2013-02-26T16:57:36-06:00 2012-04-30 420714325 MCGLADREY LLP 201 N HARRISON STREET SUITE 300 DAVENPORT IA 528011999 990 2011-05-01 362604009 OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER OTTA 8154315479 1100 EAST NORRIS DRIVE OTTAWA IL 61350 ROBERT CHAFFIN 8154315479 2013-02-01 1 JOHN J ROMANO P00227323 5638884000 2011 2016-02-25 16:41:14Z ROBERT CHAFFIN 1100 EAST NORRIS DRIVE OTTAWA IL 61350 105047955 0 X WWW.OTTAWAREGIONAL.ORG X 1964 IL THE MISSION OF OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER IS TO MAINTAIN A LEADERSHIP POSITION IN THE PROVISION OF EFFICIENT AND QUALITY HEALTHCARE SERVICES CONSISTENT WITH THE NEEDS OF THE COMMUNITY AND THE RESOURCES OF THE HOSPITAL. OUR HEALTHCARE ORGANIZATION WILL PROVIDE SERVICES FOR ALL MEMBERS OF THE COMMUNITY, REGARDLESS OF ABILITY TO PAY. 10 10 798 0 0 0 634979 563598 75080901 78492614 1828028 3944872 -2525219 -2278439 75018689 80722645 0 0 0 0 40784252 41176886 0 0 0 38319438 40843479 79103690 82020365 -4085001 -1297720 112820521 107614791 25978005 25910634 86842516 81704157 X THE MISSION OF OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER IS TO MAINTAIN A LEADERSHIP POSITION IN THE PROVISION OF EFFICIENT AND QUALITY HEALTHCARE SERVICES CONSISTENT WITH THE NEEDS OF THE COMMUNITY AND THE RESOURCES OF THE HOSPITAL. OUR HEALTHCARE ORGANIZATION WILL PROVIDE SERVICES FOR ALL MEMBERS OF THE COMMUNITY, REGARDLESS OF ABILITY TO PAY. 0 0 61623447 78492614 NON-PROFIT 99-BED, ACUTE CARE HOSPITAL, INCLUDING A 26-BED PSYCHIATRIC CARE UNIT. $7,831,733 CHARITY CARE PROVIDED. 61623447 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 76 0 1 798 1 0 0 0 0 0 1 1 0 0 0 0 X 10 10 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 IL X MICHELE KONIEWICZ 8154315479 1100 E NORRIS DRIVE OTTAWA IL 61350 STEVEN M GONZALO 1.00 X X 0 0 0 CHRISTINA CANTLIN 1.00 X 0 0 0 GEORGE SHANLEY 1.00 X 0 0 0 MARK PALMER 1.00 X X 0 0 0 MARY MORGAN 1.00 X X 0 0 0 JULIE POLANCIC 1.00 X 0 0 0 WILLIAM KUMMER 1.00 X 0 0 0 ERIC ORTINEAU MD 1.00 X 0 0 0 STEVE CHUNG MD 1.00 X 0 0 0 RENEE KRANOV RN 1.00 X 0 0 0 ROBERT CHAFFIN 40.00 X 278959 0 38971 JUDY CHRISTIANSEN 40.00 X 195776 0 17760 DAWN TROMPETER 40.00 X 137384 0 32407 CHIN SWONG MD 40.00 X 434533 0 28211 DAVID BAYLEY MD 40.00 X 378689 0 27623 MICHAEL M GLAVIN MD 40.00 X 363932 0 27211 ANTHONY FOULEN MD 40.00 X 359106 0 10962 JOSEPH W CHUPREVICH MD 40.00 X 294214 0 26521 2442593 0 209666 24 0 1 0 DRINKER BIDDLE & REATH LLP ONE LOGAN SQUARE SUITE 2000 PHILADELPHIA PA 191036996 LEGAL 424096 WOMEN'S HEALTHCARE PARTNERS OF ILL 1050 E NORRIS DR OTTAWA IL 61350 MEDICAL 415498 HINSHAW & CULBERTSON LLP 8142 SOLUTIONS CENTER DR CHICAGO IL 606778001 LEGAL 293879 ST MARY'S ANESTHESIOLOGY PC 1005 4TH ST LACON IL 61540 ANESTHESIA 278619 DOWNSTATE SHOCKWAVE THERAPIES 403 BRONCO DR STE 2 BLOOMINGTON IL 61704 MEDICAL 277894 11 30044 17730 496660 19164 16371 563598 NURSING SERVICES 623000 63269417 63269417 RADIOLOGY 900099 41142704 41142704 ROUTINE CARE 621110 26698467 26698467 LABORATORY 621500 22026353 22026353 PHYSICIAN SERVICES 900099 10982211 10982211 -85626538 -85626538 78492614 770137 770137 815459 1371120 -555661 -555661 -555661 26027961 59877 22857680 55423 3170281 4454 3174735 3174735 35153 30044 41087 -5934 -5934 CAFETERIA 722210 422366 422366 MISCELLANEOUS 900099 122928 122928 COMMUNITY CLASSES 900099 38275 38275 -2300413 -2300413 -1716844 80722645 78492614 0 1666433 643663 200112 443551 29666761 22271683 7395078 810562 597372 213190 7981133 5160816 2820317 2074767 1516953 557814 866093 866093 193020 193020 23797 23797 234492 832 233660 8910009 7724672 1185337 962480 223534 738946 1231017 500813 730204 204496 164074 40422 358995 358995 5994176 5021203 972973 902471 387744 514727 CHARITY CARE 7831733 7831733 PURCHASED SERVICES 4179676 2761356 1418320 BAD DEBT 3880134 3880134 OTHER EXPENSES 3366216 1316747 2049469 1704674 1704674 82020365 61623447 20396918 0 2700 2800 1046324 2754486 8313015 13123099 1658739 1629513 752296 736467 116669524 62766187 54967037 53903337 34623068 25095359 9915 11447427 10369730 112820521 107614791 10607515 10232477 12984302 12319976 2386188 3358181 25978005 25910634 X 86832668 81694275 9848 9882 86842516 81704157 112820521 107614791 X -1297720 -3840639 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 23797 23797 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: 27%, OR $19,109 OF MEMBERSHIP DUES TO THE ILLINOIS HOSPITAL ASSOCIATION IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. 24.6%, OR $4,688 OF MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. 4725 4725 4725 4725 4725 4725 4725 4725 1.00000 0 1 1 4149486 4149486 71156930 34728820 36428110 34804644 24597790 10206854 6558464 3439577 3118887 53903337 SELF INSURANCE TRUST 3733376 LOAN ORIGINATION COST 455041 DEBT SERVICE RESERVE FUND 1293134 BOND INTEREST FUND 176 457B FUNDS 490586 RADIATION ONCOLOGY JOINT VENTURE 863154 FOX RIVER CANCER CENTER JOINT VENTURE 1598828 PHYSICIAN LOANS 336000 OTTAWA REGIONAL HEALTHCARE AFFILIATES 1294886 CHOICES BLDG FUNDS 20436 ASSESSMENT 284113 10369730 THIRD-PARTY PAYOR SETTLEMENTS 3358181 3358181 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUND IS HELD BY THE OTTAWA REGIONAL HOSPITAL FOUNDATION, A RELATED ORGANIZATION. THE EARNINGS FROM THE FUND ARE USED FOR GENERAL SUPPORT PURPOSES. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER (HOSPITAL), OTTAWA REGIONAL HOSPITAL AUXILIARY (AUXILIARY) AND OTTAWA REGIONAL HOSPITAL FOUNDATION (FOUNDATION) HAVE BEEN RECOGNIZED AS TAX EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. IN LIEU OF CORPORATION INCOME TAXES, THE MEMBERS OF RADIATION ONCOLOGY OF NORTHERN ILLINOIS, LLC (RONI) ARE TAXED ON THEIR SHARE OF THE LLC'S INCOME, DEDUCTIONS, LOSSES AND CREDITS. THEREFORE, THESE CONSOLIDATED FINANCIAL STATEMENTS DO NOT INCLUDE ANY PROVISION FOR INCOME TAXES FOR THESE ENTITIES. OTTAWA REGIONAL HEALTHCARE AFFILIATES, INC (ORHA) IS A FOR-PROFIT CORPORATION SUBJECT TO APPLICABLE FEDERAL AND STATE INCOME TAXES. DEFERRED TAXES FOR ORHA ARE PROVIDED ON A LIABILITY METHOD WHEREBY DEFERRED TAX ASSETS ARE RECOGNIZED FOR DEDUCTIBLE TEMPORARY DIFFERENCES AND OPERATING LOSSES AND TAX CREDIT CARRYFORWARDS AND DEFERRED TAX LIABILITIES ARE RECOGNIZED FOR TAXABLE TEMPORARY DIFFERENCES. TEMPORARY DIFFERENCES ARE THE DIFFERENCES BETWEEN THE REPORTED AMOUNTS OF ASSETS AND LIABILITIES AND THEIR TAX BASIS. DEFERRED TAX ASSETS ARE REDUCED BY A VALUATION ALLOWANCE WHEN, IN THE OPINION OF MANAGEMENT, IT IS MORE LIKELY THAN NOT THAT SOME PORTION OR ALL OF THE DEFERRED TAX ASSETS WILL NOT BE REALIZED. DEFERRED TAX ASSETS AND LIABILITIES ARE ADJUSTED FOR THE EFFECTS OF CHANGES IN THE TAX LAWS AND RATES ON THE DATE OF ENACTMENT. THE HOSPITAL, AUXILIARY, AND FOUNDATION FILE 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 TAX POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO TAX EXEMPT ORGANIZATIONS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF THE ENTITY, THE CONTINUED TAX EXEMPT STATUS OF BONDS ISSUED, THE NATURE, THE 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 990T, AS APPROPRIATE. THE BENEFIT OF TAX POSITION IS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% 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 CONSOLIDATED BALANCE SHEET ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. AS OF APRIL 30, 2012 AND 2011, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED AND RECORDED AS A LIABILITY. FORMS 990 AND 990T FILED BY THE ORGANIZATION ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. FORMS 990 FILED BY THE ORGANIZATION ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEAR ENDED APRIL 30, 2008 AND PRIOR. FORM 1120 FILED BY ORHA IS SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. AUTUMN LEAVES GALA 65197 30044 35153 41087 65197 30044 35153 41087 41087 -5934 1 1 1 X 1 X 1 1 1 0 1 1 3344168 3344168 0.04280 11904297 2939804 8964493 0.11470 271562 171526 100036 0.00130 15520027 3111330 12408697 0.15880 82257 82257 0.00110 2001550 2001550 0.02560 161216 36051 125165 0.00160 2245023 36051 2208972 0.02830 17765050 3147381 14617669 0.18710 0 1425323 0 25206042 30278252 -5072210 X 1 0 1 RADIATION ONCOLOGY OF NORTHERN ILLINOIS LLC RADIATION ONCOLOGY 0.57000 0.43000 1 1 OTTAWA REGIONAL HOSPITAL & HEALTHCARE

1100 EAST NORRIS DRIVE OTTAWA IL 61350

X X X OTTAWA REGIONAL HOSPITAL & HEALTHCARE CE 1 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X X X X 1 0 1 X 0 0 2 OTTAWA REGIONAL MEDICAL CENTER INC

1614 EAST NORRIS DRIVE OTTAWA IL 61350

OUTPATIENT MEDICAL AND DIAGNOSTIC SERVICES RADIATION ONCOLOGY OF NORTHERN ILLINOIS

1200 STARFIRE DRIVE OTTAWA IL 61350

RADIATION ONCOLOGY CENTER PART I, LINE 3C: NOT APPLICABLE PART I, LINE 6A: NOT APPLICABLE PART I, LINE 7: THE COST TO CHARGE RATIO (OBTAINED FROM THE MEDICARE COST REPORT) WAS USED TO DETERMINE THE AMOUNTS REPORTED ON LINE 7. PART I, LINE 7G: A FREESTANDING FACILITY, THE HEALTH CENTER OF EASTERN LASALLE COUNTY (HEALTH CENTER), PROVIDES FREE HEALTH CARE SERVICES TO INDIVIDUALS AND FAMILIES WHO DO NOT HAVE ACCESS TO HEALTH INSURANCE, DO NOT QUALIFY FOR STATE OR FEDERAL PROGRAMS, AND DO NOT HAVE THE FINANCIAL RESOURCES TO SECURE THE HEALTH CARE THEY NEED. NINE OF OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER'S (ORHHC) PHYSICIANS VOLUNTEER THEIR SERVICES TO PROVIDE PRIMARY HEALTH CARE, AND THE HEALTH CENTER DOES NOT RECEIVE ANY FEDERAL OR STATE FUNDS. ANCILLARY SERVICES, SUCH AS LAB AND X-RAY, THAT ARE UNAVAILABLE AT THE HEALTH CENTER, ARE PROVIDED BY THE HOSPITAL AT NO CHARGE.ORHHC HAS THE ONLY HOSPITAL PROVIDING MENTAL HEALTH SERVICES BETWEEN NAPERVILLE, JOLIET, PEORIA AND THE QUAD CITIES. ALTHOUGH SEVERAL LOCAL AND REGIONAL HOSPITALS CEASED TO PROVIDE BEHAVIORAL HEALTH CARE DUE TO A LACK OF PROFITABILITY, ORHHC EXPANDED ITS PROGRAMS AND SERVICES TO MEET COMMUNITY NEEDS. WHILE THE PROGRAM CONTINUES TO OPERATE AT A LOSS (ALMOST $2 MILLION IN FY2012), ORHHC REMAINS COMMITTED TO PROVIDING THIS VITAL SERVICE. PART I, L7 COL(F): $3,880,134 OF BAD DEBT EXPENSE IS SUBTRACTED FOR PURPOSES OF COMPUTING THE PERCENTAGE IN PART I, LINE 7K, COLUMN F. THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE AS A PERCENTAGE OF TOTAL EXPENSES, LESS BAD DEBT, IS 22.73%, AND THE PERCENTAGE INCREASES TO 61.48% IF MEDICARE ALLOWABLE COSTS ARE INCLUDED IN TOTAL COMMUNITY BENEFIT EXPENSE. PART II: NOT APPLICABLE. PART III, LINE 4: PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS AND BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS. THE ORGANIZATION DOES NOT CHARGE INTEREST ON RECEIVABLES. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED PAST DUE WHEN AN AMOUNT IS PAST DUE ACCORDING TO THE PAYOR'S AGREED-UPON TERMS. PATIENT RECEIVABLES ARE WRITTEN OFF AS BAD DEBT EXPENSE WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. AS A SERVICE TO THE PATIENT, THE ORGANIZATION BILLS THIRD-PARTY PAYORS DIRECTLY AND THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED.THE AMOUNT INCLUDED ON LINE 2 WAS CALCULATED USING THE COST OF CHARGE RATIO OBTAINED FROM THE MEDICARE COST REPORT. THE AMOUNT ON LINE 3 IS ZERO DUE TO THE FACT THAT PATIENT ELIGIBILITY FOR CHARITY CARE OR FINANCIAL ASSISTANCE IS DETERMINED PRIOR TO PATIENT BILLING, THEREFORE THESE PATIENT AMOUNTS WOULD NOT BE INCLUDED IN BAD DEBT. PART III, LINE 8: THE COST TO CHARGE RATIO (OBTAINED FROM THE MEDICARE COST REPORT) WAS USED TO DETERMINE THE AMOUNT REPORTED ON LINE 7. PART III, LINE 9B: PATIENT ELIGIBILITY FOR CHARITY CARE OR FINANCIAL ASSISTANCE IS DETERMINED PRIOR TO PATIENT BILLING, THEREFORE THESE PATIENTS WOULD NOT BE INCLUDED IN THE DEBT COLLECTION POLICY. PART VI, LINE 2: THE ORGANIZATION DOES NOT CURRENTLY CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT AS IT IS NOT YET REQUIRED UNTIL TAX YEARS BEGINNING AFTER MARCH 23, 2012. PART VI, LINE 3: THERE IS SIGNAGE IN REGISTRATION, ADMITTING, AND THE CREDIT AND BILLING DEPARTMENTS COMMUNICATING THAT FINANCIAL ASSISTANCE IS AVAILABLE. SOME PATIENTS ARE UNAWARE THAT THEY MAY BE ELIGIBLE FOR MEDICAID BENEFITS, THEREFORE OUR FINANCIAL ASSISTANCE INCLUDES HELPING THE PATIENT COMPLETE A MEDICAID APPLICATION. WE ALSO PROVIDE THEM WITH ASSISTANCE IN COMPLETING OUR CHARITY APPLICATION. PART VI, LINE 4: THE ORGANIZATION'S PRIMARY SERVICE AREA IS DEFINED AS OTTAWA, MARSEILLES, SERENA, AND GRAND RIDGE (APPROXIMATELY 36,315 RESIDENTS). THE SECONDARY SERVICE AREA IS DEFINED AS (EAST) SENECA AND MORRIS; (WEST) UTICA, OGLESBY, LASALLE, PERU, MENDOTA, AND PRINCETON; (SOUTH) STREATOR; (NORTH) WEDRON, SHERIDAN, NEWARK, EARLVILLE, LELAND, SOMONAUK, SANDWICH, PLANO, AND YORKVILLE (APPROXIMATELY 135,019 RESIDENTS). ACCORDING TO THE U.S. CENSUS BUREAU IN 2000, THE PRIMARY SERVICE AREA INCLUDED AN AVERAGE OF 5.65% OF FAMILIES BELOW POVERTY LEVEL AND AN AVERAGE OF 7.5% OF INDIVIDUALS BELOW POVERTY LEVEL. THE MEDIAN AGE WAS 38.6 AND THE MEDIAN HOUSEHOLD INCOME WAS $44,675. PART VI, LINE 5: IN ADDITION TO CHARITY CARE, THE HOSPITAL PROVIDES COMMUNITY BENEFITS, INCLUDING, BUT NOT LIMITED TO, THE FOLLOWING: OPERATION OF FULL-TIME EMERGENCY ROOM PROVIDING MEDICAL SERVICES TO ALL MEMBERS OF THE PUBLIC REQUIRING SUCH CARE; MAINTENANCE OF PROVIDER AGREEMENTS WITH MEDICARE AND MEDICAID PROGRAMS; FINANCIAL SUPPORT OF AN INDIGENT CLINIC IN THE COMMUNITY; EXTERNSHIPS FOR MEDICAL STUDENTS; NURSING SCHOLARSHIPS OR TUITION PAYMENTS FOR PROFESSIONAL EDUCATION TO NON-EMPLOYEES AND VOLUNTEERS; PROVISION OF A CLINICAL SETTING FOR UNDERGRADUATE/VOCATIONAL TRAINING TO STUDENTS ENROLLED IN AN OUTSIDE ORGANIZATION; NEGATIVE CONTRIBUTIONS IN SEVERAL DEPARTMENTS INCLUDING BEHAVIORAL HEALTH; CONTRIBUTIONS TO OTHER NOT-FOR-PROFIT ORGANIZATIONS; MEETING ROOM OVERHEAD/SPACE FOR NOT-FOR-PROFIT ORGANIZATIONS; RECRUITMENT OF PHYSICIANS AND OTHER HEALTH PROFESSIONALS FOR FEDERALLY MEDICAL UNDERSERVED AREAS; PARTNERSHIP WITH COMMUNITY COLLEGE TO ADDRESS THE HEALTH CARE WORK FORCE SHORTAGE; HEALTH SCREENINGS, BLOOD PRESSURE CHECKS, ENROLLMENT ASSISTANCE IN PUBLIC PROGRAMS, INFORMATION AND REFERRALS TO COMMUNITY SERVICES AND PREVENTION PROGRAMS OFFERED FREE OR AT LOW COST TO THE COMMUNITY. PART VI, LINE 6: OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER (HOSPITAL) IS LICENSED AS A 99-BED, NOT-FOR-PROFIT, ACUTE CARE HOSPITAL, INCLUDING A 26-BED PHSYCHIATRIC CARE UNIT. THE HOSPITAL ALSO PROVIDES RELATED ANCILLARY AND OUTPATIENT SERVICES. THE HOSPITAL'S AFFILIATES INCLUDE OTTAWA REGIONAL HEALTHCARE AFFILIATES, INC. (INCLUDING ITS WHOLLY OWNED SUBSIDIARY, OTTAWA REGIONAL MEDICAL CENTER, INC.), RADIATION ONCOLOGY OF NORTHERN ILLINOIS, LLC, THE OTTAWA REGIONAL HOSPITAL AUXILIARY, AND THE OTTAWA REGIONAL HOSPITAL FOUNDATION.OTTAWA REGIONAL HEALTHCARE AFFILIATES, INC. (ORHA) IS AN ILLINOIS BUSINESS CORPORATION AND IS THE SOLE STOCKHOLDER OF OTTAWA REGIONAL MEDICAL CENTER, INC. (ORMC) AND OTTAWA REGIONAL CARDINAL SLEEP CENTER, LLC (ORCSC) AND 50% OWNER OF OTTAWA REGIONAL DME, LLC (DME). THE HOSPITAL IS THE SOLE STOCKHOLDER OF ORHA. OTTAWA REGIONAL MEDICAL CENTER, INC. WAS INCORPORATED AS AN ILLINOIS BUSINESS CORPORATION IN SEPTEMBER 2009 AND PURCHASED CERTAIN ASSETS OF A THIRD-PARTY IN DECEMBER 2009. ORMC PROVIDES OUTPATIENT MEDICAL AND DIAGNOSTIC SERVICES AND IS CONSOLIDATED WITH ORHA.OTTAWA REGIONAL CARDINAL SLEEP CENTER, LLC AND OTTAWA REGIONAL DME, LLC ARE LIMITED LIABILITY COMPANIES FORMED IN JULY 2010. ORHA HAS NOT MADE ANY INITIAL CAPITAL CONTRIBUTIONS TO THESE ENTITIES, AND THERE HAVE BEEN NO OPERATIONS WITHIN THESE ENTITIES AS OF APRIL 30, 2012.RADIATION ONCOLOGY OF NORTHERN ILLINOIS, LLC (RONI) IS A LIMITED LIABILITY COMPANY ESTABLISHED TO OWN AND OPERATE A RADIATION ONCOLOGY CENTER. THE HOSPITAL HAS A 57% OWNERSHIP INTEREST IN RONI. RONI IS CONSOLIDATED WITH THE HOSPITAL. OTTAWA REGIONAL HOSPITAL AUXILIARY (AUXILIARY) IS A NOT-FOR-PROFIT FUND RAISING ORGANIZATION WHOSE PURPOSE IS TO PROMOTE AND ADVANCE THE WELFARE OF THE HOSPITAL.OTTAWA REGIONAL HOSPITAL FOUNDATION (FOUNDATION) IS A NOT-FOR-PROFIT FUND RAISING ORGANIZATION WHOSE PURPOSE IS TO SUPPORT AND ENCOURAGE HEALTH CARE SERVICES IN FURTHERANCE OF THE PURPOSE OF AND IN ASSITANCE TO THE HOSPITAL, THROUGH PROVIDING FINANCIAL AND FUND RAISING ASSISTANCE AND IN ALL OTHER RELEVANT WAYS AIDING IN SUPPORTING HEALTH CARE ORGANIZATIONS AND INDIVIDUALS INTERESTED IN CAREERS IN HEALTH CARE. REPORTS FILED WITH STATES PART VI, LINE 7 IL X X X X 0 0 0 0 0 0 0 0 0 ROBERT CHAFFIN 261137 0 16500 0 1322 0 7600 0 31371 0 317930 0 0 0 JUDY CHRISTIANSEN 194808 0 0 0 968 0 6018 0 11742 0 213536 0 0 0 DAWN TROMPETER 136729 0 0 0 655 0 4784 0 27623 0 169791 0 0 0 CHIN SWONG MD 432888 0 0 0 1645 0 0 0 28211 0 462744 0 0 0 DAVID BAYLEY MD 356978 0 20000 0 1711 0 0 0 27623 0 406312 0 0 0 MICHAEL M GLAVIN MD 147292 0 215616 0 1024 0 0 0 27211 0 391143 0 0 0 ANTHONY FOULEN MD 359106 0 0 0 0 0 0 0 10962 0 370068 0 0 0 JOSEPH W CHUPREVICH MD 147705 0 146509 0 0 0 0 0 26521 0 320735 0 0 0 PART I, LINE 3 THE BOARD OF DIRECTORS HAS ESTABLISHED A BOARD COMMITTEE KNOWN AS THE HUMAN RESOURCES COMMITTEE WHOSE MEMBERS ARE ALL PROFESSED MEMBERS OF THE RELIGIOUS CONGREGATION KNOWN AS THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS WHO HAVE TAKEN A VOW OF POVERTY. HENCE, THEY DO NOT PERSONALLY BENEFIT FROM DECISIONS OF THE COMMITTEE. THE CHIEF EXECUTIVE OFFICER (CEO) IS NOT A MEMBER OF THE COMMITTEE. THE PERFORMANCE OF THE CEO AND HIS ACHIEVEMENT OF ANNUAL GOALS IS EVALUATED EACH YEAR BY THE FULL BOARD OF DIRECTORS, AND THIS PERFORMANCE REVIEW IS PROVIDED TO THE COMMITTEE. THE COMMITTEE ALSO OBTAINS COMPENSATION SURVEY DATA AND RECOMMENDATIONS FROM A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTANT. BASED ON ALL OF THESE FACTORS, THE COMMITTEE SETS THE BASE SALARY AND BENEFITS OF THE CEO AND APPROVES THE EXECUTIVE COMPENSATION PLAN APPLICABLE TO THE CEO. PRIOR TO PAYMENT OF ANY BONUS OR INCENTIVE COMPENSATION, THE TOTAL COMPENSATION FOR THE CEO, INCLUDING BASE SALARY, BENEFITS, AND PROPOSED BONUS OR INCENTIVE COMPENSATION, IS AGAIN REVIEWED BY A NATIONALLY RECOGNIZED COMPENSATION CONSULTANT TO ENSURE THAT NO "EXCESS BENEFIT" AMOUNT IS PAID OR FURNISHED. CITY OF OTTAWA 366006037 689419AW9 2004-08-15 16630000 REFUND SERIES 1994 BONDS; CAPITAL PROJECTS 0 0 0 3725000 16630000 1293134 12510024 8441 278700 2645000 2006 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 OTTAWA REGIONAL MEDICAL CENTER INC (ORMC) CHAFFIN, CHRISTIANSEN, TROMPETER ARE OFFICERS OF THE ORGANIZATION AND ORMC 404921 OTTAWA REGIONAL MEDICAL CENTER, INC. PAID RENT TO OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER. 0 OTTAWA REGIONAL MEDICAL CENTER INC (ORMC) CHAFFIN, CHRISTIANSEN, TROMPETER ARE OFFICERS OF THE ORGANIZATION AND ORMC 3392673 OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER PROVIDED CAPITAL CONTRIBUTIONS TO OTTAWA REGIONAL MEDICAL CENTER, INC. 0 0 DOWNSTATE SHOCKWAVE THERAPIES (DOWNSTATE) CHUNG IS DIRECTOR OF THE ORGANIZATION AND OWNS 16% OF DOWNSTATE 251722 OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER PAID MEDICAL SERVICE EXPENSES TO DOWNSTATE SHOCKWAVE THERAPIES 0 FORM 990, PART VI, SECTION A, LINE 6 OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER HAS LIFE MEMBERS WHICH ARE PERSONS WHO HAVE PAID THE HOSPITAL FIVE HUNDRED DOLLARS ($500) FOR SUCH MEMBERSHIP. THE ORGANIZATION ALSO HAS ORGANIZATIONAL MEMBERS WHICH ARE CORPORATIONS, INSTITUTIONS, ORGANIZATIONS, ASSOCIATIONS, ETC. WHICH HAVE MET THE REQUIREMENTS OF LIFE OR ANNUAL MEMBERSHIP AND HAVE SPECIFIED THAT THE SUMS DONATED BE RECOGNIZED IN THE ORGANIZATIONAL NAME. EACH MEMBER OF THE HOSPITAL SHALL HAVE ONE VOTE ON ALL PROPOSITIONS PRESENTED AND ACTED UPON AT ANY MEETING OF THE MEMBERS AT WHICH THE MEMBERS ARE PERSONALLY PRESENT OR REPRESENTED BY PROXY. FORM 990, PART VI, SECTION A, LINE 7A THE OFFICERS OF THE ORGANIZATION ARE ELECTED BY THE CORPORATE MEMBERSHIP. THESE POSITIONS INCLUDE THE CHAIRMAN OF THE BOARD, TWO VICE-CHAIRMAN, DESIGNATED FIRST VICE-CHAIRMAN AND SECOND VICE-CHAIRMAN, THE SECRETARY, AND THE TREASURER. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S GOVERNING BODY WILL MEET WITH THE ORGANIZATION'S ASSISTANT CONTROLLER AT A BOARD MEETING TO REVIEW THE FINAL FORM 990 AFTER ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C IT SHALL BE THE POLICY OF THE GOVERNING BOARD OF OTTAWA REGIONAL HOSPITAL AND HEALTHCARE CENTER TO REQUIRE THAT EACH BOARD MEMBER, PRIOR TO MAKING HIS/HER POSITION ON THE BOARD, AND ALL PRESENT BOARD MEMBERS AS SOON AS PRACTICABLE AFTER THE ADOPTION OF THIS POLICY, BUT NO LATER THAN FORTY-FIVE DAYS, SUBMIT IN WRITING TO THE CHIEF EXECUTIVE OFFICER OF THE HOSPITAL A LIST OF ALL BUSINESS OR OTHER ORGANIZATIONS OF WHICH HE/SHE IS AN OFFICER, MEMBER, OWNER OR EMPLOYEE OR WHICH HE/SHE ACTS AS AN AGENT, WITH WHICH THE HOSPITAL HAS, OR MIGHT REASONABLY IN THE FUTURE ENTER INTO, A RELATIONSHIP OR A TRANSACTION IN WHICH THE BOARD MEMBER WOULD HAVE CONFLICTING INTERESTS. EACH WRITTEN STATEMENT WILL BE RESUBMITTED WITH ANY NECESSARY CHANGES, EACH YEAR. AT SUCH TIME AS ANY MATTER COMES BEFORE THE BOARD IN SUCH A WAY AS TO GIVE RISE TO A CONFLICT OF INTEREST, THE AFFECTED BOARD MEMBER SHALL MAKE KNOWN THE POTENTIAL CONFLICT, WHETHER DISCLOSED BY HIS/HER WRITTEN STATEMENT OR NOT, AND AFTER ANSWERING ANY QUESTIONS THAT MIGHT BE ASKED HIM/HER, EITHER AS TO THE CONFLICT OR AS TO ANY SPECIAL EXPERTISE POSSESSED BY THAT BOARD MEMBER, SHALL WITHDRAW FROM THE MEETING FOR SO LONG AS THE MATTER SHALL CONTINUE UNDER DISCUSSION. SHOULD THE MATTER BE BROUGHT TO A VOTE, THE AFFECTED BOARD MEMBER SHALL NOT VOTE ON IT. IN THE EVENT THAT HE/SHE FAILS TO WITHDRAW VOLUNTARILY, THE CHAIRMAN OF THE BOARD IS EMPOWERED AND SHALL REQUIRE THAT HE/SHE REMOVE HIMSELF/HERSELF FROM THE ROOM DURING BOTH THE DISCUSSION AND VOTE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A: THE BOARD OF DIRECTORS HAS ESTABLISHED A BOARD COMMITTEE KNOWN AS THE HUMAN RESOURCES COMMITTEE WHOSE MEMBERS ARE ALL PROFESSED MEMBERS OF THE RELIGIOUS CONGREGATION KNOWN AS THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS WHO HAVE TAKEN A VOW OF POVERTY. HENCE, THEY DO NOT PERSONALLY BENEFIT FROM DECISIONS OF THE COMMITTEE. THE CHIEF EXECUTIVE OFFICER (CEO) IS NOT A MEMBER OF THE COMMITTEE. THE PERFORMANCE OF THE CEO AND HIS ACHIEVEMENT OF ANNUAL GOALS IS EVALUATED EACH YEAR BY THE FULL BOARD OF DIRECTORS, AND THIS PERFORMANCE REVIEW IS PROVIDED TO THE COMMITTEE. THE COMMITTEE ALSO OBTAINS COMPENSATION SURVEY DATA AND RECOMMENDATIONS FROM A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTANT. BASED ON ALL OF THESE FACTORS, THE COMMITTEE SETS THE BASE SALARY AND BENEFITS OF THE CEO AND APPROVES THE EXECUTIVE COMPENSATION PLAN APPLICABLE TO THE CEO. PRIOR TO PAYMENT OF ANY BONUS OR INCENTIVE COMPENSATION, THE TOTAL COMPENSATION FOR THE CEO, INCLUDING BASE SALARY, BENEFITS, AND PROPOSED BONUS OR INCENTIVE COMPENSATION, IS AGAIN REVIEWED BY A NATIONALLY RECOGNIZED COMPENSATION CONSULTANT TO ENSURE THAT NO "EXCESS BENEFIT" AMOUNT IS PAID OR FURNISHED. LINE 15B: THE BOARD OF DIRECTORS HAS ESTABLISHED A BOARD COMMITTEE KNOWN AS THE HUMAN RESOURCES COMMITTEE WHOSE MEMBERS ARE ALL PROFESSED MEMBERS OF THE RELIGIOUS CONGREGATION KNOWN AS THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS WHO HAVE TAKEN A VOW OF POVERTY. HENCE, THEY DO NOT PERSONALLY BENEFIT FROM DECISIONS OF THE COMMITTEE. THE COMMITTEE DETERMINES WHICH OFFICERS, KEY EMPLOYEES AND OTHER EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN THE EXECUTIVE COMPENSATION PLAN. BASED ON PERFORMANCE REVIEWS BY THE SUPERVISORS OF SUCH PERSONS AND COMPENSATION SURVEY DATA AND RECOMMENDATIONS FROM A NATIONALLY KNOWN INDEPENDENT COMPENSATION CONSULTANT, THE COMMITTEE APPROVES ANY EXECUTIVE COMPENSATION PLAN APPLICABLE TO KEY EMPLOYEES AND ESTABLISHES THE BASE SALARY AND BENEFITS FOR PLAN PARTICIPANTS. PRIOR TO PAYMENT OF ANY BONUS OR INCENTIVE COMPENSATION, THE TOTAL COMPENSATION FOR EACH KEY EMPLOYEE, INCLUDING BASE SALARY, BENEFITS, AND PROPOSED BONUS OR INCENTIVE COMPENSATION, IS AGAIN REVIEWED BY A NATIONALLY RECOGNIZED COMPENSATION CONSULTANT TO ENSURE THAT NO "EXCESS BENEFIT" AMOUNT IS PAID OR FURNISHED. SOME KEY EMPLOYEES LISTED IN PART VII ARE PRACTICING PHYSICIANS WHO ARE LISTED AS KEY EMPLOYEES AS A RESULT OF THE COMPENSATION THEY RECEIVE AND NOT DUE TO ANY EXECUTIVE OR MANAGEMENT POSITION WHICH THEY HOLD. SUCH PHYSICIANS GENERALLY ARE NOT PARTICIPANTS IN THE EXECUTIVE COMPENSATION PLAN, AND THEIR COMPENSATION, INCLUDING BASE SALARY, BENEFITS, AND ANY APPLICABLE BONUS OR INCENTIVE COMPENSATION, IS ESTABLISHED IN ACCORDANCE WITH NATIONALLY RECOGNIZED PHYSICIAN COMPENSATION SURVEYS AND IS SET FORTH IN WRITTEN EMPLOYMENT AGREEMENTS WHICH ARE APPROVED BY THE BOARD OF DIRECTORS OR ITS EXECUTIVE COMMITTEE. THE REVIEW PROCESSES DESCRIBED ABOVE BEGAN IN JULY 2012 FOR FISCAL YEAR 2013 SALARY DATA, AND IT WAS APPROVED TO PROVIDE AN AVERAGE OF 3% SALARY INCREASE FOR MANAGEMENT EFFECTIVE DECEMBER 2012. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -3,840,639. FORM 990, PART XII, LINE 2C: THE ORGANIZATION'S GOVERNING BOARD MEETS WITH THE AUDITORS TO REVIEW THE AUDIT REPORT AND MANAGEMENT LETTER. OTTAWA REGIONAL HOSPITAL FOUNDATION 1100 EAST NORRIS DRIVE OTTAWA IL 61350 364007569 SUPPORTS OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER IL 501(C)(3) LINE 11A, I OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER 1 OTTAWA REGIONAL HOSPITAL AUXILIARY 1100 EAST NORRIS DRIVE OTTAWA IL 61350 363854788 SUPPORTS OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER IL 501(C)(3) LINE 11C, III-FI N/A 0 OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER LIABILITY LOSS FUND 1100 EAST NORRIS DRIVE OTTAWA IL 61350 363612653 LIABILITY TRUST FUND IL 501(C)(3) LINE 11A, I OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER 1 RADIATION ONCOLOGY OF NORTHERN ILLINOIS LLC 1200 STARFIRE DRIVE OTTAWA IL 61350 753247165 RADIATION ONCOLOGY CENTER IL OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER RELATED 445732 1085041 0 0 0.57000 OTTAWA REGIONAL CARDINAL SLEEP CENTER LLC 1601 MERCURY CIRCLE SUITE 2 OTTAWA IL 61350 273625479 SLEEP DISORDER DIAGNOSTIC AND TREATMENT SERVICES IL OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER RELATED 0 0 1.00000 OTTAWA REGIONAL HEALTHCARE AFFILIATES INC 1100 EAST NORRIS DRIVE OTTAWA IL 61350 263937519 HOLDING COMPANY IL OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER C -2908240 2851734 1.00000 OTTAWA REGIONAL MEDICAL CENTER INC 1614 EAST NORRIS DRIVE OTTAWA IL 61350 271036071 OUTPATIENT MEDICAL AND DIAGNOSTIC SERVICES IL OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER C 1.00000 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 OTTAWA REGIONAL MEDICAL CENTER INC A 404921 OTTAWA REGIONAL MEDICAL CENTER INC B 3392673