2013-04-12T08:22:00-05:00 2012-05-31 420714325 MCGLADREY LLP ONE SOUTH WACKER DR SUITE 800 CHICAGO IL 60606 990 2011-06-01 362222696 SWEDISHAMERICAN HOSPITAL SWED 8159662087 1401 E STATE STREET ROCKFORD IL 611042298 WILLIAM GORSKI 8159662087 2013-03-30 1 ZACK FORTSCH P00052725 3126343400 2011 2016-02-25 16:41:14Z WILLIAM GORSKI MD 1313 EAST STATE ST ROCKFORD IL 61104 605430294 0 X WWW.SWEDISHAMERICAN.ORG X 1911 IL THROUGH EXCELLENCE IN HEALTHCARE AND COMPASSIONATE SERVICE, WE CARE FOR OUR COMMUNITY. 29 18 3561 721 513946 220112 6278731 1813920 430571829 434827414 7698068 8093553 6117475 4971442 450666103 449706329 912995 561606 0 0 206687231 215843433 0 0 0 227479413 223383007 435079639 439788046 15586464 9918283 443747620 454467569 202281926 207594843 241465694 246872726 X THROUGH EXCELLENCE IN HEALTHCARE AND COMPASSIONATE SERVICE, WE CARE FOR OUR COMMUNITY. 0 0 256650065 561606 341397228 SWEDISHAMERICAN HOSPITAL OPERATES TWO FULL SERVICE ACUTE CARE HOSPITALS WITH 386 LICENSED BEDS, AND SERVES A 12 COUNTY AREA. OUR VISION IS TO DEVELOP A FULLY INTEGRATED HEALTHCARE DELIVERY NETWORK THAT WILL CONTINUOUSLY SET THE STANDARD FOR QUALITY CARE AND SERVICE, ACCEPT RESPONSIBILITY FOR BUILDING A HEALTHIER POPULATION, PROVIDE REGIONAL ACCESS, IMPROVE RESOURCE UTILIZATION THROUGH COLLABORATION WITH KEY STAKEHOLDERS, AND MANAGE PATIENT CARE AND OUR RESOURCES IN SUCH A WAY THAT WE CREATE VALUE FOR OUR PATIENTS AND BENEFIT FOR OUR COMMUNITY. DURING 2012 WE CARED FOR 18,789 INPATIENTS AND PERFORMED 729,115 OUTPATIENT PROCEDURES. THIS INCLUDES 73,820 EMERGENCY ROOM VISITS AND 2,526 DELIVERIES. WE SPONSOR THE UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE PROGRAM AND PROVIDED $4.7 MILLION IN EDUCATION FOR PRIMARY CARE RESIDENTS. WE PARTICIPATE IN THE ILLINOIS EXCELLENCE IN ACADEMIC MEDICINE PROGRAM AND THE NATIONAL SURGICAL ADJUVANT BREAST AND BOWEL PROJECT, WHICH ARE GOVERNMENT SPONSORED RESEARCH. OUR EMPLOYEES AND VOLUNTEERS PROVIDED ALMOST 30,000 HOURS IN UNPAID COMMUNITY SERVICES. SWEDISHAMERICAN RECOGNIZES ITS RESPONSIBILITY TO ALL THE PEOPLE OF OUR COMMUNITY, REGARDLESS OF THEIR ABILITY TO PAY FOR CARE. 88460671 89221735 SWEDISHAMERICAN HOSPITAL EMPLOYS PRIMARY CARE AND SPECIALTY PHYSICIANS WHO PRACTICE AT 18 LOCATIONS THROUGHOUT OUR SERVICE AREA. WE EMPLOY SPECIALISTS IN ORTHOPEDICS, CARDIOLOGY, CARDIOTHORACIC SURGERY, NEUROLOGY, NEUROSURGERY, PULMONOLOGY/CRITICAL CARE, ONCOLOGY, OBSTETRICS AND GYNECOLOGY, RHEUMATOLOGY, PSYCHIATRY, PODIATRY, OTOLARYNGOLOGY, AS WELL AS INTERNAL MEDICINE, FAMILY PRACTICE AND PEDIATRIC PHYSICIANS. DURING 2012 OUR PHYSICIAN ENCOUNTERS WERE 368,343. 9213272 8683000 SWEDISHAMERICAN DELIVERS HOME HEALTH CARE SERVICES TO PATIENTS IN OUR SERVICE AREA. DURING 2012 WE PERFORMED 11,083 EPISODES OF CARE. 354324008 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 1 0 1 448 0 1 3561 1 1 1 0 0 0 0 0 0 0 0 0 X 29 18 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL X DONALD HARING CFO 8159662087 1313 EAST STATE ST ROCKFORD IL 61104 X FRANK BONELLI MD 2.00 X 75 0 0 PETER CHRISTMAN 2.00 X 75 0 0 DANNY L COPELAND MD 40.00 X 163915 0 47317 MICHAEL DALLMAN 2.00 X 75 0 0 PATRICK DERRY 2.00 X 75 0 0 SARA FLEMING MD - EX OFFICIO 2.00 X 75 0 0 JAMES L GINGRICH 2.00 X 75 0 0 WILLIAM R GORSKI MD 40.00 X X 558167 0 219820 ROBERT L HEAD PHD 2.00 X 75 0 0 HELEN CHUNG HILL 2.00 X 75 0 0 MICHAEL HOUSELOG 2.00 X 75 0 0 DENNIS W JOHNSON 2.00 X 75 0 0 GREGORY JURY 2.00 X 75 0 0 MARCO T LENIS 2.00 X 75 0 0 DAN LOESCHER 2.00 X X 75 0 0 FRAN MORRISSEY 2.00 X 75 0 0 JOHN C MYERS MD 40.00 X 454855 0 50655 WILLIAM ROOP 2.00 X X 75 0 0 DANIEL T ROSS 2.00 X 75 0 0 DAVID R RYDELL 2.00 X 75 0 0 JOHN SCHEUB MD 2.00 X 75 0 0 WILLIAM SCHULZ MD 40.00 X 573270 0 50342 STEVEN C SJOGREN 2.00 X 75 0 0 JAMES WADDELL 2.00 X 75 0 0 RICHARD WALSH 40.00 X X 365295 0 126709 THOMAS R WALSH 2.00 X X 75 0 0 FRANK WALTER 2.00 X 2475 0 0 AMY WILCOX 2.00 X 75 0 0 ALLEN WILLIAMS MD 40.00 X 211762 0 42385 DONALD HARING 40.00 X 324242 0 78713 KATHLEEN KELLY MD 40.00 X 345607 0 45801 MERAT ESFAHANI MD 40.00 X 808914 0 50806 STEVEN MILOS MD 40.00 X 629890 0 27981 HARVEY EINHORN MD 40.00 X 694387 0 78945 PRAKASH PEDAPATI 40.00 X 579350 0 37037 JON MICHEL MD 40.00 X 784168 0 30023 6497947 0 886534 183 0 1 0 MIDWEST HEART SPECIALISTS LTD 1901 S MEYERS ROAD SUITE 350 OAKBROOK TERRACE IL 60181 PHYSICIANS 4259410 RINGLAND-JOHNSON CONSTRUCTION PO BOX 5165 ROCKFORD IL 61125 CONSTRUCTION SERVICES 3367468 ARAMARK HEALTHCARE THE ARA TOWER 1101 MARKET ST PHILADELPHIA PA 19107 CAFETERIA AND DIETARY 2658816 UNIVERSAL HOSPITAL SERVICES INC 2601 CROSSROADS DR SUITE 105 MADISON WI 53704 EQUIPMENT SERVICES 2358487 ARUP LABORATORIES INC PO BOX 27964 SALT LAKE CITY UT 84127 LAB TESTING 1908510 118 9230 1660520 144170 1813920 PATIENT SERVICES 621990 267535251 267535251 MEDICARE/MEDICAID 621990 165226227 165226227 N.IL IMAGING JV 621990 352573 352573 1713363 1713363 434827414 6019785 6019785 26904 43957 -17053 -17053 -17053 152631161 4380183 150427389 4510187 2203772 -130004 2073768 2073768 502420 742432 -240012 -240012 INTERDEPT BILLING 561000 2214158 2072830 141328 CAFETERIA & VENDING 561000 1382507 1364903 17604 DAY CARE CENTER 624410 1276828 1276828 355014 355014 5228507 449706329 439301963 513946 8076500 531606 531606 30000 30000 4055582 1545456 2510126 162792433 126274907 36517526 7002993 5893478 1109515 30907573 28063133 2844440 11084852 8409376 2675476 1525100 1525100 129096 129096 134496 134496 588187 588187 21990981 19582535 2408446 2320285 87351 2232934 10911383 6365848 4545535 4646136 4095874 550262 12643293 7069025 5574268 251121 192722 58399 338330 137524 200806 5046196 3762652 1283544 19784818 15159192 4625626 7457206 6921436 535770 INCOME TAX EXPENSE 294131 294131 PATIENT SUPPLIES 68753736 68134180 619556 BAD DEBTS 27980347 27980347 PURCHASED SERVICES 16799841 9646513 7153328 21788324 14440853 7347471 439788046 354324008 85464038 0 27361347 15151325 56790303 78384996 312119 294828 4972377 6380256 8400620 6126896 386378355 222810215 158663845 163568140 159390048 155892313 1975596 1834079 25881365 26834736 443747620 454467569 45381916 48095146 111228588 106708525 45671422 52791172 202281926 207594843 X 233938728 239487137 1890721 1896459 5636245 5489130 241465694 246872726 443747620 454467569 X 9918283 -4511251 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 133944 133944 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: PORTIONS OF THE 2011/2012 ILLINOIS HOSPITAL AND AMERICAN HOSPITAL ASSOCIATION DUES USED FOR LOBBYING: $36,444. A LAW FIRM WAS ENGAGED TO REVIEW LEGISLATION AFFECTING HOSPITALS: $97,500. 6377718 43659 -269495 144575 6007307 5553681 98184 763174 37321 6377718 5098504 13425 457937 16185 5553681 6059940 14405 -958754 17087 5098504 0.00000 0.91000 0.09000 0 1 1 2459970 2459970 193453798 91572020 101881778 9249517 4552998 4696519 174655952 121920977 52734975 6559118 4764220 1794898 163568140 DEFERRED BOND ISSUANCE COSTS 2963144 ADVANCE TO AMERICAN RESTAURANT ASSOC. (ARA) 189268 INTEREST IN NET ASSETS OF RECIPIENT ORGANIZATION 6880982 GOODWILL 16801342 26834736 ESTIMATED DUE-3RD PARTY PAYORS 24726421 RESERVE FOR SELF INSURNACE 12665349 DEFERRED COMPENSATION 8808999 ASBESTOS RETIREMENT OBLIGATION 239942 DUE TO AFFILIATED ORGANIZATION 1830398 CURRENT MATURITIES OF LONG TERM DEBT 4520063 52791172 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 THE TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEET ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. AT MAY 31, 2012 AND 2011, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED AS LIABILITIES. 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 13819766 13819766 0.03360 89559001 71393896 18165105 0.04410 1737362 1517341 220021 0.00050 105116129 72911237 32204892 0.07820 7100179 1057223 6042956 0.01470 17038205 3012529 14025676 0.03410 1952227 1125055 827172 0.00200 928673 287585 641088 0.00160 27019284 5482392 21536892 0.05230 132135413 78393629 53741784 0.13050 0 27980000 4197000 75926972 94989541 -19062569 X 1 1 1 FEATHERSTONE PARTNERSHIP LLC AMBULATORY SURGERY CENTER 0.29630 0.00000 0.70370 2 NORTHERN ILLINOIS VEIN CLINIC LLC OUTPATIENT PHYSICIAN CLINIC 0.50000 0.00000 0.50000 2 1 SWEDISHAMERICAN HOSPITAL

1401 E STATE STREET ROCKFORD IL 61104

X X X X X 2 SWEDISHAMERICAN MEDICAL CTR BELVIDERE

1625 S STATE STREET BELVIDERE IL 61008

X X X SWEDISHAMERICAN HOSPITAL 1 0 1 1 200.000000000000 1 600.000000000000 1 X X X X X 1 1 X X 1 0 1 X 0 0 SWEDISHAMERICAN MEDICAL CTR BELVIDERE 2 0 1 1 200.000000000000 1 600.000000000000 1 X X X X X 1 1 X X 1 0 1 X 0 0 25 ONCOLOGY

209 9TH STREET ROCKFORD IL 61104

OUTPATIENT CLINIC ACT

2473 MCFARLAND ROAD ROCKFORD IL 61107

OUTPATIENT CLINIC ROCKFORD AMBULATORY SURGERY CENTER

1016 FEATHERSTONE ROAD ROCKFORD IL 61107

AMBULATORY SURGERY CENTER BROOKSIDE SPECIALTY CENTER

1253 N ALPINE ROAD ROCKFORD IL 61107

OUTPATIENT CLINIC LUNDHOLM ORTHOPEDICS

1340 CHARLES STREET ROCKFORD IL 61104

OUTPATIENT CLINIC MIDWEST HEART SPECIALISTS

1340 CHARLES STREET SUITE 300 ROCKFORD IL 61104

OUTPATIENT CLINIC WOODSIDE

3775 N MULFORD ROAD ROCKFORD IL 61114

OUTPATIENT CLINIC HOME HEALTH CARE

2550 CHARLES STREET ROCKFORD IL 61108

HOME HEALTH BROOKSIDE OCCUPATIONAL & IMMED CARE

1215 N ALPINE ROAD ROCKFORD IL 61107

OUTPATIENT CLINIC 5 POINTS CLINIC

2404 CHARLES STREET ROCKFORD IL 61108

OUTPATIENT CLINIC CAMELOT OBGYN

1415 E STATE STREET ROCKFORD IL 61104

OUTPATIENT CLINIC VALLEY CLINIC

6824 NEWBURG ROAD ROCKFORD IL 61108

OUTPATIENT CLINIC ROCK VALLEY WOMEN'S HEALTH CENTER

6861 VILLAGE GREEN VIEW ROCKFORD IL 61107

OUTPATIENT CLINIC BELVIDERE CLINIC

1700 HENRY LUCKOW LANE BELVIDERE IL 61008

OUTPATIENT CLINIC MIDTOWN CLINIC

1340 CHARLES STREET SUITE 405 ROCKFORD IL 61103

OUTPATIENT CLINIC ROSCOE CLINIC & IMMEDIATE CARE

5005 HONONEGAH ROAD ROSCOE IL 61073

OUTPATIENT CLINIC DAVIS JUNCTION CLINIC

5665 NORTH JUNCTION WAY DAVIS JUNCTION IL 61020

OUTPATIENT CLINIC WOUND CARE & HYPERBARIC CLINICS

1415 E STATE STREET SUITE 408 609 ROCKFORD IL 61104

OUTPATIENT CLINIC BYRON CLINIC

220 W BLACKHAWK DRIVE BYRON IL 61010

OUTPATIENT CLINIC NEURO AND HEADACHE CENTER

1340 CHARLES STREET SUITE 400 ROCKFORD IL 61104

OUTPATIENT CLINIC NORTHERN ILLINOIS VEIN CLINIC

1340 CHARLES STREET SUITE 404 ROCKFORD IL 61104

OUTPATIENT CLINIC MATERNAL FETAL MEDICINE

1401 EAST STATE ST ROCKFORD IL 61104

OUTPATIENT CLINIC CENTER FOR WOMEN

1340 CHARLES STREET SUITE 301 ROCKFORD IL 61104

OUTPATIENT CLINIC MARENGO CLINIC & IMMEDIATE CARE

204 E PRAIRIE STREET MARENGO IL 60152

OUTPATIENT CLINIC DIXON ONCOLOGY

101 W 2ND STREET DIXON IL 61021

OUTPATIENT CLINIC PART I, LINE 7G: THE FOLLOWING SUBSIDIZED HEALTH SERVICES ARE FOR PHYSICIANS. THESE PHYSICIANS ARE NECESSARY TO SERVE THE COMMUNITY, ARE DIFFICULT TO RECRUIT, AND THE REIMBURSEMENT DOES NOT COVER THE COST OF THE SERVICES. HOSPITAL BASED PHYSICIANS SPECIALTY CLINICS AND CALL COVERAGE PAYMENTS $11,071,137EMERGENCY DEPARTMENT PHYSICIANS $1,342,766TOTAL $12,413,903 PART I, L7 COL(F): THE BAD DEBT EXPENSE IN PART IX COLUMN A WAS SUBTRACTED FOR THE PURPOSE OF CALCULATING THE PERCENTAGE OF EXPENSE IS $27,980,347.PART 1 LINES 7 - LINES 7A AND 7F COSTS WERE CALCULATED USING THE 2012 MEDICARE COST REPORT COST TO CHARGE RATIO.LINES 7B AND 7C COSTS WERE CALCULATED USING THE COST ACCOUNTING SYSTEM. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS.ALL OTHER AMOUNTS IN LINE 7 WERE CALCULATED USING DIRECT COSTS. PART III, LINE 4: LINE 2 METHODOLOGY FOR DETERMINING BAD DEBT EXPENSE: IT IS OUR PRACTICE TO IDENTIFY, TO THE EXTENT POSSIBLE, CHARITY CASES AT THE TIME OF SERVICE. IF A PATIENT PROVIDES DOCUMENTATION THEY MEET OUR CHARITY CARE POLICY, THEY ARE NOT SENT TO COLLECTION. THOSE PATIENTS WHO DO NOT MEET PRESUMPTIVE ELIGIBILTY AND FAIL TO APPLY OR PROVIDE DOCUMENTATION ARE SENT TO COLLECTION AFTER 90 DAYS. THE ORGANIZATION AND ITS AGENTS FOLLOW THE FAIR PATIENT BILLING ACT. IF DURING THE COLLECTION PROCESS WE OR OUR AGENTS BECOME AWARE OF A PATIENT QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND THE PATIENT COOPERATES WITH THE REQUIREMENTS OF THE CHARITY CARE POLICY, COLLECTION EFFORTS ARE CEASED, AND THE ACCOUNT IS WRITTEN OFF TO CHARITY .BAD DEBT EXPENSE REPORTED ON LINE 2 REPRESENTS THE ALLOWENCE FOR DOUBTFUL ACCOUNTS. IT IS DETERMINED BASED ON HISTORICAL EXPERIENCE OF UNCOLLECTIBLE AMOUNTS AFTER CONTRACTUAL DISCOUNTS, PATIENT PAYMENTS AND AMOUNTS QUALIFIYING UNDER CHARITY ASSISTANCE POLICY.FROM THE AUDITED FINANCIAL STATEMENTS:PATIENT RECEIVABLES DUE DIRECTLY FROM PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED, LESS AMOUNTS COVERED BY THIRD-PARTY PAYERS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS AND BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS. PATIENT RECEIVABLES ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED WHEN RECEIVED. THE PAST DUE STATUS OF RECEIVABLES IS DETERMINED ON A CASE-BY-CASE BASIS DEPENDING ON THE PAYER RESPONSIBLE. PART III LINE 2 COSTS WERE CALCULATED USING THE 2012 MEDICARE COST REPORT COST TO CHARGE RATIO.PART III LINE 3 SWEDISHAMERICAN HOSPITAL'S CHARITY POLICY ALLOWS A 100% CHARITY WRITE-OFF FOR THOSE WITH HOUSEHOLD INCOME OF 200% OR LESS OF THE FEDERAL POVERTY LEVEL AND PARTIAL CHARITY WRITE-OFF FOR THOSE UP TO 600% OF THE POVERTY LEVEL. THE LATEST DATA FROM THE U.S. CENSUS BUREAU INDICATES 16.8% OF THE POPULATION IN WINNEBAGO COUNTY IS BELOW THE POVERTY LEVEL AND THE MEDIAN HOUSEHOLD INCOME WAS $47,597 WITH A HOUSEHOLD SIZE OF 2.57. FOR A HOUSEHOLD SIZE OF 3 AN INCOME OF $37,060 IS 200% OF THE POVERTY LEVEL AND $111,180 IS 600% OF THE POVERTY LEVEL. APPROXIMATELY 94% OF OUR CHARITY WRITE-OFFS ARE FOR PATIENTS WITHOUT INSURANCE WHILE 67% OF OUR BAD DEBT WRITE-OFFS ARE FOR PATIENTS WITHOUT INSURANCE. IN 2012 ONLY 15% OF ALL ACCOUNTS WRITTEN OFF TO BAD DEBT WERE RECOVERED. BASED ON DEMOGRAPHICS AND INTERNAL DATA WE BELIEVE THAT A MINIMUM OF 15% OF THE AMOUNTS WRITTEN OFF AS BAD DEBT WOULD QUALIFY FOR CHARITY, AND AS SUCH 15% OF THE BAD DEBT EXPENSE FROM LINE 2 IS REPORTED ON LINE 3. PART III, LINE 8: SWEDISHAMERICAN HOSPITAL MUST TREAT PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE GOVERNEMENT SETS NON-NEGOTIABLE MEDICARE RATES AND THE REIMBURSEMENT FROM MEDICARE HAS NOT KEPT PACE WITH THE RISING COST OF PROVIDING THOSE SERVICES. THE COST OF CARE HAS INCREASED DUE TO: WAGES AND BENEFITS NECESSARY TO KEEP HIGH DEMAND SKILLED PRACTITIONERS, MEDICAL SUPPLIES IN PARTICULAR CARDIOVASCULAR AND ORTHOPEDIC IMPLANTS AND PHARMACEUTICALS, MALPRACTICE INSURANCE COSTS, AND CAPITAL EQUIPMENT. SWEDISHAMERICAN HOSPITAL'S TREATMENT OF MEDICARE BENEFICIARIES RELIEVES THE GOVERNMENT BURDEN OF DIRECTLY PROVIDING MEDICAL CARE WHERE BY LAW THEY ARE REQUIRED TO PROVIDE TO ELIGIBLE BENEFICIARIES. DUE TO THE REQUIRMENT TO PROVIDE CARE AND THE INABILITY OF MEDICARE REIMBURSEMENT TO KEEP PACE WITH THE COST OF PROVIDING SERVICES, WE FEEL THE LOSS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES IS A PART OF OUR MISSION AND IS A BENEFIT TO OUR COMMUNITY. THE FOLLOWING IS A RECONCILIATION OF THE SHORTFALL FROM MEDICARE REPORTED ON THE COST REPORT ON LINE 7 TO THE MEDICARE SHORTFALL FROM ALL OF THE MEDICARE PROGRAMS AT SWEDISHAMERICAN HOSPITAL. THESE SHORTFALLS WERE CALCULATED USING THE COST TO CHARGE RATIO.MEDICARE SHORTFALL HOSPITAL PROGRAMS PART III LINE 7 ($19,062,569)MEDICARE SHORTFALL PHYSICIAN PROGRAMS ($29,798,415)TOTAL MEDICARE SHORTFALL ($48,860,984) PART III, LINE 9B: THE ORGANIZATION AND ITS AGENTS FOLLOW THE FAIR PATIENT BILLING ACT. IF DURING THE COLLECTION PROCESS WE OR OUR AGENTS BECOME AWARE OF A PATIENT QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND THE PATIENT COOPERATES WITH THE REQUIREMENTS OF THE CHARITY CARE POLICY, COLLECTION EFFORTS ARE CEASED. SWEDISHAMERICAN HOSPITAL PART V, SECTION B, LINE 13G: THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS TRANSPARENT AND AVAILABLE TO ALL, AT ALL POINTS IN THE CONTINUUM, IN LANGUAGES APPROPRIATE FOR HOSPITAL'S SERVICE AREA. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, APPLICATION FORM, SIGNAGE, AND FINANCIAL COUNSELOR CONTACT INFORMATION ARE AVAILABLE IN ENGLISH AND SPANISH. SIGNAGE IS POSTED PROMINENTLY AT ALL POINTS OF ADMISSION AND REGISTRATION (INCLUDING THE EMERGENCY DEPARTMENT). WRITTEN INFORMATION ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND COPIES OF THE FINANCIAL ASSISTANCE FORM ARE AVAILABLE IN ADMISSION AND REGISTRATION AREAS. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, APPLICATION FORM AND FINANCIAL COUNSELOR CONTACT INFORMATION ARE ALSO POSTED ON THE HOSPITAL'S WEBSITE. THE HOSPITAL WILL MAKE EFFORTS TO PUBLICIZE ITS POLICY IN PRINT AND TELEVISION MEDIA, WHEREVER PRACTICABLE.PATIENT BILLING COMMUNICATIONS ALSO INFORM PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. EACH BILL, INVOICE, OR OTHER SUMMARY OF CHARGES TO AN UNINSURED PATIENT INCLUDES WITH IT, OR ON IT, A PROMINENT STATEMENT THAT AN UNINSURED PATIENT WHO MEETS CERTAIN INCOME REQUIREMENTS MAY QUALIFY FOR FINANCIAL ASSISTANCE AND INFORMATION ON HOW TO APPLY FOR CONSIDERATION UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. ALL THIRD-PARTY AGENTS WHO SUBMIT OR COLLECT BILLS ON BEHALF OF HOSPITAL ARE REQUIRED TO FOLLOW THIS POLICY. SWEDISHAMERICAN MEDICAL CTR. BELVIDERE PART V, SECTION B, LINE 13G: THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS TRANSPARENT AND AVAILABLE TO ALL, AT ALL POINTS IN THE CONTINUUM, IN LANGUAGES APPROPRIATE FOR HOSPITAL'S SERVICE AREA. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, APPLICATION FORM, SIGNAGE, AND FINANCIAL COUNSELOR CONTACT INFORMATION ARE AVAILABLE IN ENGLISH AND SPANISH. SIGNAGE IS POSTED PROMINENTLY AT ALL POINTS OF ADMISSION AND REGISTRATION (INCLUDING THE EMERGENCY DEPARTMENT). WRITTEN INFORMATION ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND COPIES OF THE FINANCIAL ASSISTANCE FORM ARE AVAILABLE IN ADMISSION AND REGISTRATION AREAS. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, APPLICATION FORM AND FINANCIAL COUNSELOR CONTACT INFORMATION ARE ALSO POSTED ON THE HOSPITAL'S WEBSITE. THE HOSPITAL WILL MAKE EFFORTS TO PUBLICIZE ITS POLICY IN PRINT AND TELEVISION MEDIA, WHEREVER PRACTICABLE.PATIENT BILLING COMMUNICATIONS ALSO INFORM PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. EACH BILL, INVOICE, OR OTHER SUMMARY OF CHARGES TO AN UNINSURED PATIENT INCLUDES WITH IT, OR ON IT, A PROMINENT STATEMENT THAT AN UNINSURED PATIENT WHO MEETS CERTAIN INCOME REQUIREMENTS MAY QUALIFY FOR FINANCIAL ASSISTANCE AND INFORMATION ON HOW TO APPLY FOR CONSIDERATION UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. ALL THIRD-PARTY AGENTS WHO SUBMIT OR COLLECT BILLS ON BEHALF OF HOSPITAL ARE REQUIRED TO FOLLOW THIS POLICY. SWEDISHAMERICAN HOSPITAL PART V, SECTION B, LINE 19D: THE MAXIMUM AMOUNT THAT MAY BE COLLECTED IN A 12-MONTH PERIOD FROM AN UNINSURED PATIENT WITH FAMILY INCOME OF LESS THAN OR EQUAL TO 600 PERCENT OF THE FEDERAL POVERTY GUIDELINES FOR MEDICALLY NECESSARY SERVICES IS 25 PERCENT OF THAT PATIENT'S FAMILY INCOME. THE HOSPITAL WILL DETERMINE, ON A CASE-BY-CASE BASIS, WHETHER TO EXTEND THE SAME OR SIMILAR 12-MONTH MAXIMUM COLLECTIBLE AMOUNT TO ANY OTHER QUALIFYING SELF-PAY PATIENT WITH FAMILY INCOME OF LESS THAN OR EQUAL TO 600 PERCENT OF THE FEDERAL POVERTY GUIDELINES FOR QUALIFYING SERVICES. THE HOSPITAL RESERVES THE RIGHT TO EXCLUDE PATIENTS HAVING ASSETS WITH A VALUE IN EXCESS OF 600 PERCENT OF THE FEDERAL POVERTY GUIDELINES FROM THE APPLICATION OF THE 12-MONTH MAXIMUM COLLECTIBLE AMOUNT. FOR PURPOSES OF DETERMINING THE APPLICABILITY OF THE 12-MONTH MAXIMUM COLLECTIBLE AMOUNT, THE FOLLOWING ASSETS SHALL NOT BE COUNTED:A. THE UNINSURED PATIENT'S PRIMARY RESIDENCE.B. PERSONAL PROPERTY EXEMPT FROM JUDGMENT UNDER SECTION 12-1001 OF THE CODE OF CIVIL PROCEDURE.C. ANY AMOUNTS HELD IN A PENSION OR RETIREMENT PLAN, PROVIDED, HOWEVER, THAT DISTRIBUTIONS AND PAYMENTS FROM PENSION OR RETIREMENT PLAN MAY BE INCLUDED AS INCOME.TO BE ELIGIBLE TO HAVE THIS MAXIMUM AMOUNT APPLIED TO SUBSEQUENT CHARGES, A PATIENT SHALL INFORM THE HOSPITAL, IN SUBSEQUENT HOSPITAL INPATIENT ADMISSIONS OR OUTPATIENT ENCOUNTERS, THAT THE PATIENT HAS PREVIOUSLY RECEIVED MEDICALLY NECESSARY SERVICES FROM THE HOSPITAL AND WAS DETERMINED TO BE ENTITLED TO DISCOUNTED CARE UNDER THIS POLICY.IN NO EVENT SHALL A PATIENT WHO RECEIVES FINANCIAL ASSISTANCE UNDER THIS POLICY BE CHARGED GROSS CHARGES IN VIOLATION OF THE INTERNAL REVENUE CODE SECTION 501(R)(5)(B). FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE PROVIDED TO PATIENTS WHO RECEIVE FINANCIAL ASSISTANCE UNDER THIS POLICY, HOSPITAL SHALL NOT CHARGE AMOUNTS IN EXCESS OF CHARGES ALLOWED UNDER INTERNAL REVENUE CODE 501(R)(5)(A). ASSETS ARE NOT CONSIDERED IN DETERMINING A SELF-PAY PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER THIS POLICY, EXCEPT FOR PURPOSES OF:A. DETERMINING THE APPLICABILITY OF THE 12-MONTH MAXIMUM COLLECTIBLE AMOUNT DESCRIBED ABOVE; ANDB. IN THE CASE OF A MEDICARE BENEFICIARY, APPLYING THE MANDATORY ASSET TEST FOR MEDICARE BENEFICIARIES DESCRIBED ABOVE. SWEDISHAMERICAN MEDICAL CTR. BELVIDERE PART V, SECTION B, LINE 19D: THE MAXIMUM AMOUNT THAT MAY BE COLLECTED IN A 12-MONTH PERIOD FROM AN UNINSURED PATIENT WITH FAMILY INCOME OF LESS THAN OR EQUAL TO 600 PERCENT OF THE FEDERAL POVERTY GUIDELINES FOR MEDICALLY NECESSARY SERVICES IS 25 PERCENT OF THAT PATIENT'S FAMILY INCOME. THE HOSPITAL WILL DETERMINE, ON A CASE-BY-CASE BASIS, WHETHER TO EXTEND THE SAME OR SIMILAR 12-MONTH MAXIMUM COLLECTIBLE AMOUNT TO ANY OTHER QUALIFYING SELF-PAY PATIENT WITH FAMILY INCOME OF LESS THAN OR EQUAL TO 600 PERCENT OF THE FEDERAL POVERTY GUIDELINES FOR QUALIFYING SERVICES. THE HOSPITAL RESERVES THE RIGHT TO EXCLUDE PATIENTS HAVING ASSETS WITH A VALUE IN EXCESS OF 600 PERCENT OF THE FEDERAL POVERTY GUIDELINES FROM THE APPLICATION OF THE 12-MONTH MAXIMUM COLLECTIBLE AMOUNT. FOR PURPOSES OF DETERMINING THE APPLICABILITY OF THE 12-MONTH MAXIMUM COLLECTIBLE AMOUNT, THE FOLLOWING ASSETS SHALL NOT BE COUNTED:A. THE UNINSURED PATIENT'S PRIMARY RESIDENCE.B. PERSONAL PROPERTY EXEMPT FROM JUDGMENT UNDER SECTION 12-1001 OF THE CODE OF CIVIL PROCEDURE.C. ANY AMOUNTS HELD IN A PENSION OR RETIREMENT PLAN, PROVIDED, HOWEVER, THAT DISTRIBUTIONS AND PAYMENTS FROM PENSION OR RETIREMENT PLAN MAY BE INCLUDED AS INCOME.TO BE ELIGIBLE TO HAVE THIS MAXIMUM AMOUNT APPLIED TO SUBSEQUENT CHARGES, A PATIENT SHALL INFORM THE HOSPITAL, IN SUBSEQUENT HOSPITAL INPATIENT ADMISSIONS OR OUTPATIENT ENCOUNTERS, THAT THE PATIENT HAS PREVIOUSLY RECEIVED MEDICALLY NECESSARY SERVICES FROM THE HOSPITAL AND WAS DETERMINED TO BE ENTITLED TO DISCOUNTED CARE UNDER THIS POLICY.IN NO EVENT SHALL A PATIENT WHO RECEIVES FINANCIAL ASSISTANCE UNDER THIS POLICY BE CHARGED "GROSS CHARGES" IN VIOLATION OF THE INTERNAL REVENUE CODE SECTION 501(R)(5)(B). FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE PROVIDED TO PATIENTS WHO RECEIVE FINANCIAL ASSISTANCE UNDER THIS POLICY, HOSPITAL SHALL NOT CHARGE AMOUNTS IN EXCESS OF CHARGES ALLOWED UNDER INTERNAL REVENUE CODE 501(R)(5)(A). ASSETS ARE NOT CONSIDERED IN DETERMINING A SELF-PAY PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER THIS POLICY, EXCEPT FOR PURPOSES OF:A. DETERMINING THE APPLICABILITY OF THE 12-MONTH MAXIMUM COLLECTIBLE AMOUNT DESCRIBED ABOVE; ANDB. IN THE CASE OF A MEDICARE BENEFICIARY, APPLYING THE MANDATORY ASSET TEST FOR MEDICARE BENEFICIARIES DESCRIBED ABOVE. PART VI, LINE 2: SWEDISHAMERICAN HOSPITAL HAS PROVIDED A THIRD OF THE MONETARY SUPPORT FOR THE 2010 HEALTHY COMMUNITY STUDY, CONDUCTED BY THE ROCKFORD HEALTH COUNCIL. THE COUNCIL CONSISTS OF THE MAJOR HEALTH CARE PROVIDERS IN OUR METROPOLITAN AREA SUCH AS THE THREE HOSPITALS, CRUSADER CLINIC (A FEDERALLY QUALIFIED HEALTHCARE CLINIC), THE UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE, JANET WATTLES MENTAL HEALTH CENTER, ROSECRANCE SUBSTANCE ABUSE CENTER AS WELL AS SEVERAL REPRESENTATIVES OF NOT-FOR-PROFIT AGENCIES, AND MEMBERS OF THE CORPORATE COMMUNITY. SINCE 2001, AN ASSESSMENT HAS BEEN COMPLETED EVERY THREE YEARS TO IDENTIFY AND TRACK TRENDS AS WELL AS AREAS TO ADDRESS. THESE STAKEHOLDERS UNDERSTAND THE NEED FOR A COMPREHENSIVE COMMUNITY STUDY THAT IS FOCUSED ON THE OVERALL NEEDS OF THE COMMUNITY. SWEDISHAMERICAN HAS USED THIS DATA TO LAUNCH INNOVATIVE PROGRAMS AND COLLABORATIVE PARTNERSHIPS SUCH AS CARDIAC SCREENINGS WITHIN MINORITY COMMUNITIES. PART VI, LINE 3: FOR SERVICES PROVIDED IN THE HOSPITAL, OUR EMPLOYEES AND OUR AGENTS FOLLOW THE FAIR PATIENT BILLING ACT AND PROVIDE INFORMATION REGARDING THE AVAILABILITY OF CHARITY AND FINANCIAL ASSISTANCE AT ALL POINTS DURING THE COLLECTION PROCESS. WE HAVE POSTED SIGNAGE DISCLOSING THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE IN EMERGENCY ROOMS AND ON OUR WEBSITE. INPATIENTS ARE PROVIDED VARIOUS WRITTEN COMMUNICATIONS REGARDING THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE, AND ANY UNINSURED PATIENTS ARE SCREENED FOR MEDICAID AND ILLINOIS UNINSURED DISCOUNT ELIGIBILITY. FOR SERVICES PROVIDED IN PHYSICIAN OFFICES, FINANCIAL COUNSELORS ARE INSTRUCTED TO MAKE THE PATIENTS AWARE OF THE CHARITY CARE AND FINANCIAL ASSISTANCE POLICY DURING THE COLLECTION PROCESS AND EDUCATE THEM ON THE PROCESS OF APPLYING FOR MEDICAID. FOR SERVICES PROVIDED BY HOME HEALTH, SOCIAL WORKERS ASSIST PATIENTS BY SCREENING FOR MEDICAID ELIGIBILITY AND COMPLETING THE APPLICATION, COMPLETING CHARITY CARE APPLICATION, ASSISTING IN APPLYING FOR MEDICARE AND SOCIAL SECURITY DISABILITY BENEFITS, AND ASSISTING WITH APPLICATIONS FOR FOOD STAMP, LOW INCOME ENERGY ASSISTANCE, AND CIRCUIT BREAKER/ILLINOIS CARES PRESCRIPTION PROGRAMS. PART VI, LINE 4: FOR MORE THAN 100 YEARS, ROCKFORD, ILLINOIS HAS BEEN KNOWN AS A MAJOR INDUSTRIAL MANUFACTURING CENTER OF MACHINE TOOLS, INDUSTRIAL FASTENERS, AUTOMOTIVE PARTS AND AEROSPACE COMPONENTS. THE ROCKFORD METROPOLITAN POPULATION HAS GROWN TO MORE THAN 250,000 PEOPLE AND IT SERVES AS THE REGIONAL TRADE CENTER FOR MORE THAN 400,000 PEOPLE IN NORTHERN ILLINOIS. MAJOR EMPLOYERS IN OUR SERVICE AREA INCLUDE CHRYSLER, HAMILTON SUNDSTRAND, TEXTRON, CITY OF ROCKFORD, ROCKFORD PUBLIC SCHOOLS, AND THREE AREA HOSPITALS. ROCKFORD BOASTS MANY GREAT PARKS, SHOPPING, DINING, CULTURAL ACTIVITIES, ENTERTAINMENT AND EDUCATIONAL OPPORTUNITIES. BUT LIKE MANY CITIES IN THE UPPER MIDWEST, IT ALSO CONTINUES TO STRUGGLE TO COMPETE IN WHAT IS NOW A GLOBAL MANUFACTURING ECONOMY. IN THE 1980S, ROCKFORD'S UNEMPLOYMENT RATE REACHED 25 PERCENT, THE HIGHEST IN THE NATION, AND IT BECAME A SYMBOL FOR THE PLIGHT OF A "RUST BELT" CITY. ALTHOUGH THE ECONOMY IS MORE DIVERSIFIED NOW, ROCKFORD REMAINS HEAVILY DEPENDENT ON MANUFACTURING. ALSO IN THE 1980S, CHARGES OF DISCRIMINATION WERE LEVELED AT THE PUBLIC SCHOOL DISTRICT, CULMINATING IN A FEDERAL LAWSUIT AND 12 YEARS OF FEDERAL SUPERVISION. THESE TWO MAJOR DEVELOPMENTS HAVE HAD THEIR EFFECT ON THE LOCAL ECONOMY, THE STABILITY OF GOOD PAYING JOBS AND THE PSYCHE AND SELF-ESTEEM OF THE COMMUNITY. THEY ALSO HAVE AFFECTED ROCKFORD'S CHANGING ROLE AND IMPORTANCE TO THE REGION, STATE, AND TO SOME DEGREE THE NATION. UNQUESTIONABLY, THESE DYNAMICS HAVE IMPACTED HEALTHCARE IN THE COMMUNITY. TODAY, ROCKFORD'S UNEMPLOYMENT RATE OF 13.4% IS 15TH HIGHEST IN THE NATION. LOSS OF MANUFACTURING JOBS AND HEALTH INSURANCE COVERAGE HAS CONTRIBUTED TO STRESS AND STRAIN ON EMPLOYERS, EMPLOYEES AND HEALTHCARE PROVIDERS. TWO COMMUNITY SURVEYS HAVE IDENTIFIED HEART DISEASE, DIABETES, CANCER, PRE-NATAL CARE AND DEPRESSION AS MAJOR HEALTHCARE ISSUES IN OUR MARKET.SWEDISHAMERICAN HELPED FUND THE 2010 ROCKFORD HEALTHY COMMUNITY STUDY IN PARTNERSHIP WITH THE UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE AT ROCKFORD AND THE ROCKFORD HEALTH COUNCIL. THE STUDY REVEALED THAT MORE THAN 20 PERCENT OF THE RESIDENTS IN OUR HOSPITAL'S ZIP CODE LIVE BELOW THE POVERTY LEVEL, AND THAT THE MEDIAN HOUSEHOLD INCOME OF $25,527 IS THE LOWEST OF ALL ROCKFORD-AREA ZIP CODES. OUT-OF-POCKET HEALTHCARE COSTS ARE A PROBLEM FOR MORE THAN 45 PERCENT OF THIS AREA'S RESIDENTS, WHICH IS THE HIGHEST RATE IN THE CITY OF ROCKFORD. ADDITIONALLY, MANY RESIDENTS IN THIS VICINITY-WHICH IS AMONG THE STATE'S MOST DEPRESSED AREAS-ARE NOT ABLE TO RECEIVE NEEDED PHYSICAL OR MENTAL HEALTHCARE. THE UNITED WAY OF ROCK RIVER VALLEY' COMMUNITY ASSESSMENT FURTHER REVEALED THAT MANY LOCAL RESIDENTS LACK HEALTH INSURANCE AND ACCESS TO PRIMARY HEALTHCARE, LEADING TO PREMATURE MORBIDITY. THE ROCKFORD HEALTHY COMMUNITY STUDY IDENTIFIED EXTREMELY LOW LEVELS OF HOME OWNERSHIP IN SWEDISHAMERICAN HOSPITAL'S IMMEDIATE VICINITY. ACCORDING TO THE STUDY, MORE THAN 60 PERCENT OF RESIDENTS RENTED, WHICH WAS MUCH HIGHER THAN THE OVERALL SAMPLE (APPROXIMATELY 17 PERCENT). THE STUDY ALSO INDICATED THAT MORE THAN 12 PERCENT OF AREA RESIDENTS COULD NOT AFFORD TO MAKE BASIC HOME REPAIRS. THE UNITED WAY'S ASSESSMENT FURTHER IDENTIFIED THE NEED FOR MORE AFFORDABLE PERMANENT HOUSING UNITS, STATING: "EVEN THOUGH HOUSING IN ROCKFORD IS AMONG THE MOST AFFORDABLE IN THE COUNTRY, MANY FAMILIES, ESPECIALLY RENTERS, CANNOT AFFORD SHELTER." BY VIRTUE OF ITS MISSION, LOCATION IN THE CENTRAL CITY AND RELATIONSHIPS WITH OTHER PROVIDERS, SWEDISHAMERICAN SERVES THE NEEDS OF MANY OF THE COMMUNITY'S UNDERSERVED. FINDING WAYS TO IMPROVE THE HEALTH OF ALL AND TO MAKE ROCKFORD A MODEL COMMUNITY IN WHICH TO LIVE, WORK AND WORSHIP ARE SIGNIFICANT AND STRATEGIC INITIATIVES FOR SWEDISHAMERICAN. PART VI, LINE 5: ALTHOUGH SWEDISHAMERICAN HOSPITAL'S COMMUNITY SERVICE EFFORTS REACH A BROAD SEGMENT OF THE POPULATION THROUGHOUT NORTHERN ILLINOIS, THE HOSPITAL DEVOTES A GREAT DEAL OF ITS ENERGY AND RESOURCES TO SERVING THE CITY'S NEEDIEST PEOPLE, MANY OF WHOM LIVE IN THE URBAN CORE WHERE SWEDISHAMERICAN IS LOCATED. OUR ORGANIZATION CONTRIBUTES MILLIONS OF DOLLARS TO CHARITY AND MEDICAID CARE EACH YEAR. RECOGNIZING THAT HEALTHY COMMUNITIES ARE CHARACTERIZED BY STRONG INTERCONNECTIONS BETWEEN RESIDENTS, INFRASTRUCTURE, ORGANIZATIONS AND SERVICES, WE HAVE WORKED IN PARTNERSHIP WITH OTHER COMMUNITY-BASED ORGANIZATIONS AS PART OF THE NON-PROFIT ROCKFORD HEALTH COUNCIL INC. THE COUNCIL SEEKS TO BUILD AND IMPROVE COMMUNITY HEALTH THROUGH EDUCATION, ACTION, DIALOGUE AND LEGISLATIVE ACTIVITY AND SERVE AS A CATALYST AND COORDINATOR FOR AGENCY AND INDIVIDUAL ACTION TO ENSURE ACCESS, COST EFFECTIVENESS AND QUALITY. BEYOND OUR WORK WITH THE COUNCIL, SOME OF OUR INITIATIVES TAKE PLACE IN CONCERT WITH OTHER INDIVIDUAL COMMUNITY ORGANIZATIONS AND HEALTHCARE PROVIDERS, WHILE OTHERS ARE CARRIED OUT BY SWEDISHAMERICAN HOSPITAL TEAMS. SWEDISHAMERICAN HAS SOUGHT TO IMPROVE THE COMMUNITY'S HEALTH BY TAKING EFFECTIVE LIFESTYLE MODIFICATION PROGRAMS TO THE PEOPLE WHO NEED THEM MOST. ALTHOUGH THIS APPLIES TO THE COMMUNITY AT LARGE, WE HAVE TAKEN SPECIAL EFFORTS TO BRING THESE STRATEGIES TO THE CITY'S ELDERLY AND UNDERSERVED RESIDENTS. THIS IS DEMONSTRATED BY OUR SUCCESSFUL PROGRAM TO IMPROVE THE HEALTH OF RESIDENTS AT LONGWOOD PLAZA, A SENIOR HOUSING FACILITY LOCATED TWO BLOCKS FROM OUR HOSPITAL'S CAMPUS. FINALLY, BEYOND LIFESTYLE MODIFICATION OUR ONGOING COMMUNITY HEALTH INITIATIVES INVOLVE RESEARCH-BASED HEALTH SCREENING PROGRAMS, AS WELL AS UNIQUE HEALTH EDUCATION EVENTS THAT TARGET BOTH AT-RISK MEMBERS OF THE COMMUNITY AND HEALTHCARE PROVIDERS. OUR MISSION IS "THROUGH EXCELLENCE IN HEALTHCARE AND COMPASSIONATE SERVICE WE CARE FOR OUR COMMUNITY." IN FURTHERANCE OF ITS EXEMPT PURPOSE SWEDISHAMERICAN HOSPITAL CONTINUALLY INVESTS IN THE SURROUNDING COMMUNITY WITH PHYSICIAN ACQUISITIONS AND REGIONAL EXPANSION TO ASSURE ACCESS TO HEALTH CARE. SWEDISHAMERICAN HOSPITAL ALSO ESTABLISHED CENTERS OF EXCELLENCE AND ALLIANCES WITH OTHER HEALTH CARE PROVIDERS, INCLUDING CRUSADER CLINIC, A FEDERALLY QUALIFIED HEALTH CENTER, AND UNIVERSITY OF WISCONSIN. THIS ASSURES THE COMMUNITY WE SERVE RECEIVES THE HIGHEST QUALITY CARE. WE ALSO INVEST IN TECHNOLOGY TO ASSURE COST EFFECTIVE CARE IS DELIVERED FOR WHICH SWEDISHAMERICAN HOSPITAL HAS WON NUMEROUS AWARDS FOR ITS QUALITY OF CARE. IN ADDITION, SWEDISHAMERICAN HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF AND COMMUNITY BOARD AS PART OF ITS EXEMPT PURPOSE. PART VI, LINE 6: SWEDISHAMERICAN HOSPITAL IS A STAND ALONE HEALTH CARE PROVIDER THAT INCLUDES TWO ACUTE CARE HOSPITALS, PHYSICIAN CLINICS, PHYSICIAN EMERGENCY SERVICES, AND HOME HEALTH CARE. SWEDISHAMERICAN FOUNDATION IS A SUBSIDIARY OF SWEDISHAMERICAN HOSPITAL AND IS ORGANIZED FOR TAX PURPOSES AS A SUPPORTING ORGANIZATION. IN ORDER TO IMPROVE THE LOW RATE OF HOME OWNERSHIP IDENTIFIED IN THE ROCKFORD HEALTHY COMMUNITY STUDY, SWEDISHAMERICAN FOUNDATION (SAF) INITIATED A NEIGHBORHOOD REVITALIZATION PROGRAM IN A SIX-BLOCK AREA DIRECTLY SOUTH OF OUR HOSPITAL CAMPUS. SAF'S NEIGHBORHOOD REVITALIZATION EFFORT INCLUDES:HABITAT FOR HUMANITY HOMES: SAF ENTERED INTO A FORMAL AGREEMENT WITH THE ROCKFORD HABITAT FOR HUMANITY CHAPTER IN 2002 TO CONSTRUCT NEW AREA HOMES. BY THE END OF 2012, A TOTAL OF 29 HABITAT FOR HUMANITY HOMES HAVE NOW BEEN COMPLETED AND SOLD TO LOW-INCOME HOME OWNERS.NEW CITY-BUILT HOMES: SAF PURCHASED AND RAZED THREE, ADDITIONAL SUBSTANDARD HOMES IN THE NEIGHBORHOOD AND PROVIDED THE LOTS TO THE CITY OF ROCKFORD. THE CITY SUBSEQUENTLY BUILT THREE NEW HOMES ON THESE SITES FOR SALE TO MODERATE INCOME FAMILIES WITH PURCHASE ASSISTANCE.CRUISE FUNDRAISER: OVER THE PAST 17 YEARS, SAF'S ANNUAL FUNDRAISING GALA HAS RAISED MORE THAN $1,000,000, WHICH HAS BEEN REINVESTED INTO COMMUNITY IMPACT INITIATIVES, SUCH AS SCHOOL PHYSICALS AND IMMUNIZATIONS FOR AREA CHILDREN AND CANCER SCREENINGS FOR NEIGHBORHOOD RESIDENTS.NEIGHBORHOOD PLAYGROUND AND PARKS: BECAUSE AREA CHILDREN DID NOT HAVE A SAFE PLACE TO PLAY, SAF PURCHASED THREE CONTIGUOUS PIECES OF PROPERTY, REMOVED EXISTING COMMERCIAL AND RESIDENTIAL STRUCTURES AND PARTNERED WITH TWO LOCAL CHARITIES TO CONSTRUCT A NEW NEIGHBORHOOD PLAYGROUND. DRIVEWAY/GARAGE RENOVATION PROJECT: FOLLOWING A NEIGHBORHOOD-WIDE SURVEY, SAF COORDINATED AND IMPLEMENTED A GARAGE CONSTRUCTION AND DRIVEWAY REPLACEMENT PROGRAM. IN ADDITION TO INCREASING EXISTING HOME VALUES, THIS PROGRAM WILL HELP REDUCE ON-STREET PARKING, THEREBY INCREASING TRAFFIC FLOW AND MAKING PARKED CARS LESS VISIBLE/ACCESSIBLE TO POTENTIAL THIEVES AND VANDALS. REVERSE HOME GIFT ANNUITY PROGRAM: TO HELP STRUGGLING ELDERLY RESIDENTS REMAIN IN THEIR HOMES, SAF DEVELOPED A PROGRAM WHEREBY HOMEOWNERS DEED PHYSICAL OWNERSHIP OF THEIR PROPERTY TO THE FOUNDATION IN EXCHANGE FOR THE RIGHT TO LIVE IN THEIR HOME UNTIL DEATH OR INCAPACITY. SAF ASSUMES RESPONSIBILITIES FOR TAXES, REPAIRS, UPKEEP, LAWN MAINTENANCE AND SNOW REMOVAL. UPON TAKING ULTIMATE POSSESSION OF A HOUSE, IT WILL BE SOLD TO AN EMPLOYEE OR OTHER OWNER OCCUPANT, TO HELP INCREASE [OR AT LEAST MAINTAIN] A SIGNIFICANT PERCENTAGE OF OWNER OCCUPIED HOMES.HOMEOWNER GRANTS TO EMPLOYEES: SINCE 2004, SWEDISHAMERICAN HOSPITAL HAS OFFERED $5,000 DOWN PAYMENT ASSISTANCE TO EMPLOYEES TO HELP ENCOURAGE HOME OWNERSHIP IN THE SIX-BLOCK AREA SURROUNDING THE HOSPITAL. THIS INITIATIVE INCLUDES A FIVE-YEAR FORGIVABLE GRANT TO EMPLOYEES IN GOOD STANDING WITH NO INCOME RESTRICTIONS, AND A SECOND POSSIBLE $5,000 GRANT FOR LOW-INCOME EMPLOYEES. SINCE INCEPTION, THIS PROGRAM HAS ASSISTED 17 EMPLOYEES PURCHASE HOMES IN THE SWEDISHAMERICAN NEIGHBORHOOD.HOME RESTORATION: SINCE 2004, SAF HAS PURCHASED A TOTAL OF 27 HOMES IN THE NEIGHBORHOOD TARGET AREA, REHABBED THEM AND MADE THEM AVAILABLE TO EMPLOYEES, FIREFIGHTERS, POLICE OFFICERS AND PUBLIC SCHOOL TEACHERS, AT DISCOUNT (LESS THAN THE COST OF PURCHASE AND REPAIRS). TO DATE, 20 HOMES HAVE BEEN SOLD TO EMPLOYEES AND OTHER ELIGIBLE OWNER OCCUPANTS. IN ORDER TO ALLEVIATE FIRST-TIME HOME BUYERS' CONCERNS ABOUT THE RISING COSTS OF OWNERSHIP, THESE HOMES HAVE A SOLID ROOF, SIDING, PLUMBING, ELECTRICAL, AND A GOOD WORKING FURNACE. THIS PROGRAM WILL CONTINUE FOR AT LEAST FOUR ADDITIONAL YEARS. IN COOPERATION WITH ROCKFORD EAST HIGH SCHOOL AND DE LA GARDIE HIGH SCHOOL/GYMNASIET (LIDKOPINGS, SWEDEN), THE SWEDISHAMERICAN FOUNDATION CONSTRUCTED TWO NEW NEIGHBORHOOD HOUSES AVAILABLE FOR SALE TO EMPLOYEES OR OTHER ELIGIBLE OWNER-OCCUPANTS.IN ADDITION, THE FOUNDATION HAS PURCHASED TWO, 12-UNIT APARTMENT BUILDINGS ADJACENT TO THE HOSPITAL CAMPUS WHICH WERE IN A STATE OF DISREPAIR. APPROXIMATELY THREE-QUARTERS OF A MILLION DOLLARS WERE INVESTED IN THESE TWO BUILDINGS TO BRING THEM TO "MARKET RATE" STATUS. ENCOURAGED BY OUR COMMITMENT TO RENOVATE OUR CAMPUS AND REVITALIZE THE SURROUNDING AREA, A NUMBER OF COMMERCIAL DEVELOPMENTS HAVE OCCURRED. AMONG THEM IS A NEW WALGREEN'S DRUG STORE, WHICH RETURNED RETAIL PHARMACY SERVICES TO THE AREA FOR THE FIRST TIME IN YEARS. A THREE-STORY OFFICE BUILDING SOUTH OF THE NEW WALGREEN'S WAS COMPLETED FOLLOWED BY A 60,000-SQUARE-FOOT MEDICAL OFFICE BUILDING SOUTH OF THE HOSPITAL. PART I LINE 6A AND PART VI LINE 7 - SWEDISHAMERICAN HOSPITAL FILES A COMMUNITY BENEFIT REPORT WITH THE ILLINOIS ATTORNEY GENERAL. 1 ILLINOIS HOSPITAL RESEARCH & HEALTH FOUNDATION 700 SOUTH SECOND SPRINGFIELD IL 62704 237421930 501(C)(3) 193356 QUALITY HEALTHCARE FOR ILLINOIS UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE 1601 PARKVIEW AVE ROCKFORD IL 61107 376000511 501(C)(3) 338250 ACADEMIC RESEARCH 2 EDUCATIONAL SCHOLARSHIP FOR CHILDREN OF NON-MANAGEMENT EMPLOYEES 30 30000 SWEDISHAMERICAN HOSPITAL ONLY MAKES DONATIONS TO OTHER TAX EXEMPT ORGANIZATIONS. X X X X 0 1 0 0 0 0 0 0 0 DANNY L COPELAND MD 163915 0 0 0 0 0 13539 0 33778 0 211232 0 0 0 WILLIAM R GORSKI MD 558167 0 0 0 0 0 203194 0 16626 0 777987 0 0 0 JOHN C MYERS MD 454855 0 0 0 0 0 9924 0 40731 0 505510 0 0 0 WILLIAM SCHULZ MD 573270 0 0 0 0 0 17867 0 32475 0 623612 0 0 0 RICHARD WALSH 365295 0 0 0 0 0 101472 0 25237 0 492004 0 0 0 ALLEN WILLIAMS MD 211762 0 0 0 0 0 13671 0 28714 0 254147 0 0 0 DONALD HARING 324242 0 0 0 0 0 54670 0 24043 0 402955 0 0 0 KATHLEEN KELLY MD 345607 0 0 0 0 0 45211 0 590 0 391408 0 0 0 MERAT ESFAHANI MD 808914 0 0 0 0 0 12395 0 38411 0 859720 0 0 0 STEVEN MILOS MD 629890 0 0 0 0 0 12286 0 15695 0 657871 0 0 0 HARVEY EINHORN MD 694387 0 0 0 0 0 36204 0 42741 0 773332 0 0 0 PRAKASH PEDAPATI 579350 0 0 0 0 0 19704 0 17333 0 616387 0 0 0 JON MICHEL MD 784168 0 0 0 0 0 1244 0 28779 0 814191 0 0 0 PART I, LINE 4B WILLIAM GORSKI M.D.-457(F)-$185,327; RICHARD WALSH-457(F)-$83,605; DONALD HARING-457(F)-$34,965; KATHLEEN KELLY M.D.-457(F)-$27,344; HARVEY EINHORN M.D.-457(B)-$16,500. ILLINOIS FINANCE AUTHORITY - 2004 861091967 45200BKQ0 2004-12-21 105360720 CONSTRUCTION & EQUIPMENT CARDIAC PAVILION, RENOVATE OPERATING RM & CATH LAB 0 0 0 ILLINOIS FINANCE AUTHORITY - 2010 861091967 2010-04-19 25000000 CONSTRUCTION & EQUIPMENT CARDIAC PAVILION, RENOVATE OPERATING RM & CATH LAB 0 0 0 106458982 12819 74126290 991204 3672433 27656236 2007 1 1 1 1 25000000 25000000 2010 1 1 1 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 SCHEDULE K SUPPLENTAL INFORMATION SCHEDULE K, PART II, LINE 7 : BOND INSURANCE OF $3,672,397 WAS PURCHASED FROM BOND PROCEEDS AND IS INCLUDED AS A COST OF ISSUANCE. SCHEDULE K PART V WE ARE IN THE PROCESS OF ADOPTING A BOARD APPROVED WRITTEN POLICY THAT ESTABLISHES WRITTEN PROCEDURES TO ENSURE THAT VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH THE VOLUNTARY CLOSING AGREEMENT IF SELF-REMEDIATION IS NOT AVAILABLE UNDER APPLICABLE REGULATIONS. OUR CURRENT PROCEDURES ARE NOT WRITTEN, BUT LEGAL COUNSEL, CFO AND THE CONTROLLER REVIEW FOR COMPLIANCE. SHERYL HEAD ROBERT L. HEAD PH.D TRUSTEE, SPOUSE 82953 EMPLOYEE COMPENSATION 0 BEVERLY DERRY PATRICK DERRY TRUSTEE, SISTER-IN-LAW 76371 EMPLOYEE COMPENSATION 0 RIVERSIDE COMMUNITY BANK DAN LOESCHER TRUSTEE AND OFFICER, CHAIRMAN OF RIVERSIDE COMMUNITY BANK 10478860 BANKS FEES, CERTIFICATE OF DEPOSIT, DEMAND DEPOSIT ACCOUNTS 0 MICHELLE ROOP WILLIAM ROOP TRUSTEE, DAUGHTER 48251 EMPLOYEE COMPENSATION 0 NORTHERN ILLINOIS VEIN CLINIC FRANK BONELLI TRUSTEE 925690 1/8 PARTNER PHYSICIAN FEES 0 FORM 990, PART VI, SECTION A, LINE 2 DIRECTORS WILLIAM ROOP AND JAMES GINGRICH ARE BOARD MEMBERS OF SWEDISHAMERICAN HOSPITAL AND HAVE A BUSINESS RELATIONSHIP. DIRECTORS DAVE RYDELL AND JAMES GINGRICH ARE BOARD MEMBERS OF SWEDISHAMERICAN HOSPITAL AND HAVE A BUSINESS RELATIONSHIP. DIRECTORS DAN LOESCHER AND FRANK WALTER ARE BOARD MEMBERS OF SWEDISHAMERICAN HOSPITAL AND HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 SWEDISHAMERICAN HEALTH SYSTEM (PARENT CORPORATION) IS THE SOLE CORPORATE MEMBER OF SWEDISHAMERICAN HOSPITAL (HOSPITAL) AND AS SUCH APPOINTS ALL TRUSTEES OF AND HAS THE AUTHORITY TO APPROVE CERTAIN DECISIONS OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A SWEDISHAMERICAN HEALTH SYSTEM (PARENT CORPORATION) IS THE SOLE CORPORATE MEMBER OF SWEDISHAMERICAN HOSPITAL (HOSPITAL) AND AS SUCH APPOINTS ALL TRUSTEES OF AND HAS THE AUTHORITY TO APPROVE CERTAIN DECISIONS OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B SWEDISHAMERICAN HEALTH SYSTEM (PARENT CORPORATION) IS THE SOLE CORPORATE MEMBER OF SWEDISHAMERICAN HOSPITAL (HOSPITAL) AND AS SUCH APPOINTS ALL TRUSTEES OF AND HAS THE AUTHORITY TO APPROVE CERTAIN DECISIONS OF THE HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT VERSION OF THE FORM 990 WAS REVIEWED BY LEGAL COUNSEL AND THE CHIEF FINANCIAL OFFICER. SUBSEQUENTLY, THE AUDIT/COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS OF SWEDISHAMERICAN HEALTH SYSTEM (PARENT CORPORATION) REVIEWED A FINAL DRAFT OF THE FORM 990 AND WAS PROVIDED WITH THE OPPORTUNITY TO COMMENT AND ASK QUESTIONS. THE ENTIRE BOARD OF DIRECTORS WAS PROVIDED WITH A COPY OF THE FORM 990 BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICIES, WHICH APPLY TO ALL MEMBERS OF THE BOARD OF DIRECTORS AND TO ALL EMPLOYEES. PROCEDURES ARE IN PLACE TO INDENTIFY CONFLICTS OF BOTH DIRECTORS AND EMPLOYEES. DIRECTOR CONFLICTS ARE HANDLED BY BOARD DELIBERATION AND BOARD VOTE FROM WHICH THE INTERESTED DIRECTOR IS EXCLUDED. EMPLOYEE CONFLICTS ARE HANDLED BY THE COMPLIANCE DEPARTMENT AND IN CERTAIN INSTANCES MAY REQUIRE SEPARATE BOARD ACTION. THE BOARD IS PROVIDED WITH PERIODIC COMPLIANCE REPORTS REGARDING CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 ALL COMPENSATION DECISIONS ARE MADE BY INDEPENDENT PERSONS. WITH RESPECT TO THE PRESIDENT, CEO, OFFICERS, AND KEY EMPLOYEES, THE ORGANIZATION FOLLOWS A COMPENSATION APPROVAL PROCEDURE ANNUALLY THAT INVOLVES APPROVAL OF PROPOSED AND FINAL COMPENSATION ARRANGEMENTS BY THE ORGANIZATION'S EXECUTIVE COMPENSATION COMMITTEE USING COMPARABILITY DATA, AS WELL AS CONTEMPORANEOUS DOCUMENTATION OF COMPENSATION DECISIONS IN THE MINUTES. ALL PHYSICIAN COMPENSATION ARRANGEMENTS ARE APPROVED BY THE FINANCE COMMITTEE AND FULL BOARD OF DIRECTORS USING COMPARABILITY DATA, AS WELL AS CONTEMPORANEOUS DOCUMENTATION OF COMPENSATION DECISIONS IN THE MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS HAVE NOT BEEN PREVIOUSLY MADE AVAILABLE TO THE PUBLIC AND AUDITED FINANCIAL STATEMENTS OF SWEDISHAMERICAN HOSPITAL ARE AVAILABLE FROM PUBLICLY DISCLOSED FORM 990, THE ILLINOIS ATTORNEY GENERAL WEBSITE AND FROM THE U.S. SECURITIES AND EXCHANGE COMMISSION ELECTRONIC MUNICIPAL MARKET ACCESS SYSTEM. FORM 990, PART VII, COL. B, HOURS DONATED ANNUALLY TO RELATED ORGANIZATION: DURING THE TAX YEAR 2011 THE FOLLOWING TRUSTEES AND OFFICERS HAVE DEVOTED AN AVERAGE OF 2 HOURS PER WEEK TO SWEDISH AMERICAN HOSPITAL INSURANCE TRUST: PETER CHRISTMAN, MICHAEL DALLMAN, PATRICK DERRY, JAMES GINGRICH, ROBERT HEAD, HELEN CHUNG HILL, MIKE HOUSELOG, DENNIS JOHNSON, GREG JURY, MARCO LENIS, DAN LOESCHER, FRAN MORRISSEY, BILL ROOP, DANIEL ROSS, DAVE RYDELL, JOHN SCHEUB MD, STEVEN SJOGREN, JAMES WADDELL, THOMAS WALSH, FRANK WALTER, AMY WILCOX, SARA FLEMING MD, FRANK BONELLI MD, WILLIAM GORSKI, MD, DANNY COPELAND, MD, JOHN MYERS, MD, ALLEN WILLIAMS, MD, RICHARD WALSH, WILLIAM SCHULTZ AND DONALD HARING. DURING THE TAX YEAR 2011 THE FOLLOWING TRUSTEES AND OFFICERS HAVE DEVOTED AN AVERAGE OF 2 HOURS PER WEEK TO SWEDISH AMERICAN HEALTH SYSTEM: PETER CHRISTMAN, MICHAEL DALLMAN, PATRICK DERRY, JAMES GINGRICH, ROBERT HEAD, HELEN CHUNG HILL, MIKE HOUSELOG, DENNIS JOHNSON, GREG JURY, MARCO LENIS, DAN LOESCHER, FRAN MORRISSEY, BILL ROOP, DANIEL ROSS, DAVE RYDELL, JOHN SCHEUB MD, STEVEN SJOGREN, JAMES WADDELL, THOMAS WALSH, FRANK WALTER, AMY WILCOX, WILLIAM GORSKI, MD, RICHARD WALSH, DONALD HARING, DANNY COPELAND, MD, JOHN MYERS, MD, ALLEN WILLIAMS, MD. DURING THE TAX YEAR 2011 THE FOLLOWING TRUSTEES AND OFFICERS HAVE DEVOTED AN AVERAGE OF 2 HOURS PER WEEK TO SWEDISH AMERICAN FOUNDATION: MARCO LENIS, DAVE RYDELL, STEVEN SJOGREN, JAMES WADDELL, WILLIAM GORSKI, MD, DONALD HARING AND JOHN MYERS, MD. DURING THE TAX YEAR 2011 THE FOLLOWING TRUSTEES AND OFFICERS HAVE DEVOTED AN AVERAGE OF 2 HOURS PER WEEK TO SWEDISH AMERICAN REALTY CORPORATION: GREG JURY, STEVEN SJOGREN, FRANK WALTER, AND RICHARD WALSH AND DONALD HARING. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -3,194,737. INTEREST IN RECIPIENT ORGANIZATION -1,559,552. SURGI CENTER BOOK/TAX DIFFERENCE 176,863. OTHER 75,405. SWEDISHAMERICAN FOUNDATION -9,230. TOTAL TO FORM 990, PART XI, LINE 5: -4,511,251. SWEDISHAMERICAN HEALTH SYSTEM CORPORATION 1401 E STATE STREET ROCKFORD IL 61104 363241458 PARENT CORP. TO MANAGE & DIRECT ACTIVITIES OF ENTITITES IL 501(C)(3) LINE 3 N/A 0 SWEDISHAMERICAN FOUNDATION 1415 E STATE STREET ROCKFORD IL 61104 363097493 SUPPORTING ORG. FOR SWEDISHAMERICAN HOSPITAL FUND RAISING IL 501(C)(3) LINE 7 SWEDISHAMERICAN HOSPITAL 1 SWEDISHAMERICAN REALTY CORPORATION 1313 E STATE STREET ROCKFORD IL 611042298 363248013 TITLE HOLDING COMPANY IL 501(C)(2) SWEDISHAMERICAN HEALTH SYSTEM CORPORATION 1 SWEDISHAMERICAN HOSPITAL SELF INSURANCE TRUST 1401 E STATE STREET ROCKFORD IL 611042333 366652702 HOSPITAL MALPRACTICE TRUST IL 501(C)(3) LINE 11A SWEDISHAMERICAN HOSPITAL 1 THREE RIVERS PARTNES LLC 1313 E STATE ST ROCKFORD IL 61104 262231757 INFORMATION TECHNOLOGY SERVICES IL N/A N/A 0 0 NORTHERN ILLINOIS VEIN CLINIC 2550 CHARLES ST ROCKFORD IL 61108 201642329 OUTPATIENT HEALTH SERVICES IL N/A RELATED 266866 159695 0 1 SARI INSURANCE COMPANY 76 ST PAUL ST SUITE 500 BURLINGTON VT 05401 030308753 CAPTIVE INSURANCE COMPANY VT N/A C LSG BUILDING CORPORATION 1313 EAST STATE ST ROCKFORD IL 61104 363033985 REAL ESTATE IL N/A S STATE & CHARLES INC 1313 EAST STATE ST ROCKFORD IL 61104 363321193 HOLDING COMPANY IL N/A C SWEDISHAERICAN HEALTH MANAGEMENT CORP 1401 EAST STATE ST ROCKFORD IL 61104 363246511 SERVICE IL N/A C 0 0 0 1 0 0 0 0 0 1 0 0 0 1 0 1 1 1 SWEDISHAMERICAN REALTY CORPORATION J 7016091 COST SWEDISHAMERICAN HOSPITAL SELF INSURANCE TRUST Q 4199481 COST SWEDISHAMERICAN HOSPITAL SELF INSURANCE TRUST P 1679903 COST