2011-11-15T09:01:43-06:00 2010-12-31 RSM MCGLADREY INC ONE SOUTH WACKER DRIVE SUITE 800 CHICAGO IL 606063392 990 2010-01-01 362169179 Palos Community Hospital PALO 7089234000 12251 S 80th Avenue Palos Heights IL 604630930 Sister Margaret Wright 7089234000 2011-11-04 1 Zack Fortsch 3126343400 2010 2016-03-07 17:11:31Z Sister Margaret Wright 12251 S 80th Avenue Palos Heights IL 604630930 2944507933 0 X www.paloscommunityhospital.org X 1972 IL Healthcare Provider 14 10 3219 649 78065 -4331 993999 1191063 304944368 318318207 14503689 23525216 3757554 4805348 324199610 347839834 0 0 0 0 192633736 200533228 0 0 0 107336726 116937596 299970462 317470824 24229148 30369010 494187592 688313537 276740536 436532750 217447056 251780787 X Palos 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. 0 0 190955774 273273869 It 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. 36494038 25865408 Cardiovascular 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. 21009156 18578977 Home 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 2010, Home Health staff from Palos made more than 87,000 home care visits, 23,000 hospice visits and provided more than 39,000 hours of private nursing duty assistance. 10191040 3916138 Behavioral 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 dual diagnosis. 10191040 3916138 258650008 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 0 0 0 1 162 0 1 3219 1 1 1 0 0 0 0 1 1 0 0 0 0 X 14 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL X Hugh A Rose CFO 7089234000 12251 S 80th Avenue Palos Heights IL 604630930 Edward Mulcahy 2.00 X 0 0 0 Margaret Lustig 2.00 X 0 0 0 Sister Anna Doyle 1.00 X 0 0 0 Thomas F Courtney 2.00 X 0 0 0 Lawrence Hunt 2.00 X 0 0 0 Joseph Neverauskas 2.00 X 0 0 0 Sheila Pacholski 2.00 X 0 0 0 James Reilly 2.00 X 0 0 0 Carole Ruzich 2.00 X 0 0 0 Philip A Salvador 2.00 X 0 0 0 Christie Sever 2.00 X 0 0 0 John Ward 2.00 X 0 0 0 Sister Margaret Wright 40.00 X X 0 0 0 Thomas J Lavery 40.00 X 472411 0 28605 David B Manchester 40.00 X 415537 0 28605 Hugh A Rose 40.00 X 337248 0 23575 Randall J Oles 40.00 X 328667 0 33736 Timothy J Brosnan 40.00 X 324608 0 33736 Marion J Baron 40.00 X 283863 0 28605 Mary C Denisienko 40.00 X 255105 0 23575 Rosann S Demask 40.00 X 213497 0 26295 Margaret J Carroll 40.00 X 212680 0 25412 Bryan D Counts 50.00 X 223540 0 25311 Paul G Striegel 43.00 X 194801 0 30351 David A Cornell 44.00 X 199900 0 24156 Robert P Marino 43.00 X 193650 0 24021 Michelle B Burns 42.00 X 191465 0 30104 3846972 0 386087 56 0 1 0 Pepper Construction Company 18505 W Creek Drive Tinley Park IL 60477 Construction Services 19524109 Matthei & Colon Associates 332 S Michigan Avenue Chicago IL 60604 Architectural Services 3770537 Inner Wireless Inc 1155 Kas Drive Ste 200 Richardson TX 75081 Information Services 1265421 Palos Anesthesia & Associates 40 Shuman Blvd Suite 275 Naperville IL 60563 Anesthesia Services 870837 Imperial Laundry Systems LLC 1236 13th Street Racine WI 53405 Laundry Services 666107 178 184650 1006413 1191063 Net Patient Revenue 621110 184284110 184206045 78065 Medicare & Medicaid Re 900099 126734817 126734817 Provider Tax Revenue 900099 7199643 7199643 MRI Joint Venture 900099 99637 99637 318318207 78988175 78988175 1457080 1457080 1457080 1457080 2541084758 2596547717 -55462959 -55462959 -55462959 74400 184650 120382 -45982 -45982 Cafeteria Revenue 900099 971665 971665 Gift Shop Revenue 900099 335729 335729 Medical Records 900099 195128 195128 1891728 1891728 3394250 347839834 321634392 78065 24936314 2843616 2843616 152237428 122992207 29245221 9448211 7493220 1954991 25005362 19831338 5174024 10998611 8722816 2275795 1882028 1882028 98544 98544 179088 179088 985748 985748 7034061 1672763 5361298 807598 12873 794725 3986670 2390579 1596091 1987935 256176 1731759 393956 378664 15292 146427 113734 32693 6733182 6733182 13208308 10612864 2595444 1574388 1038791 535597 Medical Supplies 48491676 48491676 Bad Debt Expense 15680754 15680754 Illinois Provider Tax 7907103 7907103 Utilities 3305803 2644642 661161 Taxes & Licenses 371117 371117 2163210 1676626 486584 317470824 258650008 58820816 0 2348502 2141128 25809914 30995801 1205076 1322833 1451761 4366103 4667429 380747459 207672516 145600484 173074943 279556640 434477791 35183116 40299608 494187592 688313537 121925427 123687286 120145000 268120000 34670109 44725464 276740536 436532750 X 217447056 251618119 162668 217447056 251780787 494187592 688313537 X 30369010 3964721 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13838804 13838804 226716677 100792454 125924223 140191978 106880062 33311916 173074943 Investment in Affiliate 2354651 Collateral Received for Securities Loaned 33500000 Deferred Financing Costs 4444957 40299608 Obligation for Collateral Received for Securities Loaned 33500000 Tax Exempt Bond Liability Premium 7539506 Provider Tax Liability 3685958 44725464 Description of Uncertain Tax Positions Under FIN 48: Part X: The Corporation adopted the FASB-issued guidance for accounting for uncertainty in income taxes on January 1, 2007. St. George, the Hospital and the Wellness Center all file a Form 990 (Return of Organization Exempt from Income Tax) annually. When these returns are filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Examples of tax positions common to health systems include such matters as the following: the tax exempt status of each entity, the continued tax exempt status of bonds issued by the obligated group, the nature, characterization and taxability of joint venture income and various positions relative to potential sources of unrelated business taxable income (UBIT). UBIT is reported on Form 990T, as appropriate. The benefit of a tax position is recognized in the consolidated financial statements in the period during which, based on all available evidence, management believes that it is more likely than not that the position will be sustained upon examination, including the resolution of appeals or litigation processes, if any. Tax positions are not offset or aggregated with other positions. Tax positions that meet the "more likely than not" recognition threshold are measured as the largest amount of tax benefit that is more than 50 percent likely to be realized on settlement with the applicable taxing authority. The portion of the benefits associated with tax positions taken that exceeds the amount measured as described above is reflected as a liability for unrecognized tax benefits in the accompanying consolidated balance sheets along with any associated interest and penalties that would be payable to the taxing authorities upon examination. Upon the adoption of the FASB issued guidance at January 1, 2007, and since that date through December 31, 2010, there were no unrecognized tax benefits identified and recorded as a liability. Dinner 259050 184650 74400 46129 59066 15103 84 259050 184650 74400 46129 59066 15103 84 120382 -45982 1 1 X 1 X 1 X 1000.000000000000 1 1 0 1 1 4524261 0 4524261 0.01430 18990406 8377705 10612701 0.03340 0 0 23514667 8377705 15136962 0.04770 1152391 150864 1001527 0.00320 0 0 31449968 22151679 9298289 0.02930 0 0 177860 0 32780219 22302543 10299816 0.03250 56294886 30680248 25436778 0.08020 1 4235372 0 118223124 157682405 -39459281 X 1 1 1 1 Palos Community Hospital

12251 South 80th Avenue Palos Heights IL 60463

X X X PALOS COMMUNITY HOSPITAL 1 4 Orland Primary Care Center

15300 West Avenue Suite 122 Orland Park IL 60462

Primary Care Center Palos Immediate Care Center

7340 W College Drive Palos Heights IL 60463

Immediate Care Center Homer Family Health Center

15327 W 143rd Street Lockport IL 60441

Primary Care Center PCH Home Health Services

15295 E 127th Street Lemont IL 60439

Home Health Services 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 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 8.8% from 2000 to 2009 with a current estimated population of 622,128. Continued growth is anticipated. From 2009 to 2014, the population is expected to reach 650,312. Of those living within the service area of Palos Community Hospital: 50.92% are female88.84% are white86.54% are English speakingThe median age is 38.2 years31.76% are high school graduates31.52% have had some college, and 23.62% have earned a bachelor's degree or beyond. Part VI, Line 6: 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 7: Palos Community Hospital is not part of an affiliated health care system. Reports Filed With States Part VI, Line 7 IL X X 0 0 0 0 0 0 0 0 0 Thomas J Lavery 455911 0 0 0 16500 0 18375 0 14808 0 505594 0 0 0 David B Manchester 399037 0 0 0 16500 0 18375 0 12695 0 446607 0 0 0 Hugh A Rose 320748 0 0 0 16500 0 18375 0 8954 0 364577 0 0 0 Randall J Oles 312167 0 0 0 16500 0 18375 0 16894 0 363936 0 0 0 Timothy J Brosnan 308108 0 0 0 16500 0 18375 0 16603 0 359586 0 0 0 Marion J Baron 267363 0 0 0 16500 0 18375 0 12552 0 314790 0 0 0 Mary C Denisienko 238605 0 0 0 16500 0 18375 0 7522 0 281002 0 0 0 Rosann S Demask 196997 0 0 0 16500 0 16065 0 12181 0 241743 0 0 0 Margaret J Carroll 196805 0 0 0 15875 0 16071 0 10395 0 239146 0 0 0 Bryan D Counts 207040 0 0 0 16500 0 15081 0 11203 0 249824 0 0 0 Paul G Striegel 194801 0 0 0 0 0 14990 0 15734 0 225525 0 0 0 David A Cornell 199900 0 0 0 0 0 13926 0 11088 0 224914 0 0 0 Robert P Marino 193650 0 0 0 0 0 14680 0 9714 0 218044 0 0 0 Michelle B Burns 191465 0 0 0 0 0 14743 0 15734 0 221942 0 0 0 Ill Fin AuthorityPalos Comm Hospital 861091967 45200B3U0 2007-05-17 124814955 Fund construction of parking garage & power plant 0 1 0 ILl Fin AuthorityPalos Comm Hospital 861091967 45200F2Z1 2010-05-06 151146301 Fund construction of new patient bed pavilion 0 1 0 Ill Fin AuthorityPalos Comm Hospital 861091967 2010-04-12 100000000 Fund construction of new patient bed pavilion 0 1 0 124814955 55680574 2675871 66458510 2010 1 0 1 1 151146301 1950637 17439862 133288544 0 0 0 0 100000000 500000 99500000 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 Thomas F Courtney Associates Thomas F. Courtney, Director, is owner of Thomas F. Courtney & Associates 225492 Thomas F. Courtney & Associates assists Palos with collecting certain workers compensation and motor vehicle accident claims 0 Dr Mark Sinibaldi Medical Director of Palos Psychiatric Services, Former Director 125000 Medical Director 0 Form 990, Part VI, Section B, line 11 Before 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 12c On 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 15 The 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. Form 990, Part VI, Section C, line 19 All 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 3,802,053. Assets Temporarily Restricted 162,668. Total to Form 990, Part XI, Line 5: 3,964,721. St George Corporation 12251 S 80th Avenue Palos Heights IL 60463 364383840 Health Care Provider IL 501(c)(3) Line 11a, I N/A 0 St George Wellness Center 15430 West Avenue Orland Park IL 60462 364383845 Fitness Center IL 501(c)(3) Line 9 St George Corporation 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 St George Wellness Center I 36936 FMV