2014-08-14T17:04:41-05:00 2013-09-30 861065772 Deloitte Tax LLP 111 S Wacker Dr Chicago IL 60606 990 2012-10-01 362179813 SWEDISH COVENANT HOSPITAL SWED 7738788200 5145 N CALIFORNIA AVE CHICAGO IL 60625 THOMAS GARVEY 7738788200 2014-08-14 1 Laura J Gillespie P00855604 3124861000 2012 2015-11-30 17:44:51Z THOMAS GARVEY 5145 N CALIFORNIA AVE CHICAGO IL 60625 264499439 0 X www.schosp.org X 1907 IL Providing excellent healthcare services for our culturally diverse communities for over 120 years. 23 14 2271 179 2358396 0 7291187 126546 250010625 245215855 1242801 2810072 12180280 16339128 270724893 264491601 0 0 0 0 115120418 119468167 0 0 585963 136348605 132757505 251469023 252225672 19255870 12265929 451770879 467642185 301520837 290212856 150250042 177429329 X Our Mission is to provide a continuum of excellent healthcare services. Rooted in The Evangelical Covenant Church, the hospital is dedicated to serving the physical, spiritual and psychological needs of our culturally diverse communities. 0 0 222360955 259732471 Since 1886, Swedish Covenant Hospital (SCH) has been dedicated to providing community benefit healthcare services and healthcare education. As part of its mission as a not-for-profit, church-based community hospital, Swedish Covenant has served as an educational center, health rehabilitation center, illness prevention center, social support services center, and community center. Swedish Covenant Hospital serves as a solid community structure through employment of over 1,914 individuals.Recognizing its mission to the community, Swedish Covenant Hospital offers the following quality medical healthcare services regardless of race, creed, sex, national origin, handicap, age or ability to pay:General Medicine, Surgery, ICUSwedish Covenant Hospital continually offers the latest technology to meet the vast needs of the community. During the fiscal year, SCH serviced 14,066 inpatients and more than 253,500 outpatients at a total cost of $210,011,982.Physical Medicine/Rehab ServicesSCH is dedicated to providing a comprehensive Rehab Unit that combines the disciplines of physical therapy, speech therapy, occupational therapy and social work to help patients regain their strength and skills. The Rehab unit features a special room that simulates a home environment so patients can practice with home-like carpeting, furniture and fixtures while supervised by nurses. During the fiscal year, 221,451 inpatient and outpatient treatments for rehab, speech and occupational therapy were provided for a total cost of $4,532,128.Cardiac Care and RehabThe Cardiac Rehabilitation program offered by Swedish Covenant Hospital has improved the lives of many individuals with such innovative programs as Coronary Heart Disease Reversal. SCH also offers a state-of-the-art Cardiac Catheterization Lab, and other diagnostic and preventive programs. During the fiscal year, SCH provided 24,628 treatments and 1,749 procedures by the Cardiac Rehab program and Cardiac Catheterization Lab, respectively, for a total cost of $6,645,875.In addition to the program services listed above, Swedish Covenant Hospital also offers the following services to the community:Health Screening, Health Promotions, Education, PreventionSCH offers year-round health screenings to members of the community. During the fiscal year, SCH offered 9 blood pressure screening events serving 145 participants. Each year free or reduced-cost cancer screenings are offered to the community. These include prostate, skin, oral, and breast screenings. An eight-week smoking cessation class was offered. The program has had a quit rate after one year of approximately 50%.During the fiscal year Swedish Covenant Hospital served a total of 17,351 persons through participation in health promotions, education, and prevention for a total cost of $542,560.Community Wellness and Prevention programs continue to serve the community with 188 events held at the Hospital or in the community through collaboration with community partners. These events include health fairs, screenings, daytime and evening lectures, seminars, classes, Speakers Bureau presentations, childrens events and other health related activities. Throughout the year the Hospital collaborated with dozens of community organizations to provide wellness and prevention programs.Swedish Covenant Hospital publishes periodic health and wellness information which is distributed through mailings and web-based programs to 225,793 households throughout the surrounding community for a cost of $105,681.During the fiscal year, Swedish Covenant Hospital also offered transportation services to 3,978 members of the community at a net cost of $156,060.Interpreter ServicesSwedish Covenant Hospital provides in-house interpreters for patients who speak Korean, Spanish, and Russian, the primary non-English languages in the community. In FY 2013, the interpreters participated in a total of 1,491 sessions. Additionally, SCH uses professional telephone interpretive assistance and had 11,481 calls. For deaf or hearing impaired patients who request sign language interpreters, the Hospital provides interpreters through CAIRS and Chicago Hearing Society. SCH incurred a total cost of $366,669 for interpreter services serving a total of 38,432 persons.Medical Education ProgramSwedish Covenant Hospital is an independent teaching hospital, with residency programs in family medicine, osteopathic internal medicine, osteopathic transitional year and as of August 1st, 2013 Podiatric Surgery. As part of our affiliation with Midwestern University, Swedish Covenant Hospital is a training site for residents in emergency medicine and critical care residency programs. Our teaching affiliation is with Midwestern University Chicago College of Osteopathic Medicine.We also have an affiliation agreement with Rush University. This agreement allows Swedish Covenant Hospital to be a training site for their OB/GYN residents.In addition to the above, during the fiscal year ended September 30, 2013, Swedish Covenant Hospital voluntarily provided $11,477,000 at cost in charity care/uninsured discounts and provided $14,419,872 at cost in unreimbursed Medicaid services. 222360955 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 1 0 0 1 428 2 1 2271 1 1 1 0 0 0 0 1 1 0 0 0 0 X 23 14 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 IL X DAVID HERMAN 7738788200 5145 N CALIFORNIA AVE CHICAGO IL 60625 CHARLES L ADAIR 1.00 1.00 X 0 0 0 KURT D ANDERSON 1.00 X 0 0 0 LYLE BANKS 1.00 X 0 0 0 RENEE BORKOWSKI 1.00 X 0 0 0 RONALD D CURRAN MD 1.00 40.00 X 0 602751 27934 JUDITH E DABERTIN 1.00 X 0 0 0 H CLARK FEDERER MD 1.00 X 8656 0 0 MAUREEN T GIRARD 1.00 X 0 0 0 W J WESLEY KEE 1.00 X 0 0 0 DAVID J KOO 1.00 X 0 0 0 PATRICIA MERRYWEATHER 1.00 X 0 0 0 REV MARK A NILSON 1.00 X 0 0 0 JEFFREY M TILKIN MD 1.00 X 15200 0 0 TONY R VANCAUWELAERT MD 1.00 X 8859 1872 0 DENNIS C WOLFF 1.00 X 0 0 0 LAWRENCE P ANDERSON 1.00 40.00 X 0 550602 66509 DAVID A DWIGHT 1.00 40.00 X 0 581280 129403 ARMINIO SURUCCI MD 1.00 X 0 0 0 REV GARY B WALTER 1.00 40.00 X 0 157472 117568 THOMAS M PYRA 1.00 X X 0 0 0 JUDITH A PINS 1.00 X X 0 0 0 DAVID R PUTMAN 1.00 X X 0 0 0 MARK NEWTON 40.00 1.00 X X 0 891483 86418 JUDITH A BORENSTEIN 40.00 1.00 X 339571 0 40790 THOMAS J GARVEY 40.00 1.00 X 0 0 0 ANTHONY GUACCIO 40.00 1.00 X 437212 0 65934 DEREK J KELLY MD 40.00 X 341763 0 22388 MARY SHEHAN RN 40.00 X 253936 0 33362 GARY M KRUGEL 40.00 X 341134 0 64449 KAREN M SHEEHAN 40.00 X 251200 0 47385 JANIS A RUEPING 40.00 X 198328 0 34979 WALTEN BABA 40.00 X 268519 0 24154 MICHAEL FEINZIMER 40.00 X 218810 0 1716 PATRICIA KING 40.00 X 195647 0 27517 2878835 2785460 790506 92 0 1 0 MIDWESTERN UNIVERSITY 555 31ST STREET DOWNERS GROVE IL 60515 HEALTH CARE 1020870 ILLINOIS PHYSICIANS NETWORK LLC 8725 W HIGGENS RD SUITE 482 CHICAGO IL 60631 HEALTH CARE 998219 NEPHRON DIALYSIS CENTER 5140 N CALIFORNIA AVE CHICAGO IL 60625 HEALTH CARE 780758 PEDIATRIC FACULTY FOUNDATION 2300 CHILDRENS PLAZA CHICAGO IL 60614 HEALTH CARE 635940 LABORATORY CORP OF AMERICA PO BOX 12140 BURLINGTON NC 27216 HEALTH CARE 531764 53 X 22507 60000 44039 126546 HEALTH CARE SERVICES 900099 243282783 243282783 LABORATORY SERVICES 621500 1933072 1933072 245215855 -3797887 -3797887 5715933 0 5715933 5715933 5715933 6607959 0 6607959 6607959 6607959 6632 22507 0 6632 6632 14000 7838 6162 6162 ELECTRONIC HEALTH RECO 900099 2780513 2780513 PARKING GARAGE FEES 812930 1063446 1063446 CHILD CARE CENTER 624410 848037 422713 425324 5918405 5918405 10610401 264491601 259732471 2358396 2822866 2129557 634366 1495191 170705 170705 99042118 91349965 7278632 413521 3577046 3246742 315710 14594 7354852 6712297 600210 42345 7193889 6477999 684256 31634 2532320 2532320 335833 335833 132063 132063 210000 210000 24727093 22039312 2629574 58207 1055752 297249 758303 200 568227 486452 80164 1611 3758643 3300460 458183 352665 244561 91674 16430 9293100 9293100 19050083 18425330 621019 3734 10030527 9145233 885294 OTHER OPERATING SUPPLIE 35232329 35121337 109749 1243 IDPA TAX 13239800 13239800 EQUIPMENT REPAIR & MAIN 6418183 6311501 106582 100 BAD DEBT EXPENSE 2982898 2982898 2837989 2345453 490192 2344 252225672 222360955 29278754 585963 7545044 1896202 1063799 1033799 25147052 29897699 3545211 4177214 5235620 5405443 448811616 253650223 198392897 195161393 142927091 146601044 0 1989527 67914165 81479864 451770879 467642185 30869196 31671122 191741888 187224260 78909753 71317474 301520837 290212856 X 148227058 175788398 2022984 1640931 150250042 177429329 451770879 467642185 X 12265929 18564246 -3650888 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 143850 0 1 210000 353850 0 Explanation of Lobbying Activities: Part II-B, Line 1: In the course of regular business activities, the hospital or its lobbyist perform some lobbying activities on matters of interest to itself and its patients. 20575237 1532811 115000 1475757 20747291 19626213 8677201 127001 7855178 20575237 18814654 1270179 20979 479599 19626213 18354856 1341311 -13043 868470 18814654 18234850 795551 675545 18354856 0.14160 0.85840 0 1 1 7960138 7960138 190835103 79357058 111478045 763732 763732 0 223527297 156756055 66771242 25725346 16773378 8951968 195161393 CMB BOND & EQUITY FUND - FMV 118983434 F US BANK 27583818 F MERRILL LYNCH - FMV 33792 F 146601044 OTHER INVESTMENTS 894309 CAPTIVE RECOVERIES A/R 3628655 CHRPP RECOVERIES A/R 9435000 DUE FROM AFFILIATES 61282831 ASSETS WHOSE USE IS LIMITED 1433069 PA TAX ASSESSMENT 4168570 ALL OTHER CURRENT ASSETS 637430 81479864 ACCRUED LONG TERM MALPRACTICE LIABILITY 23038716 FAIR VALUE OF INTEREST RATE SWAPS 14271187 ASSET RETIREMENT OBLIGATION 1519742 DUE TO THIRD PARTY PAYERS 15574576 PA TAX ASSESSMENT 3438253 NMTC DEBT ISSUE 13475000 71317474 Description of Intended Use of Endowment Funds: Part V, Line 4: Part V, line 4: The earnings are to be used for education, charity care, and other hospital programs. Swedish Covenant Hospital is the related beneficiary of the endowment funds held by Swedish Covenant Hospital Foundation. GALA 12 18238 17096 1142 GALA 13 7055 1862 5193 1 3846 3549 297 29139 22507 6632 6632 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 10892941 10892941 0.04370 66631209 63196027 3435182 0.01380 77524150 63196027 14328123 0.05750 1279735 1279735 0.00510 3824359 2941326 883033 0.00350 1373557 124068 1249489 0.00500 271142 271142 0.00110 6748793 3065394 3683399 0.01470 84272943 66261421 18011522 0.07220 17854 17854 0.00010 17854 17854 0.00010 1 2982898 95168394 97112198 -1943804 X 1 1 1 SWEDISH COVENANT SURGERY CENTER LLC OUTPATIENT MEDICAL SERVICES 1.00000 0.00000 0.00000 2 CHICAGO CK ENTERPRISES LLC OUTPATIENT MEDICAL SERVICES 0.06000 0.00000 0.74000 3 CK PROPERTY DEVELOPMENT LLC PROPERTY MANAGEMENT SERVICES 0.33000 0.00000 0.00000 1 1 SWEDISH COVENANT HOSPITAL

5145 N CALIFORNIA AVENUE CHICAGO IL 60625

X X X X I/P & OP HOSPITAL SERVICES, SKILLED NURSING FACILITY SWEDISH COVENANT HOSPITAL 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X 0 0 1 1 200.000000000000 1 600.000000000000 1 X X X 1 1 X X X 1 0 1 X 0 0 3 LIFE CENTER ON THE GREEN INC

5157 N FRANCISCO AVENUE CHICAGO IL 60625

PHYSICAL REHABILITATION SERVICES SWEDISH COVENANT HOME HEALTH CARE

2965 W PETERSON AVENUE CHICAGO IL 60659

HOME HEALTH CARE SERVICES SWEDISH COVENANT SURGERY CENTER

5215 N CALIFORNIA AVENUE CHICAGO IL 60625

AMBULATORY SURGERY CENTER - CLOSED EFFECTIVE 9/30/13 Part I, Line 7: Each net community benefit expense is divided by total hospital expenses (excluding bad debt expense) to determine the percent of community benefits provided for fiscal year 2013. Costing Methodology - For all community benefits, we utilize the cost to charge ratio to calculate the benefit. The net operating costs are calculated by taking the total operating costs less the following: the PA tax and the non-patient care activity costs. The net gross charges are calculated as follows: gross charges less charges for community benefits. Net operating costs divided by net gross charges provides the cost to charge ratio.Part I - Line 7d - column dFor Schedule H, line 7b, column (c) the $66,631,209 in the Community Benefit Expense includes the provider assessment tax of $13,239,800. Had the provider tax been excluded, the total Community Benefit expense would have been $53,391,409. On Schedule H, line 7b, column (d), the direct offsetting revenue of $63,196,027 includes the provider tax revenue of $24,224,490 million. Had the public aid provider revenue been excluded from Schedule H, the direct offsetting revenue would have been $38,971,537. Using an adjusted total community benefit expense of $53,391,409 noted above, minus an adjusted direct offsetting revenue amount of $38,971,537, also noted above, the resulting community benefit dollar amount on Schedule H, line 7b, column (e) would have been $14,419,872. On Schedule H, line 7b, column (f) percentage of total expense would have increased from 1.38% to 5.79%.The PA tax benefit is not reimbursement for direct patient care and therefore we believe it should be excluded from the Schedule H calculations. Part I, Line 7g: Costs attributable to a physician clinic of $173,631 were included in subsidized health services. Part I, L7 Col(f): The amount of bad debt which was included on Form 990 Part IX Line 25 was $2,982,898. This was subtracted out for Schedule H calculations. Part II: Members of Swedish Covenant Hospital staff work with other organizations and participate in many activities to advocate for health improvement in our community. These include:Involvement with the Association for Community Safety Net Hospitals, participation in the Medicaid Rate Reform Tag Group, community meetings, education, and seeking of resources with regard to the planning and development of an Erie Family Health Center facility on the hospital campus to expand health services to the community. Members of the Swedish Covenant Hospital Staff have also worked to establish an affiliation with Rush University Medical Center to allow our emergency room physicians to communicate with Rush University Medical Center neurologists using robotic equipment which enables the Rush neurologists to remotely examine Swedish Covenant emergency department patients for signs of a stroke. This resource can improve patient outcomes by early and accurate diagnosis of stroke. Part III, Line 4: The audited financial statements do not contain a specific footnote related to the bad debt expense. The costing methodology is applying the cost-to-charge ratio of 20% to total bad debt expense.There are no bad debt amounts included in community benefits. Part III, Line 8: The hospital has used the standard single apportionment step down cost allocation methodology for the allocation of allowable costs (as defined by the Medicare principles of reimbursement) to the revenue cost centers. Allowable allocated costs are divided by the revenues in each ancillary department and by the days in each nursing unit to determine the appropriate ratios and cost per diems to be applied to the related Medicare ancillary charges and nursing unit days to determine the cost of Medicare services.None of the shortfall has been treated as a community benefit. The allowable costs of care for Medicare are higher than the reimbursement received from Medicare, which places a financial burden on Swedish Covenant Hospital of having to fund this loss from other areas of its operations. Therefore, we believe that the shortfall from Medicare represents a community benefit to our primary service area as we would never turn patients away. Part III, Line 9b: Charity Care Patients:If a patient has been determined to meet Hospital Charity Care Guidelines no collection agencies, lien attachments or attempts to possess real or personal property will be made.The organization implemented a policy of Presumptive Charity Care in the prior fiscal year for health care services to uninsured patients that are not expected to result in payment and no financial assistance application is completed. Patients will qualify for Presumptive Charity assistance based on their individual life circumstances, homeowner status, living address and other measurable socio-economic factors.Financial Assistance:Patients with a self-pay balance and without the resources to pay their obligations will be assessed for financial assistance by the Credit Services Department. The assessment involves an evaluation for eligibility for all appropriate levels of assistance, including governmental or partial reductions or complete charity care. SWEDISH COVENANT HOSPITAL Part V, Section B, Line 3: The Community Health Needs Assessment was produced in cooperation with the Metropolitan Chicago Healthcare Council (MCHC). The project also received input from several Community Health Needs Assessment Focus Groups, which were comprised of representatives of the partnering organizations as well as other citizens chosen for their relevant experience and interests. The sample design used for this effort consisted of a random sample of 515 individuals age 18 and older in the Swedish Covenant Hospital Service Area. Once the interviews were completed, these were weighted in proportion to the actual population distribution so as to appropriately represent the Swedish Covenant Hospital Service Area as a whole. All administration of the surveys, data collection and data analysis was conducted by Professional Research Consultants, Inc. (PRC). For statistical purposes, the maximum rate of error associated with a sample size of 515 respondents is 4.4% at the 95 percent level of confidence.The sample design and the quality control procedures used in the data collection ensure that the sample is representative. Thus, the findings may be generalized to the total population of community members in the defined area with a high degree of confidence.As part of the Community Health Needs Assessment, seven focus groups were held among key informants in the community on June 21-22 and July 11-12, 2012, each focusing on needs within different geographies or among certain populations. These key informant focus groups allowed for input from persons with special knowledge of or expertise in public health, as well as others who represent the interests of key cultural groups represented in communities served by Swedish Covenant Hospital. In all, 50 key informants participated, including physicians, other health professionals, social service providers, business leaders, minority organizations and other community leaders.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. 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. Specific names/titles of those participating are available upon request. SWEDISH COVENANT HOSPITAL Part V, Section B, Line 7: In acknowledging the wide range of priority health issues that emerged from the CHNA process, Swedish Covenant Hospital determined that it could only effectively focus on those which it deemed most pressing, most under-addressed, and most within its ability to influence. The hospital focused on 7 of the 14 identified needs. Listed below are the health priorities not chosen for action and the reasons as to why they were not selected. Injury & Violence Prevention: SCH has limited resources available to address injury and violence prevention. Other community organizations have infrastructure and programs in place to better meet this need; however, it should be noted that the SCH Emergency Department Chairman does participate in the Attorney General/Community Justice Center's gun violence prevention outreach initiatives. Limited resources excluded this as an area chosen for action. Chronic Kidney Disease: SCH regularly partners with organizations including the National Kidney Foundation to provide free screenings to the ethnicities most vulnerable to this disease. SCH feels that efforts outlined herein to improve access to health services will also have a positive impact on chronic kidney disease and that a separate set of specific initiatives was not necessary. Family Planning: Advisory committee members believe that the new partnership with Erie Family Health will not only enhance access to care but will also positively impact outreach regarding family planning education, as many uninsured individuals will be directed to Erie to establish a medical home. Erie and other community organizations have infrastructure and programs in place to better meet this need, and as a result this was excluded as an area chosen for action. Infectious Diseases: Advisory committee members felt that more pressing health needs existed. Limited resources and lower priority excluded this as an area chosen for action.Sexually Transmitted Diseases: SCH believes that this priority area falls more within the purview of the county health department and other community organizations. Limited resources and lower priority excluded this as an area chosen for action.Substance Abuse: SCH has limited resources, services and expertise available to address alcohol, tobacco and other drug issues. Other community organizations have infrastructure and programs in place to better meet this need. However, the hospital is exploring the feasibility of initiating an in-house smoking cessation program. Limited resources excluded this as an area chosen for action. HIV: SCH believes that this priority area falls more within the purview of the county health department and other community organizations. Limited resources and lower priority excluded this as an area chosen for action. Part VI, Line 2: Needs AssessmentIn the spring of 2012, Swedish Covenant Hospital (SCH) embarked on a comprehensive Community health Needs Assessment (CHNA) process to identify and address the key issues for our community.Swedish Covenant Hospital is a comprehensive health care facility providing health and wellness services to Chicago's North and Northwest side communities. This 323-bed hospital is one of the few independent, nonprofit hospitals in the area. Its 600 physicians and 2,200 employees remain focused on the hospital's mission of providing compassionate, high quality care in a healing environment. An established teaching hospital, Swedish Covenant Hospital offers a range of medical programs, including the latest cardiac, cancer, orthopedic, surgical, women's health, back health and emergency services.To address concerns about healthcare access, SCH created a partnership with Erie Family Health Center. In July 2013, Erie opened the Erie Foster Avenue Health Center on the hospital's campus. Erie Foster Avenue Health Center is a Federally Qualified Health Center which provides care to patients who come through the emergency department at SCH and might not have a medical home. Swedish Covenant Hospital (SCH) maintains a department dedicated to addressing its outreach objectives of serving the entire community, not only those who come through its doors. Building on a long tradition of service, the Community Relations Department utilizes hospital strengths alongside those of other well-established community partners. This strategy allows SCH to better understand and reach the most vulnerable sectors of the community, while meeting pressing healthcare needs. The goal is to improve the community's health status by empowering citizens to make healthy lifestyle choices. The Community Benefit Plan (Community Health Needs Assessment Implementation Strategy) identifies seven priority health issues to be addressed for providing community benefit. The implementation strategy is intended to exist over a three year time period, after which a new needs assessment and benefit plan will be developed. The following is a list of the seven priorities of the Community Benefit Plan, out of 14 community needs identified, to be addressed on an ongoing basis and reported on annually through FY16. 1. Access to health services 2. Heart disease and stroke 3. Nutrition, physical activity and weight4. Mental health and mental disorders5. Cancer6. Maternal infant and child health7. Respiratory diseases Part VI, Line 3: Patient Education of eligibility for AssistanceCharity or discounted care is available for medically necessary services as defined by Medicare, to patients who meet the financial and documentation criteria defined below. Each situation is reviewed on an individual case-by-case basis. While not absolutely essential, the need for potential charity or discounted care should be established in advance of admission or rendering of service, or shortly thereafter.The charity care policy is provided during admission procedures to all patients admitted through the Admitting Department and the Emergency Room. Signage informing patients about charity care and the availability of financial counseling is posted in the Emergency Room and the Admitting Department.In order to be eligible for charity or discounted care, the patient must be willing to provide verification of income, assets, etc. by filling out the Patient Financial Statement. It is the responsibility of the patient to voluntarily submit any and all documentation in order to be eligible to receive this discount. During the registration and information gathering process, the financial counselors will first determine if the patient qualifies for medical assistance from other existing financial resources such as Medicare, Medicaid, Kid Care, Family Care or other state or federal programs. If the patient refuses to apply for existing financial resources or to provide information necessary to the application process, charity or discounted care cannot be granted. If the application for existing financial resources is denied, or has been previously denied, consideration for charity or discounted care will then be given.Once the information on the Financial Assistance Application form is received, Credit Services Department will determine the eligibility of the patient for charity or discounted care. SCH will suspend the collection process while the Financial Assistance Application is being reviewed. The only criteria to be considered for Financial Assistance will be income and family size. Income will be evaluated against the matrix of Federal Poverty Guidelines to determine whether full or partial discount can be approved. Documentation of income can be submitted in the form of paycheck stubs, income tax returns, Social Security checks, and other documents that are indicative of income. If the information submitted is not perceived to be accurate or reliable, SCH reserves the right to request additional documentation to substantiate income or family size.The insured patient with a large balance due to deductibles and/or co-payments may be eligible for charity or discounted care. In order to qualify, the patient must complete the Patient Financial Statement and return it to the financial counselors for evaluation and recommendation.If a patient has been determined to meet the Hospital Charity Care Guidelines, no collection agencies, lien attachments or attempts to possess real or personal property will be made.No legal action by the collection agency will be taken against uninsured patients for the first one hundred twenty (120) days after discharge.If after 120 days, an uninsured patient does not provide the completed financial assistance application, SCH will utilize the PARO Presumptive Charity model to qualify the patient as appropriate for a Presumptive Charity care Discount.Illinois residents who have a family income that is no more than 600% of the Federal Poverty Guidelines (as determined each year), and who do not have any health insurance as documented through SCH's insurance verification procedures, will receive a discount in accordance with the Hospital Uninsured Patient Discount Act (210 ILCS 89/) (the Act). Part VI, Line 4: Community InformationSCH's community, as defined for the purposes of the hospital's 2012 Community Health Needs Assessment, included each of the residential ZIP Codes that comprise the hospital's Primary Service Area (PSA) and Secondary Service Area (SSA), including: 60613, 60618, 60625, 60626, 60630, 60640, 60641, 60645, 60646, 60659, 60660 and 60712. This encompasses approximately a 5 mile radius surrounding the hospital and was determined because the majority of SCH's patients originate from this area. The population of the hospital's service area is estimated at 631,311 people. It is predominantly non-Hispanic White (63.66%), but also has substantial Hispanic (28.75%) and Asian (10.87%) populations. As throughout the state and nation, our population is aging, with 10.94% currently age 65 and older. This is projected to increase in coming years, as is the need for services to meet the health needs of this older population. Median household income is below the state average at $48,386, and 12.37% of the families in our population remain below the poverty level. The hospital serves a very diverse multicultural community, with the Albany Park neighborhood serving as a key entry point for many new immigrants. To better address the needs of our highly diverse community, the hospital works regularly with dozens of community stakeholders including local ethnic groups, legislators, and community and business organizations, including: the Albany Park Community Center, Centro Romero, World Relief Chicago, Erie Family Health, Heartland Health, Korean American Community Services, Asian Human Services, Cambodian Association and the Albany Park Chamber of Commerce. These organizations serve as a link between the hospital and the many surrounding niche communities, and the hospital's Community and Government Relations teams communicate regularly online and in-person to propose solutions to issues including Access to Care and health reform. The Spanish and Korean languages represent the majority of interpretative assistance requested at the hospital. To meet this need on an inpatient and outpatient basis, the hospital employs a full time Spanish and Korean interpreter. The Korean interpreter also serves as Korean Community Relations Manager, facilitating deeper, ongoing communication between the hospital and its local Korean community partners and physicians. In addition, the hospital uses a telephonic interpretative service to meet interpretative needs in other languages, as well as for Korean and Spanish interpretation when the interpreters are not present.To better serve the Korean community, the hospital partners each year with Korean American Community Services (KACS), the Korean Medical Society and the Korean Nurses Association to host an annual Korean Health Fair at the hospital. This is an annual event, targeting the uninsured working population. More than 300 Koreans residing in the greater Chicago area attend this event to receive free or reduced cost screenings and services. KACS coordinates the event collaboratively with the hospital's Korean Community Relations Manager. In FY2013, Swedish Covenant Hospital delivered more than 250 community programs to nearly 20,000 individuals in partnership with over 100 community organizations, legislators, chambers of commerce, local businesses and schools. Topics included nutrition, fitness, stroke awareness, heart health, cancer prevention, joint health, pregnancy, diabetes education, women's health and pediatrics. Ongoing partnerships exist between many organizations but highlights include WTTW (Fun & Run kids event, medical show and tell), Budlong Elementary School (healthy nutrition for kids; laboratory tours; career information), American Cancer Society (cancer screening events), 47th Ward Alderman Ameya Pawar (Annual Wellness Fair and senior activities), Whole Foods Market Sauganash (healthy eating and lifestyle choices), Marianos (cooking with arthritis), The Breakers (health events for seniors), Neighborhood Parent Network (events and articles pertaining to children's health issues), Purple Asparagus (Delicious Nutritious Adventures at Budlong School), Centro Romero (health fair and ACA collaboration), Korean American Community Services (annual Korean Health Fair at SCH), Indo-American Center (ongoing health talks for community), Chicagoland Methodist Senior Services (wellness talks for employees and community), Polish National Alliance (health talks and screenings), Edison Regional Gifted Center (laboratory tours, school involvement through Local School Council), and Sulzer Regional Library (health talks/health fairs). Part VI, Line 5: In keeping with the Hospital's mission to provide a continuum of excellent healthcare services, any surplus funds are invested in capital improvements related to patient care or in community benefit programs.The hospital extends medical staff privileges to all qualified physicians in the communities it serves, in accordance with our medical staff development process. The hospital has an active Board of Directors who meet every two months. In addition to reviewing the hospital's financial results, they discuss the hospital's plans and programs in support of our efforts to enhance the health care environment for the entire community we service. The hospital operates the "HouseCalls" program to provide medical care to the homebound.The Hospital helps community members gain access to health care services by assisting low income families in applying for the Illinois Department of Public Aid's KidCare and FamilyCare programs. Reports Filed With States Part VI, Line 7 IL X 1 1 X X X X 0 1 0 0 0 0 0 0 0 RONALD D CURRAN MD 0 573442 0 0 0 29309 0 7500 0 20434 0 630685 0 0 LAWRENCE P ANDERSON 0 370914 0 79600 0 100088 0 37194 0 29315 0 617111 0 0 DAVID A DWIGHT 0 503155 0 0 0 78125 0 102125 0 27278 0 710683 0 0 REV GARY B WALTER 0 157472 0 0 0 0 0 28402 0 89166 0 275040 0 0 MARK NEWTON 0 506120 0 108108 0 277255 0 71154 0 15264 0 977901 0 0 JUDITH A BORENSTEIN 262359 0 0 0 77212 0 32194 0 8596 0 380361 0 0 0 ANTHONY GUACCIO 389442 0 0 0 47770 0 43240 0 22694 0 503146 0 0 0 DEREK J KELLY MD 290296 0 26247 0 25220 0 0 0 22388 0 364151 0 0 0 MARY SHEHAN RN 228626 0 0 0 25310 0 32556 0 806 0 287298 0 0 0 GARY M KRUGEL 284457 0 0 0 56677 0 40755 0 23694 0 405583 0 0 0 KAREN M SHEEHAN 219498 0 0 0 31702 0 30210 0 17175 0 298585 0 0 0 JANIS A RUEPING 181663 0 0 0 16665 0 20909 0 14070 0 233307 0 0 0 WALTEN BABA 238874 0 0 0 29645 0 7180 0 16973 0 292672 0 0 0 MICHAEL FEINZIMER 218810 0 0 0 0 0 0 0 1716 0 220526 0 0 0 PATRICIA KING 182647 0 0 0 13000 0 6011 0 21506 0 223164 0 0 0 Part I, Line 1a As part of their compensation package, vice presidents of the organization are offered a $900 reimbursement for membership dues to the health club of their choice. This benefit is treated as taxable compensation. Part I, Line 3 The Hospital and Covenant Ministries of Benevolence follow the requirements set forth in the IRS rebuttable presumption of reasonableness in determining compensation for the CEO and other officers and executive leaders of the corporation. This function is performed by the governance committee of the governing board, which is composed of only independent directors. The process includes review of comparability data, retention of an outside compensation consultant, and contemporaneous substantiation of the deliberation and decision through detailed minutes of the compensation committee and full board meetings where executive compensation is considered. Part I, Line 4b Executive Benefit Plan Covenant Ministries of Benevolence (CMB) provides certain supplemental retirement benefits to its officers and key employees. These benefits are provided through a nonqualified deferred compensation plan, under which a portion of the benefits being earned are subject to a substantial risk of forfeiture. The supplemental retirement benefits are structured to provide a retention incentive that has been determined by the Compensation Committee of CMB's Board to be of substantial value to the organization. The Committee approves all retirement benefits, together with all other forms of compensation and benefits for these and other executives, in a manner intended to qualify for the rebuttable presumption of reasonableness under the intermediate sanctions rules of federal income tax law. The following individuals participated in the Executive Benefit Plan: David Dwight: - $78,483 Lawrence Anderson - $60,018 Mark Newton - $62,538 Judith Borenstein - $24,694 Anthony Guaccio - $35,740 Gary Krugel - $33,255 Mary Shehan - $25,295 Karen Sheehan - $23,072 Janis Rueping - $17,751 Derek Kelley - $35,530 A Illinois Finance Authority 861091967 45200FEW5 2008-04-08 60000000 2008A IFA Revenue Bonds - Cap Adds & Ref of 01/16/98 & 07/22/99 issues. 0 0 0 B Illinois Finance Authority 861091967 45200FR35 2010-02-02 99390260 2010A IFA Revenue Bonds - Ref of 11/17/03 & 06/17/08 issues. 0 0 0 C Illinois Finance Authority 861091967 2010-11-03 20000000 2010C IFA Revenue Bonds - Cap Adds 0 0 0 D Illinois Finance Authority 861091967 2011-06-28 20000000 2011A IFA Revenue Bonds - Cap Adds & Construction 0 0 0 A 4895000 60846284 29 837840 7508444 52500000 2009 1 0 1 1 B 4120000 99390260 9842269 1982568 88150000 1 0 1 1 C 2396203 20001820 318305 19002109 999711 0 0 0 1 D 925000 20098509 33735 2768934 17329575 0 0 0 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 1 0 0.01500 0.00000 0.01500 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 D 1 Schedule K Supplental Information Form 990 - Schedule K - Part I - Line B - Column f The original 8038 filing for the 2010A bonds listed the issue date of the 2008B refunded bond incorrectly as April 8, 2008. The correct issue date of the 2008B refunded bond is June 17, 2008. Form 990 - Schedule K - Part II - Line 3 Difference between Issue Price and Total Proceeds of issue: The total amount of proceeds of the bond issues entered on Part II Line 3 include the investment earnings. Part II, Line 4, columns A,C and D Gross Proceeds in Reserve Funds The amounts shown here consist solely of sinking fund deposits. Part II, Line 4, column B Gross Proceeds in Reserve Funds The amount shown here consists of $9,254,532 in a reasonably required reserve or replacement fund and $587,737 of sinking fund deposits. Brooke Newton Family member of Mark Newton (CEO of Swedish Covenant Hospital) 67639 Wages paid as an employee of Swedish Covenant Hospital 0 Emily Flatley Family member of Mark Newton (CEO of Swedish Covenant Hospital) 31094 Wages paid as an employee of Swedish Covenant Hospital. 0 Kathryn Shehan Family member of Mary Shehan (VP of Swedish Covenant Hospital) 13240 Wages paid as an employee of Swedish Covenant Hospital 0 Samantha Shehan Family member of Mary Shehan (VP of Swedish Covenant Hospital) 10708 Wages paid as an employee of Swedish Covenant Hospital 0 Elizabeth Pyra Family member of Thomas M. Pyra (Member of the Board of Directors) 48024 Wages paid as an employee of Swedish Covenant Hospital 0 H Clark Federer MD Member of the Board of Directors 100000 Purchase by SCH of Dr. Federer's medical practice. 0 Form 990, Part VI, Section A, line 2 Many of the persons listed on Part VII have a business relationship with each other by virtue of sitting on related Swedish Covenant Hospital entity boards. Kurt D. Anderson, Director, and Lawrence P. Anderson, Director, have a family relationship. Form 990, Part VI, Section A, line 6 The sole member is Covenant Ministries of Benevolence (CMB). Form 990, Part VI, Section A, line 7a The member elects the Board of Directors. Form 990, Part VI, Section A, line 7b S 3.1 of the Bylaws grant reserved powers to the member, such as approval of amendments to the Bylaws of the corporation, approval of certain acquisitions, dispositions and financing, and the power to elect or remove the members of the Board of Directors of the Corporation. Form 990, Part VI, Section B, line 11 Management Review: The draft Form 990 was reviewed by multiple levels of management and by the CFO of Swedish Covenant Hospital. Board Review: The key provisions of the form will be discussed at a subsequent board meeting. Form 990, Part VI, Section B, line 12c Swedish Covenant Hospital has an Administrative Policy on conflict of interest, identifying the parameters of a conflict of interest and the requirement to disclose any such conflict of interest. Each September, the policy is distributed to the board members, key employees, directors and officers. They are asked to sign acknowledging receipt of policy and to disclose if they have any conflicts of interest. If someone is absent from the meeting or fails to return the acknowledgement, there is a follow-up with the individual until the signed acknowledgement is provided. If a person becomes an interested person he or she may be considered in determining whether a quorum is present. The interested person may make a short statement relating to the transaction or arrangement in question, but shall not vote on the motion addressing the actual or potential conflict. Form 990, Part VI, Section B, line 15 The Hospital and Covenant Ministries of Benevolence follow the requirements set forth in the IRS rebuttable presumption of reasonableness in determining compensation for the CEO and other officers and executive leaders of the corporation. This function is performed by the governance committee of the governing board, which is composed of only independent directors. The process includes review of comparability data, retention of an outside compensation consultant, and contemporaneous substantiation of the deliberation and decision through detailed minutes of the compensation committee and full board meetings where executive compensation is considered. Form 990, Part VI, Section C, line 18 A copy of the organization's Form 990 is available upon request by contacting the Swedish Covenant Hospital administration department at 773/878-8200. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are available upon request by contacting the Swedish Covenant Hospital administration department at 773/878-8200. SALES OF ASSETS OTHER THAN INVENTORY FORM 990,PART VIII,LINES 7A - 7C Publicly traded securities held in an investment pool and allocated by Covenant Ministries of Benevolence on a percentage basis. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Net assets released from restriction 103,894. Equity transfer to Covenant Ministries of Benevolence -4,700,000. Net restricted funds transfers from Swedish Covenant Hospital Foundation 945,218. Swedish Covenant Surgery Center LLC 5215 N California Avenue Chicago IL 60625 272485300 Outpatient Surgery Center IL -380995 0 Swedish Covenant Hospital Evangelical Covenant Church (ECC) 5101 N Francisco Avenue Chicago IL 60625 362167730 Church IL 501(c)(3) Line 1 N/A 0 Swedish Covenant Faculty Group (SCFG) 5145 N California Avenue Chicago IL 60625 363686216 Patient Treatment/Education IL 501(c)(3) Line 11a, I Swedish Covenant Hospital (SCH) 1 Swedish Covenant Hospital Foundation (SCHF) 5145 N California Avenue Chicago IL 60625 205055155 Supporting Organization of Swedish Covenant Hospital IL 501(c)(3) Line 7 Swedish Covenant Hospital (SCH) 1 SC Insurance Company 6970 E Chauncey Lane Suite 100 Phoenix AZ 85054 273312053 Insurance AZ 501(c)(3) Line 11a, I Swedish Covenant Hospital (SCH) 1 Covenant Village of PortlandLP 420 NE Mason St Portland OR 97211 364356838 Assisted Living Community OR N/A Coast Asset Management LLC 2450 Colorado Avenue Suite 100 E To Santa Monica CA 90404 954763400 Hedge Fund Investment CA N/A Covenant International Insurance Company Ltd Crawford House 50 Cedar Avenue Hamilton BD Insurance BD N/A 0 Covenant Trust Company 5215 Old Orchard Road Suite 725 Skokie IL 60077 363583163 Financial Services IL N/A C 0 Swedish Covenant Management Services Inc (SCMS) 5145 N California Avenue Chicago IL 60625 364073303 Physician Practice Management IL SWEDISH COVENANT HOSPITAL C -9789124 17394840 1.00000 1 Swedish Covenant Managed Health Care Alliance (SCMCA) 2740 W Foster Suite 409 Chicago IL 60625 364118659 Physician - Hospital Organization IL N/A C 0 0 0 1 0 1 0 0 0 0 1 1 1 1 0 0 1 1 1 1 Swedish Covenant Hospital Foundation L 486111 Intercompany Contract Swedish Covenant Hospital Foundation M 486111 Intercompany Contract Swedish Covenant Hospital Foundation R 123000 Cash Value Swedish Covenant Hospital Foundation S 945218 Cash Value Swedish Covenant Management Services Inc R 14980459 Cash Value SC Insurance Company M 5642846 Cash Value