2013-11-15T12:46:06-06:00 2012-12-31 CROWE HORWATH LLP 70 West Madison Street Suite 700 Chicago IL 606024903 990 2012-01-01 361799520 SOUTH SHORE HOSPITAL CORPORATION SOUT 7733565312 8012 South Crandon Avenue Chicago IL 60617 SCOTT J SPENCER 2013-11-15 true NICOLE BENCIK P00756195 3128997000 2012 2016-03-07 17:11:31Z SCOTT J SPENCER CFO 8012 South Crandon Avenue Chicago IL 60617 38140851 false X WWW.SOUTHSHOREHOSPITAL.COM X 1976 IL 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. 10 6 650 20 0 0 496578 1488771 41402707 35867333 448074 404771 886421 379976 43233780 38140851 0 0 0 0 23500755 23511666 0 0 0 19954843 18340494 43455598 41852160 -221818 -3711309 36346624 32927140 12717699 12839787 23628925 20087353 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. false false 35217441 0 36052576 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. 35217441 true true false false false false false false false true false false false true true true false false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 128 0 true 650 true false false false false false false false false false false X 10 6 true false false false false false false true true false false true true true true false true true true false IL X Scott J Spencer 7733565312 8012 SOUTH CRANDON AVENUE Chicago IL 60617 ARNOLD STEWART 10.00 X X 0 0 3041 DONALD MOLL 10.00 X X 36000 0 1150 JESSE ONG 40.00 X X 244530 0 25001 LUPE VALADEZ 10.00 X X 0 0 3043 NICK VALADEZ 10.00 X X 0 0 0 DOMINADOR DAYON 10.00 X 0 0 0 JIA HWANG 10.00 X 0 0 5015 SATYA AHUJA MD 10.00 X 26667 0 0 SUNDER VINDOKUMAR 40.00 X 191038 0 21691 THOMAS CAREY 10.00 X 0 0 0 TODD STROGER 10.00 X 0 0 0 HELEN WIERSMA 40.00 X 103614 0 11718 TIMOTHY CAVENEY 40.00 X 135790 0 25461 AYOKUNNE OLUSEUN 62.00 X 155192 0 0 JACQUELINE LEVANDOSKI 57.00 X 150910 0 13303 MARINA RESOL 58.00 X 136063 0 25674 MILICA LUKAC 70.00 X 199631 0 7121 RODOLFO RUBIO 74.00 X 301879 0 25285 1681314 0 167503 30 false true false 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 18 5000 1483771 1488771 MEDICARE/MEDICAID PAYMENTS 900099 21101254 21101254 PATIENT SERVICE REVENUE 900099 14663584 14663584 RENTAL INCOME 900099 102495 102495 0 0 0 0 0 0 35867333 404771 404771 0 0 0 0 0 0 0 0 0 0 3500 3500 3500 CAFETERIA REVENUE 900099 194733 194733 PHYSICIAN BILLING 900099 50484 50484 MEDICAL RECORDS REV 900099 35277 35277 95982 95982 0 0 376476 38140851 36052576 0 599504 0 0 0 0 833757 692018 141739 0 0 19388761 16092672 3296089 310632 257825 52807 1533345 1272676 260669 1445171 1199492 245679 0 10462 0 10462 35339 35339 0 0 13707 13707 7924558 6577383 1347175 0 20727 20727 3015997 2503278 512719 0 0 696630 578203 118427 6447 6447 0 0 0 0 1495522 1241283 254239 445841 370048 75793 MEDICAID PROVIDER TAX 2591297 2591297 DRUGS 496466 496466 FOOD 493888 409927 83961 EQUIPMENT RENTAL 176984 146897 30087 916629 760802 155827 0 41852160 35217441 6634719 0 0 226000 306780 6244480 1336134 4943411 4205702 0 0 308048 314452 159291 155211 49791771 35102972 7862565 14688799 15307178 11920062 0 0 0 0 1295651 0 36346624 32927140 3604253 3762683 3380148 563358 0 5733298 8513746 12717699 12839787 X 23628925 20087353 23628925 20087353 36346624 32927140 -3711309 169737 0 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1474845 1474845 17365161 7943927 9421234 0 29851491 26166660 3684831 1100274 992385 107889 14688799 0 ESTIMATED LIABILITY FOR PROF SERVICES 5145224 ESTIMATED THIRD-PARTY PAYER SETTLEMENTS 3368522 8513746 X FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 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. true true X true X true X true true true false false 2725499 2725499 0.06510 11591945 9731709 1860236 0.04440 0 0.00000 0 0 14317444 9731709 4585735 0.10950 105191 105191 0.00250 0 0.00000 4889993 1275208 3614785 0.08640 0 0.00000 0 0.00000 0 0 4995184 1275208 3719976 0.08890 0 0 19312628 11006917 8305711 0.19840 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0 0 0 0 0.00000 true 2014932 777820 17722992 19932177 -2209185 X true true 1 1 SOUTH SHORE HOSPITAL CORPORATION

8012 SOUTH CRANDON AVENUE CHICAGO IL 60617

X X X SOUTH SHORE HOSPITAL CORPORATION 1 true true 200 true 200 true X X X X X X true true X X X true false X X X X true X false false 7 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 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 X X false false false false false false false true false SUNDER VINDOKUMAR 191038 0 0 0 0 0 0 0 21691 0 212729 0 0 0 RODOLFO RUBIO 301879 0 0 0 0 0 4995 0 20290 0 327164 0 0 0 TIMOTHY CAVENEY 128808 0 5557 0 1425 0 4001 0 21460 0 161251 0 0 0 JESSE ONG 229261 0 10000 0 5269 0 6920 0 18081 0 269531 0 0 0 AYOKUNNE OLUSEUN 155192 0 0 0 0 0 0 0 0 0 155192 0 0 0 MILICA LUKAC 199631 0 0 0 0 0 5985 0 1136 0 206752 0 0 0 JACQUELINE LEVANDOSKI 150910 0 0 0 0 0 4571 0 8732 0 164213 0 0 0 MARINA RESOL 136063 0 0 0 0 0 4264 0 21410 0 161737 0 0 0 Non-fixed payments Schedule J, Part I, Line 7 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). 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: ; SOUTH SHORE HOSPITAL AUXILIARY 8012 S CRANDON AVE CHICAGO IL 606171199 FUNDRAISING IL 501(C)(3) 3 SSHC true false false true false false false false false false false false false false false false false false false false