2015-11-12T17:00:34-06:00 2014-12-31 350921680 CROWE HORWATH LLP 225 West Wacker Drive Suite 2600 Chicago IL 606061224 990 2014-01-01 362167847 ROCKFORD MEMORIAL HOSPITAL ROCK 8159715000 2400 N ROCKTON AVE ROCKFORD IL 61103 Henry M Seybold CFO 2015-11-11 true NICOLE BENCIK P00756195 3128997000 2014 2016-04-25 22:37:26Z JAVON BEA 2400 N ROCKTON AVE ROCKFORD IL 61103 476319225 false X WWW.RHSNET.ORG X 1883 IL To improve and protect the health and welfare of the community in accordance with our mission: Superior Care, Every Day, For all our patients. A 396-bed hospital with a Level 1 Trauma Center, Level III Neonatal Intensive Care Unit, the region's only Pediatric Intensive Care Unit & designated Disaster POD hospital. 12 7 2375 311 52402 1816 7717024 12588560 326155534 353344658 10344420 9404200 2010494 1949518 346227472 377286936 657863 770756 0 0 145187551 145668209 0 0 0 151222443 185681108 297067857 332120073 49159615 45166863 338477988 351371483 156022822 170546679 182455166 180824804 The Mission of Rockford Health System and Rockford Memorial Hospital is "Superior Care, Every Day, For All Our Patients". We will fulfill our commitment through performance excellence, innovation, and lifelong learning. false false 189901511 230704182 ROCKFORD MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT CHARITABLE HEALTHCARE INSTITUTION THAT FUNCTIONS IN ACCORDANCE WITH ALL APPLICABLE LAWS AND REGULATIONS. IN THE COURSE OF OPERATIONS, RMH IS COMMITTED TO PROVIDE SUPERIOR CARE EVERY DAY FOR ALL ITS PATIENTS. RMH IS A 396-BED REGIONAL REFERRAL HOSPITAL WHICH INCLUDES A LEVEL I TRAUMA CENTER, LEVEL III NEONATAL INTENSIVE CARE UNIT AND THE REGION'S ONLY PEDIATRIC INTENSIVE CARE UNIT. IN 2014 PATIENT CARE WAS RENDERED TO 12,100 INDIVIDUALS WHO PRESENTED THEMSELVES FOR SERVICE INCLUDING 1,508 DELIVERIES AND 3,411 INPATIENT SURGERIES ALONG WITH SUPPORTING 54,338 EMERGENCY VISITS. CHARITY CARE PROVIDED IN 2014 AMOUNTED TO $33,565,000. 77736119 119478564 RMH IS DESIGNATED BY THE IL DEPT OF PUBLIC HEALTH AS THE DISASTER POD HOSPITAL FOR THE NORTHERN IL EMS REGION. AS A LEVEL I TRAUMA CENTER, RMH PROVIDES PATIENT CARE, DIAGNOSTIC AND THERAPEUTIC SERVICES 24/7 TO ALL WHO PRESENT THEMSELVES FOR SERVICE. IN 2014, THAT INCLUDED 1,610 VISITS TO THE SLEEP LAB; 87,339 DIAGNOSTIC RADIOLOGY PROCEDURES OR TESTS; 7,244 RADIATION ONCOLOGY TREATMENTS; 32,763 CARDIAC PROCEDURES OR TESTS; 3,589 VISITS TO THE PAIN CLINIC; AND 175,753 RESPIRATORY THERAPY TREATMENTS. THROUGH THE OUTREACH SERVICES OF ROCKFORD HEALTH MEDICAL LABORATORIES (RHML), RMH HAS PROVIDED TIMELY AND RESPONSIVE LAB SERVICES TO OTHER HOSPITALS, PHYSICIANS' OFFICES, AND GOVERNMENT AGENCIES, WHILE THE IN-HOUSE LABORATORY PROVIDES TESTING FOR ALL WHO PRESENT THEMSELVES AT THE HOSPITAL FOR TREATMENT. IN 2014, RHML PERFORMED 1,592,636 TESTS. 9513330 620756 2759841 RMH HAS PROVIDED HEALTH EDUCATION AND OUTREACH IN A VARIETY OF FORMS WITHIN THE ELEVEN COUNTY AREA THAT INCLUDES SEVERAL SCHOOL PARTNERSHIPS, MENTORING, HEALTH PROGRAMS, TEACHING, JOB SHADOWING AND VOLUNTEERING. RMH HOSTS SUPPORT GROUPS, TRAINING CLASSES, AND LECTURES SERIES FOR HEALTH AND SAFETY RELATED TOPICS. EMPLOYEES STAFF COMMUNITY HEALTH FAIRS AND OPEN HEALTH SCREENINGS. IN A PROGRAM JOINTLY SPONSORED WITH RONALD MCDONALD CHARITIES, RMH STAFFS THE CAREMOBILE WHICH PROVIDED 593 HEALTH AND DENTAL CHECKUPS AND BASIC HEALTH SERVICES TO 535 UNDERINSURED AND UNINSURED CHILDREN. RMH ALSO PROVIDES BOTH FOREIGN LANGUAGE AND HEARING IMPAIRED ASSISTANCE TO PATIENTS AND THEIR FAMILIES TO HELP THEM COMMUNICATE WITH MEDICAL PERSONNEL FOR TREATMENT. FUNDS WERE ALSO USED TO IMPROVE GENERAL HEALTHCARE CONDITIONS THROUGHOUT THE STATE. REVENUE USED TO HELP SUPPORT THESE ACTIVITIES IS PROVIDED BY INVESTMENT INCOME. 957253 150000 350746 THROUGH ROCKFORD MEMORIAL HOSPITAL AUXILIARY, RMH IS ABLE TO PROVIDE EXTRA FUNDS AND SERVICES TO SUPPORT ITS MISSION. THE AUXILIARY HAS 304 VOLUNTEERS WHO LOGGED 28,676 HOURS WHILE ASSISTING WITH GREETING VISITORS, TRANSPORTING PATIENTS, FLORAL OR GIFT DELIVERIES, THRIFT SHOP AND GIFT SHOP ACTIVITIES, AND OTHER SERVICES AS REQUESTED. THE VOLUNTEERS' EFFORTS PROVIDE EXTRA FUNDS AND ENHANCE THE OVERALL HOSPITAL EXPERIENCE FOR PATIENTS, VISITORS AND STAFF. 957253 150000 350746 278108213 true true false true false false false false true true false false false true false false true false false false false false false false false true true true false true true false false false false false false false true true true false false false false true true false true false true 247 0 true 2375 true true true true BD false false false false false false false false X 12 7 false false false false true true true true true false false false true true true true true false false true true IL X DAVID VOLA CONTROLLER 8159715000 2400 N ROCKTON AVE ROCKFORD IL 61103 GARY E KAATZ PRESIDENT & CEO 1.00 59.00 X X 0 1046965 63100 CONNIE M VITALI CHAIR 2.00 0.90 X X 0 0 0 DENNIS T UEHARA VICE-CHAIR 20.50 35.00 X X 0 534513 44010 THOMAS D BUDD TREASUER 0.30 1.00 X X 0 0 0 DUANE R BACH TREASURER (Partial Year) 0.10 1.10 X X 0 0 0 JACK J BECHERER DIRECTOR 1.00 0.60 X 0 0 0 JOHN W CHADWICK DIRECTOR 0.30 0.40 X 0 0 0 ELEANOR F DOAR DIRECTOR 1.00 3.90 X 0 0 0 PAMELA S FOX DIRECTOR 0.10 0.20 X 0 0 0 JOSE L GONZALEZ DIRECTOR 0.70 53.20 X 0 373660 27255 PAUL A GREEN DIRECTOR 1.00 1.10 X 0 0 0 JEFF R SMITH MD Director 1.00 42.00 X 0 372057 27970 CURTIS D WORDEN DIRECTOR 0.50 1.90 X 0 1429 0 JULIE PETERSON SECRETARY 1.00 40.30 X 0 79211 4320 HENRY M SEYBOLD CFO 3.00 42.30 X 0 474282 33136 Carolyn Bengtson VP UTILIZATION MANAGEMENT 40.00 0 X 363166 0 26100 JOHN T DORSEY DIRECTOR 39.00 1.00 X 388306 0 25372 Daniel Parod SR VP HOSPITAL & ADMIN AFFAIRS 40.00 0 X 355061 0 39686 Susan Schreier CHIEF NURSING OFFICER 40.00 0 X 244484 0 18618 Michael Tyrkus DIRECTOR OF CYTOGENETICS 40.00 0 X 224309 0 19573 1575326 2882117 329140 52 false true true ROCKFORD HEALTH SYSTEM 2400 N ROCKTON AVE ROCKFORD IL 61103 ADMINISTRATIVE SERVICES 11273719 SCHMELING CONSTRUCTION 315 HARRISON AVE ROCKFORD IL 61104 CONSTRUCTION 4654475 PHILIPS MEDICAL SYSTEM PO BOX 100355 ATLANTA GA 30384 CONTRACT MAINTENANCE 2557001 WILSON ELECTRIC 113 S MADISON ST ROCKFORD IL 611041195 ELECTRICAL CONTRACTOR 2063450 SOLIC CAPITAL ADVISORS 1603 ORRINGTON AVE STE 1600 EVANSTON IL 60201 CONSULTING 1843563 53 7970126 4611399 7035 12588560 INPATIENT ROUTINE & ANCILLARY 900099 34995391 34995391 OUTPATIENT & EMERGENCY 621400 39596396 39596396 DIAGNOSTIC & MEDICAL LABORATORY 621500 14881802 14838948 42854 MEDICARE/MEDICAID 900099 260931834 260931834 OTHER 900099 2939235 2930764 8471 0 0 0 0 353344658 2005135 2005135 520155 370361 149794 0 149794 149794 104921640 1139353 98264535 397393 6657105 741960 7399065 7399065 CAFETERIA/FOOD SERVICE/CATERING 722320 1799724 1077 1798647 0 0 0 0 1799724 377286936 353293333 52402 11352641 770756 770756 108495336 89294310 19201026 5123199 4562259 560940 25248516 23347171 1901345 6801158 6099151 702007 217250 217250 376276 376276 290413 290413 2094698 1089756 1004942 0 941926 3114 938812 8869476 6491606 2377870 8398009 4522027 3875982 9565068 6830963 2734105 109830 82161 27669 683028 204940 478088 1358546 1358546 0 17032102 12676119 4355983 8511245 7364338 1146907 Supplies/Drugs 49657616 49572652 84964 Healthcare Services 40943460 40943460 Medicaid Assessment Tax 12095707 12095707 Equipment rental/lease 1485046 752422 732624 23051412 10046755 13004657 0 332120073 278108213 54011860 0 37268913 39298575 5967442 5939279 665327 529025 58570326 57939768 0 0 2373 2348 7324270 7844471 1498711 1461338 308998819 205094982 96298322 103903837 108088445 110751877 0 8969096 9697774 13824763 14003191 338477988 351371483 84226729 87126737 63307216 60110325 0 973275 8488877 22336342 156022822 170546679 172790119 170814135 7039887 7385509 2625160 2625160 182455166 180824804 338477988 351371483 X 45166863 -3069086 -43728139 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 36511 36511 false Schedule C, Part II-B, Line 1 Description of the activities reported on lines 1A through 1L A percentage of the 2014 Illinois Hospital Association, American Hospital Association and Metropolitan Chicago Healthcare Council dues were used for lobbying. 7866965 56884 749923 266529 13623 8393620 6847928 148494 1068646 186672 11431 7866965 6085799 69541 933066 224548 15930 6847928 5926437 95812 130832 44441 22841 6085799 4988438 320215 756626 117358 21484 5926437 0.044 0.437 0.519 false true true 65484 2535488 2600972 559677 61486316 46598709 15447284 99060 98917 143 236415805 158397356 78018449 7836989 7836989 103903837 Accrued PENSION 16471444 Accrued POST RETIREMENT Medical Benefits 5864898 22336342 Schedule D, Part X, Line 2 FIN48 (ASC 740) DISCLOSURE THERE IS NO FIN 48 LIABILITY AND AS SUCH, THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS DO NOT INCLUDE A FIN 48 DISCLOSURE. Schedule D, Part V, Line 4 Intended uses of endowment funds Funds were used to provide a lecture series, for continuing education for employees wanting to improve their credentials or to focus on a new skill or some technology not currently available in the Rockford community. There were also miscellaneous projects designated by the foundation board in accordance with the specific endowment. All funds were expended per the specific direction of each endowment. true true X true X 175 true X true true true false true true 5484259 0 5484259 0.0169 113386845 100224466 13162379 0.0407 0 0.0 0 0 118871104 100224466 18646638 0.0576 1324110 151852 1172258 0.0036 1883950 443977 1439973 0.0044 47057989 45712052 1345937 0.0042 0 0.0 6276721 6276721 0.0194 0 0 56542770 46307881 10234889 0.0316 0 0 175413874 146532347 28881527 0.0892 true 8340839 0 83614691 96042240 -12427549 X true true 2 1 ROCKFORD MEMORIAL HOSPITAL 2400 N ROCKTON AVE ROCKFORD IL 61103 HTTP://WWW.ROCKFORDHEALTHSYSTEM.ORG/ROCKFORD-MEMORIAL-HOSPITAL 0002048 X X X X X X 2 VANMATRE HEALTH SOUTH 950 S MULFORD RD ROCKFORD IL 61108 HTTP://WWW.ROCKFORDHEALTHSYSTEM.ORG/VAN-MATRE-HEALTHSOUTH-REHABILITATION-HOSPITAL 0005215 X REHABILITATION ROCKFORD MEMORIAL HOSPITAL 1 false false true X X X X X X X X 14 true true false true X http://www.rockfordhealthcouncil.org/RHorg2013/?page_id=2879 X true 14 true http://www.rockfordhealthsystem.org/about-us/community-benefit false false true X 1.75 3.0 X X X X X X true true X X X X true X X X X X true false X X X X true X false false VANMATRE HEALTH SOUTH 2 false false true X X X X X X X 14 true true false true X http://www.rockfordhealthsystem.org/about-us/community-benefit false false false true X 2.0 4.0 X true true X X X X true X X false false X X false X X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - ROCKFORD MEMORIAL HOSPITAL. In 2014, The Rockford Health Council produced a regional health needs assessment with extensive interviews and surveys taken during 2014. Contacts included Focus groups, health care providers, Community analysis, Household surveys all of which included local and state government organizations, local businesses, and local educators (pre-school through college). The survey was done with funding, cooperation, participation and assistance from all three Rockford hospitals - RMH, SwedishAmerican Hospital and St. Anthony's Medical Center. Survey is available and was promulgated within the community by the Rockford Health Council, survey participants and was made available on Rockford Health Council's website. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - ROCKFORD MEMORIAL HOSPITAL. SwedishAmerican Hospital and St. Anthony's Medical Center. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Rockford Memorial Hospital. The 2014 Healthy Community Study included analysis of various extant data related to demographics, social and economic factors, physical environment, clinical care, healthy behaviors, and health outcomes. In addition, the survey tool that was used targeted the following health related areas: general health, chronic disease/obesity, behavioral health, and maternal/prenatal and early childhood. The latter three areas had been identified in previous studies as priority areas. By focusing on these health related areas, more focused, timely, and longitudinal information will be available to evaluate effects of targeted efforts. In the analysis, some demographic and social and economic deficits were revealed. Specifically, the local community showed deficits around poverty percentages as compared to the state and to the US. In addition, the data revealed deficits in educational attainment rates around high school and college diploma rates as compared to the state. While these are crucial areas that need to be addressed by the community, many other organizations are more knowledgeable and better equipped to develop strategies to improve these areas. Programs and strategies have been and are being developed by a multitude of community organizations to begin to affect the educational attainment and poverty deficits. Some of these organizations include The Rockford Public School System, Rock Valley College, Alignment Rockford, Transform Rockford, Rockford Literacy Council, etc. While Rockford Health System does play a role in supporting these organizations and efforts, our community benefit plan focuses on affecting the health needs/deficits of the local community. Schedule H, Part V, Section B, Line 22 Facility , 1 Facility , 1 - FACILITY A-ROCKFORD MEMORIAL HOSPITAL. ROCKFORD MEMORIAL HOSPITAL (RMH) PROVIDES CARE, WITHOUT DISCRIMINATION, FOR EMERGENCY MEDICAL CONDITIONS TO INDIVIDUALS REGARDLESS OF WHETHER THEY ARE FAP-ELIGIBLE. RMH DOES NOT DISCOURAGE INDIVIDUALS FROM SEEKING EMERGENCY MEDICAL CARE BY DEMANDING PAYMENT PRIOR TO SERVICE. FAP-ELIGIBLE PATIENTS ARE NOT CHARGED MORE THAN AMOUNTS GENERALLY BILLED. IF THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE PATIENT WILL BE LIMITED IN LIABILITY TO 135% OF COST DETERMINED BY APPLYING RATIO OF COST TO CHARGES FROM MOST RECENTLY FILED MEDICARE COST REPORT TO UNINSURED PATIENT'S BILL. . THE MAXIMUM AMOUNT RMH MAY COLLECT IN A 12-MONTH PERIOD FROM A PATIENT IS 25% OF THE FAMILY'S GROSS ANNUAL INCOME. THIS POLICY DEFINES THE ILLINOIS HOSPITAL UNINSURED PATIENT DISCOUNT ACT. RMH ALSO PROVIDES TWO OTHER FINANCIAL ASSISTANCE PROGRAMS, TRADITIONAL AND CATASTROPHIC, ALONG WITH HUPDA AND WE APPLY THE HIGHEST DISCOUNT AMONG THE THREE PROGRAMS. THE AGB DISCOUNT PERCENTAGE IS TO BE DETERMINED UNDER A LOOK-BACK METHOD OF VARIOUS COMBINATIONS OF MEDICARE, COMMERCIAL INSURERS AND MEDICAID OR A PROSPECTIVE METHOD OF WHAT MEDICARE OR MEDICAID WOULD PAY. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - Van Matre HealthSouth Rehabilitation Hospital. SwedishAmerican Hospital and St. Anthony's Medical Center. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - VAN MATRE HEALTHSOUTH REHABILITATION HOSPITAL. AS THE PREMIER REHABILITATION FACILITY IN NORTHERN ILLINOIS, VAN MATRE, A 61-BED INPATIENT REHABILITATION HOPSITAL HAS BEEN FOCUSING ON PATIENT REHABILITATION BOTH IN INPATIENT REHABILITATION AS WELL AS OUTPATIENT THERAPY. THE NEED FOR REHABILITATION DUE TO STROKE AND NEUROLOGICAL DISORDERS IN NORTHERN ILLINOIS PROMPTED AN EXPANSION OF THE FACILITIES IN 2014. NEEDS OF THE COMMUNITY ARE CONTINUALLY REEVALUATED SO THAT VAN MATRE PATIENTS CAN QUICKLY RETURN TO LEADING ACTIVE AND INDEPENDENT LIVES. 0 Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 8340839 Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance THE HOSPITAL UTILIZED BOTH THE MEDICARE COST REPORT CCR (COST-TO-CHARGE RATIO) AND OUR COST ACCOUNTING SYSTEM TO DETERMINE THE COST OF CHARGES, BAD DEBT AND CHARITY CARE EXPENSE INCLUDED IN LINE 7. THE SUBSIDIZED PROGRAMS ALSO INCLUDE THE COSTS (BASED ON A CALCULATED CCR) FROM THE RELATED COMPANY ROCKFORD HEALTH PHYSICIANS (RHPH) BECAUSE THERE ARE NO PHYSICIANS COSTS INCLUDED IN THE HOSPITAL COST ACCOUNTING ANALYSIS. BAD DEBT AND CHARITY AT COST HAVE BEEN REMOVED FROM LINES 7E/7F/7G SINCE THOSE COSTS WERE PREVIOUSLY INCLUDED. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount All charges for any service provided by Rockford Memorial Hospital are the very same for every individual, regardless of whether it is for emergency or standard care and regardless of the patient's ability to pay. Each patient is then assessed for eligibility for financial assistance based on predefined criteria of financial status and income level. If the patient qualifies for financial assistance, the expected reimbursement is based on charity care policy guidelines. If the patient has no insurance and doesn't qualify for financial assistance, the expected reimbursement is 75% of billed charges. The organization maintains a bad debt reserve on the Balance Sheet. Any bad debt write-offs of patient accounts will go against the bad debt reserve. At each month end based on the accounts receivable by financial class and aging bucket, the reserve amount is re-evaluated. The amount needed to maintain the appropriate reserve level is the bad debt expense. Any payments received on patient accounts previously written off to bad debt will offset the bad debt expense. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote Rockford Health System Consolidated Audit reports: Net patient service revenue is reported at estimated net realizable amounts from patients, third-party payors, and others for services rendered. Contractual adjustments represent the difference between established rates for services and amounts paid by third-party payors. Payments under these agreements and programs are based on either a specific amount per case; costs, as defined, of rendering services to program beneficiaries; or contracted price. Amounts for uncollectible accounts are also included as reductions to net patient service revenue. Contractual adjustments and bad debts are accrued on an estimated basis in the period the related services are rendered, and are adjusted in future periods as final settlements are determined. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs The data reported for Medicare charges and payments is from the final Management Report produced by the firm that prepared the 2014 Cost Report as submitted to the Fiscal Intermediary in 2015 in compliance with all current regulations. Reported on Line 6 are allowable Medicare Costs provided by the Cost Report. Medicare costs are eliminated from the Subsidized Programs on Part 1 Ln 7g as calculated by our cost accounting analysis. A combination of cost accounting and the Medicare CCR was used for the computation of subsidized programs. This Section B-Medicare also includes 50% of the Medicare activity from Van Matre Health South (VMHS) and the corresponding cost based entirely on their Medicare CCR. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Rockford Memorial Hospital has a strong commitment to provide quality patient care for all individuals. Our mission is to provide health care to everyone who comes to our door, regardless of their ability to pay. We will submit a claim to all 3rd party payors on behalf of the patient. We help patients apply for all possible insurance or assistance such as crime victims, an automobile accident, workers' compensation, Medicaid, COBRA, local assistance and/or hospital financial assistance. If they do not qualify for any of these, we can extend payment options such as monthly payments, credit card payments or financial assistance. This is offered to patients who are experiencing legitimate financial hardships and are unable to pay for all or part of the patient's medical care. Forgiveness may apply to an amount after applying all payments such as any insurance company, health plan or personal payments, any negotiated discounts or any uninsured discounts. If a patient eligible for charity care or partial financial assistance still has a portion of the outstanding balance due, other arrangements are made. RMH accepts a variety of payments and alternative payment plans. Monthly statements are sent as payment reminders for contracted arrangements. In case of default, additional letters and calls are made to bring it to a current status. An account is turned over to a collection agency only after non-payment or no contact in 120 days although RMH will suspend collection efforts once a completed application has been received and is pending approval or denial. Schedule H, Part V, Section B, Line 16a FAP website - ROCKFORD MEMORIAL HOSPITAL: Line 16a URL: http://www.rockfordhealthsystem.org/rmh-financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - ROCKFORD MEMORIAL HOSPITAL: Line 16b URL: http://www.rockfordhealthsystem.org/rmh-financial-assistance; Schedule H, Part VI, Line 2 Needs assessment In 2014, Rockford Health System partnered with other local health care providers and educational, government, and business leaders to support the efforts of the Rockford Health Council in developing a tool and completing a study that identified various areas affecting the quality of life for our residents. Formed in 1995 as a not-for-profit community membership collaborative, Rockford Health Council is comprised of various community leaders and is committed to promoting health and improving access for the residents of northern Illinois. The 2014 Healthy Community Study included a comprehensive community analysis that reviewed demographic, socioeconomic, general health behavior, and disease incidence and mortality information for the residents of Winnebago and Boone Counties and provided comparisons to state and national data. A household survey which focused on demographic, general health conditions, behavioral health, maternal, prenatal, and early childhood health, and chronic disease and obesity was also distributed to residents throughout the community. In addition, a key informant questionnaire was conducted with various individuals throughout the community to identify health and human service needs. The completed study is available on the Rockford Health System and Rockford Health Council respective websites. In addition to the 2014 Healthy Community Study, Rockford Health System completed a community needs assessment in order to plan for and anticipate future clinical program needs and related physician requirements specific to our local and regional community. This study analyzed physicians by specialty within the community including review of suggested physician manpower requirements as determined by population forecasts, physician age, and physician accessibility of the local area and forms the basis for physician recruitment and succession planning. Out-migration analysis was also completed. Understanding why residents of the local community leave the area for various inpatient services is used to plan for future clinical programs and services that may not be readily available in our local community. The study looks at pediatric versus adult patients, actual patient diagnosis and hospital services received. All of these tools were used to develop the Rockford Health System Community Benefit Implementation Plan which was approved by the Board of Directors in 2014. An oversight committee meets routinely to ensure plan implementation of the various strategies and tactics with a progress report provided to the Board on an annual basis. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance RMH posts signs in both Spanish and English in all general registration areas and the Emergency Department to indicate that financial assistance is available for those who qualify. The organization's website states "Patients throughout Rockford Health System are treated regardless of their ability to pay. Click on the entity above to learn more." The RMH link to financial assistance and discount programs explains the process in this manner "Rockford Health System provides health care regardless of the patient's ability to pay for such care. These guidelines are intended to provide a framework to offer assistance to patients and families with legitimate financial hardship, who are unable to pay for all or a portion of their medical care. Covered services are those which are determined medically necessary by a physician. Our financial assistance programs are based on whether you have insurance coverage of any kind or are uninsured." Schedule H, Part VI, Line 4 Community information Rockford Memorial Hospital is located in Rockford, IL (Winnebago County) with a defined primary service area that includes Winnebago, Boone, and Ogle Counties. 2013 US Census Bureau estimates project the population for the entire area at slightly more than 400,500 individuals with a little more than 73% living in Winnebago County (approximately 293,000). Located in northern Illinois, the primary service area is characterized as largely rural and populated with very small communities with the exception of the neighboring cities of Rockford, Loves Park, and Machesney Park which comprise more than 197,000 individuals. The next largest community is Belvidere, located in Boone County where the entire county has a population of approximately 54,000 people. In calendar year 2014, approximately 84% of hospital inpatients were from the Primary Service Area. As a community that relies heavily on manufacturing companies and small businesses, the area was particularly hard hit in recent years. Currently, the largest employers include Chrysler (Boone County), the Rockford Public Schools, and the three Rockford health care providers. The most recent median household income figures (U.S. Census Bureau) in Winnebago County were $47,000 compared to the state's median household income of $54,000. These disparities are also reflected in unemployment, education and poverty rates. Unemployment rates have improved with most recent figures for Rockford at 7.2%. Only 21% of Winnebago County residents attain a bachelor's degree or higher while in the state 31% do. More than 17% of the residents in Winnebago County live below the poverty line and children in the community have been particularly hit with more than 27% considered at or below poverty levels. The hospital also serves the secondary service area which includes DeKalb, McHenry, Whiteside, Lee, LaSalle, Stephenson and Rock counties for select tertiary services. Schedule H, Part VI, Line 5 Promotion of community health Led by a community board of directors, Rockford Memorial Hospital (RMH) and its affiliates are very involved in promoting a healthier community. As one of Rockford's largest employers, the organization takes a leading role in financially supporting not only health-related initiatives, but also community-building activities across the region. This includes providing financial support and talent for economic development and business related activities, as well as quality of life and educational initiatives. Employees participate on community boards and are actively involved in promoting the region and its assets. Based on the results of the Rockford Health Council 2013 Healthy Community Study, the 2014 - 2017 Community Benefit Implementation Plan identified several key areas to focus efforts. For example, as the predominate provider of pediatric services, Rockford Memorial maintains its commitment to the children of our community. This is evident in our support of the Ronald McDonald Care Mobile which provides free dental and medical care to uninsured and underinsured children in five northern Illinois counties. The 40-foot, 26,000 pound mobile unit houses two patient exam rooms, a central waiting room, and a sterilization area and has provided care to more than 6,500 children since the inception of the program in 2003. This totals more than $1.85 million in free care over the life of the program. The Care Mobile is completely funded by philanthropy from the Rockford Memorial Development foundation, Rockford Memorial Hospital Auxiliary, and the Ronald McDonald House Charities of Madison. The Bridge Clinic is yet another venue for un- and under-insured adults to receive free medical treatment for chronic medical issues. Since its opening in 2008, hundreds of people from our community have received care. Many physicians and other health care providers give freely of their time to provide these services to less fortunate individuals in our community to better manage their chronic conditions. Since 2012, Rockford Memorial continues to partner with A Silver Lining Foundation to provide free breast health services to un- and under-insured women in the community. Approximately 500 women have received free screening mammograms and other breast related services and procedures since the program's inception. These are only some of the many contributions that Rockford Memorial makes to promote and improve the health of the community. Rockford Memorial remains committed to educating the public about various health care issues and initiatives and improving the lives of our citizens. RMH does not restrict admission of providers and provides an open medical staff. Schedule H, Part VI, Line 7 State filing of community benefit report IL true ROCKFORD MEMORIAL DEVELOPMENT FOUNDATION 2400 N ROCKTON AVE ROCKFORD IL 61103 363197918 501(C)(3) 150000 Program Support GIGI'S PLAYHOUSE ROCKFORD 8801 N Second St Suite 2 MACHESNEY PARK IL 61115 462014837 501(C)(3) 25000 Program Support EASTER SEALS OF METROPOLITAN CHICAGO 1939 WEST 13TH ST STE 300 CHICAGO IL 60608 362169153 501(C)(3) 11950 Program Support AMERICAN CANCER SOCIETY 225 N MICHIGAN AVE STE 1200 CHICAGO IL 60601 362167721 501(C)(3) 11000 PROGRAM SUPPORT HEALING PATHWAYS - CANCER RESOURCE CENTER 3921 E STATE ST STE D ROCKFORD IL 611082053 262173633 501(C)(3) 8500 PROGRAM SUPPORT AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVE DALLAS TX 752315129 135613797 501(C)(3) 9543 PROGRAM SUPPORT MARCH OF DIMES 1275 MAMARONECK AVE WHITE PLAINS NY 106055201 131846366 501(C)(3) 22500 Program Support ALZHEIMER'S ASSOCIATION 225 N MICHIGAN AVE SUITE 17TH FLR CHICAGO IL 606017633 133039601 501(C)(3) 5500 PROGRAM SUPPORT CARRIE LYNN CHILDRENS CENTER 826 S Main Rockford ID 61103 364057184 501(c)(3) 17024 PROGRAM SUPPORT CRUSADERS HEALTH FOUNDATION 1200 W State St Rockford ID 611022112 363259761 501(c)(3) 12000 PROGRAM SUPPORT Growth Dimensions For Belvidere-Boone County Inc 401 WHITNEY BLVD BELVIDERE IL 61008 363196645 501(c)(6) 7500 PROGRAM SUPPORT MCHC Chicago Hospital Council 222 S RIVERSIDE PLAZA 19TH FLOOR Chicago ID 606065808 362167008 501(c)(3) 15874 PROGRAM SUPPORT MILESTONE INC 4060 McFarland Rd Loves Park ID 611114402 362769801 501(c)(3) 8000 PROGRAM SUPPORT ROCK VALLEY COLLEGE 3301 N MULFORD RD Rockford ID 611145640 363037232 501(c)(3) 30000 PROGRAM SUPPORT ROCKFORD AREA ECONOMIC COUNCIL 100 Park Ave Suite 100 Rockford ID 61101 363055858 501(c)(6) 60000 PROGRAM SUPPORT ROCKFORD HEALTH COUNCIL 1601 PARKVIEW AVE Rockford ID 611071822 363229371 501(c)(3) 20000 PROGRAM SUPPORT SALVATION ARMY 416 S MADISON ST ROCKFORD IL 61104 362167910 501(c)(3) 9640 PROGRAM SUPPORT SHELTER CARE MINISTRIES 412 N CHURCH ST Rockford ID 611036811 363374370 501(c)(3) 7220 PROGRAM SUPPORT 16 2 Schedule I, Part I, Line 2 Description Of Procedure For Monitoring Use Of Grant Funds APPLICATIONS ARE SUBMITTED TO THE HOSPITAL VERIFYING A NEED FOR FUNDS OR PRODUCTS (I.E. AUTOMATIC ELECTRONIC DEFIBRILATORS-AED). A DETERMINATION IS MADE THROUGH A PREDETERMINED SCORING METHOD AS TO WHAT ORGANIZATIONS WILL BE RECIPIENTS OF THE FUNDS OR PRODUCTS. CASH CONTRIBUTIONS ARE MADE ONLY TO RECOGNIZED CHARITIES FOR WHICH GOOD FAITH REGARDING FUND USE HAS BEEN ESTABLISHED. THE CONTRIBUTION IS ONLY FOR THE AMOUNT OF THE APPEAL AND FOR A SPECIFIED NEED. Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. APPLICATIONS ARE SUBMITTED TO THE HOSPITAL VERIFYING A NEED FOR FUNDS OR PRODUCTS (I.E. AUTOMATIC ELECTRONIC DEFIBRILATORS-AED). A DETERMINATION IS MADE THROUGH A PREDETERMINED SCORING METHOD AS TO WHAT ORGANIZATIONS WILL BE RECIPIENTS OF THE FUNDS OR PRODUCTS. CASH CONTRIBUTIONS ARE MADE ONLY TO RECOGNIZED CHARITIES FOR WHICH GOOD FAITH REGARDING FUND USE HAS BEEN ESTABLISHED. THE CONTRIBUTION IS ONLY FOR THE AMOUNT OF THE APPEAL AND FOR A SPECIFIED NEED. false false false false false false false true false GARY E KAATZ PRESIDENT & CEO 0 686868 0 242722 0 117374 0 56476 0 6624 0 1110065 0 0 DENNIS T UEHARA VICE-CHAIR 0 531867 0 0 0 2646 0 37500 0 6510 0 578524 0 0 JOSE L GONZALEZ DIRECTOR 0 372112 0 0 0 1548 0 20000 0 7255 0 400914 0 0 JEFF R SMITH MD Director 0 371283 0 0 0 774 0 20000 0 7970 0 400027 0 0 HENRY M SEYBOLD CFO 0 385657 0 58079 0 30547 0 22793 0 10343 0 507418 0 0 Carolyn Bengtson VP UTILIZATION MANAGEMENT 323731 0 18682 0 20753 0 17704 0 8396 0 389266 0 0 0 JOHN T DORSEY DIRECTOR 340752 0 17043 0 30511 0 19897 0 5475 0 413678 0 0 0 Daniel Parod SR VP HOSPITAL & ADMIN AFFAIRS 291562 0 43815 0 19683 0 31939 0 7747 0 394746 0 0 0 Susan Schreier CHIEF NURSING OFFICER 219922 0 13375 0 11188 0 12156 0 6462 0 263102 0 0 0 Michael Tyrkus DIRECTOR OF CYTOGENETICS 214174 0 165 0 9970 0 13921 0 5653 0 243882 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation THE ROCKFORD HEALTH SYSTEM BOARD OF DIRECTORS HAS A COMPENSATION COMMITTEE THAT REVIEWS EXECUTIVE COMPENSATION FOR THE SYSTEM. THEY ALSO AUTHORIZE AN INDEPENDENT FIRM TO PROVIDE DATA FOR ANALYSIS OF THE INDUSTRY AND THE MARKET TO OUR COMPENSATION DEPARTMENT. THE DEPARTMENT AND COMMITTEE REVIEWS THE RESULTS AND MAKES A RECOMMENDATION TO THE BOARD WHO THEN ACTS UPON THIS INFORMATION TO SET COMPENSATION FOR RMH EXECUTIVES. Schedule J, Part I, Line 7 Non-fixed payments MANAGEMENT AND EMPLOYEES ARE PERIODICALLY FINANCIALLY REWARDED FOR EXCEEDING COMPANY AND DEPARTMENT PERFORMANCE GOALS. THE AMOUNTS ARE DISCRETIONARY AND ARE NOT RELATED TO NET EARNINGS OF THE ORGANIZATION AND ARE APPROVED BY THE CEO PRIOR TO PAYMENT WITH BOARD OVERSIGHT OF SUCH PAYMENTS. THE CEO'S FINANCIAL INCENTIVES ARE APPROVED BY THE BOARD OF DIRECTORS. A ILLINOIS FINANCE AUTHORITY 861091967 2012-05-02 35075000 REFUND 1997 SERIES BONDS false false false B ILLINOIS FINANCE AUTHORITY 861091967 45200FSG5 2008-12-11 32782769 REFUND 1994 SERIES BONDS false false false A 7695000 0 35075000 0 0 0 536807 0 0 0 34538193 0 2012 true false true true B 0 0 32782769 0 0 0 511397 17524 0 0 32253849 0 2008 true false true true A 0.0 B 0.0 A false true false false 0.0 false false true B false true true true JP MORGAN CHASE 10.3 false false false false true A true B true Schedule K, Part I, Column (e) Issue Price Not Identical to Form 8038 The total issuance of the 2008 bonds issued from Illinois Finance Authority were issued to RMH and a related organization, Rockford Health Physicians (RHPH). RMH has reported its share of the issuance on Form 990, Part X, line 20, and accordingly has reported consistently for purposes of Schedule K. The total issue price per the Form 8038 is $60,800,000, and RHPH reports the difference on its Form 990. RMH PATHOLOGISTS LTD PARTNERSHIP OWNED 25% BY CONNIE VITALI, CURRENT DIRECTOR 297127 CONTRACT FOR PATHOLOGY SERVICES false CoreFormPartIII_PartIIILine4d Description of other program services (Expenses $ 957,253 including grants of $ 150,000)(Revenue $ 350,746) THROUGH ROCKFORD MEMORIAL HOSPITAL AUXILIARY, RMH IS ABLE TO PROVIDE EXTRA FUNDS AND SERVICES TO SUPPORT ITS MISSION. THE AUXILIARY HAS 304 VOLUNTEERS WHO LOGGED 28,676 HOURS WHILE ASSISTING WITH GREETING VISITORS, TRANSPORTING PATIENTS, FLORAL OR GIFT DELIVERIES, THRIFT SHOP AND GIFT SHOP ACTIVITIES, AND OTHER SERVICES AS REQUESTED. THE VOLUNTEERS' EFFORTS PROVIDE EXTRA FUNDS AND ENHANCE THE OVERALL HOSPITAL EXPERIENCE FOR PATIENTS, VISITORS AND STAFF. Form 990, Part VI, Line 15a PROCESS USED TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL COMPENSATION FOR EXECUTIVES, INCLUDING THE TOP MANAGEMENT OFFICIAL, IS GOVERNED BY THE RHS BOARD OF DIRECTORS. THE RHS BOARD HAS ESTABLISHED A TOTAL COMPENSATION PHILOSOPHY THAT DIRECTS THE COMPENSATION PRACTICES FOR ALL EXECUTIVES. THIS BOARD HAS ESTABLISHED A COMPENSATION COMMITTEE TO ESTABLISH AND REVIEW ALL EXECUTIVE COMPENSATION ANNUALLY BASED ON THE ESTABLISHED PHILOSOPHY. AN EXTERNAL EXECUTIVE COMPENSATION FIRM PROVIDES CONSULTING ON RHS SALARY RANGES AND COMPENSATION PHILOSOPHY. THE APPROPRIATE PEER GROUP FOR COMPENSATION COMPARISON PURPOSES IS OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS SIMILAR IN SIZE AND COMPLEXITY. RHS GENERALLY CONDUCTS AN ANALYSIS OF TOTAL COMPENSATION EVERY THREE YEARS BUT MAY CHOOSE TO VARY FROM THIS SCHEDULE AS DETERMINED BY THE COMPENSATION COMMITTEE. Form 990, Part VI, Line 15b PROCESS USED TO ESTABALISH COMPENSATION FOR OTHER OFFICERS COMPENSATION FOR EXECUTIVES, INCLUDING OTHER OFFICERS AND KEY EMPLOYEES, IS GOVERNED BY THE RHS BOARD OF DIRECTORS. THE RHS BOARD HAS ESTABLISHED A TOTAL COMPENSATION PHILOSOPHY THAT DIRECTS THE COMPENSATION PRACTICES FOR ALL EXECUTIVES. THIS BOARD HAS ESTABLISHED A COMPENSATION COMMITTEE TO ESTABLISH AND REVIEW ALL EXECUTIVE COMPENSATION ANNUALLY BASED ON THE ESTABLISHED PHILOSOPHY. AN EXTERNAL EXECUTIVE COMPENSATION FIRM PROVIDES CONSULTING ON RHS SALARY RANGES AND COMPENSATION PHILOSOPHY. THE APPROPRIATE PEER GROUP FOR COMPENSATION COMPARISON PURPOSES IS OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS SIMILAR IN SIZE AND COMPLEXITY. Form 990, Part VI, Line 1a Delegate broad authority to a committee The voting members of the RHS Executive Committee consists of seven individuals, each of whom shall have a vote, including: the RHS CEO, the chairman, vice-chairman, immediate past chairman, treasurer, and 2 additional directors of the board. At least one member of the Executive Committee shall be a physician. The Executive Committee shall in all instances be comprised of at least 51% community members. In the event that one or more of the aforementioned voting members of the Executive Committee is unable to serve in such capacity, then the chairman of the corporation shall designate a replacement from among the board members. The Executive Committee Shall meet as needed. The executive committee shall review reports from the RHS CEO regarding the performance of executives of the corporation and affiliated corporations, monitor the performance of the RHS CEO of the corporation against annual objectives, and determine the compensation level of the RHS CEO. In addition, when the board of directors is not in session, the executive committee shall have all the powers, duties, responsibilities and authority of the board, except as prohibited by law. Form 990, Part VI, Line 6 Classes of members or stockholders Rockford Health System (RHS) is the sole member. RHS's rights are as follows: (a) Appoint all the directors of the corporation. (b) Nominate to the corporation's board of directors all candidates for selection as the corporation's president. (c) Approve expressly all amendments to the corporation's articles of incorporation and by-laws. (d) Approve annual budgets, and strategic, long-range and health manpower development plans of the corporation. (e) Require the corporation's board of directors to take any action (including authorizing the pledge or transfer of assets to RHS or as directed by RHS, or the execution of contracts) which would improve the credit worthiness or otherwise result in financial benefit to RHS and its tax-exempt Affiliated Corporations (provided that under no circumstances may RHS require transfer of assets in violation of law or the terms of any charitable trust or donation). (f) Approve all contracts of indebtedness effective for longer than eighteen months. (g) Approve all plans of merger or consolidation. (h) Approve the sale, lease, exchange, mortgage, pledge or other disposition of all or substantially all, the property and assets of the corporation. (i) Approve a voluntary dissolution of the corporation. (j) Approve material amendments to the corporation's standard form of physician employment agreement, provided, the corporation shall have the authority to negotiate the terms and conditions of individual physician employment agreements so long as the negotiated terms and conditions are consistent with the requirements of applicable law and the strategic, long-range and health manpower development plans approved by RHS. (k) Approve material amendments to the standard compensation system used by the corporation to establish individual physician compensation; and (l) Require the corporation's board of directors to take any action (including amending the corporation's articles of incorporation or by-laws), or to modify or rescind an action already taken, if the member determines that failure to take the action, or to modify or rescind an action already taken, may result in the corporation's failure to obtain or maintain its exemption as an organization described in Section 501(c)(3) of the Code; Form 990, Part VI, Line 7a Members or stockholders electing members of governing body SEE NARRATIVE FOR FORM 990, PART VI, LINE 6. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders SEE NARRATIVE FOR FORM 990, PART VI, LINE 6. Form 990, Part VI, Line 11b Review of form 990 by governing body The data was gathered by the accounting staff with input from the executive staff. The data was reviewed and the Form 990 prepared by the RHS staff. Once the Form 990 was completed, it was reviewed by an independent accounting firm and the organization's CFO. Form 990, Part VI, Line 12c Conflict of interest policy By written policy, RHS sends out, on an annual basis, the corporate Conflict and Duality of Interest policy to all Board members, corporate officers and other key individuals (those having responsibility and authority to make final decisions regarding the acquisition of products or services). Each recipient is required to complete a Financial Interest Disclosure Statement, which is submitted to the Vice President, Legal Services/General Counsel for review. With respect to physicians and managers who are key individuals, any potential conflict of interest is reviewed with the appropriate executive staff member for follow up with the disclosing party in order to review the matter in more detail. This includes emphasizing that the disclosing party is not permitted to participate in any negotiations for the purchase of any products or services where the conflict is deemed material, or authorize the subsequent purchase of related goods and services. The disclosing party is also required to identify each and every instance of a potential conflict as they may arise in the ordinary course of business. A similar process is followed for the Board of Directors, except that any potential conflict is reviewed by the Board's Governance Committee. Board members may comment on transactions where there is a potential conflict, but cannot vote on the related matter and may be required to leave any meeting where the potential conflict is reviewed by the Board or where the Board takes action to either approve or not approve the proposed transaction. A board member also has a continuing duty to report any conflicts as they may arise in the ordinary course of business. In the event that a potential conflict of interest is reported or discovered outside the established process, appropriate review and action would be taken. This process was last completed in 2015, when the questionnaires were sent to address any 2014 conflicts identified. The RHS Conflict of Interest Policy is available upon request. Form 990, Part VI, Line 19 Required documents available to the public Financial statements are available through the Illinois Attorney General's Office. Governing documents are available by request from the board secretary. The conflict of interest policy is not published but is available upon request. Form 990, Part VII, Section A NONEMPLOYEE COMPENSATION CURTIS WORDEN IS NOT COMPENSATED AS A BOARD MEMBER; HE RECEIVED TAXABLE NONEMPLOYEE COMPENSATION FROM RHS, A RELATED ORGANIZATION, ON A FORM 1099 FOR 2014 LEGAL SERVICES PROVIDED TO THE SYSTEM. Form 990, Part XI, Line 9 Other changes in net assets or fund balances Pension-Related changes other than net periodic pension cost - -16457892; Post-retirement medical benefit-related changes other than net periodic post-retirement cost - 467315; Net assets released from restrictions used for capital - 89817; Transfer to/from affiliates - -28173001; Net change in beneficial interest in trust - -11587; UPMIFA - 357209; ROCKFORD HEALTH SYSTEM VENTURES LLC 2400 N ROCKTON AVE ROCKFORD IL 61103 364366881 HEALTHCARE IL 3234248 9697774 NA VISITING NURSES ASSN OF THE ROCKFORD AREA 4223 E STATE STREET ROCKFORD IL 61108 362167945 HEALTHCARE IL 501(c)(3 9 ROCKFORD HEALTH SYSTEM true ROCKFORD HEALTH SYSTEM 2400 N ROCKTON AVE ROCKFORD IL 61103 363197915 SUPPORT OF HEALTHCARE IL 501(c)(3 Type III-FI NA false ROCKFORD MEMORIAL DEVELOPMENT FOUNDATION 2400 N ROCKTON AVE ROCKFORD IL 61103 362197918 SUPPORT OF HEALTHCARE IL 501(c)(3 Type I ROCKFORD HEALTH SYSTEM true ROCKFORD HEALTH PHYSICIANS 2300 N ROCKTON AVE ROCKFORD IL 61103 363097436 HEALTHCARE IL 501(c)(3 3 ROCKFORD HEALTH SYSTEM true ROCKFORD HEALTH INSURANCE LTD INSURANCE BD NA C Corporation 13764 593215 1 false false true true false false false false false true false true false false true true true true true true