2019-05-14T09:07:33-05:00 2018-06-30 KPMG LLP 191 West Nationwide Blvd Ste 500 Columbus OH 432152568 990 2017-07-01 362338884 Northern Illinois Medical Center % ROBERT GERECKE NORT 3129262000 541 N FAIRBANKS CT STE 1630 CHICAGO IL 606113309 MICHAEL S EESLEY CEO 8157885800 2019-05-08 true Mollie P Longhouse P00294881 6142492300 2019-05-07 167.68.102.5 31017320191345000003 2019-05-14 P 9C3345A26C8B7EBF72BA8D1496178D02933C26EF 45A8568F3D6DD65DED9B8AFD68B75215B242B44C 2017 2019-02-21 02:37:17Z X MICHAEL S EESLEY 385 MILLENNIUM DRIVE CRYSTAL LAKE IL 60012 485603540 false X WWW.CENTEGRA.ORG X 1956 IL TO PROVIDE QUALITY HEALTH CARE SERVICES WITH INNOVATIVE AND RESPONSIBLE USE OF RESOURCES AND PROMOTE WELLNESS FOR THE MCHENRY COUNTY AREA. 14 11 2423 423 783333 -114495 1410013 388989 399424106 473231902 3688685 4061670 7229649 5280535 411752453 482963096 0 0 0 0 137698531 156078913 0 0 0 281693243 306582029 419391774 462660942 -7639321 20302154 476545169 487411971 326804205 342098023 149740964 145313948 X The primary mission of Northern Illinois Medical Center is to provide quality health care services with innovative and responsible use of resources and promote wellness for the greater McHenry County area. false false 430674302 473437029 See Schedule O 430674302 true true false false false false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false true false false false false false false true false false false true 16 0 true 2423 true true true false false false false false false false false false X 14 11 true false false false true true false true true false false false true true true true true true true true true IL X ROBERT GERECKE 3129269495 541 N FAIRBANKS CT RM 1639 CHICAGO IL 606113309 MICHAEL EESLEY CHIEF EXECUTIVE OFFICER 0.0 40.0 X X 0 2316338 46299 CHARIE ZANCK BOARD OF GOVERNORS 0.0 4.0 X 0 0 0 CHARLES RUTH BOARD OF GOVERNORS 0.0 2.0 X 0 0 0 CHRIS NEWKIRK BOARD OF GOVERNORS 0.0 1.0 X 0 0 0 DAVE DOMEK BOARD OF GOVERNORS 0.0 3.0 X 0 0 0 IRFAN HAFIZ BOARD OF GOVERNORS / SVP - CMO 0.0 40.0 X 0 420299 1976 JIM THORPE BOARD OF GOVERNORS 1.0 2.0 X 0 0 0 LISA GLOSSON MD BOARD OF GOVERNORS 0.0 40.0 X 0 256745 30698 MICHAEL LUECHT BOARD OF GOVERNORS 0.0 4.0 X 0 0 0 MIKE CURRAN BOARD OF GOVERNORS 0.0 1.0 X 0 0 0 PAULA DORION GRAY BOARD OF GOVERNORS 1.0 2.0 X 0 0 0 TERRANCE BUGNO BOARD OF GOVERNORS 0.0 2.0 X 0 0 0 TOM CAREY Board of Directors 0.0 2.0 X 0 0 0 WILLIAM BUSSE Board of Directors 0.0 2.0 X 0 0 0 DAVID TOMLINSON EVP - CFO 0.0 40.0 X 0 1044771 63657 JASON SCIARRO PRESIDENT / COO- Termed 5/2018 0.0 40.0 X 0 785924 59571 Kumar Nathan Pres. Insur. Svcs./Gen Counsel 0.0 40.0 X 0 571084 62277 RACHEL SEBASTIAN PRESIDENT - CHM 40.0 0.0 X 0 467740 38841 SHEILA SENN SVP - COO - CHH- Termed 3/2018 20.0 20.0 X 0 295338 38654 CONNIE SECOR DIRECT SURG/CARD- Termed 10/17 40.0 0.0 X 166785 0 4110 JOHN GEINOPOLOS MEDICAL PHYSICIST 40.0 0.0 X 188466 0 59194 Lisa Evan PHARMD IP NGT 40.0 0.0 X 167766 0 22833 SUSAN CORCORAN CLINICAL STAFF PHARMACIST 40.0 0.0 X 178634 0 60603 WEIHONG HE MEDICAL PHYSICIST 40.0 0.0 X 217333 0 56896 918984 6158239 545609 119 false true false CARDINAL HEALTH - AURORA DIV 7000 CARDINAL PL DUBLIN OH 43017 HEALTHCARE SERVICES 23590001 SODEXO INC AFFILIATES PO BOX 352 BUFFALO NY 14240 HOUSEKEEPING 4641060 FFF ENTERPRISES 41093 COUNTY CENTER DRIVE TEMECULA CA 92591 HEALTHCARE SERVICES 2155260 GE HEALTHCARE 3000 N GRANDVIEW BLVD WAUKESHA WI 53188 HEALTHCARE SERVICES 1940791 ARUP LABORATORIES PO BOX 27964 SALT LAKE CITY UT 84127 LABORATORY SERVICES 1885675 78 293547 95442 388989 ANCILLARY OUTPATIENT SERVICES 621110 351207628 351207628 ANCILLARY INPATIENT SERVICES 621110 110101934 110101934 IDPA PROVIDER TAX REVENUE 621110 11922340 11922340 473231902 4588848 4588848 107 107 0 11518 11518 0 11518 11518 2113159 2439895 200549 -326736 -200549 -527285 -527285 0 0 0 0 0 0 0 0 0 CHILD DAY CARE /RETAIL PHARMACY/LACTATION 624410 2546538 783333 1763205 CAFETERIA SERVICES/EDUCATION 900099 1751535 1751535 RELATED COMPANY REVENUE 900099 205127 205127 765817 765817 5269017 482963096 473437029 783333 8353745 X 0 0 0 0 1321893 1321893 0 126516485 115075174 11441311 -864378 -786584 -77794 20712136 18848044 1864092 8392777 7637427 755350 1362716 1362716 5402 5402 0 0 0 0 21478849 19740944 1737905 4381 4381 96492565 95895219 597346 16674 15899 775 0 7834478 6817507 1016971 134133 92818 41315 0 133804 102620 31184 12024094 10941925 1082169 0 19394122 17648652 1745470 2437007 2217675 219332 RELATED COMPANY - CHS 78510624 71444668 7065956 BAD DEBT 33105551 33105551 RELATED COMPANY - CMS 15303139 15303139 IDA PROVIDER TAX 8880655 8880655 9463835 7688588 1775247 462660942 430674302 31986640 0 92587 -120074 42550177 20034601 0 0 59004288 60920449 0 0 0 0 0 0 8897834 9874673 1802900 1735314 431095522 168175119 276571875 262920403 74832266 78144435 0 0 6623112 6446654 0 0 6170130 47455516 476545169 487411971 217184003 231688605 0 0 0 0 108489024 109147647 0 0 0 0 0 0 0 0 1131178 1261771 326804205 342098023 X 146106844 141835870 3634120 3478078 0 0 149740964 145313948 476545169 487411971 X 20302154 345811 -25074981 X false true X true false X 116338 116338 248384712 57405524 190979188 15562587 1965343 13597244 157043169 108270603 48772566 9988716 533649 9455067 262920403 INTERCOMPANY RECEIVABLES 46543485 OTHER RECEIVABLES 912031 47455516 0 PROFESSIONAL LIABILITY 1261771 1261771 X Form Sch D Part X Line 2 ASC Topic 740, Income Taxes, addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded on the consolidated financial statements. Under ASC Topic 740, the Medical Center must recgonize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financials statements from such a position are measured based on the largest benefit that has the greater than fifty percent likelihood of being realized upon ultimate settlement. ASC Topic 740 also provides guidance on derecognition, classification, interest and penalties on income taxes, and accounting in interim periods and requires increased disclosures. As of June 30, 2018 and 2017 the Health System does not have a liability for unrecognized tax benefits. true true X true X true X 600. true true true false true true 5900429 5900429 0.01280 43255916 23711748 19544168 0.04220 49156345 23711748 25444597 0.05500 286396 286396 0.00060 662029 662029 0.00140 26140 26140 0.00010 974565 974565 0.00210 50130910 23711748 26419162 0.05710 true 33105551 156041612 190986298 -34944686 X true true ALGON RD SURGERT CTR OUTPATIENT SURGICAL SERVICES 0.1275 ARSC REAL ESTATE PROPERTY MANAGEMENT 0.25 2 1 NORTHERN ILLINOIS MEDICAL CENTER 385 MILLENNIUM DRIVE CRYSTAL LAKE IL 60012 3889 X X X X Cancer Center 2 CENTEGRA HOSPITAL-HUNTLEY 385 MILLENNIUM DRIVE CRYSTAL LAKE IL 60012 3889 X X X X NORTHERN ILLINOIS MEDICAL CENTER 1 false false true X X X X X X X X 17 true true true true X See Part V X See Part V X true 17 true See Part V false true X 200. 600. X X X X X X true true X X X X true X CENTEGRA.ORG/financial-assistance X CENTEGRA.ORG/financial-assistance X SAME AS 16A & 16B X X X X X X true X false X X X X true X false false Centegra Hospital-Huntley 2 true true true X X X X X X X X 17 true true true true X See Part V X See Part V X true 17 true See Part V false true X 200. 600. X X X X X X true true X X X X true X CENTEGRA.ORG/financial-assistance X CENTEGRA.ORG/financial-assistance X SAME AS 16A & 16B X X X X X X true X false X X X X true X false false FACILITY INFORMATION Form Sch H Part V Line 2 CENTEGRA HOSPITAL - HUNTLEY WAS PLACED INTO SERVICE IN AUGUST 2016. CENTEGRA HOSPITAL - HUNTLEY IS A 128 BED HOSPITAL IN HUNTLEY, ILLINOIS. IT PROVIDES SOPHISTICATED TREATMENTS AND ADVANCED TECHNOLOGY TO ADDRESS THE MOST SERIOUS MEDICAL CONDITIONS. THESE INCLUDE - LEVEL II TRAUMA DEPARTMENT 8-BED INTENSIVE CARE UNIT FAMILY BIRTH CENTER CHEST PAIN CENTER CARDIAC CATHERIZATION AND CARDIOLOGY SERVICES A FULL RANGE OF DIAGNOSTIC IMAGING ACCOUNT INPUT FROM PERSON WHO REPRESENT THE COMMUNITY Form Sch H Part V Line 5 In pursuit of a healthier community, the 2017 McHenry County Healthy Community partners commissioned a set of studies to measure and monitor the overall health of the county. With the intent of identifying the most pressing needs, the six funding partners in conjunction with 25 additional community organizations, known collectively as the MAPP agencies, will use the studies' findings to assess multiple dimensions of life in McHenry County. Similar needs assessments were completed in 2006, 2010 and 2014. The MAPP (Mobilizing for Action through Partnerships and Planning) process has been used since 2010. Each of the three studies was designed to examine the health of McHenry County from a different perspective: The Community Survey targeted the county as a whole and was open to all persons 18 years and older who lived or worked in the county. Survey participants numbered 1,090 which included 774 electronic replies and 316 paper returns. Surpassing the 2014 survey response by 46.5%, the impressive volume of replies demonstrates the value of broad and multi-layer promotion about the survey. Focus groups sought information through discussion with target populations and community leaders. Target population focus groups included 1) persons with mental illness, substance abuse, disabilities, and their parents, 2) Hispanics/Latinos 3) veterans 4) low-income mothers. Total participants in the five target population focus groups numbered 59. For community leaders, three separate focus groups were conducted. Of the 50 community leaders invited to attend, 29 persons took part. Community leaders involved in the focus groups were comprised of: Claudia Aquilina, Office Coordinator Senior Services, Inc.; Susan Bauer, Executive Director, Harvard Area Community Health Center; Julie Biel Claussen, Executive Director, Harvard Area Community Health Center; Denise Bowman, Training and Community Development, McHenry County Mental Health Board; Terry Braune, Compliance and Operations Manager, McHenry County Mental Health Board; Robin Doeden, Executive Director, McHenry County Community Foundation; Michael Eesley, CEO, Centegra Health System; Jane Farmer, Executive Director, Turning Point; Laura Franz, Executive Director, Transitional Living Services; Bona Heinsohn, President, McHenry County Conservation District; Scott Hennings; Principal Transportation Planner, McHenry County Government; Michael Hill, Administrator, McHenry County Department of Health; Suzanne Hoban, Executive Director, Family Health Partnership Clinic; Aimee Knop, Sheriff's Deputy, McHenry County Sheriff's Office; Art Krzyzanowski, Program Director, Thresholds; Ashley Lach, Manager, American Cancer Society; Kim Larson, Executive Director, Family Alliance; Mary McCann, County Board Member, McHenry County; Scott Naydenoff, Deputy Chief of Field Operations, Cary Police Department; Steve Otten, Executive Director, United Way of Greater McHenry County; Walt Pesterfield, Director, Department of Probation and Court Services; Dennis Sandquist, Director, McHenry County Planning and Development; Gerald Schalk, Chaplain, Fox River Fire District; Nancy Schietzelt, President, McHenry County Environmental Defenders; Todd Schroll, Director of Behavioral Health Services, Centegra Health System; Rebecca Stiemke, Executive Director, Volunteer Center of McHenry County; Cindy Sullivan, Executive Director, Options and Advocacy; Toni Weaver, President, PFLAG; James Wiseman, Executive Director, Northern IL Special Recreation Association. The Community Analysis gathered secondary data about McHenry County. A description of McHenry County's demographic, social, economic and health characteristics using secondary sources of information that draws extensively on the U.S. Census and Centers for Disease Control and Prevention, National Center for Health Statistics products as well as numerous other sources. CHNA CONDUCTED WITH OTHER HOSPITAL FACILITIES Form Sch H Part V Line 6a Advocate Good Shepherd Hospital and Advocate Sherman Hospital CHNA CONDUCTED WITH OTHER FACILITIES Form Sch H Part V Line 6b The 2017 McHenry County Healthy Community Study was directed by six partners. They were: Advocate Health Care, Centegra Health System, McHenry County Department of Health, McHenry County Mental Health Board, McHenry County Substance Abuse Coalition, and United Way of Greater McHenry County. Form Sch H Part V Line 7a https://centegra.org/mchenry-county-healthy-community-study Form Sch H Part V Line 7b i. https://www.mchenrycountyil.gov/county-government/departments-a-i/ health-department/health-administration/strategic-planning ii. https://www.mchenrycountyil.gov/home/showdocument?id=71454 Form Sch H Part V Line 10a https://centegra.org/mchenry-county-healthy-community-study HOW THE HOSPITAL IS ADDRESSING NEEDS AND NEEDS NOT ADDRESSED Form Sch H Part V Line 11 Centegra Health System adopted an Implementation Strategy on behalf of its three hospitals, Centegra Hospital-McHenry, Centegra Hospital-Huntley and Centegra Hospital-Woodstock, to lay out the ways our teams will address our community's health needs through 2020. As Centegra Health System continues to grow and evolve, these strategies may be amended to most effectively utilize the system's capabilities. While this Implementation Strategy addresses the priorities identified in its 2017 Community Health Needs Assessment, Centegra will also continue to offer a wide range of other services to meet additional needs that have been identified by our health system. Centegra Health System and its hospitals also are an active member in McHenry County MAPP (Mobilizing for Action through Partnerships), which has workgroups focused around the following high-priority issues facing the County: Obesity, Cardiovascular health, Active Communities, and Behavioral Health. Centegra Health System has representation on each workgroup, which partners with area organizations including the McHenry County Department of Health to establish goals and strategies to improve the health of our community. There are certain needs identified in the CHNA that are not being addressed by Centegra Health System. These needs include areas of which Centegra Health System has no expertise, and falls outside the scope of care in which Centegra Health System provides to the community. Several of Centegra Health System's CHNA partner organizations are addressing these needs. Community Benefits Program Activity Highlights: Preventative Health (7/1/2017-6/30-2018) Big Latch On, Mommy Mingle Fair Centegra Health System takes part as a host site for the Big Latch On global initiative each August. The event welcomes breastfeeding mothers and babies to come and be counted in the Big Latch On a yearly total to promote and encourage breastfeeding. The Mommy Mingle Fair immediately follows the Big Latch On and includes vendors who promote services and products for health and wellness. McHenry County police officers and Safe Kids provide free car seat safety checks in the parking lot. In FY18, this initiative totaled 100 participants. Blood Pressure Screenings The Sun City residential community offers The Wellness Center at Sun City in partnership with Centegra Health System. This on-site service provides health education, screenings and healthcare support to residents while enabling easy access to experienced providers on staff. Walk-in blood pressure screenings are available every day. In FY18, this initiative totaled 104 participants. Know Your Numbers This event was held twice and included an 8- to 12-hour fasting finger-stick blood test for cholesterol, blood sugar, blood pressure and body mass index. Attendees received a one-on-one consultation to review their results with a physician, and had access to health experts in cardiology, oncology, sleep and neuro-rehabilitation. In FY18, this initiative totaled 68 participants. Concussion Screenings The Centegra Sports Concussion Program provides a cognitive baseline assessment and the necessary follow-up care for students and individuals in youth sports programs between the ages of 10-18. The full assessment is done using the ImPACT test: . An online testing program used to test cognitive ability with certified impact consultants. . The program measures multiple aspects of cognitive function in athletes including working memory, reaction time, speed and concentration. In FY18, this initiative totaled 8,000 participants. Freshstart Tobacco Cessation Program Freshstart is the American Cancer Society's 6-week, group-based, tobacco cessation, counseling program. The program is designed to help participants stop smoking by providing essential information, skills for coping with cravings and group support. In FY18, this initiative totaled 12 participants. Patient Transportation Free transportation is made available to or from a Centegra Health System facility for people who do not have a driver's license, who are being admitted or discharged from the hospital, who are undergoing treatment that prohibits driving, or for patients without any other means of transportation. In FY18, this initiative totaled 14,500 participants. Poison Prevention Education Poison prevention education and resources from the Illinois Poison Center are provided by Centegra Health System nurses to elementary students at the kindergarten level once a year. This program is intended to educate the kindergartener and their family on poison prevention and safety, and what to do if someone is exposed to a potentially poisonous item. The goal is to prevent accidental poisonings and introduce the Illinois Poison Center phone number to the community. In FY18, this initiative totaled 2,920 participants. Skin Cancer Screenings Monthly screenings are provided between May and September by a board-certified dermatologist or a certified physician assistant. A thorough examination of the skin is performed to detect suspicious lesions and any precancerous changes. In FY18, this initiative totaled 31 participants. INCOME LEVEL OTHER THAN FPG Form Sch H Part V Line 13B In addition to the documented 200% of FPG, we also provide a sliding scale discount of 80% for those who have FPG up to 350%. In addition we have presumption charity which allows for charity discounts/financial assistance to those who currently meet Medicaid eligibility or other state programs based on FPG who may not have had insurance coverage at the time of the service we provided. OTHER FACTORS USED IN DETERMINING AMOUNTS CHARGED PATIENTS Form Sch H Part V Line 13h All patients are charged the same for services rendered. Patients may qualify for free or discounted care as described in Part VI, Line 3. Eligibility for financial assistance depends on factors such as income level, asset level and medical indigency. 28 CENTEGRA PHYSICIAN CARE 3707 DOTY RD MOB 2 STE C-E G H WOODSTOCK IL 60098 HOSPITAL OUTPATIENT DEPARTMENT CENTEGRA CARDIACPULMONARY REHAB 4309 MEDICAL CENTER DR SUITE B104 MCHENRY IL 60050 Other health care facility CENTEGRA GAVERS BREAST CENTER DIV 360 N TERRA COTTA RD CRYSTAL LAKE IL 60012 Other health care facility CENTEGRA HEALTH CENTER 360 STATION DR CRYSTAL LAKE IL 60014 Other health care facility CENTEGRA HEALTH CENTER 420 N IL ROUTE 31 CRYSTAL LAKE IL 60012 HOSPITAL BASED LOCATION CENTEGRA HEALTH CENTER 10350 HALIGUS RD 100 HUNTLEY IL 60142 Other health care facility CENTEGRA HEALTH CENTER-WEST DUNDEE 1925 HUNTLEY RD WEST DUNDEE IL 60118 HOSPITAL BASED LOCATION CENTEGRA HEALTHY LIVING INSTITUTE 10350 HALIGUS RD 220 HUNTLEY IL 60142 Other health care facility CENTEGRA HOSPITAL 10370 HALIGUS RD HUNTLEY IL 60142 HOSPITAL BASED CENTEGRA HOSPITAL - HUNTLEY 10400 HALIGUS RD HUNTLEY IL 60142 PROVIDER-BASED REMOTE LOCATION CENTEGRA HOSPITAL-MCHENRY 4309 W MEDICAL CENTER DR A200-B MCHENRY IL 60050 Other health care facility CENTEGRA MILESTONES THERAPY CENTER 394 FEDERAL DR CRYSTAL LAKE IL 60014 Other health care facility CENTEGRA NEURO REHABILITATION CENTER 500 COVENTRY LN 170 CRYSTAL LAKE IL 60014 Other health care facility CENTEGRA PHYSICAN CARE 690 E TERRA COTTA AVE CRYSTAL LAKE IL 60014 Other health care facility CENTEGRA PHYSICAN CARE 4309 W MEDICAL CENTER DR MCHENRY IL 60050 Other health care facility CENTEGRA PHYSICIAN CARE 248 E GRAND AVE FOX LAKE IL 60020 Hospital Based Location CENTEGRA PHYSICIAN CARE 1906 HOLIAN DR SPRING GROVE IL 60081 Other health care facility CENTEGRA PHYSICIAN CARE 10350 HALIGUS RD 200 HUNTLEY IL 60142 Other health care facility CENTEGRA PHYSICIAN CARE 750 E TERRA COTTA AVE CRYSTAL LAKE IL 60014 Other health care facility CENTEGRA PHYSICIAN CARE 650 DAKOTA ST CRYSTAL LAKE IL 60012 Other health care facility CENTEGRA PHYSICIAN CARE 1465 COMMERCE DR ALGONQUIN IL 60102 Other health care facility CENTEGRA REHABILITATION & SPORTS MEDICIN 4305 MEDICAL CENTER DR 3 MCHENRY IL 60050 Other health care facility CENTEGRA REHABILITATION & SPORTS MEDICIN 333 FRONT ST MCHENRY IL 60050 Other health care facility CENTEGRA REHABILITATION & SPORTS MEDICIN 3703 DOTY RD 5 WOODSTOCK IL 60098 Other health care facility CENTEGRA REHABILITATION & SPORTS MEDICIN 10450 ALGONQUIN RD HUNTLEY IL 60142 Other health care facility CENTEGRA REHABILITATION & SPORTS MEDICIN 201 N THROOP ST WOODSTOCK IL 60098 Other health care facility CENTEGRA REHABILITATION & SPORTS MEDICIN 200 E CONGRESS PKWY CRYSTAL LAKE IL 60014 Other health care facility CENTEGRA SAGE CANCER CENTER DIV 4305 MEDICAL CENTER DR A MCHENRY IL 60050 Other health care facility Financial Assistance and Community Benefits Form Sch H Part I Line 7 Line 7a-7c amounts are calculated using the Medicare cost to charge ratio. Line 7e-7i dollars are calculated from community benefit reports that are submitted by the Hospital departments for various activities and support groups that benefit the community. METHODOLOGY USED TO ESTIMATE BAD DEBT EXPENSE Form Sch H Part III Line 2 In estimating allowances for doubtful accounts, the Health System analyzes past history, existing trends, and payer sources to determine the reserves needed. BAD DEBT EXPENSE Form Sch H Part III Line 4 In estimating allowances for doubtful accounts, the Health System analyzes past history, existing trends, and payer sources to determine the reserves needed. Please reference the notes to the audited financial statements for information on the allowances for doubtful accounts. EXPLANATION OF SHORTFALL AS COMMUNITY BENEFIT Form Sch H Part III Line 8 The amount shown in line 6 represents the actual costs incurred to treat Medicare patients and is calculated by applying the Medicare cost-to-charge ratio. Therefore, the entire amount of line 7 constitutes a community benefit. PROVISIONS ON COLLECTION PRACTICES FOR QUALIFIED PATIENTS Form Sch H Part III Line 9b Centegra provides patients with consistent information on payment expectations and assists them in meeting their financial obligations. A written explanation of the payment requirements categorized by type of payor is given prior to admission/registration or upon admission/registration of each Centegra health system (CHS) patient. Centegra will bill the patient's insurance carrier. Procedures will be implemented over time and by area to collect as much as possible of the time of service unless payor contracts require billing (i.e., no assignments). 1. Admission reservation/outpatient appointment made by physician/patient. Walk-in and emergency department patients present for service. 2. Perform the patient pre-registration for applicable scheduled registrations. 3. Patient verbal consent obtained and annotated except where prohibited by law. ""On (date) at about (time), (patient or representative) orally authorized (site name) to release information concerning the patient's medical care, treatment and diagnosis to employers, insurance companies, government agencies or third-party payors and their agents, for verification of benefits and pre-certification. I (the pre-registrar) did not obtain a written consent signed by the patient, due to the patient not being physically present and limited time constraints."" This statement would be signed and dated by the pre-registrar. Patient refusal to provide oral consent requires patient notification of potential penalties and places the burden on the patient to complete payor requirements. 4. Complete insurance verification and initiate pre-certification. 5. Estimate the approximate cost of services and advise the responsible party. Explanation of the cost will fluctuate based on services ordered by the physicians. 6. Discuss the financial requirements, including payment expectations with the patient/guarantor prior to admission/registration when applicable. 7. Interview conducted by financial counselor of patients who express difficulty in meeting Centegra's payment requirements. 8. Admission/registration of patient is completed. Patient/guarantor signature for the consent to release information obtained. 9. Collect the estimated patient share. The deductible and co-payments and any non-covered amounts quoted by the carrier are due from inpatients prior to discharge and where possible, for outpatients prior to or at the time of registration. 10. Self-pay accounts are to be paid in full or screened by the financial counselor for potential state or federal program, financial assistance application or payment plan. 11. Policy regarding non-compliance with respect to payment arrangements or plans: Self-pay: patients who have not completed arrangements for one of the payment options within 120 days of the billing date will be automatically turned over to a collection agency. Broken promise/defaults: patients with delinquent payments, 15 or more days late, will be turned over to a collection agency. After insurance: processing patients who have not made payments or enrolled in one of the payment options for co-insurance and deductible amounts within 120 days of insurance payment will be turned over to a collection agency. NEEDS ASSESSMENT Form Sch H Part VI Line 2 Centegra health system identifies community health care priorities and develops activities and strategies to meet the health care needs of at risk populations within its service area. These community benefit programs promote community wellness and disease prevention, enhance community health education, and improve the quality of clinical education. In 2016, centegra health system partnered with the mchenry county health department and other hospitals and organizations to conduct the 2017 mchenry county healthy community study. The intent of the needs assessment was to understand and address the county's most pressing needs, involving partners from diverse organizations, in order to improve the health of county residents. A thorough understanding of the county's health was measured using four assessments, each from a different perspective including residents, populations in need of services, community leaders, and descriptors using secondary data sources. Through the assessments, knowledge was gained about the current health status of county residents, demographic trends, social and economic indicators, health behaviors, and utilization of health services. The assessments also attempted to understand the perceptions of community strengths and weaknesses as well as answer questions about the health and human services delivery system, unmet needs, gaps, and barriers to care. PATIENT EDUCATION OF ELIGIBILITY OF ASSISTANCE Form Sch H Part VI Line 3 Uninsured patients arriving at our emergency department and/or direct admits are screened at time of service by either an emergency department financial counselor or the health system's in-patient financial counseling team, public aid representatives, and a medication assistance coordinator to identify eligibility guidelines for federal, state and local government programs, as well as charity care. CHS's self-pay process includes a screening which is completed by using hospital form c910050 03-09 prompting an interview offering payment options and eligibility guidelines. It is at this time that a patient becomes aware of the hospital uninsured patient discount act, Medicaid, medication assistance programs, crime victims, IBCCP, cash pay fee schedules, and other hospital discount incentives. Patients are advised of timeline for completing application processes at time of service in person. Appropriate scripting is followed by CHS associates. Discounts were established following the 200%, 350% and 600% federal poverty guidelines to assist in determining charity adjustments. Applications were designed by CHS self-pay committee in accordance to our financial policy (policy number 9850-2) identifying qualifications for the medically needy/catastrophic aid. Uninsured patients opting for elective services are contacted by phone prior to their date of service by the CHS outpatient financial counseling team. CHS'S self-pay process is followed and includes a screening for federal, state and local government programs as well as charity care. An interview offering payment options and eligibility guidelines using hospital form c910050 03/09 prompts a quick eligibility determination. It is at this time that a patient becomes aware of the uninsured patient discount act, Medicaid, medication assistance programs, crime victims, IBCCP, cash pay fee schedules, and other hospital discount incentives. Patients are advised of time line for completing application processes prior to their elective services via phone. Appropriate scripting is followed by CHS associates. Discounts were established following the 200%, 350% and 600% federal poverty guidelines to assist in determining charity adjustments. Applications were designed by CHS self-pay committee in accordance to our financial policy (policy number 9850-2) identifying qualifications for the medically needy/catastrophic aid. Our health system's website offers FAQ'S and answers as well as encourages patients to contact our customer service team when they are unable to pay for services. Our health system's statements also identify detailed account and billing information encouraging the patient to contact our customer service team and inquire about financial assistance options. Documentation is essential in effective communication. Follow up teams will then move forward in a timely manner with the appropriate actions to insure all necessary documents (if applicable) are received for eligibility determinations. CHS advertises a price line encouraging patients to inquire about estimated costs for future services. The price is manned by our outpatient financial counselors from 8:00am to 7:00pm. When calls are returned with estimated costs, a conversation ensues to identify a possible financial hardship. Our self-pay process is put into effect at this time. Site registrars will notify the CHS financial counseling team when a financial hardship is identified. Emergency department financial counseling positions have been created to meet the needs of our ED patients. In addition to these new roles, a full time financial counselor position was created to meet the special needs of our cancer patients. A financial assistance coordinator reviews all financial applications, gathers needed documents, determines financial assistance and prepares each patient file for leadership approval. COMMUNITY INFORMATION Form Sch H Part VI Line 4 Centegra Health System defines its primary service area as McHenry County, an area of approximately 603 square miles and approximately 309,122 residents in 2017*. In 2017, the age distribution of the population was as follows: 29.5% ages 0-18, 56.5% ages 18-65, 14.0% ages 65 and older*. McHenry County has relatively high socioeconomic status compared to the rest of Illinois. In 2013-2017 (in 2017 dollars), the median household income of the households in McHenry County was $82,230 compared to the Illinois state average of $61,229*. The 2017 percentage of civilians in labor force ages 16+ was 70.8%, which was higher than the state of Illinois at 65.2%. The 2017 percentage of persons in poverty in McHenry County was lower than that of the state of Illinois, at 6.1% compared to 12.6%*. In 2017, the percentage of the county's population holding a high school diploma or higher was 92.8%, while the percentage holding a bachelor's degree or higher was 33.2%. The McHenry County uninsured in 2017 was 5.5% compared to the state uninsured rate of 7.8%*. The most recent data available was used in this description. *Source: US Census Bureau PROMOTION OF COMMUNITY HEALTH Form Sch H Part VI Line 5 Please see Schedule O for a detailed description of the medical center's program service accomplishments. AFFILIATED HEALTH CARE SYSTEM Form Sch H Part VI Line 6 THE LEGAL ENTITY Northern Illinois Medical Center (NIMC) operates two hospitals - Centegra Hospital - McHenry and Centegra Hospital - Huntley. NIMC IS AFFILIATED with memorial medical center of Woodstock, IL. ALL THREE HOSPITALS are acute care facilities serving the greater Mchenry county area. Centegra health system is the parent of both northern Illinois medical center and memorial medical center. Northern Illinois medical center is affiliated with health bridge fitness centers in Crystal Lake, and the medical center provides outpatient physical rehabilitation services to the community from a clinic within that location. The centegra health system foundation supports hospital operations through fundraising activities. Please see schedule R for complete listing of all affiliated organizations. STATE FILING OF COMMUNITY BENEFIT REPORT Form Sch H Part VI Line 7 IL X X X X true true false false false false false false false MICHAEL EESLEY CHIEF EXECUTIVE OFFICER 0 886518 0 806719 0 623101 0 3431 0 42868 0 2362637 0 453073 IRFAN HAFIZ BOARD OF GOVERNORS / SVP - CMO 0 326944 0 69096 0 24259 0 1907 0 69 0 422275 0 0 LISA GLOSSON MD BOARD OF GOVERNORS 0 209423 0 12356 0 34966 0 0 0 30698 0 287443 0 10600 DAVID TOMLINSON EVP - CFO 0 426425 0 323400 0 294946 0 3450 0 60207 0 1108428 0 40114 JASON SCIARRO PRESIDENT / COO- Termed 5/2018 0 96396 0 88694 0 600834 0 3533 0 56038 0 845495 0 0 Kumar Nathan Pres. Insur. Svcs./Gen Counsel 0 404047 0 90300 0 76737 0 3042 0 59235 0 633361 0 28074 RACHEL SEBASTIAN PRESIDENT - CHM 0 312880 0 86988 0 67872 0 3399 0 35442 0 506581 0 24853 SHEILA SENN SVP - COO - CHH- Termed 3/2018 0 271793 0 0 0 23545 0 2764 0 35890 0 333992 0 0 CONNIE SECOR DIRECT SURG/CARD- Termed 10/17 140321 0 0 0 26464 0 3153 0 957 0 170895 0 0 0 JOHN GEINOPOLOS MEDICAL PHYSICIST 161796 0 26670 0 59194 247660 0 Lisa Evan PHARMD IP NGT 152427 0 0 0 15339 0 1852 0 20981 0 190599 0 0 0 SUSAN CORCORAN CLINICAL STAFF PHARMACIST 158223 2110 18301 2479 58124 239237 0 WEIHONG HE MEDICAL PHYSICIST 210062 0 0 0 7271 0 0 0 56896 0 274229 0 0 0 Form Sch J Part I Line 4a The following individuals received severance payments: JASON SCIARRO PRESIDENT / COO $555,916 SHEILA SENN SVP / COO - CHH $218,327 DAVID TOMLINSON EVP/CFO $162,657 CONNIE SECOR DIRECT. SURG./CARD $86,065 Form Sch J Part I Line 4b Certain individuals listed in schedule J, Part II participate in a supplemental non-qualified retirement plan to which the hospital network makes annual contributions. The following individuals received distributions from a supplemental non-qualified retirement plan during 2017: Name Title Amount MICHAEL EESLEY CHIEF EXECUTIVE OFFICER $453,073 DAVID TOMLINSON EVP / CFO $40,144 RACHEL SEBASTIAN PRESIDENT - CHM $24,853 KUMAR NATHAN PRES. INSUR. SVCS./GEN COUNSEL $28,074 LISA GLOSSON BOARD OF GOVERNORS $10,600 RACHEL SEBASTIAN FAMILY MEMBER 506581 EMPLOYEE false BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS SCHEDULE L, PART IV ALL BUSINESS TRANSACTIONS ARE ARMS LENGTH TRANSACTIONS. SEE CONFLICT OF INTEREST DISCLOSURES IN SCHEDULE O FOR FORM 990, PART VI, LINE 2. PROGRAM SERVICE ACCOMPLISHMENTS Form 990 Part III Line 4a Executive Summary Centegra Health System (Centegra) coordinates the delivery of health care services by assisting in the management of Centegra Hospital- McHenry, Centegra Hospital-Huntley (both facilities within Northern Illinois Medical Center), Centegra Hospital- Woodstock (Memorial Medical Center), (The Medical Centers), and Centegra Health System Foundation, Health Bridge Corporation and NIMED Corporation (Affiliates). Centegra's mission is to inspire and engage our community in their health and wellness. We provide quality health care services with innovative and responsible use of resources and promote wellness for the greater McHenry County area in Illinois. During its fiscal year 2018, Centegra Health System sponsored more than 230 community events. These events focused on the high priority issues facing the county: obesity, cardiovascular health, active communities and behavioral health. The Medical Centers provide optimum quality health care, delivered by competent hospital and medical center staff, to all who seek its services regardless of race, creed, sex, national origin, handicap, age, or ability to pay. The primary mission of the Medical Centers is to enhance the health of the community as the preferred health care organization providing outstanding service and value. It is the Medical Centers' objective to serve the community with respect to providing health care services and education. Although reimbursement for services rendered is critical to the operation and stability of the Medical Centers, it is recognized that not all individuals possess the ability to purchase essential medical services. Therefore, in keeping with the Medical Centers' commitment to serve all members of its community, free care and/or subsidized care will be considered where the need and/or an individual's inability to pay exist. Medical Services are provided in a dignified manner to Medicare, Medicaid and indigent patients. System-wide, community benefits included approximately $8.8 million of charity care, over $58.0 million of government sponsored indigent health care, approximately $4.5 million of other community benefits, and over 115,000 community benefit hours. *The Medical Centers' services include, but are not limited to: Centegra Hospital-McHenry is a 179-bed facility located about 50 miles outside of Chicago. The hospital is the region's leading provider of advanced cardiovascular treatments through the Centegra Cardiovascular & Thoracic Center. It is also home to the Centegra Hip & Knee Replacement Center, the Centegra Sage Cancer Center and the Centegra Family Birth Center. As part of Centegra Health System, Centegra Hospital-McHenry achieved Magnet designation for nursing excellence. Centegra Hospital-McHenry provides sophisticated treatments and advanced technology to address the most serious medical conditions. These include: *Open-heart surgery and heart catheterizations *Joint replacement surgeries *A Level II Trauma Center and on-site Flight for Life helicopter *Certified chest pain and stroke centers *Advanced cancer treatments including radiation oncology and infusion services *Labor and delivery and on-site 24/7 obstetrics hospitalists and neonatologists *Intensive care *Medical-Surgical care and 24/7 hospitalist care *Outpatient surgery Centegra Hospital - Huntley opened its doors in August 2016 as a 384,135 square-foot, 128 bed facility. Centegra Hospital- Huntley provides sophisticated treatments and advanced technology to address the most serious medical conditions. These include: Level II Trauma emergency department 8-bed intensive care unit Family Birth Center Chest Pain Center Cardiac Catheterization Laboratory and Cardiology Services A full range of diagnostic imaging including radiology, ultrasound, MRI scanning and nuclear medicine Helipad for transporting patients Centegra Hospital-Woodstock is a 106-bed facility located about 60 miles outside of Chicago. The hospital provides exceptional inpatient and outpatient care and has won top awards for patient safety and satisfaction. As part of Centegra Health System, Centegra Hospital-Woodstock achieved Magnet designation for nursing excellence. Centegra Hospital - Woodstock provides sophisticated treatments and advanced technology to address the most serious medical conditions, including: *A Level II Trauma Center and on-site Flight for Life helicopter *Certified chest pain and stroke centers *Intensive care *Medical-Surgical care and 24/7 hospitalist care *Outpatient surgery *Inpatient behavioral health services *Weight-loss surgery through the Centegra Healthy Living Institute *State-of-the-art medical imaging Centegra Health System Foundation provides fund-raising services for Centegra Health System in conjunction with the Medical Centers. The proceeds of these activities are used to purchase medical equipment and supplies, therefore enabling the Medical Centers to better serve the community. Health Bridge Corporation provides various rehabilitation services for the Medical Centers in conjunction with Centegra Health System, by providing a fitness center and pool that serves the community in various capacities and sponsors and hosts assorted educational programs. NIMED Corporation aids in the management of the Medical Centers and several satellite locations within the Centegra Health System organization. The Medical Centersthe Affiliates' program accomplishments are summarized below. SUPPORT GROUPS Centegra Health System, in conjunction with the Medical Centers and Affiliates, sponsors or hosts many support groups for its patients as well as the community. The following ongoing support groups are held at the Medical Centers, Affiliates or in the community. By supporting these groups, the Medical Centers and Affiliates are able to provide one or all of the following: *Staff professionals who either act as facilitators of the group or function as Guest Speakers, *Space offered free or at minimal charge, *Free marketing to educate the community about these services. Programs sponsored by the Medical Centers and or Affiliates in conjunction with Centegra Health System include: Oncology Support Groups - *Cancer Transitions focuses on the needs of cancer survivors who have finished treatment with the last two years. *Caring for the Caregiver is a group for those offering care to anyone with a serious illness. The group provides an opportunity to connect with others who understand the unique experience of being a caregiver. Education and support are offered on relevant topics to assist successful management of the challenges of caregiving. *Creating Expressions links artistic experience with the emotional benefits of cancer management. *Growing Together Through Cancer Transitions is a monthly group for cancer survivors who have completed the Cancer Transitions program. Education and support is offered through the group experience to increase personal empowerment and wellness in body, mind and spirit toward the goal of long term cancer survivorship. *Centegra STAR Program Guided Patient Services (GPS) where participants receive valuable information and resources that aid them before, during and after diagnosis and treatment. Members of the Survivorship Training and Rehabilitation (STAR) certified team are available to address questions and concerns while patients participate in assessments to help create a personalized plan of care. *H.O.P.E.: High on Positive Energy is for women living with breast cancer *Look Good Feel Better is a free program offered by the American Cancer Society and teaches beauty techniques to women who are currently undergoing cancer treatment. *Partners in Cancer Transitions, a monthly support group for cancer survivors and their care partners. *Pathfinders, a support group for men and women living with cancer and their care partners. *Wig Boutique: This American Cancer Society program helps women with cancer select a free wig. *Young Ribbons, a support group for those diagnosed with breast cancer younger than the age of 45. This support group helps participants connect with other breast cancer survivors to share, learn and support one another during and after treatment. ADDITIONAL SUPPORT GROUPS AND SERVICES *A.W.A.K.E. (Alert, Well and Keeping Energetic) Support Group is a sleep disorder support group for patients and family members affected by sleep disordered breathing. The A.W.A.K.E. Support Group is part of the American Sleep Apnea Association. *ADHD Parent Support Group a free support group for parents of children with Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) this group provides opportunities for parents to share, collaborate and communicate about some of the challenges involved in raising children with ADD or ADHD. *Breastfeeding Support groups are held to support all breastfeeding moms. *Centegra Crisis Services in partnership with the McHenry County Mental Health Board offers 24-hour crisis line and 24-hour onsite response team. *Diabetes Support Group is for individuals with diabetes and their families. *Eating Disorder Support Group, a monthly eating disorder support group led by a mental health professional and a registered dietitian. *Free Freshstart/Tobacco Cessation: Centegra has partnered with the American Cancer Society to empower participants towards quitting a tobacco habit. Freshstart provides information about effective strategies and helps motivate and prepare participants to make a successful quit attempt. *Living with Grief, sponsored by Centegra Pastoral Care, offers support for adults grieving the loss of a loved one. *Stroke Support Group. *Weight-Loss Surgery Support Group for patients that have had weight-loss surgery. EDUCATION PROGRAMS The Medical Centers and Affiliates make a variety of educational programs designed to promote wellness available to all members of the community. The Medical Centers, in conjunction with Centegra Health System, work in cooperation with McHenry County College to provide a complete series of specialized training for those interested in developing their knowledge of emergency basics, or in pursuing a career in the emergency health care field. There are three levels of training available: First Responder, Emergency Medical Technician - Basic, Emergency Medical Technician - Paramedic. An Emergency Medical Dispatcher Course designed to prepare individuals for employment as dispatchers for a public service agency providing dispatch to law enforcement fire service, and/or Emergency Medical Service is also offered. The Medical Centers offer a variety of classes that can help people save lives. The Medical Centers, in conjunction with Centegra's Health Bridge Fitness Centers, offer Red Cross first aid classes that include First Aid and Cardio-Pulmonary Resuscitation (CPR). Classes help community members learn CPR prior to certification, or brush up on skills for re-certification. The Medical Centers also offer a CPR Instructor Course, International Trauma Life Support, Advanced Cardiac Life Support, and Pediatric Advanced Life Support training classes. Family health and wellness programs presented by the Medical Centers are designed to promote a healthier community. The Medical Centers offer low-cost education classes for expectant families including prenatal and cesarean birth classes, along with free hospital tours. Centegra's Healthy Living Institute offers a variety of education programs to support healthy habits toward weight loss or weight maintenance. Lipid screenings are offered periodically during the year. Integrative programs include mindful eating, understanding the healing potential of food, and journaling. Still more educational programs are offered to assist members of the community take charge of special needs in their lives, to change their lifestyles for healthier lives, as well as programs to inform the community about Advance Medical Directives, including living wills, durable power of attorney issues, organ donations, and Understanding Medicare. The Medical Centers sponsor several programs specializing in issues of concern for women including reduced fee mammograms, programs on osteoporosis, and programs on menopause. The annual Centegra Health Strong Woman Event is a program designed to give health information across a variety of topics to women in McHenry County and the surrounding area. Centegra Hospital - McHenry's Sage Cancer Center and Centegra Gavers Breast Center, together with the American Cancer Society, Gavers Community Cancer Foundation, and McHenry County College, sponsor various Cancer Awareness Programs. Centegra Health System offers colorectal cancer screenings, reduced fee mammograms, skin, oral, head and neck cancer screenings, and reduced fee prostrate (PSA) screenings. Cancer awareness also includes programs on reduction of risk for cancer through good nutrition and healthy lifestyle habits. Centegra Health System also sponsors celebrations of cancer survivorship. In addition, Centegra Health System is a learning center (clinical site) for students from a multitude of colleges and universities. Students have completed internships in programs such as nurse practitioner, nursing, nurse aide, physician assistant, social work, speech therapy, phlebotomy, diagnostic medical sonography, medical imaging, medical records, pharmacy, medical physics, surgical technology, professional counselor, substance abuse counselor, and medical assistant. Centegra Health System is also a learning site for 3rd and 4th year medical students from Rosalind Franklin University. OTHER COMMUNITY SERVICES The Medical Centers and Affiliates participate in various community events and initiatives including community health fairs and county business fairs in order to promote health and awareness in the community. Other community services are career shadowing opportunities for area students, Flight for Life Helicopter appearances, poison awareness programs, blood drives, and a variety of health screenings (blood pressure, diabetes, skin cancer, colorectal cancer, glaucoma, hearing, etc.) to promote health and awareness in the community. The Medical Centers and Affiliates also distribute thousands of informational brochures, service listings, and flyers at the request of area schools, churches, and organizations on an ongoing basis. The Referral Line (877-CENTEGRA) is a toll-free phone line sponsored by the Medical Centers. It offers free, computerized service to callers who require information or physician referrals. A trained counselor staffs the line. Several medical specialties are represented, and physicians are on staff for referrals. The line also gives information regarding physician's office hours, locations, insurance, and languages spoken. Additionally, counselors give information on Self-Help and Support Groups. The Medical Centers sponsor blood drives every year and are able to provide numerous pints of blood to those in need. The Medical Centers provide Patient Express! transportation services for individuals who require transportation to the Medical Centers. The Patient Express! van is provided and is frequently used by the disabled and elderly individuals of the community. The service is provided free of charge, although donations are accepted to defray the costs of the service. EXERCISE PROGRAMS The Medical Centers, in conjunction with Centegra Health System and Centegra Health Bridge Fitness Centers offer specialized exercise programs that help participants get moving and stay active for a healthier lifestyle. These programs include Aquatics, Individual and Group Fitness, Mind/Body including Pilates, Tai Chi, Yoga, Sports Performance, and Tennis Racquetball & Basketball. REHABILITATION / PHYSICAL THERAPY PROGRAMS Through the Centegra Hospital - McHenry's acute inpatient rehabilitation/physical therapy programs, disabled individuals can practice and master the skills required for personal hygiene, home maintenance, financial management, mobility, and social interaction in the security and privacy of the rehabilitation department. Using distinctive environments such as, apartment, car, cafe & restaurant, and an ambulation course, therapists and clinical staff are able to assess and evaluate the progress of each patient using a unique form of individual care. When individual confidence and proficiency return, discharge planning and community re-entry training complete the rehabilitation program. The Medical Centers also provide extensive Cardiac Rehabilitation and Pulmonary Rehabilitation programs. Integrated into the Cardiac Rehabilitation Program is the Centegra WellBridge program. This is a wellness membership that promotes community health by providing patients who have completed Phase II or Phase III with a supervised exercise area at Centegra Health Bridge Fitness Centers at a very low cost. Outpatient rehabilitation care and Sports Medicine Clinics at Health Bridge Fitness Centers and other locations provide sports medicine, aquatics, outpatient physical and occupational therapy programs. The Centegra Industrial Rehabilitation programs help area employers with injured employees rebuild their strength and abilities for a safe and speedy return to work. The program includes work hardening, work conditioning, functional capacity evaluations, physical and occupational therapy. Worksite Services and Programs include ergonomic consultations and evaluations as well as other educational and safety programs. The Centegra Neuro-Rehabilitation Center serves individuals who have experienced traumatic brain injury and neurological impairments due to stroke, accident, or disease. It is a comprehensive program for patients requiring intensive, interdisciplinary services on an outpatient basis. The program facilitates the individual's function and independence in the home, work, school, and community with integrated and holistic treatment. Services include physical therapy, occupational therapy, speech therapy, neuropsychology, social work, nursing, vocational counseling, and recreational therapy. This program also has access to facilities at Centegra Health Bridge Fitness Center and may work in conjunction with the Centegra Industrial Rehabilitation Program. The Centegra Milestones Therapy Center provides outpatient therapy services for children from birth through age 21. Centegra Milestones Therapy Center provides individual therapy sessions with occupational, speech and physical therapists as well as a variety of playgroups where children learn and interact in a safe and stimulating environment. TAX-EXEMPT BONDS FORM 990 PART IV LINE 24A Northern Illinois Medical Center HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, CENTEGRA HEALTH SYSTEM. AS A RESULT, THE QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED IN CENTEGRA HEALTH SYSTEM'S FORM 990. BUSINESS OR FAMILY RELATIONSHIP OF OFFICERS, DIRECTORS, ETC. Form 990 Part VI Line 2 Northern Illinois Medical Center, (NIMC), as part of Centegra Health System, has adopted specific conflict of interest policies for its governing and management staff. The policy includes, but is not limited to, when an individual, governor, committee member, officer, agent or employee believes that he or she, or a member of his or her immediate family might have or does have a real or apparent conflict, he or she should in addition to filing the disclosure notice required, abstain from making motions, voting, executing agreements, or taking any other similar direct action on behalf of the Medical Center. During fiscal year 2018, Northern Illinois Medical Center purchased certain goods, and or services from organizations with directors' affiliation. All transactions were competitively bid and were conducted at arms-length. The fees paid were at fair market value. During fiscal year 2018, Director Micheal Curran is an Officer / Director of Curran Contracting Company, supplier of excavation and asphalt pavement services. Director Charles Ruth is the Board Chairman of American Community Bank & Trust and Chief Executive Officer of Alliance Contractors. Director Tom Carey is Vice-President and majority owner, Carey Electric Contracting, Inc., supplier of electrical contracting services. Rachel Sebastian, President, Centegra Hospital - McHenry is the daughter of Chief Executive Officer, Michael Eesley. Rachel Sebastian reported to the Chief Executive Officer, Micheal Eesley. Matthew Eesley is the son of Chief Executive Officer, Michael Eesley. During fiscal year 2018, Matthew Eesley was the Director, Centegra Physician Care Outpatient Services, reporting to Mattias Carlen, Senior-Vice President - Ambulatory Services and CHW. EXPLANATION OF CLASSES OF MEMBERS OR SHAREHOLDER Form 990 Part VI Line 6 Centegra Health System is the sole member of NIMC. Centegra Health System has a single class of members. HOW MEMBERS OR SHAREHOLDERS ELECT GOVERNING BODY Form 990 Part VI Line 7a The powers and duties of the Centegra Health System members in fulfilling the purposes and objectives of the Corporation shall include, but not be limited to, the taking of action with respect to the following matters: The election of governors and the filling of vacancies on the Board of Governors, which shall be in accordance with the procedures set forth in the Bylaws. The Nominating Committee shall select one candidate for each position on the Board having a term to be voted upon for the office of governor at the next annual meeting of members. The Nominating Committee shall consider and approve a list of candidates and submit such list to the Board of Governors not less than 10 days prior to the date of the last meeting of the Board of Governors prior to the date on which notice of the annual meeting of members is to be sent, and the candidates set forth on such list shall be subject to approval by the Board of Governors. The names of the candidates so selected by the Nominating Committee and approved by the Board of Governors shall be included in the notice of the annual meeting of the members of the Corporation and shall be presented to the members of the Corporation at the annual meeting. The voting members of the Corporation may nominate candidates for the positions on the Board of Governors. Nominations by such members may be effected by means of written nomination signed by not less than 20 voting members in good standing, accompanied by a written statement of such nominee indicating a willingness to serve as a governor of the Corporation if elected. Any such nomination must be received by the Nominating Committee of the Corporation not less than 60 days prior to the annual meeting of members in order to be considered at such annual meeting. All elections shall be by secret ballot if there are more nominees than vacancies to be filled on the Board. All voting members present in person or by proxy at a meeting at which an election occurs shall be entitled to vote for governors. To be valid a ballot must not have more votes than there are vacancies. If there are more nominees than vacancies to be filled on the Board, those nominees who receive the most votes shall be elected to the Board of Governors. Members shall not be entitled to cumulate their votes in the election of governors. REVIEW PROCESS Form 990 Part VI Line 11b The review process for the Form 990 includes compilation by internal staff, detailed review by an outside tax preparer, and review by the Centegra Health System (CHS) Chief Financial Officer, prior to submission to the IRS. The tax return will be made available for the Board to review after submission to the IRS. EXPLANATION OF MONITORING AND ENFORCEMENT OF CONFLICTS Form 990 Part VI Line 12c As stated in Centegra's Bylaws, the Bylaws recognize that both real and apparent conflicts of interest sometimes naturally occur in the course of conducting daily affairs. Conflicts occur because the many persons associated with Centegra should be expected to have and do, in fact, generally have multiple interests and affiliations and various positions of responsibility within the community. The long-range interests of Centegra do not require the termination of all association with persons who may have real or apparent conflicts if a prescribed and effective method can render such conflicts harmless to all concerned. Centegra Health System has a conflict of interest policy that is intended to address such matters. 1. Duty to Disclose: In connection with any actual or possible conflicts of interest, an interested person or other person subject to this policy must disclose the existence and nature of his or her financial interest in writing to the President of Centegra or the Chief Corporate Responsibility Officer or designee, who shall provide such written disclosure to the Governors Affairs Committee of Centegra, which shall consider all conflicts of interest issues and, if appropriate, to the directors and members of committees with board-delegated powers considering the proposed transaction or arrangement. The disclosure must occur, at minimum, annually, with a Conflict of Interest Disclosure Statement being submitted no later than January 31st of each year. Copies of disclosure statements filed by Board members shall be distributed to the Board annually at the February Board meeting. 2. Determining Whether a Conflict of Interest Exists: When a conflict of interest is disclosed at meeting of the board or committee thereof, after disclosure of the financial interest, the interested person shall leave the board or committee meeting while the financial interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists. The interested person's leaving such meeting shall not affect whether a quorum exists at such meeting. 3. Procedures for Addressing the Transaction or Arrangement from Which the Conflict Arose: A. The chairperson of the board or committee shall, if appropriate, appoint a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement. B. After exercising due diligence, the board or committee shall determine whether Centegra can obtain a more advantageous transaction or arrangement with reasonable efforts from a person or entity that would not give rise to a conflict of interest. C. If a more advantageous transaction or arrangement is not reasonably attainable under circumstances that would not give rise to a conflict of interest, the board or committee shall determine by a majority vote of the disinterested directors whether the transaction or arrangement is in Centegra's best interest and for its own benefit and whether the transaction is fair and reasonable to Centegra and shall make its decision as to whether to enter into the transaction or arrangement in conformity with such determination. 4. Violations of the Conflicts of Interest Policy: A. If the administration, the board, or a committee has a reasonable cause to believe that a member has failed to disclose actual or possible conflicts of interest, it shall inform the member of the basis for such belief and afford the member an opportunity to explain the alleged failure to disclose. B. If, after hearing the response of the member and making such further investigation as may be warranted in the circumstances, the board or committee determines that the member has, in fact, failed to disclose an actual or possible conflict of interest, it shall refer the matter to the Governors Affairs Committee for consideration, which shall subsequently recommend appropriate disciplinary and corrective action to such board or committee. 5. The minutes of the board and all committees with board-delegated powers shall contain the names of the persons who disclosed or otherwise were found to have a financial interest in connection with an actual or possible conflict of interest, the nature of the financial interest, any action taken to determine whether a conflict of interest was present, and the board's or committee's decision as to whether a conflict of interest, in fact, existed. The names of the persons who were present for discussion and votes relating to the transaction or arrangement, the content of the discussions, including any alternatives to the proposed transaction or arrangement, and a record of any votes taken in connection therewith. 6. A voting member of any committee whose jurisdiction includes compensation matters and who receives compensation, directly or indirectly, from Centegra for services is precluded from voting on matters pertaining to that member's compensation, physicians who receive compensation, directly or indirectly from Centegra, whether as employees or independent contractors, are precluded from membership on any committee whose jurisdiction includes compensation matters and in which such physician may have a direct or indirect interest. 7. Each director, principal officer, and member of a committee with board-delegated powers shall annually sign a statement which affirms that such person has received a copy of the conflicts of interest policy; has read and understands the policy; has agreed to comply with the policy; and understands that Centegra is a charitable organization and that in order to maintain its federal tax exemption, it must engage primarily in activities which accomplish one or more of its tax exempt purposes. 8. To ensure that Centegra operates in a matter consistent with its charitable purposes and that it does not engage in activities that could jeopardize its status as an organization exempt from federal income tax, periodic reviews shall, at a minimum, include the following subjects: whether acquisition of physician practices and other provider services result in inurement or impermissible private benefit. Whether joint venture arrangements and arrangements with management service organizations and physician hospital organizations conform to written policies, are properly recorded, reflect reasonable payment for goods and services, further Centegra's charitable purposes and do not result in inurement or impermissible private benefit. Whether agreements to provide healthcare and agreements with other healthcare providers, employees, and third party payors further Centegra's charitable purposes and do not result in inurement or impermissible private benefit. Whether business transactions on behalf of Centegra or an entity controlled by it are the result of arms-length dealing and are no less advantageous than competitively available goods and services of like grade and quality. 9. In conducting the periodic reviews provided for in article vii, Centegra may, but need not, use outside advisors. If outside experts are used, their use shall not relieve the board of its responsibility for ensuring that periodic reviews are conducted. COMPENSATION REVIEW & APPROVAL PROCESS- OFFICERS & KEY EMPLOYEES Form 990 Part VI Line 15a & 15b The Board of Governors of Centegra Health System, through the Compensation Committee comprised of independent members free of conflict, reviewed executive compensation levels and other features of the compensation plan in accordance with the organization's approved compensation philosophy and strategy: The Committee is comprised of members of the Board of Governors, who are independent of Centegra management, have no personal interest in the compensation arrangements, are not related to, or under the control of any individual whose compensation arrangement is being reviewed and have no material business relationship with Centegra. The C-Suite's compensation is determined by the Compensation Committee in relation to comparable peers or 990 market data. Compensation for other members of the executive staff is recommended by the CEO, reviewed by the Committee, and evaluated against market data based on comparable peers. The Committee approves all compensation decisions in advance of their implementation and documents its determinations and discussions. Its decisions and deliberations are thoroughly documented and meeting minutes are kept and distributed to the Committee members (for historical reference). The Compensation Committee uses a number of external resources and comparisons, and their review includes total compensation (cash compensation, plus benefits provided by Centegra) in relation to organizational performance and prevailing industry practices of comparably-sized organizations. They have engaged the services of a compensation consulting firm (Sullivan Cotter) specializing in the not-for-profit sector that has worked with Centegra and reports directly to the Compensation Committee. Reasonableness letters and documentation are provided to the organization after each review. OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE Form 990 Part VI Line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. RELATED COMPANY - CHS Form 990 Part IX Line 24a It should be noted that the Related Company expenses in Form 990, Part IX, line 24a are allocated at 89% of total expense of the related company (Centegra Health System, FEIN 36-3196559). The allocation method is reviewed annually. RECONCILIATION OF NET ASSETS Form 990 Part XI Line 9 AFFILIATE TRANSFERS ($26,300,000) INTEREST IN FOUNDATION $1,381,062 NET ASSETS RELEASED FROM RESTRICTIONS ($156,043) ------------ ($25,074,981) Centegra Health System 541 N FAIRBANKS CT STE 1630 CHICAGO IL 606113309 363196559 Health System IL 501(c)(3) 10 NA false Centegra Health System Foundation 541 N FAIRBANKS CT STE 1630 CHICAGO IL 606113309 363196560 Fundraising IL 501(c)(3) 7 Centegra HS false NIMED Corporation 541 N FAIRBANKS CT STE 1630 CHICAGO IL 606113309 363119911 Property Mgmt IL 501(c)(3) 12B Centegra HS false Health Bridge Corporation 541 N FAIRBANKS CT STE 1630 CHICAGO IL 606113309 363196550 Health FT CTR IL 501(c)(3) 10 Centegra HS false Centegra Hospital Huntley Holdings 541 N FAIRBANKS CT STE 1630 CHICAGO IL 606113309 453449737 Support Org IL 501(c)(3) 12C NIMC true Memorial Medical Center 541 N FAIRBANKS CT STE 1630 CHICAGO IL 606113309 362179764 Hospital IL 501(c)(3) 3 Centegra HS false Centegra Management Services 541 N FAIRBANKS CT STE 1630 CHICAGO IL 606113309 364028114 Management IL Centegra HS C Corp 0 0 false false false true false false false false false false false false false true false true true true true true