2011-05-13T17:00:50-05:00 2010-06-30 RSM MCGLADREY INC ONE SOUTH WACKER DRIVE SUITE 800 CHICAGO IL 606063392 990 2009-07-01 362170143 La Rabida Children's Hospital LARA 7736366700 6501 S Promontory Drive Chicago IL 60649 Paula K Jaudes MD 7736366700 2011-05-13 1 Zack Fortsch 3126343400 2009 2016-02-24 21:20:13Z Paula K Jaudes MD 6501 S Promontory Drive Chicago IL 60649 99851765 0 X www.larabida.org X 1896 IL La Rabida Children's Hospital provides both inpatient and outpatient care to children with chronic illness, disabilities or who have been abused in a comprehensive, interdisciplinary family-centered care model. 39 39 573 219 0 0 4447032 3709309 45853233 46024029 -6906986 2455735 604717 359909 43997996 52548982 4000 0 0 25836898 27179394 200554 50000 714087 17541926 19300002 43583378 46529396 414618 6019586 108455483 118589383 13055459 14533703 95400024 104055680 La Rabida Children's Hospital (LRCH) is dedicated to excellence in caring for children with chronic illness, disabilities, or who have been abused, allowing them to achieve their fullest potential through expertise and innovation within the healthcare and academic communities. La Rabida provides comprehensive, interdisciplinary health services to children across a continuum of care, serving as a model for family - centered care. 0 0 22243627 30726313 The primary service provided by La Rabida is inpatient services to children with chronic illnesses and disabilities. In fiscal year 2010 we had 1,046 admissions and 10,142 patient days of care. La Rabida Children's Hospital serves these children regardless of race, creed, sex, national origin, or ability to pay and is the most Medicaid dependent hospital in the State of Illinois, with more than 92% of its patient days of care rendered for Medicaid program beneficiaries. La Rabida Children's Hospital is a local expert and provides a site of training for residents and medical students. We train nearly 40 physician residents and 30 medical students each year from the University of Chicago. La Rabida is also a training site for nursing, rehabilitation therapists, social work, psychology and respiratory therapy students. The hospital works to ensure that all hospital staff, both clinical and non-clinical, receives education on how to make the hospital a safe place for children. This includes quality initiatives for infection control, certification classes in CPR and Pediatric Advanced Life Support (PALS), running mock codes, classroom lectures for nurses, emergency preparedness training, and meetings on education and research. La Rabida also holds in-services as warranted for new products, policies and event-related occurrences. 12234183 15297716 The secondary services provided by La Rabida are various clinical outpatient services supportive of the special needs of our patients. These services include 6,277 treatment room visits, 14,226 physician clinic visits, and 11,616 outpatient ancillary visits. The physician clinics are for children and their siblings with chronic healthcare needs. Included in the ancillary visits are physical therapy, speech therapy, occupational therapy and infant development specialty visits. La Rabida also provides a child abuse program serving children who have been physically abused, neglected, sexually abused, or otherwise experienced trauma. 4823382 0 In conjunction with providing direct clinical care to our patients, the hospital provides various education and outreach activities in support of our patients and their families. These include caregiver training, training for other agencies in g-tube and tracheostomy care, diabetes classes for caregivers and school staff, and transportation vouchers and bus passes for families having difficulty getting to La Rabida for clinic appointments or visiting an inpatient. Case management is provided for all inpatients. 39301192 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 1 0 0 0 0 1 1 0 0 1 20 0 1 573 1 0 0 0 0 0 1 1 0 0 0 39 39 1 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X Mark Renfree 7736366700 6501 S Promontory Drive Chicago IL 606491935 Billie Wright Adams MD 1.00 X 0 0 0 Robert L Aguilar 1.00 X 0 0 0 Howard C Alper 1.00 X 0 0 0 Robert P Arthur 1.00 X 0 0 0 Fred Berglund 1.00 X 0 0 0 Dorothy E Bossung 1.00 X 0 0 0 Richard M Burridge 1.00 X 0 0 0 Michele B Bush 1.00 X 0 0 0 John G Clifford 1.00 X 0 0 0 Brian B Devane 1.00 X 0 0 0 Terence Donnelly 1.00 X 0 0 0 John M Eberle 1.00 X 0 0 0 Nuria I Fernandez 1.00 X 0 0 0 Peggy P Gann 1.00 X 0 0 0 James J Gillespie 1.00 X 0 0 0 Timothy G Goodsell 1.00 X 0 0 0 John G Gyann 1.00 X 0 0 0 Drew M Horowitz 1.00 X 0 0 0 Jeffrey Husserl 1.00 X 0 0 0 Mark E Jacobs 1.00 X 0 0 0 Gloria Jacobson 1.00 X 0 0 0 Joyce C Johnson-Miller 1.00 X 0 0 0 Jeffrey Jones 1.00 X 0 0 0 Allen Kanter 1.00 X 0 0 0 Anthony R Kitchens 1.00 X 0 0 0 Allen I Kutchins 1.00 X 0 0 0 Dana R Levenson 1.00 X 0 0 0 Alexander Sandy Lourie 1.00 X 0 0 0 Randy Markowitz 1.00 X 0 0 0 James D McKinney 1.00 X 0 0 0 Craig Miller 1.00 X 0 0 0 Lynne Pantalena 1.00 X 0 0 0 David B Patzwald 1.00 X 0 0 0 Bruce R Pfaff 1.00 X 0 0 0 Charles T Price 1.00 X 0 0 0 Daniel S Real 1.00 X 0 0 0 Emilio Salvi 1.00 X 0 0 0 Frederick B Thomas 1.00 X 0 0 0 Fred K Walz 1.00 X 0 0 0 Dilek Bishku MD 40.00 X 188808 0 26699 Michael Cleavenger 40.00 X 151666 0 7784 Aden Henry 40.00 X 176804 0 8921 Paula K Jaudes MD 32.00 X 441398 0 27031 Mark Renfree 40.00 X 220989 0 11386 Brenda Wolf 40.00 X 245229 0 12570 Tim Diamond 40.00 X 126361 0 6465 Mike Gallery 40.00 X 127312 0 6508 Frances Lefkow 40.00 X 136414 0 7493 Paul J Pasinski 40.00 X 121221 0 6151 Kevin Rath 40.00 X 167336 0 8442 2103538 0 129450 18 0 1 1 Berglund Construction 8410 S Chicago Avenue Chicago IL 60617 Construction 3004098 Loebl Schlossman & Hackl 233 N Michigan Suite 3000 Chicago IL 60601 Architecture 300630 Ernst & Young 233 S Wacker Drive Chicago IL 60606 Accounting 202515 Medical Staffing Network 3139 Paysphere Circle Chicago IL 60674 Temporary Staffing 166281 Mayer Brown LLP 230 S Lasalle Street Chicago IL 60604 Legal 142238 7 157339 3551970 123169 3709309 Medicare/Medicaid 621500 40283417 40283417 Other Patient Service 621500 3425149 3425149 Net Patient Revenue 621500 2315463 2315463 46024029 1506594 1506594 48015752 8524 47063413 11722 952339 -3198 949141 949141 444746 157339 227648 217098 217098 Cafeteria 722210 142811 142811 142811 52548982 46024029 0 2815644 1573754 1201762 220326 151666 20073385 17039040 2810274 224071 1321235 1109837 184973 26425 2669026 2241981 373664 53381 1541994 1295275 215879 30840 683936 215507 468429 302456 260112 42344 191292 164511 26781 50000 50000 5627452 5212287 415165 495699 416387 69398 9914 359656 302111 50352 7193 1931198 1622206 270368 38624 1279058 1074409 179068 25581 Med./Non-Med. Supplies 4519612 3861667 639746 18199 Miscellaneous Expense 1977673 1661246 276874 39553 Repairs & Utilities 1220297 1025049 170842 24406 Contract Staffing 366236 307638 51273 7325 Bad Debt Expense 345437 290167 48361 6909 46529396 39301192 6514117 714087 2615919 6600776 2102144 3305218 3012688 1880900 5742935 3446541 295988 358547 375738 504507 48752432 26722276 18528863 22030156 47960486 50948114 23592895 25650459 4227827 3864165 108455483 118589383 5729698 5157649 10950 7314811 9376054 13055459 14533703 X 69687025 79562924 24616558 23396314 1096441 1096442 95400024 104055680 108455483 118589383 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 494 1 84454 0 0 84948 0 34232895 16813129 17419766 2073212 1797424 275788 11239931 8004034 3235897 1206394 107689 1098705 22030156 Beneficial Interest in Assets 11487531 F Int in Restricted Net Assets 14162928 F 25650459 Payables to Third-Party Programs 1888735 Pension Obligation 6798419 Self-Insurance 688900 9376054 52548982 46529396 6019586 2736435 -100365 2636070 8655656 55411377 2736435 227648 2964083 52447294 101688 101688 52548982 46655356 227648 227648 46427708 101688 101688 46529396 Part X: Description of Uncertain Tax Positions Under FIN 48: The Hospital is a tax-exempt organization under Internal Revenue Code Section 501 (c)(3), and accordingly, no income taxes are provided for in the accompanying financial statements. The Hospital adopted the FASB-issued guidance for accounting for uncertainty in income taxes on July 1, 2009. 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 may be 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 not-for-profit hospitals include such matters as the following: the tax exempt status of the entity, the nature, characterization and taxability of joint venture income and various positions relative to potential sources of unrelated business taxable income (UBIT). The Hospital had no UBIT for the years ended June 30, 2010 and 2009. 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 sheets 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 July 1, 2009 and as of June 30, 2010, there were no unrecognized tax benefits identified and recorded as a liability. Part XI, Line 8 - Other Adjustments: Change in Interest of Foundation : 2057565. Change in Pension Obligation : -2157930. Part XII, Line 2d - Other Adjustments: Special Event Expenses: 227648. Part XII, Line 4b - Other Adjustments: Investment Fees: 101688. Part XIII, Line 2d - Other Adjustments: Special Event Expenses: 227648. Part XIII, Line 4b - Other Adjustments: Investment Fees: 101688. X X X X X X 1 PJH & Associates Fundraiser/Awards/Benefit Dinner 0 438048 50000 388048 438048 50000 388048 AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Dinner 438048 140400 297648 48667 77305 Golf Outing 105515 6960 98555 885 7643 31619 16151 58522 9979 48543 18384 26994 602085 157339 444746 885 7643 98670 120450 227648 217098 1 1 1 X 1 X 600.000000000000 1 1 0 1 1 179742 179742 0.00390 37711835 40277821 -2565986 0.00000 37891577 40277821 -2386244 0.00390 1260 590 670 0.00000 701167 226531 474636 0.01020 702427 227121 475306 0.01020 38594004 40504942 -1910938 0.01410 1 307192 0 5596 4702 894 X 1 1 La Rabida Children's Hospital

6501 S Promontory Drive Chicago IL 60649

X X Part I, Line 7: A cost to charge ratio, calculated using the IRS worksheet, was used for the Part I, Line 7 table. Part I, Line 7f: Bad debt expense of $345,437 was removed from total expenses. Part III, Line 4: Bad debt expense at cost is based upon the actual charges that are the responsibility of the patient guarantor multiplied by a calculation ratio of cost to charges using the IRS worksheet. Part III, Line 8: Medicare costs are based upon the actual charges that are the responsibility of the patient guarantor multiplied by a calculation ratio of cost to charges calculated using the IRS worksheet. Part III, Line 9b: La Rabida offers financial assistance to families who qualify, using a Financial Assistance Application. Several notices are provided to the family advising them of the availability for assistance should they meet the necessary qualifications. Part VI, Line 2:La Rabida provides specialty physicians and services for children with chronic illnesses. We work with many local institutions and physicians in identifying the needs of these children and their families. We constantly assess our capabilities to meet the social as well as the physical need of these children and work to provide a medical home for the children and their families.Part VI, Line 3:At the time of registration, families are asked to provide any insurance information that may be used in paying for the services being rendered. If insurance is not available, the family is advised of the availability of Public Assistance and the need to complete the necessary paperwork. Preliminary paperwork is completed by the Hospital and provided to the necessary Agency for follow-up by the family. It is the family's responsibility to meet with the Agency to insure eligibility. The family is also notified about our financial assistance policy and the necessary forms for qualification are provided is so requested.Part VI, Line 4:While La Rabida provides services to children throughout the metropolitan Chicago area most of the patients reside in Chicago's South Side communities. The population served by La Rabida is approximately 90% African American; the remainder of the population is almost equally divided between White (4-5%) and Hispanic (4-5%). Less than 1% of the community identify themselves as Asian or other. Females are a majority of the population at 55%, over 60% of the households with children under 18 are female-headed households. Based on census data, approximately 39% of the children in these communities are living in poverty and 32% of all families receive some form of Public Aid. Based on recent census tract data, the average annual salary in the area was $19,000, compared to an average of $32,000 for the rest of the Chicago area. Part VI, Line 6:La Rabida serves over 500 children and families through hospitalizations and 8400 through outpatient clinics annually. Almost half of La Rabida's patients (approximately 44%) are age five and under. La Rabida serves children and their families through age 18 and ensure that ongoing care is provided through referrals to local hospitals and clinics. In addition, La Rabida assists families negotiate the new bureaucracies they will encounter once the child is no longer eligible for Medicaid upon reaching age 18. La Rabida is the most public insurance dependent hospital in the state of Illinois with Medicaid comprising over 80% of the hospital's income. The following are some of the programs used to meet the needs within our community.Trauma/Abuse Program:La Rabida has one of the largest child abuse/trauma programs of any children's hospital in the country and has national recognition for cutting edge community based treatment and training programs. This program services one of Chicago's most low-income areas, as well as 39 of the poorest municipalities in the southern suburbs. Adjunct services include case management, court services (i.e. accompanying children to court to testify against the perpetrator), liaison with community hospitals and community agencies, etc. La Rabida also provides outreach, training and consultation to child service programs in the community. La Rabida currently provides ongoing consultation to the Chicago Department of Public Health Safe State Program, Ada s. McKinley Emergency Foster Care program, the Chicago Police Department Crisis Intervention team and the Vernon Park Church of God, among others. The program has provided training to many agencies, including: the Little City Foundation, Cook County State Attorney's Office, Cook County Public Guardian's Office, various Chicago Public Schools, the University of Chicago Department of Psychiatry and Department of Developmental and Behavioral Pediatrics, Casa Central, and the Illinois Violence Prevention Authority. In addition, the Behavioral Sciences Department gives a number of lectures and community presentations throughout the year to school and professional groups. With assistance from the Illinois Department of Children and Family Services (DCFS), the hospital coordinates interviews of child sexual abuse victims. Participants include the police department, state's attorney's office and DCFS. La Rabida Children's Hospital also assists DCFS in providing initial health screenings prior to placement for abused and neglected children who come into custody. La Rabida assists the Illinois Department of Healthcare and Family Services as an enrollment site for KidCare, a health insurance program for low income children and families.Premier Kids:Unlike the typical hospital that focuses on treating the child as quickly as possible and then sends them back to the community, La Rabida provides ongoing healthcare and social supports to special needs children and their families from infancy until adulthood. Premier Kids offers primary care for infants and children who are at risk due to development problems and/or medically complex conditions. Targeted and comprehensive medical management early can enhance overall health later.The Premier Kids Program is a hospital-based outpatient program, conveniently providing an array of services on site. Meeting the definition of a medical home, the program delivers care and service that is family centered; comprehensive, holistically addressing the child's needs; coordinated; team driven; and culturally sensitive.Children, five years of age and younger, enter the Premier Kids Program after having:-Graduated from a neonatal intensive care unit (NICU) or its follow-up program-An inpatient stay, following delivery-Neonatal drug exposure-Received a diagnosis that may challenge physical, motor, cognitive, and nutritional development plus emotional and social growthEach Premier Kid receives routine check-ups, immunizations and urgent care through a board certified pediatrician who also coordinates the care for the child's unique medical condition. The physician leads an interdisciplinary team of clinicians (nurses, dietician, infant development specialist, social workers and advocate) who work in partnership with each family to identify and then access the services and resources the family requires to optimize the child's health and development. By the time the child ages out of the program at age six, he or she is enrolled into the appropriate educational program. La Rabida's "one-stop shopping" medical home program is a particularly important model when working with families who are not only burdened with having a child with special needs but also have other economic stressors. This not only allows for better and easier access, its comprehensive nature maximizes positive outcomes over the long term and minimizes the use of higher cost services like duplication of diagnostic procedures and treatments, unnecessary emergency room use and inpatient hospitalization.Case Management Program:La Rabida Children's Hospital Case Management Program goal is to provide care coordination, assessment and education across the inpatient and outpatient spectrum of care to children with chronic conditions and developmental delays and disabilities. The Program's team of seventeen Case Managers (12 nurses and 5 social workers) has extensive experience and knowledge uniquely qualifying them to serve La Rabida's patients and families. Most of the social workers are Licensed Clinical Social Workers (LCSW). Nurse expertise includes Nurse Practitioners (who also serve as providers in the outpatient clinics), those trained to case manage specific chronic conditions, failure to thrive and technology dependent children. Together they provide services to over half of the hospital's patient population each year. While Case Management services are available to all patients and families, their most intensive interventions focus on patients that are medically complex and with more than one health condition and/or health care provider. The Case Management Program makes it possible to effectively provide continuous chronic care to large groups of children with various conditions from infancy to adulthood. La Rabida's Case Management program assists the families of children with chronic conditions to navigate the necessary support systems. Each child and family is assessed to determine which community linkages need to be established. Case Management coordinates care between La Rabida providers and external providers such as subspecialists (e.g., neurologists, orthopedists, endocrinologists, hematologists, etc.), Child and Family Connections, Chicago Board of Education and other Education Programs, Ounce of Prevention, Division of Specialized Care for Children (DSCC), Children's Home and Aid Society, Erickson Institute, Department of Child and Family Services, home health care agencies and medical equipment vendors. The Case Management Program has a significant impact on the ability of the family to provide necessary home care and to minimize hospitalizations.The Case Management Program performs a large array of activities. While patients and their families may receive services anywhere from a few months to many years, these activities must occur year round on an ongoing basis to ensure children and their families receive needed services in a timely manner. Following is a list of the most common activities performed by Case Management staff. -Coordination of multiple medical services and providers, including coordination of the management of technology dependent children in the home -Patient and caregiver education. For example, diabetes classes are given for caregivers, extended family and school personnel to understand how to manage the disease. The State of Illinois mandates special classes for caretakers before a medically complex child can be released to the home. These weekly classes run in four week intervals, and include: G-tube care (feeding tube), Tracheotomy Care, Ventilator care, and CPR/airway obstruction care. -Ordering of home care services (nursing and equipment)-Telephone Management (Diabetes). Toll free call in number for patients and their families staffed by diabetes specialists. In addition to providing children and their families with a way to update the Diabetes team on their current glucose readings, it provides patients and their families with 24/7 access to a clinical nurse specialist who gives recommendations on medication, nutrition and exercise adjustments over the telephone. -Feeding evaluations, including children with Failure to Thrive -Follow up of newborn screening results (sickle cell diseases) -Wound management consultation -Coordination of inpatient and outpatient rehabilitation programs -Collaboration with community agencies, such as Division of Specialized Care for Children (DSCC)-Coordination of school needs, including: assistance in preparation of 504 plans (written plan for students with disabilities that spells out the modifications and accommodations that will be needed for these students to have an opportunity perform at the same level as their peers, and might include such things as wheelchair ramps, blood sugar monitoring, an extra set of textbooks, a peanut-free lunch environment, home instruction, or a tape recorder or keyboard for taking notes and Individualized Education Plans (a legally binding document that spells out exactly what special education services the child will receive and why. It includes the child's specific disability placement, services such as a one-on-one aide and therapies, academic and behavioral goals, a behavior plan if needed, percentage of time in regular education, and progress reports from teachers and therapists. Many services take place after discharge from an inpatient stay and in between clinic/doctor visits. Case Managers that work with technology dependent children have an average ongoing caseload of about 40 patients each in addition to their day to day responsibilities for inpatient and for seeing patients in the clinics with the physicians. Each patient in the caseload requires frequent follow up, assessment and updating of written home treatment plans and orders. Updates are done every 60 days for the home nursing agencies and a more formal review is required every six months for DSCC. This requires the Case Manager to be very familiar with the child and family and, in conjunction with the primary care provider, regularly review what is/is not working and what needs to be changed.Car Seat Clinics:La Rabida also provides specialized car seats, along with training and installation, for families who have children with special needs. This includes hosting the quarterly meeting of the Illinois special needs car seat technicians. La Rabida also holds 2-3 monthly "car seat clinics" at which patients and their siblings can have their car seats checked. Both hands on and written educational information is provided at the appointments. The total number of car seat inspections in FY10 was 144. More than 100 seats were distributed and 30 special needs car seats were distributed. 45 inpatients were assessed for car seats, 21 of which had never been home. 25 inpatients who received car seats were monitored for their tolerance of sitting in a car seat. No patients failed the test. Education Programs:As a result of "bounce backs" of children receiving care in the home, a new initiative was developed in 2009 to educate home health nurses in ventilator and tracheostomy care. To date, four day-long courses have been offered to home health nurses, each of which was filled to capacity. The demand for this training is high and is something the hospital plans on expanding using video and web technology. Education is also provided for professionals in the community who work with children with special needs. This includes training for physical and occupational therapists, respiratory therapists, early intervention, speech/language pathologists, school nurses, social workers and psychologists. Some of the forums in which we provide such education includes our annual Perspectives in Care Symposium. The symposium is in its 15th year and is a day long event held in the Spring. More than 125 local health care professionals attend each year. La Rabida also develops conferences on specialized topics, such as ventilator care. The therapists in the rehabilitation department are very engaged in providing educational opportunities for their peers. In FY 2010, they hosted three workshops. La Rabida has one of only three NCAST (Nursing Child Assessment Satellite Training) instructors in the State of Illinois. (NCAST is a program which trains health professionals in the use of interactive assessment scales, both feeding and teaching, whose goal is to identify problems before they develop and when intervention is most effective.)La Rabida provides educational programs for parents and caregivers. These are provided in multiple forms, one of which is to offer "101-type" classroom setting education for families. This allows families to meet each other, learn together, and receive materials, in their own language, to take home and review and use as reference when their child is discharged home. Families who have a child with a chronic disease often must spend a disproportionate amount of time and energy on that child, and can struggle with the nurturing of healthy siblings. La Rabida offers a tutoring program for patients and their siblings to address some of these needs. The program is offered five hours per week and provides tutoring for 35 children throughout the school year. The Diabetes program offers extensive education for parents and children. Teaching is conducted by nurses, nurse practitioners and dieticians. Once a year, a program called "Diabetes 101 for Caregivers" is held. Audience members include child care providers, aunts, uncles, grandparents, and parents needing a refresher. Approximately 30 people attend each year. In addition, an advanced concept program is offered each year. This may cover issues like pancreas transplants, pumps, sensors, and the newest research. In the hospital, diabetic patients and their families attend a series of classes to ensure that they are familiar with all aspects of disease management. This training program takes place over three to four 90 minute sessions. Insulin pump classes are also available, for which La Rabida recently received a national award. The first class is in the home and the second class is in the hospital. The patient calls or faxes blood sugar information three times a week and follows up several weeks later by attending a more advanced class, for a total of three classes. These classes usually last about three hours each.Community Events:La Rabida Children's Hospital participates in community events to disseminate information on chronic disease management to affected individuals. Diabetes management, because it can be complex and overwhelming for families, children and school staff, is a good example. La Rabida holds two regional trainings (one in Chicago, one in Indiana) for personnel of schools where diabetic patients attend. La Rabida also hosted an informational table at the Diabetes Expo and provided information to more than 1,000 families about Type I and Type II diabetes. In the summer, the diabetes nurses host a Back to School Jamboree for children with diabetes to complete their school forms, network with similarly affected children, and celebrate the back to school season with free school supplies. The educational programs offered at La Rabida for families, staff, health care providers and the community are provided at significant cost to the hospital. However, it is our responsibility and desire to create the best possible environment at home and at the hospital for children with chronic disease. Part VI, Line 8:A community benefit report is filed with the Illinois Attorney General. l Part VI, Line 2: Part VI, Line 3: Part VI, Line 4: Part VI, Line 6: X 1 1 X X X 0 0 0 1 0 0 0 0 0 Dilek Bishku MD 155708 0 33100 0 0 0 15372 0 11327 0 215507 0 0 0 Michael Cleavenger 146666 0 5000 0 0 0 0 0 7784 0 159450 0 0 0 Aden Henry 166404 0 10400 0 0 0 0 0 8921 0 185725 0 0 0 Paula K Jaudes MD 284953 0 156445 0 0 0 19600 0 7431 0 468429 0 0 0 Mark Renfree 204189 0 16800 0 0 0 0 0 11386 0 232375 0 0 0 Brenda Wolf 224829 0 20400 0 0 0 0 0 12570 0 257799 0 0 0 Kevin Rath 147134 0 20202 0 0 0 8442 0 0 0 175778 0 0 0 Part I, Line 1a The discretionary spending account allows for research related trips, medical books, medical subscriptions, medical classes, organization dues, academic memberships, mailing costs, parking, computer hardware & software, and resident and/or medical student lunches. Physicians Amount Paid Amount Allowed Dilek Bishku 3,888 4,000 Paula K. Jaudes 3,458 4,000 Part I, Line 5 Maximum payout is 8% of base pay. Qualifying Trigger - Audited operating profit must be 20% better than budget. If qualifying trigger met, then individual payout is determined by measuring performance against goals. Each individual has 5-6 goals, some of which are hospital-wide,i.e., average daily census, the rest are specific to the individual/position. Each goal is weighted between 5-25% and has varying levels of performance ranging from unsatisfactory (0%) to outstanding (100%). The Compensation Committee reviews and approves the plan and individual performance. Supplemental Information Part III Paula Jaudes received compensation from the University of Chicago as follows: Base Compensation: $284,953 Bonus & Incentive Compensation: $156,445 Deferred Compensation: $19,600 Nontaxable Benefits: $7,431 Dilek Bishku received compensation from the University of Chicago as follows: Base Compensation: $155,708 Bonus & Incentive Compensation: $33,100 Deferred Compensation: $15,372 Nontaxable Benefits: $11,327 Alper Services Howard Alper, Trustee, is a owner of Alper Services 170308 Insurance premiums in which Howard Alper received commissions for brokerage services 0 Berglund Construction Company Fred Berglund, Trustee, is a owner of Berglund Contruction Company 3135719 Provides construction services and leases warehouse space to La Rabida 0 Meghan McKinney James McKinney, Trustee, is the father of Meghan McKinney 39723 Employee of La Rabida 0 Mayer Brown LLP Frederick Thomas, Trustee, is a partner of Mayer Brown LLP 123954 Legal services 0 Chicago Hospitals Risk Pooling Program Mark Renfree, Officer, is trustee of Chicago Hospitals Risk Pooling Program 846324 Insurance cooperative 0 X 6 123169 Market Quote 0 0 0 0 Form 990, Part VI, Section A, line 2 Dr. Paula Jaudes, President, and Timothy Goodsell, Trustee, have a business relationship. Brenda Wolf, Officer, her spouse has a business relationship with Allen Kutchins, Trustee. Form 990, Part VI, Section A, line 6 Members of LRCH consist of Active Trustees and Special Trustees of LRCH. In addition, the Women's Board may select up to ten (10) of its officers and/or directors to be members of LRCH. Other members may be appointed and removed by the Board of Trustees from time to time. Form 990, Part VI, Section B, line 11 The federal Form 990 and appurtenant schedules are prepared by an outside accounting firm using information provided by financial management. The forms are reviewed by the La Rabida Children's Hospital treasurer. The finalized Form 990 will be posted for the Board of Directors to review before filing. Form 990, Part VI, Section B, line 12c On a yearly basis, all Trustees and Officers are required to complete a conflict of interest document in accordance with hospital policy. A report of the disclosures is presented to the Conflicts Committee for review and determination of any conflicts and their findings are presented to the Board of Trustees. Form 990, Part VI, Section B, line 15 The compensation committee of the Board of Trustees engages external compensation consultants to advise it on competitive pay rates for the officers of the Hospital. The compensation committee is composed of non-employee independent members. Discussion is held by the committee and a recommendation is presented to the Executive Committee of the Board of Trustees for approval. Form 990, Part VI, Section C, line 19 LRCH does not make its governing documents or conflict of interest policy available to the public. Financial Statements are available on Illinois Attorney General's website. La Rabida Children's Foundation 6501 S Promontory Drive Chicago IL 606491935 363240477 Support Organization IL 501(C)(3) 11-Type III-F1 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 La Rabida Children's Foundation C 1300000