2019-08-15T16:00:18-05:00 2018-09-30 420714325 RSM US LLP 1 S Wacker Drive Ste 800 Chicago IL 60606 990 2017-10-01 362179813 SWEDISH COVENANT HEALTH SWED 7738788200 5145 N CALIFORNIA AVE CHICAGO IL 60625 THOMAS J GARVEY SENIOR VP & CFO 7738788200 2019-08-15 1 Rebekuh Eley P01247672 3126343400 50.204.145.2 2019-08-15 15:58:10 CD P 9EA1C8426C558CF80333E5767BC60C3FBAC1E655 0E4C15207DC127BDB52450F77D4060F40C3F1AE4 2017 2019-02-21 02:37:17Z THOMAS J GARVEY 5145 N CALIFORNIA AVE CHICAGO IL 60625 288320374 0 X www.swedishcovenant.org X 1907 IL Providing excellent healthcare services for our culturally diverse communities for over 120 years. 22 13 2321 229 2643457 -422572 97891 69000 250874589 264877052 5687976 6486263 17356019 16888059 274016475 288320374 965975 967425 0 0 121140349 126654743 0 0 0 137097734 141528945 259204058 269151113 14812417 19169261 480158744 486024601 304350251 290754712 175808493 195269889 X Our Mission is to provide a continuum of excellent healthcare services. Rooted in The Evangelical Covenant Church, the hospital is dedicated to serving the physical, spiritual and psychological needs of our culturally diverse communities. 0 0 244589944 967425 281765111 Since 1886, Swedish Covenant Health has been dedicated to providing healthcare services and healthcare education. As part of its mission as a not-for-profit, church-based community hospital, Swedish Covenant has served as an educational center, health rehabilitation center, illness prevention center, social support services center, and community center. Swedish Covenant Health serves as a solid community structure through employment of over 1,850 individuals.Recognizing its mission to the community, Swedish Covenant Health offers the following quality medical healthcare services regardless of race, creed, sex, national origin, handicap, age or ability to pay:General Medicine, Surgery, ICUSwedish Covenant Health continually offers the latest technology to meet the vast needs of the community. During the fiscal year, Swedish Covenant Health serviced 12,613 inpatients and more than 300,450 outpatients at a total cost of $230,922,267.Physical Medicine/Rehab ServicesSwedish Covenant Health is dedicated to providing a comprehensive Rehab Unit that combines the disciplines of physical therapy, speech therapy, occupational therapy and social work to help patients regain their strength and skills. The Rehab unit features a special room that simulates a home environment so patients can practice with home-like carpeting, furniture and fixtures while supervised by nurses. During the fiscal year, 235,460 inpatient and outpatient treatments for rehab, speech and occupational therapy were provided for a total cost of $4,995,337.Cardiac Care and RehabThe Cardiac Rehabilitation program offered by Swedish Covenant Health has improved the lives of many individuals with such innovative programs as "Coronary Heart Disease Reversal." Swedish Covenant Health also offers a state-of-the-art Cardiac Catheterization Lab, and other diagnostic and preventive programs. During the fiscal year, Swedish Covenant Health provided 35,504 treatments and 1,564 procedures by the Cardiac Rehab program and Cardiac Catheterization Lab, respectively, for a total cost of $7,562,427.In addition to the program services listed above, Swedish Covenant Health also offers the following services to the community:Health Screening, Health Promotions, Education, PreventionSwedish Covenant Health offers year-round health screenings to members of the community. Blood pressure screening events are provided in collaboration with the hospital's Stroke Education Coordinator. Each year free or reduced-cost cancer screenings are offered to the community. These included prostate, skin, cervical and breast screenings. Additionally, dozens of programs led by physicians, nurses, dietitians, personal trainers and other clinicians and experts from the hospital address topics of cancer prevention, treatment, nutrition, fitness and other healthy lifestyle recommendations.During the fiscal year Swedish Covenant Health served a total of 8,681 persons through participation in health promotions, education, and prevention for a total cost of $435,139.Community Wellness and Prevention programs continue to serve the community with over 250 events held at the Hospital or in the community through collaboration with community partners. These events include health fairs, screenings, daytime and evening lectures, seminars, classes, Speakers' Bureau presentations, children's events and other health related activities. Throughout the year the Hospital collaborated with dozens of community organizations to provide wellness and prevention programs.Swedish Covenant Health publishes periodic health and wellness information which is distributed through mailings and web-based programs to 987,949 households throughout the surrounding community for a cost of $74,275.During the fiscal year, Swedish Covenant Hospital also offered transportation services to 699 members of the community at a net cost of $104,926.Interpreter ServicesSwedish Covenant Health provides in-house interpreters for patients who speak Korean and Spanish, the primary non-English languages in the community. In FY 2018, the interpreters participated in a total of 4,106 interpretive encounters. Additionally, SCH uses professional telephone interpretive assistance and had a total of 299,609 telephonic interpretation minutes in 79 languages. For deaf or hearing impaired patients who request sign language interpreters, the Hospital provides interpreters through CAIRS and Chicago Hearing Society. Swedish Covenant Health incurred a total cost of $495,575 for interpreter services serving a total of 22,245 persons.Medical Education Program Swedish Covenant Health is an independent teaching hospital, with residency programs in family medicine, internal medicine, and podiatric surgery. Swedish Covenant Health also has fellowship programs in Critical Care Medicine and Pulmonary Critical Care Medicine. Swedish Covenant Health utilizes board-certified physicians who are either independent contractors or are employed by Swedish Covenant Medical Group , a wholly-owned subsidiary of Swedish Covenant Health to provide teaching, training and supervision of the residents in Swedish Covenant Health's Family Medicine (12 residents), Internal Medicine (25 residents), Podiatric Surgery (7 residents) residency programs as well as the Critical Care (3 fellows) and Pulmonary Critical Care Fellowships (3 fellows). As part of Swedish Covenant Health's teaching affiliation agreement with Midwestern University Chicago College of Osteopathic Medicine (MWU/CCOM), Swedish Covenant Health is a training site for emergency medicine residents. Swedish Covenant Health has an affiliation agreement with Rush University which allows for the Hospital to be a training site for their OB/GYN residents and with McGaw, the postgraduate arm of Northwestern University, to be a training site for their family medicine residents.Swedish Covenant Health is also a training site for students of three medical schools; Chicago College of Osteopathic Medicine (40), and Arizona College of Osteopathic Medicine (20), both part of Midwestern University, and for the St George's University of London program delivered by the University of Nicosia (39). In addition to the above, during the fiscal year ended September 30, 2018, Swedish Covenant Health voluntarily provided $12,115,375 at cost in charity care/uninsured discounts and provided $13,502,005 at cost in unreimbursed Medicaid services. 244589944 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 225 0 1 2321 1 1 1 0 0 0 0 0 0 0 0 0 X 22 13 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 IL X THOMAS J GARVEY 7738788200 5145 N CALIFORNIA AVE CHICAGO IL 60625 SHAMEEM A ABBASY MD DIRECTOR 1.00 40.00 X 0 341282 34889 CAROLIN ARCHIBALD DIRECTOR 1.00 X 0 0 0 RON CHADHA DIRECTOR 1.00 1.00 X 0 0 0 RONALD D CURRAN MD DIRECTOR 1.00 40.00 X 32000 764140 32419 VINCENT DIBENEDETTO DIRECTOR 1.00 X 0 0 0 H CLARK FEDERER MD DIRECTOR 1.00 40.00 X 0 244471 33878 DENNIS G HAMMER DIRECTOR 1.00 X 0 0 0 DAVID W KERSTEN DIRECTOR 1.00 X 0 0 0 BEA REYNA-HICKEY DIRECTOR 1.00 X 0 0 0 DEBRA SCHOTZ DIRECTOR 1.00 X 0 0 0 CHRIS SULLIVAN DIRECTOR 1.00 X 0 0 0 JOHN A SWANSON DIRECTOR 1.00 X 0 0 0 JEFFREY M TILKIN MD DIRECTOR 1.00 X 32000 0 0 KRISTIAN A WERLING DIRECTOR 1.00 X 0 0 0 LAWRENCE P ANDERSON DIRECTOR 1.00 42.00 X 0 735692 59758 ADAM D FINKELSTEIN MD DIRECTOR 1.00 X 28055 0 0 ROGER A OXENDALE DIRECTOR 1.00 42.00 X 0 183226 25052 REV GARY B WALTER DIRECTOR 1.00 40.00 X 0 158741 115867 ANTHONY GUACCIO PRESIDENT & CEO 40.00 3.00 X X 606521 0 93143 CHRISTOPHER J OLSON CHAIRMAN 1.00 X X 0 0 0 KURT D ANDERSON VICE CHAIR 1.00 X X 0 0 0 MICHAEL BAUGHMAN SECRETARY 1.00 X X 0 0 0 THOMAS J GARVEY SENIOR VP & CFO 40.00 3.00 X 463524 0 54625 KATHRYN DONOFRIO RN SENIOR VP, CNO 40.00 X 226391 0 42859 PATRICIA KING GENERAL COUNSEL 40.00 X 291011 0 50441 JONATHAN LIND VP & CHIEF OPERATING OFFIC 40.00 X 312829 0 56161 BRUCE MCNULTY MD CHIEF MEDICAL OFFICER 40.00 1.00 X 333974 0 63717 KAREN M SHEEHAN SENIOR VP & CIO 40.00 X 285561 0 55698 JANIS A RUEPING VP QUALITY IMPVMT/RISK MGM 40.00 1.00 X 236172 0 42700 MICHAEL FEINZIMER PHYSICIAN 40.00 X 270365 0 1650 SALIBA KOKALY VP OPERATIONS 40.00 X 218764 0 52646 LORI GUINANE AVP MANAGED CARE 40.00 X 231466 0 35530 TONY VANCAUWELAERTMD FORMER DIRECTOR,PHYSICIAN 0.00 X 0 376090 15930 MARK NEWTON FORMER PRESIDENT & CEO 0.00 X 0 967127 26622 DAVID A DWIGHT FORMER DIRECTOR 0.00 X 0 512941 23144 3568633 4283710 916729 108 1 1 0 OBHG ILLINOIS SC 10 CENTIMETERS DRIVE MAULDIN SC 29662 HEALTH CARE 1347850 MIDWESTERN UNIVERSITY 555 31ST STREET DOWNERS GROVE IL 60515 HEALTH CARE 961133 NEPHRON DIALYSIS CTR LTD 5140 N CALIFORNIA AVE STE 510 CHICAGO IL 60625 HEALTH CARE 770018 SWEDISH EMERGENCY ASSOCIATES PC 900 OAKMONT LANE SUITE 100 WESTMONT IL 60559 HEALTH CARE 546082 LAW OFFICES OF JAMES A KNEPPER PC 626 W JACKSON BLVD 4TH FLOOR CHICAGO IL 60661 LEGAL SERVICES 366815 21 X 69000 69000 HEALTH CARE SERVICES 900099 262632432 262632432 LABORATORY SERVICES 621500 2244620 2244620 264877052 2023490 2023490 5911614 0 5911614 5911614 5911614 4462773 0 4462773 4462773 4462773 PARKING GARAGE FEES 812930 1370031 1370031 CHILD CARE CENTER 624410 1152682 753845 398837 TIF INCENTIVE PAYMENT 900099 366666 366666 8087066 8087066 10976445 288320374 279121654 2643457 6486263 967425 967425 2493165 660684 1832481 95553 95553 102525998 95474281 7051717 1827508 1671210 156298 12370525 11312845 1057680 7341994 6864922 477072 1085051 1085051 262296 262296 228206 228206 175500 175500 26331230 22819741 3511489 688335 33470 654865 203121 178924 24197 4182145 4167279 14866 61273 30901 30372 6166978 6166978 16552113 16374837 177276 9180303 8395387 784916 SUPPLIES & DRUGS 41536207 41459585 76622 IDPA TAX 14909525 14909525 PERIODIC PENSION COSTS 6000000 6000000 EQUIPMENT REPAIR & MAIN 4456684 4411267 45417 9509978 8690683 819295 269151113 244589944 24561169 0 61885 3827476 1266370 1039859 527281 1144928 47049380 44071802 4750142 4601785 3130419 1240232 538106780 350125625 186433364 187981155 139731263 132751093 472610 472610 96736030 108893661 480158744 486024601 56073761 44768226 171327455 156846858 11900000 19340000 65049035 69799628 304350251 290754712 X 174720388 193604385 1088105 1665504 175808493 195269889 480158744 486024601 X 19169261 814369 -522234 X 0 1 X 1 0 X 0 1 0 0 0 0 1 152014 0 1 175500 327514 0 Part II-B, Line 1: In the course of regular business activities, Swedish Covenant Health or its lobbyist perform some lobbying activities on matters of interest to itself and its patients. 21968658 1913788 118332 1292342 22708436 22116954 1391694 234838 1774828 21968658 22060233 1753512 227079 1923870 22116954 21383248 2587312 -164316 1746011 22060233 20747291 2850273 477914 2692230 21383248 0.21620 0.78380 0 1 1 8610157 8610157 218806988 117031869 101775119 648490 609089 39401 248517027 206484232 42032795 61524118 26000435 35523683 187981155 CMB BOND & EQUITY FUND - FMV 132751093 F 132751093 OTHER INVESTMENTS 18460243 DUE FROM AFFILIATES 84802337 ASSETS WHOSE USE IS LIMITED 2124604 ALL OTHER CURRENT ASSETS 3268281 ACA 400 PROGRAM RECEIVABLE 162937 MYCARE CHICAGO RECEIVABLE 75259 108893661 ACCRUED MALPRACTICE LIABILITY 27757291 FAIR VALUE OF INTEREST RATE SWAPS 7813526 ASSET RETIREMENT OBLIGATION 1813669 DUE TO THIRD PARTY PAYERS 8704046 NMTC DEBT ISSUE 13475000 DUE TO AFFILIATES 10236096 69799628 X Part V, Line 4: The earnings are to be used for education, charity care, and other hospital programs. Swedish Covenant Health is the related beneficiary of the endowment funds held by Swedish Covenant Hospital Foundation. Part X, Line 2: Swedish Covenant Health is a not-for-profit organization under the laws of Illinois. The Internal Revenue Service has determined that Swedish Covenant Health is a not-for-profit organization described in Section 501(c)(3) of the Internal Revenue Code (the Code) and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Accordingly, Swedish Covenant Health has not provided for income taxes in the accompanying financial statements. Swedish Covenant Health and its not-for-profit subsidiaries each file Form 990 (Return of Organization Exempt from Income Tax), and the for-profit subsidiary files Form 1120 (U.S. Corporation Income Tax Return) annually. When these returns are filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Examples of tax positions common to health systems include such matters as the tax-exempt status of each entity, the continued tax-exempt status of bonds, the nature, characterization and taxability of joint venture income and various positions relative to potential sources of unrelated business income (UBI). UBI is reported on Internal Revenue Service Form 990-T, as appropriate. The benefit of a tax position is recognized in the financial statements in the period during which, based on all available evidence, management believes that it is more likely than not that the tax position will be sustained upon examination, including the resolution of appeals or litigation processes, if any. Tax positions are not offset or aggregated with other positions. Tax positions that meet the "more likely than not" recognition threshold are measured as the largest amount of tax benefit that is more than 50% likely to be realized on settlement with the applicable taxing authority. The portion of the benefits reflected as a liability for unrecognized tax benefits in the accompanying consolidated statements of financial position includes any associated interest and penalties that would be payable to the taxing authorities upon examination. At September 30, 2018 and 2017, there were no unrecognized tax benefits identified or recorded as liabilities. The Forms 990, Forms 990-T and Forms 1120 filed by the Hospital are subject to examination for up to three years from the extended due date of each return. These returns are no longer subject to examination for tax years ended before September 30, 2015. 1 1 1 X 300.000000000000 1 X 600.000000000000 1 1 1 0 1 1 10436594 10436594 0.03880 79309280 89008598 0 0.00000 89745874 89008598 10436594 0.03880 1725439 1725439 0.00640 2917842 3489465 0 0.00000 5049497 5049497 0.01880 967000 967000 0.00360 10659778 3489465 7741936 0.02880 100405652 92498063 18178530 0.06760 26751 26751 0.00010 26751 26751 0.00010 1 11210424 73966186 76152590 -2186404 X 1 1 1 CHICAGO CK ENTERPRISES LLC OUTPATIENT MEDICAL SERVICES 0.05300 0.00000 0.94700 2 CK PROPERTY DEVELOPMENT LLC PROPERTY MANAGMENT SERVICES 0.36800 0.00000 0.63200 3 ACCOUNTABLE CARE CHICAGO LLC HEALTHCARE SERVICE PROVIDER NETWORK 0.11110 0.00000 0.00000 4 UPPER MIDWEST CONSOLIDATED SERVICES CENTER LLC GROUP PURCHASING ORGANIZATION 0.01000 0.00000 0.00000 1 1 SWEDISH COVENANT HEALTH 5145 N CALIFORNIA AVENUE CHICAGO IL 60625 www.swedishcovenant.org 0002717 X X X X I/P & OP HOSPITAL SERVICES, SKILLED NURSING FACILITY SWEDISH COVENANT HOSPITAL 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X see Part V Page 8 X swedishcovenant.healthforecast.net X 1 15 1 see Part V Page 8 0 1 X 300.000000000000 600.000000000000 X X X 1 1 X X X 1 X see Part V Page 8 X see Part V Page 8 X see Part V Page 8 X X X X X 1 X 0 1 X 0 0 SWEDISH COVENANT HOSPITAL Part V, Section B, Line 5: The Community Health Needs Assessment was sponsored by the Swedish Covenant Hospital Foundation; it has been facilitated by the Metropolitan Chicago Healthcare Council (MCHC) on behalf of participating member hospitals and health systems. The project also received input from dozens of key external and internal stakeholders, which were comprised of representatives of the partnering organizations as well as others chosen for their relevant experience and interests. A precise and carefully executed methodology is critical in asserting the validity of the results gathered in the PRC Community Health Survey. Thus, to ensure the best representation of the population surveyed, a telephone interview methodology - one that incorporates both landline and cell phone interviews - was employed. The primary advantages of telephone interviewing are timeliness, efficiency and random-selection capabilities. The sample design used for this effort consisted of a random sample of 400 individuals age 18 and older in the Swedish Covenant Hospital Service Area. Once the interviews were completed, these were weighted in proportion to the actual population distribution so as to appropriately represent the Swedish Covenant Hospital Service Area as a whole. All administration of the surveys, data collection and data analysis was conducted by Professional Research Consultants, Inc. (PRC). For statistical purposes, the maximum rate of error associated with a sample size of 400 respondents is 4.9% at the 95 percent level of confidence.The sample design and the quality control procedures used in the data collection ensure that the sample is representative. Thus, the findings may be generalized to the total population of community members in the defined area with a high degree of confidence.To solicit input from key informants, those individuals who have a broad interest in the health of the community, an Online Key Informant Survey was also implemented as part of this process. A list of recommended participants was provided by Metropolitan Chicago Healthcare Council; this list included names and contact information for physicians, public health representatives, other health professionals, social service providers, and a variety of other community leaders. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Key informants were contacted by email, introducing the purpose of the survey and providing a link to take the survey online; reminder emails were sent as needed to increase participation. In all, 29 community stakeholders took part in the Online Key Informant Survey.After reviewing the Community Health Needs Assessment findings, nearly 100 external and internal stakeholders met to evaluate, discuss and prioritize health issues for the community, based on findings of the 2015 PRC Community Health Needs Assessment (CHNA). During the a detailed presentation of the CHNA findings, consultants from PRC used audience response system (ARS) technologies to lead steering committee members through a process of understanding key local data findings (Areas of Opportunity) and ranking identified health issues against an established, uniform criteria related to magnitude, impact/seriousness, feasibility and consequences of inaction. Based on the hospital's areas of expertise and partnerships with local community organizations, the Areas of Opportunity were prioritized.In order to accurately assess the needs of our medically underserved, low-income and minority populations, the following organizations were invited to participate in the Online Key Informant Survey during the spring/summer of 2015: Albany Park Community Center, Apna Ghar, Asian Human Services, C4, Cambodian Association of Illinois, Casa Central, Centro Romero, Chicago Department of Public Health, Cook County State's Attorney's Office, Erie Family Health (FQHC), Heartland Health (FQHC), Indo American Center, Korean American Community Services, Lutheran Social Services/Project IMPACT, North River Commission and the Vietnamese Association of Illinois. Through the online key informant survey, input was gathered from several individuals whose organizations work with low-income, minority populations (including African-American, Arabic, Asian, disabled, Eastern European, ethnic minorities, Hispanic, the homeless, immigrants, Indian, Japanese, Korean, LGBT population, low-income residents, Muslim, Non-English Speaking, Polish, Russian, undocumented) or other medically underserved populations (including the disabled, elderly, free care, homeless, immigrants, LGBT community, Medicaid/Medicare, the mentally ill, pregnant teens, substance abusers, undocumented, uninsured/underinsured, veterans, young adults, youth). In the online survey, key informants were asked to rate the degree to which various health issues are a problem in their own community. Follow-up questions asked them to describe why they identify problem areas as such, and how these might be better addressed. It is important to note that these findings represent qualitative rather than quantitative data. The Online Key Informant Survey was designed to gather input from participants regarding their opinions and perceptions of the health of the residents in the area. Thus, these findings are based on perceptions, not facts.During the prioritization process (which included both internal and external stakeholders), the following organizations were invited to attended a prioritization meeting in the spring of 2016, many of which represent the underserved populations of our community: Ecuadorian Consulate, Chinese Mutual Aid Association, Indo American Center, Korean American Community Services, Albany Park Community Center, Erie Family Health, Heartland Health, Asian Human Services, Hamdard Health Center, Illinois Maternal and Infant Welfare, Lutheran Social Services of Illinois, Kedzie Center, Centro Romero, Vietnamese Association of Illinois, Chicago Department of Public Health, Cambodian Association of Illinois, North Park University, North River Commission, Polish American Association, Apna Ghar, Between Friends, Korean American Women in Need (KAN-WIN), Rape Victims Advocates, STOP-IT (Salvation Army), 20th Police District, Community Justice Center, Covenant Church and Jewish Child & Family Services.The prioritization meeting is described earlier in this section. SWEDISH COVENANT HOSPITAL Part V, Section B, Line 11: In acknowledging the wide range of priority health issues that emerged from the CHNA process, Swedish Covenant Hospital determined that it could only effectively focus on those which it deemed most pressing, most under-addressed, and most within its ability to influence. The hospital focused on 6 of the 14 identified needs. Listed below are the six needs which are being addressed and how they are being addressed:1. Cancer: The SCH Community Breast Health Program (CBHP) serves women who face the greatest challenges accessing breast cancer detection and treatment due to financial, cultural, and language barriers. For our uninsured patients, grant support from The National Breast Cancer Foundation, Susan G. Komen Chicagoland, A Silver Lining and the Washington Square Healthcare Foundation is available. Through the generous support of these organizations, the program was able to provide screening and diagnostic mammograms, ultrasounds, and biopsies to low-income women over the last year. In FY18, CBHP delivered 2,100 no-charge cancer detection services to 1,471 uninsured, low-income women and navigated 285 women through the care continuum in over 620 patient encounters.2. Diabetes: The hospital's Diabetes Community Center (DCC) offers comprehensive education, resources and support to patients diagnosed with type 1 or type 2 diabetes, prediabetes and gestational diabetes. It is an American Diabetes Association accredited self-management program and has been accredited since 1998. 1-1 counseling services are available to community members as an outpatient service via physician referral. The center also provides free monthly support groups and monthly small group education sessions to offer strategies for ongoing diabetes lifestyle management. Diabetes prevention and education seminars are also offered throughout the year for the general community. In FY18, some programs included a Kidney & Diabetes Screening, Diabetes Prevention and Diabetes Myths.3. Heart Disease and Stroke: Our goal is to provide community outreach and education related to heart disease and stroke risk factors, warning signs and how to respond in an emergency. The hospital delivered several programs on and off the hospital campus in FY18 to inform community members about heart disease and stroke warning signs and risk factors. Programs included blood pressure screenings at community events as well as educational presentations. As a part of these programs, the hospital collaborated with area elected officials to provide education and blood pressure screening at events to further raise awareness about heart disease and stroke. The hospital is committed to caring for heart disease and stroke patients beyond discharge. Nursing staff in Transitional Care attempt to call all patients with a diagnosis of congestive heart failure (CHF) or hypertension after discharge home, which reinforces discharge instructions. One major highlight for FY18 in this area was the hospital's Bystander CPR and AED training initiative, which featured free, interactive practice of "hands-only" CPR with a mannequin for members of the community. In FY18, 50 Bystander CPR programs were delivered, with a total of 1,330 individuals attending the training sessions.4. Injury and Violence: During FY18, we served 69 patients who came to our Emergency Department (ED) for medical treatment following a sexual assault or disclosed a sexual assault in one of our inpatient or outpatient settings. We served 252 patients currently experiencing domestic violence. Eight patients exhibiting red flags for human trafficking and were connected with services. The Salvation Army Stop-it Program referred 14 human trafficking survivors to receive trauma-informed health care services with SCH outpatient services. The hospital also enhanced facilities within the ED in FY18 to create a safer, more private and more supportive environment for patients who have experienced violence. Additionally, female washrooms in most public areas of the hospital and outpatient facilities display signage that asks "Is Someone Hurting You?" in 5 languages (English, Spanish, Arabic, Urdu and Korean) and provides cards with phone numbers to domestic violence hotlines. Over 800 cards were taken from these washrooms during FY18.The hospital has robust partnerships related to violence prevention to foster local and regional dialogue on the subject and is also committed to ongoing training of staff within the hospital. In FY18, 26 training sessions were held with over 414 staff members trained.5. Mental health: The hospital continues to seek ways to provide appropriate resources for individuals presenting in the SCH Emergency Department (ED) with substance abuse (SA) or other mental health disorders. The hospital has a strong and robust partnership with Lutheran Social Services (LSSI), both via the ED (Project IMPACT) and via LSSI's outpatient setting on the SCH campus, the Welcoming Center. The hospital works diligently to properly connect individuals with SA disorders to the appropriate resources. After being medically cleared, patients are referred to Project Impact via a consultation order in our electronic medical records and with a phone call. Patients may be referred to outpatient resources, the Welcoming Center or inpatient detox. 6. Nutrition, Physical Activity and Weight: The hospital delivered a variety of programs on and off campus to inform community members about nutrition, physical activity and weight. Throughout FY18, the hospital hosted or participated in more than 50 events which supported healthy lifestyles. A key partner in this priority is Galter LifeCenter (GLC), our certified medical fitness facility on campus. Fitness is promoted throughout the community through notification of fitness programs hosted at GLC and in collaboration with GLC at various locations within the community. In 2010, GLC was recognized and accredited as the first and only Medical Fitness Center in Illinois from the Medical Fitness Association. As part of our continuum of healthcare services, it is one of approximately 40 certified centers in the nation, and GLC was recertified as a Medical Fitness Center in 2014 and 2017.Listed below are the health priorities not chosen for action and the reasons as to why they were not selected:Access to Healthcare Services: Since completion of the community surveys, SCH opened 2 immediate care centers (open 365 days/year) to increase access to health services. The hospital is also in the midst of an Emergency Department renovation/redesign to better meet needs of the surrounding community. SCH continues to support the community's access to healthcare services by partnering with local FQHCs. Limited resources excluded this as an area for further action.Chronic Kidney Disease: SCH regularly partners with organizations including the National Kidney Foundation to provide free screenings to the ethnicities most vulnerable to this disease. Limited resources excluded this as an area for further action. Infant Health and Family Planning: SCH continues to partner with local FQHCs (including on-campus partner Erie Family Health) in addition to OB/GYN, Midwives and Pediatricians at the hospital, in an effort to positively impact outreach regarding family planning education and infant health issues. The hospital is also engaged in a long-standing on-campus partnership with Lurie Children's Hospital. Limited resources excluded this as an area for further action. Respiratory Diseases: SCH provides respiratory screenings throughout the year at community health fairs. Community stakeholders felt that more pressing health needs existed, thus limited resources and lower priority excluded this as an area for further action.Sexually Transmitted Diseases and HIV/AIDS: SCH believes that this priority area falls more within the purview of the county health department and other community organizations. Limited resources excluded this as an area for action. Sickle-Cell Anemia: SCH has limited resources, services and expertise available to address sickle-cell anemia, and the hospital has opted to focus on health issues impacting a larger subset of the local population. Limited resources and lower priority excluded this as an area for action.Substance Abuse: SCH has limited resources, services and expertise available to address alcohol and other drug issues. Other community organizations have infrastructure and programs in place to better meet this need. However, substance abuse is integrated into our mental health need category. SCHEDULE H PART V SECTION B LINE 7A The complete URL for the CHNA on the hospital's website is: www.swedishcovenant.org/community/community-outreach-and-partnership SCHEDULE H PART V SECTION B LINE 10A The complete URL for the implementation strategy on the hospital's website is:www.swedishcovenant.org/community/community-outreach-and-partnership SCHEDULE H PART V SECTION B LINE 16A The complete URL for the FAP on the hospital's website is:https://swedishcovenant.org/for-patients-and-visitors/pay-your-bill/hospital-financial-assistance-policy SCHEDULE H PART V SECTION B LINE 16B The complete URL for the FAP application form on the hospital's website is:https://swedishcovenant.org/for-patients-and-visitors/pay-your-bill/hospital-financial-assistance-policy SCHEDULE H PART V SECTION B LINE 16C The complete URL for the plain language summary on the hospital's website is:https://swedishcovenant.org/for-patients-and-visitors/pay-your-bill/hospital-financial-assistance-policy 2 1 - LIFE CENTER ON THE GREEN INC 5157 N FRANCISCO AVENUE CHICAGO IL 60625 PHYSICAL REHABILITATION SERVICES 2 - SWEDISH COVENANT HOME HEALTH CARE 6141 N CICERO AVENUE CHICAGO IL 60646 HOME HEALTH CARE SERVICES Part I, Line 7: Each net community benefit expense is divided by total hospital expenses (excluding bad debt expense) to determine the percent of community benefits provided for fiscal year 2018. Costing Methodology - For all community benefits, we utilize the cost to charge ratio to calculate the benefit. The net operating costs are calculated by taking the total operating costs less the following: the PA tax and the non-patient care activity costs. The net gross charges are calculated as follows: gross charges less charges for community benefits. Net operating costs divided by net gross charges provides the cost to charge ratio.Part I - Line 7d - column d For Schedule H, line 7b, column (c) the $79,309,280 in the Community Benefit Expense includes the provider assessment tax of $14,909,525. Had the provider tax been excluded, the total Community Benefit expense would have been $64,399,755. On Schedule H, line 7b, column (d), the direct offsetting revenue of $89,008,598 includes the provider tax revenue of $38,110,848 million. Had the public aid provider revenue been excluded from Schedule H, the direct offsetting revenue would have been $50,897,750. Using an adjusted total community benefit expense of $64,399,755 noted above, minus an adjusted direct offsetting revenue amount of $50,897,750, also noted above, the resulting community benefit dollar amount on Schedule H, line 7b, column (e) would have been $13,502,005. On Schedule H, line 7b, column (f) percentage of total expense would have increased from 0% to 5.09%.The PA tax benefit is not reimbursement for direct patient care and therefore we believe it should be excluded from the Schedule H calculations. Part II, Community Building Activities: Members of Swedish Covenant Hospital staff work with other organizations and participate in many activities to advocate for health improvement in our community. These include:Involvement with the Association for Community Safety Net Hospitals and the IHA Advocacy Outreach Team, participation in the Medicaid Rate Reform Tag Group, community meetings, chambers of commerce, education, and seeking of resources with regard to the planning and development of the Emergency Department Renovation Project on the hospital campus to enhance emergency health care services in the community. During the 2018 fiscal year, Swedish Covenant Hospital joined with other area hospitals to participate in a collaborative of area hospitals which is now entitled the Alliance for Health Equity (AHE). AHE (formerly the Health Impact Collaborative of Cook County) is a partnership between the Illinois Public Health Institute, hospitals, health departments, and community organizations across Chicago and Cook County. This initiative is one of the largest collaborative hospital-community partnerships in the country with the current involvement of 30+ nonprofit and public hospitals, seven local health departments, and representatives of more than 100 community organizations serving on action teams. AHE is a collaboration of Chicago and Cook County-based hospitals that strives to promote a collective impact on health outcomes in the city of Chicago through an environment that fosters learning, sharing of resources, data and best practices. They are also the driving force to facilitate and execute the Community Health Needs Assessment (CHNA) for their hospital members. SCH has staff who participate in a variety committees via AHE including the following: AHE Steering Committee, Social and Structural Determinants Committee, Housing Workgroup, Mental Health and Substance Use Disorders Committee, CHNA Committee, Community Safety Workgroup, Food Access and Food Security, Policy Committee and Trauma Informed Hospitals Committee.Members of the Swedish Covenant Hospital staff have also worked to establish an affiliation with Northwestern University to allow our emergency room physicians to communicate with Northwestern neurologists using robotic equipment which enables these neurologists to remotely examine Swedish Covenant emergency department patients for signs of a stroke. This resource can improve patient outcomes by early and accurate diagnosis of stroke.Erie Family Health is a strong partner of Swedish Covenant Health, providing expanded health services for those in need through high-quality, low-cost medical care as a Federally Qualified Health Center (FQHC). The Erie Foster Avenue Health Center (one of 13 Erie locations in Chicago and the surrounding suburbs) is Erie's first location on a hospital campus, which allows for integrated care coordination along the health continuum. Through this partnership, numerous Erie providers have delivery privileges at Swedish Covenant Hospital, and Erie Foster Avenue patients have access to specialty care services provided by Swedish Covenant Health. One key element to this partnership is Erie's role as the clinical training site for SCH family medicine and internal medicine residency programs. This collaboration allows for great medical exposure and training, in part due to the nature of the diverse patient population.SCH partners with local schools and organizations to provide career days, science fair judging and other interactive tours with students. One example is a healthcare careers exploration panel which SCH hosted for students of Niles North and West high schools who were interested in health professions. Over the course of two hours, students heard candid stories from a pediatrician, pediatric nurse practitioner, dietitian, nurse, physical therapist, x-ray student, violence prevention specialist, lab director and senior administrator from our medical group. Finally, SCH remains committed to identifying housing and providing support services to homeless individuals in our area. In 2018 with support from SCH Foundation, Chicago Department of Public Health and Chicago Department of Family and Support Services, SCH implemented the Better Health Through Housing Program by identifying and enrolling 10 chronically homeless individuals who were frequent users of the SCH ED. The program connected these patients with housing and wrap-around services. SCH Foundation's support of $75,000 paid for case management which helped assist participants with daily activities, budgeting, making sure they set and keep medical appointments, pay bills, and take on other everyday responsibilities, including eventually seeking employment. In addition to the case management paid for by the Foundation, SCH provided primary care physicians and encouraged each participant to take advantage of BMH services through our partner, Lutheran Social Services of Illinois (LSSI).In addition to the above mentioned activities, SCH regularly engages in conversation to advocate for community health improvement and support, including attending meetings with the local police districts on safety/community policing and meeting with organizations who serve disadvantaged populations within our community to develop relationships/partnerships to provide preventive health screenings (including mammograms), violence prevention resources, and other free health education offerings throughout the community. Part III, Line 2: The costing methodology is applying the cost-to-charge ratio of 16.24% to total bad debt expense. Part III, Line 3: There are no bad debt amounts included in community benefits. Part III, Line 4: This statement is extracted from the SCH consolidated financial statements. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for uncollectible 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), the Hospital 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 written off against the allowance for uncollectible accounts in the period they are determined uncollectible. Part III, Line 8: The hospital has used the standard single apportionment step down cost allocation methodology for the allocation of allowable costs (as defined by the Medicare principles of reimbursement) to the revenue cost centers. Allowable allocated costs are divided by the revenues in each ancillary department and by the days in each nursing unit to determine the appropriate ratios and cost per diems to be applied to the related Medicare ancillary charges and nursing unit days to determine the cost of Medicare services. Part III, Line 9b: Charity Care Patients:The organization has a policy of Presumptive Charity Care for health care services provided to uninsured patients who are presumed eligible for charity care based on criteria demonstrating financial need.Effective January 1, 2014, the regulations adopted by the Illinois Attorney General (77 Ill. Admin. Code Part 4500, Hospital Financial Assistance under the Fair Patient Billing Act), require that a presumptive charity determination take place as soon as possible after the receipt of health care services from the hospital and prior to the issuance of any bill for those health care services by the hospital. According to the regulations, a patient's financial need must be determined by use of presumptive charity criteria (which may be accomplished through software/screening) without further scrutiny by the hospital.Financial Assistance:Patients with a self-pay balance and without the resources to pay their obligations will be assessed for financial assistance by the Financial Service Center. The assessment involves an evaluation for eligibility for all appropriate levels of assistance, including governmental or partial reductions or complete charity care. Part VI, Line 2: Needs AssessmentIn the spring of 2015, Swedish Covenant Hospital (SCH) embarked on a comprehensive Community health Needs Assessment (CHNA) process to identify and address the key issues for our community.Swedish Covenant Hospital is a comprehensive health care facility providing health and wellness services to Chicago's North and Northwest side communities. This 312-bed hospital is one of the few independent, nonprofit hospitals in the area. Its 600 physicians and 2,200 employees remain focused on the hospital's mission of providing compassionate, high quality care in a healing environment. An established teaching hospital, Swedish Covenant Hospital offers a range of medical programs, including the latest cardiac, cancer, orthopedic, surgical, women's health, back health and emergency services.To address concerns about healthcare access, SCH created an affiliation with Erie Family Health Center. In July 2013, Erie opened the Erie Foster Avenue Health Center on the hospital's campus. Erie Foster Avenue Health Center is a Federally Qualified Health Center which provides care to patients who come through the emergency department at SCH and might not have a medical home. Swedish Covenant Hospital (SCH) maintains a department dedicated to addressing its outreach objectives of serving the entire community, not only those who come through its doors. Building on a long tradition of service, the Community Relations Department utilizes hospital strengths alongside those of other well-established community partners. This strategy allows SCH to better understand and reach the most vulnerable sectors of the community, while meeting pressing healthcare needs. The goal is to improve the community's health status by empowering citizens to make healthy lifestyle choices. The Community Benefit Plan (Community Health Needs Assessment Implementation Strategy) identifies six priority health issues to be addressed for providing community benefit. The implementation strategy is intended to exist over a three year time period, after which a new needs assessment and benefit plan will be developed. The following is a list of the six priorities of the Community Benefit Plan, out of 14 community needs identified, to be addressed on an ongoing basis and reported on annually through FY19. 1. Cancer2. Diabetes3. Heart Disease and Stroke4. Injury and Violence5. Mental Health6. Nutrition, Physical Activity and Weight Part VI, Line 3: Patient Education of eligibility for AssistanceCharity or discounted care is available for medically necessary services as defined by Medicare, to patients who meet the financial and documentation criteria defined below. Each situation is reviewed on an individual case-by-case basis. While not absolutely essential, the need for potential charity or discounted care should be established in advance of admission or rendering of service, or shortly thereafter.Notices in English, Greek, Korean, Polish, Russian, Spanish and Urdu about the availability of Charity or Discounted Care are posted in the Emergency Room registration area, and the inpatient and outpatient registration areas. The information is also contained in the Patient Handbook, given to all patients upon inpatient admission. Patients and families are encouraged to speak to a financial counselor for more information and assistance. The Guidelines, along with the financial questionnaire, are posted in English, Greek, Korean, Russian, Polish, Spanish and Urdu on the hospital's website.In order to be eligible for charity or discounted care, the patient must be willing to provide verification of income by filling out the Patient Financial Statement. The patient is responsible to voluntarily submit any and all documentation in order to be eligible to receive this discount. During the registration and information gathering process, the financial counselors determine if the patient qualifies for medical assistance from other existing financial resources such as Medicare, Medicaid, Kid Care, Family Care or other state or federal programs. If the patient refuses to apply for existing financial resources or to provide information necessary to the application process, charity or discounted care cannot be granted. If the application for existing financial resources is denied, or has been previously denied, consideration for charity or discounted care will then be given.Once the Financial Assistance Application form is received, the Financial Service Center determines the eligibility for charity or discount care. SCH suspends the collection process while the Financial Assistance Application is being reviewed. The only criteria considered for Financial Assistance is income and family size. Income is evaluated against the matrix of Federal Poverty Guidelines to determine whether full or partial discount can be approved. Documentation of income is submitted in the form of paycheck stubs, income tax returns, Social Security checks, and/or other documents that are indicative of income. If the information submitted is not perceived to be accurate or reliable, SCH reserves the right to request additional documentation to substantiate income or family size.Patients who are approved for financial assistance and earn a family income less than 300% of the federal poverty guidelines will receive care at no cost for their patient balance after $300 per inpatient stay or outpatient services.The insured patient with a large balance due to deductibles and/or co-payments may be eligible for charity or discounted care. In order to qualify, the patient must complete the Patient Financial Statement and return it to the financial counselors for evaluation and recommendation.No legal action is taken against uninsured patients for the first one hundred twenty (120) days after discharge.Patients who have a family income that is no more than 600% of the Federal Poverty Guidelines (as determined each year), and who do not have any health insurance (or coverage under workers' compensation, accident liability insurance, or other third party liability) as documented through SCH's insurance verification procedures, receive a discount in accordance with the Hospital Uninsured Patient Discount Act (210 ILCS 89/) (the Act). Part VI, Line 4: Community InformationSCH's community, as defined for the purposes of the hospital's 2015 Community Health Needs Assessment, included each of the residential ZIP Codes that comprise the hospital's Primary Service Area (PSA) and Secondary Service Area (SSA), including: 60613, 60618, 60625, 60626, 60630, 60640, 60641, 60645, 60646, 60659, 60660 and 60712. This community definition was determined because the majority of SCH's patients originate from this area. The population of the hospital's service area is estimated at 634,860 people. It is predominantly non-Hispanic White (57.3%), but also has substantial Hispanic (28.2%) and Asian (11.0%) populations. As throughout the state and nation, our population is aging, with 11.0% currently age 65 and older. This is projected to increase in coming years, as is the need for services to meet the health needs of this older population. 16.5% of the families in our population remain below the poverty level. The hospital serves a very diverse multicultural community, with the Albany Park neighborhood serving as a key entry point for many new immigrants. To better address the needs of our highly diverse community, the hospital works regularly with dozens of community stakeholders including local ethnic groups, legislators, and community and business organizations, including: the Albany Park Community Center, Centro Romero, Erie Family Health, Heartland Health, Chicago Department of Public Health, Korean American Community Services (now HANA Center), Asian Human Services, Casa Ecuatoriana, Vietnamese Association of Illinois, Hamdard Center, Apna Ghar, North River Commission and the Albany Park Chamber of Commerce. These organizations serve as a link between the hospital and the many surrounding niche communities, and the hospital's Community and Government Relations teams communicate regularly online and in-person to propose solutions to issues including Access to Care and health reform.The Spanish language represents the majority of interpretive assistance requested at the hospital. To meet this need on an inpatient and outpatient basis, the hospital employs a full time Spanish medical interpreter. The hospital also employed a full-time Korean interpreter through June of 2018 to meet the needs of our Korean patients. The hospital additionally used a telephonic interpretive service to meet the needs in other languages, as well as for when the employed interpreters were not present. In FY18, 79 unique languages were accessed by our staff to communicate with our diverse patient base. To better serve the Korean community, the hospital partners each year with HANA Center (formerly named Korean American Community Services), the Korean Medical Society and the Korean Nurses Association to host an annual Korean Health Fair at the hospital. This is an annual event, targeting the uninsured and underinsured working population. More than 100 Koreans residing in the greater Chicago area attend this event to receive free or reduced cost screenings and services. HANA Center coordinates the event collaboratively with staff from SCH.In FY2018, Swedish Covenant Hospital collaborated with dozens of community organizations and local businesses to provide wellness and prevention programs. Additionally, the hospital is committed to educating the public about health and wellness online via social media. Part VI, Line 5: In keeping with the Hospital's mission to provide a continuum of excellent healthcare services, any surplus funds are invested in capital improvements related to patient care or in community benefit programs.The hospital extends medical staff privileges to all qualified physicians in the communities it serves, in accordance with our medical staff development process. The hospital has an active Board of Directors who meet every two months. In addition to reviewing the hospital's financial results, they discuss the hospital's plans and programs in support of our efforts to enhance the health care environment for the entire community we service. The Hospital helps community members gain access to health care services by assisting low income families in applying for the Illinois Department of Public Aid's KidCare and FamilyCare programs. Information about these services is distributed to numerous community organizations, churches, health fairs and school events. It is also publicized throughout the hospital campus and on the hospital web site. Medicaid applications continue to be processed for all inpatients who qualify.The Senior Health Insurance Program (SHIP) counselor continues to provide information for seniors, including information on Medicare Part D. Information about this service is also publicized throughout the hospital campus. There were a total of 94 SHIP consultations at the hospital in FY18. Part VI, Line 7, Reports Filed With States IL 1 ERIE FAMILY HEALTH CENTER 1701 W SUPERIOR ST 3RD FLOOR CHICAGO IL 60622 363088628 501 (c)(3) 950000 To help defray the costs of uncompensated care to lower income and medically underserved patients at the Health Center. FOSTER PROGRESS 4422 N RAVENSWOOD AVE CHICAGO IL 60640 473959210 501 (c)(3) 5000 To help enable youths in foster care to attend college by providing mentors, helping to connect youths to scholarship programs, and advocating at colleges and at the state level for better practices to give youths in foster care a better chance for success. 2 0 Part I, Line 2: The mission of Swedish Covenant Health is to provide excellent healthcare services for our culturally diverse community. In pursuit of this mission, the hospital will fund or otherwise sponsor programs which advance our mission. If a grant is approved by the Board of Directors, yearly progress reports will be required, with a final report required at the conclusion of the project. An annual audit may be requested, if appropriate. X 1 1 X X X X 0 1 0 0 0 0 0 0 0 SHAMEEM A ABBASY MD DIRECTOR 0 323282 0 0 0 18000 0 8100 0 26789 0 376171 0 0 RONALD D CURRAN MD DIRECTOR 32000 740140 0 0 0 24000 0 8100 0 24319 32000 796559 0 0 H CLARK FEDERER MD DIRECTOR 0 220471 0 0 0 24000 0 7500 0 26378 0 278349 0 0 LAWRENCE P ANDERSON DIRECTOR 0 370991 0 114788 0 249913 0 10245 0 49872 0 795809 0 0 ROGER A OXENDALE DIRECTOR 0 100353 0 15000 0 67873 0 2215 0 22981 0 208422 0 0 REV GARY B WALTER DIRECTOR 0 158741 0 0 0 0 0 28343 0 87524 0 274608 0 0 ANTHONY GUACCIO PRESIDENT & CEO 438289 0 82845 0 85387 0 63957 0 29186 0 699664 0 50587 0 THOMAS J GARVEY SENIOR VP & CFO 334037 0 65282 0 64205 0 39627 0 14998 0 518149 0 40205 0 KATHRYN DONOFRIO RN SENIOR VP, CNO 185608 0 26220 0 14563 0 22199 0 20660 0 269250 0 3215 0 PATRICIA KING GENERAL COUNSEL 240920 0 0 0 50091 0 24544 0 25897 0 341452 0 28772 0 JONATHAN LIND VP & CHIEF OPERATING OFFIC 222864 0 41423 0 48542 0 27100 0 29061 0 368990 0 20927 0 BRUCE MCNULTY MD CHIEF MEDICAL OFFICER 282019 0 0 0 51955 0 35750 0 27967 0 397691 0 10878 0 KAREN M SHEEHAN SENIOR VP & CIO 209130 0 32071 0 44360 0 26924 0 28774 0 341259 0 20360 0 JANIS A RUEPING VP QUALITY IMPVMT/RISK MGM 168313 0 26620 0 41239 0 14473 0 28229 0 278874 0 17550 0 MICHAEL FEINZIMER PHYSICIAN 270365 0 0 0 0 0 0 0 1650 0 272015 0 0 0 SALIBA KOKALY VP OPERATIONS 167110 0 25157 0 26497 0 22084 0 30563 0 271411 0 2497 0 LORI GUINANE AVP MANAGED CARE 176254 0 31212 0 24000 0 7215 0 28315 0 266996 0 0 0 TONY VANCAUWELAERTMD FORMER DIRECTOR,PHYSICIAN 0 327090 0 25000 0 24000 0 8100 0 7830 0 392020 0 0 MARK NEWTON FORMER PRESIDENT & CEO 0 773383 0 8208 0 185536 0 9806 0 17172 0 994105 0 0 DAVID A DWIGHT FORMER DIRECTOR 0 230697 0 0 0 282244 0 10226 0 15193 0 538360 0 0 Part I, Line 1a As part of their compensation package, vice presidents of the organization are offered a $900 reimbursement for membership dues to the health club of their choice. This benefit is treated as taxable compensation. Part I, Line 3 The Hospital and Covenant Ministries of Benevolence follow the requirements set forth in the IRS rebuttable presumption of reasonableness in determining compensation for the CEO and other officers and executive leaders of the corporation. The process includes review of comparability data, retention of an outside compensation consultant, and contemporaneous substantiation of the deliberation and decision through detailed minutes of the compensation committee and full board meetings where executive compensation is considered. Part I, Line 4b Executive Benefit Plan Covenant Ministries of Benevolence (CMB) provides certain supplemental retirement benefits to its officers and key employees. These benefits are provided through a nonqualified deferred compensation plan, under which a portion of the benefits being earned are subject to a substantial risk of forfeiture. The supplemental retirement benefits are structured to provide a retention incentive that has been determined by the Compensation Committee of CMB's Board to be of substantial value to the organization. The Committee approves all retirement benefits, together with all other forms of compensation and benefits for these and other executives, in a manner intended to qualify for the rebuttable presumption of reasonableness under the intermediate sanctions rules of federal income tax law. The following individuals participated in the Executive Benefit Plan: Lawrence Anderson - $65,285 David Dwight - $22,396 Mark Newton - $88,146 Roger Oxendale - $27,463 Kathryn Donofrio - $20,893 Thomas Garvey - $43,743 Anthony Guaccio - $62,094 Derek Kelley - $4,250 Patricia King - $27,864 Saliba Kokaly - $20,846 Jonathan Lind - $24,836 Janis Rueping - $16,153 Karen Sheehan - $25,913 Bruce McNulty - $41,126 A Illinois Finance Authority 861091967 45204EQN1 2016-12-14 121213487 2016A IFA Revenue Bonds - Cap Adds & Ref of 02/02/10 & 11/03/10 issues. 0 0 0 B Illinois Finance Authority 861091967 2016-12-14 27800000 2016B IFA Revenue Bonds - Ref of 04/08/08 issue. 0 0 0 C Illinois Finance Authority 861091967 2016-12-14 21400000 2016C IFA Revenue Bonds - Ref of 04/08/08 issue. 0 0 0 A 5765000 107725000 1346270 9624561 96754170 573661 1 1 0 1 B 2330000 27800000 157120 27642880 1 0 1 1 C 1795000 21400000 119924 21280076 1 0 1 1 A 0 0 0 0 0.01620 0.01620 0 0 1 B 0 0 0 0 0.00820 0.00820 0 0 1 C 0 0 0 0 0.00830 0.00830 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 Part II Line 3 Column A The Series 2016A bonds were issued with an original issue premium of $13,488,487. This amount is the difference in the issue price and the total proceeds of issue. Brooke Newton Family member of Mark Newton (former CEO of Swedish Covenant Hospital) 49134 Wages paid as an employee of Swedish Covenant Hospital 0 Emily Flatley Family member of Mark Newton (former CEO of Swedish Covenant Hospital) 46419 Wages paid as an employee of Swedish Covenant Hospital. 0 Form 990, Part VI, Section A, line 2 Many of the persons listed on Part VII have a business relationship with each other by virtue of sitting on related Swedish Covenant Hospital entity boards. Kurt D. Anderson, Director, and Lawrence P. Anderson, Director, have a family relationship. Form 990, Part VI, Section A, line 6 The sole member is Covenant Ministries of Benevolence (CMB). Form 990, Part VI, Section A, line 7a The member elects the Board of Directors. Form 990, Part VI, Section A, line 7b S 3.1 of the Bylaws grant reserved powers to the member, such as approval of amendments to the Bylaws of the corporation, approval of certain acquisitions, dispositions and financing, and the power to elect or remove the members of the Board of Directors of the Corporation. Form 990, Part VI, Section B, line 11b The draft Form 990 was reviewed by multiple levels of management and by the CFO of Swedish Covenant Hospital. In addition, Swedish Covenant Hospital's external public accounting firm reviews the return prior to filing. After filing, the Form 990 is provided to the Board of Directors and key provisions are discussed. Form 990, Part VI, Section B, line 12c Swedish Covenant Hospital has an Administrative Policy on conflict of interest, identifying the parameters of a conflict of interest and the requirement to disclose any such conflict of interest. Each September, the policy is distributed to the board members, key employees, directors and officers. They are asked to sign acknowledging receipt of policy and to disclose if they have any conflicts of interest. If someone is absent from the meeting or fails to return the acknowledgement, there is a follow-up with the individual until the signed acknowledgement is provided. If a person becomes an interested person he or she may be considered in determining whether a quorum is present. The interested person may make a short statement relating to the transaction or arrangement in question, but shall not vote on the motion addressing the actual or potential conflict. Form 990, Part VI, Section B, line 15 The Hospital and Covenant Ministries of Benevolence follow the requirements set forth in the IRS rebuttable presumption of reasonableness in determining compensation for the CEO and other officers and executive leaders of the corporation. The process includes review of comparability data, retention of an outside compensation consultant, and contemporaneous substantiation of the deliberation and decision through detailed minutes of the compensation committee and full board meetings where executive compensation is considered. The Governance Committee of Swedish Covenant Hospital has established the executive compensation program to enable the Organization to recruit, motivate and retain highly qualified executives to successfully carry out its Mission Statement and Core Values. The program also serves to align the interests of our executive officers with those of our community by placing a reasonable portion of compensation at risk through performance goals that, if achieved, are expected to increase the aggregate health level of the communities we serve and contribute to the long-term success of the Organization. Additionally, the executive compensation program will enable the Organization to reward performance that emphasizes teamwork and close collaboration among executive officers, supports Organizational excellence by leveraging enterprise-wide capabilities, drives efficiencies and integrates care and services for the benefit of our communities. The program will also assist the Organization in rewarding the achievement of specific annual, long-term and strategic goals, and align executive officers' interests with those of the communities we serve by rewarding performance that meets or exceeds established goals, with the ultimate objective of increasing community health. The overall executive compensation program aligns short- and long-term performance with the goals of the Organization and ensures cost-effective and efficient use of capital resources by offering the appropriate amounts and mix of compensation. Base Salary represents a fixed compensation component set at a level commensurate with the roles and responsibilities of each individual executive position to attract, motivate and retain top executive talent. The Annual Incentive Plan is a variable short-term performance-based compensation component with target award amounts set by the Governance Committee for each eligible executive position. Payouts reflect the degree to which the Organization and the individual executives have performed against predetermined 12-month metrics. Resulting total cash compensation levels may be below or above target amounts based on the Organization's performance against its short-term goals. Goals are sometimes set at a "stretch" level such that target performance may result in above-median levels of compensation. The Annual Incentive plan is intended to align the executive compensation program with the Organization's business strategy, and strengthen the relationship between pay and performance. The Long-Term Incentive Plan is a variable three-year performance-based compensation component with target award amounts set by the Governance Committee for each eligible executive position. Payouts reflect the degree to which the Organization and the individual executives have performed against predetermined 12-, 24- and 36-month metrics. Resulting total cash levels may be below or above target amounts based on the Organization's performance against its long-term goals. Goals are sometimes set at a "stretch" level such that target performance may result in above-median levels of compensation. The Long-Term Incentive Plan is intended to align the executive compensation program with the Organization's business strategy, strengthen the relationship between pay and performance, reinforce the link between the interests of executives and the long-range vision of the Board of Directors and promote the retention of executive talent. Qualified and non-qualified retirement benefit plans are provided by the Organization to help meet the executives' pre- and post-retirement financial needs, serve as a backstop for our performance-based programs and promote the retention of executive talent. The Board of Directors and the Governance Committee are comprised of voluntary citizens of the community who perform their duties without compensation for hours devoted to Board work. The Governance Committee includes an executive from the Covenant Ministries of Benevolence, the controlling member of Swedish Covenant Hospital. A majority of voting members of the Governance Committee are independent, and the Committee is responsible for the development of the philosophy, policy and objectives that guide the Organization's executive pay programs as well as establishing our performance standards and determining the compensation of our senior executives. The Governance Committee retains Pearl Meyer as their independent compensation consultant to assist the Committee in the continued development and evaluation of the Organization's compensation policies and practices and the Committee's determination of compensation. The Governance Committee has the sole authority to retain and terminate the independent compensation consultant and to review and approve the consultant's fees and other retention terms. The Governance Committee has the authority to approve new executive compensation plans and material amendments to existing executive compensation plans. The Governance Committee provides the Board with reports on its actions and decisions following every Governance Committee meeting. Management provides data, analysis and recommendations for the Governance Committee's consideration regarding the Organization's executive compensation programs and policies and assists the Governance Committee in carrying out its responsibilities. Management also provides information to the Governance Committee's independent compensation consultant in connection with the consultant's role in advising the Governance Committee. The CEO typically attends the Committee meetings. The Governance Committee also meets regularly in executive session outside the presence of management. While the Governance Committee considers the recommendations of the CEO and the input received from its independent compensation consultant, most compensation decisions for the Organization's executives are made by management within their prescribed parameters dictated by the Governance Committee. The Governance Committee retains its independent compensation consultant to conduct a comprehensive review of the total compensation provided to the Organization's executives relative to competitive and comparable market practices, ensure that the Organization's compensation programs provide total compensation opportunities that are reasonable for purposes of Intermediate Sanctions (IRC Section 4958), assess the competitiveness of the Organization's compensation programs with respect to healthcare industry peer organizations, assist the Governance Committee with its charter review, review annual disclosures and the compensation of "disqualified individuals" whose compensation is subject to a reasonableness review under IRC Section 4958, provide an opinion letter to the Governance Committee regarding the reasonableness of the compensation of the Organization's executives and other "disqualified persons and help to create a rebuttable presumption of reasonableness with regard to executive compensation. Form 990, Part VI, Section C, line 18 A copy of the organization's Form 990 is available upon request by contacting the Swedish Covenant Hospital administration department at 773/878-8200. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are available upon request, for the same period of disclosure as set forth in IRC Section 6104(d), by contacting the Swedish Covenant Hospital administration department at 773/878-8200. FORM 990,PART VIII,LINES 7A - 7C Publicly traded securities held in an investment pool and allocated by Covenant Ministries of Benevolence on a percentage basis. Form 990, Part XI, line 9: Net assets released from restriction -972,572. Equity transfer to Covenant Ministries of Benevolence -662,000. Net restricted funds transfers from Swedish Covenant Hospital Foundation 1,096,691. Equity transfer to Swedish Covenant Management Services Inc. -19,340,000. Change in Value of Swaps 7,404,895. Loss on extinguishment of debt -164,348. Net assets transferred in from LifeCenter merger 12,155,100. Change in pledge receivable -40,000. Evangelical Covenant Church (ECC) 8303 W Higgins Road Chicago IL 60631 362167730 Church IL 501(c)(3) Line 1 N/A 0 Covenant Ministries of Benevolence (CMB) 5145 N California Avenue Chicago ID 60625 363486813 Management/Support Services IL 501(c)(3) Line 12a, I Evangelical Covenant Church (ECC) 0 Swedish Covenant Hospital Foundation (SCHF) 5145 N California Avenue Chicago IL 60625 205055155 Support of Swedish Covenant Hospital IL 501(c)(3) Line 7 Swedish Covenant Hospital (SCH) 1 SC Insurance Company 6970 E Chauncey Lane Suite 100 Phoenix AZ 85054 273312053 Insurance AZ 501(c)(3) Line 12a, I Swedish Covenant Hospital (SCH) 1 Covenant Village of PortlandLP 420 NE Mason St Portland OR 97211 364356838 Assisted Living Community OR N/A Covenant International Insurance Company Ltd Crawford House 50 Cedar Avenue Hamilton BD Insurance BD N/A C 0 Covenant Trust Company 8303 W Higgins Road 6th Floor Chicago IL 60631 363583163 Financial Services IL N/A C 0 Swedish Covenant Management Services Inc (SCMS) 5145 N California Avenue Chicago IL 60625 364073303 Physician Practice Management IL Swedish Covenant Hospital C 1.00000 1 Swedish Covenant Physician Partners Ltd 5145 N California Avenue Chicago IL 60625 363120220 Managed Healthcare Provider IL N/A C 0 0 0 1 0 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 Swedish Covenant Hospital Foundation M 667432 Cash Value Swedish Covenant Hospital Foundation S 2839423 Cash Value Swedish Covenant Management Services Inc R 24949426 Cash Value SC Insurance Company M 7820646 Cash Value SC Insurance Company L 240000 Cash Value