2017-07-31T16:12:05-05:00 2016-09-30 KPMG LLP 200 East Randolph Street Ste 5500 Chicago IL 60601 990 2015-10-01 362170866 THE INGALLS MEMORIAL HOSPITAL % GARY GASBARRA INGA 7083332300 ONE INGALLS DRIVE HARVEY IL 60426 RICHARD SILVERIA EVP AND CFO 7083332300 2017-07-28 true Tara D'Agostino P01245482 3126651000 2015 2021-01-29 14:40:06Z KURT E JOHNSON ONE INGALLS DRIVE HARVEY IL 60426 297697278 false X WWW.INGALLS.ORG X 1922 IL INGALLS MEMORIAL HOSPITAL IS A NOT-FOR PROFIT ACUTE CARE HOSPITAL ORGANIZED FOR THE PURPOSE OF PROVIDING PATIENT CARE, EDUCATION, AND RESEARCH. 23 19 2705 182 961319 997367 2000693 282051535 279421204 19283201 13716080 2036175 1781802 304368278 296919779 126600 20146449 0 0 114252979 111633854 0 0 0 163455298 185587731 277834877 317368034 26533401 -20448255 534093025 482410942 211611577 195829295 322481448 286581647 INGALLS 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. false false 227322111 20119699 180293418 INGALLS 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. 26743145 60960180 THE 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. 19059709 39158179 INGALLS 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. 273124965 true true false true false false false false false false true false false false true true false true false false false false false false false false true true true true true true false false false false false false false false false false false false false false false true true true false false true 352 0 true 2705 true true true false false false false false false false false false X 23 19 false false true false true true true true true false false true true true true true true true true false IL X GARY GASBARRA 7083332300 ONE INGALLS DRIVE HARVEY IL 60426 X EUGENE FEINGOLD CHAIRMAN OF THE BOARD 1.0 3.0 X X 0 0 0 RICHARD KING BOARD MEMBER, SECRETARY 1.0 2.0 X X 0 0 0 DENNIS IRVIN BOARD MEMBER, VICE CHAIRMAN 1.0 2.0 X X 0 0 0 MICHAEL HICKS COO/BOARD MEMBER 40.0 0.0 X X 600239 0 37710 KURT JOHNSON PRESIDENT & CEO/BOARD MEMBER 40.0 4.0 X X 1470732 0 45265 KATHLEEN MIKOS CHIEF NURSING/BOARD MEMBER 40.0 0.0 X X 470769 0 28367 STEVEN ANDERSON BOARD MEMBER 1.0 0.0 X 0 0 0 RICHARD ANDERSON BOARD MEMBER 1.0 0.0 X 0 0 0 LYNDELL BECKHAM BOARD MEMBER 1.0 1.0 X 0 0 0 SAMUEL CUTRARA JR BOARD MEMBER 1.0 1.0 X 0 0 0 HEATHER DAVIS BOARD MEMBER 1.0 1.0 X 0 0 0 ROBERT HARRIS BOARD MEMBER 1.0 1.0 X 0 0 0 JERRY ITKONEN MD BOARD MEMBER 0.0 0.0 X 0 0 0 HENRY JOHNSON BOARD MEMBER 1.0 1.0 X 0 0 0 TIMOTHY JOHNSON BOARD MEMBER 1.0 1.0 X 0 0 0 CARL JOHNSON II MD BOARD MEMBER 1.0 0.0 X 0 0 0 MICHAEL KAMRADT BOARD MEMBER 1.0 1.0 X 0 0 0 NEAL KITCHELL BOARD MEMBER 1.0 1.0 X 0 0 0 MARK KOZLOFF MD PHYSICIAN/BOARD MEMBER 1.0 42.0 X 0 588659 20393 DAVID ORTH MD BOARD MEMBER 1.0 2.0 X 0 0 0 CRESSA PERISH MD BOARD MEMBER 1.0 0.0 X 0 0 0 KEVIN PURCELL BOARD MEMBER 1.0 1.0 X 0 0 0 NATHANIEL SUTTON BOARD MEMBER 1.0 1.0 X 0 0 0 MICHAEL DEVORE CHIEF INFORMATION OFFICER 40.0 0.0 X 264320 0 28283 PAUL DONOHUE VP PHILANTHROPY AND COMMUNITY 40.0 0.0 X 90980 0 13902 DIANE JACOBY ASSISTANT SECRETARY, VP 40.0 2.0 X 574185 0 44667 DEBORAH NELSON VICE PRESIDENT/COO MEDCENTRIX 40.0 0.0 X 85331 0 19966 TAMARA PROFIRIO VICE PRESIDENT/COO MEDCENTRIX 40.0 0.0 X 240938 0 17170 ALETHA ROSS VICE PRESIDENT OF HR 40.0 0.0 X 323419 0 27195 ANDREW STEFO VP - FINANCE/CFO 40.0 1.0 X 630796 0 24263 SCOTT STRAUSSER VP - BUSINESS DEVELOPMENT 40.0 0.0 X 514396 0 20546 LINDA CONWAY ASSOCIATE GENERAL COUNSEL 40.0 0.0 X 217213 0 7236 MARY JO CRANDALL LEAN FACILITATOR 40.0 0.0 X 211746 0 5860 LAWRENCE KLONOWSKI MANAGER MEDICAL PHYSICS 40.0 0.0 X 206546 0 33267 LYNN PHILIPSON DIRECTOR OF MANAGED CARE 40.0 0.0 X 199379 0 6501 HEIDI RUHE ASSOC VP BUSINESS DEVELOPMENT 40.0 0.0 X 198575 0 40014 6299564 588659 420605 112 false true false ARAMARK CORPORATION 25271 NETWORK PLACE CHICAGO IL 60673 CONTRACT FOOD, PLANT 22356227 SYNERGY BEHAVIORAL HEALTHCARE 1566 W ALGONQUIN ROAD 3149 HOFFMAN ESTATES IL 60192 IN PT AND OUT PT PSY 4881100 CERNER HEALTH SERVICES C/O US BANK PO BOX 959167 ST LOUIS MO 63195 IT SUPPORT 4791070 REED CONSTRUCTION 600 W JACKSON BLVD STE 500 CHICAGO IL 606615625 CONSTRUCTION COMPANY 4393859 JAMERSON BAUWENS 3160 MCCARTHUR BLVD NORTHBROOK IL 60062 MED ELECTRIC INSTALL 1532861 197 2000693 0 2000693 Net Patient Revenue 900099 269987443 269987443 Rental Income 900099 2553988 2553988 LAB SERVICES 621500 954142 954142 CLIENT SERVICE REVENUE 900099 949661 949661 MEDIC TRAINING 900099 119220 119220 4856750 4856750 279421204 1092151 7177 1084974 0 0 1126756 777499 349257 0 349257 349257 12623929 0 12623929 0 12623929 12623929 0 0 0 0 0 EXPENSE REIMBURSEMENT & MGMT FEES 900099 887801 887801 GIFT SHOP 900099 354226 354226 PARKING INCOME 900099 87746 87746 102772 102772 1432545 296919779 279457635 961319 14500132 20050000 20050000 96449 96449 0 0 10255402 8794007 1461395 0 85993465 77829973 8163492 2028854 1846257 182597 6316153 5747700 568453 7039980 6406382 633598 10255402 10255402 607381 607381 163982 163982 44908 44908 0 818224 818224 66923495 53574723 13348772 1321244 1321244 1640173 1476156 164017 0 0 5524646 3591020 1933626 418801 347605 71196 0 0 4738647 3885690 852957 0 16571428 14582857 1988571 13464994 12387795 1077199 MEDICAL SUPPLIES 44307369 44307369 0 PUBLIC AID ASSESSMENT 14360208 14360208 0 REAL ESTATE TAXES 1355000 880750 474250 0 LAUNDRY SERVICES 1101010 1101010 0 1970819 1040790 930029 317368034 273124965 44243069 0 16690300 0 0 0 0 0 41385841 34641963 0 0 0 0 0 0 5721103 5256985 3803988 3951722 535049712 339717373 192018062 195332339 260815096 216934465 0 0 3063752 2629877 663952 636045 9930931 23027546 534093025 482410942 84100222 65248474 0 0 -1383657 712478 109949339 107696467 0 0 0 0 0 0 0 9170537 18945673 13001339 211611577 195829295 X 318061321 282552520 4420127 4029127 0 0 322481448 286581647 534093025 482410942 X -20448255 -3251991 -9414398 -2785157 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 44908 44908 false PART II-B, LINE 1I THE 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. 416863 416863 293960391 153872722 140087669 12211665 10762484 1449181 206810443 175082167 31728276 21650350 21650350 195332339 0 TENDER PREMIUM PAYABLE (SWAP) 13001339 13001339 X 291232906 -3251991 -2394157 -5646148 296879054 818224 -777499 40725 296919779 317327309 777499 777499 316549810 818224 818224 317368034 SCHEDULE D, PART X, LINE 2 THE 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 2D INTEREST RATE SWAP VALUATION (2,394,157) SCHEDULE D, PART XI, LINE 4B RECLASS OF RENTAL EXPENSE (777,499) SCHEDULE D, PART XII, LINE 2D RECLASS OF RENTAL EXPENSE 777,499 true true X true X false true true false true true 6165171 6165171 0.01940 81365357 53986742 27378615 0.08630 87530528 53986742 33543786 0.10570 654421 654421 0.00210 583323 238620 344703 0.00110 268163 268163 0.00080 1505907 238620 1267287 0.00400 89036435 54225362 34811073 0.10970 true 6773224 1266593 102663068 126429678 -23766610 X true true 1 1 INGALLS MEMORIAL HOSPITAL ONE INGALLS DRIVE HARVEY IL 60426 WWW.INGALLS.ORG 0001099 X X X INGALLS MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 15 true false true true X INGALLS.HEALTHFORECAST.NET X true 15 true INGALLS.HEALTHFORECAST.NET false true X 200. 0. X X X true true X X true X (SEE STATEMENT) X (SEE STATEMENT) X (SEE STATEMENT) X X X X X true X false X X X X true X false false PART V, SECTION B, LINE 4 THE 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 6B THE 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 9 THE 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 16A HTTPS://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 7 INGALLS FAMILY CARE CENTER 1600 TORRENCE AVENUE CALUMET CITY IL 60409 URGENT AID, PRIMARY CARE, AND SPECIALIST SERVICES INGALLS CARE CENTER 4742 CAL SAG ROAD CRESTWOOD IL 60445 QUICK CARE CENTER AND OCCUPATIONAL HEALTH INGALLS FAMILY CARE CENTER 6701 WEST 159TH STREET TINLEY PARK IL 60477 URGENT AID, PRIMARY CARE, AND SPECIALIST SERVICES INGALLS FAMILY CARE CENTER 19550 GOVERNORS HIGHWAY FLOSSMOOR IL 60422 URGENT AID AND SPECIALIST SERVICES INGALLS WELLNESS CENTER 2920 WELLNESS CENTER HOMEWOOD IL 60430 COMPLEMENTARY MEDICINE AND COMMUNITY HEALTH PROGRAMS THE VILLA AT SOUTH HOLLAND 16300 WAUSAU AVENUE SOUTH HOLLAND IL 60473 HEALTHCARE AND REHABILITATION CENTER INGALLS CARE CENTER 16246 PRINCE DRIVE SOUTH HOLLAND IL 60473 INDUSTRIAL, MEDICAL REHABILITATION AND PHYSICIAN OFFICES PART I, LINE 3C AUTOMATIC 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 2 THE 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 3 BASED 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 4 PATIENTS 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 8 THE 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 9B INGALLS 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 2 IN 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 3 THE 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 4 THE 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 5 INGALLS 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 6 THE 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 7 THE INGALLS MEMORIAL HOSPITAL FILES A COMMUNITY BENEFIT REPORT WITH THE STATE OF ILLINOIS. true INGALLS DEVELOPMENT FOUNDATION One Ingalls Drive Harvey IL 60426 363189150 501(c)(3) 20050000 SUPPORT 1 SCHOLARSHIPS 203 96449 PART I, LINE 2 INGALLS 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. X X X X false false false false false false false true false MICHAEL HICKS COO/BOARD MEMBER 488826 0 90722 0 20691 0 7950 0 29760 0 637949 0 0 0 KURT JOHNSON PRESIDENT & CEO/BOARD MEMBER 1214467 0 224120 0 32145 0 7950 0 37315 0 1515997 0 0 0 KATHLEEN MIKOS CHIEF NURSING/BOARD MEMBER 377066 0 67981 0 25722 0 7950 0 20417 0 499136 0 0 0 MARK KOZLOFF MD PHYSICIAN/BOARD MEMBER 0 562988 0 0 0 25671 0 6625 0 13768 0 609052 0 0 MICHAEL DEVORE CHIEF INFORMATION OFFICER 229844 0 23637 0 10839 0 7090 0 21193 0 292603 0 0 0 DIANE JACOBY ASSISTANT SECRETARY, VP 471318 0 79836 0 23031 0 7950 0 36717 0 618852 0 0 0 TAMARA PROFIRIO VICE PRESIDENT/COO MEDCENTRIX 240640 0 0 0 298 0 250 0 16920 0 258108 0 0 0 ALETHA ROSS VICE PRESIDENT OF HR 267877 0 53224 0 2318 0 6600 0 20595 0 350614 0 0 0 ANDREW STEFO VP - FINANCE/CFO 510723 0 94351 0 25722 0 7950 0 16313 0 655059 0 0 0 SCOTT STRAUSSER VP - BUSINESS DEVELOPMENT 424514 0 69191 0 20691 0 7950 0 12596 0 534942 0 0 0 LINDA CONWAY ASSOCIATE GENERAL COUNSEL 197029 0 16500 0 3684 0 6366 0 870 0 224449 0 0 0 MARY JO CRANDALL LEAN FACILITATOR 187857 0 23143 0 746 0 5552 0 308 0 217606 0 0 0 LAWRENCE KLONOWSKI MANAGER MEDICAL PHYSICS 198662 0 0 0 7884 0 5342 0 27925 0 239813 0 0 0 LYNN PHILIPSON DIRECTOR OF MANAGED CARE 169296 0 25500 0 4583 0 5838 0 663 0 205880 0 0 0 HEIDI RUHE ASSOC VP BUSINESS DEVELOPMENT 157548 0 39962 0 1065 0 3011 0 37003 0 238589 0 0 0 SCHEDULE J, PART I, LINE 3 INGALLS 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 4 SOME 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 7 THE 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). A ILLINOIS FINANCE AUTHORITY 861091967 45200BHK7 2007-11-16 48000000 REFUNDING OF 2004 BOND ISSUANCE false false false B ILLINOIS FINANCE AUTHORITY 861091967 45203HPE6 2013-02-06 64815040 REFUNDING /1994 ISSUANCE & CAPITAL false false false A 2200000 0 48000000 0 0 0 0 0 0 0 48000000 0 2007 true false true true B 0 0 64815292 0 0 0 1183106 0 0 30160252 33471934 0 2015 true false false true A false false false false 0 false false false false B false false false false 0 false false false false A false false false true true true Merrill Lynch 29.5 false false false 0 false false B false true false false false false 0 false 0 false false A false B false TOTAL PROCEEDS OF ISSUE BOND ISSUE B, PART II, LINE 3 THE DIFFERENCE BETWEEN THE ISSUE PRICE AND TOTAL PROCEEDS OF ISSUE IS INTEREST EARNINGS OF $252. NO REBATE DUE BOND A, PART IV, LINE 4C THE COMPUTATION DATE FOR THE NOVEMBER 16, 2007 BOND ISSUE IS JANUARY 17, 2013. WRITTEN PROCEDURES THE ORGANIZATION IS IN THE PROCESS OF ADOPTING WRITTEN PROCEDURES. FORM 990, PART VI, LINE 1A THE 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 4 ON 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 6 PURSUANT 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 7B PRIOR 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 11B THE 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 12C PURSUANT 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 15A INGALLS 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 15B AN 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 19 DURING 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 1 EXPENSES 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 7A THE 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 9 INTEREST RATE SWAP VALUATION (2,394,157) CHANGE IN INTEREST OF FOUNDATION (391,000) ------------ Total (2,785,157) FORM 990 PART IX LINE 11G DESCRIPTION:Data processing TOTAL FEES:10976225 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN FEES TOTAL FEES:9154896 FORM 990 PART IX LINE 11G DESCRIPTION:ENVIRONMENTAL TOTAL FEES:4442492 FORM 990 PART IX LINE 11G DESCRIPTION:BIOMED TOTAL FEES:4188070 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SERVICES TOTAL FEES:38161812 INGALLS DEVELOPMENT FOUNDATION ONE INGALLS DRIVE HARVEY IL 60426 363189150 SUPPORT IL 501(C)(3) 7 UCHHD false INGALLS HOME CARE ONE INGALLS DRIVE HARVEY IL 60426 363367939 HEALTHCARE IL 501(C)(3) 9 IMH true UCM COMMUNITY HEALTH & HOSPITAL DIVISION ONE INGALLS DRIVE HARVEY IL 60426 363181170 MANAGEMENT IL 501(C)(3) 11 TYPE II UCMC false INGALLS HEALTH VENTURES ONE INGALLS DRIVE HARVEY IL 60426 363239703 AMBULATORY IL 501(C)(3) 11 TYPE II UCHHD false PRIMARY HEALTHCARE ASSOCIATES SC 71 W 156TH STREET HARVEY IL 60426 364132865 HEALTHCARE IL 501(C)(3) 9 UCHHD false INGALLS SAME DAY SURGERY CENTER 6701 W 159TH STREET TINLEY PARK IL 60477 363368549 SURGERY CENTER IL NA N/A 0 0 0 0.00000 INGALLS PROVIDER GROUP ONE INGALLS DRIVE HARVEY IL 60426 363485578 INSURANCE SERVICE IL IMH C Corp 0 7444543 1.00000 true MEDCENTRIX INC ONE INGALLS DRIVE HARVEY IL 60426 363374228 BILLING & MGMT IL UCHHD C Corp 0 0 0.00000 false INGALLS CASUALTY INSURANCE LTD ONE INGALLS DRIVE HARVEY IL 60426 980485714 LIAB INSURANCE CJ UCHHD C Corp 0 0 0.00000 false INGALLS HEALTH COUNCIL ONE INGALLS DRIVE HARVEY IL 60426 273226539 PURCHASING GROUP IL UCHHD C Corp 0 0 0.00000 false true true true false false false false false false false false true true true true true true true true INGALLS HOME CARE a(iv) 84000 FMV