2013-11-14T12:38:19-06:00 2012-12-31 420714325 MCGLADREY LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2012-01-01 362169179 Palos Community Hospital PALO 7089234000 12251 S 80th Avenue Palos Heights IL 604630930 David Manchester 7089234000 2013-11-12 1 Wayne Harder P00294296 3126343400 2012 2016-02-24 21:20:13Z David Manchester 12251 S 80th Avenue Palos Heights IL 604630930 2240762964 0 X www.paloscommunityhospital.org X 1972 IL Palos Community Hospital is a 501(c)(3) community hospital whose primary objective is the provision of inpatient and outpatient services that are responsive to the health care needs of the residents of southwestern Cook County and northeastern sections of Will County. 13 10 3279 733 126692 -17801 513089 398265 329037261 324923857 6572570 19921299 4875184 5022942 340998104 350266363 0 0 0 0 212878646 210174162 0 0 134224 119081652 119740872 331960298 329915034 9037806 20351329 699718688 742440787 441327622 451159937 258391066 291280850 X Palos Community Hospital (PCH) is a not-for-profit community hospital, which is operated in accordance with the Ethical and Religious Directives for Catholic Healthcare Facilities. The primary objective of PCH is the provision of inpatient and outpatient services that are responsive to the health care needs of the residents of southwestern Cook County and northeastern sections of Will County.In providing any service - be it preventive, curative or palliative - the overriding concern of the institution shall be that the quality of that service be of the highest caliber. PCH shall be committed to a continued review and analysis of the changing needs of the community it serves and shall respond to those needs with services that are readily available in a form that enhances their efficient use by physicians and patients. In addition, PCH shall maintain an ability to adapt to changes and influence forces in its environment effectively and expeditiously. 0 0 202375027 278739227 It is the policy of Palos Community Hospital to provide quality medical health care to all persons regardless of race, creed, sex, national origin, handicap, age, or ability to pay. The Hospital recognizes that not all individuals possess the ability or means to purchase essential medical services and further, that our mission is to serve our community with respect to providing healthcare services and healthcare education. Therefore, in keeping with the hospital's commitment to serve all members of the community, charity and/or subsidized care will be considered where the need and/or inability to pay are identified. 34331014 24417676 Cardiovascular ServicesPalos Community Hospital provides a total continuum of cardiovascular services - from diagnosis and treatment through recovery and rehabilitation - to ensure that our patients receive the complete care they need close to home. Prior to the start of the program in 2005, Palos transferred patients from their local community to other hospitals. Within 3 years, Palos ranked 14th in Illinois for heart volume. This community need has grown as can be seen with continued increases in volume since the program began. 21298150 19923148 Home HealthPalos Community Hospital Home Health, Private Duty, and Hospice services provide quality personal care and support to patients in their homes, nursing homes or hospitals. The Home Health staff assists the chronically ill, persons with functional impairments, those needing specialized skilled care at home, those recovering from a hospital stay and the terminally ill. In 2011, Home Health staff from Palos made nearly 93,000 home care visits, more than 29,000 hospice visits and provided more than 43,000 hours of private duty nursing assistance. 10658419 4915088 Behavioral HealthBehavioral Health Services at Palos meet the needs of individuals and families in the community struggling with relationship problems, emotional issues, psychological disorders and even chemical dependency. The programs include alcohol treatment; chemical dependency; group therapies for mental health or substance abuse issues; intensive outpatient programs; Kids Recover Too, since children in the family can be especially hard-hit by a parent's chemical abuse or dependency; and the Partial Hospital Program for those needing more intensive treatment for a psychiatric or duel diagnosis. 10658419 4915088 268662610 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 1 181 0 1 3279 1 1 1 0 0 0 0 1 1 0 0 0 0 X 13 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL X Hugh A Rose 7089234000 12251 S 80th Avenue Palos Heights IL 604630930 Sister Anna Doyle 1.00 X X 0 0 0 Edward Mulcahy 2.00 X X 0 0 0 Margaret Lustig 2.00 X X 0 0 0 Thomas F Courtney 2.00 X 0 0 0 Lawrence Hunt 2.00 X 0 0 0 Gregory Paetow 2.00 X 0 0 0 Sheila Pacholski until 9112 0.00 X 0 0 0 James Reilly 2.00 X 0 0 0 Carole Ruzich 2.00 X 0 0 0 Philip A Salvador 2.00 X 0 0 0 Christie Sever until 9112 0.00 X 0 0 0 John Ward until 9112 0.00 X 0 0 0 Dr Mark Sinibaldi 2.00 40.00 X 50000 263861 14994 Lynn Egan 2.00 X 0 0 0 William Hanson 2.00 X 0 0 0 Sister Margaret Wright 40.00 X X 0 0 5692 Thomas J Lavery 40.00 X 463766 0 36798 David B Manchester 40.00 X 406729 0 33504 Hugh A Rose 40.00 X 355232 0 28225 Randall J Oles 40.00 X 330824 0 37609 Timothy J Brosnan 40.00 X 348376 0 37609 Marion J Baron 40.00 X 284905 0 32262 Mary C Denisienko 40.00 X 262378 0 27672 Rosann S Demask 40.00 X 231487 0 31438 Margaret J Carroll 40.00 X 238837 0 36721 Bryan D Counts 40.00 X 219299 0 33795 Arthur M Schroeder 40.00 X 271604 0 12515 Mark D Diamond 40.00 X 236122 0 24113 3699559 263861 392947 109 0 1 0 Pepper Construction Company 18505 W Creek Drive Tinley Park IL 60477 Construction Services 66257047 Matthei & Colon Associates 332 S Michigan Avenue Chicago IL 60604 Architectural Services 3905456 Palos Anesthesia & Associates 40 Shuman Blvd Suite 275 Naperville IL 60563 Anesthesia Services 970837 Executive Health Resources Inc 15 Campus Blvd Newtown Square PA 19073 Billing/Coding Support 861198 Navin Haffty & Associates 1900 West Park Drive Suite 180 Westborough MA 01581 Information systems support 746705 40 303225 95040 398265 Net Patient Revenue 621110 317852986 317726294 126692 Provider Tax Revenue 900099 7159785 7159785 MRI Joint Venture 900099 -88914 -88914 324923857 7532742 7532742 1326407 849590 476817 476817 476817 1901881000 1889492443 12388557 12388557 12388557 244968 303225 154568 90400 90400 Cafeteria Revenue 900099 1086041 1086041 Gift Shop Revenue 900099 298402 298402 Medical Records 900099 213581 213581 2857701 2857701 4455725 350266363 327868447 126692 21872959 2962310 2962310 157080779 129893611 27187168 9445756 7666331 1779425 29377768 23843481 5534287 11307549 9177393 2130156 2056807 2056807 223951 223951 180847 180847 1223589 1223589 9029063 1854890 7174173 1060089 917 1059172 4320568 2746814 1573754 2532884 271682 2261202 438977 428703 10274 178368 157650 20718 5700226 5700226 14004194 11261413 2742781 1470976 799981 670995 Medical Supplies 49572741 49572741 Bad Debt Expense 13668770 13668770 IL Tax Assessment 7907103 7907103 Utilities 2645519 2116415 529104 3526200 1594489 1797487 134224 329915034 268662610 61118200 134224 4673521 3875661 35502265 31052727 624169 1016777 1531486 1580877 4517005 4854254 586097810 228841142 255919913 357256668 352678512 298906063 44271817 43897760 699718688 742440787 129130466 131616440 268120000 279590000 44077156 39953497 441327622 451159937 X 258281262 291166757 109804 114093 258391066 291280850 699718688 742440787 20351329 12536061 2394 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 33080 33080 0 Explanation of Lobbying Activities: Part II-B, Line 1: Illinois Hospital Association dues and American Hospital Association fees attributable to lobbying. 13912292 13912292 413884852 108989132 304895720 158300666 119852010 38448656 357256668 Investment in Affiliate 2212017 Collateral Received for Securities Loaned 32900000 Deferred Financing Costs 3864381 Malpractice Insurance Receivable 4921362 43897760 Obligation for Collateral Received for Securities Loaned 32900000 Tax Exempt Bond Liability Premium 7053497 39953497 X 348270990 12536061 849590 13385651 334885339 1223589 14157435 15381024 350266363 315872265 849590 849590 315022675 1223589 13668770 14892359 329915034 Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The Hospital has received a determination letter from the Internal Revenue Service stating that it is exempt from the payment of income taxes under Section 501(c)(3) of the Internal Revenue Code. Accordingly, income taxes are not provided for in the accompanying financial statements. The Hospital adopted the FASB-issued guidance for accounting for uncertainty in income taxes on January 1, 2007. The Hospital files a Form 990 (Return of Organization Exempt from Income Tax) annually. When this return is filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Examples of tax positions common to hospitals include such matters as the following: the tax exempt status of the entity; the continued tax exempt status of bonds issued by the obligated group; the nature, characterization and taxability of joint venture income, and various positions relative to potential sources of unrelated business taxable income (UBIT). UBIT is reported on Form 990-T, as appropriate. The benefit of a tax position is recognized in the 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 accompanying balance sheet along with any associated interest and penalties that would be payable to the taxing authorities upon examination. Upon the adoption of the FASB issued guidance at January 1, 2007, and since that date through December 31, 2012, there were no unrecognized tax benefits identified and recorded as a liability. Part XI, Line 2d - Other Adjustments: Rental Expense 849,590. Part XI, Line 4b - Other Adjustments: Unrestricted Contributions 488,665. Bad Debt Expense 13,668,770. Part XII, Line 2d - Other Adjustments: Rental Expense 849,590. Part XII, Line 4b - Other Adjustments: Bad Debt Expense 13,668,770. 2012 Dinner 548193 303225 244968 20344 108810 20345 5069 548193 303225 244968 20344 108810 20345 5069 154568 90400 1 1 X 1 X 1 X 1000.000000000000 1 1 1 0 1 1 14834296 0 14834296 0.04690 23526854 13271952 10254902 0.03240 38361150 13271952 25089198 0.07930 901663 127039 774624 0.00240 27808665 17711343 10097322 0.03190 164917 164917 0.00050 28875245 17838382 11036863 0.03480 67236395 31110334 36126061 0.11410 1 13668770 3494642 104253046 129870428 -25617382 X 1 1 1 1 Palos Community Hospital

12251 South 80th Avenue Palos Heights IL 60463

X X X PALOS COMMUNITY HOSPITAL 1 1 1 200.000000000000 1 1000.000000000000 1 X X X X X X X 1 1 X X X X X 1 0 X X X X 1 X 1 0 5 Palos Primary Care Center

15300 West Avenue Suite 122 Orland Park IL 60462

Primary Care Center Palos Immediate Care Center

7340 W College Drive Palos Heights IL 60463

Immediate Care Center Palos Home Health Care

15295 E 127th St Lemont IL 60439

Home Health Care Palos Diagnostic & Women's Center

17333 S LaGrange Rd Tinley Park IL 60477

Diagnostic testing and Women's Health Palos Sleep Disorders Center

11900 Southwest Highway Palos Park IL 60464

Sleep studies Part I, Line 3c: PCH's charity care is based on a sliding scale of the Federal Poverty Guidelines. PCH set the sliding scale to far exceed the minimum amounts set forth by the State of Illinois in The Hospital Uninsured Patient Discount Act by extending discounted care up to 1000% of the FPG vs. the minimum 600% as dictated by this law. Part I, Line 7: The best available data was used to calculate the cost amounts reported in Item 7. This includes the overall hospital cost to charge ratio as well as direct and indirect costs for certain specific departments of the hospital. Part I, L7 Col(f): The bad debt expense of $13,668,770 was included on Form 990, Part IX, Line 25, but subtracted for purposes of calculating the percentage in this column. Part II: The health of the communities that PCH serves is a very important piece of PCH's mission statement. To date, our focus has been on providing the care needed within our community at high level of quality. As such we have implemented and/or maintained programs that we feel help to improve the wellness of the people we serve. PCH believes that given limited resources and time this serves our community better than community building activities as defined in this schedule. Part III, Line 2: Bad debt expense is estimated by totaling the amounts sent to and written off by collection agencies plus an estimate of Accounts Receivable aged by financial class all multiplied by the appropriate cost to charge ratio. Part III, Line 3: Information to determine this amount is not available. Part III, Line 4: PCH calculates Charity Care cost using the hospital wide cost to charge ratio and applying that ratio to the charges written off to charity care per the hospital policy. No other Bad Debt amounts are included in the community benefit report.The Hospital provides care to all patients regardless of their ability to pay. Uncompensated care and community service provided by the Hospital are excluded from net patient service revenue. Part III, Line 8: Medicare costs are calculated using the hospital wide cost to charge ratio. PCH does include the Medicare shortfall in its Illinois state community benefits report as PCH continues to treat its Medicare community despite the fact that its costs for these patients exceed reimbursement. Part III, Line 9b: It is the policy of PCH not to pursue collection practices against patients known to qualify under the Charity Care policy. In some cases, this determination is not immediately known and collection processes are followed, but once it has been determined that a patient may be eligible for charity care, these practices are ceased. PALOS COMMUNITY HOSPITAL Part V, Section B, Line 20d: Palos Community Hospital takes its commitment to serving the uninsured and underinsured members of its community very seriously and as a result has implemented a financial assistance policy that goes above and beyond the requirements of Illinois Public Act 095-0965 "Hospital Uninsured Patient Discount Act". This State Law was enacted with an effective date of April 1, 2009 and required that hospitals offer uninsured patients who met the minimum financial requirements (i.e. earnings less than 600% of the FPG and certain asset limitations) a rate equal to 135% of the hospital's most recently filed Medicare cost to charge ratio. PCH expanded the reach of this policy by extending the minimum financial requirements to 1,000% of the FPG to help more of its community qualify for a financial benefit and to give families that earn a lower percentage of the FPG deeper discounts. This policy was also extended to all clinically-necessary procedures and was not limited to emergency care only. Using the FPG, PCH created a set of discounts for patients without insurance that ranged from free care for those who earned less than 200% of the FPG to a 40% discount off of regularly billed charges for any uninsured patient who earned less than 1,000% of the FPG. PCH also created a policy to help those who are underinsured. Similar to its uninsured policy, the underinsured policy creates a set of discounts that can be applied to co-payments and deductibles owed for those patients that earn less than 300% of the FPG. PALOS COMMUNITY HOSPITAL Part V, Section B, Line 21: Palos Community Hospital takes its commitment to serving the uninsured and underinsured members of its community very seriously and as a result has implemented a financial assistance policy that goes above and beyond the requirements of Illinois Public Act 095-0965 "Hospital Uninsured Patient Discount Act". This State Law was enacted with an effective date of April 1, 2009 and required that hospitals offer uninsured patients who met the minimum financial requirements (i.e. earnings less than 600% of the FPG and certain asset limitations) a rate equal to 135% of the hospital's most recently filed Medicare cost to charge ratio. PCH expanded the reach of this policy by extending the minimum financial requirements to 1,000% of the FPG to help more of its community qualify for a financial benefit and giving families that earn a lower percentage of the FPG deeper discounts. This policy was also extended to all clinically necessary procedures and was not limited to emergency care only. Using the FPG, PCH created a set of discounts for patients without insurance that ranged from free care for those who earned less than 200% of the FPG to a 40% discount off of regularly billed charges for any uninsured patient who earned less than 1,000% of the FPG. PCH also created a policy to help those who are underinsured. Similar to its uninsured policy, the underinsured policy creates a set of discounts that can be applied to co-payments and deductibles owed for those patients that earn less than 300% of the FPG. Because PCH's financial assistance policy so generously extends to patients who earn up to 1,000% of the FPG, it is possible that those patients could be responsible for charges that exceed an individual with insurance. If this situation arose, PCH would make every effort to work with the patient to limit their liability to a reasonable amount. Part VI, Line 2: PCH consistently seeks to serve the needs of its community in a variety of ways. In order to better identify these needs, PCH teamed with the Metropolitan Chicago Healthcare Council (MCHC) to prepare a Community Health Assessment for the primary counties that PCH serves. This Community Health Assessment is a systematic, data-driven approach to determining the health status, behaviors and needs of residents in Cook, DuPage and Lake counties, Illinois. This Community Health Assessment will serve as a tool toward reaching three basic goals:- To improve residents' health status, increase their life spans, and elevate their overall quality of life. A healthy community is not only one where its residents suffer little from physical and mental illness, but also one where its residents enjoy a high quality of life.- To reduce the health disparities among residents. By gathering demographic information along with health status and behavior data, it will be possible to identify population segments that are most at-risk for various diseases and injuries. Intervention plans aimed at targeting these individuals may then be developed to combat some of the socio-economic factors which have historically had a negative impact on residents' health.- To increase accessibility to preventive services for all community residents. More accessible preventive services will prove beneficial in accomplishing the first goal (improving health status, increasing life spans, and elevating the quality of life), as well as lowering the costs associated with caring for late-stage diseases resulting from a lack of preventive care. Part VI, Line 3: PCH utilizes several techniques to communicate a patient's eligibility for assistance under various programs. At the time of registration, each patient is referred to a copy of PCH's Charity Care Policy and asked to fill out a simple registration form that may help them qualify for Charity Care. This policy clearly lays out the eligibility requirements and what the patient must do to qualify. Also at registration, any patient without insurance is advised as to what other programs they may qualify for and are given assistance in applying as necessary. PCH employs a company that helps patients apply for Medicaid coverage and SSI disability. Upon discharge, each patient receives a summary bill that includes information related to eligibility for the Charity Care Policy. All inpatients without insurance are visited by a financial counselor who helps direct the patient and their families to the appropriate level of assistance. Signage regarding the charity care policy is posted at all registration areas and in the Emergency department. Finally, PCH proudly displays the assistance polices on their website along with a Charity application form. Part VI, Line 4: Palos Community Hospital serves growing communities that expect to experience further growth in the coming years. Communities within the hospital's service area have seen overall growth in population of approximately 7.6% from 2000 to 2011 with a current estimated population of 603,793. Continued growth is anticipated. From 2011 to 2016, the population is expected to reach 624,638. Of those living within the service area of Palos Community Hospital: 50.91% are female87.62% are white82.41% are English-speakingThe median age is 37.74 years31.60% are high school graduates30.12% have had some college, and 28.36% have earned a bachelor's degree or beyond.14.00% of the residents would be considered uninsured or Medicaid eligible.There are no other hospitals located in PCH's primary service area. Part VI, Line 5: PCH will assure the availability of quality inpatient, outpatient, emergency and home care services to the community at all times. Access to these services will be determined by clinical presentation and medical needs of the patient without consideration of the patient's ability to pay.PCH will be a resource for health education and wellness initiatives for residents of the service area.PCH will monitor the health care needs of its service area to assure the need for the services it offers and evaluate the opportunity to develop new programs and services as necessary.PCH will work together with and in support of other not-for-profit, educational, governmental, civic or community organizations, as appropriate, to promote health and wellness through awareness, education, research, access or support.PCH will have policies and procedures in place to provide for charity care for patients without financial resources, including the unreimbursed costs of government sponsored indigent health care.PCH will provide language assistance services as necessary to assure effective communication in the delivery of patient care.A majority of the governing body is comprised of persons who reside in the organization's primary service area who are neither employees nor independent contractors of the organization, nor family members thereof.All qualified physicians are eligible for consideration for staff privileges. The hospital applies surplus funds to improve patient care. Part VI, Line 6: Palos Community Hospital is not part of an affiliated health care system. Reports Filed With States Part VI, Line 7 IL X X 0 0 0 0 0 0 0 0 0 Dr Mark Sinibaldi 50000 263861 0 0 0 0 0 0 0 14994 50000 278855 0 0 Thomas J Lavery 446766 0 0 0 17000 0 18750 0 18048 0 500564 0 0 0 David B Manchester 389729 0 0 0 17000 0 18750 0 14754 0 440233 0 0 0 Hugh A Rose 338232 0 0 0 17000 0 18750 0 9475 0 383457 0 0 0 Randall J Oles 313824 0 0 0 17000 0 18750 0 18859 0 368433 0 0 0 Timothy J Brosnan 331376 0 0 0 17000 0 18750 0 18859 0 385985 0 0 0 Marion J Baron 267905 0 0 0 17000 0 18750 0 13512 0 317167 0 0 0 Mary C Denisienko 245378 0 0 0 17000 0 18750 0 8922 0 290050 0 0 0 Rosann S Demask 214487 0 0 0 17000 0 17049 0 14389 0 262925 0 0 0 Margaret J Carroll 221837 0 0 0 17000 0 17965 0 18756 0 275558 0 0 0 Bryan D Counts 202789 0 0 0 16510 0 15653 0 18142 0 253094 0 0 0 Arthur M Schroeder 271604 0 0 0 0 0 0 0 12515 0 284119 0 0 0 Mark D Diamond 236122 0 0 0 0 0 6856 0 17257 0 260235 0 0 0 Part I, Line 3 The CEO contract is a management contract with the religious order. The Executive Committee of the Board of Directors has the responsibility for the contract and fees. Annually Human Resources gathers market data on executive positions from a variety of published survey sources such as Metropolitan Healthcare Council (MCHC), Mercer, Watson Wyatt, etc. The market data is analyzed for organizations of our size and characteristics (FTE's, revenue, beds, region, non-for profit, stand alone institutions, etc.) The mean, median and if available the 90th percentile rates are provided to the President/CEO for consideration and reviewed with the Board of Directors. Discussion and process are contemporaneously documented in the minutes. A Ill Fin AuthorityPalos Comm Hospital 861091967 45200B3U0 2007-05-17 124814955 Fund construction of parking garage & power plant 0 1 0 B ILl Fin AuthorityPalos Comm Hospital 861091967 45200F2Z1 2010-05-06 151146301 Fund construction of new patient bed pavilion and backfill of current struct 0 1 0 C Ill Fin AuthorityPalos Comm Hospital 861091967 2010-04-12 100000000 Fund construction of new patient bed pavilion and backfill of current struct 0 1 0 A 124814955 55680574 2675871 66458510 2010 1 0 1 1 B 157566708 1950637 155616071 2012 0 0 1 1 C 100000000 500000 11420000 88080000 2013 0 0 0 0 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 1 0 0 0 0 Thomas F Courtney Associates Thomas F. Courtney, Director, is owner of Thomas F. Courtney & Associates 172000 Thomas F. Courtney & Associates assists Palos with collecting certain workers compensation and motor vehicle accident claims 0 Kathleen Wright Sibling of Sister Margaret Wright, CEO 56993 Employment 0 Form 990, Part VI, Section A, line 6 St. George Corporation is the sole Corporate Member. Form 990, Part VI, Section A, line 7a St. George Corporation holds the power to appoint members of the governing body. Form 990, Part VI, Section A, line 7b St. George Corporation can exercise action on the following matters: (a) removal of directors, with or without cause; (b) all amendments to these bylaws or the Corporation's Articles of Incorporation; (c) The sale or transfer of substantially all of the property of the corporation, except for leases in excess of one year; (d) all long term borrowing in excess of one year; (e) merger or consolidation by the Corporation with any other institution, hospital, corporation or legal entity; (f) formal affiliation with a medical school or research facility; (g) acceptance of any gift, bequest or legacy that imposes a permanent or continuing obligation on the Corporation for a period of more than one year; (h) decisions to authorize voluntary dissolution of the Corporation or to revoke proceedings therefor; (i) adoption of a plan for the distribution of the assets of the Corporation; and (j) any other matters required by law to be submitted to the Corporate Member or which the Board determines by resolution to submit. Form 990, Part VI, Section B, line 11 Before filing the Form 990, the organization presented the completed Form 990 to the Finance Committee of the Board for their review and approval. After the Finance Committee approved the Form 990, it was submitted to the Board for final approval. Form 990, Part VI, Section B, line 12c On an annual basis key personnel (VP, department heads (budget administrators)) and all purchasing staff must complete a Conflict of Interest Form disclosing any conflict of interest that may exist or be perceived to exist between themselves and/or family members and vendors, contractors and others PCH has a contract/transaction agreement. These annual disclosure statements are reviewed by the VP of Human Resources. Any issue identified as part of this annual disclosure is referred to the President of PCH for disposition. Persons completing the conflict of interest form know to disclose any potential conflicts on an ongoing basis. An individual with a conflict of interest would be excluded from any discussion, vote, or decision that involved the conflict or decision. Form 990, Part VI, Section B, line 15 The CEO contract is a management contract with the religious order. The Executive Committee of the Board of Directors has the responsibility for the contract and fees. Annually Human Resources gathers market data on executive positions from a variety of published survey sources such as Metropolitan Healthcare Council (MCHC), Mercer, Watson Wyatt, etc. The market data is analyzed for organizations with similar size and characteristics (FTE's, revenue, beds, region, non-for profit, stand alone institutions, etc.) The mean, median and if available the 90th percentile rates are provided to the President/CEO for consideration and reviewed with the Board of Directors. Discussion and process are contemporaneously documented in the minutes. Form 990, Part VI, Section C, line 19 All policies, governing documents and financial statements required to be available to the public are available upon request. Requests can be made from the Financial Department of Palos Community Hospital. St George Corporation 12251 S 80th Avenue Palos Heights IL 60463 364383840 Health Care Provider IL 501(c)(3) 11 a, Type I N/A 0 St George Wellness Center 15430 West Avenue Orland Park IL 60462 364383845 Fitness Center IL 501(c)(3) 9 St George Corporation 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0