2019-08-14T14:58:35-05:00 2018-09-30 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2017-10-01 361564290 NORWEGIAN AMERICAN HOSPITAL INC NORW 7732928200 1044 NORTH FRANCISCO AVENUE CHICAGO IL 60622 GARY KRUGEL CFO 7732928200 2019-07-29 1 DAVID LOWENTHAL P00378651 3122071040 2019-07-29 67.59.56.30 2019-07-29 09:12:54 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 75C7EC6AC54A61BA087900A4F9B91D17BA572CD0 2017 2019-02-21 02:37:17Z JOSE R SANCHEZ 1044 NORTH FRANCISCO AVENUE CHICAGO IL 60622 120474233 0 X WWW.NAHOSPITAL.ORG X 1935 IL NORWEGIAN AMERICAN HOSPITAL PROVIDES QUALITY AND COMPASSIONATE HEALTH CARE SERVICES BY PARTNERING WITH PATIENTS AND THEIR FAMILIES, OUR EMPLOYEES, PHYSICIANS AND THE COMMUNITIES WE SERVE. 11 10 1061 20 0 0 553820 514431 119423330 119820418 66517 121264 18120 18120 120061787 120474233 0 0 0 0 57082109 57300067 0 0 0 60766060 61702489 117848169 119002556 2213618 1471677 109791838 110549699 69320416 70745120 40471422 39804579 X NORWEGIAN AMERICAN HOSPITAL PROVIDES QUALITY AND COMPASSIONATE HEALTH CARE SERVICES BY PARTNERING WITH PATIENTS AND THEIR FAMILIES, OUR EMPLOYEES, PHYSICIANS AND THE COMMUNITIES WE SERVE. 0 0 75673843 119820418 NORWEGIAN AMERICAN HOSPITAL IS A PREMIER HEALTH CARE PROVIDER WHERE THE PATIENT COMES FIRST. AS AN ORGANIZATION OF CAREGIVERS, NORWEGIAN AMERICAN INSPIRES TO CONSISTENTLY HIGH STANDARDS OF QUALITY, FAMILY-CENTERED HEALTH CARE SERVICES AND COST EFFECTIVENESS. NORWEGIAN AMERICAN HOSPITAL SEEKS TO PROMOTE WELLNESS WITHIN THE FAMILY AND TO BE DYNAMIC PARTNERS IN HEALTH WITH THE COMMUNITIES IT SERVES. FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2018, NORWEGIAN AMERICAN HOSPITAL ESTIMATES IT PROVIDED $5,368,986 IN CHARITY CARE COST FOR HEALTHCARE SERVICES AND SUPPLIES PROVIDED TO MEMBERS OF THE COMMUNITIES SERVED UNDER ITS CHARITY CARE POLICY. THESE MEMBERS DID NOT HAVE THE ABILITY TO PAY FOR SERVICES RECEIVED. NORWEGIAN AMERICAN ALSO PROVIDED CARE TO PATIENTS WHO ARE BENEFICIARIES OF MEDICARE, MEDICAID, BLUE CROSS AND MANAGED CARE REIMBURSEMENT PROGRAMS. REIMBURSEMENT AMOUNTS FOR THESE PROGRAMS ARE LESS THAN CHARGES AND IN SOME CASES LESS THAN COST. FOR FISCAL YEAR 2018, NORWEGIAN AMERICAN HOSPITAL SERVED 6,142 PATIENTS ADMITTED WHO RECEIVED 33,366 DAYS OF HEALTHCARE SERVICES. 75673843 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 112 0 1 1061 1 1 1 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL X GARY KRUGEL CFO 7732928200 1044 NORTH FRANCISCO AVENUE CHICAGO IL 60622 BILLY OCASIO CHAIRMAN 5.00 0.00 X X 0 0 0 WILMI SCHMIDT VICE-CHAIRWOMAN 4.00 0.00 X X 0 0 0 JOHN MONTEVERDE SECRETARY 8.00 0.00 X X 0 0 0 LOUIS J MANETTI TREASURER 8.00 0.00 X X 0 0 0 RICHARD A BLABOLIL BOARD TRUSTEE 2.00 0.00 X 0 0 0 ADAM A BORIS BOARD TRUSTEE 2.00 0.90 X 0 0 0 KEVIN CMUNT BOARD TRUSTEE 4.00 0.00 X 0 0 0 CARMEN C HOVANEC BOARD TRUSTEE (THRU 05/2018) 2.00 0.00 X 0 0 0 MICHAEL E REED BOARD TRUSTEE 2.00 0.00 X 0 0 0 OLGA SAAVEDRA MD PRESIDENT OF MEDICAL STAFF 4.00 0.00 X 0 0 0 MIGUEL TOVAR BOARD TRUSTEE 2.00 0.00 X 0 0 0 DAN YUNKER BOARD TRUSTEE 2.00 0.00 X 0 0 0 GIANCARDO PIANO MD BOARD TRUSTEE (THRU 05/2018) 4.00 0.00 X 206250 0 0 JOSE R SANCHEZ PRESIDENT AND CEO (EX-OFFICIO) 40.00 0.00 X 554280 0 689880 GARY KRUGEL CHIEF FINANCIAL OFFICER 39.10 0.90 X 346626 0 15561 STEPHEN DEPOOTER CHIEF INFORMATION OFFICER (THRU 04/2018) 40.00 0.00 X 229417 0 19001 MICHELLE Y BLAKELY PHD CHIEF OPERATING OFFICER 40.00 0.00 X 240298 0 6164 MAX IZBICKI PHYSICIAN OB/GYN 40.00 0.00 X 395477 0 5179 NATASHA T JENKINS PHYSICIAN OB/GYN 40.00 0.00 X 379361 0 19064 NARAYAN RAVISHANKAR ANESTHESIOLOGIST 40.00 0.00 X 341257 0 16224 JANA RICHARDS PHYSICIAN OB/GYN 40.00 0.00 X 342448 0 5793 ARUN VERMA DIRECTOR MEDICAL G.I. 40.00 0.00 X 257351 0 9618 JAMES KOLKA FORMER CHIEF OPERATING OFFICER 40.00 0.00 X 241100 0 2367 3533865 0 788851 81 1 1 0 QUEST DIAGNOSTICS 12989 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 LAB SERVICE CONTRACT 3387564 SODEXO INC & AFFILIATES 4880 PAYSPHERE CIRCLE CHICAGO IL 60674 DIETARY & FACILITIES MANAGEMENT SERVICES 2375686 US BANK CORPORATE TRUST 2501 SW 1ST AVE SUITE 200 PORTLAND OR 97201 NURSING STAFFING AGENCY 1764923 CONTINENTAL ANESTHESIA 1301 W 22ND ST 610 OAKBROOK IL 60523 ANESTHESIA SERVICE CONTRACT 1608054 STAFFENCY LLC 221 W COLLEGE AVE 2ND FLR APPLETON WI 54911 NURSING STAFFING AGENCY 1383225 17 514431 514431 MEDICARE/MEDICAID PAYMENTS 621110 68083766 68083766 MEDICAID ASSESSMENT REVENUE 621110 23494972 23494972 NET PATIENT SERVICES 621110 17020942 17020942 ACA ACCESS PAYMENTS 621110 7704996 7704996 OPERATING REVENUE 621110 3251584 3251584 264158 264158 119820418 121264 121264 18120 0 18120 18120 18120 120474233 119820418 0 139384 X 2136706 2136706 45454297 33405707 12048590 598080 598080 5806096 4588484 1217612 3304888 2380149 924739 293866 293866 87330 87330 19717196 15456216 4260980 125165 80575 44590 1639014 80920 1558094 1285983 91028 1194955 89874 35422 54452 1444850 1444850 4256598 1589774 2666824 1617784 20942 1596842 IL MEDICAID AND ACA TAX 8486885 8486885 MEDICAL SUPPLIES 7763722 7860127 -96405 PROVISION FOR BAD DEBT 4545886 4545886 NON-MEDICAL SUPPLIES 1486133 1208693 277440 8862203 4329920 4532283 119002556 75673843 43328713 0 20681005 13941153 7042987 7125323 14839827 20260196 1253875 1394435 1153872 1247630 144306097 110006018 32568258 34300079 18500357 18372378 13751657 13908505 109791838 110549699 17399307 21829212 17547854 17185496 4850000 12133329 29523255 19597083 69320416 70745120 X 38410826 37988194 2060596 1816385 40471422 39804579 109791838 110549699 X 1471677 217446 -2355966 X 0 1 X 1 0 X 0 1 0 0 0 0 1 190000 0 1 59550 249550 0 PART II-B, LINE 1: HOSPITAL REPRESENTATIVES HAVE DIRECT CONTACT WITH LEGISLATORS, THEIR STAFF, AND OFFICIALS WITHIN THE ADMINISTRATION REGARDING ISSUES RELATED TO THE PROVISION OF HEALTHCARE AND HEALTHCARE FINANCING. HOSPITAL REPRESENTATIVES HAVE ENGAGED IN DIRECT MEETINGS WITH LEGISLATORS, LEGISLATIVE STAFF, AND AGENCY STAFF. THEY HAVE ALSO HAD PHONE CONVERSATIONS AND CORRESPONDED BY EMAIL. WRITTEN COMMUNICATION IN THE FORM OF MEMOS AND LETTERS IS ALSO USED. ADDITIONALLY, A PORTION OF MEMBERSHIP DUES PAID TO THE ILLINOIS HOSPITAL ASSOCIATION AND THE METROPOLITAN HEALTHCARE COUNCIL ARE USED FOR LOBBYING PURPOSES. 0 0 4840913 4840913 69304570 53240845 16063725 3689647 3245074 444573 60985058 53520099 7464959 5485909 5485909 34300079 BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 1716385 DUE FROM AFFILIATES 107716 INSURANCE RECOVERIES RECEIVABLE 4343796 INVESTMENT IN JOINT VENTURE 391403 INVESTMENT IN SUBSIDIARY 692225 OTHER ASSETS 3601212 PROPERTY HELD FOR FUTURE USE 1189446 NET PENSION ASSET 1866322 13908505 ACCRUED MALPRACTICE LIABILITY 14309694 CONDITIONAL ASSET RETIREMENT OBLIGATION 2699718 DUE TO THIRD PARTY PROGRAMS 2587671 19597083 1 1 1 X 1 X 600.000000000000 1 1 1 0 1 1 4848696 4848696 0.04240 58342042 66418716 0 0.00000 63190738 66418716 4848696 0.04240 536946 484767 52179 0.00050 2521510 1988705 532805 0.00470 3058456 2473472 584984 0.00520 66249194 68892188 5433680 0.04760 1 4545886 0 20724656 20656628 68028 X 1 1 1 CENTURY PHO INC TO OBTAIN AND MANAGE CONTRACTS WITH HEALTH MAINTENANCE ORGANIZATIONS. 0.50000 0.00000 0.50000 1 1 NORWEGIAN AMERICAN HOSPITAL INC 1044 N FRANCISCO CHICAGO IL 60660 WWW.NAHOSPITAL.ORG X X X X NORWEGIAN AMERICAN HOSPITAL INC 0 0 1 X X X X X X X X X 16 1 1 1 1 X SEE PART V, SECTION C 1 16 1 SEE PART V, SECTION C 0 1 X 200.000000000000 600.000000000000 X X X X 1 1 X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X 1 X 0 X X 1 X 0 0 NORWEGIAN AMERICAN HOSPITAL, INC. PART V, SECTION B, LINE 5: STAKEHOLDERS AND COMMUNITY PARTNERS HAVE BEEN INVOLVED IN MULTIPLE WAYS THROUGHOUT THE ASSESSMENT PROCESS, BOTH IN TERMS OF PROVIDING COMMUNITY INPUT DATA AND AS DECISION-MAKING PARTNERS. AVENUES FOR ENGAGEMENT IN THE CHNA INCLUDE: - STAKEHOLDER ADVISORY TEAM - HOSPITALS' COMMUNITY ADVISORY GROUPS - DATA COLLECTION: COMMUNITY INPUT THROUGH SURVEYS AND FOCUS GROUPS - ACTION PLANNING FOR STRATEGIC PRIORITIES (BEGINNING SUMMER 2016) THE CENTRAL STAKEHOLDER ADVISORY TEAM INCLUDES REPRESENTATIVES OF DIVERSE COMMUNITY ORGANIZATIONS FROM ACROSS THE WEST SIDE OF CHICAGO AND WEST COOK SUBURBS. MEMBERS OF THE STAKEHOLDER ADVISORY TEAM ARE VERY IMPORTANT PARTNERS IN THE CHNA AND IMPLEMENTATION PLANNING PROCESS, CONTRIBUTING IN THE FOLLOWING WAYS: (1) PARTICIPATED IN A SERIES OF 8-10 MEETINGS BETWEEN MAY 2015 AND AUGUST 2016 (2) CONTRIBUTED TO DEVELOPMENT OF THE COLLABORATIVE'S MISSION, VISION, AND VALUES (3) PROVIDED INPUT ON ASSESSMENT DESIGN, INCLUDING DATA INDICATORS, SURVEYS, FOCUS GROUPS, AND ASSET MAPPING (4) SHARED DATA THAT IS RELEVANT AND/OR FACILITATED THE PARTICIPATION OF COMMUNITY MEMBERS TO PROVIDE INPUT THROUGH SURVEYS AND FOCUS GROUPS (5) REVIEWED ASSESSMENT DATA AND ASSISTED WITH DEVELOPING FINDINGS AND IDENTIFYING PRIORITY STRATEGIC ISSUES (6) PARTICIPATED IN ACTION PLANNING TO DEVELOP GOALS, OBJECTIVES, AND STRATEGIES FOR IMPROVING COMMUNITY HEALTH AND QUALITY OF LIFE (7) JOINED AN ACTION TEAM TO HELP SHAPE IMPLEMENTATION STRATEGIES THE CENTRAL STAKEHOLDER ADVISORY TEAM INCLUDES THE FOLLOWING MEMBERS:AGE OPTIONS AGING CARE CONNECTIONS AMERICAN CANCER SOCIETY CASA CENTRAL CATHOLIC CHARITIES CHICAGO POLICE DEPARTMENT - 14TH DISTRICT CHICAGO PUBLIC SCHOOLS COMMUNITYHEALTH DIABETES EMPOWERMENT CENTER HEALTHCARE ALTERNATIVES SYSTEMS HOUSING FORWARD INFANT WELFARE-OAK PARK/THE CHILDREN'S CLINIC INTERFAITH LEADERSHIP PROJECT LOYOLA UNIVERSITY STRITCH SCHOOL OF MEDICINE METROPOLITAN PLANNING COUNCIL MILE SQUARE HEALTH CENTER PCC WELLNESS PLCCA: PROVISO LEYDEN COUNCIL FOR COMMUNITY ACTION PROVISO TOWNSHIP MENTAL HEALTH COMMISSION RESPIRATORY HEALTH ASSOCIATION SAINT ANTHONY'S HOSPITAL WEST 40 INTERMEDIATE SERVICE CENTER WEST COOK YMCA WEST HUMBOLDT PARK DEVELOPMENT COUNCIL WEST SIDE HEALTH AUTHORITY WICKER PARK BUCKTOWN CHAMBER OF COMMERCE NORWEGIAN AMERICAN HOSPITAL, INC. PART V, SECTION B, LINE 6A: NORWEGIAN AMERICAN HOSPITAL'S CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITALS:- GOTTLIEB MEMORIAL HOSPITAL- LOYOLA UNIVERSITY MEDICAL CENTER - NORWEGIAN AMERICAN HOSPITAL- PRESENCE SAINTS MARY AND ELIZABETH MEDICAL CENTER- RML SPECIALTY HOSPITALS (HINSDALE & CHICAGO)- RUSH OAK PARK- RUSH UNIVERSITY MEDICAL CENTER - STROGER HOSPITAL - COOK COUNTY HEALTH AND HOSPITAL SYSTEM NORWEGIAN AMERICAN HOSPITAL, INC. PART V, SECTION B, LINE 6B: NORWEGIAN AMERICAN HOSPITAL'S CHNA WAS CONDUCTED WITH THE FOLLOWING HEALTH DEPARTMENTS AND COMMUNITY ORGANIZATIONS:- CHICAGO DEPARTMENT OF PUBLIC HEALTH- COOK COUNTY DEPARTMENT OF PUBLIC HEALTH- OAK PARK HEALTH DEPARTMENT- ILLINOIS PUBLIC HEALTH INSTITUTE PART V, SECTION B, LINE 7A, CHNA WEBSITE: HTTPS://WWW.NAHOSPITAL.ORG/WP-CONTENT/UPLOADS/2018/11/CHNA-HOSPITAL-OVERVIEW-CHAPTER-NAH-2016_FINAL.PDF PART V, SECTION B, LINE 10A IMPLEMENTATION STRATEGY WEBSITE: HTTPS://WWW.NAHOSPITAL.ORG/WP-CONTENT/UPLOADS/2018/11/CHNA-HOSPITAL-OVERVIEW-CHAPTER-NAH-2016_FINAL.PDF PART V, SECTION B, LINE 16A, FAP WEBSITE: HTTPS://WWW.NAHOSPITAL.ORG/WP-CONTENT/UPLOADS/2019/07/FINANCIAL-ASSISTANCE-POLICY-AUGUST-2018.PDF PART V, SECTION B, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://NAHOSPITAL.ORG/WP-CONTENT/UPLOADS/2015/11/FINANCIAL-ASSISTANCE-APPLICATION.PDF PART V, SECTION B, LINE 16C, PLAIN LANGUAGE SUMMARY OF FAP WEBSITE: HTTPS://WWW.NAHOSPITAL.ORG/WP-CONTENT/UPLOADS/2018/12/NORWEGIAN-AMERICAN-HOSPITAL-SUMMARY-OF-ASSISTANCE-POLICY.PDF PART V, SECTION B, LINE 16I: PATIENTS WILL BE INFORMED OF FINANCIAL ASSISTANCE THROUGH VARIOUS METHODS. NOTICES INFORMING PATIENTS OF FINANCIAL ASSISTANCE WILL BE POSTED IN ADMISSION AND REGISTRATION AREAS. IT WILL ALSO BE PROVIDED TO PATIENTS, OR GUARANTORS, IN THEIR ADMISSION PACKET AND IN BILLING STATEMENTS. THIS INFORMATION, AND THE NOTICE POSTED IN HOSPITAL LOCATIONS, WILL BE IN ENGLISH, AND IN ANY OTHER LANGUAGE THAT IS THE PRIMARY LANGUAGE SPOKEN BY AT LEAST 5% OF THE RESIDENTS IN THE SERVICE AREA. TRANSLATIONS IN SPANISH AND POLISH CAN BE OBTAINED BY CALLING THE HOSPITAL'S PATIENT FINANCIAL SERVICES AND ARE CURRENTLY AVAILABLE ON THE HOSPITAL'S WEBSITE: HTTPS://WWW.NAHOSPITAL.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE/ PART V, SECTION B, LINE 22D: THE HOSPITAL DETERMINES THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO THE FAP-ELIGIBLE INDIVIDUALS BY CALCULATING THE UNINSURED PATIENT DISCOUNT AMOUNT AND APPLYING IT TO PATIENT ACCOUNT. THE DISCOUNT AMOUNT IS CALCULATED BY SUBTRACTING FROM 100% THE PRODUCT OF THE HOSPITAL'S COST TO CHARGE RATIO (FROM WORKSHEET C PART 1 FROM THE MEDICARE COST REPORT) AND 135% (MEDICARE COST ALLOWED TO CHARGE TO UNINSURED PATIENTS). NORWEGIAN AMERICAN HOSPITAL'S UNINSURED DISCOUNT FOR FY 2018 IS 60% AS ROUNDED UP FROM THE CALCULATION AS SHOWN BELOW. 2018 COST TO CHARGE RATIO = 32.59%32.59% X 135% = 44.00%100% - 44.00% = 56.00%THE HOSPITAL PROVIDES A 72% DISCOUNT TO UNINSURED PATIENTS. NOTE, THE 72% UNINSURED DISCOUNT PROVIDED TO OUR PATIENTS EXCEEDS THE MINIMUM REQUIREMENT UNDER ILLINOIS LAW. PART I, LINE 3C: NORWEGIAN AMERICAN HOSPITAL USES THE FPG TO DETERMINE FREE AND DISCOUNTED CARE. PATIENTS WITH ELIGIBLE ASSETS AND INCOME ABOVE THE 200%, BUT NOT EXCEEDING 600% OF FPG, ADJUSTED FOR FAMILY SIZE, WILL RECEIVE A DISCOUNT ON MEDICALLY NECESSARY SERVICES PROVIDED TO THEM, BASED UPON A SLIDING SCALE ESTABLISHED BY HOSPITAL POLICY. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED ON LINES 7A AND 7B IS THE COST-TO-CHARGE RATIO DERIVED FROM THE IRS'S SCHEDULE H, WORKSHEET 2 INSTRUCTIONS. NORWEGIAN AMERICAN HOSPITAL USED ITS INTERNAL ACCOUNTING RECORDS TO CALCULATE THE AMOUNTS REPORTED IN LINES 7E AND 7F.MANAGEMENT DOES NOT CONCUR WITH WORKSHEET 3 INSTRUCTIONS IN REGARDS TO INCLUDING THE PROVIDER TAX EXPENSES IN WITH COLUMN (C) TOTAL COMMUNITY BENEFIT EXPENSE, AS WELL AS INCLUDING THE PROVIDER TAX REVENUE IN COLUMN (D) DIRECT OFFSETTING REVENUE. IF THESE WERE REMOVED FROM THE WORKSHEET 3 CALCULATION, NET COMMUNITY BENEFIT EXPENSE ON LINE 7B, COLUMN (E) WOULD HAVE BEEN $12,275,020 OR 10.72 PERCENT OF TOTAL EXPENSE. THIS WOULD HAVE INCREASED THE TOTAL NET COMMUNITY BENEFIT EXPENSE ON LINE 7K, COLUMN (E) FROM $3,220,309 TO $18,228,396 OR 15.93 PERCENT OF TOTAL EXPENSE. PART I, LINE 7G: NORWEGIAN AMERICAN HOSPITAL DID NOT INCLUDE ANY COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC AS SUBSIDIZED HEALTH SERVICES. PART I, LINE 7, COLUMN (G):THERE WAS A TOTAL OF BAD DEBT EXPENSE OF $4,545,886 SUBTRACTED FROM TOTAL EXPENSES. PART III, LINE 2: THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2, IS THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX. PART III, LINE 3: ALL OF THE HOSPITAL'S PATIENTS AUTOMATICALLY QUALIFY FOR FINANCIAL ASSISTANCE IF THEY DO NOT HAVE INSURANCE (THEY ARE CONSIDERED "SELF-PAY AND GIVEN 72% DISCOUNT). ONCE THE HOSPITAL DETERMINES THAT A PATIENT HAS NO INSURANCE, THEY AUTOMATICALLY DISCOUNT THE BILL BY 72%. SO THERE ARE NO INDIVIDUALS THAT MAY HAVE BEEN ELIGIBLE FOR FINANCIAL ASSISTANCE AND DID NOT RECEIVE ANY. BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS WITH INSURANCE THAT MAY NOT HAVE PAID THEIR SHARE/CO-PAY OF THE BILL OR ATTRIBUTABLE TO PATIENTS THAT RECEIVED FINANCIAL ASSISTANCE (72% DISCOUNT) BUT DID NOT PAY THEIR 28%. THEREFORE, ZERO HAS BEEN REPORTED IN PART III, LINE 3. PART III, LINE 4: AUDITED FINANCIAL STATEMENTS FOOTNOTE REGARDING BAD DEBT EXPENSE: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. 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 THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (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), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS 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 STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) 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 TO BE UNCOLLECTIBLE.PART III, LINE 6: MANAGEMENT DOES NOT CONCUR WITH PART III, SECTION B MEDICARE, LINE 6 REPORTING INSTRUCTIONS REGARDING UTILIZING ALLOWABLE COSTS FROM MEDICARE WORKSHEET B. IF MANAGEMENT USED THE ACTUAL AMOUNT OF COSTS TO CARE FOR MEDICARE PATIENTS, ALLOWABLE COSTS WOULD HAVE BEEN REPORTED AS $37,138,812 AND THE AMOUNT OF (SHORTFALL) WOULD HAVE BEEN ($16,414,156). PART III, LINE 8: COSTING METHODOLOGY USED IS THE MEDICARE COST REPORT WHICH UTILIZES A STEP-DOWN METHOD OF COST ALLOCATION. THIS ORDER OF ALLOCATION FOR OVERHEADS HAS BEEN PREDETERMINED BY MEDICARE AND IS PRINTED OUT ON THE COST REPORT. THE MOST COMMON OVERHEAD IS ALLOCATED FIRST TO ALL OTHER OVERHEADS AND THE PATIENT CARE COST CENTERS. THEN THAT COST CENTER IS CLOSED AND THE NEXT MOST COMMON OVERHEAD IS ALLOCATED. THIS IS CONTINUED UNTIL ALL THE OVERHEADS ARE ALLOCATED OUT. THE SEPTEMBER 30, 2018 COST REPORT DID NOT SHOW A SHORTFALL. PART III, LINE 9B: THE COLLECTION POLICIES CONTAIN PROVISIONS ON THE COLLECTIONS PRACTICES TO BE FOLLOWED FOR PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. SUCH PRACTICES ARE: CHARITY - UPON APPROVAL OF PATIENT'S CHARITY APPLICATION THE COLLECTIONS ARE STOPPED, PATIENT'S BALANCE IS WRITTEN OFF ACCORDINGLY AND PATIENT IS NOTIFIED IN WRITING; UNINSURED PATIENT - UPON DETERMINATION THAT PATIENT HAS NO INSURANCE, 72% DISCOUNT IS APPLIED TO PATIENT ACCOUNT AND PATIENT IS NOTIFIED IN WRITING FOR THE OUTSTANDING BALANCE. PART VI, LINE 2: NORWEGIAN AMERICAN HOSPITAL'S COMMUNITY BENEFIT PLAN WAS DEVELOPED TO ESTABLISH STRATEGIES FOR IMPROVING ACCESS TO CARE AND POSITIVELY AFFECTING THE HEALTH OF THE COMMUNITIES THAT IT SERVES. ADDITIONALLY, THE PLAN SETS THE COURSE FOR STRENGTHENING EXISTING PARTNERSHIPS AND BUILDING NEW ONES WITH INDIVIDUALS AND ORGANIZATIONS WITHIN NORWEGIAN AMERICAN HOSPITAL'S PRIMARY SERVICE AREAS IN ORDER TO LEVERAGE AND MAXIMIZE THE IMPACT OF ITS PROGRAMS. DEVELOPMENT OF THE PLAN IS DERIVED THROUGH THE STRATEGIC PLANNING OF NORWEGIAN AMERICAN HOSPITAL'S BOARD OF TRUSTEES AND THROUGH ORGANIZATIONAL INVOLVEMENT IN COMMUNITY PARTNERSHIPS. THE GOALS DEVELOPED FOR PLANNING COMMUNITY SERVICES INVOLVED MEETING WITH PHYSICIANS AND COMMUNITY PARTNERS TO DETERMINE WHERE THE GAPS OF CARE AND SERVICES COULD BE FILLED THROUGH NORWEGIAN AMERICAN HOSPITAL INVOLVEMENT. IN DEVELOPING ITS COMMUNITY BENEFITS PLAN, NORWEGIAN AMERICAN HOSPITAL SET THE FOLLOWING GOALS:1) SERVE AS A CATALYST/CONVENER FOR THE OBESITY AND DIABETES INITIATIVES IN HUMBOLDT PARK.2) PROMOTE INITIATIVES THAT ENHANCE ACCESS TO HEALTH CARE FOR THE UNINSURED AND UNDERINSURED.3) NORWEGIAN AMERICAN HOSPITAL LEADERSHIP TO ASSUME AN ACTIVE ROLE IN COMMUNITY BASED ORGANIZATIONS BOARDS, TASK FORCES AND COMMUNITY EVENTS. PART VI, LINE 3: NORWEGIAN AMERICAN HOSPITAL INFORMS AND EDUCATES PATIENTS AND PERSONS, WHO MAY BE BILLED FOR PATIENT CARE, ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S CHARITY CARE POLICY ON ITS INTRANET AND THROUGH FLYERS. PATIENTS ARE PROVIDED THESE POLICIES AT THE TIME OF REGISTRATION AND ARE ALSO AVAILABLE UPON REQUEST. PART VI, LINE 4: NORWEGIAN AMERICAN HOSPITAL SERVES A PRIMARY COMMUNITY AREA AND A SECONDARY COMMUNITY AREA. THE FOLLOWING INFORMATION WAS OBTAINED FROM THE US CENSUS BUREAU, 2010 CENSUS.THE PRIMARY COMMUNITY AREA CONSISTS OF THE FOLLOWING AREAS, ZIP CODES AND POPULATION:- AUSTIN- BELMONT-CRAGIN- HERMOSA- HUMBOLDT PARK- LOGAN SQUARE- WEST TOWN- IRVING PARK- NORTH CENTER- EAST GARFIELD PARK- WEST GARFIELD PARK- NORTH LAWNDALE WHITE HISPANIC AFRICAN-AMERICANPRIMARY ZIP CODES POPULATION - PERCENTAGE 60618 46,754 51% 42,771 46% 2,559 3%60622 33,399 64% 15,289 29% 3,860 7%60624 958 3% 1,160 3% 35,987 94%60639 8,056 9% 68,639 76% 13,712 15%60647 34,357 39% 47,697 55% 5,237 6%60651 2,538 4% 21,756 34% 39,973 62%THE SECONDARY AREA CONSISTS OF THE FOLLOWING AREAS, ZIP CODES AND POPULATION:- ARCHER HEIGHTS- BRIGHTON PARK- CAGE PARK- GARFIELD RIDGE- WEST ELSDON- SOUTH LAWNDALE- PORTAGE PARK- PULLMAN WHITE HISPANIC AFRICAN-AMERICANPRIMARY ZIP CODES POPULATION - PERCENTAGE 60612 8,738 26% 4,319 13% 20,412 61%60623 2,301 2% 59,438 65% 30,369 33%60625 47,050 60% 28,304 36% 3,297 4%60632 12,939 14% 76,902 84% 1,485 2%60641 32,054 45% 38,057 53% 1,552 2%60644 1,506 3% 1,583 3% 45,559 94%60640 44,239 67% 9,923 15% 11,628 18%NORWEGIAN AMERICAN HOSPITAL'S AGE FOR THE FISCAL YEAR WAS AS FOLLOWS:AGE PERCENTAGE0-14 2%15-44 44%45-64 37%65-74 9%75+ 8%NORWEGIAN AMERICAN HOSPITAL'S RACE AND ETHNICITY FOR THE FISCAL YEAR WAS AS FOLLOWS:RACE PERCENTAGEASIAN 1%AMERICAN INDIAN OR NATIVE ALASKAN 0%BLACK OR AFRICAN-AMERICAN 43%WHITE 13%OTHER 43%ETHNICITY PERCENTAGEHISPANIC 41%NON-HISPANIC 59% PART VI, LINE 5: IN ADDITION TO PROVIDING QUALITY INPATIENT AND OUTPATIENT SERVICES, NORWEGIAN AMERICAN HOSPITAL REACHES BEYOND ITS WALLS AND INTO COMMUNITIES THROUGH AN ARRAY OF ACTIVITIES AND PROGRAMS DESIGNED AND DELIVERED TO BENEFIT THE COMMUNITIES IT SERVES. THESE COMMUNITY BENEFITS INCLUDE: - CARE THAT IS PROVIDED FREE, SUBSIDIZED OR WITHOUT FULL REIMBURSEMENT FROM MEDICARE, MEDICAID OR OTHER GOVERNMENT INSURANCE PROGRAMS.-SERVICES RESPONDING TO UNIQUE COMMUNITY NEEDS, SUCH AS DIABETES SERVICES, EMERGENCY CARE, BEHAVIORAL HEALTH SERVICES, SUBSTANCE ABUSE, PEDIATRIC CARE-A-VAN; AS WELL AS HEALTH SCREENINGS, IMMUNIZATION PROGRAMS, SCHOOL-BASED HEALTH CARE AND OTHER COMMUNITY OUTREACH PROGRAMS.-EDUCATION TO TRAIN PHYSICIANS, NURSES, RADIOLOGY TECHNICIANS, AND OTHER HIGHLY SKILLED HEALTH CARE PROFESSIONALS.-VOLUNTEER SERVICES PROVIDED BY HOSPITAL EMPLOYEES WHO VOLUNTEER IN THEIR COMMUNITIES AND COMMUNITY MEMBERS WHO VOLUNTEER AT THE HOSPITAL. IN FYE 2018, THE HOSPITAL CONTRIBUTED TO HURRICANE MARIA RELIEF EFFORTS BY SENDING PHYSICIANS AND NURSES TO PUERTO RICO TO DIRECTLY ASSIST WITH CARE. ADDITIONALLY, EMPLOYEES CONTRIBUTED THEIR PTO AND THE HOSPITAL FOUNDATION CONTRIBUTED MONETARILY.-LANGUAGE-ASSISTANCE SERVICES, SUCH AS TRANSLATORS, SIGNAGE, FORMS, BROCHURES, PATIENT EDUCATION MATERIALS AND OTHER INFORMATION IN LANGUAGES OTHER THAN ENGLISH.-DONATIONS BY NORWEGIAN AMERICAN HOSPITAL OF MEETING AND CLINIC SPACE, AS WELL AS OTHER ASSISTANCE TO COMMUNITY GROUPS. PART VI, LINE 6: NOT AFFILIATED PART VI, LINE 7, REPORTS FILED WITH STATES IL X 1 1 X X 1 1 0 0 0 0 0 1 0 GIANCARDO PIANO MD BOARD TRUSTEE (THRU 05/2018) 206250 0 0 0 0 0 0 0 0 0 206250 0 0 0 JOSE R SANCHEZ PRESIDENT AND CEO (EX-OFFICIO) 535500 0 0 0 18780 0 687646 0 2234 0 1244160 0 0 0 GARY KRUGEL CHIEF FINANCIAL OFFICER 275423 0 70000 0 1203 0 5300 0 10261 0 362187 0 0 0 STEPHEN DEPOOTER CHIEF INFORMATION OFFICER (THRU 04/2 229061 0 0 0 356 0 4849 0 14152 0 248418 0 0 0 MICHELLE Y BLAKELY PHD CHIEF OPERATING OFFICER 239262 0 0 0 1036 0 0 0 6164 0 246462 0 0 0 MAX IZBICKI PHYSICIAN OB/GYN 395340 0 0 0 137 0 0 0 5179 0 400656 0 0 0 NATASHA T JENKINS PHYSICIAN OB/GYN 379151 0 0 0 210 0 5300 0 13764 0 398425 0 0 0 NARAYAN RAVISHANKAR ANESTHESIOLOGIST 339353 0 0 0 1904 0 5300 0 10924 0 357481 0 0 0 JANA RICHARDS PHYSICIAN OB/GYN 342238 0 0 0 210 0 4756 0 1037 0 348241 0 0 0 ARUN VERMA DIRECTOR MEDICAL G.I. 257351 0 0 0 0 0 0 0 9618 0 266969 0 0 0 JAMES KOLKA FORMER CHIEF OPERATING OFFICER 155680 0 10000 0 75420 0 0 0 2367 0 243467 0 0 0 PART I, LINE 1A NAH PAYS MEMBERSHIP DUES ON BEHALF OF JOSE R. SANCHEZ, PRESIDENT AND CEO, TO A SOCIAL CLUB. THE MEMBERSHIP IS USED EXCLUSIVELY FOR BUSINESS PURPOSES. PART I, LINES 4A-B JAMES KOLKA RECEIVED $74,582 OF SEVERANCE PAY IN THE CALENDAR 2017. JOSE R. SANCHEZ, PRESIDENT AND CEO, PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. $682,346 WAS CREDITED TO HIS ACCOUNT IN THE FISCAL YEAR 2018. PART I, LINE 7 AS INDICATED IN SCHEDULE J, PART II, SEVERAL OFFICERS AND HIGHEST COMPENSATED EMPLOYEES OF THE ORGANIZATION RECEIVED A BONUS BASED ON PERFORMANCE AND THE FINANCIAL RESULTS OF THE ORGANIZATION. THE BONUSES WERE APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD. A ILLINOIS FINANCE AUTHORITY REVENUE BONDS SERIES 2008 861091967 45200FMS5 2008-08-15 5000000 SEE PART VI 0 0 0 B ILLINOIS FINANCE AUTHORITY REVENUE BONDS SERIES 2008 861091967 45200FMT3 2008-08-15 14450000 SEE PART VI 0 0 0 A 1180000 5000000 798334 1159612 157619 2884435 2008 1 0 1 1 B 610000 14450000 798333 1159612 157620 12334436 2008 1 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 0 0 0 THE ARBITRAGE GROUP 0 0 0 0 0 B 0 0 0 0 0 0 THE ARBITRAGE GROUP 0 0 0 0 0 A 0 B 0 SCHEDULE K SUPPLENTAL INFORMATION THE SERIES 2008 BOND PROCEEDS, TOGETHER WITH OTHER AVAILABLE FUNDS, WERE USED TO REFUND THE OUTSTANDING PRINCIPAL AMOUNTS OF CERTAIN BONDS IN THE AMOUNT OF $3,467,000, TO PAY OR REIMBURSE THE HOSPITAL FOR THE PAYMENT OF THE COST OF ACQUIRING, CONSTRUCTING AND EQUIPPING CERTAIN OF THE HOSPITAL'S HEALTH CARE FACILITIES, TO FUND A DEBT SERVICE RESERVE FUND FOR THE BENEFIT OF THE SERIES 2008 BONDS, AND TO PAY CERTAIN EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE SERIES 2008 BONDS. JOHN MONTEVERDE MD TRUSTEE 193463 THE HOSPITAL PAID ST. JOHN HEART CLINIC S.C. FOR MEDICAL SERVICES. TRUSTEE JOHN MONTEVERDE OWNS 100% OF ST. JOHN HEART CLINIC. 0 FORM 990, PART VI, SECTION B, LINE 11B THE BOARD RETAINS THE SERVICES OF AN INDEPENDENT CPA FIRM TO PREPARE THE ORGANIZATION'S FORM 990. MEMBERS OF THE FISCAL SERVICES DEPARTMENT, THE CHIEF FINANCIAL OFFICER AND THE CHIEF EXECUTIVE OFFICER REVIEW THE COMPLETED FORM 990 AND PROVIDE A FULL COPY TO ALL MEMBERS OF THE FINANCE & AUDIT COMMITTEE. AFTER FORM 990 IS REVIEWED AND ACCEPTED BY THE FINANCE & AUDIT COMMITTEE, A COPY IS MADE AVAILABLE TO ALL VOTING MEMBERS OF THE GOVERNING BODY PRIOR TO FILING. THE GOVERNING BODY IS PROVIDED A REASONABLE AMOUNT OF TIME TO REVIEW THE RETURN AND ASK ANY QUESTIONS DIRECTLY TO ORGANIZATION MANAGEMENT OR THE CONTACT AT THE INDEPENDENT CPA FIRM PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL TRUSTEES, OFFICERS, AND KEY EMPLOYEES AND KEY PHYSICIANS (AS DEFINED IN THE BOARD'S CONFLICT OF INTEREST POLICY) OF THE CORPORATION ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY. IN ADDITION, ALL INDEPENDENT CONTRACTORS WHO PROVIDE SERVICES AND/OR MATERIALS TO THE CORPORATION IN EXCHANGE FOR $20,000 OR MORE IN PAYMENT DURING ANY FISCAL YEAR SHALL BE SUBJECT TO THESE PROVISIONS. ALL PERSONS SUBJECT HERETO SHALL BE HEREINAFTER REFERRED TO AS "COVERED PERSONS." THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION IS RESPONSIBLE FOR PUBLICIZING THE PROVISIONS OF THIS ARTICLE TO THE PERSONS AFFECTED THEREBY. NO PERSON SHALL BECOME A TRUSTEE, OFFICER, OR EMPLOYEE OR MEDICAL DEPARTMENT DIRECTOR OF THE CORPORATION WITHOUT FIRST ACKNOWLEDGING IN WRITING TO THE CORPORATION THAT HE OR SHE HAS REVIEWED, FULLY UNDERSTANDS AND IS IN COMPLIANCE WITH THE PROVISIONS OF THE CONFLICT OF INTEREST POLICY. ALL COVERED PERSONS SHALL PROMPTLY DISCLOSE TO THE BOARD OF TRUSTEES OF THE CORPORATION ALL SUBSTANTIVE POTENTIAL CONFLICTS OF INTEREST WHICH SUCH PERSON DISCOVERS OR WHICH IS BROUGHT TO HIS OR HER ATTENTION. SUCH DISCLOSURE SHALL INCLUDE SUBMISSION TO THE BOARD OF A WRITTEN STATEMENT OF THE FACTS SURROUNDING THE CONFLICT OF INTEREST AND AN OPPORTUNITY TO MAKE A BRIEF ORAL STATEMENT TO THE BOARD WITH RESPECT TO THE MATTER IN QUESTION. AN ANNUAL DISCLOSURE STATEMENT SHALL BE CIRCULATED TO ALL COVERED PERSONS TO ASSIST THEM IN CONSIDERING SUCH DISCLOSURES. IN ADDITION, THE POLICY IS MONITORED PERIODICALLY THROUGHOUT THE YEAR FOR ANY CONFLICTS OF INTEREST. PROMPT DISCLOSURE NOTICES OF CONFLICT SHALL BE FILED WITH THE PRESIDENT OF THE CORPORATION OR ANY OTHER PERSON DESIGNATED BY HIM FROM TIME TO TIME TO RECEIVE SUCH NOTIFICATIONS. ALL DISCLOSURE NOTICES RECEIVED HEREUNDER SHALL BE NOTED FOR RECORD IN THE MINUTES OF A MEETING OF THE BOARD OF TRUSTEES. THE PRESENCE OF THE TRUSTEE WHO IS DIRECTLY OR INDIRECTLY A PARTY TO THE TRANSACTION IN QUESTION OR A TRUSTEE WHO IS OTHERWISE NOT DISINTERESTED MAY BE COUNTED IN DETERMINING WHETHER A QUORUM IS PRESENT FOR THE PURPOSE OF THE MEETING, BUT SHALL NOT BE PRESENT OR HAVE A VOTE WHEN THE BOARD OF TRUSTEES OR A COMMITTEE OF THE BOARD DISCUSSES AND TAKES ACTION ON THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER/VICE PRESIDENT MEDICAL AFFAIRS AND CHIEF FINANCIAL OFFICER WERE REVIEWED BY AN EXTERNAL ORGANIZATION SPECIALIZING IN COMPENSATION MANAGEMENT. THE RESULTS OF THAT REVIEW WERE PROVIDED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 NORWEGIAN AMERICAN HOSPITAL INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES - NONMEDICAL: PROGRAM SERVICE EXPENSES 1,430,134. MANAGEMENT AND GENERAL EXPENSES 1,157,742. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,587,876. OUTSOURCED SERVICES: PROGRAM SERVICE EXPENSES 126,250. MANAGEMENT AND GENERAL EXPENSES 388,075. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 514,325. TEMP AGENCY: PROGRAM SERVICE EXPENSES 4,689,007. MANAGEMENT AND GENERAL EXPENSES 141,145. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,830,152. PROFESSIONAL FEES - MEDICAL: PROGRAM SERVICE EXPENSES 8,448,114. MANAGEMENT AND GENERAL EXPENSES 935,438. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,383,552. CONSULTING FEES: PROGRAM SERVICE EXPENSES 111,995. MANAGEMENT AND GENERAL EXPENSES 685,031. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 797,026. LAB SERVICES FOR CLINICS: PROGRAM SERVICE EXPENSES 21,990. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,990. OUTSOURCED PAYROLL: PROGRAM SERVICE EXPENSES 628,726. MANAGEMENT AND GENERAL EXPENSES 953,549. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,582,275. FORM 990, PART XI, LINE 9: INCOME (LOSS) FROM NORWEGIAN AMERICAN HOSPITAL FOUNDATION 93,907. INCOME (LOSS) FROM INVESTMENTS IN JOINT VENTURES -260,482. CHANGE IN MARK TO MARKET SWAP -95,831. PENSION RELATED CHANGES, OTHER THAN NET PERIOD PENSION COST 645,321. NET ASSETS RELEASED FROM RESTRICTION -338,118. IMPAIRMENT OF EQUITY INVESTMENT -2,400,763. NORWEGIAN AMERICAN HOSPITAL FOUNDATION 1044 NORTH FRANCISCO AVENUE CHICAGO IL 60622 363257131 SUPPORTING FOUNDATION IL 501(C)(3) LINE 12A, I NORWEGIAN AMERICAN HOSPITAL INC 1 CENTENNIAL MEDICAL MANAGEMENT CORPORATION 1044 NORTH FRANCISCO AVENUE CHICAGO IL 60622 363394548 OUTPATIENT PHARMACY IL NORWEGIAN AMERICAN HOSPITAL INC C 1583647 714407 1.00000 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 CENTENNIAL MEDICAL MANAGEMENT CORPORATION A 9772 BOOK VALUE NORWEGIAN AMERICAN HOSPITAL FOUNDATION A 4800 BOOK VALUE NORWEGIAN AMERICAN HOSPITAL FOUNDATION C 514431 BOOK VALUE