2019-05-13T22:08:53-05:00 2018-06-30 ERNST & YOUNG US LLP 950 MAIN AVE CLEVELAND OH 44113 990 2017-07-01 362170133 Holy Cross Hospital % Matthew Doyle HOLY 7732572937 2701 West 68th Street Chicago IL 60629 MATTHEW DOYLE INTERIM CFO 7738845153 2019-05-13 true ERICA M FERTEMLES P01608257 2168615000 99.46.67.29 36964520191335000017 2019-05-13 P 34163F381DEDE5EE0CABDD6E8F3BD042227F3C04 6DFBA33F1DAEE8CAFFEB9AC40683ECF49AA6169A 2017 2019-02-21 02:37:17Z LORI PACURA 2701 WEST 68TH STREET CHICAGO IL 60629 126476457 false X www.holycrosshospital.org X 1928 IL SEE SCHEDULE O 27 26 1261 13 0 0 300000 812504 129056337 121763523 1985405 2052934 1213494 1847496 132555236 126476457 0 0 0 0 67330856 66388038 0 0 0 72594160 59046689 139925016 125434727 -7369780 1041730 158158339 160086159 45336756 48707815 112821583 111378344 The Hospital is a Catholic Health Care Organization sponsored by the, Sister of St. Casimir. By our commitment to witness to the healing, mission of Jesus, we contribute to healthy communities and promote quality health care to all with compassion. false false 115686311 123124149 THE HOSPITAL IS A NOT-FOR-PROFIT CATHOLIC HOSPITAL THAT SERVES A LARGE AREA OF CHICAGO'S SOUTHWEST SIDE. LOCATED IN MARQUETTE PARK, THE HOSPITAL PROVIDES EMERGENCY, MEDICAL/SURGICAL, SPECIALTY, DIAGNOSTIC AND PRIMARY CARE SERVICES TO COMMUNITIES THAT ARE HOME TO MOSTLY AFRICAN AMERICAN AND LATINO FAMILIES. THE EMERGENCY DEPARTMENT SEES AN AVERAGE OF 50,000 PATIENTS PER YEAR AND AVERAGES 20,000 AMBULANCE VISITS. THE HOSPITAL IS A DISPROPORTIONATE SHARE HOSPITAL AND IS A VITAL SAFETY NET HOSPITAL. 115686311 true true false true false false false false false false true true false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true X 0 0 true 1261 true false false false false false false false false false false X 27 26 false false false false true true true true true false false true true true true true true true true false IL X Matthew Doyle 7732575964 1500 S CALIFORNIA AVE CHICAGO IL 60608 Abraham Morgan Director 2.0 10.0 X 0 0 0 Albert Grace Director & Vice Chair 2.0 10.0 X X 0 0 0 Alejandra Garza Director 2.0 10.0 X 0 0 0 Alex Dubuclet Director 2.0 10.0 X 0 0 0 Alex Pissios Director 2.0 10.0 X 0 0 0 Anne Donnelly Director 2.0 10.0 X 0 0 0 Bettylu Saltzman Director 2.0 10.0 X 0 0 0 Bob Wolfberg Director 2.0 10.0 X 0 0 0 DANIEL KATZ MD BD MBR/PHYSICIAN UNTIL 4/11/18 2.0 38.0 X 0 445767 0 David Smith DIRECTOR 2.0 10.0 X 0 0 0 David Spielfogel DIRECTOR 2.0 10.0 X 0 0 0 John Benevides DIRECTOR UNTIL 4/11/18 2.0 10.0 X 0 0 0 Jonathan Jonas Director & Treasurer 2.0 10.0 X X 0 0 0 Karen Teitelbaum President & CEO 11.0 29.0 X X 0 896062 13905 Keith Wakefield Director 2.0 10.0 X 0 0 0 Laurie Hernandez Director 2.0 10.0 X 0 0 0 Lee Miller Director 2.0 10.0 X 0 0 0 LESLIE BOND DIRECTOR 2.0 10.0 X 0 0 0 Leslie Davis Director & Secretary 2.0 10.0 X X 0 0 0 Mark Frisch Director 2.0 10.0 X 0 0 0 Michael J Hayes DIRECTOR 2.0 10.0 X 0 0 0 Robert Markin Director & Board Chair 2.0 10.0 X X 0 0 0 Robert Shakno Director 2.0 10.0 X 0 0 0 Roxanne Decyk Director 2.0 10.0 X 0 0 0 Immacula Wendt sr Director 2.0 10.0 X 0 0 0 Tom Nodine Director 2.0 10.0 X 0 0 0 Vincent R Williams DIRECTOR 2.0 10.0 X 0 0 0 Vivian Funches Director 2.0 10.0 X 0 0 0 Wayne Lerner Director 2.0 10.0 X 0 0 0 Charles Weis Jr Exec.VP Adm/CFO Until 12/31/17 11.0 29.0 X 0 564538 23384 Justin D Bynum Interim CFO Until 2/2/18 11.0 29.0 X 0 136633 1852 Loren Chandler CFO & COO 11.0 29.0 X 0 495021 34052 Lori Pacura President, Acute Care Hospital 20.0 20.0 X 0 294990 24944 Bakul Patel Chief Inf Offcr Until 6/29/18 11.0 29.0 X 0 319383 5400 Deborah Davisson Chief Nursing Officer 40.0 0.0 X 206371 0 17289 James Richardson Chief Medical Officer 40.0 0.0 X 349452 0 22402 Jason N Spigner Chief Human Resources Officer 11.0 29.0 X 0 250317 7088 Rachel Dvorken Exec. VP & General Counsel 11.0 29.0 X 0 377393 5400 Dennis Ryan Vice President 40.0 0.0 X 180510 0 14295 Donnica Austin Vice President- Operations 40.0 0.0 X 197771 0 5879 Kelvin Nickles Staff Nurse 40.0 0.0 X 161715 0 7160 Mireya Vera Director - Community Affairs 40.0 0.0 X 157413 0 20498 1253232 3780104 203548 69 false true false SODEXO INC AFFILIATES 9801 WASHINGTONIAN BLVD GAITHERSBURG MD 20878 OPERATIONAL SERVICES 1698116 PROFESSIONAL NURSING 325 N WELLS ST 900 CHICAGO IL 60654 STAFFING SERVICES 1169232 NAVIGANT HEALTHCARE CYMETRIX 150 NORTH RIVERSIDE PLAZA SUITE 21 CHICAGO IL 60606 REVENUE MANAGEMENT 703230 RENOVO SOLUTIONS 4 EXECUTIVE CIRCLE SUITE 185 IRVINE CA 92614 OPERATIONAL SERVICES 595181 CAREMARK 2211 SANDERS ROAD NORTHBROOK IL 60062 Employee Benef. Mgmt 442671 26 0 812504 0 812504 MEDICARE/MEDICAID 662110 56790627 56790627 0 0 PATIENT REVENUE 622110 64854615 64854615 0 0 PARKING 812930 103271 103271 0 0 CAFETERIA 722514 15010 15010 0 0 121763523 2052934 2052934 0 0 486870 486870 0 486870 486870 0 0 0 0 0 0 0 0 0 0 INSURANCE PROCEEDS 900099 837572 837572 0 0 WALGREENS PHARMACY REBATES 900099 193127 193127 0 0 OTHER PHARMACY REBATES 900099 78860 78860 0 0 251067 251067 0 0 1360626 126476457 123124149 0 2539804 0 0 0 0 0 0 0 0 616065 0 616065 0 0 0 55228376 53210910 2017466 0 406885 394678 12207 0 6216094 6021603 194491 0 3920618 3802999 117619 0 19337 19337 0 0 251590 0 251590 0 500 0 500 0 85020 0 85020 0 0 0 0 0 0 0 2693246 2612449 80797 0 0 0 0 0 235504 217245 18259 0 3760981 0 3760981 0 0 0 0 0 1546688 1546688 0 0 29363 27797 1566 0 0 0 0 0 8182 7842 340 0 461568 461568 0 0 0 0 0 0 7822016 7822016 0 0 677724 557739 119985 0 INTERCO PHYS & DEV SVC 16431846 16431846 0 0 MEDICAL SUPPLIES 8650391 8650391 0 0 PROVIDER ASSESSMENT 7691072 7691072 0 0 BAD DEBT 869714 869714 0 0 7811947 5340417 2471530 125434727 115686311 9748416 0 0 795481 7245 12959736 13934242 50157 323121 22565276 37651716 0 0 0 0 0 0 2059078 1898317 2154228 5903368 131229198 43056674 93730752 88172524 0 0 11593239 11289505 0 0 0 0 12250392 906121 158158339 160086159 33022085 29018947 0 0 8277 0 0 0 0 0 0 0 0 0 0 0 12306394 19688868 45336756 48707815 X 112757580 111378344 64003 0 0 0 112821583 111378344 158158339 160086159 1041730 596395 0 0 -3081364 X false true X true false X false true false 0 false 0 false 0 false 0 true 85020 false 0 false 0 85020 false SCHEDULE C, PART II-B, LINES 1B & 1G DESCRIPTION OF THE LOBBYING ACTIVITIES Sinai Health System engages in education and other activities to influence legislators regarding federal and state policies primarily related to Medicaid, Sinais major payer and the safety net of many of its patients. The System lobbying activities are coordinated through Roberta Rakove, Senior Vice President for Sinai Health System. Lobbying is conducted on behalf of the entire Sinai System, therefore registered state lobbyists are registered to represent all entities within the Sinai health System. All lobbying expenses incurred are paid by Sinai Health System. At the federal level, Sinai Health System does not utilize contract lobbyists. Sinai does use an outside firm to assist at the federal level with the development of grant proposals but the firm does not operate as a lobbying entity with Sinai. Sinai Health System collaborates with the American Hospital Association, the Illinois Hospital Association, the Premier Hospital Alliance, Americas Essential Hospitals, and the Jewish Federation of Metropolitan Chicago/Jewish United Fund. At the state level, Sinai utilizes three outside lobbying firms. 1700000 1700000 88733958 19131025 69602933 707906 212767 495139 33663156 23712882 9950274 6424178 6424178 88172524 NORTHERN TRUST AGREEMENT 11224999 F CD - LAKESIDE BANK 64506 F 11289505 0 PROFESSIONAL LIABILITY 13325702 DUE FROM AFFILIATES 6213166 STEWARD FEES 150000 19688868 X FORM 990, SCHEDULE D, PART X, LINE 2 FIN 48 (ASC 740) Footnote INCOME TAXES: MOUNT SINAI HOSPITAL MEDICAL CENTER, SCHWAB REHABILITATION HOSPITAL AND CARE NETWORK, MOUNT SINAI COMMUNITY FOUNDATION, HOLY CROSS HOSPITAL, SMG AND SINAI COMMUNITY INSTITUTE, INC. ARE TAX-EXEMPT ORGANIZATIONS UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND EACH, AS REQUIRED, FILES A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. PROGRESS HEALTH INC. FILES FEDERAL AND ILLINOIS FORMS 1120 (U.S. CORPORATION INCOME TAX RETURN) ANNUALLY. The Corporation adopted Financial Accounting Standards Board (FASB) issued guidance for uncertainty in income taxes. This guidance prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. Examples of tax positions common to health systems include such matters as the following: the tax-exempt status of each entity, the nature, characterization and taxability of joint venture income and various positions relative to potential sources of unrelated business taxable income (UBIT). UBIT is reported on Form 990T, 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 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 percent likely to be realized on settlement with the applicable taxing authority. The portion of the benefits associated with tax positions taken that exceeds the amount measured as described above is reflected as a liability for unrecognized tax benefits in the consolidated balance sheet along with any associated interest and penalties that would be payable to the taxing authorities upon examination. As of June 30, 2018, there were no unrecognized tax benefits identified and recorded. Forms 990 and 1120 filed by the Corporation are subject to examination by the Internal Revenue Service (IRS) for up to three years from the extended due date of each return. Forms 990 and 1120 filed by the Corporation are no longer subject to examination for the years ended June 30, 2014 and prior. true true X true X 300. true X 600. true true false true true 9971077 0 9971077 0.08000 66078707 63487195 2591512 0.02080 76049784 63487195 12562589 0.10080 33332 33332 0.00030 170857 170857 0.00140 19421 19421 0.00020 223610 223610 0.00190 76273394 63487195 12786199 0.10270 true 869714 169594 30371022 30820411 -449389 X true true 1 1 Holy Cross Hospital 2701 West 68th Street Chicago IL 60629 www.sinai.org 0000992 X X Holy Cross Hospital 1 false false true X X X X X X X X X 15 true false false true X SEE PART V, SECTION C X true 16 false true false true X 300. 600. X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X true X false X X X X true X false false Part I, Line 6a Holy Cross Hospital took into account input from persons who represent the community. In 2015, as part of the fy16 chna (june 2016 chna), Holy Cross Hospital facilitated focus groups with community members to better understand the needs and assets of the community that makes up its primary service area. Focus group participants were selected to represent medically underserved, low income, marginalized and minority populations. The purpose of the focus groups were to gain insight on the most pressing health conditions affecting each community, the barriers to overcoming those conditions, and how a community hospital such as Holy Cross Hospital might help improve the community's health. These groups were held in both English and Spanish, as appropriate. Many people contributed to the CHNA Report, including the staff of the Sinai Urban Health Institute. These are all people trained in public health (most are graduates of schools of public health with MPH or PHD degrees). We thus believe that the public health credentials of the authors of this report are substantial and notable. SCHEDULE H, PART V, SECTION B, LINE 7A - CHNA WEBSITE HTTP://WWW.SINAI.ORG/CONTENTS/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS-CHNA SCHEDULE H, PART V, SECTION B, LINE 11 Holy Cross Hospital is now using the implementation plan that was created as part of the June 2016 CHNA. The CHNA identified significant health needs and barriers to care faced by the communities served by Holy Cross Hospital. Holy Cross Hospital leaders developed an implementation plan and rollout strategy that aligns with the Hospitals strategic plan and will be implemented over the course of three years. Holy Cross Hospital is addressing all of the significant needs identified in the june 2016 chna which include: - Diabetes - Cardiovascular health - Asthma - Cancer - Access to mental health services - Gun violence Holy Cross Hospital has implemented projects such as providing community education around asthma, breast health, diabetes, maternal and child health, and violence prevention. In the Hospital, we have conducted HIV screening programs, worked on a quality improvement project to address COPD readmissions and assisted patients with social service needs. It is our goal to provide the best care possible to address the needs of our community. The CHNA and its implementation plan have assisted in guiding our work on how to address the needs of our community. Holy Cross Hospital remains fully engaged in implementing the strategies and expects to substantially complete the identified plans by the time of the next CHNA. SCHEDULE H, PART V, SECTION B, LINE 16A & 16B - FAP DOCUMENTS WEBSITE HTTP://WWW.SINAI.ORG/CONTENT/FINANCIAL-ASSISTANCE-0 SCHEDULE H, PART V, SECTION B, LINES 16C & 16I - FAP DOCUMENTS Holy Cross Hospital included a one-page policy summary with its FAP Application Form. However, Holy Cross Hospital realized this summary does not meet all of the plain language summary (PLS) requirements. Holy Cross Hospital is in the process of revising the document so it will meet all of the PLS requirements. During FY18 Holy Cross Hospital POSTED on its website (www.SINAI.org) the FAP (in English) and FAP application form (in English and Spanish). Holy Cross Hospital recently finalized the Spanish version of the FAP and it is now posted on Holy Cross' website. Holy Cross Hospital will also post the translated PLS when available. Per Holy Cross Hospital's june 2016 CHNA, Spanish is the predominant language spoken among the Limited English Proficiency (LEP) population served by Holy Cross. Part I, Line 6a Related Organization Community Benefit Report The Community Benefit Report is prepared by parent corporation Sinai Health System (36-3166895). Part I, Line 7a and 7b Net Community Benefit Expense for Financial Assistance and Medicaid Holy Cross Hospital provided approximately $10 million in financial assistance to the patients it served this year, in addition to a Medicaid shortfall of $2.6 million. The Hospital received Provider Tax Revenues and other ACA payments to offset the costs to provide care for the Hospitals disproportionally high Medicaid and financial indigent populations. On an aggregated basis, Sinai Health System provided over $40 million in financial assistance, in addition to a Medicaid shortfall of $33 million. Part I, Line 7, Column F Explanation of Bad Debt Expense Bad debt expense was included on Form 990, Part IX, line 25, column A, but was subtracted from the total expenses for the purpose of calculating the percentage in this column. Bad debt expense is $869,714. PART III, LINE 2 METHODOLOGY USED TO ESTIMATE BAD DEBT EXPENSE Holy Cross Hospital estimates bad debt expense based upon managements assessment of historical and expected net collections considering historical business and economic conditions, trends in health coverage and other collection indicators. Management assesses the allowance for uncollectible accounts based upon historical write-off experience. Part III, Line 3 Methodology Of Estimated Amount & Rationale For Including Community Benefit Holy Cross Hospital first determines if a patient qualifies for charity care. If a patient is classified as charity care, they would not be included as bad debt. Some patients do not desire to complete the charity care applications and as such can be included in the bad debt amounts. One example of a patient population that does not complete charity care applications is undocumented workers. Part III, Line 4 Bad Debt Expense The Corporation maintains allowances for uncollectible accounts for estimated losses resulting from a payors inability to make payments on accounts. The Corporation estimates the allowance for uncollectible accounts based upon managements assessment of historical and expected net collections considering historical business and economic conditions, trends in health care coverage, and other collection indicators. The Corporation recognizes a significant amount of patient service revenue at the time services are rendered even though the Corporation does not assess the patients ability to pay at that time. As a result, the provision for bad debts is presented as a deduction from patient service revenue (net of contractual provisions and discounts). For uninsured patients that do not qualify for charity care, the Corporation establishes an allowance to reduce the carrying value of such receivable to their accounts based upon historical write-off experience. After satisfaction of amounts due from insurance, the Corporation follows established guidelines for placing certain past-due balances with collection agencies, subject to the term of certain restrictions on collection efforts as determined by the Corporation. The Corporation generally does not charge interest on past due accounts. A significant portion of the Corporations provision for doubtful accounts relates to self-pay patients, as well as co-payments and deductibles owed to the Corporation by patients with insurance. Part III, Line 8 Explanation of Shortfall as Community Benefit Holy Cross Hospital had a Medicare shortfall of $449,389 this year, which was not treated as community benefit per Catholic health association usa guidelines, and was excluded on the Community Benefits Report submitted to the Illinois Attorney Generals office. Holy Cross Hospital utilized the cost to charge ratio calculated using IRS Form 990, Schedule H, Worksheet 2 (Ratio of Patient Care Cost to Charges) to estimate cost to provide care to Medicare patients. Such cost is offset by Medicare receipts to determine shortfall. Part III, Line 9b Provisions on Collection practices for Qualified Patients Holy Cross Hospitals collection process includes both letter and calls to inform patients of their outstanding balances and to explain available payment options. If the patient is uninsured, a discount is applied to the patients account in accordance with Illinois Patient Uninsured Act. In addition, resources are made available to patients throughout the collections process. These resources include a charity program targeted to low income individuals residing in Sinai Health System core service area, and non-interest bearing payment plans that start as low as $25 a month. The debt collection practices only apply to charity patients to the extent of the copayments or patient portion balances and not to amounts that have been approved as charity or financial assistance. PART VI, LINE 2 Needs Assessment Holy Cross Hospital uses various methods to assess the health care needs of the community it serves. Important information is gathered from the census updates, Illinois Department of Healthcare and Family Services, the Department of Public Health, Cook County Department of Public Health, City of Chicago Department of Public Health, University of Chicago Urban health Initiatives, churches, community organizations and advocacy groups. Because of the Hospitals close relationship with leaders of the new communities program, the Hospital was instrumental in establishing The Healthy Chicago Lawn Advocacy Coalition. Holy Cross Hospital has served as the host site and primary health resource for the majority of Healthy Chicago Lawn Coalitions planning, education and advocacy initiatives. Healthy Chicago Lawn has prompted the development of many relational, educational and promotional health awareness activities in the Chicago lawn community. As a result of the partnership with community organizations, Holy Cross Hospital has become more accessible to community groups and residents. There has been as increased awareness of the services provided by the Hospital which has resulted in positive health outcomes in the communities served by Holy Cross Hospital. The Hospital also assesses the needs of the community through the Parish Nurse program. Community outreach nurses attend church meetings where information is received about the sick parishioners at home and in nursing homes. There are three large catholic churches in the community that have a formal Holy Cross Hospital Parish Nurse Program. The Hospital has designated a nurse to service these churches. The nurse conducts blood pressure screenings and health assessments for 100 regular parishioners. New parishioners, who are uninsured, are assisted with referrals. Also, home visit arrangements are made for at risk seniors. The Hospital also has a volunteer team at churches to assist with health fairs and health education events, such as the Merck Pharmaceuticals sponsored diabetes education program for the Latino community. Another source for assessing the health care needs of the community is through membership in 10 community organizations, each of which is deeply invested in addressing one or more social determinants of health, such as housing, violence and youth services. Community groups have reques3eted the Hospital for health care professionals to join their boards and assist with the direction of their advocacy and policies. Unpaid Hospital staff have become board members of these organizations, which has helped the Hospital identify the needs of the community and in turn communicate to the leadership of these organizations that the resources the Hospital has to serve them. Part VI, Line 3 Patient Education Of Eligibility For Assistance Holy Cross Hospital informs patients of the charity care policy through signage in the Hospital, written communication, statements and related corporation Sinai Health System website. Each hospital bill, invoice, or other summary of charges to an uninsured patient shall include with it, or on it, a prominent statement that an uninsured patient who meets certain income requirements may qualify for an uninsured discount along with information regarding how the patient may apply for financial assistance. Part VI, Line 4 Community Information Holy Cross Hospital, as a part of Sinai Health System, serves a population base of over one million people located on the west side of Chicago. Approximately 48.2 % of Holy Cross Hospitals patients are Medicaid recipients and 5.3% are uninsured. Holy Cross Hospital treats a high number of Medicaid patients. Holy Cross has admitted over 4,500 Medicaid patients per year. Holy Cross has provided care through 288 births. Holy Cross Hospital Emergency Department had 47,966 patient visits. Holy Cross Hospitals medical interpreter services supports over 150 different languages including American sign language, making Sinai Health System a best practice medical program in the nation for deaf and hard to hearing patients and the limited English proficient patients. PART VI, LINE 5 Promotion of Community health Holy Cross Hospital, as a part of Sinai Health System, has a board comprised of respected leaders in banking, finance, manufacturing, legal, health care and other industries. Holy Cross Hospital extends medical staff privileges to all qualified physicians for many departments. Holy Cross Hospital invests any surplus funds into improving patient care. Holy Cross also participates in the following community benefit programs: Parish Nurse Program Community outreach nurses attend church meetings where information is received about the sick parishioners at home and in nursing homes. There are three large catholic churches in the community that have a formal Holy Cross Hospital Parish Nurse Program. The Hospital has designated a nurse to service these churches. The nurse conducts blood pressure screenings and health assessments for 100 regular parishioners. New parishioners, who are uninsured, are assisted with referrals. Also, home visit arrangements are made for at risk seniors. Vaccine for Children Program with CDPH The Hospital works closely with grade school and high school nurses in the community. The purpose of this program is to assist children who are in need of recommended immunizations to remain in school. Vaccines are administered during school hours. Most of these children are on Medicaid or have no insurance. The vaccines are obtained from CDPH and the parents are not charged for administering the vaccines. The Hospital also documents in the State I Care Registry all immunizations given and assists the school nurses with medical immunizations by verifying the students immunizations found in the state system. Community health Fairs The Hospitals representatives attend community group events and fairs. The Hospital provides free health screenings and health education materials at these events. On average, there are approximately 40 events per year. Influenza Program The Hospital administers flu immunizations during the year. These flu shots were administered at senior group meetings, churches and health fairs for community groups. We formed a joint influenza program with Walgreens who provided free influenza vaccines to people with no insurance and ten area churches. Hospital Referrals for At Risk Seniors Under this program, in certain situations, the Hospitals health care professional will make a home visit to assess an at risk seniors living situation after discharge from the Hospital. Participation in Community Health Speakers Bureau The Hospitals health care professionals participate in promoting healthy lifestyles by volunteering to be speakers whenever community and civic groups as for assistance in having a speaker for their events. Part VI, Line 6 Affiliated Health Care System Roles and Promotion Located on Chicagos West and Southwest Side, Sinai Health System is comprised of Mount Sinai Hospital, Holy Cross Hospital, Schwab Rehabilitation Hospital, Sinai Childrens Hospital, Sinai Community Institute, Sinai Medical Group, and Sinai Urban Health Institute. The entities of Sinai Health System collectively deliver a full range of quality inpatient and outpatient services, as well as a large number of innovative, community-based health, research and social service programs. We focus our collective depth of expertise and passion to improve the health of the 1.5 million people who live in our diverse service area. With our team of dedicated caregivers, Sinai Health System is committed to building stronger, healthier communities. For more information on Sinai Health System, visit HTTP://WWW.SINAI.ORG/. Part VI, Line 7 States Where Community Benefit Report Filed Illinois false true false false false false false false false Bakul Patel Chief Inf Offcr Until 6/29/18 0 300470 0 16270 0 2643 0 5400 0 0 0 324783 0 0 Charles Weis Jr Exec.VP Adm/CFO Until 12/31/17 0 468379 0 33204 0 62955 0 0 0 23384 0 587922 0 0 DANIEL KATZ MD BD MBR/PHYSICIAN UNTIL 4/11/18 0 445330 0 0 0 437 0 0 0 0 0 445767 0 26403 Deborah Davisson Chief Nursing Officer 188603 0 15037 0 2731 0 0 0 17289 0 223660 0 0 0 Dennis Ryan Vice President 167331 0 10692 0 2487 0 3260 0 11035 0 194805 0 0 0 Donnica Austin Vice President- Operations 186987 0 10190 0 594 0 3832 0 2047 0 203650 0 0 0 James Richardson Chief Medical Officer 344452 0 5000 0 0 0 0 0 22402 0 371854 0 0 0 Jason N Spigner Chief Human Resources Officer 0 237835 0 0 0 12482 0 0 0 7088 0 257405 0 0 Karen Teitelbaum President & CEO 0 755327 0 58680 0 82055 0 5400 0 8505 0 909967 0 0 Kelvin Nickles Staff Nurse 156333 0 5000 0 382 0 905 0 6255 0 168875 0 0 0 Loren Chandler CFO & COO 0 440517 0 39540 0 14964 0 5400 0 28652 0 529073 0 0 Lori Pacura President, Acute Care Hospital 0 275127 0 16410 0 3453 0 5400 0 19544 0 319934 0 0 Mireya Vera Director - Community Affairs 151497 0 3480 0 2436 0 1575 0 18923 0 177911 0 0 0 Rachel Dvorken Exec. VP & General Counsel 0 303600 0 26484 0 47309 0 5400 0 0 0 382793 0 0 FORM 990, SCHEDULE J, PART I, LINE 3 METHODS USED BY RELATED ORG TO ESTABLISH CEO COMPENSATION SINAI HEALTH SYSTEM (SHS) HAS A HUMAN RESOURCES COMMITTEE TO SUPPORT THE ORGANIZATIONAL PERFORMANCE OF SINAI HEALTH SYSTEM AND ITS RELATED ENTITIES THROUGH THE ALIGNMENT OF EXECUTIVE COMPENSATION WITH SYSTEM STRATEGIES AND PROGRAMS AND ENSURE COMPLIANCE WITH APPLICABLE LAW. THE VOTING MEMBERS OF THE COMMITTEE ARE INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE ESTABLISHES DETAILED GOALS ANNUALLY OR MORE FREQUENTLY AS CIRCUMSTANCES REQUIRE. THE COMMITTEE ESTABLISHES DETAILED GOALS ANNUALLY FOR THE PRESIDENT AND CEO AND OTHER EXECUTIVES, AND REVIEWS PERFORMANCE AGAINST THESE GOALS ON AN ANNUAL BASIS. THE COMMITTEE ANNUALLY ENGAGES AN OUTSIDE INDEPENDENT COMPENSATION CONSULTANT TO BENCHMARK THE SALARIES AND BENEFITS OF THE ORGANIZATION'S ASSISTANT VICE PRESIDENT AND ABOVE. COMPENSATION IS BASED ON: A) DETAILED WRITTEN PERFORMANCE OF THE PRESIDENT AND CEO; B) EACH ELEMENT OF COMPENSATION, DATA OF THE COMPENSATION PROGRAM IN EFFECT FOR CEOS OF COMPARABLE ORGANIZATIONS; AND C) ANNUAL REVIEW OF CEO PERFORMANCE IS CONDUCTED AGAINST SHS ESTABLISHED GOALS. THE COMMITTEE MAINTAINS WRITTEN MINUTES WHICH ARE MAINTAINED IN EXECUTIVE ADMINISTRATION. FORM 990, SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN MOUNT SINAI HOSPITAL'S (MSH) SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WAS ESTABLISHED AS A NON-QUALIFIED RETIREMENT PLAN FOR ITS KEY EMPLOYEES; SPECIFICALLY THE CHIEF EXECUTIVE STAFF. THIS PLAN PROVIDES ADDED BENEFITS THAT MAY BE ABOVE AND BEYOND THOSE THRESHOLDS COVERED IN OTHER TRADITIONAL RETIREMENT PLANS. SERP IS ENTIRELY FUNDED BY THE EMPLOYER. THE MSH COMPENSATION COMMITTEE REVIEWS AND APPROVES ACCEPTANCE AND/OR MODIFICATIONS TO THE SERP PLAN. THE MSH'S SERP PLAN OUTLINES THE ANNUAL EARNINGS PER THE INDIVIDUAL PARTICIPANTS AS WELL AS THE TIME FRAMES OF VESTMENT PER THOSE RESPECTIVE INDIVIDUALS. THE PLAN VESTS UPON TWO YEARS OF SERVICE OR ATTAINMENT OF AGE 65. CY2017 INCREASE IN VALUE OF THE BENEFIT PAYMENTS NOT VESTED CHANDLER, LOREN F. $6,801 $1,051 DVORKEN, RACHEL $41,025 $1,628 WEIS JR, CHARLES $51,670 $2,058 TEITELBAUM, KAREN C. $54,406 $2,294 FORM 990, SCHEDULE J, PART I LINE 7 NON-FIXED PAYMENTS SINAI HEALTH SYSTEM HAS A HUMAN RESOURCES COMMITTEE TO SUPPORT THE ORGANIZATIONAL PERFORMANCE OF SINAI HEALTH SYSTEMS AND ITS RELATED ENTITIES THROUGH THE ALIGNMENT OF EXECUTIVE COMPENSATION WITH SYSTEM STRATEGIES AND PROGRAMS AND ENSURE COMPLIANCE WITH APPLICABLE LAW. THE VOTING MEMBERS OF THE COMMITTEE ARE INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE ESTABLISHES DETAILED GOALS ANNUALLY OR MORE FREQUENTLY AS CIRCUMSTANCES REQUIRE. THE COMMITTEE ESTABLISHES DETAILED GOALS ANNUALLY FOR THE PRESIDENT AND CEO AND OTHER EXECUTIVES, AND REVIEWS PERFORMANCE AGAINST THESE GOALS ON AN ANNUAL BASIS. THE COMMITTEE ANNUALLY ENGAGES AN OUTSIDE INDEPENDENT COMPENSATION CONSULTANT TO BENCHMARK THE SALARIES AND BENEFITS OF THE ORGANIZATION'S ASSISTANT VICE PRESIDENT AND ABOVE. COMPENSATION IS BASED ON DETAILED WRITTEN PERFORMANCE OF THE PRESIDENT AND CEO, EACH ELEMENT OF COMPENSATION, DATA OF COMPENSATION PROGRAM IN EFFECT FOR CEOS OF COMPARABLE ORGANIZATIONS, AND CONDUCTS AN ANNUAL REVIEW OF CEO PERFORMANCE AGAINST ESTABLISHED GOALS. THE COMMITTEE MAINTAINS WRITTEN MINUTES WHICH ARE MAINTAINED IN EXECUTIVE ADMINISTRATION. FORM 990, PART I, LINE 1 MISSION STATEMENT AS A MEMBER OF SINAI HEALTH SYSTEM, HOLY CROSS HOSPITAL'S MISSION IS TO IMPROVE THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES IT SERVES BY PROVIDING EMERGENCY, MEDICAL, SURGICAL, AND PRIMARY CARE SERVICES. THE VISION IS TO BE A NATIONAL MODEL FOR THE DELIVERY OF URBAN HEALTHCARE. FORM 990, PART V, LINE 1A FORM 1096 TRANSMITTAL OF U.S. INFORMATION RETURNS HOLY CROSS HOSPITAL REPORTS ZERO ON FORM 990, PART V, QUESTION 1A AS IT IS NOT REQUIRED TO FILE FORM 1096, TRANSMITTAL OF U.S. INFORMATION RETURNS. ALL OF THE CORPORATION'S ACCOUNTS PAYABLE REPORTABLE ON FORM 1096 ARE PAID BY SINAI HEALTH SYSTEM, WHICH ISSUES ALL FORMS 1099, AND THE EXPENSE IS TRANSFERRED TO HOLY CROSS HOSPITAL. FORM 990, PART VI, LINE 1A BOARD DELEGATING POWERS TO EXECUTIVE COMMITTEE THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE BOARD CHAIR, VICE CHAIR(S), SECRETARY, TREASURER AND PRESIDENT. THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT REGULAR BUSINESS OF THE CORPORATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OR LAW. WHEN ACTION IS TAKEN BY THE EXECUTIVE COMMITTEE, IT WILL BE REPORTED TO THE BOARD AT THE NEXT MEETING OF THE BOARD. Form 990, Part VI, Line 6 DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS Sinai Health System (EIN 36-3166895) is the sole corporate member of Holy Cross Hospital. Form 990, Part VI, Line 7a DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS DIRECTORS ARE ELECTED BY THE SOLE CORPORATE MEMBER, SINAI HEALTH SYSTEM, FOR A TERM OF 3 YEARS FROM AMONG THOSE PERSONS NOMINATED BY THE SINAI HEALTH SYSTEM BOARD RECRUITMENT, EDUCATION AND NOMINATING COMMITTEE. FORM 990, PART VI, LINE 7B DESCRIBE CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING THE SOLE CORPORATE MEMBER HAS CERTAIN RESERVED POWERS OVER SIGNIFICANT CORPORATE ACTIONS, INCLUDING MATTERS SUCH AS APPOINTMENT OF CORPORATE OFFICERS, AMENDMENT OF GOVERNING DOCUMENTS, APPROVAL OF A MERGER, CONSOLIDATION OR DISSOLUTION, APPROVAL OF BUDGETS AND STRATEGIC PLANS, APPROVAL OF INDEPENDENT CERTIFIED PUBLIC ACCOUNTANTS FOR THE ORGANIZATION, AND APPROVAL OF NON-BUDGETED LONG-TERM DEBT. Form 990, Part VI, Line 11b DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVENING BODY TO REVIEW 990 The Form 990 information was initially provided by the finance staff with multi-disciplinary input from Public Affairs, Corporate Compliance and other appropriate staff of the organization. The Form 990 was then prepared by Ernst & Young, LLP and reviewed by senior finance staff and other members of senior leadership. Prior to the filing, the Form 990 was made available to the full board of directors. Form 990, Part VI, Line 12c DESCRIBE THE PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST THE CONFLICT OF INTEREST DISCLOSURE FORM IS COMPLETED AND SIGNED ANNUALLY BY ALL BOARD MEMBERS AND OTHER EMPLOYEES WHO ARE IN A POSITION TO INFLUENCE PURCHASING DECISIONS, AFFILIATIONS OR REFERRALS, HIRING DECISIONS OR CONTRACTS. CONFLICTS DISCLOSED ON THE CONFLICT OF INTEREST DISCLOSURE FORM ARE TAKEN INTO CONSIDERATION WHEN MAKING BOARD COMMITTEE ASSIGNMENTS. IN ADDITION, INDIVIDUALS WHO HAVE A CONFLICT OF INTEREST MUST ABSTAIN FROM PARTICIPATING IN DECISIONS AFFECTING THE INTERESTED PARTIES AND MAKE IT CLEAR WHY THEY ARE ABSTAINING. IF THE POTENTIAL FOR CONFLICT OF INTEREST EXISTS, EMPLOYEES AND PHYSICIANS ARE REQUIRED TO DISCUSS THE SITUATION WITH MANAGEMENT. BOARD MEMBERS OF THE SINAI HEALTH SYSTEM OR ANY OF ITS ENTITIES ARE REQUIRED TO REPORT POTENTIAL CONFLICTS TO THE CHIEF COMPLIANCE OFFICER WHO WILL REVIEW POTENTIAL CONFLICTS WITH THE SINAI HEALTH SYSTEM CHIEF EXECUTIVE OFFICER AND CHAIRMAN OF THE BOARD OF DIRECTORS. FORM 990, PART VI, LINE 15A & 15B COMPENSATION REVIEW & APPROVAL PROCESS - OFFICERS & KEY EMPLOYEES Sinai Health System has a Human Resources Committee that approves all executive compensation arrangements, including incentive compensation. Sinai Health System's Human Resources Committee supports the organizational performance of Sinai Health System and its related entities through the alignment of executive compensation with system strategies and programs, and ensures compliance with applicable law. The voting members of the Committee are independent members of the board of directors. The Committee meets twice annually or more frequently as circumstances require. The Committee establishes detailed goals annually for the President and CEO and other executives, and reviews performance against these goals on an annual basis. The Committee annually engages an outside, independent compensation consultant to benchmark the salaries and benefits of the organizations assistant vice presidents and above, as well as a few directors. Compensation is based on detailed written performance appraisals and external market data. In an executive session, the Committee reviews the performance of the President and CEO, each element of compensation, data of compensation programs in effect for CEOs of comparable organizations, and conducts an annual review of CEO performance against established goals. The Committee maintains written minutes which are maintained in executive administration. Form 990, Part VI, Line 19 THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC Governing documents, conflict of interest and financial statements are made available upon request and after review by management. 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