY HEALTH 0 898754 0 388608 0 230295 0 12150 0 31295 0 1561102 0 0 SCOTT MIROWITZ MD DIRECTOR AS OF 1/18; PROFESSOR 0 541514 0 51273 0 15869 0 12150 0 9079 0 629885 0 0 RONALD POTKUL MD DIRECTOR; LUMC PHYSICIAN 0 688759 0 63793 0 9509 0 20250 0 23461 0 805772 0 0 WILLIAM SMALL MD DIRECTOR; PROFESSOR 0 543506 0 48140 0 17614 0 12150 0 21174 0 642584 0 0 KEITH VESELIK MD DIRECTOR THR 12/17; MEDICAL DIRECTOR 0 321063 0 38584 0 3906 0 20250 0 21656 0 405459 0 0 LORI PRICE PRESIDENT GMH 0 360610 0 157823 0 112910 0 20250 0 26799 0 678392 0 14438 BLAINE PETERSEN TREASURER; EVP & REGIONAL CFO 0 557910 0 159838 0 80400 0 12150 0 26125 0 836423 0 0 DANIEL ISACKSEN ASSISTANT TREASURER; VP FINANCE 0 362229 0 52626 0 495 0 8100 0 24495 0 447945 0 0 JILL RAPPIS SECRETARY; SVP LEGAL & GENL COUNSEL 0 340242 0 91673 0 6950 0 48465 0 14837 0 502167 0 0 MARIA PEKAR ASSISTANT SEC.; ASSOC GENL CNSL 0 247668 0 27455 0 1067 0 39062 0 23173 0 338425 0 0 DAVID HECHT MD MS MBA EVP, CLINICAL AFFAIRS 0 612869 0 140651 0 8490 0 20250 0 9607 0 791867 0 0 BERNARD GAWNE JR CHIEF MEDICAL OFFICER 334725 0 26645 0 7144 0 12150 0 19032 0 399696 0 0 0 GINGER HOOK VP CHIEF NURSE OFFICER 229076 0 32921 0 333 0 16070 0 16631 0 295031 0 0 0 EWA BOGACZ CRITICAL CARE RN 169767 0 0 0 47 0 5167 0 8151 0 183132 0 0 0 ELIZABETH MCLAIN CRITICAL CARE RN 167267 0 0 0 86 0 10150 0 8541 0 186044 0 0 0 SANDRA SWANSON ADMIN DIR PERIOP/PERINATAL SVCS 119120 0 21387 0 17330 0 42923 0 11290 0 212050 0 0 0 JOE VADAKARA DIRECTOR OF PHARMACY 139952 0 9291 0 86 0 18722 0 1567 0 169618 0 0 0 RICHARD O'CONNELL FORMER KEY EMPLOYEE 0 31633 0 193351 0 655879 0 7059 0 9566 0 897488 0 0 DONNA HALINSKI FORMER OFFICER; VP CLINICAL AFFRS 0 277088 0 39888 0 1207 0 53875 0 23997 0 396055 0 0 AJAY SIAL FORMER OFFICER 0 0 0 0 0 278567 0 0 0 10666 0 289233 0 281131 ELLYN CHIN FORMER OFFICER; VP PAYOR STRATEGIES 0 283346 0 44577 0 662 0 28350 0 24075 0 381010 0 0 ALAN GOLDBERG FORMER KEY EMPLOYEE 39559 0 0 0 180406 0 7685 0 23577 0 251227 0 0 0 PART I, LINE 3 GOTTLIEB MEMORIAL HOSPITAL IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. GOTTLIEB MEMORIAL HOSPITAL'S CEO IS PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF GOTTLIEB MEMORIAL HOSPITAL'S CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINES 4A-B THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN CALENDAR 2017. THESE AMOUNTS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: ALAN GOLDBERG - $162,438 RICHARD O'CONNELL - $448,968 AJAY SIAL - $281,131 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2017. THE PLAN PROVIDES RETIREMENT BENEFITS TO CERTAIN TRINITY HEALTH EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. BENEFITS FOR PARTICIPANTS VESTED IN A PLAN WERE PAID OUT IN 2017, AND BENEFITS FOR PARTICIPANTS NOT YET VESTED IN A PLAN WERE ACCRUED IN 2017. THE FOLLOWING PAYOUTS FOR 2017 FOR THE PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: BENJAMIN CARTER - $191,020 LARRY GOLDBERG - $189,922 SALLY JEFFCOAT - $199,865 RICHARD O'CONNELL - $202,294 BLAINE PETERSEN - $66,698 LORI PRICE - $83,519 ROGER SPOELMAN - $141,449 THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH RESTORATION OR RETENTION PLAN. THE RESTORATION PLAN PROVIDES RETIREMENT BENEFITS FOR CERTAIN TRINITY HEALTH SYSTEM OFFICE EXECUTIVES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($270,000 FOR 2017). THE FOLLOWING PAYOUTS FOR 2017 FOR THESE PLANS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: BENJAMIN CARTER - $100,285 LARRY GOLDBERG - $189,505 LORI PRICE - $14,941 JILL RAPPIS - $3,939 COLUMN (F) OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF GOTTLIEB MEMORIAL HOSPITAL (GMH) IS LOYOLA UNIVERSITY HEALTH SYSTEM. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A LOYOLA UNIVERSITY HEALTH SYSTEM IS THE SOLE MEMBER OF GMH. LOYOLA UNIVERSITY HEALTH SYSTEM HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF GMH. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, LOYOLA UNIVERSITY HEALTH SYSTEM MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. LOYOLA UNIVERSITY HEALTH SYSTEM MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, AND MODIFICATIONS TO GOVERNING DOCUMENTS. AS THE PARENT OF THE NATIONAL TRINITY HEALTH SYSTEM, CERTAIN POWERS ARE RESERVED TO TRINITY HEALTH CORPORATION. THESE INCLUDE THE AUTHORITY TO ADOPT OR MODIFY THE ORGANIZATION'S GOVERNING DOCUMENTS, TO APPROVE MAJOR CHANGES SUCH AS A MERGER OR DISSOLUTION, AND TO APPROVE SIGNIFICANT FINANCE MATTERS IN EXCESS OF CERTAIN LIMITS ESTABLISHED BY TRINITY HEALTH CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING, THE FORM 990 FOR GMH IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE BOARD OF DIRECTORS. EACH MEMBER OF THE BOARD RECEIVES A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C GMH HAS ADOPTED TRINITY HEALTH'S GOVERNANCE POLICY NO. 1, WHICH SETS FORTH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND PROCESSES. IT APPLIES TO ALL "INTERESTED PERSONS" OF GMH, WHICH INCLUDES DIRECTORS, PRINCIPAL OFFICERS, KEY EMPLOYEES, AND MEMBERS OF COMMITTEES WITH BOARD-DELEGATED POWERS. INTERESTED PERSONS ARE EXPECTED TO DISCHARGE THEIR DUTIES IN A MANNER THE PERSON REASONABLY BELIEVES TO BE IN THE BEST INTERESTS OF GMH AND TO AVOID SITUATIONS INVOLVING A CONFLICT OF INTEREST. ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND TO AFFIRM THEIR RECEIPT OF THE CONFLICT OF INTEREST POLICY, COMPLIANCE WITH ITS REQUIREMENTS, AND AGREE TO NOTIFY THE ORGANIZATION OF CHANGES IMPACTING THEIR ANNUAL DISCLOSURE IN ACCORDANCE WITH THE POLICY. THE ANNUAL DISCLOSURES ARE PROVIDED TO INTERNAL LEGAL COUNSEL AND THE INTEGRITY AND COMPLIANCE OFFICER, FROM WHICH LEGAL COUNSEL PREPARES A REPORT FOR THE BOARD CHAIR AND CEO. A SUMMARY OF POTENTIAL CONFLICTS IS REVIEWED WITH THE BOARD OF DIRECTORS OF GMH (OR A DELEGATED COMMITTEE OF THE BOARD) ON A YEARLY BASIS. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO GMH OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF GMH (OR A DELEGATED COMMITTEE OF THE BOARD) IS RESPONSIBLE FOR THE REVIEW OF TRANSACTIONS TO DETERMINE WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS. IN THE EVENT OF AN ACTUAL CONFLICT, THE BOARD (OR A DELEGATED COMMITTEE OF THE BOARD) WILL EITHER AVOID THE CONFLICT OR APPROPRIATELY SCRUTINIZE THE TRANSACTION TO ENSURE IT IS IN THE BEST INTERESTS OF GMH. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE POLICY FURTHER ADDRESSES THE PROPER DOCUMENTATION OF THE PROCEEDINGS AND POTENTIAL DISCIPLINARY AND CORRECTIVE ACTION FOR VIOLATIONS OF THE POLICY. THE POLICY IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 15 QUESTIONS 15A AND 15B ARE ANSWERED "NO" BECAUSE THE COMPENSATION FOR CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF GMH IS ESTABLISHED AND PAID BY TRINITY HEALTH, A RELATED ORGANIZATION. IN ESTABLISHING CEO AND CFO COMPENSATION, TRINITY HEALTH FOLLOWS A PROCESS AND POLICY THAT IS INTENDED TO MIRROR THE IRC SECTION 4958 GUIDELINES FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" WITH REGARD TO COMPENSATION AND BENEFITS. AS PART OF THAT PROCESS, THE COMPENSATION AND BENEFITS OF THE CEO AND CFO OF GMH ARE REVIEWED AT LEAST ANNUALLY BY THE TRINITY HEALTH BOARD OR THE TRINITY HEALTH HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. AS PART OF ITS REVIEW PROCESS, THE HRCC RETAINS AN INDEPENDENT FIRM EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS. FORM 990, PART VI, SECTION C, LINE 19 GMH IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, GMH INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. GMH'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS TO AFFILIATES -2,243,475. FORM 990, PART XII, LINE 2 GMH'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY18 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS MI 49503 272491974 HEALTH CARE SERVICES MI 501(C)(3) LINE 10 TRINITY HEALTH-MICHIGAN 1 ALLEGANY FRANCISCAN MINISTRIES INC 33920 US HIGHWAY 19 NORTH SUITE 269 PALM HARBOR FL 34684 581492325 GRANT MAKING FL 501(C)(3) LINE 12A, I TRINITY HEALTH CORPORATION 1 ASYLUM HILL FAMILY MEDICINE CENTER INC 114 WOODLAND STREET HARTFORD CT 06105 061450170 HEALTH CARE SERVICES CT 501(C)(3) LINE 3 TRINITY HEALTH OF NEW ENGLAND CORP INC 1 BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 421500277 HEALTH CARE AND HOSPITAL SERVICES IA 501(C)(3) LINE 3 MERCY HEALTH SERVICES-IOWA CORP 1 BAUM HARMON MERCY HOSPITAL AND CLINICS FOUNDATION 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 262973307 FOUNDATION IA 501(C)(3) LINE 12A, I BAUM HARMON MERCY HOSPITAL 1 BEECHWOOD INC 2212 BURDETT AVE TROY NY 12180 141651563 TITLE HOLDING COMPANY NY 501(C)(2) N/A LTC (EDDY) INC 1 BETHLEHEM HAVEN OF PITTSBURGH 905 WATSON STREET PITTSBURGH PA 15219 251436685 HOMELESS SHELTER PA 501(C)(3) LINE 7 PITTSBURGH MERCY HEALTH SYSTEM INC 1 BEVERWYCK INC 40 AUTUMN DRIVE SLINGERLANDS NY 12159 141717028 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 BRIGHTSIDE INC 1221 MAIN STREET SUITE 213 HOLYOKE MA 01040 042182395 HEALTH CARE SERVICES MA 501(C)(3) LINE 10 THE MERCY HOSPITAL INC 1 CAPITAL REGION GERIATRIC CENTER INC 421 WEST COLUMBIA STREET COHOES NY 12047 141701597 LONG TERM CARE NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 CARING PARTNERS HOME HEALTH INC 1200 EARHART RD ANN ARBOR MI 48105 201681131 HOME HEALTH SERVICES MI 501(C)(3) LINE 10 GLACIER HILLS INC 1 CATHERINE MCAULEY HEALTH SERVICES CORP PO BOX 995 ANN ARBOR MI 48106 382507173 HEALTH CARE SERVICES MI 501(C)(3) LINE 3 TRINITY HEALTH-MICHIGAN 1 CATHOLIC HEALTH MINISTRIES 20555 VICTOR PARKWAY LIVONIA MI 48152 GOVERNANCE AND MANAGEMENT OF TRINITY HEALTH SYSTEM VT 501(C)(3) LINE 1 N/A 0 COLUMBUS ACQUISITION CORP 111 CENTRAL AVENUE NEWARK NJ 07102 262616342 INACTIVE ENTITY NJ 501(C)(3) LINE 10 SAINT MICHAEL'S MEDICAL CENTER 1 DILEY RIDGE MEDICAL CENTER 6150 EAST BROAD STREET COLUMBUS OH 43213 342032340 HEALTH CARE AND HOSPITAL SERVICES OH 501(C)(3) LINE 3 MOUNT CARMEL HEALTH SYSTEM 1 DUBUQUE MERCY HEALTH FOUNDATION 250 MERCY DRIVE DUBUQUE IA 52001 262227941 FOUNDATION IA 501(C)(3) LINE 12A, I MERCY HEALTH SERVICES-IOWA CORP 1 DYERSVILLE HEALTH FOUNDATION INC 1111 3RD STREET SW DYERSVILLE IA 52040 205383271 FOUNDATION IA 501(C)(3) LINE 12A, I MERCY HEALTH SERVICES-IOWA CORP 1 EAST NORRITON PHYSICIANS SERVICES INC ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN PA 19428 232515999 HEALTH CARE SERVICES PA 501(C)(3) LINE 3 MERCY PHYSICIAN NETWORK 1 EDDY LICENSED HOME CARE AGENCY 433 RIVER ST SUITE 3000 TROY NY 12180 141818568 HOME HEALTH SERVICES NY 501(C)(3) LINE 3 LTC (EDDY) INC 1 EMBRACING AGE INC 333 BUTTERNUT DRIVE DEWITT NY 13214 461051881 PACE PROGRAM NY 501(C)(3) LINE 10 ST JOSEPH'S HEALTH INC 1 EMPIRE HOME INFUSION SERVICE INC 10 BLACKSMITH DRIVE MALTA NY 12020 141795732 HOME HEALTH SERVICES NY 501(C)(3) LINE 10 HOME AIDE SERVICE OF EASTERN NEW YORK INC 1 FARREN CARE CENTER INC 1221 MAIN STREET SUITE 213 HOLYOKE MA 01040 042501711 LONG TERM CARE MA 501(C)(3) LINE 3 THE MERCY HOSPITAL INC 1 FRANCISCAN ELDERCARE CORPORATION PO BOX 2500 WILMINGTON DE 19805 223008680 LONG TERM CARE (INACTIVE) DE 501(C)(3) LINE 10 ST FRANCIS HOSPITAL 1 GLACIER HILLS FOUNDATION 1200 EARHART RD ANN ARBOR MI 48105 208072723 FOUNDATION MI 501(C)(3) LINE 12A, I GLACIER HILLS INC 1 GLACIER HILLS INC 1200 EARHART RD ANN ARBOR MI 48105 381891500 SENIOR LIVING COMMUNITY MI 501(C)(3) LINE 10 TRINITY CONTINUING CARE SERVICES 1 GLEN EDDY INC 1 GLEN EDDY DRIVE NISKAYUNA NY 12309 141794150 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 GLOBAL HEALTH MINISTRY 20555 VICTOR PARKWAY LIVONIA MI 48152 421253527 HEALTH CARE SERVICES MI 501(C)(3) LINE 12A, I TRINITY HEALTH CORPORATION 1 GOOD SAMARITAN HOSPITAL INC 5401 LAKE OCONEE PARKWAY GREENSBORO GA 30642 261720984 HEALTH CARE AND HOSPITAL SERVICES GA 501(C)(3) LINE 3 ST MARY'S HEALTH CARE SYSTEM INC 1 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 701 W NORTH AVE MELROSE PARK IL 60160 363332852 HEALTH CARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 GOTTLIEB MEMORIAL HOSPITAL 1 GOTTLIEB MEMORIAL FOUNDATION 701 WEST NORTH AVENUE MELROSE PARK IL 60160 743260011 FOUNDATION IL 501(C)(3) LINE 12C, III-FI N/A 0 GOTTLIEB MEMORIAL HOSPITAL 701 W NORTH AVE MELROSE PARK IL 60160 362379649 HEALTH CARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 LOYOLA UNIVERSITY HEALTH SYSTEM 0 GRAND RAPIDS MEDICAL EDUCATION PARTNERS 945 OTTAWA AVE NW GRAND RAPIDS MI 49503 237270669 MEDICAL EDUCATION TRAINING PROGRAMS MI 501(C)(3) LINE 12A, I TRINITY HEALTH-MICHIGAN 1 HACKLEY LIFE COUNSELING 125 E SOUTHERN AVENUE MUSKEGON MI 49442 381386362 HEALTH CARE SERVICES MI 501(C)(3) LINE 10 MERCY HEALTH PARTNERS 1 HAWTHORNE RIDGE INC 30 COMMUNITY WAY EAST GREENBUSH NY 12061 800102840 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 HEART CENTER OF GREATER WATERBURY INC PO BOX 2153 WATERBURY CT 06722 830416893 MANAGEMENT CT 501(C)(3) LINE 12A, I N/A 0 HERITAGE HOUSE NURSING CENTER INC 2920 TIBBITS AVE TROY NY 12180 141725101 LONG TERM CARE NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 HOLY CROSS CARENET INC PO BOX 9184 FARMINGTON HILLS MI 48152 521945054 LONG TERM CARE MD 501(C)(3) LINE 10 TRINITY CONTINUING CARE SERVICES 1 HOLY CROSS HEALTH FOUNDATION INC 1500 FOREST GLEN ROAD SILVER SPRING MD 20910 208428450 FOUNDATION MD 501(C)(3) LINE 7 HOLY CROSS HEALTH INC 1 HOLY CROSS HEALTH INC 1500 FOREST GLEN ROAD SILVER SPRING MD 20910 520738041 HEALTH CARE AND HOSPITAL SERVICES MD 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION 1 HOLY CROSS HOSPITAL INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 33308 590791028 HEALTH CARE AND HOSPITAL SERVICES FL 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION 1 HOLY CROSS OUTPATIENT SERVICES INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 33308 465421068 HEALTH CARE SERVICES FL 501(C)(3) LINE 10 HOLY CROSS HOSPITAL INC 1 HOLY CROSS PRIMARY CARE INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 33308 812531495 HEALTH CARE SERVICES FL 501(C)(3) LINE 10 HOLY CROSS HOSPITAL INC 1 HOME & COMMUNITY HEALTH SERVICES INC 114 WOODLAND STREET HARTFORD CT 06105 810723591 HOME HEALTH SERVICES CT 501(C)(3) LINE 10 TRINITY HEALTH OF NEW ENGLAND CORP INC 1 HOME AIDE SERVICE OF EASTERN NEW YORK INC 433 RIVER ST SUITE 3000 TROY NY 12180 141514867 HOME HEALTH SERVICES NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 HOSPICE OF NORTH IOWA 232 SECOND STREET SE MASON CITY IA 50401 421173708 HOSPICE SERVICES IA 501(C)(3) LINE 10 MERCY HEALTH SERVICES-IOWA CORP 1 HOSPICE OF SIOUXLAND 4300 HAMILTON BLVD SIOUX CITY IA 51104 383320710 HOSPICE SERVICES IA 501(C)(3) LINE 12A, I N/A 0 IHA HEALTH SERVICES CORPORATION 24 FRANK LLOYD WRIGHT DR LOBBY J ANN ARBOR MI 48106 383316559 HEALTH CARE SERVICES MI 501(C)(3) LINE 10 TRINITY HEALTH-MICHIGAN 1 JOHNSON MEMORIAL HOSPITAL INC 114 WOODLAND STREET HARTFORD CT 06105 475676956 HEALTH CARE AND HOSPITAL SERVICES CT 501(C)(3) LINE 3 TRINITY HEALTH OF NEW ENGLAND CORP INC 1 LANGHORNE MRI INC 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE PA 19047 232519529 HEALTH CARE SERVICES (INACTIVE) PA 501(C)(3) LINE 10 ST MARY MEDICAL CENTER 1 LANGHORNE PHYSICIAN SERVICES INC 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE PA 19047 232571699 HEALTH CARE SERVICES PA 501(C)(3) LINE 10 ST MARY MEDICAL CENTER 1 LIFE AT LOURDES INC 2475 MCCLELLAN AVENUE PENNSAUKEN NJ 08109 261854750 PACE PROGRAM NJ 501(C)(3) LINE 3 OUR LADY OF LOURDES HEALTH CARE SERVICES 1 LIFE AT ST FRANCIS HEALTHCARE INC 7TH AND CLAYTON STREETS WILMINGTON DE 19805 452569214 PACE PROGRAM DE 501(C)(3) LINE 10 ST FRANCIS HOSPITAL 1 LIFE ST FRANCIS CORPORATION 7500 K JOHNSON BOULEVARD BORDENTOWN NJ 08505 222797282 PACE PROGRAM NJ 501(C)(3) LINE 10 ST FRANCIS MEDICAL CENTER TRENTON NJ 1 LIFE ST JOSEPH OF THE PINES INC 100 GOSSMAN DRIVE SOUTHERN PINES NC 28387 272159847 PACE PROGRAM NC 501(C)(3) LINE 3 ST JOSEPH OF THE PINES INC 1 LIFE ST MARY 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE PA 19047 262976184 PACE PROGRAM PA 501(C)(3) LINE 10 ST MARY MEDICAL CENTER 1 LOURDES ANCILLARY SERVICES 1600 HADDON AVENUE CAMDEN NJ 08103 222568525 VOLUNTEER SERVICE AUXILIARY NJ 501(C)(3) LINE 12B, II OUR LADY OF LOURDES HEALTH CARE SERVICES 1 LOURDES CARDIOLOGY SERVICES PC 1600 HADDON AVENUE CAMDEN NJ 08103 274357794 HEALTH CARE SERVICES NJ 501(C)(3) LINE 3 OUR LADY OF LOURDES HEALTH CARE SERVICES 1 LOURDES MEDICAL CENTER OF BURLINGTON COUNTY 218 SUNSET ROAD WILLINGBORO NJ 08046 223612265 HEALTH CARE AND HOSPITAL SERVICES NJ 501(C)(3) LINE 3 OUR LADY OF LOURDES HEALTH CARE SERVICES 1 LOYOLA MEDICINE TRANSPORT LLC 905 W NORTH AVE MELROSE PARK IL 60160 474147171 TRANSPORATION SERVICES IL 501(C)(3) LINE 10 LOYOLA UNIVERSITY MEDICAL CENTER 1 LOYOLA UNIVERSITY HEALTH SYSTEM 2160 SOUTH FIRST AVENUE MAYWOOD IL 60153 363342448 HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT IL 501(C)(3) LINE 12B, II TRINITY HEALTH CORPORATION 1 LOYOLA UNIVERSITY MEDICAL CENTER 2160 SOUTH FIRST AVENUE MAYWOOD IL 60153 364015560 HEALTH CARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 LOYOLA UNIVERSITY HEALTH SYSTEM 1 LTC (EDDY) INC 2212 BURDETT AVE TROY NY 12180 222564710 MANAGEMENT SERVICES FOR LONG TERM CARE NY 501(C)(3) LINE 12B, II ST PETER'S HEALTH PARTNERS 1 MARIAN HOME HEALTHCARE 801 5TH STREET SIOUX CITY IA 51101 383320705 HOME HEALTH SERVICES (INACTIVE) IA 501(C)(3) LINE 12A, I MERCY HEALTH SERVICES-IOWA CORP 1 MAXIS HEALTH SYSTEM 3805 WEST CHESTER PIKE STE 100 NEWTOWN SQUARE PA 19073 911940902 HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT (INACTIVE) PA 501(C)(3) LINE 12A, I TRINITY HEALTH CORPORATION 1 MCAULEY CENTER INC 275 STEELE ROAD WEST HARTFORD CT 06117 061058086 SENIOR LIVING COMMUNITY CT 501(C)(3) LINE 10 MERCY COMMUNITY HEALTH INC 1 MCAULEY CLINIC CORPORATION PO BOX 992 ANN ARBOR MI 48106 382561013 HEALTH CARE SERVICES (INACTIVE) MI 501(C)(3) LINE 3 CATHERINE MCAULEY HEALTH SERVICES CORP 1 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