2013-05-15T13:37:08-05:00 2012-06-30 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2011-07-01 366000085 THOREK MEMORIAL HOSPITAL THOR 7735256780 850 W IRVING PARK ROAD CHICAGO IL 60613 EDWARD BUDD 7735256780 2013-05-14 1 CAROL LALONDE CPA P00181637 2695674500 2011 2016-02-24 21:20:13Z EDWARD BUDD 850 W IRVING PARK ROAD CHICAGO IL 60613 175092705 0 X WWW.THOREK.ORG X 1911 IL HEALTH CARE SERVICES 8 7 561 0 210 0 0 0 62183249 67930991 10019692 3854232 1158207 1942354 73361148 73727577 0 0 0 0 23308722 22689433 0 0 0 31852484 31316524 55161206 54005957 18199942 19721620 233276455 231137649 43344618 30142594 189931837 200995055 X THOREK HOSPITAL IS COMMITTED TO PROVIDING APPROPRIATE PATIENT SERVICES IN A CARING AND COST-EFFECTIVE MANNER. THOREK HOSPITAL SEEKS TO SERVE ITS PATIENTS, PHYSICIANS, EMPLOYEES, AND COMMUNITY BY PROVIDING QUALITY SERVICES AND ENCOURAGING EMPLOYEE EXCELLENCE. THOREK HOSPITAL WILL SUPPORT EDUCATION AND WILL ACT AS A RESPONSIBLE MEMBER OF OUR COMMUNITY AND THE HEALTHCARE SYSTEM. 0 0 42729404 67930991 THOREK MEMORIAL HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THOREK HOSPITAL, WE RECOGNIZE THAT IT IS THE HOSPITAL'S MISSION TO SERVE THE COMMUNITY BY PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION AND THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PAY FOR ESSENTIAL MEDICAL SERVICES. THEREFORE, IN KEEPING WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF OUR COMMUNITY, WE PROVIDE FREE CARE AND OR SUBSIDIZED CARE TO INDIVIDUALS WHO ARE UNABLE TO PAY FOR ESSENTIAL SERVICES; AND PROVIDE HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT OUR COMMUNITY. 42729404 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 72 0 1 561 1 1 1 0 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 IL X EDWARD BUDD 7739756806 850 W IRVING PARK ROAD CHICAGO IL 60613 X PETER KAMBEROS 40.00 X X 257239 0 1434 MARIO ADAJAR 6.00 X 3600 0 0 EDWIN C LENNOX 6.00 X X 7800 0 0 JAMES E NUGENT 6.00 X X 7800 0 0 JAY MOHAN MD 6.00 X 0 0 0 ROBERT J BAUDINO 6.00 X 7600 0 0 ANASTASIOS MALLIARIS 6.00 X 6400 0 0 PHILIP GORELICK MD 6.00 X 2800 0 0 JAMES DIESFELD MD 6.00 X 5663 0 0 EDWARD BUDD 40.00 X 201977 0 11551 MORGAN FRANCIS MURPHY III 40.00 X 173735 0 5027 MARY MCCAHILL 40.00 X 168505 0 4932 KEVIN HIGDON 40.00 X 0 0 0 NITIN BARMAN 40.00 X 354506 0 7854 JOHN HUNNIFORD 40.00 X 233294 0 4586 THOMAS TRIANTAFILLOU 40.00 X 169336 0 0 VIVEK GUPTA 40.00 X 164055 0 0 MARIAN URIARTE 40.00 X 153636 0 780 FRANK SOLARE 40.00 X 267325 0 11551 FIDEL CASTILLO 40.00 X 125824 0 0 2311095 0 47715 18 1 1 0 LEOPARDO COMPANIES INC 5200 PRAIRIE STONE PARKWA HOFFMAN ESTATE IL 60192 SERVICES 1064643 UNITED MAINTENANCE SERVICE 1550 S INDIANA AVE STE 300 CHICAGO IL 60605 SERVICES 626570 THE NORTHERN TRUST COMPANY 300 ATLANTIC STREET STE 400 STANFORD CT 069013540 SERVICES 601453 EPMG OF ILLINOIS SC 2000 GREEN ROAD STE 300 ANN ARBOR MI 481051571 SERVICES 536090 UNITED SECURITY SERVICES 1550 S INDIANA AVE STE 300 CHICAGO IL 60192 SERVICES 437382 31 NET PATIENT REVENUE 621110 60876728 60876728 MEDICAID ASSESSMENT RE 621110 7042217 7042217 CAPITATION REVENUE 621110 12046 12046 67930991 3942674 3942674 722544 0 722544 722544 722544 101276686 101346825 18303 -70139 -18303 -88442 -88442 REFERENCE LAB 900003 1093585 210 1093375 DIETARY CASH SALES 900099 113751 113751 MISCELLANEOUS 900099 12474 12474 1219810 73727577 67930991 210 5796376 1243215 1243215 18751283 15772401 2978882 2694935 2153643 541292 71987 71987 80265 80265 1880819 1485962 394857 23242 23242 215879 215879 774818 774818 3658655 2890562 768093 1650418 1650418 MEDICAL SUPPLIES 9432667 7452386 1980281 PURCHASED SERVICES 7395228 5842684 1552544 MEDICAID ASSESSMENT 3864386 3864386 BAD DEBT 2198047 2198047 70113 55394 14719 54005957 42729404 11276553 0 17229055 15622212 1100000 4246004 11146042 878903 1042784 1238181 826221 96216765 50912696 39003589 45304069 160615205 154246166 10065518 1850155 233276455 231137649 5259059 6088907 15275744 13657602 101055 13918 22708760 10382167 43344618 30142594 X 189931837 200995055 189931837 200995055 233276455 231137649 X 19721620 -8658402 X X 0 1 1 X 0 X 12825957 12825957 50161928 30477952 19683976 1531919 1296865 235054 27057741 19137879 7919862 4639220 4639220 45304069 FIXED INCOME SECURITIES 54186085 F EQUITY SECURITY FUNDS 91906226 F GOVERNMENTAL SECURITIES 8153855 F 154246166 SELF-INSURANCE RESERVE 4864051 THIRD PARTY PAYOR SETTLEMENTS 5282591 CONTINGENT LIABILITIES 235525 10382167 73727577 54005957 19721620 -8658402 -8658402 11063218 65069175 -8658402 -8658402 73727577 0 73727577 54005957 0 54005957 0 54005957 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE INTERNAL REVENUE SERVICE HAS RULED THAT THE HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL, AND HAS CONCLUDED THAT AS OF JUNE 30, 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO JUNE 30, 2009. 1 1 1 X 0 1 1 1 0 1 1 816083 816083 0.01580 15406630 19451025 -4044395 0.00000 16222713 19451025 -3228312 0.01580 223546 223546 0.00430 2520699 1920772 599927 0.01160 2744245 1920772 823473 0.01590 18966958 21371797 -2404839 0.03170 1 2198047 1318829 22239436 13810224 8429212 X 1 1 1 1 THOREK MEMORIAL HOSPITAL

850 W IRVING PARK ROAD CHICAGO IL 60613

X X X THOREK MEMORIAL HOSPITAL 1 1 1 200.000000000000 0 1 X X X X X X X 1 1 X X X X X X 1 0 1 X 0 0 PART I, LINE 3C: THOREK PROVIDES MEDICALLY NECESSARY SERVICES TO ALL PATIENTS THAT REQUIRE IT, REGARDLESS OF RACE, CREED, COLOR, GENDER, OR COUNTRY OF NATIONAL ORIGIN AND WITHOUT REGARDS TO ABILITY OF THE PATIENT TO PAY FOR SUCH SERVICES. THOREK PROVIDES A MINIMUM 53% DISCOUNT OF CHARGES FOR ALL PATIENTS WITHOUT INSURANCE, REGARDLESS OF INCOME OR ASSETS. PATIENTS ARE ELIGIBLE FOR AN ADDITIONAL 25% QUICK PAY DISCOUNT ON THE REMAINING AMOUNT DUE AFTER THE INTIAL 53% DISCOUNT. PATIENTS ARE ELIGIBLE FOR ADDITIONAL PAYMENT REDUCTIONS AND OR INTEREST FREE PAYMENT PLANS UP TO AND INCLUDING COMPLETE WRITEOFF OF CHARGES FOR PATIENTS THAT ARE ELIGIBLE FOR THE HOSPITAL'S CHARITY CARE POLICY OR SHOW SEVERE FINANCIAL DISTRESS. PART I, LINE 6A: THOREK PREPARES AND FILES THE ANNUAL NON PROFIT HOSPITAL COMMUNITY BENEFITS PLAN REPORT BY DECEMBER 31 OF EACH YEAR WITH THE ATTORNEY GENERAL'S OFFICE OF THE STATE OF ILLINOIS. PART I, LINE 7: FINANCIAL ASSISTANCE AT COST AND UNREIMBURSED MEDICAID: A COST TO CHARGE METHODOLOGY BASED ON THE MEDICARE COST REPORTS WAS USED TO CALCULATE THE COSTS OF CHARITY CARE. COSTS WERE DETERMINED IN ACCORDANCE WITH GUIDELINES PUBLISHED BY THE CATHOLIC HEALTH ASSOCIATION IN CONJUNCTION WITH THE AMERICAN HOSPITAL ASSOCIATION INCLUDING THE FOLLOWING METHODOLOGIES; DIRECT COSTS INCLUDE THE HOURLY WAGES OF EMPLOYEES PROVIDING SERVICES, COST OF SUPPLIES, COST OF SPACE UTILIZED TO PROVIDE SERVICES, AND ANY OTHER DIRECT COSTS INCURRED IN THE PROVISION OF SERVICES AND A COST TO CHARGE METHODOLOGY BASED ON THE MEDICARE COST REPORTS. INDIRECT COSTS WERE INCLUDED WHERE APPLICABLE BASED UPON A COST TO CHARGE METHODOLOGY BASED ON THE MEDICARE COST REPORTS OR CALCULATED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM. FOR ALL COSTS, THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN THIS SECTION AS WELL AS THROUGHOUT SCHEDULE H. FOR SOME COSTS, THE BEST AVAILABLE DATA WAS OBTAINED VIA THE HOSPITAL'S COST ACCOUNTING SYSTEM. IN OTHER INSTANCES, A COST TO CHARGE RATIO WAS CALCULATED AND APPLIED TO THOSE CHARGES FOR THOSE SERVICES. PART I, LINE 7G: THOREK HAS NOT INCLUDED COSTS ATTRIBUTABLE TO ANY PHYSICIAN CLINIC AS PART OF SUBSIDIZED HEALTH SERVICES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2198047. PART II: IN 2012, THOREK FOCUSED MOST OF ITS COMMUNITY EFFORTS IN TO OTHER COMMUNITY ACTIVITIES SUCH AS HEALTH FAIRS AND PROVIDING SERVICES TO CHICAGO HOUSING AUTHORITY RESIDENTS AND OTHER ACTIVITIES THAT WERE NOT "COMMUNITY BUILDING" AS DESCRIBED BY THE CATHOLIC HEALTH ASSOCIATION. PART III, LINE 4: THE COST OF BAD DEBT AS REFLECTED IN PART III LINE 2, WAS CALCULATED USING A COST TO CHARGE RATIO USING THE MEDICARE COST REPORTS. ANY DISCOUNTS PROVIDED OR ANY PAYMENTS RECEIVED AND APPLIED TO A PATIENT ACCOUNT ARE APPLIED TO THE ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFFS AND ARE NOT INCLUDED IN THE PROVISION FOR BAD DEBT IN THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS. THE PROVISION FOR DOUBTFUL ACCOUNTS IS CALCULATED BASED ON HISTORICAL NET COLLECTIONS AND BAD DEBT WRITE-OFFS CONSIDERING ECONOMIC AND PATIENT FINANCIAL CONDITIONS, CHANGES IN HEALTHCARE COVERAGES, AND OTHER COLLECTION INDICATORS. MANAGEMENT WILL PERIODICALLY ASSESS THE APPROPRIATENESS OF THIS ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON HISTORICAL WRITE-OFF PERCENTAGES BY PAYOR. FOR ACCOUNTS WITH REMAINING PATIENT RESPONSIBILITY AFTER INSURANCE PAYMENT, THOREK WILL FOLLOW ITS POLICY (AND REQUIRED BY PAYORS INCLUDING MEDICARE) FOR PLACING CERTAIN OF THESE ACCOUNTS WITH PAST DUE BALANCES AND NO PAYMENT OR COMMUNICATION BY THE PATIENT WITH OUTSIDE AGENCIES SUBJECT TO THE RESTRICTIONS PLACED ON THIS ACTIVITY BY THE HOSPITAL MANAGEMENT. THOREK PATIENT ACCOUNTS MANAGEMENT MANUALLY REVIEWS ALL SELF-PAY ACCOUNTS PRIOR TO PLACING THE ACCOUNTS FOR BAD DEBT. LARGE ACCOUNTS (GREATER THAN $5,000) WILL BE REFERRED TO SENIOR MANAGEMENT FOR REVIEW. THROUGH THIS PROCESS, THE PATIENTS' CREDIT HISTORY AND SCORE IS EXAMINED TO DETERMINE IF THE PATIENT HAS FINANCIAL MEANS TO PAY ANY OF THE AMOUNT OWED. IF THE PATIENT IS NOT COOPERATIVE WITH THIS PROCESS AND THE PATIENT DOES NOT QUALIFY UNDER THE HOSPITAL'S CHARITY CARE POLICY, THE ACCOUNT MAY BE FORWARDED TO A COLLECTION SERVICE, BUT ONLY WHEN ALL OTHER METHODS HAVE FAILED. WE BELIEVE THAT GREATER THAN 60% OF THE ACCOUNTS CHARGED AS BAD DEBT ARE LIKELY ELIGIBLE FOR CHARITY CARE BUT SUFFICIENT INFORMATION OR DOCUMENTATION IS NOT RECEIVED FROM PATIENT IN ORDER TO ALLOW CLASSIFICATION AS CHARITY CARE. THOREK, THEREFORE, BELIEVES THIS PERCENTAGE APPLIES TO THE TOTAL BAD DEBT EXPENSE AS A WHOLE. THEREFORE, OF THE $2,198,048 OF BAD DEBT EXPENSE, THOREK BELIEVES APPROXIMATELY 60% OF THIS AMOUNT, OR $1,318,829, LIKELY REPRESENTS CHARITY CARE.THE FINANCIAL STATEMENTS FOR THOREK MEMORIAL HOSPITAL FOR THE YEAR ENDING JUNE 30, 2012 DID NOT CONTAIN A FOOTNOTE THAT REFERENCED THE PROVISION FOR BAD DEBT EXPENSE FOR THE 2012 FISCAL YEAR AUDIT. HOWEVER, THE HOSPITAL DID PROVIDE SIGNIFICANT AMOUNTS OF UNCOMPENSATED CARE TO ITS UNDERINSURED AND UNINSURED PATIENTS DURING THE FISCAL YEARS ENDING 2012. THE HOSPITAL'S PROVISION FOR BAD DEBT WAS INCLUDED IN THE STATEMENT OF OPERATIONS FOR FISCAL YEARS ENDING JUNE 30, 2012 AND AGGREGATED $2,198,048 IN CHARGES. ANY CONTRACTUAL ADJUSTMENTS OR OTHER DISCOUNTS AND PAYMENTS ARE NOT INCLUDED IN THE PROVISION FOR BAD DEBT EXPENSE IN THE THOREK MEMORIAL HOSPITAL FINANCIAL STATEMENTS UNLESS THE PAYMENT REPRESENTS A RECOVERY OF AN AMOUNT THAT HAD BEEN PREVIOUSLY WRITTEN OFF AND CLASSIFIED AS PROVISION FOR BAD DEBT EXPENSE. THE RECOVERY IS RECORDED IN THE TIME PERIOD IN WHICH IT OCCURS. PART III, LINE 8: MEDICARE COSTS ARE ALLOCATED BY COST CENTER IN ACCORDANCE WITH MEDICARE REGULATIONS. THE COSTS ARE CALCULATED USING A COST TO CHARGE RATIO. PART III, LINE 9B: THOREK PROVIDES FINANCIAL ASSISTANCE TO ALL PATIENTS THAT REQUEST IT. IN ADDITION, THOREK SEEKS TO ENGAGE PATIENTS PROACTIVELY TO DETERMINE IF FINANCIAL ASSISTANCE IS NEEDED, ESPECIALLY AT THE TIME OF SERVICE. THIS SERVICE IS ACCOMPLISHED BY COMMUNICATING THE AVAILABILITY OF FINANCIAL ASSISTANCE TO THE PATIENT THROUGH POSTED SIGNS THROUGHOUT THE HOSPITAL AS WELL AS NOTICES ON THE HOSPITAL WEBSITE AND ALL BILLING CORRESPONDENCE. FURTHERMORE THE HOSPITAL FINANCIAL COUNSELORS WILL PROVIDE ASSISTANCE RANGING FROM ASSISTANCE IN COMPLETING THE HOSPITAL'S CHARITY CARE POLICY, TO PROVIDING PAYMENT PLANS TO THOSE WITHOUT INSURANCE OR WITH PATIENT RESPONSIBILITIES AFTER REIMBURSEMENT BY THE PRIMARY INSURANCE, AND WILL SEEK INSURANCE COVERAGE FOR THOSE PATIENTS UNINSURED. THE HOSPITAL'S FINANCIAL COUNSELORS WILL SEEK TO MAKE CONTACT AND WORK WITH THE PATIENT OR THEIR FAMILY TO HELP THEM IN ANY WAY POSSIBLE TO MEET THEIR FINANCIAL RESPONSIBILITIES IN A SUPPORTIVE MANNER OR IDENTIFY ELIGIBILITY FOR THE HOSPITAL'S CHARITY CARE POLICY. FINANCIAL COUNSELORS WORK WITH PATIENTS IN PERSON WHILE STILL AN INPATIENT IF APPROPRIATE, AFTER AN OUTPATIENT SERVICE AT THE HOSPITAL, OR SOON AFTER SERVICE IS PROVIDED TELEPHONICALLY. AS PART OF THIS PROCESS, THE COUNSELORS WILL ATTEMPT TO DETERMINE IF THERE ARE ANY THIRD PARTY PAYERS WHICH MAY BE AVAILABLE TO HELP THE PATIENT MEET THEIR OBLIGATIONS. THE COUNSELORS WILL WORK WITH OUR PATIENTS TO DETERMINE IF THEY ARE ELIGIBLE FOR MEDICAID OR OTHER STATE OR LOCAL FUNDED PROGRAMS INCLUDING CRIME VICTIMS, ALTERNATIVE INSURANCE INCLUDING COBRA, WORKER'S COMPENSATION, AND/OR OTHER APPROPRIATE THIRD PARTY LIABILITY PAYOR. THE HOSPITAL CONTRACTS WITH AN OUTSIDE FIRM TO PROVIDE ONE FULL-TIME FINANCIAL COUNSELOR AND SUPPORTING STAFF THAT WORK WITH APPROXIMATELY 150 PATIENT ACCOUNTS PER MONTH.THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE BEGINS WITH A PHONE CALL OR MEETING WITH THE PATIENT TO COMPLETE THE HOSPITAL CHARITY CARE APPLICATION FORMS AND/OR PROVIDED EVIDENCE OF THE NEED FOR FINANCIAL ASSISTANCE. IF THE CHARITY CARE APPLICATION MEETS THE HOSPITAL CHARITY CARE GUIDELINES OF 200% OF THE FEDERAL POVERTY GUIDELINES, NO FURTHER COLLECTION ACTIVITY OCCURS AND THE AMOUNT IS APPROPRIATELY RECORDED AS CHARITY CARE AND WRITTEN OFF AFTER THE 53% INITIAL DISCOUNT IS APPLIED. FOR PATIENTS THAT DO NOT MEET CHARITY CARE GUIDELINES, A 53% (BASED ON 400% OF FEDERAL POVERTY GUIDELINES) INITIAL DISCOUNT IS TAKEN. THE REMAINING AMOUNT WILL BE PAID BASED UPON AN AGREED UPON PAYMENT PLAN WITH THE PATIENT OR WILL RECEIVE FURTHER DISCOUNT BASED UPON THE INDIVIDUAL PATIENT'S FINANCIAL SITUATION. ANY FINAL AMOUNT THAT WILL BE PAID IS DETERMINED AND PAID IN FULL OR ACCORDING TO AN AGREED UPON PAYMENT PLAN WITH THE PATIENT. EVERY OPPORTUNITY WILL BE MADE TO ENSURE THE PATIENT HAS THE CHANCE TO PAY WHAT THEY CAN AFFORD TO BASED UPON THEIR FINANCIAL SITUATION AT THAT TIME. THE HOSPITAL DOES NOT ATTEMPT TO GARNISH ANY WAGES OF THE PATIENT, DOES NOT FILE LIENS ON ANY PERSONAL PROPERTY OF THE PATIENT, NOR DOES IT PURSUE ANY OTHER AGGRESSIVE COLLECTION TECHNIQUES IN PURSUIT OF PAYMENT. THOREK MEMORIAL HOSPITAL PART V, SECTION B, LINE 19D: UTILIZED THE STANDARD DISCOUNT PER ILLINOIS STATE REQUIREMENT. PART VI, LINE 2: THOREK WILL BE UTILIZING A COMMUNITY HEALTH ASSESSMENT SURVEY (CONDUCTED IN 2009) WITH AN ASSISTANCE OF AN OUTSIDE RESEARCH FIRM IN ORDER TO CAPTURE PRIMARY AND SECONDARY DATA ON THE HEALTH STATUS AND OPPORTUNITIES FOR IMPROVEMENT OF HEALTH SERVICES IN ITS COMMUNITY. THE PRIMARY DATA WAS OBTAINED THROUGH A TELEPHONE SURVEY OF OVER 1,000 ADULTS IN COOK COUNTY THROUGH A 20-25 MINUTE INTERVIEW WITH 136 INDIVIDUAL QUESTIONS THAT ADDRESSED THE FOLLOWING ISSUES: SELF-REPORTED HEALTH STATUS, PHYSICAL AND MENTAL HEALTH STATUS, INFECTIOUS & CHRONIC DISEASE, MODIFIABLE HEALTH RISKS, ACCESS TO HEALTHCARE SERVICES, HEALTH EDUCATION & OUTREACH, AND HEALTH INFORMATION SOURCES. THESE SURVEYS WERE CONDUCTED IN ENGLISH AND SPANISH. THE PRIMARY DATA WAS SUPPLEMENTED WITH SECONDARY DATA INCLUDING SUCH SOURCES AS CDC, FBI, COUNTY AND STATE PUBLIC HEALTH DEPARTMENTS, NATIONAL CENTER FOR HEALTH STATISTICS, AND THE U.S. CENSUS BUREAU DATA. THE SECONDARY DATA INCLUDES BUT IS NOT LIMITED TO THE FOLLOWING TOPICS: LEADING CAUSES OF DEATH, AGE-ADJUSTED DEATH RATES, VACCINE-PREVENTABLE CONDITIONS (IT WAS NOTED THAT 70% OF ADULTS SURVEYED DID NOT RECEIVE A FLU SHOT WITHIN THE PAST TWELVE MONTHS), STDS, HIV, AND OTHER INFECTIOUS DISEASES, AND FBI CRIME INDEX. THOREK PLANS TO USE THE ASSESSMENT INFORMATION TO EXPAND EXISTING AND CREATE NEW COMMUNITY HEALTH PROGRAMS MOST NEEDED BY UNDERSTANDING THE PREVALENCE OF CHRONIC CONDITIONS, BARRIERS TO ACCESS, AND OTHER HEALTH ISSUES IN THE COMMUNITY.IN ADDITION TO THE SURVEY, THOREK HAS HISTORICALLY AND WILL CONTINUE TO IDENTIFY PRIORITIES FOR COMMUNITY BENEFIT THROUGH THE FOLLOWING INTERNAL REVIEW:THE THOREK MEMORIAL HOSPITAL (TMH) COMMUNITY NEEDS ASSESSMENT IS AN ONGOING PROCESS CONDUCTED BY TMH MANAGEMENT AND SUMMARIZED ANNUALLY IN THE ANNUAL NON PROFIT HOSPITAL COMMUNITY BENEFIT PLAN REPORT SUBMITTED TO THE ATTORNEY GENERAL'S OFFICE OF THE STATE OF ILLINOIS. THIS PROCESS UTILIZES INFORMATION OBTAINED FROM HEALTH AGENCIES AND PRACTITIONERS, COMMUNITY ORGANIZATIONS, AND COMMUNITY REPRESENTATIVES. THIS INFORMATION HAS BEEN GATHERED EITHER THROUGH REVIEW OF PUBLISHED INFORMATION, WRITTEN FEEDBACK, OR DIRECT INTERVIEWS OR DISCUSSIONS WITH PHYSICIANS AND PATIENTS. INDIVIDUALS INCLUDED ARE PHYSICIANS AND ALLIED HEALTH PROFESSIONALS, REPRESENTATIVES FROM THE ELDERLY POPULATION, LOCAL EMPLOYERS, AND COMMUNITY REPRESENTATIVES. FINDINGS FROM THE ASSESSMENT INDICATE: - TMH SERVES A POPULATION HAVING LIMITED ECONOMIC MEANS - THE POPULATION SERVED BY TMH IS NOT BASED ON GEOGRAPHIC PROXIMITY - THERE IS A CONSENSUS BETWEEN TMH AND ITS MEDICAL STAFF REGARDING GOALS - THERE IS LOW CONSUMER AWARENESS OF TMH SERVICES, HOWEVER, THIS IS IMPROVINGTHE TOP PRIORITY UNMET HEALTH NEEDS, BY AGE GROUP, ARE AS FOLLOWS. - ADULTS: ACCESS TO SERVICES (INSURANCE, COST) - SENIORS:COST; MEDICATIONS; POST-HOSPITAL SUPPORT; AND TRANSPORTATIONTHOREK MEMORIAL HOSPITAL HAS ADDRESSED AND/OR PLANS TO ADDRESS THESE IDENTIFIED PRIORITY NEEDS IN THE FOLLOWING WAYS IN THE COMMUNITY:IMPROVE ACCESS TO SERVICES - AMBULATORY CARE. TMH HAS FOCUSED ON THE EXPANSION AND DIFFERENTIATION OF ITS AMBULATORY CARE PROGRAMS IN ORDER TO IMPROVE ACCESS AND SERVICE. THE AMBULATORY CARE DEPARTMENT HAS BEEN PHYSICALLY EXPANDED AND SEPARATED INTO DISTINCT COMPONENTS. - CENTER FOR PRIMARY CARE. TMH OPERATES ITS CENTER FOR PRIMARY CARE. THIS NOT ONLY INCREASED THE SPACE DEVOTED TO AMBULATORY CARE, BUT PROVIDES A PHYSICALLY DISTINCT AREA DESIGNED TO HAVE THE LOOK AND FEEL OF A PRIVATE MEDICAL OFFICE RATHER THAN A "WALK-IN CLINIC". - COMMUNITY AND LOCAL EMPLOYER HEALTH FAIRS AND EDUCATION SESSIONSFOCUS ON NEEDS AND CONCERNS OF SENIORS - CHA PROGRAM. TMH PROVIDES ACCESS TO MEDICAL SERVICES FOR RESIDENTS OF FIVE NEARBY CHICAGO HOUSING AUTHORITY (CHA) RESIDENTIAL FACILITIES BY OPERATING MEDICAL OFFICES IN THESE BUILDINGS. RESIDENTS OF THESE BUILDINGS ARE PREDOMINANTLY SENIORS WHO QUALIFY FOR SUBSIDIZED HOUSING BASED ON FINANCIAL NEED. TYPICAL OFFICE STAFFING CONSISTS OF AN RN AND A PHYSICIAN. IN ADDITION, PHARMACEUTICALS NEEDED BY RESIDENTS ARE DELIVERED FREE OF CHARGE FOR THOSE RESIDENTS THAT REQUIRE THEM BASED ON AN APPROPRIATE COMPLETED SCRIPTS BY THE PHYSICIANS. IN ADDITION TO THE PROVISION OF HEALTH SERVICES, EDUCATIONAL, SOCIAL, AND OTHER ACTIVITIES ARE ARRANGED BY STAFF FOR THE PATIENTS OF CHA AT FIVE SITES ON THE NORTH SIDE OF CHICAGO, IN THOREK'S PRIMARY SERVICE AREA. NO AMOUNTS ARE BILLED BY THE HOSPITAL FOR HEALTHCARE SERVICES PROVIDED AT THESE SITES. THOREK HOSPITAL ALSO HELPS TO PROVIDE ACCESS TO SPECIALTY (CONSULTANT) PHYSICIAN SERVICES TO MEMBERS ON AN AS NEEDED BASIS. - MEDICATION. RECOGNIZING THE NEED TO PROVIDE ACCESS, EXPAND ALTERNATIVES, AND IMPROVE CONVENIENCE TO THOSE WE SERVE, TMH CONTINUES TO PROVIDE MEDICATION THROUGH ITS OUTPATIENT PHARMACY TO HOSPITAL PATIENTS AND CHA RESIDENTS. - TRANSPORTATION. TMH PROVIDES TRANSPORTATION VIA HOSPITAL VAN AND CONTRACTED TRANSPORTATION SERVICES BASED ON HOSPITAL TRANSPORTATION POLICIES TO 50+ CLUB MEMBERS AND OTHERS WITHIN DESIGNATED GEOGRAPHIC BOUNDARIES, AS DETERMINED APPROPRIATE BASED ON NEED AND CLINICAL STATUS, WHEN HOSPITAL SERVICES HAVE BEEN SCHEDULED IN ACCORDANCE WITH THE HOSPITAL'S TRANSPORTATION POLICY. INCREASE AWARENESS OF HEALTH PROGRAMS AVAILABLE - COMMUNICATION OF SERVICES TO THE COMMUNITY AND ITS ORGANIZATIONS - COMMUNITY HEALTH EDUCATION PROGRAMS DISCUSSING PREVENTION AND WELLNESS - ACCESS TO HOSPITAL AND PHYSICIAN SERVICES PART VI, LINE 3: THOREK UTILIZES SEVERAL METHODS TO COMMUNICATE ITS RESPONSIBILITY TO INFORM AND EDUCATE PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER GOVERNMENTAL PROGRAMS OR THE HOSPITAL'S FINANCIAL ASSISTANCE AND CHARITY CARE POLICIES. THE HOSPITAL POSTS THE AVAILABILITY OF FINANCIAL ASSISTANCE AND CHARITY CARE IN ENGLISH AND SPANISH IN ALL REGISTRATION AND MOST WAITING AREAS THROUGHOUT THE HOSPITAL. THE AVAILABILITY FOR CHARITY CARE AS WELL AS THE WORKSHEET TO CALCULATE ELIGIBILITY FOR CHARITY CARE IS POSTED ON THE HOSPITAL'S WEBSITE. IN ADDITION, ALL BILLS AND STATEMENTS SENT TO PATIENTS INCLUDE INFORMATION REGARDING THE FINANCIAL ASSISTANCE AND CHARITY CARE OPPORTUNITIES IN ENGLISH AND SPANISH. THE HOSPITAL ALSO CONTACTS FOR A FULL TIME FTE TO PROVIDE FINANCIAL COUNSELING TO PATIENTS WHICH INCLUDES THE ASSISTANCE IN THE MEDICAID APPLICATION PROCESS AS WELL AS A SEARCH FOR OTHER COVERAGE OPTIONS AVAILABLE. MEMBERS OF THE BUSINESS OFFICE ALSO WORK WITH PATIENTS TO SEE WHAT OTHER COMMUNITY RESOURCES MAY BE AVAILABLE TO THE PATIENT FOR CURRENT AND FUTURE CARE PROVISION. THE FINANCIAL COUNSELOR AND MOST OTHER EMPLOYEES IN THE HOSPITAL BUSINESS OFFICE AND PATIENT REGISTRATION ARE FLUENT IN SPANISH, AND PHONE TRANSLATORS ARE USED FOR OTHER LANGUAGES. PART VI, LINE 4: THOREK MEMORIAL HOSPITAL IS REPRESENTATIVE OF THE WIDE CROSS-SECTION OF THE POPULATION THAT IT SERVES. ITS COMMUNITY INCLUDES A SIZABLE NUMBER OF AFRICAN AMERICAN, ASIAN, AND HISPANIC RESIDENTS AS WELL AS A VARIETY OF OTHER ETHNIC GROUPS. THOREK MEMORIAL HOSPITAL'S LONG-STANDING STATUS AS A PREFERRED PROVIDER OF MEDICAL SERVICES FOR EMPLOYERS, ALSO WITH A MULTI-ETHNIC MEMBERSHIP, CONTRIBUTES TO A WELL-ESTABLISHED WORKING CLASS ETHNIC CUSTOMER BASE. THE DEMOGRAPHIC SECTION OF THIS PLAN INCLUDES A LISTING THAT GIVES THE ETHNIC DISTRIBUTION OF INPATIENTS FOR FY 2012. SINCE THOREK MEMORIAL HOSPITAL'S MEDICAL STAFF ALSO REFLECTS ETHNIC DIVERSITY, WE EXPECT TO MAINTAIN A SIGNIFICANT ETHNIC CUSTOMER BASE.ALTHOUGH THOREK MEMORIAL HOSPITAL SERVES PATIENTS THROUGHOUT THE CHICAGO METROPOLITAN AREA AND EVEN AS FAR AWAY AS INDIANA AND WISCONSIN, WE HAVE DEFINED OUR COMMUNITY BASED UPON GEOGRAPHIC PROXIMITY. A PRIMARY SERVICE AREA HAS BEEN IDENTIFIED CONSISTING OF NEARBY ZIP CODE AREAS. THOREK MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF THE FOLLOWING:GRACELAND (60613),LINCOLN PARK (60614), KEDZIE-GRACE (60618), RAVENSWOOD (60625), UPTOWN (60640), LOGAN SQUARE (60647), EDGEWATER (60660), W.ROGERS PARK (60645), ROGERS PARK (60626), DIVISION (60651), AUSTIN (60644), CRAGIN (60639), GARFIELD PARK (60624), NEAR WEST (60612), HAWTHORNE (60623), PILSEN (60608), AND NEAR SOUTH (60616), AS WELL AS ZIP CODES 60653, 60615, 60621, 60637, 60620, 60619, 60649, AND 60628. THE PRIMARY NOT-FOR-PROFIT COMMUNITY HOSPITALS ALSO SERVING THIS AREAINCLUDE: WEISS MEMORIAL HOSPITAL, ILLINOIS MASONIC MEDICAL CENTER (ADVOCATE), SWEDISH COVENANT HOSPITAL, ST. JOSEPH HOSPITAL (RESURRECTION), NORWEIGAN AMERICAN HOSPITAL, METHODIST HOSPITAL, AND ST. MARY AND ST ELIZABETH HOSPITALS (RESURRECTION). APPROXIMATELY 85% OF ADMISSIONS SERVED AT THOREK ARE FEDERALLY FUNDED OR SELF PAY/CHARITY. THE HOSPITAL CONTINUES TO MEET THE CRITERIA FOR A DISPROPORTIONATE SHARE HOSPITAL FOR MEDICARE MEDICAID HIGH-VOLUME ADJUSTMENT FOR THE DEPARTMENT OF HUMAN SERVICES (PUBLIC AID). PART VI, LINE 5: NET COMMUNITY BENEFITS EXPENSE FOR THOREK IN 2012 IS AS FOLLOWS (FROM THE ANNUAL NON PROFIT HOSPITAL COMMUNITY BENEFITS PLAN REPORT FILED IN ACCORDANCE WITH THE ILLINOIS ATTORNEY GENERAL GUIDELINES):CHARITY CARE AT COST - $816,083LANGUAGE ASSISTANT SERVICES - $11,726SUBSIDIZED HEALTH SERVICES - $476,157OTHER COMMUNITY BENEFIT PROGRAMS - $211,820THESE COSTS INCLUDE THE COSTS TO PROVIDE STAFFING AND SERVICES AT VARIOUS HEALTH FAIRS HELD IN THE COMMUNITY THROUGHOUT THE YEAR. THESE HEALTH FAIRS ARE STAFFED BY PHYSICIANS, NURSES, AND MEDICAL ASSISTANTS THAT ARE EMPLOYEES OF THE HOSPITAL. THE SERVICES PROVIDED AT THESE FAIRS INCLUDE BLOOD PRESSURE CHECKS, BLOOD GLUCOSE SCREENINGS, CHOLESTEROL TESTS AS WELL AS FLU SHOTS. ALL SERVICES ARE PROVIDED FREE OF CHARGE AT THESE HEALTH FAIRS. IN ADDITION, THE HOSPITAL PROVIDES (FREE OF CHARGE) GUARDIANSHIP SERVICES THROUGH A LOCAL LEGAL FIRM FOR THOSE INPATIENT PSYCHIATRIC PATIENTS WHO ARE NOT ABLE TO MAKE APPROPRIATE MEDICAL DECISIONS FOR THEMSELVES. ALSO INCLUDED IN OTHER COMMUNITY BENEFIT PROGRAMS IS THE PROVISION OF TRANSPORTATION TO HOSPITAL PATIENTS THAT REQUIRE THIS SERVICE TO RECEIVE APPROPRIATE MEDICALLY NECESSARY HEALTH CARE AND PHYSICIAN SERVICES. THE TRANSPORTATION FOR THESE PATIENTS IS PERFORMED IN ACCORDANCE WITH THE HOSPITAL TRANSPORTATION POLICY TOTAL CHARITY CARE AND COMMUNITY BENEFITS - $2,256,968IN ADDITION, THOREK REPORTED BAD DEBT EXPENSE OF $2,198,047 IN 2012.THOREK EXTENDS MEDICAL STAFF PRIVLEGES TO QUALIFIED PHYSICIANS IN AND AROUND OUR COMMUNITIES AND SEEKS TO PROVIDE THE PHYSICIANS, NURSES, TECHNICIANS, AND ALL OTHERS INVOLVED IN THE DELIVERY OF CARE WITH THE SAFEST AND MOST CURRENT TECHNOLOGICALLY ADVANCED HEALTHCARE ENVIRONMENT POSSIBLE. ALL SURPLUS FUNDS ARE REINVESTED IN THE ORGANIZATION IN ORDER TO CONTINUE TO PROVIDE HIGH QUALITY YET EFFICIENT HEALTH CARE SERVICES TO THOREK'S COMMUNITIES IT SERVES AND TO CARRY OUT ITS MISSION FOR PATIENT CARE, EDUCATION, AND OTHER SERVICES AS NEEDED IN THE COMMUNITY. MEMBERS OF THE BOARD OF TRUSTEES ARE APPOINTED ON THE BASIS OF THEIR EXPERTISE AND EXPERIENCE IN A VARIETY OF AREAS BENEFICIAL TO THOREK. REPORTS FILED WITH STATES PART VI, LINE 7 IL X X X X X 0 0 0 0 0 0 0 0 0 PETER KAMBEROS 237129 0 20110 0 0 0 0 0 1434 0 258673 0 0 0 EDWARD BUDD 181770 0 20207 0 0 0 0 0 11551 0 213528 0 0 0 MORGAN FRANCIS MURPHY III 153634 0 20101 0 0 0 0 0 5027 0 178762 0 0 0 MARY MCCAHILL 143395 0 25110 0 0 0 0 0 4932 0 173437 0 0 0 NITIN BARMAN 354399 0 107 0 0 0 0 0 7854 0 362360 0 0 0 JOHN HUNNIFORD 233191 0 103 0 0 0 0 0 4586 0 237880 0 0 0 THOMAS TRIANTAFILLOU 166733 0 2603 0 0 0 0 0 0 0 169336 0 0 0 VIVEK GUPTA 164004 0 51 0 0 0 0 0 0 0 164055 0 0 0 MARIAN URIARTE 153426 0 210 0 0 0 0 0 780 0 154416 0 0 0 FRANK SOLARE 267218 0 107 0 0 0 0 0 11551 0 278876 0 0 0 FIDEL CASTILLO 125824 0 0 0 0 0 0 0 0 0 125824 0 0 0 PETER KAMBEROS CHAIRMAN OF THE BOARD AND COO 53139 PETER'S NEPHEW THERON PAPPAS WAS EMPLOYED BY THOREK MEMORIAL HOSPITAL THROUGH 8/1/11. 0 FORM 990, PART VI, SECTION B, LINE 11 HOSPITAL MANAGEMENT PREPARES A DRAFT OF THE FORM 990 RETURN WITH THE ASSISTANCE OF AN INDEPENDENT ACCOUNTING AND TAX FIRM. THE HOSPITAL'S INDEPENDENT ACCOUNTING AND TAX FIRM PRESENTS THIS DRAFT VERSION OF THE 990 TAX RETURN TO THE HOSPITAL BOARD OF TRUSTEES. THE BOARD OF TRUSTEES HAS THE OPPORTUNITY TO REVIEW THE RETURN, ASK QUESTIONS, AND SUGGEST CHANGES. THE BOARD OF TRUSTEES APPROVES THE FINAL VERSION OF THE RETURN AND MANAGEMENT FILES THIS RETURN WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL REGULARLY AND CONSISTENTLY MONITORS COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY THROUGH AN ANNUAL REVIEW AND COMPLETION OF THE ANNUAL BOARD MEMBER QUESTIONNAIRE AND CONFLICT OF INTEREST POLICY BY EACH MEMBER OF THE BOARD OF TRUSTEES. THE CORPORATE COMPLIANCE OFFICER REVIEWS AND ENFORCES THE CONFLICT OF INTEREST POLICY. IF A CONFLICT ARISES, THE BOARD MEMBER ABSTAINS FROM VOTING ON THE RELEVANT ISSUE. FORM 990, PART VI, SECTION B, LINE 15 DURING FISCAL YEAR 2012, THE HOSPITAL ENGAGED SULLIVAN AND COTTER MCHC TO PROVIDE A COMPARATIVE SALARY ANALYSIS FOR OFFICERS. THE INFORMATION WAS DISTRIBUTED TO THE COMPENSATION COMMITTEE OF THE BOARD. THE COMMITTEE WILL THEN MAKE RECOMMENDATIONS TO THE BOARD OF TRUSTEES ON AN ANNUAL BASIS. ALL DECISIONS BY THE BOARD OF TRUSTEES ARE DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII: NED BUDD WORKED AN AVERAGE OF AT LEAST 1 HOUR PER WEEK AT A RELATED ORGANIZATION. JAGAN MOHAN WORKED AN AVERAGE OF AT LEAST .5 HOURS PER WEEK AT A RELATED ORGANIZATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -8,658,402. FORM 990, PART XII, LINE 2C: THERE WAS NO CHANGE FROM PRIOR YEAR. THE THOREK FOUNDATION 850 WEST IRVING ROAD CHICAGO IL 60613 366124318 SUPPORT THOREK MEMORIAL HOSPITAL IL 501(C)(3) 11C THOREK MEMORIAL HOSPITAL 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0