2019-05-13T15:37:01-05:00 2018-06-30 990 2017-07-01 363332852 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION GOTT 7082169000 701 W NORTH AVE MELROSE PARK IL 60160 DANIEL ISACKSEN CFO 7082169000 2019-05-13 170.232.227.252 2019-05-13 15:36:53 ED P 943C2B779621AE68CF3E0BED5C235FDF89DF7949 931FD144836D950546B27D5795367136474FF98E 2017 2019-02-21 02:37:17Z SEE SCHEDULE O MARY ELIZABETH CLEARY 701 W NORTH AVE MELROSE PARK IL 60160 99749509 0 X WWW.MACNEALHOSPITAL.ORG X 1984 IL TO PROVIDE HEALTH CARE AND HOSPITAL SERVICES 12 5 93 112 1785878 -240067 0 0 1854900 97222497 12814 720856 634284 1639967 2501998 99583320 0 2670 0 0 1231442 6902748 0 0 0 1435256 86237693 2666698 93143111 -164700 6440209 21962813 321481272 33989743 444836581 -12026930 -123355309 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 COMMUNITY HEALTH SERVICES CORPORATION IS A MEMBER OF LOYOLA UNIVERSITY HEALTH SYSTEM AND TRINITY HEALTH. 1 1 89683522 2670 96818557 GOTTLIEB COMMUNITY HEALTH SERVICES (GCHSC) IS A WHOLLY-OWNED SUBSIDIARY OF LOYOLA UNIVERSITY HEALTH SYSTEM.PRIOR TO MARCH 1,2018, GCHSC PRIMARILY OWNED AND EQUIPPED HEALTH CARE AND COMMUNITY-BASED SOCIAL SERVICES FACILITIES. GCHSC OUTREACH ACTIVITIES AND PROGRAMS IN FY18 INCLUDED: CHARITABLE HEALTH CLUB MEMBERSHIP PROGRAMS, AQUATIC THERAPY AT GOTTLIEB MEMORIAL HOSPITAL, MAGIS IN MOTION DONATION OF PERSONAL HYGIENE ITEMS TO THE HOMELESS, AND SUPPORT FOR THE AMERICAN HEART ASSOCIATION WALK IN SEPTEMBER 2017.MACNEAL HOSPITAL, A 368-BED HOSPITAL LOCATED IN BERWYN, ILLINOIS, HAS BEEN PROVIDING QUALITY HEALTH CARE IN THE CITY OF CHICAGO AND IN THE NEAR WESTERN SUBURBS. MACNEAL HOSPITAL OFFERS COMPREHENSIVE AND COMPASSIONATE SERVICES THAT INCLUDE OBSTETRICS, ORTHOPAEDICS, CARDIOLOGY, CARDIAC REHABILITATION, SPORTS MEDICINE, REHABILITATION SERVICES, ONCOLOGY, HOME HEALTH, EMERGENCY AND IMMEDIATE CARE SERVICES, BARIATRIC SURGERY, AND MUCH MORE. WE ALSO OFFER THE LARGEST BEHAVIORAL HEALTH SERVICES PROGRAM IN THE CHICAGO AREA.MACNEAL HOSPITAL PROVIDES EXCELLENT MEDICAL EDUCATION PROGRAMS, INCLUDING THE FIRST FAMILY MEDICINE RESIDENCY PROGRAM ESTABLISHED IN ILLINOIS, WHICH REMAINS ONE OF THE LARGEST AND MOST DYNAMIC OF ITS KIND. WE ARE COMMITTED TO SERVING OUR COMMUNITIES WITH EDUCATIONAL OFFERINGS. 89683522 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 3 0 1 93 1 1 1 0 0 0 0 0 0 0 0 0 X 12 5 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 IL X DANIEL ISACKSEN 7082164253 2160 SOUTH FIRST AVENUE MAYWOOD IL 601533328 ROGER SPOELMAN DIRECTOR; INT PRES & CEO AS OF 4/18 2.00 53.00 X X 0 993383 48564 ME CLEARY DIRECTOR; SECR & GCHSC PRES AT 3/18 55.00 0.00 X X 0 0 0 LARRY GOLDBERG CHAIR THR 12/17; DIR & CEO THR 2/18 2.00 53.00 X X 0 1615151 28733 SUSAN CONNER DIRECTOR; CHAIR AS OF 3/18 2.00 0.00 X X 0 0 0 MARC SCHWARTZ DIRECTOR 10/17-2/18;CHAIR 12/17-2/18 1.00 5.00 X X 0 0 0 LORI PRICE DIR & PRES THR 2/18; GOTTLIEB PRES 2.00 53.00 X X 0 631343 47049 YVONNE MURPHY MD DIR & VICE CHAIR AT 3/18; PHYSICIAN 50.00 0.00 X X 0 0 0 BLAINE PETERSEN DIR THR 12/17; TREAS & REGIONAL CFO 13.00 42.00 X X 0 798148 38275 JOY CUNNINGHAM DIRECTOR 10/17-2/18 1.00 5.00 X 0 0 0 OMAR DUQUE DIRECTOR 10/17-2/18 1.00 5.00 X 0 0 0 STEVE AN GOLDSTEIN MD DIRECTOR 10/17-2/18; LUMC PROFESSOR 1.00 5.00 X 0 618 602 LORI HEALEY DIRECTOR 10/17-2/18 1.00 5.00 X 0 0 0 SCOTT MIROWITZ MD DIRECTOR 10/17-2/18; LUMC PROFESSOR 1.00 49.00 X 0 608656 21229 JUAN MORENO DIRECTOR 10/17-2/18 1.00 5.00 X 0 0 0 REV JOHN O'CALLAGHAN SJ DIRECTOR 10/17-2/18 1.00 5.00 X 0 0 0 RONALD POTKUL MD DIRECTOR 10/17-2/18; LUMC PHYSICIAN 1.00 49.00 X 0 762061 43711 BRIAN PROCTOR DO DIRECTOR 10/17-2/18; GMH COMM CHR 1.00 11.00 X 0 25000 0 WILLIAM SMALL JR MD DIRECTOR 10/17-2/18; LUMC PROFESSOR 1.00 49.00 X 0 609260 33324 JOSEPH BRESNAHAN MD DIRECTOR AS OF 3/18; PHYSICIAN 2.00 0.00 X 0 0 0 ESTHER CORPUZ DIRECTOR AS OF 3/18 2.00 0.00 X 0 0 0 DAVID LEVY MD DIRECTOR AS OF 3/18; MED STAFF PRES 2.00 0.00 X 0 0 0 FRANCISCO MENCHACA DIRECTOR AS OF 3/18 2.00 0.00 X 0 0 0 ROBERT MIKOLS DPM DIRECTOR AS OF 3/18; PHYSICIAN 2.00 2.00 X 0 20813 0 RICHARD JOUSEF MONDRAGON DIRECTOR AS OF 3/18 2.00 0.00 X 0 0 0 SUSAN PORTO MD DIRECTOR AS OF 3/18; PHYSICIAN 50.00 0.00 X 0 0 0 FRANCES VLASSES DIRECTOR AS OF 3/18 2.00 0.00 X 0 0 0 DANIEL ISACKSEN ASST TREAS 12/17-2/18; GMH VP FIN 2.00 48.00 X 0 415350 32595 DONNA WALLACE ASST TREAS AT 3/18; REG CONTROLLER 2.00 48.00 X 0 129819 5599 JILL RAPPIS SEC THR 2/18; SVP LEGAL & GENL CNSL 2.00 48.00 X 0 438865 63302 MARIA PEKAR ASST SEC AT 12/17; ASSOC GENL CNSL 2.00 48.00 X 0 276190 62235 GLORIA MURRAY DIRECTOR GCHS FITNESS CENTER 50.00 0.00 X 123163 0 22441 ELLYN CHIN FORMER OFFICER; VP PAYOR STRATEGIES 0.00 40.00 X 0 328585 52425 AJAY SIAL FORMER OFFICER 0.00 0.00 X 0 278567 10666 123163 7931809 510750 1 1 1 0 CATALINA SERVICES INC 1350 LOUIS AVE ELK GROVE VILLAGE IL 60007 JANITORIAL SERVICES 113100 1 NET HEALTH PROGRAM SVC REV 622110 95441399 93815654 1625745 HFC MEMBERSHIP FEES 713940 1781098 1781098 97222497 509889 509889 39388 126801 39388 126801 0 0 210967 0 210967 210967 210967 OTHER RELATED REVENUE 622110 798229 638096 160133 INTERCOMPANY REVENUE 622110 583709 583709 CAFTERIA REVENUE 722514 258029 258029 1639967 99583320 96818557 1785878 978885 X 2670 2670 6425868 6077286 348582 113579 107418 6161 363301 343593 19708 300 284 16 64037 64037 44668831 42457080 2211751 170047 160822 9225 2185418 2066866 118552 2241101 2119529 121572 3137047 2957890 179157 22053 20857 1196 73265 69291 3974 3988469 3988469 2144749 2028403 116346 1905791 1802408 103383 MEDICAL SUPPLIES 15090357 15090357 HOSPITAL PROVIDER TAX 4791911 4791911 BAD DEBT 2879875 2879875 EQUIPMENT MAINTENANCE 2407836 2277219 130617 466606 441294 25312 93143111 89683522 3459589 0 4122195 5812898 63876227 21160 5178787 4000 2880762 28821719 5603808 7328702 23217911 42919999 27440655 132195002 10507916 17937871 21962813 321481272 576763 81137337 11049 13778 1107337 33401931 362578129 33989743 444836581 X -12026930 -123355309 -12026930 -123355309 21962813 321481272 X 6440209 205293 -117973881 X X 0 1 X 1 0 X 0.98170 0.01830 9909011 3292618 6616393 16839115 2311190 14527925 2073593 2073593 23217911 COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 9850492 F HEDGE FUNDS 5628852 F EQUITY METHOD INVESTMENTS 11961311 C 27440655 INTERCOMPANY ACCOUNTS RECEIVABLE 11351299 MISCELLANEOUS RECEIVABLES 6088807 OTHER CURRENT ASSETS 2528 INVESTMENT IN UNCONSOLIDATED AFFILIATES 495237 17937871 INTERCOMPANY ACCOUNTS PAYABLE 46319211 OTHER CURRENT LIABILITIES 1299272 INTERCOMPANY NOTES PAYABLE 313500000 ASSET RETIREMENT OBLIGATION 1263730 OTHER LONG-TERM LIABILITIES 195916 362578129 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 1065062 1065062 0.01180 22136219 19618719 2517500 0.02790 23201281 19618719 3582562 0.03970 23201281 19618719 3582562 0.03970 1 2879875 0 21728584 16069681 5658903 X 1 1 1 NOMCMACNEAL RAD THERAPY JV LLC RADIATION THERAPY 0.45000 0.00000 0.55000 1 1 MACNEAL HOSPITAL 3249 SOUTH OAK PARK AVENUE BERWYN IL 60402 0006106 X X X X MACNEAL HOSPITAL 1 0 1 0 0 1 X 200.000000000000 600.000000000000 X X X X X X 1 1 X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 MACNEAL HOSPITAL PART V, SECTION B, LINE 2: MACNEAL HOSPITAL WAS OPERATED BY VHS OF ILLINOIS, AN UNRELATED ORGANIZATION, FROM JULY 1, 2017 TO FEBRUARY 28, 2018. EFFECTIVE MARCH 1, 2018, GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION ACQUIRED THE HOSPITAL FACILITY FROM VHS OF ILLINOIS. MACNEAL 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. PART V, SECTION B, LINE 16A WWW.MACNEALHOSPITAL.ORG/FOR-PATIENTS/INSURANCE-FINANCIAL-SUPPORT/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 16B WWW.MACNEALHOSPITAL.ORG/FOR-PATIENTS/INSURANCE-FINANCIAL-SUPPORT/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 16C WWW.MACNEALHOSPITAL.ORG/FOR-PATIENTS/INSURANCE-FINANCIAL-SUPPORT/FINANCIAL-ASSISTANCE 17 1 - MACNEAL HOSPITAL CTR FOR CANCER CARE 6801 34TH ST STE 107 BERWYN IL 604025594 CANCER CENTER 2 - MACNEAL CENTER FOR INTERNAL MEDICINE 3722 S HARLEM AVE SUITE LL34 RIVERSIDE IL 605462312 OUTPATIENT CLINIC 3 - GCHSC OUTPATIENT CLINIC 3231 S EUCLID AVE 5TH FLOOR BERWYN IL 604023466 OUTPATIENT CLINIC 4 - MACNEAL WOUND CARE 3722 S HARLEM AVE STE 100 RIVERSIDE IL 605462320 OUTPATIENT CLINIC 5 - BERWYN MAGNETIC RESONANCE CENTER 3345 OAK PARK AVE BERWYN IL 604023434 IMAGING CENER 6 - GCHSC IMMEDIATE CARE 125 N LAGRANGE RD LAGRANGE IL 605252041 URGENT CARE 7 - BRIDGEVIEW THERAPY 7020 W 79TH ST BRIDGEVIEW IL 60455 OUTPATIENT CLINIC 8 - GCHSC DIABETES CLINIC 3722 S HAREN AVE STE 202 RIVERSIDE IL 605462331 OUTPATIENT CLINIC 9 - MACNEAL OUTPATIENT IMAGING 3722 S HARLEM AVE RIVERSIDE IL 605462312 IMAGING CENER 10 - MACNEAL PAIN CENTER 2550 SOUTH OAK PARK AVE BERWYN IL 604024661 OUTPATIENT CLINIC 11 - MACNEAL PSC 3231 S EUCLID AVE 1ST FLOOR BERWYN IL 60402 PATIENT DRAW STATION 12 - RIVERSIDE PSC 3722 S HARMEN AVE LOWER LEVEL RIVERSIDE IL 60546 PATIENT DRAW STATION 13 - CERMACK PSC 6425 W CERMAK BERWYN IL 60402 PATIENT DRAW STATION 14 - BRIDGEVEW PSC 7020 W 79TH STREET BRIDGEVIEW IL 60455 PATIENT DRAW STATION 15 - LAGRANGE PSC 47 S 6TH AVE 1ST FLOOR LAGRANGE IL 60525 PATIENT DRAW STATION 16 - RVER FOREST PSC 7411 W LAKE STREET STE L140 RIVERFOREST IL 60305 PATIENT DRAW STATION 17 - CHMG ARCHER OB-GYNE 6187 S ARCHER AVE SUITE 102 CHICAGO IL 60632 PATIENT DRAW STATION 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 COMMUNITY HEALTH SERVICES (GCHSC) PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT IT SUBMITS TO THE STATE OF ILLINOIS.IN ADDITION, GCHSC 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.GCHSC 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, $2,879,875, 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 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: GCHSC 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, GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION IS REPORTING ZERO ON LINE 3, SINCE THEORETICALLY ANY POTENTIAL CHARITY CARE SHOULD HAVE BEEN IDENTIFIED THROUGH THE PREDICTIVE MODEL. PART III, LINE 4: GCHSC 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: GCHSC 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 - MACNEAL HOSPITAL ASSESSES THE HEALTH STATUS OF ITS COMMUNITY 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 MAY USE PATIENT 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.SINCE MACNEAL HOSPITAL WAS ACQUIRED BY GCHSC IN THE 4TH QUARTER OF TAX YEAR 2017 AND IS NEWLY OPERATING AS A TAX-EXEMPT HOSPITAL, A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) HAS NOT BEEN CONDUCTED, BUT A CHNA WILL BE CONDUCTED WITHIN THE NEXT TWO TAX YEARS AS REQUIRED. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - GCHSC 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. GCHSC 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. GCHSC HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 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 - MACNEAL HOSPITAL IS A COMMUNITY TEACHING HOSPITAL THAT HAS BEEN IN BERWYN FOR ALMOST A CENTURY. ITS SERVICE AREA IS COMPRISED OF 27 ZIP CODE AREAS IN THE WESTERN SUBURBS AND CHICAGOLAND AREA. THE OVERALL SERVICE AREA HAS CLOSE TO 900,000 RESIDENTS AND LATINX COMPOSE NEARLY 50% OF TOTAL SERVICE AREA. THERE HAS BEEN AN OVERALL DECREASE IN MEDIAN HOUSEHOLD INCOME, AND SIGNIFICANT HEALTH DISPARITIES EXIST AMONGST NEIGHBORING COMMUNITIES. AT LEAST 10 HOSPITALS PROVIDE SERVICES TO ALL OR A PORTION OF THE SAME SERVICE AREA AS MACNEAL HOSPITAL AND FIVE OF THE ZIP CODES ARE DESIGNATED AS MEDICALLY UNDERSERVED OR MUP LOW INCOME. PART VI, LINE 5: OTHER INFORMATION - MACNEAL HOSPITAL IS COMMITTED TO EXTENDING ITS SERVICE TO THE COMMUNITY BEYOND THE HOSPITAL WALLS. IT HAS AN ACTIVE PRESENCE IN THE COMMUNITY BY PARTICIPATING IN 60 COMMUNITY EVENTS PROVIDING HEALTH EDUCATION INFORMATION, RESOURCES AND/OR SCREENINGS. EVENTS HAVE INCLUDED HEALTH FAIRS, KIDNEY SCREENINGS, AND A DINNER WITH A DOCTOR LECTURE SERIES WITH AUDIENCES INCLUSIVE OF A WIDE RANGE OF AGES, ETHNICITIES AND LANGUAGES. IN ADDITION, THROUGH THE VOLUNTEER SERVICES DEPARTMENT AND IN PARTNERSHIP WITH BOY SCOUTS OF AMERICA, MACNEAL OFFERS THE HEALTH EXPLORERS PROGRAM TO 12 STUDENTS FROM LOCAL AREA HOSPITALS. THIS PROGRAM PROVIDES AN OPPORTUNITY FOR STUDENTS TO LEARN ABOUT NUMEROUS HEALTH CAREERS AND VOLUNTEER IN A DEPARTMENT OR UNIT WITHIN THE HOSPITAL AND AT COMMUNITY EVENTS THAT THE HOSPITAL PARTICIPATES IN OR HOSTS.MACNEAL HOSPITAL PARTICIPATED IN ADVOCACY EFFORTS TO PASS TOBACCO 21 LEGISLATION IN THE STATE OF ILLINOIS, WHICH PASSED IN BOTH THE HOUSE AND SENATE. UNFORTUNATELY THE GOVERNOR VETOED THE BILL. WE WILL CONTINUE TO PURSUE TOBACCO 21 LEGISLATION WITH THE NEWLY ELECTED ADMINISTRATION AT THE STATE.MACNEAL HAS STARTED ITS JOURNEY FOR BABY-FRIENDLY DESIGNATION WITH AN ASSESSMENT, AND HAS A GOAL TO COMPLETE AT LEAST 9 OF THE 10 COMPETENCIES BY THE END OF FY19. BABY-FRIENDLY HOSPITALS ARE HOSPITALS THAT ARE RECOGNIZED FOR ENCOURAGING BREASTFEEDING AND MOTHER/BABY BONDING, WHICH IS KNOWN TO PROVIDE HEALTH BENEFITS FOR INFANTS, CHILDREN, AND MOTHERS. PART VI, LINE 6: GCHSC 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 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 CHAIR THR 12/17; DIR & CEO THR 2/18 0 870178 0 346231 0 398742 0 12150 0 16583 0 1643884 0 183120 LORI PRICE DIR & PRES THR 2/18; GOTTLIEB PRES 0 360610 0 157823 0 112910 0 20250 0 26799 0 678392 0 14438 BLAINE PETERSEN DIR THR 12/17; TREAS & REGIONAL CFO 0 557910 0 159838 0 80400 0 12150 0 26125 0 836423 0 0 SCOTT MIROWITZ MD DIRECTOR 10/17-2/18; LUMC PROFESSOR 0 541514 0 51273 0 15869 0 12150 0 9079 0 629885 0 0 RONALD POTKUL MD DIRECTOR 10/17-2/18; LUMC PHYSICIAN 0 688759 0 63793 0 9509 0 20250 0 23461 0 805772 0 0 WILLIAM SMALL JR MD DIRECTOR 10/17-2/18; LUMC PROFESSOR 0 543506 0 48140 0 17614 0 12150 0 21174 0 642584 0 0 DANIEL ISACKSEN ASST TREAS 12/17-2/18; GMH VP FIN 0 362229 0 52626 0 495 0 8100 0 24495 0 447945 0 0 JILL RAPPIS SEC THR 2/18; SVP LEGAL & GENL CNSL 0 340242 0 91673 0 6950 0 48465 0 14837 0 502167 0 0 MARIA PEKAR ASST SEC AT 12/17; ASSOC GENL CNSL 0 247668 0 27455 0 1067 0 39062 0 23173 0 338425 0 0 ELLYN CHIN FORMER OFFICER; VP PAYOR STRATEGIES 0 283346 0 44577 0 662 0 28350 0 24075 0 381010 0 0 AJAY SIAL FORMER OFFICER 0 0 0 0 0 278567 0 0 0 10666 0 289233 0 281131 PART I, LINE 3 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION'S PRESIDENT 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 COMMUNITY HEALTH SERVICES CORPORATION'S PRESIDENT: - 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 INDIVIDUAL RECEIVED SEVERANCE PAYMENTS IN CALENDAR 2017. THIS AMOUNT IS INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: AJAY SIAL - $281,131 COLUMN (F) OF SCHEDULE J, PART II INCLUDES THE PORTION OF THIS AMOUNT THAT WAS REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2017. THE PLAN WILL PROVIDE 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: LARRY GOLDBERG - $189,922 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: 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. BHS DIGESTIVE DISEASE ASSOCIATES JOSEPH BRESNAHAN, MD, DIRECTOR, IS AN OWNER OF BHS DIGESTIVE DISEASE 160133 BHS DIGESTIVE DISEASE PROVIDED BILLING SERVICES TO GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 0 ARCHER FAMILY MEDICINE DAVID LEVY, MD, DIRECTOR, IS AN OWNER OF ARCHER FAMILY MEDICINE 61062 ARCHER FAMILY MEDICINE PAID RENT REVENUE TO GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 0 FORM 990, PART III, LINE 2 UNTIL MARCH 1, 2018, THE GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION (GCHSC) WAS CLASSIFIED AS A SEC. 509(A)(2) PUBLIC CHARITY. EFFECTIVE MARCH 1, 2018, GCHSC PURCHASED THE ASSETS AND LIABILITIES OF VHS OF ILLINOIS. THE PURCHASE INCLUDED THE PURCHASE OF MACNEAL HOSPITAL, AND THEREFORE GCHSC IS NOW CLASSIFIED AS A SEC. 509(A)(1) PUBLIC CHARITY BECAUSE IT OPERATES AS A HOSPITAL AS DESCRIBED UNDER SEC. 170(B)(1)(A)(III). FORM 990, PART III, LINE 3 EFFECTIVE JUNE 30, 2018, GCHSC TRANSFERRED THE OPERATIONS OF THE FITNESS CENTER TO GOTTLIEB MEMORIAL HOSPITAL. FORM 990, PART VI, SECTION A, LINE 4 THE ARTICLES OF INCORPORATION AND BYLAWS OF GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION WERE AMENDED AND RESTATED TO CHANGE THE SOLE MEMBER. EFFECTIVE OCTOBER 27, 2017, THE SOLE MEMBER IS LOYOLA UNIVERSITY HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 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 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION. LOYOLA UNIVERSITY HEALTH SYSTEM HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION. 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 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 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 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 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 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION, 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 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 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 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION (OR A DELEGATED COMMITTEE OF THE BOARD) ON A YEARLY BASIS. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION (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 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION. 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 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION'S PRESIDENT AND CERTAIN OFFICERS IS ESTABLISHED AND PAID BY TRINITY HEALTH, A RELATED ORGANIZATION. IN ESTABLISHING PRESIDENT 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 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 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 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 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. GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 34,721,742. MANAGEMENT AND GENERAL EXPENSES 1,991,576. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,713,318. MEDICAL SPECIALIST FEES: PROGRAM SERVICE EXPENSES 3,374,920. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,374,920. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 521,826. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 521,826. MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 791,254. MANAGEMENT AND GENERAL EXPENSES 45,385. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 836,639. BILLING SERVICES: PROGRAM SERVICE EXPENSES 3,009,457. MANAGEMENT AND GENERAL EXPENSES 172,617. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,182,074. RECRUITING SERVICES: PROGRAM SERVICE EXPENSES 37,881. MANAGEMENT AND GENERAL EXPENSES 2,173. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,054. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS TO AFFILIATES -117,973,618. EQUITY LOSS IN UNCONSOLIDATED AFFILIATES -263. FORM 990, PART XII, LINE 2: GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY18 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. FORM 990, PAGE 1, DOING BUSINESS AS NAMES: MACNEAL MEDICAL GROUP MACNEAL HOSPITAL MACNEAL HOSPITAL SNF CHICAGO HEALTH SYSTEM ACO LLC 750 PASQUINELLI DRIVE SUITE 204 WESTMONT IL 60559 453020116 ACCOUNTABLE CARE ORGANIZATION IL 0 21903 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION L MEDICINE LABS LLC 701 W NORTH AVE MELROSE PARK IL 60160 371878743 LABORATORY SERVICES IL 1625744 1262702 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 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 0 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 1 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 10720 COLUMBIA PIKE SILVER SPRING MD 20901 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 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