2018-05-15T14:54:04-05:00 2017-06-30 ERNST & YOUNG US LLP 950 MAIN AVENUE STE 1800 CLEVELAND OH 44113 990 2016-07-01 362170133 Holy Cross Hospital % Loren Chandler CFO HOLY 7738845153 2701 West 68th Street Chicago IL 60629 LOREN CHANDLER CFO 7738845153 2018-05-15 true ERICA M YIKE P01608257 2168615000 2016 2022-09-23 18:48:47Z LORI PACURA 2701 WEST 68TH STREET CHICAGO IL 60629 132555236 false X www.holycrosshospital.org X 1928 IL SEE SCHEDULE O. 26 25 1261 7 0 0 237520 300000 118854856 129056337 1075212 1985405 2365395 1213494 122532983 132555236 0 0 0 0 72242909 67330856 0 0 0 56865091 72594160 129108000 139925016 -6575017 -7369780 157417259 158158339 38386648 45336756 119030611 112821583 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 127555124 129839394 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 HAs MORE AMBULANCE DAILY VISITS THAN ANY OTHER ILLINOIS HOSPITAL. THE HOSPITAL IS A DISPROPORTIONATE SHARE HOSPITAL AND IS A VITAL SAFETY NET HOSPITAL. 127555124 true true false true false false false false false false true true false true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 0 0 true 1261 true false false false false false false false false false false X 26 25 false false false false true true true true true false false true true true true true true true true false IL X Loren Chandler CFO 7732575658 1500 S CALIFORNIA AVE CHICAGO IL 60608 X Robert Markin Director & Board Chair 2.0 10.0 X X 0 0 0 Albert Grace Director & Vice Chair 2.0 10.0 X X 0 0 0 Leslie Davis Director & Secretary 2.0 10.0 X X 0 0 0 Jonathan Jonas Director & Treasurer 2.0 10.0 X X 0 0 0 Daniel Ash Director 2.0 10.0 X 0 0 0 John Benevides Director 2.0 10.0 X 0 0 0 Anne Donnelly Director 2.0 10.0 X 0 0 0 Alex Dubuclet Director 2.0 10.0 X 0 0 0 Mark Frisch Director 2.0 10.0 X 0 0 0 Laurie Hernandez Director 2.0 10.0 X 0 0 0 Daniel Katz MD Director 2.0 38.0 X 0 605550 25981 Abraham Morgan Director 2.0 10.0 X 0 0 0 Tom Nodine Director 2.0 10.0 X 0 0 0 Gary Niederpruem Director 2.0 10.0 X 0 0 0 Alex Pissios Director 2.0 10.0 X 0 0 0 Bettylu Saltzman Director 2.0 10.0 X 0 0 0 Robert Shakno Director 2.0 10.0 X 0 0 0 Keith Wakefield Director 2.0 10.0 X 0 0 0 Bob Wolfberg Director 2.0 10.0 X 0 0 0 Roxanne Decyk Director 2.0 10.0 X 0 0 0 Vivian Funches Director 2.0 10.0 X 0 0 0 Alejandra Garza Director 2.0 10.0 X 0 0 0 Wayne Lerner Director 2.0 10.0 X 0 0 0 Josh Metnick Director 2.0 10.0 X 0 0 0 Lee Miller Director 2.0 10.0 X 0 0 0 Sr Immacula Wendt Director 2.0 10.0 X 0 0 0 Lori Pacura President 38.0 20.0 X 0 274015 15396 Karen Teitelbaum CEO 6.0 36.0 X 0 747897 7954 Charles Weis Jr CFO 6.0 37.0 X 0 518321 13667 Deborah Davisson CNO/VP -Patient Care Services 40.0 0.0 X 196929 0 0 Dennis Ryan VP-Mission Effect &Ext Affairs 40.0 0.0 X 168671 0 7594 Donnica Austin Vice President- Operations 20.0 20.0 X 191430 0 874 Kelvin Nickles Registered Nurse 40.0 0.0 X 191379 0 6107 James Richardson Chief Medical Officer 40.0 0.0 X 158140 0 8718 906549 2145783 86291 56 false true false SODEXO INC AFFILIATES 9801 WASHINGTONIAN BLVD GAITHERSBURG MD 20878 OPERATIONAL SERVICES 1973877 NAVIGANT HEALTHCARE CYMETRIX 150 NORTH RIVERSIDE PLAZA CHICAGO IL 60606 REVENUE MANAGEMENT 1336013 sodexo ctm inc 9801 washingtonian blvd GAITHERSBURG MD 20878 operation services 1153711 Professional nursing inc 325 n wells 9th floor CHICAGO IL 60654 staffing services 1126120 superior health linens llc 490 mills road JOLIET IL 60433 laundry services 748630 14 0 300000 0 300000 MEDICARE/MEDICAID 622110 73211497 73211497 0 0 PATIENT REVENUE 622110 55733548 55733548 0 0 PARKING 812930 100677 100677 0 0 CAFETERIA 722514 10615 10615 0 0 129056337 1985405 1985405 0 0 430437 430437 0 430437 430437 0 0 0 0 0 0 0 0 0 0 E H R STIMULUS REVENUE 900099 464067 464067 0 0 WALGREEN PHARMACY REBATE 900099 137705 137705 0 0 CATALYST SCHOOLS STEAM 900099 65000 65000 0 0 116285 116285 0 0 783057 132555236 129839394 0 2415842 X 0 0 0 0 0 0 0 0 428977 428977 0 0 0 57488207 55312592 2175615 0 489000 474330 14670 0 4951506 4802961 148545 0 3973166 3853971 119195 0 49459 49459 0 132150 132150 0 0 0 0 0 85020 0 85020 0 0 0 0 0 0 0 8080104 3028246 5051858 0 0 0 0 674356 652576 21780 0 3940269 3940269 0 0 0 0 1689706 1689706 0 0 30252 29527 725 0 0 0 13843 12434 1409 0 461280 461280 0 0 0 0 0 0 8599224 8599224 0 0 1955368 1573539 381829 0 INTERCO PHYS & DEVELOP SERV 13789827 13789827 0 0 BAD DEBT 13317972 13317972 0 0 MEDICAL SUPPLIES 9192339 9192339 0 0 PROVIDER ASSESSMENT 7402036 7402036 0 0 3180955 3180955 139925016 127555124 12369892 0 0 -3194 795481 13273411 12959736 29280 50157 19098821 22565276 0 0 0 0 0 0 2097026 2059078 5623400 2154228 129173016 35442264 87868137 93730752 0 0 11479748 11593239 0 0 0 0 17950630 12250392 157417259 158158339 23288726 33022085 0 0 0 8277 0 0 0 0 0 0 0 0 0 0 15097922 12306394 38386648 45336756 X 118966608 112757580 64003 64003 0 0 119030611 112821583 157417259 158158339 -7369780 1160752 0 0 0 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false 0 false 0 false 0 false 0 true 85020 false false 0 85020 false SCHEDULE C, PART II-B, LINES 1B & 1G SUPPLEMENTAL INFORMATION SINAI HEALTH SYSTEM ENGAGES IN EDUCATION AND OTHER ACTIVITIES TO INFLUENCE LEGISLATORS REGARDING FEDERAL AND STATE POLICIES RELATED TO MEDICAID, SINAI'S 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 SYSTEM, THEREFORE REGISTERED STATE LOBBYISTS ARE REGISTERED TO REPRESENT ALL ENTITIES WITHIN SINAI HEALTH SYSTEM. SOME EXPENSES ARE ALLOCATED TO MOUNT SINAI HOSPITAL AND HOLY CROSS HOSPITAL BUT THE EXPENSES ARE PAID BY SINAI HEALTH SYSTEM. AT THE FEDERAL LEVEL, SINAI HEALTH SYSTEM DOES NOT UTILIZE CONTRACT LOBBYISTS. SINAI HEALTH SYSTEM COLLABORATES WITH THE AMERICAN HOSPITAL ASSOCIATION, THE ILLINOIS HOSPITAL ASSOCIATION, THE PREMIER HOSPITAL ALLIANCE, AND THE JEWISH FEDERATION OF METROPOLITAN CHICAGO/JEWISH UNITED FUND. A PORTION OF DUES FROM THE AMERICAN HOSPITAL ASSOCIATION AND THE ILLINOIS HOSPITAL ASSOCIATION SUPPORT FEDERAL LOBBYING. AT THE STATE LEVEL, SINAI UTILIZES TWO OUTSIDE LOBBYING FIRMS. 1700000 1700000 94059884 15615913 78443971 707906 172411 535495 32460014 19653940 12806074 245212 245212 93730752 NORTHERN TRUST AGREEMENT 11528967 F CD - LAKESIDE BANK 64272 F 11593239 DUE FROM AFFILIATES 8854745 DUE FROM THIRD PARTY PAYORS 2493592 WORKER'S COMPENSATION TRUST 902055 12250392 0 PENSION AND POST RETIREMENT 365972 STEWARD FEES 300000 PROFESSIONAL LIABILITY 11640422 12306394 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, 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 consolidated 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, 2017 and 2016, 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, 2013 and prior. true true X true X 300. true X 600. true true false true true 9727495 9727495 0.07680 16246330 39591977 25973825 39591977 9727495 0.07680 1126 1126 1126 1126 25974951 39591977 9728621 0.07680 false 13317972 4748420 38448387 34817044 3631343 X true true 1 1 Holy Cross Hospital 2701 West 68th Street Chicago IL 60629 www.holycrosshospital.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 Schedule H, Part V, Section B, Line 5 In 2015 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 HCH 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/CONTENT/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 June 2016 CHNA. The CHNA identifies significant health needs and barriers 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 is addressing the following significant health needs: - Diabetes - Cardiovascular Health - Asthma - Cancer - Access to mental health services - Gun Violence Holy Cross 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 During the preparation of its June 30, 2017 Form 990, Holy Cross Hospital discovered that its financial assistance policy (FAP) and plain language summary of the FAP were not translated into the primary languages spoken by limited English proficiency populations. In addition, the plain language summary of the FAP, as well as the translated versions of the FAP and plain language summary of the FAP were not widely available on a website. Upon discovering these omissions, Holy Cross Hospital immediately took action and is currently taking steps to correct these issues. Part I, Line 6a Related Organization Community Benefit Report The community benefit report is prepared by the parent corporation Sinai Health System (36-3166895). Part I, Line 7 Explanation of Costing Methodology The costing methodology utilized throughout this report is the cost to charge ratios based on the Medicare and Medcaid costs reports. Total cost per the Medicare Cost Report worksheet B, PT1 column 27 divided by total inpatient gross revenue. Part I, Line 7, Column F Explanation of Bad Debt Expense The bad debt expense was included on Form 990, Part IX, Line 25, column A but was subtracted from the total expenses for purposes of calculating the percentage in this column. The bad debt expense is $13,317,972. 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 care 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. The corporation estimates bad debt expense 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. Management assesses the allowance for uncollectible accounts based upon historical write-off experience. Part III, Line 4 Bad Debt Expense Per Audited financial statements Note 1 Patient Accounts Receivable, 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 patient's 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 estimated net realizable value. Management assesses the adequacy of the allowance for uncollectible accounts based on 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 terms 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 corporation's 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 There was no shortfall this year. The costing methodology utilized throughout this report is the cost to charge ratios based on the Medicare and Medicaid cost reports. Total cost per the Medicare Cost Report worksheet B, PT1 column 27 divided by total inpatient and outpatient gross revenue. Part III, Line 9b Provisions on Collection practices for Qualified Patients Holy Cross Hospitals collection process includes both letter and call series built 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 the Illinois Patient Uninsured Act. In addition, resources are made available to patients throughout the collections process. These resources included 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 an 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 requested 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 on the Sinai Health Systems 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 and serves a population base of over one million people located on the west side of Chicago. 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 all 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 - Through the Hospitals Parish Nurse Program, the Hospital has dedicated a nurse to conduct blood pressure screenings and ongoing health assessments for approximately 100 regular parishioners. The nurse also attends church meetings where she receives information about the sick parishioners at home and in nursing homes. Arrangements are made to assist the sick parishioners. The hospital participates with seven catholic churches in conducting health education workshops and assist the uninsured with referrals. There are 30 senior groups that meet once a month for diagnostic testing, health assessments and health education. Most of these seniors are in their 80s and 90s and the Hospital assists them with having ongoing physician appointments and helping them with their medical needs, by ongoing health assessment and transition to assisted living or homemaker referrals. 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 ask for assistance in having a speaker for their events. Part VI, Line 6 Affiliated Health Care System Roles Holy Cross Hospital is part of the Sinai Health System. The Sinai Health System is a unique health care delivery system on the West and Southwest sides of Chicago. Mount Sinai Hospital was founded in 1919 to provide care to Eastern European Jewish immigrants in the area as well as to create a place for Jewish doctors to practice. The Sinai Health System now serves predominantly Black and Latino communities, but our mission has remained the same. This mission addresses our desire to make a difference in both the individuals and the communities we serve. As we develop innovative and effective ways to do this, we strive to become the national model for the delivery of urban health care. Along with Holy Cross Hospital, the system includes Mount Sinai Hospital, Schwab Rehabilitation Hospital, Sinai Childrens Hospital, Sinai Medical Group, the Sinai Community Institute, and the Sinai Urban Health Institute. For more information on the 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 Lori Pacura President 0 262120 0 0 0 11895 0 0 0 15396 0 289411 0 0 Deborah Davisson CNO/VP -Patient Care Services 190256 0 0 0 6673 0 0 0 0 0 196929 0 0 0 Dennis Ryan VP-Mission Effect &Ext Affairs 160185 0 0 0 8486 0 0 0 7594 0 176265 0 0 0 Donnica Austin Vice President- Operations 179390 0 0 0 12040 0 0 0 874 0 192304 0 0 0 Karen Teitelbaum CEO 0 682437 0 0 0 65460 0 0 0 7954 0 755851 0 0 Charles Weis Jr CFO 0 463824 0 0 0 54497 0 0 0 13667 0 531988 0 0 Daniel Katz MD Director 0 574396 0 0 0 31154 0 0 0 25981 0 631531 0 0 Kelvin Nickles Registered Nurse 191032 0 0 0 347 0 0 0 6107 0 197486 0 0 0 James Richardson Chief Medical Officer 154332 0 0 0 3808 0 0 0 8718 0 166858 0 0 0 FORM 990, Part I, LIne 3 - Methods Used By Related Org to Establish CEO COMPENSATION THE ORGANIZATION PAYS OUT COMPENSATION BASED ON THE FOLLOWING PROCEDURES AND GUIDELINES: SINAI HEALTH SYSTEM (SHS) HAS AN EXECUTIVE COMPENSATION 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: 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, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN MOUNT SINAI HOSPITAL'S (MSH) SUPPLEMENTAL EARLY 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. UNLIKE NON-QUALIFIED PLANS, IN WHICH THE KEY EXECUTIVES ELECT TO DEFER THEIR COMPENSATION IN ORDER TO RECEIVE THAT COMPENSATION AT A LATER DATE, MOUNT SINAI HOSPITAL'S SUPPLEMENTAL EARLY RETIREMENT PLAN IS ENTIRELY FUNDED BY THE EMPLOYER (MOUNT SINAI HOSPITAL AND MEDICAL CENTER). THE MSH COMPENSATION COMMITTEE REVIEWS AND APPROVES ACCEPTANCE AND/OR MODIFICATIONS TO THE SERP PLAN. THE MSH'S SERP PLAN OUTLINES THE YEARLY EARNINGS PER THE INDIVIDUAL PARTICIPANTS AS WELL AS THE TIME FRAMES OF VESTMENT PER THOSE RESPECTIVE INDIVIDUALS. Charles Weis Jr. $49,697 Karen Teitelbaum $47,370 FORM 990, PART I LINE 7 - NON-FIXED PAYMENTS THE ORGANIZATION PAYS OUT BONUSES BASED ON THE FOLLOWING PROCEDURES AND GUIDELINES: SINAI HEALTH SYSTEM HAS AN EXECUTIVE COMPENSATION 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 0 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 of Holy Cross Hospital consists of the board chairman, and at least 15 but no more than 17, members of the board of directors. The board chairman appoints the members of the Executive Committee. The Executive Committee has the power to transact regular business of the corporation during the period between meetings of the board, subject to limitations imposed by the board or law. When action is taken by the Executive Committee, it is reported to 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 Board members are nominated by the Board Recruitment, Education, and Nominating Committee of the sole corporate member, Sinai Health System, and elected by the members from among those persons approved for appointment by the sole corporate member. FORM 990, PART VI, LINE 7B DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING The sole corporate member, Sinai Health System, has the following rights and powers: (a) To amend Holy Cross Hospitals Articles of Incorporation and corporate Bylaws. (b) To approve, interpret or amend the Mission Statement of Holy Cross Hospital. (c) To determine Holy Cross Hospitals compliance with Holy Cross Hospitals stated corporate purposes and Mission Statement. (d) To elect Holy Cross Hospitals Directors from among those persons nominated by the Board Recruitment, Education and Nominating Committee of the Sole Corporate Member. (e) To remove a Director by a two-thirds vote of the Sole Corporate Members Board of Directors at any time with or without cause. (f) To appoint the Chair, Vice Chair, President, Secretary and Treasurer of Holy Cross Hospital from among those nominated by the Board Recruitment, Education and Nominating Committee of the Sole Corporate Member, and to remove any such officers at any time with or without cause. (g) To approve all plans of merger, consolidation, joint venture or affiliation with Holy Cross Hospital. (h) To establish from time to time the "corporate limit" referred to in these reserved powers, which may be expressed either as a dollar amount or as a percentage of a budget. (i) To approve annual operating budgets and multi-year capital budgets and strategic plans of Holy Cross Hospital before expenditures pursuant to such budgets and plans may be made. Once the budgets are so approved, Holy Cross Hospitals Board of Directors may vary expenditures within the limits established from time to time by the Sole Corporate Member. (j) To approve the non-budgeted sale, lease (capitalized or otherwise), exchange, mortgage, pledge or other disposition of property and assets of Holy Cross Hospital in anyone fiscal year which is in excess of the corporate limit. (k) To approve all non-budgeted contracts obligating Holy Cross Hospital to expend or repay an amount in excess of the corporate limit. (l) To approve the creation or acquisition of majority-controlled or majority-owned subsidiaries or affiliates of Holy Cross Hospital. (m) To approve Holy Cross Hospitals non-budgeted incurring of long-term debt or obligating its assets in excess of the corporate limit. (n) To approve the appointment of independent certified public accountants for Holy Cross Hospital and its subsidiaries and affiliates. (o) To approve any voluntary dissolution and any liquidation of Holy Cross Hospitals assets. (p) To approve all executive compensation arrangements, including incentive compensation, for Holy Cross Hospital. 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 Integrity 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, employed physicians, management personnel as well as other employees who are in a position to influence purchasing decisions, affiliations or referrals, hiring decisions or contracts. The form is completed on appointment to the board of directors of Sinai Health System or any one of its entities, upon hire for any relevant job category or at the time of appointment to the medical staff. In addition to the annual filing of the form, an update is required to be filed any time there has been a change. 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 Integrity 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 Systems Executive Compensation Committee approves all executive compensation arrangements, including incentive compensation, for Holy Cross Hospital. Sinai Health System has an Executive Compensation 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 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 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. SINAI HEALTH SYSTEM 15TH STREET CALIFORNIA AVE CHICAGO IL 60608 363166895 PARENT CORP IL 501(c)(3) 12 TYPE ii NA false MT SINAI HOSPITAL MEDICAL CENTER 15TH STREET CALIFORNIA AVE CHICAGO IL 60608 361509000 HEALTHCARE IL 501(c)(3) 3 SINAI HEALTH true SCHWAB REHAB HOSPITAL & CARE NETWORK 1401 S CALIFORNIA AVENUE CHICAGO IL 60608 362179802 HEALTHCARE IL 501(c)(3) 3 SINAI HEALTH true SINAI COMMUNITY FOUNDATION 2760 W 15TH PL 7TH FLR CHICAGO IL 60608 363305449 HEALTHCARE IL 501(c)(3) 12 TYPE i SINAI HEALTH true SINAI COMMUNITY INSTITUTE 2653 WEST OGDEN AVE CHICAGO IL 60608 363932824 HEALTHCARE IL 501(c)(3) 10 SINAI HEALTH true PROGRESS HEALTH INC 2701 W 68TH STREET CHICAGO IL 60629 364109153 MGMT SERVICES IL HCH C CORP -252599 447610 1.00000 true false false false false false false false false true false true false false true false false false MOUNT SINAI HOSPITAL K 1600098 COST Sinai Health System P 6806458 COST