2016-05-12T15:42:03-05:00 2015-06-30 KPMG LLP 191 West Nationwide Blvd Ste 500 Columbus OH 432152568 990 2014-07-01 362338884 Northern Illinois Medical Center % DAVID TOMLINSON NORT 8157885800 4201 Medical Center Drive McHenry IL 60050 DAVID TOMLINSON SVP, CIO, CFO 8772368472 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 319990192 false X www.centegra.org X 1956 IL See Schedule O 14 8 1503 265 395949 -34591 286949 9089 230928713 256904977 5805848 12272162 5804995 7503826 242826505 276690054 0 0 0 0 86072442 92540073 0 0 0 139786632 151438802 225859074 243978875 16967431 32711179 301995790 297525658 124474340 124325097 177521450 173200561 X See Schedule O false false 220496015 257488063 See Schedule O 220496015 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 1 0 true 1503 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 MILLENNIUM DRIVE Crystal Lake IL 60012 Michael S Eesley CEO 0.0 40.0 X X 0 1758472 143057 Charie Zanck Director 0.0 2.0 X 0 0 0 Charles Ruth Director 0.0 2.0 X 0 0 0 Chris Newkirk Director 0.0 1.0 X 0 0 0 Jack Porter Director 0.0 1.0 X 0 0 0 Kathy Powell Director 0.0 4.0 X 0 0 0 Luke Johnsos Director 0.0 2.0 X 0 0 0 Micheal Luecht Secretary/Treasurer 0.0 4.0 X 0 0 0 Mike Curran Chairman 0.0 2.0 X 0 0 0 Pat Morehead Director 0.0 4.0 X 0 0 0 Richard Lind Director 0.0 1.0 X 0 381037 21386 Terrence J Bugno Director 0.0 4.0 X 0 0 0 Tom Carey Vice Chairman 0.0 3.0 X 0 0 0 William Cox Director 0.0 2.0 X 0 0 0 Lisa Glosson MD Director 0.0 1.0 X 0 240373 30204 David Tomlinson SVP/CIO/CFO 0.0 40.0 X 0 532558 58217 Jason R Sciarro President/COO 0.0 40.0 X 0 955765 90238 Rachel Sebastian VP Site Administrator 40.0 0.0 X 355872 0 58949 Belinda A Wagner Pharmacist 40.0 0.0 X 149895 0 6434 Connie K Secor Director 40.0 0.0 X 172618 0 6480 John G Geinopolos Medical Physicist 40.0 0.0 X 176469 0 27326 Susan H Corcoran Pharmacist 40.0 0.0 X 140962 0 26671 Debra A Brasier Coordinator - Anti-Coag 0.0 0.0 X 139424 0 25795 1135240 3868205 494757 50 false true false Medline Industries One Medline Place MUNDELEIN IL 60060 Hospital Supplies 5230556 Sodexo Inc Affliates 4880 Payshere Circle CHICAGO IL 60674 Management Services 3129615 Precyse Solutions LLC 1275 Drummers Lane Ste 200 WAYNE PA 19087 Coding Services 2060607 Gilcor Contruction Corp 232 Harrison Street BARRINGTON IL 60010 Construction Serv 1576565 Carefusion Pyxis 25082 Network Place CHICAGO IL 606731250 Inventory Supply 1206742 33 9089 9089 ANCILLARY OUTPATIENT SERVICES 621110 157628863 157628863 ROUTINE PATIENT SERIVCES 621110 82260733 82260733 ANCILLARY INPATIENT SERVICES 621110 22056157 22056157 IDPA PROVIDER TAX REVENUE 621110 10540933 10540933 CHARITY CARE/ADMIN ALLOWANCE 621110 -15581709 -15581709 256904977 7729525 7729525 185 185 0 0 0 0 47841079 1511 43300138 4540941 1511 4542452 4542452 0 0 0 CAFETERIA SERVICES AND EDUCATION 900099 1084948 1084948 CHILD DAY CARE CENTER 624410 763302 363900 399402 RELATED COMPANY REVENUE 900099 600915 600915 5054661 583086 32049 4439526 7503826 276690054 257488063 395949 18796953 X 0 0 0 0 468373 468373 0 74317762 65243343 9074419 1192554 1046940 145614 11446826 10049134 1397692 5114558 4490055 624503 884380 884380 0 0 42029 42029 0 0 10961667 10160437 801230 31068 31068 41749836 41221749 528087 13656 9754 3902 0 2712712 1400661 1312051 208782 191253 17529 0 94882 73105 21777 3684045 3234212 449833 0 9517395 8355293 1162102 3419657 3002107 417550 RELATED COMPANY - CHS 45647361 40521763 5125598 BAD DEBT 8594280 8594280 RELATED COMPANY - LAB 5649212 5649212 IDPA PROVIDER TAX 7589544 7589544 10638296 9632105 1006191 243978875 220496015 23482860 0 50285 34682 18364355 12913819 0 0 38059244 40334050 0 0 0 0 0 0 4224410 6001456 1590094 2071362 209583533 146482590 64140996 63100943 107369678 99840363 0 0 6135475 7953557 74009 37013 61987244 65238413 301995790 297525658 24625530 25926914 0 0 0 0 96263546 95880611 0 0 0 0 0 0 0 0 3585264 2517572 124474340 124325097 X 174778073 168453765 2743377 4746796 0 0 177521450 173200561 301995790 297525658 X 32711179 -14805063 -22227005 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 42029 42029 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 34.5% of dues, on average, are allocable to lobbying activities. false 65000 65000 83339494 42346002 40993492 1764249 1715118 49131 123084976 102421470 20663506 1329814 1329814 63100943 INTERCOMPANY RECEIVABLES 62627517 OTHER RECEIVABLES 2610896 65238413 0 PROFESSIONAL LIABILITY 2517572 2517572 X FIN 48 (ASC 740) Footnote Schedule D, Part X, Line 2 ACS Topic 740, Income Taxes, addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded on the consolidated financial statements. Under ACS Topic 740, the Health System must recgonize 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 financials statements from such a position are measured based on the largest benefit that has the 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 3253613 3253613 0.01380 22831978 11728198 11103780 0.04720 26085591 11728198 14357393 0.06100 10 3007 95417 17401 78016 0.00030 6 284 416272 416272 0.00180 16 3291 511689 17401 494288 0.00210 16 3291 26597280 11745599 14851681 0.06310 true 2466558 1715504 81505924 92808999 -11303075 X true true Algon Rd Surgery Ctr Outpatient Surgical Services 0.12750 ARSC Real Estate Property Management 0.25000 1 1 Northern Illinois Medical Center 4201 Medical Center Drive McHenry IL 60050 X X X X Cancer Center Northern Illinois Medical Center 1 false false true X X X X X X X X 14 true true true true X www.centegra.org X www.co.mchenry.il.us X true 14 false N/A 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 Account Input from Person Who Represent the Community Schedule H, Part V, Line 5 The Health Systems 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. CHNA conducted with other hospital facilities Schedule H, Part V, Line 6a Advocate Good Shepherd Hospital and Advocate Sherman Hospital CHNA conducted with other facilities 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, Pioneer Center for Human Services, Senior Services Associates, Inc., United Way of Greater McHenry County, Woodstock Consolidated Unit School District 200. Needs not addressed 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 fall 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. Income Level other than FPG 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 presumption 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, assset level and medical indigency. Other Billing Determination of Individuals without insurance Schedule H, Part VI, Line 22D See Part VI Supplemental Information for Billing and Collection Policies regarding persons eligible for financial assistance. 21 Crystal Lake Medical Arts Imaging Center 360 Station Drive Suite 150 Crystal Lake IL 60014 Medical Imaging Center Gavers Breast Center 360 N Terra Cotta Road Crystal Lake IL 60012 Medical Imaging and Breast Care Center NIMC Rehab & Sports Medicine Clinic 200 Congress Parkway Crystal Lake IL 60014 Sports Medicine and Rehabilitation Clinic NIMC Neuro-Rehabilitation Center 500 Coventry Lane Crystal Lake IL 60014 Neurotrauma Day Treatment Center NIMC Rehab & Sports Medicine Clinic 2507 N Richmond Road McHenry IL 60050 Physical Rehabilitation Clinic Centegra Health Center - Huntley 10350 Haligus Road Huntley IL 60142 Anticoagulation Clinic, Medical Imaging, & Bariatric Center Centegra Home Health Care 213 North Front Street Suite 2 McHenry IL 60050 Home Health Care Centegra Home Medical Equipment 213 Front Street Suite 2 McHenry IL 60050 Medical Equipment Centegra Home Medical Equipment 1118 North Main Street Algonquin IL 60102 Medical Equipment Centegra Milestone Therapy 394 Federal Drive Crystal Lake IL 60014 Therapy Centegra Physician Care - Fox Lake 248 E Grand Avenue Fox Lake IL 60020 Physician Care Centegra Physician Care - Fox Valley 650 Dakota Street Suite A Crystal Lake IL 60012 Physician Care Centegra Physician Care - Fox Valley 1465 Commerce Drive Algonquin IL 60102 Physician Care Centegra Physician Care - Neurology 750 E Terra Cotta Avenue Crystal Lake IL 60014 Physician Care Centegra Physician Care - Spring Grove 1906 Holian Drive Spring Grove IL 60081 Physician Care Centegra Physician Care - Surgical Assoc 690 E Terra Cotta Avenue Suite A Crystal Lake IL 60014 Physician Care Centegra Physician Care - Gavers 360 N Terra Cotta Avenue Suite A Crystal Lake IL 60014 Physician Care Centegra Physician Care - Woodstock 3707 Doty Road Suites C D E G Woodstock IL 60098 Physician Care Centegra Rehab & Sports Med Cl - McHenry 333 Front Street McHenry IL 60050 Sports Rehabilitation Medicine Centegra Rehab & Sport Md Cl - Woodstock 201 N Throop Street Woodstock IL 60098 Sports Rehabilitation Medicine Centegra Rehab & Sports Med Cl - Huntley 10450 Algonquin Road Huntley IL 60142 Sports Rehabilitation Medicine Schedule H, Part I, Line 7 Line 7a-7c dollars 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 $8,594,280 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 of Est Amount & Rational for Including in Community Benefit Schedule H, Part III, Line 2 The actual gross bad debt write-offs of $8,594,280 were multiplied by the cost to charge ratio of .2870 to estimate the cost of bad debt. Methodology of Est Amount & Rational for Including in Community Benefit Schedule H, Part III, Line 3 The estimated amount of bad debt expense (at cost) which could be reasonably attributable 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 bed 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. The amount of cost that exceeds reimbursement is actual cost to treat patients and is therefore treated as a community benefit. 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 REFERENCE 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 of cost that exceeds reimbursement is actual cost to treat patients and is therefore treated as a community benefit. Provisions On Collection Practices For Qualified Patients Schedule H, Part III, Line 9b Centegra provides patients with consistent information on payment expectations and assists them in meeting their financial obligations. A written explanation of the payment requirements categorized by type of payor is given prior to admission/registration or upon admission/registration of each Centegra Health System (CHS) patient. Centegra will bill the patient's insurance carrier. Procedures will be implemented over time and by area to collect as much as possible of the time of service unless payor contracts require billing (i.e., no assignments). 1. Admission reservation/outpatient appointment made by physician/patient. Walk-in and Emergency Department patients present for service. 2. Perform the patient pre-registration for applicable scheduled registrations. 3. Patient verbal consent obtained and annotated except where prohibited by law. On (date) at about (time), (patient or representative) orally authorized (Site Name) to release information concerning the patient's medical care, treatment and diagnosis to employers, insurance companies, government agencies or third-party payors and their agents, for verification of benefits and pre-certification. I (the Pre-Registrar) did not obtain a written consent signed by the patient, due to the patient not being physically present and limited time constraints. This statement would be signed and dated by the Pre-Registrar. Patient refusal to provide oral consent requires patient notification of potential penalties and places the burden on the patient to complete payor requirements. 4. Complete insurance verification and initiate pre-certification. 5. Estimate the approximate cost of services and advise the responsible party. Explanation of the cost will fluctuate based on services ordered by the physicians. 6. Discuss the financial requirements, including payment expectations with the patient/guarantor prior to admission/registration when applicable. 7. Interview conducted by Financial Counselor of patients who express difficulty in meeting Centegra's payment requirements. 8. Admission/registration of patient is completed. Patient/guarantor signature for the Consent to Release Information obtained. 9. Collect the estimated patient share. The deductible and co-payments and any non-covered amounts quoted by the carrier are due from inpatients prior to discharge and where possible, for outpatients prior to or at the time of registration. 10. Self-Pay accounts are to be paid in full or screened by the Financial Counselor for potential State or Federal Program, Financial Assistance application or payment plan. 11. Policy regarding non-compliance with respect to payment arrangements or plans: Self-Pay: 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. Broken Promise/Defaults: 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 insurance payment will be turned over to a collection agency. 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 Northern Illinois Medical Center of McHenry, IL is affiliated with Memorial Medical Center of Woodstock, 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. Northern Illinois 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. STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 IL Facility reporting group(s) Schedule H, Part VI Northern Illinois Medical Center is a 179 bed facility with a Level II nursery and a center for cancer care, Sage Cancer Center. In addition, NIMC operates four off-site physical rehabilitation centers offering therapy services, as noted in Part V. NIMC also operates two sites where medical imaging services are offered, as noted in Part V. X X X X X false true false false false false false false false Michael S Eesley CEO 0 886904 0 572117 0 299451 0 123550 0 19507 0 1901529 0 0 Richard Lind Director 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 R Sciarro President/COO 0 633906 0 320770 0 1089 0 64349 0 25889 0 1046003 0 0 Rachel Sebastian VP Site Administrator 308070 0 47802 0 0 0 27171 0 31778 0 414821 0 0 0 Belinda A Wagner Pharmacist 149895 0 0 0 0 0 3350 0 3084 0 156329 0 0 0 Connie K Secor Director 161210 0 11408 0 0 0 4189 0 2291 0 179098 0 0 0 John G Geinopolos Medical Physicist 176469 0 0 0 0 0 1776 0 25550 0 203795 0 0 0 Susan H Corcoran Pharmacist 140962 0 0 0 0 0 1531 0 25140 0 167633 0 0 0 Debra A Brasier Coordinator - Anti-Coag 139424 0 0 0 0 0 2876 0 22919 0 165219 0 0 0 Lisa Glosson MD Director 0 227492 0 0 0 12881 0 6747 0 23457 0 270577 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: Michael Eesley $117,500 Jason Sciarro $58,449 Rachel Sebastian $20,923 David Tomlinson $26,674 Rachel Sebastian Family member 468373 Employee false Carey Electric Board Member is Owner 102215 Electrical Services false Carey Electric Board Member is Owner 10932300 Electrical Srvcs-Huntley Hosp false Curran Contracting Company Board Member is Officer 137537 Construction-Huntley Hospital false Alliance Contractors Board Member is President 189000 Construction-Huntley Hospital false Business Transactions Involving Interested Persons Schedule L, Part IV All business transactions are arms length transactions. See conflict of interest disclosures in Schedule O for Form 990, part VI, Line 2. Northern Illinois Medical Center made payments for construction costs of Huntley Hospital. Organization's Mission Form 990, Part III, Line 1 The primary mission of Northern Illinois Medical Center is to provide quality health care services with innovative and responsible use of resources and promote wellness for the greater McHenry County area. Northern Illinois Medical Center's services include, but are not limited to: 179 licensed-bed Comprehensive Medical Center (42,467 patient days in fiscal year ending June 30, 2015), Level Two Trauma Center, 24 hr Emergency Medicine Physicians, On-site Flight for Life Helicopter (347 flights in fiscal year ending June 30, 2015), Portable TDD (Telephone Device for the Deaf) on site, Center for New Life including Level Two Nursery (3,547 newborn patient days in fiscal year ending June 30, 2015), Antenatal Testing Center, Prenatal Classes, Hello Daddy and Dial-A-Dad pagers, Very Important Sibling Classes, Lamaze Classes, Breastfeeding Classes, Intensive and Intermediate Care Units, Sage Cancer Center (16,305 radiation oncology procedures and 2,780 medical oncology visits in fiscal year ending June 30, 2015), Cardiac Surveillance, Cardiac Catherization Suite, Three-level Cardiac Rehabilitation Program (22,589 visits in fiscal year ending June 30, 2015), Heart Failure Clinic, Full-body CT Scanner and Magnetic Resonance Imaging (MRI) (19,804 CT Scans and 3,352 MRI procedures performed in fiscal year ending June 30, 2015), PET/CT scans, Women's Diagnostic Services (In Medical Imaging), Center for Physical Rehabilitation (6,692 patient days in fiscal year ending June 30, 2015), Inpatient unit, Independence Square, Occupational, Physical and Speech Therapies, Outpatient Therapies, Respiratory Therapy, Home Health Care (32,119 visits in fiscal year ending June 30, 2015, Neurotrauma Day Treatment Program, Sports Medicine Clinic, Occupational Health, Patient Express! Transporation, Extra Touch Program, Pastoral Care, Social Service, Community Education Programs, Support Programs/Groups, and Nutritional Therapy Services. Form 990, Part III, Program Service 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. Centegra's 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 region's 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 and 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 familie FORM 990, PART IV, LINE 24 NORTHERN ILLINOIS 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, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON CENTEGRA HEALTH SYSTEM'S FORM 990. Business or Family Relationship of Officers, Directors, Etc. Form 990, Part VI, Line 2 Northern Illinois Medical Center, (NIMC), 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, officer, agent or employee believes that he or she, or a 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 the Medical Center. During fiscal year 2015, Northern Illinois Medical Center purchased certain goods and/or services from organizations with director affiliation. All transactions were competitively bid and were conducted at arms length. The fees paid were at fair market value. During Fiscal year 2015, Director Michael Curran is an officer/director of Curran Contracting Company. Director Kathy Powell is an employee and Vice President of Home State Bank. Director Patrick Morehead is on the Board of Directors and a 1% owner of Home State Bank. Director Charie Zanck is a Director 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.Tom Carey is Vice President of Carey Electric. Vice President Rachel Sebastian is the daughter of CEO Michael Eesley. Description of Delegated Duties 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 Inc. & Affiliates was used to manage Food & Nutrition and Environmental Services work. Perot (Dell) provided management and support services for the Information Systems area. None of the outsourced managers or directors are executive level staff, and none of them need to be named in Part VII. Explanation of Classes of Members or Shareholder Form 990, Part VI, Line 6 Centegra Health System is the sole member of NIMC. Centegra Health System has a single class of members. How Members or Shareholders 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 on 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 list to the Board of Governors not less than 10 days prior to the date of the last meeting of the Board of Governors prior to the date on which notice of the annual meeting of members 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 of the members of the Corporation and shall be presented to the members of the Corporation at the annual meeting. The voting members of the Corporation may nominate candidates for the 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 Form 990 and related schedules are compiled by CHS staff. The review process for the 990 includes detailed review by an outside auditor, bond counsel, 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 As stated in Centegra's Bylaws, the Bylaws recognize 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 Centegra should be expected to have and do, in fact, generally have multiple interests and affiliations and various positions of responsibility within the community. The long-range interests of Centegra do not require the termination of all association with persons who may have real or apparent conflicts if a prescribed and effective method can render such conflicts harmless to all concerned. Centegra Health System has a conflict of interest policy that is intended to address such matters. 1. Duty to Disclose: 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 arrangement. 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 statements filed by Board members shall be distributed to the Board annually at the February Board meeting. 2. Determining Whether a Conflict of Interest Exists: When a conflict of interest is disclosed at 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 members 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: A. The chairperson of the board or committee shall, if appropriate, appoint a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement. B. 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. C. 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 or 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: A. 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. B. 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. Compensation Review & Approval Process - Officers and & Key Employees 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 C-Suite's compensation is determined by the Compensation Committee in relation to comparable peers based on 990 market data. Compensation for other members of the executive staff is recommended by the CEO, reviewed by the Committee, and evaluated against market data. The compensation Committee approves all compensation decisions in advance of their implementation and documents its determinations and discussions. Its decisions 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. Reasonableness letters and documentation are provided to the organization after each review. Other Organization Documents Publicly Available Form 990, Part VI, Line 19 All governing documents, policies, and financial statements 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 65% 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 $15,566,044; Benefits $3,269,782; Payroll Taxes $1,022,086; Purchased Services/Professional Fees $13,667,089; IT Expenses $4,618,399; Office Expenses $1,370,116; Advertising and Promotional $1,393,654; Other Expenses $4,740,184. Other changes in net assets FORM 990, PART XI, LINE 9 AFFILIATE TRANSFERS $(26,000,000) INTEREST IN FOUNDATION $3,772,995 ------------- TOTAL $(22,227,005) Centegra Health System 385 Millennium Drive Crystal Lake IL 60012 363196559 Health System IL 501(c)(3) 11c NA 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 Memorial Medical Center 3701 Doty Road Woodstock IL 60098 362179764 Hospital IL 501(c)(3) 3 Centegra HS false none Centegra Management Services 385 Millenium Drive Crystal Lake IL 60012 364028114 Management IL Centegra HS C Corp false false false true false false false false false false false false false true false true true true true true