2016-05-14T06:59:13-05:00 2015-06-30 861065772 Deloitte Tax LLP 111 South Wacker Drive Chicago IL 60606 990 2014-07-01 362170840 Copley Memorial Hospital Inc c/o Rush-Copley Medical Ctr COPL 6309786200 2000 Ogden Avenue Aurora IL 605044206 Brenda VanWyhe CFO 6309786200 2016-05-13 1 Laura Gillespie P00855604 3124861000 2014 2016-09-27 15:27:22Z Barry Finn 2000 Ogden Avenue Aurora IL 605044206 389201223 0 X www.rushcopley.com X 1886 IL To provide advanced medicine with quality outcomes and extraordinary care. 19 17 2143 217 0 0 548821 1298770 291634837 290263450 12073736 11171382 7092206 7946784 311349600 310680386 50133 54863 0 0 132863510 130954530 0 0 0 144418502 132805142 277332145 263814535 34017455 46865851 458989462 464071482 233857390 242506219 225132072 221565263 X The mission of Rush-Copley is to provide advanced medicine with quality outcomes and extraordinary care. 0 0 202004869 54863 297917089 Copley Memorial Hospital, Inc.'s mission is to provide advanced medicine with quality outcomes and extraordinary care. To that end, the medical center seeks to serve the community in ways that engage, educate and empower. In 2015, Copley Memorial Hospital, Inc. proudly collaborated with dozens of civic and community groups to impact the knowledge, health and well being of the community. Copley Memorial Hospital, Inc. offers free educational programs ranging from hand hygiene education aimed at preschool and primary grade school aged children to annual seminars educating adults about diabetes, heart health, cancer prevention, weight control, smoking cessation and more.A community newsletter is published and highlights health information and calendar of events info to 90,000+ households throughout the hospital service area. Free and reduced cost health screenings are regularly offered including free blood pressure monitoring on a walk-in basis.Electronic newsletters also highlighting health information, news and events are emailed monthly: Healthy eUpdate and FitNotes. These newsletters average 13,500 and 3,300 emails respectfully. 202004869 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 164 0 1 2143 1 0 0 0 0 0 0 0 0 0 0 0 X 19 17 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL X Brenda VanWyhe 6309786200 2000 Ogden Avenue Aurora IL 60504 X Thomas Alexander Director 1.00 2.00 X 0 0 0 Trish Anen Director 1.00 2.00 X 0 0 0 James Baka Director 1.00 2.00 X 0 0 0 Cati Cederoth Director 1.00 2.00 X 0 0 0 Alice Daniele MD Chief of Staff/Director 1.00 2.00 X 0 0 0 Bruce Dienst Vice Chairman of the Board/Director 1.00 2.00 X 0 0 0 Richard Edelman Director 1.00 2.00 X 0 0 0 Ronald Hem Director 1.00 2.00 X 0 0 0 Dennis Keane MD End 1214 Past Chief of Staff/Dir 1.00 2.00 X 0 0 0 Stephen Kelanic MD Beg 115 Vice Chief of Staff/Director 1.00 2.00 X 378639 0 34087 Herbert Knight Director 1.00 2.00 X 0 0 0 Maryanne Locklin Director 1.00 2.00 X 0 0 0 Dave Mead Director 1.00 2.00 X 0 0 0 Mark Metzger Chairman of the Board/Director 1.00 2.00 X 0 0 0 Avery Miller Director 1.00 2.00 X 0 0 0 Jerome Roberts End 1014 Director 1.00 2.00 X 0 0 0 William Skoglund Vice Chairman of the Board/Director 1.00 2.00 X 0 0 0 Christine Sobek Director 1.00 2.00 X 0 0 0 Andrew VanEekeren Director 1.00 2.00 X 0 0 0 Suresh Velagapudi MD Past Chief of Staff/Dir 1.00 2.00 X 15000 0 0 Barry Finn President & CEO/Director 40.00 3.00 X X 844572 0 423018 Ryan Asmus VP General Counsel/Secretary 40.00 3.00 X 279915 0 64518 Lynn Scott Assistant Secretary 40.00 3.00 X 77142 0 14519 Brenda VanWyhe Sr. VP, Finance & CFO/Treasurer 40.00 3.00 X 352920 0 70306 Gail Bumgarner Sr. VP, Strategy 40.00 0.00 X 501048 0 18924 Dennis DeMasie VP, Information Technology & CIO 40.00 0.00 X 272584 0 65008 John Diederich Sr. VP, Operations & COO 40.00 1.00 X 415264 0 132368 Brenda Fann MD Assistant VP, MedAffairs 40.00 0.00 X 277209 0 40498 Diane Homan MD VP, Quality & PSO 40.00 0.00 X 372480 0 79427 Steve Lowenthal MD Sr. VP, Medical Affairs & CMO 40.00 0.00 X 594067 0 34491 David Petasnick Assistant VP, Ancillary Services 40.00 0.00 X 183251 0 31345 Alex Pope VP, Philanthropy & CDO 40.00 1.00 X 222101 0 57890 Mary Shilkaitis VP, Patient Care Services & CNO 40.00 0.00 X 271663 0 67754 Suzanne Sterchi Assistant VP, Patient Care 40.00 0.00 X 188496 0 34574 Teressa Alexander MD Physician 40.00 0.00 X 606949 0 38572 Todd Guynn MD Physician 40.00 0.00 X 976804 0 44791 Edward Lipman MD Physician 40.00 0.00 X 527802 0 36423 Dimitry Ruban MD Physician 40.00 0.00 X 926259 0 36647 Sepehr Sani MD Physician 40.00 0.00 X 848167 0 28022 9132332 0 1353182 240 0 1 0 Sodexo 4880 Paysphere Circle Chicago IL 60674 Food and Cleaning Service Management 3709030 Pepper Contruction 18505 West Creek Drive Tinley Park IL 60477 Construction 3079250 Anthelio One Lincoln Drive Suite 200 5400 Dallas TX 75240 Medical Records Management 2536836 Anderson Mikos Architects 1420 Kensington Road Suite 306 Oak Brook IL 60523 Architects 779515 Critical Care Physicians of Illinios LL PO Box 645037 Cincinnati OH 452645037 Medical Services 753017 26 1298770 276006 1298770 Net Patient Service Re 621110 269790098 269790098 Medicaid Tax Revenue 621110 22361103 22361103 Other Program Revenue 900099 -1887751 -1887751 290263450 7335974 7335974 78708 78708 1287652 1492950 -205298 -205298 -205298 79223476 1561111 76981057 46830 2242419 1514281 3756700 3756700 Outside Service Rev. 621990 7653639 7653639 Cafeteria Revenue 621990 259516 259516 Gift Shop Revenue 453220 226440 226440 12487 12487 8152082 310680386 297917089 0 11464527 54863 54863 6400078 6400078 98155953 73616965 24538988 2608953 1956715 652238 14945467 11209100 3736367 8844079 6633059 2211020 6501745 4876309 1625436 284827 284827 204408 204408 48217 48217 37795 28346 9449 5043497 3782623 1260874 1046535 1046535 60059367 45044525 15014842 12121992 9091494 3030498 7035992 5276994 1758998 115071 86303 28768 69339 52004 17335 6383597 6383597 16335716 16335716 2782157 2086618 695539 Medicaid Provider Tax 11242189 11242189 0 0 Laundry 895274 895274 0 0 Consulting 800889 800889 0 0 Collection Fees 629400 629400 0 0 1167135 875351 291784 263814535 202004869 61809666 0 213480 3093073 19157212 12379679 40320674 43613785 4606762 4866214 8803680 8686033 343062855 204519289 130241216 138543566 237158566 246440896 3974135 18487872 2474101 458989462 464071482 121505916 114017505 89609546 105163568 22741928 23325146 233857390 242506219 X 219954035 216735015 5178037 4830248 0 225132072 221565263 458989462 464071482 X 46865851 -4467193 -45965467 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 48217 48217 0 Part II-B, Line 1: Copley Memorial Hospital, Inc. is a member of various organziations that advocate on legal and policy issues that affect healthcare. A portion of the annual membership dues paid by Copley Memorial Hospital, Inc. to these organizations is attributable to lobbying activities. 11931067 2373022 204733 1969950 12538872 11161160 1178338 1068336 1476767 11931067 11131204 980802 712783 1663629 11161160 10648390 1409175 364134 1290495 11131204 9770170 878220 1349773 1349773 10648390 0.06260 0.61480 0.32260 0 1 1 18295699 18295699 192218340 110703916 81514424 126279740 93815373 32464367 6269076 6269076 138543566 Long Term Deferred Rent Obligation 624276 Deferred Gain on Sale Long Term 8844853 Long Term SERP 5439115 Long Term Market Adjustment Swap Liability 8416902 23325146 X Part V, Line 4: Rush Copley Foundation holds the Voris (income for CMH Cancer Care), Kobisk (Board restricted income to CMH), Copley (income unrestricted), Dobbins (income for CMH Women's Health), and Movement Disorder (income for CMH Movement Disorder Progam) Endowments. Rush Copley Foundation also holds the following Quasi Endowments; Nursing (income for CMH Future of Nursing Scholarships), Fox Valley Heart (income for the Heart Institute), and Waterford Place (income for CMH Cancer Resource Center Endowments. These funds are held for the benefit of Copley Memorial Hospital, Inc. Part X, Line 2: The Internal Revenue Service has determined that the Corporation, the Hospital, Ventures and the Foundation are qualified as tax-exempt organizations under Internal Revenue Code Section 501(c)(3); accordingly, income taxes are not provided for in the accompanying consolidated financial statements. The Medical Group operates as a taxable corporation and accounts for income taxes under Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) 740 (formerly, FASB Statement No. 109, Accounting for Income Taxes). No provision for income taxes was recorded for 2015 and 2014 due to operating losses. 1 1 X 1 X 300.000000000000 1 X 600.000000000000 1 1 1 0 1 1 4393509 4393509 0.01670 66805300 49697183 17108117 0.06480 0.00000 71198809 49697183 21501626 0.08150 70283 70283 0.00030 4884246 579335 4304911 0.01630 0.00000 0.00000 56709 56709 0.00020 5011238 579335 4431903 0.01680 76210047 50276518 25933529 0.09830 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 1 33986963 3398696 84646270 88764042 -4117772 X 1 1 1 1 Copley Memorial Hospital 2000 Ogden Avenue Aurora IL 605044206 www.rushcopley.com 2150791 X X X X Copley Memorial Hospital 1 0 0 1 X X X X X X X X X 12 1 1 1 1 X https://www.rushcopley.com/about/community-health-needs-assessment-reports/ X 1 12 1 https://www.rushcopley.com/about/community-health-needs-assessment-reports/ 0 0 1 X 300.000000000000 600.000000000000 X 1 1 X X X X 1 X https://rushcopley.patientcompass.com/hc/guarantor/prepareBillingOption2.do X http://www.rushcopley.com/app/files/public/1242/pdf-financial_assistance_fo X https://rushcopley.patientcompass.com/hc/guarantor/prepareBillingOption2.do X X X X 1 X 0 X X X 1 X 0 0 Copley Memorial Hospital Part V, Section B, Line 5: In conducting the Community Health Needs Assessment, the hospital took into account input from persons who represent the broad interests of the community served. This included community residents and experts in a range of areas including public health, minority populations, disparities in health care, social determinants of health, and health & social services.Persons who represent the broad interests of the community served included:- Board of Directors- Hospital Administration- Community Health Needs Committee- Partnerships with Kane County- Partnershhips with Kendall County- Communtiy Health Survey- Focus Groups- Secondary Data AnalysisFor complete details about how the hospital took into account input from persons who represent the broad interests of the community served, the hospital's community health needs assessment can be accessed at: http://www.rushcopley.com/about/community-health-needs-assessment-report/ Copley Memorial Hospital Part V, Section B, Line 6a: Rush-Copley Medical Center, Cadence Health Delnor Hospital, Presence Mercy Medical Center, Presence St. Joseph Hospital (Elgin), and Advocate Sherman Hospital worked together to develop the County's IPLAN (Illinois Project for Local Assessment of Needs). The IPLAN is a community health assessment and planning process that is conducted every five years by local health jurisdictions in Illinois. The collaborative participation in the planning process, plan development, and identification of the health needs for the County served as a foundation for the development of each of the hospital's respective Community Health Needs Assessments. Copley Memorial Hospital Part V, Section B, Line 6b: The Kane County Health Department along with the INC Board and Fox Valley & Elgin United Ways worked together to develop the County's IPLAN (Illinois Project for Local Assessment of Needs). The IPLAN is a community health assessment and planning process that is conducted every five years by local health jurisdictions in Illinois. The collaborative participation in the planning process, plan development, and identification of the health needs for the County served as a foundation for the development of the hospital's Community Health Needs Assessments. Copley Memorial Hospital Part V, Section B, Line 11: Implementation Strategy to Meet Significant Health Needs Identified in CHNA:Rush Copley is continuing progress on the implementation of strategies identified in the strategy implementation plan for the three health need priorities. Key progress and accomplishment highlights include: - Developed and implemented a healthy weight web page and shared community resources. - Developed and implemented a healthy weight program, which was developed by Rush-Copley staff, physicians, dieticians, and personal trainers. - Developed a family-based healthy weight/lifestyle program, which was developed by Rush-Copley staff, physicians, dieticians, and Healthplex personal trainers. - Developed and implemented a community walking club, which included community presentations, resources, and pedometers for all participants. - Developed and implemented a community toolkit and resources for residents to start their own Couch to 5K club. - Worked with community leaders to develop a standard evidence based approach for diabetes follow-up care. - Developed a plan for and in the process of achieving Advanced Inpatient Diabetes Care Certification through the Joint Commission - Provided diabetes screenings and education at a number of community events. - Developed a funding program and partnership with Walgreens to provide medication assistance to those in need. - Partnered with Walgreens to implement the Well Transitions program to ensure chronic disease patients understand their home medication and have an available resource to ask questions once discharged. - Created and implemented a web based inventory of universal medication assistance program. Copley Memorial Hospital Part V, Section B, Line 16i: Our financial assistance policy is listed on our website. Also we have a spot on the bills that we send to the patients that states we have a financial assistance policy. In addition, our patient financial staff will discuss the policy with the patients if they see that a need for assistance might exist. Copley Memorial Hospital Part V, Section B, Line 22d: Self Pay discount of 30% applied to the same total charges billed to all patients. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Copley Memorial Hospital Part V, Section B, line 16a website: https://rushcopley.patientcompass.com/hc/guarantor/prepareBillingOption2.do Copley Memorial Hospital Part V, Section B, line 16b website: http://www.rushcopley.com/app/files/public/1242/pdf-financial_assistance_fo Copley Memorial Hospital Part V, Section B, line 16c website: https://rushcopley.patientcompass.com/hc/guarantor/prepareBillingOption2.do 6 River West Radiation Center LLC 1221 N Highland Avenue Aurora IL 605044206 JV Oncology Community Alliance Home Health 4050 Healthway Drive Aurora IL 605044206 JV Home Health Rush-Copley Healthcare Center 1100 West Veterans Parkway Yorkville IL 60560 Free Standing Emergency Care, Radiology, Lab, and Occupational Health Servic Rush-Copley Cardiovascular Consultants 2000 Ogden Avenue Aurora IL 605044206 Cardiovascular Services Midwest Center for Advanced Imaging 4355 Montgomery Road Naperville IL 60564 Radiology Services Midwest Center for Advanced Imaging 963 129th Infantry Drive Suite 140 Joliet IL 60431 Radiology Services Part I, Line 7: A cost accounting system was used to calculate the amounts reported in the table and a cost to charge ratio was utilized. The cost accounting system addresses all patient segments (Inpatient, Outpatient, Emergency Room, Private Insurance, Medicaid, Medicare, Uninsured and Self Pay). Part III, Line 4: Net patient service revenue is reported at the estimated net realizable amounts from third-party payors, patients, and others for services rendered. RCMC has agreements with third-party payors that provide for payments at amounts different from established rates. Payment arrangements include prospectively determined rates per discharge; reimbursed costs; per diem payments; and discounted charges; including estimated retroactive settlements under payment agreements with third-party payors. RCMC recognizes patient service revenue associated with services provided to patients who have third-party payor coverage on the basis of contractual rates for the services rendered. Provisions for adjustments to net patient service revenue are accrued on an estimated basis in the period the related services are rendered and adjusted in future periods as final settlements are determined. For uninsured patients that do not qualify for charity care, RCMC recognizes revenue based on its discounted rates. On the basis of historical experience, a significant portion of RCMC's uninsured patients will be unable or unwilling to pay for the services provided. Thus, RCMC records a significant provision for uncollectible accounts related to uninsured patients in the period the services are provided. Patient accounts receivable are based on gross charges and stated at net realizable value. Accounts receivable are reduced by an allowance for contractual adjustments, based on expected payment rates from payors under current reimbursement methodologies, and also by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, RCMC analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate appropriate allowance for doubtful accounts and provision for uncollectible accounts based upon management's assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage, and other collection indicators. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for contractual adjustments and allowance for doubtful accounts.For receivables associated with services provided to patients who have third-party coverage, RCMC analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for uncollectible accounts (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), RCMC records a significant provision for uncollectible accounts 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 discounted rates and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts in the period they are determined uncollectible.RCMC's allowance for doubtful accounts increased from 23.9% of gross accounts receivable less contractual allowances at June 30, 2014 to 23.1% of gross accounts receivable less contractual allowances at June 30, 2015. The increase in the allowance as a percentage of gross accounts receivable less contractual allowances was due to higher self-pay volumes and lower accounts receivable from third-party payors. Part III, Line 8: All of the shortfall reported in line 7 should be treated as community benefit because if we did not provide the service, the burden of the costs would fall on the government. Costs of treating Medicare patients are calculated using the IRS calculated percentage. Part III, Line 9b: It is our policy not to pursue collection practices against patients known to qualify for Charity Care or other financial assistance. In certain cases it may not be easily determined whether or not a patient qualifies for Charity Care or financial assistance. However, if after collection practices have begun, it later becomes known the patient qualifies, the collection efforts cease. Part VI, Line 2: Community need is assessed through review of community and hospital data, periodic assessments with physician and clinicians, and reporting of information from hospital committees. Further input from the community arises from the community based board of directors, various forms of patient input, and hospital involvement with government, health industry, and community agencies. The hospital also actively participates in formal needs assessments conducted by government and community agencies. Part VI, Line 3: At the time of service, Copley Memorial Hospital, Inc. patients are given a billing brochure, which describes the financial assistance/charity care program availability. This information is also posted at the registration check-in desks, in an inpatient guide, and on the Rush Copley website. Financial counselors are available to explain the program in detail to patients who are seen without insurance coverage. All patient billing statements advise the patients to call and inquire on the details as needed. Part VI, Line 4: Copley Memorial Hospital Inc.'s primary service area is approximately Kane County and Kendall County, Illinois located 45 to 55 miles southwest of Chicago. Kane County has a population of 527,000 people and is predominantly urban and suburban. Nearly 32% of the population is of Hispanic or Latino origin. Persons over the age of 65 comprise 11.6% of the population, and the poverty rate is 11.1%. Aurora, the second largest city in Illinois, dominates the county. Historically an industrial city, Aurora has experienced a considerable loss of manufacturing jobs and is transitioning its economy. Kendall County, to the south of Kane, has a population of 121,000. Persons over the age of 65 comprise 9.0% of the population, and the poverty rate is 4.8%. The northwest section of the county is suburban while the remainder is rural. Part VI, Line 5: Copley Memorial Hospital Inc.'s mission is to provide advanced medicine with quality outcomes and extraordinary care. To that end, the Medical Center seeks to serve the community in ways that engage, educate and empower. Copley Memorial Hospital, Inc. serves all patients who present for care and serves the surrounding community along with a Board of Directors with a strong community base. The Board Members are independent community leaders and are selected based upon their expertise and experience in a variety of areas of benefit to the organization and their role as Board Members who direct and guide management in carrying out our mission. Board Members are not compensated for their service. As a charitable organization, all surplus funds are used to further our charitable purpose, mission and to serve the community. Some of our primary programs are: community health fairs, breastfeeding education classes, child care classes, etc. Copley Memorial Hospital, Inc. provides access to physician, acute care, diagnostic, and rehabilitative services to people, regardless of ability to pay, through a number of facilities and services located throughout the service area. It provides programming related to health education, prevention, and support targeted to specific populations. Medical education extends to clinical settings for nursing education and a family practice residency. Employees fill board and committee leadership positions for a number of economic development and social service agencies in communities throughout the service area. Part VI, Line 6: Copley Memorial Hospital, Inc. has an affiliation with Rush University Medical Center that covers governance and other organizational relationships. Both organizations are parties to a master trust indenture that established an obligated group for purposes of issuing long-term debt. Copley Memorial Hospital is one part of Rush Copley Medical Center along with Rush Copley Medical Group, Rush Copley Foundation, and Copley Ventures. Part VI, Line 7, Reports Filed With States IL X 1 0 X X X X X 0 1 0 0 0 0 0 1 0 Stephen Kelanic MD Beg 115 Vice Chief of Staff/Director 290613 0 81158 0 6868 0 5200 0 28887 0 412726 0 0 0 Barry Finn President & CEO/Director 663885 0 165660 0 15027 0 387685 0 35333 0 1267590 0 0 0 Ryan Asmus VP General Counsel/Secretary 218688 0 53100 0 8127 0 34310 0 30208 0 344433 0 0 0 Brenda VanWyhe Sr. VP, Finance & CFO/Treasurer 277807 0 67260 0 7853 0 46150 0 24156 0 423226 0 0 0 Gail Bumgarner Sr. VP, Strategy 248211 0 52605 0 200232 0 5200 0 13724 0 519972 0 0 0 Dennis DeMasie VP, Information Technology & CIO 228991 0 34866 0 8727 0 34916 0 30092 0 337592 0 0 0 John Diederich Sr. VP, Operations & COO 351494 0 54000 0 9770 0 98951 0 33417 0 547632 0 0 0 Brenda Fann MD Assistant VP, MedAffairs 264700 0 4050 0 8459 0 5200 0 35298 0 317707 0 0 0 Diane Homan MD VP, Quality & PSO 290378 0 70564 0 11538 0 50628 0 28799 0 451907 0 0 0 Steve Lowenthal MD Sr. VP, Medical Affairs & CMO 400667 0 95580 0 97820 0 5200 0 29291 0 628558 0 0 0 David Petasnick Assistant VP, Ancillary Services 166103 0 11132 0 6016 0 3425 0 27920 0 214596 0 0 0 Alex Pope VP, Philanthropy & CDO 179512 0 34408 0 8181 0 26431 0 31459 0 279991 0 0 0 Mary Shilkaitis VP, Patient Care Services & CNO 219619 0 42044 0 10000 0 35100 0 32654 0 339417 0 0 0 Suzanne Sterchi Assistant VP, Patient Care 164434 0 16415 0 7647 0 3456 0 31118 0 223070 0 0 0 Teressa Alexander MD Physician 441642 0 151563 0 13744 0 5200 0 33372 0 645521 0 0 0 Todd Guynn MD Physician 613882 0 355057 0 7865 0 5200 0 39591 0 1021595 0 0 0 Edward Lipman MD Physician 343650 0 175268 0 8884 0 5200 0 31223 0 564225 0 0 0 Dimitry Ruban MD Physician 920121 0 0 0 6138 0 5200 0 31447 0 962906 0 0 0 Sepehr Sani MD Physician 840613 0 0 0 7554 0 5200 0 22822 0 876189 0 0 0 Part I, Line 1a The organization provides to all employees the use of an athletic facility that is owned and operated by a related tax exempt organization. Part I, Line 4b SERP PLAN of CMH (Accruals): Barry Finn $382,485, Mary Shilkaitis $30,530, John Diederich $93,751, Steve Lowenthal $0, Dennis DeMasie $30,236, Diane Homan $45,428, Brenda VanWyhe $40,950, Alex Pope $22,691, Gail Bumgarner $0, and Ryan Asmus $29,810. Please note that these amounts are included in the amounts listed on Schedule J, Part II, Column C. There is no constructive receipt of these amounts by the individuals until they are paid out as they are subject to a substantial risk of forfeiture. Any individual payouts would be included as reportable compensation on the recipient's annual W2 form. Steve Lowenthal received payments in 2014 of $78,642 and Gail Bumgarner received payments in 2014 of $191,857. Part I, Line 7 Incentive bonus plan based on a series of approved strategic accomplishments. Part II, Column (B)(ii): Physician Bonus & incentive compensation: Physician bonuses were paid based on individual productivity goals A Illinois Finance Authority 861091967 45203HS45 2015-02-11 105601668 Refund bonds issued 5/28/2008, 2/10/2009, and 7/29/2009 0 0 0 A 105601668 824030 145 104777638 0 1 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 Part IV, Line 6, Column A: This question is being answered without regard to a yield-restricted advance refunding escrow financed with proceeds of the bonds. X Med Supplies 1 200000 FMV X Mannequin 1 68804 FMV X Lighting 1 7202 FMV 0 0 0 Form 990, Part III, Line 4a: Summary of 2014 Health Programming During 2014, Copley Memorial Hospital, Inc. sponsored, partnered or participated in over 600 community-based programs and events with special emphasis on improving the health and wellness of adults, children and underserved populations. Nutrition and Weight Loss Nine programs aimed at providing sound nutrition advice and weight loss strategies were held during the year with a total of 76 people attending. YouFit was launched in 2015. YouFit is a program focusing on the importance of combining physical activity and nutritional guidance. Participants learn from a variety of experts including Rush-Copley physicians, Healthplex personal trainers and registered dieticians. Four sessions were held and a total of 33 participants benefited from the 12-week program. Community Walking Club Rush-Copley offers the community the tools and resources to start their own walking club. Presentations are provided to organizations such as schools, park districts and anyone interested in walking their way to health. A pre and post test is given to the participants to observe their progress. 192 community members are part of the walking club. Diabetes Free fasting glucose screenings were provided to over 130 community members. A Diabetes Open House event was held with 107 community members in attendance. Smoking Cessation The Freedom from Smoking class was offered five times with a total of 15 participants. This free eight-week program provides the support and the skills needed to quit smoking. Four sessions were conducted in English and one session was conducted in Spanish. Cancer Awareness and Information The Help for You program on breast cancer education was provided at the Latina Health Fair, African American Health Fair, and Communities in School's Back to School Fair. Educational materials were provided to over 400 participants. Dr. Zaidi presented a program "Get the Scoop on the Scope" to 19 participants and Dr. Zhang presented "To Screen or not to Screen" to 20 participants. The Caring Forward Cancer Survivorship program was provided on a quarterly basis with at total of 40 attendees. Additional venues where information to 150 participants was provided on cancer and sun safety include Play it Safe, church health fairs and the Health and Wellness Symposium. At the annual celebration of National Cancer Survivors Day, there were more than 400 participants in attendance. Latina Talks (Platicas Para Mujeres) and Community Talks Latina Talks (Platicas Para Mujeres) is an educational series geared toward the healthcare needs of Latina women. Latina Talks is offered eight times a year from September through April targeting Latina women in the Fox Valley area. Topics presented by professional healthcare providers include: Abnormal Bleeding, Breast Health, Yoga Demonstration, Heart Disease in Women, Alzheimer's and a demonstration on making a healthy salad and smoothie and more. Typically, between 10 and 25 women attend the monthly sessions. In addition, Rush-Copley partners with Aurora University nursing students to provide free child care. The student nurses also provide a healthy snack and provide education on topics such as healthy eating and exercise to the children. Over 150 women have benefited from the presentations in the last year and over 100 children have attended child care which takes place in the preschool classroom of the Prisco Community Center. Expanding on the Latina Talks program, Rush-Copley in collaboration with the Aurora Public Library offered three Community Talks for both men and women, in Spanish. Topics included an interactive session on Effective Parenting, Heart Attack: Prevention, Causes and Treatment and Nutrition: Organic, Local or Natural. More than 50 community members participated in the Community Talks series. Health Exhibits at Sci-Tech Hands on Museum Rush-Copley Medical Center and Sci-Tech Hands On Museum collaborated to produce a multi-part exhibit targeting children in the 5-16 age range. The exhibits are displayed in the lunch room and adjacent corridor of the museum. One exhibit will enable visitors to measure their heart rate after exercising and make the link between exercise and heart health. Another tests visitors' knowledge about the amount of sugar in popular beverages and educates them about diabetes. Smaller exhibits on the lunch room pillars display the USDA's "My Plate" graphic, the "5-4-3-2-1-Go!" program, "Eat-this-not-that" information, and other kid-friendly information about nutrition and health. A hand-washing exhibit to demonstrate the importance of effective hand-washing techniques was placed in the lunchroom at SciTech to ensure that the message reaches children at a time when they can apply the lessons learned directly to their own eating habits for immediate reinforcement. Children place their hands in the sink to start an interactive video that shows the right technique and length of time needed to remove dirt and germs. Pink lights shine on their hands, simulating germs, until the right amount of time and activity has elapsed. Older Adult Education Educational and interactive talks designed to provide seniors with health information and education are presented regularly at the Beecher Community Center in Yorkville in collaboration with Senior Services Associates, Inc. This program called "Wellness is a Way of Life," reaches approximately 300 seniors annually. "The Breakfast Club," a program that targets the senior community at large, provides presentations that include question and answer sessions on healthcare topics. The program takes place at Sunnymere, an assisted living facility in Aurora, and is attended annually by 150 seniors. Rush-Copley, in collaboration with the Oswego Senior Center, Northeastern Illinois Area Agency on Aging, Oswegoland Park District, University of Illinois Extension Program and the Kendall County Health Department, is hosting an ongoing, Healthy Habits Workshop and Challenge Series for Senior Citizens in Kendall County to combat obesity. Each workshop is offered as an 8 week course. Rush-Copley is providing health education, screenings, and fitness demonstrations for participants. Rush-Copley also provides health education programming for the Caregiver Education Series hosted by the Oswego Senior Center. This monthly series incorporates informative presentations, along with lunch or dinner, to caregivers who are supporting loved ones with chronic health issues. Pregnancy and Childbirth Prenatal education classes are offered to couples who are pregnant or considering having a baby. Class topics include Childbirth Education, Baby Care Basics, Breastfeeding, Becoming a Grandparent, Boot Camp, C-Section, Bringing Home Baby and Child Safety. Tours of the Family Birth Center are also provided. Over 2,160 people participated in 2015. Vascular Presentations on the causes, symptoms and treatments for varicose veins had 52 participants. Attendees receive a free vein screening. Movement Disorders Four community programs were offered to people who were experiencing or care for a person experiencing a movement disorder. Nearly 250 people attended these programs. Ongoing programs include land exercises, water exercises, art therapy, Parkinson's disease and essential tremor support with over 100 participants. Women Over 300 women attended programs aimed specifically for them. Topics in the Women to Women series included Beyond Babies, Bladder, Bone, Breast Health, Cracking the Teen Code, Kid Friendly, Parent Approved and Osteoporosis. Other program topics included Financial Freedom and Continence. Physician Referral and Service Line Copley Memorial Hospital, Inc. offers a free physician and information referral telephone service to the community. This service allows community members to talk with a call advisor to match a person's health needs and preferences with the physician of their choice or link callers to services provided by the medical center. Over 11,500 people used this service in 2015. Website Copley Memorial Hospital Inc.'s website, rushcopley.com, with translation available into dozens of languages, offers access to free health information, a health encyclopedia, and a symptom checker. In 2015, there were over 1 million visits to rushcopley.com and online resources. Form 990, Part VI, Section A, line 2 Many of the persons listed on Part VII have a "business relationship" with each other by virtue of sitting on related Rush-Copley Medical Center entity boards. Barry Finn, RCF President & CEO/Director, and William Skoglund, RCF Vice Chairman of the Board/Director, have a business relationship. Barry Finn is a board member at Old Second National Bank and William Skoglund is the Chairman and CEO at Old Second National Bank. Mr. Skoglund does not serve on Copley Memorial Hospital, Inc.'s compensation committee and has recused himself from any discussions or votes that involve Mr. Finn's salary. Form 990, Part VI, Section A, line 6 Rush-Copley Medical Center, Inc. ("RCMC") is the sole corporate member of Copley Memorial Hospital, Inc. ("CMH"), Rush-Copley Medical Group, NFP ("RCMG"), Copley Ventures, Inc. ("CV"), and Rush-Copley Foundation ("RCF"). Form 990, Part VI, Section A, line 7a CMH's Board of Directors includes at least nine (9) individuals elected by the sole corporate member, RCMC. Each of these elected directors is also a member of the Governing Board of CMH's sole corporate member, RCMC. The election and re-election of all CMH directors is at the direction of RCMC at the annual Governing Board meeting. Vacancies on the CMH Board of Directors are filled by CMH's sole corporate member, RCMC. In accordance with certain procedural requirements stated in the bylaws, elected directors may be removed by the affirmative vote of two-thirds of the board of directors of CMH's sole corporate member, RCMC. Form 990, Part VI, Section A, line 7b The Board of Directors of CMH's sole corporate member, RCMC, has the following exclusive powers over CMH: (1) the election of the Board of Directors; (2) any amendment to the Articles of Incorporation or Bylaws of this Corporation (3) the borrowing of any sum, the principal of which exceeds $500,000.00, or which has a stated term of greater than one year, or which is secured by a mortgage of all or any portion of the Corporation's real property or the creation of a security interest in the Corporation's assets, including personal property and revenues, for the benefit of the lender, lessor or vendor, or the defeasance, advance payment or cancellation of any outstanding debt of the category described herein; (4) any voluntary dissolution, merger, consolidation, sale or transfer of any of the Corporation's assets (above a material dollar threshold as a percentage of the Corporation's assets as determined in conjunction with the Corporate Member) or any creation of a subsidiary or affiliate of this Corporation; (5) application to the Illinois Health Facilities Planning Board or any successor for a permit or certificate of need for a proposed activity, whether or not involving a capital expenditure; (6) Approval of all new or changes to existing annual and long-term capital and operational budgets or long-term or master strategic plans; (7) any agreement or transaction, either of which is of a material nature, with another corporation controlled by or affiliated with the Corporate Member or which is a subsidiary of the Corporate Members; (8) sale of any of the Corporation's real property or interest therein or purchases of any additional real estate; (9) the audited financial statements and bond disclosures of the Corporation; (10) selection and annual evaluation of the President; and (11) the annual audited financial statements and bond disclosures of the Corporation. Form 990, Part VI, Section B, line 11 The Form 990 tax return is prepared by our external tax advisor with data provided by our organization. A draft of the Form 990 is provided to management for review and comment. The Board of Directors is provided with an approved copy of the Form 990 before it is filed. Form 990, Part VI, Section B, line 12c Annually, Officers, Directors, Key Employees, Management Team (Department Directors and Managers), and Billing Office personnel of Copley Memorial Hospital, Inc. are required to disclose interests that could give rise to conflicts. The conflict of interest statements are submitted and reviewed by the Chief Compliance Officer and the Audit and Corporate Integrity Committee of the Board. Those key personnel with conflicts are advised to recuse themselves from participating in decision-making related to the conflict. Form 990, Part VI, Section B, line 15 With respect to the CEO/VPs of the organization and key senior management, the organization follows a compensation approval procedure annually that involves approval of proposed and final compensation arrangements by the organization's Compensation Committee and full board of Directors using comparability data, as well as contemporaneous documentation of compensation decisions in minutes. Form 990, Part VI, Section C, line 19 Form 990 available upon request. The organization does not make its governing documents or conflict of interest policy available to the public. Copies of the financial statements (whether or not audited) are provided upon reasonable request such as for a bank loan or to a bond rating agency. The financial statements are available on the Attorney General's website. Form 990, Part VII, Section B Amounts paid to Pepper Construction represent amounts paid for services and materials. These amounts cannot be separated. Form 990, Part XI, line 9: Net assets released from restriction used for capital 276,006. Transfer of assets to affiliates-net -18,512,650. Change in interest in net assets of Foundation -347,789. Swap value adjustment -1,104,301. Transfer of assets from Rush Copley Foundation -1,298,771. Loss on Early Extinguishment of Debt -24,773,384. Other -204,578. Form 990, Part XII, Lines 2a & b: Although the organization does not receive stand alone GAAP financial statements it does receive on an annual basis from independent auditors consolidated entity GAAP financial statements (audited) for it and its affiliates. Rush Copley Medical Center Inc 2000 Ogden Avenue Aurora IL 60504 363193787 Parent Company IL Section 501(c)(3) Schedule A, Line 11a N/A 0 Rush Copley Health Care System Inc 2000 Ogden Avenue Aurora IL 60504 363584043 Bridge Board RCMC & RUMC IL Section 501(c)(3) Schedule A, Line 11a N/A 0 Rush-Copley Foundation 2000 Ogden Avenue Aurora IL 60504 363093877 Grants to Charitable Organizations IL Section 501(c)(3) Schedule A, Line 7 Rush-Copley Medical Center Inc 1 Copley Ventures Inc 2000 Ogden Avenue Aurora IL 60504 363370216 Rental Prop., Infirmary Care, and Healthplex Fitness Center IL Section 501(c)(3) Schedule A, Line 3 Rush-Copley Medical Center Inc 1 Rush University Medical Center 1700 West Van Buren Street Chicago IL 60612 362174823 Hospitals IL Section 501(c)(3) Schedule A, Line 3 N/A 0 Yorkville Physical Therapy & Sports Medicine Center LLC 2000 Ogden Avenue Aurora IL 60504 364236345 Physical Therapy & Sports Medicine IL N/A Rush Copley Cardiovascular Consultants LLC 2000 Ogden Avenue Aurora IL 60504 273234201 Cardiovascular Medicine IL Rush-Copley Medical Center Inc Related -2208393 3090132 0 0 0.99000 Rush Copley Medical Group NFP 2000 Ogden Avenue Aurora IL 60504 363235315 Physician Practices IL N/A C 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 0 Rush-Copley Foundation C 1298770 Fair Market Value Rush Copley Medical Group A 609987 Fair Market Value Rush-Copley Foundation I 276006 Fair Market Value Rush-Copley Foundation Q 1022764 Fair Market Value Rush Copley Medical Center Inc I 18512650 Fair Market Value Copley Ventures Inc K 680045 Fair Market Value Copley Ventures Inc R 468000 Fair Market Value