NORTHWESTERN MEMORIAL HEALTHCARE: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
NORTHWESTERN MEMORIAL HEALTHCARE (EIN 36-2169179)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-14
IRS object ID
201243199349304644
Schema version
2011v1.2
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-14T15:05:52-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN420714325EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MCGLADREY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11 S WACKER DRIVE STE 800AddressLine1
CityCHICAGOCity
StateILState
ZIP Code60606ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN362169179EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Palos Community HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPALONameControl
Phone7089234000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line112251 S 80th AvenueAddressLine1
CityPalos HeightsCity
StateILState
ZIP Code604630930ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSister Margaret WrightName
TitleCEOTitle
Phone7089234000Phone
Date Signed2012-10-22DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameZack FortschName
PTINP00052725PTIN
Phone3126343400Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSister Margaret WrightNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line112251 S 80th AvenueAddressLine1
CityPalos HeightsCity
StateILState
ZIP Code604630930ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2083187985GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.paloscommunityhospital.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1972YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionPalos Community Hospital is a 501(c)3 community hospital who's primary objective is the provision of inpatient and outpatient services that are responsive to the health care needs of the residents of southwestern Cook County and northeastern sections of Will County.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees3347TotalNbrEmployees
Total Nbr Volunteers681TotalNbrVolunteers
Total Gross UBI133546TotalGrossUBI
Net Unrelated Business Txbl Income-344NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1191063ContributionsGrantsPriorYear
Contributions Grants Current Year513089ContributionsGrantsCurrentYear
Program Service Revenue Prior Year318318207ProgramServiceRevenuePriorYear
Program Service Revenue CY329037261ProgramServiceRevenueCY
Investment Income Prior Year23525216InvestmentIncomePriorYear
Investment Income Current Year6572570InvestmentIncomeCurrentYear
Other Revenue Prior Year4805348OtherRevenuePriorYear
Other Revenue Current Year4875184OtherRevenueCurrentYear
Total Revenue Prior Year347839834TotalRevenuePriorYear
Total Revenue Current Year340998104TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year200533228SalariesEtcPriorYear
Salaries Etc Current Year212878646SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year23270TotalFundrsngExpCurrentYear
Other Expense Prior Year116937596OtherExpensePriorYear
Other Expenses Current Year119081652OtherExpensesCurrentYear
Total Expenses Prior Year317470824TotalExpensesPriorYear
Total Expenses Current Year331960298TotalExpensesCurrentYear
Revenues Less Expenses Prior Year30369010RevenuesLessExpensesPriorYear
Revenues Less Expenses CY9037806RevenuesLessExpensesCY
Total Assets BOY688313537TotalAssetsBOY
Total Assets EOY699718688TotalAssetsEOY
Total Liabilities BOY436532750TotalLiabilitiesBOY
Total Liabilities EOY441327622TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY251780787NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY258391066NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionPalos Community Hospital (PCH) is a not-for-profit community hospital, which is operated in accordance with the Ethical and Religious Directives for Catholic Healthcare Facilities. The primary objective of PCH is the provision of inpatient and outpatient services that are responsive to the health care needs of the residents of southwestern Cook County and northeastern sections of Will County.In providing any service - be it preventive, curative or palliative - the overriding concern of the institution shall be that the quality of that service be of the highest caliber. PCH shall be committed to a continued review and analysis of the changing needs of the community it serves and shall respond to those needs with services that are readily available in a form that enhances their efficient use by physicians and patients. In addition, PCH shall maintain an ability to adapt to changes and influence forces in its environment effectively and expeditiously.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense202445488Expense
Revenue281144450Revenue
DescriptionIt is the policy of Palos Community Hospital to provide quality medical health care to all persons regardless of race, creed, sex, national origin, handicap, age, or ability to pay. The Hospital recognizes that not all individuals possess the ability or means to purchase essential medical services and further, that our mission is to serve our community with respect to providing healthcare services and healthcare education. Therefore, in keeping with the hospital's commitment to serve all members of the community, charity and/or subsidized care will be considered where the need and/or inability to pay are identified.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense37223272Expense
Revenue25953151Revenue
DescriptionCardiovascular ServicesPalos Community Hospital provides a total continuum of cardiovascular services - from diagnosis and treatment through recovery and rehabilitation - to ensure that our patients receive the complete care they need close to home. Prior to the start of the program in 2005, Palos transferred patients from their local community to other hospitals. Within 3 years, Palos ranked 14th in Illinois for heart volume. This community need has grown as can be seen with continued increases in volume since the program began.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense21773027Expense
Revenue19913665Revenue
DescriptionHome HealthPalos Community Hospital Home Health, Private Duty, and Hospice services provide quality personal care and support to patients in their homes, nursing homes or hospitals. The Home Health staff assists the chronically ill, persons with functional impairments, those needing specialized skilled care at home, those recovering from a hospital stay and the terminally ill. In 2011, Home Health staff from Palos made nearly 93,000 home care visits, more than 29,000 hospice visits and provided more than 43,000 hours of private duty nursing assistance.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense10867283Expense
Revenue4931140Revenue
DescriptionBehavioral HealthBehavioral Health Services at Palos meet the needs of individuals and families in the community struggling with relationship problems, emotional issues, psychological disorders and even chemical dependency. The programs include alcohol treatment; chemical dependency; group therapies for mental health or substance abuse issues; intensive outpatient programs; Kids Recover Too, since children in the family can be especially hard-hit by a parent's chemical abuse or dependency; and the Partial Hospital Program for those needing more intensive treatment for a psychiatric or duel diagnosis.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp10867283TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev4931140TotalOfOtherProgramServiceRev
Total Program Service Expense272309070TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096207NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees3347NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Hugh A Rose CFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7089234000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line112251 S 80th AvenueAddressLine1
CityPalos HeightsCity
StateILState
ZIP Code604630930ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (28 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Sister Anna Doyle
Secretary1.00XX000
Edward Mulcahy
Chairman2.00XX000
Margaret Lustig
Vice Chair2.00XX000
Thomas F Courtney
Director2.00X000
Lawrence Hunt
Director2.00X000
Gregory Paetow
Director2.00X000
Sheila Pacholski
Director2.00X000
James Reilly
Director2.00X000
Carole Ruzich
Director2.00X000
Philip A Salvador
Director2.00X000
Christie Sever
Director2.00X000
John Ward
Director2.00X000
Dr Mark Sinibaldi
Director2.00X027869018712
Sister Margaret Wright
President40.00XX000
Thomas J Lavery
VP Medical Affairs40.00X476202036423
David B Manchester
VP Professional Services40.00X416185033129
Hugh A Rose
VP Finance/CFO40.00X358696027850
Randall J Oles
VP Support Services40.00X338969037234
Timothy J Brosnan
VP Planning/Community Rela40.00X356366036694
Marion J Baron
VP Facilities & System Man40.00X291749031887
Mary C Denisienko
VP Human Resources40.00X262555026389
Rosann S Demask
VP Nursing40.00X235506030860
Margaret J Carroll
Chief Information Officer40.00240578030491X
Bryan D Counts
Staff Physician40.00223989032880X
Arthur M Schroeder
Staff Physician40.00243027017719X
Mark D Diamond
Staff Physician40.00228676017164X
Haris Aleem
Staff Physician40.00205373017176X
Mini Sara Cherian
Staff Physician40.00199481023632X
FieldValueIRS element (for citing)
Total Reportable Comp From Org4077352TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs278690TotalReportableCompFrmRltdOrgs
Total Other Compensation418240TotalOtherCompensation
Number Individuals GT100 K128NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Pepper Construction Company
18505 W Creek DriveTinley ParkIL60477Construction Services63262218
Matthei & Colon Associates
332 S Michigan AvenueChicagoIL60604Architectural Services2000955
Inner Wireless Inc
1155 Kas Drive Ste 200RichardsonTX75081Information Services1283581
Palos Anesthesia & Associates
40 Shuman Blvd Suite 275NapervilleIL60563Anesthesia Services950004
Perfusion Technologist of Greater Chicag
PO BOX 713Oak ForestIL60452Perfusion Services689576
FieldValueIRS element (for citing)
Number Of Contractors GT100 K37NumberOfContractorsGT100K
All Other Contributions513089AllOtherContributions
Total Contributions513089TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
Net Patient Revenue621110186290566186157020133546
Medicare & Medicaid Re900099135499152135499152
Provider Tax Revenue90009971996437199643
MRI Joint Venture9000994790047900
FieldValueIRS element (for citing)
Total Program Service Revenue329037261TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column5873570TotalRevenueColumn
Exclusion$5,873,570ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real1334667Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real854881Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real479786Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column479786TotalRevenueColumn
Exclusion$479,786ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1742034000Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1741335000Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities699000Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column699000TotalRevenueColumn
Exclusion$699,000ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Cafeteria Revenue9000991030550$1,030,550
Gift Shop Revenue900099326157$326,157
Medical Records900099193241193241

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column2845450TotalRevenueColumn
Related Or Exempt Function Income2845450RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue4395398TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column340998104TotalRevenueColumn
Related Or Exempt Function Income331942406RelatedOrExemptFunctionIncome
Unrelated Business Revenue133546UnrelatedBusinessRevenue
Exclusion$8,409,063ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total3006013Total
Management And General3006013ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total160709017Total
Program Services132339411ProgramServices
Management And General28369606ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total9665360Total
Program Services7813015ProgramServices
Management And General1852345ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total27885576Total
Program Services22541368ProgramServices
Management And General5344208ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total11612680Total
Program Services9387136ProgramServices
Management And General2225544ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total2237582Total
Management And General2237582ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total106803Total
Management And General106803ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total187291Total
Management And General187291ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total55616Total
Management And General55616ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total1139507Total
Management And General1139507ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total7655895Total
Program Services2299506ProgramServices
Management And General5356389ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1188043Total
Program Services20420ProgramServices
Management And General1167623ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total4348227Total
Program Services2697730ProgramServices
Management And General1650497ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2164569Total
Program Services225461ProgramServices
Management And General1939108ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2890844Total
Program Services2312675ProgramServices
Management And General578169ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total419813Total
Program Services408743ProgramServices
Management And General11070ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total143923Total
Program Services115054ProgramServices
Management And General28869ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total6537528Total
Program Services6537528ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total14259158Total
Program Services11465384ProgramServices
Management And General2793774ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1520848Total
Program Services916166ProgramServices
Management And General604682ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Medical Supplies5027025750270257
Bad Debt Expense1292902612929026
Illinois Provider Tax79071007907100
Taxes, Licenses and Reg626561626561

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2493061Total
Program Services2123090ProgramServices
Management And General346701ManagementAndGeneral
Fundraising23270Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total331960298Total
Program Services272309070ProgramServices
Management And General59627958ManagementAndGeneral
Fundraising23270Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2141128BOY
EOY4673521EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY30995801BOY
EOY35502265EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY1205076BOY
EOY624169EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1451761BOY
EOY1531486EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY4667429BOY
EOY4517005EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis474457319LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec218537406LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY173074943BOY
EOY255919913EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY434477791BOY
EOY352678512EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY40299608BOY
EOY44271817EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY688313537BOY
EOY699718688EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY123687286BOY
EOY129130466EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY268120000BOY
EOY268120000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY44725464BOY
EOY44077156EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY436532750BOY
EOY441327622EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY251618119BOY
EOY258281262EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY162668BOY
EOY109804EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY251780787BOY
EOY258391066EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY688313537BOY
EOY699718688EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses9037806ReconcilationRevenueExpenses
Reconcilation Other Changes-2427527ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$55,616OtherActivitiesAmount
Total Lobbying Expenditures IIB55616TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1:ReturnReference
ExplanationIllinois Hospital Association dues and American Hospital Association fees attributable to lobbying.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis13882791OtherCostOrOtherBasis
Book Value13882791BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis309249132OtherCostOrOtherBasis
Depreciation105269482Depreciation
Book Value203979650BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis151325396OtherCostOrOtherBasis
Depreciation113267924Depreciation
Book Value38057472BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings255919913TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
Investment in Affiliate2300931
Collateral Received for Securities Loaned33400000
Deferred Financing Costs4154669
Malpractice Insurance Receivable4416217
FieldValueIRS element (for citing)
Total Book Value Other Assets44271817TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Obligation for Collateral Received for Securities Loaned$33,400,000
Tax Exempt Bond Liability Premium$6,991,198
Provider Tax Liability$3,685,958
FieldValueIRS element (for citing)
Total Of Amounts44077156TotalOfAmounts
Total Revenue340998104TotalRevenue
Total Expenses331960298TotalExpenses
Excess Or Deficit For Year9037806ExcessOrDeficitForYear
Net Unrealized GL On Investments-2427527NetUnrealizedGLOnInvestments
Total Adjustments-2427527TotalAdjustments
Excess Or Deficit Per FS6610279ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt338338815TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-2427527NetUnrealizedGainsInvestments
Other Revenues911430OtherRevenues
Revenue Not Rptd F990-1516097RevenueNotRptdF990
Revenue Subtotal339854912RevenueSubtotal
Investment Expenses Not Included1139507InvestmentExpensesNotIncluded
Other Revenues Not Included3685OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt1143192RevenueNotRptdOnFinStmt
Total Revenue Per Form990340998104TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt331675672TotExpensesEtcAuditedFinclStmt
Other Expenses Included854881OtherExpensesIncluded
Expenses Not Rptd F990854881ExpensesNotRptdF990
Expenses Subtotal330820791ExpensesSubtotal
Investment Expenses Not Included21139507InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt1139507ExpensesNotRptdOnFinStmt
Total Expenses Per Form990331960298TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Uncertain Tax Positions Under FIN 48:Part X:The Hospital has received a determination letter from the Internal Revenue Service stating that it is exempt from the payment of income taxes under Section 501(c)(3) of the Internal Revenue Code. Accordingly, income taxes are not provided for in the accompanying financial statements. The Hospital adopted the FASB-issued guidance for accounting for uncertainty in income taxes on January 1, 2007. The Hospital files a Form 990 (Return of Organization Exempt from Income Tax) annually. 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 hospitals include such matters as the following: the tax exempt status of the 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 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 balance sheet along with any associated interest and penalties that would be payable to the taxing authorities upon examination. Upon the adoption of the FASB issued guidance at January 1, 2007, and since that date through December 31, 2011, there were no unrecognized tax benefits identified and recorded as a liability.
Part XII, Line 2d - Other Adjustments:Rental Expense 854,881. Net Assets Released from Restrictions 56,549.
Part XII, Line 4b - Other Adjustments:Temporarily Restricted Contributions 3,685.
Part XIII, Line 2d - Other Adjustments:Rental Expense 854,881.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage1000.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Benefit Expense13182247TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense13182247NetCommunityBenefitExpense
Percent Of Total Expense0.03970PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense22199497TotalCommunityBenefitExpense
Direct Offsetting Revenue10990152DirectOffsettingRevenue
Net Community Benefit Expense11209345NetCommunityBenefitExpense
Percent Of Total Expense0.03380PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Benefit Expense35381744TotalCommunityBenefitExpense
Direct Offsetting Revenue10990152DirectOffsettingRevenue
Net Community Benefit Expense24391592NetCommunityBenefitExpense
Percent Of Total Expense0.07350PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs5NumberOfActivitiesOrPrograms
Total Community Benefit Expense924869TotalCommunityBenefitExpense
Direct Offsetting Revenue136320DirectOffsettingRevenue
Net Community Benefit Expense788549NetCommunityBenefitExpense
Percent Of Total Expense0.00240PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense32507011TotalCommunityBenefitExpense
Direct Offsetting Revenue24610046DirectOffsettingRevenue
Net Community Benefit Expense8163563NetCommunityBenefitExpense
Percent Of Total Expense0.02460PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense165560TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense165560NetCommunityBenefitExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs5NumberOfActivitiesOrPrograms
Total Community Benefit Expense33597440TotalCommunityBenefitExpense
Direct Offsetting Revenue24746366DirectOffsettingRevenue
Net Community Benefit Expense9117672NetCommunityBenefitExpense
Percent Of Total Expense0.02750PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs6NumberOfActivitiesOrPrograms
Total Community Benefit Expense68979184TotalCommunityBenefitExpense
Direct Offsetting Revenue35736518DirectOffsettingRevenue
Net Community Benefit Expense33509264NetCommunityBenefitExpense
Percent Of Total Expense0.10100PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$3,419,327BadDebtExpenseAmount
Amount Reimbursed By Medicare124509000AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare140846135CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-16337135MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Palos Community HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line112251 South 80th AvenueAddressLine1
CityPalos HeightsCity
StateILState
ZIP Code60463ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1PALOS COMMUNITY HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent1000.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Other FactorsXOtherFactors
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed1AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities4NumberOfOtherFacilities

Other Facilities OtherFacilities (4 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Orland Primary Care Center
15300 West Avenue Suite 122Orland ParkIL60462Primary Care Center
Palos Immediate Care Center
7340 W College DrivePalos HeightsIL60463Immediate Care Center
Homer Family Health Center
15327 W 143rd StreetLockportIL60441Primary Care Center
PCH Home Health Services
15295 E 127th StreetLemontIL60439Home Health Services

Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
Part I, Line 3c: PCH's charity care is based on a sliding scale of the Federal Poverty Guidelines. PCH set the sliding scale to far exceed the minimum amounts set forth by the State of Illinois in The Hospital Uninsured Patient Discount Act by extending discounted care up to 1000% of the FPG vs. the minimum 600% as dictated by this law.
Part I, Line 7: The best available data was used to calculate the cost amounts reported in Item 7. This includes the overall hospital cost to charge ratio as well as direct and indirect costs for certain specific departments of the hospital.
Part II: The health of the communities that PCH serves is a very important piece of PCH's mission statement. To date, our focus has been on providing the care needed within our community at high level of quality. As such we have implemented and/or maintained programs that we feel help to improve the wellness of the people we serve. PCH believes that given limited resources and time this serves our community better than community building activities as defined in this schedule.
Part III, Line 4: PCH calculates Charity Care cost using the hospital wide cost to charge ratio and applying that ratio to the charges written off to charity care per the hospital policy. No other Bad Debt amounts are included in the community benefit report.
Part III, Line 8: Medicare costs are calculated using the hospital wide cost to charge ratio. PCH does include the Medicare shortfall in our Illinois state community benefits report since PCH continues to treat our Medicare community despite the fact that our costs for these patients exceed our reimbursement.
Part III, Line 9b: It is the policy of PCH not to pursue collection practices against patients known to qualify under the Charity Care policy. In some cases, this determination is not immediately known and collection processes are followed, but once it has been determined that a patient does qualify for charity care, these practices are ceased.
Part V, Section B, Line 11h: Living expenses, family size and credit reports are also used for calculating amounts charged to patients.PALOS COMMUNITY HOSPITAL
Part V, Section B, Line 13g: The measures used to publicize the Financial Assistance Policy within the community served by the hospital facility are not explicitly written in the Financial Assistance Policy. However, the Hospital publicizes the policy in the listed ways as a general guideline of the organization.PALOS COMMUNITY HOSPITAL
Part V, Section B, Line 19d: Palos Community Hospital takes its commitment to serving the uninsured and underinsured members of its community very seriously and as a result has implemented a financial assistance policy that goes above and beyond the requirements of Illinois Public Act 095-0965 "Hospital Uninsured Patient Discount Act". This State Law was enacted with an effective date of April 1, 2009 and required that hospitals offer uninsured patients who met the minimum financial requirements (i.e. earnings less than 600% of the FPG and certain asset limitations) a rate equal to 135% of the hospital's most recently filed Medicare cost to charge ratio. PCH expanded the reach of this policy by extending the minimum financial requirements to 1000% of the FPG to help more of our community qualify for a financial benefit and giving families that earn a lower % of the FPG deeper discounts. This policy was also extended to all clinically necessary procedures and was not limited to emergency care only. Using the FPG, we created a set of discounts for patients without insurance that ranged from free care for those who earned less than 200% of the FPG to a 40% discount off of regularly billed charges for any uninsured patient who earned less than 1000% of the FPG. We also created a policy to help those who are underinsured. Similar to our uninsured policy, this creates a set of discounts that can be applied to co-payments and deductibles owed for those patients that earn less than 300% of the FPG.PALOS COMMUNITY HOSPITAL
Part V, Section B, Line 20: Palos Community Hospital takes its commitment to serving the uninsured and underinsured members of its community very seriously and as a result has implemented a financial assistance policy that goes above and beyond the requirements of Illinois Public Act 095-0965 "Hospital Uninsured Patient Discount Act". This State Law was enacted with an effective date of April 1, 2009 and required that hospitals offer uninsured patients who met the minimum financial requirements (i.e. earnings less than 600% of the FPG and certain asset limitations) a rate equal to 135% of the hospital's most recently filed Medicare cost to charge ratio. PCH expanded the reach of this policy by extending the minimum financial requirements to 1000% of the FPG to help more of our community qualify for a financial benefit and giving families that earn a lower % of the FPG deeper discounts. This policy was also extended to all clinically necessary procedures and was not limited to emergency care only. Using the FPG, we created a set of discounts for patients without insurance that ranged from free care for those who earned less than 200% of the FPG to a 40% discount off of regularly billed charges for any uninsured patient who earned less than 1000% of the FPG. We also created a policy to help those who are underinsured. Similar to our uninsured policy, this creates a set of discounts that can be applied to co-payments and deductibles owed for those patients that earn less than 300% of the FPG. Because our financial assistance policy so generously extends to patients who earn up to 1000% of the FPG, it is possible that those patients could be responsible for charges that exceed an individual with insurance. If this situation arose, Palos Community Hospital would make every effort to work with the patient to limit their liability to a reasonable amount.PALOS COMMUNITY HOSPITAL
Part VI, Line 2: PCH consistently seeks to serve the needs of its community in a variety of ways. In order to better identify these needs, PCH teamed up with the Metropolitan Chicago Healthcare Council (MCHC) to prepare a Community Health Assessment for the primary counties that PCH serves. This Community Health Assessment is a systematic, data-driven approach to determining the health status, behaviors and needs of residents in Cook, DuPage and Lake counties, Illinois. This Community Health Assessment will serve as a tool toward reaching three basic goals:- To improve residents' health status, increase their life spans, and elevate their overall quality of life. A healthy community is not only one where its residents suffer little from physical and mental illness, but also one where its residents enjoy a high quality of life.- To reduce the health disparities among residents. By gathering demographic information along with health status and behavior data, it will be possible to identify population segments that are most at-risk for various diseases and injuries. Intervention plans aimed at targeting these individuals may then be developed to combat some of the socio-economic factors which have historically had a negative impact on residents' health.- To increase accessibility to preventive services for all community residents. More accessible preventive services will prove beneficial in accomplishing the first goal (improving health status, increasing life spans, and elevating the quality of life), as well as lowering the costs associated with caring for late-stage diseases resulting from a lack of preventive care.
Part VI, Line 3: PCH utilizes several techniques to communicate a patient's eligibility for assistance under various programs. At the time of registration, each patient is referred to a copy of PCH's Charity Care Policy and asked to fill out a simple registration form that may help them qualify for Charity Care. This policy clearly lays out the eligibility requirements and what the patient must do to qualify. Also at registration, any patient without insurance is advised as to what other programs they may qualify for and are given assistance in applying as necessary. PCH employs a company that helps patients apply for Medicaid coverage and SSI disability. Upon discharge, each patient receives a summary bill that includes information related to eligibility for the Charity Care Policy. All inpatients without insurance are visited by a financial counselor who helps direct the patient and their families to the appropriate level of assistance. Finally, PCH proudly displays the assistance polices on their website along with a Charity application form.
Part VI, Line 4: Palos Community Hospital serves growing communities that expect to experience further growth in the coming years. Communities within the hospital's service area have seen overall growth in population of approximately 7.6% from 2000 to 2011 with a current estimated population of 603,793. Continued growth is anticipated. From 2011 to 2016, the population is expected to reach 624,638. Of those living within the service area of Palos Community Hospital: 50.91% are female87.62% are white82.41% are English speakingThe median age is 37.74 years31.60% are high school graduates30.12% have had some college, and 28.36% have earned a bachelor's degree or beyond.
Part VI, Line 5: PCH will assure the availability of quality inpatient, outpatient, emergency and home care services to the community at all times. Access to these services will be determined by clinical presentation and medical needs of the patient without consideration of the patient's ability to pay.PCH will be a resource for health education and wellness initiatives for residents of the service area.PCH will monitor the health care needs of its service area to assure the need for the services it offers and evaluate the opportunity to develop new programs and services as necessary.PCH will work together with and in support of other not-for-profit, educational, governmental, civic or community organizations, as appropriate, to promote health and wellness through awareness, education, research, access or support.PCH will have policies and procedures in place to provide for charity care for patients without financial resources, including the unreimbursed costs of government sponsored indigent health care.PCH will provide language assistance services as necessary to assure effective communication in the delivery of patient care.
Part VI, Line 6: Palos Community Hospital is not part of an affiliated health care system.
ILReports Filed With StatesPart VI, Line 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (15 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Dr Mark Sinibaldi
01950000836900000018712029740200
Thomas J Lavery
459702000165000183750180480512625000
David B Manchester
399685000165000183750147540449314000
Hugh A Rose
34219600016500018375094750386546000
Randall J Oles
322469000165000183750188590376203000
Timothy J Brosnan
339866000165000183750183190393060000
Marion J Baron
275249000165000183750135120323636000
Mary C Denisienko
24605500016500018375080140288944000
Rosann S Demask
219006000165000170280138320266366000
Margaret J Carroll
224078000165000182420122490271069000
Bryan D Counts
207489000165000150810177990256869000
Arthur M Schroeder
2430270000000177190260746000
Mark D Diamond
2286760000000171640245840000
Haris Aleem
2053730000000171760222549000
Mini Sara Cherian
1994810000067150169170223113000

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
Ill Fin AuthorityPalos Comm Hospital
86109196745200B3U02007-05-17124814955Fund construction of parking garage & power plant010
ILl Fin AuthorityPalos Comm Hospital
86109196745200F2Z12010-05-06151146301Fund construction of new patient bed pavilion010
Ill Fin AuthorityPalos Comm Hospital
8610919672010-04-12100000000Fund construction of new patient bed pavilion010

Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)

Total ProceedsTotalProceedsRefunding EscrowRefundingEscrowIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount UnspentAmountUnspent
1277469845568057426758716645851020101011
157367895195063776505816000072689848
100000000500000000099500000

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
00000
00000
00000

Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
000000
000000
010000

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Thomas F Courtney Associates
Thomas F. Courtney, Director, is owner of Thomas F. Courtney & Associates230326Thomas F. Courtney & Associates assists Palos with collecting certain workers compensation and motor vehicle accident claims0
Kathleen Wright
Sibling of Sister Margaret Wright, CEO55723Employment0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 6St. George Corporation is the sole Corporate Member.
Form 990, Part VI, Section A, line 7aSt. George Corporation holds the power to appoint members of the governing body.
Form 990, Part VI, Section A, line 7bSt. George Corporation can exercise action on the following matters: (a) removal of directors, with or without cause; (b) all amendments to these bylaws or the Corporation's Articles of Incorporation; (c) The sale or transfer of substantially all of the property of the corporation, except for leases in excess of one year; (d) all long term borrowing in excess of one year; (e) merger or consolidation by the Corporation with any other institution, hospital, corporation or legal entity; (f) formal affiliation with a medical school or research facility; (g) acceptance of any gift, bequest or legacy that imposes a permanent or continuing obligation on the Corporation for a period of more than one year; (h) decisions to authorize voluntary dissolution of the Corporation or to revoke proceedings therefor; (i) adoption of a plan for the distribution of the assets of the Corporation; and (j) any other matters required by law to be submitted to the Corporate Member or which the Board determines by resolution to submit.
Form 990, Part VI, Section B, line 11Before filing the Form 990, the organization will present the completed Form 990 to the Finance Committee of the Board for their review and approval. After the Finance Committee has approved the Form 990, it will be submitted to the Board for final approval. Copies of the Form 990 will be available to the Board as requested.
Form 990, Part VI, Section B, line 12cOn an annual basis key personnel (VP, department heads (budget administrators)) and all purchasing staff must complete a Conflict of Interest Form disclosing any conflict of interests that may exist or perceived to exist between themselves and/or family members and vendors, contractors and others PCH has a contract/transaction agreement. These annual disclosure statements are reviewed by the VP of Human Resources. Any issue identified as part of this annual disclosure is referred to the President of PCH for disposition. The Conflict of Interest Policy is 1-2-9 in the Administrative Policy Book. The policy includes a copy of the annual disclosure statement.
Form 990, Part VI, Section B, line 15The CEO contract is a management contract with the religious order. The Executive Committee of the Board of Directors has the responsibility for the contract and fees. Annually Human Resources gathers market data on executive positions from a variety of published survey sources such as Metropolitan Healthcare Council (MCHC), Mercer, Watson Wyatt, etc. The market data is analyzed for organizations of our size and characteristics (FTE's, revenue, beds, region, non-for profit, stand alone institutions, etc.) The mean, median and if available the 90th percentile rates are provided to the President/CEO for consideration and reviewed with the Board of Directors. Discussion and process are contemporaneously documented in the minutes.
Form 990, Part VI, Section C, line 19All policies, governing documents and financial statements required to be available to the public are available upon request. Requests can be made from the Financial Department of Palos Community Hospital.
Form 990, Part VIIThe following Trustees and Officers have devoted time to St. George Corporation: Sister Margaret Wright - President - 1 hour Sister Ann Doyle - Secretary - 1 hour Thomas F. Courtney - Director - 1 hour James Reilly - Director - 1 hour Hugh Rose - VP Finance/CFO - 10 hours Mark R. Sinibaldi - Director - 40 hours The following Trustees and Officers have devoted time to St. George Wellness Center: Sister Margaret Wright - President - 1 hour Hugh Rose - VP Finance/CFO - 1 hour Timothy J. Brosnan - VP Planning/Community Relations - 2 hours Marion J. Baron - VP Facilities & System Management - 1 hourHours Devoted For A Related Organization
Form 990, Part XI, line 5:Net unrealized losses on investments: -2,427,527.Changes in Net Assets or Fund Balances:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
St George Corporation
12251 S 80th AvenuePalos HeightsIL60463364383840Health Care ProviderIL501(c)(3)11 a, Type IN/A0
St George Wellness Center
15430 West AvenueOrland ParkIL60462364383845Fitness CenterIL501(c)(3)90St George Corporation
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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