2014-10-31T16:40:44-05:00 2013-12-31 CROWE HORWATH LLP 70 WEST MADISON STREET SUITE 700 CHICAGO IL 606024903 990 2013-01-01 362167847 ROCKFORD MEMORIAL HOSPITAL ROCK 8159715000 2400 N ROCKTON AVE ROCKFORD IL 61103 HENRY M SEYBOLD CFO 2014-10-30 true NICOLE BENCIK P00756195 3128997000 2013 2015-11-30 17:44:51Z GARY KAATZ 2400 N ROCKTON AVE ROCKFORD IL 61103 488447032 false X WWW.RHSNET.ORG X 1883 IL TO IMPROVE AND PROTECT THE HEALTH AND WELFARE OF THE COMMUNITY IN ACCORDANCE WITH OUR MISSION: SUPERIOR CARE, EVERY DAY, FOR ALL OUR PATIENTS. A 396-BED HOSPITAL WITH A LEVEL 1 TRAUMA CENTER, LEVEL III NEONATAL INTENSIVE CARE UNIT, THE REGION'S ONLY PEDIATRIC INTENSIVE CARE UNIT & DESIGNATED DISASTER POD HOSPITAL. 15 9 2422 309 51654 0 5807034 7717024 322774917 326155534 10581871 10344420 1928538 2010494 341092360 346227472 492362 657863 0 0 139266562 145187551 0 0 0 141390627 151222443 281149551 297067857 59942809 49159615 341780038 338477988 188477035 156022822 153303003 182455166 THE MISSION OF ROCKFORD HEALTH SYSTEM AND ROCKFORD MEMORIAL HOSPITAL IS "SUPERIOR CARE, EVERY DAY, FOR ALL OUR PATIENTS". WE WILL FULFILL OUR COMMITMENT THROUGH PERFORMANCE EXCELLENCE, INNOVATION, AND LIFELONG LEARNING. false false 172735229 211880362 ROCKFORD MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT CHARITABLE HEALTHCARE INSTITUTION THAT FUNCTIONS IN ACCORDANCE WITH ALL APPLICABLE LAWS AND REGULATIONS. IN THE COURSE OF OPERATIONS, RMH IS COMMITTED TO PROVIDE SUPERIOR CARE EVERY DAY FOR ALL ITS PATIENTS. RMH IS A 396-BED REGIONAL REFERRAL HOSPITAL WHICH INCLUDES A LEVEL I TRAUMA CENTER, LEVEL III NEONATAL INTENSIVE CARE UNIT AND THE REGION'S ONLY PEDIATRIC INTENSIVE CARE UNIT. IN 2013 PATIENT CARE WAS RENDERED TO 12,532 INDIVIDUALS WHO PRESENTED THEMSELVES FOR SERVICE INCLUDING 1,377 DELIVERIES AND 3,603 INPATIENT SURGERIES ALONG WITH SUPPORTING 49,377 EMERGENCY VISITS. CHARITY CARE PROVIDED IN 2013 AMOUNTED TO $33,923,122. 68219918 113812046 RMH IS DESIGNATED BY THE IL DEPT OF PUBLIC HEALTH AS THE DISASTER POD HOSPITAL FOR THE NORTHERN IL EMS REGION. AS A LEVEL I TRAUMA CENTER, RMH PROVIDES PATIENT CARE, DIAGNOSTIC AND THERAPEUTIC SERVICES 24/7 TO ALL WHO PRESENT THEMSELVES FOR SERVICE. IN 2013, THAT INCLUDED 1,522 VISITS TO THE SLEEP LAB; 85,087 DIAGNOSTIC RADIOLOGY PROCEDURES OR TESTS; 9,310 RADIATION ONCOLOGY TREATMENTS; 32,478 CARDIAC PROCEDURES OR TESTS; 3,781 VISITS TO THE PAIN CLINIC; AND 203,065 RESPIRATORY THERAPY TREATMENTS. THROUGH THE OUTREACH SERVICES OF ROCKFORD HEALTH MEDICAL LABORATORIES (RHML), RMH HAS PROVIDED TIMELY AND RESPONSIVE LAB SERVICES TO OTHER HOSPITALS, PHYSICIANS' OFFICES, AND GOVERNMENT AGENCIES, WHILE THE IN-HOUSE LABORATORY PROVIDES TESTING FOR ALL WHO PRESENT THEMSELVES AT THE HOSPITAL FOR TREATMENT. IN 2013, RHML PERFORMED 1,515,131 TESTS. 7482457 487863 70130 RMH HAS PROVIDED HEALTH EDUCATION AND OUTREACH IN A VARIETY OF FORMS WITHIN THE ELEVEN COUNTY AREA THAT INCLUDES SEVERAL SCHOOL PARTNERSHIPS, MENTORING, HEALTH PROGRAMS, TEACHING, JOB SHADOWING AND VOLUNTEERING. RMH HOSTS SUPPORT GROUPS, TRAINING CLASSES, AND LECTURES SERIES FOR HEALTH AND SAFETY RELATED TOPICS. EMPLOYEES STAFF COMMUNITY HEALTH FAIRS AND OPEN HEALTH SCREENINGS. IN A PROGRAM JOINTLY SPONSORED WITH RONALD MCDONALD CHARITIES, RMH STAFFS THE CAREMOBILES WHICH PROVIDED 1,078 HEALTH AND DENTAL CHECKUPS AND BASIC HEALTH SERVICES TO 954 UNDERINSURED AND UNINSURED CHILDREN. RMH ALSO PROVIDES BOTH FOREIGN LANGUAGE AND HEARING IMPAIRED ASSISTANCE TO PATIENTS AND THEIR FAMILIES TO HELP THEM COMMUNICATE WITH MEDICAL PERSONNEL FOR TREATMENT. FUNDS WERE ALSO USED TO IMPROVE GENERAL HEALTHCARE CONDITIONS THROUGHOUT THE STATE. REVENUE USED TO HELP SUPPORT THESE ACTIVITIES IS PROVIDED BY INVESTMENT INCOME. 868825 170000 343348 THROUGH ROCKFORD MEMORIAL HOSPITAL AUXILIARY, RMH IS ABLE TO PROVIDE EXTRA FUNDS AND SERVICES TO SUPPORT ITS MISSION. THE AUXILIARY HAS 309 VOLUNTEERS WHO LOGGED 32,266 HOURS WHILE ASSISTING WITH GREETING VISITORS, TRANSPORTING PATIENTS, FLORAL OR GIFT DELIVERIES, THRIFT SHOP AND GIFT SHOP ACTIVITIES, AND OTHER SERVICES AS REQUESTED. THE VOLUNTEERS' EFFORTS PROVIDE EXTRA FUNDS AND ENHANCE THE OVERALL HOSPITAL EXPERIENCE FOR PATIENTS, VISITORS AND STAFF. 868825 170000 343348 249306429 true true false true false false false false true true false false false true false false true false false false false false false false false true true true false true true false false false false false false false true true true false false false false true true false false true false true 258 0 true 2422 true true true true BD false false false false false false false false X 15 9 false false false false true true true true true false false true true true true true true false false true true IL X DAVID VOLA CONTROLLER 8159715000 2400 N ROCKTON AVE ROCKFORD IL 61103 CONNIE M VITALI VICE-CHAIR 2.00 0.85 X X 0 0 0 DUANE R BACH TREASURER 0.10 1.10 X X 0 0 0 ELEANOR F DOAR CHAIR 1.00 3.90 X X 0 0 0 GARY E KAATZ PRESIDENT & CEO 1.00 59.00 X X 0 1022487 54975 CURTIS D WORDEN DIRECTOR 0.50 1.90 X 0 4568 0 DENNIS T UEHARA DIRECTOR 20.50 35.00 X 0 517998 42292 JACK J BECHERER DIRECTOR 1.00 0.50 X 0 0 0 JAMES W BRECKENRIDGE DIRECTOR 1.00 41.00 X 0 259859 24631 JEFF R SMITH MD Director 1.00 42.00 X 0 481744 21910 JOHN W CHADWICK DIRECTOR 0.30 0.31 X 0 0 0 JOSE L GONZALEZ DIRECTOR 0.70 53.20 X 0 379146 28049 PAMELA S FOX DIRECTOR 0.10 0.11 X 0 0 0 PAUL A GREEN DIRECTOR 1.00 1.10 X 0 0 0 STACIE TALBERT DIRECTOR 1.00 2.00 X 0 0 0 THOMAS D BUDD DIRECTOR 0.30 1.00 X 0 0 0 HENRY M SEYBOLD CFO 3.00 42.25 X 0 495528 28346 JULIE PETERSON SECRETARY 1.00 40.25 X 0 77351 9182 CAROLYN BENGTSON VP UTILIZATION MANAGEMENT 40.00 0 X 355946 0 29264 JOHN T DORSEY VP Clinical Integration 60.50 1.30 X 343105 0 23565 MICHAEL TYRKUS DIRECTOR OF CYTOGENETICS 40.00 0 X 225600 0 20976 RO NGUYEN PHARMACIST 40.00 0 X 180848 0 14883 SUSAN SCHREIER CHIEF NURSING OFFICER 40.00 0 X 258262 0 18967 1363761 3238681 317041 54 false true false ROCKFORD HEALTH SYSTEM 2400 N ROCKTON AVE ROCKFORD IL 61103 ADMINISTRATIVE SERVICES 4621481 PHILIPS MEDICAL SYSTEM PO BOX 100355 ATLANTA GA 30384 CONTRACT MAINTENANCE 2188303 WILSON ELECTRIC 113 S MADISON ST ROCKFORD IL 611041195 ELECTRICAL CONTRACTOR 1231190 ADVANCED ICU CARE INC PO BOX 671773 DALLAS TX 752671773 REMOTE MONITORING 1223400 CARDIAC SURGERY ASSOCIATES 2650 WARRENVILLE ROAD STE 280 DOWNERS GROVE IL 60515 SURGICAL SERVICES 1170635 50 818754 6894297 3973 7717024 INPATIENT ROUTINE & ANCILLARY 900099 57008369 57008369 OUTPATIENT & EMERGENCY 621400 50933039 50933039 DIAGNOSTIC & MEDICAL LABORATORY 621500 12850779 12808943 41836 MEDICARE/MEDICAID 900099 199697696 199697696 OTHER 900099 5665651 5657839 7812 0 0 0 0 326155534 3783880 3783880 0 0 538853 316055 222798 0 222798 222798 147405127 1058918 141654941 248563 5750186 810355 6560540 6560540 0 0 0 CAFETERIA/FOOD SERVICE/CATERING 722320 1787696 2006 1785690 0 0 0 0 0 0 1787696 346227472 326105886 51654 12352908 657863 657863 0 0 0 0 0 107852225 91429184 16423041 5795566 4545926 1249640 24696649 20963319 3733330 6843111 6151616 691495 0 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RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 48020 48020 false Schedule C, Part II-B, Line 1, Description of the activities reported on Lines 1a through 1i A PERCENTAGE OF THE 2013 ILLINOIS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION DUES WERE USED FOR LOBBYING. 6847928 148494 1068646 186672 11431 7866965 6085799 69541 933066 224548 15930 6847928 5926437 95812 130832 44441 22841 6085799 4988438 320215 756626 117358 21484 5926437 2071454 369919 2640776 76266 17445 4988438 0.05000 0.45300 0.49700 false true true 65484 2535488 2600972 544835 61133467 45310484 16367818 99060 98821 239 244832955 171160564 73672391 3656902 3656902 96298322 0 ACCRUED PENSION 2577822 ACCRUED POST RETIREMENT MEDICAL BENEFITS 5911055 8488877 Schedule D, Part V, Line 4, Intended uses of endowment funds FUNDS WERE USED TO PROVIDE A LECTURE SERIES, FOR CONTINUING EDUCATION FOR EMPLOYEES WANTING TO IMPROVE THEIR CREDENTIALS OR TO FOCUS ON A NEW SKILL OR SOME TECHNOLOGY NOT CURRENTLY AVAILABLE IN THE ROCKFORD COMMUNITY. THERE WERE ALSO MISCELLANEOUS PROJECTS DESIGNATED BY THE FOUNDATION BOARD IN ACCORDANCE WITH THE SPECIFIC ENDOWMENT. ALL FUNDS WERE EXPENDED PER THE SPECIFIC DIRECTION OF EACH ENDOWMENT. SCHEDULE D, PART X, LINE 2, FIN48 (ASC 740) DISCLOSURE THERE IS NO FIN 48 LIABILITY AND AS SUCH, THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS DO NOT INCLUDE A FIN 48 DISCLOSURE. true true X true X 1.75 true X true true true false true true 10638383 0 10638383 0.03580 74525255 79001285 -4476030 0.00000 0 0 0 0.00000 0 0 85163638 79001285 6162353 0.03580 5529315 2706807 2822508 0.00950 562343 28161 534182 0.00180 67907689 65232847 2674842 0.00900 0 0 0 0.00000 444722 0 444722 0.00150 0 0 74444069 67967815 6476254 0.02180 0 0 159607707 146969100 12638607 0.05760 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0 0 0 0 0.00000 true 19265461 0 81482385 99900024 -18417639 X true true 2 1 ROCKFORD MEMORIAL HOSPITAL 2400 N ROCKTON AVE ROCKFORD IL 61103 HTTP://WWW.ROCKFORDHEALTHSYSTEM.ORG/ROCKFORD-MEMORIAL-HOSPITAL 0002048 X X X X X X 2 VANMATRE HEALTH SOUTH 950 S MULFORD RD ROCKFORD IL 61108 HTTP://WWW.ROCKFORDHEALTHSYSTEM.ORG/VAN-MATRE-HEALTHSOUTH-REHABILITATION-HOSPITAL 0005215 X REHABILITATION ROCKFORD MEMORIAL HOSPITAL 1 true X X X X X X X X 11 true true true X http://www.rockfordhealthcouncil.org/RHorg2013/ X X X X X X X X true false true true 175 true 300 true X X X X X X X true true X X X X X true false X X X X true X false false VANMATRE HEALTH SOUTH 2 false true true 200 true 400 true X X true true X false false X X false X X false false Schedule H, Part V Sec B, Line 3, Community Served by Needs Assessment (1) - ROCKFORD MEMORIAL HOSPITAL: IN 2011, THE ROCKFORD HEALTH COUNCIL PRODUCED A REGIONAL HEALTH NEEDS ASSESSMENT WITH EXTENSIVE INTERVIEWS AND SURVEYS TAKEN DURING 2010. CONTACTS INCLUDED FOCUS GROUPS, HEALTH CARE PROVIDERS, COMMUNITY ANALYSIS, HOUSEHOLD SURVEYS ALL OF WHICH INCLUDED LOCAL AND STATE GOVERNMENT ORGANIZATIONS, LOCAL BUSINESSES, AND LOCAL EDUCATORS (PRE-SCHOOL THROUGH COLLEGE). THE SURVEY WAS DONE WITH FUNDING, COOPERATION, PARTICIPATION AND ASSISTANCE FROM ALL THREE ROCKFORD HOSPITALS - RMH, SWEDISHAMERICAN HOSPITAL AND ST. ANTHONY'S MEDICAL CENTER. SURVEY IS AVAILABLE AND WAS PROMULGATED WITHIN THE COMMUNITY BY THE ROCKFORD HEALTH COUNCIL, SURVEY PARTICIPANTS AND WAS MADE AVAILABLE ON ROCKFORD HEALTH COUNCIL'S WEBSITE.; Schedule H, Part V Sec B, Line 4, Other Hospital Facilities included in Needs Assessment (1) - ROCKFORD MEMORIAL HOSPITAL: SWEDISHAMERICAN HOSPITAL AND ST. ANTHONY'S MEDICAL CENTER.; Schedule H, Part V Sec B, Line 20d, How amounts charged to FAP-eligible patients were determined (1) - FACILITY A-ROCKFORD MEMORIAL HOSPITAL: ROCKFORD MEMORIAL HOSPITAL (RMH) PROVIDES CARE, WITHOUT DISCRIMINATION, FOR EMERGENCY MEDICAL CONDITIONS TO INDIVIDUALS REGARDLESS OF WHETHER THEY ARE FAP-ELIGIBLE. RMH DOES NOT DISCOURAGE INDIVIDUALS FROM SEEKING EMERGENCY MEDICAL CARE BY DEMANDING PAYMENT PRIOR TO SERVICE. FAP-ELIGIBLE PATIENTS ARE NOT CHARGED MORE THAN AMOUNTS GENERALLY BILLED. IF THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE PATIENT WILL BE LIMITED IN LIABILITY TO 135% OF COST DETERMINED BY APPLYING RATIO OF COST TO CHARGES FROM MOST RECENTLY FILED MEDICARE COST REPORT TO UNINSURED PATIENT'S BILL. THE MAXIMUM AMOUNT RMH MAY COLLECT IN A 12-MONTH PERIOD FROM A PATIENT IS 25% OF THE FAMILY'S GROSS ANNUAL INCOME.; SCHEDULE H, PART I, LINE 3C, CRITERIA FOR DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE ROCKFORD MEMORIAL HOSPITAL (RMH) OFFERS TWO CHARITY CARE PROGRAMS - HUPDA AND OUR TRADITIONAL CHARITY CARE PROGRAM. WE WILL PROCESS CHARITY CARE FOR WHICHEVER PROVIDES THE HIGHEST PERCENTAGE OF DISCOUNT. HUPDA IS THE ILLINOIS HOSPITAL UNINSURED PATIENT DISCOUNT ACT FOR ALL UNINSURED PATIENTS. ELIGIBILITY CONSISTS OF BEING AN UNINSURED ILLINOIS RESIDENT, INCOME BELOW 600% OF FPG, BEING TREATED FOR A MEDICALLY NECESSARY CONDITION OR EVENT, LIMITED TO 25% OF ANNUAL INCOME. PATIENTS SUBMIT PROOF OF INCOME INCLUDING TAX RETURNS/PAY STUBS. TRADITIONAL DISCOUNTS FOLLOW OUR INTERNAL TRADITIONAL CHARITY CARE PROGRAM FOR THOSE WHO ARE UNINSURED OR ARE INSURED WITH A PATIENT LIABILITY. THIS INCOME LIMIT IS 300% OF FPG. PATIENT MUST SUBMIT PROOF OF INCOME THAT INCLUDES TAX RETURNS. UNDERINSURED PATIENTS MAY BE ELIGIBLE FOR OTHER DISCOUNTS TOWARDS THE PATIENT LIABILITY. THERE ARE ALSO POTENTIAL DISCOUNTS FOR CATASTROPHIC FINANCIAL ASSISTANCE AND/OR PROMPT PAY. EXTENUATING CIRCUMSTANCES MAY ALSO BE TAKEN INTO ACCOUNT. OUR PARTNER HOSPITAL VMHS IS A FOR-PROFIT HOSPITAL THAT IS PART OF A LARGER HEALTH ORGANIZATION. THEREFORE MOST OF THE RESPONSES CONCERN ONLY THE RMH PROCESS AND PROCEDURES. SCHEDULE H, PART I, LINE 6A, COMMUNITY BENEFIT REPORT ROCKFORD HEALTH SYSTEM PREPARES AN ANNUAL HOSPITAL COMMUNITY BENEFIT REPORT AS REQUIRED BY THE STATE OF ILLINOIS. THE REPORT INCLUDES DATA FOR ROCKFORD MEMORIAL HOSPITAL (RMH) AS WELL AS THE OTHER FOUR RELATED TAX-EXEMPT ORGANIZATIONS. THE REPORT IS DISTRIBUTED WITHIN THE HEALTH SYSTEM AND IS ALSO AVAILABLE UPON REQUEST. OUR PARTNER HOSPITAL VMHS IS A FOR-PROFIT HOSPITAL THAT IS PART OF A LARGER HEALTH ORGANIZATION. AS SUCH, THEY DO NOT PREPARE A COMMUNITY BENEFIT REPORT. THIS AND MOST OF THE ADDITIONAL NARRATIVE RESPONSES CONCERN ONLY THE RMH PROCESS AND PROCEDURES. Schedule H, Part I, Line 7, Costing Methodology used to calculate financial assistance THE HOSPITAL UTILIZED BOTH THE MEDICARE COST REPORT CCR (COST-TO-CHARGE RATIO) AND OUR COST ACCOUNTING SYSTEM TO DETERMINE THE COST OF CHARGES, BAD DEBT AND CHARITY CARE EXPENSE INCLUDED IN LINE 7. THE SUBSIDIZED PROGRAMS ALSO INCLUDE THE COSTS (BASED ON A CALCULATED CCR) FROM OUR PHYSICIAN CLINIC BECAUSE THERE ARE NO PHYSICIANS COSTS INCLUDED IN THE HOSPITAL COST ACCOUNTING ANALYSIS. BAD DEBT AND CHARITY AT COST HAVE BEEN REMOVED FROM LINES 7E/7F/7G SINCE THOSE COSTS WERE PREVIOUSLY INCLUDED. Schedule H, Part I, Line 7, col(f), Bad Debt Expense excluded from financial assistance calculation 0 Schedule H, Part III, Line 2, Bad debt expense - methodology used to estimate amount ALL CHARGES FOR ANY SERVICE PROVIDED BY ROCKFORD MEMORIAL HOSPITAL ARE THE VERY SAME FOR EVERY INDIVIDUAL, REGARDLESS OF WHETHER IT IS FOR EMERGENCY OR STANDARD CARE AND REGARDLESS OF THE PATIENT'S ABILITY TO PAY. EACH PATIENT IS THEN ASSESSED FOR ELIGIBILITY FOR FINANCIAL ASSISTANCE BASED ON PREDEFINED CRITERIA OF FINANCIAL STATUS AND INCOME LEVEL. IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, THE EXPECTED REIMBURSEMENT IS BASED ON CHARITY CARE POLICY GUIDELINES. IF THE PATIENT HAS NO INSURANCE AND DOESN'T QUALIFY FOR FINANCIAL ASSISTANCE, THE EXPECTED REIMBURSEMENT IS 75% OF BILLED CHARGES. THE ORGANIZATION MAINTAINS A BAD DEBT RESERVE ON THE BALANCE SHEET. ANY BAD DEBT WRITE-OFFS OF PATIENT ACCOUNTS WILL GO AGAINST THE BAD DEBT RESERVE. AT EACH MONTH END BASED ON THE ACCOUNTS RECEIVABLE BY FINANCIAL CLASS AND AGING BUCKET, THE RESERVE AMOUNT IS RE-EVALUATED. THE AMOUNT NEEDED TO MAINTAIN THE APPROPRIATE RESERVE LEVEL IS THE BAD DEBT EXPENSE. ANY PAYMENTS RECEIVED ON PATIENT ACCOUNTS PREVIOUSLY WRITTEN OFF TO BAD DEBT WILL OFFSET THE BAD DEBT EXPENSE. Schedule H, Part III, Line 4, Bad debt expense - financial statement footnote ROCKFORD HEALTH SYSTEM CONSOLIDATED AUDIT REPORTS: NET PATIENT SERVICE REVENUE IS REPORTED AT ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED. CONTRACTUAL ADJUSTMENTS REPRESENT THE DIFFERENCE BETWEEN ESTABLISHED RATES FOR SERVICES AND AMOUNTS PAID BY THIRD-PARTY PAYORS. PAYMENTS UNDER THESE AGREEMENTS AND PROGRAMS ARE BASED ON EITHER A SPECIFIC AMOUNT PER CASE; COSTS, AS DEFINED, OF RENDERING SERVICES TO PROGRAM BENEFICIARIES; OR CONTRACTED PRICE. AMOUNTS FOR UNCOLLECTIBLE ACCOUNTS ARE ALSO INCLUDED AS REDUCTIONS TO NET PATIENT SERVICE REVENUE. CONTRACTUAL ADJUSTMENTS AND BAD DEBTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED, AND ARE ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED. Schedule H, Part III, Line 8, Community benefit & methodology for determining medicare costs THE DATA REPORTED FOR MEDICARE CHARGES AND PAYMENTS IS FROM THE FINAL MANAGEMENT REPORT PRODUCED BY THE FIRM THAT PREPARED THE 2013 COST REPORT AS SUBMITTED TO THE FISCAL INTERMEDIARY IN 2014 IN COMPLIANCE WITH ALL CURRENT REGULATIONS. REPORTED ON LINE 6 ARE ALLOWABLE MEDICARE COSTS PROVIDED BY THE COST REPORT. MEDICARE COSTS ARE ELIMINATED FROM THE SUBSIDIZED PROGRAMS ON PART 1 LN 7G AS CALCULATED BY OUR COST ACCOUNTING ANALYSIS. A COMBINATION OF COST ACCOUNTING AND THE MEDICARE CCR WAS USED FOR THE COMPUTATION OF SUBSIDIZED PROGRAMS. THIS SECTION B-MEDICARE ALSO INCLUDES 50% OF THE MEDICARE ACTIVITY FROM VAN MATRE HEALTH SOUTH (VMHS) AND THE CORRESPONDING COST BASED ENTIRELY ON THEIR MEDICARE CCR. Schedule H, Part III, Line 9b, Collection practices for patients eligible for financial assistance ROCKFORD MEMORIAL HOSPITAL HAS A STRONG COMMITMENT TO PROVIDE QUALITY PATIENT CARE FOR ALL INDIVIDUALS. OUR MISSION IS TO PROVIDE HEALTH CARE TO EVERYONE WHO COMES TO OUR DOOR, REGARDLESS OF THEIR ABILITY TO PAY. WE WILL SUBMIT A CLAIM TO ALL 3RD PARTY PAYORS ON BEHALF OF THE PATIENT. WE HELP PATIENTS APPLY FOR ALL POSSIBLE INSURANCE OR ASSISTANCE SUCH AS CRIME VICTIMS, AN AUTOMOBILE ACCIDENT, WORKERS' COMPENSATION, MEDICAID, COBRA, LOCAL ASSISTANCE AND/OR HOSPITAL FINANCIAL ASSISTANCE. IF THEY DO NOT QUALIFY FOR ANY OF THESE, WE CAN EXTEND PAYMENT OPTIONS SUCH AS MONTHLY PAYMENTS, CREDIT CARD PAYMENTS OR FINANCIAL ASSISTANCE. THIS IS OFFERED TO PATIENTS WHO ARE EXPERIENCING LEGITIMATE FINANCIAL HARDSHIPS AND ARE UNABLE TO PAY FOR ALL OR PART OF THE PATIENT'S MEDICAL CARE. FORGIVENESS MAY APPLY TO AN AMOUNT AFTER APPLYING ALL PAYMENTS SUCH AS ANY INSURANCE COMPANY, HEALTH PLAN OR PERSONAL PAYMENTS, ANY NEGOTIATED DISCOUNTS OR ANY UNINSURED DISCOUNTS. IF A PATIENT ELIGIBLE FOR CHARITY CARE OR PARTIAL FINANCIAL ASSISTANCE STILL HAS A PORTION OF THE OUTSTANDING BALANCE DUE, OTHER ARRANGEMENTS ARE MADE. RMH ACCEPTS A VARIETY OF PAYMENTS AND ALTERNATIVE PAYMENT PLANS. MONTHLY STATEMENTS ARE SENT AS PAYMENT REMINDERS FOR CONTRACTED ARRANGEMENTS. IN CASE OF DEFAULT, ADDITIONAL LETTERS AND CALLS ARE MADE TO BRING IT TO A CURRENT STATUS. AN ACCOUNT IS TURNED OVER TO A COLLECTION AGENCY ONLY AFTER NON-PAYMENT OR NO CONTACT IN 120 DAYS ALTHOUGH RMH WILL SUSPEND COLLECTION EFFORTS ONCE A COMPLETED APPLICATION HAS BEEN RECEIVED AND IS PENDING APPROVAL OR DENIAL. OUR PARTNER HOSPITAL VMHS IS A FOR-PROFIT HOSPITAL THAT IS PART OF A LARGER HEALTH ORGANIZATION. MUCH OF THE INFORMATION THAT WOULD NORMALLY BE REQUIRED FOR A NON-PROFIT IS NOT PERTINENT. THEREFORE MOST OF THE RESPONSES CONCERN ONLY THE RMH PROCESS AND PROCEDURES. SCHEDULE H, PART V, GENERAL INFORMATION REGARDING HOSPITAL #2 OUR PARTNER HOSPITAL VMHS IS A FOR-PROFIT HOSPITAL THAT IS PART OF A LARGER HEALTH ORGANIZATION. MUCH OF THE INFORMATION THAT WOULD NORMALLY BE REQUIRED FOR A NON-PROFIT IS NOT PERTINENT. THEREFORE MOST OF THE DETAILED RESPONSES CONCERN ONLY THE RMH PROCESS AND PROCEDURES. SCHEDULE H, PART V, SECTION B, LINE 20, MAXIMUM AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS ALL CHARGES FOR ANY SERVICE PROVIDED BY ROCKFORD MEMORIAL HOSPITAL ARE THE VERY SAME FOR EVERY INDIVIDUAL, REGARDLESS OF WHETHER IT IS FOR EMERGENCY OR STANDARD CARE AND REGARDLESS OF THE PATIENT'S ABILITY TO PAY. EACH PATIENT IS THEN ASSESSED FOR ELIGIBILITY FOR FINANCIAL ASSISTANCE BASED ON PREDEFINED CRITERIA OF FINANCIAL STATUS AND INCOME LEVEL. IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, THE EXPECTED REIMBURSEMENT IS BASED ON CHARITY CARE POLICY GUIDELINES. IF THE PATIENT HAS NO INSURANCE AND DOESN'T QUALIFY FOR FINANCIAL ASSISTANCE, THE EXPECTED REIMBURSEMENT IS 75% OF BILLED CHARGES. SCHEDULE H, PART V, SECTION B, LINE 21, CHARGES BILLED THE CHARGES BILLED ARE ALWAYS UNIFORM, THE COLLECTED AMOUNTS MAY VARY DEPENDING ON APPLICABLE DISCOUNTS. Schedule H, Part VI, Line 2, Needs assessment. IN 2010 THE ROCKFORD HEALTH COUNCIL BEGAN TO GATHER DATA FROM THE NORTHERN ILLINOIS REGION ENCOMPASSING WINNEBAGO AND BOONE COUNTIES. RHS SUPPORT WAS FINANCIAL, TECHNICAL AND INCLUDED SIGNIFICANT REPRESENTATION ON BOTH THE ROCKFORD HEALTH COUNCIL BOARD OF DIRECTORS AND THE SURVEYING STAFF. THIS COLLABORATIVE EFFORT, PARTNERING HEALTHCARE AND EDUCATION, GATHERED, ANALYZED AND REPORTED ON THE HEALTH NEEDS OF THE COMMUNITY. THE OTHER TWO AREA HOSPITALS BOTH SUPPORTED AND PARTICIPATED TO PRODUCE A MAJOR EFFORT WHICH WAS RELEASED TO THE COMMUNITY IN JULY 2011. IT REVEALED TRENDS, CHANGES AND UNMET NEEDS. THE SURVEY IS AVAILABLE ON THE ROCKFORD HEALTH COUNCIL WEBSITE. THIS ASSESSMENT SERVES AS A BLUEPRINT FOR FUTURE HEALTH CARE INITIATIVES AND POINTS TOWARD GROWTH IN OUR REGION. THE PRIORITIES IDENTIFIED WERE USED AS THE FRAMEWORK IN THE DEVELOPMENT OF THE RHS COMMUNITY BENEFIT PLAN. EACH PRIORITY HAS A SPECIFIC OVERRIDING STRATEGY WITH STATED DETAILED TACTICS AND MEASURABLE OBJECTIVES. AN EXECUTIVE SUMMARY DETAILING THE PROCESS AND FINDINGS, THE RHS COMMUNITY PLAN DOCUMENT, AND A PARTIAL INVENTORY DETAILING MANY OF THE SIGNIFICANT PROGRAMS AND INITIATIVES THAT SUPPORT RHS COMMITMENT TO IMPROVING THE OVERALL HEALTH AND WELL-BEING OF THE COMMUNITY RESIDENTS WERE INCLUDED. IN DECEMBER 2011, THE BOARD OF DIRECTORS APPROVED THE RESOLUTION TO ADOPT THE ROCKFORD HEALTH SYSTEM COMMUNITY BENEFIT PLAN AND SUBSEQUENT IMPLEMENTATION OF ITS RECOMMENDATIONS. RHS IS CONTINUING WITH DEVELOPMENT AND IMPLEMENTATION OF A COMPREHENSIVE MULTIFACETED COMMUNITY BENEFIT PLAN TO IMPROVE THE OVERALL HEALTH AND WELL-BEING OF RESIDENTS IN THE PRIMARY SERVICE AREA. Schedule H, Part VI, Line 3, Patient education of eligibility for assistance. RMH POSTS SIGNS IN ALL GENERAL REGISTRATION AREAS AND THE EMERGENCY DEPARTMENT IN BOTH SPANISH AND ENGLISH TO INDICATE THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR THOSE WHO QUALIFY. THE ORGANIZATION'S WEBSITE STATES "PATIENTS THROUGHOUT ROCKFORD HEALTH SYSTEM ARE TREATED REGARDLESS OF THEIR ABILITY TO PAY. CLICK ON THE ENTITY ABOVE TO LEARN MORE." THE RMH LINK TO FINANCIAL ASSISTANCE AND DISCOUNT PROGRAMS EXPLAINS THE PROCESS IN THIS MANNER "ROCKFORD HEALTH SYSTEM PROVIDES HEALTH CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR SUCH CARE. THESE GUIDELINES ARE INTENDED TO PROVIDE A FRAMEWORK TO OFFER ASSISTANCE TO PATIENTS AND FAMILIES WITH LEGITIMATE FINANCIAL HARDSHIP, WHO ARE UNABLE TO PAY FOR ALL OR A PORTION OF THEIR MEDICAL CARE. COVERED SERVICES ARE THOSE WHICH ARE DETERMINED MEDICALLY NECESSARY BY A PHYSICIAN. OUR FINANCIAL ASSISTANCE PROGRAMS ARE BASED ON WHETHER YOU HAVE INSURANCE COVERAGE OF ANY KIND OR ARE UNINSURED." Schedule H, Part VI, Line 4, Community information. ROCKFORD MEMORIAL HOSPITAL IS LOCATED IN ROCKFORD, IL (WINNEBAGO COUNTY) WITH A DEFINED PRIMARY SERVICE AREA THAT INCLUDES WINNEBAGO, BOONE AND OGLE COUNTIES. 2012 US CENSUS BUREAU ESTIMATES PROJECT THE POPULATION FOR THE ENTIRE PRIMARY SERVICE AREA AT CLOSE TO 399,000 INDIVIDUALS WITH A LITTLE MORE THAN 73% LIVING IN WINNEBAGO COUNTY (APPROXIMATELY 295,000). THE HOSPITAL ALSO SERVES THE SECONDARY SERVICE AREA WHICH INCLUDES DEKALB, MCHENRY, WHITESIDE, LEE, LASALLE, STEPHENSON AND ROCK COUNTIES FOR SELECT TERTIARY SERVICES. LOCATED IN NORTHERN ILLINOIS, THE PRIMARY SERVICE AREA IS CHARACTERIZED AS LARGELY RURAL AND POPULATED WITH VERY SMALL COMMUNITIES WITH THE EXCEPTION OF THE NEIGHBORING CITIES OF ROCKFORD, LOVES PARK, AND MACHESNEY PARK WHICH COMPRISE NEARLY 198,000 INDIVIDUALS. THE NEXT LARGEST COMMUNITY IS BELVIDERE, LOCATED IN BOONE COUNTY, WHERE THE ENTIRE COUNTY HAS A POPULATION OF APPROXIMATELY 54,000 INDIVIDUALS. IN CALENDAR YEAR 2012, APPROXIMATELY 85% OF HOSPITAL INPATIENTS WERE FROM THE PRIMARY SERVICE AREA. AS A COMMUNITY THAT RELIES HEAVILY ON MANUFACTURING COMPANIES AND SMALL BUSINESSES, THE AREA HAS BEEN PARTICULARLY HARD HIT IN RECENT ECONOMIC TIMES. CURRENTLY THE LARGEST EMPLOYERS INCLUDE CHRYSLER (BOONE COUNTY), THE ROCKFORD SCHOOL DISTRICT, AND THE THREE ROCKFORD HEALTH CARE PROVIDERS. THE MOST RECENT MEDIAN HOUSEHOLD INCOME FIGURES (U.S. CENSUS BUREAU) IN WINNEBAGO COUNTY WERE $47,600 COMPARED TO THE STATE'S MEDIAN HOUSEHOLD INCOME OF APPROXIMATELY $56,600. THESE DISPARITIES ARE ALSO REFLECTED IN UNEMPLOYMENT, EDUCATION AND POVERTY RATES. UNEMPLOYMENT RATES REMAIN HIGH AT 10.2% IN ROCKFORD IN APRIL 2014 COMPARED TO STATE FIGURES AT 7.5%. ONLY 21% OF WINNEBAGO COUNTY RESIDENTS ATTAIN A BACHELOR'S DEGREE OR HIGHER, WHILE IN THE STATE 31% DO. 17% OF RESIDENTS LIVING IN WINNEBAGO COUNTY ARE BELOW THE POVERTY LINE COMPARED TO OVERALL STATE LEVELS OF SLIGHTLY MORE THAN 13%. CHILDREN IN THE COMMUNITY HAVE BEEN PARTICULARLY HARD HIT WITH CLOSE TO 28% CONSIDERED AT OR BELOW POVERTY LEVELS. (WINNEBAGO COUNTY HEARTLAND ALLIANCE 2011) ALL OF THESE CONDITIONS HAVE RESULTED IN INCREASING PRESSURES ON THE COMMUNITY. ROCKFORD MEMORIAL HOSPITAL IS LOCATED IN THE OLDER, WESTERN PORTION OF THE COMMUNITY AND SERVES A SIGNIFICANT INDIGENT AND ELDERLY POPULATION. THIS IS EVIDENT WHEN LOOKING AT INCOME LEVELS FOR HOUSEHOLDS LOCATED IN ZIP CODES IN WESTERN ROCKFORD WHERE THE HOSPITAL RESIDES. FOR EXAMPLE, THE U.S. CENSUS BUREAU 2008-2012 AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES FOR INDIVIDUAL ZIP CODES LISTS MEDIAN HOUSEHOLD INCOME FOR WEST SIDE ZIP CODES AS FOLLOWS: 61103 $35,960; 61102 $31,701; 61101 - $29,909. THE GEOGRAPHIC DISPARITIES ARE EVIDENT WHEN THESE NUMBERS ARE COMPARED TO HOUSEHOLDS LOCATED IN THE EASTERN PORTION OF ROCKFORD. IN COMPARISON, THE 3 LARGEST EAST-SIDE ZIP CODES HAVE THE FOLLOWING MEDIAN HOUSEHOLD INCOMES: 61107 $56,348; 61108 - $47,067; 61109 - $41,315. (NOTE THAT 61109 IS THE THIRD LARGEST EAST-SIDE ZIP, IN TOTAL POPULATION). AS THE ONLY AREA AND NORTHERN ILLINOIS HOSPITAL OFFERING LEVEL III NEONATAL INTENSIVE CARE AND COMPREHENSIVE PEDIATRIC AND PEDIATRIC INTENSIVE CARE SERVICES, ROCKFORD MEMORIAL HOSPITAL IS COMMITTED TO CHILDREN AND IS THE MAIN PROVIDER OF CHILDREN'S SERVICES IN THE AREA AND THE GREATER TERTIARY SERVICE AREA. WITH ONE IN THREE CHILDREN CURRENTLY AT OR BELOW FEDERAL POVERTY LEVELS IN WINNEBAGO COUNTY AND THE OVERALL ECONOMIC CONDITION OF THE COMMUNITY, THE HOSPITAL CONTINUES TO SEE INCREASING NUMBERS OF UNINSURED AND PUBLIC AID PATIENTS IN RECENT YEARS AND THIS TREND CONTINUES TO GROW. Schedule H, Part VI, Line 5, Promotion of community health LED BY COMMUNITY BOARDS OF DIRECTORS, ROCKFORD MEMORIAL HOSPITAL (RMH) AND ITS AFFILIATES ARE EXTREMELY INVOLVED IN PROMOTING A HEALTHIER COMMUNITY. AS ONE OF ROCKFORD'S LARGEST EMPLOYERS, THE ORGANIZATION TAKES A LEADING ROLE IN FINANCIALLY SUPPORTING NOT ONLY HEALTH-RELATED INITIATIVES, BUT ALSO COMMUNITY-BUILDING ACTIVITIES ACROSS THE REGION. IT INCLUDES PROVIDING FINANCIAL SUPPORT AND TALENT FOR ECONOMIC DEVELOPMENT AND BUSINESS-RELATED ACTIVITIES, AS WELL AS QUALITY OF LIFE AND EDUCATIONAL INITIATIVES. EMPLOYEES PARTICIPATE IN COMMUNITY BOARDS AND ARE ACTIVELY INVOLVED IN PROMOTING THE REGION AND ITS ASSETS. THE RHS BOARD IS COMPRISED OF PERSONS WHO RESIDE WITHIN THE ORGANIZATION'S PRIMARY SERVICE AREA , WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME AND/OR ALL OF ITS DEPARTMENTS OR SPECIALTIES. ROCKFORD MEMORIAL HOSPITAL IS COMMITTED TO TREATING ALL PATIENTS IN IMMEDIATE NEED OF MEDICAL SERVICES REGARDLESS OF THEIR ABILITY TO PAY. WE ALSO PROVIDE EXTENSIVE OUTREACH, EDUCATION AND HEALTH SCREENINGS TO BENEFIT THE COMMUNITY. COMMUNITY OUTREACH - IN 2013, ROCKFORD HEALTH SYSTEM HELD A SERIES OF FREE COMMUNITY PROGRAMS DESIGNED TO EDUCATE THE PUBLIC ON IMPORTANT HEALTH ISSUES. COMMUNITY SCREENINGS AND WELLNESS EVENTS INCLUDED CAR SEAT SAFETY CHECKS, BLOOD PRESSURE, WEIGHT, CHOLESTEROL AND DIABETES. SOME OF THE TOPICS COVERED IN THIS YEAR'S PROGRAMMING INCLUDED STROKE EDUCATION, URINARY INCONTINENCE, MENOPAUSE, HEART HEALTH, END OF LIFE PLANNING AND CPR. RONALD MCDONALD CARE MOBILE - IN 2003, THE ROCKFORD MEMORIAL HOSPITAL CHILDREN'S MEDICAL CENTER BEGAN A PARTNERSHIP WITH RONALD MCDONALD HOUSE CHARITIES TO PROVIDE FREE DENTAL AND MEDICAL CARE TO UNINSURED AND UNDERINSURED CHILDREN IN FIVE NORTHERN ILLINOIS COUNTIES VIA THE RONALD MCDONALD CARE MOBILE, THE 40-FOOT, 26,000-POUND MOBILE UNIT THAT HOUSES TWO PATIENT EXAM ROOMS AND A STERILIZATION AREA. IN 2012, THE PROGRAM CELEBRATED THE MILESTONE OF PROVIDING CARE TO MORE THAN 5,000 CHILDREN, NOW TOTALING MORE THAN $1.5 MILLION IN FREE CARE OVER THE LIFE OF THE PROGRAM. THE PARTNERSHIP HAS PROVIDED MORE THAN 6,900 DENTAL VISITS, 1,500 MEDICAL VISITS, AND 1,300 IMMUNIZATIONS. IN ADDITION, MORE THAN 600 FAMILIES RECEIVED MEDICAL AND DENTAL INSURANCE COVERAGE THROUGH ALL KIDS/KIDCARE AS A RESULT OF THEIR INTERACTION WITH THE CARE MOBILE. FOR THE FIRST YEARS OF THE PROGRAM, THE MEDICAL/DENTAL CLINIC ON WHEELS WAS SHARED WITH ANOTHER HOSPITAL IN MADISON. IN 2012, ROCKFORD MEMORIAL HOSPITAL WAS EXCITED TO TAKE FULL OWNERSHIP OF THE CARE MOBILE VEHICLE, GREATLY EXPANDING THE FREE MEDICAL AND DENTAL CARE WE PROVIDE TO NEEDY CHILDREN IN NORTHERN ILLINOIS BY MORE THAN DOUBLING THE MONTHS OF OPERATION. THE CARE MOBILE IS COMPLETELY FUNDED BY PHILANTHROPY INCLUDING THE ROCKFORD MEMORIAL DEVELOPMENT FOUNDATION, ROCKFORD MEMORIAL HOSPITAL AUXILIARY, AND THE RONALD MCDONALD HOUSE CHARITIES OF MADISON. THE BRIDGE CLINIC - ROCKFORD HEALTH SYSTEM PARTNERS WITH THE FIRST PRESBYTERIAN CHURCH AND SECOND CONGREGATIONAL CHURCH OF ROCKFORD TO OPERATE THE BRIDGE CLINIC. VOLUNTEER PHYSICIANS, MEDICAL STUDENTS, NURSE PRACTITIONERS AND NURSES PROVIDE BASIC MEDICAL CARE TO UNINSURED AND UNDERINSURED ADULTS AT THIS FREE SATURDAY CLINIC HOUSED IN A DOWNTOWN ROCKFORD CHURCH. THE BRIDGE CLINIC ALSO OFFERS FREE CLASSES AND EDUCATIONAL RESOURCES SUCH AS DIABETES EDUCATION. MANY OF THE PHYSICIANS AND STAFF ARE VOLUNTEERS FROM ROCKFORD MEMORIAL HOSPITAL AND COSTS FOR OPERATING THE CLINIC ARE COVERED THROUGH PHILANTHROPY SPONSORED BY ROCKFORD HEALTH SYSTEM. SINCE ITS OPENING IN 2008, HUNDREDS OF PEOPLE HAVE BEEN CARED FOR FROM OUR COMMUNITY. WITH THE ROCKFORD REGION'S UNEMPLOYMENT RATES THE HIGHEST IN ILLINOIS, THE BRIDGE CLINIC AND ITS STAFF HELP RELIEVE STRESS, PARTICULARLY FOR UNEMPLOYED INDIVIDUALS WITH CHRONIC MEDICAL ISSUES. THE BRIDGE CLINIC IS A SAFE PLACE TO RECEIVE THE BASIC MEDICAL ATTENTION THEY NEED, FREE OF CHARGE. VIDEO INTERPRETATION - PATIENTS WHO SEEK MEDICAL CARE AT ROCKFORD HEALTH SYSTEM HAVE VERY DIVERSE NEEDS. FOR SOME, HAVING A DIRECT CONVERSATION WITH A DOCTOR CAN BE CHALLENGING. IT MAY BE BECAUSE THEY CANNOT HEAR OR SPEAK ANOTHER LANGUAGE. SINCE 2011, VIDEO INTERPRETATION IS AVAILABLE FOR THE DEAF AND HARD OF HEARING, AS WELL AS SPANISH-SPEAKING PATIENTS. LAPTOP COMPUTERS WITH VIDEO CAMERAS, IN ROCKFORD MEMORIAL HOSPITAL AND ACROSS ROCKFORD HEALTH PHYSICIAN OFFICES, QUICKLY LINK SKILLED INTERPRETERS WITH PATIENTS AND CAREGIVERS. BOTH PATIENTS AND HEALTH CARE PROFESSIONALS CAN REST ASSURED THAT THERE HAS BEEN AN ACCURATE EXCHANGE OF INFORMATION FOR PURPOSES OF DIAGNOSIS AND TREATMENT. AUTOMATIC EXTERNAL DEFIBRILLATORS - FOR MORE THAN 10 YEARS, ROCKFORD HEALTH SYSTEM, IN PARTNERSHIP WITH THE ROCKFORD MEMORIAL DEVELOPMENT FOUNDATION, HAS BEEN HELPING COMMUNITY NON-PROFIT ORGANIZATIONS OBTAIN AUTOMATIC EXTERNAL DEFIBRILLATORS (AEDS). THESE PORTABLE, EASY-TO-USE DEVICES ADMINISTER IMMEDIATE, LIFE-SAVING TREATMENT THAT SHOCKS A HEART IN CARDIAC ARREST BACK TO A REGULAR HEARTBEAT. FROM THE INCEPTION OF THE PROGRAM IN 1999 THROUGH 2012, THE FOUNDATION HAS DONATED 126 AEDS TO COMMUNITY ORGANIZATIONS AND FACILITIES IN THE ROCKFORD AREA THROUGH ITS EXTERNAL GRANTS PROGRAM. THERE ARE MANY STORIES OF LIVES SAVED IN OUR COMMUNITY, THANKS TO THE DONATED AEDS. THE WINNEBAGO COUNTY SHERRIFF'S OFFICE, WHICH HAS RECEIVED 13 AEDS FROM THE ROCKFORD MEMORIAL DEVELOPMENT FOUNDATION, HAS USED THESE LIFE-SAVING DEVICES 16 TIMES AND ALONE HAS REPORTED FIVE "SAVES." REACT AIR TRANSPORT SERVICES - THE ROCKFORD MEMORIAL HOSPITAL REACT TRANSPORT PROGRAM IS ACCREDITED THROUGH THE COMMISSION OF AIR MEDICAL TRANSPORT SYSTEMS (CAMTS) AND IS AVAILABLE TO PROVIDE ACUTE CLINICAL EXPERTISE AT THE SCENE OF THE ACCIDENT. IN 2013, OUR HELICOPTER AND HIGHLY TRAINED STAFF WERE AT ACCIDENT SCENES TO STABILIZE AND TRANSPORT EMERGENT PATIENTS TO THE HOSPITAL. THE HELICOPTER AND CREW COMPLETED 151 TRANSPORTS DURING 2013. THE REACT CREW CONSISTS OF CRITICAL CARE TRAINED NURSES WITH A MINIMUM OF 5 YEARS OF INTENSIVE CARE EXPERIENCE. THESE INDIVIDUALS HAVE RECEIVED ADDITIONAL TRAINING IN ADVANCED CARDIAC LIFE SUPPORT (ACLS), PEDIATRIC ADVANCED LIFE SUPPORT (PALS), ARE MEMBERS OF THE NEONATAL RESUSCITATION PROGRAM AND ARE SPECIFICALLY TRAINED AS TRAUMA NURSE SPECIALISTS. IN ADDITION, THEY ARE INTERNATIONAL TRAUMA LIFE SUPPORT (ITLS) TRAINED, AMERICAN HEART ASSOCIATION CPR TRAINED, CRITICAL CARE RN (CCRN) CERTIFIED AND CRITICAL CARE FLIGHT NURSE (CFRN) TRAINED. FLU SHOT PARTNERSHIP - FOR THE SECOND YEAR, ROCKFORD MEMORIAL HOSPITAL AND THE WINNEBAGO COUNTY HEALTH DEPARTMENT CREATED A UNIQUE COALITION TO IMPROVE COMMUNITY DISASTER PREPAREDNESS AND HEALTH PREVENTION ACTIVITIES. THE PARTNERSHIP COMBINED A PANDEMIC DISASTER DRILL AND THE OPPORTUNITY TO PROVIDE INFLUENZA IMMUNIZATIONS TO AT-RISK MEMBERS OF THE COMMUNITY. IN 2012, ROCKFORD MEMORIAL DEPLOYED REGION 1 DISASTER EQUIPMENT TO FIVE COMMUNITY SITES (INCLUDING A LOCAL FOOD PANTRY), COORDINATING PARTICIPATION BY SIX HEALTH SCIENCE SCHOOLS. IN ALL OVER 100 NEW VOLUNTEERS PARTICIPATED IN THE DISASTER DRILL AND OVER 450 FLU SHOTS WERE PROVIDED TO COMMUNITY MEMBERS. Schedule H, Part VI, Line 6, Affiliated health care system ALL OF ROCKFORD HEALTH SYSTEM (RHS) ENTITIES WORK CLOSELY WITH THE COMMUNITY AND ROCKFORD MEMORIAL HOSPITAL (RMH) TO ADDRESS IMPORTANT HEALTH NEEDS OF THE COMMUNITY. TIME, TALENT AND RESOURCE DONATIONS - BOTH FINANCIAL AND IN-KIND CONTRIBUTIONS TO LOCAL COMMUNITY NONPROFIT ORGANIZATIONS WERE MADE BY ROCKFORD HEALTH SYSTEM IN 2013. THOSE DONATIONS RANGE FROM MANPOWER AT NONPROFIT ORGANIZATION'S FUNDRAISING EVENTS, TO FINANCIAL SUPPORT OF QUALITY OF LIFE INITIATIVES TO PROVISION OF NO-COST HEALTHCARE EDUCATION AND SERVICES. IN 2013, FINANCIAL DONATIONS ALONE AMOUNTED TO MORE THAN $400,000. OUR EMPLOYEES, MANAGEMENT STAFF, AND LEADERSHIP ALSO SERVE HUNDREDS OF HOURS ON COMMUNITY BOARDS AND WE PARTNER WITH MANY ORGANIZATIONS ON MAJOR COMMUNITY-CENTERED INITIATIVES, SHARING TIME AND EXPERTISE. FREE MAMMOGRAM PROGRAM - IN 2012, RHS LAUNCHED A PARTNERSHIP WITH A SILVER LINING FOUNDATION TO PROVIDE NO-COST MAMMOGRAMS AND FOLLOW-UP DIAGNOSTIC SERVICES TO UNINSURED AND UNDERINSURED WOMEN IN THE REGION, ENSURING THAT MEDICALLY UNDERSERVED WOMEN HAVE ACCESS TO QUALITY BREAST CANCER SCREENING AND EDUCATION. IN 2013, THE FIRST FULL YEAR OF THE PROGRAM, THE ROCKFORD HEALTH SYSTEM WOMEN'S CENTER PROVIDED 139 SCREENING MAMMOGRAMS, 46 DIAGNOSTIC MAMMOGRAMS, 33 BREAST ULTRASOUND SCREENINGS AND 9 STEREOTACTIC BIOPSIES AT NO COST TO AREA WOMEN, TOTALING ABOUT $52,000 IN CARE. THE PROGRAM IS COMPLETELY FUNDED BY PHILANTHROPY AND INCLUDES SUPPORT FROM INDEPENDENT PATHOLOGISTS AND RADIOLOGISTS. THANKS TO THE PROGRAM, A NUMBER OF WOMEN HAD THEIR BREAST CANCER DETECTED AND TREATED. FOR OTHERS, THE PROGRAM PROVIDED PEACE OF MIND THAT THEY HAVE ACCESS TO THIS POTENTIALLY LIFE-SAVING SCREENING. NORTHWEST COMMUNITY CENTER - THANKS TO FINANCIAL SUPPORT FROM ROCKFORD HEALTH SYSTEM, OVER 5,000 BREAKFASTS WERE SERVED IN 2013 AT NORTHWEST COMMUNITY CENTER ON ROCKFORD'S WEST SIDE. THE BEFORE SCHOOL BREAKFAST PROGRAM ALLOWS WORKING PARENTS TO DROP OFF THEIR ELEMENTARY AND MIDDLE SCHOOL CHILDREN AT THE CENTER FOR A HOT, NUTRITIOUS BREAKFAST. BESIDES THEIR FIRST MEAL OF THE DAY, THE CHILDREN ALSO GET HELP WITH HOMEWORK, COMPUTER AND SOCIALIZATION SKILLS, AS WELL AS A RIDE TO SCHOOL. STUDIES HAVE SHOWN THAT CHILDREN HAVING A HEALTHY BREAKFAST IN THE MORNING ARE MORE LIKELY TO BE ATTENTIVE IN THE CLASSROOM. OTHER PROGRAMS SUPPORTED BY ROCKFORD HEALTH SYSTEM RELATED TO ACCESS TO HEALTHY FOOD INCLUDE SUPPORT FOR THE ROCKFORD RESCUE MISSION, THE NORTHERN ILLINOIS FOOD BANK, AND THE ROCK RIVER VALLEY FOOD PANTRY. ADOPT A SCHOOL - FOR WELL OVER 10 YEARS, ROCKFORD HEALTH SYSTEM HAS COLLABORATED WITH NEIGHBORHOOD ELEMENTARY SCHOOLS ASSISTING THEM WITH SPECIAL NEEDS. NEARLY 90% OF THE CHILDREN ATTENDING OUR NEIGHBORHOOD SCHOOLS LIVE IN POVERTY. AT THE ELEMENTARY SCHOOL LEVEL WE PARTNER WITH TWO SCHOOLS, CONKLIN AND WELSH. AT WELSH, RHS EMPLOYEES VISITED CLASSROOMS ON A WEEKLY BASIS THROUGHOUT THE SCHOOL YEAR, TALKING ABOUT CAREERS AND HELPING TO PREPARE STUDENTS FOR THE ANNUAL CAREER FAIR. IN TURN, WELSH TEACHERS SPENT A DAY AT RHS LEARNING ABOUT VARIOUS CAREERS. ADDITIONALLY, BEGINNING AT YEAR-END 2013, RHS STAFF HELPED THE WELSH STUDENT COUNCIL SET UP AND PREPARE STUDENTS TO RUN A SUPPLY STORE AT THE SCHOOL. AT CONKLIN, YOU WILL FIND RHS EMPLOYEES CHAPERONING EVENING EVENTS, WORKING ON CLASSROOM READING, AND RAISING FUNDS TO SUPPORT NEEDY FAMILIES WITH HOLIDAY GIFTS. OTHER EDUCATION-RELATED ORGANIZATIONS INITIATIVES SUPPORTED BY ROCKFORD HEALTH SYSTEM INCLUDE ALIGNMENT ROCKFORD AND GOLDEN APPLE OF ROCKFORD. GIGI'S PLAYHOUSE - AS A CHILDREN'S MEDICAL CENTER - INCLUDING THE REGION'S ONLY HIGH-RISK MATERNITY, NEONATAL INTENSIVE CARE AND PEDIATRIC INTENSIVE CARE UNITS - RHS WORKS COLLABORATIVELY WITH A VARIETY OF COMMUNITY ORGANIZATIONS THAT PROVIDE SERVICES TO CHILDREN AND FAMILIES. FOR EXAMPLE, RHS HAD BEEN A MAJOR SUPPORTER OF GIGI'S PLAYHOUSE, A DOWN SYNDROME AWARENESS AND EDUCATIONAL CENTER, HELPING THE ROCKFORD AREA CENTER TO OPEN IN 2010. GIGI'S PLAYHOUSE PROVIDES NO-COST RESOURCES, SPECIALIZED TEACHING, AWARENESS/EDUCATION AND SUPPORT TO INDIVIDUALS WITH DOWN SYNDROME, THEIR FAMILIES AND THE COMMUNITY. SINCE OPENING, GIGI'S PLAYHOUSE HAS BEEN A "HOME, A HAVEN, AND A HANGOUT" FOR OVER 50 FAMILIES WITH DOWN SYNDROME. MARCH OF DIMES - LIKEWISE, RHS HAS LONG BEEN A COLLABORATOR WITH AND SUPPORTER OF THE MARCH OF DIMES, JOINTLY FOCUSED ON HELPING EVERY BABY HAVE A HEALTHY START TO LIFE. WE WORK TOGETHER TO HELP MOMS HAVE HEALTHY PREGNANCIES, MANAGE RISKS THAT ARISE, AND PROVIDE A HEALTHY START TO LIFE FOR THEIR BABIES. WE ALSO WORK TOGETHER TO PROVIDE CARE, TREATMENT AND SUPPORT WHEN THERE ARE COMPLICATIONS IN THE PREGNANCY, WHEN A BABY BORN IS PREMATURELY, OR WHEN A NEWBORN FACES OTHER CHALLENGES AT BIRTH AND BEYOND. OTHER CHILDREN'S ORGANIZATIONS WITH WHICH WE PARTNER AND TO WHOM WE PROVIDED CHARITABLE SUPPORT IN 2013 INCLUDE EASTER SEALS, THE HAVEN NETWORK, MILESTONE, INC., THE NORTHERN REGION CHILDREN'S HOME & AID SOCIETY, ROCKFORD MELD, THE CARRIE LYNN CHILDREN'S CENTER, THE BOYS & GIRLS CLUBS OF ROCKFORD, AND THE ROCKFORD PARK DISTRICT. REMEDIES - ANOTHER OF THE COMMUNITY CHARITIES SUPPORTED BY ROCKFORD HEALTH SYSTEM IN 2013 IS REMEDIES, A HEALTH AND HUMAN SERVICES AGENCY THAT HELPS ADULTS AND THEIR CHILDREN DEAL WITH PROBLEMS ARISING FROM SUBSTANCE ABUSE OR DOMESTIC VIOLENCE. THE DOMESTIC VIOLENCE PROGRAM PROVIDES A 24-HOUR EMERGENCY SHELTER, CRISIS HOTLINE, AND A BROAD ARRAY OF COUNSELING, EDUCATION AND OTHER ASSISTANCE. SUPPORT FROM ROCKFORD HEALTH SYSTEM ALLOWS REMEDIES TO PROVIDE OVER-THE-COUNTER MEDICINES AND OTHER SUPPORT TO ADULTS AND CHILDREN FLEEING VIOLENCE. ROCKFORD HEALTH SYSTEM ALSO PROVIDES SUPPORT TO OTHER ORGANIZATIONS PROVIDING COMMUNITY RESOURCES FOR SUCH IMPORTANT ISSUES AS POVERTY, VIOLENCE, MENTAL HEALTH AND SUBSTANCE ABUSE INCLUDING: ROCKFORD SEXUAL ASSAULT COUNSELING, THE ROCKFORD RESCUE MISSION, THE SALVATION ARMY, THE ROSECRANCE FOUNDATION, AND NAMI NORTHERN ILLINOIS MENTAL HEALTH AWARENESS. SUPPORT FOR OTHER COMMUNITY RESOURCES - ROCKFORD HEALTH SYSTEM PARTNERS WITH A WIDE VARIETY OF COMMUNITY ORGANIZATIONS THAT PROVIDE DIRECT SUPPORT AND SERVICES TO AREA CITIZENS. AMONG THE COMMUNITY ORGANIZATIONS SUPPORTED BY ROCKFORD HEALTH SYSTEM IN 2013 ARE: THE ALZHEIMER'S ASSOCIATION, THE AMERICAN CANCER SOCIETY, THE EPILEPSY FOUNDATION, HEALING PATHWAYS CANCER RESOURCE CENTER, AND RAMP. DIVERSE NEEDS - ROCKFORD HEALTH SYSTEM COLLABORATES WITH ORGANIZATIONS ACROSS OUR COMMUNITY ENSURING THAT MANY DIVERSE POPULATIONS BENEFIT FROM OUR SUPPORT. IN 2013, ROCKFORD HEALTH SYSTEM PROVIDED SUPPORT FOR MINORITY NURSING SCHOLARSHIPS, THE ROCKFORD AREA MINORITY MANAGEMENT ORGANIZATION, THE BLACK HEALTHCARE INITIATIVE, AND LA VOZ LATINA. EMPLOYEE CRISIS FUND - PHILANTHROPY HAS ALWAYS BEEN A VITAL PART OF ROCKFORD HEALTH SYSTEM SINCE ITS VERY BEGINNINGS. THROUGH THE RHS FAMILY CAMPAIGN, WE EXTEND THAT SAME OPPORTUNITY AND SATISFACTION TO ALL OUR EMPLOYEES AND VOLUNTEERS. ONE OF THE COMPONENTS OF THE ANNUAL RHS FAMILY CAMPAIGN IS THE EMPLOYEE CRISIS FUND WHICH IS TOTALLY FUNDED BY EMPLOYEE AND VOLUNTEER DONATIONS AND SUPPORTS RHS EMPLOYEES DURING TIMES OF NEED. RHS PROVIDES A ONE-THIRD MATCH TO THE TOTAL GIFTS FROM EMPLOYEES. SINCE ITS INCEPTION IN 2007, THROUGH 2013, THE FUND HAS PROVIDED MORE THAN $364,000 IN ASSISTANCE TO FELLOW EMPLOYEES FACING DIFFICULTIES. SUPPORT OF MORE THAN $50,000 WAS PROVIDED IN 2013 ALONE. THE ASSISTANCE COMES IN MANY FORMS AND MAY INCLUDE PAID TIME OFF FOR EMPLOYEES WHO HAVE LOVED ONES WITH SIGNIFICANT MEDICAL CONDITIONS OR TO HELP PAY EXPENSES RELATED TO HOMES DAMAGED BY FIRE AND FLOOD. THESE ARE ONLY A COUPLE OF EXAMPLES OF HOW RHS AND OUR EMPLOYEES COME TOGETHER TO HELP THOSE IN NEED. HEALTHY WOMAN - CLOSE TO 600 WOMEN FROM THE ROCK RIVER VALLEY ATTENDED HEALTHY WOMAN 2013. THE ANNUAL EVENT, SPONSORED BY THE WOMEN'S CENTER AT ROCKFORD HEALTH SYSTEM FEATURES A KEYNOTE SPEAKER, FREE HEALTH SCREENINGS, AND A HEALTH AND WELLNESS EXPO THAT FEATURES INFORMATION ABOUT VARIOUS RHS PROGRAMS AND PREVENTATIVE MEASURES TO OPTIMIZE WOMEN'S HEALTH. ROCKFORD HEALTH SYSTEM CAREGIVERS ALSO PROVIDED A VARIETY OF COMMUNITY EDUCATION, HEALTH PROMOTION AND EDUCATION EVENTS THROUGHOUT THE COMMUNITY IN 2013. TOPICS INCLUDED STROKE AWARENESS AND PREVENTION, PERIMENOPAUSE, ENDOMETRIOSIS, DEPRESSION SCREENINGS AND ADVANCED ILLNESS MANAGEMENT AND PALLIATIVE CARE. (SEE CONTINUATION #1 BELOW) SCHEDULE H, PART VI, LINE 6, AFFILIATED HEALTH CARE SYSTEM (CONTINUATION #1) ELDER ABUSE PROGRAM - THE ELDER ABUSE NEGLECT AND EXPLOITATION STAFF FROM VISITING NURSES ASSOCIATION WAS INSTRUMENTAL IN FORMING THE WINNEBAGO AND BOONE COUNTIES ELDER FATALITY REVIEW BOARD, A MULTIDISCIPLINARY TEAM COMPRISED OF CORONERS, LAWYERS, POLICE OFFICIALS, AND ELDER ABUSE STAFF. THE PURPOSE OF THE BOARD IS TO REVIEW QUESTIONABLE DEATHS OF AREA SENIORS THAT MAY POTENTIALLY BE ATTRIBUTED TO ABUSE. INPUT FROM INDIVIDUALS WHO INTERVENE IN ELDER ABUSE CAN ACTUALLY CLOSE THE DOOR ON A QUESTIONABLE DEATH OR OPEN IT TO FURTHER INVESTIGATION. REVIEW BOARDS SUCH AS THIS HAVE HELPED WITH THE PROSECUTION OF THOSE WHO ABUSE SENIOR CITIZENS. NEIGHBORHOOD HOME OWNERSHIP PROGRAM - ROCKFORD HEALTH SYSTEM OWNS APPROXIMATELY 40 HOMES AND/OR APARTMENT BUILDINGS CLOSE TO THE WEST-SIDE CAMPUS. THESE HOMES AND APARTMENTS ARE RENTED AND SOLD TO EMPLOYEES IN AN EFFORT TO MAINTAIN THE LONG-TERM STABILITY OF THE NEIGHBORHOOD. WITH A PREDOMINATELY OLDER WEST-SIDE NEIGHBORHOOD IN AN AREA THAT HAS BEEN PLAGUED WITH SIGNIFICANT INCIDENCES OF CRIME, LONG-TERM STABILITY IS CRUCIAL TO THE AREA. IN ADDITION TO PROVIDING RENTAL OPPORTUNITIES FOR EMPLOYEES, RHS OFFERS A NEIGHBORHOOD HOME OWNERSHIP PROGRAM WHICH PROVIDES NO INTEREST LOANS TO COVER DOWN-PAYMENT AND CLOSING COSTS FOR EMPLOYEES PURCHASING HOMES IN THE IMMEDIATE AREA AROUND THE HOSPITAL'S N. ROCKTON AVE. CAMPUS. ROCKFORD POLICE DEPARTMENT AND NEIGHBORHOOD WATCH INITIATIVES - ROCKFORD HEALTH SYSTEM IS PARTNERING WITH THE CITY OF ROCKFORD AND THE ROCKFORD POLICE DEPARTMENT TO FIGHT CRIME IN OUR WEST SIDE NEIGHBORHOOD, INCLUDING HOSTING NEIGHBORHOOD WATCH MEETINGS AT ROCKFORD MEMORIAL HOSPITAL. HUNDREDS OF RESIDENTS HAVE ATTENDED AND ARE ENCOURAGED TO ASSIST POLICE IN IDENTIFYING PROBLEMS AND IMPROVING THE NEIGHBORHOOD BY REPORTING CRIME OR SUSPICIOUS ACTIVITY. THE MEETINGS HAVE PROMPTED THE POLICE DEPARTMENT TO SET UP PATROLS AND HAVE AN ONGOING DIALOGUE WITH RESIDENTS. Schedule H, Part VI, Line 7, State filing of community benefit report IL true ROCKFORD MEMORIAL DEVELOPMENT FOUNDATION 2400 N ROCKTON AVE ROCKFORD IL 61103 363197918 501(C)(3) 170300 PROGRAM SUPPORT UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE 1601 PARKVIEW AVE ROCKFORD IL 61107 376000511 501(C)(3) 40000 PROGRAM SUPPORT GIGI'S PLAYHOUSE ROCKFORD 8801 N SECOND ST SUITE 2 MACHESNEY PARK IL 61115 462014837 501(C)(3) 25000 PROGRAM SUPPORT KISHWAUKEE COLLEGE FOUNDATION 21193 MALTA RD MALTA IL 601509600 237433949 501(C)(3) 15000 PROGRAM SUPPORT ROCKFORD SYMPHONY ORCHESTRA 711 N MAIN ST ROCKFORD IL 61103 261180940 501(C)(3) 5936 PROGRAM SUPPORT EASTER SEALS OF METROPOLITAN CHICAGO 1939 WEST 13TH ST STE 300 CHICAGO IL 60608 362169153 501(C)(3) 12488 PROGRAM SUPPORT OSF HEALTHCARE FOUNDATION 800 NE GLEN OAK AVE PEORIA IL 616033255 371259284 501(C)(3) 10088 PROGRAM SUPPORT AMERICAN CANCER SOCIETY 225 N MICHIGAN AVE STE 1200 CHICAGO IL 60601 362167721 501(C)(3) 11000 PROGRAM SUPPORT HEALING PATHWAYS - CANCER RESOURCE CENTER 3921 E STATE ST STE D ROCKFORD IL 611082053 262173633 501(C)(3) 10000 PROGRAM SUPPORT AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVE DALLAS TX 752315129 135613797 501(C)(3) 10000 PROGRAM SUPPORT MARCH OF DIMES 1275 MAMARONECK AVE WHITE PLAINS NY 106055201 131846366 501(C)(3) 10000 PROGRAM SUPPORT ANDERSON GARDENS 318 SPRING CREEK ROAD ROCKFORD IL 61107 364201695 501(C)(3) 7500 PROGRAM SUPPORT GOLDEN APPLE FOUNDATION 6870 ROTE ROAD STE 103 ROCKFORD IL 611072690 363890062 501(C)(3) 5750 PROGRAM SUPPORT ALZHEIMER'S ASSOCIATION 225 N MICHIGAN AVE SUITE 17TH FLR CHICAGO IL 606017633 133039601 501(C)(3) 5500 PROGRAM SUPPORT 14 0 Schedule I, Part I, Line 2, Procedures for monitoring use of grant funds APPLICATIONS ARE SUBMITTED TO THE HOSPITAL VERIFYING A NEED FOR FUNDS OR PRODUCTS (I.E. AUTOMATIC ELECTRONIC DEFIBRILATORS-AED). DETERMINATION IS MADE THROUGH A PREDETERMINED SCORING METHOD AS TO WHAT ORGANIZATIONS WILL BE RECIPIENTS OF THE FUNDS OR PRODUCTS. CASH CONTRIBUTIONS ARE MADE ONLY TO RECOGNIZED CHARITIES FOR WHICH GOOD FAITH REGARDING FUND USE HAS BEEN ESTABLISHED. THE CONTRIBUTION IS ONLY FOR THE AMOUNT OF THE APPEAL AND FOR A SPECIFIED NEED. false false false false false false false true false GARY E KAATZ PRESIDENT & CEO 0 686128 0 226760 0 109600 0 48223 0 6752 0 1077462 0 0 JAMES W BRECKENRIDGE DIRECTOR 0 227262 0 0 0 32597 0 20000 0 4631 0 284491 0 0 JOSE L GONZALEZ DIRECTOR 0 377598 0 0 0 1548 0 20000 0 8049 0 407195 0 0 JEFF R SMITH MD DIRECTOR 0 468970 0 12000 0 774 0 20000 0 1910 0 503653 0 0 DENNIS T UEHARA DIRECTOR 0 515352 0 0 0 2646 0 37500 0 4792 0 560290 0 0 HENRY M SEYBOLD CFO 0 378047 0 76079 0 41402 0 22952 0 5394 0 523875 0 0 CAROLYN BENGTSON VP UTILIZATION MANAGEMENT 299379 0 43391 0 13176 0 19393 0 9871 0 385210 0 0 0 JOHN T DORSEY VP CLINICAL INTEGRATION 342331 0 0 0 774 0 19195 0 4370 0 366671 0 0 0 RO NGUYEN PHARMACIST 159531 0 16766 0 4551 0 9636 0 5247 0 195731 0 0 0 SUSAN SCHREIER CHIEF NURSING OFFICER 214964 0 32580 0 10718 0 12528 0 6439 0 277229 0 0 0 MICHAEL TYRKUS DIRECTOR OF CYTOGENETICS 206621 0 9252 0 9728 0 14060 0 6915 0 246576 0 0 0 Schedule J, Part I, Line 3, Arrangement used to establish the top management official's compensation THE ROCKFORD HEALTH SYSTEM BOARD OF DIRECTORS HAS A COMPENSATION COMMITTEE THAT REVIEWS EXECUTIVE COMPENSATION FOR THE SYSTEM. THEY ALSO AUTHORIZE AN INDEPENDENT FIRM TO PROVIDE DATA FOR ANALYSIS OF THE INDUSTRY AND THE MARKET TO OUR COMPENSATION DEPARTMENT. THE DEPARTMENT AND COMMITTEE REVIEWS THE RESULTS AND MAKES A RECOMMENDATION TO THE BOARD WHO THEN ACTS UPON THIS INFORMATION TO SET COMPENSATION FOR RMH EXECUTIVES. Schedule J, Part I, Line 7, Non-fixed payments MANAGEMENT AND EMPLOYEES ARE PERIODICALLY FINANCIALLY REWARDED FOR EXCEEDING COMPANY AND DEPARTMENT PERFORMANCE GOALS. THE AMOUNTS ARE DISCRETIONARY AND ARE NOT RELATED TO NET EARNINGS OF THE ORGANIZATION AND ARE APPROVED BY THE CEO PRIOR TO PAYMENT WITH BOARD OVERSIGHT OF SUCH PAYMENTS. THE CEO'S FINANCIAL INCENTIVES ARE APPROVED BY THE BOARD OF DIRECTORS. A ILLINOIS FINANCE AUTHORITY 861091967 2012-05-02 35075000 REFUND 1997 SERIES BONDS false false false B ILLINOIS FINANCE AUTHORITY 861091967 45200FSG5 2008-12-11 32782769 REFUND 1994 SERIES BONDS false false false A 4495000 0 35075000 0 0 0 536807 0 0 0 34538193 0 2012 true false true true B 0 0 32782769 0 0 0 511397 17524 0 0 32253849 0 2008 true false true true A 0.00000 0.00000 0.00000 B 0.00000 0.00000 0.00000 A false true false false 0.0 false 0.0 false true B false false false true true true JP MORGAN CHASE 10.3 false false false false true A true B true SCHEDULE K, PART I, COLUMN (E), ISSUE PRICE NOT IDENTICAL TO FORM 8038 THE TOTAL ISSUANCE OF THE 2008 BONDS ISSUED FROM ILLINOIS FINANCE AUTHORITY WERE ISSUED TO RMH AND A RELATED ORGANIZATION, ROCKFORD HEALTH PHYSICIANS (RHPH). RMH HAS REPORTED ITS SHARE OF THE ISSUANCE ON FORM 990, PART X, LINE 20, AND ACCORDINGLY HAS REPORTED CONSISTENTLY FOR PURPOSES OF SCHEDULE K. THE TOTAL ISSUE PRICE PER THE FORM 8038 IS $60,800,000, AND RHPH REPORTS THE DIFFERENCE ON ITS FORM 990. Sch K, Part IV, Line 2c, ISSUER NAME: ILLINOIS FINANCE AUTHORITY: No Rebate Due. THE CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFORMED ON 6/4/13. RMH PATHOLOGISTS LTD PARTNERSHIP OWNED 25% BY CONNIE VITALI, CURRENT DIRECTOR 237113 CONTRACT FOR PATHOLOGY SERVICES false Form 990, Part VI, Sec A, Line 1a, Delegate broad authority to a committee THE VOTING MEMBERS OF THE RHS EXECUTIVE COMMITTEE CONSISTS OF SEVEN INDIVIDUALS, EACH OF WHOM SHALL HAVE A VOTE, INCLUDING: THE RHS CEO, THE CHAIRMAN, VICE-CHAIRMAN, IMMEDIATE PAST CHAIRMAN, TREASURER, AND 2 ADDITIONAL DIRECTORS OF THE BOARD. AT LEAST ONE MEMBER OF THE EXECUTIVE COMMITTEE SHALL BE A PHYSICIAN. THE EXECUTIVE COMMITTEE SHALL IN ALL INSTANCES BE COMPRISED OF AT LEAST 51% COMMUNITY MEMBERS. IN THE EVENT THAT ONE OR MORE OF THE AFOREMENTIONED VOTING MEMBERS OF THE EXECUTIVE COMMITTEE IS UNABLE TO SERVE IN SUCH CAPACITY, THEN THE CHAIRMAN OF THE CORPORATION SHALL DESIGNATE A REPLACEMENT FROM AMONG THE BOARD MEMBERS. THE EXECUTIVE COMMITTEE SHALL MEET AS NEEDED. THE EXECUTIVE COMMITTEE SHALL REVIEW REPORTS FROM THE RHS CEO REGARDING THE PERFORMANCE OF EXECUTIVES OF THE CORPORATION AND AFFILIATED CORPORATIONS, MONITOR THE PERFORMANCE OF THE RHS CEO OF THE CORPORATION AGAINST ANNUAL OBJECTIVES, AND DETERMINE THE COMPENSATION LEVEL OF THE RHS CEO. IN ADDITION, WHEN THE BOARD OF DIRECTORS IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE ALL THE POWERS, DUTIES, RESPONSIBILITIES AND AUTHORITY OF THE BOARD, EXCEPT AS PROHIBITED BY LAW. Form 990, Part VI, Sec A, Line 6, Classes of members or stockholders ROCKFORD HEALTH SYSTEM (RHS) IS THE SOLE MEMBER. RHS'S RIGHTS ARE AS FOLLOWS: (A) APPOINT ALL THE DIRECTORS OF THE CORPORATION. (B) NOMINATE TO THE CORPORATION'S BOARD OF DIRECTORS ALL CANDIDATES FOR SELECTION AS THE CORPORATION'S PRESIDENT. (C) APPROVE EXPRESSLY ALL AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION AND BY-LAWS. (D) APPROVE ANNUAL BUDGETS, AND STRATEGIC, LONG-RANGE AND HEALTH MANPOWER DEVELOPMENT PLANS OF THE CORPORATION. (E) REQUIRE THE CORPORATION'S BOARD OF DIRECTORS TO TAKE ANY ACTION (INCLUDING AUTHORIZING THE PLEDGE OR TRANSFER OF ASSETS TO RHS OR AS DIRECTED BY RHS, OR THE EXECUTION OF CONTRACTS) WHICH WOULD IMPROVE THE CREDIT WORTHINESS OR OTHERWISE RESULT IN FINANCIAL BENEFIT TO RHS AND ITS TAX-EXEMPT AFFILIATED CORPORATIONS (PROVIDED THAT UNDER NO CIRCUMSTANCES MAY RHS REQUIRE TRANSFER OF ASSETS IN VIOLATION OF LAW OR THE TERMS OF ANY CHARITABLE TRUST OR DONATION). (F) APPROVE ALL CONTRACTS OF INDEBTEDNESS EFFECTIVE FOR LONGER THAN EIGHTEEN MONTHS. (G) APPROVE ALL PLANS OF MERGER OR CONSOLIDATION. (H) APPROVE THE SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE CORPORATION. (I) APPROVE A VOLUNTARY DISSOLUTION OF THE CORPORATION. (J) APPROVE MATERIAL AMENDMENTS TO THE CORPORATION'S STANDARD FORM OF PHYSICIAN EMPLOYMENT AGREEMENT, PROVIDED, THE CORPORATION SHALL HAVE THE AUTHORITY TO NEGOTIATE THE TERMS AND CONDITIONS OF INDIVIDUAL PHYSICIAN EMPLOYMENT AGREEMENTS SO LONG AS THE NEGOTIATED TERMS AND CONDITIONS ARE CONSISTENT WITH THE REQUIREMENTS OF APPLICABLE LAW AND THE STRATEGIC, LONG-RANGE AND HEALTH MANPOWER DEVELOPMENT PLANS APPROVED BY RHS. (K) APPROVE MATERIAL AMENDMENTS TO THE STANDARD COMPENSATION SYSTEM USED BY THE CORPORATION TO ESTABLISH INDIVIDUAL PHYSICIAN COMPENSATION; AND (L) REQUIRE THE CORPORATION'S BOARD OF DIRECTORS TO TAKE ANY ACTION (INCLUDING AMENDING THE CORPORATION'S ARTICLES OF INCORPORATION OR BY-LAWS), OR TO MODIFY OR RESCIND AN ACTION ALREADY TAKEN, IF THE MEMBER DETERMINES THAT FAILURE TO TAKE THE ACTION, OR TO MODIFY OR RESCIND AN ACTION ALREADY TAKEN, MAY RESULT IN THE CORPORATION'S FAILURE TO OBTAIN OR MAINTAIN ITS EXEMPTION AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE CODE; Form 990, Part VI, Sec A, Line 7a, Members or stockholders electing members of governing body SEE NARRATIVE FOR FORM 990, PART VI, LINE 6. Form 990, Part VI, Sec A, Line 7b, Decisions requiring approval by members or stockholders SEE NARRATIVE FOR FORM 990, PART VI, LINE 6. Form 990, Part VI, Sec B, Line 11b, Review of form 990 by governing body THE DATA WAS GATHERED BY THE ACCOUNTING STAFF WITH INPUT FROM RMH AND RHS EXECUTIVE STAFFS. THE DATA WAS REVIEWED AND THE FORM 990 PREPARED BY THE RMH SENIOR ACCOUNTANT. DURING THE PROCESS, THERE WERE ONGOING MEETINGS HELD WITH A GROUP CONSISTING OF THE RHS CFO, THE CONTROLLER, AND THE SENIOR ACCOUNTANT. ONCE THE FORM 990 WAS COMPLETED, IT WAS REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. A COPY OF THE FORM 990 WAS MADE AVAILABLE TO ALL BOARD MEMBERS ON A SECURE INTRACOMPANY WEBSITE BEFORE FILING WITH THE IRS. Form 990, Part VI, Sec B, Line 12c, Conflict of interest policy BY WRITTEN POLICY, RHS SENDS OUT, ON AN ANNUAL BASIS, THE CORPORATE CONFLICT AND DUALITY OF INTEREST POLICY TO ALL BOARD MEMBERS, CORPORATE OFFICERS AND OTHER KEY INDIVIDUALS (THOSE HAVING RESPONSIBILITY AND AUTHORITY TO MAKE FINAL DECISIONS REGARDING THE ACQUISITION OF PRODUCTS OR SERVICES). EACH RECIPIENT IS REQUIRED TO COMPLETE A FINANCIAL INTEREST DISCLOSURE STATEMENT, WHICH IS SUBMITTED TO THE VICE PRESIDENT, LEGAL SERVICES/GENERAL COUNSEL FOR REVIEW. WITH RESPECT TO PHYSICIANS AND MANAGERS WHO ARE KEY INDIVIDUALS, ANY POTENTIAL CONFLICT OF INTEREST IS REVIEWED WITH THE APPROPRIATE EXECUTIVE STAFF MEMBER FOR FOLLOW UP WITH THE DISCLOSING PARTY IN ORDER TO REVIEW THE MATTER IN MORE DETAIL. THIS INCLUDES EMPHASIZING THAT THE DISCLOSING PARTY IS NOT PERMITTED TO PARTICIPATE IN ANY NEGOTIATIONS FOR THE PURCHASE OF ANY PRODUCTS OR SERVICES WHERE THE CONFLICT IS DEEMED MATERIAL, OR AUTHORIZE THE SUBSEQUENT PURCHASE OF RELATED GOODS AND SERVICES. THE DISCLOSING PARTY IS ALSO REQUIRED TO IDENTIFY EACH AND EVERY INSTANCE OF A POTENTIAL CONFLICT AS THEY MAY ARISE IN THE ORDINARY COURSE OF BUSINESS. A SIMILAR PROCESS IS FOLLOWED FOR THE BOARD OF DIRECTORS, EXCEPT THAT ANY POTENTIAL CONFLICT IS REVIEWED BY THE BOARD'S GOVERNANCE COMMITTEE. BOARD MEMBERS MAY COMMENT ON TRANSACTIONS WHERE THERE IS A POTENTIAL CONFLICT, BUT CANNOT VOTE ON THE RELATED MATTER AND MAY BE REQUIRED TO LEAVE ANY MEETING WHERE THE POTENTIAL CONFLICT IS REVIEWED BY THE BOARD OR WHERE THE BOARD TAKES ACTION TO EITHER APPROVE OR NOT APPROVE THE PROPOSED TRANSACTION. A BOARD MEMBER ALSO HAS A CONTINUING DUTY TO REPORT ANY CONFLICTS AS THEY MAY ARISE IN THE ORDINARY COURSE OF BUSINESS. IN THE EVENT THAT A POTENTIAL CONFLICT OF INTEREST IS REPORTED OR DISCOVERED OUTSIDE THE ESTABLISHED PROCESS, APPROPRIATE REVIEW AND ACTION WOULD BE TAKEN. THIS PROCESS WAS LAST COMPLETED IN 2014, WHEN THE QUESTIONNAIRES WERE SENT TO ADDRESS ANY 2013 CONFLICTS IDENTIFIED. THE RHS CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. FORM 990, PART VI, LINE 15A, PROCESS USED TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL COMPENSATION FOR EXECUTIVES, INCLUDING THE TOP MANAGEMENT OFFICIAL, IS GOVERNED BY THE RHS BOARD OF DIRECTORS. THE RHS BOARD HAS ESTABLISHED A TOTAL COMPENSATION PHILOSOPHY THAT DIRECTS THE COMPENSATION PRACTICES FOR ALL EXECUTIVES. THIS BOARD HAS ESTABLISHED A COMPENSATION COMMITTEE TO ESTABLISH AND REVIEW ALL EXECUTIVE COMPENSATION ANNUALLY BASED ON THE ESTABLISHED PHILOSOPHY. AN EXTERNAL EXECUTIVE COMPENSATION FIRM PROVIDES CONSULTING ON RHS SALARY RANGES AND COMPENSATION PHILOSOPHY. THE APPROPRIATE PEER GROUP FOR COMPENSATION COMPARISON PURPOSES IS OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS SIMILAR IN SIZE AND COMPLEXITY. RHS GENERALLY CONDUCTS AN ANALYSIS OF TOTAL COMPENSATION EVERY THREE YEARS BUT MAY CHOOSE TO VARY FROM THIS SCHEDULE AS DETERMINED BY THE COMPENSATION COMMITTEE. FORM 990, PART VI, LINE 15B, PROCESS USED TO ESTABALISH COMPENSATION FOR OTHER OFFICERS COMPENSATION FOR EXECUTIVES, INCLUDING OTHER OFFICERS AND KEY EMPLOYEES, IS GOVERNED BY THE RHS BOARD OF DIRECTORS. THE RHS BOARD HAS ESTABLISHED A TOTAL COMPENSATION PHILOSOPHY THAT DIRECTS THE COMPENSATION PRACTICES FOR ALL EXECUTIVES. THIS BOARD HAS ESTABLISHED A COMPENSATION COMMITTEE TO ESTABLISH AND REVIEW ALL EXECUTIVE COMPENSATION ANNUALLY BASED ON THE ESTABLISHED PHILOSOPHY. AN EXTERNAL EXECUTIVE COMPENSATION FIRM PROVIDES CONSULTING ON RHS SALARY RANGES AND COMPENSATION PHILOSOPHY. THE APPROPRIATE PEER GROUP FOR COMPENSATION COMPARISON PURPOSES IS OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS SIMILAR IN SIZE AND COMPLEXITY. Form 990, Part VI, Sec C, Line 19, Required documents available to the public FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE ILLINOIS ATTORNEY GENERAL'S OFFICE. GOVERNING DOCUMENTS ARE AVAILABLE BY REQUEST FROM THE BOARD SECRETARY. THE CONFLICT OF INTEREST POLICY IS NOT PUBLISHED BUT IS AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A, NONEMPLOYEE COMPENSATION CURTIS WORDEN IS NOT COMPENSATED AS A BOARD MEMBER; HE RECEIVED TAXABLE NONEMPLOYEE COMPENSATION FROM RHS, A RELATED ORGANIZATION, ON A FORM 1099 FOR 2013 LEGAL SERVICES PROVIDED TO THE SYSTEM. Form 990 , Part XI, Line 9, Other changes in net assets or fund balances PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST - 19750046; POST-RETIREMENT MEDICAL BENEFIT-RELATED CHANGES OTHER THAN NET PERIODIC POST-RETIREMENT COST - 1096475; NET ASSETS RELEASED FROM RESTRICTIONS USED FOR CAPITAL - 20163; TRANSFER TO/FROM AFFILIATES - -50255075; NET CHANGE IN BENEFICIAL INTEREST IN TRUST - 885914; UPMIFA - 299908; ROCKFORD HEALTH SYSTEM VENTURES LLC 2400 N ROCKTON AVE ROCKFORD IL 61103 364366881 HEALTHCARE IL 3316891 8969096 NA VISITING NURSES ASSN OF THE ROCKFORD AREA 4223 E STATE STREET ROCKFORD IL 61108 362167945 HEALTHCARE IL 501(C)(3) 9 ROCKFORD HEALTH SYSTEM true ROCKFORD HEALTH SYSTEM 2400 N ROCKTON AVE ROCKFORD IL 61103 363197915 SUPPORT OF HEALTHCARE IL 501(C)(3) 11 - Type III - FI NA false ROCKFORD MEMORIAL DEVELOPMENT FOUNDATION 2400 N ROCKTON AVE ROCKFORD IL 61103 362197918 SUPPORT OF HEALTHCARE IL 501(C)(3) 11 - Type I ROCKFORD HEALTH SYSTEM true ROCKFORD HEALTH PHYSICIANS 2300 N ROCKTON AVE ROCKFORD IL 61103 363097436 HEALTHCARE IL 501(C)(3) 3 ROCKFORD HEALTH SYSTEM true ROCKFORD HEALTH INSURANCE LTD BUTTERFIELD BANK BUILDING 6TH FLOOR HAMILTON HAMILTON BD 12 INSURANCE BD NA C CORPORATION 22923 579451 1 false true true false false false false false true false true false false true true true true true true