2017-05-12T12:53:15-05:00 2016-06-30 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2015-07-01 362222696 SwedishAmerican Hospital SWED 7796964727 1401 East State Street Rockford IL 611042298 Patricia DeWane Chief Financial Officer 7796964727 2017-05-12 1 Wayne Harder P00294296 3126343400 2015 2021-01-29 14:40:06Z William Gorski MD 1313 East State Street Rockford IL 61104 617851604 0 X www.swedishamerican.org X 1911 IL Through excellence in healthcare and compassionate service, we care for our community. 27 21 3449 265 214746 87822 179492 1350615 40142419 512634446 356336 6079924 349289 4608476 41027536 524673461 0 193320 0 0 18598880 242130283 0 0 0 20434939 268254806 39033819 510578409 1993717 14095052 678988654 692738272 252743465 252114223 426245189 440624049 X Through excellence in healthcare and compassionate service, we care for our community. 0 0 268384524 193320 395863097 SwedishAmerican Hospital (SAH) operates two full service acute care hospitals with a combined total of 367 licensed beds serving the greater Rockford region, Northern Illinois and Southern Wisconsin. Our vision is to develop a fully integrated healthcare delivery network that will continuously set the standard for quality care and service, accept responsibility for building a healthier population, provide regional access, improve resource utilization through collaboration with key stakeholders, and manage patient care and our resources in such a way that we create value for our patients and benefit for our community. During 2016, we cared for 17,533 inpatients and performed 848,298 outpatient procedures. This includes 86,580 emergency room visits and 2,443 deliveries. We sponsor the University of Illinois - College of Medicine Program and provided $5.9 million in education for primary care residents. Our employees and volunteers provided over 38,000 hours in unpaid community services. SwedishAmerican recognizes its responsibility to all the people of our community, regardless of their ability to pay for care. 79134008 65577118 SwedishAmerican Hospital employs primary care and specialty physicians who practice at 28 locations throughout our service area. We employ specialists in orthopedics, cardiology, cardiothoracic surgery, endocrinology, allergy, neurology, neurosurgery, pulmonology/critical care, hematology/oncology, obstetrics and gynecology, maternal fetal medicine, rheumatology, psychiatry, podiatry, otolaryngology, as well as internal medicine, family practice, immediate care and pediatric physicians. During 2016 our physician encounters were 362,499. 38636435 48206019 SwedishAmerican Regional Cancer Center opened to the public in October 2013. The center is part of a collaboration with UW Health and its nationally recognized University of Wisconsin Carbone Cancer Center. The two-story facility offers radiation therapy, medical oncology, chemotherapy and infusion services. Patients have access to clinical trials, state-of-the-art linear acceleratory treatments such as IGRT, IMRT, Rapid Arc, OBI and stereotactic services, and advanced medical imaging. The Regional Cancer Center is staffed by medical and radiation oncologists, physicists, dosimetrists, radiation therapists and nurses. During 2016 our out-patient encounters were over 23,561. 7584449 7352235 SwedishAmerican Home Health Care is a quality leader in providing individualized care in patients' homes. Working in partnership with a patient's doctor, our certified, trained staff provides a wide range of services and specializes in helping patients to remain independent and comfortable. Our experienced caregivers include registered nurses; certified nursing assistants, dietitians; physical, occupational and speech therapists; and medical social workers. RNs provide assessments, treatments and medication administration. Our therapists provide assessments and treatments. Medical social workers assist with assessments, counseling and helping patients and their families' access available community resources. SNAs provide baths and personal grooming. Our staff has the credentials and advanced training needed to assure that patients receive the highest quality of care possible. During 2016 we performed 29,456 episodes of care. 7584449 7352235 393739416 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 1 0 1 375 0 1 3449 1 1 1 0 0 0 0 0 0 0 0 0 X 27 21 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 IL X Patricia DeWane 7796964727 1313 East State Street Rockford IL 61104 William R Gorski MD President & CEO 40.00 6.00 X X 1301696 0 295608 Thomas R Walsh Chairman of the Board 2.00 6.00 X X 100 0 0 Daniel T Ross First Vice Chairman 2.00 6.00 X X 100 0 0 William Roop Immediate Past Chairman 2.00 6.00 X X 100 0 0 James Waddell Audit/Compliance Chairman 2.00 6.00 X X 100 0 0 Patrick Derry Quality and Safety Chairman 2.00 6.00 X X 100 0 0 Jeffrey J Kaney Sr Chairman of Joint Conference 2.00 6.00 X X 100 0 0 Danny L Copeland MD Trustee 40.00 6.00 X 203751 0 44278 Michael E Dallman Trustee 2.00 4.00 X 0 336240 44251 James L Gingrich Trustee 2.00 6.00 X 100 0 0 Robert L Head PhD Trustee 2.00 6.00 X 100 0 0 Helen Chung Hill Trustee 2.00 6.00 X 100 0 0 Michael Houselog PhD Trustee 2.00 6.00 X 100 0 0 Gregory Jury Trustee 2.00 8.00 X 100 0 0 Marco T Lenis Trustee 2.00 6.00 X 100 0 0 Fran Morrissey Trustee 2.00 6.00 X 100 0 0 David R Rydell Trustee 2.00 6.00 X 100 0 0 Steven C Sjogren Trustee 2.00 8.00 X 100 0 0 Frank Walter Trustee 2.00 8.00 X 100 0 0 Amy Wilcox Trustee 2.00 6.00 X 100 0 0 Allen Williams MD Trustee 40.00 6.00 X 263306 0 52489 Rev Dr Kenneth Board Trustee 2.00 6.00 X 100 0 0 Michael Broski Trustee 2.00 6.00 X 100 0 0 Robert Flannery Trustee 2.00 44.00 X 0 472820 59232 Peter Christman Trustee (until Sept 2015) 2.00 42.00 X 0 748978 58667 John Scheub Trustee (until Sept 2015) 2.00 6.00 X 100 0 0 John Shiro MD Ex-officio, Medical Staff President 2.00 0.00 X 7000 0 0 Frank Bonelli MD Ex-officio, Medical Staff Past President 2.00 0.00 X 0 0 0 Mark Cormier MD Ex-officio, Medical Staff Vice-President 2.00 0.00 X 3000 0 0 Patricia DeWane Chief Financial Officer 40.00 8.00 X 300855 0 45702 Donald Daniels Chief Operating Officer 40.00 6.00 X 492198 0 92857 Donald Haring Chief Financial Officer (until 1/4) 40.00 8.00 X 615326 0 84699 Kathy Kelly MD Chief Clinical Integration Officer 40.00 0.00 X 491558 0 51728 Michael J Born MD Chief Medical Officer 40.00 0.00 X 420721 0 51648 Harvey Einhorn MD Physician 40.00 0.00 X 672509 0 62560 Howard Kaufman DO Physician 40.00 0.00 X 591479 0 50424 Mohamed Zeater MD Physician 40.00 0.00 X 691901 0 47594 Merat Karbasian-Esfahani MD Physician 40.00 0.00 X 696044 0 61484 Steven Milos MD Physician 40.00 0.00 X 661851 0 53545 Richard Walsh Former Chief Operating Officer 0.00 0.00 X 680082 0 17813 8095277 1558038 1174579 263 1 1 0 Advocate Medical Group 2311 West 22nd Street Suite 202 Oakbrook IL 60523 Physician Services 4550262 Eagle Hospital Physicians 16000 North Dallas Pkwy Suite 450 Dallas TX 75248 Physician Services 3325866 Universal Hospital Services Inc 2601 Crossroads Drive Suite 105 Madison WI 53704 Equipment Services 2597831 Ringland Johnson Construction 1725 Huntwood Drive Cherry Valley IL 61016 Construction Services 2388703 Rockford Anesthesiologists 2202 Harlem Road Suite 200 Loves Park IL 61111 Physician Services 2002126 154 187330 1163285 1350615 Patient Services 621990 342376718 342376718 Medicare/Medicaid 621990 168232850 168232850 2024878 2024878 512634446 7458158 7458158 112472 82765 29707 29707 29707 91355274 361870 92363259 732119 -1007985 -370249 -1378234 -1378234 Cafeteria & Vending 561000 1517407 1508476 8931 Day Care Center 624410 1513298 1513298 Interdept. Billing 900099 1342249 1342249 205815 205815 4578769 524673461 516998469 214746 6109631 169320 169320 24000 24000 5778450 556796 5221654 182190043 139337517 42852526 8122593 6737815 1384778 33666894 26479602 7187292 12372303 9102400 3269903 1595465 52949 1542516 177768 177768 248949 248949 508014 508014 44699080 30681977 14017103 2934544 90406 2844138 9067644 5862387 3205257 6492567 5966833 525734 16168567 8963986 7204581 278644 230198 48446 662149 225991 436158 2919523 602060 2317463 24616449 20162700 4453749 10260772 2303453 7957319 Patient Supplies 85004857 84355503 649354 Bad Debts 33591411 33591411 IPA Provider Tax 11073107 11073107 Repairs & Maintenence 8466399 5801383 2665016 9488897 1367622 8121275 510578409 393739416 116838993 0 30206767 16485197 63840136 71565153 7078539 75000 9550795 9586404 11919956 15005294 332465126 35100653 298291188 297364473 230393079 249167469 1754592 2092767 25953602 31396515 678988654 692738272 50266590 47273462 133123242 127783413 69353633 77057348 252743465 252114223 X 416122919 430804204 3905562 3968728 6216708 5851117 426245189 440624049 678988654 692738272 X 14095052 1038185 -754377 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 248949 248949 0 Part II-B, Line 1: Portions of the 2015/2016 Illinois Hospital and American Hospital Association dues used for lobbying: $45,678. A law firm was engaged to review legislation affecting hospitals: $203,271 7112945 10986 -203624 258013 6662294 7122296 -9351 7112945 7093718 15490 405420 392332 7122296 6571756 10038 655660 143736 7093718 6007307 11537 668467 115555 6571756 0.00000 0.87820 0.12180 0 1 1 7272306 7272306 229091990 9425841 219666149 16497567 1796627 14700940 75169540 23338944 51830596 4433723 539241 3894482 297364473 Due to Third Party Payors 41823918 Reserve for Self Insurance 23504137 Deferred Compensation 6879708 Asbestos Retirement Obligation 294886 Current Maturities of Long-term Debt 4554699 77057348 X Part V, Line 4: 1) Needs of the Mother/Baby Family Birthplace 2) Medical and Non-medical health improvement initiatives 3) Rehabilitation or orthopedic programming and services within the greater Rockford community 4) Oncology patient services 5) Educational materials for the families of oncology patients 6) Chaplaincy program including grief services and counseling 7) Cardiology services 8) Medical programs and care for children 9) Cardiac education for women Part X, Line 2: 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 associated with the tax positions taken that exceeds the amount measured as described above is reflected as a liability for unrecognized tax benefits in the accompanying consolidated balance sheet along with any associated interest and penalties that would be payable to the taxing authorities upon examination. At June 30, 2016 and 2015, there were no unrecognized tax benefits identified or recorded as liabilities. 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 3254887 3254887 0.00680 108990550 83047658 25942892 0.05440 2486994 1088947 1398047 0.00290 114732431 84136605 30595826 0.06410 7434671 1894241 5540430 0.01160 22638022 590900 22047122 0.04620 319939 319939 0.00070 940446 237782 702664 0.00150 31333078 2722923 28610155 0.06000 146065509 86859528 59205981 0.12410 0 33591411 5038712 71029034 77387598 -6358564 X 1 1 1 Featherstone Partnership LLC Ambulatory Surgery Center 0.28570 0.00000 0.71430 2 Northern Illinois Vein Clinic LLC Outpatient Physician Clinic 0.50000 0.00000 0.50000 2 1 SwedishAmerican Hospital 1401 E State Street Rockford IL 61104 X X X X X A 2 SwedishAmerican Medical Ctr Belvidere 1625 S State Street Belvidere IL 61008 X X X A Facility Reporting Group - A 0 0 1 X X X X X X X X X 15 1 1 0 1 X www.swedishamerican.org/about/chna X 1 15 1 www.swedishamerican.org/about/chna 1 0 1 X 200.000000000000 600.000000000000 X X X X X X 1 1 X X 1 X www.swedishamerican.org/patients_visitors/charity_care_policy/ X www.swedishamerican.org/patients_visitors/charity_care_policy/ X www.swedishamerican.org/patients_visitors/charity_care_policy/ X X X X X 1 X 0 X X X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: SwedishAmerican Hospital, - Facility 2: SwedishAmerican Medical Ctr. Belvidere Group A-Facility 1 -- SwedishAmerican Hospital Part V, Section B, line 5: Primary data was obtained from the 2014 Healthy Community Study provided by Rockford Health Council which contained results and analytics from both a Healthy Community Survey and the Key Informant Questionnaire. The 2014 Healthy Community Study consists of two sections. Section I contains questions relating to four categories - (1) general health, (2) behavioral health, (3) maternal, prenatal, and early childhood health and (4) chronic disease and obesity. Section II contains six demographic questions. Surveys were developed in English and Spanish language format with written and electronic versions. The Surveys were distributed in three phases. In Phase 1, the surveys requesting parent survey participation were distributed to students in Rockford Public School District 205. In Phase 2, surveys were mailed to residents of Boone and Winnebago County through a third party vendor. In Phase 3, a postcard was delivered to a random sample of households in Winnebago County providing access information to the survey on the Rockford Health Council Website. The Rockford Health Council identified a group of 49 individuals as Key Informants and distributed a questionnaire to them that asked them to rate their awareness of efforts to address each of the key focus areas identified in the 2010 Healthy Community Study that needed improvement. Group A-Facility 1 -- SwedishAmerican Hospital Part V, Section B, line 6a: SA Hospital has two hospital facilities, SwedishAmerican Hospital located in Rockford Illinois, and SwedishAmerican Medical Center Belvidere located in Belvidere, Illinois. The definition of the community for purposes of the Community Health Needs Assessment (CHNA) was based on the internal patient origin information by zip code for SAH and SAMC's combined emergency room and inpatient discharges. Both Hospital Facilities defined its community for the CHNA as Boone and Winnebago Counties, Illinois since over 89% of emergency room patients and 84% of inpatients draw from this area. The CHNA was conducted together for both facilities. Group A-Facility 1 -- SwedishAmerican Hospital Part V, Section B, line 11: In acknowledging the wide range of priority health issues that emerged from the CHNA process, the hospital determined that it could only effectively focus on those which it deemed most under-addressed and most within its ability to influence. Group A-Facility 1 -- SwedishAmerican Hospital Part V, Section B, line 16i: The hospital's financial assistance policy is transparent and available to all, at all points in the continuum, in languages appropriate for Hospital's service area. The hospital's financial assistance policy, application form, signage, and financial counselor contact information are available in English and Spanish. Signage is posted prominently at all points of admission and registration (including the emergency department). Written information about the hospital's financial assistance policy and copies of the financial assistance form are available in admission and registration areas. The hospital's financial assistance policy, application form and financial counselor contact information are also posted on the hospital's website. The hospital will make efforts to publicize its policy in print and television media, wherever practicable.Patient billing communications also inform patients of the availability of financial assistance. Each bill, invoice, or other summary of charges to an uninsured patient includes with it, or on it, a prominent statement that an uninsured patient who meets certain income requirements may qualify for financial assistance and information on how to apply for consideration under the hospital's financial assistance policy. All third-party agents who submit or collect bills on behalf of hospital are required to follow this policy. Group A-Facility 1 -- SwedishAmerican Hospital Part V, Section B, line 22d: The maximum amount that may be collected in a 12-month period from an uninsured patient with family income greater than 200% of the federal poverty guidelines and less than or equal to 600 percent of the federal poverty guidelines for medically necessary services is 25 percent of that patient's family income. The Hospital will determine, on a case-by-case basis, whether to extend the same or similar 12-month maximum collectible amount to any other qualifying self-pay patient with family income of less than or equal to 600 percent of the federal poverty guidelines for qualifying services. The hospital reserves the right to exclude patients having assets with a value in excess of 600 percent of the federal poverty guidelines from the application of the 12-month maximum collectible amount. For purposes of determining the applicability of the 12-month maximum collectible amount, the following assets shall not be counted:A. The uninsured patient's primary residence.B. Personal property exempt from judgment under Section 12-1001 of the Code of Civil Procedure.C. Any amounts held in a pension or retirement plan, provided, however, that distributions and payments from pension or retirement plan may be included as income.To be eligible to have this maximum amount applied to subsequent charges, a patient shall inform the Hospital, in subsequent hospital in-patient admissions or outpatient encounters, that the patient has previously received medically necessary services from the hospital and was determined to be entitled to discounted care under this policy.In no event shall a patient who receives financial assistance under this policy be charged "gross charges" in violation of the Internal Revenue Code Section 501(r)(5)(b). For emergency or other medically necessary care provided to patients who receive financial assistance under this policy, hospital shall not charge amounts in excess of charges allowed under Internal Revenue Code 501(r)(5)(a). Assets are not considered in determining a self-pay patient's eligibility for financial assistance under this policy, except for purposes of:A. Determining the applicability of the 12-month maximum collectible amount described above; andB. In the case of a Medicare beneficiary, applying the mandatory asset test for Medicare beneficiaries described above.The hospital facility used the average prior fiscal year 12 month period of paid in full Medicare and commercial insurance rates when calculating the maximum amounts that can be charged. Group A-Facility 2 -- SwedishAmerican Medical Ctr. Belvidere Part V, Section B, line 5: Primary data was obtained from the 2014 Healthy Community Study provided by Rockford Health Council which contained results and analytics from both a Healthy Community Survey and the Key Informant Questionnaire. The 2014 Healthy Community Study consists of two sections. Section I contains questions relating to four categories - (1) general health, (2) behavioral health, (3) maternal, prenatal, and early childhood health and (4) chronic disease and obesity. Section II contains six demographic questions. Surveys were developed in English and Spanish language format with written and electronic versions. The Surveys were distributed in three phases. In Phase 1, the surveys requesting parent survey participation were distributed to students in Rockford Public School District 205. In Phase 2, surveys were mailed to residents of Boone and Winnebago County through a third party vendor. In Phase 3, a postcard was delivered to a random sample of households in Winnebago County providing access information to the survey on the Rockford Health Council Website. The Rockford Health Council identified a group of 49 individuals as Key Informants and distributed a questionnaire to them that asked them to rate their awareness of efforts to address each of the key focus areas identified in the 2010 Healthy Community Study that needed improvement. Group A-Facility 2 -- SwedishAmerican Medical Ctr. Belvidere Part V, Section B, line 6a: SA Hospital has two hospital facilities, SwedishAmerican Hospital located in Rockford Illinois, and SwedishAmerican Medical Center Belvidere located in Belvidere, Illinois. The definition of the community for purposes of the Community Health Needs Assessment (CHNA) was based on the internal patient origin information by zip code for SAH and SAMC's combined emergency room and inpatient discharges. Both Hospital Facilities defined its community for the CHNA as Boone and Winnebago Counties, Illinois since over 89% of emergency room patients and 84% of inpatients draw from this area. The CHNA was conducted together for both facilities. Group A-Facility 2 -- SwedishAmerican Medical Ctr. Belvidere Part V, Section B, line 11: In acknowledging the wide range of priority health issues that emerged from the CHNA process, the hospital determined that it could only effectively focus on those which it deemed most under-addressed and most within its ability to influence. Group A-Facility 2 -- SwedishAmerican Medical Ctr. Belvidere Part V, Section B, line 16i: The hospital's financial assistance policy is transparent and available to all, at all points in the continuum, in languages appropriate for Hospital's service area. The hospital's financial assistance policy, application form, signage, and financial counselor contact information are available in English and Spanish. Signage is posted prominently at all points of admission and registration (including the emergency department). Written information about the hospital's financial assistance policy and copies of the financial assistance form are available in admission and registration areas. The hospital's financial assistance policy, application form and financial counselor contact information are also posted on the hospital's website. The hospital will make efforts to publicize its policy in print and television media, wherever practicable.Patient billing communications also inform patients of the availability of financial assistance. Each bill, invoice, or other summary of charges to an uninsured patient includes with it, or on it, a prominent statement that an uninsured patient who meets certain income requirements may qualify for financial assistance and information on how to apply for consideration under the hospital's financial assistance policy. All third-party agents who submit or collect bills on behalf of hospital are required to follow this policy. Group A-Facility 2 -- SwedishAmerican Medical Ctr. Belvidere Part V, Section B, line 22d: The maximum amount that may be collected in a 12-month period from an uninsured patient with family income greater than 200% of the federal poverty guidelines and less than or equal to 600 percent of the federal poverty guidelines for medically necessary services is 25 percent of that patient's family income. The Hospital will determine, on a case-by-case basis, whether to extend the same or similar 12-month maximum collectible amount to any other qualifying self-pay patient with family income of less than or equal to 600 percent of the federal poverty guidelines for qualifying services. The hospital reserves the right to exclude patients having assets with a value in excess of 600 percent of the federal poverty guidelines from the application of the 12-month maximum collectible amount. For purposes of determining the applicability of the 12-month maximum collectible amount, the following assets shall not be counted:A. The uninsured patient's primary residence.B. Personal property exempt from judgment under Section 12-1001 of the Code of Civil Procedure.C. Any amounts held in a pension or retirement plan, provided, however, that distributions and payments from pension or retirement plan may be included as income.To be eligible to have this maximum amount applied to subsequent charges, a patient shall inform the Hospital, in subsequent hospital in-patient admissions or outpatient encounters, that the patient has previously received medically necessary services from the hospital and was determined to be entitled to discounted care under this policy.In no event shall a patient who receives financial assistance under this policy be charged "gross charges" in violation of the Internal Revenue Code Section 501(r)(5)(b). For emergency or other medically necessary care provided to patients who receive financial assistance under this policy, hospital shall not charge amounts in excess of charges allowed under Internal Revenue Code 501(r)(5)(a). Assets are not considered in determining a self-pay patient's eligibility for financial assistance under this policy, except for purposes of:A. Determining the applicability of the 12-month maximum collectible amount described above; andB. In the case of a Medicare beneficiary, applying the mandatory asset test for Medicare beneficiaries described above.The hospital facility used the average prior fiscal year 12 month period of paid in full Medicare and commercial insurance rates when calculating the maximum amounts that can be charged. 28 1 - Regional Cancer Center 3535 N Bell School Road Rockford IL 61114 Outpatient Clinic 2 - Midwest Heart Specialists 1340 Charles Street Suite 300 Rockford IL 61104 Outpatient Clinic 3 - Stateline Clinic 4282 E Rockton Road Roscoe IL 61073 Outpatient Clinic 4 - Woodside Clinic 3775 N Mulford Road Rockford IL 61114 Outpatient Clinic 5 - Lundholm Orthopedics 1340 Charles Street Rockford IL 61104 Outpatient Clinic 6 - Brookside Specialty Center 1253 N Alpine Road Rockford IL 61107 Outpatient Clinic 7 - Dixon Oncology 101 W 2nd Street Dixon IL 61021 Outpatient Clinic 8 - SwedishAmerican Home Health Care 2550 Charles Street Rockford IL 61108 Home Health 9 - Belvidere Clinic 1700 Henry Luckow Lane Belvidere IL 61008 Outpatient Clinic 10 - SAMG Obstetrics & Gynecology 209 9th Street Rockford IL 61104 Outpatient Clinic 11 - Rock Valley Women's Health Center 6861 Villagreen View Rockford IL 61107 Outpatient Clinic 12 - Neuro and Headache Center 1340 Charles Street Suite 400 Rockford IL 61104 Outpatient Clinic 13 - Rockford Ambulatory Surgery Center 1016 Featherstone Road Rockford IL 61107 Ambulatory Surgery Center 14 - Five Points Clinic 2404 Charles Street Suite 800 Rockford IL 61108 Outpatient Clinic 15 - SA Immediate Care 2473 McFarland Road Rockford IL 61107 Outpatient Clinic 16 - UW Health Surgery at SwedishAmerican 1340 Charles Street Suite 301 Rockford IL 61104 Outpatient Clinic 17 - Valley Clinic 6824 Newburg Road Rockford IL 61108 Outpatient Clinic 18 - Wound Care & Hyperbaric Clinics 1415 E State Street Suites 408 and 609 Rockford IL 61104 Outpatient Clinic 19 - Pulmonary and Sleep Disorder Clinic 1401 E State Street Rockford IL 61104 Outpatient Clinic 20 - Midtown Clinic 1340 E State Street Suite 405 Rockford IL 61104 Outpatient Clinic 21 - Davis Junction Clinic 5665 North Junction Way Davis Junction IL 61020 Outpatient Clinic 22 - CamelotState St OBGYN 1415 E State Street Rockford IL 61104 Outpatient Clinic 23 - Cardiothorasic Surgery 1340 Charles Street Suite 300 Rockford IL 61104 Outpatient Clinic 24 - Byron Clinic 220 W Blackhawk Drive Byron IL 61010 Outpatient Clinic 25 - Northern Illinois Vein Clinic 1340 Charles Street Suite 404 Rockford IL 61104 Outpatient Clinic 26 - Maternal Fetal Medicine 1401 E State Street Rockford IL 61104 Outpatient Clinic 27 - Rochelle Clinic 380 Illinois Route 38 East Rochelle IL 61068 Outpatient Clinic 28 - Marengo Clinic and Immediate Care 204 E Prairie Street Marengo IL 60152 Outpatient Clinic Part I, Line 7g: The following subsidized health services are for physicians. These physicians are necessary to serve the community, are difficult to recruit, and the reimbursement does not cover the cost of the services.Hospital based physicians' specialty clinics and coverage payments: $18,286,489Emergency department physicians: $1,297,749Total: $19,584,238 Part I, Ln 7 Col(f): The bad debt expense in part IX Column A was subtracted for the purpose of calculating the percentage of expense is $33,591,411. Part I, Line 7: 7a and 7f costs were calculated using the 2015 Medicare cost report cost to charge ratio. Lines 7b and 7c costs were calculated using the cost accounting system. The cost accounting system addresses all patient segments. All other amounts in line 7 were calculated using direct costs. Part III, Line 2: Methodology for determining bad debt expense: It is our practice to identify, to the extent possible, charity cases at the time of service. If a patient provides documentation they meet our charity care policy, they are not sent to collection. Those patients who do not meet presumptive eligibility and fail to apply or provide documentation are sent to collection after 90 days. The organization and its agents follow the fair patient billing act. If during the collection process we or our agents become aware of a patient qualifying for charity care or financial assistance and the patient cooperates with the requirements of the charity care policy, collection efforts are ceased and the account is written off to charity. Bad debt expense reported on line 2 represents the allowance for doubtful accounts. It is determined based on historical experience of uncollectible amounts, after contractual discounts, patient payments and amounts qualifying under charity assistance policy. Part III, Line 3: SwedishAmerican Hospital's charity policy allows a 100% charity write-off for those with household income of 200% or less of the federal poverty level and partial charity write-off for those up to 600% of the poverty level. The latest data from the U.S. Census bureau QuickFacts for Winnebago and Boone counties, which are the counties served by the healthcare facilities, indicates the following: Winnebago County - 14.7% of the population is below the poverty level, the median household income was $48,225 and a household size of 2.51, Boone County - 10.3% of the population is below the poverty level, the median household income was $58,248 and a household size of 2.95. The 2016 poverty guidelines per the Office of Assistant Secretary for Planning and Evaluation, (http://aspe.hhs.gov) indicate for a household size of 3, an income $40,320 is 200% of the poverty level and $120,960 is 600% of the poverty level. Approximately 72% of our charity write-offs are for patients without insurance while 57% of our bad debt write-offs are for patients without insurance. In 2016 only 13% of all accounts written off to bad debt were recovered. Based on this demographic and internal data we believe that a minimum of 15% of the amounts written off as bad debt would qualify for charity, and as such 15% of the bad debt expense from line 2 is reported on line 3. Part III, Line 4: Patient accounts receivable are reduced by an allowance for uncollectible accounts. In evaluating the collectability of accounts receivable, the hospital identifies troubled accounts, reviews historical experience and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for uncollectible accounts and provision for bad debts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for uncollectible accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for uncollectible accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for uncollectible accounts. Part III, Line 8: SA Hospital must treat patients regardless of their ability to pay. The government sets non-negotiable Medicare rates and the reimbursement from Medicare has not kept pace with the rising cost of providing those services. The cost of care has increased due to: wages and benefits necessary to keep high demand skilled practitioners, medical supplies in particular cardiovascular and orthopedic implants and pharmaceuticals, malpractice insurance costs, and capital equipment. SA Hospital's treatment of Medicare beneficiaries relieves the federal government burden of directly providing medical care which by law they are required to provide to eligible beneficiaries. Due to the requirement to provide care and the inability of Medicare reimbursement to keep pace with the cost of providing services, we feel the loss from services provided to Medicare beneficiaries is a part of our mission and is a benefit to our community. The following is a reconciliation of the shortfall from Medicare reported on the cost report on Line 7 to the Medicare shortfall from all of the Medicare programs at SA Hospital. These shortfalls were calculated using the cost to charge ratio.Medicare shortfall hospital programs Part III, line 7: ($6,358,564)Medicare shortfall physician programs: ($29,645,554)Total Medicare Shortfall: ($36,004,117) Part III, Line 9b: The organization and its agents follow the fair patient billing act. If during the collection process we or our agents become aware of a patient qualifying for charity care of financial assistance and the patient cooperates with the requirements of the charity care policy, collection efforts are ceased. Part VI, Line 2: SA hospital has provided monetary support for the 2014 Healthy Community Study, conducted by the Rockford Health council. The Council consists of the major health care providers in our metropolitan area such as the three hospitals, Crusader Clinic (a federally qualified healthcare clinic), the University of Illinois College of Medicine, Janet Wattles Mental Health Center, Rosecrance Substance Abuse Center as well as several representatives of not-for-profit agencies, and member of the corporate community. Since 2001, an assessment has been completed every three years to identify and track trends as well as areas to address. These stakeholders understand the need for a comprehensive community study that is focused on the overall needs of the community. SA has used this data to launch innovative programs and collaborative partnerships such as cardiac screenings within minority communities. In April of 2015, SA Hospital contracted with RSM-US LLP to complete a three year follow-up Community Health Needs Assessment (CHNA) for both SA Hospital and SA Medical Center Belvidere as required by the Internal Revenue Code, Section 501(r). An implementation strategy has been adopted to meet the prioritized needs identified by the CHNA. Part VI, Line 3: For services provided in the hospital, our employees and our agents follow the fair patient billing act and provide information regarding the availability of charity and financial assistance at all points during the collection process. We have posted signage disclosing the availability of charity care and financial assistance in emergency rooms and on our website. Inpatients are provided various written communications regarding the availability of charity care and financial assistance and any uninsured discount eligibility. For services provided in physician offices, financial counselors are instructed to make the patients aware of the charity care and financial assistance policy during the collection process and educate them on the process of applying for Medicaid. For services provided by home health, social workers assist patients by screening for Medicaid eligibility and completing the application, completing charity care application, assisting in applying for Medicare and social security disability benefits, and assisting with applications for food stamps, low income energy assistance, and circuit breaker/Illinois cares prescription programs. Part VI, Line 4: The communities served by SA Hospital include the Rockford Metropolitan Service Area (MSA) and the counties of Winnebago, Boone, and to a lesser degree Ogle and Stephenson Counties. Ogle and Winnebago counties have medically underserved area (MUA) designations for the White Rock Service Area (MUA 916) and Winnebago Service Area (MUA 7011). The U.S. Census bureau had the 2015 estimated population for the Rockford MSA at 340,663. Today, the unemployment rate of the Rockford MSA is 5.8%, ranking in the bottom 10% of the nation. SA Hospital is located in the city of Rockford, Illinois, in Winnebago County, where the percentage of households below the poverty level is 14.7%. SwedishAmerican Medical Center Belvidere is located in the city of Belvidere, Illinois, in Boone County, where the percentage of households below the poverty level is 10.3%. Of the patients served by SA Hospital at all facilities, 28.4% are uninsured or Medicaid recipients. Five different facilities exist in the community to address inpatient needs, all of which offer discounts or charity care to uninsured and needy patients. There is one federally qualified healthcare facility. SA Hospital helped fund the 2014 Rockford Healthy Community Study in partnership with the University of Illinois, College of Medicine at Rockford and the Rockford Health Council. In addition to general health issues, the study also focuses on three other areas of need identified by Rockford Health Council. They are: 1)Behavioral Health 2)Maternal, Prenatal, and Early Childhood Health 3)Chronic Disease and ObesityGeneral Health:Both Boone and Winnebago counties have a lower rate of primary care physicians (PCP) 78% compared to the state 96% and the nation 86% and the rate of access to PCP is lower for Boone County 59% than for Winnebago Counties 82%. In contrast, the percentage of adults in the region without a regular doctor 14% is lower than the state 18% and the nation 22%. Nevertheless, 54% of Boone and Winnebago population has been identified as living within an area where there is a shortage of healthcare professionals.Behavioral Health:The Study revealed that half of the respondents know where to find resources for mental health and suicide issues and almost half believe that both issues have no impact on their neighborhoods. Approximately 20% believe there is a lack of social or emotional support for the region which is consistent with that of the state and national rates.Maternal, Prenatal, and Early Childhood Health:The Study found that most respondents believe that regular prenatal care is necessary and that it is easy for mothers and their children to access these types of resources within their neighborhoods. Only 6% of mothers in the region are without prenatal care or receive it late in their pregnancy compared to 5% for the state and 17% for the nation. This is further supported by low infant mortality rates for Boone County 5% and below state and national rates but not for Winnebago County at 8% and above the state and national rates per 1,000 live births. Additionally, the teen birth rate for Boone County 30% is lower than the state 35% and Winnebago County at 46% and the incidences of teen birth rate for all comparative groups have declined over a 10 year period between 2002 and 2012.Chronic Disease:Respondents to the Healthy Community Study recognize that obesity plays a significant role in chronic disease and that it has an impact on their neighborhood. More than half acknowledge that healthy food options and access to community parks, recreational areas and fitness facilities are crucial to a reduction in chronic disease and obesity. However, the Study illustrates less than 5% of Boone County and 11% of Winnebago County live within 1/2 mile of a park and for each 100,000 it is estimated that 5 facilities exist in Boone County and 9 facilities in Winnebago County with an estimated regional population of 350,000. By virtue of its mission, location in the central city and relationships with other providers, SwedishAmerican serves the needs of many of the community's underserved. Finding ways to improve the health of all and to make Rockford a model community in which to live, work and worship are significant and strategic initiatives for SA Hospital. Part VI, Line 5: Although SA Hospital's community service efforts reach a broad segment of the population throughout northern Illinois, the hospital devotes a great deal of its energy and resources to serving the city's neediest people, many of whom live in the urban core where SwedishAmerican is located. Our organization contributes millions of dollars to charity and Medicaid care each year.Recognizing that healthy communities are characterized by strong interconnections between residents, infrastructure, organizations and services, we have worked in partnership with other community-based organizations as part of the non-profit Rockford Health Council Inc. The council seeks to build and improve community health through education, action, dialogue and legislative activity and serves as a catalyst and coordinator for agency and individual action to ensure access, cost effectiveness and quality. Beyond our work with the council, some of our initiatives take place in concert with other individual community organizations and healthcare providers, while others are carried out by SA Hospital teams.For example, SwedishAmerican has worked with the City of Rockford and other area development groups-including ZION Development, Habitat for Humanity and Kids Around the World-to serve as a catalyst for revitalizing the area surrounding our campus with homes, green space and commerce. A large part of this movement was a $100 million campus expansion and renovation project. Despite economic and strategic pressures to move eastward, as many businesses in our area have done, SwedishAmerican joined several other area organizations and made a commitment to remain in central Rockford. One immediate benefit of our redevelopment effort was the expansion of the hospital's emergency department. Among the state's busiest, this is where many of our community's underserved residents come for medical care. In order to improve the low rate of home ownership identified in the healthy community studies, SwedishAmerican initiated a Neighborhood Revitalization Program in an 81-block area adjacent to our hospital campus. Working with the City of Rockford and local Habitat for Humanity officials, we have replaced substandard dwellings with new Habitat homes. Additionally, we partnered with the William Charles Charitable Trust and Kids Around the World to build a new playground that allows neighborhood children the opportunity for play, without having to cross major thoroughfares and traffic hazards. In the past decade, the SA Foundation purchased two, 12-unit apartment buildings adjacent to the hospital campus which were in a state of disrepair. Approximately three-quarters of a million dollars were invested in these two buildings to bring them to "market rate" status. Encouraged by our commitment to renovate our campus and revitalize the surrounding area, a number of commercial developments have occurred. Among them is a Walgreens' drug store, which returned retail pharmacy services to the area for the first time in years. A three-story office building south of the new Walgreens' was completed, followed by a 60,000-square-foot medical office building south of the hospital. SwedishAmerican has sought to improve the community's health by taking effective lifestyle modification programs to the people who need them most. Although this applies to the community at large, we have taken special efforts to bring these strategies to the city's elderly and underserved residents. This is demonstrated by our successful program to improve the health of residents at Longwood Plaza, a senior housing facility located two blocks from our hospital's campus. Finally, beyond lifestyle modification our ongoing community health initiatives involve research-based health screening programs, as well as unique health education events that target both at-risk members of the community and healthcare providers. SwedishAmerican's organization-led efforts to improve the quality of life in our community are not exclusively health-related. One example is the partnership we formed twenty years ago with nearby public schools, where a very high percentage of the students come from underserved families. The long-term and ongoing goal of our partnership with area schools has been to improve the academic and socio-emotional wellbeing of the school environment and student body. While SwedishAmerican has come forward with a number of ideas and proposals for additional ways in which it can impact the students and faculty at area schools, it always has been sensitive to the wishes and desires of the community in implementing only those programs that correspond with the school's agenda and strategic goals. Beyond large-scale, organization-led initiatives, our employees independently devote extensive amounts of time and resources to a large number of programs, services and activities throughout northern Illinois. Part VI, Line 6: SA Hospital a division of UW Health offers services at two acute care hospital facilities, physician clinics, physician emergency services, and home health care. SwedishAmerican Foundation is a subsidiary of SA Hospital and supports it through fundraising activities.Following a campus renovation project that began in 2000, the SwedishAmerican Foundation (SAF) implemented a massive neighborhood revitalization and replacement initiative to transform a large area surrounding the hospital campus into "a neighborhood of choice...not chance." This project brought together the forces of SwedishAmerican, SAF, the City of Rockford and countless charitable and commercial entities to improve the quality and availability of area housing. In March of 2015 the program was recognized by The United Way of Rock River Valley with the inaugural Strong Neighbor Award. Because strong neighborhoods make a strong community, United Way is leading a place-based strategy that will dramatically improve the quality of life for children and families. Two of the region's most challenged neighborhoods (Ellis Heights and Midtown District) are the strategic focus of this plan. SwedishAmerican was cited for being a vital partner to the Strong Neighborhoods initiative and for building better neighborhoods for our children and families. United Way noted SwedishAmerican's commitment to transforming the area surrounding the Hospital from an at-risk, predominantly rental-occupied part of Rockford to a stable, owner-occupied neighborhood.SwedishAmerican's neighborhood revitalization effort includes:Habitat for Humanity Homes: Several years ago SwedishAmerican entered into a formal agreement with the Rockford Habitat for Humanity Chapter to construct new area homes. By the end of 2015, dozens of Habitat for Humanity homes have now been completed and sold to low-income home owners who qualify through Habitat For Humanity. Habitat For Humanity now holds annual application seminars on SwedishAmerican campus for our employees and members of the neighborhood.Midtown Community Work Day: In June 2016 SwedishAmerican Foundation collaborated and co-sponsored the first annual Midtown Community work day. Together with Rockford Habitat for Humanity and Thrivent Financial we initiated an exterior home improvement grant application for Midtown District homeowners. This was a one day event that utilized volunteers from Swedes, Habitat, Rockford Police, Thrivent, East High School, Rockford Fire and community members to work with grant recipients to help complete exterior repairs to six homes which totaled $15,000 of improvements to the community - all in just one day! Neighborhood Playground and Parks: Because area children did not have a safe place to play, SAF purchased three contiguous pieces of property, removed existing commercial and residential structures and partnered with two local charities to construct a new neighborhood playground. Since the completion of these projects, SwedishAmerican Foundation maintains their appearances with regular visits from our landscaping company. This ensures we maintain the beauty of the parks and playgrounds for our neighborhood to enjoy. Homeowner Grants to Employees: Since 2004, SwedishAmerican has offered $5,000 down payment assistance to employees to help encourage home ownership in the six-block area surrounding the hospital. This initiative includes a five-year forgivable grant to employees in good standing-with no income restrictions and a second possible $5,000 grant for low-income employees. Since inception, this program has assisted 33 employees purchase homes in the SwedishAmerican neighborhood.Home Restoration: Since inception of the Neighborhood Revitalization Program, SAF has purchased dozens of homes in the neighborhood target area, rehabbed them and made them available to employees, firefighters, police officers and public school teachers, at discount (less than the cost of purchase and repairs). This year, through a competitive process, 14 additional properties were identified and work completed. To date, 70 50/50 property improvement projects have taken place. Other completed projects include: - 3 new construction homes - 28 rehab houses by SAF - 23 Habitat for Humanity houses rehabbed with SAF - 2 apartment buildings rehabbed (24 units) - 2 duplexes rehabbed (4 units) - 16 grants for new garages/driveways - 32 houses purchased in the neighborhood by SwedishAmerican employeesStrong Neighborhood House:This year, SwedishAmerican collaborated with the Rockford Police Department and City of Rockford to open the first-ever community "Strong Neighborhood House." SwedishAmerican purchased and renovated the house and licensed it to the Rockford Police Department as a place for officers to build a closer relationship with neighbors. Additionally, it is a space where officers can help facilitate problem solving and ultimately reduce crime in the neighborhood. The house has set office hours each morning, Monday through Friday. Officers patrol the neighborhood throughout the day and evening and stop by the house at any time. Showing a strong police presence in the neighborhood is giving residents a hope for change and a better future.Over the last year the Rockford Community Police Officer has been working hard to increase programing and utilization of the house to better serve the needs of the neighborhood. Jackson Oaks Neighborhood Association holds monthly meetings at the Strong House along with The Fatherhood Project, Girl Scouts, and La Voz Latina. United Way and Goodwill also host special programs throughout the year, more specifically during times when children have a "no school day". SwedishAmerican Foundation will continue to collaborate with the Rockford Police Department to grow these programs and introduce new programs in years to come. Lifestyle Medicine and Wellness Programs:SwedishAmerican is committed to building a healthier community of senior adults. More than a decade ago, the health system and ZION Development Corporation began discussing the unique health needs of low-income senior residents living at Longwood Plaza, a 65-unit facility located two blocks from SwedishAmerican Hospital's campus. The two partners wanted to not only provide a way for seniors to have safe housing; they also wanted to equip residents with the tools and education for living healthier lives. With the assistance of a generous donation by the Walter D. Williams estate, SwedishAmerican and ZION created a wellness program to meet the needs of seniors' right where they lived.The wellness program involves three components: assessment, data analysis and program implementation. SwedishAmerican developed the program, set the budget, established staffing needs and recruited initial participants. Participants are then screened for blood pressure, cholesterol, blood sugar, weight and body mass index measurements. Health and diet histories also were completed at this time. Data was later compiled and analyzed, the program was further developed and staff was hired. Every week, participants are encouraged to meet with a Licensed Clinical Professional Counselor, Registered Nurse, Personal Trainer, Licensed Massage Therapist and attend exercise class twice a week. In the initial project, on-site services began for 34 participants. Each participant met individually with staff members to discuss recent changes in health status and completed stress, depression and hostility scales. Those who did not have a primary care physician were referred to a doctor for an initial physical. Individuals at high risk of depression were identified and given initial consultations with specially trained registered nurses. Participants met with a licensed dietitian to review specific nutritional needs and selected one or two nutritional goals that encouraged optimal health and that could be measured in future screenings. Nutrition and exercise classes also began meeting weekly and biweekly, respectively, at Longwood Plaza.Every year, participants are required to complete a Health Risk Assessment, Biometric Screen and Program Satisfaction Survey. Based on this data, programming for the upcoming year is planned/appropriate staff is hired.Because of the "food desert created when a grocery store left the area several years ago, participants receive $10 worth of fresh fruits and vegetables every week as an incentive for participation. Part VI, Line 6 Continued: Results for FY2015-2016:To track health and wellness, participants complete biometric tests (cholesterol, weight, blood pressure and glucose), diet diaries and psychosocial testing at the start of the program and every year thereafter. This year's results include: - Body Mass Index: 25% (5/20) improved - Triglycerides: 20% (4/20) reduced triglyceride to normal range - Fasting Blood Sugar: 15% (3/20) improved their level to normal range - Blood Pressure: 45% (9/20) reduced their blood pressure to normal rangeStaff continues to receive positive comments about the benefits of the wellness program. The objective data appears to support these positive remarks. Goals have been set for FY 2016-2017 to continue to increase individual healthy changes.Better Life Wellness/YMCA Partnership:SwedishAmerican created a medical wellness center called BetterLife Wellness within the downtown Rockford YMCA. The center offers a variety of services for members and the general public, including: - Wellness educational programs, classes and support groups - Screenings and health risk assessments - Personal health coaching - Weight management programs - Therapeutic massages, Reiki and reflexology - Healthy cooking classes and grocery tours - Smoking cessation classes - Relaxation and stress management education - Healthy Heart screensBetterLife expands our capacity to help people of all ages, physical abilities and limitations lead healthier lives. Our unique holistic health experience and expertise will be incorporated into the individualized wellness prescriptions and coaching offered to our participants. The powerful combination of active medical oversight, experienced and credentialed staff, and the utilization of an individual's personal health status are intended to reduce health risks, improve well-being and bring a measureable impact upon improving the overall health of our community. Part VI Line 7: SA Hospital files a community benefit report with the Illinois Attorney General. 1 Illinois Hospital Research & Education Foundation 1151 East Warrenville Road Naperville IL 60566 237421930 501(c)(3) 169320 Quality Healthcare for Illinois 1 0 Scholarship - educational scholarship for children of non-management employees. 24 24000 Part I, Line 2: IHREF is a tax exempt research entity. SA Hospital works closely with grantee organizations or receives reports from them as appropriate. 0 1 0 0 0 0 0 1 0 William R Gorski MD President & CEO 722446 0 354373 0 224877 0 276126 0 19482 0 1597304 0 224877 0 Danny L Copeland MD Trustee 203751 0 0 0 0 0 15890 0 28388 0 248029 0 0 0 Michael E Dallman Trustee 0 308427 0 27813 0 0 0 25740 0 18511 0 380491 0 0 Allen Williams MD Trustee 263306 0 0 0 0 0 18910 0 33579 0 315795 0 0 0 Robert Flannery Trustee 0 439446 0 33374 0 0 0 34851 0 24381 0 532052 0 0 Peter Christman Trustee (until Sept 2015) 0 700533 0 48445 0 0 0 34851 0 23816 0 807645 0 0 Patricia DeWane Chief Financial Officer 245820 0 45573 0 9462 0 39552 0 6150 0 346557 0 0 0 Donald Daniels Chief Operating Officer 354793 0 137405 0 0 0 73709 0 19148 0 585055 0 0 0 Donald Haring Chief Financial Officer (until 1/4) 412934 0 159400 0 42992 0 67347 0 17352 0 700025 0 42992 0 Kathy Kelly MD Chief Clinical Integration Officer 340073 0 123542 0 27943 0 49596 0 2132 0 543286 0 0 0 Michael J Born MD Chief Medical Officer 333248 0 87473 0 0 0 33355 0 18293 0 472369 0 0 0 Harvey Einhorn MD Physician 672509 0 0 0 0 0 21200 0 41360 0 735069 0 0 0 Howard Kaufman DO Physician 591479 0 0 0 0 0 16015 0 34409 0 641903 0 0 0 Mohamed Zeater MD Physician 691901 0 0 0 0 0 7950 0 39644 0 739495 0 0 0 Merat Karbasian-Esfahani MD Physician 696044 0 0 0 0 0 16033 0 45451 0 757528 0 0 0 Steven Milos MD Physician 661851 0 0 0 0 0 16033 0 37512 0 715396 0 0 0 Richard Walsh Former Chief Operating Officer 84460 0 47600 0 548022 0 1208 0 16605 0 697895 0 428444 0 Part I, Line 3 All compensation is determined by SwedishAmerican Health System and is paid by SwedishAmerican Hospital. All compensation decisions are made by independent persons. With respect to the President, CEO, and Officers, SwedishAmerican Health System follows a compensation approval procedure annually that involves approval of proposed and final compensation arrangements by the SA Hospital's Executive Compensation Committee using comparability data, as well as contemporaneous documentation of compensation decisions in the minutes. All physician compensation arrangements are approved by the Finance Committee and full Board of Directors using comparability data, and are contemporaneously documented in the minutes. Part I, Line 4b Compensation for the plan year 2015 include: William Gorski M.D. 457(f) - $236,926; Donald Haring 457(f) - $46,147; Donald Daniels 457(f) - $35,274; Kathleen Kelly M.D. 457(f) - $28,396; Michael Born M.D. 457(f) - $26,465; Patricia DeWane 457(f) - $20,155. Contributions to the 457(f) plan during 2015 include: William Gorski, M.D. - $236,925; Donald Haring - $46,147; Donald Daniels - $35,274; Patricia DeWane - $20,155; Kathleen Kelly M.D. - $28,396; Michael Born M.D. - $26,465. Payments from the 457(f) plan during 2015 include: William Gorski, M.D. - $224,877; Richard Walsh - $548,022; Donald Haring - $42,992. These payments are reported as taxable income on Part II, column (B)(iii). Part I, Line 7 SwedishAmerican Hospital has a formal plan for short term incentives and bonuses. The incentives are paid based on a combination of both individual goal achievement and corporate goal achievement (i.e. the Pillar goals). The executive compensation committee, comprised of board members, has discretion to approve the incentives and bonuses. Part II, Column F: The amounts shown in column F were reported as deferred compensation in prior years but paid out in the current year. The amounts are also included in column B(iii). A Illinois Finance Authority - 2010 861091967 2010-04-19 25000000 See Part IV 0 0 0 B Illinois Finance Authority - 2012 861091967 45203HLW0 2012-09-27 41833485 See Part IV 0 0 0 C Illinois Finance Authority - 2015 861091967 45203HY89 2015-03-27 76980000 See Part IV 0 0 0 A 7500000 25000000 25000000 2010 0 1 1 1 B 41888629 648001 41240628 2013 0 0 0 1 C 3135000 76980000 76980000 2007 0 1 1 1 A 0 0 0 0 0 0 1 B 0 0 1 1 0 0.01850 0.01850 0 0 1 C 0 0 0 0 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 0 1 0 0 0 0 0 1 A 1 B 1 C 1 Part II, Line 7: Bond insurance of $3,672,397 was purchased from bond proceeds and is included as a cost of issuance. Part I, column (f): 2010 Bond: Construction & Equipment Cardiac pavilion, renovate operating room & catheterization lab completed in 2007. Bond was re-issued in 2010 as a direct bank placement. 2012 Bond: Construction & Equipment Regional Cancer Center 2015 Bond: Construction & Equipment Cardiac pavilion, renovate operating room & catheterization lab completed in 2007. The bond was remarketed on 3/27/15. Sheryl Head Robert L. Head, PhD, Trustee, Spouse 111629 Employee compensation 0 Form 990, Part VI, Section A, line 4 The bylaws were amended on October 1, 2015 to include a new description for the members of the Executive Committee. The Executive Committee shall consist of the same individuals who serve as the members of the Executive Committee of SwedishAmerican Health System Corporation. Form 990, Part VI, Section A, line 6 SwedishAmerican Health System (Parent Corporation) is the sole corporate member of SwedishAmerican Hospital (Hospital). Form 990, Part VI, Section A, line 7a SwedishAmerican Health System (Parent Corporation) is the sole corporate member of SwedishAmerican Hospital (Hospital) and as such appoints all trustees. Form 990, Part VI, Section A, line 7b SwedishAmerican Health System (Parent Corporation) is the sole corporate member of SwedishAmerican Hospital (Hospital) and as such appoints all trustees and has the authority to approve certain decisions of the Hospital. Form 990, Part VI, Section B, line 11 A draft version of the Form 990 was reviewed by legal counsel and the Chief Financial Officer. Subsequently, the Audit/Compliance Committee of the Board of Directors of SwedishAmerican Health System (Parent Corporation) reviewed a final draft of the Form 990 and was provided with the opportunity to comment and ask questions. The entire Board of Directors was provided with a copy of the Form 990 before it was filed. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with its conflict of interest policies, which apply to all members of the board of directors and to all employees. Procedures are in place to identify conflicts of both directors and employees. Director conflicts are handled by board deliberation and board vote from which the interested director is excluded. Employee conflicts are handled by the compliance department and in certain instances may require separate board action. The Board is provided with periodic compliance reports regarding conflicts of interest. Form 990, Part VI, Section B, line 15 All compensation is determined by SwedishAmerican Health System and is paid by SwedishAmerican Hospital. All compensation decisions are made by independent persons. With respect to the president, CEO, and officers, and key employees, SwedishAmerican Health System follows a compensation approval procedure annually that involves approval of proposed and final compensation arrangements by the organization's Executive Compensation Committee using comparability data, as well as contemporaneous documentation of compensation decisions in the minutes. All physician compensation arrangements are approved by the Finance Committee and full Board of Directors using comparability data, as well as contemporaneous documentation of compensation decisions in the minutes. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statements have not been previously made available to the public. The consolidated audited financial statements of SwedishAmerican Hospital are available from the Illinois Attorney General Website and from the U.S. Securities and Exchange Commission electronic municipal market access system. Form 990, Part XI, line 9: Interest in Recipient Organization -476,619. Surgi Center Book/Tax Difference -58,603. Decrease Due to Merger -31,825. SwedishAmerican Foundation -187,330. University of WI Hospital and Clinics 600 Highland Avenue Madison WI 53792 391835630 Hospital and Clinics WI 501(c)(3) Line 3 N/A 0 University of WI Medical Foundation 600 Highland Avenue Madison WI 53792 391824445 Supported Organization WI 501(c)(3) Line 9 University of WI Hospital and Clinics 0 Regional Division Inc 301 South Westfield Road Suite 320 Madison WI 53717 391446049 Regional Parent Corporation to manage and direct activities of entities WI 501(c)(3) Line 11a University of WI Hospital and Clinics 0 University Health Care Inc 301 South Westfield Road Madison WI 53717 472553196 Support Organization WI 501(c)(3) Line 11a University of WI Hospital and Clinics 0 SwedishAmerican Health System Corporation 1401 East State Street Rockford IL 61104 363241458 Parent Corporation to manage and direct activites of entities IL 501(c)(3) Line 11a Regional Division Inc 0 SwedishAmerican Foundation 1401 East State Street Rockford IL 61104 363097493 Supporting Organization for SwedishAmerican Hospital fundraising IL 501(c)(3) Line 7 SwedishAmerican Hospital 1 SwedishAmerican Realty Corporation 1313 East State Street Rockford IL 61104 363248013 Title Holding Company IL 501(c)(2) SwedishAmerican Health System Corporation 0 SwedishAmerican Hospital Self Insurance Trust 1401 East State Street Rockford IL 61104 366652702 Hospital Malpractice Trust VT 501(c)(3) Line 11a SwedishAmerican Hospital 1 Wisconsin Therapies Inc 600 Highland Avenue Madison WI 53792 391807425 Support Organization WI 501(c)(3) Line 11d University of WI Hospital and Clinics 0 Generations Fertility Care 2365 Deming Way Middleton WI 53562 273496527 Reproductive endocrinology and infertility services WI 501(c)(3) Line 9 N/A 0 Wisconsin Dialysis 3034 Fish Hatchery Road Fitchburg WI 53713 300072647 Dialysis Services WI 501(c)(3) Line 11c N/A 0 Madison Surgery Center 7974 UW Health Court Middleton WI 53562 391940656 Health care services and training WI 501(c)(3) Line 9 N/A 0 Three Rivers Partners LLC 1313 East State Street Rockford IL 61104 262231757 Information Technology Services IL N/A N/A 0 0 Northern Illinois Vein Clinic 2550 Charles Street Rockford IL 61108 201642329 Outpateint Health Services IL N/A RELATED 113321 58281 0 1 0.50000 Chartwell Wisconsin Enterprises LLC 2241 Pinehurst Drive Middleton WI 53562 391796267 Parent entity of CMW and CMW-HR WI N/A N/A 0 0 SARI Insurance Company 76 St Paul Street Suite 500 Burlington VT 054014477 030308753 Captive Insurance Company VT SAHS Corporation C 1 LSG Building Corporation 1313 East State Street Rockford IL 61104 363033985 Real Estate IL SAHS Corporation S 1 State & Charles Inc 1313 East State Street Rockford IL 61104 363321193 Holding Company IL SAHS Corporation C 1 SwedishAmerican Health Management Corp 1313 East State Street Rockford IL 61104 363246511 Management Services IL State & Charles Inc C 1 Physician's Care Network 1313 East State Street Rockford IL 61104 363455791 Health Services IL State & Charles Inc C 1 Unity Health Insurance 840 Carolina Street Sauk City WI 53583 391450766 Health Maintenance Organization WI University Health Care Inc C 1 Health Professionals of Wisconsin 301 South Westfield Road Madison WI 53717 391806711 Real Estate WI University Health Care Inc C 1 0 0 1 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 SwedishAmerican Foundation C 187330 Cost SwedishAmerican Self Insurance Trust Q 903000 Cost SwedishAmerican Self Insurance Trust R 4150000 Cost SwedishAmerican Realty Corporation K 6624790 Cost TriRivers Partners LLC J 292811 Cost SwedishAmerican Realty Corporation D 109499 Cost University Health Care Inc P 1816126 Cost University of WI Medical Foundation P 2022600 Cost University of WI Hospital and Clinics P 559892 Cost Regional Division Inc J 569535 Cost Regional Division Inc Q 464516 Cost