2012-04-09T11:59:35-05:00 2011-05-31 MCGLADREY & PULLEN LLP ONE SOUTH WACKER DR SUITE 800 CHICAGO IL 60606 990 2010-06-01 362222696 SWEDISHAMERICAN HOSPITAL SWED 8159662087 1401 E STATE STREET ROCKFORD IL 611042298 WILLIAM GORSKI 8159662087 2012-04-06 1 ZACK FORTSCH 3126343400 2010 2016-02-24 21:20:13Z WILLIAM GORSKI MD 1313 EAST STATE ST ROCKFORD IL 61104 562138035 0 X WWW.SWEDISHAMERICAN.ORG X 1911 IL THROUGH EXCELLENCE IN HEALTHCARE AND COMPASSIONATE SERVICE, WE CARE FOR OUR COMMUNITY. 25 15 3397 394 865793 582809 1517458 6278731 407756569 430571829 4763472 7698068 6179586 6117475 420217085 450666103 997867 912995 0 0 193172438 206687231 0 0 0 212707417 227479413 406877722 435079639 13339363 15586464 414750554 443747620 196678144 202281926 218072410 241465694 X THROUGH EXCELLENCE IN HEALTHCARE AND COMPASSIONATE SERVICE, WE CARE FOR OUR COMMUNITY. 0 0 261460913 870995 342926250 SWEDISHAMERICAN HOSPITAL OPERATES TWO FULL SERVICE ACUTE CARE HOSPITALS WITH 386 LICENSED BEDS, AND SERVES A 12 COUNTY AREA. OUR VISION IS TO DEVELOP A FULLY INTEGRATED HEALTHCARE DELIVERY NETWORK THAT WILL CONTINUOUSLY SET THE STANDARD FOR QUALITY CARE AND SERVICE, ACCEPT RESPONSIBILITY FOR BUILDING A HEALTHIER POPULATION, PROVIDE REGIONAL ACCESS, IMPROVE RESOURCE UTILIZATION THROUGH COLLABORATION WITH KEY STAKEHOLDERS, AND MANAGE PATIENT CARE AND OUR RESOURCES IN SUCH A WAY THAT WE CREATE VALUE FOR OUR PATIENTS AND BENEFIT FOR OUR COMMUNITY. DURING 2011 WE CARED FOR 19,918 INPATIENTS AND PERFORMED 681,176 OUTPATIENT PROCEDURES. THIS INCLUDES 72,276 EMERGENCY ROOM VISITS AND 2,433 DELIVERIES. WE SPONSOR THE UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE PROGRAM AND PROVIDED $4.7 MILLION IN EDUCATION FOR PRIMARY CARE RESIDENTS. WE PARTICIPATE IN THE ILLINOIS EXCELLENCE IN ACADEMIC MEDICINE PROGRAM AND THE NATIONAL SURGICAL ADJUVANT BREAST AND BOWEL PROJECT, WHICH ARE GOVERNMENT SPONSORED RESEARCH. OUR EMPLOYEES AND VOLUNTEERS PROVIDED OVER 34,000 HOURS IN UNPAID COMMUNITY SERVICES. SWEDISHAMERICAN RECOGNIZES ITS RESPONSIBILITY TO ALL THE PEOPLE OF OUR COMMUNITY, REGARDLESS OF THEIR ABILITY TO PAY FOR CARE. 74160209 0 84271474 SWEDISHAMERICAN HOSPITAL EMPLOYS PRIMARY CARE AND SPECIALTY PHYSICIANS WHO PRACTICE AT 18 LOCATIONS THROUGHOUT OUR SERVICE AREA. WE EMPLOY SPECIALISTS IN ORTHOPEDICS, CARDIOLOGY, CARDIOTHORACIC SURGERY, NEUROLOGY, NEUROSURGERY, PULMONOLOGY/CRITICAL CARE, ONCOLOGY, OBSTETRICS AND GYNECOLOGY, RHEUMATOLOGY, PSYCHIATRY, PODIATRY, OTOLARYNGOLOGY, AS WELL AS INTERNAL MEDICINE, FAMILY PRACTICE AND PEDIATRIC PHYSICIANS. DURING 2011 OUR PHYSICIAN ENCOUNTERS WERE 342,716. 9345972 0 8438317 SWEDISHAMERICAN DELIVERS HOME HEALTH CARE SERVICES TO PATIENTS IN OUR SERVICE AREA. DURING 2011 WE PERFORMED 10,068 EPISODES OF CARE. 344967094 1 1 0 1 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 1 0 1 477 0 1 3397 1 1 1 0 0 0 0 0 0 0 0 0 X 25 15 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL X DONALD HARING CFO 8159662087 1313 EAST STATE ST ROCKFORD IL 61104 HELEN CHUNG HILL 2.00 X 100 0 0 DANNY L COPELAND MD 2.00 X 180861 0 27246 GORDON H GEDDES 2.00 X 500 0 0 JAMES L GINGRICH 2.00 X 100 0 0 ROBERT L HEADPHD 2.00 X 100 0 0 DENNIS W JOHNSON 2.00 X 100 0 0 GREGORY JURY 2.00 X 100 0 0 MARCO T LENIS 2.00 X 100 0 0 SARA FLEMING MD - EX OFFICIO 2.00 X 100 0 0 FRAN MORRISSEY 2.00 X 100 0 0 JOHN C MYERS MD 2.00 X 474570 0 21112 JOHN SCHEUB MD 2.00 X 100 0 0 STEVEN C SJOGREN 2.00 X 100 0 0 JAMES WADDELL 2.00 X 100 0 0 THOMAS R WALSH 2.00 X 100 0 0 AMY WILCOX 2.00 X 0 0 0 ALLEN WILLIAMS MD 2.00 X 226279 0 39935 WILLIAM SCHULZ MD - EX OFFICIO 2.00 X 543538 0 41865 PATRICK DERRY 2.00 X 100 0 0 WILLIAM RGORSKI MD 40.00 X X 706992 0 207101 RICHARD WALSH 40.00 X X 741854 0 113760 DAN LOESCHER 2.00 X X 100 0 0 WILLIAM ROOP 2.00 X X 100 0 0 DAVID R RYDELL 2.00 X X 100 0 0 FRANK WALTER 2.00 X X 100 0 0 DONALD HARING 40.00 X 376070 0 65358 KATHLEEN KELLY MD 40.00 X 394721 0 68275 HARVEY EINHORN MD 40.00 X 704898 0 61815 PRAKASH PEDAPATI MD 40.00 X 630521 0 32392 FAUZIA KHATTAK MD 40.00 X 518499 0 33104 MERAT ESFAHANI MD 40.00 X 805772 0 31989 STEVEN MILOS MD 40.00 X 641116 0 18330 6947891 0 762282 174 0 1 0 ARUP LABORATORIES INC PO BOX 27964 SALT LAKE CITY UT 84127 LAB TESTING 2270430 ROCKFORD ANESTHESIOLOGISTS ASSOCIATION 202 HARLEM RD SUITE 200 LOVES PARK IL 61111 PHYSICIANS 1439937 HLS WHEELING LLC 3723 RELIABLE PARKWAY CHICAGO IL 60686 LAUNDRY SERVICES 1398565 INFINITY HEALTHCARE PHYSICIANS SC 111 EAST WISCONSIN AVE MILWAUKEE WI 53202 PHYSICIANS 955699 HOLMSTROM & KENNEDY PC PO BOX 589 ROCKFORD IL 61103 ATTORNEYS 870884 47 1112489 5166242 6278731 PATIENT SERVICES 621990 257327091 257327091 MEDICARE/MEDICAID 621990 169428989 169428989 N.IL IMAGING JV 621990 2045942 2045942 OTHER PROGRAMS 900099 1749535 1749535 N.IL SCANNING JV 621990 20272 20272 430571829 6023804 6023804 234926 47139 187787 187787 187787 110419044 1976951 108725789 1995942 1693255 -18991 1674264 1674264 491264 703062 -211798 -211798 INTERDEPT BILLING 561000 2862700 2648524 214176 CAFETERIA & VENDING 561000 1371002 1361693 9309 DAY CARE CENTER 624410 1265476 1265476 642308 642308 6141486 450666103 434370248 865793 9151331 870995 870995 42000 42000 4463454 1601720 2861734 155734582 118092412 37642170 6902133 5673317 1228816 28792993 26182747 2610246 10794069 8002179 2791890 1093359 -89950 1183309 129096 129096 126242 126242 578952 578952 18943221 17398481 1544740 2815205 76095 2739110 10854807 5854923 4999884 4040431 3559525 480906 12210150 5996701 6213449 233905 174024 59881 358178 140637 217541 5056047 4967676 88371 19188236 14909410 4278826 8404286 7670298 733988 INCOME TAX EXPENSE 192000 192000 PATIENT SUPPLIES 69093026 64158303 4934723 BAD DEBTS 36446891 36446891 PURCHASED SERVICES 17759770 10232735 7527035 IPA PROVIDER TAX 7062613 7062613 12892998 5943362 6949636 435079639 344967094 90112545 0 19654577 27361347 61907167 56790303 298583 312119 4511834 4972377 5471495 8400620 358730773 200066928 156809474 158663845 138899842 159390048 5082146 1975596 22115436 25881365 414750554 443747620 38489895 45381916 114603545 111228588 43584704 45671422 196678144 202281926 X 210736438 233938728 2254696 1890721 5081276 5636245 218072410 241465694 414750554 443747620 X 15586464 7806820 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 126242 126242 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: PORTIONS OF THE 2010/2011 ILLINOIS HOSPITAL AND AMERICAN HOSPITAL ASSOCIATION DUES USED FOR LOBBYING: $36,292. A LAW FIRM WAS ENGAGED TO REVIEW LEGISLATION AFFECTING HOSPITALS: $89,950. 5553681 98184 763174 37321 6377718 5098504 13425 457937 16185 5553681 6059940 14405 -958754 17087 5098504 0.88000 0.12000 0 1 1 2459970 2459970 188431491 84229314 104202177 8750177 3861547 4888630 152650069 107501244 45148825 6439066 4474823 1964243 158663845 DEFERRED BOND ISSUANCE COSTS 3236905 ADVANCE TO AMERICAN RESTAURANT ASSOC. (ARA) 189268 INTEREST IN NET ASSETS OF RECIPIENT ORGANIZATION 8563850 GOODWILL 13891342 25881365 ESTIMATED DUE-3RD PARTY PAYORS 15320269 RESERVE FOR SELF INSURNACE 13066789 DEFERRED COMPENSATION 8924703 ASBESTOS RETIREMENT OBLIGATION 302231 DUE TO AFFILIATED ORGANIZATION 3646399 CURRENT MATURITIES OF LONG TERM DEBT 4411031 45671422 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THERE IS NO FIN 48 LIABILITY AND AS SUCH, THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS DO NOT INCLUDE A FIN 48 FOOTNOTE. 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 11342433 11342433 0.02410 82438499 69782533 12655966 0.02680 1295945 1008978 286967 0.00060 95076877 70791511 24285366 0.05150 7173426 1038997 6134429 0.01300 14453848 2642764 11811084 0.02500 1931455 1177464 753991 0.00160 1061840 281546 780294 0.00170 24620569 5140771 19479798 0.04130 119697446 75932282 43765164 0.09280 0 8771960 1315794 75743506 93571346 -17827840 X 1 1 1 FEATHERSTONE PARTNERSHIP LLC AMBULATORY SURGERY CENTER 0.33300 0.00000 0.66700 2 NORTHERN ILLINOIS VEIN CLINIC LLC OUTPATIENT PHYSICIAN CLINIC 0.50000 0.00000 0.50000 2 1 SWEDISHAMERICAN HOSPITAL

1401 E STATE STREET ROCKFORD IL 61104

X X X X 2 SWEDISHAMERICAN MEDICAL CTR BELVIDERE

1625 S STATE STREET BELVIDERE IL 61008

X X X NOT REQUIRED 1 19 ONCOLOGYPTAM REHABCARDIAC REHAB

209 9TH STREET ROCKFORD IL 61104

OUTPATIENT CLINIC ACT

2473 MCFARLAND ROAD ROCKFORD IL 61107

OUTPATIENT CLINIC MIDWEST HEART

1340 CHARLES STREET ROCKFORD IL 61104

OUTPATIENT CLINIC AMBULATORY SURGERY CENTER

1016 FEATHERSTONE ROAD ROCKFORD IL 61107

AMBULATORY SURGERY CENTER HOME HEALTH

2550 CHARLES STREET ROCKFORD IL 61108

HOME HEALTH BROOKSIDE SPECIALTY

1253 N ALPINE ROAD ROCKFORD IL 61107

OUTPATIENT CLINIC WOODSIDE

3775 N MULFORD ROAD ROCKFORD IL 61114

OUTPATIENT CLINIC BROOKSIDE

1215 N ALPINE ROAD ROCKFORD IL 61107

OUTPATIENT CLINIC 5 POINTS

2404 CHARLES STREET ROCKFORD IL 61108

OUTPATIENT CLINIC VALLEY

6824 NEWBURG ROAD ROCKFORD IL 61108

OUTPATIENT CLINIC CAM OB BEHAVIORAL HEALTH

1415 E STATE STREET ROCKFORD IL 61104

OUTPATIENT CLINIC BELVIDERE CLINIC

1700 HENRY LUCKOW LANE BELVIDERE IL 61008

OUTPATIENT CLINIC ROSCOE CLINIC

5005 HONONEGAH ROAD ROSCOE IL 61073

OUTPATIENT CLINIC DAVIS JUNCTION CLINIC

5665 NORTH JUNCTION WAY DAVIS JUNCTION IL 61020

OUTPATIENT CLINIC BYRON CLINIC

220 W BLACKHAWK DRIVE BYRON IL 61010

OUTPATIENT CLINIC NORTHWEST CLINIC

3906 N MAIN STREET ROCKFORD IL 61103

OUTPATIENT CLINIC MARENGO CLINIC

204 E PRAIRIE STREET MARENGO IL 60152

OUTPATIENT CLINIC ROCHELLE CLINIC

510 LINCOLN HIGHWAY ROCHELLE IL 61068

OUTPATIENT CLINIC DIXON ONCOLOGY

101 W 2ND STREET DIXON IL 61021

OUTPATIENT CLINIC PART I, LINE 7G: THE FOLLOWING SUBSIDIZED HEALTH SERVICES ARE FOR PHYSICIANS. THESE PHYSICIANS ARE NECESSARY TO SERVE THE COMMUNITY, ARE DIFFICULT TO RECRUIT, AND THE REIMBURSEMENT DOES NOT COVER THE COST OF THE SERVICES. HOSPITAL BASED PHYSICIANS SPECIALTY CLINICS AND EMERGENCY COVERAGE PAYMENTS $8,318,480EMERGENCY DEPARTMENT PHYSICIANS $1,320,633AFFILIATE EMERGENCY DEPARTMENT AND PRIMARY CARE PHYSICIANS $386,182TOTAL $10,025,295 PART I, L7 COL(F): THE BAD DEBT EXPENSE IN PART IX COLUMN A WAS SUBTRACTED FOR THE PURPOSE OF CALCULATING THE PERCENTAGE OF EXPENSE IS $36,446,891.PART 1 LINES 7 - LINES 7A AND 7F COSTS WERE CALCULATED USING THE 2011 MEDICARE COST REPORT COST TO CHARGE RATIO.LINES 7B AND 7C COSTS WERE CALCULATED USING THE COST ACCOUNTING SYSTEM. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS.ALL OTHER AMOUNTS IN LINE 7 WERE CALCULATED USING DIRECT COSTS. PART III, LINE 4: IT IS OUR PRACTICE TO IDENTIFY, TO THE EXTENT POSSIBLE, CHARITY CASES AT THE TIME OF SERVICE. IF A PATIENT PROVIDES DOCUMENTATION THEY MEET OUR CHARITY CARE POLICY, THEY ARE NOT SENT TO COLLECTION. THOSE PATIENTS WHO FAIL TO APPLY OR PROVIDE DOCUMENTATION ARE SENT TO COLLECTION AFTER 90 DAYS. THE ORGANIZATION AND ITS AGENTS FOLLOW THE FAIR PATIENT BILLING ACT. IF DURING THE COLLECTION PROCESS WE OR OUR AGENTS BECOME AWARE OF A PATIENT QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND THE PATIENT COOPERATES WITH THE REQUIREMENTS OF THE CHARITY CARE POLICY, COLLECTION EFFORTS ARE CEASED, AND THE ACCOUNT IS WRITTEN OFF TO CHARITY .FROM THE AUDITED FINANCIAL STATEMENTS:PATIENT ACCOUNTS RECEIVABLE AND DUE FROM/TO THIRD-PARTY PAYERS: THE COLLECTION OF RECEIVABLES FROM THIRD-PARTY PAYERS 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 PAYER HAS PAID, BUT PATIENT RESPONSIBILITY AMOUNTS (DEDUCTIBLES AND CO-PAYMENTS) REMAIN OUTSTANDING. PATIENT RECEIVABLES, WHERE A THIRD-PARTY PAYER 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 PAYERS.PATIENT RECEIVABLES DUE DIRECTLY FROM PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED, LESS AMOUNTS COVERED BY THIRD-PARTY PAYERS 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. PATIENT RECEIVABLES ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED WHEN RECEIVED. THE PAST DUE STATUS OF RECEIVABLES IS DETERMINED ON A CASE-BY-CASE BASIS DEPENDING ON THE PAYER RESPONSIBLE. THE HOSPITAL GENERALLY DOES NOT CHARGE INTEREST ON PAST DUE ACCOUNTS. RECEIVABLES OR PAYABLES RELATED TO ESTIMATED SETTLEMENTS ON VARIOUS CONTRACTS THAT THE HOSPITAL PARTICIPATES IN ARE REPORTED AS THIRD-PARTY PAYER RECEIVABLES OR PAYABLES.PART III LINE 2 COSTS WERE CALCULATED USING THE 2011 MEDICARE COST REPORT COST TO CHARGE RATIO.PART III LINE 3 SWEDISHAMERICAN HOSPITAL'S CHARITY POLICY ALLOWS A 100% CHARITY WRITE-OFF FOR THOSE WITH HOUSEHOLD INCOME OF 200% OR LESS OF THE FEDERAL POVERTY LEVEL AND PARTIAL CHARITY WRITE-OFF FOR THOSE UP TO 600% OF THE POVERTY LEVEL. THE LATEST DATA FROM THE U.S. CENSUS BUREAU INDICATES 13.8% OF THE POPULATION IN WINNEBAGO COUNTY IS BELOW THE POVERTY LEVEL AND THE MEDIAN HOUSEHOLD INCOME WAS $47,646 WITH A HOUSEHOLD SIZE WAS 2.53. FOR A HOUSEHOLD SIZE OF 3 AN INCOME $37,060 IS 200% OF THE POVERTY LEVEL AND $111,180 IS 600% OF THE POVERTY LEVEL. APPROXIMATELY 90% OF OUR CHARITY WRITE-OFFS ARE FOR PATIENTS WITHOUT INSURANCE WHILE 65% OF OUR BAD DEBT WRITE-OFFS ARE FOR PATIENTS WITHOUT INSURANCE. IN 2011 ONLY 10% OF ALL ACCOUNTS WRITTEN OFF TO BAD DEBT WERE RECOVERED. BASED ON THIS DEMOGRAPHIC AND INTERNAL DATA WE BELIEVE THAT A MINIMUM OF 15% OF THE AMOUNTS WRITTEN OFF AS BAD DEBT WOULD QUALIFY FOR CHARITY. PART III, LINE 8: IF SWEDISHAMERICAN HOSPITAL DID NOT PROVIDE SERVICES TO MEDICARE BENEFICIARIES THERE WOULD NOT BE ADEQUATE ACCESS WITHIN THE COMMUNITY. THE SERVICES PROVIDED TO MEDICARE BENEFICIARIES ARE CRITICAL TO THE HEALTH OF THE COMMUNITY WE SERVE. THE REIMBURSEMENT FROM MEDICARE HAS NOT KEPT PACE WITH THE RISING COST OF PROVIDING THOSE SERVICES. THE COST OF CARE HAS INCREASED DUE TO: WAGES AND BENEFITS NECESSARY TO KEEP HIGH DEMAND SKILLED PRACTITIONERS, MEDICAL SUPPLIES IN PARTICULAR CARDIOVASCULAR AND ORTHOPEDIC IMPLANTS AND PHARMACEUTICALS, MALPRACTICE INSURANCE COSTS, AND CAPITAL EQUIPMENT. DUE TO THE LACK OF ALTERNATIVES IN THE COMMUNITY AND THE INABILITY OF MEDICARE REIMBURSEMENT TO KEEP PACE WITH THE COST OF PROVIDING SERVICES, WE FEEL THE LOSS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES IS A PART OF OUR MISSION AND IS A BENEFIT TO OUR COMMUNITY. THE FOLLOWING IS A RECONCILIATION OF THE SHORTFALL FROM MEDICARE REPORTED ON THE COST REPORT ON LINE 7 TO THE MEDICARE SHORTFALL FROM ALL OF THE MEDICARE PROGRAMS AT SWEDISHAMERICAN HOSPITAL. THESE SHORTFALLS WERE CALCULATED USING THE COST TO CHARGE RATIO.MEDICARE SHORTFALL HOSPITAL PROGRAMS PART III LINE 7 ($17,827,840)MEDICARE SHORTFALL PHYSICIAN PROGRAMS ($23,674,704)MEDICARE SHORTFALL HOME HEALTH PROGRAMS ($176,823)TOTAL MEDICARE SHORTFALL ($41,679,367) PART III, LINE 9B: THE ORGANIZATION AND ITS AGENTS FOLLOW THE FAIR PATIENT BILLING ACT. IF DURING THE COLLECTION PROCESS WE OR OUR AGENTS BECOME AWARE OF A PATIENT QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND THE PATIENT COOPERATES WITH THE REQUIREMENTS OF THE CHARITY CARE POLICY, COLLECTION EFFORTS ARE CEASED. PART I LINE 6A AND PART VI LINE 7 - SWEDISHAMERICAN HOSPITAL FILES A COMMUNITY BENEFIT REPORT WITH THE ILLINOIS ATTORNEY GENERAL. THE AMOUNTS AND ACTIVITIES REPORTED IN THE COMMUNITY BENEFIT REPORT INCLUDE ACTIVITIES OF SWEDISHAMERICAN HOSPITAL AND ITS SUBSIDIARIES. SWEDISHAMERICAN FOUNDATION IS A SUPPORTING ORGANIZATION TO SWEDISHAMERICAN HOSPITAL. SWEDISHAMERICAN FOUNDATION IS NOT A HOSPITAL, BUT IS A TAX EXEMPT ENTITY. ALL AMOUNTS ON SCHEDULE H ARE FOR SWEDISHAMERICAN HOSPITAL ONLY, BUT THE ACTIVITIES ON PART VI LINE 6 INCLUDE THE ACTIVITIES CONDUCTED THROUGH THE FOUNDATION. PART VI, LINE 2: SWEDISHAMERICAN HOSPITAL HAS PROVIDED A THIRD OF THE MONETARY SUPPORT FOR THE 2010 HEALTHY COMMUNITY STUDY, CONDUCTED BY THE ROCKFORD HEALTH COUNCIL. THE COUNCIL CONSISTS OF THE MAJOR HEALTH CARE PROVIDERS IN OUR METROPOLITAN AREA SUCH AS THE THREE HOSPITALS, CRUSADER CLINIC (A FEDERALLY QUALIFIED HEALTHCARE CLINIC), THE UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE, JANET WATTLES MENTAL HEALTH CENTER, ROSECRANCE SUBSTANCE ABUSE CENTER AS WELL AS SEVERAL REPRESENTATIVES OF NOT-FOR-PROFIT AGENCIES, AND MEMBERS OF THE CORPORATE COMMUNITY. SINCE 2001, AN ASSESSMENT HAS BEEN COMPLETED EVERY THREE YEARS TO IDENTIFY AND TRACK TRENDS AS WELL AS AREAS TO ADDRESS. THESE STAKEHOLDERS UNDERSTAND THE NEED FOR A COMPREHENSIVE COMMUNITY STUDY THAT IS FOCUSED ON THE OVERALL NEEDS OF THE COMMUNITY. SWEDISHAMERICAN HAS USED THIS DATA TO LAUNCH INNOVATIVE PROGRAMS AND COLLABORATIVE PARTNERSHIPS SUCH AS CARDIAC SCREENINGS WITHIN MINORITY COMMUNITIES. PART VI, LINE 3: FOR SERVICES PROVIDED IN THE HOSPITAL, OUR EMPLOYEES AND OUR AGENTS FOLLOW THE FAIR PATIENT BILLING ACT AND PROVIDE INFORMATION REGARDING THE AVAILABILITY OF CHARITY AND FINANCIAL ASSISTANCE AT ALL POINTS DURING THE COLLECTION PROCESS. WE HAVE POSTED SIGNAGE DISCLOSING THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE IN EMERGENCY ROOMS AND ON OUR WEBSITE. INPATIENTS ARE PROVIDED VARIOUS WRITTEN COMMUNICATIONS REGARDING THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE, AND ANY UNINSURED PATIENTS ARE SCREENED FOR MEDICAID AND ILLINOIS UNINSURED DISCOUNT ELIGIBILITY. FOR SERVICES PROVIDED IN PHYSICIAN OFFICES, FINANCIAL COUNSELORS ARE INSTRUCTED TO MAKE THE PATIENTS AWARE OF THE CHARITY CARE AND FINANCIAL ASSISTANCE POLICY DURING THE COLLECTION PROCESS AND EDUCATE THEM ON THE PROCESS OF APPLYING FOR MEDICAID. FOR SERVICES PROVIDED BY HOME HEALTH, SOCIAL WORKERS ASSIST PATIENTS BY SCREENING FOR MEDICAID ELIGIBILITY AND COMPLETING THE APPLICATION, COMPLETING CHARITY CARE APPLICATION, ASSISTING IN APPLYING FOR MEDICARE AND SOCIAL SECURITY DISABILITY BENEFITS, AND ASSISTING WITH APPLICATIONS FOR FOOD STAMP, LOW INCOME ENERGY ASSISTANCE, AND CIRCUIT BREAKER/ILLINOIS CARES PRESCRIPTION PROGRAMS. PART VI, LINE 4: FOR MORE THAN 100 YEARS, ROCKFORD, ILLINOIS HAS BEEN KNOWN AS A MAJOR INDUSTRIAL MANUFACTURING CENTER OF MACHINE TOOLS, INDUSTRIAL FASTENERS, AUTOMOTIVE PARTS AND AEROSPACE COMPONENTS. THE ROCKFORD METROPOLITAN POPULATION HAS GROWN TO MORE THAN 250,000 PEOPLE AND IT SERVES AS THE REGIONAL TRADE CENTER FOR MORE THAN 400,000 PEOPLE IN NORTHERN ILLINOIS. MAJOR EMPLOYERS IN OUR SERVICE AREA INCLUDE CHRYSLER, HAMILTON SUNDSTRAND, TEXTRON, CITY OF ROCKFORD, ROCKFORD PUBLIC SCHOOLS, AND THREE AREA HOSPITALS. ROCKFORD BOASTS MANY GREAT PARKS, SHOPPING, DINING, CULTURAL ACTIVITIES, ENTERTAINMENT AND EDUCATIONAL OPPORTUNITIES. BUT LIKE MANY CITIES IN THE UPPER MIDWEST, IT ALSO CONTINUES TO STRUGGLE TO COMPETE IN WHAT IS NOW A GLOBAL MANUFACTURING ECONOMY. IN THE 1980S, ROCKFORD'S UNEMPLOYMENT RATE REACHED 25 PERCENT, THE HIGHEST IN THE NATION, AND IT BECAME A SYMBOL FOR THE PLIGHT OF A "RUST BELT" CITY. ALTHOUGH THE ECONOMY IS MORE DIVERSIFIED NOW, ROCKFORD REMAINS HEAVILY DEPENDENT ON MANUFACTURING. ALSO IN THE 1980S, CHARGES OF DISCRIMINATION WERE LEVELED AT THE PUBLIC SCHOOL DISTRICT, CULMINATING IN A FEDERAL LAWSUIT AND 12 YEARS OF FEDERAL SUPERVISION. THESE TWO MAJOR DEVELOPMENTS HAVE HAD THEIR EFFECT ON THE LOCAL ECONOMY, THE STABILITY OF GOOD PAYING JOBS AND THE PSYCHE AND SELF-ESTEEM OF THE COMMUNITY. THEY ALSO HAVE AFFECTED ROCKFORD'S CHANGING ROLE AND IMPORTANCE TO THE REGION, STATE, AND TO SOME DEGREE THE NATION. UNQUESTIONABLY, THESE DYNAMICS HAVE IMPACTED HEALTHCARE IN THE COMMUNITY. TODAY, ROCKFORD'S UNEMPLOYMENT RATE OF 13.4% IS 15TH HIGHEST IN THE NATION. LOSS OF MANUFACTURING JOBS AND HEALTH INSURANCE COVERAGE HAS CONTRIBUTED TO STRESS AND STRAIN ON EMPLOYERS, EMPLOYEES AND HEALTHCARE PROVIDERS. TWO COMMUNITY SURVEYS HAVE IDENTIFIED HEART DISEASE, DIABETES, CANCER, PRE-NATAL CARE AND DEPRESSION AS MAJOR HEALTHCARE ISSUES IN OUR MARKET.SWEDISHAMERICAN HELPED FUND THE ROCKFORD HEALTHY COMMUNITY STUDY IN PARTNERSHIP WITH THE UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE AT ROCKFORD AND THE ROCKFORD HEALTH COUNCIL. THE STUDY REVEALED THAT MORE THAN 20 PERCENT OF THE RESIDENTS IN OUR HOSPITAL'S ZIP CODE LIVE BELOW THE POVERTY LEVEL, AND THAT THE MEDIAN HOUSEHOLD INCOME OF $25,527 IS THE LOWEST OF ALL ROCKFORD-AREA ZIP CODES. OUT-OF-POCKET HEALTHCARE COSTS ARE A PROBLEM FOR MORE THAN 45 PERCENT OF THIS AREA'S RESIDENTS, WHICH IS THE HIGHEST RATE IN THE CITY OF ROCKFORD. ADDITIONALLY, MANY RESIDENTS IN THIS VICINITY-WHICH IS AMONG THE STATE'S MOST DEPRESSED AREAS-ARE NOT ABLE TO RECEIVE NEEDED PHYSICAL OR MENTAL HEALTHCARE. THE UNITED WAY OF ROCK RIVER VALLEY' COMMUNITY ASSESSMENT FURTHER REVEALED THAT MANY LOCAL RESIDENTS LACK HEALTH INSURANCE AND ACCESS TO PRIMARY HEALTHCARE, LEADING TO PREMATURE MORBIDITY. THE ROCKFORD HEALTHY COMMUNITY STUDY IDENTIFIED EXTREMELY LOW LEVELS OF HOME OWNERSHIP IN SWEDISHAMERICAN HOSPITAL'S IMMEDIATE VICINITY. ACCORDING TO THE STUDY, MORE THAN 60 PERCENT OF RESIDENTS RENTED, WHICH WAS MUCH HIGHER THAN THE OVERALL SAMPLE (APPROXIMATELY 17 PERCENT). THE STUDY ALSO INDICATED THAT MORE THAN 12 PERCENT OF AREA RESIDENTS COULD NOT AFFORD TO MAKE BASIC HOME REPAIRS. THE UNITED WAY'S ASSESSMENT FURTHER IDENTIFIED THE NEED FOR MORE AFFORDABLE PERMANENT HOUSING UNITS, STATING: "EVEN THOUGH HOUSING IN ROCKFORD IS AMONG THE MOST AFFORDABLE IN THE COUNTRY, MANY FAMILIES, ESPECIALLY RENTERS, CANNOT AFFORD SHELTER." BY VIRTUE OF ITS MISSION, LOCATION IN THE CENTRAL CITY AND RELATIONSHIPS WITH OTHER PROVIDERS, SWEDISHAMERICAN SERVES THE NEEDS OF MANY OF THE COMMUNITY'S UNDERSERVED. FINDING WAYS TO IMPROVE THE HEALTH OF ALL AND TO MAKE ROCKFORD A MODEL COMMUNITY IN WHICH TO LIVE, WORK AND WORSHIP ARE SIGNIFICANT AND STRATEGIC INITIATIVES FOR SWEDISHAMERICAN. PART VI, LINE 6: ALTHOUGH SWEDISHAMERICAN HOSPITAL'S COMMUNITY SERVICE EFFORTS REACH A BROAD SEGMENT OF THE POPULATION THROUGHOUT NORTHERN ILLINOIS, THE HOSPITAL DEVOTES A GREAT DEAL OF ITS ENERGY AND RESOURCES TO SERVING THE CITY'S NEEDIEST PEOPLE, MANY OF WHOM LIVE IN THE URBAN CORE WHERE SWEDISHAMERICAN IS LOCATED. OUR ORGANIZATION CONTRIBUTES MILLIONS OF DOLLARS TO CHARITY AND MEDICAID CARE EACH YEAR. RECOGNIZING THAT HEALTHY COMMUNITIES ARE CHARACTERIZED BY STRONG INTERCONNECTIONS BETWEEN RESIDENTS, INFRASTRUCTURE, ORGANIZATIONS AND SERVICES, WE HAVE WORKED IN PARTNERSHIP WITH OTHER COMMUNITY-BASED ORGANIZATIONS AS PART OF THE NON-PROFIT ROCKFORD HEALTH COUNCIL INC. THE COUNCIL SEEKS TO BUILD AND IMPROVE COMMUNITY HEALTH THROUGH EDUCATION, ACTION, DIALOGUE AND LEGISLATIVE ACTIVITY AND SERVE AS A CATALYST AND COORDINATOR FOR AGENCY AND INDIVIDUAL ACTION TO ENSURE ACCESS, COST EFFECTIVENESS AND QUALITY. BEYOND OUR WORK WITH THE COUNCIL, SOME OF OUR INITIATIVES TAKE PLACE IN CONCERT WITH OTHER INDIVIDUAL COMMUNITY ORGANIZATIONS AND HEALTHCARE PROVIDERS, WHILE OTHERS ARE CARRIED OUT BY SWEDISHAMERICAN HOSPITAL TEAMS. SWEDISHAMERICAN HAS SOUGHT TO IMPROVE THE COMMUNITY'S HEALTH BY TAKING EFFECTIVE LIFESTYLE MODIFICATION PROGRAMS TO THE PEOPLE WHO NEED THEM MOST. ALTHOUGH THIS APPLIES TO THE COMMUNITY AT LARGE, WE HAVE TAKEN SPECIAL EFFORTS TO BRING THESE STRATEGIES TO THE CITY'S ELDERLY AND UNDERSERVED RESIDENTS. THIS IS DEMONSTRATED BY OUR SUCCESSFUL PROGRAM TO IMPROVE THE HEALTH OF RESIDENTS AT LONGWOOD PLAZA, A SENIOR HOUSING FACILITY LOCATED TWO BLOCKS FROM OUR HOSPITAL'S CAMPUS. FINALLY, BEYOND LIFESTYLE MODIFICATION OUR ONGOING COMMUNITY HEALTH INITIATIVES INVOLVE RESEARCH-BASED HEALTH SCREENING PROGRAMS, AS WELL AS UNIQUE HEALTH EDUCATION EVENTS THAT TARGET BOTH AT-RISK MEMBERS OF THE COMMUNITY AND HEALTHCARE PROVIDERS. OUR MISSION IS "THROUGH EXCELLENCE IN HEALTHCARE AND COMPASSIONATE SERVICE WE CARE FOR OUR COMMUNITY." IN FURTHERANCE OF ITS EXEMPT PURPOSE SWEDISHAMERICAN HOSPITAL CONTINUALLY INVESTS IN THE SURROUNDING COMMUNITY WITH PHYSICIAN ACQUISITIONS AND REGIONAL EXPANSION TO ASSURE ACCESS TO HEALTH CARE. SWEDISHAMERICAN HOSPITAL ALSO ESTABLISHED CENTERS OF EXCELLENCE AND ALLIANCES WITH OTHER HEALTH CARE PROVIDERS, INCLUDING CRUSADER CLINIC, A FEDERALLY QUALIFIED HEALTH CENTER, AND UNIVERSITY OF WISCONSIN. THIS ASSURES THE COMMUNITY WE SERVE RECEIVES THE HIGHEST QUALITY CARE. WE ALSO INVEST IN TECHNOLOGY TO ASSURE COST EFFECTIVE CARE IS DELIVERED FOR WHICH SWEDISHAMERICAN HOSPITAL HAS WON NUMEROUS AWARDS FOR ITS QUALITY OF CARE. IN ADDITION, SWEDISHAMERICAN HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF AND COMMUNITY BOARD AS PART OF ITS EXEMPT PURPOSE. PART VI, LINE 7: SWEDISHAMERICAN HOSPITAL IS A STAND ALONE HEALTH CARE PROVIDER THAT INCLUDES TWO ACUTE CARE HOSPITALS, PHYSICIAN CLINICS, PHYSICIAN EMERGENCY SERVICES, AND HOME HEALTH CARE. SWEDISHAMERICAN FOUNDATION IS A SUBSIDIARY OF SWEDISHAMERICAN HOSPITAL AND IS ORGANIZED FOR TAX PURPOSES AS A SUPPORTING ORGANIZATION. IN ORDER TO IMPROVE THE LOW RATE OF HOME OWNERSHIP IDENTIFIED IN THE ROCKFORD HEALTHY COMMUNITY STUDY, SWEDISHAMERICAN FOUNDATION (SAF) INITIATED A NEIGHBORHOOD REVITALIZATION PROGRAM IN A SIX-BLOCK AREA DIRECTLY SOUTH OF OUR HOSPITAL CAMPUS. SAF'S NEIGHBORHOOD REVITALIZATION EFFORT INCLUDES:HABITAT FOR HUMANITY HOMES: SAF ENTERED INTO A FORMAL AGREEMENT WITH THE ROCKFORD HABITAT FOR HUMANITY CHAPTER IN 2002 TO CONSTRUCT NEW AREA HOMES. BY THE END OF 2010, A TOTAL OF 29 HABITAT FOR HUMANITY HOMES HAVE NOW BEEN COMPLETED AND SOLD TO LOW-INCOME HOME OWNERS.NEW CITY-BUILT HOMES: SAF PURCHASED AND RAZED THREE, ADDITIONAL SUBSTANDARD HOMES IN THE NEIGHBORHOOD AND PROVIDED THE LOTS TO THE CITY OF ROCKFORD. THE CITY SUBSEQUENTLY BUILT THREE NEW HOMES ON THESE SITES FOR SALE TO MODERATE INCOME FAMILIES WITH PURCHASE ASSISTANCE.CRUISE FUNDRAISER: OVER THE PAST 16 YEARS, SAF'S ANNUAL FUNDRAISING GALA HAS RAISED MORE THAN $1,000,000, WHICH HAS BEEN REINVESTED INTO COMMUNITY IMPACT INITIATIVES, SUCH AS SCHOOL PHYSICALS AND IMMUNIZATIONS FOR AREA CHILDREN AND CANCER SCREENINGS FOR NEIGHBORHOOD RESIDENTS.NEIGHBORHOOD PLAYGROUND AND PARKS: BECAUSE AREA CHILDREN DID NOT HAVE A SAFE PLACE TO PLAY, SAF PURCHASED THREE CONTIGUOUS PIECES OF PROPERTY, REMOVED EXISTING COMMERCIAL AND RESIDENTIAL STRUCTURES AND PARTNERED WITH TWO LOCAL CHARITIES TO CONSTRUCT A NEW NEIGHBORHOOD PLAYGROUND. DRIVEWAY/GARAGE RENOVATION PROJECT: FOLLOWING A NEIGHBORHOOD-WIDE SURVEY, SAF COORDINATED AND IMPLEMENTED A GARAGE CONSTRUCTION AND DRIVEWAY REPLACEMENT PROGRAM. IN ADDITION TO INCREASING EXISTING HOME VALUES, THIS PROGRAM WILL HELP REDUCE ON-STREET PARKING, THEREBY INCREASING TRAFFIC FLOW AND MAKING PARKED CARS LESS VISIBLE/ACCESSIBLE TO POTENTIAL THIEVES AND VANDALS. REVERSE HOME GIFT ANNUITY PROGRAM: TO HELP STRUGGLING ELDERLY RESIDENTS REMAIN IN THEIR HOMES, SAF DEVELOPED A PROGRAM WHEREBY HOMEOWNERS DEED PHYSICAL OWNERSHIP OF THEIR PROPERTY TO THE FOUNDATION IN EXCHANGE FOR THE RIGHT TO LIVE IN THEIR HOME UNTIL DEATH OR INCAPACITY. SAF ASSUMES RESPONSIBILITIES FOR TAXES, REPAIRS, UPKEEP, LAWN MAINTENANCE AND SNOW REMOVAL. UPON TAKING ULTIMATE POSSESSION OF A HOUSE, IT WILL BE SOLD TO AN EMPLOYEE OR OTHER OWNER OCCUPANT, TO HELP INCREASE [OR AT LEAST MAINTAIN] A SIGNIFICANT PERCENTAGE OF OWNER OCCUPIED HOMES.HOMEOWNER GRANTS TO EMPLOYEES: SINCE 2004, SWEDISHAMERICAN HOSPITAL HAS OFFERED $5,000 DOWN PAYMENT ASSISTANCE TO EMPLOYEES TO HELP ENCOURAGE HOME OWNERSHIP IN THE SIX-BLOCK AREA SURROUNDING THE HOSPITAL. THIS INITIATIVE INCLUDES A FIVE-YEAR FORGIVABLE GRANT TO EMPLOYEES IN GOOD STANDING-WITH NO INCOME RESTRICTIONS, AND A SECOND POSSIBLE $5,000 GRANT FOR LOW-INCOME EMPLOYEES. SINCE INCEPTION, THIS PROGRAM HAS ASSISTED 17 EMPLOYEES PURCHASE HOMES IN THE SWEDISHAMERICAN NEIGHBORHOOD.HOME RESTORATION: SINCE 2004, SAF HAS PURCHASED A TOTAL OF 27 HOMES IN THE NEIGHBORHOOD TARGET AREA, REHABBED THEM AND MADE THEM AVAILABLE TO EMPLOYEES, FIREFIGHTERS, POLICE OFFICERS AND PUBLIC SCHOOL TEACHERS, AT DISCOUNT (LESS THAN THE COST OF PURCHASE AND REPAIRS). TO DATE, 20 HOMES HAVE BEEN SOLD TO EMPLOYEES AND OTHER ELIGIBLE OWNER OCCUPANTS. IN ORDER TO ALLEVIATE FIRST-TIME HOME BUYERS' CONCERNS ABOUT THE RISING COSTS OF OWNERSHIP, THESE HOMES HAVE A SOLID ROOF, SIDING, PLUMBING, ELECTRICAL, AND A GOOD WORKING FURNACE. THIS PROGRAM WILL CONTINUE FOR AT LEAST FOUR ADDITIONAL YEARS. IN COOPERATION WITH ROCKFORD EAST HIGH SCHOOL AND DE LA GARDIE HIGH SCHOOL/GYMNASIET (LIDKOPINGS, SWEDEN), THE SWEDISHAMERICAN FOUNDATION CONSTRUCTED TWO NEW NEIGHBORHOOD HOUSES AVAILABLE FOR SALE TO EMPLOYEES OR OTHER ELIGIBLE OWNER-OCCUPANTS.IN ADDITION, THE FOUNDATION HAS PURCHASED TWO, 12-UNIT APARTMENT BUILDINGS ADJACENT TO THE HOSPITAL CAMPUS WHICH WERE IN A STATE OF DISREPAIR. APPROXIMATELY THREE-QUARTERS OF A MILLION DOLLARS WERE INVESTED IN THESE TWO BUILDINGS TO BRING THEM TO "MARKET RATE" STATUS. ENCOURAGED BY OUR COMMITMENT TO RENOVATE OUR CAMPUS AND REVITALIZE THE SURROUNDING AREA, A NUMBER OF COMMERCIAL DEVELOPMENTS HAVE OCCURRED. AMONG THEM IS A NEW WALGREEN'S DRUG STORE, WHICH RETURNED RETAIL PHARMACY SERVICES TO THE AREA FOR THE FIRST TIME IN YEARS. A THREE-STORY OFFICE BUILDING SOUTH OF THE NEW WALGREEN'S WAS COMPLETED FOLLOWED BY A 60,000-SQUARE-FOOT MEDICAL OFFICE BUILDING SOUTH OF THE HOSPITAL. 1 ILLINOIS HOSPITAL RESEARCH & HEALTH FOUNDATION 700 SOUTH SECOND SPRINGFIELD IL 62704 237421930 501(C)(3) 302106 QUALITY HEALTHCARE FOR ILLINOIS UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE 1601 PARKVIEW AVE ROCKFORD IL 61107 376000511 501(C)(3) 568889 ACADEMIC RESEARCH 2 EDUCATIONAL SCHOLARSHIP FOR CHILDREN OF NON-MANAGEMENT EMPLOYEES 42 42000 OTHER INFORMATION: PART IV: SWEDISHAMERICAN HOSPITAL ONLY MAKES DONATIONS TO OTHER TAX EXEMPT ORGANIZATION. X X X X 0 1 0 0 0 0 0 0 0 DANNY L COPELAND MD 180861 0 0 0 0 0 14454 0 18280 0 213595 0 0 0 JOHN C MYERS MD 474570 0 0 0 0 0 6370 0 24855 0 505795 0 0 0 ALLEN WILLIAMS MD 226279 0 0 0 0 0 13831 0 30474 0 270584 0 0 0 WILLIAM SCHULZ MD - EX OFFICIO 543538 0 0 0 0 0 17763 0 30055 0 591356 0 0 0 WILLIAM RGORSKI MD 524486 0 182506 0 0 0 192359 0 16188 0 915539 0 0 0 RICHARD WALSH 661631 0 80223 0 0 0 95772 0 19208 0 856834 0 320602 0 DONALD HARING 297150 0 78920 0 0 0 52176 0 14294 0 442540 0 0 0 KATHLEEN KELLY MD 330690 0 64031 0 0 0 65773 0 3690 0 464184 0 0 0 HARVEY EINHORN MD 704898 0 0 0 0 0 38415 0 30194 0 773507 0 0 0 PRAKASH PEDAPATI MD 630521 0 0 0 0 0 19600 0 16889 0 667010 0 0 0 FAUZIA KHATTAK MD 518499 0 0 0 0 0 8820 0 31821 0 559140 0 0 0 MERAT ESFAHANI MD 805772 0 0 0 0 0 7759 0 29153 0 842684 0 0 0 STEVEN MILOS MD 641116 0 0 0 0 0 7350 0 14760 0 663226 0 0 0 PART I, LINE 4B PART I LINE 4B-WILLIAM GORSKI M.D.- 457(F)-$174,596; RICHARD WALSH - 457(F)-$78,009; DONALD HARING-457(F)-$32,576; KATHLEEN KELLY M.D.-457(F)-$26,401. ILLINOIS FINANCE AUTHORITY - 2004 861091967 45200BKQ0 2004-12-21 105360720 CONSTRUCTION & EQUIPMENT CARDIAC PAVILION, RENOVATE OPERATING RM & CATH LAB 0 0 0 ILLINOIS FINANCE AUTHORITY - 2010 861091967 2010-04-19 25000000 CONSTRUCTION & EQUIPMENT CARDIAC PAVILION, RENOVATE OPERATING RM & CATH LAB 0 0 0 106458982 12819 74126290 4663637 27656236 2007 1 1 1 1 25000000 25000000 2010 1 1 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 NA 0 NA 0 1 0 0 0 NA 0 NA 0 1 SCHEDULE K SUPPLENTAL INFORMATION SCHEDULE K, PART II, LINE 7 : BOND INSURANCE OF $3,672,397 WAS PURCHASED FROM BOND PROCEEDS AND IS INCLUDED AS A COST OF ISSUANCE. SHERYL HEAD ROBERT L. HEAD PH.D TRUSTEE, SPOUSE 40041 EMPLOYEE COMPENSATION 0 BEVERLY DERRY PATRICK DERRY TRUSTEE, SISTER-IN-LAW 76308 EMPLOYEE COMPENSATION 0 RIVERSIDE COMMUNITY BANK DAN LOESCHER TRUSTEE AND OFFICER, CHAIRMAN OF RIVERSIDE COMMUNNITY BANK 11245418 BANKS FEES, CERTIFICATE OF DEPOSIT, DEMAND DEPOSIT ACCOUNTS 0 HEARTLAND FINANCIAL USA INC FRANK WALTER TRUSTEE KEY EMPLOYEE HEARTLAND FNL. PARENT OF RIVERSIDE BANK 11245418 BANKS FEES, CERTIFICATE OF DEPOSIT, DEMAND DEPOSIT ACCOUNTS 0 FORM 990, PART VI, SECTION A, LINE 2 DIRECTORS WILLIAM ROOP AND JAMES GINGRICH ARE BOARD MEMBERS OF SWEDISHAMERICAN HOSPITAL AND HAVE A BUSINESS RELATIONSHIP. DIRECTORS DAVE RYDELL AND JAMES GINGRICH ARE BOARD MEMBERS OF SWEDISHAMERICAN HOSPITAL AND HAVE A BUSINESS RELATIONSHIP. DIRECTORS DAN LOESCHER AND FRANK WALTER ARE BOARD MEMBERS OF SWEDISHAMERICAN HOSPITAL AND HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 SWEDISHAMERICAN HEALTH SYSTEM (PARENT CORPORATION) IS THE SOLE CORPORATE MEMBER OF SWEDISHAMERICAN HOSPITAL (HOSPITAL) AND AS SUCH APPOINTS ALL TRUSTEES OF AND HAS THE AUTHORITY TO APPROVE CERTAIN DECISIONS OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A SWEDISHAMERICAN HEALTH SYSTEM (PARENT CORPORATION) IS THE SOLE CORPORATE MEMBER OF SWEDISHAMERICAN HOSPITAL (HOSPITAL) AND AS SUCH APPOINTS ALL TRUSTEES OF AND HAS THE AUTHORITY TO APPROVE CERTAIN DECISIONS OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B SWEDISHAMERICAN HEALTH SYSTEM (PARENT CORPORATION) IS THE SOLE CORPORATE MEMBER OF SWEDISHAMERICAN HOSPITAL (HOSPITAL) AND AS SUCH APPOINTS ALL TRUSTEES OF AND HAS THE AUTHORITY TO APPROVE CERTAIN DECISIONS OF THE HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT VERSION OF THE FORM 990 WAS REVIEWED BY LEGAL COUNSEL AND THE CHIEF FINANCIAL OFFICER. SUBSEQUENTLY, THE AUDIT/COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS OF SWEDISHAMERICAN HEALTH SYSTEM (PARENT CORPORATION) REVIEWED A FINAL DRAFT OF THE FORM 990 AND WAS PROVIDED WITH THE OPPORTUNITY TO COMMENT AND ASK QUESTIONS. THE ENTIRE BOARD OF DIRECTORS WAS PROVIDED WITH A COPY OF THE FORM 990 BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICIES, WHICH APPLY TO ALL MEMBERS OF THE BOARD OF DIRECTORS AND TO ALL EMPLOYEES. PROCEDURES ARE IN PLACE TO INDENTIFY CONFLICTS OF BOTH DIRECTORS AND EMPLOYEES. DIRECT CONFLICTS ARE HANDLED BY BOARD DELIBERATION AND BOARD VOTE FROM WHICH THE INTERESTED DIRECTOR IS EXCLUDED. EMPLOYEE CONFLICTS ARE HANDLED BY THE COMPLIANCE DEPARTMENT AND IN CERTAIN INSTANCES MAY REQUIRE SEPARATE BOARD ACTION. THE BOARD IS PROVIDED WITH PERIODIC COMPLIANCE REPORTS REGARDING CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 ALL COMPENSATION DECISIONS ARE MADE BY INDEPENDENT PERSONS. WITH RESPECT TO THE PRESIDENT, CEO, AND OFFICERS, THE ORGANIZATION FOLLOWS A COMPENSATION APPROVAL PROCEDURE ANNUALLY THAT INVOLVES APPROVAL OF PROPOSED AND FINAL COMPENSATION ARRANGEMENTS BY THE ORGANIZATION'S EXECUTIVE COMPENSATION COMMITTEE USING COMPARABILITY DATA, AS WELL AS CONTEMPORANEOUS DOCUMENTATION OF COMPENSATION DECISIONS IN THE MINUTES. ALL PHYSICIAN COMPENSATION ARRANGEMENTS ARE APPROVED BY THE FINANCE COMMITTEE AND FULL BOARD OF DIRECTORS USING COMPARABILITY DATA, AS WELL AS CONTEMPORANEOUS DOCUMENTATION OF COMPENSATION DECISIONS IN THE MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY HAVE NOT BEEN MADE AVAILABLE TO THE PUBLIC. THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF SWEDISHAMERICAN HOSPITAL ARE AVAILABLE FROM PUBLICLY DISCLOSED FORM 990, THE ILLINOIS ATTORNEY GENERAL WEBSITE AND FROM THE U.S. SECURITIES AND EXCHANGE COMMISSION ELECTRONIC MUNICIPAL MARKET ACCESS SYSTEM. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 7,749,067. OTHER 57,753. TOTAL TO FORM 990, PART XI, LINE 5: 7,806,820. FORM 990, PART VII - A COMPENSATION REPORTED FOR TRUSTEES, DANNY COPELAND, M.D., JOHN C. MYERS, M.D., ALLEN WILLIAMS, M.D., AND WILLIAM SCHULZ, M.D., RELATED TO WAGES RECEIVED AS EMPLOYEES OF SWEDISH AMERICAN HOSPITAL. SWEDISHAMERICAN HEALTH SYSTEM CORPORATION 1401 E STATE STREET ROCKFORD IL 61104 363241458 PARENT CORP. TO MANAGE & DIRECT ACTIVITIES OF ENTITITES IL 501(C)(3) LINE 3 N/A 0 SWEDISHAMERICAN FOUNDATION 1415 E STATE STREET ROCKFORD IL 61104 363097493 SUPPORTING ORG. FOR SWEDISHAMERICAN HOSPITAL FUND RAISING IL 501(C)(3) LINE 11A SWEDISHAMERICAN HOSPITAL 1 SWEDISHAMERICAN REALTY CORPORATION 1313 E STATE STREET ROCKFORD IL 611042298 363248013 TITLE HOLDING COMPANY IL 501(C)(2) SWEDISHAMERICAN HEALTH SYSTEM CORPORATION 1 SWEDISHAMERICAN HOSPITAL SELF INSURANCE TRUST 1401 E STATE STREET ROCKFORD IL 611042333 366652702 HOSPITAL MALPRACTICE TRUST IL 501(C)(3) LINE 11A SWEDISHAMERICAN HOSPITAL 1 NORTHERN ILLINOIS SCANNING 1401 EAST STATE ST ROCKFORD IL 61104 363868145 INPATIENT/OUTPATIENT CT DIAGNOSTICS IL N/A RELATED 158317 0 1 0.00000 SARI INSURANCE COMPANY 76 ST PAUL ST SUITE 500 BURLINGTON VT 05401 030308753 CAPTIVE INSURANCE COMPANY VT N/A C LSG BUILDING CORPORATION 1313 EAST STATE ST ROCKFORD IL 61104 363033985 REAL ESTATE IL N/A S STATE & CHARLES INC 1313 EAST STATE ST ROCKFORD IL 61104 363321193 HOLDING COMPANY IL N/A C SWEDISHAERICAN HEALTH MANAGEMENT CORP 1401 EAST STATE ST ROCKFORD IL 61104 363246511 SERVICE IL N/A C 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 SWEDISHAMERICAN REALTY CORPORATION J 6635344 COST SWEDISHAMERICAN FOUNDATION C 1112489 COST SWEDISHAMERICAN HOSPITAL SELF INSURANCE TRUST Q 1000910 COST SWEDISHAMERICAN HOSPITAL SELF INSURNACE TRUST P 4858380 COST