HUMBOLDT PARK HEALTH: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- HUMBOLDT PARK HEALTH (EIN 36-1564290)
- Tax period
- 2010-10-01 to 2011-09-30
- Filed
- 2012-08-14
- IRS object ID
- 201222279349303137
- Schema version
- 2010v3.4
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-08-14T15:00:59-05:00 | Timestamp |
| Tax Period End Date | 2011-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCGLADREY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 S WACKER DRIVE STE 800 | AddressLine1 |
| City | CHICAGO | City |
| State | IL | State |
| ZIP Code | 60606 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 361564290 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Norwegian American Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | NORW | NameControl |
| Phone | 7732928200 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1044 North Francisco Avenue | AddressLine1 |
| City | Chicago | City |
| State | IL | State |
| ZIP Code | 60622 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Anthony Evers | Name |
| Title | CFO & CIA | Title |
| Phone | 7732928200 | Phone |
| Date Signed | 2012-08-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | David Faje | Name |
| Phone | 3126343400 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Jose R Sanchez | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1044 North Francisco Avenue | AddressLine1 |
| City | Chicago | City |
| State | IL | State |
| ZIP Code | 60622 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 111718010 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.nahospital.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1935 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | Norwegian American Hospital provides quality and compassionate health care services by partnering with patients, their families, our employees, physicians, and the communities we serve. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 15 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1274 | TotalNbrEmployees |
| Total Nbr Volunteers | 54 | TotalNbrVolunteers |
| Total Gross UBI | 84134 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -64970 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 627714 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 7368620 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 109076880 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 104206058 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 80646 | InvestmentIncomePriorYear |
| Investment Income Current Year | 47198 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 7797 | OtherRevenuePriorYear |
| Other Revenue Current Year | -17670 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 109793037 | TotalRevenuePriorYear |
| Total Revenue Current Year | 111604206 | 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 | 51472391 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 51560570 | 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 | 60157014 | OtherExpensePriorYear |
| Other Expenses Current Year | 57667454 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 111629405 | TotalExpensesPriorYear |
| Total Expenses Current Year | 109228024 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1836368 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2376182 | RevenuesLessExpensesCY |
| Total Assets BOY | 94745926 | TotalAssetsBOY |
| Total Assets EOY | 95583955 | TotalAssetsEOY |
| Total Liabilities BOY | 61138493 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 65863584 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 33607433 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 29720371 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | Norwegian American Hospital provides high quality and compassionate health care services by partnering with patients and their families, our employees, physicians and the communities we serve, "is a direct reflection of the organization's more than 116-year old tradition of caring for its neighbors - people and families who live in the surrounding communities. The mission statement is central to all organization planning. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 87560858 | Expense |
| Revenue | 104206058 | Revenue |
| Description | Norwegian American Hospital is a premier health care provider where the patient comes first. As an organization of caregivers, Norwegian American inspires to consistently high standards of quality, family-centered health care services and cost effectiveness. Norwegian American Hospital seeks to promote wellness within the family and to be dynamic partners in health with the communities it serves. For the fiscal year ended September 30, 2011, Norwegian American Hospital forgone $14,556,719 worth of charges for healthcare services and supplies provided to members of the communities served under its charity care policy. These members did not have the ability to pay for services received. Norwegian American also provided care to patients who are beneficiaries of Medicare, Medicaid, blue cross and managed care reimbursement programs. Reimbursement amounts for these programs are less than charges and in some cases less than cost. For fiscal year 2011, Norwegian American Hospital served 8,705 patients admitted who received 37,177 days of healthcare services. | Description |
| Total Program Service Expense | 87560858 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 171 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1274 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 15 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 1 | LocalChapters |
| Policies Reference Chapters | 1 | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | 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 | Anthony Evers CFO CIA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7732928200 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1044 North Franscisco Ave | AddressLine1 |
| City | Chicago | City |
| State | IL | State |
| ZIP Code | 606222743 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (24 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 | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| Marta Cerda | ||||||||
| Chairwoman | 10.00 | X | X | 0 | 0 | 0 | ||
| Billy Ocasio | ||||||||
| Vice Chairman | 4.00 | X | X | 0 | 0 | 0 | ||
| Sandra Valenzuela | ||||||||
| Secretary | 8.00 | X | X | 0 | 0 | 0 | ||
| Louis Tinajero | ||||||||
| Treasurer | 8.00 | X | X | 0 | 0 | 0 | ||
| Patrick Driscoll | ||||||||
| Member-at-Large | 2.00 | X | 0 | 0 | 0 | |||
| Ibrahim A Majzoub MD | ||||||||
| President of Medical Staff | 2.00 | X | 0 | 0 | 0 | |||
| Duke Miglin | ||||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | |||
| Tochukwu O Onyekwuluje | ||||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | |||
| Hector J Rodriguez | ||||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | |||
| Rafaela Munoz-Ulrich | ||||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | |||
| Carmen C Hovanec | ||||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | |||
| Enrique Lopez | ||||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | |||
| Wilmi Schmidt | ||||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | |||
| John Monteverde | ||||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | |||
| Jose R Sanchez | ||||||||
| President & CEO Ex-Officio | 40.00 | X | X | 65817 | 0 | 0 | ||
| Clare Ranalli Esq | ||||||||
| Counsel | 2.00 | X | 0 | 0 | 0 | |||
| Anthony Evers | ||||||||
| CFO | 40.00 | X | 0 | 0 | 0 | |||
| Duane Fitch | ||||||||
| Interim CFO | 40.00 | X | 0 | 0 | 0 | |||
| Lucy R Hammerberg | ||||||||
| Physician | 40.00 | 308402 | 0 | 18617 | X | |||
| Murali K Vinta | ||||||||
| Physician | 40.00 | 244808 | 0 | 3458 | X | |||
| Maureen Tart Lee | ||||||||
| Physician | 40.00 | 243243 | 0 | 0 | X | |||
| Helio Zapata | ||||||||
| Physician | 40.00 | 237115 | 0 | 5650 | X | |||
| Rosally V Starr | ||||||||
| Physician | 40.00 | 234979 | 0 | 0 | X | |||
| Michael J O'Grady Jr | ||||||||
| Former CEO | 0.00 | 310980 | 0 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1645344 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 27725 | TotalOtherCompensation |
| Number Individuals GT100 K | 56 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Owens & Minor Inc | |||||
| 12199 Collection Center Drive | Chicago | IL | 60693 | Medical & Surgical Products | 1891236 |
| Amerisource Bergen Corp | |||||
| 21978 Network Place | Chicago | IL | 60673 | Pharmaceutical Distribution | 1526870 |
| Cleveland Dovington Partners | |||||
| PO Box 5940 | Carol Stream | IL | 60197 | Staffing Services | 1476659 |
| Krause Construction | |||||
| 3330 Edison Street | Blue Island | IL | 60406 | Construction | 1309704 |
| Humboldt Park Emergency Services | |||||
| 903 Commerice Drive Suite 160 | Oak Brook | IL | 60523 | Emergency Services | 1112197 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 62 | NumberOfContractorsGT100K |
| Related Organizations | 46940 | RelatedOrganizations |
| Government Grants | 7000000 | GovernmentGrants |
| All Other Contributions | 321680 | AllOtherContributions |
| Total Contributions | 7368620 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| Medicare/Medicaid Paym | 621110 | 68994128 | 68994128 | |
| Medicaid Assessment Re | 621110 | 17997156 | 17997156 | |
| Net Patient Services | 621110 | 14131328 | 14131328 | |
| Operating Revenue | 621110 | 2839879 | 2839879 | |
| Dietary Cafe Sales | 900099 | 243567 | $243,567 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 104206058 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 47198 | TotalRevenueColumn |
| Exclusion | $47,198 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 33725 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 113804 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -80079 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -80079 | TotalRevenueColumn |
| Unrelated Business Revenue | 21725 | UnrelatedBusinessRevenue |
| Exclusion | -$101,804 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Info Sys User Fees | Description |
| Business Code | 532420 | BusinessCode |
| Total Revenue Column | 62409 | TotalRevenueColumn |
| Unrelated Business Revenue | 62409 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 62409 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 111604206 | TotalRevenueColumn |
| Related Or Exempt Function Income | 103962491 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 84134 | UnrelatedBusinessRevenue |
| Exclusion | $188,961 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 376797 | Total |
| Program Services | 376797 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43062118 | Total |
| Program Services | 32144797 | ProgramServices |
| Management And General | 10917321 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5096747 | Total |
| Program Services | 3771593 | ProgramServices |
| Management And General | 1325154 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3024908 | Total |
| Program Services | 2298930 | ProgramServices |
| Management And General | 725978 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5628776 | Total |
| Program Services | 4277870 | ProgramServices |
| Management And General | 1350906 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 485576 | Total |
| Program Services | 369038 | ProgramServices |
| Management And General | 116538 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 135996 | Total |
| Management And General | 135996 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3998 | Total |
| Management And General | 3998 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6428591 | Total |
| Program Services | 4885729 | ProgramServices |
| Management And General | 1542862 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51521 | Total |
| Program Services | 39156 | ProgramServices |
| Management And General | 12365 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 169128 | Total |
| Program Services | 128537 | ProgramServices |
| Management And General | 40591 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 982907 | Total |
| Program Services | 747010 | ProgramServices |
| Management And General | 235897 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1771607 | Total |
| Program Services | 1319108 | ProgramServices |
| Management And General | 452499 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1779 | Total |
| Program Services | 1352 | ProgramServices |
| Management And General | 427 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 189123 | Total |
| Program Services | 143733 | ProgramServices |
| Management And General | 45390 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1422445 | Total |
| Management And General | 1422445 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3813276 | Total |
| Program Services | 2898090 | ProgramServices |
| Management And General | 915186 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4059337 | Total |
| Program Services | 3085096 | ProgramServices |
| Management And General | 974241 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Provision for Bad Debt | 10941489 | 10941489 | |
| Medical Supplies | 9109808 | 9109808 | |
| IL Medicaid Tax Assessm | 6433044 | 6433044 | |
| Lease & Rental | 1841381 | 1399450 | 441931 |
| Repairs and Maintenance | 1232751 | 936891 | 295860 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2964921 | Total |
| Program Services | 2253340 | ProgramServices |
| Management And General | 711581 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 109228024 | Total |
| Program Services | 87560858 | ProgramServices |
| Management And General | 21667166 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1269974 | BOY |
| EOY | 7463503 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18439457 | BOY |
| EOY | 12090208 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 7000000 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12521073 | BOY |
| EOY | 11985509 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1177411 | BOY |
| EOY | 1141445 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4527530 | BOY |
| EOY | 3049608 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 114184161 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 78597001 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33048120 | BOY |
| EOY | 35587160 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10167862 | BOY |
| EOY | 6354479 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13594499 | BOY |
| EOY | 10912043 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 94745926 | BOY |
| EOY | 95583955 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8452438 | BOY |
| EOY | 9553977 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9299602 | BOY |
| EOY | 4746520 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22459854 | BOY |
| EOY | 21825392 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 526358 | BOY |
| EOY | 234540 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20400241 | BOY |
| EOY | 29503155 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 61138493 | BOY |
| EOY | 65863584 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31591582 | BOY |
| EOY | 19942936 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2015851 | BOY |
| EOY | 9777435 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33607433 | BOY |
| EOY | 29720371 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 94745926 | BOY |
| EOY | 95583955 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2376182 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -6263244 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 1 | DirectContactLegislators |
| Direct Contact Legislators | $191,552 | DirectContactLegislatorsAmount |
| Rallies Demonstrations | 1 | RalliesDemonstrations |
| Other Activities | 0 | OtherActivities |
| Total Lobbying Expenditures IIB | 191552 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4529913 | OtherCostOrOtherBasis |
| Book Value | 4529913 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 43853973 | OtherCostOrOtherBasis |
| Depreciation | 28648462 | Depreciation |
| Book Value | 15205511 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3112770 | OtherCostOrOtherBasis |
| Depreciation | 3004501 | Depreciation |
| Book Value | 108269 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 59200130 | OtherCostOrOtherBasis |
| Depreciation | 46944038 | Depreciation |
| Book Value | 12256092 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3487375 | OtherCostOrOtherBasis |
| Book Value | 3487375 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 35587160 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (6 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Property Held for Future Use | 1189446 |
| Investment in Joint Venture | 5806312 |
| Due from Affiliates | 260737 |
| Beneficial Interest in Net Assets of Foundation | 2545781 |
| Due from Third-Party Programs | 326097 |
| Investment in Subsidiary | 783670 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 10912043 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (6 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Accrued Malpractice Liability | $9,397,530 |
| Conditional Asset Retirement Obligation | $3,003,625 |
| Net Pension Liability | $15,823,186 |
| Sodexho Capital Lease | $11,118 |
| Due to Third-Party Programs | $1,184,197 |
| Deferred Lease | $83,499 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 29503155 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Description of Uncertain Tax Positions Under FIN 48: | Identifier |
| Return Reference | Part X: | ReturnReference |
| Explanation | The Hospital is a tax-exempt organization under Internal Revenue Code Section 501(c)(3) and, accordingly, no income taxes are provided for in the accompanying consolidated financial statements relating to these organizations. The Hospital files Form 990 (Return of Organization Exempt from Income Tax. When this 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. Examples of tax positions common to health systems include such matters as the following: the tax-exempt status of each entity, the continued tax-exempt status of bonds issued by the obligated group, the nature, characterization and taxability of joint venture income and various positions relative to potential sources of unrelated business taxable income (UBIT). 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. Upon the adoption of the Financial Accounting Standards Board (FASB) - issued guidance at July 1, 2008, and as of each subsequent fiscal year-end, there were no unrecognized tax benefits identified and recorded as a liability. Form 990 filed by the Hospital is subject to examination up to three years from the extended due date of each return. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 600.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4953806 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4953806 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04540 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 95256168 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 101122938 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -5866770 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 100209974 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 101122938 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -912964 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04540 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 304981 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 221789 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 83192 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 957109 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 100927 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 856182 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00780 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1262090 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 322716 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 939374 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00860 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 101472064 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 101445654 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 26410 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05400 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $3,003,381 | BadDebtExpenseAmount |
| Amount Attributable To | 1001327 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 25721561 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 23876533 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 1845028 | 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 | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership | Physicans Profit Or OwnershipPhysicansProfitOrOwnership |
|---|---|---|
| 1 Century PHO Inc | ||
| To obtain and manage contracts with health maintenance organizations | 0.50000 | 0.50000 |
| 2 Family Health Network Inc | ||
| Provider of managed health care services for the indigent under contract wi | 0.20000 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | Norwegian American Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1044 N Francisco | AddressLine1 |
| City | Chicago | City |
| State | IL | State |
| ZIP Code | 60660 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| 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 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| Part I, Line 3c: Norwegian American Hospital uses the FPG to determine free and discounted care. Patients with eligible assets and income above the 200%, but not exceeding 600% of FPG, adjusted for family size, will receive a discount on medically necessary services provided to them, based upon a sliding scale established by hospital policy. | ||
| Part I, Line 6a: Norwegian American Hospital prepared an annual Community Benefit Report which is submitted to the Attorney General of the State of Illinois. | ||
| Part I, Line 7: The costing methodology used to calculate the amounts reported in the table is the cost-to-charge ratio derived from the IRS's Schedule H, Worksheet 2. | ||
| Part I, Line 7g: Norwegian American Hospital did not include any costs attributable to a physician clinic as Subsidized Health Services. | ||
| Part I, L7 Col(f): There was a total of bad debt expense of $9,941,492 subtracted from total expenses. | ||
| Part II: In addition to providing quality inpatient and outpatient services, Norwegian American Hospital reaches beyond its walls and into communities through an array of activities and programs designed and delivered to benefit the communities it serves. These community benefits include: - Care that is provided free, subsidized or without full reimbursement from Medicare, Medicaid or other government insurance programs. -Services responding to unique community needs, such as diabetes services, emergency care, behavioral health services, substance Abuse, Pediatric Care-A-Van; as well as health screenings, immunization programs, school-based health care and other community outreach programs. -Education to train physicians, nurses, radiology technicians, and other highly skilled health care professionals. -Volunteer services provided by hospital employees who volunteer in their communities and community members who volunteer at the hospital.-Language-assistance services, such as translators, signage, forms, brochures, patient education materials and other information in languages other than English. -Donations by Norwegian American Hospital of meeting and clinic space, as well as other assistance to community groups. | ||
| Part III, Line 4: The cost methodology used to calculate the amount reported as Bad Debt Expense, at cost, is the cost-to-charge ratio derived from the IRS's Schedule H, worksheet 2.Audited Financial Statements footnote regarding bad debt expense: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 from third-party payors 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 patients are carried at the original charge for the service provided less discounts provided under the Hospital's charity care policy, less amounts covered by third-party payors and less an estimated allowance for doubtful receivables. Management determines the allowance for doubtful accounts by identifying troubled accounts and by historical experience applied to an aging of accounts. The Hospital considers accounts past due when they are outstanding beyond 45 days with no payment. The Hospital generally does not charge interest on past due accounts. Patient receivables are written off as uncollectible accounts expense when deemed uncollectible. Recoveries of receivables previously written off are recorded as a reduction of uncollectible accounts expense when received. Receivables or payables related to estimated settlements on various contracts in which the Hospital participates are reported as amounts due from or to third-party programs. | ||
| Part III, Line 8: Costing Methodology used is the Medicare cost report which utilizes a step-down method of cost allocation.This order of allocation for overheads has been predetermined by Medicare and is printed out on the cost report.The most common overhead is allocated first to all other overheads and the patient care cost centers.Then that cost center is closed and the next most common overhead is allocated.This is continued until all the overheads are allocated out. | ||
| Part VI, Line 2: Norwegian American Hospital's Community Benefit Plan was developed to establish strategies for improving access to care and positively affecting the health of the communities that it serves. Additionally, the Plan sets the course for strengthening existing partnerships and building new ones with individuals and organizations within Norwegian American Hospital's primary service areas in order to leverage and maximize the impact of its programs. Development of the plan is derived through the Strategic Planning of Norwegian American Hospital's Board of Trustees and through organizational involvement in community partnerships. The goals developed for planning community services involved meeting with physicians and community partners to determine where the gaps of care and services could be filled through Norwegian American Hospital involvement. In developing its Community Benefits Plan, Norwegian American Hospital set the following goals:1) Serve as a catalyst/convener for the Obesity and Diabetes initiatives in Humboldt Park2) Host community-based education events such as ESL, life skills training, job seeking skills, etc. 3)Promote initiatives that enhance access to health care for the uninsured and underinsured. 4)NAH Leadership to assume an active role in community based organizations Boards, Task Forces and Community Events | ||
| Part VI, Line 3: Norwegian American Hospital informs and educates patients and persons, who may be billed for patient care, about their eligibility for assistance under federal, state or local government programs or under the organization's charity care policy on its intranet and through flyers. | ||
| Part VI, Line 4: Norwegian American Hospital serves a Primary Community Area and a Secondary Community Area. The Primary Community Area consists the following areas, zip codes and population: -Austin-Belmont-Cragin-Hermosa-Humboldt Park-Logan Square-West Town-Avondale-Irving Park-North Center-East Garfield Park-West Garfield Park-North Lawndale Park White Hispanic African-AmericanPrimary Zip Codes Population - Perecentage60618 26,023 37% 42,597 60% 2,392 3%60622 15,379 40% 18,385 48% 4,634 12%60624 1,032 4% 244 1% 25,798 95% 60639 6,124 7% 60,432 74% 15,295 19%60647 14,923 21% 51,598 73% 4,173 6% 60651 2,703 14% 16,294 83% 708 4%The Primary Secondary Area consists the following areas, zip codes and population: -Archer Heights-Brighton Park-Gage Park-Garfield Ridge-West Elsdon-South Lawndale-Portage Park-Pullman White Hispanic African-AmericanSecondary Zip Codes Population - Perecentage60612 5,071 24% 2,800 13% 13,682 63%60623 1,175 1% 58,174 67% 27,111 31% 60628 2,252 3% 1,838 3% 66,955 94%60632 13,641 20% 49,881 75% 3,323 5%60641 28,875 54% 23,567 44% 1,025 2%60644 2,057 5% 598 1% 38,526 94%60804 10,122 17% 48,680 81% 1,245 2%Norwegian American Hospital's Age for fiscal year 2011 was as follows:Age %0 16%1-19 4%20-64 68%65-84 11%85-99 2%100+ 0%Norwegian American Hospital's Race and Ethnicity for fiscal year was as follows:Race %American Indian or Alaska 0%Asian 1%Black or African American 43%White 10%Other 46%EthnicityHispanic 47%Non-Hispanic 53% | ||
| IL | Reports Filed With States | Part VI, Line 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lucy R Hammerberg | |||||||||||||
| 308402 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 18617 | 0 | 327019 | 0 | 0 | 0 |
| Murali K Vinta | |||||||||||||
| 244808 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 3458 | 0 | 248266 | 0 | 0 | 0 |
| Maureen Tart Lee | |||||||||||||
| 243243 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 243243 | 0 | 0 | 0 |
| Helio Zapata | |||||||||||||
| 237115 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 5650 | 0 | 242765 | 0 | 0 | 0 |
| Rosally V Starr | |||||||||||||
| 234979 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 234979 | 0 | 0 | 0 |
| Michael J O'Grady Jr | |||||||||||||
| 0 | 0 | 0 | 0 | 310980 | 0 | 0 | 0 | 0 | 0 | 310980 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | Part I, Line 4a | ReturnReference |
| Explanation | Michael J. O'Grady, Jr. received a severance payment in the amount of $310,980 | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| Illinois Finance Authority Revenue Bonds Series 2008 | |||||||
| 861091967 | 45200FMQ9 | 2008-08-15 | 4500000 | See Part V | 0 | 0 | 0 |
| Illinois Finance Authority Revenue Bonds Series 2008 | |||||||
| 861091967 | 45200FMS5 | 2008-08-15 | 5000000 | See Part V | 0 | 0 | 0 |
| Illinois Finance Authority Revenue Bonds Series 2008 | |||||||
| 861091967 | 45200FMT3 | 2008-08-15 | 14450000 | See Part V | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)
| Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Refunding EscrowRefundingEscrow | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|---|
| 4500000 | 798333 | 1159612 | 157619 | 2384436 | 2008 | 1 | 0 | 1 | 1 |
| 5000000 | 798334 | 1159612 | 157619 | 2884435 | 2008 | 1 | 0 | 1 | 1 |
| 14450000 | 798333 | 1159311 | 157620 | 12334436 | 2008 | 1 | 0 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 | 0 |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Schedule K, Part I, Line A, B, and C Column (f) - Description of Purpose: | Identifier |
| Explanation | The Series 2008 bond proceeds, together with other available funds, were used to refund the outstanding principal amounts of certain bonds in the amount of $3,467,000, to pay or reimburse the Hospital for the payment of the cost of acquiring, constructing and equipping certain of the Hospital's health care facilities, to fund a debt service reserve fund for the benefit of the Series 2008 bonds, and to pay certain expenses incurred in connection with the issuance of the Series 2008 bonds. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sibery Group | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | Duane Fitch, Interim CFO, is a member of the Sibery Group | Relationship |
| Amount Of Transaction | 1487062 | AmountOfTransaction |
| Description Of Transaction | Consulting Fee | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section B, line 11 | The Form 990 is reviewed by members of the Fiscal Service department, followed by a review of the Chief Financial Officer and the Chief Executive Officer. | |
| All Trustees, Officers, and key employees and key physicians (as defined in the Board's Conflict of Interest Policy) of the Corporation are subject to the conflict of interest policy. In addition, all independent contractors who provide services and/or materials to the Corporation in exchange for $20,000 or more in payment during any fiscal year shall be subject to these provisions. All persons subject hereto shall be hereinafter referred to as "Covered Persons." The Chief Executive Officer of the Corporation is responsible for publicizing the provisions of this Article to the persons affected thereby. No person shall become a Trustee, Officer, or Employee or Medical Department Director of the Corporation without first acknowledging in writing to the Corporation that he or she has reviewed, fully understands and is in compliance with the provisions of the conflict of interest policy All Covered Persons shall promptly disclose to the Board of Trustees of the Corporation all substantive potential conflicts of interest which such person discovers or which is brought to his or her attention. Such disclosure shall include submission to the Board of a written statement of the facts surrounding the conflict of interest and an opportunity to make a brief oral statement to the Board with respect to the matter in question. An annual disclosure statement shall be circulated to all Covered Persons to assist them in considering such disclosures. Nevertheless, prompt disclosure notices of conflict shall be filed with the President of the Corporation or any other person designated by him from time to time to receive such notifications. All disclosure notices received hereunder shall be noted for record in the minutes of a meeting of the Board of Trustees. The presence of the Trustee who is directly or indirectly a party to the transaction in question or a Trustee who is otherwise not disinterested may be counted in determining whether a quorum is present for the purpose of the meeting, but shall not be present or have a vote when the Board of Trustees or a committee of the Board discusses and takes action on the transaction. | Form 990, Part VI, Section B, line 12c | |
| In order to determine the pay level of an executive employee, Norwegian American Hospital utilizes wage data from a variety of sources including Metropolitan Chicago Health Care Council, Integrated Healthcare Services and Sullivan and Cotter. Compensation rates are determined based on the relevant experience and education of the candidate as compared to average survey ranges. Additional information on market conditions is obtained as needed via other published sources. Executive Recruitment firms, if engaged, can provide data regarding the market rates for executives with comparable experience and assist in establishing total compensation packages during the offer process. | Form 990, Part VI, Section B, line 15 | |
| Norwegian American Hospital, Inc makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. | Form 990, Part VI, Section C, line 19 | |
| Changes in Net Assets or Fund Balances: | Income from Centennial Medical Management Corp. 328,022. Income from investments in joint ventures 348,972. Pension related changes, other than net periodic pension cost -7,470,168. Foundation Net Income 661,584. Interfund Transfer -131,654. Total to Form 990, Part XI, Line 5: -6,263,244. | Form 990, Part XI, line 5: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Norwegian American Hospital Foundation | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1044 North Francisco Ave | AddressLine1 |
| City | Chicago | City |
| State | IL | State |
| ZIP Code | 60622 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363257131 | EIN |
| Primary Activities | Supporting Foundation | PrimaryActivities |
| Legal Domicile State | IL | LegalDomicileState |
| Exempt Code Section | 501(c)(3) | ExemptCodeSection |
| Public Charity Status | Line 11a, I | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Norwegian American Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | ControlledOrg |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Centennial Medical Management Corporation | |||||||||||
| 1044 North Francisco Ave | Chicago | IL | 60622 | 363394548 | Outpatient Pharmacy | IL | N/A | C | 292747 | 1011002 | 1.00000 |
| Century PHO Inc | |||||||||||
| 1029 North Sacramento Ave | Chicago | IL | 60622 | 363935696 | Health Care Services | IL | N/A | C | 5379 | 1304416 | 0.50000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 1 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Century PHO Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | E | TransactionType |
| Amount Involved | 54991 | AmountInvolved |
| Method Of Amt Determination | Book Value | MethodOfAmtDetermination |
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