2016-08-15T15:03:21-05:00 2015-09-30 350921680 CROWE HORWATH LLP 225 West Wacker Drive Suite 2600 Chicago IL 606061224 990 2014-10-01 362170866 The Ingalls Memorial Hospital INGA 7083332300 One Ingalls Drive Harvey IL 60426 ANDREW STEFO CFO 2016-08-12 true John V Woodhull P01305268 3128997000 2014 2016-09-27 15:27:22Z Kurt E Johnson One Ingalls Drive Harvey IL 60426 305074597 false X www.Ingalls.org X 1922 IL The Ingalls Memorial Hospital strives to improve the health of the communities it serves by investing in the latest medical technologies, the structural needs of our facilities, and our employees. During the year Charity care services were provided, as reported on the organization's audited financial statements. 23 19 2693 182 1014876 -80849 1093026 997367 288059903 282051535 6552602 19283201 2437156 2036175 298142687 304368278 140448 126600 0 0 118484643 114252979 0 0 0 163227631 163455298 281852722 277834877 16289965 26533401 526405432 534093025 211419746 211611577 314985686 322481448 Ingalls Memorial Hospital strives to improve the health of the communities it serves by investing in the latest medical technologies, the structural needs of our facilities, and our employees. (Cont. in Schedule O) false false 244288361 126600 282094122 PATIENT CARE: THE INGALLS MEMORIAL HOSPITAL (IMH) INCLUDES A 500+ CERTIFIED BED HOSPITAL AND A NETWORK OF COMPREHENSIVE OUTPATIENT CENTERS THAT FEATURE A FULL ARRAY OF HIGH-TECH DIAGNOSTIC AND TREATMENT SERVICES. AS THE AREA'S ONLY INDEPENDENT NOT-FOR-PROFIT HEALTHCARE SYSTEM, IMH HAS THE ABILITY TO ENSURE THAT OUR RESOURCES ARE DIRECTED TO AREAS THAT RESULT IN THE GREATEST BENEFIT TO OUR PATIENTS AND THE COMMUNITY. 208000 208000 WITH THE CLOSING OF TINLEY PARK MENTAL HEALTH SERVICES, THE IDHS GRANT FOR INPATIENT PSYCH SERVICES PROVIDES UNINSURED INDIVIDUALS IN NEED OF MENTAL HEALTH INPATIENT CARE WHEN SERVICES ARE INSUFFICIENT OR UNAVAILABLE. 41730 41730 RESEARCH: THE INGALLS MEMORIAL HOSPITAL CONDUCTS RETINAL VASCULAR RESEARCH, A STUDY OF PATIENTS 50-85 YEARS OLD WITH LARGE BILATERAL DRUSEN AND ADVANCED AGE-RELATED MACULAR DEGENERATION. USE OF HIGH-DOSE ANTI-OXIDANTS AND ZINCS REDUCE PROGRESSION TO ADVANCED AGE-RELATED MACULAR DEGENERATION. 17162 17162 THE HOSPITAL RECEIVED THE NATIONAL BIOTERRORISM GRANT, WHICH IS TO BE USED TO BUILD AND PRIORITIZE REGIONAL CAPABILITIES THAT SUPPORT THE DEVELOPMENT OF MEDICAL SURGE AND CONTINUITY OF OPERATIONS WITHIN AND ACROSS HEALTHCARE REGIONS. 17162 17162 244555253 true true false true false false false false false false true false false false true true false true false false false false false false false false true true true true true true false false false false false false false false false false false false false false false true true true false false true 351 0 true 2693 true true true false false false false false false false false false X 23 19 false false false false true true true true true false false true true true true true true true true false IL X Andrew Stefo 7083332300 ONE INGALLS DRIVE Harvey IL 60426 EUGENE M FEINGOLD CHAIRMAN OF THE BOARD 1.00 3.00 X X 0 0 0 RICHARD M KING BOARD MEMBER, SECRETARY/TREASURER 1.00 2.00 X X 0 0 0 DENNIS J IRVIN BOARD MEMBER, VICE CHAIRMAN 1.00 2.00 X X 0 0 0 MICHAEL HICKS CHIEF OPERATING OFFICER/BOARD MEMBER 40.00 0 X X 506501 0 37666 KURT E JOHNSON PRESIDENT/CEO AND BOARD MEMBER 40.00 4.00 X X 1204434 0 44479 KATHLEEN MIKOS RN MSN CHIEF NURSING OFFICER AND BOARD MEMBER 40.00 0 X X 380568 0 35166 SAMUEL J CUTRARA JR CPA BOARD MEMBER 1.00 1.00 X 0 0 0 ROBERT L HARRIS BOARD MEMBER 1.00 1.00 X 0 0 0 HENRY K JOHNSON BOARD MEMBER 1.00 1.00 X 0 0 0 MICHAEL P KAMRADT BOARD MEMBER 1.00 1.00 X 0 0 0 NEAL E KITCHELL BOARD MEMBER 1.00 1.00 X 0 0 0 DAVID H ORTH MD BOARD MEMBER 1.00 2.00 X 0 0 0 KEVIN PURCEL BOARD MEMBER 1.00 1.00 X 0 0 0 TIMOTHY D JOHNSON BOARD MEMBERR 1.00 1.00 X 0 0 0 NATHANIEL K SUTTON BOARD MEMBER 1.00 1.00 X 0 0 0 HEATHER DAVIS BOARD MEMBER 1.00 1.00 X 0 0 0 LYNDELL S BECKHAM Board Member 1.00 1.00 X 0 0 0 MARK KOZLOFF MD BOARD MEMBER 1.00 42.00 X 0 563284 22172 RICHARD ANDERSON BOARD MEMBER 1.00 0 X 0 0 0 CARL JOHNSON II MD BOARD MEMBER 1.00 0 X 0 0 0 CRESSA PERISH MD BOARD MEMBER 1.00 0 X 0 0 0 STEVEN ANDERSON BOARD MEMBER 1.00 0 X 0 0 0 BEHNAM ZAKHIREH MD BOARD MEMBER 1.00 X 0 0 0 MICHAEL J DEVORE CHIEF INFORMATION OFFICER 40.00 0 X 245814 0 28592 DIANE JACOBY ASSISTANT SECRETARY, VICE PRESIDENT, GENERAL COUNSEL 40.00 2.00 X 484213 0 46381 JOSEPH M MOSER VP Development - Foundation 1.00 40.00 X 310241 0 27400 ALETHA ROSS VICE PRESIDENT OF HUMAN RESOURCES 40.00 0 X 272089 0 27491 ANDREW K STEFO VP - FINANCE/CFO 40.00 1.00 X 543210 0 36466 SCOTT C STRAUSSER VP - BUSINESS DEVELOPMENT 40.00 0 X 429038 0 12880 TAMARA PROFIRIO VICE PRESIDENT/COO MEDCENTRIX INC 40.00 0 X 258670 0 49419 LAWRENCE KLONOWSKI MANAGER MEDICAL PHYSICS 40.00 0 X 197292 0 37398 HEIDI RUHE IMH DIR BUSINESS DEVELOPMENT 40.00 0 X 143653 0 39631 LINDA B CONWAY IMH ASSOCIATE GENERAL COUNSEL 40.00 0 X 178037 0 8670 MARY JO CRANDALL IMH LEAN FACILITATOR 40.00 0 X 172432 0 5552 LYNN S PHILIPSON IMH DIRECTOR OF MANAGED CARE 40.00 0 X 156682 0 9772 5482873 563284 469135 108 false true true ARAMARK CORPORATION 25271 NETWORK PLACE CHICAGO IL 60673 CONTRACT FOOD, PLANT, HOUSEKEEPING, AND TRANSPORTATION SERVICES 21933475 SYNERGY BEHAVIORAL HEALTHCARE 1566 W ALGONQUIN ROAD 3149 HOFFMAN ESTATES IL 60192 IN PT AND OUT PT PSYCHIATRIC SERVICES 4881100 KURTZ AMBULANCE SERVICES INC PO BOX 129 NEW LENOX IL 60451 AMBULANCE SERVICES 1993851 RADIOLOGY IMAGING CONSULT POB 110 71 W 156TH ST HARVEY IL 60426 RADIOLOGISTS 1246082 SULLIVAN URGENT AID CENTER ONE TRANSAMERICA PLAZA DR SUITE 360 OAK BROOK TERRACE IL 60181 EMERGENCY ROOM PHYSICIANS 1051827 70 X 952854 44513 997367 Net Patient Service 900099 272221155 272221155 Rental Income 900099 880360 880360 Client Service Revenue 900099 687676 687676 Lab Services 621500 1032953 18077 1014876 Medic Training 900099 210186 210186 7019205 7019205 0 0 282051535 1365211 1365211 1113451 706319 407132 0 407132 407132 17917990 17917990 0 17917990 17917990 EXPENSE REIMBURSEMENT & MGMT FEES 900099 884148 884148 PARKING INCOME 900099 110119 110119 CHILD CARE CENTER 900099 194569 194569 440207 440207 0 0 1629043 304368278 282361014 1014876 19995021 X 29750 29750 96850 96850 4079587 4079587 92259002 83313712 8945290 2528725 2295837 232888 8133870 7384764 749106 7251795 6583925 667870 7215210 7215210 151152 1564 149588 158265 158265 512568 512568 52057981 41570165 10487816 0 1556297 1396018 160279 9997597 9997597 632084 408283 223801 369047 307678 61369 4770762 3928722 842040 15963516 14046297 1917219 1790302 1641197 149105 Medical Supplies 52696487 52300594 395893 Laundry 1010196 1010196 PUBLIC AID ASSESSMENT 14162517 14162517 Gift Shop 236372 236372 174945 0 174945 0 277834877 244555253 33279624 0 5693103 16690300 45690951 41385841 0 0 0 5304088 5721103 3368564 3803988 515409098 323391036 184590112 192018062 270333523 260815096 0 3485894 3063752 702916 663952 7236281 9930931 526405432 534093025 53486644 84100222 499053 -1383657 140032211 109949339 0 17401838 18945673 211419746 211611577 X 310631518 318061321 4354168 4420127 314985686 322481448 526405432 534093025 X 26533401 -16683120 -2354519 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false true 43706 43706 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Used for the specific lobbying of unallowable expenses by medicare. These funds also support a variety of programs focused on advocacy and representation. 416863 416863 275366130 147802402 127563728 12211665 10263476 1948189 204642100 165325158 39316942 22772340 22772340 192018062 632113 Other Long Term Payables 6808325 Tender Premium Payable (Swap Valuation Payable) 11505235 18945673 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote The Corporation, IMH, IHV, IDF, and IHC are nonprofit corporations as described in Section 501(c)(3) of the Internal Revenue Code (the "Code") and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. These entities are also exempt from state income taxes on related income. IPG is an Illinois not-for-profit corporation that is taxable for federal income tax purposes. true true X true X false true true false true true 8186314 8186314 0.0295 73607411 49404669 24202742 0.0871 342354 210669 131685 0.0005 0 0 82136079 49615338 32520741 0.1171 320627 320627 0.0012 589930 312310 277620 0.0010 0 0.0 0 0.0 686966 686966 0.0025 0 0 1597523 312310 1285213 0.0046 0 0 83733602 49927648 33805954 0.1217 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 15400215 9132328 100599493 117179573 -16580080 X true true 1 1 INGALLS MEMORIAL HOSPITAL WWW.INGALLS.ORG 0001099 X X X INGALLS MEMORIAL HOSPITAL 1 true false true X X X X X X X X X 15 true false true true X ingalls.healthforecast.net X true 15 true ingalls.healthforecast.net false false true X 2.0 0.0 X X X X true true X X X true X www.ingalls.org X www.ingalls.org X www.ingalls.org X X X X X true false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - INGALLS MEMORIAL HOSPITAL. The Community Health Needs Assessment was sponsored by Ingalls Memorial Hospital in cooperation with the Metropolitan Chicago HealthCare Council. The project also received input from a Community Health Needs Committee, created for this purpose, which was comprised of representatives of the partnering organizations as well as other citizens chosen for their relevant experience and interests. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - Other Organizations. See Line 5 Above Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Ingalls Memorial Hospital. The significant needs in the Community were identified as preventing the two leading causes of death within the service area of Ingalls Memorial Hospital. The causes are cardiovascular diseases (including heart attack and stroke) and cancer. In order to educate about these causes of death we provide learning opportunities and patient screening for the community. Programs are offered through the year to educate the public about their risk for heart attacks and strokes. We hold community talks at local events (churches, festivals and those hosted by Ingalls). We also offer an online screening tool which provides participants an opportunity to learn more about their risk for cardiovascular disease and also provides them with information/tools to improve their health status. We specifically teach about stroke warning signs by holding education opportunities for church and women's groups. To address the high mortality rates for cancer in the area we will offer education and cancer screenings. Mammography and colorectal cancer screenings will be addressed with campaigns to educate about the importance of regularly scheduled screenings. 8 Ingalls Family Care Center 1600 Torrence Avenue Calumet City IL 60409 Urgent Aid, Primary Care, and Specialist Services Ingalls Care Center 4742 Cal Sag Road Crestwood IL 60445 Quick Care Center and Occumpational Health Ingalls Family Care Center 6701 West 159th Street Tinley Park IL 60477 Urgent Aid, Primary care, and specialist services Ingalls Family Care Center 19550 Governors Highway Flossmoor IL 60422 Urgent aid and specialist services Ingalls Wellness Center 2920 Wellness Center Homewood IL 60430 Complementary medicine and community health programs The Villa at South Holland 16300 Wausau Avenue South Holland IL 60473 Healthcare and Rehabilitation Center Ingalls Care Center 16246 Prince Drive South Holland IL 60473 Industrial, medical rehabilitation and Physician Offices Ingalls Family Care Center 4647 West Lincoln Highway Matteson IL 60443 Laboratory, Imaging, and Diagnostic services Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance Ingalls utilizes a cost to charge methodolgy., Charges associated with the related categories are then used to determine cost related to such revenue. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount The amount of bad debt reported on line 2 is estimated using the same methodology used to report bad debt in the hospital's audited financials. Schedule H, Part III, Line 3 Bad Debt Expense Methodology Based on poverty levels of the surrounding community, it is estimated that approximately 59.3% of the bad debt expense is attributable to patients who would have been eligible under the hospital's financial assistance policy. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote Patient accounts receivable are uncollateralized patient obligations that are stated at the amount management expects to collect from outstanding balances. These obligations are primarily from local residents, most of whom are insured under third-party payor agreements. The System bills third-party payors on the patients' behalf, or if a patient is uninsured, the patient is billed directly. Once claims are settled with the primary payor, any secondary insurance is billed, and patients are billed for copay and deductible amounts that are the patients' responsibility. Payments on accounts receivable are applied to the specific claim identified on the remittance advice or statements. The System does not have a policy to charge interest on past due accounts. Patient accounts receivable are recorded in the accompanying consolidated balance sheets net of contractual adjustments and an allowance for uncollectible accounts, which reflects management's best estimate of the amounts that will not be collected. Management provides for contractual adjustments under terms of third-party reimbursement agreements through a reduction of gross revenue and a credit to patient accounts receivable. In evaluating the collectibility of patient accounts receivable, the System analyzes historical loss experience on revenue from self-pay patients. Using the loss experience rate, the System estimates the appropriate allowance for uncollectible accounts and provision for bad debts. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for uncollectible accounts. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs The hospital believes the full amount of the shortfall from Medicare should be treated as community benefit because it serve all patients regardless of insurance or ability to pay, and it cannot negotiate contractual rates with the medicare program. The hospital must accept what the medicare program pays. The methodology used in determining medicare used in the community benefits report is medicare charges multiplied by the medicare cost report, cost to charge ratio Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Ingalls Memorial Hospital has a fiduciary duty to seek reimbursement for services it has provided from individuals who are able to pay, from third party insurers who cover the cost of care, and from other programs of assistance for which the patient is eligible. To determine whether a patient is able to pay for the services provided as well as to assist the patient in finding alternative coverage options if they are uninsured or underinsured, the hospital follows the following criteria related to billing and collecting from patients. Collecting Information on Patient Health Coverage and Financial Resources Patient Obligations: Prior to the delivery of any health care services (except for cases that are an emergency or urgent care service level), the patient is expected to provide timely and accurate information on their insurance status, demographic information, changes to their family income or insurance status, and information on any deductibles or co-payments that are owed based on their existing insurance or financial program's payment obligations. The detailed information will include: a. Full name, address, telephone number, date of birth, social security number (if available), current health insurance coverage options, citizenship and residency information, and the patient's applicable financial resources that may be used to pay their bill; b. Full name of the patient's guarantor, their address, telephone number, date of birth, social security number (if available), current health insurance coverage options, and their applicable financial resources that may be used to pay for the patient's bill; and c. Other resources that may be used to pay their bill, including other insurance programs, motor vehicle or homeowners insurance policies if the treatment was due to an accident, worker's compensation programs, and student insurance policies, among others. It is ultimately the patient's obligation to keep track of and timely pay their unpaid hospital bill, including any existing co-payments, co-insurance, and deductibles. The patient is further required to inform either their current health insurer (if they have one) or the agency that determined the patient's eligibility status in a public health insurance program of any changes in family income or insurance status. The hospital may also assist the patient with updating their eligibility in a public program when there are any changes in Family Income or insurance status, but only if the hospitals made aware by the patient of facts that may indicate a change in the patient's eligibility status. Patients are required to notify the state public program (Office of Medicaid), information related to any lawsuit or insurance claim that will cover the cost of the services provided by the hospital. Hospital Obligations: Ingalls Memorial Hospital will make all reasonable and diligent efforts to collect the patient insurance status and other information to verify coverage for the health care services to be provided by Ingalls Memorial Hospital. These efforts may occur when the Patient is scheduling their services, during pre-registration, while the patient is admitted in the hospital, upon discharge, or during the collection process which may occur for a reasonable time following discharge from the hospital. This information will be obtained prior to the delivery of any non-emergent and non-urgent health care services (i.e., elective procedures and scheduled procedures). Ingalls Memorial Hospital will delay any attempt to obtain this information during the delivery of any EMTALA level emergency level or urgent care services, if the process to obtain this information will delay or interfere with either the medical screening examination or the services undertaken to stabilize an emergency medical condition. The hospital's reasonable and diligent efforts will include, but is not limited to, requesting information about the patient's insurance status, checking any available public or private insurance databases, and following the billings rules of a known third party payer. If the patient or guarantor/guardian is unable to provide the information needed, and the patient consents, the hospital will make reasonable efforts to contact relatives, friends, guarantor/guardian, and the third party for additional information. Ingalls Memorial Hospital will also make reasonable and diligent efforts to investigate whether a third party resource may be responsible for the services provided by The hospital, including but not limited to: (1) a motor vehicle or homeowner's liability policy, (2) general accident or personal injury protection policies, (3) worker's compensation programs, (4) student insurance policies, among others. In accordance with applicable state regulations or the insurance contract, for any claim where Ingalls Memorial Hospital's reasonable and diligent efforts resulted in a payment from a private insurer or public program, Ingalls Memorial Hospital will report the recovery and off set it against the claim paid by the private insurer or public program. The hospital further maintains all information in accordance with applicable federal and state privacy, security and ID theft laws. Schedule H, Part V, Section B, Line 16a FAP website - INGALLS MEMORIAL HOSPITAL: Line 16a URL: www.ingalls.org; Schedule H, Part V, Section B, Line 16b FAP Application website - INGALLS MEMORIAL HOSPITAL: Line 16b URL: www.ingalls.org; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - INGALLS MEMORIAL HOSPITAL: Line 16c URL: www.ingalls.org; Schedule H, Part VI, Line 2 Needs assessment In addition to the Community Health Needs Assessment that was conducted, the hospital has a community relations department whose sole purpose is to assess and address the healthcare needs of the community. The hospital partners with community groups to identify needs, strengthen existing community programs, and plan newly needed services. Specific attention is paid to the needs of low income and vulnerable populations. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance The hospital informs and educates patients and persons who may be billed for patient care about the eligibility for assistance by posting signs throughout the patient registration areas regarding patient payment options. In addition, patients are also informed via the hospital's website, individual patient statements and financial counselors. Below are additional details regarding how the hospital informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under the hospital's financial assistance policy. Signage: Signs or similar written notices regarding the availability of Financial Assistance Program will be visible at all hospital points of service, to create awareness of the Financial Assistance Program. At a minimum, signage will be posted in the emergency department and the admission registration area. All public information and/or forms regarding the provision of Financial Assistance Program will use languages that are appropriate for the service area in accordance with the state's Language Assistance Services Act. Hospital Bill/Invoice: Patient bills or statements shall include a prominent statement that patients who meets certain income requirements may qualify for financial assistance and information regarding how a patient may apply for consideration under the hospital's financial assistance policy. Patient Handbook /Brochures: Handbooks or brochures will be available at points of service areas. Via internet: A summary of the Financial Assistance Program will be available pursuant to this policy and will be available at www.ingalls.org. Upon Request: Upon request, a copy of the Financial Assistance Program Policy will be made available. Application Forms: Forms used to determine a patient's eligibility for Financial Assistance will be made available at point of service to all patients or family members. Forms are also available at www.ingalls.org. Schedule H, Part VI, Line 4 Community information The hospital's immediate services area faces a number of different challenges such as: *The highest rate in the metro area for persons below poverty level, *The greatest numbers of persons on Medicaid, *The highest rates of uninsured individuals, and *The highest rates of unemployed individuals. The median income for a household in the hospital's service area was $26,133, and the median income for a family was $36,580. About 29.9% of families and 34.7% of the population were below the poverty line, including 47.8% of those under age 18 and 16.1% of those age 65 or over. The information above was obtained from the United States Census Bureau. http//factfinder.census.gov. 2014 Data Schedule H, Part VI, Line 5 Promotion of community health The hospital's service area has historically seen the highest Pregnancy Outcome Risk Index in the state. As such, Ingalls has partnered with local service agencies to offer the Healthy Baby Network which provides medical care and social service programs for mothers at risk. Ingalls contracted with a local group of OB/GYNs to provide around the clock care in our emergency room for women who present with no prenatal care and are at higher risk. The area's local children also have among the region's lowest immunization rates. Accordingly, Ingalls has, for many years, offered free community programs to provide needed vaccinations. Ingalls Board of Directors consists of business and community members that live locally. Besides the President and CEO we have one employed physician that serves as a director. No members are contractors or family members of a contractor. All requests for applications are reviewed and acted upon by our Professional Affairs Committee. If this committee feels that there is a need for a particular service and/or a patient need exists, the applicant is felt to meet minimum qualifications, an application is offered. The medical staff supports improvements in patient care and ongoing education to the medical and professional staff through funding of numerous medical education activities. We are accredited by the Illinois State Medical Society to award CME category 1 credit. The CME Committee is responsible for oversight of the monthly CME activities which are sponsored by the hospital and both medical and professional (nursing, quality, etc.) staff are invited and encouraged to attend the programs. The medical staff also supports the hospital and community by contributing to various events including the annual benefit. Schedule H, Part VI, Line 6 Affiliated health care system The Ingalls Memorial Hospital is part of the Ingalls Health System. The Ingalls Health System was incorporated to support and encourage health and human services through the following affiliates: *The Ingalls Memorial Hospital *Ingalls Health Ventures *Medcentrix, Inc. *Ingalls Development Foundation *Ingalls Home Care *Ingalls Provider Group *Ingalls Casualty Insurance *Ingalls Same Day Surgery, Ltd. *Ingalls Care Network true Harvey Community Center 15320 Center Avenue Harvey IL 60426 501(c)(3) 5000 Donation 1 0 SCHOLARSHIPS 229 96850 0 N/A N/A Schedule I, Part I, Line 2 Description Of Procedure For Monitoring Use Of Grant Funds Scholarships are paid directly to the educational institutions in order to ensure the funds are used for their intended purpose. Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. Scholarships are paid directly to the educational institutions in order to ensure the funds are used for their intended purpose. X X X X false false false false false false false false false MICHAEL HICKS CHIEF OPERATING OFFICER/BOARD MEMBER 486310 0 0 0 20191 0 10800 0 26866 0 544167 0 0 0 KURT E JOHNSON PRESIDENT/CEO AND BOARD MEMBER 1199403 0 0 0 5031 0 10800 0 33679 0 1248913 0 0 0 KATHLEEN MIKOS RN MSN CHIEF NURSING OFFICER AND BOARD MEMBER 372846 0 0 0 7722 0 10800 0 24366 0 415733 0 0 0 MARK KOZLOFF MD BOARD MEMBER 0 538113 0 0 0 25171 0 2600 0 19572 0 585456 0 0 MICHAEL J DEVORE CHIEF INFORMATION OFFICER 234974 0 0 0 10839 0 9699 0 18893 0 274406 0 0 0 DIANE JACOBY ASSISTANT SECRETARY, VICE PRESIDENT, GENERAL COUNSEL 479182 0 0 0 5031 0 10800 0 35581 0 530594 0 0 0 JOSEPH M MOSER VP Development - Foundation 307796 0 0 0 2445 0 10002 0 17398 0 337641 0 0 0 ALETHA ROSS VICE PRESIDENT OF HUMAN RESOURCES 269771 0 0 0 2318 0 9196 0 18295 0 299580 0 0 0 ANDREW K STEFO VP - FINANCE/CFO 517988 0 0 0 25222 0 10800 0 25666 0 579675 0 0 0 SCOTT C STRAUSSER VP - BUSINESS DEVELOPMENT 408847 0 0 0 20191 0 10800 0 2080 0 441918 0 0 0 TAMARA PROFIRIO VICE PRESIDENT/COO MEDCENTRIX INC 240466 0 0 0 18204 0 8838 0 40581 0 308089 0 0 0 LAWRENCE KLONOWSKI MANAGER MEDICAL PHYSICS 189325 0 0 0 7968 0 8650 0 28748 0 234690 0 0 0 HEIDI RUHE IMH DIR BUSINESS DEVELOPMENT 142684 0 0 0 969 0 6193 0 33438 0 183283 0 0 0 LINDA B CONWAY IMH ASSOCIATE GENERAL COUNSEL 176219 0 0 0 1817 0 7452 0 1218 0 186707 0 0 0 MARY JO CRANDALL IMH LEAN FACILITATOR 171625 0 0 0 807 0 5552 0 0 0 177984 0 0 0 LYNN S PHILIPSON IMH DIRECTOR OF MANAGED CARE 152592 0 0 0 4090 0 6634 0 3138 0 166454 0 0 0 A Illinois Finance Authority 861091967 45200BHK7 2007-11-16 48000000 Refunding of 11/10/2004 Bond issuance false false false B Illinois Finance Authority 861091967 45203HPE6 2013-02-06 64815292 REFUNDING OF 7/19/1994 BOND ISSUANCE; CAPITAL PROJECTS false false false A 0 0 48000000 0 0 0 0 0 0 0 48000000 0 2007 true false true true B 0 0 64815292 0 0 0 1183106 0 0 30160252 33471934 0 2015 true false false true A false false false false 0.0 0.0 0.0 false false false B false false false false 0.0 0.0 0.0 false false false A false false false false true true Merrill Lynch 29.5 false false false false false B false true false false false false false false false A false B false Schedule K, Part IV, Line 7 Written procedures to monitor requirements of section 148 The organization is in the process of adopting written procedures to monitor the organization's ability to remain in compliance with the arbitrage requirements under Section 148 of the Internal Revenue Code. The organization strives to stay abreast of federal regulations and considers the repercussions of all significant activities which could foreseeably have an impact on the organization's tax exempt bonds and the associated federal tax regulations. The policy/procedure has been drafted and will be approved and implemented before the organization's next fiscal year ending Speptember 30, 2016. Schedule K, Part III, Line 9 Written procedures to ensure all nonqualified bonds are remediated The organization is in the process of adopting written procedures to ensure all nonqualified bonds (if any) of the issue are remediated in accordance with the associated regulations. The organization strives to stay abreast of federal regulations and considers the repercussions of all significant activities which could foreseeably have an impact on the organization's tax exempt bonds and the associated federal tax regulations. The policy/procedure has been drafted and will be approved and implemented before the organization's next fiscal year ending Speptember 30, 2016. Schedule K, Part V Written procedures to ensure violations are identified and corrected The organization is in the process of adopting written procedures which dictate how management timely identifies and corrects violations of federal tax requirements using the voluntary closing agreement program (VCAP) provided by the IRS when self-remediation is not available to the organization. The organization strives to stay abreast of federal regulations and considers the repercussions of all significant activities which could foreseeably have an impact on the organization's tax exempt bonds and the associated federal tax regulations. In the event a violation is identified the organization's policy is to correct the violation as soon as possible, while working with the federal authorities as necessary to ensure that sufficient controls are present which will guard against future violations. The policy/procedure has been drafted and will be approved and implemented before the organization's next fiscal year ending Speptember 30, 2016. Schedule K, Part II, Line 3 Proceeds of issue Bond proceeds $64,815,040 Form 990, Part III, Line 4d Description of other program services (Expenses $ 17,162 including grants of $)(Revenue $ 17,162) THE HOSPITAL RECEIVED THE NATIONAL BIOTERRORISM GRANT, WHICH IS TO BE USED TO BUILD AND PRIORITIZE REGIONAL CAPABILITIES THAT SUPPORT THE DEVELOPMENT OF MEDICAL SURGE AND CONTINUITY OF OPERATIONS WITHIN AND ACROSS HEALTHCARE REGIONS. Form 990, Part VI, Line 15b PROCESS USED TO DETERMINE COMPENSATION FOR OTHER OFFICERS AN OUTSIDE COMPENSATION CONSULTANT IS USED TO RENDER A REASONABLE OPINION AS TO WHAT PERCENTAGE OF INCREASE A VICE PRESIDENT SHOULD RECEIVE BY PERFORMING A MARKET COMPARISON FOR ALL VICE PRESIDENTS. THE PROCESS TO DETERMINE AN INCREASE IN COMPENSATION FOR VICE PRESIDENTS WAS PERFORMED IN THE PRIOR YEAR FOR THE CURRENT YEAR'S COMPENSATION. SALARY INCREASES ARE APPROVED ANNUALLY BY THE PRESIDENT AND EXECUTIVE COMMITTEE ONCE RECEIVED BY THE OUTSIDE CONSULTANT. DIRECTORS AND MANAGERS RECEIVE AN INCREASE IN COMPENSATION BASED ON WHETHER OR NOT PERFORMANCE GOALS HAVE BEEN REACHED. BEFORE A FISCAL YEAR STARTS PERFORMANCE GOALS ARE PUT TOGETHER BY THE DIRECTOR OR MANAGER AND SUBMITTED TO THE VICE PRESIDENT FOR APPROVAL. APPROVED GOALS ARE THEN REVIEWED BY ALL OTHER EXECUTIVES. ONCE APPROVED BY ALL, THESE ARE THE GOALS FOR THE YEAR. AFTER THE YEAR IS OVER THE PERFORMANCE GOALS ARE REVIEWED BY THE VP AND DIRECTOR OR MANAGER. MARKET ADJUSTMENTS ARE SET BY THE IMMEDIATE VP AND SENT TO ALL EXECUTIVES FOR THEIR APPROVAL. Form 990, Part VI, Line 1a Delegate broad authority to a committee The Board of Directors shall appoint annually from its membership an Executive Committee of not less than five (5) nor more than nine (9) members, of which three (3) members shall be the Chairman, the Vice Chairman, and the Secretary/Treasurer of the Hospital. The Executive Committee shall have and exercise all of the powers of the Board of Directors not prohibited by statute or Section 1 of the Hospital's bylaws between meetings thereof. Form 990, Part VI, Line 6 Classes of members or stockholders Pursuant to the organization's governing documents, the sole voting member of the organization is Ingalls health system (ihs), a related tax-exempt organization. As the organization's sole corporate member, ihs has the right to participate in the organization's governance. IHS has the right to elect, appoint, or remove any board of director of the organization without cause at any time. In addition, the sole corporate member has the exclusive right to approve or ratify significant decisions of the organization's governing body. Significant decisions of the organization's governing body include, but are not limited to, the right to approve long-term capital and operational budgets, to approve a plan of dissolution or merger with another organization, and to approve the development, construction or implementation of any new healthcare facility, program, or service. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Please see the narrative for Part VI, Section A, Line Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders Please see the narrative for Part VI, Section A, Line Form 990, Part VI, Line 11b Review of form 990 by governing body The full form 990, including supplemental schedules, was presented by the Chief Financial Officer to the Finance Committee at a committee meeting. The full board has granted to the Finance Committee authority to approve the Form 990. The full board will receive a report from the Finance committee, describing the Finance committee's review performed. The form 990 will be available at the organization's board meeting for each member's review. Form 990, Part VI, Line 12c Conflict of interest policy All officers, directors, board members, and key employees must avoid situations in which their personal interests may conflict, or appear to conflict, with the interest of Ingalls; and Ingalls reviews its own relationships with other care providers, educational institutions, and payers to determine if potential conflicts exist. Employees shall have the continuing affirmative duty to report to the President and Chief Executive Officer (CEO) of Ingalls any personal ownership interest or other relationship that might affect their ability to exercise impartial, ethical business judgments in the area of their responsibilities. Per the entity's conflict of interest policy, employees at management level will be required to complete a "Certification and Disclosure" form, on a schedule determined by the Corporate Compliance Officer. Completion of this form is a job requirement for all managerial employees, and may be required of non-management employees as determined by the President and Chief Executive Officer and the Corporate Compliance Officer. Employees also have a duty to report conflicts or potential conflicts of interest of which they may be aware involving other employees. Each situation reported shall be reviewed by the President and CEO, and Ingalls Corporate Compliance Officer, and a determination shall be made as to whether a conflict of interest exists or may arise from such a situation. The decision of the President and CEO and Corporate Compliance Officer regarding whether a conflict exists shall be final. The employee handbook mentions the entity's conflict of interest policy. Each employee is required to sign an acknowledgment of the handbook upon employment. Form 990, Part VI, Line 15a Process to establish compensation of top management official IN SETTING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION, THE EXECUTIVE COMMITTEE RELIES ON RECENT COMPARABILITY STUDIES THAT PROVIDE COMPENSATION DATA FOR SIMILARLY QUALIFIED PERSONS IN COMPARABLE ORGANIZATIONS TO SUPPORT ITS DECISION-MAKING PROCESS. IN ADDITION, THE ORGANIZATION RECEIVED AN INDEPENDENT COMPENSATION REVIEW BY WILLIS TOWERS WATSON IN NOVEMBER 2014. THE COMMITTEE ADEQUATELY DOCUMENTS ITS COMPENSATION DETERMINATIONS, DELIBERATIONS, AND APPROVAL OF THE TOP MANAGEMENT OFFICIAL'S COMPENSATION IN THE MEETING MINUTES. THE PROCESS FOR REVIEWING AND DETERMINING COMPENSATION FOR THE CEO WAS LAST UNDERTAKEN IN THE NOVEMBER 2014. Form 990, Part VI, Line 15b Process to establish compensation of other employees IN SETTING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION, THE EXECUTIVE COMMITTEE RELIES ON RECENT COMPARABILITY STUDIES THAT PROVIDE COMPENSATION DATA FOR SIMILARLY QUALIFIED PERSONS IN COMPARABLE ORGANIZATIONS TO SUPPORT ITS DECISION-MAKING PROCESS. IN ADDITION, THE ORGANIZATION RECEIVED AN INDEPENDENT COMPENSATION REVIEW BY WILLIS TOWERS WATSON IN NOVEMBER 2014. THE COMMITTEE ADEQUATELY DOCUMENTS ITS COMPENSATION DETERMINATIONS, DELIBERATIONS, AND APPROVAL OF THE TOP MANAGEMENT OFFICIAL'S COMPENSATION IN THE MEETING MINUTES. THE PROCESS FOR REVIEWING AND DETERMINING COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS LAST UNDERTAKEN IN THE NOVEMBER 2014. Form 990, Part VI, Line 19 Required documents available to the public Financial statements, governing documents, and conflict of interest policies are not required disclosures pursuant to Internal Revenue Code (IRC) Section 6104. These documents are not available to the public at this time. Form 990, Part VII, Section B, Line 1 Expenses for Ingalls Health System Expenses of Ingalls Health System (IHS) and related entities (see Schedule R) are paid by IHS. IHS is responsible for issuing the 1099's to independent contractors, and subsequently allocates a percentage of the expense and receives reimbursement from the related entities. Form 990, Part VIII, Line 7a Gross Amount of Sales of Securities The organization's investments are held in a pooled investment account managed by Northern Trust. Realized gains and losses are pooled and allocated to the participants. The Ingalls Memorial Hospital receives monthly information on the funds from Northern Trust and determines the total gain or loss amounts. However detail is not provided. Form 990, Part VIII, Line 2f Other Program Service Revenue Release of AARA Funds - Total Revenue: 2199996, Related or Exempt Function Revenue: 2199996, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Other Program Service Revenue - Total Revenue: 2749747, Related or Exempt Function Revenue: 2749747, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; SNF THERAPY - Total Revenue: 2069462, Related or Exempt Function Revenue: 2069462, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Gift Shop - Total Revenue: 310044, Related or Exempt Function Revenue: 310044, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Medical Staff - Total Revenue: 130163, Related or Exempt Function Revenue: 130163, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part IX, Line 11g Other Fees Other Contract Service - Total Expense: 19835159, Program Service Expense: 16810909, Management and General Expenses: 3024250, Fundraising Expenses: ; ARAMARK-Suppport Services - Total Expense: 20765000, Program Service Expense: 17442600, Management and General Expenses: 3322400, Fundraising Expenses: ; Outsourcing of Behavorial Health Services - Total Expense: 5967154, Program Service Expense: 5012409, Management and General Expenses: 954745, Fundraising Expenses: ; Patient Financial Collection Services - Total Expense: 3186421, Program Service Expense: , Management and General Expenses: 3186421, Fundraising Expenses: ; Contractual Ambulance Services - Total Expense: 2304247, Program Service Expense: 2304247, Management and General Expenses: , Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances MEDICAL STAFF EXPENSES - 174945; GIFT SHOP EXPENSES - 236372; INTEREST RATE SWAP VALUATION - -1545903; CONTRIBUTIONS FOR A SPECIFIC PURPOSE - 65958; TRANSFERS FROM AFFILIATES - 98250; RELATED ORGANIZATIONS - -952854; MEDICAL STAFF OFFICE REVENUE - -130163; GIFT SHOP REVENUE - -310044; UNRESTRICTED CONTRIBUTIONS - 8920; INGALLS DEVELOPMENT FOUNDATION ONE INGALLS DRIVE HARVEY IL 60426 363189150 SUPPORT IL 501(c)(3 7 IHS false INGALLS HOME CARE ONE INGALLS DRIVE HARVEY IL 60426 363367939 HEALTHCARE IL 501(c)(3 9 IMH true INGALLS HEALTH SYSTEM ONE INGALLS DRIVE HARVEY IL 60426 363181170 MANAGEMENT IL 501(c)(3 Type II NA false INGALLS HEALTH VENTURES ONE INGALLS DRIVE HARVEY IL 60426 363239703 AMBULATORY IL 501(c)(3 3 IHS false PRIMARY HEALTHCARE ASSOCIATES SC 71 W 156TH STREET HARVEY IL 60426 364132865 HEALTHCARE IL 501(c)(3 9 IHS false INGALLS SAME DAY SURGERY CENTER LTD 6701 W 159TH STREET TINLEY PARK IL 60477 363368549 SURGERY CENTER IL NA N/A INGALLS PROVIDER GROUP ONE INGALLS DRIVE HARVEY IL 60426 363485578 INSURANCE SERVICE IL IMH C Corporation 0 5399100 1 true MEDCENTRIX INC ONE INGALLS DRIVE HARVEY IL 60426 363374228 BILLING & MGMT IL NA C Corporation false INGALLS CASUALTY INSURANCE LTD ONE INGALLS DRIVE HARVEY IL 60426 980485714 LIAB INSURANCE CJ NA C Corporation false INGALLS HEALTH COUNCIL ONE INGALLS DRIVE HARVEY IL 60426 273226539 PURCHASING GROUP IL NA C Corporation false true false true false false false false false false false false true true true true true true true true