2012-05-15T09:37:17-05:00 2011-06-30 McGladrey LLP 1 S Wacker Dr Suite 800 Chicago IL 60606 990 2010-07-01 362170133 Holy Cross Hospital HOLY 7738841604 2701 West 68th Street Chicago IL 60629 Michael Lawrence 7738841604 2012-05-15 1 Zack Fortsch 3126343400 2010 2016-02-24 21:20:13Z Wayne Lerner 2701 West 68th Street Chicago IL 60629 117376544 0 0928 X www.HolyCrossHospital.org X 1928 IL Holy Cross Hospital (HCH or the Hospital) is a Catholic Health Care Organization sponsored by the Sisters of Saint Casimir. By our commitment to witness to the healing mission of Jesus, we contribute to healthy communities and promote quality health care to all with compassion. 13 11 1092 20 0 0 1115870 584498 109389667 114975146 280643 170396 968620 1374833 111754800 117104873 0 0 0 0 52492687 55556350 0 0 56737 58616630 59666506 111109317 115222856 645483 1882017 81348173 70478447 62845912 36556814 18502261 33921633 The Hospital is a Catholic Health Care Organization sponsored by the Sisters of St. Casimir. By our commitment to witness to the healing mission of Jesus, we contribute to healthy communities and promote quality health care to all with compassion. 0 0 107377419 115885052 The Hospital is a not-for-profit Catholic hospital that serves a large area of Chicago's Southwest side. Located in Marquette Park, the Hospital provides emergency, medical/surgical, specialty, diagnostic and primary care services to communities that are home to mostly African American and Latino families. Many of the patients the Hospital serves are uninsured or underinsured. The emergency department sees an average of 50,000 patients per year and have more ambulance daily visits than any other Illinois hospital. The Hospital is a Disproportionate Share Hospital and is a vital safety net hospital. 107377419 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 97 0 1 1092 1 0 0 0 0 0 1 1 0 0 0 0 X 13 11 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X Michael Lawrence CFO 7738845150 2701 West 68TH Street Chicago IL 60629 Wayne Lerner 40.00 X X 509001 0 11866 Diane Howard 0.50 X X 0 0 0 John R Ball MD JD MACP 0.50 X X 0 0 0 Anthony Bozzano MD 0.50 X 0 0 0 Sister Regina Marie Dubickas 0.50 X X 0 0 0 Sr Theresa Dabulis 0.50 X 0 0 0 Barbara Fahey 0.50 X 0 0 0 Chia Huang MD 0.50 X 0 0 0 Larry Margolis 0.50 X 0 0 0 Nancy Streitmatter MD 40.00 X 150010 0 5869 Sivaramaprasad Tummala MD 0.50 X 0 0 0 Sister M Immacula Wendt 0.50 X 0 0 0 Sister Margaret Zalot 0.50 X 0 0 0 Michael Lawrence 40.00 X 329996 0 8641 Paul Teodo 40.00 X 220496 0 6525 Shelia Mischke 40.00 X 193745 0 6211 Dennis Ryan 40.00 X 169809 0 5771 Cathy Kallal 40.00 X 275000 0 3953 Sr Juline Revas 40.00 X 146513 0 4230 Anna Carvalho 40.00 X 147817 0 2476 Solomon Greer MD 40.00 X 240529 0 7006 Justin McCarthy 40.00 X 143998 0 2749 Kenneth Pelehac 40.00 X 180192 0 6248 2707106 0 71545 44 0 1 0 Professional Nursing Inc 325 N Wells Street 9th Floor Chicago IL 60610 Medical Services 2040377 Rehabcare Group Inc POBox 502096 St Louis MO 63150 Medical Services 1943138 Noel Alcantara MDSC PO Box 2909 Darien IL 60561 Medical Services 1665920 Aramark Servicemaster 25271 Network Place Chicago IL 60673 Support Services 1384182 Superior Health Linens LLC 2905 Syene Road Madison WI 53713 Support Services 900516 23 71881 156958 355659 584498 Medicare/Medicaid 624100 79813167 79813167 Net Patient Revenue 624100 35161979 35161979 114975146 195043 195043 648368 183441 464927 464927 464927 6800 31447 -24647 -24647 -24647 56783 71881 56783 0 Cafeteria 621400 321083 321083 Parking 621400 103066 103066 485757 485757 909906 117104873 115885052 0 635323 2142377 2142377 44934874 42599200 2335674 248653 229507 19146 4944856 4564102 380754 3285590 3092383 193207 1368562 1368562 136806 136806 14880500 14163742 716758 4142 4142 2246398 2219191 27207 13523 11279 2244 24871 14905 9966 215505 215505 5511261 5511261 3709520 3709520 Medical Supplies 11912015 11912015 Provision for Bad Debt 9860018 9860018 Medicaid Assessment 5509291 5509291 Food 804804 746668 58136 Membership 145997 2091 143906 3323293 3012599 253957 56737 115222856 107377419 7788700 56737 7708748 4921220 14476032 9391489 225279 104206 12321545 10807555 3000 1582688 1625775 906913 531108 131857642 94758818 40590453 37098824 2971590 5158389 561925 839881 81348173 70478447 16180473 15599799 12625000 1973841 1513053 32066598 19443962 62845912 36556814 X 17285406 33258171 1216855 663462 18502261 33921633 81348173 70478447 X 1882017 13537355 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 201042 0 1 29699 230741 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: $29,699 represented 32% of the American Hospital Association and Illinois Hospital Association membership dues that are allocable to lobbying activities. 1337233 1337233 52957624 31429631 21527993 75738165 61954764 13783401 1824620 1374423 450197 37098824 Investments Designated Under Debt Agreements 1340445 F Investments Designated Under Workmen's Compensation Agreements 543971 F Other Investments 100000 F Investments Designated Under Self-Insurance Trust Agreement 3173973 F 5158389 Accrued Pension Benefit 14836940 Reserve for Professional Liability 4607022 19443962 Description of Uncertain Tax Positions Under FIN 48: Part X: The Hospital has received a determination letter from the Internal Revenue Service stating that it is exempt from the payment of federal income taxes under Section 501(c)(3) of the Internal Revenue Code. The Hospital files a Form 990 (Return of Organization Exempt from Income Tax) annually. When the return is filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. UBIT is reported on Form 990T, as appropriate. The benefit of a tax position is recognized in the consolidated financial statements in the period during which, based on all available evidence, management believes that it is more likely than not that the position will be sustained upon examination, including the resolution of appeals or litigation processes, if any. Tax positions are not offset or aggregated with other positions. Tax positions that meet the "more likely than not" recognition threshold are measured as the largest amount of tax benefit that is more than 50 percent likely to be realized on settlement with the applicable taxing authority. The portion of the benefits associated with tax positions taken that exceeds the amount measured as described above is reflected as a liability for unrecognized tax benefits in the accompanying consolidated balance sheets along with any associated interest and penalties that would be payable to the taxing authorities upon examination. Annual Fundraising Dinner 128664 71881 56783 2500 6961 39837 3000 4485 128664 71881 56783 2500 6961 39837 3000 4485 56783 0 1 1 1 X 1 X 150.000000000000 1 1 1 0 1 1 5250344 5250344 0.04560 34417113 36492393 -2075280 0.00000 39667457 36492393 3175064 0.04560 16358 16358 0.00010 16358 16358 0.00010 39683815 36492393 3191422 0.04570 1 2620000 2451799 47018884 40468437 6550447 X 1 1 1 1 Holy Cross Hospital

2701 W 68TH Street Chicago IL 60629

X X X X NA 1 1 Archer Clinic

at 6084 S Archer Chicago IL 60638

OP clinic Part I, Line 7: A cost to charge ratio, calculated using the IRS worksheet, was used for the Part I, Line 7 table. Part I, L7 Col(f): Bad debt expense of $9,860,018 was included on Form 990, Part IX, Line 25, column A but subtracted from the total expenses for purposes of calculating the percentage in this column. Part III, Line 4: The collection of receivables from third-party payors and patients is the Hospital's primary source of cash for operations and is critical to its operating performance. The primary collection risks relate to uninsured patient accounts and patient accounts for which the primary insurance payor has paid, but patient responsibility amounts (deductibles and copayments) remain outstanding. Patient receivables, where a third-party payor is responsible for paying the amount, are carried at a net amount determined by the original charge for the service provided, less an estimate made for contractual adjustments or discounts provided to third-party payors. Patient receivables due directly from the patients are carried at the original charge for the service provided less amounts covered by third-party payors, discounts for patients that are uninsured and an estimated allowance for doubtful receivables. Management estimates this allowance based on the aging of its accounts receivable and its historical collection experience for each payor type. Recoveries of receivables previously written off are recorded as a reduction of bad debt expense when received. Using the cost to charge ratio of 28.8%, the cost of bad debt is approximately $2,620,000. The past due status of receivables is determined on a case-by-case basis depending on the payor responsible. Interest is generally not charged on past due accounts. Prior to writing-off the amounts as bad debts expense, the Hospital's Patient Financial Services department reviews the self-pay balances. Where the patient has chosen not to cooperate with our charity care policy, the Hospital utilizes a program that accesses the patients' credit information and identifies patients that qualify for charity care under our policy. These reports show that over 90% of all uninsured patients and patients with a self-pay balance after insurance payment qualify for charity care. The estimated amount of bad debt expenses at cost attributable to patients eligible under the Hospital charity care policy is estimated to be $2,451,800. Part III, Line 8: Medicare costs are allocated in accordance with Medicare regulations. Part III, Line 9b: The Hospital's policy is to provide those who are indigent, as defined by Regionally Adjusted Federal Poverty Guidelines, with Charity Care or Partial Charity Care to relieve the financial burden associated with medically necessary treatment. The Hospital's policy establishes appropriate procedures for providing free care to qualified patients. It also serves to ensure compliance with all applicable federal, state, and local laws. The Financial Aid policies are available to all of the Hospital's indigent patients, who may be uninsured, underinsured or have suffered a catastrophic injury. The Hospital's Self-pay Debt Reduction Policy provides uninsured, underinsured, low-income and medically indigent patients with debt reduction provisions in order to alleviate the burdensome financial obligations associated with receiving acute and unexpected medical care. Part VI, Line 2: The Hospital uses various methods to access the health care needs of the community it serves. Important information is gathered from the census updates, Illinois Department of Healthcare and Family Services, the Department of Public Health, Cook County Department of Public Health, City of Chicago Department of Public Health, University of Chicago Urban Health Initiatives, churches, community organizations and advocacy groups. Because of the Hospital's close relationship with leaders of the new communities program and the commissioner of the City of Chicago Department of Health, the Hospital was instrumental in establishing the Healthy Chicago Lawn advocacy coalition. The Hospital sponsors the Healthy Chicago Lawn administrative office and coalition mettings. The Hospital has served as the host site and primary health resource for the majority of Healthy Chicago Lawn Coalition's planning, education and advocacy initiatives. Healthy Chicago Lawn has promoted the development of many relational, educational and promotional health awareness activities in the Chicago Lawn community. As a result of the partnership and host status with Healthy Chicago Lawn, the Hospital has become more accessible to community groups and residents. There has been an increased awareness of the services provided by the Hospital as a result of these partnerships with community organizations. Leadership staff of the Hospital serve on the steering committee of Healthy Chicago Lawn.Since the inception of Healthy Chicago Lawn, there has been a positive and productive synergy between the Coalition and the Hospital to improve health awareness which has resulted in positive health outcomes in the communities served by the Hospital. The Hospital also assesses the needs of the community through the Parish Nurse program. Community Outreach nurse attend church meetings where information is received about the sick parishioners at home and in nursing homes. There are three large Catholic churches in the community that have a formal HCH Parish Nurse program. The Hospital has designated a nurse to service these churches. The nurse conducts blood pressure screenings and health assessments for 100 regular parishioners. New parishioners, who are uninsured, are assisted with referrals. Also, home visit arrangements are made for at risk seniors. The Hospital also has a volunteer team at churches to assist with health fairs and health education events, such as the MERCK Pharmaceuticals sponsored diabetes education program for the Latino community. Another source for assessing the health care needs of the community is through membership in community organizations. Community groups have requested that the Hospital's health care professionals join their boards and assist with the direction of their advocacy and policies. Unpaid Hospital staff have become members of board of these organizations, which has helped the Hospital identify the needs of the community and in turn communicate to the leadership of these organizations the resources the Hospital can provide to them. Part VI, Line 3: The Hospital has posted in the Inpatient and Outpatient Admission areas and on its website the notice of its Charity Care Policies. This includes taking steps to ensure that Charity Care literature, Brochures and Applications Forms for Charity Care are readily accessible to patients at the Hospital's key locations. Notification of the availability of charity care is also printed on patient statements. Financial Counselors are located on campus that review the patient census for inpatient, outpatient and surgical areas to assist in-house patients identify the availability of potential insurance coverage and assist them with completing financial aid paperwork. At the earliest time feasible, HCH personnel obtains the necessary patient financial records and documentation regarding eligibility for any and all types of alternative funding to expedite processing of patient charity care applications. Part VI, Line 4: The Hospital has a primary service area ("PSA") consisting of six ZIP code areas with a population of 451,000, and a secondary service area ("SSA") consisting of five additional ZIP code areas with a population of 271,000. The entire PSA/SSA is located in the City of Chicago. For the fiscal year ended 6/30/2011, 71% of the patients admitted to the Hospital were African American and 12% were Latino. Also only 13.2% of the patients admitted to the Hospital were covered by private health insurance, with 76.8% being covered through public sector programs (primarily Medicaid and Medicare). Approximately 6.3% of the Hospital's patients are classified as charity care. The Hospital's admissions are initiated to a very substantial extent (at least 72%) through the Hospital's Emergency Department. According to the Illinois Department of Public Health, the Hospital accepts more EMS transports than any other Hospital in Illinois - three times as many as John H. Stroger Hospital (formerly Cook County Hospital), the largest component of the health care services safety net for public sponsored health care in Chicago. As demonstrated by the insurance and admission status of its patient population, the Hospital has provided, and continues to provide necessary medical services to an underserved and underinsured community population that is heavily minority and poor. In fact, the PSA has experienced the second highest rate of foreclosures as compared to similar areas throughout the state. Finally, three of the zip codes in the PSA rank as the 1st, 2nd and 6th lowest average health status in all of Chicago. Part VI, Line 6: Parish Nurse Program - Through the Hospital's Parish Nurse Program, the Hospital has dedicated a nurse to conduct blood pressure screenings and ongoing health assessments for approximately 100 regular parishioners. The nurse also attends church meetings where she receives information about the sick parishioners at home and in nursing homes. Arrangements are made to assist the sick parishioners. The hospital participates with seven catholic churches in conducting health education workshops and assist the uninsured with referrals.Senior Groups - There are approximately 30 senior groups that meet once a month for diagnostic testing, health assessments and health education. Most of these seniors are in their 80's and 90's and the Hospital assists them with having ongoing physician appointments and helping them with their medical needs.Vaccine for Children Program with CDPH - The Hospital works closely with grade school and high school nurses in the community. The purpose of this program is to assist children who are in need of recommended immunizations to remain in school. Vaccines are administered during school hours. Most of these children are on Medicaid or have no insurance. The vaccines are obtained from CDPH and the parents are not charged for administering the vaccines. The Hospital also documents in the state I CARE REGISTRY all immunizations given and assists the school nurses with medical immunizations by verifying the student's immunizations found in the state system.Community Health Fairs - The Hospital's representatives attend community group events and fairs. The Hospital provides free health screenings and health education materials at these events. On average, there are approximately 45 events per year.Influenza Program - The Hospital was involved in flu immunizations for the community during the year. These flu shots were administered at senior group meetings, churches and health fairs for community groups.Hospital Referrals for At Risk Seniors - Under this program, in certain situations, the Hospital's health care professional will make a home visit to asses an at risk senior's living situation after discharge from the Hospital.Participation in Community Health Speakers Bureau - The Hospital's health care professional participate in promoting healthy lifestyles by volunteering to be speakers whenever Community and civic groups ask for assistance in having a speaker for their events. Reports Filed With States Part VI, Line 7 IL X 1 1 X X X X 0 0 0 0 0 0 0 0 0 Wayne Lerner 489001 0 20000 0 0 0 2450 0 9416 0 520867 0 0 0 Nancy Streitmatter MD 150010 0 0 0 0 0 1500 0 4369 0 155879 0 0 0 Michael Lawrence 274996 0 55000 0 0 0 2450 0 6191 0 338637 0 0 0 Paul Teodo 209996 0 10500 0 0 0 2100 0 4425 0 227021 0 0 0 Shelia Mischke 184995 0 8750 0 0 0 1850 0 4361 0 199956 0 0 0 Dennis Ryan 150009 0 19800 0 0 0 1500 0 4271 0 175580 0 0 0 Cathy Kallal 260000 0 15000 0 0 0 2600 0 1353 0 278953 0 0 0 Sr Juline Revas 139813 0 6700 0 0 0 0 0 4230 0 150743 0 0 0 Anna Carvalho 141317 0 6500 0 0 0 1413 0 1063 0 150293 0 0 0 Solomon Greer MD 240529 0 0 0 0 0 2405 0 4601 0 247535 0 0 0 Kenneth Pelehac 180192 0 0 0 0 0 1802 0 4446 0 186440 0 0 0 Part I, Line 1a HCH pays for the social club dues of Wayne Lerner. The social club is used for hospital business and the expense is not included in his compensation. Form 990, Part VI, Section A, line 6 The members of the Hospital are the General Superior and the members of the General Council of The Sisters of Saint Casimir. Form 990, Part VI, Section A, line 7a The members of the Hospital have the exclusive power to appoint and remove, with or without cause, the Trustees of the Hospital and establish terms for such Trustees consistent with these Bylaws; and to remove the Officers of the Hospital. Form 990, Part VI, Section A, line 7b The Members have the exclusive power to: (a) Adopt, alter, amend and repeal statements of mission, philosophy or purpose; (b) Amend or repeal the Bylaws or Articles of Incorporation of the Hospital and to adopt new Bylaws or Articles of Incorporation of the Hospital; (c) Select auditors and legal counsel different from those retained by the Hospital. To provide independent review, counsel, audit, advice or representation to the extent deemed necessary in the discretion of the Members; (d) Acquire and/or dispose of, mortgage or otherwise encumber or hypothecate the Hospital's real property; and (e) Reserve the exercise of such rights as the Members deem necessary to ensure consistency with the mission and philosophy of the Sisters of Saint Casimir, or to comply with applicable law (civil or church). Form 990, Part VI, Section B, line 11 The Form 990 is prepared by our tax advisors based on information provided by HCH's accounting department. The Form 990 is reviewed by the Controller and the CFO. Form 990, Part VI, Section B, line 12c Conflict of Interest statements are completed by members of the Board and senior management each year. The Executive Committee follows up on any conflict of interest which is brought to its attention whether from an executive, an employee or a Board member. They would investigate and decide on an action plan which could either resolve the conflict or assure that it would not interfere with the operations of the Hospital. At the present time, no members of the Board or senior management team have any involvement with the hospital which could be seen as a conflict of interest. Form 990, Part VI, Section B, line 15 The Executive Committee acts as the Compensation Committee of the Board. Their actions are documented in committee minutes in the customary fashion. They act on all recommendations for changes in compensation as presented by the President/CEO. Form 990, Part VI, Section C, line 19 Copies of all governing documents (except those relating to executive sessions) are available upon request. Individuals should make inquiries through the Office of the President/CEO. Once requested and upon the approval of the Board Chair, documents would be made available for review. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -26,027. Change in Minimum Pension Liability 13,699,515. Temporarily Restricted Contributions -136,133. Total to Form 990, Part XI, Line 5: 13,537,355. The Sisters of St Casimir 2601 W Marquette Rd Chicago IL 60629 362170966 Religious order IL 501(c)(3) 1 N/A 0 Holy Cross Health Partners Inc 2701 West 68TH Streer Chicago IL 60629 364109153 CONTRACTING AND CLAIMS ADMINISTRATION IL HOLY CROSS HOSPITAL C 1226773 1.00000 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 Holy Cross Health Partners Inc K 778380 FMV Holy Cross Health Partners Inc P 72000 FMV Holy Cross Health Partners Inc C 300000 FMV