2019-05-15T18:26:33-05:00 2018-06-30 861065772 DELOITTE TAX LLP 50 S 6TH STREET SUITE 2800 MINNEAPOLIS MN 554021844 990 2017-07-01 362170840 COPLEY MEMORIAL HOSPITAL INC C/O RUSH COPLEY MEDICAL CTR COPL 6309786200 2000 OGDEN AVENUE AURORA IL 605044206 BRENDA VANWYHE CFO 6309786200 2019-05-15 1 KRISTINA RASMUSSEN P00143920 6123974000 71.195.91.55 2019-05-15 14:42:13 ED P C9ED19D146748CAC02A1A8999E376782BC08CAB7 D6D028B83EC7BAE48696A0FE418AC7215527A94E 2017 2019-02-21 02:37:17Z X BARRY FINN 2000 OGDEN AVENUE AURORA IL 605044206 332213210 0 X WWW.RUSHCOPLEY.COM X 1886 IL TO PROVIDE ADVANCED MEDICINE WITH QUALITY OUTCOMES AND EXTRAORDINARY CARE. 19 16 2272 340 0 42376 1184698 940320 305721600 305059403 11311285 9835156 3263860 1457569 321481443 317292448 37187 20551 0 141773145 142023489 0 0 140580195 141021217 282390527 283065257 39090916 34227191 582894855 636915894 266830962 275843333 316063893 361072561 X THE MISSION OF RUSH COPLEY IS TO PROVIDE ADVANCED MEDICINE WITH QUALITY OUTCOMES AND EXTRAORDINARY CARE. 0 0 224155520 20551 306334760 COPLEY MEMORIAL HOSPITAL'S MISSION IS TO PROVIDE ADVANCED MEDICINE WITH QUALITY OUTCOMES AND EXTRAORDINARY CARE. TO THAT END, THE MEDICAL CENTER SEEKS TO SERVE THE COMMUNITY IN WAYS THAT ENGAGE, EDUCATE AND EMPOWER. IN FY2018, COPLEY MEMORIAL HOSPITAL PROUDLY COLLABORATED WITH DOZENS OF CIVIC AND COMMUNITY GROUPS TO IMPACT THE KNOWLEDGE, HEALTH AND WELL-BEING OF THE COMMUNITY. COPLEY MEMORIAL HOSPITAL OFFERS FREE EDUCATIONAL PROGRAMS RANGING FROM HAND HYGIENE EDUCATION AIMED AT PRESCHOOL AND PRIMARY GRADE SCHOOL AGED CHILDREN TO ANNUAL SEMINARS EDUCATING ADULTS ABOUT DIABETES, HEART HEALTH, CANCER PREVENTION, WEIGHT CONTROL, SMOKING CESSATION, CHRONIC HEALTH AND MORE.A COMMUNITY NEWSLETTER IS PUBLISHED AND HIGHLIGHTS HEALTH INFORMATION AND CALENDAR OF EVENTS INFO TO 80,000+ HOUSEHOLDS THROUGHOUT THE HOSPITAL SERVICE AREA. FREE AND REDUCED COST HEALTH SCREENINGS ARE REGULARLY OFFERED INCLUDING FREE BLOOD PRESSURE MONITORING ON A WALK-IN BASIS.ELECTRONIC NEWSLETTERS ALSO HIGHLIGHTING HEALTH INFORMATION, NEWS AND EVENTS ARE EMAILED MONTHLY: HEALTHY EUPDATE AND FITNOTES. THESE NEWSLETTERS AVERAGE 60,000 AND 6,000 EMAILS RESPECTFULLY. ADDITIONALLY, CANCER CARE NEWS, TARGETED AT CANCER CARE PATIENTS AND THEIR FAMILY AND CARE GIVERS, WAS SENT TO APPROXIMATELY 2,400 EMAIL ADDRESSES.DURING FY2018, COPLEY MEMORIAL HOSPITAL SPONSORED, PARTNERED OR PARTICIPATED IN OVER 600 COMMUNITY-BASED PROGRAMS AND EVENTS, SPECIFICALLY GROUPS AIMED AT IMPROVING THE LIVES OF CHILDREN AND ADULTS. PROGRAMMING HIGHLIGHTS INCLUDES CAR SEAT SAFETY CHECKS, NUTRITION AND WEIGHT LOSS INFORMATION, HEART HEALTH ADVICE, CANCER SURVIVORSHIP AND MORE.COPLEY MEMORIAL HOSPITAL OFFERS A FREE PHYSICIAN REFERRAL SERVICE, PROVIDES A FREE SPEAKER'S BUREAU TO COMMUNITY-BASED GROUPS AND ROUTINELY PARTICIPATES AND SPONSORS OR DONATES TO HEALTH FAIRS AIMED AT MINORITY POPULATIONS INCLUDING THE YEARLY AFRICAN AMERICAN HEALTH FAIR AND THE ANNUAL LATINO COMMUNITY HEALTH FESTIVAL.COPLEY MEMORIAL HOSPITAL'S WEBSITE, WITH TRANSLATION INTO DOZENS OF LANGUAGES, OFFERS FREE HEALTH INFORMATION AND ONLINE RESOURCES.TOGETHER, THESE INITIATIVES PROVIDED A POSITIVE INFLUENCE FOR THOUSANDS OF RESIDENTS IN THE COMMUNITIES SERVED BY COPLEY MEMORIAL HOSPITAL. 224155520 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 199 0 1 2272 1 1 1 0 0 0 0 0 0 0 0 0 0 X 19 16 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X BRENDA VAN WYHE 6309786200 2000 OGDEN AVENUE AURORA IL 60504 THOMAS ALEXANDER DIRECTOR (END 9/17) 1.00 2.00 X 0 0 0 TRISH ANEN DIRECTOR 1.00 2.00 X 0 0 0 JAMES BAKA DIRECTOR 1.00 2.00 X 0 0 0 PATRICK CARMODY DIRECTOR (START 9/17) 1.00 2.00 X 0 0 0 CATI CEDEROTH DIRECTOR 1.00 2.00 X 0 0 0 BRUCE DIENST CHAIRMAN OF BOARD/DIRECTOR 1.00 2.00 X 0 0 0 RICHARD EDELMAN DIRECTOR 1.00 2.00 X 0 0 0 RONALD HEM DIRECTOR 1.00 2.00 X 0 0 0 GARRETT KATULA DO VICE CHIEF OF STAFF/DIRECTOR 41.00 2.00 X 282985 0 31661 STEPHEN KELANIC MD VICE CHIEF OF STAFF/DIRECTOR 41.00 2.00 X 432990 0 30652 HERBERT KNIGHT DIRECTOR 1.00 2.00 X 0 0 0 MARYANNE LOCKLIN DIRECTOR 1.00 2.00 X 0 0 0 DAVE MEAD DIRECTOR 1.00 2.00 X 0 0 0 MARK METZGER DIRECTOR 1.00 2.00 X 0 0 0 AVERY MILLER DIRECTOR 1.00 2.00 X 0 0 0 LUIS PEREZ DIRECTOR (START 9/17) 1.00 2.00 X 0 0 0 WILLIAM SKOGLUND VICE CHAIR BOARD/DIRECTOR 1.00 2.00 X 0 0 0 CHRISTINE SOBEK DIRECTOR 1.00 2.00 X 0 0 0 ANDREW VANEEKEREN DIRECTOR 1.00 2.00 X 0 0 0 BARRY FINN PRESIDENT & CEO/DIRECTOR 40.00 3.00 X X 1548342 0 31424 RYAN ASMUS VP GENERAL COUNSEL/SECRETARY 40.00 3.00 X 369599 0 68925 BRENDA VAN WYHE SR. VP FINANCE & CFO/TREASURER 40.00 3.00 X 451921 0 73852 GAIL BUMGARNER SR. VP, STRATEGY 40.00 0.00 X 425727 0 13696 DENNIS DEMASIE VP, INFORMATION TECH & CIO 40.00 0.00 X 706868 0 16312 JOHN DIEDERICH SR. VP, OPERATIONS & COO 40.00 1.00 X 546495 0 166993 BRENDA FANN MD ASSISTANT VP, MEDAFFAIRS 40.00 0.00 X 328916 0 31335 DIANE HOMAN MD VP, QUALITY & PSO 40.00 0.00 X 514808 0 28351 STEVE LOWENTHAL MD SR. VP, MEDICAL AFFAIRS & CMO 40.00 0.00 X 688691 0 14347 DAVID PETASNICK ASSISTANT VP, ANCILLARY SVCS 40.00 0.00 X 220651 0 26208 ALEX POPE VP, PHILANTHROPY & CDO 40.00 1.00 X 265822 0 57932 MARY SHILKAITIS VP PATIENT CARE SRVCS & CNO 40.00 0.00 X 329112 0 69372 SUSAN STERCHI ASSISTANT VP, PATIENT CARE 40.00 0.00 X 223270 0 30184 MARK SHARP-SCHINSKY MD PHYSICIAN 40.00 0.00 X 1251245 0 34713 DIMITRY RUBAN MD PHYSICIAN 40.00 0.00 X 983547 0 29999 KEVIN KELLY MD PHYSICIAN 40.00 0.00 X 918213 0 25958 ARIF SALEEM MD PHYSICIAN 40.00 0.00 X 797358 0 30916 TERESSA ALEXANDER MD PHYSICIAN 40.00 0.00 X 786376 0 30836 12072936 0 843666 281 0 1 0 SODEXO 4880 PAYSPHERE CIRCLE CHICAGO IL 60674 FOOD AND CLEANING SERVICE MANAGEMENT 3815793 ANTHELIO HEALTHCARE SOLUTIONS 1 LINCOLN DR STE 200 5400 LBJ FRW DALLAS TX 75240 MEDICAL RECORDS MANAGEMENT 3383999 INTUITIVE SURGICAL INC 1020 KIFER ROAD SUNNYVALE CA 94086 MEDICAL EQUIPMENT REPAIR AND SERVICING 749265 FOX VALLEY ACUTE DIALYSIS 1300 WATERFORD DRIVE AURORA IL 60504 DIALYSIS SERVICES 729544 ANDERSON MIKOS ARCHITECHTS LTD 17W110 22ND ST STE 200 OAKBROOK TERRACE IL 60181 ARCHITECTS 705498 23 940320 940320 NET PATIENT SVC REV 621110 280453805 280453805 MEDICAID TAX REVENUE 621110 26268734 26268734 OTHER PROGRAM REVENUE 900099 -1663136 -1663136 305059403 6715380 6715380 1028489 1527099 -498610 -498610 -498610 15091651 1421788 13393663 0 1697988 1421788 3119776 3119776 OUTSIDE SERVICE REV. 621990 1275357 1275357 CAFETERIA REVENUE 621990 370143 370143 GIFT SHOP REVENUE 453220 310679 310679 1956179 317292448 306334760 0 10017368 20551 20551 12517291 12517291 97794335 73345751 24448584 2731101 2048326 682775 19269235 14451926 4817309 9711527 7283645 2427882 7231028 5423271 1807757 301084 301084 205028 205028 52616 52616 67508 67508 8038431 6028823 2009608 734934 734934 15368262 11526197 3842065 10354941 7766206 2588735 7613985 5710489 1903496 179743 134807 44936 79399 59549 19850 4994742 4994742 18688404 18688404 159749 119812 39937 MEDICAL SUPPLIES 47932872 47932872 MEDICAID PROVIDER TAX 13082016 13082016 REPAIRS/MAINTAINENCE 845744 845744 COLLECTION FEES 557626 557626 4533105 3399829 1133276 283065257 224155520 58909737 0 14069478 21141985 47096725 48943347 5293019 5846586 12924563 5868524 407433492 235025498 174456445 172407994 269805003 287617692 3282363 3190961 55967259 91898805 582894855 636915894 132461230 134171486 101622859 99162939 32746873 42508908 266830962 275843333 X 313148752 357208458 2915141 3864103 316063893 361072561 582894855 636915894 X 34227191 8795464 1986013 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 52616 52616 0 PART II-B, LINE 1: COPLEY MEMORIAL HOSPITAL, INC. IS A MEMBER OF VARIOUS ORGANIZATIONS THAT ADVOCATE ON LEGAL AND POLICY ISSUES THAT AFFECT HEALTHCARE. A PORTION OF THE ANNUAL MEMBERSHIP DUES PAID BY COPLEY MEMORIAL HOSPITAL, INC. TO THESE ORGANIZATIONS IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. 11691205 1193365 662110 1577382 11969298 10975986 2004750 512030 1801561 11691205 12538872 1093070 104565 2760521 10975986 11931067 2373022 204733 1969950 12538872 11161160 1178338 1068336 1476767 11931067 0.22000 0.69000 0.09000 0 1 1 19257712 19257712 234484556 122430595 112053961 3743627 2934648 808979 144913914 109660255 35253659 5033683 5033683 172407994 DUE FROM AFFILIATES 86316107 INVESTMENTS IN JOINT VENTURES 3228715 MISCELLANEOUS 2353983 91898805 LONG TERM DEFERRED RENT OBLIGATION 754377 DEFERRED GAIN ON SALE LONG TERM 4591141 LONG TERM SERP 2574317 LONG TERM MARKET ADJUSTMENT SWAP LIABILITY 6571685 DUE TO RELATED PARTY 28666693 UNAMORTIZED BOND DISCOUNT -649305 42508908 X PART V, LINE 4: RUSH COPLEY FOUNDATION HOLDS THE VORIS (INCOME FOR CMH CANCER CARE), KOBISK (BOARD RESTRICTED INCOME TO CMH), COPLEY (INCOME UNRESTRICTED), DOBBINS (INCOME FOR CMH WOMEN'S HEALTH), AND MOVEMENT DISORDER (INCOME FOR CMH MOVEMENT DISORDER PROGAM) ENDOWMENTS. RUSH COPLEY FOUNDATION ALSO HOLDS THE FOLLOWING QUASI ENDOWMENTS; NURSING (INCOME FOR CMH FUTURE OF NURSING SCHOLARSHIPS), FOX VALLEY HEART (INCOME FOR THE HEART INSTITUTE), WATERFORD PLACE (INCOME FOR CMH CANCER RESOURCE CENTER) AND COPLEY (INCOME FROM THE COPLEY ENDOWMENT). THESE FUNDS ARE HELD FOR THE BENEFIT OF COPLEY MEMORIAL HOSPITAL, INC. PART X, LINE 2: THE INTERNAL REVENUE SERVICE HAS DETERMINED THAT THE CORPORATION, THE HOSPITAL, VENTURES AND THE FOUNDATION ARE QUALIFIED AS TAX-EXEMPT ORGANIZATIONS UNDER CODE SECTION 501(C)(3); ACCORDINGLY, INCOME TAXES ARE NOT PROVIDED FOR IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE MEDICAL GROUP OPERATES AS A TAXABLE CORPORATION AND ACCOUNTS FOR INCOME TAXES UNDER FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740. NO PROVISION FOR INCOME TAXES WAS RECORDED FOR 2018 AND 2017 DUE TO OPERATING LOSSES. AS OF JUNE 30, 2018, THE MEDICAL GROUP HAD NET OPERATING LOSS CARRYFORWARDS OF APPROXIMATELY $116,866,000 FOR INCOME TAX PURPOSES THAT ARE AVAILABLE TO OFFSET FUTURE TAXABLE INCOME. IF NOT UTILIZED, THESE CARRYFORWARDS WILL BEGIN TO EXPIRE IN 2019. BASED ON THE UNCERTAIN REALIZATION OF THESE CARRYFORWARDS, A VALUATION ALLOWANCE HAS BEEN RECORDED TO FULLY RESERVE THESE CARRYFORWARDS. 1 1 X 1 X 200.000000000000 1 X 600.000000000000 1 1 0 1 1 3961766 3961766 0.01400 68800321 54093488 14706833 0.05200 72762087 54093488 18668599 0.06600 67319 67319 0.00020 4031361 1091639 2939722 0.01040 21606 21606 0.00010 4120286 1091639 3028647 0.01070 76882373 55185127 21697246 0.07670 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 1 32367543 3236754 88098623 109421433 -21322810 X 1 1 1 1 COPLEY MEMORIAL HOSPITAL 2000 OGDEN AVENUE AURORA IL 605044206 WWW.RUSHCOPLEY.COM 2150791 X X X X COPLEY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 15 1 0 0 1 X SEE PART V, SECTION C. X 1 15 1 SEE PART V, SECTION C. 0 1 X 200.000000000000 600.000000000000 X X X 1 1 X 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 1 X 0 X X 1 X 0 0 COPLEY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: IN CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED. THIS INCLUDED COMMUNITY RESIDENTS AND EXPERTS IN A RANGE OF AREAS INCLUDING PUBLIC HEALTH, MINORITY POPULATIONS, DISPARITIES IN HEALTH CARE, SOCIAL DETERMINANTS OF HEALTH, AND HEALTH & SOCIAL SERVICES. PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED INCLUDED: BOARD OF DIRECTORS, HOSPITAL ADMINISTRATION, COMMUNITY HEALTH NEEDS COMMITTEE, PARTNERSHIPS WITH KANE COUNTY, PARTNERSHIPS WITH KENDALL COUNTY, COMMUNITY HEALTH SURVEY, FOCUS GROUPS, AND SECONDARY DATA ANALYSIS. FOR COMPLETE DETAILS ABOUT HOW THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED, THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE ACCESSED AT: HTTP://WWW.RUSHCOPLEY.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-REPORT/ COPLEY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: THE KANE COUNTY HEALTH DEPARTMENT, RUSH COPLEY MEDICAL CENTER, NORTHWESTERN DELNOR HOSPITAL, AMITA MERCY MEDICAL CENTER, AMITA ST. JOSEPH HOSPITAL (ELGIN), AND ADVOCATE SHERMAN HOSPITAL WORKED TOGETHER ALONG WITH THE INC BOARD TO DEVELOP THE COUNTY'S IPLAN (ILLINOIS PROJECT FOR LOCAL ASSESSMENT OF NEEDS). THE IPLAN IS A COMMUNITY HEALTH ASSESSMENT AND PLANNING PROCESS THAT IS CONDUCTED EVERY THREE TO FIVE YEARS BY LOCAL HEALTH JURISDICTIONS IN ILLINOIS. THE COLLABORATIVE PARTICIPATION IN THE PLANNING PROCESS, PLAN DEVELOPMENT, AND IDENTIFICATION OF THE HEALTH NEEDS FOR THE COUNTY SERVED AS A FOUNDATION FOR THE DEVELOPMENT OF EACH OF THE HOSPITAL'S RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENTS. COPLEY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: THE KANE COUNTY HEALTH DEPARTMENT, RUSH COPLEY MEDICAL CENTER, NORTHWESTERN DELNOR HOSPITAL, AMITA MERCY MEDICAL CENTER, AMITA ST. JOSEPH HOSPITAL (ELGIN), AND ADVOCATE SHERMAN HOSPITAL WORKED TOGETHER ALONG WITH THE INC BOARD TO DEVELOP THE COUNTY'S IPLAN (ILLINOIS PROJECT FOR LOCAL ASSESSMENT OF NEEDS). THE IPLAN IS A COMMUNITY HEALTH ASSESSMENT AND PLANNING PROCESS THAT IS CONDUCTED EVERY THREE TO FIVE YEARS BY LOCAL HEALTH JURISDICTIONS IN ILLINOIS. THE COLLABORATIVE PARTICIPATION IN THE PLANNING PROCESS, PLAN DEVELOPMENT, AND IDENTIFICATION OF THE HEALTH NEEDS FOR THE COUNTY SERVED AS A FOUNDATION FOR THE DEVELOPMENT OF EACH OF THE HOSPITAL'S RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENTS. COPLEY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: IMPLEMENTATION STRATEGY TO MEET SIGNIFICANT HEALTH NEEDS IDENTIFIED IN CHNA:RUSH COPLEY IS CURRENTLY WORKING ON THE IMPLEMENTATION OF STRATEGIES IDENTIFIED IN THE FY17-FY19 STRATEGY IMPLEMENTATION PLAN FOR THE THREE HEALTH NEED PRIORITIES IDENTIFIED IN THE FY2016 CHNA. KEY ACCOMPLISHMENT HIGHLIGHTS DURING THE YEAR ENDED JUNE 30, 2018 INCLUDE THE FOLLOWING: - DEVELOPED AND IMPLEMENTED A HEALTHY LIFESTYLE FAMILY PROGRAM FOR THE HISPANIC/LATINO COMMUNITY AT NO COST TO PARTICIPANTS (23 FAMILIES). A MAJORITY OF INDIVIDUALS IMPROVED THEIR KNOWLEDGE ABOUT A HEALTHY LIFESTYLE AND SAW AN IMPROVEMENT IN THEIR PHYSICAL ACTIVITY PERFORMANCE.- DESIGNED, DEVELOPED, AND IMPLEMENTED FOUR PROFESSIONALLY PRINTED BILINGUAL NUTRITION POSTERS THAT WERE INSTALLED AT FOUR LOCAL FOOD PANTIES FOR NATIONAL NUTRITION MONTH. ADDITIONALLY, RCMC PROVIDED EDUCATIONAL SESSIONS ON THE CONTENT OF THE NUTRITION POSTERS AT TWO OF THE FOOD PANTRIES WITH AN ESTIMATED 100 TOTAL PARTICIPANTS.- WORKED WITH CITY OF AURORA TO DEVELOP FOUR HEALTHY EATING COOKING DEMONSTRATION VIDEOS WITH BILINGUAL SUBTITLES THAT FEATURE HEALTHY HISPANIC/LATINO RECIPES.- PARTNERED WITH COMMUNITY ORGANIZATIONS TO DEVELOP A PILOT FOOD PRESCRIPTION PROGRAM FOR VULNERABLE POPULATIONS THROUGH THE NEW KANE COUNTY FOOD HUB PROGRAM.- CONTINUED TO OFFER THE 12-WEEK HEALTHY WEIGHT LOSS PROGRAM, YOUFIT, WHERE PARTICIPANTS SAW AN AVERAGE DECREASE OF 1.1 BMI POINTS AND LOST AN AVERAGE OF 7.3 POUNDS. - BASED ON PARTICIPANT FEEDBACK FROM THE YOUFIT PROGRAM, RCMC DEVELOPED A MAINTENANCE HEALTHY WEIGHT LOSS PROGRAM CALLED YOUFIT MORE, AN 8-WEEK PROGRAM FOR THOSE WHO ARE CONTINUING OR RENEWING THEIR WEIGHT LOSS GOALS.- CONTINUED THE PROCESS DEVELOPED BY RCMC CARE MANAGEMENT OF SCHEDULING POST-DISCHARGE FOLLOW-UP APPOINTMENTS WITH A PCP FOR PATIENTS TREATED IN THE ED WHO DO NOT HAVE A PCP OR ARE UNAWARE OF THEIR PCP, ESPECIALLY THOSE WHO ARE VULNERABLE, HAVE A CHRONIC DISEASE, AND/OR ARE HIGH UTILIZERS OF THE ED. CARE MANAGERS SCHEDULED APPROXIMATELY 1,800 POST-DISCHARGE FOLLOW-UP APPOINTMENTS IN FY18.- CONTINUED THE PROCESS DEVELOPED BY RCMC CARE MANAGEMENT OF SCHEDULING POST-DISCHARGE FOLLOW-UP APPOINTMENTS FOR THE HIGH-RISK CHRONIC DISEASE INPATIENTS. IN FY18, 83% OF CHF PATIENTS AND 100% OF STROKE PATIENTS HAD THEIR POST DISCHARGE FOLLOW-UP APPOINTMENT SCHEDULED FOR THEM BEFORE DISCHARGE. - DEVELOPED AND IMPLEMENTED A MEDICATION ADHERENCE PILOT PROGRAM FOR HEART FAILURE AND CORONARY INTERVENTION PATIENTS. DURING THE PILOT PROGRAM 92% OF PATIENTS HAD DISCREPANCIES IN THEIR MEDICATION LISTS WHICH WERE RECONCILED.- BEGAN THE DEVELOPMENT OF A CHRONIC DISEASE COMMUNITY EDUCATION SERIES TO PROVIDE TOOLS AND RESOURCES FOR HOW TO MANAGE CHRONIC HEALTH CONDITIONS. - CONTINUED TO ACTIVELY PARTICIPATE WITH COMMUNITY PARTNERS IN THE DISCUSSION AND DEVELOPMENT OF RESOURCES AND EDUCATION REGARDING APPROPRIATE CARE SETTINGS.- RCMC CARE MANAGEMENT PROVIDED ONE-ON-ONE EDUCATION IN THE ED ABOUT APPROPRIATE CARE SETTINGS TO APPROXIMATELY 1,000 PATIENTS IN FY18.- IN FY18, RAN 27 PROGRAMS IN THE COMMUNITY RELATED TO THE TOP IDENTIFIED NEEDS OF OBESITY, CHRONIC DISEASE AND ACCESS TO CARE WITH OVER 950 ATTENDEES.THE FOLLOWING NEEDS ARE NOT BEING ADDRESSED BY COPLEY MEMORIAL HOSPITAL: (1) BEHAVIORAL HEALTH, INCLUDING MENTAL HEALTH AND SUBSTANCE ABUSE. IT WOULD NOT BE FEASIBLE FOR THE HOSPITAL TO DEVELOP THIS TYPE OF PROGRAM, BUT THE HOSPITAL WORKS CLOSELY WITH BEHAVIORAL HEALTH PROGRAMS IN THE COMMUNITY IN ORDER TO ASSIST PATIENTS IN ACCESSING CARE. (2) ACCESS TO CARE: TRANSPORTATION FOR HEALTH CARE SERVICES. IT WOULD NOT BE FEASIBLE FOR THE HOSPITAL TO DEVELOP THIS TYPE OF PROGRAM, BUT THE HOSPITAL CONTINUES TO ADDRESS THE NEED FOR TRANSPORTATION THROUGH A NUMBER OF PROGRAMS, RESOURCES, GRANTS AND OUTREACH ACTIVITIES IN THE COMMUNITY, INCLUDING: PROVIDES CAB FARE AND BUS VOUCHERS, COORDINATES PUBLIC TRANSPORTATION, AND HELPS IDENTIFY PATIENTS APPROPRIATE FOR COUNTY-FUNDED TRANSPORTATION. (3) INCOME, JOB-READY WORKFORCE AND EDUCATION. THIS NEED IS BEING ADDRESSED THROUGH THE KANE COUNTY IPLAN WITH A DEDICATED KANE HEALTH COUNTS COMMITTEE DEVELOPING AND IMPLEMENTING STRATEGIES TO IMPROVE INCOME, JOB READINESS AND EDUCATION ATTAINMENT IN THE COMMUNITY. WHILE THE HOSPITAL IS NOT IN A POSITION TO IMPACT THIS NEED ON A LARGE SCALE THROUGHOUT THE COMMUNITY, THE HOSPITAL HAS A NUMBER OF PROGRAMS IN PLACE THAT HELP ADDRESS THIS NEED, INCLUDING: EMPLOYEE TUITION REIMBURSEMENT PROGRAM, OFFERING EMPLOYEES REIMBURSEMENT FOR SPECIALTY CERTIFICATION/CONTINUING EDUCATION, AND PARTNERING WITH LOCAL SCHOOLS TO PROVIDE JOB-READINESS PROGRAMS FOR THE HEALTH CARE WORKFORCE. PART V, SECTION B, LINE 7A HTTPS://WWW.RUSHCOPLEY.COM/APP/FILES/PUBLIC/3767/CHNA-FY2016-FINAL.PDF PART V, SECTION B, LINE 10A HTTPS://WWW.RUSHCOPLEY.COM/APP/FILES/PUBLIC/3768/RCMC-IMPLEMENTATION-STRATEGY---FY2016-FINAL.PDF PART V, SECTION B, LINE 16A HTTPS://WWW.RUSHCOPLEY.COM/APP/FILES/PUBLIC/4528/FINANCIAL-ASSISTANCE-CHARITY-CARE-POLICY.PDF PART V, SECTION B, LINE 16B HTTPS://WWW.RUSHCOPLEY.COM/APP/FILES/PUBLIC/4526/FINANCIAL-ASSISTANCE-APPLICATION.PDF PART V, SECTION B, LINE 16C HTTPS://WWW.RUSHCOPLEY.COM/APP/FILES/PUBLIC/4530/PLAIN-LANGUAGE-SUMMARY.PDF 5 1 - RIVER WEST RADIATION CENTER LLC 1221 N HIGHLAND AVENUE AURORA IL 605044206 JV ONCOLOGY 2 - CASTLE SURGICENTER 2111 OGDEN AVE AURORA IL 60504 AMBULATORY SURGERY CENTER 3 - RUSH COPLEY HEALTHCARE CENTER 1100 WEST VETERANS PARKWAY YORKVILLE IL 60560 FREE STANDING EMERGENCY CARE, RADIOLOGY, LAB, AND OCCUPATIONAL HEALTH SERVI 4 - RUSH COPLEY CARDIOVASCULAR 2000 OGDEN AVENUE AURORA IL 605044206 CARDIOVASCULAR SERVICES 5 - MIDWEST CENTER FOR ADVANCED IMAGING 4355 MONTGOMERY ROAD NAPERVILLE IL 60564 RADIOLOGY SERVICES PART I, LINE 7: THE COST TO CHARGE RATIO CALCULATED IN WORKSHEET 2 WAS USED TO CALCULATE THE AMOUNTS REPORTED IN TABLE A. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS (INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED AND SELF PAY). PART III, LINE 4: NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM THIRD PARTY PAYORS, PATIENTS, AND OTHERS FOR SERVICES RENDERED. RCMC HAS AGREEMENTS WITH THIRD PARTY PAYORS THAT PROVIDE FOR PAYMENT AT AMOUNTS DIFFERENT FROM ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, PER DIEM PAYMENTS, AND DISCOUNTED CHARGES, INCLUDING ESTIMATED RETROACTIVE SETTLEMENTS UNDER PAYMENT AGREEMENTS WITH THIRD PARTY PAYORS. RCMC RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENT WHO HAVE THIRD PARTY PAYOR COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR SERVICES RENDERED. PROVISIONS FOR ADJUSTMENTS TO NET PATIENT SERVICE REVENUE ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED TO FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, RCMC RECOGNIZES REVENUE BASED ON ITS DISCOUNTED RATES. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OR RCMC'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR SERVICES PROVIDED. THUS, RCMC RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED.PATIENT ACCOUNTS RECEIVABLE ARE BASED ON GROSS CHARGES AND STATED AT NET REALIZABLE VALUE. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS, BASED ON EXPECTED PAYMENT RATES FROM PAYORS UNDER CURRENT REIMBURSEMENT METHODOLOGIES, AND ALSO BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, RCMC ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), RCMC RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE.THE DIFFERENCE BETWEEN THE DISCOUNTED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED UNCOLLECTIBLE. PART III, LINE 8: ALL OF THE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE IF WE DID NOT PROVIDE THE SERVICE, THE BURDEN OF THE COSTS WOULD FALL ON THE GOVERNMENT. PART III, LINE 9B: IT IS OUR POLICY NOT TO PURSUE COLLECTION PRACTICES AGAINST PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR OTHER FINANCIAL ASSISTANCE. IN CERTAIN CASES IT MAY NOT BE EASILY DETERMINED WHETHER OR NOT A PATIENT QUALIFIES FOR CHARITY CARE OR FINANCIAL ASSISTANCE. HOWEVER, IF AFTER COLLECTION PRACTICES HAVE BEGUN, IT BECOMES KNOWN THE PATIENT QUALIFIES, THE COLLECTION EFFORTS CEASE. PART VI, LINE 2: COMMUNITY NEED IS ASSESSED THROUGH REVIEW OF COMMUNITY AND HOSPITAL DATA, PERIODIC ASSESSMENTS WITH PHYSICIAN AND CLINICIANS, AND REPORTING OF INFORMATION FROM HOSPITAL COMMITTEES. FURTHER INPUT FROM THE COMMUNITY ARISES FROM THE COMMUNITY BASED BOARD OF DIRECTORS, VARIOUS FORMS OF PATIENT INPUT, AND HOSPITAL INVOLVEMENT WITH GOVERNMENT, HEALTH INDUSTRY, AND COMMUNITY AGENCIES. THE HOSPITAL ALSO ACTIVELY PARTICIPATES IN FORMAL NEEDS ASSESSMENTS CONDUCTED BY GOVERNMENT AND COMMUNITY AGENCIES. PART VI, LINE 3: AT THE TIME OF SERVICE, COPLEY MEMORIAL HOSPITAL, INC. PATIENTS ARE GIVEN A BILLING BROCHURE, WHICH DESCRIBES THE FINANCIAL ASSISTANCE/CHARITY CARE PROGRAMS AVAILABLE. THIS INFORMATION IS ALSO POSTED AT THE REGISTRATION CHECK-IN DESKS, IN AN INPATIENT GUIDE, AND ON THE RUSH COPLEY WEBSITE. FINANCIAL COUNSELORS ARE AVAILABLE TO EXPLAIN THE PROGRAM IN DETAIL TO PATIENTS WHO ARE SEEN WITHOUT INSURANCE COVERAGE. ALL PATIENT BILLING STATEMENTS ADVISE THE PATIENTS TO CALL AND INQUIRE ON THE DETAILS AS NEEDED. PART VI, LINE 4: COPLEY MEMORIAL HOSPITAL INC.'S PRIMARY SERVICE AREA IS APPROXIMATELY SOUTHERN KANE COUNTY AND KENDALL COUNTY, ILLINOIS LOCATED 45 TO 55 MILES SOUTHWEST OF CHICAGO. KANE COUNTY HAS A POPULATION OF 535,000 PEOPLE AND IS PREDOMINANTLY URBAN AND SUBURBAN. NEARLY 32% OF THE POPULATION IS OF HISPANIC OR LATINO ORIGIN. PERSONS OVER THE AGE OF 65 COMPRISE 13% OF THE POPULATION, AND THE POVERTY RATE IS 11%. AURORA IS THE SECOND LARGEST CITY IN ILLINOIS, AND IT DOMINATES THE COUNTY. HISTORICALLY AN INDUSTRIAL CITY, AURORA HAS EXPERIENCED A CONSIDERABLE LOSS OF MANUFACTURING JOBS AND IS TRANSITIONING ITS ECONOMY. KENDALL COUNTY, TO THE SOUTH OF KANE, HAS A POPULATION OF 127,000. PERSONS OVER THE AGE OF 65 COMPRISE 10.0% OF THE POPULATION, AND THE POVERTY RATE IS 5.4%. THE NORTHWEST SECTION OF THE COUNTY IS SUBURBAN WHILE THE REMAINDER IS RURAL. PART VI, LINE 5: COPLEY MEMORIAL HOSPITAL'S MISSION IS TO PROVIDE ADVANCED MEDICINE WITH QUALITY OUTCOMES AND EXTRAORDINARY CARE. TO THAT END, THE MEDICAL CENTER SEEKS TO SERVE THE COMMUNITY IN WAYS THAT ENGAGE, EDUCATE AND EMPOWER. COPLEY MEMORIAL HOSPITAL SERVES ALL PATIENTS WHO PRESENT FOR CARE AND SERVES THE SURROUNDING COMMUNITY ALONG WITH A BOARD OF DIRECTORS WITH A STRONG COMMUNITY BASE. THE BOARD MEMBERS ARE INDEPENDENT COMMUNITY LEADERS AND ARE SELECTED BASED UPON THEIR EXPERTISE AND EXPERIENCE IN A VARIETY OF AREAS OF BENEFIT TO THE ORGANIZATION AND THEIR ROLE AS BOARD MEMBERS WHO DIRECT AND GUIDE MANAGEMENT IN CARRYING OUT OUR MISSION. BOARD MEMBERS ARE NOT COMPENSATED FOR THEIR SERVICE. AS A CHARITABLE ORGANIZATION, ALL SURPLUS FUNDS ARE USED TO FURTHER OUR CHARITABLE PURPOSE, MISSION AND TO SERVE THE COMMUNITY. SOME OF OUR PRIMARY PROGRAMS ARE: COMMUNITY HEALTH FAIRS, BREASTFEEDING EDUCATION CLASSES, CHILD CARE CLASSES, ETC. COPLEY MEMORIAL HOSPITAL PROVIDES ACCESS TO PHYSICIAN, ACUTE CARE, DIAGNOSTIC, AND REHABILITATIVE SERVICES TO PEOPLE, REGARDLESS OF ABILITY TO PAY, THROUGH A NUMBER OF FACILITIES AND SERVICES LOCATED THROUGHOUT THE SERVICE AREA. IT PROVIDES PROGRAMMING RELATING TO HEALTH EDUCATION, PREVENTION, AND SUPPORT TARGETED TO SPECIFIC POPULATIONS. MEDICAL EDUCATION EXTENDS TO CLINICAL SETTINGS FOR NURSING EDUCATION AND A FAMILY PRACTICE RESIDENCY. EMPLOYEES FILL BOARD AND COMMITTEE LEADERSHIP POSITIONS FOR A NUMBER OF ECONOMIC DEVELOPMENT AND SOCIAL SERVICE AGENCIES IN COMMUNITIES THROUGHOUT THE SERVICE AREA. PART VI, LINE 7, REPORTS FILED WITH STATES IL PART V, SECTION B, LINE 16I THE FOLLOWING DISCLOSURE IS IN ACCORDANCE WITH REV. PROC 2015-21 SECTION 7 IN REGARDS TO SCHEDULE H, PART V, SECTION B, LINE 16I:FOR THE FISCAL YEAR ENDED 6/30/18, COPLEY MEMORIAL HOSPITAL, INC. (CMH) PROVIDED SPANISH TRANSLATIONS OF THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, AND FINANCIAL ASSISTANCE APPLICATION. ADDITIONALLY, CMH PROVIDES LANGUAGE ASSISTANCE FREE OF CHARGE FOR MANY OTHER LANGUAGES (SEE HTTPS://WWW.RUSHCOPLEY.COM/ABOUT/LANGUAGE-ASSISTANCE/). HOWEVER, FOR PART OF THE TAX YEAR, (CMH) DID NOT HAVE THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, AND FINANCIAL ASSISTANCE APPLICATION TRANSLATED INTO EACH OF THE PRIMARY LANGUAGES SPOKEN BY LIMITED ENGLISH PROFICIENCY (LEP) POPULATIONS. DUE TO THE AVAILABILITY OF TRANSLATION ASSISTANCE, CMH IS NOT AWARE OF ANY INDIVIDUALS WHO WERE ADVERSELY IMPACTED BY THIS OVERSIGHT. AS OF SEPTEMBER 30, 2018, CMH HAD ALL OF THE TRANSLATIONS COMPLETED AND AVAILABLE ON THEIR WEBSITE. CMH HAS ALSO IMPLEMENTED PROCEDURES TO ENSURE COMPLIANCE WITH THIS REQUIREMENT IN THE FUTURE BY ANNUALLY REVIEWING THE LEP POPULATIONS AND ADDING ADDITIONAL TRANSLATIONS AS NEEDED AND UPDATING THE TRANSLATIONS SHOULD THERE BE CHANGES TO THE DOCUMENTS. PART V, SECTION B, LINE 20A THE FOLLOWING DISCLOSURE IS IN ACCORDANCE WITH REV. PROC 2015-21 SECTION 7 IN REGARDS TO SCHEDULE H, PART V, LINE 20A: DURING THE TAX YEAR, COPLEY MEMORIAL HOSPITAL (CMH) DID NOT PROVIDE A PLAIN LANGUAGE SUMMARY OF THE FAP WITH THE WRITTEN NOTICE ABOUT UPCOMING ECAS PROVIDED TO PATIENTS AT LEAST 30 DAYS BEFORE INITIATING THOSE ECAS. IN FY18, CMH PROVIDED BILLING COMMUNICATIONS THAT INCLUDED COMMENTS ON THE FINANCIAL ASSISTANCE AVAILABLE TO PATIENTS, BUT DID NOT TECHNICALLY PROVIDE THE PLAIN LANGUAGE SUMMARY WITHIN THE WRITTEN NOTIFICATION. THIS WAS DISCOVERED IN APRIL 2019 AS CMH WORKED WITH TAX CONSULTANTS ON SCHEDULE H. CMH ESTIMATES THIS AFFECTED AN ESTIMATED 10,000 TO 12,000 CMH PATIENTS WHO RECEIVED THE WRITTEN NOTICE ABOUT UPCOMING ECAS WITHOUT THE PLAIN LANGUAGE SUMMARY. CMH HAS SINCE IMPLEMENTED PROCEDURES TO ENSURE COMPLIANCE WITH THIS REQUIREMENT GOING FORWARD. CMH WILL BEGIN INCLUDING THE PLAIN LANGUAGE SUMMARY WHEN MAILING A PREANNOUNCEMENT TO THE PATIENT THAT ECA WILL BE TAKEN. THE ANNOUNCEMENT IS MAILED A MINIMUM OF 30 DAYS PRIOR TO ANY ECA BEING TAKEN AND WILL NOW INCLUDE THE PLAIN LANGUAGE SUMMARY. THIS WILL ENSURE THAT ALL PATIENTS THAT COULD POTENTIALLY RECEIVE AN ECA IN THE EVENT OF NON-PAYMENT WILL HAVE RECEIVED THE PLAIN LANGUAGE SUMMARY AT LEAST 30 DAYS IN ADVANCE. ADDITIONALLY, CMH MAKES EFFORTS TO NOTIFY ALL PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE ORALLY THROUGHOUT THE BILLING PROCESS IN COMMUNICATIONS PRIOR TO INITIATING ANY ECAS. PART V, SECTION B, LINE 22B THE FOLLOWING DISCLOSURE IS IN ACCORDANCE WITH REV. PROC 2015-21 SECTION 7 IN REGARDS TO SCHEDULE H, PART V, SECTION B, LINE 22B:DURING THE TAX YEAR, COPLEY MEMORIAL HOSPITAL, INC. (CMH) COMPLETED THE AGB CALCULATION AND APPLIED IT TO PATIENT ACCOUNTS. HOWEVER, CMH DID NOT INCLUDE IN ITS FINANCIAL ASSISTANCE POLICY THE AMOUNTS GENERALLY BILLED (AGB) PERCENTAGE NOR DID IT EXPLAIN HOW MEMBERS OF THE PUBLIC MAY READILY OBTAIN SUCH PERCENTAGES. CMH'S AGB CALCULATION USES THE LOOK-BACK METHOD BASED ON CLAIMS ALLOWED BY MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS THAT PAY CLAIMS TO THE HOSPITAL FACILITY DURING A PRIOR 12-MONTH PERIOD. CMH IS WORKING TO UPDATE THE FINANCIAL ASSISTANCE POLICY TO INCLUDE INFORMATION ON WHERE PATIENTS CAN FIND THE AGB PERCENTAGE AND WILL MAKE THIS AVAILABLE TO PATIENTS. CMH DETERMINED THAT THIS OVERSIGHT DID NOT CAUSE ANY PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE TO BE CHARGED GREATER THAN AGB AS THE PERCENTAGE WAS CORRECTLY CALCULATED AND APPLIED TO PATIENT ACCOUNTS. CMH HAS ALSO IMPLEMENTED PROCEDURES TO ENSURE ANNUAL COMPLIANCE WITH THIS REQUIREMENT IN THE FUTURE. CMH WILL REGULARLY REVIEW THE AGB PERCENTAGE AND WILL MONITOR THE PERCENTAGE USED TO MAKE SURE ANY PATIENT WHO QUALIFIES FOR FINANCIAL ASSISTANCE ISN'T OVER CHARGED. X 1 0 X X X X X 0 1 0 0 0 0 0 1 0 GARRETT KATULA DO VICE CHIEF OF STAFF/DIRECTOR 242706 0 33621 0 6658 0 4803 0 26858 0 314646 0 0 0 STEPHEN KELANIC MD VICE CHIEF OF STAFF/DIRECTOR 292307 0 139702 0 981 0 5143 0 25509 0 463642 0 0 0 BARRY FINN PRESIDENT & CEO/DIRECTOR 739783 0 304470 0 504089 0 5400 0 26024 0 1579766 0 0 0 RYAN ASMUS VP GENERAL COUNSEL/SECRETARY 260044 0 89490 0 20065 0 43447 0 25478 0 438524 0 0 0 BRENDA VAN WYHE SR. VP FINANCE & CFO/TREASURER 343863 0 103950 0 4108 0 56642 0 17210 0 525773 0 0 0 GAIL BUMGARNER SR. VP, STRATEGY 264528 0 89490 0 71709 0 5042 0 8654 0 439423 0 0 0 DENNIS DEMASIE VP, INFORMATION TECH & CIO 255408 0 72540 0 378920 0 4200 0 12112 0 723180 0 274721 0 JOHN DIEDERICH SR. VP, OPERATIONS & COO 442975 0 89490 0 14030 0 141455 0 25538 0 713488 0 0 0 BRENDA FANN MD ASSISTANT VP, MEDAFFAIRS 264568 0 40519 0 23829 0 5163 0 26172 0 360251 0 0 0 DIANE HOMAN MD VP, QUALITY & PSO 316957 0 108330 0 89521 0 4012 0 24339 0 543159 0 0 0 STEVE LOWENTHAL MD SR. VP, MEDICAL AFFAIRS & CMO 424406 0 139730 0 124555 0 5400 0 8947 0 703038 0 0 0 DAVID PETASNICK ASSISTANT VP, ANCILLARY SVCS 185984 0 32298 0 2369 0 3600 0 22608 0 246859 0 0 0 ALEX POPE VP, PHILANTHROPY & CDO 200782 0 61776 0 3264 0 32679 0 25253 0 323754 0 0 0 MARY SHILKAITIS VP PATIENT CARE SRVCS & CNO 225317 0 79599 0 24196 0 41378 0 27994 0 398484 0 0 0 SUSAN STERCHI ASSISTANT VP, PATIENT CARE 164421 0 35074 0 23775 0 2400 0 27784 0 253454 0 0 0 MARK SHARP-SCHINSKY MD PHYSICIAN 733184 0 496389 0 21672 0 1440 0 33273 0 1285958 0 0 0 DIMITRY RUBAN MD PHYSICIAN 956074 0 8879 0 18594 0 5400 0 24599 0 1013546 0 0 0 KEVIN KELLY MD PHYSICIAN 909079 0 5544 0 3590 0 692 0 25266 0 944171 0 0 0 ARIF SALEEM MD PHYSICIAN 536669 0 239099 0 21590 0 5400 0 25516 0 828274 0 0 0 TERESSA ALEXANDER MD PHYSICIAN 471139 0 289013 0 26224 0 5340 0 25496 0 817212 0 0 0 PART I, LINE 1A THE ORGANIZATION PROVIDES TO ALL EMPLOYEES THE USE OF AN ATHLETIC FACILITY THAT IS OWNED AND OPERATED BY A RELATED TAX EXEMPT ORGANIZATION. PART I, LINE 4B CMH OFFERS A SUPPLEMENTAL RETIREMENT PLAN TO CERTAIN EMPLOYEES WHO PARTICIPATE IN THE EXECUTIVE BENEFITS PROGRAM. THERE IS NO CONSTRUCTIVE RECEIPT OF THESE AMOUNTS BY THE INDIVIDUALS UNTIL THEY ARE PAID OUT AS THEY ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE UNTIL INDIVIDUALS MEET THE REQUIRED VESTING PERIOD. ONCE VESTED, PAYOUTS WOULD BE INCLUDED AS REPORTABLE COMPENSATION ON THE RECIPIENTS ANNUAL FORM W-2. THE AMOUNTS PAID OUT OF THIS PLAN IN 2017 WERE AS FOLLOWS: BARRY FINN - $474,302, STEVE LOWENTHAL - $85,214, DENNIS DEMAISE - $372,803, DIANE HOMAN - $60,566 AND GAIL BUMGARNER -$46,301. PART I, LINE 7 INCENTIVE BONUS PLAN BASED ON A SERIES OF APPROVED STRATEGIC ACCOMPLISHMENTS. A ILLINOIS FINANCE AUTHORITY 861091967 45203HS45 2015-02-11 105601668 REFUND BONDS ISSUED 5/28/2008, 2/10/2009, AND 7/29/2009 0 0 0 A 3085000 105601668 86043195 824030 145 22355870 0 1 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 PART IV, LINE 6, COLUMN A: THIS QUESTION IS BEING ANSWERED WITHOUT REGARD TO A YIELD-RESTRICTED ADVANCE REFUNDING ESCROW FINANCED WITH PROCEEDS OF THE BONDS. FORM 990, PART III, LINE 4A SUMMARY OF FY18 HEALTH PROGRAMMING DURING FY18, COPLEY MEMORIAL HOSPITAL SPONSORED, PARTNERED OR PARTICIPATED IN OVER 600 COMMUNITY-BASED PROGRAMS AND EVENTS WITH SPECIAL EMPHASIS ON IMPROVING THE HEALTH AND WELLNESS OF ADULTS, CHILDREN AND UNDERSERVED POPULATIONS. NUTRITION AND WEIGHT LOSS YOUFIT HELD THREE 12-WEEK SESSIONS WITH A TOTAL OF 14 PARTICIPANTS ENROLLED IN THE PROGRAM. PARTICIPANTS LEARNED FROM A VARIETY OF EXPERTS INCLUDING RUSH COPLEY PHYSICIANS, HEALTHPLEX PERSONAL TRAINERS AND REGISTERED DIETICIANS. FAMILIA SALUDABLE - A SIX-SESSION, ONCE A MONTH FAMILY FOCUSED COMMUNITY NUTRITION AND FITNESS BASED HEALTHY LIFESTYLE PROGRAM EDUCATED 25 FAMILIES AND A TOTAL OF 58 PARTICIPANTS. THE NUTRITION PORTION OF THE PROGRAM WAS CONDUCTED IN ENGLISH WITH SPANISH INTERPRETATION. THE EXERCISE PORTION WAS CONDUCTED IN SPANISH. EACH FAMILY WAS PROVIDED WITH A BINDER THAT INCLUDED THE PRESENTATION AS WELL AS TOOLS SUCH AS ACTIVITY CALENDAR AND RECIPES. EACH FAMILY ALSO RECEIVED PORTION PLATES, STRETCH BANDS AND OTHER ITEMS TO CONTINUE THEIR HEALTHY LIFESTYLE JOURNEY. COMMUNITY WALKING CLUB RUSH COPLEY CONTINUES TO OFFER THE COMMUNITY THE TOOLS AND RESOURCES TO START THEIR OWN WALKING CLUB. PRESENTATIONS ARE PROVIDED TO ORGANIZATIONS SUCH AS SCHOOLS, PARK DISTRICTS AND ANYONE INTERESTED IN WALKING THEIR WAY TO HEALTH. A PRE AND POST TEST IS GIVEN TO THE PARTICIPANTS TO OBSERVE THEIR PROGRESS AND PEDOMETERS AND WALKING LOGS ARE PROVIDED TO KEEP THEM MOTIVATED. 30 NEW COMMUNITY MEMBERS WERE ADDED TO THE COMMUNITY WALKING CLUB. DIABETES FREE FASTING GLUCOSE SCREENINGS WERE PROVIDED TO OVER 69 COMMUNITY MEMBERS. SMOKING CESSATION FREEDOM FROM SMOKING SMOKING CESSATION FREEDOM FROM SMOKING IS A SEVEN-WEEK, EIGHT-SESSION PROGRAM SPONSORED BY THE AMERICAN LUNG ASSOCIATION AND HOSTED BY RUSH COPLEY MEDICAL CENTER. SESSIONS ARE LED BY A CERTIFIED FACILITATOR. FOUR PROGRAM SESSIONS WERE HOSTED WITH A TOTAL OF NINE PARTICIPANTS. CANCER AWARENESS AND INFORMATION RUSH COPLEY GASTROENTEROLOGISTS, DR. TOMMY PACANA, DR. DHIRAJ GULATI AND NURSING STAFF FROM THE DIGESTIVE HEALTH SERVICES PRESENTED GET THE SCOOP ON THE SCOPE TWO TIMES WITH A TOTAL OF 27 PARTICIPANTS. AT THE ANNUAL CELEBRATION OF NATIONAL CANCER SURVIVORS DAY HELD AT WATERFORD PLACE CANCER RESOURCE CENTER, THERE WERE MORE THAN 100 PARTICIPANTS IN ATTENDANCE. DR. HO MYONG, MEDICAL ONCOLOGIST AND HEMATOLOGIST AND STEPHANIE BEAM, CLINICAL ONCOLOGY PHARMACIST PRESENTED HORMONE THERAPY FOR BREAST CANCER: WHAT IS IT AND HOW DOES IT WORK? THERE WERE 25 PARTICIPANTS THAT ATTENDED. RUSH COPLEY'S COMMUNITY HEALTH OUTREACH COORDINATOR AND ADVANCE PRACTICE NURSE GYNE ONCOLOGY ALONG WITH THE AMERICAN CANCER SOCIETY HOSPITAL SYSTEMS MANAGER PRESENTED THE "YOU ARE THE KEY" PRESENTATION FROM THE CDC HPV VACCINATION TOOLKIT TO 26 EAST AURORA SCHOOL DISTRICT 131 SCHOOL NURSES AND HEALTHCARE COORDINATORS. RUSH COPLEY PARTNERED WITH ALAS-WINGS TO HOST ALAS ON WHEELS MOBILE SALON AT WATERFORD PLACE CANCER RESOURCE CENTER. AT THIS EVENT, 23 WOMEN BENEFITTED FROM RECEIVING A DONATION OF MASTECTOMY BRAS AND PROSTHESIS. COMMUNITY HEALTH TALKS COMMUNITY HEALTH TALKS IS AN EDUCATIONAL SERIES GEARED TOWARD THE HEALTHCARE NEEDS OF THE LATINO POPULATION. COMMUNITY HEALTH TALKS IS OFFERED SEVEN TIMES A YEAR FROM SEPTEMBER THROUGH APRIL AND TARGETS WOMEN, MEN AND CHILDREN OVER THE AGE OF 12 IN THE FOX VALLEY AREA. SOME OF THE TOPICS PRESENTED BY PROFESSIONAL HEALTHCARE PROVIDERS INCLUDE: ADVANCED DIRECTIVES FOR HEALTHCARE, STRENGTHENING PARENT CHILD RELATIONSHIPS, HOW TO MANAGE DIABETES DURING THE WINTER MONTHS, TAKING CARE OF YOUR HEALTH! THE IMPORTANCE OF CANCER SCREENINGS, HOW TO PREVENT/REVERSE CARDIAC DISEASE, THE AGING BRAIN AND HOW TO MANAGE CHRONIC DISEASE. TYPICALLY, BETWEEN 10 AND 25 WOMEN AND MEN ATTEND THE MONTHLY SESSIONS. CLOSE TO 120 PARTICIPANTS ATTENDED AND BENEFITTED FROM THE PRESENTATIONS IN FY18. HEALTH EXHIBITS AT SCI-TECH HANDS ON MUSEUM EXHIBITS CONTINUE TO BE DISPLAYED IN THE LUNCH ROOM AND ADJACENT CORRIDOR OF THE MUSEUM TARGETING VISITORS IN THE 5-16 AGE RANGE. THE EXHIBITS ENABLE VISITORS TO MEASURE THEIR HEART RATE AFTER EXERCISING AND MAKE THE LINK BETWEEN EXERCISE AND HEART HEALTH. ANOTHER TESTS VISITORS' KNOWLEDGE ABOUT THE AMOUNT OF SUGAR IN POPULAR BEVERAGES AND EDUCATES THEM ABOUT DIABETES. SMALLER EXHIBITS ON THE LUNCH ROOM PILLARS DISPLAY THE USDA'S "MY PLATE" GRAPHIC, THE "5-4-3-2-1-GO!" PROGRAM, "EAT-THIS-NOT-THAT" INFORMATION, AND OTHER KID-FRIENDLY INFORMATION ABOUT NUTRITION AND HEALTH. A HAND-WASHING EXHIBIT TO DEMONSTRATE THE IMPORTANCE OF EFFECTIVE HAND-WASHING TECHNIQUES WAS PLACED IN THE LUNCHROOM AT SCITECH TO ENSURE THAT THE MESSAGE REACHES CHILDREN AT A TIME WHEN THEY CAN APPLY THE LESSONS LEARNED DIRECTLY TO THEIR OWN EATING HABITS FOR IMMEDIATE REINFORCEMENT. CHILDREN PLACE THEIR HANDS IN THE SINK TO START AN INTERACTIVE VIDEO THAT SHOWS THE RIGHT TECHNIQUE AND LENGTH OF TIME NEEDED TO REMOVE DIRT AND GERMS. PINK LIGHTS SHINE ON THEIR HANDS, SIMULATING GERMS, UNTIL THE RIGHT AMOUNT OF TIME AND ACTIVITY HAS ELAPSED. IN ADDITION TO THE DAILY VISITORS THE MUSEUM HOSTS DAILY (75,000 VISITORS A YEAR), SCI-TECH HANDS ON MUSEUM CONTINUES TO PARTICIPATE IN FIRST FRIDAYS, A VENUE IN THE DOWNTOWN THAT PROVIDES ARTS AND CULTURE TO THE COMMUNITY AND DRAWS 100 300 COMMUNITY MEMBERS AND VISITORS TO THE MUSEUM FOR THE FIVE HOUR EVENT MOST MONTHS OF THE YEAR. HEALTHY HANDS TO HELP SCHOOL-AGED CHILDREN UNDERSTAND THE IMPORTANCE OF HAND WASHING, RUSH COPLEY MEDICAL CENTER OFFERS A FUN AND EDUCATIONAL PROGRAM FOR SCHOOLS AND COMMUNITY GROUPS CALLED HEALTHY HANDS. THE PROGRAM PROVIDES AN EXPLANATION OF GERMS AND HOW THEY SPREAD. AN INTERACTIVE PRESENTATION INCLUDES THE USE OF "GLOW" GERMS USING A GEL AND THE USE OF A BLACK LIGHT TO SHOW "GERMS." IF THE PARTICIPANTS WASH THEIR HANDS CORRECTLY AND FOR THE PROPER AMOUNT OF TIME USING ANTIBACTERIAL HAND GEL, THEIR HANDS SHOULD NOT SHOW THE "GLOW" GERMS WHEN THEY ARE PLACED UNDER THE BLACK LIGHT A SECOND TIME. THE CHILDREN ARE GIVEN A BOOK MARK THAT SHOWS HOW TO PROPERLY WASH THEIR HANDS. IN FY18 A TOTAL OF 84 CHILDREN PARTICIPATED IN THE HEALTHY HANDS DEMONSTRATION HELD AT A FITNESS FUN FAIR. PLAY IT SAFE PLAY IT SAFE IS A FUN AND INTERACTIVE FAMILY EVENT THAT EDUCATES PEOPLE OF ALL AGES ABOUT IMPORTANT HEALTH TOPICS AND INJURY PREVENTION. IT IS AN ANNUAL EVENT HOSTED BY RUSH COPLEY EMERGENCY SERVICES AND RUSH COPLEY HEALTHPLEX. MORE THAN 500 PEOPLE ATTEND THIS ANNUAL EVENT NOW IN ITS TENTH YEAR. OLDER ADULT EDUCATION RUSH COPLEY, IN COLLABORATION WITH THE OSWEGO SENIOR CENTER, THE UNIVERSITY OF ILLINOIS EXTENSION AND THE KENDALL COUNTY HEALTH DEPARTMENT, IS HOSTING AN ONGOING WORKSHOP AND CHALLENGE SERIES FOR SENIORS IN KENDALL COUNTY TO COMBAT OBESITY. KNOWN AS HEALTHY HABITS FOR SUCCESSFUL LIVING, THIS IS A 9-WEEK PROGRAM DESIGNED FOR SENIORS WHO WANT TO BE HEALTHIER - PARTICIPANTS ARE ENCOURAGED TO MAKE SUSTAINABLE LIFE CHANGES TO MEET THEIR HEALTH GOALS. RUSH COPLEY HEALTHPLEX FITNESS TRAINERS PROVIDE EXERCISE DEMONSTRATIONS FOR PARTICIPANTS TO ENCOURAGE AN ACTIVE LIFESTYLE. TEN SENIORS ENROLLED AND PARTICIPATED IN THE SESSION HELD FEBRUARY THROUGH APRIL 2018. IN FY18, RUSH COPLEY PROVIDED SPEAKERS FOR FIVE SCHEDULED PRESENTATIONS IN THE DOCTOR'S NOTES SERIES HELD AT THE OSWEGO SENIOR CENTER. THIS SERIES EDUCATES SENIORS ON VARIED HEALTH TOPICS RELATED TO AGING. OVER 60 SENIORS ATTENDED. ADDITIONAL PROGRAMS SCHEDULED FOR SENIORS WERE HELD AT VARIOUS LOCATIONS THROUGHOUT THE COMMUNITY AND INCLUDED TOPICS SUCH AS HEART HEALTH, DIABETES EDUCATION, STROKE AWARENESS, ADVANCED CARE PLANNING, HOW TO USE AN AED, AND JOINT REPLACEMENT. OVER 150 SENIORS ATTENDED THESE PROGRAMS. PREGNANCY AND CHILDBIRTH PRE-AND POSTNATAL CLASSES ARE OFFERED TO COUPLES AND FAMILIES WHO ARE EXPECTING OR HAVE A BABY. CLASS TOPICS INCLUDE: CHILDBIRTH EDUCATION. BABY CARE BASICS, BREASTFEEDING PART I, BREASTFEEDING PART II, WORKING & BREASTFEEDING, BECOMING A GRANDPARENT, BOOT CAMP FOR NEW DADS, BRINGING HOME BABY, INFANT MASSAGE CLASS, FAMILY BIRTH CENTER TOURS, CHILD SEAT SAFETY, SIBLING CLASS, AND INFANT CPR AND HOME SAFETY. OVER 1,860 PEOPLE PARTICIPATED IN FY18. HEART SURVIVOR WALK ATTENDEES RECEIVE A FREE VEIN SCREENING. THE 2018 HEART SURVIVOR WALK AND BREAKFAST AT BLACKBERRY FARM HAD 98 PARTICIPANTS. PARTICIPANTS PARTICIPATED IN A ONE MILE WALK AND ENJOYED COMPLIMENTARY BREAKFAST. AWARDS WERE GIVEN FOR THE OLDEST SURVIVOR, YOUNGEST SURVIVOR AND SUPER SURVIVOR. PARTICIPANTS AND THEIR GUESTS WERE EDUCATED BY DRS. ALWARSHETTY, NUYLES AND LOME ABOUT THE IMPORTANCE OF RECOGNIZING SIGNS AND SYMPTOMS OF A HEART ATTACK, THE IMPORTANCE OF CALLING 911 AND LEADING A HEART HEALTHY LIFESTYLE. FORM 990, PART III, LINE 4A SUMMARY OF FY18 HEALTH PROGRAMMING (CONTINUED FROM ABOVE) MOVEMENT DISORDERS RUSH COPLEY'S MOVEMENT DISORDERS PROGRAM PROVIDES SUPPORT AND MANAGEMENT OF PARKINSON'S DISEASE, ESSENTIAL TREMOR, DYSTONIA AND ATAXIA TO HELP PATIENTS MAXIMIZE THEIR MOBILITY, COORDINATION, AND QUALITY OF LIFE. PROGRAM OFFERINGS INCLUDE SUPPORT GROUPS, EXERCISE CLASSES BOTH ON LAND AND WATER, GROUP BOXING, ART AND MUSIC THERAPY AS WELL AS SPECIAL EVENTS WITH GUEST SPEAKERS TO MORE THAN 200 PARTICIPANTS. WOMEN OVER 50 WOMEN ATTENDED TWO PROGRAMS IN THE WOMEN TO WOMEN HEALTH SERIES. TOPICS INCLUDED TREATING GYNE CONDITIONS FROM ROBOTIC SURGERY TO RECOVERY AND FOOD SENSITIVITIES IN FAMILIES. STROKE PROGRAMS ON STROKE EDUCATION WERE HELD ON 5/1/18 WITH 30 PARTICIPANTS IN ATTENDANCE AND 5/16/18 WITH 25 PARTICIPANTS IN ATTENDANCE. PHYSICIAN REFERRAL AND SERVICE LINE COPLEY MEMORIAL HOSPITAL OFFERS A FREE PHYSICIAN AND INFORMATION REFERRAL TELEPHONE SERVICE TO THE COMMUNITY. THIS SERVICE ALLOWS COMMUNITY MEMBERS TO TALK WITH A CALL ADVISOR TO MATCH A PERSON'S HEALTH NEEDS AND PREFERENCES WITH THE PHYSICIAN OF THEIR CHOICE, LINKS CALLERS TO SERVICES PROVIDED BY THE MEDICAL CENTER AND MANAGES REGISTRATION FOR RUSH COPLEY CLASSES AND PROGRAMS. OVER 8,600 PEOPLE USED THIS SERVICE IN FY18. WEBSITE COPLEY MEMORIAL HOSPITAL'S WEBSITE, RUSHCOPLEY.COM, WITH TRANSLATION AVAILABLE INTO DOZENS OF LANGUAGES, OFFERS ACCESS TO FREE HEALTH INFORMATION. IN FY18, RUSHCOPLEY.COM HAD NEARLY 700,000 USER SESSIONS AND OVER 1,614,000 PAGE VIEWS. FORM 990, PART VI, SECTION A, LINE 2 ALL OF THE PERSONS LISTED ON PART VII HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON RELATED RUSH COPLEY MEDICAL CENTER ENTITY BOARDS. FORM 990, PART VI, SECTION A, LINE 6 RUSH COPLEY MEDICAL CENTER, INC. ("RCMC") IS THE SOLE CORPORATE MEMBER OF COPLEY MEMORIAL HOSPITAL, INC. ("CMH"), RUSH COPLEY MEDICAL GROUP, NFP ("RCMG"), COPLEY VENTURES, INC. ("CV"), AND RUSH COPLEY FOUNDATION ("RCF"). FORM 990, PART VI, SECTION A, LINE 7A CMH'S BOARD OF DIRECTORS INCLUDES AT LEAST NINE (9) INDIVIDUALS ELECTED BY THE SOLE CORPORATE MEMBER, RCMC. EACH OF THESE ELECTED DIRECTORS IS ALSO A MEMBER OF THE GOVERNING BOARD OF CMH'S SOLE CORPORATE MEMBER, RCMC. THE ELECTION AND RE-ELECTION OF ALL CMH DIRECTORS IS AT THE DIRECTION OF RCMC AT THE ANNUAL GOVERNING BOARD MEETING. VACANCIES ON THE CMH BOARD OF DIRECTORS ARE FILLED BY CMH'S SOLE CORPORATE MEMBER, RCMC. IN ACCORDANCE WITH CERTAIN PROCEDURAL REQUIREMENTS STATED IN THE BYLAWS, ELECTED DIRECTORS MAY BE REMOVED BY THE AFFIRMATIVE VOTE OF TWO-THIRDS OF THE BOARD OF DIRECTORS OF CMH'S SOLE CORPORATE MEMBER, RCMC. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS OF CMH'S SOLE CORPORATE MEMBER, RCMC, HAS THE FOLLOWING EXCLUSIVE POWERS OVER CMH: (1) THE ELECTION OF THE BOARD OF DIRECTORS; (2) ANY AMENDMENT TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THIS CORPORATION (3) THE BORROWING OF ANY SUM, THE PRINCIPAL OF WHICH EXCEEDS $500,000.00, OR WHICH HAS A STATED TERM OF GREATER THAN ONE YEAR, OR WHICH IS SECURED BY A MORTGAGE OF ALL OR ANY PORTION OF THE CORPORATION'S REAL PROPERTY OR THE CREATION OF A SECURITY INTEREST IN THE CORPORATION'S ASSETS, INCLUDING PERSONAL PROPERTY AND REVENUES, FOR THE BENEFIT OF THE LENDER, LESSOR OR VENDOR, OR THE DEFEASANCE, ADVANCE PAYMENT OR CANCELLATION OF ANY OUTSTANDING DEBT OF THE CATEGORY DESCRIBED HEREIN; (4) ANY VOLUNTARY DISSOLUTION, MERGER, CONSOLIDATION, SALE OR TRANSFER OF ANY OF THE CORPORATION'S ASSETS (ABOVE A MATERIAL DOLLAR THRESHOLD AS A PERCENTAGE OF THE CORPORATION'S ASSETS AS DETERMINED IN CONJUNCTION WITH THE CORPORATE MEMBER) OR ANY CREATION OF A SUBSIDIARY OR AFFILIATE OF THIS CORPORATION; (5) APPLICATION TO THE ILLINOIS HEALTH FACILITIES PLANNING BOARD OR ANY SUCCESSOR FOR A PERMIT OR CERTIFICATE OF NEED FOR A PROPOSED ACTIVITY, WHETHER OR NOT INVOLVING A CAPITAL EXPENDITURE; (6) APPROVAL OF ALL NEW OR CHANGES TO EXISTING ANNUAL AND LONG-TERM CAPITAL AND OPERATIONAL BUDGETS OR LONG-TERM OR MASTER STRATEGIC PLANS; (7) ANY AGREEMENT OR TRANSACTION, EITHER OF WHICH IS OF A MATERIAL NATURE, WITH ANOTHER CORPORATION CONTROLLED BY OR AFFILIATED WITH THE CORPORATE MEMBER OR WHICH IS A SUBSIDIARY OF THE CORPORATE MEMBERS; (8) SALE OF ANY OF THE CORPORATION'S REAL PROPERTY OR INTEREST THEREIN OR PURCHASES OF ANY ADDITIONAL REAL ESTATE; (9) THE AUDITED FINANCIAL STATEMENTS AND BOND DISCLOSURES OF THE CORPORATION; (10) SELECTION AND ANNUAL EVALUATION OF THE PRESIDENT; AND (11) THE ANNUAL AUDITED FINANCIAL STATEMENTS AND BOND DISCLOSURES OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 TAX RETURN IS PREPARED BY OUR EXTERNAL TAX ADVISOR WITH DATA PROVIDED BY OUR ORGANIZATION. A DRAFT OF THE FORM 990 IS PROVIDED TO MANAGEMENT FOR REVIEW AND COMMENT. THE BOARD OF DIRECTORS IS PROVIDED WITH AN APPROVED COPY OF THE FORM 990 BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, OFFICERS, DIRECTORS, KEY EMPLOYEES, MANAGEMENT TEAM (DEPARTMENT DIRECTORS AND MANAGERS), AND BILLING OFFICE PERSONNEL OF COPLEY MEMORIAL HOSPITAL, INC. ARE REQUIRED TO DISCLOSE INTERESTS THAT COULD GIVE RISE TO CONFLICTS. THE CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED AND REVIEWED BY THE CHIEF COMPLIANCE OFFICER AND THE AUDIT AND CORPORATE INTEGRITY COMMITTEE OF THE BOARD. THOSE KEY PERSONNEL WITH CONFLICTS ARE ADVISED TO RECUSE THEMSELVES FROM PARTICIPATING IN DECISION-MAKING RELATED TO THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 WITH RESPECT TO THE CEO/VPS OF THE ORGANIZATION AND KEY SENIOR MANAGEMENT, THE ORGANIZATION FOLLOWS A COMPENSATION APPROVAL PROCEDURE ANNUALLY THAT INVOLVES APPROVAL OF PROPOSED AND FINAL COMPENSATION ARRANGEMENTS BY THE ORGANIZATION'S COMPENSATION COMMITTEE AND FULL BOARD OF DIRECTORS USING COMPARABILITY DATA, AS WELL AS CONTEMPORANEOUS DOCUMENTATION OF COMPENSATION DECISIONS IN MINUTES. FORM 990, PART VI, SECTION C, LINE 19 FORM 990 IS AVAILABLE UPON REQUEST. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. COPIES OF THE FINANCIAL STATEMENTS (WHETHER OR NOT AUDITED) ARE PROVIDED UPON REASONABLE REQUEST SUCH AS FOR A BANK LOAN OR TO A BOND RATING AGENCY. THE FINANCIAL STATEMENTS ARE AVAILABLE ON THE ATTORNEY GENERAL'S WEBSITE. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 100,019. SWAP VALUE ADJUSTMENT 1,893,927. OTHER -7,933. FORM 990, PART XII, LINES 2A & 2B: ALTHOUGH THE ORGANIZATION DOES NOT RECEIVE STAND ALONE GAAP FINANCIAL STATEMENTS IT DOES RECEIVE ON AN ANNUAL BASIS FROM INDEPENDENT AUDITORS CONSOLIDATED ENTITY GAAP FINANCIAL STATEMENTS (AUDITED) FOR ITSELF AND ITS AFFILIATES. 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