2012-08-03T16:33:40-05:00 2011-09-30 ERNST & YOUNG US LLP 155 NORTH WACKER DRIVE CHICAGO IL 60606 990 2010-10-01 362340313 Northwest Community Hospital NORT 8476181000 800 WEST CENTRAL ROAD ARLINGTON HEIGHTS IL 60005 Stephen O Scogna 2012-08-03 3128792000 2010 2016-02-24 21:20:13Z Bruce K Crowther 800 W Central Road Arlington Heights IL 60005 848122804 false X www.nch.org X 1953 IL NCH operates an acute care hospital in Arlington Heights, IL. The hospital exists to provide quality compassionate healthcare services to the people of the Northwest suburban community of Chicago. 18 17 3860 850 0 0 58803610 1732845 429297770 464896764 3115869 1384958 6127030 6015024 497344279 474029591 438997 2958497 0 0 236671537 242624121 0 0 0 216879648 236398778 453990182 481981396 43354097 -7951805 610945530 591409283 440717241 440310263 170228289 151099020 X NORTHWEST COMMUNITY HOSPITAL EXISTS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE AND TO MEET INDIVIDUALS' HEALTHCARE NEEDS. false false 53227428 0 52896610 CARDIAC NORTHWEST COMMUNITY HOSPITAL'S (HOSPITAL) CARDIAC CARE PROGRAM PROVIDED QUALITY, PATIENT-CENTERED COMPASSIONATE CARE, REGARDLESS OF ABILITY TO PAY, TO APPROXIMATELY 32,000 INPATIENTS AND OUTPATIENTS DURING FY 2011. THE TREATMENT WAS PROVIDED IN HOSPITAL'S STATE-OF-THE-ART DIGITAL CARDIAC CATH LAB SUITES, INCLUSIVE OF ITS HIGH TECH OPERATING ROOMS AND PRIVATE FAMILY-CENTERED PATIENT CARE ROOMS. AN ON-CALL TEAM OF NURSES, RADIOLOGY TECHS, OR TECHS, CARDIOLOGISTS AND SURGEONS WERE READILY AVAILABLE 24 HOURS A DAY, 7 DAYS A WEEK, TO PROVIDE EMERGENT CARE TO THOSE WITH CARDIAC DISEASE. THE CARDIAC TEAM WORKS WITH THE EMERGENCY ROOM AND MULTIPLE NEIGHBORING COMMUNITY PARAMEDICS AND EMERGENCY PERSONNEL TO EXCEED THE NATIONAL BENCHMARK OF DOOR TO BALLOON TIME (OR OPEN ARTERY) IN LESS THAN 90 MINUTES FOR PATIENTS PRESENTING IN HOSPITAL'S EMERGENCY ROOM HAVING AN ACUTE MI. HOSPITAL HAS BEEN REPEATEDLY RECOGNIZED FOR ITS COMMITMENT TO QUALITY OUTCOMES AND IS CURRENTLY RECOGNIZED AS AN ACCREDITED CHEST PAIN CENTER BY THE SOCIETY FOR CHEST PAIN CENTERS AND AN ACCREDITED ECHO LAB BY THE INTERSOCIETAL COMMISSION FOR THE ACCREDITATION OF ECHOCARDIOGRAPHY LABORATORIES (ICAEL). IN ADDITION, HOSPITAL HAS ALSO BEEN RECOGNIZED FIVE TIMES BETWEEN 2000 AND 2010 AS A THOMSON REUTERS TOP 100 HEART HOSPITAL FOR PROVIDING EXCELLENCE IN A COST EFFECTIVE MANNER TO MULTIPLE CARDIAC PATIENT POPULATIONS. HOSPITAL HAS ALSO BEEN THE RECIPIENT OF MULTIPLE HEALTHGRADES AWARDS FOR EXCELLENCE IN CARDIAC SERVICES, MOST RECENTLY IN 2010. THE CARDIAC DEPARTMENT ALSO PROVIDES MULTIPLE SCREENING AND EDUCATION PROGRAMS, INCLUDING FREE INDIVIDUAL CONSULTATIONS WITH CARDIAC REHAB PERSONNEL FOR COMMUNITY MEMBERS CONSIDERED TO BE AT RISK FOR DEVELOPING HEART DISEASE BASED ON THEIR COMPLETION OF HOSPITAL'S ON LINE SCREENING TOOL. IN FEBRUARY 2011, HOSPITAL HOSTED A COMMUNITY EVENT WHICH PROVIDED FREE BLOOD PRESSURE, CHOLESTEROL AND BMI SCREENINGS WHICH WERE USED TO CALCULATE AN INDIVIDUAL'S RISKS OF DEVELOPING HEART DISEASE. IN ADDITION, PHYSICIANS PROVIDED EDUCATION ON HEART HEALTH AND WELLNESS. OVER 300 PEOPLE PARTICIPATED IN THE EVENT. 41491548 0 33649484 GENERAL SURGERY HOSPITAL'S GENERAL SURGERY PROGRAM PROVIDED QUALITY, PATIENT-CENTERED, COMPASSIONATE CARE, REGARDLESS OF ABILITY TO PAY, TO 3,180 GENERAL SURGICAL PATIENTS (INPATIENT AND OUTPATIENT) DURING FY 2011. PROCEDURES WERE PERFORMED IN STATE-OF-THE-ART OPERATING ROOMS WHICH INCLUDED THREE DEDICATED MINIMALLY INVASIVE SURGERY SUITES. THE GENERAL SURGERY PROGRAM PROVIDED CARE FOR BOTH PEDIATRIC AND ADULT POPULATIONS. IN FY 2011, HOSPITAL PARTNERED WITH CHILDREN'S MEMORIAL HOSPITAL IN CHICAGO TO PLAN FOR A NEONATAL SURGERY PROGRAM TO SUPPORT ITS NEW LEVEL 3 NICU. THE GENERAL SURGERY PROGRAM ALSO INCLUDED DAVINCI ROBOTIC CAPABILITIES AND A DEDICATED PANCREATIC SURGERY PROGRAM. GENERAL SURGERY SERVICES WERE PROVIDED 24 HOURS A DAY, 7 DAYS A WEEK, AND THE PROGRAM WAS DESIGNATED A LEVEL 2 TRAUMA CENTER. HOSPITAL RECEIVED MULTIPLE HEALTHGRADES AWARDS WHICH INCLUDE GI SERVICES. GENERAL SURGERY MORTALITY AND SURGICAL SITE INFECTIONS OBSERVED TO EXPECTED RATIOS WERE IN THE "LOW" RANGE BASED ON HOSPITAL'S CASE MIX INDEX. A MULTIDISCIPLINARY TEAM WORKED TO IMPROVE RESULTS IN THE SURGICAL CARE IMPROVEMENT PROJECT'S CORE MEASURES. AN ADVANCED PRACTICE NURSE WAS HIRED TO OVERSEE SURGICAL OUTCOMES AND IMPROVE PERFORMANCE IN ALL SURGICAL SPECIALTIES. AREAS OF CONCENTRATION INCLUDED: ANTIBIOTICS ADMINISTERED WITHIN 60 MINUTES OF INCISION, APPROPRIATE ANTIBIOTICS ADMINISTERED, ANTIBIOTICS DISCONTINUED WITHIN 24 HOURS, APPROPRIATE HAIR REMOVAL, URINARY CATHETER REMOVED POST-OP DAY 1 OR 2, SURGERY TEMPERATURE MANAGEMENT, BETA BLOCKER PRIOR TO SURGERY AND VTE PROPHYLAXIS. THE MAJORITY OF HOSPITAL'S OUTCOME MEASURES WERE AT OR ABOVE BENCHMARK LEVELS. 34301326 0 27461105 ORTHOPEDICS HOSPITAL'S ORTHOPEDIC PROGRAM PROVIDES QUALITY, PATIENT CENTERED COMPASSIONATE CARE, REGARDLESS OF ABILITY TO PAY, 24 HOURS A DAY, 7 DAYS A WEEK TO ADULT AND GERIATRIC PATIENTS REQUIRING ORTHOPEDIC INTERVENTION WITH CASE MANAGEMENT INTEGRATED INTO THE DELIVERY OF CARE. THE UNIT TEAM, PRIMARILY COMPOSED OF REGISTERED NURSES, ASSISTED BY PATIENT CARE TECHNICIANS; PHYSICAL, RESPIRATORY, OCCUPATIONAL AND SPEECH THERAPISTS; DIETITIANS; CHAPLAINS AND PHARMACISTS, PROVIDES EVALUATION AND TREATMENT OF ILLNESS IN THE ACUTE PHASE AND ADVANCED CLINICAL MANAGEMENT OF THE ORTHOPEDIC PATIENT. PATIENT-FOCUSED CARE AND EDUCATION ARE PROVIDED IN RESPONSE TO A NUMBER OF DIAGNOSES, INCLUDING: TOTAL JOINT REPLACEMENT, FRACTURES, NON-HEAD INJURIES, BACK PAIN, AND EPIDURAL INTERVENTION. FORM 990, PART III - OTHER PROGRAM SERVICES, LINE 4D GASTROENTEROLOGY HOSPITAL'S GASTROENTEROLOGY (GI) CENTER PROVIDES QUALITY, PATIENT-CENTERED COMPASSIONATE CARE TO PATIENTS, IN NEED OF DIAGNOSTIC AND THERAPEUTIC ENDOSCOPIC PROCEDURES REGARDLESS OF ABILITY TO PAY, 24 HOURS A DAY, 7 DAYS A WEEK. THE GI CENTER HAS BECOME A REGIONAL REFERRAL CENTER FOR PATIENTS IN NEED OF INTERVENTIONAL PROCEDURES INCLUDING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AND ENDOSCOPIC ULTRASOUND. A STATE-OF-THE-ART INTERVENTIONAL SUITE OFFERS PATIENTS ACCESS TO SUPERIOR QUALITY CARE BY PROVIDING DIGITAL IMAGING. HOSPITAL'S INTERVENTIONAL TEAM IS LED BY AN EXPERT INTERVENTIONAL PHYSICIAN AND AN INTERVENTIONAL PROCEDURE CONSULTANT. THIS TEAM PROVIDES SAME-DAY CARE FOR PATIENTS IN AND BEYOND HOSPITAL'S SERVICE AREA WHO ARE IN NEED OF INTERVENTIONAL PROCEDURES. IN FY 2011 THE GI CENTER PROVIDED SERVICE FOR 12,951 PATIENTS. IN ADDITION TO THE PROGRAM SERVICES LISTED ABOVE, HOSPITAL PROVIDES MANY OTHER HEALTHCARE SERVICES ON A DAILY BASIS. THESE ADDITIONAL PROGRAMS INCLUDE CLINICAL EDUCATION AND RESEARCH, NEONATAL CARE, AND EMERGENCY CARE. HOSPITAL IS A SUBSIDIARY ENTITY OF NORTHWEST COMMUNITY HEALTHCARE (NCH). NCH WAS ESTABLISHED TO OWN, OPERATE, CONTROL, AND OTHERWISE COORDINATE THE DELIVERY OF HEALTHCARE WITHIN THE SERVICE AREA OF HOSPITAL AND COORDINATE THE ACTIVITIES OF THE VARIOUS CORPORATIONS AFFILIATED WITH NCH. SUBSIDIARIES OF NCH INCLUDE HOSPITAL, NORTHWEST COMMUNITY HOSPITAL FOUNDATION (FOUNDATION) AND NORTHWEST COMMUNITY DAY SURGERY CENTER, INC., (DAY SURGERY CENTER) WHICH ARE NOT-FOR-PROFIT ENTITIES; NORTHWEST COMMUNITY HEALTH SERVICES, INC., WHICH OWNS AND OPERATES THE NCH MEDICAL GROUP, A MULTI-SPECIALTY PHYSICIAN PRACTICE THAT WAS ESTABLISHED IN 2010 AND NPC-CYBERKNIFE, LLC, WHICH ARE TAXABLE ENTITIES; AND NCH CASUALTY INSURANCE SPC LIMITED (NCHCI), A CAYMAN ISLANDS CORPORATION. 266880243 2958497 350889565 395900545 true true false true false false false false true true false false false true false false true false false false false false false false false true true true false true true false false false false false true false false true false false false false false true true true true false false true 444 0 true 3860 true false false false false false false false false false false X 18 17 true false false false true true true true true false true true true true true true true true true true false IL X SANDY SORIA 8476184636 3060 SALT CREEK LANE ARLINGTON HEIGHTS IL 60005 X M Shan Atkins 1.0 X 0 0 0 James H Bishop 1.0 X 350 0 0 Beth A Brooks 1.0 X 0 0 0 Craig E Christell 1.0 X 550 0 0 Dale J Garber 1.0 X 0 0 0 Louis A Gatta 1.0 X 550 0 0 Charles A Hempfling 1.0 X 750 0 0 Diane G Hill 1.0 X 550 401 0 Francis J Lamberta MD 1.0 X 350 0 0 Robert J Longo MD 1.0 X 350 0 0 Allen S Malmed MD 10.0 X 48550 0 0 Louis J Marsico 1.0 X 550 0 0 Ali N Shariatzadeh MD 10.0 X 350 0 0 Donald D Torisky 1.0 X 750 0 0 Marla E Glabe 1.0 X 0 0 0 Mary R Sheahen 1.0 X 350 0 0 William D Soper MD 1.0 X 0 0 0 Daniel P DiCaro 1.0 X X 550 0 0 Max Brittain Jr 10.0 X X 550 0 0 Thomas P MacCarthy 10.0 X X 350 0 0 Bruce K Crowther 26.0 X X 573021 0 218463 Michael B Zenn 31.0 X 639498 163 81911 Stephen O Scogna 31.0 X 0 0 0 Mark Lusson 40.0 X 291773 0 63908 Mary Stack 40.0 X 169224 0 42722 Robert Klasek 40.0 X 150676 0 37841 Gary Skiba 40.0 X 168119 0 36390 Dale Beatty 38.0 X 272752 0 37913 Leighton Smith MD 40.0 X 483902 0 78607 GEORGE MORRIS 40.0 X 212991 0 44240 LAURA POLLACK 40.0 X 142665 0 38451 Ann Sayvetz 40.0 X 250702 0 28330 Michael C Hartke 40.0 X 355659 38562 30119 Willis G Parsons MD 40.0 X 1735307 0 16642 Malcolm Bilimoria MD 40.0 X 1439819 0 37765 Rameez Alasadi MD 40.0 X 733332 0 26520 Tahseen Mohammed MD 40.0 X 294293 0 27868 Sonia Mehta MD 40.0 X 312872 0 36865 Gail A Finn 0.0 X 256289 0 14404 Dawn Walden 40.0 X 135715 0 32432 Angela Stefaniu 40.0 X 226434 0 44484 8900493 39126 975875 191 true true false Deloitte Consulting LLP 111 South Wacker Dr CHICAGO IL 60606 CONSULTING SERVICES 2941870 Siemens Medical Solutions USA Inc Dept CH 14195 PALATINE IL 60055 IT SUPPORT 2178414 Finelight Inc 1801 South Liberty Drive Suite 300 BLOOMINGTON IN 47403 MARKETING 1869827 HLS-Wheeling LLC 13028 Collection Center Dr CHICAGO IL 60693 LAUNDRY SERVICES 1794848 Transcend Services Inc Dept 40089 PO Box 740209 ATLANTA GA 30374 MED. TRANSCRIPTION 1581436 88 1618852 113993 1732845 Net patient services 621110 460812809 460812809 Lab services 621500 2492049 2492049 Classes and training 900099 1068184 1068184 Nursing services - Palatine Opportunity Center, Li 900099 176364 176364 Research - Hos, GIS 900099 347358 347358 464896764 1776082 1776082 329 329 0 2498292 1146765 1351527 1351527 1351527 372116417 169443 372536151 141162 -419734 28281 -391453 -391453 0 0 264132 269135 -5003 -5003 CAFETERIA 722210 1800186 1800186 Reinsurance Recovery 900099 1685235 1685235 Communications 900099 336516 336516 846563 846563 4668500 474029591 464896764 0 7399982 2958497 2958497 0 0 0 4277503 4277503 0 184665591 149061791 35603800 11424292 8945227 2479065 29228060 22794764 6433296 13028675 10394517 2634158 0 810970 23706 787264 338071 338071 30000 30000 0 176215 176215 25615079 11473517 14141562 1826109 7220 1818889 80653525 76217639 4435886 6499159 5061262 1437897 0 9817170 8825108 992062 516077 293237 222840 0 286877 229226 57651 8193608 8193608 0 40268458 30997149 9271309 6942266 6724572 217694 Bad Debt 41968664 41968664 Illinois provider tax 11676136 11676136 Dues 316243 42370 273873 Other 464151 12335 451816 481981396 395900545 86080851 0 16891000 15555289 2397078 3112463 51457091 55078694 90465 94386 283430 305372 4483867 4752063 9536463 6193121 645198526 245766920 407905178 399431606 104611294 94056794 5433417 5753291 7856247 7076204 610945530 591409283 64574817 65928264 6463988 3090185 288780000 283300000 80898436 87991814 440717241 440310263 X 164794872 145345729 4475858 4793222 957559 960069 170228289 151099020 610945530 591409283 X -7951805 -11177464 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 30000 false false true 52045 82045 false Lobbying Activities Part II-B, Line 1F Northwest Community Hospital pays dues to certain hospital associations which use a portion of these dues for lobbying. 2248734 169337 -10576 87845 2319650 2160499 9266 78969 2248734 2131037 39825 -10363 2160499 0.51000 0.49000 0.00000 false true true 1789072 1789072 307048484 98457960 208590524 213114236 90707544 122406692 105980254 48206919 57773335 17266480 8394497 8871983 399431606 0 PENSION OBLIGATION 53071853 DUE TO THIRD-PARTY PAYORS 30447201 INTEREST RATE SWAP LIABILITY 2127017 ASSET RETIREMENT OBLIGATION 1046437 DUE TO AFFILIATES 145868 SHORT TERM CAPITAL LEASE OBLIGATION 250257 LONG TERM CAPITAL LEASE OBLIGATION 903181 87991814 TRANSFER AND IMPAIRMENT OF GOODWILL SCHEDULE D, SUPPLEMENTAL INFORMATION DURING FY 2011, THE HOSPITAL PURCHASED CERTAIN BUSINESS LINES FROM NORTHWEST COMMUNITY HEALTH SERVICES, INC. NEW ACCOUNTING GUIDANCE REQUIRED AN IMPAIRMENT TEST WHICH RESULTED IN THE WRITE-OFF OF GOODWILL IN ITS ENTIRETY ($6,748,415). SEE THE AUDITED FINANCIAL STATEMENTS FOR MORE INFORMATION. DESCRIPTION OF INTENDED USES OF ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS ARE CREATED ACCORDING TO HOSPITAL NEEDS AND DESIGNATION OR PREFERENCES OF THE DONOR(S) SUPPORTING THE ENDOWMENT FUND. SCHOLARSHIP FUNDS, CONTINUED EDUCATION, OR FUNDS FOR PATIENT CARE IN A HOSPITAL DEPARTMENT DESIGNATED BY THE ENDOWMENT FUND ARE EXAMPLES OF FUND USES. true true X true X true X true true false true true 6886446 0 6886446 0.01570 39525477 26631340 12894137 0.02930 0 0 0 0.00000 46411923 26631340 19780583 0.04500 1303050 66579 1236471 0.00280 1102861 546292 556569 0.00130 306964 52482 254482 0.00060 28000 0 28000 0.00010 612877 0 612877 0.00140 3353752 665353 2688399 0.00620 49765675 27296693 22468982 0.05120 false 11730242 1055722 157977945 201103780 -43125835 X true true 1 1 Northwest Community Hospital

800 W Central Road Arlington Heights IL 60005

X X X Northwest Community Hospital 1 11 NCH MENTAL HEALTH & YOUTH CENTER

901 W KIRCHOFF ROAD ARLINGTON HEIGHTS IL 60005

IN & OUT MENTAL HEALTH AND YOUTH SUBSTANCE ABUSE TREATMENT NCH IMMEDIATE CARE & IMAGING CENTER

519 S ROSELLE ROAD SCHAUMBURG IL 60193

WALK IN URGENT CARE CENTER, IMAGING SERVICES & OUTPATIENT PHYSICAL MEDICINE SERVICES NCH IMMEDIATE CARE & IMAGING CENTER

15 S MCHENRY ROAD BUFFALO GROVE IL 60089

WALK IN URGENT CARE CENTER, IMAGING SERVICES & OUTPATIENT PHYSICAL MEDICINE SERVICES NCH CARDIAC & PHYSICAL MEDICINE REHAB

900 W CENTRAL ROAD ARLINGTON HEIGHTS IL 60005

OUTPATIENT CARDIAC REHAB PROGRAM AND PHYSICAL MEDICINE SERVICES NORTHWEST COMMUNITY HOSPITAL HOME HEALTH

3060 SALT CREEK LANE ARLINGTON HEIGHTS IL 60005

HOME HEALTHCARE SERVICES NCH IMMEDIATE CARE & IMAGING CENTER

199 W RAND ROAD MOUNT PROSPECT IL 60056

WALK IN URGENT CARE CENTER AND IMAGING SERVICES NORTHWEST COMMUNITY HOSPITAL IMAGING

1450 BUSCH PARKWAY BUFFALO GROVE IL 60089

IMAGING SERVICES NCH OUTPATIENT CENTER

3300 KIRCHOFF ROAD ROLLING MEADOWS IL 60008

OUTPATIENT PHYSICAL MEDICINE SERVICES NCH IMMEDIATE CARE CENTER

1201 S RAND ROAD LAKE ZURICH IL 60047

WALK IN URGENT CARE CENTER & OUTPATIENT PHYSICAL MEDICINE SERVICES NCH PHYSICAL MEDICINE & REHAB

1590 N ARLINGTON HEIGHTS ROAD ARLINGTON HEIGHTS IL 60005

OUTPATIENT PHYSICAL MEDICINE SERVICES NCH OCCUPATIONAL WELLNESS & REHAB

455 S ROSELLE ROAD SCHAUMBURG IL 60193

OCCUPATIONAL WELLNESS & REHAB PART I, LINE 3C CHARITY CARE POLICY THE HOSPITAL PROVIDES EMERGENT AND MEDICALLY NECESSARY SERVICES TO ALL PATIENTS WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY. THE WRITTEN CHARITY CARE POLICY IS WIDELY DISTRIBUTED AND COMMUNICATED TO THE COMMUNITY. UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THE AMOUNT OF FREE CARE PROVIDED IS DETERMINED BY FINANCIAL NEED AND IS NOT LIMITED BY BUDGETED AMOUNTS. PATIENTS EARNING LESS THAN 200% OF THE FEDERAL POVERTY GUIDELINES RECEIVE FREE CARE AND THOSE BETWEEN 200% AND 400% OF THE GUIDELINES RECEIVE DISCOUNTED CARE ON A SLIDING SCALE. THE FINANCIAL ASSISTANCE PROGRAM LOOKS AT BOTH THE CURRENT INCOME AND THE INCOME FROM THE PREVIOUS YEAR (AS DISPLAYED IN TAX DOCUMENTS) AND THEN CALCULATES POTENTIAL BENEFITS BASED UPON EACH VARIABLE, OFFERING ITS PATIENT'S THE MOST GENEROUS BENEFIT. THIS POLICY ACKNOWLEDGES THE FRAGILE NATURE OF EMPLOYMENT AND THE IMPACT OF PREVIOUS YEAR HARDSHIPS. CONSISTENT WITH THE ILLINOIS UNINSURED PATIENT DISCOUNT ACT, PATIENTS WITHOUT INSURANCE COVERAGE ARE ELIGIBLE FOR A DISCOUNT IF THEIR INCOME IS AT OR BELOW 600% OF THE FEDERAL POVERTY GUIDELINES. OF THE REMAINING BALANCE, THE PATIENT'S LIABILITY IS CAPPED AT 25% OF THE FAMILY'S ANNUAL INCOME. PART I, LINE 6A COMMUNITY BENEFIT REPORT THE HOSPITAL'S COMMUNITY BENEFIT ACTIVITIES ARE INCLUDED IN AN ANNUAL REPORT ISSUED BY NORTHWEST COMMUNITY HEALTHCARE, THE SOLE CORPORATE MEMBER OF THE HOSPITAL. PART I, LINE 7 COSTING METHODOLOGY THE FOLLOWING METHODOLOGIES WERE USED TO DETERMINE THE AMOUNTS REPORTED IN THE TABLE FOR LINE 7: PART I, LINES 7A - 7D, RATIO OF COST TO CHARGES AS DETERMINED USING WORKSHEET 2 IN THE FORM 990, SCHEDULE H INSTRUCTIONS. PART I, LINES 7E - 7I, COSTS WERE DETERMINED USING THE DIRECT COSTS FOR THE SPECIFIC PROGRAM OR SERVICE FROM THE HOSPITAL'S GENERAL LEDGER SYSTEM, WHICH ADDRESSES ALL PATIENT SEGMENTS. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES THE HOSPITAL HAS NOT INCLUDED ANY COSTS RELATED TO A PHYSICIAN CLINIC AS PART OF SUBSIDIZED HEALTH SERVICES. PART IV, LINE 7, COLUMN (F): BAD DEBT EXPENSE THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN PART IX, LINE 25, COLUMN (A) THAT WAS EXCLUDED FROM THE CALCULATION OF THIS PERCENTAGE WAS $41,968,664. PART III, LINE 1 BAD DEBT EXPENSE THE HOSPITAL RECORDS BAD DEBT EXPENSE IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HFMA STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES PER GAAP. PART III, LINE 4 BAD DEBT EXPENSE NORTHWEST COMMUNITY HOSPITAL IS INCLUDED IN THE AUDITED FINANCIAL STATEMENTS OF NORTHWEST COMMUNITY HEALTHCARE (NCH) AND SUBSIDIARIES. THE TEXT OF THE FOOTNOTE REFERENCING BAD DEBT EXPENSE IN THE FY 2011 AUDIT IS AS FOLLOWS: "[NCH] EVALUATES THE COLLECTABILITY OF ITS ACCOUNTS RECEIVABLE BASED ON THE LENGTH OF TIME THE RECEIVABLE IS OUTSTANDING, PAYOR CLASS AND THE ANTICIPATED FUTURE COLLECTIBLE AMOUNTS BASED ON HISTORICAL EXPERIENCE. ACCOUNTS RECEIVABLE ARE CHARGED TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS WHEN THEY ARE DEEMED UNCOLLECTIBLE." WRITE-OFFS ARE SHOWN NET OF CONTRACTUALS AND DISCOUNTS. THE HOSPITAL'S BAD DEBT EXPENSE AS REPORTED ON LINES 2 AND 3 WAS DETERMINED USING THE COST TO CHARGE RATIO CALCULATED USING WORKSHEET 2 IN THE FORM 990, SCHEDULE H INSTRUCTIONS. FOR FY 2011, THE HOSPITAL RECORDED PROVISIONS FOR BAD DEBT EXPENSE OF $11,730,242 (AT CHARGES) OF WHICH IT IS ESTIMATED THAT 9% OF THIS AMOUNT WOULD HAVE BEEN REPORTED AS CHARITY IF THE PATIENT WOULD HAVE FULLY COMPLETED THE CHARITY APPLICATION PROCESS. THIS ESTIMATE IS BASED ON PATIENTS WHO BEGAN THE FINANCIAL ASSISTANCE PROCESS BUT DID NOT RESPOND TO THE HOSPITAL'S REQUEST FOR ADDITIONAL INFORMATION AND/OR COMPLETE THE APPLICATION FOR DETERMINATION. THESE PATIENTS WERE DEEMED VIABLE CANDIDATES TO RECEIVE FINANCIAL ASSISTANCE FOR THEIR SERVICES BY THE HOSPITAL'S FINANCIAL COUNSELORS. THE FINANCIAL COUNSELORS FOLLOWED UP IN WRITING AND BY PHONE IN AN ATTEMPT TO OBTAIN THE NECESSARY INFORMATION FOR THE FINANCIAL ASSISTANCE DETERMINATION. PART III, LINE 8 MEDICARE SHORTFALL THE MEDICARE SHORTFALL REPORTED IN PART III, LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE: (A) WITHOUT THE MEDICARE PROGRAM, IT IS LIKELY THAT MANY OF THESE INDIVIDUALS WOULD QUALIFY FOR CHARITY CARE OR MEDICAID; (B) BY THE HOSPITAL ACCEPTING PAYMENT BELOW COST TO TREAT THESE PATIENTS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; (C) THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTIONS IN MEDICARE REIMBURSEMENT MAY ACTUALLY REDUCE ACCESS TO CARE FOR THESE INDIVIDUALS; AND (D) THE AMOUNT SPENT BY THE HOSPITAL TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO OTHER COMMUNITY NEEDS. Part III, LINE 9B COLLECTION PRACTICES IT IS THE POLICY OF THE HOSPITAL TO OFFER PATIENTS A PAYMENT PLAN OR FINANCIAL ASSISTANCE WHEN IT BECOMES KNOWN OR SUSPECTED THAT A PATIENT NEEDS SUCH ASSISTANCE. FINANCIAL COUNSELORS CONTACT AND WORK WITH THE PATIENT OR THEIR FAMILY TO HELP DETERMINE IF THERE ARE ANY THIRD PARTY PAYORS WHICH MAY BE AVAILABLE TO HELP THE PATIENT MEET THEIR OBLIGATIONS, SUCH AS MEDICAID, COBRA, WORKERS COMPENSATION, OR SPECIALIZED GRANT PROGRAMS. IF NO THIRD PARTY PROGRAMS ARE IDENTIFIED, THE FINANCIAL COUNSELORS WORK WITH THE PATIENT TO HELP THEM APPLY FOR CHARITY DISCOUNTS OR PAYMENT PLANS. FORMS ARE AVAILABLE IN ENGLISH AND SPANISH, AND TRANSLATION SERVICES ARE PROVIDED IN MANY LANGUAGES. IN ADDITION, ALL PATIENT BILLS AND STATEMENTS INCLUDE INFORMATION ABOUT HOW TO APPLY FOR FINANCIAL ASSISTANCE AND THE INFORMATION IS ALSO POSTED ON THE HOSPITAL'S WEBSITE. COLLECTION ACTIVITY WILL BE SUSPENDED DURING THE CONSIDERATION OF A COMPLETED FINANCIAL ASSISTANCE APPLICATION OR AN APPLICATION FOR ANY OTHER HEALTHCARE BRACKET (I.E, MEDICARE, MEDICAID, ETC.). A NOTE IS ENTERED INTO THE PATIENT'S ACCOUNT TO SUSPEND COLLECTION ACTIVITY UNTIL THE FINANCIAL ASSISTANCE PROCESS IS COMPLETED. ACCOUNTS IN THE FINANCIAL ASSISTANCE PROCESS WILL BE MONITORED AND, UPON THE DECISION TO APPROVE OR DENY FINANCIAL ASSISTANCE, THE PATIENT'S ACCOUNT WILL BE UPDATED. IF THE FINANCIAL ASSISTANCE APPLICATION IS APPROVED WITH A PERCENTAGE LESS THAN 100% OR DENIED, THE PATIENT'S ACCOUNT WILL BE NOTED AND THE HOSPITAL WILL RESUME THE SELF PAY COLLECTION ACTIVITY IN COMPLIANCE WITH ITS SELF PAY FOLLOW-UP PROCEDURES. Part VI, LINE 2 NEEDS ASSESSMENT IN 2010, THE HOSPITAL PARTICIPATED IN A REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENT OFFERED BY THE METROPOLITAN CHICAGO HEALTHCARE COUNCIL (MCHC) IN PARTNERSHIP WITH PROFESSIONAL RESEARCH CONSULTANTS (PRC). THE ASSESSMENT CONSISTED OF A 30-MINUTE TELEPHONE HEALTH SURVEY THAT WAS CONDUCTED IN ENGLISH AND SPANISH. OVER 1,200 SURVEYS WERE CONDUCTED, WITH 240 IN THE NORTHWEST REGION OF THE COUNTY, WHERE THE HOSPITAL IS LOCATED. CAREFUL CONSIDERATION WAS TAKEN TO ENSURE THAT THE DEMOGRAPHICS OF THOSE PARTICIPATING IN THE SURVEY MIRRORED THE DEMOGRAPHICS OF THE COMMUNITY. THE GOAL OF THE SURVEY WAS TO TARGET ACTUAL HEALTH STATUS, BEHAVIOR AND EXPERIENCES, RATHER THAN PERCEPTIONS. ISSUES ADDRESSED INCLUDED SELF-REPORTED HEALTH STATUS, PHYSICAL HEALTH STATUS, MENTAL HEALTH STATUS, DEATH AND DISABILITY, INFECTION AND CHRONIC DISEASE, BIRTHS, CHILDREN'S HEALTH STATUS, MODIFIABLE HEALTH RISKS, ACCESS TO HEALTHCARE, HEALTH EDUCATION AND OUTREACH, AND HEALTH INFORMATION SOURCES. THE ASSESSMENT ALSO INTEGRATED THE MOST RECENT SECONDARY PUBLIC HEALTH DATA TO COMPLEMENT THE PRIMARY TELEPHONE SURVEY DATA. A HOSPITAL TEAM COMPRISED OF REPRESENTATIVES FROM COMMUNITY SERVICES, IMMEDIATE CARE/WELLNESS, FINANCE, NURSING AND MARKETING DEPARTMENTS THEN REVIEWED RESULTS FOR THE HOSPITAL'S PRIMARY AND SECONDARY SERVICE AREA AND COMPARED IT TO LOCAL, STATE, AND NATIONAL DATA AS WELL AS HEALTHY PEOPLE BENCHMARKS. COMMUNITY HEALTH IMPROVEMENT PLANS WERE DEVELOPED AND PRESENTED TO THE COMMUNITY HEALTH AND OUTREACH COMMITTEE, A COMMITTEE OF THE BOARD OF DIRECTORS, FOR FINAL APPROVAL. THE MOST PREDOMINANT FINDING WAS THE DIFFICULTY THE COMMUNITY HAS IN ACCESSING HEALTHCARE SERVICES WHICH INCLUDES PRIMARY, ORAL, AND BEHAVIORAL HEALTH SERVICES, AS WELL AS PRESCRIPTION MEDICATION. ASSESSMENT FINDINGS SHOWED THAT 39.2% OF THOSE SURVEYED HAD DIFFICULTY ACCESSING PRIMARY HEALTH CARE IN THE PAST YEAR, 22.4% HAD NOT SEEN A DENTIST IN THE PAST YEAR, AND 16.5% OF THE SURVEYED POPULATION REPORTED SKIPPING PRESCRIPTIONS TO SAVE ON COSTS. ANOTHER MAJOR CONCERN AND FOCUS OF THE COMMUNITY HEALTH IMPROVEMENT PLANS WAS IN RESPONSE TO THE STARTLING OBESITY RATES, WITH 48.2% OF THE HOSPITAL'S SERVICE AREA BEING OVERWEIGHT OR OBESE. THROUGHOUT FY 2011, THE HOSPITAL'S COMMUNITY SERVICES DEPARTMENT, WITH OVERSIGHT FROM THE COMMUNITY HEALTH AND OUTREACH COMMITTEE, CONTINUALLY REVIEWED THE IDENTIFIED HEALTH CONCERNS AND THE COMMUNITY HEALTH IMPROVEMENT PLANS THAT WERE IMPLEMENTED TO ADDRESS THE NEEDS. MEASUREMENT TOOLS WERE DEVELOPED FOR ALL PROGRAMS AND MONITORED REGULARLY TO ENSURE THEIR IMPACT AND EFFECTIVENESS. ALSO IN 2011, THE HOSPITAL WAS GIVEN THE OPPORTUNITY TO PROVIDE SUGGESTIONS AND FEEDBACK TO MCHC ON THE 2010 ASSESSMENT TOOL WHICH WILL BE INCORPORATED INTO THE NEXT ASSESSMENT THEY CONDUCT IN 2012. THE HOSPITAL HAS ALREADY COMMITTED TO PARTICIPATING IN THE NEXT ASSESSMENT AND WILL USE THE FINDINGS OF THAT ASSESSMENT TO MAKE ANY MODIFICATIONS NEEDED TO THE CURRENT COMMUNITY HEALTH IMPROVEMENT PLAN. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE FINANCIAL ASSISTANCE PROGRAM AT NORTHWEST COMMUNITY HOSPITAL IS COMMUNICATED WIDELY TO PATIENTS AND VISITORS IN ENGLISH AND SPANISH USING THE FOLLOWING METHODS: (1) SIGNAGE IN ENGLISH AND SPANISH IS POSTED THROUGHOUT THE ORGANIZATION AT ALL ACCESS POINTS, INCLUDING THE EMERGENCY DEPARTMENT AND OUTPATIENT REGISTRATION AREAS. THESE AREAS ALSO STOCK AND MAKE AVAILABLE A BROCHURE, PRINTED IN ENGLISH AND SPANISH, DESCRIBING THE HOSPITAL'S POLICY. A FULL-TIME INTERPRETATION SERVICE DEPARTMENT IS AVAILABLE TO ASSIST THOSE WHO NEED ADDITIONAL INFORMATION IN OTHER LANGUAGES. IN 2011 THE HOSPITAL RESPONDED TO OVER 18,000 IN-PERSON REQUESTS AND 4,700 TELEPHONIC REQUESTS IN 45 DIFFERENT LANGUAGES. (2) EACH PAGE OF THE HOSPITAL'S WEBSITE (WWW.NCH.ORG) CONTAINS THE FOLLOWING FOOTNOTE: "NORTHWEST COMMUNITY HOSPITAL IS A CHARITABLE ORGANIZATION AND PROVIDES FINANCIAL ASSISTANCE TO THOSE WHO ARE ELIGIBLE. FOR MORE INFORMATION, CLICK HERE." A LINK TAKES VISITORS TO A SUBSEQUENT PAGE THAT DESCRIBES FINANCIAL ASSISTANCE/CHARITY CARE AND PROVIDES A PHONE NUMBER TO CONTACT AN NORTHWEST COMMUNITY HOSPITAL FINANCIAL COUNSELOR. APPLICATIONS FOR FINANCIAL ASSISTANCE, IN ENGLISH AND SPANISH, ARE AVAILABLE FOR DOWNLOAD ON THE HOSPITAL WEBSITE. (3) ALL EXTERNAL HOSPITAL PUBLICATIONS INCLUDE THE FOLLOWING NOTE: "NORTHWEST COMMUNITY HOSPITAL IS A CHARITABLE ORGANIZATION AND PROVIDES FINANCIAL ASSISTANCE TO PEOPLE WHO ARE ELIGIBLE. FOR MORE INFORMATION PLEASE CALL 847.618.4542 OR VISIT OUR WEBSITE AT WWW.NCH.ORG." (4) INFORMATION ON FINANCIAL ASSISTANCE IS INCLUDED WITH EVERY PATIENT BILL. (5) FINANCIAL COUNSELORS PROVIDE FINANCIAL ASSISTANCE INFORMATION TO PATIENTS DURING THEIR REGISTRATION AND WORK WITH PATIENTS IDENTIFIED AT REGISTRATION OR AFTER ADMISSION TO HELP THEM GET THE ASSISTANCE THEY NEED, ANSWER QUESTIONS, SET UP PAYMENT PLANS AND FACILITATE APPLICATIONS FOR GOVERNMENT PROGRAMS SUCH AS MEDICAID. PART VI, LINE 4 COMMUNITY INFORMATION NORTHWEST COMMUNITY HOSPITAL IS LOCATED IN ARLINGTON HEIGHTS, ILLINOIS, A SUBURB LOCATED APPROXIMATELY 25 MILES NORTHWEST OF CHICAGO. ITS PRIMARY SERVICE AREA CONSISTS OF ARLINGTON HEIGHTS AND THE SURROUNDING SUBURBS OF MT. PROSPECT, PALATINE, AND ROLLING MEADOWS. THE HOSPITAL'S SECONDARY SERVICE AREA IS COMPRISED OF BARRINGTON, BUFFALO GROVE, DES PLAINES, ELK GROVE VILLAGE, HOFFMAN ESTATES, LAKE ZURICH, PROSPECT HEIGHTS, SCHAUMBURG AND WHEELING. THESE AREAS HAVE A COMBINED POPULATION OF APPROXIMATELY 659,000 PEOPLE. THIS NUMBER HAS REMAINED FAIRLY STABLE AND GROWTH OVER THE NEXT 5 YEARS IS EXPECTED TO BE RELATIVELY FLAT. THE HOSPITAL'S TOTAL SERVICE AREA IS PREDOMINATELY CAUCASIAN (70%), FOLLOWED BY HISPANIC (13.9%), ASIAN (12.3%) AND ALL OTHER (3.8%). THE HISPANIC POPULATION IS EXPECTED TO GROW BY 12.1% AND THE ASIAN POPULATION 10.5% OVER THE NEXT 5 YEARS. OF INDIVIDUALS LIVING IN THE HOSPITAL'S TOTAL SERVICE AREA, 8.7% ARE ON MEDICAID AND, PENDING HEALTHCARE REFORM, THIS IS EXPECTED TO GROW BY 18.4% OVER THE NEXT FIVE YEARS. OVER THE PAST 10 YEARS, THERE HAS BEEN A DECIDED SHIFT IN THE AGE OF THOSE LIVING IN THE HOSPITAL'S SERVICE AREA. A PORTION OF THE 18-44 AGE GROUP MOVED INTO THE 45-64 AGE GROUP, RESULTING IN A 19.2% INCREASE. FURTHERMORE, IT IS ESTIMATED THAT IN THE NEXT 5 YEARS, THE AREA WILL SEE FURTHER MIGRATION INTO THE 65+ AGE GROUP. THERE ARE FOUR OTHER HOSPITALS LOCATED IN THE HOSPITAL'S SERVICE AREA. THE ENTIRE PRIMARY SERVICE AREA AND A SIGNIFICANT PORTION OF THE SECONDARY SERVICE AREA HAVE BEEN DESIGNATED AS A MEDICALLY-UNDERSERVED AREA. THE HOSPITAL SUPPORTS BOTH A FEDERALLY QUALIFIED HEALTH CENTER LOCATED ACROSS THE STREET FROM THE HOSPITAL, AND A COUNTY RUN PRIMARY CARE CLINIC, ALSO LOCATED IN THE HOSPITAL'S PRIMARY SERVICE AREA. PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH THE HOSPITAL PROMOTES THE HEALTH OF ITS COMMUNITY IN MANY WAYS AS FOLLOWS: (1) A MAJORITY OF THE HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF PERSONS WHO LIVE OR WORK IN THE HOSPITAL'S PRIMARY SERVICE AREA AND ARE NOT EMPLOYEES OR CONTRACTORS OF THE HOSPITAL. (2) A STANDING COMMUNITY HEALTH AND OUTREACH COMMITTEE OF THE HOSPITAL BOARD PROVIDES OVERSIGHT IN MONITORING AND EVALUATING THE EFFECTIVENESS OF ITS COMMUNITY BENEFIT PLAN, INCLUDING CHARITY CARE, COMMUNITY HEALTH EDUCATION, COMMUNITY MEDICAL/DENTAL CLINICS, AND COMMUNITY HEALTH IMPROVEMENT INITIATIVES. (3) MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE HOSPITAL'S COMMUNITY FOR SOME OF ITS DEPARTMENTS. (4) THE HOSPITAL MAINTAINS ANY SURPLUS FUNDS IN THE HOSPITAL ITSELF OR AT NORTHWEST COMMUNITY HEALTHCARE (A 501(C)(3) SUPPORTING ORGANIZATION AND SOLE MEMBER OF THE HOSPITAL) FOR FUNDING CAPITAL IMPROVEMENTS IN TECHNOLOGY, FACILITIES OR PATIENT CARE EQUIPMENT, AND SUPPORTING HOSPITAL OPERATIONS OR COMMUNITY OUTREACH INITIATIVES. (5) THE HOSPITAL HAS DEDICATED STAFF THAT SERVE AS MEMBERS, CHAIRPERSONS, OFFICERS, AND BOARD MEMBERS OF LOCAL AND NATIONAL ORGANIZATIONS DEVOTED TO IMPROVING THE HEALTH AND WELLBEING OF COMMUNITY MEMBERS. THESE ORGANIZATIONS INCLUDE: WINGS (WOMEN IN NEED GROWING STRONGER), NORTHWEST SUBURBAN ALLIANCE ON DOMESTIC VIOLENCE, HARPER COLLEGE NURSING ADVISORY COMMITTEE, METROPOLITAN CHICAGO HEALTHCARE COUNCIL HEALTH CARE WORKFORCE ADVISORY INSTITUTE, SUSAN G. KOMEN FOUNDATION, NORTHERN FOX VALLEY ONCOLOGY NURSING SOCIETY CHAPTER, CHICAGO DENTAL SOCIETY, HOSPICE OF NORTHEASTERN ILLINOIS, HEALTHWORLD, BRIDGE YOUTH AND FAMILY SERVICES, LITTLE CITY FOUNDATION HUMAN RIGHTS COMMITTEE, AS WELL AS LOCAL BOARD OF HEALTH DEPARTMENTS AND ROTARY CLUBS. (6) THE HOSPITAL HAS DEDICATED STAFF THAT ASSIST WITH ADVOCACY INITIATIVES TO PROMOTE COMMUNITY, STATE, AND NATIONAL EFFORTS TO IMPROVE THE HEALTH OF THE POPULATION. THIS INCLUDES THE OBESITY EPIDEMIC THROUGH THE EFFORTS OF THE ILLINOIS ALLIANCE TO PREVENT OBESITY AS WELL AS CANCER RESEARCH AND PREVENTION THROUGH THE AMERICAN CANCER SOCIETY. (7) COLLABORATIVE true AMERICAN CANCER SOCIETY 1114 N ARLINGTON HTS RD ARLINGTON HTS IL 60067 131788491 501(c)(3) 10000 RELAY FOR LIFE AMERICAN HEART ASSOCIATION PO BOX 4002902 DES MOINES IA 50340 135613797 501(c)(3) 5300 CHICAGO HEARTWALK HEKTOEN INSTITUTE LLC 2240 W OGDEN AVE CHICAGO IL 60612 366006541 501(c)(3) 95405 VISTA CLINIC SUPPORT SPECIAL LEISURE SERVICES FOUNDATION 3000 W CENTRAL STE 205 ROLLING MEADOWS IL 60008 363145710 501(c)(3) 15000 SPECIAL OLYMPICS NORTHWEST COMMUNITY HEALTHCARE 800 WEST CENTRAL RD ARLINGTON HTS IL 60005 363125209 501(c)(3) 2750000 NET ASSET PAID GLOBUS RELIEF 1775 W 1500 SOUTH SALT LAKE CITY UT 84104 841369453 501(C)(3) 237911 FMV MEDICAL SUPPLIES MISSION TRIPS AMHE INCORPORATED 1166 EASTERN PKWY BROOKLYN NY 11213 237357680 501(C)(3) 159687 FMV MEDICAL SUPPLIES 7 0 Form 990, Schedule I Description of Organization's Procedures for Monitoring the Use of Grants Grants in support of Northwest Community Hospital's (HOSPITAL) mission are monitored by Northwest Community's Finance Committee and Board of Directors as part of the monthly review of Hospital's financial results. Significant grants to unrelated 501(c)(3) or governmental organizations are approved by Hospital's commmunity services department and are monitored through ongoing interactions with officials of those recipients regarding program services provided in Hospital's service area. true false false true false false false false false Bruce K Crowther 571013 0 0 0 2008 0 201820 0 16643 0 791484 0 0 0 Michael B Zenn 637690 0 0 0 1808 163 63787 0 18124 0 721409 163 0 0 Mark Lusson 224424 0 0 0 67349 0 52333 0 11575 0 355681 0 65291 Mary Stack 167416 0 0 0 1808 0 29016 0 13706 0 211946 0 0 0 Dawn Walden 108290 0 0 0 27425 0 24421 0 8011 0 168147 0 0 0 Angela Stefaniu 101520 0 0 0 124914 0 24419 0 20065 0 270918 0 60356 Robert Klasek 149130 0 0 0 1546 0 26934 0 10907 0 188517 0 0 0 Gary Skiba 166311 0 0 0 1808 0 24483 0 11907 0 204509 0 0 0 Willis G Parsons MD 1599548 0 135759 0 0 0 14700 0 1942 0 1751949 0 0 0 Malcolm Bilimoria MD 1439819 0 0 0 0 0 14700 0 23065 0 1477584 0 0 0 Rameez Alasadi MD 665453 0 67879 0 0 0 9900 0 16620 0 759852 0 0 0 Tahseen Mohammed MD 265490 0 0 0 28803 0 14700 0 13168 0 322161 0 0 0 Sonia Mehta MD 303264 0 0 0 9608 0 9800 0 27065 0 349737 0 0 0 Gail A Finn 3503 0 0 0 252786 0 13517 0 887 0 270693 0 24710 Dale Beatty 254944 0 0 0 17808 0 30312 0 7601 0 310665 0 0 0 Leighton Smith MD 413459 0 0 0 70443 0 64700 0 13907 0 562509 0 0 0 GEORGE MORRIS 211083 0 0 0 1908 0 27175 0 17065 0 257231 0 0 0 LAURA POLLACK 140807 0 0 0 1858 0 23327 0 15124 0 181116 0 0 0 Ann Sayvetz 248894 0 0 0 1808 0 14611 0 13719 0 279032 0 0 0 Michael C Hartke 355412 38315 0 0 247 247 22169 2169 2893 2888 380721 43619 0 0 OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN SCHEDULE J, PART I, LINE 3 THE NOMINATION AND COMPENSATION COMMITTEE OF THE NORTHWEST COMMUNITY HEALTHCARE (NCH) BOARD IS RESPONSIBLE FOR SETTING THE COMPENSATION OF THE PRESIDENT/CEO. COMPENSATION IS REVIEWED USING AN EXTERNAL COMPENSATION FIRM, PINP, INC. THE REVIEW ALSO UTILIZES COMPARISONS TO SIMILAR ORGANIZATIONS THROUGH REVIEW OF FORMS 990, USE OF COMPARISON STUDIES FROM THE METROPOLITAN CHICAGO HEALTHCARE COUNCIL AND OTHER SOURCES. THE PROCESS IS DOCUMENTED IN THE MINUTES OF THE NOMINATION AND COMPENSATION COMMITTEE. SEVERANCE PAYMENTS SCHEDULE J, PART I, LINE 4A THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAY DURING THE CALENDAR YEAR 2010 PURSUANT TO A WRITTEN SEPARATION AGREEMENT WITH THE HOSPITAL: GAIL A. FINN: $226,468 ANGELA STEFANIU: $48,314 COMPENSATION BASED ON REVENUES OF THE ORGANIZATION SCHEDULE J, PART I, LINE 5A THE FOLLOWING GASTROENTEROLOGISTS RECEIVED BONUS PAYMENTS UNDER THE TERMS OF THEIR WRITTEN EMPLOYMENT CONTRACTS. THE AMOUNTS WERE BASED ON A PERCENTAGE OF PROFESSIONAL COLLECTIONS (I.E. COLLECTIONS FROM THE PHYSICIAN'S PERFORMANCE OF PROFESSIONAL MEDICAL SERVICES) EXCEEDING A SPECIFIED THRESHOLD UNTIL A CAP SPECIFIED IN THE CONTRACT IS REACHED. WILLIS G. PARSONS, MD: $135,759 RAMEEZ ALASADI, MD: $67,879 SUPPLEMENTAL INFORMATION SCHEDULE J, PART II, COLUMN C CERTAIN OFFICERS AND KEY EMPLOYEES OF NORTHWEST COMMUNITY HOSPITAL PARTICIPATE IN A SECTION 457(F) DEFERRED COMPENSATION PLAN. CURRENT YEAR DEFERRED AMOUNTS ARE INCLUDED IN PART VII, COLUMN F AND SCHEDULE J, PART II, COLUMN C. CURRENT YEAR DISTRIBUTIONS, INCLUDED IN PART VII, COLUMN D; SCHEDULE J, PART II, COLUMN B(III); AND SCHEDULE J, PART II, COLUMN (F) ARE: GAIL A. FINN: $24,710 MARK LUSSON: $65,291 ANGELA STEFANIU: $60,356 ILLINOIS FINANCE AUTHORITY 861091967 45200FNR6 2008-09-19 151075932 SEE PART V false false false ILLINOIS FINANCE AUTHORITY 861091967 45200FNU9 2008-10-17 86820000 SEE PART V false false false 0 0 151417356 0 0 0 1468340 0 0 149949016 0 0 2010 false false true true 0 0 86820000 0 0 0 598075 93000 0 0 86128925 0 2008 true false true true false false false false false 0.00000 0.00000 0.00000 true 0.00000 0.00000 0.00000 false false false false false false false true false false false true Description of Bonds Schedule K, Part I ISSUER NAME: ILLINOIS FINANCE AUTHORITY ISSUER EIN: 86-1091967 CUSIP #: 45200FNR6 ISSUE PRICE: $151,075,932 DESCRIPTION OF PURPOSE: PROCEEDS USED FOR: CONSTRUCTION OF A PATIENT TOWER AND PARKING GARAGE; EXPANSION AND RENOVATION OF THE HOSPITAL'S EMERGENCY DEPARTMENT AND SURGERY SUITES; RELOCATION OF CERTAIN DEPARTMENTS ON THE HOSPITAL'S CAMPUS; AND PURCHASE OF CERTAIN EQUIPMENT USED IN THE HOSPITAL'S BUSINESS. TOTAL PROCEEDS OF ISSUE: THE TOTAL PROCEEDS INCLUDE $341,424 OF INVESTMENT EARNINGS. ISSUER NAME: ILLINOIS FINANCE AUTHORITY ISSUER EIN: 86-1091967 CUSIP #: 45200FNU9 ISSUE PRICE: $86,820,000 DESCRIPTION OF PURPOSE: PROCEEDS WERE USED TO REPAY A TAXABLE LOAN, THE PROCEEDS OF WHICH WERE USED, TOGETHER WITH OTHER FUNDS, TO REDEEM THE AUTHORITY'S SERIES 2002A BONDS (NW COMMUNITY HOSPITAL) IN APRIL 2008. James J Smith MD PHYS PRACTICE SUPPT X 85793 90465 true true true 90465 ADAM SKIBA SEE PART V 76102 SALARY false AMY SKIBA SEE PART V 63033 SALARY false MEGAN STACK-SWEET SEE PART V 63882 SALARY false CHARLIE CROWTHER SEE PART V 18669 SALARY false RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION SCHEDULE L, PART IV ADAM SKIBA IS THE SON OF KEY EMPLOYEE, GARY SKIBA. AMY SKIBA IS THE DAUGHTER OF KEY EMPLOYEE, GARY SKIBA. MEGAN STACK-SWEET IS THE DAUGHTER OF KEY EMPLOYEE, MARY STACK. CHARLIE CROWTHER IS THE SON OF DIRECTOR AND OFFICER, BRUCE K. CROWTHER. DESCRIPTION OF RELATIONSHIPS FORM 990, PART VI, QUESTION 2 BRUCE K. CROWTHER, DIRECTOR AND CEO, AND JAMES BISHOP, DIRECTOR, SERVE ON THE NORTHWEST COMMUNITY HOSPITAL (HOSPITAL) BOARD AS WELL AS ON THE BOARDS OF WINTRUST FINANCIAL CORPORATION AND BARRINGTON BANK AND TRUST COMPANY NA. MICHAEL ZENN, HOSPITAL OFFICER, AND JAMES BISHOP, HOSPITAL DIRECTOR, SERVE ON THE BOARD OF VILLAGE BANK AND TRUST (A WINTRUST BANK). HOSPITAL DOES NOT TRANSACT ANY BUSINESS WITH WINTRUST FINANCIAL, BARRINGTON BANK, OR VILLAGE BANK AND TRUST. DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PART VI, QUESTION 6 NORTHWEST COMMUNITY HEALTHCARE (NCH) IS THE SOLE CORPORATE MEMBER OF NORTHWEST COMMUNITY HOSPITAL (HOSPITAL). AS SUCH, IT ELECTS OR APPOINTS THE MEMBERS OF HOSPITAL'S GOVERNING BODY AND APPROVES SIGNIFICANT DECISIONS. DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS FORM 990, PART VI, QUESTION 7A NCH IS THE SOLE CORPORATE MEMBER OF HOSPITAL. AS SUCH, IT ELECTS OR APPOINTS THE MEMBERS OF THE GOVERNING BODY OF HOSPITAL PERIODICALLY OR AS VACANCIES ARISE. DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS FORM 990, PART VI, QUESTION 7B NCH IS THE SOLE CORPORATE MEMBER OF HOSPITAL. AS SUCH, IT MUST APPROVE CERTAIN ACTIONS OF HOSPITAL. ACTION IS TAKEN BY A MAJORITY VOTE OF THE NCH BOARD WITH A QUORUM PRESENT. NCH MUST APPROVE THE FOLLOWING TYPES OF DECISIONS BY HOSPITAL: VOLUNTARY DISSOLUTION, MERGER, CONSOLIDATION OR SALE OR TRANSFER OF 10% OR MORE OF THE HOSPITAL'S ASSETS; SALE OF REAL PROPERTY OR INTEREST THEREIN; CREATION OF A SUBSIDIARY OR AFFILIATE; ANNUAL AND LONG-TERM CAPITAL AND OPERATING BUDGETS; AMENDMENT, ALTERATION OR REPEAL OF HOSPITAL'S ARTICLES OF INCORPORATION OR BYLAWS; SELECTION OF AUDITORS; APPOINTMENT, REMOVAL AND EVALUATION OF HOSPITAL DIRECTORS; DEBT OR INDEBTEDNESS, GUARANTEES OR BORROWINGS; APPOINTMENT, COMPENSATION, BENEFITS AND EVALUATION OF OFFICERS; APPOINTMENT AND EMPLOYMENT OF THE PRESIDENT; AND ACTIONS TAKEN BY TRUSTEES OF THE NORTHWEST COMMUNITY HOSPITAL EMPLOYEES RETIREMENT PLAN. DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, QUESTION 11B A COPY OF FORM 990 WAS MADE AVAILABLE TO THE MEMBERS OF THE BOARD OF HOSPITAL PRIOR TO FILING. THE AUDIT AND COMPLIANCE COMMITTEE OF THE NCH BOARD REVIEWED FORM 990 FOR AFFILIATES OF NCH PRIOR TO DISTRIBUTION TO THE FULL BOARD. DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, QUESTION 12C EACH YEAR, THE CONFLICT OF INTEREST POLICY AND QUESTIONNAIRE IS SENT TO DIRECTORS, OFFICERS AND KEY EMPLOYEES. EACH RESPONSE IS REVIEWED BY THE GENERAL COUNSEL AND THOSE IN WHICH ANY ACTUAL OR APPARENT CONFLICT WITH THE PRESENT ROLE IS DISCLOSED, ARE REVIEWED BY THE PRESIDENT/CEO AND BOARD CHAIRPERSON. IN THE CASE OF ANY CONFLICT INVOLVING AN ENTITY OR PARTY WITH WHICH HOSPITAL IS DEALING OR COMPETING, THE PERSON WITH THE CONFLICT MAY NOT PARTICIPATE IN ANY DECISIONS REGARDING THAT PARTY. INDIVIDUALS WHO ARE INDEPENDENT CONTRACTORS, OFFICERS, DIRECTORS, OR EMPLOYEES OF OTHER HEALTHCARE FACILITIES IN HOSPITAL'S SERVICE AREA MAY NOT SERVE ON NCH'S OR ANY RELATED ORGANIZATION'S BOARD OR BOARD COMMITTEE. IN ADDITION, THE POLICY INCLUDES A SAMPLE CONFLICT OF INTEREST DISCLOSURE LETTER TO BE USED IF A CONFLICT ARISES AFTER SUBMISSION OF THE ANNUAL QUESTIONNAIRE AND BEFORE THE NEXT. SUCH DISCLOSURE LETTERS WOULD BE REVIEWED AS NOTED ABOVE AT THE TIME THEY ARE RECEIVED. COMPENSATION DETERMINATION PROCESS FOR TOP MANAGEMENT OFFICIAL FORM 990, PART VI, QUESTION 15A THE NOMINATION AND COMPENSATION COMMITTEE OF THE NCH BOARD IS RESPONSIBLE FOR SETTING THE COMPENSATION OF THE PRESIDENT/CEO WHO IS THE TOP MANAGEMENT OFFICIAL. COMPENSATION IS REVIEWED USING AN EXTERNAL COMPENSATION FIRM, PINP, INC. THE REVIEW ALSO UTILIZES COMPARISONS TO SIMILAR ORGANIZATIONS THROUGH REVIEW OF FORMS 990, USE OF COMPARISON STUDIES FROM THE METROPOLITAN CHICAGO HEALTHCARE COUNCIL AND OTHER SOURCES. THE PROCESS IS DOCUMENTED IN THE MINUTES OF THE NOMINATION AND COMPENSATION COMMITTEE. COMPENSATION DETERMINATION PROCESS FOR OFFICERS & KEY EMPLOYEES FORM 990, PART VI, QUESTION 15B THE NOMINATION AND COMPENSATION COMMITTEE OF THE NCH BOARD IS RESPONSIBLE FOR APPROVING THE COMPENSATION OF THE OFFICERS AND KEY EMPLOYEES (VICE PRESIDENTS) OF HOSPITAL BASED ON RECOMMENDATIONS FROM THE PRESIDENT/CEO. THE REVIEW UTILIZES COMPARISONS TO STUDIES FROM THE METROPOLITAN CHICAGO HEALTHCARE COUNCIL AND OTHER SOURCES. THE PROCESS IS DOCUMENTED IN THE MINUTES OF THE NOMINATION AND COMPENSATION COMMITTEE. AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC FORM 990, PART VI, QUESTION 19 GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE NOT MADE PUBLIC. HOSPITAL'S FINANCIAL STATEMENTS ARE INCLUDED IN THE ANNUAL CONSOLIDATED AUDIT REPORT OF NCH AND SUBSIDIARIES. THE CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC VIA THE MUNICIPAL SECURITIES RULEMAKING BOARD'S ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE AT WWW.EMMA.MSRB.ORG. AVERAGE HOURS WORKED PART VII, SECTION A THE FOLLOWING INDIVIDUALS ARE EMPLOYEES OF NORTHWEST COMMUNITY HOSPITAL AND GENERALLY WORK 40 HOURS PER WEEK. A PORTION OF THEIR REGULAR WORK WEEK IS SPENT PROVIDING SERVICES TO NORTHWEST COMMUNITY DAY SURGERY CENTER, INC., NCH AND NORTHWEST COMMUNITY HOSPITAL FOUNDATION, WHICH ARE 501(C)(3) AFFILIATES OF HOSPITAL: BRUCE K. CROWTHER (14 HOURS), MICHAEL B. ZENN (9 HOURS), LEIGHTON SMITH, MD (2 HOURS), STEPHEN O. SCOGNA (9 HOURS), AND DALE BEATTY (2 HOURS). STEPHEN O. SCOGNA, NORTHWEST COMMUNITY HOSPITAL CFO, BEGAN HIS EMPLOYMENT IN APRIL OF 2011. AS SUCH, HIS FY2011 COMPENSATION IS APPROPRIATELY INCLUDED ON FORM 990, PART IX; HOWEVER, HE HAD NO CALENDAR YEAR 2010 COMPENSATION TO REPORT ON FORM 990, PART VII. RECONCILIATION OF NET ASSETS - OTHER CHANGES IN NET ASSETS FORM 990, PART XI, QUESTION 5 OTHER CHANGES IN NET ASSETS: UNREALIZED LOSS ON INVESTMENTS (1,910,317) INTEREST RATE SWAP LOSS (151,878) PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST(9,400,636) RESTRICTED FUNDS TRANSFER - SILVER LINING PROGRAM (34,507) CHANGE IN TEMPORARILY RESTRICTED NET ASSETS 317,364 CHANGE IN PERMANENTLY RESTRICTED NET ASSETS 2,510 ---------- (11,177,464) NORTHWEST COMMUNITY PHYSICIANS ASSN LLC 3060 SALT CREEK LANE ARLINGTON HTS IL 60005 510457240 PATIENT CARE IL 3325001 628745 N/A NCH SERVICE COMPANY LLC 3060 SALT CREEK LANE ARLINGTON HTS IL 60005 263791362 PATIENT CARE IL 1965773 465970 NCPA LLC NORTHWEST COMMUNITY HEALTHCARE 800 WEST CENTRAL ROAD ARLINGTON HTS IL 60005 363125209 SUPPORT ORG IL 501(C)(3) 11 TYPE II NA NORTHWEST COMMUNITY DAY SURGERY CTR INC 675 WEST KIRCHOFF ARLINGTON HTS IL 60005 363540436 OUTPATIENT IL 501(c)(3) 3 NCH NORTHWEST COMMUNITY HOSPITAL FOUNDATION 3060 SALT CREEK LANE ARLINGTON HTS IL 60005 363125193 FUNDRAISING IL 501(c)(3) 7 NCH NPC-CYBERKNIFE LLC 800 WEST CENTRAL ROAD ARLINGTON HEIGHTS IL 60005 204462828 EQUIPMENT LEASING DE NA N/A NORTHWEST COMMUNITY HEALTH SERVICES INC 800 WEST CENTRAL ROAD ARLINGTON HEIGHTS IL 60005 363312906 HEALTHCARE SVCS IL NA C CORP NORTHWEST COMMUNITY CAPCO INC 800 WEST CENTRAL ROAD ARLINGTON HEIGHTS IL 60005 364027717 MANAGED CARE IL NA C CORP 355000 801938 1.00000 NCH CASUALTY INSURANCE SPC LTD 68 WEST BAY ROAD KY1-1102 GRAND CAYMAN CAYMEN ISLANDS CJ 980442062 INSURANCE CJ NA C CORP NCH PHYSICIANS COOPERATIVE 800 WEST CENTRAL ROAD ARLINGTON HEIGHTS IL 60005 201830299 GROUP PURCHASING IL NA C CORP 1.00000 false false true false false false true false false true true false false false false true true false NORTHWEST COMMUNITY CAPCO INC P 239609