2016-05-12T15:35:12-05:00 2015-06-30 KPMG LLP 191 West Nationwide Blvd Ste 500 Columbus OH 432152568 990 2014-07-01 362179764 Memorial Medical Center % David Tomlinson MEMO 8157885800 3701 Doty Road Woodstock IL 60098 DAVID TOMLINSON SVP, CIO & CFO 8157885800 2016-05-10 true MOLLIE P LONGHOUSE P00294881 6142492300 2014 2016-08-17 19:52:53Z Michael S Eesley 385 Millennium Drive Crystal Lake IL 60012 141496630 false X www.centegra.org X 1914 IL The mission of Memorial Medical Center is to provide quality healthcare services with innovative and responsible use of resources and promote wellness for the McHenry County area. 14 8 962 139 16135 -41698 556550 461790 135571374 127937273 2104691 1735308 3943340 4308423 142175955 134442794 0 0 0 0 54192882 49899762 0 0 0 81214340 76642618 135407222 126542380 6768733 7900414 142304387 139276939 88158606 86175448 54145781 53101491 X The mission of Memorial Medical Center is to provide quality healthcare services with innovative and responsible use of resources and promote wellness for the greater McHenry County area. false false 106156918 127976340 SEE SCHEDULE O 106156918 true true false true false false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false false true false false false false false true false false false true 2 0 true 962 true true true false false false false false false false false false X 14 8 true true false false true true false true true false false false true true true true true true true true true IL X David Tomlinson 8157885800 385 Millenium Drive Crystal Lake IL 60012 MICHAEL EESLEY CHIEF EXECUTIVE OFFICER 0.0 40.0 X X 0 1758472 143057 CHARIE ZANCK BOARD OF GOVERNORS 0.0 2.0 X 0 0 0 CHARLES RUTH BOARD OF GOVERNORS 0.0 2.0 X 0 0 0 CHRIS NEWKIRK BOARD OF GOVERNORS 0.0 1.0 X 0 0 0 JACK PORTER BOARD OF GOVERNORS 0.0 1.0 X 0 0 0 KATHY POWELL BOARD OF GOVERNORS 0.0 4.0 X 0 0 0 LISA GLOSSON MD BOARD OF GOVERNORS 0.0 1.0 X 0 240373 30204 LUKE JOHNSOS BOARD OF GOVERNORS 0.0 2.0 X 0 0 0 MICHAEL LUECHT BOARD OF GOVERNORS 0.0 4.0 X 0 0 0 MIKE CURRAN BOARD OF GOVERNORS 0.0 2.0 X 0 0 0 PAT MOREHEAD BOARD OF GOVERNORS 0.0 4.0 X 0 0 0 RICHARD LIND BOARD OF GOVERNORS 0.0 1.0 X 0 381037 21386 TERRENCE BUGNO BOARD OF GOVERNORS 0.0 4.0 X 0 0 0 TOM CAREY BOARD OF GOVERNORS 0.0 3.0 X 0 0 0 WILLIAM COX BOARD OF GOVERNORS 0.0 2.0 X 0 0 0 DAVID TOMLINSON SVP/ CIO/ CFO 0.0 40.0 X 0 532558 58217 JASON SCIARRO PRESIDENT/ COO 0.0 40.0 X 0 955765 90238 SHEILA SENN SVP CHIEF OPERATING OFFICER 40.0 0.0 X 240431 0 35211 JENNIFER OETGEN MANAGER, PHARMACY 40.0 0.0 X 139651 0 16368 SUELLEN AUS-DER-AU CLINICAL STAFF PHARMACIST 40.0 0.0 X 148609 0 16597 LISA EVAN CLINICAL STAFF PHARMACIST 40.0 0.0 X 142272 0 5698 ANTHONY K LEUNG CLINICAL STAFF PHARMACIST 40.0 0.0 X 136664 0 27398 RANDALL E VANDUYN CLINICAL STAFF PHARMACIST 40.0 0.0 X 134989 0 26250 942616 3868205 470624 24 false true false Sodexo Inc Affliliates 4880 Paysphere Circle Chicago IL 60674 Food, ES & POM Mgmt 1759625 CARDINAL HEALTH-AURORA DIV 7000 CARDINAL PLACE DUBLIN OH 43017 MEDICAL SUP & DRUGS 6459871 GILCOR CONSTRUCTION CORP 121 HARRISON STREET BARRINGTON IL 60010 CONSTRUCTION 2320722 GE HEALTHCARE 15724 COLLECTIONS CENTER Chicago IL 60693 MEDICAL EQUIPMENT 910071 PRECYSE SOLUTIONS LLC DEPT1736 PO BOX 11407 BIRMINGHAM AL 35246 SERVICE 2019569 35 142964 318826 0 0 461790 Routine Patient Services 621990 42021512 42021512 Ancillary I/P Services 621990 80367 80367 Ancillary O/P Services 621990 85867113 85867113 IDPA Provider Tax Revenue 621990 9994324 9994324 Charity Care/Admin Allow 621990 -10026043 -10026043 127937273 1948401 1948401 181 181 0 1047799 1047799 0 1047799 1047799 6840562 7053836 -213274 -213274 -213274 0 0 0 Cafteria Sales 721000 444460 444460 Other Income 900099 2324173 15416 2308757 CHS Allocation 621990 69535 69535 422456 39067 719 382670 3260624 134442794 127976340 16135 5988529 0 0 0 0 332456 332456 0 39399631 32251565 7148066 886307 719438 166869 6447619 5233700 1213919 2833749 2300227 533522 463039 463039 116079 116079 0 28541 28541 0 0 8665482 6181790 2483692 4086 4086 18403892 17757750 646142 13183 10183 3000 0 2377635 1929988 447647 85122 69013 16109 0 48390 35787 12603 2631595 2136133 495462 0 6377409 5176708 1200701 1984698 1611030 373668 Purch Srvcs Rltd Prty 24854180 20174781 4679399 Provision for Bad Debts 4761022 4761022 IDPA Provider Tax Assessment 5778597 5778597 Other Misc. Expenses 49668 25120 24548 126542380 106156918 20385462 0 -85479 -479060 7911190 2856421 0 0 21978146 17282666 0 0 0 0 0 0 2118095 2251672 952809 831853 142511236 102938560 40575839 39572676 30913748 29817654 0 0 6031318 5078500 0 0 31908721 42064557 142304387 139276939 15494562 14867358 0 0 0 0 70044942 69797249 0 0 0 0 0 0 0 0 2619102 1510841 88158606 86175448 X 50281248 50136974 3864533 2964517 0 0 54145781 53101491 142304387 139276939 X 7900414 -2467117 -6477587 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 28541 28541 false Description of Lobbying Activities Schedule C, Part II-B, Line 1I As part of our dues payments to the Illinois Hospital Association, American Hospital Association and Metropolitan Chicago Healthcare Council, approximately 30% of dues, on average, are allocable to lobbying activities. 219884 219884 75585100 51120495 24464605 3212830 2008034 1204796 63493078 49810031 13683047 344 0 344 39572676 DUE FROM AFFILIATES 40109771 OTHER RECEIVABLES 1193762 ESTIMATED INSURANCE RECOVERIES 761024 42064557 0 SELF-INSURED PROFESSIONAL LIAB 1440285 OTHER LONG-TERM LIABILITIES 70556 1510841 X ASC Topic 740-Uncertain Tax Position Footnote Schedule D, Part X, Line 2 ASC Topic 740, Income Taxes, addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded in the consolidated financial statements. Under ASC Topic 740, the Health System must recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured by the largest benefit that has a greater than fifty percent likelihood of being realized upon ultimate settlement. ASC Topic 740 also provides guidance on derecognition, classification, interest and penalties on income taxes, and accounting in interim periods and requires increased disclosures. As of June 30 2015 and 2014, the Health System does not have a liability for unrecognized tax benefits. true true X true X true X 600. true true true false true true 2268163 2268163 0.01860 14852450 5152517 9699933 0.07970 17120613 5152517 11968096 0.09830 432480 432480 0.00360 673432 673432 0.00550 88808 88808 0.00070 390 390 1195110 1195110 0.00980 18315723 5152517 13163206 0.10810 true 4761022 1131226 32827873 41742994 -8915121 X true true Algonquin Rd SurgCtr Outpatient Surgery Center 0.12750 ARSC Real Estate Hol Real Estate Holding Company 0.25000 1 1 Memorial Medical Center 3701 Doty Road Woodstock IL 60098 X X X Memorial Medical Center 1 false false true X X X X X X X X 14 true true true true X See Part V Section C X See Part V Section C true 14 false true false true X 200. 600. X X X X X X true true X X X X true X www.centegra.org X www.centegra.org X www.centegra.org X X X X X true X false X X X X true X false false Needs Assessment ACCOUNT INPUT FROM PERSON WHO REPRESENT THE COMMUNITY SCHEDULE H, PART V, LINE 5 THE HEALTH SYSTEM WORKS WITH THE DEPARTMENT OF PUBLIC HEALTH AND OTHER AREA HOSPITALS TO CONDUCT THE ASSESSMENT. COMMUNITY SURVEY. A DESCRIPTION OF COMMUNITY ISSUES AND PROBLEMS BASED ON A SAMPLE OF MCHENRY COUNTY RESIDENTS. THE SURVEY WAS CONDUCTED ONLINE WITH THE LINK WIDELY BROADCAST BY PARTNER ORGANIZATIONS, AND SUPPLEMENTED BY A PAPER VERSION DISSEMINATED AT NUMEROUS EVENTS AND LOCATIONS. SURVEY RESPONDENTS NUMBERED 744 WITH A 60/40 SPLIT BETWEEN ONLINE AND PAPER RESPONDENTS. QUESTIONS IN THE SURVEY COVERED: * COMMUNITY FEATURES * FINANCIAL ISSUES * HEALTH STATUS - PERCEPTION OF HEALTH AND PREVALENCE OF DISEASES AND CONDITIONS (PHYSICAL AND MENTAL) * ACCESS TO CARE * HEALTH INSURANCE STATUS * ABUSE, SUICIDE, CARE OF OTHER PERSONS KEY INFORMANTS. INTERVIEWS WITH 21 COMMUNITY LEADERS, AGENCY DIRECTORS, AND OTHER PEOPLE CONSIDERED EXPERTS IN THEIR FIELD BASED ON PROFESSIONAL EXPERTISE, KNOWLEDGE OF LOCAL HUMAN SERVICES SYSTEM OR POSITION OF INFLUENCE. AS SELECTED BY THE PARTNERS, MANY KEY INFORMANTS OR THEIR PREDECESSORS AT THEIR ORGANIZATIONS HAD BEEN INTERVIEWED FOR THE 2010 STUDY. INTERVIEW QUESTIONS FOCUSED ON COMMUNITY ASSETS, CHALLENGES, TARGET GROUPS IN NEED OF SERVICES, AND PERCEPTION OF STRENGTHS AND WEAKNESSES OF HEALTH AND HUMAN SERVICES DELIVERY. KEY INFORMANTS WERE INTERVIEWED BY FOUR VOLUNTEER INTERVIEWERS, RECORDED, AND TRANSCRIBED BY HEALTH SYSTEMS RESEARCH STAFF. HOSPITAL FACILITIES THAT JOINTLY CONDUCTED NEEDS ASSESSMENT SCHEDULE H, PART V, LINE 6A ADVOCATE GOOD SHEPHERD, ADVOCATE SHERMAN HOSPITAL OTHER ORGANIZATIONS THAT JOINTLY CONDUCTED NEEDS ASSESSMENT SCHEDULE H, PART V, LINE 6B MCHENRY COUNTY DEPARTMENT OF HEALTH, FAMILY ALLIANCE INC., MCHENRY COUNTY COLLEGE, MCHENRY COUNTY COMMUNITY FOUNDATION, MCHENRY COUNTY MENTAL HEALTH BOARD, POINEER CENTER FOR HUMAN SERVICES, SENIOR SEVICES ASSOCIATES, INC., UNITED WAY OF GREATER MCHENRY COUNTY, WOODSTOCK CONSOLIDATE UNIT SCHOOL DISTRICT 200. SCHEDULE H, PART V, LINE 7A http://centegra.org/mchenry-county-healthy-community-study/ SCHEDULE H, PART V, LINE 7B https://www.co.mchenry.il.us/county-government/departments-a-i/health-depa rtment/health-administration/strategic-planning https://www.co.mchenry.il.us/home/showdocument?id=30455 https://www.co.mchenry.il.us/home/showdocument?id=30455 Schedule H, Part V, Line 11 The ways in which Centegra Health System is addressing the significant needs identified in its most recently conducted CHNA are thoroughly described in the attached implementation strategy. There are certain needs identified in the CHNA that are not being addressed by Centegra Health System. These needs include areas of which Centegra Health System has no expertise, and falls outside the scope of care in which Centegra Health System provides to the community. Several of Centegra Health System's CHNA partner organizations are addressing these needs. System's CHNA partner organizations are addressing these needs. INCOME LEVEL OTHER THAN FPG USED IN DETERMINING AMOUNTS CHARGED PATIENTS SCHEDULE H, PART V, LINE 13B In addition to the documented 200% of FPG, we also provide a sliding scale discount of 80% for those who have FPG up to 350%. In addition we have presumptive charity which allows for charity discounts/financial assistance to those who currently meet Medicaid eligibility or other state programs based on FPG who may not have had insurance coverage at the time of the service we provided. OTHER FACTORS USED IN DETERMINING AMOUNTS CHARGED PATIENTS SCHEDULE H, PART V, LINE 13H ALL PATIENTS ARE CHARGED THE SAME FOR SERVICES RENDERED. PATIENTS MAY QUALIFY FOR FREE OR DISCOUNTED CARE AS DESCRIBED IN PART VI, LINE 3. ELIGIBILITY FOR FINANCIAL ASSISTANCE DEPENDS ON FACTORS SUCH AS INCOME LEVEL, ASSET LEVEL AND MEDICAL INDIGENCY. OTHER BILLING DETERMINATION OF INDIVIDUALS WITHOUT INSURANCE SCHEDULE H, PART V, LINE 22D SEE PART VI SUPPLEMENTAL INFORMATION FOR BILLING AND COLLECTION POLICIES REGARDING PERSONS ELIGIBLE FOR FINANCIAL ASSISTANCE. 3 CENTEGRA WOODSTOCK OUTPATIENT BH 527 WEST SOUTH STREET WOODSTOCK IL 60098 OUTPATIENT BEHAVIORAL HEALTH CENTEGRA SLEEP DISORDERS CLINIC 1122 N MAIN STREET ALGONQUIN IL 60102 SLEEP DISORDER CLINIC CENTEGRA WOUND AND HYPERBARIC CENTER 11650 SOUTH ROUTE 47 HUNTLEY IL 60142 WOUND AND HYPERBARIC CENTER Schedule H, Part I, Line 7 LINE 7A-7C AMOUNTS ARE CALCULATED USING THE MEDICARE COST TO CHARGE RATIO. LINE 7E-7I AMOUNTS ARE CALCULATED FROM COMMUNITY BENEFIT REPORTS THAT ARE SUBMITTED BY THE HOSPITAL DEPARTMENTS FOR VARIOUS ACTIVITIES AND SUPPORT GROUPS THAT BENEFIT THE COMMUNITY. Schedule H, Part I, Line 7, Column F BAD DEBT EXPENSE IN THE AMOUNT OF $4,761,022 IS INCLUDED ON FORM 990, PART IX, LINE 24(B), COLUMN A, BUT WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN SCHEDULE H, PART I, LINE 7, COLUMN (F). METHODOLOGY USED TO ESTIMATE BAD DEBT EXPENSE SCHEDULE H, PART III, LINE 2 THE ORGANIZATION USES AN ANALYSIS BASED ON HISTORY OF THE TYPE OF PAYER AND THE DAYS OUTSTANDING OF THE RECEIVABLE TO DETERMINE AN ESTIMATE OF THE AMOUNT THAT WILL BE UNCOLLECTIBLE. METHODOLOGY OF EST AMOUNT & RATIONALE FOR INCLUDING IN COMMUNITY BENEFIT SCHEDULE H, PART III, LINE 3 THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE (AT COST) WHICH COULD BE REASONABLY ATTRIBUTED TO PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IF SUFFICIENT INFORMATION HAD BEEN AVAILABLE TO MAKE A DETERMINATION OF THEIR ELIGIBILITY WAS BASED ON THE SELF PAY PATIENT ACCOUNTS WHICH WERE WRITTEN OFF AS BAD DEBTS. THESE AMOUNTS WERE THEN MULTIPLIED BY THE COST TO CHARGE RATIO. ANY PAYMENTS RECEIVED DURING THE FISCAL YEAR ON THESE ACCOUNTS WERE DEDUCTED FROM THE COST. BAD DEBT EXPENSE SCHEDULE H, PART III, LINE 4 In estimating allowances for doubtful accounts, the Health System analyzes past history, existing trends, and payer sources to determine the reserves needed. Please referenece pages 13 and 17-18 of the audited financial statements for notes on the allowances for doubtful accounts. EXPLANATION OF SHORTFALL AS COMMUNITY BENEFIT SCHEDULE H, PART III, LINE 8 THE AMOUNT SHOWN IN LINE 6 REPRESENTS THE ACTUAL COSTS INCURRED TO TREAT MEDICARE PATIENTS AND IS CALCULATED BY APPLYING THE MEDICARE COST-TO-CHARGE RATIO. THEREFORE, THE ENTIRE AMOUNT OF LINE 7 CONSTITUTES A COMMUNITY BENEFIT. PROVISIONS ON COLLECTION PRACTICES FOR QUALIFIED PATIENTS SCHEDULE H, PART III, LINE 9B IF A PATIENT QUALIFIES FOR A 100% CHARITY/FINANCIAL ASSISTANCE DISCOUNT, COLLECTION OF THE ACCOUNT IS NOT PURSUED AS A BAD DEBT. THE ACCOUNT IS WRITTEN OFF IN FULL AT THE TIME OF THE DECISION. IF A PATIENT RECEIVES A PARTIAL DISCOUNT FOR FINANCIAL ASSISTANCE, ANY REMAINING BALANCE WILL BE TREATED IN ACCORDANCE WITH THE FINANCIAL POLICY REGARDING SELF PAY BALANCES AND MAY BE OFFERED A PAYMENT PLAN OPTION. THE PAYMENT PLAN IS IN INSTALLMENTS ($25 MINIMUM), WITH THE FIRST PAYMENT DUE AT DISCHARGE. PAYMENT PLANS ARE NOT TO EXCEED 36 MONTHS WITHOUT DOCUMENTATION OR VERBAL COMMUNICATION OF ABILITY TO PAY. DOCUMENTATION MAY INCLUDE A COMPLETED FINANCIAL STATEMENT. PATIENTS WHO HAVE NOT COMPLETED ARRANGEMENTS FOR ONE OF THE PAYMENT OPTIONS WITHIN 120 DAYS OF THE BILLING DATE WILL BE AUTOMATICALLY TURNED OVER TO A COLLECTION AGENCY. PATIENTS WITH DELINQUENT PAYMENTS, 15 OR MORE DAYS LATE, WILL BE TURNED OVER TO A COLLECTION AGENCY. AFTER INSURANCE PROCESSING, PATIENTS WHO HAVE NOT MADE PAYMENTS OR ENROLLED IN ONE OF THE PAYMENT OPTIONS FOR CO-INSURANCE AND DEDUCTIBLE AMOUNTS WITHIN 120 DAYS OF THE INSURANCE PAYMENT WILL BE TURNED OVER TO A COLLECTION AGENCY. AS AN EXCEPTION, THE DIRECTOR OF PATIENT FINANCIAL SERVICES MAY REVIEW AND RECOMMEND FURTHER DISCOUNTS. NO INTEREST CHARGES WILL ACCRUE ON ACCOUNT BALANCES IN WHICH PAYMENTS ARE BEING MADE. Needs Assessment SCHEDULE H, PART VI, LINE 2 CENTEGRA HEALTH SYSTEM IDENTIFIES COMMUNITY HEALTH CARE PRIORITIES AND DEVELOPS ACTIVITIES AND STRATEGIES TO MEET THE HEALTH CARE NEEDS OF AT RISK POPULATIONS WITHIN ITS SERVICE AREA. THESE COMMUNITY BENEFIT PROGRAMS PROMOTE COMMUNITY WELLNESS AND DISEASE PREVENTION, ENHANCE COMMUNITY HEALTH EDUCATION, AND IMPROVE THE QUALITY OF CLINICAL EDUCATION. IN 2013, CENTEGRA HEALTH SYSTEM PARTNERED WITH THE MCHENRY COUNTY HEALTH DEPARTMENT, UNITED WAY OF MCHENRY COUNTY AND OTHER HOSPITALS AND ORGANIZATIONS TO CONDUCT THE 2014 MCHENRY COUNTY HEALTHY COMMUNITY STUDY. THE INTENT OF THE NEEDS ASSESSMENT WAS TO UNDERSTAND AND ADDRESS THE COUNTY'S MOST PRESSING NEEDS, INVOLVING PARTNERS FROM DIVERSE ORGANIZATIONS, IN ORDER TO IMPROVE THE HEALTH OF COUNTY RESIDENTS. A THOROUGH UNDERSTANDING OF THE COUNTY'S HEALTH WAS MEASURED USING FOUR ASSESSMENTS, EACH FROM A DIFFERENT PERSPECTIVE INCLUDING RESIDENTS, POPULATIONS IN NEED OF SERVICES, COMMUNITY LEADERS, AND DESCRIPTORS USING SECONDARY DATA SOURCES. THROUGH THE ASSESSMENTS, KNOWLEDGE WAS GAINED ABOUT THE CURRENT HEALTH STATUS OF COUNTY RESIDENTS, DEMOGRAPHIC TRENDS, SOCIAL AND ECONOMIC INDICATORS, HEALTH BEHAVIORS, AND UTILIZATION OF HEALTH SERVICES. THE ASSESSMENTS ALSO ATTEMPTED TO UNDERSTAND THE PERCEPTIONS OF COMMUNITY STRENGTHS AND WEAKNESSES AS WELL AS ANSWER QUESTIONS ABOUT THE HEALTH AND HUMAN SERVICES DELIVERY SYSTEM, UNMET NEEDS, GAPS, AND BARRIERS TO CARE. PATIENT EDUCATION OF ELIGIBILITY OF ASSISTANCE SCHEDULE H, PART VI, LINE 3 UNINSURED PATIENTS ARRIVING AT OUR EMERGENCY DEPARTMENT AND/OR DIRECT ADMITS ARE SCREENED AT TIME OF SERVICE BY EITHER AN EMERGENCY DEPARTMENT FINANCIAL COUNSELOR OR THE HEALTH SYSTEM'S IN-PATIENT FINANCIAL COUNSELING TEAM, PUBLIC AID REPRESENTATIVES, AND A MEDICATION ASSISTANCE COORDINATOR TO IDENTIFY ELIGIBILITY GUIDELINES FOR FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS, AS WELL AS CHARITY CARE. CHS'S SELF PAY PROCESS INCLUDES A SCREENING WHICH IS COMPLETED BY USING HOSPITAL FORM C910050 03-09 PROMPTING AN INTERVIEW OFFERING PAYMENT OPTIONS AND ELIGIBILITY GUIDELINES. IT IS AT THIS TIME THAT A PATIENT BECOMES AWARE OF THE HOSPITAL UNINSURED PATIENT DISCOUNT ACT, MEDICAID, MEDICATION ASSISTANCE PROGRAMS, CRIME VICTIMS, IBCCP, CASH PAY FEE SCHEDULES, AND OTHER HOSPITAL DISCOUNT INCENTIVES. PATIENTS ARE ADVISED OF TIMELINE FOR COMPLETING APPLICATION PROCESSES AT TIME OF SERVICE IN PERSON. APPROPRIATE SCRIPTING IS FOLLOWED BY CHS ASSOCIATES. DISCOUNTS WERE ESTABLISHED FOLLOWING THE 200%, 350% AND 600% FEDERAL POVERTY GUIDELINES TO ASSIST IN DETERMINING CHARITY ADJUSTMENTS. APPLICATIONS WERE DESIGNED BY CHS SELF PAY COMMITTEE IN ACCORDANCE TO OUR FINANCIAL POLICY (POLICY NUMBER 9850-2) IDENTIFYING QUALIFICATIONS FOR THE MEDICALLY NEEDY/CATASTROPHIC AID. UNINSURED PATIENTS OPTING FOR ELECTIVE SERVICES ARE CONTACTED BY PHONE PRIOR TO THEIR DATE OF SERVICE BY THE CHS OUTPATIENT FINANCIAL COUNSELING TEAM. CHS'S SELF PAY PROCESS IS FOLLOWED AND INCLUDES A SCREENING FOR FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS AS WELL AS CHARITY CARE. AN INTERVIEW OFFERING PAYMENT OPTIONS AND ELIGIBILITY GUIDELINES USING HOSPITAL FORM C910050 03/09 PROMPTS A QUICK ELIGIBILITY DETERMINATION. IT IS AT THIS TIME THAT A PATIENT BECOMES AWARE OF THE UNINSURED PATIENT DISCOUNT ACT, MEDICAID, MEDICATION ASSISTANCE PROGRAMS, CRIME VICTIMS, IBCCP, CASH PAY FEE SCHEDULES, AND OTHER HOSPITAL DISCOUNT INCENTIVES. PATIENTS ARE ADVISED OF TIME LINE FOR COMPLETING APPLICATION PROCESSES PRIOR TO THEIR ELECTIVE SERVICES VIA PHONE. APPROPRIATE SCRIPTING IS FOLLOWED BY CHS ASSOCIATES. DISCOUNTS WERE ESTABLISHED FOLLOWING THE 200%, 350% AND 600% FEDERAL POVERTY GUIDELINES TO ASSIST IN DETERMINING CHARITY ADJUSTMENTS. APPLICATIONS WERE DESIGNED BY CHS SELF PAY COMMITTEE IN ACCORDANCE TO OUR FINANCIAL POLICY (POLICY NUMBER 9850-2) IDENTIFYING QUALIFICATIONS FOR THE MEDICALLY NEEDY/CATASTROPHIC AID. OUR HEALTH SYSTEM'S WEBSITE OFFERS FAQ'S AND ANSWERS AS WELL AS ENCOURAGES PATIENTS TO CONTACT OUR CUSTOMER SERVICE TEAM WHEN THEY ARE UNABLE TO PAY FOR SERVICES. OUR HEALTH SYSTEM'S STATEMENTS ALSO IDENTIFY DETAILED ACCOUNT AND BILLING INFORMATION ENCOURAGING THE PATIENT TO CONTACT OUR CUSTOMER SERVICE TEAM AND INQUIRE ABOUT FINANCIAL ASSISTANCE OPTIONS. DOCUMENTATION IS ESSENTIAL IN EFFECTIVE COMMUNICATION. FOLLOW UP TEAMS WILL THEN MOVE FORWARD IN A TIMELY MANNER WITH THE APPROPRIATE ACTIONS TO INSURE ALL NECESSARY DOCUMENTS (IF APPLICABLE) ARE RECEIVED FOR ELIGIBILITY DETERMINATIONS. CHS ADVERTISES A PRICE LINE ENCOURAGING PATIENTS TO INQUIRE ABOUT ESTIMATED COSTS FOR FUTURE SERVICES. THE PRICE IS MANNED BY OUR OUTPATIENT FINANCIAL COUNSELORS FROM 8:00AM TO 7:00PM. WHEN CALLS ARE RETURNED WITH ESTIMATED COSTS, A CONVERSATION ENSUES TO IDENTIFY A POSSIBLE FINANCIAL HARDSHIP. OUR SELF PAY PROCESS IS PUT INTO EFFECT AT THIS TIME. SITE REGISTRARS WILL NOTIFY THE CHS FINANCIAL COUNSELING TEAM WHEN A FINANCIAL HARDSHIP IS IDENTIFIED. EMERGENCY DEPARTMENT FINANCIAL COUNSELING POSITIONS HAVE BEEN CREATED TO MEET THE NEEDS OF OUR ED PATIENTS. IN ADDITION TO THESE NEW ROLES, A FULL TIME FINANCIAL COUNSELOR POSITION WAS CREATED TO MEET THE SPECIAL NEEDS OF OUR CANCER PATIENTS. A FINANCIAL ASSISTANCE COORDINATOR REVIEWS ALL FINANCIAL APPLICATIONS, GATHERS NEEDED DOCUMENTS, DETERMINES FINANCIAL ASSISTANCE AND PREPARES EACH PATIENT FILE FOR LEADERSHIP APPROVAL. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 CENTEGRA HEALTH SYSTEM DEFINES ITS PRIMARY SERVICE AREA AS MCHENRY COUNTY, AN AREA OF APPROXIMATELY 603 SQUARE MILES AND 327,502 RESIDENTS. THIS COUNTY IS AMONG THE FASTEST GROWING COUNTIES IN ILLINOIS WITH AN 18.7% POPULATION GROWTH FROM 2000-2010. THE AGE GROUPS WITH PROJECTED POPULATION GROWTH FROM 2012 TO 2017 ARE THE 20-44 WITH 0.4% AND THE 65+ AGE GROUP WITH 15.8% GROWTH. THE COUNTY'S OVERALL POPULATION IS PROJECTED TO INCREASE BY 0.9% IN THE NEXT FIVE YEARS (2013 TO 2018). FOR 2010, THE AGE DISTRIBUTION OF THE POPULATION WAS AS FOLLOWS: 30% 0-19, 32% 20-44, 28% 45-64, AND 10% 65+. MCHENRY COUNTY HAS RELATIVELY HIGH SOCIOECONOMIC STATUS COMPARED TO THE REST OF ILLINOIS. MEDIAN HOUSEHOLD INCOME FOR 2012 WAS $76,683 COMPARED TO THE IL STATE MEDIAN INCOME OF $55,137. THE MARCH 2014 UNEMPLOYMENT RATE WAS 7.8% WHICH IS LOWER THAN THE STATE AVERAGE OF 8.3%. FOR 2012, THE PERCENTAGE OF THE COUNTY'S POPULATION HOLDING A HIGH SCHOOL DIPLOMA OR HIGHER WAS 92.0%, WHILE THE PERCENTAGE HOLDING A BACHELOR'S DEGREE OR HIGHER WAS 33.1%. THE MCHENRY COUNTY UNINSURED RATE IN 2012 WAS 9.8% COMPARED TO THE STATE UNINSURED RATE OF 12.8%. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 PLEASE SEE SCHEDULE O FOR A DETAILED DESCRIPTION OF THE MEDICAL CENTER'S PROGRAM SERVICE ACCOMPLISHMENTS. AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 MEMORIAL MEDICAL CENTER OF MCHENRY, IL IS AFFILIATED WITH NORTHERN ILLINOIS MEDICAL CENTER OF MCHENTRY, IL. BOTH HOSPITALS ARE ACUTE CARE FACILITIES SERVING THE GREATER MCHENRY COUNTY AREA. CENTEGRA HEALTH SYSTEM IS THE PARENT OF BOTH NORTHERN ILLINOIS MEDICAL CENTER AND MEMORIAL MEDICAL CENTER. MEMORIAL MEDICAL CENTER IS AFFILIATED WITH HEALTH BRIDGE FITNESS CENTERS IN CRYSTAL LAKE, AND THE MEDICAL CENTER PROVIDES OUTPATIENT PHYSICAL REHABILITATION SERVICES TO THE COMMUNITY FROM A CLINIC WITHIN THAT LOCATION. THE CENTEGRA HEALTH SYSTEM FOUNDATION SUPPORTS HOSPITAL OPERATIONS THROUGH FUNDRAISING ACTIVITIES. PLEASE SEE SCHEDULE R FOR COMPLETE LISTING OF ALL AFFILIATED ORGANIZATIONS. STATES WHERE COMMUNITY BENEFIT REPORT FILED SCHEDULE H, PART VI, LINE 7 IL X X X X X false true false false false false false false false MICHAEL EESLEY CHIEF EXECUTIVE OFFICER 0 886904 0 572117 0 299451 0 123550 0 19507 0 1901529 0 0 LISA GLOSSON MD BOARD OF GOVERNORS 0 227492 0 0 0 12881 0 6747 0 23457 0 270577 0 0 RICHARD LIND BOARD OF GOVERNORS 0 381037 0 0 0 0 0 0 0 21386 0 402423 0 0 DAVID TOMLINSON SVP/ CIO/ CFO 0 410838 0 118720 0 3000 0 32533 0 25684 0 590775 0 0 JASON SCIARRO PRESIDENT/ COO 0 633906 0 320770 0 1089 0 64349 0 25889 0 1046003 0 0 SHEILA SENN SVP CHIEF OPERATING OFFICER 207726 0 32705 0 0 0 19650 0 15561 0 275642 0 0 0 JENNIFER OETGEN MANAGER, PHARMACY 137676 0 1975 0 0 0 1981 0 14387 0 156019 0 0 0 SUELLEN AUS-DER-AU CLINICAL STAFF PHARMACIST 148609 0 0 0 0 0 3779 0 12818 0 165206 0 0 0 ANTHONY K LEUNG CLINICAL STAFF PHARMACIST 136664 0 0 0 0 0 2840 0 24558 0 164062 0 0 0 RANDALL E VANDUYN CLINICAL STAFF PHARMACIST 134989 0 0 0 0 0 3691 0 22559 0 161239 0 0 0 Received Severance, Supplemental NQ Retirement, Equity-Based Compensation Schedule J, Part I, Line 4b The following people received the following amounts as part of a supplemental nonqualified retirement plan: Micheal Eesley $117,500; Jason Sciarro $58,449; David Tomlinson $26,674 and Sheila Senn $14,315 Carey Electric Director 57687 Electrical Contractor false SCHEDULE L, PART IV ALL BUSINESS TRANSACTION WITH INTERESTED PERSONS ARE ARM'S LENGTH TRANSACIONS, SEE CONFLICT OF INTEREST DISCLOSURE FOR FORM 990, PART VI, LINE 2. FORM 990, PART III, PROGRAM SERVCE ACCOMPLISHMENTS Executive Summary Centegra Health System (Centegra) coordinates the delivery of health care services by assisting in the management of Centegra Hospital- McHenry (Northern Illinois Medical Center) and Centegra Hospital Woodstock (Memorial Medical Center), (The Medical Centers), and Centegra Health System Foundation, Health Bridge Corporation and NIMED Corporation (Affiliates). In March 2014 Centegra Health System broke ground at Centegra Hospital Huntley. Centegras mission is to inspire and engage our community in their health and wellness. We provide quality health care services with innovative and responsible use of resources and promote wellness for the greater McHenry County area in Illinois. During its fiscal year 2015, Centegra Health System sponsored 230 community events. These events touched more than 232,000 individuals. The Medical Centers provide optimum quality health care, delivered by competent hospital and medical center staff, to all whom seek its services regardless of race, creed, sex, national origin, handicap, age, or ability to pay. The primary mission of the Medical Centers is to enhance the health of the community as the preferred health care organization providing outstanding service and value. It is the Medical Centers' objective to serve the community with respect to providing health care services and education. Although reimbursement for services rendered is critical to the operation and stability of the Medical Centers, it is recognized that not all individuals possess the ability to purchase essential medical services. Therefore, in keeping with the Medical Centers' commitment to serve all members of its community, free care and/or subsidized care will be considered where the need and/or an individual's inability to pay exist. Medical Services are provided in a dignified manner to Medicare, Medicaid and indigent patients. System-wide, community benefits included approximately $5.9 million of charity care, over $45 million of government sponsored indigent health care, approximately $4.7 million of other community benefits, and over 89,000 community benefit hours. *The Medical Centers' services include, but are not limited to: Centegra Hospital-McHenry is a 179-bed facility located about 50 miles outside of Chicago. The hospital is the regions leading provider of advanced cardiovascular treatments through the Centegra Cardiovascular & Thoracic Center. It is also home to the Centegra Hip & Knee Replacement Center, the Centegra Sage Cancer Center and the Centegra Family Birth Center. As part of Centegra Health System, Centegra Hospital-McHenry achieved Magnet designation for nursing excellence. Centegra Hospital-McHenry provides sophisticated treatments and advanced technology to address the most serious medical conditions. These include: *Open-heart surgery and heart catheterizations *Joint replacement surgeries *A Level II Trauma Center and on-site Flight for Life helicopter *Certified chest pain and stroke centers *Advanced cancer treatments including radiation oncology and infusion services *Labor and delivery and on-site 24/7 obstetrics hospitalists and neonatologists *Intensive care *Medical-Surgical care and 24/7 hospitalist care *Outpatient surgery Centegra Hospital-Woodstock is a 106-bed facility located about 60 miles outside of Chicago. The hospital provides exceptional inpatient and outpatient care and has won top awards for patient safety and satisfaction. As part of Centegra Health System, Centegra Hospital-Woodstock achieved Magnet designation for nursing excellence. Centegra Hospital - Woodstock provides sophisticated treatments and advanced technology to address the most serious medical conditions, including: *A Level II Trauma Center and on-site Flight for Life helicopter *Certified chest pain and stroke centers *Intensive care *Medical-Surgical care and 24/7 hospitalist care *Outpatient surgery *Inpatient behavioral health services *Weight-loss surgery through the Centegra Healthy Living Institute *State-of-the-art medical imaging Centegra Health System Foundation provides fund-raising services for Centegra Health System in conjunction with the Medical Centers. The proceeds of these activities are used to purchase medical equipment and supplies, therefore enabling the Medical Centers to better serve the community. Health Bridge Corporation provides various rehabilitation services for the Medical Centers in conjunction with Centegra Health System, by providing a fitness center and pool that serves the community in various capacities and sponsors and hosts assorted educational programs. NIMED Corporation aids in the management of the Medical Centers and several satellite locations within the Centegra Health System organization. The Medical Centers' and the Affiliates' program accomplishments are summarized below. SUPPORT GROUPS Centegra Health System, in conjunction with the Medical Centers and Affiliates, sponsors or hosts many support groups for its patients as well as the community. The following ongoing support groups are held at the Medical Centers, Affiliates or in the community and are free of charge. By supporting these groups, the Medical Centers and Affiliates are able to provide one or all of the following: *Staff professionals who either act as facilitators of the group or function as "Guest Speakers," *Space offered free of charge, *Free marketing to educate the community about these services. Programs sponsored by the Medical Centers and or Affiliates in conjunction with Centegra Health System include: *Alcoholics' Anonymous is a twelve-step program for individuals recovering from alcohol dependence. *Alcoholics' Anonymous, Women's Group is a special group for women. *Al-Anon is a twelve-step program group for codependent individuals. *Arthritis Support Group is for individuals with arthritis. *A.W.A.K.E. Support Group is for those individuals with sleep apnea *Better Breathers Club is for those individuals with pulmonary disease and their families. *Cancer Transitions focuses on the needs of cancer survivors who have finished treatment within the last two years. *Caregivers' Support Group is for those who care for someone with a chronic or life-threatening illness. *Creating Expressions links artistic experience with the emotional benefits of cancer management. *Diabetes Support Group is for individuals with Diabetes and their families. *Epilepsy Support Group is for individuals with Epilepsy and their families. *Families' Anonymous is a support group for families with chemically dependent members. *Fibromyalgia Support Group is for those suffering from Fibromyalgia. *Get Help Live Longer is a smoking cessation education and support group. *Hat's Off is a group for women diagnosed with any type of cancer meeting every month. *Headwinds is a support group offered to survivors of traumatic brain injury and their family members and caregivers. *HOPE: High on Positive Energy is for women living with breast cancer *Participation in conjunction with the Pioneer Center, providing information on topics such as managing behavioral problems and the financial issues of long-term care. *Infertility Support Group is a group for couples or individuals experiencing infertility problems. *Living with Grief, sponsored by Centegra Pastoral Care, offers support for adults grieving the loss of a loved one. *Looking Beyond is for people diagnosed with Cancer, their family members, and friends. *Look Good Feel Better is a free program offered by the American Cancer Society and teaches beauty techniques to women who are currently undergoing cancer treatment. *Make Today Count is a group for anyone with a life-threatening illness as well as their family and friends. *McHenry County Crisis Line provides 24-hour mental health information, referral services, and crisis assistance. *Multiple Sclerosis (MS) Support Group is under the Illinois Chapter of the National Multiple Sclerosis Society. The group is open to persons with MS, their family members and others interested in the treatment and management of the disease. *Narcotics Anonymous is a twelve-step support program for those recovering from narcotics dependence. *Nuts and Bolts is a unique support group for stroke survivors who are 55 years of age or younger. The emphasis of this group is on assisting the families as they adapt to the special lifestyle changes of the young stroke survivor. *Pathfinders is a support group for adults with any cancer diagnosis. *Partnering Through Care is for those living with cancer and their care partners. *Partners in Cancer Transitions is a monthly educational support group for cancer survivors and their care partners. *Perinatal Grief Support Group is for anyone who has experienced the loss of a newborn or an infant through miscarriage, ectopic pregnancy, or Sudden Infant Death Syndrome (SIDS). *St. Peregrine's Cancer Support Group is a non-denominational support group for patients and their families and fri Form 990, Part IV, Line 24 Memorial Medical Center holds a liability on its books for tax-exempt bonds, which is an allocation from its sole corporate member, Centegra Health System. As a result, the question was answered no, and Schedule K will be completed in Centegra Health System's Form 990. Business or Family Relationship of Officers, Directors, Etc Form 990, Part VI, Line 2 Memorial Medical Center, (MMC), adopted specific conflict of interest policies for its governing and management staff. The policy includes, but is not limited to, when an individual, governor, committee member, agent or employee believes that he or she, or member of his or her immediate family might have or does have a real or apparent conflict, he or she should in addition to filing the disclosure notice required, abstain from making motions, voting, executing agreements, or taking any other similar direct action on behalf of MMC. Notwithstanding, it is realized that both real and apparent conflicts of interest sometimes naturally occur in the course of conducting daily affairs. Conflicts occur because the many persons associated with MMC should be expected to have, and do in fact generally have multiple interests and affiliations, and various positions of responsibility with the community. The long-range interests of MMC do not require the termination of an association with persons who have real or apparent conflicts, if an effective method can render such conflicts harmless to all concerned. During fiscal year 2015, MMC purchased certain goods and/or services from organizations with director's affiliation. All goods were competitively bid and conducted at arm's length. The fees paid were at fair market value. Rachel Sebastian, Vice President, is the daughter of Micheal Eesley, CEO. During Fiscal year 2015, Director Michael Curran is an officer/director of Curran Contracting Company. Director Kathy Powell is an employee and vice president at Home State Bank. Director Patrick Morehead is on the Board of Directors and a 2% owner of Home State Bank. Director Charie Zanck is CEO and Vice Chairman of American Community Bank & Trust. Director Charles Ruth is the Board Chairman of American Community Bank & Trust. Director Chris Newkirk is a shareholder of American Community Bank & Trust. Director Tom Carey is the Vice President and Majority Owner of Carey Electric. Description of Delegated Duities to Management Company Form 990, Part VI, Line 3 Management Companies were used for the daily operations and management of the following services for the health system. Sodexho was used for Food and Nutrition, Plant Operations and Maintenance, and Environmental Services work. Dell Marketing LP was used for the management of the Information Systems area. Professional Business Consultants was used for the management of the Managed Care department. Hearthstone Management Services was used for daily operations of the Skilled Nursing Facility. These companies were responsible for staffing decisions, personnel supervision, and financial planning. None of the organization's current or former officers, directors, trustees, key employees of highest compensated employees were compensated by the management companies during the calendar year 2014. Explanation of Classes of Members or Shareholders Form 990, Part VI, Line 6 Centegra Health System is a sole member of MMC. Centegra Health System has a single class of members. HOW MEMEBERS ELECT GOVERNING BODY Form 990, Part VI, Line 7a The powers and duties of the Centegra Health System members in fulfilling the purposes and objectives of the Corporation shall include, but not be limited to, the taking of action with respect to the following matters: The election of governors and the filling of vacancies of the Board of Governors, which shall be in accordance with the procedures set forth in the Bylaws. The Nominating Committee shall select one candidate for each position on the Board having a term to be voted upon for the office of governor at the next annual meeting of members. The Nominating Committee shall consider and approve a list of candidates and submit such a list to the Board of Governors not less than 10 days prior to the date of the last meeting of member is to be sent, and the candidates set forth on such list shall be subject to approval by the Board of Governors. The names of the candidates so selected by the Nominating Committee and approved by the Board of Governors shall be included in the notice of the annual meeting for the members of the Corporation and shall be presented to the members for the Corporation at the annual meeting. The voting members of the Corporation may nominate candidates for positions on the Board of Governors. Nominations by such members may be effected by means of written nomination signed by not less than 20 voting members in good standing, accompanied by a written statement of such nominee indicating a willingness to serve as a governor of the Corporation if elected. Any such nomination must be received by the Nominating Committee of the Corporation not less than 60 days prior to the annual meeting of members in order to be considered at such annual meeting. All elections shall be by secret ballot if there are more nominees than vacancies to be filled on the Board. All voting members present in person or by proxy at a meeting at which an election occurs shall be entitled to vote for governors. To be valid a ballot must not have more votes than there are vacancies. If there are more nominees than vacancies to be filled on the Board, those nominees who receive the most votes shall be elected to the Board of Governors. Members shall not be entitled to cumulate their votes in the election of governors. Form 990 Review Process Form 990, Part VI, Line 11b The review process for the 990 includeS compilation by internal staff, detailed review by an outside auditor, bond counsel, the Controller and Chief Financial Officer, prior to submission to the IRS. The tax return will be made available for the Board to review after submission to the IRS. Explanation of Monitoring and Enforcement of Conflicts Form 990, Part VI, Line 12c 1. In connection with any actual or possible conflicts of interest, an interested person or other person subject to this policy must disclose the existence and nature of his or her financial interest in writing to the President of Centegra or the Chief Corporate Responsibility Officer or designee, who shall provide such written disclosure to the Governors Affairs Committee of Centegra, which shall consider all conflicts of interest issues and, if appropriate, to the directors and members of committees with board-delegated powers considering the proposed transaction or agreement. The disclosure must occur, at minimum, annually, with a conflict of Interest Disclosure Statement being submitted no later than January 31st of each year. Copies of disclosure statement filed by the Board members shall be distributed to the Board annually at the February Board meeting. 2. When a conflict of interest is disclosed at a meeting of the board or committee thereof, after disclosure of the financial interest, the interested person shall leave the board or committee meeting while the financial interest is discussed and voted upon. The remaining board or committee shall decide if a conflict of interest exists. The interested person's leaving such meeting shall not affect whether a quorum exists at such meeting. 3. Procedures for addressing the transaction or arrangement from which the conflict arose. The chairperson of the board of committee shall, if appropriate, appoint a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement. After exercising due diligence, the board or committee shall determine whether Centegra can obtain a more advantageous transaction or arrangement with reasonable efforts from a person or entity that would not give rise to a conflict of interest. If a more advantageous transaction or arrangement is not reasonably attainable under circumstances that would not give rise to a conflict of interest, the board of committee shall determine by a majority vote of the disinterested directors whether the transaction or arrangement is in Centegra's best interest and for its own benefit and whether the transaction is fair and reasonable to Centegra and shall make its decision as to whether to enter into the transaction or arrangement in conformity with such determination. 4. Violations of the Conflicts of Interest Policy: If the administration, the board, or a committee has a reasonable cause to believe that a member has failed to disclose actual or possible conflicts of interest, it shall inform the member of the basis for such belief and afford the member an opportunity to explain the alleged failure to disclose. If, after hearing the response of the member and making such further investigation as may be warranted in the circumstances, the board or committee determines that the member has, in fact failed to disclose an actual or possible conflict of interest, it shall refer the matter to the Governors Affairs Committee for consideration, which shall subsequently recommend appropriate disciplinary and corrective action to such board or committee. 5. The minutes of the board and all committees with board-delegated powers shall contain the names of the persons who disclosed or otherwise were found to have a financial interest in connection with an actual or possible conflict of interest, the nature of the financial interest, any action taken to determine whether a conflict of interest was present, and the board's or committee's decision as to whether a conflict of interest, in fact, existed. The names of the persons who were present for discussion and votes relating to the transaction or arrangement, the content of the discussions, including any alternatives to the proposed transaction or arrangement, and a record of any votes taken in connection therewith. 6. A voting member of any committee whose jurisdiction includes compensation matters and who receives compensation, directly or indirectly, from Centegra for services is precluded from voting on matters pertaining to that member's compensation, Physicians who receive compensation, directly or indirectly from Centegra, whether as employees or independent contractors, are precluded from membership on any committee whose jurisdiction includes compensation matters and in which such physician may have a direct or indirect interest. 7. Each director, principal officer, and member of a committee with board-delegated powers shall annually sign a statement which affirms that such person has received a copy of the conflicts of interest policy; has read and understands the policy; has agreed to comply with the policy; and understands that Centegra is a charitable organization and that in order to maintain its federal tax exemption, it must engage primarily in activities which accomplish one or more of its tax exempt purposes. 8. To ensure that Centegra operates in a matter consistent with its charitable purposes and that it does not engage in activities that could jeopardize its status as an organization exempt from federal income tax, periodic reviews shall, at a minimum, include the following subjects: Whether acquisition of physician practices and other provider services result in inurement or impermissible private benefit. Whether joint venture arrangements and arrangements with management service organizations and physician hospital organizations conform to written policies, are properly recorded, reflect reasonable payment for goods and services, further Centegra's charitable purposes and do not result in inurement or impermissible private benefit. Whether agreements to provide healthcare and agreements with other healthcare providers, employees, and third party payors further Centegra's charitable purposes and do not result in inurement or impermissible private benefit. Whether business transactions on behalf of Centegra or an entity controlled by it are the result of arms-length dealing and are no less advantageous than competitively available goods and services of like grade and quality. 9. In conducting the periodic reviews provided for in Article VII, Centegra may, but need not, use outside advisors. If outside experts are used, their use shall not relieve the board of its responsibility for ensuring that periodic reviews are conducted. Compensation Review & Approval Process Form 990, Part VI, Line 15b The Board of Directors of Centegra Health System, through the Compensation Committee comprised of independent members free of conflict, reviewed executive compensation levels and other features of the compensation plan in accordance with the organization's approved compensation philosophy and strategy: The Committee is comprised of members of the Board of Directors, who are independent of Centegra management, have no personal interest in the compensation arrangements, are not related to, or under the control of any individual whose compensation arrangement is being reviewed and have no material business relationship with Centegra. The Chief Executive Officer's compensation is determined by the Compensation Committee in relation to appropriate comparability data. Compensation for other members of the executive staff are developed by the CEO, reviewed by the Committee, evaluated against market data, and approved by the Committee. The Committee approves all compensation decisions in advance of their implementation and documents its determinations and discussions. Its decision and deliberations are thoroughly documented and meeting minutes are kept and distributed to the Committee members (for historical reference). The Compensation Committee uses a number of external resources and comparisons, and their review includes total compensation (cash compensation, plus benefits provided by Centegra) in relation to organizational performance and prevailing industry practices of comparably-sized organizations. They have engaged the services of a compensation consulting firm (Sullivan Cotter) specializing in the not-for-profit sector that has worked with Centegra and reports directly to the Compensation Committee. Other Organization Documents Publicly Available Form 990, Part VI, Line 19 All documents are available upon request. FORM 990, PART IX, LINE 24A IT SHOULD BE NOTED THAT THE RELATED COMPANY EXPENSES IN FORM 990, PART IX, LINE 24A ARE ALLOCATED AT 35% OF TOTAL EXPENSE OF THE RELATED COMPANY (CENTEGRA HEALTH SYSTEM, FEIN 36-3196559). THE ALLOCATION METHOD IS REVIEWED ANNUALLY. EXPENSE DETAIL IS AS FOLLOWS: SALARIES $8,724,825; BENEFITS $1,488,234; PAYROLL TAXES $550,354; PURCHASED SERVICES / PROFESSIONAL FEES $7,277,978; IT EXPENSES $1,953,631; OFFICE EXPENSES $1,729,072; ADVERTISING AND PROMOTIONAL $33,388; OTHER EXPENSES $3,096,698. FORM 990, PART XI, LINE 9 Change in Investment in Foundation $(551,587) Transfer to Affiliates $(5,926,000) ------------ TOTAL $(6,447,587) Centegra Health System 385 Millennium Drive Crystal Lake IL 60012 363196559 HEALTH SYSTEM IL 501(c)(3) 11c NA false Northern Illinois Medical Center 4201 Medical Center Drive McHenry IL 60050 362338884 HOSPITAL IL 501(c)(3) 3 Centegra HS false Centegra Health System Foundation 385 Millennium Drive Crystal Lake IL 60012 363723610 Fundraising IL 501(c)(3) 11a Centegra HS false NIMED Corporation 385 Millennium Drive Crystal Lake IL 60012 363119911 Property MGMT IL 501(c)(3) 11c Centegra HS false Health Bridge Corporation 385 Millennium Drive Crystal Lake IL 60012 363196550 HEALTH FT CTR IL 501(c)(3) 11c Centegra HS false Oak Creek Lodge 385 Millennium Drive Crystal Lake IL 60012 363591359 Hospital IL 501(c)(3) 3 Centegra HS false Centegra Hospital-Huntley 10400 Haligus Road Huntley IL 60142 453449737 Hospital IL 501(c)(3) 3 Centegra HS false Centegra Management Services 385 Millenium Drive Crystal Lake IL 60012 364028114 Physican Practice IL Centegra Health C Corp false false false true false false false false false false true true true true false false false false true true