HUMBOLDT PARK HEALTH: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- HUMBOLDT PARK HEALTH (EIN 36-1564290)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-13
- IRS object ID
- 201412259349300931
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-08-13T09:15:10-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381357951 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 S RIVERSIDE PLAZA 9TH FLOOR | AddressLine1 |
| City | CHICAGO | City |
| State | IL | State |
| ZIP Code | 60606 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 361564290 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORWEGIAN AMERICAN HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | NORW | NameControl |
| Phone | 7732928200 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1044 NORTH FRANCISCO AVENUE | AddressLine1 |
| City | CHICAGO | City |
| State | IL | State |
| ZIP Code | 606222743 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | GARY KRUGEL | Name |
| Title | CFO | Title |
| Phone | 7732928200 | Phone |
| Date Signed | 2014-08-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID LOWENTHAL | Name |
| PTIN | P00378651 | PTIN |
| Phone | 3122071040 | Phone |
| Date Prepared | 2014-08-12 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JOSE R SANCHEZ | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1044 NORTH FRANCISCO AVENUE | AddressLine1 |
| City | CHICAGO | City |
| State | IL | State |
| ZIP Code | 606222743 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 110366673 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.NAHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1935 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | NORWEGIAN AMERICAN HOSPITAL PROVIDES QUALITY AND COMPASSIONATE HEALTH CARE SERVICES BY PARTNERING WITH PATIENTS AND THEIR FAMILIES, OUR EMPLOYEES, PHYSICIANS AND THE COMMUNITIES WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 17 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1065 | TotalNbrEmployees |
| Total Nbr Volunteers | 53 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 244439 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 292977 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 108355310 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 109990574 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 37025 | InvestmentIncomePriorYear |
| Investment Income Current Year | 8299 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -151133 | OtherRevenuePriorYear |
| Other Revenue Current Year | -44489 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 108485641 | TotalRevenuePriorYear |
| Total Revenue Current Year | 110247361 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 51898800 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 52682955 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 56277998 | OtherExpensePriorYear |
| Other Expenses Current Year | 56217405 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 108176798 | TotalExpensesPriorYear |
| Total Expenses Current Year | 108900360 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 308843 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1347001 | RevenuesLessExpensesCY |
| Total Assets BOY | 110887572 | TotalAssetsBOY |
| Total Assets EOY | 106466124 | TotalAssetsEOY |
| Total Liabilities BOY | 82112613 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 71514384 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 28774959 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 34951740 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | NORWEGIAN AMERICAN HOSPITAL PROVIDES QUALITY AND COMPASSIONATE HEALTH CARE SERVICES BY PARTNERING WITH PATIENTS AND THEIR FAMILIES, OUR EMPLOYEES, PHYSICIANS AND THE COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 89112016 | Expense |
| Revenue | 109990574 | Revenue |
| Description | NORWEGIAN AMERICAN HOSPITAL IS A PREMIER HEALTH CARE PROVIDER WHERE THE PATIENT COMES FIRST. AS AN ORGANIZATION OF CAREGIVERS, NORWEGIAN AMERICAN INSPIRES TO CONSISTENTLY HIGH STANDARDS OF QUALITY, FAMILY-CENTERED HEALTH CARE SERVICES AND COST EFFECTIVENESS. NORWEGIAN AMERICAN HOSPITAL SEEKS TO PROMOTE WELLNESS WITHIN THE FAMILY AND TO BE DYNAMIC PARTNERS IN HEALTH WITH THE COMMUNITIES IT SERVES. FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2013, NORWEGIAN AMERICAN HOSPITAL FORGONE $5,100,000 WORTH OF CHARGES FOR HEALTHCARE SERVICES AND SUPPLIES PROVIDED TO MEMBERS OF THE COMMUNITIES SERVED UNDER ITS CHARITY CARE POLICY. THESE MEMBERS DID NOT HAVE THE ABILITY TO PAY FOR SERVICES RECEIVED. NORWEGIAN AMERICAN ALSO PROVIDED CARE TO PATIENTS WHO ARE BENEFICIARIES OF MEDICARE, MEDICAID, BLUE CROSS AND MANAGED CARE REIMBURSEMENT PROGRAMS. REIMBURSEMENT AMOUNTS FOR THESE PROGRAMS ARE LESS THAN CHARGES AND IN SOME CASES LESS THAN COST. FOR FISCAL YEAR 2013, NORWEGIAN AMERICAN HOSPITAL SERVED 6,977 PATIENTS ADMITTED WHO RECEIVED 33,076 DAYS OF HEALTHCARE SERVICES. | Description |
| Total Program Service Expense | 89112016 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 145 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1065 | NumberOfEmployees |
| Employment Tax Returns Filed | 0 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 17 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GARY KRUGEL CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7732928200 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1044 NORTH FRANCISCO AVENUE | AddressLine1 |
| City | CHICAGO | City |
| State | IL | State |
| ZIP Code | 606222743 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (25 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| BILLY OCASIO | |||||||
| CHAIRMAN | 10.00 | X | X | 0 | 0 | 0 | |
| WILMI SCHMIDT | |||||||
| VICE CHAIRMAN | 4.00 | X | X | 0 | 0 | 0 | |
| SANDRA VALENZUELA | |||||||
| SECRETARY | 8.00 | X | X | 0 | 0 | 0 | |
| LOUIS TINAJERO | |||||||
| TREASURER | 8.00 | X | X | 0 | 0 | 0 | |
| ADAM BORIS | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| RICHARD BLABOLIL | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| RAFAEL CAMPANINI | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| CARMEN HOVANEC | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| CHRISTINA KSOLL | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| ENRIQUE LOPEZ | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| LOUIS MANETTI | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| IBRAHIM MAJZOUB | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| MANUEL MARTINEZ | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| DUKE MIGLIN | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| JOHN MONTEVERDE MD | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| HECTOR RODRIGUEZ | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| OLGA SAAVEDRA MD | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| JOSE R SANCHEZ | |||||||
| PRESIDENT & CEO | 40.00 | X | 556424 | 0 | 130000 | ||
| ANTHONY EVERS | |||||||
| CFO | 40.00 | X | 331563 | 0 | 46494 | ||
| ABHA AGRAWAL | |||||||
| COO | 40.00 | X | 24231 | 0 | 0 | ||
| PRATIBHA RASTOGI | |||||||
| PHYSICIAN | 40.00 | 298656 | 0 | 0 | X | ||
| NARAYAN RAVISHANKAR | |||||||
| PHYSICIAN | 40.00 | 268424 | 0 | 39434 | X | ||
| MURALI VINTA | |||||||
| HOSPITALIST | 40.00 | 294602 | 0 | 31244 | X | ||
| JANA RICHARDS | |||||||
| PHYSICIAN | 40.00 | 254655 | 0 | 0 | X | ||
| CARRIE SMITH | |||||||
| PHYSICIAN | 40.00 | 250139 | 0 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2278694 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 247172 | TotalOtherCompensation |
| Number Individuals GT100 K | 64 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| SODEXO AMERICA LLC | |||||
| 3020 WOODCREEK DRIVE | DOWNERS GROVE | IL | 60515 | DIETARY AND FACILITY SERVICES | 2959930 |
| US BANK CORPORATE TRUST | |||||
| PO BOX 70870 | ST PAUL | MN | 551709705 | TRUST SERVICES | 1305898 |
| MEDICAL INFORMATION TECHN | |||||
| PO BOX 74569 | CHICAGO | IL | 60696 | INFORMATION TECHNOLOGY | 1068538 |
| NAVIN HAFFTY & ASSOCIATES | |||||
| 200 CORDWAINER DRIVE SUITE 100 | NORWELL | MA | 02061 | INFORMATION TECHNOLOGY | 508327 |
| HLS LAUNDRY SERVICES | |||||
| 45 WEST HINTZ ROAD | WHEELING | IL | 60090 | LINEN/LAUNDRY SERVICES | 500061 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 26 | NumberOfContractorsGT100K |
| Related Organizations | 292977 | RelatedOrganizations |
| Total Contributions | 292977 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MEDICARE/MEDICAID PAYMENTS | 621110 | 64669970 | 64669970 |
| MEDICAID ASSESSMENT REVENUE | 621110 | 21665301 | 21665301 |
| NET PATIENT SERVICES | 621110 | 16167493 | 16167493 |
| OPERATING REVENUE | 621110 | 4659943 | 4659943 |
| MEDICAID EHR INCENTIVE PROGRAM RE | 621110 | 2827867 | 2827867 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 109990574 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 35722 | TotalRevenueColumn |
| Exclusion | $35,722 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 47400 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 91889 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -44489 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -44489 | TotalRevenueColumn |
| Exclusion | -$44,489 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 27423 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -27423 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -27423 | TotalRevenueColumn |
| Exclusion | -$27,423 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 110247361 | TotalRevenueColumn |
| Related Or Exempt Function Income | 109990574 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | -$36,190 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1372539 | Total |
| Program Services | 1043130 | ProgramServices |
| Management And General | 329409 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43434614 | Total |
| Program Services | 33010306 | ProgramServices |
| Management And General | 10424308 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 684920 | Total |
| Program Services | 520539 | ProgramServices |
| Management And General | 164381 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4165729 | Total |
| Program Services | 3165954 | ProgramServices |
| Management And General | 999775 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3025153 | Total |
| Program Services | 2299116 | ProgramServices |
| Management And General | 726037 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 268869 | Total |
| Program Services | 204340 | ProgramServices |
| Management And General | 64529 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 70292 | Total |
| Management And General | 70292 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 219747 | Total |
| Management And General | 219747 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8781832 | Total |
| Program Services | 6674192 | ProgramServices |
| Management And General | 2107640 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 144299 | Total |
| Program Services | 109667 | ProgramServices |
| Management And General | 34632 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 145738 | Total |
| Program Services | 110761 | ProgramServices |
| Management And General | 34977 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69431 | Total |
| Program Services | 52767 | ProgramServices |
| Management And General | 16664 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2917558 | Total |
| Program Services | 2217344 | ProgramServices |
| Management And General | 700214 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7887 | Total |
| Program Services | 5994 | ProgramServices |
| Management And General | 1893 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 126577 | Total |
| Program Services | 96199 | ProgramServices |
| Management And General | 30378 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1606582 | Total |
| Management And General | 1606582 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4539792 | Total |
| Program Services | 3450242 | ProgramServices |
| Management And General | 1089550 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1817008 | Total |
| Program Services | 1380926 | ProgramServices |
| Management And General | 436082 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| PROVISION FOR BAD DEBT | 12932233 | 12932233 |
| MEDICAL SUPPLIES | 9012204 | 9012204 |
| IL MEDICAID TAX ASSESSM | 7626408 | 7626408 |
| EQUIPMENT RENTAL | 2884054 | 2884054 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3046894 | Total |
| Program Services | 2315640 | ProgramServices |
| Management And General | 731254 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 108900360 | Total |
| Program Services | 89112016 | ProgramServices |
| Management And General | 19788344 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4361786 | BOY |
| EOY | 4726832 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15794932 | BOY |
| EOY | 20743904 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3500000 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15646620 | BOY |
| EOY | 13837625 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1035055 | BOY |
| EOY | 901645 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2200183 | BOY |
| EOY | 7597483 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 125506722 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 87162571 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38321184 | BOY |
| EOY | 38344151 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5010517 | BOY |
| EOY | 2334574 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25017295 | BOY |
| EOY | 17979910 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 110887572 | BOY |
| EOY | 106466124 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10153290 | BOY |
| EOY | 10070002 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3362809 | BOY |
| EOY | 3496011 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21155932 | BOY |
| EOY | 20446471 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47440582 | BOY |
| EOY | 37501900 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 82112613 | BOY |
| EOY | 71514384 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22237723 | BOY |
| EOY | 29511824 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6537236 | BOY |
| EOY | 5439916 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28774959 | BOY |
| EOY | 34951740 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 110887572 | BOY |
| EOY | 106466124 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1347001 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 4829780 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 1 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 1 | DirectContactLegislators |
| Direct Contact Legislators | $210,000 | DirectContactLegislatorsAmount |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $119,293 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 329293 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | HOSPITAL REPRESENTATIVES HAVE DIRECT CONTACT WITH LEGISLATORS, THEIR STAFF, AND OFFICIALS WITHIN THE ADMINISTRATION REGARDING ISSUES RELATED TO THE PROVISION OF HEALTHCARE AND HEALTHCARE FINANCING. HOSPITAL REPRESENTATIVES HAVE ENGAGED IN DIRECT MEETINGS WITH LEGISLATORS, LEGISLATIVE STAFF, AND AGENCY STAFF. THEY HAVE ALSO HAD PHONE CONVERSATIONS AND CORRESPONDED BY EMAIL. WRITTEN COMMUNICATION IN THE FORM OF MEMOS AND LETTERS IS ALSO USED. ADDITIONALLY, A PORTION OF MEMBERSHIP DUES PAID TO THE ILLINOIS HOSPITAL ASSOCIATION AND THE METROPOLITAN HEALTHCARE COUNCIL ARE USED FOR LOBBYING PURPOSES. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4529913 | OtherCostOrOtherBasis |
| Book Value | 4529913 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 46888244 | OtherCostOrOtherBasis |
| Depreciation | 31321067 | Depreciation |
| Book Value | 15567177 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3112770 | OtherCostOrOtherBasis |
| Depreciation | 3040595 | Depreciation |
| Book Value | 72175 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 70396187 | OtherCostOrOtherBasis |
| Depreciation | 52800909 | Depreciation |
| Book Value | 17595278 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 579608 | OtherCostOrOtherBasis |
| Book Value | 579608 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 38344151 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (7 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| INSURANCE RECOVERIES RECEIVABLE | 6504741 |
| PROPERTY HELD FOR FUTURE USE | 1189446 |
| INVESTMENT IN JOINT VENTURE | 6932281 |
| DUE FROM AFFILIATES | 177392 |
| BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION | 2153752 |
| INVESTMENT IN SUBSIDIARY | 826748 |
| OTHER ASSETS | 195550 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 17979910 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (7 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ACCRUED MALPRACTICE LIABILITY | $18,005,334 |
| CONDITIONAL ASSET RETIREMENT OBLIGATION | $2,836,102 |
| NET PENSION LIABILITY | $12,871,552 |
| SODEXHO CAPITAL LEASE | $11,116 |
| DUE TO THIRD PARTY PROGRAMS | $3,444,327 |
| DEFERRED LEASE | $33,400 |
| EQUIPMENT LOANS | $300,069 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 37501900 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT AS OF SEPTEMBER 30,2013, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO SEPTEMBER 30, 2010. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 600.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5125621 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 5125621 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05340 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 47012338 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 50951481 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -3939143 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 52137959 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 50951481 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1186478 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05340 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 281733 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 229601 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 52132 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1724846 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1432947 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 291899 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00300 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2006579 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1662548 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 344031 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00350 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 54144538 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 52614029 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1530509 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05690 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $12,932,233 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 23896488 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 22513499 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 1382989 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 CENTURY PHO INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Ent Primary Activity | TO OBTAIN AND MANAGE CONTRACTS WITH HEALTH MAINTENANCE ORGANIZATIONS. | DescriptionEntPrimaryActivity |
| Organization Profit Or Ownership | 0.50000 | OrganizationProfitOrOwnership |
| Officers Etc Profit Or Ownership | 0.00000 | OfficersEtcProfitOrOwnership |
| Physicans Profit Or Ownership | 0.50000 | PhysicansProfitOrOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORWEGIAN AMERICAN HOSPITAL INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1044 N FRANCISCO | AddressLine1 |
| City | CHICAGO | City |
| State | IL | State |
| ZIP Code | 60660 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.NAHOSPITAL.ORG | WebsiteAddress |
| Licensed Hospital | X | LicensedHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORWEGIAN AMERICAN HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 600.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAMILY HEALTH NETWORK | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 322 GREEN STREET SUITE 400 | AddressLine1 |
| City | CHICAGO | City |
| State | IL | State |
| ZIP Code | 60607 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | PROVIDER OF MANAGED CARE SERVICES FOR THE INDIGENT. | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: NORWEGIAN AMERICAN HOSPITAL USES THE FPG TO DETERMINE FREE AND DISCOUNTED CARE. PATIENTS WITH ELIGIBLE ASSETS AND INCOME ABOVE THE 200%, BUT NOT EXCEEDING 600% OF FPG, ADJUSTED FOR FAMILY SIZE, WILL RECEIVE A DISCOUNT ON MEDICALLY NECESSARY SERVICES PROVIDED TO THEM, BASED UPON A SLIDING SCALE ESTABLISHED BY HOSPITAL POLICY. | ||
| PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED ON LINES 7A AND 7B IS THE COST-TO-CHARGE RATIO DERIVED FROM THE IRS'S SCHEDULE H, WORKSHEET 2 INSTRUCTIONS. NORWEGIAN AMERICAN HOSPITAL USED ITS INTERNAL ACCOUNTING RECORDS TO CALCULATE THE AMOUNTS REPORTED IN LINES 7E AND 7F.MANAGEMENT DOES NOT CONCUR WITH THE WORKSHEET 3 INSTRUCTIONS IN REGARDS TO INCLUDING THE PROVIDER TAX EXPENSES IN WITH COLUMN (C) TOTAL COMMUNITY BENEFIT EXPENSE, AS WELL AS INCLUDING THE PROVIDER TAX REVENUES IN WITH COLUMN (D) DIRECT OFFSETTING REVENUE. IF THESE WERE REMOVED FROM THE WORKSHEET 3 CALCULATION, NET COMMUNITY BENEFIT EXPENSE ON LINE 7B, COLUMN (E) WOULD HAVE BEEN $10,099,750 OR 10.52 PERCENT OF TOTAL EXPENSE. THIS WOULD HAVE INCREASED THE TOTAL NET COMMUNITY BENEFIT EXPENSE ON LINE 7K, COLUMN (E) FROM $1,530,509 TO $15,569,402 OR 5.69 PERCENT TO 16.22 PERCENT OF TOTAL EXPENSE. | ||
| PART I, LINE 7G: NORWEGIAN AMERICAN HOSPITAL DID NOT INCLUDE ANY COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC AS SUBSIDIZED HEALTH SERVICES. | ||
| PART I, L7 COL(F): THERE WAS A TOTAL OF BAD DEBT EXPENSE OF $12,932,233 SUBTRACTED FROM TOTAL EXPENSES. | ||
| PART III, LINE 4: AUDITED FINANCIAL STATEMENTS FOOTNOTE REGARDING BAD DEBT EXPENSE:ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY).FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2, IS THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX.ALL OF THE HOSPITAL'S PATIENTS AUTOMATICALLY QUALIFY FOR FINANCIAL ASSISTANCE IF THEY DO NOT HAVE INSURANCE (THEY ARE CONSIDERED "SELF-PAY" AND GIVEN 60% DISCOUNT). ONCE THE HOSPITAL DETERMINES THAT A PATIENT HAS NO INSURANCE, THEY AUTOMATICALLY DISCOUNT THE BILL BY 60%. SO THERE ARE NO INDIVIDUALS THAT MAY HAVE BEEN ELIGIBLE FOR FINANCIAL ASSISTANCE AND DID NOT RECEIVE ANY. BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS WITH INSURANCE THAT MAY NOT HAVE PAID THEIR SHARE/CO-PAY OF THE BILL OR ATTRIBUTABLE TO PATIENTS THAT RECEIVED FINANCIAL ASSISTANCE (60% DISCOUNT) BUT DID NOT PAY THEIR 40%. THEREFORE, ZERO HAS BEEN REPORTED IN PART III, LINE 3.PART III, SECTION B: MANAGEMENT DOES NOT CONCUR WITH PART III, SECTION B MEDICARE, LINE 6 REPORTING INSTRUCTIONS REGARDING UTILIZING ALLOWABLE COSTS FROM MEDICARE WORKSHEET B. IF MANAGEMENT USED THE ACTUAL AMOUNT OF COSTS TO CARE FOR MEDICARE PATIENTS, ALLOWABLE COSTS WOULD HAVE BEEN REPORTED AS $26,398,139 AND THE AMOUNT OF (SHORTFALL) WOULD HAVE BEEN ($2,501,651). | ||
| PART III, LINE 8: COSTING METHODOLOGY USED IS THE MEDICARE COST REPORT WHICH UTILIZES A STEP-DOWN METHOD OF COST ALLOCATION. THIS ORDER OF ALLOCATION FOR OVERHEADS HAS BEEN PREDETERMINED BY MEDICARE AND IS PRINTED OUT ON THE COST REPORT. THE MOST COMMON OVERHEAD IS ALLOCATED FIRST TO ALL OTHER OVERHEADS AND THE PATIENT CARE COST CENTERS. THEN THAT COST CENTER IS CLOSED AND THE NEXT MOST COMMON OVERHEAD IS ALLOCATED. THIS IS CONTINUED UNTIL ALL THE OVERHEADS ARE ALLOCATED OUT. THE SEPTEMBER 30, 2013 COST REPORT DID NOT SHOW A SHORTFALL. | ||
| PART III, LINE 9B: THE COLLECTION POLICIES CONTAIN PROVISIONS ON THE COLLECTIONS PRACTICES TO BE FOLLOWED FOR PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. SUCH PRACTICES ARE: CHARITY - UPON APPROVAL OF PATIENT'S CHARITY APPLICATION THE COLLECTIONS ARE STOPPED, PATIENT'S BALANCE IS WRITTEN OFF ACCORDINGLY AND PATIENT IS NOTIFIED IN WRITING; UNINSURED PATIENT - UPON DETERMINATION THAT PATIENT HAS NO INSURANCE, 60% DISCOUNT IS APPLIED TO PATIENT ACCOUNT AND PATIENT IS NOTIFIED IN WRITING FOR THE OUTSTANDING BALANCE. | ||
| PART V, SECTION B, LINE 20D: THE HOSPITAL DETERMINES THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO THE FAP-ELIGIBLE INDIVIDUALS BY CALCULATING THE UNINSURED PATIENT DISCOUNT AMOUNT AND APPLYING IT TO PATIENT ACCOUNT. THE DISCOUNT AMOUNT IS CALCULATED BY SUBTRACTING FROM 100% THE PRODUCT OF THE HOSPITALS COST TO CHARGE RATIO (FROM WORKSHEET C PART 1 FROM THE MEDICARE COST REPORT) AND 135% (MEDICARE COST ALLOWED TO CHARGE TO UNINSURED PATIENTS). NORWEGIAN AMERICAN HOSPITALS UNINSURED DISCOUNT FOR FY 2013 IS 60% AS ROUNDED UP FROM THE CALCULATION AS SHOWN BELOW. 2012 COST TO CHARGE RATIO = 29.96% 29.96% X 135% = 40.45%100% - 40.45% = 59.55% | NORWEGIAN AMERICAN HOSPITAL, INC. | |
| PART V, SECTION B, LINE 1: THE ORGANIZATION IS IN THE PROCESS OF COMPLETING ITS COMMUNITY HEALTH NEEDS ASSESSMENT AND IT WILL BE COMPLETED BY OCTOBER 27, 2014. THE ORGANIZATION HAS ACTED IN GOOD FAITH IN MEETING ITS COMMUNAL RESPONSIBILITIES. THE ORGANIZATION BELIEVES THAT THE DELAY IN COMPLETION OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT OCCURRED UNDER CIRCUMSTANCES WHICH MAY CONSTITUTE REASONABLE CAUSE. | ||
| PART VI, LINE 2: NORWEGIAN AMERICAN HOSPITAL'S COMMUNITY BENEFIT PLAN WAS DEVELOPED TO ESTABLISH STRATEGIES FOR IMPROVING ACCESS TO CARE AND POSITIVELY AFFECTING THE HEALTH OF THE COMMUNITIES THAT IT SERVES. ADDITIONALLY, THE PLAN SETS THE COURSE FOR STRENGTHENING EXISTING PARTNERSHIPS AND BUILDING NEW ONES WITH INDIVIDUALS AND ORGANIZATIONS WITHIN NORWEGIAN AMERICAN HOSPITAL'S PRIMARY SERVICE AREAS IN ORDER TO LEVERAGE AND MAXIMIZE THE IMPACT OF ITS PROGRAMS. DEVELOPMENT OF THE PLAN IS DERIVED THROUGH THE STRATEGIC PLANNING OF NORWEGIAN AMERICAN HOSPITAL'S BOARD OF TRUSTEES AND THROUGH ORGANIZATIONAL INVOLVEMENT IN COMMUNITY PARTNERSHIPS. THE GOALS DEVELOPED FOR PLANNING COMMUNITY SERVICES INVOLVED MEETING WITH PHYSICIANS AND COMMUNITY PARTNERS TO DETERMINE WHERE THE GAPS OF CARE AND SERVICES COULD BE FILLED THROUGH NORWEGIAN AMERICAN HOSPITAL INVOLVEMENT. IN DEVELOPING ITS COMMUNITY BENEFITS PLAN, NORWEGIAN AMERICAN HOSPITAL SET THE FOLLOWING GOALS:1) SERVE AS A CATALYST/CONVENER FOR THE OBESITY AND DIABETES INITIATIVES IN HUMBOLDT PARK.2) HOST COMMUNITY-BASED EDUCATION EVENTS SUCH AS ESL, LIFE SKILLSTRAINING, JOB SEEKING SKILLS, ETC.3) PROMOTE INITIATIVES THAT ENHANCE ACCESS TO HEALTH CARE FOR THE UNINSURED AND UNDERINSURED.4) NORWEGIAN AMERICAN HOSPITAL LEADERSHIP TO ASSUME AN ACTIVE ROLE IN COMMUNITY BASED ORGANIZATIONS BOARDS, TASK FORCES AND COMMUNITY EVENTS. | ||
| PART VI, LINE 3: NORWEGIAN AMERICAN HOSPITAL INFORMS AND EDUCATES PATIENTS AND PERSONS, WHO MAY BE BILLED FOR PATIENT CARE, ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S CHARITY CARE POLICY ON ITS INTRANET AND THROUGH FLYERS. PATIENTS ARE PROVIDED THESE POLICIES AT THE TIME OF REGISTRATION AND ARE ALSO AVAILABLE UPON REQUEST | ||
| PART VI, LINE 4: NORWEGIAN AMERICAN HOSPITAL SERVES A PRIMARY COMMUNITY AREA AND A SECONDARY COMMUNITY AREA.THE PRIMARY COMMUNITY AREA CONSISTS OF THE FOLLOWING AREAS, ZIP CODES AND POPULATION:- AUSTIN- BELMONT-CRAGIN- HERMOSA- HUMBOLDT PARK- LOGAN SQUARE- WEST TOWN- IRVING PARK- NORTH CENTER- EAST GARFIELD PARK- WEST GARFIELD PARK- NORTH LAWNDALE WHITE HISPANIC AFRICAN-AMERICANPRIMARY ZIP CODES POPULATION - PERCENTAGE 60618 46,754 51% 42,771 46% 2,559 3%60622 33,399 64% 15,289 29% 3,860 7%60624 958 3% 1,160 3% 35,987 94%60639 8,056 9% 68,639 76% 13,712 15%60647 34,357 39% 47,697 55% 5,237 6%60651 2,538 4% 21,756 34% 39,973 62%THE SECONDARY AREA CONSISTS OF THE FOLLOWING AREAS, ZIP CODES AND POPULATION:- ARCHER HEIGHTS- BRIGHTON PARK- CAGE PARK- GARFIELD RIDGE- WEST ELSDON- SOUTH LAWNDALE- PORTAGE PARK- PULLMAN WHITE HISPANIC AFRICAN-AMERICANPRIMARY ZIP CODES POPULATION - PERCENTAGE 60612 8,738 26% 4,319 13% 20,412 61%60623 2,301 2% 59,438 65% 30,369 33%60625 47,050 60% 28,304 36% 3,297 4%60632 12,939 14% 76,902 84% 1,485 2%60641 32,054 45% 38,057 53% 1,552 2%60644 1,506 3% 1,583 3% 45,559 94%60640 44,239 67% 9,923 15% 11,628 18%NORWEGIAN AMERICAN HOSPITAL'S AGE FOR THE FISCAL YEAR WAS AS FOLLOWS:AGE PERCENTAGE0-14 2%15-44 44%45-64 37%65-74 9%75+ 8%NORWEGIAN AMERICAN HOSPITAL'S RACE AND ETHNICITY FOR THE FISCAL YEAR WAS AS FOLLOWS:RACE PERCENTAGEASIAN 1%AMERICAN INDIAN OR NATIVE ALASKAN 0%BLACK OR AFRICAN-AMERICAN 43%WHITE 13%OTHER 43%ETHNICITY PERCENTAGEHISPANIC 41%NON-HISPANIC 59% | ||
| PART VI, LINE 5: IN ADDITION TO PROVIDING QUALITY INPATIENT AND OUTPATIENT SERVICES, NORWEGIAN AMERICAN HOSPITAL REACHES BEYOND ITS WALLS AND INTO COMMUNITIES THROUGH AN ARRAY OF ACTIVITIES AND PROGRAMS DESIGNED AND DELIVERED TO BENEFIT THE COMMUNITIES IT SERVES. THESE COMMUNITY BENEFITS INCLUDE: - CARE THAT IS PROVIDED FREE, SUBSIDIZED OR WITHOUT FULL REIMBURSEMENT FROM MEDICARE, MEDICAID OR OTHER GOVERNMENT INSURANCE PROGRAMS.-SERVICES RESPONDING TO UNIQUE COMMUNITY NEEDS, SUCH AS DIABETES SERVICES, EMERGENCY CARE, BEHAVIORAL HEALTH SERVICES, SUBSTANCE ABUSE, PEDIATRIC CARE-A-VAN; AS WELL AS HEALTH SCREENINGS, IMMUNIZATION PROGRAMS, SCHOOL-BASED HEALTH CARE AND OTHER COMMUNITY OUTREACH PROGRAMS.-EDUCATION TO TRAIN PHYSICIANS, NURSES, RADIOLOGY TECHNICIANS, AND OTHER HIGHLY SKILLED HEALTH CARE PROFESSIONALS.-VOLUNTEER SERVICES PROVIDED BY HOSPITAL EMPLOYEES WHO VOLUNTEER IN THEIR COMMUNITIES AND COMMUNITY MEMBERS WHO VOLUNTEER AT THE HOSPITAL.-LANGUAGE-ASSISTANCE SERVICES, SUCH AS TRANSLATORS, SIGNAGE, FORMS, BROCHURES, PATIENT EDUCATION MATERIALS AND OTHER INFORMATION IN LANGUAGES OTHER THAN ENGLISH.-DONATIONS BY NORWEGIAN AMERICAN HOSPITAL OF MEETING AND CLINIC SPACE, AS WELL AS OTHER ASSISTANCE TO COMMUNITY GROUPS. | ||
| PART VI, LINE 6: NOT AFFILIATED | ||
| IL | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Independent Consultant | X | IndependentConsultant |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOSE R SANCHEZ | ||||||||||||||
| PRESIDENT & CEO | 464884 | 0 | 77500 | 0 | 14040 | 0 | 130000 | 0 | 0 | 0 | 686424 | 0 | 0 | 0 |
| ANTHONY EVERS | ||||||||||||||
| CFO | 249896 | 0 | 75000 | 0 | 6667 | 0 | 0 | 0 | 46494 | 0 | 378057 | 0 | 0 | 0 |
| PRATIBHA RASTOGI | ||||||||||||||
| PHYSICIAN | 298656 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 298656 | 0 | 0 | 0 |
| NARAYAN RAVISHANKAR | ||||||||||||||
| PHYSICIAN | 268374 | 0 | 0 | 0 | 50 | 0 | 5000 | 0 | 34434 | 0 | 307858 | 0 | 0 | 0 |
| MURALI VINTA | ||||||||||||||
| HOSPITALIST | 294294 | 0 | 0 | 0 | 308 | 0 | 5000 | 0 | 26244 | 0 | 325846 | 0 | 0 | 0 |
| JANA RICHARDS | ||||||||||||||
| PHYSICIAN | 249189 | 0 | 5000 | 0 | 466 | 0 | 0 | 0 | 0 | 0 | 254655 | 0 | 0 | 0 |
| CARRIE SMITH | ||||||||||||||
| PHYSICIAN | 248874 | 0 | 0 | 0 | 1265 | 0 | 0 | 0 | 0 | 0 | 250139 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | NAH PAYS MEMBERSHIP DUES ON BEHALF OF JOSE SANCHEZ TO A SOCIAL CLUB. THE MEMBERSHIP IS USED EXCLUSIVELY FOR BUSINESS PURPOSES. |
| PART I, LINE 4B | JOSE SANCHEZ $125,000 WAS CREDITED TO HIS ACCOUNT IN THE CALENDAR YEAR 2012. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)
| Bond ReferenceBondReferenceCd | Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|---|
| ILLINOIS FINANCE AUTHORITY REVENUE BONDS SERIES 2008 | ||||||||
| A | 861091967 | 45200FMQ9 | 2008-08-15 | 4500000 | SEE PART VI | 0 | 0 | 0 |
| ILLINOIS FINANCE AUTHORITY REVENUE BONDS SERIES 2008 | ||||||||
| B | 861091967 | 45200FMS5 | 2008-08-15 | 5000000 | SEE PART VI | 0 | 0 | 0 |
| ILLINOIS FINANCE AUTHORITY REVENUE BONDS SERIES 2008 | ||||||||
| C | 861091967 | 45200FMT3 | 2008-08-15 | 14450000 | SEE PART VI | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Refunding EscrowRefundingEscrow | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 4500000 | 798333 | 1159612 | 157619 | 2384436 | 2008 | 1 | 0 | 1 | 1 |
| B | 5000000 | 798334 | 1159612 | 157619 | 2884435 | 2008 | 1 | 0 | 1 | 1 |
| C | 14450000 | 798333 | 1159612 | 157620 | 12334436 | 2008 | 1 | 0 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Bond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTest | Change In Use Bond Financed PropChangeInUseBondFinancedProp | Non Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
| C | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiled | Rebate Not Due YetRebateNotDueYet | Exception To RebateExceptionToRebate | No Rebate DueNoRebateDue | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Superintegrated HedgeSuperintegratedHedge | Hedge TerminatedHedgeTerminated | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Written Proc To Monitor ReqsWrittenProcToMonitorReqs |
|---|---|---|---|---|---|---|---|---|---|---|---|
| THE ARBITRAGE GROUP | |||||||||||
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| THE ARBITRAGE GROUP | |||||||||||
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| THE ARBITRAGE GROUP | |||||||||||
| C | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCHEDULE K SUPPLENTAL INFORMATION | Identifier |
| Explanation | THE SERIES 2008 BOND PROCEEDS, TOGETHER WITH OTHER AVAILABLE FUNDS, WERE USED TO REFUND THE OUTSTANDING PRINCIPAL AMOUNTS OF CERTAIN BONDS IN THE AMOUNT OF $3,467,000, TO PAY OR REIMBURSE THE HOSPITAL FOR THE PAYMENT OF THE COST OF ACQUIRING, CONSTRUCTING AND EQUIPPING CERTAIN OF THE HOSPITAL'S HEALTH CARE FACILITIES, TO FUND A DEBT SERVICE RESERVE FUND FOR THE BENEFIT OF THE SERIES 2008 BONDS, AND TO PAY CERTAIN EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE SERIES 2008 BONDS. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TIMOTHY EGAN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | TIMOTHY EGAN IS A FAMILY MEMBER OF DUKE MIGLIN, TRUSTEE | Relationship |
| Amount Of Transaction | 218260 | AmountOfTransaction |
| Description Of Transaction | TIMOTHY EGAN IS AN EMPLOYEE OF NORWEGIAN AMERICAN HOSPITAL AND RECEIVED GROSS COMPENSATION OF $218,260 IN FYE 2013. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE BOARD RETAINS THE SERVICES OF AN INDEPENDENT CPA FIRM TO PREPARE THE ORGANIZATION'S FORM 990. MEMBERS OF THE FISCAL SERVICES DEPARTMENT, THE CHIEF FINANCIAL OFFICER AND THE CHIEF EXECUTIVE OFFICER REVIEW THE COMPLETED FORM 990 AND PROVIDE A FULL COPY TO ALL MEMBERS OF THE FINANCE & AUDIT COMMITTEE. AFTER FORM 990 IS REVIEWED AND ACCEPTED BY THE FINANCE & AUDIT COMMITTEE, A COPY IS MADE AVAILABLE TO ALL VOTING MEMBERS OF THE GOVERNING BODY PRIOR TO FILING. THE GOVERNING BODY IS PROVIDED A REASONABLE AMOUNT OF TIME TO REVIEW THE RETURN AND ASK ANY QUESTIONS DIRECTLY TO ORGANIZATION MANAGEMENT OR THE CONTACT AT THE INDEPENDENT CPA FIRM PRIOR TO FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL TRUSTEES, OFFICERS, AND KEY EMPLOYEES AND KEY PHYSICIANS (AS DEFINED IN THE BOARD'S CONFLICT OF INTEREST POLICY) OF THE CORPORATION ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY. IN ADDITION, ALL INDEPENDENT CONTRACTORS WHO PROVIDE SERVICES AND/OR MATERIALS TO THE CORPORATION IN EXCHANGE FOR $20,000 OR MORE IN PAYMENT DURING ANY FISCAL YEAR SHALL BE SUBJECT TO THESE PROVISIONS. ALL PERSONS SUBJECT HERETO SHALL BE HEREINAFTER REFERRED TO AS "COVERED PERSONS." THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION IS RESPONSIBLE FOR PUBLICIZING THE PROVISIONS OF THIS ARTICLE TO THE PERSONS AFFECTED THEREBY. NO PERSON SHALL BECOME A TRUSTEE, OFFICER, OR EMPLOYEE OR MEDICAL DEPARTMENT DIRECTOR OF THE CORPORATION WITHOUT FIRST ACKNOWLEDGING IN WRITING TO THE CORPORATION THAT HE OR SHE HAS REVIEWED, FULLY UNDERSTANDS AND IS IN COMPLIANCE WITH THE PROVISIONS OF THE CONFLICT OF INTEREST POLICY. ALL COVERED PERSONS SHALL PROMPTLY DISCLOSE TO THE BOARD OF TRUSTEES OF THE CORPORATION ALL SUBSTANTIVE POTENTIAL CONFLICTS OF INTEREST WHICH SUCH PERSON DISCOVERS OR WHICH IS BROUGHT TO HIS OR HER ATTENTION. SUCH DISCLOSURE SHALL INCLUDE SUBMISSION TO THE BOARD OF A WRITTEN STATEMENT OF THE FACTS SURROUNDING THE CONFLICT OF INTEREST AND AN OPPORTUNITY TO MAKE A BRIEF ORAL STATEMENT TO THE BOARD WITH RESPECT TO THE MATTER IN QUESTION. AN ANNUAL DISCLOSURE STATEMENT SHALL BE CIRCULATED TO ALL COVERED PERSONS TO ASSIST THEM IN CONSIDERING SUCH DISCLOSURES. IN ADDITION, THE POLICY IS MONITORED PERIODICALLY THROUGHOUT THE YEAR FOR ANY CONFLICTS OF INTEREST. PROMPT DISCLOSURE NOTICES OF CONFLICT SHALL BE FILED WITH THE PRESIDENT OF THE CORPORATION OR ANY OTHER PERSON DESIGNATED BY HIM FROM TIME TO TIME TO RECEIVE SUCH NOTIFICATIONS. ALL DISCLOSURE NOTICES RECEIVED HEREUNDER SHALL BE NOTED FOR RECORD IN THE MINUTES OF A MEETING OF THE BOARD OF TRUSTEES. THE PRESENCE OF THE TRUSTEE WHO IS DIRECTLY OR INDIRECTLY A PARTY TO THE TRANSACTION IN QUESTION OR A TRUSTEE WHO IS OTHERWISE NOT DISINTERESTED MAY BE COUNTED IN DETERMINING WHETHER A QUORUM IS PRESENT FOR THE PURPOSE OF THE MEETING, BUT SHALL NOT BE PRESENT OR HAVE A VOTE WHEN THE BOARD OF TRUSTEES OR A COMMITTEE OF THE BOARD DISCUSSES AND TAKES ACTION ON THE TRANSACTION. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER/VICE PRESIDENT MEDICAL AFFAIRS AND CHIEF FINANCIAL OFFICER WERE REVIEWED BY AN EXTERNAL ORGANIZATION SPECIALIZING IN COMPENSATION MANAGEMENT. THE RESULTS OF THAT REVIEW WERE PROVIDED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES. | |
| FORM 990, PART VI, SECTION C, LINE 19 | NORWEGIAN AMERICAN HOSPITAL INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART VI, SECTION B, LINE 16B: THE ORGANIZATION DOES NOT GENERALLY INVEST IN FOR PROFIT ENTERPRISES. THE BOARD HAS IN ONE INSTANCE AUTHORIZED AN EXTREMELY LIMITED INVESTMENT IN JOINT VENTURE WHICH WAS DEVELOPING TECHNOLOGY CONSISTENT TO AND COMPLEMENTARY TO THE ORGANIZATION'S MISSION. | ||
| FORM 990, PART XI, LINE 9: | INCOME (LOSS) FROM CENTENNIAL MEDICAL MANAGEMENT CORP 85,509. INCOME (LOSS) FROM NORWEGIAN AMERICAN HOSPITAL FOUNDATION -300,838. INCOME (LOSS) FROM INVESTMENTS IN JOINT VENTURES 401,941. PENSION RELATED CHANGES, OTHER THAN NET PERIOD PENSION COST 4,643,168. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORWEGIAN AMERICAN HOSPITAL FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1044 NORTH FRANCISCO AVENUE | AddressLine1 |
| City | CHICAGO | City |
| State | IL | State |
| ZIP Code | 60622 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363257131 | EIN |
| Primary Activities | SUPPORTING FOUNDATION | PrimaryActivities |
| Legal Domicile State | IL | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 11A, I | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORWEGIAN AMERICAN HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | ControlledOrg |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTENNIAL MEDICAL MANAGEMENT CORPORATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1044 NORTH FRANCISCO AVENUE | AddressLine1 |
| City | CHICAGO | City |
| State | IL | State |
| ZIP Code | 60622 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363394548 | EIN |
| Primary Activity | OUTPATIENT PHARMACY | PrimaryActivity |
| Legal Domicile State | IL | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORWEGIAN AMERICAN HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 886858 | ShareOfTotalIncome |
| Share Of EOY Assets | 906118 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Controlled Org | 1 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 1 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| NORWEGIAN AMERICAN HOSPITAL FOUNDATION | ||
| A | 4800 | BOOK VALUE |
| CENTENNIAL MEDICAL MANAGEMENT CORPORATION | ||
| A | 9772 | BOOK VALUE |
| NORWEGIAN AMERICAN HOSPITAL FOUNDATION | ||
| C | 292977 | BOOK VALUE |
| CENTENNIAL MEDICAL MANAGEMENT CORPORATION | ||
| S | 85508 | BOOK VALUE |