2013-11-14T14:00:41-06:00 2012-12-31 CROWE HORWATH LLP 70 West Madison Street Suite 700 Chicago IL 606024903 990 2012-01-01 362167847 ROCKFORD MEMORIAL HOSPITAL ROCK 8159715000 2400 N ROCKTON AVE ROCKFORD IL 61103 HENRY M SEYBOLD 2013-11-11 true NICOLE BENCIK P00756195 3128997000 2012 2016-02-25 16:41:14Z GARY KAATZ 2400 N ROCKTON AVE ROCKFORD IL 61103 582568235 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, REGION'S ONLY PEDIATRIC INTENSIVE CARE UNIT & DESIGNATED DISASTER POD HOSPITAL. 14 9 2377 325 195195 -20749 5435291 5807034 339554608 322774917 2459256 10581871 1986709 1928538 349435864 341092360 580004 492362 0 0 144424398 139266562 0 0 0 153454822 141390627 298459224 281149551 50976640 59942809 363793401 341780038 206619071 188477035 157174330 153303003 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 154982202 199747307 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 2012 PATIENT CARE WAS RENDERED TO 12,478 INDIVIDUALS WHO PRESENTED THEMSELVES FOR SERVICE INCLUDING 1,444 DELIVERIES AND 3,609 INPATIENT SURGERIES ALONG WITH SUPPORTING 51,767 EMERGENCY VISITS. CHARITY CARE PROVIDED FOR 2012 AMOUNTED TO $28,075,442. 67783150 122636474 RMH IS DESIGNATED BY THE IL DEPT OF 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 2012, THAT INCLUDED 1,453 VISITS TO THE SLEEP LAB; 86,684 DIAGNOSTIC RADIOLOGY PROCEDURES OR TESTS; 9,287 RADIATION ONCOLOGY TREATMENTS; 34,667 CARDIAC PROCEDURES OR TESTS; 4,622 VISITS TO THE PAIN CLINIC; AND 179,304 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 2012, RHML PERFORMED 1,479,031 TESTS. 7014054 342362 71792 RMH HAS PROVIDED HEALTH EDUCATION AND OUTREACH IN A VARIETY OF FORMS WITHIN THE ELEVEN COUNTRY 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 869 HEALTH AND DENTAL CHECKUPS AND BASIC HEALTH SERVICES TO 789 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. 827926 150000 126441 THROUGH ROCKFORD MEMORIAL HOSPITAL AUXILIARY, RMH IS ABLE TO PROVIDE EXTRA FUNDS AND SERVICES TO SUPPORT ITS MISSION. THE AUXILIARY HAS 325 VOLUNTEERS WHO LOGGED 34,380 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. 827926 150000 126441 230607332 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 215 0 true 2377 true true true true BD false false false false false false false false X 14 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 X CONNIE M VITALI 2.00 0.85 X X 0 0 0 DUANE R BACH 0.10 1.10 X X 0 0 0 ELEANOR F DOAR 1.00 3.90 X X 0 0 0 CURTIS D WORDEN 0.50 1.90 X 0 18585 0 DENNIS T UEHARA 20.50 35.00 X 0 507590 72283 JACK J BECHERER 1.00 0.50 X 0 0 0 JAMES W BRECKENRIDGE 1.00 41.00 X 0 445914 39060 JOHN T DORSEY 0.10 61.10 X 0 409023 53444 JOHN W CHADWICK 0.30 0.31 X 0 0 0 JOSE L GONZALEZ 0.70 53.20 X 0 399407 56036 PAMELA S FOX 0.10 0.11 X 0 0 0 PAUL A GREEN 1.00 1.10 X 0 0 0 STACIE TALBERT 1.00 2.00 X 0 0 0 THOMAS D BUDD 0.30 1.00 X 0 0 0 GARY E KAATZ 1.00 59.00 X 0 961658 93117 GORDON LANGEJANS 40.00 0 X 219809 0 30311 HENRY M SEYBOLD 3.00 42.25 X 0 494404 70335 JULIE PETERSON 1.00 40.25 X 0 75015 35063 CAROLYN BENGTSON 40.00 0 X 339961 0 54615 CURT LESHER 40.00 0 X 172377 0 38313 LAWRENCE VERFURTH 40.00 1.50 X 259012 0 25660 MICHAEL TYRKUS 40.00 0 X 226706 0 49299 SUSAN SCHREIER 40.00 0 X 264621 0 49906 1482486 3311597 667444 53 false true false ROCKFORD HEALTH SYSTEM 2400 N ROCKTON AVE ROCKFORD IL 61103 ADMINISTRATIVE SERVICES 4763789 SCHMELING CONSTRUCTION CO 315 HARRISON AVE ROCKFORD IL 61104 GENERAL CONTRACTORS 3092384 PHILIPS MEDICAL SYSTEM PO BOX 100355 ATLANTA GA 30384 CONTRACT MAINTENANCE 2054731 AIR METHODS CORP PO BOX 676592 DALLAS TX 752676592 HELICOPTER PILOT/SERVICES 1436058 MAYO MEDICAL LABORATORIES PO BOX 4100 ROCHESTER NY 559034100 LABORATORY TESTING SERVICES 1042592 48 870128 4931417 5489 5807034 INPATIENT ROUTINE & ANCILLARY 900099 98859736 98859736 OUTPATIENT & EMERGENCY 621400 69732023 69732023 DIAGNOSTIC & MEDICAL LABORATORY 621500 11930019 11746314 183705 MEDICARE/MEDICAID 900099 139821409 139821409 OTHER 900099 2431730 2422532 9198 0 0 0 0 322774917 3586530 3586530 0 0 536112 364857 171255 0 171255 171255 247933687 172672 240916923 194095 7016764 -21423 6995341 6995341 0 0 0 CAFETERIA/FOOD SERVICE/CATERING 722320 1757283 2292 1754991 0 0 0 0 0 0 1757283 341092360 322582014 195195 12508117 492362 492362 0 0 0 0 0 103993097 85200087 18793010 5381445 4374602 1006843 23066010 18624783 4441227 6826010 6112775 713235 0 258011 0 258011 297388 0 297388 0 0 547066 0 547066 9240372 4026923 5213449 0 807051 4566 802485 9417072 7168681 2248391 9224258 4317772 4906486 0 9012931 6696888 2316043 103954 83327 20627 0 568698 163212 405486 2539697 2539697 0 15535989 10380321 5155668 3443552 1518646 1924906 MEDICAID ASSESSMENT TAX 11011998 11011998 SUPPLIES/DRUGS 47269068 47229572 39496 HEALTHCARE SERVICES 12025414 12025414 BAD DEBT EXPENSE 582993 582993 9505115 8052713 1452402 0 281149551 230607332 50542219 0 0 4300 4200 24657024 45078098 393042 1375860 63598137 71148268 0 0 8339 4325 6499050 6050023 6476302 1538962 298391247 206639147 88477965 91752100 153262728 103789353 0 8289455 8585231 12127059 12453618 363793401 341780038 113099756 91027514 67936205 66349107 0 174834 0 25408276 31100414 206619071 188477035 X 148928034 144823779 5621137 5854065 2625159 2625159 157174330 153303003 363793401 341780038 X 59942809 3245439 -67059575 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 37267 37267 false Description of the activities reported on Lines 1a through 1i Schedule C, Part II-B, Line 1 A PERCENTAGE OF THE 2012 ILLINOIS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION DUES WERE USED FOR LOBBYING. 6085799 69541 933066 224548 15930 6847928 5926437 95812 130832 44441 22841 6085799 4988438 320215 756626 117358 21484 5926437 2071454 369919 2640776 76266 17445 4988438 2893435 40484 -844100 18365 2071454 0.05000 0.45800 0.49200 false true true 65484 2531757 2597241 529772 61140833 44404780 17265825 99060 96472 2588 219279623 162137895 57141728 14744718 0 14744718 91752100 0 ACCRUED POST RETIREMENT MEDICAL BENEFITS 6273851 ACCRUED PENSION 24826563 31100414 FIN48 (ASC 740) DISCLOSURE SCHEDULE D, PART X, LINE 2 THERE IS NO FIN 48 LIABILITY AND AS SUCH, THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS DO NOT INCLUDE A FIN 48 DISCLOSURE. Intended uses of endowment funds Schedule D, Part V, Line 4 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. true true X true X 1.75 true X true true true false true true 9026648 0 9026648 0.03210 69583332 71699376 -2116044 0.00000 0 0 0 0.00000 0 0 78609980 71699376 6910604 0.03210 3971072 1338460 2632612 0.00940 1266435 111279 1155156 0.00410 18600320 17569645 1030675 0.00360 0 0 0 0.00000 376880 0 376880 0.00130 0 0 24214707 19019384 5195323 0.01840 0 0 102824687 90718760 12105927 0.05050 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 17301651 0 71349805 82914059 -11564254 X true true 2 1 ROCKFORD MEMORIAL HOSPITAL

2400 N ROCKTON AVE ROCKFORD IL 61103

HTTP://WWW.ROCKFORDHEALTHSYSTEM.ORG/ROCKFORD-MEMORIAL-HOSPITAL 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 X REHABILITATION ROCKFORD MEMORIAL HOSPITAL 1 true true 175 true 300 true X X X X X X X true true X X X X X true X false X X X X true X false false VANMATRE HEALTH SOUTH 2 true true 200 true true X X true true X false false false X false false CRITERIA FOR DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE SCHEDULE H, PART I, LINE 3C 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. COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A 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. Costing Methodology used to calculate financial assistance Schedule H, Part I, Line 7 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. Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 0 Bad debt expense - methodology used to estimate amount Schedule H, Part III, Line 2 AMOUNTS FOR UNCOLLECTIBLE ACCOUNTS ARE 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. Bad debt expense - financial statement footnote Schedule H, Part III, Line 4 ROCKFORD HEALTH SYSTEM CONSOLIDATED AUDIT REPORTS: THE SYSTEM'S POLICY IS TO PROVIDE MEDICALLY NECESSARY HEALTH CARE SERVICES REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR SUCH CARE. RHS MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE CHARITY, UNCOMPENSATED CARE AND COMMUNITY BENEFIT IT PROVIDES. THESE RECORDS INCLUDE THE COST FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS POLICIES AS WELL AS THE ESTIMATED DIFFERENCE BETWEEN THE COST OF THE SERVICES PROVIDED TO MEDICAID PATIENTS AND THE REIMBURSEMENT RECEIVED FROM THE STATE FOR THIS CARE. THE COSTS OF SERVICE ARE ESTIMATED USING THE ANNUAL COST-TO-CHARGE RATIO. DURING THE YEARS ENDED DECEMBER 31, 2012 AND 2011, THE FOLLOWING LEVELS OF CHARITY CARE AND COMMUNITY SERVICE, INCLUDING SERVICES FOR WHICH THE SYSTEM RECEIVED NO REIMBURSEMENT OR WAS REIMBURSED BELOW COST, WERE PROVIDED. THE SYSTEM ACTIVELY SPONSORS COMMUNITY BENEFITS THAT RESPOND TO COMMUNITY NEEDS. THESE PROGRAMS FOCUS ON THE UNDERSERVED WITH THE INTENTION OF IMPROVING THE OVERALL HEALTH OF THE ENTIRE COMMUNITY. EXAMPLES OF THIS OUTREACH INCLUDE MOBILE CLINICS, PARTNERING WITH LOCAL SCHOOLS AND EMPLOYERS TO PROVIDE HEALTH SCREENINGS, SUPPORT AND HEALTH EDUCATION; PROVIDING SOCIAL SERVICES, SUCH AS MULTI-FAITH MINISTRY, INTERPRETERS AND SUPPORT GROUPS; PROVIDING EMERGENCY MEDICAL TRAINING TO OTHER PROVIDERS ACROSS THE REGION; AND SERVING AS THE REGION'S EMERGENCY DISASTER RESPONSE CENTER. OUR 24 HOUR EMERGENCY ROOM, MENTAL HEALTH SERVICES, AND MULTIPLE CONVENIENT CARE LOCATIONS PROVIDE FOR VARIOUS AND TIMELY HEALTH CARE NEEDS THROUGHOUT THE REGION. SINCE BAD DEBT IS OFTEN DIFFICULT TO DISTINGUISH FROM CHARITY CARE DUE TO INSUFFICIENT DATA PROVIDED BY THE PATIENT, RMH CONTINUES TO PROVIDE SUPERIOR CARE TO ALL PATIENTS AS A PART OF ITS MISSION AND CONSIDERS THE COST OF BAD DEBT WRITEOFFS AS A SUBSTANTIAL BENEFIT TO THE COMMUNITY. VAN MATRE HEALTH SOUTH IS A PARTNERSHIP 50% OWNED BY ROCKFORD HEALTH SYSTEM VENTURES LLC, A DISREGARDED ENTITY OWNED 100% BY ROCKFORD MEMORIAL HOSPITAL. IT IS A FOR-PROFIT ORGANIZATION THAT DOES NOT REPORT ANY SEPARATE FOOTNOTE REGARDING CHARITY CARE OR BAD DEBT. Community benefit & methodology for determining medicare costs Schedule H, Part III, Line 8 THE DATA REPORTED FOR MEDICARE CHARGES AND PAYMENTS IS FROM THE FINAL MANAGEMENT REPORT PRODUCED BY THE FIRM THAT PREPARED THE 2012 COST REPORT AS SUBMITTED TO THE FISCAL INTERMEDIARY IN 2013 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 Collection practices for patients eligible for financial assistance Schedule H, Part III, Line 9b 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. 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. GENERAL INFORMATION REGARDING HOSPITAL #2 SCHEDULE H, PART V 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. DETERMINATION OF MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS SCHEDULE H, PART V, SECTION B, LINE 20 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. ONCE A PATIENT IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, THE APPLICABLE DISCOUNTS ARE APPLIED TO HIS/HER ACCOUNT. Means used to determine amounts billed Schedule H, Part V Section B, Line 20d (1) ROCKFORD MEMORIAL HOSPITAL - ALL PATIENT ACCOUNTS ARE REVIEWED FOR INSURANCE, FOR OTHER POTENTIAL PROVIDERS OR GOVERNMENT ASSISTANCE. THEN ALL DISCOUNTS AVAILABLE TO EITHER INSURED, SELF-PAY, UNDERINSURED OR UNINSURED PEOPLE ARE APPLIED. AFTER DETERMINING THE LIABILITY FOR EACH PERSON AT THE TIME OF BILLING, OTHER REQUESTS FOR FINANCIAL ASSISTANCE ARE PROCESSED, FURTHER ASSISTANCE MAY BE OFFERED AND DISCOUNTS APPLIED, PAYMENT PLANS ARE SET UP, AND PAYMENT AGREEMENTS REACHED. THEN, AFTER 120 DAYS OF NO CONTACT OR INACTIVITY ON A PAST DUE BALANCE, THE ACCOUNT MAY BE TURNED OVER TO A COLLECTION AGENCY.; CHARGES BILLED SCHEDULE H, PART V, SECTION B, LINE 21 THE CHARGES BILLED ARE ALWAYS UNIFORM, THE COLLECTED AMOUNTS MAY VARY DEPENDING ON APPLICABLE DISCOUNTS. Needs assessment. Schedule H, Part VI, Line 2 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 OF 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. Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 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 WEB SITE 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." Community information. Schedule H, Part VI, Line 4 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 292,000). 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 MORE THAN 196,000 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 11% IN ROCKFORD IN JULY, 2013 COMPARED TO STATE FIGURES AT 9.4%. ONLY 21% OF WINNEBAGO COUNTY RESIDENTS ATTAIN A BACHELOR'S DEGREE WHILE IN THE STATE CLOSE TO 31% DO. CLOSE TO 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 2007 - 2011 AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES FOR INDIVIDUAL ZIP CODES LISTS MEDIAN HOUSEHOLD INCOME FOR WEST SIDE ZIP CODES AS FOLLOWS: 61103 - $36,599; 61102 - $33,545; 61101 - $29,316. 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 - $55,897; 61108 - $46,449; 61114 - $68,515. 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. Promotion of community health Schedule H, Part VI, Line 5 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. 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 2012, 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 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, TOTALING MORE THAN $1.3 MILLION IN FREE CARE OVER THE LIFE OF THE PROGRAM. THE PARTNERSHIP HAS PROVIDED MORE THAN 6,250 DENTAL VISITS, 1,300 MEDICAL VISITS, AND 950 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, WITH MORE THAN 1,400 ENCOUNTERS. 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 2012, OUR HELICOPTER AND HIGHLY TRAINED STAFF WERE AT 83 ACCIDENT SCENES TO STABILIZE AND TRANSPORT EMERGENT PATIENTS TO THE HOSPITAL. 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. Affiliated health care system Schedule H, Part VI, Line 6 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 2012. THOSE DONATIONS RANGE FROM MANPOWER AT NONPROFIT ORGANIZATION'S FUNDRAISING EVENTS, TO FINANCIAL SUPPORT OF QUALITY OF LIFE INITIATIVES TO THE DISTRIBUTION OF SURPLUS SUPPLIES FROM OUR GREEN STORE. ADDITIONALLY, THE EXTERNAL GRANTS PROGRAM OF THE ROCKFORD MEMORIAL DEVELOPMENT FOUNDATION PROVIDES SUPPORT TO COMMUNITY NONPROFITS THAT SERVE AS AN EXTENSION OF ROCKFORD HEALTH SYSTEM'S HEALTH CARE MISSION. IN 2012, FINANCIAL DONATIONS ALONE AMOUNTED TO NEARLY $350,000. 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 FREE 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 THE FIRST YEAR OF THE PROGRAM, THE ROCKFORD HEALTH SYSTEM WOMEN'S CENTER PROVIDED FREE SCREENING MAMMOGRAMS TO MORE THAN 180 WOMEN. OTHER FREE DIAGNOSTIC SERVICES PROVIDED INCLUDE DIAGNOSTIC MAMMOGRAPHY, BREAST ULTRASOUNDS AND STEREOTACTIC BIOPSY. NORTHWEST COMMUNITY CENTER - THANKS TO FINANCIAL SUPPORT FROM ROCKFORD HEALTH SYSTEM THROUGH THE ROCKFORD MEMORIAL DEVELOPMENT FOUNDATION, OVER 5,000 BREAKFASTS WERE SERVED IN 2012 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. ADOPT A SCHOOL - FOR WELL OVER 10 YEARS, ROCKFORD HEALTH SYSTEM HAS COLLABORATED WITH NEIGHBORHOOD ELEMENTARY SCHOOLS ASSISTING THEM WITH SPECIAL NEEDS. BOTH SCHOOLS HAVE NEARLY 90% OF THE CHILDREN ATTENDING WHO LIVE IN POVERTY. WHETHER IT IS BUYING REWARDS FOR STUDENTS, TREATING STAFF TO PIZZA PARTIES, SPECIAL HOLIDAY TREATS FOR CHILDREN OR SUPPORTING FAMILIES WITH CHRISTMAS GIFTS, THE STAFF AND ADMINISTRATORS AT ROCKFORD HEALTH SYSTEM HAVE CONSISTENTLY REACHED OUT TO SUMMERDALE ELEMENTARY SCHOOL AND NOW CONKLIN ELEMENTARY SCHOOL. BOTH SCHOOLS ARE NEAR THE ROCKFORD MEMORIAL HOSPITAL CAMPUS. GIGI'S PLAYHOUSE - 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 RESOURCES, SPECIALIZED TEACHING, 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. MILESTONE, INC. - ONCE AGAIN IN 2012, THE ROCKFORD MEMORIAL DEVELOPMENT FOUNDATION SUPPORTED MILESTONE INC., THE REGION'S LARGEST PROVIDER OF RESIDENTIAL, DEVELOPMENTAL AND VOCATIONAL SUPPORT SERVICES FOR ADULTS AND CHILDREN WITH DEVELOPMENTAL DISABILITIES. THIS YEAR, FUNDING HELPED MILESTONE PROVIDE A THERAPEUTIC WHIRLPOOL FOR RESIDENTS. REMEDIES - ANOTHER OF THE COMMUNITY CHARITIES SUPPORTED BY ROCKFORD HEALTH SYSTEM IN 2012 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. 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 2012 ARE: CARRIE LYNN CHILDREN'S CENTER, BARBARA OLSON SCHOOL OF HOPE, ROSECRANCE FOUNDATION, WINNEBAGO COUNTY COURT APPOINTED ADVOCATE (CASA) PROGRAM, GOLDEN APPLE FOUNDATION, CENTER FOR SIGHT AND HEARING, HEALING PATHWAYS, THE ALZHEIMER'S ASSOCIATION, NORTHERN ILLINOIS DIABETES COALITION, LITTLE HANDS MAKE A BIG DIFFERENCE, RETREAT AND REFRESH STROKE CAMP, MARCH OF DIMES, RAMP, BLACK HEALTHCARE INITIATIVE COALITION, YMCA KIDS ON THE MOVE, REMEDIES, HAVEN NETWORK, EASTER SEALS, ARTHRITIS FOUNDATION, FAMILY COUNSELING SERVICES, GIRLS SCOUTS, MUSCULAR DYSTROPHY ASSOCIATION, AND VARIOUS FOOD PANTRIES. DIVERSE NEEDS - ROCKFORD HEALTH SYSTEM COLLABORATES WITH DIVERSE ORGANIZATIONS ACROSS OUR COMMUNITY ENSURING THAT MANY DIVERSE POPULATIONS BENEFIT FROM OUR SUPPORT. IN 2012, ROCKFORD HEALTH SYSTEM PROVIDED SUPPORT FOR MINORITY NURSING SCHOLARSHIPS, THE ROCKFORD AREA MINORITY MANAGEMENT ORGANIZATION, THE BLACK HEALTHCARE INITIATIVE COALITION AND THE CONVERSATION CAFÉ, BLACK DOCTORS ASSOCIATION, AS WELL AS THE YMCA'S BLACK AND LATINO ACHIEVERS. ROCK RIVER VALLEY FOOD PANTRY - THANKS TO THE GENEROSITY OF ROCKFORD HEALTH SYSTEM EMPLOYEES, NEARLY 71 BOXES OF FOOD AND OVER $1,200 WERE DONATED TO THE ROCK RIVER VALLEY FOOD PANTRY DURING INTERNAL THANKS-FOR-GIVING FOOD DRIVE IN 2012. WITH HIGH UNEMPLOYMENT RATES ACROSS THE REGION, ROCKFORD HEALTH SYSTEM EMPLOYEES SET UP EACH YEAR TO HELP THOSE LESS FORTUNATE. 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 2012, THE FUND HAS PROVIDED MORE THAN $290,000 IN ASSISTANCE TO FELLOW EMPLOYEES FACING DIFFICULTIES. THE ASSISTANCE COMES IN MANY FORMS AND MAY INCLUDE PAID TIME OFF FOR EMPLOYEES WHO HAVE LOVED ONES WITH SIGNIFICANT MEDICAL CONDITIONS OR 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. NURSING HOME MONTHLY MEETINGS - MONTHLY LINKAGE MEETINGS HAVE BEEN ESTABLISHED WITH LOCAL NURSING HOMES IN ORDER TO PROVIDE SEAMLESS CARE AND IMPROVE THE HEALTH STATUS OF PATIENTS WITH CHRONIC DISEASES. ACUTE SITUATIONS CAN OCCUR RAPIDLY WITH MANY OF THESE PATIENTS. IN AN EFFORT TO IMPROVE THEIR ONGOING CARE, RHS HAS PARTNERED WITH THESE ORGANIZATIONS TO ENSURE THAT BEST PRACTICE MEDICINE IS OCCURRING ACROSS THEIR SPECTRUM OF CARE. THESE BEST PRACTICES MAY BE AS SIMPLE AS WEIGHING PATIENTS DAILY TO EVALUATE THEIR CURRENT STATUS AND TAKING PROACTIVE MEASURES AS NECESSARY WHEN CHANGES IN STATUS DO OCCUR. THESE MEETINGS HAVE FOSTERED RELATIONSHIPS AMONG PROVIDERS; PROVIDED FOR MORE SEAMLESS TRANSFERS; REDUCED GAPS IN CARE; AND HELPED ENSURE ALL PROVIDERS ARE "ON THE SAME PAGE" IN THE CARE PLANS FOR THESE COMPLEX CHRONICALLY ILL PATIENTS. HEALTHY WOMAN - CLOSE TO 600 WOMEN FROM THE ROCK RIVER VALLEY ATTENDED HEALTHY WOMAN 2012. THE ANNUAL EVENT, SPONSORED BY THE WOMEN'S CENTER AT ROCKFORD HEALTH SYSTEM FEATURES A KEYNOTE SPEAKER AND HOUSES A HEALTH AND WELLNESS EXPO FEATURING A VARIETY OF INFORMATION ABOUT VARIOUS RHS PROGRAMS AND PREVENTATIVE MEASURES TO OPTIMIZE WOMEN'S HEALTH. 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. (SEE CONTINUATION #1 BELOW) AFFILIATED HEALTH CARE SYSTEM (CONTINUATION #1) SCHEDULE H, PART VI, LINE 6 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 HOUSING PROJECT - ROCKFORD HEALTH SYSTEM OWNS APPROXIMATELY 45 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 HAS ESTABLISHED AND MAINTAINED 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. State filing of community benefit report Schedule H, Part VI, Line 7 IL true UNITED WAY OF ROCK RIVER VALLEY 612 N MAIN ST STE 300 ROCKFORD IL 61103 362167843 501(C)(3) 35000 PROGRAM SUPPORT MIDWEST FOUNDATION FOR ORTHOPAEDIC RESEARCH AND EDUCATION 324 ROXBURY RD ROCKFORD IL 61107 264444554 501(C)(3) 6000 PROGRAM SUPPORT EASTER SEALS OF METROPOLITAN CHICAGO 1939 WEST 13TH ST STE 300 CHICAGO IL 60608 362169153 501(C)(3) 13550 PROGRAM SUPPORT ROCKFORD SYMPHONY ORCHESTRA 711 N MAIN ST ROCKFORD IL 61103 261180940 501(C)(3) 12936 PROGRAM SUPPORT AMERICAN CANCER SOCIETY 225 N MICHIGAN AVE STE 1200 CHICAGO IL 60601 362167721 501(C)(3) 10000 PROGRAM SUPPORT GROWTH DIMENSIONS S 200 SOUTH STATE STREET BELVIDERE IL 61008 363196645 501(C)(6) 7500 PROGRAM SUPPORT UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE 1601 PARKVIEW AVE ROCKFORD IL 61107 376000511 501(C)(3) 40000 PROGRAM SUPPORT ROCK VALLEY COLLEGE FOUNDATION 3301 N MULFORD RD ROCKFORD IL 61114 363037232 501(C)(3) 25000 PROGRAM SUPPORT RAMP 202 MARKET STREET ROCKFORD IL 61107 363149827 501(C)(3) 5500 PROGRAM SUPPORT ROCKFORD MEMORIAL DEVELOPMENT FOUNDATION 2400 N ROCKTON AVE ROCKFORD IL 61103 363197918 501(C)(3) 150000 PROGRAM SUPPORT 9 1 Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 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 FOR THE AMOUNT OF THE APPEAL AND FOR A SPECIFIED NEED. false false false false false false false false false CAROLYN BENGTSON 277522 0 61305 0 1134 0 30160 0 24456 0 394576 0 0 0 CURT LESHER 147095 0 9599 0 15683 0 19014 0 19299 0 210690 0 0 0 DENNIS T UEHARA 0 504944 0 0 0 2646 0 36485 0 35798 0 579873 0 0 GARY E KAATZ 0 660277 0 270760 0 30622 0 64722 0 28395 0 1054775 0 0 GORDON LANGEJANS 108705 0 51194 0 59910 0 13601 0 16709 0 250119 0 0 0 HENRY M SEYBOLD 0 370116 0 122614 0 1674 0 42488 0 27848 0 564740 0 0 JAMES W BRECKENRIDGE 0 444366 0 0 0 1548 0 0 0 39060 0 484974 0 0 JOHN T DORSEY 0 408000 0 0 0 1024 0 22500 0 30944 0 462467 0 0 JOSE L GONZALEZ 0 398273 0 0 0 1134 0 17000 0 39036 0 455443 0 0 LAWRENCE VERFURTH 196090 0 59462 0 3461 0 6532 0 19129 0 284673 0 0 0 MICHAEL TYRKUS 204546 0 12191 0 9969 0 29149 0 20150 0 276005 0 0 0 SUSAN SCHREIER 210881 0 48293 0 5447 0 26621 0 23285 0 314528 0 0 0 Arrangement used to establish the top management official's compensation Schedule J, Part I, Line 3 THE BOARD OF DIRECTORS HAS A COMPENSATION COMMITTEE THAT REVIEWS EXECUTIVE COMPENSATION. 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 MAKE A RECOMMENDATION TO THE BOARD WHO THEN ACTS UPON THIS INFORMATION TO SET COMPENSATION FOR EXECUTIVES. A ILLINOIS FINANCE AUTHORITY 861091967 45200FSG5 2008-12-11 32782769 REFUND 1994 SERIES BONDS false false false B ILLINOIS FINANCE AUTHORITY 861091967 2012-05-02 35075000 REFUND 1997 SERIES BONDS false false false A 0 0 32782769 0 0 0 511397 17524 0 0 32253849 0 2008 true false true true B 0 0 35075000 0 0 0 536807 0 0 0 34538193 0 2012 true false true true A false false false false false false 0.0000 0.0000 0.0000 false false 0.000000 false false B false false false false false false 0.0000 0.0000 0.0000 false false 0.000000 false false A false true false false true true JP MORGAN CHASE 10.3 false false false 0.0 false false true B false true false false false false 0.0 false false false 0.0 false false true A true B true ISSUE PRICE NOT IDENTICAL TO FORM 8038 SCHEDULE K, PART I, COLUMN (E) 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. CONNIE VITALE RMH BOARD MEMBER PARTNER, RMH PATHOLOGIST 388028 CONTRACT FOR PATHOLOGY SERVICES false Delegate broad authority to a committee Form 990, Part VI, Section A, Line 1a THE VOTING MEMBERS OF THE 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 CAPCACITY, 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. Classes of members or stockholders Form 990, Part VI, Section A, Line 6 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 REQUIRETRANSFER 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; Members or stockholders electing members of governing body Form 990, Part VI, Section A, Line 7a SEE NARRATIVE FOR FORM 990, PART VI, LINE 6. Decisions requiring approval by members or stockholders Form 990, Part VI, Section A, Line 7b SEE NARRATIVE FOR FORM 990, PART VI, LINE 6. Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b 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 VP OF FINANCE, 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. Conflict of interest policy Form 990, Part VI, Section B, Line 12c THE RHS CONFLICT OF INTEREST POLICY SAYS THAT ALL BOARD MEMBERS WILL BE ASKED ANNUALLY TO FILL OUT A DOCUMENT CONCERNING ANY CONFLICT OF INTEREST THEY MIGHT HAVE. DUE TO AN OVERSIGHT, ONLY THE NEW BOARD MEMBERS WERE ASKED TO DO SO IN 2011, BUT ALL BOARD MEMBERS HAVE BEEN REQUESTED TO DO SO IN 2012. PROCESS USED TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL FORM 990, PART VI, LINE 15A 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. PROCESS USED TO ESTABALISH COMPENSATION FOR OTHER OFFICERS FORM 990, PART VI, LINE 15B 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. Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE ILLINOIS ATTORNEY GENERAL'S OFFICE. GOVERNING DOCUMENTS ARE AVAILABLE BY REQUEST FROM THE BOARD SECRETARY. NONEMPLOYEE COMPENSATION FORM 990, PART VII, SECTION A CURTIS WORDEN IS NOT COMPENSATED AS A BOARD MEMBER; HE RECEIVED TAXABLE NONEMPLOYEE COMPENSATION ON A FORM 1099 FOR 2012 LEGAL SERVICES PROVIDED TO THE SYSTEM. Other changes in net assets or fund balances Form 990 , Part XI, Line 9 PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST - -7984501; POST-RETIREMENT MEDICAL BENEFIT-RELATED CHANGES OTHER THAN NET PERIODIC POST-RETIREMENT COST - -525317; NET ASSETS RELEASED FROM RESTRICTIONS USED FOR CAPITAL - 432200; TRANSFER TO/FROM AFFILIATES - -59191988; NET CHANGE IN BENEFICIAL INTEREST IN TRUST - -105575; CHANGE IN FAS124 VALUATION - -22894; UPMIFA - 338500; ROCKFORD HEALTH SYSTEM VENTURES LLC 2400 N ROCKTON AVE ROCKFORD IL 61103 364366881 HEALTHCARE IL 2872238 7684604 NA VISITING NURSES ASSN OF THE ROCKFORD AREA 4223 E STATE STREET ROCKFORD IL 61108 HEALTHCARE IL 501(C)(3) 9 ROCKFORD HEALTH SYSTEM true ROCKFORD HEALTH SYSTEM 2400 N ROCKTON AVE ROCKFORD IL 61103 SUPPORT OF HEALTHCARE IL 501(C)(3) 11 NA false ROCKFORD MEMORIAL DEVELOPMENT FOUNDATION 2400 N ROCKTON AVE ROCKFORD IL 61103 HEALTHCARE IL 501(C)(3) 3 ROCKFORD HEALTH SYSTEM true ROCKFORD HEALTH PHYSICIANS 2300 N ROCKTON AVE ROCKFORD IL 61103 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 22568 556528 1 false true true false false false false false true true true true true true true true true false true