SOUTH SHORE HOSPITAL CORPORATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- SOUTH SHORE HOSPITAL CORPORATION (EIN 36-1799520)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-15
- IRS object ID
- 201333199349306068
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-15T12:46:06-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE HORWATH LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 70 West Madison Street | AddressLine1 |
| Address Line2 | Suite 700 | AddressLine2 |
| City | Chicago | City |
| State | IL | State |
| ZIP Code | 606024903 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 361799520 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTH SHORE HOSPITAL CORPORATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SOUT | NameControl |
| Phone | 7733565312 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8012 South Crandon Avenue | AddressLine1 |
| City | Chicago | City |
| State | IL | State |
| ZIP Code | 60617 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SCOTT J SPENCER | Name |
| Title | CFO | Title |
| Date Signed | 2013-11-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | NICOLE BENCIK | Name |
| PTIN | P00756195 | PTIN |
| Phone | 3128997000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
Name Of Principal Officer Business NameOfPrincipalOfficerBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SCOTT J SPENCER CFO | BusinessNameLine1 |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8012 South Crandon Avenue | AddressLine1 |
| City | Chicago | City |
| State | IL | State |
| ZIP Code | 60617 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 38140851 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SOUTHSHOREHOSPITAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1976 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | SOUTH SHORE HOSPITAL CORPORATION IS A NOT-FOR-PROFIT HOSPITAL DEDICATED TO PROVIDING THE HIGHEST QUALITY OF HEALTHCARE POSSIBLE TO THE SOUTH SHORE COMMUNITY. THE CHARGES FORGONE FOR SERVICES FURNISHED UNDER ITS CHARITY CARE POLICY DURING THE YEAR ENDED DECEMBER 31, 2012 APPROXIMATED $8,299,328. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 650 | TotalNbrEmployees |
| Total Nbr Volunteers | 20 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 496578 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1488771 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 41402707 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 35867333 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 448074 | InvestmentIncomePriorYear |
| Investment Income Current Year | 404771 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 886421 | OtherRevenuePriorYear |
| Other Revenue Current Year | 379976 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 43233780 | TotalRevenuePriorYear |
| Total Revenue Current Year | 38140851 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 23500755 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 23511666 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 19954843 | OtherExpensePriorYear |
| Other Expenses Current Year | 18340494 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 43455598 | TotalExpensesPriorYear |
| Total Expenses Current Year | 41852160 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -221818 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -3711309 | RevenuesLessExpensesCY |
| Total Assets BOY | 36346624 | TotalAssetsBOY |
| Total Assets EOY | 32927140 | TotalAssetsEOY |
| Total Liabilities BOY | 12717699 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 12839787 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 23628925 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 20087353 | NetAssetsOrFundBalancesEOY |
| Mission Description | SOUTH SHORE HOSPITAL CORPORATION IS A NOT-FOR-PROFIT HOSPITAL DEDICATED TO PROVIDING THE HIGHEST QUALITY OF HEALTHCARE POSSIBLE TO THE SOUTH SHORE COMMUNITY. THE COSTS FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY DURING THE YEAR ENDED DECEMBER 31,2012 APPROXIMATED $3,047,396. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 35217441 | Expense |
| Grants | 0 | Grants |
| Revenue | 36052576 | Revenue |
| Description | THE HOSPITAL IS AN ACUTE CARE FACILITY PROVIDING SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY AT NO CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY DURING THE YEAR ENDED DECEMBER 31, 2012 APPROXIMATED $8,299,328. IN ADDITION TO CHARITY CARE, THE HOSPITAL ALSO PROVIDES OTHER COMMUNITY BENEFITS SUCH AS PROVIDING MENTORS AND VOLUNTEERS, AND IT ALSO SPONSORS HEALTH FAIRS THROUGHOUT THE COMMUNITY. EMPLOYEES OF THE HOSPITAL PARTICIPATE IN A MENTORING PROGRAM FOR CHILDREN WITHIN THE COMMUNITY. THE PROGRAM'S GOAL IS TO MOTIVATE STUDENTS TO COMPLETE THEIR HIGH SCHOOL EDUCATION WITH AN EMPHASIS ON THE OVERALL IMPORTANCE OF EDUCATION AND PRE-EMPLOYMENT PREPARATION. | Description |
| Total Program Service Expense | 35217441 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 128 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 650 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | false | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Scott J Spencer | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7733565312 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8012 SOUTH CRANDON AVENUE | AddressLine1 |
| City | Chicago | City |
| State | IL | State |
| ZIP Code | 60617 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| ARNOLD STEWART | |||||||
| VICE CHAIRMAN | 10.00 | X | X | 0 | 0 | 3041 | |
| DONALD MOLL | |||||||
| TREASURER | 10.00 | X | X | 36000 | 0 | 1150 | |
| JESSE ONG | |||||||
| PRESIDENT AND CEO | 40.00 | X | X | 244530 | 0 | 25001 | |
| LUPE VALADEZ | |||||||
| VICE-PRESIDENT/SECRETARY | 10.00 | X | X | 0 | 0 | 3043 | |
| NICK VALADEZ | |||||||
| CHAIRMAN OF THE BOARD | 10.00 | X | X | 0 | 0 | 0 | |
| DOMINADOR DAYON | |||||||
| DIRECTOR | 10.00 | X | 0 | 0 | 0 | ||
| JIA HWANG | |||||||
| DIRECTOR | 10.00 | X | 0 | 0 | 5015 | ||
| SATYA AHUJA MD | |||||||
| DIRECTOR | 10.00 | X | 26667 | 0 | 0 | ||
| SUNDER VINDOKUMAR | |||||||
| DIRECTOR | 40.00 | X | 191038 | 0 | 21691 | ||
| THOMAS CAREY | |||||||
| DIRECTOR | 10.00 | X | 0 | 0 | 0 | ||
| TODD STROGER | |||||||
| DIRECTOR | 10.00 | X | 0 | 0 | 0 | ||
| HELEN WIERSMA | |||||||
| ASST SECRETARY | 40.00 | X | 103614 | 0 | 11718 | ||
| TIMOTHY CAVENEY | |||||||
| ASST TREASURER AND CFO | 40.00 | X | 135790 | 0 | 25461 | ||
| AYOKUNNE OLUSEUN | |||||||
| REGISTERED NURSE | 62.00 | 155192 | 0 | 0 | X | ||
| JACQUELINE LEVANDOSKI | |||||||
| REGISTERED NURSE | 57.00 | 150910 | 0 | 13303 | X | ||
| MARINA RESOL | |||||||
| REGISTERED NURSE | 58.00 | 136063 | 0 | 25674 | X | ||
| MILICA LUKAC | |||||||
| REGISTERED NURSE | 70.00 | 199631 | 0 | 7121 | X | ||
| RODOLFO RUBIO | |||||||
| PHYSICIAN | 74.00 | 301879 | 0 | 25285 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1681314 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 167503 | TotalOtherCompensation |
| Number Individuals GT100 K | 30 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| BERGLUND CONSTRUCTION | |||||
| 8410 SOUTH CHICAGO AVENUE | CHICAGO | IL | 60617 | CONTRACT SERVICES | 6555758 |
| COMPLETE RX | |||||
| 3100 S GESSNER SUITE 640 | HOUSTON | TX | 77063 | CONTRACT SERVICES | 2694027 |
| IL IND EMI | |||||
| 7032 COLLECTION CT DR | CHICAGO | IL | 60693 | EMERG RM PHY | 558342 |
| CARDINAL HEALTH MEDICAL PRODUCTS & SERVICES | |||||
| P O BOX 70539 | CHICAGO | IL | 606730539 | CONTRACT SERVICES | 535074 |
| ELMURST REFERENCE LABORATORY | |||||
| PO BOX 4060 | CAROL STREAM | IL | 601974060 | CONTRACT SERVICES | 487674 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 18 | NumberOfContractorsGT100K |
| Related Organizations | 5000 | RelatedOrganizations |
| Government Grants | 1483771 | GovernmentGrants |
| Total Contributions | 1488771 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MEDICARE/MEDICAID PAYMENTS | 900099 | 21101254 | 21101254 |
| PATIENT SERVICE REVENUE | 900099 | 14663584 | 14663584 |
| RENTAL INCOME | 900099 | 102495 | 102495 |
| 0 | |||
| 0 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 35867333 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 404771 | TotalRevenueColumn |
| Exclusion | $404,771 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 0 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 3500 | GrossSalesOfInventory |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3500 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3500 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| CAFETERIA REVENUE | 900099 | 194733 | $194,733 | |
| PHYSICIAN BILLING | 900099 | 50484 | 50484 | |
| MEDICAL RECORDS REV | 900099 | 35277 | 35277 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 95982 | TotalRevenueColumn |
| Related Or Exempt Function Income | 95982 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 376476 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 38140851 | TotalRevenueColumn |
| Related Or Exempt Function Income | 36052576 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $599,504 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 833757 | Total |
| Program Services | 692018 | ProgramServices |
| Management And General | 141739 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19388761 | Total |
| Program Services | 16092672 | ProgramServices |
| Management And General | 3296089 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 310632 | Total |
| Program Services | 257825 | ProgramServices |
| Management And General | 52807 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1533345 | Total |
| Program Services | 1272676 | ProgramServices |
| Management And General | 260669 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1445171 | Total |
| Program Services | 1199492 | ProgramServices |
| Management And General | 245679 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10462 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 10462 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35339 | Total |
| Management And General | 35339 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13707 | Total |
| Management And General | 13707 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7924558 | Total |
| Program Services | 6577383 | ProgramServices |
| Management And General | 1347175 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20727 | Total |
| Program Services | 20727 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3015997 | Total |
| Program Services | 2503278 | ProgramServices |
| Management And General | 512719 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 696630 | Total |
| Program Services | 578203 | ProgramServices |
| Management And General | 118427 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6447 | Total |
| Program Services | 6447 | ProgramServices |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1495522 | Total |
| Program Services | 1241283 | ProgramServices |
| Management And General | 254239 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 445841 | Total |
| Program Services | 370048 | ProgramServices |
| Management And General | 75793 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAID PROVIDER TAX | 2591297 | 2591297 | |
| DRUGS | 496466 | 496466 | |
| FOOD | 493888 | 409927 | 83961 |
| EQUIPMENT RENTAL | 176984 | 146897 | 30087 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 916629 | Total |
| Program Services | 760802 | ProgramServices |
| Management And General | 155827 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41852160 | Total |
| Program Services | 35217441 | ProgramServices |
| Management And General | 6634719 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Total Joint Costs TotalJointCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 226000 | BOY |
| EOY | 306780 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6244480 | BOY |
| EOY | 1336134 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4943411 | BOY |
| EOY | 4205702 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 308048 | BOY |
| EOY | 314452 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 159291 | BOY |
| EOY | 155211 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 49791771 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 35102972 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7862565 | BOY |
| EOY | 14688799 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15307178 | BOY |
| EOY | 11920062 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1295651 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36346624 | BOY |
| EOY | 32927140 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3604253 | BOY |
| EOY | 3762683 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3380148 | BOY |
| EOY | 563358 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5733298 | BOY |
| EOY | 8513746 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12717699 | BOY |
| EOY | 12839787 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23628925 | BOY |
| EOY | 20087353 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23628925 | BOY |
| EOY | 20087353 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36346624 | BOY |
| EOY | 32927140 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -3711309 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 169737 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1474845 | OtherCostOrOtherBasis |
| Book Value | 1474845 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 17365161 | OtherCostOrOtherBasis |
| Depreciation | 7943927 | Depreciation |
| Book Value | 9421234 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 0 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 29851491 | OtherCostOrOtherBasis |
| Depreciation | 26166660 | Depreciation |
| Book Value | 3684831 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1100274 | OtherCostOrOtherBasis |
| Depreciation | 992385 | Depreciation |
| Book Value | 107889 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 14688799 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ESTIMATED LIABILITY FOR PROF SERVICES | $5,145,224 |
| ESTIMATED THIRD-PARTY PAYER SETTLEMENTS | $3,368,522 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 8513746 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | FIN 48 (ASC 740) footnote | Identifier |
| Return Reference | Schedule D, Part X, Line 2 | ReturnReference |
| Explanation | THE HOSPITAL HAS ESTABLISHED ITS STATUS AS AN ORGANIZATION EXEMPT FROM INCOME TAXES UNDER THE INTERNAL REVENUE CODE ('THE CODE') SECTION 501(C)3 AND THE LAWS OF THE STATE IN WHICH IT OPERATES. A TAX POSITION IS RECOGNIZED AS A BENEFIT ONLY IF IT IS "MORE LIKELY THAN NOT" THAT THE TAX POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. THE AMOUNT RECOGNIZED IS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED ON EXAMINATION. FOR TAX POSITIONS NOT MEETING THE "MORE LIKELY THAN NOT" TEST, NO TAX BENEFIT IS RECORDED. THE HOSPITAL RECOGNIZES INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST AND INCOME TAX EXPENSE, RESPECTIVELY. THE HOSPITAL HAS NO AMOUNTS ACCRUED FOR INTEREST OR PENALTIES AS OF DECEMBER 31, 2012 AND 2011, RESPECTIVELY. DUE TO ITS TAX-EXEMPT STATUS, THE HOSPITAL IS NOT SUBJECT TO U.S. FEDERAL INCOME TAX OR STATE INCOME TAX. THE HOSPITAL IS NO LONGER SUBJECT TO EXAMINATION BY U.S. FEDERAL TAXING AUTHORITIES FOR YEARS BEFORE 2009 AND FOR ALL STATE INCOME TAXES THROUGH 2009. THE HOSPITAL DOES NOT EXPECT THE TOTAL AMOUNT OF UNRECOGNIZED TAX BENEFITS TO SIGNIFICANTLY CHANGE IN THE NEXT 12 MONTHS. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2725499 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2725499 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06510 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11591945 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9731709 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1860236 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04440 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 14317444 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9731709 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4585735 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10950 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 105191 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 105191 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00250 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4889993 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1275208 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3614785 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08640 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 4995184 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1275208 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3719976 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08890 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 19312628 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11006917 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8305711 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.19840 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Building Expense | 0 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Building Expense | 0 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Building Expense | 0 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Environmental Improvements EnvironmentalImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Building Expense | 0 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Building Expense | 0 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Building Expense | 0 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Building Expense | 0 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Building Expense | 0 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Building Expense | 0 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 0 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $2,014,932 | BadDebtExpenseAmount |
| Amount Attributable To | 777820 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 17722992 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 19932177 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2209185 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTH SHORE HOSPITAL CORPORATION | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8012 SOUTH CRANDON AVENUE | AddressLine1 |
| City | CHICAGO | City |
| State | IL | State |
| ZIP Code | 60617 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTH SHORE HOSPITAL CORPORATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 200 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 7 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (7 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| SOUTH SIDE PROFESSIONAL BUILDING | ||||
| 7906 SOUTH CRANDON AVENUE | CHICAGO | IL | 60617 | PHYSICIAN OFFICE |
| HIGHLAND MEDICAL CENTER | ||||
| 8201 SOUTH ASHLAND | CHICAGO | IL | 60620 | PHYSICIAN OFFICE |
| SHARED PHYSICIAN OFFICE SPACE | ||||
| 8012 SOUTH CRANDON AVENUE | CHICAGO | IL | 60617 | PHYSICIAN OFFICE |
| FAMILY MEDICAL CENTER | ||||
| 1424 WEST 87TH STREET | CHICAGO | IL | 60620 | PHYSICIAN OFFICE |
| SENIORS & GENERAL WELLNESS CENTER | ||||
| 2525 EAST 83RD STREET | CHICAGO | IL | 60617 | PHYSICIAN OFFICE |
| WEST PULLMAN CENTER | ||||
| 12251 SOUTH HALSTED STREET | CHICAGO | IL | 60628 | PHYSICIAN OFFICE |
| EAST SIDE MEDICAL HEALTH CENTER | ||||
| 10551 SOUTH EWING AVENUE | CHICAGO | IL | 60617 | PHYSICIAN OFFICE |
Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Bad Debt Expense excluded from financial assistance calculation | Schedule H, Part I, Line 7, column(f) | 0 |
| SUBSIDIZED HEALTH SERVICES | SCHEDULE H, PART I, LINE 7G | N/A |
| Bad debt expense - methodology used to estimate amount | Schedule H, Part III, Line 2 | THE BAD DEBT RESERVE IS AN ESTIMATE OF THE ACCOUNT BALANCES THAT WE EXPECT TO NOT COLLECT DESPITE THE PATIENTS ABILITY TO PAY. THE ESTIMATE WHICH IS UPDATED MONTHLY IS BASED ON HISTORICAL WRITE OFF PERCENTAGES. THESE PERCENTAGES ARE ADJUSTED TO REFLECT ANY BAD DEBT RECOVERIES. |
| Bad debt expense - methodology used to estimate amount as community benefit | Schedule H, Part III, Line 3 | OCCASIONALLY PATIENT ACCOUNTS WILL BE WRITTEN OFF TO BAD DEBT BUT THEN ARE LATER DETERMINED TO BE UNCOLLECTIBLE DUE TO THE PATIENT BEING UNINSURED OR ELIGIBLE FOR PUBLIC AID. ONCE DETERMINED THAT THE PATIENT HAS NO ABILITY TO PAY, THE ACCOUNTS ARE WRITTEN OFF AS CHARITY WRITE-OFFS. |
| Bad debt expense - financial statement footnote | Schedule H, Part III, Line 4 | THE HOSPITAL'S BAD DEBT EXPENSE (AT COST) WAS CALCULATED BY APPLYING THE MEDICARE COST TO CHARGE RATIO FROM THE 2012 MEDICARE COST REPORT TO THE CHARGES WRITTEN OFF TO BAD DEBT. DISCOUNTS AND PAYMENTS ON PATIENT'S BAD DEBT ACCOUNTS ARE TREATED AS A REDUCTION IN BAD DEBT EXPENSE. MOST OF THE ACCOUNTS WRITTEN OFF TO BAD DEBT ARE FOR UNINSURED PATIENTS, OBTAINING TREATMENT IN THE EMERGENCY ROOM, FOR WHICH NO PAYMENT HAS BEEN RECEIVED. IF SUFFICIENT INFORMATION HAD BEEN AVAILABLE TO MAKE A DETERMINATION OF ELIGIBILITY FOR FINANCIAL ASSISTANCE, THESE ACCOUNTS WOULD MOST LIKELY HAVE BEEN WRITTEN OFF TO CHARITY CARE. THE HOSPITAL'S FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE EXPLAINING HOW THE HOSPITAL ACCOUNTS FOR BAD DEBT. THE HOSPITAL PROVIDES A RESERVE FOR BAD DEBT ACCOUNTS AND EVALUATES THE ADEQUACY OF THE RESERVE AS PART OF THE MONTHLY REPORTING OF FINANCIAL RESULTS. THE HOSPITAL ADVISES ALL UNINSURED PATIENTS OF OUR FINANCIAL ASSISTANCE POLICY AND PROVIDES ACCESS TO THE POLICY ON OUR WEB SITE. IN ADDITION, THE HOSPITAL WILL ASSIST PATIENTS IN OBTAINING HEALTH CARE INSURANCE WITHOUT COST TO THE PATIENT. THOSE PATIENTS THAT DO NOT APPLY FOR FINANCIAL ASSISTANCE AND WHO DO NOT PAY THEIR ACCOUNTS ARE WRITTEN OFF TO THE BAD DEBT RESERVE. |
| Community benefit & methodology for determining medicare costs | Schedule H, Part III, Line 8 | MEDICARE ALLOWABLE COSTS WERE DETERMINED BY APPLYING THE MEDICARE COST TO CHARGE RATIO FROM THE 2012 MEDICARE COST REPORT TO THE MEDICARE CHARGES. APPROXIMATELY 60% OF OUR PATIENTS ARE SENIORS WITH MEDICARE INSURANCE, BUT ARE UNABLE TO PAY THEIR COINSURANCE AND DEDUCTIBLE AMOUNTS. CONSISTENT WITH THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THESE ACCOUNTS ARE EITHER WRITTEN OFF TO CHARITY CARE OR BAD DEBT EXPENSE. MOST OF THE MEDICARE SHORTFALL IS THE RESULT OF THESE ACCOUNTS. HENCE, THE HOSPITAL IS SUBSIDIZING THE MEDICARE REIMBURSEMENT AS PART OF OUR COMMUNITY BENEFIT PROGRAM. |
| Collection practices for patients eligible for financial assistance | Schedule H, Part III, Line 9b | IN RECOGNIZING THE MEDICAL NEEDS OF THE INDIGENT, SOUTH SHORE HOSPITAL PROVIDES QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, COLOR, SEX, NATURAL ORIGIN, SEXUAL ORIENTATION, HANDICAP, AGE OR ABILITY TO PAY. OUR FINANCIAL ASSISTANCE POLICY IDENTIFIES CIRCUMSTANCES UNDER WHICH SOUTH SHORE HOSPITAL WILL EXTEND CARE FREE OF CHARGE OR AT A DISCOUNT, COMMENSURATE WITH THE ABILITY TO PAY, TO A PATIENT WHOSE FINANCIAL STATUS MAKES IT IMPRACTICAL OR IMPOSSIBLE TO PAY FOR NECESSARY MEDICAL EXPENSES. THE NECESSITY FOR MEDICAL TREATMENT OF ANY PATIENT IS BASED UPON CLINICAL JUDGEMENT WITHOUT REGARD TO THE FINANCIAL STATUS OF THE PATIENT. |
| POLICIES AND PROCEDURES | SCHEDULE H, PART V | SOUTH SHORE HOSPITAL CORPORATION IS CURRENTLY IN THE PROCESS OF REVISING THE POLICY FOR ITS HOSPITAL BASED ON THE GUIDANCE PROVIDED IN THE PROPOSED 501(R ) REGULATIONS ISSUED IN JUNE 2012. THE RESPONSES TO PART V REFLECT THE CURRENT POLICIES AND PROCEDURES IN PLACE AT THE HOSPITAL. |
| FAP ELIGIBLE COSTS | SCHEDULE H, PART V, SECTION B, LINE 19D | THE CURRENT FINANCIAL ASSISTANCE POLICY ENSURES THAN AN FAP ELIGIBLE PERSON WILL NOT PAY MORE THAN THOSE WITH COMMERCIAL INSURANCE. THE POLICY IS CURRENTLY IN THE PROCESS OF BEING REVISED BASED ON THE GUIDANCE IN THE PROPOSED 501(R) REGULATIONS ISSUED IN JUNE 2012. |
| Means used to determine amounts billed | Schedule H, Part V Section B, Line 20d | (1) SOUTH SHORE HOSPITAL CORPORATION - UNINSURED PATIENTS WITH HOUSEHOLD INCOME LEVELS GREATER THAN 200% ARE EVALUATED FOR A PAYMENT PLAN BASED ON A DISCOUNT DETERMINED BY THE PATIENTS OVERALL FINANCIAL STATUS AND ABILITY TO ASSUME A PAYMENT PLAN.; |
| Needs assessment. | Schedule H, Part VI, Line 2 | SOUTH SHORE HOSPITAL IS ORGANIZED EXCLUSIVELY TO PROVIDE THE HIGHEST QUALITY OF HEALTHCARE POSSIBLE TO EACH INDIVIDUAL PATIENT OF THE SOUTH SHORE COMMUNITY REGARDLESS OF RACE, COLOR, CREED, AND FINANCIAL STATUS. IN DOING SO, WE FOCUS ON PROVIDING A SAFE ENVIRONMENT FOR OUR PATIENTS AND STAFF WHILE ADDRESSING THE SPECIAL NEEDS OF THE COMMUNITY. SOUTH SHORE HOSPITAL DOES NOT SET ANY LIMITS ON THE AMOUNT OF FREE CARE TO THE INDIGENT. ANY PATIENT THAT COMES TO OUR FACILITY FOR TREATMENT IS TREATED REGARDLESS OF ABILITY TO PAY. IN PROVIDING SERVICES TO ADDRESS THESE NEEDS, THE HOSPITAL HAS HISTORICALLY OPERATED AT A LOSS, WHILE WORKING DILIGENTLY TO CONTROL OUR COSTS. |
| Patient education of eligibility for assistance. | Schedule H, Part VI, Line 3 | ALL UNINSURED PATIENTS ARE ADVISED OF OUR FINANCIAL ASSISTANCE POLICY AS PART OF THE ADMISSIONS PROCESS. IN ADDITION THE FINANCIAL ASSISTANCE POLICY AND PROCEDURE IS AVAILABLE THROUGH OUR WEB SITE. WHENEVER POSSIBLE, SOUTH SHORE HOSPITAL PROVIDES ASSISTANCE TO UNINSURED PATIENTS IN OBTAINING HEALTH CARE INSURANCE AT NO COST TO THE PATIENT. THIS ASSISTANCE INCLUDES VISITS WITH THE PATIENT WHILE IN THE HOSPITAL, AND FOLLOW-UP VISITS TO THEIR HOME TO ENSURE THAT INSURANCE APPLICATIONS ARE COMPLETED AND FILED IN A TIMELY MANNER. THEN APPROPRIATE FOLLOW UP IS DONE WITH MEDICAID AND OTHER INSURERS TO ENSURE THE APPLICATIONS ARE PROCESSED TIMELY. THOSE PATIENTS THAT DO NOT QUALIFY FOR MEDICAID ARE USUALLY WRITTEN OFF TO CHARITY. |
| Community information. | Schedule H, Part VI, Line 4 | THE SOUTH SHORE HOSPITAL SERVICE AREA CONSISTS OF TWELVE ZIP CODES IN THE SOUTHEAST SIDE OF THE CITY OF CHICAGO. SIX OF THE ZIP CODES COMPRISE ABOUT 80% OF OUR ADMISSIONS (ZIPS 60617, 60619, 60649, 60620, 60637, AND 60628). THESE ZIP CODE AREAS HAVE A COMBINED ESTIMATED POPULATION OF ABOUT 200,000. SOME OF THE KEY HEALTHCARE NEEDS OF THIS CORE ZIP CODE AREA ARE: -THERE IS A DISPROPORTIONATELY LARGE POPULATION OF UNINSURED PEOPLE IN THIS AREA. AS A RESULT, SOUTH SHORE HOSPITAL TREATS A LARGE PERCENTAGE OF OUR PATIENTS FREE OF CHARGE OR AT A DISCOUNT. -THERE IS A DISPROPORTIONATELY LARGE POPULATION OF INSURED PEOPLE IN THIS AREA THAT CANNOT AFFORD TO PAY THEIR COPAYS AND DEDUCTIBLES. AS A RESULT, THE ANNUAL HOSPITAL BAD DEBT EXPENSE IS VERY LARGE. -THERE IS ALSO A DISPROPORTIONATELY LARGE POPULATION OF INDIGENT PEOPLE INSURED WITH MEDICAID IN THIS AREA. ON AVERAGE, ABOUT 25% OF OUR INPATIENTS HAVE MEDICAID HEALTH COVERAGE. ABOUT 30% OF THE EMERGENCY ROOM OUTPATIENT VISITS ARE MEDICAID PATIENTS USING THE EMERGENCY ROOM AS A DOCTORS OFFICE. -DRUG ABUSE IS A SERIOUS PROBLEM IN OUR AREA, WITH THE NEED FOR DETOX AND REHAB SERVICES. -AN INCREASING NUMBER OF PEOPLE IN OUR CORE ZIP CODES ARE INFECTED WITH HIV. |
| Promotion of community health | Schedule H, Part VI, Line 5 | IN ADDITION TO THE SERVICES PREVIOUSLY NOTED IN THIS SCHEDULE, THE HOSPITAL ALSO PROVIDES FREE IMMUNIZATIONS, PATIENT EDUCATION ASSISTANCE, LANGUAGE ASSISTANCE, TRANSPORTATION SERVICES, AND SENIOR WELLNESS PROGRAMS, AT NO COST TO THE PATIENT. THE HOSPITAL ALSO PARTICIPATES WITH LOCAL, INDEPENDENT ORGANIZATIONS IN CONDUCTING ABOUT 50 HEALTH SCREENING EVENTS PER YEAR. IN ADDITION, THE HOSPITAL CONTRIBUTES FUNDS TO LOCAL, NON-PROFIT ORGANIZATIONS ACTIVELY ENGAGED IN MEETING THE SOCIAL, ECONOMIC, SPIRITUAL, MENTAL AND HEALTHCARE NEEDS OF OUR COMMUNITY. WHILE MOST OF OUR PATIENTS HAVE HEALTHCARE INSURANCE THROUGH MEDICARE OR MEDICAID, NEITHER OF THESE PROGRAMS COVER THE COST OF PROVIDING THE CARE. AS A RESULT, THE HOSPITAL USUALLY OPERATES AT A LOSS WHILE SUBSIDIZING THESE PROGRAMS. |
| State filing of community benefit report | Schedule H, Part VI, Line 7 | IL |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | true | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SUNDER VINDOKUMAR | ||||||||||||||
| DIRECTOR | 191038 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 21691 | 0 | 212729 | 0 | 0 | 0 |
| RODOLFO RUBIO | ||||||||||||||
| PHYSICIAN | 301879 | 0 | 0 | 0 | 0 | 0 | 4995 | 0 | 20290 | 0 | 327164 | 0 | 0 | 0 |
| TIMOTHY CAVENEY | ||||||||||||||
| ASST TREASURER AND CFO | 128808 | 0 | 5557 | 0 | 1425 | 0 | 4001 | 0 | 21460 | 0 | 161251 | 0 | 0 | 0 |
| JESSE ONG | ||||||||||||||
| PRESIDENT AND CEO | 229261 | 0 | 10000 | 0 | 5269 | 0 | 6920 | 0 | 18081 | 0 | 269531 | 0 | 0 | 0 |
| AYOKUNNE OLUSEUN | ||||||||||||||
| REGISTERED NURSE | 155192 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 155192 | 0 | 0 | 0 |
| MILICA LUKAC | ||||||||||||||
| REGISTERED NURSE | 199631 | 0 | 0 | 0 | 0 | 0 | 5985 | 0 | 1136 | 0 | 206752 | 0 | 0 | 0 |
| JACQUELINE LEVANDOSKI | ||||||||||||||
| REGISTERED NURSE | 150910 | 0 | 0 | 0 | 0 | 0 | 4571 | 0 | 8732 | 0 | 164213 | 0 | 0 | 0 |
| MARINA RESOL | ||||||||||||||
| REGISTERED NURSE | 136063 | 0 | 0 | 0 | 0 | 0 | 4264 | 0 | 21410 | 0 | 161737 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Non-fixed payments | Identifier |
| Return Reference | Schedule J, Part I, Line 7 | ReturnReference |
| Explanation | JESSE ONG RECEIVED A BONUS DUE TO EXCEPTIONAL PERFORMANCE DURING THE YEAR. THIS AMOUNT IS REPORTED IN SCHEDULE J, PART II, COLUMN (B)(II). TIM CAVENEY RECEIVED A BONUS DUE TO EXCEPTIONAL PERFORMANCE DURING THE YEAR. THIS AMOUNT IS REPORTED IN SCHEDULE J, PART II, COLUMN (B)(II). | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Family/business relationships amongst interested persons | Form 990, Part VI, Section A, Line 2 | LUPE VALADEZ - FAMILY RELATIONSHIP, NICK VALADEZ - FAMILY RELATIONSHIP |
| Review of form 990 by governing body | Form 990, Part VI, Section B, Line 11b | A FULL COPY OF THE FORM 990 WILL BE PROVIDED TO THE BOARD MEMBERS VIA EMAIL FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS.. |
| Conflict of interest policy | Form 990, Part VI, Section B, Line 12c | EACH OFFICER, DIRECTOR, TRUSTEE AND KEY EMPLOYEE IS SUBJECT TO THE CONFLICT OF INTEREST POLICY. THE BOARD'S CONFLICT OF INTEREST COMMITTEE REVIEWS EACH MEMBER'S CONFLICT OF INTEREST STATEMENT ON AN ANNUAL BASIS. THE BOARD COMPARES PRIOR AND CURRENT YEAR CONFLICT OF INTEREST STATEMENTS, AND REPORTS ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST TO THE ORGANIZATION'S HUMAN RESOURCES DEPARTMENT. ACTUAL CONFLICTS OF INTEREST ARE DOCUMENTED WITH THE ORGANIZATION'S HUMAN RESOURCES DEPARTMENT ANNUALLY. OFFICERS, DIRECTORS, TRUSTEES AND EMPLOYEES ARE ALL COVERED UNDER THE ORGANIZATIONS CONFLICT OF INTEREST POLICY. SHOULD THERE BECOME KNOWN, AT ANY TIME, A CONFLICT OF INTEREST BETWEEN ANY MEMBER STAFF, HOSPITAL PERSONNEL OR OTHER HEALTHCARE PROVIDERS AND THE HOSPITAL, AND THE HOSPITAL OR ANY OF ITS AGENTS, THE INDIVIDUAL (S) MAY EXCUSE HIMSELF/ HERSELF FROM DISCUSSIONS AND/ OR DETERMINATIONS WITH THE IDENTIFIED HEALTHCARE PROVIDER(S). |
| Process used to establish compensation of top management official | Form 990, Part VI, Section B, Line 15a | THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS THE CEO'S PERFORMANCE ON AN ANNUAL BASIS. IN SETTING THE COMPENSATION OF THE ORGANIZATION'S CEO, THE COMMITTEE COMPARES INDUSTRY COMPENSATION FIGURES TO THE CEO'S COMPENSATION PACKAGE. THE FINAL DETERMINATION AND DELIBERATIONS REGARDING THE CEO'S COMPENSATION PACKAGE ARE DOCUMENTED IN THE MINUTES OF THE BOARD OF DIRECTORS MEETING. THE PROCESS FOR DETERMINING COMPENSATION OF THE CEO WAS LAST UNDERTAKEN IN MARCH OF 2012. |
| Process used to establish compensation of other officers/key employees | Form 990, Part VI, Section B, Line 15b | THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS THE PERFORMANCE OF THE OFFICERS AND KEY EMPLOYEES ON AN ANNUAL BASIS IN SETTING THE COMPENSATION OF THESE INDIVIDUALS, THE COMMITTEE COMPARES INDUSTRY COMPENSATION FIGURES TO THEIR FINANCIAL PACKAGES. IF ANY INDIVIDUAL'S COMPENSATION IS DISCUSSED DURING THE MEETING, THAT INDIVIDUAL IS REQUIRED TO RECUSE THEMSELVES. THE PROCESS FOR DETERMINING COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES WAS LAST UNDERTAKEN IN MARCH OF 2012. |
| Governing documents, conflict of interest policy and financial statements available to the public | Form 990, Part VI, Section C, Line 19 | FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. |
| Other Expenses | Form 990, Part IX, Line 11g | PURCHASED SERVICES - TOTAL EXPENSE: 4488257, PROGRAM SERVICE EXPENSE: 3725253, MANAGEMENT AND GENERAL EXPENSES: 763004, FUNDRAISING EXPENSES: ; PHYSICIAN FEES - CONTRACT SERVICES - TOTAL EXPENSE: 2640563, PROGRAM SERVICE EXPENSE: 2191667, MANAGEMENT AND GENERAL EXPENSES: 448896, FUNDRAISING EXPENSES: ; REPAIR AND MAINTENANCE SERVICES - TOTAL EXPENSE: 795738, PROGRAM SERVICE EXPENSE: 660463, MANAGEMENT AND GENERAL EXPENSES: 135275, FUNDRAISING EXPENSES: ; |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTH SHORE HOSPITAL AUXILIARY | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8012 S CRANDON AVE | AddressLine1 |
| City | CHICAGO | City |
| State | IL | State |
| ZIP Code | 606171199 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | FUNDRAISING | PrimaryActivities |
| Legal Domicile State | IL | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 3 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SSHC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | true | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
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