FURP.ORG / PUBLIC DATA EXPLORER

INGALLS MEMORIAL HOSPITAL: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
INGALLS MEMORIAL HOSPITAL (EIN 36-2170866)
Tax period
2015-10-01 to 2016-09-30
Filed
2017-07-31
IRS object ID
201732129349300928
Schema version
2015v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2017-07-31T16:12:05-05:00ReturnTs
Tax Period End2016-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1200 East Randolph Street Ste 5500AddressLine1Txt
CityChicagoCityNm
State AbbreviationILStateAbbreviationCd
ZIP60601ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN362170866EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1THE INGALLS MEMORIAL HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% GARY GASBARRAInCareOfNm
Business Name ControlINGABusinessNameControlTxt
Phone7083332300PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1ONE INGALLS DRIVEAddressLine1Txt
CityHARVEYCityNm
State AbbreviationILStateAbbreviationCd
ZIP60426ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRICHARD SILVERIAPersonNm
Person TitleEVP AND CFOPersonTitleTxt
Phone7083332300PhoneNum
Signature2017-07-28SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonTara D'AgostinoPreparerPersonNm
PTINP01245482PTIN
Phone3126651000PhoneNum
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerKURT E JOHNSONPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1ONE INGALLS DRIVEAddressLine1Txt
CityHARVEYCityNm
State AbbreviationILStateAbbreviationCd
ZIP60426ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$297,697,278GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.INGALLS.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1922FormationYr
Legal Domicile StateILLegalDomicileStateCd
Activity Or MissionINGALLS MEMORIAL HOSPITAL IS A NOT-FOR PROFIT ACUTE CARE HOSPITAL ORGANIZED FOR THE PURPOSE OF PROVIDING PATIENT CARE, EDUCATION, AND RESEARCH.ActivityOrMissionDesc
Voting Members Governing Body23VotingMembersGoverningBodyCnt
Voting Members Independent19VotingMembersIndependentCnt
Total Employee2705TotalEmployeeCnt
Total Volunteers182TotalVolunteersCnt
Total Gross UBI$961,319TotalGrossUBIAmt
PY Contributions Grants$997,367PYContributionsGrantsAmt
CY Contributions Grants$2,000,693CYContributionsGrantsAmt
PY Program Service Revenue$282,051,535PYProgramServiceRevenueAmt
CY Program Service Revenue$279,421,204CYProgramServiceRevenueAmt
PY Investment Income$19,283,201PYInvestmentIncomeAmt
CY Investment Income$13,716,080CYInvestmentIncomeAmt
PY Other Revenue$2,036,175PYOtherRevenueAmt
CY Other Revenue$1,781,802CYOtherRevenueAmt
PY Total Revenue$304,368,278PYTotalRevenueAmt
CY Total Revenue$296,919,779CYTotalRevenueAmt
PY Grants And Similar Paid$126,600PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$20,146,449CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$114,252,979PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$111,633,854CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$163,455,298PYOtherExpensesAmt
CY Other Expenses$185,587,731CYOtherExpensesAmt
PY Total Expenses$277,834,877PYTotalExpensesAmt
CY Total Expenses$317,368,034CYTotalExpensesAmt
PY Revenues Less Expenses$26,533,401PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$20,448,255CYRevenuesLessExpensesAmt
Total Assets BOY$534,093,025TotalAssetsBOYAmt
Total Assets EOY$482,410,942TotalAssetsEOYAmt
Total Liabilities BOY$211,611,577TotalLiabilitiesBOYAmt
Total Liabilities EOY$195,829,295TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$322,481,448NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$286,581,647NetAssetsOrFundBalancesEOYAmt
MissionINGALLS MEMORIAL HOSPITAL STRIVES TO IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES BY INVESTING IN THE LATEST MEDICAL TECHNOLOGIES, THE STRUCTURAL NEEDS OF OUR FACILITIES, AND OUR EMPLOYEES.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$227,322,111ExpenseAmt
Grant$20,119,699GrantAmt
Revenue$180,293,418RevenueAmt
DescINGALLS MEMORIAL(IMH)INCLUDES A 500+ CERTIFIED BED HOSPITAL AND A NETWORK OF COMPREHENSIVE OUTPATIENT CENTERS THAT FEATURE A FULL ARRAY OF HIGH-TECH DIAGNOSTIC AND TREATMENT SERVICES. IMH MAKES SURE THAT OUR RESOURCES ARE DIRECTED TO AREAS THAT RESULT IN THE GREATEST BENEFIT TO OUR PATIENTS AND THE COMMUNITY.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$26,743,145ExpenseAmt
Revenue$60,960,180RevenueAmt
DescTHE PHARMACY PROVIDES SERVICE TO BOTH OUR INPATIENTS AND INFUSION CENTER PATIENTS. INCLUDED IN THE SERVICES PROVIDED ARE ANTIBIOTIC DOSING, DOSING BASED ON KIDNEY FUNCTION, BLOOD GLUCOSE MANAGEMENT, AND ANTICOAGULANT DOSING AND MONITORING. THE INPATIENT PHARMACY IS OPEN 24/7. WE PROCESS APPROXIMATELY 45,000 MEDICATION ORDERS AND MAKE 1,700 INTERVENTIONS PER MONTH.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$19,059,709ExpenseAmt
Revenue$39,158,179RevenueAmt
DescINGALLS PERFORMS AN ARRAY OF SURGICAL SERVICES INCLUDING ELECTIVE, NON-ELECTIVE, COMPLEX AND HIGHLY SPECIALIZED PROCEDURES. SURGEONS ON STAFF AT INGALLS SPECIALIZE IN EVERY AREA OF SURGERY, INCLUDING, BUT NOT LIMITED TO CARDIOTHORACIC SURGERY, ORTHOPEDIC SURGERY, NEUROSURGERY, SPINE SURGERY, GENERAL SURGERY, AND VASCULAR SURGERY. IN FY 2016 INGALLS PERFORMED 2,525 INPATIENT SURGERIES AND 3,240 AMBULATORY SURGERIES.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$273,124,965TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsYes (true)GrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document352IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee2705EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members23GoverningBodyVotingMembersCnt
Independent Voting Member19IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsYes (true)ChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldILStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonGARY GASBARRAPersonNm
Phone7083332300PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1ONE INGALLS DRIVEAddressLine1Txt
CityHARVEYCityNm
State AbbreviationILStateAbbreviationCd
ZIP60426ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (36 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
EUGENE FEINGOLD
CHAIRMAN OF THE BOARD1.03.0Yes (X)Yes (X)$0$0$0
RICHARD KING
BOARD MEMBER, SECRETARY1.02.0Yes (X)Yes (X)$0$0$0
DENNIS IRVIN
BOARD MEMBER, VICE CHAIRMAN1.02.0Yes (X)Yes (X)$0$0$0
MICHAEL HICKS
COO/BOARD MEMBER40.00.0Yes (X)Yes (X)$600,239$0$37,710
KURT JOHNSON
PRESIDENT & CEO/BOARD MEMBER40.04.0Yes (X)Yes (X)$1,470,732$0$45,265
KATHLEEN MIKOS
CHIEF NURSING/BOARD MEMBER40.00.0Yes (X)Yes (X)$470,769$0$28,367
STEVEN ANDERSON
BOARD MEMBER1.00.0Yes (X)$0$0$0
RICHARD ANDERSON
BOARD MEMBER1.00.0Yes (X)$0$0$0
LYNDELL BECKHAM
BOARD MEMBER1.01.0Yes (X)$0$0$0
SAMUEL CUTRARA JR
BOARD MEMBER1.01.0Yes (X)$0$0$0
HEATHER DAVIS
BOARD MEMBER1.01.0Yes (X)$0$0$0
ROBERT HARRIS
BOARD MEMBER1.01.0Yes (X)$0$0$0
JERRY ITKONEN MD
BOARD MEMBER0.00.0Yes (X)$0$0$0
HENRY JOHNSON
BOARD MEMBER1.01.0Yes (X)$0$0$0
TIMOTHY JOHNSON
BOARD MEMBER1.01.0Yes (X)$0$0$0
CARL JOHNSON II MD
BOARD MEMBER1.00.0Yes (X)$0$0$0
MICHAEL KAMRADT
BOARD MEMBER1.01.0Yes (X)$0$0$0
NEAL KITCHELL
BOARD MEMBER1.01.0Yes (X)$0$0$0
MARK KOZLOFF MD
PHYSICIAN/BOARD MEMBER1.042.0Yes (X)$0$588,659$20,393
DAVID ORTH MD
BOARD MEMBER1.02.0Yes (X)$0$0$0
CRESSA PERISH MD
BOARD MEMBER1.00.0Yes (X)$0$0$0
KEVIN PURCELL
BOARD MEMBER1.01.0Yes (X)$0$0$0
NATHANIEL SUTTON
BOARD MEMBER1.01.0Yes (X)$0$0$0
MICHAEL DEVORE
CHIEF INFORMATION OFFICER40.00.0Yes (X)$264,320$0$28,283
PAUL DONOHUE
VP PHILANTHROPY AND COMMUNITY40.00.0Yes (X)$90,980$0$13,902
DIANE JACOBY
ASSISTANT SECRETARY, VP40.02.0Yes (X)$574,185$0$44,667
DEBORAH NELSON
VICE PRESIDENT/COO MEDCENTRIX40.00.0Yes (X)$85,331$0$19,966
TAMARA PROFIRIO
VICE PRESIDENT/COO MEDCENTRIX40.00.0Yes (X)$240,938$0$17,170
ALETHA ROSS
VICE PRESIDENT OF HR40.00.0Yes (X)$323,419$0$27,195
ANDREW STEFO
VP - FINANCE/CFO40.01.0Yes (X)$630,796$0$24,263
SCOTT STRAUSSER
VP - BUSINESS DEVELOPMENT40.00.0Yes (X)$514,396$0$20,546
LINDA CONWAY
ASSOCIATE GENERAL COUNSEL40.00.0$217,213$0$7,236Yes (X)
MARY JO CRANDALL
LEAN FACILITATOR40.00.0$211,746$0$5,860Yes (X)
LAWRENCE KLONOWSKI
MANAGER MEDICAL PHYSICS40.00.0$206,546$0$33,267Yes (X)
LYNN PHILIPSON
DIRECTOR OF MANAGED CARE40.00.0$199,379$0$6,501Yes (X)
HEIDI RUHE
ASSOC VP BUSINESS DEVELOPMENT40.00.0$198,575$0$40,014Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$6,299,564TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$588,659TotReportableCompRltdOrgAmt
Total Other Compensation$420,605TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K112IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
ARAMARK CORPORATION
25271 NETWORK PLACECHICAGOIL60673CONTRACT FOOD, PLANT$22,356,227
SYNERGY BEHAVIORAL HEALTHCARE
1566 W ALGONQUIN ROAD 3149HOFFMAN ESTATESIL60192IN PT AND OUT PT PSY$4,881,100
CERNER HEALTH SERVICES
C/O US BANK PO BOX 959167ST LOUISMO63195IT SUPPORT$4,791,070
REED CONSTRUCTION
600 W JACKSON BLVD STE 500CHICAGOIL606615625CONSTRUCTION COMPANY$4,393,859
JAMERSON BAUWENS
3160 MCCARTHUR BLVDNORTHBROOKIL60062MED ELECTRIC INSTALL$1,532,861
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K197CntrctRcvdGreaterThan100KCnt
Related Organizations$2,000,693RelatedOrganizationsAmt
All Other Contributions$0AllOtherContributionsAmt
Total Contributions$2,000,693TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
Net Patient Revenue900099$269,987,443$269,987,443
Rental Income900099$2,553,988$2,553,988
LAB SERVICES621500$954,142$954,142
CLIENT SERVICE REVENUE900099$949,661$949,661
MEDIC TRAINING900099$119,220$119,220

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,856,750TotalRevenueColumnAmt
Related Or Exempt Func Income$4,856,750RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$279,421,204TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,092,151TotalRevenueColumnAmt
Unrelated Business Revenue$7,177UnrelatedBusinessRevenueAmt
Exclusion$1,084,974ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$1,126,756RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$777,499RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$349,257RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$349,257TotalRevenueColumnAmt
Exclusion$349,257ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$12,623,929SecuritiesAmt
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$12,623,929SecuritiesAmt
Other$0OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$12,623,929TotalRevenueColumnAmt
Exclusion$12,623,929ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtExclusionExclusionAmt
EXPENSE REIMBURSEMENT & MGMT FEES900099$887,801$887,801
GIFT SHOP900099$354,226$354,226
PARKING INCOME900099$87,746$87,746

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$102,772TotalRevenueColumnAmt
Related Or Exempt Func Income$102,772RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$1,432,545OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$296,919,779TotalRevenueColumnAmt
Related Or Exempt Func Income$279,457,635RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$961,319UnrelatedBusinessRevenueAmt
Exclusion$14,500,132ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$20,050,000TotalAmt
Program Services$20,050,000ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$96,449TotalAmt
Program Services$96,449ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$10,255,402TotalAmt
Program Services$8,794,007ProgramServicesAmt
Management And General$1,461,395ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$85,993,465TotalAmt
Program Services$77,829,973ProgramServicesAmt
Management And General$8,163,492ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$2,028,854TotalAmt
Program Services$1,846,257ProgramServicesAmt
Management And General$182,597ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$6,316,153TotalAmt
Program Services$5,747,700ProgramServicesAmt
Management And General$568,453ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$7,039,980TotalAmt
Program Services$6,406,382ProgramServicesAmt
Management And General$633,598ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$10,255,402TotalAmt
Management And General$10,255,402ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$607,381TotalAmt
Management And General$607,381ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$163,982TotalAmt
Management And General$163,982ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$44,908TotalAmt
Management And General$44,908ManagementAndGeneralAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$818,224TotalAmt
Program Services$818,224ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$66,923,495TotalAmt
Program Services$53,574,723ProgramServicesAmt
Management And General$13,348,772ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$1,321,244TotalAmt
Management And General$1,321,244ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,640,173TotalAmt
Program Services$1,476,156ProgramServicesAmt
Management And General$164,017ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$5,524,646TotalAmt
Program Services$3,591,020ProgramServicesAmt
Management And General$1,933,626ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$418,801TotalAmt
Program Services$347,605ProgramServicesAmt
Management And General$71,196ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$4,738,647TotalAmt
Program Services$3,885,690ProgramServicesAmt
Management And General$852,957ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$16,571,428TotalAmt
Program Services$14,582,857ProgramServicesAmt
Management And General$1,988,571ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$13,464,994TotalAmt
Program Services$12,387,795ProgramServicesAmt
Management And General$1,077,199ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtFundraisingFundraisingAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$44,307,369$44,307,369$0
PUBLIC AID ASSESSMENT$14,360,208$14,360,208$0
REAL ESTATE TAXES$1,355,000$880,750$0$474,250
LAUNDRY SERVICES$1,101,010$1,101,010$0

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,970,819TotalAmt
Program Services$1,040,790ProgramServicesAmt
Management And General$930,029ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$317,368,034TotalAmt
Program Services$273,124,965ProgramServicesAmt
Management And General$44,243,069ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$16,690,300BOYAmt
EOY$0EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$41,385,841BOYAmt
EOY$34,641,963EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$5,721,103BOYAmt
EOY$5,256,985EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$3,803,988BOYAmt
EOY$3,951,722EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$535,049,712LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$339,717,373LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$192,018,062BOYAmt
EOY$195,332,339EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$260,815,096BOYAmt
EOY$216,934,465EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$3,063,752BOYAmt
EOY$2,629,877EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$663,952BOYAmt
EOY$636,045EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$9,930,931BOYAmt
EOY$23,027,546EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$534,093,025BOYAmt
EOY$482,410,942EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$84,100,222BOYAmt
EOY$65,248,474EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY-$1,383,657BOYAmt
EOY$712,478EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$109,949,339BOYAmt
EOY$107,696,467EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$9,170,537EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$18,945,673BOYAmt
EOY$13,001,339EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$211,611,577BOYAmt
EOY$195,829,295EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$318,061,321BOYAmt
EOY$282,552,520EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$4,420,127BOYAmt
EOY$4,029,127EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$322,481,448BOYAmt
EOY$286,581,647EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$534,093,025BOYAmt
EOY$482,410,942EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$20,448,255ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$3,251,991NetUnrlzdGainsLossesInvstAmt
Prior Period Adjustments-$9,414,398PriorPeriodAdjustmentsAmt
Other Changes In Net Assets-$2,785,157OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$44,908OtherActivitiesAmt
Total Lobbying Expenditures$44,908TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1IFormAndLineReferenceDesc
ExplanationTHE HOSPITAL PAYS DUES TO THE ILLINOIS HEALTH AND HOSPITAL ASSOCIATION. A PORTION OF THESE DUES ARE USED TO SUPPORT LOBBYING BY THE ASSOCIATION FOCUSED ON ADVOCACY AND REPRESENTATION.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$416,863OtherCostOrOtherBasisAmt
Book Value$416,863BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$293,960,391OtherCostOrOtherBasisAmt
Depreciation$153,872,722DepreciationAmt
Book Value$140,087,669BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$12,211,665OtherCostOrOtherBasisAmt
Depreciation$10,762,484DepreciationAmt
Book Value$1,449,181BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$206,810,443OtherCostOrOtherBasisAmt
Depreciation$175,082,167DepreciationAmt
Book Value$31,728,276BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$21,650,350OtherCostOrOtherBasisAmt
Book Value$21,650,350BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$195,332,339TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescTENDER PREMIUM PAYABLE (SWAP)Desc
Amt$13,001,339Amt
FieldValueIRS element (for citing)
Total Liability$13,001,339TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$291,232,906TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$3,251,991NetUnrealizedGainsInvstAmt
Other Revenue-$2,394,157OtherRevenueAmt
Revenue Not Reported-$5,646,148RevenueNotReportedAmt
Revenue Subtotal$296,879,054RevenueSubtotalAmt
Investment Expenses Not Incld$818,224InvestmentExpensesNotIncldAmt
Other Revenues Not Included-$777,499OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$40,725RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$296,919,779TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$317,327,309TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$777,499OtherExpensesIncludedAmt
Expenses Not Reported$777,499ExpensesNotReportedAmt
Expenses Subtotal$316,549,810ExpensesSubtotalAmt
Investment Expenses Not Incld2$818,224InvestmentExpensesNotIncld2Amt
Expenses Not Rpt Fincl Stmt$818,224ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$317,368,034TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PART X, LINE 2THE HEALTH SYSTEM APPLIES THE PROVISIONS OF ASC TOPIC 740, INCOME TAXES, WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN. UNDER ASC 740, TAX POSITIONS ARE EVALUATED FOR RECOGNITION, DERECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. AS OF SEPTEMBER 30, 2016, THE HOSPITAL DOES NOT HAVE AN ASSET OR LIABILITY RECORDED FOR UNRECOGNIZED TAX POSITIONS. THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE.
SCHEDULE D, PART XI, LINE 2DINTEREST RATE SWAP VALUATION (2,394,157)
SCHEDULE D, PART XI, LINE 4BRECLASS OF RENTAL EXPENSE (777,499)
SCHEDULE D, PART XII, LINE 2DRECLASS OF RENTAL EXPENSE 777,499

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CarefalseFPGReferenceDiscountedCareInd
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,165,171TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$6,165,171NetCommunityBenefitExpnsAmt
Total Expense0.01940TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$81,365,357TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$53,986,742DirectOffsettingRevenueAmt
Net Community Benefit Expns$27,378,615NetCommunityBenefitExpnsAmt
Total Expense0.08630TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$87,530,528TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$53,986,742DirectOffsettingRevenueAmt
Net Community Benefit Expns$33,543,786NetCommunityBenefitExpnsAmt
Total Expense0.10570TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$654,421TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$654,421NetCommunityBenefitExpnsAmt
Total Expense0.00210TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$583,323TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$238,620DirectOffsettingRevenueAmt
Net Community Benefit Expns$344,703NetCommunityBenefitExpnsAmt
Total Expense0.00110TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$268,163TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$268,163NetCommunityBenefitExpnsAmt
Total Expense0.00080TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,505,907TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$238,620DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,267,287NetCommunityBenefitExpnsAmt
Total Expense0.00400TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$89,036,435TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$54,225,362DirectOffsettingRevenueAmt
Net Community Benefit Expns$34,811,073NetCommunityBenefitExpnsAmt
Total Expense0.10970TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$6,773,224BadDebtExpenseAmt
Bad Debt Expense Attributable$1,266,593BadDebtExpenseAttributableAmt
Reimbursed By Medicare$102,663,068ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$126,429,678CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$23,766,610MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1INGALLS MEMORIAL HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1ONE INGALLS DRIVEAddressLine1Txt
CityHARVEYCityNm
State AbbreviationILStateAbbreviationCd
ZIP60426ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.INGALLS.ORGWebsiteAddressTxt
State License0001099StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
Teaching HospitalYes (X)TeachingHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1INGALLS MEMORIAL HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted15CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLINGALLS.HEALTHFORECAST.NETOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt15ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLINGALLS.HEALTHFORECAST.NETStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care0.FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URL(SEE STATEMENT)FAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL(SEE STATEMENT)FAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URL(SEE STATEMENT)FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Medicare RatesYes (X)MedicareRatesInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, SECTION B, LINE 4THE HOSPITAL IS REPORTING THE TAX YEAR BEGINNING FOR WHICH IT LAST CONDUCTED ITS CHNA. THE CHNA WAS FINALIZED DURING THE TAX YEAR ENDED SEPTEMBER 30, 2016. PART V, SECTION B, LINE 5 IN CONDUCTING ITS MOST RECENT CHNA, THE HOSPITAL SOUGHT TO SOLICIT INPUT FROM INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY. POTENTIAL PARTICIPANTS IN THE CHNA INCLUDED PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND A VARIETY OF OTHER COMMUNITY LEADERS. THESE PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. PARTICIPANTS WERE CONTACTED BY EMAIL AND ASKED TO PARTICIPATE IN A SURVEY. THROUGHOUT THIS PROCESS, INPUT WAS GATHERED FROM SEVERAL INDIVIDUALS WHOSE ORGANIZATIONS WORK WITH LOW-INCOME, MINORITY POPULATIONS, OR OTHER MEDICALLY UNDERSERVED POPULATIONS.
PART V, SECTION B, LINE 6BTHE COMMUNITY HEALTH NEEDS ASSESSMENT WAS SPONSORED BY INGALLS MEMORIAL HOSPITAL IN COOPERATION WITH THE METROPOLITAN CHICAGO HEALTHCARE COUNCIL. THE PROJECT ALSO RECEIVED INPUT FROM A COMMUNITY HEALTH NEEDS COMMITTEE, CREATED FOR THIS PURPOSE, WHICH WAS COMPRISED OF REPRESENTATIVES OF THE PARTNERING ORGANIZATIONS AS WELL AS OTHER CITIZENS CHOSEN FOR THEIR RELEVANT EXPERIENCE AND INTERESTS.
PART V, SECTION B, LINE 9THE HOSPITAL IS REPORTING THE TAX YEAR BEGINNING FOR WHICH IT LAST ADOPTED AN IMPLEMENTATION STRATEGY RELATING TO THE TAX YEAR ENDED SEPTEMBER 30, 2016. PART V, SECTION B, LINE 11 THE SIGNIFICANT NEEDS IN THE COMMUNITY WERE IDENTIFIED AS ACCESS TO CARE; HEART DISEASE AND STROKE; CANCER CARE; NUTRITION, PHYSICAL ACTIVITY & WEIGHT; AND INFANT HEALTH AND FAMILY PLANNING. TO ADDRESS ACCESS TO CARE, INGALLS REFERENCED HEALTH DATA FINDINGS WHICH SUGGEST OPPORTUNITIES TO ADDRESS BARRIERS TO HEALTHCARE ACCESS AROUND APPOINTMENT AVAILABILITY AND LOCATING A PHYSICIAN. PHYSICIAN RECRUITMENT, ENHANCED CLINICAL SERVICES, AND EXPANSION OF OUTPATIENT SERVICES WERE THE PRIMARY REASONS FOR THE MERGER BETWEEN THE UNIVERSITY OF CHICAGO MEDICINE AND INGALLS HEALTH SYSTEM, NOW KNOWN AS UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. THE MERGED HEALTH SYSTEMS WILL IMPROVE ACCESS ACROSS THE SPECTRUM OF CARE BE IT FOR A ROUTINE, PREVENTATIVE CHECKUP OR A COMPLEX, LIFE SUSTAINING TREATMENT. INGALLS HELD A COMMUNITY LEADERS FORUM, PARTNERING WITH ELECTED OFFICIALS, EDUCATORS, FAITH LEADERS, COMMUNITY NON-PROFITS, PATIENTS, PHYSICIANS, AND STAFF, TO SHARE INFORMATION AROUND ACCESS TO CARE THROUGH THE UCM/INGALLS MERGER. ADDRESSING THE ISSUE OF HEART DISEASE AND STROKE, INGALLS HAS IMPLEMENTED A NUMBER OF ACTION STEPS FOCUSED ON PREVENTATIVE CARE IN THE COMMUNITY, WHILE ALSO INVESTING MORE THAN $1 MILLION IN DIRECT CARDIAC EQUIPMENT AND PATIENT CARE SERVICES IN THE HOSPITAL. ACTION ITEMS INCLUDE A MONTHLY WALKING PROGRAM WITH HEALTH EDUCATION LECTURES AND SCREENING HELD AT COMMUNITY CENTERS AND LOCAL MALLS; THE SOUTHLAND HEALTH FAIR WHICH PROVIDES EKG TESTS, CARDIAC COUNSELING, AND PATIENT EDUCATION AND REACHES MORE THAN 600 PARTICIPANTS; LIFELINE SCREENING OFFERED TO OVER 90 PATIENTS PER MONTH AT THE INGALLS WELLNESS CENTER; AND COMMUNITY HEALTH FAIRS, FEATURING INFORMATION BOOTHS, FITNESS TESTS, AND OTHER ACTIVITIES OFFERED IN PARTNERSHIP WITH THE AMERICAN HEART ASSOCIATION AND INGALLS CARDIOLOGY DEPARTMENT AND WELLNESS CENTER. TO ADDRESS CANCER, INGALLS WILL CONTINUE TO INVEST IN THE LARGEST COMMUNITY BASED CANCER RESEARCH PROGRAM IN THE SOUTH SUBURBS, SCREENING 300 PATIENTS ANNUALLY AND ENROLLING 60 PARTICIPANTS IN ACTIVE CLINICAL DRUG TRIALS, ONE THIRD OF WHICH ARE MINORITY PATIENTS. IN ADDITION, INGALLS WILL IMPLEMENT A NUMBER OF COMMUNITY BASED INITIATIVES, INCLUDING: CONQUERING BREAST CANCER FORUM, AN ANNUAL EVENT FOR 300-500 PARTICIPANTS IN WHICH A FREE FORUM ADDRESSES HEALTH DISPARITIES IN BREAST CANCER AMONG MINORITY PATIENTS POPULATIONS; FREE MAMMOGRAMS, THROUGH PARTNERSHIP WITH SILVER LINING FOUNDATION, TYPICALLY PROVIDED TO 5-10 PATIENTS PER MONTH; AND THE COMMUNITY IMPACT GRANT, FUNDED THROUGH INGALLS DEVELOPMENT FOUNDATION, WHICH SECURES RESOURCES FOR PATIENTS TO PAY FOR CANCER TREATMENTS. IN RESPONSE TO FINDINGS THAT OBESITY AND OVERWEIGHT CONDITIONS AMONG CHILDREN AND ADULTS ARE UNFAVORABLE IN THE REGION, INGALLS WILL IMPLEMENT A NUMBER OF ACTION STEPS, INCLUDING: NUTRITION COUNSELING OFFERED VIA A SERIES OF FREE WORKSHOPS AND COOKING DEMONSTRATIONS PROMOTING GOOD NUTRITION BY A LICENSED DIETICIAN; AND THE COMMUNITY GARDEN, LOCATED IN THE PARKING STRUCTURE OF INGALLS HOSPITAL, WHICH DELIVERS 200 POUNDS OF FRESH PRODUCE TO AREA FOOD PANTIES. TO ADDRESS FINDINGS THAT THE BIRTH WEIGHT AND INFANT DEATH RATE IN THE INGALLS SERVICE AREA IS WORSE THAN THE REGION, STATE, AND NATION, INGALLS WILL CONTINUE TO INVEST IN THE FOLLOWING ACTIONS: HEALTH BABY NETWORK, WHICH IS DESIGNED TO GET ECONOMICALLY DISADVANTAGED PREGNANT ADOLESCENTS AND TEENS THE HEALTHCARE AND SOCIAL SERVICES THEY NEED IN ORDER TO ENSURE HEALTHIER OUTCOMES FOR THEMSELVES AND THEIR UNBORN CHILDREN. THIS PROGRAM, ON AVERAGE, IS PROVIDED TO 7% OF THE 800-1,000 DELIVERIES MADE BY THE HOSPITAL EACH YEAR; KID FIT CAMP, IN WHICH AN ESTIMATED 500 PARTICIPANTS STRIVE TO ACHIEVE GRADUAL WEIGHT LOSS AND MAINTENANCE TO ENSURE PROPER GROWTH AND DEVELOPMENT; COMMUNITY SCHOLARSHIPS PROVIDE 14 SCHOLARSHIPS TO HIGH SCHOOL SENIORS WHO WILL BE SENIORS GRADUATING TO PURSUE CAREERS STUDYING HEALTHCARE. IN ADDITION TO THE PRIORITY AREAS IDENTIFIED, INGALLS REMAINS COMMITTED AS PART OF THE COMMUNITY HEALTH NEEDS IMPLEMENTATION TO ADDRESS, THROUGH DIRECT PATIENT CARE IN PARTNERSHIP WITH OUR PHYSICIANS, THE FOLLOWING HEALTH NEEDS IDENTIFIED IN THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT: CHRONIC KIDNEY DISEASE, DIABETES, HIV/AIDS, INJURY & VIOLENCE, MENTAL HEALTH, POTENTIALLY DISABLING CONDITIONS, RESPIRATORY DISEASE, SEXUALLY TRANSMITTED DISEASES, SUBSTANCE ABUSE, AND TOBACCO ABUSE.
PART V, SECTION B, LINE 16AHTTPS://WWW.INGALLS.ORG/PDF/INGALLS%20HOSPITAL%20FAP%20PROGRAM%20DETAILS.P DF PART V, SECTION B, LINE 16B HTTPS://WWW.INGALLS.ORG/PDF/FAP_APPLICATION.PDF PART V, SECTION B, LINE 16C HTTPS://WWW.INGALLS.ORG/PDF/INGALLS%20HOSPITAL%20FAP%20PROGRAM%20DETAILS.P DF
FieldValueIRS element (for citing)
Facility7FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
INGALLS FAMILY CARE CENTER
1600 TORRENCE AVENUECALUMET CITYIL60409URGENT AID, PRIMARY CARE, AND SPECIALIST SERVICES
INGALLS CARE CENTER
4742 CAL SAG ROADCRESTWOODIL60445QUICK CARE CENTER AND OCCUPATIONAL HEALTH
INGALLS FAMILY CARE CENTER
6701 WEST 159TH STREETTINLEY PARKIL60477URGENT AID, PRIMARY CARE, AND SPECIALIST SERVICES
INGALLS FAMILY CARE CENTER
19550 GOVERNORS HIGHWAYFLOSSMOORIL60422URGENT AID AND SPECIALIST SERVICES
INGALLS WELLNESS CENTER
2920 WELLNESS CENTERHOMEWOODIL60430COMPLEMENTARY MEDICINE AND COMMUNITY HEALTH PROGRAMS
THE VILLA AT SOUTH HOLLAND
16300 WAUSAU AVENUESOUTH HOLLANDIL60473HEALTHCARE AND REHABILITATION CENTER
INGALLS CARE CENTER
16246 PRINCE DRIVESOUTH HOLLANDIL60473INDUSTRIAL, MEDICAL REHABILITATION AND PHYSICIAN OFFICES

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3CAUTOMATIC UNINSURED SELF-PAY DISCOUNT A DISCOUNT OF 65% OF GROSS CHARGES, PROVIDED TO ALL UNINSURED PATIENTS WITHOUT REQUIRING EVIDENCE OF INABILITY TO PAY. THIS DISCOUNT IS DESIGNED TO ENSURE THAT PATIENTS ARE CHARGED AT A RATE GENERALLY COMPARABLE TO THAT APPLIED TO INSURED PATIENTS. 1. THERE IS NO APPLICATION PROCESS FOR THE PATIENT TO RECEIVE THE UNINSURED DISCOUNT. THE DISCOUNT IS APPLIED BASED ON THE ACCOUNTS SELF-PAY/UNINSURED STATUS. 2. PATIENTS RECEIVING PRE-NEGOTIATED DISCOUNTS FOR HOSPITAL SERVICES WILL NOT BE ELIGIBLE FOR THIS UNINSURED DISCOUNT. 3. IF A PATIENT IS SUBSEQUENTLY APPROVED FOR FINANCIAL ASSISTANCE, THE AUTOMATIC DISCOUNT WILL BE REVERSED SO THAT THE FULL AMOUNT CAN BE RECOGNIZED AS A CHARITY ALLOWANCE. 4. IF A PATIENT SUBSEQUENTLY PROVIDES EVIDENCE OF INSURANCE COVERAGE, THE AUTOMATIC DISCOUNT WILL BE REVERSED AND THE INSURANCE COVERAGE PROVIDED WILL BE BILLED ACCORDINGLY. 5. PATIENT WHO ARE OTHERWISE INSURED AND CHOOSE NOT TO USE THEIR INSURANCE COVERAGE ARE INELIGIBLE FOR THIS AUTOMATIC DISCOUNT. PART I, LINE 7 INGALLS UTILIZES A COST TO CHARGE METHODOLOGY. CHARGES ASSOCIATED WITH THE RELATED CATEGORIES ARE THEN USED TO DETERMINE COST RELATED TO SUCH REVENUE.
PART III, LINE 2THE AMOUNT REPORTED AS BAD DEBT EXPENSE IS DETERMINED BY APPLYING THE RATIO OF COST TO CHARGES (RCC) TO THE TOTAL CHARGES WRITTEN OFF TO BAD DEBT AS REPORTED IN THE AUDITED FINANCIAL STATEMENTS. THE RCC WAS DETERMINED UTILIZING WORKSHEET 2 FROM FORM 990, SCHEDULE H INSTRUCTIONS. THE BASIS FOR THIS COSTING METHODOLOGY IS THE HOSPITALS OPERATING EXPENSES (EXCLUDING BAD DEBT) ADJUSTED BY OTHER OPERATING REVENUE AND COMMUNITY BENEFIT EXPENSE DIVIDED BY GROSS PATIENT CHARGES. CHARGES.
PART III, LINE 3BASED ON AN ANALYSIS OF PATIENT ACCOUNT DETAIL, IT IS ESTIMATED THAT APPROXIMATELY 18.7% OF THE BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS WHO WOULD HAVE BEEN ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IF SUFFICIENT INFORMATION WAS OBTAINED. THE PERCENTAGE WAS DERIVED BY TAKING THE TOTAL AMOUNT OF BAD DEBT WRITTEN OFF FOR SELF PAY PATIENTS PER THE HOSPITAL'S PATIENT ACCOUNTS SYSTEM OVER THE TOTAL AMOUNT OF BAD DEBT WRITTEN OFF FOR ALL TYPES OF PATIENT ACCOUNTS.
PART III, LINE 4PATIENTS ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENTS ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS RECEIVABLE. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR 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 SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR ACCOUNTS RECEIVABLE, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH PATIENT RESPONSIBILITY (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 PATIENTS ARE SCREENED AGAINST THE SYSTEMS CHARITY CARE POLICY. FOR ANY REMAINING PATIENT RESPONSIBILITY BALANCE, THE SYSTEM RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS RECEIVABLE 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. THE SYSTEMS ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, WHICH INCLUDES UNINSURED PATIENTS, RESIDUAL COPAYMENTS AND DEDUCTIBLES FOR WHICH MANAGED CARE HAS ALREADY PAID, AND CERTAIN AGED MEDICAID AND MEDICAID MANAGED CARE ACCOUNTS RECEIVABLE, INCREASED FROM 21.5% OF ACCOUNTS RECEIVABLE AT SEPTEMBER 30, 2015 TO 28.8% OF ACCOUNTS RECEIVABLE AT SEPTEMBER 30, 2016. WRITE-OFFS INCREASED IN FISCAL YEAR 2016 TO 20,370. THE SYSTEM DID NOT HAVE SIGNIFICANT WRITE OFFS FROM THIRD PARTY PAYORS.
PART III, LINE 8THE HOSPITAL BELIEVES THE FULL AMOUNT OF THE SHORTFALL FROM MEDICARE SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE IT SERVES ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY, AND IT CANNOT NEGOTIATE CONTRACTUAL RATES WITH THE MEDICARE PROGRAM. THE HOSPITAL MUST ACCEPT WHAT THE MEDICARE PROGRAM PAYS. THE METHODOLOGY USED IN DETERMINING MEDICARE USED IN THE COMMUNITY BENEFITS REPORT IS MEDICARE CHARGES MULTIPLIED BY THE MEDICARE COST REPORT, COST TO CHARGE RATIO.
PART III, LINE 9BINGALLS MEMORIAL HOSPITAL HAS A FIDUCIARY DUTY TO SEEK REIMBURSEMENT FOR SERVICES IT HAS PROVIDED FROM INDIVIDUALS WHO ARE ABLE TO PAY, FROM THIRD PARTY INSURERS WHO COVER THE COST OF CARE, AND FROM OTHER PROGRAMS OF ASSISTANCE FOR WHICH THE PATIENT IS ELIGIBLE. TO DETERMINE WHETHER A PATIENT IS ABLE TO PAY FOR THE SERVICES PROVIDED AS WELL AS TO ASSIST THE PATIENT IN FINDING ALTERNATIVE COVERAGE OPTIONS IF THEY ARE UNINSURED OR UNDERINSURED, THE HOSPITAL FOLLOWS THE FOLLOWING CRITERIA RELATED TO BILLING AND COLLECTING FROM PATIENTS. COLLECTING INFORMATION ON PATIENT HEALTH COVERAGE AND FINANCIAL RESOURCES PATIENT OBLIGATIONS: PRIOR TO THE DELIVERY OF ANY HEALTH CARE SERVICES (EXCEPT FOR CASES THAT ARE AN EMERGENCY OR URGENT CARE SERVICE LEVEL), THE PATIENT IS EXPECTED TO PROVIDE TIMELY AND ACCURATE INFORMATION ON THEIR INSURANCE STATUS, DEMOGRAPHIC INFORMATION, CHANGES TO THEIR FAMILY INCOME OR INSURANCE STATUS, AND INFORMATION ON ANY DEDUCTIBLES OR CO-PAYMENTS THAT ARE OWED BASED ON THEIR EXISTING INSURANCE OR FINANCIAL PROGRAM'S PAYMENT OBLIGATIONS. THE DETAILED INFORMATION WILL INCLUDE: A. FULL NAME, ADDRESS, TELEPHONE NUMBER, DATE OF BIRTH, SOCIAL SECURITY NUMBER (IF AVAILABLE), CURRENT HEALTH INSURANCE COVERAGE OPTIONS, CITIZENSHIP AND RESIDENCY INFORMATION, AND THE PATIENT'S APPLICABLE FINANCIAL RESOURCES THAT MAY BE USED TO PAY THEIR BILL; B. FULL NAME OF THE PATIENT'S GUARANTOR, THEIR ADDRESS, TELEPHONE NUMBER, DATE OF BIRTH, SOCIAL SECURITY NUMBER (IF AVAILABLE), CURRENT HEALTH INSURANCE COVERAGE OPTIONS, AND THEIR APPLICABLE FINANCIAL RESOURCES THAT MAY BE USED TO PAY FOR THE PATIENT'S BILL; AND C. OTHER RESOURCES THAT MAY BE USED TO PAY THEIR BILL, INCLUDING OTHER INSURANCE PROGRAMS, MOTOR VEHICLE OR HOMEOWNERS INSURANCE POLICIES IF THE TREATMENT WAS DUE TO AN ACCIDENT, WORKER'S COMPENSATION PROGRAMS, AND STUDENT INSURANCE POLICIES, AMONG OTHERS. IT IS ULTIMATELY THE PATIENT'S OBLIGATION TO KEEP TRACK OF AND TIMELY PAY THEIR UNPAID HOSPITAL BILL, INCLUDING ANY EXISTING CO-PAYMENTS, CO-INSURANCE, AND DEDUCTIBLES. THE PATIENT IS FURTHER REQUIRED TO INFORM EITHER THEIR CURRENT HEALTH INSURER (IF THEY HAVE ONE) OR THE AGENCY THAT DETERMINED THE PATIENT'S ELIGIBILITY STATUS IN A PUBLIC HEALTH INSURANCE PROGRAM OF ANY CHANGES IN FAMILY INCOME OR INSURANCE STATUS. THE HOSPITAL MAY ALSO ASSIST THE PATIENT WITH UPDATING THEIR ELIGIBILITY IN A PUBLIC PROGRAM WHEN THERE ARE ANY CHANGES IN FAMILY INCOME OR INSURANCE STATUS, BUT ONLY IF THE HOSPITALS MADE AWARE BY THE PATIENT OF FACTS THAT MAY INDICATE A CHANGE IN THE PATIENT'S ELIGIBILITY STATUS. PATIENTS ARE REQUIRED TO NOTIFY THE STATE PUBLIC PROGRAM (OFFICE OF MEDICAID), INFORMATION RELATED TO ANY LAWSUIT OR INSURANCE CLAIM THAT WILL COVER THE COST OF THE SERVICES PROVIDED BY THE HOSPITAL. HOSPITAL OBLIGATIONS: INGALLS MEMORIAL HOSPITAL WILL MAKE ALL REASONABLE AND DILIGENT EFFORTS TO COLLECT THE PATIENT INSURANCE STATUS AND OTHER INFORMATION TO VERIFY COVERAGE FOR THE HEALTH CARE SERVICES TO BE PROVIDED BY INGALLS MEMORIAL HOSPITAL. THESE EFFORTS MAY OCCUR WHEN THE PATIENT IS SCHEDULING THEIR SERVICES, DURING PREREGISTRATION, WHILE THE PATIENT IS ADMITTED IN THE HOSPITAL, UPON DISCHARGE, OR DURING THE COLLECTION PROCESS WHICH MAY OCCUR FOR A REASONABLE TIME FOLLOWING DISCHARGE FROM THE HOSPITAL. THIS INFORMATION WILL BE OBTAINED PRIOR TO THE DELIVERY OF ANY NONEMERGENT AND NON-URGENT HEALTH CARE SERVICES (I.E., ELECTIVE PROCEDURES AND SCHEDULED PROCEDURES). INGALLS MEMORIAL HOSPITAL WILL DELAY ANY ATTEMPT TO OBTAIN THIS INFORMATION DURING THE DELIVERY OF ANY EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA) LEVEL EMERGENCY LEVEL OR URGENT CARE SERVICES, IF THE PROCESS TO OBTAIN THIS INFORMATION WILL DELAY OR INTERFERE WITH EITHER THE MEDICAL SCREENING EXAMINATION OR THE SERVICES UNDERTAKEN TO STABILIZE AN EMERGENCY MEDICAL CONDITION. THE HOSPITAL'S REASONABLE AND DILIGENT EFFORTS WILL INCLUDE, BUT IS NOT LIMITED TO, REQUESTING INFORMATION ABOUT THE PATIENT'S INSURANCE STATUS, CHECKING ANY AVAILABLE PUBLIC OR PRIVATE INSURANCE DATABASES, AND FOLLOWING THE BILLINGS RULES OF A KNOWN THIRD PARTY PAYER. IF THE PATIENT OR GUARANTOR/GUARDIAN IS UNABLE TO PROVIDE THE INFORMATION NEEDED, AND THE PATIENT CONSENTS, THE HOSPITAL WILL MAKE REASONABLE EFFORTS TO CONTACT RELATIVES, FRIENDS, GUARANTOR/GUARDIAN, AND THE THIRD PARTY FOR ADDITIONAL INFORMATION. INGALLS MEMORIAL HOSPITAL WILL ALSO MAKE REASONABLE AND DILIGENT EFFORTS TO INVESTIGATE WHETHER A THIRD PARTY RESOURCE MAY BE RESPONSIBLE FOR THE SERVICES PROVIDED BY THE HOSPITAL, INCLUDING BUT NOT LIMITED TO: (1) A MOTOR VEHICLE OR HOMEOWNER'S LIABILITY POLICY, (2) GENERAL ACCIDENT OR PERSONAL INJURY PROTECTION POLICIES, (3) WORKER'S COMPENSATION PROGRAMS, (4) STUDENT INSURANCE POLICIES, AMONG OTHERS. IN ACCORDANCE WITH APPLICABLE STATE REGULATIONS OR THE INSURANCE CONTRACT, FOR ANY CLAIM WHERE INGALLS MEMORIAL HOSPITAL'S REASONABLE AND DILIGENT EFFORTS RESULTED IN A PAYMENT FROM A PRIVATE INSURER OR PUBLIC PROGRAM, INGALLS MEMORIAL HOSPITAL WILL REPORT THE RECOVERY AND OFF SET IT AGAINST THE CLAIM PAID BY THE PRIVATE INSURER OR PUBLIC PROGRAM. THE HOSPITAL FURTHER MAINTAINS ALL INFORMATION IN ACCORDANCE WITH APPLICABLE FEDERAL AND STATE PRIVACY, SECURITY AND ID THEFT LAWS.
PART VI, LINE 2IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT THAT WAS CONDUCTED, THE HOSPITAL HAS A COMMUNITY RELATIONS DEPARTMENT WHOSE SOLE PURPOSE IS TO ASSESS AND ADDRESS THE HEALTHCARE NEEDS OF THE COMMUNITY. THE HOSPITAL PARTNERS WITH COMMUNITY GROUPS TO IDENTIFY NEEDS, STRENGTHEN EXISTING COMMUNITY PROGRAMS, AND PLAN NEWLY NEEDED SERVICES. SPECIFIC ATTENTION IS PAID TO THE NEEDS OF LOW INCOME AND VULNERABLE POPULATIONS.
PART VI, LINE 3THE HOSPITAL INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THE ELIGIBILITY FOR ASSISTANCE BY POSTING SIGNS THROUGHOUT THE PATIENT REGISTRATION AREAS REGARDING PATIENT PAYMENT OPTIONS. IN ADDITION, PATIENTS ARE INFORMED VIA THE HOSPITAL'S WEBSITE, INDIVIDUAL PATIENT STATEMENTS, AND FINANCIAL COUNSELORS. BELOW ARE SOME ADDITIONAL DETAILS REGARDING HOW THE HOSPITAL INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. SIGNAGE: SIGNS OR SIMILAR WRITTEN NOTICES REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAM WILL BE VISIBLE AT ALL HOSPITAL POINTS OF SERVICE TO CREATE AWARENESS OF THE FINANCIAL ASSISTANCE PROGRAM. AT A MINIMUM, SIGNAGE WILL BE POSTED IN THE EMERGENCY DEPARTMENT AND ADMISSION REGISTRATION AREA. ALL PUBLIC INFORMATION AND/OR FORMS REGARDING THE PROVISION OF FINANCIAL ASSISTANCE PROGRAM WILL USE LANGUAGES THAT ARE APPROPRIATE FOR THE SERVICE AREA IN ACCORDANCE WITH THE STATE'S LANGUAGE ASSISTANCE SERVICES ACT. HOSPITAL BILL/INVOICE: PATIENT BILLS OR STATEMENTS INCLUDE A PROMINENT STATEMENT THAT PATIENTS WHO MEET CERTAIN INCOME REQUIREMENTS MAY QUALIFY FOR FINANCIAL ASSISTANCE AND INFORMATION REGARDING HOW A PATIENT MAY APPLY FOR CONSIDERATION UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THE FOLLOWING ARE MADE PUBLICLY AVAILABLE VIA THE HOSPITALS WEBSITE, HTTPS://WWW.INGALLS.ORG/FINANCIAL-ASSISTANCE 1. PATIENT BROCHURES 2. FINANCIAL ASSISTANCE POLICY 3. APPLICATION FORMS USED TO DETERMINE A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE. 4. PLAIN LANGUAGE SUMMARY OF FINANCIAL ASSISTANCE POLICY
PART VI, LINE 4THE HOSPITAL'S IMMEDIATE SERVICES AREA FACES A NUMBER OF DIFFERENT CHALLENGES SUCH AS: *THE HIGHEST RATE IN THE METRO AREA FOR PERSONS BELOW POVERTY LEVEL, *THE GREATEST NUMBERS OF PERSONS ON MEDICAID, *THE HIGHEST RATES OF UNINSURED INDIVIDUALS, AND *THE HIGHEST RATES OF UNEMPLOYED INDIVIDUALS. THE MEDIAN INCOME FOR A HOUSEHOLD IN THE HOSPITAL'S SERVICE AREA WAS $22,014, AND THE MEDIAN INCOME FOR A FAMILY WAS $35,292. ABOUT 32.2% OF FAMILIES AND 36.4% OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 51.1% OF THOSE UNDER AGE 18 AND 18.7% OF THOSE AGE 65 OR OVER. THE INFORMATION ABOVE WAS OBTAINED FROM THE UNITED STATES CENSUS BUREAU. HTTP//FACTFINDER.CENSUS.GOV. 2015 DATA
PART VI, LINE 5INGALLS MEMORIAL HOSPITAL IS LOCATED IN HARVEY, IL, A COMMUNITY WHERE THE MEDIAN HOUSEHOLD INCOME IS $22,000. OF THE APPROXIMATELY 25,000 RESIDENTS, 36.4% LIVE AT OR BELOW THE POVERTY LINE (ACCORDING TO 2011-2015 AMERICAN COMMUNITY SURVEY 5-YEAR PROFILES). INGALLS IS COMMITTED TO PROMOTING THE HEALTH OF THE LOCAL COMMUNITY AND WORKS TO ADDRESS SPECIFIC NEEDS BY LEADING AND COLLABORATING ON PROJECTS THAT WILL DIRECTLY IMPACT THE HEALTHCARE OF AREA RESIDENTS. PROMOTION OF COMMUNITY HEALTH: ONE PROJECT THAT INGALLS OFFERS IS THE HEALTHY BABY NETWORK WHICH IS A COLLABORATION WITH LOCAL SOCIAL SERVICE AGENCIES TO PROVIDE PRENATAL MEDICAL CARE AND LINKAGE WITH SOCIAL SERVICE PROGRAMS FOR MOTHERS WHO ARE AT RISK FOR PRE-TERM DELIVERIES DUE TO LACK OF PRENATAL CARE. INGALLS ALSO OFFERS ACCESS TO FREE AND /DISCOUNTED PHYSICALS, DENTAL SCREENINGS AND VACCINATIONS FOR SCHOOL AGED CHILDREN WHO ARE AT RISK OF NOT STARTING THE SCHOOL YEAR ON TIME BECAUSE OF LACK OF ACCESS TO CARE. EACH YEAR INGALLS PROVIDES CARE TO BETWEEN 500 AND 600 CHILDREN ON DAY. IN ADDITION TO THE HEALTHCARE OFFERINGS, INGALLS HANDS OUT OVER 1,000 BAGS OF SCHOOL SUPPLIES TO CHILDREN IN ATTENDANCE SO THAT SOME OF THE FINANCIAL BURDEN CAN BE LIFTED FROM FAMILIES IN NEED. EACH YEAR INGALLS HOSTS A COMMUNITY HEALTH FAIR. THIS EVENT IS ONE OF THE MOST COMPREHENSIVE HEALTH FAIRS IN CHICAGOS SOUTHLAND REGION AND OFFERS OVER 25 FREE SCREENINGS (INCLUDING TOTAL CHOLESTEROL BLOOD TESTS AND 12-LEAD EKG). ON AVERAGE APPROXIMATELY 600 ATTENDEES TAKE ADVANTAGE OF THE FREE SCREENINGS FOR THIS EVENT AND THERE ARE NO RESIDENCY RESTRICTIONS. COMMUNITY BOARD: THE INGALLS BOARD OF DIRECTORS MEMBERSHIP IS COMPRISED OF LOCAL BUSINESS AND COMMUNITY MEMBERS THAT LIVE IN THE CHICAGO AND THE SOUTH SUBURBAN REGION. IN ADDITION TO THE PRESIDENT, ONE EMPLOYED PHYSICIAN SERVES AS AN ELECTED BOARD MEMBER. ALL MEMBERS ARE IN COMPLIANCE WITH THE BOARD CONFLICT OF INTEREST POLICY AND ARE REQUIRED TO COMPLETE AN ANNUAL CERTIFICATION AND DISCLOSURE FORM. QUALIFIED PHYSICIANS: INGALLS RESPONDS TO REQUESTS FOR APPLICATIONS TO JOIN THE MEDICAL STAFF MADE BY QUALIFIED PHYSICIANS IN THE COMMUNITY. THE INGALLS PROFESSIONAL AFFAIRS COMMITTEE REVIEWS INQUIRIES AND PROVIDES APPLICATIONS TO PHYSICIANS WHO MEET THE MINIMUM QUALIFICATIONS FOR MEDICAL STAFF MEMBERSHIP IF THERE IS A NEED FOR A PARTICULAR SERVICE AND/OR A PATIENT NEED EXISTS WITHIN THE COMMUNITY. STAFF EDUCATION: THE INGALLS MEDICAL STAFF SUPPORTS IMPROVEMENTS IN PATIENT CARE AND ONGOING EDUCATION TO THE MEDICAL AND PROFESSIONAL STAFF THROUGH FUNDING OF MEDICAL EDUCATION ACTIVITIES. INGALLS IS ACCREDITED BY THE ILLINOIS STATE MEDICAL SOCIETY TO AWARD CME CATEGORY 1 CREDIT. THE CME COMMITTEE IS RESPONSIBLE FOR OVERSIGHT OF MONTHLY CME ACTIVITIES WHICH ARE SPONSORED BY THE HOSPITAL. BOTH MEDICAL AND PROFESSIONAL (NURSING, QUALITY MANAGEMENT, ETC.) STAFF ARE INVITED AND ENCOURAGED TO ATTEND THE PROGRAMS.
PART VI, LINE 6THE INGALLS MEMORIAL HOSPITAL IS PART OF THE INGALLS HEALTH SYSTEM THAT IS NOW KNOWN AS UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. THE INGALLS HEALTH SYSTEM WAS INCORPORATED TO SUPPORT AND ENCOURAGE HEALTH AND HUMAN SERVICES THROUGH THE FOLLOWING AFFILIATES: *THE INGALLS MEMORIAL HOSPITAL *INGALLS HEALTH VENTURES *MEDCENTRIX, INC. *INGALLS DEVELOPMENT FOUNDATION *INGALLS HEALTH COUNCIL *INGALLS HOME CARE *INGALLS PROVIDER GROUP *INGALLS CASUALTY INSURANCE *INGALLS SAME DAY SURGERY, LTD. *INGALLS CARE NETWORK *PRIMARY HEALTHCARE ASSOCIATES, SC *PRIMARY HEALTHCARE ASSOCIATES, SC
PART VI, LINE 7THE INGALLS MEMORIAL HOSPITAL FILES A COMMUNITY BENEFIT REPORT WITH THE STATE OF ILLINOIS.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1INGALLS DEVELOPMENT FOUNDATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1One Ingalls DriveAddressLine1Txt
CityHarveyCityNm
State AbbreviationILStateAbbreviationCd
ZIP60426ZIPCd
FieldValueIRS element (for citing)
Recipient EIN363189150RecipientEIN
IRC Section501(c)(3)IRCSectionDesc
Cash Grant$20,050,000CashGrantAmt
Purpose Of GrantSUPPORTPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeSCHOLARSHIPSGrantTypeTxt
Recipient203RecipientCnt
Cash Grant$96,449CashGrantAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2FormAndLineReferenceDesc
ExplanationINGALLS MEMORIAL HOSPITAL (IMH) PROVIDED A CONTRIBUTION TO INGALLS DEVELOPMENT FOUNDATION (IDF) TO ADEQUATELY FUND AND PERPETUATE THE FOUNDATIONS OPERATIONS IN ORDER TO SUPPORT THE INGALLS HEALTH SYSTEM, NOW KNOWN AS UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. IMH ALSO PROVIDED A CONTRIBUTION TO IDF FOR THEIR YEARLY BENEFIT SHOW. SCHOLARSHIPS ARE PAID DIRECTLY TO THE EDUCATIONAL INSTITUTIONS IN ORDER TO ENSURE THE FUNDS ARE USED FOR THEIR INTENDED PURPOSE.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (15 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
MICHAEL HICKS
COO/BOARD MEMBER$488,826$0$90,722$0$20,691$0$7,950$0$29,760$0$637,949$0$0$0
KURT JOHNSON
PRESIDENT & CEO/BOARD MEMBER$1,214,467$0$224,120$0$32,145$0$7,950$0$37,315$0$1,515,997$0$0$0
KATHLEEN MIKOS
CHIEF NURSING/BOARD MEMBER$377,066$0$67,981$0$25,722$0$7,950$0$20,417$0$499,136$0$0$0
MARK KOZLOFF MD
PHYSICIAN/BOARD MEMBER$0$562,988$0$0$0$25,671$0$6,625$0$13,768$0$609,052$0$0
MICHAEL DEVORE
CHIEF INFORMATION OFFICER$229,844$0$23,637$0$10,839$0$7,090$0$21,193$0$292,603$0$0$0
DIANE JACOBY
ASSISTANT SECRETARY, VP$471,318$0$79,836$0$23,031$0$7,950$0$36,717$0$618,852$0$0$0
TAMARA PROFIRIO
VICE PRESIDENT/COO MEDCENTRIX$240,640$0$0$0$298$0$250$0$16,920$0$258,108$0$0$0
ALETHA ROSS
VICE PRESIDENT OF HR$267,877$0$53,224$0$2,318$0$6,600$0$20,595$0$350,614$0$0$0
ANDREW STEFO
VP - FINANCE/CFO$510,723$0$94,351$0$25,722$0$7,950$0$16,313$0$655,059$0$0$0
SCOTT STRAUSSER
VP - BUSINESS DEVELOPMENT$424,514$0$69,191$0$20,691$0$7,950$0$12,596$0$534,942$0$0$0
LINDA CONWAY
ASSOCIATE GENERAL COUNSEL$197,029$0$16,500$0$3,684$0$6,366$0$870$0$224,449$0$0$0
MARY JO CRANDALL
LEAN FACILITATOR$187,857$0$23,143$0$746$0$5,552$0$308$0$217,606$0$0$0
LAWRENCE KLONOWSKI
MANAGER MEDICAL PHYSICS$198,662$0$0$0$7,884$0$5,342$0$27,925$0$239,813$0$0$0
LYNN PHILIPSON
DIRECTOR OF MANAGED CARE$169,296$0$25,500$0$4,583$0$5,838$0$663$0$205,880$0$0$0
HEIDI RUHE
ASSOC VP BUSINESS DEVELOPMENT$157,548$0$39,962$0$1,065$0$3,011$0$37,003$0$238,589$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PART I, LINE 3INGALLS MEMORIAL HOSPITAL IS RESPONSIBLE FOR DETERMINING AND ADMINISTERING COMPENSATION FOR ALL OFFICERS OF EACH RESPECTIVE ENTITY WITHIN THE UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. CORPORATE STRUCTURE. BELOW IS THE PROCESS USED TO ESTABLISH COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL. IN SETTING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION, THE EXECUTIVE COMMITTEE RELIES ON RECENT COMPARABILITY STUDIES THAT PROVIDE COMPENSATION DATA FOR SIMILARLY QUALIFIED PERSONS IN COMPARABLE ORGANIZATIONS TO SUPPORT ITS DECISION-MAKING PROCESS. IN ADDITION, THE ORGANIZATION RECEIVED AN INDEPENDENT COMPENSATION REVIEW BY WILLIS TOWERS WATSON IN SEPTEMBER 2015. THE COMMITTEE ADEQUATELY DOCUMENTS ITS COMPENSATION DETERMINATIONS, DELIBERATIONS, AND APPROVAL OF THE TOP MANAGEMENT OFFICIAL'S COMPENSATION IN THE MEETING MINUTES. THE PROCESS FOR REVIEWING AND DETERMINING COMPENSATION FOR THE CEO WAS LAST UNDERTAKEN IN SEPTEMBER 2015.
SCHEDULE J, PART I, LINE 4SOME OF THE INDIVIDUALS LISTED ON THE FORM 990 HAVE A SEVERANCE PROVISION IN CONJUNCTION WITH THEIR EMPLOYMENT WITH THE HOSPITAL. THE SEVERANCE PROVISIONS RANGE FROM 26 WEEKS TO 76 WEEKS, DEPENDING ON THE TERM OF EMPLOYMENT, WITH UP TO AN ADDITIONAL 24 WEEKS TO 30 WEEKS SEVERANCE IF THE LOSS OF EMPLOYMENT OCCURS AS A RESULT OF JOB ELIMINATION OR GOOD REASON TERMINATION AS A RESULT OF A CHANGE OF CONTROL.
SCHEDULE J, PART I, LINE 7THE COMPENSATION PACKAGE FOR THE CEO INCLUDES THE OPPORTUNITY TO EARN INCENTIVE COMPENSATION BASED ON A COMBINATION OF MEETING OR EXCEEDING PRE-DETERMINED GOALS. ALL INCENTIVE COMPENSATION IS SUBJECT TO REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE AND HAS BEEN REPORTED ON SCHEDULE J, PART II, COLUMN B(II).

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
ILLINOIS FINANCE AUTHORITY
A86109196745200BHK72007-11-16$48,000,000REFUNDING OF 2004 BOND ISSUANCEfalsefalsefalse
ILLINOIS FINANCE AUTHORITY
B86109196745203HPE62013-02-06$64,815,040REFUNDING /1994 ISSUANCE & CAPITALfalsefalsefalse

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtBond DefeasedBondDefeasedAmtTotal ProceedsTotalProceedsAmtIn Reserve FundInReserveFundAmtCapitalized InterestCapitalizedInterestAmtRefunding EscrowRefundingEscrowAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCredit EnhancementCreditEnhancementAmtWorking Capital ExpendituresWorkingCapitalExpendituresAmtCapital ExpendituresCapitalExpendituresAmtOther Spent ProceedsOtherSpentProceedsAmtUnspentUnspentAmtSubstantial CompletionSubstantialCompletionYrCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintInd
A$2,200,000$0$48,000,000$0$0$0$0$0$0$0$48,000,000$02007Yes (true)falseYes (true)Yes (true)
B$0$0$64,815,292$0$0$0$1,183,106$0$0$30,160,252$33,471,934$02015Yes (true)falsefalseYes (true)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndPrivate Bus Use By OthersPrivateBusUseByOthersPctBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndRemedial Action TakenRemedialActionTakenIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
Afalsefalsefalsefalse0falsefalsefalsefalse
Bfalsefalsefalsefalse0falsefalsefalsefalse

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndTerm Of HedgeTermOfHedgePctSuperintegrated HedgeSuperintegratedHedgeIndHedge TerminatedHedgeTerminatedIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndBusiness Name Line1GICProviderName/BusinessNameLine1TxtGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
Merrill Lynch
AfalsefalsefalseYes (true)Yes (true)Yes (true)29.5falsefalsefalse0falsefalse
0
BfalseYes (true)falsefalsefalsefalsefalse0falsefalse

Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
Afalse
Bfalse

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
TOTAL PROCEEDS OF ISSUEBOND ISSUE B, PART II, LINE 3 THE DIFFERENCE BETWEEN THE ISSUE PRICE AND TOTAL PROCEEDS OF ISSUE IS INTEREST EARNINGS OF $252.
NO REBATE DUEBOND A, PART IV, LINE 4C THE COMPUTATION DATE FOR THE NOVEMBER 16, 2007 BOND ISSUE IS JANUARY 17, 2013.
WRITTEN PROCEDURESTHE ORGANIZATION IS IN THE PROCESS OF ADOPTING WRITTEN PROCEDURES.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (17 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, LINE 1ATHE BOARD OF DIRECTORS SHALL APPOINT ANNUALLY FROM ITS MEMBERSHIP AN EXECUTIVE COMMITTEE OF NOT LESS THAN FIVE (5) NOR MORE THAN NINE (9) MEMBERS, OF WHICH THREE (3) MEMBERS SHALL BE THE CHAIRMAN, THE VICE CHAIRMAN, AND THE SECRETARY/TREASURER OF THE HOSPITAL. THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE ALL OF THE POWERS OF THE BOARD OF DIRECTORS NOT PROHIBITED BY STATUTE OR SECTION 1 OF THE HOSPITAL'S BYLAWS BETWEEN MEETINGS THEREOF.
FORM 990, PART VI, LINE 4ON OCTOBER 1, 2016, THE UNIVERSITY OF CHICAGO MEDICAL CENTER (UCMC), AN INDEPENDENT HEALTH SYSTEM SERVING CHICAGO, ACQUIRED INGALLS HEALTH SYSTEM (IHS), NOW KNOWN AS UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC., AND ITS AFFILIATES THROUGH AN AFFILIATION AND MEMBER SUBSTITUTION. AS A RESULT OF THIS TRANSACTION, IHS AND ITS AFFILIATES BECAME A WHOLLY-OWNED SUBSIDIARY OF UCMC THROUGH A NEWLY CREATED COMMUNITY HEALTH AND HOSPITAL DIVISION OF UCMC. INGALLS MEMORIAL HOSPITAL (IMH) FILED AMENDED AND RESTATED ARTICLES OF INCORPORATION ON SEPTEMBER 30, 2016 TO REFLECT THE FOLLOWING CHANGES: - THE NAME OF ITS SOLE MEMBER CHANGED FROM INGALLS HEALTH SYSTEM TO UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. - IN THE EVENT OF DISSOLUTION, IMH WILL FIRST PAY OR MAKE PROVISION FOR THE PAYMENT OF ALL OF THE LIABILITIES AND OBLIGATIONS OF THE ORGANIZATION. THEREAFTER, THE BOARD WILL ADOPT AND IMPLEMENT A PLAN OF DISTRIBUTION TO THE SOLE MEMBER, IF THE SOLE MEMBER IS IN EXISTENCE AND QUALIFIED UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). IF THE SOLE MEMBER IS NOT IN EXISTENCE OR SO QUALIFIED, THE ASSETS WILL BE DISTRIBUTED TO AN ORGANIZATION THAT AT THE TIME QUALIFY UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). ANY SUCH ASSETS NOT DISPOSED WILL BE DISPOSED OF BY A COURT OF COMPETENT JURISDICTION OF THE COUNTY IN WHICH THE PRINCIPAL OFFICE OF THE ORGANIZATION IS THEN LOCATED TO AN ORGANIZATION(S) QUALIFIED UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). IN ADDITION, IMH AMENDED AND RESTATED ITS BYLAWS ON SEPTEMBER 30, 2016 TO REFLECT THE FOLLOWING CHANGES: - THE PURPOSES OF IMH WILL BE TO PROMOTE ANY TYPE AND NUMBER OF HEALTH CARE SERVICES, EDUCATIONAL SERVICES, RESEARCH SERVICES, AND ASSISTANCE TO UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. - THE NAME OF ITS SOLE MEMBER CHANGED FROM INGALLS HEALTH SYSTEM TO UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. - SECTIONS ADDED AND AMENDED TO DESCRIBE THE GENERAL POWERS AND RESERVED POWERS OF THE SOLE MEMBER. - AMENDMENTS TO THE GENERAL POWERS OF THE BOARD OF DIRECTORS. - THE NUMBER OF DIRECTORS SHALL BE SEVENTEEN AND THE NUMBER OF DIRECTORS EX OFFICIO SHALL BE EIGHT. - AT ALL MEETINGS OF THE BOARD OF DIRECTORS A MAJORITY THEREOF OR NINE DIRECTORS WHICHEVER SHALL BE LESS, PROVIDED THAT IN NO EVENT SHALL A QUORUM CONSIST OF LESS THAN ONE-THIRD (1/3) OF THE WHOLE BOARD OF DIRECTORS, SHALL BE NECESSARY AND SUFFICIENT TO CONSTITUTE A QUORUM FOR THE TRANSACTION OF BUSINESS, AND THE ACT OF A MAJORITY OF THE DIRECTORS PRESENT AT A MEETING AT WHICH THERE IS A QUORUM SHALL BE THE ACT OF THE BOARD OF DIRECTORS. - THE OFFICERS OF THE CORPORATION SHALL BE A PRESIDENT, A SECRETARY/TREASURER, AND SUCH OTHER OFFICERS AND ASSISTANT OFFICERS AS THE BOARD MAY AUTHORIZE. - THE ARTICLES OF INCORPORATION AND BYLAWS OF IMH MAY BE AMENDED, MODIFIED OR REPEALED, AND NEW AND DIFFERENT BYLAWS AND ARTICLES OF INCORPORATION MAY BE ADOPTED, ONLY BY THE SOLE MEMBER.
FORM 990, PART VI, LINE 6PURSUANT TO THE ORGANIZATION'S GOVERNING DOCUMENTS, THE SOLE VOTING MEMBER OF THE ORGANIZATION IS UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC., FORMERLY KNOWN AS INGALLS HEALTH SYSTEM, A RELATED TAX-EXEMPT ORGANIZATION. AS THE ORGANIZATION'S SOLE CORPORATE MEMBER, IT HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE. FORM 990, PART VI, LINE 7A PRIOR TO 9/30/2016, UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. (FORMERLY INGALLS HEALTH SYSTEM) HAS THE RIGHT TO ELECT AND APPOINT ANY BOARD OF DIRECTOR OF THE ORGANIZATION. EFFECTIVE 9/30/2016, DIRECTORS, OTHER THAN THE DIRECTORS EX OFFICIO, SHALL BE ELECTED ANNUALLY BY UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC., OR AT SUCH OTHER TIMES AS MAY BE DETERMINED BY THE SOLE MEMBER OF THE CORPORATION.
FORM 990, PART VI, LINE 7BPRIOR TO 9/30/2016, UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. (FORMERLY INGALLS HEALTH SYSTEM) HAS THE RIGHT TO REMOVE ANY BOARD OF DIRECTOR OF THE ORGANIZATION WITHOUT CAUSE AT ANY TIME. UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. HAS THE EXCLUSIVE RIGHT TO APPROVE OR RATIFY SIGNIFICANT DECISIONS OF THE ORGANIZATION'S GOVERNING BODY. SIGNIFICANT DECISIONS OF THE ORGANIZATION'S GOVERNING BODY INCLUDE, BUT ARE NOT LIMITED TO, THE RIGHT TO APPROVE LONG-TERM CAPITAL AND OPERATIONAL BUDGETS, TO APPROVE A PLAN OF DISSOLUTION OR MERGER WITH ANOTHER ORGANIZATION, AND TO APPROVE THE DEVELOPMENT, CONSTRUCTION OR IMPLEMENTATION OF ANY NEW HEALTHCARE FACILITY, PROGRAM, OR SERVICE. EFFECTIVE 9/30/2016, UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. SHALL RETAIN THE RIGHT TO REMOVE ANY DIRECTOR, OTHER THAN DIRECTORS EX OFFICIO, WITH OR WITHOUT CAUSE, AT ANY TIME. UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. MUST APPROVE ANY MODIFICATION OR AMENDMENT TO ANY MISSION STATEMENT, STATEMENT OF GOALS OR VALUES, THE ARTICLES OF INCORPORATION OR THE BYLAWS OF THE CORPORATION; THE SALE, LEASE, EXCHANGE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; AND THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION.
FORM 990, PART VI, LINE 11BTHE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH INFORMATION PROVIDED BY MANAGEMENT. THE FULL FORM 990, INCLUDING SUPPLEMENTAL SCHEDULES, WAS PRESENTED BY THE CHIEF FINANCIAL OFFICER TO THE FINANCE COMMITTEE AT A COMMITTEE MEETING. THE FULL BOARD HAS GRANTED TO THE FINANCE COMMITTEE AUTHORITY TO APPROVE THE FORM 990. THE FULL BOARD WILL RECEIVE A REPORT FROM THE FINANCE COMMITTEE DESCRIBING THE FINANCE COMMITTEES REVIEW PERFORMED. PRIOR TO FILING WITH THE IRS, THE FORM 990 WILL BE AVAILABLE AT THE ORGANIZATIONS BOARD MEETING FOR EACH MEMBERS REVIEW.
FORM 990, PART VI, LINE 12CPURSUANT TO THE ORGANIZATIONS CONFLICT OF INTEREST POLICY, ALL OFFICERS, DIRECTORS, BOARD MEMBERS, AND KEY EMPLOYEES MUST AVOID SITUATIONS IN WHICH THEIR PERSONAL INTERESTS MAY CONFLICT, OR APPEAR TO CONFLICT, WITH THE INTEREST OF INGALLS, AND INGALLS REVIEWS ITS OWN RELATIONSHIPS WITH OTHER CARE PROVIDERS, EDUCATIONAL INSTITUTIONS, AND PAYERS TO DETERMINE IF POTENTIAL CONFLICTS EXISTS. BOARD MEMBERS AND EMPLOYEES SHALL HAVE THE CONTINUING AFFIRMATIVE DUTY TO REPORT TO THE PRESIDENT AND CHIEF FINANCIAL OFFICER (CEO) OF INGALLS ANY PERSONAL OWNERSHIP OF INTEREST OR OTHER RELATIONSHIP THAT MIGHT AFFECT THEIR ABILITY TO EXERCISE IMPARTIAL, ETHICAL BUSINESS JUDGMENTS IN THE AREA OF THEIR RESPONSIBILITIES. PER THE ORGANIZATIONS CONFLICT OF INTEREST POLICY, BOARD MEMBERS AND EMPLOYEES AT MANAGEMENT LEVEL WILL BE REQUIRED TO COMPLETE A CERTIFICATION AND DISCLOSURE FORM, ON A SCHEDULE DETERMINED BY THE CORPORATE COMPLIANCE OFFICER. COMPLETION OF THIS FORM IS A REQUIREMENT FOR ALL BOARD MEMBERS AND MANAGERIAL EMPLOYEES, AND MAY BE REQUIRED OF NON-MANAGEMENT EMPLOYEES AS DETERMINED BY THE PRESIDENT AND CEO AND CORPORATE COMPLIANCE OFFICER. EMPLOYEES ALSO HAVE A DUTY TO REPORT CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST OF WHICH THEY MAY BE AWARE OF INVOLVING OTHER EMPLOYEES. EACH SITUATION REPORTED SHALL BE REVIEWED BY THE PRESIDENT AND CEO, AND INGALLS CORPORATE COMPLIANCE OFFICER, AND A DETERMINATION SHALL BE MADE AS TO WHETHER A CONFLICT OF INTEREST EXISTS OF MAY ARISE FROM SUCH SITUATION. THE DECISION OF THE PRESIDENT AND CEO AND CORPORATE COMPLIANCE OFFICER REGARDING WHETHER A CONFLICT EXISTS SHALL BE FINAL. PERSONS WITH A CONFLICT ARE PROHIBITED FROM PARTICIPATING IN THE GOVERNING BODYS RESOLUTION OF SUCH CONFLICT. THE ORGANIZATION FURTHER PROMOTES KNOWLEDGE AND UNDERSTANDING OF THE CONFLICT OF INTEREST POLICY IN THE EMPLOYEE HANDBOOK. EACH EMPLOYEE IS REQUIRED TO SIGN AN ACKNOWLEDGEMENT OF THE HANDBOOK UPON EMPLOYMENT.
FORM 990, PART VI, LINE 15AINGALLS MEMORIAL HOSPITAL IS RESPONSIBLE FOR DETERMINING AND ADMINISTERING COMPENSATION FOR ALL OFFICERS OF EACH RESPECTIVE ENTITY WITHIN THE UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. CORPORATE STRUCTURE. BELOW IS THE PROCESS USED TO ESTABLISH COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL. IN SETTING THE TOP MANAGEMENT OFFICIALS COMPENSATION, THE EXECUTIVE COMMITTEE RELIES ON RECENT COMPARABILITY STUDIES THAT PROVIDE COMPENSATION DATA FOR SIMILARLY QUALIFIED PERSONS IN COMPARABLE ORGANIZATIONS TO SUPPORT ITS DECISION-MAKING PROCESS. IN ADDITION, THE ORGANIZATION RECEIVED AN INDEPENDENT COMPENSATION REVIEW BY WILLIS TOWERS WATSON IN SEPTEMBER 2015. THE COMMITTEE ADEQUATELY DOCUMENTS ITS COMPENSATION DETERMINATIONS, DELIBERATIONS, AND APPROVAL OF THE TOP MANAGEMENT OFFICIALS COMPENSATION IN THE MEETING MINUTES. THE PROCESS FOR REVIEWING AND DETERMINE COMPENSATION FOR THE CEO WAS LAST UNDERTAKEN IN SEPTEMBER 2015.
FORM 990, PART VI, LINE 15BAN OUTSIDE COMPENSATION CONSULTANT IS USED TO RENDER A REASONABLE OPINION AS TO WHAT PERCENTAGE OF INCREASE AN OFFICER OR KEY EMPLOYEE SHOULD RECEIVE BY PERFORMING A MARKET COMPARISON FOR ALL OFFICERS AND KEY EMPLOYEES. THE PROCESS TO DETERMINE AN INCREASE IN COMPENSATION OF SALARY INCREASES ARE APPROVED ANNUALLY BY THE PRESIDENT AND EXECUTIVE COMMITTEE ONCE RECEIVED BY THE OUTSIDE CONSULTANT. DIRECTORS AND MANAGERS RECEIVE AN INCREASE IN COMPENSATION BASED ON WHETHER OR NOT PERFORMANCE GOALS HAVE BEEN REACHED BEFORE A FISCAL YEAR STARTS. PERFORMANCE GOALS ARE PUT TOGETHER BY THE DIRECTOR OR MANAGER AND SUBMITTED TO THE VICE PRESIDENT FOR APPROVAL. APPROVED GOALS ARE THEN REVIEWED BY ALL OTHER EXECUTIVES. ONCE APPROVED BY ALL, THESE ARE THE GOALS FOR THE YEAR AFTER THE YEAR IS OVER. THE PERFORMANCE GOALS ARE REVIEWED BY THE VICE PRESIDENT AND DIRECTOR OR MANAGER. MARKET ADJUSTMENTS ARE SET BY THE IMMEDIATE VICE PRESIDENT AND SENT TO ALL EXECUTIVES FOR THEIR APPROVAL.
FORM 990, PART VI, LINE 19DURING FISCAL YEAR ENDED 9/30/2016, THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICTS OF INTEREST POLICIES WERE NOT MADE PUBLICLY AVAILABLE. THE HOSPITAL IS IN THE PROCESS OF CHANGING THIS POLICY FOR THE FOLLOWING FISCAL PERIOD.
FORM 990, PART VII, SECTION B, LINE 1EXPENSES OF INGALLS MEMORIAL HOSPITAL (IMH) AND RELATED ENTITIES (SEE SCHEDULE R) ARE PAID BY INGALLS HEALTH SYSTEM (IHS) NOW KNOWN AS UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. IHS IS RESPONSIBLE FOR ISSUING THE 1099'S TO INDEPENDENT CONTRACTORS, AND SUBSEQUENTLY ALLOCATES A PERCENTAGE OF THE EXPENSE AND RECEIVES REIMBURSEMENT FROM THE RELATED ENTITIES.
FORM 990, PART VIII, LINE 7ATHE ORGANIZATION'S INVESTMENTS ARE HELD IN A POOLED INVESTMENT ACCOUNT MANAGED BY NORTHERN TRUST. REALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. THE INGALLS MEMORIAL HOSPITAL RECEIVES MONTHLY INFORMATION ON THE FUNDS FROM NORTHERN TRUST AND DETERMINES THE TOTAL GAIN OR LOSS AMOUNTS. HOWEVER DETAIL IS NOT PROVIDED.
FORM 990, PART XI, LINE 9INTEREST RATE SWAP VALUATION (2,394,157) CHANGE IN INTEREST OF FOUNDATION (391,000) ------------ Total (2,785,157)
FORM 990 PART IX LINE 11GDESCRIPTION:Data processing TOTAL FEES:10976225
FORM 990 PART IX LINE 11GDESCRIPTION:PHYSICIAN FEES TOTAL FEES:9154896
FORM 990 PART IX LINE 11GDESCRIPTION:ENVIRONMENTAL TOTAL FEES:4442492
FORM 990 PART IX LINE 11GDESCRIPTION:BIOMED TOTAL FEES:4188070
FORM 990 PART IX LINE 11GDESCRIPTION:CONTRACT SERVICES TOTAL FEES:38161812

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
INGALLS DEVELOPMENT FOUNDATION
ONE INGALLS DRIVEHARVEYIL60426363189150SUPPORTIL501(C)(3)7UCHHDfalse
INGALLS HOME CARE
ONE INGALLS DRIVEHARVEYIL60426363367939HEALTHCAREIL501(C)(3)9IMHYes (true)
UCM COMMUNITY HEALTH & HOSPITAL DIVISION
ONE INGALLS DRIVEHARVEYIL60426363181170MANAGEMENTIL501(C)(3)11 TYPE IIUCMCfalse
INGALLS HEALTH VENTURES
ONE INGALLS DRIVEHARVEYIL60426363239703AMBULATORYIL501(C)(3)11 TYPE IIUCHHDfalse
PRIMARY HEALTHCARE ASSOCIATES SC
71 W 156TH STREETHARVEYIL60426364132865HEALTHCAREIL501(C)(3)9UCHHDfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1INGALLS SAME DAY SURGERY CENTERBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line16701 W 159TH STREETAddressLine1Txt
CityTINLEY PARKCityNm
State AbbreviationILStateAbbreviationCd
ZIP60477ZIPCd
FieldValueIRS element (for citing)
EIN363368549EIN
Primary ActivitiesSURGERY CENTERPrimaryActivitiesTxt
Legal Domicile StateILLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1Txt
FieldValueIRS element (for citing)
Predominant Income TypeN/APredominantIncomeTypeTxt
Share Of Total Income$0ShareOfTotalIncomeAmt
Share Of EOY Assets$0ShareOfEOYAssetsAmt
UBI Code V$0UBICodeVAmt
Ownership0.00000OwnershipPct

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPctControlled OrganizationControlledOrganizationIndLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
INGALLS PROVIDER GROUP
ONE INGALLS DRIVEHARVEYIL60426363485578INSURANCE SERVICEILIMHC Corp$0$7,444,5431.00000Yes (true)
MEDCENTRIX INC
ONE INGALLS DRIVEHARVEYIL60426363374228BILLING & MGMTILUCHHDC Corp$0$00.00000false
INGALLS CASUALTY INSURANCE LTD
ONE INGALLS DRIVEHARVEYIL60426980485714LIAB INSURANCEUCHHDC Corp$0$00.00000falseCJ
INGALLS HEALTH COUNCIL
ONE INGALLS DRIVEHARVEYIL60426273226539PURCHASING GROUPILUCHHDC Corp$0$00.00000false
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (true)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1INGALLS HOME CAREBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction Typea(iv)TransactionTypeTxt
Involved$84,000InvolvedAmt
Method Of Amount DeterminationFMVMethodOfAmountDeterminationTxt