2015-11-10T15:43:32-06:00 2014-12-31 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2014-01-01 362169179 Palos Community Hospital PALO 7089234000 12251 S 80th Avenue Palos Heights IL 604630930 Dr Terrence Moisan CEO 7089234000 2015-11-10 1 Wayne Harder P00294296 3126343400 2014 2016-03-07 17:11:31Z Dr Terrence Moisan 12251 S 80th Avenue Palos Heights IL 604630930 1219753748 0 X www.paloscommunityhospital.org X 1972 IL Palos Community Hospital is a 501(c)(3) community hospital whose primary objective is the provision of inpatient and outpatient services that are responsive to the health care needs of the residents of southwestern Cook County and northeastern sections of Will County. 10 6 3121 815 76913 -23519 762789 750923 332023935 354038951 26695484 30031252 8877781 8013703 368359989 392834829 0 0 0 0 211780822 197457271 0 0 0 148308256 156213497 360089078 353670768 8270911 39164061 830546184 875786472 507358445 517581046 323187739 358205426 X Palos Community Hospital (PCH) is a not-for-profit community hospital, which is operated in accordance with the Ethical and Religious Directives for Catholic Healthcare Facilities. The primary objective of PCH is the provision of inpatient and outpatient services that are responsive to the health care needs of the residents of southwestern Cook County and northeastern sections of Will County.In providing any service - be it preventive, curative or palliative - the overriding concern of the institution shall be that the quality of that service be of the highest caliber. PCH shall be committed to a continued review and analysis of the changing needs of the community it serves and shall respond to those needs with services that are readily available in a form that enhances their efficient use by physicians and patients. In addition, PCH shall maintain an ability to adapt to changes and influence forces in its environment effectively and expeditiously. 0 0 219781025 309684789 It is the policy of Palos Community Hospital to provide quality medical health care to all persons regardless of race, creed, sex, national origin, handicap, age, or ability to pay. The Hospital recognizes that not all individuals possess the ability or means to purchase essential medical services and further, that our mission is to serve our community with respect to providing healthcare services and healthcare education. Therefore, in keeping with the hospital's commitment to serve all members of the community, charity and/or subsidized care will be considered where the need and/or inability to pay are identified. 38053139 26534945 Palos Community Hospital provides a total continuum of cardiovascular services - from diagnosis and treatment through recovery and rehabilitation - to ensure that our patients receive the complete care they need close to home. Prior to the start of the program in 2005, Palos transferred patients from their local community to other hospitals. Within 3 years, Palos ranked 14th in Illinois for heart volume. This community need has grown as can be seen with continued increases in volume since the program began. 20671561 19935001 Palos Community Hospital Home Health, Private Duty, and Hospice services provide quality personal care and support to patients in their homes, nursing homes or hospitals. The Home Health staff assists the chronically ill, persons with functional impairments, those needing specialized skilled care at home, those recovering from a hospital stay and the terminally ill. In 2014, Home Health staff from Palos made over 97,000 home care visits, more than 27,000 hospice visits and provided almost 42,000 hours of private duty nursing assistance. 9370868 4530441 Behavioral Health 9370868 4530441 287876593 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 211 0 1 3121 1 1 1 0 0 0 0 1 1 0 0 0 0 X 10 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X Roger Russell 7089234000 12251 S 80th Avenue Palos Heights IL 604630930 Edward Mulcahy Chairman 2.00 1.00 X X 0 0 0 Gordon B Nash Jr Vice Chair 2.00 1.00 X X 0 0 0 Lawrence Hunt Secretary 2.00 X X 0 0 0 Lucie Boyadjian Director 2.00 X 0 0 0 Dr Terrence Moisan Director/CEO 40.00 11.00 X X 719992 0 0 Dr Charles Polcaster Director 2.00 1.00 X 0 0 0 Philip A Salvador Director 2.00 X 0 0 0 Dr Mark Sinibaldi Director/Physician 2.00 40.00 X 50000 267547 30053 Dr Michael Sobczak Director 2.00 X 0 0 0 Jack Vainauskas Director 2.00 1.00 X 57812 0 0 Charles E Reiter III Contracted General Counsel/Assistant Secretary 40.00 10.00 X 385490 0 0 David B Manchester VP Professional Services 40.00 X 412488 0 41938 Hugh A Rose VP Finance/CFO 40.00 11.00 X 400367 0 25372 Randall J Oles VP Support Services 40.00 X 323798 0 46623 Timothy J Brosnan VP Planning/Community Relations 40.00 2.00 X 340935 0 52918 Mary C Denisienko VP Human Resources 40.00 X 263658 0 31939 Rosann S Demask VP Nursing 40.00 X 248948 0 42204 Edgardo Tenreiro CEO (Past) 40.00 X 710717 0 12549 Gary Zmrhal Interim CFO 40.00 X 237069 0 0 Margaret J Carroll Chief Information Officer 40.00 X 263794 0 31506 Muhamad Krad Staff Physician 40.00 X 348686 0 16762 Arthur M Schroeder Staff Physician 40.00 X 319437 0 49540 Abdul Rahmad Safadi Staff Physician 40.00 X 297311 0 16795 Mark D Diamond Staff Physician 40.00 X 271963 0 36637 Haris Aleem Staff Physician 40.00 X 269324 0 25326 5921789 267547 460162 126 0 1 0 Pepper Construction Company 18505 W Creek Drive Tinley Park IL 60477 Construction Services 50818573 Matthei & Colin Associates 332 S Michigan Avenue Chicago IL 60604 Architectural Services 1314295 Mayo Collaborative Services 200 1st St SW Rochester MN 55905 Laboratory Services 1206776 Michuda Cconstruction Inc 11204 S Western Avenue Chicago IL 60643 Construction Services 1058375 Palos Anesthesia & Assoc 12251 S 80th Ave Palos Heights IL 60463 Anesthesia Services 1029171 63 162575 588348 750923 Net Patient Revenue 621110 343946121 343869208 76913 Provider Tax Revenue 900099 10257673 10257673 MRI Joint Venture 900099 -164843 -164843 354038951 7987304 7987304 1212599 776694 435905 435905 435905 848034000 825990052 22043948 22043948 22043948 51875 162575 152173 -100298 -100298 Intercompany Revenue 900099 2674269 2674269 Meaningful Use 900099 2569852 2569852 Cafeteria Revenue 900099 954958 954958 1479017 1479017 7678096 392834829 360685176 76913 31321817 3739463 3739463 150919472 125305273 25614199 8677483 7030531 1646952 23447044 18996887 4450157 10673809 8647962 2025847 2517766 2517766 1519870 1519870 203650 203650 1393370 1393370 11379133 5632381 5746752 812841 812841 3731067 2061799 1669268 5018782 1113407 3905375 410274 400057 10217 200031 139162 60869 13765517 13765517 22219918 17833992 4385926 1467430 701596 765834 Medical Supplies 54533770 54533770 Bad Debt Expense 13249377 13249377 IL Tax Assessment 11300343 11300343 12490358 7164539 5325819 353670768 287876593 65794175 0 15872740 10626072 34579286 43591141 2625430 6324715 1832782 2335433 3809005 2528664 658227419 217853790 388225802 440373629 339308326 359983334 44292813 10023484 830546184 875786472 135507415 143465772 331630000 367670000 40221030 6445274 507358445 517581046 X 323068034 358092770 119705 112656 323187739 358205426 830546184 875786472 X 39164061 -12361275 8214901 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 14313923 14313923 396831743 126973833 269857910 160921496 90879957 70041539 86160257 86160257 440373629 Obligation for Collateral Received for Securities Loaned 64600 Tax Exempt Bond Liability Premium 6380674 6445274 X 365956876 -12361275 928867 -11432408 377389284 1393370 14052175 15445545 392834829 339956888 928867 928867 339028021 1393370 13249377 14642747 353670768 Part X, Line 2: The Hospital has received a determination letter from the Internal Revenue Service stating that it is exempt from the payment of income taxes under Section 501(c)(3) of the Internal Revenue Code. Accordingly, income taxes are not provided for in the accompanying financial statements. The Hospital adopted the FASB-issued guidance for accounting for uncertainty in income taxes on January 1, 2007. The Hospital files a Form 990 (Return of Organization Exempt from Income Tax) annually. When this return is filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Examples of tax positions common to hospitals include such matters as the following: the tax exempt status of the entity; the continued tax exempt status of bonds issued by the obligated group; the nature, characterization and taxability of joint venture income, and various positions relative to potential sources of unrelated business taxable income (UBTI). UBTI is reported on Form 990-T, as appropriate. The benefit of a tax position is recognized in the financial statements in the period during which, based on all available evidence, management believes that it is more likely than not that the position will be sustained upon examination, including the resolution of appeals or litigation processes, if any. 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 percent likely to be realized on settlement with the applicable taxing authority. The portion of the benefits associated with tax positions taken that exceeds the amount measured as described above is reflected as a liability for unrecognized tax benefits in the accompanying balance sheet along with any associated interest and penalties that would be payable to the taxing authorities upon examination. Upon the adoption of the FASB issued guidance at January 1, 2007, and since that date through December 31, 2013, there were no unrecognized tax benefits identified and recorded as a liability. Part XI, Line 2d - Other Adjustments: Rental Expense 776,694. Fundraising Expenses 152,173. Part XI, Line 4b - Other Adjustments: Unrestricted Contributions 802,798. Bad Debt Expense 13,249,377. Part XII, Line 2d - Other Adjustments: Rental Expense 776,694. Fundraising Expenses 152,173. Part XII, Line 4b - Other Adjustments: Bad Debt Expense 13,249,377. Dinner/Celebration 214450 162575 51875 128666 23507 214450 162575 51875 128666 23507 152173 -100298 1 1 X 1 X 1 X 1000.000000000000 1 1 0 1 1 5294250 5294250 0.01500 34961935 21535979 13425956 0.03800 40256185 21535979 18720206 0.05300 851786 100403 751383 0.00210 25425675 17659223 7766452 0.02200 177740 177740 0.00050 26455201 17759626 8695575 0.02460 66711386 39295605 27415781 0.07760 1 13249487 101256985 123871994 -22615009 X 1 1 1 1 Palos Community Hospital 12251 South 80th Avenue Palos Heights IL 60463 X X X PALOS COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 13 1 1 0 1 X www.paloscommunityhospital.org/CHNA X http://www.palos.healthforecast.net/ X 1 13 0 1 0 1 X 200.000000000000 1000.000000000000 X X X X X 1 1 X X X X 1 X X X X X X X 1 0 X X X X 1 X 1 0 PALOS COMMUNITY HOSPITAL Part V, Section B, Line 5: As part of the community health needs assessment, two focus groups were held with key informants from across Cook County. A list of recommended participants for the focus groups was provided by the sponsors. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Focus group participants included a representative of public health, as well as several individuals who work with low-income, minority or other medically underserved populations, and those who work with persons with chronic disease conditions. PALOS COMMUNITY HOSPITAL Part V, Section B, Line 6a: Metropolitan Chicago Healthcare Council; Edward Hospital; Swedish Covenant Hospital; Northwest Community Hospital; Ingalls Memorial Hospital; Little Company of Mary Hospital & Health Care Centers; St. Anthony Hospital; St. Bernard Hospital and Health Care Centers; Central DuPage Hospital; University of Illinois Medical Center at Chicago; Elmhurst Memorial Healthcare; Franciscan St. James Health - Chicago Heights; Thorek Memorial Hospital; Palos Community Hospital; Rush University Medical Center; Northwestern Memorial Hospital; Lake Forest Hospital; Adventist Hinsdale Hospital; University of Chicago Medical Center; Mercy Hospital and Medical Center; Adventist GlenOaks Hospital; Jackson Park Hospital and Medical Center; Adventist LaGrange Memorial Hospital; La Rabida Children's Hospital; Norwegian American Hospital; Rush Oak Park; Vanguard Health Chicago (including: West Suburban Medical Center; Westlake Hospital; Weiss Hospital and MacNeal Hospital); Resurrection Health Care (including: Holy Family Medical Center; Our Lady of the Resurrection Medical Center; Resurrection Medical Center; Saint Francis Hospital; Saint Joseph Hospital and Saints Mary & Elizabeth Medical Center); Alexian Brothers Hospital Network (including: Alexian Brothers Behavioral Health Hospital; Alexian Brothers Medical Center; Alexian Brothers Rehabilitation Hospital and St. Alexius Medical Center). PALOS COMMUNITY HOSPITAL Part V, Section B, Line 11: No, in consideration of the top health priorities identified through the CHNA process and taking into account hospital resources and overall alignment with the hospital's mission, goals and strategic priorities - Palos focused on developing strategies and/or supporting strategies and initiatives to improve:- Access to health services- Nutrition, Physical Activity and Weight Status- Mental Health & Mental DisordersIn acknowledging the wide range of health priority health issues that emerged from the CHNA process, Palos Community Hospital will focus on those within its immediate ability to influence. Some of the priority issues such as injury and violence prevention and those related to maternal and child health fall more purview of the county health department and other health organizations. Others such as kidney and respiratory diseases may be considered in future needs assessment implementations. PALOS COMMUNITY HOSPITAL Part V, Section B, Line 22d: Palos Community Hospital takes its commitment to serving the uninsured and underinsured members of its community very seriously and as a result has implemented a financial assistance policy that goes above and beyond the requirements of Illinois Public Act 095-0965 "Hospital Uninsured Patient Discount Act". This State Law was enacted with an effective date of April 1, 2009 and required that hospitals offer uninsured patients who met the minimum financial requirements (i.e. earnings less than 600% of the FPG and certain asset limitations) a rate equal to 135% of the hospital's most recently filed Medicare cost to charge ratio. PCH expanded the reach of this policy by extending the minimum financial requirements to 1,000% of the FPG to help more of its community qualify for a financial benefit and to give families that earn a lower percentage of the FPG deeper discounts. This policy was also extended to all clinically-necessary procedures and was not limited to emergency care only. Using the FPG, PCH created a set of discounts for patients without insurance that ranged from free care for those who earned less than 200% of the FPG to a 40% discount off of regularly billed charges for any uninsured patient who earned less than 1,000% of the FPG. PCH also created a policy to help those who are underinsured. Similar to its uninsured policy, the underinsured policy creates a set of discounts that can be applied to co-payments and deductibles owed for those patients that earn less than 300% of the FPG. PALOS COMMUNITY HOSPITAL Part V, Section B, Line 23: Please see explanation in Part V, Section B, Line 22d above. Part V, Section B, line 3 The sample design used for this effort consisted of a random sample of 216 individuals age 18 and older in the Palos Community Hospital Service Area. All administration of the surveys, data collection and data analysis was conducted by Professional Research Consultants, Inc. (PRC). Part V, Section B, line 16b http://www.paloscommunityhospital.org/app/files/public/1409/financial-assistance-cover-letter-and-application-2014.pdf Part V, Section B, line 16c http://www.paloscommunityhospital.org/patients-visitors/billing/financial-assistance/ Part V, Section B, Line 16 Financial Assistance Policy Website Availability PALOS COMMUNITY HOSPITAL Part V, Section B, line 16b website: See Part V PALOS COMMUNITY HOSPITAL Part V, Section B, line 16c website: See Part V 5 Palos Primary Care Center 15300 West Avenue Suite 122 Orland Park IL 60462 Primary Care Center Palos Intermediate Care Center 7340 W College Drive Palos Heights IL 60463 Intermediate Care Center Palos Home Health Care 15295 E 127th St Lemont IL 60439 Home Health Care Palos Diagnostic & Women's Center 17333 S LaGrange Rd Tinley Park IL 60477 Diagnostic Testing and Women's Health Palos Sleep Disorders Center 11900 Southwest Highway Palos Park IL 60464 Sleep Studies Part I, Line 3c: Palos Community Hospital charity care is based on a sliding scale of the Federal Poverty Guidelines. PCH set the sliding scale to allow charity in access of the regional minimum amount set forth by Illinois in the Hospital Uninsured Patient Discount Act by extending discounted care up to 1,000% of the FPG vs. the minimum 600% as determined by law.All self-pay patients are provided information regarding our charity care program at the time of registration; self-pay patients are requested to complete a one-page application. This enables the Hospital to expedite the charity care approval process. For balances after insurance, patients are made aware of our charity care program via the statement they receive. Additional information is available on the Hospital's website.The Financial Counselors see approximately 7 patients daily (1680 per year) for assistance with screening for Medicaid applications, Financial Assistance, Payment plans, estimated pricing for services, account review/inquires/complaint, Medicare Liability, etc. The Financial Counselors assist patients with current, past and future visits. The Financial Counselors and Self Pay Collectors processed 3253 financial assistance applications in 2014. There were 1963 charity adjustments, 474 presumptive eligibility charity adjustments, 318 Medicare Bad Debt charity adjustments and 498 charity denials. There has been a decrease in the number of charity applications due to the Affordable Health Care Act. With the expansion of the Medicaid programs we have a significant increase in the number of patients that are already covered and/or qualify for Medicaid or Medicaid Replacement Plans. Part I, Line 7: The best available data was used to calculate the cost amounts reported in Item 7. This includes the overall hospital cost to charge ratio as well as direct and indirect costs for certain specific departments of the hospital.Part I, Line 7 Col(f): The bad debt expense of $13,249,487 was included on Form 990, Part IX, Line 25, but subtracted for purposes of calculating the percentage in this column. Part II, Community Building Activities: The health of the communities that PCH serves is a very important piece of PCH's mission statement. To date, our focus has been on providing the care needed within our community at high level of quality. As such we have implemented and/or maintained programs that we feel help to improve the wellness of the people we serve. PCH believes that given limited resources and time this serves our community better than community building activities as defined in this schedule. Part III, Line 4: PCH calculates Charity Care cost using the hospital wide cost to charge ratio and applying that ratio to the charges written off to charity care per the hospital policy. No other Bad Debt amounts are included in the community benefit report.The Hospital provides care to all patients regardless of their ability to pay. Uncompensated care and community service provided by the Hospital are excluded from net patient service revenue. Part III, Line 8: Medicare costs are calculated using the hospital wide cost to charge ratio. PCH does include the Medicare shortfall in its Illinois state community benefits report as PCH continues to treat its Medicare community despite the fact that its costs for these patients exceed reimbursement. Part III, Line 9b: It is the policy of PCH not to pursue collection practices against patients known to qualify under the Charity Care policy. In some cases, this determination is not immediately known and collection processes are followed, but once it has been determined that a patient may be eligible for charity care, these practices are ceased. Part III, Line 2: Bad debt expense is estimated by totaling the amounts sent to and written off by collection agencies plus an estimate of Accounts Receivable aged by financial class all multiplied by the appropriate cost to charge ratio. Part III, Line 3: Information to determine this amount is not available. Part VI, Line 2: PCH consistently seeks to serve the needs of its community in a variety of ways. In order to better identify these needs, PCH teamed with the Metropolitan Chicago Healthcare Council (MCHC) to prepare a Community Health Assessment for the primary counties that PCH serves. This Community Health Assessment is a systematic, data-driven approach to determining the health status, behaviors and needs of residents in Cook, DuPage and Lake counties, Illinois. This Community Health Assessment will serve as a tool toward reaching three basic goals:- To improve residents' health status, increase their life spans, and elevate their overall quality of life. A healthy community is not only one where its residents suffer little from physical and mental illness, but also one where its residents enjoy a high quality of life.- To reduce the health disparities among residents. By gathering demographic information along with health status and behavior data, it will be possible to identify population segments that are most at-risk for various diseases and injuries. Intervention plans aimed at targeting these individuals may then be developed to combat some of the socio-economic factors which have historically had a negative impact on residents' health.- To increase accessibility to preventive services for all community residents. More accessible preventive services will prove beneficial in accomplishing the first goal (improving health status, increasing life spans, and elevating the quality of life), as well as lowering the costs associated with caring for late-stage diseases resulting from a lack of preventive care. Part VI, Line 3: PCH utilizes several techniques to communicate a patient's eligibility for assistance under various programs. At the time of registration, each patient is referred to a copy of PCH's Charity Care Policy and asked to fill out a simple registration form that may help them qualify for Charity Care. This policy clearly lays out the eligibility requirements and what the patient must do to qualify. Also at registration, any patient without insurance is advised as to what other programs they may qualify for and are given assistance in applying as necessary. PCH employs a company that helps patients apply for Medicaid coverage and SSI disability. Upon discharge, each patient receives a summary bill that includes information related to eligibility for the Charity Care Policy. All inpatients without insurance are visited by a financial counselor who helps direct the patient and their families to the appropriate level of assistance. Signage regarding the charity care policy is posted at all registration areas and in the Emergency department. Finally, PCH displays the plain language summary of the FAP on their website along with the FAP application. Part VI, Line 4: Palos Community Hospital serves growing communities that expect to experience continued growth in the coming years. Communities within the hospital's service area have seen overall growth in population of approximately 7.6% from 2000 to 2014 with a current estimated population of 622,571. Continued growth is anticipated. From 2014 to 2019, the population is expected to grow by 1.3%. Zip codes within the Palos Community Hospital service area include:60462, 60467, 60463, 60464, 60465, 60482, 60445, 60452, 60477, 60487, 60453, 60455, 60457, 60458, 60459, 60415, 60805, 60655, 60803, 60439, 60441, 60491, 60423, 60448, 60451Of those living within the service area of Palos Community Hospital:50.91% are female87.62% are white79% are English-speakingThe median age is 40.1 years30% are high school graduates23% have had some college, and29.5% have earned a bachelor's degree or beyond.14.00% of the residents would be considered uninsured or Medicaid eligible.There are no other hospitals located in PCH's primary service area. Part VI, Line 5: Palos Community Hospital is an acute care facility with 362 operating beds, 14 operating rooms, nearly 600 affiliated physicians and approximately 3,100 employees. Within the service area, PCH serves as a resource for health education and wellness initiatives for residents. PCH continues to monitor the health care needs of its service area to insure the need for the services it offers and evaluate the opportunity to develop new programs and services as necessary. PCH works with and in support of other not-for-profit, educational, governmental, civic or community organizations, as appropriate, to promote health and wellness through awareness, education, research, access or support. Demonstrating PCH's commitment to disease prevention and wellness, more than 150 community education programs were held with approximately 3,000 participants during the year. These include programs such as Survive and Thrive, an event geared toward cancer survivors; Fall Prevention Fair, targeted at seniors to help them avoid falling; and The Ultimate Food Fight, informing attendees on how diet can prevent cancer. Additionally, PCH serves as a resource for health information to community members. PCH participated in health-focused events in Palos Heights, Orland Park and Homer Glen providing health screenings focused on either heart or bone health. To support local non-profit organizations, PCH's Speakers Bureau provided nearly 20 speaking presentations throughout 2014. Topics covered during these presentations include heart health, stress management and healthy eating. In 2014, PCH launched the employee volunteer program to support local non-profit organizations. The employee volunteer program provides opportunities for staff members to contribute their time or donate goods to support community organizations helping area residents in need. Employee volunteers helped at a number of events such as the American Cancer Association's Making Strides against Breast Cancer Walk. Food, coat and pajama drives were held to support Together We Cope, a local organization serving families in 27 communities of Chicago's south suburbs to help prevent homelessness.To educate area residents about heart disease as well as to support the American Heart Association with their outreach efforts, PCH participates in the AHA Heart Walk as well as 200 employees and their loved ones. The event takes place within the PCH service area.Each year, a few community cancer screening programs, as well as the direction of the Cancer Program at PCH, are designed in response to our community's needs based on guidance provided by the PCH Oncology Committee. This group, consisting of hospital leaders, caregivers and physicians, provides direction on how to better meet the needs of cancer patients in our community. In 2014, PCH hosted a skin cancer screening event and offered free colorectal cancer screening kits. The low-dose CT Lung Cancer Screening was launched in 2014. The PCH cancer program received the 2014 Outstanding Achievement Award from the Commission on Cancer (CoC) of the American College of Surgeons. PCH is one of a select group of five hospitals in Illinois and only 75 hospitals in the United States with accredited cancer programs to receive the prestigious award.Palos Community Hospital is governed by the Board of Directors, comprised of community leaders from the hospital's service area. Further demonstrating the hospital's connection to the community is the representation from community members to help shape our programs to better meet the needs of our residents. An example of this is the Diabetes Advisory Council. This group, consisting of community members as well as hospital leaders, provides input on how to better shape our diabetes program to meet the needs of our residents. In 2014, PCH hosted its annual Diabetes Fair to help individuals with diabetes and their loved ones learn how to manage the condition. The PCH Volunteer program provides more than 100 high school student with the opportunity to fulfill community service requirements annually. Additionally, hundreds of adult volunteers donate their time to PCH while having the opportunity to make new friends and experience the feeling of contributing to the community. PCH assists the homebound and elderly in the community with two special programs, Home Delivered Meals and Lifeline. Home Delivered Meals are provided to people who are homebound, live alone and are unable to prepare their own meals. The program offers recipients two meals a day which are planned by hospital dietitians, prepared in the hospital kitchen and delivered by PCH volunteers five days a week. The meals are available at a discounted rate and are subsidized by the hospital. The Home Delivered Meals program has an average of 45 recipients living in Palos Heights, Palos Hills, Palos Park, Orland Park and Orland Hills. To further support homebound and elderly area residents, PCH offers Lifeline, a medical alert system. The device, installed in participants' homes, can help detect falls and provide a simplified means to signal for assistance from a loved one or emergency services if needed. PCH can support up to 170 participants at a time. PCH serves as a Senior Health Insurance Program (SHIP) site. This is a free statewide health insurance counseling service for Medicare beneficiaries and their caregivers. The hospital provides office space and other resources to support volunteers offering community members information and resources regarding applying for Medicare and Medicare coverage.PCH provides financial assistance to people with limited means. Uninsured or underinsured individuals may be eligible for discounts on the cost of care. Financial counselors are available to help patients determine terms befitting of the financial situation, as well as provide patients with information regarding local, state and federal assistance programs.For the purpose of disease prevention, PCH provides the influenza vaccination to all employees, volunteers and patients during flu season. To help heart failure and COPD inpatients transition from the hospital to home, Palos Community Hospital offers the Heart Failure/COPD Wellness Clinic. The hospital applies surplus funds to the improvement of patient care. Part VI, Line 6: Palos Community Hospital is not part of an affiliated health care system. Part VI, Line 7, Reports Filed With States IL X X X 1 0 0 0 0 0 0 0 0 Dr Terrence Moisan Director/CEO 600992 0 0 0 119000 0 0 0 0 0 719992 0 0 0 Dr Mark Sinibaldi Director/Physician 50000 267547 0 0 0 0 0 15831 0 14222 50000 297600 0 0 Charles E Reiter III Contracted General Counsel/Assistant 385490 0 0 0 0 0 0 0 0 0 385490 0 0 0 David B Manchester VP Professional Services 396792 0 0 0 15696 0 19500 0 22438 0 454426 0 0 0 Hugh A Rose VP Finance/CFO 213511 0 0 0 186856 0 16984 0 8388 0 425739 0 0 0 Randall J Oles VP Support Services 306794 0 0 0 17004 0 19265 0 27358 0 370421 0 0 0 Timothy J Brosnan VP Planning/Community Relations 323931 0 0 0 17004 0 19259 0 33659 0 393853 0 0 0 Mary C Denisienko VP Human Resources 246158 0 0 0 17500 0 19397 0 12542 0 295597 0 0 0 Rosann S Demask VP Nursing 231448 0 0 0 17500 0 18751 0 23453 0 291152 0 0 0 Edgardo Tenreiro CEO (Past) 107217 0 0 0 603500 0 8225 0 4324 0 723266 0 0 0 Gary Zmrhal Interim CFO 237069 0 0 0 0 0 0 0 0 0 237069 0 0 0 Margaret J Carroll Chief Information Officer 246790 0 0 0 17004 0 19500 0 12006 0 295300 0 0 0 Muhamad Krad Staff Physician 348686 0 0 0 0 0 0 0 16762 0 365448 0 0 0 Arthur M Schroeder Staff Physician 319437 0 0 0 0 0 19500 0 30040 0 368977 0 0 0 Abdul Rahmad Safadi Staff Physician 297311 0 0 0 0 0 0 0 16795 0 314106 0 0 0 Mark D Diamond Staff Physician 271963 0 0 0 0 0 19500 0 17137 0 308600 0 0 0 Haris Aleem Staff Physician 269324 0 0 0 0 0 8253 0 17073 0 294650 0 0 0 Part I, Line 3 Annually, Human Resources gathers market data on executive positions from a variety of published survey sources such as Metropolitan Healthcare Council (MCHC), Mercer, Watson Wyatt, etc. The market data is analyzed for organizations with similar size and characteristics (FTEs, revenue, beds, region, non-for profit, stand alone institutions, etc.) The mean, median and, if available, the 90th percentile rates are provided to the President/CEO for consideration and reviewed with the Board of Directors. Discussion and process are contemporaneously documented in the minutes. Part I, Line 4a Mr. Rose received a severance package from Palos Community Hospital that was within the terms and conditions of the agreement. The severance was based on length of service and responsibilities. Additional terms and conditions of the confidential severance agreement will be provided to the IRS upon request. Mr. Tenreiro received payment relative to an employment agreement and certain contested matters. Amounts paid during the current period are properly reflected on the employees W-2 and disclosed in column B(iii) on Schedule J, Part II. A Ill Fin AuthorityPalos Comm Hospital 861091967 45200B3U0 2007-05-17 124814955 Fund construction of parking garage and power plant 0 1 0 B Ill Fin AuthorityPalos Comm Hospital 861091967 45200F2Z1 2010-05-06 151146301 Fund construction of new bed tower and modernization of existing bed tower 0 1 0 C Ill Fin AuthorityPalos Comm Hospital 861091967 2010-04-12 100000000 Fund construction of new bed tower and modernization of existing bed tower 0 1 0 A 124814955 2675871 122139084 2010 1 0 1 1 B 157566708 1950637 155616071 2012 0 0 1 1 C 100000000 500000 99500000 2013 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 1 0 0 0 0 A 0 B 0 C 0 Palos Anesthesia Associates Dr. Michael Sobczak, Director is the President of Palos Anesthesia Assoc. 1029171 Palos Anesthesia Associates provides anesthesia services for Palos patients 0 Form 990, Part VI, Section A, line 6 St. George Corporation is the sole Corporate Member. Form 990, Part VI, Section A, line 7a St. George Corporation holds the power to appoint members of the governing body. Form 990, Part VI, Section A, line 7b St. George Corporation can exercise action on the following matters: (a) removal of directors, with or without cause; (b) all amendments to these bylaws or the Corporation's Articles of Incorporation; (c) The sale or transfer of substantially all of the property of the corporation, except for leases in excess of one year; (d) all long term borrowing in excess of one year; (e) merger or consolidation by the Corporation with any other institution, hospital, corporation or legal entity; (f) formal affiliation with a medical school or research facility; (g) acceptance of any gift, bequest or legacy that imposes a permanent or continuing obligation on the Corporation for a period of more than one year; (h) decisions to authorize voluntary dissolution of the Corporation or to revoke proceedings therefor; (i) adoption of a plan for the distribution of the assets of the Corporation; and (j) any other matters required by law to be submitted to the Corporate Member or which the Board determines by resolution to submit. Form 990, Part VI, Section B, line 11 Senior management reviewed the Form 990 that was prepared by our tax advisors with the information we provided to them. Once reviewed by senior management it was made available to our Board. Form 990, Part VI, Section B, line 12c On an annual basis directors, key personnel (VP, department heads (budget administrators)), and all purchasing staff must complete a Conflict of Interest Form disclosing any conflict of interest that may exist or be perceived to exist between themselves and/or family members and vendors, contractors and others PCH has a contract/transaction agreement. These annual disclosure statements are reviewed by the VP of Human Resources. Any issue identified as part of this annual disclosure is referred to the President of PCH for disposition. The full Board reviewed the disclosure statements of each Director that identified an interest. Persons completing the conflict of interest form know to disclose any potential conflicts on an ongoing basis. An individual with a conflict of interest would be excluded from any discussion, vote, or decision that involved the conflict or decision. Form 990, Part VI, Section B, line 15 Annually, Human Resources gathers market data on executive positions from a variety of published survey sources such as Metropolitan Healthcare Council (MCHC), Mercer, Watson Wyatt, etc. The market data is analyzed for organizations with similar size and characteristics (FTEs, revenue, beds, region, non-for profit, stand alone institutions, etc.) The mean, median and, if available, the 90th percentile rates are provided to the President/CEO for consideration and reviewed with the Board of Directors. Discussion and process are contemporaneously documented in the minutes. Form 990, Part VI, Section C, line 19 All policies, governing documents and financial statements required to be available to the public are available upon request. Requests can be made from the Financial Department of Palos Community Hospital. Documents are available for the same period of disclosure as set forth in IRC Section 6104(d). Form 990, Part XI, line 9: Net Asset Transfer From Affiliate 8,222,000. Animal Therapy Fund -7,099. St George Corporation 12251 S 80th Avenue Palos Heights IL 60463 364383840 Health Care Provider IL 501(c)(3) 11 a, Type I N/A 0 St George Wellness Center 15430 West Avenue Orland Park IL 60462 364383845 Fitness Center IL 501(c)(3) 9 St George Corporation 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0