HOLY CROSS HOSPITAL: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
HOLY CROSS HOSPITAL (EIN 36-2170133)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-16
IRS object ID
201421369349301402
Schema version
2012v2.0
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-05-16T13:57:18-07:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN362170133EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Holy Cross HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHOLYNameControl
Phone7732575443Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12701 West 68th StreetAddressLine1
CityChicagoCity
StateILState
ZIP Code60629ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLoren ChandlerName
TitleSenior VP FinanceTitle
Date Signed2014-05-16DateSigned
Authorize Third PartyfalseAuthorizeThirdParty
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Initial ReturnXInitialReturn
Name Of Principal Officer PersonAlan H ChanningNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line115th California AveAddressLine1
CityChicagoCity
StateILState
ZIP Code60608ZIPCode
FieldValueIRS element (for citing)
Gross Receipts123406159GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web Sitewww.holycrosshospital.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1928YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionThe Hospital is a Catholic Health Care Organization sponsored by the Sister of St. Casimir. By our commitment to witness to the healing mission of Jesus, we contribute to healthy communities and promote quality health care to all with compassion.ActivityOrMissionDescription
Nbr Voting Members Governing Body52NbrVotingMembersGoverningBody
Nbr Independent Voting Members49NbrIndependentVotingMembers
Total Nbr Employees1074TotalNbrEmployees
Total Nbr Volunteers3TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year510792ContributionsGrantsPriorYear
Contributions Grants Current Year337966ContributionsGrantsCurrentYear
Program Service Revenue Prior Year111339197ProgramServiceRevenuePriorYear
Program Service Revenue CY121483000ProgramServiceRevenueCY
Investment Income Prior Year76656InvestmentIncomePriorYear
Investment Income Current Year142442InvestmentIncomeCurrentYear
Other Revenue Prior Year2204228OtherRevenuePriorYear
Other Revenue Current Year1379304OtherRevenueCurrentYear
Total Revenue Prior Year114130873TotalRevenuePriorYear
Total Revenue Current Year123342712TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year52528351SalariesEtcPriorYear
Salaries Etc Current Year54963227SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year60479884OtherExpensePriorYear
Other Expenses Current Year63312431OtherExpensesCurrentYear
Total Expenses Prior Year113008235TotalExpensesPriorYear
Total Expenses Current Year118275658TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1122638RevenuesLessExpensesPriorYear
Revenues Less Expenses CY5067054RevenuesLessExpensesCY
Total Assets BOY78674121TotalAssetsBOY
Total Assets EOY150672222TotalAssetsEOY
Total Liabilities BOY57913516TotalLiabilitiesBOY
Total Liabilities EOY34117027TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY20760605NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY116555195NetAssetsOrFundBalancesEOY
Mission DescriptionThe Hospital is a Catholic Health Care Organization sponsored by the Sister of St. Casimir. By our commitment to witness to the healing mission of Jesus, we contribute to healthy communities and promote quality health care to all with compassion.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense110756271Expense
Revenue122186516Revenue
DescriptionThe Hospital is a not-for-profit Catholic hospital that serves a large area of Chicago's Southwest side. Located in Marquette Park, the Hospital provides emergency, medical/surgical, specialty, diagnostic and primary care services to communities that are home to mostly African American and Latino families. Many of the patients the Hospital serves are uninsured or under insured. The emergency department sees an average of 50,000 patient per year and have more ambulance daily visits than any other Illinois hospital. The hospital is a Disproportionate Share Hospital and is a vital safety net hospital.Description
Total Program Service Expense110756271TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiestrueReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10961074NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1074NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members52NbrVotingGoverningBodyMembers
Number Independent Voting Members49NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonHoly Cross HospitalNamePerson
Telephone Number7732575443TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12701 West 68th StreetAddressLine1
CityChicagoCity
StateILState
ZIP Code60629ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (54 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerInstitutional TrusteeInstitutionalTrusteeHighest Compensated EmployeeHighestCompensatedEmployee
William Singer
Honorary0.000.00000
Ruth Rothstein
Honorary0.000.00000
Richard Gilford
Honorary0.000.00000
Lenard Baritz
Honorary0.000.00000
Klaus Wisiol
Life Director0.000.00000
AR Umans
Life Director0.000.00000
Bruce Stickler
Life Director0.000.00000
Lawrence Sherman
Life Director0.000.00000
Harold Sherman
Life Director0.000.00000
Bettylu Saltman
Life Director0.000.00000
Abraham Morgan
Life Director0.000.00000
Michael Mitchel
Life Director0.000.00000
Susan Manilow
Life Director0.000.00000
Ernest Karmin
Life Director0.000.00000
Bernard Kalish
Life Director0.000.00000
Richard Hoffman
Life Director0.000.00000
Alan Inbinder
Life Director0.000.00000
Henri Havdala MD
Life Director0.000.00000
Howard Gilbert
Life Director0.000.00000
Paul Francis
Life Director0.000.00000
Paul Cherner
Life Director0.000.00000X
Terry Wheat
Director0.000.00000X
Sr Immacula Wendt
Director0.000.00000X
Steve Topel
Director0.000.00000X
Robert Steele
Director0.000.00000X
Alan Solow
Director0.000.00000X
Ben Soldinger
Director0.000.00000X
Robert Shakno
Director0.000.00000X
Maurice Schwartz
Director0.000.00000X
Wayne Pierce
Director0.000.00000X
Gloria Materre
Director0.000.00000X
Bret Maxwell
Director0.000.00000X
Robert Markin
Director0.000.00000XX
Gary Keller
Director0.000.00000X
Jonathan Jonas
Director0.000.00000X
Albert Grace
Director0.000.00000X
Neal Goldstein
Director0.000.00000X
Aida Giachello
Director0.000.00000X
Mark Frish
Director0.000.00000X
Leslie Davis
Director0.000.00000X
John Danaher MD
Director0.000.00000X
Charles Brown
Director0.000.00000X
Daniel Cantrell
Director0.000.00000X
Kenneth Luccioni
Treasurer0.000.00000XX
Sharson Rossmark
Vice President12.000.00000XX
Gary Niederpruem
Chairman20.000.00000XX
Yogi Ahluwalia MD
Director0.000.00000X
Loren Chandler
Vice President0.000.00000X
Alan H Channing
Director0.000.00000X
Wayner Lener
CEO40.000.0055159800X
Paul Toeodo
COO40.000.0022916403590X
Catherine Kalial
CMO40.000.0016052204632X
Kathryn Loeb
VP Patient Care40.000.0015269504002X
Dennis Ryan
VP Comm &External40.000.0014900004002X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1242979TotalReportableCompFromOrg
Total Other Compensation16226TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Superior Health Linens LLC
230006 Momentum PlaceChicagoIL606890006Support Services872286
Renovo Solutions
1801 East Park CourtPlace BldgD 206Santa AnaCA92701R & M Plant Equipmen596681
Emergency Room Care Providers
Dept 4034 PO Box 3065Oakbrook ILLinoisIL605223065Medical Services875208
Alcantara Noel GMDSC
PO Box 2909DarienIL605617909Medical Services1416068
24 IHIM LLC
2000 Spring Road Suite 200Oak Brook IlIL60523Medical Services587791
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Government Grants336846GovernmentGrants
All Other Contributions1120AllOtherContributions
Total Contributions337966TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Net Patient Revenue6241002886900028869000
Medicare/Medicaid6241009261400092614000
FieldValueIRS element (for citing)
Total Program Service Revenue121483000TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column116559TotalRevenueColumn
Exclusion$116,559ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real265241Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real63447Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real201794Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column201794TotalRevenueColumn
Exclusion$201,794ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other25883Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other25883Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column25883TotalRevenueColumn
Exclusion$25,883ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Parking62140094133$94,133
Cafeteria and Vending621400380761$380,761
All other621400702616702616
FieldValueIRS element (for citing)
Total Other Revenue1177510TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column123342712TotalRevenueColumn
Related Or Exempt Function Income122185616RelatedOrExemptFunctionIncome
Exclusion$819,130ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1857699Total
Management And General1857699ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total44372142Total
Program Services43640145ProgramServices
Management And General731997ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total4924738Total
Program Services4648953ProgramServices
Management And General275785ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3808648Total
Program Services3608868ProgramServices
Management And General199780ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1058841Total
Management And General1058841ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total95004Total
Management And General95004ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total229167Total
Program Services229167ProgramServices

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total18035249Total
Program Services14918500ProgramServices
Management And General3116749ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total3398Total
Program Services3398ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2283981Total
Program Services2177200ProgramServices
Management And General106781ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total66569Total
Program Services64927ProgramServices
Management And General1642ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total21931Total
Program Services11364ProgramServices
Management And General10567ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total13240Total
Program Services13240ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total5852661Total
Program Services5852661ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total2800806Total
Program Services2800806ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
all other expenses21917552191755
medicaid assessment64047316404731
medical supplies1151093711510937
Bad debt1195124211951242

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total792919Total
Program Services728377ProgramServices
Management And General64542ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total118275658Total
Program Services110756271ProgramServices
Management And General7519387ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3015585BOY
EOY5679428EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY15320028BOY
EOY13844855EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY232625BOY
EOY623880EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY11812870BOY
EOY12592974EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1555118BOY
EOY1502404EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY557457BOY
EOY461664EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis106500827LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3278152LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY33475578BOY
EOY103222675EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY11684979BOY
EOY9469667EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1019881BOY
EOY3274675EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY78674121BOY
EOY150672222EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY17740240BOY
EOY20288078EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY40173276BOY
EOY13828949EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY57913516BOY
EOY34117027EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY16815493BOY
EOY115828144EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3945112BOY
EOY727051EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY20760605BOY
EOY116555195EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY78674121BOY
EOY150672222EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses5067054ReconcilationRevenueExpenses
Reconcilation Other Changes90727536ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Form4720 Filed4955 TaxfalseForm4720Filed4955Tax
Correction MadefalseCorrectionMade
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorstrueDirectContactLegislators
Direct Contact Legislators$229,168DirectContactLegislatorsAmount
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$29,852OtherActivitiesAmount
Total Lobbying Expenditures IIB259020TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart II-B, Line 1iIdentifier
Return ReferencePart II-B, Line 1i - Other Activities DescriptionReturnReference
ExplanationThe amount of $20,239 represented 32% for American Hospital Assn and $9613 represented 29% of Illinois Hospital Assn membership dues allocable to lobbing activities.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis801611OtherCostOrOtherBasis
Book Value801611BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis83434304OtherCostOrOtherBasis
Depreciation1529629Depreciation
Book Value81904675BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1544085OtherCostOrOtherBasis
Depreciation18497Depreciation
Book Value1525588BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis19324106OtherCostOrOtherBasis
Depreciation1730026Depreciation
Book Value17594080BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1396721OtherCostOrOtherBasis
Book Value1396721BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings103222675TotalOfBookValueLandBuildings
Total Of Book Value Securities9469667TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Steward Fees$3,158,000
Professional Liability$9,509,707
Pension and Post retirement$1,161,242
FieldValueIRS element (for citing)
Total Of Amounts13828949TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierPart XIdentifier
Return ReferencePart X : FIN48 FootnoteReturnReference
ExplanationSchedule D Part X Line 2INCOME TAXES: THE CORPORATION, MOUNT SINAI, SCHWAB, HOLY CROSS, SMG, AND SCI ARE TAX-EXEMPT ORGANIZATIONS UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND EACH AS REQUIRED FILES A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. HCHP FILES FEDERAL AND ILLINOIS FORMS 1120 (U.S. CORPORATION INCOME TAX RETURN) ANNUALLY.THE CORPORATION ADOPTED FASB ISSUED GUIDANCE FOR UNCERTAINTY IN INCOME TAXES. THE GUIDANCE PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE CONSOLIDATED FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAXEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. EXAMPLES OF TAX POSITIONS COMMON TO HEALTH SYSTEMS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX-EXEMPT STATUS OF EACH ENTITY, THE NATURE, CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME AND VARIOS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). UBIT IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY.TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50 PERCENT LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE CONSOLIDATED BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. AS OF JUNE 30, 2013 AND 2012, THERE WERE NOT UNRECOGNIZED TAX BENEFITS IDENTIFIED AND RECORDED.FORMS 990 AND 1120 FILED BY THE CORPORATION, MOUNT SINAI, SCHWAB, HCH, SMG, AND SCI ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) FOR UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. FORMS 990 AND 1120 FILED BY THE CORPORATION, MOUNT SINAI, SCHWAB, HCH, SMG, AND SCI ARE NO LONGER SUBJECT TO EXAMINATION OF THE YEARS ENDED JUNE 30, 2009 AND PRIOR SINCE.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicyfalseCharityCarePolicy
Written PolicyfalseWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage600.000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense10341527TotalCommunityBenefitExpense
Net Community Benefit Expense10341527NetCommunityBenefitExpense
Percent Of Total Expense0.09730PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense31349300TotalCommunityBenefitExpense
Direct Offsetting Revenue31736739DirectOffsettingRevenue
Net Community Benefit Expense-387430NetCommunityBenefitExpense
Percent Of Total Expense0.90260PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense41690827TotalCommunityBenefitExpense
Direct Offsetting Revenue31736739DirectOffsettingRevenue
Net Community Benefit Expense9954097NetCommunityBenefitExpense
Percent Of Total Expense0.99990PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense6925TotalCommunityBenefitExpense
Net Community Benefit Expense6925NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense6925TotalCommunityBenefitExpense
Net Community Benefit Expense6925NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense41697752TotalCommunityBenefitExpense
Direct Offsetting Revenue31736739DirectOffsettingRevenue
Net Community Benefit Expense9961022NetCommunityBenefitExpense
Percent Of Total Expense1.00000PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$11,971,577BadDebtExpenseAmount
Amount Attributable To981119AmountAttributableTo
Amount Reimbursed By Medicare40732263AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare27422031CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall13310232MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Holy Cross HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line12701 West 68th StreetAddressLine1
CityChicagoCity
StateILState
ZIP Code60629ZIPCode
FieldValueIRS element (for citing)
Website Addresswww.holycrosshospital.orgWebsiteAddress
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Teaching HospitalXTeachingHospital
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Holy Cross HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA ConductedtrueCHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Information GapsXInformationGaps
OtherXOther
Needs Assessment Conducted13NeedsAssessmentConducted
Take Into AccounttrueTakeIntoAccount
Other FacilitiesfalseOtherFacilities
CHNA Widely AvailabletrueCHNAWidelyAvailable
Own WebsiteXOwnWebsite
Develop Community PlanXDevelopCommunityPlan
Participate Community PlanXParticipateCommunityPlan
All Needs AddressedtrueAllNeedsAddressed
Organization Incur Excise TaxfalseOrganizationIncurExciseTax
File Form4720 Report Excise TaxfalseFileForm4720ReportExciseTax
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent600.0000FPGFreePercent
Uses FPG DiscountedfalseUsesFPGDiscounted
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application MethodfalseExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Provided On AdmissionXProvidedOnAdmission
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Other Actions TakenXOtherActionsTaken
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part VI - States Where Community Benefit Report FiledIL
Part VI - Affilated Health Care System Roles and PromotionParish Nurse Program - Through the Hospitals ParishNurse Program, the Hospital has dedicated a nurse to conduct bloodpressure screenings and ongoing health assessments for approximately 100regular parishioners. The nurse also attends church meetings where shereceives information about the sick parishioners at home and in nursinghomes. Arrangements are made to assist the sick parishioners. Thehospital participates with seven catholic churches in conducting healtheducation workshops and assist the uninsured with referrals.Senior Groups - There are 30 senior groups that meet once a month fordiagnostic testing, health assessments and health education. Most ofthese seniors are in their 80s and 90s and the Hospital assists themwith having ongoing physician appointments and helping them with theirmedical needs, by ongoing health assessment and transition to assistedliving or homemaker referrals. Vaccine for Children Program with CDPH - The Hospital works closely with grade school and high school nurses in the community. The purpose of thisprogram is to assist children who are in need of recommended immunizations to remain in school. Vaccines are administered during school hours. Mostof these children are on Medicaid or have no insurance. The vaccines areobtained from CDPH and the parents are not charged for administering thevaccines. The Hospital also documents in the state I CARE REGISTRY allimmunizations given and assists the school nurses with medicalimmunizations by verifying the students immunizations found in the statesystem.Community Health Fairs - The Hospitals representatives attend communitygroup events and fairs. The Hospital provides free health screenings andhealth education materials at these events. On average, there areapproximately 40 events per year.Influenza Program - The Hospital administers flu immunizations during theyear. These flu shots were administered at senior group meetings,churches and health fairs for community groups. We formed a jointinfluenza program with Walgreens who provided free influenza vaccines topeople with no insurance and ten area churches.Hospital Referrals for At Risk Seniors - Under this program, in certainsituations, the Hospitals health care professional will make a home visit to asses an at risk seniors living situation after discharge from the Hospital.Participation in Community Health Speakers Bureau - The Hospitals health care professional participate in promoting healthy lifestyles by volunteering to be speakers whenever Community and civic groups ask for assistance in having a speaker for their events.
Part VI - Explanation Of How Organization Furthers Its Exempt PurposeHoly Cross Hospital has posted in the Inpatient andOutpatient Admission areas and on its website the notice of its CharityCare Policies. This includes taking steps to ensure that Charity Careliterature, brochures and applications forms for Charity Care are readilyaccessible to patients at the Hospitals key locations. Notification ofthe availability of charity care is also printed on patient statements.Financial Counselors are located on campus that review the patient census for Inpatient, Outpatient and Surgical areas to assist in-house patients identifies the availability of potential insurance coverage and assist them with completing financial aid paperwork. At the earliest time feasible, HCH personnel obtains the necessary patient financial records and documentation regarding eligibility for any and all types ofalternative funding to expedite processing of patient Charity CareApplications.
Part VI - Community Building ActivitiesNo community building activities (as reported in Part II) are reported. Holy Cross Hospital reports all community related activities as part of Part I - Charity Careand Certain Other Community Benefits.
Part VI - Community InformationHoly Cross Hospital uses various methods to assessthe health care needs of the community it serves. Important informationis gathered from the Census Updates, Illinois Department of Healthcare and Family Services, the Department of Public Health, Cook County Department of Public Health, City of Chicago Department of Public Health, University of Chicago Urban Health Initiatives, Churches, community organizations and advocacy groups.Because of the Hospitals close relationship with leaders of the NewCommunities Program, the Hospital was instrumental in establishing theHealthy Chicago Lawn advocacy coalition. Holy Cross Hospital has servedas the host site and primary health resource for the majority of HealthyChicago Lawn Coalitions planning, education and advocacy initiatives.Healthy Chicago Lawn has prompted the development of many relational,educational and promotional health awareness activities in the ChicagoLawn community. As a result of the partnership with communityorganizations, Holy Cross Hospital has become more accessible to communitygroups and residents. There has been an increased awareness of theservices provided by the Hospital which has resulted in positive healthoutcomes in the communities served by Holy Cross Hospital.The Hospital also assesses the needs of the community through the ParishNurse program. Community Outreach nurse attend church meetings whereinformation is received about the sick parishioners at home and in nursinghomes. There are three large Catholic churches in the community that havea formal HCH Parish Nurse program. The Hospital has designated a nurse toservice these churches. The nurse conducts blood pressure screenings andhealth assessments for 100 regular parishioners. New parishioners, whoare uninsured, are assisted with referrals. Also, home visit arrangements are made for at risk seniors. The Hospital also has a volunteer team at churches to assist with health fairs and health education events, such as the MERCK Pharmaceuticals sponsored Diabetes Education program for the Latino community.Another source for assessing the health care needs of the community isthrough membership in 10 community organizations each of which is deeply39 invested in addressing one or more social determinants of health, such as housing, violence and youth services. Community groups have requested the Hospital for health care professionals to join their boards and assist with the direction of their advocacy and policies. Unpaid Hospital staff have become members of board of these organizations, which has helped the Hospital identify the needs of the community and in turn communicate to the leadership of these organization the resources the Hospital has toserve them.
Part VI - Needs AssessmentHoly Cross Hospitals policy is to provide those whoare indigent, as defined by Regionally Adjusted Federal PovertyGuidelines, with Charity Care or Partial Charity Care to relieve thefinancial burden associated with medically necessary treatment. TheHospitals policy establishes appropriate procedures for providing freecare to qualified patients. It also serves to ensure compliance with allapplicable federal, state, and local laws. The Financial Aid policies are available to all of the Hospitals indigent patients, who may beuninsured/underinsured or have suffered a catastrophic injury. TheHospitals Self-pay Debt Reduction Policy provides Uninsured,Underinsured, low-income and medically indigent patients with DebtReduction Provisions in order to alleviate the burdensome financialobligations associated with receiving acute and unexpected medical care.
Part V, Line 18e - Other Actions Took Before Any Collection ActionsMount Sinai Hospital informs patients of the charity care policy through signage in the hospital, written communication, statements and related corporation Sinai Health System website. Each hospital bill, invoice, or other summary of charges to an uninsured patient shall include with it, or on it, a prominent statement that an Uninsured Patient who meets certain income requirements may qualify for an Uninsured Discount along with information regarding how the patient may apply for financialassistance.Number of Hospital Faciltiy - 1
Part V, Line 3 - Account Input from Person Who Represent the CommunityHCH partnered with community-based organizations to facilitate four focus groups with 48 community members. There were two focus groups conducted in Chicago Lawn, one in Englewood and another in West Englewood. The purpose of these focus groups was to gain insight into the most pressing health conditions affecting each community, the barriers to overcoming those issues, and how a community hospital such as HCH can help improve the community's health. These groups were held in both English and Spanish, as appropriate.Many people contributed to this report. Among these has been the staff of the Sinai Urban Health Institute. These are ALL people trained in public health (most are graduates of schools of public health with MPH or PhD degrees). One of the authors (Dr. Whitman) was the founding member of the Epidemiology Program of the Chicago Department of Public Health. That program grew from 0 to 53 people during his 10-year tenure at the Department. We thus believe that the public health credentials of the authors of this report are substantial and notable.Number of Hospital Faciltiy - 1
Part V, Line 1j - Description of Other Needs AssessmentHoly Cross Hospital as a part of Sinai Health System serves a population base of over one million people located on the west side of Chicago. One outlying facility,Sinai's Touhy Clinic on the north side of Chicago, sees refugees from many nations (for example Sudan, Iraq and Burma) as well as resident Orthodox Jewish and Russian populations. Otherwise, Sinai Health System serves primarily African-American andLatino patients. Over 60% of Sinai's patients are Medicaid recipients and 13% areuninsured. Sinai's interpreter services support 150 different languages including American Sign Language making Sinai one of the strongest medical programs in the nation for Deaf and Hard of Hearing patients. Sinai treats more Medicaid patients than any other hospital in Illinois. Ninety-four percent of Sinai's patients are individuals classified in minority race categories. Sinai treats 107,000 childrenper year and admits 6,000 inpatients to Sinai Children's Hospital inclusive of pediatric visits for asthma and diabetes. Sinai's neonatal intensive care unit sees approximately 370 neonatal patients per year and obstetrics cares for 2,000 mothers categorized as high risk pregnancies. Holy Cross Hospital Emergency Department has56,000 patient visits per year; the equivalent of six patients every hour. Among those patients the proportion of uninsured patients is 30% - greater than twice the proportion of uninsured patients for Mount Sinai Hospital in total. Holy Cross Hospital's service area has an average household income of $49,840.Number of Hospital Faciltiy - 1
Part III, Line 9b - Provisions On Collection Practices For Qualified PatientsHoly Cross Hospital's collection process includes both letter and call series built toinform patients' of their outstanding balances and to explain available paymentoptions. If the patient is uninsured a discount is applied to the patient's accountin accordance with Illinois Patient Uninsured Act. In addition, resources are madeavailable to patients throughout the collections process. These resources include: acharity program targeted to low income individuals residing in Sinai Health Systemcore service area, and non-interest bearing payment plans that start as low as $25 amonth. The debt collection practices only apply to charity patients to the extent ofthe copayments or patient portion balances and not to amounts that have beenapproved as charity or financial assistance.
Part III, Line 8 - Explanation Of Shortfall As Community BenefitConsistent with Medicare guidelines, rules & regulations, non-allowable costs areoffset on worksheet A via A-8 adjustments. General Overhead cost centers costs arestep down on Worksheet B using various approved statistics such as square footage,gross salaries, pounds, FTE's and etc.
Part III, Line 4 - Bad Debt ExpenseThe collection of receivables from third-partypayors and patients is the Hospitals primary source of cash foroperations and is critical to its operating performance. The primarycollection risks relate to uninsured patient accounts and patient accountsfor which the primary insurance payor has paid, but patient responsibilityamounts (deductibles and copayments) remain outstanding. Patientreceivables, where a third-party payor is responsible for paying theamount, are carried at a net amount determined by the original charge forthe service provided, less an estimate made for contractual adjustments ordiscounts provided to third-party payors.Patient receivables due directly from the patients are carried at the cost attributable to patients eligible under the Hospitals charity care policy original charge for the service provided less amounts covered by third-party payors, discounts for patients that are uninsured and anestimated allowance for doubtful receivables. Management estimates thisallowance based on the aging of its accounts receivable and its historicalcollection experience for each payor type. Recoveries of receivablespreviously written off are recorded as a reduction of bad debt expensewhen received. Using the cost to charge ratio of 24.83%, the cost of baddebt is approximately $2,399,000.The past due status of receivables is determined on a case-by-case basisdepending on the payor responsible. Interest is generally not charged onpast due accounts.Prior to writing-off the amounts as bad debts expense, Holy CrossHospitals Patient Financial Services department reviews the self-paybalances. Where the patient has chosen not to cooperate with our CharityCare Policy, the Hospital utilizes a program that accesses the patientscredit information and identifies patients that qualify for charity careunder our policy. These reports show that approximately 33% of alluninsured patients and patients with a self-pay balance after insurancepayment, qualify for charity care. The amount of Bad Debts expense at
Part III, Line 2 - Methodology Used To Estimate Bad Debt ExpenseHoly Cross Hospital first determines if a patient qualifies for charity care. If apatient is classified as charity care they would not be included as bad debt. Somepatients do not desire to complete the charity care applications and as such can beincluded in the bad debt amounts. One example of a patient population that does notcomplete charity care applications is undocumented workers. The corporationestimates bad debt expense based upon management's assessment of historical andexpected net collections considering historical business and economic conditions,trends in health care coverage, and other collection indicators. Management assessesthe allowance for uncollectible accounts based upon historical write-off experience.
Part I, Line 7, Column F - Explanation of Bad Debt ExpenseThe bad debt expense was included on Form 990,Part IX, Line 25, column A but was subtracted from the total expenses for purpose of calculating the percentage in this column.The bad debt expense is $11,971,577
Part I, Line 7 - Explanation of Costing MethodologyThe costing metholodogy utilized throughout thisreport is the cost to charge ratios based on the Medicare and Medicaidcost reports.Total cost per the Medicare Cost Report worksheet B,PT1 column 27 divided by totalinpatient and outpatient gross revenue.
Part I, Line 6a - Related Organization Community Benefit ReportThe community benefit report is prepared by parent corporation Sinai Health System.Holy Cross Hospital prepares and files the Annual Non-Profit HospitalCommunity Benefit Plan Report with the office of the Attorney Generalof the State of Illinois.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgComp Report Prior990 Filing OrgCompReportPrior990FilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg
Wayner Lener
CEO5504101188551598729001
Paul Toeodo
COO2291642327542729963590
Kathryn Loeb
VP Patient Care1526951566974002
Dennis Ryan
VP Comm &External1490001530022035094002
Catherine Kalial
CMO1605221651543374204632

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSch J, Part I, Line 1aIdentifier
Return ReferencePart I, Line 1a: Relevant information in regards to selections on 1a.ReturnReference
ExplanationHCH pays for the social club dues of Wayne Lerner. the social club is used for hospital business and the expenses is not included in his compensation.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part XI, Line 9Other Changes In Net Assets Or Fund Balances - Other Increases= $90727536
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableFile the Financial Statement with the Illinois Charitable Organization Annual ReportFile the Annual Financial Statements990 Public Disclosure Community BenefitsFile the A-133 Grant ReportFile Form SF-SAC to the Federal Audit Clearinghouse
Form 990, Part VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesReview by the compensation committee and independent auditors.
Form 990, Part VI, Line 15aForm 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top ManagementReview by the compensation committee
Form 990, Part VI, Line 12cForm 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsThe Conflict of Interest Disclosure Form is completed and signed annually by all board members, employed physicians, management personnel as well as other employees who are in a position to influence purchasing decisions. In addition to the annual filing of the form, an update is required to be filed any time there has been a change. Based on the information disclosed, the Chief Integrity Officer, along with other members of management and counsel as needed, implements an appropriate conflict management plan, which may include requiring the interested party to abstain from participation in certain decisions. The information disclosed also is taken into consideration in making Board and Committee assignments. Further, board members are required to disclose potential conflicts relating to Board and Committee proceedings to the appropriate Board or Committee Chair for appropriate conflict management procedures, including abstention from participation in certain decisions.
Form 990, Part VI, Line 11bForm 990, Part VI, Line 11b: Form 990 Review ProcessThe 990 was initially prepared by the Finance Staff with multi disciplinary input from Public Affairs, Corporate Integrity and other appropriate staff of the organization. The 990 was then reviewed by Senior Finance staff and other members of Senior Leadership. Prior to the filing, the 990 was made available via email to Finance Board Committee. The 990 form was presented as a discussion item for the Finance Board Committee where members had an opportunity for questions and comments. The 990 was also made available via email to the full Board of Directors.
Form 990, Part VI, Line 6Form 990, Part VI, Line 6: Explanation of Classes of Members or ShareholderThe board member of Sinai Health System and Affiliates

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatus
HOLY CROSS HEALTH PARTNERS INC
2701 WEST 68TH STREETCHICAGOIL60629364109153CONTRACTING AND CLAIMS ADMINISTRATIONILHOLY CROSS HOSPITALfalse
SINAI COMMUNITY INSTITUTE INC
2653 W ODGEN AVECHICAGOIL60608363932824COMMUNITY SERVICEILSINAI HEALTH SYSTEMfalse501(C) 37
MOUNT SINAI COMMUNITY FOUNDATION
2750 W 15TH PLACECHICAGOIL60608363305449ILSINAI HEALTH SYSTEMfalse501 (C) 3509 (A) (3)
MOUNT SINAI HOSPITAL
15TH AND CALIFORNIA AVECHICAGOIL60608361509000HEALTH CAREILSINAI HEALTH SYSTEMfalse501 (C ) 3170 (B ) (1) (A)
SCHWAB REHABILITATIN HOSPITAL
1401 CALIFORNIA BLVDCHICAGOIL60608362179802HEALTH CAREILSINAI HEALTH SYSTEMfalse501( C)3170 (B) (1) (A)
SINAI HEALTH SYSTEM
2750 W 15th PlaceChicagoIL60608363166895Health CareILNAfalse501(c)3509(A)(3)

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1HOLY CROSS HEALTH PARTNER INC36-4109153BusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12701 WEST 68TH STREETAddressLine1
CityCHICAGOCity
StateILState
ZIP Code60629ZIPCode
FieldValueIRS element (for citing)
Primary ActivityCONTRACTING & CLAIMS ADMINISTRATIONPrimaryActivity
Legal Domicile StateILLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1HOLY CROSS HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityC CORPTypeOfEntity
Percentage Ownership1.00000PercentageOwnership
Controlled OrgfalseControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
HOLY CROSS HEALTH PARTNERS INC
p83000FMV
HOLY CROSS HEALTH PARTNERS INC
k536991FMV

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierPart IV, Identification of Related Organization Taxable as Corp or Trust:Identifier
ExplanationHoly Cross Health Partners, Inc.Ein: 36-41091532701 West 68th StreetChicago, Il 60629Primary Activity: Contracting and Claims AdministrationDirect Controlling Entity: Holy Cross HospitalExplanation

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