2015-04-14T09:00:22-05:00 2014-05-31 420714325 MCGLADREY LLP 1 SWACKER DRIVE STE 800 CHICAGO IL 60606 990 2013-06-01 362222696 SwedishAmerican Hospital SWED 7796964727 1401 E State St Rockford IL 611042298 Patricia DeWane VP Finance/Treasurer 7796964727 2015-04-14 1 Zack Fortsch P00052725 3126343400 2013 2016-02-25 16:41:14Z William Gorski MD 1313 East State St Rockford IL 61104 655215779 0 X www.swedishamerican.org X 1911 IL Through excellence in healthcare and compassionate service, we care for our community. 26 18 3313 744 651161 491689 4815838 4125517 445165745 474265535 10708821 11571895 4610509 4722280 465300913 494685227 561606 274017 0 0 213603436 217475239 0 0 0 229894226 252380736 444059268 470129992 21241645 24555235 521850360 563483149 250968297 262066778 270882063 301416371 X Through excellence in healthcare and compassionate service, we care for our community. 0 0 268730636 274017 376226306 SwedishAmerican Hospital (SAH) operates two full service acute care hospitals with 369 licensed beds and serves a 12-county area. Our vision is to develop a fully integrated healthcare delivery network that will continuously set the standard for quality care and service, accept responsibility for building a healthier population, provide regional access, improve resource utilization through collaboration with key stakeholders, and manage patient care and our resources in such a way that we create value for our patients and benefit for our community. During 2014, we cared for 17,579 inpatients and performed 745,951 outpatient procedures. This includes 75,061 emergency room visits and 2,515 deliveries. We sponsor the University of Illinois - College of Medicine Program and provided $5.5 million in education for primary care residents. Our employees and volunteers provided over 35,000 hours in unpaid community services. SwedishAmerican recognizes its responsibility to all the people of our community, regardless of their ability to pay for care. 68369708 0 56165800 SwedishAmerican Hospital employs primary care and specialty physicians who practice at 30 locations throughout our service area. We employ specialists in orthopedics, cardiology, cardiothoracic surgery, endocrinology, allergy, neurology, neurosurgery, pulmonology/critical care, hematology/oncology, obstetrics and gynecology, maternal fetal medicine, rheumatology, psychiatry, podiatry, otolaryngology, as well as internal medicine, family practice, immediate care and pediatric physicians. During 2014 our physician encounters were 339,759. 31156009 0 39495942 SwedishAmerican Regional Cancer Center opened to the public in October 2013. The center is part of a collaboration with UW Health and its nationally recognized University of Wisconsin Carbone Cancer Center. The two-story facility offers radiation therapy, medical oncology, chemotherapy and infusion services. Patients have access to clinical trials, state-of-the-art linear acceleratory treatments such as IGRT, IMRT, Rapid Arc, OBI and stereotactic services, and advanced medical imaging. The Regional Cancer Center is staffed by medical and radiation oncologists, physicists, dosimetrists, radiation therapists and nurses. During FY 2014 our out-patient encounters were over 83,000. 7688008 0 6480532 SwedishAmerican delivers home health care services to patients in our service area. Major areas of home health care include: RN nursing services providing assessments, treatments and medication administration, intravenous infusion therapy, physical, speech and occupational therapy services and in-home personal care assistants. During 2014 we performed 26,323 episodes of care. 7688008 0 6480532 375944361 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 1 0 1 361 0 1 3313 1 1 1 0 0 0 0 0 0 0 0 0 X 26 18 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL X Patricia DeWane VP FinanceTreasur 7796964727 1313 East State St Rockford IL 61104 William R Gorski MD President & CEO 40.00 4.00 X X 2389533 0 254694 Richard Walsh Chief Operating Officer 40.00 6.00 X X 453842 0 124620 Danny L Copeland MD Trustee 40.00 4.00 X 221902 0 38958 James L Gingrich Trustee 2.00 4.00 X 100 0 0 Robert L Head PhD Trustee 2.00 4.00 X 100 0 0 Gregory Jury Trustee 2.00 6.00 X 100 0 0 Marco T Lenis Trustee 2.00 6.00 X 100 0 0 Dan Loescher Chairman until May 2014 2.00 4.00 X X 100 0 0 Fran Morrissey Trustee 2.00 4.00 X 100 0 0 John C Myers MD Trustee 40.00 6.00 X 531578 0 57977 William Roop Immediate Past Chairman 2.00 4.00 X 100 0 0 David R Rydell Trustee 2.00 6.00 X 100 0 0 John Scheub MD Joint Conference Chairman 2.00 4.00 X X 100 0 0 Steven C Sjogren Trustee 2.00 8.00 X 100 0 0 James Waddell Audit/Compliance Chairman 2.00 6.00 X X 100 0 0 Thomas R Walsh Chairman/Secretary 2.00 4.00 X X 100 0 0 Frank Walter Trustee 2.00 6.00 X 100 0 0 Amy Wilcox Trustee 2.00 4.00 X 100 0 0 Allen Williams MD Trustee 40.00 4.00 X 257988 0 51125 Patrick Derry Quality and Safety Chairman 2.00 4.00 X X 100 0 0 Peter Christman Trustee 2.00 4.00 X 100 0 0 Michael E Dallman Trustee 2.00 4.00 X 100 0 0 Helen Chung Hill Trustee 2.00 4.00 X 100 0 0 Michael Houselog Trustee 2.00 4.00 X 100 0 0 Jeffrey J Kaney Trustee 2.00 6.00 X 100 0 0 Daniel T Ross Second Vice Chairman 2.00 4.00 X X 100 0 0 Donald Haring VP Finance/Treasurer 40.00 8.00 X 701510 0 75920 Kathleen Kelly MD VP Medical Affairs 40.00 0.00 X 431021 0 46627 Harvey Einhorn MD Physician 40.00 0.00 X 560045 0 77268 Steven Milos MD Physician 40.00 0.00 X 608425 0 47110 Melissa Macias MD PhD Physician 40.00 0.00 X 731703 0 14047 Merat Esfahani MD Physician 40.00 0.00 X 668553 0 57423 Howard Kaufman DO Physician 40.00 0.00 X 547633 0 46433 8105833 0 892202 214 0 1 0 Ringland-Johnson Construction PO Box 5165 Rockford IL 61125 Construction Services 19609701 Varian Medical Systems Inc 70140 Network Place Chicago IL 60673 Medical Services 5037317 Midwest Heart SPS Ltd 1901 S Meyers Rd Ste 350 Oakbrook Terr IL 60181 Physicians 4075176 Philips Healthcare PO Box 100355 Atlanta GA 30384 Medical Services 2801125 Universal Hospital Services Inc 2601 Crossroads Dr Ste 105 Madison WI 53718 Equipment services 2586434 130 305170 3730544 89803 4125517 Medicare/Medicaid 621990 286048016 286048016 Patient Services 621990 186850038 186850038 1367481 1367481 474265535 8845441 8845441 37441 69367 -31926 -31926 -31926 154058719 9128920 151150732 9310453 2907987 -181533 2726454 2726454 Day Care Center 561000 1430659 1430659 Cafeteria & Vending 561000 1400862 1389303 11559 Interdept. Billing 624410 1283083 1283083 639602 639602 4754206 494685227 478368580 651161 11539969 243017 243017 31000 31000 6981906 1150001 5831905 163969999 126925679 37044320 8709631 7316436 1393195 26752342 21975863 4776479 11061361 8384475 2676886 1182210 1182210 133512 133512 135603 135603 663968 663968 24295109 22417408 1877701 3036484 116883 2919601 12153092 5829460 6323632 5350006 4976202 373804 13769516 7627607 6141909 260798 205076 55722 490856 216000 274856 5606212 3540524 2065688 21370599 17625831 3744768 9647735 9090916 556819 Patient Supplies 73201305 72724926 476379 Bad Debts 35315464 35315464 Purchased Services 15108153 9056523 6051630 IPA Provider Tax 14407834 14407834 16252280 6767236 9485044 470129992 375944361 94185631 0 26458098 29141594 61625064 68412201 250214 201199 6529568 7913712 8554210 7524192 447060859 252489902 179560777 194570957 208115148 214978191 1771351 1793593 28985930 38947510 521850360 563483149 43502558 45244331 143878109 139418595 63587630 77403852 250968297 262066778 X 261739936 291771938 3321200 3491811 5820927 6152622 270882063 301416371 521850360 563483149 X 24555235 5525992 453081 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 135603 135603 0 Part II-B, Line 1: Portions of the 2013/2014 Illinois Hospital and American Hospital Association dues used for lobbying: $45,603. A law firm was engaged to review legislation affecting hospitals: $90,000. 6571756 10038 655660 143736 7093718 6007307 11537 668467 115555 6571756 6377718 43659 -269495 144575 6007307 5553681 98184 763174 37321 6377718 5098504 13425 457937 16185 5553681 0.00000 0.86730 0.13270 0 1 1 6807233 6807233 232039006 107376814 124662192 11187695 5906972 5280723 188081568 133877384 54204184 8945357 5328732 3616625 194570957 Deferred Bond Issuance Costs 3123249 Advance to American Restaurant Assoc. (ARA) 189268 Interest In Net Assets of Recipient Organization 18833651 Goodwill 16801342 38947510 Due to Third Party Payors 35705421 Reserve for Self Insurance 18055327 Deferred Compensation 8921579 Asbestos Retirement Obligation 294886 Due to Affiliated Organization 9967124 Current Maturities of Long-term Debt 4459515 77403852 X Part X, Line 2: Tax positions are not offset or aggregated with other positions. Tax positions that meet the "more likely than not" recognition threshold are measured as the largest amount of tax benefit that is more than 50% likely to be realized on settlement with the applicable taxing authority. The portion of the benefits associated with the tax positions taken that exceeds the amount measured as described above is reflected as a liability for unrecognized tax benefits in the accompanying consolidated balance sheet along with any associated interest and penalties that would be payable to the taxing authorities upon examination. At May 31, 2014 and 2013, there were no unrecognized tax benefits identified or recorded as liabilities. 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 8520523 8520523 0.01960 77954069 73292080 4661989 0.01070 3564926 2435657 1129269 0.00260 90039518 75727737 14311781 0.03290 0.00000 7423021 2116223 5306798 0.01220 19066190 692761 18373429 0.04230 1659639 46317 1613322 0.00370 1021248 314721 706527 0.00160 29170098 3170022 26000076 0.05980 119209616 78897759 40311857 0.09270 0 35315464 5297320 76893731 93065685 -16171954 X 1 1 1 Featherstone Partnership LLC Ambulatory Surgery Center 0.28570 0.00000 0.71430 2 Northern Illinois Vein Clinic LLC Outpatient Physician Clinic 0.50000 0.00000 0.50000 2 1 SwedishAmerican Hospital 1401 E State Street Rockford IL 61104 X X X X X A 2 SwedishAmerican Medical Ctr Belvidere 1625 S State Street Belvidere IL 61008 X X X A Facility Reporting Group - A 1 X X X X X X X X X 12 1 1 1 X www.swedishamerican.org/about/chna X X X X X 0 0 1 1 200.000000000000 1 600.000000000000 1 X X X X X X X 1 1 X X X 1 0 X X X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: SwedishAmerican Hospital, - Facility 2: SwedishAmerican Medical Ctr. Belvidere Facility 1 -- SwedishAmerican Hospital Part V, Section B, line 3: Primary data was collected from interviews with community leaders and stakeholders. The hospitals commissioned in-depth interviews with community members who represent the broad interests as well as the specific populations in the Rockford area. The interviews measured perspectives on a range of issues that affect the population's health and well-being, e.g., community resources, barriers to health care providers, and reasons for high rates of disease and mortality. Interviews were completed with the individuals from the following organizations:Lifescape Community ServicesShelter Care MinistriesEmployers' Coalition on HealthRockford Area Economic Development CouncilCity of BelvidereRockford Chamber of CommerceOgle County Public Health DepartmentState Senate Representative of Rockford/BelvidereRosecrance Health NetworkWinnebago County Public Health DepartmentBelvidere Community Unit School District 100Crusader Community HeathRock Valley CollegeWinnebago County State's Attorney's OfficeYWCA RockfordLa Voz LatinaUniversity of Illinois College of Medicine, RockfordCity of Rockford Facility 1 -- SwedishAmerican Hospital Part V, Section B, line 4: SA Hospital has two hospital facilities, SwedishAmerican Hospital located in Rockford, Illinois, and SwedishAmerican Medical Center Belvidere located in Belvidere, Illinois. The definition of the community for purposes of the Community Health Needs Assessment (CHNA) was based on the patient origin information by zip code for combined emergency room and inpatient discharges at both facilities. The counties of Boone, Ogle, and Winnebago represented 86% of emergency room and 85% of inpatients and they were determined to be the definition of the community for the CHNA. The CHNA was conducted together for both facilities. Facility 1 -- SwedishAmerican Hospital Part V, Section B, line 7: In acknowledging the wide range of priority health issues that emerged from the CHNA process, the Hospital determined that it could only effectively focus on those which it deemed most under-addressed and most within its ability to influence. Facility 1 -- SwedishAmerican Hospital Part V, Section B, line 14g: The hospital's financial assistance policy is transparent and available to all, at all points in the continuum, in languages appropriate for hospital's service area. The hospital's financial assistance policy, application form, signage, and financial counselor contact information are available in English and Spanish. Signage is posted prominently at all points of admission and registration (including the emergency department). Written information about the hospital's financial assistance policy and copies of the financial assistance form are available in admission and registration areas. The hospital's financial assistance policy, application form and financial counselor contact information are also posted on the hospital's website. The hospital will make efforts to publicize its policy in print and television media, wherever practicable.Patient billing communications also inform patients of the availability of financial assistance. Each bill, invoice, or other summary of charges to an uninsured patient includes with it, or on it, a prominent statement that an uninsured patient who meets certain income requirements may qualify for financial assistance and information on how to apply for consideration under the hospital's financial assistance policy. All third-party agents who submit or collect bills on behalf of hospital are required to follow this policy. Facility 1 -- SwedishAmerican Hospital Part V, Section B, line 20d: The maximum amount that may be collected in a 12-month period from an uninsured patient with family income of less than or equal to 600% of the federal poverty guidelines for medically necessary services is 25% of that patient's family income. The hospital will determine, on a case-by-case basis, whether to extend the same or similar 12-month maximum collectible amount to any other qualifying self-pay patient with family income of less than or equal to 600% of the federal poverty guidelines for qualifying services. The hospital reserves the right to exclude patients having assets with a value in excess of 600% of the federal poverty guidelines from the application of the 12-month maximum collectible amount. For purposes of determining the applicability of the 12-month maximum collectible amount, the following assets shall not be counted:A. The uninsured patient's primary residence.B. Personal property exempt from judgment under section 12-1001 of the code of civil procedure.C. Any amounts held in a pension or retirement plan, provided, however, that distributions and payments from pension or retirement plan may be included as income.To be eligible to have this maximum amount applied to subsequent charges, a patient shall inform the hospital, in subsequent hospital in-patient admissions or outpatient encounters, that the patient has previously received medically necessary services from the hospital and was determined to be entitled to discounted care under this policy. In no event shall a patient who receives financial assistance under this policy be charged "gross charges" in violation of the internal revenue code section 501(r)(5)(b). For emergency or other medically necessary care provided to patients who receive financial assistance under this policy, hospital shall not charge amounts in excess of charges allowed under internal revenue code 501(r)(5)(a). Assets are not considered in determining a self-pay patient's eligibility for financial assistance under this policy, except for purposes of: A. Determining the applicability of the 12-month maximum collectible amount described above; andB. In the case of a medicare beneficiary, applying the mandatory asset test for medicare beneficiaries described above. Facility 2 -- SwedishAmerican Medical Ctr. Belvidere Part V, Section B, line 3: Primary data was collected from interviews with community leaders and stakeholders. The hospitals commissioned in-depth interviews with community members who represent the broad interests as well as the specific populations in the Rockford area. The interviews measured perspectives on a range of issues that affect the population's health and well-being, e.g., community resources, barriers to health care providers, and reasons for high rates of disease and mortality. Interviews were completed with the individuals from the following organizations:Lifescape Community ServicesShelter Care MinistriesEmployers' Coalition on HealthRockford Area Economic Development CouncilCity of BelvidereRockford Chamber of CommerceOgle County Public Health DepartmentState Senate Representative of Rockford/BelvidereRosecrance Health NetworkWinnebago County Public Health DepartmentBelvidere Community Unit School District 100Crusader Community HeathRock Valley CollegeWinnebago County State's Attorney's OfficeYWCA RockfordLa Voz LatinaUniversity of Illinois College of Medicine, RockfordCity of Rockford Facility 2 -- SwedishAmerican Medical Ctr. Belvidere Part V, Section B, line 4: SA Hospital has two hospital facilities, SwedishAmerican Hospital located in Rockford, Illinois, and SwedishAmerican Medical Center Belvidere located in Belvidere, Illinois. The definition of the community for purposes of the Community Health Needs Assessment (CHNA) was based on the patient origin information by zip code for combined emergency room and inpatient discharges at both facilities. The counties of Boone, Ogle, and Winnebago represented 86% of emergency room and 85% of inpatients and they were determined to be the definition of the community for the CHNA. The CHNA was conducted together for both facilities. Facility 2 -- SwedishAmerican Medical Ctr. Belvidere Part V, Section B, line 7: In acknowledging the wide range of priority health issues that emerged from the CHNA process, the Hospital determined that it could only effectively focus on those which it deemed most under-addressed and most within its ability to influence. Facility 2 -- SwedishAmerican Medical Ctr. Belvidere Part V, Section B, line 14g: The hospital's financial assistance policy is transparent and available to all, at all points in the continuum, in languages appropriate for hospital's service area. The hospital's financial assistance policy, application form, signage, and financial counselor contact information are available in English and Spanish. Signage is posted prominently at all points of admission and registration (including the emergency department). Written information about the hospital's financial assistance policy and copies of the financial assistance form are available in admission and registration areas. The hospital's financial assistance policy, application form and financial counselor contact information are also posted on the hospital's website. The hospital will make efforts to publicize its policy in print and television media, wherever practicable.Patient billing communications also inform patients of the availability of financial assistance. Each bill, invoice, or other summary of charges to an uninsured patient includes with it, or on it, a prominent statement that an uninsured patient who meets certain income requirements may qualify for financial assistance and information on how to apply for consideration under the hospital's financial assistance policy. All third-party agents who submit or collect bills on behalf of hospital are required to follow this policy. Facility 2 -- SwedishAmerican Medical Ctr. Belvidere Part V, Section B, line 20d: The maximum amount that may be collected in a 12-month period from an uninsured patient with family income of less than or equal to 600% of the federal poverty guidelines for medically necessary services is 25% of that patient's family income. The hospital will determine, on a case-by-case basis, whether to extend the same or similar 12-month maximum collectible amount to any other qualifying self-pay patient with family income of less than or equal to 600% of the federal poverty guidelines for qualifying services. The hospital reserves the right to exclude patients having assets with a value in excess of 600% of the federal poverty guidelines from the application of the 12-month maximum collectible amount. For purposes of determining the applicability of the 12-month maximum collectible amount, the following assets shall not be counted:A. The uninsured patient's primary residence.B. Personal property exempt from judgment under section 12-1001 of the code of civil procedure.C. Any amounts held in a pension or retirement plan, provided, however, that distributions and payments from pension or retirement plan may be included as income.To be eligible to have this maximum amount applied to subsequent charges, a patient shall inform the hospital, in subsequent hospital in-patient admissions or outpatient encounters, that the patient has previously received medically necessary services from the hospital and was determined to be entitled to discounted care under this policy. In no event shall a patient who receives financial assistance under this policy be charged "gross charges" in violation of the internal revenue code section 501(r)(5)(b). For emergency or other medically necessary care provided to patients who receive financial assistance under this policy, hospital shall not charge amounts in excess of charges allowed under internal revenue code 501(r)(5)(a). Assets are not considered in determining a self-pay patient's eligibility for financial assistance under this policy, except for purposes of: A. Determining the applicability of the 12-month maximum collectible amount described above; andB. In the case of a medicare beneficiary, applying the mandatory asset test for medicare beneficiaries described above. 30 Regional Cancer Center 3535 N Bell School Rd Rockford IL 61114 Outpatient Clinic Rockford Ambulatory Surgery Center 1016 Featherstone Road Rockford IL 61107 Ambulatory Surgery Center Midwest Heart Specialists 1340 Charles Street Suite 300 Rockford IL 61104 Outpatient Clinic Woodside 3775 N Mulford Road Rockford IL 61114 Outpatient Clinic Lundholm Orthopedics 1340 Charles Street Rockford IL 61104 Outpatient Clinic Brookside Specialty Center 1253 N Alpine Road Rockford IL 61107 Outpatient Clinic Neuro and Headache Center 1340 Charles Street Suite 400 Rockford IL 61104 Outpatient Clinic Home Health Care 2550 Charles Street Rockford IL 61108 Home Health Camelot OBGYN 1415 E State Street Suite 200 Rockford IL 61104 Outpatient Clinic 5 Points Clinic 2404 Charles Street Rockford IL 61108 Outpatient Clinic Dixon Oncology 101 W 2nd Street Dixon IL 61021 Outpatient Clinic Valley Clinic 6824 Newburg Road Rockford IL 61108 Outpatient Clinic Belvidere Clinic 1700 Henry Luckow Lane Belvidere IL 61008 Outpatient Clinic Wound Care & Hyperbaric Clinics 1415 E State Street Stes 408 609 Rockford IL 61104 Outpatient Clinic Rock Valley Women's Health Center 6861 Village Green View Rockford IL 61107 Outpatient Clinic Brookside Occupational & Immediate Care 1215 N Apline Road Rockford IL 61107 Outpatient Clinic ACT 2473 McFarland Road Rockford IL 61107 Outpatient Clinic Pulmonary and Sleep Disorder Clinic 1401 E State Street Rockford IL 61104 Outpatient Clinic Midtown Clinic 1340 Charles Street Suite 405 Rockford IL 61104 Outpatient Clinic Davis Junction Clinic 5665 North Junction Way David Junction IL 61020 Outpatient Clinic Roscoe Clinic & Immediate Care 5005 Hononegah Road Roscoe IL 61073 Outpatient Clinic Cardiothorasic Surgery 1340 Charles Street Suite 300 Rockford IL 61104 Outpatient Clinic Byron Clinic 220 W Blackhawk Drive Byron IL 61010 Outpatient Clinic SA Immediate Care 2473 McFarland Road Rockford IL 61107 Outpatient Clinic Marengo Clinic and Immediate Care 204 E Prairie Street Marengo IL 60152 Outpatient Clinic Northern Illinois Vein Clinic 1340 Charles Street Suite 404 Rockford IL 61104 Outpatient Clinic Maternal Fetal Medicine 1401 E State Street Rockford IL 61104 Outpatient Clinic Center for Women 1340 Charles Street Suite 301 Rockford IL 61104 Outpatient Clinic SAMG Obstetrics & Gynecology 209 9th Street Rockford IL 61104 Outpatient Clinic Rochelle Clinic 380 Illinois Route 38 East Rochelle IL 61068 Outpatient Clinic Part I, Line 7g: The following subsidized health services are for physicians. These physicians are necessary to serve the community, are difficult to recruit, and the reimbursement does not cover the cost of the services.Hospital based physicians' specialty clinics and coverage payments: $15,260,561Emergency department physicians: $1,209,533Total: $16,470,094 Part I, Ln 7 Col(f): The bad debt expense in part IX column A, that was subtracted for the purpose of calculating the percentage of expense, is $35,315,464. Part I, Line 7: Line 7a and 7f costs were calculated using the 2014 Medicare Cost Report, cost-to-charge ratio. Lines 7b and 7c costs were calculated using the cost accounting system. The cost accounting system addresses all patient segments. All other amounts in line 7 were calculated using direct costs. Part III, Line 2: Methodology for determining bad debt expense: It is our practice to identify, to the extent possible, charity cases at the time of service. If a patient provides documentation they meet our charity care policy, they are not sent to collection. Those patients who do not meet presumptive eligibility and fail to apply or provide documentation are sent to collection after 90 days. The organization and its agents follow the fair patient billing act. If we or our agents become aware of a patient qualifying for charity care or financial assistance during the collection process, and the patient cooperates with the requirements of the charity care policy, we cease collection efforts, and we write off the account to charity. Bad debt expense reported on line 2 represents the allowance for doubtful accounts. It is determined based on historical experience of uncollectible amounts, after contractual discounts, patient payments and amounts qualifying under charity assistance policy. Part III, Line 3: SwedishAmerican Hospital's (SA Hospital's) charity policy allows a 100% charity write-off for those with household income of 200% or less of the federal poverty level and partial charity write-off for those up to 600% of the poverty level. The latest data from the U.S. Census Bureau for Winnebago, Boone and Ogle counties, which are the counties served by the healthcare facilities, indicates the following: Winnebago county - 17% of the population is below the poverty level, the median household income was $47,543 and a household size of 2.56; Boone county - 10% of the population is below the poverty level, the median household income was $63,670 and a household size of 3.01; Ogle - 10% of the population is below the poverty level, the median household income was $55,590 and a household size of 2.54. The 2012 poverty guidelines per the Office of Assistant Secretary for Planning and Evaluation, (http://aspe.hhs.gov) indicate for a household of 3, an income of $38,180 is 200% of the poverty level and $114,540 is 600% of the poverty level. Approximately 85% of our charity write-offs are for patients without insurance, while 68% of our bad debt write-offs are for patients without insurance. In 2014, only 10% of all accounts written off to bad debt were recovered. Based on this demographic and internal data, we believe that a minimum of 15% of the amounts written off as bad debt would qualify for charity, and as such, 15% of the bad debt expense from line 2 is reported on line 3. Part III, Line 4: Patient accounts receivables are reduced by an allowance for uncollectible accounts. In evaluating the collectability of accounts receivable, the hospital identifies troubled accounts, reviews historical experience, and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for uncollectible accounts and provision for bad debts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for uncollectible accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for uncollectible accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due, for which third-party coverage exists for part of the bill), the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted, is charged off against the allowance for uncollectible accounts. Part III, Line 8: SA Hospital must treat patients regardless of their ability to pay. The government sets non-negotiable Medicare rates and the reimbursement from Medicare has not kept pace with the rising cost of providing those services. The cost of care has increased due to: wages and benefits necessary to keep high demand skilled practitioners, medical supplies (in particular, cardiovascular and orthopedic implants and pharmaceuticals), malpractice insurance costs, and capital equipment. SA Hospital's treatment of Medicare beneficiaries relieves the federal government burden of directly providing medical care, which by law, they are required to provide to eligible beneficiaries. Due to the requirement to provide care and the inability of Medicare reimbursement to keep pace with the cost of providing services, we feel the loss from services provided to Medicare beneficiaries is a part of our mission and is a benefit to our community. The following is a reconciliation of the shortfall from Medicare reported on the Cost Report, on line 7 to the Medicare shortfall from all of the Medicare programs at SA Hospital. These shortfalls were calculated using the cost to charge ratio.Medicare shortfall hospital programs Part III, line 7: ($16,171,954)Medicare shortfall physician programs: ($8,723,543)Total Medicare Shortfall: ($24,895,497) Part III, Line 9b: The organization and its agents follow the fair patient billing act. If we or our agents become aware of a patient qualifying for charity care or financial assistance during the collection process, and the patient cooperates with the requirements of the charity care policy, collection efforts are ceased. Part VI, Line 2: SA Hospital has provided a third of the monetary support for the 2010 Healthy Community Study, conducted by the Rockford Health Council. The Council consists of the major health care providers in our metropolitan area such as the three hospitals: Crusader Clinic (a federally qualified healthcare clinic); the University of Illinois College of Medicine, Janet Wattles Mental Health Center; Rosecrance Substance Abuse Center, as well as several representatives of not-for-profit agencies and members of the corporate community. Since 2001, an assessment has been completed every three years to identify and track trends, as well as areas to address. These stakeholders understand the need for a comprehensive community study that is focused on the overall needs of the community. SA Hospital has used this data to launch innovative programs and collaborative partnerships, such as cardiac screenings within minority communities. In April of 2013, SA Hospital contracted with McGladrey LLP to conduct a Community Health Needs Assessment (CHNA) for both SA Hospital and SwedishAmerican Medical Center Belvidere, as required by the Internal Revenue Code, Section 501(r). An implementation strategy was adopted to meet the prioritized needs identified by the CHNA. Part VI, Line 3: For services provided in the hospital, our employees and our agents follow the fair patient billing act and provide information regarding the availability of charity and financial assistance at all points during the collection process. We have posted signage disclosing the availability of charity care and financial assistance in emergency rooms and on our website. Inpatients are provided various written communications regarding the availability of charity care and financial assistance and any uninsured discount eligibility. For services provided in physician offices, financial counselors are instructed to make the patients aware of the charity care and financial assistance policy during the collection process and educate them on the process of applying for Medicaid. For services provided by Home Health, social workers assist patients by screening for Medicaid eligibility and completing the application, completing charity care application, assisting in applying for Medicare and social security disability benefits, and assisting with applications for food stamps, low income energy assistance, and Circuit Breaker/Illinois Cares prescription programs. Part VI, Line 4: The communities served by SA Hospital include the Rockford Metropolitan Service Area (MSA) and the counties of Winnebago, Boone, Ogle and Stephenson. Ogle and Winnebago counties have medically underserved area (MUA) designations for the White Rock Service Area (MUA 916) and Winnebago Service Area (MUA 7011). The 2010 U.S. Census Bureau had the population for the Rockford MSA at 348,360. Today, the unemployment rate of the Rockford MSA is 11%, the 13th highest in the nation. SA Hospital is located in the city of Rockford, Illinois, in Winnebago County, where the percentage of households below the poverty level is 16.3%. SA Medical Center Belvidere is located in the city of Belvidere, Illinois, in Boone County, where the percentage of households below the poverty level is 10.2%. Of the patients served by SA Hospital, at all facilities, 26% are uninsured or Medicaid recipients. Five different facilities exist in the community to address inpatient needs, all of which offer discounts or charity care to uninsured and needy patients. There is one federally qualified healthcare facility. SA Hospital helped fund the 2010 Rockford Healthy Community Study in partnership with the University of Illinois College of Medicine at Rockford and the Rockford Health Council. The study revealed that more than 20% of the residents in our hospital's zip code live below the poverty level, and that the median household income of $25,527 is the lowest of all Rockford-area zip codes. Out-of-pocket healthcare costs are a problem for more than 45% of this area's residents, which is the highest rate in the city of Rockford. Additionally, many residents in this vicinity - which is among the state's most depressed areas - are not able to receive needed physical or mental healthcare. The United Way of Rock River Valley community assessment further revealed that many local residents lack health insurance and access to primary healthcare, leading to premature mortality.The Rockford Healthy Community Study identified extremely low levels of home ownership in SA Hospital's immediate vicinity. According to the study, more than 60% of residents rented, which was much higher than the overall sample (approximately 17%). The study also indicated that more than 12% of area residents could not afford to make basic home repairs. The United Way's assessment further identified the need for more affordable permanent housing units, stating: "even though housing in Rockford is among the most affordable in the country, many families, especially renters, cannot afford shelter."By virtue of its mission, location in the central city and relationships with other providers, SA Hospital serves the needs of many of the community's underserved. Finding ways to improve the health of all and to make Rockford a model community in which to live, work and worship are significant and strategic initiatives for SA Hospital.Part VI, line 5: Although SA Hospital's community service efforts reach a broad segment of the population throughout northern Illinois, the Hospital devotes a great deal of its energy and resources to serving the city's neediest people, many of whom live in the urban core where SA Hospital is located. Our organization contributes millions of dollars to charity and Medicaid care each year. Recognizing that healthy communities are characterized by strong interconnections between residents, infrastructure, organizations, and services, we have worked in partnership with other community-based organizations as part of the non-profit Rockford Health Council Inc. The council seeks to build and improve community health through education, action, dialogue, and legislative activity and serves as a catalyst and coordinator for agency and individual action to ensure access, cost effectiveness, and quality. Beyond our work with the council, some of our initiatives take place in concert with other individual community organizations and healthcare providers, while others are carried out by SA Hospital teams.SA Hospital has sought to improve the community's health by taking effective lifestyle modification programs to the people who need them most. Although this applies to the community at large, we have taken special efforts to bring these strategies to the city's elderly and underserved residents. This is demonstrated by our successful program to improve the health of residents at Longwood Plaza, a Senior Housing Facility located two blocks from our Hospital's campus. Finally, beyond lifestyle modification, our ongoing community health initiatives involve research-based health screening programs, as well as unique health education events that target both at-risk members of the community and healthcare providers.Our mission is "through excellence in healthcare and compassionate service, we care for our community." In furtherance of its exempt purpose, SA Hospital continually invests in the surrounding community with physician acquisitions and regional expansion to assure access to health care. SA Hospital also established centers of excellence and alliances with other health care providers, including Crusader Clinic, a federally qualified health center, and the University of Wisconsin. This assures the community we serve receives the highest quality care. We also invest in technology to assure cost effective care is delivered for which SA Hospital has won numerous awards for its quality of care. In addition, SA Hospital maintains an open medical staff and community board as part of its exempt purpose. Part VI, Line 6: SA Hospital is a stand alone health care provider that offers services at two acute care hospitals, physician clinics, physician emergency services, and home health care. SwedishAmerican Foundation is a subsidiary of SwedishAmerican Hospital and supports it through fundraising.In order to improve the low rate of home ownership identified in the Rockford Healthy Community study, SwedishAmerican Foundation (SAF) initiated a neighborhood revitalization program in a six-block area directly south of our hospital campus. SAF's neighborhood revitalization effort includes:Habitat for Humanity homes: SAF entered into a formal agreement with the Rockford Habitat for Humanity chapter in 2002 to construct new area homes. By the end of 2012, a total of 29 Habitat for Humanity homes have now been completed and sold to low-income homeowners.New city-built homes: SAF purchased and razed three additional substandard homes in the neighborhood and provided the lots to the city of Rockford. The city subsequently built three new homes on these sites for sale to moderate income families with purchase assistance.Cruise fundraiser: Over the past 19 years, SAF's annual fundraising gala has raised more than $1,200,000, which has been reinvested into healthcare facilities serving patients at the Regional Cancer Center of SwedishAmerican and healthcare services in the community outreach to schools for physicals and immunizations for children, and cancer screenings for residents.Neighborhood playground and parks: Because area children did not have a safe place to play, SAF purchased three contiguous pieces of property, removed existing commercial and residential structures, and partnered with two local charities to construct a new neighborhood playground.Driveway/garage renovation project: Following a neighborhood-wide survey, SAF coordinated and implemented a garage construction and driveway replacement program. In addition to increasing existing home values, this program will help reduce on-street parking, thereby increasing traffic flow and making parked cars less visible/accessible to potential thieves and vandals.Reverse home gift annuity program: To help struggling elderly residents remain in their homes, SAF developed a program whereby homeowners deed physical ownership of their property to the Foundation in exchange for the right to live in their home until death or incapacity. SAF assumes responsibilities for taxes, repairs, upkeep, lawn maintenance, and snow removal. Upon taking ultimate possession of a house, it will be sold to an employee or other owner occupant, to help increase (or at least maintain) a significant percentage of owner occupied homes.Homeowner grants to employees: Since 2004, SA Hospital has offered $5,000 down payment assistance to employees to help encourage home ownership in the six-block area surrounding the Hospital. This initiative includes a five-year forgivable grant to employees in good standing with no income restrictions, and a second possible $5,000 grant for low-income employees. Since inception, this program has assisted 30 employees in purchasing homes in the SA Hospital neighborhood.Home restoration: Since 2004, SAF has purchased a total of 30 homes in the neighborhood target area, rehabbed them and made them available to employees, firefighters, police officers and public school teachers, at a discount (less than the cost of purchase and repairs). To date, 22 homes have been sold to employees and other eligible owner occupants. In order to alleviate first-time home buyers' concerns about the rising costs of ownership, these homes have a solid roof, siding, plumbing, electrical, and a good working furnace. This program will continue for at least four additional years. In cooperation with Rockford East High School and De La Gardie High School/gymnasiet (Lidkopings, Sweden), the SAF constructed two new neighborhood houses available for sale to employees or other eligible owner-occupants.In addition, the Foundation has purchased two, 12-unit apartment buildings, adjacent to the hospital campus, which were in a state of disrepair. Approximately three-quarters of a million dollars were invested in these two buildings to bring them to "market rate" status. Encouraged by our commitment to renovate our campus and revitalize the surrounding area, a number of commercial developments have occurred. Among them is a new Walgreen's drug store, which returned retail pharmacy services to the area for the first time in years. A three-story office building south of the new Walgreen's was completed, followed by a 60,000-square-foot medical office building, south of the Hospital. Part 1 Line 6A and Part VI Line 7: SA Hospital files a community benefit report with the Illinois Attorney General. 1 Illinois Hospital Research & Health Foundation 1151 E Warrenville Rd Naperville IL 60566 237421930 501(c)(3) 243017 Quality healthcare for Illinois 1 0 Educational scholarship for children of non-management employees 31 31000 Part 1, Line 2 IHREF is a tax exempt research entity. SA Hospital works closely with grantee organizations or receives reports from them as appropriate. 0 1 0 0 0 0 0 0 0 William R Gorski MD President & CEO 611233 0 115686 0 1662614 0 236785 0 17909 0 2644227 0 1166136 0 Richard Walsh Chief Operating Officer 394632 0 57305 0 1905 0 107243 0 17377 0 578462 0 1905 0 Danny L Copeland MD Trustee 221902 0 0 0 0 0 16256 0 22702 0 260860 0 0 0 John C Myers MD Trustee 531578 0 0 0 0 0 14633 0 43344 0 589555 0 0 0 Allen Williams MD Trustee 257988 0 0 0 0 0 18281 0 32844 0 309113 0 0 0 Donald Haring VP Finance/Treasurer 345745 0 50531 0 305234 0 59119 0 16801 0 777430 0 220688 0 Kathleen Kelly MD VP Medical Affairs 378168 0 52853 0 0 0 45786 0 841 0 477648 0 0 0 Harvey Einhorn MD Physician 560045 0 0 0 0 0 37900 0 39368 0 637313 0 0 0 Steven Milos MD Physician 608425 0 0 0 0 0 15428 0 31682 0 655535 0 0 0 Melissa Macias MD PhD Physician 731703 0 0 0 0 0 0 0 14047 0 745750 0 0 0 Merat Esfahani MD Physician 668553 0 0 0 0 0 15428 0 41995 0 725976 0 0 0 Howard Kaufman DO Physician 547633 0 0 0 0 0 14457 0 31976 0 594066 0 0 0 Part I, Line 3 All Compensation is determined by SwedishAmerican Health System and is paid by SwedishAmerican Hospital. All compensation decisions are made by independent persons. With respect to the President, CEO, and Officers, SwedishAmerican Health System follows a compensation approval procedure annually that involves approval of proposed and final compensation arrangements by the SA Hospital's Executive Compensation Committee using comparability data, as well as contemporaneous documentation of compensation decisions in the minutes. All physician compensation arrangements are approved by the Finance Committee and full Board of Directors using comparability data, and are contemporaneously documented in the minutes. Part I, Line 4b William Gorski M.D.- 457(f)-$200,797; Richard Walsh - 457(f)-$88,755; Donald Haring-457(f)-$38,719; Kathleen Kelly M.D.-457(f)-$29,589. Part II Column F: The amounts shown in column F were reported as deferred compensation in prior years but paid out in the current year. The amounts are also included in column B(iii). A Illinois Finance Authority - 2004 861091967 45200BKQ0 2004-12-21 105360720 Construction & equipment cardiac pavilion, renovate operating rm & cath lab 0 0 0 B Illinois Finance Authority - 2010 861091967 2010-04-19 25000000 Construction & equipment cardiac pavilion, renovate operating rm & cath lab 0 0 0 C Illinois Finance Authority - 2012 861091967 45203HLW0 2012-09-27 41833485 Construction & equipment Regional Cancer Center 0 0 0 A 18180000 106458982 12819 74126290 991204 3672433 27656236 2007 0 1 1 1 B 3750000 25000000 25000000 2010 0 1 1 1 C 41888629 648001 41240619 9 2013 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 1 1 0 0.02000 0.00000 0.02000 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 Part II, Line 7: Bond insurance of $3,672,397 was purchased from bond proceeds and is included as a cost of issuance. Sheryl Head Robert L. Head, PhD Trustee, Spouse 102049 Employee compensation 0 Beverly Derry Patrick Derry Trustee, Sister-in-law 88592 Employee compensation 0 Michelle Roop William Roop Trustee, Daughter 10797 Employee Compensation 0 Form 990, Part VI, Section A, line 2 Directors William Roop and James Gingrich have a business relationship. Directors Dave Rydell and James Gingrich have a business relationship. Directors Dan Loescher and Frank Walter have a business relationship. Directors James Gingrich and Amy Wilcox have a business relationship. Directors Robert L. Head, PhD, Helen C. Hill and Dave Rydell have a common business relationship. Directors Dave Rydell and Robert L. Head, PhD have a business relationship. Directors Peter Christman and Michael Dallman have a business relationship. Directors William Roop and Amy Wilcox have a business relationship. Form 990, Part VI, Section A, line 6 SwedishAmerican Health System (Parent Corporation) is the sole corporate member of SwedishAmerican Hospital (Hospital). Form 990, Part VI, Section A, line 7a SwedishAmerican Health System (Parent Corporation) is the sole corporate member of SwedishAmerican Hospital (Hospital) and as such appoints all trustees. Form 990, Part VI, Section A, line 7b SwedishAmerican Health System (Parent Corporation) is the sole corporate member of SwedishAmerican Hospital (Hospital) and as such appoints all trustees and has the authority to approve certain decisions of the Hospital. Form 990, Part VI, Section B, line 11 A draft version of the Form 990 was reviewed by legal counsel and the Vice-President of Finance. Subsequently, the Audit/Compliance Committee of the Board of Directors of SwedishAmerican Health System (parent corporation) reviewed a final draft of the Form 990 and was provided with the opportunity to comment and ask questions. The entire Board of Directors was provided with a copy of the Form 990 before it was filed. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with its conflict of interest policies, which apply to all members of the Board of Directors and to all employees. Procedures are in place to identify conflicts of both directors and employees. Director conflicts are handled by Board deliberation and Board vote from which the interested director is excluded. Employee conflicts are handled by the compliance department and in certain instances may require separate Board action. The Board is provided with periodic compliance reports regarding conflicts of interest. Form 990, Part VI, Section B, line 15 All compensation is determined by SwedishAmerican Health System and is paid by SwedishAmerican Hospital. All compensation decisions are made by independent persons. With respect to the President, CEO, Officers, and key employees, SwedishAmerican Health System follows a compensation approval procedure annually that involves approval of proposed and final compensation arrangements by the organization's Executive Compensation Committee using comparability data, as well as contemporaneous documentation of compensation decisions in the minutes. All physician compensation arrangements are approved by the finance committee and full Board of Directors using comparability data, as well as contemporaneous documentation of compensation decisions in the minutes. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements have not been made available to the public. The consolidated audited financial statements of SwedishAmerican Hospital are available from the Illinois Attorney General Website and from the U.S. Securities and Exchange Commission electronic municipal market access system. Form 990, Part XI, line 9: Interest in Recipient Organization 26,102. Surgi Center Book/Tax Difference -84,751. Other Changes in Net Assets 816,900. SwedishAmerican Foundation -305,170. SwedishAmerican Health System Corporation 1401 East State St Rockford IL 61104 363241458 Parent corporation to manage & direct activities of entitites IL 501(c)(3) Line 11b N/A 0 SwedishAmerican Realty Corporation 1313 East State St Rockford IL 61104 363248013 Title holding company IL 501(c)(2) SwedishAmerican Health System Corporation 1 SwedishAmerican Foundation 1415 East State St Rockford IL 61104 363097493 Supporting Organization for SwedishAmerican Hospital fundraising IL 501(c)(3) Line 7 SwedishAmerican Hospital 1 SwedishAmerican Hospital Self Insurance Trust 1401 East State St Rockford IL 61104 366652702 Hospital Malpractice Trust IL 501(c)(3) Line 11a SwedishAmerican Hospital 1 Three Rivers Partners LLC 1313 E State St Rockford IL 61104 262231757 Information Technology Services IL N/A N/A 0 0 0.50000 Northern Illinois Vein Clinic 2550 Charles St Rockford IL 61108 201642329 Outpatient Health Services IL N/A Related 215553 82667 0 1 0.50000 State & Charles Inc 1313 East State St Rockford IL 61104 363321193 Holding Company IL SAHS Corporation C 1 Sari Insurance Company 76 St Paul St Suite 500 Burlington VT 054014477 030308753 Captive Insurance Company VT SAHS Corporation C 1 LSG Building Corporation 1313 East State St Rockford IL 61104 363033985 Real Estate IL SAHS Corporation S 1 SwedishAmerican Health Management Corp 1401 East State St Rockford IL 61104 363246511 Management Service IL State & Charles Inc C 1 0 0 1 1 0 0 0 0 0 1 1 0 0 0 1 0 1 1 0 SwedishAmerican Foundation C 305170 Cost SwedishAmerican Self Insurance Trust P 423906 Cost SwedishAmerican Self Insurance Trust Q 1894400 Cost SwedishAmerican Realty Corporation K 6704162 Cost TriRivers Partners LLC J 54893 Cost SwedishAmerican Realty Corporation D 1897343 Cost